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0032 RIPPLE COVE ROAD
3a C'�-e 'THE?I Application number ... .�`.......� ...�?�..�••• Date issued........ - 1Ix. .................................. I BAILIN BM i, MAS& - I AUG 2 9 2010 Building inspectors initials...... I ............................. one. 3.2-S- /r5- , Map/Parcel................................................................. TOWAI O� 8AHNSABLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATEERIZATION PROPERTY MORMATION L--:,-- 7 Address of Project: _R Zil2ple_ (ave NUMBER STREET VILLAGE Owner's Name: Arie-s Phone Number 5oS- 776-1,,,(j J Email Address: +e-r\r\el e Cell Phone Number Project cost 2 0 -7 Check one Residential V/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 5.e,. arga�a oe,4rc--� Date: F- TYPE OF WORK 1�iding 0 Windows (no header change)# Insulation/Weatherization Doors (no header Change)# I Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name 4/e,J ccr,�IeV4 1,fl-I)JOWS Home Improvement Contractors Registration(if applicable)# 17 3 2-Lt-S- (attach copy) Construction Supervisor's License# 09 E70:7 (attach copy) Email of Contractor V; 1, C�Oen I Phone number 1101 z 2- R -J 900 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS 11v A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8e 00arn-9.30 am or 3.30 pm-4.30pnL Commercial events may require Fire Department approval, *WOOD/COALJPELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEN2TION Homeowner's Name: Telephone Number Cell or Work number I understand any responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CAM 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 PLICAIT9 S SIGNA I' Signature o Date All permit applications are subject to a building official's approval prior to issuance. I er��Wal Agreement Document.and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England.... y g Agnes.Tenney i Legal Name:Southern New England Windows,LLC 32 Ripple Cove Rd RI#36079, MA#173245,CT#0634555, Lead Firm#1237 : Hyannis,MA 02601 wieoow RE �nc..Exr 10 Reservoir Rd I Smithfield,RI 02917 _ H:(508)776-6908 - - Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Agnes Tenney Contract Date: 08/17/18 Buyer(s)Street Address: 32 Ripple.Cove Rd,.Hyannis,_MA 02601 Primary Telephone Number: (508)776-6908: Secondary Telephone Number. Primary Email: tenney@up.edU Secondary Email: Buyer(s)hereby jointly,and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance With the terms and conditions.described in this Agreement" Document and Payment Terms,any documents listed in the Table of Contents,and any other,document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorpporated herein by reference(collectively,this"Agreement'). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $5,207. By signing this Agreement,you acknowledge that the Balance Due;and the Amount Financed must be made.by personal check;bank check,credit card,or cash.- Deposit Received: : $800 Balance Due: $4,407 Fstimated Start: Estimated Corimpletion:. 8 to 10 weeks' . .8 to 10 weeks Amount Financed: $4,407 Method of Payment: _ y Credit Card We schedule installations based on the'date of the signed contract and secondarily on ':Financing the date inwhich:we complete the technical measurements.The installation date that we are providing at this time is only an estimate..We.will communicate an official date and time at a later date:.Rain and extreme weather are the most common causes for delay. . . . . Notes: $800 paid via Visa; $4407:via Greensky; Plan 2521;Taxes paid in Barnstable MA Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)"hereby acknowledges that Buyer(s)_1).has.read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do,not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANYTIME NOT LATER THAN MIDNIGHT OF 08/21/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE.THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN . EXPLANATION OF THIS RIGHTT, Legal Name:Southern New England Windows,LLC y dbai Reneiva) n rsen of Southern New.England Signature of Sales Person " . Signature Signature Josh O,charsky Agnes Tenney Print Name of Sales Person Print Name" Print Name . UPDATED:.08/17/18 Page 2 / 10 i Of -e of Consumer Affairs and Business Re9iIlation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor RegPstrat-Ion Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS -LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD L+N-COLN, RI 02865 Update Address and return card.Mark reason for change. Address 7. Renewal _. Employment = Lost Card Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 173245 Type: Ild Park Plaza-Suite 5170 Expiration: 9/i9/2Q 18 Supplement Card Boston.MA 02I16 IUTHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDERSON IIAN DENNISON ALBION RC JCOLN, RI 02865 Q.Undersecrelary Not valid without signature Ez 1D a_ ✓U 1Stu;ii.Fyi;�` :lE �.:`:,Cziiv lrt�tio = G~:+.i ��..'1a.d;:..eG lv.7 SIR_AN D DENNISON LA ONE CICHARLTON VIA .g�� vV:E iS$ I ' The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,,Suite 1 DD Boston,MA 02114-2017 Workers,��orkers, Compensation Insurance Affidavit:Builders/Contraciors/Electricians/Plumbers. TO BE F1LED WITH THE PERMITTING AUTHORITY. A licantInformation - Please Print Le ' ) Tame (Business/OrganizaiioMndMdual): Address: ,[ City/State/Zip: Phone# �,Q( _ 2> Are you an emplov&9 Check the appropriate boa Type of project(required): ] I am a employer with �0 employees-(full and/or part-time).* 7..D New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in �Y coP�nY-(No workers'comp..insurance required.] 8• D Remodeling 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required-1 9• ❑Demolition 4.❑I am a homeowner and wM be hiring contractors to conduct all work on my property, w»ro _ I . i 10 D Building addition 1 � ensure that aU contractors either have workers'compensation insurance or are sole 11_�Electrical repairs or additions proprietors with no employees S.n I am z genera contractor and I have hired the sub-contractors listed on the attached sheet 12.D Plumbing repairs or additions These sub-contractors have employees and have worker.'comp.insurance? 6.D We are a corporation and its o$cen have exercised their right of exemption,per MGL c. '4. Oihei e�o o r 152 F 1(4),and we have no employees.(No workers'comp.insurance required.] <C e(a<f,e 'Airy applicant that checks box gl must also fill out the section below showing their workers'compensation policy information I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afndavii indicating such. 4Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have emp)oyees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my empl(yees. Below is the policy and job sue information Insurance Company Name: Ire met)S Policy#or Self-ins.Lic. : 3 7 Z R .- Z ExpirarioL Date: O / 1 Job Site Address 3 2- � 12 Ile h e-- rf City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$],SDO.OD 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.A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. i do hereby certify under th airs and penalties of perjury that the information provided above is true and correct Si atom: -Jbex e D2te: Phone : qD ai-2Z 8=T Pe Official use only. Do not write in this area,to be completed by nit:or town official City or Town,: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone P: I - CERTIFICATE OF DATE(MM/DD/YYYY) `...� LIABILITY INSURANCEF12/2912017 THIS CERTIFICATE 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). 'RODUCER CONTACT CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 °HONE 303-988-0446 Denver CO 80202 EMAIL FAX No:303-988-0804 DDRE : COMail cobizinsurance.com WSU S AFFORDING COVERAGE NAIC S NSURED ESLERCO-01 INSURER A:Acadia Insurance Company 31325 Southern New England Windows, LLC. INSURER s:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: :OVERAGES CERTIFICATE NUMBER:1252851165 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH 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.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. ISR ADDL SUER ,TR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLIC A X COM MERCIAL GENERAL LIABILITY MM/DD MMIDDY EXP LIMITS CPA3158728 1112016 1/72019 EACH OCCURRENCE S 1,000.Wl) CLAIMS-MADE �OCCUR DAMAGET RENTED PREMISES occurrence S 300.0W MED EXP(Any one person) S 10.0D0 PERSONAL 8 ADV INJURY $1,ODD,D00 GEN L AGGREGATE LIMrr APPLIES PER:- I GENERAL AGGREGATE $2.O0D,000 X POLICY❑PR LOC - � PRODUCTS-COMP/OP AGG $2.000.000 OTHER: S A AUTOMOBILE LIABILITY N CPA3158726 I 1112016 1112016 COMBINED SINGLE LIMB - X _ Ea accident S 000 DOG ANY AUTO �ALL OWNED S ULED BODILY INJURY(Per person) S AUTOS AUTO BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED + PROPERTY DAMAGE AUTOS I Per accident $ I $ A X UMBRELLA LAB N OCCUR CPA315872E 1112016 1/12019 EACH OCCURRENCE $10.ODO.DDD EXCESS LIAB CLAIMS-MADE AGGREGATE S 10.ODD.00D DED X RETENTION$ B AND S EMPLOYERS COMPENSATION � WCA3158729-20 111201E 111201c X PER OTH- AND EMPLOYERS LIABILITY Y/N_ STATUTE ER ANY PROPRIETORMARTNER (ECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A EL EACH ACCIDENT $1,OOD,000 (Mandatoryes.describe in NH)and EL DISEASE-EA EMPLOY S 1,000,)00 H yya�ss descibe under DESCRIPnON OF OPERATIONS below, C PWlution Uabik 75300733400DO EL DISEASE-POLICY LIMR $1,000,000 Claims-Made Policy 1/12D1E 11112(19 Each Occurrence $1.000;DW Retroactive Date 06202013 A99re9ate S1.0D0,000 Deductible $10,000 'ESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional.Remarlcs Schedule,may be attached H more space Is required) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED:BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AurHORrzED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ►CORD 25,(2014/01) The ACORD name and logo are registered marks of ACORD r IKE Town of Barnstable Permit# Expires 6 months from issue date �7 Regulatory_ Services Fee sniwsrns�, ` JS M"�'16.59. Richard V. Scali,Director.. ® t7 D � U prEp MA't° Building Division Mai Tom Perry,CBO,Building Commissioner AlAY 10 2016 200 Main Street,Hyannis,MA 0 VU www.town.barnstable.ma.us YNOF B '�USTABI F Office: 508-862-4038 t Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY X5_ I I� Not Valid without Red X-Press Imprint Map/parcel Number IJ Property Address 4!0 C�t� XResidential Value of Work$ •Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Nam Telephone Number Home Improvement Contractor License#(if applicable) ��r✓/l� Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance z. Check one: ❑ I am a sole proprietor " ❑ I am the Homeowner Q�I have Worker's Compensation Insurance Insurance Company Name�� �i/i� �✓�2� O&o el�,y Workman's Comp.Policy# yU� Gt� C7;4 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ARe-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 Windows/doors/sliders:U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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\FORMS\building permit forms\EXPRESS.doc Revised 040215 The Cownr=wealth of-Wds-sachusetts . M ., Departrrrent o,f Indr yb ial Accrderds - Office of.£mtigations 600 Washington Street Boston,JVA 02111 irPPi.v mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Ciantracturs/EIetri;cianslP'Iu nbers Applicant Infarmation Please,Print . 'bi Name(13ULWeMf013an=d10n11ff dMI). Address: > ; City/stal&zip .® C� Phone 1ou an employer?Check the ppropriate box: Type of project(required): 1 am a employer with 4. ❑I am a general contractor and I 6 ❑New construction - employees(fu11 andlor pAe * have]Tired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling slop and have no employees These sub-contractors have g_ [_].Demolition' wodzing for me in any capacity employees and have workers' [No worbem'comp.insurance comp. nsurantit-1 9. ❑wilding addition r d. 5. ❑ We are a corporation and its 10:ElElectrical repairs or additions �e � 3.❑ I am.a homeowner doing all work officers have-exercised their 11.❑Plumbing repairs or'additiom myself[No workers'comp- right.of exemption per MGL afr C.152, §1(4h and we have na i*+��nce required-]I ' employees-[No woslDers' 1313 other camp.insurance required.] 'Any appBC=that checks boa P1 Most also fill out:the sectionbelow showing their worker'compemsatioupolicy informadarL #Homeowners who submit tftis dfidmit indcating fty are dGmg all waak and.diem hire autside contractors nmst submit a new affidnit indicating mcb- fCoatractors ibst chect This boa must attached sir sddihooal sheet showkag the name of the sub-ccmirsct m and state whether or not those entitk s ham employees.Ifthesu6-caatactvts have empIoyves,theyxmnrpmuidetheir workers'comp.policy number. I am art ernpkl,wr tliat is pm,ding ivarkers'cougmisi ort insurance for iuy employ,ees Betacv is d ie policy and jab site ircformalion. Imutance,Company Name. , Poli *'or Self--ills.Lic. y� /, ,,mot / r (��GJ ✓��®��7© [/ �I(O Expiration Irate: �c Job Site Addt�: CitylStatel7.tp: Al aoue�/ Attach:a copy of the wark . s compensation policy declaration page(showing the policy nu er and espirarhon date). Failure to secure coverage as required.under Section 25A o€MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,5000.OQ and.for one-year imprisonment,as well as ci%ril penalties.in the fog of a STOP WORK ORDER and a fine of up to WOM a day against the violator. Be adsdsed that a copy of this statement maybe forwarded tb the Office of Investigations of the DIA for insurance-coverage verification. Ida Iit=t-eby cerhf,a>ider tFtepaues r¢ n ' s ofper ju I that the infbrma&a pm ided abmv is true and carrect Sitmature: Date: Phone i;:C (ZY� Official use only. ,Do not write in this area,to be completed by city ortonrn official. City or Tome: Perr uitMicense if Issuing Anflaority(circle one): 1.Board of Health 2.Building Department 3.CiiylTotiwn Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Mfarmatian and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empIoyees. p .tc)this Vie,a a.enq7Iayee is defined as°`_.every person is the service of another under any conhract of hue, express or,implied,oral or yr t ta. An errrployer is defined as"an individual,partnersb.�,association,corporation or other Legal entity,or ray two or more of the foregoing engaged in a joint emtzprise,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 tbree apartments and who resides therein,or the occupant of the - dw-dE g house of another who employs persons to do mafiitE n ce,construction or repair work on such dweIIing house or on the grounds or budding appurtenautthereto shallnotbecanse of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sties 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 buildiags in the commonwealth for ray applicant who has aotproduced acceptable evidence of compliance with the insurance.coverage required_" commonwealth ofits oliiicalsubdivisionsshall either the commanw 152 25 states"N �y P Additionally,MCrL chapter , § C(7} _ enter into any contract for the performance,ofpubhc waric until acceptable evidence of compliance with the fimiran ce._ requirements of this chapter have been presented to the contracting anfhorityf AppIicants Please fill out the workers'compensation affidavit completely,by chet:lang the boxes mat apply to your sitnafion and,if necessary,supply sub-contactor(s)name(s), addresses)and phone number(s)along with their cer(ificate(s) of in su-ante. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)wifh 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. B e advised that this affidayrt may be submittr d to the Department of Industrial ce cove e. Also be sure to and date-he affidavit The affidavit should Accidents for confirmation ofm�n rag sign be retained to the city or town that the application for the permit or license is being requested,not the Deparmmeat 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-his rrance license ntmmber on the appropriate line. City or Town Officials t - Please be stare that the affidavit is complete and pried legibly. The Department has provided a space at the bottom of tie affidavit for you tD fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill n the pm�it/Iicrose number which.will be used as a reference number. In addition,an applicant that must submit multiple pen atucense applications in any given year,need only submit one affidavit mdicaang current policy inlf6rnation(ifnecessary)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 maimed by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fit=perndts 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 (Le. a dog license or permit to bum leaves ern.)said person is NOT regrdred to complete this affidavit: The Office of Investigations would hIt 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 mess,telephone and fax number: Tie Amman tit of Masnachussz� Dtpalimmt cif Ii dnstdal Ac cident% �it�of�ntvt�ig�tio� �QQ�asbin.�an Stet - Bastmk MA QI11 Tf,-I.4 617 727-4900 Qxt 4€16 or I-&' 7-IASRAFF, Fag 617-727 7749 revised 4 24-07 xaas-,gGvIdia - �tF+e Toys ,0 Town of Barnstable ArfD�� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property .1 . hereby authoriz �4�� � to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signs of Owner 657 - Date e e Print ame r If Property Owner is applying for permit,please`complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 — . Town of Barnstable Regulatory Services VE TOif,` Richard V.Scali,Director Building Division r � r * RAMSTASM • Tom Per Building Commissioner Msec r3'� AIF1 39. ��0� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town 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 2.15) 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\F-NFRESS.doc Revised 040215 i Aco a' CERTIFICATE 4F LIABILITY INSURANCE 0313012016 THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN% EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTRIfTE A CONTRACT BETWEEN THE MUMS MURER(S), AUTHORVED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: 0 Ilhe ce=c flu Ro)deI Is an ADOMONAL MURED,the poTic"co must be crAw bd. If SUBROGATION IS WAN®,m*$u2 to the terms and cormifflons of dw phrtley,mWn poRdm may reguve an endorsement A stdoloWR on III&effil alo does not cwlM rl9his fo lm c""cate holder in Tien of such ematsmoengs) MOW" Room tare)a51-sbw Pan:t9701 s51-4N8 cONrAcr Sullivan insurance Agency SULUVAN ff=RANCE AGENCY pwww 876 851-A600 Ax (9T1�851.4848 BW MAIN STREET TEWKSBURY MA 01876 ONUMMM AFPOR0110 COVERAGE NAIc# mamt m A : XS Brokers Insurance Agency,Inc THOMAS A HILCHEY Iirs a : ACE Group OBA THOAAAISS A HILCHEY CONSTRUCTION 82 OLD CHATHAM ROAD hNaufm a HARWICH MA 02M - INBUREA E ,....ERF COVERAGES CERTIFICATE NUMBER:25048 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIWEO- NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTVFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORMD BY T14E POLICIES 13ESCRMM HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIEg LIMB'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IM TyPEoFOwItANCE A9U1 v" POLICY kli umpoucriff PaIJCIrow Lam TA A GOMMK umtLffy 3AA104273 09>Z6115 OW26M6 EwmaccuumNm 8 1,000,000 X COMMERCIAL serteRAL LIABrury DAMPMTORENM FROSSES Ob $ 50,000 CLAM MAM r—wl1-=J OccUR Mom.E7O+(Any onQ permn) S 1,000 PEPsONAL&POYINAW S 1,00%000 GENERA.ABATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCrs-COMPIOP AW S 2,000,000 Poucr lac S Awoehrwa Wamy � ehhE�tmhiT 8 ANY AUTO BwLy INJURY{Per OB►w) S Au.OMN �1LY IN,WRY ate) 8 AUTOS HIRW AUTOS PFAVEMYGANAGEf f ullsspJlA ulre OCCUR . EACH OCCURRENCES MOM UAB CWMS#AADE AGGREGATE f DW 8 f B WWORKM COMMIMM 5562UB-2E085404MG 03f15N6 03M5H7 X I wRY� f AND BtPllft Mw uAmuff ylN Am v TohtsM"MUMwrnhe EL.EACHACCOWNT 5 100,000 OFSICEAIeEMM ENCLUO 7 �Y NIA eLO EAE PL(WIM f 100,000 pqusweryhnh� OE ON OFhmEaArroNsueha. - E.I.0155AbG?WdCyLIMB f 3110,000 DESCRIPTION OF OPWATWIN I=010N8I VENWAM Paso AOORD tut,A"*XW ftww ke adaAft Amore 69M N M*ft41. Thomas Hileley Is excluded for Ile Workers Compensation Poley. CERTIFICATE HOLDER CANCELLATION Thomas Hii ehey SHOULD ANY OF THE ABOVE DE3CRl81ED POLICIES BE CANCELLED BEFORE THE EKPIRATION DATE THEREOF. NOTICE WILL SE DELIVERED IN A+CCOROANCE WiTHTHE POLICYPROVISIONIL AU1hMfaM RVRESMATM Aftenttom ACORD 25(2MOY 0 ACORD CORPORATION. All d&W trasmved. The ACORD name and logo arse marks of ACORD agh&aam vam far bLdWulwe'anly LawmVE"Eff OOTOR = aeg to: OM9 Two id g9Fp# i-ism TEAS A.f = w 'HOiAS MaJOHEYF�'' 4�4- 9ttt, _ -- '�€��ip i�it52vt8�1IItse _ { Massachusetts Departmen O d Standards Safety - � Safety Board of Building Regulations License:tS-034718 - Construction Sup rjisor :. THoMAS A HILCfO:Y 82OLDCHATHAMRD HARlMCH IBC 02646 s " ..w� C Expiration: Commissioner 0911912017 3 Assessor's map and lot number hS SYSTEM MUST BE NTALLED IN COMPLIANCE Sewage Permit number6..-...4, sd...... .... WITH ARTICLE II STATE- 4,NITARY CODE AND .TOWN �Qyo*TNET,�o TOWN OF BAft"TX LE BJHBSTSDLE. NAM a w U-IL INO INSPECTOR . � ar a• o- APPLICATION FOR PERMIT TO ..' .. w!.. ^:.,2.......................................................................................... TYPE OF CONSTRUCTION ........../ .�...A.).-A.AF.. .......................................................................:....................... .......... .......7%3....19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .,Zp..;7. .....4.6....... ...tC,.Q.C�.�.�..��........ ... .. . .Ahl.41/s.............................. Proposed Use ...1.1.G: .l..!, .. v..c..e...................../......;?!. &&..t.. -. /....................................... I......................... Zoning District ......I.R. 13.....................................................Fire District ..... . .[ ........................................ /� / Name of Owner�7/.//.��T�X..G...... .>SA..<SI..Address ..�...��... ... f2 .Q�;L...., Nameof Builder ...... 0-4v-..4.-......................................Address .................................................................................... Nameof Architect ...................... ........................................Address .................................................................................... Numberof Rooms ........�.................................................Foundation 1.6..lvC..d-..4-..777,!.'....................................... Exieriarl0.4,rr. .............................................. Floors .t .G`- .........................................................Interior,5 ............ Heating ,f� L-, %/� /.. ............................................Plumbing 0.0..P.P.�.Y?..,, .. .................. ... ................................................... Fireplace .../......................................................................Approximate Cost ./..f,...."7:' .......................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ......7..b7 o..7�.Q............... Diagram of Lot and Building with Dimensions Fee - SUBJECT TO APPROVAL OF BOARD OF HEALTH l/ -12 "U QJ 0- a S /! i i �C I , ?S la t) -30 Y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ell Name ............ ................ Hudson, Kenneth E. 16264 ......1 1f2 story... No .........:....... Permit for .. ..... ........... + single family dwelling ................................................................... Ri le Cove Road Location...... ............................................... i ......................Hyannis........................................ Owner ..........Kenneth E. Hudson..... .................... t Type of Construction ........................ rame...._.. t r ................................................................................ Plot ............................ Lot .........�1:6................ !k V Permit Granted .. ..................... 19 73 i i/1 V y Date of I pecti ................. . . ..... .....: 7 Date Co plet .............. PERMIT REFUSED .............................................................. 19 + ............................................................................... I ............................................................................... ............................................................................... 3 i t Approved ................................................ 19 r . ............................................................................... ..................... ......................................................... TOWN OF BA,RNSTABLE BUILDING PERMIT PARCEL ID 325 116 GEOBASE ID 2330' 6 JADDRESS 32 RIPPLE COVE ROAD PHONE Hyannis ZIP TAT `46 BLOCK LOT SIZE , � DBA DEVELOPMENT DISTRICT HY 1PERMIT 16171 DESCRIPTION REPLACE EXISTING DECK 1OX26 & SX16 ( PERMIT TYPE BADDD TITLE BUILDING PERMIT ADD DECK 1 CONTRACTORS PROPERTY OWNER - Department of Health, Safety ARCHITECTS: and Environmental Services I TOTAL FEES: $: a 00 ( BOND $_00 CONSTRUCTION COSTS $5,000.00 434 RESID ADD/ALT/CONV 1 PRIVATE P' s� MASS. � I 1639. OWNER TENNEY, AGNES D ADDRESS 1965 SW HUNTINGTON .AVENUE " PORTLAND OR BUILD I � BY DATE ISSUED 06/23/1996 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- i CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR I 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 FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- ' (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. i 4.FINAL INSPECTION BEFORE OCCUPANCY. • i M BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT C 2 BOARD OF HEALTH ` OTHER: SITE PLAN REVIEW APPROVAL I I I I I WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY j VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. I� I BUILDING PERMIT `OF,HE ip�� The Town of Barnstable O� BA LE.MASS. • Department of Health Safety and Environmental Services MASS. i639• �0 �E1639. Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection _ Location �� � .- � oo fw e- C1lPePermit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: k(., RPO'k"61 Ue�\/ 7ei� 6V-c'-&� 1�7 (5, 2'k.. -) Rao .._ 0 r-,z 0 U L L.erg 6 A K 7-0 C RX 6Y'!7'- A � w r Please call: 508-790-6227 for reeinspection. ry, Inspected by � ( � � tY�., �L � �''t-+j Date - 7i � a '' �rt� P f-r . t lr r Engineering Dept.(3rd floor) Map `�� Parcel 7 a Permit# �✓ House# �^ Q.JTr� Date Issu d G ''�-�"�/ka B or)(8:15 -9:30/1:00-4:30) S� Fee Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) �! Plane' �1HE rq, Defini ' _ 19 ' BARMIASFI E. �rFO MA'S s�� TOWN OF BARNSTABLE Building Permit Application Pro] reet Add r ss Village Owner Address Telephone — a Permit Request 6 x 1:1?6 First Floor :90 / square feet Second Floor square feet Construction Type- eS 5Cc,/e 71,ej. e Estimated Project Cost $ 5�6610-V,61 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full f a<awl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existin New Half: Existing New �v `- No. of Bedrooms: Existing New Total Room Count(not including baths): Existing fa New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes [ No Fireplaces: Existing New Existing wood/coal stove ❑Yes o Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) [fNone Shed(size) �9 ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE DA ;—,2 6:-1 Za BUILDING PERMI DENIED FOR THE F WING REASON(S) 5��� � }( �- .. } �: � i -�J ik � I r WE O . The Town of Barnstable , suss. % Department of Health Safety and Environmental Services ram? `` P Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only 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. Est.Cost 471?J Type of Work•. �7Z: lea of Work• Owner's Name l- q Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under S1,000. ing not owner-occupied Owner pulling own permit Notice is hereby given that:OWNERS PULLING THEIR OWN PERMIT OR _ROVEMENTG WITH WORK DOREGISTERED NOT HAVE CONTRACTORS FOR APPLICABLE HOME � ACCESS TO THIN 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. OR ---_ nVVnVVC Name The Commonwealth oflVassachuse& fry Department of Industrial Accidents _ e�iceo�/ esagalirens _ 600 Washington Street Boston,Mass 02111 Workers'Compensation Insurance Affidavit nte: t�i� f A/ -5 10 nieowner perfotmina all work myself. e proprietor and have no one working in any capacity ❑ I am an employer providing workers'cotnpensatian for my employees working on this job. Qmpany n tit : . . . . . . : . . . Bone# insuranee olfe '# ❑ i am a sole proprietor,general contractor,or homeowner(ein:le one)and have hired the contractors listed below who have the following workers' compensation polices: rarnnnnv addlrscs:. .. cilia bheitc# lIIsurSrice co. '' •policy#.. .. jPjnI)3nx name: -- nMiorie•th Jn.jurarlcr,c0. J�AIiCiY>!1' F'eilure to secure coverage as required tinder Section 15A of NGi.152 tan lead to the Imposition of ct•iatin4l ptnaltics*[a fine up to$1,500.00 andlor one years'imprisonment as well as civil penaltiq in the furm of a STOP WORK ORDER and a tine 01`5100.00 a day against Me. I understand 1114E a copy or this statement may be forwarded to the UlSoe of Investigations Of Ibe DJA For coverage verification. I do/Earthy ccrriJy dtr the pmns au penalties ofperjary that tAe iitforew ion providrd about is erur and corma. Signature ! 6 '.� — / �A a Print numc_L7 15 ; hone It nfticial use only do not waste in this area to be completed by city or town otficiel city or town; permitAiccasc# Building Ocpartaten! �I,ietnaiaR Bnard 17 check if immediate response is required QSeleetiatn's Office QHealfh Dtparimrnt can tact person; phone+y; nOther (revisca iroi PlAt • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. ., DATE 0. 02 s JOB LOCATION "?/ C / Number treet address S tion of town „ OMEOWNER" �o / Name or Home phone( Work phone PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Stat Building Code and other applicable codes, by-laws, 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 compl 'with said procedures and requirements. HOMEOWNER'S SIGNATURE v APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER' S EXEMPTION The code state that: "Any Home Owner performing work for which a . bui-lding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if a Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home 'bwner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her / er responsibilities, bil communities require, as P hies, man q part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of 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. i It - • � r • ►' � fir. � 1; �v � . . �. I ,`f►� ) f ^fir• - • , • �1 �� �� '(.. � 43 V�j c� V.. r rr r V � vi ti � rt t � � t4 011u 10 �41�11CN l FEE r ccTOWN OF BARNSTABLE, MASS. a M 0� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO 0 ., _............................................................................................_.....:.—.......--- ..........._..._.................. ............._..............................._......_.._...._..........._.._...... _._..... O � (PROPERTY OWNER) � (ADDRESS) .yyy spp+a To ........................................:...............................................:._.........................__` ._.__............................................................................................................................_... ._ (BUILD) / (ALTER) (REPAIR) \ A ad age )TYPE OF BUILDIN6)y (APPROXIMATE SIZE) O ^w /// 1 ° ............................................_._.................__ . eo" p LOCATION ......_......_._......._......_.__.._......_. .......................... 1 _ � (STREET c NUMBER) � (VILLAGE) �J\ NAME OF BUILDER OR CONTRACTOR ......_............__. m(Do APPROXIMATE COST — C I HEREBY AGRE�ONF R TO ALL THE RULES AND REGULATIONS OF THE TOWN d OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. omvA �A tV (OWNER) (CONTRACTOR) V a° O� r BUILDING INSPECTOR Subject to Approval of Board of Health. �� � � �"`� � -� �'. 0. a ox Sewage Permit number 7 Zf 11 If TABLE | TOWN - �� �- � - . � � ~ � . MU& BUILDING ; � 0N � � �� N �� ; INSPECTOR ��0N N N_0N N ���� �� �� � ���� � �� �� � . � �' �� ' APPLICATION FOR PERMIT -�� /-..='------'--------------'----------,- TYPE OF CONSTRUCTION -.,-.`211. .<....------------.--.----.--------------.. ` __.... ...............................--------- .--. / TO THE INSPECTOR OF BUILDINGS: � The undersigned hereby applies for o permit according to the following information: Location ................................................. /� .. --------.---------__________ � c� Proposed Use °����������!!�--------------..------'-' '' '- - --------'--------' Zoning District ........... --.-------------..Fioa District - ........................................... � �� | Name of Ovvno, .��c��..�.z����.��.�.�����--------.*ud,ex ^.~-.x�.����.-«��s�����'�-..--v^�� ---- � Nome of Builder ...^ ^�- . . .�~�----A66,eo -------.. ......................................................... � . Nome of Architect ------.~-----._----------.A66reu ---------------~------------ Number of Rooms ---.^`I-5 ---------------'Foun6oho» . .. ........................................... � Ex/e,ior -. ��-----------RuoGng ....... ................. ---------- Floors ..C?,o ��������_------------------.|nh��r ' ---______. � Heating ......... � ./. -------------.Plumbing -----.�-. -------------.. �"/�. Fireplace ---. �-�/--------------------'Approximo�e Coo .���..---- Definitive Plan Approved by Planning Board --------------- _------------l9--------' Area ......... )�� Lot of � and Building with Dimensions Fee ____..r=�.�7_---�-~- -' SUBJECT TO APPROVAL OF BOARD OF HEALTH / ;7 Z t7b /*o ( , �» | . | \ � " --- 0 /- ��- �� -- � � _�»\& - | hereby agree to conform to all 'the Rules and Regulations of the Town of 8ornxhz6le regarding the above � construction. ' _ ........... �. .......................... � Hudson, K. E. No .... 9 9„ 1/2 story 16..8 Permit for 1 .............. ... , ..........single family dwelling Location Ri��le Cove Road L � �� ............................................ .....................HY.anrus.......................................... I Owner ......... t..E....Hudson.............................. Type of Construction ........... rWM®.................... Plot .................................Lot ..........#46.. ............... f Permit Granted ..........per" 1 ....19 7 � f Date of Inspection .19 Date Completed PERMIT REFUSED r 6 ................................................................ 19 .................................... ....................................... , ........................................,...................................... ...................... .................................................... f f ........................:....................................I................. a Approved ................................................ 19 ............................................................................... '. ..................... ..................................... ................ - !