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0065 SUDBURY LANE
e5 S �P64� wa„e _ - - — J --- TOWN OF BARNSTABLE BUILDING PERMIT Et-tAcn- Se va- a71 Map Parcel 13WL Application # Health Division Date Issued 7 Conservation Division Nov 14 2017 Application Fee " Planning Dept. f®wN ap&ARNS7A Permit Feel �...,. SLE Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address b A/ HV ANC, - Village Owner C� L�� '� - �e i� Address SAM C - Telephone Ses 737 _ OO P q Permit Request 1^i/1/ I; <d + �� w Square feet: 1 st floor: existing proposed — 2nd floor: existing a proposed — Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio* QP Construction Type Lot Size 1) . Grandfathered: ❑Yes 4 No If yes, attach supporting documentation. Dwelling Type: Single Family 8 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes . No On Old King's Highway: ❑Yes )�rIlo Basement Type: 21 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Zo Number of Baths: Full: existing new 13� Half: existing new ' Number of Bedrooms: existing mew Total Room Count (not including baths): existing new First Floor Room Count 5 Heat Type and Fuel: .0 Gas ❑Oil ❑ Electric - ❑ Other Central Air: A Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing .❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes IdNo If yes, site plan review# -Current Use 0� 7Q,24-6'2C Proposed Use 90W, (ZM el-t • LW,3S , APPLICANT INFORMATION y. (BUILDER,OR HOMEOWNER) i Name 5 )Ac.kA Telephone Number Address �� License# (f— 1 -0 9 '1 4-� t5 0V 1 64 01 Home Improvement Contractor# l Oa Email F A f_�u)0v fi, M1- J qQ 6MII Worker's Compensation # Stec 5w COI So 5a of A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�� cw --- S PO-SA SIGNATURE DATE 1 a i J t 1 FOR OFFICIAL USE ONLY APPLICATION # i �I• DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER - - I DATE OF INSPECTION: FOUNDATION FRAME z9h M - C � INSULATION -$ h! FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING K 9ir 6�024 s . its n Xeed-4 p-itu e cex-f DATE CLOSED OUT ASSOCIATION PLAN NO. "F Y7w CCouwzomveaIdt of-Massadrrrsetff. . Depwtiffent of 1udus hd At:ddeYds office- }ry 6V O WashhIgtoxl a9treet -- Bastarx,14M 02LU turvttzmmmgor1dia Warlmrs' Campensafi m Immn-ance Affidavit Bider-dCuntrac=tursMectdcians(Phwahers AppUcamthformatign Please Print Nam�3n�**R�anfJa�inal��i�3�Lo t� S �%7ip1 i/ll Ci- /�►�LO h(yZ�14/C i Vie' Are you an employer?C'heckthe appropriate box; ' T f project L❑ I am a 1 ugh 41 am a general contractor and I Y o P Ject tr eged}: 6. employees(fisll amVor part-time * have lmed.the subr confi=tors .❑New ion r 2.❑I am a sale prgpzietaff orpatier- Usfed on the attached sheet. 7 Remodeling ship and have:no employees These sub-contractors have g_ ❑Demolition wadring formm in any capadty employees andhave wodmze 9. 0 Building addition [Ida wpdoeL$' camp_insurance comp-mmnanml required—] 5. ❑ We am a•corporation and its 10[a EtePfdcal repairs or a des 3_❑ I am,a homeowner doing all;work officers have exercised their 1LEI Plumbingrepairs or additiew myself[Na ffi'camp_ TiE#of exemption per MGL 1,❑Roof repairs. insurance reSair•ed]i c-152,§lM audwe have no employees.[go wAers' 13_❑Other camp_insurance required_] d'AnyappEi Beatchedcshoa#l=4aka fill outtheswioabgaysira g3iekwa&ed comp—saf; upeE4i=ffi=j6am. gameawraam who sabot tFris afEda<<ii=dk2tMg&-ey im daiag a]FwaA 8UithMhie OUt3de COEt 3LCtarS2IIRSt 5ahmit1UPW afCidavk iadicoig sacs_ TCanalactors ffizt checYihis bax mmt attarl, =addifi-21 sheet shoviagthen2me of the sub-cc=sotos smd stye whdhet arnot&ose eatides�- e employee.1fthesnh-contadaes1=e employees,theynnstpmtdde#heat Wadcm.'ramp.paliy numbet I arri art etrtpio}�rr flertl isgra�zding n�orkets'can resrdzare ittsrtrarzea�'vr m}*empTa}'ees $ably is fltepolicy turn job site hifon n/Idom r TnsuranceCompanyName: Cc 'Policy#1or Self ins_I ic_ l tl .SD 96S6d to(7 A KpiiationDate: 01/70! aiO 1.e rob site Address: &S v e)DA U&y cii State&�p: eAN'A!i M126 a copy of the work-ere compensationpolicy'declarationpnge(showing the poricp number and.expiration Sate). Failure to secure coverage as requirednnder Section 25A of MGL ti 15-7 can lead to the imposition of cr* " penalties of a fine up to$Una Oa and1or one-yearimprism meut,as we11 as civil penalties iia the fomz of a STOP WORK ORDER=d.a Ee of up to$25(LOO a tray agar the violator. Be adzdsed that a copy of this statement.maybe forwarded to the Office of Inestigatinns of the DIA for insurance-coverage y nn_ Ida herz6y csrftb a andrpsn WeY a fp4ury flurtffis ireforma€i=prmi&d abotg is bar$artd earrec-t ip�afnr� Bate: Phone� ��r� �� � �•'� t7„�€cicd rrs�ariF,1: Da riot aprita€n tt�.axeQ,tit be crrfngleted lip�'art`nii�i iv�frcuit City or'I'oww PermWLice6se:9 Emiring-knthar€ty(cane one): L Board of Health 2.Building Peparhni mt 3.f 'frown,Clerk 4:Electrical Inspector S.Pbimbing Inspector f.Other . Coact Person: Phone#: --- 6 formation and Instructi0las Maw Gc=al Laws ffieptex 152 regtru-es all employers'to Provide wolb'=lIpensaflou for their employees. Pumat-to this stye,an eaTIayr=is defined as¢:evetyPersonin he sEmce of mwffi=uwJ=aay contact ofhfir express or implied,oral or " AIL�Tayer is d fined as_an inc i ffi tal,partnership, associaticm,corpo_�ion or otb -legal�-y, mY wo or more of the foregoing (Ifioe=ga ed m a Joint ,and mc�g fm legal repres�ves of a deceased employer,or$ie rmeiM or trustee of an indrvidnal,parUsh.�ip,msochfaon or othe�Iega1 entity,emp7oY�Amy - However the owner of a dw i i?ghoms havmgnotmamtbaathreeapartments amdwho rides!herein,urfile occaPant ofthe- dwelImg house of another whn employs Pm$sm s to do mabtenm .cmmstrtLr.ti on or repair wolk on such&?Ml mg house or on the grotmds or bmVmg agpmtmz3Ailiereto sballnotb=mse of such employmm±be d=nedto be an employe" MGL chapter 152,§25C(6)also scats flid¢every sfafe or local rcemdmg agency shall withhold ffie issuance ar renewal of a license or permit to operate a buldiess or to construct bu7dmgs in the co--Dawealth for MY applirasttwho has aotpradmced acceptable evidence of compliamm with tbr-msur=ca coverage required." Addxiionally.MGL fit=152,§25CM states-W6 therr the _ nor my ca poIilical subdivisions sbaIl enter into any confxar-tforljieperfonn�e�ofpnblic wm:kmd1 a�ptable eQidnace off eompliancewi the msra�ce. req===fs of bats chapter have been presented to the coniradmg.anfhozhy AP]?hcaats .' Your siivaiation ec and,if Please fiII oiot file vTorloers'compensation affidavit completely,by ehe�g b a app to Cep s) nessarL Ply sob-oont udor(s)miners), addresses)mdphane n�ber(C)along w Of insrnmlce Limited Lia. iOY Campanies(ILC)or UnitedLiabilityPar�s7�s(L P)witb.no employees other i�the members or parbacm-4,are not rimed to carry wolj=e con3pe•osafion iusoranm If an LLC or LLP does have employees,apolicyisrequired. Beadvisedfhat this affrdayitmaybe,m mitfedtotiieDepafinentoflndzlsf-W Aceidems for confirmation of ftmn-ance coverage Also be sure to signand date the af7tdav1f Ilae affidavit should be retinae to$e city or town tbat the application for tha pew or license is being r$gmested,not the D epar�exrE of Turin¢iTi al A_eci dents. �T,rmTdyatt have any gnestions g the law or ifyon are reed to obtain.a WoriC=' compensation polieY,Please call the Depar[me�at the nnmbea listed below Self-insured companies should�imrr their self-msar�ceIic mDnumberontheappropriatelme. City or Town Qt�tdals - r PIe use be sore that the affidavit is complete and grimed Iegihly. The Department has Provided a space at the bottom of t1ie:affia�d for you to full out in the event thD Office of Tnvwdgati=hzs to coafactyouregardi.ag the applicant Please be stye to f 1I in tine PF` .j Iiccmr-n=ber which will be used as a reference rnDnIbez la addition,an applicant that must submit muhiple penait Ucense apPlibBfi s in any given yew,nee i only submit one affidavit indicating cmzent u olicy fi fu=aation(if neces ary)and under`Tob Site A_mmse the applicant should�"aII locations in (may or ed or nza�ed bythe city or tu-wn maybe provided to the . town)_'A copy of the-aff chwitihathas been officially stamp . applicant as pmof that a valid affidavit is on file far f�e'pennits or Iieem A new affidavkm mist be{ I1-- oiat earh year.•Wherre a home owner or citizen is obtaining a license or permit not related to arty business or commercial v (ie_a.dog license orpennit to bum leaves e#c.)saidperson is NOT req�red to complete this affidavit The Office ofInvestigati=wouldhketof makyoumadvance for your coopmdionandshOuldyonlmve any questions, please do nothes$ate to givem a call. the Departure fs address,telephone and fax number: 1 Depa dment of I�dmgftid A_rcidenf 654 wn R.agtov 1 &oil II T(�L 4 617-' -4 cxt 4-06 or 1477 MA aAFE Fax,#617`27 7M R=ised4-24--07 maw- 1*�dza ' A WC Guide to Wood Construction in High Wind Areas:11 D mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)t Q Check 1.1 SCOPE Compliance Wind Speed (3-sec.gust)............................................................:.......................................:.............110 mph WindExposure Category................................................................... .,.........:...................................:.............B 1..2..APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories <_2 stories RoofPitch ...........................................................................(Fig 2)........................................... s 12:12' MeanRoof Height ..............................................................(Fig 2). ........... ............................. ft 5 33' BuildingWidth,W...............................................................(Fig 3). ............................................. _ft-5 80' Building Length,L ........................................... ...... .(Fig 3). ................... .... _ft <_80, ...... ...... ................ ....... .. Building Aspect Ratio(LNV) ................................................(Fig 4). ..'....:...................................... 5 3:1 Nominal Height of Tallest Opening2 .....................................(Fig 4): ............................................ <_6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections....................:(Table 2)..............................:................................. 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete..................................:......................................................................... .:............:..... ConcreteMasonry........................................ .................. ..... .............................................. 2.2 ANCHORAGE TO FOUNDATION" 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an altemative in concrete only Bolt Spacing—general ................................. ........(fable 4).............................................. in. Bolt Spacing from endroint of plate ............................(Fig 5)...................................... in.<_6"—12" Bolt Embedment—concrete........................................(Fig 5).................................................._in.z 7" Bolt Embedment—masonry.........................................(Fig 5)............................................ in.>_15" PlateWasher...............................................................(Fig 5)...............................................z 37 x 3"x Y4" 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension...................................(Fig 6)......................................... _ft 512' .......... Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6) ...................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall.:..............(Fig 7).....................................................—ft 5 d Maximum Cantilevered Floor Joists , Supporting Loadbearing Walls or Shearwall................(Fig 8)............................:....................... ft 5 d Floor Bracing at Endwalls...................................................(Fig 9)..�................................................................. Floor Sheathing Type .............................................. .....(per 780 CMR Chapter'55).... . .................. ... Floor Sheathing Thickness ..........................a.....................(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.............................................. .(Fig 10 and Table 5)..........................._ft 510, Non-Loadbearing walls................................................(Fig 10 and Table 5)........... .,....:.........-ft 5 20' Wall Stud Spacing .............................:..........................(Fig 10 and Table 5)..................._in.5 24"O.C. Wall Story Offsets ........................................................(Figs 7&8)........................................... ft <_d 4.2 :EXTERIOR WALLS" Wood Studs Loadbearing walls...........................: (Table 5) in. Non-Loadbearing walls................................................(fable 5)..............................2x_-_ft in. Gable End Wall Bracing Full Height Endwall Studs............................................(Fig 10).................:.......:....:.'................................ WSP Attic Floor Length—...... ength........< ...................................(Fig 11)................................................ ft�W/3 Gypsum Ceiling Length(if WSP not used)...................(Fig 11).............................. -ft z 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. . (Fig 11). .................:.. ...:. .... ..... ..... .... or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ......................................:.................(Fig 13 and Table 6)......................................—ft Splice Connection(no.of 16d common nails).............(Table 6).......................................................... I AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)' Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(fables 7)...................................................... Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(fable 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9).................................._ft_in.511 SillPlate Spans ........................................................(Table 9).................................._ft_in.511' Full Height Studs (no.of studs)...................................(Table 9)........................................................ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9)............................... _ft—in.512' Sill Plate Spans..........................:................................(Table 9).................................. ft_in.s 12" Full Height Studs(no.of studs)....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV Minimum Building Dimension,W Nominal Height of Tallest Openingz 6'8" SheathingType.............................................(note 4)....................................................... Edge Nail Spacing.................................:.......(Table 10 or note 4 if less)....................... in. FieldNail Spacing.........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(fable 10). .................................................... _ Percent Full-Height Sheathing......................(Table 10). ...... .......................................... _% 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Maximum Building Dimension,L Nominal Height of Tallest OpeningZ......................................................................... s 6'8' SheathingType.......... ................. .............(note 4)............:....................................... Edge Nail Spacing. ..........:............................(Table 11 or note 4 if less) .................... in. Field Nail Spacing.........................................(Table 11)................................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................ Percent Full-Height Sheathing.......................(Table 11)................... ° 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?............................ . .................. .................. ......................I.......................... 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............._ft<_smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).............................................U= plf Lateral.............................................(Table 12).........:...................................L= plf Shear..............................................(Table 12)..............................................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker.........................................(Figure 20)..... ........_ft 5 smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no.of 16d common nails)...(Table 14).......................................L= lb. Roof Sheathing Type........................................... . ...(per 780 CMR Chapters 58 and 59) ........... Roof Sheathing Thickness........................................... ............................................ _in.z 7/16'WSP Roof Sheathing Fastening...........................................(Table 2)...................................I......I............... _ Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then 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 18a and Figure 18b- 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%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#2-grade. AWC'Guide to Wood Construction in High WindAreas:110 mph,Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 4• a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. 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 floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment -WHEN THIS EDGE FUNM ON - _. _ FifiAhA1NG41SE8dFUtp-S "• ` u 11 tI a ,1 1 Y Id 11 11 11 1 11 _ 11 11 1 If I 11 11 1 11 11• 11 'L 1 ' 11 II 1 5 11 I l H II C „ 11•F 1 F _ It Q 11 it 1 E It OD h .rl 1 Z iL It] 11 11 I{ 11 g 1 IW„ i{'Ir if ii'Ts 1 Wl• ii rl tl. ' rr • n 41569LE EDGE -------- PAN I ti I v See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in Sigh Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 r Moo ; u Ba tI I' i I FRAMING MEMBERS r 1EDGE 94TEWEEMIr- I r r I , I ;E r r STACK 3'MrL ?MAIL PATTERN � PANEL PAMM EDGE DOUBLE MAIL EDGE SPACING DEMI. Detail Vertical and Horizontal Nailing for Panel Attachment y -A WC Guide to Wood Construction in High Wind Arens:110 mph Wind Zone ' Massachusetts Checklist for Compliance (7so CmR 5301.2.1.1)1 FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a no mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCMioo niph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category(B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has. been used in North Carolina over the past 10 to 15 years which has performed well in severe hurricane weather in that state. Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner - 200 Main Street, Hyannis,MA 02601 >�rn�. aASM www.town.barnstable.ma.us 165 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print- DATE: cc-- JOB LOCATION �S mac) iJ '�,�V A/V number streeett village "HOMEOWNER": ")6,Z4CD0 R.'�Y(� ✓0A �)3:70,619� name home phone# work phone# CURRENT MAILING ADDRESS: S SC I bo" (!N/ HY MIJ: S Od-60V 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 p cedure d ents an;dW will comply with said procedures and requirements. Si ature 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 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. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.dor 08/16/17 Town of Barnstable Building Department Services MAJINST" ' `KARR Brian Florence,CBO i639. �`� Building Commissioner p� 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 " f Property Owner Must j Complete and Sign This.Section : - If Using A Builder a 00% D I ,as Owner of the subject property hereby authorize (A B U(,00 S " U 100/-M6 ZJ,Ox-4Y) ,to act on my behalf, in all matters relative to work authorized by this building permit application for: S - Su�B 0 g4� /n/ -HYAIVn/=`s-A-19 (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. Signature of Owner S o cant q6e4LC)o (IZ- 00" Print Name Print Name I Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:09/16/17 f 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 LeLyitbly - Name(Business/Organizationandividual): CA3L 1 OU.S Su] C I e l C j,4- Address: f if J2 9�N. W A'\/ paG� #: �e ,3 City/State/Zip: W . jy�u� 4hone G o 3 Are you an employer?Check the appropriate box: Type of project(required): I.❑ lam a employer with 4. V9I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.1IIRemodeling 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. required.] S. ❑ We are a corporation and its 10.Wlectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions myself. [No workers'comp.- right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state-whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. y 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 5 5o(f 0 -�ec E e )OY Cr_ Policy#or Self-ins.Lic.#: W CC _500 Sbl 50S6 a Q 1 :. A Expiration Date: b 2Q--->)(9 Job Site Address:-6-5 4JUC 80 City/State/Zip: - �YA 01 r 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. Ida hereby certify nder thepains and penalties of perjury that the information provided above is true and correct Signature: Date: - Phone#: LSIDL -36 o D 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 'Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the 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)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#61.7-727-7749 Revised 4-24-07 www.mass.govldia ENO 5.7 10 a in n.. lb . 4 T�6 40'-7N ; L — ol '. --- - --- , E ��� � � 7C - � Q-XOUV 0SUi ��V� - DEN 1v n S BUILDING DEPT. 1S �r,,LL.S, ►x.� NOV 14 2017 TOWN OF BARNSTABLE Kitchen Bathroom Bathroom Master Bedroom l Living Room Bedroom Bedroom 40 La ici ;u ; 51 n u u; ;n i n I Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-109981 � Construction Supervisor JOAO DEMOURA 22 SMITH STREET HYANNIS MA 02601 Expiration: 12/2212019 Commissioner ti,� �%/e 'l%nur.rrrcrzrurrr//!,o/r,�jr :., �..,.•L rc:;.irir�rr it//.•; —office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR 1 �� €''Registration 172023 Expiration Type: 9/7/20181 Supplement Card FABULOUS HOME IMPROVE!MENT''INC JOAO DEMOURA 11 SIERRA WAY W.YARMOUTH, MA 02673 Undersecretary - ���eaai aas zraca (�>'o, - tceorc ar�eCJ�y ' _Office of Consumer Affairs&Basi esszAc9ulation f^ HOME IMPROVEMENT CONTRACTOR ; Registration ;'17,2023 Type: Y Expiration 9/7/2018 Corporation FABULOUS HOME IMPROVEM At"INC A` a EDSONLL DE MOURA # r 11 SIERikA WAY �.c W.YARMOUTH,MA 02&3' Undersecretary i r - Client#:761993 2FABULOUSHO DATE(MMIDDIYYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE . ' 911512017 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 NAME: Dowling&O'Neil ____ Dowling&O'Neil Insurance Agency PHONE FAX — 9 Y (AiC,No,Ext)_508 775-1620 ---_- — f (A/C;NNo):5087781218_ 973 lyannough Road E-MAIL coi doins.com _ P.O.BOX 1990 ADDRESS@__.____ INSURER(S)AFFORDING COVERAGE — I NAIC# Hyannis, MA 02601 �— - - Y INSURER A:Safety Indemnity Insurance Company _ `33618 - INSURED INSURER B:Associated Employers Insurance Company 11104 Fabulous Building and Remodeling, Inc. . — -INSURER C -- 11 Sierra Way _. MA 02673 INSURER D West Yarmouth, INSURER E - - - - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. L RR --'ADDL SUER;^- - POLICY EFF POLICY EXP I TYPE OF INSURANCE__ _IINSR IWVp!_ POLICY NUMBER (MMIDD/YYYYL.(MM/DDIYYYY)_! LIMITS A GENERAL LIABILITY BMA0026715 05/16/2017 05/16/2018 EACH OCCURRENCE $1 000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $1001000 CLAIMS-MADE I X I OCCUR MED EXP(Any one person) i S 5,000 PERSONAL&ADV INJURY !$1,000,000 - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I - - - I -PRODUCTS-COMP/OP AGG- $2,000,000 � PRO- r I I � -- -- POLICY I ;JECT IOC -� ----�- - - - g -- I AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT " 1Ea accitlenp _ I$ 1 ANY AUTO - BODILY INJURY(Per person) I S ALL OWNED SCHEDULED I j BODILY INJURY(Per accident) S J AUTOS AUTOS NON-OWNED PROPERTY DAMAGE--i- -T ' - , HIRED AUTOS AUTOS _ I -.— •_---- - _.--.... ---� - - ....--- - _ .—l._....__ 'UMBRELLA LIAB OCCUR (^ .I EACH OCCURRENCE $ �I^l EXCESSLIAB CLAIMS-MADEi 'A_GGRE_GATE �_ DED RETENTION s_ --T; --i WCC5A050150562017A 0911012017' � s — B WORKERS COMPENSATION i 09/10/2018,.X r O S ATU- _ ERHAND EMPLOYERS LIABILITY y/N - ANY PROPRIETOR/PARTNEREXECUTIVE I i E.L EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? —N I,N 1 A i - I- -- (Mandatory in NH) _LE.DISEASE-EA EMPLOYEEI$500,000 If yes,describe under - I - -_I DESCRIPTION OF OPERATIONS below __ - __ j_E.L.DISEASE-POLICY LIMIT $500,000 I I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE A-r ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S197928IM197927 CBD 1 ------------- �e �P�rvrrzoozcoe�clC/i p Tice of Consumer Affairs&Busiuesf s Regulation r ME IMPROVEMENT CONTRACTOR I I Registration: ExpiratiI Q20�3 Type: <I =9 � 8>>r`' Supplement Card FABULOUS HOME IMPR JOAO DEM , OURA 11 SIERRA WAY W.YARMOUTH, MA 026731 Undersecretary Jau01.sSILULUOO 6L0ZIZZIZ6 ��1 �V :uoi;e�idx3 ' �J I , 109Z0 VW SINN S ZZ r µ ly now31411w0 OVOP L'Ieu" uoijonjlsuo0 �osinjadnS asuaoi8660V'S0e n6a� 6uip1ln910 Pleo9 Pue suot� 1 asnyoesseW gnd do 3uaw31edatJ s}3 ment of Public Safety Building Regulations and Standards mass Depart , Board of B 109981 License: CS- ervisor Construction Sup JOAO DEMOURA STREET HYANN S MA 02601 n , Expiration: 1212212019 Commissioner aan;eu;1!s;noy;! P118A 10 ,i III i 9iiZ0 vw`uoIsog OLiS al!nS-ezgla mica 01 uo!;glngag ssau!sng pug srle33V iawnsuoD;o aag�0 :o;uan;aa puno331 •a;gp uo!;gndxa ay;aao;aq C!uo asn!enpin!pu!�o;p!!gA uo►;e1;sl2al ao asuaal l j IM CERTIFIC44TE OF INSU LATIOAf M R,, NATIONAL FIBER NATI®NAL FIBER PART I-GENERAL ADDRESS OF RESIDENCE: NAME&ADDRESS OF INSTALLER: P.Q.Box 52 West Dennis, NNA 0-2 M- - DATE OF INSTALLATION COMPLETION: 0� PART 11-AREAS INSULATED WALLS( 9(!)Q SQ. FT.) CIELINGS( . 'SQ. FT.) FLOORS( SQ.FT.) TYRE OF INSULATION: ►''t -r• W-J TYPE OF INSULATION: TYPE OF INSULATION: MANUFACTURER:� 1 MANUFACTURER: MANUFACTURER: R-VALUE AMOUNT R-VALUE AMOUNT R-VALUE AMOUNT INSTALLED INSTALLED INSTALLED INSTALLED INSTALLED INSTALLED FM Ic PART III-CERTIFICATION 1, VC>'L%-1,r;e�te� CERTIFY HAT THE R NCE IDENTIFIED IN PART I WAS INSULATED AS SPECIFIED IN PART II AND THEE= r INSTALLATIONWAS CONDUCTED IN CONFORM CE T APIy C BLE CODES,STANDARDS,AND REGULATIONS. (AUTHORIZED SIGNATURE) This certificate must be completed and prominently posted adjacent to all areas which are insulated with pragrarn funds. L �. _ l e_ TOWN OF BARNSTABLE =3 �,• �.}�, ♦e Permit No. --------------=---=- swSr.n B111It�1IIg' IY18peCtOr Cash rua ------yY`-- ��OY11Y � OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Capr ;C.ol,'11 Realty Trust Address 765 Fahnicut h v,'.csad, 11yar is l f.t - 3'7 iG ti CY f.71+Y ties T 4 nra T3<rns,:s;o Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector - `:� ,s,- Inspection date f } 2 R g Engineering Department rr. � r � Inspection date — r p THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. � � 1 ... .......�. Building'Inspector .........................� .r� .........�...............»... 00 fO0 0 20' ; s-� LO 32 127. 26 N C 37 1 U Ix � Lo, 33 'cj . o 32 k� 162.53 Lo-r 35 L_O, 3 CERTIFIED PLOT PLAN V LoT 37 SuDBwzy LAND' NIANNIS NEW CONSTRUCTION ONLY = ;fit TOP OF FOUNDATION IS 3-57 FEET IN ABOVE LOW POINT OF ADJACENT N4suR�►�y� 0AjoothS14914AASS ROAD. SCALE I = 30 DATE m,9a 2"J 82 LDREDGE ENGINEERING CO.IN I CERTIFY THAT THE CLIENT F2RN'CO SHOWN ON THIS PLAN IS LOCATED EOISTERED REGISTERED JOB NO. 205 ON THE GROUND AS INDICATED AND CIVIL I LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BYE 3 2�D OF BARNSTAB,, M/ASS. 712 MAIN STREET CH.BY: JOB H YA N R I S, MASS. SHEET-L OF I DATE CR LAND SURVEYOR ' -�,� �� �� s� � lot �s map' number ~ �� z - ' � . � -'�� Sewage Permit number ���..�-��-----------..__ ' / /� ' ' ' �� �� Howse number ��,� , . � - '^~�'---------'----' ' | | ' 8 � . | ' .~- ' r�������77l�T �]��� �� - ' TOWN� ��/ �"�� �_��� N _ �� / ` N�K��� ��� A LE . _-- ''- _ - ^ CO �� NN ^ ' �� N0NN�N0N �� �� 0 ������0� ' -- - - ---- - -- -- - ~~ - ~- -~ ,0����� �� OQ��l��/����*�mou� , ^' _~._..-~~ APP0CAT ON FOR PERMIT To ..�..Oono Single��.. _.. ^ �--'_'-_--- - -- . ' ------- --- ---------------._------..-.-.-------. . , �� 7�� � ����� l ��*�^ , --'''~]'- --�------ ^u--- ' | TO THE INSPECTOR OF BUILDINGS: � The undersigned hereby applies for q permit according to the following information: � �� ' ��tion ��� — �� � ,� �� ���u �+� �� �����|,� 1q.. ���� � -'-'�'-'' '---'' ' '^~-'~'~'' 'y''------~-~`----`''r ''~ - --'~^~~--------' ProposedUse ------------.--------.-..---------..---..~~.----.----'---'-'---'' Zoning District -D.�.B.�-_-----.------------Fine District .Hvar��.i{�------~----._-__'___, � Nome of Owner Oa .�� o.oro..Ile.aItv_�.���.t____.Address 7� ....nImoutb.. x.. _____ Nome of 8vi|6p, Fza.no��-Ile��I.�]���t��t�-D�`�. ~�A66nss 7�5...FaIouo��tb_Road�x.. ��_____ Inc Name of Architect -------�---.-.--------'_A66res -.-------------------,----,--. Number of Rooms ...s.iX........................................................Foundation ]�^.C�---------- ...................................... ^ Eme,io, 6 ard' ��-8)j Jq------Ropfing -.Aaphalt. __-_________ Floors .............................. ......................................Interior .....ahQ.Q.t.. ..................................................... Heating 8a.s-�-]�xVV����-----------------..Plumbing ..1�.]�0-�-Q�P�e��----___________. Fireplace .-----------------------..ApproximoteCoo A�O.t.000�.00........................................ Def nhiveF1on Approved by Planning 800nj 19----' Area ...�0�4 ����_ft�___ | Diagram of Lot and Building with Dimensions Foe ........~ ____ � SUBJECT TO APPROVAL OF BOARD OF HEALTH 010 \ / v / ` � � � ---'_`� | | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name CAPRICORN REALTY TRUST 238.75 One Story 114 Permit for .................... ` Single Family Dwellin .................................................................�............ r Lot #37 65 Sudbury Lane Location ............ ` Hyannis - r Capricorn Realty Trust Owner .................................................................. - Frame Type .of Construction ............................... .......... 4 .t ..... ...................................... .......... Plot ........................ Lot .........'..... ........... e r� march 15, 82 Permit Granted .......................................:1,9 + Date of Inspection ..` .. ..... .....:......19 Date Com Id/...• � �:.. .1917 ? PERMIT REFUSED { ; ............. .............................................. 19 f n x .................... ...........: _ ............................... ..............................:................................................ .....................................................6......................... { Aproved .......... ..................................... 19 /r . ... .1 .. ... ..... . . .. �r rr: Assessor's map and lot number ...... ** .......... 7...* **'**"* Se THE Toffy 9 :Z 3 %Nage Permit number ........................................................ 33AR33TAXLE, Hcvse number ... ....... MAO& 1639- MOR TOWN OF BARNSTABLE BUILDING INSPECTOR APPLIC donstruct Single Family Dwelling ATION FOR PERMIT TO ....................................... ................................................... TYPE OF CONSTRUCTION .Wqad.......Frame ... ................................................................................................................. ......... ................19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .......�.7....... ........ ................................................. ProposedUse ............................................................................................................................................................................. Zoning District ...R.B.. . ...........................................................Fire District Hyannis............................................................ . . . .. . .. .......... .... Name of Owner Capricorn...Realty Trust Address �§�...Falmouth...Road,. . . ....Hyannis................ ...... .. .... ....... ..... .... .................................. ....... .. . ........ .... .. .. . ....... ....... .. Franco Real Estate Dev. C Name of Builder .......................................................... .,.,OAddress Z§5..Falmouth Road, Hyannis ...........................................I.............................. Nameof Architect ..................................................................Address .................................................................................... six Numberof Rooms ...................................................................Foundation P...c..............................I......................................... Exierior clapboard and/or shingles ...Roofing ....A��phalt...shingles . .. ....... ....... ............................................................ ... ............ .......................................................... Floors ..c.a.rpe.t.....................................................................Interior .....qjjqq� rock .carpet....... .. .................................................................. Heating Ga.s.......F....W...A...........................................................Plumbing ..:t..yfq...7:...qjqp ..................... .......................... Fireplace N.one........................................................................Approximate Cost A0,000.oo ....... ................................................................ Definitive Plan Approved by Planning Board --------------------------------19--------- Area ...1.0..56...!�q......ft.......... Diagram of Lot and Building with Dimensions Fee ....... - ':7:7—" ........... SUBJECT TO APPROVAL OF BOARD OF HEALTH = 0/0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ............. Name 4 CAPRICORN REALTY TRUST A=271-47 23875 One Sto No ...........t Permit f r .......................... -Single Fam y Dwelling ............................................................................... Location Lot #3 7 6.. ....5 Sudbury. . ....Lane.. . .... ....... .... .... .. ............1T.y.annis............................................. Owner ...Capricorn. . . . . ....Realty. . . ...Trust... .... .. .... .. .... .... .. .... .. .. ............... Frame Type of Construct'ion .......................................... ................................................................................ Plot ........................ Lot ................................ Permit Granted ............Mar,9h... 82 Date of Inspection ....................................19 Date Completed ................:.....................19 PERMIT REFUSED ................................................................ 19 ..................... . .. ��. ..�.. ._ . . . _ _ ............................................................................... Approved ................................................ 19 ......... ....... ........................................................