HomeMy WebLinkAbout0021 PRAM ROAD
�,►,� Permit Town of Barnstable *
Regulatory Services fee 6monthsJrom issue' date
BARNSTABIA
• 1r Richard V.Scali,Director
Building Division
Paul Roma,Building Commissioner k 2 r
200 Main Street,Hyannis II l pgp0 201?
www.town.bamstAble.ma.us
Office: 508-862=4038 F4x: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Lnprint
Map/parcel Number �e
Property Address 1� S V C)
❑Residential XValue of Work$ 0 G C) Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
0a1
one:
m a sole proprietor
m the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Rejq st(check box)
M Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ctm
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
*Where required: Issuance of this permit does not exempt compliance'with other town department regulations,i.e.Historic,Conservation,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:
Q:\WPFILES\FORNIMbuilding permit forms\02RESS.doc
01/25/17
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AppHcant Infosmat u Flewe•Print�e I�
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AddF a� v� Kc rQ60L .
�Cifyf�tatel�ilr Phan��.
Are you an employer?C7t€:ckthe appropriate ba= ' Type of project(required}:
L❑ I am a employer wi. 4. ❑I am a general contractor and I ❑
employees(full andfor par time * Bove hired the sulr-coa 6_ Ides aansi�ciaog
2.❑ I am a sale prvpdetor orparteei lisft✓d onth-e.attad and sheet. 7_ ❑RemadeH
shsp and have no employees Ebese sab-cuutractors have S_ ❑Demalifion,
a fix is employees andhave wodmrs'.
�b �y�� l 9:.❑S,uilding addition.' Ca .
0 WOdM Camp,insunme Comp_mLWMrI
5. ❑ We are a corpomfion and its M❑Eleodcal repairs or adcrifions
3_ I am a homemm-er doing all wodt officers have exercised fhear 1 L❑Plumbiagrepaiss ar nddifi0ns•
Myself No woikers' - �Wx of exemption per U(M i7❑Roof
- _ ieF�
insurance•requured_j� c.152,g1(4k andwehaveno
emplayees_[No workers' s-E]Other
comp.insarance required_]
•Bay agp&�C�st cbe�sbaa�l tffi.st also ffioartthe sectioabeIowslinfiing 3ieQworlcrss'compeasatinupuTicgia�rmsaon_
Snmeown¢swbo submit$sis�Ha«inffcatb g�y Rmdaing allvra t mild mbim outadecon:tractars� submitanewaffid t SIIC11
fCa�actnu�tchecYirhistraxmQstattarhed�anaddi6nnslsixeetsLoua�tbena�oftUesnb-c�trscto-s�dsi�earls�araot•�nseenMiesha�e
empimleas.Ifthemib-c=—±=taeshave empicyeas;they 'plauide then wodmxs'romp.policy mmaben
I am are eiriplapRr dliais pr4n din.,urorkeis'campmsdimi in=ran ca for rzry enWra3cees EdDiv is dhapaticy arse jeh sEte
infornzatlaiL
Ins=Mce Companyy1fame:
P ricp.-'.-or Self-iw.lie.--&IL FkpsE donDate:
Job Rte A-ddress: CWSt9e/zip:
Attach a copy of the workers'compensationpoIicydeclaration page(showing the poficy masher and expiration date).
Failure to secure coverage as required uader Section 25A of MGL a 15.7 can lead to the iimposi n of rAminal penalties of a
fine up to$1,540:4U an Xor me gear imprisormw�nt,as well as mil penaltiees m the foss of a STOP WORK ORDERand a foe
of up to$250-00 a day against the violater. Be adsdsed M-st a copy of this stafement.sway be forwarded ta the Office of
In-esfigadom of the DIA,for ins mce coverage verifica3iaa..
Ida keriy cgrtif�c rf flea frruris m�Pars afFax13' attJis irE, arao`zmt prmud abai�is bus arzd correct
6
Simid=: s Irate /00 )01-
00&id um sail}. Do not avrite in tFrs Brea,br be cmnpletesd by city artonrn vJ97cirit
City or Town: Permifflcease;g
Issuing Amfhar€fy(ca de one):
L Board of Reahh I Building Department 3.City1rowa Clerk ..Electrical hmpector S.Phimbmg Inspector
6.Other
Contact Person: Phone#:
--- 6
Maceac-�mce s Ge teaal Laws 152 regmres an employers in 1�. �ensatron for their employees-
Pnrsaa�to this sty,an Novae is defined as":eveaYpetSon m.�a service of aaoi3s vndeg any,contract°f Imo,
express or jc plie 'oral or written
assoca�csA coipar�ion or other IegaI e�y,or any two or mme
An Moyer is defined as"an individual,P��, '
of the foregoing m a Joint Vie,�i mh ding fm le gal�sefivo9 of a deceased employer,or the
assocaton or other Iegal mfdY,�°Y��IDY�- However the
receiYer or frastee of an I,Pip,. ii or the.o ofthe-
owner of a dwellirse haying not more than ibree apazfraenis and who resides fherem, ccopant
ng ho
dwelling house of encoder who employs persaus tD do mace,rt, Stro rat;an or repair wok on such dymBing Douse
or oa the grounds or bm7dmg appmfsna�th shallnotbecause of such m3ploymentbe doemedto be an employ"
MGL chapter 152,§25C(6)also states that-evergs'fain or local liiceusing agency shall Withhold fhe issaance or
renewal of a license or permit to operate a hBsiness or to coast rlict buff ings in•the Commonwealth for any
applicanf who has not prodncod acceptable evidence of compliance t�n the hmmr=ce coverage ragaireir
Ad:dztionaIfy,MGM chapter I52,§25C()states=Nedher the com�al h nor aIIp off political subdivisions shall
ealtez rota spy contract for the per=ame ofpobliowantuubl acceptable evidence of campliancewitb ite insoi`�ce.
ems of this cbapfeahavebeeingrese&edin th- mnjractmg.avihozity-7
APPIicaats
Please fill opt the wow'compensation affidavit completely,by chug the bOx=that apply to your situation and,if
necessa'y,supply s°b-oo r(s)nane(s), addr�es)and phonenvmber(s)along vei$ttheir ce tE afe(s)of
insurance. L�dLiability Companies(LLC)or LimitedLisbiTity parinesshigs�I P)' IlO�PIOY other than the
members or paxtneas,are not rbqca-ed to c=Y warke2s' compensation f Lgor ce- If m L LC or LLP does have
empIoyees,apolicyis , Boadvisedthat this a$fdayitmaybesobmi`�dlgtheDepmfinentofrndustlial
Accidects for co=Fmmaii.on of fism-.m=coverage Also he sure to sign and date ateffidavit a The affidavit should
b e retnmed to the city or town that the application for the peanit or license is being regnest A not the D epzdmmt of
Led ctrial Acc deatr Sbonldyou bavo any gnesttons regarding$i a Ian or if Se; are ur'd ed�obtain a wnri�s'
compensation poficy,please call�Depar[mcut at the nnmber IisiEdbelog* Self-insured yes should enter their
s eIf-ins=mco,U.c=se umber on tha Imo.
City or Town OffEdals -
Please be sm-e that tie affidavit is camplete andprimed Iegfly. The Depa tmenthas provided a space at the bottom
of the affida�for you to fill out is tine eymt tho Office of Investigafraas has to codar °Q regarding a applicant
P lease bo sm a to fM in the pormit/Iic=e,mnber which wM be used as a recce giber. In addition,an applicant
that must subnafi:3 aultipI0 pea aWhc=se applib t I=m any given year,need only submit one affidavit mdimfIng current
p olicy mforatiom(if nommsmy)and under"Tob 5`lfe Ad&ese the applicant should write°&U locations in-(MY°r
town)-"A copy of•the.a$davit.thathas been officially stunped or markedbythe'city or town ded In tie
may be provi
applicant as proofti�at a valid affidavit is on file for faime permits or Iicer sex. Anew aiidavit mztst be hIled o of eta ch
year.glhere a home owner or�is obfaiamg a U=so or permit not related io any business or comme scial v n�
dug license or permit to bum lmves etc.)mid pe}son is XOT row- to complete this affidavit
TbeOfficeofln �"TM wouUbh--tot=.kyoumadvm=:Eoryo-ormoperationand.shouldyouhaveany4II=fiCEDS.
please do noth hate to give us a call
The Department's address,telephone and;ax m=her.
Deparbnmt of lidutdal AOCUenta
tan
BQADD,M&02111
Ta 4 617-727-49W mt 4.06 or 1-977-MA S&4
Fax#.617 727 7M
revised 4-24-07 � 9Urf cam.
':. Town of Barnstable
* Regulatory Services
of Richard V.'Scali,Director
Building Division
MARNSTAI= * Paul Roma,Building Commissioner
MASS
039. 200.Main Street, Hyannis,MA 02601
M www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print "
X DATE:
JOB 1ACATIO o S G J
numb_ '� D / street village
,`�i �7
"HOMEOWNER": ��)1 L 62.1/( 6 1 l,L i Z �? ? — ����S)
name home phone# work phone#
CURRENT MAILING ADDRESS: 0
city/ wn state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 115) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORIAMbuilding permit formsEMRESS.doC
06/20/16
�"E Town of Barnstable
Regulatory Services
Richard V.Scab,Director.
Building Division.
Paul Roma,Banding Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Off ce: 508-862-403 8 Fax: 508-790-6230
{
Property Owner Must
Complete and Sign This Section
If Us*rilr A Builder
I ,as Owner of the subject property
hereby authorize to act on my behA
in all matters relative to work authorized by this building permit application for:
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
QYORMS:OWNE"ERMISSIONPOOIS
07-20-201 7 & 1_91 0 36P
MASSAC:HUSETTS STATE EXCISE TAX
BARNSTABLE ;COUNTY REGISTRY OF. DEEDS
Data_: G7-`0-2017 a 01:36am
Ct1T: E36 Doc': 36342
Fee: �964.4.4 Cons: $282YO00.00
P_.t�fi, eTH�'LE COUNTY EXCISE TAX
QUITCLAIMDEED., BAR TABLE
COU„TT F'EGIv1F°Y OF DEEDS
D1 %-2 2017 a 01;36i m
68-6 i:rrr: '6342�
Fe:3: $R61=92 Mons: 222t01111,(10
We, WILLIAMJ.McCARTYand M. CAROLYNMcCARTY,husband and wife,of 17 Handel
o Road Billerica,Massachusetts
For consideration paid,and in full consideration of Two Hundred Eighty-Two Thousand and
00/100 ($282,000.00)Dollars
e Grant to WILFREDO'PLEITEZ,being un-'married, of 14 Pepper Lane,Hyannis,
Massachusetts 02601
h WITH QUITCLAIM COVENANTS
i
The land together with any buildings thereon, situated in Barnstable County,Massachusetts,
bounded and described as follows:
r
r
>, NORTHEASTERLY by Lot 4 as shown on hereinafter mentioned plan,one hundred
�L twenty-four and 85/100(124.85)feet;
° EASTERLY by Pram Road, as shown on said plan, eighty-seven and 97/100
(87.97) feet; and
SOUTHERLY by Lot 6, as shown on said plan,one hundred and 92/100(100.92)
feet; and -
WESTERLY by land of Frank L. Horgan et ux as shown on said plan,one
hundred twenty-one and 94/100(121.94)feet.
Containing 11,340 square feet and being shown as LOT 5 on a plan of land entitled"`Rudder
Village' a residential subdivision in West Hyannis Port,Mass.Property of Rudder Realty Trust.
(J.P.Lanza& S.H. Lanza Trustees) scale 1 inch=60 feet, Jan 3, 1967,Ed.Kellogg, Civil Engr",
which said plan is recorded with the Barnstable County Registry of Deeds in Plan Book 212,
Page 61.
The above-described premises is subject to and together with the benefit of all rights,right of
ways, easements,restrictions,reservations, and enc}mibrances on record,insofar as the same are
now in force and applicable.
For my title reference, see Deed from Robert J. Macon, dated September 8,2006,recorded with
the Barnstable County Registry of Deeds in Book 21332,Page 238. Also,see Barnstable County
Probate No. for Doris A. Macone. See Death Certificate recorded with said Deeds in Book
21076,Page 35 and Estate Tax Release recorded in Book 21076,Page 36.
<signature page to follow>
WITNESS my hand and seal this day of June1017. '
WILL c J
COMMONWEALTH OFMASSACHUSETTS
Middlesex, s
On this c6 day of June 2017,before n igned notary public,personally appeared
RULL9MI MCC roved to be through satisf tory evidence of identification,which
was a valid driver's icense,to be the person w name is signed on the preceding or attached
document,and Te3gec7`t a signed it voluntarily for its stated purpose.
����•��. O N-A/vN''�•,,,,
o
Notary Public
My commissir5nMK*W9i#to =Q=Z
Notary Pobilc ¢ 8'°
My Commission Expira November 6,2021 ���� ir,, ��,��pp" •�`���y
Commonwealth of M�
'''��ipptMpa iSSIPG\\\\\
WITNESS my hand and seal.this day of June 2017.
M. CAROLYNYWcCARTY
STATE OFNEWHAMPSHIRE
Rockingham, ss.
On this day of June 2017,before me,the undersigned'notary public,personally appeared
M. CAROLYIV MCCARTY,proved to be through satisfactory evidence of identification,which
to be th�erson whose name is signed on the preceding or attached
was a valid driver's'license,
document, a kAgwle`d-g ee that she signed it voluntarily for its stated purpose..
_�f_
Notary Pubis ''Q��:� N ss`oN•.9��
My commission expires: . - ooM Es
__Q. P,R 2p22 :o=
EMMA JANE HILTON-ANNALORO __-2
Notary Public-New Hampshire ��;� WS
My Commission Expires May 17, 2022 , '�� •'`�Tq RY
H "STABLE REGISTRY 4F DEEDS
�h,111111I I111111�.
John F. Meade, Register
r��������T7�T �lu�� ��. � ��^ l�T�3r�� � ��� l� ��
TOWN|� � �_� �� /� �� |� �� � /� ������
|
| 33ARNSTAELt039.
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APPLICATION FOR PERMIT TO --..�}1/J/./y'./-.1`��o[- .....��l�. .. .................................................
TYPE OF {�(�� �
CONSTRUCTIONr --'—''~'~''~ ^~---------------'----'-----------.
�.
�
---..lp��..
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�
TO THE INSPECTOR OF BUILDINGS: -=^-^. ' 'following .
T6e undersigned hera6v 000iee for o pennit occor6ing to the information:
Location ...............C9.../.......PtA.Y',
-__. -0_..`__.. /-//��%.kI.r��[ ...............................
. '
� l-/
� Use ----.././�d./... ....
............................................................................................. .........................
Zoning District --.-..-..--.-..-.--.-.------..Rva District ----.. -. |
. ------------.-------.Name �
U Ph.a.!n
ofOwner -/�C\ - -J.�.YY _
__.A66 �o .. q/'_. .__ h/��_/��
� ~ '
�\�
Nome of Builder ---"�=,Y�l��-------------.A66rmx -.-'.---.-----..-----.------.--.
�
Nome of Architect ........ ------------'Ad6rea ------------- ..................
/ �w � .� /
Number of Rooms ----.�-----------------.Foun6ohon ����n/����'g-'�� .....�!-00�O�}�---.
� i)
Exterior ---- \ .bv»g.d/--------------.Roofing -.� �~�_--'___________~_
.
Floors -----.�]�|�<'����.C�-------.------.]nUaho, --.. m�/ ~
V' 7_-l'----�r----------------
Heating ................ '...................................................Plumbing .......... .-e......................................................
Fireplace ................6U.*\.e......................................................Approximate Cost _��.. O7�.....................................
______ '
Definitive Plan
Diogram of Lot and Building with Dimensions o
SUBJECT TO APPRD I! OF BOARD OF HEALTH \ |
Waasmm* Robert J. .
�
t� m�e�
` *uI ^
---_ -_-_ .
it Ior
No _ .................................... ,
� .
-----..1-----.�.-------___—__.
.
Location21 Pram Road
—.. ,
|
)
Owner pm �
(
�
` frame `
Type or Construction .......................................... ] ~
^
................................... ----------- �
Plot --................... . 'Lot
, � .�.---------
-
�
7g
Doh* of Inspection
`
'J
Dote Completed .�����
. ~
` 1 �
PERMIT REFUSED
—
-----`---------------- lV '
-
.................. -------------'
'----^---------------------''
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—.--------------.-----..----,
'-----------------'--^—'----'
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[
Approved ................................................ lQ �
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.......................... /
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--------------------~—...—....
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o
Engineering Dept. (3rd floor) Map Qf A/g Parcel ° �ermit# 9�Q
House#. 11-1� Date Issued
G
Board of Health Prd floor)(8:15 -9:30/1:00 4:30) a fz<�1a(e_�V- 1& Fee
Conservation Office(4th floor)(8:30-9:30/1:00-2:00)
Planning Dept.(1st floor/School Admin. Bldg.) pFtNE gyp;_
efin ive Plan Approved by Planning Board 19 p 0 SEPTIC7 ;
cioALL �8
WbgTn o�
TOWN OF BARNSTABEE'ao MEENTA ®®F ri
Building Permit Application i "�' PIT"
Project Street Address
Villages /� j�y�/�/S al fizz
Owner�Ze td �s�G'r9�/c Address
Telephone 77,1 'dGGSp
Permit Request =��; — /►-� T ,� j ;• .F Eri✓
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ ; 000
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Ua,"' Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes dNo On Old King's Highway ❑Yes f8io
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
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat�ype and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Centro Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
5
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
_ Builder Information
Name 1,9w G; AM Vim Telephone Number
Address LD S'' e� ��,eJ l�j G ?lii� ,� License# �.6'70'3 �-
<d���/ �:�iy�� ✓tml�sr� " A Home Improvement Contractor# 46d0 7,00
Lam`- Worker's Compensation#D£P CgJ,--A �!34iy
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Oc J:'
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
t
j
DATE ISSUED
MAP/PARCEL NO.
r • }
f I '
f
ADDRESS VILLAGE
OWNER c'
DATE OF INSPECTION:
FOUNDATION
,
FRAME i
INSULATION r
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL '
FINAL BUILDING -
DATE CLOSED OUT }
ASSOCIATION PLAN NO. '
•^..,,r"'•.�-,.r-�..-•r-.•.-v�r.rr�++i`•^^.--^-'�--�..�..-o•..•-r....-..y,�,,W`•'�'� •.-.+'�.-..^w.•� •.� `�.r.+'.^..-��-..rr.-,.••,^,'Yi--.,-✓'+v-.^. .,y.••r.+-.... ..r.,rrrLL�..-�._..-�,,..,-...,rn....�-�
Assessor-'I map-, and lot number O/
t a rr.
Sewage:Permit number ...?-2o.... . .......
yofTNETo�. TOWN OF` ' BARNSVfcffl� s�-` A�AD T �
ABB9TADL&.B • ,.
9� - BUILDING INSPECTOR,
'EO NPY a• ,
r
g
APPLICATION FOR PERMIT TO ..................... ..
U/L .. ......... ............ ..............................................
COr
TYPE OF CONSTRUCTION ....................I ...............................................IU 12. 7..4...............................
........... ............t,.. ......191....7.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..........�a1......... .../ / .......Ll. .....
....... y .lv!tll 5............................................................................
ProposedUse ...............Zl(J/,006 ...... / �� .................. ........................................................................................
Zoning District ...............1z..0..............I................ ..............Fire District
Name of Owner .1�4 ..Z.K.R ....:)..k'�.Gt�.�''�.r......Address o` � �I��M �� ..`l!.�I.�..N� ......
. .............. ....... ............. ....
> > u t Jl kti L_ 4uE
Name of BuiIdeSI)P\OAJFJn.......G 62.1.!AJ...Address ............. .A.l MQ.v.1 H...................................
r
Name of Architect ........... Q..A)./::................................Address
cu
1 .....................................
Number of Rooms ................../........................ ....................Foundation �L Ze' T......
Exterior .......�VL .Roofing ....A �l'�L�. • ..GLc�............
Floors . ... .. ................ .. �Inte or ......... ... ......................................
Heating ........./V(O.A.)"4....................................................Plumbing ....... ........ .�..r�.....................................................
Fireplace ................. ... .. .......................................................Approximate Cost .............f /... .0. .............................. .
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area ..... .�O
Diagram of Lot and Building with Dimensions Fee ............
.......................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
®(3 i
ADS �TIatJ
� � O
19� HaysL �
1 �30 �
I hereby agree to conform to all the Rules and Regulations of t wn of Barn r g rding the above
construction.
Name ................ ....o.... ..... .. ........ ..........................
Macome, Robert
e
No ...17291 add t�.............. Permit for .....: ... /��
%safamily dwelling,
...............................................................................
' ell
Location ........2.1...Pr.a.m.-.Roa,d...............................
.Hyannis
............. . .....Robert..
M...a..c..o..m..e.. ...........................
Owner. .................................... .Type'6f/Construction .......... ......................
................................................................................
/r 4.-
Plot .... ..................... Lot ................................
Permii Granted
� .........Au u s.t..28......'�19 74
Date of`Inspection . ......
f
9
Date Completed
PERMIT REFUSED
"o
. ............................................................. 19 IT 7
............................................................ ...................
.........................................................
Ij
. ....... r
J ....
,
...............................................................................
Z'le
............................:..................................................
re11410-
Approved .......................................... ..... 19
I................;.....................................................
............... ........ .............................................
Assessor's� map and lot ,number .!='1 I
c s
Sewage Permit number ..`..//**0'.au
P
T"ET°�� TOWN OF BARNSTABLE
Z BAH.H9TSIILEI i
"b 9 BUILDING
INSPECTOR
9
'FO MPS a'
r^
APPLICATION FOR PERMIT TO &U� L/C l / / "
L
/, ,® DD Coal �f i tr
TYPE OF CONSTRUCTION ....................v4�!...................................................��.................................................
........... ............ ......191....7..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according
� o the following information:
�/�/4Location ...........�/...... /!!I......../.1...4 ............✓..l...y/�.it�N/�............................................................................
./ �/� G AR.F�..........................................................................Proposed Use ................. .... ............ ... .......... ....................................
ZoningDistrict ... l?............................................... District y 1................... . .................................. ............... ... .........................................................
Name of OwneCr .1.`4 �. �T.... ..�.C�. M..fir.......Address o` �NI � `P� ...�.�5,......
.... ...............................................................
) 1 U )ictM 11Ktti L_ ►�u
Name of Builder , �.F..� ......� `�V.F.2 .�. ...Address .�.!' . v sty..... .................................
Nameof Architect ...........,A/ .N.... .................................Address ............................................................s......................
Q i
Number of Rooms /J..............................................Foundation k��/.0 �LdC, , V /*'0—OT1.....................
Exierior .......�1./. /7E �1 .�1 �1.. /!�!I�l'�C1 .Roofing .... �!� LT......� ��/A/(a LfS............
............ ......
Floors /�cT �(IN20/ C f��Pnt nor V.....�
/ / r
Heating .........I..nVQ*
: ..................................................Plumbing ................n................................................................
Fireplace ................. .......................................................Approximate Cost ..............44..4?o .......................
Definitive Plan Approved by Planning Board -------------------------- .. � 0...��0. S,/.
19______--. Area
Diagram of Lot and Building with Dimensions Fee
�5
.............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
• t
q�fj � T�atJ
r
14%
19 � H 0 F-
L
I hereby agree to conform to all the Rules and Regulations of
theTwn of..Barn table rg rdi.ng th.e above
construction. e
Name .;. . •... .... .. ................. ........ .....................
Macome,. Robert Q/ g_ A/a
17291 add to single
No Permit for
t family dwelling
...............................................................................
Location 21 Pram Road
Wyannis
...............................................................................
Owner ...........Robert...........................Macome............................
Type of Construction frame
s..............................................................................
Plot ............................ Lot ................................
Permit Granted ........Augus.tr,..28............19 74
Date of Inspection ..................................'..19
Date Completed ......................................19
i r
PERMIT REFUSED
........................................................... . 19
...............................................................................
...............................................................................
...............................................................................
...............................................................................
Approved ................................................ 19
...............................................................................
...............................................................................
f
The Commonwealth of Ma sachusctts
04-1. Departrnerrt of Irrdttstrial Accidents
: - Office ofiot✓estigatioas
I' •ter 600 if ifs/titr tun Street
A." Bostutr,Mass. 02111
Workers' Compensation Insurance Affidavit
AVplicant.in 7--7 -7 _ -
PR
i
location:
city i ,� 3 5 12hone K �2.11�Sr✓
O 1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
.LL�z^"$.,,.+�zC� -C.�r r .++�.e^!� ;x+�'!�Q'2en" ,+'S'� 'm* �w•."'i'^�"`? '�'.b...:,�:� - w.,.".�a..•.::::.c�.-. x.
,'-. �...s•..�.m z-.v.nt�:�+�:id....�cs:.:i.:a�:�...�'-".fa�'.' f�c.:L:a•u..�'=.: ....-'�' ....'�'.�..•' ^":• .;`*"_^t`l.,'e`?�f't*_.rr•-...r..`<-r.n--;._nqr,
1 am an employer providing workers' compensation for my employees working on this•lob.
company name:
address:
cih phone 0
incur,knee co / �' / �yL %/ policy O Z�;-g
i.�y-• rz'!`^-"'•.,±t^-cis •a.-yr�.r�.,. t... ,:� *ups- ...... ...s'...La_-_t.:Y..L.�. _ ..
1 am a sole proprietor,general contractor,or homeowner(circle one) and hay. hired the contractors listed below who have
the following workers' compensation polices
comnanv name:
address:
phone#•
insurance co. olio,h
--_-•_._•.-._._.__.�_—... _ ,_y.r_�zr si -..:r,:. :r�..aas1::.i�a:u�•+:al ��.%�:,:•�1�..: '`"--;57=--- ..-i:-._ -' �t .v ..t.•
company name:
address
ct v• hone k:
insurance co. nlicv#
r—... ._,
`Atiacb additionalslicet if ricccssary. Nta rc •sc;. t �; 'rk� =y-��.`r ,. -,� .-fin-m-- ice,--.—iF"—+�5 •r z,�
{__. ._.__..�—_.._..w.�_—.._��? 'i _ [a-...aaior�_�_........-. - Y3.asi.:r. '� ���Lam§ a{?�.�.ticX. 1f.I +.:C.131.f►.r./sf:.Cl:. .
Failure to secure coverage as required under Section 25A orAlGL 151,can lead to the imposition o'criminal penalties ora fine up to 51.500.00 and/or
one Fears'imprisonment as cell as civil penalties in the form ora STOP\PORK ORDER and a fire of s100.o0 a day against me. I understand that a
copy of this statement may he fonrarded to the Office of Investigations orthc DIA for coverage vc-ihcation.
t do hcreht•certift•and t aims mid itallies of perjug that the iii/arntation provided c5ove is true and correct. .
t
Sisnaturc Date
Print name AAZ/-)� �C�I/ Phone
tc� i see only do not write in this area to be completed by city or town official
. city or town: permitAiccnsc 9 -Building Department
k 0Liccnsing hoard
O check if immediate response is required �Scicetmen's Office
olicalth Department
contact person: phone 9: nOther
The Towvn. of Barnstable -
NAM Department of Health Safety and En*wonmental Services
Building Division
Ma
367 Main SUCC4 Hyaaais MA 02601
Ralph Crosses
Qff cc 308-790�Z27 $wag Ca�issio r-
F= 509-775-3344
For office use oaiy _ -
permit no.
Date -
AFFIDAVIT
HOME 50ROVEMENT CONTRACTOR LAW
SUPPL ZAENT TO PERmT APPUCAIIONI
MGL c. 147.A that the mreconstraction,alteraueas,renev=oa,repays,mod�05 CDnV'�,
� ed
unprovement,.rea=-4 demolition. or man of as addition to-any g CW= oaurgi
buiIding containing at least one but not more than four dwelling units or to which,ad}acent
to such residence or buEding be done by registered contract m with certain cc cePtions,ilong with attic
requircraents-
Type of Wank: -��i/� � "
Est. Cost
Address of Work: v2/ /Z. f i7 !/1,�' ��T /t/� c► -
Ov6mer.Name:
Y
Date of Permit Application:
I hercb<certify that:
I
1
Registration is not re rmi for the following reason(s):
t
Work excluded by lacy
Job ander S1,000
Building act awner=oocag cd
ow=pulling own psrmst -
Notice is hereby gh=that:
OWNERS PULLING THEIR OWN PDEALING NOWT HAVEACCESS TO ME
)FOR APPLICABLE HOME IMFROVO4ENT WORK DO
ARBITRATION PROGRAM OR GUARANTY FUND UNDEFL MGL c-147A
SIGNED UNDER PENALTIES OF PERSURY
1 hereby apply for a permit as the agart of the ow•aer.
Date Regtscrauou No.
OR
L
07 e -Co I
I
,HOME .IMPROVEMENT CONTRACTORS REGISTRATION
�. = Board of Building Regulations and Standards
�`�= One Ashburton Place - Room 1301
:Boston, t1assachusetts 02108 • j
I
H0ME IMPROVEMENT CONTRACTOR L-------------------------""-------
Res_stration 100740 Expiration 06/23/98 I L
Type — PRIVATE CORPORATION
HOME IMPROYBEii CONTRACTOR
F G Registration 100740
CAPIZZI HOME IMPROVEMENT., INC. I Type - PRIVATE CORPORATION
Thomas Capizzi , Sr . Expiration 4b/23/48
1645 Newton Rd . I
Cotult MA 02635 CAP:ZZI HOMC IMPROVEMENT, INC
Z
o0 S a Tf Sr.
d—�'T-' Newton Rd.
Cotuit MA 026.E
i
� �Jiwt "- not
DEPARTMENT
ONE AGIiGUR t
DOSTUN,
y T,';�•:'ins'"i''
jAUG110'NiSUPERVISOR LICENSE
i s ri s:.�ik
lsat' _ Expires: .
�SXt�3.GAPIZ IaJR: ..`.