HomeMy WebLinkAbout0197 RALYN ROAD I°1� RA'Y1J� KoR �
. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0—M At
Map Parcel Application# (p SV
Health Division Date Issued
Conservation Division 0--- Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved�by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address
Village (AMA 1 r
Owner Rowo FF��1�e_(LSL� (� Address
Telephone
Permit Request t to C,E o CA94?aa j �- �l 8'
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 0• Construction Type Wn
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: 0 existing 00newize_
r•--•f
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
/l (BUILDER OR HOMEOWNER) - -
Name S��- ��'��� C) Telephone Number 5-0$' 3 33 - K S3 3
Address P. _ sex � License# 0-4ZCI S"7
A r w)o tL 025*-6 Home Improvement Contractor# I b 15�O
Email ToS CCU u TJees 6 Yy cm c K,,Norker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
a
FOR OFFICIAL USE ONLY
APPLICATION #
i
'DATE ISSUED
. MAP/ PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
4
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
_1
ASSOCIATION PLAN NO.
i4i2a'+'Ck i3^r s .. Tr. ! GC PuL aret.
_r Bopf4-of i',.:yc.-lo icns ar c�3tanda:ds
Co.nstructSon Sipe:visor
License: CS-042957
J SCOTT CEWEN& - 'r
PO BOX 564
SAGAMORE Mk- 02
ExPiratier
Commissioner 09/2.0120:
Unrestricted-Buildings of any use group which
contain less than 35,000 cubic feet(991M )of r
enclosed space.
Failure to Possess a.current edition of the Massachusetts F
State Building Code is cause for revocation of this license.
For DPS Licensing information visit: www"Mass.Gov/DPS
iV
ro S .
,e L►cense:or reg►strat►on valid for ind►vidul use only
before the expiation date If found return to "{
`4Office.of Consumer Affa►rs and,Business Regulat►on� "
f
-10 Park Plaza-Sulte 5170
02116• 1
Boston;MA . s
of Valid without s►gnatur
fy,5`'{.f•Fw ajP „�^ uti.�. b.s ,,. - ,y3r� p V lQG�729r1,/�%i21.U.000LC
�ZCC6BZ�6'.
-s. - Office of Consumer Affairs&Business Regulation ' -
V OME?MPROVEMENT CONTRACTOR
egistration
1:61550 Type:
�•. WE xoirationk 1.Q127/20.16 DBA.
CIMENO CONSTRUCTEO[�f `
J:SCOTT CIMENO .
j7lYIEARLING.'.RUN RI7 _
BOURNE, MA 02532 ="
Undersecretary
,
f .
f
I � e
Town of Barnstable
Regulatory Services
Ms
MAW Richard V.Scab,Director..
16"3 �'� Building Division `
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 t Fax: 508-790-6230
Property Owner Must
Complete and Sign-This.'.Section ' }{ =A.
If Using A Builder
I, as Owner of the subject property
hereby authorize SC o IT ��'�d to act on my behalf,
in all matters relative to work authorized by this building permit application for:
r
(Address of Job)
**Pool fences and alarrris are the responsibihtp of the-applicant:Pools
are not to be filled or utilized before fence is installed and all final
spections are performed and accepted.
'71 Aueaza
QS' e of er S' a of Applicant
i
0JAo
t 'U IT
Print Name Print Name
Date
QTORMS:OWNERPERMISSIONPOOLS
r Town of Barnstable
Regulatory Services _.
o� Richard V.Scab, Director
Building Division
Paul Roma,Building Commissioner
3IL63 �� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
/L (DATE: Please Print
� ` � _ n
JOB LOCATION: I% �1V U • �Tu 1
number street village
"HOMEOWNER": �06;� �n d e.�re.-
name home P
hone# work hone#
P
CURRENT MAILING ADDRESS:
city/town state zip code
.The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisors
DEFINITION OF HOMEOWNER* 4
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 suchV'Se'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.Sta)e 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 gerson(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 to amend
and adopt such a form/certification for use in your community.
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Town of Barnstable *Permit#
Expires 6 months from issue date
�7 Regulatory Services Fee
BAMSrABM
A Thomas F. Geller,Director ,
IVY
X-PRESS PERMIT
MASS ♦� Ill ��77 Building Division
Tom Perry,CBO, Building Commissioner J.UL 18 2013
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 TOWN (DE LE
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
a. Not Valid without Red X-Press Imprint
�ti2..Map/parcel Number -6
Iq7 /�
Property Address 64 TV 1 i
f
residential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Andress ko&N 4I1/,D Q.L(. do- j
p+ P
Contractor's Name t,..i Q, Wb Telephone Number W 33.5 /e.9 3
Home Improvement Contractor License#(if applicable) /GAS Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Chec one: '
[ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side /
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission..
y o the Home Improvement Contractors License&Construction Supervisors License is
req e .
SIGNATURE:
Q:IWPFILES\FORMS\build g permit forms\EXPRESS.doc
Revised 061313
r
r
,
The Commonwealth ofMassachusetts
Department of Iadusiriat Accidents
Off ice of Investigations
600 Washmgton Street
Boston,MA 02111
wwn,,mas&gov/dia
Workers' Compensation Insurance A Havit:BidlderslContrachwsfFlectricians/Ph nbers
Applicant Information Please Print Legibly
t
Nine _
f
Address:
l itylstat zip: Phalle
Are you an employer?Check the appropriate boa: T of project r
4_ I am a contractor aacl I glue P 7 �.��=
1.❑ I am a employer with ❑ t 6- ❑New consh.uction '
loyees(full and/or part-time).* have hired the sub-contractors
2.J71 am.a sole proprietor orparb er- fisted on,the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contactors have 8. ❑Demolition
we ddng for mein any capacity_ employees and have woodmn'
[No workers' comp.insurance camp.msi+.unce 1 9. ❑Building addition
required_] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions
3.❑ I am a homeowner doing allwodc officers have exercised their 11..❑Plumbing repairs or additions
myself [No workers'comp- right of exemption per MGL
insurance ? c-152;§1(41 and we have no 12_❑Roof repairs ,
employees.[No workers'
13.❑Other
comp-insurance required-]
'AzE3`apphcza that checks boat#1 must also fill out the sectian be1aw sh=mgtbeir vmde&compensatimpolicy Wtrmnian.
1 Homeoanrs who subaint this affidwit indicating they ate doing an weak and then hoe aut d&contractors mast submit a new affidavit indicating such_
1Canhscton that deck trig boat must attached au additional sheet showing the name of the sub-camttxtm and state whether aaatt me entities bave
empbryees. If the mb-c mttactats Lave emphryees,dwy mast pmuide their workers'camp.Pommy number.
I am an empk5,w that isprovfiUng workers'conTeasaffon inmrance for my tmrpkomees. $tow is the ptrlicy MW job site �
informatiom
Insurance Company Name:
Policy#or Self-ins-:Lie.#: Fxpiration Date:
Job Site Address: Citvl tote zip:
Attach a copy of the workers'compensation policy declaration page(showing the.policy number and expiration date).
Failure to secare coverage as required under Section,25A of MGL c 152 can lead to the imposition of criminal penalties of a }
fine up to S 1,500.00 and/or one-year impuisonmenk as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA far i„suranre coverage verificadan.
I do hereby carhfjt�y the pr rs anrlpevta es oj'psrjury that iRfarirQataort prm d I�Ja`bovv is true and ciarrect g
Si bate:
Phone#: Sd QC-1,,3.7—.IS:13
Ojff trial use only. Do not write in A&area,to be compifeted by sty or town affic$at
City or Town: PermitUcense# `
Issuing Authority(circle one): ,
1.Board of Health 2.Bmlding Department 3.C hyfr wn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
1
R .
oFTME Town of Barnstable
Regulatory Services
BARNSrAB�—g Thomas F. Geiler,Director '
i639" ♦�
o rrwY' Building Division
Tom Perry,Building Commissioner
200 Main Street;Hyannis;MA 02601
www.town.barnstablema.us
Office: 508-8624038 Fax: 508-790-6230 `
f
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, -- , as Owner of the subject
l l property
�
hereby authorize )L�� ,i rr� �l�C� to act on mp behalf,
. R
in all matters relative to work authorized by this building permit
( dress of Jo )
R
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
S' tore of er ' Signature of Applicant
0. ri
Print Name Print Name
Date
Q:FOR W:0WNERPERTvMJ0NP00LS 62012
�V, Town of Barnstable
Regulatory Services
A�RN7+-1AR14 ► Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION.
Please Print
DATE:
JOB LOCATION:
number sheet village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town
swe ap 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
accep table to the Building Offic
ial,that he/she shall be responsible onsible for all such work Rerformed under the building permit. (Section
._
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town.of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
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
r that such Homeowner shall act as supervisor."
for hire to do such work, P
engages a person(s)
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
or. The homeowner actin as Supervisor
or is
'ceased Supervisor. P
person as it world with a h g
proceed against the unlicensed p P
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.
C:\Users\decollk\AppDa$\LocaAMivaosoft\Vrmdows\Temporary Internet Files\Contentoudook\QRE6ZUBN\E3?RESS.doc
Revised 053012
I
} Massachusetts -Department s Public Sa;ety
Board of Buiiding Regulations and Standards
CGnstruction S pe:risor
t License CS-042957
`} I Is
J SCOTT CIIVM
PO BOx-W
t SAGAMORE MAr 02a¢1
_x ;ira*.icr
Commissioner 09/20/2014
4
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Office of Consumer Affairs &Business Regulation-Mass.Gov Page 1 of 1
The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) f�?`.yr
Consumer Affairs and Business Regulation
Home Consumer Home Improvement Contracting
Home Improvement Contractor Registration Lookup
You can search/filter the registration list by any of the criteria below.
Search by Registration Number
R
Search by Registrant Name -__...____..._.__._:._...
Search by City _..:-_....___--._..__._.-..-.--.._._._.._______' Zip Code --._.._._._..____J
;Search Registrants
Click on the registration number to view complaint history. You can also view arbitration and Guaranty.Fund
history. ; {
The list is current as of Wednesday, July 17, 2013. -
Search Results
REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION
NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS
CIMENO CIMEN.O, J.SCOTT 161550 P.O. BOX 564 10/27/2014 Current
CONSTRUCTION SAGAMORE, MA 02561
t
I
{
http://services.oca'.state.ma.us/hic/licenseelist.aspx 7/18/2013
4
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
JName(Business/Organization/Individual): cyP',,()T C /M;5wti
Address: in,4- o2qz
City/State/Zip: Phone#: O '
Are you an employer?Check the appropriate box: Type of project(required):
1.El 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.VI am a sole proprietor or partner- listed on the attached sheet. 7. [ Remodeling
ship and have no employees 'these sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp. insurance. 9. ❑Building addition
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
m se ' right of exemption per MGL
Y �o workers comp. 12.❑Roof repairs
insurance required.]t c. 152, §1(4);and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,50.0.00 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 certi nde'�hpain�sandpenaldes of perjury that the information provided above is true and correct
Signafore: Date:
Phone#: 00- 333- f373.37
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#:
r
Town of Barnstable'
* Cal/0 3 able Permit#
Regulatory Services E%pLra 6mon8rsfrow issue date
sAatvsrwaLF, : Fee_ c 3�r
MASS Thomas F. Geiler,Director 1
MA't
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstabid.ma.us
Office: 508-862403 8
EXPRESS PERMIT APPLICATION - RESIDENTIAL O ,y Fax: 508-790-6230
/ Not Vaild without Red X-Press Imprint
-Map/parcel Number
Property Address ��
L�xesidential Value of Work Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name
Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) k
❑Workman's Compensation Insurance t
Check one:
❑ I a sole proprietor
I am the Homeowner -PRESS E
❑ I have Worker's Compensation Insurance RMIT
I+..'L. r J ``
nsurance Company Name TOWN CIF
✓orkman's Comp. Policy# a NSTABL E
opy of Insurance Compliance Certificate must accompany each permit.
:rmit Requ t(check box)
Re-roof(stripping old shingles) All construction debris will be taken
mi
❑ Re-roof(not stripping. Going over existing layers of roc)
iRe-side
Replacement Windows/doors/sliders. U-Value doors
�town
aximum�,e
�ofnlows
*Where required: Issuance of this permit does not exempt compliance with othepart nent
onservation,etc.
"'Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
q ired.
NATURE
i
PFILESTORMSIbuilding permit formslE)TRESS.doc
.sed 070110 i
The Commonwealth.ofMassachuseits
f Department oflndustrialAccidents
Offzce of Investigations
.600 Washington Street
\4 % Boston, M4 021JI
�v
www.mass govhlid
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
�N2.me �. s�/Organization/Individua]):���{ 11 1�� �N,S� '
�Adddres�'` T
City/State/ ipi ` d Phone#:
Are you an employer?Check the appropriate box: T e of project re uire
YP, P ] ( 9 �:
1.❑ 1 am a employer with 4. ❑ I am a general contractor and.I 6. El New construction
employees(full and/or part-time).* have hired the sub-eontraciors
2.❑ I.am a sole proprietor or partner- listed on the attached sheet. t y. ❑Remodeling
ship and have no employees These sub-contractors have 8. M Demolition'
working,for me in any capacity. workers' comp. insurance.
9. ❑ Building addition
�0workers' comp. insurance 5. ❑ We are a corporation and its
__;requu ed.] officers have exercised their
I0.❑ Electrical repairs or additions
]am a homeowner doing all work right,of exemption per MGL I I.0 Plumbing repairs or additions ;
myself. [No workers' comp. . C. 152, §](4), and we have no 12.E] Roof re airs .
insurance required.] t employees.[No.workers' S
13.
comp. insurance required.] __ �� _
*Any applicant that checks box f 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 hue 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-contractor and their workers'comp.policy information.
lam an employer that isproviding workers'compensation insurance far trry employees Below is the policy and job site
znformatian.
Insurance Company Name:
.Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for.insurance coverage verification.
1
Ido her fy the pains and penalties ofperjury that the information provided above is true and correct
Date:
�---
F
Phone#:
FOther
only. Do not w7*e in this area;to be completed by city or town'offwiaL
n: - PermitlLicense#
[6.
ority(circle one):
Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspectgr S.Plumbing Inspector
i
,
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 emyloyer 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 Iegal 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 onto 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()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 co erage. 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 iii 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 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,telephone and fax number.~
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations' '
600 Washington Street
Boston,-MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Town of Barnstable
tHErok,o
y. Regulatory Services
i Thomas F. Geller,Director
-
�, Building Division
En t�j Tom Petry,Building Commissioner
200 Mani-Street, Ayannis,MA 02601
Rwv.towmb arnstable-ma.us
Ofcc: 508-862-403 8 Fax. 508-790-5230
HOMEOW R LrcrvdSE EX KMON
Plruse Print
Dfi7
JOB----CATION:
number street village
I. rolrrEowN_rm": �T
name ome phone# work phone#
CURRB7(I M:ti71 IG IDD�S: %AzAn Q h l�
ettyhown statz zip code
The current option 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,prodidcd that the owner acts as
supervisor.
DEFWTrTON OF EOMXOWR'ER
Pcrson(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 dwc mg, attached or detached structurm accessory to such use and/or fa=struct=. A
person who constrgcts more than one home in a two-year period shall.not be considered a bomeoRraer. Such (.
"homeowner"shall submit to the Building Official on A form acceptable to the Building Official, that heshe shall be
responsible for all such work performrd'under the building permiL (Section 109:1.1)
Th,cimdersigacd`homeowner"asstnmes responsibility for compliance with the State Building Code and other
applicable codes, bylaws,rotes and regulations:
The tmdcrsigned`lomcowner"ccrtiLcs that.hdshe,understands the Town ofBarnstablc Bolding Dcpart=t
mum rmim mspaction procedures and rc:gmir cnf3 and that he/she.will eoroply with said procedures and
requirements.
OSignature - ar
Approval ofButld ng,OfEcial !
Note: Three-family dwellings containing 35,000 cubic feet or larger well be required to coaPly with the
State Building Code Section 127.Q Construction Control.
' SOl1�OwKER'S EXEMFTlON •
-The Code states that Any homeov—parfornaing worrc for which a btnildatg pmait is requir cd shall be exempt from the provisions f
of this section(S=ddn 1 D9.1.1-Iiccrxiag erumsttvetion Supayisors);provided that if the horneotvncr copgcz a parsoo•(s)for hire to do such
work,that such Hemeawn a shall ad as supervisor,•
Leroy bomernvners who use this ncemp60 are unawar c that they art:Laurninx the responsibilities of a supervisor(see Appendix Q,
/,ides&Rcg la dons for ISc^+T^+g Construction Supervise=,Section 2.15) This lack of awarenr=Men rrsults in serious problems,particularly _
vhat the homeowner hires unlicensed pasorss- In this ease,our Board cannot proceed a jLhuf the unlicrmcd parson as it would with i licensed
:upervisor. The homeowo car acting as Supervisor is ultimately msponsible.
To crm=that the homeowner is fully awm7-of hiArrimsponstbilitics,many communities require,as part of the permit appBra lion,
tat the homeot3mcr certify that bdshe undastands the rtspaanbtliticr of a Supervisor. On the last page of this issue is a•form cutrmtly used by
:veral towns. You may care t amend and adopt such a fernJ=rtifieation for use in Your community.
o� Ty Town of Barnstable
o
RegvlatoryServices
MARS $ Thomas F. Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main 5trcck Hyammis,MA 02601
www.to w n.b arnstab l e_ma.us
Office: 508-862-4-03 8 Fax: 508-790-623 0
Property Owrier'Must ,
_ Complete and Sign This. Section-" .
IfIf�A Builder
as Owner of the subject.,
roperty
hereby authon7p to act on my behalf,
in III matteIS relative to work authorized by this buMng permit application for.
(Address of job)
signature of Owner Date :•' ;.„ , r k, ,
V—
Print Name
If Provertv Owneris applying forpermitplease complete.the
Homeowners License Exemption Form on :the re erect
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Town of Barnstable
Regulatory Services
f THE Tp�
do Thomas F.Geiler,Director ;Vold
Building Division
snaxsTaaLE.
9 Mnss •� Tom Perry,Building ngf;
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 t Fax: 508-790-6230
Approved:
Fee:
Permit#: VDU( j I ( '7
HOME OCCUPATION REGISTRATION
Date: c5 7— b
-� . QC.�Z6Z S I�t p l c,
Name: ���� � Phone#: 'Q�� 7 Z �d ti 7 /
Address: 19-7 ga IVI, • Village:( 07�4
Name of Business: 44 En 1ei' PiSe-s _
Type of Business: P)to feidti GG 1rA& Map/Lot: z2os�
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have re d d agree wi th above restrictions for my home occupation I am registering.
Applicant: - Date: S 2-S 6 6
Homeoc.doc Rev.5/30/03
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL.,367
Main Street, Hyannis,MA 02601 (Town Hall)
iy1r@)1!• GI
DATE: S z 6 d
Fill in please: _
APPLICANT'S YOUR NAME: Og�27` < Q let ZOFS k
BUSINESS YOUR HOME ADDRESS: JR7 'RA LV61 /ld -�
617-k'�Z-0 y7�
TELEPHONE # Home Telephone Number 6 - ' Z-
NAME OF NEW BUSINESS UBERP21 ES Y YPE OF BUSINESS a e r
IS THIS A HOME OCCUPATIONOYES " NO
Have you been given appro al frqq��;;tthe bu'Id' g.division? 'YE NO
ADORE SS OF BUSINESS 7 /act`% a MAP/PARCEL:NUMBER
When"starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -.(corner of Yarmouth
Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COM ER'S�O- FIThis individ I h s n imfad f n permit requireme t pertain to this type of business.
57
u horiz i tuce
COMMENTS: _ � � C
2. BOARD OF HEALTH
This individual has been rm(. of the ermit requirements that pertain to this type of business.
T fir- Fture
Authorized Sign *
COMMENTS:�DZ 7cevta- l�yr PfeE�4Z �evsa- l�y+ Pf�-
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
' Authorized Signature**.
COMMENTS:
TOWN OF BARNSTABLE Permit No. -------.--_---
Building Inspector
Cash
OCCUPANCY PERMIT song ---__
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 c f-,�v'h nm & mo-r'' ill h1a rX 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.
.....................................................7 19......__ ..................................................................._..............................�._._
Building Inspector
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sspr's map and lot number ......0 L'2 F-d
a //h
THE
Sewage Permit number .......... ..... .... ....................... SEMC SYMM
INSTALM 0 CM STAKE,
House number ...................... .13.] 0 WM MAM
.......... ..............................4. 0 -
Wn MErs 039
ENVIRONMENTAL CODE
TOWN 5OF -BARNSTAvB TIONS
BUILDING, IRSPECTOR
APPLICATION FOR PERMIT TO ............CO.N.S.T...R.U'CT..................................................................I............................
.... .. .. .......
TYPE OF CONSTRUCTION ........WOOD FRAME SINGLE FAMILY DWELLING
..................................... .............
....................... ............19...
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby ap lies fo ermit according to the following information:
Location .....LP.t t....... ...................................................................................... .......
ProposedUse ............Dwelling................................................................................... ............................................................................
ZoningDistrict .........................................................................Fire District ....CQ:Wlt..........................................................
Name of Owner .5.tjep.hjer)....&....M.P.r.ri.l.1....M.a.r.x ,,,,,,Address .....
Name of Builder ......D.a.v.i.d...T.e.l.l.e.ggn..........................Address ..... 1620
.........................................................
Name of Architect ....qamq....................................................Address .....5.All1p.....................................................................
Number of Rooms ....5....or....6................................. .............Foundation AQ.....P.Qmx�q.d...q.Q.Rq.;:@.tA...........................
Exterior ..... n g.l.q
..........................Roofing .....aAp.hAlt.............................................................
Floors .......Rine
Interior .....
............................................................................ 2 ................................................
—. —Heating- ....::.........................:.....Plumbing
...P.' L...4nd....C.QP.P.Pr..........................................
Fireplace ....I..........................................I...................................Approximate Cost ..... ...........................r
Definitive Plan Approved by Planning Board -------------------------------19--------- Area ......!...................
Ref. Planbook' 229 Page 53
Diagram of Lot and Building with Dimensions Fee
See Plan ...........5;�2 ............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...... ..............................) ..............
tiv rx, Stephen & Merrill
...ZJ.95a.. Permit for .Single... ••••
Dwelling
.................. ........................................... 7
Location .L,rat.Ata 197 Ral• n••Road......•••••• +�
Cotuit �f
Owner ...Stephen..&..M&r.r-.11...Manx..............
Type of Construction
YP ..........game. ...................
4
....,...... ............... ...............................................
Plot ........................ Lot ...........................
Permit Granted ...........January..ao,......19 $p ;
l t�
Date of Inspection .........19
Date Completed ......... ... C.......J 19 ,
PERMIT REFUSED
r. N. ...... .. 19 r
.... .� > : ......... J — M
.................................................... T _
...... ................................................ -.
. •...... • . ..................•....•...•..�•......•..•• • �.. e;. • -
II/ • •..............•
•...• .�• •Qua.®. •...............• •....• ^' • ^�,.,�� � �. -
lip M V
Appr . ....'..0. ................................... 19 N`�=
............. ................................................... r '�
1
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Assessor's map and lot number �'..............'. �.........:. :• THE Qy0,F
/s-
Sewage Permit number ...........(Oa(',
.............................................
Z DA"STAUE E, i
House number MAM
p 1639. \0�
a m a'
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ........... �:.,i.RU T
.....................................................................................................
........: ...................................F3 A `-C S T `!'L t F A-1 r I-Y D L E L I-t ,
TYPE OF CONSTRUCTION ........................................................................................
.......................�. 17.1.............19...�..:.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .....r. ? ..... 1 ..........v l.......!...:.t1,........tu....t......................................................................... ...........................
ProposedUse ........... VF'.�.1. n..?............................................................................................................................................
Zoning District ........................................................................Fire District ....COtu i t
..............................................................
Name of Owner ..i.taphsn......... crTi ] 1.... ".3rx...........Address ....1.A...Ravl,vn...Rd..... ...............................ti ..........
Name of Builder ..... avi.d...Tellenee..........................Address ....P...q.:....inx...15?(1..............................................
Nameof Architect ........ ........................................................Address ....S mt .....................................................................
Number of Rooms .. !...�.r �...............................................Foundation 10" nnured concrete
..... ..............................................................
Exterior .....�hl.�-!1� or �1Z..,bna.rd..........................Roofing ....e-.Q!13.It..............................................................
...................c l
Floors ' .`'' Interior ....�." s`i?e,trn--k
................................................................... ..........................................................................
Heating ......�.......`....`....!�.�................. .....................................Plumbing ...:. :. ...........................................
Fireplace Approximate Cost '1 q- '1 D j rin
..:............................................. .....:........................................................:.....
Definitive Plan Approved by Planning Board ______________________________19________. Area � , ` i.......:..................................
i 3.Rr'�7 7+C 2?,l Pane 53
-biagram of Lot and Building with Dimensions Fee
.. .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I
1�1
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. /
Name ......:: a .:#`%L.:..... ....: .:..'...:.......................
/ A 22 50
. v� _
. . '
Marx, 3tepbeo & Merrill
' No -`2.19.53... Permit for ......
' ___.___.D�eIlin�______,_,_~_.^_..
Location ....Lat'-#q,Br'19.7''Bu-l-yn''R«wad.........
Owner '
Typ e of Construction ,.......F.rarfie......................
�
o ......
�
Permit Granted Date of Inspection
uo/e Completed
PERMIT REFUSED
___. —. l�
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Approved ................................................ lg
. .
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-------.---..—...---.~.—.....—.~... \
. `
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NOTE: TAPERED CAP
THIS DETAIL IS FOR INFORMATIONAL PURPOSES
ONLY. EACH INDIVIDUAL DECK FRAMING DESIGN
SHOULD BE CHECKED BY A REGISTERED
STRUCTURAL ENGINEER TO INSURE ITS 1X3 TRIM BOARD
SAFETY AND CONFORMANCE TO THE LATEST 2 - 2X8 NAILER
REQUIREMENTS OF THE MASSACHUSETTS STATE
BUILDING CODE. 2 X 2 BALUSTERS
4' MAX. CLEAR SPACE BETWEEN
i
4X6 WOOD POST AT 5'-3- O.C. MAX.
!j CONTINUOUS TO FOUNDATION
P)
s T r
SIDING 2X6 NAILER
20 OZ.. ALUM. FLASHING 5/4 DECKING
4X4 ALUMINUM PLYNTH BLOCK SPACER
3/4 DIAM. LAG BO
AT 2'-(l O.C. l— 2 - 2Y.8 BEAM
STAGGER THROUGH BOLT TO EACH POST
1' AIR SPACE L2X8 DECK JOISTS AT 15' D.C.7 �--- WITH TWO 3/,C DAMETER BOLTS
SHEATHING 2X8 HEADER METAL JOIST HANGER AT 90TH ENDS OF
UNE OF 1X8 LEDGER BOLTED TO SOLID BLOCKING EACH JOIST
BUILDING W/ 3/f LAG BOLTS 2'-B' O.C. STAGGER.
SEAL BOLT HEAD CONTINUOUS4X8 WOOD POST
20 OZ. ALUM. FLASHING
10'-O' MAX. SPAN
pa
b
• � I
In
z -
ALL DECK FRAMING TO BE PRESSURE TREATED 'N METAL POST ANC40R
( WOLMANIZED .40 LOS. it
/ CU. FT. ) 1�� O DIAMETER CONCRETE BASE
ALL HARDWARE & NAILS TO BE GALVANIZED MIN. 4'-Cr BELOW GRADE
z_
%0 LINE OF GRADE
L J
•4'
RECOMMENDED DECK CONSTRUC"FlON
OT W SCALE
3/90 CAPIZZI HOME IMPROVEMENT INC.
10-45 NEB" TOWN ROAD /f7 e.1tLYA)
COT UIT, h'A 02635 �L,
TEL. 428-0518 / 1-800-262-5060 a7 .--,7- ��
' 'Original VELUX flashing�
makes it easy to install
a VELUX
window in any roof
A carpenter, roofer or skilled The VELUX flashings are With the use of the
do-it-yourself homeowner can supplied in two models, kerb/flashing systems,
open the roof in the morning types L and U, for use at tightness is dependent on
and have it closed again that 20° (approx. 4112) -85° good craftsmanship and
same day. On new pitch. quality caulking.
constructions, important Should it be required to gang Windows with copper flashing
time-savings can be realized. windows vertically or are available on special
It is an economical job to have horizontally, VELUX gang request.
done for you. flashings are available. The finished job looks just as
VELUX has planned In case of installation below good from the outside as it
everything for simple, fast 20° pitch, the VELUX kerb/ does from the inside. VELUX
installation. There are easy- flashing type VP offers a window units are designed to
to-follow directions, of course. neat solution. Available in be built into your roof,
But, the real key to the ease of types L and U, the kerb/ maintaining its graceful
installation is that the flashing flashing raises the level of appearance.
supplied by VELUX greatly the window by 10° above the VELUX roof windows are an '
simplifies an otherwise roof slope to the required asset to your home, no matter
time-consuming job. pitch for proper functioning. how you look at it.
It is no small matter that you Note the minimum pitch for
are also assured of a completely the VPL is 10° (approx.2112)
tight roof. and VPU 12° (approx.2112).
VELUX flashing type L VELUX flashing type U
sheathing sheathing
roofing felt roofing felt
head flashing head flashin batte
' insulation ��� ;�� ,; � insulation
vapor barrier vapor-
---- or barrier
horizontal soffit horizontal soffit
sill
sill flashing
flashing ;
vertical sill ! vertical sill
lining - lining
side gutter
step flashing / roofing felt
fi
\ ng roo felt � � � _ r
batten
r sheathing
sheathing �:�
18
i
} 41
Assessor's map (1st Floor): �� �TNE
Assessor's ma and lot number JIC,SYSTEMMUSS,BEConservation — / — IIOISLLED IN COMP
Board of Health(3rd floor): ICE �I�� `"�����
Sewage Permit number _. // vZ TITLE 5 Isa MLE
(ENVIRONMENTAL CODE AND '°o ts3o. d'
Engineering Department(3rd floor): �� TOWN
House number T® NREGULAT'IONS
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWNOF BARNSTABLE
� BUILDING INSPECTOR
APPLICATION FOR PERMIT TO yi✓STr�r' l��yx �.+���,nJs --5��' ®�, Qi����jz/,7
TYPE OF CONSTRUCTION MeA /�IX 3Z 7j
7-- /3 19 �.3
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location d ��
Proposed Use `
Zoning District Fire District
Name of Owner/-,.dl V, �GG17SCL61yy / Address 7L� —71i
Name of Builder Address
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior
Heating Plumbing
Fireplace 1 Approximate Cost _ /0J dznD
ti.
Area yy8
Diagram of Lot and Building with Dimensions Fee j
i
N7
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above nstruction.
Name >
Construction Supervisor's License ' lS y�/!r-
FLEISCHMAN, JERRY & NANCY
<.,! No 36027 Permit For BUILD DECK:
Single Family Dwelling- ` i
Location 197 Ral lyn Road
Cotuit r
;
Owner �:Jerry & Nancy Fleischman •.
Type of_Construction Frame
i
'Y, , ! •, i i 1 t
Plot Lot t
Permit., ranted July 15 , 19 93 -
_ ,
Date of Inspection 19
Date�ompreTed G 19 _. 1
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