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Town of Barnstable *PermitX,RR
ES PERMIT Expires 6 months front issue date
®�e Regulatory Services Fee
AUG 14 2007 Thomas F. Geiler,Director
TOWN
Building Division Co- Fit
Tom PeCommissionerS/b7
,
0
� BARNSTAB�
. y,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 (70
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press bnprint
Map/parcel Number 1 ( 3
Property Address 61QV (¢J (-A
❑Residential Value of Work Q CO Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address C 4 A
Contractor's Name eWqk11 Qla-C Telephone Number
Home Improvement Contractor License#(if applicable)
—�- -
��
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
C one: -
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compens lion surancee
Insurance Company Name
Workman's Comp.Policy# (,(A od)� O l
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to " l°b�.�1: `�✓ .
❑ Re-roof of stripping. Going over existing layers of roof)
e-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
A
t
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
I
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Ho em t Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
^,''� ..,. 1.,�?��i�"" �tln}�Y� .F. ^wswoVix'nc F,n+4s3'�-�.�', Tatat:g'.9y+1°d"i.7o'Xq'�p"s^;c".+w''aC•rr°^. �^7.w... -..Y�'V"'z�L:��%G�'r��''t^"''�'y�.�'l`E`�'"q°'�u.'�.«'•'-"'" r�r v-.--�. � o
- r ,ssr lad • ; -� '
v �
P.O. Box 311 E M�AV�TT� h 508-367-1679
Centerville, MA 02632 � � Th T;R U CST I O Fax: 508-790-1856
PROP AL SUBMITTED TO: PHONE: t DATE:
STRE€T- JOB NAME: JOB#: ��
{ (Aj v (k l�( d
CITY,STATE a d ZIP Cp JOB LOCATION:
C . u��
ARCHITECT: DATE OF PLANS: JOB PHONE:
We hereby submit specifications and estimates for:
0
-- cill�- U) L f�� oil.
¢ Vr0P05¢ hereby to furnish material and labor-complete in accordance with the above specifications, for the sum of:
dollars($ '2, ?orb. nt )
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices. Any alteration or deviation from above specifi- Signature
cations involving extra costs will be executed only upon written orders,and will become g
an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be
accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by us if not accepted within days.
insurance. Our workers are fully covered by Workman's Compensation Insurance.
CC>e�ltdriCe of propool-The above prices,specifications
,bad conditions are satisfactory and are hereby accepted. You are authorized Signature:
fo do the work as specified. Payment will be made as outlined above. l
Date of Acceptance: Signature: �,✓ w
J GTE Panv�.aoouueczlCl a�
i
Board of Building Regulations and Stands:ds License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registratio 145356 . 1
Ex iration One Ashburton Place Rm 1301
p 1/12/2009 Tr# 127522
I Boston,Ma.02108
Type
i'
1 EMMANUEL CONSTRUCTION ' "
HECTOR SANCHEZ �' '}
. `286 STRAWBERRY HILL?RD {
}rX CENTERVILLE,MA 62632 Administrator Not valid without signature
The Commonwealth of Massachusetts
Department of Industrial Aecidents
Office of Investigations
^�' d 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumb.ers
Applicant Information Please Print Le 'bl
Name(Business/Organization/Individual): .
Address: (//�L OAC 3
City/State/Zip: Phone.#: ��
Are you an employer? Check the appropriate box: Type of project(required):.
1.❑ I am a employer with 4. EJ I am a general contractor and I
employees(full and/or part;time).* have hired the sub-contractors 6. ❑New construction .
2. I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling
hip and have no employees These sub-contractors have g. Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
'3.❑ officers have exercised their I am a homeowner doing all work 11.El Plumbing repairs or additions
myself: [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' •13.❑ Other
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 anew affidavit indicating such.
TContractars 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 providb their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is.the policy and Job site
information.
Insurance Company Name:
Policy#or Self-ins,Lic.#: / � Cj��. ®� 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 IIA for insurance coverage verification,
I do hereby certify:end ains-a enalties of perjury that the information provided above is ue and correct:
Sienature: Date: 3A
Phone#:
Official use only. Do not write in this area,tb 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#:
�j►,E 'Town of Barnstable.
e y
Regulatory Services
Thomas F.Geiler,Director
'OTfc�t..ta Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,-MA 02601
"w.town.b arnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using ABuilder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to.work authorized bythis budding permit application for: .
(Address of Job)
Signature of Owner Date
Print Name
Q TORMS:OwNERPERMIS S ION
l
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 113 Permit#
` Health Division Date Issued - (Y-
Conservation Division Feed 00
Tax Collector
treasurer h"
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
' r L
Project Street Address
Village DIMEL `
Owner _bam" 4 S L PC id o(D Address 139 'k)a/u0,`61c I/
Telephone 50L(- `*_12 //,6
Permit Request f�D G�1 G/1 (�� l l��O� GGlJ 4VZ* tZlr��f/l�vo
(Squarest floor: existing' proposed- 2nd floor: existing proposed Total new
Estimated Project Cost Zoning District Flood Plain Groundwater Overlay
VConstruction Type
1 '
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
C
Dwelling Type: Single Family ❑ Two Family 0 Multi-Family(#units)
ge of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
'J
asement Type: ❑Full ❑Crawl ❑Walkout ❑Other
r_
sement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
L
umber of Baths: . Full: existing new Half:existing new
0
1 umber of Bedrooms: existing new
a Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: O Gas ❑Oil ❑ Electric ❑Other
Central Air: 0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:O existing ❑new size
Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
J BUILDER INFORMATION
&VIInon,Name_ !_ I/ 51 /_11 n g ,o n Telephone Number 2500'73�-?7,
Address l�Ll/GUI�� 5� , rJf�� `�/j License#' 07,A7S2
&A O/S9 l Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ��
SIGNATUREA�Zf DATE
r FOR OFFICIAL USE:ONLY ( -
+ PERMITNO. l
i
DATE ISSUED
MAP/PARCEL NO.
ADDRESS �' = VILLAGE e
OWNER
t r
DATE OF INSPECTIONS
FOUNDATION
FRAME ;
s INSULATION
c ti 2. 1
FIREPLACE f
ELECTRICAL: ROUGH FINALr +
PLUMBING: ROUGH y FINAL
t
z GAS: ROUGH FINAL
` FINAL BUILDING
'
DATE CLOSED OUT i
s$ ASSOCIATION PLAN NO.
w
tir
tr li
CF THE r,
. .�{.°: The Town of Barnstable
BARNSTnsr e. •
MAM Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,t alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction'of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.Type of Work: Pp I6�celR/I zz� 0/11c/l4/S ! Estimated Cost
Address of Work: 131 UAVAII'r- WAfk
Owner's Name:,,16Lyj le-JL PO l%dO//o
Date of 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
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
/Z!..,z a 0
Date Contfactor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
> CUR AfPMdfz J
Tabbz.I=b(amdaaed)
preseripdve Paelcam for One and Two-Family Reald.0 nlal Bulldlnp Rested with Fad Farb
MAXIMUM MINIMUM
Glaaag Glazing Cdliflg Wall Floor 8as=um Slab HC1nz6VC00iw8
Anal(%) U-valuer R-value' R value' R-valueJ Wall pamcur Etluipmem Ell!=L-?
Padcaae Rrvalue' &value'
5701 to 6500 Heati rn'
ng Degree Da
Q 12% 0.40 38 13 19 10 1 6 Normal
R 12% 032 30 19 19 10 6 Normal
S 129A 030 38 13 19 t0 6 85 AFUE
T 15% 0.36 38 13 23 WA WA Normal
U 13% 0.46 38 19 19 10 6 Normal
V 370 U.44 jo 13 w fives WI:. !S AFUE
W 15% O.S2 30 19 19 10 6 S AFUE
X I8% O32 38 13 25 WA WA Normal
Y 18•/. 0.42 38 19 25 WA WA Normal
Z 18% 0.42 38 13 19 10 6 90 AFUE
AA Ir/4 0.30 30 19 19 10 6 90AFUE
I. 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:
cl-forms-f980303a
780 CMR Appendix J
Footnotes to Table J5.2.1 b:
' 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 wall
area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement.
For example,3 W of decorative glass may be excluded from a building design with 300 ft of glazing area.
'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 full
insulation thickness over the exterior wails without compression, R-30 insulation may be substituted for R-38
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the stun of cavity
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
J.L_ .___ul_�-.i VI NVn Yl U&i
me condhionea spacc dUU Ute ell il—d y
'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 walls. Windows and sliding glass doors of conditioned
basements must be included with the other glazing. Basement doors must meet the door U-value requirement
described 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 J5.2.I a
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 0.35).
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
. ME-T --
— Department of Industrial Accidents
::_. _
Office911HY85998988S
-� ` 600 Washington Street
- �,,, Boston,Mass. 02111
Workers' Co m ensation Insurance davit
name: /7/L l'C d V A/LI M4 )'A lJ d/4�1
//.
location: /3 4U1 f IV I V I.t A �
city Ra 4,a�j. le /9/ ,4 ohone# �D�• -32~ '��/
❑ I am a homeowner performing all work myself. capacity
*in any
r
❑ /%%%%%%/ % %%%%%net%/G%%%%%%%%no one 1/////G%%//%/ %%%//%%/%%%%��%%%%%/%%%///////%/%%/%/%%%%/��%/%%%%/�%%/%/�/GO///////%/%/%///l
m an employer providing workers'compensation for my employees working on this job.
......
•.. ..... ......: .. :.... :. :::F :::..........:v: ::::.i:'::.:.:..' :.:: isii:i::::::::::i:.:::::ii:.::-::•::::i::i:•::::•::::.�i............i..:::.:i}i4:4iy}yv::.�:i}i:i:::}i:i:::ii:ii::.::::.
comoanv.name.. :.:,,.. ;: `: 1�1 ' Lz.:: .::d :� , :_...:.:,::.:::::<::;.;:;<.;:;;;;;;>;;; «.;::<.;:<.;:<.;;;;>;::.;.:::::::;;:..;:.;>:::.:;.;;<:,.;.::::::..
.
. . ............. .....
,. ..:....,;;,:i ::;; '":;>'.;:::_:`I!.:: ;;:::` i'i:'i?i3 'S';"_;'�,:<:',:: :,y:C .: `::::;;. asisisi:><::i;[;::::t: :;;:; ::::1.?::is ::[?:! asisi' -: i ::i si%i':5:?%?? i i%:::i?ii[iF::%::i:nisi:i as s' :'::i'i::['"? ':S ii
0 citvw. /�' t lit s f''� shone#. ; f ::. :..:: ,::.:.:::.......::::
:::: :::
:......:.::.....>.:::::::.::::.,. >::::::::::::::;
:::::::::.:.:...:::::::.:::.::::.:::.:::::::..:.............
..................................................
insurance co.: es. f C:::..::.:•. .:.. olicv#.;:;t'v/?�, .<. :/' _:. :::::. :.
///
❑ 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:
compan
. ::;
d ess.ad r
...... .......................
-:::iR:::%f:.
:.::::::.:::.':.:....:. ::::.:..:....................:.......................... .::......::...:.:..:..:..:..:�::::;�::.. :: -:>: �:::.:-::::::::::.y::.:
:-::K•::.�::..:
............................... ...........................::::•::........... ............................:::.�:::::::::...............:....... .......:...
...............................................::::. .................:.........................................................................: :...::......................................................................
one:
cityi :.: .... ,:.:: . ::::.. ...... ...:.. ....:.
1.
.............. ..........................
.:..: %::;:.......::......::: :4::..,.:::;::::is ::i::::iiS ::::5<::::{:' :::�'::: `'::;::::::;:::::: ? : ::5:: ::3 ': :::-::::: :i::'::::'::::<::::::::'-��:ri:: 5:::::::`::2`:`i.:::....::i ':
insnrance:ca.. ,,. .......,. ... opi&#:..::;,.;-:,::.::.::.::,:;,::..::...:..:.:::.::.::.<:;,;..<;:;::<::.>;>;>::::<< .,,-a,;>.< :^:<::«:»:>;:
_...... ........ -.
address:
:..
::>::
city:. -phone lf. ; >,.,..:.::`: ::: >>:':.>::
-.:........ . . ....::.:::::::::::.::.::::..:::::::;::::::::..
................................
....... ..................... .... .................................... -:.;::.:.....::. ....... :...................::..::..
:..:::.:........
,.
:.
insurance co.: ;<;;::<::;:::;::...-......:>::«:: ....... .. ::. . ,.,. .> .:...............
�.
- Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.0o and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby certify under the p ' and penalties of perjury that the information provided above is trap and comet
Signature t; a� Date ����'`� _ .
vo
Print name s/� PM/251 ld,12�B//— a-Z Phone#5i -7 ~,7731
official use only do not write in this area to be completed by city or town official
city or town: perndt/license# . ❑BuIIding Department
. ❑Ltcemjng Board
❑check if immediate response is required ❑Selectmen's Office
. _ ❑Health Department
contact person: phone#; ❑Other
Uemsed 9/95 PJA) .
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law",an employee is defined as every person in the service of another under any contract
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 receiver or
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 renewal
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 permitJlicense number which will be used as a reference number. The affidavits may be retuned 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 imlesugadons
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 exL 406, 409 or 375
.�' Rn lie -Vairv�na� ,
r51'�
?; OEPARTMENT OF PUBLIC SAFETY
I '
CONSTRUCTION SUPERVISOR LICENSE
Number Expires:
.
RestricteGTo �; , g0 j
NARK J PDidD
109 LAKESHORE OR
HOLLISTON, MA 01746
x = a HOME IMPROVEMENT CONTRACTOR ¢"
Registration 120456Vi z A"
TypeYPRIVATE CORPORATIONr
,3 ExpirationQ1/O1/OO,x
v t � ¢ BIL RAY ALUM SIDING CORP
POND s
ADMINIS7gg7pqECMONT RD
fi
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .
Map Parcel Permit# _ 3B-7/L
Health Division Cal; � � Date Issued *-7
Conservation bivision Fee
Tax Collector ": . : Qf �4e '5/zl �l
Treasurer
IN CALLED IN 6MPLlAiI;Z"W'U
Planning Dept. WITH TITLE 5
ENVIRONMENTAL CODE AND
Date Definitive Plan Approved by Planning Board TOWN REGULATIONS
Historic-OKH Preservation/Hyannis
Project Street Address
Village
Owner �DVy�c/I/CG dzCap Address
Telephone 7 �`l q
Permit Request ALS MV L Sa6
Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new
Estimated Project Cost Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. .
'Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑Full ❑Crawl ❑Walkout 0 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 O Oil. ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:0 existing ❑new size Pool:O existing ❑new. size Barn:O existing ❑new size
Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization 0 Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name G -'d� !� Telephone Number /2 �
Address License#
Home Improvement Contractor#
Worker's Compensation# &/o
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
1
SIGNATURE sit- DATE _ 5—a9 ft?
t
- - FOR OFFICIAL USE.ONLY _
cI PERMIT NO.
DATE ISSUED -
MAP/PARCEL NO.
-
, ADDRESS. '-' ,. .� .. VILLAGE
OWNER � } `�•� .-- ,j —4. �t ; � • ' ` <• , _ _�
DATE OF INSPECTION.
FOUNDATION
FRAME
INSULATION r ;
FIREPLACE - r
ELECTRICAL: ROUGH _` =? FINAL
PLUMBING: ROUGH FINAL
Ile
GAS: ROUGH ": t ' FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
,k '
The Town of Barnstable
n,►iensr,+sr�
9 Department of Health Safety and Environmental Services
1619.
rEDMO'�� Building Division
367 Main Street,Hyannis MA 02601
Office: 508-8624038 Ralph Cressen
Fax: 508-790-6230 Building Commissioner
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.
Type of Work: trwglt r(old Estimated Cost
Address of Work:
Owner's Name: �71/lC/1/�G
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
[3lob Under$1,000
Building not owner-occupied
Downer 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 U14DER PENALTIES OF PERJURY
I hereby apply for a permit as the a nt the owne .
f 1 -� 7
Date dontractor Name f Registration No.
OR
Date Owner's Name
q:forms:Affidav
The Commonwealth of Massachusetts
Department of Industrial Accidents
- 9 Office ofln�estigations
HMO600 Washington Street
Boston,Mass 02111
Workers' Com,pensation Insurance Affidavit
name:
location:
city phone#
❑ I am a homeowner performing all work myself.
❑ I am a sole roonetor and have no one working in a>1v ca achy `
❑ lam an employer providing workers* compensation for my employees working on this job.
comonnv name:
address:
city. phone#�
insurance co. noiim#
////////----/%/////////%///////////%///%///.:%/i..
❑ I am a sole proprie r, general contract , or homeowner(circle one)and have hired the contractors listed below who
have .
the folloning workers compensation polices:
comvanv name: L
..
address. -. . _ . .. - :.;....... •::.:::..:.
dtv: phone#-:.. .
insurance cn. ""'
;ZiriGG//GG,///iiii0////,/%/////iiiii�GOOGG////i//G/ii//////Oi///////////////////////O///////
comanv name:
address-
CRY: phone#? . ..
insurance co.
Fallure to secure coverage as required tinder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or
one vears'imptisonmrnt as well as civil penalties in the form of a STOP♦VORK ORDER and a fine of 3100.00 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 verification.
I do hereby cent' ' nder h pains an#penalties of perjury that the information provided above is tarp and correct
signature CG Date I _
Print name Phone#
official use oniv do not write in this area to be completed by city or town otIIcial
city or town: permitNcense q ❑Building Department
E)Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; - ❑Other
(lrnaea 9,95 PIAI
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any coati
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 recmve:
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 stare 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.. Sh6uld 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.
�i,!� ���i ���i,,��i �i,.���%ice
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 permittlicense number which will be used as a reference number. The affidavits may be rettnned io
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:µ .._ _.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
0mce of IWo=tl0adons .
600 Washington Street
Boston'Ma. 02111
fax#: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
Y
a
a HOME IMPROVEMENT CONTRACTORS REGISTRATION
l= Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston , Massachusetts 02108
HOME IMPROVEMENT CONTRACTOR
Registration 1204S6 Expiration 01/01/00
• Type - PRIVATE CORPORATION
BIL-RAY ALUM . SIDING CORP
JOHN O 'NEIL
40 ELMONT RD
ELMONT NY 11003
I
Date Hour 4-
To
WHILE YOU WE OUT
M
Of
Phone
Area Code Phone Number
Telephoned &Returned Call Left Package
Please Call Was In Please See Me
Will Call Again Will
Return Important
Message
Signed
AVERY FORM NO.50-736 PRINTED IN USA
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel /U.% G � y -Permit#
1
Health Division -�17 Date Issued h;21
Conservation Division t Fee 7� d
flive
Tax Collector
Treasurer
lilT @lip. .,
Planning Dept.
L�Eti IN
�H TI TLE 5
Date Definitive Plan Approved by Planning Board. `' , ' �Ni/fF ONMENTAL COJEE AND ;
TOWN REGU LA.TGON,Historic-OKH Preservation/Hyannis `
Project Street Address
k .
Village �tcit,'� l✓/G Lam'
Owner/�� /��rlrlc�yrCK /�Li �B W Address 39
> '
Telephone 7&5P -- 2-I348
Permit Request I"Oy STALE' 52. ��4 % ��y 4<14? _,,c �
"•���'�ie�7;'�rn/•j (N/�J�t•�J /eJ ����� •/-2 G jX L o �.�0 f`�1 — ��'�oi/�`_
Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new
Estimated Project Cost 1,3,060 Zoning District Flood Plain Groundwater Overlay
Construction Type '
Lot Size 'Grandfathered: ❑Yes 0 No If yes, attach supporting documentation.
Dwelling Type: Single Family r�Two Family ❑ Multi-Family(#units) -
Age of Existing Structure Historic House: ❑Yes • 24 On Old King's Highway: 0 Yes VN0
Basement Type: ❑Full . 0 Crawl ❑Walkout' ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full:existing new Half:existing new
b
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
• a .
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air:, ❑Yes, ❑No - Fireplaces: Existing New Existing wood/coal stove: O Yes ❑ No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new- size
Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes 4IVo If yes,'site plan review#
Current Use Proposed Use•
- BUILDER INFORMATION
Name �f J12_Z/ Telephone Number !6�rd:5'
Address_ 6vZs7 License# 6S7• 03 2-
Home Improvement Contractor#
--:01— V21`-7- "Io/21-?=oreA Wgrker's.Compensation#Qgto43,Bz _ e2
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS.PROJECT WILL BETAKEN TO
SIGNATURE :.DATE
r ; FOR OFFICIAL USE ONLY
lent
PERMIT NO.
T tr • _ — 1 e ram. 4 - t• _ • •� •
a l
DATE ISSUED' a, .. �+ s• _
MAP/PARCEL'NO.}
ADDRESS . . . VILLAGE ' �, a ' r , • e a f ,
} .. _ _ ' .ems _ ,,. � •
OWNER
—DATE OF INSPECTION: •- �
FOUNDATION
FRAME
INSULATION
FIREPLACE + +=. _ �, � . ' .�:y ,- - . r r} ' � .; �+ , �• �, ►4
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
oe
GAS: ROUGH 4 FINAL
FINAL BUILDING
DATE CLOSED OUT ;
r as f
ASSOCIATION PLAN NO.
i,
y HOME IMPROVEMENT CCNTRACTCP,S REGISTRaTICN
Board Of Eu i lc nc P,ec; Iati c is arrd S`to ridares i
one Ashourtor. Place - Room 130!
Fos to t , M.Essac'husetts 02108
ME IMPROVEMENT CONTR-.CTC^r, . - ----- ----- ---------------
cistratioi 1 007=0 1 Ex _10 orl 06/23/00 -
_�3 -
i 7 i HOME lM.PRCV=_mE e i
Tnoras Cap T_ SreV
2645 Newto rr Pc
CctU.1; MA 02635 ;
--
- OErAP,iABI OF P03:IC'SAF:rt
:.. •• C"-5S 'IOA SJP._ViSu£ IIC::tSE
t• L_�� C: G7M 14 jZE(1444 {
Res' ic.ad Te,: It
THCXn<. Z C�PIZZI JP..
288 PERCIVAL 02
. :.
. .. _ ... .. .. .. ••_ '. _ U Od DYfTAOif YA .•fir•..
\� , %`'� 1i G�i Ji2CLGGd.e'kGCZL
4i�rc��• �
600 �,
Bosto►r, hfass. 02111
Workers' Compensation Insurance Affidavit
cant information _ •�%:�':��. ,_;
location•
CM phone J
I am a homeowner performing all work my self.
I am a sole proprietor and no one \%corking in any capacity
am an employer prop iding workers* compensation for my employees \v orking on this job:
am any name: ' ZZ leq r�G>��yIG11�r
AddreW
/ W C,2. 3-� phone a:
�urt� ince co _L �T / T�/ i policy if e-749&i 88 Z
I- __.. .. .. . -y—••..� •c, err---c ..-.•Y—�--•;-,r.r:
I ant a sole proprietor. general contractor• or homco%%-ncr(circle orre) and have hired the contractors listed belo\% %%ho ha-,g
the folio«im_workers compensation polices:
t4i2P•
iddrcsc.
phone N•
jn<urincc ce notice a
• '-... .: T_``'__.?�;_ ..�.._.. .. ._,.•�: r.::.mac.?u�S�.. _
m an
phone 9:
vortex tt
` ticlii3dTti'oa'��3e�If�Ce
Failure to secure coverage as required under Section 25A of-MUL 152 can lead to the imposition of eritaind penalties of a tine UP to a s,5M w andlo
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and t fine of SIOO.QB a day against me. I uaderstind that a
copy of this statement may be fornarded to the Office of Investigatloas of the DLl for coverage vecificatioe.
(do hereby eerrify un Ir ins an enalues of perjury that the information provided above is true and.correct Q
.r� Date /2--Cr
Signature
Print name e Phone l
official use only do not rite in this area to be completed by city or town oReial
city or taN e: - _- _ permit/liccnsc q oBuildiag Department
C]Llccnsiag Board
O check if immediate response is required OSelcctmea•s Department
I
Ql{c:lth Department
1 contact person: phone u: _ __ _ f lOther_
Op niE T�
0
� The To Barnstab
le
T
Town of B
• $A$H$rABIS
9 MARL Department of Health Safety and Environmental Services
1659. �0
Fo ram' Building Division
367 plain Street, Hyannis MA 02501
Office: 508-790-6717 Ralph Crossen
Fax: 508-790-6230 Building Commission_-
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.
Type of Work: lC Est. Cost /3 a-t9eo)
Address of Work:
Owner's Namef
Date of Permit Application:
I hereby certify that:
Re-istration is not required for the following reason(s):
Work excluded by law
Job under 51,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERIMIT OR DEALING WITH UNREGISTERED
CONTRACTORS. FOR APPLICABLE HOME IMPROVEML E`IT ,WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Cont Name � Registration No.
OR
Date Owners Name
PLOT PLAN
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines _----_---_
Sewerage disposal (cesspool)
Well LEY
I I
I (lot. . . . . . . . . . .ft. rear)
Abuttor's
Name g Abuttor'
Lot # Name
Lot #
If this is a REAR YARD
corner lot, � .ft. If this
. . .
write in name • . . ' •` ' corner 1
of street. -- write it
name of
,04 0 04 other
bstreet.
SIDE YARD HOUSE SIDE YARD
FT.�
,
,
• SET BACK
• .ft. ;
(lot...... .... .. . .... . .ft. frontage)
i3 -
/ (NAME OF STREET)
Information
Supplied by
MARK NORTH POINT
TAPERED CAP
MI TRIU BOARD
2 - 2X6 ►WLER
2 X Z BALIJ=MS
MAX. CLEAR SPACE SEtw
06 YMOD POST AT s,—.r c
b = CONflIIuo:IS To mu:taATION
20 07. AL-Uu. FuLsHINC 2X6 NMLER
4X4 ALUMINM p«{ OnCX SPACE 3/4 OECMNC
3l MAU. M .73
1' AIR SPACE L iteErw
Zm - 273 OmC JOLZs AT Ir I _ 1HR000H 80LT TO E%CH P0:
9IEATMNC � WADER . OZ7 TYPO 1/{ aiwaFR ec
UNE OF
81lILOINCtX13J/IG R SM3E0 M SMM BLQClCNCF. METAL JC.ST Wwc R
WAL BOLT }{�08� r-8' O.G . EKQI JOLST AT
m ALLJ>�,
F7.AS7•ilr(C CONMUMM 4XB Wr000 POS
,
to•� . SPAN
vb
m �
ALL OECX FRAIIINC TO BE PRESSURE 7REATM
�^ ® UETAL POST uIC.40lt
ALL HNtDIMARE ac NMLS TD 8E CAL,VANIZM ' a /�" Ir OLWE7ER CC=
MIN. 4•-T Mi Ow DEHI�S
B ( UNE OF G7A,OE
LJ
r
SHED REGISTRATION
3 �
location of shed(address)
property owner's name
cy >e
size of shed
P Q
signature date
/ Z
Old King s Highway Historic District Commission jurisdiction?
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
shed
LOT
8�
LOT 34
w
LOT
60, �-
�' LOT
33
139-=__
o' 6`' 80
0
C '2'-=_= 2 64r
o
°46�60 �6
� LOT 32
RES. ZONE: "RC"
SE TEA CKS--
FRONT 20 '
SIDE' 10'
REAR 10 '
FLOOD ZONE "c__- PLOT PLAN RES ZONE.- "RC"
TO AN.CENTER VILLE SCA LE-1 "=30' PL. REF.-281 i72M, 24 7184 ELE V N�A
I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSUMNL5
tN OF Ata P. 0. BOX 265
BUILDING IS LOCATED ONv� �y UNIT 1, 403 INDUSTRY ROAD
1
PAIRzy
THE GROUND AS SHOWN MERITHEW ; MARSTONS MILLS, MASS. 02648
No 32098 v'i
TEL� 4,?8—0050
PR
FAX.• 420-5553
UL A. ,MERITHEIV r' JOB
DATL 8 _6%Z NUMRER51___
Assessor's .map a'nd. lot number r1n .....J. ...... '*-0 ® G 7�
_ I SEPTIC SYSTEM MUST=BE
L�Sr 7� $ ' INSTALLED IN COMPLIANCE ,
Sewae�Permit;number C.�.7 .......... s }
g { WITH A°;TICLE II STATE
' SANITARY CODE AND TOWN,
TOWN OF BARNS` � BLE
o° cyaYa�m BUILDING # INSPECTOR
°'
APPLICATION FOR PERMIT TO .... /../.. .... .............................. ��.................................................
GJ
42
TYPE OF CONSTRUCTION ...5.........�J®d¢ ... / .. ............................................................�
I ..........;r..'/, .2.. .......19. 5;
TO THE INSPECTOR OF BUILDINGS:
The undersigned here applies for a permit according to th�followiinng1information-
Lcation ....... .... .......... .F' t°/..1..c '.� -" / .. ........................................................... ..... .....
ProposedUse ..........:.. ..........................' ' ' .......................................:..........................................................................................
ZoningDistrict ........ .. ....................................................Fire District ..... .1 ..C............................................................
$..........Address ......../V,/O�.! 'V.11
Name of Owner ............................................
........... ....Q. .. ...... .........
f ) /
Nameof Builder ................................................................... Address ....................................................................................
Nameof Architect ..................................................................Address ..................................................:.................................
Numberof Rooms .................�........................................Foundation ..........................
Exterior ..........�.....�1.�..................................................Roofing ..........
:4.,!;. ......00�........... ... .............................
oc
Floors ........Interior
Beating ......:..2... i.. ..�.... C' ................Plumbing ............ ................................................................
r.............
Fireplace .........................:...Approximate Cost. ..... �..�..' .. ......................................
.....................................................
Definitive Plan Approved by Planning Board ___ --------__-------- _____ Area
Diagram of Lot and Building with Dimensions Fee 3 2
. ..........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I J
J
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable rggarding the above
construction.
Name . ........ .. ..... ..... ... ........... .............................
�
~ Capwwidm Development
`
'
-
o/� -l839l one story,
� N
, � .----- Permk for ....................................
� single fam1ln dwellino
� --:`--------..-------.—~-----
. w � - �
' War���� Way _
. �
Location� '----_-----------.--.-- . `
'
�-- Centerville
—.
..—.—��---~.—.----------..�----.
~ Capewide Development
- Owner ----..�.—_—_____..�___,___..
^ . .
frame
| '
Type ofConstruction .....................
�------.
� �
r' ---'—'—' —'.—'----------'' ---'
7 ` -
� .Pkz —.. ............ Lot ..............��3--z—
` .
� . .
17 76 -
Permit G,onoa6 ............ ---]V
Date of Inspection - k "� ....--..-l9 '
� ~�
. -- [��e Como��e6 ..�1�.o�Z.��.�� .......... A
� PERMIT REFUSED
.----.---_------------.. lA
'
' -'.......----..,-------.----.--...—..
_.�z—...--.—.--..--.,—.---------. ~
-_--.,.---.�—.—.-- .................................
^ `. .
---~----,---.--.—.--...—.—..---. '
.
. lg ' �
� '�,'r�`~~ —'------------_—' ,
| —._----.--..--.—.
-----------...�-
. '
_ |
n r -.
Ass �bp and lot number ....'.... .. ..... �/ /M��� _ -O i'�
Sewage-Permit number ..:....................... .9.. ........r.........:...
Q
°f7NET TOWN OF BARNSTABLE
Z B9HBSTA.13
"ASIL
6 9 - BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .... ..:.1.............. ........... ............................. .,rr. ................,................................
TYPE OF CONSTRUCTION ............. � � .`�...... ................'7... `^ .... ............................................................
.r.'.
.............. �'1..................19..
f�
TO THE INSPECTOR OF BUILDINGS:
The undersigned
hereb applies for a permit
according to the following information:
Location ...... /'�......�..�.............1 s`.+ ...... .... ....... ....:� .......................................................................
Proposed Use . -' ' . r.. ^�
ZoningDistrict........:.a...`:-.......................................................Fire District .....�.:. ....................................................................
Name of Owner .......' ..............Address .........%..`"
Nameof Builder ....................................................................Address ...................................
Nameof Architect ..................................................................Address ......................................................................................
Numberof Rooms .................:J..............................................Foundation ................•...............................................................
. i-i-=
/ / L i- ��
Exierior ....................................................................................Roofing ..........:...1... yr�'....�......j.r........`.............................
Floors ........`...../!/..........................................................Interior .......... .................................................................. ....
Heating .....?. r..... ... �..f.....' ......J`.. y.. .................Plumbing .............`......................................................................
I"1
Fireplace ............:r..................................................................Approximate Cost ......^ .�:.. .....................................
Definitive Plan Approved by Planning Board ---��`�`* *t -�!'F -----19 �-�__. Area {...:_.... . _ ................
Diagram of Lot and Building with Dimensions Fee
......... Via:............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ............... ..- ....................:: .......... .........
-
Capawide Development A=148-113
�
18391 one story,
single
�
. '
,-,mil. dwelling_ -
.---.---.--.------------- .
. ,
Warwick Way �^
� Location ---'--.'�--------------'
/
Centerville
\ ^---'----^^----^-----------'— '
�
C ��
` -r - --
~~'~'
. `
'
\ frame
� .,r. .. Construction_ . .
. .
-----------'' '
'
� .
� not ............... ........../ Lot ................................
` .
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