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0204 CAP'N CROSBY ROAD
y ' Cap n Cis -- , 4 t o ►. Town of BarnstableBuildin . � . . b. >r PostdThis Card So That it�isVisible;from the StreetApproved�Plans MustbeRetamed on.Job an,dthis Card Mustbe Kept art:; y. 811RN.�P'!' OM y„ ,� '_ '.°, `. ,. ,�^s" ..� �'* sa "�,. w r'�r m Permit Posted Unt1l Final Inspection Has Been Made �;, , :� "" Where a Certificate if Occupancy_is Required;such Building shall No,1- i ccupied until a Finallnspection has been made. , ..-' Permit No. B-20-2038 Applicant Name: Jonathan Whipple A provals Date Issued: 07/31/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/31/2021 Foundation: Location: 204 CAP'N CROSBY ROAD,CENTERVILLE Map/Lot: 193-210 Zoning District: RC Sheathing: Owner on Record: CHIRIATTI,RICHARD&THERESA Contractor Name" -JJONATHAN N WHIPPLE Framing: 1 Address: 204 CAP'N CROSBY ROAD Contractor License: 'S 078683 2 CENTERVILLE, MA 02632 Est. Project Cost: $3,663.00 Chimney: Description: Insulation attic,install home air sealing,insulated bath exhaust Permit Fee: $85.00 1 Insulation: hose,ventilation chutes,whole house fan cover. Perform Fee Paid $85.00 combustion safety test and blower door test. Final Date.. 7/31/2020 Project Review Req: BATH FANS MUST BE VENTED TO THE OUTSIDE., ; f Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after�issuance. All work authorized by this permit shall conform to the approved application and the approved construction docume ts.for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zo6ing by laws anJ codes. This permit shall be displayed in a location clearly visible from access street or_road a6l d shall be maintained open for,public inspection for the entire duration of the: Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures.by;the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: . Service: 1.Foundation or Footing -+ Rough: 2.Sheathing Inspection , 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed - Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low.Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT t7ov � Final: LZMASi . T Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee • sattxsrnst.E, • o��� LT 1(3 Richard V.Scali,Interim Director arFD MA'S a Building Division SEP Tom Perry,CBO,Building Co ones _ 23 ?�15 200 Main Street,Hyannis,MAA OF IRA ARNST Office: 508-862-4038 F . 08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number i � 10 Property Address .26q l i r'1 Crosby W- i Residential Value of Work S nl j 41 3 3 Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address ff;a�t -)Lj r e° �o �i �CtoT ���'r�sby i�� �'C�✓�fet'��l�e NiJ� �z�o3Z _. Contractor's Name Neui fro T✓►'la S Ilene ioC K1 Telephone Number 900 -14 54 - Q 5' 5 s Home Improvement Contractor License#(if applicable) /L/(, S 8 Email: T Pec,c.a C_1 OR 'UekoQrO C-o✓►-•\ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [9-I have Worker's Compensation Insurance Insurance Company Name ACa d iea _-rn syral Ce C,[S Workman's Comp.Policy# hJ0 -2 O-2 O� 0 0 3 SRO a — 0 Z Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) - ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U Value .30 (maximum 5)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Whei:required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property wne must sign Property Owner Letter of Permission. A cop of the me I ovement Contractors License&Construction Supervisors License is equi ed. SIGNATURE: QAWPFILES\F0U4S\building permit s\EXPRESS.doc Revised 061313 ' IYIA Keg IF 14000a _..,..-,. ., t,wtract CT Reg#0605�118 ® Federal ID#20-2625129 RI Reg#26463 HomelrppioVgment3dludons Corporate Headquarters,26 Ceder St,Woburn,MA,(P)800-342-2211(F)781-933.9626•www.newprO.Com THIS CONTRACT MADE THE �� day of �-a 20_11' between_ (Hnmeowaersf/ (H—PA—) 1 teas/CnRSo(�f„��q78•6,11 4Jz� of G „J era►s C�,�,' r v( t b (s' Z (Addles) /aryl IsrW (UP :.. the"Owner"and NEWPRO Operating,LLC,"NEWPRO". ( ,, 0rpr0PiW&r-e only NEWPRO hereby agrees that itwill for the consideration hereinafter mentioned,tumish all labor and material necessary tolnstall.the following described work at the premises located at: d.� The job address is a condominium. -'Job Adolf �.jff»r�� Y ..- • 1M1 l'�r" Y. :.7F74, F"�0. 4..,f Y : d1:��r 4.. _.... ... NI�(�C; ffi Qrlds: YES NOIj CONTOUR USDL JJEURO U DIAMOND VVIndow color QTY Windoweollor CITY OBSITMP:ttocerton/ [ TOP ❑BOTTOM InC Int C (Exteriorcoi rd) ❑HALF ❑FULL Ext: Ext Vent latches: YEs EINO Capping Color: O ,:,tY7 ash. A=C�aS)J4T 'Please/nfile% PVC o4LJ NoMarU No Cap pIn $IidlAg Sij de�D . F—IfELT :— r RRV'INI<hll # ti S t r t Color In. Out 1 Double Hung b '7 Active: Left Center Right Customer urmetsfends Nat NEWPRO® . 2 Lite Slider HII SN BB BGE WH does not do any painting or staining. 3 Lite Slider 0A Ia.114) t �� y,��„9� � (le:when remov or re interior ..�..FY;...._ .r.!7.., ng pig' 3 Lite Slider (tea,113,113) Color In: Out: stops or trim) NEWPRO®ia not respo- Casement(Hinged Right) Fiberglass Steel nsible for conditions or ciraunstances bay. Casement(Hinged Left) HDWR: SH BB AGB AB ORB onditsoonwlindudingwndenseganresu- t,i�.,.;q�,,. Twin Casement y ' j__.. -. Itlng from o due b pre mdsfing conditions Stationary Casement olor In: Out: /done% Td a Casement OK ia,tr4 - _ �c�s da Pl ) �` ._ �.@;,z?r.4:.., OCASH..TripleCasement (latn,t/3) Color in: Oul: Balancecompletion . Picture Window HDWR: SN BB AGB AB Sash Only Left Hinge Right Min a FINANCE Hopper WWWO .;. ✓ Bank completion Ionn signed at Installatlon Awning Color In: Out: Garden Window Fiberglass steel Bay Window(Root)Bosh} HDWR: SN Be AGB AS ORB Bow INIndow(Roof i sofllt) 673 Other Color In: Out: @' Other HII DESCRIBE dYORK&PROM0770NSAPPL/ED.- IrrgR 10 o 6Ail La"los a ea.Itek-e m i r G a� �y�Z2 Ea w 11 ft rlt k rvwf u2 r w e ow �.v.eS naval Est.SlertDate: ✓7 ,s Comp.pale: I!� Customer understands this Is an"estimated dele" v }� Owner has read an agrees to the terms and c6rinfifinne on the front and the reverse of this Agreement. Owner specifically agrees to the.(1)Total Cash Price;(2)work being performed;and(3)work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right. DO NOT SION THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only): Notice to buyer: (1)Do not sign this Agreement If any of the spaces intended for the agreed terms to the extent of then available information are left blank. (2)You are entitled to a copy of this Agreement at the time you sign It. (3)You may at any time pay off the full unpaid balance due under thle Agreement, and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges. (4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under thle Agreement. (5)You may cancel this Agreement It It has not been signed at the main office or branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made. See the accompanying notice of cancellation form for an explanstion of buyers rights. (Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing Board consumer education materials. (Owner's Initials) By. )LI EIN# signs&� �d- Product Spoclallo rPdn eJ J � By: Signed:%, NEWPROOporating, V Owner US-15 WHITE:Branch Copy YELLOW:Customers Copy PINK:File Copy GOLD: Finance Copy R0714 Board of Building Regulations and Standards ' t unerructi''u Sullrrcirur License: CS-096093 "• THOMpS E PEAC,Oc Y" P.O.Box 505 Seekonk MA 02771 Expiration ! commissioner 04/08/2016 . - .:,,, ' , ��i ,f� 1.�i? iz'l•�'d'�•u'1^•I'�'C��d'�:�'a���2 !i� �''�'�C�';:�:��''C°✓2•l�':d'C��r�• Office of Consumer Affairs mid Business Regulation 4. 10'Park Plaza - Suite 5170 Boston, Massachusetts 02116 -'� Home Improvement Contractor Registration Registration: 146589 Type: Supplement Card Expiration: 5/5/2017 NEWPRO OPERATING, LLC. TOM PEACOCK 26 CEDAR.ST'. WOBURN, MA 01801 Update Address'and return card.Mark reason for change. �.Address Renewal Employment EjLost Card SCA 1 'ri 20M-05/11 free of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration: 146589 TYPO 10 Park Plaza-Suite 5170 L >° Expiratior► ;;5/5120.17 Supplement C:rrd Boston,MA 02116 NEWPRO OPERATING,?.LL•C-, TOM PEACOCK tin , ' j• 26 CEDAR ST. WOBURN, MA 01801 Undersecretary x of valid without signature f - - { The Commonwealth of Massachusetts Department of Indus-dial Accidents ' Office of Investigations 1 Congress,Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:BuUders/Contractors/Electa'icians/Plumbers Applicant Information J1 n Q Please Print Leaabiy Name(Business/Orgmizaton/IndMduai): Ne �f" J� 0 0 P.0 0 -rf N G Address.:== ,;P City/State/Zip: 'tJ v -N I - /8 v Phone#: l` �:�- q✓ l l Agg.you an employer?Check the appropriate box: tr Type of project(required): ; L% I am a employer with J 0 -4� 4. ❑ 1 am a general contractor and I ' # have hired the sub-contractors 6. ❑New construction ` employees(fuIl and/orpart-tune): 2.❑ I am a sole*oprietor or partner- listed on the attached sheet. 7. ❑Remodeling I ship and.have no employees These sub-contractors have g, ❑Demolition workmg for me many capacity. employees and have workers' ! [No workers' comp.insurance comp.insurance.# ❑Building addition required.] 5. ❑ We area corporation and its 10.❑Electrical repairs to additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions right of exemption MGL myself [No workers g per comp. � p p 12.❑Roof repairs � insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.10ther W I rl 1 LJ comp.insurance required.] 4Any applicant that checksbox#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner;who submitthis affidavit indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating sack tContractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mnst provide their workers'comp.policy number. _ l I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and-job site infonnation. Insurance Company Name: '�1i G� ll' C Policy#or Self-ins.Lic.#: Vt! (i' 0 o — 0 C' � Expiration Date: Job Site Address: e ptd, n C�O s y City/State/Zip: �n7tt,l✓�1�� r~'L Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as r re under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 d/or ojj� year uiipriso ent as well as civil penalties in the form of a STOP WORK ORDER and a Ime of up to$250.00 a ay agairfst the A at; a advised that a copy of this statement may be forwarded to the Office of Investigations of e DIA for ce �'erage verification. I do hereby ce fy ender the p erealties of perjury that the information provided above is true and correct ' Signature: Date: 9 Z -S' Phone#: 80 — Z 1O al use only. Do not write in this area,to be completed by city or town affWaL Ci or Town: Permit/License# I suing use (circle one);_ 1.Board of Health I Building Department 3.City/Town Clerk 4.Electrical Inspector 5.]Plumbing Inspector l 6.Other f Contact Person: Phone#: AC�® ® /'� . .-..._.--OATE{MMfDD1YYYY) CERTIFICATE p �pFE ®F LIABILITY INSURANCE 5/1/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ THIS.CERTIFICATE OF INSURANCE.DOES NOT CONSTITUTE.A.CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED. REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Melissa Pflug Mackintire Insurance Agency Inc PH CNN (50.8)366-6161 ac No:(508)366-5202 fAd 11 West Main Street ADoRIeSS:melissap@mackintire.com INSURERS AFFORDING COVERAGE NAIC# Westborough MA 01581-1931 INSURER Netherlands 24171 INSURED INSURERB:1,ibert Mutual/Peerless 24198 Newpro Operating LLC INSURER C Acadia Insurance Co. 1 I 26 Cedar St. INSURERD: ),} INSURER E: Woburn tA; MA 01801 INSURER F: COVERAGES CERTIFICATE-NUMBERIAaster 14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE'INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN.IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED-BY PAID CLAIMS. INSR I ADDL SUER I POLICY EFF I POLICY EXP UMW LTR I TYPE OF INSURANCE WVDPOLICY NUMBER.-_ I MMIDD I IAMIOD ` x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A ! !CLAIMS•MADE OCCUR I I I I I DAMAGE TO REP cD PREMISES(Ea occurrence) S 100,000 i 5,000 HGEN','L ICBP 85895?7 12/31/201412/31/2015I MEDEXP(Anyoneperson} i SPERSONAL&ADVINJURY I S 1,000,000 AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE - 2,000,000 X POLICY PRO- I ' L JECT LOC PRODUCTS-COMP/OP AGG S 2,000q 000 ! i OTHER: AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT I E. .ddenU S 1 '000,DOD A I ANY AUTO i ? i I BODILY INJURY(Per person) S ALL OWNED X SCHEDULED I>� 8584174 {12/31/2015 12/31/20151 BODILY INJURY(Per accident) AUTOS AUTOS X HIRED AUTOS- X NON-OWNED j - PROPERTY DAMAGE 5 - AUTOS + I Peraccident ' Uninsured motorist B!sprit Gmit S 3,000 X UMBRELLA UAB X 1 OCCUR i I I (EACH OCCURRENCE,. 15 5-O00 000 13 EXCESS UAB 71 CLAIMS-MADEI I I AGGREGATE IS 5,000,000 I DED -X RETENTIONS 10,0001 I I.CU..9582578 12/31/2024I12/31/2015 15 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY !YIN X STATUTE I ER ANY PROPRIETORIPARTNERIE(ECLITILE OFFICER/MEMBER EXCLUDED? I N/A l E.L.EACH ACCIDENT !S' 500,000 C (Mandatory in NH) ! WC-20-20-003506-02 5/1/2015 5/1/2016 I E.L.DISEASE-EA EMPLOYEd S 500,000 !If yes,describe under DESCRIPTION OF OPERATIONS below ( I I E.L.DISEASE-POLICY LIMIT S 500,000 f 1 - I 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Timothy Moynagh/MEL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r�D+en+I r-4.� 0*,WZ,� Town of Barnstable *Permit# & Expires 6 rrrowlis from-issue elate Regulatory Services Fee BAMSTABLE. i6 Thomas F: Geiler, Director Building Division 10�/S�o9 Tom Perry, CBO, Building.Comrnissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 193 2)0 Proper . Address • ® C*% ��' ao Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ��� Contractor's Name Telephone Number�t;�.�, . Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) X-P RESS ❑Workman's Compensation Insurance MIT Chec ne: OCT t 3 2009 I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE ❑ I have Worker's Compensation Insurance Insurance Company Name � .j �.1r.Q'4 Workman's Comp, Policy Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) ❑ Re-roof(strippingold shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows. U-Value. (maximum 44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. om Improvement Eontrac ors icense & Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\E, ress\EXPRESSPERMIT.DOC Revise060409 c► ,i The Commonwealth of Massachusetts Department of Industrial Accidents �' Office of Investigations 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ;M� ,� Address: SZ3 c in� h >D City/State/Zip: Phone #: ' aQ—6 SO Are you an employer?Check the appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I gwMoyees(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' 9. ❑ Building addition [No workers' comp. insurance comp, insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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. 1 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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un r the pains and pen Ities of perjury that the information provided above is true and correct. Signature: Date: 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#: t Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as".-every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(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 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-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)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 Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new 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 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. 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 # 617-727-7749 Revised 4-24-07 www.mass.gov/dia r , �1HE,� Town of Barnstable Regulatory Services 9BMWSTABLXMAN. g* Thomas F.Geiler;Director o;A. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job /Signature of er ate €/ JL-WaNkC Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S D W N ERP E RM I S S I ON • 9 Town of Barnstable o Regulatory Services Bnxxsrns[.e Thomas F. Geiler,Director Mass. 9�A 16g9. ,.� Building Division, TED MA'1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office:. 508-862-4038 <Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 )]� JOB LOCATION: �� �p �)0 ?L al number str village "HOMEOWNER": 640AR..M name Ihone work phone 4 t CURRENT MAILING ADDRESS: city/town state zip.- e The current exemption f `homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowner o engage an individual for hire who does not possess a license,provided that the owner acts as x; supervisor. DEFINITION OF HOMEOWNER / Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner".certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION, The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC I . i �ie TJa�ninxa�ulea/•C�L �✓�croaae�zuaelta. �, �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registraton\141991 Expiration 3/3I2010 Tr# 264420 �£ +� � ;¢TYpe DBA" HARBORSIDE REMODELING -' j ROBERT WALSH 250 CAPTAIN CROSBY Administrator J CENTERVILLE,MA 02632- J 1 _. .- Mllssachusetts- Department of Public Safety Board of Building Regulations a r nd Standads Construction Supervisor License License: CS 57394 Restricted to: 1 G ROBERT G WALSH 71 WALNUT ST MARSTONS MILLS, MA 02648 Expiration: 6/2/2011 Commissioner. T.r#: 16666 i r �•—,; Commonwealth of Massachusetts r The Trial Court v Middlesex Division Probate and Family Court Department Docket No Probate of Will With/Without Sureties Name of Decedent Marguerite n KPnnoh ��- — Domicile at Death 6 Cumberland Road Newton Massachusetts 0246.5 (street and no.) (city or town) (county)�rtrtl P�Px ?16 Date of Death— 9/1 9nn6 (zip) Name and address of Petitioner 1 . Charles E. Woodlock, 81 Albemarle Road, Newtonville, rs n Ld1 lT A-02 No .210 ' Status__;('X, XI �G7f, Names f n Fvec Heirs at law or next of kin of deceased Including surviving spouse: Name Residence Relationship (minors and incompetents must be so designated) s p o atta-..h ed That said deceased left a will-akVkotAgc 1>(§) -herewith presented, wherein your petitioner(s) i5kare named co-execut and wherein the testat ri x had requested that your petitioner(s) be exempt from giving surety on A,:kgf4heir bond(s). The petitioner(s) hereby certif that a copy of this document, Y t along with a 'copy of the decedent's death certificate,has been sent by certified mail to the Division of Medical Assistance, P.O. Box 15205, Worcester, Massachusetts 01615-9906. Wherefore your.petitioner(s) pray(a) that said will- -may be proved and allowed, and that N/kg2/they be appointed executar.,; thereof, with/without surety on Wia/bxr/their bond(g) and certif l P.G under the penalties of perjury that the statements herein contained are true to the best of his/her/their knowled e and belief. Date October 13, 2006 Signature(s) Y The undersigned hereby assent to the foregoing petition and to the allowance of the will wit out testimony. DECREE persons interested having been notified in accordance with the law or having assented a no !f�� 'being made thereto, it is decreed that said instr nt(�) be approv d and allowe as the i F of said deceased, and that sai etitioner(s): °f V be appointed execute--� thereof, first giving bond with suretior the due performance of said trust. Date � :� 2007 cJ-P2(1t/o1) Justice of the robate nd Family Court mcpfc DATED JUN 1 2 2001 I the under signed e gn d HEREBY CERT IFY th at am I. the Register of the Probate and Family Court in the County of-Middlesex, such that I have Custody of the records of said Court,. and I further Certify that the foregoing is a photographic 'Copy of the decree of appointment of the fiduciary, that said fiduciary has given bond as required by the law and that said appointment remains .in full force. Witness, by my hand and seal of �the Probate Court of the Commouwealth;;of. Massachusetts, in Cambridge. DAI.'_TCIVT7D nv n nn 7- `oF,HE rti Town of Barnstable BARNSTABLE. * Regulatory Services MASS. 039 Building Division prFD MA'S a, 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection 7eec k- Location J-0q Crz+s �y Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Les wn-� r1xeA- COL u nl TOP s V4 r`i aVLc -"I v- rc sy 0 3 4 he-CAC d j�2,r ` 5 aN 6ea n r'A� ha ae- ` 4-iCA "C L3Y Please call: 508-862-493$for re-inspection. Inspected by Date IHE T° Town of Barnstable BARNSTABLE. ` Regulatory Services 9 MASS. i679. Building Division pTED MA'S a. 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection be_c. na Location '1011 0 D'ri (I rz)s e Permit Number r Owner Builder One notice to remain on job site, one notice on file in Building Department. The following ` items need correcting: ( 1 1 A) anAra" 1 oti S rn�� Y11Pe Ct7 LY b y r`t°Gl /^C Yrie It T 'CcrGi` S n r V1tt�C�. -r �� S CL� �eQ f n i►tiA-_S � tl V P v s C , t �fd3y Please call: 508-862-40-3g for re-inspection. Inspected by Date 11ZJa9 No-r P&LE TO FILL 7'Hj5 odd` ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION `" ) i � �rA fl l Map Parcel . Application # v To 0 o>S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 01':"0 L4 C:�Ate- e—n S-/:,, 1 ` Village v _ moG 4iF Owners B Address Telephone G'��—S �2 —gn ca Permit Request 1,6i G i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type AA/gE2F Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family t Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Vull ❑ 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: 3 existing —'new Total Room Count (not including baths): existing _ new First Floor Room ount ' Heat Type and Fuel: ❑ Gas ❑ Oil '�lectric ❑Other `R ` Central Air: ❑Yes WNo Fireplaces: Existing New Existing wood 's al stoves ❑Yes IZI�No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑e isting 'new; size_ ca Attached garage: existing O new size _Shed: ❑ existing ❑ new size _ Other: N � Zoning Board of Appeals Authorization, ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use Cu�4zo -'" APPLICANT INFORMATION (BUILDER OR'HOMEOWNER) Name 426Z!Zg )�_-, ,��1� Telephone Number Address JR License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G' SIGNAT DATE. 1 } ►' , ` FOR OFFICIAL OSE ONLY s APPLICATION# DATE ISSUED - MAP PARCEL NO. ADDRESS VILLAGE OWNER i • DATE OF INSPECTION: . FOUNDATION OU DATION � s FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH 'FINAL ' ,FINAL BUILDING 2J09 ': r r r F DATE CLOSED:OUT I w . t r ASSOCIATION PLAN NO. 1 r ti J • �oFIME,, Town of Barnstable Regulatory Services BAANSTABLE. Thomas F. Geller, Director ,P MASS. g f 639. Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW 1 ]] Y Owner: Woo d!" Map/Parcel: Project Address, 904 (��:, Cno Ly Builder` jQwwe,— The following items were noted on reviewing; y mamas M�►��r�Y�, ! I.. below 2M�C ® Sao SSa i e] ye k Oder 1 J — p-- Eh1l® i Reviewed by: Date. Y/blo .Q:Forms:Plnrvw The Commonwealth of Massachusetts P0 GEof C C. Department of Industrial Accidents �'f S 0 to rll Office of Investigations (1 p'E"" CS&O ,,t 00 Washington Street Boston, AM 021I1 www.mass.goWia Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual):./2 el cl -70 Phone.#: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet 7. E]Remodeling These sub-contractors have g, []Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 Building addition comp.insurance.$ [No workers' comp.insurance required.] 5. F-I We are a corporation and its 10.[]Electrical repairs or additions 3. 1 I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1�.0 Roof repairs insurance required.]t c.152, §10), and we have no ] employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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'con-rp.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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of cnrnTrial 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 be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p ' s a d penalties of perjury that the information provided above is true and correct. Date: �Si a Phone 4: Official use only. Do not write in this area, to he.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#: . ^�.,*.'fie'• Information and Instr°u.ctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other Iegal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." r MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." AdditionaIly,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 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), addresses) and phone numbers) 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 Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter the 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 permit/license number which will be used as a reference number. In addition, an applicant that must.submit multiple pernut/licensc applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sile Address" the applica-dt should write"all locations in (city or town)."A copy of the affidavit that has been off cially 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. A new affidavit must be fillcd out each year.:Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would hle 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 Commonwf,-an of Massachusetts Deputmmt of ladvs xial AGcid(,nts Office of Luvest.gati.ons 600 Washington Street Boston, MA 02111 TO. # 617-727-49,00 ext 406 or 1-V7-MASSAFE Fax## 617-727-7749 Revised 11-22.06 wwW.ma-ss..gov/pia • -� ,QQi Town of Barnstable ; �v�� < s. �c 1HE tq� tiT Regulatory,�ervices BARNSTABLE Thomas F. Geller, Director MASS. %639. Building Division lFD AAA't Tom Perry,Building Commissioner 200 Main Street, Hyannis., MA 02601. ,m,w`v.town.Wrnstable.ma.us Office: 50.8-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION. Please Print DATE: JOB LOCATION: of b!�e 02"o oto {f� vt l/c-- number street village "HOMEOWNER": a name home phone# work phone# CURRENT MAILING ADDRESS: I �� v}may � ���—'• !B C) city/town `.. state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does.not possess a license,provided that the owner acts as supervisor. DEI+INITION OF HOMEOWNER' Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there,is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to suchuse and/or farm structures. A . wo-year period shall nat be considered a homeowner. Such person who constructs more than one home in a•{ "homeowner"shall submit to the Building Official on a form acceptable to,the Building Official, that he/she shall be . responsible for all such work performed under the building permit, (Section,,109.1.0 1 The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other " applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requireme ts. ' i ature of H meowner L Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or largerwill be required to„comply with the T State Building Code"Section 127.0 Construction Control. - HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions'` of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeownar shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for.Licensing Construction Supervisors Section 2.15) This lack of awareness often results in serious pmblems,partieululy• when the homeowner hires unlicensed persons. In this case,out Board cannot proceed against the unlicensed person as it would Huth a licensed Supervisor, The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is.a form currently used by . several towns. You may care t amend and adopt such a form/certification for use in your community. o�YHer Town of Barnstable Regulatory Services Y Y s�SS. Thomas F. Geiler, Director t4 ]Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Secti If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authoriz by this building permit application for: ddress of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Residence 204 Captain Crosby Lane Centerville, MA Side View ` ' Existing house . A 4. ,1 2x4 PT rails and 2x2" PT pickets (5"OC) } Existing 3 season porch a _ _O„ v �� 2x10 PT earn 2x6 PT joists, box and : 5 3 ledger .� d e g - o • -n. w 6 w (.,ally , o� Existing tally columns Existing Co crete pad 2x10 PT stringers and concrete piers Residence 204 Captain Crosby Lane Centerville, MA Top View rt Existing lally columns and concrete piers Existing' 3 ` season porch ` Existing stair slab 1 ft' " -- - r-- New triple 2x10 PT beam �� 5/4x6" PT decking New 2x6 PT joists 16"OC ' = New 2x6 PT.joists 161'OC 3/8x4" lag screws, staggered, 32"OC, top and Ne 2x6 PT ledger with 2x6 bottom Existing house joist hangars * AssIs'or's map and lot number ..�. ... �?..9...,,,..,./�® � � /16 91-20- 1 ^ 7 / i THE 10�0 Sewage Permit number ........ .(�?.c�� .[........................:'g 6yy✓yy sNouno Bb a NV3IMWV4�House number a t 00,0�t63q. \0� TOWN OF BA-*- 7 SAS3Ud3S BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,,,, Suf folk Realty Trust ........................................................................................................... TYPE OF CONSTRUCTION Single. family residential .......................... .... ep?tember...20,,..1,971�..,..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....Lot...# 58 Cap.�.n..Crosby...Road......C,enterv„i.l�. ,... `1 ........42.6 .2:.....:.................................... Proposed Use ........single family residential ........................................................... .......................................... Zoning District single,,.f.am ily,,.res, Fire District ...�enville-0steryille ........................... Name of Owner ...Suffolk R,eaIty„�zUst.............Address .........P.O. Box 308 Centerville ..... ................................................................... Name of Builder same ,.Address camp,,,,,,,,,,,,, , .................................................................. ......................... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms eight ........................Foundation .........PQPX-ed .............. Exierior cedar Shing.les...................................Roofing .......a,Sp.halt...sk1iagle.5................................... ................................. carpet over underla ment Floors ....................................................................................Interior .......5} JSO... .Q ... 2�.aS ez................................ Heating electr. lC Plumbing g ..........pvr................................................................. Fireplace brick & block Approximate Cost 40 0.00 00 ..................... �........................... ............. Definitive Plan Approved by Planning Board ________________________________19________. Area .....1840 . . .............................. O Diagram of Lot and Building with Dimensions �� Fee ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to confo m to all the Rules and RegulatioT of the Town of Barnstable regar ing the above construction. / � + (57 Name '..J�... ................................... IN Suffolk Realty Trust A=193-209 & k sewage 79-621 .210. i •� �� 216 ; I swy'o �.........73.. Permit for ..dwe4.4- nq ... ...s....................................................................... y1�i { Location ..lat..58.....20.4..Cap•!•Fv.•G-rosby...R-6e . I ' .........................Cen.torv.1.1.a.e.............................. Owner .....Suffio.lk..Rea.l.ty...T-r-ust................. Type of Construction ..........frame are..................... s ......... ................................................................. A Plot ......................... . Lot ................................ Permit Granted ...... .V.Rt.......20...............19 79 Date of Inspection ....................................19 Date Completed ............... ..... ............... 19 PERMIT REFUSED ` .............A .. Lil. .............................. 19 S. ..................................... ........... .............................. a to Ic . w ............................................ �. .. . ............................................. Approved�......5.N......... ...................... 19 ............. ......r x�.... ...... ............. ! ..................................... (7 V Assessor's map and lot number .. ........... CF T E l� e Sewage Permit number . .... ���../.�.n2..�................:....... �``� �y� f�,.— � Bey w Z BABH9TADLE, i i7 6/ / House number ............................................ ro rasa ........................... p i6}q. 9��FQ MPY a� TOWN OF BARNSTABLE r BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... u-�'falk...Realty..Trust................................................................ TYPE OF CONSTRUCTION .....................ai nc71 g... a:�?':�:Y.... F ;i,c�Pn t, a?............................................... S.e—)t.ember ?0. l��1,§........ ..... .......................... TO THE INSPECTOR OF BUILDINGS:' The undersigned hereby applies for a permit according to the following information: Location ....Lnt... ,'n C"osbV..:;�o,,cl ....Cpna, r�ri...�,� ..�1.,?�........n 'F: ?............................................ ProposedUse ........single...` zm .....;... n..... .................................................................... Zoning District Si nale f ;ma.lV„r s c nt i 1„ „Fire District ...�.F ^:tarzr; �,l,u�-OSterv„il.1;P Name of Owner ...Stz{ calk ;P7;t,y,,,T* iat ............. F'. G. Box 308 CPntervill.e.......... Address .............................................................. .. ... Nameof Builder ..........Satre................................................Address ......................... ?m.e................................................ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..............Piaht........................................Foundation `?DLit, erl cc�Y?c Atk'.............................................. .............. Exierior Cedar sx ...Roofing asiahal.t Shi„n,c�1,P� .......hi.nc.....les....... ................................ ............................................ Floors .carpet over under.laY-ment .Interior CDa tar................................ Heating e.lectr iC .....................................................................Plumbing ..........Y.-A.r.- ................................................................ Fireplace b.:.i.ck...S ...b.loc.�........................................Approximate Cost .................40....00.0.,.O...Q.. ............................. . .. .... ... .. .......l.. Definitive Plan Approved by Planning Board ----------------------_---------19________. Area 184 0 Diagram of Lot and Building with Dimensions Fee ............ 1.......... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � r 1 A -....5... 4 i X. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �t •`.i}, �,., ' ' Name .....................n..............`...............!....................... Suffolk Realty :A=193-'l z 2 0 //�� sewage 79-261 &909_ /V No .... Permit for on-&..stoar-y••d 1• inq ...................................................... ......... .............. Location ....l.ot-58....2-04•.Gav) osby Rd. ................... . ............ ................. Owner ...Suf.fo•1•k,••Rea•1• • ..T•rust..................• !k Type of Construction ............f-rame................... . Plot ..................... .�.......................... Lot . i /. ........ Permit Granted ......:,Uep,t. ..............19 79 Date of Inspection ......... ........................19 Date Completed 19 ...... ............................... RMIT REFUSED ........................./..... ...... .. ....... 19 ....... �. ..�. '��.............. .................. ,�. ......... Approved ................................................ 19 ............................................................................... ............................................................................... I �I TOWN OF BARNSTABLE Permit No. _--______—__—_. Building Inspector • Cash -------------- OCCUPANCY PERMIT Bona 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 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. ............................................. __......._. ..__W._._ ....... . . .........................._.... Building Inspector -FROM TOWN OF BARNSTABLE t . BUILDING° DEPARTMENT 397,MAIN STREET . Mr, Francis Lahteine. HYANNIS? MA 02601 Town Clerk Phone: 775-1120 SUBJECT: FOLDHERE - DATE" .. February 12 1980 M E S S`A G E Work has been completed under Building Permit #21673 (Suffolk Realty Trust)., _ Please release Bond. SIGN D DATE _ REPLY SIGNED - I Ne7•RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY - PRINTED IN U.S.A. - qa•r � � °` 9G >> � 9G •� P 9( .7 Cop, 44.2 ,, + SUS-5 41 LUf3 M/ 6X /,5T Fo 7� O l .s:77 . V S. W. 1 . , - Dot. I / f: F�IIfE sty r� a ;5 .ry� : f✓' TEST ROLL / 801 6 01 A25501- TS LOT LOT DATE : S- /f - '79 TOl,JAJ WATER / AVA / LA8LE /"Vsp. P, M/ N//`SUM BU IL Z) AIG 5E7-8,9cK /2E0U/ RE/117ENTS c 2QA-/ 119� v� IV,-gY NO 7-ED P�' r�PosEZ� 13EDr'ocoMS .3 (D E/e SEE IV E' rar9� E sy5 'TE/ f CINLESS JES/Gn/ FL.OG�/ -330 4-1-20 DES / G/`/ LOFgDIA►IG /S USED s`PT/e Sys TE /'`/I co/vs'r� ucTr oN SI-/�9,�,L TPPoPOS,ED �EF�,GN PEfE'C O C /-7T/0/`l TE''S 7- 6 IA-I/Q s s. -7�" t��?-T�_r� 7 f�f1/D 7-fJ j�f . O� E3A�'�VS-s 13 LE f-1,Er L TN 2EG UL A7 / O/ti/S'. SILL ELEV. 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