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0089 TROUT BROOK ROAD
�9 �' ��� i��` � r - i c b r •. 1 „ ^ oF�H`E rocs Town of Barnstable "Permit# E.cpires 6 months rom issue date Regulatory, Services Fee IARN STABI E ' z, 7AAss. Thomas F. Geiler;Director 163g. Building Division , r Tom Perry, CBO, Building'Commissioner 200 Main Street,Hyannis,MA 02601 w. wwrv.town.barnstable.ma.us ; Office:, 508-86274038 ' k Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - :RESIDENTIAL ONLY Not Valid without)W X--Press Imprint Map/parcel Number Property.Address Residential Value of Wo Minimum fee of$25.00 for work under$6000.00 r�DC� O`vner'sName&Address 11(0 E Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) a KRR Construction Supervisor's License# (if applicable) APR 0 2010 RWorkman's Compensation Insurance Check one:. OWN OF BARNSTABLE Q I am a sole proprietor ® I am the Homeowner. - ❑ I have WorkePs.Compensation Insurance Insurance Company Name Workman's Comp.Policy#' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to &VIV1 '� l El Re-roof(notstripping. Going over existing layers of roof) F71 Re-side #of doors E] Replacemerh Windows/doors/sliders.U-Value .(maximum .44)# of windows *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 Home Improvement Contractors License & Construction Supervisors License is regix ed; SIGNATURE: i . The Comrnonwealth of Massachusetts Departrnent of Industria..l Accidents Office of Investigations �, 600 Washington Street ' Boston, MA 02111 si w;•vw.mass.gov/dia Workers' Compensation Insurance Affidavit: ]builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: (ro c,A row 2c» � l r City/State/Zip: `T S� Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction employees (full and/or part-time),* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9, ❑ Building addition [No workers' comp. insurance comp.insurance. required.] 5. [] We area corporation and its 10.❑ Electrical repairs or additions 3:Yy I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions _-__myself, [No workers'_coznp, right of exemption per MGL _..12.E.Roof.repairs.. ........ insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a de :e pa' an enalties o erjury that the information provided above is true and correct. �-� Si nahtre: Date: 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 5. Plumbing Inspector 6. Other r,._,+....+'o..,- Phnne#- r IInformation.�®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an eniployee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." co An employer is defined as an individual,partnership,association,corporation or other legal g entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair.work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the ��. __ _---- _ -.. members or partners,are not required to carry workers compensation insurance, If an LLC or'LLP does have employees, a policy is required. Be advised that this affidavit maybe 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia i Town of Barnstable o Regulatory Services Thomas F. Geiler,Director saatasrnar,E, 039.q Building Division �m '' ABED pAA�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ s villa nuer e street� -� 5��- "HOMEOWNER": L'rr Ct9.P i _ name home phone# work phone# CURRENT MAILING ADDRESS: (jF2 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 inspect' procedures and requirements and that he/she will comply with said procedures and requiremen . Signa a of Homeowner ,. Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner'hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFlLES\FORMS\homeexempt.DOC 1 of IKE Tp� 'Town of Barnstable Regulatory Services sl x A&& Thomas F. Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bariastable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORNfS:OWNERPERM1SS10N TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t �07 30 Map dZ Par el 073 �Permit-# Health Division V03 1)M Date Issued I M" � Conservation Division Application Fee Tax Collector I Permit Fee e ` pjv Treasurer �I-LL�7 pC SYSTEM MUST BE Planning Dept. t;:STALLED IN COR11PUANCE Date Definitive Plan Approved by Planning Board Vffi;TITLE 5 Historic-OKH Preservation/Hyannis T EG'Jumcpu Project Street Address 69 1JRDt>T 6ROo K POAD Village_CoTyl r Owner _ IC A A E L V/A N/ E rre/V Address N TRo u-T f3(2oo IG IZO A t) Telephone 50 S - +Zg - 79 13 Permit Request Coiv5Tayc- r 12, X (S'X 52-" A60Vf ROU"o OVAL 5wInitMIL%1G rpot^ L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 400 Construction Type Lot Size 2 Z, Z 50 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: Cl Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ c Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use © -all co BUILDER INFORMATION Nam4A� S_66)A 5luj mfg AQUS 4 Telephone Number JrOg 17600 Address-+�b�; w 4 o vpir 14w V j ! rrr ZS License# F45T FALA 11W. (144 02-15 3 Home Improvement Contractor# ( 36 G(2,�Q Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO rALYAot)TA 1 Di2E SIGNATURE DATE (6 • 2 1 • 03 FOR OFFICIAL USE ONLY - PERMIT NO. • r DATE ISSUED MAP/PARCEL NO. ADDRESjS-` VILLAGE OWNER DATE OF-INSPECTION: FOUNDATION 1 FRAME' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ' - Department of Industrial Accidents office of/alvesdgat/ans 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit { name: lo�c�Bon CJ'1 �QD uT BQ D p ci A D Z�0 3 S phone# 5a8' / / 3 ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one worku m* capacity n �` :• . /�} .: :.: ah .#.:..... . :�nstixaa0e:co..: : ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have own workers co lices: the following ...................::.::::::. .. an:;name.;....... .....;.:....:... •:• .<. :::�s•«i<:�::: ............:: »fv >:: s <xi4ii _ �':#�?i;:;:i:{i::;isy2ii:;:;::4ii:v::'ii;;{;�i4:�2;{�:;�::�is;:�sr?j:�:i.•.^:::::::.;�? 6:i:::vi:'.:;>:•>»>:;•i>::.:4;.y;:<;•};;:::;'i>.i:4f.;i:•>ii:•:\;;:}:4i.O:';i:>:::'::^>:;.::,.::::.y::•..::•:..•F.�::�..r`�•..>':::::::4.»i:,,�>..'::.•:;.::..::.:iii::;;:;>:;:i;: i�}r^• Y.J •••:•�'.�,� l'�'!�'.}:Q:�:�:y:<<::{:;:;:?:>?;{:?}':;:;';�:t�'is;:;}{<:,}:ry'•,:}?i;ti':::::•::vi:i�'�:•>?:i;i:;:::•:�::�;:}}:y;�Y}i•� is o N ;'•i:•ivi?.{h::+{•i>:•:i>i v�::.;•i}i):;i:ii:{;{:iv: 4i>iii:iY:;•>'•y:;•:::::. ;::%iiis ::}�i'ri:;:j?:�i{�;:;i:?;:;:';i:; :?iT�ii>:is�:�'�!:;;r`;:y:`�}:�:�i:Y:::::'2:i:?::Y:?"%;:�:�';: 1mnLanC s < ? : oli`>: OF BaSm a to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of crinrninal pennalties of a Sue np to 51,500.00 and/or one years'Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a Ste of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oice of Investigations of the DIA for coverage verification. I do hereby cgo under the p and penalties of perjury that the information provided above is truo and correct Date /D•2�. Signature e Print name ✓F SktVA)A• Phone# ofndal use only do not write In this area to be completed by city or town official permittlicense# ❑Building Departmmt city or town: ❑Licensing Board ❑seleclnen's Office ❑checkif Immediate response is required C]gealth Department contact person: phone#; Oother Owned 9/95 PJA) 1 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. r r 1:..� �i.`1p+i1'.' y J .-• �V'•z i t i✓..• .� 11•i.a4 ; 1 An employer is defined as an individual,partnership, association, corporation other legal entity,or an1.y two or;more of the aforegoing engaged,in a joint enterprise, and including the legal representativesof&deceased'dmployq, or the receiver or trustee of an individual,partnership, association or other legal entity, employing,employees. However_the o11 wner 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 requiired. .Additionally;:neither the commonwealth nor any of iti political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this cliapter`have'beenpresented to;tlie contracting authority. •4✓ Applicants Please fill in the workers' compensation 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 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 obtaina 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/licease number which will be used as a reference number. The affidavits may be retizied to 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. /////////////%% ix%////%%%�%%�%�////%%%/O/�////%��/%�///%�%%�%�//// The Department's address,'telephone and fax number: A" The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of investigsuous 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °FZME T Town of Barnstable Regulatory Services * BABKSrABL&, ' Thomas F.Geiler,Director KM% 9�pr 1 39.MA'S Ohl Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date I D•2(•D3 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:600K ACr 046 604*0 rMn fbjEstimated Cost Address of Work: 0( 740v7- gl;?eo,4E� Owner's Name: 01161 /46 L-- t A1V,1_::_r7TA/ Date of Application: 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 wner: �0• •�3 Date Contractor e Registration No. OR Date Owner's Name Q:forms:homeaffidav Town of Barnstable Regulatory Services a KAMB t ,Thomas F.Geiler,Director - E ' En u►+"�� Building Division Tom Ferry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Prvperty.Owner Must Complete and Sign.This Section If Using� Builder 3 !CA E L VAaU F,,T1'F ,as Owner of the subject property hereby authorize T1{E SIA_1 MMb AAA P o 4 5PA Q'V P to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) 89 7so y it BROOK ROAD �:.., 10• ZI•03 *impatume of Owner Date Ale-Alf-L e ✓ANCTT64 Print Name Q:FORMS:OWNERPERMISSION .,rr r 1 ,..,..Of: G Rip ATIONS a J License: L�NSriitUC710N SU�R�R NwrAer-CS ofimmsfig SWdatw To: 00 ' 435435 wAQUOrf HGWYH E FALNKUM. MA 02M ations ul BOartl of Buildingtam 1301 - : n Place, _ One Ashburton Q2108-1618 Boston, ate; 05r01r1�s Vi�R R UCENSE �i�To: 00 I ice�e: CONSTRUOTION SUPER -p5t01f2� Number CS - 07 804 Yxvm F CAVANAUCM 435 W M UOLT,MA�36 . E gAL Tr.tro' 7$934 ��ion. Keep wP��fPt and rt of address a h Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration _ Repletradon: .130888 Type: DBA Expiration: 4/8104 The Swim Pool Spa sale & Ser, MaketGrp Steven Senna P.O. Box 3612 E. Falmouth, MA 02636 Update Address and return card.Mark reason for change. [] Address C] Renewal Employment U Lost Card ENCLOSURE MR OTJTD SXAI]gvffvE[NC _ CPSC,NSPI BOCA&SBM L f BA MUM CODES R ' LATCH I�•ET.FAP 59!� 50Cx LATC . o Y. t s j Iwo cs�7►: a _. w . :,�•. Ai k, �. TF tt NOWAY r ln _ d 07- i. COD Wl ox A 11 W. J I 4 l 42 MAW �� __. . . � .: -. .. �:. .iJA:- =.t'1-":e:�..a.,ri-�aJtd"i-�. .,.. 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EC40 Filter ® r EC5OC75XESTL EC50 AC Power-Flo LX 1 1,23 1 64 lbs. j •` P15801,1 H.P. EC50CBOX5S EC50 AC Power-Flo LX 1'k 2,3 1 66 lbs. Power-Flo LX Modular Platform Base EC50CBOX5STL EC50 AC Power-Flo LX 11k 1,23 1 66 lbs. Union Connection 1—All filters include SP1022C 11W drain plug. Hose Package _- 2—All pumps have 6'power cord,except system designated with`TL-,which incorporates a 3 ft.twist lock cord. EC4075XES System Components 1.3'twist lock cord(UL) 2.SP0723 deluxe drain valve �50CJ5XES includes:` 3.1 'fz°hose packages include:two(2)1 'h"x 6'lengths of hose,hose adapters and stainless ;fC50 Filter with Clamp steel hose clamps •nSP15801,1 H.P. Power Flo LX Pump A:: •Modular Platform Base •Union Connection Y a'k'Hose Package • EC50C75XES 1 Asses'sor's Office(1st floor) Map . e 6 Z Lot U73 • 47 IRSea�• -,"Conservation Office(4th floor) L� ,. Date Issued / Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Fee - `7 /En ineerin Dept. 3rd,floor House#1 4EPMC�� M MUST BE g g P ( ) INST P dE Planning Dept.(1st floor/School Admin. Bldg.) Definitiv lan p ved by Planning Board 19 � 6 � • ODE AND 4 °SONS TOWN OF BARNSTABLE Building Permit Application Project St t Addre T fo,,V- Village C_ (� Owner Address Telephone ' Permit Request Fo d' f _ Gr>r•S r,>G3- dr o,M r��1� S1 �� Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet .eEstimated Project Cost $ $-Sop oD Zoning District Flood Plain Water Protection Lot Size Grandfathered ? r Zoning Board of Appeals Authorization Recorded Current Use �cs� -.1-'�� v�.��e✓s �„o,�.te Proposed Use Construction Type tJaxQ Commercial Residential / y Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure /S• ,,l,> Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths / No.of Bedrooms -21 Total Room Count(not including baths) First Floor Heat Type and Fuel laird Id- 4% Go Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name luec,40 Oaf G ,,f c-�-_ � Telephone Number 417 9 - 5-313 Address �Iel^.. ,- �� License# p(y Home Improvement Contractor# _ /15-L Y / Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A✓°t5w /L SIGNATURE DATE -JT-9,- BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) I ' o , FOR OFFICIAL USE ONLY t PERMIT NO. #9806 ; DATEISSUED August, 21, 1995 MAP/PARCEL NO. 022.073 ADDRESS 89 Trout Brook Road VILLAGE Cotuit, MA 02635 6 OWNER Michael & Marianella Vanetten DATE OF INSPECTION: FOUNDATION FRAME INSULATION 9/1;zz�� FIREPLACE' ELECTRICAL: ROUGH FINAL PLUMBING: , iOgOH FINAL GAS: °`} :'ROi ,GII FINAL _ FINAL BUILI#IN i" DATE CLOSEO< ASSOCIATIOI�AN 4` 111/02/94 Ii:02 V6177277122 DEPT LAD CoMnonwaa& of MaMaClzudeffi ' 7nainaR10�.�, ..J�►acida+s�s 600 WaaLlim S &&ny ///aa�ac�rsa& 02f f 1 - James l CampbeQ j . . ' Commissioner Workere.,COompert don Insurance Affidavit fir � - ... caomaerpaoss�e.► . with a principal place of business at: ccainsem�� do hereby certify under the pains and penalties of pantry, that: () I am an employer providmg workers' compensation coverage for tay employees wor this job. Insurance Company Policy Number I am a sole proprietor and have no one working for Me in any capadty. () I am a sole proprietor, general conuzccor or homeowner (dale one) and have fire: contractors MTed below who have the following workere vorapensation policies. Contractor Insurance CUMMY/Poiicy ICI• Contractor Insurance Company/Policy N Contractor Insurance-Company/Policy N () I am a homeowner performing all the work myself. I unamund gat a co7f of dis s=e:nent va•l be fw asded to due Office of fmmdpdons of duct C A for aawne verMation and that fa cc a.fie:s rsG:red under Sec ion 25R of MGL 152.can iead to the kMWidmll of atning paaida era floe of up W S1,50C yeas' imprho=ant as well as dvii penaides in the four.of a STOP WORK ORDER:lid a f e of S 100.00 a dal►Mh=me- Signed / day of S/- , 19 9=_ LicenseelPerinittee Building Deparanent Licensing Board Selec=ens Office Health Oeparttnent The Town of Barnstable KAMM Department Hof Health Safety and Environment Services Building Division: 367 Main Street,Hyaumis MA 03601 OiFce: 508-790.6227 RalphCm ignading Fes 508-775-3344 • ' For office use only . Permit rno. � Date f AFFIDAVTP HOME nVIPROVEMENTCONTRACr0RLAW SUPPLEMENT TO PERNIITAFMCAMN MGL a 142A requires that the"teoonstruction,alte:ad= rmoadm rum n10dC On,emersi° improvement, temcn-4 demolition. or capon of an addition to any Pm4misting °WE= o= cpr bonding captaining at least one but not more than fair dandling units ar to sC'tIrl whiCh are ad#C to such residence or banding be done by registered c mtsa=s%with re,taiacwcPdOM along with art Type of work: /� Address Owner.Natae: Date cf Permit Application: - 2 - 5 5 I hereby ceray that: Regjau on is not required for the follcming rcasw(s): work euladedby law obtmderSl coo Bnilaing na cwna,00cagied pnuiagoanpe:mst . Notice is hereby grata that: __ CONTRACM OWNERS PULLING OMEO� �T WORKRMIT OR IT riOr MAGI m CESS ?OM 7 CDR APPLICABLE H 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 cvmcr: Date Cosmamor name Registrzdan Na OR nwnees name COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY. OF ONE ASHBORTON PLACE - . MASSACHUSETTS BOSTON,MA 02108 I ` CAUTION / EXPIRATION DATE I , FOR PROTECTION AGAINST EFFECTIVE DATE LIC-NO. RESTRICTIONS t THEFT, PUT RIGHT THUMB 4 PRINT IN APPROPRIATE C. BOX ON LICENSE. BLASTING OPERATORS MUST INCLUDE PHOTO. PHOTO(BLASTING OFF ONLY) FEE: `�+.► � I NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ! w�II1II fO Aosssss s ofrnge HEIGHT: STAMPED-OR-SIGNATUREO THE COMMISSIONER yauaa� ss���Opld/RO, Code/s to-gmeM-Iorrov~on THIS DOCUMENT MUST BE � SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE THE HOLDER WHEN EN- � OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. del—, HOME IMPROVEMENT- CONTRACTOR Registration 115241 • Type - INDIVIDUAL Expiration 01/13/96 NICHOLAS'C SOUKE ICHOLAS C. SOUKE , ND81 ADM MAIN ST COTUIT MA 02635 � I ty I x � I 2-` -2 1� � i Ate zGw� V r` k V V�av Assessor's office Osf floor): ` �;2�2_ 0 .�3 sepive THE Assessor's 'map and lot-number ........... ... . IM,!TPV , n IN of Health (3rd floor): / Sewage Permit number �.O .L!L.� ,.g w ` �dT SHd9T&BLE. Engineering Department (3rd floor):. '}� i -5;f :x TA t s` House number ..............................:............. .�.. .... RI V L rAea TOWN' G Definitive Plan_Approved by Planning Board ------------_-------------------19________ APPLICATIONS PROCESSED: 8:30-9:30 A.M. and. 1:00'•2:00 P.M. only _ TOWN; ,Of. BARNSTAB.LAE: SUhLDINZ INSPECTOR n - APPLICATION FOR PERMIT TO ..:..! LA.:.P.. .....S .. . ��.l.1..................................................................... TYPE OF CONSTRUCTION ......... T^�:G�� . �R /�� ...............�......................... ............................:...................19 `�,/ / � TO THE INSPECTOR OF BUILDINGS: • The undersigned hereby applies for a permit according to the following information: Location ....D... ... �I�Q�.i....... 1 4����.. 0�'D.... ..(d .�v.L 1... ..... a. .`' .::.� G.g• .........:.......:................... ProposedUse, ...: .Ml. .... .......U."...............................: ................. ......:. .............. ......... .................................. Zoning District ..l.�.F_$ t.p E�/ 7 /,�L Fire District Sr.. C ti %r/a L . ........................... ...... .......................................... ... �C �N� T/� 7, t�q /,�RsaK:.�p.-. �aTvr i /�. Name of Owner .................. . Address ....... .. /� '. ....` �v v .. ........ .. Name of Builder - ............... .. ....: ....:... ddress ....... i' !...4�... !cr��y— � y .. ... in.............37 Name of Architect . ....Address f..........,. Number of Rooms .... .. / ......... .........Foundation w !�....`-��✓ t�£ �.( ....... .. ... Exterior .6c � GA ES5 .............................................Roofng .....;.........................`...................... Floors ..1" ..................`...................................................Interior .-..• � "iT, .... `. .................................... ...... Heating .. d 1Z-CEO /�/�..................................................Plumbing ...........•.(" d�E ........................................... .... lVw e�r ...::................Approximate Cost ........^^..�.Fireplace .......................:.. PP 4ie... aoo Area .. 0. Diagram of Lot and�Building with Dimensions 3 oG Fee .. ' o i � � Y ti c7o ` '._ NooSE ti 7 y ' (Faa h yovSE f}OCrr,sN7, . . To 300,vDARy ot,aD ARY �laE� UPE) No Rro R o 4D OCCUPANCY PERMITS REQUIRED', FOR NEW DWELLINGS I hereby ag?ee.to conform to all 'the Rules and Regulations of the:Town of Barnstable regarding the above construction. Namer.....6.................. ..................... Construction Supervisor's License .. �Y.:........... HAND, KENNETH T. No :323:41 : 'Permit for Addition ' $ .ngle �Fam , Dwelling _ - Location .. 89 Troutbrook Road,' """ "" .................... otuit............................................ Owner ...Kenneth ,T. Hand..{ .... . R. Type ofrConstrudior ".Frame... r .........:......: • r f�� `� e; � max. -�; �." � � a_ - .`. _ `_ ! �a. ' '»` � +�="� 4 � � , Plot .M........................ Lot`_v ... ................ „• � �� �✓`F r•�_�/, � _ Lj e # - i+ � i .. I f•s April- 25 - 88 Permit Granted ...... ....................... ....19 ", �.- �. "•Y fyt � ..fix � 1 I Date of`Inspection .:.:" .. ...._ .....'..... :19 Date Completed mC. ,� ...19 Off• � "� .. .ems- � F • r'1 f A ,� 1 _ i.� �'d.=' f _ 4 k i .. ,•r i� ..i � ( ' , ' - •` ` _r t C i -�`�,+`�'�"�� G"'T� Y,:'�"y3r- aid,-.}�}�.,'�`yr'i,,r,'.gl,.�y�:,..!"+:�+I'*-�YY'."'^,sl^>•�y...,,w +�ry3'§rt^ -� Assessor's map and lot number ��� f...:.. ......... . Z. .. . (� S Sewage Permit number .. ........ ....rl...................................... T"Er TOWN OF BARNSTABLE Z BAWST"LL M6 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....,,,,,,CONSTRUCT NEW DWELLING ......................................................................................................... TYPE OF CONSTRUCTION FRAME ..................................................................................................................................... .......... pril.....0.�...............t9?5.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............Lot 30 TroutBrook Road -� "HILLCREST" in Cotu. t - Barnstable ........ ..... ........................... .......... ..... ..... Proposed Use ...Dwellin. ..g ....... .. . ................................................................................................................................................ Zoning District ...RD- ..............................Fire District ...COtU.it Name of Owner .SEA.-LA.K..E CORD............:....................Address QY... - SATIdw ,h......M.asg e... Name of Builder 11EA-LAKE CORP. ........Address ..5,.AMF........................................................................ ............................................................ Name of Architect ...............................................Address --"-- ............. .................................................................................... Number of Rooms Foundation 10" Walls -Poured Concrete-7"-4" .................................................................. .........................................................Pour Exlerior C+T'hite Cedar Clear Shingles Roofing #235 Self-Seali cl Asti alt„ qinales .................................................................... ........ Floors Kit-Bath-Vinyl Sheet/All Other HardWOOd Interior ..��. ShE�trO,-k ......... Heating .O.i.l..Fo.red..Warm..Ais.......................................Plumbing ....Copy.&. P.1ast.1.0 ............................................ . .. .... ........ .......... ...... .. . . .. Fireplace V? ..................................Approximate Cost $?9!000.00 Definitive Plan Approved by Planning Board ---------Jc'tn-__L5_______19 73__. Area ?,250f Diagram of Lot and Building with Dimensions Fee ........$24...48... .. .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH v V N U Q I hereby agree to conform to all the Rules and Regulations of-the Town of'Barnstable regarding the above construction. �,,,,, ���,.°�-• �"' Name ..................................... ' U �A40�n ` Sea-Lake Corp. 17655 1 1/2 story, a No ................. Permit for .................................... single family dwelling ......................r......................................................... Tkroutbrook Road Location ... .......................................................... Cotuit ............................................................................... Sea-Lake Corp. Owner .................................................................. frame Type of Construction ................................... ............................................... ................. #34 Plot ............................ Lot ......... � ............... I Permit Granted ........Apri1...23..............19 75 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 f ............................................................................... ................................................................................ ................................................................................ Approved .................................... ........... 19 ............................................................................... ............................................................................... Assessor's office (1st floor):_ 0 7� � - �F TNE1tO Assessor's map and lot number ............................................ �f Board of Health (3rd floor): 15 d�Q ► o" Sewage Permit number ... o ...s1✓ .. �'1 /,n Z BJB39TAXLE, Engineering Department (3rd floor): OCJ): MA°a House number G °o +63a• Definitive Plan Approved by Planning Board ________________________________19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....1.%�_� ...... ......Roo.�y.................................................................... rc TYPE OF CONSTRUCTION ............./..........K�At-2AN4 ........................................................................................................ ...........................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned-hereby' pplies 'for a permit according to the following information: Location ...... ..F.......1.. .4..R'...... 4e.e�bK .....'.�.��.......... C? 7U.f. .... �E. ..:.�� .4!. �11....................................... n n l.. ProposedUse .... G.A/.............................................................. ................................................................. n -- Zoning District ... t..E.s�? E.N;I(..��! `:..............................Fire District /C ES� 1� A%..�.'.��' -.................................... Name of OwnerKFNN.f,r�..W'...T I/ /V'�...................Address ..�`� leQ'dfiT. . 2d.U/{.. ... �. .j..j. .. .�l+Q..... . l..�hrr. .. Name-of Builde`rr..�C ("i '.V. , N. �.t "Address �U � JI(" L�fl f�: �1 •3' Name of Architect .............. eut......................................Address ......................-: "�� Number of Rooms ............. ...................................................Foundation .... Ot/'IQ�D �G.....sYi! Exterior )lls:....�!.: �!�!h`-`` ............ ..'............Roofing ...../. � .. �L= ................................... .../...... ..... QQ t�I� Floors ..... ..................................................................Interior ...5.7CFf==!...12D.ek� ................................................ v 1 {. F02C€6) � oA/ Heating ;...........'!(..i2.............................................Plu'mbing /.. f Fireplace .." �rN'f ...Approximate Cost ..`.....�� ���' /1 i........... ................:...................................... d /Area ...�D ...'f .............. �1 0 ................... . � Diagram of Lot and Building with Dimensions j c f� Fee 5 .. ..................... u . d j t t71P 1�IfiN po /* I r i 36-_ r AAW �1 r�QOM J{o(ISE 4oerorto N re e ? -� ro. #eQwvAty 14Al ): T2bU4f Bi�OGL(Z, o 4,D,� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. I Name .............. .....!............. .......... Construction Supervisor's License HAND, KENNETH T., A=22-073 No ....32.3.41. Permit for ...Addition Sin le. Famil �Dwelli.n Location ...89; Troutbrook.,..Road............. Cotuit Owner .....Kenneth,.,T. Hand . ................................... Type of Construction ..Rz.dMP........................... ............................................................................... > Plot ............................ Lot ................................ Permit Granted .......Apr.i.1...2.5............19 88 Date of Inspection ....................................19 Date Completed ......................................19 Or Assc'sor's map and lof number (F! 3................. INSTALLED WITH H 3`IC E I1 �r�4ii' Sewage Permit numbe .. .... . ............ IAMT,4k y CC RQGU �* ��V IN f?"E.r TOWN OF BAR N.SAB LE i BAB.BSTABLE, i 1 pY�,e�� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..........CONSTRUCT NEW DWELLING ........................................................................................................ .. TYPE OF CONSTRUCTION FRAME Apri l...1�.r...............19.75.. TO THE INSPECTOR OF BUILDINGS: The undersigned.hereby applies for a permit according to the following information: Location ............Lot 30 TroutBrook Road — "HILLCREST" in iYotgit,,,-,,,$ �,t �. Q,,,,,,,,,,,,, ........................................................... ........... . ProposedUse ..Dwelling..................................................................................................................................................... Zoning District ...RD-2..........................................................Fire District ....Q.Qtpit........................................................... Name of Owner ,SEA-LAKE CORP. .............Address ..P...Q......5.Q ... 6.4...-...,�r�31GTaJL.�YJI�...NIdSS..,.:. ...................................... Name of Builder AEA-LAKE...COR ....................................Address ..SAKE........................................................................ Name of Architect -----._.............................................Address ----- .................. .................................................................................... Number of Rooms ................Foundation 10" Walls -Poured Concrete-7"-4" ...............................:................. ........................................................ 4 dour R Exterior .......White Cedar Clear'..Shingles „Roofirg235..,Se.], -.SQL, , g,, � p .�at... c �,Qs Floors Kit—Blth—Vi _S.heet,/All Othex„RP9*QQ.d.interior ."..Sk1eet.C:Qck....................................................... Heating Oil Forced Warm Aix Plumbing ....Copier. & Plastic ............ ........................................... Fireplace $2 000.00 .....Yes......................................................................Approximate Cost ..........►..................................................... .... Definitive Plan Approved by Planning Board -------- _15--------19 73___, Area 22,250f.......................... Diagram of Lot and Building with Dimensions Fee ...$2i.48 ... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations f\the �Toow, of Barnstable r . arding the a ove construction. Name .. "aL`'r`".......... . .........�. Sea Lake Corp. N,., 17655 Permit for ...1 1/2 story, �;` ..... ............. single family dwelling r. ` Location .........................................................tbrook Road R A . Cotuit ............................................................................... Owner Sea..=..Lake Corp..,.................... ............. ............... 4 Type of Construction ........fra .....me .... ........... #30 Plot ............................ Lot ................................ t Permit Granted .........April 23 ..........19 75 ' Date of Inspection Date Completed .��..P�.l ..�.�.............19 PERMIT REFUSED .............. 19 A ............................................................................... .1 . 1 r ................................................................................ - it ............................................................................... �.l •� jj � y Approved .. .................... r; i e r • ra t yt Fe OL • '• - .. CD -I.:1 �4j w }i�`ets 4 1rf ± ► r am �5 c .c utx c "r. 4,0` Apr t 1 .' • Engineering Dept.(3rd floor) Map Parcel 73 Permit# a 791a "House# V Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) `7�✓� CLIO ' Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) C, �G ! P) Planning Dept.(1st floor/School Admin. Bldg.) SEPT6- C UST BE { Definitive Plan A proved by Planning Board 19 II�ST�1PLIANCE TOWN OF BARNSTABLE ����� OVEAND TOW REGULATIONS Building Permit Application Project Street.Address C9 f2 � y�/2�8�` , � cm)ey Lo- 'j p Village / Owner -1 Address Telephone yZ EY Permit Request rL /3Li7� Y//NFL. i �> iCi C /��/� Gr//•,/LAB G� First Floor square feet Second Floor square feet Construction Type �tff %i ps/�yL Estimated Project Cost $ G2:90 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 21 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes l'lo On Old King's Highway ❑Yes UJIqo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes M o If yes;site plan review# - Current Use Proposed Use Builder Information Name /dy! &V z /� Telephone Number "12ef 47d Address Y d1Y—�,*477WA.,l p iT License# US 7 O 3Z ZZ/ Home Improvement Contractor# /00 7V® Z �%;f- % Worker's Compensation# e9fW a313 Z_ -.?92 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE /� •—/z^F7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. u l DATE ISSUED MAP/PARCEL NO. 21. ADDRESS VILLAGE- OWNER DATE OF INSPECTION: - - f , FOUNDATION FRAME INSULATION ' FIREPLACE ELECTRICAL:'' ROUGH FINAL. PLUMBING: ' ROUGH FINAL GAS: RO; JGHa FINAL' Eg FINAL BUILDING". .. 7:, ' DATE CLOSED OOTR 77 r' a y; ASSOCIATION PLANA410. C. , Engineering Dept.'(3rd floor) Map 0 a- Parcel ( 7.3 `� Permit# House# Date Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30)Tf-7S� , AV J2-/f.79 7 Fee el k1L Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) Awl Planning Dept.(1st floor/School Admin. Bldg.) f THE Definitive Plan Approved by Planning Board 19 BARNSTABLE. f {{f MASS TOWN OF BARNSTABLE f. Building Permit Application 4 Project Street Address l/�"ail®d. �'),y Lo—, A- 'j p Village C,�7-XII% Owner /� � c//ygEL fart/ ✓ Address Telephone Ile —7757/- Permit Request-.! 3 ��{ � / �'�iz) First Floor square feet Second Floor - r` square feet Construction Type .• -. - Y./ � / Estimated Project Cost $ 4. ''O Zoning,District Flood Plain Water Protection s Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family p Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes p"No On Old King's Highway ❑Yes ®FNo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number,ofBaths: Full:` Existing-- New 't' Half:' Existing f New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: p Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑`No If yes, site plan review# - Current Use Proposed Use Builder Information Name /o '� i 2,z t/f-� Telephone Number Address /G h'.f" .64—*,7nWn.l 67yi 7- License#:�4'''7 e-) 32. Horne Improvement Contractor# /00 71V0 • y 7 `- f is i?1 Worker's Compensation# D&W 5 Z, _V 92 , NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) - FOR OFFICIAL USE ONLY T PERMIT NO. s _ DATE ISSUED` MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION FRAME INSULATION _ M FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH •-FINAL . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r f • �- •�• •• •• • - �- �-.elf.,~ .�.� .•�i. -v`�• '� e� ��,t � - 077- c ✓" ,• t - , - • �Mgg.Qv�r_�c;- car . c7taFs F_ stFra;� t - as-c ct Bu;�cir`c Fe �tLcrs A;,� F,s„cL► tnr. Fiace -•FCC... t atts G208 I CON RAC e aF t �`r�_icr 1o4740 ExP?rat:a-. C� - � i 57:C— FR=VA►c- CaF;:--QFL►IQi`E t •-: VVMEMN—, INC . _ .• .' . f RM�.=��_.� ice:� TR_r„zs Cap=�i , �r_ - ?3` Ne'+t`c:► F:d . _ t CAL" art-E�`.T j DEPARTMENT OF PUBIIt SAFETY CONSTRUCTION SUPERVISOR LICENSE Nusber: Expires: Restricted To: 16 THOMAS X CAPIZZI Jp i..::.-:.•, r 286 PERCIVAI OR {t BAP,NST ABLE, MA 02668 The Commonwealth of Massachusetts Department of Industrial Accidents Oaks ollayestlpstlsss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant informa6on: aim •. J !� 24_V'Z . Q 10c360n 02 G 9 f- ohone s I am a homeowner performing all work myself. Q 'I am a sole proprietor and have no one working in any capacity s i am an employer pro%iding workers- compensation for my employees working on this job. om am• name: address: city nhone 0- Insurance co -�L �j� i Oolicv u ZZS2—� I am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed below %tiho ha-,e the following %porkers- compensation polices: company name: address: Sicv- phone 4: insurnoce co ooliev company name: dtv Rhone#- vrance co a Failure to secure coverage as required under Section 25A of:MGL 152 can lead to the imposition of criminal penalties of aline op to S1400m and/or one,Years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100M a day against me. 1 sadetstiod that a copy of this statement may be forwarded to the Once of investigadons of the DU for coverage verification. do-hereby certify under t ains and pert es ojperjury that the information provided above is true and correct ate _l L/Z^� - Signature - Print name ��r'Tfi�?� �'� ��� l Phone N ofticiat use only do not r rite in this area to be completed by city or town official city or town: permitnicense tl rlBuilding Department (3Ucensing Board check if immediate response is required 261 c2Selectmen's OMce (3Health Department contact person: phone pt_ (508) 398-2231 eat. mO u Irev,sed iM P)A) . THE r, The Town ®f Barnstable Department of Health Safety and Environmentai Services De Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosser. O:fice: 508-790-6227 Building Coma- Fax: 508-790-6230 For office use oniy Permit no. Date Z-47 AFFMAVIT HOME MIPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, one buconstruction n t dmoref an than fourn to any dwelling nn1 artng to owner occupied building containing at structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements Type of Work: d/'GN ��� ®w� Est Cost Address of Work: gi ✓�C011�,es��r�� Owner's Name Date of Permit Application: /z'" I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED T HAVE CONTRACTORS FOR APPLICABLE OGRAM OR GiJ HOME RA►RANTY FUND UNDER MGLOVEMENT WORK Do O 14ZA ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply fora permit as the agent the o / !-nnrTRetnT 1Y9mp Registration 140. .; t ;. e ^ •.. B BiLco - � /2 - a ALfI�A�.L FULL. ►-✓,o�L - I „i BAN 9!r'.L�LocCo:f �4't -�_ '_Q.. ? - ".Or.G•zE JrO� ex a2 c�TEEY_ C3cYosa> 7'�-`�T'c�` I ?ox c �cj.I1JS ,f I _ FL P[ _ - .. _ - 8 � -3-� � .4 9 •f.,��r I __ i � ac.c'oc.l' r A h p t G \ I � _ PS-1•-- - BLaGYf _ kn - _ , `k0 \4 � ✓'•2 x Gs �i L G c.cJ G "s�[ �*4 i r_'rtr ---- ! t 1 vV/e-4L- BGoeeCo✓T 3 I - r - „ z:$ i r . , oo M a O/2Mo&!�e_ N; 1i.: of p O lb � .� - w` j �A -T�4oaf- $�® ZAO I c i AlI�6G is �..r �. . 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