HomeMy WebLinkAbout0084 SIXTH AVENUE (HYANNIS) $ILI F��'�,
T
Town of Barnstable *Permit# /
Ex�r�res 6 months from-issue date
Building,Departli�ent Fee
®�
�,,,m'"LE ; Brian Florence,CBp `
�ebA ,0� Building Commissioner
rED MPS A 200 Main Street,Hyannis,MA 026004 4
www.town.bamstabil t 17s �C 0
Office: 508-862-4038 � ®,, Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTMOV'NLY
�� ^ / Not Valid without Red X-Press Imprint -
Map/parcel Number ')- fJ�
Property Address l fj g
Residential Value of Work$ - Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address _ A )O
�l V& l
Contractor's Name ��Rlp Telephone Number V42
11112
Home Improvement Contractor License#(if applicable) o� Email: �(� /10 , Can,
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance ,
Insurance Company
p Y Name
Workman's Comp.Policy#_, j 'IT 503
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 PJAJA
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
,ML
Replacement Windows/doors/sliders.U-Value "(maximum.32)#of windows
#of doors: `
*Where required; Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner pitifiRsign Property Owner Letter of Permission.
A copy of t o e Improvement Contractors License&Construction Supervisors License is
requir
SIGNATURE:
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P�u - 6_`❑New oonstcuctifla
employees(fi d andlor par�time).* have hiredthe sub-contractass
2.❑ I am a sale pnopiietor orpartner- Iisied cathe attached sheet 7. ❑Remodeling g
ship and have no.employeer.- These sob-contractors have g-•❑Demolitiaa
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for me is employees andhaye wo&m'
9. ❑Buildttig addition
[No i4DdMrs-Camp Msurance comp-insu anm
required-] 5. ❑ File are a corporation and its lt}❑Electrical repairs or addttions
3.❑ I am a homeoumer doing all work officers have exercised their 1 L❑Plumbing repairs ar additions.
myself[No w-oskes'comp_ right.of eseragon per MGL i?'❑Roofrepaus
ih employees,[No dwodoers ttd ���—��1/t
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employees.If the m`k-cantxct=have empld ea%they nnurpmuide1ju*warkeW—wmp.13Grkyn=ber.
I am an inmzrarme,for iqy eHTp� ees Betoov is tfte paHcy and join site
inflornzation. -
h5mance,companyName: C. C.
'Policy�cr Self--its Lic-— ��C l! 0®! 3 —9 03.
F piratioa I}ate:
Job Site Address: ( 61MI VZ 41AIAAAALSCity/StatelZip: AJ !`
Atfach a Copp Of the workers'comp ensation.policp•decla ration page(showing the policy number and expiration date).
Failure to secure coverage as required udder Sectiaa 25A of MGL a M can lead to the imposition of criminal penalties of a
fine up to$1,5OO:OO andf'or one-yearimpfisvgmeuta as Well as ciO penallies.in the form of STOP WORK ORDER-and a fm
of up to$250_0O a clay against the violator_ Be adtased that a copy of this statement maybe forwarded to the Office of
lzrvesEgatiom of the DIAI€ar- ce coverage verifitafion:
I do hereby cer fy m tk ' s and par�atl s a.fFsr ui}'fhatfl�s uz,for�ccr#ivr>protzrTed abm�a is bars d correct
Sit>�xe: Date=
Phone364)
Ofi%vfat uss anf. Da riot tvrke in this 1rrea €e tie coinpfeted by ciiy artoirn cr,jjrcraL
4
Cky or Town: Permiff ice' e#
Tgsring Authority(C1rC1e,one):
i Board of Hvdth 2.1Budding Department 3.Gtyffown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
contact PMDW. Phone 9:
ormation and Instructions ; .../
Massachusetts Geheaal Laws chat i 152 re Qc r all cmplay=to provide woes'compensation for their employees. '
pia,tto•his Sim,as mvpkyee is defined as.`�.every person in ihe service of another wader way coufract ofhnre,
Mgzcss or implied,oral or written.."
An elnpLay,a-is defined as"�ind�idual,partnership,associaficn.corporation or other Iegal erdiiy,or any two or mole
of the foregoing engaged in a Joint entm isa,and inc]ndmg the legal=pesenfafi ves of a deceased employer,or the
receiver or t astee of an individual,par i sbip,association or other legal entity;employing employees- However the
owner of a dweIIing house baying not mare than three apart mm s mad who resides therein,or the occupant of the -
dwr,Iling house of another who employs persons tD do mainteUEnce,constraction or rspa r work on such dwelling house
or on the groua& or bmlding agparten=tthereto shaRnotbecanse of such employmeEtbe deemedtn be an employer-"
MGL chapter 152,§25C(6)also sfatn that'everystate or local licensing agency shall withhold$ze issuance or
renewal of a license or permit to operate a business or to construct bu ldiags in the coramGnePealth for any
applicant who has not produced acceptable evide:um of compliance with the insurance.covexage required-"
Additionally,MGL chapter 152,§25C(7)sfafns`Neither the counnonwealth nor gy ofits political subdivisions shall
eater info any contract for theperfonnance ofpnblicworkuntil acceptable evidence of compliance with the msm-arce._
re Uj renjeuts of this chapter have been presented to the contracting anth ortyf
APpgcan-ts
Please fill oizt the workers'compensation aifrdavit completely;by checI�g e boxes that apply to you situation and,if
necessary,supply sub-contractors)name(s), address(es)and phone rumiber(s) along with theircertdicate(s) of
nsn-r=ce. Limited Liability Companies(LLC)or LimitedLiabffity Partnerships(LIP)wnno employees other.than the
members or pamtncrs,are not required to easy workers'compensaf on insozance. If an LLC or LLP does have
employees,a policy isrequued. Be advised that thisaffidayh maybe snbm t--dtotheDepa-tmentof Industrial
Accidents for confirmation of insuranee coverage- Also be sure to sign and date;ire affidavit. The affidavit should
be-retn�ned to the city or town that the application fur the permit or license is being mgae shA not the Department of .
InrTnstUj A r-md=±s. Sbouldyou have aiy questions regarding the law or ifyou are regns-ed to obtain a workers'
compensation policy,please call the Deparimem±at the number listed below. Self-insured companies should enter their
self-insm-ance license njmber on the appropriate line.
City or Town offitcials
Please be sine that tiie affidavit is complete andpri�dlegiibly- The Department has provided a space at the bottom
of the affidavit for you to f01 out in the event the.Office of Investigations has to cordact you regarding the applicant-
Please;be sure to fM in the pcnna license number which will be used as a reference nBmber. In addition,an applicant
that Must submit m_vliiple pe�tllicanse applications in any given yew,need only submit one affidavit
>adigt
policy inbLnation.(if necessary)and under"job Site A daarese the applicant should write"all locations in (GitY m'
towri)-A copy of-the.affidavit that has been officially stamped or mariced by the city or tows maybe provided to the
in each
i " mast be fined o
applicant as proof that a valid affidavit s on iJ1e for fiofrue�perII.iits or licenses Anew affidavit
year.Where a hone owner or cit=is obtaining a license or permit not ielattd to my business or commercial Taof=
(i e. a dog license or peunit to bum leaves etc.)said person is MOT regaEd to complete this affidavit
The Of afr.�s ce of Investig would hie to thank you is advance for your cooperation and should you have any questions,
Please do not hesitate to give us a call
The Depmrt¢Lenfs address,tr-lcphone and Ax nnmber:
Th.L-Ca=:kanwCtth of Massac ,
. Dega�xn.�4f 1ad�izzalA�ckd�nts
off j=of jilyestkatiom
?� I�fA F�111
Tf,-L 4 617'27-4 t,-xt 406 or 1477-MA S.4F
Fax 617` 27'749
Revised 4-24-07 .Maz-gavIdia.
ToWn of.Barnstable
ti
Building Department
9 $ Brian Florence,CBO ,
E1 1k Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us .
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and-Sign.This,Section'
If Using A Builder
as.Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is install and all final.
inspections are performed and accepted.
Signature of Owner ign e o cant
Print Name Print Name
LJ
Date`
Q
:FORMS:OWNERPERMLSSIONPOOLS "
Rev:10/17
• lvvru �l .uaivaiaui�
�oFZHE rowti Building Department
o� Brian Florence CBO
Building Commissioner
BAMSTABLE, '
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
�C DATE:
�, JOB LOCAnt:!
number street village
X -HOMEOWNER- 13 LOA r�
name home phone# work phone#
CURRENT MAILING ADDRESS:_
city/town state zip code
The current exemption for"homeowners"was extended to include owner-ocgUied.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
re uirements.
Signature of Homeowner '
Approval of Building Official
t
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 to amend
and adopt such a form/certification for use in your community.
x
3 s 144 ass achuset s - Department of public Safety
Board of Building Regulations and Standards
{.U1Nti'UCi.iI117 SGi7C'I'\lspr _
License:,CS-108659 "".
FABIO PRETTI
38 WENDWARD WAY.-:` . -
West Yarmouth MA 02673
d J
Expifation
a un7rnissiorter 04/19/2019
�.%/r Coo»r1laa�t-tuetc�l/CfC/f�a.i�ac�tt�n((�
Office of Consumer Affairs&Business Regulation—WEr"2 HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
�� TYPE:Individual before the expiration date. If found return to:
I} ✓ Registration Expiration Office of Consumer Affairs and Bu 'ness Regulation
_ 182418 06/18/2019 10 Park Plaza-Suite 5170
FABIO PRETTI Boston,MA 02116
DB/A FABIO HOME IMPROVEMENT
FABIO PRETTI
38 WENDWARD WAY._ .,r_. �
YARMOUTH,MA 0267S--'_ Undersecretary N a I tthout signature
A CERTIFICATE I ILIT I L� E D�T�,I�,D>�YY
3/30/1F
THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE *DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENDS 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. J
IMPORTANT: If the certificate holder is an ADDITiOI+AL INSURED,the policy(ies) must be endorsed, If SUBROGATION IS WAIVED,subject to I
the terms and conndi4aons of the policy,certain policies may require an endowment. A statement on this certificate does not confer rights to the
I certificate holder in lieu of such endorsemen4s)•
PRODUCER Cow ^T
NAMEi PAUL SCHLEGEL
Schlegel & Schlegel ins Broker �PHQNE G FAX -
(5084 771-8381 I t!�IC,No): (508) 771-0663
34 Main Street: aUfA!
NOW: sc:hlegelinsurance@gtnail.com
West Yarmouth, MA 02673 _ iNSuRKE SZAFFORDirneovERAGE_ NA IC
--- ._ ---- __ — — — INSURER A. NCI JNSLTMNCE COMPANY 114788
I UZUREU I14SUR'cRB:A7LANTIC CHARTER — —r =---�
FABTO PRETTI —�— —
IrdSL1RER c
38 Wendward Way INSURER D:
WEST YARMOUTH, MA 02673 INSURERS:
_
iNsL1FtER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED'SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY`REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFOMED 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.
ALAiLlSUBRI POL Y E IC FF i POUCYt7(P T —� -- —^ --- — -- --
LTR TYPE OFINSURANCr I INS Ydjd� M POLICY NUM-dPR �(MMIMNYYY)I(MIMMi01YYYY)I PATS j
A �GFNERALLIABILI'IY T A-,S6863A ( 11/19l16r 11/19/17
EACH OCCURRENCE $ Imo. ,OQQ iJOQT
i I I i DAMAGETORENTED � T
1 GOR4ViFRCIALGENERALL:ABILIT'Y Imp 500,000
CLAIMS-MADE L.� c:OUR to QO
( I MED EW(Arty person) I S T 3,0 o -
,._
j � I PERSONAL&ADV INJURY_ $__;_,QQ(�`Q•QG
GENERAL AGGREGATE 1 $ 2Ak0,QOQ__!
GENT AGGREGATE LIMITAPPLIIEESPER � � 1 I PRODUCTS-COMP OPAGG���O�
POLICY I PRO-
ACT r I LOC I i ($
_AUTOMOBILE LIABILITY I t�Ea accident) $ -- -
j ANY AUTO I IBODILY INJURY(Per person) 1$
I ALL OWNED SCHEDUI-ED
AUTOS AUTOS ! I ( i 160UILY INJURY(Per accident) $
NON-OWNED I I i �PFtDf'EF',fYD�tv14GE g
HIREDAUTOS AUTOS i i �(Peraccdant ��
. {UMBRELLA LIAR
CC UR (EA IT OCCURRENCE I $
H EXCESS LIAR CLAIMS-h1ADE I I AGGREGATE
- - —
DED RETENNON$ _ i Iq _ I S'
$ WORKERS COMPENSATION 1 i T�.VQO � O? 1/I�/�61..1 119�17 WC STATU- OT_H-. ^AND EMPLOYERS'LIA.BIL,ITY {1 N I I =1 THY 1 LALTS ��
ANY PROPRIe-TGRIPARTNERIEXECUTNE I j I EL tACHACO[ Ni_ 1 $ -100,000
OFFICE MEMBER EXCLUDED? � N i A � ''
(�1at tatary in NH) i j ( ; E.L.DISEASE-EA EMPLOYEE ¢ 1Q0'000 �
1 )ESrRIPTiONOFOPERATIONSbSiou I E.L,DISEASE-POLICYLiMIT $ �oQ 000
I I I I 1
�
�;OKRIP110N QF OPERATIONS 1 LOWIQNS!VEHICLES (Attach ACORD 101,Ada Uottal Reim". Sc hedui:,if tnoro atvica is requirPl)
1?ttB10 PPLE` TI K ,5 ELECTED NOT TO BE COVERED ,UNDER HIS CURB) NT WORKERS COMPENSATION POLICY
E
s �;:ICATEO� i= CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
}+�Yfa PFETTI j ACCORDANCE V4ITH TI4E POMY PROVISIONS.,
I 36 Wend and rdiay
`IEST X'Al M.WTH, HA 02673 i AUTHORIZE D REPRESENTATIVE
I I
i v �
G?1986 C lop, - , D CORPORATION. All rights reserved.
ACORD Za(2010105) The ACORD Frame and logo are registerad marls of ACORD
Phone: Fax: E-Mail: ERIBEIRO@KHST.US
�. ^® DATE(MM/DD1YYYY)
� CERTIFICATE OF LIABILITY ITY INSURANCE 12/1/17
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. ( . CO .. PAUL SCHLEGEL _
Schlegel & Schlegel Ins Broker PHONE (508 771-8381 A/X No: (508) 771-0663
u.34 Main Street E-MAIL
West Yarmouth, MA 02673 ADDRESS: schlegelinsurance@gmai1 com
INSUfiERIS)AFFQRDINGCOVERAGE NAIL#
INSuR�:Nt IT�tTRANCE COMPANY 14788
INSURED r .TIC CHARTER URERt9tAT
FABIO PRETTI INSURERC:
FABIO HOME IMPROVEMENT INC INSUR R� Qom__ _
38 WENWARD WAY --- .
+ INSURER E
WEST YARMOUTTI, MA 02673 tNsuRERF:
I COVERAGES CERTIFICATE NUM6E`R. r. REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF ItJSUTANCE LISTED BELAW HP,V BEAN ISSUEb l O TFiE 1P1SUR.E,D(NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY OI NTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TIC POIaICIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE[SEEN REDUCED BY PAID CLAIMS.
IN'SR ADDL SUBR — T 4— POLICY EF.F'
LTR TYPE OF INSURANCE POUCYNU,1 IDDIY MMIDDYYYY LIMITS
__ EACHOCCU
A GENERAL LIABILITY I Y MPS3 b„R 1�/1 / 7 �,S/19I�S DAM�AGETQ�RENC�Ena1 $ 1490 .000
RENTED`
X COMMERQIAL GENERAL LIABILITY T . (Ea aecu e e $ 500,000
CLAIMS-MADE OCCUR ME EXA(Arty one Person) $ 10,000
PERSONAL&ADV INJURY $ 11000,000
GENERAL AGGREGATE $ 2,000,000
GEN'LAGGREGATlELIMITAPPLIESPER
r _. _.
,• PROD UC.T-S--COMP.,./O.P,.'AGG _$.. 2,0001000.. .-
POL LOGRCO T IN R SINGLE-LIMITAUTOMQBILELIAQILITY )
,.
ANY AUTO QODILY INJURY(Per person) $
ALLOWNED SCHEDUED
AUTOS AUTOS' - BODILY LNJURY(Per accident) $
WOWNED PROPER RTY DAMAGE NO i
HIRED AUTOS $_ —AUTOS' i Pqr ccidanf $
i
�X I UMSRELIA4IAB OCCUR �C's T R Q/Q/l� 9TO' EACH OCCURREN
RCE $ OOO OQO
4 F
F cEssLlAe CLAIMS.MADE AGGREGATE $ 3 Q00,000
DED RETENTION$ ' _
$
1I�RKERS COMPENSATION
S WCVOQ35�037/ 9/ 9 Y19/18 WQR1C _LIMITS - H
AND EMPLOYERS"LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUTNE I E.L.EACH ACCIDENT $ _ 100,000
OFFICE RIMEMBER EXCLUDED? N I A
(Mandatory in NH) E.L.DISEASE EA I_T MPLOYEE $ 100,000
If yyes describe kinderDESGRIPTIONOFOPERATIONSbelow E' L,'DISEASE POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES Attach ACQRD 101,Additional Ra rJsS Schedule,if more s(. rnp patio is regL red)
FABIO PRETTI HAS ELECTED NOT TO BE COVERED UNDER .PIS CURRENT WORKERS CONPENSATION POLICY
CER fIFICATE HOt pER CANCELLATION
SHOULD ANY OF THE ASOVE DESCRIBED POLICIES BE CANCE4LED 13EFORE
THE F;XPIR/�TION DATE. THEREOF, NOTICE tN1_L BE DELNERED IN
YATCHMAN COI�TCOMINIUM TRUST ACCORAAId -E WITH THE POLICY PROVISI,QNS.
500 OCENA STREET
HYANNIS.MA, 02601 AUTHORiZEDREPRESENTATIVE
R ;RPQRATIt?N All rights reserved,
ACORQ 25(2010/05) The APORP name and logo are registered marks of A -Old ,
Phone: Fax; E Mail; FA�iIOPTTI@YAH O. OM
Town of Barnstable Permit#
Expires 6 months from issue date
Regulatory Services Fee
BAPMNSresc E.
MAM 0 Thomas F.Geiler,Director
i639
Building Division
Tom Perry,CBO, Building Commissioner / G�
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 Number
Ala-
Prope Address
zResidential Value of Work Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
r ( Z, toIV
7
Contractor's Name H Ef11� �`, Telephone Number Ld�p
+yr —�—f��e ,-
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance XPRESS �G�R�
Check one: 'T
❑ I am a sole proprietor
❑ I am the Homeowner SEP —6 2012
❑ I have Worker's Compensation Insurance
Insurance Company Name s 11 i�QWN nR gARNST
ABLE
Workman's Comp.Policy# 7A�I t9bi _Qn I�}_
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Req t(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over - existing layers of roof)
Re-side
#of doors
Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red$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.
4ingpe
of the Home provement Contractors License&Construction Supervisors.License is
d:
i
SIGNATURE:
Q:\WPFILES\FORMmS\EXPRE$$.doC
Revised 053012 -
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
UV www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib�
Name(Business/Organization/Individual): TkaL
Address: ��i ►'h. (� - -�j�a�
City/State/Zip: GPhone.#:
Are you an employer? Check the appropriate bo Type of project(required):_
1. I am a employer with 4.JZI am a general contractor and I 6. ❑New construction
employees(full and/or part time)-* have hired the stab-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 for me in any capacity. employees and have workers'
$• 9. ❑Building addition
[No workers' comp.insurance. comp.insurance.required_] 5. 10. Electrical repairs or additions We are a corporation-and its ❑ p
3.❑ I am a homeowner doing all-work officers have exercised their 11.>the
ng repairs or additions
myself. [No workers' comp: right of exemption per MGL 12. pairs i
insurance required.]t c. 152, §1(4),and we have no .
employees.[No workers' 13.
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:.
tContractors 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:
A,
Policy#or Self-ins.Lic.#: �(7 � 04 VL'N I at)Q Expiration Date:
Job Site Address: �� � City/State/Zip:
Arkq
Wq
Attach a copy of the workers' compensation poficy 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$250.00•a day against the violator. Be advised that a copy of this statement maybe forwardedto the Office of
InvestiLyations of the DIA fov6Nnce covera e verification..
I do hereby certify under a pains n en es of p rjury.that the information provided above 's true and-correct.
Si ature: Date:
Phone#:
Official.use only. Do not write in this area, to be,completed by city or town officiaL•
City or Town: Permit/License#
Issuing Authority(circle one):
A Board of Health 2.Building Department.3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Nlassachusetts - Department of Public Safety
4 Board of Building Regulations and Stand'ard.s
. -- C'i}nstt•rrctiirz Suti4�r•ti.���r Si�i•li�rit,� ' ��� "`'
License; CSSL-09940 ;
MICHAEL J VIOLAy
811 ASS
AH WAY
HULL MA 02045 s ;
954, .%. •
E;4ph ation
Commissioner 02/24/2014
JUN-05-2012 08:33 THD-AT HOME SERVICES, 'INC P.00li001
i
CERTIFICATE OF LIABILITY INSURANCE Ddtalul�n�Txrr,
06/04/2010 I
THIS C&KTtFWATi IB 14840 AS A MATTER OF INFORMATION ONLY AND CONFSRS NO RIGHTS UPON THE BERTIFICATE HOLDER. THIS
CERTIFICATE DM NOT AFFIRMATIVELY OR NEGATIVELY AMERO, EXItNO OR ALTER THE COVERAOF AFFORDED 13Y THE POLICIES
SELow THIS CER'YIPICAT9 OF INSURANCE 'DM NOT CONSTITUTE A CONTRACT DEMEEN THE 10VING INSUReR(3), At)WRQED
RiraPA011INTATIVI£OR PWIDUCtSR,AND THE CMFiCATE HOLDER- -
IM the cardficote holder Fs an A EQ, tha Po muse IDS *"d0rWdA W st1 s,at to
the %MW and CondMloos of the PONW, "Min LZOlRM wAy requIra an mndomement. A sta0mnent on thta aofelaorte BBas not ®ORfov giame to the �
osrdfir*8 holder In lieu of such andotssman!(s).
rR00YC[R NAND:
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DBA JOHN P BERCMZY IS AGENCY A0011aaal
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THIS IS TO CERTIt-Y HAT TIE„,POLICIES Of INSURANCE LISTED BELOW ;WV-E SEEN 13=60 TO TWI! J CD R NE POLL OD
INDICATIA. NOTWITH$TANOING ANY REQUIRCMENT, WPM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICM TIVS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TH5 INSURANCE AFFORDED BY THE POLIGIE3 00CRIBEO HEUIN IS SU640T TO Au THE 'tEFtMs,
EXCLUSION&AND CON0111ON30F SUCH POLIMM UAGTS SHOWN MAY HAVE:13I16N RiDUCEO OY PAID CLAIMS.
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CSRITPICATE HOLDER CANCELLATION
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ATT. �19TALLBR RYLATZDIQF3 DA;PT.. SmWLD ANY OF THE ABOVE OPSMUD POLICIES BE CANDLED wFORE
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TOTAL P.001
HOME IMPROVEMENT C.'.ONTRA,C'L'
PLEASE READ THIS
u J Sold;Furn shin and Listalled by:
Branch Name: Boston Datc: p ( r ^� 1'HD A t•Home Services,hie.
d/b/a The[Ionic DC pot At:Home Services
908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 / f✓
Toll FrLe(800)657-518 ;Fax(508)845 6017
Branch Number:31 I'ederid ID#75-2.698460:ME Lie#C 02 39;RI Cont.Licit 16427
/ '/CT-Lic#HIC-0565522;MA I lom vc e linproment Contractor Reg.#126893
Installation Address: 6 f� ( ..,,.(iC_/. Yuan M a► (_. . ._ 0 ab —,)----
C ty State Zip'
Purchaser(s): Work Phone: Home Phone: Cell Phone:
Home Address; QA TO��
(if different from IoSlallation Address) {city c-15Q +k L 5 St to Zip
E-mail Address(to reouivc project communications and Horne.Depot updates):
❑I DO NOT wish to receive any marketing entails from The.Home Depot
Project Information: Undersigned("Customer"),the owners of the property located at the above installatiot address,agrees to buy,
and THLi Al-Home Services,Tnc,("The Home Depot")agrees to furnish.deliver and arrange Iitr the install tion("Instrllut'ton")of
all materials described on the:below and on the referenced Spec Shu:t(s), all of which are incorporated in o this Contract by this
reference.along with any applicable State Supplement and Payment Summary attached hereto and any Charge Orders(collectively,
"(contract"):
Job#: p"t.mW Rer-10 P oducts- Sec SllCCt(s)#: Project Amount
LlRoofing Siding Windows Insulation $
G
uuen/Covcrs ❑Enrry Door; ❑ � � ,,J (5
❑G
Roofing LjSiding ❑Windows Insulation
❑Gat.ter,/Cuvcrs ❑Entry Doors C]
_ETRuolin Siding El Windows El hisulation
❑Gutters/Cover. ❑Dary Doors❑ �
Roofing Ll Siding Lj Windows ❑1115ulation
❑Gutters/Covem ❑rralry Doors ❑.
� I
NUnimum ZS%Deposit of Contract Amount due upon execution of this eonu-JL Total Contract Amount $
Maine Pun:hamrs ioH,y not deposit.more than one-third of the Contract Amount
Customer agrees that,immediately upon completion of the work for each Product, Customer will execute a Completion Certificate
(one for each Product as defined by an individual Spee Sheet)and pay any balance due. AS applicable,ea-ll Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder.
The Home Repot rescrvus the.right to issue a Change Order or terminate this Contract or any individual Prod CL(s)included Herein,at
its discretion,if The.Home.Depot or its audiorizeti service provider determines that it cannot perform its oblig'Lions due to a stnictural
problem with die home.environmental hamrds such as mold,asbestos or lead paint,other safety concerns,p icing errors or because
work required to complete thejob was not included in the Contract.
Payment Summary: The Payment Summary# �p_! _-2 7 _. included as part of this COIIILTict.. sets forth the total
Contract amount and payments required fir the deposits and final payments by Product.(as applicable).
NOTICE TO CUSTOMER
You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note:
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product
is complete.
In the event of termination of this Contract.Customer agrees to pay The Home Depot the costs of inalLrials,labor,expenses
and services provided by The Home Depot or Authorized Service Provider through the date of tern intion,plus any other
amounts set forth in this Agreement or allowed under applicable law, THE HOME DEPOT MAY WI HIIOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMFN'I' MADE, WITHOUT
LIMITIN(.THE HOME DEPO T'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreenjent between Customer
and The.iIonic Depot with regard to lire Products and Installation services and supersedes all prior discussion: and agreements,either
oral or written,relating to said Products and Installation.This Agreement cannon be assigned or amended except by it writing siLned
by Customer and The IIorne Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the
tennis id and has received a Co/p�y of Ihi Agreement.
A led 6I Slab by: a
Custor r s SignatuCree Date Sales Co sultant'S Si mature Date
Telephone No.
Customer's Signature Date Sales Consultant License No. _
CANCELi,ATiON: CUSTOMER MAY CANCEL THIS ` (a. applicubjc)
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVF,RING WR11"1'EN NOTICE TO THE HOME
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS I
HAY AYYE,R SIGNING THIS AGREEMI.NT, THl 1
STATE SUPPLEMENT ATTACHED HERETOI
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
CUSTOMER'S SPATE.
NO'1'ICb::,UIDITIONAI.'I'b:RMS AND CONDITIONS ARE STATED ON'I'tit;RL•VI?RSF:SIDE AND ART:PART Or 111s CONTRACT
0:h711-77 r1-.4r; inn. o...--. r_ .......
ZA d SHV ;odea awoH << h6LhLS690S 3N0Hd'KQdX32692 LS:02 £0-90-2 0Z
1
,.t Aug 05 12 09:33p Chris Read - � 1-508-681-8800P,1 �
HOME IMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Furnished and Installed by:
Branch Name: Boston Date:; / THD At-Hom
e Services,Inc.
O/SlI d/b/ai The Florae Depot.Al-Home Services
908 Boston Turnpike,Unit I,Shrewsbury,MA 01545
Toll'..Frcc!(800)657-5182: Fax(508)845-6017
Branch Number:31 Federal ID 9 75-2698460 MF Lic s C 02431);RI Cont,Lick 16427
CT Lie#I I1C.0565522 MA Homt-Improvement C'oraactor Reg.9 126993
Installation Address: tYV,�ljJ�/>�j /.. '. _
City -zip
Zip
Purchaser(s): Work Phone: Home phone: Cell Phone:
Home Address: 11, /it��/141r�� 5� A/£k/�p� �`��ays�
(If different from In�stal`latiioon�A�dress) City T i tuts Zip
grail Address(to receive project communications and[-ionic Depot updates):
] DO NOT wish to receive any marketing emails from The Home Depot
Project Information: Undersigned("Customer"),the owners of the property located at dw above installation address.agrees to buy.
and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange;fix the installation("Installation")of
all materials described on the below and on the referenced Spec Sheet(s), all of which are iinuorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached heretd,and any Change Orders(collectively,
"Contract"):
Job#: nmm 1R6@ ,.1e) Products: Sec Sheets 4: Project:1mount
outing ❑Sidinc ❑Windows ❑Insulation
l 0GuL1crs/Covcrs ❑Entry Doors ❑ 15?12
❑Rooting ❑Siding ❑Windows ❑Insulation
❑Guacrs/Covers ❑Entry Dours ❑
❑Roofing ❑Sidin ❑Windows ❑Insulation
I $
❑Guttcrs/Covcrs DEntry Doors❑_
❑Rooting ❑Siding ❑Windows ❑Insulation $
❑Guttcrs;Covcrs ❑Entry Doors ❑ �___.._...._.
Minimum25%Deposit of Contract Amountdueupon execution of this contract. G�
Total Contract Amount $ /Maine Purchasers may nut deposit more than one-third of the Contract Amount.
Customer agrees that, immediately upon completion of the work for each Product,Custumerlwill execute a Completion Certificate
(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this
Contract agrees to be jointly and severally-obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual PIMIUCt(5)included herein,at
its discretion.ii'Thc Home Depot or its authorized service provider determines that it cannot perlbrm its ubligalions due to a su_uctural
problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because
work required to complete the job was not included in the Contract.
Payment Summary: The Payment Summary ' :7/6� / included as part of this Contract, sets forth the total
Contract amount and payments required for Lhe deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a completely tilled-in copy of the Contract at the time,you sign. Do not sign a Completion Certificate(note:
there is one Completion Certificate for each listed Product as defined by individual Spec Shee(s)before work on that Product
is complete.
In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials, labor,expenses
and services_provided by The Home Depot or .Authorized Service Provider through the date of termination,plus any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAN'WITHHOLD AMOUNTS
OWED TO THE 710N9E DEPOT FROM 'rHE DEPOSIT PAYMENT Olt OTHER PANINIEN'I'S MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agrccmaris,either
oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signets
by Customer and The Home Depot.Customer acknowledges and agrees that CLI3tOnlCr has read,understands.volunLrrily accepts the
terms of and has received a copy of this Agreement.
Accep by Submitted�j L,
'
0 20 2 X
mer's Signature ate Sales onsullant's Signattl Date
Telephone No.
ustomcr's Signature �atc � Sales Consultant License No.
CANCELLATION: CUSTOMER MAY CANCEL THIS
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE TO THE HOME
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY AFTFR SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
CUSTOMER'S STATE.
NOTICE:ADDITIONAL TF.RNt5 AND CONDITIONS ARF.STATISD ON'I'I'IE REVI-AiSE SIDE ANI.)ARE 1':\R'r OFTOIS CONTRA('['
05-10-12 While-Branch File Yellow-Customer
01
O fice of Consumer Affair and Business Regulatiota P :
10 Park Plaza - Suite 5.1.70
Boston, Assachusetts.02116 .
lozzie Improve . '. �ontractor-Registration
Repiatratlon: ..128893 .,
Type; 'supplement Carl . W�
ExplraUon:' 8/3/2014
-
The Home Depot &,t Home Setvi
RICHARD FALLONE MCl
2690 CUMBERLAND PARKWAY - ' W
ATLANITA; GA 30339 -
•
Af Update Address and return card.Murk renson.ior chnngc.
Address 0 Renewal .Fmployn►ent ❑ Lost Cnrd'
DP S-GA1 a.50Pd•04/04-W 01216
& t wi leg a�,/� edc/iueeA2
office of Consumer Affnirs&Business Regulation License or registration valid for individul use only
before tits expiration date. If found return to:
OME IMPROVEMENT CONTRACTOR office of Consumer affairs and Bus! ess Regulation
r 1 •:TYPa: 10 ParkPlaza-Suite:5170
Re istration,�,�26893
� le' ent Cana Boston IVU 02116
'
Su m
Exptraf(tinr,'•,'•'8�314 PP ^
�l
t�s
H to
T he Home Depdl .:,,•.,..
AqL
tg
RICHARO FALLt�Nic:,t�,F.�=.y
2690 CUMBERI-Ah"."',t'
at valid with si nature
GA 30339` !,';'•=�' Undersecretary
q¢�o
Assessors map and lot number
Sewage Permit number ......&d1 ...�1kai'. .... . . . SEPTIC SYSTEM MUST BE
INSTALLED IN COMPLIANCE t BARNSTABLE.
House number ....:( C . ... - WITH ARTICLE I1 ST o rnea
ATE. 90 i639• 0�
SANITARY CODE AND TOWN ��MAI a`
TOWN OF BARI' TTA% LE
BUILDING INSPECTOR
APPLICATIONFOR PERMIT TO .............................................................................................................................
Lai./�iQ 1. .... '?' JIJ?7�I +�t�
TYPE OF CONSTRUCTION ........./
�
............. 1:2......19.
:..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ....:1 .�...... 6-1.46..... V .............!!` � . ...... . . ''1. ...pvz .................................................
Proposed Use ........
ZoningDistrict ....�..................................................................Fire DistrictQ......................................................,�............a...........
Name of Owner �.�.Q.2 .�/ W'�� COA...............Address �4 �.� t ...AX?5 2./1. .A ,..;l
Ada.
� ,,, c pp
Name of Builder /..�� .`y...... d(a:.16. ......................Address v�.�..J��'��'(/G/��.. �/.�JLk _`...�K...�Q ��1!10�(��
Nameof Architect ..................................................................Address .....................................................................................
Number of Rooms ... .l!l. ... .................................Foundation ..............................................................................
Exterior .... ............................Roofing ......................... ..........................................................
Floors �.. ... � � Interior ..... pp
.....,................................7.. . ..................................................
r
Heating ........................................................................:.........Plumbing ..... e).... 2? . ...... .....:'......................
Fireplace ..................................................................................Approximate Cost ...............v1.�V.!�.Y......................................
Definitive Plan Approved by Planning Board -----------____---------------19________ . Area ... ,.. ...................
Diagram of Lot and Building with Dimensions Fee ..��
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name c..... . . ......l..ax..f
.................
Wilcox, Marylin A=246-131 Y
No . 1.135:.... emit-for .Addition..................
...............................................................................
Location .......467....6th Ave....... ,
S
...................... ..........................
Owner Mar lin W a
_ ,... .. ....................ilcox.................. _........
Type of Construction ..........................................Fram a
f `' ►
........ ' .................................................................
'Plot ............................ Lot ................ .. ......... w
r
t
Permit Granted .,,,,,March 26 1979
Date of Inspection ...................: • ...19 `
Date Completed .....................................
PERMIT REFUSED
........:c.. «... :... . :.................................. 19
.......... .......................................F...........
................... .....................................................
.......... r:... .:1.................................................... ! # + ^' �� ♦-
#"t.............................................. fh r i n
:.'Approved:................................................ 19
\ ...............................................................................
.................... ..........................................................
6 � i
M '
Assessor's map and lot number .T ."`!. .1. f... .� <T,
Q�Of TH E TOE
Sewage Permit number ...... `..�!...
...............
r ° Z EAEH9TADLE. i
House number .... '.? ..... ............ ".......f 7....... ''✓.� K............ 9O rnea
O s639. \0�
�'0 YPY a•
TOWN 'OF BARNSTABLE
BUILDING INSPECTOR
APPLICATIONFOR PERMIT TO .......................:.....................................................................................................
TYPE OF CONSTRUCTION ....tjf ...............................................# J kl- ' ........!. .. s
...... ...... /�.. �"?. 19
�+ TO THE INSPECTOR OF BUILDINGS:
Thrundersigne eby applies for a permit according to the following information:
L .........................:` :Z` .............4?.Z ..�. ' ...i'`2/..`� .-.k.?...'.'.. P't?.... ...:...
ProposedUse ...................... .,....................................................................................................................................................
ZoningDistrict ........................................................................Fire District ....................................................................t.........
Name of Owner . z fiE.!.' ..... �. '...°'......................Address ...5 ..... t? i'' r�� ....�ti t~ .. �td
.- l
Name of Builder Cr�°!'f...... f . .......................Address ta.1....` : z a t tr � J, .! :......! ..'.a.....?..!!..
....... .........
r
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ...r ?.:C. i............. + .................................Foundation. ..............................................................................
Exierior ....L{ 1r2 ............ .e`� ! r.:..............:.:...............................Roofing .........................,..........................................................
Floors �;F 1 ,r t,X�`!" ;r^ Interior ..67. :... ..... !
.....j. ................................................................ r ............. .. ...............................
Heating f......:..............................................................i.Plumbing ..... ..! .... ........
f e� ....................
....'r ... ............... .Y. .......
Fireplace ................... ..........................................................Approximate Cost ...............% ......................................
Definitive Plan Approved by Planning Board -------------------------- ��! 1 ...........,,..••
19- - - Area r....;2....... ..
Diagram of Lot and Building with Dimensions Fee ... c
SUBJECT TO APPROVAL OF BOARD OF HEALTH
J�
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name..... ...................................
� Wilcox, Marylin A=248~131
. . . `
No ..... Permit ior ....���it�qg..............
------- ` --------`'—'---''
�°
Location ................................
...................W".]�yamiapDtt............................. '
Owner --..�arvIin�l�iI���.--------..
Type or Construction nvuu
Lo
Plot ........................../t .....
Permit Granted ./n.r.c.h..2.6...............19 79
Date - --,ectito ....................................19
up,e Comp
PERMIT REFUSED
�
� -----_ .. lV...................
............................. ./ ''. --'^------~—
^—.---.. ^ . . ..---~--.----.. '
----'— ^---' ' --^'—^''
. Approved ........................................ lg
..`
—^---------------^^-----'---'
-----------.-----~..--~......—
`
-
'
| �--
IV
•boo