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o, ,., its, Town of Barnstable *Permit#
Expires 6 months
4,'- i Regulatory Services date
:' snarsr�s.
k
taee Richard V.Scali,Interim Director r `s',
M�
Building Division
Tom Perry,CBO,Building Commissioner A U G 2 7 2014
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 TOWN OF'Sa.'` ",0.4 i4,?:',;' 0
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number .511 /b 31 &)O
Property Address 1() Bu r 'n g UX1 g0.r'n S
--)--elle--
Residential Value of Work$ j 101,— Minimum fee of$35.00 for work under$6000.00
yi
Owner's Name&Address 1YV 1 n1 4ae,u3 > , ,d Bunwuj Ru,\ C�.�e °
(
Y01111 s 0A(1) .))
Contractor's Name "Q �ri CSS6 h Ta r reS Telephone Number ®/m ®`/ L 3 FY
Home Improvement Contractor License#(if applicable) /e(o Er f 3 Email:
Construction Supervisor's License#(if applicable) 1 ()05741LQ
Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
0 I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name kegs) ilitivpsiiHRE //S °
Workman's Comp.Policy# V 0/ilk /2-
Copy of Insurance Compliance Certificate must accompany each permit.
1 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 - 36 (maximum_35)#of window _
#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 I li er"0 sign Property Owner Letter of Permission.
A copy r of H l'p Improvement Contractors License&Construction Supervisors License is
P
. required. '; r _ -
ef
SIGNATURE: ��� i /7
T: \VIN DBuilding Changes\EXP. S ' i�i a 'RESS.doc
Revised 061313
f
i %l' • HOME IMPROVEMENT CONTRACT
PLEASE.READ THIS
Sold,Furnished and installed by:
Branch Name:Boston North&South Date:_/,/I LI THD At-Home Services,Inc.
d/b/a The Home Depot At-Home Services '
Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545
. . Toni Free 577-903r3768
Federal ID#75.269846b;ME lie#C 02439;Ell Cont.List 16427
� CT Lie#IiIC"0565522;MA'Home Improvement Contractor Reg.#126843 .
Installation Address: �d `30 h n t. ,,,„ i�.J Ce s-E• r nit>•�� t'et p �I. 3 �-�"
City State Zip • .
Pu chaser(s): • Work Phone: Horne Phone: Cell Phone:
i-v v,r1 e4-u)Q.r t • [ ] [ ] [5 36a 5?/
[ ] [ ] [ ] •
Home Address:
(If different from Installation Address) City State Zip
E-mail Address(to receive project communications and Home Depot updates): •
❑l DONOT wish to receive any marketing cmatls from The Home Depot •
Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,
and THD At-Homc Services,inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation(`installation")of
all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by.this
. reference,along with any applicable State Supplement and Paymcnt Summary attached hereto and any Change Orders(Collectively,
..Contract"):
Job#: omtervad R wC 3 Products: Spec Sheets)#: Project Amount
Q � Ucu
Rong USiding�Windows 0 Insulation•
9 6 �� UGutrers/Covets❑Entry Doors❑ 70 VcsI $ Sl 1-, .
(Roofing USiding U Windows LI Insulation
Cuucrs/Covers❑Entry Doors❑" - $ '
D
—❑Roofing ❑Siding U windows U insulation
•
❑Gutters/Covers❑Enay Doors ID $
—❑Roofing ❑Siding U Windows Ll Insulation •
❑Gutters/Covers❑Entry Doors ❑ $
•
'Minimum TS%Deposit of Catmad Amount dna upon execution oftbb c
Marne Purchasers may not deposit more than ane•mirder the ContractAmout TortatGmtractArarunt $ 5'//
Customer agrees that,immediately upon completion of the work for each'Product,Customer will execute a Completion Certificate
(one'for each Product as defined by an individual Spec'Sheet)and pay any balance'due. As applicable,each Customer under this
Contract agreesjointly arid to be joinid severally obligated and liable hereunder. '
The Home'Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included.herein,at .
its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
.problegi with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because
work required to complete the job was not included in the Contract.-
Payment Sumarv: The'Payment Summary# a 9- 'O5.2?
rn included as part of this Contract,sets forth the total •
Contract amount and paymetts'rcquired for the deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a'completely alien-in copy ofthe Contract at the time you sign. Do itotsign a Completion Cet ifiCitte(notc:
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on.that Product
is complete.
In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses
and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Hume Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either
oral or written,relating to said Products and installation.This Agreement cannot be assigned or amended except by a writing signed
by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarii accepts the
terms of and has received a c this Agreement. y p
A epto tl Submi hG/�^ Q i nrZ
Customer's Sign. a Date Sales rsultant's Signature Date
- X Telephone No. p253/ 67'0 4 Vg
Customer's Signature Date
CANCELLATION: CUSTOMER MAY CANCEL THiS Said Consultant License No.
AGREEMENT WITHOUT PENALTY OR OBLIGATION (as applicable)
BY DELIVERING'WRITTEN NOTICE TO THE HOME
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY ASTER SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRE.SCRIBF.D BY LAW IN
CUSTOMER'S STATE.
' NOTICE'ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND.ARE PART OF THIS CONTRACT
xi-OT-14
• Whte-Branch File Yellow-Customer '
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Id Wl3SS:Oi TIDELI 'Q'ad ILZZ29£80S: '0N XH.i pe5wat: WOJ.a
• , - ; - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.
Map r ' Parcel 07 6f0 ` Permit# 4os
0)'
Health Division • • - Date Issued S-3I — 9 9
Conservation Division • ( Fee $,2 ., 00
•
'► -
Tax Collector : _, • - . ,' ' Gd;,
Treasurer Ulrit}IVANBAkir, • � ,II,,
N 17
Planning Dept. .
i , r )'/''...•G '‘)
Date Definitive Plan Approved by Planning Boarde
Historic-OKH Preservation/Hyannis • Z
Project Street Address /U '7 "�'� -e (t f n t 1�'✓_[\,it,
, ` • .
l� C lK-�. Y
Village _ - "-- 74 —hc4.,bfe
•
Owner - -
�'''°::" "f"l-"- I A. ,� � RiCCJ
if----., ��,
Telephone •
Permit Request sSf t P C - BOO'- c� -
Square feet: 1st floor:existingproposed 2nd floor:existingproposed Total new ��
q e .9ris
,/
Estimated Project Cost j it 0 — Zoning District Flood Plain Groundwater Overlay
Construction Type •
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family d Two Family ❑ Multi-Family(#units)
Age of Existing Structure HistorictHouse: ❑Yes Colo On Old King's Highway: CIYes O-N'o
Nq'
Basement Type: ❑Full ❑Crawl ❑Walkout O 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
2.--- .
Heat Type and Fuel: ❑Gas 0 Oil ❑ Electric. 0 Other
Central Air: 0 Yes 0 No Fireplaces: Existing New Existing wood/coal stove: CI Yes CI No•
Detached garage:❑existing CI size Pool: 0 existing 0 new size Barn:0 existing ❑new size
Attached garage:O existing ❑new size Shed:❑existing 0 new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use -
"
. BUILDER INFORMATION
Name ''� Ga j �-- Telephone Number So , S 3 e`r.Q
Address // p/01 6 Li-y may •
License# 0 G2 %C 5-
f :r a.1d k.-' cX 7A7,1 ��'J'''� Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE -m. (` . �'s� —
/� DATE _ 9
,
• t • ,-, . • a
k FOR OFFICIAL USE ONLY
4
PER-MIT NO. . '• P.
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• i ,. + ,
DATE ISSUED ' , �' _ . ` ,
4, - ; -}
1 ,� .:
MAP/PARCEL NO. - , . .. - _ t
•
• ,• I' , _ -
ADDRESS VILLAGE '
-1' . • - s,
OWNER ' - - , '
�. T * r "
DATE OF INSPECTION �' w rti - 1 ..
FOUNDATION • _ ..
d r - _ ,
FRAME r = _
INSULATION - ' - - ',
FIREPLACE =
' t t•
ELECTRICAL: ROUGH • FINAL 4 ; ' . .
•
PLUMBING: ROUGH •:• FINAL i
' 3 ,
" GAS: ROUGH FINAL r•
n, .` . - -
FINAL BUILDING •
' -
r DATE CLOSED OUT- .� c, • •
• ASSOCIATION PLAN NO. • i • :
•
i `i _ ,
• - '
,�TMe
�� , The Town of Barnstable
• BARNSTABLE.
1 Department of Health Safety and Environmental Services
'ram ' " Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation;repair,modernization,conversion,
improvement,removal,demolition,or construction of:an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with'certain exceptions,along with other
requirements.
Type of Work: /e-�u o „ Estimated Cost /fv 0
Address of Work: /o >�,��„y L a p
Owner's Name: q '(-
Date of Application: d
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
Job Under$1,000
OBuilding 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 IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
— 3 f — 9 fin. J542- , (� .‘
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav