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HomeMy WebLinkAbout0015 TUCKER ROAD 5- oil ►j, own of- Barnstable > , ; uilding _ - ',.• i Post�Thi-,Card, o fhat it is Nis bie From-the$treet. App.roved'Plans Must be Retained on Job and`.this Card Must be Kept I S h, �=fSAI'3sY' ('AliLt" •' - a . Posted Until Final Inspection Has Been Made -• l xbs9• .,g rermit � L Where a Ce.rtifica e;of-Occupancy;is;Req:uired such:6..uildir g shall Not be Occupied until a Final�ln.spection has.been made: Permit No. B-17-3385 Applicant Name: todd leduc Approvals Date Issued: 10/19/2017 Current Use: Structure Permit Type: Building-Insulation- Residential Expiration Date: 04/19/2018 Foundation: Location: 15 TUCKER ROAD, HYANNIS Map/Lot: 309-154 Zoning District: RB Sheathing: Owner on Record: ARVANITIS, KRISTA&LEIGH Contractor Name: TODD LEDUC Framing: 1 Address: 4080 PALMETTO WAY Contractor License: CSSL-106019 2 SAN DIEGO,CA 92103 Est. Project Cost: $5,000.00 Chimney: Description: Air sealing and insulation of attic flat, kneewall slopes, basement Permit Fee: $85.00 Insulation: ceiling and basement door. .Fee Paid: $85.00 Project Review Req: Date:. 10/19/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations., Health Work shall not proceed until the Inspector has approved the.various stages of construction. Final: ...Persons contracting with_unregiste red.contractors.do,not-have access to the gua ra Inty-ful rid'_'_.(as1 set.forth'i In MG c.142A). Fire Department - Building plans are to be available on site 'All Permit Cards are the property of the APPLICANT-ISSUED.RECIPIENT_ Finale ONL=,"J C Coyle, Brenda From: Niemi, Maureen Sent: Friday, June 28, 2013 1:03 PM To: Coyle, Brenda Cc: Niemi, Maureen Subject: Arvanitis 15 Tucker Road Parcel 309-154 Good afternoon, Brenda, Re: Arvanitis, Costa G Tr 15 Tucker Road, Hyannis, MA Parcel 309-154 Please be advised that Mr. Arvanitis is within one year of delinquency; therefore, there is no problem with an issuance of a permit. If you have any questions, please do not hesitate to contact me at 508-862-4055. Very truly yours, Maureen Maureen E. Niemi Town Collector Town of Barnstable P.O. Box 40 Hyannis, MA 02601-0040 Tel: 508-862-4055 Fax: 508-790-6310 Email: Maureen.niemi@town.barnstable.ma.us 1 7 y 3� �,►,� Town of Barnstable '*Permit# Expires ti months from issue date Regulatory Services Fee `3, * BARNSTABLE, 1619. a VPERMIT Thomas F.IGeiler,Director X-DRESS ,t x Building Division , Tom Perry,CBO, Building Commissioner JUN 2 8 2013 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 TOW R 4P_NSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number a Property Address r PYq 1?n 1 S rA l4 b Residential Value of Work$ is-co- Minimum fee of$35.00 for work under$6000.00 . Owner's Name&Address COST ` , ( � Contractor's p Name � r/ ( f 190M' P Pp> Telephone Number Home Improvement Contractor License#(if applicable) Email: J P,ct ,S('C, 4 B e u '7 0 Construction Supelvisor's License#(if applicable). S f'j6�j' IS 2 9WorkmanIs Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner , I have Worker's Compensation Insurance Insurance Company Name ✓ j� u,ro 7�' Workman's Comp.Policy# We ©qU y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) f M Cq h• ( of 0 Cl Al KRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to w fi✓Gl'S/C �U Ct 1 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 6' ❑ Re-side ❑ Replacement Windows/doors/sliders"U-Value (maximum 35)#of windows ` R #of doors: ■ ❑,Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. _ Separate Electrical&Fire Permits required. , „- *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.` ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License•&Construction Supervisors•License is required. " SIGNATURF,: 0 ✓all," e C:\Users\decollik\AppData\L \Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc . Revised 061313 = ' r. • MANSM)�n' • - - ' MAS& Town of Barnstable RFD MA'I 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: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section r If Using A Builder R I ®STG(S rvct tit r I�I �j , as Owner of the subject property. hereby authorize J�✓1 / /OvHe ! ' ���l � ct on my behalf, ° in all matters relative to work authorized by this bu ding permit application for: (Address of Job) Signature of Owner Date Print Name = If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the , ` reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 T'Ire. Conninottiveattlr of'►assachus•etts Departmew.ofbirdusi iWAccitlenix- - Office.of hivestigatioms 600 TI'aslibigton.Sheet Bostoir,:'MIA 02111 flit%i'.Ilra-s:5'.gOr'rfl�la Workers' Compensation Insurance Affidavit: builders,C'ontr actor slElectricianslPlumbers Applicant Information. •Please Print Legibly Naine(Business#Orgauizadon'Iudisidual): !4) e #V1 ✓l�Lt�Pr�� P `-� ® r a�F L�c�� Address ! 2 CityV`Stater'Zip: P or r?4 j A ` LO(Phone 4: �p s Are,you an emgtoy-er" I Cheek appropriate box: Tge of project(required):' 4. aril a general contractord I'an 1. am a employer with ❑ 6- ❑New c mtructioa employees(full anc or part-time).* have lined the sub-contractors `'.Elril I a a sole proprietor or partner-, li€Aed on the attached sheet. ❑Remodeling ship and have no employees These:sub-contractors have. $. ❑Demolition working for me in any ca acit5. employees and have workers" p 9. ❑Building addition [No workers-comp-insurance cornp.insurance: required.] 5- ❑ We.are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their i 1.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per`•iGL. 1='❑Roof repairs. insurance required.]'1 c. 152_y 1(4):and we:have no errrplopee -[No workers' 13.0 Other comp-insurance:required-] •tray app raut tha;checks ens=1¢u ut a1:=-o fill au the sKc.�iou'Sel'mv,shondng sheer woA-ers'caurpensation policy inforruatian. T omeo3rne_s who submit this affidavit indicating they are doing all wwk- and then hire outside rontra,cto=s ar1_t subnih,a nex affidavit ind7catm;sadL fianttactors¢hat clrecls;this box must attached am addidom.A sheet sh©rsilug the name of slue sub-cmiractors and stare whether or not those ea,;ides have employees. I`the sue cantracto_s hate etnafwees,--he?,must wro.ide their workers'comp.policy number.. lr afre art ePJrglol'er deaf Lipros5idMg Prnork Fist tompeirsatioBt ilrs'lrraiic-F fDY'fJrti'FiiipFDi eF•4. Beloit is tleepolic-y aiidjob sire ilt�OJ'JJ[a'r7Ole. �� ,�7 /, Insurance Company Fame: ✓ /� / / t//��1 'n6 (, /C© Pa1ic,��ar S e1f--ins.Lie.+: v v Exprratxoti Date: Jab Site Addre:.-- C t( it:}-State.Zp: ?attach a copy of the.workers'compensation polio-declaration page(shoming the policy number and expiration date). Failure-to secure coverage.as required raider Section.25A of MGL.c. 152 can lead to the itnpa.sitioa of crirniml penalties of a fine tip to S1,500.00 and,?or one-year imprisonment,as well as citiY1 penalties in the.fault of a STOP WORK ORDER and a fine. r of up to$'250.00 a da.� against:the:violator. Be advised that.a Cop,,.of thr.:statetn�eut M, be forwarded to the Offree of Investigations of the.DU for insurance coverage.verification. l do 3resebp . t�.-fJ der°the Jes QP jl�PrQFIiBS of peril tTra.t fire rnf-tiration provided above is erne and correct Srtore: �/ V P5 � 2 ' c. Date. Phone 3H ' Official.use.onky. Do nor write in this area,to be.complererl bu'city or towle of dial. City,or Town: Permit/License A Issuing Authority(circle.one): 1.Board of Health 2.Building Department 3.CityTmsm Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6.Other Contact Person: Phone M ' 6 ACORD TM CERTIFICATE OF LIABILITY INSURANCE 0911M/DD/YYYY) 09/17/2012 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. it SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Brenda G i I I ette Mason & Mason Insurance Agency, Inc. acoNoExt: 781 .447.5531 acNo:781 .447.7230 458 South Ave. E-MAIL ADDRESS: Whitman, MA 02382 PRODUCER Brenda G 1 I I ette INSURER(S)AFFORDING COVERAGE NAIC u INSURED - - INSURER A: Main Street America Assurance 29939 Home Improvement Specialists of Cape Cod Inc INSURERB: The Travelers Indemnity Compan 25658 PO Box 1224 INSURERC: Star Insurance 000204 Hyannis, MA 02601 INSURER D INSURER E: r INSURER F: COVERAGES CERTIFICATE NUMBER: 12/13 bu i 1 t by KW REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE j SR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS MM/DD MM/DD/YYYY GENERAL LIABILITY MP04936J 09/02/2012 09/02/2013 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS-MADE a OCCUR V'", "_ MED EXP(Any one person) $ 10,00 A PERSONAL&ADV INJURY $ 1,000,00 + " GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JPRO-- LOC $ AUTOMOBILE LIABILITY BA263BN65612SE 04/24/2012 04/24/2013 COMBINED SINGLE LIMIT $ ANY AUTO - (Ea accident) 1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS -• - BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS - , - (Per accident) - $ X NON-OWNED AUTOS ' ' _ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE r $ RETENTION $ $ WORKERS COMPENSATION WCO42864 09/15/2012 09/15/2013 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N - TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER INCLUDE E.L.EACH ACCIDENT $ - 500,000 C OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) r E.L.DISEASE-EA EMPLOYE $ 500,000 DESCdescribe under RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 TT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Residential remodeler ` . 4 CERTIFICATE HOLDER CANCELLATION FAX: `508:775.2887' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable AUTHORIZED REPRESENTATIVE 200 Main St. Hy nnis, MA 02601 Philip W. Mason ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 4 1 Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Surers•i wr License: CS-069152 JOHN M FALACCi PO BOX 1224 = =` Hyannis MA 02661 0%`' Expiration commissioner 12/11/2014 L N �, Crvaac�nucae( License or registration valid for indi return use only before the expiration date. If found return eg Ofliee of Consumer Affairs&BusmCTOR ula IMPROVEMENT CONTRA ofr,,e of Consumer Affairs and Business Regulation HOMEType: 10 Park Plaza-Suite 5170 Registration:,:�148770 MA 02116 Private Corporation Boston, Expiration; ..t0512013 . HO E IMPROVEMENT SPECIALIST OF CAPE COD a ^_ , Af JOHN FALACCI +a , } 25 IYANNOUGH ROAD,.J Not valid without signature 1i1�i a ' Undersecretary. HYANNIS,MA 020 . - 3 Town of Barnstable �7 DIME �Qn Regulatory Services �. Thomas F.Geiler,Director " BARNSCABLE, ` Building Division MASS. i°rBnMp�6. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 pa-�Aj�j PERMIT# Q�U FEE: $ SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less �'�c�e � _s Location of shed(address) Villa Lv� A DMSO (-�Ldl)L626 - z3 07 C� Pro rty owner's name telephotY6 number Size of Shed Map/Parcel# Si a Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 . PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:052813 h�r Ju ,y.K a i g¢ ,�,--ram — a+i's�, •rypd'r,. ^Kv""y`r""�"_`k''''� %�1 o //.o v" N ^mV V. 9Z�FjU S,cDNa. /QZ6c y- IV \ 1 o � . .N f\) YJ h . �, T< 13 QV) 2v, t9a0 s,.F 71(A/ ti u, / U 0 l k V/D7 � r/ C Q _ � i 780 . kLORE ayeND `L;ftV�l; L E G E N D = --- .EXI$TIN0 SPOT ELEVATION Cx® CONTOUR ---- O --- CERTIFIED PLOT PLAN E31i1 `[IN� F141.3HED SPOT ELEVATION F1 1,4HED ;CONTOUR ® F- y cis /-/XA A/A/ / NOTE The location of any existing under wound sewerage:, wells, ,or other utilities shown on this plan is approx-, IN :mate only as determined from records and/or verbal ., . information. The contractor is responsible for the verification of the existing locations in the field. SCALE, P DATE RED GE ENGINEERING CO. llai ���• _ CLIENT. I CERTIFY THAT THE PROPOSED E�3ISTERE REGISTERED jOS N®, �'?/�� BUILDING SHOWN ON THIS . PLAN ' ""^ CONFORMS TO THE ZONING LAWS - -- A .A. /�'� „V RARNSTABLE-, MASS. �a+E Town of Barnstable *Permit# Expires 6 months from issue date • aARD73rABL& ; Regulatory Services Fee Thomas F.Geiler,Director qm �° n Building Division 4�� Tom Perry,CBO, Building Commissioner 4 200 Main Street,Hyannis,IVIA 02601 ®P,q r009 www.town.bamstable.ma-us Office:" 508-86 Fax: 508-790-6230 E;A49'PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 27 t:2/6 0"1 00"Tit Property Address ilJ� u c�Ge`� r l y `'y r S o M Residential Value of Work d Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address' C6 S%AL' 14e V,4-Aj i '71-5 Contractor's Name �, / . C • e ' Telephone Number Home Improvement Contractor License#(if applicable) VF-7 7 U Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Chec ne: I am a sole proprietor ❑ 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name M A S QA,/ I 1144,06AJ Workman's Comp.Policy# ky L tl 1�) cc Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to /W'u 0 u. Z ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value (maximum.44) *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. Ho e Improvernt ontractors License is required. ,SIGNATtiRE: Q:Fomts:expmtn; Revise071405 g'. License or registration valid for individul use only Regulations and Standard n date: If found return to: n Rc ul expiration Board of Building g CONTRACTOR before the e p jjj Board of Building Regalationsand Standards HOME IMP. CONTRA OIIe Ashburton Place Rm 1301 Registration: 148770 Tr# 260205 Boston,Ma.02108 Exprration 10I25I2009 t Private corporation HOME tMPROVEMENT,:SPECIALIST OF CAPE COD ✓ JOHN FALACCI ,ro..,_ Not 44v!ithout signature 251YANNOUGH ROAD' Administrator HYANNIS,MA 02061 Massachusetts- Department of Public 5�rfet�' Board of Building RegUlations and Standards Construction Supervisor License Licenser CS 69152 Restricted to: 00 JOHN M FALACCI k PO BOX 1224 �' HYANNIS, MA 02601 1.C7— ./�i` Expiration: 12/11/2010 ('nnmisi mc� Tr#: 7462 OR4 CERTIFICATE OF LIABILITY INSURANCE D10/09/z 08' PRODUCER (781)447-5531 FAX (781)447-7230 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mason & Mason Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 458 South Ave. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitman, MA 02382 Gwen Vosburgh INSURERS AFFORDING COVERAGE NAIC# INSURED Home Improvement Specialists of Cape Cod Inc INSURERA: National Grange .Mutual 14788 PO Box 1224 INSURERB: Star Insurance 000204 Hyannis, MA 02601 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ' MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS MM GENERAL LIABILITY MP049363 09/02/2008 09/02/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY J ECT PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC0428640 09/15/2008 '09/15/2009 WC STATU- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? OFFICER IS INCLUDED E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS esidential remodeler CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main St. . OF ANY KIND UPON THE INSURER,.ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE David H Mason ACORD 25(2001/08) ©ACORD CORPORATION 1988 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 Aaplicant Information ! Please Print Lej ibly (Business/Organization/individual):(Business/Organizationdividual): ( S ' 6 Address: C •S City/State/Zip: AAWAft C Phone #: Are y an employer'Check the appropriate bog: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction - employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. t 7. Remodeling 2 ❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ R repairs insurance required.]t 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 they workers'comp.policy information I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name: Policv 9 or Self-ins. Lic.#: Q .. 0 Expiration Date: Job Site Address: {� / d CfGe---K City/State/Zip: 1A/tf 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby rtify u der the p an enalties of perjury that the information provided above is true and correct iunature: n Date: ✓ � 7 �© ' Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable . &uwsrAsL& " h,'� Regulatory Services — Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 - -- --- --- Property Owner Must --- Complete and Sign This Section IfUsing A Builder I �0��!>� /'flC-VA—t// 777 S ,as Owner of the subject property hereby authorize A�' to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature 0 ' e Date 60 C77K (124 AJ I Print Name Q:Forms:expmtrg Revise071405 • oFSHE loy, Town of Barnstable Regulatory Services sa MASS. Thomas F.Geiler,Director y Mass. �, e1.39 `0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ��L E Ail N S Estimated Cost . A;2 Address of Work: eyt /J� Owner's Name: S%/K �2Vif-Al t 777 S Date of Application: 't'r a C1 d n7 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 or ape t as the agent of the owner: Date V, Contractor Name Registration No. OR Date Owner's Name Q:forms:homeafdav �°PYRE Tom, Town of Barnstable *Permit# OfV?& Expires 6 rtronths from issue dale Regulatory Services F e BARNSTABLE, " MAC' Thomas F. Geiler, Director63 n r�p- , Building Division APR ?, 2 2009 Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 TOWN OF SARNSTAKE www.town.barnstable.ma.us Of cc: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY l l �}/ Not Valid without Red X-Press Imprint M ap/parcel Number.' ✓J0 l 606` C_ ` Property Address �9 \\ ,Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address ( 4\\ Contractor'sName Telephone Numbers I lame Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ( n (� �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy # Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑❑`Re-side r^� J Replacement Windows/doors/sliders. U-Value �l (maximum .44) *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. copy oft a Home Improvement Contractors License is required. l . SIGNATUIRF: �.'441'I II.I.SU t)RMS\huilding permit forms\EXPRESS.doc Revised 100608 Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT IN �✓J�t r��► j , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO /�' e LESSEE TO APPLY FOR A BUILDING PERMIT 1N ACCORD CE H 7 CMR, THE MASSACHUSETTS STATE BUILDING CODE. ,-'lam �� SIGNATURE OF OWNER: 7 OWNER'S ADDRESS: �e��Ps��e c 9 . OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE- APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Client#:41298 CAPIHOM ACORD- CERTIFICATE OF LIABILITY INSURANCE 'ZT4nin8D/YYY1� PRODUCER /30108 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8 dray Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE INSURED NAIC# Capiai Home Improvement, Inc. INSURER A: NGM Insurance Company Capizzi Enterprises, Inc. INSURER B: American Home Assurance 1645 Newtown Road INSURER C: Cotuit,MA 02635 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DR AGE SO RENTED D occurrence) $5O OOO CLAIMS MADE a OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYF71 jE O- LOC PRODUCTS-COMP/OP AGG $2 00O 000 A AUTOMOBILE LIABILITY M1 M28044 06/08/08 06/08/09 ANY AUTO COMBINED SINGLE LIMIT $SO0,000 (Ea accident) ALL OWNED AUTOS BODILY INJURY - X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY $ (Per accident) X Drive Other Car ___ .. .... PROPERTY DAMAGE. •-. (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY:, A EXCESSNMBRELLA LIABILITY AGG $ - CUB1076H 06/08/08 06/08/09 EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE AGGREGATE $5 000 000 DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND WC6957000 12/25/08 12/25/09 X WC STATU- OTH- $ EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION TowSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 200 Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In_ DAYS WRITTEN Hyannis, MA 02601 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hy IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #S40650/M40647 KW © ACORD CORPORATION 1988 1 `��ee -Po-m�no�.xu�eall�z a�./�aaarulu�tetta - Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTf�ACTOR before the ezpirtition'drite. If found return'to. a �f`AL Board of Building Regulations and Standards RegisQA!to.,p; 100740 One Ashburton Place I2m 1301 pJ ratl l7n_`t23I2010 ti_t_ - Boston,Ma.02108 R M �plement Card CAPIZZI HOMEt�,.J M' NT� y CHARY GUSTAFSOt ; 1645 Newton Rd. `�:,`•.,��;� �'� `��„� Cotuit, MA 02635 Administrator NYo-vali itho.t nature vBoitrki„f Bttiittht, ttc:!gulatimis and St Etldilyd,s Construction Supervisor License "License: CS 74640, . Restricted.to. ` GARY GUSTAFSON � _1< 8 SHORT-WAY , SANDWICH, MA 02563 1112912010 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/Eleetricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organizationtlndividual): `\ZZ� Address:�� _'(� �,,� City/State/Zip: Phone.4_5&``1C�� 'R31(6 Aryo:�n employer?Check the appropriate box: Type of project(required): 1I a employer with - 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part.time).* have hired the sub-contractors ..2:❑ I am a sole proprietor or partder-' listed on the attached sheet. 7.�emodeling 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.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 Homeowncrs 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 subcontractors have amployccs,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: Y C k Policy#or Self-ins.Lic. Q�i�Q Expiration Date: Job Site Address� L k City/State/Zip: `rN Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152,can lead to the imposition of crimuial penalties of a fine tip 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 PIA for'iRsuranco coverage verification. I do hereby certi nder th a' nd penalties of perjury that the information provided above is true and correct: Si cure: Date: v.1 Phone#: Official use only. Do not write in this area,to be completed by city or town official ' City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M oy' � 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 foregoingg-engag in a jom enterprnse;cl=ineZudmg the legal.represen-M&-e3_ZfydeceasedCmpioYer,-airthe"=.-=- 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( )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 inssuiance 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 suh-contractors)name(s),address(es)andphone number(s)along with their certificate(s)of insmance. 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 co lete'and printed legibly..The Department has provided a space at the bottom mP P • 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A newv affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone-and fax number: 10 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext-406 or 1-877-MASSAFE Fax# 617-727-7749 Re✓ised 1 i-22-06 www.mass.gov/dia _ `HsTS,AJih _ - fi 1:04 (wrtlrl� �I�w 1 , swrro � ssr; -nupL6% ar�T (bF _p . 9ls s v = 5cn p Cvu 5b Co r o ow .. Q oc -Sari aff, A4 L�Y�11n� .- moo s<-r tia5. P Ole, e�. ,� �g • _ EX131,� Ap jOc t?,• r . 7�>=MOVtc-CSC 15T. t3b.5E C+�FC� : j � "� U ✓ ` NY64 ITS t` -�Fz• j�a:rfoJ� EI&{ ANO AE Rom . - p ur t-c o a,T eP5E..&16►•t r �0 a I t�l�� +pLEx •ou-rt frs i 54 ua L. s pa c I N ca er n u1 i wa(.L. p o a ri ✓( f _�oQo a y EL0%V I _ _. ✓.p I • - l000 ej_P�EGow � . U�i RANGEeDOORS-/�,; �( TRIM j w CwFfR WORKTOPS' . _ . - 10 360 wa_�} - �� J ✓ ` �p r,�W--_(�. F:w �r�(w.klfej?rCv�rf�� CUSTOMER. ` ADDRESS (�G --- -= 9 1 ColoO - - PHONE N _ `- ORDER No. A L J_ -- � � _ • _wow��rCEx ourl� r A-r DRAWING NtAP�OrOVtAL ; IGHT;�" �^- CEILINGHpIGHT CILLHE �5 cX�3T• dN0 17EPLsW/ CUSTOMS DATE i� I / ,)EPARTMENT OF PUBLIC SAFETY � COMMONWEALTH - s� � OF 1010 COMMONWEALTH AVE. ; BOSTON MASS.02215" W' s MASSACHUSETTS ' w.. f LICENSE: �•K� Y7 W 1 s J ••►�- EXPIRATION DATE CONSTR. SUPERVISOR . !mod'N. '. ►�O1 _� '. � .. - ia M o ; " : "Ya 07/31/1993 W. EFFECTIVE DATE LIC N0. EMT, Jay RESTRICTIONS In I o W--j i 6• 08/0'/1988 048677 pp p".-2 FAMILY HOME.: 9 w&zti R08ERT L ELMORE , III 118 CLARK STREET- �. -- S # 013-56-9338 i NEWTON MA1,02159 PHOTO(BLASTING OPR ONLY) FEE: ) 0600, HEIGHT; NOT VALID UNTIL SIGNED BY LICENSEE A .OFF ULLY STAMPED R•SIGNATUR F iNE O ONER DOS: THIS DOCUMENT MUST BE� S ATURE OF LICENSEE CARRIED ON THE PERSON OF may. `� ���...yyy �E THE IN THIDERS WHEN OCCUPATION u; ��vv . OTHERS:RIGHT THUMB PRINT ED M THIS OCCUPATIONi air lYT�OMM(SSIONER ZOOM•2-87.81429 / '4 y .I ���� � / � Assessor's office(tst Floor): 6YSTEM MUST BE Assessor's map t number 3O S/ INSTALLED IN COMPLIANCE SINE YO`` Conservation �� �41�®NMENTAL COWITH TrU DE AND Board of Health(3rd floor): Sewage Permit number j— 4 7 TOWN REGULATIONS �asar�ant Engineering Department(3rd floor): i639. House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: , Location / C.! C�P Off. G�/7 Proposed Use 1AI`rZZOP IVCA/' Zoning District '-s Fire District Name of Owner 6 52 ,�,J.r * , .�o� Address - .C,c# ay8&-77- Name of Builder ��� �G/?�0,�� 3��93 Address 7 - Name of Architect Address 7( CD1 I-93S Number of Rooms Foundation Exterior Roofing Floors Interior Heating ,/U/— Plumbing Fireplace Approximate Cost Area Q £ Diagram of Lot and Building with Dimensions Fee �( Ci� cc ap OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg the a0oveconsyu ion. Name �— '/3l 93 o y8 Construction Supervisor's License ' j COSTAS, ARVANITIS No' 35049 Permit For REMODEL KITCHEN Single Family Dwelling ' Location 15 Tucker Road j Hyannis Owner. Arvanitis Costas Type'of Construction, Frame _ - J - Plot Lot ! Permit Granted May 11 , 19 92 Date-of.!nspection 19 - Date Completed6 �' 19 t jz io t ' • ' ' ; �' i ; fry. • . � t , ! 1