HomeMy WebLinkAbout0042 SAINT JOSEPH STREET Josey6 ST
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map I Parcel` ;Application #C201Z I
Health Division "Date Issued b C v
Conservation Division Application Fee
Plannin 9 De t. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/Hyannis
Project Street Address y� �14 J05ea k si- t
Village �4&1711 S
Owner �,eAf'ell &Ae-bO Address f
Telephone
nd .
Permit Request 1 ►'l ba5 e-m e yl
Square feet: 1 st floor: existing35prop sed 2nd floor: existing proposed Total new
Zoning District H aeAACS Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size 0500 Nc�f . Q!Acres Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family°.Url Two Family ❑ Multi-Family (# units)
Age of Existing Structure 1`�"1 Historic House: ❑Yes i3 No On Old King's Highway: ❑Yes U No
Basement Type: '® Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ti4-1
�50
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: o� existing new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: M Gas ❑ Oil ❑ Electric ❑Other
Central Air: ❑Yes Fireplaces: Existing New Existing wood/coal stove: ❑Yes ZNo
Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ] ng size_
• Attached garage: ❑ existing ❑ new size _Shed: ®'existing ❑ new size — Other: C-) z
-n
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ cn
Commercial ❑Yes ❑ No If yes, site plan review# 3
►-' . I>
Current Use Proposed Use c a
C M
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) -- -
Name &e(mn Tele hone Number '7-7 J986 ��o �
�/ c 11 p
Address 7V �10+ )ioSeoM- - (S License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE - DATE f0A llz9
FOR OFFICIAL USE ONLY
APPLICATION#
r .DATE ISSUED
Y %PARCEL NO.MAR ,
P
t
ADDRESS VILLAGE
OWNER
E
; t
f
.,t
DATE OF INSPECTION:
's
FRAME
1 U+INSULATION jL'
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
�GAS"i- iF3.F:7' ROUGH ' mow G ; FINAL
I�
fFI.NAL,BU1LD.ING!I-L f 0-4ilA FUR
w DATE;CLOS,ED.OUT . :
ASSOCIATION PLAN NO.
}
4 -
*. ° ;M Th.e`Com nonwealth of Massachusetts°
Department of industrialAccidenIs
office of Investigations
600 Washington Street .
t Boston,MA 02111
sy www.mrzss:gov/dia
Workers' Compensation Insurane.e Affidavit: Builders/C.ontr.acto;rs/Electricians/Plu rrlbers
- Please Print'Le ibY
Applicant Information'
Name (Business/Organization/Individual): -Teen a(Ao
Address:
City/State/Zip: H 1111�5 d2-Ca�� Phone #`. ��y'.
=�35-7
Ct
Are you an employer?-Check the appropriate box: Type of project (required):
1.0 z a employer with 4• ❑ I am_a general contractor and I5. New construction
oyees-(full and/or part,tune).* have'hired the sub-contractors.. _ -_ __-.
2.❑ I am'a sole proprietor.or.,partner
listed on the attached sheet. 7. E Remodeling
ship and have no ,employees These sub-contractors have g,� Demolition
employees and have workers'
working for me in any capacity. 9. [] Building addition
No workers' comp. insurance comp. insurance.
/1 equired.]
5. We are a corporation and its 10.❑ Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 1 1.❑ 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
ernp)oyees. [No workers' ]3. Other
comp. insurance required.]
4fLny applicant that cheers box#1 must also fill out the sceLion below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work ac
and Lhcn hire outside contrtors must submil a new affidavit indicating such.
tContractors that check this box must attached an additions)sheet showing the name of[tic sub-contractors and state whcthcr or not.thosc•entities have
employees. If thc'sub-contractors have employers,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 ,
Insurance Company Name:
Policy# or Self.-ins:tic, #: Expiration Date:
Job.Site Address: City/State/Zip:
Attach a copy of the workers' comperisa.tion policy declaration page (showing the policy number arid expiration date).
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy,of this statement maybe forwarded to the Office of
Investigations of the DLk for.insurance coverage verification:
I do hereby ce We, he pains and penalties ofperjury that the information provided eve t trite and correef.
Si gnature:
Phone'#: .
Official use,on/y. Do not write in this area, to be completed by city or town official,
City or Town.-
Issuing FermitlLicense #
Authority (circle one):
1. Board of Health Z. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
b..Other
Contact Person: Phone #:
Information and fnstructzons
Massachusetts Gcneral Laws chapter 152 requires all employers to provide workers' compc•nsalion for thcif cTnA0yecs.
Pursuant to this statute, an einployee is dcfincd as "...every person in the scrv;cc of another under any contract of hirc,
express or implied, oral or written."
An employer is defined as "an individual, partnership, assoualion, corporation or other lcga) entity, or any two or Marc
of the foregoing cogaged in a joint cnfeipnse, and including the legal represenlat ves of a dcccased employer, or the
receiver or trustee of aD individual, partnership, association or other legal entity employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant l the
dwelling house of another who employs persons to do mainicnancc, constniclion or repair work on such dwelling house
or on the grounds or building appurtenant,(hereto shall not because of such employment be deemed to be an employer,'
MGL chapter 152, §25C(6) also slates that "every state or local licensing agency shall lvithl)old the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant JYho has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the conunonwea)th nor any of its political subdiv,sions shall
cntefinto any contract for theperformance ofpub)ic-work until aec'eplable evidence ofcompliaocc with the ins
�uanec
requirements of this ehapterhave been presentcd to the contracting authority."
Applicants
Please fill out.the workers' compensation affidavit completely, by checking the boxes that apply to your sitt�alion and, if
necessary, supply sub-contractors) narne(s), addresses)and phone numbers)along with their certificates) of
insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than flit
members orpartners, are not required to carry workers' compensation insurance. lfan LLC or LLP does have
employees, e policy is required. Be advised that this affidavil may be submitted to the Deparimcni of lodustn'a)
Accidents for confirmation of insurance coverage. Also be sure to sign and date th•e affidavit, The affidav)i should
be returned to the city or town thai•the application for thopennit or license is being requested,not theDepartmen( of
Industrial Accidents. Shou]d you have any questions regarding the law or if you.are required to obtain e,workers'
compensation policy,please call the Department at the number listed beloW, Self�nsiued companies should enter their
self-insurance license number on the appropriate line.
City or Tovrn Officials
Please be sure that the affidavit is complete andprintcd legibly, The Deparimeni has provided a space M the bottom
of the a daYil for you to fill out in the event the Office ofInvestigations has to contact you regarding (he applicant.
Please be sure to fill in the permi0Jiccnsenumber which will be used as a,refcrencc number. J�addition an applicant
enthat must submit multiple permiUlicense applications in any given year, need only submit one afLdavi es(indic ting (c)ty or
policy information()if necessary)abd under"Job Site Address" the applicanl should write "all loc�ibon rovide d Co the
town),"'A copy of the affidavit that has been officially stamped or marked by the city or town may p
applicanl as proof that a valid a$idavit is on file for future permits or licenses. A new affidavit^;{rust be filled ou l each
year. Where a home Dwner or eitizcn is obtaining a license orpermil not relaicd to any businessor commercia enture'
l v
(i.c, a dog liccnsc or per to burn ]caves etc) said person is NOT required to complete this aEdavit.
d should shave any questions,
The Office of Investigations war 1 e o -JDt7Uo rradven
�raHnn an
please do not bcsitale to give us a call.
The Departmcnt's•address, tclephonc and fax number:
The.Co=onwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. 617-727-4900 exl 406 or 1-877-MASSAFE
Fax # 617-727-77.49
Revised 4-24-07 www.mass.gov/dia
l
I
Town of Barnstable
of rtiF r
ti
o Regulatory Services
Thomas F. Geiler, Director
165p. ,� BaUding Division
PrEO µA't r'
Tom Perry, Building Commissioner
200 Main Sf�eet_Hyannis MA.02601
°RwSv.tot�n.barnstable_ma.us
Office: 508-862-403 8 Fax: 508-790-6230
FIOTIEOWNER LICENSE EXEMPTION.
/ - Plcast 1'rin[
DATE:
JOB LOCATION: �f2, S- 411-4 YG"i,
cnumbcr street v liagc
"HOMEOWNER": VJQ�I �,rbd So8"��� 6C>
name i home phone# work phone# -
CURRENT MAILING ADDRESS:
city/town. state ap cndc
T11e current exemption for"homeowners"was extended to include owner-occupied dwellings of six twits 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_ .
DEFIRMON OF HOMED 7\'ER
Person(s) wbo 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 sizuctures accessory to such use and/or faun structures. A
person who constrt{cts more than one home in a two-year period shall not be considered a bomeowner. Such
"homeowner"shall submit to the Building.Ofbcial.on a form acceptable to the Building Official, that belshe shall be
responsible for all such work performed under the building permit. (Section 100.1.1)
The undersigned "hDMr_0VrDr,f assumcs"responsibility for compliance with the State Building Code and other
applicable codes, bylaws, rules and regulations.
The undersigned "homeowm-r"certifies that.beJshc understands the Town of Barnstable Building Department
minima., ' on procedures and requirements and that he/sbe will comply with said procedures and
rc .
Signature of Homcowna ,
Approval of Building Official. y
Note: Thrce-family dwellings containing 3S,000 cubic feet or larger will be required to corrrply with the
State Building Code Section:127.0 Constr-trctibn Control.
+ HOMEOWNER'S EXEMPTION
.Tbc Code states that: "Any homeowner performing work for which a building permit is rcquir�d shall be cxcrnpt from the provisions
of this scction•(Sccdcrn )09.).1 -Licensingofc_cnstmction Supervisors);provided that if nc�homcovmer engages a poson(s)far bin:to do,such
viork, that such HoMc,Dwncr shall act as svpervisor."
Many homeowners who use this exemption arc unawzm that thcy.an:assuming ncc responsibilities of a supervisor(sec Apprndiz Q,
Ry)cs&R�gv)ations for Licensing Cogstniction Supervisors,Section'2.15) This lack of awarcncss often results in serious problcrtu,particularly
when the homeowner.hires unlicatscd persons- In this case;our Board cannot proceed against the un)ieensed person as it would with a licarnsed
Supervisor. The homeowner acting as Supervisor is ultimately respons-ib)c. +
To ensure thal the homeowner is M)y aware of hisAcT rrsponib0itics, many communities require, as part of the permit application.,
that the homcovmer certify that hdshe understands the responnbi)itics of a Supervisor. Oa the last page of this.issue is a form curr=by used by
several towns. You may cart t amend and adopt such a formlccrtificztion for use in your cormmunity.
Q:for7T-Ls:homceacMp1
Tt*rr- � Town of Barnstable
0
Regulatory Services
7.ARXbT.IHL.�
Thomas F. Geiler,Director
Eon Building Divisiou
Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town_barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
Property O�wrier Must .
Complete and Sign This Section
If Using A Builder
I, , as Own of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this buildi g ermit application for.
ss of Job)
5ignatv.re of Owner Date
Priat NuTif
If Property Owner is appl 'ng for pe=*t please complete. the
Homeownen License Exemption Form on the reverse side,
Q:F0RMS:0 WNERPERMiSS)ON
ti
71 Ul o S
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C s i
LA
3 � P`
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r Town of Barnstable *Permit# . �000G1
Expires 6 months from issue date
Regulatory Services Fee
v�Al�asiE Thomas F.Geiler,Director
A 2008 Building Division �.
Tom Perry,CBO, Building Commissioner
SARNSTAB 200 Main Street,Hyannis,MA 02601
L� www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 07
Property Address q2 %3 ,`n 4 Jos r 1 St
Residential Value of Work'$�R_,000 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address D �Wrl �b0
Contractor's Name Si-�n se-v-b(-3 Telephone Number 7-7`f-836-,;Z,39-
Home Improvement Contractor License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
91 am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company.Name ,
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) r( . f(
dRe-roof(stripping old shingles) All construction debris will be taken to OeM,�S 1i'wvJ &I-
❑Re-roof(not stripping. Going over existing layers of roof)
MRe-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)
*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 is required.
SIGNATURE: .
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revise020108
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): S�"- ,-)
Address: L12 641-4 Tos-<D�
City/State/Zip: cG4,i5 MIJ, ®2.&O ( Phone.#: 7 7`l _V6 — 239? -
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
.2.❑ I am a sole proprietor or:parhier- listed on the attached sheet. .7. .❑Remodeling
ship and have no employees These sub-contractors have g•, ❑Demolition _
rkin for me in an capacity. employees and have workers'
g y p t3'• $ 9. ❑Building addition
o workers'comp.'insurance comp.insurance.
5. We are a corporation and its 10.❑Electrical repairs or additions
required.] ❑_
3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we,have no
employees. [No workers' 13.❑ Other
comp.insurance required.]. .
*Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$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
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 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy'of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi n er pains and penalties of perjury that the information provided above is true and correct
Si ature: Date:
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 Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees.
Pursuant to this statute,an employee is defined as"...every person in.the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
g g. . J rP .
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
ther who employs p to s persons to do maintenance construction or repair work on such dwelling house
dwelling house.of ano p P
g
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking,the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _(city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the"
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person,is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-977-MASSAFE
Fax#617-727-7749
Revised 11-22-06
www.mass.gov/dia
Town of Barnstable
�oF1HE
Regulatory Services
t BARNSfABLE Thomas F.Geiler,Director
y MAss. g
i6.59• Building Division
rFD .�s Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
p Please Print
DATE:
JOB LOCATION:
��n++umber L street p �/�pvillage
"HOMEOWNER':V�%1 (V O 7 6 CJ�Fa D �7./ 03fio'�3�
name home phone# work phone#
CURRENT MAILING ADDRESS:
1_0 oa6o 1
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 cr 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)
a
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
requ'
Signature of Homeowner F
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 fora-L/certification for use in your community.
Q:for ns:homeexempt
n/
°Ftra,, Town of Barnstable
Regulatory Services
yQB''RNSTABM
MASS. Thomas F.Geiler,Director
rE1639.I16, 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
Property Owner Must
Complete and Sign This Section
' If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
Signature of Owner Date -
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORM&O W N E RP E RM IS S ION
Town of Barnstable
r� CF THE 1p� '
P� do Regulatory Services
+ + Thomas F.Geiler,DirectorBARNSTABM
s _
9� 6 yes Building Division
j°rEn tr►A'�° Tom Perry,Building Commissionervu,�
200 Main Street, Hyannis,MA 02601 ,
www,town.barnstable.ma.us
24
Office: 508-862-4038 �`'r �51� '-�— Fax`508-790-623(
PERMIT# OtU� 701 FEE: $ �
SHED REGISTRATION
120 square feet or less
Location of shed(address) y Village
12v�n ��p SD Sr` `7—7 S— 0 y Z�
Property owner's name Telephone number
Size of Shed Map/Parcel
194QS/0
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
]PLOT PLAIT
Q-forms-shedreg _ V
REV:042506
C.
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291243
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NOTE:PARCEL LINES N1AV NOT BE ACCURATE. The DISCLAIMER:This map is for planning purposes only. It d i
parcel lines on this map are only graphic representations of may not be adequate for legal boundary determination or ( 0 5 10 20 Feet
Assessor's tar parcels. They are not true property regulatory interpretation.This map does not represent an X ;
boundaries and do not represent accurate relationships to on-the-ground survey.
physical objects on the map such as building locations.
1 inch equals 20 feet
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t yOFTHETo�a TOWN OF B ARNSTA.BLE ---
i BA NSTADLE,NAB i
o �a�e�� BUILDING . INSPECTOR
APPLICATION FOR PERMIT TO �.... f�........ .......... ....
TYPE OF CONSTRUCTION :.. . X .....�LR._1.�.............................................
...............................
)..................19A
TO THE INSPECTOR OF BUILDINGS:
The undeZZ.k
hereby applies for a permit according.to the following information:
Location . .....�1 :...... .... .. . ... �6 ................................................................................................
Proposed Use ....�Z), .... .....,� ... . )................... ...
��tititi .
Zoning District .Zf dl�.............................................Fire District ... ,
Name of Owner ... ......./..................Address .. >> �.�°��l ......
l
Name of Builder .......1. ...Address ......:...�. /.......................................................................
Nameof Architect ...... .........................I ...........................Address ......... .........................1. .........................�.�.............
Number of Rooms ...... ... Q..q'l..................................Foundation ...�.../( .........................................
Exterior ... �� ....:. .............................................Roofing ......
/ �. ... ...................................................
Floors �f ®�a
..... . . ... .. Interior ...:.. ...0. o..............................................
Heating ....(,CJ........ .�.. ................................................Plumbing .......! ..V..................................................................
/ �( �. orz Fireplace ...../C...........................................................................Approximate Cost ..... Od...............................................
Definitive Plan Approved by Planning Board ---------------_---------------19--------. �!
Diagram of Lot and Building with Dimensions / LS
SUBJECT TO APPROVAL OF BOARD OF HEALTH
N
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I hereby agree to conform to all t Rules and-Regulation's of the Town of Barnstable regarding the above
construction.
Name .......... G .C .......
Drouin Corp.
15936 one sry
No ................. Permit for. .....................to...............
single fa#ly dwelling
...............................................................................
St. Joseph St.
.............N��nrds
.............. ......0........................ ...........
1.
Owner ......... ....Droui ..Corp'...
.............. .... . .......................
Type of Construction ..................frame...............
................................................................................
Plot ............................ Lot ......... ................
February 27 73
Permit Granted' ......................................—19
Date of Inspection ............... ........ ............19
Date Completed ..... ......19
MGM
PERMIT REFUSED-
................................................................. 19
.�.......................................0.....................0.................
ISO
................................................................................
. ...............................................................................
................................................................................
Approved ................................................. 19
...............................................................................
.............................................o.................................
oFtME t� Town of Barnstable *Permit#
Expire.4 6monthsfrom issue date
�SZAB� Regulatory Re ulator Services
.
v MAN'
1639•. Thomas F.Geiler,Director
��
RFD N1°'`a Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 -
Fax: 508-790-6230
EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number �� C
Property Address
esidential Value of Work
Owner's Name&Address P*q 19
Contract zis Name L' BG �� � 'ur'`"` °"" Telephone Number
Cn
Home Improvement Contr for License#(if applicable)
���
r� Q
Construction Supgvisor's License#(if applicable)
E�Wo,kmin's Compensation Insurance '
Check 6 e:
0 I ai a sole proprietor
I aathe Homeowner
E]A'have Worker's Compensation Insurance
r
Insurance Company NameJ` "
Workman's Comp.Policy# �WC Mq 3 3O
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
V-siplacement Windows. U-Value �3' (maximum.44)
❑ Other(specify)
"Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature L
Q:Forms:expmtrg
Revised121901
A JUL7-15-2004 THU 12: 23 PM P. 001/001
,
RRG: The B11-BBY Group
Fax Transmittal Data. .Report
All Salesmen faxing their Work to the corporate office, must complete this form and send it Ong
with all required paperwork. r�
. _
tat,
Tb: .
Prom:
Customer Inform ion:
Applicant's Name 1 U
Address `S
City, State, Zip n
Home Phone # 9 - V 7Q- Business Phone # ( ) -
Mmanced Transactions:
Approved by Sears: Account #
Approval Code #
Date of Approval
Defement: Yes No
Def'amrnt Date
Cash Transactions:
Amount of Sale $
Amount of Deposit $
Verified Receipt of Deposit
Paper`' ol, Cheddist: Be sure you check off the following conip)eied fomts:
Convact Specification Sheet NYU-CCT Application
pricing S eel
SearsCharge Slip Drawing Sheet(s)
VIP Ap)lications Any Miscellaneous Docult7eMs
Y
Is this a VIP Applicatio).)/Customer Yes No
'JUL7.15-2004 THU 12: 24 PM P. 001/001
SEARS, YW�NDOW CONTRACT Maine
Ne.DD1899
NM LJo.No.
BERVIOES tL MATERIAL PROVIDED - , Meaeechuseas uo•No.120456
Vermont Uc.No.
Home Services BII-Ray Aluminum Siding Corp. Rhode Island Uc.No.13707
New York City Department of
Boston.800-SEARS-31 of Queens, Inc. Consumer Affairs uc.No.0730888
Hertford Areal BOO-SEARS-99 A Sears Authorized Contractor Yonkers 1397-Putnam P0934
Providence Area,888-SEARS51 F.I.D.No.11-23304e9 Westcneatar WC0819-He7
Hampshire:600-829-2375 Connecticut Department of
New Ham
p 190 Cedar Hill Road, Marlboro, MA 01752 consumer Affairs uc.No.00532770
JOB#_ v � Service/Repairs: 1-888-245-7294, NE
TO
O I�AYt>704_b S 1 L0I, pc DATE
'/ cc--�-� pp O
ADDRE88 4 02 I Ez `7,Sf Ny iez CITY F�i AV.)IS STATE IP o z 4 o
PHONE Nome(SdQ '�,2V 67ros WORK( ) EMAIL
v(� JOB SRE ADDRESS(IF DIFFERENT)
APPLI190 VINYL WINDOW SYS'Y112MS /
General Description of Work at Above Address) Approx Start Date 9 d 5`
Type of House Frame ❑Masonry Approx Completion Date F A
(WOTHU A40 MATERIALS PEnmirnNo)
SPEOIFIOATIONS
Saar,approved materials will be finished and Inatelled to these spsolfloatlons:
YES NO PLEASE READ CAREFULLY:ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER.
1,a H Remove wlndowe from opening where Hey ow etdst on:
2. FIRST LEVEL #Openings #New Window Units
S. ❑ SECOND LEVEL #Openings #New Window Units
4• ❑ 79 THIRD LEVEL #Openings #New Window Unite
S. ❑ BASEMENT #Openings #Now Window Units
B. ❑ Ir OTHER #Openings N New Window Until
7. C1 Removal of Metal or other units requiring modified Installation #Openings 11 of Units
6. ❑ 9 Install new palntable Mouldings Inside Slope IY of Openings Clamshell or Caging#of Openings
11. ❑ 2' Install now Master Frame#of Openings
in. ❑ New window units to have double sb'ength Insulated lase 7/6'total thickness
11 ❑ New window unite to have fusion welded sash# Y
12, ❑ New window units to have fusion welded(reme#�
13• C3 New window units to have complete Energy Pockagege cog of: 913A.)) Low E Argon filled Insulated glees #of Unite
13131 Low E Krypton/Argon Insulated glass with in)eclatl foam Insulated frames 8 sashes #of Units
14. ❑ New window units to have Cam Lock(s) or Latch Lock(,)
I8. New window unite to have NlohWsnt Latches
19. New window units to have Obscured Glass# Hall Full
17. New window unite W have half(1/2)acreen uii screen on casementrype wlpdoT-
1 B. Install PVC coated aluminum to window frames Color w 14,TE #of Openings
to. Caulk and seal windows with 3 point system
20• Remove and dispose of a I windows and/or storm windows
21. 1 Color of windows to be Timbenone Sandtone (Full Energy Package Not Available)
22,(3 :B� windows to have Odds 15ronlal Diamond O FOIL ❑ 1/2
Additional Imo
23JOr ❑ Total#of Double Hungs Total#of Hoppers
Total#of CeeeMarla
Total#of Awnings
Total#of Two Ute SI are Total#01 Throe Lite sliders Sld._or Equal
Tbtll#of Dead Lite/Pictures Total#of Basement Slldere
24.❑ 0 Special Orderwlndows(InAddlGDninAbove)
26.8r C) Clean up.As job related dabda will be removed from properly on completion of work
26•5� 0 Insuranoe-All workman,compensodon and liability Is malmalned All 0lecounre Have Been Applied.
27.1W ❑ Warranty-Mailed to customer upon completion and full payment Is received W500d 1`2rme,4,main will Acade•
26.❑ ar- Payments-(On nominanced orders)i&payable to Installer on day of Installation gap
29.'� ❑ All Discount&nave been applied
Cash Total$ _ Less depeelt 25% Balance Measure 1/2
O CASH K FINANCED$ does not Include Interest Complet)on 1/2
11 financed,balance payable In ALI.LU monthly installmente of approximately$ -�per month,payable by'Owner'to contractor,
but If financed by Owner man Owner will pay said amount to the lending IA1111 fen plus such Interest and CGred t slervlce charge of sale lending metitutldn payable dlrany
to the lending Institution loaning ouch monlas to-Owner and will execute a Retail Installment obligation and any documents required by such lending Inatitodon In
connection vnlh said loan.
SO.❑ eff Addldonal Information
31.M Work Not to Be Done
.,CONTRACTOR IS NOT RESPONSIBLE POP ANY t°xISTINQ 9ECURIT($Vs EI l§-"PL6A2—A0Mi7vt•AL SHADES,VERTICALS,
BLINDS,tURTAINS,DRAPES-OR WIND'OVy MOUt�TEQ AIR`CONDITIONRIIS;'klbI�`TO tiili;W )f'QLLATION OF YOUR.NEW
WINDOVIE:INEiTALLER6 ARE NOT RESPONS,IBLE.FCR THE REMOVAL OR-INSTALLATION OFICH96e TYPES IT
EMS.
TEMS.
Notice:If financed,any holder of this Consumer Credit Contract Is CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A WARRANTY
sub act to all claims and defenses which the debtor could assert PROBLEM.
aGa nst the seller of goods or services obtained pursuant hereto or
with the proceeds hereof. Recovery by the debtor shall not exceed BALESMAN HAS NO AUTHORITY TO CHANGE ANY ITEMS OR MAKE ANY
amounts paid by debtor hereunder. REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND
"OWNER"REPRESENTS THAT NONE HAVE BEEN MADE TO OR RELIED
"OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLICATE UPON BY"OWNER".YOU ARE ENTITLED TO A COMPLETELY FILLED IN
ORIGINAL OFTHIS AGREEMENT AND TO BETHE AUTHORIZED AGENT DUPLICATE ORIGINAL OF THIS AGREEMENT.
OF ALL"OWNEAS" OF THIS PROPERTY UPON WHICH THE WORK
OR THE MATERIALS ARE TO BE SUPPLIED. NOTICE TO THE HOME "YOU,THE BUYER MAY CANCEL THIS TRANSACTION AT ANY
_ OWNER(S),GUARANTOR(S),LESSEE($),CO-SIGNER(S)." TIME PRIOR TGNINIGHT WTHE.THIRD BUSINESS 13AY_AFTERTHE DATE OF TRANSACTION. SEE - --
�! OF
Contractor,at the expense of owner,shall procure ell permits required by law. CANCELLATIONHIS FORM FOR AN EXPLANAT ONCHE OFTH S TICE RIGHT.
1. Do not sign this agreement before you read It or If it contains any ON ALL ORDERS CANCELED AFTER THE RECESSION
blank spaces or If It does not contain everything agreed upon. PERIOD, CUSTOMERS WILL BE RESPONSIBLE FOR A 45%
2.'Any person who shall have ca-signed,guaranteed or signed any credit ADMINISTRATIVE AND RESTOCKING FEE."
applloation or note relating to this agreement hereby accepts to be
bound by Ibis agreement. SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS,
S. Owner(a)represents that the contents on the back of this agreement
Is a true part hereof and has been read and accepted by Owner.
k 4. ALL INSTALLATION LABOR GUARANTEED 1(ONE)YEAR. DATE 9Zl
Print A
Salesmen's Names a /+O t.-rq-.�D signature i
selemen`e
UomnasNo '4 0 �S Signature
REV 3/o3
Xe 16
M-TolBui ding Regula ions and Standards
One Ashburton Place - Room 1301
-a� .Boston. Massachusetts 02108'
Home Improvemeilt,Dptractor Registration
Registration: 120456
' Type: Supplement Card
i.. Expiration: 1/2/20D6
BIL-RAY ALUM. SIDING CORD
John O'Neil
40 ELMONT RD
ELMONT, NY 11003 k =7r
Update Address and return card.Mark reason for change.
Address Renewal Employment R Lost Card
✓fie�omamzooz�aeaf o�./�aaeaclurenlld <
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registrajtipn; 120456 One Ashburton Place Rm 1301
E 7rtion 112/2006
Boston,Ma.02108
Typg. pplement Card
-
BIL-RAYALUM. G-Gpl ? <<?
�...-1_. ,-.
John O'Neil
40 ELMONT RD
ELMONT, NY 11003 +�r Administrator' Not valid without signature
t