HomeMy WebLinkAbout0066 HOLLY POINT ROAD 0
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 23 Parcel 0 q Application # Af o
Health Division Date Issued "7--7- I
Conservation Division Application Fee
i°
Planning Dept. �Q® Permit Fee
Date Definitive Plan Approved by Planning Board A
Historic - OKH _ Preservation/Hyannis O
Project Street Address (IDl,D �ko k\v
Village Sek�v Ave,
Owner Ms�k c_ Aocq*Az-- Address ( b �b11u '&OA tg_� CecJ�lc�y� \e
Telephone Boi-7 ) I Lw b o e�o
Permit Request , C. ,% r:�
.0 U --
Square feet: 1 st floor: existing 3 proposed 2nd floor: existing proposed Total new J�O
Zoning District % Flood Plain Groundwater Overlay Project Valuation S0 Construction Type'New`� �
Lot Size ° 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes to No On Old King's Highway: ❑Yes B/ No
Basement Type: Val ❑Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.)_ Basement Unfinished Area(sq.ft
Number of Baths: Full: existing- new Half: existing new
Number of Bedrooms: existing 0new
Total Room Count (not i cluding baths): existing new First Floor Room Count
Heat Type and Fuel:(not
❑Oil ❑ Electric Other
Central Air: Les ❑ No Fireplaces: Existing V New Existing w Istove: Y p g g wood/coal ❑ es 0/No
Detached garage: ❑ isting ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_
Attached garage: existing ❑ new size'Ahed: d existing ❑ new size Other:
Zoning Board of Appeals thorization ❑ Appeal # Recorded ❑
Commercial ❑Yes No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name�/,-MeS S . ��1 i�c,cX Qc Telephone Number 5� � C6(p5S
Address ` License# v y l S
c-) A p_-2_to t-�2� .Home Improvement Contractor#. � 0
Email �5S fit,% mcask Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUR 4 DATE 0 t `7
FOR OFFICIAL USE ONLY
APPLICATION #
I
DATE ISSUED
MAP/ PARCEL NO.
f ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
t
FINAL BUILDING
f
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Camwoi weak*of Ma"admset&
artment��AcdFdt�
` Office vf ad&rss.
600 Wasb&glou S`t eet
Boston,MA#2HI
Wurlm ' Cumpensa�Imi�ce Af.-m iers
ApvHcamt
Iuarmaf qu .y Please Print
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Addge to �VGz V \ PA
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(M:js M� 7 3657 6 s
Are you an employer?:Checkthe appropriate bum
L El am a i wig 4_ ❑I am a geaeral coufmctar ant€I Type of project{req�,ec _
employees(:rum araifor Fart�me j.
* have hired.9w� �- ❑New oonstauioa
2 I am a sale psnprielar orpartaw- fisted on*e att6ched.sheet 7. elmg
s9 p and have no employees These sub-caaftd=have Q Demafifian
wcddng forma ia any capacity. employees andhwe wogs'
P_�„�,�I g- ElBair addifica.
[No �ppmp_rr�ctx�nrtr C CM .
5: We we a corpomfioaaadifs I�❑Electacal repairs osad s
3-❑ I ama fio aeowner ailwmk 1L Plumbia.
Myself[No was right of a fiou per M(M � gregairs or a�fiams
+++c=rLce Iequired j i ' 0.M JIM andwela�veao L_0 Roofllrpaus
employem[I`Ta 13-Elother
coaxp_ium=required_]
;Amy Hsst sheds E��1 mast also ffiomEths sechoabeTaw�g Hieswadcas'mmp�tiagpnTecgi��mL
�ameeamerswbo snba�dads.�daa� g 8�ep�d�m�ag�ra�sa�H�3�aat�c�ctarsamst sahmitaaew�d�eit mdiasi�,z►cfy ,
=Camm�ffist ebecY i s b=mast attedseH=sdditiaea2 sizeet sLaoriag tiienaa of die tmti state vrl�eth�araottbnse a sbsae
employees.T€the Ies tTiegmnstpmt ide tea ads' P•pJ whet .
lam mi euip �sr tliatis praxirtg workers'catr�rertsrdiort iitsruarres#vrp3'ees. SeTacv ZS 1i8 prr8cy jab site
i$formatiarr. - - _. •
Iasucanse Company Name:
Pofitry 4 or SeH inn Lit_ Hp�nDate_
Job lute fiddre=l9 1 to�1�( �o i y► -CtL y� ,,/�j► \�' Csfgl5titelMp C12►n
teach a copy of the warkere compensationpolicg declaration page(shOWing the poFLCY mn3her and CMpiration date}.
Fare to seam-e coverage as requireduaderS=&n 25A o€MiOL c_1�CBn lMd to the imposition of gal pet%of a
fine up to S L500:OQ aadfor one-yewimprisonment n well as civil p—xNe in the f fe
aun of a SI P�T(3R1£€�ffi]El and a in
of DP to Z5(LW a(kY Wind#5e violator_ Be advised Old a Copp of this st d=ed maybe forwarded to the Office of
hwestigadws of the M for fim=mw coverage vedfrrati=
Ida hem"under tits pis andpenaffres afpadhq f uEttT a u�f aruuW provided above is bras arid correct
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=a aagy. Do nor in ffd3 area i§r fie meted by Cftyarta�Fn.ofjrcral
My or Tama: P un�
Ling?xffi*'ty(cacle-Otte):
L Board of Mail& leg Department 3.faytrumm tali d„Electrical hnpednr S.Yl�biag Iasltecimr
C.Other
Conbct Person Phan#:
6
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AWC Guide to Wood Construction in High Wind Areas:110 mph.Wind Zone
Massachusetts Checklist for Compliance(780 C►IR 5301.2.1.1)t
- _ C( deck
1.1 SCOPE - Compliance
Wind Speed(3-sec.gust)................................................................
Wind Exposure Category..._.................... .........I........ ................................... .. .. 1.10 mph —
1.2 APPLICABILITY
Number of Stories .................................... .......... .(Fig 2). stories 5 2 stories
Roof Pitch ......:..::..:.......(Fig 2)...................... 512:12
Mean Roof Height ....................... Fl 2 ,
BuildingWidth,W......................_...................:.. ..............(Fig 3)........................_. ..... . — —
'Building Length,L ............................................................(Fig 3). _ft 5 80' —
.......
9 P (LAN) —ft s 80
Building As Ratio ..................._.........................(Fig 4)................................................ 5 3:1 _
Nominal Height of Tallest Opening2 (Fig 4)........:....................................... 5 6'8'
1.3 FRAMING CONNECTIONS' _
General compliance with framing connections:...................(Table 2)..................... . ..' . ...
2.1 FOUNDATION
Foundation Wails meeting requirements of 780 CMR 5404.1 t <
Concrete.......................................
........................
Concrete:Masonry..................................................................... ` _ ............................._...............
2.2 ANCHORAGE TO FOUNDATION1,3 -
5/8'Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only
Bolt Spacing—general............ ...........(Table 4)............................... in.
Bolt Spacing from endrjoint of plate .... ............(Fig 5)............_.._................... in.5 6"—12" --
Bolt Embedment—concrete............... ..........a............(Fig 5).............._........ - .. in.;-,7"
Bolt Embedment—masonry.................. ..... .............(Fig 5)...................... ....... . • '►n.z 15" .
PlateWasher......................................... ................(Fig 5)................ _ ..................... ..Z 3'x 3"x 1/4*
3.1 FLOORS "
Floor framing member spans checked (per 780 CUR Chapter 55
Maximum Floor Opening Dimension........`...........................(Fig 6).............................. It 512:or L/2 or W/2
Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..................... ............_:...
Maximum Floor Joist Setbacks —
Supporting Loadbeadng Walls or Shearwall.................(Fig 7)............................. _ft sd
Maximum Cantilevered Floor Joists - � —
Supporting Loadbearing Wails or Shearwail................(Fig 8)..........................................
Floor Bracing at Eidwalls.................................. .........:.:(Fig 9)..........................
Floor Sheathing Type ........................................................_ (per 780 CMR Chapter 55)..........................
Floor Sheathing Thickness.................. ......................_......(per 780 CMR Chapter 55)....................... in. _
Floor Sheathing Fastening..................................................(Table 2).._d nails at—in-edge/=in field
4.1 WALLS }, —
Wall Height
Loadbearing walls.....:......................................a...........(Fig 10 and Table 5).................• ._......._ft s 10'
Non-Loadbearing walls.......................:........................(Fig 10 and Table 5)...,......................._ft 5 20'
Wall Stud Spacing ........................................................(Fig 10 and Table 5).................... in.5 24"o.c.
Wall Story Offsets .......(Figs 7&8).................... —ft 5 d
42 EXTERIOR WALLS' < —
Wood Studs
Loadbearing wails. ................................... .....(fable 5)....... .........2x ft .
_ _m. ,
Non-Loadbearing walls.............................. .............(Table 5)......................................2x -_it in.
Gable End Wall Bracing
'Full Height Endwall Studs• ......................._:..................(Fig 10)........._........_........................ _
WSP Attic Floor Length................................:.:........:....(Fig 11)..................................•..........._ft zW/3
Gypsum Ceiling Length(if WSP not used)....:..............(Fig 11)......................... ..—it Z 0.9W
2 x 4 Continuous Lateral Brace @ 6 it.o.c...(Fig 11)...................
..........................................
.
Double Top Plate
Splice Length ........................................................(Fig 13 and Table 6)_...............................:.... ft
Splice Connection(no.of 16d common nails)..............(Table 6)..................._................. `
AWC wide to Wood Construction in Nigh Wind Areas:110 mph Wind Zone
Massachusetts Checklist for Compliance(7so CMR 5301.2.1.01
Loadbearing Walt Connections
Lateral(nm of endnailed 16d common nails)..............{Table 7)..............................................I..........
Non-Loadbearing Wall Connections
Lateral(no.of endnaffed 16d common nails).._...........(Table 8).............._.......................................
Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
Header Spans ................_..................................:...('fable 9).................................._ft—in.511'
SRI Plate Spans ................... (Table 9)...._.............. ..._ft_in.511' _
Full Height Studs (no.of studs)...... .ia;....................(Table 9)....................................I...................
Non-Load Bearing Wall Openings(rewrd largest opening but check all openings for compliance to Table 9)
Header Spans.............................................................. (fable 9)...... . ft_in.512'
Sill Plate Spans....;..................I.........I.........................(Table 9)..... .................... fF_in.51Z' —
Full Height Studs(no.of studs)............_......................(Table 9)..................................__:. .....
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously" '
Minimum Building Dimension,W
Nominal Height of Tallest Opening
Sheathing Type................_.......
........:.....
.......
(note 4)......................................................
Edge Nail Spacing....................................... (rabie 10 or note 4 if less).......:................ in.
Field Nap Spacing P 9..................:.......................(Table 10).....................................:........... in. _
Shear all
(no.,of 16d common nails)(Table 10)_.......................I..............................
Percent Full-Height Sheathing.................-....(Table 10).......................I............................._% ' _-
5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..............
Maximum Building Dimension,L
I Nominal Height of Tallest Opening2..................................... _<
} 6
Sheathing Type................................ .......— (note 4)................................................
Edge Nap Spacing.................... ........:_.........(Table 11 or note 4 if less)................. in. _
Field Nail Spacing ......
pa g.........................................(Table 11).:........................:.........._..:........ in. _
Shear Connection(no,of 16d common nails)(Table 11)........................................................ _
Percent Full-Height Sheathing.......................(Table 11)....................................................
5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).....................
Wall Cladding
Rated for Wind Speed?............._. .............................................
...........
5.1 ROOFS
framing
Roof
- g member spans checked?...................... (For Rafters.use AWC Span Tool,see BBRS Website) _
Roof Overhang ...................................................(Figure 19).............. ft 5 smaller of 2'or L/3
Truss or Rafter Connections at Loadbearing Walls —
i Proprietary Connectors
Uplift...............................................(Table 12)...........................................U= plf _
Lateral............................................(Table 12).............................................L= pif
Shear...........................................I (Table 12).............:..............................
S= plf _
Ridge Strap Connections,if collar ties not used per page 21.....(Table 13)..............................T= p!f _
Gable.Rake Outlooker.........................................(Figure 20).............._ft s smaller of 2'ortJ2
Truss or Rafter Connections at Non-Loadbearing Walls -
Proprietary Connectors
Uplift_..............................................(Table 14)...................................
.. ..._.U= lb.
Lateral(no.of 16d common nails)...(Table 14)...............................".-..:..L= lb. _
Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59).................. _
Roof Sheathing Thickness........................................................................................._in.a 7/16"WSP
Roof Sheathing Fastening .........................................(Table 2)........ .........
_... ....
Notes: _ —
1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to 11 comply with the requirements of
780 CMR 53012.1.1 Item 1.If the checklist Is met in its entirety then the fopowing metal straps and hold downs are not
required per the WFCM 110 mph Guide:
a. Steel Straps per Figure 5
b. .:20 Gage Straps per Figure 11
c. i Uplift Straps per Figure 14
d. i All Straps per Figure 17
e. `Comer Stud Hold Downs per Figure 18a.
2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing
requirements shown in Tables 10 and 11.
3. The bottom sill plate in exterior wails shall be a minimum 2.in.nominal thickness.pressure treated#2-grade.
- --�
-WC Guide to Wood Corrstructioa in J� fr U uzdAreas_110 atph jP=dZorze '
• Massa chuset CheeI st foi C4mpH mce[no c&,:R i3ni 1:1)I
4. - _ -
m From Tables 113 and 11 and lmz tt of wall sheaffsing and Building Aspectltaflo,determine pelt FU&Height
Sheathimg and hlat�SFacku r'equi enteni's - -
b. Wood Structural Panels shall be n**=fhit9ahess of 711 r and be instabd as fallow,— . .
L Panels shalt be installed Wt ShMnA ass parial is studs-
L Ad hotel joatb shad D=r over and be nailed io fianing '
irL on single scary i mnstrucfion,panels shad be attached is bofinm pi iss and .tnattber of the double
oz�UPPW-Pan0IsshalLbea�fached toAhi top member.affhe - .
pb.m and to band joist at boibm of paneL U a�r�riF rouble tap - ----ppFr of Iower pane!shad be made fn band jot5t .
and lower aftachment made to lowest plate at ftrst fi6orframing.
v. Hcdmrtfal hall spacing of dptble top plates,band joisfs,and girdem shalt•be a dOL61a row of Bd -
staggered at 3 inches on center per figures below:Ve*2c and Hcdmrtg NmTtng for Parse!Afiachment
$. Gfaang profezSort a}stew house orhorimtzfaladdrfion—required fprnjecflI i rtvle orria�rto short:(9enerall]'t south of
Rte.23 or north of l?tE-.B)
b)verficai adCMDn—nDt requYied unless there ls e x ensive r>=tlmrds n in the fast floor
c)replace nentiMdous—needs energy mnswtraiion rampWc!only(chap 93)
S.Wood Frame Consftuction Manual(WFCN� for 110 MPH,Exposure B maybe obfauhedfiam the Ametimh Wood Count:
(A NC)viabste. LK
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See Date tan Next Paga - -
•V iergral and HDih { NwTng ll et itrral Bnd Hoorn r�I Nar
far Panel Attachment fnF t'azhel Afischtrtt -
• Town of Barnstable
Regulatory.Services
dE Richard V.Scab, Director-
�; =Building Division
PSAM` Paul Roma,Building Commissioner
6ssL �� 200 Main Street, Hyannis,MA 02601 =
www.town.barnstable.ma.as
Office: 508-862-4038 - Fax; 5.08-790-6230
r
HOMEOWNER410ENSE
E MenON
DATE.
Pf a Print
JOB LOCATION:
number village
"HOMEOWNER". '
name home phone# wo phone#
CURRENT MAILINGADDRESS
city/town state zip code
.The current exemption for"homeowners"was extended to' clude owner-o cupied dwellinizs of six units or less and
to allow homeowners to engage an individual for hire who d es not possess a " ense,provided that the owner acts
as supervisor. , w
DEFINITION OF H MEOWNER
Person(s)who owns a parcel of land on which he/she resides r intends eside,on which there is,or is intended to
be,a one of two-family dwelling,attached or detached stru es acces ry to such use and/or faun structures.•A
person who constructs more than one home in a two-year peri d of be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form le to the Building Official,that he/she shall be
re onsible for all such work performed under the buildin (Section 109.1.1)° k
The undersigned"homeowner"assumes responsibility for:co liance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she d s the Town of Barnstable Building Department.
minimum inspection procedures and requirements and heh he will comply,with said procedures and"
requirements. h
Signature of Homeowner
t.
Approval of Building Official,
Note: Three-family.dwellings con g 35,000 cub' feet or larger will be required to comply,with the a
State Building Code Section 127.0 Constru ' - Control.
OMEOWNER'S EX EMPnON
The Code states that;,"Any,hoxqeowner performir g work for which a building permit is required .:
shall be exempt from.the-provisions of section(Section 09.1.1-Licensing of construction Supervisors);
provided that if the homeowner engag a person(s)for hir to do such work,that such Homeowner shall act .
as supervisor."
jd
Many homeowis exemption are un ware that they are assuming the responsibilities of
a supervisor(see Appen Regulations for Lic nsing Construction Supervisors,Section 2.15)
This lack of awareness serious problems,jae
cularly when the homeowner hires unlicensed
persons. In this case,out proceed against ficensed person as it would with a licensed.
Supervisor. The homeoSupervisor is ulti responsible.
To ensure that the homeowner is fully aware of r responsibilities,many communities require,
as part of the permit application,that the homeowner cehat he/she understands the responsibilities of a
Supervisor. On the last page of this issue is a form curresed by several towns. You may care to amend
and adopt such a form/certification for use in your comm .
Town of Barnstable
Regulatory Services
PIAM Richard V.SmIi,Director
* Building Division
Paul Roma,Building Commissioner_
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.ns ,
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must'.=
Complete and Sign This Section
',If Using A Builder
I ,as Owner of the subject property,
t L,1 ram►WOO,!� c
hereby authorize Oar Gr�,►� 1�,v,1c�t"c. � F�etn Ae-k+ e. to act on my behalf-
in all matters relative to work authorized by this building peunit application for.
PA
(Address of Job) .
**Fool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signaxure of Ovwnet. Signature of Applicant
Print Name Print Name
Date
WORMS:OWNE"ERMISSIONPOOLS y
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-101989
Construction Supervisor s
'JAMES S ELLINWOOD kF
68 FRAZER WAY
MARSTONS MILLS MA 0260
Ff f.r r
u:. .r...�,4..... :Expiration..
Commissioner 01M3PT0i9-
Construction Supervisor
Restricted to:
Unrestricted-'Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of
enclosed space,
ti
v
f
Failure to possess a current edition of the Massachusetts '
State Building Code is cause for revocation of this license, r
DIPS Licensing information visit:WWW.MASS.GOVlDIPS
'��Lia;�a�rtnzantaeal��Cilr✓ii�:;ctc�iu�el,�a _
Office of Consumer Affairs&Business Regulation License or registration valid'for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
egistration: ,At3725 Type: Office of Consumer Affairs and Business Regulation
xpiration:,>711`77 _iZ; DBA 10 Park Plaza-Suite 5170
17, Boston,MA 02116
NORTHGROUP BUI AN # MODELING
i
JAMES ELLINWOOQ�rs t
68 FRAZIER WAY'
MARSTONS MILLS,MA 02�4$ --._
Undersecretary Not valid without signature
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` Town of Barnstable *Permit#2�1
vs q�' '1'� Expires 6 months from issue date
�T Regulatory Services Fee
w snttxsrasts
A rsnss. Richard V.Scali,DirectorsP#1ESS:#6fWj
I .
tED MA't ,
Tom Perry,CBO,Building Commissioner - NOV O 6 2015
200 Main Street,Hyannis',MA 02601 TaWN OF BARNS gRNSTA6LF
Office: 508-862-4038 Fax: 508-BU-6230
EXPRESS PERMIT APPLICATION -, RESIDENTIAL ONLY
z3Z _ 0 Not Valid without Red X-Press Imprint
Map/parcel Number `` \
Property Address (p 6 On k\ t.t
Residential Value of Work$ 1 K 0 0 0. Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address l.Pt V\Q e\/1
Wo \Ao\\ 'Po\^A - T-4;1- Creel `\-e mn
Contractor's Name_3CV,..%>✓S S �tr, l.' Wao Telephone Numberf 3(7`7 �(o5S
r i
ODD KVorAv ,rev�p I3V%\d,tr. l Qw.o �Itr+S.
Home Improvement�ontracfor License#(if aAlicable) 1 (n 3 AS'T 5 Email:S c S �..1A-1!.�wc:P4 L u y✓n CG.s�. ✓���
Construction Supervisor's License#(if applicable) C-s O
❑Workman's Compensation Insurance l
Check one:
%J�H am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# '
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑ Re-roof(hurricane nailed)(not\stripping. Going over existing layers of roof)'
Re-side Q
e
- 1
Replacement Windows/doors/sliders.U Value 1 maximum.32 #of windows �O
P ( )
#of doors: _
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical& Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,'Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission. ,
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
f F '
SIGNATURE:
Q:\WPFILES\FO S\b ilding permit formS\EXPRESS.doc
Revised 040215
i
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?lie Comrr:'a1r•ivealth of-Wrrssrrclrruetts
Depclrhrrent ofIndushial Acciderds
- O,ffw.e ofIrrve-stigatrons
600 Washington Street '
_.- vston,_�A 0211T-
fry sn;,,. assgvv1din
Workers' Compensatian Insurance Affidavit Bu ilders/Contractrrrs/EIectdcianslPlumbers
Applicant Information Please Print L .Z'tb '
Naive(Bos®esst�Drgan�ationfFnchvidnai J o�vy��5 S �1 �r►wpy aL, �Lti•-v�o d r�•-,a�
Address:_ (o$ 'F'ra�s Q--/
City/Stabef g Phone. Sod. 3�—t S5(C.
Are you an emplo}er 7 Cheek the appropriate box: Type of project(required):
I.❑ I am a employer with. 4. ❑I am a general contractor and I 6. ❑New construction
employees(fall an&or part-time}.* have)tired the sub-contractors
2:JQ-Lam a sole proprietor or partner- ]fisted on the attached sheet 7. Remodeling
Ship and have no employees " These sub-contractors have $_ ❑Demolitionwod ng for me is any capacity employees and havre workers'
[No wormers' comp.insurance cep-msurance.1 9. ❑Building addition
required-] 5. ❑ We are a corporation and its 10❑Electrical repairs or additions'
officers have•exercised their
3.❑ I am.a homeowner doing all work 11_❑Plumbing repairs or additions
myself-[No workers'camp- right of exemption per MGL 12-❑Roofrepairs
insurance required]l• c.152, §1(4h andw6 have no
employees.[No woilmrs' 13.❑'Other
comp.insurance required.]
*Any WBcaatthat checks box#1 must also fill outthe sectionbelaw shoving their workers'compensatiouponcy informaaoo-
I Somem uners Who submit dais af5dasqt M fc=ng they are doing s11 work sad they hire outside contractors mast submit a new affidavit indicating such-
fCcmr&ctms that check this boa must attached as additional sheet showing the nmeof the sub-conductors and state Whether or nottbase eetitiesawe
employees. If the sub-contractors have employees,they must pmide their workers'comp.policy number.
lam an ealpinyer titat is protadbW rvorkers'cougmisadvii iimirance f or my employ,ees Betory is thepvticy arrd jab site
information.
Insurance Company Nance:
Policy 441-or Self-ins.Lic-:9 Expiration Date:
Job Site Address:_60 kNn�%Sj cityistaw2{ p:.0 ph &. V ae. A&tA
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 nriminai penalties of a
fine up to$1,50D OD and for one-year imprisonmenk as well as chit penalties in the form of a STOP WORK ORDERand a fine '
of up to MO-DO a day against the-violator. Be adidsed that a copy of this statement may be bxwarded to the Office of.
Investigations.ofthe DIA.for insurance coverage verification.
I do here-byfevii. ander the pains and penatfies ofper fury that the infonnafionpm i&d abm a is tare and correct
$i t hate: Z 0 t
Phone
Official use only: Do not mrite in f fix area,to be coinpWod by dV ortorrn official "
City or Town: Permitf kense
Issuing Authority circle one
1.Board of$•ealth 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and fnstruefions
Massachusetts General Laws chapter 152 requires all employms'to provide warmers'compensation for their employees.
Pursaani-to this stye,an.enplayee is defined as-"—every person in the service of another under RELY contract of hie,
express or implied,oral or wriitrn.."
An 2nploy�is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the for en egoing gaged in a Joint enfrrprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employ(--es. 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 Iicen�se or permit to operate a business or>o construct buildings na the commonwealth for ray
applicant who has not produced acceptable evidence of cumplian.ce with the insurance.coverage required-"
Additionally,MCrL chapter 152, §25CM states"Neither the commonwealth nor any of its political subdivisions shall
enter in,'n any contract for the perlozmance ofpublic work unfi7 acceptable tviden=of compliance with the in uranc6-
req TTP_.TTTents of this chapter have been presented to the contracting avihoiity-" t
Applicants
Please fill out the wodcers'compensation affidavit completely,by Cher' the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(m)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 requited to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is regoir' 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 retuned to the city or town that the application fir the permit or license is being requested,not the Department of
n 1st al Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers'
compensation policy,please call the Department at the number lisind below. Self-insured companies should enter their
self-insurance license number on fhe appropriate line.
City or Town Officials .
Please be sm a that the affidavit is complete and pried 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 sine to fill in the peffi%tJlicense ntanber which will be used as a reference number- In.addition, an applicant
that must submit multiple petmitllicense applications in any given year,need only submit one affidavit indicating current
p olicv im�rmat on Cif 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 '
'd affidavit is on file for firture ermits or licenses_ A new affidavit must be EUe;d out each
applicant as 'rooft3iaf a valid vrt p
aPP P -
year.Where a home'owner or citizen is obtaining a license or permit not related to any business or commercial venture
(ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your.cooperation and should you have any questions,
please do not hesitate to give us a call.
The Departruenf s address,telephone and fax niunber:
j�C_G.nMjonWesjtbL of Massachusd-_t[s
Dtparmmt C&I I us rial Accident%
off!=of 1.
vesfintia=
604"washiVGI t
Boston.,MA G2111
T(,-L 4 617 727-4900 ext 4€6 or i-9 - SAFF
Fax#617-727 7M
Revised 4-24-07 mi ��
iK
of Bait` k
Town� r�tsta�ile�
M {.
Regulatoky Services w
,Richard V.ScA Interim Director
tom' Bui ldiag DivisionS.
°
Tom Perry,Building Commissioner r
200 M�ainpStree}ey�LAe�y�az,�my�is7,MA,022601
Iemaus
Office: 508-8624038
Fax:. 509-79"i30
rop
e Owner Must
Complete.and Sign This Section i E
j
•
o.
If Usixl_&A Builder j
,,.as Owner•of the sublectproper-ty,
3? [5��` J�?�r�-�,.;'�„�,..da X�.�,�d.n.,., t" i�,��vr��g� ;:�5 ,• ' ,
hereby authorizecx _ r k
� t a act on mY b ehalfy'
in aU.ma.ttets relative torwotk authorized by thys building permit
"� f AddLeSS Qf Job
+ * ;. -..
Pool fences and alarms are.the respojtisibility.of thr—applicant. Pools' -
,
are not;to be filledNor.ut zed before fence is ifistalled and all final ,
inspections.are peitfonned and accepted..
nA
} • , ' Signature of Cr tore of Applicant
/Z_ ',J
Paint Name Print Name
Date
i
� - r
Massachusetts -Department of Public Safety*
Board of Building Regulations and 5ta;;oa ds
Construction 5upen isor Unrestricted-Buildings of any use group which
License: CS-101989 ,,� cones less thai►35,000 cubic fed(991M )Of
enclosed space
JAMS S ELLINV�bO
a FRAMR WAY
MARSTONS MIEIS 't> J. �
� ,�► FxpiratPon Failure to possess a current edition of the Massachusetts' '
Commissioner - 0111#017 � State Building Code is cause foe.revocation of.this license. -
+• A ^"+. For Dk ute/nsing information visit: www.Mass.Gov/DPS
r .l 3. '
C/fzea>iancor�caeall/t O�C�t1a0rQC�i[ISCfid s �' a �' ..
Office of Consumer Affairs&Business Regulation •License or registration valid for individul use only.
to-
o'
IMPROVEMENT CONTRACTOR "`. * before the expiration date. If found return to: �
geistration:g ;�63725 ,Type:,*,, " Office of Consumer Affairs and Business Regulation
xpiration 71 CT1k-17 DBA 10 Park Plaza-Suite 5170 4' - , •.4 '
f ,, Boston,MA 02116
f
NORTHGROUP BUIL li A�hlli?REMODELING "',f fi" '_
JAMES ELLINWOOD� _ x +
68 FRAZIER WAY'
MARSTONS MILLS,MA 0284$ Undersecretary Not valid without signature y
Y
a i t 4 y P '�, �S °r,� b'. - - err .+.,�•" l� + r -
4, r
w 511( dK
I'--
Town of-Barnstable *Permit#aDUoQ--�D
Fapires 6 months from issue date
Regulatory Services Feed
BARNBTM
KAM Thomas F.Geiler,039. X�PRESS PERMIT
Building Division .
Tom Perry,CBO, Building Commissioner , L l
200 Main Street;Hyannis,MA 02601
www.town.barnstable.ma.us . -� (�� �PRNSTAE�E.
Office: 508-862-4038 `Fax:508-790-6230
EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY
FF tt t ' Not Valid without Red X-Press Imprint
Map/parcel Number oZ
Property Address W, %rAt,1W Rig-)— RC)
ww esb
$tResidential Value of Work�`'i0�d Minimum fee of$35.00 for work under$6000.00 '
Owner's Name&Address es-Q.►p,
1
Contractor's Name 1 lh�A M 6 C-�17c-rU s w Telephone Number' s�1 ' 52A b
Home Improvement Contractor License#(if applicable) H- 1 29 / 7'-a
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance "
Check one: -
I am a sole proprietor
I am 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)
Fj 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
#of doors
Replacement Windows/doors/sliders.U-Value .2 5 (maximum.35)#of windows Is
!Where required: Issuance of this p8imii does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: P pe, Owner must sign Property Owner Letter of Permission..
A c y of the Home Impr a Pt Contractors License&Construction Supervisors License is
uired.
SIGNATURE:
CAUsers\decollik\AppData\Local icrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\E)CPRESS.do6
Revised 072110
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): j 140 A Y
Address: !hJ 1QE, ( ls�
City/State/Zip: p Phone #: C) t)24110
Are you an employer?lCheck the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.( 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
workingfor me in an capacity. employees and have workers'
y p n'- # 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.]f c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other VJ,wJD Ow r7
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.
$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.
z:
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 tA DIA for insurance coverage verification.
I do hereby ce i nder e p ins a d p a ie of perjury that the information provided above is trueand correct
Si mature: Date:
Phone#: 2A 6
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#:
x:
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f
236
oF�
= RARNMOLE,
1`1 Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
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
Property Owner Must
Complete and Sign This Section
If Using A Builder,
t�
I I �1 r 4.- doc—eras Owner of.the subject property
hereby authorize 'VVV V i to,Act on my behalf,
in all matters relative t6 work authorized by this building permit application for:
C.1/'� �.-� �Q�'1� ( VYd �E1`�1C 2Vt v�.� (/441. �'<M
'Y (Address of Job)
� It
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc
Revised 072110
1
Licedse or registration valid for individul use only
Office of Consumer Affairs&Business Regulation, before the expiration date. If.found return to:
HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
Registration � 12999& 10 Park Plaza-Suite 5170
Expiratig 9/2011 Tri. 291511 Boston,MA 02116.
-
Type` E: �; lndi��dual=
TIMOTHY A.MACDOttALQ
S
TIMOTHY MACDONALD- r"
tf � n
36 BONNEY.BRIAR
PLYMOUTH,MA 02360'.: : Undersecretary Yvilig without signature
y ivI tssachusetts Department of Public Safet.
Board of Building.Repiations and.Standards
• Construction Supervisor License
License: Cs 29853 .
Restricted to: 00
#
TIMOTHY A MACDONALD "
36 60NNEY'BRIAR'DR .o
PLYMOUTH,MA 02360
r _
Expiration:, 1D22/2011
(bmmi-sinner
Tr#: ;13192
Asse sor's map and lot number ....�'/.�`3 a... ..!{.. �
6'.:gd -7! � w/r e- IILGfiLG�c/
�GGGfyy/�
Sewage Permit num er ..........�!0....................
yOFTNErO�y TOWN OF BARNSTABLE
i i MMSTOHLE, 0�
"b 9 E Y BUILDING INSPECTOR
�FPY p'
APPLICATION FOR PERMIT TO ...
TYPE OF CONSTRUCTION ............................. .................... ..............................................
19�`..............
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applie rya per it c ing o th Ilowi inform i n:
.. . . .. . .. ..... .. . �. '. ..� . �... . .�....................
Location ..... ..� � .. y... . � ���� ........
I ,
ProposedUse ... ...... . . . . ........ ......... ..... ... .............................................................................................................
// ..Fire District ...............
Zoning District ..�.�I....�...d.. .. ... -+C.%�.���....... ..... ... .......................................
Name of Owner r .................Addres . : ..
.... . . .. ............ . . .... . . .......... ...
Name of Builder/!? � .. ... . . ..... .........Address ��Z .. . .. ... � .. ...
Name of Architect r+ ........ .... ................................................`
..............................................tf.. . ..............Address .............. ....
Number of Rooms' ... ........... .......... ................................Foundation .. .. .......................................
r
Exierior ...................Roofing ..... . . ..... ........................... .....................................
Floors ........ .. ... . ....+.. .......... .....Interior .......... .......................................
n
Heating ......... .0 '. .. ...........................................Plumbing .......... .. ...............................................
Fireplace .......... .....................................Approximate Cost ......... .....................'... ...................
.
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area .....( �(!..: .. .. .... ....c.
Diagram of Lot and Building with Dimensions Fee ............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. .... ..... .. ..........
-----~--------------------. . '
Weiss, Ronald M.
17770 add to single
family dwelling
Holly Point,Rfead-'
Centerville
Ronald M. Weiss
frame
^ .
#65
plot --------`- Lot ----------'
� -
�
-
' June 20 75
Permit Granted ........................................lg . /
/ -
Dotoof |nxpectioh -.. ----.lg ~ '
Dote Complete ��y..xw7..��..................l9- '
i
,
^
PERMIT REFUSED
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...............................................................................
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Approved ................................................ 19
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7,11
Assessor's map' and lot number ......... .......v............
c, i
iNSTALLED IN COMPLIANCE
Sewia. e. Permit ,number ..:.... . WITH ARTICLE It, STATE.
g ........:.............. ............ :...
rl r. SANITARY CODE AND TOM
a ULA
�QyoFTxEro��oz 'TOWN OF BARN� T 'LE
tj
0 17
c t
BAHH§TABLE,
0M BUI.LDING INSPECTOR
9�p 1639•
�O MPY o'' y J r� f f�.
zt
`r APPLICATION FOR PERMIT TO. ... .fib. ...................................UU
TYPE OF .CONSTRUCTION �� .P.... LZ.1AW► .........................................................
......!`�............19.3
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... . .........0 .......... .0..{,L t,/ �JOd�? G1....•d./ ?. ...... .: r /'LV/E-I:F-r................
ProposedUse .... �'S�.Q.�s�!�r.At......................................................................................................................................
/� :
Zoning District .. ...........................................................Fire District 614, 7��..��'•Ldnn1 '® .,l... R V/4-.L:L.
Name of Owner +!e. ...... ��6!........................Addressk14QS�...'X�w'4u�2!.�,iGtJir •• 5�•1f/�$-S
Name of Builder ........
'`� ............... .............................Address M10�./.A�l.�a.... .�..°�.... V4e............................
Name of Architect ... ................................Address ............
Number of Rooms ............4. ..................................................Foundation .. ! .................................................
....
Exterior ........................................................... Roofing ..................................................................
FloorsCiQ� '� Interio ji -m
... (,�,QLL � -/......... . ................... . . .... ......... ................. .. .....................
/, ,l
HeatingY<f�/4r! .�,�m....ka'
..........................................Plumbing .... ....C A ft15.................................................
Fireplace ..... ./. e .................................................................Approximate Cost ... !!U C� d
Definitive Plan Approved by Planning Board ---------------_---------------19________. Area ........�5 ..5-
: ...
Diagram of Lot and .Building with Dimensions Fee 3.5
.�..�—............. .... .Jr........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I /
64,
�7
j - .
so
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
NameL ......... I..... ... .........................
�
' Keddy" Donald
. f
'
� No —l2l70— Permit for ......RAPA..§tA;Xu........ | ''
� ---''�lugle'Jamily..8��� ------
. �
Location --.. —;�—_----.
'
/ . /
-------.~~~^~~r~il~e----------..
. '
� .
Owner ............Donald ...........................
� ----~.
` ! '
� Type of Construction ........frame......... ............. | '
' ---- . . ~
��. ----.---------------- -
\ , -
' \
> Plot --------'.. Lot ---..�65----' '
� '
/ ...........
Permit —Granted . '
' --. �m�m--�4 lA---- 74
/ Dote of ^ . ^
. ='
Dote Como��a6 -------------l� - ~
� . . .
/
< '
) PERMIT REFUSED
. --
' -----`----.---.�.--.----. 19 `
( '
�m ,� ----:�.------...----------.. - ^
^ '
. '
er- ^+=~~�.:- .—.--....-------..—.—.--.
.............! �E—_----,---.....—._—.—.
�
� ��
`
............................................... 19
� ^�--.------------.~....—.--..---
- ,
------------------------'—^'
�����
Assessor's map and lot number ...... /2
Sewage Permit number ....... ........... ...............................
TOWN OF BARNSTABLE
ii
i. iARNSTAILE, :0
MABEL
39. BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .....................
YYPEOF CONSTRUCTION ...........��.P..: . ..............................................................................
...........193.E
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .........14Y. 0 .......... l.n,. ,.er .E.k....i(./A-..I..-Z,..................
ProposedUse ..... ............................................................................... .........................................
Zoning District Raj............................................................Fire DistricA N P,-P V I L-,(-.
.........................
Name of Ownej A��D-....<
A-.nv!n1 ......................Address COX A
Name of Builder -TW—s
...................Address ....................................
Name of Architect ... .....................Address'
....................Address'....... .10�...........................................................
Numberof Rooms ...........(ti...................................................Foundation .......................................
Exterior ........
.............................................................Roofing ................................................
l-iy�........ ...........i.... ....................
Floors ............. ................................I nteriof
Heating,.1 P,m....At i��I...........................................Plumbing ............................................................
,iAA' 77W-;r
Fireplace ..... .........................................Approximate Cost ... ...........................T.,
Definitive Plan Approved by Planning Board --------------------------------19-------- - Area ........
o.S-
5
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
SO
A
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
...............................Name J
'
Keddv Donald
'
'
No ...1.7l.7.0— Permit for ......qn!@�.A�5?Ny---.
''^^~~m~~''^ .. °
CCU
Location --
.....................'�enter~ille..............................''
{]vvnor .......... ---------' '
1
1
Type of Construction ............f.r.aue..................
--------------------------'
/
Plot ............................ Lot ---'�65..............
-
Permit Granted ............Jooe...24............. q 74 ^ _
�
Date of Inspection ------------lP '
� .
Date Completed ...................................... �
�
PERMIT REFUSED
-----_--------------.. 19 �
`
'--------------------------
^--~~------^-------------'--'
� -----.-----.—..-----.—.—.----.
----^-----^----^^^--^—^~^—'—^—
- - .
Approved
-
................................................ lV
'
---------------'—^^----^----
,
-----------'------------~—^'
�
-
Sewage Permit number ..........................................................
| T E ������7�J ���� �� � �� �T�� �? � �� �� �7 /
| TOWN�� |� ��]� BARNS TABLE
BUILDING
N �� �� ���������� ��
� IMUSTAMLL
��NN N N-N� N ���� INSPECTOR
���= �.Nm N 0N ��
�� �� � ���� � �� �� � �� �� � ���� � �� ��
'
' �� '
APPLICATION FOR PERMIT TO ----------------..r..:.._--------------------
' ,TYPE OF CONSTRUCTION --------''^'-----------'----------------------''
|
�
|
� ................................................lg........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for o permit according to the following information:' �
Location ----------------__—.________.________.____.,_,_____,._.___,,__.__.__.
, Proposed Use -------------.______.,_,__.^_________________.,__,_,._'________.
—Zoning Di Roe District District —.--.—.—.--._---..~-------.. o --------..—.---------------.
Nomeof Owner -----------------------.A66reu ---.—_--.-----..--..--~.~_.--_,—
Nome of Builder ----------.-----------'Address ........................................
Nome of Architect ----------------------A6dn*ss ----------------------______
-,
Nunn6e, of Rooms ----------------------Foun6otion ---------------.----------.
Exierior --------------------------~—Roofing ----------------------------
F|oon -----------------------.—.---]nterior ....................................................................................
Heating ---------------------------.F1um6ing ---------------------------.
Fireplace ---------------------------.Approximo^e Cost -------------.----,.,__,.,
Definitive Plan Approved by Planning Board lV----' Area ..........................................
Diagram of Lot and Building with Dimensions Fee _______________
SUBJECT TO APPROVAL Of BOARD OF HEALTH wJ�
f I /F------------
. ,
� .
|
| ,
�
'
�
| hereby agree to conform to all the Rubs and Regulations of the Town of Barnstable regarding the above
construction.
| moma ............,.-.-~..--....__,,________,
Weiss, Ronald M. A=232-44
�
family .
..................�
�-�& - - ==� `
Loco ����X r9�ot :�= ,
�.-----------� .
�
Centerville
u9oa1¢ ........../.............
xx Wai
�
�
�
.......................................................L
Plot ............................ Lot .../..#65
'
° '
Permit Granted
�
Date of Inspection .......w].......................19
uu/e Completed �
"
EIZIT REFUSED
[ lV
� � �� . .
�. ......................... ...................................................
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...................... ---------'—^------'—''
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----- ------~------'---'---' '
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----.-----.—.-----..—...—~--.—.—
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Approved ,�*�����^ ........... 19
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---------------~--------.-- �
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