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HomeMy WebLinkAbout0161 EISENHOWER DRIVE //o/ xifP/I�74sc+er dr, / / TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION J Parcel Applicatior^� Map .. 3 41)3Kk5 la Health Division Date Issued Conservation Division - Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis _ Project Street Address >�f i S'do J-�aw Y r �� v"I- Village a `� Owner Address Telephone Permit Request Q �c_17N�1 H e- Z T]s rat to S �; ;1^th!z N, AA/? N U. �J i"'t�0 1, ell C79►'l. G�A'� 't-►i�A�M A "L_ -c If�ly�c eln�L ;.y e'IS' sA�> f— Square feet: 1 st floor: existing�W_9proposed A 2nd floor: existing N proposed Total new O Zoning District ti Flood Plain Groundwater Overlay Project Valuation ) e/.construction Type �-- y Lot-Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: ingle Family Two Family ❑ Multi-Family(# units) Age of Existing Structure �1 ?e, Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: �d Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) IV A Basement Unfinished Area (set Number of Baths: Full: existing_ new Half: existing 0-A new Number of Bedrooms: existing 0 new Total Room Count (not including baths): existing _new First Floor Room Count.w Heat Type and Fuel: Nl Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes o Fireplaces: Existing New Existing wood/goal stove❑Yew ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:*existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use 2-_S Proposed Use Ys t" APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameC�-�n�- �A ►,.,u.� Telephone Number .moo� —� s �o� S-� Address License # 0`7 t/;t® Home Improvement Contractor# Email A M u 4 43-n s Worker's Compensation # t04ZSCIO Cam ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� `/ FOR OFFICIAL USE ONLY r, APPLICATION# '} DATE.ISSUED ' M1 . MAP/PARCEL N0. ADDRESS VILLAGE- ;. OWNER PIP DATE OF INSPECTION: FOUNDATION FRAME INSULATION Is 14 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT { ASSOCIATION PLAN NO. E f r f a i The Canswomueatth orf Ma!rsachr,-setts D eparhment of firr&w ial Accidents t�,'ice of Investigations 600 Washington Street sior4 CIA 02111 wwmniassgov1dia NTarkers' Compensation Insurance Affidavit: B.udders/Contracturs/Electdcians/Phunbers Applicant Infoi ation Please Printibly Name(F3usmes�rOlgauizatioatlnd�idnai7: (��+\ �-�A�� u�c.� Address: t �6 e.Qy 7 city//tat'-Jap: tJ/N.S Phone ik- Aire you an employer?Check the appropriate:box: T of project r 4. I am a general contractor and I �� p J (required): 1,'F am a employer with - ❑ g, 6- ❑Neu*cons tru Sion employees(full and/or part.-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on.the attached sheet. 7_ ❑Remodeling ship and have no employees These sub-contractors lmq-- 8. Demolition working, for me in any capacity. employees and have workers' 9- ❑Budding addition [No workers'cDmp_insurance comp-inslrance I required.] 5. ❑ 'Ne are a corporation and its 10-E]Electrical repairs or additions 3.❑ I am a homemmer doing,all work officers have exercised theme 11. Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.:0 Roof repairs insurance required.]1 c. 152,§1(4X and we have no employees-[No workers' 13-❑Other comp-insurance required-] "'Any applirauf that checks box-1 most also fill out the section below showing their worker'compensatianpolicy-infumixtion. T lrameowners who submit this afiidai-it indxst ng they are doing all wank and then Lae outside comractors mast submit a new affidavit skating sach- ZContractors that check This box nml attached an additional sheet showing the name of the wb-canusc=and state whether ornot those entities>am employees. ifthe subcontractors have employees,tfiz}'most provide their workers'comp.policy number. lam are employer that isprm iding workers'compensadon insurance for try employees. Below is the palecy and jab site nformadon. Insurance Company Nance: Policy##or Self-ins.Lie.4: I.J 4 L 3 aO S V I �� �� l;?0 pirationDate: � a 1 Job Site Address: 1 b 1 1 ✓ >�O 4,z 1--`�� ; t%�— city/staterzip: G,C tq 1"t •9 40J— Attach a copy of the workers'compeusation.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 Iiavestigatims.of the DIA for insurance coverage verification. Iola tier i. under reins acid penalties ofpeditry tleattlte ireformatioit protzded abot is frets nd correct: Si - Date `� l Phone 9- Official use on it.'. Da not write in thiss area,to be completed by city ar town afficiaL City or Town: PermitUcense A Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cif rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - - 6 DADM-12 OP ID:KS CERTIFICATE OF LIABILITY INSURANCE'£ . 0412°°"YYY' 4/24/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. CON ACT PRODUCER Phone:508-398-6060 N E: Bryden&Sullivan Ins Agency a Fax:508-394-2267 PHONE FAX of Dennis Inc. AIC No: 486 Route 134,PO Box 1497 E-WL " So. Dennis,MA 02660 Dennis Office INSURER(S)AFFORDING COVERAGE NAIC# ` iNSURERA:Associated Employers Insurance INSURED David Dadmun INSURER 6:` 51 Pond Street Unit 7 INSURERC: West Dennis,MA 02670 INSURER D INSURER E: 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICYNUMB R LIMITS . GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ ( , PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY F1 PRO- LOC $ AUTOMOBILE LIABILITY " ISINGLE Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED" AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED ` PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLALIAB. ..00CUR - ' - _♦1 ` EACHOCCURRENCE $ . EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION ` $ WORKERSCOMPENSATION " X WC STATU- OTH- AND EMPLOYERS'LIABILITY ;,' T R L M ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE WCC500501127312013A 08/21/13' 08/21/14 E.L.EACH ACCIDENT $-' 100,00 OFFICER/MEMBER EXCLUDED? ® N I A (Mandatory in NH) k' k E.L.DISEASE-EA EMPLOYEE 100,00 If yes,describe under ESCRIPTION Fop ERATION below z' E.L.DISEASE-POLICY LIMIT $ SOO,OO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Renarks Schedule,If more space Is required) Operations performed by the named insured as provided for by the terms and , conditions in the policy. David Dadmun has opted to exclude himself from w Workers Compensation benefits. CERTIFICATE HOLDER CANCELLATION ' BARNS-1 SHOULD ANY OF THE E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE .DELIVERED IN TbWn Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS.. Building Dept. 4 200 Main Street J'AU. HO,R,yINgo DnR,EPR,ESENNT,ATIVE� Hyannis,MA 02601 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD' p¢SKE 7p (( 1 (j ��gg ,{� p� tpl�y7g�p \•p\ ILLS.S �6'� .�1.o n O Bar A9.stable �J f - Regulator Sen ices Richard V.Scali,Director Building Div sio13` Thomas Peru°,CBO Building Commissioner 200 Main S'-re--L Hya.]na,Itiiy 02501 �t�F�r.tnR-n.harnsin ble.nia.us ax: 50S- -5_3', Properi-v, 0,;v er dust Complete and Sion This.Section If Using A Builder. I• 1 __iJ. "„.1� +� •5�3�'l�t: r:v grope J:L bF 1Ur�1CTL?e h to 1L.� ll matters rcLare to-x-C_-aa, ,n> ?ec be cLis bui:�ns a�-Mlit ap ucv o>: V s_. y�.'^'.. �,J -- -- (Address of job) f P. 0 :-,CZ D3tt is J l Win=N- 2-Me _ Ii Properh,Ovmer is appMue for permit please complete the Homeowner,License Exemption Form on the reverse side ( :',1 rl 11?S'+FC�Ri.4S'+cc:iding p=rm..it Y\ev;scd J51:__ ��eanirrrarucrercll�. /Glas ac�cr eL7� ` - Office of Consumer Affairs&Business Regulation MOME IMPROVEMENT CONTRACTOR egistration 128718 Type: W ''Expiration 5/9/2015 DBA D.L.DADMUN CUSTOM BUILDERS{` DAVID DADMUN 51 POND ST Q`K W.DENNIS,MA 02670 Undersecretary n I� Massachusetts - V Department of Public Safety Board of Building Regulations and Standards Construction Supervisor I & 2 Fainil% License: CSFA-074205 DAVID L DADM"\ 51 PO ND STREET v West Dennis MA;02670 � Jf I441.\• Expiration Commissioner 12/31/2014 • S • . (,,. �+'� �, _�•+"_ t I�^�'f"j� ���'�_�'o_. i rC7 �7 l/ 7 � '��1`� t�..i.J 1•—�[J L.,.J-!._�''� ,�C„ � .. , .. r r T ' F`3 f to fi ! i :J A : r • r ... 1 , ji _ t i: i.. {yy ' r 1 l ` y a i i q 4 • i ' i 1� _ I 1 -'� pl• .�, ,l.. ; d,. .�I } } j r �l 1 •i-•�A J�� ;cam. '„� ri ��� , I x 1 77 : i I A G I t. q , 3_ r I F I ; I i i lip sw sl�lGY h N Ifl1 Town: of Barnstable *Permit ` ` p Expires 6 hs ram issue d e . Regulatory Services",- Fee �axsz,�sr.E, t, TQV,pSTAL' Richard V.Scali,Interim Director .Qip 165s �6 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number f3 C/ /L) Property Address Residential Value of Work$ ®� Minimum fee of$35.00 for work under$6000.00 " Owner's Name&Address __� l Zea E CO"�y t- Contractor's Name /�v y A vti�,� Telephone Number U �d (-,`� Syr 1 F Home Improvement Contractor License#(if applicable)1� g�) Email: " pCy d. �� tr" �,� /©� y+il,q 1 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance _ Check one: ❑ I am a sole proprietor ❑ I am the Homeowner FKIA have Worker's Compensation Insurance Insurance(Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) i Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over . existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required SIGNAT QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 27ze+1✓'oasr mortypea th of assuehuusefts Depmrhnent ofl didiastrWAccidents - - Office o f"investkatiorus y 600 FPashington W eet Boston,M4 02111E waiRmasmgoufdia Workers' CompensationIusaranceAffitdavit:BuildersfCantractursMectricians/Numbers ApWk-ant Information Please Print h. Name Q)A ►-L u A-/ ot- GSty1Stat'17_ip_GJ, to N 1S A C5-) Phone Are you an employer?Check the appropriate bo= Type of project rolect(required): . am a employer 4. I am a contractor and I 6. ❑ ao New nstrucbm I_ I p toer with ❑ employees(full and/orpart­time).* have hired the sub-contractors 2-❑ I am a sole proprietor orpartner listed on the attached sheet 7. ❑Remodeling slog and have no employees These sob-contractors have g_ ❑Demolition have workers' worlang forme in any capacity employees and h$ Q_ ❑Building addition li [No wor)i.ess'comp.insurance comp-insurance required-] 5. ❑ We area corporation and its 10-.❑Electrical repairs or additions 3.❑ I am a homeowner doing all wort of hmm exercised their 11_E]plumbing repairs or additions myself.LNo workers'comp- right of exemption per MGL . 12-❑Roof repairs insurance ance required-]1 c.152,§1(4),and we bane no employees_[No wmkws' 13_❑other comp_msurance required-] *Any appUcwr that checks boa#1 toast also fl1 out the section b9aw showing their wcaus'compensation parMT inffirroxtim THomeowners who submit this affidavit in rxdmg they are damg 2U ruck and buss him outside contractors—st submit a near a53dwk m�r�.sod - toi nars that check this boot mast 9ttsrhed,as additianal sheet showing the name of die sub-cots and state whether nrnat those m ies Nave employees. If the soh-wntmctars hwe empLUws,they must provide their workers'comp.policy numbes .x am an empInyar tiatisprmidurg tt,orkers'compoi sahon insurance for my emglnym, Beloty is fie poficl and job site inform0 i011. bism-ance Company Name: Policy::_or Self-ins-Lic.;k 44t�) C_L So U Expiration Date: Al I Job Site Address:/�, v e,l`c-1r r' citylstatelZip: tLo top to A Affach a copy of the workers'compensation policy declaration page(showing the policy number and expui-Ation dater). Failure to secure coverage as requiredunder.Sectron 25A of MGL c. 152 can lead to the imposition of'a iminal penalties of a fine up to$1,500.00 and/or one-yearimpsisoninet,as well as civil putties 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 maybe forwarded to the Office of luvestigations of the DIA for insurance coverage verifrcatio>L I do here nnrd�r t ifdpenalfies ofpedury that Me inform tioii protrzded above is rid correct 1 Sitma Date: A / J Phone#:_- s-o l f tciai use auF}v I*not emits in this area,to be completed by do or town a,f jSciaL City or Town: PermitUcense# issuing Autharity(dreie one): 1.Board of Health 2.Building Department 3.CiVFownt Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other �e` ea�a»zo�rrc.eal/X o`C%llasire�r%elY - Office of Consumer Affairs&Business Regulation SOME IMPROVEMENT CONTRACTOR a� �f egistration 128718 Type: Expiration:.,--::;5/9/2015 ; DBA D.L.DADMUN CUSTOMBUILDERS" DAVID DADMUN 51 POND ST W.DENNIS,MA 02670 " Undersecretary : � v Massachusetts Department Of Public Safety Board of BuildingRe gulanons and Standards Construction SuPen°isor 1 ? Fain ilA License: wv �r CSFA-074205. � DAVID L DADMU 51 POND STREET f West Dennis MA-02670Pr // .. Commissioner ^Piration 12/31/2014 DADM-12 OP ID:KS ,a�oRo6 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/24/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY. OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER Phone:508-398-6060 N°AMNE cr Bryden&Sullivan Ins Agency PHONE FAX of Dennis Inc. Fax:608-394-2267 o AC,No: 485 Route 134,PO Box 1497 EE4WLs So. Dennis,MA 02660 Dennis Office INSURERS AFFORDING COVERAGE NAIC# INSURERA:ASSOciated Employers Insurance INSURED David Dadmun INSURERS: 51 Pond Street Unit 7 INsuRERc West Dennis,MA 02670 INSURER D:. INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF - POLICY EXP LIMITS` GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY_ PREMISES Ea occurrence $ CLAIMSWADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN"L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY (Ea ac 1 LIM Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED, BODILY INJURY(Per accident) $ AUTOS AUTOS PROP DAMAGE $ HIRED AUTOS PROPERTY NON-OWNED AUTOS Per ERTY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE. $ DED RETENTION $ WORKERS COMPENSATION X WSTATU- OTH- AND EMPLOYERS'LIABILITY TORCYLM ER A ANY PROPRIETOR/PARTNER/EXECUTNE Y© N/A CC500501127312013A 08121/13 08/21/14 E,L,EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00( DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) operations performed by the named insured as provided for by the terms and conditions in the policy. David Dadmun has opted to exclude himself from Workers Compensation'benefits. CERTIFICATE HOLDER CANCELLATION BARNS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED.IN ACCORDANCE WITH THE POLICY PROVISIONS: Town of Barnstable Building Dept. 200 Main Street AUTHORI�DREPRESENTarnE Hyannis,MA 02601 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services RAMSTABIX «MASS. - Richard V. Scali,Director .� i6g9 ��1DrEp 39 Building Division Tom Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Building Permit Procedure for Residential Addition Or Remodel Or Dock ❑ Determine map and parcel number and enter it on application. ❑ Historic District Commission,200 Main Street,approval required prior to construction/demolition for any properties located in a Historic District: • Old Kings Highway Historic District(north of the Mid Cape Highway) • Hyannis Main Street Waterfront Historic District(See map for boundaries) • Historic Preservation(if applicable). ❑ If ZBA relief(Special Permit or Variance is required for Project): ❑Copy of ZBA decision ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date ❑ Approvals from the following departments are required and can be obtained at 200 Main St.: ❑Health Department (8:00—9:30 AM&3:30—4:30 PM {as of March 2"d,20051 ❑Conservation Department (8:00—9:30 AM&3:30—4:30 PM) ❑Tax Collector {can be obtained from Building Department} ❑Treasurer {can be obtained from Building Department} ❑ Permit must contain complete owner information, full description of project, correct square footage of project,valuation of project(do not include hvac),building detail for Assessor's Office, complete builders information, including signature and date of application.. ❑ 5 sets of reduced house plans measuring 11"x 1711,scaled 1/4"= 1' & fully dimensionalized are required. Plans must include a foundation, cross section, framing schedule, insulation detail & floor plan showing location of smoke detectors(located with a Red `S'.) ****** IF USING ENGINEERED LUMBER AND/OR STRUCTURAL STEEL,ENGINEERING DATA MUST BE PROVIDED****** ❑ Plot plan or mortgage survey required for any addition. ❑ Workers Compensation Insurance Affidavit form must be submitted for any workers hired. In the event the homeowner takes out the permit, subcontractors hired must supply this. Copy of Insurance Compliance Certificate must be submitted. ❑ Mass Compliance Checklist ❑ Construction Supervisors License&Home Improvement Contractor's License OR ❑ Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. ❑ Property owner must sign Property Owner Letter of Permission. ❑. A NON-REFUNDABLE Application Fee must be paid upon receipt of application number. All checks should be made out to the Town of Barnstable ❑ CHIlVINEYS: Need Home Improvement License,no plot plan required ❑ PIERS AND DOCKS:Need Construction Super License AND Home Improvement License. OWNER- CANNOT PULL OWN PERMIT. ❑ Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission . I L639. 6,��� . ow ®f Barnstable ea Ma{ - Regulatory Sen ices Richard V.Scali,Director Building Division Thomas Perry,CBO Building ComMi9SiOUCF 200 Main SiieeL H1Y a unis MA 02601 xvw,,v.to%-n.barnsta ble.ma.us aa: CGS-790-6230 Property ®,caner Must Complete and Sign This Sect-ion If Using A Builder j A t'L 1 D . K Le 6 uiL a: Owner of jj,:subject proper_;' ".r _ to ac 02 _- behalf, ;n rll matters 1eL-are to trc_k aumotr zee bT t ds: uilding?emit applicabo or: 1 ► Sp aI+V Li,1E-P— D CoT-o iT- 1"HA (Address of Job) isL3tutc of Ort-nu Date A LEER - . WIL6 W 5 if Property.ONvner is applying for permit,please complete the homeowners License Exemption Form on the reverse side C:i\'.TFiL'—'S'+FOPJAS,e:;dingpermit o:r&EiO>RESS.roc P.e4;scd J 613 3 G-d �' TOWN OF BARNSTABLE BUILDING PERMIT APPLI ; IO1 TQ� Map U Parcel f 7i �f;, Applicat�fQn Gq0l (O1 0*_ Health Division f"?,Bate Issued Z11 Conservation Division A30pcation Fee Planning Dept. Permit Fie Date Definitive Plan Approved by Planning Board Y; Historic - OKH Preservation/ Hyannis Project Street Address / E-1 5 eV 14 o W 2 tL Village C O Tu T Owner /Q L 6 e-iz--T- D ­ _ f.W (,2 13 4 R Address Telephone 6(7 9�r-2 - 5-35 73 Permit Request EQ�n o v-e_ I-I Le rl o orzs A,"tJ C i+� cTS - jZCM o u,e S�c eT'2oc k 13A-7 iL" h s r4-L4 S . 1 [ /NG ZA1 7-0 40,+M2 A-y - A/b -Sj n4cT't_-/12 ty D y q Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 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 ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��cal ti� L A-u tz t A Telephone Number 791 77 Address < L E &W DR License#-O S 0-6'1 7 o I R-0cXJ-1'bJJ M A ® Z3 70 Home Improvement Contractor# /4DLa7 Email (p '`'sAl` ci`" Worker's Compensation # CC- 00 3 d 3 17 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Cis S%/L�GCTI D/✓ �GLsY/�ST let U' N /"/Le ;Ae27-51 SIGNATURE DATE :?-Zd' -/ r FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING /I Y DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachuse& Department of IndustrialAccidents WOffice of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia _ Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Please Print Legi. Name(Business/Organizadon/Individual): Address: 6> N e WO L 7 T//-1 �S l (,c/�t G City/State/Zip: ,,�41 I Pee y 6a 6�t Phone#: s�`13 9"a q b 5 Are you an employer?Check the appropriate bog: Type of project(required): l.Ja I am a with employer 4. ❑ I am a general contractor and I —� 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ®.Demolition workingfor me in an capacity. employees and have workers' Y aP tY• 9. ❑Building addition [No workers' Comp. insurance Comp.insurance$ 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 l2.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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 the policy and job site information. Insurance Company Name: T W e a2 G %ZD LZ u° Policy#or Self-ins.Lie.#: WCC o 6 3 b 3 1 7 Expiration Date: Job Site Address: I :z qe/y` b w eA- l7/L City/State/Zip. 6`r—Le c T L,(A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify at is under the p and penalties of perjury that the information provided above is true and correct Signature Date: Phone#: -7 1 7.7 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 . r 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 to carry workers' compensation insurance. If an LLC or LLP does have. employees,a policy is required. Be advised that this affidavit maybe 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 Accidents 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.rnass-gov/dia i Client#:34309 MULTISTA ACORDTM DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/19/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Maria Barnowski NAME: Starkweather&Shepley PH°NE 401 435-3600 FAX 4 aC,No EXt: A/c,No): 01 431-9326 PO Box 549 E-MAIL ss: mbarnowski@starshep.com Providence,RI 02901-0549 401 435-3600 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:American Safety Insurance INSURED INSURER B:Beacon Mutual Ins Co 24017 Multi-State Restoration Cape Cod INSURER C:Tower Group Division,Inc. INSURERD:Hartford Ins Group 19682 68 Nicholetta's Way,Unit G INSURERE: Mashpee MA 02649 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP R TYPE OF INSURANCE LIMITS INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY EPK102728 0 1/01/2014 01/01/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $50,000 CLAIMS-MADE F_x1 OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:5,000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC - $ JECT D AUTOMOBILE LIABILITY 02UENQT4762 - 1/01/2014 01/01/201 COEa accident $1,000,000 MBINED SINGLE LIMIT . X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 50845(RI) 12/01/2013 12/01/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A Y/N WCC0030317(MA) 7/16/2013 07/16/201 E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: 161 Eisenhower Drive,Cotuit MA S / CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 62601 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S549204/M546890 MBB 1: d for in drac�zujo off �P ou License or registraon datetion , If found return todividul use only i Masi. before the expiration ulation ffice of Consumer Affairs&Business Reg OVEryAENT CONTRACTOR` Office of Consumer Affairs and Business Reg ME IMPR Type: 10 Park Plaza Suite 5170 _ atd Boston,MA 02116 egistration 140427 j Supplement ; I e �� iration 1011512015 Exp I MULTI STATE RES ORATION INC CAPE COD URIA' i RICHARD ga 1 Not valid without signature p:0.Box 2210 Undersecretary MASPHEE;MA 02649 _---:— u Massachusetts - Department of Public Safety ..Board of Building Regulations and Standards Construction Supenisor I & 2 Family ,. License: CSFA-051784 RICHARD D LAI$IA 1 LEAH DR. s Rockland MA 02370 h� J,�.., � { Expiration 04/01/2015 Commissioner MULTI—STATE RESTORATION, INC. FIRE* FLOOD.*WIND* SMOKE*HURRICANE*VANDALISM i Fed ID#050515889 CONTRACTORS REGISTRATION#140427 AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT ►'1� L herein referred to as `.`Customer",authorizes MULTI-STATE RESTORATION,INC.,herein referred to as "MULTI-STATE",to perform a y and 1 necess c eaning and construction services on Custo rs'proner� at: 1 i s1. Telephone: 73 and with respect to items that need to be cleaned at a remote location,t remove wTd clean such items as necessary. C, 33 Customer authorizes Insurance Company,herein referred to as "Insurance Company",to directly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers'name,and to deposit Insurance Company checks or drafts for MULTI-STATE services. Customer agrees to pay Customers'deductible in the amount of$ that applies to this claim. If the loss is not covered by insurance,CustomerMatay tot I t to MULTI-STATE upon receipt of the invoice. 1174- - Signature of Owner It is my understanding that the services to be performed by MULTI-STATE will be limited to those,which are authorized by my Insurance Company. Insurance Company Name Policy Number . Customer agrees that MULTI-STATE is working for the Customer and not the Insurance Company or agent/adjuster. Additional remarks: I have re t 's document ankcompletely understand and agree to same. 16 Signat Date Printed Name P.O. BOX 2210•MASHPEE, MA 02649.866-921-9111 •FAX 774-238-4422 --. _------_.w.-__-__._.._�_.__.._._ f3/+-rti e R, tQ Cod- d C l 45se.l �NT-It r r ,�i sENH oWEP .DRI v` 67 `* �! 37' LOT 4 • �jC l STING r'OUN�Rr��ra 1� �9 OF RICHA tiG / o JAMS �. O'HEA N G.a lio. 27171 N c,svt��°�,¢ CERTIFIED PLOT PLAN /N \Sl1RV�� 7-&l7- -� MASS. / I CERTIFY THAT THE 17�2�� 'z;�,zi-ate% RICHARD L/ O'NEARN, R.L.S., R. S. SqOWN ON THIS PLAN IS LOCATED /9/ MAIN ST. (RTE. 28) ON THE GROUND AS INDICATED AND WEST DENNI S , MASS . CONFORMS TO THE ZONING LAWS DATE: �'✓ ' SCALE: "= -� f OF E'.� ',.;7�Lzj'7MAS S. JOB A10. CL/EN T.. ,, Al SHEE T OF DAB — REG. V LAND SURVEYOR DR. f3 Y Fl y ,.•`� •e TOWN OF BARNSTABLE Permit No. ___________ -�+�- Building Inspector 1 11mnAc Cash 7 A/YL --------------—------- __- oO,rO YPY OCCUPANCY PERMIT Bond ----___""_"___"___:_- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to l lcwF L�.'i "� '� Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ......................I.............................. I9__ _ ..................................................................................._..........._._._ Building Inspector - 7� i ssef or's map and lot number .... .. ...;2 ...L.. �/N — �G — OS THE to Sewage Permit number( .. ... ......................... SEPTIC; SYSTEM' MUST BE INSTALLED-;IN COMPLIANCE 2 DARNSTADLE, ♦ N r House number .......�.,�.1�. ...........................:................... WITH AR . TICLE II STATE _ . 900 039 SANITARY CO�E_AND&N c�aYA,. TOWN OF BAR.I�9'` '-ALALj t BUILDING.- I N S P E C T OR. APPLICATION FOR PERMIT TO TYPEOF CONSTRUCTION ................................................................:.......................:............................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... ...4le.......4�......................:.................................... Proposed Use ..... /1/ ��rt �� � �/.. ��4 ��',............................................................................: . ZoningDistrict ........... ...................................................Fire District .................................................................... Name of Owner ddress Name of Builder ............ ...................................Address 1. Name of Architect .� ........Address .... � ....... ...... .......................... Number of Rooms ..... z6 ..........Foundation .... Exterior .... �!b'? ? .... - .0 ..............Roofing ........................... Floors ..... i! 4...............................................Interior ...........................:........................................................ Heating 1�a�7 ..Wet e.:.:.. ��`.........Plumbing .................................................................................. Fireplace ............. ! ' .. ..................................................Approximate Cost ...... :. '.............................. Definitive Plan Approved by Planning Board -------------------_----------- Area ..................................:....... Diagram of Lot and Building with Dimensions Fee 7S of ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i .5 c I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable,regarding the above construction. Name . t> . ..... .. Tidewater Realty --rust 286?9 -- —/ling ----.. iutl family------.--. .---- �Location —..l6l..� � ----' Cotuit .�---.---------.—.----.------. ` . Owner, TidewaterRealtyTroot -- .. .. __.. � Typa'o; Consruc/ion -----.���p�.----.. . .......... ` plot �/______.._ �t ..____.��____ . '�� . � ^ - October I? 78 Permit Granted � . . . . . ..lg ` / p / bate of Inspection �. ---l9 . ~ , . / . . - Dote Completed ....................................... ' - ������� � PERMIT_ ~ . . . . , '' lA .. / . . . . � // +.. - ___ - -------- . ' �--'= .......................................................... � '--~'v����� —^^^^---~----^'''r � . ----...--�-.--.---....-----_—.�. , . . / . ____---------._—. l9 ~ . . � . ' -------------'--^^~---'--^~—' ' ° « ----.-----------..---..~.'—...— . . . . f � 7 L Assessor's map and lot number j........................................` + � ( U/�� /'L ��rl - 4 - Q�Of TH E Sewage Permit number ................. ..... .' '`.Z,;011 // f Z BAUSTADLE, i House number ........................'..................................................... 9� M6 a 0, O 39• �0 �E 0 MAY Or TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ........................................................................................:............................................ .............................. ........19, X- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: •Location ..............:.. ........:.. ... ! .srn...<.,:f�.c t`?:...:'�� i���........ . .......:........:... Proposed Use ....... S�..... Zoning District .......... ..................................................r G,x;: ,>.r n ^r -.................................................................................... �- Fire District .............................................................................. .... ....... Name of Owner •4��'W,?X/,-,'.;.—Address .n ........... ......... ..`...!.......... :..::: ..... 1... • Name of Builder ............. ...r'c'`?" ..... .. r.. ...Address .....................................: ........ .:................................. Name of Architect ,'"t�r� .r-r"`~�•......:.!ir 3 �J......Address ..... ........................ Number of Rooms .......................... .......................................Foundation .......... .r ..!r.... .-a.. .....................:.............................................. Exterior ...... ......... . rat=*^..............Roofing sr> !Y.........`...u...r.'" ,'`. ............................ Floors ...... ............Interior .................................................................................... Heating �,� _ /,: ,,�/.�� YJ?.............................= Plumbing .................................................................................. :................................ Fi replace ............... �;'......................................................Approximate Cost ......:3.:..... ?. M. =...................................... • t^.� . Definitive Plan Approved by Planning Board -------------------_-----------19---_--- . Area r "-' '.......................................... 7-5 Diagram of Lot and Building with Dimensions Fee ' SUBJECT TO APPROVAL OF BOARD OF HEALTHY<1 .' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . '�''�: . .........L ..............................J'�v Tidewater Realty � =39� -�ur- oNo --2—O6?9.. Permit for .uu . �--- ~� � ' ^ -- — --��.�. ~ single family dwelling -----~-----~----^----^-----' Location --..16.1.. .�pi..v,&---.. Cotuit ----'----^-----------------' Owner ............Tide .QX'�� � ' Type of ^ � Plot Lot ' _ Permit^ Granted ..........0/otber...1.7........19 78 Dote of Inspection ' ' PERMI REFUSED 'u ~- --r ... ... �~----- ^ / ~ ...... ....................................... ................. .... ^ ^ ........................................ � [ --- ...... ----. _ Approved y � ................................................ lg � -------.-------~—.---------. -----------'-----~—^---''^'^^'—