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0575 OLD STAGE ROAD
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Building Commiss 9 i639. ,b� g �� �'0�fp Cl A 200 Main Street,Hyannis,M,4'o, � y www.town.barnstable.ma.us 41 Office: 508-862-4038 /� JW Fax: 508-790-6230 r� ` 16 f� EXPRESS PERMIT APPLICATION kAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Pro erty Address �� Residential Value of Work$ S (00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A v�.r Syr c e-K Contractor's Name d CoJ' `, tg 1ru•reA^l4,, Telephone Number2— Home Improvement Contractor License#(if applicable) �(6�0�(2j Email: CoR t,�Q�ac� ►n @ q v�no�: God Cons tion Supervisor's License#(if applicable) 4 Q�C(Q Cons Compensation Insurance Check one: ❑ I a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A,, Workman's Comp.Policy# i Copy of Insurance Compliance Certificate must accompany each permit. Permit Rep st(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to a 3 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) - ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value ' (maximum.32)#of windows #of doors: •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner mu t sign Property Owner Letter of Permission. A copy of t o Improvement Contractors License& nstruction Supervisors License is' required. SIGNATURE: QAWPFILESTORMSEXPRESS2017 t� The Commomvetr&h ofMassadJrusetts DVrarbwazt of Indh striol Accidents - - Office o•f Im*stigatims 600 Washi.aglon street Boston,MA 02HI --- wrvtu mas�g��ilia Wcwkers' Campensafcon Insurance Affidavit B.uiillders(CantraciursMec dcianslPlumbers Applicant Information ( please print E 'bly Name �� anizatis}afl &ddal}n LG e C 01 T�l9 VIle vti Y OW' Addre.w. UA - V u an employer?Checkthe appropriate box: ' Type of project r I. I out a era 1 with 4. ❑I am a general contractor and I F ] { p� 6- ❑New constmcticn employees(fall anNor part-time)s have hired the sub'-cam ctms 2.0 I am a sole proprietor or partnee r- Tested=the attached sheet, 7. ❑Remodeling ship and have no.emplcyees. These sub-comdractars have 8.-❑Demolition woxidng for me in any capacity. employs and hay*e wodrers' g- ❑BRuildmg additieu [No 1 od=S'comp.imsurance comp.msaranml required_] 5_ ❑ We are a corporation and its 10❑Electrical repairs or additions officers have esmcised their 3_El 1 am homeov�ner doing all wade 1L❑Plumbing repairs ar additions. [No workers'{'°mP'- rigbL of emmnptibn Per MGL. l�I—I R�fr�� . insurance required]F c.152,§1(4�andwe have no .L�J- emphyyew_[No,orb,$■ 13_ V Other Vb r ca=p-insurance Od *AnygVficmn&dwtcbedmboa Rnmstalsof�o�thesectioabeTows�a►vug�eiriaoskecs'cnmpersafiaapalicgia�¢msa� Sameoaners Who salmnt this affidma imiff==g tizzy axedoimg alfProt sad theahim outsidecontmct=vrmst emitanewa8idaeit mdicsdae sach- fCcutactoxstbatcbeckiW bmn=z=r�h anaddi =21sheer5haaia9thenameofthesub-caatrscm¢ sad stzmwhegmor met fhoseeoddesbwe employees.Iftbes*,h..��have empleyee,theY=Istpnnided&k warkexs'tamp paliynmabez I a rt an eittplo r flint is prmRi workers'cotziperesatrnrt insurarres f or itx;}•enipFoy�es $eToty is die paticy aad job site i jormatiars Insurance Company Name: r� PoFrcy or Self-ius.I.ic-9 915 LhO ExpirationDate: 03 Job Oe A&m= - �J Q Cify/Statd ip: (!CtnACCV A e . Attach a copy of the workers'carmpensationpo cy-declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section:25A of MGL c.M can lead to the imposidon of criminal penalties of a fine up to$L50D OD an&or one-yeasimprssm==3 ,as we11 as cif penalties m die fonm of a STOP WORK ORDEAand a fine of up to$250_00 a day against the violator. Be advised that a copy of this sWememt may be forwarded to the Office of Investigations oft he DIA for insurance coverage vr an- IaFo Hereby certify ander.the ar a.... thatilie ihformaffmspmiiWabmeIs bars and correct Sit�taturec Date: 0 2 • �6 phone ik - fib$ 46g�ol02___ Office L use anly. Do stat tyke in ttd area,to be campleted by city ortotMa ap•f)'iciat City or Town: Perrmiff iceuse:g Lnumg Authority(circle one): L Board of Hzdt€t I BuTieing Department 3. Town Clerk 4.Mechical Inspector 5.Plumbing EmsEwctar 6.Other Contact Person: Phone& haformation and Instructions zss c setts CTMaPaa1 Laws Chapter M req=es all emplapers to provide w033eas'compeosEfion for their employees. Pmsaa&to this sfatufe,an=VIay=is defined as.,_every person in the sexdce of another under any contract of hfir, esp~ress ar impHC4,oral ar Wat na" Aa employer is defined as"an indxvid±oal,partaersh�,association,comporai3on or other IegaI entity,or any two or more of the foregoing engaged m a Joint entmpp se,aadinclnd-mg the legal represen a&es of a deceased employer,or the receives or trustee of an individual,parfamship,association or other legal entity,employing employees- However the owner of a dwelling house having not more thin three apartments and who resides therein,or the occupant ofthe - dwuUiag house of anniher who employs persons to do maintcuance,consf ct icm or repair work on such dwelling house or on the groun4s or bm7ding appu�thereto shallnotbmanso of such mmploymentbe dEemedtn be an employer." MOL chapter 152,§25C(6)also sues that"every state or local TirP�agency shall witiiliold ffie issuance or renewal of a Hcerse or permit to operate a business or to construct bux-ldhip is the comamonwealth for any applicant who has notprodnced acceptable evidence of cdmnpfiancewn the mTmrance.eoYeJragerequn-ed." Additionally,MCrI.chapter IA§25CM states-Tmither the mint any ofits political subdivisions shall enter into any contract fur the perfoffi ance of public work uutil acceptable evidence of complimcewith the fil=aT,ce. regL�aenfs of this chapter have been presented to the cunt=ti anihoi'ty." A_Pplic=±s - Please fol out the worIoas'compensation affidavit completely,by checking ihe boxes that apply to your situation and,if necessary,amply sub-cantrac or(s)name(s), address(es)and phono n= er(s)alongwlhthea cmti acate(s)of „sr„a„ce. Limited Liability Companies(LI-C)or United Liability-Partn=ships(LLP)wifhno employees other than the members or panne"-,are not rbquired to cant'wom keys'compensation insurance- If an LZC or LLP does have da " be snbmid to the D a-tment of Industrial employees,a policy is regnim:ed. B e adVzsed that this affi yrt may eP Accidents for confirmation of incur mvms-age. Also be sure to sign and date the aftidavi-t. The affidavit should bezr etmmed to tHe city or town that the application fur the permit or license is being requested,not the Departum-e at of . ions the Iaw or if u are regaued to obtain a workers' Tnrh,.efrial Arl--rLTPa'��s. got7Td.yDIIhave ally gnesiz regarding ye compcafic policy,please call the Department at the number lisp below. Self- �paniesshould entertheir e„ s elf-insurance license number on the apprapriafe line. City or Town OMciala . f Please be sore that:the a$Lwk is complete and prn3tmd 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 permitllicease rnnaber which will be used as a reference nranber. Iu addition,an applicant that must submit iaubiple peuniitllicense applitations is any given pear,need only submit one affidavit indicating can t ohcy mlfbraation elf necessary)and under"Job Site Address"the applicant should write"all IocatiLas m (�Y or p town)_"A copy of the-affidavitthat has been officially stamped or marked by. e city c town may be provided to the applicant as proofthat a valid affidavit is on file for fdure'peunits or licenses. A new affidavitmust be filled out each year.Where a home owner or citizen is obtaining"license or permit notrelatedP any business or commmrcial4aat=e (i-a. a dog license or pemoit to bump Ieaves etc.)said person is NOT to complete this affidavit: tre to thank you m advance for your cooperation and should you have any gctesiions, The Office of Investig�s would li please do not hesitate to give us a call. The Department's address,telephone and fax mmn-ber: *of�nstts �a�anwe�t DeparEment of Iudugdd AwZent% f ice Of e&tFgktio.� �Q E�11F Fax 617 727 774-9 Icevised 424D7 .ma �fr�za AC�® DATE(MMIDDIYYY`() �, CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER ACT NAME: Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY PHONE 508 775-1620 ac No: E-MAIL ADDRESS: Isullivan@doins.com 973 IYANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURERE: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 162263 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. ILT R ADDLTYPE OF INSURANCE JUM SU n POLICY NUMBER POLICY M D Y EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ TO CLAIMS-MADE OCCUR DAMAS(RENTED PREMI ESES Ea occurrence) $ MED EXP Any one person $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PET LOC - PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident) cid nl $ ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A accident) BODILY INJURY Per ident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Peraccident) $. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X I STATUE - OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? I NIA1 NIA NIA R2WC835340 06/03/2017 06/03/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 - N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Anat011 SIVItSkI ACCORDANCE WITH THE POLICY PROVISIONS. 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 Daniel M.Cro ul�y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation One Ashburton Place ' Suite 1301 Boston, Ma sach�usett's 02108 Home Improveme Contactor Registration Type: Corporation CAPE COD HOME IMPROVEMENT,INC. Registration: 1 �' � Expiration: 12/043 2(06/2(2018 27 MILL POND RDa �w WEST YARMOUTH,MA 02673 H 4 Update Address and Return Card. SCA 1 4 20M-05117 ICI ,-.- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENTCONTRACTOR Registration valid for individual use only TYPE:Ggrooration before the expiration date. If found return to: eeaistrattoni Expiration. Office of Consumer Affairs and Business Regulation 168043 � =. 2/06/2018 10 Park Plaza-sui CAPE COD HOM4,fAP_.°ti N. INC. Boston,MA 0 ANATOLI SIVITSKI 27 MILL POND RD. WEST YARMOUTH;MA 2 3 Not valid wit out signature Undersecretary , 1 us Depart of Pubfic Safety MO-Stachuse ment I Boardof Building Regulations and, Standards Constru, ctlion SuperVisor' 'SPecialtv e dig . iCSS,L-1,06040 . , s 71 ANATOLI Sivi tsj�a 222 BUCK ISLAND RID-6 . West Yarmouth 2 6 7a, g \2 ir .. Y 0/ 0 *woo& Exp at* Commissioner Ale4ll CAPE COLD y�pc�®p HOME py��p9 Q��7��M ���}y y�61��p}p p� {'II)�Ill'Ilfl{)fry'CIf1C1'{ CAPE COD 15 y®mil pff�y IMPROVEMENT mfllVHiyjl`� g �RB 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001, (508) 469.0102 CAPECODINC@GMAIL.COM, WWW,RoOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME ---------------------------------------------------------------------------------------------- PROPOSAL 1 1 -09.2017 TO ANN SWECK LOCATION: 575 OLD STAGE RD, CENTERVILLE WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR MAIN COMPOSITION SHINGLE ROOF: • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST.DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION (APA). NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE.DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE FLANGES,PERIMETER DRIP EDGE MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. • ONE FTOW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL LINE A MINIMUM OF 18 INCHES TO PROVIDE PROTECTION AGAINST DAMAGE FROM ICE DAMS. INSTALLATION OF ONE LAYER OF ROOFING UNOERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERTAINTEED SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SIX NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. • INSTALLATION OF A SHINGLE-OVER RIDGE VENT,VENT IN THIS AREA IS CONTINUOUS AND WILL LAKN CAPE COD HOME IMPROVEMENT T 4 GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAG�N CAPE COD �f I•luncimmircmrnt GAPE COD HOME IMPROVEMENTTM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617)710.1001, (508) 469.0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW,FACEBOOK.COM/CAPECODHOME WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS, SINCERELY CAPE COD HOME IMPROVEMENT TM THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI "TONY" SIVITSKI ACCEPTED BY SIG TF_ ACCEPTED BY ATE _��I ._V ACCEPTED BY SIGN DATE CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY - PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVCMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS P'AGI '" TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map I9 Parcel OU 3 Application # Health Division Date Issued ZYI/Y Conservation Division ®k Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board IA Historic - OKH _ Preservation / Hyannis Project Street Address 5 J l3, k-rV l I Ill-f, yZ(O J Z Village C � Owner An Y1 \ Y�•5W e,t Address Telephone 1?� CA0 3013(p Permif.Re Request &�—L lY� (Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ZI C)00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) r Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'&?,-ighway: fl Yes ] No; Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) can %0 v Number of Baths: Full: existing new Half: existing new rn Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER--OR-HOMEOWNER)"- `Name )n �`�� -- WTelephone Number �& Address J�7 S �1( License # �rl \0 l It MCA CA Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 I j LI FOR OFFICIAL USE ONLY APPLICATION# DATE3ISSUED MAPS/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FfREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT,--- AS-QC.IATION PLAN NO. ' f s the t ommonweaan oimassacauseus Deparment of Industrial Accidents Office of Investigations = 600 Washington Street Boston,MA 02111 www.mass govhUa Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information 7 Please Print Legibly Name(Business/Organizafion/ dividuaD n n Address:_ City/State/Zip: hn Yom I I ' I a Phone (D % -2 3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with I,Ell am a general contractor and I employees(fuII and/or part-time).* have hired the sub-contractors 6. ❑New construction , 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-cofactors have 8. Demolition working for me in any capacity, employees and have workers' co insurrance# 9. ❑Building addition [No workers Comp.inct,rance comp- � �] 5. E We are a corporation and its 10.E Electrical repairs or additions 3: I am`a homeowner doing all work ' Officers have exercised their 11.E Plumbing repairs or additions myse]f [No workers' comp. right of exemption per MGL 12.E Roof rep airs §14 and we have no 152. , , insurance required.]t c ( ) „� employees.[No workers' •13 Other comp.in urance 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 hue outside contractors must submit a new affidavit indicating such. tha t at check this box must atfached an additional sheet showing the name of the sub-cant ractors and stair whether or not those entities bave employees. If the sub-contractors have employees,they mast provide their workers'camp.policy number. lam an employer that is provLRng workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: r_ PoIicy#or Self-ins.Lic.#: Expiration Date: cdob Site Address: .l " `�14XCiQ- Cot— _ City/Stateaip ckatuNo, Attach a copy of the workers'f ompensati'onnppo�licy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a �e P fine up to$1,500.00 and/or one-year imprisomnent,as well as civil penalties in the form of a STOP WORKORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement:may be forwarded to the Office of Investigations of the DIA"for insurance coverage verification: I do hereby c nder p . and penalties of perjury that the information provided above is true and correct S _ --Date: l Phone#: A Official use only. Do not write in this area,to be completed by city or town offidaL 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'cmplayers to provide workers'compensation for their employees. Pursuant to this statue,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An empfi er is defined as"an individual,partnership,association,corporation or o legal entity,or any two or more of the foreg g engaged in*a joint enterprise,and including the legal repres of deceased employer,or the receiver or tee of an individual,partnership,association or other legal entity, plo36g employees. However the owner of a dweIig house having not more than three apartments and who resi s th#n,or the occupant of the dwelling house of another who employs persons to do maintenance,constructi or/epair work on such dwelling house or on the grounds or btu:t .ding appurtenant thereto shall not because of such Io n be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local!i using gency shall withhold the issuance or renewal of a license of permit to operate a business or to co ct b Zings in the commonwealth for any applicant who has not produ�ed.acceptable evidence of co Rance with the insurance coverage required." Additionally.MGL chapter 152,§25C(7)states"Neither the ommonwealth nor any of its political subdivisions shall enter into any contract for the p once of public work tit acceptable evidence of compliance with the irmi ante requirements of this chapter have b resented to the c trading authority." Applicants Please fill out the workers' compensation affi t letely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addr es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or ed Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry wore ' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that davit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverag . Also a sure to sign and date the affidavit The affidavit should be returned to the city or town that the applicati for the p or license is being requested,not the Department of Industrial Accidents. Should you have any que ors regar the law or if you are required to obtain a workers' compensation policy,please call.the Departm t at the numb ed below. Self-insured companies should enter their . self-insurance license number on the approp e line. City or Town Officials Please be sure that the a/davit is compl and printed legibly. The D artment has provided a space at the bottom of the affidavit for you tut in the ent the Office of Investigations as to contact you regarding the applicant Please be sure to fill in tit/lic a number which will be used as a r erence number. In addition,an applicant that must submif multiplit/lic e applications in any given year,ne my submit one affidavit indicating current policy information(if ne ) d under"Job Site Address"the applicant sh uld write"all locations in (city or town)."A copy of the a th- has been officially stamped or marked by the m'or town may be provided to the applicant as proof that a davit is on file for future permits or licenses. A w affidavit must be filled out each year.Where a home owen is obtaining a license or permit not related to business or commercial venture 1 e.a dog license or perum leaves etc.)said person is NOT required to comple this affidavit The Office of Investigatiuld blue to thank you in advance for your cooperation and uld you have any questions, .pleasedonothesitateto a call. The Department's address telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Aocidents Office of lavest igations 600 washingtau Stet. Boston=MA 02111 Tel.#f 17-727-4900 ext 406 or 1-877-MASSAF Fax#617-727-7749. Revised 424-07. vww.ma ,gGWdia Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division - * �� Tom Perry,Building Commissioner 16.19.am ��� 200 Main Street, Hyannis,MA 02601 pTEoI a www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: ` (�J I � ' '� J . Please Print ,ham /��c.� C�j g�A JOB LOCATION: / . ) � ,,ti ilia[( - L� number _> J� street village "HOMEOWNER': -1_ I I 1 n K ,5W cl ,/ ` ! y /� I _ name �j - home phone# work phone# CURRENT MAILING ADDRESS: J V Kc 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 undersigns "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pr ed s ano requirements' and that he/she will comply with said procedures and requirements. t/ w f Signature Ho meo er 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:\WPFILF.S\FORMS\building permit forms\EXPRESS.doc Revised 061313 Town of Barnstable KJ: • � °; Regulatory Services&AR `y 'STABM MASS. Richard V.Scali,Director 039. '°rED M(►`l p`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ax: 508-790-6230 e ProP rty Owner Must Complete and Sign This S Ztion If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho d by s n this di ermit a lication for g P PP r. (Address of Job) "Pool fences and rms are the responsibility of the applicant. Pools are not to be f' ed or utilized before fence is installed and all final inspections ar performed-agid accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS S7 S- ofd Stnye Cf , �, x to i ;�x 0 -�.rrijq P �1 X 6 Post �T I- 3'-4 .00 -100 l� Ex ; sf- ^y 5 vh � � �. r 3 G a jA--o--7 — � Alf y P r y soa� ,cr o �x fO TO �� 5t PTLa Iq �t Q�lt� 2x10 TH.� Ve P - �' SST s�wP 7' osfi 14' of-� �pTHETp�,� The Town of Barnstable BARNSTABLE. ' Department of Health Safety and Environmental Services Ti MASS. 0P a-p a6}9• N0 fEUMPy° Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection F5�A L. Location IS 17 J ) AGE 1Z b Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Oy U Sar�O Z n1Sf E-C-i) o Aj ® SMPP-oPEZ� L.A7C' ZAL. SUPp6P-T FOP AT = (')P9QsPEA LATEeAL SUEP00el FDP. P6STS 3LAPP627�)JG :TMPR0PE-IZ LA-7fP-AL CO,QN'r—CTJ0I\J F02 C� �T Please call: 508-862-4038 for re-inspection. Inspected by Date �)� Town of Barnstable *Permit(;)?o � Expires 6 monUtsfrom issue date Regulatory Services Fee EMANSTABLF, KA 16 9 ��� Thomas F.Geiler,Director Q l �AjEbMA't�' � Ot3�!II Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable:ma.us . Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number i Q 1 0® 3 Property Address LLF_ residential Value ofworkt -C) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address�, r� LA :Rt�I�t �� Contractor's Name ?U�� Telephone Number_ `]S(; ® 94�1 Home Improvement Contractor License#(if applicable) Z Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance 7Ch kone: .«s I am a sole proprietor ❑ I am the Homeowner p U G 21 6 ❑ I have Worker's Compensation Insurance OW( OFBARNSTA.SLE, Insurance Company Name' Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) VRe-side _ El Replacement of doors Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is Arequi SIGNATURE: Q:\WPFILES\FORMS\building permit forms\E RESS.doc Revised 070110 The Commonwealth of Massachusetts I; Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizafion/Individual):. Address: OLC' \®w ) Vito City/State/Zip: AW 05 M A, Q a GO 1 Phone #: SO% -1 9® 05 cl 4 Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 mployees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.VIII am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any.capacity. employees and have,workers' [No workers' comp.insurance comp.insurance.$ 9• ❑Building addition required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their - 11.❑-Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs t. insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other_ S XZX N1 C- comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that'a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify underLhe pains and penalties of perjury that the information provided above is true and correct. Signafore: Date: Phone#: Q 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#: THE T Town of.Barnstable Regulatory Services { { * saxxsrasc.El ♦ .. y Mass. �+ Thomas F. Geiler,Director Fni A�A�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the propertysubject J here y authorize o v to act on my behalf, in all matters relative to work authorized by this building permit application for- 6jak °aG 3 , (Address gf Job) S g afore of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISS ION �pF SHE r � Town of Barnstable . y�P Regulatory Services BARNSTABLE, Thomas F.Geiler,Director 4 MASS. g i639• ♦0 Building Division �PrFD"u'y A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 0260 www.town.barnstable.ma.us Office: 508-862-4 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEM ION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: f city/town state zip code The current exemption for"homeowners"was extended incl de.owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who a not possess a license,provided that the owner acts as supervisor. DEFINITION OF H OWNER Person(s)who owns a parcel of land on which he/she resides in ds to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached strut es acc sory to such use and/or farm structures. A person who constructs more than one home in a two-year per' d shall n t be considered a homeowner. Such "homeowner"shall submit to the Building Official on a fo . acceptable t the Building Official, that he/she shall be res onsible for all such work performed under the building ermit. (Sectio 09.1.1) The undersigned"homeowner"assumes responsibility for ompliance with the to Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she unde tands the Town of Bamstab Building Department minimum inspection procedures and requirements and t-he/she will comply with said ocedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 351,000 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 wkiich 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." r 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'responsioilities,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:formr s:homeexempt _ Office of Consumer Affairs and usiness.Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement CPntractor Registration =- r= Registration: 119952 Type: Individual Expiration: 9/24/2011 Tr# 294576 GUY L. RUFO GUY RUFO 10 OLD TOWN RD. HYANNIS, MA 02601 Update Address and return card.Mark reason for change. ❑ Address Renewal Employment 0 Lost Card DPS-CA1 is 50M-04/04-G101216 , � ✓1ze �o�rno�uueaC�'a�✓��aaaac�uaella . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration ' )19952 10 Park Plaza-Suite 5170 Expiratlon._�9124/2Q11 Tr# 294576 Boston Type; `Individual ,MA 02116 GUY L. RUFO ", GUY RUFO s 10 OLD TOWN RD. .. HYANNIS,MA 02601`\"-''="` Undersecretary No alid with ut signature - � iMassachusells- Department of Public SafetN Board of Building- Re�-ulations and Standards Construction Supervisor License One- and Two- Family Dwellings License: CS 56192 GUY L RUFO m a, 10 OLD TOWN RD s HYANNIS, MA 02601 ' Expiration: 12/11/2012 ('ommissioner Tr#: 12900 SO—; -,;, Assessor's ap(1st Floor): Al D0� `TNE Assessor's map and lot number PAC TO`` Conservation vv w i Board of Health(3rd floor): , 1 ssa,�r�nta Sewage Permit number Engineering Department(3rd floor): ~�° 0 o• House number ��err Definitive Plan Approved by Planning Board 19 . APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO G'4U579r,j-.7- yX#.20 � , 'c, , 24,e0,eSM_ A010'r- 6;A�p me t TYPE OF CONSTRUCTION 2T �� -- 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �� L/D i 1I//all- Proposed Use Zoning District Fire District Name of Ownerl1'/ zmv 6a�_ Address ir. rv/ ✓ter✓ Gi Name of Builder Address/��s../U vdiJ �� �X- Name of Architect Address Number of Rooms Foundation Exterior Roofing ;zfzt .4P%81?,6X o&Ar1r6 oni rao�J�N Floors - Interior Heating Plumbing re, Fireplace Approximate Cost Area o w Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above nstruction. j Name �i- 711!pzo Construction Supervisor's License 4!!ZA � M/M LAWRENCE BRADY v RE—ROOF if No �—r2-5- Permit For BUILD PLATFORM ; Single Family Dwelling ; ; 575 Old Stage Road Location _ Centerville I M/N�^Lawrence Brady f �• Owner. s Wood/rubber roof Type of Construction Plot Lot October 6 Permit Granted 19 3 Date of Inspection 19 ` A Date Completed — r �S 19 , ' 3 x. - Pow NA ✓T R� T cAS9'2 ANC ROST'� Jlip- SEPTIC SYST Mid MUST BE Assessors ma and lot number ....... .... v INSTALLED S ' p �1........ ......:...... IN C(3M�IPLIR�1 T - . ., . . ............. IT LE 5 Sew-age Permit, number/ .: ... ..... . E�B �QVMENTAL Q� CODETOWN 3 /i REGULATION oB'EUST A BLE,House number . . ice'� : . r rba ... ...... .... � ....................... ........ .... ... .... � a i MPY a' TOWN • OF RARNSTABLE BURDIHG ANSPECTO R` r • APPLICATION FOR PERMIT TOO' ���t� .C.. � TYPE OF CONSTRUCTION ........Cod ... . . ... . . .. � .... 'y,! �P..`.......•1.:................................19.g ~ TO THE INSPECTOR OF BUILDINGS: The under9ned hereb applies fora r'mit ac" r 'ng to folio ing informs ion: Location .. ................... Proposed Use ... .... ........ ............................................................. .. .. ... .. ..... ..... .................... .. ..... ... ZoningDistrict .................................................. Fire District................ .....:............. ..................................:......::........... Name of Owner R . .. ...... s ..................Address .�r<3: Name of Builder" Nameof Architect ...:............................:....:............................Address .................................................................................... " Number of Rooms .............. .... . ............................................Foundation .:-::7=................................................................. Exterior ...... . .......:..:......................Roofing ...C�.1i.0i1..:.............. ....... ..........?.............. Floors .................. .-...............................................:......:.Interior .................... ............................................................... Heating ..........Plumbing Fireplace ..................................................................................Approximate Cost ................. ................:........... Definitive Plan Approved,by Planning Board -----------___:---_-----------19.______:. Area ................ .:.......:.............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 Sj G /7 C • OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of 2,�oBarnstable r arding he above construction. Name ................ STEIN, WALFRED No 24117.... for ,...ENCLOSE SUN DECK .................................. Single FalilY Dwelling ................................................................................ Location .....1-575 Old Stage 1Road........................................................... -,Centerville ............................................................................... A Walfred Stein Owner ................................................................... Type of Construction .................Frame......................... . ....................................................I............................. Plot ............................ Lot ................................. Permit Granted June. 7, - .........19 82 .c 11 Date of Inspection .............................:....... 19 Date Completed ......................19 Cr 41 r''s maps and.lot ;number ................... 01 . .... . 01 .�............. s' 4SEITPET-IIC SypeM tT EINSTALLED IN GO- s ? , Y M P TI 'LIi — ANCBSe<wrage.•Dermt,number ...... ........:......................�......... CLE 11 STATE 9_ I i SANITAF?y CC. �of.tME To It AND pWN. TO W N OF BAI:'N,-S ABLE _ Z 8A&1,9T11DL8: 9°O0 aYa�e`� t, aBUILD°ING INSPECTOR ro .APPLICATION FOR PERMIT TO . 8 v� ..................... 'TYPE OF 'CONSTRUCTION. "' 74 g� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informatiom i . Z- 01.4..... ..�1.V64. ......4.......� ..... Location ........ ....^^..rr........ ......1l................ ..... i ..................... .....::.....:.................... ProposedUse .......L.`l.f�.. .:`. .... .G--........................................... . ................................................................... Zoning District ..............',`:. ...................... .................Fire District .........0 ... �.l. �........................... Name of Owner . , /:........vr�,........ . L" ............. .:.........Address ................. .. 1 . ... .....�. . r1 ..-�...............,... Name of Builder ....... .......................................` .........Address ........................................................................................ L � � c Nameof Architect ..................................................................Address ..................................................:................................ Numberof Rooms ..................c-5..........................:..............Foundation .........C........................~....�...�.............................. �� �� s �� � Exieior ............................................ .............Roofing ........:...... S. ... ` ............................... CA ��` ��v Floors1.1.`' '!v..................c�1 .......`...................Interior ,.................. 7/:.....:...... ...........�............................ Heating ......... 1 .0...........1: c... ...`.............Plumbing ........................4...........'s ,...................... jj G2sZ/� Fireplace ..................1...........'...................:.........................:...Approximate Cost ............ ................................... .. Definitive Plan Approved by Planning Board ________________________________19________, Area. .................... .......... ......... /76 Diagram of Lot and Building with Dimensions Fee ��jj ........:�; .... ...................... SUBJECT TO APPROVAL.OF BOARD OF HEALTH r , . . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... . ............................. Smith, J. K. 1804�� ". . one story, " 1 .........ti. Permit for .................................... ` w ;:. sj�,jiglefamilyAwelling f ........ • Locotio►1.W..' ld \Stage Road'....................... !" .......e Centerville .... .... .................. y J. K. Smith . .. '' . i q-er .................................................................. Type of Construction ...,.•••...frame.............!................. ,,; ....... ...................................... .................... - Plot ....... .. ........ . Lot ............`.#..12............. November 12 15 Permit Granted .................. 7,yd��S C�', Date of Inspection ...///o�.. ..... )19 Date Completed . �9,ly .,.r.9 19 1 Lj T PERMIT REFUSED . , . r. . ........ ............... 19 _ ,, ell ...................... :............ ................. U ... ,,: �.... ` ..... ........ ........................ /.... �. ................................................ 7:. _ _ ' ' + d „ F .. f .... . .... ........... - 1 Approved .., ............................................ 19 �. ............................................................................... _ e ....................... ...� f Y L.oTc LoTiz V 90 - ti • 80 �7 til o�O � •�O � fOv.�./O � , Y7. ti N --TSB/' z3'oo• Zo/.2/ -� J V 7- CERTIFIED PLOT PLAN L O C AT I O N'. G L-_A17 E',O f//L L E SCALE: /"= '/a — DATE °✓ _ S /9�S R E F E R E N C E 1 ZoT 'fg e^1/_A,Vv c o l�.2T �G 9.v 01323 7-3`r y"t/ o A T' .��yam' 1-7 I HEREBY CERTIFY THAT THE BUILDING GAG !_ AND SL' R cY0R T SHOWN ON THIS PLAN 15 L O C A T E D ON THE GROUND AS S H O W N HEREON AND THAT It L�oi�✓c _ CONFORM, T O THE S': 111OF ZONING BY - LAWS OF THE TOWN OF �llgsf9t' 8�ge,c%5Ti96G� WHEN CONSTRUCTE D ��+ GEORGE yGN c� LOW,1R. y BAR NSTABLE SURVEY CONSULTA �. T5, 1Nr �� wEST YARMOUTt4 V A-SS Oau