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jD {;, �� ., ` � .;, �. M1 n, ,, ,� ��- � .. � I, ;, �, � r ,. �� �� � � � „° r4.7 r1 p -TTe Town of Barnstable 7y of �ti Permit# c � - Expires 6 atontlis from issue dale T Regulatory Services Fe 13ARV5rA.BLE, �— OAS. Thomas F. Geiler, Director GJ Building Division . Tom Pcrry,.CI30, Building Cornrnissioner 200 Main Street, Hyannis, MA 02601 www..town.barnstable,ma.us Office: 508-862-4038 Fax;'508-790-6230 EXPRESS PERMIT APPLICATION ,- RESIDENTIAL ONLY Not Valid tvitliort1l Red X-Press lmi rinl Map/parcel.Nuniber Ce),2— �j/",/ f� , %, /v Property Address. �� • _ sidential Value of Work D _ Minimum fee of,535.00 for work under$6000.00 1' r Owner's Nam e & Address v . Y1 tj F0 5 'o . 2 . Contractor's Name Telephone Number �� �� Home Improvement Contractor License #(if applicable)_ , Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one; I am a sole proprietor I am the Homeowner ❑ I have Worker's Compenlsation insurance .P PER ' ` Insurance Company Name Workman's Comp. Policy# BARNSTABL Copy of Insurance Compliance Certificate nrlist accompriny each per Permit Request (check box).. ❑ Re,-roof(h,urricane nailed) (stripping old shingles) All construction dehi•is'will be taken to ❑ Re-roof(hurricane nailed) (not stripping- Going over existing'Iayers of roof) &'Re-side #of doors,, �l eplacement Windows/dooWsliders. U-Valtie `(maximumm'.35)# of windows *Where required:.lssuance of this permirdoes not exeinnt compliance wish other town depiirtmerit regulations, i.e,.Ftistoric,conscryation,etc. ***Note: Property Owner'musf signProperty Owner Letter of Permission. A copy of the Home Improvement Contractors.License &,Construction supervisors License is rcq ired. , SIGNATURE; n QAWf FILE OIiMSIb iilding permit fo,mslGXPRESS.doc Revised 072110 The Conrrrroirivealik of jlfassachlrsetts -- r Departmerr.toflrr.rlrrstrlalAccidetrts f— 3 7, Office of Invesfigafions d 600 Washhigtorr Street t Bosttarl, IM4 02111 tb')b,iN.rll ass.g0vJ'(Ira Workers' Campensati.ou Insurance-Affida-vit: Builders/+C'on:ti-,ictoi-&/El:ectiiciaus/PIumbers Iicant Information Pl ease Print Le 'bIti Name. (Btisines 'DrgauLation'Individcaal): �y�� ��t/j C` � 5 O All- 9 C��t ^� C1ty/ tc1tC/zLII: 1'011t' Sd c>2 �iry you an employer? Check..the appropriate boa.: 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 ❑"mew constrlrc.tiou 2..❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling shipand have no employees These sub-contractors have 8- ❑ Demolition working :for me in any capacity. employees and have workers' [No w a workers' corup.insurnce comp-insurance..Y �. ❑.Bnildim,g addition 5. We.are.a corporation and.it.s 10:❑Electrical repairs ora.ddi.tions required.] ❑ p 3-i am a.h ownl omeer doing-all w ❑work afl�cers have exercised th-err 11. Plumbing repairs or additions myself. [No wroj-kM' comp. right of exemption per NMGL 12.0 Roof repairs insurance required.]T c 152, §l(4)„ and we have no employees.[No workers' 13-0 (7.thei' comp.insurance:required-] *Any appticaut thatchecbs box#1.must also fill out the section below sbvwing their ww)ieis'compensa:ti.an policy iufonwtian- Y Homeowners wbo submit this.affidavit indicating they are doing all work and then hire outside contractors Wrist submit a raew affidavit indicating swell' ko,ntractors that check this box mom t attached in addrr3aaal sheet sho-wing the name of(be sub-CMtraC.tY}rs anal stst2'[betiNr or not those entities have - en3ployees. If the sub-contractors have employees,they nnist provide their wurkers'comp.policy number. Tam arr errtglo3 trr tTtat is prourdirrg ttrork�rs'corirpertsalron irrsrrrvsrrce for rrry ertrplo�ees. Belot is the policy anal job site inforffratrorl . Insurance Company Name: Policy A or Self-ins.Lic.#: Expiration Date: Job Site Address: Cit}/StateiZip: Attach a copy of the win-kegs'compensation policy declaration page(sho«ring the policy number and espir ation date). Failure to secure coverage as required under Section 25t1 of MGL c.. 152 can lead to the imposition of criminal penalties of a fine up to$1 w.,500.00 and/or one-year imprisonment,as ell.as ciLril penal.li.es 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 tire.D.LA for insurance coverage verification: I o h&eby certify rx.reder tho rrirt d pe.nalh:es of perjury that the htforrrtatian protZded.above is trite'and correct. Si ature: rr// Date: O,f(Iicial use only. Do not tnrite in this area, to be conipleted by city or town:o�ciaL 00 or Town: Permit/License Issuing Authority(circle one): 1.Board of Healtb 2. Ruiltling Department 3. C.ifylrown Clerk 4, Electrical Inspector 5.Plumbing Inspector b,Other Contact Person: Phone M r - of THE r " + HARNSTAHLE, "SS Town of Barnstable AIFD MA'I a Regulatory Services ThomasY. Geiler, Director Building Division Thomas Perry, C.BO - Building Commissioner 200 Main Street, Hyannis,'MA 02601 www.town.barnstable.ma.os Office: 508-862-4038 �. �., 1W { 4 Fax: 508-790-6230 Property Owner Must b .: Complete and Sigh This Section' If Using .A, Builder as Owner of the subject property hereby authorize • to,act on my behalf, in all matters relative to work authorized by this buildin ermit application for.: (Address of Job) Signature of Owner Date Print Name IF Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILESIFORMSIbuilding permit forms\EXPRESS.doe Revised 07211 _ ��olrq�i Town of Barnstable ' Regulatory Services I ASS.., Thomas F. Geiler, Director 09• .� a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off ce_ 548-862-4038 Fax: 508-790-6230 --------------------________ HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:_ number street village "HOMEOWNER ��G�/� �l3�/] reS'a,41 name f home phone H work phone# CURRENT MAILNG ADDRESS: �(/. /�OX 3o,�p 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 supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures.-A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. f d The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requi��nts and that he/she will comply,with said procedures and requirements. signifture of Romebwner 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 ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." F 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 g 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 "s• adopt such a form/certification for use in your community. " Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc F Revised 072110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health`Division Date Issued O g lo Conservation Division �-� ,Application Fee a Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board His toric - OKH _ Preservation / Hyannis Project Street Address Village �� t Owner F"/__0 k/r_/ f) b 9 50 2/ Address ZO-J LAl Telephone s-0 f- - -/�X Permit Request 1, X / S S el-%le zy Y-a £>// S Square feet: 1 st floor: existing/�proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,eV° o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �9' Two Family ❑ Multi-Family (# units) Age of Existing Structure V Historic House: ❑Yes On Old King's Highway: ❑Yes �vo Basement Type: mull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) k� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing - new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing S new First Floor Room Count -� Heat Type and Fuel: A Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Fireplaces: Existing_jGNew Existing wood/coal stove: ❑Yes JIII- to p+wy aew'f-,�ize Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size Barn: ❑Pesting _ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ~'f w _n Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ „ Commercial ❑Yes 0 No If yes, site plan review# �9 = - Current Use Proposed Use NOrn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Names r�G�. ��''U£ec'��ru Telephone Number Address /-� ��/`�t/ A,- License # Gvv a e2 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE C-% �® t FOR OFFICIAL USE ONLY ,,'APPLICATION# DATE ISSUED _ MAP/PARCEL NO.; .ADDRESS VILLAGE ._OWNER 1 _ DATE OF INSPECTION: FOUNDATION F FRAME ` INSULATION - A FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ; GAS: ROUGH FINAL - FINAL BUILDING - 1ttiJ DATE CLOSED OUT, f ASSOCIATION PLAN NO. f The Cornrnonwealth of Massachusetts Department of lndustrial Accidents Offxce of Investigations 600 Washzneon Street .Boston, AL4 02111 ''• www.mass.gov/dia • Yorkers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plurnbers Applicant Information Please Print Legi.b� CN- I r1e�(BusinesslOrganization/Individual): i��Y ev- lj i2 s • �Adc'tre'ss� �S �-t/1 vt ��. • City%State/Zrp �`�i � C Phone.#: �.• vAre you an employer? Check the appropriate boa=: Type()[project(required): I.❑ I am a employer with 4• ❑ I am a general contractor and 1 6• ❑New construction employees (frill and/or part time).* have hired the nib-contractors listed on the attached sheet 7. ❑Remodeling 2.❑ I am a'sole proprietor or partner- • ship and have no employees These sub-contractors have g• Demolition employees and have workers' working for mein any capacity. employers []Building addition [No workers'.comp.•insurance comp. insluanca.t requred] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions- . l3.(yg' T am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers comp. right of exemption per MGE 12.❑ Roof repairs in.s„rance required]t c, 152, §1(4), and we have no 13.❑ Other . employees. [No workers' comp,insurance required.] 1.1 *Any applicant that chocks box#1 must also fill out the section below showing their workm' compmv4on policy information. t Hommv mt,-s who submit this affidavit indicating they arc doing all work and than hire outside contractors must submit anew aff,davitindicating such. $Contractors that check this box must attached an additional chart showing the name of the sub-contractors and state whether or not those entities have employers. If the sub-contractors have employees,they must pro-vid✓;their workers'comp.policy number, .ram an employer that isprcvidingworkers'compensati.Dn insurancefor my employees. Below is thepolicy andjob 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 impositionrim of criminal penalties of a Eno up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of 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 IDEA for insurance coverage verification. X do hereby,cerfifyunder the pains-and enaldes of perjury that the information provided above is true and correct. < G Date: a Phone Official use only. Do not write in this area, tb be campLeted by city or town official City or Town: Pern itlLicense# Issuing Authority(circle one): 1. Board of Health 2, Building Department 3, City/Tow-a Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone{f: information and Inst Auctio' ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thtract fhiio,s; Pursuant to this statute an enfpLoyee is defined as"...every person in the service of another under any contract of biro, express or implied, oral or written." An ernptoyer 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 appurienan`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 u,dthhold the issuance ar renewal of a license or permit to operate a business or to construct buildings in the coznmon)vealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL ohaptcr 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 q7th the insurance this chapter have been resented to the contracting authority." zcquiremrents of p P Applicants. Please fill out the workers' compensation aff davit completely,by chcclring the boxes that apply to your situation and, if necessary, supply sub-contractors) namc(s), addresses) and phone nurnber(s) along with their certificates)of insurance. United Liability Companics*(LLC) or Limited Liability Partnerships (LI2)with no employees other than the ur members or partners, arc not xequiicd to carry workers' compensation insurance• If an LLC or LLP does havc cut of Industri l employees, a policy is required. Be advised that this affidavit may be submitted to the Departm a Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affiidavit should be returned to the city or town that the application for.the permit or liconsc is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are rcquixed to obtain a workers' compensation policy,please call the Department at the nurgbcr listed below. Sclf-insured companics should enter their self-insu=(n o license number on the appropriate line. City or Towlr Offlcials Please be sure that the affidavit is complete and printed legibly. Tbc Department has provided a space at the bottom regarding the applicant. of tho affidavit for you to fill out in the event the Office of Investigations has to contact you Please be sure to Lila in the permit/liccnse number which will be used as a reference number. In addition, an applicant that must submit multiple permit/licensc applications in any given year, need only submit oup affidavit indicating current policy_information(if arcessary) and under`Job Site Address" the applicant should write"all locations in (city or town)."A cbpy of the aff davit that has been officially stamped or near cd licenses. A new of town may b berDYidcd tofillcd out each applicant as proof that a valid affidavit is on file for future prrinits or year.Whczo a home owner or citizen is obtaining a license or pezznit not related fo any business or commercial venture davit (Le. a dog ccnse or-permit to burn leaves ctc.) said person is NOT required to complete this affi J .Tbo Office of Investigadons would lice 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, tclephone•and fax number: I ae cbmmanw(>,4tb of Massnhliu f,-tts D�-,pa,bmcmt of 7n.di .s•4 A.rFcidcQts OfRce of Sx� estigati.anS 600 Washington Street B�stan, MA 02111 Tcl; # 617-727-490.0 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 yV, 5.gpy/�ia Town of Barnstable y�� of[HEry� Regulatory Services * Thomas F. Geller, Director BAFtttSTA131E, hfA55. Building Division s61p• �� �PrFo rya Tom perry,Building Commissionel' . . 200 Main Street, Hyannis., MA 02601 ,AIwtY,town.barnstable.ma.us ,,; Fax; 508-790-6230- Office; 508-962-4038 ==—Ho0 IEOWNER LICENSE EXEMPTION �y Plense Print DATE: /V ` 2 JOS LOCATION: number village treet . ,,HOMEOWNER': T—z home phone k work phone# name . ,r7 CURRENT MAILING ADDRESS: 10, ✓ A✓ In Oat G 3:S state zip code city/town The current exemption for"home owners"was extended to include owner:occupied dwcUigg 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. DEM, 1TION OF HOAJEOII'NER 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:st•uctures, 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) nsibility for compliance with the State Building Code and other The undersigned"homeowner" assumes respo applicabloco fts, bylaws,rules and,regulatioils. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department and requirements and that he/she v;ill comply with said proce e durs and minimum inspection procedures Signature of J40meowncr 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 ETOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions 1o9,1,,i Licensing of construction Superviso rs);provided that if the homeowner engages a person(s)forhire to do such of this section(Section work, that such Homeowner shall act as supervisor," Many homeowners who use this exemption are unaware that they are assuming the responsibilities is a supervisor(see Appa�d ul�arl Rules &•Rcgula•tions for Licensing Constrbction Supervisors;Scction 2,15) This lack of awareness often results in serious problems,p Y 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 hoeowner is fully aware of his/her responsibilities,many communities require,as part of[he permit application, m nsibilities of a Supervisor. On the last page of this issue is a form currently used by [ha.t the homeowner certify chat hdshc understands the respo several towns, you may care t amend and adopt such a fom✓ccrtification for use in your community. �0FVEross Town of Barnstable Regulatory Services s�xxsxABre, Thomas F, Geiler, Director v truss. � 059, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.to)vn.ba rnsta ble-m n.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign. This Se tion If Usiazg A Builder a- Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work au orized by this b ' ding permit application for: (Address ) Signature of Owner to Print Name If Property Own& is applying for permit please complete the Homeowners se Exemption Form on the reverse side. - ey! 711 bsc,r y c 3 s -P Z N --- Lin .�' a r o} ig 0. Q L F ul"'U"N ufl%A "IF I UJ%N L e �{ 1 r GO T � °� TZo ' � OWNED BY dt o..t "� a D `! SCALE i ` o DArE- ^Y Zj 6 .061tA _ "1 u N0RA9AN GROSSMAN------REGISTERED LAND SURVEYOR 3 C ➢��. L I HEREBY CERTIFY THAT THIS FOUNDATION i5 LOCATED f- i ON _TrNE LOT AS SHOWN AND CONFORMS TO THE TOWN OF BARNSTABCE. ZONING REGULATIONS REGARDING SETBACKS FROM STREET LINES AND LOT LINES . NORMAN . GROSSMAN R.L.S. DATE J s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 0 Parcel lY Application# Health Division Conservation Division Permit# Tax Collector Date Issued o�L Treasurer Application Fee � Planning Dept. Permit Fee /7`0 U� Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis b 1� .Project Street Address �`f� d9 f4** ROA7 1� Village 60 To 1 Owner E4 C2 ��r) PO M240 517,1Y6ke 9. P1 Address 9,5— A Y1V aw CG r[J/%��- Telephone 0 /.Z0 777 0 Permit Request r12f 4 siyaKf_ 014AI#6e 2E40Vc, 13 /-'LaaA- 0-0 ),8"7- 2Xld 10'& C lL���V4, s/fEEi >l��l.o I �SvL�9T/mow ��v����oti ` Ale-L` Py a" 8/y06 4 64 f6N G TC i✓ Sfc�i t2cC l J ryv't�L o ri d>? J<viEA,iei_ T WO-/ 0 r� Square feet: 1 st floor:existing proposed 0 2nd floor:existing U proposed 0 Total new Zoning District �J Flood Plain Groundwater Overlay Project Valuatiofi ld a4 ly m U Construction Type W&Gd 1'kn-m E/ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(#units) i Age of Existing Structure J 1) Historic House: ❑Yes �/o On Old King's Highway: ❑Yes ❑No Basement Type: lIQ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) S d Basement Unfinished Area(sq.ft) Y66 Number of Baths: Full:existing new Half:existing new 0 Number of Bedrooms: existing3 new 6 Total Room Count(not including baths):existing new y First Floor Room Count Heat Type and Fuel: &Y'Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Flo Fireplaces: Existing New y Existing wood/coal stove: ❑Yes k<0 Detached garage:Q existing ❑new size 0 Pool:0 existing ❑new size Barn:❑existing ❑neat; size.) Attached garage: existing ❑new size Shed:. xisting ❑new size 0 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ , Commercial ❑Yes ❑No if yes,site plan review#-- Current Use Proposed Use BUILDER INFORMATION Name r fa&l Sf,\II`e`�Telephone Number c�Q Z�o Address.2,2-- /9 4,,/L 1 c/3 ry W h Y License# 0 7 4 f.L a 1Z T; �'L lyjylS AM � � ® Home Improvement Contractor# Worker's Compensation# ®�L d) 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO YA PL tav v r h lydl�:./L 1, SIGNATURE � ���—✓ �,�Ji( GJ4 DATE �i � FOR OFFICIAL USE ONLY r 'PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAM a l�! $ �. 1�— ;�o —0(. kryl'L'A^.% INSULATION.��' �`"•�7—U�o /1�K F�t'/l�f9fi I,I.Y� s�!'A��x. K �"e oc FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t ol k FINAL BUILDING �tJJ/A O�c- ,® p � DATE CLOSED OUT ASSOCIATION PLAN NO. 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 Le�ibll Name (Business/organization/individual): \^I 1 /✓ / �1/j'�f(� S�t/rj� 6 S Address: .9— A1,Ali Y City/State/Zip: �--'fyl'VIS D,)&G Phone#: 57G 5' Are yyu an employer? Check the-appropriate bog: Type of project(required): 1. I am a employer with 2 6 4. ❑ I am a general contractor and I 6. ❑New constuction employees(full and/or part-time).* have hired the sub-contractors r-� 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• �1 Remodeling ship and have no employees These sub-contractors have 8: ❑ Demolition working for mein any capacity. workers' comp.insurance. g, M Building`addition [No workers'Comp.insurance 5. ❑ We are a corporation and its required.] --- officers have exercised their 10. ectrlcal r r additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L hlmbi repairs off• 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 policyinformation' ' t Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such lContractors that check this box must attached an additional sheet showing the name oftbe sub•contradtors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and.1'ob site information. n Insurance Company Name: f'n`!3 C L L!9' LAJ : I�19 �. Policy#or Self-ins.Lie.#: 'S O ©C ,� Expiration Date: G 0 Job Site Address: ,/ )A 9�1`afy co-jai'i' Hly City/State ' *:��U 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$1,50Q.00 and/or one-year imprisonment, as well as civil penalties in the form oi'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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Sign Date: Phone#: 7e e 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 Fiealth 2.Building IDepartmem 3.City/Town Clerk e.Electrical Inspector 5.Plumbing laspe&or 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.oral or written." An employer is defined as-"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the ' dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 numbers)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 Icoverage. 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 Depariment 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/licens a 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. Anew 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. j 617-727-4900 ext 406 or 1-1077-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/aia �oFIKE>a Town of Barnstable do ' Regulatory Services &ARNSTAByr c.Eg+ Thomas F.Geiler,Director �p ib;q. ♦0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 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. Type of Work:-Etr\L S/yO/(�J L Estimated CCost_! o Address of Work:- f Y'L nlfj d, C 0 o /Vo) Owner's Name: i!�,) 9,6,o/ SA AAEA—40 11 Date of Application:��� 0 -"G I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law [—]Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date (® " Owner's Name Q:fomislomeaffidav M CMR Appendix J Table JS.ZIb(continued) Prescriptive Packages for One and Two-Family Residential Buildings ideated with Fossil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Acre'(%) U-value R-value' R-value' R-value` well paimeter Equipment Efficiency' Package R-value° R-value' 5701 to 6500 Besting Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal s 12% 0.50 38 13 19 10 6 85 AFUE ET IS% 0.36 38 13 25 WA N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A WA 85 AFUE w 15% 0.52 30 19 19 10 6 85 AFUE X IS% 0.32 38 13 23 N/A N/A Normal Y 18% 0.42 38 19 25 N/A WA Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: fi"q 1)+rV 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 2, 6-® 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): w- NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a i 780 CMR Appendix J Footnotes to'Fable J6.2.1b: m Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 iF of glazing area. Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling,R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be.substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see-Table J52.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels.Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value Table J1.5.3b. If a door contains lass and an aggregate U-value rating for that door is not available, include the m g glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- r value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 °fIR A. Town of Barnstable ti Regulatory Services 4 46 BARNSTABLE, naAss. Thomas F.Geller,Director 9. Building Division. _. . prfD MA'S A Tom Perry, Building Commissioner 200 Main Street, ' t, Hyannis,MA b2601 www.town.barustable.ma.us Office: 508-862-403 8 - Fax: 508-790-6230 Property Owner Must _ Complete and Sign This Section If Using Builder -.: . I, ry�Q e�s .-. ,as Owner of the subject property hereb authorize- �k�r Yl y _ to act on nay behalf, in all matters relative to work authorized_bythis building permit application for: (Address of f6by Signature of Owner Date Print Ndime �,::,..x:+trii-dw:'s#a..+M-.+-,.t.-.,......w,rdreaS«.�',-cw,.z.;....;�..«.•.a..7.artii...i��w,..Plwar+b:�w•+Yr�tl�irawzw:.,,.e,.t.+r+.,...,...-_+.rw�aew. .. .erw..rk+.:tit#-+:a..n..it•A.r.•,,.wa.-_...-.w<.._ ..�....,:..:�...acNun-..s......,�r.-•s•dW:nNa..-e.yu& QTORM&OWNERPERMISSION i �� ��fi^./✓"J?FYJ?fiiPv6 �2�.2/�/l�.e'/.rifif�LECG�.'r�c; BOARDOF BUILIJI :ItEGd1LATlOMS License CONSTRUCTION SUPERVISOR Numberr.CS. 074928 Birthdate 08/10/1961 Expires 08/10/2008 Tr:no: 1273.0 Restricted,:00 _ y WILLIAM'WHALEN 1 122 POND STREET G",, BREWS TER, MA 02631 '_<' Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i" Registration: 129244 ` . ._ Expiration: 7/30/2007 Type: Private Corporation Whalen Restoration Services Inc. William Whalen 22 American Ways South Dennis,MA 02660 Administrator Date: 10/4/2006 Time: 3:25 PM To: Kathleen @ 9,1,5087609995 RAG Ins. Agcy. Page: 001 Client#:32193 W HIALRES ACORDT,a CERTIFICATE OF LIABILITY INSURANCE 1DATE(MMJU 0/04106DfYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOTAMEND,EXTEND OR P.O.Box 1601 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED NSURER A: Arbella Protection Co Whalen Restoration Services Inc NSURERB: Arbella Mutual Insurance Company 22 American Way NSURER C: South Dennis,MA 02660 NSURER D: NSURER E: COVERAGES 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 AF=GRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN NAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MMIDD, DATE MMiDDIYY LIMITS A GENERALLIABILRY 8500024585 OCOV06 04/01/07 EACH OCCURRENCE $1000000 X COMPAERCIAL GENERAL LIABIL TY DAMAGE SO RENTED PREM occurrence) $1 OO OOO CLAIMS MADE a CCCUR MED EXP(Ary one person) $5 000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP!OP AGG s2,000,000 PRC- PCLICI JECT LOC EC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (For person) HIRED AUTOS BODILY INJURY $ NON-OVINED AUTCS (Per accident) PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY 4600021586 04/01106 04/01107 EACH OCCURRENCE $1 000000 X CCCUR CLAIMS MADE AGGREGATE $1 00O O00 $ HX DECUCTIBLE $ RETENTION $10000 $ B WORKERS COMPENSATION AND 9091320406 M01106 04/01107 X WC ST.ATU- OTH- EMPLOYER ILITY EL EACH ACCIDENT $50O OOO ANY PROPRIETORIETOR . . /PARTNERIEXECUTIVE , OFFICERIMEMBER EXCLUDED? E.L.D SEASE-EA EMPLOYEE $500,000 If yes,cescrite under SPECIAL PROVISIONS below E.L.D SEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Floyd and Patricia Sanderson DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL -Q_ DAYS WRITTEN 95 Ralyn Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Cotult, MA 02635 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE oi f ) ACORD 26(2001108)1 of 2 #S24732/M22264 CBR © ACORD CORPORATION 1988 T TOWN OF BARNSTABLE Permit No. _________�___ I s�x.>< ; Building Inspector Cash •� YY9 __----- �OYPY�\ OCCUPANCY PERMIT Bond ______ No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to M-nn l c Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19..._ _ ........................................ ......_...... ._ .� w Building Inspector 'r1: „,Z {,�% 1 :+�y 4 ••• �:; i l My�•.jY';.¢'�Y'��p'xY t�.Mr - r r1>�i.t . "'iF.3h` ��'6l ij�; .i��'{'`�'T �- `syp,�„x r'.r �)xp{,.'s 7z � 'A �..zfi. 1 x i A -4 a 3 Abr a t ry !x- .�d"4 � '�; �" e a,3 •ti.� Y at qt �..c.pJ J; r :"-' � y' i � i:7 '�..# � �' ,r.'~ sp' <`� sE�.. i ,�,i"�s t r��Ott � ��.•e+•{r ! 9ri�ix` �;:;�6 t 't t'. r �t _ + •`. �^'.- ; �' y ( R �, > `i 4'�`!.•^czk� �r'T,�'y` �g"� i.ff ,� °x�,�.�yy,� `'y,��r���� a �g -tit fir ^•r t• M .,,. 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AfOR'MAIy,GRl1SSMAN-- --`——REC15fERED LAND S_IJ1t E'YOR -3� C I` r• Fr I HEREBY CERTIFY THAT THIS FOUNDATION• IS LOCATE© 4 ON TIHE LOT;AS SHOWN AND CONFORMS TO THE TOWN` �OF OF BARNSUKE. 'ZONING REGULATIONS REGARDIN�S � s9 p. _ g= r SETBACKS FROMr STREETLINES AND LOT LINES , �tgty, if;' 12?7S ` IYORtGAIat . GROSSMANR.L.S. OATEN 't, a ., �� Y � � +•f ' s� w' .;x �_ �' .may � . a .Fiy � �+ :1i P 7���� y�~;'��.�i�x�°Y�`mx�w'+�' . �£ ,, -�`` ,;�+ "�::�'a�15 y.a.;,>r��.�r ,^''rc., � .� �, ��`r�k�r'Sf���,� '''.�"'-� '�'' �+��'`�'•3rr7�.4�nL*�'^ � rt' v 3 � fy n r Asses. �s map and lot number ... ..... .:.dS.a.z...............`..` � ypi THE t0� Sewage Permit number .. } SYSTEM... :�............................M f MUST BF- INSTALLED , SEPTIC �=� IN COMP Z BaBaSTADLE, blouse number ....a..�;?..l:..�.:.................................. .............. - . 6rasa t f 9 TT €0DE ANC G� OVara`e� i TOWN OF BAR NSTABLE'4' a 1 BUILDING INSPECTOR APPLICATIONFOR 'PERMIT TO ............................:................................................................................................ TYPE OF CONSTRUCTION .,.. ........ ................... `.. .�..... ..................................... k/ �:.. ....4..7...............191.1. TO THE INSPECTOR OF BUILDINGS: The undersigneed- hereby applies for a permit according to the following information: Location .. . ... .,.J..........`. '��y.Il ...,ILi?4.A........�.0+t,(i mc�............Oa.63� �eJu�. � ' ProposedUse ................................ . ...................................................................... ........................................................ RZoning District ............ . . ............................................Fire District ......... ......................................... Name of Owner tS FO.� ��rL� ...Address `.V.`.! �'�� .��.....`.j�-C` Name of Builder ....... .v�?vU e �O\�C���G�e ( \M ......................................c,�..Address .................................... .......................................... 'Name of Architect ..................................................................Address ............................................................................. ...... Number of Rooms ................................... ..............................Foundation .......... / ................. Exterior 0�9C /Roofing ....1.1..5 /? ......... J.v'.I. ................................ Floors � 4 � � ............. Interior ......0 l� ..................... ..... ../..L................................................ Heating T!!. X ... ... ............. Plumbing ............ e..,......$T�.I................................................. Fireplace ................. .............................................................Approximate Cost .... ................................................. Definitive Plan Approved by Planning Board ---_----------------------------19________. Area ............. �./.� .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTHX0 3C) n I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NameJ. ..J.............. ................. ............... . . � . . ` THEOHARIDIS., DENNIS Ji---.. . ' '14 - Permit for _S.i__Ie.. anzi ..Dvve.11iog___.__ | Location Lo.t~#23_.95_ ..Road__.. .___.. i __..___.�__�_____~_ -='----� DennisZ�eyc�����i��io C�vnar . . ' . . . -. . �.. - ------------- ---Frame Type of 'Construction .. � ---------.. ^ ---r-^--'-----------------'' ( � Plot .............................. Lot ` ^ u" _--------. ----------'� May 7 , '` Ol Permit Granted -------------]A � Date of Inspection ---------�.'--lV . . . - (970MIZZ ' ' _ _ \ ,PERMIT REFUSED ' ............................................ lg . .......... ` ~_ �� ----- '-- '' ~~'-^-''--------'' ' ............... ............................................................... . _...J� ��-...--,.- -,.----'-.,..^''--'_' . . " ^ � ---,------------ lg Approved } � /* [ ~ - - -^-- _---_ ' - ' -' - --- --- ' -------.-----...,.--..---_.---. . ' ' -------'------------^^^^^^^^'`' i ` | ' ' Assessor's map and lot number 4 4/ &TH E t0 P Sewage Permit number .....�'�... . . �... ............................. �' ✓ Z BAUSTABLE. i House number ................................ Maes RFD MAY a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 3 U �.`1 ..................................................................................................................:.......... TYPE OF CONSTRUCTION .... :.. �?.�`...........`..�t'` \VlC; ... li..� '. ......................... .. �. ....l1,0C(` t V................19. . .. .................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. C ... .. .: ......... ICI 1&.l... ....................O ilc`�...................................................J� ' `5 I�J ProposedUse ....................................Q.........................................................................................................I......................... f Q ZoningDistrict ...:................ ......................................,.....Fire District ......... ......... ................................................. Name of Owner ................... ......................... ...Address . CL1�ty,) .� ..... � i iZC� .. f ..............U:......... f Name of Builder - �tJbl7t �� �"��\UittiC�...S 1� r `...::........................................:...Address .............................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................... .�...........................................Foundation .....................................� f7�`' J Exterior f � (.. s '�'1 r f7ft{r _ /�4101,PIAMloofing .... .l f1C31�-....:-,1?I1'Q/C::......................... ..................... ............ .t.:.....5-:...:'.`�! �',. 4...................................Interior ......>� '...�t...:.4:....................................................... Floors ........t........ � Heating Plumbing ...................._-- '- r r?............. . .... ................ .........`.. ............................................... Fireplace ............... .............................................................Approximate Cost .... ................................ Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ------------------- C-. 3 t l � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ff�} 1 1 r Name ...."......... THEOHARIDIS, DENNIS 22-6:1� J No ,2..0........ Permit for ,One...Story........... Single Family Dwell ' Location Lot #2 3 9 5 Ra 1Xn Road Cotuit ............................................................................... Owner ..Dennis Theoharidis ................................................... Type of Construction ..Fram.e ............................. ................................................................................ Plot ......................... . Lot ................................ Permit Granted ...MaY..7.:.....................19 81 Date of Inspection ..........L ..............19 Date Completed .................. ................19 PERMIT EFUSED ................................................................ 19 ............1..6T..... '!Z ......................... f 9 ................................................................................ ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................