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0173 THANKFUL LANE
�>3 �Iior�/s�'...1 .G1 . rt Application number... p P_rl ® Date Issued...... . t..r/ . 5 ... ice' q, � Building Inspectors Initials..........may. �,�'� .. � - A.. ............ T %!N 0� bA8NS f ABLE a.. ' '......dQ,3..... Map/parcel........... ..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ��3 �l�ivi� cUlr U . NUMBER STREET VILLAGE Owner's Name- di S%�!�L�< -CfgZjae 'phone Number - i Email Address: C4 vl C-%cCo n., CeaoA/Wc,h ofCell Phone Number Pr dect cost $ j Check one Residential !/ Commercial OWNER'S AUTHORIZATION y As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK r1 (—.1✓, Sliding 0 Windows (no header change)# 0 Insulation/Weatherization Imo' Doors (no header change) # I Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to `t_ ►/L,esLc- STJa� CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # (attach copy) r Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD-OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER...................................................�...... *For Tents Only* ,f Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent_X. X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number �� �D3�l� (/ f Cell or Work number ©3 (r� G��y I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. f Signature Date PLICANT'S SIGNATURE Signature Date �o All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 f,- wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly C�Name(Business/Organization/Individual): <C-. - Address: City/State/Zip: 61h7V I ? one#: 03 yJ 61ulf 1// 61(0 6I' Y ' Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4.0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7..❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor in an capacity. employees and have workers' Y P tY• 9. ❑Building addition /[No workers' comp.insurance comp.insurance.$ quired.] ` 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. - right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other 1 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do h reby certi nder the ppainhandpenalties of perjury that the information provided above istrue and correct. Si afore: � Date: ,Phone#: ' F use only. Do not write in this area,to be completed by city or town official Town: Permiti'License# Authority(circle one): of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#: . 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 employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: • . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 640 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#61.7-727-7749 www.mass.gov/dia Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-39870399 8/31/16 SEP 0 6 Lo16 TOWN OF BAR) j fASL Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 16-2242 Dear Mr. Perry This affidavit is to certify that all work completed for 173 Thankful Lane,Cotuit has been inspected by a third,party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey i 9 1 R TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 039 Parcel 0 Application # as Y Health Division Date Issued O 1 '" `6 � Conservation Division Application Fee Planning Dept. Permit Fee `J Date Definitive Plan Approved by Planning Board (A� Historic - OKH _ Preservation/ Hyannis Project Street Address L3 wa . ,��,� Village Owner e C .c Con e. Address 5 o► nt Telephone II I 1 p Permit Request Prd �� �9 ��et} s �'a -fkG 6areaei4o �11 1k e +a tr c_ cA c f G c i eA, Ae. o4 u,A e- 1�- 16oufft, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5 Oro 6 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) a1-4 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King Highway.—Q Yes, ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) v A Number of Baths: Full: existing new Half: existing n rn 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: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name 1 la aok°i Telephone Number S re g 4 R 3 Address License# Oot 7(2 Y�Wmazrk 14 0166� Home Improvement Contractor# Email Worker's Compensation # s�1OII a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO of fm e 1 h SIGNATURE DATE A FOR OFFICIAL USE ONLY ` APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: - FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. y N o�s"Eigti ON To . of Barnstable o o qu atory Se ces Mc6krd V.S ali,D rectur 16y; `loin Perry:Bu.Id ug C�IA1=*SiUucr 204 Ma u'%t O Ilywiais, 02601 hvaq�vn:barnstal.c ma,os Office: 508=862=!1Q':8 Fax- 508-/00-6?s(: f . . Property OwnerMust Complete.and Simon This 'Section: �f�7srn� A�u�lder "IS 0m,ier of die subject propert hereby authorize.. co ace oa nay behalf; in.all matters rc-,6 lb work authofiwd this b= c3iap peiauit application for: . r {Address of Pool fences and'alarms are the respom b.il4 of the applicant. Pr 015. are not to be filled or qt Upc,d bc.fc re fcnce is installed au k all ffinal sp ct o s arc w ed and - .ce.epta 01, Signature.of er Si, atlzre.of:Applieai�t. Pent_Name . I'iuc:Name_ Date+ Q;E3RI4Sio11'!.'FFTf'3RT.iI�SiOTIY(3()1:.5 � i r. . , I ACORV CERTIFICATE OF LIABILITY INSURANCE DATE cMMIDDIYYYI) 4/12/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETNEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE.OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the:policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms.and conditions of the policy,certain policies may require an endorsement. A.statement on this certificate does not confer rights:to the certificate holder In lieu of such endorsements. PRODUCER CONTACTRisk Strategies Company NAME: Risk Strategies Company ac° (781)986=4400 FAc_Ne c(761)963.4920 15 Pacella Park Drive aT pO RlEsscrandolphcld@risk-strategies.com Suite 240 r• INSURER (S)AFFORDING COVERAGE NAICS Randolph MA 02368 INSURER A:'Selective Ins. of America INSURED INSURER Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERC:S.tar Insurance Co 7 D Huntington Ave ` " INSURER D: INSURERE: - South Yarmouth MA 02664 INSURERF: COVERAGES CERTFFI@ATE NUMBER:CL16412.11375 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR,.CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE,TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDL SUER - - - POLICYEFF POLICYEXP LiR- TYPE.OF-INSURANCE POLICY NUMBER.. MM/DD MMIDD LIMIT'S ....... . X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000- A CLAIMS-MADE �OCCUR PREMISES Ea occurrence) $ 100.,000 x $1994450 i0/16y20i5 10/16/2016. MED EXP(Any oneperson) $ 10,000. PERSONAL&ADVINJURY $. _ 1,0.00,00.0: GENL AGGREGATE LIMIT PP_PLIES-PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY I JECT E-1.LQC r • 9. PRODUCTS-COMPIOP AGG $ 2,0:00,00.0..- OTHER: $ AUTOMOBILELIABILRY O BINEDf SINGLE I' $ 1,000,,000 8 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS AWRA46796600 11/6y2015 11/6/2016 BODILY IN,AJRY(Per accident) $ . - •. NON-OWNED -• PROPERTY'DAMAGE.rx HIREDAUTOS X AUTOS 4' Peraccident $ X UMBRELLA LIAR X OCCUR EACH.OGCURRENCE $ 1 000 000 A EXCESS LIAB CLAIMS-MADE r I. . -`« AGGREGATE $ 1 000 000 DED I X I RETENTION$ NIL 91994480 • - 10/16/2015 1.0116/2016 $ WORKERS COMPENSATION, - Officers IncluQ.ed for r •' I .'r1 �x 'PER - OTH-- - -- - AND EMPLOYERS'LIABILITY t G STATUTE ER ANY PROPRIErOR/PARTNERIE)ECUTIVE YIN NIA Coate;age - E.L.EACH ACCIDENT $ 500 000 OFFICERIMEMBER.EXCLUDED? C (Mandatory In NH) .- UCOSS540.700. 4/9/201.6 41.9/2,017 E.L!DISEASE-EA EMPLOY $ 5Q.0-000 If yes,describe under tt'' '" - " - DESCRIPTIONOF OPERATIONS�below - -r' '. , ^+ . .. E.L.DISEASE-POLICY LIMIT $ - 500,000 DESCRIPTION OF OPERATIONSI.LOCAT10N51 VEHICLES(ACORD 161,.Additional Remarks Schedule,may be;attached1rmore spaee:ls required) - National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included a,s Additional'Insuieds with respects to the'General Liability coverage of named insured as required by written} contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation ' THE EXPIRATION DATE THEREOF, M0710E WILL BE,DELIVERED IN Cap® Light Compact ' ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 460 West ixlain Street ( .- � AU HORIZED:REPRESENTATIVE Hyannis, M* 09601 Michael Christian/CLG '` �' �`� " a _ 01088-2014 ACORD CORPORATION. All eights rasoNed. ACORD 25(20.14/01) ~` - The ACORD name and logo are;registered marks of ACORD- INSg25:(zo.401) The Commonwealth of Massachusetts _ Department of Industrial Accidents 1 Congress Stree4 Suite 100 Boston,MA 02114-2017 pv www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name( usiness/O.rganization/Individual):Cape Save Inc Address:.7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employerwith . 15 employees full and/or, art-time " ❑ : ( p >� 7. :Q New construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ 8: ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.M I am a homeowner doing all.work myself.[No workers'comp.insurance required.]t 9. El Demolition Q' 4.❑;I am a homeowner and will be hiring contractors to.conduct all work on my property: twill, 10 Building.addition ensure that all contractors either have workers'compensation insurance or are sole 11.[:]'Electrical repairs or additions proprietors with no employees. 12.®Plumbing repairs or additions . 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.r-1 Roof repairs These sub-contractors have employees and have workers'comp.insurance 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.2 Other Insulation 152,§1(4),and We have no.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 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.polity 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:. Star Insurance Co. Policy#or Self-ins.Lic.#: WC085540700 Expiration Date: 4/9/2017 Job Site Address: 173 Thankful Lane City/State/zip:Cotuit Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration.date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-yeas 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.A,copy of this statement may be forwarded to the Office.of Investigations of the DIA for insurance coverage verification. 1 do hereby ceiWfy under th ,pains and penalties of perjury that the information provided above is true and correct. Si_ atum. Date: 8/4/16 Phone#:508-398-0398 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#: 4 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5.170 - Boston,Massachusetts 02116:,. Horne Irnprovemem,- on factor Registration � . Reg�stratlon 171380_ I a Type. Corporation * Expiration: 3/14/2018 Til 41. 291. CAPE SAVE ING WILLIAM McQLUSKEY ;f g 7-D HUNTfNGTON AUENUE SOUTH YARMQUTHI MA 07664, s " w W � Update Address and return card Mark reason for change. Address Renewal Em to went . iost.Card ❑. 0 px SCR 1 0 20M-08hl 0f a C�QQllt111697LL/CCLt'.l�Q�C�/�t/QJJLLCfatl„C� _ - ,- f ce of Con sumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date :If foundireturn to = Registration j713ga Type:; Office of Consumer Affairs'and Business Regulation r Expiration 3/14/2018' Corporation 1'Q Park Plaza-Suite 5170 ' Boston;.MA 02116 CAPE SAVE INC WILLIAM McCLU,SKEY 7-0 HUNTINGTON AVEN E SOUTHYARMOUTH,MA U2664 Undersecretary 'Not vslid' i signature . Massachusetts-Department of Public Safety / Board of 8uiiding Regulations and Standards 411111111i1L11711 JLLIIC/:Y Ili11 JIi4L1A_il V' License: CSSt_102776 WILLIAM J MC 0U ,�- 37.N.AUSETROAD i Mtls: West Yarmouth I%A Expiration. Commissioner 06128/201.7' TOWNiOF BARNSTABLE BUILDING PERMIT APPLICATION /? rL, Map U Parcel = Application# N � / 7 Health Division. Date Issued Conservation Division Application Fe P Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis fv Project Street Address - 173 T ANeFUL LArw Village r-.07y►"r Owner Ca.frt � caryt;& 66cone, Address 1 73 Law, LOE(r 07_63S Telephone (c 0 3401(0 —(00 Permit Request 4PD 754-7'-k1aVVM Cg7&ln, /1.�,/1j AD/0- t/7cke4l 6dVII,16qr 1,51- e/X/C Square feet: 1 st floor: existing nV s�r posed 72nd floor: existing ?3259p posed Total new Zoning District o�t7 lood Plain Groundwater Overlay Project Valuation D Construction Type DU�JdtL� kc�f. z Lot Size GZ ' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0/ Two Family ❑ Multi-Family (# units) Age of Existing Structure IRS Historic House: ❑Yes Qa'No On Old King's Highway: ❑Yes eNo Basement Type: 53"F'ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 6 �R Number of Baths: Full: existing new Half: existing 0 new 0 Number of Bedrooms: ) existing Pnew Total Room Count�(not including baths existing new First Floor Room Count Heat Type and Fuel: R(Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes YNo Fireplaces: Existing I New Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: iexisting ❑ new size _Shed: Ifexisting ❑ new size _ Other: --� U. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes LAo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) kq f Name Cal- - ClceoNe_ Telephone Number W3 Address 113 f�wk�iL Lane_ , ��+r 02435 License # Home Improvement Contractor# Email QF[0 cco rre, ®eCuv-t 1 i n k<n y fi Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Samsfy6tv gfg Wog ni Main kilts N SIGNATURE C DATE FOR OFFICIAL USE ONLY `APPLICATION # i ,DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE ,w OWNER f �r DATE OF INSPECTION: a ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. - i- �' F i A i E Cowraoi'E}l MM of Ma£wdrweif5 De whwent of radustria t Ar ud xts f i -ce t .S 600 Wasldugon Sitreet k Bastont MA 02HI r ' �rt�l.masgtrnfifra: - - Warkers' Compensa tim Insurmce avft:Buflders/Cmtz=hws EIecbricianslFlmmbers Applicant InfOT'IlIatign Pl@ase Print Na=MUSM Addresw A3 Vn n k�v` . L A (�evl-fi MA , eifyfs t p �r 0 2(03r Phone� ' 3 �O �� � Are you an mployer?Check the appropriate barn Type of project(ram: LEI I am a employes with, 4 ❑I am a general contractor and I 6. ❑New wag employees(fiff andfor part-fiime).* #tee lvred.the subs contractors 1❑ I'am a sole prop etni orpart w Tisted onthe aftsched sheet. 7. ©SIemodeHng ship and have no employees. These sub-contractors have 8- ❑Demalifioa wairing forme is any capacity emlyloyew andhave wodcass' E NO 'comp-Msarmce, comp.inn 1 araw g- ❑ n.Building addition 1 5. ❑ We are a cogxnation and its 14❑Elechical repairs or aeons -3. I fiameou�er daizig au VM& ofiaoers have eescssad their 1 L❑Phumbingrepairs or adclitims myself[Na ems'00MF- right of exemption per MGL 11[]Roofrepairs irm ms=mod-]i tw 15Z§1(4} andwe have no, employem[No wodoess' 13-0 other cow insurance required.] •Any"y5co"i'stcbecUbasFl-stalsof0loutthesectionbalaws�kgtbeawoziezeco=pmszt; policy l ameoaraers arho submit this affldnt=&csfag they axe doing all era*sazl then ham ouw&cant remc wast submit a new afdaeis mdirwiv sudL fC'amxaetors fwt checl'flds bus mast attached tot additiffia1 sheet sbasaxgthe name of ft sub-c=t ms and swewLegm ornot those eatitinbR%m employees.Tftbesub-conmu±share emplay�s,ifieY pmvAe their=dEm'=uR policy mimhor Jain an eutpiaper Heat isprm�dircg tuorkers'caeerperesairirrt irtsurattcs fcr eaty aurPtn3ee� Belvev is Iles ptr�cy a�¢d jQli situ iriformaliars y , Insurance Company Name Policy�4*1 or Self-in&Zit.;�: _ F�pi a Date: Job Site Address: M CetylStawmp: Attach a copy of the workers'comapensationpolicy deciaration page(shouisg the policy m ruber and expiration date). Fail=to setae coverage as requiredunder Section 25A of MGL c.M can lead to the imposition of c rninai p ns ies of a fine up to$1,50a OU andlor one-yearsmprism=esd as well as civil penalties.in the fog of a STOP WORK ORDER and a$ne of up to$250-00 a clay against the violatm Be ad dsed that a copy of this statetned maybe forwarded to the Office of Investigatiom ofthe DIAA for fi=mce coverage verification.' Ida hereby c air s pmahim ofgerjrury that flee iaforma€zm pemidrrl ahmw is b are and correct iyiEaatQre: //' (�/,q Date: (j Phone ig afYcia[use wily. Do Ant write in arms area,tar be t mxpWad by chy artr►tr-n offs rat City or Tos€ez: Permit tense-4 Lssui g Au&or€ty(tom trace): L Board of Health 2.Buff ing Departramt 3.cdyirviwa aerk d.Electrical hmpecto€ S.gybing Inspector 6.Other Contact Person: Phone-9: 1haformation and Instructions hfassacIr ceffs CTc= l Laws cbapt�r 152 requires all=ploy=to provide wo6me compensation for their employees. PMM=atto this st&nte,an=47Ivyee is defined as'�.every peon.in fio=vice of another under airy cmftm t ofhir., egress or implied,oral or wriitea." An errpIaya is deed as`an filth dual,pa¢inersb�,association,corporairon or other Legal entity,or any two or more of the foregoingengaged is a joint eoter�,and inclndmgthe legal�e�es of a deceased employer,or th o ee refvear or trustee of an individual,part=ship,=Dciabon or other legal eoiity,employes exoploy=s- However the owner of a dwelling house hav iag nat more than three apa dme=ts and who resides thamio,or the occapant of fhe dweM g house of moffi=who employs pm=w to do mace,canstr azdan or repair wmc on such dwelling house or on the grounds orbm mg appza�therdn sbaUnotbecanse of sack employmentbe deemed t o be an eoployer." MI GL chapter 152,§25C(6)aim states that every state or IocaI Ucensing agency shall wrthhold the issnan ce or renewal of a license or permit to operate a bIIsmess or to coast Tact bwj&ngs is the commonwealth for any applicantwho has notprDcluced acceptable evidence of corupltamce with the hmurance.coverage regnired-" Additionally,M(M chapter 152, §25C(7)sites-Neither the comm cmweal&n.or nay of its political subdivisions shall enter mto any contract for the pmf z:mz=ofpublio wait unbl acceptable evidence of compliance with the insormc-6._ requirements of this Chapter have been prssestrd to the g MAontYf Please fol oil the wormers'compensation affidavit completely,by chec n +'he boxes that apply to your situation and,if necessary,supply sab. idractar(s)name(s), addresses)and phone mtmber(s)along with their certcHca(s)of n=ance. Limited Liabi-Uy Companies(LLQ or Limited Liability'Partae�brps(LLP)w>ihm employees other than the members or pmtacrs,ale not req�ed to cry woricexs'compensation;n r^m^0p If an LLC'or LLP does have employees,a policy is required. Be advised that this afdaYit maybe snbmitfed to far Department of Iudnstrial Accidents for confimation of insurance coverage Also be sure to sign and dab--the affidavit The affidavit should be r eet=ed to the city or town that the application for the permit or license is being requested,not the Department of Iudastrial A=d=ts- Rouldyon have any gnestions regazdmg the lave or ifyou are reguired to obtaa a worms' compensation poT Cy,please call the Department at the numbez listed below. Self-insured campanies should ear their self-T:�ce license numTnr an the approp¢iate lore. City or Town Officials Plewe,be sore that the affidavit is complete and pradedIegmly. The Department has provided a space at the bottom of the affidavit:for you in fill out in the event the Office of Inves6gat tom has to con aLtt you regm-dmg the applicant Please be sort to fol in the pen it cease number which wdI be used as a refezemce number. In addition,an applicant that must smbmit multiple pen WHceose applibaticm in any given year;need only submit one affidavit indicating dent policy inl nation(if necessaiy)and under`Job Site.A-d&c s"the applicant shor-Id wr11-"all IocatiLns a (CitY Gr town)-"A copy of the•aff davit that has beca officially stanped or mmkDd byAe any ar town may be provided to the ' applicant as proof that a valid affidavit is on file for fabz pe nits or licenses A new affidavitmnst be filled out each year.'giThe=a home owned or citizen is obtaining a License or pc=nitnot imlatcd to any business or commezzial veotu e Cie. EL dog license or permit to b=Leaves etc-)said person is NOT regaa-cd to complete this affidavit The Office of Investigations would like to th;mk you in advance for yam cooperation and should you have any qnestious, please do not heshate to give us a call The Deparimenfs address,telephone and faz number- - 'a CGMMM_W�of Massachn-Mm- ent cif Xnds -ia}Accidents ==of llr�fl= C04-Waaaqban ' BEM 0�1II Tf,-L#6I7-727-49W cat 4-06 Q.r 1-a77-MASS Fax#617 727'74-9 Revised¢24-07 WW maz�uu�f din 'down of Barntlble Regudato A rp Services $ftcbard V.S=H,n%=tDr . Tom Pertly,$fig =ALAM 200 Mda StrM4 MA 026o i wV Feg S08-790-MO . Of 6cw. 568-862403 8 . Pjp�p�gLQ'�SI�TIDN 1. % 'Pte7sePtint . C��� 6o� � b®ephomc T' ' 173 � C- ��/C. C07v f C 02�gg� GAnD�s: 2 fo ea r`�omwne ' Was ceded inclIIaa owarr-occzUied dweIIiaes_of siz tmiis or less and is alto The cnarnf ��own.Grs to engage as ineiividnal fir hirewho dins notpossms a H=ase,gtovided f[zatthe ownm ads as supervisor. n�rr osgo Pemn(s)V&D pros a.prof land oawbichhdsberesidesorinum toresid4 abwbiohticis sm nsbs�Ge {gyp dweUmg,stud or deiscl�ad st=nc(nzes arxessarY to sorb use and/or fiwn s- . A p Mid on a f bomc is atwo-yt=pcs�d shalt natbe Ahm� ors S'=h� d'.sbaII seta fae Bm aat bdaba shall be r�cpoaszbla bran sack wa�cv��Qadrrthebm7a p acccptablr,to the Bing Of adA . f 109.L1) , gncd`,�iezaaowned�'assames resprmss�bildp for�lia�w&ft St&,BuRdmg coda and otiie[amicable wars, bylm .rnlu ter' t $atTidsba ids ft Tom mtBamvb4z Bulmg DTmtmztw==nzspcdl ho 1 aadtheds]�cws"ll complpwi$isffidgrocpres andr �- • Appeal afBm7dmmgf}�dal - ' • Not_ Thrca-fly dw�V mmtahg 35,000 cabio feat m IaLgcr wiIlbe rimed to PiF wiffi BDr7din Sedian>Z7.0 Conatrnrknn CaotmL gp3+�oWI�B s K be e ll xam etformiag work for winch a bm�Pam rid sha 'Tfie CCAaC sfatrs t aAaY hanaeowner p of eons•[rartion isors)�P fbatif file Iiomeo� foam fhe praddons of this secfi— (Sec nn 1091.1-Liceasmg that each Homeawnrr shah net as sape�r- " engagzs a gctso�s)for hire tp do such worwork, sre-er=bmg t31L respoumlMitirs of a.MPM' i Many homeowners Who use$ris a mptioa a� are �' This Iark of awareness o$ (sea�pra�c 0.P Ies Rti Fafmas for Licensing Cons(rac�a S`aP O�S °n In��oIIr Board cannot resaita in serious problems,p=fienkdywhen fficho=wwner'hats mT=msed pem pxuc=d agamst tb.e trnl'roeased P=soa as it would wiffi a ficeased Supa v sor- The.homeowner acting as SuPer�is umh ately respoasr'bie. maap Cmm>a��req�as Part of f T,)casra a f-E$r a homeowner is wy xware of b i%rmer rMpanAh ands ds fie m=m--�+Mf=of a Super`dsor. On flee Iasf pit aPP = Oa�fhat Eric homeowner crrfifY tiiathdsbc �P of ffiis as¢e is a form eurrentEj,tsed bp.sereml tnW=L Yon rasp care t:wTmm and adopt sach a fnrml=tjT=ztiDn for D your camsanztltY- prm�fr�sl Br-Risad 06i313 • �`/ .I� --- V��V� WWII G' Ij •..' • - ., MAP SKETCH ADDENDUM Borrower/client CICOONE' CARL & CARRZE Property Address . 173 THANKFIJLL LANE city O(7I'[.TI`1' County BARNSMLE State MA zip Code 02635 Lender r BUILDING SKETCH ..:...:...:...:..:.......:..:...:... L m. F ...... :...:...:.....:...:...: ..:.......:. .........:...:...:......: : . . ..:...:...:..........: ...:...:...:. ............... ; , . . . .. . . . . . . . . . . . . . . . . . . ..: :.......... 1 ...:..:...:...: .:.:...:..:...:........................ ..... .:...........:. ......................,.. :. .. . . ...........:..:.. ... Tj ` . . . ..:..:...:..................... .. • . . . . • . - - . . • . . . . . . . . . . . . . - - — ......-•---. w . . . . . . .. . . . : .. -- ..... .. ..... . . . - .:...::.:..: ........... . .} }.. i...i.. .....: ..........i...:......;...:...:.• "..:...:.....:..... i Town of Barnstable *Peru#,---R cc, So 7 YC'f Ezptres 6 oaths from Lssue date . Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CEO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508490-6230 M- RESS PERAUT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number () - V Z Property Address 1 /7 residential Value of Work Minimum fee of S25.00 for work under$6000.00 Owner's'Name&Address_ Xwe Contractor's Name Telephone Number•1/70 Horne Improvement Contractor License#(if applicable)� � Construction Supervisor's License#(if applicable) UWorlonan's Compensation l mmmce Ch one. P 1 I am a sole proprietor MAY — 6 2008 I am the Homeowner ❑ I have Worker's Compensation Inura snce TOWN OF BARNSTABLE msurance Company Name Workman's Comp.Policy# 7opy of Insurance Compliance Certificate must be on file. 'ennit Reques check box) Re-roof(stripping old shingles) All construction debris will be taken m ❑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 pemdt does not exempt compliance with other town department regulati i.e.Historic;Cop3etyation,etc. Property ***Note: P Fes'f the ooe t signr proper Contractors License iswner Letter of emssirequired.. ^— IGNATM: 1 :Forms:expmtrg �` The Commonwealth of Massachusetts ` Department oflndusir d AdcUm& Off lce of Investigations 600 Washington Street Boston,MA 02111 'A"-mass gov/ilia Workers'*Compensation Insurance.Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Infarmation Please Print Legibly Name(BudUess/or tion&dividuat): � �� ///�/l✓��/ � -Address. City/StateJZip: EPIone.#: Are you an employer?Check the appropriate bog: -Type of project(required)% 1.❑ I a employer with • ❑ I sun a general contractor and I 6. ❑New construction . employees(full and/or part;time).* have wed the stab-contractors o. I am a'sole rietor or partner- listed on the-attached sheet: 7. ❑Remodeling FroP ship and have no employees These sub-conrzackm have g, 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers'comp.insurance camp.MsM '# required.] S. [] We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I tun a homeowner doing ell work officers have ehxercised t I I.[]Plunking repairs or additions raysel£[No workers comp. p 12.❑Roof repairs insurance required.]t em ploy .[ and or have no ..13.❑odw • employees. es.[No workers' . comp.insurance!!!SW red.] *Any applicant that checks box#1 must also fill out the section below showing their workus'compensation poUcY infarmatim t Homwwaea who sublot this affidavit indicating they are doing all work and t tat hire outside contractors must submit a new affidavit indicating'such. tc6nuaetm thetcheck thisbox must attaehad ma additloaat sheet showing the nm ofthe subcontractors and state whether arnot those entities have employ=. lrthe sub-contractors'have aMloym.thaymustptwido their workers'comp.policynumber. I am an employer that is providing workers'compensation insurance for my employee& Below is.the pokcy and job site inform"Won. Insurance Company Name: Policy#or Self-ins.Lie,#: Expiration Date: Job Site Address: / ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Faihre,to secure coverage as required under Section.25A of MGL c.152 can lead to the imposition of crim irwl penalties of a fine lip to S 1,500.00 and/or one-year impristmunent,as well as civil penalties in the farm of a STOP WORK ORDER and a fine ofu p to$250.00 a day against the,violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for hmp aoe co—M-9e verification I do hereby ce the p pen of perjury that the information provided above.is true and correct Date: _ officfal use only. Do not write n is area,to a covwIdedAY city or town 001cial City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4:Electrical Inspector 5.Plumbing Lisp ector 6.Other Phone Contact Person: #• .71 �1ae1°amnnoouuea� o���aaaac`uc�etrfa- :,.. _" >I3oal d of 13uildingResulaEio(!sand Standa!ds. } License or rcb!stratlon valid&mdivEdul use only DOME IMPROVEMENT CONTRACTOR ` before the expiration date. If found return to s Boardof Duilding Regulations and Standards -Registration 11,4813 One Ashburton Place Rm 1301 , Expiration �.0/27/2009 Tri# 26085i c z �- Boston;INIa.02108` a J.ype: DBA, . . JAMES D DANFORTH iREMOD j r JAMES DANFORTH x _ '-j r! • { s 1105 OLD POST RP ` 'I —tag ;OTUIT,MA 02635 Not valid�vithout.sig ture -- Admini .iator 3 �� ,l ESTIMATE James Danforth P.O. BOX 973 COTUIT, MA. 02635 (508) 420-5131 Carl-Ciccone 173 Thankful Lane Cotuit, MA. August 11, 2007 Roofing work to be completed as follows. Remove the existing roofing shingles from entire house and garage roofs. Install 8" aluminum drip edge at the roof's gutter line. Install ice and water shield 3ft. up onto the roof. Install 151b. felt'paper over the roof sheathing. Install new vent pipe flashing. Install an Architectural type roofing shingle, using a 30-year Certainteed Woodscape, which is an algae resistant shingle. Install a ridge vent across all roof peaks. House and shrubs will be covered with tarps while work is:in progress. Removal of rubbish: Material and labor$6,700.00 j Wo 0 Insurance certificated to be issued toy e s a o 'ob. s p�� -/0V_1 6'�I' -�;o Vn, Acceptance,of Propo Signature: Date of Acceptance: /C Signature: 4`• /L `� / 1 t , TOWN OF BARNSTABLE __ �`` •e Permit No. ------------------ I'` Building Inspector t VA"IT M Cash a VAI OCCUPANCY PERMIT Bond ---- __------- No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Ni Ckersr-,n HomP— Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .................................................. 19..._.__ ..................................... :................................................................ Building Inspector Assessor's map and lot number .. � C�_ ............` /�I SEPTIC SYSTEM MUST BE e 6!' t`�J g S;� INSTALLED IN COMPLIANCE Sew�ge Permit number ......................................................... WITH ARTICLE II STATE t SANITARY CODE AND TOWN 0 TOWN - OF BARN NUEE t'2 f0 Gi 'y 111 • ..i: • "�• i Z BAR3 TADLB, 9. BUILDING INSPECTOR r 1 n,7. CP p� APPLICATION FOR-PERMIT TO ly i,ri e 'sa #07776S " TYPE OF CONSTRUCTION ............K�4.... !z1 rn......... tl'� !................... ..................................................... t ............................ l.. .....19 7� - TO THE INSPECTOR OF BUILDINGS:, The undersigned hereby applies for a permit according to the following information, Location ....... .�✓ fs��............... 20�5......... h. 'f ..�? ... .........� I...................................... �� ��rr � v✓ ProposedUse .....p fy'....11 �`.. .................................................................................................................................................. ticFireDistrict .. �,Zoning District .....1�R............................................................... .. ............................................................... Name of Owner ..................Address ........................ .................................................... ............................................................ Name of Builder .6-7aoewee �''D ovfh6V...��+ '...........Address ... ®.. ex...g ..... 35�/� i /�-115F . ...... ... . .... .. ....... ............................ Name of Architect ............. .........Address .....mh be-awf'........H 1......016 S,? .................................. Number of Rooms ................Foundation ...J..Cd vr.� .................................................. .................................................................. Exierior N�YTG CGCzi" T .3P/ Roofing ......�J.�l' ...... Af I i �'.�t.!�f�s�.................... ./................................... ....i .. .............. Floors ......H-ar l...G��' .Interior ........ .�`�'.. ............................................................. ...................................................................... Heating ..... �:r...w.:AT ................................................Plumbing .................................................................................. Fireplace ........i GS..................................................................Approximate Cost .............. jf ......................................... Definitive Plan Approved by Planning Board ________________________________19________. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby :agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above -construction. /� Name .1/../.............................. ... Nickerson Homes . , ^ ' � ,' No uu��r� one m \ ^ , '�''---'' ' ~^^_'~ ------'���--- . _ dF���� ----'*- ---.^..'-----::—.------. . Thankful Lane ` Locution ... ---.—.--.---------.- --�'�' ' ----..--. --------.-----.— .� .. 7- Nickerson --..-- . - Owner ............................................. ^ ! Type of Construction ...........frame............................... -----..—.---.--.---^-----..---... . #14 Plot ............................ Lot ................................ � ' ^ ' 8 - 78 ' + Permit Granted --. J -- _—...]V ' ' Date of Inspection —..11 .-- --.l9 � ' . | Como|ah�6 - z�. ' ' lg ^ - ^ �. . . � � . . � .- PERMIT REFUSED ' ' ` - ~ -` r- —. ' - . . . . ........... ���� .--r''`e�^���^�"c°="`="�'=--'^`----'--'' . , . �: . .-- ........................................... '''' �.` ��^^ —,r'� ' ' � . ' � � Y ' —.. ---.—.�:.---........—.—.—.~.--.-.' / ^ ^ Approved ..�-----_--------- lg ' ' ' ' —...—�--��-------.~.....---.—..--- ' _~ ` \ ' . --------------..------.--.-.—.. / ' ' ~ | .^ Assessor's map and lot number Sewage, Permit number ........................................................ TOWN OF BARNSTABLE Z BARNS LE, i MASIL 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO �V °'C e rye,w !./a 9,q CS ........ .......................... ..................................................................... TYPE OF CONSTRUCTION ........... .... .... .: .?:?......... .. :............................................................................ ............................. p„� ....19.....`1"" TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location co W.,? e_h/s r L O� 1� t� v•.. � ?iA�,� ProposedUse ....................................................................................�.�................................................................................... i Zoning District .. ..............................................................Fire District . 11C-.`f`�..................................................... Name of Owner / 1'41'f aW We;Wl�.......:...................Address .................................................................................... . Name of Builder t i:ew ov iliAy....:'�.' '...........Address .......... ........................................................ Name of Architect ... ,G '✓f r-r1 f r�.t' ........................Address t hlti'a�r ";?. ryG 3 3 ............... .................................................................................... Number of Rooms Foundation )Po,,-e,,/ .................................................................. ........... .................................................................. Exterior ' ......................Roofng ....... .r,. .... .r...f..........►�...S.....�.t.a.....f..........S..k.i. r.7vrG/s'S................... Floors h. l rr. Interior .......: ry t" .l ......................................................... Heating .a +Tfr ...............................Plumbing .................................................................................. Fireplace ........�CS...................................................................Approximate Cost ............./.e..� ......................................... Definitive Plan Approved by Planning Board ------------------------- � -------19--------. Area .......................... .......�.... .�'..,� Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r I hereby agree to conform to all the, Rules and Regulations of the Town of Barnstable regarding the above construction. �Gr 1P .... 4r��/ Name ......... ..... ............. .......... Nickerson Homes A=39-23 20281 on�story INo ................. Permit for .................................... ` single family dwell.ing .......................................... ........:............... 173 Thankful Lane sLocation ................................................................ ai...`...:�. ................................ . . Nickerson Homes a' Ownr .................................................................. ' fr Type of nstruction I....... t ...................................... ..................................... #14 + Plot ............................ Lot ................................ June 8 Permit Granted .... ...................................19 78 Date of Inspection .......19........................ Date Completed ---...............................19 r PERMIT EFUSED i F' ............................ 19 .r. ..! .. ................ .......... ...... .. ..... .. ... .......�.............j...................... �.. ..�! ... a ....................................... ........................................................ iApproved ................................................ 19 f S ............................................................................... i i I`t 1 t r 'Town of Barnstable THE 1 Regulatory Services TOWN OF SRN t'A'bni , Thomas F.Geiler,Director " RM NSrABLE. ` Building Division 70€- AUG 25 AI-11 9: 4 5 �prE�Mp�la`� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us DIV - �.sr.T M, Office: 508-862-4038 Fax: 508-790-6230 PERMIT# j V FEE: $ SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less 00 tk 7,3 Location of shed(address) Village Property owner's name Telephone number A39&23 Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Cow rvation-C-ommission.(signature is.required) CS gn_off hours_for C.onservation_8 Q0-m930&3:30-4.30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. LT -MUST--BE—ACCOMPANIED BY A� PLOT PLAN° ' Q-forms-shedreg n REV:052813 s- 03 i f ,��; . _. -�.__ _- �___._-... - ---�_._.--_-.--__-______.___�--____�_w________-.__. 4--.-----__-- _ _ • , w�,�: ----- � i �r' _-..y.�_ '+^ �� .t / -- __-- --- ---___ - - r � , :� ,. �!.. `I.. -_.. / i ram" i ��'�_C.�J - ,. � -- � , { ---.... ___-__ �Q -_� .�- O _ _ -- . . i ,�� � �,� �� I ��, i t � - �, -- ._ . _-- _ . sZ.� s � 3� .. _._. �� 'a� �0 _ - - � � � � � N - -- - � s r � � � � '_r7 :.� ' � � �� � � i � � . � � •� •� � � �� � ,. �� r i - ___.._-- _ _-.. _. ... - '� { T— �_�� +sa. � — ,. �. �� i� / }� y lv:=�� _ ,_: _.._ . _ V ��..�'�tat'. t-�J�-]'..a "=i`•.-�.��!��/V(Z, ��.�� p �cTC.<o�. -��'�.O\ �L�.l�',j ���„P ��� ?':. N ,,,�,� :,t' f-� � � . �� �� -_, ` ���--�1 �; -. � - I' O -- r I � i } Nk S1. 8Z : r r i f 1 i � s ��.��!•�r�--+` .r'"�''��'T�.���'•E �--c.�?�`�•�t'?•�:1C`� �F���ti�,;,� ..��r�te�,a ��—I�,.��_ ..�::= 71�� SV.�JEZ� 1�'Z� � 1