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0019 OLD OYSTER ROAD
,� . ' �� � f� ,��� 5��� ._. .. �... ., .�. Uo� -, a _ r._ _„ a .g. ... ... �. � ' 4,.. n �� ) �� III II i i I Town of Barnstable Building t Post This Card So That it is Visible,From the'Street-Approved Plans Must be Retained on Job and-this Card Must be kept uaar�rn�ce Posted Unti[Final Inspection Has Been Made. Permit Where a Certif a'Wof Occupancy is Required,,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-3178 Applicant Name: Timothy morse Approvals Date Issued: 10/11/2019 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 04/11/2020 Foundation: Location: 19 OLD OYSTER ROAD,COTUIT Map/Lot: �020®017 _N Zoning District: RF Sheathing: Owner on Record: MORRISSEY,GERALD J& KAREN TRS Contractor Name:«-,Timothy morse Framing: 1 N, Address: 170 TREMONT ST, UNIT 1601 Contractor License: 162263 2 BOSTON, MA 02111 . i` v ,. Est. Protect Cost: $17,500.00 Chimney: i Description: demolition of existing chimney. rebuild fire box and chimney Permit Fee: $ 139.25 Insulation: Project Review Req: Fee Paid: $ 139.25 Date: 10/11/2019 Final: 1 Plumbing/Gas Ruh Plumbing: Rough :g s F.Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this 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 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,by.,the Building and Fire Officials are=provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing h: 2.Sheathing Inspection _„ . �. _,. � r 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 Buildingplans are to be available on site p Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENTA�/t� S Application Number. .... . ..................................... MASSIL Permit Fee..... .........other Fee i....................... 659. TotalFee Paid...................... ........................................ ...... TOWN OF BARNSTABLFy Permit Approval by.,....... . . ...... ........... on... :P:..�.i.�.�.�. ... BUILDING PERMIT map........d074 :..................Parcel:.... .......................... APPLICATION Section 1 — Owner's Information and Project Location Project Address- t 9 0(`C/1 OV5k.r Village Ccrivil- Owners Name t<t-ts"42.1 Porr i, s s Owners Legal Address City State zip, - Owners Cell# 70-3 `)Cf!-Z- E-mail , Section 2 —Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet IT Commercial Structure under 35,000 cubic feet Singlel Two Family Dwelling Section 3 — Type of'Permit❑ Al LIN- New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use El Demo/(entire structure) El Finish Basemefit El Family/Amnesty El Fire Alarm Rebuild El Deck Aparbiaent. El Sprinkler System ❑ Addition ❑ Retaining Wall F] Solar i"Renovation ❑ Pool El Insulation Other—Specify Section 4 - Work Description h H AI e --ext-st;' j nhi'myve--y i Id 4��e,box eaAA164 Cat,kzq kkie-4 11/1515,61 R,T.s;.qt linds;ted Application Number.................................................... Section 5—Detail Cost of Proposed Constructio �� yJ�� Square Footage of Project Age of Structure, j 5 ,5015 505 Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors _ q ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System L�J Masonry Chimney ❑Add/relocate bedroom i Water Supply ❑ Public _ ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: f Coe W& P_ I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past?. ❑ Yes ❑ No Last updated: 11/15/2018 Town of Barnstable BuBdiing Department Services . s Brian Florwee,CBO ° Balding Commiaaimner 200 Man sates,Hyannis;MA 02601 www.to mbumuteble mans Oifce: 509462-4038 Falc 50&790-6230 Property Owner Must Complete and Sign This Section If Usigg A BWlder L as Owner of the subject property hereby authorize �n'l G H d t'3 to act on my behalf in aIl matters relative to wort:autho&.cd by this budding pem*appfic adm Sus Uk J, O� Sic -�_A. (fat"i yy A a)-('a sr' (Address of Job) "Pool fences and slam, are the responsibility of the applicant Pools I are not to be filled or utilized before fence is installed and all final inspections are performed and acc epted. i tureorowner Signature of Applicant ` Print Name Date Rer.08l160 . Town of]B a rmtable 30dung]Department tment Seances Buina Momace,CBO Q, Building CommbW ner 200 Main Street. ff'aoais.MA 0260, m a www.town.barnatable.ma.us Office: 508-862-4038 Fax: 508-790-R30 HOnAZOWNU IdC M ECOd 7[ON DAM_ rrn,e rAft JOB rocAr[oN I `� cxa a.f g-�-ew- C.dTV i-T- o 1 TMIP 'HOMowNM- zrrv� Yl�. 1rY�r rr( Co o� WQ*phase CURREWM&MG ADDRffiS 7d �j'Y/Y►� �6y� The cuaeat acanption for tOeD Goode homeowne"to an "was who to bnchrda of six units or lose and to allow eaga8e mdividaal for hoe who does not Pow a license,nT'dam fit ' *• Person(s)who owns a parcel of kod an which he/she EFt MOM OF HO�owN� ?= (8) ' attached parcel resides or Ada m rsslde,an which them or is a me or two- home m a two-year Period shalt net bed accessmY to such use and m ur harm atnrctu�. A persiu�dvd to cmuftMon =ft fuse one acceptable to the Bmlrgg a homeowner. Such"homeownd'shall sabm to the BUffi ft OgcW on a form 7he bj,���regulationL�meowner" MPMNZMY��liauce with the State Buildiog Code and ottmr applicable codes, 77W nadersigaed"homeowner"Cmtlfm that he/she imdeiUM&the Town of Barnstable end r+equimmeats and that he/she will comply with said end �partmedot mia3mnm a ofAameowaer Appmvet afBw7dmg Offictat . Note: Thme-Sammy dw0 wing 35,000 cubic fed or larger wlll be Section 127.0 Contraction QMftL roquit+ed to comply a►ith State Baildiag Code The Code states that: HOs's Thom the provirdons of this secHo�homeowner Performing work for which a building perms is(SeWon 109 Ll-Ucensing of construction hatred SW be�Pt engage+a Persons)for hire to do such work,that such Homeowner shall act as u h)p�ed that if the homeowner - pervlsor. MR"homeowners who nee this et:emption are amwan that they (�Appeadis Q.RWO&Regulations for I.Irxnstng Construction are�$the responaN1111ea of a supervisor results in serious problems,particularly when the homeowner moMalcomors,won 2.15) 716 hack of aw"Mesa on= ledProm agahrst the anlleensed tmnroa as It would with a IYcenaed gyrpe Ile oh Peraomeo�wn onr cannot ultimately responsible' °fig for b To More that the bomeowner b fully aware of his/her Perm it applieatton,that the homeowner certify that he/she and Rods bili�ea,many COMMUnitles as part of the this issue 6 a form carrengy used erstands the respomdbilift of a Sn your eommuntty, sm' . You may care to amend and adopt such a (rervisor. �°the last page artt8eaeton for use in 0&1 g t�mit .doc T�e �irru%o2areo,���,/�litiwta�.��?�eCl�, s�•a?`� 4 _Office of Consumer Affairs&Business Regulsiion W4y i HOME IMPRO EMENT CONTRACTOR ' T .IndiAdual €x�iration MO TIMOTHY O6/25/2021 R _ '. 17 TIMOTHY 21 RATCHFORD QUINCY,MA 02169- . Undersecretary F Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston,MA 02118 ` S Not valid without signature a ' Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,006 cubic feet(991 cubic meters)of enclosed space. �= Commonwealth of Massachusetts Division of Professional Licensure Failure to possess a current edition of the Massachusetts Board of Building Regulations and Standards State Building Code is cause for revocation of this license. j Cons f;t> ti� For information about this license i `� tSrvisor Call(617)727-3200 or visit www.mass.gov/dpl ! CS-113937 fIc�pires:08/26/2023 TIMOTHY JA_MES k. 21 RATCHFORD GI - QUINCY MA 03169 1 Commissioner � � --- The Commonwealth of Massachusetts Department.of IndustrWAccidents 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 Ledbly Name(Business/OrganiziWon/Individual): 1 w\ o o-e Cd h5't-ry Ch'01 7 Address: 2 j City/State/Zip: Qvv c (IL'(oi Phone#: D Z--5 /_ Z70 5-- Are you an employer?Check the appropriatFI : Type of project(required): 1.❑ I am a employer with 4. 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 working for me in any capacity. employees and have workers' 9.. ❑Building addition [No workers'comp.insurance Comp•irrc,rr ce i 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 r 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c:152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor;mast 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 worker:'comp.policy number. , ` I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site ' information. , Insurance Company Name: Policy#or Self-ins.Lic.#: 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c u er the pains and penalties of perjury that the information provided above is true and correct: Si store: Date: 2 y f Phone#• 2-5/ Z?O OfjscW 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#: 6 . 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 Bran 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 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 permittlicense 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.mm.gov/dia AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD"YYY) `� 05/31/2019 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 CONTACT NAME: Ryan Kent Ironside Insurance Group,LLC t PHONE E t (617)227-2400 nA/c Ne, (617)910-2472 112 Water Street Ste 401 E-MAIL ort@ironsidei com ADDRESS: su PP g• INSURERS AFFORDING COVERAGE NAIC# Boston MA 02109 INSURER A: XS BROKERS/Penn America Insurance Company INSURED - • INSURER t3: Ace American/ ASC Construction LLC INSURER C: 35 Melbourne Ave INSURER D: INSURER E: _ Hyannis MA 02601 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP - LTR POLICY NUMBER MWDD/YYYY) (MWDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000' MED EXP(Any one person) $ 5,000 A PAV0206491 04/19/2019 04/19/2020 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED + BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR } CLAIMS-MADE AGGREGATE $ DED RETENTION$ , $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? N/A WC000563971 05/22/2019 05/22/2020 (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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. ` AUTHORIZED REPRESENTATIVE a " ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Application Number.................................I.......... R Section 9= Construction Supervisor Name lr`m 0�" �-kz;,(5e_ Telephone Number Zsl 0 Address ZI R.,4,, ,�6 C f✓ City . (A ✓-C, State a Zip UZ r� ` License Number I 1 3 License Type Uo lre5('-JctAxpiration Date `f l L ip �'Z-22 Contractors Email 4"'t o 5-C 100 G rVu-x i ,Co i.vCell # 7 2.5/ `Z7v 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 re ' d by 780 CMR an e Town of Barnstable.Attach a copy of your license. Signature Date C Z Section 10—Home Improvement Contractor Name (i M CjHI'lu o�r7t Telephone Number 5 7 Zs�1 Z 7p L F Address 2 V ( o' vl City (Iwo 'State Zip 0 2-I e Registration Number 149 Z Expiration Date (1z 1 z Z % I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 C d L'eTown of Barnstable.Attach a copy of your H.I.C... • Signature -- Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number f. 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. E Signature Date APPLICANT SIGNATURE f Signature Date L 5- % Print Name IIm- o H-U j c Telephone Number 5�5-7 Z-S�I Z 70 E-mail permit to: dor5e Q® �rrv� c�i . cc',;.r: Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ ` Conservation ❑ `' For commercial work,please take your plans directly to the fire department for approval Section 13 — Owner's Authorization i as Owner of the subject property hereby authorize t to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name R t I s i J � \ l Last updated: 11/15/2018 Commonwealth of Massachusetts Sheet Metal-Permit Map Parcel Date: (0' Permit Estimated Job Cost: $ �� Permit Fee: $ a R -Plans Submitted: YES NO Plans Reviewed: YES NO Business License # /(� Applicant License# Business Information: Property Owner/.Job Location Information: `� inn �Name: ,��� � ��� �i Name; � Street: JZ ✓ T �' Street: �/ ev City/Town: ��Y�4 re �� City/Town '�� Telephone: a B P �6 e Tele honer 6l Z . p x Photo I.D.required/ Copy of Photo I.D. attached. YES- -V-- NO Staff Initial J-1 restricted license J-2/M-2-restricted to dwellings 3-stories or less and cominercial up to 10,000�sq. ft. /2-stories or less Residential: 1-2 family Multi-family` Condo/Townhouses Other - Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other14-1 ' --� Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number'of St. es: Sheet metal work to be completed: New Work: Renovation: '. HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System . Ly Metal Chimney Vents AirBalancing Provide detailed description of work.to be done: 46 /> 4/0 40 �..[. /'IJ�///l�l ,!i t�' ,,-. /�f/- f����°�'ey�'Jr° G'/I'�JGi/IG���✓. .�1`'I 17 � dr i r INSURANCE`COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes Ue**No ❑ If you have checked Y_a,indicate the type of coverage by checking the appropriate box below: A liability insurance policy, ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement.: Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 3y checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be n compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. - / . V Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection ` Date Comments Type of License: ly Master 'itle ❑ Master-Restricted :ityffown []journey person .Signature of Licensee 'ermit# ❑Joumeyperson-Restricted License Number: ee$ ❑ t Check at www.mass.govldol ispector Signature o`.f Permit Approval - Tate Commonwealth.of Massachusetts UV. 57 Department of Industrial Accidents` Office of Invesikations. 600 Washington Street - Boston,MA.02111, www.mass.gov/dia Workers' Compensation Insumn.ce Affidavit. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/orgmization/ludividuaD: A,T 11,04�ii1� -me'' Address: J 2 City/State/Zip: ��t�`a'c�l�lta� J�1Ca G�ZS Phone.#: Are you an employer?Check the appropriate box: Type of pi oject(required):; 1.�I an a employer with_y 4. ❑ I am a general:contractor and I. * have hired the sub=contractors 6: ❑New construction . employees(fill and/or part-tmze). , 2.❑ I am a•sole proprietor or partner- listed on the'attached sheet 7. [ Remodeling ship and have no employees These sub-contractors have Y 8. ❑Demolition working for me is any capacity, employees and have workers' co insurance•$ 9. El.Building addition [No workers' camp.insurance _ mP• required.] 5• ❑ We are a corporation and its. 10.7 Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work : 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL, , 12.❑Roof repairs insurance required.]t C. 152, §1(4), and we have nD 13.❑ Other employees. [No workers' , Pomp.insurance required.] *Any applicant that checks box#1 Est also fill out the section below showing their workers'compensation policy information. t Homeowners who subnut 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'corm,policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepo&cy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# -7' / / �� 9 /M1I Expiration Date: J lob Site.Address.. // 01141 City/State/Z p: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failuie.to.secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of climmal 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$250700 a day against the violator. Be advised that a copy of this stat=mitmay be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify r the pains and penalties of perjury that the information prgvided above is true and correct S' tare: Date: Phone 4: Official use only. Do not write in this area, tb be completed by city or town ociaL City or Town: PermitlLicense# -Issuing Authority.(circle one): r .1.Board.of Health. 2.Building Dep artment nt 3.City/Town Cler k 4' e 'g .Electrical c Ptri aI Inspector 5.Plumbing Inspector 6. Other - Contact Person: Phone#: Town of Barnstable RegulatoryServices s+aNsr�ara - I+ea Thomas F.Geiler,Director i639 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder. . ♦SS F ' as Owner of the subject Property J P PAY hereby authorize p iPde to act on m be T � in all matters relative to work authorized by'this building permit (Address of Job) *Pool fences and alarms are the responsibilityof the,a licant.PP , Pools. are not to be filled before fence'is installed and-pools are not to be utilized until all final inspections are performed and accepted. tote of Owner S• e of Applicant ~ ,R.. . de �t �avY►�5 gip. Print Name print Name Q:FORMS:OWNERPERMISSIONPOOLS. Town of Barnstable 'THE i Regulatory Services s�ttvsreare, : Thomas F.Geiler,Director tAsa A 0 9. �m� Building Division- tED Mpr" Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.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# work phone# CURRENT MAILING ADDRESS: `'• 1 city/town sta a .� zip c%de The current exemption for"homeowners"was extended to include own&-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 log.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 - A AJ i 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 � ; a` A•• i' " > 1t .0 The Code states that: "Any homeowner performing work for which a building permit is require g al`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." e 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 w - Supervisor. The homeowner acting as Supervisor is ultimately responsible. V 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 fom-/certification for use in your community. Q:forms:homeexempt IAXall TH O f MAgSACH ll+ 'COMMONW E A • CTED ' ER-UNRESTRI ,.;;/'_•'�2:;`'.:; ;t MAST t . ISSUES THE ABODE l ICENSE 70`; "; - .. JAMCS M DIEDE A/C.. �. CAT NUMET 98g557 101 04/28/13 • CAT!pats Dmym �. . CeRTIFICATE OF LIABILITY INSURANCE 11 02/2011 PRodLDEw (781) 34d-8578 THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C.L. Hollis ItLtdlsrancm Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 27 Glen Stictlwt - ALTER E COVERAGE AFFORDED BY THE POLICIES BELOW. 1tought,on MA 02072- `. INSURERS AFFORDING COVERAGE NAIC E IteEURW IN1WFMg A CNA DRT SATING i AIR CONCIXTIONING DDA tNe R R B:TWIN CITY FIRE P.0. .BOX 666 u R c:VALLEY FORCE R . SU$SARD HAY MA 02532- RRE: CVRAH THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTVVITHSTANOING ANY REQUIREMENT,TERM OR CONDITION Q WITH F ANY CONTRACT OR OTHER DOCUMENT 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. AG REBATE LIMITS SHOWN MAY HAVL`BEEN REDUCED BY PAID CLAIMS. Llrq POLICY WR TNJN TYPE OF INSURANCE POUOY NUMBER CATf MIOD1Y1f DAME MMMONITY UMrm AXL09/12/2011 09/12/2012 1,000,000 A OBNERALLIAXUTY 4017719112 i X RCVIIyENE LIABILITY IVIED AGE RED oWr ! 300,000 PRNTM (Es oolxr�.rwe 9 - CLAWLURE ODOUR IVIED FXP M one ascn i 10,000 PERSO d ADV INJURY d 1,000,000 OENERAL AggRGOATE s 2,000,000 GEN L AGGREGATE LIMIT APP�LIP.6 PER P DU IOp $ 2,000,000 7C POLICY M PR 171 LaL C AUTOMOBIL6UASIUTY 4016640007 05/04/2011 05/04/2012 COMBINED 61NGLELIMIT 9 1,000,000 ANY AUTO (Ea arridwdy ALL OVWiDAUT08 �1r / F / / / BODILY INJURY i (Pv pw=n) X BCHEDULEOAUTO>T X HIRWAVrOS - , / / / / BODILY INJURY d (Pa auddW) X NON.ONMED AU108 PROPERTY DAMAGE : (Pat acdA tt) GARAGE WMUTY AUTO ONLY-EA ACCIDENT d ANY AUTO / / / / OTHER THAN EA A d AUTO ONLY: AGO d axe LA LIA I STY / / / A OCCURRENCE S OCCUR CLAIMS MADE AGG d DEDUCTIBLE RETENTION I y s B AND 00acTK9573 00/13/2011 09/13/2012 1 TOR TLAWrT I I E ANY PROPASTORIPARTNERdr-MCUTNE! E.L.EACH ACCI ENT ! 5001000 OFFICER)MEMSSR EXCLUDE07 Y / / / E.L.DISEASE-EA EMPLOYEE S 500,000 u yes.dAt►ulttler E.L PECUIL GVI ION balmDISEASE-POLICY LIMIT l 500,000 OTHER DESCWTION OP OPERATIONSII OCATIONSNCNtCLESIEXCLUStONB ADDED 9Y ENDORSIMENTISMAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (506) 564-9595 (508) 790-6230 SHOULD ANY OF THE A90V8 ORACRIGED POLICIES 9E OANPELLED ROOM THE " EXpIRAT1DN DATE TNEREOF, THE ISSUING INSURER VALL ENCEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFlCATB MOLDER NAMED TO THE LEFT,OUT TOWN OF BARNSTABLIB PAIWRE TO DO&0 SMALL IMPOSE NO 09LAIATION OR LIABILITY OF ANY KIND UPON THB WXSTABLZ BUILDING DEPT INSU I?$AtIi JMORREPRESENTATIVES. 200 MATH ST AUTN011liBDI1EPRF.9ENrwTIVE RYANNIB b!A 02601- ACORD R(MI1011) a ACORD CORPORATION 1988. INeZ07A(0101�OS Fya 1 of 2 Product Catalog-Air Conditioners • • A ,. ` Page 14 ' January 2012 Supersedes July 2011 General Model No. 13ACX- 13ACX- 13ACX- 13ACX- 13ACX- ` 13ACX- 13ACX- Data 018 024 1 030 036 042 048 060 Nominal Tonnage 1.5 2 `2.5 3 3.5 4 5 'Sound.Rating Number(dB) 76 76 76 76 80 80 80 Connections Liquid line o.d.-in. 3/8 3/8` 3/8 _ 3/8 3/8 3/8 3/8 (sweat) Suction line o.d.-in. 3/4 3/4 3/4 7/8 7/8 7/8 1-1/8 7 Refrigerant(R-410A)fumished 3 lbs. 13 oz. :4 lbs.6 oz. 4 lbs.4 oz. 5 lbs.9 oz. 6 lbs.6 oz. 7 lbs.8 oz. 10 lbs.0 oz.. Outdoor Diameter-in. 18 18 18 18 22 22 - 22 Fan Number of blades 3 3 4. 4 4 4 4 Motor hp 1/10 1/10 1/5 1/5 1/4 114 1/4 Shipping Data lbs.-1 package 138 138 144 151 188 205 232 Line voltage data-60 hz-1 ph 208/230V 208/230V 208/230V 208/230V 208/230V 208/230V 208/230V 3 Maximum overcurrent protection.(amps) 20 30 30 35 40 50 60 °Minimum circuit ampacity 12 17.5 18.7 21.9 25.3 28.9 34.6 Compressor-Rated load amps 9.0 13.4 14.1 16.6 28.8 . LL 21.8 26.3 Condenser Fan Motor-Full load amps 0.7 0.7 1 1< 1.1 1.7 1,7 1.7 `NOTE-Extremes of operating range are plus 10%and minus 5%of line voltage:., 'Sound Rating Number rated in accordance with test conditions included in AHRI Standard 270. Y Refrigerant charge sufficient for 15 ft.length of refrigerant lines. 3 HACR type circuit breaker or fuse. "Refer to National or Canadian Electrical Code manual to determine wire,fuse and disconnect size requirements e .. - P ' ` - .. . r s ,. r ! Y f'*F• - ICI UnitarySmallHP ® ® C' �r8TE0 US REGISTERED _ © -/MEMBER evyp r QUALITY SYSTEMS Intertek NOTE—Due to Lennox'ongoing commitment to quality,Specifications,Ratings and Dimensions subject to change without notice and without incurring liability. Improper installation,adjustment,alteration,service or maintenance can cause property damage or personal injury.. Installation and service must be performed by a qualified installer and servicing agency. ©2012 Lennox Industries Inc. _ Product Catalog -Air Handlers ' H Page 6 s January 2012 - Supersedes July 2011 General Model Number CBX32M CBX32M1 .CBX32M CBX32M CBX32M CBX32M Data 018/024 . -030 -036 -042 -048 -060- Nominal Tonnage 1.5-2 Z57 y 3 3.5 4 5 Refrigerant R-410A' R-410A R-410A R-410A R-410A R-410A Connections Suction(vapor)line-sweat 5/8 3/4' 3/4 7/8 7/8 7/8 in. Liquid line-sweat 3/8 . 3/8. 3/8 3/8 3/8 3/8 Condensate drain-fpt .(2)3/4 (2)3/4` (2)3/4- (2)3/4 (2)3/4 (2)3/4 Blower Data Wheel nom.diameter x width-in. 10 x 7 10 x 8 11 x 8 11 x 8 11-1/2 x 9 12 x 9 Blower motor output-hp 1/5 1/3 1/3 1/3' 1/3 1/2 Air Volume Range-cfm 350-1.030 335-1290 485-1525 700-1825 740-1910 1050-2115 .4 Filters Number 1 1 Size-in. 15x20.x 1 20.x2Ox 1 20x22x 1 20x.22x 1 20x24x 1 20x24x 1 Shipping Data lbs.(1 package) - 136. 157. 177 181 206 206 Voltage-1 phase 208/230V 208/230V 208/230V 208/230V 2081230V 208/230V Voltage-3 phase -- °460V -- °460V °460V, 2 Maximum overcurrent protection(unit only)all voltages 15 15 15 , 15 15 - :,15 3 Minimum circuit ampacity(unit only)-208/230V 2 2 2 3 3 5 460V --- --- 2 -- 2 3 Disposable frame type filter. R 2 HACR type circuit breaker or fuse. 3 Refer to National or Canadian Electrical Code manual to determine wire,fuse and disconnect size requirements.Use wires suitable for at least 167'F. 4 Blower motor is 460V-1 phase.Optional electric heat is 460V-3 phase. - '' c ® Lus � �-. . REGISTERED LISTED QUALITY SYSTEMS NOTE-Due to Lennox'ongoing commitment to quality,Specifications,Ratings and Dimensions subject to change without notice and without incurring liability. 4 Improper installation;adjustment,alteration,service or maintenance can-cause property damage or personal injury. _ Installation and service must be performed by a qualified installer and servicing agency. 02012 Lennox Industries Inc. I ro cp( o Town of Barnstable Permit# wt 1W.k s 6 nwnths nm e e Regulatory Services Fee Thomas F.Geiler,Director • Building DtY1Sltltl. Tam.Perry,CBU, Building Commissioner 200 Main Street;Hyannis,MA 02601 u+ww.tDwn.barnstable.m,Lus Office: 508-862-4038 Fay:5I38-790-6230 EXPRESS PERWT APPLICATION - RESIDENTIAL ONLY J Not V dId rvitkW Red X:-Press jnTrtnt Map/parcel Number � z 0 Property Address / �' 0> y j's i e y ?a C 6�u, t . VResidential Value of Work fed Minimum fee of$35.00 for work under$6000.00 Owner's blame&Address /�/�lit'/P 17Y o-rl J Jt X (i 114,�4 16 CV4 _1 7 0 -ree ot tl-.12A lklrml RV 2111 Contractor's Name �J V.� �rl�? L3r� rf z 2 i#d er'.�t/�!'�l��r�` f �l�`elep�io��lumber f l�,� C i/'� f f Si,Z Home Improvement Contractor License#(if applicable) 1 Ali j ytt Constmation Supennsor s License#(if applicable) ERMUT CR�orkman's Compensation Insurance NOV' 9 2011 Check one:. . C] I am a sole proprietor TOM OF B R N STAB i I am theRbmeowner . [ I have.._Worl 's Co*ensation insurance Insurance CampaTty Name' Wolekman's Camp.Policy 0 ) W G Y d y 5 A 61 Copy of Insurance Cot6tiliaube_Certificate must accompany each permit. Permit Request(check box). � � ,r Re-roo£(tr€crr cane aailed):(stripping 6Id shingles) All construction.debris will be.takken to N4 pz 6 Q Re-raof(purr carte nail ed )(not W4ping. Going over existing layers of rood. (❑ Re-side #of doors ❑;: Rettlacen t tVtndo�x%sJdoQrs/sliders IT Ttalue (tnwdtnum.35)#o£cvindaws *Where tcgiiir 3 Esstmnce artb s pqt"=do s not exempt compliance moth other t<swn deparnnent cegutations,i e.Historic.Consemation,etc. **'Tate Property. er zuuA sty Property Owner Letter of Pe ion., A py a th Dome Impravemeut Cflntractors-i�cease:Sc Coastraction Supervisors"license_':s:. w SIGNATtJFtI . . C.IilseaskteclhklAppi7ata #tWindavks7�.lszter3set-pitelGantettt 0u21udS tUDr87AtllJpSS; Revised ff72i fU Page 7 of 7 Capizzi Home Improvement Inc. Specifications and:Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, 4 1l6 VI 550lv�wTHE PROPERTYLOCATED AT ��I �(�X ��5�✓ IN (� �i ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY.AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING . DE. SIGNATURE OF OWNER: F � OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS::- 1645 Newtown Rd., Cotuit,MA1 02635 APPLICANT'S TELEPHONE: 508-428-0518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: I ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AL4 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors&ie-ctricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): G P 7-1 d 0}—I r. 4-MI _TJG Address: G 4 New,oLvJ 7L City/State/Zip: (64u i f . MA L),Z�9s Phone#: -ry Are you an employer?Check the appropriate bog: Type of project(required): 1.114am a employer with LIO 4. I am a general contractor and I employees(full and/or part=time). * have hired the sub-contractors 6. 0 New construction 2.[] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. 0 We.are a corporation and its 10.M Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E].Plumbing revairs or additions myself. ' right of exemption per MGL Y (No.workers comp. 12.[�400frepairs` insurance required]t c. 152,§1(4),and we have no . employees.to ees. [No workers' ME]Other f comp.insurance req uired.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowneo who sabot this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ` :Contractors;hat check this box must attached an additional sheet showing the name of the sub-contractors and state whethdr or not those entities have employees. If the sub-contractors have employees,they:must provide their workers'comp:policynumber. I am an employer that is providing.workers'compensation insurance for my employees Below is the poUcy and.job site information. Insurance Company Name: C 1/ lz 7 y ��,/U�L/> ,L�/(/�'41/l9 Al.(,*— � - . Policy#or Self-ins.Lic.#: N 2tl. G G 32G S� � Expiration Date: �b t 1 Job Site Address: J@l'�/ J E �- : 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance verage verification. ' I do hereby certify un,*1thevd1n1andpena1des ofperjury that the information provided above is true and correct Sign CrDate: Phone#: Official use only. Do not write in this area,to be completed by city or town officia[ City or,To": f Permit/License# Issuing Authority(circle one): t 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:. Phone#: i ,p _ aft6'I� L�✓GCLCcfGC1!✓2{1$G� � .. ., 1 1\ Office of Consumer Affairs&Business Regulation - " License or registration valid for is dividut.use only . OME IMPROVEMENT CONTRACTOR before the e#ration date. If found return to. g =� Office of CansunierAffairs and Business Regulation ReqlstratlonrQD0740 Type. 10 Park Plaza-Suite 5170 , ExpIraf��12- Supplement Gard 1oston,M ::021'16 CAP1771 NOME1Wffi e' GARY GUSTAFS — ° 1645 NevAon Rd Cotuit,MA 02635 " Undersecretary i s 'dwritftoulsignature tftxx.ectiusi:it�- Depa rtt scot of Public ��tfciti Bojt:'cI of Bttiltlitl�g Re.ttl:ttiems itttti Standards Construction Supervisor' License License: Cs 74 M . GARY GUSTAFSON 8 SNORT WAY _ SANDWICH, MA 02563 Expiration, 11f 012 T rn '7058 Cek,•f- `y. Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE °6;02;Zo�;'") 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 terns 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 - NAME:C Karen Walther - Rogers&Gray Ins.-So.Dennis PHONE 508-760-4630 F 508-258-2230 A/C No Ext: A/C,No 434 Route 134 AnnRess: waltherka@rbgersgray.com P.O.BOX 1601 PRODUCER South Dennis,MA 02660-1601 CUSTOMER ID#: INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Insurance Co. Capiai Home Improvement,Inc. INSURER B:ACE Property&Casualty Ins.Co Capiai Enterprises,Inc. INSURER C 1645 Newtown Road Cotult,MA 02635 INSURER D: INSURER E: 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 MAYBE 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 kDDLSUBR1 POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSR 6VVD POLICY NUMBER MM/DD MM/DD - - LIMITS - A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/2012 EACH OCCURRENCE $1,000,000 X MERCIAL GENERAL LIABILITY - - DAMAGE TO RENTED - - PREMISES Ea occunence $500 000 CLAIMS-MADE a OCCUR - MED EXP(Any one person) $10,000 COM - PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 " GEN'L AGGREGATE LIMIT APPLIES PER: , "PRODUCTS-COMP/OP AGG $2,000,000 POLICY JE PRO- F LOC - $ - A AUTOMOBILE LIABILITY �I, M1 M28044 06/08/2011 06/08/201 _COMBINED SINGLE LIMIT - $ - P ANY AUTO (Ea accident) 500,000 BODILY INJURY(Per person) $ ' ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE' - - X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS .. - $ - X Drive Other Car $ A UMBRELLA LIAR X OCCUR - CUB1076H 06/08/2011 06/0812012 EACH OCCURRENCE $5 000 000 EXCESS LIAB CLAIMS-MADE - - AGGREGATE - ,$5 OOO 000 - DEDUCTIBLE X RETENTION 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC srATu- OTH- ANDEMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVEY/N - - - E.L.EACH ACCIDENT $1,000,000 - OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE$1,000,000 _ If yes,describe under DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT $1 OOO,OOO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional insured status is provided under the general liability when required by a written contract with the certificate holder CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN " Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 0198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S67537/M67480 MEE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ©02 0 Parcel Application AD"P Health Division Date Issued Conservation Division Application Fee Planning-Dept. Permit Fee Date Definitive.Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 19 ol_z O ys7p d Iq Village Owner ffK2ren a' 6 feral4 rK-. P_aL SS f-- y Address l76 7rCffidM �J+ 1(o 0 Telephone Permit Request FA)ADuk 71w o A IR010/ k IS b- &AcTT2jc 4T UN(T 5 &I . -t 0 oX 4 tAx W 4&0 co /2 T l> Square feet:'1 st floor: existing/$proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project.Valuati /,91000•y0 Construction Type �2 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting ddcurn tation. l� I � � Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) ' Age of Existing Structure R 7 Historic House: ❑Yes ❑ No On Old King's Highway:-©Ye`s-a❑ 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 l new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil X Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing I 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 57ke f+�l� Telephone Number So7 6 Address 5� 5 / ��i'l`_ License # 1 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (401 R T Z SIGNATURE `� DATE YI r k I FOR OFFICIAL USE ONLY ,€ APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 0� t G t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' 'r k GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' r t The Commonwealth of Massachusetts Department of Industrial Accidents :A i Office of Investigations EIIN.-- i 600 Washington Street ti" Boston,MA 02111 tV www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 0 City/State/Zip: •c � �z- ! one #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑,I am a general contractor and I 6. 0 New constriction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner listed,on the attached,sheet. 1 7• XPeMDdeling ship and have no employees These sub-contractors have 8. ❑ Demolition' working for me in any capacity. workers' comp. insurance: 9. ❑Building addition [No.workers' comp. insurance 5 We are a corporation and its ]0.❑ Electrical repairs or additions required.] .officers have exercised their , 3.❑ I am a homeowner doing all work 'right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t. 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 submits new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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 -y . fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form a STOP WORK ORDERand 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 c Tand the pains and enaldas Rperjury that th information provided above is t ue and correct Signature . 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): LBoard of.Iiealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: -Phone#: a 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, constr uLtion 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 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 bum 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 0,2111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia r IR Massachusetts= Department of Public Safetc Board of Building Regulations and Standards ,Construction Supervisor License $«« License: CS 12414 , STEPHEN�W rBRI,TTON i ��PO BOX 897/500.MAPLEST %,W BARNSTABLE MA 02668 j ,N Expiration: 7/21/2013 C'ommisSioner Tr#: 345 T11ze i�a�rarrea�zcuea�l a�/�aaaaclzuael�d License or registration valid for individul use only. Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation. R Registratiori1fi5568 10 Park Plaza Suite 5170 Expiration=3/2/2042 Tr# 293967 Boston,MA 02116 Typ01 EDte Cerp'o-ation oGRYPHON BUIUQ „NC, 7I STEPHEN BRITTON- � faCTr V _ 500 MAPLE STREET — \ 'f4i WEST BARNSTABLE MAj�2668 Undersecretary VN., lid without signature i - MASMTown of Barnstable Regulatory Services Thomas F. Geiler;Director i Building Division Thomas Perry, CBO Building Commissioner .200 Main Street, Hyannis,MA 02601 www.to w n.b a rnsta b l e.m a,u s Office: 508-862-403 8 Fax: 508-790-6230. Property.wvner Must Complete and Sign This Section If Using A Builder I, firer — as Owner of the subject property hereby authorize kd'-V\ kDet?4 JAI,C• to act on my,behalf, in all matters relative to.tdork authorized by'this building perrnit'application for: 19 U116 gee. 11- (Address of Job)" *Sgnaturc of Owner Date. rk Print Nari-ie If Property Oiyner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. r • C:\Users\dccollik\AppData\Local\MicrosofllWindows\Tcmporary lntcmct FilcslContcnt.outlDok\DDV87,4pZ\EXPRESS.doc Revised 0721 10 Town of Barnstab-Ie THE Regulatory Services Thomas F. Geiler, Director EARMSTABL6, r Building Division Tom Perry, Building Commissioner .200 Main Street, Hyannis, MA 02601 www.t6wri.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# work phone# CURRENT MAILING ADDRESS: city/town ' state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire.who does not possess a license, provided that the owner acts as su ervisor. 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 performedvnder 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 wifIr-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 rcquired,shall be exempt from the provisions of this section(Section 109.1.) -Licensing-of construction Supervisors);provided that if the homeowner engages a persons)for hint to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption-=unaware that they are assuming the responsibilities ofa supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Sccbon 2.)5) This lack ofawarcness 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 ofa 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 fnnn/Ccrtlf eati0n for use in your community, Q:forms:homecxcmpt Assessor's map and lot number. �.......�4.4.T....'. � � CY � •- ., INSTALLED IN COMP.IAI Sewage Permit numberTH "" }, SA IT Y G b T-,m ........................................... r '7 1.�1�F1® GUtA.T - PyoFtNETo�� TOWN OF BARNSTAE i BAUSTADLE. i "6 9 D Y �•� BUILDING INSPECTOR O� PY p' r .f APPLICATIONFOR PERMIT TO ..................................................................... TYPE OF CONSTRUCTION ...�fC..9.O.iQ. ...FAAM.g..... A A:............................................................... . L. .:..... r'a�..........19.� TO -THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information: Location .Q .p.....1 . !. ...1. ... ;?OAi ..... ..e�t- `." ... AN. ..?on. .....:...Crx.!-?.�.' ...................... ProposedUse ............................................................................................................................................................................. 1 Zoning District ........................................................Fire District ..9.0... w.!. n Nameof Owner .............Address ....... ........................................................ Name of Builder ..........Address .W..N. 0 .......�r Nameof Architect ..................................................................Address .........................................................., Number of Rooms .............../I................................................Foundation ...... .............. Exterior ...�60.D....... A'1 !.RG...........................Roofing ! 14L '7........................................................ Floors ....CA?�A!;Rlk 4.........................Interior ................................................ HeatingOct ..........................................................Plumbing ........ Q.?A ........................................................... Fireplace ................................:.....................Approximate Cost ...... ! .��" A. Definitive Plan Approved by Planning Board ---------------_---------------19_______. Area ® � .`....?. t'J Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH • y V �k�sTt►�® I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ................ Pureka, Thomas , No 17619 Permit for „enclose patio NCO jq ............................................................................... Locatior,d ...Old.. y Oster & Lewis Pond Roads .. ........................... t Cotuit ............................................................................... Owner ......Thomas Pureka s Type of Construction ............fra. me.................... ... .... t ............ ............................................................... Plot ....`...................... Lot ................................ Permit Granted ..........M.a.rch...26............19 75 Date of Inspection Date Completed ... ........ .... ...............19 PERMIT REFUSED .................................................... 19 i +............................................................................... ................................................................................ ............................................................................... ........:....................................................................... Approved .................................................. 19 ti ............................................................................... ................................................................................ ; s Assessor's map and lot number � INSTALLED IN CUMPLIANCE Sewage Permit number ..i '1_ `—... .......................... WITH '%f:ate II S w OWN �eOU L i 0 W N 10" F B ARNSTA ca ° Z BAUMBLE,t639- BUILDING INSPECTOR e 0 ONO�' APPLICATION FOR PERMIT TO .. N...."'. '.... ...... .. . .. ............. ........... .................. .............. P n. 1 C �i �..C? TYPE OF CONSTRUCTION ........................... .................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:' <.. Location .�..p..... .!..`�..?.. .r....�>�'?.r1.!�....y :. ..fit` .:....�.....1 Rty. .. fi !,::m?........�..4��.F.y.,k ............... ProposedUse ..................................................... ........... .... ........... ............... ........ ......... .. _.................................. ZoningDistrict ..... ...r .......................................................Fire District .. ........ ......... .................................... Name of Owner ..�. C�V� .' .... L�.�?.i .f<-t .. .......Address ...... �'..►.�,aE-f........................................................ Name of Builder .�lr-1f > . .... .... /�1 ...........Address � m?.�../�: ( :r .� �. i : ' .... 41 T .�.2.t..�. ..... P. Name of Architect ......Address Number of Rooms ....:....... Foundation Exierior ... ...........................Roofing ......................................................... ....................................... Floors il� F/.-',/�' .. t 1w, ; . 11 T i i ./'l r ' :.........�.......:.... Interior r.l�:...�..{.......:.�?.............. Heating ...........N�s; e.a'=:..........................................................Plumbing ....... ........ ............................................................. Fireplace .......... ,. '................................................................Approximate Cost ...... �:? �..:"..... ....................... �.. Definitive Plan Approved by Planning Board _____ ______________________19________. Area :..i...`:y.... !....................`.....� Cf Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 43 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ff� Nam l" ... '. ��T f'.:!.?..' I .............. Pureka, Thomas D Permit #17619 encl. se patio Old Oyster &Lewis and Roads : Cotiuit Thomas Pureka March 26, 19 5 ' f s, +i I r,( 4 4 -..y SEPTIC SYSTEM MUST BE Assessor's map and lot number ..............b......................... `NSTALLED IN COMPLIANCE ,/ 6. WITH X-RTICLE Il STATE Sewage Permit number .7..A. ............................. SANITARY CODE AND TOWN REGULATIONS. �QyoF?NET��o TOWN OF BARNSTABLE ro ti � i i 33AR33TABLL i O 39- BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...........B.v.!'.4:.p................................................................................................. TYPEOF CONSTRUCTION ........... ................................................................................:................:...... .......... .....t. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........OLD....01.-S.: EA..... ...RID.:...!G:Q'?'Va:r..MA9s ......0.14Z��.. ProposedUse .............REk i.P.E&C:IE.................................................................................................................................. Zoning District R..al.-4.............................................Fire District ................................. e Name of Owner oM. :.. +.... . . . .............Address .+-1. ..... � 5...�.�:...D...... . ....g2.f7� Name of Builder CA , . .. -. laEs.. IkPLAN�?. !��Address ,. .... ia .l. !Jt1..i�...�./.r.....Pl ®. ,, Name of Architect ........(I.\'. f) ...Address .. e.Qa �..�{.................. Numberof Rooms ..............6................................................Foundation ... .. .. . ..........................................:....... Exterior ... . .j ............. .. .... � . A . . � f . . . . . . ............... Floors ... .T. ........................................................Interior .................................................................................... ..... G ma�cc,, Heating �LfC��/ C:.............................................Plumbing C�P.P.�.(� 9`— Fireplace .............[. ............................................................Approximate Cost .. ' !....... ......d0............... Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area f. ..g. ..................... 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 f. .�.. J. rY . ............... /!� / �.I � o Pureka, Thomas T. No ..T63'j..... Permit for ........one,..stO ........ single family duelling ............`..�.` ................................................................ . Location`" ` Old Oyster Road .............. ......................................... Cotuit ............................................................................... { Owner ........Thomas T. Pureka ......................................................... Type of Construction ..................frame f Plot ............................ Lot .................. ........... i Permit Granted .. .....JulY..1Q...............19 73 i Date of Inspection ............... ........ .........19 Date Complete ...!!!........ .. 19 E, PERMIT REFUSED i f 7 C�' 2 ............................................................................... ................................................................................ t ............................................................................... ............................................................................... 1 Approved ............................................................................... y � LTOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � Map 00Z Parc 1 Permit# 13 l 3 _..._ , Health Division Date Issued Conservation Division iak Fee Tax Collector• 0C �y�R9 SEPT6C SYSTEM MUST Trea qsnipin urer - INSTALLED IN COMPLIANCE WITH TITLE 5 Planning ENVIRONMENTAL CODE AND * TOWN REGULATIONS Date Definitive Plan ed by Planning Board Historic-OKH ation/Hyannis Project Street Address QG D t�ys7z=� �`� Ararhr� � C1rr�2�rzrn �&�€g k-.JI_ Village e6TU iT r. Owner. VA-CEM 1�4.e 21 Ss Address 170 Tzcm1� Telephone 617 " 3 q Z— &Z Z- Permit Request VmY I SiD► � Qe Dki(414-e4t , Me-W 3[�'�C �o A e,cfC (v nT) t /3 / ��xs'� fv Q&SC&4J w iAJd ��jmen i tOl. V 1luL ,►— S]i Q !l&s s 0/ aY PW _eeamPin:f Square feet: 1 st floor:existing I , b sF proposed 2nd floor:existing proposed Total new Estimated Project Costs 3 Zoning District Flood Plain- Groundwater Overlay Construction Type W-4bD P nr , Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. t Dwelling Type: Single Family Two amily ❑ Multi-Family(#units) Age of Existing Structure 24 Historic House: ❑Yes LU o 'On Old King's Highway: ❑Yes aKo Basement Type: Full ❑Crawl ❑Walkout ❑Other Jk , Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) d� 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 ri 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:0 existing ❑new size Barn:❑existing ❑new size Attached garage:Aexisting ❑new sizee Shed:❑existing ❑new, size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ •Commercial ❑Yes YNo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION /� Name (. 4P rZZi 6- Telephone Number Address l b u S 148Z0-0(y/-e '- License# 105 4 S7 Fad eS p 7 d-7`f 7 Home Improvement Contractor# 1007 `l O Worker's Compensation# o o W 6r3Z O b4J , ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO )'hF�R 1 C.A74 A!r_,CZ"5e_ SIGNATURE DATE _ 0? j� FOR OFFICIAL USE ONLY ' PERMIT NO. DATE ISSUED MAP/PARCEL.NO. ADDRESS _ VILLAGE- OWNER DATE OF INSPECTION: ) FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH; FINAL PLUMBING: ROUGHS FINALrr _ • •• GAS: , ROUGHS_- Z FINAL . • � ...fit .\, n • ' ' ,4! t ' ' . FINAL BUILDING ' 0 -„ �'t too 0 - DATE CLOSED OUT Rijr - ASSOCIATION PLAN NO. FEB-08-99 09:00 AM 2 5084202164 P.01 Home Improvement Vinyl siding, roofi19. windows, additions, decks. Fall Service Home Improvements �. 1-E04-262-5060 FA,`<TRANSMISSION ti TO: FAX N O.: � _ - ---- x ATTEN710N: NUMBER OF PAGES(INCLUDING COVER): NOTES: L�-re .. C_ `rl4A dydcr &X S 0 e rt U ;� a cj Le- e r r � ss C z I 15$c NpnAe.wr Rca4 (508)428-951 S FAX(50€;428-1547 Cotu it. N#.A02635 Window & Door . Prime Products ftge 01 t„n Dealer Name —. <_ z l AocouriY _ Ship Via Delivery Bequest Date Ordered y/U Warehouse Truck U Standard Address U Facto Direct O ial rY �� Cust.P.O. ,.L U Factory Pickup j U Pick up at f�L o#SG- 7 7 .. Ordered by 3 Job Name �Y10�C� l �`i O1€� � 1�� �A�'V„'�- t"1 t S6"- (Delivery Area) oc le Window Specifications, Interior Exterior Glazing: Screeas: Bay18®w Type: She: Color: Color: _ �&alf �3 ftM Angle: W811 Depth: Venew any! I- w g While hite 0 Full J Wood c ❑Almond D Almond Argon UNone U CSC 1� f �4 9l16`(STD) interior: Oak U Aluminum U O Bronze a Med_t3ranze J Ofascx>Ine 4ef D1Y � Other Cl toclk U Pine Q Dark Bronze .1 Special Temp- Grids: "i nter PW -�2'0" Sirct+ �� Sash Type: U Catalog Size U Oak Frame: U Other U Colonial In-Glass i-'Multi-point loc 4!2'4' _. ❑Mechanical! Q Oaktone U Replacement U Colonial Snap-In (i1 of liter) "elded T 1 Fin ❑Diamond In-Glass GGMf!Ji_NT& a .. Heigh a(or I', aq Jar 4 �� m — 00 fJ Vinyl Patio Doors w Colonial Ouant' Size Style Grids Glazing Color A _�— ❑ Standard 10 Low-E U Argon U Bevelled Wall Hardware Prep Dew wood O Brass ❑Multi-pond Loc" Q Slairtlass system Indudes aus1om Deadbolt Steel Wheels polished brass h"40 p 9 id Custorner Signature: Window ®ter Friars Products Page of - -'- Ship Via Delivery Request Date Ordered m Dealer Name C-o4 P/` Account# l Address O Warehouse Truck U Standard 2" ( 9 0 Q Factory Direct J Special Cust-P.O. !t — -- - Factory Pickup Q Pick up at � s Ordered by D Job Narne ow, `.w -d �-- _ (Delivery Area) I mow Specifications: Interior Exterior Glazing: Screed: BRYAB®W Type: Size: Color: Color O Bart J DH Angle: Flankem: Wall depth: Veneer o -SrVinyl 14mopening 4White J white ow- l ulf U Woad 0 Buck ]Almond U Almond ow-E Argon U atone U CSMT U 10' Q t'S" O A 9l16"(STD) Interior: Oak- U Aluminum Q TTT Ci Bronze O Med.Bronze G Obscure U Center P U 45130P U t�9' J Other U Birch J Stock U Pine a Dark Bronze U Special remp. Grids: U Center inf 0 A5 U 2'4" ,Si;efs N Sash e: 9 O Multi p®in4 tacit U 2'4' � U Catalog Size 0 Oak Frame: G Olt�er C!Colonial In�tass I*-iulschanical Q OaMone U Replacement U Colonial Snap-in of l ite3) Q Welded Mail Fin U Diamond In-Glass COMMENTS: y �- ! rA Vinyl Ratio Doors N Colonial Quantityl Size Style I Grids Glazing . Color a ® Standard © Low-E Argon a Bevelled Wall Hardware Prep Depth Wood Q Brass O MLA-"it U ckvq 0 StWnlesa system includes ctsran --- — Deadball Steel Aheets 9dished brass handle T _ _ m Fl Customer Sicgnature: ._._ _ _ _ _--_ '-- ••__.-"..'.•'- •.,,,, � ( '+I-.-.- _ �12C C00097/I92092RlIPQG�2 6�v'(�CQ�:Sa�uJe/,/.J I{ DEPARTMENT OF PUBLIC SAFETY HOME IMPROVEMENT CONTRACTOR ; Registration 100740 CONSTRUCTION SUPERVISOR L CERSE Type - PRIVATE CORPORATION Number 7 Expi e=: Restrji6ted To:� 00 CAPIZZI HOME IMPROVEMENT, INC ;} _ x , as Capizzi, Sr. CAPI2_, TH0MAS �T ADMINISTRATOR i 45 Newton Rd. 1645` NEWTOWN RD Cotuit MA 02635 COTUIT, MA 02635 as{3{ 67— DEPARTMENT OF PUBLIC SAFETY ON,SUPERVISOR LICENSE CONSTRUGTI i Number --- `- Expires: -- Restricted f BO r TNOMAS`' CAPIZZI JR s' f !' ^�z `280 PERC'IVAL OR E 1.I W BARNSTABLE, MA 02668 �, �,'�"'��-. ✓�ie �a»vrnaiauiea� a�=�v3ac�ZUJ�'d t DEPARTMENT OF PUBLIC SAFETY , c CONSTRUCTION SUPERVISOR LICENSE Number-' Expires: Restricted Tot 00 _ FREOER-ICK_V. RASCH III t x '1060-80URNE RD PLYMOUTH, MA 02360 The Commonwealth of Massachusetts Department of Industrial Accidents tfl1l/Cr 81/OYCSUg8ffeas 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole et or and have no one rkin in acity VU I am an employer providing workers' c. ompensati n for my employees working on this job. m an ......a _ .........:...::... ... ... X. X. ci ... : ,. .: finsurance cot ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation.polices: >: ;: ;:;.. .....:: con: anv name. .;: "" `.::` ::>:<`.:`.»>:<'>::`>::::'.`:;'.::.:: :.:..: ":::::::.. ::::::.:::::::::.. ::::...:::.:::..::::...:.. ..::::..:..... address. :::;>:<>:;>: :<h.:.:...... ............ .............................. ..::::::::::nii:vi:i4:<::vim:•}'+?:C:<:::::::::::::::.:�i:+:•:�'•i ..r.,t;..::::::........:::nvJ}y.;::;::.;::;;.;:.; :•y't4}}:^:;}}}:viii}.. ::::::::.�.�::::::::::.�:::::...........:......:....::•..:•.....................:..:.....................................:.:..........................:::i?:v:v.:i..v?!•:is i •::• n....:....:.....:...:.:............:.... .............................................................................................................................................................. ::n�.:::v:::::v:•:�v:n-::is Y.,}.�...}:::x•.'rt....................!t ti:.}::. ........................... ...................................:...:::.: i:C iivii::5;:;:;i:;i::;i:;} i::ti;S......i:}SLjiy:}i:CC::iiY:i ......................................... :::::........ .........}j::'t:::::•:i::.;'::::::.::-:•::•}:•:::•;};•::•::::..... •::::.....;..;..::::.;.•:::::�. 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I naderstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pairs/and p,(e�nmaz1 ies of p pedury tthat the infonnmion provided above is 0w.arzd e/orre�d c�/L- Signature C � Ll /�_G2�C�i s+ ' Date Nh / Print name �2c� r�,c l/- /� Phone# omeW ease only do not write in this area to be completed by city or town official city or town: paadt/Itcense# Qguildhig De. pattmmt ClUcensing Board [Ichecicif immediate response is regvlred ❑Selecdnen's Olce 0Bealth Department contact person: phone#; ❑Other 0erad 9195 PW saccucsEtt * SiTlF7CA7E .S #SSUED AS A MATTER OF EIFORMATION NORCROSS & Z,EIGF�TON 2NC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NOLDEFL THIS CERTIRCATE DOES NOT AMEND, EXTEND OR H1TP /WW'W.NLINS.COM ALTER THE COVERAGE AFFORDED BY THE POUCMS BELOW. 437 STATION AVE COMPANIES AFFORDING COVERAGE S YARMOUTH MA 02664 COMPANY A MARYLAND INS GROUP W$URED COMPANY CP m I ZZ I HOME IMPROVEMENT INC B THE HARTFORD COMPANY 1645 NEWTOWN RD c COTUIT MA 02635 COMPANY D 'COVERAGES .:":"' .,.,...> ;xx `>'::;.-::�?;.; r:.`..'�[..wa...>....w...a�.•..�r:.,w:c•:awtia::::....»Mai..'nw»...,..:o>.�.w..•:wa..a...:....: .. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD INDICATE], NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA i cc MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE!N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO ►OUCY EFFECTIVE POUCY EXPOUTION LDM� CC I TYPE OF INSSURANCE I POUCY NUMBER DATE(MM/O0fM I DATE(MMMONY)LTR I cErf£RwLILAautrY RGP281928.22 04/01/98 4/01/99 GE: AGGREGATH Is2 , 000 000 X COL)MEACtAL GLNEAAL UABRJ'TY vRCCUCTS•COMP/0P AGGj s2, O O O 1 O O O CLAIMS MADE OCCUR - PE2SONAL 3 ACV PLIURY I s1, O 0 O , 0 0 0 IOWNEA'S 3 CONTRAC"OR'S PAOT EACIr OCCURRENCE I s1 000 , 000 FR_DAMAGE(Any orr are)i s 50 , 000 M E: EX; (A.-y or.per>an) I S 10 , 009 LA L1ABIUTY 08MCP399948 04/01/98 4/01/99 ' C043;NE0 SING'`LIMIT I s , O NED AL'i..S - 3CD,LY II._ RY L_=D ALTOS (Pv xz n) k' 0001000 A'TCS - 3CC:LY IN:L'RY N� AITOs (P•''�"�"') sl 000 , 000 = s 500 , 000 (LITY A'�O ONLY• EA ACC:DE� s '0C--E°.nAN AL:O ONLY i EXCESS LALT BIY EACr OCCI==ctCE I S IUMBRELA FORM IS CTHER THAN'JMSRE_LA FORM - i s _' WORKERS COMPENSATION AND I OSWBBZ2826 04/01/98 4/01/99 I X EMPLOYERS' UABILlTY EjC!= AC.:'.=�- I s 100 , 000 THE PRCPRIE7OR/ I,a 1 E:o,S ASE'.,oucy UMr I s 500 , 000 PAa-NEA-S1EX_CUTIVE 100 , 000 OFFICERS ARE. �I EXCL c' C'ScaS'c 1 Eu�LOY=E S OTHER ` i • DESCRIPTION OF OPEAAnONS1oCAT)O1tSNEMCLMZPE.:JL ITEMIS FOR VARIOUS CONTR-kCTED JOBS :.:. cERTiFiCA I E. ROLDER :>' ..>...M.�.. ww.w..w�...... ,_��..� W40ULD ANY OF THE ABOVE DESCRIBED POU=L S BE CJWC`LLED BEFORE THE 071RATION DATE TH!3tEOF,THE SSUING COMPANY WILL ENDEAVOR TO MAIL -- D1.V5 WRCTTE?I mamdE TO THE CERTIFICATE matmER NAMED TO TmE LEFT. SLIT FALURE TO MAL.SUCH I+ancs SK"DdPOSE NO OBUGATIOM DR UA82lrY OF ANY emc uPON THE COMPANY. ITS AC=`fS "OR RR=__r Tff-S AUTHORIZED REPRESENTATIVE Michelle Connors C .. ..... ... v. 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The Town of Barnstable• �rAAi�` • 9 � �' Department of Health Safety and Environmental Services ; �9. ,' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: lW heG(C, �n �U'+�domi Repl• Est. Cost 3 3. ��•°� — J nn Address of Work:� d�� lT� l Owner's Name > dM n vP t C�cS�L� Date of Permit Application: Q?1 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law. Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING , WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as.the agent.of, the owner: Date Contractor Name Registration No.. eflP ! zz1 4rM _7� OR Date Owner's Name Window & Door Prime Products Page of F►ARVEY a 0 Order Form Harvey Industries, Inc. • 725 Huse Road • Manchester, NH 03103-2339 Dealer Name ( �?'/ Z / Acc unt# Ship Via Delivery Request Date /Ordered ❑Warehouse Truck ❑Standard Address ❑ Factory Direct U Special Cust. P.O. ❑ Factory Pickup Cl Pick up at 7 7 � Ordered by Job Name _ o (-C'tS'>1-I �i O�(� ��� ►� Cb V,. �' (Delivery Area) C/C, Window Specifications: Interior Exterior Glazing: Screen: Bay/Bow Type: Size: Color: Color: '"tear -Hall ❑DH Angle: Flankers: Wall Depth: Veneer ,Vinyl g "White White ❑Low-E ❑Full U CSMT ❑ 10- ❑ 1'5" �(4 9/16"(STD) Interior: ❑Wood c ❑Almond ❑Almond ❑Low-E Argon ❑None o 0 Center DH ❑30 �1'9" ❑Other Ell ❑Aluminum U ❑Bronze ❑ Med.Bronze ❑Obscure 'VcCenter PW 45° ❑2'0" Birch lock ❑ Pine El Dark Bronze ❑Special Temp. Grids: CI Multi-point lock( U 2'4" Sash Type: ❑Catalog Size O Oak Frame: U Other U Colonial In-Glass ❑Mechanical O Oaktone U Replacement ❑Colonial Snap-In (#of lites) -Welded ZV4ail Fin ❑Diamond In-Glass COMMENTS: Product . - CVDH 32 x 58 •. - . . .. . Vinyl Patio Doors Colonial Quantity Size Style Grids Glazing Color ❑ Standard U Low-E ❑ Argon ❑ Bevelled Wall Hardware Prep Dept ❑Wood Cl Brass ❑Multi-point Locking ❑Stainless system Includes custom ❑Deadboll Steel Wheels polished brass handle Customer Signature: Window & Door Prime Products Page-of- Order Form Harvey Industries, Inc. .• 725 Huse Road • Manchester, NH 03103-2339 Dealer Name , Z- i ___ __ Account# Ship Via Delivery Request Date Ordered Q 0 Warehouse Truck 0 Standard Address O Factory Direct O Special Cust. P.O. 0 Factory Pickup / ❑ Pick up at G 3 �j ' � �� Ordered by Job Name t'1(l o f-C^ 5� \ O�(� ` ( 2� c��15� �— / (Delivery Area) K_.�v Window Specifications: Interior Exterior Glazing: Screen: Bay/Bow Type: Size: Color: Color: Clear 0 Half ❑DH Angle: Flankers: Wall Depth: Veneer 'Vinyl -Opening 4White -"White ❑Low-E 4-Full ❑CSMT 010, ❑ V5" ❑4 9/16"(STD) Interior: 0 Wood 0 Buck 0 Almond 0 Almond 0 Low-E Argon ❑None ❑Center DH ❑300 ❑ 1'9" 0 Other ❑Oak ❑Aluminum ❑TTT O Bronze ❑Med.Bronze ❑Obscure ❑Center PW ❑45* 0 2'0" ❑Birch ❑Stock ❑Pine ❑Dark Bronze ❑Special Temp. Grids: ❑Multi-point lock 0 2'4" Sash Type: ❑Catalog Size ❑Oak Frame: Cl Other 0 Colonial In-Glass '1"echanical 0 Oaktone ❑ Replacement ❑Colonial Snap-In (#of lites) ❑Welded Nail Fin ❑Diamond In Glass COMMENTS: Quantity Product x J Vinyl Patio Doors Colonial Quantit Size Style Grids Glazing Color ❑ Standard ❑ Low-E 0 Argon ❑.Bevelled Wall Hardware Prep Depth ❑Wood 0 Brass ❑Multi-point Locking ❑Stainless system Includes custom ❑Deadbolt Steel Wheels polished brass handle Customer Signature: ti - X Z 8�4�usTa�l G l6c yxG 1� �osr I f ' 7 r o c S �✓L — ♦�X/sU P7 a,�,6a�sFs r Baa�S q C'o-rA ` w �'Z $A'lllST6�l L i� - •: yxG PT PosT • . .. �vt 3'/A P7 EPL V T ,OeaOTI4L,.V ' iGTWS T .00 0 Q �)/a t drJ, 19 (2,0 .� " , Sl If i• f, ; , t \. 130 " , ............... \\ Y MAN ` \ y \ i \ ................. i w "' ... , ...... ......... .............. t \ w , \ s \1 i `� .\\..\.., : ...................- E .........k ........... .......... ----------------- vx�-' ................. , 4IR6.4 A / ` MAP24 . � ` � , 1. 1 \ ^•f...... ; / \ / ........ ` \ AA , j f 1 t F �I f f )gLL PRaPEKT p k",6 A - Y X. A f C� QD� ' N« lkCIL304 , -- 29 -- - - r �S �{ 1 .'�w ..n _ ,. . �R ._ _ _ _._ _�_�_��_._ _.__ . T_�. __ _��. _ _ _ _� .t _ '._ .. _ .___. __��_�_�.�_� .__ _ __� _ _ � _ _ _ _.__ ..._ r _ _ _�. _ _�..__,�_ _ .__ _ __.. __ _ ._ .. _ {� _ — - — �. 1 AI Assessor's map and lot number ....... .....................6............ 4,E • � ��s� ��v e ��sr /�a��g 6�F�.�� Sewage Permit number .................. ........ ........ ........... .. ��Qy�FTHEp��yo� TOWN OF BAR.NSTABLE MSTLNABLE. i . 9 � 39.ae� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....M E......�vPA—k (L C.E9??A ..........................................E ....... . ..... TYPEOF CONSTRUCTION .......... .R ....................................................................................................... ...........V .......1.0 ........1973. a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...............Q.0.....QYA.7 .9....... . !©7'LO1.�.. A.IMA........................................................... ProposedUse .......................................................... ............ ................................................................................................... Zoning District .....:.... '..................................................Fire District Name of Owner 1 (ti�!!1 ��' 7; ..........Address 39...!me-:W S'....R.P.:....aa�M0.IX.I.Mft..�2-1*7F Nameof Builder ....................................................................Address ......:............................................................................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ............�..................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .............................................��............................... Firepp ..................................................................................A Approximate Cost .......�.3.©.�......... lace PP ............................... Definitive Plan Approved by Planning Board ________________________________19________. Area ................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. --v!'! ! ........ ............. .................. i Pureka. Thomas 1. ; .r No .......1..37..6. Permit for move frame dwelling ... ............ .......... ... next lot I q............................................................ Location Cotuit .........................::..............:..................................... f Thomas T. Pureka Owner ............. .................................................. Type of Construction ................... frame ....................... ................................................................................ 1 , Plot ............................ Lot ................................ i r Permit Granted Axly..10..............19 73 Date of Inspection ....................................19 Date Com leted .............. .............. .......19 j PERMIT REFUSED ' ................................................................ 19 I ,l ............................................................................... ................................................................................ ; ............................................................................... ............................................................................... Approved ................................................. 19 f I ............................................................................... ' .............................................................................. r 304ODH FRONT DOOR 52, 304ODH 304ODH i i existing walls to be removed 0 o m o LIVING BEDROOM BEDROOM Cn t y 2668 2668 N d' — 04 E doorway to be filled in { 2668 I i DINING KITCHEN MASTER BDRM BATH N r.— —V 0S631 jL —� — II 7068 3068 304ODH 304ODH 52' i . Co I PORCH 00 LEGEND n � WALL TO REMOVE WALL TO FILL IN I Designed Especially For: APPROVED BY: DATE GRYPHON BUILDERS, I N C. Karen & Gerald Morrissey DESIGN PLANS ARE PROVIDED FOR THE Home Improvement Contractor ALL DIMENSIONS AND SIZE SCALE: DATE: West pp�/� ♦ Y FAIR USEBY THE CLIENT OR HIS AGENT. Number 165568 DESIGNATIONS GIVEN ARE PO Box 2$2 WeSt Barnstable, IYIA 02668 g Old Oyster Rd. PLANS REMAIN THE PROPERTY OF THIS SUBJECT TO VERIFICATION ON A-1 y FIRM AND CAN NOT BE USED OR REUSED Construction Supervisor License JOB SITE AND ADJUSTMENT 9/10/2011 508-362-1282 CotUlt, MA WITHOUT PERMISSION. Number012414 TO FIT SITE CONDITIONS. o Q�onno..av r /G' Loomis J v N A SS A ca _ a.4 ' !1 Q4-dco (35.4-7 Qo sA -%' Lacvs t� s c►d pp�.. 5 r. � v O SC 426- i iN- =Z;2e:o d -Z -T- 1 t 0o ro 8� e�tisov�o ® sc s�.t-� t !►�C.=do �T Ju►�L>� 8, l�i'l3 ^ O O � � QIG►.�A.Q1� A. gA.�tTF3'tZ - Sum-VE (C� Ail Aov 5's co 4 2!/6 fl <t��t°OF ZI ,471 S s RICh-ARD A. ® RAXT( Fi '~` v su -73.58 ' 15S.Oo 30.00 L�Wi � � ot�lt� tzvAL� UNDER THE SUDZUVISI Nil CCWWJ�,&4 A W NOT REr outRzD ----------------- � �,�e3 - 17 Locv S 'E'er o a l� a4.22- do Lrwi s vd+� 'Q4-4? ' O Sc uap� sr. W-� P O P A t'4 OP t-j C=> O o - `�• CO`TW U 1 `T' S AZ W-ST t IBLX - KA A S S Q m F•o¢. 88 -Sd•oo�- - - .Q. Q. d t t o. C> - �. 9 0 -1 A M P S C. -rlZt PP !- S I tvA. 4,=> F-C" �V�►� 8,1973 • • � O tZl C t-1 4Q� A . P.�AX.T�-cz- St�2.v t-�oc� d Q. T"C>AAAS -t' Q�tZEkA O of N b ! 3E A. � s3AX iEft No 2.1048 0 80' I!, 0- 1r3. c.8. i o-7.d l �:P`� A � d APPROVAL ISARNSTA13LE PLANNING BOA P1714 A UNDER THE SUBDIVISION CO3"- t'ROf- LA tW L' I,r 3 To � Usti t+ Co�v�.►c� ►o� W IT" A�JO�1�t 1�!G �...r0►f�11� . Sk.