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Application number .-.3v(z2
TOWN OF BARNSTABLE Fee ............................. ................
B"NSTABM u.
MAS& Building Inspectors Initials.... ...................
%63 F Date Issued..... .. .......q—...) k... ....................
Map/Parcel.......... ... .......................
TOWN OF BARNSTABLE SCANNED
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION FEB 0 4 2020
PROPERTY INFORMATION
Address of Project: h-1 fnoct On owt
NUM STREET
Owner's Name: Phone Number
Email'Address: Cell Phone Number
Project cost$ Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make applicatioh for a building pen-nit in accordance with 780,CMR
Owner Signature: ORAJY�, Date:
TYPE OF WORK
Siding Windows (no header change) # Insulation/Weatherization
4,11boors (no header change) # Commercial Doors require an inspector's review
Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Reg,istration(if applicable) # 349 10 —(attach copy)
Construction Supervisor's License# (attach copy)
Email of Contractordimtud�d ee �CKA_, ' 1,�Vone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER ...............................:............................
*For Tents Only*
Date Tent(s) will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X , X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
n ®Signature Date 4
All permit applications are s ject a building official's approval prior to issuance.
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Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Const€ucfscvloI `1�r Specialty
CSSL-099138 E�, Kpires:01/2812022
JAMES P CURLEY,
287 FULLER ROAD,
CENTERVILL6MA'02632, <
Commissioner
_..
•f ��rtr�rt^iiiWr.���� �r�•lUrr..riirl/i
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Individual
Registration Expiration before the expiration date. If found return to:
.exist O xRira 021 Office of Consumer Affairs and Business Regulation
JAMES CURLEY d 1000 Washington Street -Suite 710
.r Boston,MA 02118
JAMES P.CURLEY ,
287 FULLER RD. M `'
CENTERVILLE,MA 02632 �� .w..
Undersec Not valid without sigrtaure
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uir %_""1rr1Ur9Fveu1an vJ IrluaauLituaCua
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 �1 t Q Please Print Legibly
Name(Business/Organization/Individual): OJ`� "'�`�(M--
Address:
City/State/Zip: ���s 1t��Q401 Phone #:
Are you an employe . heck the appropriate box: Type of project(required):
1. I am a employer with 4. I am a general contractor and I
20 employees(full and/or part-time).* have hired the sub-contractors 6. New construction
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'
Y p �'• 9. Building addition
[No workers' comp. insurance comp. insurance.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 1 Plumbing repairs or additions
myself, workers comp.
m ' right of exemption per MGL
Y [ P 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#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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb certify der he ains a p alties of perjury that the information provided LLab a is true and correct
Si natur . Date:
Phone#:
Official use only. Do not write ' is area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
U-
' ( —/V✓Ste'
Town of Barnstable ermit9
r
itT0A1hsfrour Issue Artie
Regulatory Services FeeV.
,:,:..
Richard V.Scali,Interim Director y. �A,� 4Ak79
/
Building Division
0 c` Tom Perry,CBO,Building Commissioner ,
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma,us
Office: 508- �2-4038 Fax:508-790-6230
EXTRE SS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Yalld without Reif X-Pravhnprfut
Map/parcel Number. I/
Property Address I
residential Value of-Work$ Minimum fee of$35,00 fo work under$6000,00
Onmer's Name&Address , I oxme-
Contractor's Name Telephone Number IVA—
Home Improvement Contractor License#(if applicable) I Email: S
Construction Supervisor's License#Of applicable)
3a ,
[]Workmen's ompensation Insurance
Ch one:
I am a sole proprietor
I am the Houteotvner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Worktnan's Comp.Policy#
Copy of Insurance Compliance Cortiiicate must accompany each permit.
Permit Reque (check box)
e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to D
❑Re-roof(hurricane nailed)(not stripping, Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections requited.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this ponnit does not exempt compiimee with otlier toum department regulations,i.e.Historic,Conserwiion,etc.
***Note: Property Owner must sign P Owner Letter of Permission,
A copy of t o rovemen ontractors License&Construction Supervisors License is
red
SIGNATURE:
Q:\wPPILES\F0RUS1 ddi rmttforms\HXPRrSS.doc
Revised 061313
e
Town of Barnstable
Regulatory Services
` Thomas F.Geller,Director
Building)Division
Tom Perry,Building Commissioner
200 Main Street;Hyannis,MA 02601
• www town.barnstable hams
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Music
Complete anti. Sign This Sectaion.
If Using A.Builder
I,^ \► V Y 11 1 �U 1 Y ►�y I --,as Owner of the subject ptop"
hereby authorize to act on my behalf,
in all matters telative to work authorized by this building permit.
(Address of fob)
**Pool fences and alarms are the responsibility of the applicant. Fools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
atute pf Owner ' S' aA�Ppfic t
�o
P dnt Name Print Name
Date '
Q-.F0RMS:0IVNBRPHMSS10NP 01B 6r2012
Town of Barnstable *Permit# Oti S53
Expires 6 months from a date
.p�j n�SS PERMIT n Z .. V
Regulatory Services Fee
APR 14 2006 Thomas F.Geiler,Director
RNSTABLp Building Division
TOWN OF BA Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.townbamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Aap/parcel Number
'roperty Address A,0//!1C,6_ i✓C�
Residential Value of Work ' � inimum fee of$25.00 for work under$6000.00
)wner's Name 8i Address -0111fl &9NX16z11_1
-ontractor's Name e�E r 1,40M65 1AC : Telephone Number
Some Improvement Contractor License#(if applicable)
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 CompeMationnIInsurance
assurance Company Name
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 -3 6
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.
ome Improvem Co, actors License is required.
35IGNATURE:
2Torms:expmtrg
tevise071405
� I
Town of Barnstable
Regulatory Services
Thomas F.Geller,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.maxs
Office: 508-862-4038 Fax: 508-790-6230
Property Ommer Must
Complete and Sign This Section
If Using A Builder R
I, �70111V C6A1 t/6F1,,(— ,as Owner of the subject property
,L/Q Q .
hereby authorize ���e e- , M46: e g e� r`�'kvP to act on my behalf
in all matters relative to work authorized by this building permit application for:
(Address of Job)
$' tare of Owner ate
&, I
Print Name
Q:FORM&OWNEUERMMSION
_ate
Town of Barnstable
h�P ~� Regulatory Services
Thomas F.Geiler,Direetor
9� MAM
�� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-8624038
Fax: 508-790-6230
•PERW, TT# FEE: $ G
9/o a
SHED REGISTRATION
120 square feet or less
I
Location of shed(address) illage
eil Property owners name `� ,A g.- /3 `�' 9
Telephone number6 _
Size of Shed f `� I�Z, !G
Map/Parcel#
Signa a Date
Hyannis Main Street Waterfront Historic District? v ,
Id King's Highway Historic District Commission jurisdiction? '
Conservation Commission(signature required) Jo ?
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COAEVWSION$,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE.THE APPROPRIATE CONZUSSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY' A PLOT PLAN
�1 1
File number 020510-23 UNREGISTERED LAND
Attorn : BABANIKAS,ZIEDMAN& KING Deed Book 12855 Pa a 64
Lender: Plan Book 306 Pa a 17 Lots 90
Owner; ELSIE B. CANDITO REGISTERED LAND
A lieant. JOHN F.& NAN I. CONNELL Reg Book Sheet Lot(s):
Date: 5/30/2002 Certificate of Title
Assessor's Ma Blk: Lot Census Tract
MORTGAGE INSPECTION PLAN Scale: 1"=40'
117 PRINCE HINCKLEYROAD, CENTERVILLE, MA
I
N/F Atwood '
y100.00' w
v
Lot , #90 ys'
I
15, 0 0 0�, s.f I
Lot 89 Deck Canopy I
Lot 9
0 , O
�,#117
1 Stry.
0
100.00' To Henry Loring Rood
PRINCE HINCKLEYRDAD
............................_..................._................. .............._................................................................ .............-........� .._..._...............
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ZONING DETERMINATION
UNLESS OTHERWISE SHOWN,THE MAJOR STRUCTURES HEREIN WERE IN COMPLIANCE WITH LOCAL APPLICABLE ZONING BYLAWS IN
EFFECT WHEN CONSTRUCTED OR IS EXEMPT FROM VIOLATION ENFORCEMENT IF EXISTING MORE THAN TEN YEARS.THIS PLAN IS BASED
ON RECORDED DEEDS,PLANS,ASSESSOR'S MAPS AND OCCUPATION. FENCES,DRIVEWAYS,MINOR STRUCTURES,ETC.,IF SHOWN,ARE
SUBJECT TO SUCH CHANGES AS AN INSTRUMENT SURVEY MAY DISCLOSE.
FLOOD DETERMINATION j
THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY# i
250001 0015 C AS ZONE C DATED 8/19/1985 BY THE NATIONAL FLOOD INSURANCE PROGRAM.
CERTIFICATION
...........................................----------...----------------------------- --------
I CERTIFY TO THE ABOVE ATTORNEY, BANK Otde Stolle Land Survey Co., Inc. �tN OF
AND THEIR TITLE INSURANCE COMPANY, 32S Bedford Street JOHNMAss�'
THAT THERE ARE NO VISIBLE .� 6
ENCROACHMENTS OR EASEMENTS EXCEPT Lakelvltte, MA 02346 LAw,�NCE 1P €
"Iv UoBY - �►i p
AS SHOWN AND THAT THIS PLAN WAS Tel: (800) 993-3302 " No.
PREPARED UNDER MY IMMEDIATE Fax: (8-00) 993-3304 �'� '
SUPERVISION. J
GENERAL NOTES: This mortgage inspection plan was prepared for the above mentioned client as of this date an ntended ol" CEtrted to
be a land or property fine survey. No comers were set. It cannot be used for preparing deed descriptio ,con - or establishing fe'ice,hedge or
building lines. The land as shown hereon is based on client furnished information and may be subject tnso further -sales,taking,easements and right
of way. No responsibility is extended to the land owner or occupant. It is not intended to be recorded.
TOWN. OF BARNSTABLE 20171 Si3/7a
- Permit No. --------------------------------
i 11.U�STAT.� Building-:Inspector cash
r $400 6 00 8 �
•o ' --__------------------
p 1639•
°woh. OCCUPANCY PERMIT Bond ---------------------
"No building nor structure shall be erected, and no land, building or structure.shall be
used for / new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Alan E. Small Address Centerville
lot 090 117 Prince Hinckley Road, Centerville
Wiring Inspector , w Inspection date ��/
Plumbing Inspe oral �/( Inspection date
Gas Inspector� � Inspection date
i
Engineering Department Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
S
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..................... .............I..............., 19......�_ ..................................................._............p.__................_.......�
Building Inspector
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Assessgr's map and lot number .... .....f... �.: / o G
SEPTIC SYS `M P 'U �T E� 3
INSTALLED IN COMPLIANCE
w Sewage�Permit number ................' yl... .................. = WITH ARTICLE 11 STATE
....,.
_ tA. SANITARY CODE AND TOWN
'i� Qy�F 7N E (1) +. ® � ®� BAR S LE
tj :S 1 • Ow �..
i BARNS
Dim . � �- G�: �S P E C T 0 R
900 1639• �0 U ILL D I .I N
APPLICATION FOR>,PERMIT TO .. ........... ..............:.......................... ....................... ..............................
-; TYPE OF CONSTRUCTION .......,.;;�... :............................ ...............
.................10.
2.1
\ TO THE INSPECTOR OF BUILDINGS:
° The undersigned hereby applie for a permit according to the following information:
Location ... .. .... ...................................
�............ .............. .�,�.o.........
ProposedUse. .......... .. . ......... ....................................................................
Zoning District ................................................ ......................Fire District ..... �--
Name of Owner ... . .............Address ...................... 4.....................................
.Name of Builder ................................................`..................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Roo s .....6......................................................Foundation ....0 ..,......................................................
Exterior ..4....................................................Roofing ........a ...........................................
Floors Interior ......... �/��
......",,......,,.".................... !1�161.........................................................
Heating ......../�......• //
.........................................w ...........................Plumbing ........1-:�L ,.,,. .... ....................................
Fireplace ..................... ................ .....................................Approximate Cost .. .�/. ......................
Definitive Plan Approved by Plan ng Board ________________________________19________. V Area ...1 9610n!. . S.!'...'..........
Diagram of Lot and Building with Dimensions `` Fee y
SUBJECT TO APPROVAL OF BOARD OF HEALTH
" WOo Od
Y
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name . . .Y..'.. ... ....................................
-
. .
^
'
Smalls Alan E.
°~ 20171 one story /
Noi................. Permit for ------------mmucft .
mingle family dwelling
-----------..--.------~—~.—~.
\ 117 �rl�ce Hinckley Road '
/ �"`""`". .---..---.—^--.--.------~ /
+ °
�e���r����e
' . .
^—`'—^----------^^—'---------'
Alan E. Small
Owner ------~—______________.
� Type of Construction
' `__.fnmame.q_.____..
' |
------.-----.—.—.—.—.---.—.---.. '
' #��
' Plot .—.-------. Lot ----------..
' ^
' . .
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y��� � � .
,Permit Granted ----- "--_----lQ �� ^^
nd}e of Inspection ..... lV ^ '
_
Date
Corn |eto�
~
PERMIT REFUSED
.—.-------.....—.------.. 19
'
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.—...----.—_.-------..---..—/...--
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.—.----.—....—.'...-.�.----~—.---/^..
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Approved --------------r— ]g
. . .
------------~--~---.-----.~. �
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. . .
--^---.—..---.----.-------.—~
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