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HomeMy WebLinkAbout0012 WEQUAQUET LANE �,;�, �/`� �"�l��� r� ��-•mil�.. ' . , , : y + r � e n r { f ' r r m . a , +r z T y .. r a.. `�y i� -�: . � --. ,, _ t tl �, ` _. v. ,. x. .:. a ,� .� � , �, _ ,_ .. ,. °- . _. ., .: � — ._ ry , ., � 9 .. ,, ;. : �: � - � ,. ,. _ - .- .. .. ... ,. :. .,- - c -. ,, ., - - ,. � � . - � a - _ - .- �! Town of Barnstable Building BnnSr�su ;Post This Card So That rt�s Visible.From the Street Approved Plans Must be Retained on Job and;#his Card Mustbe Kept TM" Posted Untikfmal Inspection',Has ea °�� Wher39 e a Certificate`of Oceu ,anc is Re ulred;such'Buildm shall Not be Occu ied until a�Einal Ins ectionhas been made Permit P Y 9 g � Permit NO. B-19-3855 Applicant Name: ' LARRY NICKULAS Approvals Date issued: 11/15/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/15/2020 Foundation: Location: 12 WEQUAQUET LANE,CENTERVILLE Map/Lot; 250-010 Zoning District: RD-1 Sheathing: Owner on Record: LORTIE,LEO A& DOROTHY P Contractor Name `.. LARRY D NICKULAS Framing: 1 Address: 12 WEQUAQUET LN Contractor'License CS'00226S 2 CENTERVILLE, MA 02632 Est Project Cost: $5,000.00 Chimney: Description: re-roof-barnstable landfill 3 Permrt Fee: $35.00 a Insulation: Project Review Req: Fee Paid- $35.00 bate. •�` 11/15/2019 Final Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author¢ed'by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved appl cation.arid the;approved construction documents�for whichthis permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws.and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public insgectn for the entire duration of the Final Gas work until the completion of the same. , �'; x-_ � 3`� � •' Electrical The Certificate of Occupancy will not be issued until all applicable signatures by', he Building and;'Fiee Officials are provided on this.permit. Minimum of Five Call Inspections Required for All Construction Work: h Service: 1.Foundation or Footing M , 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application number.......................................... Fee ...........................��.... ............................ Building Inspectors Initials.................... ems. ................... l619- DateIssued................................................................. Map/Parcel........ ..................................................../ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: /Z— Gr NUMBER STREET VILLAGE Owner's Name: _�=�® nl;12, Y I Phone Number Email Address:''". Cell Phone Number Project cost$ CY0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property Y I hereby authorize P to make application for a uilding permit in accordance with 780 CMR Owner Signature: �-✓ Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than I'layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION _ Contractor's name ZGtg'/\i t �u�0 Home Improvement Contractors Registration(if applicable)# 17 ;70 �3 (attach copy) Construction.Supervisor's License# /,O ze2 J (attach copy) Email of Contractor >` ref Phone numberb. � %G 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 Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number. Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and�documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. 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/Organi tion/Individual): ,���/''�j /`�G1. �e.lCC6 Address: City/State/Zip: 0--ell- Phone#: Are you an employer?Check the appropriate b x: Type of project(required): 1.El am a employer with 4. I am a general'contractor and I %Ep ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction m a sole proprietor or partner- ; ... listed on.the attached sheet. 7. ❑Remodeling and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• ' 9. ❑Building addition [No workers'comp.insurance M- =`comp: insurance t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL lg.Roof repairs insurance required:]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must also fill out thesection below showing their workers'compensation policy information. _ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for,my employees. Below is the policy and job site information. Insurance Company Name: _ Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby certify under the ins and penalties of erju that the information provided above is true d correct Si ature: �`� Date: Phone#: C 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,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,§25C(6)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,MGL chapter 152,§25C(7)states"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." i Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 Accident office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia I Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construetion'Supervisor C5-002265 Expires: 01/18/2020 LARRY D NICKULAS - PO BOX 507 W BARNSTABLE;MA 02668 Commis sioner x inn,ll Office of Consumer Affairs&Business RegulationHOME IMPROVEMENT CONTRACTOR TYPE:,Jndividual Registration valid for Individual use only Real*rationExpiration before the expiration date. If found return to: 179703 08/27/2020 Office of Consumer Affairs and Business Regulation LARRY NfCKULAS,.., 1000 Washington Street-Suite 710 Boston,MA 0211a LARRY - 616 HUCKINS NECK RIJ CENTERVILLE,MA 02632 / Undersecretary N vali without signature WESTRAD-01 MCLAUGHLIN ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmYY)11/6/2019 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 have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER NNT AME CT Ro !ersGray,Inc. PacDNN � 77816 Rte13n I .En):(800)553-1801 , -2156 SouthDenis,MA 02660 ail@rogersgray.com INSURERS)AFFORDING COVERAGE f NAIC @ INSURER A:Selective Insurance Company of South Carolina 119259 INSURED INSURER B Associated Employers Insurance Company 111104 Weston Radway DBA ARC Construction I INSURER C: 20 Longview Dr. INSURER D Yarmouthport,MA 02675 INSURER E: I INSURER F: 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. NOTWITHSTANDING 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 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. INSR I 'ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE D I 1,000,000 A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE I$ !'1 I DAMAGE TO RENTED _ 500,000 —I —�CLAIMS-MADE u OCCUR I I 3 2333090 1130/2019 1/3012020 REMI a�5(Eccurrence) is I MED EXP Any one person) I$ 15,000 PERSONAL&ADV INJURY IS 1,000,000 I 3,000,000 GENI'L AGGREGATE LIMIT APPLIES PER: I I GENERAL AGGREGATE 1$ X POLICY 7 PRO- I LOC I I 3,000,000 JECT I PRODUCTS-COMPIOP AGG $ OTHER: I COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY I I I _(V- wdenl)_ $ i� I ANY AUTO � I I i BODILY INJURY Per person � ( I OWNED SCHEDULED I AUTOS ONLY I I AUTOS I BODILY INJURY(Per accident) $ LLL��HI.R�D NOn1AWNED I PROP cider MAGE E Auu''OS ONLY AUTOS ONLY I (Per accident) _ $ I UMBRELLA LIAR OCCUR j I EACH OCCURRENCE I$ i EXCESSLUIB � �CLAIMS-MADE] � i � � I AGGREGATE I$ DED I RETENTION$ I B I WORKERS COMPENSATION LSTATUTE L I ERH AND EMPLOYERS'LlAWLITY YIN I WCC50050183212019A 1/3012019 1130/2020 ' 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE � ry � i� E.L.EACH ACCIDENT 500,000 OFFICERIMEMBER EXCLUDED? ,' -- !N I A i I i E.L.DISEASE-EA EMPL (Mandalay in NH) If yes,descn'be under I I E.L.DISEASE-POLICY LIMIT($ 500,000 I DESCRIPTION OF OPERATIONS below I � � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The certificate holder Is an additional insured under CGL,provided it is required in writing to name the certificate holder as an additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Larry Nickulas ACCORDANCE WITH THE POLICY PROVISIONS. 250 The Plains Rd West Barnstable,MA 02668 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Barnstable ildi .,..w ,y.+....,+we•.. 9.`S' `wex , _7-drt`;': •�a :.<€ q� eewri`. .`Y' .:"� 'w .' "N- gI Post This Card So That rt is'VisibleFrom the Street Approvred Plans Must be Retained on Job and this Card Must be Kept MItN•JYABSZ*. • .,s % :,ski, 3 ' S �: £'_` e t v MA Posted Unt�l,Final Inspection Has pp ' Where a Certificate of Occupancy s Requi redsuch Building shall Not„be Occupiedzuntil a Final Inspectionx has been made . • .w " w.' Permit No. B-19-2584 Applicant Name: LORTIE, LEO A& DOROTHY P Approvals Date Issued: 08/12/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 02/12/2020 Foundation: Location: 12 WEQUAQUET LANE,CENTERVILLE Map/Lot 250-010 Zoning District: RD-1 Sheathing: Owner on Record: LORTIE, LEO A&DOROTHY P :Contractor Name; Framing: 1 Address: 12 WEQUAQUET LN Contractor License: 2 CENTERVILLE, MA 02632 Est Project Cost: $0.00 Chimney: Perit Fee: m 35.00 Description: SHED 8X8 $ Fee Paid ' $35.00 Insulation: Project Review Req: , Date E` 8/12/2019 Final: t r z Plumbing/Gas Rough Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afteeissuance. Final Plumbing: All work authorized by this permit shall conform to the approved application,and the approved construction documents:r which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshallbe incompliance with the local zoning.by-laws and codes. This permit shall be displayed in a location clearly visible from access treet or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. ' Electrical The Certificate of Occupancy will not be issued until all applicable signatures byAhe Building and'Fire Officials are,providecl on this'permit. Minimum of Five Call Inspections Required for All Construction Work:°'," Service: 1.Foundation or Footing „ 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining`is installed „ 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy _ Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: a r �I • - To*n of Barnstable o{�THE rp Bailding Department Services Brian Florence,CBO �. Building Commissioner t65 200 Main Street, Hyannis,MA 02601 1.6 pjEO www.town.barnstable.ma us Office: 508-862-403 8 Fax: 508-790-6230 PERMU9 =� : $35.00. SHED REGISTRATION RESIDENTI,kL ONLY 200 square feet or less LDcatim o shed(address) V-silage Property owner's name Telephone number Size of Shed Nfap/Parml# Signature Date Hyam is Main Street Waterfront Historic District? . Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway D Conservation Commission(sign=8:00-9:30 =&3:30-4:30 Sign off hours for Conservatio PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF TBE ABOVE COMMISSIONS,TBERE MAY BE A REVIEW PROCESS AND APPLICATION PEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST U ACCOMPANIED BY A PLOYPLAN Q- rms-sbrdreg REV:08/6/17 �0 oFtKE r� Town of Barnstable *Permit# ,gam Expires.6 m nths fro 'sue date 3' Regulatory` Services k Fee * tARNSTABLE, • - e - - - 9�A , . A`0$ Thomas F. Geiler,Director .SII�p n� lED Mp�l k �."J Building Division V Tom Perry,CBO, Building, ommissioner 200 Main.Street,Hyannis,MA.02601 _www.town.barnstable ma.us ' Office: 508-862-4038 lax,.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL`ONLY Not Valid without Red X-Press Imprint Map/parcel Number G360 y t Property Address L 7 t 41,uxo v t=% r'/ /✓>_ r►/.i 1 L rs rZ77 . ` _.. °Residential Value of.Work v Minimum;fee of.$25.00 for work under$6000.00 f r Owner's Name&Address Contractor's Name ut,('� V11 �,4 Telephone Number'77N= Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) - r__N k (�(�G X.P PERMI . . . ❑Workman's Compensation Insurance k" s MAY-2 4 2010, Check one: " I am a sole proprietor 'TOWN OF BARNS ABL ❑ I am the Homeowner 0 I have Worker's Compensation Insurance_ Insurance Company NameS. Workman's Comp.Policy.# t. .. Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) k g - r', [ "Re-roof(stripping oldsshingles) All construction debris will be taken to ;� ❑Re-roof(not stripping. Going over r existing layers of roof) Re-side 4, t #of doors .. F] Replacement Windows/doors/sliders U-Value' `r'(maximum.44)#'of windows *Where'required;"Issuance of this permit does'not exempt compliance with other town department regulations ix Historic,fConservation,etc: *,"*Note Property Owner must sign Property Owner Letter of Permission' ` r7y oft o me Improvement Contractors Licensee.& Construction Supervisors License is A"w e e ire SIGNATURE: F. s QAWPFILESTORIvIS\building permit forms EXPRESS.doC f r r Revised 090809 r e = T r: n 4 a V The Commonwealth of ltMassach usetts Department of Industrial Accidents Office of Investigations . 19 �t 600 TVashington Street Boston, MA 02111 t www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r r Name (Business/Organization/Individual): \ .4, n (Lam•D 1k A e,"b— Address: City/State/Zip: ' Phone Are you an employer? Check Aa app opriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hued She sub-contractors 2.M'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 d have workers'an working for me in any capacity. employees9. ❑Building addition. [No workers' comp.insurance comp.insurance.# 5. ❑ We are a corporation and its ME]Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions - right of exemption per MGL 12Roof.re airs _.. ._ _ ..... _........_....... ,........_..., _ .-.... p insurance required.}t -- J. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required) ' *Any applicant thatch ecks 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. lContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy #or Self-ins, Lie.#: 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 t-rp 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 D1A for insurance coverage verification. -1 do hereby cerll der t Te pains and penalties ofperjury that the information provided above is true and correct. SiQnah.ire. " Date: Phone# 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 Information and Instructi®n.s Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for.their employees. Pursuant to this statute,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, §25C(6) 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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners,are not required tocarry workers'compensation insurance If an LI.C,oi LL P"does have employees, a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permit license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia 1 4"i ,l J V J own of Barnstable oFIKEI ' Regulatory Services BARNSTABLE, ' Thomas F. Geiler,Director- y MAM $ fp1,a`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 ww�v.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property r hereby authorize Pia Vib W, o 144 A to act on my behalf, in all matters relative to work authorized by this building permit application for: .;? L4�% i- (Address of Job) Signature of Owner Dat Print Name .a 1 in for e rmit lease 'Complete the ner 1s . If Propert;�Ow pp y. g . � P _ Homeowners License Exemption Form on the.reverse side: ,\ QFORMS:OWNERPERMISSION Y r Town of Barnlstable o regulatory Services 4 Thomas F. Geiler,Director • 3ARNMBLE, WUSS 9� 039. � Building Division AlED �a Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 wrvw.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone#i work phone{! CURRENT MAILING ADDRESS: city/town state zip code The curient exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner o Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q AWPFILES\FORM Soho m eex empt.DOC 4, ,per ✓lie T�arrvnaarc�aea�.� o��/�aQaac/u.,aelta � _' ' } \ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration, 162081 } Board of Building Regulations and Standards Expiration 1/14/2011 Tr# 279746 One Ashburton Place Rm.1301 q „- z i Roston,Ma.02108 ��Type Individual DAVID WILL IAM:RICHARQS III DAVID RICHARDS t i "yam � $36 COTUIT RD ,,. Not valid without signature MASHPEE, MA 02649 Administrator Massachusetts--Department ofPublic Safety y «' �! Board of Buildin- Regulations and Standards Cohstru6tibn,Supervisor License ' License: CS 101506 —_ Restricted to00 r S DAVID RICHAF D Si,10, _t 436 COTUIT'RD _ �+. 'MASHPEE€.MA 02649• Expiration: 1 1/291201 2 (:ummisionet Tr#: 101506 W� �t r Town of Barnstable *Permit# )6C Q 9C �{. Expires 6 months from issue date Regulatory Services Fee aAuvsrns Thomas F..Geiler,Director 94�,,rE0 9. ��� Building Division $�iSf us S PERMPerry,CBO, Building Commissioner MAY - 5 2008 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508, WbF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY - Not Valid without Red X-Press Imprint Map/parcel Number /5j5"6 Property Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name 4L�� Telephone Number Home Improvement Contractor License#(if applicable) 1�2C5 T� [XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner .I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 2 <5&0< F2(� 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 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permirforms\EXPRESS.doc Revise020108 Anderson Brothers Construction, Inc. Ma.Bid.Lic.#074101 Proposal Ma.Registration#128778 TO: Mr.and Mrs.Lortie FROM: Sean Anderson SUBJECT: Window replacement: Centerville,MA DATE: 04/01/08 Job description: a Remove and dispose of existing windows. ■ Interior and exterior trim removed. ■ Install provided,Andersen®windows in existing openings. 0 Rough-opening space newly insulated. e Azek®trim installed around exterior of windows to match existing style. ■ T/2"colonial trim used for interior trim matching existing style and composition. All windows installed with screens and grills: ■ Job sight cleaned and magnetized for nails daily. Amount of described work: $89,100.00 (includes all materials,labor and disposal) Notes: All trim,inside and out,will be installed to"paint,ready." Exterior applications fastened with stainless steal nails/screws. Pay schedule: Fifty percent(50%)of the noted price is due at the commencement of work. The remaining 50%is due in 25%increments; 25%half way to completion and 25%at completion. i Acceptance of Proposal: G^ The above price and specifications are Customer's signature satisfactory and hereby accepted. In the event of non-payment,the customer shall be responsible for all costs of collection, Anderson Brothers including statutory interest and reasonable attorney's fees. Sean(a�(508)280-7326 sea(a�ca)ecod.net Eric(c(508)280-6600 4.. r k. se,._- 4 Y. h a r s?i r ;r N-,e;k ;'•�eKr'c^' .._ _ s � rr 77 e - F I ✓lie ' owtwto mweal o�/ aaaacluiaeCra -- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registfi ibn,,428778 Board of Building Regulations and Standards EzpiraUon 5/16/2009 Tr{� 128798 One Ashburton Place Rm 1301 1 T a Individual Boston,Ma.02108 yp�� SEAN E.ANDERSON SEAN ANDERSOON 50 TROWBRIDGE �— W.YARTMOUTH,MA 02673 Administrator No id without signature The Commonwealth of Massachusetts f Department o DeP Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers : Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): 5 - Address' L/JjliOn l��Lf� City/State/Zip: �/� 0 0 � Phone.#: /2_7V °�d—�✓ Are you an employer? Check the appropriate box: Type of project(required): . general contractor and I 1.�I-am a employer with Z 4 � I am a 6. ❑New construction employees full and/or art time).* have hired the stab-contractors ( P listed on the attached sheet 7. ❑Remodeling 2.El I am a•sole or partner- proprietor • - ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp.-insurance comp•msurance.t 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 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 0 goof repairs insurance require ]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other . comp.insurance required_] Any applicant that cheeks box#1 must also fill out the section below showing their workcrs'compensation policy inforrmtion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Z__Mtractors that check this box must attached an additional sheet showing the name of the subi:orriractors and state whether or not those entities have employees. If the sub-contractors have employces,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.#: e3 9 d 1< 99 G Expiration Date: Job Site Address: Zc C�j ewi� - o—_ City/Stat:e/Zip: V l 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 rrimifial penalties of a fine tip 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 ce under the ins•and penalties of perjury that the information provided abo a true and correct. O Signature: Date: !� Phone# r 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#: ns - Informatlon and In.structI o Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,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 orbuiW ng appurtexi4nt�th-ereto shall.not becausg,of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing ag,epcy shall witttholdahe issuance or renewal of a license orpermit to operate a business or to construct buildings in t1ie•e6muionwealth36t any applicant who has'not prdtiuced4ceelitable evidence of compliance w h tH,e insu appe_co�erage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonweilth iior any bf its pohfical-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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contracto (s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance, Limited Liability Companies'(LLC)or Limited Liability Partnerships(LL.P)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is completeand d 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'4ft.m 'ear.=qn addition, an applicant that must subb3it multiple permit/license applications in any given yea> nee V'Pd only submitMono affidavit indicating current g policy information(i4ecessary)and under"Job Site Address" the applicant should' ri 4"all locations in (city or townf 'A bpy aflt ie a�ffdavit that has been officially stampe of marked, the city or town maybe provided to the applicant as proo�'f thatla valid affidavit is on file for future per�ts-or lice#ns�,-- ndw-iffi&41 must be filled out each year.Where a home owner or citizen is obtain a license or permit not related to any business or commercial venture (i.e. a dog license or:permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call: The Department's address,telephone-and fax number. Ail „ ='. :% The Commonwealth of Massachusetts Dgwtnent of Industrial Amidets. A Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 4-06 or 1-977-MASSAFE Fax# 617-7227-7749 Revised 11-22-06 www.mass.gov/dia oF�HEr�„l, Town of Barnstable Regulatory Services + MUMSTABL6, MASS. Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner- 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I C6-t) as Owner of the subjectproperty ., 1 hereby authorize ��L�kX< �G7Z��i� to act on,my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Serif rfd� Signature.of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable ti Regulatory Services ,. g Y« - • 1' • Thomas F.Geiler,Director Building Division TFD � Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 026.01 www.town.barnstable.ma.us Office: 508-862AO38 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: . JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six urits}or less and to allow homeowners to engage an individual for hire who does not possess a license;provided that the owner acts as supervisor. DEFINm6r41,OF-n@'IE'ow1VERa Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to ' be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such " al submit to the Building Official on a form acceptable to the Building Official,that he/she shall be "homeowner shall g P responsible for all such work performed undetthe building Taermit=, (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible, To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, he/she understands there responsibilities of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that h sp P several towns. You may care t amend and adopt such a form/certification for use in your community. '-I Assessor's map and lot' number ��/ �. `�"�� B 41 lele o — L4 ,2 7.77, r`t � SEPTIC SYSTEM MUST BE 17-' -' '4 J t INSTALLED IN COMPLIANCE r SewagegPermit number ..................:................. ........��.. WITH ARTICLE II STATE SANITARY CODE AND JOW4 �FTNETQ� Y, TOWN' OF BARNS` BIX . i BASHSTABL$ S � �,,• }ua "6"�� } Y BUIL.DING p INSPECTOR �O 39• �0 0 kul p' v` APPLICATION FOR PERMIT TO ............�. .. .. .. . ..................... TYPE OF CONSTRUCTION ................ ... ....................:..... ,.......:.......................:.......... Y L. ..................19. .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: '�►� Location .. ? `^�'': .... �a.�.........Y.. ..... .. . ..... . .... . ..1 .:......(-- '.�("' .......................... ProposedUse ....ti.."...............��"c.. -................................. ............................................................................ Zoning District ............................ Fire District .... {.1�'?R?*'. !.j.................................. tLtd Name of Owner ... ........;"'.`......:.......................Address ................... .A'll f t j3...................................... A— Name of Builder S ..`..'.. 1V3.C-.1*7,,.�.,.**...................... ..,..............Address .................... ........................................... Nameof Architect ..................................................................Address .................................................................................... Q Number of Rooms ..................................................................Foundation c Exterior .........eoo. ' `. :�..............................Roofing 'J5 h.►is�(.�_. Floors '' .........Interior � . Heating t:.�..4..�........... . 1. -.h't/�'I 4'1.... .Plumbing ................................ .......................... �..r—......: ' !.. .................... Fireplace .........1..........'e..DLt.. .�4G� .....................Approximate Cost ............................................................. ..... 9 Definitive Plan Approved by Planning Board -------_______—-----------19________. Area ....... 1P.v........5. ...'..... Diagram of Lot and Building with Dimensions Fee .......... ............ .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH S I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .................. ....... ....................................... l Lortie, Leo 1 ti - ', 19246 1 1/2 story No ................. Permit for' . single�.farmly.'dwelling........................ r Strawberry Hill`Road Ii r r� Location ........ .. ..................... Hyannis —t r+ ; ........... ...................................... ................... Owner .........Leo Lortie.. �. ..., .. ........ .. .. .... ,�. h r 1 1 Type ofConstruction frame ...... .............................. ..................... 1 Plat r;► ......... ..... Lot ...... ~� .i. - ... ... ......... ,,Permit Granted ............ ,.............:.....19 6,.,� - • Date of'Inspection ..... . : ..�..... T.....19 r. Date Completed ..Q. d<...� .........19 - >_ z. -'PERMIT REFUSED .......................................ti ....................... 19 1 a .:.................................................................. ,. ,.Approved .... 19 ................... .................................... ....... - l^ } Assessor's map and lot number r� � '"/ ... Y� /J� �~ 77 Sewabe Permit number ................................. ............. TNET���ow ' TOWN OF BARNSTABLE BASH9TABLE i ' °�opYa�•� BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................... TYPE*,OF CONSTRUCTION .............!... ............................................................................................................. 37 ................ S ................................1 . .................19. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for ta,permit according to the/following information: Loption ... f 2 '1�.-�n_/L, ....... N c f. ........ '? / ti...................................... ProposedUse ...5 ". .(.(`j...C..'"'.................... ........................................................................................................ Zoning District ........................................................................Fire District 1L?inn f ;* i _�.............. Name of Owner ... 0..7/....... .�..�:.............................Address ....................*• .......................................................... , F ' t r Name of Builder �. S ..........................Address`........................ ... ............................................................ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .............................Foundation I ` KC n'...... ..............:.........�............................. Exterior .......... .:.... ........C. ...........................Roofing �� Floors . .................................Interior ......................�� l .....f.`.......,....� .................... Heating .......... �..1..�.,......... I � ``-!! ! �n..........Plumbing .....................�....1 ..:::....... :.................... Fireplace .........1...........-P..'(-: .P4..�4:..............................Approximate Cost ............... ... Gf/"l ..................:..... � f Definitive Plan Approved by Planning'Board -----------_-----—-----------19________. Area ............`©.. .........0 ....... Diagram of Lot and Building with Dimensions Fee ................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �"' ✓ Lortie, Leo A=250-10 19246 1 1/2 story ` No ............�-0... Permit for .......................... ....... single family dwelling 12.. � Location ........... ... .... � nns........................... ..................................... e i Owner ..........Leo Lor�4e .............. ................................. Type of Construction ........�.?:m.............:........... ....................................... ................................ Plot ........................ Lot .............................. > Permit Granted ......May... 4...................19 77 Date of Inspection ...................................19 Date Completed''......................................19 PERMIT REFUSED � ... 19 ............................................................................... ............................. ............................................ Approved ................................................ 19 ............... —)kak- a .'f�..t.yr ..�,.•�,_.. _......�v-,Esa •,�..+r"Y «r t • f. . P•a 'i,'.s - ,,,,. r,,. �.... -. .>' ,,....,. .. , r . 7 ,. ;. '^^ . i. dv,,.F7k �w d .x,♦ r�J,:;k#.f`� '4k' �'kr,�s.�i� .!,�"� V�.,..0.. `7'- '� ti '.��'r,.nsr �,:.,,�� �. __ .°k y`^e'�p` 7rt �, ,;.. s �`yg�5�.�.,a�*�5.-, L�4, .-.s .. '7. ,'?" wV.rr-' �` "r` �*�. 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