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0019 THREE PONDS DRIVE
4 9 n , „ o + . i6 y , it . . a �� � d.ram y y 5 ❑ �� m�4 ���. w, s , ,A ..b y ,, � '_ , .,. . v �t �-us.,J ,,'dS i" �.gx x _ °w' q-�x.: g❑ s`9 '� r} ��' 0 n n _ r � x a, ^ =E. � R s F s . u v M � e • a9 h 6 f. o , , s ` F t� Application number. ` .�.............. ........ Fee ......................... .......................p....................... SAM M Building Inspectors Initials... : ................................. 1639 Date Issued...l� /� Map/Parcel................................................................. TOWN OF BARNSTABLE . . EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Owner's Name: ,a2WIV4 3 ,agh,,i T- Phone Number - 5-0 6 W a — 34/Z Email Address: Cell Phone Number Project cost $ 19 -/JX Check one Residential �� Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with * CMR Owner Signature: Date: ���y TYPE-OF WORK ED Siding 1 Windows (no header change)# D Insulation/Weatherization Doors (no header change) # Commercial Doors require an inspector's review 0 Roof(not applying more than I layer of shingles) Construction Debris will be going to \/^Z'' c -H D- C-� P l CONTRACTOR'S INFORMATION Contractor's name '+ Home Improvement Contractors Registration (if applicable)# Q 2 416 3 (attach copy) Construction Supervisor's License# 'T7 9 0 0• (attach copy) Email of Contractor ' b Phone number --fC18 03 2.) 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 KTesting 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 To of of rnst e. Signature ' . Date APPLICANT'S SIGNATURE Signature 21FDate 2 of 2U All permit applications are subject to a building official's approval prior to issuance. i Commonwealth of Massachusetts Division of Professional Licensure -Board of Building Regulations and Standards ConstF,ii,6ti�n blpprvisor 11; ' CS-077800 tplres:06/27/2022 WAYNE T LOFTUS 78 ARROWHEAD DR t HYANNIS MA'-02601. i . Commissioner leoirzrniriaet=e�illc�✓ll«��Cc�lt:cl/ office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE.:Individual before the expiration date. If found return to: Registration Exuiration Office of Consumer Affairs and Business Regulation 132463:-=._:=. 02/07/2021 1000 Washington Street-Suite 710 WAYNE T LOFTUS Boston,MA 02118 D/B/A LOFTUSCONSt.RUGTION WAYNE T.LOFTUS _ �k~ 78 ARROW HEAD DRIVE HYANNIS,MA 02601 = Not valid without signature Undersecretary' 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): (� Ay N� �6 ���✓� Address: `76 /446to d 'lop , City/State/Zip: J ^wA;)5 /hq 02601 Phone#: ✓s6 U e3 Z t 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 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.V 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.$ required.] 5. We are a corporation and its 10.. Electrical repairs or additions 3. 1 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#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 thepolicy and job site information. Insurance Company Name: ' Policy#or Self-ins.Lic.M 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 certif7unad r the pains an'd pe •es f perjury that the information provided above is true and correct 2� 2(} Signature: Date: Phone#: .�©9 5go I 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#: — — ov ,MCCARTHY aC` RE ,JCTION co 4 sid `tial and Commercial Buiider YIZATTONSPECIALIST'�, d ` '� CCAHTHYC G EB: WWW. October 21, 2014 MG Town of Barnstable . Thomas Perry CBO Building Commissioner . 200 Main Stret Hyannis, MA 02601 p yr RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201405797 at 19 THREE PONDS DRIVE has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction 7i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map TO ' ;,�`Application # �� 3 Parcel l�2 + a ;, r Health Division ] SEP -2 P",! Date Issued 9 7J I .♦ Conservation Division Application Fee 56 Planning Dept. Permit Fee Q Vw . r Date Definitive Plan Approved by Planning Board Historic- OKH _ Preservation/ Hyannis Project Street Address 5 ti �� �•�9, , Village �c�-, rwlit Owner Address Telephone 4-12v Permit Request _Wx,�L,rdt.�._ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ef/ 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 Number of Bedrooms: existing _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 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) , Name Mike McCarthy Construction Telephone Number PO Box 52 Address West Dennis. MA 02670 License# CeU (508) 280-6964 CSL,-586=3-3 HIC-169393 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 X /'- FOR OFFICIAL USE ONLY APPLICATION# ti DATE ISSUED 4� t MAP/PARCEL NO. Y- +r ADDRESS VILLAGE OWNERr DATE OF INSPECTION: , K a � fIFOUNDATION, ,: , . ..t•, ,,��s �t... 'FRAME ;,,INSULATION FIREPLACE ELECTRICAL: - ROUGH FINAL r' PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL 4 } FINAL BUILDING. DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts -Department of Public Safety Board of Building Regulations and d Standards 01 Ilst I'll Clio n superi isur License: CS-058633 MICHAEL J Mcc'AR PO-BOX 52 W DENNIS MA 0267 . 4.. Expiration Commissioner 04/10/2016 J Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNIS MA 02670 -�_ Update Address and retur-card.Mark reason.for change. scni 2onn_osr�i E] Address ❑ [:]"Employment �] Renewal " to Lost Card t, /.;/ P Yment /f The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 wwlp.mass gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/El lectricions/Plumbers Applicant Information Please Print Le 'bI Mike- c arthy Construction Name(Husiness/Organizagon/lndividual):_ PO BOX 52 Address: West Dennis, N11A 02670 City/State/Zip: CS1pA§§ 3 HIC-169393 Are u an employer?Check the appropriate box: Type of project(required): 1.&I am it employer with 4. ❑ I am a general contractor and I --�— 6. Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole propridtor or partner- listed on the attached sheet.t ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.Insurance. 9. ❑Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. e.152,11(4),'and we have no 12.❑R of repairs insurance required.]t employees.[No workers' . 13.Q'�ther comp.Insurance requited.] i *Any applicant that cbecly box#1 mast also till out the sexton below showing their workers'compensation policy Inkmadon. t Homeowners oho submit this affidavit indicating they am doing all work and then hire outsido contractors must submit a new afdavil.Indicating such. lContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'.comp.policy Inormation. I am an employer that is providing workers'compensaflon Insurance for my employees Below IS the policy and job slle Information. {� Insurance Company Name: Policy#or Self ins.Lic.M. VW( Ica-GO1169- Expiration Date: Job Site Address: / 1,�c �_�e City/Stawalp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to seetin coverage as required under Section 25A ofMGL c.152 can.lead to the imposition ofcrlminal 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 it day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification. Ida hereby cer7t&r! d e pa a enaUtes ofpedury that the Information provided above Is true and correc4 I Ll ture• Date: iL I Phone P Ofjlclal use onCy. Do not write In this area,to be completed by chy or town off ciaL } Pertalt/License# City or Town; i Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6.Other Contact Person: Phone#: • AC6kb® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/10/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 01962-001 kRAJACT Bryden&Sullivan Ins Agcy of Dennis Inc PO Box 1497 �?� e,Ext; (508)398-6060 ,No.: (508)394-2267 So Dennis,MA 02660 1986s: IN URERM)AFFORDING COVERAGE NAIC 0 INSURED INSURE A• A.I.M.Mutual Insurance Company 26168 - ——.—__ Michael McCarthy Construction Inc INSURER B P 0 Box 52 INSURERC, West Dennis,MA 02670 INSURER D: INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07VVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 'AI-IICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE , yp POLICY NU MBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERAL LIABILITY DAMAGE TO RENTED $ REMI Ea occurrence) CLAIMS MADE OCCUR MED EXP(Any one person) $ -- PERSONAL&ADV INJURY $ -- — __ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ �OLICY UECOT F OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT t a accident $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ _AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ yypRKERg pM gpn N yy�gT U TH $ ANNyD ERM�PPLROC�YEETRp8R��pCIgARBTILNQETRY�EX N X TORY LA�ITS OER ' A OFFICER/MEMBER EXCLUDED?ECUTNEr N/A VWC-100-6017656-2014A 7/17/2014 7/17/2015 E.L.EACH ACCIDENT $ 500,000.00 (Mandatory In NH) �Y J E.L.DISEASE-EA EMPLOYEE $ 500,000.00 D �sCRB ON OF SPERATIDNS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD OWNER AUTHORIZATION FORM I is ')7%A M66Ln& (Owner's Name) , owner of the property located at (Property Address) (Property Address) T�JG�Irdl� 1,, S hereby authorize (Subcontractor) w an authorized subcontractor for RISE°Engineering, to act on my behalf to obtain.a building permit and to perform work on my property. Owner's ignature Date r i l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7� Parcel Application # Health Division Date Issued /1-Li/y . Conservation Division Application Fee Planning Dept. Permit Fee CJ Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address �I Ards Vuit Village l k I l Owner&KA � _�' Address BSI - kco« vk1V� Telephone Permit Request / 6 Car-4K� c.` I� l JC l (2 4nee- 7).0__&t--b n _f)ttki room n-oldt oV1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District D' Flood Plain Groundwater Overlay Project Valuation Construction Type :.Lot Size Grandfathered: ❑Yes N.No If yes, attach supporting documentation. Dwelling Type: Single Family ®. Two Family ❑ Multi-Family (# units) Age of Existing Structure 10k 2._ Historic House: ❑Yes �No On Old King's Highway: ❑Yes E o 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 _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 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 S i w��� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ltz� a C-" Telephone Number Addresses v License # 005-6 Home Improvement Contractor Email Worker's Compensation # ALL CONSTRUCTION DEB LILTING F4M THIS PROJECT WILL BE TAKEN TO 4� C, o to 47 SIGNATURE DATE i h FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER G. l DATE OF INSPECTION: FOUNDATION FRAME INSULATIONS FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL p. RNAL BUILDING I�. DATCLOSED OUT i F'ik7ASSCS ATION PLAN NO. p Departineiit of Industrial Accidents p _ Office of livestigations = 604 Mashingtaiz Street Boston,AM 02111 5y wivw lass g ovIdia Workers' Compensation Insurance A.ffdaNdt: Buiidirs/Contractors/Electilcians/P'Iumtpers AuHcant Information Please Print Le�ibl Name (3u.siaess/orgmiza-,ow divzdual): 6 Address: . ` City/State/zip: ',U!22K VIA /PfA 1000,tz, Phone#. t � Are you an employer'?Check the appr6priate bo. Type of project(required): 1.❑ I am a employers with 4. I am a general contractor and I 6 �9/N ew construction employees(full and/or part tune).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the atta.ohed sheet. # Remodeling ship and have to employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. g, ❑Building addition PTO workers' comp.insurance 5. ❑ W6 are a corporation and its 10.❑Electrical repairs or additions I officers have exercised their 3.❑ I am a homeowner doing all v.ork right of exemption per MGL 1LEI Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12:❑Roof repairs insurance required.]i 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 wntractdrs must submit a new affidavit indicating such. $Contractors that check this box mist attached an additional'sheet showing the name of the sub-contractors and their workers'comp.policy infonanation. I arrr an errrplayer•that is providing workers'compensation insurar€ce for my ernp.10yees. Belau;is the policy and job site vr�fQr"rnc�ion. . Insurance Company Name: . ` Policy#or Self-ms.Lic.#:_ (�U:Z Expiration Date: . Sob Site Address: City/state/Zip: Attach a copy of the workers' comp ens ation policy declaration gage(showing the policy nnm.ber and expiration date). Failure to secure coverage as required older Section 25A of MGL c. 152 can lead to the imposition•of.criminalpenalties of a fine up to$1,500.00 and/or one-year mrprisomnent as well as civil p enalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against the vioLator. 3e advised that a copy of this statelmnt maybe for karded to.the Office of Investigations.of the DIA for insurance coverage verification. g do hereby cerfify trader the pains arrd perrahiles of perjury i1sat the infcrrrradanpr"oidded above is tme�md carr eet. Siature: Date: L Phone# Official use orrly�. o trot�crite in this area,to he con i leted by city or rar,,ra off cif City or Town: Pernut/License-4 Issuing Authority (drele one): 1.Board of Health 2.Building Departs lent 3. City/Toma Clerk 4-Electrical Inspector 5.Plumbing Inspector G.Other Ceataet Person: Phone#: f Subcontractor's Insurance 2012 GL P01icy GL Policy WC Policy WC Policy Sub Contractor Effective Date Expiration . Effective Date Expiration All Cape Garage Door 508-398-2757 06/01/04 10/07/12 06/01/04 12/01/14 Baxter Nye Engineering&Surveying_ 508-771-7622 08/11/05 09/29/12 08/20/04 11/20/14 Campbell,William 508-790-3517 08/26/04 08/26/12 07/13/04 10/13/14 Cape Cod Marble&Granite 508-771-2900 07/01/05 07/01/13 08/16/05 11/13/14 Cape Concrete Forms 508-922-1910 06/05/07 09/29/12 12/07/07 :11/13/14 Carpet Barn Inc 508-548-1443 01/01/06 05/01/13 01/01/05 09/20/14 Chaves,Robert 508-362-9929 08/13/04 08/13/12 12/17/04 11/13/14 Christopher Costa&Associates, Inc: : 01/22/08 08/27/12 . 02/06/07 12/13/14 Coy's Brook,Inc 508-394-8442 04/24/04 04/24/13 09/21/04 12/13/14 Davids Building&Remodel 508-428-3214 01/01/07 01/01/13 06/14/04 12/01/14 Hill Construction 508-888-8154 04/29/07 04/29/12 ..08/14/04 10/13/14 Jeffrey Lauder 508-221-1046 12/09/06 04/05/12 . DBA-N/A 09/20/14 Kitchen Appliance Mart 508-77172221 08/12/04 . : . 08/12/12 01/01/05 12/01/14 . MAP Insulation 508-888-3599 1.0/01/07 10/01/12 10/01/07 10/13/14 Northern Sealcoating 508-398-9474 10/01/07 10/01/12 04/01/07 12/01/14 Pastore Excavation Inc. 06/05/08. 06/05/12 10/12/08 11/13/14 . Wood Floor Specialists :. 508-888-3958 1 02/03/08 1 02/03/13 T 02/03/08 12/01/14 1 JoB �'_'TA:.A�►F r Q-yQ rre _l., t Dom, r;. 41 SHEET NO OF v AA TAYLOR DESIGN CALM.LATEDBY TE t CHECKED BY y --� �. .... _..�_. P'1��,S.S A.G.�Wy t�r_.'TT 5...:. 5-�-�,r� ,..�.tr�4���•.o.(,y �e�,��, ...:I L:�tTt�-• s{aac _�P.S..: etLG-rGc.....- 30100 o _._. . tr c..,� ... `S t tz I Ar we ., ran.• 571, _. JOB C-2 D 9,Vt&O-) A-tn t pe P SHEET NO. OF -� TAYLOR DESIGN CALCULATED BY C2 DATE- .C6i`•L�"A- CHECKED BY DATE CALE �.,..Cato �. . . b5o c -r its-= ..mow . w . z ez !Mac-ne te. A-0r. OYO '3 (L. .ar... cv� rno�ws (4ss {3 V. te.. vrl.n� nR.xcpv—*, ..�41 d�"[' ��t. ci✓.. = 13� � � .. c4.>T . — r Office of Consumer Affairs and Business Regulation .� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 113786 Type: Private Corporation �+ Expiration: 7/16/2015 Tr# 241689 BAYSIDE BUILDING INC BRIAN DACEY r "" PO BOX 95/ 3 BAYBERRY SQ CENTERVILLE, MA 02632 '' ` Update Address and return card.Mark reason for change. sCA i 0 20M-05/11 Address 0 Renewal 0 Employment Lost Card �e�na»z��enrrtnetrll�o�C'il�aJdrec�ttdeltJ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 1.13786 Type: Office of Consumer Affairs and Business.Regulation /a xpiration = 7/16/2015 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 BAYSIDE BUILDING INC BRIAN DACEY PO BOX 95/3 BAYBERRY SQ 4 CENTERVILLE, MA 02632 Undersecretary bNotd without A�Ptun i 1. 9)nt YMassachusetts--Department of Public Safety Board of Building Regulations and Standards u Construction Supervisor License: CS-005645 ' BRIAN T DACEY- PO BOX 95 _ CENTERVII.LE CIA02632 r �c ° Expiration Commissioner 04/19/2016 1. A. Y,/ t f Aim 5 .. i f � i y r i I l tioF�ker y Town of Barnstable Regulatory Services Thomas F.Geiler,Director g� �� ATfD Ifi��k1 BufldlIlg Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabk.ma.us Office- 508-862-4038 Fax: 508-790-6230 Property C+vme* r Must Complete and Sign This Section If Using ABuilder • ��I ds Ovmer of the subject property � herebyauthorize �� to act on my behalf, -in-all-matters relative to.work authorized by this b�il.ding permit application for: . (Address of Job) Sign e ate Print Name Q:FORN4 S:01'Tn ERPERA4IS S I0N f r,. SHEETNO OF o - TAYLOR DESIGN g, CALCULATED BY TE 3- 1-= CHECKED BY l 't aN L..C�Tr�tv34t.�cru.e -ru L.ovs-� _. . . ...n.. .......... koim- off.,.... .. _ / 1 F SHEET NO. � OF TWOR DESIGN CALCULATED BY- DATE_.Cp"���� CHECKED BY DATE CALE czl Lrt t.'J . t to � � G J. — /ti .3(0 AS t (L�.mac... . le 1�•��.vr> C.�P4�F*r Cot.wnUesr�31. G�-.cc* (4.�3F�.� 's'i- . (41 ,qw���- i i 414 he _ P a � l d s�� oFro Town. of Barnstable *Permit# ' Regulatory Services L.rp "r'rr fe w BARV513LE, �$ �1q - ThomaMITs F. Geiler, Director Building Division gp T ' ` '(_11'Y Tom Perry, CBO, Building Commissioner TOWN OF SARNSTAQ - 260 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us �f ? Office: SOS 862-4038 �-P vo ('., - EXPRESS PERMIT APPLICATION - RE Fax: 508-790-6230 RESIDENTIAL ONLY Not Valid)PNiout Red X-Press Lrrpriitt Map/parcel Number Property Address 9 f1n e,r� c3t1 S 1 )N_ , _ F,►n ,�. ��e� `�� cc� - ❑ Residential Value eoof_Worrk S.CC)O. Minimum fee of$35.00 for-work under$6000.00 Owner's Name Address �/a Q,_ ,.1� .vl Contractor's Name Telephone Number Horne Improvement Contractor License #(if applicable) s Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ am a sole proprietor EWI am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy{I Copy of Insurance Compliance Certiflcate must accompany each permit. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will betaken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers.of roof) EK"'Re-side wn #of doors . Replacement Windows/doors/sliders. U Value t_ (maximum .35) # of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conscrvalion,etc. ***Note: Property Owner must sign Property Owner.Letter.of Permission. A copy of the Home Improvement Contractors License & Construction-Supervisors License is required. / 9 SIGNATURE; G� ; Q:\WI31.--ILES\FORMS\bijildingperi-nii forms\EXPRESS.doc Revised 0721'10. The Co i nrorrwea.11h of Massadwselts Deparf7rient ofI nditslrial Acciderrls Office of Invesfigalions iY . 600 Washington�5Ireel Boston :!V4 02111 f1.'t!w wass.govIdra 'Warkers' Compensi ion Insurance Af'fd.4-6t: Builders/+Conti-.-ictors,/Electizcians/PIumbers Applicant Information xlease hint Legibly Nance (Balsiness)Orgaui7abon7n&vidr>al raw/1 Address: /rT__;_/J1EE- 14u City/State/Zip: M4, Phone #:Are you an employer?Check the appropriate b Type of project(required), - I gatir a eneml contractor and I 1.❑ lam a ernployea-�t�ifh g 6- ❑.New construction w eruployees(full and/or part-time).* 111ve hired.the sub-contractors 2.,❑ I am a sole proprietor or partner- listed on tine attached sheet. 7. 0_Remodeling ship.and have no employees These scab-contractors have g. 0 Demolition ,working :for me in any capacity. employees and have workers' [No workers, comp,ft surance comp-insurance..Y �- [].Building addition 5. We are.a corporation and its ME]Electrical repairs or additions required] ''. ❑ p 3.❑ :I am a.homeowner doing-an work affi.cers have exercised their I LD Plumbing repass or additions myself. [No,tvorlcers' comp, right of exemption per NMGL 12.0 Roof repairs insurance required.]T c_ 152, §1<4)„ and vve have.no employees.[No workers' 110 Other comp: insurance required.] . 'Any applicant thstchecls box#1.mtW also fillout the.section below Oo.wing theirTvnrker'conrpevsatiou policy infonwtian- I Haaneown-Ers who submit this affidavit indcating they are doing aff work and then hire autsida contractors must submit.a anew of idavit indicating such- =Can1radprs that check this bout must attached au sdditional sheet showing the name of(he sub-contractors and state whether or not those entities have employees. If the sub-,contractors have emplDyLes,they.must provide their worker'comp.policy number. 7 ant au eu►plol er tkat is prop idirrg rt ark rs'co]rrpErrsah:on il:tsrtrrcrr.ce for my ertrplo�ess. B lowe'is tlas poliry and,jvb site infornrah'ort Insurance Company Name: Policy#or Self-ins-Lie.#: Expirntion Date: Job Site Address: City/State/Zip: Attack a cap), of.the workers'compensation policy declaration page(showing the policy num6e.r and expu•ation date). Failure to secure coverage as required under Section 225.rL 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 ciTnl penalties in the form of a STOP'WORK ORDER anal a fine � of up to$250.DO a day against the-6olator.•Be advised that a copy of this statement may be fomarded to the Office of Investigations of file D.IA for insurance coverage verification. I do ltem.by certify tsrGder the pairis.and pe,.tatti.es of peijeiry tltat t to is forrttrrhott prmrided.abotre L tr ug—and correct. " Si store: ' ` ' Date: Phone#: Q rial use only. Do not write in this area,to be conipleted by city'or town t7fcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. (`.ity/Town Clerk 4, Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Plione#: • IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 0ATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED �E POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN ISSUING INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. . APORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(iea) must be endorsed. If SUBROGATION S WAIVED, subject to the terms and conditions of the policy,certain policies may require and endorsement A statement rn this certificate does not confer ri hts tD the certificate holder in lieu of such endorsement PRODUCER G H Dunn.lnsurance Agency Inc Pc Box 330 BLDxerds Bey,MA 02532 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Stuart&Cc Lie 176 Teatic eat Hwy Unk 13 TestIcket, MA 0253UOOO y ^ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 00 - LTR I TYPE OF INSURANCE POLICY NUMBER POLJCV EFPECrWE DATE POLOY EVILATION DA1E A WORKERSCOMPENSATFUN D EMPLOYERS'LABILITY E PROPRIETOR! LIMITS PARTNERSIMCUTIVE OFFICERS ARE: IVCL❑EXCL❑ 9943090 9/1k010 9/15/2011 FARYLIMITS OTHER CwaapaA;0IwtoMAOpaalmvO*. CIDENT $ 500,00POLICY LIMB $ 500,00�4CH EMPLOYEE 500.00( DESCRIPTION OF OPERATIONSJYEHICLMSPECIAL ITEMS RE:NO PARTNERS ARE COVERED BY THE WORKERS COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION TOWN OF FALMOUTH MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN HALL EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 59 TOWN HALL SQUARE WIiTETHE POLICY PROVISIONS. FALMOUTH,MA 02540 a `AUTHORIZED REPRESENTATIVE rosy 'I'ow ®f Barnstable ' Regulatory Services �^JASS.. '$» Thomas F. G'eiler, Director r619. Building Division Tom Perry, Building Commissioner " 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 548-862-4038 Fax:.508-79026230 [IOMEOWNER LICENSE EXEMPTION Please Print DATE;, 10B LOCA,r10N: d wnber street village "HOMEOWNER" ' HA� �a3 4 t(___2 name 7tTe phone work phone H 7 CURRENT MAILNG ADDRESS: -J city o state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six units`or less aid 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 intendecl to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for•all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"' 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 requireme is a�d tha he/she will n y ith said procedures and,requirements: ". I i nature of Homeown.cr 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 Secti6n.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 109.1.4 -Licensing ofconstruction Supervisors)';provided that if the homeowner engages a person(s)for hire to do such work,that-such Homeowner shall act as supervisor." 6 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 ofva arene'ss 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/hcr 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 caret amend and' adopt such a form/certification for use in your community.. Q:\WPFILES\FORMS\building permit formSIEXPRESS.doC Revised 072110 of THE Tp� x + aARNSMBLE, ■ Town of Barnstable pIFD MA'S a Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us _ `s Office: 508-862-4038 Fax:.508-790 6230 . Property ®wrier Must Complete and Sig n Section � g' ff Using A Builder I, as Owner of the subject property hereby,authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name v If Property 0>wner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QAWKILESTOR Muilding permit forms\EXPRESS.doc Revised 072110 rk T�r Town of Barnstable *Permit# �oF - yP Expires 6 months fromisissue date * srns�, Regulatory Services FeeMAS anxx v$ 1639.. � Thomas F.Geiler,Director A'ED1A°`A` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number Property Address OiviS Ar Cesidential Value of Work r Owner's Name&Address 6WAla gp � Wee "69N / Contractor's Name �jele rl?o Gfl e� Telephone Number Home Improvement Contractor License#(if applicable) 11%✓,7r v. ' Construction Supervisor's License#(if applicable) � _5 ` ❑Workman's Compensation Insurance Ch one: r p I am a sole proprietor t X-PRESS PERMIT ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance JUN 01 3 2002 w Insurance Company NameTOWN OF TABLE Workman's Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to f ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side �/ 14 s Replacement Windows: U-Value _ (maximum.44) - ❑ Other(specify) ° *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,eta Slgnatua F Q:Forms:expmtrg F A0/.�o�nmaoozurea C o�./�agaaelauae a BOARD OF BUILDING REGULATIONS. °t License: WNSTRUCTION SUPERVISOR r Q Numbe€v 065651 ES f$M&T,'004 Tr.no: 24151 Re`stw �d xf MICHAEL D CRONE , . I PO BOX 92 MASHPEE, MA 02649` Administrator y. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registk-'al- l%--1 9388 Ex A ITdE106 //3fl 2003 Vie- bBA CROINE BUILDI,t BUJ I17CA�1=��1 MICHAELCROkNE� - `FP \ /> 75 CAYUGA AUE M/:ASHPEE,MA-02649 Administrator TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map G Parcel ZZia I v Permit# ` -52 `2 5EL Health Division Date Issued if Conservation Division Fee' f od ✓tea/ - Tax Collector, t Treasurer N09 , Planning Dept. Date Definitive Plan Approved by Planning Board ` Historic-OKH Preservation/Hyannis .Project Street Address gee- Village GAAXW& Owner �Ow� �tr1,41gaAW,`J� Address Telephone y621 l 6 Permit Request _ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost , ON O Zoning District Flood Plain Groundwater Overlay Construction Type ` Lot Size Grandfathered: ❑Yes 0 No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure c2d 41W Historic House: ❑Yes �lo On Old King's Highway: ❑Yes ..4r to Basement Type: ❑Full ❑Crawl ` O 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 Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other ' Central Air: ,0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: O Yes ❑No Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:O existing 0 new size Attached garage:❑existing 0 new size Shed:O existing' ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes ❑No If yes, site plan review# Current Use Proposed Use i • BUILDER INFORMATION 1�r Name C BG�e ApeZ/� Telephone Number 7 l 7 5f.3 Address / V'4e/ !�. ��OLc/ License# v Home Improvement Contractor# /'W as 6 p Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO • 6 SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. • ' ,t- r i ADDRESS , - .' j VILLAGE OWNER 1 +` ;. 4 a DATE OF INSPECTION FOUNDATION y f FRAME - y INSULATION 44L FIREPLACE ELECTRICAL: ROUGH = FINAL t• PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL' FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. ` r r c� -��••..: ...—cif..-��s�rvrz-a�r�irv�7rlaaCiiC.i3 r required unless same color/same materials specified on application =, Map/parcel number Sign-offs m: / Tax Collector Treasurer of quares of shingles or square footage of roof to be shingled ecify stripping old shingles or going over old roof. If going over dhow many roof layers existing now []what size are rafters? What is span? Complete dwelling information for the Assessor's Dept. -if known i [� Workman's Comp. form L3' Home Improvement Contractor Affidavit(RESIDENTIAL ONLY) '_- 1 Home Improvement Contractor's License OR omeowner's License Exemption(RESIDENTIAL ONLY Check expiration date on license COMMERCIAL WORK-No License is required. Fee q-forms-PERMITS 1 Rev 6W8 f 367 Main Street,Hyannis MA 02601 ` r f£cd:�308-862-4038 Ralph Cressen ax: 508-790-6230, BuiIding'Commission!:- Permit no. Date s 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. r. Type of Work: Estimated Cost !(, Address of Work: Owner's Name: 6zo— � / 0z k—� Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by taw C]Job Under S 1,000 Building not owner-occupied E30wner 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 Date Contractor Name Registration No. OR Date Owner's Name q:fbmu:Afr1dav �__ �=�� Olfict all�restl�atfons 600 Washington Street •�'u, Boston,Mass. 02111 Workers' Compensation Insurance Afflidavit aM name: location-- city �.� oa�e / phone ❑)It a homeowner performing all work myself. /////GR�'GG(///GiV//G(//IG�RtiRtiG�A//(iV�(4W4G(•G�"'✓%�� �//////�i%//�//�//IG%//%/ ///J//�///NI'i... I am an employer providing svorkers' compensation for my employees working on this job. . comnnnv name: address: :.. :;. . . ... .. city nhoee* insurance cn. 011cv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who hale the folloning Nvorkers' compensation polices: comnanv name: address- .... .• dtv: phone* •'v insurance co. 11oiiiv#••• . .. ►:- ... % :: ;::. ««X<,:,.... •.4:<:,... ..k;i�;{7ti:•J ;..j�..i.'�•�'jv'xvvm�S.Vr::. comnanv name: :... ... �r:•k,.;::... ... address- pits: Phone#= ... :x:,....;:. ................... . .•.:.J..•.:... mow..' ...'.. ... •' •♦ insurance co. oiiiro# ...,....:••.:••,•..:•':;N .a..:::.:. .aa -r % '////,/%� '/l/,%%//O//////////% 'l�///// / Failure to secure Coverage as requited under Section 25A of MGL 152 can lead to the Imposition,of erfmwat penalties of a tlae tip to st300.0o and/or one years'imprisonment as well m dvil penalties in the form of a STOP NVORIC ORDER and a line of SI00.00 a day against me. I understand that a copY of this statement may be forwarded to the OMce of Investigations of the DIA for coverage veeitleation. . 1 do hereby egnify�under the p ' an enalties of pedury that the information provided above is true.mid correct Signature _ Date Print name /�PlJch a�� Uw Phmte# �d�y273y Econtactper3on: do not write in this area to be completed by city or town official town: •:permif/lit ease o Mudding Departrnent [3Llcensing Board diats response is required ❑Seleet:nten's OfIIce C3Health Department phonet/: 0 Other_ ltsv+sec d,95 PJAI Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for tht: employees._As quoted from the "law", an employee is defimed as every person in the service of another underaav�can of hire, express or implied, oral or written. An employer is defined as an individual partnership, association, corporation or other legal entity, or any two or more c: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec=zer trustee of an individual, partnership, association or other legal entity, employing employees. 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 an such dwelling house or on the grounds c: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew- of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the . commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work utmi acceptable evidence of compliance with the insurance rcquiremeais of this chapter have been presented to the contracting authority. Applicants • Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insu ace coverage. Also be sure to sign and .date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is ,being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of thr affidavit for you to fill out in the event the Office of iavestigatioas has to contact you regarding the applicant. Please be sure to fill in the pernuttliccase number which will be used as a reference number. The affidavits may be rictami3 io the Department by mail or FAX unless other arrangements have been.made. The Office of Investigations would hlce to thank you in advance for you cooperation and should you have any questions. Please do not hesitate to give us a call. The Deparanent's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of Imrestfoatloas _ 600 Washington Street Boston;Ma. 02111 fax#: (617) 727--7749 phone #: (617) 7274900 e= 406, 409 or 375 II 3 ✓�ie �OMAN iuuea�/lt a���cra�ctcfzuretl DEPARTMENT OF PUBLIC SAFETY 1 CONSTRUCT.iON,SUPERVISOR LICENSE Nu�ber Expires: Restr'lcted To 00 HICHAEL D>`CROUE 75 CAYUGA AVE MASHPEE, NA 02W ' } � 'PFYa,o'-Cr Z-3`.�. •'' d' �.t I'-71 ✓ fir' !'`_ ': = Stia4388 �`�- e a . Y � xp�ratian Rr 6/24/94 fi� � �- tROV LD NG TRENODELIV6 f11 AEL !� CVE: #b � �t;ATOR AVE 3Rw, UMW#� i ,'r y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ", Permit# 3�3 33 - .. d won Date Issued /d - 47' 90 • �' � Fee Treasurer Planning Dept. r Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Addres 1416,14 .S w Village a0� Owner /b n, e� Q Address Telephone Permit RequestOU Square feet: is oor: existing proposed 2nd floor:existing proposed — Total new Estimated Project Cost - �0 Zoning District Flood Plain Groundwater Overlay Construction Type rh/ 4- c) O0ell Lot Size 4C Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Al*' Two Family ❑ Multi-Family(#units) Age of Existing Structure_ S Historic House: ❑Yes. o On Old King's Highway: ❑Yes W- No Basement Type: X�ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing " new Half:existing a new D .ti Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel:�s ❑Oil ❑Electric ❑Other Central Air: O Yes Al No Fireplaces: Existing New 'Existing wood/coal stove: ❑Yes 4-90 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 Ada, el �i�(�W�' Telephone Number _�W Address .5' 6a V v e;_ License# �S (t6 __6 ,&_As�toe A4- 07 6 Home Improvement Contractor# ~ Worker's Compensation# A1�4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ri Vf SIGNATURE R DATE /4 ' 2d 97- i y FOR OFFICIAL USE ONLY, PERMIT NO � s� `' ! � • � �'1�� _- . ' �" • ,•" r :� is r • , � _ s ,DATE ISSUED • - MAP/PARCEL NO:. t ADDRESS VIL12AGE OWNERFl y DATE OF INSPECTION" ' T FOUNDATION FRAME 1 • 3' - .fir � ., INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL ' E PLUMBING: ROUGH t FINAL i - • ;y, r GAS: ROUGH FINAL K F k FINAL BUILDING' -"' DATE CLOSED OUT + ASSOCIATION PLAN NO. t n The Town of Barnstable �$ Department of irealth Safety and Environment Services Building DtvislOn 367 Main Strew►Hya=ds MA C60I Ranh Crass= Oil ME.790-6ZZ7 +` Huildkg �s-r Fax: 309-7M-6730 For a use oniy Permit —Y War AFFMAVIT HOME zwROVEMENT'CONTRAGTOR LAW `SUPPLMWENTTD FERMITAPPLICA17ON MGL c. NZA Rquff= that the "rercustracifOn, siteratfons, renovation,, repair, moderniz:aan- conversion. improvement. removai, demotIfion, or construction of an addition to any pretzissing owner occupied building containing at Ivan one but not more than tour dwdbg Waits or to structures which areaddscent to such residence or building be done by registered contractors. with certain c meptions.siong aith other requirements. ... Type of Wor ,c/l Est.Cost• /� ®y� — st: ��� Address of Work: . Ae Owner's Name Date of Permit Appffcstion: I hereby certify that: Registration is not required ror the foitowing reason(s): Work ezduded by taw Job under SUM Budding not owner-occupied WUW Pulling Own permit Notice is inert G T� OWN PERMI? OR OEALMG WrM QNREGIS' MIC OWNERS ULL CONTRACTORS FOR APPZ'I�ON PROG:LAh OR GiJARAN'CY FUND UNDER MGZ i4ZA LE HDIVIE MIPRCIVUAMT WORK Do NOT � ACCESS TO TSE.�I?RA %Gs- D UNDER PEi`"TM OF PERJURY thereby uppiy fbru.permit as the eat of the l Cantractor flame $motion No. Date OR t, Oweees flame Daze —-=— The Commonwealth of Massachusetts _ . " - Department of Industrial Accidents Office offfiYesdoo fops - 600 Washington Street - .`v Boston,Mass. 02111 i — Workers' Compensation Insurance Affidavit p/ name: 2-ti,it'-, 11 x e /-C'a(� location: ` �p CitV zZ&,�IW4-- o a.W ( phone# O7 7 y ❑ am a homeowner performing all work myself. . I am a sole proprietor and have no one workiz in acity /G%%/. RX%/i%%%%%%%%%%%%%/G%%%%%%%%%%%%%%/ %/ /%/%%%/%%%%%%%%%%%%/////%%%/%%%///J�%��%/�%%%/�%%//////%//�iG '91�, ❑ I am an employer providing workers'compensation for my employees working on this job. . ...... ......... ............. ::::::.:::::....:::.. an name.; .: .:::..:::::: ;::::-:-:::..:.;:.;:.;;;::::::.::.;:::.::::::;::;.;:.;;:.;;:.;:;,;>:::>:::......:::.: .:: - wy y .. ;:::.::.>;::. .. 1. :::.i:.:.i::::.. .. ...:.:.::.. :. .::.;. :.;.;.:..::..:.::.:: A' r>:: :: .. City ;.:::..;; ::. .......................... ...:. ,..:::.:Dhone#: a.;:t:::::;::;:.:... -:--.: :,:.:..: >::>::>::::>::::t:_::.;::::e<.::.>::::>::>: :::::::.::.:.:..::>:.::.::.:.:.:.:::.::.;:.;:.;:.::.>:.:.:;.:.:.;.:;.:..,-.,.:.;:;.,':::.:::;;;.::.:>.,:.;:.:t: insurance co ::;:.:.;'.<. : : ::>;:::;,;::.::.:::.;:::>::>:::»::>::;;:zs::•;:<:::>:.>::;::»:.>::>::::>:.>::»::>.:::>::::::.....::::':':...:: .xo ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have `- the following workers'compensation polices: . ::,..:. com !nv name. ;.:::::;:.::.;..>::':.::.>:>;:.::'::.>:::;::.:>':>::»<::::>:::xxx t::;:.:<::::>::::::>::::<::t::t::<:::>::>::::::::: DM. .::..:::;:* ���i�i��iiii�����������������������!�������������:��l�:�l�:� ..... . :; ::;:,, ,- X::* ....... *, X--**...-::::::;;:X::; :Im, I. -''I''.I...I.. I :>z>:: :<::<::: ,..:.;:.::.::::. ::::::::::::.;:::,:::.:::::.::::::::.........................:.::.::.:............-:-:-.................................................. address:. ....... .:., ... . .:.,.. .....::... . . .... : :::.:.....::...:....::.::::::.:::::::..........::.::.:::::::.:::::::.::.....::::.:::.::::..:::.......... ..:.:.;:. ::w S!:.ctx.:,. . r. .:::.:.::::: ::::::::.:•:::::::::::::::::::•:::::•:::::::.::.::::::.:::.....:.:::::.:.:::..... .................. :.:.::.:..:::::::::::::.:::.:.::::::.:::::::::.:::::.:::::::•::::::.:::::.::•...:......:.........::::.:::.•:::::....... :..................:.............................................:::.::::::::..::::.::•:.:.:_:::::::._::: � :<;:: 3 ..., .,....::::::.:::.:::..:.::::.::.:::::::.:.::..................%........................................ ::..:..,., .trr :.... :..;;i.;i:I..iii:.if.; '..:..:.:.: .........:........ h :::;;..:.:: Z. :::..::.;:.;:.;::...;:.;:.;:.:;.;:.:..;.;:.:::;: Done#. ::::>:::':;:::>;::»:::: «::::<:>:::::<<>:>::;>::>:«::<:>::>::><::<::::::::>:::<:::::::>:<:>::>:<:>:<>:::::::::.... ::•::::i.••••:::. tt•i:?i::viv:ii} ........:w:.�: ':�::........... ,:::::::::,�.�::::::::•r::.�:::::::•.. .... .:.::::::::...:::.�::::::::::::::::.:....:::::::::::::.:iii:.::v...:::::::.:::::......:::::::::::::::::::::.�::.::�:::::.�::•::•::.;::•::.:ii::':ist•:.i:.ii:.i:.i:•::t:•i:.::i•iii....i:.::.;;.::::::..................::::::::i ii:•.:.. ... .J:....... ...::::.::::::::........................:.....::.::::::::::::::..............................t..:...,...f............................a... ..::�..5.. .....A.:::.vrr Cc e,CQ:..::::::::::::::::.:..::::..::.:.::::::......,.:::.:::::::;.::::::.::.::;r.:.::::;:a....r>:•;::.:a.;.:...:,.:.::.:.....:.::.:.:.. M. ::.::::::.:::::.:::.::::::....................................:......>r.+:':.�.<.�..............:_. ...-.< camDaav name: 1.:: .. .. ...:......;;; ......:.:::..::::..... ..::.:::. ........ .. .. :: ............. ......... . . :.;:.::.;:::::.:..::•;;::;.:;: ::::............................. ...................:.:::.......: ... :x ;:? .......::.::::.::.: ::: address:' ....::. tltl»w. tihene#.. ..::..:....;:. ..: :.:...1....... .........................:::::::::.:::.:::::::::::,"-'-,`--::.........................................................................::::::::..:._:::::::.:::.:::::....:::.:::::::::::::::::::::.::::::::::::::..... .................................................................................................................. ::.::::::::::::.:::...:................::::::::::::::::::::::::::::::::::.::..:t:: :::::.:::.:::.:::::::::::::::,.::::.:::.::::.::::.:::::.::::,..::.,::::.:::::.:....................................... ................:::.. ::.::..::::.::::::::::::.:::.:::::.::::::::::.:...........................:..........::....................,,:.......... > A.:�... ::::: atnrance.ca...._. ..............................................._......_._......._:...._........................_..,,..,.:... olicv#.....:::::.::::,::::.::::.:::::.:::.:::::::::.::::::::::::;;::.;<>N;;.tt.,>;;;:..<...;:.;>>::.::.::: Fafisue to seems coverage as required under Section 25A of MGL 152 can lead to the ingaddon of crhnbW penalties of a fine up to S1,500.Oo and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Offlce of Investigations of the DIA for coverage verifiestion. I do hereby cartijy under the p ' and es erj that the injormalion provided above is tirrw and coned Signature Date �� " `�� Print name /' / / 'cG / -�b C�®���___: Phone# � �/ /��3 / official.use only do not write in this area to be completed by city or town oiHdal • city or town: permitilice se# QBupding law— Department ❑checkif Immediate response is required (]Licensing Board ❑Sdectruen s Office ❑Heal&Depart contact person• phone#; _ ❑Other 4avued 9/95 PJ/U Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the:.r employees. As quoted from the "law", an employee is defined as every person in the service of another under any co=-- of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive:c: trustee of an individual,partnership, association or other legal entity, employing employees. 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renew&' of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant.who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. , Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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 returned to the city or town that the application for the permit or license is .'being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed 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 sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned fo the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat 406, 409 or 375 7=CZMAp0..stj ' � ._ � TabtaJSZib(eoa�aoe� ` Fj sm ipdn Fadca;ea for O6 and Twa-Familp ReaWUMW Bnlldlow Seated with Fmd Falk !MAXIMUM NIIamum ceiling Floor 8aaemaat slab Hradag/C.00liag A m''((%) u v.iaa� &Vahmj R�daa� ipybLj wag ?aim= Emir' Pa.' -1 &w8fi a' I a-vaim, S10I to 6500 Heads;pe0e+ee pays' Q 12% OAO 33 13 19 1 !0 6 Nomai R 12% 032 30 19 19 10 6 Nommi s 129i om 39 13 19 10 6 U AFUE T 15% 035 38 !3 25 WA WA Normal 11 13% OA6 35 19 19 10 6 Nomal i/ ISb" A" �s Ida WA WA "AFEM w 13% 052 30 19 19 10 6 sS AFUE JC Is•/. am 38 13 23 WA WA Noma! Y IVA 0A2 31 19 23 WA WA Normal Z 12% 0 42 3s 13 19 10 6 90 AFUE AA I 030 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING. 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-f=4980303a r r Footnotes to Table J5Z.lb: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,. skylights;. and. basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross walI area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 it'of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the fulI insulation thickness-over the exterior walls without compression, R 30 insulation may be substituted for R-3 8 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the condi Toned spar:and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall. For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade wails. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement descnbed in Note b. 'The R-value requirements•are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.Z.la NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 035). c) If a ceiling,wall,floor, basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I OEPARIBENT OF PUBLIC SAFETY CONSTRUCTION;SUPERVISOR LICENSE Nu�ber Expires: Restricted:Tu 00 MICNAEt='D'r'CROOE JZ.,,wWeW 15 CAYUGA"AVE MASHPEE, NA 02649 k w . I�D�N6 i"REMODELYN6 ��'- 926�4 t � TOWN OF BARNSTABLE Permit No. - — -- 1 �mn..� Building Inspector cash ------------------------ P"L VAI OCCUPANCY PERMIT Bond ----__-----------__-__ "No building nor structure shall be erected, and no land, building or structure shall be usled for a 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 Suffol'r Pealty Trust Address —hree ive, Gent= Wiring Inspector Inspection date Plumbing Inspector — ,,. Inspection date Gas Inspector Inspection date 1 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. ....................................................-7 19....._ _ ..................................................................................................._........-_ Building Inspector SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANC TOWN OF BARNST11h"LE BU INSPECTOR APPLICATION FOR PERMIT TO ........... ....P/,Suf fb,�!Ik Realty Trust' The undersigne hereby ap lies for a permit according to the following information: Proposed Use .....sinale family residential ' Nameof Architect ----------------------Ad6rou .......................... ......................................................... Number of Rooms -------������----------.Foundation ...............pq!�K���..!����������-------.. Exlerio, —' ...�j�inol�g.-------------'Roofing —.�/�o�alt�— ��.-----------.. �� nla Floors �����I��t'g!���..������l�J����t------.]nteri�r --_..i7���g�t`..~—..�t���----------.. Heating hgt..J�ate)�...bY.. ' J.....................Plumbing ......................Pff.Q..................................................... Fireplace ..............bucicic.8...bl.Qc-k.................................Approximate Cost ----- ............................. Definitive Plan Approved by planning Board 19 Area 1.8.4.0 —' � u of Building and ov/ /ng nn Dimensions"*.^ � __ SUBJECT TO APPROVAL OF BOARD OF HEALTH (3 AX . 10 ~~� � p~ / � � w - ' — r .� f~'| hereby agree to conform top -- n - � of Barnstable regarding He abovecons,rucfion. � � �,� ' Nome —. ---.... ` '8off0lk Realty Trust v � � � ( 2lUIO oue ^^No Permit for ~~~^�� ^ ' ..-----. � -------- --- � ___.. .. .dweIl _____.. Location ---l�--.-------.Driva___.. ' __._._,___.CeoterviIle,_________ Owner ----.SuffbIk,B I .Trust_.__ ` �ra�a ' Type of Construction -------------- � ^� --------------------------.. Plot --'------.. Lot.---.#3O----- Permit Granted — �l'�.]g ?� ' ---'~ ^ � ' Dote of Inspection —..�����'�—�...�---l9 . Dote Completed ---_—. ------]9 ' < PEPJAIT . . : . REFUSED ' . � . . ----------..--.-----`—.. . . ----.---..-- ...................................----.. . . ' . . . --.---....----,--.---... —'�..--.—. ' .--.—,,---.-------~.--....----... � -----~-....—.—...,....—..—..---.�.� * Approved ........ lV ^ � -------------`—......--......—..�.. . ` . -------'.---.---------~---.— ^ | �� ] Assessor's map and lot number .............................. ( 7 q YNe r f � . tp Sewage Permit number ................................................. ..... - 1 T Z BARNSTABLE, i Housenumber .................................... ..................................-. 90o N & �e o MAX a' TOWN OF BARNSTABLE I� BUILDING INSPECTOR APPLICATION FOR PERMIT TO SuFfolk Realty Trust. ........................................................................................................ TYPE OF CONSTRUCTION ................Si. .ng.: l.e....famii. . . . .....re. ...sidenti. . . . .al... . . ... .. . .. .. . ..::.Y .. .. .. .... .. . .. ..................................................... aanua r;v'..3�.............19..7 g TO T.H.E—I.NS.P_ECT..OR_OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ................r:nt....r...?f1,.T,hrPP F ands., Dr.i.vr ....................................................... ........................... ProposedUse ......single.....amilv...`esidential............................................................................I......................... Zoning District ...'?;lncr1Q fam:.ly residential Fire District ......Centerville—Gsterville ............................... ............................................................. • Name of Owner .Su Eolk ..ealtY Trust Address .......P.C.•...Box 308 Centerville ..... .......... ....... .. ........ ..... ... . .. . ......... ........ ................ . .... ..... Name of Builder Same .....Address sarie ............................................................... .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms s,,,v�'??...............................Foundation Dour. ed Concrete ........................... .............................................................................. Exierior ..... t'3�t1 shi.n.al;es..........................................Roofing ....asphalt shingles .......... ..................................................................... Floors t... ....rp - wor underlaymen{ ...Interior skj.xn--coat olss�er................................ .n................................................ ....................................... Heating ... ......................Plumbing ..................... v ..................................................... Fireplace 1,. ;c.K.......... rrk..................................Approximate Cost 3C; .000, 0Q Definitive Plan Approved by Planning Board _______________________________19________. Area 1840 .................................. Diagram of Lot and Building with Dimensions } ' Fee f ........•. j ............................. ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH lr r c AN I hereby agree to conform to`all the_Rules-and-Regulations of`the Town of Barnstable regarding the above construction. . Name...s... ................ .........�..................'*"``................ Suffolk Realty Trust A=193-192 a y 21010 .....one stor�r No ................. Permit, for `x singld family dwellin Location 1. ... 9 Three Ponds riv .. . ....... . ... Centervi ale ............................................:.:,............................... Trust Owner ....................Suffolk Re................ ...I..t..Y.................... Type of Construction frame f I .................................... ....................................... i L Plot :........................... Lot ....... ..... � Q ... i Permit Granted ........Januaryu..31:...........19 79 Date of Inspection ........................ .....19 Date Completed .......................... ..........19 PERMIT REFUSED r ...... ......... .... �.... ..... 19 ...... .......... � `' ...................... ........................................... .................................. ............................................... ..... .............. ... i.....�....................................... Approved ................................................ 19 ............................................................................... ............................................................................... 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A � m / � LI DATA ,t y f re 10 ! 3q . ' sv 0 Z 7- P 130 yT.a I . l � TEST- A O L E- � �, �� RESULTS 3 G Z `�-� / 2.8 ' F / D le- r' 'vL �,,�tiy vo o �3 � o � � T � � o -S U E K, 0VEA? -5 GE 14- 1?0 Dc_ S / G LOF? 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I _. .. _. __. .. .� �i. I➢I:. >f II_ ,x, ik ;., ttr tl t ( '4 {}.�,, a,. tl,: tt'� .. .:A': lL w .: .. � ❑ � ..: .=in,',--- '�'.:a ��a t._: r n'.]k,„v ��::: I h�'..iz�; 5I ;��lh � 1�"3 :�. -. "� � Q.. ILLI I. :�t: - - � �3 - I .I - ADDITION ." i ! _ ADDITION I I I y f — y I I I I r—. ----=---------------- ----�� -=- ! SHEET L I I I 1 -------- -------�- ��--- --------- ------ -- ---�-- -- RIGHT ELATION LEFT ELEVATION yoB: 1408 SCALE: V4' = I'-C' - .. :. .: .: .. SCALE: 1/4' _ V_L,. :. DRAWN"BY: KW DATE: : �t/3l14 Z: IN ADDITION O _ /. Y^ .. .. .. .. .. .. .ail MEMO - - - lill JJJ 4 4 5/0" q 4 5/8 4 4 5/0 - m j i IN INN 0 iCp . .. :': �.. .. I ': I� o mm_' ..N EW p „ SCREENED PORCH. —�_ '. o PATIO - _ . L•I U a � L _ o F IA R N J\ NEW b'SLIDER .. � .. - O m 2m .. .: .. .. .. .. -. .. .. S/IOW .B .: .. iI .. .. .. . ... .. .. A N.. aa V P°v 2 HEADER 3 2xl MDR HGHT .. � %°A F F ..lisp CHAIR'RAIL+ (3)2.12 HEAD .. .. MA o CLOSET ... 4g _ UPLIVING v jz Cl2 .. .. .. .. .. .. .. - _ .. .. - 25'3/4°x25'3/4• �A,1H5�' WAINSCOT � � ER :DINING (CARPET).. ROOM II c ROOM d,1 MDR HGHT.. .. � � OPEN TO AZOV (OAK) .�. .. .. 2 18° 2� .. (2)9 I/4'LVL'S ABOVE I-—— —— — —— — - . y v_ .. .. LIN. CATHEDRA j I CEILIN4 - - 9'-b' - a 3'-0' S'-4n. V-0' j4`4° - '°'-6' FAMILY .: �� -_ Q .. W.: 2 �44.4 c. im .: .. .. H. .TW24410 .. .1.1 T" ROOM Q. _ . --- - 30 1 0°x ° MICRO77a, . .. . . 3 PIECE CROWN MOULDING- .. .'T PANTRY O C . (OAK): � ry SUITE (OAK) KITCHEN I zm c12 _ . . UITEER - 2Q .. ..: m .. _ ABOVE 2 i J _- 25':3/4'x25'3/4' . :. .: (CARPET) �. MDR W.W. .. .. OPENED TCN E ;Z - _ A.F.F. N KI � F - � U Q .. .. .. 10. .. CHAIR RA.ILf. BEAD BD .. 2l. .. .. _ .. .. .. .. OUTSIDE. y Z .. .. .. .. TW244 .. WAINSCOT .- .. I... .. W-4 1/2' �9'-5.1/2" SHOWER; W .. .. (OAK)m LAUNDRY:: /5 - FOYER I[ CATWEDRAL .. - uP I I BREAKFAST I'— o o 28 N a DAK LA .. .. '. .. .. � OAK v CLOSET _ .. - .. .. .. .. _ REF. .. T(3)ZxIO HEADERS R7�. m I ABEAM OA'�O�J,E WORKBENCH - �w .. m BRICK 1 1 m w ^ I v� \ 9 LITE V 2360 m (2r110 HEADER: PO � Q _ .. R--� - - - - �—w _ - .. _ :. 1 .._. - 4w24410 �° Z .. .. ..'2'-9' 10'-6' - 2'-9' S'-0' B'-9' 4.9°. W-6' 0 4'-6' - - .m 30 /B'x60.7/0' gly -, J S .. _ n l!- .. .. .. @c IL .TW24410 GARAGE TW244a: _ .. � 30:I/B•x60�7/0• .. /B• : . tu =3 FIRST :FLOOR PLAN SCALE: 1/4" 1._On W/ �AN501'1 w . i SHEET L7 .. jo&B 1408 DRAWN BY: KW' DATE: : Z: - -- - 'I . � {n. _ .. (2)P.T.2d0 GIRDER' I I .. .. .. .. .-I P.T.6.6 POST .. ~ . O1�ICONCRETOSE FOOTING .. .. .. .. ... I. _ . .. .. W .. � .. i 25°BIG FOOT .. .. I I W 4 L: I m Cb ao : . t o s m O *ww d I IXIsnNG I BASEMENT..: FOUNDATION PLAN I�.I SCALE 1/4" 'SI DOUBLE E6RIM JOISTob . .. .. .. JOIST HUNG"BOTH ENDS: .. �. .. .. .. .. .. .. ..-.. '.'. .. - SIMPSON H2.5 � "FA MPSON H25 ..: .' FASTENERS AT ALL - -' _. .. RAFTER/TOP PLATE - � . .. .. .: .\ -..: - - .. PLATE JTYP.'ROOFTOP. .. ..: .. .. .. ..: _ JUNCTIONS TOP .. .. ��j�N�� � �IX13TING ,A .. -.. ERS OP 2x10'e 6"16'O.C. N W -- T D^.RAIL. ALL .. .. .. .: .. .. DM ROOFING LA .. .. i: Ixb FASCIA�'/Ix4 SECOND MEMBERNOT FORT DECORATIVE USAGE .. .. .. .. .. ..: .. .. .. CONTINUOUS VENTING SOFFIT .. .. .. . .. ... ... RUBBER MEMBRANE . 5/�8°�PLYWOOD .. .. .. .. .. I .. .. I IxB FRI¢E BD.'W/BED MOULDING ' IOOD SHEAT'NING/ • . .. - .. . . \ .. 2x10 CONT HD sPOST CAP BC82 .. ... PT .. � (82x1 m . .. .. '..`r� FASTENEDLEDGER b°5/8°R 12 _ _ .. dx4 P.T.POST .. .. TYP.EXTERIOR WALL LAG BOLTS 16° m 2x10 CONT.SHDR'. o .� -IXISTING I.. .. .. c SCREE ED PORCH FIRST FLOOR. 8� .. .. ,Do DECKING j F 0 a. . m IFT .: IXISTING .. .. .. : . .. .. .. .. G ___ _____ ___ __ . .. .. .. - SOLID�AZEK.SKIRT. � TO BELOW RADE 2zl{ F IXISTING w ' BASEMENT 6 BASEf'IENT ..: ... : : ... P.T.2XIIO GIRDER .. .. .. .. .. .. .. `P'T-2xi0:LEDGER .T - _FASTENED W/(2)5/S° - w .. .. .. LAG BOLTS 16.D.C. — 8'O° � 1 : .. .. .. .. .. .. I .. .. P.T. 6 POST ' SIFIPSON.POST.BASE - 10'CONCRETE SONG PIER L J .: '. L I J J 2B°BIG FOOT FOOTING .. ,(—. o — ' ..ADDITION ^, IL Lu FIRST FLOOR FRAMING PLAN ll .. SECTION SCALE. 1 = —on .. .. U. I' .. .. .. .. 111 Q a. o � ll! Q. to a. W Z.. z3 H . SHEET JOB: iawa DRAWN'BY= Kh! DATE: 4f3/IA