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Map/parcel Number o?30 00 2.. Property Address c� 44) �/� �.� a-l-r 7 (Residential Value of Work$ ;�� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �#�A)I) G-kv 0-0 XP11 o z o �® 9 Contractor's Name �U l! Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 0700-7 7 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor , ❑ I am the Homeowner . I have Worker's Compensation Insurance. coInsurance Company Name ' �� 5��� ®�. . W orkman's Comp.Policy# W 0.41 /0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. .Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value C 30 (maximum.35)#of windoC #,of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Lsmance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er sign Property Owner.Letter of Permission. A copy of H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: T:\KEVIN MBuilding Changes\02 S5 AftleMRESS.doc Revised 061313 Robert Higgins 508-888-4442 PA E'OME rV1PROVEUE7,JT CO _— t'LLASE NTRACT Branch Nattae:BosorMs n„ grant:tt North&South Dater�j�/ Nttarber:31 and 33 Sold,Furnished and In THD Ar-Horne Sery cc d/Wa The Home Depot At-Horne S S.Incc a 908$uston Turnpike,Unit 1, Shrewsbury ltgq 01545 Federal ID#75-2698460; Toll Free 877-903 3768 Lt9tailation Address; f HIC,056S522; <qA Ho Lie#C(Q439:RI ConL Lie#16427 -376S toe hnProvemant yr{pnetm.Reg.#1 SS93 �rcbaver(s): City St e D B ork Pborte: p f Home Phone: Cell Phone: Iiorne Address: [ 1, (If different from Installation Address) "-mail Address(to receive City Q I DO NOT wish to Protect communications and Home Depot updates): State receive any marketing emails from x'tr and THD for—gin: Undersi The Home Depot At-Home ("Customer"),the owners of the property all Materials described ces'Inc.("rbe Home Depot')agrees to furi located at the a reference,alntr the below and on the referenced deliver and gbove installation address,gees to buy, g with arty aPPliCable State Su r>rttced Spec Shect(s), all of which are 3 cot o Jbr ral installation lmstgeesan")of "Contract'): pplement and Pa meat Stunmar P ed into this'Contract by this Y attached hereto and any Change Orders(collectively, Job#: nnn.nnra�� Products: R10i31 LSiding irtdows lnsalation 3 '"$beet s)#: �1 7 ❑Gutters 1 Covets C1Entry Dnorc +" �t� P'Yr t Amouat Roofing Siding L Windows[ I 79 s lnsnlatioq ❑Guttem/covers ❑Bury Doors ❑ Roofing Sidia� -"'- $ d Windows lnsul:gion i]Gutters 1 Covers ❑Fr try Dotn❑ R001in $ 8 Siding Windows Insulation ❑Gullet/Cnverx ❑Booty Doors ❑ ZCHlimutu 25%Deposh of CMURL, ]tavee Pat> rosy not de Amount dm upon exemdon of this eoetr ita- pasitmoretltmtflne,[Lird of theCotihadAmm�L Pota!Contract Alttount 5 Customer ages that,immediately upon completion of dtc,,vork for each Product-Customer will execute a Completion t'ertifieatc lone for each Product as defined by an individual Spec Sheet)and pay any baliutce due. As applicable.each Customer under this C011=agrees to be jointly and severally obligated and liable hereunder. The liome t)epot reserves the rigbt to issue a Chance Order or terminate.this Contract or any Individual Pniduct(s)included herein,at provider determi its discretion,if The Home Depot or its authorized servit a determines,that it cannot pertorrn its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or Iead paint,Other safety concerns,pricing errors or because work required to complete the job was not included in the onttram Payment Summary: The Pa)7nent Summary# "/ / included as parr of this Contract, sets li>rth the coral Contract amount and payrnents required for the deposits and final puyinettts by Product(as applicable). NOTICE TO CUSTOMER Von are entitled to a completely tilled-in copy of the Contract at the time you sign. Do not Rign a Completion Certificate(note: There is one Completion Certirrcale for each listed Product as deCuted by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Horne Depot the costs of materials,labor,expenses and sen"ices provided b}•The Home Depot or Authorized Service Provider through the date of termination,plus any other" amounts set forth in this Agreement or allowed under applicable law. TI1E 140NIE DEPOT MAY WITHHOLD AMOUNTS OIVM TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYAlFNIS 14t4DE, IVITHOUT LISQTFYC,THE HONIE DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acce lance and Authorization: Customer agrees and understands that this Agreement is the entire agreemenr between Customer. and The one Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral cx written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read.understands,voluntarily accepts the term,of and has received a copy of this Agreement. Aece by: Sots tt I use er s 5ignaturr Date - S es Consultant's ig ature , r D k .t Teleph(ue Customer's Signature Datc Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS taeapplicrble) AGREEMENT WITHOUT PENALTY OR OBLIGATION ' BY DELIVERING WRITTEN NOTICE TO THE HOME _ DEPOT BY I131D1\IGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SMLEMENT ATTACHE HERETO CONTAINS A FORM TO USE IF ONE IS SPEcu,ICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:AtintTIOKAL TERMS AtVD C0NJ)lTr0YS AXE STATED ON THE KF VER$E SIDE AND ARE PART OFTHIS CONTRACT ij_pgtg White-Branch File Yetow-Customer P IP May 11, 2013 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres — CSSL # 100546 HIC # 163528 Michael Viola — CSSL #•099403 HIC # 140993 Vincent Smith - CS # 106837 HIC #'165927 Timothy Thomas -- CS # 51899 HIC # 152121 Ronaldo Solano — CSSL# 101027 HIC # 152206 Joseph Duarte - CS # 70077 HIC # 132349 Douglas Szynal CSSL # 103950- HIC # 146142 d Brian Laroche - CSSL # 100478 HIC # 152612 Joseph McKeon — CSSL# 98863 : HIC # 132614 If you have any.questions please contact Mike Bedard our permit coordinator at 508-962-6942 or myself at 617-438-9017. S' erel uss one Bra Installation Manager THD At-Home Services, Inc. 908 Boston Turnpike- Unit 1 •Shrewsbury, MA 01545 Phone:774-275-2139•Fax:508-845-6076•Toll Free:800-657-5182 The Commonwealth of Massachusetts ti Department of Industrial Accidents Office of Investigations 4 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciatis/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): J �'CTF/110 rA�//�Xo Address:_ /S City/State/Zip: ! �60fr�ti d `�� Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4.`❑ I am a general contractor and I —* have hired the sub-contractors 6. ❑New construction 2 employees(full and/or part-time),I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees-and have workers' Y9. ❑ Building addition [No workers comp. insurance comp. insurarice.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp..insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation.policy.information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . $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 einplbyees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.-#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead.to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nder the a' sand en . ies of erjury that the information provided abo a is true and correct S re:.. Date: Phone#: W`�3 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#: • f G J esvness a on *c`e0ffo�"=cr/"a4n 10 Park P1m - Saute 5170 Boston, lV4mhusetts 02116 146me I prove' a. ontra+ctor Region itq The Home Depot.At-Home S® '1:�p� ' :! ►� ANDREW SWEET 2090 CUMBERLAND PARKwAY)WrM,00 ATLANTA, GA 30339 update Addrm nd rtnrn card.Mark rams f edam ❑ Ad&m ❑ Ron"' ❑ RwO"Gmt ❑ 11w crrd oPsaa, o aoov+�aso��ns or do*, star � QmaCe sicanamr Affitrt aad BN/IOOM Regalat♦eB Tom 10 ftA rhm•3laMs 5170 Smvbmod ftd 8orton4 MA 0116 ANDREW GA vadereeerearr Department of Industrial Accidents Office of Investigations ' 600 Washington Street 9�< Boston,�A-02111 w w"ww naass.gov1diu Workers'...Compensation Insurance Affid I avit: g.uilders/Contraetors/Eiectri€ians/Plu ber—q Applicant Information / Please Print Le ibt� Nam e(B usiness/Orga nization/I ndividual):, ;/tC� Address: 5 �A 1717 City/State/Zip: ` _. . . 3e g Phone#: �,��, �► . Are you an employer?Check the appropriate x: Type of project(required): 1. I am a employer with 4...[l1 am a general contractor and.1 6 New construction employees OWLandlor part-time), have hired,the sub-contractors listed on the attached sheet. 7. [�Remodeling ' 2.❑ I am a sole proprietor or paxtner- - 1. ship and have no employees. These sub-contractors have g• ❑DemoLtion workingfor mein an capacity. _ employees and have workers' Y P tY $ 9. ❑Building addition [No workers'comp.insurance comp.insurance. 5. We are a corporation and its 10.❑ Electrical repairs or additions required.]' ❑ 3.❑ I am a'homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions myself,[No.workers'comp. - right of exemption per MGL 12,[] Roof repairs- insurance required,] t c. 152,§1(4),and,we have no employees:[No workers' 13. �Other O L Z comp..insurance required.] 'Any applicant that checks'box#1 must also fill out the section below showing theirworkers'compensation policy i formation. t Homeowners who submit this affidavit indicating they are doing all work and then.hire-outside contractors must submit anew affidavit indicating such. zContractors 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. ry f I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. a Alew. lla.,,hi.p TN5-, Insurance Company Name: co-,; Policy#or Self:ins.Lic.M 1(V 0 l l 0 9 2� Expiration Date: 1 I ✓ o I �N/ Ci p - -���, f Job Site Address: � ty/State/Zi t:� �4�-�� Attach a-copy of the:workers"com ensation policy declaration page(showing the policy number and exptratimn 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$1,5e0.06 and/or octe-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 th lator. Be advised.that a copy of this statement may be forwarded to the Office of Investi ations of the DIA for ce coverage verification. I do hereby certify under t ans and nalties of perjury that the information provided above s tru, and correct. Signature: Date: Phone 401 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5 Plumbing Inspector 6.Other Contact Person: Phone#: _ T v . all St. ma 57- 1- tfi y Duarte ieense ar~-�94str.ation'valicl;for iiidWWu use ! a fore�the ex�irtion da'�e: '�uac�return idY ` ��s�ce��f �:�n�uin���ffa�rs acid�us�ii+ess Reg��atinn a� 3orft TiA V k ,v f ! ,}, 'S'. a* �� F � yam. � ��. • �. �'!,� di i ) ri wi. r� � i11a � t -F3 �. .y , 24 S � � r� 1 rt Oft �� � �3`..: s. � . SIR iiiliiiiillll�l�1;111111 _ f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �?3t) Parcel r�,o-y � —FILE Application# Health Division 9-. , Conservation Division Permit# Tax Collector _ 4�f � --- Date Issued Treasurer Application Fee t 00 Planning Dept. Permit Fee 3J a o Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 591 /°W/Nk1fVs ZWAIE Village eIFALIZXWl ,Z� Owner i7o'SWW i)1_A4/Ji•e0 Address 6-y/ 4#1,i//.c/�(S L4h4_::: Telephone d - 771-61RF i Permit Request &rFA1;,7;2A,1 ran QU ,E,ZSTia/b Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �g'DDo- — Construction Type A )e N Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. / Dwelling Type: Single Family Y" Two Family ❑ Multi-Family(#units) Age of Existing Structure yA3; Historic House: ❑Yes a'1lo On Old King's Highway: ❑Yes eNo Basement Type: ❑Full ❑Crawl &Ilalkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel:. ❑Gas Cl Oil ❑Electric ❑Other Central Air: _ ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No r, Detached garage:❑e�xi ing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached ara e: existing ❑new size Shed:❑existing ❑n i g g g d e s g new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial` ❑Yes -❑'No ` "If yes;site plari Current Use Proposed Use BUILDER INFORMATION 'Name_'__�.SA,(i Dr W2wufu. Telephone Number) 5-V9- 771-6,4? Address ! /rd��w'yay� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ai����� FOR OFFICIAL USE ONLY PERMIT„NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: / FOUNDATION �f�! JA FRAME( 1/t) INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r: GAS: ROUGH FINAL {4 FINAL BUILDING !� a DATE CLOSED OUT ASSOCIATION PLAN NO. 1 he C:ommonweaun of juassaenuseus Department of Industrial Accidents Office of Investigations 600 Washington,Street Boston, MA 02'111 " www.mass gov/dia Workers' Compensation'Insurance Affidavit: Builders/Contractors/Electricians/Pluffibers Applicant Information + Please Print Legibly Name (Business/Organization/Individual): dv Address: !�'Yr PIIILI yj;' 4-A/1;7_ City/State/Zip: - Clhc, &,_lZe , /yam •&�,-Phone#: iZV- 77t.-64'9 Are you au employer? Check the-appropriate box: Type of project(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* , have hired the sub-contractors 2.❑ I am a sole proprietor or'partaer- listed on the attached sheet $ 7. ❑ Remodeling ship and have no employees These sub-contractors have S: ❑-Demolition working forme in any capacity. workers' comp.insurance.• g. � g addition [No workers'!Comp.insurance ' S. ❑ We are a corporation and its required.] officers have exercised their 10.11 Electrical repairs Or additions j I am a homeowner doing ail work right of exemption per MGL 11.13 Plumbing repairs ®x additions myself.[No workers' comp. c. 152,§1(4),and we have no insurance required.] t . employees. [No workers' 12.❑ Roof iepaias comp.insurance required.] 13•❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infornzation' t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such!Contractors that check this box must attacbed an additional sheet showing the name of the sub-contractors and their workers'comp,policy iafoiznatian. I am an employer that is providing workers'compensation insurance for.my employees. Below is the policy and,yob site information. Insurance Company Name: 7z Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' c pensation 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$1,50Q.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 DI A.for insurrance coverage verification. I do hereby cerd4 under the pains andpenalties ofperjury that the information provided above is true and correct, Sature: Date: Phone :a 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 lnspeetor 6. Other Contact Persona: Phone#: r a oFIKE�w,. Town of Barnstable 0 Regulatory Services 9BARNSTABLE,S.MASS. _ Thomas F.Geller,Director 039.M �A�EDMA'��' Building ]Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Penn it 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: YA4C:,'p FoT Estimated Cost X Ve o Address of Work: i 0111.'Al yg 64--W 9 Owner's Name: Date of Application: &—1'7 —O 4 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ,oBuilding not owner-occupied wner 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 hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. OR Z*Aa�� Date Owner's Signature Q mpfiles.forms:homeaffidav Rev: 060606 r Town of Barnstable �DFTHE Tp� Regulatory Services BARNSrABLE, Thomas F.Geiler,Director 9 MASS, g �A 039• Building Division reps s 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: tro '1 1-D 16 /,, JOB LOCATION: Ste/ P<7(W1,1 S CA , �-r✓v yiGL�_ number street village "HOMEOWNER": v.IQs G� f7 r h(,�u 0 A9--?71"61,'9 5-Z'— name home phone# work phone# (CURRENT MAILING ADDRESS: S j-✓bt 1, 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 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 of two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require ents. ,/" 'gn re 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 i i d F / CERTI FI ED PLOT PLAN LOCATION . .�^ TC- ViGG�fSCALE . ..1 a," ° DATE 'TL,Y. PLAN REFERENCE Sao wti CAA / 6.A.:-: -5Zo X`N OF Rlgsf� PG . .?�. . . . . .. .. . . . .. . . . . . . . . . .. .. . EDWA 20GGG1Q0 ® I CERTIFY THAT THE 9 O �1 S77/✓C- C3'tj/G1�t�f Fs� Isil �� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND' l L���� AS SHOWN HEREON AND THAT IT CONFORMS TO THE II SETBACK .REQUIREMENTS OF THE TOWN OF . . . .WHEN CONSTRUCTED. DATE REGISTERED LAND SURVEOR ROOF SHEATHING 1k0 s�a' 1�. The Town of Barnstable RAFTER SIZE Department of Health Safety and 2" X Environmental Services Y Building Division CEILING JOIST SIZE: 2" X - a 0. C. WALL STUDS �p 2" X T O.C. FLOOR SHEATHING= " SILL 2"X fa FLOOR JOISTS SIZE: 2"X O.C. FOUNDATION WALL THICKNESS ✓ „ BASEMENT FLOOR SLAB THICKNESS FOOTING SIZE � � - X TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6?-30 Parcel 116 66cD � Permit# Health Division Q M Date Issued 99 Conservation Division IMR5 r°Plf �• t:,�p `� Fee Tax Collector , Treasurer L Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village �'�7 e►"v�/lc s1 Owner '�S-o P c MQ q t 6 Address Telephone 7 7 L 6/eT 1? Permit Request %o &ter 1di-Q:r PXlsnHu i �� FZGoe/ F, 3.<I 12,.Q Square feet: 1st floor: existing 1;Z000 proposed o/9C�2nd floor: existing proposed Total new,93_6_�4_ Estimated Project Cost 40, Zoning District Flood Plain Groundwater Overlay Construction Type U_9 a Lot Size ®G Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing StructurV oVo yes 4- Historic House: ❑Yes 14110, On Old King's Highway: ❑Yes ❑`No Basement Type: Lyf Full Cl 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 new Total Room Count(not including baths):existing new First Floor Room Count n Heat Type and Fuel: ❑Gas it ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage: existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name (=f//w'/®s �AL 1 s�� V Telephone Number 27/'/5//6 Address License# OOG& '3 Home Improvement Contractor# !!-elC qq Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Og 44 17 SIGNATURE Z DATE FOR OFFICIAL USE ONLY PERMIT NO. ti' Y `4 ,..DATE ISSUED l MAP/PARCEL NO. - ADDRESS rt VILLAGE c OWNER, DATE OF INSPECTION ;s FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ° FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. t C k r� .FUISN rD RLKElVE �I ILrNE¢LEVEL% Hpwrs.OFFIc6$PTGC (�.YDG`I JI/. -FlC'xN/Se' `.�� [ENOVE"DG1)¢{FVN+f� J I. nNL ii T� _—_� �AOEN�S WC.Icc Y ' T rtE RElcrwrw — q P L_ —_ — I I__"1 — .__ 1 A I A1Gi_E.----•.._ — NM LDMELY FEZ .\ / 4M_��.y�jpP o"1+°NY eiMPv6 poxv.IP IIr CRE�G¢StADE¢{FPI.ME Nf FY 4S�FPP��eE3,4AF., II JEW 913T'2 I C'fROTPIEDODfgoN 1\.¢E Y sL /. /v FL G S1�SNES r[v ECP4uv E/R e. 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I W�6.G. / 1 WWn: ..--_G nL�:•� ' n _ > M:6EDEafOu 9 9 NI - 'J I � L1([l GA.L.IAY OIir � /r/�•1'-.�O': I Jid .�4�.- R<K1WG N� fNOOix�iNnN I A.ri . , GV.a N9f61S.°N'�N{.oWER LEVELfltEI� PEA'IFE NEW L'f 1°C i L.` 0{ r_NEW DECK AE•l� r 9 Su.E J E (ARfUH.MNc t°SH°�fEU - t Aq KE2.fOL l3AD6 rw F?,WI� -I. fJ(Mnlfi(Mti/RDDFiUG�. F✓SN.� N m1 2" '/i ' �,- 4 - ��-4' fyfLS;�LOfJF PLAN LaWER�EVEL P�INI .'' � I �_ 1 .� •�' -I ,ly J _31L kEVSHL —_ .. .. -.. .... .......__ I T.--��•r �F �� l sno Faonuo r uocw��c �. H� ., a .s� � _ q� �•I�ro f 1 e•2 [oUr IONE<c G°"L..,6.�.tr.� �— sure b I I � -. ..�.. o u.:sr2 s <uue. I ° �11'•2y.�D a .En sormNc,niE� Ii 3 ,; '6 .,2 I• I ," Wi <..F. I 1 i 'e, le d ,�. I - :(Set Pc t-o z•soNE.+ux°, root FFA,, --�:— - _ll� eI mm� sEesrw." F I I .o•.me.0 L Aueenet°Pt��wN-.ro..<s '(FLAN«1«nr) ,�11�ir,.,<,.•.... a - I 1 �2ee�.e e n y .. .. I• woloor/� I��� I N .i I dl; � I I 4ay rest � - :eec.Fcro. I .'"�'' ._._���...._...,�o,o e N N . 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(3rd floor) Map 2,30 Parcel //�'-Qo Permit#" �e a _ House# :�'ir/ �' Date Issued 2—'Af ' Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) -Z `G � ;� A P1auniffg-Be�-(1st floor/School Admin. Bldg.) I SE IC DIE: Definitive roved by Planning Board 19 IN$TA IPLIANCE g TOWN OF BARNSTABLE ENVIRON CODE AND - Building Permit Application TOWN REGULATIONS Ik Project Street Ad ress Ste/ ay Village Owner Address 5-F/ Telephone - 7 C 6 t P z Permit RequestN � vt t First Floor square feet Second Floor square feet Construction Type F � Estimated Project Cost $ 07eJ a C� J Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing 3 New_, Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information. Name Telephone Number Address License# 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 SIGNATURE DATE ��� BUILDIN PE MIT DENIED FOR THE FOLLOWING REASON(S) Cgr FOR OFFICIAL USE ONLY PERMIT NO. -r DATE ISSUED MAP/PARCEL NO. ! •" ADDRESS VILLAGE' OWNER ' • � ' - ark DATE OF INSPECTION:, FOUNDATION'. FRAME I ` ' 4. INSULATION FIREPLACE - ELECTRICAL: i ROUGH FINAL PLUMBING: ROUGH •` FINAL Afl GAS: ROUGH>_ FINAL' } FINAL BUILDINGy { n` � rr0 et DATE CLOSED OUT, t r ' I ~= in . ASSOCIATION PLAN_Nrn O�� A`*essor's office(1st Floor): Assessor's map and lot number Board of Health(3rd floor): 7ALLED IN '� MPU Sewage Permit number VVITH 5 2 B 9TGDLL i Engineering Department(3rd floor): �S; 4sa II House number JAB M ��.Ci�® c 39. �a \m' Definitive Plan Approved by Planning Board 19 ��®� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BU I-LDING INSPECTOR APPLICATION FOR PERMIT TO f©�� �A 4 c 1 CQ ti 6 G�10� x TYPE OF CONSTRUCTION u ` ° e U� �s' ' ����0 tl -l-' 19 69 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location � n h i ri vie i L n . Met. ®2- 1C3 Z � 64r Proposed Use to r6L Zoning District_Pw (I 4,q b V CO Fire District G Name of Owner Al4 ��- W 140°-4tAddress PIS cry n @U.3 h- I � I Name of Builder iG�Q.fJ e,&UMM Address � i�' P aX a hatt2- Name of Architect /v A Address W Number of Rooms e- °� Foundation h Exterior Roofing Floors a K 1 Interior f Heating�, ' Plumbing Fireplace Approximate Cost 2 066 . 0 U D Area DiagramI Lot and Building with Dimenlons �j F e � b4 to htd , 1;::4 X 16+ 01 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 BEAUMONT, LEO & BETTE y. - } ' (,No 33262 Permit For BUILD STORAGE SHED Accessory to Dwelling zJ Location .581' Phinneys Lane (Lot Centerville r 4 Owner -Leo & Bette Beaumont Type of-Construction Wood Frame Plot Lot I � Permit Granted October 4 /".i 19 89 T ~M Date of Inspection _1_19 Y< Date Completed ' 1960 hill i i _ Y 9' _ ♦ r vow - 2 0 / SYSTEM MUST SE Aesesso�s map and lot number ................ ..... SEPTIC COMPLIANCE LED IN COIF O$TH E _ ��,....., INSTAL TITL 5 Sewage Permit number ,...... g.C7......` ...... WjTE1 E 6 E A '„ vlp/ EN N�AflENTAL CYIONS = BAHMAS& E, House number . J`.5...............J................... V,R® t4 REGULATIONS 900 "6 9. YAY < TOWN OF BARNSTABLE BUILDING -,,,,, INSPECTOR. APPLICATION FOR PERMIT TO* ....... •.. �V .�..� ........4^..:��!G../�.. ... ......... y � TYPE OF CONSTRUCTION ......!%L/..r f�..'%L........... .... .......u�.�..v....... ....... ........19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the fall wing information: 0 tc� Location . Ok........ ..... .h.. .... ..5........-111J ..................... . !.G.[..�..........l ......................... _ ProposedUse ............ ...... ........ ......... /.`.... ........................................................ ............... Zoning District ............. ..QJ...............................................Fire District ....... 7UW Name of Owner ... ...��:zt.&.l ..................... . .......................gu. A Name of Builder .... ..�::`. . ....... ........... . ........ . .....Address Nameof Architect ....................y.... .. ..................................Address .................................................................................... Number of Rooms .................J........................................Foundation ......... Exterior .............. ..........................................Roofing ............ 4! ............................................ .................................................Interior e Floors ��.�.,a � ........���".(........�.....�..�.�............................... ............... . g �l�... ' Plumbing ........... /Heating .................. !.. � .. .............................. .. ..... ... ................ .. .................. Fireplace ......................... ......................................................Approximate Cost .....41..�1.....C ............... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area Iz-.4 . .'. ..............:.... Diagram of Lot and Building with Dimensions Fee 10.Q. -S SUBJECT TO APPROVAL OF BOARD OF HEALTH Tod ,4 C 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 e 5/.�4e...�:... .R��..��1.�,/...... .. Construction Supervisor's License ........ BEAUMONT, LEO E. & BETTE A. - No�,,Lv-.P�!L Permit for MI.AtQKY.................. Single Famil ..D elljAg.................... ....................................Y ...... • L 575 Phinn Location ...................... ................:C.en.t.e.rville...................................... Owner ...1; 'Leo E. & Bette A. .............................:......... Type of,Coristruction ....Fraw........................... .. .................... .......................................................... Plot ............................ Lot ................................ Permit Grant .........July 8,............:...................19 86 Date of Inpection .....................................19,7,0 Date Completed ......... ....4•5(. Y-i 9 jo 0 1-t 144 z 0 .i t _• wJ- I r;4�� ►� �jIV2 a /. o8Q �IGZ � I 1 � CERTIFIED PLOT PLAN LOCATION . .C, W T��1644 ��5S .. SCALE .4°.... DATE PLAN REFERENCE B7 uG LoTZ WA/ 0 F k4s o`a EDWf4 j � E. o I(� Y 90 26100 I CERTIFY THAT THE <`sd �fCISTFR�`�J°.� SHOWN ON THIS PLAN IS LOCATED ON-THE GROUND' c �g�gk0� AS.SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REOUIREMENT_S OF THE TOWN OF lSf� . . . .WHEN CONSTRUCTED. DATE .•JC�v /G//7r31ss - //--v /3eW- "0,17-- 10.9W- 77v.V&,-Z REGISTERED LAND SURVE,OR SNM''73 i 4C' I t 70 1 . % \� • 1 / zlo ,1 v i 4S, six •� „ , _S � T�sr � p�ibsd"L� wArg� Liv6 / ,/y y7 f— tzev. I STAL'Er 474u So' 48 IVo72r- EZ&Vg77o�✓s 434s" oM /•fE791v S�4 L�vErz f LOCATION C�� �?2l/iG.« SCALE . l ii,.'4rO.i . . DATEhri PLAN REFERENCE' .;6e'#V G. •. LT o '"z. • -��pLvN Oil/ L�,".,8� �Z ♦�,9 t:ao•;:yi1Yt) CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE AROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE —SET PArv_Rfn:.MENIVNITS-0r-Tn C-�•G N—OF WHEN CONSTRUCTED. DATE � . . . , . . . . . .. . L� Gs: 8c°�v�-1o�/T- P��iTio•vE`.'�' . REGISTERED LAND SURVEYOR THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A m / �C(' �'J LI DATA T_ SUILDING ' TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT p'.g WEATHER CARD 2( f'� 29 f 1DATE 19 PERMIT NO. APPLICANT Uv'""':-tea• `Y 5 1''i'i ..C''Y' � c?"'lc . :;�:iieti?.iV1.ai.: ADDRESS (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO 1'U _.LC: " '' `- -'+ (_)L STORY_ ik:lP_ f+;?');i ..11 ii:JE'e_1.11?? DWELLING UNITS { (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) �J 1'i�:i_i3;:1• V x.:atEcr.y d a,ia+" DISTRICT I (NO.) `(STREET) j BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION i 1 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sywi:tt:k 1 I ( j AREA OR f VOLUME .�•_• .J1 y ,V:; PERMIT ESTIMATED COST .� FEE (CUBIC/SQUARE FEET) OWNER 1_r.LL` s •;.::i:.. �Ja rl?fI:1C�' _ l c_t::_ l i t A. _ BUILDING DEPT. r = ADDRESS BY ' THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR ® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED 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 IJOES.NOT RELEASE THE APPLICANT FROM THE CONDITIONS J OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. 7!{ MIYIMUNI OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND,THIS WHERE APPLICABLE SEPARATE I INSPECTIONSL RE QUIRED R WORK: AL CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL,. PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL, MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE I OCCUPANCY. - POST THIS CARD SO IT IS VISIBLE FROM STREET y - BUILDIN INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 I 2 /Ns9 G r TING !NSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS 11 �S ' 2 2 WCRK S,•AL_ NCT ..=PC HED UNTIL THE PERMIT WILL BECOME NULL ANO VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS CAR_ NsaECTCR HAS APPROVED T+E VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANG7LD FOR BY TELEPH�N: j STAGES OF CONSTRUC7ioN: PERMIT IS ISSUED AS NOTED ABOVE_ OR WRITTEN NOTIFICATION, g ,,..... ...- -i•rs^..- .. Y..,-,a..!• '.'-:. .• ze.r:,,..`.T�'....•«�^-i:; ., ..., '4,-.n;.y,,.`,�Y ;nY,., ... ✓���^r... s ... y.,�,...4° .r. , .. ...., �^�. :r� ..14 ti oFTME TOWN OF BARNSTABLE Permit No. .......29615 BUILDING DEPARTMENT { Cash B°8NA I TOWN OFFICE BUILDING ' ,65 uv X HYANNIS,MASS.G2601 Bond .... CERTIFICATE OF USE AND OCCUPANCY Issued to Leo E. & Bette A. Beaumont Address 581 Phinney's Lane, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ..ctober 20 19.......$6..:... �" -----�_ Building Inspector ice_