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Home My WebLink About0097 SUNNY-WOOD DRIVE �r � t Town of Barnstable *Permit#A614Ae395�h _01 Expires 6 montWrom issue date Regulatory Services Feeia, + snaxsresiA + MASS.AD Thomas F.Geiler,Director Building Division �- Tom Per CBO Building g Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038: Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number- J 7;i 9 36 LiSI yl Property.Address 1 /t,✓ Residential Value of Work' yOD Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address- �,Q tl—w�hC I C, 6 \i t.! Contractor's Name � t_l. Telephone Number__, Home Improvement Contractor License#(if applicable) a 67 Construction Supervisor's License#(if applicable) e s NOW ❑Workman's Compensation Insurance "`sPR Check one: P.-If am a sole proprietor SEP 2 7 2012 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE P y Workman's Comp.Policy#' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane,nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers ofroof) ❑ Re-side #of doors. Replacement Windows/doors/sliders.U-Value s2. (maximum.35)#of windows _Z ❑ Smoke/Carbon.Monoxide detectors 4 floor plans markedwith red S and inspections required. Separate Electrical&Fire Permits.required. *Where required:`Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.d Revised 053012 i } I Office of Consumer Affairs&B siness Regulation Lccnse or registration valid for mdiv►dul use only 4 HOME IMPROVEMENT CONTRACTOR ! before the expiration date. If found return to: Registration: ,� 12676 Type: Office of Consumer Affairs and Business Regulation Yp j Expiration: 4/15/2013 'DBA 10�-Park Plaza-Suite 5170 s Boston,MA 02116 :a RI LYNCH HOME JMPROVEMENTS. - vt � � RICHARD: LYNCH JR 86 ENSIGN RD. CENTERVILLE, MA 02632 Undersecretat dome Y (;�Not valid witho ture Mass is husetts Dep u-tment of Public Bata', nct a ds Bourn of-Build'. :fie"uJuti(i��s urid St r Construction Supe"rvisor License,,, License: CS 53837 r RICHARD C LYNCH 86 ENSIGN RD } , CENTERVILLE, MA 02632 Expiration: 'g/11/2013 , Tr#: 4446 r A J 1 , The Commonwealth of hlassat husetfs Department of Indusftwial Accidents Ojoice of Investigations 600 Washington,street .Boston,M,402111 nms,,mas&gaoldia Workers' Compensation Insurance Affidavit Bid ders/C:ontractarslElectricc ans/Plumbers Applicant Information Please Print Leeibly Naive tksine duaU= t c L.A tyC n V" t° w+n Address_: T City/State/Zip O 96 3 R Phone Are you an employer?Check the appropriate boa: T of project r �. I am a contractor and I Type P J ( �= 1.❑ I am a employer with ❑ 6. ❑New construction Amployees(fu11 andlor part-time).* have hired the sub-conhwtors 2. I am a sole proprietor or parker- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sob-contractors have g_ ❑Demolition employees and.have;workers' working forme in any capacity. I 9_ ❑Budding addition [No workers,comp.insurancecamp.insurarme 5. ❑ .We are a corporation and its 11D.❑Electrical repairs or additums equired� officers have exercised their 11. Plumbing airs or additions 3.❑ I,am a doing all work ❑ g�p ,l£ o workeers' right of exemption per MGL �� - 12.❑}hoof repairs c.152, 1 4 and we have no iric�xa„n�reclairetl.]t $ (.� o workers' 131YOther (ti ►K N o e.9 S employees- comp•.msnrauoe regtipuL • applicant that checks Los#1 mast also fill out the section below showing their workers'c atiaa.policy inf oration. Aomeaarnets who submit this affidatirit indicating they are doing all walk ami dum hie outside c:onuactors mnst submit anew aff davit indicating such YContractors Ilia check this boa must attached an additional sheet showing the name of the sub-camttsctm and state whether oruot those entities have employees..If the sub cantractots Lace employees,Suey m, provide their workers'comp.policy member. I am an emptnnyar that is providing workers'congwasa on.insurance for my ewp1c!j ee& Betaw is the policy and job site. information. Imu aace Coffip any Nam: Policy#or Self-ins.:Lie.#: Expiration Date: Jab Site Address City/State zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as regtrired 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 m3prisonmeat,as well as civil penalties in the form of.a STOP WORK ORDER and a fine of up to$250-0U a day against the violator. Be.advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage Verification.. I do hereby colig the }ts and mi ss gfperjkiy thatthe info rmation-protRded above fs true and correct Si #tire: Date: Phone#_ D t�1,fjiciat use only. Do not write in this area,to be campleted by city or town official City or Town. Permitff kense# Issuing Authority(circle.one): 1.Board of Health I Building Department 3.Cityfrown Cleric 4..Electrieal Inspectors S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 OF THE tp�r,_ • lARN9TABLE. + ' ,. Town of Barnstable 1°lEa raor A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.Ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, � _ i /c o K/ e , as Owner of the subject property hereby authorize LK to act on my behalf, in all matters relative to work authorized by this building permit application for: Su (Ad ess of Job) Signature of Ow er J Date - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESIFORMSIbuilding permit formsTYPRESS.doC Revised 051811 a �tME 'Town of Barnstable Regulatory Services � . Thomas F.Geiler,Director AS 9�A1659. ,�$ rFn 5.�a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work_performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building_Code " Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION - The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as"supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the . permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc �vised 051811 at �3 3 Ae A& i — a • AssQssor's map and lot number ................................... ,.y ...... CF THE T Sewage Permit number' ... �.�. ........./.C?`..: —j IC SYSTEM MU- ... INSFA g D yT. B House number ..........�....�.. ... fi '�i , TI `L 90 cs.� MA86 G� MP TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION .FOR PERMIT TO ........ F.ami.1y...D-we-l1.irag................................ TYPE OF CONSTRUCTION ....... ...W,o:od. Frame.. .................................... .......................................... -4.. ........19.....85 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......Zot.l...4A......�.UW-y....W.Qo.d..D.r......Hyara-n-is-�.. M................................................................................ Proposed Use Zoning District ' ...............................Fire District '::.Hyannis '. .... ................................................................ Name of Owner .Capricorn Realty Trust .Address ....Z§.6 Falmouth d. Hyann s................ Name of Builder r ranco Real Estate Dev. CoAddress ......Same ........... ................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..,,Six „•,,,,,,,,,,Foundation P C ........................................... .............................................................................. Exterior Clapboard and/or Shingles................Roofing ......Asphalt Shingles................................... Floors ...Carpet................. ..............................................Interior ......Sheetrock Heating Gas-F .W.A. ...Plumbing ....... ................................................ None 60 000.00 Fireplace ..................................................................................Approximate. Cost ......... ........�................. Definitive Plan Approved by Planning Board ________________________________19________ . Area .... .'..5. .,... 't.�.S... Diagram of Lot and Building with Dimensions Fee Z.�X_s .. ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH rJc^a I c�J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and-Regulations of the Town of Barnstable regarding the above construction. / Name.( . ...... . ��Vl..`-�1....... Construction Supervisor's License ......��V.��..... ..... ........ CAPRICORN REALTY TRUST N6 .... Permit for „One. StM............. .........Single. FaT.i.1v..Dw.e.11.ia&...................... Location Lot 41,..... ...Sunny„Wood. Dr.iv.e.... ...... . .... ... . ...............HyAlalli.s................................................. Owner .......Capg.i.q.qrn...Rea.l.ty.l.r.us.t............ . ...... ...... . Type of Construction ...Er.sling............................. ........................................................... ................... Plot ............................ Lot ................................. Permit Granted October.. . . ..I.,..................19 85 ........ . . .. Date of Inspection ....................................19 Date C npleted.......... ...... IL r .....(F/. ........19 Assessors map and lot number ......................................23 ..... Sewage Permit number C� � '.� .................... Z EAUSTAXLE, i Housenumber ......................................................................... 90� Mb& mxf tr�� TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......0c?20—st,r.v"q h..C:ix, ................................ TYPE OF CONSTRUCTION ...............WOOd. Y.ram.e........................................................................................... .........a 1.z..........19.....5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......LOt...# Ta:r ....................................... ................................... ProposedUse ..................................................................................................................°......................................................... Zoning District .....R.B...........................................................Fire District ...H.yannis......................................................... Name of Owner Cap. corn Realty 1�rUst _„Address .....7.6?5b.-Palmouth R.d . Hyanni s Name of Builder t'ranc0 Real Estate Devi COAddress ......Same ...... ................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .....S1X.....................................................Foundation ..............��'....'...................................................... Exterior Cpboard and/or Shingles Roofing ......Asphalt Shingles .................... s..... .. Floors var.Je 4...................................................................Interior ......SheStrOck ................. ......................................................................... Heating . . Plumbing '4'TU—Ccn'rler' .......................................... .................................................................................. Fireplace !one 6o, 000 , OU .....................................................................Approximate. Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area 1oS6 Sg,......1t..s.., Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. , .. . .. . ..... . ....................s..... Construction Supervisor's License .................................... t � 28514 ..�V�u..e—'' S. —to—r—y---'--VNo -----.. Permit for -- S l ~---------- -- — — Location —��..�l.^..07.. 'Wo»6..D�i��. � .................. l�(2ngi�------'........................... Ovvne, —..C�ftQKi��. ..TK��t---- - Type of Construction —�rame............................ ' --------------------------. Plot ............................ Lot ................................ ' Oc�ober 9 8� Permit Granted --------.�----.]0 ' Dote of Inspection ------------lg Dote Completed ------------.]q | ' ~ / / y ^ � � . -- - ' ' Aq � ~ ,.j... .. - �'-. .. - .. _. ..r..y ,.e_ , rry; r - '4. .w. n5. .. .. r �. _.+. .y.... r♦ 7 . ter• r . ' o�THE,� TOWN OF BARNSTABLE 18514 Permit No. ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .........HYANNIS,MASS.02601 Bond .....X.. . . CERTIFICATE OF USE AND OCCUPANCY Issued to Capricorn Realty Trust' Address Lot #41, 97 Sunny Wood Drive Hyannis, 14assachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD . 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. j �1- � ........ .�.... 19...... .... .. Building Inspector 1L . Z •'f��,: TOWN OF BARNSTABLE BUILDING DEPARTMENT of TOWN OFFICE BUILDING � rua t639• � HYANNIS, MASS. 02601 �0 rAY►. MEMO TO: Town Clerk t FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by hBuilding Permit $k.. ....! .» �`f' ........................................................... ................................„..........................»..»..»...»»». issuedt ... . . ..» ..... .....................»....._...»...»»... » 'Please release the performance bond. iz1 Su' C �' '�Q RldsTd�LE dvlAs �►r3 . kx': n.n•a:: g �$stfyX•tr4n, F - T ' r - i ,s_ r i i.. x" .- ':- - 7 ;t'F-'iw.o '?'._ia,�, t �"`"•'nR-a_:s ' .,. r 'OATS r ,xr .r ' rt .:x° "PER APPLICANT ADDRESS %U �l __....... (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO Build. Dwiall_iRg 1 S .11 is Fi;t1)].�'" ;)»(:?:ll:?j NUMBER OF (_) STORY y DWELLING UNITS (TYPE OF IMPROVEMENT) N0, (PROPOSED USE) Y ' AT (LOCATION) �`OL 1T1, JL SU`i)'J ;:r. ;) (JV`li'.� i1)`<Ti?t , : ZONING ( _ (No.)' (STREET) DISTRICT BETWEEN fif AND (CROSS'STREET)-.. (CROSS STREET) SUBDIVISION op "4 a i 7 `F' , f4l LOT LOT BLOCK SIZE BUILDING IS TO BE FT I1DF J3Y_ '> r'•,. FT, LONG BY FT. IN HEIGHT AND SHALL CONFORIGI CONSTRUCTION r ?r TO TYPE / EGROUP BASEMENT WALLS OR FOUNDATION ". • sg - (TYPE) REMARKS/ w 4 $' AREA OR 1V�L i'i• .CL A g �t ` /� VOLUME r ESTIM OSTr �sjt �g iPERMIT � ricor CUBIC/SO r r a' G ! OWNER 76 5 ADDRESS BUILDING DEPT. /i'. y •; BY r i a THIS PERMIT CONVEYS NO RIGHT TO rC_CUPY ANY STREET, ALLEY OR SIDEWALK,'OR.ANY PART THEREOF EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON_PUBLIC"PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,'MUST REAP- ' ' PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM,THE OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. CONDITIONS MINIMUM OF' THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB•ANQ THIS WHERE APPLICABLE SEPARATE Y•' + ;�.. ALL..CONSTRUCT ION.WORK: > CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. �FOOTINGS ELECTRICAL, PLUMBING AND - FOUNDATIONS OR I MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2.'PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL - I MEMBERS(READY,TO LATH). `3.FINAL INSPECTION'BEFORE FINAL.INSP CTION HAS BEEN MADE., OCCUPANCY. ; POST THIS CARD SO IT IS VISIBLE FROM STREET ;.' L 'BUIL'DING.INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS- r 4 /Q'•, a (�• 2 2/. HEAT7NG.IN3` ' I N G APPROVALS REFRIGERATION INSPECTION APPROVALS 1 RING OTHER Z Z I - ., ' •_ � �.�. a4kg �-s�r BOARD ALT OF RE H 4WtR L tv r r tir't tarE' Pc NUL:, AND :<04 If CONSTRUCTFf7 .;4•: s wN ,{, La eW,. � f+rc P 1GS RNCRt vF„ Ke t:a r ti r e AOe.+,.t? ,)4RTEC WITHIN SlK't!ONTNS Oi DATE-TiF(E AN of F+ rt+GED f0A 8Y TELEPHONeWrt }a a ¢' F 09V. TG Imo. r^N + I Ir, t OA WRITTEN NOTiF1CATlpN ,r r �j 1 P€F•AlT iS ,SUED AS NOTED ABOVE. - .. a , �2 q s i,o is Al 140 to, I5 3?t 5z lo({ qw.FZlTu,QE r4. ��o � t. 3.co , 34 3 N N N Sq.9J �J � a � 27•so - a. 4rn �. a tr.o o ,8 51 LET `{� 32.2G 67' 20" W /55 00 _ SUNNy h/000 ��/VE Vk OF o FRANK WHITING' y o 0 s, No. 298 � 9Lis I Ll►N�5�� Tf,/E STe�c Tu�E OE�iCTEa '✓ .S Go C.eTE_p S�oc.�w iU.S o< Yi✓c'.do TE � i(�o j E G�SEa F-v.e s� CAPE COD SURVEY - -7-gs CONSULTANTS 3261 MAIN ST., ROUTE 6A BARNSTABLE VILLAGE, MA 02630 ��.T�-��- .✓, .3- /44 8-08 (617) 362-8133 Engineering Dept. (3rd floor) Map Parcel Germit# ,� 70 House# � � Date Issue �'lJ 'L Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) ��`l,2- Fee - Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) ' Cf THE 19 -- BARNSTABLE, ' MARR- �rFo r�i9ud"�� TOWN OF BARNSTABLE rrA, Building Permit Application Pro' eet Address vl S ury w ozC) 0(Z Lod- `llj Village a - , / I Owner L i RN V 1,to Address S19M�. Telephone Permit Request /41n�6 n i I N' 5 oe, 7P�g/gi-xv First Floor . a square feet Second Floor square feet Construction Type VR&5, 5vz j(2kean Lum6fa- Estimated Project Cost $ OI SOO . 0-0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure /9 Y(R S Historic House ❑Yes p-o On Old King's Highway ❑Yes f Flo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Meat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Galage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name (7 09-14 e C 2A NA✓`� Telephone Number 7 Address & 2O cvI 0 S7M"6kPrZy ; l Q/' License# (ILA 'I u-NTCZi Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 018moruo '01 5Q2 SA' CoNSl2vL11or" Ou+ - 5702 SIGNATURE DATE, 411�.1'9 BUILDING PERMIT D IED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY 1 PERMIT NO. DATE ISSUED MAP/PARCEL N t ADDRESS VILLAGE OWNER P" DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ,3 PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ,p -7 IL f(it Nil } y� � m 1 l b, 70 tf `7TWiRS �.7'b CNHm F@CLO � �sT RP1 CAP b Oj(k ro FQAmEn iriTlt �' Xg qT/G"0 C. axy KA�1 �3A�' S p65Ts RRi` yXy v,,,TA 9,,sT FACT �' 3 F96w)i- 5t2+N6rro NUyv& �'' S„�sThaN6i2S 3x`b �� p05T Foovi"G $` Sg�►v b ® C)EcY-i 6 is 51y b ` Q.T. �7 51-niQs AeE- a STC.ps ; Q��dA�7 AA Wu- N4,Is —(b6e v5W FEwcI L .C. `32 gig cz Al 140 I-I t m.&4 4 Qs. V` G .P. y�( N 3 .m N "f` �'OUNGaT/GW o N Q- 59•97 J o � . lo o• 4or -- - ig, o LcGE1/ a N � Zo. a o N h � �QO �g s� ��•So Cr.a � r Lo7- 41 322G P S/2' S7' 2On W SUNNY h/opp .0.e/VE' ---------------- N OF ._ s WANK TIN(3 i+ No. 29889 � 9EC/STEREO s L LAND Spy .SSE Sj--etiGT��E �✓ 4�..v�Co csT-E� i1�G o T /aL�Q.cf /c/r1 �4=�v ids oc 7��✓c-,d.4TE .[3� � `yJi��S c GoG�Ti o�✓. , s /S PG.rr.� �s ,�o•e two T E CAPE COD' SURVEY CONSULTANTS 3261 • _ MAIN ST., ROUTF �e a w THE COMMONWEALTH OF MASSACHUSETTS Board of Building Regulations and Standards Transaction No. One Ashburton Place- Room 1301 Boston,Massachusetts 02108 > Registration No. Application for Registration as a Effective Date Home Improvement Contractor or Subcontractor MGL Chapter 142A, CMR 780-6 Expiration Date FOR OFFICE USE ONLY Date 3��3��1) 1. Name Print the nattio of the individual or business applying for the registration(not both) Z Mailing Address � o D .. e 1 2 , 7757 - 77e) Area Code&Telephone Number 3. C.tty C V,vT i;1()E- state % Zip 4. Street Address(if different) Print street and Number(P.O.Box not acceptable) City state Zip 5. Applicant type: 0 Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation ❑ Public Corporation (See instructions on back regarding enclosing a city or town registration under the DBA or"fictitious name"law-MGL c 110,ss 5&6) 6. _(see instructions) 7. Number of Employees to 8. individual responsible for Home Improvement Contracts 60*61-- ("?2?1 GfR� 9. Title of individual responsible for Home Improvement Contracts G w 10. Does the applicant or responsible individual hold any other construction related state,city,town licenso or registrations? C N yes,complete the table below. Use additional paper if necessary. Yes Nc Type license or registration Issued By License or Expiration, Name of license Holder registration number Date net on+s7 5� It2 ', 'T ' of, W, b 3 Ci C GR 9y-- I .. i 13. - Include two separate certified checks or money orders-one marked"Registration Feel one marked"Guaranty Fund'. ALL APPLICANTS MUST INCLUDE A GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FEE.See instructions on back for am0I of foes. Make all certified checks or money orders payable to"Commonwealth of Massachusetts" Pursuant to Massachusetts General L xm Chapter 62C section 49A,I cedW tinder the penalties of perjury that I, to my rilmawledge and bellef,have Ned all state tare returns and paid all state taus required under law. Title held with applicant Signat of applicant or applicant's representative 0tie &arinooau�ealll a�✓�aataolutett �, :1 DEPARTMENT OF PUBLIC SAFETY r CONSTRUCTION SUPERVISOR LICENSE No�ber Expires: 1 Restricted Toy ":00 .�,G,ARY'C GRAHAM n '690'OLD STRANBERRY HILL R , j /T= CENTERVILLE, MA 02632 .7 °FWE The Town of Barnstable • anaxsr"M • 9� "� �0� Department of Health Safety and Environmental Services ArEo Mop" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no.' Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW I ' SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. / Type of Work: f.xUs ors O .c 1C Est.Cost Address of Work: �I 2 L'ow, WuoO QQ, CC1VT1P.A1d)f 4/"Owner's Name G , i Win/ V EPJG 0 Date of Permit Application: 3 )13 127 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Cont for Name Registration No. OR Date Owner's Name ►' The Common►+-cult/1 of Atassachusctts •�i _._. �:_�- Department of Industrial Accidents A 1 ;iWOffice 0111 e=9211ons 600 Washington Street Boston, Maas. 02111 ` ��•` Workers' Compensation Insurance Affidavit. �lpplic•tnt information': Please PRINT j /nam • C v location- 7 Or".7, 4-a;,D A W A le nhcme# 77s'937 v I am a homeowner performing all work myself. Fie, am a sole proprietor and have no one working in any capacity • .. .-v... .-.e...;-..�-.s-•.._......._..r�„—,...:'lew.s+.r.s•.sgRT..�.�n++�_.•.�:�Tr•w...r..•�..^.ewe.�.+'�wwrtw...�•w.w..*..+...... .+++r.......—..e.w�...-^....__....-:. .._....._... L. --- .:.......«...:�...,..—..�.......- - yam,. ;. .._,..-. •.r.:��. ' .. ......,_... ..-_',. --�•�•• �:...�._..�_�.__�.� I am an emplover providing workers' compensation for my emplovees working on this job. company name: address: city: phone#- insurance co. policy# I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the followin! workers' compensation polices: comnnm• name: address: cirv: _phone#- insurance rn. nniicy# comninv name: address rity. phone#- insurance co. policy# Attach additional sheet if neccssary� .`- _ _ ^�—'fir* •• ^''''=�'� `Jr�..��YYO.►f�'�.�Y.J+1��. �� .�'.i.J._-��—i,.._ ;�,.��:�--.......�.w�W'��•i�ivr-+��.:i.'�i'.�it`.�ta•.w��.ax: F::ilurc to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a lineup to SI.500.00 andiur une%cars'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereht certij• tnder the pains and penalties ojperjuly that the information provided above is tru and correct. Sicnacurc DateLl Print name Phone# official use unly do not write in this area to be completed by city or town official `-• city or town: permit/license 0 r(Building Department Licensing Board 0 check if immediate response is required c3selectmen's Office f [3I1caith Department contact person: phone#: r Other , ,