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0057 STUB TOE ROAD
• L I 144" TYPIC41- _DI =C� �1-1 rc_L( _TT'�.4"'r,� yor (WI tnhZTe�eyvr�r+.� 06.5E,C VA T/O A/ P/75 sty*is -T 00f GcuA L "le Co(.A rro^/ 4A7 T 2/�n,., /..►c/y , 0�3E'�CV•tT/ON5 sy: - OW Q J ""'r_'o p,1 � t.OT �l�l .1.}✓.i.�.C.{. ,= 6ogt0 0�' llF.4tTH 3 ,4 1 CP ko v 7 L�► `-a ry 4-7 b • � � .50 .ram 1 L�a1r Uv v . (o Q,•T s ti, Of THE T Town of Barnstable *Permit �y Expires 6 months froin issue date °� Regulatory--Services Fee Z BARNsTABLe : Thomas F.Geiler,Director - MASS. $Ar.e39�p.� �61llldflllg Dgvfl3fl®11< QV1ArN ED MA _ Tom Perry,CiiO; wilding Commissioner D, 200 Main Street,Hyannis,MA 02601 1" www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/,parcel Number 6 4c) l d �- Property Address ? �) � �Q �C:�� C�; h.c t-1 I M/I Residential Value of Work J j(Z)U• U Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -b(l l n a Contractor's Name_ ) C� C rU Telephone Number — F36 6.2 i Home Improvement Contractor License#(if applicable) �' L ❑Workman's Compensation Insurance �PRESS IT Check one: ❑ I am a sole proprietor O C T `u El Pin the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name 13 b 00 h C ef, Workman's Comp.Policy# V y c• g G C)6 1 a Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ®Re-roof(stripping old shingles) All construction debris will be taken to �Gi ((c`_ uja S ry,v 1 LC ❑Re-roof(not stripping: Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Dome Improvement Contractors License is required. i a t - o s CA; SIGNATURE: o u'a 0 Q:Forms:buildingpennits/express C) 1-- Revised 123107 m y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 _ www.mass.gov/dia Workers'"Compensation Insurance Affiddvit: Builders/Contractors/Electricians/Plumbers Applicant Information Please(Pri�nt LeiblY Name(Business/Organization/bdividual): (jlr(z) Address YYI I"4� Ci /State/Zi i ty p. W g Are ou an employer? Check the appropriate bog: 'Type of project(required):. 1: I am a employer with 4. [] I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* • have hired the sub-contractors le proprietor or partner- ship listed on the'attached sheet. 7. Remodeling 2.(� I am.a so p p p ship and have no employees These sub-contractors have S. []Demolition �rorkin for me m an capacity. employees and have workers g y P ty 9: []Building addition [No workers' comp.insurance — comp. insurance. required.] 5. We are a corporation and its WE Electrical repairs or additions •3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Pl bung repairs or additions ' myself.[No workers' comp. right of exemption per MGL 12• Roof repairs insurance.required.]t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers 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 anew affidavit indicating such. tContractors 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 jab site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: b Site Address: Td hod_ Ciy/State/Zip: 4 kllq ou.Jo S 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 tip 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$258,00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the 1DIA fox insurance coverage verification _ Ido hereby certi under the ns•an p nalties ofp Si ature: Date:erjury that the information provided above is true and correct. a , Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: ' Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: ACORDM CERTIFICATE OF LIABILITY INSURANCE 08/05/2008' PRODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 39 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Roycroft & Kuehne Builders Inc INSURERA: Arbella Protection Insurance 65 Eben Smith Road INSURERB: Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: GRANITE STATE INSURANCE CO 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM/DDIM DATE(MMIDDNYI LIMITS GENERAL LIABILITY 8500022738 08/01/2008 08/01/2009 EACH OCCURRENCE $ 1,000,000 _X]COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE M OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY 7AM0277014095 10/18/2007 10/18/2008 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ BX HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ A PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC 990610 08/06/2008 08/06/2009 X I TORWC STAImTU- FP OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 E ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below I E.L.DISEASE-POLICY LIMIT $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATTN BUILDING DEPARTMENT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 MAIN STREET OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. HYANNIS, MA 02601 AUTHORIZED REPRESENTATIVE Joanne Bretton ACORD 25(2001108) FAX: (508)420-1947 ©ACORD CORPORATION 1988 IME Town of Barnstable mumsTneLE, " 1639.h Regulatory. Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 20.0 Main Street, Hyannis,MA'02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Si ` This Section p � - If Using A Builder I, �JC�►I�t C,Z cT. Mo U ,as.Owner.of the subject property hereby authorize 1 C'4a'1 .T, rd IL� to act on my behalf, in all matters relative to work authorized by.this building permit application for: 5 Sib `6C ;�000�—I Co-h;t,i-f, Valk 026 3 .S (Address of Job) ignature of Owner Date Tint Name Q:Fonns:buildingpennits/express Revised 123107 i..z.., � - - .� r1 � I:: t!'a!/F//Lfi/6fUCt7(�/i Of�.vif'(CI•iita•CdLtGiF.� at Board of Building Regulations and Standards Construction Supervisor License �! tw' License: CS 83280 Birthdate: • 11/29/1964 y Expiration: 11/29/2010 Tr# 5313 Restriction: 00 SEANJ ROYCROFT 65 EBEN SMITH RD CENTERVILLE,MA 02632 Commissioner ,per ✓lre 'L�a�n�naouoea�o''✓Itaaaac/auaeka Board of Building Regulations and Standards s HOME IMPROVEMENT CONTRACTOR Registration: 141225 Expiration: 1/22/2010 Tr# 262207 Type: Private.Corporation ROYCROFT&KUEHNE BUILDERS,INC. Sean Roycroft '§ 65 Eben Smith Road ,�Qa -Centerville,MA 02632 Administrator ' a? TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � Parcel SEPTIC SYSTEM IAL� hermit# ��,� INSTALLED IN COMPLIANT_._. Health Division 3 ', -*, WITH TITLE 5 Date IssuaW �s p0 ENVIRONMENTAL CODE A Conservation Division �' Z TOWN REGULATIONS �e �f� Tax Collector Treasurer i i Planning Dept. ; Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �l ����✓ �� �0 ,Village ccqv Owner V` Address _20� Telephone 5 46 ` 3 Permit Request. ,C Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 1A W Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �A No On Old King's Highway: ❑Yes No Basement Type: ❑Full ❑Crawl (P Walkout ❑Other Basement Finished Area(sq.ft.) z�3 Basement Unfinished Area(sq.ft) Y7 Number of Baths: Full: existing 1 new Half:existing new Number of Bedrooms: existing J, new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: CA Gas ❑Oil ❑Electric ❑Other Central Air: 0 Yes � No Fireplaces: Existing - New Existing wood/coal stove:. 2�es 0 No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:[existing ❑new size Shed:❑existing U/new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name f J l/ Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULT NG FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR-OFFICIAL USE ONLY 'PERMIT NO. O ', DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE , OWNER`S J j DATE OF INSPECTION: FOUNDATION c` , FRAME' INSULATIOk +: FIREPL?A'QE= ,i� ELECTRLC . 0 '.ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING, t DATE CLOSED�OUT ASSOCIATION PLAN NO. a The Town of Barnstable * snxivsrAat,E, • K g Department of Health Safety and Environmental Services 1639.. Building Division EO MA' 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 n Building Commissioner TOWN OF.BARNSTABLE P rmrt: yff 75" - SOLID FUEL STOVE PERMIT ate e Fee: ��'vQ Owner: G Phone: � a�( Address: f�v Village: Map/Parcel: U"V� �, �" Date: Stove A. New Use B. Type: adian (Circulati C. Manufacture Lab. No. D. Model No.: k-. �►�(. 0 Chimney A. New xistin (If existing,please note date of last cleaning B. Flue Size C. Are other appliances attached to Flue? JVO D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: Q r I ()L S12P S a B. Sub Floor Construction: Installer 33 wa rq poll ", allQ{ Name: �- ° ° c a U LA. Address: Phone: S - 6 2 3 Location of Installation: APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Stove.doc I EyS s��► Inc. Gb P.O. Box 90, Sandwich, MA 02563 (508) 888-5114 Date Detach and return this portion with remittance $ -------------------------------------- -------- DATE DESCRIPTION AMOUNT I C, Ja' TOTAL The Town of Barnstable &UMSTABM Department of Health Safety and Environmental Services' 039. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 } Ralph Crossen Fax: 508-790-6230 Building Commissioner TOWN OF BARNSTABLE P ` SOLID FUEL STOVE PERMIT Dat : .. _,e _. Ali '�� Fee: �� sad ' Owner: Phone: Address: g Villa -e.--- - --- -_. -- _- . Map/Parcel: �" ({ Date: Stove -A. New Use - B. Type: adian /Circulat C. Manufacture . y Lab. No. .20'10 _ D. Model No. a _..------ ---- Chimney 1 A. New xistin (If existing,please note date of last cleaning 00 B. Flue Size C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined i Hearth A. Materials: ' Or 1 c 1C V B. Sub Floor Construction: Installer II__ 33 (Ala t Q I'I Q l(C Name: l- ° �t I Vl��L1 Address: �, Phone: Location of Installation: APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the . —Ruildinv Tncnector k t - •• •'. •. ♦ � . oaf" � • i 1 t. . R 6'Q„ Ront ',Ex' posure T 11 -11 1 Siding,,� Actual Door TBD ,a . Header, Jacks as a r appropriate F = t Rear Exposure ,". i Tl - 11 Siding ' Actua l Double 'Door TBD Headers , jacks - as appropriate " off � O CO LJ j 18.0" -� (Front) Right Exposure T1 -11 Siding . ,,.2x4. Construction • d v Y A - Y u � - , _ 5 v � y• a (Front) Left Exposure T1 -11 Siding: 2x4 Construction -------- Ai 17' N n L) �Al� Joyce 'Plan 2x8 FAT Hangers at all flush framing Y - 4 Y pry, ------------------------_------------------------- __ /J/ I i I I I I� I I I I , I 1 I t Vt> l 1 . i _ 4 The Commonwealth of Massachusetts Department of Industrial Accidents =-�� � Olflce ollorest/gsdons 600 Washington Street ; -- Boston,Mass 02111 WorkersCompensation Lunrance Affidavit - �/// name: �p . location city n /� hone# v Z ' I am a homeowner performing all work myself. I am a sole proprietor and have no one workan inany capicity workers'compensation for my employees working,on this job.:: : ;;:::<;:.«::::<::: :<:><:<:;:: Iam an employer rovldmg mp.... ..:.::::::::.::.<:;;:.;;;;:.:.;•::.::..::. .;:.;:.;;: ;:::::::.: ::::::;:::::::::::::::.;:.;:.::::.:.:::.::.:.::......:;:.;:.:::::.:.:..:::.:::;<;: any name:: ;;:.;<::::;:.:;..:.::.;::.;: COMI dd s rp s. :::.:::.: ::::::.:.:..:.........:. hors e city* :..... ...::::.::.:::::. < :.;:.. %/ ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have wln wor ......:.:::::::::.::.::::<.:::::::::::::::::::::::,::::::::.:_::::::.:.:::::::::::::.:.::::::::::::::::::.;:.;:.;;;:<.>;:.;;.;:;:::<: the following kers compensation P ::: ;:: :.;:.::::::::::::,::,:: .: :.:::::.::::::::::::::::::.; ;.nam v an ..:. :.....,::..::.:::.:,...:,......,. ::. : . .::::: ; ::....:.:.:: : : : s ....................... y .:::::........ ::::..........::.::.:.............::.::::::>::..................... ... .......... e: any - .- - :::»:::;:>;>::»»::>:;>.<:>:«:>::>:;:>::::;;:::•;::. c .:._ ::.::..:..:.:..._. . ....:::....•::::::::::....::•::::...:...... ::: address. : :... :.: ::>>::?:::: >::>::;.... ..... .::::......................::............................................::. .::..::<:::::<::::::;;:::>:>;:::>::»�:;:::>:;::>::. hen oli tVN insnrancir as required wider ader Section 25A of MGL 152 can lead to the impositlon of criminal penalties of a fine up to S1,500.00 and/or FeIInre to secure coveragepenalties in the form of a STOP WORK O one yeah'imprisonment well as civilRDER and a fine of$100.00 a day against me. 1�dez d awn copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce fy under the p ' and penalties of perjury that the information provided above is tnu and correct Si Al Phone# �a�7 Print name omcial use only do not write in this area to be completed by city or town official permit/Ilcense# ❑Building Department City or.town: ❑Licensing Board OSelectmen's Otflce ❑checkif immediate response is required ❑Health Department contact person: phone#; ❑Other --------------- (0wrmed 9/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checldng the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Imlestlgadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 °F THE r, The Town of Barnstable • anxivsrnei.e. • Department of Health Safety and Environmental Services 059. 9.t a Building Division 367 Main Street,Hyannis MA 02601 Office:. 508-862-4038 Ralph Crossen Building Commissioner . 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: 1 �� Estimated Cost �� Address of Work: J J 17 Owner's Name: l Date of Application: s1 Z"I ov 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. S 4(fa I Date Owner's Narde q:forms:Affidav J The Town of Barnstable a Department of Health Safety and Environmental Services � � t Building Division BAMSTABM " ASS.Mass. 367 Main Street;Hyannis MA 02601 'OtED� ` 'Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION t r Please Print DATE: JOB LOCATION: J U j G� G.`C� 6bW number _ / stree�tj village "HOMEOWNER": U �h (/ 11 �. name < home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six,units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as 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. 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 pr t dures an r q irements. b Si a of ome wne Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. QTORMS:EXEMPTN s TOWN OF BARNSTABLE BUILDING'PERMIT APPLICATION Map Parcel V • ' Permit# Health Division �— � Date Issued 6 Conservation Division Fee ��l •19e Tax Collector -("f SEPTIC SYSTEM MUST BE Treasurer ��_ g! 'INSTALLED IN COMPLIANCE t. Planning Dept. ► � ENVIRONMEM&CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address ) �IrU a -AT AD .Village V I T o e� e Owner O� Address saa Telephone �" �'j Permit Request _ _hhreE'L CIQ.r f (olf chid- Squarefeet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 140 �P_ Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family p 6 Two Family ❑ Multi-Family(#units) Age of Existing Structure l Historic House: ❑Yes 1 No 'On Old King's Highway: ❑Yes PM No Basement Type: ❑Full ❑Crawl -��,/Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full existing I new Half: existing I new Number of Bedrooms: existing . new Total Room Count(not including baths):existing 5 new First Floor Room Count Heat Type and Fuel- 1 Gas ❑Oil ❑ Electric ❑Other Central Air: Cl Yes No Fireplaces: Existing New . Existing wood/coal stove: lies ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: existing ❑new size Shed:Ere'xisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ,❑Yes 2No If yes,'site plan review# Current Use Proposed Use BUILDER INFORMATION j Name Telephone Number .Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO r' -SIGNATUR� , DATE - i N — FOR_OFFICIAL USE ONLY - PERMIT NO. t 'DATE ISSUED4 MAP/PARCEL NO-. - ADDRESS .. VILLAGE OWNER ', DATE OF INSPECTtO FOUNDATION , FRAME I INSULATION FIREPLACE _ r ELECTRICAL: ROUGH FINAL ROUGH FINAL PLUMBING: > FINAL GAS: ROUGH -- FINAL BUILDINGtv DATE CLOSED OUT Vim• ® - ASSOCIATION PLAN NO* � + t vt Rimt , 4 The Commonwealth of Massachusetts , Department of Industrial Accidents " ��x-r; ::_-:'.. Olfrc�oflmestigations " 600 Washington Street Bostonp Mass. 02111 Vc� - workers' Comimensation Insurance Affidavit • name: J 1/ t location: hone# S city LU a I am a homeowner performing all work myself. pI am a sole rietor and have no one worldn m anv rap , / //0////////%%//O//%%/%/%/%//%/%/%/// //%G///�// 1 workin on this 'ob ensation for my emP°3'eeS....:.:::.::::::$.::.;':;;:.;.::. >:.:<. .;:.::::<:::><>;:;;;>; :;: workers comp..............::::.:::?{:::::.::•:::....:.>:::.::::.::::..:...:::....::::.:. I am an a .providing................:::::::.:::..::.::::...::::::.:::.::....::::..:... ......... ❑ ::.........:::............::.::.::.:.......... ..:.:::............:: ........:.:. ......::.:.........::: ...........::..:................::::::::::::.::::::::::::::::;.:;;:::::.:::.;;:.:::::: COM PS anv nam are a . It on contractor,or homeowner(circle one)and have hired the contractors listed below who ❑ I am a sole proprietor,gen have the following war ..........co :p.:�m,.:..s...a....t....t...o....n..... .P.:: : :.. .:: ................... ... ?:;+i:;i}:j�::`:isi::j::��;:;i:::{::{:ii:;:�i:`;:;':}:'v':'^:}:iiii�.:�+:•:?>:is????:`:v:•ii:}}::{i}i{i:':Jiii?i`:ice G::�:v}:i':i i s ij;:�:>}rii':i�:i:S:?;}i:i.ilit4'{•v::-Ti:Sv:::::.v:::::................ . .. .............:::::::::•:::.}'•}t:{{:tit:i::i}{{}:;;::r•}is4:nvp:}i'iiiit:i}:::};'ry';}{}:;{:?:{.v:::-:.:::.; as .........: .............:....:...... .,.........}}::.::.,.�.:.:,:.: ..............:.:::...........:.::.::..:.�..:::..... v.... ::.:::::.........................:............ :.............:.............:...........:.:............:.:::.. ................::,............,....::........ .:.:.... bone. .':::::.: :.;.......... ::<<::::..;.: ...... ............:w:::v. •,Avnv:.v:::nvv:S:�:}::::::::::+.::::::-•ti•}}}'••}::•tiw:•..:-.. ...:..N...... .. .........................:.............:.....::::::::::...:..:::::....:..�.. ::.;:::::::::::,::::::::::?::•;:•::^:.4::+:.:v ::::::•:n}.....v:::•::::vv::•'•.. ,4.:::C:•::::r.•...•f.:.:•v.,:..:.............,vtir.;<}.•ii:�:i;:<:`: O�IN/r:..:: :::::.:....:.;•.::::::.::::::.:::: �/ .................. ' r- a ....... ........::v::....:-:isiii:::i:?ii:?:i::;;}iti'::i}:iiiiQ:iii:::i::�riii::%i::is?::$i>::�i<+Tiiit::;:i`ii i:S::j:•i:ii}:`;iii�:i?v:ijiii$:is i':::'::i:•:-`i:^:iii::.. :. anv n ..................... ss: dr e ;. :::::.................. ...:. ..�...�:::.::............ ..:•::::::::::::::::::N:?;{•}jiffy;{:itiry{{::•}iiY�:•v:v.......... .h. ...,;.,......... .. ........... x»> oli Failnre to secure coverage as regoired raider Section 25A m of a l S2 era Ind to the impositionanda of criminal penalties of a flue to 51�00.00 and/or one years'imprisonment as weIl as eivII penalties is the form o!a STO of the DIA foWORK r�coverage v�eetiflcatlon Of 00 a day against me I understand that a copy of this statement maybe forwarded to the Office of Iavom o that the information provided above is true and tarred I do hereby fy under e p ' I G1J1�' /� Date 5 Signature O Phi# Print name olIlcial use only do not write in this area to be completed or town official by efly � • permit/liceme# ❑Bunding Department city or town: ❑Idcensing Board []Selectmen's Office ❑check if immediate response is required ❑Health Department phone#, ` ❑Other contact person• Ugvued 9195 P11U Information and Instructions sachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation fder or the* Mas is defined as every Person the service of another sa employees. As quoted from the"law", an employeein of hire, express or implied, oral or written. is defined as an individual, partnership, association, corporation or other legal entity, or any two or more o or An employerrepresentatives of a deceased employer, or th the foregoing engaged in a joint enterprise, and including the legal rep ever the owner of a g � trustee of an individual,partnership, association or other legal entity, employing employees. ow not more than three apartments and who resides therein, or the occupant of the dwelling house of j dwelling house having ounds or another who employs.persons to do maintenance, construction or repair work m such dwelling house or on the gr because of such employment be deemed to be an employer. building appurtenant thereto shall not MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or who has renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant not produced acceptable evidence of compliance with the insurance coveragrequired.erforma Additionally,ubli neither o the commonwealth nor any of its political subdivisions shall enter into any contract b resented to the contracting k until acceptable evidence of compliance with the msutance requirements of p of this chapter authority. 70011 Applicants Please fill in the workers' comp ens affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe of Industrial Accidents for confirmation of insurance CO°�e• Also be sure to sign and submitted to the Department or town that the application for the permit or license is date the affidavit. The affidavit should be returned i the i S have any questions regarding the"law"or if you being requested,not the Department of Industrial Accidents: Should you at the number listed below. are required to obtain a workers' compensation policy,Please call the Department ME M City or.Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the Please affidavit for you to fill out in the event the Office of has to contact you regarding the applicannumber. The affidavits may be returned io ure be s to fill in the permit/license number which will be used as a reference the Department by mail.or FAX unless other arrang®eats have been made. u in advance for cooperation and should you have any questions- please like to thank you you The Office of Investigations wool please do not hesitate to give us a call. zemm The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of imrestloatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 ` phone#: (617) 727-4900 eat. 406, 409 or 375 I . / The Town of Barnstable �: Services. .�MkRNS SLE. HA►SS �g Department of Health Safety and Environmental Building Division Leo►u►{ 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commission.= Fax: 508-790-6230 . Permit no. Date AFFIDAVIT HOME IMPRO_VEMENTTCC TONS APPLICATION SUPPLEMENT T 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 mom 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. timated Cost Type of Work: k Address of Work: - l J ru I U 1 I Owner's Name: J t U Date of Application: F 1 hereby certify that: Registration is not required for the following reason(s): rlWork excluded by law QJob Under S1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: LING WITH UNREGISTERED OWNERS PULLING TTHOR CBLE HOME WORK DO NOT HAVE CONTRACTORS O FUND UNDER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Registration No. Date Contractor Name 400n DatePsNme 0:forms:Affidav The Town. of Barnstable �ptHE Department of Health Safety and Environmental Services ' Building Division aAaMSTAat.E. ' 367 Main Street,Hyannis MA 02601 MASS. 9 i639. 10$' �p�FO MA'I A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: bW V" JOB LOCATION: 6-1 ,_I I� ) number itreet village "HOMEOWNER": -4 / VLS2 name j home phone work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as 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.. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building partment minim inspection procedures and requirements and that he/she will comply with said pr c d s and r u e/ments. - y ture of iiomeownffvU Approval of Building Official Note: Three-family dwellings containing 35,000.cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN AL - �ck Uj i arc t14 i m . - -�-' At Ir �3 - _ pia pV, L F LL tt/ cc ® , Q WOw0 � OCL E�Xt Sr'wc, Z-/Yj f-l-- b CCP: C3 W 0 W 0 �f � C1 � 111 oQo- a. W Q !-- to Uj O Q a Lu -jzo . � uo, c.5o © o,-- jvm z !t! cc LU Eu G l" an � d e r � � ,���� . 11 r A.u� �" a S fu V/ ��aa� tv��� wl f _ t &R-Al ��; / ,per. ) _ /i ,'" �_ •�.._—_,� 0 33 1 TL, V i—••,', /_ a � ��"- f ( t '�1 ' � / 1 n� i -t�' � ,..i 11 � � ,,..ems,.. wo ���"`=-�=_—��/.�-'��,�• �\. �� � ,` !1 ;fin• /.1 ��` wn : 09 , / wn �:�---••-3t,44 d�ram., •\� \ �� -•,\ ,urn -\_/� .::. r, 110le r 15 6-1 , iH It wa , • wL..�' I '• 92 � � •a8 ini •IIA j �`\ O ,8y _� Div ,� 1 � :•} ' `�\\ `�; in �\ 8 , \ 83 \ � ,�• yam' 1 we « 36 ' '� 1 6p / \\ 10 we wil 120 SO 14i 'I' . ' I f • 4 '62 \ \\ den / ��a ,, - j 1 ,� pg'g •\\ `� j'/ ar 'I { t 71Z, r .^ ;"�` \\ ��;'r���,_ 1. �;� ``3*� ' \\•n ,} / ,—,,,,� .,\ `•,�,\ '} ,\s� ._J j� 63• \ \\\ `• \ j` .« \ do '/-` �.,nlo`�' 1 I t � � n ��"�/ t /,/, •r� w6 / il'`,1\ /, �._._ \\1\ \\` w«1.54 77, Oil jk 65 v 1 �� •n �i 5 // J\ \ •\ \•n i� '\ 12 / IWAP ,.f 1:1/ice�\�\,.�-- =j/ i, E„� ti.-•--�-�'.`\\i W j �\_: •—\ `'F;� \`V `.. t•I ,y'I owe w4v t wit In NN- 10, we Jam../ _ ,f ; �. r r ^� :r`•�� lOg `\\ \�,`\\ `•,� `\ l �` we lei /lam: // Vora` .\✓ .. 110 — •,._„\1� \ ` �t \ i \` j/ Y14 24 \ -.\ D, r• we 21: we A 92 xn 38 t gin; we 117 Yc / % 36 I a (60 �. Ana k 1�0 \ l Y 1-21 Ike -624 / A» - .••1/ IS '; ;b2�—`. `r��!:\ a \ \ � , Jam/ /� \\\•�,` p we 134 1301 "^�C�on 64, i if �•� �:`; 1 a`, _.,' Aa it \ ;"\t ;` �.. •,�.( :,.. J / \` : o/ \ ram:: /,. 75 �.�In` 4 • � f, rr 1�A ` �`v�l , 't Y MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1-or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-26-2000 DATE OF PLANS TITLE: COMPLIANCE': PASSES ` Required UA =1 101 Your Home = 90 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA =3= --------------------------------------------------------------------------- CEILINGS 336 30.0 0.0 12 WALLS: Wood Frame, 16" O.C. 534 13.0 3.0 38 GLAZING: Windows or Doors 42 0.400 17 DOORS 20 0.350 7 FLOORS: Over Unconditioned Space 336 19.0 16 COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate , has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer - Date t ' k MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 5-26-2000 Bldg. . Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location -WINDOWS AND ,GLASS DOORS: [ ] 1. U-value: 0.40 For windows without labeled U-values, describe features: # Panes Frame Type + Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ l 1. U-value: 0.35 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed_ lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a .0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: IA Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service .water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: # [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air. and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall--be provided. HVAC --- HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4. r MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ---NOTES TO FIELD (Building Department Use Only) ------------------------- r } - 1 k 1 °>o TOWN OF BARNSTABLE Permit No. --25879 Building Inspector cash 'Oe •639 a °- OCCUPANCY PERMIT Bond `' Issued to Idar Acres Realty Sr,l. :address 4 putterquL Circle Co u_ '- Wiring Inspector f — -- Inspection date f Plumbing Inspector ,�^ / Inspection date �l Gas Inspector Inspection date Engineering Department Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 1J........... ................. --------- .�`......Builcliiia...Inspector _.. .......... ��•.° '°°.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT i �aaasr = TOWN OFFICE BUILDING nut HYANNIS, MASS. 02601 '�o rnr MEMO TO Town Clerk 9 FROM-: Building Department DATE': tune 10, 19.8.5 I' An Occupancy Permit has been issued for the building authorized by • - Y `:� 4 Building Permit #.. .............. 25879 »....»........................................................................... »»»» Cedar Acres Realty Trust issuedto ... .......................».•.._......»......». ....................... . .................»................».....»....»... .. Please release the performance bond. to ' .. •.. ,-,,_ ,:' ROBERT RAYMOND• CY No.21583 Al o •o � I uj F . IL tijo �-- x W � cNI' t }W LL Q TV lu Q � (D ; • •-- - . . . Asa w �'�.. ' t ZZ, a " may zui 'tu _' q�• _ � *�«�� .. ref+a°F+r' '+. 42 Li jr . t i 4..o sA, Assessor's map and lot number ...�i ... .�..��.-...�®� , -�..-' .. ................ THE ` Q�pi Tp1` fa - { ' Sewage Permit number .:.................... ...........a.'F�.....:..:............ d .w yt,►4j Z 111AMTADLE, i House number ............................!....... ............................... 9 MAO& t639- 'Ego?MPY or TOWN 'OF BARNSTABLE BUILDING ' INSPECTOR Construct APPLICATION. FOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION Wood Frame r.�. ..........................................19...; TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lot 34 Butternut Circle, Cotuit, Ma. Location ....................................................................................................................................................................................... Residential j. Proposed Use ...................................................................................................................................................•......................... ZoningDistrict ..................R.C.................................................Fire District ......... r'n+,,, , ..................................................... Cedar Acres Realty Tr. 24 Great Pond Dr. , So. Yarmouth, Ma. Nameof Owner ......................................................................Address .................................................................................... M same Nameof Builder ....................................................::..............Address .................................................................................... Nameof Architect ....................NSA......................................Address .................................................................................... Number of Rooms ............5 .Foundation ,•Poure�dCOnCrete ........... ........................................ .................................................................... Exterior cedar shingle .......Roofing asphalt shingle .............................................................................. .................................................................................... Floors plyweod .......Interior sheetrock ............................................................................... .................................................................................... Heating ..... F'HW=teas ° i. ...Plumbing ..:....1 1/2 baths.......:...................:.................. .........I.............. ........ . ....... .. ....... ..... ....... r Fireplace one.....................................................................Approximate Cost ..... 5. .O.0............................................... Definitive Plan Approved by Planning Board Sept. ` 21_________19_73 Area .......................................... Diagram of Lot and Building with Dimensions Fee ..................................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. CONST. SUP. L1C. 016681 ` x Name �' ,.::.... .............. CEDAR ACRES RE LTY TRUST A=40-102 19-.r40 - Iva No P16rmit *r .......... tt ...........Single...Family Dwelling 11 i!��j........ `7 Z............. Location 34.c....... � .. ...................... .. .. ..C.±.. l e Cotuit .........................................................................1 Owner ...Cedar Acres Real.t..v Trust ......................... .Type of Construction ......:FX:A1AQ....................... ................................................................................ Plot ............................. Lot ................................. Permit Granted ...Pec.emb.er...1.5........19 83 ..December Date of Inspection ....................................19 Date Completed ................................19 PERMIT REFUSED ....................... .... 19 . ............................ .................................... -Z I ......I ler.0. ............ ............................................... .................................... . . ... .. ............................ . ... . ... ....\.— .................................... . . .. ... ... ........................ Approved ......... 19 ............................................................................... ............................ .................................................. r �Q o Assessor's map and lot number ...... ..._.....1.. . ....... .... p�*THE qSewa a Permit number t ..` 6/.................. ' s a@ d 'NST LL.ED Si r- B 9 LE,Z AHB TAB i.r House number ....................................y......................... W;i K i 90o rb 9 TOWN OF BARNSITA-RL4'Kj� .- BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................Construct.................................................................................... TYPE OF CONSTRUCTION Wood Frame ..................................................................................................................................... :r ........ .................19...? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lot 34 Butternut Circle, Cotuit, Ma. Location ....:........................:.......................................................................................................................................................... Residential ProposedUse ...................................................... .................................... ........................................................ ZoningDistrict ..........C_().t�.li.t.................................................... i .....:.:........::RC.................................................Fire District Name of Owner Cedar Acres Realty Tr. Address 24 Great Pond Dr. , So. Yarmouth, Ma. ....................................... ......... .................................................................... f. Builder Same Name o .............. ............................ ....................Address .................................................................................... Nameof Architect ...................:NSA......................................Address .................................................................................... Number of Rooms '.. :5.........................................Foundation ,.poured. ...concrete. . . ............................ .. .. ....... ....... .. edar shingle asphalt shingle Exterior .......c...............................................................................Roofing .................................................................................... plrywood sheetrock Floors ...........................................................:............Interior .................................................................................... t�!?lA�-Wrr?C. �... L.G tL.11i .Heating ......:`:.. ::..:.J. :........................ ....................Plumbing ......L..:�/..� ace .......Fireplace ......:............ p o .......................................................Approximate Cost ..... 5.1. .0....................................... Definitive Plan Approved by Planning Board _Sept.___21_________19_73 Area ......� ?.2,?......'.......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r\ 101 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. CONST. SUP. LIC. 016681 Name .......................... ........................ CEDAR ACRES REALTY TRUST - 125879 One Story No ................. Permit for .................................... s Single Family Dwelling ............................................................................... Location .TaA k... .44......^ -- i.x lea Cotuit 5 / 9" 16t Owner ...Cedar Acres Realty..Trust ..... ......... Type of Construction Frame.......................... YP ..... Plot .� .... r, .:..:... Lot ................................ December 15, 83- Permit Granted ........................................19 4 r Date of Inspection 19 Date Completed ....... -5..........19 PERMIT REFUSED s. ,_ ............................................................. 19 ............................. ................................................. r ...........................................................................a.... S ^ .......................................................................'..... S 4 -J J Approved ................................................ 19 . ............................:................................................:. ::.................................................................. ..i