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4042 MAIN STREET
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Fee .................l..tl.10........................ .................... ` ` ` 12018 Building Inspectors Initials.... .. TOWN t J�( 1 4JNb�l`! ��� bA ��b����C Date Issued....... .Q. ..�'`.V............................. O -0 6OB Map/Parcel...... .................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: �4o- NUMBER STREET VILLAGE Owner's Name: ,� on -� Phone Number Email Address: Phone Number a.7 L4-OT Project cost$ 1045-&0, Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize (�t`t`c a C C A CC to make application fo a uilding pe t in accordance with 780 CMR Owner Signature: Date: i TYPE OF WORK fft Siding 0 Windows (no header change)# 0 Insulation/Weatherization ,0 Doors (no header change)# Commercial Doors require an inspector's review ; E Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name pqg D r c T '"-'�3�c✓L S Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License#4f.'s - n CJ�t'g (attach copy) Email of Contractor A cue ems,1( e� C Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.................................................... :.'� For Tents Only Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X ' X 31 X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event P Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the locations of each tent Fuel source being used LP tank 20 lbs. or> Yes No_____, if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date ANT SAS I G_NA__TURE Signature Date o �U All permit applications alre subject to a m ifi W _4- rovalprior to issuance- V* Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made. Permit Eonu�+" Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-18-3612 Applicant Name: PROJECT MANAGERS LLC Approvals Date Issued: 10/31/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 04/30/2019 Foundation: Location: 4042 UNIT 1B MAIN ST./RTE 6A(BARN.), Map/Lot: 336-072-OOB Zoning District: RF-2 Sheathing: Owner on Record: PORTER,STEPHEN D& LOUISE G Contractor Name: PROJECT MANAGERS LLC Framing: 1 Address: PO BOX 273 Contractor License: 155863 2 CUMMAQUID, MA 02637 Est. Project Cost: $ 10,500.00 Chimney: Description: siding&roof replacement Permit Fee: $ 160.00 Insulation: Project Review Req: Fee Paid: $ 160.00 Date: 10/31/2018 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT : ., ,. The Commonwealth of Massachusetts 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 Legib nly Name(Business/OrganizaEon/Individual): !"A0 \C c- 11A A,_�-4-S"P-^ Address: City/State/Zip: V A ,040 r11 A1+ Phone Lt: Are yo , employer? eck the appropriate bog: Type of project(required): 1. am a r with emP to e 4. ❑ I am a general contractor and I Y � 6. construction * have hired the sub-contractors ❑New employees(full and/or part-time). ntra tors 2.❑ 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' 9. ❑Building addition [No workers'comp.insurance comp.insurance. required] 5. ❑ We are a corporation and its 10.ElElectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions �o workers con myself ' right of exemption per MGL Y P. 12.[��f repairs insurance required.]t c. 152, §1(4),and we have no a ; employees. [No workers' 13.❑Other ,l 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-contractor 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: �✓ZrQ-✓�l`e�C S Policy#or Self-ins.Lic.#: 1`(-U� !Z�(�-�<7 Expiration Date: �- Job Site Address: 4- 044af(� �J��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 cerrti'fy/under t e pains n hies of perju hat the 'nformation provided above is true and correct: Signature: (rt/ Date: ( fir c__ Phone#: Official use only. Do not write in this area,to be completed by city or town officz City or Town: PermitlLicense# 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 4 Massachusetts Ge7ral Uws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute an to ee is defined as"...every-person in the service of another under any contract of hire, , emp y express or implied,oral or written." An employer is defined "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tnistee of an in 'dual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house ha ' g not more than three apartments and who resides therein,or the occupant of the dwelling house of another who ploys persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building app errant thereto shall not because of such ployment be deemed to be an employer." MGL chapter 152,§25C(6)also states "every state or local licens' agency shall withhold the issuance or renewal of a license or permit to oper a business or to construct uildings in'the commonwealth for any applicant who has not produced'accep le evidence of compliant with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) s"Neither the commo ealth nor any of its political subdivisions shall enter into any contract for the performance o ublic work until ac table evidence of compliance with the insurance requirements of this chapter have been presente to the contracting ority." Applicants , Please fill out the workers compensation affidavit y,affida ' co letel b checking the boxes that apply to-your situation and,if aloe with their certificates)of ram s address es d h a number(s) g necessary,supply sub-contractor(s) e(), ( ) P insurance. Limited Liability Companies(LLC)or Limite tab' 'ty Partnerships(IL P)with no employees other than the members or partners,are not required to carry workers' coin ation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit ay be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be re o sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pe o 'tense is being requested,not the Department of qkc%T..l]d vnu_have.-anv.anesfions reear Q the or if you are required to obtain a workers compensation policy,please call-the-Department at the num er listed b ow. Self-insured companies shouia enter meir . self-insurance license number on the appropriate line. l City or Town Officials Please be sure that the affidavit is complete and printed lebly. The Departm t has provided a space at the bottom of the affidavit for you to fill out in the event the Office off Investigations has to ntact you regarding the applicant~ Please be sure to fill in the permit/license number which�will be used as a referee number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only mit one affidavit indicating current policy information(if necessary)and under"Job Site A ess"the applicant should ' "all locations in (city or town)."A copy of the affidavit that has been officially ped or marked by the city town may be provided to the applicant as proof that a valid affidavit is on file for fut e permits or licenses. A new davit must be filled out each year.Where a home owner or citizen is obtaining a lice�sa or permit not related to any b ess or commercial venture (i.e.a dog license or permit to bum leaves etc.)said p On is NOT required to complete affidavit. The Office of Investigations would hike to thank you' advance for your cooperation and sho you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commm Lwo th ofMassachusats Dgwtmenl of-Industrial Accidents Qftice�of avestigatims 600 ashington Street; Bo MA 02111 Tel,# 617-727-4900 cxt 406 or 1-977-MASSAFE Fax 9 617-727-7749 Revised 4-24-07 www-m=,gov/dia TRAVEUR541 . BO cE COMPENSATION AND EM-pLi3yERS UABILTrY POIACY TYPE AR jNFORDEA'ION PAGE WO OLD W 01 A) POLICY HUMBEM (6_�- 23 �IT, W-17 , e j TRAVELERS 1WEt*qT'' C€N?ANY-OF ANEERIvA mCCI GO CODEE:13439 INSURED: PRODUCER PROJECT WAAMRS LLO EBWARD j =GRAIH 1N5 1.5 L NGTIM LAIC P a Bm 1003 YARMBUTI-PURT. NA 026 GEMS NA 02638 insured is A L s9ff iED LIABILITY C€WA€ly O ea daces and ide cao a its are.sh j,in the schedule(s)aMched. 2. The Aoricy pevied is morn 12-223-1€'10 -1.2-2 3. A- WORKERS COMPENSATION'NWR- F-_ Pair one of tha policy appi s to 7ar�Grs ComVensallan Law of the state(S)-E'er here: gA m e E DLO` LIA$I I �SRA �Ea paft Tutu€lf porky appii to wod.'ski each smote!mod in kem 3-A- Tne iiimfts of our HabW under Part Two are: B adfy IT.-"by AccWark S 500WO Each Accident Baay may- MamE $ 500 O Pricy 11mit Booby Ird by i�- �^ $ Each��p�y� O r aiER STAB S Part Three I the policy appliss to the ems,i3 any,iced here: m COVERAGE REPLACED BY EMORSEMENT WC 20 03 06B a 1leduies: SEE LIS"i I "€dF E3RSE€ NTS - EX ENSION €IF-INFO FACE d f�-_ by ou€' nuals of-91A8s,f�asciii�aor�, and Rom. e €c€ aE €t � I3 and C .: awe au ditto be lode ANY ft�. 3 t "x' DATE OFiSSUEt 2-29-17 v4 ST ASSIt f: FrCE= Mqtjl5 INOUS AFF 161 PRODUCER EDWARD J MC6RAT"H I 2 191 I I 171 i Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement--ontractor Registration Type: LLC tv Registration: 155863 PROJECT MANAGERS LLC r.;} _:.. .!fr="� r - � i,.� Expiration: 05/14/2019 15 LEAN IJV. ( ��---' ' -- j `; YARMOUTHPOR'F,MA 02675 Update Address and return card. Mark reason for change. SCA1 0 20M-05/11 office of Consumer.Iffairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Regisiration valid for individual use only TYPE:LLC befordthe expiration date. If found return to: Reoistratiein Expiration Office of Consumer Affairs and Business Regulation —155863.' 05/14/2019 Boston 10 Par k Plaza-Suite 5170 PROJECT MANAGE) SLLC-s; ` MA 02116 WILLIAM PLAN INSHERT--` 15 LEXINGTON LN: of valid without signature YP.RMOUTHPOR f,MA 02675 Undersecretary achusetts of Mass sure Comm°no prote u 1 ,ons 1c d Standards an d°t gu 1din9 Reg-NN rvi 020 Boar on trt . S P�`3 it 1012512 -- supervisor Construction e group which contain �I Buildings of any of enclosed CS-0g5gg1 Jnrestricted- 991 cubic meters) 000 cubic feet( F p�ANtNSH�E .� C ass than 35, p s ace. .� ��LIAM O�`LANE' U2675 5 15 L�7CINGT PO MAA�£ Oiti YARMOUTH /VOlSS�� Commissioner V" ossess a current edition of the.Massachusetts Failure top Code is cause for revocation of this license. daft State Building mass.govldp► fi17r 727 3200 or vbsit twww license Call( ) / a Town of Barnstable *Permit#20! 69 q qq p Evires 6 months from issue date Regulatory Services Fee • RAnxtvs ASIX • 6 9.1 Richard V.Scali,Director 3 ♦0 RFD MA'S A y� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 OCT www.town.barnstable.ma.us 012015 Office: 508-862-4038 TOWN OF4C4TABLE 08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL e � -r` ©� Nov Valid without Red X-Press Imprint Map/parcel Number 3 Ad O Prope ddress t /t/`�� �� (� Residential Value of Work$ 3 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L. _e_ Q® C��eZ M 0.,% S GZ I6 A- 2Aao, ' 4e Contractor's Name V n©7 CT /A41k+M4C Telephone Number Home Improvement Contractor License#(if applicable)_ �� 3 Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 024 I am a sole roprietor ❑ I e Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ - oof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Prope wner r of Permission. A copy of the H e p veme t Contractors icense&Construction Supervisors License is required? SIGNATURE: QAWHILESTORNIMbuilding pe orms\EXPRESS.doc Revised 040215 1 T7te Commonwealth of-Massachusetts Deparaffen o,f rn drustrial Accideras !�,f k.e of Investigations - 600 Washingion,S$reet y Boston,AA 02111 fvrvtu»mass govIdira Workers' Campensation Insurance Affidavit-Builder-s/Contractors/ElecEr cianslPlumbers Applicant Infarmatian Please Print LegibIy Name(Sasiuemx)rgmizafionm dmdnal)> �G?C5�e-� ��1 ���e•�1 ,_ Address GitylStat � �2 el �v 00--k- I�n� AP=am employed?Check the appropriate box: Type of project(required): 1. employer with 4. ❑I am a general contractor and I employees(fun andl`orpnr#-time). * have hired the sub-contractors 6- ❑New consixucfiiog 2.❑ I am a sale proprietor or partner- listed on the attached sheet. I ❑Remodeling slip and have no employees. These sub-contractors have g_ ❑Demolition wanting for me in any capacity employees aitd have wodiers' [Noorbars�' comp.insurance comp-irlsuranml 9. El Building addition w required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeolAmer doing all work officers have exercised their 11.❑Plumbing repairs or'additions myself workers' right of exemption per MGL �` �o -insurance required.]s c.152, §1(4h and we have no 12.❑Roofrepairs employees.[Naworkers' 13.0 Other comxp.insurance required.) *Any gT cwC&iatchecksboxAlmnstalsofilloutthesectionbelawstowingtheirworlieie-compevsationpolicyinformation_ 1 Homevamers who submit this affidavit;rdkzt Mg they are doing alI wcak and then hire outside contractors mast submit anew affidavit indicating such fCantractors thst check.This boat must attached an ar]did uat sheet shovaiag the name of the sub-cnatn;rtxs and state whether or not those entities have employees.If the sub-contactois hive employees,they matstpmvidetheir vrorkers'romp.policynumher. I a►n ark eiiipisr€Teat is prmddin fi�orikers'coniperisaltaai insurance for myeirrpLayes Setoiv is t7te policy rcR,I job she inforasalsom Insurance Company Nam: (/_1JAQL0t(eE Policy or Self-ins.tic_ :-- � cl? 6 — Expiration Date: /0)AC) Job Site Address: YQ C 6� �Z C� � d v l��''f 7� City/State/Zig: &4:�:- L"-sj'�41 Attach a copy of the workers'coampensationpolicy 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.f or one-year imprisonment as well as civil peualties.in the form of a STOP WORK ORDER and a fine of up to WO-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!, ! c!t I do here-by certify utitdter to its It n ' so. attile uijbrtr adwi prmrided abmw is bare acid carrect Sionature: 73a#e: (� Phone 9- Official use drily. Do not trrite in this area,to be camplete.+d by city artenm ofjticiat City or"Toni: PermitUcense# Issuing Aathority(tdrde one): 1.Board of Health 2.BuRding Department 3.Cityi Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Maecachuseft s Geheral Laws chapter 152 regIIaes all employers to provide wokeas'compensation far then employees. pamuantto.this statute,an.enploye�_is defined as."_.every Person in the service of another under any conhract of hire, � express or impliecL oral or wiiti� An E7npIoyM_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 mchi ding the legal repres . es of a deceased employer,or the receiver or trustee of an individual,pa taership,association or other legal e tity,employing employees. However the owner of a dwe house having not more than three apartments and wh resides therein,or the occapant of the - dwel�house o other who employs peasons to do maintenance, on or repair work on such dwelling house or oa the grounds o binding appr iteuanttheretn shaIlnotbecause of ch employmentbe deemedto be an employer." MGL chapter 152, §25 also states that"every state or local Tic " agency shall withhold the issuance or renewal of a license or pe . to operate a business or to co ct buildings in the commonwealth for any applicant who has not prod acceptable evidence of comp " ce WidL the i�,cnran_ce.coverage required." AddidonaIly,MGL chapter I5 §2SC(7)states"Neither the �weall3i nor a'uy of its political subdivisions shall enter into any contract for the pe manse ofpublic work� table evidence of compliance with the insm7an CO._ requirements of this chapter have b presented to the co authozrty" Applicants Please fill out the workers'compensation davit compl y,by checking the boxes that apply to your sitnation and.,if necessary,supply sub--r-ontrartor(s)name(s), dresses) phone numbers)along with their cerii acate(s)of min nce. Limited Liability Companies(LLC) r L' ility Partnerships(LLP)with no employees other than the members or partners,are not regtmed to carry wo err' ensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that yitmaybe sub*r,--d to the Department of Industrial Accidents for confirmation of insurance coverage. be sure to sign and date the affidavit. The affidavit should be retomed to the city or town that the application for emit or license is being requested,not the Department of n ' Accideaifs. Should you have any questions the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the numb listed below. Self-insured companies should enter tbeir self-incn,a,ce license mmnber on the appropriate line! City or Town Officials . \� �b Please be sui e that tine affidavit is complete and printed legibly. 'Iartm.ent has provided a space at the bottom of the affidavit for you t o fill out in the event the Cra e of Investig to contact you regarding the applicantPlease be sure to fi11 in the pe�itllicense nwnbea which will be usre ce number. In addition, an applicant that must submit multiple permitllicense applicatins in.any given eed.o submit one affidavit indicating current policy ii� oration(if necessary)and under"Job it-,Address"theant sho d•trite"all locations is (cty or town)_"A copy of the.affidavit that has beta offi•tally stamped ord by the or town may be provided to theapplicant as proof drat a valid affidavit is on fle fufnre permit'snses A n davit must be fiI1ed out each year.Where a home owner or citizen is ob a license or perm related to any ess or commercialventure(ie. a dog license or permit to bum Ieaves etc.) d person is NQTred to complete affidavit The Office of Investig�ians would like to. you in advance fo cooperation and rho �d you have any questions, please do not hesitate to give us a call- The Department's address,telephone and fax nine _ 'Ihe CG.Mn!t�QnweaZt3r of Massachus M ' Delta dment of l idmitial Ardent-, office of kvestiotim% ��4- tan t Bos MA G2111 T(,-L 4 617 727-49QO Cx 4-06 or I9 -I LkSSAM Fax#617-727 7749 Revised 4-24-07 .Ina gavidia t BARNSfASLE, « 9� ' ,.� Town of Barnstable ArEp�p Regulatory Services Richard V.Scali,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 Using A Builder I as Owner of the subject property hereby authorize ��O ` ' V I � �* �to act on my behalf, in all matters relative to work authorized by this building permit application for: 40 V, M4�q,) S4 (Address of Job) G Cd 15 Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFELES\FORMS\building permit foims0TRESS.doc Revised 040215 Town of Barnstable Regulatory Services �oF rOlyr Richard V.Scali,Director Building Division t UMNSPABM Tom Perry,Building Commissioner 1KAss. 9 1639. `0� 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# wor hone# . ! CURRENT MAILING AD RESS: - city/town state zip code The current exemption for"homeowners"was extended to include owner-occn ied wellin s of six units or less and to allow homeowners to engage \ individual for hire who does not possess a license, ro 'ded that the owner acts as su ervisor. DEFINITION OF HOMEO Person(s)who owns a par el of land on which he/she resides or intends to res' e,on which there is,or is intended to be,a one or two- family dwelling,attached detached structures accessory to such use and/o farm structures. A person who constructs more than one home in a two-year periods all not be considered a homeowner. Such"h eowner"shall submit to the Building Official on a form acceptable to the Building O cial,that he/she shall be res onsible for such work Rerformed under the building ermit. (Section 109.1.1) The undersigned"homeowner" sumes responsibility for compli a with the State Building Code and other applicable codes, bylaws,rules and regulations. � The undersigned"homeowner"ce es that he/she unders the Town of Barnstable Building Department minimum inspection procedures and requirements and that a/she will comply said procedures and requirements. 7 Signature of Homeowner f y Approval of Building Official - Note: Three-family dwellings containin 5,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. I/ OMEOWNER'S EXEMPTION The Code states that: "Any homeowner p forming w1.ork for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1- icensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such w/ork,that suc Homeowner shall act as supervisor." Many homeowners who use this exemption are aware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Cons uction Supervisors,Section 215) This lack of awareness often results in serious problems,particularly when the homeown r hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licen ed Supervisor. The homeowner acting as-Supervisor is ultimately responsible. `/ To ensure that the homeowner is fully aware of his/her r onsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she undersds the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care(amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit formsEXPRESS.doc Revised 040215 • CI iX -711311 G n Town of Barnstable *Permit#—�" Fee 6monthsjromissuedate Regulatory Services Mesa Richard V.Scali,Dir_ector� s (� Building Division Paul Roma,Building Commissioner 2016 200 Main Street,Hyannis,MA 02601 www.town.Qtt%$ie.ma usi B f�STAB LE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /ti ^��W Valid without Red X-Press Imprint Map/parcel Number V J Property Address__ lyo y j V L/ (4- ,�11�t 5 +4 Cj (/I 4-c:=� esidential Value of Work$ „2, a-rU Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address -�-�Q_ �B J" Contractor's Name V') C.. Telephone Number !jK iC-,7-L(6 /L 71 Home Improvement Contractor License#(if applicable) ����'C�3 Email: L-.,i t , ov� CA Construction Supervisor's License#(if applicable) S ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I gpethe Homeowner Zkrhave Worker's Compensation Insuran Insurance Company Name ,/�/��. �c 1 Workman's Comp.Policy# 6 Utz — 5-Q�5-0-1 9- 7 G —1 S Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re- (hurricane nailed)(not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders.U-Value _ (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Ow etter of Permission. A copy of the om provement Con acto License&Construction Supervisors License is require . I SIGNATURE: Q:\WPFILES\FORMS\building permit fomis\EXPRESS.doc 06/20/16 P_ A The Commompea'}*cqf assachusetlx Deparhmeut cr,f ruibutrid Acciden& Office0 600 Washblglon Street Boston,MA 021II Fop M. rrrasagovIa7a NVOrl;;,ers' C Insurance Affidavit Bwlders CantracturslEIedTkianslPbmzbers Appucalm#InforrnailaII PletsePrintF *�►Iy I`dame B V'�t o j ccJl'— ✓��-vy+4S QnS L L., C , Address: �� �� �✓� Lo eaT4,4- one- _4570ri�—,,I`{6— Ce?t Are you an employer?Ciree the appropriate box: Type of project(regnred): I C�'I am a emPioye3 s�ith 4. ElI am a general contractor andI employees(fall andVor part-time)-* have)sired the sob-co ctors 6. ❑New c=stnxtic s 2.❑ I am a sale propdetor orpartuer- Tisted on the attached sheet 7. ❑Remodeling. shs p and bavie no employees . Ilese smb-cantractors have g ❑Demolition w ryng forme in aay capacity: employees andhase worms' [NO W06MM,Comp. 9..El Building ac iiiaa finun=e comp-msura�1 f -] I ❑ re We a a corporation and its 10-❑Electrical repaim or a,d4tious , 3_❑ I am a homeowner doing all work officers have exercised their 11-❑Phmsbiag repairs or at3clitions myself o wo ' right1�v of esempfiou per M(M in ngs ce equired-I1 - c.132,§1(4�andwe have no ❑Boat employees.[No Wo&Ms' 13-❑Other �1-�-L cam-instmince requhA] ',troy apgfi_Mt&4 cheftboa#1 mast also filloaithe sectionbelowshuwiag t5e¢wa&eas'compenmfianpaYmyitdvrmaff=_ Ota4rS Wl7D Snb�tt'dus a�da[ i n�ai�g dey Rm =4 ailwa&=dBienlire air&coatmf*=mnst submit aneyvafr3aa&mdieaf m such fCautracingth chec]rthisboxmastrtar% naadditionalsheer stowing thenameofthe�.and statewhetherm not f6aseendtiesb.nm employees.If themb-c=t adaeshave emplayw_,they mnstPnMide eir madmrs'gyp•pelicy atmdser- I am an employer fliat is protariritg workers'cotrtpertsd(ian ursriraece,for wy earpLayees Below is t7tepoticy and f ob site irrformcrtiars / IasmanceCompanyNatne: 'Policy,torSelf-ius. (7 kU-6 —5 � S�`7�ZT7� �-t��iisa4iasDafe: t���•�t6 Job Tde Address± 1Y0 e-[_'Z Q764 CitylStai:e/T;p: Attach a-capy ofthe workers'.ronzpensationpolicy declaration pap(shriving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MCrL c.157 can lead to the imposition of criminal penalties of a fine up to$L5Oa OO amVor ori;yiiir impdsm=erd,as well as rim penalties is lhe fa=of a STOP WARS ORDER and a fie of up to -00 a day against the violator. Be chased that a copy of this zblemesLt sway be f nmided to the Office of lavedigations of the DIA€m ismmnrg coverage verffica I do hereby c0#5,cinder ps abim 0 th the in,farwadw ptm.ided abmv h true and correct o Date- Pie ik '.6 t LI 021cfit see ata]�F. Do not write in fds area;to be wmpleted by taty artown gjgf ial City or Town: PermitUcense; Lnuing Authority(carle one): L Board of Health I BwIaing Depaatneat I Cltp To>va Clerk 4 Electrical hupector S.Planbhaig Inspector 6.Other Com#act Person: Phone#: 6 r ormation and Instructions massarhmeft c=teaal Laws chaps M retires aU eupIoy=to In M&was'sensation fX their employees. , Pn¢suantto this stoke,an employee is dbfined as¢.everyperson.in the seavi.cc of anotl=md=nay contract of hire, a cxpmm or iarpliec%oral or wzftbea•" An er is dci ftd as"an indrviffiA parb=shT,I tion; oration or other Iegal e f iy,or any two or more of the foregoing engaged is aJoint ,andindhe I repres�aiives of a.deceased employer,or the receiver or trustee of an individual,part amship,associ o legal mtity,employing employees. However$ie owner of a.dweIlmg house having not more than.threeand who resides therein,or the occupant of the - dwu;IImg house of=who employs persons tD do ,cansfruct on or repair work.on such dwelling house or on the grounds appurtenantfetetra sbaIlof ear employment be deemed to be an employer." MGL cbaptnr l52,§25C(�� � �� st f es that"every stat —renewalofaTicemeorper> tooperateabusinessnstract bindingsin the commGmmalth for any appUcani-who has notproduced acceptable evidencmpU=m withtheftLwrancecoverageregnired."Additionally,M(ff-chapter §25CM status fiTeifhnor�yy ofits poIrftcal snbdivisions shall ester into any contract for the p ce ofpublic wacceptable evidence of campbi an cewith 9ie insurmmce.resets ofthis chapter beeo.presentedto tiieanfhozcfy." Applicants Please fill ol-± the woticeas' comp ' n affidavit leteb(,by g$e boxes that apply to your situation and,if necessazY, pPh`sob-cantracfir(s) s), es)and p�nnmbea(s) along with their ce�tfic e(s) of himnance. Limited Liability Compares or Liabr7ityPartne�s(LIP)wifiino employees othea'than the members or partners,are not regrmed to compere firm insurance. If an LLC or LLP does have al employees,a u policy is red. Beadvised afficdayrtmaybesobmitted to,the;Deparbnentofladust- Accidents for confirmabm of ins' co Also be sure to sign and date-he affidavit. The affidavit should be retrrmed to the c or town that the appfi forth permit or license is being regnestrA not the Department of dY , I:j±stiz.al lA c - �ig Should you have any regarding the law or ifyou are regpred to obtain a worms' Cpxnpensafion policy,please call the Depar[m nnmberBsfedbelow. Self-fim red companies should entm their self-m sur,r=license number on the Ime. City or Town Officials t Please;besore that the;affidavit iscompl andpriedl a ly. TheDeparlmenEhasgrovidedspaceatthebottom of the affidavit for you to frIl Olt in the a the Office o has to 6ontacstyoumgmx1ing the applicant- Pleas 5 be,sure to fill in.the pemit•Ilicense which wiII b used as a reference number. In-addition,an applicant that must submit multiple petm>flIicense litatrons in my � year,need only sahmit one affidavit badicatiag cat policy fi f�,r�ati on(if necessary)and ffid,�a`fob Site Address"f3ie ' licant should write"aII locations in (may or town)-"A copy of the:-affidavit that has ea officially stamped.or by the city ar town may b e provided to the applicant as proo�tdlat a valid affidavit i on file four fz�se permits or es. Anew affidavit must be tiled.oiit each year.Where a home owner or citizen is obtaining a license or permit no to any tin es-�or commercial ve e (Le. a dog license or permit to berm leaves e�.)said pm-son is N to complete this of i& it The Office of iu-m igafrouzs would him to thmmk you m advance for Your co rsajian and should you have may qaestLom, please do not hesbdm to give us a calL The DrpFtu emfs address,telephone and� er. , ' I tip Of M& aOht cif 1n� Accidents 6M waaaomstf-'d B YA(RI II Fax#617 727-7M R.evise,d¢24-07 g r Town of Barnstable Regulatory Services `S. ' Richard V.Scali,Director 6;;►�� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I 5Le PC J , as Owner of the subject property hereby authorize �� � r v `�� to act on my behalf, in all matters relative to work authorized by this building permit application for: 4 O ,l 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 inspec ' s are performed and accepted. 4 Signature of Owner Signature of Applicant � � / ►tll ���L Pant Name Print Name I Date Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable V Regulatory Services oFtl Richard V.Scali,Director Building Division swRrrsl'nsM ' Paul Roma,Building Commissioner 1639. 200 Main Street, Hyannis,MA 02001 iOrEn � www.town.barnstable.ma. s Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE E MPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/townXiin state zip code The current exemption for"homeowners"was e inclu enwner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire wh poss ss a license,provided that the owner acts as supervisoIO OF HOMEOWNER Person(s)who owns a parcel of land on which he intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures to s h use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considerewn r. uch"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she son ible r all such work performed under the buildin ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for co pliance wit he State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understan the Town of B ble Building Department minimum inspection procedures and requirements and that he/she will comply with aid procedures and r uirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubi feet or larger will be required to com with the State Building Code Section 127.0 Construction Control. HOMED ER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is requi d shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided thatt'f the homeowner engages a person(s)for hire to do such work,that such Hom° wner shall act as supervisor." Many homeowners who use this exemption are unaw re 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 Wres unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a license Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Office of Consumes Affairs and Business Regulatijn _ ;r 10 Pal Plaza - Suite 5170 Boston,'Massachusetts 02116 Home Improve'nent Con"tractor Registration Registration: 155863 Type: LLC Expiration: 5/15/2017 Tr# 266546 ia,i�yY-r3 !t-_--I IWI P OJECT MANAGERS LLC ''�% F sill fLLIAM PLANINSHEK } ,.., 15' LEXINGTON LN. ` '; 4 YI RMOUTHPORT, MA 02675 Update Address and return card.Mark reason for change. �—Y Address Renewal Employment ❑ Lost Card SCA 1 C. 20M-05/11 j � ��ae�pan7/rrzaracaea�Ch a�GvGczaaar�uaeG� i. Offic of Consumer Affairs&Business Regulation II License or registration valid for individul,use only i I II OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: l Office of Consumer Affairs and Business!Regulation egi;tration: ,<;55863 Type: I i 10 Park Plaza-Suite 5170 , WExpiration:_=5%f5f71.7; LLC Boston,MA 02116 PROJECT MAN GERS=L1C G WILLIAM PLANT SHE aF1.1—`I_hj 15 LEXINGTON N. YARMOUTHPO ,MA 02675' Undersecretary Not valid w' t nature Massachusetts -Department of Public Safety Board of Building Regulations and Standards ' �unStrliCiiuli �iiNcT-riSur License: CS-095981 TA S WILLIAM F PLA$1N 15 LEIHNNGTON s YARMOUTH PORT W Expiration � J�� 10/25/2016 Commissioner Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. • Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DP5 j^. 1 Regulatory Services P��tr Thomas F. Geiler,Director Building Division r Mnss Tom Perry,Building Commissioner Q7 i639 ♦� A s 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: 1 �G53 HOME OCCUPATION REGISTRATION Date:rl�5%�d�l Phone#: ' Address: Village:�Gi.h�i�7�6GCAL�_ Name of Business: Type of Business: Map/Lot C 7-Z00 IIV'I'F.NT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,pro`aded that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential vol!pes;--4 and no increase in air or groundwater pollution. Ca After registration with the Building Inspector,a customary home occupation shall be permitted as of riglk subject to e following conditions: C83 � . a The activity is carried on by the permanent resident of a single family residential dwelling/unit,located-.51ithirn that dvvelling unit. ,: . „ Such use occupies no more than 400 square feet of space. a There are no external alterations to the dwelling wlich are not customary it residential buildings,and there is µ no outside evidence of such use. ,p C No trnffnc will be generated in excess of normal residential volumes. - y a The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. a There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. . There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. O No sign shall be displayed indicating the Customary Home Occupation. . If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. Y No person shall be em loyed in die Customary Home Occupation nvho is not a permanent resident of the - dwelling t I, the undersigned,l e d e w th ove strictions for my home occupation I am registering. Applicant: Date: /l Honieoc.doc Rev.01/3/08 YOU WISH TO OPEN A BUSINESS? For Your,Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601:(Town Hall) and get the Business Certificate that is required by law. F - DATE: .� Fill-in please: �W�^� _� APPLICANT'S YOUR NAME/ BUSINESS YOUR HOME ADDRESS:q r � ' TELEPHONE # . Home Telephone Number NAME OF CORPORATION: TYE.ONAME OF NEWBISINES F BUSINESS S'/�i /�✓ IS THIS A H..OME OCCUPATI ADDRESS OF,BUSINESS MAP/PARCEL NUMBER ��7� [Ass,essing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — [corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSION 'S OFF E This individu I ha'IS in a of ny er it requireme is t at pertain to this type of business MUST COMPLY WITH HOME OCCUPATION Aut prized na RULES AND REGULATIONS. FAILURE TO COMMENT / COMPLY MAY RESULT IN FINES. L A y 2. BOARD OF EALTH This individual has been informed of the permit requirements that pertain to this type.of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of.business. Authorized Signature* COMMENTS: } Y - i t,,,,, TEngi,neering Dept. (3rd floor) Map 3& Parcel 0 2' 00 6 Permit# House# 40 4 Z Date Issue Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee �6 • Conservation Office(4th floor)(8:30-9:30/1:00- 2:00) Planning Dept. (1st floor/School Admin. Bldg.) oF�►�,p Definitive Plan Approved by Planning Board 19 ' MA&S,kl# �& E tQ V vlEO TOIWN OF BARNSTABLE Building Permit/Application ,J Project Street Address `7 0 yp` 20L)7-e Co DO- LeT Village ,' Owner �C'f� O // f1 Address14 Telephone `S O — (O p` �� Permit Request / 007 First Floor . square feet Second Floor square feet Construction Type Estimated Project Cost $ U 0, Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family L ' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New 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) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name / �' OK �X%�/�O Telephone Number Address // ,(n30 %U C9 S,7—IV License# CS 0 S—.S ep 7-0 /1/I A✓�f�D�f� l�S Home Improvement Contractor# /1;? 1? V y0 Worker's Compensation#- (,� G y0 CP 775 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 THE FOLLQVrING REASON(S) R-� t r 't FOR OFFICIAL USE ONLY = r K PERMIT NO. / DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION { FRAME - - f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL — s FINAL BUILDING r v 6~ 1 DATE CLOSED OUT ASSOCIATION PLAN NO. Assessors offioe (1st floor): _� �,U '�� 'THE Assessor's map and lot number .... -�`�. .. ... .1�.............. Board of Health (3rd floor): IySTALLED IN COMPLI""tfO °" Sewage Permit number ................. q. �..1 ... WITH TI' -E 5 t A39TSDLL, Engineering Department (3rd floor): EPIw"II�t®HMEHTAL CODE o Naas House number ................................. a �� H REGULA S °'° 'M a.0 .............................'... TOW TIOI� o v 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�Q�C/cS%�ZG /.. .... CnX.....O.....1� ............................................... r TYPE OF CONSTRUCTIONQ.. vEc '` � . ................. ................ -�.. 19.4..6- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location lKQ..... ........................................ Proposed Use .. ... ..... Zoning District ......v.\22 ..................................Fire District ........���(Y..................................................... Name of Owner ss - /fit/ LOCe%f�.. 1/ZTP/Z.............Address .!��JY ./ale /.cGJT.Z I?2lVda.u-.e/�f/yl Name of Builder . ............Address .. m Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..............Plumbing ............................................................................................. ......................................................... r Fireplace ..................................................................................Approximate Cost ......7c� !............................. Definitive Plan Approved by Planning Board ------------------------_-------19________ . Area ......�............................... Diagram of Lot and Building with Dimensions Fee �............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town f Barnstable regarding the above construction. Name ... ..... .. .. ... ................ Construction Supervisor's License ....O"k............ PORTER, STEPHEN & LOUISE 31748 Add Deck No ................. Permit for .................................... Single Family Dwelling .......................................................................... Location 4042 Main Street ................................................................ Cummaquid .................................................................... ......... Owner ....&....L o.14.i.s.e...P.or.t.er-- .. .... .. .... Type of Construction ....Frame ....................... .............. 4. ............................................................................... Plot ............................. Lot ................................ , Permit Granted ......March...................29...............19 88 Date of'Inspection ....................................19 ;7 sYe " -Date Completed ..................... .19 37 17; cost w 225 IN'M 1"TY .iLT Id I1 12 W— —E I• ,I GRACE LI88Y � ,IO I I , DOROTHY N. FIELD I . ,t--S 84°04'12'E 12I.27 I t i TALES OF CAPE COD,INC. LC. 31477A I m 181 0 � Of 0 1 I co to I IB� _ 25,386 SO.FT. IZI KENNETH & , — I 1 _�.. S 84°58'06'E 103.81 t I I PHYLLIS C. I ; 1� t ROBERT F. 9 WILLMAN W 1 , , t 3_ CATHERINE C.RYAN I01 v i i ; 0 ! 0 ; � o I I It�j� I I o0 0 q i , z 0 I A I I _ o o0 ROGER P. 9 I I 12.634 SO.Fr. y0� I SARAH WILLIAMS I I Ict 00 1 I I I 1 iN ' Kf i I I 1,45 , 10T.TG :` 165.61 i S g4.53'10 W 6A 4 WIDE E HIGHWAY ROUTE 1909 _0. STAT PLAN OF LAND IN BARNSTABLE,(CUMMAQUID) MASS. T FOR THIS PLAN CONFORMS WITH 0 REGULATIONS OF THE RICHARD K. allo ALISON W. MARTIN S. 40 20 0 40 xlk-� �'7 AUGUST 11, 1982 m 82 SCALE IN FEET REG.LAND SURVEYOR EDWARD E.KELLEY REG. LAND SURVEYOR CUMMAOUID,MASS. APPROVAL UNDERE SUBDIVISION CONTROL LAW NOT REOU tr -I* .... ... . DATE.... .. .. ........ PLANNING BOARD BARNSTABLE '••.n.� ; 0 {_ 3 I 11 I t 1 1 PLAX-2S8 BK.17 r. scaly PLAN REF _