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0355 BEARSE'S WAY
/ass Jam- -- - ---�,\ - - - - - - � - --�� OestForDemand http://s*irig.cvsinc.net/files//cvd/l/12846/conffrniatioii city 20110121... CODE VIOLATION SERVICES, INC. 700 Automation Drive, Unit F Windsor, CO 80550V. Phone-. (949) 732-8145 Fax: (866) 484-5104 E-Mail: orders@cvsinc.net CVS Code Violation Report Confirmation Attn: Code Enforcement City of Barnstable Per my conversation with Jen from Building, at 12:55 PM on 01/21/2011, 1 am confirming that there are not any open or pending code violations or code violation fines on the property 355 Bearses Way Barnstable, MA 02601. T hank yo u. Suzi Mertz Customer Service Associate Code Violation Services SLIZI'@cvsino.net (970) 460-3579 Mission Statement:To be the single point, Nationwide solution for assisting Cities, Banks and Servicers to f alleviate neighborhood blight due to abandoned housing. 9 9. 1 of 1 1/21/2011 12:.56 PM i ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel r Application# r�b o 7 6XI6 Health Division r Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee 'S Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3's-S Village �2�is Owner r y y� �4 Address e,s �wy Telephone � pp� Permit Request &rt01/QT/O/! - AC�/ v2 wit'<S�i.-� B�s2�r,P,z7'� Gyi4dC)w ��.�� ��.e.�sf 6�;/� ���,.,,�� w¢�� w/��s t- ��/•ass _ � �� '� l���� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �� — Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family J;V Two Family ❑ Multi-Family(#units) Age of Existing Structure 60 Historic House: ❑Yes )Q No On Old King's Highway: ❑Yes ONo Basement Type: ,V Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing a new f Total Room Count(not including baths):existing new First Floor Roo Count _2 Heat Type and Fuel: ❑Gas A Oil ❑Electric ❑Other + Central Air: ❑Yes No Fireplaces: Existing �yvOs New Existing woo al stov�❑Ye° VNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ xisting�]newg.;isize Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: w - . Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION NameAew44 ,` �Ouv7w,_ Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY ` PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION - FIREPLAC E ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ! FINAL BUILDING ®1 V DATE CLOSED OUT ' ASSOCIATION PLAN NO. I is . ' The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wrvw.mass.govldia ' Workers' Compensation Insurance Affidavit: Builders/Colitractors/Electridans/Plumbers Applicant Information /j -.Please Print Le gib Name(Business/Orgauization/Individual): . Address: Xecz,5'p's Gv� City/State/Zip: 491=44111-F A?4 W661 Phone.#: Are you an employer?Checkthe appropriate box: :Type of pioject(required):. 1:❑ I am a employer 4. ❑ I am a general contractor and I ntp Yer with 6. ❑New construction . "employees (full and/or part-time).* have hired the sub-contractors liste&on the'attached sheet. 7. Remodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have slip and have no employees 8. ❑Demolition -Workingfor me in an capacity. employee;;and have workers' Y P tY• $. 9. ❑Building addition [No workers' comp,insurance comp; insurance. 10.❑Electricalrepairs ox additions required.] 5. ❑ We are a corporation and its 3 I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions ' comp. c. of exemption per MGL myself.[No workers'co insurance.re 12.❑Roof repairs ed. c. 152, §1(4),and we have no � ]t 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 ornot those entities have . employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is.the policy and job site, information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date' - job Site Address: G`ity/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 tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine lip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forrn 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 bIA for insurance coverage verification. I'do hereby certrfy and the pains•and pe Iti of perjury that the information provided above is true and correct Si tore: — Phone#: 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.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information anct instructions Massachusetts General Lays chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a:-deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of.the � such dwellin house repair work on s lion or r g persons to do maintenance construe dwelling house of another who employsp , P e employer." or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an mp Yer. MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced�acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter-152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public-work until acceptable evidence of•co4lia-mie withtlie insurance requirements of this chapter have been presentedto the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability'Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law-or if you are requirea to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line;. City or 'Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all•locations in (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant.as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial 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 like to thank you'in advance for your cooperation and should you have any questions, please'do not hesitate to give us a call The Depaximent's address,telephone-and fax number;: The Commonwealth Of M=Aclhusats Npartment of IndusWal Accidents ' P.M"of In�;ivesidi-gatioIts 6gfk wawnst6 Step B.cston,. 02111 • . Tel.#617-727-4W ext 406 or 1-877-MASSAFE Fax#617-' 7^7749 Revised 11-22.06 www.mm.gov/dia L �oFIMEro 'Town of Barnstable P p . Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 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: le-116 cot 40 g Estimated Cost / Address of Work:*, PftVqAo� -j S leoe,,S &20! 9k Owner's Name: 2% Date of Application: ;?�/Q I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 ElBuilding 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: Date Contrac Name Registration No. �7 ZI',l OR Date Owner's Name Q:foims:homeafndav ME Town of Barnstable yP��F1 Tp��o� ` Regulatory Services „ snxxsTnni e, . Thomas F.Geiler,Director v MASS �A 0 9• Building Division rED p. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: JOB LOCATION: [/� f,Tj numberstreet F G village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: ��✓ �PQiCf'S �/�.�/ P1/,9 �o�lQo city/tAm state zip code The current exemption for"homeowners".was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance-with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner" a 'fies that he/she understands the Town of Barnstable Building Department minimum ins on proced e d requirements and that he/she will comply with said procedures and require ts. Si attire of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hireto 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 forn-/certification for use in your community. Q :forms:homeexempt a ��4 . � ny I- b o Apkey, �10&0 Y, i - r I e I 41-r � � / s c �1yk";how � .. y �`"' t,y1Sh or.{) f` ,� {� ` �._ a��rd �---- � x� •lea'�=��.sex: . r t h' 3 CARS!N MONOXIDE MUST J3E INSTALLED PER ALARMS ' MASSACHUSEINS MLDN CODE Cut Fou,44+lorl - '/U x ' Q ) IMPORTANT- UPGRADE REQUIRED yt S� �G(� f �2C>✓f t�Ct v"'�� STATE BUILDING CODE REQUIRES THE UPGRADING OF ��C� Oh "�/ x(a ��l�� ��`1 SMOKE DETECTORS FOR THE ENTIRE mOv DWELLING WHEN ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. p JJ / �- NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE J�C'I!►'>tove T�, BQ ir►Q! I Re° .�t�d -��p�l INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. A) .f4x Zn ;, -,,,r,_, �f�D..µP „'arm S 4 !�" .�,"�"'�..�' jS�`x;;p.. � �u_,.� SAY � # �s_` r ,z v Ss "�<�' "emu-;• ,''",� -ry,�.- ,�` ;; ��' "�"ai'�:� � q;a.�,�$'1 x*'fir` `, #'r $ ,e' t,� fi ;:,, � r;l y#'C `c`, <";= K�,:. a 't s,' "'� ..'r�e•'iz 14`. .��,�'¢ �ll i � ..�' :yr, .�E .v -f 1;�f " _ _•-�F � :�' 'f• a€ 1 '` k`_ - - � � f ,z 0 'k .�. f%]a ` �f�';'e �'r •�.,�. 'zr+ l a..��"+'� ��- ;,� _`.r�,-r� �r ,r�'e'� �'- �^ ,� p .-u� �, �. "-MErP ,r�,. :.F7 t�, � 6� 'u,�r, w p' r—" �s ,C= e f. � _��a �r,°'=a�� �� '�-t-'_ „•� `� � Qk- > 6_�Ny- �D ✓ � � ,d, r �� � '�� � r y'4 y r' -.��w,' $`� h f a ,x L � ytt a 3, _2 4 IT- , ' ems ``' .n•a' � < �: �'"�-.. �•'. e., 3r..,;F, '' %=ri - _ t "vqx ;''�" .N;x'v,qJk• �v �'. �+ ,'s",.: 5 3t ".� #34 a '•� �`�� t �° ,•�.R yl �'� d'#r, ,x.,,s „zs� +� :•yi.��� � � w z� F z,� h,} - T eve, �w ..tt 'c`a �"' ..r �� x ' Md x`a'� } e� '1 .Si• t _._ a ` x yv' "� •:. x'�'- '�:c „*mom- -,, INEt � TOWN OF BARNSTABLE B d1ld[n Application Ref: 2001_02.. �� PP BARNSTASLE, Issue Date: 05/11/07 Permit MASS. �A i639. ��� Applicant: LANDI `IY ai�,-AS Permit Number: B 20071017 Proposed Use: SINGLE FAMILY DOME Expiration Date: 11/08/07 Location 355 BEARSES WAY Zoning District RB Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 292021 Permit Fee$ 25.00 Contractor PROPERTY OWNER Village HYANNIS App Fee$. 50.00 License Num OWNER Est Construction Cost$ 1,500 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REMOVE EXIST BASEMENT WINDOW,REPLACE WITH EGRESS W DAIS CARD MUST BE KEPT POSTED UNTIL FINAL SCUT FOUNDATION LARGER TO SIZE EGRESS-FOR 3RD BEDROOM INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: LANDI, THOMAS BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 185 SETH GOODSPEED WAY INSPECTION HAS BEEN MADE. OSTERVILLE,MA 02655 ,, 9 Application Entered by: PR Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET;ALLY OR SIDEWALK OR,ANY PART THEREOF EITHER TEMPORARILY OR PERMANENTLY; ENCROACHEMENTS-ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION: STREET,OR ALLY,GRADES AS WELL:AS.DEPTH AND LOCATION OF,PUBLIC'SEWERS'MAY BE OBTAINED FROM THE DEPARTMENT OF P-UBLIC.WORKS,..; THE ISSUANCE OF.THIS PERMIT DOES NOT,RE*LEASE.THE APPLICANT FROM`THE CONDITIONS`OF ANTY APPLICABLE SUBDMSION.RESTRICTIONS, . MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). `- ID - n p, BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 I 2 2 2 3 r �l 1 Heating Inspection Approvals Engineering Dept �= V Fire Dept �f,`��0� 2 Board of Health r RESS PER 11rown of Barnstable- *Permit# °1 X-P Expires 6 o m Issue date DEC 272 Regulatory 005 Re ulato Services Fee 00 Thomas F.Geiler,Director TOWN OF BARNSTABLE 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 �� V� Property Address Residential Value of Work �00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �z2- —COM4T S Z0,11' Contractor's Name 116qTelephone Number Home Improvement Contractor License#(if applicable) + eense- 1,1 Pl ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Worktnan's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) r Re-roof(stripping old shingles) All construction debris will be taken to Q ClMhS�� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. H e Improvement C�Wtactors License is required. SIGNATURE: Q:Fo=..expmtrg Revise071405 O --- Deparfinent of Industrial Accidents " Office.of Investigations. ' . ' a 600 Washington Street Boston,MA 02111 wwro.rnas&gov/dia Workers' Compensation hmurance Affidavit: Builders/Contractors/Electricianss/Pluffibers ApyUcant Information Please Print Legibly Name (Business/orgam=tiondn&adual): Oi his Address: /9.5 SP74� 60el City/State/Zip: Phone#: � Are you an employer? Check the-appropriate box:. Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I ' 6. ❑New construction employees (fill'and/or part-time).* have hired the sub-contractors . 2.El 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. workers' comp.insurance. • g, ❑ Building addition [No workers' comp.insurance 5, ❑ We are a corporation and its 10.❑Electrical repairs or.additions required.] officers have exercised their 3. I am a homeowner doitg all work right of exemption per MGL 11-❑ Plumbing repairs or additions myself.,[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t 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 $Contractors thatcheck this bozmust attached an additional sheet showing the name of the sub-contrabtors and their workers'cam.policy informstioa lam an employer that is providing workers'compensation insurance for my employees. Below h the policy and job site information. Insurance.Company Name: Policy#or Self-ins. Lia#: Expiration Date: Job Site Address: City/Stat&74 Attach a copy of the workers' compensation policy declaration page(showing the policy number andexpiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of'criminalpen2lties of a fine up to$.1,500,.00 and/or one-yeas imprisomnent, as well as civil penalties in the form of a STOPVORK 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 certify un the pains and nitres of perjury that the information provided above is true and correct Si afore: Date:'. �. �� Phone#: 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 Instructions, Massachusetts General Laws chapter 152 requires all employers to Provide wor cP' �a� y contract Pursuant to this statute, an employee is defined as ...every person m the service -of anotherexpress or implied,oral or written." ers association,Farporation or other legal entity,or any two or more An employer is defined aR,:' ivi¢aal,.pa bip�. of the foregoing.engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. Howeypr.tlie owner of a dwelling hous a having not more than three apartments and who resides therein, or.the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair woiInn such dwelling house or on the grounds or binding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." ter 152, 25 states"Neither the commonwealth nor any of its-political subdivisions shall Additionally,MGL chap .. § �� enter into any contract for the perfonnance of public work until acceptable evidence of compliance with the insurance requirements of•this chapter have been presented to the contracting authority." applicants Please fill out the workers' compensation affidavit completely,by chec> g the�bonxewihthlcer�h'your fiica certificate(s) of on and,if necessary,supply sub-contractor(s)name(s),addresses)and phone numb ( ) g . insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department Of'Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of ions regarding the law or-if you are required to obtain a workers' Industrial Accidents. Should you have any quest compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fin out in the event the Office of Investigations has to contact you regarding the appl ict Please be sure-to fill lathe permit/hcewe number which will be used as a reference number. In addition,an applicant that must submit multiple permit'license applications in any given year,need only submit one affidavit indicating can eat policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _____' (city or A of the•.affidavit that has been officially stamped or marked by the city or town may be provided to the town). copy at•a valid affidavit is-on file for.future perm'U•or-licenses..Anew affidavit must be filled out each applicant as proof th year,Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit hike to thank you in advance for your cooperation and should you have any questions, The Office of Investigations would 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 40.6 or•l-877-MASSAFE Fax#617-7274749 Revised 5-2645 www.mass.gov/din TOWN OF BARNSTABLE BUILDING PERMIT•APPLICATION Map Parcel `��� �, Permit# �'9 ' �f Health Division T / _.<<— � • Date Issuee�?.,� . . Conservation Division ,`/ Fee Tax Collector '461 Treasurer 001 F G r + 6 Planning Dept. ALLE0 Ise =JAPUANCE Date Definitive PI A ved by Planning Board Historic-OKH' Preservation/Hyannis ; •� " i Project Street Address Village - Owner Luz . lea, Ch nt' Pe'r-l�-L4 Address ''yc2 i � Telephone Permit Request �0 CtYV'.l (' 1�'1fi a 1 Uary) a Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost C d) J I or) Zoning District Flood Plain Groundwater Overlay i Construction Type , Lot Size Grandfathered: ❑Yes , ❑No If yes;attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes to .• . Basement Type:*ull ❑Crawl ❑Walkout' ❑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 -Heat Type and Fuel: ❑Gas l Oil• • Cl Electric ❑Other Central Air: ❑Yes A No 'Fireplaces: Existing New Existing wood/coal stove: ❑Yes `'®No Detached garage:❑existing 0 new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Aexisting ❑new size .Shed: existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# 'Recorded❑ .Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# AFL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREf~� <�,X us J / Y DAE _ 1-'L C FOR OFFICIAL-USE ONLY ' PERMIT NO. DATE ISSUED re MAP/PARCEL NO. ADDRESS I VILLAGE l a. OWNER DATE OF INSPECTION: - . . ti `• � i. • -- } • � - y FOUNDATION 3 r . _ • ; §; i - ' i FRAME s .. c: F" ~ INSULATION FIREPLACE i ELECTRICAL: ROUGH < FINAL PLUMBING: ROUGH _ FINAL _ GAS: ROUGH FINAL FINAL BUILDING C � "V`[✓1. -// �. 7 _ - r DATE CLOSED OUT , �, ASSOCIATIONTLAN NO. 180CMR Appmdt;j Table JS=b(condnued) Prescriptive Packages for One and Two-Fan*Residential Buildings Sated witb Fossil Fneh MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor I Basement Stab Heating/Cooling Area'('/I) U-valuer R value' R-value' R value' Wall Perimeter Eqm1mcm Elfcicaq' pie R value' R value' 5101 to 6500 Heating Degree DaW Q 12% 0.40 30 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 95 AFUE T 15% 0.36 38 13 23 N/A N/A Normal U IS'/• 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 8S AFUE W 115% 0.52 30 19 19 10 6 95 AFUE X 18% 0.32 38 13 25 N/A WA Normal Y IS% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 •19 10 6 90 AFUE AA 1811, 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: I 11 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3O 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY 92): 7 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPR AL: YES: NO: q-forms-080303a 780 CMR Appendix J Footnotes to Table J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fe of decorative glass may be excluded from a building design with 300 ft of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. 'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 ......... - - The Commonwealth of Massachusetts Department of Industrial Accidents .._T Office O110yestigations 600 Washington Street Boston,Mass. 02111 Workers' Com,pensation Insurance Affidavit name: LN .i'`)C — 'Si location L.L city hone# �, f 6,33 3 I am a hdineowner performing all work myself. I am a sole propnetor and have no one working in any ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. compnnv name: address: city: phone#: insurance co. P01icV# ///////////////////////////'//�// /////////// ////%%/%/////////////%/////////// /// //////%///////%////////////////%/%/i///i., I am a sole proprietor, generai contractor, omeown ircle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address city: phone#: insurnnce co. Volim# ::;.:: .... :. campanv name: -_.. address: - city- phone#: -. insurance ea. olii:y# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Wte up to 51,500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a llne of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verillcation. I do hereby certify..0 der the p and pen ' of perjury that t _information provided above is true and correct '� 7�--� I cam' Signa re' Cam' Date 1' _ Print name 0 QA Le-L 1, h5� -j Phone# )t�?� —d, 3 oMcial use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (rmua W95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any coau--c-, of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver c_ trustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews; of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Investlgatfons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 � �TMe ' o Department of Health Safety and Environmental Services Building Division BARNM sa�' 367 Main Street,Hyannis MA 02601 1659. ,0� �rEb MA'I� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: MCAruk 8, !JOB LOCATION:3,5s (� C �,� h number street I I village "HOMEOWNER': �hGPerr- - 3 name home Ohone# work phone# CURRENT MAILING ADDRESS: �� c>e . i n IS' IKA (t 1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building.permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirerneig�s and that he/she will comply with said procedures and .require ents. L,PL G -- �Sig=reomeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a fonn/certification for use in your community. QTORMS:EXEMPT I i 0 �G • I I �� I iC,7 I j is �• i 1 I C r r : i i i I I I I I t I i I l - ' _ I ', �p5 ' � 3dT2 �' lOt�...�---�`_` fo 7 �----._•'•`.'�"' a�d a> ----��`mm°--- ..�.r,.7�f�,�--"s`�'--"—. �'� �°--�;—��. I + i - i t 10 I. I 1 i 1 I i - i Of f I , C 1 : y { r Eli ; I i. I I i • i : 110 �q Voca 7 i i i I `�. G7 i l I k 1 I • 1 1 i i , 1 n, r i , I I I� �i• It V�,l j I i j I 1 ....`. 1 � �' ..�' ''' � � •---�...�._.,,_,�.._ .a rj•%� fit' < M. I - � I i I I i. ni 147 Z� I RESIDENTIAL ADDITIONS OR ALTERATIONS If located: North of Route 6 - any work visible from outside- needs approval from OKH ❑ In Hyannis - If work visible from outside- Check to see if it's included in the Hyannis Historic Waterfront District- if so it needs approval from them APPLICATION PACKAGE MUST INCLUDE: Er Map/parcel number Approval Sign-offs from: Health (� Conservation(if exterior work) f Tax Collector Treasurer . If ZBA relief(Special Permit or Variance is required for project: F-JCopy of ZBA Decision Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date. Street address [� Owner's name & address Permit request- full description of proposed project(u-value of replacement windows if applicable) Square footage -proposed project [� Estimated project cost Complete Dwelling information for Assessor's Office ❑ Builder's information E]' Signature Plot plan 2 sets of reduced (8.5"x 11: or 8.5" x 14")plans with cross section& framing schedule Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name & Worker's Comp policy number Y� Energy Compliance Form Copy of Construction Supervisor's License & Home Improvement Specialist's License OR❑ Homeowner's License Exemption Form. Fee CHIMNEYS Need Home Improvement License No plot plan required PIERS & DOCKS Need Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMITS 1 Rev3/5/99 r- Engineering Dept. (3rd floor) Map Parcel ® P rmit# House# ` Date Issued Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30)� � � `�J� Fee �- Conservation Office (4th floor)(8:30-9:30/ 1:00-2:00) 41EN DE SEPTI E 19 INST ANCE TOWN OF BARNSTAB 9RO AND yecteetA�ddress Building Permit Application TOWN EGULAMOM3 t 4-IAN�iS " Village" .�. Owner � !_�/� ��� Address Telephone 5_0 k — - 52 Permit Request 11,ol r ' q � First Floor square feet Second Floor square feet Construction Type (JJc5od Y✓A.AW C Estimated Project Cost $ ®00 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family )ij' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 2,,S- Basement Unfinished Area(sq.ft) 12t� Number of Baths: Full: Existing�_ New Half: Existing New No. of Bedrooms: Existing 2- New Total Room Count(not including baths):Existing New First Floor Room Count HPot 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) L 2 X ❑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 ��6A) kX_ &%A/S,0t_ACTelephone Number 5-4k- 7;/ 300 Address 62 1'1 t/`v'-P License# C2 L �3 y4ce , Am)e-S /Ul Home Improvement Contractor# /00 Worker's Compensation# iS /7 0© K6 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 0 J� &A-10D ( SIGNATURE DATE BUILDING PERMIT DENIED F4 THE 4LOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. b DATE ISSUED MAP/PARCE NO a ADDRESS VILLAGE_ OWNER r " DATE OF INSPECTION: FOUNDATION FRAME (b INSULATION FIREPLACE Al ELECTRICAL: ROUGH FINAL PLUMBING: ' ROUGH FINAL GAS: #; ROIJGI` FINAL , FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO,. • f i F i r.Yw�Yi(1+A•.'ww' .,h 1 2 T f r i did �� i ix � ��¢�•c v,;�y�l+�F�°*}���'''!' e��to � e b , , n Yt" T ',y7 {3i�F4� �' rsy rn 'd4y- ar+ .tYT'�r'kt"=.fr `' At. 41i- s ✓ �, 5 'J ' +�,SVI$t rti. v tr 54 i,` t iy$ 1 ., , f . V ,+ ,� 7 * h�4 F �,x� S=. �� rr=+ .r ,• F 'rcns vit t e ..d d *•�,.rn t ,5 •TFr �i ., a 1 �, �.. �� 3�,T t r, av, t � ....o * i t Rr £µ,%,'j t t d• 4 ' t �'s . x°y`ifs'fl?�"'+�w,. �,.':. , #oa..x e'i � .,'F', ♦ n, r d �, �,a.�a µ "_ fX n!r ar l � v�. i ��+ xt T .-t i , tr.a '.. +J.,t '�i'G_,l•+x'•iR r .l b +v ,<,•e.a•_:wr• r.,s •¢ — - r� 7 �: .g r, 'd-"''"1+Yr"t,., .b .i4. .!t't+•e�..n.-.s:, ------- '$'� ti�'""s[•.jit"'L'' r - ,� s, tn`�• .2. 1 ,F'YY'3``"' '4'' dt 3. xS.s'4.. i r __._ �, - t e x,rC9 J«�74 d '�`vz+ '✓rt-5,!"`r' }.44. �� I n:. t3 5 v .t4 4 Lk 1yi;sia �'toSn•rr E 4` t P a 'Ad k,yr"P4t r d rµbA — t ww_ .--T'_ ON c t j.ryxM lot fi 7 '1a�r'' -55t'''} v t y .N �5' i� # � � r. e �'�' x did�+ � + k/ i 1 �x � `r '% i;�p -- �--�—=•�- , � �pMC$ ritr � d +}.•.y,x�k'a ,.�`�x i� r�ay�. yf FTSrJ. t a ---- ? �7�-�•. ..�—'J1 �.��_ efi `Y} ��.'f .dffn `.fr i pr �;i� t ✓r iaiY4xe gm b r 7 i t"X - wr•7 to s. r'7 r" 'k •,,a f 1. ..tZ'S'd 7. � f�- e�rY t iw ty�.K:r I h, � FRi r �,i,�P�- +7�.• '3. // rw , cic y.N.. �� '� r >���IIIII�IIIIIIIIIIIh I�I�Glillll 1�III ,. ,,-� l Mill e �c�� � Est?:����I^.'�II�I�III lII11I lIlIII�II�IIIII�I 7 — c a ti The Town of Barnstable _ of Health Safety and Environmental Services MIMS �� Department Building Division,- 367 Main Street,Hyannis MA 0260' Ralph Crossen Office: 508.790-6227 Building Commissioner Fax: 508-790-6230 For office use only i Permit no._ Date AFFIDAVIT �OME�ROVEMENT CONTRACTOR,LAW SUPPLEMIENT To PERMIT APPLICATION air, modernization, MGL C. 142A requires that the "reconstruction, alterations, renovation, rep pre-existingn to any conversion, improvement, removal, demoiitionone but not moretion than four an odwelling units or to owner occupied building containing at least tered contractors, with structures which are adjacent to such residence r building be done by regis certain exceptions,along with other OnEst.Cost Type of Work. ® . . -o��S Address of Work: Owner's Name Date of Permit Application: I hereby certify that: Regs:y ren is not.required for the following reason(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is he given that: PERNIIT OR DEALING WTTH UNREGISTERED OWNERS PULLING THEIR OWN WORK DO NOT HAVE O MGL c.14ZA CONTRACTORS FOR APPLICABLE SOME IIIMPROVEMENTNT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UND SIGNED UNDER PENALTIES OF PERJURY I hereby apply i for a p it the agent of the owner. 1601 AUE 6 / Registration No. q 9� Contractor Name OR. Owner's Name i nafP The Cunrtrtunivealth of Atassachusetty - •p Department of Industrial Accidents =i ;_ ;:� _ • 0>fceo1129YOW9,71/otts 600 ff'as/ri►r/;tt►rr Street Bt►awn.Mass. (12111 Workers' Compensation insurance Affidavit B.P. _,.--- :.,...•.�•-.-.•:r.,-,..-._.-_.....�.�...�--- nitcant Information• Plense p- mNT'le`av name* �r 1pcition Silly /JI-L4 A1UA)I)J phone# rJ I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity __.t,:•�.x...�Y....e--r.r-•_'I-�'-+'..LSI-?�Iys�.s.rw.,V4�. :..,s.—;...m- -* _• ..,: ,;... _ M�^�'--^^--'r..�{••-^-•_�s•�"- I am an emplover providing workers compensation for my employees working on this job. co.mnam•name: 3z, addreas• 7 / i 1�/�/L>T!!Y) �✓�1,(� . !d<.•• � �-/V/y 1...� phone#• 1509 - ?7I insurnnee co �A ( ) .� policy# /��� ® / ZZ �6 r ,. _ .,: .-:.�... .,,...�.,o:awe.......:+n....e.�.....+y----••-,•..........a�...�..... I am a sole proprietor. general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: csrmp•tm• n•tmc• •tddress• - city phone#• insurnnee co policy# �- ^5•: ., ... - - _., x+rlf!::: •:ri�o'ti=---r,s^ -^r�re.f•;*�7l•:==�—•qsrr•►.•:a�-�;-{7'7r•R�+w+.csi,.sr::Tc-'wwy.^ `!;:^ea"^..y'.�.�.ri;'!"_".� cnm am•name: address: rip•• phone#• incurnnce co policy# 7Attach additional sheef if necessat ;w a>; � rr;yt�.. :•z:.t..�1 ......,�r:.�....• .. ..ray """y'b4•-�M»•••Ewa•+—�+� Failu re ec to sure era covge as rcquircd under Section 25A of AICL IS2 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andior one 1 cars'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.o0 a day against me. 1 understand that a copy of this statement may be forwarded to the Officc of Investigations of the DIA for coverage verification. ' I do herehl certij i •r the airs attd penalties ojpedun•that the injornwtion prorided above is true and coTect. Si_nature Date Print name �� Phone# 3/` 0 70M.Ci2lse only do not write in this area to be completed by cit or town officialwn: permit/license# nBuilding Department Licensing Board check if immediate response is required C35clectmen's Office LJ C311ealth Department contact person: phone#; riOther Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' for the employees. As quoted from the "law", an cn►ploree is defined as every person in the service of another under anv contract of hire, express or implied, oral or written. An enzpinrer is dcf mcd as an individual, partnership, association. corporation or other legal entity, or any two or 1110, the foregoing crianued in a joint enterprise, and including the legal representatives of a deceased employer, or the = rcceiver or trustee of an individual , partnership, association or other legal entity, employing; employees. However tL owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwcllin`g house of another who employs persons to do maintenance , construction or repair work on such dwelling_ he or on the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section _'5 also states that every state or local licensing Agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildinbs in the commonwealth for any applicant iwito has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Appiicants ' Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of,Industrial Accidents. Should ydtt have any questions regarding the "law"or if you are require to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding tite applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned /ihe Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question.. 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 fax #: (617) 727-7749 44- (417) 717_.19M nvt lflf_ 409 nr 17; Engineering Dept. (3rd floor) Map Parcel Permit# 17 q6 L House# Date Issued Board of Health(3rd floor)(8:15 -9:30%1:00-4:30)ff-V--')/ Cl'� de� Conservation Office (4th floor)(8:30- 9:30/1:00-2:00) �tHE SEPTIC 'ST BE 19 BNSTi�UE ' '��iE TOWN OF BAIRNSTABL vino ®0E AND Building Permit Application TOWN REGULAMONS Pro' Ftreet Address 3J55, 13EpoQ56-s co" 4 Village 4 AAuA!`s Owner 14-6(-La J A-S S C M Address 3 SS lj C4/2� L4--)4:�, Telephone '7r7l- `j 2- 3 Permit Request ®A-/-�u ® ec� o - First Floor square feet Second Floor square feet Construction Type Wc, n cl Estimated Project Cost $ on Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family X 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 C�C7�/us w� Telephone Number So 1- 7 7/ ��l� Address 2/`7 7%o ��� , License# 0 S -- ®6 3"s- Home Improvement Contractor# Worker's Compensation# /517-00 -- 027.,,2 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 v 1-;14 SIGNATURE DATE 2 " `6 BUILDING PERMIT DENIED F0VrHE F LLOWING REASON(S) a FOR OFFICIAL USE ONLY PERMIT NO. el - DATE ISSUED w . MAP/PARCE NO i ADDRESS VILLAGE OWNER c DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE { ELECTRICAL: ROUGH FINAL PLUMBING: c,-ROUGH, FINAL - GAS: -r �~ UGN r FINAL FINAL BUILDINWf r ' DATE CLOSED OU ASSOCIATION P---;XOz-", ' f>p A The ,Town of Barnstable � �_ 13ARM"�' ent of Sealth Safety and Environmental Services 4 NAM $ Departm Building Division NIA 02601 367 Main Street,Hyannis Ralph Crossen Office: 508-790-6227 Building commissioner Fax: 508-790-6230 For office use only Permit no. Date__---------- AFFIDAVIT HOME IIVII'ROV To EMENTE�CONTRACTOR TIONw SUPPLEMENT requires that the "reconstruction, alterations, renovation, repair, modernization, MGL c. 142A q re-existing conversion, improvement, removal, demolition,lone but not more than four o dwelling units or to owner occupied building containing at tared contractors, with structures which are adjacent to such resident r building be done by registered certain exceptions,along with otherrequirements. 9 300 C� /��. Est.COSt Type of Work• Oil 0�- Address of Work. � b � K.S. � U`► Owners Name ame Date of Permit Application: I hereby certify that: Registration is not required for the following reasou(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit i Notice is hereby given that: OR DEALING WITH UNREGISTERED OWNERS PULLING THEIR OWN PERMIT WORK DO NOT HAVE HOME MIPROVEMENT CONTRACTORS FOR APPLICABLE UNDER MGL c. 14ZA ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY apply for a permit as e a nt of the owner: I hereby PP Y L, � Registration No. C tractor Name Date OR. Owner's Name natP The Common wealth of Massachusetts usetts •+:i. Dc partmcnt of Industrial Accidents `�_ 0>rceo!/avestf920fts 6#1'1 Washington Street Boston.Alas. (12111 Workers' Compensation Insurance Affidavit Aphlir�n�t nformation• iaPle:►se PRiNT'le�ibl� nameCM, s loci ion: 4W �4rv�y,'sghoneZ- iw 0 1 am a homeowner performing all work myself. OI am a sole proprietor and have no one working in any capacity rr :. .,'..a:.`.. 'ae`..rs-.m.RTK7 .mti;�,s„- ^..,....-...1.^.�-*.,.:..-:.: ..e.._-__.-.. .,.,.w..,. ""^"! """•"' "'w'n'4'e""•_..,s.=, I am an emplover providing workers' compensation for my employees working on this job. comi2anv name: (f / address: ? LJ-e )4 Rhone N! Z.2 incurince co U-)40sAL) 27;sS nolicv# / V 7 I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: c►ommp•tnv name: address: city phone#• incur-ince co nolicv# �- ., - .. �. - - _• „cnr::- •:r�wrc-=�-r^s•..:•.•Z,rt:'f�.,:R�:.s-•,---area��-�;TJ.rs►,+wwa�ssr:.r:+...;. y�v..r��a....�w;.ina.:'�"^.—rr cmmr)im•name: address- City phone#• insurance co nolicv# -Attach additional sheet if nicessar �w �:_ ��:,f� °:.a• °,r-�•"_ '` ""�"• - Pailure to secure coverage as required under Section 25A of AIGL M can lead to the imposition of criminal penalties of a fine up to 51.500.00 andiur one}•cars'imprisonment as well as civil penalties in the form 0172 STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement ma%.be forwarded to the OMce of Investigations of the D1A for coverage verification. ' I do herchr certifl raider /rc p sand penalties of perjun•that the information provided above is true and correct. / _ Si_naturc -Date, Print name 15� O CG&AV5 &:' D�e Phone# a oRcial use oniv do not write in this area to be completed by city or town official city or town: permitilicense# riBuilding Department pLiccnsing Board check if immediate response is required C3Scicctmen•s Office ' [3licalth Department contact person: phone#• r9Uther irc„sed 1,os PJAI II Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers*-confo lsation for the enlplovees. As quoted from the "law", an emploree is defined as every person in the service of another under an, contract of hire, express or implied, oral or written. An enrplorer is defined as an individual. partnership, association. corporation or other legal entity, or any two or nor the foregoing enLaged in a joint enterprise, and including the legal representatives of a deceased emplover, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However th owner of a dwellina, house Navin` not more than three apartments and who resides therein, or the occupant of the dwcllin`�t, house of another who employs persons to do maintenance , construction or repair work on such dwelling lic or oil the urounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that every state or local licensing a'genc,% shall withhold the issuance or renewal of a license or permit to operate a business or to construct buiidings in the commomi-ealth for anv applicant ,who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political,subdivisions shall enter into anv contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. - Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all-affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law'or if you are requires to obtain a workers- compensation policy, please call the Department at the number listed below. . .... ..... •. ..: ... ...._._..: :.�.;,?. :'cv;:' -. ,r.L.:y;;,��:d.r '�.,It .Y• Ciro• or -Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question. please do not hesitate to give us a call. . Tile Department's address:-telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 !- r6171 777-4900 rvt_ :106_ 409 or 171; �.`.. , yM� ,.-b.�- Rjl�w ... sty--0•.v .�...�..,r ,�.1:� �L!�R � �,` _ `F _ -_ 1�'I���r1E �� � ' l'si �4.'- ._ � .i _ J. ..q_�: _ c i - ' ��x ��.d W o�� aan o ran � o � :.r. ?� S F--� G - G ... � G� Jj - rr .b o b� ' � rr m o � k � �� �. v _ ""' �' o w �'n ! ' N 7U -�' �1 r+ .�� A Z �O � to Pn a` ' P�� '""� O m .-c X' .fV �• ` .. u+ " C w W � T � � � 3 Assessor's map and lot number .. .pa-aa ?... � d/ /... yoFF Sewage Permit number ... Lgal . ' O'TI�+ House number .... f':��".5.�'%5.... : :.lr . .....�? NST�D IN 1 WITH TI TOWN- OF BARNSTA BUILDING INSPECTOR APPLICATION FOR PERMIT TO �.�� ..... �. ...�.?. .�'�� f ....................................:..:......... TYPE OF CONSTRUCTION ... XX ...... .: :................. t ...pr, .............19.. . TO'THE INSPECTOR'OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ....... W.......1...............!...l.11 B.. �.. ...J.... ..... .............................. . .......: ........ . ......................... . r ProposedUse .... .................................:............................................................................................................. Zoning District . ../.: .j'�.��J�..�..��.....................................Fire District . Ea.. ..r0..'. .............................................. Name of Owner ..... ...... ........�.�.1.k....Address 3.......... ...�...�.... .. L.�.�`�..,.. �. . ..... S. . � �1 Name of Builder 4?Jy.�7. :r�.......r-..1....il. .�.��..:�.t t.Address 3.5. . �� .Y'J S. . ' .... .............1 Nameof Architect ...............................................................:..Address ...........+...............................:......:... ............:................. Numberof .Rooms ..O.q.!� ...................................................Foundation ...................................................... Exierior .A.li L� ......�....�. '. ..�.'. .�.. �. .................Roofing .... ..��.. ..�' .h�.�:.r................... Floors .W'. . .. Interior Heating �. .� �.�y .....................................:...:.................Plumbing .....:�..4....... . ....,.....:.............:...........::.:....:............. Fireplace ...... 4....`�,C�: .......................................................Approximate Cost �i..�.3�. � . ...........................C .... :.. Definitive Plan Approved by Planning Board ___ _______.________________19________. Area . ........ .....:........ do Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �rC2 W r � I hereby agree to conform to all the R les and Regulations of the Town of Barnstable regarding the above construction. Name "!.....".'.:...Il' ..... ............................ BASSETT, DONALD E. 22128 Addition No ................. Permit for .................................... Build—Fralte Ga agq................. ............................................. ... ....... Location 355 Bearses Way................................................................ .................. ........................................... Owner Donald E. Bassett ............................................................. Type Co-pstruction ..................... t . ................................................................................ Plot ... ......:I................ Lot ......... ........ ............ Permit Gr-a6ted ............-2kpk.il...1.6.,.....-ig 80 Date of Inspection ...A. 9 ez)Date Completed ..................... 19 PERMIT REFUSED, ........................................................... -19 f ......................................... ............................. ............. An...... ............................................... ............ ........... .............................................. ............ ....... ................. .................................. Approv *.m........................................ .19 ............ ............ ........................................................... ?` e;7 �d y.3a Assessor's map and lot number ...1;.?..9r� THE TO Sewage Permit number i. ./.s.?!.�1+..,. ✓... .!?.�. tl � /� 7f7 � B9 .... f� y/� ( `� MAMMAL, i�„ �,lr,.�� S tlt.1 . House number � � �' �' rase � t TOWN OF BARNSTABLE BUILDING' INSPECTOR A LICATION FOR PERMIT TO ................. .... .................. .......... .. ................................................. TYPEOF CONSTRUCTION ...........................................,,.......................................................................................... h f ........:.......:..... ...... .....:...........19.. ..: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....r...?............ ............�..�..... .`.:............ ..t'...��...............I.... .. �..�......�.c......... .................................................. ` ProposedUse ..... .!..'. ........................................................................................................................................................... Zoning District ... r r n� t Fire District �..� � 'r t-1 r-l..}. �1........................................... ................................................. ..... ... .......... ..... ,Name of Owner ...:f...t.'.. '.�............ ...........?. .. .'.`..?. Address .:. '. ....' t .t'. . ...'^. l r?........."...`. 1..:?. . .!..:'.... Name of Builder ....... .......�... 1 q .-� ' .`.......Address �. �.�.... ............... ...... $'t-) t� if .....�� .�,�!,i'``.�:........ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .Z.. .t.....................................................Foundation .!..,.:.nr"I .f,.��......................................................... Exierior .......f'.t'�1 :.................Roofng JN� !� � �............................. ........ ... - ............................ Floors . ....Interior ........... .. . ;aC ........................................... Heating— .....ice -..................................- ...........................Pl,umbing ......;........ .................................................................. Fireplace ...... ... ...1. . ........`..................................................Approximate Cost .......................................................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ...�C%. ......... ................. C+i Diagram of,Lot and Building with Dimensions Fee ... SUBJECT TO APPROVAL OF BOARD OF HEALTH J L r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 0 ... .....11130 ................................ BASSETT, DONAIYL*� E 2 9 2—,z2:2Z— If I No ..22.12B.. Permit for J0rj.tj,' ............. Bui4d `F r-ame G&rag ....................................................... I............... Location 355 Bearses...Wa .............................. .......Y........................ ...............SHY.aP?ii.s............................................. Owner ...Do.n.al.d...E..... Bassett ............ .. .... .. .. . .. . .. ....... Type of Construction JF/KAMP........................... ............................................................:................... Plot .............. Lot ................................ Permit Granted .....Ap.r.i.1....1.6..........19 80 ..... .. .... Date of Inspection ...................................19 Date Completed ...................I....................19 PERMIT EFUSED ................. ..... .. ...................... 19................. ..... ............... ....0...................... ......................../....... ................ I ,r .... .......... ..... ......................i...................... ............................................................................... Approved, ........ .................... 19 ............................................................................... ............................................................................... - Assessor's map and lot'number ... !"u .:`4.1....... • R :4 Sewage Permit number .................:......................................... T Er°�° TOWN OF 'BARNSTABLE L: i BAHigSTA&L i < Mb a,,. � BUILD�I,NG = INSPECTOR O 39• , t2 ;'t �0 t OypY- L! d .� ..... f y. ...�(..�..:. . ...F. ........................................................ L, APPLICATION FOR PERMIT TO ... y...:. ... . . ...�.. ..... . ........ `.o TYPE OF CONSTRUCTION to t ....!.. ........19...L.k _TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....r;!.. .1...... .. ........................:...................................:..............:....................... ProposedUse ..... .. . .. .. ..... . ...........................................................:................................................................................. ZoningDistrict ............................... ...................................Fire District .... .... ................................................................... CName of Owner .. .. V Lz�� .....Address .s1. .5.. l�✓ ..a... ... ...... . 22 fC Name of Builder ::�������.Q..�G'��!�.Address .�1.......,/..... .. ... .... .. .. ... .......... ......... Nameof Architect .............................................................:.....Address .................................................................................... Number of Rooms ...1,1...T14-'.:..........................................Foundation ili.21'z........ ...................................... Exterior .(/.W44,,,Yn..-x... ... ...........................Roofing ............................................. Floors Interior' ` .. .................. .......................... .................................................... Heatingv ...........................Plumbing t Fireplace .....P .......................................................................Approximate Cost ....... U. ................................................. Definitive Plan Approved by Planning Board ________________________________19________ . Area ................................ Diagram of Lot and Building with Dimensions Fee ...../067.. ...`......... ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 f Cim. • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . G ....`-!....: ................................. Bassett, Donald E. { 16466 - -- storage r No Permit fo_r t, shed -356 Bearses ay - Location _ Hyannis .,, L.7 ..........:................... ......................................... `J Owner ....................DOnld..E'...Bassett Type of Construction Plot ........................ .. Lot ................................ M " 4 tr✓ - . June 17� . 76 '7 Permit Granted ...............1914 .d Date of Inspection ..... .......19 Date Completed 4 - .19 _ PERMIT REFUSED'' ................................................................ 19 Li ............................................................. ............................................ .... .....-.-.... �• � w. :.:� r �y � � r ..........................:Y................................................... Approved .............. 19 "- AJ ............................................................. ...................................................... ...............4:� i/� - Assessor's map and lot number ..........................:................ �y �-! c3 Sewage Permit number ....................:..................................... `c, Z' ., r. TOWN OF BARNSTABLE l i? T i B TABLE, 9� "b 9 '0m� BUILDING INSPECTOR , , r APPLICATION FOR PERMIT TO .. - ......:�,........... !! ........................�. ............................................................... TYPE'OF CONSTRUCTION .................................................................................... ......j........................................... z Y�.cm 0 f 1 19. !, r* ..............� .... ....... c� TO—T°Fi[INSPECTOR'OF,BUILDINGS:. The undersigned hereby applies for a permit according to the following information: Location .... .. ...... ......V „cG ...:................................................................................................... ProposedUse ...�1,/( / .1/(/... ............................................................................................................................ . ............ ZoningDistrict ...............................rf. .. ............................Fire District ... ................................................................. Name of Owner (t?11� ��.. . .. ! �1.•.... ....Address A �P/' /�...L/IJ�lit/I r Name of Builder !j? <! .. �... r'' .Address P-��C I ....... ......... '! �. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ... -P ............................................Foundation . ,� �Exterior ..�.....:..�.:��!. ..:±...].�......... ....E,.............................Roofing ...,...........y ............................................. Floors /`�"t /1 ........................7........................Interior ......." . ...`.�. y ............... ......................................r................................... �hieating _,.U.._,.. ........ Plumbing ..............................:.....f...........:............................. Fireplace .........................Approximate Cost ....... ................................................ Definitive Plan Approved by Planning Board ________________________________19________. Area .............................. .. Diagram of Lot and Building with Dimensions Fee • SUBJECT TO APPROVAL OF 'BOARD OF HEALTH F . 0— hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ./!„/"�/? �( ...- .!.....;l 3................................ � ___-- - -, _-_~_d E. _ 2-~—~ . ~~� 18466 storage she No ."""". for 0 ' � .......................... ' _. .... - 355 Bearses Way - Location ................................................. ...........4anni s -------------------------- \ O. vner ---�onald E. �ass'ett ------.. -----------'' ' ` '/r~ of ~~~^~^^ ` . . � ^ ' nc* L ^ Ju2e 17 . . 6 ` } Permit Granted . . . .Date of cti . ` Date Com | . . . . ` \ . � { . / . __ T REFUSED ) . / - . . . ^ -----' ° f � ' .................................................. ............................ . �� . -------.--.--~.—. . .—..—..----.— ' � ' . . ' ^ Approved ................................................ 19 � ------------------------.-- . . ` ------------------------...— .