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" ,,, "', �11'1` I . 1;�Ift,''1"if il,"�',_­ t A i � ­,`�4',�,!,� ,,,I, , - ,,, ,, ,�;� :,;,I", ��', 'i-, , ,� ,, � I 4 I C', ,,.�­_ ,,�,�, it _,.", , "�, , � , " i ,Z', ,�,."��.�",� ,i iti,�,,i��iA,�,r�iL I,�,,,,,�.`,,��4�f"i k,,,,�t�v�A��*,,�;;,e�",,,,,J�� � ,,��,,�,_�", i, li� , "i - I I 4�1i�",t,�, �,, ,�'_�, i,; ,o­_ W , �Lg,-,�,,,i�s,k��,f�,'.P-;',�,,�,,.:�"',"""��,,,,�,,�;�",��,�,(�,;:"",:",���,,,��:�!i",j,"',t,­�i� "I 'L " - , � �. , , , lhyfoi��#,_-,,_t;rv:, ,i, - ,�", I ­1�i,`t'ri'11*4'1,� ,��, 14"'l, �.`it,W�m,,I,�`f i`,� e I it, 11111�' on I A o', � Town of Barnstable- *Permit Expires 6 nths from issue date Regulatory Services Fee -00 . g Y omas F.Geiler,Director 3�8d1SN2l`ds �O NMO Building Division 9OOZ �+ ti Ndr Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 d S ,8d•)( .m www.towmbarnstablea.us Office: 508=��Z-� Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 40 .• V� Property Address - 1 esidential Value of Work _ Minimum feo of$25.00 for work under$6000.00 Owner's Name&Address T Rex s „r 1.t Contractor's Name_ �� E� Telephone Number Home Improvement Contractor License#(if applicable)_ J r3 Jo/to I Construction !ervisorl s License#(if applicable) /9./7 DR2 / _.. ...... _. .- .... _. ..... [31orlana33!s Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I amthe Homeowner' ❑ I have Worker's Compensation Insurance Insurance Company Named L u WOrkt'nan's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(chec e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side. 0- Replacement Windows. U-Value (max,'minn.44) *When required: Issuanca 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. H rov ontractors License is required. SIGNATURE: Q:Fcrms:expmtrg Revise071405 0 c "Pr ci0. f Fi c LacFj C -Oil : Al t b • E 15cwoi.c aug I-Isril VtAg, fit; � p �,�b ' t� U� lr �r b W,10 LE 4 mr-S u.;s,,aurrz sliq ry gC:c0tds1;ce.rrqp zbcgLmu lou) a;.rg joc�rl prig gjul cogs 1494 Falmouth Rd. #115, Centerville, MA 02632 LANDMARK , —B AR ARGHtTECTURAL STYLE - ._ October 29, 2005 DAVID STILL INSTALLATION ADDRESS; P.O.BOX 323 45 BRIDGETT'S PATH W. HYANNISPORT, ®26�$4 s aF Y r R ': y COREY & COREY3�iierebyy�.p-o�o%es(Xto perf6rni h' fbilolUti f s6rficei iA aknivat and professional manner and in accordance with the manufacturers s ecifications and local building i P g codes. Remove and Haul AwayQf;the OJd As� AltlRoofin Shingles-, Al T P g Re Nail All Plywood-Shgathng ast needed.; Supply and.Install CERTAINTEEID LANDMARK AR 30: 30 YEAR WARRANTY, 10 YEAR SURE START PROTECTION CLASS A FIRE RATED ALGAE RESISTANT 245 POUND EXTRA HEAVY WEIGHT, SELF-SEALJNG, 70 MPH WIND. WARRANTY, MULTI-LAYERED, LAMINATED ARCHITECTURAL, STYLE, FIBERGLASS BASED ASPHALT SHINGLE with New England's exclusive COPPER/CERAMIC ST0NES.wq#i,a FULL.1.0 IMAR WARRANTY AGAINST ALGAE CONTAMINENT COLOR: 2 Supply and Install CERTAINTEED ICE &WATER'SHIELD WATERPROOF UNDERLAYMENT SYSTEM.on Roof Eaves & Under the Step Flashing on the Chimnf Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install ALPHAPROTECTOR-SUL SYNTHETIC UNDERLAYMENT MEMBRANE htta://www.nermarproduct&com/onlineformstalnhaprotector.pdf upl 'mad AIR VENT SHINGLE VENT II. GE VENT fn&e tyre Main.Ridge. Y �nata`il ALUMINUM&NEOPRENE SOIL PIPE FLASHINGS dean and Remove Debns from wor area afterjo'b ls'eompletecl. TOTAL INVESTMENT $ 4450.00 O d Payable immediately upon completion. POSSIBLE EXTRA CARPENTRY: Any Rotted or. Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or`Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus 20% and Labor at the Rate of$50.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORD SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CH ES COREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and then on a pro-rated basis for 30 Years Total if the shingles becomes defective: CERTAINTEED Warrants the Shingles up to a 70 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. Any alteration or deviation from above specifications,will be executed only upon written orders and will become an extra charge,over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance upon the above work.. This proposal may be withdrawn by us if not accepted within thirty days. COREY & COREY carries Workman's Co pensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: t j /1(f ACCEPTED BY: SUBMITTED BY: e DAVIT) STILL, CHARLES CO ' HOMEOWNER COREY & C •a Board of Building Regulattuns and Standards F1OME 1MPOVEMENT CONTRACTOR RegistraW 3�WE6 plr fi 6L612Q06 fP R MENTS COREY&COREY CHARLES CORE iW FALMOUTH R n . CENTERVILLE,MA 0263 Administrakor +Department oflridastiial Accidents Office of Investigations 600 Washington Street SL) Boston,MA 02111' q '� •" •rs ww.mass.gov/dia Workers, Compensation Insurance Affidavit: builders/Contractors/Electriciaras/Plun A licant.Informati®n Please Print Leodbly Name (Business/org==tion/IndMdual)' . Address: City/State/Zip: v 6/ Phone#: '� 8 City �• Are you an employer? Check the-appropriate bo •• Type of project(required): 1.❑ l am a employer with 4. Wam.a general contractor and I ' 6. ❑New construction employees (full'and/or part time).* have hired the sub-corrractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractrs 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 officers have exercised their 10.0 Electrical repairs or.additions . required,] . . 3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing fepairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.(No workere 13.❑ Other . comp.insurance required) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: 4 t Homeowners who submit this affidavit indicating they we doing all-work and then hire outside contractors must submit anew affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub•eont ubton and their workers'comp.policy infosaration. am an em ' information. ;T11) ? �j U �y Insurance,Company Name: \ Policy#or Self-ins.Lie. #: Expiration Date, Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number andexpiration date). Failure to.secure coverage as required under Section25A 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 die forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the pains and penalties of perjury that the information provided ab ve is true and correct. sinafore: Dater 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#: 1[nformatioina and Instructions General Laws chapter 152 requires all employers to provide workas'"compensation for their employees. f. Massachusetts Person in the service•of another under any contract of hire, p�suant to this statute, an employee is defined as"...every P r express or implied,oral or w " ritten. ~ l� er is defined aS:`:`P4 dual,pa ersbup,•,association,Fctrporaiion or other legal entity,or any two or more An emp y of the foregoing.engaged in a joint enterprise,and inchrding the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However-*e owner of a dwelling house having not more than three apartments and who resides therein,or.the occupant of the construction or repair woiYtin such dwelling house dwelling house of another who employs Persons to do maintenance,appurtenant thereto shall not because of such employment be deemed to be.an employer." or on the grounds or building 6 also states that"every state or local licensing agency shall withhold the issuance or 52 25Ct; ) MGL chapter 1 , § renewal of a license or permit to operate a business or to construct buildings in thetom ionwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its'political subdivisions shall enter into any contract for the performance of public work until acceptable.*evidence of compliance with the insurance ?equirements of'this chapter have been presented to the contracting ty Applicants . Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if supply sub-contractors)name(s),address(es)and phone number(s)along with their certifieate(s) of the necessary, PP Y with no employees other than arts s P wi emp .Y . • insurance. Limited Liability Companies(LLC).or Emoted Liability Partnership (LL ) • members Limit e * 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 maybe 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 dtY 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' lease call the Department at the number listed below, Self-insured companies should enter their. compensation_pohcy_,.P._. . _ —. .— -- - - - —-..__.___..._... self-insurance license number on the appropnate hue. 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 save to fill in the permit/icense number which will be used as a reference munber. In addition,an applicant e permit/license applications in any given year,need only submit one affidavit indicating current that must submit multipl Site Address" applicant should write"all locations in (city or policy infommation(if necessary)and under"Job to,,411 A copy o f 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 permit;•or-liceoses..Anew affidavitmustbe filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or Permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. TheDepart3nent's address,telephone and.faxnumber: The Commonwealth,of Massachusetts . I}eparttnent of Indi4strial,Accidents . . .. .. s ..Office 9:f Investigations ?' r• eet .. _ 'S ' G40•Washin �on .fir. . 0211 1� . Boston,MA • ' `Tel.#617-727-4900 ext 40.6 or•1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/dia Engi.=t�!edng D_ePt (3rd floor) Map Parcel ['0 0 �`� Permit# p2 L House# S F-S - Date Issued `t 14 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 9 3-2S- y- Fee � Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) gt:(1st floor/School Admin. Bldg.) SEPTIC SY SZ,BE pproved by Planning Board 19 INSTALLE A IANCE w TOWN OF BARNSTABL VIRoNME ®E AND TOWN REGULATIONS Building Permit Application Project Street Address y,5^ t 066?� 700TW C-Dt-v "T- -41 C7 . Village-C,#-6CVyC-kL-4LLJJ Owner: Address TES 6P4 10&6% -61 Telephone 14 cl--P Permit Request MD j3wLnrD!t J-rwd , wood First Floor 6 square feet Second Floor square feet Construction Type U-joo0 Estimated Project Cost $ �,0096v- Zoning,District Re, Flood Plain AD Water Protection out Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ;1 ' Two Family ❑ Multi-Family(#units) Age of Existing Structure k1P, Historic House ❑Yes )No On Old King's Highway ❑Yes Wo Basement Type: 4Full ❑Crawl. ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) S ' Number of Baths: Full: Existing _ New Half: Existing New No. of Bedrooms: Existing %) New T Total Room Count(not including baths): Existing 5 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 )oo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) *None ❑Shed(size) ❑Other(size) aw 6 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use n Builder Information Name /� J� 1 }) Telephone Number Address�,�,�2ia�(,g PfN License# rn�e(�Za HA CgjL,3A Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t SIGNA RE DATE Z 4^ BUILDI G PERMI DENIED FOR THE FOLLOWING REASON(S) �� 1 l ' r FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED Y " MAP/PARCEL NO. ADDRESS VILLAGE t OWNER DATE OF INSPECTION: FOUNDATION FRAME `, INSULATION < < FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: kOlJGH FINAL , GAS: RDIG - FINAL FINAL BUILDING i sl gg 6 = DATE CLOSED OUT'' 3 . LiO.ASSOCIATION PLAN y 1 - } SO�. IV o to t � cN .31�? f ef"SM ;W 33 - h ' SM 169 AP ASSESSOR* _ i ARMr319 Ili ! 11 1, _ ~,1~ �� ti`` '�' f ' t ;;: t " SST - —�^""� [-�"r i� • • 238 031u � K•r � + �` + r „ `•,,, , ;' `•.. ____,.._.... _ � � ` . 240 Ac 233+' ONAC 234 242 Y 105 i I• Y771 - . 235 36K , 031u { 1 , i •.,t.. +� 2 O.lou :>•,, 0.35K 96 r19 i O.AK 1 , -, ~,.._..._., , w7/ Y11 f 93-2 +� 93-5 0s:x ..Yns t33 k r)1 ,�; ',OJ3x ' ,, �. .,',/.... - :♦. __ �I r` _ r/9e i, i �`♦. 90 `.� w119 0.50u 03JK �dp ` J 93 4 0.35K ISS d15 r 03JK i i C) \ 34 ``�. i QAC 01 i02 1.0 I >''' . 93-3 ` ; cw( `•` ��. n `ate(^ `'" _-%_ at5 1 / , — .w2 raouwrueeosESo+(9 x� `==`t313 -4 i .,�` 105 35u 0.35K `\ 0.3e : J 103 35 + ', \`♦}ENIN� `:. 84 .� dt2: Ogg `104 Q3il ```♦. `�,: O.S/K `♦. `� yT, ) T 0.35K + JIK. K. 85 "+� t A, Jtt L 108 %` 92 •�, _ , l37u i `♦\ d131 i \,\ �`♦. I,' 36 `� ♦� !• `,� `� 42DI f d139 i ♦.�`` 83 i 0. `\ ' ♦ aUu 0.62u` 15-1 O./SK 87 s15/ + �� YIl9 tt �� ♦ tas2K \ t - - t O.11u rll/ 03J1{ t107 `♦ `t�l'•. - s �� 13-6 El 1 2 ISu ```6 t't,t• ;, `'i ; `'� ♦`♦ / 31u` `�♦�>.♦\\ - ^7 Y526 •,.i - ;'' ~� �� _. - B8 ,t: . aaK + r100 37 +1 ' 7 :1�' �' ,��'., O.I)K 5-3 OAK .�' / 0t AIS ;' 11 ,.-i i �„^'" ` ```♦\: + -'i< r.: �'�i 1 YS]7 \ 13 7 4 114 E ♦ � . ` ` , . , 'O.sOKD./Ou 15`5 «50 , 15-4 Y10S 0�iilji�: _ VS31031K 0 o356f E`• \\\\ �• 1;38 129 -131 0 7 �o31K` t *19 o.37x _y __ Q 15-7 1 op _ _ 45 is 115 52 40 0.31x _ 036u ` �\ 128 ---� ► 039K• i�`�� 115 dm o.uu --- 15-9 ` IQ 0.34u ♦, \ dD i -- 11-4 r56/ + . O.qx 44 ``�;: <�. 0.36u �` a �569 F r - 15-8 _ i•........41 `.53 +lot ' 127 ♦`. i' Yv, C�`'� i:�> 03441 119 ', ♦`V, 11 0.3Su )" ---L.J 15-10 o.2u r: 11-5 #575 0.311( d2 O 4 a ~.L579 i. 0.636( The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-796-6230 , Building Commission, Fogy office use only Permit no. J 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: Est. Cost ddress of Work: 4,S W— t) M er's Name �A�ateof Permit Application: cl I hereby certify that: Registration is not required for the following reasor(s): Work excluded by law Job under S1,000. 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 MWROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR ,�fl-i-� r y-�I�—�� ✓ pu�ti1 R• � , The Continon wealth of:1 tassac husetty •+;ii - -�'`-- j•�r Department of Industrial Accidents • y ,I Ofliceollnvestlgat/ans 600 N•ashinrton Street a• , '. Bowon, Jfaxv. (12111 ` Workers' Compensation Insurance Affidavit �nnhcant tntormatton. Please PR11VT lebii j 1 am a homeowner performing all work myself. ❑ am a sole proprietor and have no one working in anv capacity • .. �Yr. •..A�.-•PVT-'---.....•^_•1���. Tr •• w-Mw.w�.�..►•.�..r..�-w•.• ❑ I am an emplover providing workers' compensation for my employees working on this job. commie name: address• • city: nhnnc#• insurance co. nolicv# ❑ 1 am a sole proprietor. general contractor. or homeo�s•ner(circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: comnanv name: addreSS' city. nhnnc#: insurance cn. noliev# cofnnanv name: address: tin: nhnnc#• insurance co Policy Of .AttachadditifinalsheetifnlCcssaty� =• •;,�..^_-•+ -•,+%__ ••- -•' - __"'•"•%�•i".'."�^_'•�=`*:•,•• a•.-.•-=^�_ -:_:�.,...� ;•.•�^ :��' Failure to secure cnveracc as required under Section 25A of t11GL 152 can lead to the imposition of criminal penalties of a line up to SI.500.UU andiur une%cars•imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement ma%•be furn•arded to the Office of Investigations of the DIA for coverage verification. 1 do leer rut!cf ilrc p rrrs orr crraltics ojprrjun•tlicr the information prorided above is true rltt correct. Si:na re Datc '�/(� Print n e Phone# _ w 'rofrcial use niv do not write in this area to be completed by city or town official •� 1 cit}•or town: permit/license# I-113uilding Department C3Ucensing hoard check if immediate response is required C3Seieetmen's Office C311c2lth Department contact person: phone#: rJUther�— information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for the emplrnres. As quoted from the "law". an cmphtree is dcfincd as every person in the service of another under any Na.. contract of hire, express or implied. oral or written. An empinrer is dcfincd as an individual. partnership, association. corporation or other legal entity•, or any two or nor the foregoing engaged in a joint enterprise. and including the le-Ma 1 representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However th owner of a dwellin�a, house haying 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_ ho or on the arounds or building appurtenant thereto shall not because of such employment be deemed to be an employe: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issu. 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. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter 1, been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to;your situation and supplying company names, address and phone numbers as all affidavits 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 requires to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department lias provided a space at the bottom o; the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plez be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t the Department by mail or FAX unless other arrangements have been made. The Office of investi=ations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to aive us a call. - The Department's address. telephone and fax number: The Commonwealth Of Massachusetts _ r Department of Industrial Accidents ;rx' Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 4 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. Z- DATE ` ,/ JOB. LOCATION (,.LCC Number Street address Section of town /, 'HOMEOWNER" Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Officia on a form acceptable to the 'Building Official, that he/she shall be responsibl for all such work performed under the building-permit. (Section 109. 1. 1) The undersigned "homeowner" assumes _ responsibility for compliance with the Sta Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building De ent minimum inspection procedures and requirements Zan that he/she wil comply 'th said dures and requirements. HOMEOWNER'S SIGNATU APPROVAL OF BUILDING CIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER' S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Ownez shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for • licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious ,problems,. particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/tier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the laat page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. i i u b Floor stringers 2X6 16"on center floor 1/2M'plywood studs 2 4 21on` center sides tecture t1,1 1 roof truse�9771kI 2 ' on center 1/2"plywood--.roof drip edge each 'side 1 "X6" rake trim self seal asfault shingles (roof ) connor boards1aX4#$ ramp 3 'X3 ' ramp 2"X6"pt. 1/2"plywood over -- 2 side aluminum louvers f 16 ,v 7 r DANIEL.bd Page 2 _ Asses d 7 sor's map and lot number ..................... ...................... f: S Sewage Permit number ......................................................... T CE ,Flouse number. ................. ... . 163;9: �0 O MAt 71 y. TOWN, OF BARNSTABLE BUILDING INSPECTOR y % APPLICATION FOR PERMIT TO °.... ..... ...................... ................................. ..�. TYPE OF CONSTRUCTION 0A..Q.f`.. ................. .................................................. �....... ...................... ........... ........':19.2' TO THE INSPECTOR OF BUILDINGS: The undersigns hereby 'es for a permit according the folwi g inform tion: Y ° Location .................. F. ....... .... .. ...... .. .......... .... ...... . ........... .�. ..... . ProposedUse ....... .. ...... .... :...........................:.........................................................................::..... ZoningDistrict ......... .................. ...........................................Fire District .............................................................................. Name of Owner . ttR ............. Address /"z'_L ��4!ut yeC Name of Builder Address........ ..... ... .f.�..!!c-� ................ Name of Architect ..................................................................Address .......................... Number of Rooms ........................0.......................................Foundation ..... �. _ Qh Exienor ... -J�.........................................�...� Roofing ...:...... ... .......P.. .............................................. .. . o Floors . .........�j . ..................................................... Interior Heating .....F14. .--V ............................ .......,...........Plumbing ................/.... !?- ................ ...... .... Fireplace ... ......... ..... ...... ... ......... ......... .........Approximate Cost .�.....:n.p.®............................. .. ... Definitive Plan Approved by Planning Board ________________________________19________. Area Diagram of Lot and Building with Dimensions Fee C2/1 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. Name .. .......... ........................................... ................. Breen, Joseph 20794 one . No —.---... Permh for ------.�..��.�-- ` ' single family dwelling A -----.-----..------.--------. Location ..........45..8ri t'_�..Patb_____.. / Centerville ` —.- -. .--- ---------------- . , C)wx!ar ----�!����! .�����!---------. . Type of ' .......................................... ^ _—� —_ � . ' Y ..--.--.--.^-----------------.. .��ot ---------. �t ----..��9.---- ' '. . ~ r~ . ^ ' ' November 8 78 . � �armk Granted -------------..lg -. � � D�fa of |n � �/Z�—_—..lg�4 �� �� ' . ^' ^ Date Completed —/r�l(��/.�..�----lg _ -' ' / PERMIT REFUSED i ,_.---.--,---.,---------- lV . ' ^ ~ . --.--.----~----.. .----.—_—.--.. . . ` ^----..."....----.----~,..-----..—. ` —~--.^...—.-._----.----..~----- —.-------....—.-----...—..---.—. ' ' ' v Approved .............................. lg ' ZrX~�^--�—'���.�.:,�— ' ` . ^ ------''--------------~.--.. ' . ' Assessor's map and lot number .!.......................................... v ' Q Sewage Permit number ........................................................ d r . Z BARNSTABLE. i r 1'l} ouse number ..................:...........!.............I............................ 9� MA811 p 1639. ,off 0 m a�9 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .I.................. .... -t:.le .........�............... � ...................................... TYPE OF CONSTRUCTION !,� r r !X . .............. ......................................... ........................ .............1923 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........:'.........`y �:.7,t. i ..°. ......��..!�: ......... .a.<; t a a Q:' ........................................................1a.. .. ProposedUse ........ A.hn �. ;k q....... .rtn,1.L............................................................................................................... .� ZoningDistrict ..........................................................................Fire District ......../...............,.{...............j.. ..................................... Name of Owner .......•� .,t ......'? ,y . ....................Address -72-2. !�v1tu /f_I'A Y ciAX '.�...�..,./....... .......... .........................'v�11 .... ...,. x Name of Builder W./R�t &. .................Address ........,........................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..............................Foundation o \ . .................................... .......... ... i ......... .................................................... Lr Exterior .....:..:.. ��-• ^ � � ! '..Roofing �-g-� r I Floors 1 . w . r D ......................................................Interior `r Y HeatingPlumbing ................................................................................... Fireplace ..................:�'.:4..a . ..................................................Approximate Cost ...... .....:.C-0.a...r. .............................. rb 1 Definitive Plan Approved by Planning Board ________________________________19________. Area .......... ...........: . :`............ � r Diagram of Lot and Building with Dimensions Fee d`•............C.I... ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH s I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . � � Name .. .. ............... Dreeu, Joseph (not {zlotted) ' No .....2O�9.4 Perm-it for —.oae.. ---'sin ^ ' -----..rg'-'�=�:j+''*=el^in�*------ - _- - � Location —_ ................... | | -------- ............................... Owner . ',p= of C" s""`'°"' @ 99 .............. - ` N" ?8 � - un,e Completed 7MIT REFUSED j \ — ' ~ —' vT �� ....U.....~ ........... —'-1 ........... ----- -^— '--��`—^'''i7—'^^ , .______,,,. Approved � . . ---------------- lA -------'------^—'—'^'—^—'—~^'—`— ` -------.-------------.--.....- THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) A , 111 I m / IL DATA CI -S .S/? l i4j 7 7 , T /' /U ?, /!r d� ./: x f, �i �' �``. ✓Js. f fG �.'S+c� g /J ry V`� �� C�O�/ S T c1/��!/L ;/r'j'j n ro J t 00 (0, I i 1 t ' \ �✓ �'/��/ 7114,ye 8 a 10 so e. / 1 i nit" 'eIf•, x>» s:, '" .` '"�� '"" x_ RAN!( FRANK C ' i q ONERY CONERY 1 + p Mo. No. 6232 1 Sx£ �� t F076TB��pO NAL��6 ��'A SU PLANOF LAND -/a c�.u ..� 1. 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O / W ,� d �s /6390'f mod' G c� \ /50 O �� - N { /3 0, S - - try _ '�? `� D.34 AC. y h •' O r. 1p , c9 O.38 4C p ' 1' -, 0•. i 0.34 AC'. n O /5000 o cv m_o ` 30 ti m 0.34 A ° /Z o o.o,"'% �- N AREA 5q.FT 1- AC,0Es 1 � � � c. � 2Ri �9 `o e< HIV 4�vo �� �000 _�� ,0 aj :o /5331i'f fi G �., � .YL l J4 !/ g,�� ao AMES !l/A�' 688/6 1. 58 �S O IV 0.00 �5� y� ZO ni /S 33 -, _ /00.0 0.35 Ac. 37' • 3 ,� I ae/DGE.T 5 54229 /• 24 \ per. �Q (� a `s9' S ,' co /S/.3/ W ' N 76. O - 8) P IS'3 47./2 5 P - y 7'A2An!AC /8606 •43 2 4. E ,� 2 ,'�,r ! , r ��, �� ` . 02, 9 /4 Z /•48.69 0 �e P-30.00 fln�� r 30�� a l. S QOAp E SKUNeNET 26344 60 �� p '�'Gi<��(i L� , ?_/838i O.$OA �, /3 3� ��p0 �PS� / 6� ZZp 9e ' Oti�c (C=l8.l) s- /5022•t �'64 aG5 l(Q ROA D 5 = 16 80/S 3.86 sq R a��o �F� w <10 100�� �: 0'34 Ac/0,, �0' 0 �305 00 �� .�"�4 r� s 01 42 . 2 A 2 r 5 i e / LOTS = 6238-,4 14.32 t�s,��o A<q s6 S� 9 oc,9 9i �' �/ i5,0 23 3• /7 T- I I J Z �:T3 LGCUS 17? 1i, Z '��0 �s /539/�: I - Qy G 3�0 O0 ti< 6e 35 /' 5 vi �G• 0 W v' O l ` � G�~�U'e0uirf, TOTAL 79/889 I8.Z cif, 2� /98 . EF" 9(9/ a�' �0 10'° o, �. o.35-Ic. o ti I i � Q ` I C1� s ��� -'s 2 /5 0 /6 �O (Cz l9 3)0 FIVE " �q i3 00/ / 3 I- 16/34•-* l0p G s N 0.37Ac. Oii�,O� 's, I I SCALE /' -0000' / o ✓� -e __ rW / G �-Q FT�v�a FND`l` /2p,oo n 227/7*t 1 -s-_ ,�, 2 52 4c 1 SUB D/V/5/On/ PLAN OF!A,vO /n/ // 5 i c , CEA/7-E,eV/LLE /1455. ,(A�Q oQ0 S2z �. S9.9 _ CC_/8.2) n ,ti'C /A/ T<NE TON✓A/ OF BA2IVSTA8LE /i9 3/. kp /S . � I ALAV E . SM,4LL FO 6 2g9 2 OO Os I 1 30oC G ,/S .46E 106 .TKS TRU5 T 80 0 , B 9/' WIDE PLAiv 600•4= 3/0 PAGE 3S FOt/ND SCALE I 60 NJA�cN 3, /978 1 NEOEBy CE2T/FY 71%.4T 7/115 PL<!N A4G .;LJ 5 IqA DE /tiI ACCO•eOLINCE HIIT,�/ Tr'E -- - - -----'- _ � 0A2NS7-Aa4-E PLA,vIVI, C7 /50A,e1-1) /IV- O 60 120 1490 ZONE QC - 2y S -57.eUG7/01,,1S An/o TI-16 PEA2MAA1--1v7 POIA.I,:5 SNON/.v D,v THE PLA.1-4•eE /iv 15000° /OO• ✓V/DTH EXISTENCE OA.I 771E G,eOU.va. GE0,2GE. LOW-0 CO. 197e i Z TU2iVE,2 L A AJE -�• DATE •-EG. L�II✓ SU•eVE yO,e I F eAn/C/,5 A. LANTE/NE, CLE e/c DATE OF AlEARIAIG iJ11!l� S I�?� SOUT/1 YA,2MOUT�/, NJA. OF- 714E TOWN OF 48A-2A1S7ABLE f�E2E.By CE,eT/Fy THAT THE DATE APPPOVED y�l1.L£L�T?� NOTICE OF A PPROV,4 L OF 7-/-//5 DATE 5/GI✓ED to .�..7w 1q 1ST PL.4 N By THE BAR^-^/ 7-A13LE I CE2TiFy THAT 7-/-/15 %7LA" AIAS PLANNING 60A,2D NAS BEEN B ,VS ABLE P AIA.IIn1G 8p4•Z-10 BE':ti P2EPAeErD /NCUn/Fa2M/Ty ZEcE/VED AvD.eECO.eoED AT vVI -N T7/E !-ULES An/o �EGULAT/O,V5 BE11,/G A 50801VI-FION OF LAI✓D Ti-/15 OGF/CE ANO TNATNOAPPEAL ^L �E ,CEG,�TE25 OFDEEI�5ncTNF AS 2ECOe17ED ItiTHE •2EGIST�Y WAS 2EcE/VEDDlJ2',vG771E7N/E�vey CC 1MOA.I;-t EA�TN OF^-JAS5ACHUSETTS OF DEE17S PLAN F,300� ZS8 PAGE 3Z. DAYS NEXT -AFTER 5UC N 2ECE/A' AND 2ECOeDIAIG OF SA/0 NOTICE !r 3 %•9� - AssEsso,c5 /Lf.4P /65 7��7s .�.�..-. Q-.�./t 9� G�Gia.l' 0.4 TE •rEG LA,vO 5o e y0x� LOT 12 DATE TOWAI CLEk.e