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0235 OLD CRAIGVILLE ROAD
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J�„,. ,3r.:i, .2'`,.s LIhIu,� , t, "`"�i 'i a .#,..'7m ..... �i �.'NM � ll+•kf� av�i�,1..r� .��}4RM �E fh .. .... ..U'ri' ... .'.. �,....V1�t.� r1n x,.....'.,... :, ;��}�` 'n!:5�.�,•9Ati'p• - t,..�t\ ..C. �. l ...K. ..., .. .. .: ..,.- } _::.a. �' _-, ��....,; ..- � ,���>'t_ v PaiONE CALL ilvil , 1 a BIKE Town of Barnstable *Permit# , � l s� tres 6 months from issu date �. Regyu vi �-latory Services fee yBPAW MASS. � Richar V.+Sci?Director Eo1639. . T��f //�� 5 4,�Ilding Division OF/ Paul Roma,Building Commissioner d�l Mr P K a'_ 200 MafiilS�,trKeeet,Hyannis,MA 02601 www.to�:Uamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address3 i/�. ( �" ✓ // �; ❑Residential -Value of Work$ r 5�AVO Minimum fee of$35.00 for work under$6000.00 - ; Owner's Name&Address a75; 3- i Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance . Check one: . ❑ I am a sole proprietor rw I am the Homeowner I have Worker's Compensation Insurance t' Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value 5, eI ► maximum.32)#of windows #of doors: ' ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked.with red S and inspections required. Separate Electrical&Fire Permits required. *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 required. SIGNATURE: ! _ - Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 The Camrnarnveakh gifMaYsraclr-Tetfs Deparbnent affr dus&hd Accide Q cc o�rnw-%V m. 600 Washington Street -- Baston,41A 02I1I -- witn i.mmmgovldia Workers' CmupensatianImm—auceAffidavi-B.tilders/CantractarsMedTkLm slPbmibers App kaut Infnrmaf an Please Print (als� rJQAaIZ�11)a 0 Aff,/ .410 3, Citgl�fatel Phan Are you an employerMheckthe appropriate bar: Type of project(required}: 1. I am4 I am a gezieral contractor and I ❑ . ❑ employeesp(andforpart-time).* ❑have hired the sub-contractors I6. Rem cEia� 2.❑ I am a sole etas or listed on the attached sheet �_ ❑Remodeling. Fromm 1 These sub-contractors have ship and have as employees. 9- ❑Demolition wadzing for me in any capacity- employees and bave workers' 9..❑Building additica r [NO wod ew comp fiumrrnce comp mererarxr 10: Electzical nrad&fions required-] 5. ❑ We are a cozporatiflm.and its w ❑ repairs 3.[0,I am Immeowner doing all work offacers have exercised their 1L❑Piumbingrepaim or additians myself[No workers'comp- Hof rmmrpfion r M no �.0 Roafrepairs innMnre required-I f L� e employees.[NOWOAers' 13-0 Other comp-ksaraace required.] *AAy appEic=&at cbed xb=ffI mast also fiIloutthe sectioabeTa[vshn�iug iheirwadces'comp�riaaparicgi�rnsauaa I Hameawnem v6a submift ffiis Rffld2vigi gtLeyaierLsingslE Wo>iccudtheahaeautsid�rm**��*+�mnstsubmitanezvaSxdaYiCmdieabnesacTi . fCo 1ff st check iW box must attached as additi mal sheet showk g ft enwme of thee sob-� and stile whether or mat flme emitimb. +e emp3oyees.Iftbesab ron�rt shave emPIoSers,cfieYmustpms�dgthxa trorke&c=rP-PoIiqF nt m I am as employer 6atis provhUng,workers caugmLsrdian utsurance jar my employees Below is thepaaIicy arced job site inforrnaiian. Insurance CompanyNamte: Policy¢or Self-itt€Lim E pira ionDaie= Job Sit�Address: CnylStzwz�p: Attach aropy of the workers'comapensadonpolicy declaration page-(showing the policy number and expiration date). Failure to serum coverage as required under Section 25A of MGL c.157 can lead to the imposition Qf criminal penfluies of a fine up fo SI 50D.OU andlor Qrie-yearimprisossmerd.as well as tivr1 peualg s is Ihe form of a STOP WORK ORDER.and a Hw of up-to$250_00 a dap against the-viobdur_ Be ad-iaised tixa#a copy of this statement maybe far waraded fn the OfHce of Investigations ofthe DIA for imsu rance coverage Ledfrcafinn- Id'a herastry cm*aJrdar tkepains and pwaWes ofpet lY f7zattJia infarmatiaitprntided above trice and correct; Dom, �(--a V Z1 .5 / f 6r „F==ip: cam. ONs OBk at gas aady, D-a zwt write in 66 area,to be completeod by city artown tjo7cial City or TGwn: Pe:tf;cease 9 Ewning Authority(drde one): LBoard0flIe2lffit I?uiffiring DgmImeat 3.CAyfrown Clerk 4.Electrical Inspector S.Phzmbmg Inspector ' 6.Other Coact Person: Phone#- Information and lastructiolis �f; 7J�R car7mce3ts Ge"neaal Laws chaps M requires an=ploy=to provide VMTM&��on fir fhj-z eaaplcr5n= p this Vie,an MPioyee'is defined as-o.eveaypersonin Ifio service of ffider any coaft-act ofbne, CXp=ss\ `nor finplied,oral or Vlh=.7 ;� r ' - associaii or�ioa or legal entry,or any two or more Au.�&7M-is 'T fmrd as an P A P of a deceased employer,or f3ie ofthe,forgoing=agagcdm a joint ,andinclnfmgfhe legal Y �P oy receer iv or"tiust'ee of an mdividaal,p - ,association or ofherlegal entity employing eaoployees. However the owner of a."welling horse bavmgno more than three apartments emzi w# s therein,or fhe occupant of the: - dw Mag horse of another who crap persons fn do mainfi cc, on or repair work on snrh dweIIing Jioose or oathe gTDA& or.'bm7dmgapp therein shaIlnotbecause ofsr h Iaymcotbe deemedt0 be an employer." MGL diaptes I522§2$C(6)also iliat"every state or local agehcy slaaII witShoId ffie iss^a=ce or renewal of a1coreimlit to op a baseness or to contract dings en the co�amonwealth for any appIicantw• roduced a ptable evidence of cdmpTianihm 4ncQ,-ar�ce covearagerequired.Ad ditionallyer I52,§25 states Neither fhe noraay of>ts political subs Sion shall ent-Z min anTthe p ce nfpublic wo�u Ie evidence of campliancewlLh 1horeq[m�memtsss have been enfed%the contracting ozitY-" Applicants Please EL o7-± e woi as' mpeusafion affidavit comp ` ,by chmldng o boxes ffiat apply to your situation and,if necessary,sr�p r(s)name{ , address(es) anber(s) a long with.their cert�c a e(s) of msor�ce. Liability anies C)or Limiter ility Parfn iFs(LIP)withno eanployees other Phan the members or p are not to woZcersl ensat<on iaMMMC-E If an LLC or LIP does have empToyees,apoli isregaftc& ad - thatthis yitmaybesubmitf:edtoth.eDepailmentof Industrial Accidents for co " IL Of co _ ATs esure to sign and datefhe affdaYit The afhdavitshould be returned%the. ify or town th apply "on for a permit or license is being regaes6--d,not the Deparhneat of ; I - sa, youhmvc "ons ! fhelaworifyonaieregoiie'dto obtain aworlg:cs' T, eu compsationpoh ,pltasecalltheDep at zmmberlii�below Self-msoredcm33pmiesshonlcl cater fiiea' self-;T,R ,ce Iice�s n=bCr on the City. r Town WE! " Please be the is eamplete legibly. The Departinenthas provided a space st the bottom of the affidavit out i a the event n ce Of Investigation has to confaat yoaregardmg th a applicant Please be sure to Ell in "cease - will be used as arefm ceuuuiberr_ Ia-addi(ion,an applicant that must submit m Ie p -cease -gig.need only sahmit one affidavit indicating c=mt policy in�rnation (if )and nndea` o "the apph o m (city or town)-"A copy of the-affida that has been - ed or mid bye-cam or may be provided to me appIic t as proo- 'hat a valid davit is on ri for p or licenses A new affidavit must be fiIled of t each year.Where a home owner or is o a li or p . not related to any business or commeadial vim= to bun leaves _ said ers is ICI requid t reo cor�Iete his affidavit: (ie_,a dog hcease orpe®zt , )� P _ 1 The Office ofln?csfiga-cans would like to. r youkadvance for ur cooperation and should you have myq=st1CMS> please do not hesitate to give us a call_ The Departmenfs address,telephone and.AVIer: Th a of Of TTV AGCtd t MA an s 02111 Tc,-L 4 617-' -49(k md 406 or 14M M A GA F Fax#617 727 774-9 Reviscd 4-24--D7 Town .of Barnstable Regulatory Services MAE& A Richard V.Scali,Director - ,� Building Division. t� Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Co m Iete and Sign This Sec ' ri f Us' A Builder I , as Owner of the subject property - hereby authorize to act on mybehal f in all matters relative to work authorized building permit application for. ( dress of Job) **Pool fences and s are the responsi\ffioe applicant Pools are not to be fille or utilized before fenlled and all final inspections are p ormed and accepted Signature-of Owner Signature of App 'cant Print Name Print Dame Date QYORMS:OWNERPERMISSIONPOOLS ,_• Town of Barnstable Regulatory Services �T E b Richard V.Scali,Director Building Division aARNBrAI= Paul Roma,Building Commissioner as,►sa 39. �� 200 Main Street, Hyannis,MA 02601 Ep www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: �� �7 /.2:V�(<//% U JOB LOCATION: I ' Vy�( ( c�C. t!q�Zyel? �j ✓vG• �v - �v� ti number _ street village" -HOMEOWNER': U� /f O q r�`�C 4 �� SA11 s , - name �1home Oh�one# work phone# CURRENT MAILING ADDRESS: AW city/town state zip code The current exemption for"homeowners"was extended to include owner-occgRied 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 rocedures and requirements pAthat he/she will comply with said procedures and requirements. G' Sign a Homeo 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFLLES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Parcel Detail Page 1 of 3 6 A te?, Tuesday,November 15 2016 Logged In As: Parcel Detail Parcel Lookup Parcellnfo _..._ ... ................._. � ....,. w ..,,.... ... ..... Parcel ID 248-124 T^�) Developer Lot SLOT 1 .I Location 23570 D CFtAIGVILLE Pri Frontage 75 .,,—- ,...,I Sec Road EDGEWOOD ROAD I sec Frontage P Village Centerville I Fire District tC-O-MM Town sewer exists at this address ENO ) Road Index 1145^ Asbuilt Septic Scan: . Interactive Map 248124 1 m , Owner Info owner SARMATETEFtA CONW) co- Owner %VIEIRA, MARCOS FEFI streets 235 OLD CRAIGVILLE R 5 streetz 2 SAIL AWAY m� city CENTERVILLE I state MA ","'......�'Zip 02632 ,nanl country Land Info ..... ................... .._.................................................... ... ....................................................... Acres T.23 I use rSmgle Fam MDL-01 I Zoning RB I Nghbd',Ol05 Topography jLevelF I Road Utilities Public Water,Gas,Septicl ' Location , —'—.,- w Construction Info Building 1 of 1 Year 1970 strict le/Hip wall Wood Shingle �:W ,a��. .. w Living Area 1490 . cooer�Asph/F GIs/Cmp Type;None i Style Cape Cod wall Drywall Rooms 3 Bedrooms Model Residential Floor Carpet Rooms G2 Fu11-0'4alf Grade Heat <,m Total Average I Type Typical I Rooms 4Rooms Stories 1 1/2 Stories - J Frei Gas F etion Poured Conc Gross 2772 Area , Permit History Issue Date Purpose hermit# , Amount Insp Date Comments 1 6/5/1996 Out Building 15624 1$3,600 6/1/1997 12:00:00 AM Shed - Visit Hist01)I Date Who Purpose http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=17713 11/15/2016 ok • Town of Bar stable:.. , . .... A .. ... ... ..:r 3J`^- _,. _,. 1'>L' S .ir .J •:41 4 ,�" ^': m g.x..1,+. �'}k.k Mw A"S " �y.._ 1 _`s"..`t4:. ? ;:KF..e�.sh�v �,+-.a-..tF. (^.Yr.. :M,-n-b4ti�'.'•,t: i',.%,:w :..�i..:...,?�r. 5k.?�w�.,;.�r: .9G...n ��t In g�. ''`'�' � ,. �: = F t. oved�Plans�MustFbe' etamed'on`�Job'and�this Cartl Must be�`Kept x,K ,_ . ; ,:.�. :...: •.k. -r.,hi k„ r .5 T, at,.t,.ls Visible From:X.�.S s .�� Q17Pf � � 7� � . ..�: z ,P,. st:F7...(C'�a d �..h.•x � .. >r h e,, , ..... • .:.. .... r. • .. ,. ft.�. fv J.c s. Xx„t.1: 4 ep __{.a:.,?w+.. .,:, .1 },.,� �.Is�.r..»c.'• . � n e. --:.; s.,,a 3-��"-.$'i.rlL n; ,+j as:4�fn 3R'4 IL I�ANB'rABLE.. a. a .+P s,.,., tSR.'p., £' .r�' -,. $�,>t. •c. F°..•si;k. y. ,. �x.- U..:S,r`+1�. ,f71� t$ ,r.t.' •rvi i u A tl t"' ", ". "' �i :7'f ,rlS_: F .:,:�`?s 'Y` '. '+ i .. gip.1.?'. ?-+ram his .r n+�►ss i slris `"etionHasBeenMa Postetl�,Until F p+�. . .h <k _ r ... �. rt�..�..r,.i., -. b aaa :..I. s >,,!4.,. ... �.,-x_ T •,�,L.� r ' k?', :� ., z,�. - .7'_ s F s5r. .� ,:- p rm f639 ♦ r � rfi '3 �wd4,t, :a ,? N... .> zz, ...rp ». ems _ n L K 1 ei 111it :. ' •.. .: r �Ce if cafe of�Oec i anc.i ,Re. ulr, d��u h Bufld�ng�s.hall Not be OccupiedAur}til a FFinal�lnspection�haspbeenYmade � ; :. n►�xr ... .. )W e e a rt ,). �,�.s 4 ,; ,, eye .Y _T,..�. .._-�..���.a . „�-;�. .. ,t.u�M._.. �...,�.�.,.�..;��fw,.�r..r...i...7� - �,�.. _ . ....•.z Permit No. B-17-1479 Applicant Name: VIEIRA,MARCOS FERNANDO BRAGA TR Approvals Date Issued: 05/15/2017 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: 11/15/2017 Foundation: System Map/Lot 248-124 Zoning District: RB Sheathing: Location: 235 OLD CRAIGVILLE ROAD,CENTERVILLE �' Contractor Name: Framing: 1 Owner on Record: VIEIRA,MARCOS FERNANDO BRAGA TR Contractor license 2 Address: 25 SAIL AWAY Est Project Cost: $0.00 Chimney: CENTERVILLE, MA 02632 Permit Fee: $35.00 Description: smoke detector upgrade Fee Paid, $35.00 Insulation: Project Review Req: smoke detector upgrade Date 5/15/2017 rnal. F � a Y� 9 Plumbing/Gas S f r „r Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance. All work authorized by this permit shall conform to the approved application'and the,approved construction documents for which this permit has been granted.All Gas: All construction,alterations and changes of use of any building and strct uures shall be incompliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures 6y the Building and Fire40fficials are provided on this permit. Service: _ Minimum of Five Call Inspections Required for All Construction Work , 1.Foundation or Footing ". Rough: _ g -� 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6:Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: :: .. .:"Persgns corltracting;with,unregistered-contractors do;not have access to-the guaranty fund"-(as set�forth.In MGL c.142A). t Department Fire Building plans are.to be avai,lable"on'site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued Conservation Division Application Fee s Planning Dept., Permit Fee 131-D Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 01-d- Village Owner nc c"S Jieli (fix• Address S -Ile Telephone y l Permit Request �1 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 ❑ new size _Shed: ❑ existing ❑ new size _ Other: ��t �� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ MAY ' 52017 Commercial ❑Yes ❑ No If yes, site plan review# TOWN OFSARNS7,4. Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - — - {-- f a Name Telephone Number 1' Address 0?5— � ' License # &�frAlt, 0 11A 3� Home Im rovement Contractor# p Email mcr C(95 b �` e fm *\1 C,2m Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f SIGNATURE U DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ?Tim�omua'ara�ealt�t�rf 1�`ussr�c�t�et[s. _ , Dep aattneut&frarlwtrid Accide7z& Q, Ge of Inve-i igazd nts 3 600 Washbigii on�tkeet foonwaxLgovIdia Baston,MA 02111 NVorl ers' CGmpensafia n Insmrance Affidavit Sniders/ContractursMecb i,cians/Plumbers 1 pj �TIIfGnmfiGn PleaseP1in1 F.e�1IV Name Address- Are you an employer?C heekthe appropriate bores T of project r 4. I am a ea�al contractor and I Y� P ] ( �l�d}'= I.❑ I am a employes with ❑ � 6. ❑New constmctim employees(full andfor Part-time)-* have hiredthe mb-contractors. 2.❑ I am a sale prRprietm Or partner- listed on the attached sheet., '?. ❑Reeaod HRH ship and have;no employees Thew sub-confractors have 8., Demolifina wodting forme in any employees and have wodlers' 9. ❑Rnildm addifim required 5. ❑ We are a coaporation and its 10:❑Eleehical repairs or ad&dioas 3_❑ I am a homemmer doing all work officers have emewised their 1 L❑Plumbingrepairs ai additiam. mpse€No vokkkets'comp- fight of exemption per MGL 17❑Roafrepairs - ismenianre required-]Y c.152,§1(4),aadwe have no l rNwos�ess' 13_❑Other e'er 09�-[NO. '�` coup.fasn:mm require&] ',3.¢yVyIicmtdwtcbedssbas91mustalsaffirnrtthesactionbdowsha -jtEi&woAerecompensatioupelicyiaformsfimL' 1 F=wwnsm who submft fI&sf5da%If indizaf- thv_y 2m doing all Waal and&=hie auWe cont®cmummst M*Mit anew affidzeft indicztin-such. fContxctq IEmt chwI tV box mast sttacbed aaadditiffial sheet sbawBojthensmeof the sob-cansctxssnd state whether ornotirhose wfitksbwe mployees.Ifthesub-contmdoesbive employee-%Iheymnstpso a&thAr srorkers'romp.policy ammbw- I errs art eaatpioyer tliatis prauidbU tuarkers'compaLsah'oaa inmirance or my empkwas $010a4 is$IirPV icy anti job sfta Tnsmxnce CompanyName: "Poficy#or Self-ice Iie_ ExpiradonDate: Job Site Addt:e= ;city/State/zip: Attach a copy of the workers'compensationpolicp decFaration page(showing the policy number and expiration date). Failure to secure coverage as requiredut dm Section 25A o€MGL m 1572 c2m lead to the imposition.of aimim I penalties of a fine up to$1,500 OG andfor one-Dear impfisoomeuf�R—s w611 as dvil penalties,in the fog of a STOP WORD ORDER and a fzme of up to$250-00 a dap against the violator. Be advised that a copy of this statement maybe forwarded to the Office of 1mvestigations o€the DIA,for mi sumnce coverage veEificah JL I do hereby ca& t paitres andpauMnafpajury f nd thin inf onna#mi.prm ded a 6mg is trace mid correct $ivsaatnra Date_ Phone 02kial use anly. Do not write in dais area,fir be c vjnpleted by rdfy ar tomat gffir &L City or To-= PernufiLicense# I uing AnfisOrity(circle one): L Board of Health 7 Building Department 3.CitylTown Clerk 4.Electrical Fnspector rr.Plumbing Fnspectar 6.Other Contact Person: Phone#: c-�ans _ arrr�a�an and has M&Ssach=etfs ocb aal Laws chaps 152 re:Tdr=alb empIoy=to provide workers'compensation for their employees. p thisstdnte,,an mq7&5yna is defined as¢;ev ery person in the service of another under any coi±ract of hii� empress or implied oral or wry:' Aut exnP&7,r is defined as-an huRvidA partn��,assc didiom,corporation or other Iegal e�iiy,or any iFvo or more of the foregoing engaged m a3o�Vie,and including the legal=prc:seafafives of a dwzased enTIoyer,or the receiy=or t ustee of an individual,pmt=sl i .association or other legal entity,employingemployees- However fibs owner of a dweIInzgihonse havingnotmore than#hree apadmen s and-who resides therein,or the occ¢fsaat ofibe- dwelling hDnse of er who employs persons to do m ,conskmc f;on or repair vac on such dwelling house or on tho grotmds or eppmta thereto shallnotb a of sash employmeattbe deemedto be,an employer." MGL chapter 152,§25C(6 staiEs that aeyery state or Rcensing agency shall.withhold ffie issuance or retie aI of a ficease or pe ' ' to operate a business or to nsfr act bmldmgs in the coin—unwealth for sup' applic,=tw'ho has not produ acceptable evidence of mprance with the hcmrance.coverage regah: l-" Additionally.M(H-chapter 152,§ states¢Neither•thcannngawraM nor a'ny of ifs poIifical subdivisions shall enter into any cont cad et for the p ofpublio work a cuTtable evidence of compliance with iiLe-, -an e. reTa-enimt�of this chaptra have been eased to the anihol*f AppHcauts Phase fill out the workers'compensation arfi comp Ietaly,by dimkiog the boxes that apply to youW sitnaiion and,if necessary,yoppfy sub- onf actors)name(s), es) phone nnmber(s)along with their certfficate(s)of „cr„m ce. L=ited Liability Compames(LLC)or Liabi7ityPart mmbips(LIP)wnno employees other than the members or partners,are not mquired to catty wo eosation ii s cc- If an LLC or LLP does have employees,apolicy is required. Be advised that this dayitmaybe snbmitb�-,d to the Department of Industrial Accidents for confirmation of msmanm coverage. Also a sure to sign and date the affidavit The affidavit should bereirmied to!he city or town that the application fior e p or license is being requested,not the Depalimeat of the law or ifyon �,�ial A c dets- Svnnldyon have auy questions are reposed fi�obtain a woticers' compensation policy,please call the Deparfineat at number " below. Seif-ms<aed campanies should e err their self-insurance license number on the appmptiafe lm . City or Town Offi ak t Please be sore that the affidavit is enmpl=Md - legibly- 'lhe D ariment has provided a space at the bottom of the affidavit for you t o fill out i a the e cc ofTnvestgaflMS to cou act you g the applicant PIe�s e be sore to fill in the pea�ifi/Iice�se mmiber "rh will be used as a cr.nombes. In addition,an applicant that must submit multiple pennitllicense appli�ati in any givenyear,need my submit one affidavit rating cmaent policy information.(ifnecessaty)and under`Tob Q_d ss"the applicant old Wit --all locations in (may or gown)"A copy of the•affidavit that has be=o ally stmnped or marked by th city or town may be provided to the ' Iicant as 'rooftha t a valid affidavit is on file fvjnre permits or licenses_ A ew a$idav�mvst be filled.out eiach ffPP P _ . . year.-Where a home owner or citizen is obtaining license or permit not related tQ business or commer>rial ve:odzae e_a dog license;or permit to bmn Ieaves e#c.) - person is NOT required to camp this affidavit The Office of InVe o�-^Ts would]zke to flunk yo ut advance for your mope�ion should you have any questions, please do nothesifatetb give us a call_ The DeFartinmf a address,telephone and fax mmaber: - of MassachusaM Departnent of1adustdUAcceinta (ice,of Tlx �t(o= .6W W8,4 Stceet T(-,1.:#617-727-4900 Mt 406 err 1477 MA&'CAM Fax#617` 27 7749 Revisexl42"7 •maS1.gPg1dia s 4 �uG ip Town of Barnstable Regulatory Services pGtHE Richard V.Scali, Director Building Division • aA STABLE. • Paul Roma,Building Commissioner MAS& 039A. �m 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. J _ HOMEOWNER LICENSE EXEMPTION - I oC hic 7 Please Print DATE:' J /� q 70B I.00ATION:��� lU�/���i� , � number I� street village �HolV1EowNER7: I 1 l�,rr OS �/� jas name home phone work phone# URRENT MAILING ADDRESS: t4 �C�i l l �IAcity/town state zip code " er-occu ied dwellin s of six units or less and he current exemption for. homeowners was extended to include own p ao allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts 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 Hermit. (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 ements. r AX VAW"', Si ature 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 to amend and adopt such a form/certification for use in your community. DIME Town of Barnstable Regulatory Services f, ` Richard V.Scali,Director Building Division Paul Roma,Building Commiss oner 200 Main Street,Hyannis,M 02601. www.town.bJnTbis ///a.us Office: 508-862-4038 �1� Fax: 508-790-6230 Property.0Must Complete and S SectionIf Usi er I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho by this building permit application for: (Addy ss of Job **Pool fences and alarms ar the responsi\fthLlicant. Pools are not to be.filled or u ' ' ed before fend all final inspections are performe and accepted Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMSAWNERPERMISSIONPOOLS F ..., . KE DETE TORS REVIE ED �-iS 7 D TE BARNSTABLE BUILDING DEPT. FIRE DEPARTMENT D kTE BOTH SIGNATURES ARE REQUIRED FOR PER WITING I i3E D13A rr� �3 C�D cs (3 C D 2 N i� t I��r __...... j .. «� 1' d ., u-� ;� 3 5— o i d �c�, II � Ca�C- ��C�5 P YY12 n�t `v,� Fi n i 5�►eat z 7 1��2 Coihmo.nwealth of Massachusetts Sheet Metal Permit Map Parcel Date: Permit## �o �IJ _ Estimated Job Cost.$ C--1 Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# , Applicant License# ZI7- Business Information: Property Owner/Job Location Information: Name Name: =0 C n S COASTAL Stre r=AIING &AIR COND., INC:. Street:d2 �S nzno 6R4 (SL.,g11L/= 1039 ASH ST City/TaTON, City/Town: GC/)TEP 1/-1-1L Telephone: (' —965—q yt'-7- Telephone: JCS 7 41— Photo I.D. required/Copy of Photo I.D. attached: YES No - staft iumal X1 1 -l�unrestricted licens d-2/ -2-restricted to dwellings 3-stories or less and commercial up to I O,OaO sq. ft. /2-stories or.less Residential: 1-2 family ✓ Multi-family Condo/Townhouses (?Other Commercial: Office ,Retail Industrial Educational 7�t Fire Dept.Approval Institutional_ Other �1f�r� �? `41 Square F Dotage: under 1.0,000 sq: ft._ over. 10,000 sq. ft.- Number of Storiies 1 ..- 11Z— Sleet metal W-Ork to be completed: New Work: Renovation: I/ I-TVA.0 Metal Watershed Roofing, Kitchen Exhaust System Metal Chimney/gents Air Balancing Provide detailed description of work to be done: C�2�7ZIU� E,� �� S�`STEyI/1 �CCCDIVr--T6&P-Lc-- z4)g c-a-� L/ENt s TC-) R E71"Azi?v F 1 t INSURANCE COVERAGE: I have a current liability insurance policy or its equivAlerot which meets the requirements of M.G.L.Ch. 412• Yes[I. No If you have checked y YZI,indicate tho type of coverage by.checkiag the appropriate,box below: F A liability.insurance policy Other type of indemnity ❑ Band ❑ OWNER'S INSURANCE WAIVER: I.am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and-that my signature on.this permit application waive, this requirement. I a t - Check One Only �. owner C] Agent ❑ I Signature of Owner or Owner's Agent , By checking this bozo,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true acid accurate to the best of my knowledge and that ail sheet metal work and installations performed under the permit issued for this.application will be in compliance with all pertinent provision of the Massachusetts Building.Code.and Chapter 112 of the.General Laws. , Duct inspection required prior to]nsulation installation,YES fV0 Press Insgections Date Comments -- i 1 i i I. Final Insnection Date Comments ,Type of license` 3Y �/ Master ritie, 0 Master-Restricted rtyrr-oWn ❑Journeyperson Signature of Licensee Permit ❑Journeyperson-Restricted License Number: `r Chec k k at wvvvt;niass.®gd/dnl f nspector Signature of Permit Approval - ppgj� RW�ViI4��WiOno ll$ Exii�`�.,. s�S4 r � r ,.,'a •- _ �,a �„„fir �"a ��' '� " i - F Offc� 5694cam Q b2 t a } rr bus. �`v � ^k *`' V ux s �." �tt; 1C� c :�7E`!` a1 � �T RE r73✓$NAu s �,v a.yi^' ' AQ x � s Aw Y' Ar x £ � � ail ? 5 C At—ryou 'n ,j�,x ,a t ,gyp y y MOP'y t: hetcbp'aaG�Efi�. rt08Off "dii x"t m��matss"celaktae%work a�nthauzed by tbss building pemtt r s 4' LLlvT . tAaas of Job) at 3u £,y Poo��ence��az�d- lam are the re nssEbzlzty of the apptrcant �X'o41s" r sgare�n4tto i3 ;fil2ed befi�ze feriCC1618t'dQ( 'd2it� II0C1S iiClt O�JCi �r E , [it3tZC<I t1t1t2I'"a122aI 1r18CCt1t}rdS 1tCCiilttl� C 2tYitGC�3#@Sz fto no=sy NOT re 4. &` Er ,rm a } lip 3�PAN gm pj 9m �1� rx S1AtN8tI1C � s. i.� : - '`aar'� a Fitt-Name 3x(3 2 , � �� D��� ,,., sf�3sr r �Ta, r � r £ h The Commonwealth ofMazssaachusetts Depadment of lnd.us&W Accidents ®,ffxee of.£nvestigaations: 660 Washington*reef Boston,MA 0211 w w.mass.gov1diaa P6'orkers' Co>7ipe �iraaace Affidavit: Builders/Contractors/Elecfa ciaus/Pl bees AI1�ticant oxa AIR .R .....oBM Please Trint Legibly Name(BusinesslorgaBrza i T� Address: BROCKTON, ESA 02301 City/State/Zip: Phone.r: OR— �- 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 employees(full and/or part-time). . havehu ed the sub contractors 6. []New construction , .listed on the,attached.sheet. 7• mode 2;❑ I am 'sole proprietor or paz'tzter- � 'e � . and have no employees These sub-contractors have Y 8, []Demolition working for me- any capacity, employees and have workers' 9. Buildin addition ` [No workers'comp.insurance, comp.msura.nce.t' S required.] 5. We are a corporation and its 10.[]Electrical repairs or additions officers have.exercised their utg °pairs or additions 3.❑ I am a hornecwner dog all work 11.[ Plumb' z myself [No workers'comp right of exemption per MGL ' insurance required:]t c. 152, §1(4),and we have no 12,❑Roof repairs employees: [Nb,workers' 13.❑ Other comp;insurance required. °Any.appli.^.antthatchrks box#1 must also fit out the section below showing:their workers'compensation policy mforntation. t Horneowners 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 mustprovide their workers'comp.policy number. I am an employer that isproviding workers,'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_. E; 77y •AIRlb [ UA C_, Policy#or Self-ins,Lic.#_Iyyyy��/!� V'n C2y C) Z/- Expiration Date: Yob Site Address:o7ps 6G� � 1�//ZCGL �� CitylStateJZip: l � GG� 1/u Attach..a copy of the•workers'compensation policy declaratioII page.'(showin the policy number and expirafaon-date). Faslure;to.secure coverage as required under.Section 25A.of MGL c. 152 can lead'to the imposition of criminal o€'a, fine;up to$1,500.00"and/or 0Ue=year"impzisoumenf,.as well as ci it penalties in the:form of a STOP WORK ORDER.and a.firze of up to$250:40 a day against the violator. Be advised that a copy of this statenzezit maybe forwarded to the Office of Investigations of 1he DIA for insurance coverage verification. I do hereby ce ti er thepains andpenalties ofperjury that the information provided above is true and corrects Si mature: Date: Phone ql Z1l�. 0 ciai use'only. Do not"writeln this area,to:be complleted 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: •Fhone :.. P ` ACO® DATE(MM/DDNYYY) �- CERTIFICATE OF LIABILITY INSURANCE o1/2s/2o17 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(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 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 lieu of such endorsement(s). PRODUCER CONTACT Judy Salkovitz Bearce Insurance Agency, PHONE 670 Pleasant Street (508)586-3400 (AICFAX (508)586-3700 MA 02301 Brockton E-MAIL Jsalkovitz@bearce.com INSURER(S)AFFOROINO COVERAGE NAIC 0 lblaURER .Acadia Insurance Co. INSURED Commerce Ins CO. Coastal Heating&Air Conditioning,Inc. jNsugEg C•Liberty Mutual 24198 1039 Ash Street Brockton MA 02301 fflURER E INSURER F 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS" C X COMMERCIAL GENERAL LIABILITY X X BKS55722745 12/05/2016 12/05/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR DAMAGE TO RENTEDPRFMIqFS(Ea occurrence) E 100,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO. LOC PRODUCTS-COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X X ZT5262 COMBINED SINGLE LIMIT 07/17/2016 7/17/2017 E 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X AUT EEDS PROPERTYDAMAGE-Lai acciden + E included $ C X UMBRELLA LIAB X occuR US055722745 12/05/2016 12/05/2017 1,000,000 EACH OCCURRENCE E EXCESS LIAB CLAIMS-MADE - 10,000 AGGREGATE g, 1,000,000 $ A WORKERS COMPENSATION MAARP300047 09/14/2016 09/14/2017 X PER OTH- AND EMPLOYERS'LIABILITY YYY 111 NNNJTF ANY PROPRIETOR/EXCLUDED? N I NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDEDT 'u (Mandatory In NH)describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 R OF PERATIONS below It es, E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION AI 032284 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN -�� Q k n 5� `�_ ACCORDANCE WITH THE POLICY PROVISIONS. l �w � AUTHORIZED REPRESENTATIVE Fax:( ) - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD tr COMMONWEALTH OF MAlSS�1CHUSETTS COMMONWEALTH.OF MASSACHUSETTS • • • • • • • - • • •] me sits 1. ,.•BOARD OF SHEET METAL WORKERS SHEET METAL 1NORKERS ISSUES THE FOLLOWING LICENSE AS A ISSUES THE FOLLOWING LICENSE A$A I Y _ W; MASTER-UNRESTRICTED BUS18gr 1 PETER MERIANOS PETER MERIANOS 1039 ASH ST COASTAL HF.yT1NG AND AIR CONDITIO NING INC Y BROCKTON, MA 02301.6238 'Z 1039 A$H STREET." EiRO.CKTON,MA 02301 I 232 47 07I2812017 1200 02I08/Z0.1a3 15448 V. t, CONTROL# J 5 4 6 2 2 7 '. 7' IMPORTANT 'CONTROL a ; 87 If your license lost,damaged or destroyed;is Inaccurate;or IMPORTANT - needs to be corerected,vlatt our web site at mass.gov/dpl for. Instructions to ensure the proper mailing of your Renewal n ro r„cerise is lost;damaged or destroyed;is inaccurate;or Application and any other correspondence. ntwds to oe corrected,visit our web sits at mass.gov/dpl for This license is subject to Massachusetts General Laws and - .nstructtons to ensure the proper mailing your Renewal A Dpl,cat-on and any other correspondence.e. regulations.Your license is a privilege,and cannot be lent or� - - assigned to any person or entity under penalty of law.Keep this .n.s,.cense is suolect to Ma;sachusetts General Laws and license on your person or posted as required by law and/or 'e944110115. Your license is a privilege,and cannot be lent or regulations. assigned to any person or entity under penalty of law.Keep this `',cons* on your person or posted as required by law and/or. fogwlai,ons. IA�S{SACHrUFSPETsT�S�E t�D R?,�l LICE S a°SA Ina A\N'{ Y3s •. ar. i51SFXt .��'� e 1039 ASN;ST � t BROCKTO_N MA 0230. 623� — r // r%/ //Sr OD 07142075 Rev 0T/iSm09 // � - i j - Map Parcel ermit# Conservation Office(4th floor)(8:30-9:30/1:00-.2:00) , �'I %ate Issued C^ '9l� Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) e, 01-1 e M ' Engineering Dept. (3rd floor) House# SE cpppg§�y(� J rl-^�Fmi. lNCE d - 19gl'�I�*OTN N'VnRONMEAND TOWN OF,BARNSTABLE�®�� � � r} /& . Building,Permit Application Pr ' Street ddress Village c - ' = Address Owner 23. Telephone o? R ' Permit Request First Floor Ad square feet Second Floor square feet Estimated Project Cost $ �o O Zoning District A Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Corn ercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure L11() Basement Type: Finished Historic House Unfinished Old King's Highway AJ6 Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel ° Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds a , Other Builder Information Name Telephone Number ,�d 2- BSI 17 13 Add License# Low_ Home Improvement Contractor# Co 9 3 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 SIGNATURE DATE i! 5 — BUILDING PE M DENIED FOR THE FOLLOWING REASON(S) ol FOR OFFICIAL USE ONLY PERMIT NO. 0 D TE ISSUED M P/PARCEL NO. k ' ADDRESS VILLAGE _ OWNER DATE OF INSPECTION: 1 } FOUNDATION �r� '' s , FRAME �,�- v INSULATION �J�r FIREPLACE, ELECTRICAL: ROUGH FINAL - PLUMBING ROUGH—, '. FINAL GAS: ROUGH' ° FINAL k . ems, - • r FINAL BUILDING DATE CLOSED OUT? 44 ASSOCIATION N011 CAPE COD DECKS s .... REMODELING. Designer Deckr /122 -'r 44 V .� DECK IN '. SCALE 1/4 in.equals 1 ft. 44 4 i r r E � u U�� s 6 � v - � vF ✓ �' I P GO I, S 5 Law EEO No F l W S i �• r E' /L w4 7 , A419 va rJ D fi k S J 2 / 5 w. a APPROVAL APPROVAL `, Date