HomeMy WebLinkAbout0201 OLD STRAWBERRY HILL ROAD / -- - - - - - ao� � � ,�
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T
Town of Barnstable *Perms
Expires 6 mo s n
Regulatory Services Fee
i s
• =ARN31^ABM s
AM
1639.
t3 1�' Richard V.Scali,Interim Director
�
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS EERMLT APPLICATION - RESIDENTIAL ONLY
Valid without Red X-Press Imprint
Ma(i/parcel Number Q d 0 &kaz
Property Address ?0 1 roe L D STKAW GE9 R X (4 ((,(_ iZ b 1AJ 1!
Q Residential Value of Work$S,2,Q Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address tafo/ Sat/ZA r,20t Old sfrnu (la U ' TAie�s, 64 D2,000-1
Contractor's Name_':)o&zF1AQl N u_�. V A/t N vw S Ii/V)L)/_S0,&J Telephone Number �d —?��` 7900
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable) 0 /q67o 7
AiMWorkman's Compensation Insurance ✓
Check one:
❑ I am a sole proprietor JUL 2 2015
❑ I am the Homeowner T
I have Worker's Compensation Insurance F ®w►n t
ti OF UA tU h t
ABLE i
Insurance Company Name A) l JVs _ _
Workman's Comp.Policy# WL4_
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Window doors 'ders:.U-Value • 30 (maximum.35)#of w' ows
#of do s: �;o
._❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections require .
Separate Electrical&Fire Permits required.
`Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Consenvation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement.Contractors License&Construction Supervisors License is
required.
SIGNATURE:
T:\KEVIN DBuilding ChangesTXPRESS PERMIT\EXPRESS.doc
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Office of Consum r Affairs? d&siness.Regulation
10 Park Plaza,-$ ite 51?0
1 Boston,Massachusetts-.021.1°6
' Home Improvement Contractor Registrattor
Oegis"ion: 173245
Type: SuppleMentrard
Expiration4 9ft91201t3+
S.OUTIHERN NEW ENGLAND'.1!NINDOWS,-LL• a
26 ALBlONAD
LINGQIN;Ri 02865 4._
{tpdate Address and.retprn esrd..�lfark reasoofor rbnnAe -
sG:i t:aRtosit Address,`Rtriavrnl e�.tmploymeet, ',S.oseCard:
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ME:IMPROVEMFATCONTRACTOR: before:theespirmtiondate.Iffoundretu'reto: .
s 45ttatiurr - afiiice.ofConsvmer Amirs and Bnsiness.Regoiaf on '
80, 173245. Type 10 Park Plaza,-Suite 5170 -
•• Expiratlori: 9/t..92016 Supp"-nt rTd Boston,51A 023I6 .
SOUTtlERN.h7E!N:EI�GLAtJO%MNDOWS C '
- z RENEVIIACSYIINDER.SON" . .
3- OENNISONIISMAN, -
ZgiALBIONRI)' Q Q�
ii derxcr`efary- Nkvatid:`v bi o vsigneturm.
i
77ze Commonwealth of massacht.,Setts
Department of IndustrialAccidents
' Office of Investigations
U. � I Congress Street,Suite 100
1� _ Boston, .
MA 02114 2017
www.mass gov/dia
Workers'Compensation Insurance Affidavit.-builders/Contractors/ElectriciansIPlumbers
A licant Il�f®raaaafio>m
- Please Print Le ibly
Naine (Business/Or�aaization/Indit�idval): SOUTHERN NEW ENGLAND WINDOWS LLC
Address: 26 ALBION ROAD. -
City/State/Zip: LINCOLN, R►02865 407-228-9800
Are you an employer?Check the appropriate box: Phone#:
'
1.0 I via
employer with 20 4_ (� I am a general contractor and I Type of project(required):
employees(full and/or part-time)_T., have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole ro rietor
p p or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have
iworking for me in any capacity. employees and have workers' g' ❑Demolition
[No workers' comp. insurance comp. insurance_= 9. El Building addition
3.❑ required.] 5- ❑ We are a corporation and its 10_❑EIectrical repairs or additions
I am a homeowner doing all work officers have exercised their
myself 1 L❑Plumbing repairs or additions
[No workers'comp. right of exemption per MGL
insurance required.] T c. 152- §1(4).and we have no 12.[]Roof repairs
employees. [No workers' 13.11MI Other DOOR REPLACEMENT
comp.insurance required.]
Any applicant that checks box T 1 must also fill out the section below shoeing their nrorkers'compensation policy information_
eCHomeonners who submit this af&dau'it indicating they are doing all work and then hire outside con tractors must submit a new affida itindicating such
ontractors that check this box must attached an additional sheet showine the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must proiide their workers'comp_policy number
am an employer that is providing workers'
information. compensation insurance for my employees Below is the policy and joh site
Insurance Company Name: ARGONAUT INSURANCE COMPANY
Policy#or Self-ins. Lic. #": WC927938352394 —
Expiration Date: 08121/2015
Job Site Address: 0�0 l O(r{ S'Tr�r,�G,e�►� l� (� (�
Ciq'/State/Zip: vane S, /A
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration
Failure to secure coverage as re p on date).
required under Section 2�A of MGL c_ 152 can lead to the foie up to SI2500.00 and/or one-year imprisonment imposition of criminal penalties of a
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 pains and pendlies of per jury t1W the information provided above is true and correct.
Simature: e
`�
Phone#: 401-228-9800
77use only. Do not write in this area,to be cofnpleted by city or town official.
n• Permit/Licensehority(circle one):health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Ia�s ctor
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Town of Barnstable *Permit?
"
" 1 Regulatory Se Expires6
,R ry I'V10ES Fee
* s�arrsricsig;�
� tt Thomas F. Geller,Director
Bpilding Division
f`A`f3, , Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 5 08-862-403 8 Fax: 508-790-623 0
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number C) l rAAe— 00z
Property Address ' r Ft L.) tz � ) G
esidential Value of Work rl /6f� Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address l.. A QO L SOOz.�+
&11 a l J 3-he 14 IJ btR2y )
Contractor's Name /�zt. I Q Telephone Number /4��X 34(Z ZZ`l
Home Improvement Contractor License#(if applicable)G 416 5-6�
Construction Supervisor's License#(if applicable) / d ! 3
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name/,YA k/n 4 t ez c_
Workman's Comp. Policy# WG ?G V J-1.7
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
[ 7Re-roof(stripping old shingles) All',construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/doors/sliders. U-Value 0. #of doors
(maximum .44)#of windows_
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Prope 0 r must si Property Owner Letter of Permission.
A c the Home I pro ent Contractors License& Construction Supervisors License is
u' ed-.
f
JGNATURE.
AWPFILESTORMSIbuilding orms\EXPRESS.doc
.evised 070110
' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
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): lir Li c)
Address: c Gc'cAr✓_ 5 1 L
City/State/Zip: W b U a P� YM ¢ Phone #:
F2.
re you an employer? Check th�ppropriate box:
Type of project(required):
�am a employer with 4. ElI am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors .6• ❑New construction
❑ I am a sole proprietor or partner- listed on the attached sheet. 7. r modeling
ship and have no employees 'These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp,insurance.$ 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.0 I am a homeowner doingall 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.
(Contractors that check this box must attached an additional sheet 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 the policy and job site
information. II
Insurance Company Name:fi?/ �
Policy#or Self-ins,Lic.#:We 5% q 3"?7 y Expiration Date: .6 Z
Job Site Address:0 Q t' �cle/ q4_j City/State/Zip:6-0—fx�t�s µto'
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 ins 4nce cover catio .
I do hereby certify er t pains and 2hies f p that the information provided above is true and correct
Signature-
Phone#:
Official 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 In
:5.Plumb'ing Inspector
6. Other
Contact Person: Phone#:
-( e "VgOOUCEp. S(J�;';66.6161 FAX 508.366.5202 THIS CERTIFICATE IS ISSUED AS A MATTER OF MATN
Mackintire Insurance Agency, Inc. ONLY AND CONFERS NO RIOHTS UPON THE CERTIFICATE
11 West Main Street HOLDER.THIS CERTIFICATE DOES NOT AMENDEXTEND
Westborough, MA 015B1-1431 ALTER THE C VERAOF AFFORDED BY THE POL
INSURERS AFFORDING COVERAGE INSURED-NewproOperatang_LL__._ -. _.�.___:_ -.. . __ ._-.._.INsuRERA;'Peerless insurance Co: . . .26 Cedar St. INSURER a!
Woburn, MA 01801 INSURERC:
INSURER D:
INSURER S:
COVERaGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT'WTH3TANDING
ANY REOUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT VWTH RESPECT TO WHICH 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.,
I Sfi 00 TYPE OF INSURANCE POLICY NUMBER POLICY O FECTIV6 POLICY EXPIRATION LIMITS
GENERAL LIABILITY CUP OSSS-370 2/32/2010 12/3112011 EACH OCCURRENCE S I.00o.Op
X COMMERCIAL GENERAL LIABILITY. DAMAGE TO RENTED S lO OQ
CLAIMS MADE Q OCCUR MED EKP(Any one potion) S 1S,0.
A PERSONAL A ACV INJURY 5 1 QOO,O
GENERAL AGGREGATE S 2 QOQ o
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2 Q00,OO
POLICY PRO•
JECT LOC AUTOMOBILELIABILITY BA 8584174 12/31/2010 12/31/ZO11 COMBINED SINGLE LIMIT
ANY AUTO (Ee eoeldom) S
1,000,0.0
ALL OWNED AUTOS BODILY INJURY
A
x SCHEDULEDAUTOS (Perperion) S
X HIRED AUTOS BODILY INJURY
X NON-OWNEO AUTOS (Per eeeldenll S
PROPERTY DAMAGE S
(Per accWen)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGD 6
EXCEOGIUMBRE"LIABILITY Q 9582578 12/31/2010 1Z/31/2011 EACH OCCURRENCE S 5,000f QO
OCCUR CLAIMS n=ADF AGGREGATE
A :
DEDUCTIBLE S
X RETENTION S 10,00 S
WORKERS COMPENSATION AND WC8645974 OS/01/2011 OS/01/2012 WCSTATU- OTH•
EMPLOYER3'UAHILITY -F
A ANY PROPRIETOR/PARTNERIE1(ECUnVE E.L.EACH ACCIDENT I SOO OOO
OFFICER/MEM8EREXCLUDEO.1 E.L.DISEASE-EA EMPL;YEE S SOO,000
I( eRs,oesuihe under
51'ECi6l PgDVISIDNS Below E.L.DISEASE-POLICY LIMIT I. SOO OOO
OTHER
DESCRIPTION OF OPERATIONS I LOC4T10N8 VEHICLES I EXC USIONB AD ED BY ENDOR6HMENT1 SPECIAL PROVIO N$
The City of Marlboro Ts additional Wsurec With respect to Genera Liability as required
Dy wFi tten contract
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TD MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH2 LOFT,
BUT FAILURE TO MAIL OUCH NOTICE SHALL IMPOSE NOOBLIOATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPREBMNTATIVE
Timothy Mo na h
%CORD 26(2001/08) CACORO CORPORATION 1988
Massachusetts- Department of Public,Safet%
Board of Buildim, Re�,ulations anil Standards
Construction Supervisor License
Licenser CS 96093
Restricted_toe 00
THOMAS PEACOCK JR •_
38 OAKLAND AVENUE s _
SEEKONK, MA 02771
�-�- Expiration: 4/8/2012
i lnnmi<�ioncr Tr#: 20816
3�\ �/ � tom/I��1.'[.�/✓'J
0 fi oMom=me�rAffai and Business Regulation
10 Park Plaza Suite 5170
Boston, F_ ssachusetts 02116
Home Improver ontractor Registration
r`— Registration: 146589
Type: Supplement Card
--3 i Expiration: 5/5/2013
NEWPRO OPERATING; LLC. I' t
TOM PEACOCK
26 CEDAR ST.
WOBURN MA 01801
i" Update Address and return card.Mark reason for change.
-�t^ Address ❑ Renewal Employment Lost Card
OPS-CAI is 50M-04/04•G101216
✓foo
ze 7�omanw"nu�nalffz a��•l�ardczc/wee�a
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration—IA6589 Type: 10 Park Plaza-Suite 5170
y Expirat[gn-5j51-MJ;3 Supplement Card Boston,MA 02116
NEWPRO OPERANC 1L :=
TOM PEACOCK
26 CEDAR ST
WOBURN. MA01801
09-26-'11 08:36 FROM-Newpro-Wheeling Ave, 1-781-932-0860 T-800 P0001/0001 F-400
CT Reg#0605216 63263
RI Reg#26463 Win and Um
Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342.2211 (F)781-933-9626,www.newpro.com
THIS CONTRACT MADE THE day of 20 between
CA Vb av 5�8 -2-� 41
(Nome Owners) (Home Ph Al (Bus(Cel/Phone)
of cA( ,� 4tiv►i
(Address) (City) Rip)
the"Owner"and NEWPRO Operating, LC, "NEWPRO". The job address is a condominium.
NEWPRO hereby agrees that it will for the consideration hereinafter mentioned,furnish all labor and material necessary fo install the following
described work at the premises located at r
LAW
(Job Address) (E-Maofor proprietary use only
TOTAL i I IAdditional Model TOTAL
Windows Purchased NEWPRO Work Number Qty CASH
Window Color In: Out Sliding Glass Door PRICE
Capping Color . Steel Security Door
VJ4-r Door Color In: Out! DEPOSIT
Model Name Model Numbs s Sidelites WITH �8 d
Double Hun New Construction Unit ORDER
Picture Window Storm Door BALANCE
Casement Obscure Glass M DUE AT
2 Lite/3 Lite Slider Screens LFWEL INSTALL
Bay/Bow Frame Please Initial:
Roof, ❑ soffit: ❑ Customer understands that NEWPRO®does not CASH
Garden Window do arty painting or staining, Cie;when removing Balance paid to installer at installation
Awning or replacing interior stops or trim)
Hopper NEWPRO®is not responsible for conditions or
Shaped circumstances beyond its control including con- FINANCE
Other densation resulting from or due to pre-existing BsnK comoleno inmlleuon
GRIDS I C ial L go conditions.
DESCRIBE WORK j a a G
aaaa
s✓Le
Est.Stag Date: Customer understands this is an"estimated date 14U I Est Comp.Date:
m g
Initials LiCustomer understands all Steel Security doors will have a 3/4"aluminum threshold installed over existing threshold.
It shall be the obligation of NEWPRO to obtain any and all permits necessary under this agreement,as the Owners Agent. The Owners who secure their ,
own construction-relatM permits,or deal with unregistered Contractors will be excluded from the guaranty fund provisions of li 142A. All Home
Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor relating to a registration
should be directed to; Director,Home Improvement Contractor Registration,One Ashburton PI,Room 1301,Boston,MA 02108,(617)727.8598. If the i
Owner is obtaining financing by way of a Retail Installment Sales Agreement,such Agreement shall include a time schedule of payments to be made under
said contract and the amount of each payment stated in dollars,including all finance charges. The Retail Installment Sates Agreement shall be incorporated I
herein by reference. If the Owner is obtaining a revolving credit line to pay,in whole or in part,for the contract amount herein,the terms of the revolving
line of credit including interest rate and payment terms,shall be clearly set out on the credit application. The portion of the credit application referencing
a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars,including an finance charges,shall be
incorporated herein by reference.
NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of$100,000-$300,000.
If the Owner refuses to permit NEWPRO to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason
whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of the price agreed to be paid,as fixed,
liquidated and ascertained damages,and not as a penalty,without further proof of loss or damage.
NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control.
Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter!
into this agreement
This contract represents the entire agreement between Owner and NEWPRO and cannot be changed except in writing signed by both the Owner and i
NEWPRO. I
You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We,the
aforesaid owners,certify that immediately.after the signing of the aforesaid agreement,a copy was furnished to us.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the
seller,which may be his main office,or branch thereof, provided you notify seller in writing at his main office or
branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day
following the signing of this,agreement. (Saturday is a legal business day). See the attached notice of cancellation; .
form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
The owner has seen"sample"warranties that will be provided by NEWPRO upon installation. Sampie warranties provided to 00rnor, ,l
IN WITNESS WHEREOF,the parties have hereunto signed their names this 7-10 day of 20 �
t EIN# Signed
Marketing Fteprosoritative Printed Name Owner �
AccepaPDXTE
ra LLC
e.
i
By
OwnaOV
ICE Office of Consumer Affairs aadBuaiaess RenOD WARWICK BRANCH OFFICE
26 Cedar St TenptPlaze,Striae 5170 24 Minnesota Ave
Woburn,MA 01601 gnum,,MA 02116 Warwick,RI 02888
(P)800-242-9974(From NE) Phone. (617)973.8700 (P)800-356-3312(From NE)
(F)781-933.0717 (F)401.732.1371 1
py
WHITE: Branch Copy YELLOW; Customers Copy PINK: File Copy GOLD: Finance Co
ua+5 Rd508
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map �j� Parcel�r Ge Permit# �9q6
Health Division 10) c}� ��J Date Issued
Conservation Division r�lz-�-l.a� It77 Fee ��C.0 a
Tax Collector ish �OS�" CONNECTED SEWER ACCOUNT PeA
� �o� I d
Treasurer
Planning Dept. Checked in By
Date Definitive Plan Approved by Planning Board Approved By
Historic-OKH Preservation/Hyannis
Project Street Address J Q ad A�&
� I
Village Q
OwnerE Address \ CQ-/21_ Cd�
Telephone ✓� — r]
Permit Request JJ 6�11U CA I- X Q
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation 1 34 60 Zoning District Flood Plain Groundwater Overlay
Construction Type t=`
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentat on.
Dwelling Type: Single Family Q Two Family ❑ Multi-Family(#units)
r.>
Abe of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ;0 No
Basement Type: Full ❑Crawl ❑Walkout ❑Other '
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
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: CIII'Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O 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
BUILDER INFORMATION
� Tele hone Number �' _/
Name N
Address License#
` Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE i DATE
FOR OFFICIAL USE ONLY
L
b
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION Q
FRAME Q
� r
INSULATION U
ri
FIREPLACE
L%
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL" =
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
i
LI
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office.of Investigations
600 Washington Street
Boston,MA 02111
www mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information Tease Print Le 'bl
Name (Business/organization/Individual):
Address: b
.City/State/zip. GUI_ Ph
Are '�:`�/ ��:� .���
Are you an employer? Check the-appropriate box:. Type of project(required):
1.❑ I am a•employer with. 4. El am a general contractor and I 6. ❑New construction
employees(fa1T and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or parEner-
listed'on the attached sheet # ? Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me.in.,any capacity. workers' comp.insurance. 9. ❑ Binding addition
(No workers' comp.insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or.additions
, rI
equired] officers have exercised their
3.LJ am a homeowner doing all work . right of exemption pei MGL 1'1.❑ Plumbing repairs or additions
myself.-(No workers' comp. c. 152, §1(4), and we have no - 12.❑ Roof repairs
insurance required-]t employees.(No workers"
eq ], 13:❑ Other
camp.insurance required.]
; pP showing their workers'compensation policy information:
Any a lrcant thatchecks box#1 must also fill out the sectron�below
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 sheet showing the name of the sub-contractors and their workers',cow.,-policy information.
I am an employer that is providing workers compensation insurance for my employees-'Below is the policy and job site•
information.
Insurance.Company Name:
Policy#or Self-ins.Lic.#: 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 imprisoinnent, as well as,civil penalties in the form of a STOPWORK ORDER and a fine
of u.p to$250.00 a day against the violator. Be advised that a copy of this statement may
Investigations of the DIA for ins forwarded to.the Office of .
insurance coverage verification.
I do hereby certify under MUM MUM=and penalties of perjury that the information provided above is true and correct:
i ature: Date:*.
Phone#'
Official use only. Do not write in this area,to be completed by city.or Town o lciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Instructions.
Information and Ins
ter 152 uires all employers to provide workers' compensation for their employees.
Massachusetts General Laws chap person inthe service of another under any contract of hire,
Pursuant to this statute, an employee is defined as"...every p
express or implied,oral or written."
association, rporation or other legal entity,or any two or more
An employer is defined aS=: Mdivid A-Tal�ergl?iP�: toyer,or the
of the foregoing•engaged in a joint enterprise, and o ��n or other legalhe legal renti'ty employing employees.yees. How.oypr.te
receiver or trustee of an individual,partnership,
use having not more than three apartments and who resides therein,or.the occup
owner of a dwelling ho ant of the
dwelling house another who employs persons to do maintenance,construction or repair woik-on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed m be an employer."
MGL chapter 152,§25C(6)also states that"every.state.or local licensing agency shall withhold the issuance or
Tenewal of a license or permit to operate a business or to construct buildings in thecommonwealth for any
a plicant who has not produced acceptable evidencevf compliance with the insurance coverage required."
P ter 152, 25C states"Neither the cormnoirwealth nor any of its-political subdivisions shall
Additionally,MGL chap .. § (�
enter into any contract for the performance of public work until accep aI evidence of compliance with the insurance
iequirements 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),addresses) and phone numbers) along with their certificates)of
C or Limited Liability Partnerships(LLP)with no employees other than the
' insurance. Limited Liability Companies(LL )
are not required
members or partners; ired to cant'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 sip and date the affida estedn t Ihe Departaieaof should.
be returned to the city or own that the application for the permit or licens g eq
Industrial Accidents. Should you have anyparr m nti the n�er�� or.if you are required to obtain.a wor)cersl
below.. S 1f-insured companies should enter their
compensatioupolicy,please call the Department
self-insurance license number on the appropriate line.
City or Town Officials .
Please be sure that the affidavit is complete and printed legibly. The D co has ou regarding the applicanvided a space at the t
of the affidavit for you to fill out in the event the Office of Investigat io Y
me permi Iicant
Please be sure'to fill in Vlicense number which will be used as a reference number. In addition,an app
that mat
submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site stamped he applicant should or marked by the city orte"all town locations
be provided to the or
town)."A copy of the-affidavit that has been of in
f tamp
applicant as proof that a valid affidavit is on file for;future permits•or'liceases..Anew affidavit mutst be filled out.each
year.Where a home owner or citizen is obtaining a license or permit not r co anete business affidavit
commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT requiredcomplete
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 Massachusetts .
Department of Industrial.Accidmts
_ Office of Ilnvestigatdons
600'WashingEon Street .
Boston,MA 02.111.
` Tel. #617-727-4900 ext 406 or I-877-MASSAFE
Fax#617-7274749
Revised 5-26-05 www.mass.gov/dia
TME Town of Barnstable
°^ Regulatory Services
' systAs :.t Thomas F.Geiler,Director
� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost
Address of Work:
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
❑Bu' ding not owner-occupied
caner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
�Ja�W. A C,-O57 OR
17%Date Owner's 16mie
Q:forms:homeaffidav
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GE-,eT/F/E'I� PLOT OL�4N PRE PAR r=D FOR:
LOCF�T/O�t/: CRL..D S'rR.4tJB�eL�� t-Ftu.¢�. . LlY4.iti�c,
—*OTC A,—E: � � ZO L��gTC: CcZ Z.S3
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i Ci✓iL Ed/G/A,/EEt3 /
�O[JTE Gq—Y��.eMOC/Ts-/, MASS. WaAwc•Tt(lf/�J J-oo ecG. L.gwo S evrYoe '
Assessor's offioe (1st tfloor):
/�it�T�j_ � • G� TM of THE toy
Assessors map and lot number .................:..........................
Bo{rd of,h"ealth (3rd floor): /
Sewage Permit number ............. ' :.......:-�;�???....�' T.3'/,F' = BARa9TsnLE, S
Engineering Departments(3rd floor): �oos,rb 9,
House number :.:'.............:::' ..........................................t ti •E0MAId��
APPLICATIONS PROCESSED 8:30-9 30 A.M. and 1:00.2:00 P.M. only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
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APPLICATION FOR PERMIT TO vim- ........ ........� Y �...
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TYPEOF CONSTRUCTION ....... ... ......................................................................................
........Z........--- ---.19
TO THE INSPECTOR OF BUILDINGS: 4
The undersigned hereby applies for a permit according to the following information:
Gar / 'N'i�� •LC� ,tSirb�s Lo �ar�„ ,Z� ..... �i �
Location .................wy....... ........ ... ........................................................................... ........................... f ........�E.0
.................
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ProposedUse ....Aff� /C.�.......\......................................................j .............................................
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Zoning District ........,` .�.� 6........................... .. ...............Fire District ...... P �� 5!� i ....................................�:.......
..........
v�sio�
Name of Owner ....� ... ... .......... ... ........Address 8.. a S.......
Name of Builder ........... Address ....... j. .t� . .. u ........................
Name of Architect 7? Ztry��"�..........................Address(r�..(.�!'..... /............ .." .? .............
a
Number of Rooms ................................................................Foundation 40.0 ... �
Eefor 0 6 � / /,4...Roofing �f
• ..........................
Floors ?? t ..... r..f�X!I ...................................Interior . ....` ../ •S' /�I'..................................
Heating ..:.......S_ ' 'C..:7"�21� Plumbing'. ... r ::.... C/:.(,. :.:.............:..........
Fireplace ............... . �y ............ . .... Appr
oximate Cost ......................................%.......
Definitive Plan Approved by Planning Kard ---i --------19 gf�7, Area ........�1;117 ..............
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Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH � rWf
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OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the-Rules and Regulations of the Town of Barnstable regarding the above
construction. F-
M Name . ............. ........! ....... ;
Construction Supervisor's License ... 0."�..�-Y).............
�1 •
FN
S E AFF�DABLE HOME DIVISION, INC. 2
4�� oo� A=250-66
f2105 Permit for ...1.?. Story
. ..................
Single Family dwelling
on ....Lot #1, 201 Old Strawberry Hill Road
..............................................
//y_
Hyannis
...........................................................
Owner ..day. ,�1. ...?�f .Qd, l�le,,,Home...Division, Inc.
f e
Type of Construction ............F.rame................. `
...............................................................................
Plot ............................ Lot ................................
3 .
Permit Granted .......July...22............ 88
Date of Inspection ..........................:.........19
Date Completed ......................................19
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O'THE TOWN OFBARNST.ABLE permit
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
7 �Yl
.679• �
�o,uv► HYANNIS,MASS.02601 Bond s
CERTIFICATE OF USE AND OCCUPANCY
Issued to Bayside Affordable Home Division, Inc.
Address Lot #1, 201 Old Strawberry Hill Road
Hyannis, Massachusetts
_ t •
USE GROUP FIRE GRADING t OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT^BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
t
October 25.,...... 19....88.......... ..... �'
................ ,J
Building Inspector
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
_ SAUOT ' TOWN OFFICE BUILDING
rug.
i639' HYANNIS, MASS. 02601
` MEMO TO: Town Clerk
FROM: Building Department
DATE: /If f
An Occupancy Permit hasJ been issued for the building authorized by
BuildingPermit $#.... 0� / ....... ................................. f.................. .. �..... - ... ....._ ...
issued to ..... -�.�_ ��k�,// / l„( �//jl'/.. �C;..�1;. �� /, /�
V
Please release the performance bond.
Dn 1 ! o c� s—CJ
CONTINUATION OF ROAD BOND
BUILDING
The undersigned owner/contractor hereby a-, we 'to ff IP;ZT, °"?r
bond in force until the fio l kwi ng :nor. i`c ams are cotno'
satzsfacti on of the Eng3 neeri ng Sec-Z!on a,.;. "the Par M,en=
14orks.
loam and seedshouada:-s as soon as
/ weather permits.
1/ other (explain) �1/ffr-O�rJ n�
1/C—?�J
LQi?TI4N ; �1-07- / ) D D CD / t,J6LYL(2�' /-�i? L Ioe
SIG D Q4: r%Contractor
c Git{E��IR1 AUTNOR,,Z1-, ION
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TOWN OF BARNSTABLE, MASSACHUSETTS moUIL"U"ING _"'Pt , 81
.1uiy 4,2
'5U-66 c)2
DATE 19
Owne r PERMIT NO.--
APPLICANT ADDRESS
(NO.) (STREET) (CONTR'S LICENSE)
build dwelling :;-Lilgia famil-f dwe 11 i
PERMIT TO (-) STORY I NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
&.0 L #.L =1 Ulu ocr.1w5erry al i I moaa, r1yalmls ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION
LOT-BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
Sewage 2 3 15 (TYPE)
REMARKS:
60.N D,
AREA OR 768 sq. ft. 66,400 PERMIT 61.50
VOLUME ESTIMAT--' _-OST FEE $
(CUBIC/SQUARE FEET)
13ayside A-rZord-ablv home o4ivis-ion, jilt:.
OWNER
BY
ADDRESS r 77�rm�j
z . 9, bip 5, r 't
i i2z v.-;:6 3;� BUILDING DEPT.
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL 1APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FO.R CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND
ALL CONSTRUCTION WORK: PERMITS ARE REQUIRED FOR
1. FOUNDATIONS OR FOOTINGS. MADE.
WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTAL'.ATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH).
3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD SO IT IS VIS113LE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
2 2 2
HEATING INSPECTION APPROVALS ENGINEERING DEPARTME7
/0 4/'
OTHER
BOARD OF HEALTH
WORK SHALL NOT PROCEED UNTIL THE INSPEC_ PERMIT ',v!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOP, HAS APPROVED THE VARIOUU$ STAGES OF i WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. I PERMIT ;S ISSUED AS NOTED 'OvE. NOTIFICATION.
OF BARNSTABLE, MASSACHUSETTS BUILDING MI�
A-25U-66 .,u
jwii(2L' DATE 19 PERMIT NO 321.05
APPLICANT ADDRESS
} - IN0.) (STREET) (C O N T R'S.L I C E N S EI
ttj PERMIT TO build dwelling .� :».;7«�.E? fainily dwelling NUMBER OF 1
(_) STORY DWELLING(TYPE OF IMPROVEMENT) N0. (PROPOSED USE) UNITS
sOL: fJ_ L,l 1.Ili .'.�C.;"..iWt)c"'.1':'y' )il_ 1 Roac , yLi:nis ZONING tC AT (LOCATION)
(NO.) (STREET) DISTRICT
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT
LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN-HEIGHT AND SHALL CONFORM IN CONSTRUCT[
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
Sewage #41315
REMARKS:
AREA OR 766 Gq. Lt. 86,400 ..61'.511
VOLUME ESTIMATc' .:UST .�j PERMIT -
(CUBIC/SOUARE FEET) FEE
OWNER iiayside Atturdabie oycie. Jivi:s-ic.)ri, Lll,c. _
'
BUILDING DEPT. y '/�.� •,
f ADDRESS
BY
I
I.: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY C
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST- BE A
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OSTAINE
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDI
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. T 101
MINIMUM
INSPECTIONS REQUIRED FOR OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ELECTRICAL, PLUMBING'' AND
1. FOUNDATIONS OR FOOTINGS.
MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALI,#TIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH).
F 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD S® IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
1 1 "SAI t�cy
O. 1
2 Z — r
3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMEWT
1 _
/Y�7 -
OTHER12
lG TS
- - BOARD OF HEALTH
WORK,SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THWCARD CAN
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ''1OVE, ARRANGED FOR BY TELEPHONE•,OR WR1TTi
NOTIFICATION.
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2 f-/EeE$Y� GECT/FY ='TI•/fiT TA/E 8C//L2)P/.V49- 1.
SHON/A1 OA1 TN/S PLAN /S LOCFiTEa O.V TiNE 3�
yBoc/.vD AS �NOWiV HE�EOti/ i`\K or
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ARMED
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�Oc/TE G!a^-Yt�,eMOc�TH, M�is�, a.grt� .e��. L-q�va sciev�Yo.e
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Assessor's offioe Us't floor): / ��� �� . 4ery Bpi TOE
Assessor's map and lot number ............................................
Board of Pealth Ord floor): /��� '- -
SewSew /�
age Permit number ................ ........14...(07....10 ��� i BARNSTABLE, i
Engineering Department (3rd floor): +°o N AM
9�
House number ............................................. MUST CONNECT TO o YPI
.................:....... TOWN $
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only'-,
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......�..... ........ .� ...
TYPE OF CONSTRUCTION .......G ... ..
. . .....................................................................................
/ .......................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
r
Location ........ ..'........ .......�,10�Df2S�...clp�l ?C771.....�.....��. si�e�2V
......................... .... .............................. ..
Proposed Use ...............................................................
c .................................................................
ZoningDistrict ........ C^f�-.......�............................ . . ............Fire District ......... ... .. �S..................................... .......
Name of Owner .... ...c Zf/l�Sl el OTC ��Zl!<
Address /�:........ ..........1�....... /............ ..G ..
Name of Builder ........... c�. )..............................Address ...................(5 ........................................
Name of Architect ..?........
..��.,9.'11 ..........................Address C�'J� ... L...... /1" �...... TZJ�/�.............
Number of Rooms ................. .............................................Foundation
Exterior ..Ci .................Roofing . � /.......................................................
Floors ' "... (..(l��✓1f'4...................................Interior .�. >A/. ..�....C7.YZ 'U/r
........................
Heating 771-7�.,(-........................................Plumbing ...... .Y - .........`....0 ew..0 :.�...........................
IV
Fireplace ..........................,.t. ...
.. /4 K0ard----
........ Approximate Cost a. ...........................17Definitive Plan Approved by Planning . lQ-_______19 Area S //....... .. ..........-
Diagram of Lot and Building with Dimensions Fee . .................
SUBJECT TO APPROVAL OF BOARD OF HEALTH �aJ
?,011le
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform.to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... f'............. .........................
Construction Supervisor's License ...ld. 0.67(.y..........
BAYSIDE AFFORDABLE HOME DIVISION, INC.
No ...�r2105 Permit for .....1 z...Story.........
Sin l...e. Family....Dw ing
..Location Lot #1 201 Old Strawberry Hill- Road
..•.'..........................................
...................Hyannis.........................................
Owner Bayside Affordable Home Division,. `Inc. ,
, ! f
Type of Construction Frame
..........................................',
..............
Plot ............ ............ Lot ................................
f Jul 22. 19 ✓- i .�
Permit Granted .......
.... 88.... .X..... ..!
Date of Inspection ........ .......
Date Completed ......:G......-:.. .P`r........::..19 '
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The Town of Barnstable
B&4RMN rasi.E, •
BIAS& Department of Health Safety and Environmental Services
16
rFc " Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
SHED REGISTRATION
Location of shed(address) Village
Property owner's name Telephone number
LOX 4R6-0 -066 — 00 :,z
e of Shed Map/Parcel#
SipatdW Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required)
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
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