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HomeMy WebLinkAbout0008 GOAT FIELD LANE ACTIVE w' r 5 Application nu er... 1 ...... ..�.. oil a9 ARFtq Fee..................T­.��..*.................................... ` 'JUN Building Inspectors Initials..0......C&a ^ O���AI 2142019 Date Issued:..... C�:� .......1......................... 8A RNS Y ��� Map/Parcel.............:.4. d � .................... TOWN OP BARNSTABLE - EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: it& RuNbER STREET VILLAGE Owner's Name: _ r�e���,/„�. Phone Number Email Address: u,vJ4l W Cell Phone Number � it tvA-9 ,(, Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Q Siding Windows (no header change)# F-1 Insulation/Weatherization PDoors (no header change)# Commercial Doors require an inspector's review © Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Va d L_,,4 er4 t " CONTRACTOR'S INFORMATION Contractor's name ,�C C - . L Home Improvement Contractors Registration(if applicable)# b 3 (attach copy) Construction Supervisor's License# �j o (attach copy) GC_,-<oo-- , C- Email of Contractor V 01 64 Phone number 6M-77co — c,— � ALL PROPERTIES TH T 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* . t •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 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 Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)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 unde the rules and regulations for Licensed Construction Supervisor in acc d c with 780 the Massachusetts State Building Code. I understand the constructio in ec ' n proc res,specific inspections and documentation required by 780 CMR and th o of arnstab e. Signature Date __�12 V;/ APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Z 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 Legibly Name(Business/Organization/Individual): I _ .r�/�G Address: T c City/State/Zip: ` / U C Phone#: - 2'5 Are you an employe . C eck the appropriate box: Type of project(required): 1.� employer to er am a em with ..� 4. ❑ I am a general contractor and I ❑ employees(full and/or part-time):* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have. g• ❑Demolition workingfor me in an capacity. employees and have workers' Y p t3'• 9. El Building addition [No workers' comp.insurance comp.insurance.: 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C; / G✓- Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Q 4r,11-i �� City/State/Zip: GLt/l dj��1 Q h a co of the workers compensation ensation policy declaration page(showing the policy numb�x expiration date). Attach PY P P Y P g ( g P Y P ) 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 aga• th7a9ce 'olator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the ]A o ins coverage verification. I do hereby ce n er a a' and penalties of perjury that the information provided a77" rue and correct Si ature: Date: Phone#: 4_2K -"/�6 — � 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 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 dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit 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 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. The Office,of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www,mas.s.gov/dia y The Cooperative Bank of Cape Cod POSITIVELY DIFFERENT r 1 mycapecodbank.com • 508.568.3400 •� Office of Consumer �C-���aQaacliccQe�Za �= HOME Ins Affairs&Business Regulation F. ROVEMENT CONTRACTOR k TYRE Corporation igis r Exnir ion �4/08/2-020 CAPE &ISLAND CpISf >f µYUTfdN=C0 INC. JOSHUA KOURI ' -55 ELM AVE. HYANNIS, MA 02601 ` Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ` Const� rvisor CS-074660 �� e �ires: 02/12/2021 AU r 4 a' JOSHUA X KAURI_� PO BOX 210 CENTERVILLE ,7 a f - - Town of Barnstable *Permit# r7' �•e Regulatory Se CeS ee 6 months1rom issue date BAMMABL S. e' Richard V.Scali,Director ryggp\\• 59. Building Division jj1A/ 1 , ► Paul Roma,Building tssion � 200 Main Street,Hyanrii�;I 01 �U>P www.town.barmtable.ma.i Office: 508-862-4038 /� Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL1UNLY !�1 f _ O]� Not Valid without Red X-Pr s Lriprint Map/parcel Number d `1 U / '^ )C*Property Address �- ,� �t/, 11 L- _� Residential Value of Work$ V, (ZZ� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address G/l d "/-1 � f b Contractor's Name_C / CZ) I-) C-- Telephone Number `7 CB 3 J (n Home Improvement Contractor License#(if applicable) k Construction Supervisor's License#(if applicable) �?y !a C v c,41 orkman's Compensation Insurance Check one: ❑ I am a sole proprietor . ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# C�,� - �� ~- -7 7 q-�/0- l`, Copy of Insurance Compliance Certificate st accompany each permit. Permit Reque check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to [ Gl✓Gt.,- ,� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows f #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr erty O er must sign Property Owner Letter of Permission. py of a Home Improvement Contractors License&Construction Supervisors License is e uired. SIGNATURE: QA)ATFILESTORMS\building permit forms\EXPRESS.doc 01/25/17 t � . The CoruutompeaWt ajf'Maysadiusetts Department qf c1nd Accide>'rts 600 WaskiugtoFt y treet BastoY4 AIA 0211I ' f�vtuma���vfi�ia Wurl ers' Cwffi ensaflan.Insm-mce Aff davit BuRder-dCuntrachmsMecbi "ten fibers AppU -t Infi imam P'iease F'rint 1V a= - C/T C ( J Are you an employer? eekthe appropriate b= ' Type of project(regiimd): L v a employer wf& //�— 4. ❑I am a genaral contractor and I 6. ❑New constuctsa employees(full andfor partlsme,* lmve laredfm soar-contmctom 2-D I am a sole lrropdetor•orpa tner- listed onthe atUched sheet. 7 ❑Remodeling These sab-cmilractors has*e slip and ba<<e na employees • 8. ❑Demolition woddng forme is any capacity. employees and bar,e worirers' 9. ❑Building addition INo er rs' cflmp.insum„ce Comp.T"Llo�# retZuired j 5- ❑ We are a c4xporafion and its 10❑Eleoibud repairs,or additions 3.❑ I am a homeouaer doing 91 Vol:k officers have exercised their 1 L❑Phm3bsagrepairs ar kWiams s6i o w ukers' right of eseaxltfiau per MGL ry repairs � � - c.l5z,§l(4kamdwehaveno L.❑Rflafr , incni ce rerzsni ed i employees-[Nowo&ess' 13_❑f7f$er cozp.m mi mce required_) rgay npgff®24;bat ebedcsbas�1 mast also fiIta�attbm secBo¢be7m�sbaidag dieawodce�campeasatiompoycyiaincmauom. . t E rmwmerswbo submit ffi s afii&nff inffrzting&-my zm doing d iva l mAd=him oatadecaatmcmrsmast.sabmitaaewaSxd:rdt indi�na sacfi fCaomac4ors�s2 chec7�thir boot mast attached=addifinnsl sneer slowing fliens�n.�e of me snb-cam m and state whedes or mat those ensifieshsm ernp9oyees.Iftbesnb-c=t=±os uceemployees,ffieymIIastgmtadtdw*Rnrkea'clmP•poRUaumbet lain art errtpr�trt>irpraui workers'coarpertsric+at irtszirartca�nr rrt}*employees: $erap9 is 25heptrIicy anti job sate informat7AtL Insamnce:compmtp'ibe: r Poficy or�f-ins.11C.¢ �o G Cj '���� �i.�U ��' pira4iauDafe: Job TifeAddres v ��T CifplSta �/1 Attarh a.ropy of the warkers'compensationpoFcydeclarafion page(showing the poficy numbek and empiration date). Fare to secure coverage as requiredundes Section 25A of MGL a 157—can lead to the imposition of criminal penalises of a fine up to$1500:0a asdfor one-year impfisonmen,as well as dvR penalties in Itie,fana of a STOP WORK ORDERand a fate of up to$250-00 a day a - the vio r. Be adsised that a copy of this statement.m ay be forwarded to the Office of Investigatinso orte DIA W instn:anc coverage,,kart.= FrI'alterariycsrf�f3' -POWNes* .perjCrythattheircj`arms&wpro1,i&,daboveis(rusmidwrrect Date- OOzdd am wiry. Duo ttat write in flds urea,Al be crrtrtpreted by city Urfe11-11 offXutt City or Tow a- Per•nAtEkense 4 Issuing Authority(circle one): L Board of lreaH•li r.Buffirm Department 3.CUylrowa Clerk 4.Electrical Inspector S.Plumbing Ensgector Other Contact Person: Mone#: -- 6 c1In 'y �• H, w . S � G S• �' w ro �'� �C � w ci O q O � ro FBro rho a+ �, � m 1,4 ro co pi v R 4 0 � a 1pa �P. w � Or P3 � lam, D �.,' o' �y '-'• Ki R� k! � frci➢ 00 rp Et Et 1p W r �rPp ' E Al W. r CD a71 , P F7 p " Hr 0 Er Id th g Et C7' D t6 P' IdId Q I-h b o 0, c9 U• `V �. PPL' : � cP • Town of Barnstable Regulatory Services F+ of Richard V.Scali,Director Building Division . R t I Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner - — Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner 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 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\M(PRESS.doc 06/20/16 r Town of Barnstable ` Regulatory Services Richard V. Scali,Director. Building Division. Panl Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 509-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L , as Owner.of the subject property hereby authorize to act on.my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QFORMS:OWNERPERMISSIONPOOIS ACC) CERTIFICATE OF LIABILITY INSURANCE °ATE`MMI°°"""' �..+� 5/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NCACT AME: 44 BARNSTABLE ROAD- PHONE FAx PO BOX 250 A/c No Ext: (AIC No): HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: CAPE & ISLANDS CONSTRUCTION COMPANY INC INSURERC: PO BOX 210 CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35624081 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE 1 RENTED PREMISESS Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO JECT F—] LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-377540-017 5/7/2017 5/7/2018 ,/ STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBEREXCLUDED7 FN] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 1 $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 35624081 1 1-377540 1 17-18 WC 1 n0270258 1 5/14/2017 11:09:46 PM (PDT) I Page 1 of 1 Estimate 1401 Date Jun 1,2017 Cape & Islands Construction Co. P.O. Po Box 210 Centerville Ma.02632 Terms 508,775.7663 Ship Via Ship Date Barbara&Jay Baldwin 8 Goat Field Rd. Hyannis,Ma.02601 CERTAINTEED Certainteed Shingle Roof 10,450.00 Strip existing shingles from roof. Secure any loose sheathing. Install Hicks brand vented aluminum drip edge. Install Wip brand Ice&Water Shield to all eves,rakes,valleys and all protrusions. Install Rhino brand Synthetic Felt Underlayment. Install Certainteed Quick Start starter shingles to all rakes&eves. Install Certainteed LIFETIME Landmark architectural shingles. Storm nail all shingles. (State building code requires 4 nails,we use 6) Re-flash all vent pipes with new boots. Install Rigid Vent 11 ridge venting. Remove and dispose of all job related waste. leave your ro r there! Provide all manufactures warranties and rj cV LIFETIME warranty on our labor, if it ever fails due to our workmanship we i Jvl I fix it,forever! It's The Best In The Business. Please no so a es And longest available ANYWHERE! GENERAL General 475.00 Remove and fill in roof vents. Remove re-insta gutter guards. .1 Total $10,925.00 Signature � 4 � f l s /�— f 9®f Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-074660 Construction Supervisor JOSHUA X KOURI PO BOX 210 CENTERVILLE MA 02632• ' Expi ration: Commissioher 02/12/2019 7 Cjfie �Affairs Office of Consuiness Regulation HOME IMPROVEMENT CONTRACTOR t Registration:: 165936-� Type: •, ExpiratiorUE= Private Corporation ? INC. CAPE&ISLAND CO;L� 1C JOSHUA.-KOURI � 55 ELM AVE. HYANNIS,MA 02601 Undersecretary ----------- - ---------------- — Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIPS Licensing information visit: WWW.MASS.GOV/DPS License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10_Pa"rk Plaza-Suite 5170 Boston,MA 02116 of al' without signature F , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q f'ri A Map Parcel Application # Health Division �' , ='' ' ' "' ` `, ' Date Issued Conservation Division Application Fee Planning Dept .„N..�.�_,.�. Permit Fee � Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address J Village %%zl Owner Address ���� ye- Telephone 24J .?� c�®4Z Permit Request /'tKb.,f z::�// IZZ6 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 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 9.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 Number 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ,�' ,AiA �,�c/ ,4(4 1, 7,'14 Telephone Number ✓� ��5�21� Address/Sr .o 2�d,F� l�>L� License# /a D ZM U Home Improvement Contractor# Email f1i1/ �,/2i�i�s`J��1!Ofc/ , 494t Worker's Compensation #kJZ��D -3/f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / �� �(r FOR OFFICIAL USE ONLY i APPLICATION # DATE ISSUED MAP/ PARCEL NO. 'x ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL + GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r Town .of Barnstable Regulatory Services s NAM � k!Oard V.Scaly Director s63q. ♦0 Tom Perry,Building Commissioner 200Main Street;Hyannis.MA,02661 www.town.barnstabie_rnams Office: 508-862-4038 Fax: 508-790.-6230 Troperty Owner Must Complete and Sign This Section if�sineABudde I, GI Y bGI►'�i 8r ld� � �'i as Owner of die ixibJect properly r hereby authorize : caz e S'� ' G[t�ii�j to act on.rnybeb0, , tJ in-A matters Maim to work authmized bythis bufiding pemut application for iC1,d .1.11n rhlAhn;S M'% 67-&-P) (Address *Pool.fences afid ala=arse the responsa it c�'of the ap licarit. l'cio1 .are aot.to be:filled or.ut'tlredbe�t�re,fenoe is`i.�t;allecl acid all f`ir�l ' inspettions are:perfarmed and.accepted. Signamm of Owner Sljna re of Applicant �9G WA A) Print Name grim Nairn D Q:FORMS ONNNF.RPEWSS10NPW1S Z The Contra ortfvercltl, of hlrrssrtchusetts Departm-ent of lnrlustrlral Accidents 1 Congress Street, Sulte 100 Uq Boston, MA 02114.2017 )vww,=s,gov/d1a Ww-kers' Compensation Insurance Affidavit: B�ilders/Contractors/Electricians/Plumbers. 6Rpl(cant Inforniallon TO BE FILED WITH THE PERMITTING AUTHORITY, ' Please Print Lc i Name(Business/Organization/individual): l � ^� JK Address:—/p City/State/Zip: " 'G � /�r9 d 2 Phone Are you an employer? Oseck tbo appropriate box: _ " Type of project (requlrcd); ~ I.�-i am a employer with �„omploycos(full and/or part-time),' 2,Q l am a$olo proprietor or pertnorship and have no ampioyaas working for me in 7' New Construction any capacity,(No workers'comp. Insurenco required,) $,".'[] Remodeling 3.(]I am a homeowner doing all work mysolf (No workers'comp,Insurenco raquirod,)t 9, ❑ DemOlition CC]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will i [) Building addition ensure that all contractors either have workers'compensation insurance or are solo proprietors with no employees: 11.[] Electrical repairs or additions S.Q I am a general contractor and I have hired the sub•conlractors listed on the attached shoat, 12,[]Plumbing repairs or additions These sub•contraotors have employeos and hays workers,comp, Insuranco.l 13.(] repairs 6.p We are a corporaff}on and its clovers have exarolsed their right of exemption per MOL o, 14. ,Other_/ 152,1110),and we have no employees.(No workers'comp,insurance required,) Any applicant That choc box N I must comp ensati also fill out the soelio,I below showing the Homeowners ir woron policy Information. who submrt'4his aP(ldavit indicating they are doing kers'all work and then hire outside contractors must.submit a new affidavit indicating sucli.�^ lConlractors that check this box must attached an additional shoot showing the name or the sub•contrsctors and state whether or not(hoso entities have employees. If the subcontractors hays employees,they must proyido their workers'comp.policy number, 1 ant an employer that is providing workers' lnformntlon, compensation insurance for y employees. Below s t/te policy and job site insurance Company Name: Policy N or Self ins, Lio, b: Expiration Date: Job Site Address; L'�a /�� �.� �nn Faiac•Ir a copy of the workers' compensatin policy d ciaratge (showing�he Policy nu er•and Failure to secure coverage as required under MOL Q. 152, §25A es a criminal violation punishable b a fine expiration da ic), andlor one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER y up to$1,500.00 day agtiinst the violator. A copy'of,,this statement may be forwarded to the Office of I and a fens I f i s'u5ra QQ coverage verification, Investigations of the D1A for insurance IS rlo hereby cerWunder the pales arul penalties ofperlury thnl the lr�'orrrtatton provlrled above !s true and cor t natu e; i' recr hoe a; Z Offdelal use only, Doyhot Wriee In thls area, to be completed by elty or toil,offlcla4 City or Torva; �, Pertnit/Licease h Issuing Authority (circle one); I. Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector S, Plutnbin Inspector T 6, Other g spector Contact Person; Phone#: Massachusekta (Department of Public Safety ^^^^�^^^ I(t• / Board of Building Regulatlons and Standards License: CS•100988 Constrw,tlon Supervisor e ' ``�..1.� I� cic� '�it•�+�� HENRY E CAS•810 Y 8 SHED ROW > • WEST YARMOUfH ' Expiration: Colnmissloner 1111112017 a b _ Office of Consumer Affairs and Business Regulation 10 Park Plaza = Suite 5170 Boston, Mae4USettS 02116 Home Improvemee. tractor Registration ( In Type: Corporation ,. " "~ Registration 153567 1 Inc Cape Cod Insulation "' n� � �'. � Expiration: 12/14/2018 18 Reardon Circle So, Yarmouth, MA 02664 t' C iCA 1 Li 20M•05/11 Update Address and return card, Mark reason for change. ' ... __--_..._... --•_-.__ ..-__._�_.. __._.___...�.__._._..._.___...._..__._....C�1-Aur.'�::asta—C'1-ft�nru:;~;!_!��: ,►q�y�ert,_��,ost.C.ar�... ds�oa���raoacuea�C/c o��aaaac%ccoeGld Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT COORACTOR Registration valid for Individual use only i TOO, Corporation before the expiration date. If found return to: - :eglst:ration Ex Ik r atlon Office of Consumer Affairs and Business Regulation � I l 12/14/2018 10 Park Plaza c Suite 5170 /• i.� Boston,MA 02116 Cape Cod Insu � == !' Henry Cassidy' 18 Reardon Circ 2 CG l So.Yarmouth,MA`SC� ''" Undersecretary Not valid without signature -�1 CAPECOD-27 DEATON CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/29/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRE$ENTATIXE OR PRODUCER,AND THE CERTIFICATE HOLDER. .0 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT ME: Rogers&Gray Insurance Agency,Inc. PHo e 434 Rte 134INC,No): 877 816.2166 South Dennis,MA 02860 ADDRESS:mall ro ers ra .com INSURER 8 AFFORDING COVERAGE NAIC q INSURER A:Peerless Insurance Company INSURED INSURER S:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURERD:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURERE: INSURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY,PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER MMI'OLDD/YYYY POL'_WMIDC P LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 0 OCCUR CBP8263063 04/01/2016 04/01/2017 EM E a occurrence) $ 100,000 MED EXP fAny onePerson) $ 6,000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECi LOCH PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: AUTOMOBILE LIABILITY C MB ED I GL LIMIT $ 1,000,000 B ANY AUTO 8232707COM01 04/01/2016 04/01/2017 BODILY INJURY(Par person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PR P R A AUTOS d $ $ X UMBRELLA LIAO X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESSLIAB CLAIMS•MADE EXCIOOOO635001 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate WORKERS COMPENSATION $ 2,000,000 AND EMPLOYERS'LIABILITY P A TE ER D YIN ANY OFFICER/MEMBER ER/EXCLUDE NIA NIA WCE00431802 08130/2018 08/3012017 E.L.EACH ACCIDENT $ 11000,000 (Mandatory In NH)6descrbedAd E.L.DISEASE-EA EMPLOYEE $ 11000,000 El If yyea describe under DESGIRIPTION OF OPERATIONS below DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CLEAResult,Eversource and National Grid are listed as Additional insureds on this pollcy on a primary,non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rfnhtn raanrvari 4 -aY-17 CAPE COD INSULATION /IIIA Ot Ali IIAMtIII IF1AY FOAM IUSYINDIO IAIII OUI11A1 INIUTA110N IIIl11,01 tip / 1-800-696-6611 .o� I Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed.& completed the insulation and weatherization work at the property listed below, Cape Cod Insulation did this in accordance to the specifications listed on the building permit application, All work has been inspected by a certified Building Performance .Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes 11l �r�—. (�) ( ) ( my) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) 4'N-e,r-,l/ (VO r k Fe r)ro r "e'o1 Sincerely 2Hi E ssration, sident Insc• Town of Barnstable *Permit of THE Tp�� Expires 6 months from issueeddate Fee J • �' Regulatory Services Thomas F.Geiler,Director 01 f0 Building Division Peter F:DiMatteo, Building Commissoneri 367 Main Street, Hyannis,MA 02601w S' 2 6 boo' CR�I1 Office: 508-862-4038 7*0W V oF8 AIL, Fax: 508-r 90-6230 EMPRESS PERMIT APPLICATION - RESIDENTIAL ONLY R'�sT'I Vot Valid without Red X-Press Imprint Lf 7 �� Map.�parcel`lumber ` Propem•Address ' Value of Work 2�'lDr"3 Residential , Owner's Name&Address Contractor's Name ��-" t� ` t+-��"'e Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) r ' I ❑Worktnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner I have Worker's Compensation Insurance • Insurance Company Name a' .�•'1 Workum's Comp.POlicv# �. Permit Request(check box) Re-roof(stripping old shingles) >❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value. ( 44) ❑ Other(specify) •Where required: issuance of this t d not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Signantre Q:Forrrs:expmtrc:r%-4) 0601 TOWN OF BARNSTABLE Permit No. Building Inspector cash ------- 1619. a VAN OCCUPANCY PERMIT Bona -------X---- 7____. s Issued to BaVSide B11ildinq Co. Address Lot Zr 8 Coat Field Lane, West Hyannisport Wiring Inspector ; /jam, Inspection date Plumbing Inspector Inspection date Gas Inspector .� ( s Inspection date / ;.Engineering Department 'r/ �--- Inspection date Board of Health �'ti z Inspection date 3 f/ THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. OF j ........................... 19 /e_zf -,-- Z40 Building Inspector . - FROM r TOWN OF BARNSTABLE Mr. Francis LahI . BUILDING G DEPARTMENT •fin Clerk' " „"" `� "�' �` 7 MAIN STREET- . HYANNIS, MA &601- ' , 775-1120, SUBJECT' FOLD HERE DATE MESSAGE Walk has been-cx ed-mide -Permit Numbers 261.89, 26362,t 26363 (Baysic3e Co. Bi4fl-I Please release Zits.° „ ti a:9 rr.g.n.�„e w,.Qw+s aP.•4•aa a'e- '1� 3. f�c a't•,'�!•^o Crmaac�71F s--^�•. ,yyg.+••m'.tF.x",.it 4"e6+f+r>.a':x . .� +.. SIGNED DATE - REPLY. --' .SIGNED' Ne7-Rml - - - RECIPIENT: RETAIN WHITE-COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDERS SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. S S8�Z1 , z Y 3 0. d ,q a- z,. .. z.0 O is tL/ ZA730TH CoT' r 2 89 G r . -o e i l y� SI 2.o vd O L D. row N AOA D y', vy i b rs CERTIFIED N t4 PLOT PLAN Wa ac Rt} E Rr n �0 0o v s r _ ucl r i i4N�t/IS Pap T loa`w1OrH IN 2. SCALE, 4/0 DATE ► 3 /2�/8 y DW0C EN01 ffgINNG CLIENT�Rys'ACE I CERTIFY THAT THE EGISTERED� REGISTERED 83"" o'2" SHOWN ON .THIS_ PLAN 19 LOCATED CIVIL LAND JOs NO:._ ......_,�.,. ON .THE GROUND AS INDICATED ANU - ENGINEER SURVEYOR ON.by$ -kW CONFORMS TO THE ZONING LAWS OF BARNSTABLE , MASS. R E E T 712 MAIN S T Ci611Y+ — IiYANh( IS MASS BHEETj. f -L-4 DATE REG. LAND SURVEYOR s -:� S , i d Assessor., s map'and lot number J ....... i �� •{...... ;!?P IN tr! -O 'q<� �ai , ; PyoF?HEtp�f a /.S �11967 TIC Sewage Permit number ....... '.......`...:. ��� ENVIRONMENTAL CODE AN d* f.V REGULATIONS = 33AUSTODLE, House number y ^ea B........................................ ..•�. 'O, MASIL 0� 0 YFY a� TOWN OF BARNSTABLE r BUILDING INSPECTOR F APPLICATION FOR PERMIT TO � �1!.,..... !,V ... .. ... .... ....................... TYPEOF CONSTRUCTION ..... ...�..��.......................................................................................... ............. .. .................. ........ ISS TO THE INSPECTOR OF BUILDINGS: The undersig ed hereby applies forp permit according to th ollow' nformatio : • . �.� . ...........:.. :: Location ... ..... - /...... . ProposedUse .........va/U .......... ... ...-.. .................................................................................................. Zoning District ......... 'vim' ...... Fire District yR¢/1!lr�. ........ . ............................... Name of Owner ... �� Ce-.Address .... ....i/. .. ...... .............................................. Name of Builder ...54�o. e..............................................Address .........5.l. ......... .. .^'.. ....................... Q Address ........ Name of Architect u.:.D ��e ........ .E;x!'"�'.1/ ..... ........... ................ ....... Number of Rooms .... ...C/o.... .......................... . ..... ..........Foundation ..... 1/. .. ... .... ... C Exlerior ..l /'�'�` �.. ....Roofing ......... / � .. CP✓.,r u. (�. 12 v Floors �..... ...................Interior ... ...�✓�r�sa°.... ..... ..... .. C4.. 1.. Heating .... ............................................Plumbing ... . ...0$. .�j� !i Fireplace .........1 ................................................ .........Approximate. Cost... a' . .. . �. .......... Definitive Plan Approved by Planning Board ________�_--___'---------19� Area ../........ � ........�. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 IVfV OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnst ble rega dthe above construction. �n Name ................. r....�. ........ ............... .......Construction Supervisor's License .. t........(................ II -i..WAYSIDE BUILDING CO. 26189. 12 Story .N� ................. Permit for .................................... Single Family Dwelling . .............I.................................................................. Lot 1, 8 Goat Field Lane., Location ................................................................ West Hyannisport ............................................................. Owner ......B.ay.s.i doe...B.u.i.1.d.i.n.4 Co...._... .. .... .. .... .. Type of Construction ...Frame....................................... ................................................................................ Plot ...I........................ Lot ................................. Permit,Granted 2 March 22, - --jq 84 ...................................... Date of Inspection ..................................:.'19 Date Completed .................0t.1 9# 47 i rt 7. Assessor's map and lot number .... ..;!...............I...... + � Gj/> L `��/���� THE �pU Tp� " Sewage Permit number .................................8.3..............? P �— Z BARNSTABLE, 5 i House number .................... .....Rg........................................ ' rasa s639. \0� 'ED M a' TOWN OF BA^RNSTABLE BUILDING INSPECT^OR APPLICATION FOR PERMIT TO . ! teG " i.! ./ r ....................... TYPEOF CONSTRUCTION ............................W.........�............................................................................................. 19. TO THE INSPECTOR OF BUILDINGS: /f The undersigned hereby/applies fporr a /permit according to the following,ii/nforma/tiion": / Location . .. �. (,...�) j./....!.. � ^ ' r�l.... ....a.c f f ..................... ProposedUse .........��/ �L:..f.... ./�!�(G .�C; .-1 ":....................J.............................. ............................... Zoning District ......:.......... 1........ ... ................. ..........Fire District ,� :.*�+!r�r;.. ........./...,....j Name of Owner ....rr :�l. ../�-�,../. .,! �1.... !/... .Address .... /..../�1 ` ;J� .! ... �f................................ ... !. .. . .. .... ... r Name of Builder .....2��Ze� ..........................Address 0 "'.. Name of Architect ✓.:. .. �. .............................Address .......... n.47. .Z'�. ..... ................ Number of Rooms .......!.. ?................................,.A......:..........Foundation ..... .�!. .....,. ? r a—&........................... Exierior ....... .. .:...... .` ..... .......(1&1:2111....Roofing ............... f�.:��.:............................................... Floors !.!L�/l„�.................Interior ................ .......... f•............../...,......../ .................. ;y_, Heating Plumbing /t /_ �f' .:[. ..9., � �. Fireplace ............ : ...............................................J.:........Approximate. Cost .....//;�>.7.. .•................................................. Definitive Plan Approved by Planning Board ____ � _ `.__ ��-�~� ' =-.. . ------19�-------. Area Diagram of Lot and Building with Dimensions Fee ................+............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules,and Regulations of the Town of Barnstable regardIrig the above construction. Name .............. .... .............. j� L��/ Construction Supervisor's License ........:��./................ 1 BAYSIDE BUILDING CO. A=247-200 ,a47- 2aC2 No 26189 Permit for 1 z...Story............. Single Fa.........y Dwelling...... Lot 1 8 Goat Field Lane Location ................. ..................... ............. ......... West HyannisPor ..... .......................... / OwnerBay side BuildingCo / ...... ..........................................�............. Type of Construction ...,Frame .................. ................................................................................ Plot ............................ Lot ................................ Permit Granted „March 22, 19 84 Date of Inspection ....................................19 Date Completed ......................................19