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A .r ;39' Y l/ A PRE '` *Permit 3V i wn of Barnstable ZHE o ,e date OF ,j "� N 1 �� RegulatoryServices `' U � marvsrABLE, MISS. �y pryqqp��� ."� Thomas,3 F.Geiler,Director p 1 h r PA�-p_f'!O L 1 '�D 1"'`` Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Fax:.508-790-6230 Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number f )3.�OS1_-�3 d 69‹ r If P 0 3 9' /t ri Property Address 3 c! )11 S / / A tgi Residential Value of Work goo. O U Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Z 14 Gt 3' 14 HobgSoti 39vs� 4/N s / Telephone Number 6/7'" c �y` Contractor's Name Fe, b Fb�f �-� �M4 �" Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C .Szoig6 ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to in Goingexisting layers of roof) I:Re-roof(hurricane nailed)(not stripping. over ❑ Re-side .,�— Dodgy #of doors T 1q.rz. Repla ;ment Windows/doors sliders i -Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: 4, The Commonwealth of Massachusetts Department of In 'lustriat Accidents N Office of Investigations P. 600 Washington Street t. , y Boston,. 02111 .,* -,..a-t www nass.govldia Workers' Compensation Insurance Affidavit:Br tiers/ConlractorslElectiicianslPlumbers Applicant Information Please Print Legibly GIName 4Businee�slChgaurzatioellndividual): 7 a A 1=,--/J 1.d. J 11' Z"`J Ades: 7/c fit //i1. 0 t 2 ,-eityiSta'telZip:.7t t..A.,5/ =yt d / cl 4 / Phone#: 6( ?--cis'? L'Are f u an employer?Check the appropriate bow Type ro ype of p ]ect(required): 1.❑ I am a employer with 4. ❑ I am a general c-ontractor and I 5 ❑New construction employees(full and/or part-time).* have hired the subcontractors 2$ a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling 'i and have no employees These sub-contractors have S. ❑Demolition employees and have Viers' working for me in any capacity. }. ❑Building addition INo workers' comp.insurance camp.insurance- rammed] 5- ❑ We area corporation and its 10.❑Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself [No workers'camp_ right of exemption per MGL 12.❑Roof repairs insurance required.]r c. 152,§1(4),and we have no e } Jam- to [No workers' 13.0 Other comp.insurance required.) • 'Any applicant that checks box Al must also fill out the section below showing then waivers'compensation policy in/amanita. I Homeowners who submit this affidavit in&ating they axe chine Alvah wa h and then hire outside contractors mast submit a new affidavit indicating such tContradnrs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ar not those entities have employees. If the sub-contractors have employees,they must provide their Workers'comp.policy number. lain art employer that is providing workers'compensation insurance for ray employees Below is the policy and job site information. Insurance Company Name: Policy#or.Sel€ins.Lie.#: 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 crimi nal penalties of a fine up to$1,500_00 and/or one-year imprisonment,as well as civil penalties in the fun=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 stat t may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pal and penalties ofpetury that the information provided above is tare and correct Signature:'- -, e- '_`Iyate=—,C%y tc.)7 Phone#:.--------- ------- - O al use only. Do trot write in this area,to be completed by city or town official . City or Town: PermitiLicense# Tooling Authority(circle one): . 1..Board of Health 2.Building Department 3.Cityffown Clerk d.Electrical inspector 5.Plumbing Inspector 6.Uttrer.. Phone#: . of THE Tots, .. •• IAxxsrnace, ▪ ►sue Town of Barnstable • AlF,, �� — Regulatory Services Thomas F. Geiler,Director Building Division • Thomas Perry, CBO 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 UsingABuilder a I, /4402.,4 A. h4L erseiV , as Owner of the subject property hereby authorize Ro3"YRr ii. e a -ue, to act on my behalf, in all matters relative to work authorized by this building permit application for: c c/S M/tA' $r eamA 0e MA- (Address of Job) rThci adds.< ‘. ‘, 70(c.. east._____, • S a e of Owner Date / 1/'¢teA .4. Ned fr Sol. Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form onthe reverse side. 1WPFILES\FORMS\buildin Q: g permit fonnslEXPRESS.doc • • `r� �00HE r�� • . P Town of Barnstable . .psi,. Co' - .,� : Regulatory S rvices BARNSTABLE, ' Thomas F. Geiler Director fpmt4 Building ivision Torn Perry,Build' g Commissioner 200 Main Street yannis,MA 02601 • www.tow".barnstable.ma.us Office: 508-862 138 Fax: 508-790-6230 HOMED ER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number .treet village HOMEOWNER name home phone# work phone# CURRENT MAILING ADDRESS: - city/town state zip code The current exemption for"homeowners"was ex -nded to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who ..es not possess a license,provided that the owner acts as supervisor. - ► FINITION OF HOMEOWNER Person(s)who owns a parcel of land on which -/she sides or intends to reside,on which there is, or is intended to be, a one or two- family dwelling,attached or detached structure accesso ‘ to such use and/or farm structures. A p ersgnywh®constructs morethan one ' • home in a two-year period shall not be considered a home.wner. Such"homeowner"shall submit to ill'e Building Official on'a form:"'''' acceptable to the Building Official,that he/she shall be res.. sible for all such work,.erformed under the buildin_ permit. (Section 109.1.1) 1 -2). k -fi ;- .' - The undersigned"homeowner"assumes responsibility for comp .nce with the State Building Code and other applicable codes, bylaws, rules and regulations. f. 1. The undersigned"homeowner"certifies that he/she undeFRands the Ty wn.o, Barnstable Building Department minirn•um inspection procedures and requirements and that he/slfe will comply with said procedures a nd`t equirements. ' Signature of Homeowner tj Approval of Building Official ' , Note: Three-family dwellings,j ontaining35,b00 cubic feet or larger will b required to cdmply`With the"State Building:Code Section 127.0 Construction Control. "". .. HOMEOWNER'S EXEMPTION The Code states that: "Any homeown r 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); rovided that if the homeowner engages a person(s)for hire to oo,such work,that such Homeowner shall act as, supervisor.,, ": :" r ,r :r o.a.`r • !x '».b'x-`'.. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a pervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particul A y when the homeowner hires unlicensed persons. In this case:our Board cannot proceed against the unlicensed person as it would with a licensed Superyisor. 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 ,r 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 b everal towns. You may care t amend and adopt such a form/certification for use in your community. . r;.i vim,"TM rnrvo.Am L..:fA:-....e....:♦r....ACYDDCCC Ann r. \ . . \ , . . : { . . \ I . } ` < I ! . . . . . `• \ ` / . . . \ . . a . } . f . 3 . » § ( \ HaSGhuwt! 2Departm£N of Public \J/� ƒ\ Board of Bui Q m; R 7 m§n&/end Standards . Construction Supervisor License . . License: 31mƒ . . . . / '/.:, . \+ ROBERT J LEBLANC : A VIRDmA FARME LANE ° Ar CAR aL, UA q7 1 ^ � �~ \ \ ; t . I, Expiration: «.aƒ . / 2 ( ,_..._r . Tr#: 674141 . . ƒ / . . . TILE COMMONWEALTH OF MASSACHUSETTS or OCABR Use Only. OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION 241 10 Park Plaza, Suite 5170 trationNo: v ) Bostoa , , MA 02116 f a IV751 I r Application for Registration as a Home Im•roveme I t • - Contractor or Sub-Contractor ExpiratitittNati: f 2013 "ter' (MGL c.142A;201 CMR 18.00) • OFFICE OF CONSUMER AFFAIRS 1. NAME OF APPLICANT: v �-� - `'4 (MUST BE EITHER AN INDIVIDUAL,CORPORATION,LLC,LLP,TRUST,OR OTHER LEGAL ENTITY) 2. NUMBER OF EMPLOYEES: 3. APPLICANT TYPE: DIVIDUAL _CORPORATION _PARTNERSHIP _TRUST (CHECK ONE--MUST BE AME LEGAL ENTITY AS THE ENTITY IDENTIFIED IN#1) • 4. FEDERAL TAX ID#: 5. APPLICANT PHONE#: (p I1- I ` '-3 1 L APPLICANT EMAIL ADDRESS: • 6. MAILING ADDRESS: C 'Lt,,su roe : --rbWiJsC/W0 • ()Li ] 61 • STREET CITY STATE ZIP 7. PERMANENT ADDRESS: SA 1 4 6- STREET CITY STATE ZIP PLEASE NOTE THAT A P.O.BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUST LIST A STREET ADDRESS. • 8. IF THE APPPLICANT IS A CORPORATION OR A PARTNERSHIP,PLEASE PROVIDE THE NAME,ADDRESS,SOCIAL SECURITY#AND 1'1'1'LE OF THE INDIVIDUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S THE TRUST'S OR THE PARTNERSHIP'S WORK(Please review the Instructions before answering this question): LAST FIRST TITLE 9. IF APPLICANT IS DOING BUSINESS UNDER A D/B/A,PLEASE STATE THAT D/B/A,AND ATTACH A COPY OF THE FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK: . n 1 4 . of 1HE r Town of Barnstable *Permit D 1 a61 9)C.Y3 �bf O� Expires 6 months um ' ue die ..,f Regulatory Services Fee _. * AIANET,RTY f - 1 �� Thomas F.Geller,Director • 1?---- . -F. ATE 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 .33 5b 5 t • Property Address 39(5 i Aitt S1 F 6 A Comn'1AV A 6 . t [iResidential Value of Work`2 c-11- Minimum fee of$35.00 for work under 56000.00 ' Owner's Name&Address i 4 J.J kertf q o,t; 31 IF 'Mn 1io S' . ^� ;Jds't octki Ar ► , contractor's Name ,ef>tc J, S V1:tk Telephone Number 56 36 -3S 8 come Improvement Contractor License#(if applicable) /S o 7S-6 :onstruction Supervisor's License#(if applicable) °- l L 2t, aa . ]Worlanan's Compensation Insurance -PRESS PERMIT Che k one: am a sole proprietor APR 03 2012 ' ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance - isurarice Company Name • TOWN OF BARNSTABLE 'orkman's Comp. Policy# " opy of Insurance Compliance Certificate must accompany each permit. .rmit Request(check box) . • 2I xe-roof(stripping old shingles) All construction debris will be taken to aIsaal ce yftizivioAL, pis pa • -❑Re-roof(not stripping. Going over existing layers of roof) • • ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows •*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. • A copy of the Home Improvement Contractors License& Construction Supervisors License is required. 5 YrNATURE: PFILESIFORMSIbui]ding perm$ 1EXPRES3.doe c4 nwealth-of- Massachusetts.-. - _ - --- ---- Department of Industrial Accidents Office of Investigations —° • 600 Washington Street :An„1 VW` Boston,MA 02111 • • :.5° www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information c Please Print Legibly --- -- Name(Business/Organization/Individual) f _tei� 4 --svvv k1 . - -- ---.._..-___ .------- --- -=--- •Address: 39(IS t 1At`41 St • . City/State/Zip: C.)AImdt ut D, tfV 0101 Phone.#: 5.6% 3,t 2- - 3 ca Are you an employer? Check the appropriate box: Type of project(required):; 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction . 2.ISc I 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' comp.insurance. • 9• El Building addition • [No workers' comp.insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions myself. [No workers'comp. right Of exemption per MGL 12.®Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other • comp.insurance required.] • . • *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. t . I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 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 maybe forwarded to the Office of Investigations of the DIA for-insurance coverage verification. I do hereby ify under the pains and penalties of perjury that the information provided bov is true and correct Signature:. Date: 4 z .1 2-- . Phone#: S'a7 3(9- - 3 S U Official use only. Do not write in this area,to be completed by city or town official. • City or Town: • • Permit/License# • Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector • - 6.Other •• • Contact Person: . • • Phone#: • Information and Instructio -s Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant t this statute,an employee is defined as "...every person in the service of an leer under any contract of hire, express or .implied,oral or written." An employer refined as"an individual,partnership,association, corporation o other legal entity,or any two or more of the foregoing ngaged in a joint enterprise,and including the legal represent,lives of a deceased employer,or the- receiver or trustee of an individual,partnership,association or other legal en.' employing employees. However the • owner of a dwelling h use having not more than three apartments and who -sides therein, or the occupant of the dwelling house of another'•who employs persons to do maintenance,cons• ction or repair work on such dwelling house or on the grounds or buillrg appurtenant thereto shall not because of suc, employment be deemed to be an employer. MGL chapter 152, §25C(6)als tates that"every state or local licens'ii g agency shall withhold the issuance or renewal of a license or permit to perate a business or to construe,buildings in the commonwealth for any • • applicant who has not produced.ac eptable evidence of complian,e with the insurance coverage required." ' Additionally,MGL chapter 152, §25C states`Neither the comm. wealth nor any of its political subdivisions shall enter into any contract for,the performanc, of public work until ac.-ptable evidence of compliance with the insurance requirements of this chapter have been prese ed to the contrac:i authority." Applicants • • Please fill out the workers' compensation affidavit'cop.. -tely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(e� an.:l'hone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limitedia.'.'ty Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'co. bensa h.n insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be ubmitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also/be sure f ssign.and date the affidavit. The affidavit should be returned to the city or town that the application for tl#e permit or lic• selis being requested,not the Department of Industrial Accidents. Should you have any questions rgarding the law or you are required to obtain a workers' . compensation policy,please call the Department at the number listed below. elf-insured companies should enter their self-insurance license number on the appropriate lint'. City or Town Officials Please be sure that the affidavit is complete'andprin ted legibly. The Department has provi d a space at the bottom of the affidavit for you to fill out in the event tie Office of Investigations has to contact you re ding the applicant. • Please be sure to fill in the permit/license number which will be used as a reference number. In a ition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affida 't indicating current policy information(if necessary)and under.;"Job Site Address"the applicant should write"all locations ' (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be proded to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filledout each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercia venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would liketto 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 \ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 • Tel.#617-727-4900 ext 406 or 1-$77-MASSAFE • Revised 11-22-06 Fax#617-727-7749 • . . www.mass.gov/din ottHEToito- Town of Barnstable , Regulatory Services Thomas F.Geiler,Director ��,,s639. 1 �Fo_� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnsta ble.ma.us Office: 508-86'2-4038 - --- -Fax: 508 790-6230 - — . Property Owner Must Complete and Sign This Section If Using A Builder I, 4`'¢ i9 Ahiabessdkr as Owner of the r subject l property hereby authorize Pzi izie c4'1/'774- to act on my behal , in all matters relative to work authorized by this building permit fry ra S T yr�+A®'f.) (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. S tore of Owner Signature Applicant 1,44i-,24- /4,101:.6-s 0,4 Aec 64-Lk Print Name Print Name Date • Q:FORMS:OWNERPERMISSIONPOOLS i. 1I. �T , Town of Barnstable (.."-- „,J. �s; "0 Regulatory �* g ry Services '* �nxxsT�sLe * Thomas F.Geiler,Director y MASS. `b 1pep 3.E".0�. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannil,MA 02601 www.town.barnstable.ma..us Office: 508-862-4038 / Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPT ON Please Print DATE: • JOB LOCATION: \ number street -� village "HOMEOWNER": \ name ''.\ home phone# work phone# CURRENT MAILING ADDRESS 1 • city/town , , state + zip code 1. The current exemption for"homeowners"was extended to in 'ude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who dots not possess a license,provided that the owner acts as supervisor. DE NITION OF OMEOWNER Person(s)who. owns a parcel of land on which h he resid/ or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detac -d structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-y:. period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official;on a '. o. acceptable to the Building Official,that he/she shall be res.onsible for all such work •erformed under the buil.'.1#.ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility f©r comp .ice with the State Building Code and other applicable codes,bylaws,rules and regulations. 0,. The undersigned"homeowner"certifies that he/she nnherstands the To c of Barnstable Building Department minimum inspection procedures and requirements and}that he/she will co is with said procedures and requirements. Signature of Homeowner 1 t. Approval of Building Official , Note: Three-familydwellings containing5 000 cubic g feetFor-larger will be required t \comply with the State Building Code Section 127.0 Construction Control. ,,, %.\-- ',,, . A }-1 HOMEONK'NER'S EXEMPTION , The Code states that: "Any homeowner performing work•for which a building permit is required shall be exempt froorn'the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, • that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt • • i117 ' a �<.� .-.r- ‘ � . ,Office of,Cou uwer`Affai s'&B :License or registration valid for individul use only usmess Re g before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR P Registration ; 150950 Type Office of Consumer Affairs and Business Regulation ± 10 Park Plaza-Suite 5170 Expiration: 5/8/2012 •• DBA Boston,MA 02116 PE ER J.'SMITH HOME IMPROVEMENT 1-5 PETER SMITH \ r- 392 MAINF. 5ST. CUMMAQUID, MA 02637 • Undersecretary • Not vITIC ithout signature -3'' Massachusetts - Department of Public Safet • Board of Building Regulations and Standard Construction Supervisor Specialty License License: CS SL 99486 Restricted to: RF,WS t7t Y l PETER SMITH PO BOX 36 - ,VSt�,1 CUMMAQUID, MA 02637 -- — �y � Expiration: 11/1/2013 ('ununissiunet. Tr#: 7029 r ' 1' 1 Engineering Dept. (3rd floor) Map ��0 • Parcel .e9(S / � Permit# ,.- /`q?6 5 House# 3 5'A5---- Date Issued /1 -- 4 -96, Board of Health(3rd floor)(8:15 -9:30./1:00-4:30) !0 _n Z-1 Feg,. 4,0,,. 04,5-I 6 Conservation Office (4th floor)(8:30-9:30/1:00-2:00) te'' � >> P LG L. 1st ('�'�'i`'r� " 'p .fN .tl L 19 • BARNSTA9LE; •, '.� MASS. �� V t6yq.��,� TOWNOFB f(5MP�J . ARNSTABLE . Building Permit Application . IProject Street Address Z9 i S 1--- Village o,J\rb\-&+u i-f \ Qv,vut Ai\-C- Q vA; cP Owner \r..� AI ddress 3 i I S VI&Ck'k o 5-\'• C`AA vhqraAl' 'Telephone(se;%) '36 4 - Cp ") a- . Permit Request ( �- 2/AA. 'tl- A e 0 A t sl/l-;.-eV1 First Floor square feet Second Floor square feet •Construction Type -�/� Estimated Project Cost $ \ 3 (.&-0-to Zoning District Flood Plain Water Protection Lot Size Grandfathered Li Yes ❑No Dwelling Type: Single Family a/' Two Family ❑ Multi-Family(#units) Age of Existing Structure 7 Historic House kKes ❑No On Old King's Highway cs ❑No Basement Type: ❑Full @<rawl ❑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 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) r- ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes p o If yes, site plan review#Current Use j ,U ,t C Q 1.t, v� Proposed Use_At,. .s�_ n Builder Information Name . C \tom.." --�( 1,, _ Telephone Number Ce r - ?-) I - ) 3 5 0 Address T� ,, ,.,,� 0, License# eN,,/1 I ik�� . t '( c) i Home Improvement Contractor# ( 0 '1 r7 q (act Worker's Compensation# '( 3 Lf )( �c) ? LI 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 1 cenn1/4.4.A- \--kiN % . 1\ SIGNATURE6,1, .... DATE /%/ A b . BUILDING PERMIT DENIED FOR,THE FOLLOWING REASON(S) 111111111M1=1111111 .?\ ___ • FOR OFFICIAL USE ONLY • C a A: I it [7 '.:k PERMIT NO. 1 # DATE ISSUED MAP/PARCEL NO ' �; If ADDRESS Zf VILLAGE F= 1 ,•4 OWNER ti i f r 1 DATE OF INSPICTION: ' .FOUNDATION . r FRAME I2/3o/%, qr p ' ' INSULATION t .Yry FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I GAS: ROUGH FINAL - FINAL BUILDING 4 j • 1 , DATE CLOSED OUT 1 ASSOCIATION PLAN NO. ; ` I � 3315 Ma r, 5)- . C1)intk m q u�� , 61i4 E c <kS • 0 1 Asv. . Qua Tf�e tot e) . }„v. r . WWW en to anZ+ � �� J �C� ✓ M Or- t..Y�M�a✓� I1,,,1 xxx 3) la.u.„ ao' 0 0 o y) ZA,s1-aU 2 c..5 �Na aaa NINCI Cl N.N • 1 i D,f IL! I 1 1 } 1 j 1 • I'* \g.1 ct '. A_ _ w e" _ /4 - q- _7 s- Assessors map and lot number/',rye t 3 3-S" 'LS1 `'� „a .SEPTIC 6Y` '`° Ii INSTALLED IN COMPLIANCE t . Sewage Permit number .1 A\• WITH ARTICLE II STATl tt SANITARY COX AND ,t M �QyOFTHE?NI* `]TOWN OF BARYST SL � y 1 /ro yti'7r t. • Z, BAHH9TIIILB, 94,,, M6°.p •.� r BUILDING INSPECTOR aYPY APPLICATION FOR PERMIT TO O V I L Ci OW t'"/I pool- . TYPE OF CONSTRUCTION ........... .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: y� Location ....... , ? V Sr eLI.!/.Y.l..y✓..I.!�. .0.(.d......eele--!ll.or `�: aeg .beek- Proposed Use J co vii).v ......7.- O L Zoning District ....R..i 3 Fire District 5t.,i.wow PfIvKl sJ Name of Owner .../11.4ae9/04-0l' elilPie V Address eV/41 V 3T euiwki f/4 4✓1.a_ ,,nn /2 d Name of Builder .)r.. �y �.p.V'/'//h'�'P -� -�AJ.C.Address if CV? O'�1''� Name of Architect �- Address �� Number of Rooms '—�— Foundation • l=.pp.i?F!Y.►..IPRf + Exterior _ Roofing Floors Interior —,—.--^ Heating Plumbing Fireplace _ Approximate Cost 1j D O O e 0 0 Definitive Plan Approved by Planning Board 19 . Area L-6702 1.074 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH --- -- i 51 Imo — 65 _i_ ,l 6 IbX Pool b lW •3I 4 �5 e•e�5 1)0 o 0 s v t i 444 Al ST I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above / construction. . Name ....4(..s�..V'(.,! eP .r/Uc eve.) Pinkhan,-Sharon & Margaret Laber '� No 17928 Permit for swimming pool I . Location''fs Main Street & kBayberry Lane Cummaquid Owner Sharon Pinkhan & Margaret Laber Type of:Construction private pool . • Plot ..... Lot i 0 Permit0Granted September 8 19 75 Date of Inspection 19 Date Completed / D/°%11/'s— 19 0 PERMIT REFUSED = ' 19 :Jill . 4 Approved 19 4 t c r"kJ 37 ti s li fl 6*THE ro TOWN OF BARNSTABLE i 331110—iTA.1.3'I, I .jr, MAO& A BUILDING INSPECTOR 4gto,, 2639. 6. APPLICATION FOR PERMIT TO %,144( ...or e.,.. ck-ka-k-.1 Ottax4(47 614 ye-- .. TYPE OF CONSTRUCTION C7rif 196 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby aeplies for a permit according to the , i -- followingomat' n: Location IAA4t 7AH cy. -4--- ‘ , frs' bfr' / v Proposed Use „...,./1--LkiriTiai / Zoning District Fire District e, ,„4, Name of Owner AQ 'R‘(' P WE- I-- L. Address ey--kr ... .L., . r Name of Builder Address Name of Architect ----7,-ynt, . Address ' /1 .4 Number of Rooms ".74, --. Foundation 0-44 Exterior Oe.,81 o--otAL Roofing GZe4 Floors -----)I Meer-- Interior vt_, ,,__2.„ Heating 14it.A-- Plumbing I Fireplace Approximate-----Avrx-L Approximate Cost Diagram of Lot and Building with Dimensions ----- , f/1 -111,L 4 \ ! )00 (......__ -:-.-.?- , a/AILAVOtet\H Q14 C;IAL 01 - .• i k 7 . ii/ :-. r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding t e above construction. 6 /r-'4-1 Name T i 1 i Kelly, Mabry D. / No 7$18 Permit for add storage shed to garage Location Jup.i er I n l , Main Street R �G �� Barnstable Owner Aubry D. Kelly a Type of Construction Frame :. ; \ .c.,l'Q -t` ��' Plot Lot p Permit Granted November $, 1961 i Date of Inspection 19 1'. Zs •n Date Completed 19 • / +n ` .) ) ,o Y �� sel PERMIT REFUSED ti . . 19 j k • f' i[ Approved 19 • 1 , THE ro TOWN OF BARNSTABLE .fr $11: It BARN;TA111E, i 1r0,9 "6"31gt 0 • BUILDING INSPECTOR i').,;...t. . APPLICATION FOR PERMIT TO ke--rno ve iiv a o Kci-A€ 5 AND -R‘e /,e 4 Ili ouii-pitvAsir Ex , s-,-, TYPE OF CONSTRUCTION . - 2AI t I 1 ____. e c ig 19.C..? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location TT e 6 A -74--.3A./..b.cr T..ii.....14A.N . Proposed Use II o e/„s E- Zoning District Fire District Name of Owner0..S.CAR.O.DO.A.N.f.--,TT?, Address 6.e STA 1,4 D i S 1-4 (-DAy la /46.K.7.1-% Name of Builder 5A-YY) e Address Name of Architect .....N..O.A.0 Address Number of Rooms Li Foundation Exierior OD 0.D Roofing A.,S.P IN A 1-. T Floors GO 0 0 D Interior .5ke.c -r eb c -+ P -Heating 3 r AC- Q.__ Plumbing ,,, Fireplace No Approximate Cost /AO‘*" Difinitive Plan Approved by Plannirg Board _ _J-9 • A 4e.e4 --/eecLeei Diagram of Lot an ilding with Dimensions — r , V i No, A , , ..,, , , , ,7,---, ... 1 efc $() \A\t\ - . 036571)1d .r.r/gli.h/t esLfg f 4,4' \4t 11' - .5- e 1 C 4lo 0 1 piZes 5 ..., 1 1 . 1 FL 6 R 5 "4 4 ) - i OA-6 e -1 ,,, 6:, 5,_i / 6 °I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. N a m Id Lid 0 Doane, 9scar W. Jr .,o No .....42cQ.9 Permit for .....r..ezzo.ue... tt porches and remodel 3 pus* \S • Location Owner Oscar W. Doane, Jr. - Type of Construction j:ncn e it • i Plot Lot { Permit Granted ..DR.e.e.Mb.e.r....2.8 19 69 4 Date of Inspection 19 3 �•, ri Date Completed i/® / 6 19 7e ! } } _ PERMIT REFUSED 19 Approved 19 f (t • 1