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0421 SCUDDER AVENUE
Town of Barnstable , "' T�+.. x .:i� w' :-. ='as... ", .r . & .: .. ` .' .: '�' ^ ,}.:� <y.. '; .; - N,, _ I BPuei 3 4 �i 9, .' Post This Card So That rt;is:Uisible From.the Street Approved.,Plans Must:be Retained on ioband thas�Card Must be Kept ,; Post?edUnti Finalwlrs ection Has'Been`Made.. .' u x ° ' ere. Certificate of Occu anc, =is Re u�red,usuch,Bu�ldm steal)Not be Occu iedaunt�l;a Finalz lns ,ecllon has been:made tg Permit NO. B-17-4156 Applicant Name: ENOS CONTRACTING Approvals Date Issued- 12/21/2017 Current Use: Structure Permit Type- Building-Addition/Alteration Residential Expiration Date: 06/21/2018 Foundation: Location: 421 SCUDDER AVENUE, HYANNIS Map/Lot 288-138 Zoning District: RF-.1 Sheathing: 11l -777 Owner on Record: FINNEY,SUZANNE P W ` Contractor Name` ENOS CONTRACTING Framing: 1 Address: 53 RIDGE ROAD Contractor°License�1ik073 2 WRENTHAM, MA 02093 , m Est Pro ect Cost: $ 18,000.00 u 1� Chimney: Description: Remove Front Porch-move window in Kitchen Install new flooring- Permit Fee: $ 141.80 Install new Cabinets Insulation: . rt Fee Paid,` $ 141.80 Project Review Req: REMODEL. REDUCTION OF FOOTPRINT " Date 12/21/2017 Final: 1y Plumbing/Gas 31 � � Rough_Plumbing:- x Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed�by�Yhis permit is commenced within six months after issuance. Rough Gas:'. All work authorized by this permit shall conform to the approved application a'nd the approved construction documentsfor which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and steuttbres shall be in compliance with the local zoning by laws a'nd codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public mspec' J6n for the entire duration of the work until the completion of the same. x fT � ;?p' Electrical mot, Service: The Certificate of Occupancy will not be issued until all applicable signatures by`the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:,, r ' Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth'in MGL c.142A). Fire Department Building plans are to be available on site . Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT [+�--� �� 4 ( HE tpy� �• 0 O �� Application Number....... -..,..1�.....�.�.�...l.l......... �a, C PP ........ * BARNSTAB +* �I ..................................... Permit Fee. Other Fee. ...................... 3a6jLL)1fV���* DEBT TotalFee sh...............�...: .. ................................... DEC o 4 Z017 TOWN OF BARNST-ABLE l �VIV LE Permit Approval by On.. z-1.U...�...... 17 BUILDING PERMIT B��NS I� �� ' . G APPLICATION Map..............1.. ...................Parcel...........1.5 .................... Section 1 — Owners Information and Project Location Project Address 421 SC v d d e w k ve Village Owners Name_ Vic- 12L, �� Z i P7 e Owners Legal Address—4 Z I �c Vd f/rc City_ C9 CAM Nr S Pd K' State Zip Owners Cell# E-mail wC od a Section 2 —Structural Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify Section 4—Detail d< Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number i -3#Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated: 11/7/2017 Section 5 - Work Description -e f°1?aP/Ne. men,, do C tl 4P o Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal &On Site Historic District [] Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: f' -7� I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use k e f Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/7/2017 } Massachusetts Department of Public Safety Board of Building Regulations,and Standards 1 License: CS-103146 Construction Supervisor , MITCHELL B ENOS,MITCHELL 5 ROBINWOOD RD BUZZARDS BAY MA 02532;h �� = Expiration: Commissio er 01105/2079 offica o Consurer Affairs Busmen Pi OME-IMPKOVEMENT CON- A FDAi�' %Re' Individual R rstiation E i e 180673 , rrtto 3 10'r0 a�? 1�8 Eros Con•,ac Wbh ll ' t UndQrJ�zi e�1 Registration valid for individual use only before the expiration date. if found'return to: Office of Consumer Affairs and Business Regulation 1A; afk Plaza S,Lite 5170 Bonin;MA 02116 — N t vaild vwlt iut sign al AC R® CERTIFICATE OF LIABILITY INSURANCE °ATE(MM/°°"""' `�I I 1 11/06117 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).. PRODUCER II NAME: 1 Kira Watkins T M Ryder Insurance Agency Inc ac°No Ext: 508-947-7600 aC No; 608-947-0400 8 Thatchers Row,PO Box 71E-MAIL Middleboro,MA 02346 ADDRESS: info@tmrydeccom INSURER(S)AFFORDING COVERAGE NAIC INSURERA: Norfolk$Dedham INSURED INSURER 8: Mitchell Enos DBA We Do That INSURER C: Remodeling/Donna Enos INSURER D: 5 Robinwood Rd Buzzards Bay,MA 02632 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD F MM/DD P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 —77 DAMAGE To RENT CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 51000 A R1785987A 10/15/17 10/15118 PERSONAL 8 ADV INJURY $ GEN'LAGGREGATE LIMRAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 EST LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 500,000 ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident A AUTOS ONLY X AS 91765329A 06/01/17 06/01/18 ( ) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ 500,000 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LWB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E:L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ ff yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ J. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) r a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Victoria Vezina - ACCORDANCE WITH THE POLICY PROVISIONS. 421 Scudder Ave I Hyannisport,MA 02647 AUTHORIZED REPR SE ATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORID name and logo are registered m rks of ACORD 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): M 1,4C Ar I l Address: S Rd b,,, wed�! c� City/State/Zip: v 2.z y` Phone#: f 7 6, 6 T -Z ' k 3 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 2WI am a sole proprietor or partner- listed on the attached sheet. 7. [remodeling ship and have no employees These sub-contractors have g, ®'Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers' comp. insurance comp._insurance.: required.] 5. ❑ We are a corporation and its . M❑Electrical repairs or additions 3.❑ I am a homeowner doing all work ' officers have exercised their 11.❑ Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. 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. l Insurance Company Name: !" O r_(U l Policy#or Self-ins.Lic.#: fl 17 Expiration Date: d p✓. It Job Site Address: "_f L J SC c4 dt,. 44-- City/State/Zip: t y a 4 y r S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains nd penalties of perjury that the information provided ab ve 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 ;I Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department,of Industrial.Accidents Office of Investigations 600 Washington.Street Boston,MA 0211.1 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia Section 9—Construction Supervisor Name Telephone Number (� /� 6( f 2 q 'j�,3 Address 6* City 4,n rr� State P7 Gt Zip 0 Z S 3 2. License Number ( A3 License Type_Expiration Date 0 1105 I T Contractors Email e d 6 i >'j v Ar Cell# 6--/7 ( % 2 q Y I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re aired by 780 CMR and the Town of Barnstable.Attach a copy of your license. C� Signature Date ( �� Section 10—Home Improvement Contractor Name A 1 4C 4 e ll l-H d„r Telephone Number Address S /?66%'A&6o; 12U City 04,22yr4r 65 State Zip 0 Z-5j 2_ Registration Number Z06 ?3 Expiration Date l O I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code., I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature�i2 L/L�- Date 2 / / 7 Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections andi documentation required by 780 CUR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date 11 j Print Name p� 0, Telephone Number 61 ? Z el k E-mail permit to: we do f'h el (,,j t C /'I Last updated: 11/7/2017 ��_: Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) El Historic-District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval Section 13 —Owner's Authorization as Owner of the subject property hereby authorize 1�h l� j'h(�S to act on my behalf, in all �t e �- matters relative to work authorized by this building permit application for: l S CvW V r- 11 v O 10L . E (Address of job) t / e of Owner date Prim ame l/ Last updated: 11/7/2017 I i oFt, , Town of Barnstable *Permit# Qy Expires 6 nrontl from issue date Regulatory Services Fee' o "� �--- v. BARNSTABLE. * - r� Mass Thomas F. Geiler,Director 1639. pTfD MP't A 'OPPRIS Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 �, �P� d ` www.town.barnstable.ma.us 010 Office: 508-862-4038. �p� 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number e-- Property Address ?.E(A Q/Residential Value of Work � ' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address W1.- ' Contractor's Name g-a 4/e C GYPS. !i( Telephone Number SA ' Home Improvement Contractor License#(if applicable) /'5 V-P 3 6 Construction Supervisor's License#(if applicable) ❑Workman's ompensation Insurance Che one: I am a sole proprietor ❑ I am 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 Request(check box) [ Re-roof(stripping old shingles) Ali construction debris will be taken to �/ T/}//1✓Q ❑ Re-roof(not stripping. Going over existing layers of roof) ❑. Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign-Property Owner Letter of Permission. L A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: G ' QAWPFILES\FORMS\build' permit forms\EXPRESS.doc Revised 090809 The Commonwealth oflVlassachusetts Department oflndustrialAccidents 1x "t-- 1' Office oflnvestigations . !' 600 Washington Street —' ' Boston MA 02111 - rr� rvyvm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): ,s'1 t i Address: City/State/Zip Phone #: j?1Z� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. 0 I am a general contractor and I �mploy`ees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction2.Lb l am a sole proprietor or partner- listed on the attached sheet. 7, ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P Y• 9. ❑ Building addition [No workers' comp. insurance comp.insurance.t required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof re airs . insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other, comp. insurance required.] *Any applicant that checks box fll 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. tContradtors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob 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 cert'A under the pains and Pena ties of perjury that the information provided above is true and correct. Signature: Date: Phone#' J F 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 S. 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 eniployee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house or on the grounds or building'appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone 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 permiUlicense number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you.have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia IL �He row Town of Barnstable y1(J T Regulatory°-,Services BAMSTABM v� ems. , :Thomas F. Geiler,Director 16.39. Building Division^ _TomTerry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstablexiaxs Office: 508=862-4038 Fax: 508-790-6230 t ij k• Property.Owner Must Complete and Sign This Section X If Using A Builder 77 I as Owner of the subject property hereby authorize .� / A �. to act on my behalf; in�all matters'relative to work authorized by this building permit application for. of 6b) P Slfn7ature of er Da e t Print Name a t If Prooedy_Q her is for pennitplease complete the Homeowners License Exemption Formi on the reverse side. Y OTORMS:OWNERPERIv1ISS]ON;" F Town of Barnstable Regulatory Services * Thomas F. Geiler,Director 11"NSrwsl,E, r 9� 1MASI9 ,�� Building Division olfDta Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bariastable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: d C / JOB LOCATION: number / street village •HOMEOWNER": name o� home phone# work phone# CURRENT MAILING ADDRESS: eW city/town state zrp 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, rp oyided that the owner acts as supervisor. . �.. .<...,..-:=rT1FFT�1 T7n*,.OF HOMEOOWNfst�„ ` - Person('sj who owns a parcel of land on which he/shr: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 3 "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. Sig tune 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 dQ 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 fom-Jcertification for use in your community. Q:\WPFILF-S\FORMS\homeexempLDOC 91te Boar o ui m e ula�`ons Ankanarg g �s� One Ashburton.Place - Room 130-1 C " Boston, Massachusetts 02108 Home Improvement:Contractor Registration ti Registrati6n: 154836 Type: DBA , iration: 4/10/2011 Tr# 284101 OLDE MILL REMODELING CO RONALD FREGEAU 50 RASPBERRY LANE MARSTONS MILL; MA 02648 Update Address and return card.Mark reason for change. Address Q Renewal El Employment Lost Card DPS-CAI 0 A0M-08(08-DSSUF0RMCA108212008 , • i . k v. Board'of BwldingRegnlahons and Standai ils Constructson Supervisor License '.� s License_CS 23665; g. x pp max. f . t < xp�rati6n t}E23/2010 T`# 22553 :. f � f :t RONALD C p.REGE3 { IS&TIMBER N MARSTOf�S_NItLLS,tiAA02648: Commis'sioaer x 1 - t OU 35,000 cf enetosed space . E lA Masonry only a s ka�1Qre to possess a cur;eirtedi% v the M1,ssac6usetS�a6Cuiicing oAte :. . tIs ause.fox revoeafYon of thwolicefise. r p d Property Location: 421 SCUDDER AVE MAP ID: 288/ ' 138/// Other ID: Bldg#: 1 Card 1 of 1 Print Date:04/08/1999 ;"a ement Description ommercia ata ements e ype RanchElement Description Model 1 Residential eat ade C C Frame Type UBM Baths/Plumbing tones 1 Story Occupancy 0 CeilingfWall ooms/Prtns 2 Exterior Wall 1 14 Wood Shingle /o Common Wall 2 Wall Height 0 Roof Structure 3 able/Hip 12 Roof Cover 3 sph/F GIs/Cmp I: 20 Interior Wall 1 3 Plastered 2 5 rywall ement Go de Description actor Interior Floor 1 14 Carpet Complex 2 Floor Adj Unit Location Heating Fuel 3 Gas eating Type 9 Typical Number of Units 2 C Type 1 None Number of Levels 14 %Ownership Bedrooms 3 3 Bedrooms Bathrooms 1 2 Bathrooms € 10 32 0 na Full .... :'' .. :< `` - I.Base Rate Total Rooms 5 Rooms Size Adj.Factor 1.09077 1 Grade(Q)Index 1.01 ath Type Adj.Base Rate 52.88 13 Kitchen Style Bldg.Value New 85,348 Year Built 1919 ff.Year Built 1980 rml Physcl Dep 17 uncnl Obslnc on Obslnc �v pecl.Cond.Code pecl Cond% code I Description Pergageiulu mge am. Overall%Cond. 83 eprec.Bldg Value 70,800 Code Description LIB Units Unit Price Yr. Dp Rt "IoCnd Apr. Value Fireplace , FGR2Garage-Avg L 528 20.00 1975 1 100 8,20 UAM Code Description Living Area ross Area Area net Cost n eprec. Value ers oor , , FOP Porch,Open,Finished 5 1 10.5 52 PTO Patio 41 4 5.3 2,22 UBM Basement,Unfinished 1,14 23 10.5 12,16 WDK Wood Deck 24 2 5.2 1,26 11ti. Gross Liv ease rea 1,301g a Property Location: 421 SCUDDER AVE MAP ID: 288/ 138/// Other ID: Bldg#: 1 Card 1 of 1 Print Date:04/08/1999 � . '.. . i IT "AM , ; r Description Code Appraised ValueAssessed l UNDLETT,PRISCILLA 801 O BOX 181 RESEDNTL 1010 73,30 73,30 ANNISPORT,MA 02647 SIDNTL 1010 8,20 8,20 BARNSTABLE,MA ,.." VITAr rIYATX ccount Tax Dist. 400 Land Ct# er.Prop. #SR VISION Life Estate DL I Notes: DL 2 T,,'t.j 1279209 , ;q r. Code Assessed Value r. O e I Assesseda ue rr. Code Assessed value -IV_wg 1010 > > 70( 1999 1010 73,30 199 1010 73,00 1999 1010 8,20 199 1010 8,20 ota. 12 7,-M, Total. ota. This signature ac now a ges a visit by aData Co ector or Assessor ARM ,,:yams Year lypelvescription Amount Code Description number Amount Comm.Int. Appraised Bldg.Value(Card) 70,800 Appraised XF(B)Value(Bldg) 2,500 Appraised OB(L)Value(Bldg) 8,200 ota. I Appraised Land Value(Bldg) 45,700 �', � .; Special Land Value ONLY-CONSLAB FY95 REMOVED CND Total Appraised Card Value 127,200 Total Appraised Parcel Value FACTOR. Valuation Method: 127,200 Cost/Market Valuation Net TotalAppraised arce a ue 127,200 r "VI WAW j '. ermit ID Issue Date lype Description Amount Insp.Date o Comp. ate omp. Comments Date urpose esu t B29026 3/1/86 AD 8,00 1/15/89 100 HP ADD'N 2/15/88 ME g p j. pecia acing �. nit rice an a ue Use Go deDescription one ronta e Depth Units nit ace actor actor otes- Single Fam , Total an nit �Wal Landa a , TNElp�o* f►� TOWN OF BARNSTABLE V i sARISTA n ! 6 q. MASSACHUSETTS 1 Solid Fuel Stove Permit Jq DATE OF APPLICATION .... ......................................... FtRE IYET'r. ISSUING PERMIT ............................................................ /� � NC,.R1................................................ NAME (owner)!%..... .`.Lr2 ........./...LvIU. �-. P.lr...... NAME (Installer) ✓......1./. ................... ADDRESS ADDRESS ...... .../...�V ................ STOVE TYPE �'��"�'"�� CHIMNEY NEW EXISTING v................. ........................................................................................... . ........................ ........................ Manufacturer ........... 1.(°rC�.r10 ........................................................ CHIMNEY: Masonry ................v...................................................................... p Mass. Approval ................�.�.�:.c.........1. ..7.J............................................... CHIMNEY: Metal ................................................................................................... This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed address in accordance with an application on file with the ..� c, •-........................ Fire Department, it. ....... ............. ....... and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. Issued By: ............ . ../.4........ ' ... ... .. ............................................................Title ........rr....................... ''�` �... Date �..l..l...... (� Permit to install expires 60 days after issue date Stove .................(": e.A .. .©.® ..... .~<% ... .....................................................................................:............................................................................................ Stove Clearance Floor .........................6- I .............................................................................................................................................................................................................................................. SmokePipe ................ ' .L ........W..... L.L............................................................................................................................................................................................................ SmokePipe Clearance .............. 8. ............................................................................................................................................................................................................................... Chimney ..... ............ r Y .................................................................................................................................................................................................................................................... SmokeDetector ........... .............................. ............................................................................................................................................................................................................. The undersigned hereby certi s tat the installation of solid fuel burning stove and equipment made under au- thority of permit dated ....... �...✓.... ��................ has been made in accordance with prov' onsKe/o °n1 \ �of Massachusetts State Building Code now currently m effect and pertammg thereto ............. ........../.�1� ���..... Installer Title ................................................ INSTALLATION APPROVED ` ( �� /�� By: ...................,,...,...........................: date WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR PINK: APPLICANT. +�. TOWN OF BARNSTABLE S RMSTABL MASSACHUSETTS U Solid Fuel Stove Permit DATE OF APPLICATION ...............�..Izmff.......................... T. ISSUING PERMIT ............................................................ NAME (owner) !:.M.G`Z. ..... NAME (Installer) ADDRESS SC u 1,��!�r........ ADDRESS -���p �- .. \ .. ........................................................................ STOVETYPE ........................ 1. ................................................. CHIMNEY: NEW ........................ EXISTING ........................ Manufacturer �4744' ; -- D de P"'- i:S....... CHIMNEY: Masonry .................................................. .. ................. ................................................... .......... ............................................ Mass. Approval ...........:................ f' ........7................................................... CHIMNEY: . Metal ...................................................................................:............... This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed address in accordance with an application on file with the ................................................................................................... Fire Department, and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. Issued By: Xe)e..!%A'I'�•� ......................................................Title �""'� �'�S Date .3����—� .if........ Permit to install expires 60 days after issue date Stove .....'4TL�t,cl ... D tte:... ! .,�' ..... w60 � Stove Clearance .......................... ..�.....................k ...................... GG/h Box/� Floor ............................................................................................................................................................................................................................................................................................................ Smoke Pipe ` ............................................ ............................................................................................................................................................................................................................................... SmokePipe Clearance ........................ram .... ........ .... ........: ...''''. ........................................................................................... Chimney ..................A& ............................................................................................................................................................................................ ............................ SmokeDetector ............................. ..5................................................................................................................................................................................................................................ The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au- thority of permit dated ...... / —�� prow' ions o o nwe......... .................... has been made in accordance with of Massachusetts State Building Code now currently in effect and pertaining thereto .......... ... <• . ..... .. . ....... Installer INSTALLATION APPROVED ... . �.�/ B,y:.... Title date WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT ... ... �, ;.rt.-.� 5..,. ' •�K,+,ar`'_—`�;? �5"�rv'!4,3i;'�''•`il� ta1r+v::p. .�.... ,�p:.yw;,yw'^�p,y°h4r'S.H .,+,+E.ii t ,�i:.....k � .. � w"S-Fr,: ..,. .,. s: o- .. Assessor's office(1st Floor): G Assessor's map and lot number 9 h f' 1 Qyas T�; Board of Health 3rd floor): Sewage Permit number r l! Z ID) LE i Engineering Department(3rd floor): NAB& House number /Y �✓ �"� °° '`639' Definitive Plan Approved by Planning Board / 19 a �Fq:rwA APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE J BUILDING INSPECTOR Aad APPLICATION FOR PERMIT TO eOA4.S7-a U 7- / `©L�/T"/d1 J-S �O /p�/.=Gr �' (3�f' 1 6—G' TYPE OF CONSTRUCTION /--;,2 4",4 4,- �/'} 19 lJ i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 41 2 / C y-P 2 C`1z 411.5, Awls P-�0✓c F— Proposed Use /s e--,- r/12 e- Zoning District Fire District j Name of Owner 1,e 11'14�'<. -- pp./sc i -A PviUP4 C''TrAddress -7 � I' /T/r.c.i/7�c�Tr�" !>f���`-� Address Name of Builder Name of Architect Address Number of Rooms Foundation L L oc,.FC Exterior avr� S/���G�vf Roofing ��✓��� li Floors l T. `' wev_5,1�r)t Pvu/z crrV Interior Heating d"'a� r��sac Plumbing f 2 t /U � Fireplace Approximate Cost r" 'Area Diagram of Lot and Building with Dimensions Fee 2 `�1 > -*arc:• i A/tAety 6,9ah c,15" ° hjN3 ! � t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. Name�` Xf� / �/ /6 ell Construction Supervisor's Licenser RUNDI,ETT, WI FRED & PRTSCILLA A=288-138 No 33895 Permit For Build Addition & Garage Single .Family Dwelling Location 421 Scudder Avenue Hyannisport Owner. Wilfred & Priscilla Rundlett Type of Construction Frame Plot Lot Permit Granted August 2, 19 90 Date of Inspection 19 Date Completed 19 PERPAHT COMPLETED 9 Assessor's map and lot number. . ..../. .................. THE O �� ' w r y F Sewage Permit number .................. �.... . . ............House number .'�L..... :................ 9oa . . AUSTADLE MAB6 ........r..... C t639 DMPYa�9 TO,' OF• BARNSTABL•E ' . . BUILDING INSPECTOR 4 APPLICATION FOR PERMIT JO .!....... .. ....... ®...ram' �U6' ' � rx�fd� v .................. .... .................. TYPE OF CONSTRUCTION ............. i7�L.P..... �4 !. .:..:..::................................:................................ r w ............ ✓L......./�.......19.8�? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following i ormation: Location........... '�........ /%. . ram.L`�jL... v ..........:.~' L r1� 1 ...................... w ' Proposed Use ..........�`- y"" .L�lf?.�r� .......L-'�x rfl�'/,�� ..... . .��.............Qr ................................ ......... ZoningDistrict ...............�.1..... ..............................................Fire District ........ ........................................................ Name of Owner G(�r crT2[,r,4...../ 1/ 4.LT....AddressG(o.. .! �rrT':4 ` Name' of Builder ....�.L %Lc '......./aA1 ?G4�r✓....... .Address c /��L�i2v�.y...`'.�+....�� ..... 6Xr-��r�o T Name of Architect ........5,-......-�...e....-.................................Address 6 ."` Number of Rooms .................. p .Foundaiion e°uG12(ri-v' ��c vG!�f.................. /................................. ...................................................... 0 o G p /�T3�.c . Exterior ......... �..........�......5r...................... c�..................Roofing ........ ............................................................... Floors ....... ../<... L�SGP" .. .v�0�!011^,f'�nt�tiar ...... `.W :.�-` ....................... . ........ Heating ... .............. ....y................._..............................Plumbing. ...........�........J ... ...................... .............. Fireplace .......... !' . !. .4 .................................................Approximate Cost ................................ . Definitive Plan Approved by.Planning Board ________________________________19_______ . Area O it EA C/7' ......................... Diagram of Lot and Building with.Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH • L�jc st��aly t 20 I •�_- IG' j OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above'- construction. Name . ..... ... ......... U..l. . ........................................... Construction Supervisor's License dll� ��Q RUNDLETT, WILFRED '1 24830, = ADDITION + No ............ . Permit for .................................... .� . Single Family Dwelling ' ................................. t 421 Scudder Avenue Location ................................ ... .................... Hyannisport t ........ ................................................................ + Owner .....Wilfred Rundlett.................. Type of Construction Frame - _ • + sPlot .. ............... Lot .......................... y + V i Permit Granted .....MarCh.: 4.t..... r' ...19 83 t . ' k Date of Inspection ............................:'......�,19 ► Y _ s^5 Date' Completed ...... .. !19 cti / Assessor's map and lot''number ....��—/ . `` 0'�- � Quo FT ET Sewage Permit number .................. ....,:. �....:....:U....: ti 1 Z 33ARISTABLE. i House number ... { . J:...... ,.....'.................,................ �p 6 1 3 q. \0 MOR TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .:....... ? .........✓.,o... b...GL./� / •�?,t /jlTidG yG�c-� ............... .. .................................... t TYPE OF CONSTRUCTION ............. 0.4..��..... �� '. .......................................................................... ....... :...... .......19.8�? s To THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following ,information: Location ..........••!••2 ........ ..ii.F�...7 ....1v .......... f � ' ::% :_��.! . ........................ Proposed, Use . .iz/L/f/ . ( . ^ ...... .................................................:..................... Zoning Di strict Fire District ........l7 �. !t/�f J ................................ .. .............................................. Name of Owner ...... AP.4.4:F7�....Address .��G?.�r.` r ..Name of Builder .......RVA, PI_4.f. ....Address 1T� g. C'GJ:...........xarco -' .....- ........ . ....... Name of Architect ........ ................................Address a ................................................................ Number of Rooms .............. .......Foundation ....."�'"Gn /'"r � `'uc lrx �.............................. .................................................... ....... Exierior ..........zvo ate...... .Roofing ................................ ....................................... �/N L Floors /T .��3'G......./�'..`✓.U..Qtr.�c.��!�nterior ...... .�/..,...v.? c...... ......................................... d Heating ' ...........................................Plumbing ........... ................................................ ... Fireplace A�.14_1.G'5' ................................................Approximate Cost / d� Definitive Plan Approved by Planning Board -----------_-------------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee J SUBJECT TO APPROVAL OF BOARD OF HEALTH i Z ---- /J e k • OCCUPANCPERMITS REQUIRED FOR NEW DWELLINGS r r I hereby agree to conform to all-the Rules and Regulations of the Town of Barnstable regarding the above construction. Name / �l�o��!!� y.. ........................................... Construction Supervisor's License ..D ....... RUNDLETT, WILFRED A=288-133 24830 permit for ..ADDITION No .. ................ Single FamilyDwel i .....................................Y ................ .....Ig................ Location .421.... cudder AyeU.Ue................ ..................Hyannis.Por ................................ Owner .,Wilfred Rundeqt;.t..................... Type of Construction .X: .dMe........................... ............................................................................... Plot ............................ Lot ................................ March 4, 83 Permit Granted ........................................19 Date of Inspection 19 Date Completed ......................................19 . eG � l l , En�ineertn De t. 3rd floo "Ma Parcel oZ O � g P ( ram)` P G�� Permit# chi �S House# Date Issued J g Board of ealth(3rd floor)'(8:15 -9:30/1:00-4:30) r Fee Conservation Office.Qih floor)(8:30-9:30/1:00- 2:00) Planning Dept. (1st floor/School Admin. Bldg.) T'4�CF � IKE Def ' ive ` an Approved by Planning Board 19 �����/� TOWN OF BARNSTABLE � �� Building Permit Application 4/v® Proje tree}Address > -�, Village 5 Owner �. �r_ SG,�c.,� ,Q,��L[rT�'Address y Z / Telephone S-0 8 Permit Request / a,a •� c c. Pb 2c:/�,' SX /®' ( G S/F) First square feet q Floor ® square feet Second Floor s 9 q � Construction Type Estimated Project Cos Ks 1,96(0 a o o Zoning District Flood Plain Water Protection Lot Size • 0 b S 6 o x/e6 Grandfathered ❑Yes ❑No Dwelling Type: Single Family 9,* ^ Two Family ❑ Multi-Family(#units) Age of Existing Structure 6,0 {' Historic House ❑Yes IrNNo On Old King's Highway ❑Yes ❑No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) } � Number of Baths: Full: Existing Z. New Half: Existing New No.of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing New First Floor Room Count (� Heat Type and Fuel: Urb"'as ❑Oil ❑Electric ❑Other Central Air ❑Yes W<o Fireplaces: Existing New Existing wood/coal stove &fe's ❑No - Garage: ❑Detached(size) Z Z X Z y` Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) r ❑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 DATE BUILDING PERMIT ENIED FOR THE FOLLOWING REASON( 441s . _ FOR OFFICIAL USE ONLY PERMIT NO. , 'Z- �3O f DATE ISSUED MAP/PARCEL NO. ; ADDRESS VILLAGE OWNER DATE OF INSPECTION: c`1' FOUNDATION FRAME INSULATION FIREPLACE _ ELECTRICAL _ RfJUlGP FINAL PLUMBING ^' ROWH FINAL R , Y GAS: qxl o GH FINAL ' .' - �-"_. FINAL BUILDING° - �: ✓' S�� -� DATE CLOSED OUT ASSOCIATION PLAN NO. The Cunri1rohlrealth (T-1fassach"scin w • '•,i 7 ;-=tv Departt"cttl of Industrial.4ccidents �� 1• n w �a! \,,i;tJ ��•;�+ 61'111 !f'ashi";;tun Street •�S-•••,:!`.`�- ' �� Bustu'r. Afuas. 03111 Workers' Compensation Insurance Affidavit Aj It an in rm inn• eC 21r 11Rr L(-V-Gr7! n. ' �• N G �Cs�P' hem 77/— Ti50 ,IKl am a homeowner performing all wort: myself. Q I am a sole proprietor and have no.one working in any capacity [1 1 am an empiover providing workers' compensation for-my employees working on this job. enntn inv n tmt addreso- f cin•• _ nhnnc t!• nniicv� incur�ncc cn �� _ [I I am a soie proprietor.'eneral contractor. or homeowner(circle Otte) and have hired the contractors listed below who the following workers compensation polices: cnMrInn,%, nnmc• adtirccr cin nhnnc ii- iwmrnnrr rn. nniicc d - - cnm rim nnmc- addr"c- cin nhnnc 1�• insurance c nfic•!l Attach adJitio_nal sheet iCneeMa_va .:._" :.t ._.., _-':':" .::�•-:_-_=... .........�. •:.• ... �a""�_.~.':" Fuiiure cn secure cnvcrace as required under Seaton 35A of pIGL in can lead to the imposition of criminal penalties of a line up to S1SDU.UU ant one%cars'imprisonment as%vcil:ts civil penalties in the form of a STOP AVORK ORDER and a fitte of S100.00 a dad•against me. I understand th:. cope of thi.matentcut may be furwnrdcd to the Olrtce of investigations of the DIA for coverage verification. I do herehr cord r i ruler the pains and penalties of perjuq Ilia'the information prodded above is tru rid comet. Si=nature Dat Print name Phone# T,oRcial use only Ju not write in this area to be completed by city or town of6ciai t' cin or tmt n• permit/liccnse># r'IBuilding Department • C3ucensing Board orri check if immediate response is required C211cait oe s rtmec �ticalth llcpartmenc ref lthrr Massachusetts General Laws chapter 152 section ,S requires all employers to provide workers' compensation for their :mplovecs. As quoted from the -law-. an enlplitree is defined as every person in the service of another under any :ontract of hire (express or implied. oral or written. m emplitrer is dcf incd as an individual, partnership. association. corporation or other legal entity. or any I%%,o or more . is forcuoing cnuaged in a joint enterprise. and including the legal representatives of a dcc=cd employer, or the :cciver or tntstce of an individual , partnership. association or other legal entity, employing employees. Ho%vever tfic caner of a d%%,ellutg house having not more than three apartments and who resides therein. or the occupant of the wclling house of another who employs persons to do maintenance , construction or repair work on such dwclling houi flu __rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. 1GL cha.ptcr I52 section 25 also states that every state or local licensing agency shall withhold the issuance or Auei%-al of:I license or permit to operate a business or to construct buildings in the conimoiriveaith for an- )plicant «•Iio ltns not produced acceptable evidence of compliance svith the insurance cover eve required. dditionall:,. neither tite commonwealth nor any of its political subdivisions shall enter into any contract for the rformznce of public work until acceptable evidence of compliance with tite insurance requirements of this chapter ha c-n presented to the contracting authority. . • •.. • i_ .. • .'.... • .. iy_ii� :1•~ _ Ali.. ..... )plicants :asc fitl in the workers' compensation affidavit completely, by checking the box that applies to your situation and 'plying• company names. address and phone numbers as all affidavits may be submitted to the Department of .ustrial .-accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The :.-;Ovit should be returned to the city or town that the application for the permit or license is being requested. the Department of Industrial Accidents. Should you have any questions regarding the "law- or if you are required otain a «orkersi cotnpensatiot. policy. please call the Department at the number listed below. or Towns :se be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of .affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas ure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless other arrangements have been made. Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. SO. do not hesitate to _give us a =11. Department`s address. telephone and fax number. The Commonwealth Of Massachusetts -�' Department of Industrial Accidents _ rt Office of Investigations 600 Washinbton Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (6I7) 7274900 ext. 406, 409 or 375 The Town of Barnstable j vH AL AM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissi 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. pe of Work: ary��� °�!a ar' Est. Cost � A/Address of Work: Owner's Name Gam! 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. Building not owner-occupied =Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR TOWN OF BARNSTABLE BUILDING DING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ZDATE lease print. , JOB. LOCATION Number Street address Section of town /'HOMEOWNER" ✓`G�i2�sID c.�lo-O— ��/l'S� Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupie( 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 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 Offic: on a form acceptable to the Building Official, that he/she shall be responsif for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code and other applicable codes, by-laws, rules and regulations. The unders _gned, "homeoc:ner" 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICI 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 building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if 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 "dwner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/tier responsibilities, man communities require, as part of the permit application, that the Home Owner -ertify that he/she understands the responsibilities of a supervisor. On the la--t page of this issue is a form currently used by several towns. You may --are to amend and adopt such a form/certification for use in your community. ✓fie �omrnonwea�i o�./�aaaa�a/euaella DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Na�be : -Expires: t�' ��x strcted Toni `00 NILFRED H RUNDLETT �:POBO% 181 HYANNISPORT, MA 02647 Assessor's map and lot number ........-,z ..... . STHE 'W46 SEPTIC SYSTEM MUST L'-11 Sewage Permit number ........ ...................... ..... ...... ...... INSTALLED IN COMPLIAN 33AR33TALLE, House number ................................................................. WITH TITLE 5 MM& It EINVIRONMENTAL CODE 039.of .1 MC TOWN OF BARMMAMIONI BUILDING INSPECTOR . APPLICATION FOR PERMIT TO .................................................................. TYPE OF CONSTRUCTION ...... ................................................................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..../7./ .......Is C-U --D Z)6—tz_ 45" /7/ .......................................4k..... ........ ........................................................... Proposed Use .................................................................. .................. . ...................... ............................................. Zoning District ... . . . ..............................................Fire District ..... .. ................................. - S� Name.of Owner .. .........Address 1z1f sc ................................................... Name of Builder 116�,141--lz ............... ....Address .............. Nameof Architect ..................................................................Address ........................ ........................................................... Number of Room-s......... ...............................................Foundation ... .................. Exterior ..................................................................Roofing .... ............................................................................... Floors .............................Interior :5 a C.,e-r ......................................................... ........................................................................... Heating ...................................................................................Plumbing ......e4-lee/<.................................I...............?...... Fireplace ......... proximate C ........ ............... ................Ap Definitive Plan Approved by Planning Board --------------------------------19--------- Area Sr .................. Diagram of Lot and Building with Dimensions Fee ...ILI)e..S6................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........... ..... .... . . ..................... Construction Supervisor's License ...61�1 Xf,4/1 1� ................................. RUNDLETT, WILFRED 29026 Build Addition ................. Permit for .................................... Single Family Dwelling ............................................................................... Location ......42.1.........Scudder.............Avenu..e................... . Hyannisport ............................................................................... Wilfred Rundlett Owner .................................................................. Frame Type of Construction .......................................... . ................................................................................ IPlot ............................ Lot ................................ Permit Granted ........ .......19 86 Date of Inspection ................................19 Date Completed ............................... .....19 J6 k 1.2 M i � � , J Q . 1 \ - � _ � � { / � 1 � J � i � �(` � ! V r . � � N `� � �: q dip o� - � .£, � � Q i � � � � -; ,�,�, T �. w � � � T � mil^ � ` _ vJ `�1 -- � �� a - � � .� � t^ - � Q .9/ �J o� d �i •J ��" �' V ' , ,� _ p wj 039. WAY Ar. TOWN OF BARNSTABLE BUILDING INSPECTOR . ,-..TO,THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Zoning District ...... t-r..............................................Fire District ....( ..... .. Name of builder ....Address 0 cle"a- ` Nameof Architect ....................................................................Address -------------..----.--.--.--,—.. /�� Number of Rooms —� -------'--.�----'Foundohun —[������������—*�������[--,—__ Ax/erior ...................................:,'....Roofing ' ........................................................... .Floors .......... ................................................ ...................Interior .................................................... ` ' Heating .—..L.�_--'_—`--',----_—�,`--_Plumbing _,^��<��{��—...._,�`..—_^..---�___..^.. - ' - L�- ~�� Fireplace ---^��.�\j�------------------'Approximate Cos*�--��.����<,.�5.��................................... | � Definitive Plan Approved by Planning 800nJ 1Q-------- ' Area .....S1.1 -----. � �) �) Diagram of � and Building with Dimensions Fee —/�L^���u���,/.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' ., ' ` -- '-- ^ . � . . � -�, ^ ` /~ 0[CUPANCY PERMITS REOU|RED FOR NEW DWELLINGS -- / / | hereby og,oe to conform to all the Rules and Regulations of the Town of 8qmnsto6|o regarding the above ' construction. ' ' Nome .r��... .... ^�� Construction Supervisor's License —���:�����1�.��_— | ` / r7RTUINDLETT, WILFRED A=288-138, No .2.9.026..... Permit for ..Addition ............................/�n.................. Sin le..Fa ilv Dwelling,,,,,,,,,,,,,,,, ,,,,,, ...... ..............9..... ....M.... ................... ........... ..... Location ......421...Scudder Avenuk .................................... ........ ........................ ............. .... ............ Owner ......UUX94..AMAI@tt.......................... Type of Construction. ........................... ................................................................................ Plot ............................ Lot ............................... Permit Granted ............March...1.2?........19 86 Date of Inspection ....................................19 Date Completed .....................................19 ThOTE Arm 1/10 4 BAXTER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street • Osterville, Massachusetts 02655 • Tel. (508) 428-9131 WILLIAM C. NYE, P.L.S. - President PETER SULLIVAN, P.E. - Vice President-Engineering \ RICHARD A. BAXTER, P.L.S. -Vice President May 9 , 1990 Mr . Wilson H . Rundlett 786 Liberty Square Road Boxboro, Ma 01719 Re : Scudder Ave Dear Mr . RundIett I. w,ts not z'h 'Ie t:.o r..lc,t de:l irvit:(:-� answer at the Bu-ild-ing Inspectors c)1 f ic;e t:oci,=.ay , all in pector s were at a (:onference . I d-id find o�rt fi•c;rn 1v11- 101)b'ii t:he Building l.nspEct.ors secretary, thaI- t:he existing I:)t�ri -1ciing l irie could I:-)e extend d if the proper setbacks were complied wit.-.h at the original construction data . This, -is a determination the Building Inspector , Mr . Joseph Da Luz , will have to make . You have to document when the original garage was constructed . Joe Da Luz_ will then check the setbacks for that date. If you complied at that time he has the option of letting you build no closer to the line than the original construction . Please contact Joe Da Luz directly with this information . We will proceed with the Plan and will not finalize it until we hear from you . Very truly yours , Richard A . Baxter For •1)< Nye , Inc . RAB/s`I c M1iMIiEH,`,'i)l CAPE COD SOCIETY OF PROFESSIONAL_ENGINEERS AND LAND.SURVEYORS i AMERICAN CONGRESS ON SURVE)'INi;AND MAPPING MASSACIIIISt_1 IS ASSOCIA71ON 0f'(.AND SURVEYORS AND CIVIL. ENGINEERS f.,y7 ijpMlS f7,11' S.};'.fit t,Y�+.a�.'"'84"` ��YSP t.':f; � t ,q'.. ,. •1t� ,'r,4.. � n'"ix y � ;�u u,��7r W Yri:+'4' f�-0'xY� ��' .+�"+/ 7 i i�"'�&'7•t" � {✓n /� rtd,t�:.a°! 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Y , .•; ,s :f. ay,k r (,a 4,fa:;*t��" 'C ^I'. r1 yM sk`� '.+�'1 r9S fs, .�,;'R •,�,!',�r' 'a�x•;�l,'�v t �� ���. a: Ss 4§t.�x`r•-.'�X..`��i�" �' +�ky,''r� " �l�' u�- ? l 1"i �'i r n' Assesspr' office(1st Floor): >3 t3 p.i( Assessor's map and lot number Board of Health(3rd floor): n�/,� Sewage Permit number (/✓ �/ � HAHd9'fSDLL i Engineering Department(3rd floor): / O House number pO' O efinitive Plan Approved by Planning Board 19 � R U71 APPLICATIWNP 'Fl" SUES 030-9:30 A.M.and 1:00-2:00 P.M.only a� nservat4o N OF B A R.N S T A B L E 7 ma7 , LDIWG INSPECTOR gaud � r,// �jdd I coo A r APPLICATION FOR PERMIT TO 4" -ST/l UC v� D L7/7-10AJs �� hlovx[l a- 6id214 c, t rr TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:: Location L� Z C U D of L�2 1iGr, JT"/4 A4VIS PO/t'7- Proposed Use ���5^�l Zoning District /�T , Fire District csag�a63-75�is Name of Owner A41Lf2 L'"b �' -v yPi-L-;,rAddress Name of Builder .• yAJOLCrs'7- Address Name of Architect Address m Number of Rooms Foundation -04 oc.rt Exterior G�aoD /��/n/�c�-f Roofing z4sPlye4V- f/f/,jC-CL:l Floors ( tic cm V05, 4r j�iooalzu-p eo vc, �',OIZaG0- Interior Heating —�-Ov- Plumbing 40/ye Fireplace N O Approximate Cost Area Diagram of Lot and Building with Dimensions Fee 7P ; o /= Al 4 y /0 O L-x ST xl� I J Ll �b 6 I IcJ,S j v h qI 71rz woSC 0 N F---z 7-' L X r 5 T / i✓ 6- AS-6 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License D A/e,4�O "z- 'RUNDLETT, WILFRED & PRISCILLA r Puild Addition & Gara e ��No 33895 Permi�For g 5ngle-,,.Family el-ling Location 4- dde 2'1'� cu _Avenue Hyan` isport i Owner Wi1ffed? & P•siscilla Rundlett b Type of Construction n F> ame Plot Lot { Permit Granted August 2 . 19 90 Date of Inspection 19 Date Completed i l 6 y M •l N 0 Est CIA a SCc, e C®o�sI rue, 1 T k }e Y ao� t�a low Wilkff ROOM 4 �'Y fix►S BUILDING DEP7 DEC 0 4 2017 0, TOWN OF BAI-INITAB-L; h — S 4- t ..--�'i`" �l--1 C a,JT/.✓'v ous � / z�tea•_/'E;.�'r `__�—o" �., /f/JJ PL yscal<cp SH E/1r N irS G P I r V4F.J T- --------- _ R ,� �• :� , C• � t YSGD7? H� T Q• sc 1? ..•S A f+//��r �/.- Ip EX IS r-i rc/G a e x 2 x J Ca Q ! • 1 L'X /ST / ��Cr- A qo R1 - k '•. N 3�yn _/�LYus ocr t7 ,Su II Ft o a�. i , -., ...X i o" 'To 1.STS .:./4 Qr 4 J ` 11 U ;, /! r. N r• ir.. ,q A QR/GGIAfG /� \ J�- J V"" Ap IS g o n�C R .1 n ,.A „ r - a . : A• as �.,��. � '; r. � 0, �, .414 )a;-, S S �S.E'' C rr"i o .� .� T 5 C F-;;�- o SS S i. c -rIar� ' B �yis, a rr c r y2/ Scr,ar3<rnz �4vc.� f/Y. A.IAI/SP�aIZrr i`1�ss, SCALE: yar P Q JJ APPROVED BY DRAWN BY DATE: 3/8b 1 �✓ /y /Zf Ui✓3�t ? CA 7PAEry✓Ti2y :�C 7?4—rro Of L/�G SE' �8L G i f3 a--z o x L3 a>L o rrG,+/ .'V. jx, _. .er I DRAWING NUMBER ,' DIETZGEN MASTER FORM198MF . a _ i t C r�CUSS ,..SL•`�: T/�,i.i A �L�'�b IYG" G-Jc/�'T/NrG (t�rn/Ov4�S C f L-X/SY/wl /vAL G V C rz oss Se-c do Al v � b ID G o a r-z J�/^/iar� A �r DL Armor. i ri�r /--a 7C /�'/T`2. Ilf 3 LeJ/G F J� L:f� �'T tt.✓D t 4r Y T .-Sc v rs s SCALE: IY' _ / Q" APPROVED BY DRAWN BY DATE: ` 8�o W `✓ //� u.✓z�c d-r CA I--- 73L L r[3Ar/2 Ty rS�. T1'o,, Z3axt3�.e o vGH /�'1art, /VA55, Lrc. 4 /G6S0 DRAWING NUMBER DIETZGEN MASTER FORM198MF - 6tA14rVjjj,c ifAGM L ,,< G `T,+o xo►� N/� C�ca� l� � M� 04,j Z 1 J Locos SILac`fc N �� ��,t���n.rlC�, S►k�V �'$ t- - Lo w NE x.� "�"t �?A r [x bT1 Gc N"i'tt 1 4V C I ,t O Nl F.60 � Logw cb l_A W At !li o \� ) ( \ y h Q \ p1 /`7 I � s � / 91 (A W tNJ woe. -b(L JA�1 p - *ter-...x...J .. -r._..�»„1•�..,....^€`'w..A...�.....-"'.rw.... !, r"w .'e.1�$.r.?. . }.. :�rl�..,,.A..rI� � /So • coo p ,� =Tn � ( \ � !o "D q �IF EL AN t ►C F_So u QC Er AMA"4A *R�y Foe-> . `~ L C f j i A INN 5TA ,Ll ►Y�►�r.a►s Pv►zT� Nl �1 . Ci`r� FYH ' `TNTu��Di - PIP rL s N c y r)U Ht Q►2.k:0 Q LF j CJ f� U t 4�t`1! 3, L ETT' PLTER . „_ , 1 SU(.LIVAN )990 1 > U• DUNE 4, 1°19 No. 29733 °lC� s a9 TO i1` 'pU4K,1 1 S ►vo T 3A S �.. C?II.1 6 Y :G l a��' ; t F, ►!,?(� J u611 1`� ICI t�TIW Mtn YN T" '$Q(W t-;Y ��1� "C'�l� i11to. A9334 n lRC G�1�•'s�;•�1�r— � �r.A 140 '� o C-C se.T`S sIgow 3 To �'tf� y2 eQS ��s - 1 G P. r 1C. 5 Igovuo� N r2r►- 1 3`� Tl eAeX-C-L I ?,,Q)LDIQG ►ti1S CCIv9, i OtL C' vv��C CAIV C�;.�y,., 12 �>Z, P A F c Z ca . �v �rrY u 6'a S t� i — , ��c/�-1pLr��t7 �?� I L=x i ST i.✓fir 7 9 �. GA/t 4 6, e Q _ _ � N It./O J I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License �/ 6 L 3. `•Y � �,� � 1 y-r Q ^C i t I ; I I I i 1i i I � I O S T-S y - - ' C J ' - T. J F? e.: cw(i I - 1 D =1 i- C T ,v'' f—: 1 7' /JW.P W- E 7-7- '2 : / /_. SCALE %2 _ / APPROVED BY DRAWN BY , DATE Y DRAWING NUMBER DIETZGEN MASTER FORM 198M4