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0037 SILVER LANE
31 �S;.�y� G,�y� � - - - -- L r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel— Application # o Health Division Date Issued jc" Ple Conservation Division Application Fee S� Planning Dept. Permit Fee lllV (J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address S ! ��1 Ue+r L ti Village is Owner ��2 ���n &,curo Address .?f7 5 u �n . Telephone /��G Permit Request e�2j if �2 44� G 1_QQd kA 1'nd P (1 S,in® d6_4 z/Je /dim _a4w d )?CX MPS !a-44e-A �1�c� �o aL)-se- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Flo. cd Construction Type l��a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 5-No On Old King's Highway: ❑Yes fa No Basement Type: �61 Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ 2 new Half: existing new Number of Bedrooms: V existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ILGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 29 No Fireplaces: Existing �_ Z New Existing wood/coal stove: ❑Yes; ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑new 1i'ze_ Attached garage:f.existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ,,,-Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RIC I 0,d A00CV-114 Telephone Number Address 27 0414-y/ 'VI License# es lktrj7onf A'llr %1,4. Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO X04)A 14 Ad�;�I� SIGNATURE 41e4j DATE / FOR OFFICIAL USE ONLY i. APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i lft: . e D arfinenta liidurfrial�Ccridentr 09,=gflm ertiga Ow 600 w 'iF ington Street Bestm,MAOZrrr ' - www.Mrs:gavlaa Workers' CompensafionIn ur2nceA$dzvffi-Bmlders/Contra.efnrs[MectdcLu"lmnbers A-pplicgn.t Information Please Print Le -b Address: 2 SI ' ldnliAl - • City/SiaW2 p: 4 , IS AA 62SYf Phone k 0 _ y Are you an employer?Check the appropriate bo:c • T�ta of protect{req�ed): L❑ Iamz 4. Tama emzpkiper wi$i ❑ goal cmafracw�T ' fi Q Neste c®st<mciitm mapIo=(fall and/or pmt tiaw)-* bavo hfirdthe sab-ca madras 2. I am a sole proprietor or pattaw listed CII the a0acb"I sbext. 7. ❑Rem dcliag ship and have no employees �o sah- o bane ' g- ❑DrnzoIiiiaa worlimg forme in e�capacity. �Pk3' have watiCt�' . [No walim s'comp.ksi-'ce comp-i,, •A•,�r# 9• ❑Building addition 5. []We ate a corporation and its I0.[}M=trimlrepajm or adadoms 3.❑ I am a ha®oaWner doing all wor3c officers have r md fhenr IL Q phmbingTepah:s or additions myselt[go wozi�rs'comp. ri&ofmm mpfmperM(M LIE]Roof impaim ;•,�„�„ xrgtzaed.J t c.152,§I(4),and we bane no emzPlnyexs.[No I3. Other — /-?k *Amy appfiamtthat checks box#1 mast also f M outt m res r,a bckw showmgtbrawad cl'cmopc mgf;on policy fid=Mfi= "t mmwwaca who sulaatlins daa.vtma.imgih=yem doing zU wodcimd d=bhe outside wmactaa=stml=itLnrw afdarkkacacgmg=:b- tCoaimdms that checkthis box most of-lied in eddrtimml shadsbowirwthe m—of the m&coaftxctxts sad date whdhcr or notifinc cdities have employees•ifthe soh-c �c hm=pb y=,they mmstFUVAe then•wm3fa'—ap-p°Iu.Y=-bQ Ion am Mnplayer that is propidmgvorkas'corzparsatiott irssu =m for my rarPlayem YdVV it the poTuy and job site . i�rfarmativn. Insareooce Company Name: Policy#or Self-ins.I ic.#: Fxpiiatirm Date: ' .Tob Site Address: Cog/StatPJ?.ip: P Affm A a copy of the workers'compensation pormy declaration page(skowing tb.e poruy m=ber and apimfion data). Fatima to se:cmb coverage as xzquind mnder Seati=25A ofMCd,m M cm l and to the imposition of criminal pmaiNe of a. fare up to$I,500.00 and/or one�yi. nnprismmcnt as wr11 as ciVRPmRhMS in the faun of a STOP WORg ORDER and a free Of'PP to$250-00 a day against the violator. Be advised mat a copy of this sfatcra maybe forwarded to the Office of Iuvc sdgadms of the:DIA fir insmmm coveaage vidticatiom. Ida hereby crrAYy the arms anri-P=ahrhm vfPe jy that the bzfor=a gon provided above it trrce and eDirect - t bad: E o n:ority(circle one:):ealth 2 BtuldingDepartmetrt 3.CifylTown Clerk 4.Ele tdcalTnspictor S.PbnnbingTnspec�rsoa: Phone# r - f Lnformation and Instructions ' Massachusetts General Laws ffiVft r IS2 regaes aII eoploy=m provide worker'aouxpeasatian for ffiCk MaPIoyees. p this statate,an rmplayre is defined as=.every person.in ffe service of another eider any corfract ofh r, mqx=or implied,oral orwch ." An.mTkye'is defined as`an indrvidnaI,Pam•essocietipm,coxpmiation or ofer legal an tf,or icmy two or more of the foregoing= aged in a joint Mftg dse,audinchuimg the legal representatives of a,deceased employer,or$co receiver or trrstae of an h0vidnA partam3bip,association or other Iegal eaiitp,mnplopmg employers. However the owner of a dwellinghouse havingnotmore ifien fb=apa ments and who resides flierem,or the occapant OHM- dwelling house of anu ier who employs persons to do maims contraction or repair wor3c an such dweIImg horse or on fhe grounds or bcn7dmg Epp themto shall not becsmse of mwh emplaymm t be deemed in be an employer." MGL chapter 152,§25C(6)also siaii s that"everystafe or Iocal licensing agency shall withhold the issuance or renewal of a license or perms to operate a business or to construct buildings i:n the counnonwealth for any applicautWho has not produced acceptable evidence of compliance wiM then insuranc L coverage required." AtmiiionetI MGM chapter ISl,§25C(7)states mlTcW=the commcarpvean nor any ofifs political subdivisions shall enter into any carcbmct fhrthr-pmf=m=ofpabho woo until acceptable evidence of complianee vMh the insurance.. roquirenieats of this chapter have been presented to the conhwting mx&orityf' Applicanris , Please fill out file waxl=rs'compensation affidavit completely,by chw.Icing the boors that apply to your silnaflm and,if necessary,supply sob-=dmct=(s)nsme(s). ad&=s(es)and phane nimber(s)along wj&ffi=ceatficatP(s)of insurance. Limited Liability Companies(LLG')or LimedLiahility Parit amzhips gl P)within employees olher than the members or pmtners,are not regtmzd to caty wo6cers'compensation insznmm If an LLC or L LP does have empIcyow,apolicy is regaaed. Be advisedthattbis affida-i tmaybe sub®.ithd to the Department of Industrial Accidents fi)r conflamatiam ofinsuranco coverage Also be sure to sign and date the of i&vit Zhe affidavit should be retied to Ihe city or town that the application.for the penit or license is being requested,not the Department of Industrial Accidents. ShouIdyou have any questions regarding the law or ifyou arm regand to obtain a workers' compensationpolicy,please call the Depahaent at fe number listed below. Self-iosrued companies should eater their self insruance license n=bcr on the appropriate line. City or Town Officials Please be sure that the affidavit is camplete and priated legibly. The Deparbnent has provided a space at the bottom of tine affidavit for you to fill out in the event the Office of Tmr�cations has to contact you regarding the applicant Please be sure to fill in the pm iOicrose number which wiill be used as a rzfwmce mmnbcr. In addition,an applicant fluct must sabmit multiple peonh/Iiceose gTlimd=in any given years nced only sabmit one affidavit indicating caueut policy fi fonm•ation(if necessary)and under'?ob Site Addrsss"fe applicant should write"all locations in (city or town)."A copy of the•affidavit that has been.officially sfsmped or marked bythe city or town may be provided to•tire applicant as proof that a valid affidavit is on file for forme permits or licenses. A new affidavit must be filed out each year.Where a home owner.or chizra is obtaining a license our permitnotrelatzd to any business or commercial V&3tU a (ie.a dog license or pemait to bum leaves etc.)said person is NOT regmred to complete this affidavit - The Office of Investigations would Ike to thank you in advance for yaw cooperation and should you have any questions, please do not hesitate to give us a call TheDel5tca mfs address,telephone and ft number. . - Tha CaMMMWMItbE of ROacliusetbi . Dzpailmmit ofTridustcialAaoa4.cmta office Of I.vestgatio= . �UQ�t�iiz�tan S�e� , • Boston.MA 02111 TQL if 617?27-49W cit 4-06 or 1477 MASSAFE Fax# 617 727 77� 1Zeviscd424-07 w�m��vldia t � ' C guide to Wood Corrstr•uctfoir fit Hi Ir Wind Areas: 110 firph IF'rnd Zone AFi� � Massachusetts Cheddist for Compliance(790 Ct1R5301.Z.1.1)t Loadhearing Wall Connections • Lateral(no.of 16d common naits)-----......._.-..:.-__:..Crables 7)........__.......................... ........__.. Non-L•aadbearing Wall Connections Calera!(no.of 16d common nails)... -.....__.:.......:.....(Table 8)._.......__..._......... ._:...._..........__.. Load Bearing Wall Openings(record largest opening but,check all openings for compliance to Table 9) Header Spans ......................._._-------:.............(Table 9)................_........._.. _ft_in.S 11' Sig Plate Spans -_----____--------- .»....._...._._.........._.(table 9)_..._........_...._.._..... _ft in.511' . FuA Height Studs (no.of""studs)._._..._.�..._.�:........(1'able 9)..................................... Non4mad Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................__.....:._._.._.._,....(Table g)................._............._ft_in.512' , Sill Plate 5 ns.... ; R )••---•-•-- --- pa _._.._.._.._...._.............._._.._..._... abfe9 ............ _ft—in.s 2 Full Height Studs(no.of studs)..._....._......._.__.._....(fable 9)........_..........._.......... _.w.._..........: Exterior Wall Sheathing to Resist Uprift and Shear Simultaneously4 Minimum Building'Dimension,W Nominal Height of Tallest Openfng2 ...... .............. SheathingType....... -•......_.....(note 4):,......._......._..............._......-.. Edge Nail Spacing......... (Table(Table 10 or note 4 if Field Nail Spacing able 10 Shear Connection(no.of 15d common nails)(fable 10)............._................................. -•_ Percent Full-geight Sheathing..__' ......(Table 10)._--__----_-_-____----__--___._.--___-_- 5%Additional Sheathing for Wall with Opening>6'B-(Design Concepts)._..__........... Maximum Building Dimension,L Nominal Height of Tallest 0pening2..................................................................... SheathingType_._..........._......__.........._......(note 4)....................—------_---------_..._ Edge Nail 5 aan ..._-_.._._....(Table i 1 or note 4 if less)....._.._........... krr_ Feld Nag-Spacing (fable l l)........ ..................._.....' in. Shear Connection(no,of 15d common nails)(Table 11)........................._... :.....:...._......_- — Percent Full-Height Sheathing_._.;__........ -(Table 11)........__...._..�.._....__...:..__.____ 5%Additional Sheathing for Wall with'Opening>B'8"(Design Concepts).. Wall Cladding Ratedfor Wind Speed?._................_..........__.--...._....._.............._........._......._.__._.......»_._._:...... ' 5.1 (tOOFS . Roof fiaming member spans checked?._......:.:..:_:......(For Ratters use AWC Span Tool,see BBRS Website) 19 ..._. • Roof Overhang ........................... ..........::.:....................:.-........;....(Figure ) ..... ft s smaller of 2'-or L13 :.._ Truss or Rafter Connections at Loadbearing Wags ; Proprietary Connectors = 12) ....................._.U= plf Uplift........._................. .__. ........................... - .(Table 12)_...:...........__ .......L= pff Lateral..................._......-_.__........ _._.__..-.._. 12)............._............. = ' S - -pIf Ridge Strap Connections,if collar ties not Used per.page 21...(Table 13)...._._......._.......-._.T= plf Gable Rake Ouflooker........................ ...:..__._(Figure 20)........ ft ft s smaller of 2'or L2 Truss or r Rafter Connections at Non-Loadbea rig Walls• Proprietary Connectors Uplift--___....:...._....w...___:_..�.__..(Table 14).........__._..._.......__.._:_..�U= Ib- Lateral(no.of i 6d common nails)_.(Table 14)......................................L Roof Sheathing Type-_.-------:___••____-.__-_.--_:______(per 780 CMR Chapters 58 and 59) Roof Sheathing Thickness................._:-.._.__..:_...:.....__....._._...-.._._.-._....__.:__in.z 7/16'WSP - Roof Sheathing Fastening, .:_:__.......__..........(fable 2)_.............._:.............,._..........._......... Noter- i. , This cheddisE shag be met in its enfin:ty,excluding the specific exception noted In 2,to comply with the requirements of 780 CMR.5301.21.1 Item 1.if the checklist is met in its entirety than the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 - e. Comer Stud Hold Downs per Figure 1 Ba and Figure 166 2 'Exception:Opening heights of up to 8 R shag be permitted when 5`Y°is added to the percent full-height sheathing 'requirements shown in Tables 10 and 11. - 3. The bottom sill plate In exterior walls shall be a minimum 2 in.nominal thickness pressure treated 92-gr4e. ' AW'Gnide 10 ll'ond Construction irl ffiglr 1KndAreas:110 tflplr Wad Zone Massachusetts Checklist folr Compliance(78o CiMR53llt�.I.I)' • " " Cheek - + Compliance 1.1 SCOPE WindSpeed(3-sec.gust).....•..._._._.__._.. ....._...__.._..___......-...._-._...___...............:..__.__.110. mph WindExposure Category........_...._...._ ..»..... _» ...__................_..._...._................_..._._......_.._:_B Wind Exposure Category................Engineering Required For Entire Project.......................................C - 12 APPL.ICABILITY Number of Stories(a roof which exceeds 8 In 12 slope shall be considered a story) stories s 2 stories RoofPitch.........__.._..:._......._......_.-___-_........_..... , ...(Flg 2) ..._...... ..........._.......... 512:12 ' Mean'Roof Height._._»._..._.__._.__.........._._.. .....(Flg 2)....... .........._...._........_._. ft S 33' Building Width,W_._.._...__......._:_............_.._..^...__,..(Fig 3)...............:...._........._.__--,_It s ao, BuildingLength,L• ......_.._.._......._........._........._ .._.._(Fig 3)___.-........................................ ft S 80' Building Aspect Ratio _.(Fig 4 - Nominal Height of Tallest Openingz .._.......___:�;:;.._.......(Flg 4)...._-...._._:..................... 1.3 FRAMING CONNECTIONS General compliance with framing connections_...__....._....(Table 2)........................................._........_........ . Z1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 54D4.1 Concrete...........................:.......................:.......................................................................... ConcreteMasonry........__._._.__..__._....._.._......._............_:....._.._......:._._._.............._..__:........-..... 22 ANCHORAGE TO FOUNDATiON14 5/8'Anchor Bolts4mbedded or W Proprietary Mechanical Anchor;as an alternative in concrete only SoltSpacing-general.................................._-..:-(Table4).._._...._..........._....-.__.._...._ - In. Bolt Spacing from endljoint of plate..__..... ......__....(Flg 5)....... ..:................. in.s 6'-12'. Bolt Embedment-concrete....._..._........._......w._._...(Flg 5)......__..........__.....:._..�.---__... in.Z r Bolt Embedment-masonry...._........_ • ......_._......._(Fig 5)_ _."t_....................___ in_2!15' ' Plate -5).._...............""_-_"---"_-_-__."_-___-k 3"x 3'x'/A' 3.1 FLOORS Floor•6aming member spans checked ..._...._.._...._...._...(per 780 CMR Chapter 55)........._.._..._...._...__. Maximum Floor Opening Dimension...:.___......_..........._..(Fig 6 ' Fuil Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..:..................................... Mhximiim Floor Joist Setbacks Supporting Loadbearing Wail's or Shearwall...._.._.._...(Fig 7)........._........................_....._......Tft 5 d Maximum Cantilevered Floor Joists Supporting Loadbeanng Walls or Shearwal........_.-Fig 8)_..._....._...._. ....._ft s d FloorBracing at Errdwails__......_........__.._._..._....._._..__(Fig 9)_........_.._......_.._.._............._.._. ...._. Floor Sheathing Type .-._.-"_...._.._.._...:.....__......_...........(per 780 CMR Chapter 55).........:...».__---.."._.._ Floor Sheathing'ibIftess.........._....._...».._......_.......:..._(per 780 CMR Chapter 55).................... In_ Floor Sheathing Fastening_........................._............_.......(Table 2)_—d nails at . in edge/—in field 4.1 WALLS " Wall Height Loadbearing walls._...._.�_......._.._....__......_.........._.(Flg 10 and Table 5)_........ ft 51 D' Non-Loadbearing walls ....._:._......_. Fi 10 and Table 5 It'S 20' Wall Stud Spacing .-..»...._.. ..._. ..... ...-.p g .-. .:.. .__. .....»(Flg 10 and Table 5)..�........._ —to•s 24'o.c. Wad Story Offsets ._»_.___-._..____---._.....__......._.»...(Figs 7&8)_.........._.............._.».__ _ft S d 4.2 l-7aMOR•WALLS' . Wood Studs Loadbearing virally._._._...:_......_...._..._......_._..._...._(Table 5)...._.»........._.._.._.2x ft in. ...»a able 5 - ' o a g wail .__._........_.._._.._....._._. (T )._.........:...........__..2x ft ui. , Gable End Wad Bracing — — Full Height Endwall Studs...__._._._...._ ._._......_ .(Fig 10)_...... .. WSP•Attia Floor Length.__.._....... ....._._......:(Fig 11)__..._..._......._.._.__....._.. ft kW/3 'Gypsum Calling Length(If WSP not used)............ :.(Fig 11). ... .._._ .............._. ft;--0.9W - and 2 x 4 Cbntinuous Lateral Brag @ 6 ft_o.c._Fig 11 or 1 x 3 ceiling furring strips @ 1T spacing min.with 2 x 4 blocking @ 4 ft spacng in end Joist or truss bays Double Top Platir Splice Length .....__._w_:._.»_........._.... . .(Fig 13 and Table 6)................"-._"_"-.. —ft _ Splice Connection(no.of 15d common nails)......___..(Table e)___._-............._.........._..:.._._...... AFFC Guide to Wood Coristri•icfiorr in High 1a�inditreas: 110 at /)rsd Zone Massachusetts Chec.Idist for Compliance(780 CMR 4. ' a. From Tables 10 and 11 and location of wall sheathing and Builtf[ng Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7116"and be installed as follows: L Panels shall be Installed with strength axis parallel to studs. IL All horizontal joints shall occur over and be nailed to framing. gL On single story construction,panels shall be attached b bottom plates and top member of the double • top plate. •- , !v. On two story construction,upper panels shall be attached to the top•member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first boor framing. v. Horizontal nag spacing at double top plates,band joists,and girders shall be a double row of ad staggered at 3 inches on center per figures beiow:Vertical and Horizontal Nailing for Panel Attachment S. Glazing protection:a)new house or horizontal addition—required if project Is 1 mile or closer to"shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first•ffoor c)replacement windows—needs energy conservation compliance only(chap 93) 8.Wood Frame Construction Manual(WFCM)for 1.10 MPH,Exposure B may be obtained from the American Wood Council (AWC)website, YVF ITIMEDMEFEMON ' FW IMUSEWN"s 'ATb"= At N A At it o !1 It•{u. I ! I II• . dat idj o A I7 .Q •1 tat 1 , it Q it ! ► 1 ° FAA611Nt'aMF].RBt� ► iri itit !' S ' ! ► r ,! _ ► - I— d U �; ; . ! t! „ yge li j► 1 •`. It H 11 . DOt1t3LE�G� S'TM a•MM1 NAI4SPACJNf3 Wl►L PAT7EitJ 9Pig, t� PRt�'� EDt,'.'E I]ou9lENAR®GES?AMG MT7tiL. . Sea DataU on Next Page Detall Vertical and Horizontal Nailing Vertical and Horizontal Nailing for Panel Attachment for Panel Attachment ' Town of Barnstable o � . Regulatory Services Richard V.Scala,Director Bu ldh g Division Tom Perry,Building Commissioner _-----�__ ._._ . . .._._.---.• ---..._. 200 Main Street,Ey=*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 J P PAY - hereby authorize to act on my behalf, in all matters relative to work authorized bytil building permit application for. (Address of Job) '`'`Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled-or utEwd before fence is installed and all final inspections are performed and accepted o S1�TTp of App 1 At , � vU2' V e ff Print Name Paint Name Date a WORMs:OWI PERMISSMWOOIS 'i-own ot-Barnstame . Regulatory Services aF rOiyy Richard Y.SmIt Director Building bivWon SXUaMMAMM Tom Perry,Bu kling Commissioner 200 Main Sh=f, Hyannis,MA 02601 wWw town.barnstable.ma.us . Office: 508-862-4038 Fwa 509-790-6230 H0ME0w1aR UC W EUMRTTON -- -- — IImsePtint DATE: JOB LOCATIM mamba sued village '�iolv>EowxEtt: , name home phone work phone 0 CURRENTMAII NGADDRESS: eityft m ata>z zip code The current exemption for"homeowners"was extended to include owner-oggmied dwellings of sic units or less and to allow homeowners to engage an individual far hire who does not possess a license,provided that the owner acts as supervisor. DEFIIQt!'ION OFHO.MEOVnUR Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm strictures. A person who constructs more th m 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 resoonsrble for all such work performed under the buiMing permit (Section 109.1.1) The undersigned".homeowner"assumes responsibility fur compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she nnderstu ds the Town ofBarnsteble Building Deparimentminiffinn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signahue of&meowner . Approval ofBim7ding 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 E%El<IMON 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 assurnM9 the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. . Q.XWFHM\FORMslbO&gpermitfioo OEURFSS.doc Revised 061313 Scrir4i, oe, k r / �y .. a 111 P S " IT hc .„+ ,�.v n•,n r YJ x tl v �,......_...... g 11 W C�/e maa��aaaztaec_clf/aC�l��i�t sic/u clts office of Consume Affairs&Business Regulation �OME IMPROVE RENT CONTRACTOR ff�ih_ registration: J30373 Type: 5i Expirafron 2/ $12016 Individual -- RICHARD FOGARTY RICFIARD FOGARTY :_2 254 WALNUT ST g=� MARSTONSMILLS MA 02648 Undersecretary 9LOZ/�LJL 6 Jauo►sstwwoo uol}ejldx3 OY7W S 3oq Smolsam .LS ZMl'IVAA M �-' 2>�90�T d Q�IVHJlt2I `t. �g6£gp S�:asuaoi-j rrnr.cadnc nntsin tisuo- ::=:`,c.er'�'�?5 pte suo;;e;n�a� 6u.lrl:rg Jo P1eofi A}ajes otlgnd;o tuawpedaO-s}}asntlnessew Town of Barnstable *Permit 74 IT Regulatory Services Fee Richard V.Sea%Interim Director lWst'.. d @ TO �� � - � �Al�LE Tom P Perry,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.banastable.ma.as Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Vaud without Red X Impmat Mab/parcel Number t� �� Property Address S residential Value of Work$ l 3'751? � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � /Ui< O � N S„��-_GNP f�1> S•rYl 6?,6o I ADdb Contractor's Name S o cAAMU Q-F—. W t 1U 11I S A FM)UksoaTelephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 0 /q67b 7 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ' I have Worker's Compensation Insurance Insurance Company Name MAW- 1A5 Workman's Comp.Policy# W6- 7 a*7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Re uest(check box) [} Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value -�t) (maximum.35)#of window Q #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where mpiced_ wusnee of this permit does not exempt compliance with other town department mgule ww,i.e.Historic,Cowavauon,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. t • � SIGNATURE• TAKEV1K_D\BuU bg Changes\EXPRESS PBR?vff 1MRESS.doc Revised 061313 Southern New England Windows d.b.a Dnr�naa,al 4+��Anel®rean of SNE _.,�� M.'¢ssce,lz -+t: L� ;;twr£S7l ev,Cf t�Ui?:;iC S",5.:i`y' Board O��..i:;�lCfliiCJ 1 eC6lla avltS and c'tP..it tl$.f35 CS4395M § BRL4N D DRNNMN } { 7 LA VMS PON16. IIMCU Chariton MA'01507 ;a • • moo#3A \` _ ' . CG ilra,.==icr r 09/0812016 I , w Office of Consumer Affairs d Business Regulation —'n g 3{ jj 10 Park plaza - Suite 5170 Boston, Massachusetts 02116 Home.Improwement Contractor— Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119/2616 DENNISON BRIAN - 26 ALBION RD LJNGOLN, R!02865 Update Address and return.card.,Mark reason for change.. sGA 14: 20,MrOsrn / Address C Renewal. �Employment i` Lost Card ,•.� Jae��y:,»rc.rrru�irll�f�'C':%(rr.°.Nir�rr.•r/(� , .' ffice of Consumer Arf3irs&6usinessReoulafionLicense.or registration valid for individul use only. . y !'fQME IMPROVEMENT CONTRACTOR before the,expiration date..7f found return to: —� f=Registration 173295 Type' Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration: 9/10/2016 Supplement•:;ard Boston,i41r102116 SOUTHERN NEW ENGLAND WINDOWS LIC. RENEWAL BY ANDFRSON DENNISON BRIAN 26 ALBION RD LINCOL'N,RI 02365 Gnderseeretary Not va'. ..iLle4uCsignaLure: The Commonwealth of Vgiassachusetts Department of indus&W Accideaats ®ffa�e oflnvestigataons 600 Washington Street Boston,M-4 02111 wmmass gov/dia ®Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electrieians/Plmmbers Applicant Information PIease Print Legibly Name(Business/Organiaation/Individual): �5 0-t-7 ku! Zip/ A l Address: o"2 L tJ r CitylStateMP.- L/N-C.m tit - 0--7565- Phone#: LJO �M 'Are you an employer?Check the appropriate boas Type of project(required): 1.�!am a employer with 9-0 4. ® I am a general cJn tor and I 6 New construction employees(full and/or part-time).* �e hired the stractors ❑ 2.111 am a sole proprietor or partner- listed on the aheet 7. (]Remodeling ship and have no employees - These sub-contrahave 8. ®Demolition working forme in a�capacity. employees and horkers' 9 ❑ g addition [No workers'comp.insurance tromp.insurance. required.] 5. 0 We are a corporad its 10.0 Electrical repairs or additions 3.® I am a homeowner doing all work officers have exe their 11. Plumb' r g ❑ mg epairs or additions myself.[No workers'comp, right of exemptioOLinsurance required.]t c. 152,§1(4),andave no 12.®Roofrepairs employees. [No ws' 13 OtherWI/'V lei comp.insurance rd.] gAay applicant that cheeks box#1 must also fill out the section below showing their workers,compensation policy bin t Homeowners who submit this affidavit indicating they are doing all wank and then hire outside contractors must submit a new affidavit indicating suck tconhaetors that check this box must attached an additional sheet showing the name of the smb-coatract na and state whether or not those entities have employees. If the sub-conl:actors have employees,they mostprovide their wadorra'comp.policymrmber. I am an employer that is providing workers'compensation insurance for my employee& Below is the polio,y and job site information. Insurance Company Name: O Policy#or Self-ins.Lic.M W ' 7 �j 9 3 S neon Date: Job Site Address: � ( c7/G I!�� � City/Statef4:, v- 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby Ze ains and penalties�qfpeju�ry&&the aref®rnration provided ab v is true and correct Si afore: Date: t / Phone#: 7 / Official use only. Do not write in this area to be completed by city or town official City or Town: Permit/License# _ Issuing Authority(circle ones 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Impector 5.Plumbing Inspector 6eZther Apr.06.2015 18:17 PAU1 CONBOY RENEWAL ANDER. 781 545 1213 "PAGE. 1/ 2 ftnewalRSF L By lid byAndusm •mmw Bi Alhiuo 1Zuad * I ltitsriil,ltP(atis L�a1�trri ai�7v [J� 1'iariu:l9fifi-5(,,i.2'Fi:�-Fsu,4(i1.b33,C�(11 rcAu,l�..¢��ui•v�i+� Sontkeen New.Gogia.d NFaedawc,ddZ dAda Roaawal by Asftis®a of Southern Nitro EnSht d CUSTOM WINDOW AND DOOR UMODEFiNG AGREEMENT �ft 6 u'r A-, bq=r(sI ScecrFblrcpr.Grfa�.Ord>7p Caia(t P.Sa�oac_ �'.y_jrfL C!/ /dsvr¢ - -"-- - �/ /��✓PIS���yr_•I..LIJi_�!09`��/ "• --- - __ -._ :.ratrae-� �:�. .5�+/��!%j.�_r�%_���ems..-► rdwiwier,��� d�77//'.3�G ne«� ne�N •fa'��3�-�C#,$ 17tt}Yr(iJ 5arebyjait511y:attd tatrur lily xc3 iu Past b6nc,d��pnximm nc►c1lti?SCtVR# :i�HAuuhi:ns Yarn Ei &uui Y�Snrfmm f:l ft �, d/hf:1 Ra ircnail by Mdi:mm of Simfltom M.Av L'a�(<agumn lcw),its nmumt•i=,wilh tim 6anm sual iXnidils.Um ifekul led uu USE(tabu and dW Mevw 4 tlos ugrcetneuL libel Im 16.;Mad.ted gm4immitulki Jkurtmryti lcallibcdveOy,teas"ilia-,tmnere} (3 Memiu-C 4 mulls O tiOAT f. TgtaliOA �j� Ear�a%W SeDvelat Qsto Ntet od of Pay m u Ched: I:!66 crd Deposit Received tom. . _ - Crerfc Grads are omeed 11 t d+g"t only-.macaLi is la of die' BnPaioee et art cif js6(3 )—_-: Etrtrgrp f Cnmpiatlon imst.BPl m ilea Oudb Cad Pty Mt iormL By slpilns ttat.' Atrosmwat;you anowlbdgp than rha 8thnro at Snit of toll and the Bahnm an i siiki�witi ic.i. a N of�6,.tM 4 t*mmo#by t*w CaM7n 4Dt jmE it-- . , - .' tafd End mum�a mgda�`far�angl chuck-_hank cfiecta,ae cadn' 10ayer(t}}a bee atad vttdt�sataada tistt this Agreamast titwoas tbs era a�d�tvtsuidm5 6atwm&►be P si and.. Chili thus ate mo vurbttl vixieriouialip Am&B auy of t1 i tsama'of thus tugroctmeu:.Htty-Wil anbn&w&djjee tbac 13 )-ts} (1)tree,onset th Agmc®eai, toeo■s d8 t)bfi uiaat§dnd bag "a doi,nptski d;�-0petl;a"�Ia eiA copy oP tbitt "elip„r,lndaditig the two ai"4ed mc Nodaea of Gael�mt o on the datetlr wiffiltea above and(2}was oaajly ialosa►ed 4 8nyr�T.rigii to cancel 41"AQseemcaf.:BQ:NOT SIGN T'HiCS GONTR=T:FFT*TME ARE ANY lt1.A K SPACES. (Rftvtdo lalwad�'ttie�IYre{vf 3s',otace to Ruyxrt{l}1)o nut es�t�'Agroemcstt d+�4'of the spaces iatsatded l6as tl�e a tertnti m tBt etcttmt of then avattable iafgrttaatltio tare left iftitstb.(x}`You tu•c entitled m w trogyof�,ie+tg�e><ot�,t+#itu torte Yon tx�u i*-(�"Yon tatty eta way time pity off tie tau unpaid h#itmec due wee tlhia Agreemta6 and$a a:a dofmg sop may 6e emthiled aii reeelve a pandol tAme of eho fioaaateo and'ieswiwpcs An,rps.(4)'lea igilft Li has r%4 to mdawfrtlty emetr your premises or eauittnit stay,bi bash of flue probe to reporo=ara goads ptisie6aged antkse Olin Affiifeaetaa t$)You meoi ttaao l dds Agreetneiit' It It Ira not been algaedatthe;ti W#oliiee.oe a braniaho®er of the"er;proWdedSou iodif rhe'seller. his orhert" nf7icc.pr lu tinckol�ce slwiwati In the Agtiee ,uat fitter thausttidnight of i6.,t6ird`caieudttr day alker the_day oir,wbleh the bujim eigita the Agreinittk4 emdeiding Sanday sad airy haiidiy of which teguktr moildeRverles are root made.Sit the aecomp"v iiiemotico of eameenatlam Toarm forat a etium at bityar W Itlg hta' i4Lty�:r{yj nra:tv� Rh t4f."IM1101 - RenewRl.by t�gf�,i' a Bayu(s) om i$"l'nttlLilL�"• _ `gtkatl y `Silsrwlut�<:_ 126 uM.F PtlruNaueeo ft;dt ct f'riiiA'Tlstt*+e Prim N �` V0141 THE HUYF (s),;MAY lftW9PL T l8 MACTION,AT.ANY,TIM>PRiOR''TOHMN10HT OF T1IM. >IQ sS3 DDA�YAa7rr>rnx THE TDXTE OF�,">�l I.t.�S tRAN&&.od ON M TM jLt A im r��nM OF CANOE.IATION t0a>1s F0KANyeOTICE— — — ON * _ NOfiC yrcAFtcmimmM Date aF'l tsaction 1'ou may:cancel ' Date of Tltittratdon.:' :You may cancel ere this inn;with y peiit,lty o_iAltgattor ifmin this transaetionj wti,wbut&4 l penalty'or obigb * f tlhro:bltir rr ha bbyM@dtta.'ff you taw three hsnesa hahieda If n you aeirm al,ml. P^'PT tradid t'h a"1r:payment;made fay,you rJnder ate I peoperq tratfed n,any pajrrrt�v� by'snit tuber flits Conm4a or Safe,and u1ry its tiabPs irratrutttent't ecoated I +Contrast or Sale,aitid my aegaLiable irm6ument emilcuted b1T yoe.wiil be'retttnmd.with(in ten bu mess days foll"rris I by jrou will be rotutbmd wlfitln trttt busltyres days lalloirltig raedltkt bar the Solidi of your ca®aellaePotl notPtx,art( Irbil i "rcoeP bbyy.the Seller'ef viiitr"eancelladin'notke;and ar. iecn..ty Trite* t ar+ti!t)i oat of.the,liartsactttat wbl be s u ty ittttBrest atf I out of tit® urar►sattfc�at,str111 be C,'tf1ClMt If sae tea cl. a mtastMe C availabPe tu'the S�� I canceled.If Camel you ballet make avaitebPe to ills Seller: at your,resldwooiin.suvssumdallyas tic dettoriisah ety�owyrvtriidynem.itisXvaWxllyatgoodeondi sa<.whan received,attic foods dellve;,ed to rbu undvw this Go�4 sego• l receiwd,any goods diliiured to you undesr'Nna Contra,ct.vr wim.or you:tiny;f you wiskccifitoiy.wltlW thir.itlstrcicetatl>t of i 5�a;.or ytis n»sK,ti ytrii.wish cQiTtply itri�t this tn6t ctiotes of :t ;the Seller re3ardia►E the returtb'rltt(trnant of the good>A rt H+e:a the Setter iegair ing they ietum sltiptruaett of the'goods ak the, St�iA,eitpense and risk:I(ybu do make the goods 9YA91bW'I'Saki s s Ss mnd i iik.if you db ivx the E�ads available to.thr Selher sad the$Wler does not plc_k theM up wttl,lti is the S and'ths S4tler tl0tts tttlt pEtlt nt►orn t+P 1Ltttlf�n ;tweaq days of the dgti of t:attcelia'"%yob may retelr►'ar •t `tsvr*days oI the date 04 raaecftelonj you may reWn ar d-npow of the g"ids with*ut wq fuither ahh$ahtsn Of you 1 d`iisposa of die$oa&vAthout any(urdw o6111 tlon,tf y4u foi! rrlal�the sonde avatlalhle l4 4ite 8eileiy tiR if lieu agree I fail"i01t1a ,Nit moods firatia$k HO tilteileir.or if Yeu.age to'return the goods to the Seller and fad to do M bind YOU "Wm ffia goads i*this Seller and fall to do tom,thm you. :retrain liablia far' ifortiiamj� a("all c6ligitmtc{urid4r,tl,e ratnaiti.Ra17lu,�perbimance.'of A uialigationx utrdvr the' r st:onteact:(o cartceltbtsatssse#loi�,txrail"or tldPirtr ttgi<ed l t'.QrttracCTo t 0ert a1tis't►atieetcdioie.tiaa[i ce deliver a aFgrted dated "oo¢y:,at thi3 sarLtelfatiett tbk;tc:ar_arty other 'rid dated 4 1r of this.caittelWan vW ce or atry other, wettnitottg6er.setidatefu�a Z4AertevtAibllAlndeYtenof'l vnirtttiettttltice,o�aetidstrlcg�rt buWenswslbyAtrdarsen4f Snuth4ih kim Cxtzland at2'6Aitiion Road,L Lea 26bS, t.SoiMerti Miles EnsW 'at 2+tAlb M Roid.Li WWNRI 021165; sh141":LALT'ER"T'HAN MiDNIGKT (W': ;I NOT LATERTHdtN iVIbNtGHT bs (Date) - 4 HEREsT,GIMICEL,T}+ISTRANSACTIO V. 1 HEMBY CAMCELTHIST-RAl4SACTIOM ,. . � !W�+✓a �: '� Pebat ttaett - .Dtd:a - eut�t teafa� PNat Nttn! - thWl.. < RNA Copy whU6 Beryar Cmiryr Yo9k' a.-' C ptiq ,? N „ Ae RO O® CERTIFICATE OF LIABILITY IN DATE(MM/DD/YYYY) l `� INSURANCE 08/12/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis of New Jersey, Inc. NAME: c/o 26 Century Blvd PHONE FAX P.O. Box 305191 E-MAIL •1-877-945-7378 AIC No:1-888-467-2378 Nashville, TN 372305191 USA ADURESS:certificatssWwillis.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of SR 39926 INSURED Southern New Ragland Windows LLC INSURER B:The Beacon Mutual Insurance Company 24017 D/B/A Renewal by Andersen INSURER C:Argonaut Insurance Company 19801 26 Albion Road Lincoln, RI 02865 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:W529169 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MWDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 A y MED EXP(Any one person) $ 10,000 S 2029459 08/10/2014 08/10/2015 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 POLICY a JEa a LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY CEa MBIBINdED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL O SCHEDULED AUUTOSS AUTOS S 2029459 08/10/2014 08/10/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS - Per accident A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,:OOA EXCESS LIAB CLAIMS MADE S 2029459 08/10/2014 08/10/2015 AGGREGATE $ 5,000',.000. , DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N X STATUTE ER B ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? � NIA 0000068028 08/21/2014 08/21/2015 E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Work Camp/EL Covg: NC927938352394 08/21/2014 08/21/2015 E.L Ea. Accident - $1,000,000 Statutory Limits - WC B.L. Disease Policy List - $1,000,000 .L Disease Ea. Employee - $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required own of Nattapoisett is included as an Additional Insured as respects to General Liability when required by written contract/agreement as per policy orm. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of Mattapoisett 16 Main St P-r, Jy". 11attapoisett, MA 02739-0000 7L C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD SR ID:6629625 BATCR:Batch #: 79627 = a t Town of Barnstable *Permit#f y/Ala)` Expires 6 mo&s from issue dale �T Regulatory Services Fee r e� * snxtvsrnat.e, 9� atnss.1639. Richard V. Scali,Interim Director ArED MA't A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �, Not Valid without Red X-Press Imprint Map/parcel Numbel�O Property Address Residential Value of Work$ /(60, CA-' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address a Contractor's Named Telephone Number $`4� Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) O,?9yl ❑Workman's Compensation Insurance ' , IT Check one: JAN 2 Y 2�14 �, I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance T®wN OF 13ARNSrgBLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: Q:\WPFILES\FORMS\building permit fonns\EXPRES . oc Revised 061313 r ._J 17ie Commorrivealth of Vassachusetts Deparftnent of bulmsfrial Accidents Office of Investigadons s 600 Washbigton Street Boston,MA 02111 ww inamgov'dia Workers' Compensation Insurance Affidavit:Builders/ContractorsMectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Ownization/indhUnal): .41d C -Cf "COO�7�y Address: �2,<Y AJa/n W city/statr/zip:&,ari A /�l At? A Air 0 026 V8 Phone 9- s'68- �7y� Are you an employer?Check the appropriate box: �T :3'1 of o`ect(required): pT' J (r�I d)= 4_ I am a contractor and I ❑ 1.❑ I am a employes with general 6_ New otmstnrctiou employees(full and/or part-time)* have hied sub=contractors. 2_ I 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 forme in any capacity_ employees and have workers' 9_ ❑Building addition [No workers' comp.insurance comp_insurance_I required] 5. We area corporation and its 10..❑Electrical repairs or additions officers have exercised their 11..❑Plumbin repairs or additions I❑ I am a homeowner doing all wards gp . myself. [No workers'comp- right of exemption per MGL 12_.❑Roof repairs insurance regaired.]1 c. 152, §1(4),and we have na // employees-[No workers' 13-.❑Othee Re , I,l'lto comp_insurance required.]: *Any apptictat that checks boa-1 mast also fill out the section below slowing their woden'compensation policy nformation- T Homeowners who submit this.affidavit indicating they.are damg all work and then hire o=de contractors oast submit a am affidavit indurating mdL 1Cantracturs that check this box must attached an additional sheet showiing the name of the sub-cona3ctim and state whether ornot those emfities have employees. If the subcoutractors have employees,they must provide their wars'comp.policy number. I am an employer that isp 4"4dsrtg tt orke-rs'cornpertsalion irtsrtrance f br ttty e.mpLayeU Below is Ste policy and,}ob site infOrmalron. Insurance Company Name: Policy#or Self-ins-Lic.4: Expiration Date: Job Site Address: City/State/Zip: Attach a ropy of the workers'compensation polies 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 ofcriminal 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 Im,estigations of the DIA for insurance:coverage verification. I do hereby c;erti: ha its and penalises of pcUnty that flee information prat�ided abmw is bw anti correct Sitntature: Date: 12,411 . Plums; Off vial use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Issuing Authority,(circle one): 1.Board of Health 2.Building Department 3.Cit !Town Clerk 4.Electrical luspecto€ 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 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 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 Iocal 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 cei t ificatc(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 confznmtion of insurance coverage. Also be sure to sign and date the affidavit. 'I he 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 vrorkers' 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 permitllicense 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 M (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. Anew 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 G-c.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Ike 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 Indust dal Accidents Off m of kvest?gatians 600 Washington Street Boston,MA 02111 Tel#617-727-4900 W 4 Q6 or 1-977 MASSAFE Revised 4-24-07 Fax# 617-727-7 749 vr .mass_gov/dia �l = °F-ME ram, Town of Barnstable ti ✓ °� Regulatory Services �tnxrr Bm SS, g* Thomas F.Geiler,Director 639.. 46.1 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 VII .Aown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L , as Owner of the subject property hereby authorize 1 CA,/ l'd✓: 1 to act on my behalf, in all matters relative to work authorized by this building permit 3 7 S (' / V.-e4 � C) (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. F Signature of Owner Signature of Applic 54 iI y 13a untj ; 4 nrl ac�� Print Naive Print Name l Id-b Date Q:F0RMS:0WNERPERNflSSI0NP00LS 6/2012 1) S oET Town of Barnstable Regulatory Services EARNSTAMY, Thomas F.Geiler,Director Um 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s) for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currentl),used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\LocallMicrosoft\Windows\Temporary Intemet Files\Content.0utlook\QRE6ZUBN\EXPRFSS.doe Revised 053012 :► . Office f wlo.°"e ., k�u�,a s' Q a License or registration valid for iudrvidul use only HOME IMPROVEMENT CONTRACTOR.:. before the expiration date. If found return to: Registration 130373 Type: Office of Consumer Affairs and Business Regulation Expiration: 2/2812014 Individual 10 Park Plaza-:Suite 5170 - Boslon�IVIA 021ib-'.:• . , RI D FOGARTX RICHARD FOGARTY= 254 WALNUT ST MARSTONSMILLS, Undersecretary Not valid out signa e Massachusetts -Department of Public Safety. Board of Building Regulations and Standards i Construction Supen iwr License: CS-063941 ts, , fUC 1-A"P FOG RTlC 254 WALNUT ST ' MARSTONS MM.S Mi�02648 - Expiration ' 11/11/2014 Commissioner TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # �" . — Health,Division Date Issued c A Conservation Division ✓ Application Fee Planning Dept. Permit Fee lIG 'r Date Definitive Plan Approved by Planning Board oK ,`4 -Zy- I3 Historic - OKH _Preservation / Hyannis Project Street Address 5_ Village Owner Address �� S,`Uaj_ LAka. Telephone 50Y 2 13 36 Permit Request RPM6 d ll�� k S r�� Id 11�t. 6 k// dec k r4 4on d6or o -10 house Square feet: 1 st floor: existing 10proposed 2nd floor: existingproposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 00-Ud Construction Type I: 00d Lot Size /3 CTe Grandfathered: ❑Yes "o If yes, attach supporting documentation. Dwelling Type: Single Family Uf Two Family ❑ Multi-Family (# units) // Age of Existing Structure 73 Historic House: ❑Yes �o On Old King's Highway: ❑Yes 2Tlo Basement Type: dFull ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �'vff Number of Baths: Full: existing .2 new Half: existing new Number of Bedrooms: 3 . existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑ Other © o Central Air: ❑Yes i(No Fireplaces: Existing New Existing woQ:d/ oal stove' ❑`des ❑ No 00 Detached garage: ❑ existing ❑ /new size— W existing ❑ new size _ Barn: Ole(isting O'new;size_ Attached garage: Udexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes WA No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name tc�ard 1�_0 4/- Telephone Number 5_4 8• %9'- 89y% Address o?rV 4)Ali d7 S t License # (S- 0 6-39 y l .Ad w_( ✓�� ��S ma• 0- ( y g Home Improvement Contractor# 1172 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� �� �r t � FOR OFFICIAL USE ONLY R APPLICATION# r `. DATE ISSUED MAP/PARCEL NO. Y `R ADDRESS VILLAGE Fr OWNER ' 4z DATE OF INSPECTION: : -FOUNDATION . FRAME �3 INSULATION FIREPLACE F ELECTRICAL: ROUGH FINAL y PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ,g r.` '..i .. _ 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): OC-Lrd ro4ar 6 Address: City/State/Zip: Agrf nS , r!S Phone k S '- 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.[9 I 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 tY• 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 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 i i employees. [No workers' 13.❑Other . �e� k 6 x 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. lContractors 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.Lie.#: 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$1,50.0.00 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 u er the pains andpenalties ofperjury 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'#: I 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 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 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)acid 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 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia-. i Town of Barnstable ti Regulatory Services + sntuvsTws�, + y� MASS. g Thomas F.Geiler,Director s6gq. �� 16.19 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject l property hereby authorize 414ic r— —6 to act on my behalf, in all matters relative to work authorized by this building permit. S�1 vim- 4,(W Ae,— A P S (Address of Job) C) **Pool fences and alarms are the responsibility of the applicant. Pools are not to.be filled or utilized before fence is installed and all final inspections are performed and accepted. AIA L:�� Signature oflowner Signature of Apphc 5 � 1 2Rl A'cLfrl A mr-7' Print Name Print Name —� �U l3 Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 �IK Town of Barnstable Regulatory Services '"'MAB& E Thomas F.Geiler,Director �F 39. 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit-is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Office o��on me at ns�q ega1'at,'`r License or registration valid for,-,,,,,., ul use only HOME IMPROVEMENT CONTRACTOR ,hefor J;t expiration date. If found return to: Registration _,130373 Type: Office of Consumer Affairs and Business Regulation Expiration 2/2W2014 Individual 10 Park Plaza-Suite 5170 Boston;IVIA 02!llb k!6FRD FOGARTY i RICHARD FOGARTY 254 WALNUT ST- MARSTONSMILLS,MA.U2648_- Undersecretary Not valid without signa e 1�t Massachusetts -Department of Public Safety Board of Su'ild,ing Regulations and Standards Omstructiun Superi'i-sor License: CS-063941 RICHARD P FOGAL rr�y'�Il,u 254 WALNUT ST = MARSTONS NII�I.S NiA 0 8 :xpiratlon Commissioner 11/11/2014 o µ • o- _ y I � � }(p,� ._t J_. ,• gg � � r �7 Tfir....._ ti '__ � ,.� .�_2R.... �. .__,. .........�,, w._,..�.... ..... .... _,,,.. ..... 1-4 71 0 1-11", zi 7. 7 7. rl-91 — ..,. �,_.. t , ' xn_.:+w.r,uw.n...,»r„,w, '�":µN+�.:..i.xr>»aan.u'�eusFxA6ie,Ww,e�W;v+CA.nw.,.aM+weMw,'M�::a•wN ! a!r..'.b.w-. v..;u�.,Me4.,nw•r�>aanrt�n:ve'.r rpn.•knn-�Y,,�-rw.�.,. , . ..::...., ,...+t .,,••✓•.;.,... '...,r uv..l a.,.. ff 4,..� ..„«...n ..,�,._ ....n. c......•. ,� yny iw,.e n ' ✓d/caS �6r�QnC., xG Soi'tf& t 0 t ;poil F OZX Va`:ra'ft:�!'�Ps��M]^"M ..swvaem..e��Nnuunwwvawwuwa+.x:s'a'.e:.si+:[t.. 'MAHssbt�+J.wr.Jtr&s}'y�.'Qa.t�,,.Y'cW�ggli�V.n,rt l'M k€1�.Fi ...av'Mq.>:,.'•4, ..-.:ti°F':T,.:n nr,iwv.1.«t�vr+.�it`.,nf n. • x n urwa Y f �g� � �/fin• . � � �� d Jt" � ;�,, �, � } _ :i�..�.....«..,�.....+.,.......:�..,�...,._,....:....««.....w•«................._,....� �d' �.,...�.m.....,....,..».,w.«...........�..-:—...«�..»„�............,.....�.—.:...,..,,,_..,.,.*...r—... �'R-. ~NM�.�,,.�56°�,��„�..,«.w,. �r„�„$...ww.w..H�. �:M .. •. t g 6 JIL q M 111 A 4 � � n d .....,. ._....e.,....,,.....�....__r..... .. ......,....:. .... ..:..,r.........,..... .....n... . Town of Barnstable Geographic Information System April 11,2013 268161 � #81 0AA �s oA \V`�� AAA VA 268162a #87 2W 159 #21 ' 268158 #37 RPM 268157 \[/�n w 6'xil' #43 �� sr4v�R RN DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:268 Parcel:158 Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:BOURN,SALLY A Total Assessed Value:$292700 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-owner: Acreage:0.33 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:37 SILVER LANE f such as building locations. Buffer W+ ✓I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 14. Map. Parcel Application # "�-' iv Health Division Date Issuedz-- Conservation Division Application Fee Planning'Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis - Project Street Address Village i7 I� Owner _�Gi �� P, Address -5tIlfl Lf7 Telephone Permit Request '1 c� l cal✓ �� Ale Alw;,- s Square feet: 1 st floor: existing ibproposed 2nd floor: existing proposed Total new 6 Zoning District Flood Plain Groundwater Overlay Project Valuation � U b.eo Construction Type eo Lot Size[ re, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family L Two Family ❑ <Multi-Family (#units) Age of Existing Structure �0 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 1Q Full ❑ Crawl r❑Walkout ❑ Other Basement Finished Area(sq.ft.) �/� Basement Unfinished Area(sq.ft)��� Number of Baths: Full: existing_ new Half`. existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: dGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes O No Fireplaces: Existing t-�2 New Existing wooWdoal stovi3 ❑lids d No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn ❑-existing anevsize_ Attached garage: 2 existing ❑ new size _Shed: La/existing ❑ new size — Other } 5 wh Zoning Board of Appeals Authorization ❑ Appeal # Recorded,❑ ' Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ew r' .} Telephone Number Address 2-r� �44 r/ License # A✓(,A/7Y ti.)i L� Home Improvement Contractor# /.?a Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO q S'�SIGNATURE ,,1X DATE�. ' . L i FOR OFFICIAL USE ONLY 'APPLICATION# z DATE ISSUED MAP/PARCEL NO. r� ADDRESS VILLAGE i OWNER DATE OF INSPECTION: f FOUNDATION FRAME I� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i� DATE CLOSED OUT ASSOCIATION PLAN NO. r. E, 1 The Commonwealth of Massachusetts Department oflndustrial Actzdents e t Office of Investigations 600.Washington Street , Boston,MA 02I11 W".mass.gov/dia - Woi-kers Compensation Insurance Affidavit: Bun ders/Contractors/Electricia.ns%P1nrnliers, - Applicant Information {a +, Please Print Legibly Name(Business/OrganizationlIndividuat): Ric Address: Sa4 rl✓ J'�" e ? ¢ * :r k City/State/Zip: - ya Are you an employer?Check the appropriate.bog q F11_100E project(required) t 1.'❑ I am a employer with 4• ❑ I am a general contractor and I employees(full and/or part-timel * . have hired the'sub-contractors ew con'struciion I am a'sole proprietor or partner listed on.the-attached sheet., emodeling� a These sub-contractors have t ` ship and have no employees _ emolition working for me in:any capacity. a ' employees and have workers' "` co $' wlding"addition" *[Noworkers' comp.insurance mp:insurance.required) `5 ❑ We are a corporation and its ectrical repairs pr additions3.❑ I am a homeowner do' atl-work a. officers have exercised their "mbuig repairs or additions myself [No:workers'comp: - right of exemption per 1VIGL insurance re ed t c 152 1 4 and we have`no 12.❑Roofrepairs 13.❑ Other `.employees. o workers' _ . '�',,VT _ .,comp.insurance required.) _ h w" *Any applicant that checks box#1 Est 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 they 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 4 I am an employer that isproviding workers'compensation insurance for-my employees ;Below is hepolicy and job site information. Insurance Company Name:- Policy }.- #or Self-ins. # - y Lic ' "Expiration Date Fa ~ lob Site Address: Attach a copy of the workers' compensation policy declaration page-(showing the poli1.cy number an expiration date). . Failure.to secure coverage.as re - " - ` � , g quired under Section 25A of MGL c.1152 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;;WORg-ORDER and a fine�' a of up to$250.00 a day against the violator.`Be advised that a copy-of this statemerit.may be forwarded to'.the Office of Investigations of the DIA for insurance covera a verification. I do here# certi under the Ws-and enalti ;_Y fy p p es of perjury That the information provided above is'true and correct i r: Signature:, G. ,Date: ( Phone#. ;CC1 Official use only. Do not write in this,area, fo be completed by city or town official r City or.Town: Permit)License# p` ' `Y Issuing Authority(circle one) _ 1.Board of Health;2 Building Department,3. City/Town Clerk 4 Electrical Inspector 5.Plumbing In ` 6. 0ther Contact Person: Phone#. �i 4, nK 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 receiver or trustee-of an individual, arts association or other le partnership, • gal 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).aho 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." AdditionaIly,MGL chapter 152, §25C( )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 presents to the contracting authority." Applicants Please fill out the workers compensation sffidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s);addresses)and phone number(s)along with their certificates)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 havd employees,a policy is required Be advised that this affidavit maybe:submitted to the Deparmment 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"all4ocations 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 ersoij is NOT re ed to complete P required 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:. e Commmviwth of M=arhuwas Departmejat of lama AwA mts Office Qf baves-tigations 600 Washingtcui StmQkt r BostGn,.MA 02111 T4.#61 7- 7-4900 ext 446 o�r 1•-M MASSAFE Revised 11-22-06 Fax## 617-727-774� . wwwmaSs. -OV/dia E T Town of Barnstable Regulatory'Services rNAB& Thomas F.Geiler,Director 1659. o i Bnilding,Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstabie.maxs Office: 508-862-4038 j Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using_A Builder L - , as Owner of the subject property . hereby authorize to act on my behalf, in all matters relative.to work authorized b34 building permit application for. (Address of Job) ' Signature of er Date s Print Name If P%*erty Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side: 'Q:FORMS:OWNERPERMISSION Town of Barnstable T Regulatory Services. Thomas F.Geller,Director 9�A1639. ,�� Building Division �a 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 Please Print DATE: JOB LOCATION: number street. village "HOMEOWNER": name home phone# work phone# , CURRENT MAIIJNG ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER - Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. . Signature of Homeowner , Approval of Building Official Note: Three-family dwellings containing 35,000;cubic feet or larger will be required to comply with the State BuildingCode Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt P ' r L r . '1lassachu.etts- Department of Public Sa#"ct% Board of Building- Re-ulations and Standards Construction Supervisor License License: CS 63941 RICHARD P. FOGARTY 254 WALNUT..'.ST _. - MARSTONS`MILLS; MA 02648 r.r �--G-- �-y-! Expiration: 11/11/2012 ('+qumissionca Tr#: 5739 . Office f ons�um ai "$a"4igess egu a License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , Registration: ,_a30373 Type: Office of Consumer Affairs and Business Regulation Expiration 2128/2014 Individual 10 Park Plaza-Suite 5170 —= F Boston,MA 02116 RI RD FOGARTY RICHARD FOGARW 254 WALNUT ST MARSTONSMILLS,MA 02648 Undersecretary Not valid without signa e . r ke U.<-e- bLul x 3-2 t 41 R Town of Barnstable Building Department Complaint/Inquiry Report Date: Rec'd by: Assessor's No.: Complaint Name: Location Address: WP Originator Nainc: Street: � _ "�"¢ � " •_����•r Slate: Zip: y 2 Vdlage: Telephone: D/E 7 71`,!7-3 9 Complaint = . Description: Inquiry 0 Description: For Once Use Only Inspector's Action/Comments Date: Inspector. E Follow-up Action Adclitional Info. Attached r int,nictnhudon: IW to-Depar=cni File Assessors map and lot number s �FTHET v Sewage Perrot number .. � .......,.D s r r i E • ` Z AHBA9eTADL • House number .......: r a 7.... ..................... ....: .:............. M 6 0 YPY Or. TOWN OF BARNSTABLE BVILDINIG NSPECTOR APPLICATION FOR PERMIT TO ................................jr ................................e..... ............. .. TYPE OF CONSTRUCTION �- . ..'r .... ............................................................................................ - N-/1 /� ....... ............................19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: AWE- Location .................®�..!................. ........................�!.� �� �i/. ......................... ^ ........................ ................................... Proposed Use ... ... i. .� ..1?:....../....... j......................... ................... Zoning District ..............................:Fire District A7vlf'� ...................... ................. f ... ,, ................................... Name of Owner�7 1' :Jj...� T-...................... Address ..................................................... Name of Buildertrd�t y1�..1 .8. ��. '°' 4,. .Address ,� `-.. d .. lf,�� � j l � ... r ° Name of Architect ..................................................................Address .............................................................p.................:..... Number of Rooms Foundation ........:............:. Y7 r ,.�.......................................... . Exierior .fr�. ..�d'�... � T f. I�?..., J'? daj,�e—;;... .....Roofing ............. S , ,��.p _E,�� - Floors ......................................................................................Interior .... .:.:.~ .. ........::...... .......... ................................. Heating ..... 7 .. ..... ..............................................Plumbing ......... AL ............................................................... Fireplace .... ..� .....................................................................Approximate Cost ..................✓ ...................... ........ ' Definitive Plan Approved by Planning Board -----------_:__---------------19--------. Area .... ....................... Diagram of Lot and Building with Dimensions Fee .......�r.7/:.... ....,...... SUBJECT. TO APPROVAL OF BOARD OF HEALTH t C� 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 .... ..... : ...:L...... .... - Construction Supervisor's License Qf......`..................... PINE, DAVID No no Build .AVdit i ....668.8... Permit for .................................... SiA'gle Family.. ................ .............I...................... ..... LocdtiA ...3.7......S.i l.v e.r...La-ne.....I.................... .. .. .. .... .... .. ..... .... ^V • ..................... S............................. .......... J Owner .....David Pine ............................................................. Type of. Construction ....E.17.ame........................ ........... • fit Plot ............................ Lot ................................. ,Permit Gran,,6d J.Vily...1i....................19 84 Date of Inspection. ........................ .........M9 --Date Completed ........................19,:2 "Assessor's m ' and lot number- 7: j : .} THE • _ C,� � Bpi tp�y Sewage?lPerml number ....... ...... ,/, r Z B9S8STABLE.'i House number .:`.-./: Z.n, ' :3...................... . 90o NAGI 639- • d 0 mp, a�0 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO t� ` ....... II N9...................................:.... TYPE OF CONSTRUCTION ,l ................ ............................................................" '...... ............. 1. z............................19 TO THE;INSPECTOR OF BUILDINGS: -'""—"The undersigned hereby applies for a permit according to the following information: ' Location ............ .� .� ........A111- ........!..�,1 . N �` ..................................................... ......................... .....: �.. '+►, Proposed Use .. � ��.... /��....Q ��� ................................................ ..... ........................................... �' .... r ...Fire /�/ Zoning District ....................!..1. ....................................... District ............. � 1. �!! ......................:............ j� Name of Owner /4 I. ... 1Vr% Address .. /�v��..���.!`............................................. Name of Builder !•a••r J✓v /r ........... .4 ....v......�....L..U.............(.�....�Addrs 19 Name of Architect ............................Address ......................:............... ......................:.:...,....................................................... Number of Rooms ....Foundation .��.! �� *� �� '� ..... . . .................... .. .. . .... Exterior ! .I , .0 ��...gh.�k4dc..........Roofing ...... ....:. .............................. Floors Y Interior htef �GG / ....... .©........a.. ............ . .................... �a. .......... ............... .. ... . ....................... ...... ..... ..... ... ... .. HeatingK ✓......... .........................:...........................Plumbing .........MQ............................................................... Fireplace .....V�5 ..................................._...................Approximate Cost .................!......`.C. .V.Q.......................... .. Definitive Plan Approved by Planning Board -----------_--_---------------19-- ----. Area ......�M�"� ...................:.... Diagram of Lot and Building with Dimensions Fee - .:. SUBJECT TO APPROVAL OF BOARD OF HEALTH r � - � r _ Io N 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. r Name /�.. ...LF ....... /J 4/ 7 • Construction Supervisor's License .................................... PINE, DAVID A=268-158 NoUUa..... Permit for .Build Addition ............................. ......5.jfjgjQ.. ................ Lon ...... ..................... ..................... ........................................ Owner ...pAyid...Pin.e..................................... Type of Construction ...F);.aJn.P............................ ................................................................................ Plot ............................ Lot ................................ Permit Granled .....!T"� ..iy...1....2..,...............19 84 Date of Inspection ....................................19 Date Completed ......................................19 Assessor's map and lot number .. S� SYSTEM MUST BE TALLED IN COMPLIANCE 7HETp�o Sewage -Pbrmit number ..........�, .... ..................:..... eye ,ry g IT TITLE 5 ro " E�'��✓sr9�y�lFtJOENTA yC01DE ` Z SAWSTAXLE. i House number ......................................................................... �e .a s-,. ,. , .. O� MAIL O 1639. \0� M a' TOWN OF BARNSTABLE - BUILDING INSPECTOR SAPPLICATION FOR PERMIT TO ........ ..... '.<.. cl?+ rd ko........a.��............................... TYPE OF CONSTRUCTION ......... ............................:. ..... ................. 6 zl.... . ............19- TO THE INSPECTOR OF BUILDINGS: The undersignedd/hereby applies for a permit according to the following information: Location / /C_UF� Gf1AJ� ..:................................................................ ................................................... . �................. Proposed Use .......... !!c? +!!Y!.1q!y.. .e,T ........ d .:........................................................................................... ZoningDistrict ........................................................................Fire District .................................".............................................. Name of Owner�.�..lJ.. .......W.... Y ................... ....Si L✓?2 Z-4,V6 1,'6 ' T Address y........................s. Name of Builder PNT1e`� St/(CDi.�� .�u�a�t&aG.Address ../6?..��....I4!&'16 41�,"OV US' POiU Y `.W&, I r Name of Architect .......A/..L. .................................................Address .......1. .—4............. Number of Rooms .........../V 4.............................................Foundation .....��U���...�ThZ�.Y.............................. Exierior .........N/A.................................................................Roofing .......�1VA..................................................................... Floors ..........................................................Interior .............1u '9.............................................................. Heating .......�1!?..................................................................Plumbing .........�h... ................................ .......................... �J Fireplace ........�Y. ........................................ ......................Approximate'Cost ............. Qd ........................................ Definitive Plan Approved by Planning Board -----------_------_-----------19--------. Area .... / ...zLi Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �uQ W Y sett 176� � (A S t L�/&IZ L OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �F� �U iiri6 0 . G Name ................................. . . ..... .....�.... Construction Supervisor's License OOQO:.S PYHE, DAVID W. No .... Permit for .....SWIMMING POOL ................................ Accesso........ to Dwell in .................. ...................... • Location .....3.7........Si.........lver...Lane......... ................... . ........ ......................Hvan.......nis............................. ................. Owner ..Da.vid..W....ID ............... ...... ne .... . ........................ Type of Construction .......................................... 2 ................................................................................ Not ....................... Lot................................... November 5, 84 -'Permit Granted ...................... 19 Date of Inspection.. ....................................19 ,Date Completed .......0. ...... ...... Assessor's map',and lot number ... . ...................................... . �, THE f =t Bpi tp� 4� fo�Q��♦o► Sewage Pe�hlit 'number ........... 1 ..................................... Z SAW STAX E.s House number ........ r NA66 pp 1639. 000 �'0 YPY Or TOWN OF BARNSTABLE BUILDING INSPECTOR �n3 JG. APPLICATION FOR PERMIT TO .......��......... d? ....... .... ....!..bvL�............................... TYPE OF CONSTRUCTION ......... 1. `! 'r A�. ........................................................................................ .................V.....................19..N TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following/ information: Location 37 SJ�.UF,e G✓9AVL j�ivv/S //"li-� .............. t ...................�. ................ ,. ..............................,............... ................................... ProposedUse .......... 5ce.�: ................................................................................................. � 4 Zoning District ::...............................::.....................................Fire District ..........:....................................: • Name of Owner--DA ��..'...:..w.:.. y!vN'.:... ......Address 3 .....�ILt/f,� Li9niE........................' 5.............. fir//C��.v� ` )4.1-0i tz�.�C 4"y ! W,44ovvc , Gyiu I.Lf/JS'S Name of Builder .....F!. y. O ........................Address /67 Nameof Architect ....... .................................................Address .......:!ll.11q................................................................... Number of Rooms .......N14 ...............,.........Foundation .....�ocl�t�...l���................................ 1. ...................... 'i Exterior .........N.A.........................................................A......Roofing ........N��................................................................... FloorsN,i9..........................................................Interior .............N� .............................................................. '....................... Heating .......a .................................................................Plumbing ........ !...G' ......................................................... .........A Approximate Cost ...............Fireplace ........ goo C)j N.j ..................................................... pp ..........................................:. Definitive Plan Approved by Planning Board _______-----------_-----------19________. Area .... y .'t................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 00 _ 160 4-AL �( �ooa6A �xi�T. ��,lElliA)4- S 1 L IZ- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name F!? y...!JU..civ� Construction Supervisor's License ....5200P S IY8E, ZAJ/ID W. A=268-158 � 27179 PoolNo -- .--. Permit for —.���.����1----.. � Aocn�o to Dwelling —..,� ---.---.--.—.--------'--. '. � Location ......3I.Silvax'Iusxe........................... ^ ------'.^+y"ujj;U�*........................................... � � Owner —..Daxd&.WL'I-Y-n�............................... � ' Type of Construction -------------- ' -------.—.----------------- . � Plot ............................ Lot ----------' ` � 0om�obez 5 O4 ' Permit Granted -----._--���---l0 Date of Inspection ------------l9 . Dote Completed -----.-------lV ' � � . . / . � �� ^ � . ~ - � ` ����� I 3 � To Date Time WHILE YOU WERE OUT M � of ^� Phone Area Code` Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Me sage i / e 4 Kxl���'/a-cs/✓ Operator AMPAD 23-021-200 SETS �JJ,] EFFICIENCY® 23-421-400 SETS CARBONLESS VIS . � f ��r �.� I E TOWN OF BAR NSTABLE BARNS LE. 1639- BUILDING ' INSPECTOR 4 7 rJ VF. L L APPLICATIONFOR, PERMIT TO ............................................................................................................................. StW6-L�...........�A UTYPE OF CONSTRUCTION ..................................... ........................................................................... j ........ ............. ,91 TO THE INSPECTOR OF BUILDINGS: -.4 The--undersigned hereby applies for a permit -according to the following information: LA Location .................................................. Proposed Use ......... .. ....... .......................................................................................... ........................ ... ............. .... ........... .. 4y#�-t%j W is Zoning District. ...... ............ ... ............... . .... .......................Fire District .............................................................................. 06 (Ztj � 7 1?Name of Owner4.A .Address . LA , HjAqNr .... .. .. ... . ......... ...... ...... . ... .Name' of Builder ..... - ................................................................Address .................................................................................... Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ........(0.P4..E............................................Foundation ............................................................ . .... ........................................ .... .... .... CLA Exi&ior ...................DIEDA(Z- .:........................Roofing .... .......................................... ...... ....... ....... ....... ...................................... Floors ...e....................... .......................................Interior ... Heating ........ ..................................Plumbing. ...................... . ............... ....................................... ............ Fireplace .....................................................................................Approximate Cost ................74,15 &D, Definitive Plan, Approved by Planning Board ----------------—----------- z �, e Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH j < < M 0 7% Q 2: < L1j f:� CrE_ W < < 0 LL (:Z) CL 0 F- LL1 F -skj < V) F- Ld'z *t%< < U) M lY 1_4 z < ED i-- LU p. V., ' ® a\ l < z I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Bourn, Wa`""� R. ~-' � ' . � ' ��d No ..�����-� Permi� fur -.--- .!������. ` � �� � � z ---.----..-----=----..,.-----. � 37 Si]�r I�nm-- Location --. --- -..^�r--.- '-'------' ......................Hy.anni��--.-----------. Il Owner ---������-.��...�����---'-----' ` � Typo of Construction ----- ----- ' | _---.-.~-------------------. ^ ^ � Plot ............................ Lot ................................ Permit Granted --'J ..I2-..-.]V 73 w Date of Inspection lV °e^ *~ PERMIT REFUSED � ----..—.---..--.------,. lA ' --------.-..--.--------._---.. ' . ` -_--.-..-.~~.---.------.-....-. � � - ^--'--'-------''--`-^^~^^^-~'~^^^-' -'-------'----------''----'---' Approved .. lQ -------.------------------- -------------------,---....... ' | ' ' .