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1 I i I j i 5('� 1 F 'i S. II I a�M..� oFtME r Town of Barnstable *Permit# Expires 6 mo the rom issue date * Regulatory Services Fee * anxrtsTABLK v� Mass. $ Thomas F.Geiler,Director 1639. 10 ArED PAA�A Building DivisionF��ll Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / O O© Not Valid without Red X-Press Imprint Map/parcel Number 0"� e Property Address Residential Value of Work$ `� �OD• GU Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S14A c Contractor's Name 'I(o„N '66 C Un Telephone Number I y ' '2�F ' 0.3 4 Home Improvement Contractor License#(if applicable) 1599,k 2 Email: Construction Supervisor's License#(if applicable) to E ' f G/ 696 eq pomp ❑Workman's Compensation Insurance ®PRESS ChSOeone: [�I am a sole proprietor AUG 19 2013 ❑ I am the Homeowner ❑ I have Worker's lCompensation Insurance fli'V4 Insurance Company Name 3 r CIG�( J U `t 4 f TOWN OF BARNSTABLE Workman's Comp. Policy# f 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 ❑U<Iroof(hurricane nailed) noj stripping. Going over existing layers of roof) Re-side !jl St. 4,A tit. 1 ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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: roperty caner must sign Property Owner Letter of Permission. copy the Home Improvement Contractors License&Construction Supervisors License is r quir SIGNATURE: Q:\WPFILES\FORMS\building permit forms RESS.doc Revised 060513 1 . The Commonwealth of Massachusetts Dep,arhnent of1"ndustr al Accidents Office o,f Investigations 600 Washington Street Boston,MA 02111 Wt4'm7nas&gov1dla Workers' Compensation Insurance Affidavit:B-uilders/ContractorsMectricians/Plumbers Applicant Information Please Print 'b Name(B�oWnizatioa&dividml). ZLtAe? Address: Zk G i97 CitylStat&Zip: f o Phone 4- 7 - 2 3 - 0 3 G Are you an employer?itheck the appropriate boa: Type of project r 4_ lama contractor and I 3� � 3 (���- I_❑ I am a employer with ❑ general 6_ ❑New construction employees(full and/or part-time)* have hired the sub contractors. 2- I am a sole proprietor or partner listed on the attached sheet; 7- deg ship and have no employees These sub-contractors have g_ ❑Demolition. w for me in an c ci �. employees and have woticers' otlCing y spa t5 1 9_ ❑Building addition [No workers' comp_insurance comp.insurance. required-] 5. ❑ We are a corporation and its ME Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_.❑Plumbing repairs or additions myself [No workers'comp- right:of exemption per MGL 12_❑Roof repairs insurance required.]b c-152,§1(4),and we have no r r 1311 Other Wk employees_[No workers' t 4 �--1 comp-insurance required-] *Aiayzpp1ic=that checks boat#1 must also fill out the section below showing their woakers'coarpensatioa polio infutmatia- T Homeowners who submit this affidavit indicating they are doing all wolc sad then hire outside contractor nmst submit anew affidavit indicating such- ZContractor that check this boot must attached an additions)sheet showing the name of tie sub-coa>trscton and state whether or not these entities have employees. If the mVconttactors have employees,they must provide their workers'camp.policy number. I am arc employer that is prm iding workers'compensation insurance far azy employees. Below is Sre policy and job site information. C - Insurance Company.Name: 3 rf Jle t ' Policy#or Self-ins.Lie#: T 7 U l7 M Expiration Date. Job Site Address: 2 z,yr wd e// Z AI CityMatelZip: &L Attach a copy of-the workers'compensation policy declaration page(shoving 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 a rend tkapains andpenalties ofperjury that the information pratzded above is hue and correct Si ture: Date: 1 , /6 .X eel Phone#- �7 y �f}rcia1 rise only. Do not write in this area,to be completed by city or town o i'ciaL City or Town: Permit/License At Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other e Contact Person: Phone#: 6 , t Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL.chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liabili-ty Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation offfisurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit Ls complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license of permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is l,,TOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, Please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Degaitment of Industrial Accidents off m of Invcstigattioxns 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 Www.mass_gov/dia Massachusetts -Department of public Safety Board of Buittling Regulations 9 and Standards Construction Super,isor License: GS-101696 TIMOTHY P JOFq4soN ; 180 MEGAN RID Hyannis MA 02661 ' 9 i s Expuat on Commissioner ...08/2312014 { C��ie pay mancvecci a� aaccc�iuQelta ..Officerot Consumes Affaiirs&Business Regulation License or FV00*ygi��d for ind�vidul:use only W -,-M'E IMPROVEIYIENT.CONTRAGTOR ..... —e ,;the eptratiot►date. ii..found return to: eg�stration 59982 Type: 9ffce of Consumier AffaiFs a_nc� psiuess:Regulation Piration 61* -14 bBA 10 Park Plaza Sai 5190 4.oston, 01116 TIMOTHY.P JOHNSQIV�L 75 _m.fGT10N r ply s� TIMOTHY JOHNSON"'��� 180 MEGAN RD HYANNIS;WA 02601 Undersecretatry Not !i without signature. THE r Town of Barnstable -Regulatory Services t BALR`'S'M Thomas F.Geiler,Director rEp N,p.� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit. 1 (Address of Job) *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is,installed and all final inspections are performed and accepted. ature of Owner Signature of App cant LCPI Print N e Print N e Zo Dad Q:FORM&OWNERPERMISSIONPOOLS 62012 mot , Town of Barnstable } Regulatory Services '"'"SS. ` Thomas F.Geiler,Director 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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. DEFE TfION 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 fonn acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 Itgages'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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 - _ Q Enginefering Dept.(31d. �floor Map_ = 0'1Q = Parcel 0:'0 6' Permit# n�� (-1 _ House# / Date Issued 5— -91- Board of Health( floor (8:15 -9:30/1:00-4:30). e1P�. Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) I .. Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC S{ UST.BE INSTALLS Dei�ddress n r ed'by Planning Board r 19' ' ENVIRON TOWN OF EARNSTAELE TOWN D�AN©REATIONS Building Permit Applicationroject Street j,Ut jl TVlil�`�� Jan Village 00-htil ' a Owner IIr�hP. l 1V LGil'1 U�! Address Telephone Gf Permit Request �� First Floor - square feet Second Floor square feet Construction Type Estimated Project Cost $ Ar" - d7� Zoning,District lf/ Flood Plain Water Protection Lot Size Grandfathered ❑Yes No Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes )a No On Old King's Highway ❑Yes 2r.,No Basement Type: ❑Full ❑Crawl P'Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing / New No.of Bedrooms: Existing 6 1. New Total Room Count(not including baths): Existing 4o New First Floor Room Count Heat Type and Fuel: p'Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes 2rNo Fireplaces: Existing _ New Existing wood/coal stove ❑Yes JNo - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) y 8Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes @ No If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# 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 BUILDING PERMIT DENIED FOR TIgE FOLLOWING R T� �/l�Ay _ I FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED _ MAP/PARCEL NO. ADDRESS .VILLAGE w' , OWNER _: _ .. _ J - •, `",� DATE OF INSPECTION: ` we FOUNDATION FRAME - = ° INSULATION FIREPLACE - •, - --• - -M1 _.�-�.t '�.. t ELECTRICAL: ROUGH FINAL ' PLUMBING: UGI4L FINAL > t- t GAS: GIB FINAL FINAL BUILDIN '��[5 " r � � r DATE CLOSED 013 co ASSOCIATION PLI O. [n w[ �` V t . . : The Town of Barnstable 99$ Department of Health Safety and Environmental Services i- Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date — I' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW' SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other equirements. Type of Work: Est.Cost ^� Address of Work: l"MI`ll _0 P C&&4- Owner's Name— Date of Permit Application: /3 — 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME EkIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name r — d I' The Cotnntoalrealth of:lfassachusctty ' fir `;--==�•�:- Dcpttrttttent of lndustrial.4ccid nts AMC fif1=9=19,71/ors 600 111ashhIglott Street •�:'•�`�.� �'� Busrott„11ua:v. OZlll W'orkcrs' Compensation Insurance Affidavit -- -• -- - - PI P v i ii an inf rn1 ion• location city eeiz7=- nhone 1t T�� I am a homeowner performing all wort:myself. I am a sole proprietor and have no one working in any capacity [� am an entplover providing workers' compensation for my employeeworking on this job. cemoam• name: address• city. nhone#• insurance cn neiicv>Y a - or. ;t nera con vac '" r rcic one) and have hired the contractors listed beiow who ha the following workers' compensation polices: cemnanv n• toe, atitiresc• cin•• nhone a• nnlic� inciirnncc rn _ .�.. _ ....-•. Tit.. ••_:_. �r�.��ZL iS•'f!�.w•S'.. ..T. wi_...i.- cemnnn• n•tmc addres.r. _ cin•• - nhnne � insurance CO. policy d Attachaddid n21 sheet ifnecei_iirv�.....":.{ ^_..� �^�a"':ate . �n��."M: •+� +.• "a«'�: --.a'•— Faiiure to secure cuweracc as required under Section 3A of NIGL 152 can lead to the imposition of criminal penalties of a line up to SI.500.00 andiur vac Fears' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy'of this statement may be forwarded to the Office of Investigations of the DIA for coverage verik2tion. !do hereby certift•rutder th pails and penalties of perjuty that the information provided above is true and correct. Signature nn Date Print name I l "l4 ��✓� /f �0 r` Phone>* �d y• �� official use univ do not write in this area to be completed by city or town official cit} or town: permitilicense># rtlluilding Department .. .• C3Ucensing hoard check if immediate response is required OSciectmen s URce ►• �- 0lleallh Department contact person: phone#; rtUthcr iniormatton anu instructtuna Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As cluoted from the "lam'. an enrphoree is defined as every person in the service of another under am, contract of1iire:cxpress or implied. oral or written. An enrphor r is defined as an individual. partnership. association. corporation or other legal entity•, or any two or morc . the foregoing_ en�saged in a joint enterprise, and including the legal representatives of a deceased employer. or the recci%•er or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dweliing }louse having not more than three apartments and who resides therein. or the occupant of the dmJeliin�_ house of another who employs persons to do maintenance , construction or repair work on such dwelling_ hour -)r on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. '� g iall withhold issuance or v1GL clt:t ter I�_ section _5 also states that c�•cn• state or local licensing a cnc} sl 1 old tltc ts. •en01a1 of a license or permit to operate a business or to construct buildings in the commnvealth for anN- :pplic:int who fins lint prod;!ced accepi lVle evidence of compliance with the insurance coverage req�uir�ld. Wditionalk'. neither the commonwealth nor am• of its political subdivisions shall enter into any contract for the erformance of public work until acceptable evidence of compliance with the insurance requirements of this chapter iia .-en presented to the contracting authority. plicants !ease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and ipplying company natnes. address and phone numbers as all affidavits may be submitted to the Department of dustrial Accidents for confirmation of insurance covera`e. Also be sure to sign and date the affidavit. The Yidavit should be returned to the city or town that the application for the permit or license is being requested. .)t the Department of Industrial Accidents. Should you have anv questions regarding the "law' or if you are required obtain a «•orkers' compensation policy. please call the Department at the number listed below. ;n' or'Towns =se be sure that the affidavit is cornplete and printed legibly. The Department has provided a space at the bottom of affidavit for you to fill out in the event the Oh ice of lvvestigations has to contact you regarding the applicant. Pleas sure to fill in the permit/iicense number which will be used as a reference number. 77te afIidavits may be returned to Department by mail or FAX unless other arrangements have been made. e Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. -ase do not hesitate to __ive us a cz-ll. M.r....�•� .._ ._....•.-. .��-w�_ITw.Ji_.L•.�._-_.�wr..i -.��T.I��..���..w-IY�. .T.Y�y�a-w� _. e Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents `f Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749. J phone : (6I7) 7274900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION LL �j� - Number Street address Section of town "HOMEOWNER" i 141:yhm v Name Home phone Work phone - - PRESENT MAILING ADDRESS 1 ) ©L�x ao d S . oC. 10A 0�()0z 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 such homeowners to engage an in- dividual 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 re- side, 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 Officia on a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Sta Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "ho.iteow errs certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said ocedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Ownez shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for , licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ''Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Fier responsibilities, man communities require, as part of the permit application, that the Home Owner 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. e 0 �� S�e efi Y�csctQ V o i 'n�oW t'Xts'tinS �g�1-c��T_ a�4 � � 72 G/�K�..c<�i L.►. �l cS'tJ`�ET l�uc�lc �'YL►'td avt�l^�J (,J y-�/,r Cd r-�,�:�� r�tdt�rJ J'us p asp-cicc�' �'e<le•c j •� Assessor smap and lot number ............................... ... �FTHET�� Sewa a Permit number ....................... U? ? Q f g .... . J- d y Ep� s�R �� �� 9C SYSTEM STD:f�'�� EL'uST 241- Z BJHB9TADLE, i Housenumber: ........ .... ........ .......,...............................:...:.. gpi g �ALLED IN !r NAM �, 'o WITH TITLE TOWN OF ,BAWNSTAB'LE To .1 BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO '.:.:... . ... '. ....... .:....: ............... ....... ......................... ' TYPE OF CONSTRUCTION /.��4'�`T,� ................... ...: .c ... ..............19..... TO.THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a, permit according to the .following information: .. ..... �-- ProposedUse ......... ....... ... .. ... ...... . ... ........................................................................................ r- Zoning District ...`% .............Fire District ... ........ Name of Owner ..... ..Address ....��T.. `.......................... . Name of Builder .... ..Address .......:... Nameof Architect :....y ..'................:...............................Address ......... . ....................................................................... Number of .Rooms ...1. ....... ................Foundation ...:. Exterior. ,.Roofing ........... .. ................ .. ............. ... ti � II Floors ....... . . . ...s..... ......... .... :.Interior ..........��.,,� zi?�1c .�cOU>`... . .......L! ►5.� Heating % ,,5.............................::........Plumbing ............. -.......................................................:... Fireplace :............... . .. ........................................................Approximate. Cost ...� ..Q.J..�?a17�. a � $ Definitive Plan Approved by Planning Board ________________________________19--------. Area ...... .................... Diagram of Lot and Building with Dimensions Fee ......... ./..:..................tl. SUBJECT TO APPROVAL' OF BOARD OF HEALTH T OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of T hrns.tab ding the above construction. Name .. . re. ...... .......... .......... 01 Construction Supervisor's License ..,.,, �................ t lu1Pi2'1'OLI, ELI ZAB= No .................2og73 Permit for 111 stony ................................... Single Family Dwelling.:.................. Location .Lots...1.3A...&..l4A....Windmi.11. ................Cott lt,......................................: ......... Owner{....Elizabeth..�' tt li........ ... ...... Type.of Construction ...Ez ........... ' ...:.. ......................................... .......................... Plot ............................ Lot ................................ 4 t r Permit Granted ...September..l�' .......1.9 84 Date of,lnspectiorv'a?;t ....................19 _ Date Complet cl ............19 ' _ - " ( _ }+ .. �.���������E�� �� _ 'J , - h � • - Fes~ ' . V Assessor's map and lot number .... �.(� •�h ....c... +' 2 0 ypFTHE TO Sewage Permit number TO JJ LE House number ................................�...................................... � p , 39. \e • �a war a• TOWN OF BARNSTABLE BUILDING-INS-PECTOR APPLICATION FOR PERMIT TO ...... r ...�'(. ...../f ......... /I ) v TYPE OF CONSTRUCTION ..... �7 ......�./? ! t (,,,..................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit li`according to the following information: Location ..... /. ..... „7>,•. ..... � ... -. -.......................................................... ProposedUse ........ v!.�.�-c .....'7? .. -� ��YGL..?....,........................................................................................ V M ZoningDistrict ... . ... ...................... .................Fire District ........:.......................................... .......................... Name of Owner ......�.. . .......... ...../.�:.�!lU.(�...Address .......................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect .....N/ ....:...........................................Address .................................................................................... Number of Rooms ..�C......t.................. ...... .................Foundation ....dr .: r............................................ Exterior (,..C..!,!!!�!.�!i�t�. '-....��.�Gr .....................<� ..!.Roofing ............!!! /.....................•....' ,••:•••:••�••�• .....).... J Floors . ...................... .......'`....0 � (..............Interior .......... .. v�.T..,�..�.,...................�-G ....... tt•'j,! G ..S ...Plumbing ............. .............................................................. Heating / Fireplace ............... _../..................................................Approximate. Cost ....(..n..d..'...�`7T CJ. ....................... Definitive Plan Approved by Planning Board -----------_-------------------19________ . Area .:........................................ Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF, HEALTH r • � l 11' r t 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 l construction. rName .....� ...... ........... ........... Construction Supervisor's License ....©�..q. ........... N � MAMLI, ELIZABETH / A-44.0 6=40-24 + 0 o - aac� ✓ �I- . No ... ... Permit for .V2..9,..Qz .....O v lY..DY e Wl a........ Location 10tAs..13A.. AAA.... .s..2.. .ti9 , d1J. Lane L Z70 ....................... Qta.t........................................... Owner ...Bl1z :k.11.. tWli......................... Type of Construction ...FX:-�M............................ ................................................................................ Plot ............................ Lot ................................ } � Y Permit Granted ..September. 1�...........19 84 Date of Inspection ....................................19 Date Completed ......................................19 S � / 4 m•'��' �1 ± TOWN OF BARNSTABLE Permit No. 26973 = Building Inspector sia,rr.n, Cash OCCUPANCY PERMIT Bond __________�____ Issued to Llizabeth Mattoli Address 1 lots 11A 14A Windmill Lane, Cotuit Wiring Inspector �(� �'` � — Inspection date Plumbing Inspector,f' c 1 ,, Inspection date Gas Inspector a 1� x - Inspection date Engineering Department ` ' !� , � ,f f� t .` Inspection date 1/ I Board of Health ,�� , Inspection date THIS PERMIT WILL NOT BE VALID, AND THE'BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. fBudding Inspector 9 JOSEPH D. DALuz _ 4TELEPHONEt 775-1120 Building Committiontr EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING • HYANNIS, MASS. 02601 i i MEMO TO: Town Clerk FROM: Building Department DATE: May 31 1985 F An ,Occupancy,, Permit has been issued for the building authorized by ; Building Permit # q�3 issued to Elizabeth Mattoli Please release the performance bond. L . i " I i ' r .try'=,..;. �•".�r. � � , �, ; �.Y,C� c-• P�T � S"Rr � � F:"_`fit .Iv ;s.. . _ i !► � � -- --J PP.C�� ti.�ic� �' ;1 "I'"H of € DAVID .S C. THIRIN c N.. 29976 sroNa� �J q,3 COCA/OA-/ Shot-spiv yE.eEo�t/Co�1/?�K-5 61/iry .SCA � /,,y SO ° �>A TE j r-A S.,r,),E,c 4 A,A S,f- rB.a r-� -,4.ds .�E��,2E/✓c � C��•c�!!/.E''E�9�i(/.�..�' O.� 7-f•/E TGY�/it%,D,� '"—'-' ':;�4 TE ,g,A xT,E,e,!�.V> ///C. 7"///S �,v/S ,(/��-- ,�.�SEO ,4.Y �f?�'G/srE.2F� L.•4�-�O sveVEYar� AO.�'�/C.4i�' . Ez/Z—A l i ' v 5 I aiv IQv �kjy a��1 Tog-?- IT. � . c_:cam�.�.► S 1'r�N l l r I F r �3 = 4 � �n 1 �`.�� VT,(--I CA t_- -.' 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