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Fngine&ing Dept. (3rd floor) Map Parcel -f`i " Permit# �
House# �' - Date Issued /3
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) ,1 Fee' S
Conservation Office(4th floor)(8:30-9:30/1:00=72:00) -
Planning Dept.(1st floor/School Admin. Bldg.) + SEPT IC $Y ST BE
' INSTALLED IAIVCE
Definitive Plan Approved by Planning Board t 19 ..
1R/I e
+ ENVIRON I � E AND
r TOWN OF BARNSTABLE,T ��R,RP IONS
Building,Permit Application
Project Street Address G a-,x'z
Village
Owner s�, ,�� Address���i►t/�Zel✓za k,6�
Telephone 77,5"•-7. ,7
Permit Request
G4&;p� r.✓
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ et>o
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
d
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes Er�o On Old King's Highway ❑Yes �o
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 ' No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name Z /� Telephone Number IW2&5'S`7 E
Address License# e96�D 3
Home Improvement Contractor# ,tea
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 RESU TING FROM THIS PROJECT WILL BE TAKEN TO
lT1JT>� '
SIGNATURE a "" DATE
BUILDING PERMIT DENIED FOR THE F LOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. - - e2
DATE ISSUED - -5
MAP/PARCEL NO.
i fi
ADDRESS VILLAGE`
OWNER ', + + t .
t
. T
DATE OF INSPECTION:, - -
FOUNDATION -
FRAME
INSULATION - -
FIREPLACE
i
i
ELECTRICAL: ROUGH .��•. f FINAL ,
PLUMBING: f.46UGH•', r FINAL
GAS:•' �`ROUGH- FINAL
FINAL BUILDING
DATE CLOSED OUT; " y
ASSOCIATION PLAN-NO. • t -
A 0
T"t
. . °: The Town of Barnstable
• a�srsrastE •
9 � Department of Health Safety and Environmental Services
Ea ��� Building Division
367 Main Street, Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no.
Date 10-/154—9�
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: Est. Cost
Address of Work:dfy��tTo�'1/'
Owner's Name„_Z?It&�/dGe�'
Date of Permit Application:
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
CONTRACTORS FOR .APPLICABLE ROME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGZAhI OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
12,2,1
Date ont ctor i me Registration No.
OR
Date Owner's Name
\� ' �N ,
Chi
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
�licant information•
z
•tm�'
Loy ation•
66. phonc
O 1 am a homeowner performing all work myself.
am a sole proprietor and hive no one working in any capacity
am an employer prop iding'\Workers' compensation for my employees working on this job.
opt any name:
addrea• ,l� �J /V�*-JTlJu7.c.7 /i� J�' •
re,97v17_ �VIW 9z� J Z9_ c�� /P
3 phone#• '7� /'
0 lam a sole proprietor. general contractor.or homeowner(circle oute) and have hired the contractors listed belo\� \%ho has:g
the follo«ini,workeri compensation polices:
sStl.:tlt3n�•n.
cc•
phonc#•
policy.If
in'tirnricc ca.
rompiny name:
insyrginge co.
volley#
M ■u{l1U YQ M Ma- �t LM M A/
Failure to secure coverage as required under Section 25A of�tGL 152 cis lead to the imposition al enmtad peaanics of a uoc aP to�..N+.v.. V
one years'imprisogment as well as civil penalties is the form of a STOP WORK ORDER and it fiat of S100.00 it day agalost me. I understand that a
copy of this statement may be fomardcd to the OtTicc of Investigatioas of the DIA for coverage verification.
do hereby certify un r ins an enalti`es of perjury that the information provided above is true and correct
Date 41--/
Signature ` p
Print name �� e.� �� Phone
official use only do not.+rite in this area to be completed by city or town official J
city or town: permittliccnse of -Building Department
QLicensiag Board
O cheep if immediate response is required QSeieettnea's Office
011catt1h Department
contact person: phone M:_ )_ -Other—
Z � .
mm � t/7G� �� I/I .L��G��LL�GGGfGLLCWiGG4
E HOME IMPROVEMENT CONTRACTORS REGISTRATION
Board or Building Regulations and Standards i
One Ashburton . Place — Room 1301
Boston , Massachusetts 02108
. HOME IMPROVEMENT CONTRACTOR --------------------------------- - _
Registration 100740 Expiration 06/23/00 i
Type — PRIVATE CORPORATION
IMPROVEHNT CONTRACTOR
Regi�trctiCi 1C0'd^v
CAPIZZI HOME IMPROVEMENT , INC . I �.� •'•
Thomas C a P i z z i 5 r I Tree ' PRIVATE CORPORATiO4
1645 Newton R d . Expiration 05/23/00
Cotult MA 02635
i CAP177I HONE i4PROVE"E�T IN
—o . j�aS Ca�! :i, Sr
IStS Hawtor Rd.
j Cotuit MA 026-
�7 .
• i �2. L....91.47itl�P,Q/L'
_ OEPARTMEMT OF PUBLIC SAFETY
C0NSTP,UCTI09 SUPEPVISOR LICEASE
Mueber: Expires:
Restricted To: It
i TROMAS I CAPIZZI JP,
• �..::.—✓":: - 286 PERCIVAL OR I
o:..•: . '. ...' •• ,.. :: = ... ...• ,. - ':.:. ....'::' � ..�' - l AaDMC7d01C r1 �9t�e