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1084 CRAIGVILLE BEACH ROAD
n Y n r . c k . ':.. .w.-�.� ,...,•. ^..._r ,a..� .._.�. ...�.,t-e�� � -,.a. sue...._. - 1 ��y oFIKKE Town of Barnstable *Permit# Expires 6 months from issue date-, Building Department Services Fee � sMW6resrs, : Brian Florence,CBO bUft ,0� Building Commissioner 'OrFo Mpt 200 Main Street,Hyannis, `` www.town.bamstable.•1K,-W Office: 508-862-4038 a08-790-6230 SEP 19 2017 EXPRESS PERMIT APPLICATION - r e Not Valid without Red X-Press Imprint Map/parcel Number Property Address 0IF q �fre t_�S esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l/ O rc( t�Pf`�SL Contractor's Name Telephone Number_ fO( asT'. (0 r Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ' ❑ I am a sole proprietor [ the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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) p e-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner must sign Property Owner Letter of Permission. copy of the Home Improvement Contractors License-&Construction Supervisors License is equired. SIGNATURE: V. t Q:\WUMES\FORMS\building permit forms\EXPRESS.doc AV 08/16/17 I . The Commomveah*ofMas-yadmsetts �e�,c+�tit�erzt a,�Lrtriz�striat�cc�r�e�rts . Office of- Inves#gations _ Boston,ALA 02111 • '' fVFVk4LT17[IS��DY�lt�i[I Wurke& Cmnpens2danInmimnce Affifla"'t-Seders/CbnfractersMect ciansfPhanhers pHcam#Infm-m2f= Please Print Le tTy_ i P Name „zm� ian/Ina �G�, 1 �•y P r z CJ Address of Phaam-4k' Are you an employer?Checktheapprogriatebam Tppegf project(re oae : 4. I am a gesreaal coairsctas aad I L❑ I am a employer wilt 6. ❑New amstmction employees(fall andfor part-time).* lave hiresithe suer-cones 2.❑'I am a sale proprietctr orpariaer- lided onthe attached sheet. 7. Elize odeHng Thesesilb-contrac-torsha e sip and�e no employees . S. ❑Demolifiba g, formle in employees atdbace wogs' nt3� � $ 9. El S,uildt�addition . jld0 W06MM, Camp.insamce- comp_mcnMnV 5- ❑ W6 are a cmposafiou and its 10 ElELeef 1 regaus or a des 3'94 amLa bomeovmn er doing a1i work officers have-e—sed funk 1 L[]Plmalxingrepairs or additions. my � self o woirk -ers' tight of a unpHon per MGL 7 c.1.52,§I{4�,andwelia�en:b L-❑Rflafregairs �cnraFlrerequired i ' i . employees.Ugo WQ,�,r„e,S� . 13:❑other cozq.m15QrSr,m reY""-I 'Any apg&c mtfast cherksbas 91 mnA also Mouttke sectioab9vvshm&Sdie¢woaeW mmpeasatiaupaTtyit�cma'uao Ernnma uaerswho submit rFris KM&va`i g tbvy ar�t3aic�alEwe¢ic aadtfieaLaE a>nsiderm++are,.samct.5nbffitauewsr�da�t icdi�ng sacFi fCoartac{ais3�a2dusckih►strmcmustsGad =zrmifional shad showkgaenmntofftsub-c�mxadstdevrheShetaraot-ffiaseealtksbwe aVlayees.Ifthesab-cantntdneshave mnpIqees�tfieym stpmvd&t%ek uvrkers'ramp.13aTi3r number. I am art erspla�xr flc�isprauidirrr;�vorkets'coutperesrdiart irtsrirartca}vr my*empT��ees $eloav is fJtepaticF and je8 sitR Fa,�atmrrdtorL ' Insurance Ca mpany.Name: •Po=ficy 41or Self-ins I.ic_ ` bpi aI : Job Re Addm= CifyfStawZip: Attach 2 tap} of the n+orkere compensxtioapalkrdeclaration page(showing the policy,number and•expiration Mate). Failure to secure coverage as regairednudes Suction 25A of MGI.c.157-can lead to the imposition of criminal penalties of a bme up to$UOD Oa andfor one-year imprisoume-,as we t1 as civil penalties is the fona of a STOP W DRF ORDERand a$me of up to$d00 a clap axgaiast the violator. Be advised fiat a copy of this statement maybe Rwwarded fm the Office of Iwvestigattons of coverage v on- 1 da herghy Ager pra'rls�, psr ras a g cr f7iatfits i t;arrrtatiar�prat rTed aba� i�bats ari d cxrrrect Date- 0, cd use aryl}: i}a tut trrrts frt tFt lrre�, r be carr<plreteYi 5F rrrtnn�i rr; at , City or To-nu: ?t`erszFiftLiceFtse# Lwling-kntlrar€t3r(cir&Otte): L Board of H•ealtit I3uilfng Ilepartmcat 3.Cityfrowa Clerk 4.Electrical Inspector S.Plumbing Lupeztor S.Other Contact Person: Phvne#: Tmformation and last coons, Massac �Genie Laws chapter M ties all=qAay=to ode�° cmmpensaiion for t ee=employees. ' Pm inn this statute,an Ioyee is defined as¢:a tYP�an in$ie service of whet under amY COntrad of Iu,;, express or implied"oral or vzit -" associalian,corpordt3on or other legal=tty,or anY tWo or more An�plr yes ys defamed as"aim p d I er o€the foregnmg ina c mt Indmg the legal se ves of a deceased emp oY ,or tbg: rMej,ver or trC s 0f al baViCTag Parft=ShiP,association or other legal entity,=PInYMg emPloyem goweve-.r the o�vnetofad�veIImgl�nsel g�tmorethaatTnee mt e�sandwboresidesfhmeem.,Or the oc of - dwelliag bonne of mwfi�.er who employs pemons to do , or�pait��on such dwelling house or on the grounds or bmldmg appt d� themb shaRnotb=anse of such employmentbe decmodto be an employer." MGL chapter 152,§25C(6)also Sides ffid-every sfafe or io cal Ring g agency shag yvMILDId$e Tssttastce or renewal of a Ticeasa or permit to opm—ate a busim�or to construct bw1dmgs k thr,comm.mnwealfh for any aPFhcantWIio has not produced acmptahle evidenM of c6mpTianm Wn the hm¢rauca covemg-eregmh: Mdponally,M TC� ter ISZ,§25CM states-Neer fife comMZMWeal$i nor�y of its political snbdrvisions shall � r intro any cont:ad for the performance ofpnblio wo3k r�I acceptable evid,:ace of compliancewi$i tb a zosoranCe.. r eams of lures chHPt_z have bey pry OQ g anfio ty." AppHca rfs Please f[I oil the wo if r.T=7 compensation ar'�davit completely,by d=jcI mg the boxes aPPIY to Your sifnaiion and, nec:essary,snPPIy sorb- {s)nan��s), �- es)andphonennmbet(s)along wtthf�Cet��s)of antes or L=Ed.Liabfljtp`FarEneiships(LI P)�ono�loY=o Bier fh�tip e instaance_ r�,�„i�d LiahtZiEY� (�� t . does have members or partners,are not rimed to carry workers'compeosafion�anm If an LLC or LLP employees,apol-icyisregaired. Beadvisedibattiiisaffidayitmaybesnbmitted ieDegafinemtofTndns-fetal Acci 07 mr confrcmafion of fi=m a mvm g� �O be sure to sego and date the afidavit- The affidavit should bo_m amcd to ffie city or town that the application.fnr the permit or license is be ing regoeste d,no t the D eparEme of t Lnch i, Asp �nts Shouldyou have aay gnesdms regal the law or ifyon are req�ed to obtain.awo�ers' ease call the D arinemmmberlisiEdbelow Self-insured c®panics should a atrx- their compemsationporteY,Pl � f t at the r . self-;,,crn-ice license member on tie appmpuafe line. City or Town Offcills - f I The D arfinemt has provided a space of the bottom Please be sere that the affidavit is campIe�and P�d �h= � tYonm g e applicant OI the affidavit for you to fill o- m the event the Office of Investtgaftoas Pleasebe&=to fMintbepemitlliceisemraberv7hich will beusedasarelbrencouamber_Tnaddi on,an applicant must sabniii multiple pe�tllicense apglinations in any g M agME,need only submit one affidavit indicating con�t or policy infarnation[if necessary)and nmder`Tob Site bps"the applicam Fhorld7 asII lacati,W in (�Y town):'A copy of tl=-affidavitthat has be n officially stamped madre by the ChY or tnwn may be provided to the ' applicant as proofthat a valid affidavit is on file for bAm peunits or licenses A new a$dav itUn, t be filled O• t card year.Where a home owner or citi-zea is obt Enm a license or permit not zelated pD any bminess or commmm ial e a dog license orpeamittob�Iea4es etc-)sauiPeEs°n isllOTzed��mple#ethis affidavet The Office ofTnveSffg�ns wnvldli` -_.tn thankyouinadvaace for your cooperation and shovidyouhave�Y q , please do nothesitafm to give ns a call The Deparfm M f s addrCSS,telephone and Ax number: - att of hfassachusC6 Depaxtia-Mt cif 1ndnhial.Aocgen , ' �ansl�fA E�11� • Fax9 617=727 7749 Revise d4-24-'07 Town of Barnstable Building Department:Services as,►sa R�RAAS&f� : Brian Florence,CBO 639� `�� R 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 I y Bider Owner of the subject property hereby authorize to act on my behalf, in all matters relative to�Wo autho ' ed by this building permit application for: Y (Adabesi of Job) **Po ol fences d alarms are the r onsibility of the applicant Pools ' are not to e filled or utilized befo fence is installed and all final inspe ns are performed and accep d. Signature of Owner --.S• . fApplicant Print Name '' Print Name Date ; s 1 • QTORM&OWNERPERNOSIONPOOIS Rev:09/16/17 , Town of Barnstable ' Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 MAW www.town.barnstable.maus Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: '� I� JC� -- Please Print . JOB LOCATION: � �i��'( C M 1!�L'f �'' ., number J street village "HOMEOwNER": \ d11, _/ 6"",ftV,-4C-ESQ i° ""'j-a -- 101�_ 7 name // home phone# work phone# CURRENT MAILING ADDRESS: e-n 40 k1:A0-W fD e" . `\1`y F6 1 mLIC 1� gci r 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. DEFINITION OF HOMEOR'NER 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 de ign `homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proc dare erne is and that he/she will comply with said procedures and requirements. Sign of meowner 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 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. Q:\wPFILES\FORMS\building permit forms\EXPRESS.doc 08/16/17 Sh-7115 :f V n+� Town of Barnstable *Permit y Expires 6 mont roan' K Regulatory Services Fee iA IMA IX MASS.16 9 • Richard V.Scali,Director t639 �� Building Division Tom Perry,CBO,Building Commissioner . -200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address — C ./` Ln Ile BP 6k PA' .A sle_r,>�G ❑Residential Value of Work$_ �O-OV• n Minimum fee of$35.00 for work under$6000.00 ` _Owner's Name"&'Address !Y Q�ri f p� d ✓�j� -. 1.(7. 7-a-Ag L iA iyc2 P ,�� E v'er I&Id 9- P 0-2-9/s Contractor's Name — Telephone Number Home Improvement Contractor License#(if applicable)' Email: . F Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance - it Check one: �tam a sole proprietor MAY 2.1 2015 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit_Re uest eck box) 6-roof(hurricane nailed)(stripping old shingles) All construction debris will'be taken to_P ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide'detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. r !SIGNATURE A a-Y Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Of r The Comm mreaM of Massachusetts tmmt of Industrial Acccidewa ©,�f ice ofInm igations 600 Wadvinglou Street Boston,MA 92111 nw w'Maimgosvfdia, Workers'Compensation Insnranee Affidavit: Bu*lderslCnntrack slElertricianslPlaffibers Applicant Information Please Print Ieo'bly Name 1): _� � — ad- GityfSta drip: 4: Are you an employer?Qteckthe appropriate ax: . T ' 1.El am.a with 4. ❑ 6_ ❑E of proje construction ct I am a general contractor and I {required}: employeesGr part-time)-* have hired the sub-contractors 2.❑ I am.a sole proprietor or partner- listed on the attached sheet. 7- [-]Remodeling ship and have no employees ' These sob-contractors have g- ❑Demolition w for me in t employ and have workers' c�ng �capacity. 9_ ❑Budding addition [No workers'comp-insurance COS msur e Z d.] 5. ❑ We are a corporatim and its 10..❑Electrical repairs or additions 3V.21 am a homeowner ding all work officers halm exercised t#ueir 1 L❑Plumbing repairs or additions - myself[No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance f c.152, §1(4) and we have no employ .[No workers' 131 Other es camp.insurance required-1 •flay applit ant dmt checks box C mast also fill aut the section below showing fiL&waakere campensalimparmy mformatioa HomeoamRrs who submit this affidavit indk=g they are doing&U wmk and then hire oumde coummmis must submit a new affidavit indicst ag such. tCMMWM tbat cheek tbis boot must attached am additional sheet showing the name of the sub-camas and state whets crnw those entice bme employees. If the sub-<=mtctors base employees,Say mnstpmvide their wa ins'comp.policy number. lam en employer titat is proi.*Nng nwrkers'congmisadon inmrauce for my employwes. Betow is the policy ad job ske infbrmatiom insurance Company Name: Policy#or Self ins.Uc.#: Expiration Date: Job Site Address: CitylStatelzip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and ezp ration date). Failure to secure coverage as required uiucler Section 25A o€MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one-year imprisonment as well as civil penalties in the form of a STRIP WORK ORDER and a fine of up to 525O.00 a day against the-violator- Be advised 1hat a copy of this statement may be forwarded to fix Office of Investigations ofthe DIA for insurance coverage verifsttation- I do keo eby carhfy M.der the pairs dpenahies of perjure that Ste iafarrrtation protztied abo, 'is true and carries r—Date:' - hes CPhone 4: - B� Al -Ze 95 Official use only. Do'not write in this area,to be comp Wed by city or town ofciat City or Town: PermitlIkense# Issuing Authority(cirdle one). LL 1.Board of Health 2.Bunging,Department 3.C tylrowiv Clerk `k Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#•- - _ 6 Townof Barnstable ' Regulatory Services Richard V.Scali;Director Building Division swxrrsTesLIC. ' Tom Perry,Building Commissioner MASS. E1 39%. 200 Main-Street, Hyannis;MA'02601 www.town.barnstable.ma.us` Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _.., DATE: Please Print JOB LOCATION: d c {Q number -__.. L_^street—,--_- - a , •HOMEOWNER"1)ai1 j j IP L/ -1 ? �YC>� "�/o S/ name ' ..home phone#>- r-�- j :work phone#_ CURRENT MAILING ADDRESS: l Ia.A l eGU-&C d-1 r - city/town . ..,. n -state '--.zip code The current exemption for"homeowners"was extendedao 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. 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) r 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 _ procedur and requirem is and that he/she will comply with said procedures and requirements. 4-1 '> Signature of Homeowner c 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. Y 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\building permit forms\EXPRESS.doC Revised 040215 = BARNSTABLE, � ,.� Town of Barnstable �ArfD Mf►�� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 1508-862-4038 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 Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 oF1HE r Town of Barnstable �Per2it#1 1 b Expires 6 months rom issue date .� Regulatory Services Fee snxlvsrnsLE, MASS 9�A 1639. ��� Thomas F. Geiler,Director , rfp►�w+" � �13 I�t t ,��L, Building Division U Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,-MA 02601 www.town.bamstable.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 Property Address I PIFy &-- ,(,t(,p w i& /147 EJ-1C'esidential Value of Work QTCT6- Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number( Home Improvement Contractor License#(if applicable) s Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance a -PRE X-PRESS, PERMIT Check one: ❑ I am a sole proprietor - A U G 3 0, 2 0J I ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit R�Z(stripping k box) old shingles) All construction.debris will be taken to �! ❑ Re-roof(not stripping. Going over existing layers of roof). ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *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. opy a Home Improvement Contractors License & Construction Supervisors License is r u' .ed. SIGNATURE: / Q:IWPFILESTORMSIbuilding permit formslEXPRESS.doC Revised 070110 4yy 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):./ n �- Address: iz �i,1V/- X - City/State/Zip:_73 f hone #: S " re you an employer?Check th appropriate box:. 4. I am a general contractor and I Type of project(required): 7,� .El I am a employer with 0 g employees (full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.[:1 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑.Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' [No workers' comp:insurance comp.insurance.t 9• ❑Building addition re . d.] 5• ❑ We are a corporation and its 10.[]Electrical repairs or additions _ 3. am a homeowner doin all work officers have exercised their g 11.❑Plum epairs or additions myself [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12. oof repairs employees. [No workers' 13•0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. , $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 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 cer u der th p enalties of perjury that the information provided above is true and correct Sign.a re: c�AsO / r` y Date: Phone M 7 Official use only. Do not write'in this area,to be completed by city or town officidl City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department :3. City/Town Clerk 4.Electrical Inspector-5. Plu 6.Other mbing Inspector . Contact Person: Phone#: THE, Town of Barnstable Regulatory Services : BARNSTABLE, : Thomas F.Geiler,Director MASS. 9�A 039. �� Building Division rED Mp'l 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: &— y tl JOB LOCATION: qV((1 �[C�•( � �911�P,/.L� /1� �.number i street village "HOMEOWNER": I.G/sC I � PP © �Y '�I y �J�L r � name home phone# work phone# CURRENT MAILING ADDRESS: t;l_ city/t state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling 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. 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 under ' ed`homeo er"certifies that he/she understands the Town of Barnstable Building Department minim inspec on ce requirements and that he/she will comply with said procedures and requ' e ,ents. 1 Si ature 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:forms:homeexempt THE Town of Barnstable Regulatory Services s utrrsT"LE, MASI Thomas F. Geiler,Director Fni 9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 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. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant � pp Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Co Di- 2))5�O 7dA K{ . aF Er y Town of Barnstable *Permit) � Expires 6 months from issue � 1ARN L � � Regulatory S `7 ervices Fee r 9$prE1 S i f omas F.Geiler,Director 1 Building Division FEB 12 2007 Tom Perry, Building Commissioner Office: 508-862TC-VV 03 C)F8 SARNSTABL 00 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid witliout Red X-Press Imprint Map/parcel Number Property Address © C� C:*i' C.l '7r Residential Value of Work � � 1 � � Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address c� ► a C-V 1Ck , C�y t l-ma c jZ y Contractor's Name_. _ t`1 "7 ( 0rn ,Q ���� Telephone Number Home Improvement Contractor License#(if applicable) d Q Construction Supervisor's License#(if applicable) ❑Workman's Compensation insurance 0. Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance assurance Company Name�� jl;2,0(1?� sr , n �M G.CJt�'�CD Norkman's Comp.Policy#-_ + :opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. gnature Forms:expmtrg vise063004 C�a PAP IZ G 21 Home Improvement Inc. I, Thomas Capizzi Jr.; owner of Capizzi Home Improvement, hereby authorize Lisa Haworth,to sign on my behalf for permit applications filed through the town. Signed: . . . _ Thomas apizzi, r. Date: aworth Date: 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 Client#:47298 CAPIHOM t ACORD. CERTIFICATE OF LIABILITY INSURANCE 01109107DrrrYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers$Gray Ins.Agency,inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. - - - South Dennis,MA 02660-1S61 INSURERS AFFORDING COVERAGE NAICik INSURED - INSURER A; National Grange Mutual Ins.Co. Caplzzi Home Improvement,Inc. INSURER B: American intematlonal Gr Caplzzl Enterprises,Inc. INSURER C: 164S Newtown Road --Ootuit,MA 02635 INSURERD: - Y -.' INSURER COVERAGES THE PO LICIES OF INSU RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU D RE NAMED T ABOVE OR TH E HE POLICY PERIOD INDICATED.NOTWITHSTANDING~ " ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUNENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR. MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER - - POLICY EFFECTIVE POLICY EXPIRATION - 'LIMITS _ A GENERAL LIABILITY MPOW07_ MOM 06/08/07 EACH 000URREnCE $1 000 OOO X COMMERCIAL GENERAL LIABILITY - - - - DAMAGE TO RENTED $500 OOO OLAIMSMADE .a OCCUR - . VIED-EXP(Any cite peninn) $10,000 . :PERSONALS ADV INJURY "$1.000 000- GENERAL AGGREGATE -'$2 00O OOO -GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COUP/OP AGG $2,000 000 .- POLICY - JEt° LOC. - t AUTOMOBILE LIABILITY - idBWEGSINGLELIMIT $ 4NY AUTO . . - iEz accident) ALL OMED ALTOS BODILY INJURY' SCHEDULED AUTOS (Perpembn) HIRED AUTOS BODILY INJURY $. NON-OWNED-AUTOS - (Peramd=) PROPERTY DAM kd E e 17CE LIABILRY AUTO ONLY-EA ACCIDENT'; $ - Y AUTO C - OTFERTHAN EA ACC $ - AUTO MLY: EXCESSAJMBRELLA LIABILITY EACH DCCURREh E $ - _ .. OCCUR CLAIMS.MADE lwGREGATE .....<, DEDUCTIBLE s $... ' RETENTION B WORKERS COMPENSATION AND 1764953 _ 12f26/06 ." 1 J2516T '101 STAlrU OTH- EINPLOYERS'LIABILITY E.L'EACH AC„CIDENT -" $500,000 ''MY PROPRIEORRARTNER/EXECUTIVE - --- --- - - -- CFFICER/MEMSEREY.CLUDED? If yes,desvlm under - - EL.DISEASE-EA EMPLOYE $SOO 000 SPECL4I.PROVISIONS to cw - - E:LDISEASE-POLICY UMn $5bl)000 OTHER - -__.....,.,, ...._....w3..-.....-....:.. ......,. <-,_...._ , DESCRIPTION OF OPERATIONS i LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ':CERTIFICATE HOLDER CANCELLATION ---- - - -�----- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUINGINSURER➢ALL ENDEAVOR 70 MAL In ..DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. .----- -------- --- - —_—. AUTHORIZED REPR£SENTATIVE ACORD 26(2001/08)1' of 2 #26435_ � _...—,Dly ®,ACORD.CORPORATION 1988 �----— the tommenweaun OJ mass"nuselts 3 Depar meet of Industrial Aeddents • Office AFL 600 Washington,street ems` Boston,MA 0211I �vww:�nnssgov ;Workers'Coimpe asation Insurance Affidavit W ders/Contractors/Electriciaiis/Plunabers Aplilica nt.information : : Please P int Le ibly .: .. :<......�.C-_ ......r ,. ........ ....:-. ct..t-.:..ay.wac�.......... .... .4�,.. .-t r'�,f�.:7+—.. _. __,. ..... _... .. » ....r..............<. ..r..•.- 1 . (Bnsmes ganizahoii/Indivtdual) _ - A ddress i.-645 Neaivown Tel 4?.8 95i8800.262 5060 CityfState/Zip r e ou an empioyer?Clieck the appropriate bog Type of prayed(required): I am a employer Avith ..sue `4 ❑ I am a general.contractor and:i 6 �New constrIIcnon a emPloYees(fiill and/or dart tune).* have haeci tl�e:sn -cflntractos 2 se ner g ship grid have no employees a Thesetub-conttacmrsbave S. Demohiwn Ewoilong foriile m ally capacity. workers'comp .�IIsurance B 9g uis addition -'IN o w®rkeis'comp msuraiice 5 ❑ tie aie`acorporaiwnsnd ris . regirured j Qlficers.have exercised their i©Q Electrical repans.or additions 3?,❑ I ant a homeowner doing all work ?fit of eg�empfilon per iVIGL 1 l Q Phimbmg repairs of a�ddi#ions myselfTo workeis' comp' c i S2,§1{4},anc we have no I�oofepairs msuiance rued]fi employees o j ,` woikt>rs , �:: � r,� camp i�snranceregnned.j * Y apphcattt that checks box#3 must a]so fll onte section below showing theirworkers''compensahon pphcy mfoaimahon t Homeowners who submit this affidavit mcheatffig they axe dome ail work snd 8�en,hue outade contractors must submit a new aiidavrt�nche0173g such xConhsc�s 8mt check fins box must atfsc�ed an addfi©nai sheet showing fl►e name ofthe sib-contractors and their wooers' �o7icy nafoirfiation. I am an employer'tliat>;sprot g workers _ mpeiisatron rnsurance�finrrrzy I0. - _ w is the .emp eeS �eln pn �o7�i site Insurance Company` �'Policy#or Self-ins �S + ^� W t� Job`Site Address . , CitylState/Z _ -.. Attaci;a copy of the workers--compens icon pohcyearati waepDlpg { cy nainber:"and ezp'i�'aton;.date). Failure to secure cov. a as r aired under Section 25A of MGL c i52 can leadto the' ; Itilpos' n of crimuna penalties of a fine up m$ ,5i10{AD and/or one ear y m3pnsonment;as.well as civ eIIaIties m the form of a STOP WORK O DD, of p ZSil9ll a,.day�gaiiistthe�vioiaGoL Se dvised`that a copy-o�tiirs=sstatement inay be forvc�arded'to file de, - .. .._.. :v4,... .a. A of d a'i�ine lnviestigations ofthe DiA:<for i�c►�ta�ce-��ge�+erificatron."" - - --._�,.. _ . f do'hereby uncle the pnsns and penalties of tnfornatton provided above.is true alai correct w z_ _- _ that the Date: Phone Of, 'kW use oirly'. Do:not write m this area,to be cavoWedby city or town offeW `Permit%Lieense# Issuing Authoialy(crcle�one)c _ _ 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other ------- Board of Building Regulations acid Standards One Ashburton Place - Room 1301 ;Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 100740 Type: Privets Corporation EXPIretion: 6/23/2008 CAPIZZI ,WO'ME IMPROVEMENT, -INC, Thomas 'Caplzzi,Jr. 1645 Newton Rd. COtuit, MA 02635 Update Address and return card:Mark reason for change. DP"Al.tb 50M-04/06 pC8898 Address Renewal Q Bmployment FLost Card ✓1z6 TDO�i�ftG4tto¢acciz d�✓//Gddd�tcCJP,fl� l bard of Building Regulations and Standards License or registration valid for IndiAduI use o home iMPROVEMENT CONTRACTOR ' before the expiration date. If found return to `Registration: 100740 Board of Building Regulations and Standards; Expiration:* 812312oo8 OnaAs"urtbn PIace.Rm 1301 Type: Private Corporation Boston,M.02108 CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi,jr. �_.,, .1645 Newton Rd. -- Cotuit, MA 02635 Deputy Administrator Not valid without signature ' 130ARD t1NF SUILDIN13.#Q ; NNS ! 1-lL�nse: �COS7Rl.iCTION S '� i Nuinb2b' 051032 S i `at' 1s3 15671 . � Y THOM .� ��• � s ..�1 AS X CAP! ` y ,. d JA Y I I 1 64S 1VEW7'0111+N Colu7r s: i t r � y � ��- s I ©ilJ ;17p/J Sl TG ee,J eve d or- eQrrec,i pcidv-c5� v vK v y JOSEPH D. DALuz Building Commissioner TELEPHONE: 775.1 120EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 April 12, 1991 Mrs. Phyllis F. Lytle 115 Commercial Street Braintree, Mass. 02184 RE: A=206-129 Dear Mrs. Lytle: This office has received a complaint regarding the storage shed on your property. Aln on site inspection indicates that the shed in question is within the side yard setback. The shed will have to be moved to comply with the required setback of the RC zoning district. Please inform this office when the shed has been moved. Since ely yours, Richard arse Building Inspector RRB/df Enc: 1 3-1.3 -.RC. RD, RF-1 and RG Residential Districts `1) .. Principal Permitted Uses: The following uses are permitted in theRC, RD, 'RF-'1and' RG Districts: �. A) Single .;family residential dwelling (detached) . `2) Accessory Uses ".The following uses are permitted as , accessory uses in° the'„Rd' RD; RF-1 and RG Districts:" A) Keeping, stabling and maintenance of horses subject to the provisions of Section 3-1. 1(2j (B) herein. 3) Conditional Uses: The following uses are permitted as conditional uses in the RC, RD, ' RF-1 and RG Districts, providE r.t a Special Permit is first obtained from the Zoning Board of Appeals subject to the provisions of `.Section 5=3 . 3-herein and subject to the specific standards for such- conditional uses a: , ,-...,,.,. .,required. in .this section: A)il Public or private regulation golf courses subject to the provisions of Section 3-1. 1(3) (B) herein: B) Keeping, stabling and maintenance of horses in excess of the density provisions of Section 3-1,. 1(2) (B) (b) herein, either on the same or adjacent lot as the principal building to which such use is accessory. C) FamilyA subject to the artment subj p � provisions}of Section' 3- 1 ; 1. 1(3) (D) herein. i � ij i D) Windmilis 'and other devices- for the conversion of wind energy to i electrical or mechanical energy, but, only as an accessorY use.; 4) Special Permit Uses: The following uses are permitted' as ! .. special permit uses in the RC, RD, RF-1 and RG-Districts, provided a Special Permit is first obtained from the Planning Board: y - A) Open Space Residential Developments subject to the provisions of Section 3-1.7 herein. 5) Bulk Regulations: ZONING MIN.LOT MIN.LOT MIN.LOT MINIMUM YARD MAXIMUM BLDC DISTS. AREA FRONTAGE WIDTH SETBACKS IN FT. HEIGHT IN F7 SQ.FT. IN FT. IN FT. --------------- FRONT SIDE REAR RC 43560 20 100 20 # 10 `10 30 * RD 43560 20 125 30 # 15 15 30 RF-1 43560 20 125 30 # 15 15 30 * RG 65000 20 200 30 # 15 15 30 :* * Or two and one-half (2-1/2) stories whichever is 'lesser. # 100 Ft. along Routes 28 and 132 . 12 t. ;. A=206-129 1084 Craigville Bch. Road JosrPil U. DALUZ Centerville TCLmPNONL•i 770-1120 /!nilJin� C,urnmiuiontr EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02801 October 18, 1990 , Mrs . Phyllis F. Lytle 115 Commercial Street A=206-129 Braintree, Mass . 02184 Dear Mrs . Lytle : This office has received a complaint alleging that you have a storage shed located on your property which is to close to the property line. After I made an inspection' of -Sdme, it does appear toe-be to close. Your property is located .in a 1ZD-I district zone. The set backs in this -zone is thirty feet front and ten feet for side and rear lot lines. Please contact this office regarding this matter. x Yours truly, Richard Z. Be arse l�lZli/(.l •p . 4 18 Dix Street Winchester, MA. 01890 October 12, 1990 Mr. Richard Bearse, Bldg. Insp. 367 Main Street Hyannis, MA. 02601 Dear Mr. Bearse: We have owned our summer home at 1090 Craigville Beach Road, Centerville since 1978. In September after we had moved back to Winchester, our neighbor, Mrs. Phyllis Lytle moved a large storage shed to within about 2 feet of the mutual property boundary. a The shed now effectively blocks our bedroom window from the prevailing air flow. Apparently, it was blocking one of her windows before, but now instead of moving it a few feet, she has moved it far enough to do the same thing to our window. We feel the shed location is inappropriate for the following three reasons: 1) We believe it is in violation of the set back restrictions. 2) The location of the shed is detrimental to our property. 3) The shed in its present location detracts from the overall appearance of the neighborhood. We request that you give this matter some consideration and then tell us what steps we might take in order to have Mrs. Lytle move the shed to a more appropriate location. Your help would be very much appreciated. Sincerely, P.S. We did express our displeasure to Mrs. Lytle on Sept. 22, when we discovered the change, but did not sense a willingness on her part to correct the situation. �r5 h;i O� l �wSve LCc. Aci ed Winchc>:ter, MA. 01 Fi90 October 12, 1990 Mr. Richard Bearse, Bldg. Insp. 36 Main Street Hyannis, MA. 02601 Dei:r Mr. Bearse: We have owned our summer home at 1090 Craigville Beach Road, Centerville since 1978. In September after we had moved back to Winchester, our neighbor, Mrs. Phyllis Lytle moved a large storage shed to within about 2 feet of the mutual property boundary. The shed now effectively blocks our bedroom window from the prevailing air flow. Apparentl: it was blocking one of her windows before, but now instead of m, ng it a few feet, she has moved it far n,,ugh to do the same thing our window. We feel the shed location is inappropriate for the following, cln-o,• reasons, j� 1) We believe it is in violation of the set back restrictions. 2) The location of the shed is detrimental to our property. 3) The shed in its present location detracts from the overui.li appearance of the neighborhood. We request that you give this matter some consideration and then tell us what steps we might take in order to have Mrs. .Lytle move the shed to a more appropriate location. Your help would be very much-"appreciated. Sincerely, Luu\i'� \ pyrle! P.S. We did express our displeasure to Mrs. Lytle on Sept. 22, when we discovered the change, but did not sense a willingness on her part to correct the situation. J ASS O!"S o c jLF c� � ZZ e- ,13C..Gh )ed } c �`5 L L e, h�yL � �. Y pry. Assessor's map and lot number .. � a / .............. F / rO a d0 �� o `; C3 �Of THE T�� Sev f ge Permit number . ................`........................ .............. n • AHB9 E, i House number• ............../ .• ....... ...:. t ' B TADL ... ..... . 9�Oo�r63 9� a it p MAY Or TOWN, OF BARNSTABLE BUILDINGINSPECTOR APPLICATION FOR PERMIT TO .:........... ...!d... L�. i/✓G... TYPEOF CONSTRUCTION ...........:............................. ................: .... .....................................:.:........::............• ......................l �C TO THE INSPECTOR OF BUILDINGS: The undersigned' hereby applies for a permit according to the following information: r/ ID.S � ..... . � r � ...:..: ...o....Location .................... ..... ..... ...... .... ...........Proposed Use ............................................1�:.....:...:................:......:......:....................................................... ............ Zoning District ........ ................................. .... ............Fire District ....c7n..................................................... .... Name of Owner .. .19•S "�.. .e .i�.............. .Address .. D fsy....0 ! Name of Builder ,� ��J `!� �— .......::......Address ............:............................................................................ Name of Architect ......:.......... ...Address Numberof Rooms .........................................................'........Foundation ..............................................................:............... Exterior .......:.......... . ...............................:..........................._.......Roofing ................................................................................... Floors Y v �c�/� � ................:........................Interior ........:........................................................................... Heating ...................................................................................Plumbing .................................................................................. Fireplace ........................................,......,.......::.....:..................:Approximate. Cost............................................... ................... ....... .................. Definitive Plan Approved by,Planning Board _______________________________19________. Area . ...... .. .. ...................... Diagram of Lot,and Building with Dimensions Fee a ............... .:.................... n SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ......� .... . .... Construction Supervisor's 'License f........... LYr=, PHYLLIS + ` No ..... Permit for DECK................ Single Family..Dwe11in%..................... % F l . �. " 1084 Crai ille Beaciz Road Location Road ....................... - Centerville ...........r .. t _ r Owner Phyllis Lytle �. ..�.... .�. .. Frame................1.......... Type of Construction' .................. �.� Plot ............................ Lot ................................ Ma Permit Granted ..:... ....2.......... v19 84 , Date of.lns Inspection !`l9 p . ........... ............ ^ r Date Completed 901� c ^j� J y � Awl'' �• ,f i� jf + 1 p` 1. *_. . .,,, r•- ,b. k Assessor's map and lot number ..��.� ..:.:...°...9............ ;2 ®p SINE to � � Q T Se. ge .Permit number .......................,:'................................ t 133AHH9Ti►DLE, i House number .............. .....D........ ..................................:.;... v rasa DO 2639' ♦� t, •� `` Aj�`,o YFY d� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 2 j �....... TYPE OF CONSTRUCTION ................................. .../ G. ....yf`...../�.... .................................... ........................ Ly ......................19. TO THE INSPECTOR OF BUILDINGS: ti The undersigned hereby applies for a permit according to the following information: Location v.......�.b j t d .�.. ......................4 C"'�`�i 1� ............................... ProposedUse ................. ...e./C........................... ........,...........................................................I......................... Fire District 4a-..-..v................................................ Zoning District ........ ..................................................... ...... Name of Owner ....✓..... `...t.. .�..��.. . ....t.i. ........ . Address . ..`�. .... !'t'' ! 6 yr fl y C .►��`t�q �/ f Nameof Builder ................................... ............................... ddress ................................ ......... ......... ......... ............... Nameof Architect ...................................................................Address .................................................................................... 'Number•of Rooms .......... ..................................:....................Foundation .............................................................................. Exierior .................... ..................................................:::....:.....Roofing Floors. ..............©O,o............................................,..........Interior .............................................. Heating .. .f..Plumbing .......{.... . ....... ! ti ✓ �Q - Fireplace j ......Approximate. Cost....... ..... Definitive Plan Approved by Planning Board -----------___----_-----------19_ ___. Area ....... .....:..................... Diagram of Lot and Building with Dimensions _ Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 �T r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS: a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 6 7 Name .. .... ............ Construction Supervisor's License ...!J ?LQJ.......... LYTLE, PHYLLIS A=206-129 No . 6 04 w�.......... Permit for ...... Deck ..........Single Family..PWq;Ljing.................... Location .... C 1084 .K ............. . ....R.Q.ad... Centerville ........................................................................ ...... Owner Phyllis Lytle.................................... Type of Construction ......FT4M.......................... ................................................................................ Plot .......................... Lot ................................. Permit Granted .......M.ay..2 2.1...................19 84 Date of Inspection ................ ...................19 Date Completed ......................................1'9 TOWN OF BARNSTABLE BUILDING PERMIT 'IARCEL ID 206 129 GEOBASE ID 12467 ADDRESS : 1084 CRAIGVILLE BEACH RD PHONE Centerville ZIP - LOT 40 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 4749 DESCRIPTION REROOF PERMIT TYPE BROOF TITLE BUILDING PERMIT ROOFING Department of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: TOTAL FEES: $50.00 BOND $_00 px CONSTRUCTION COSTS $.00 750 ROOFING AND SIDING * 1ARNSTAMY, • MASS. OWNER LYTLE, PHYLLIS F i639' Ae� ADDRESS 115 COMMERCIAL ST FD MA'S BRAINTREE . MA BUILD I SI DATE ISSUED 06/09/1995 EXPIRATION DATE B `TOWN OF BARNSTABLE BUILDING PERMIT 4-41R(CEL ID 206 129 GEOBAFE ID 12467 AD RESS 1084 CRA -II LLE BEACH RD , PHONE Centerville ZIP LOT 40 --'' BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 4749i% ' DESCRIPTION REROOF PERMIT TYPE BROOF TITLE BUILDING PERMIT ROOFING - Department of Health, Safety CONTRACTORS: and Environmental Services I ARCHITECTS:. .` I TOTAL FEES: $50.00 s BOND $.00 V`T CONSTRUCTION COSTS $.00 . 750 ROOFING AND SIDING ; ,, :. m • RARNSPABLE, • -� MAM 059. I TER LYTLH, ' PHYL;LI S F A ADDRESS 115 COMMERCIAL ST BRAINTREE MA / 1 BUILD =. AIV'ISI N DATE ISSUED 06/09/1995 EXPIRATION DATE BY ✓!� _.•v'�-�� ---=------- ---_----f--------- ---- i DIVISION APPROVALS FOR CERTIFICATE OF'OCCUPANCY TO BE SIGNED.BY EACH DIVISION HEAD UPON COMPLETION BUILDING: ' = - DATE: `r'COMMENTS: PLUMBING: DATE: ` r' COMMENTS: ;r ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: . y TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARL COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. 0 ti I fe f O/v I <, �1TOWN OF BARNSTABLE BUILDING PERMIT 11'AidEL ID 2 3 GROBASE ID , 12467 AD S! ' 1084 *:. I .LE BEACH ItD PHONE Cen�tery 11e ZIP -- LOT 4.O �" BLOCK LOT SIZE i DBA V DEVELOPMENT DISTRICT CO PERMIT 4749 r. DESCRIPTION REROOF I' PERMIT TYPE BROOD' TITLE BUILDING -PERMIT ROOFING Department of Health, Safety CONTRACTORS: and Environmental Services c ARCHITECTS. I TOTAL FEES:. $50-Ott I BOND CONSTRUCTION COSTS $-CQ Qi► 1 750 ROOFING AND SIDING * BARN3PABI.E, * I O IINER LYTLE,' I'FfiY LIS F E�'. ADDRESS . 115 :COMMERCIAL ST f a I BRAINTREE MA BUILD •. I �ISION DATE` ISSUED 06/09/1.995 y EXPIRATION DATE BY �` � - !l �, THIS PERMITCONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR. ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE-RETAINED ON,JOB AND _ 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF`OCCU_ PERMITS ARE REQUIRED FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL:NOT BE ELECTRICAL,PLUMBINGAND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION•HAS BEEN-MADE. ANICAL INSTALLATIONS.. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 1 i 2 r9 . 2 _ 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH . OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE.ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION: 508-790-6227 BUILDING PERMIT Assessor's Office(1st floor) Map C�j Lot OC. ermit# `1'j� 9 .Consertiation Office(4th floor) (O Z � Date Issued Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Fee Engineering Dept.(3rd floor) House#1 Planning Dept.(1st floor/School Admin.Bldg.) RNSPABLE.�` Definitive Plan A Planning Board 19 e ED N1K�� TOWN OF BARNSTABLE Building Permit Application Project Street UA11111t41,5 0 7 (���i�// Village Owner L y f� V��i�.� �' Address Telephone ' Permit Request Total 1 Story Area(include 1 story garages&decks) j square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use /s/ )M C Z' Proposed Use Construction Type Commercial Residential x , Dwelling Type: Single Family y Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished C4A&/I Old King's Highway Number of Baths l No.of Bedrooms 0Z Total Room Count(not including baths) - First Floor Heat Type and Fuel Central Air Fireplaces l Garage: Detached, Other Detached Structures: Pool Attached Barn None Sheds Other � Builder Information /Name ; F C d,,1 s&-y()z(1 1" Telephone Number � �fJ Address 7 �S` �?�/c/Gi RUC License# d;,. O° d 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 &Bk r✓�-AV A) r SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED , MAP/PARCEL NO. ► - ; ADDRESS �' VILLAGE OWNER - r DATE OF INSPECTION: I 3 FOUNDATION FRAME ' INSULATION FIREPLACE r' ELECTRICAL: ROUGH -FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ? ASSOCIATION PLAN NO. . i ' Assessor's Office(1st floor) Map Lot /(;:I'-?, Permit# Conservation Office(4th floor) ,� �� ` Date Issued Board of Health(3rd floor)(8:30-9:30/1:00-2.00) Fee Engineering Dept.(3rd floor) House#1 / Planning Dept.;(1st floor/School Admin.Bldg.) Definitive Plan Approved by Planning Board 19 6 FO MKS� TOWN OKBARNSTABLE Building Permit Application Project Street Address /�� r��,Q-j'tA Village Owner t/��P 1 '/�c�/1/��i��� Address Telephone ( T7 Permit Request r Total 1 Story Area include 1 story garages&decks square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size ' Grandfathered ? Zoning Board of Appeals Authorization- Recorded Current Use �'�,/ Y1/n C/1 �Q 47 r - Proposed Use ( Construction Type Commercial 4 . Residential [ Dwelling Type: Single Family V Two Family Multi-Family, Age of Existing Structure Basement Type: Finished A ,' Historic House Unfinished C414AII Old King's Highway Number of Baths ! ! No.of Bedrooms t - Total Room Count(not including baths) _ First Floor Heat Type,and Fuel 411;4 (' Central Air /J 6 Fireplaces l Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds - Other �— Builder Information Name /e C d Ai sS U r -(� t` j Telephone Number 0/ Address AP/j;,14 �( _ License# Home Imp rovement.Contractor oIL a Worker's Compensation-4" 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 1;,9k^<r'Ap A)6. SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) t -- FOR.OFFICIAL USE ONLY , PERMIT NO. DATE ISSUED MAP/PARCEL NO.'' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION + I 4 FRAME 4 INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL - y PLUMBING: ROUGH FINAL ` • ` ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. e TOWN OF BARNSTAB11-s . BUILDING DEPARTMENT COMPLAINT/INQUIRY vePORT _ Assessor's NO. Date .5 Fec'd B Fist Name T,ast Name v --- ORIGINATOR Street State Zi Villa e Tele hone: Home _ Work Descri tiOR- �. I -COMPLAINT INQUIRY Requestor's Signature Xv, COMPLAINT Street Address LOCATION OFFICE USE ONLY r} Ins ector INSPECTOR'S Date �J ACTION COMMENTS G - U � FOLLOW:-�_ ACT I Ot: a � � hDD?TZO.aL ,,e e - II7FO. ATTACHED G DEPI,R:YE2'T FILE YELLOW - INSPECTOR COPY DZ.SiRIEL'TZON: PINKWHITS- INSPECTOR,(RETURN TO OFFICE KISC1 dew�o The Town of Barnstable BARNS AB �mg Department of Health Safety and Environmental Services 116 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME RViPROVEMENT 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 Address of Work: Owner Name: Date of Permit Application: I hereby certifv that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-oocrpied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hcreby apply for a permit as the agent of the owner: Date Contractor name Registration No. - OR Date Owner's name 11;02,94 17:02 '$6177277122 DEPT IND ACCID Q 00: C atiunonivaatm, o/ Ylva-,Jac{i.usettj a1JctPartmenL o�J'i:du�trial.�dcccde� 600 Wu�toa St-1 James J.Campbell &ton, ///aaaadmisib 02 f f f Commissioner Workers' Compensation Insurance Affidavit with a principal place of business at: LI (aw/st"iZiv) do hereby certify under the pains and penalties of perjury, that: () I am an -employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors lined below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I under<_[;nd t :t z copy of&,is statement will be fone.,zrded to cite Office of Invesdgadons of the DIA for coverage verification and that failure to secure courage s rec.:;.-Ed under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisdne of a fine of up to S 1,500.00 zndlor cn years' impriserrent u well civil penalties in the four f a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this -ej7day of 1 Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 4o9, 375 m T1T_..�lr T A-Tr" A-T --T1 NTO T -rr)A4TT �1[ " A=206-129 JOSEPH D. DALUz -- 790-6227 Building Commissknts TELEPHONE:X=4EXXX NDCEXXRX TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 May 3, 1991 Mrs. Phyllis Lytle 115 Commercial Street Braintree, MA 02184 RE; : :A=206-129 1084 Cra.igville Beach Road, Centerville Dear Mrs. Lytle: I am .in receipt of your letter re the tool shed on your property. However, it is my responsibility to have all complaints received by this office investigated. A building permit is not required for a tool shed 100 square feet or less in size - it must be placed so as to conform to the zoning re- quirements. The requirement in your area is 10 feet from the side line and 10 feet from the rear line. Please understand that this is not harrassment and that your shed was the only one mentioned in the complaint. If I may be of any further assistance please contact me. Peace, �1 � 6�seph D. D L Building Commissioner JDD/gr 1 �- ,OD G �� �C4 - 'a: r i ♦ '� - - ; � � � �► JOSEPH D. DALuz Building Committioner TELEPHONEt 775.1120 EXT. 107 TOWN , OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 April 12, 1991 Mrs. Phyllis F. Lytle 115 Commercial Street Braintree, Mass. 02184 RE: A=206-129 Dear Mrs. Lytle: This office has received a complaint regarding the storage shed on your property. Rn on site inspection indicates that the shed in question is within the side yard setback. The shed will have to be moved to comply with the required setback of the RC zoning district. Please inform this office when the shed has been moved. Since ely yours, , Richard �earse Building Inspector RRB/df Enc: 1 3-1.3 -RC, RD, RF-1 and RG Residential Districts Principal.,Permitted_ Uses: . The following uses are permitted ii the RC, RD', RV'-1"and`RG Districts: << _3 A) Single 4amiAly residential dwelling (detached) . 2) Accessory Uses "' .The following uses are permitted as accessor, uses in the`RC; RD,' RF-1 and RG Districts: ' A)' Keeping, ..Stabling and. maintenance of horses subject to . th( provisions "of section 3-1.1(2'' (B) herein. 3) Conditional Uses: The following uses are permitted as conditional uses in the RC, RD, RF-1 and RG �bi•stricts;, providE ;,. a: Special Permit is first obtained from the Zoning .Board` of Appeals subject` to the provisions of `.Section 5=3 . 3 `herein and subject to the specific standards for`-such conditional uses a: required in this section: A);z Public or private regulation golf courses subject to the provisions of Section 3-1. 1(3) (B) herein. B), Keeping, stabling and maintenance of horses in excess of the density provisions of Section 3-1.1(2) (B) (b) herein, either on the same or adjacent lot astthe- principal building to which such use is accessory. T Cj~ Family subject to the provisions-•.`of Section 3- �.'.. � 1. 1(3) (D) herein. D):: Windmills and other devices for the conversion- of wind energy to electrical or mechanical energy, but only as an accessory use. € ." 4) Special Permit Uses: The following uses are permitted as special permit uses in the RC, RD, RF-1 and RG Districts, provided a Special Permit is first obtained from the Planning Board: A) Open Space Residential Developments subject to the provisions of Section 3-1.7 herein. 5) Bulk Regulations: ZONING MIN.LOT MIN.LOT MIN.LOT MINIMUM YARD MAXIMUM BLD( DISTS. AREA FRONTAGE WIDTH SETBACKS IN FT. HEIGHT IN F`. SQ.FT. IN FT. IN FT. --------------- FRONT SIDE REAR RC 43560 20 100 20 # ` 10 410 30 I RD 43560 20 125 30 # 15 15 30 RF-1 43560 20 125 30 # 15 15 30 RG 65000 20 200 30 # 15 15 30 , * * Or two and one-half (2-1/2) stories whichever is lesser. # 100 Ft. along Routes 28 and 132 . 12 FOR ATETIME 4 P.M. M G . �"h#E,}N�C3 O F '~�x PHONE '! Lfi�Cki�L EA Coll,����UMBERI EXTENSION �1 p f? `itit t'�11 l MESSAGE i1(J ` WANTS 70 SIGNED TOPS 9 FORM 4006^ o(o — /lZ.� NOTES _ /1A1� i �D'1 J C In •-ia�`� i Ze b --- ..w L0-cjI tRAIwVILLE BEACH R` CTA 710 TDS 300 Co EY I 124671 ? I-fA�LI1% ADDRESS --____ P( s�I �[1 �r jti � 1 ' LYTLE, PHYLLIS E' tsr F''9 Al REA 146A;`� V 5 2 8-71;1 1 f';Tc7000 115 COMMERCIAL ST SPI 17 SP2 7 - - SF3 BRAINTREE MA 02134 r" 993 5 EY s 3 975 0 n 1125 C'ONSTJ ------LEGAL DESCRIPTION---- TRUE MET 14411.0 o REA CLASSJFIEV _ #LAND? I •_`6,90( A 6 D LlRD - -86,300 A.3D fMF _ .57300 .ASO OTH -. #S,'D(S)--CARD--1 1 57,200 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE ##PL 1084 CRAIGVILLE; .RD TAX EXEMPT #DL LOT 40 -RE:S f P N a"L- -?441.0 0 44100 144100 #RR 0369 0070 OPEN SPACE- INDUSTRIAL- = r E:XEjr,PT 10 N S _ LAST AC TIVITr 70610 u"S, s s " .. ..- if � i. •.r n , .. . — -r� _ ... 1 y Assessor's Office(1st floor) Map �f Lot Z ermit# Conseation Office(4th floor) Date Issued Board of Health(3rd floor)(8:30-9: /3 10 :00--2:00) _Fee �J Engineering Dept.(3rd floor) House#1 Planning Dept.(1st floor/School Admin.Bldg.) 4 RARNSTAMS, Definitive Plan F Planning Board 19 6 TOWN ®F BARNSTABLE Building Perinit Application Project Street A Village0,r Owner [ V�Lf lj ie1/ _� /t! Address T - Telephone Permit Request ' T Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use /y,M L, HQ Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family y Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished C -&1// Old King's Highway / Number of Baths ( No.of Bedrooms Total Room Count(not including baths) _ �` First Floor Heat Type and Fuel lAQ Central Air _ /(/C% Fireplaces / Garage: Detached, Other Detached Structures: Pool �— Attached Barn ----- None Sheds _ Other . Builder Information Name .7 ye-oC4f Telephone Number_ Address � ,.� ��,� �( License# y'�,cJic/f O 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 '�r✓C /� . SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) TOWN OF BARNSTAts.�r;a . BUILDING DEpARTMENT T ColipLAINT/INSL Assessor's NO. s Rec'd Date B First Vame st Name ORIGMTOR Street Zi State villa e Work Tele hone: Home Descri tion. 7 -COMPLAINT INQUIRY ReVestor's Signature �/ COMPLAINT Street Address 7;OCATION °` OFFICE USE ONLY s ins ec o INSPECTOR'S Date ACTION/ J�e� COMMENTS Jf FOLLO ;-UP ' ACTI01" 7,DDI IIgFO. RTTACHED YELLOW — I2:SPECTOR CppY DZS.'Zi IEL'TIOtl: hY.ZTE — DEPhRTY�'1:T FILE TO OFFICE Y.GR.� PZ13K — Z2dSPECTOR (RETURN Kiscl . . °: The Town of Barnstable URMAUX- • K $ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: Es Cost Address of Work: Owner Name:. Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby giv en that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date . Contractor name Registration No. OR Date Owner's name 11%02`Q4 1 7:02 V6177277122 DEPT IIN*D ACCID Col�vnolutleatilL 0/ �I&Jjaclztt6etb i nn ' a[.�aparfinenl o�.�nc�u�fria�✓�iccidan� 600 W uAinjfom Stmet ton aaac" 02111 . .. _ mes J.Cam . Ja bell P Commissioner Workers' Compensation Insurance Affidavit with a principal place of business at: (C�cr�srser�zia) do hereby certify under the pains and penalties of perjury, than () I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number �I am a sole proprietor and have no one working for me in any capacity. (} I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor 'Insurance Company/Polity Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing ail the work myself. I understand that a COPY oft;is s:::tement will be forwarded to the Office of invest prions of the DIA for co"Trage verification and that failure to recur ccvrage:s ree:ired under Section 25A of MGL 152 can lead to the imposition of criminal penaities consisdn¢of a fine of up to S1,500.00 and/or c ye.rs' imprissor n;ent as well civil penalties in the fo f a STOP WORK ORDER and a fine of$100.00 a day against me.7 Signed this lday of Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department ----- >. rn-r Aante Yanz &na anz_ 4n9° 375