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0043 JACKSON AVENUE
ot �._ 'x a, , o RIB ` a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #_ {3- 1-7- S1 Health Division Date Issued 3-? �� P� Conservation Division Application Fee Planning Dept. Permit Fee kS' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Addr ss 9? �i6,/U C E A) Village Owner Address Telephone D d' Permit Request` L(.� H P.�LJT _ l'u Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type_�"� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing U new size _Shed: ❑ existing ❑ new size _ Other:RU►I DING DEPT Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ MAR 0 6 2017 Commercial ❑Yes �No If yes, site plan review# OWN OF BARNSTABLE Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��� ' Telephone Number _"J° Zia Address '� �( License # bb Home Improvement Contractor# Email R k 9LZA A,i U 4t-Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: } FOUNDATION t� FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 40, U owMassachusetts Oepartment of Public Safety Board of Building Regulations and Standards license; 08-100988 Constructlon Supervlaor { 4 HENRY 8 CAS•SICY, '', �•,, 'I 8 SHED ROW WEST YARMOU;YH Expiration; Commissioner 111111201T r� a Office of Consumer Affairs and Business Regulation 41v/ 10 Park Plaza .' Suite 5170 Boston, Ma ^diusetts 02116 °°a Home Improveme:: .o•.tractor Registration ( Type: Corporation CaCape Cod Insulation Incc r '..k I µ , ' Registration: 153567 p , r� �, w Expiration: 12/14/2018 18 Reardon Circle So. Yarmouth, MA 02664 IV Update`- •�'' Update Address and return card, Mark reason for change, 1 +5 20M•06l11 --•---.._..___•__. -- -•-�-.__._. _..�-C�1•Atlr.:.�a.aa-!-!11�ru�l;:at•-!�F�xplc�yp'�ent,_17�.�,afrC.ar�i. . �e�am��tartruea�C/oyO�aaaac/tuaetld• ' Office of.Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only i t•h'e, Corporation before the expiration date. If found return to: Exnlratlon Office of Consumer Affairs and Susine egulation `` ° 3' 10 Park Plaza-Suite 6170 ` I 7).x 12/14/2018 1,]f Boston,MA 021 Cape Cod Insul t( ft'11 N'. Henry Cassidy 18 Reardon Ciro l' / R n CC . . So,Yarmouth,M4 "'� Undersecretary 111d7 ho lgnature The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Y•�''V www.mass.govldia l orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING..AUTHORITY. Apolicant Information Please Print Le ibl Name (Business/Organization/Individual) lL 4416 W 4 Address: 10 wG�OV�. City/State/Zip:150. G+.ryu0u,`&I .OtPC Phone#: V�06�`�fir' L14 Are you an employer?Check the ppropriate box: Type of project(required): Ij�l am a employer with �►7 employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.O I am a homeowner and will be hiring contractors to conduct all work on my property. I will 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.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.7 We are a corporation and its,officers have exercised their right of exemption per MGL c. 14. Other 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,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: l el(../"V�(l IoNv(&6, - Policy#or Self ins.Lic.#: C�> �j Q Expiration Date: Job Site Address: G� , City/State/Zip x�k Attach a copy,of the workeIs, ompensation polic 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-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certio u7// ains and p It'es ofperjury that the information provided above ist eandcorrectSi nature. Date: Phone#: Official use only. Do not whie in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other IL Contact Person: Phone#: CAPECOD•27 DEATON CERTIFICATE OF LIABILITY INSURANCE DATE. 7129/2016zal2ols THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, I. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 Ileu of such endorsements , PRODUCER CONTACT 434 R e&Gray Insurance Agency,Inc, NAMWargo, o 877 81s•2166 South Dennis,MA 02880 malldfDrogeragray.com INSURERS AFFORDING COVERAGE NAIC q INSURER A I Peerless Insurance Company INSURED INSURER a:Sefe Insurance Company 39464 Cape Cod Insulation,Inc, INSURER c r Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER Atlantic Charter Insurance Com an 44326 South Yarmouth,MA 02884 INSURER E t INSURER P I COVERAGES CERTIFICATE NUMBER: 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, INSLT R TYPE OR INSURANCEA091 POLICY NUMBER 4 Wow I M DO LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE Q OCCUR CBP8283063 04101/2016 04/01/2017 k(JF TO RENTED $ 100,000 -PREMISES(Ea occur(enco)} • MED EXP(Any one arson E 6,000 PERSONAL if ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: OENERALAOOREOATE E 2,000,000 X POLICYQ j�T �LO� PRODUCTS•COMPIOPAGO $ 2,000,000 OTHER: $ f AUTOMOBILE LIABILITY CE. BI ED S OL LIMIT $ 1,000,000 B ANY AUTO 6232707COM01 04/01/2016 0410112017 BODILY INJURY(Per person) $ ALL OWNED �( SCHEDULED AUTOS AUTOS BODILY INJURY(Per sccldent) S X HIRED AUTOS X AUT03ED R $ $ X UMBRELLA LIAR X OCCUR ' EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE EXC10006636001 0410112018 0410112017 AGGREGATE $ DED X RETENTIONS 101000 WORKERS COMPENSATION Aggregate . E 2,000,000 AND EMPLOYERS'LIABILITY D ANY PROPRIETOR/PARTNERIEXECUTIVE YIN WCE00431902 0813012016 0613012017 E.L•EACHACCIDENT E 1000000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 It yyea describe under OES RIPTI N OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101,Addlllonal Remarks Schedule,maybe Attached If more$pace Is required) Workers Compensation Includes Officer's or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CLEAResult,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non-contributory basis, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ®1988.2014 ACORD CORPORATION. All rinhfa raeearvari Town of Barnstable t Regulatory Services • Richard V.Sci+Ii,Dkedor Bumag DMsioa 'tom P&77 `Con m loner 200 Maui Street Hyannhs MA.02601 www.town barnstablemm tw Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and$.ign. s Se;fioxx If UsMS:AA L, L� f Uoc ; ,as Ofter.0Tbeae ject pmpenyg hen�bp autho �!_P \ J �o act on my bed in an matters rehmim w vmrk authorized by this bufl&q.peanut applicadan for. J. Address o��ob�- .,"P-661 fences and aiasms.are the respoz 'of`she-apl*=t. Pbols are n6 to belVed or Wffix '.bdoit fence is-Mistalkdand all fiiaal pecuons are performed and accepted. wVaMm 6,0imer Sigrace of Applicant A Print Nacre 11-7 Q:F0RM&-0WNWMRM V0NBWLS CAPE COD INSULATION 71ry �q N n 1111110WS IIAMIIII IPA AY FOAM IUIi1ND10 IAIT$ OUIIIDI INIIIIAl10N f111IN01 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St >�� ✓�� Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance .Institute '(BPI) inspector, All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village iCacvAe.�c� V3 .r• Alf.- Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) N r / GVO r k r} o r.*r dal �4�ti Sincerely 2Hi E ssrationpinc, sident Ins TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map Parcel Application#C�200 6D61 ct Health Division Conservation Division Permit# Tax Collector Date Issued-, Treasurer Application Fee �Z ®� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owned Qi Address Telephone 0 -7a�' ?f r ����� Permit Request /e �►'O fix'/� d / a&--v 1''!Lc A%e1;71 'w/ _ az o/ S x,C S a / FHO v,d, a F S( 9)K Ag).a f _ e Square feet: 1st floor:existing proposed 2nd floor:existing proposed otal new Zoning District DES Flood Plain uir, Kn)6CGroundwater Overlay Project Valuations Construction Type Lot Size a , Grandfathered: ❑Yes ❑ No If yes, attach supporting do umentatPdd. Dwelling Type: Single Family( Two Family ❑ Multi-Family(#units) �- Age of Existing Structure Historic House: ❑Yes -Na On Old King's Hi ay: ❑'Fes a No Basement Type:&J F4fl ❑,Crawl 4;J f lkout ❑Other ru Basement Finished Area(sq.ft.) n 4-1 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: as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 6JOo Fireplaces: Existing New Existing wood/coal stove: ❑Yes 4+4e,-- Detached garage::❑existing ❑new size Poo:❑existing Elnew size Barn:❑existing ❑new size ` Attached garage l/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., ._ .- m-- - - Proposed-Use BUILbER INFORMATION Name 4i a` Telephone Number Jos -r79C /�4 i I Address (.. � License# f-�GS Da��o Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS.RESULTING FROM THIS PROJECT WILL BE TAKEN TO 61GNATURE : / DATE T , FOR OFFICIAL USE ONLY i PERMIT NO. } DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: i FOUNDATION 1 FRAME f4 INSULATION t 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' rit tt i 6 Office of Investigations 600 Washington Street s Boston, MA 02111 www.mass. ov/da'g a Workers' Compensation Insurance Affidavit: Builders/Contractors/1;lectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indictual): t � /9 VON 7-� [ C_ �7"?f� FOP, 67S M7-E Address:�'` �- City/State/Zip:_ Q 7'EK P/X_/,k:_ Phone#: Are you an employer? Check the appropriate boa: Type of project(required): 1.El am a employer with 4. El am'a general contractor and I employees(full and/or part-time).* have hiredthe'sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. emodeling ship and have no employees These sub-contractors have 8. ❑Demolition ;r working for mein any capacity. workers' comp;insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its r 3.� requiie' d.] officers have exercised their 10.❑Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself, [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp,policy information. am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site nformation. nsurance Company Name: 'ohcy#or Self-ins.Lie.#; Expiration Date: bb Site Address: City/State/Zip; kttach a copy of the workers' compensation policy declaration page(showing the-policy number and expiration date). railure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office.of nvestigations of the DIA for insurance coverage verification. - do hereby c t,un er the pai an endIdes of perjury that the information provided above is true and correct ems- a afore: Date: 'hone#: — 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#: { -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 udder 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 numbers)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 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 Depwtngnt of Industrial Accidents Office of Investigations 600 Washington Street Boston:,MA 02111 Tel. #617-7,2-7-4900 ext 406 or 1-$"77-MASSAFE Fax##617-727-7749 Revised 5-26-OS www mass.gov/dia 1 V TV ix V1 L"A JLL L"L;1G Regulatory Services sexzvsxa� . ` Thomas F.Geller,Director '"'`ss' $ 1659. ►tee'► Building Pivision Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towA.bzrnstable.ma.us fice: 508-862-4038 Fax: 508-*-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW ' -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adjacent to \ such residence or building be done by registered contractors,with certain exceptions,along with other requirements. 0 Type of Work: RE tYD OEA-/to 6— Estimated Cost Address of Work 19GKL6 X UL r EA)-LE f—(/14 / Owner's Name• % _ J� ZZ�/_-I X AQ S 1-4 Date of Application U. l :Z I hereby certify that Registration is not required for the following reason(s); 7work excluded by law ❑.Job Under$1,000 -Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OyINERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. Ozt ' Date Owner's Signature Q:wpfi]es.forms:homeaffidav Rev: 060606 OFIKE r�Y Town of Barnstable Regulatory Services BARNSTABLE,p: Thomas F.Geiler,Director 9 MASS. 0 1639• pe Building Division tE0 MA't 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: /� �-O JOB LOCATION: number street village HOMEOWN R":944ta- so name home phone# work phone# CURRENT MAILING ADDRESS: J �u� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and req 1rements. Signature of Homeowner CAy eG 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:forms:homeexempt gsr. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerviile, MA.02632-3117 6, 508-790-2375 x1 • FAX: 508-790-2385 John M: Farrington,Chief. Martin O'L.MacNeely, Fire Prevention Officer Craig E.Whiteley;Deputy Chief Francis M. Pulsifer, Fire Prevention Officer November 16, 2006 Mr. Thomas Perry Building Commissioner- Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Commissioner Perry: Pursuant to MGL Chapter 148 Section 28A, I am making you aware and request your interpretation of a suspected un-permitted apartment without proper egress at: .43 Jackson Avenue Centerville, MA During a recent inspection at this address, I observed a single- family residence converted to (2) separate,living areas including a partial kitchen, bath and bedroom. Both the apartment and the bedroom do not have adequate secondary means.of egress. There is afire alarm permit pending for this address fora sale/transfer of the property. The permit will remain open until your office conducts an investigation of the issues noted. Please advise me of your interpretation and any corrections needed to correct the-issues. Thank you for your anticipated cooperation with this issue. I may be reached at 508-790-2375 with questions or concerns relative to this inspection. Sincerely, - Francis M. Pulsifer Fire Prevention Officer Cc: Robin Giagregorio "Commitment to Our Community" MLS Page 1 of 3 _✓ Listing Summary Listing#20612869 �-I3 49"JacksonAve, 'Centerville, MA 02632 Pndg w/Contingencies (10/30/06) i $399,900 (LP) Beds: 3 Baths: 2 (2 0) (FH) Sq Ft: 1296 Lot Sz: 0.320ac Town: Barn Yr: 1974 Remarks , Picture Location, location. Three bedroom, .two bathroom, ranch style home approximately 3/10ths of a mile to ! 4 ' Covell's Beach Crai ville Walk out i f lower level is nicely finished, possibly an in-law situation however buyer must obtain permission from town of E Barnstable, for such use. Don't miss this opportunity to be in an excellent area, reminiscent of Old Cape Cod i Room sizes, square footage and � . . Additional Pictures Pictures U Attached Docs = ........... .. . ...... ....... ... ..... .__.__._. _._. . ........ .. ._..... ..... .......... See Map; Agent Darlene M Scranton-Ashlev'M (ID:U1J3)Primary:508-362-3000 x120 Office Kinlin Grover GMAC Real Estate(ID:KINL14)Phone:508-362-300o, FAX:508-362-8220 Property Type Single Family Property Subtype(s) Single Family Status Pndg w/Contingencies(10/30/06) Town Barnstable Commission Sub Agent Comma Buyer Agent Comm. Dual Agent Comm. Dual Var Comm ` 0% .03% 03% No Facilitator Comm 03% Listing Type _ Excl.Right to Sell Owner Name Maria Domanske County Barnstable Tax ID C103823 Beds 3 Baths (FH) 2(2 0) Structure.(approx sq ft) 1296 :." Sq Ft Source Field Card Lot Sq Ft(approx) 13939 4 "Lot Acres(approx) ,0.320 Lot Size Source (Assessors Records) Year Built 1974 .3 " Publish To Internet" Yes Listing Date 16/12/06 -All Office.Remarks Call listing agent to accompany all showings,easy to show as house is vacant.Good extra space in finished lower level.Great area! Directions To Property Craigville Beach Road to left on Jackson#15 is on left side. _ _. _ 77---- Listing Page E a .Commission-Other 0% ' Showing Instructions Appointment Req.,Call Listing Office,Yard Sign ..._ _........_,..__.. _.. ......... ..... ..._............ ...:._. _.... _. - .... _.. .. F' General Page . &. Zoning Residential ,. . ...n •.....�T. �. ..n TTI.t11T A w XT!_" .."4 t/'I C/nnA 41ALS Page_2 of 3. Year Built Desc. Approximate Total Rooms 6 Total Levels 1.0 Basement Baths 0.0 Level 1 Baths 0.0 Level 2 Baths 0.0 Level 3 Baths 0.0 Basement Yes Basement Description Finished,Walk Out Foundation Concrete Foundation Width 40 Foundation Depth, 30 Fndation Wing Width 0 Fndation Wing Depth -0 Irregular Yes Lot Depth 0 Lot Width 0 i Association No j Annual Assoc.Fee 0 Assoc.Fee Year 0 . Garage Yes #of Cars 0 _ Garage Description Attached Parking Description. Paved.Driveway Year Round Yes Separate Living Qtrs No Waterfront No . 3 Water View No. Convenient To Golf Course,House of Worship,Medical Facility,School Miles to Beach .1 -.3 Beach Description Ocean Beach Ownership Public 1 Street Description Paved Interior Page Fireplace Yes Number of Fireplaces 0 Floors Hardwood,Partial Carpet,Vinyl ......_.............................._.............._. ._......_........._...................._.............._......._...__......._.........._.._..__......................_........_........_..._.._...... Exterior t Style Ranch Pool No i Dock NO Exterior.Features Deck,Storm Doors,Storm Windows Roof Description Asphalt,Pitched i I Siding Description Clapboard Mechanical i H eating/Cooling Natural Gas,Hot Water Water/Sewer/Utility Septic,Electricity,Gas,Town Water Hot Water/Water Heat Natural Gas,Tank ._.._. ....._....._.........................._._._......_......_._._._._............._.....__......_.._._....._._...._._.........................._.._._................-----._.._.._._._......_......__.....-__.._......._......._.._....._..__................_...................................................................................._............._.._..._..........._._.__..__..: ......................._._.._._._._....._:._..__..._...._.........._._..._...._.........................._...._....._............ _.._------..__..........._.._.._.._.._ _.._............................._..................................._._................. Legal/Tax Annual Tax .1790 Tax Year 2006 Land Assessments 221600 Improvement Asmt 146800 Other Assessments 15500 Total Assessments 383900 Annual Betterment 0.00 j Unpaid Betterment 0.00 ( To Be Assessed Unknown 1 Mass Use Code 101-Single Family '1VILS Page 3 of 3 Title Reference-Book 0 Title Reference-Page 0 Land Court Cert# C103823 , Underground Fuel Tnk Unknown ' i Lead Paint `Unknown j Flood Zone ...........-..........._._._.__........._Unknown.__. ... j _._.........................._............._____,.._._......._._........_......._....._.-..____..._.._.._.__..___.._._._.._... Information has not been verified;is not guaranteed,and is subject to change.Copyright 2006 Cape Cod&Islands Multiple Listing Service, Inc.All rights reserved Copyright©2006 Rapattoni Corporation.All rights reserved. .. i i. 111nAT11'11T'ALXT._r'------A0_TnTlt-XTATST-._ Parcel Detail Page 1 of 3 1lP(-ice' �� � ' J E(/, _r f ft' f l��+4 r a`s '�^-��t Lj .� '`af. l £1 3-t a`7 " Logged In As: Thursday, Novemb. Parcel Detas i Parcel.Lookup Parcel Info Developer Parcel ID `226-130-001 Lot LOT ILOT 10 _------ _._-- Location ;43 JACKSON AVENUE I Pri Frontage Sec Road i Sec _-.._------------- Frontage I Village ICENTERVILLE Fire District;C=O-MM Sewer Acct i Road Index 0785 Interactive ° Map AA I ' n Owner Info e o owner'DOMANSKA, MARIA I �o-owner streets 15 JACKSON AVE ! Street2 City CENTERVILLE I State AMA zip 102632 Country lUS . Land Info Acres 0.32 use 'Single Fam MD 01 Zoning # Li Nghbd 10109 Topography Level Road Raved utilities Public Water,Gas,Septic Location r Construction Info Building I of 1 Year,-—--,----.- Roof _. _._- ___.. _. Ext` __. .___--_.___ _ l� 11974 Built Struct Walls Gable/Hip I Wood on Sheath I a, p" — V V Effect 1807 -: _ _ � Roof As h/F GIs/Cm T ---- AC�None�_._,.___-._._._-._._.i ' - C ` p. p ype Area over '" e Bed Style Ranch wall,Drywall I Rooms3 Bedrooms Bath i Model 'Residential Int I 2 Full I �1 Floor Rooms- Heat,-- _ __"...__,__.__. Total ; __.___ ..- Grade ;Average , Hot Water I ,6 Rooms Type Rooms 1 L 1 - http:Hissgl/intranet/propdata/ParceIDetai1.aspx?ID=15723, E 11/16/200 a 4 . 1 any, WIN k AW . fill TOO E ,� ��k , �u '��5'X a' a.a <Z. ifl� YI�II I E1 I+I' p A Ej Y Wgz $ f a j � 'emsAI Z 71 AL will � •�'.�� f�:;. �� �£ as �3;��...e<- �'„ s r � �s � s ''/ Gi� �l� 5�r y�� � ��/, �/� oFZHE ra,, Town of Barnstable Regulatory Services s" ASS. ' � MASS. " Thomas F.Geiler,Director 9 M g CpA .i639 ♦0 1p1639 p Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 November 17, 2006 Ms. Maria Domanski 15 Jackson Avenue Centerville, MA 02632 Re: Illegal Apartment: 43 Jackson Avenue Centerville, MA 02632 Map: 226 Parcel: 130-001 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home,which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Si erely tLin dson Amnesty Zoning Enforcement Officer Building Department gforms:zoning3 X PRESS PERIINrr Town of Barnstable *Permit# b DECExpires 6 months from iss e 200� 7 Regulatory Services Fee TOWN OF B Thomas F.Geiler,Director b T®WAI Building Division OF �qRNp y,CBO, Building Commissioner 200�Iain Street,Hyannis,MA.02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY � // Not Valid without Red X-Press Imprint Map/parcel Number Property Address %J ('i�s®/1/ /�/e- 1,e e /le 1W Residential Value of Work co® Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address V(��ZP1 1/51t- r Contractor's Name �� � �/JSy�/Z�� �o s7 Telephone Number S©.0 d°W G 1e Home Improvement Contractor License#(if applicable) Ay4�/o7 411 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance C�6k one: L"J I am a sole proprietor i ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance F I Insurance Company Name �L"Al� -./Qme lca MS. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ffRe-roof(stripping old shingles) All construction debris will be taken.to '1/1/1e2 40� Y& Z yyc ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exe co pliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro must gn roperty Owner Letter of Permission. A copy o o -fnprovement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 91te 7 Comwwwwea" Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 " Boston, Massachusetts 02108 Home Im p �rovemen I .:I tractor Registration Registration: 144409 r"7 Type: DBA IVAN CONST `, Expiration: 10/4/2008 1�, _ IVAN KLYUCHAK 9 VIRGINIA RD `" s _ — ----- --------------- MEDWAY, MA 02053 J% Update Address and return card.Mark reason for change. DPS-CA1 0 50M-05/08-PC8490 [� Address Renewal L] Employment 1 Lost Card The Commonwealth PfMassachusetts Department of Industrial Accidents N'1 1 Office of Investigations f I ; 600 Washington$treet Boston, M4 02II1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Orgenization/lndividual): � /�� C " 9 Address: l//fZD /1✓/O �" City/State/Zip: ' : lmeAW ' /V OZ0 3 Phone #:_ J&P7 61Z� Are you an employer? Check the appropriate box: Type of protect(required); 1.❑ I am a employer with 4..❑ I am a general contractor and 1 6, ❑New construction 2.Vmployees(full and/orpart-time).*- have hiredthe'sub-contractors I am a sole proprietor or partrier- listed on the attached sheet.t 7. 0 Remodeling ship and have no employees • These sub-contractors have 8. ❑Demolition working for me in any•capacity, workers' comp.insurance, 9. ❑Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10.[]Electrical repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself, [No workers' comp. e. 152, §1(4), andwehaveno 12.❑Roof repairs insurance required.] t 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. 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 sbowing the name of the sub-contractors and their workers'comp,policy information. Tam an employer that is providing workers'compensation insurance for-my employees. Below is the policy and job site . 'nformation. nsurance Company Name: ?olicy#or Self-ins.Lie.4: Expiration Date: 'ob Site Address: %3 MKS©/{/ Ale— City/State/Zip; Uttach a copy of the workers' compensation policy declaration page(showing the-policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a . . ine 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 if up to$250.00 a day against the violator, Be advised that a copy of this statement maybe forwarded to the Office of avestigations of the DIA for insurance cover •verification. •do hereby certify unde s a Wefialdies of perjury that the information provided above is true and correct ;i ature: Date: l fz CLO, d�?z 4557 t1"2 10 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: ?bone#: nformation and Instructions r Massachusetts General Laws chapter 152 requires all 'employers to providi workers compensation for their employees, _ Pursuant to this statute, an employee is defied 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 ox the foregoing engaged in a j oint 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 necessaryy,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their cerkificate(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 permitnicense 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.There 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 D-epartmpt of Industrial.Accidents Office of Investlgatians 600 W`ashbgton Strett ' Bast Gil.,MA 02111 Tel, # 617-727-4•900 ext 406 or 1-977 MASSY Fax:ff 617-727-7749 Revised 5-26-05 w .mass.gov'Idia ofz r x Town'of Barnstable ti P Regulatory Services s^xNUME . , $ Thomas F. Geller,Director Eo;.. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Let/ vSi� as Owner of the subject property hereby authorize 111WA1 � e�o� to act on my behalf, in all matters relative to work authorized by this building permit application for: �3 J�aei«oti Ale-, /ot r d26'3z (Address of Job) jZ1 /2- '00 C Signature of Ow er Date 2v Print Name t Q:FORMS:OWNERPERMISSION 1 y�FTMEt��♦ TOWN OF BAR.NSTABLE H6HH3TSHLE, i p39. BUILDING INSPECTOR UAf APPLICATION FOR PERMIT TO G:...<.G. !?.P......cl. .. 4e......... 4.h.................................. TYPE OF CONSTRUCTION ./. � ... ...:.. . ........ - :.................................................. . ................................................19.7Z. TO THE INSPECTOR OFILBUILDINGS: €. . The undersigned hereby' applies for a permit according to the following information: Location G � j./ CCIC,st�r.! Eve, a--hle-ry f. ..... JJ . .. . ... ................. ................................................... ... .. .................................. ProposedUse .......f '.................`................ ............................................................ ........................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner . ...............................................o l t ,S .....................Address ................................... Call h)14 Nameof Builder ....................................................................Address ..... ............................................................................. } F� a4yq -j:.Pv/l1hgA1 D`�,fTi-_ Address ..... Name of Architect ............. .................................. ...j ?..............�.rqh .................... ................... • Number of Rooms ............. ........................:.............:..........Foundation ......................................` 4? Cry? .:..............:....... Exterior ..................�....<......jl.................................................Roofing ....................5� .`..`...'.....J�``k ............................... Floors !...rr�.•'s©o.... ............................................Interior ........... f .......W` .............................................. Heating ....1 � bu........................� ���`'S:.....................Plumbing ..................................`�.b :... o r,�`^:..... .................... Fireplace .. .......................................... A roximate Cost 1391. .................... . ... Definitive Plan Approved by Planning Board ---------------____----------- 1.9 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH =- (n m Q ,. `100 � Cam _ I� `• V J � W 140e � U_ O 00 [r .� Q` jl 13 W LU l`_ LU (n CO tJ i- LLJ 1-; j r� STD VAf I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the bove construction. ��� Name .... ..........�.............` ...................... i Kontrimas S. No .... Pe'rmit for ,.,,,,.,one,. ..s.tory......... . .... . ........ single family dwelling ............................................................................... Location Lt3 Jackson Ave. ............................................................... -74 ........................C.e.nterville............................... WI .. . ................... Owner ............S.—Ko.ntrim..a.s............................ Type of Construction ..............frame,,,,,,,,,,,,,,,,, ................................................................................ CIA Plot ............................ Lot ................#IQ.......... Permit Granted ....... .....October 31 72� o t - Date of Inspection ..... Date Completed ...... ........19 PERMIT REFUSED ................................................................ 19 ............................................................................... ........................................................................ .........................................................................I...... ........................................................................ Approved ................................................ 19 ............:................................................................... ............................................................................... /1r1.2 !� ,L /3,0 PG� ,� Assessor's map and-lot number .......................................... e ,;, a. SEPTIC SYSTEM MUST BE m INSTALLED IN COMPLIANCE Sewage Permit number ..... . .... ��.G�la� : :f i WITH I �AS'TICLE I i STATE • -'�j� .. �.� � SXNITARY CODE AND TOWN o�7NETo . TOWN - OF, BARN9. i BAHBSTADLE .• a T "AB` RUIsIDING INSPECTOR MPY a' s• t ~lam-d�.��' F-a'e- (Cu�.. C� .. APPLICATION FOR PERMIT TOE' ./...•..•••. ......................................................................... ..:.............................. TYPE OF CONSTRUCTION ........:..... .........1. ...............19 `... TO THE INSPECTOR OF BUILDINGS: f The undersigned hereby applies for a permit according to the. following information: Location ......�` ��...... �CJ�01_........... e............. �QV U itl2...4. 'bs.................................................:....... ProposedUse ............................... :.:................:............................................ nn Zoning District . — l�2 U tT Fire District ..............................................................VLSI ................ . �p I►^C`�. I c� �.� �.ce Address Name of Owner II__ ................:... �... ...`'J...``....................1.............................. Name of Builder .:..... Y?QS C�.:...... .lC h4.:......... ..................'1J t . ..`S.t........Cc`.'�:...... ..� ......... i Address ... Nameof Architect ..................................................................Address ........................................:........................................... (( .........Foundation i Number of Rooms ......................................................... ...............................................:............................... Exterior ......Roofing ....................:........ ...................................................... Floors ......................................................................................Interior ...........................................:...:......`.............................. I:.Heating ...... .. .. ............. g .................................................................................. o �� 00 ...............Fireplace N�.............................................................Approximate Cost ................................................................ Y Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ............................•.............. Diagram of Lot and Building with Dimensions Fee ........../.. ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH f . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r arding the above construction. Name .............................................. ... ............. ... Kantr1mamv S. ----- ' 18879 rebuild-fire -----.. 9armh�or --------. - -- 3 ' --..����dama��'--�----------------. - . ' ' , XXXXXMgKXX Location ......... --_.______.�5..�e��a�� .�ve�mm.. ' ` .`-----.. ----.—..---- ' , . ` Ovvne, .........8�..Kpmtr.imaa___'__.�__'.. . . Typo 'Construchon ---................................. '~ / ^ -------------------------- ` - Plot ............................. Lot ___��_______ � ^ - . December 16 76 Permit, Granted —. ----.lg Date of |n»oe��m / ` � � . . Dote Completed .. —.—.lA \ . PERMIT - ' -------�_--.-----.--- lP ' ' - � . � = ----'''---../--------..o------- —_---.—.----_-----,_----'.�.. ' - 'x—'—''---'_ --------^—',—~----- � ' ' ...-----.r.----.. .. � — ---...--.---- � Approved.................................................. lg -------------------------.'' ------------------------...— ' - `Assessa*,'s map and lot_)number '.' j r Sewage Permit number ........................,'.....:..................:...... ` r j. *THEt��o �` TOWN OF �BARNSTABLE t. i 89$$9TADLE; r 9 M 39 U U 11 D.IN G. I N S PE C T�O R r, 'Ep ypY .` APPLICATION FOR'PERMIT TO ! !! ............ ' .... r: TYPE OF CONSTRUCTION ...................................... . /........................... ..........,9.7.?. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r C Location .............1.5....... ........Pr.K............................... .................... i..:.:Y: ............................. ProposedUse ..............................:. .. ..... :ke..... ...... .................................... ...:... ZoningDistrict .................�e................................................Fire District ........... ."'. ...................................................... Name of Owner .................Address ... .Vt •OY1...:..T1V�......... 4..�!�1�1� ........ h << Nameof Builder ....................................................................Address .................................................................................... Nameof"Architect ................................................................. Address .................................................................................... Numberof Rooms •..,..................................................................Foundation . .............................................................................. Exterior .................W.l ..............................:...................Roofing ............. �. .......... aa Floors W A.V .Interior Heating ......................:....................."--..........................Plumbing .................................................................................. Ae� s Fireplace ............................................. ...........................Approximate Cost ...........1 ..0.0........................................... Definitive Plan Approved by Planning Board -----------------------_------19________. Area ............./. ............ ....... Diagram of Lot and Building with Dimensions Fee ............ .> T........................ SUBJECT .TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r garding the above construction. Name ............... .. ..................................... n I Hedwig Kontrimas r 1 19346 �!..No ................. Permit for ..U> � It Shed....... ........................:...................................................... Location ....1:5...Jack$.Q.n..A.item........................... 1� ...... Centervi 1.1e..........................:........... Owner ...Hedwig..Kontrinl� ............................ Type of Construction ....FTile........................... ,�. •,�, ............................................................................... Plot M-2 k.....L:M.0. Lot ................................ ... r Permit Granted .......June 29s...............19 77 Date of Inspection .... ..•................ .19 *, Date Completed .. ....19 PERMIT REFUSED ...................................................... ...................... ....................... t nj ry ............ ..................... ......................f...........,f r ................. ......................... ............................................................ .....�............ - '{:. «,.�• - f L • ,.� � - �� / - � fin✓! ,j '� , Approved ............................................ 19 .................................................................. .... _ ^ .J .. ............... . 110MMOM ■ommm :n CCCM■nE■Mmmn CC:::mmmmmm■:CC■■C:■■ ■■■■S ®N ■ ■�■�■.CC■w.■/M■C■ M■■M■ ■■.NHMN■■■■ .■ ■ ■■■■■■■■■■■■■■■mm■m■m■mmmmmmmm■mm■■N■■E■mmm■m■M■■■■■ ■ am am N■■■■■ ■moM/!S■M ■ man am S■■n ■■W■HM■■M■N■ ■ ■■■ ■E■■■OEm■mmmm■mmmmmmm■■m■mmmmm■■mm■■■■MH■■■■■■■■■■ ® ■■ ■■■■■■■■■■■■■■uu■■■■/!■■■■■■■■■■■■ ■■■NH■■■■ ■H■■#■■ ■M■ ■■■■■■■■■■■■■■■■■■■■■EMMM■■■MM■■■M■■■M■■■■■■■■■■■■■■ �_ ENE■ S■N■■N11 ■/■■■■■■■ ■■ MOE■MEH■H■ ■■■■■■■SM■■■■■■■■■■ MEMO■■■■■■■■■■■■■■■■■■■■■■■ r !■■■Cw■■ ■■E■■/!■■■ ■ ■■ ■■■■■H■■■■■■ ■■ ■■■##■■HHm■ssm■M■■moss■■■■■ MEN ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■Now ■ ■■■■■■■■MEMEM■■WmomsCCCEMSEEMENN■■■ E■!■■■�■■■■■■■ammommomm mo■■ommo■H■mC■■lomm■mmms m ■■ s■■■■■■■■■■■E■■■■E■■■■■■■■■■■■■ EE m■■■of■■■■■■■■■■■■■■SCN/mS■■■■■■■■■■■ mmmm■■HNmmmM■O■#MMOMM■M■WCCi■ M iiiiiiiiiiiiii ii iiiiiii iiiiiii ■!NNENEEMMEMEM WCCCmmosoommmommC�EICC Ni�IN■o no M■EN �■milmioomm■omm=Cii■Eis■MESONC■CCIi■■■■■■■■■■■■■■■ MMm■MM■sE■s■E■■■■■■■■■■■■■■moons■ s■s■■mommom■■■ m■mo■mmo■mm■■■■■ ■E■NON M■MMM■m■mMMMMM■MMMMMI ■■ESN■■ ■mmo■■o■■■M■S■■■■■■■■■■■E■■E■■■■■■■■■■■■!■■S■■sS /s■o■ONs■■M!■ ■■■m■■■sHEH■■ m#■■mm■■ElIIE■E■■■■■■■■■■� g■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■mm■■mm■mm■m■■■ m■■■■■■■■mom■ ■■■ ■ ■■ ■H ■■■■■■■■■m�N■■■■s■■s■■■■ NNE■MEor ■■■■N■■EN■■■s■■■■■■■■EMs■■E■No■■■■s■■■■■■■!■■■■■■■:■■■■■■■■■■■ ■■■■EMIIHCCI. 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