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0170 TARAMAC ROAD
.r' r-� 7 / � �.J �� ' ..� 0 I BIKE Town of Barnstable *Permit#� U Building Department Services Expires 6 moVeefrom issue date ,A ,,,�,, Brian Florence,CBO r� 1 •� Building Commissioner amc ' ✓ ' �✓ V 200 Main Street,Hyannis,MA 02601 " www.town.barnstable.ma.us ,p �' Office: 508-8624038 �� ��`� Fax: 508-790-6230 MI , .H �.. _r EXPRESS PERT APPLICATION - RESIDENTIAL"VO'KUY nnC� Not Valid without Red X-Press Imprint Map/parcel Number�'" U✓ Property Address a o Residential Value of Work$ Z Minimum fee of$35.00 for work under$6000.00 0 Owner's Name&Address Ala, Contractor's Nam Telephone Number ,&®ZO7ty Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) � l�� JRWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name /` Workman's Comp.Policy#"15 0?Z1,6 j ® _AT Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to / ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value' (maximum.32)#of windows #of doors: •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE(_//W"_'1),edL� QAWPFILESTORNIMbuilding permit fohnsTYPRESS.doc 08/16/17 The Commornreah*ajfMasuadrusdLr Deparknaut qfrm11arssfrid Acddemtv i� Office of hrW0,gatiorrs VJ 600 Washbigton Skreet Baston,CIA O2111 ' t�vi�t�tras�g*txvfiiict . Wm- Im& C=pensafra n ce Affidavit$cgderslC xnfractarsMectdcianAnumbers . ApPHcantWwmAnn A Please Print Le - Nam(HusIFtP at,rrafirn,Rn iaRaS Address: ° �ityfStatel Phvac Are you an employer?Check- app opriate bay ' Type of project(required): I_�-I oat a employ urtb 4. ❑I am a general confractur and I employees * Bare hired the subLcontactcus 6. ❑New ooaos5�u iaa Io ees f�11 andfor 2.❑lam a sale proprietor orparbxr Tisted otlthe attached sheet . y- ❑Rem° dahng Wiese sub-conlaactors bale Demnlifiom slop and Ftav�e as e�mplcyzes ' g- ❑ worldn, forme im any capacity. . employees andhave wodmrs- 9. ❑Build addition INoS4 rs' CAIIlp_;avt. �� cE7mp_;�na�rtt Lml 5. ❑ We are a corporation and its 10-� 1 repairs or ad�as 3_❑ requta h afficers have esrscised� 1L Plumbing r airs or additions. I am a homeoymea�doing all vcotic ❑ � eP _ _ of exemgfiou per M(M 7 � e Mysel'No d q p c.152,§I(4k and we have no Rflofrepaixs employees.[To worms' 13. �Otlier cam-i��e -] '$ayappFicztut�atcheclssboa#1 alsoMoaittheseetionb9vvshasdagdie-sa*o&eWcvmpensafiauparwyinfnnsd= ffomeowasswhesabmitthisd da�aia r� Hueyare3aiogsgwmicea�fheabiieaat9detaatisctotsmnst.snbmittanewxfft =!tindicabnnsnrx FCa�actn6$steheckthis4mcmusta4taohe�saaddibnnalslrzetsTuotciagtvenzmeoflhesa�t-cflmdirct<rs�elst�evr}edhe¢arnatirbosae�hiti�sl>s� employees.If thesnbtaatadMA=eempIoFe'-%theymntstgmvidet3 it uvrkrls'ramp.palmatm3beL I am all employer flint is pram ' Q yvorkecs'ca rdiort irrsrirarrea jar ray*empiny�es $doiv is fit r pvHgy=d jab acre ircfor maticim Ice compmuy Fame: t 'Porky 4,11 or Self--in€Tic.-, Fwpiration Date: �/ ' Job�Ad % cityfStater .tp: Attach 2 copy of the warkere compensationpolicydeclaration Me(showing the poficy number and expiration date). FaRure to secure coverage as required nudes Section 25A of MGL c.1572 can lead to the i3mposifton of criminal penalties of a fine lap to$UOO 00 and/or one-year imprisonments as well as civil penalties,in the farm of a STOP WORK cRDERand a fame of up to$250_00 a day against the violator. He advised that a cagy of this statement,sway be f awarded to the Office of ItnvFestigadons ofthe DIA for ihs mace coverage v ow , I rta keraby r tzuder tics ptIIres a.fF0rjur 'that the irrf arma6mr•pmtidkd abatis i5 6=and carrad Sitmatu ° Date: ,2�-If Phone;�7 C09 Clwe -A� 0Bkia1 aW artly Da itat w rite in tFds area,tct be rrmnpie a by tarp ar'tott�n official City or Towu: PermitfLicense 4 Bsuing Autharity(dmle one): L Board of 3&2ltlt 3.RuTd"ing Departmeut 3.(My1rown Clerk 4 Electrical Inspector S.Plumbing Lnpectar 6.Oither Contact Person: Phone 9: vrmation an' d lastructions . .1 Mg e G al Laws cfi�M rues an employers provide worio�s'compens�ion far th=employees- p this sty,an�Iap�is defined as. _every person fn.�e s avice of another a¢y contact of Iifie, express or implied,oral or vzi t� An empkyer is de<fuued as`pan in�idaal,p=tncn;hT,association,corpara#ion or o1i�leg entity,or an two or mom of the foregoing=9aged is a Joint=UzPdsa,and inGkffi3g the,legal repaes�-=of a deceased emplayer,ar the receiver or t3L s of an kdrvidizal,parftimsbip,asociatum or offier•legal entiY,=2&ymg employee- However the owner of EL dweller3ghousebavmgnotmaret3zaat1¢ee a ar�nenis and�ho resides, the ocarga�office- dweBi ng house of amoS�r who employs persnus to do cer,cm*uctiau or repair work a a such dweIling house or on the grounds or bm7dmg appzi�theaetn shaIlnotbecanse of surd employmentbe,deemedtu be an employees" MGL chapterlso I5Z,§25C(6)a sues that'every sty ar local Ii=Ldug agencY shaII withhold the 7 sauce err ewal of a Ifcease or permit to operate a business a to construct bmldmgs na the commonwealth for nay ren a-Pplicantwho bas notprodnc:ed acceptable evidence of cdmpTiance e�itTi fiIxe insurance coverageregrtired,, AdditionaIIy,MGM chapter 152,§25CC7)states fileiffiea the commoawcabh nor nay ofifs political subdivisions shall ester into any fur the perftmante ofpublio wail-mmI acceptable evidence of eamPH4acewn 9ie m .sIUMC _ r eams ofais cbaptrshavM1;f-- .pxrsea tedin the r•,,*ac:��.anfhoi-dy:' Please dut the Wow'compensation affidavit completely.by ch=lcmg the;boxes that apply to your situation and,if fi ll n��Y,Supgy s)�e(s), �-sCes)andphone�ber(s)alongwifhth=c�c8t*)of nmrrance_ LimitedLiabHityCompames(LLC)orLkdtedLiability sPatfw s(LIP)•w�no employmes other than.tho arm are not to clay wozl�s'comp ensation ��ce. If an LLC or T T 1p does have embers or � rimed m p _ �pIoyees,apolicyisrecinlzed. Be advised that lf�rsafIldaylt maybe submit(�dto the Deparfinentoflndysfnal Aecide�mr confirmaiinn of ice cov�ge Also be sure In sign and daf ire affidavit The affidavit should be•ref=rned to-ffie city or town that the application fur the permit or Iicense is being rcgtmi A not the Department of L r ast i aj A CCi den ts_ MMUNyon have any gaesdons regarding lice law or ifyou are regriied to obtain a workers' =npmsationpoltcLpI=smcaathoDepmtznedatfho mmrberlis�dbelOw Self-fimn-edcompaniessbonlden rfieir self-;,,can ce IicMse number on the appropriate am City or Town OM als - Please be sure that tho affidavitis complete andpriedlegibIy_ The Department has provided a space at tfie bottom of the affidavit for you to fill out in the event the Office oflnve °� tocox>�cty°ureg g the applicant P lease be sure to fll in the peuIliceme,nvmbes which will be used as a refeiace zmmber. In.addition,an applicant that must submit multiple peen-dhcense apphtah=m any gives year,need only submit me affidavit indicating=mt policy iuf =anon(ifnecessazy)and under-Tob�e.A ddi "tie applicant shbuldwrite-all locations in. (�Y or town):'A copy of�-affidavittf�at has been officaany s =ped•or maimed by thD city or town may be provided to the rO aPP P licant as ' ofthat a valid affidavit is on file for full."e•pmmiis or licenses- Anew affidavk nn=t be:®ed o'ut earls _ year.-Where a home owner or citizen is obtaining a license or permit not=jated in any business or comM=cW Y=±Lro tie.a dog license or peunit to bum Ieaves eta.)said person is NOT reed to colopletn this affidavit The Office of lnyestigajior worahlx to thank you in advance for your cooperzaan and shouldyou have any quesfions, please do nothesiiai to give us a caM The I3eparimenfs amass,telephone and fax 'I1 CD=j0UWt*of MassachnscEb , �EzfalAo�d�nts • face of�-� tio� T�c�ao-usl�E�11� T��.4 -727 49O=t 4.06 err 1477 MA aAM Fax It 617` 27 77D Keviscd4-24-07 M gar[ i Town of Barnstable Building Department Services ` Brian Florence,CBO KAM 1659. R�� Building Commissioner p 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 t Property Owner Must Complete and Sign This Section, , - If Using A Builder I ,as Owner of the subject property hereby authoriz to act on my behalf in all matters relative to work authorized by this adding permit application for: (Address of Job) **Pool 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. S' e o er Signature of Applicant Pa Print Name Print Name G Date QTORMS:OWNERPERMISSIONPOOLS Rev:0&/16/17 Town of Barnstable Building Department Services Brian Florence,CBO ; Building Commissioner 200 Main Street, Hyannis,MA 02601 sAIUMABLe. KAM www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 or two- .family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building hermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that:."Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results-in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q.\WPFILES\FORMS\building permit forma\EXPRESS.doc 08/16/17 09/28/2017 05:07PM 9788514848, SULLIVAN PAGE 01/03 j CERTIFICATE OF LIABILITY INSURANCE CERTI� ago, coda' . i LICIES THIS CERTIFlCATE IS ISSUED AS A MATTER OF ►NFORb1AT10N ONLY MID CONFERS NO RIGttTS UPON THE CERT1t=1CA LDER THIS CERTIFICATE- DOES NOT AFFIRMATIVELY N WS NOT O�N,I,EF'COMND.�T BE1WEEOlt ALTER T"&N THE ISStANO iNSURIMS), AUTHBy INE OORIZED BELOW. THIS CERTIFICATE OF INSURANCE REPRESk'ITfATNE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: tt she oe eata ho)d9r ii on WDI ZONAL INSURED.the Poll*[=) must be endorsed. K corWO MION IB WAIVED, eu to t to the trams and the ge M 6t k pougr,eeRal%potkies require en endorunw&A sfatal11610 en lids osr00eate doss no oorlhar to ftw ompltoabe holder In tteu of such etldoraetnenK aoM Sullivan Insunnoe Ayetay p,opl, arts: (976)8bi-Mgo Fare ts7e)05-450 Alt Ss 1.4848 SULLIVAN INSURANCE AGENCY PH0 78 6514800 I9 895 MAIN STREET s.w TEWKSBURY MA01878 u1sU (61 AFfORDaLG NAICt1 INSUt1t3N A•: )ES B FOXO s In=rM"AB ,Ma II mmR s : ACE Group THOMAS A HILQWY DBA THOMAS A HILCHEY CONSTRUCTION 82 OLD CHATHAM ROAD tNeUI tx HARWICH MA 02t(45 IN9unERE INB{ittER F tAV¢RAGt:S CERTIP LATE NUMBER: 28364 REVISION NUMBF�Z: THIS 1.9 TO CERTIFY THAT THE POLICIES OF 1NBURANCE LISTED BBERIOD IAW FIAVE BEEN 1$6UED TO THE INSURED NAMED ABOVE R THE POLICY H INDICATED. NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEF(TIRCATE MAY IIE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICI65 DESCRIBED HEREIN 0 SUBJECT TO ALL THE TERMS. E D CO DITI S S C POLI I-a.LIMA f8 SH N YHA S N CE BY�P ID thaw Lam INS% rnI5 OF IastrrRAMM POLICY NUMt1lR 1.000.000 A Amy 3EGUIS N/26f17 0110tiMA snCFlOccuri NCs i •X COMMERvAi.DENML UA81LnY Mo.Ev Wry arts 1—) i 1,000 cwMSMOE a OCCUR PERSONAL a AW KRIRY i 1,00 00 e1;N�t AGGREGATE s 2,00 . 00 PRODUM•GottProP Aso i 2,000.Q00 G0N'L AGGREGATE LIMIT APPUE0 M' _ poucy Lao %E S ll�smld�A wr°mow UML" 80DILYINAM(P-Caren) i MY-AM SOHEOULED BODILY IWURY IPw.alone) 5 ALL OWNED Ratios s XNOB HIRED AUTOS LACH OCCURRENCE i WORILLA LLAM OOCU>i AGGREGATE wws um CLNMSINADE i OED F cB rwnoN i egB2Ug,ZE09S4Q-0.17 Q.U15N7 09M5H8 TOM utMs ER i MtO 100,000 C=$ � B.L EACH ACCIDENT S 8 E7mWC� you � N/A 6.L.01SgA9&6AEMPL•OYEE • 'IOO.000 p1.,ero�tnrpq E,LO1GP •r'OUCYUMti S 50D,000 E awo�a"QotP aPEa�no►te blow tor.AtIdR)wvL RwMLMe SsLWdtdb N lean aPK+it npuirae) OE6010PTION O!'OPMIATN7Ni!LOCATIONS/VENICLS6INodI ACORo . Tom Hilchey Is exduded*am the WD*m COMPen8860a PC'* CERTIFICATE H E CANCELtA N SHOULD AWY OF THE ABOVE OEBCRUM POMM BE CANCELLED BEFORE Town Of Deftma ,TNB EXPIRATION DATE THMOW, NOTICE WILL Be DELIVERED IN on Rout0134 ACCORDANCE wim THE POWC1►PROVISIONS. Sate Dennis,MA 02600 ATiYE G� rrnl Attention: __ .... ..r, n AB . • E 1 • r �. Commonwealth of Massachusetts ' 5� Division of Professional Licensure . Board of Building Regulations and Standards N Constr L&t- �ri`l§sis'pervisor ���ires: 09/1912019' CS-034718 7HOMAS A HILCHEY�, +" 82 OLD CHAtAAM ROAD 1 HARWICH MA 02645 r � L ' Commissioner C4 _ 1 .. Office of Consumer Affairs!h 13usiness-Re9ulation Registration valid for individual use only R HOME IMPROVEMEPiT CONTRACTOR _ before the expiration date- if found return to:uta4lon -- r Type: Individual Office of Consumer Affairs and Business Reg Sisgatio i o 1fl Park plaza-Suite 5170 110649 = im02/2018 Boston,MA 02116 Thomas A.Nilctiey_ =_ Thomas Nlchey:. :;:. ':' r� 82 Old Chatham Road.; i<•f ✓` Harwich,MA 02845_.';° ..:. Undersecretary Not valid writia®u4 signatu�' Town of Barnstable ,*'THE Tp ° �o Regulatory Services �. Thomas F.Geller,Director • BA STABIX • DMIAS& 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 �II3)oy� PERMIT# FEE: $ J SHED REGISTRATION 120 square feet or less r, i 0 Qt Location of shed(address) Village 5� -42,0 - .\ g Property owner's name'v Telephone number Size of Shed Map/Parcel# 104 ?p�atuare Dat Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) P� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN . Q-forms-shedreg REV:121901 3 'r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel /0 Permit# ®o �� Health Division 71=I Z�; 3/ �7 —(y Date Issued Conse n Division Fee d Tax Collector " SEPTIC SYSTEM MUST BE Treasurer a7PQY►� �A - ` ��� � _���i�� INSTALLED IN COMPLIANCE WIMME S Pla ept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATONS His H Presepua#mVI-1yannis ° Project Street Address 69 A919 fnfi-0— /CGl Village Owner A-T 11) A-kt-;L5DA1 Address �,d. B�X ��?�3 g����, d1k---J, Telephone t 7 —766 41 - r Permit Request i I ,EE P ` / s E Sl Square feet: 1 st floor: existing proposed `" 2nd floor:existing proposed Total new Y - (A� Estimated Project Cost Zoning District= Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered:. ❑Yes O-Pd'o If yes,attach supporting documentation. .Dwelling Type: Single Family a,--/"Two Family ❑ ° Multi-Family(#units) Age of Existing Structure; Historic House: ❑Yes W4fo On Old King's Highway: ❑Yes UNd' 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 Number of Bedrooms: existing w. new Total Room Count(not including baths):existing new First Floor Room Count ' 4 Heat Type and Fuel: 0 Gas ❑Oil ❑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 Elo_ If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name C /24 �YJI/M,917)� Jelephone Number Address /(o ff rIe0 i�7Jd./ - License l i�ul+�► f/� Da��� Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE d�� DATE �D FOR OFFICIAL USE ONLY 't ' - PERMIT NO. � � t DATE ISSUED MAP/PARCEL NO. � >. ADDRESS r i ; VILLAGE OWNER DATE OF INSPECTIdII: FOUNDATION` (� 1 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH I FINAL PLUMBING: ROUGH'-Z j FINAL - � �� t .. fi,., x � �. 1 '' _. -'+ - _ . : .. sill .• • GAS: ROUG13 t^3 = FINAL i FINAL BUILDING - m tc r ! +y f f red m e * ; `'- _ - a• . + DATE CLOSED OUT .- ��, t' ra 0rn {' e r ♦ a y ASSOCIATION PLAN NO et Q' r s M ,y i /7�T�mwl~R& - �--- c�(��/fie 7 PICAC. 5,5 S6 OA� i i • 1 t ! Sp 4cc-D O FP tit./44(1L 6 �3�r 3 - 2 x ZL �1 re DE%.. - — C .C. ��y10 �i2. �n )((� -..�.. •l..�Jjl�flr,;;,r:; /f' (f!„P4J l�rri !." ToG Ael iJD� 7 � Jj 11 U�� �. S 0 c f//Cl1L SPAGE,D OFP LL UEUC/ v(, L.A h S r' - 1 3 2 x loll G;r<.u G C?.a. .,ly Fr�or� .ir ��' v0�lD TuL� lo f _ The Commonwealth of Massachusetts .t1 i-i--� --- . + - Department of In dushial Accidents :.._�. _. r = � •• _�.,�� 600 Washington Street b't Boston,Mass. 02111 Workers' Comp ra ensation Insurance Affidavit " EMU6t��/ / /�/',/r....''�,r "`... name: ovation: f.a r city phone# �- ❑ I am a homcowner performing all work myself. ❑ I am a sole P=rietor and have no one workig in anv ca acity /// ... I am an emplo�•er providing workers'compensation for my employees working on this job. eomponv name: address: - _;_. ... . .... .. . .. .. ciM. 4 nl[1� t0a to 3s nhone Insurance co. 011m# W� �` i•... ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the folloiiing workers' compensation polices: company name• address• dtv phone#: insornnce CO. ,:.. eamnanv name: address, dri- ... phone#: _ . .. .. .. .. ;.. 011ty# ....:�... ��..:..:�� � :::.::::v::vi:;:"i:.;:. .:'��is v.: �:-�::::'::.:K'�•::"::::.v.w:r nsurance co. Faaure to secure coverage as required under Section ISA of MGL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I m►derstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify raider the pains and�pa/eolties peduq that the information provided above is trn:an eo ed Date � ,,, _ Print name EA)FOCA V. R11 S C H_131 Phtme i q�g— C.ontnctpemon: ly do not write is this area to be completed by city or fawn otBdat town: permit/license 0 ❑Building Department ❑Ilceasiag Board medLte ra e b aired -- — --- ------ ---- -— ----- Pons req Sded:etea a Office— --- OHealth Department phone ft; ❑Other (nvuta 9,95 PJA1 �TIM r The Town of Barnstable 9 '� �0 L Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissiore- Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c- 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. PIP Type of Work: R S F/(t51tst.Cost �d9. ��•� . fir v s��r �P/YI Address of Work: / /� Owner's Name mg Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit ,f Notice is hereby given that: EALING WITH UNREGISTERED OWNERS PULLING THEIR OWN PERMIT HOMETIMPRO OR DVEMENT WO DO NOT HAVE CONTRACTORS FOR APPLICABLE 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: Q L / 00 Contractor Name Registration No. Bat n LAP /2--z" OR n.�ners Name • (�\ ✓t(r6'C�097Wno)rUI¢Q�o�� uN.�d Restr l e ll T_. 'I'% oilL�� 1�II/*i 7{iHAS CAGIZZ-: HOME IMPROVEMENT CONTRACTOR CRegistration 1007401 16116 NEWTOt0 ;C Type - PRIVATE CORPORATION .OTI N. 2 Expiration 06/23/00 CAPIZZI HOME IMPROVEMENT,_I( � �,��y�;Q��as Capizzi, Sr. ADMINISTRATOR 1045 Newton Rd. - Cotuit MA.02635 DEPARTMENT OF PUBLIC SAFETY CONSTRUCT-ION SUPERVISOR LICENSE Number: Expires: Resir-icted io:. Be THOMAS X`CAPIZZI JR '288 PERCIVAL OR W BARNSTABLE, MA 02668 �1 ✓aie �o�rrrrrorrureall� n��.-r/�rr��n�U.teCl� OEPAR W NT OF )U8LTC SAFETY � CONSTRUCT,uN SUPEr'.VISOk LICENSE Kf000-�, Number: xoires: Restricted To: 28 r _ FREOERTCN V RASC' iI: BOURNE RO . PLYMOUT9. MA K 368 ESTIMATED PROJECT COST WORSSHEET Value LIVING SPACE square feet X$55/sq. foot= GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/s . foot= 5�6 q q OTHER square feet X$??/sq. foot= Total Estimated Project Cost g99091Sb TOWN OF BARNSTABLE Permit No. -------20777 --- Building Inspector Inspector I twn.sc Cash -- °"`"~� OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first havink,'-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 dames K. Smith Address Vnt 1 A 17n T=mnrnntr Rnna . f'.Pn1F-�rE»l l n Wiring Inspector _--` Inspection date Plumbing InVedfoor t,��" "1 Inspection date Gas Inspector C o Inspection date Engineering Department l i,f f y Z�z t lI c ;' 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. } /� 77 ..................._......{ ................._, 19._Y .......................�Building�Inspector •Asses rs map and lot number SEPTIC SYSTEM �.. ...... .. ......� pf INSTALLED IN Sewage Permit number ........................................................ .,cam WITH ARTICLE 1" � SANITARY COD ! Ba�B� House number ............. .7.......... ...............................:.............. ClILATtMS. 'moo "ib}q. •� 0 YPY - TOWN OF BARN-STABLE BUILDINGS "I:H�SPECTOR APPLICATION FOR .PERMIT TO ....... t?�, 6.. tnl�.4��,1. .................... TYPE OF CONSTRUCTION ...... QM-b.......FG_%-i"F..................................................................................... ......................... 19.1a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......... .....A4...... TPtz MpIC.......K4?. lit........ ::................................................... ProposedUse ....'1ESI.bG.IM1.Fk4...............................................................................................................................:..... Zoning District ... .....................................Fire District ..... E►JT .I�V.9!-4. ..-.. 2Ul,LI C- Name of Owner .. MES.....K..... .................Address .... qt Name of Builder .....��`�1L .................Address �?�tM ............................................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...4........ l. 1k1D...........................Foundation .... ................................................. Exterior ..... LF1P Q .......................Roofing ............. k1A.Pl,V.1................................................ Floors .......W.DK.._T ..NAJW . .....................................interior ......... 1................................................. Heating ....FAW....._ez.. .000 ......................................Plumbing .......... ................................................. Fireplace .....f�k)E................................................................Approximate Cost .....30'xmo............ ................. . ........ Definitive Plan Approved by Planning Board -----------_____—-----------19_ . Area .......19 ...S .....5 ....:........ Diagram of Lot and Building with Dimensions Fee 1....... ..:l........... SUBJECT TO APPROVAL OF BOARD OF HEALTH ZOAJ ., . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. Ta. v ... .6 ............. f �x • Smith, James K. 4 20777 one story , No ................. Permit for .................................... ' single family dwelling Location 170 Taramac Road ............................................................... 'Centerville James..K....Smith..................................... tv, Owner ............................. ' Type of Construction frame A .............................................................................._ #14 Plot ............................ Lot ............. Permit Granted ........November...6.. ......19 78 Date of Inspection .....�.j.. .. ....19 Date Completed .....�� ..... ..............19 Ox , PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ...................................... . ... t f v , Approved.,................................................ 19 s r `# Assei-or s map and lot number ......................../ .......... . 7. 7�J—r " + f f— C( r 77 _ Q��f THE Tp�f Sewage Permit number ........................................................ EARNSTLELE, House number .................:..............'..'.............:......... ra MASL 0 MPy TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .............:�'�....F:.:: tr:. c^ �,�'`.:. F.:..:.w........................................ ................. TYPE OF CONSTRUCTION ...... .. rn 1 .:*';�" ...:.....................................:............................................ ............... i .........................I...: ' ...:$ .19. I ;HE INSPECTOR OF BUILDINGS: The HE hereby applies for a permit according to the following information: Location ..........!............................. �.Pic �.f......�..........1'..t .:':! ........�. ' .:..i........�.`............................................................... ProposedUse ... .......!.!......`.:....1.:.'.!......................................................................................................................................... Zoning District ... .:'....y. ...::..... ....................... ...........Fire District ..... ... ............................................................. Name of Owner ✓ . �R! ..................Address ........ ......................................... Name of Builder .......-�t..........................................................4 Address ....... ::::.��lt= ................................................................... Nameof Architect ..:.— ........................................................Address .................................................................................... Number of Rooms E!.XX,_-!t Foundation . ...................................................... Exterior .....S..... `t'k .c Eiw:�f� ►..' .:.4. ........................Roofing .......... c.t 1 .��: ...F................................................ Floors ......1.... t.t -I Rk - L> " k ..... .....................................................Interio ........................... ................................................. Heating .... .: ..`. .%........................................Plumbing �............... .............. ........... ........................................................... Fireplace ...... .................................................................Approximate Cost ........ '.: r:`............................................ Definitive Plan Approved by Planning Board ---------------_------------____19 ______: Area 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 `.............`....................: :...........} ... ' ................... I , Smith, James K. A I89 *' ' - /- 20777 one v� < No -----.. Permit for -----.�����--_ � � /~ ! . single family dwell ~ ----~^---~'—''-----------'^~—'' lTO ' Location mIt �eo ` mith . Owner '---- K. '- Construction � ; � nu/ ' mv"". ^==. . Date of � -_- Completed_ PER T REFUSED | 7 l9 , . —. � � ` . -- .`.. .0N -/---------.. . ' ( ��' / \ �� � � / � ~'---^]y^^'—''~--- --~'`'—^----''' w ' '---'^^^^^^^--~—^'' ^^'—~--'—~^--'' ` � ~---^----^^'^^---r-------^^—'— Approved' ................................................ lg ` -------'-------'-^—'--------'' � =------.--------.—..---...---. '. . I. `;4. _ -Q-,�-�...,'�,-II:,o,I'�I.._4-,.'"�,��,�"'�"--,I-:,.. /S7`� .I.,.-,�:I*I!;�l"%.u-..,-R .•.r 1, L .fij lTvt�I ..�� t ✓•.Y AT M .T^' F_i Ii-' - �� •�` ( - �I,..'"-�' 1. I. I. I. �� �� p��+'y..qy� -i:",( �t(\ K �, €C �.R ;1 t�-e1,-�,-,'��,,-,�'.,..���. Y. .. 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