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HomeMy WebLinkAbout0082 WILLOW AVENUE g �. � �����1Ue-� .� �x. ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel v Application # 5 s Health Division Date Issued Conservation Division Application Fee v Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board c� Historic - OKH _ Preservation / Hyannis � . ., JJ (D 4 4 , Project Street Address �U2 Village a 256) Owner k`I/G/C ���� AddressZ c,✓i w Telephone ?21 sfa o Permit Request A) 72 Ve,-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Val uatic �.��eD Construction Type Lot Size // Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No 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 Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑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 ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number T _360 901 Addressyw License # / � Pt26 3 Home Improvement Contractor# 16 35� Worker's Compensation # 7PJ U-6- 43-3 P2 -c� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L o� SIGNATURE DATE > �� �Z 45 e < FOR OFFICIAL USE ONLY '4 APPLICATION# i '! DATE ISSUED r , MAP/PARCEL NO. r , ' ADDRESS VILLAGE OWNER �} DATE OF INSPECTION: ' FOUNDATION y FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL tr 'f PLUMBING: ROUGH FINAL 'A GAS: ROUGH FINAL P f FINAL BUILDING i DATE CLOSED OUT 4 ASSOCIATION PLAN NO. 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 Lep-ibly Name (Business/Organization/In&viduaI): Address: City/State/Zip: Phone#:_ )aj,`t4�0-90ZI Are you an employer?Check the appropriate box: 11aI am a employer with 7 _ 4. 0 I am a general contractor and I Type of project(required): 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. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity, employees and have workers' [No workers'comp. insurance comp:ins„-AnCe.$ 9. El Building addition . required.] 5. ❑ We are a corporation and its _ 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required]t c. 152, §1(4), and we have no employees. [No workers In 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. tContractors that check this box must attached an additional sheet showing the name.of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C--es Policy#or Self-ins,Lic.#: ZPJ UG3—`/433P--:'-�, —y--// Expiration Date: Job Site Address7�o - ✓ _ c.�//GC c7cc� City/State/Zip:_ dJ��+��//7 / } Attach a copy of the workers' compe sation 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'.thata copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification; I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature, Dater Z Phone#: '�Dd' a �2 E only. Do not write in this area to be completed by city or town official Town: PermitlLicense# hority(circle one): Health 2.Building Department 3'. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: �TME Town of Barnstable . Regulatory Services �g Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner ` 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-794-6230 Property Owner. Must Complete and Sign This Section If Using A Builder as Owner of_th- e sub'ect ro? p perty hereby authorize' /OWZfE 5 G 9-1 1LSS7/1"I y to act on ray behalf; in all matters relative to Work authorized by this building permit +_ w IA-.,'( 1.C—C7 rrc. All I-r'/�91iis�/l� (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner ture of Applicant Print Name i 7)-- Print Name Date QYORMS:OWNERPERMISSIONPOOLS r To ' of Barnstable 0 Reg-arafbry Services 8.(RNG'fYF[fF p. Thomas F. Geiler,Director MARL O o y k�� wilding Dfyisioii Tom Perry, Building Commissioner 200 Main-S`frcct;_Aysnnis,MA_Q2601 _ t�ew.town.bar-asFable.ma_us . �ffrce; 508-862-4038 Fax: 509-790-6230 a0?rMOV M LjMTrE=h=O.N Plrrse Print DATE JOB LOCA ON: number short Nllage . "HOMFA WhlE3t": nano home phone# work phone 4 CURRENT}MAILING ADDRESS: city/town state 4 code Tic current exemption for"homeowners"was extended to include owner-occupied dwel±azs of six traits or Iess and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as sirperyisor. - DE1<ThI2 GN OF Hole�M0Tt7,.'ER P erson(s)who awns 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, attsched or detached strn.ct ors accessory to such use and/or farm structtx=. A person who constructs more than nne home in a two-year period shall not be considered a hatneownrr, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Ofn'4 that be/she shall be responsible for all such work pmfozm d.under the building permit (Section log.1.1) T4e undersigned`bomeownar"a,murots responsibility for cou:jpliance with the State Building Code and other applicable codes, bylaws,robs and regulations. The undersigned"honmowner"certifies thathe/she undcrytmds the Town of Barnstable Building Department raaT*+T**n* n i�cction prrocedpres and ragtruzments and that he/she will comply with said procedures and rcgrur'ements. tirr:of Homcowncr , _ppmval of Building Off cW , Note: Three-family dvmllmgs containing35,000 cubic feet or larger will be mquirt;d to camply with the (ate Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMMbN The Code states that: "Aay homeowner pafemning work for which a building pa7mt is required shall In=opt from the,provision; this section.(Section 109.1.1 -Lioeasifig of eonsta-scion enzsors rovidcd Slip ),p that of Lhe homeo-vyner engages a pescm(s)for has to do such Frk,that such Aomeownez shaIl act as supervisor.^. . 1r�any hmncownas who use this exemption arc unaware that they art assutrring the rrspoUmb$itiea of a supervisor(see Appendix Q, )cs&Regulation for I.aecmsing Comrbuction Supevisars,Scetioa 2.15) This lack of awareness results bftm in seious pmblams,particularly zn the homeoer wn hires unlicrosod perrmm In.this nogg our Board cannot proceed against the unlicensed person as it'R�au1d with p Heennd rcrvisor. The homcowocr acting as Supervisor is uhiznztrly rrsponstbin ' To alsurc that the'homeowner;fully aware of is/hcrrespoasbrlitim,marry rDummmities rzquire,as part of tho permit application, the homeowner urtify that hedshe undastandr fine recp=bflitim of a Supevisor. On the last page of this issue is a farm currently used by sal towns You may can t amard and adopt such a famrlcertification for use in your community, rms:homeuempt I ' s A lUissa husetb,- Delfiriment of Puhiic•Safet� ': Boat of Building 42c�'utations and Standards `+ construction Supervisor Specialty License :License: CS SL 100546' • Restricted to WS. ERICSSOI` TORRES *16.HOOVER ROAD . `WEST YARMOUTH, MA 02673 .. Expiration: 6/18/201.2 Commissioner Tr#: 100546.- . -� ": ✓1ze'-�anvneoxu�ea/� a��/�.raoacluzae(,ta ' Office of Consumer Affairs&Bdsines's Regulation V. HOME.IMPROVEMENT CONTRACTOR Registration *463528 Type: Expiration: 777/20;13 DBA -ER SSON HOME MPRRO EV MENT(Z lJ ERICSSON TORSOk - y >r 1 tw" 1 . 96 HOOVER RD e ;o WEST YARMOUTH,'MA 0267;3.'s7 Undersecretary 1 }+ jj 1 a NOTICE NOTICE TICE TO Q TO i 1 EMPLOYEES EES EMPLOYEES 7 0'� O,�M Svc The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that I (we) have provided for,payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-4433P24-8-1 1 ) 1 1 -09-1 1 TO 1 1-09-12 POLICY NUMBER EFFECTIVE DATES a m— BRYDEN & SULLIVAN INS AG 88 FALMOUTH ROAD HYANNIS MA 02601 NAME OF INSURANCE AGENT ADDRESS PHONE# ` s TORRES, ERICSSON DBA 16 HOOVER ROAD ERICSSON HOME IMPROVEMENT Oa _ WEST YARMOUTH MA 02673 # EMPLOYER ADDRESS m� EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services ate, provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected'to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS ' 002886 W20P1G02 TO BE POSTED BY EMPLOYER. ~' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P Map Parcel 0 Application # r�6 Health Division Date Issued Z Conservation Division Application Fe `,/_Y/ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Addresses Village Owner ` ' '" �� � Address /6� Telephone Permit Requester/��E T/,P 73 77,- 7-�-7 --�/� C�X %L /� �9woOCG dre,l SC✓�c..fS',,, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation C' Construction Type—• �' ` y} Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docu�,menta�ttion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes O�No 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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑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 ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address / ���G 2� — License # a7 j7 Home Improvement Contractor# Worker's Compensation # 7�-� `4� 454 �► ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE , FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE j , ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL ;4 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f " s The Corrttnonwealth of Massachusetts Y Department of Industrial Accidents Office of Investigations . 600.Washington Street 1 Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Indivi dual): d��Gvd� C Address: City/State/Zip: Y(kl_) Phone #: Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am°a employer with 6 E]New construction have hired the sub-contractors. employees(frill and/or part-tone).* .__._.en . ;" lam a sole proprietor.or partner listed on the attached sheet. 7. ❑Remodlfilig 1 ship and have no employees These sub-contractors have g. Demolition working,.for me in any capacity.,.. employees and have workers' 9 0 Building addition [No workers coy rip. insurance comp.insurance. ,5:-� We are a'corporation and its 1 O..D;.Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per ivIGL 12.[]Roof repairs irsurance required.] t c. 15.2,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.].. *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name:' Policy#or Self-ins.Lic.#: �T-J 00__44�33P24—F--/) Expiration Date: Job Site Address; �� '�(v/ �W h1J - City/State/Zip `Fj�8260 � _ t'1�1 5260! Attach a copy of the workers'compensation.policy.declaration page(showing the policy number and expiration date). Failure to secure coveragesas•required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,5.00.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00�a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature,: Date: z 112 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): 4 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 emplJyers to provide workers' compensation for their employees. Pursuant to this statute, an eiilployee is defined as "...every person n the service of another under any contract of hire, i 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 enterprise, and including the legal representatives of a deceased employer, or the of the foregoing engaged in a joint receiver or trustee of an individual, partnership, association of 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,constnclion 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." MOL 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,MOL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perforrhance of public-work until acceptable evidence of compliance with the insr�rance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out.the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es) and phone number(s) along with their certificates) of insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance.'If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of lndustria] 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 pen-nit 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.permiU]icense number which will be used as a.reference number. In addition, an applicant nt that must submit multiple perm rise applications in any given year, need only submit one affidavit indicating(city or policy information(if necessary) and under"Job Site Address".the applicant should write"all locations in town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i,e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call, The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of�Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 9 617-727-7749 Revised 4-24-07 www.rrtass.gov/dia NOTICE , M NOTICE TO a TO EMPLOYEES EMPLOYEES 09 M sq . The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL'.ACCIDENTS' - . 600 Washington Street, E oston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will.give you notice that I (we) have provided for payment to our injured employees under the.above mentioned_ chapter by insuring with:' THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE_ `COMPANY .f _•P.0. BOX 1450. MIDD.LEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-4433P24-8-1 1 ) 1 1 -09-1 1 TO 1 1 -09-1 2 POLICY NUMBER EFFECTIVE.DATES BRYDEN & SULLIVAN INS AG, . 88' FALMOUTH ROAD HYANNIS MA 02601 . NAME OF INSURANCE AGENT ADDRESS PHONE # 0 TORRES, ERICSSON DBA 16 :HOOVER ROAD ERICSSON HOME IMPROVEMENT WEST YARMOUTH MA 02673 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE o - . MEDICAL TREATMENT The above named:insurer. is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of-the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured:employee. The employee may select his or her own physician. The reasonable-cost of the services a provided .by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at.the NAME OF HOSPITAL ADDRESS 002886 w20P1G02 TO_BEt POSTED BY EMPLOYER ;y us�teh:uNttt♦ Uy :ii truant of Pulilic 5atctc``. 13ta<u d dt'Building; Re,,I itibns and.Sfan(l.tr l5 Gotistruction Supervisor Specialty License License CS SL 100846 Restricted to WS x F uri% Ck ERICSSON TORRES y ` ` . 46 HOOVER ROAD 1/VEST:YARMOUTH:°MA02673 a. r . 7Xoirahon 6/18%2012 - (omm,siuncr 1 r# 100M6 t.. • a • Town of Barnstable t Re ato Serice r namurra�urn F v_- � S KM Thomas F. Ge1er,Direst or Bufl ng Di ivWon Tom Perry,B ulding Commissioner 200.MHin Street,ffyam i*MA 02601 W WADWn.barnstable.ma.us Office: 509-862-403 8 Fax: 508-790-6230 Property owner Pro e � p r Must Complete and Sign'This Section If Ua . A Builder as Owner of the sub)ect property hereby authorize 6 C SS p to act on=T behalf, in aR matters relative to work aathq=(-_d by this b=ldiag permit ='li ow Avg �601 (Adci_ress bf Job) . - I Poof fences and alarms are the responsibility of the a ficant PP . Pools are not to be filled before fence is installed and pools are not to be utilized until all.final inspections are performed and accepted. Signature of.Owner ignatQre of Appiicant e Frint Name U 2 �j -� Priat Name �2 l L , Da QY0RMS:DWMMPM=SIDNP0D s SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 3 NO. 2612-210288 e Store 2612 HYANNIS Phone: (508)778-8948 VALIDATION AREA - 65 INDEPENDENCE DRIVE Salesperson: SMH3004 HYANNIS, MA 02601 Reviewer: " This is only a QUOTE for the merchandise and services printed below. This becomes an - Agreement upon payment and an endorsement by a'Home Depot register validation. Name Home Phone RIGAS E °(508)420-2270 . Address 65 SHERYLES WAY' Work Phone Company Name" o'h MARSTONS MILLS' loboescriptfon 01/1.5WINDOWS` State Ma Zip 02648-1436 > c°"n" QUOTE is valid for this date:01A6/2012 s We reserve the right to limit the quantities handise �GUSTOMER3PICKUP #!t1 MERCHANDISE AND SERVICE SUMMARY sold to customers ..Y.. n.., :5,.k .. ... . ..<` REF# W02 SKU# 515-664 Customer Pickup/Will Call S.O. MERCHANDISE TO BE PICKED UP: S/O SILVER LINE BLDG REF# S01 ESTIMATED ARRIVAL DATE: 1 PRD a.. h s r.... " C � :..> .... .. .,..:. .. ._ RI E EACH EXTENSIRI ON .D.ES .RIPTLO ' C S0101 709-956 1.00 EA 7550/ @ 23 1/2"X 59 1/2" R.O.24"X,60 / 755 '(#1)@ .$259 61 $259.61 {7551[23.51l59.5]111L1017 001011121010115)*N*lENERGY STAR=YESIZIP=02601 ZONE=NORTHINEW CONSTRUCTIONi7 WINDOWICASEMEN U755017551IC-1 SINGLE CASEMENT 9 1/2"1R.O: 24"X 60" MOVING DIRECTION=L COLOR=WHITE G S0102 700-956 1.00 EA 7550/(CONTINUED)/(CONTINUED) PTION=LO 5 NIGLASS Y- $0.00 $6.00 STRENGTH=SINGLE STRENGTH GLASSES LL SCREEN LATCH=STAN DAR D HINGEIU S0103` 709-956 1:00 EA 7550/ @ 28" X 59 1/2"JR.O.28 1 50{#2)@ Y `' $264.27 $264.27 {7551[28159.5]11 JR101710010 JENERGY �STAR=YESjZIP=02601 O = THINEW_CONSTRUCTION 175501FULL - WINDOW CASEM 55 151 C-1 SINGLE CASEMENTI28"X 59 1/2"IR.O. 28 1/2"X 60" MO TION=R COLOR=WHITE GLAZING OPT C.O,NT INUE N,D ONEXT P,,AGE*'`x�r � O i u WILL-CALL MERCHA UP FOR WILL CALL Will-Call items mthe store for 7 days only. ; �`MERCHANDISExPICK'UP F` � PROCEED TO WILL�`CALL OR Check your current order status online at ,v SERVICE DESK AREA f .� www.homedepot.com/orderstatus , > . Y „ (Pro.Customers Proceed To The;Pro Desk) , _'r_ (9801) 0100249732 Pape 1 of 3 NO. 2612-210288 Customer CODV SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RIGAS Page 2 of 3 NO. 2612-210288 �`� CUrSTOIVIER PICKUP�#1 ' T ; REF#W02 S0104 709-956 1.00 EA 7550/(CONTINUED)/(CONTINUED) ION=LOWE3 ARGONIGLASS Y $0.00 $0.00 STRENGTH'=SINGLE STRENGTH GLASSISCREEN=FULL SCREEN LATCH=STANDARD HINGE 6.0.2 S0105 ' 709-824, 4.00 EA 2392/.@ 57 1/2" X 45" R.O. 58 X'45 1/2"/2392{#3}@ Y $269.84 $1,079.36 {2392[57.51l45111 I0I7I00�011 11 110101110}*N"JENERGY STAR=YESIZIP=02601 OZONE=NORTHINEW CONSTRUCTION 123001FULL WINDOWISLIDING WINDOWS123921239212 PANEL SLIDERI57 1/2" X 45"IR.O. 58" X 45 1/2"COLOR=WHITE GLAZING OPTION=LOWE3 ARGON IGLA S0106 709-824 4:00 EA 2392/(CONTINUED)/(CONTINUED) SS STRENGTH=SINGLE STRENGTH Y $0.00 GLASS SCREEN=HALF SCREEN 6.0.2 ` S0107 709-824 4:00 , EA 2392/ @.:45"• X 21 1/2" R.O.45 1/2" X 22"/2392{#4}C Y $180.60 $722.40 ro` {2392[45121.5]111017100101:11111010 .0}* I-JENERGY STAR=YESIZIP=02601 OZONE=NORTHINEW CONSTRUCTION 123001FULL WINDOW SLIDING WINDOWS12392�239212'PANEL SLIDER145'X 21 1/2"IR.O;45 1/2" X 22" COLOR=WHITE GLAZING OPTION=LOWE3 ARGON GLA S0108 709-824 4.00 EA 2392/(CONTINUED)/(CONTINUED) SS STRENGTH=SINGLE STRENGTH Y $0.00 $0.00 GLASS SCREEN=HALF SCREEN 6.0.2 VENDOR-SPECIAL INSTRUCTIONS:' 6.0.2:: SCHEDULED PICKUP DATE: Will be scheduled u on arrival of all,S/O Merchandise • $2 325.64 „ END.OF CUSTOM R,PICKUP-:REF#W02 xs �r TOTAL CHARGES OF ALL MERCHANDISE & SERVICES • - • 1 _ $2,325.64 SALES TAX $145.35 TOTAL. $2 470.99 BALANCE DUE $2 470.99 Paae 2 of 3 NO. 2612-210288 Customer CoDV Page 3 eof,3 NMO. 2612-210288 The,'Home Depot' s Specibi Service LL Will Call/Direct Ship/Delivery b z Returns: Except,where prohibited"by law, all returned Special Order Merchandise is subject to a�fifteen percent (15%) restocking=fee. Custom made goods are notr returnable. Will Call: The Home Depot Storewill call"the number provided on`the invoice when Order is available..r A"Will Call held at the Store for over thirty,(30) days shall besubject to the `' `"abandoned property,laws inTyourstate. Direct Ship., Direct Ship merchandisewill be sent by the',vendor and/or,manufacturer to the address`on the, nvoice Delivery: Home.Depot shall arrange for its Delivery gent to deliver the Order to the address identified on.the,Invoice pursuant'to.the following terms and conditions: Roads Notice: The delivery:address.must be'accessible by vehicle over roads and bridges rated to handle up to and including (4o):,forty ton loads. If:any.portion;of Del.iveryAgent's route must traverse a section;of road'that is not.rated to"handle a forty ton.load or.heavier, Customer will be responsible for seeking a:waiver, at Customen's expense, from the"appropriate governmental authority. If Customer-is-.,unable to obtain,a waiver, delivery service will not be'available:to the delivery address Unattended Drop. �If Customer will not be resent to acce t the delivery,:,�. p p - and the'delivery can be left.'unattended,'Please.indicate by initialing.below: 'By initialing h'' .1 authorize,Delivery Agent to leave`the merchandise -- unattended,following.`delivery and accept fu.Irresponsibility for any resulting loss,of, or damage to, the-merchandise:. - -Curbside Deliveries Only- 'You are.purchasing merchandise that has been-designated by Home Depot-for curbside delivery only. Your'purchase doessno#include delivery beyond curbside„on- premise:or im-house ("Additional Services") orthe installation/hook-up:.of merch"andise (':'Non,-' included.anstalfation Services"), and`Horne Depot has not authorized-its.Home Depot Delivery Agent;('°Delivery Agent") to=,perform such Additional'Services or-Non-included.Installation Services.'ln.the e'vent-you•request,.and`Delivery Agent agrees"to"pe,orm;`Additional Services "and/or Non included Installation Services, YOU`ASSUMETHE RISK OF, AND FULL'LIABILITY. FOR; ANYj RESULTING,PERSONAL.INJURY DAMAGE TO PROPERTY; OR DAMAGE TO MERCHANDISE°.Also, anyNon-included Installation Sdrvices"siall.void"any express or implied warranty',provide. d-by Home Depot and may.void the"manufacturer's warranty on the merchandise so installed 3By signing.below,you acknowled4e that.you have read-and fully.understand the,terms,of this waiver,.and release, and you intend into be a complete`and unconditional re/ease of all liability:in regard to any requested Additional Services and/or Non-.-included Installation Services Accepted by: y. X . - ni i1Fi�nt� `Customer's'Signature Date r Page 3 of 3 No. 2612-210288 ,Customer Copy u Assessor's map and lot number ................. .........................: ' QyOf THE Tp�y Sewage Permit number . . ---f{ F �%Il.. ./.:��/.fa� SAP I IC SYS, EM MUST B INSTALLED IN COMPLIA EaEasTAIILE, House number ........................................................................ WITH ARTICLE ll STATE 9�0 "e 9. 0m� SANITARY CODE AND TCW °MaYa� TOWN OF BARN XB" E .BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..:... ..... .... ....C!`'.�..............:.......................:. ........... ........ ... ....... ..'.^.y.... TYPEOF CONSTRUCTION ......... ...CS�!J. ' . .................................................................................... ............. . . .......................3,( �`5..........19..f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .... ` ... a .............: �!.�?u?� 4 ......1 .�4�! i... .�....�.. ........... ProposedUse .......i.v ............ ..........................................................................................:..............I......................... Zoning District .......................... ...... /........... ..........................Fire District .............................................................................. Name of Owner .: ?'! .�!!u-�..........................Address . .. . .................... Name of Builder ................................ �'�3 ✓' Address ... ..... ... ........ Nameof t l .Address. ..................................................... ............................................•. ...-................................... Number of Rooms .....d.a ............................................Foundation �D ........ F�.................. ...................................... Exterior ....1.: '`.. ......................:....................................:Roofing ........ �......................................................... FloorsInterior 4..................... ............. .................... .......................................... Heating ..................................:......Plumbing ...../?i!Z�............................................................. Fireplace e--.........................................................Approximate Cost °2C) ............................................6.. Definitive Plan A roved b Plannin Board __________________________ // . S O 'Opp Approved Y 9 19 ----. Area d.........................f Diagram of Lot and Building with Dimensions Fee y SUBJECT .TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. tp Name ..... ........... .... .. . .............. .............. .... Chas-, Donald A=327-70 • i No ..2.1092.... Permit for ..:�S,Xxsr.>�C.t�..Addi. ior,. i F i ..... Location . ...W111ow.•Ave........ .................. .................... ............................................ Owner .....Dona,l.d..Chase................................... Type -of Construction ...cDnCret.�.. �Luldt on ...steel••bui•1diag............................................. Plot t .... .............. Lot ......................... , Permit Granted :.........Ma rh...1.5............19 79 Date of Inspection ...........................I..........19 , Date Completed 19 ` PERMIT REFUSED ................. .................. .................. ' 19 .............................................................................. ............................................................................... ........................... ............................................. ............................................................................... Approved ....:........................................... 19 • ............................................................................... Assessor's map and lot number ....:-.......................................} CF THE t0 Sewage Permit number Z 33AUSTADLE, i House number ........................................................................ rt y NAG& 039. 00 ! tl ypY Ar TOWN OF BARNSTABLE BUILDING INSPECTOR 4 'YA.G1 !l tiv C t c�I (e 1/.4 rt. /fit APPLICATION FOR PERMIT TO ................................................ ...-.�...`..................�................................................ TYPE OF CONSTRUCTION ........ �,r�ra. .... ' f.�n.�' ° .``: "!.......��........................................... cz ... .......................`3 .` ............9..7 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following �inlformation: Location .....�. ....1'f � e 1r ..� ^r Le........... ..........V#A........................................................... Proposed Use Zoning District ` t �x 4 _n ..........................Fire District .............................................................................. ........................................... Name of Owner ti/,.tr►rc f';f�fi �� e�F.:..........................Address .................................................................................... L l..fi�✓1 Cr/ f trrr' O l� f�dl t ( Name of Builder a� ,..ann--'� .Address ..................... ....... .....................................jt?:.:+^-•� Name of Architect /rn..�' ..................................................Address .................................................................................... . Number of Rooms Q /?A,6 .............................................Foundation .............................................................. Exterior .... f �:...................................................................Roofing ......... ` .......................................................... Floorst�n� .. /.cJ..... ....................................Interior............................. .................................................................................... Heating ... .T-4.-...............................................:.............Plumbing ...... Fireplace .. *''` :->.........................................................Approximate Cost .........99.1..................................... Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area I.. Diagram of Lot and Building with Dimensions Fee � � SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. �'.f;....................... . ^ . Chase, Donald A=327-70 No ...21O92'` Permit for .CgX!;itX?lr.t..Addition � , ...'............'.........................,.................................' - ' Location h6illcW..Aoe.,----.------- ----..—"--_------------------. Owner . ).0nal.d..[hazm------------.. Type of Construction —.uu&r-ne±&'faauadatiau .P:�exP.I..t.Uildiog............................................... " � Plot - � ` ( --- - 'OPERMIT REFUSE- -u.f'-' .( ' 19...................................... ......... . .......... ' — ''--'' —'--------' \~J ................................~�—... .................................... � n ---~~—'—^'----~--~^^^----^—~—^ ' Approved ................................................ lQ � --------------~—'----~—'---'' ----------------'--~—^^^--^—' TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 327 070 GEOBASE ID 24181 ADDRESS 82 WILLOW AVENUE PHONE HYANNIS ZIP I LOT 2 3 & BLOCK LOT SIZE DBA DEVELOPMENT DISTRICTT HY I�I PERMIT 68320 DESCRIPTION 1/ 20 SQ FT. 1/ 55 SQ. FT. SIGNS I PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: PROPERTY OWNER ARCHITECTS: Department of � .- Regulatory Services-------- ' TOTAL FEES: $125.00 BOND CONSTRUCTION COSTS $1,000.00 t'EIE 750 ROOFING AND SIDING 1 PRIVATE .e Z aniwsrasM MU& I 1639. �FD MA'S a I BUILDJNG DIVISION i - BY /I DATE ISSUED 04/23/2003 EXPIRATION DATE - CC/ I Town of Barnstable y�P�OFTHE Tph�O� Regulatory Services ` Thomas F. Geiler,Director B"R'''ST"B`E' ` Mn Building Division y ss. � i6gg•AtE Mp.t a Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office 508-862-4038 Fax: 508-790-6230 Tax Collector �1-7/ Treasurer Y/g 3 Application for Sign Permit Applicant: Cj O—b&AIL"ssessors No, DS T �D Doing Business As: n __ e No. Sign Location Street/Road: Zoning District: Old Kings Highway? Y /No Hyannis Historic District? Yes Property Ow�rex Name: Telephone: Address: Village: Sign Contrac or C6 Y Name: r Telephone: 7 7 l G Address: Village: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Autho I r ized Agent: ZV Date: V17Cz�::3 Size S/ Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: Signl.doc rev.122801 � ® e 2` �/ L►=�1lJV zo S Q FT" State of the Art Dry Cleaning Center 5 -7 SQ FT' 0 R 02a&w : s 3 -N L-1 0 State of- the Airt Diry CgsanEng Centeir I � f SCALE I/2 ' 1 ft.. l o s oe l c 5 K}E 2E7r9 LTA TeZ i.J57` /3K® l 6 7 2 0 P. l 80 Y� yy / JORDAN SIGN COMPANY 108 ENTERPRISE ROAD 2 7-oT,9L 6U/,C,�/�C F2ow7I�7E (3Q1 -r - HYANNIS, MA 02601-2212 3 LOCAL 508-771-4020 '�' S 4 )=T FAX 508-771-6658 r 1 r 7-1-IC 04 Da zo. iS FF TH i 5 0� c � =so E�des a i17 g .._ _ ._.,.......- �..� ...,. ..�. ..�.,. �.._ .. n#n, +R4 • p n I A p CI I i) r ote f_" ( .`. F FFF ate _ i F• '- `\i �A• _� 1► � z to 1► I 7"1-11s /S TEE Ok D cIM56- TO BV 6 577,9 r 1a.J, 7`�/ESE S i6--.vS 7-0 7-96-SE ro VENTS TN i 5 oz 6 S (GA-) SO S 7-0 �E- �� ove a N0 5850 103 Enterprise Road Hyannis, MA 02601-2212 on Material Tel: 508-771-4020 FAX: 508-771-6658 Work Order & Invoice size O S/F O D/F . 2 Name Quantity Email: signs@mediaone.net Street Color Date / / Bkgd Color City, State, Zip Copy Color O CONTRACT Phone Fax Copy Color 0 DAY WORK Auth. By P.O. # O Design/Sketch Work O Fabrication O Outside Work Description (Details On Rear) Qty Material Each Total Date Emp Hours Rate Cost Date Emp Hours Rate Cost Fabrication Labor TTL Installation Labor Date Emp Hours Rate Cost Installation Total Labor Total Materials Sub Total Sales Tax Materials Total Fab. Labor Sub-Total Install Total Total Due i P`Op tHErC The Town of Barnstable BARNSTABLE. Department of Health Safety and Environmental Services 7 MASS. 0A 1639• �0 PTfD IA0. Building Division . 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: k-M IG io 5 fQr!j.4s Map/Parcel: a 0 Project Address: �-2 Wl<<o w AVL Builder: c olz df3-"✓ saN 0 The following items were noted on reviewing: �✓ �� ,f3 l Z a,V€ An&s 7 i✓ Tip 7 S S a / 0 Al AOUVAOZS �✓ /� Reviewed by: Date: 3 q:buildinglorms:review. 1 e I �Jh -� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map U UWN Parc I D � Permit# .._ � Health Division D. ql l o Date Issued Y" 6L c 7P,Q3 �Y - r Conservation Division J o Application F e �Tax�Collector_-7 Permit Fee , ,Treasurer. p *iEiSlon Planning Dept. APPLICANT MUST OBTAIN ASEWER CONNECTION PERMIT FROM THE Date Definitive Plan Approved by Planning Board ENGINS!,:R.ING DIVISION PRIOR TO CONS ,_XCTION. Historic-OKH Preservation/Hyannis " Project Street A s 4WI-11,U) &L" X AL. Village OwnerAicv-AA, (,krt- Address r Telephone Permit Request &MM& 6J WtVJ4:0 r + Y ''A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. Project Valuation 60D Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft,) Basement Unfinished Area(sq.ft) _ Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing 0 new size Pool:❑existing ❑new size Barn:❑existing ❑new size `attached garage:❑existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial U?fe"s' ❑No . If yes, site plan review#. Current Use Proposed Use BUILDER INFORMATION Name Telephone Number ��w�' `C3 1 3 Address 3 YXit License#074 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1'�U t' WIT� r SIGNATURE DATE r FOR OFFICIAL USE ONLY F - TIERMIT NO. t t DATE ISSUED i MAP/PARCEL-NO. T ADDRESS LA VILLAGE OWNER • " DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. f The Commonwealth of Massachusetts Department of in Accidents 0 0lllcr911HAM MtlONS -" — 600 Washington Street . Boston,Mass. 02111 Woricers' Cum easation I mrmce Affidavit ME 2' (. ovation: � `�"'��� • a crying all work myself: I aat P . 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Faihne m sseoar eorvenv as stgades$smdar t3ee 2SA otMQ.L4 aalel is ttia/�aaYlaads�Yaai pmaities da tlaa ap to and/or � �It a Weaasdynpeaauiesfa tbafosmof&am MOM nIr aaia�d3i00.00adaFs�imtm+�Ichat A da MU of ibis summed=q be forwarded to the Oftioa of Ia►estl=sd=otfba M&taa etnMP* EdWadod I do ismiy cff*undw dl cPdw md pr of pajrny gh.w prvRdada a it truce Ltd carted jDaw Plint naE= n � oingw ose oatl ao act wttta in this area to be completed by cify or taws of"dal cuy or town: — * 0c Bo':d ❑ebscidflaanedtateresPonuisn4�ed ❑Healt!►Deperanes� ire' poshu contact person: ' (terra 0193 PIA! Information and Instructions Massachuserts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thziz employees. As quoted from the."law", an employee is defined as every person in the service of another under any cones:- of hire, express or implied_ offal or written. defined as an individual artnershi association, corporation or other legal entity, or any two or more of em lover is . P P�. � An. P. . the-foregomg enraged in a joint enterprise, and including the legal represerrtadves of a dec=ed employer, or the receive.- or trtis�ee of an individual, partnership, association or other legal entity, employing employees- However the owner of a dwelling house having not more than three apamne=and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do tnar*t*� , can=uctim or repair vkxk on such dwelling house or on the grounds cr building appurtenant thereto shall not because of such employment be deemed to be as employer. MGL chapter 152 section 25 also states that every state or local.licensing agency shall withhold.the issuance or renewai 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,np-4+ the cammnaweaith nor any of its political subdivisions shall ca=into any camr=for the perfort ar ca of public work until acceptable evidence of compliance with the insurance requirements oftbis chapter have been presented to the authority. - •Applicants Please fill in the workers' compensation affidavit completely,by the.boxthat applies to your siMFdcm and company names,address and phane mnnbers along with a certificate-of ksur nee as all affidavits may be sup-lying ~ submitted to the Department of Industrial Accidents for cmatian ofinsMaaco coverage. Also be sure to sign and - 4 date the aff davit. The affidavit should be.retamed to the city ortownthatthe application for the pcMUt or iic=e is being requested,not the Departmeat of Industrial Accidents. Should you have nay quesd=regal the"law"or if y u are required to obtain a workers'compcnszdcEm policy,Please call the Department atthe amber listed below. City or Towns - Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bc�ott of the affidavit for you to fill out in the event the Office of Investigatimrhas to watact you regarding the applim= Please be sere to fill is the penahllicease mtmber which will be used as a referrace numl;er. 'Ihe affidavits may be rc�nea t^ the Department by mail or FAX unless other arraagexamats have beeamade. The Office of Investigations would like to thank you m advance for you cooperation and should you have any questions. please do not hesitate to give us a call. /�;, The Deparuneat's address,telephone and faxmmlber: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesdoadods 600 Washington Street Boston,Ma. 02111 far#: (617) 727-7749 phone #: (617) 727-4900 exL 406, 409 or 375 f ` 4> oFt r Town of Barnstable Regulatory Services MASS. Thomas F.Geiler,Director �p .i6;q 10 rFn 39 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize w to W di,8 to act on my behalf, in all matters relative to w rk authorized by this building permit application for(address of job) Signature of Owner Date Print Name R Q:FORM&OWNERPERMIS SION BOARD OF BUILDING k2EGULATi©N Ucensf r: EONSTRUCTION SUPERVASOR I I Numbera- y i 9 Bittla�tfat# 4�3A 932 es 1 Q-MG04 Tr.no: 13558 RNGPLO KALDIS�ti �� 3 BITFERSWEET Lf� A MARWIOM, MA 0264� -•. Administrator I ,