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Home My WebLink About0479 PUTNAM AVENUEr474 �� Rye . Town of Barnstable g§ Buildin %,��''�'" `�.�.: dr � ��s�" d '��w �1%.n�' �>% �,'r� .;�,masav?s v"e"* �'e .�•,P*,,, v".�?�� ''�%'�`:'.�'��<`" ` ''; �`3z�,�. g t,Ttiis� r-�So That its`sVisible:;From'=the`Street� A `rove"d�P,,Ian's Mustrbe�Retamedxon Job antl�:fihis Card Must be�Ke� i Pos ;�4i ed Until Final Inspection Has-Been Matle x -sup-' - � ar, ific teof,,Occu anc. <is,Re uretl such�Buildi�n .shall Not be Orcu ied u'n it a�Fin j Ins ect�ort has bee made Permit eaa Permit No. B-18-2422 Applicant Name: MID CAPE ROOFING Approvals Date Issued: 08/01/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/01/2019 Foundation: Location: 479 PUTNAM AVENUE,COTUIT Map/Lot 038 010 Zoning District: RF Sheathing: Owner on Record: CAMPBELL, DONALD G&KATHLEEN R ,� x, Contractor Names MID CAPE ROOFING Framing: 1 Address: 479 PUTNAM AVENUE A � Contractor Licen�se�161458 2 Ni, A COTUIT, MA 02635 Est Project Cost: $6,485.00 Chimney: Description: roof � � Permit�Fee: $35.00 Insulation: Project Review Req: a Fee Paid $35.00 �' Date 8/1/2018 Final: ,,. 14, TV Plumbing/Gas z i _ r� Rough Plumbing: Building Official 3 Final Plumbing: This permit shall be deemed abandoned and invalid unless the work aattionzedzby this permit is commenced within siz months afier`issuance: 3 Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documentsAfor W6 this permit has been granted. All construction,alterations and changes of use of any building and str ahf s'°h II tie in compliance with the local zoning by aws*and codes. Final Gas: 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 work until the completion of the same. Ai Electrical The Certificate of Occupancy will not be issued until all applicable signatu by'ahe'Buildmg and?Fire Officials areprovidedon.this permit. Service: Minimum of Five Call Inspections Required for All Construction Work?'. _<„ 1.Foundation or Footing < Rough: 2.Sheathing Inspection " 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Building Post This Card�So That rt is�Uis�bleFrom the Street A roved.Plans Must be§Retained on,Job and,this GardMust:be Ke t -' lARN8TA01.L. .v � `,s•,I. -,,.",, ,� •- =` ,, 1 '+ ;� Posted Until Final Inspectlon�Has Been Made �' .W§.here a,Cert�ficate:of Occu anc -isuRe wired such=Buil`dm shall Not be Oceu ied until:.a F,nal Ins ect�on h s been made Pei mit Permit NO. B-18-2422 Applicant Name: MID CAPE ROOFING Approvals Date Issued: 08/01/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/01/2019 Foundation: Location: 479 PUTNAM AVENUE,COTUIT Map/Lot 038 010 Zoning District: RF Sheathing: Owner on Record: CAMPBELL,DONALD G&KATHLEEN R Contractor Name; MID CAPE ROOFING Framing: 1 74 Address: 479 PUTNAM AVENUE , ContractorL5,ense 161458 2 _� .; r COTUIT, MA 02635 Est Project Cost: $6,485.00 Chimney: Description: roof Permit Fee: $35.00 Insulation: Project Review Req: FeePaid $35.00 b - W '1 'Da' ' 8/1/2018 Final: - ` Plumbing/Gas Rough Plumbing: .. .- Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed'bAhis permit is commenced within six�months fter`issuance. Rough Gas: n All work authorized by this permit shall conform to the approved applicatio and the"approved construction documents�for which`this permit has been granted. All construction,alterations and changes of use of any building and strd6tufes�shall a in compliance with the local zoning'by lawsand codes. final Gas': VWAX This permit shall be displayed in a location clearly visible from access street&r road and shall be maintained open foripublic'inspection for the entire duration of the work until the completion of the same. k N11 L lk Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the 6uild'p and�Fire Officials are prov�detl on tthis permit. Service: Minimum of Five Call Inspections Required for All Construction Work L G ." 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 4 .Application number..—..�.....�.. ;` . .F�... . .... W . Date Issued............... ................................ #�ltt.'tiE$TliBLC. " atY `�� iild ...... .... ing Inspectors Initials.. ..................... r01411,1 c/ Map/Parcel:.......... ......................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: J 9 T�7�� ,�a five- �'g NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number Project cost $ Check one Residential c / Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby,authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑R of(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor'swname Home Improvement Contractors Registration(if applicable) # 1415(57g (attach copy) Construction Supervisor's License# 0 5 y1,/20 . (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN L A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.................................................... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: �� e,•-4� 4- Phone#: Are you an employer?ChecK the appropriate box: Type of project(required): 1.❑ I am a employer with - 4. ❑ I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.Dram a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P t3'• # 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.F] Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state,whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: L/w 5 d 2 Y Expiration Date: Z / Job Site Address: `7 @! /-p,U f,ti 0c,,-c City/State/Zip: 4CcWc„ IM44- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature Date: .1 2 Phone#: �i � 5 fib l Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ; Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license orIpermit 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 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.#617-7274900 ext 406 or 1-877-MASSAFE Fax#61.7-727-7749 Revised 4-24-07 vvww,mass.govldia yr 1 1 MID CAPE ROOFING 11 RUSSO ROAD WEST YARMOUTH, MA 02673 508-775-3799/508-385-8801 Barry Merrill & Paul Merrill Job Site Address Mailing Address Name: A'r L��.� c- I i o Name: ��^� � Street: <17 Street: r.61, City: CEO:t- City: Co Telephone: Telephone: We hereby propose to furnish all the materials and all the labor necessary for the completion of: roof replacement of the dwelling at the above address. Mid Cape Roofing proposed to remove and dispose of the existing roof. The roof will be replaced with CertainTeed Landmark shingles. Aluminum drip edge will be installed along the gutter line. Ice&Water Shield installed on bottom edges to protect ice back-up. 15 pound felt paper will also be applied. The shingles will be installed using 1% inch roofing nails. New pipe vent collars will be installed. Ridge vent will be install.ed.along the ridgeline of the roof to provide proper venting p p p of the attics ace. g p Mid Cape Roofing guarantees the workmanship for a period of 10 years. All walls and landscaping will be protected from damage;the property will be raked and cleaned of all debris. All material is guaranteed to be as specified and the above work is to be performed in accordance with specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: $C,oY1:S.00—All discounts have been applied. Payment made as follows: Deposit.of: 1.g,�00 the day job is started and remainder paid on completion. Any alteration or deviation from the above specifications involving extra costs will become an additional charge over and above the estimate and will be discussed with the homeowner. .Respectively Submitted by Mid Cape Roofing NOTE: This proposal may be withdrawn by Mid Cape Roofing if not accepted within 30 days. Acceptance of Proposal The above prices, specifications and conditions are satisfactory and.are hereby accepted. Mid Cape Roofing is hereby authorized to perform work as specified with payments made as outlined.above. Accepted: °'`^' �/e �c��wraosut=ecilt�i n�C�'v,G�'oacr-.a:a%', Aftwrs a. L....:._._ ENT i:C';iT..,,. T- pe, Psrtnership P- Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const\uetibrtyS'i5pe rvisor, CS-054428 7 = E.ires: 05/21/2020 BARRY B MERRILL > 312 SKUNNKE-T RD MHz. CENTERVILLE`RA 02632� a� -ko • Commissioner i �;r, i;2,ctr.ltion va!r fir ino ndvni us r.`vr! .. . befornta a%Piro vn date f found r _. R of Gensu,r Aff l!.M,ar+d b s!vVz 0 =tx?lazy SIs to 51170 l Bcs`,,n;MA 021'<4 s ' Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to posses s a current edition of the Massachusetts State Building Codeis cause for revocation of this license. For information about this license -a govldpl Call(617)727-3200 or visit www. Town of Barnstable .r—'`y oFTME Regulatory Services I Q' Richard V. Scali,Interim Director y BARNSTABLE, " Building Division MASS. 1639' 1k, Tom Perry,Building Commissioner FD MP'1 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 v6D PERMITN:�2tV/ �. FEE: $ SHED REGISTRATION RESIDENTIAL ONLY o 200 square feet or less Location of shed(address) Village - 'Property owner's name Telephone number R4112 5V a / 0/0 a Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation8:00-9:30&3.30;4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 .r CB FND CB FND. SAVERY PARK �A� LOT LINE FROM .M PLAN BOOK 211 PAGE 87 S 88" 2'30" E 73.28' ' 3 CB FND :� �3 . CB FND _. M LOT LINE FROM >/ PLAN BOOK 100 PAGE 91 o6 \ SCREENED W . PORCH �58 Z w 1y' W PROPOSED 025.6' K ADD/ON r \ R O ^ram 01 �" O Z N J\ Ct\ �O LOT 1A 13,879 SF _z o I des ` \ CB FND CB FND 143.03' . LOT 2A N 88'12'30" W \ STREET LINE FROM PLAN BOOK 100 PAGE 91�\ STREET LINE FROM PLAN BOOK 211 PAGE 87. \ NOTES: 1. HOUSE No. 479 PUTNAM AVE 2. ASSESSORS No. MAP 038 PARCEL 010 3. SITE IS WITHIN: FLOOD ZONE C EXISTING `�� PROPOSED ,;�'�``��` ZONING DISTRICT: R7 STRUCTURES \`�\ STRUCTURES (FRONT SETBACK: 30' - SIDE: 15') BUILDING CODE WIND EXPOSURE CATEGORY B 4. SITE IS NOT WITHIN: ZONE 11 OF A PUBLIC WATER SUPPLY. I CERTIFY THAT THE HOUSE IS WIND BORNE DEBRIS ZONE \It10Fs sgc LOCATED LOT 1A AS SHOWN. 5. BUILDING LOT COVERAGE: 'v EXISTING: 10.9% PROPOSED: 12.61% �� THOMAs o JACKS ON v BUNKER a NO.32653 p OFESSIONAL AND SURVEYOR 0 9 �o . BSS . SS /STE DESIGN DATE: ENGINEERING & SURVEYING CERTIFIED . PLOT PLAN -PREPARED FOR www.bssdesign.com D.ONALD CAMPBELL BSS Design, Incorporated 479 PU TN AM •AVEN U E 164 Katharine Lee Bates Rd Falmouth Massachusetts 02540 BARNSTABLE, MASSACHUSETTS 508.540.8805 FAX 508.548.8313 date drawn job number dwg number —50 scale 1" = 30' 6/16/11 EJP, TJB. 6038 P19 4 �' k1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O Parcel 0 / 0 Application# Health Division g 7 34 3 Conservation Division ® D ' SEPTIC SYSTEM MUST BE Permit# / 1 2. 7 q Tax Collector INSTALLED IN COMPLIANCE DateIssued WITH TITLE 5 Treasurer ENVIRONMENTAL CCLIE ANDApplication Fee TOWN REGULATIONS Planning Dept. Permit Fee � _ � Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 4/' 69 uTAia yw U_g_ Village Owner -'Dv v gkr C—, CayK,P btAl Address W 7 i0olAid m ✓Q U•k- Telephone S08 c/ 23 Permit Request Qer"u-f, w e,,� t- rW I&C-e W a Vh i 21 10 U-e.cj Square feet: 1st floor:existing 3 b proposed �Z0 2nd floor:existing proposed Total new Zoning District 97 Flood Plain C Groundwater Overlay Project Valuatio r�`�'1/, 000 Construction Type W6001 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family d Two Family ❑ Multi-Family(#units) Age of Existing Structure Sf k�'s Historic House: ❑Yes UdNo On Old King's Highway: ❑Yes M No Basement Type: aFull ❑Crawl E(Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 11 S 2 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 S Heat Type and Fuel: C"Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes 11"No Fireplaces: Existing New Existing wood/coal stove: NYes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑664 size: �^l Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ i Z Commercial ❑Yes ❑No If yes,site plan review# �: Current Use Proposed Use BUILDER INFORMATION V Name�00,2"j cC Telephone Number Address _ 7 cf �u'��val �� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��Av,y 6z"Hl `l SIGNATURE DATE ? FOR OFFICIAL USE ONLY T PERMIT NO. DATE ISSUED ' MAP/PARCEL NO.. t ADDRESS VILLAGE OWNER DATE OF INSPECTION: bAolz FOUNDATION r� 8A 6 X0e4 a� T- }- FRAME `-i Cam? N INSULATION `"' ._. r_ •_ ., m FIREPLACE C? -- .r_ ELECTRICAL: MROUGH FINAL r PLUMBING: ROUGH. FINAL GAS: ROUGH FINAL FINAL BUILDING l� 11�JJJJj DATE CLOSED OUT ASSOCIATION PLAN NO. s� The Commonwealth of'Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 02111 `,N ,•v' www.rnas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Inforn>uition Please Print L, epbl Name (Business/Organization/Individual): l A.).ctrm ( V►1� �Q%L� Address: Lf-7 a Vts< A u k City/State/Zip: (.y�y t �fj. c 26 3'� Phone#: `�;-CJZ q 2F� —7 7 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 employees (full and/or part-time).* have hired the sub-contractors [ New construction 2.❑ I am a sole proprietor or p a per- . listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have Sr. ❑ Demolition working for me in any capacity.' workers' comp.insurance. 9. ❑ Building addition o workers' Comp. insurance 5. ❑ We are a corporation and its equired,] officers have exercised their 10.❑ Electrical repairs or additions 3.V I am a homeowner doing all work right of exemption per MGL I I.El 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' ! comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such FContractors 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 Comp any Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure.coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Siggnature: " /� �- t Date: Q-3ZsOM Phone#: q{ Z�K _71?'9 3 Official use only. Igo not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): I.Board of Health- 2.Building Department 3.City/Town Clerk 4.Electricai inspector 5.Plumbing Inspector � 6. Other Contact Person: Phone#: 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the .receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than-three.apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." 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 certificates) 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. Se advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te1. r 617-727-4900 ext 406 or 1=a77-MASSAI~E Fax ; 617-727-7749 Revised 5-26-05 vr�-w.mass.zov/dia MOptME►a Town of Barnstable Regulatory Services EAM� ' Thomas F.Geiler,Director �A s639. �0 rEo,,,prA Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. -- // y Type of Work:D&k (mil SC.o'e,0N PU GCS Estimated Cost ) Address of Work: 14- I D Q_6A)a kV1 U�Q �d 00 t,1 rho,- Owner's Name: f tart V` • �b��' Date of Application: I hereby certify that: r Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑B ilding not owner-occupied awner 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. Cit.wR �Z Da a Owner's Name Q:f=:homeaffidav r i r L ■ ■ ■IIM■■i■f■�1■li�llllI■1'�■! ■MII■ �{■■�` ■■■■■ ■ ■ ■ ■.I■MI■■■IMIM■1�1 ail' i : !■1■■lEM INSIM[N1! am■■ ■MmEMMM ■■ ■■■ Oil■■��■f'■M1■1■■Ifi�!■�!■1■■ ■■ I�■■ii�■■■ �. :" !�'■■■■ MMMEEMMMEM No E ME ^iii■■11■■■■■■■■1■■■1 ■ ■■■tlll■■■EN■MaM■■ ■ ■ME11■■NEEMEMIEM■I ■ N ■ml■■■■■t�O■Mid'; , . ■ ■■ ■■■11■■� !■■■■ ■■■1■■N■■ ■ 11!■■■■■[ lM ■■ ■■■■ ■■EN1■tMEN■MMIME■INEE■■■■ llf■■■ ■ENEM■r■ OMEN �ii11■■■■■■■■ OA�I■■■■■■■ 1!!■■■e■■EON MENE ■■ 11■■■■■■■■ i■■i■■■■■■■I-I !■�� GlM■■ ONE ■■ 11■■■■ ■■■11■■I■■■ems■■ Il!/..�■! 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EO■ ■■M■IEEE ■■l1IM ■ ■■■1■M IN 1 ■ ■ E■■■■■■ 'Il■■■ ■■r�1■ ■ ■M■I■■ IN ■ ■ ■ ■■M■MME■MMEMEE111M■MEE■■IEEE■■■ Mom ME mmumifflom IN Ea nown MONSHL" UNMOOR OMEN ills ON MMMu1mMMwwwwMwM1111MM NINE A ana�manuo______o-- M■E ----r0XMIUMMMUNMENSIMMI �■■■ 1 MOMERNMEMMEME EM ■ No ■ ■i ■ Emom MM■MMMM■MM ■M�won ■MOM ■� Town of Barnstable �FtHE 1p� Regulatory Services sAantszasM Thomas F.Geiler,Director y NAss. 059• .• Building Division TED MA't A 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: G 3 JOB LOCATION: 17 9 UVU PLM XVq nunumber /' street village "HOMEOWNER": /ON�C� �� CGZ6 SV8,- cl Z;2�-78 Z'X S"o��888_ _ o sZ S' name home phone# work phone# CURRENT MAILING ADDRESS: /—j V C326Y c 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 suyeryisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signs re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control.. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt r CB FND CB FND SAVERY PARK LOT LINE FROM \ PLAN BOOK 211 PAGE 87 S 88'1 2'30" E 73.28' \ CB FND CB FND \ LOT LINE FROM \ PLAN BOOK 100 PAGE 91 00 \ PROPOSED SCREENED ' W PORCH D 26 5 \ Z WLd \ 0 25.6' , DECK \ �6'• Q EXISTING \ o z c6 \ F` N LOT 1 A \\ O 13,879 SF \\ Q o Q Z \ \ CB FND \ Q— CB FND 143.03' LOT 2A N 88'12'30" W STREET LINE FROM PLAN BOOK 100 PAGE 91�\ \ STREET LINE FROM PLAN BOOK 211 PAGE 87. \ \ NOTES: 1. HOUSE No. 479 PUTNAM AVE 2. ASSESSORS No. MAP 038 PARCEL 010 3. ZONING DISTRICT: R 7 (FRONT SETBACK: 30' — SIDE: 15') 4. FLOOD ZONE: ZONE C 5. NOT IN ZONE 2 6. EXISTING BUILDING LOT COVERAGE 10.0% I CERTIFY THAT THE HOUSE IS O LOCATED 0 OT 1A AS SHOWN. F Aq,�ss Oy , 9 THOMASJACN G� BSS , 0 BUKSNKER `�' ROF SIONAL ND SURVEYOR BU D E S 1 0 N NO.32653 oe L LAI�S�Q DATE: LAND SURVEYING CIVIL ENGINEERING LAND PLANNING CERTIFIED PLOT PLAN PREPARED FOR BSS Design, Incorporated DONALD CAMPBELL Katharine Ise Bates Rd Falmouth 479 PUTNAM AVENUE Falmouth Massachusetts 02540 508.540.8805 FAX 508.548.8313 BARNSTABLE, MASSACHUSETTS scale 1" = 30' date 03/10/06 drawn EJP job number 6038 dwg number P12-23 Town of Barnstable *rermit# g 11-5 O,* XVIres 6 months from Issue date Regulatory Services Fee 6 �"o XAM Thomas F.Gellert Director 0 �EDN1p`� Building Division Tom Perry, Building Commissioner x® tfl1 ; 200 Main Street,.Hyannis,MA 02601 Office: 508-862-4038 SEP~l 4 2 go-05 Fax: 508-790-6230 �_n,. EXPRESS PERMIT APPLICATION - RESIDENTIA�,��'g L� Not Valid without Red X-Press Imprint ap/parcelNumber C.3F0 f D G(17 e •opertyAddress �7�/ �,761J( l M X 6,-C Residential Value of Work 00 C Minimum fee of-$25.00 for work under$6000.00 wner's Name&Address �10,/A Lei CGL Mit 42 1Y7 j 4e&*Yrn.x^ Xo-e' �L�Ox 1.771) ontractor_s_Name . �'J�/lilt Telephone Number S-®8- "V2 9 -79 2- -7 ome Improvement Contractor License#(if applicable) 'onstruction Supervisor's License#(if applicable) ]Workman's Compensation Insurance Check one; . ❑ I am asole proprietor [v]'I an the Homeowner ❑ I have worker's Compensation Insurance osurance Company Name Vorkman's Comp.Policy# ;opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) Mo' e roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof] aRe-side Replacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Properly Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. 4igaature Z:F(m=:expn trg Etevise063004 The Commonwealth of Massachuseds Department of industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' i www mas&gov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information Please Print Legibly Name(Bu4iness/0rga13iZ2d 'vidiiat) Address' L/ �U� � �tr-c 37 1.� - .City/State/Zip:.:: ��'�vr Phone#�• .��' r/•Z, Are you an employer? Cheek the-appropriate box:. ,Type of project(required): 1,[] Z am a employer with 4. ❑ I am a general contractor and I 6, ❑New construction employees(full and/or part-time).*,. have hired the sub-contractors . . 7. Remodeling 2.[] I am a sole proprietor or partner- listed on the attached sheet $ and have no employees These sub-contractors have .8. Demolition ship i workers' comp.insurance. g, ❑ Building addition working.forme in any•capacity. ' [No workers' comp.insurance 5• ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required] officers have exercised their t of exemption per MGL ll.[r Plumbing repairs or additions I am a homeowner doit<g all.work . p 3 myself.•[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance regained]t employees. (No workers'- 13.❑ Other camp.insurance required *Any applicant that checks box#1 must also M out the section below showing their workers'compensation policy information 's t Homeowners who submitthis affidavit indicating they are doing all-work and thenbire outside coutmctars must submit anew affidavitindicaiing such tContract ns that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'camp::poky won. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance•Comp any 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 cam lead to the imposition of cri alpenglties 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 aline 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 certify under the pains and penalties of perjury that the information provided above Is true and corrects. Si afore: /' Date: 3 .S Phone#: S-G Offccial 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 CoutactPerson: Phone#: n and Instructions. Inforniatio 152 t uires all employers to provide workers' compensation for their employees. Massachusetts General Laws chaptererson in the service of another under any contract of Iiire, purr-aunt to this statute, an employee is defined is ,...every p express or implied,oral or written." or two or more :`: �pat.:p�perslup,.:association, eorporation or other legal Canty, :�Y An employer is deft employer,or of the foregoing•engaged in a joint enterprise, and including the legal representatives of a deceased emp Y arm association or other legal entity, employing employees. Ho�tever:the receiver or trustee of an individual,partnership, ant of the owner of a dwelling house having employs s per thansons three d sp��n and who o��'Wo k��dwelling house dwelling house of another who emp ys building appurtenant thereto.shall not because of such employment be deemed to be an employer." or on the grounds or MGL chapter 152, §25 C(b)also states that"every siate.or local licensing agency shall withhold'the issuance or Tenewal of a license or pew to operate a business or to construct buildings in the commonwealth for any licant who�has not produced acceptable evidencevf compliance t insurance o f itsti coveragerequired." divisions shall app ter 152, 25C states `Neither�e commonw Y ub Additionally,MGL chap .. $ (� meter into any contract for the performance of public work until acceptable evidence of compliance with the insurance 1eq�ememts of this chapter have been presented to the contracting authority.» Applicants . ' ,b• checking the boxes that apply to your situation and,if. Please fill out the workers' compensation affidavit comp lete lY Y necessary,supply sub-contractors)name(s), address(es)and phone n s) sdnLP)��n�yetis ath6r than-the Durance. Limited Liability Companies(LLC)or Limited Liability lip (L members or partners; are not required to c workers affidavit maybe submitted to the Department of Industidal employees,a_policy is required. Be advisedThe Accidents for c0ufm ation of insurance coverage.. Also bee sure or license is beingrequested,unot the Depdaztment of should be returned to the city or town that the application for theped to obtainawoi*era'-- Industrial Accidents. Should you have any questions regarding the law dr•if you are required comstrial i Accidents. Slue call the Department at the number listed below.. Self-insured companies should eater their self-insurance license number on the appropriate line. City or Town Officials Please be sere 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 tens a number which w be used as a reference number. In addition, an applicant Please be sure'to fill in the pernnt/h applications in any given Year,need only submit one affidavit indicating current that must submit multiple Peraitlh andense app applicant should write"all locations in_(city or policy information(if necessary)and under"lob Site Address"•the app ' be provided to the H A co of.the• davit that has been officially stamped or mazked by the city or town may P. town). copykenses..Anew applicant as proof that a valid affidavit is on file for; use oreronit not elated to anyalness bmmercial venture year.Where a home owner or citizen is obtaining a lice p (Le. a dog license or permit to burn leaves etc.)said person is NOT requir ed to complete this affidavit The Office oftigations would lice to thank you in advance for your cooperation and should you have any questions, es please do not hesitate to give us a call. The Department's address,telephone and fax m aber: The Commonwealth of Massachusetts , _ - Department of Industrial,Accidents . Office 9f jnvestigations . s ;• .600•Washington Street . V Boston,MA 02.111. ' :`Tel. #617-727-4900 ext 40.6 or•1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia Town of Barnstable �EtME T�O Regulatory Services Thomas F.Geiler,Director gARNSTABLE. : � MAM 1639. ��.� Building Division rf0 � Tom Perry,Building Commissioner 200 Maia Street, Hyannis,MA 02601 www.town.barnstable.ma.us ice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION'.. /Y��_lJ�.fi2/r�it number street village '1xolv1EO1ArNEx':!2 O1___a f r 0e e/7LO/z/ fG8� name home phone# work phone# M > CURRENT AMING ADDRESS: �� !1 2/� / 212 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 suvervisor. 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 vermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code States that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor!' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board-cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your corrununity. n•o,..rne•h,w.,.arvr„nt . Assessor's map and lot number ...... �, /U SEPTIC SYSTEM Mun BE' INSTALLED IN COMPLIANCE Sewage Permit number ' .............................. WITH ARTICLE it STATE SANITARY CODE AND TOWN Of BAR.NSTX1%` � yDi TH E tOi� r, .- i IMiNSTABLE, 0 pYae�, BUILDING INSPECTOR APPLICATION FOR PERMIT TO / .....Za...... .... .••...•... TYPEOF CONSTRUCTION .........f..../.a. !.`f. :"................................................................................................ .........n5. ..19../. TO THE INSPECTOR OF BUILDINGS: _�# The undersigned hereby applies for a ermit according to the following information: Location ...... ..... ..... ..........r—..I .. ....................................................................................... ProposedUse ............f�Y .................................................................................................................................. ZoningDistrict .............Le.r...............................................Fire District ............ .................................... Name of Owne1V#,PR a., ....F...6A 4 ...Address I....l7 ...... A�.�!'.�. .. Name of Builder 741.?.........04-I.P.7./6/.....Address ........��i ��............................................ Nameof Architect .................... -- ..............................Address ..................... ......................................................... Number of Rooms ................/..............................................Foundation ( Exterior f..4fi.6� � 4 .............................Roofing ................A—A i =..(...................................... Floors ........1, aoVa .7710 ...............................Interior ..........�(p..T..6 4 Z�..................................... Heating ......A..l..Q...7-...t<� ,. � .................................Plumbing ................... ...................................................... Fireplace ..................................................................................Approximate Cost ...........` . �.10......................... A Definitive Plan Approved by Planning Board --------------------_---------19________. Area ° .... ............ Diagram of Lot and Building with Dimensions Fee ........................ .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH /� t j 0 Y �T 1;;Z ! ?U 1-,M /V I hereby agree to conform to all the Rules and Regulatioris of the Town of Barnstable regarding t above construction. Nam ... .... . . .... ................. �' I � �"� . -~~oe�ao^ x�mz�1om F. � � } � 1AA8n | au ' No ..��.��—. Permit for ----.. . ---��..��^-----------.. ^ ` .....I�ztnaam.�ve.�_______----.. . . . .................... .......................................... ----'' �'� Ovvnar �. 'r \ � ---==�==�--.. .r=^��,=—____\ . Type of Construction ..................Xroap............ ---~—^------- �.------------- j \ " . ' Plot ............................ Lot ----------'' � t } \ ' ^ . Perm 'October ` - . 19 uo,e or mopecoo - ......................|* Dot6 ~Completed '� ' P ��..��°��«. , / PERMITRIEFUSED ' � ^----'----^--.--------.. lA | | ----------- '------'' ^-----~— ( ` �� ---..=c�.�—/......— .__________ | . � . . — .........��..'----.--~-----.----.. ` �z �� . —'��..,��.^�--.----..--.,-----~— ' , 19 ' - ......................................................... �� -` � --� �� ` - �� —'c-----------~—'---^^—' � . . . ,