Loading...
HomeMy WebLinkAbout0112 LINDA LANE LcT h�— TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MapIAlb Parcel Health Division Date Issued I —V -t Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address I� �(��. L•r� Village Owner 6,ri-.614 , Address S.Mc Telephone 41— 5-J&47K> Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation IS-- Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family GX'/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq., Number of Baths: Full: existing new Half: existing :' new' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c al stove,::❑Y99 ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ - Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AaMiko My_r_2Fth3, Construction Telephone Number PO Box 52 Address Weser Dennis, ,atete 70 License# Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBR+`IIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO •\.Y Ih �V11. SIGNATURE DATE l l Iir FOR OFFICIAL USE ONLY APPLICATION# 1 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y v DATE CLOSED OUT ASSOCIATION PLAN NO. OWNER AUTHORIZATION FORM I I, zRP, rL (Owner's Name) i - owner of the property located at 2- (Property Address) `t /LI G,-z`O/ (Property Address) �r hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. ' - �. Cam• • Owner's Signatu e ` Date P I Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC,kR �. PO BOX 52 W DENNIs MA 1 167�, ' ,A Expiration Commissioner 04/10/2016 R Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY — - ----- - P.O. BOX 52 ---- -------- - WEST DENNIS MA 02670 ---- ---- -- Update Address and return card.Mark reason for change. Address Renewal SCA1 ii 20M-05/11 �!:/ Ij Employment Lost Card- The Commonwealth of Massachusetts Department oflndustrurlAccidents Office of Investigations 600 Washington Street Boston,MA 02111 iviop.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El leetricians/Plumbers Applicant Information Please Print Le ' I Mike McCarthy Construction Name(Business/Organization/lndividuai):_ PO Box 52 Address: Nest Dennis, AIA 02670 City/State/Zip: CSIpg§§#3 HIC-169393 Are y u an employer?Check the appropriate box: Type of project(required); 1. 1 am a employer with 1 4. El am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet;x 7. Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity, workers'comp,insurance. 9. Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its M E1 Electrical repairs or additions required.j officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MOL 11.❑Plumbing repairs or additions myself.[No workers'comp, c.152,§1(4),'and we have no 12.❑R f repairs insurance required.]t employees.[No workers' 13. er comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy hdbrmadon. t Homeowners who submit titis affidavit indicating they are doing all,work and then hire outside contractors must submit a new affidrdt indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub•conkactors and their workers'comp,policy hdrnmadon. lam ail employer Mat i s providing workers'compensation instumtce for my employees Below is the policy and job site Information, Insurance Company Name: . • �J .�� Policy#or Self ins.Lie.ff: V W L 1 W-(o 1%4- ' � Expiration Date: Job Site Address: City/State/Zip: t Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of I Investigations of the DIA for insurance coverage verification. Ida hereby cer foy'11 e pa a enallies ofperJury that the ihforntalion provided ab ve is[rue and correct, i Si ture• D ate. I r rhone I Offleial use ortCy. Do not write in this area,to be completed by city or toivil official t City or Town; Permit/I.leense i'/ Issuing Authority(circle One): 1.Board of Health 2.Building Department 3,CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: TE 4coRo® CERTIFICATE OF LIABILITY INSURANCE DA 07/101DD/YYYY) 07/1o/2o1a THIS CERTIPICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 NRUJACT Bryden&Sullivan Ins Agcy of Dennis Inc IUC.No.Et): (508)398-6060 ,No,: (508)394-2267 PO Box 1497 �'sss: So Dennis,MA 02660 — INS ERIS,)AFFORDING COVERAGE _ NAIC# _ _ INSURERA: A.I.M.Mutual Insurance Company_ 26158 INSURED INSURER B: Michael McCarthy Construction Inc INSURER C: P 0 Box 52 INSURER D: West Dennis,MA 02670 --- INSURER E INSURER F, I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NG i VMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 'AI-IICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INS POLICY NUMBER MMlDD MM/DDIYYI Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ES(E RENTED $ PR MI a ocwn ce) _ CLAIMS-MADE OCCUR MED EXP(Any one person $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GLEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ I I RO- IPOLICY ECT "0C AUTOMOBILE LIABILITY I Ea acal ED SINGLE LIMIT 7 $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS �_AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS accident _ $ __.. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ - A aNYICROPRI ��Fj/PJ J(y�fj/j(ECUTIVE YID NIA VWC-100-6017666-2014A 7/17/2014 7N 712015 E.L.EACH ACCIDENT $ __ 500,000.00 (Mandatory in NH) tx�`U to( u E.L.DISEASE-EA EMPLOYEE $ 500,000.00 DESsCRII lON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,060.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of Barnstable mBuilding RAMSTA IPosi This-Card So Thatit is'�Visible From the�Street;-Approved-Plans Must'be=Retained on Job and'this Card Must lie Kept `' ` sPosted Untif Final Inspection Has Been Made. r ` Permit Where,a.Certificate of Occupancy is Required,such Building shall Not be Occupied until:a Final Inspection has been made lull Permit NO. B-19-962 Applicant Name: AWESOME HOME INC. Approvals Date Issued: 03/27/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/27/2019 Foundation: Residential Map/Lot: 248-087 Zoning District: RB Sheathing: Location: 112 LINDA LANE, HYANNIS Contractor Name: _AWESOME HOME INC. Framing: 1 Owner on Record: GRINBLATAS, IZRAILAS&GALINA Contractor License: 163240 2 Address: 11 ADMIRALS LN ° "" � Est. Project Cost: $ 123;800.00 Chimney: SOUTHBOROUGH, MA 01772 g a �� Permit Fee: $681.38 Description: Framing repair,(1) Bathroom replacement of.bath tub vanity and i Insulation: Fee Paid:- $681.38 water closet. (2) Bathroom replacement of vanty and WC. - Final: ' Date. 3/27/2019 Hardwood floor and Insulation. Finish Carpenty painting interior.._ r HVAC new Furnace, existing duets(due to water,damage) wl� � Plumbing/Gas Project Review Req: _ Rough Plumbing: Building Official I Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i ° Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:j = Service: 1.Foundation or Footing [ f Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical;Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department �ssz Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ti Application Number...................... '" " ' r PIP Mnes Permit Fee....... ..........................Other Fee. ASS. �` s ....................... 1 A Total Fee Paid....s............................................. .... ... . 3�E��frlin TOWN OF BARNSTABLE Permit Approval b lvl BUILDING PERMIT%,,�, ` ` Map............al... .....................Parcel........D. ...................... APPLICATION Section 1 — Owner's Information and Project Location Project Address ��2 �,//'I�Gr 6� Village ti lil Owners Name_ �� f 2 Q IZ I Vn�0 1 G(�Q S Owners Legal Address \ J City H N> Ci h i State I "t Zip p Owners Cell# 4�E-mail Section 2 -Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Xf Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify c. . Section 4 - Work Description I 1 E 12 vvl ' E Q p ec' t1 v4,v� t , 3 vh tke �e e VVx e11 4 a Vq r`4 V ti C' a Wig/ /4A%9 ,z /n 5</q /q 6co .`n�'�► �� �h &I" mx " D 2z P Mc I,- �fnhC? h Last undated: 11/15/2018 Application Number..................................................... -Section 5—Detail j Cost of Prq `! Construction 23 �O "OSquare Footage of Project 6 O S Age of Structure �n 2 , nn� ''" '''- T'ig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method MA Checklist WFCM Checklist Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7-Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 The Commonwealth of Massachusetts Department of IndustfialAccidents Office of Invesdgations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): W cf e,-<D Vh P PO Vl-i e V\ Address: ) ./9 J �J,f V7 Aro <z I (f-(2. S4 1 9 ©2 y -t' City/State/Zip: V�W �f C� Phone#: 2�D 6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction 2.9ployees(full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed m the attached sheet. 7. P Remodeling ship and have no employees These sub-contractors have S. El Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.incnran 9. ❑Building addition �t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sbeet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the airs and penalties of perjury that the informationprovided above is true and correct: Signature: Date: —3Z.2 2-0 Phone#: C% �rj 2 CA9 ( Qfjkial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or.licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of M&wchuseM Department of Industrial Accidents Office of I,nvestigad ms 600 Washington Street Boston,MA 02111 . Tel.#617-727-4900 ext 406 or 1477-MASSAFE Revised 4-24-07 Fax#617-727-7749 , www.mm.gov/cite Commonwealth of Massachusetts �fze C�arinao�ruaeti�a C%vLcraeac�ivae%y1 Division of Professional Licensure Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR �- Construction,,$u�AAA 1 & 2 Family TYPE:Corporation �. . Reolstration Expiration s3-40 05/26/2019 CSFA-102195 ftwres: 01118/2021 AWESOME HOME IN r i . ROMAN V l)ANILOV� n�' y 183 WINCHESTER ST ROMAN DANILOW r7 [ --f NEWTON MA 02461X 183 W INCHESTERST NEWTON,MA'02461 Undersecre i1j € ' Commissioner � I � - ���::�: �;�:::"��.��'��.::� '�-: ��."��::...��:��:�::�i:�!��'- :W,cov"Inn. ;��- �i�:.�i��!�,,�,,����.'.��..��..��:���i��:!,!:i;���.���:,!�:!!"� - -�!� , . - '7� tea, r ' Wn Oftarnsable -..a d` X n a2.: ti .. t�riun F��rnre;G � '�' $uI ' Camiglssionrr -` 2t Main Sirtv41:et, yann�a�U QZ�t?tAM? M ja a,, 8- sW ki t.wry tows�.barns t�.m�r a to—-�"li�limilviiiio h W k cc' 4�Q3$ Fax St8 7230 o , sas z "$. r x, s `rye a sTAK, $ .n '. a �.. ' ° '+'` _ k a Y X FR` E J 3A A5 ,A. .i` A .y ¢_ b ,X'roperty Owner Abut �.111x M Comp.�lete and Sign' ' us Section ~x a Pr c may.? a ? "k'. `"'r x t 2w s r �, I itt A _ fs Buitlrler 'a ' r a 'r. X 4k y * «.� "GANWO 'F''' ATZ t a - t r F 5 y 4 J}A J/♦, x 1 I, ,as xt?wner of the subtect prbpertY h : ill : � heceb authc�rixe y 'IV, to act cm m.11 y behal,' � ; �x V , � �111-1 - Som " 'e:` r g. as 'a ..A�,-. �, a w ASs " &� .. x x sn a!l mat�ers r�tarive to work authorized by this bwtcn perrnit npplteatspn for Y ` , x � � x y x Y ^+'KA-T'Y`$` X.h Y L ^x i :�� "4^� i� � \.( M lrA +fib,. ! ty5, a ¢g y'11 r CAaIIrBs Of j0�!} M f h ' �'e� 3 f. Pool,£e0eM-Ms-arid'I ,,, -s ar.57"e the responsibility o t applicant 31'odls x, y fk ,��1'1 Y ' are n4 to, ,filled or ut�lixed`b £ore fegiice is installed#and all a1 � a I-WAqa ✓ ka g k iizpections;ttare per£o"NOried and accepted g E s " u '' a . 01 d. ., � z '. i k a x f t'S .r�k .v � /�'} ' ff E ) �`�l az " - — # ,� -� r fra. / z @ 7� t 'R N'�' Szgnatures�f QvvnIm.n = S Okure b ,,,pp cant11 '3_ 3� X, h r E _A Y Y Y w k rk con-maR.to look A04 so { ' istAll _ " X s Y : " Pfi,'fjNai]e, Pant Name ' i '� k ,? a5�. H T f., t �, r 3 x' '3 k k Z k'XM�, - ,� - : - cx y Date k ,g .y ' , r - a k. ,n v t w gsx :.� ay . Y .T g :7$� a M "' a.. sa" " , ,n va � '�' - p ,; �� xitcMs dfrtRMtssroivrcxxs &. ,..,.,z"-, ,.," ._,... .h......_,._ .._'-s'..,.�,..,, .,. ._,n.�..:...$.,�._�,�._, .�,,-_.» ,_..,qm..". .�....... r. .� i21 1 RUILDiNG DEP`1" J MAR 2 6 2019 E Application Number........................................... Section 9- Construction Supervisor (5/7"3 5 7- 20 o 6 Name (�vh c�ti 11 1�q ti 1 1 d U Telephone Number Address IS-3 Uv,'k, c e c/9P SE /V&W-'110 V7 State /Y/`t Zip License Number �Q 2 t License Type ,,._k iration Date O/ /81202 I Contractors Email W49 e,-D 7n �O s�P ` /yIq Cell# �`� - 5 2LO0� P �� I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 C d the Town of Barnstable.Attach a copy of your license. Signature Date � 12015 Section 10-Home Improvement Contractor Name &e f-01rIC•' D m e 1 v1 C Telephone Number (6777 � Address/cP5 ,v►dief2 p ity &w-/Ov1 State 1y/q Zip 02 Registration Number /6'3 2 �0 Expiration Date 5zg- e/w l S I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date -3 2 2 O l-9 I Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date t+ APPLICANT SIGNATURE Signature Date ,3 12 -?- 20/.9 Print Name Ifo W Q 0 lj6i M /F/O y Telephone Number Q / E-mail permit to: ( till 0 e 1,-)o V�l C' V) C Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department © Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department F Conservation ❑ For commercial work,please take your plans directly to the fire department for approval r Section 13- Owner's Authorization i I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name i i i i / Last updated. 11/15/2018