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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application #
Health Division Date Issued G
Conservation Division Application Fee (�
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address
Village
Owner 1 Address ✓1
Telephonel' Z 6
Permit Request l �iU ���Tl a 71-b
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
;Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type- V ,���' v
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do-RumeWation.
CM
Dwelling Type: Single Family 9' Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's ighway f b Yet❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w ='
w m
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 bath 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 AppealYo
orization ❑ Appeal # Recorded ❑
Commercial ❑Yes If yes, site plan review# -
Current Use Proposed Use
APPLICANT INFORMATION
UILDER OR HOMEOWNER) - -- — - - -
Name Telephone Number
Address i J 0 (�/�li1�-2 License # NO
t.' _
Home Improvement Contractor#
Worker's Compensation # aeA00
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 7i
{� P
FOR OFFICIAL USE ONLY
APPLICATION#
9
` - DATE ISSUED
,f
MAP/PARCEL NO.
r; ADDRESS VILLAGE -
,x
OWNER -
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL f
FINAL BUILDING
e DATE CLOSED OUT
ASSOCIATION PLAN NO. -
i
i
Massachusetts - De r rrtment of Public `iafet�
Board of Builtlin, Relgulations and Staodards.
Qonstrujction Supervisor License
Licenw`CS� 100988
nrtt7� r
HENRY CASSIDY ,
8 SHED ROW #
WEStT `¢ARMOUTH, MA 02673 < *'
w ,
Expiration: 11/11/2013
(',nuniis ivncr Tr9: 7620
pdTR11V1161R 0(?a1�f/
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 153567
Type: Private Corporation
Expiration: 12/15/2b14 Tr# 233831
CAPE COD INSULATION, INC
HENRY CASSIDY
18 REARDON CIRCLE
SO. YARMOUTH, MA 02664 --- --------- ---- ....................._...
Update Address and return card. Marls reason.for change.
Address (_� Renewal Employment I � lost Card
SGA i
160, rarrer,rz.tC(;rX�/iG O C?'l'[cLJJnC�4Lac!lYl ..
4\ OI'liec of Consumer Affairs& Business Regulation License or registration valid for individul use only
b lj{OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 153567 Type: Office of Consumer Affairs and Business Regulation
xpiration: 12/15/2014 Private Corporation 10 Park Plaza-.Suite 5170
n„= Boston,MA 02116
CAPE COD INSULATION;;INC:
HEENRY CASSIDY
18 REARDON CIRCLE
S0.YARMUUTN, MA 02664
Lludersecrretary of Val —— —-
' witho t )at re
I
The Commonwealth of'Massachusetts Print Form
Department oflndustrial Accidents
fiP.'--
r:_: x-_ ; Office of'Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
N"Inic (13risiness/Organization/Individual): 4
` � I Phone #: -r2DQJ- �' ' - IZ l
Are you an employer? Check It a appropriate box:
Type of project(required):
I. I ;un it employer with 00 4. ❑ 1 am a general contractor and 1
cnihloye:cs (full and/or part-time).
* have hired the sub-contractors 6- ❑ New construction
I : rn a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship;nod have no employees These sub-contractors have g, ❑ Demolition
working fitr rr:e in any capacity, employees and have workers'
I No workers' comp. insurance comp. insurance.
$ 9. Building addition
required-I 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
-3.❑ 1 gun a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
ntysel f. I No workers' camp. right of exemption per MGL 12,❑ Roof repa rs
inaur-artce required-] t c. 152, §1(4), and we have no
employees. [No workers' 13•� Other
comp, insurance required.]
Any applicant that checks-box#1 n:rust also till out the section below showing their workers'compensation policy information.
I Inntcuwncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a Crew affidavit indicating such.
<Colluactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
unplo)ecs. Ifthc sub-contractors have employees,they must provide their workers'comp.policy number.
l uni tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
in f ornnrfron.
In',ur<utccCompany Name:__
I'ulic> it or tiell=ins. Lic. :. WGA ODz5 `r'I DI Expiration Date:
.loh Site Address: ZZ �'VvI�J Cit /State/Zi � �
-- �'-- y p� � � --
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Faiiurc to secure; coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ol'a
tin; up to b 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-tlp to'i"_'50.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Invcsnit ations ofthe DIA for insurance coverage verification.
l do hereby certify..nller the painsgnd )enalties of erfury that the information provided above 's tare and correct
tiik nature: / �/ % -1'7 Date:' 4 V J
Uf ficiul use only. Do not write in this area, to be completed by city or town official.
City ol-Town: Permit/License#
Isstrilrg ?authority (circle one):
1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
ti, Other
i'moact Person: Phone#:
I U
GlIelltilt: 4597
ACORD-
CERTIFICATE OF LABILITY 1N%5U
RANCE
Linn(ruin un),vi
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IFIC.ATk-, 001;�S NOT IV (GhT$UJ�6-N--T-1-i-I-—C I---
0
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Vf-,Ly AiVlkllf).EXHADORALTERTHE CQVLI�ACLz AFFOfk[)IZ-D oy -rlllz p()L.IC Fz�
il"�)VV- llll�i C!L�WFIFWATIH OF INSURANCE rJOES NO'I'CCJN$Ili it ii�.'A CON I'"CTBEIVU-,L-.N-11-11:
F-,C.Fl
�TIFICATE I i6w�l�. A-111 1QM4LLI
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"VIll lfii�l, [VIA 0,.Ui0 1 9 Intwullice compall
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------- NIIVISION IqUivitil,it.
............
1 10 I'A'I I I 1' 1-0 111 IN RU 0 NAN I I::D Ali CAI I I kly I)l j,jk�j)
ANY CONTRAC r OR 0TI IER DO(',U&11--- 'I mil-I I.
."I ION L N
MAY 111-ATAIN, THE IN$URAI,kct
;N01 I ION':,; Cl( SLICi-I ' -ki�"]"�)C-o fly rl'� pol.'C'CS I)PSCRIDW HER N L L
ANIJ U CILS� Llmkl*�', filEEN IRCOUCE0 UY M10 CLAIMS.
G I' CO AI.L. I I W I I I�Ni:j.
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------------ LLqlul y)a_,L I Pill -17.7:7-...........
U4101 12 012 04/0-1/2 0-1:- E.,kcvj cjc(:I.,pirt L:PIC.L". $1 ON U00
0,AUV IN A.11 b Ij 00,000
....... U L:IjLIAI-R 6 1111 r UA I 1:; 0 0 Lt.U U 0
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—11W&A of lill ucillelit.
L L12� 10 IL 14)L-1
CANCELLATION
SH01.11.0 ANYOF THE A130VC� PQL.Wlki;i Lit- IJI-J Oil;
THE EXPINA'rION DATF THEREOF. NOTICi- WILL 1W LIFLIVHlt.Ll 1.
ACCORDANCE WITH THE POI-lk'N' PROVInjowi.
. ...........
'1011 -2WIU ACOND CL)NPOHATION.All 0910 W;Itjmd,
of I 11W ACCiRl.)namn and 1000 Afkl fukjklurod make c)(ACORD
m�-,'y
- r
� .l
60 West hi2in S-ttezt
Hyar3 ,MA 02601-3698
S a �508)Tz-sue F�08)T5-7-434�
�'z Y oa-2R Iines
Corporation n�rn�.brxorcajxcod_m�
HOME OVNER WE4THERIZATION WORK PERM T&.FUEL RELEASE.
PIRA SE 1FLL OUI_ -STGN TIM TORM SOU RE
THE APPLICANT HOME OWNER-
hereby
consent to and agree tbat weathej:ixation work may b e
done by the Weath izztion Pzogram of Housing Assistance Corp oration ( hexcla of er rcleat as
`Aocn�) on the propery lotted at
The weatherization work done-mill be based on- program�ma�nc plaorities and availability bf funding and
itmay mi cl-ade aIl or some of"-the following meas-o-res=
Weather-sLLipping�z canIlctg of windows and doors,insulation of atdcs, sidewalk Fz basement,attic .
and other ventilatiou measutes and.possioly replaccmcnt o-c Daddy de- iorated windows_Ia
considez-ion:"of the yr eatherization work to be clone at my home I agree to rhz fo�owzn9-.
glue pa=ission to the 'Ag=cy'irs.agents and em.,QIoyees to W av I Ona,G or across said
property with Bach equipment and materials as may be necessary to peaf=weat erization
work on said property_
2_ The Housing Assistance Corpo'ration reserves the I:i&to mi spect the fzael or utility bill for the
weathez3zed unit on an ongoing basis for ao more than Live (5}years after the weatLcrtzatlon
work is completed
I have read the provisions of this agzeemcot as listed and freely give my consent
Hozac Owixr=(Signature) / •f
Date_
Agent (signature)"
Date
H A.0^moved Weatbcxizattou Company
{ Caliber Building&Remodeling Cape Cod aito� Cape Save Creswell Cons�ucfio�
FrontierEuer;y SoMom Lol Sons Peter Sr th ResoltrionEn y^
Rock Solid Cora�,¢u on �l Cam Ins aan
y�«)i y
CAPE CODTO jOF
1'NSULATIONAPR 16 AM Q
IIRSR 4lAif 3eAM{{S5 SPRATFOAM {USP{NRRF
PARS UUR{RS INW"TION CGLINai -
1-600-696.-6611 .
DIV
Town of Barnstable ,
Regulatory Services
Building Division
200 Main. St
Hyannis, MA 02601
Date: G/^b
0 /i � -
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed &
completed the insulation and weatherization work at the property listed below. Cape Cod'
Insulation did this in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(BP-I) inspector. All work preformed meets of exceeds Federal & State Requirements. .
Property Owner Property Address Village
D ✓i 11,E a T( Air e1
Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted
Ceilings ) (
Slopes ( ) ( ) ( ) ( )
Floors
Walls ( ) ( ) ( ) ) )
Il SQ /NS
Sincerely
He r(Cod
Cas y Jr, President -
C, e I I ulation, Inc.
}
l
Assessor's map.and lot number .... ............. *TNE
L
SEPTIC SYSTEM MUS
Sewage Permit number ...... ....... .:,D : � INSTALLED IN 311IMPLIANCE
.. .........
WITH TME 5
i IIA"STABLE,
Ho6se number ............................... ENVIRONMENTAL CODE AM MAO&
039.
Ar
TOWN REGULATIONS D MAX
TOWN OF. BARNSTABLE
BUILDING INSPECTOR
APPLIAPPLICATION FOR PERMIT TO. I LV(5
C ... ........ ....................... . ........................................................
TYPE OF CONSTRUCTION .....Lo 6 a
............... .... ....................... ...............................
.......... .................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...... ......... .........P...!`
.............................. .................................................
ProposedUse ....... ................. ...................................................................................................................................................
Zoning District ........................................................................Fire District .....6-W-re�e t�j............................
.................
Name of Owner .... .................................Address ...
Name of Builder J? .6m >.....h, .-/.PAddress
�-y 7......
Name of Architect
A W-e
..............................................Address ....................................................................................
Number of Rooms ....... 1�..............................................Foundation ... ........................................
Exterior ........f:�./:7//..............................................................Roofing ...... .............................................................................
Floors ...... IQ ow-T- 5)7.ee ID)Ae
...............Interior .........
.......................................................................
Heating ...... .......... ..:...................................Plumbing ......
Fireplace .... ..................Approximate Cost .......... ......
5/...................... ........
Definitive Plan Approved by Planning Board --------------------------------19--------- Area ...... .............
Diagram of Lot and Building with Dimensions Fee ............. ....................
SUBJECT TO APPRIVAL OF BOARD OF HEALTH
N If ZVI
017
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 ..........................
Construction Supervisor's License ....................................
VILLA, JUDY
No r.2870 .... Permit for .........
`, single family
dwelling.............................
274 AmesLocation ............. ............ ................................
Centerville
.......................................................... ........
Owner ........ ......Judy.............Villa
.............................
Type-6f Construction .............T-X! ..................
........................................................... ...................
7-4 plot
............................ Lot ...............................
Permit-Granted ......................T1 21........1985
Date of Inspecti ..14.....19. . S-
Date Completed ....... 1 qJ<
R eve
A id lot number ,� :- ?NE
�0F
ewa a Permit number ........
O
g ..........'Y.d:3............................ r SEPTIC SYSTEM MUST
INSTALLED IN C
OMPLIA aaasTLELE,
House number .....:............... ........... . ..............'......... WITH TITLE 5 '00639. 0�
MABB
N ENVIRONMENTAL COOS AnyaYa� `
TOWN OF BARNSjI"2�.I �TIONS
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ........BUi1d..Singl`e...F.amily...Ixrell,ing..........................................
o frame
TYPEOF CONSTRUCTION ..........:..........Wo......d................. ............................:.............::............................................
y .........s7lay..2-9....................19.8Q..
TO THE INSPECTOR OF BUILDINGS: `
The undersigned hereby applies for a permit according to the following information:
Location ...Lo±...225...Ames...Way,...C.ent.erville...................................................:...................................................
Proposed Use ......S121gIe... ' 1 . .;Y... 4'. ,a,�Xlg...................................................... .................................... .........
Zoning District ......... ....................... District ..........C!~nisr.via..1.E-0st.ervi.1..le..........
-Name of Owner .........TA]w!p.. ......am tla.................. ...Address ...............Barxmtahle..........................................
Name of Builder ...... .........................Address ...............Barnstabl.e..........................................
Nameof Architect --- ..........Address........................................................ ..............................:.....................................................
Number of Rooms ......Five.................................................Foundation ..........Rauxad...Concrete.............................
Clapboard & T111 As halt Shin les
Exierior ....................................................................................Roofing .............�........................g...................................
Floors ........................Wal...tm...wall...............................Interior
. .Ili•Van..................................................
g ...Q7,a .......................................Plumbing .......... —...baths................................................
Heatin W b
Fireplace ..................................................................................Approximate Cost ............SJ.5.0.QCQ..............:................
Definitive Plan Approved by Planning Board ---------------__--------------19--------. Area ....... �b4....J..�.....'.
Diagram of Lot and Building with Dimensions Fee ............ .....................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
e
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...... An"1�....................................
JAMES K.
Lot #225 274 Ames Way
James K. Smith
Frame
Z9
PEiMIT REFUSED
� .-..--...----.------............—_—.— �
�
�
` .
0TKIr TOWN OF BARNSTABLE Permit No. ----------_---------
Building Inspector
saurua Cash
OCCUPANCY PERMIT Bond -------------
- �--�� ---
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Tams K. Smith Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
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.
//gyp
........................................ 19 ........................................ ........ .. _ _ ._
Building Inspector
SOIL LOG
E. A. ONE LOAM 6 FILL - li•MA% o p
( ( a 9�•2
T4� DIST.C. I. ..' , i
0
BOX 1•.•'. 1000 GAL. .
1000 e e „
10'MIN. GAL I:.'.•': PRECAST OR o F" 24 P6¢G cJ 3f1
SEPTIC I; BLOCK MIN - �
JrO,A/
TANK 6' �; SEEPAGE • '•. : I QO/� --$�
Sl ,• • I
s���8• PIT
20' MIN. ' ' a ` 1 SA83.7
' FOUNDATION I 1 %2" WASHED STONE I 4�.
I i
I I
ELEVATION SKETCH - 10' 1 PERC. RATE: %»
SCALE ; I" = 4' TEST BY
,a TOWN INSPECTOR: vRr
E ORATOR'
77v"vT rwx TEST MADE ON :
Q Z6 79
CdtiG'.CG'TE' F�l/Nvn'rT'iDi✓ .SNDW/y/
f/E,G�GW GVY,ls Go G,tT?'E D •/iS/ T�/E �
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tN Of s
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P.
I..APSLEY y
No.22597
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- room
rl
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ay
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.100, nl
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No. 27654 C,
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^i "'" r•'►1 �'sION E
12.
��ESTirYrATED l)Alty X'Lo47 �r
saueaors�No 4gas�er 4PruaF� xrlo Eqs./eqs+/a.e. . ZAU-
-79 S,fr x l o G,►? A,�S.f' 79 Q,RL,
-%'r0i. z47 5,Oc guq s.R D .
E
ELEVATION SCHEDULE wu iOvAyW� faYfi>f»ti►,�� To Tiy�� d11'�
PROPOSED SITE PLAN
I. INV. AT FOUNDATION = Q'4 •c-7- a
2. INV. INTO SEPTIC TANK _ 9A.4Z SEWAGE SYSTEM DESIGN
IN
3. INV. OUT OF SEPTIC TANK = q��1�, BpQAj...)r &_F C�'E�l* •�VlI.,C.S.� HAS !)4. INV. INTO DISTRIBUTION BOX ° 14--o SCALE; I" = 2Q' �T� 19 '7 �
5. INV. OUT OF DISTRIBUTION BOX = l3 .88 C - "�•4� "�
6. INV. INTO SEEPAGE PIT = 43 -70 CAPE COD SURVEY CONSULTANTS
• ROUTE 132
7BOTTOM OF PIT = '3 HYANNIS ,MASS.