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HomeMy WebLinkAbout0225 MEGAN ROAD �a S I've n --�c� �� � � s E ALTERNATIVE WEATHERIZATION Date: �� f Town of Bar stable q 200 Main St - Hyannis,MA 02601 L" Re:Pe�rnnit# Village:.::::, 'Fhe insulation/weathra ,aRb�i �!vo � accbv&hce with>74�6C1 •:has.�een completed - - Regarc)S. Timothy Cabral, President CSL-105454 58 DICKINSON STREET FALL RIVER,MA 02721 ( (508) 567-4240 ALTERNATIVEWEAMERIZATION@GMAIL.COM 0W Application number PRODate Issued............`Q.l.� �/.. .. Building Inspectors Initials... . ............................ t JUN 13 2010 g TOWN* BARBS SABLE Map/Parcel. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY Pa0RMATTON Address of Project: NUMBER %' ' ' ' STREET VU,LAd Owner's Name: rl`l am UyLt,s Phone Number �� - / 76 " ys.�o Email Address: Ci @ lu+/yl49 &2Xell Phone Number Project cost ��� Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize)I m.D (�q to make application for a building permit in accordance with 0 CMR Owner Signature: Q,P_ (,� Date: TYPE OF WORK -Siding Windows(no header change).# : Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's,review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name /"1 7�-#6-k 1 k Home Improvement Contractors Registration(if applicable)!# (attach copy) Construction Supervisor's License# zo_W l (attach copy) c�i( Ccr7vL Email of Contractor kA U e zo- d-t @ Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent Y(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) r Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. 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 If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PL 'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Permit Authorization rMss vF Form Site ID: 3418646 Customer: Brian Jones I, r Ck n J 0 n Je 5 ,owner of the property located at: (Owner's Name,printed) 225 Megan Road Hyannis, MA 02601 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor fisted below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owners Signature: Date: a'vlye a Geflus eell'se Ji 016,,Aia *Go*****so* o **soi,0 see@a e 0 0 00*a9 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: "L�c X,2 Participating Contractor to Name: RISE Engineering Phone: 401-784-3700 Email: For Offirce Use Only Rev. 102015 if i The Commonwealth of Massachusetts Department of Industrial Accidents a I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.[E]I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction. 2.❑I am a sole proprietor or partnership and have no employees working for me in 8, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.❑✓ Other INSULATION 6.❑We are a corporation and its officers have exercised their right of exemption.per MGL c. 152,§1(4),and we have no employees.[No workers'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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#: XWO(19)58867158 Expiration Date:6/8/19 Job Site Addres &"'�S City/State/Zip: "y Attach a copy of the workers'co9f ensation policy declaration page(showing the policy nu er and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and t ains a en ties#J erjury that the information provided above is true and correct. Sianafore: Date: O Phone#:508-567-4 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#: ACO CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) 06/11/18 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 UUNIALA NAME: Anthony F.Cordeiro Insurance Agency a/C N Ell:; 508NE -677-0407 FAX No): 508-677-0409 171 Pleasant Street E-MAIL Fall River,MA 02721 ADDRESS: HSouza@Cordeirolnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty 2 Lark St INSURER D Fall River,MA 02721 INSURER E INSURER F: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDYIYYYY) (MMO DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 16,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL aADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ B AUTOS ONLY X AUTOS Y BAS58867158 06/08/18 06/08/19 X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE $ 1,000,000 DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT YIN N UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? n N/A XWO58867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary&Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road AUTHORIZED REPR Waltham,MA 02461 ESENT � t ©1901 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD c, . F '' •� fit s ty to V51. Stkw Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Ma chusetts 02116 Home lmproveme�"tractor Registration Corporation Type: P� ALTERNATIVE WEATHERIZATION,INC Registration: 175683 =F:f _y y 2 LARK 5T Expiration: 05I2812019 FALL RIVER,MA 02721 � i _ Update Address and return card. Mark reason for change, vrnent n Ln�t��it+._....-._..... Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE,Ccmorationbefore the expiration date. If found return to: &Gtdration 92 rraijon Office of Consumer Affairs and Business Regulation .., i75- 05IM2019 10 Park Plaza-Suite 5170 F}1T�'fER}fO ALTERNATIVE WN,INC, n,MA 02116 TIMOTHY CABRAL r FALL RIVER,MA 02721 Under-secretary flt V flat 83 i re Town of Barnstable' TOWN OF BARUNSTABL oFt"E r ti Regulatory Services 9• f)P Thomas F. Geiler,Director a HAS& ` Building Division v l 1619. � ri i Tom Perry,Building Commssone �P.fp MA A 200 Main Street, Hyannis,MA 02601 fi www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# �p1 FEE: SHED REGISTRATION 120 square feet or less Location of shed.(address) Village 5508--7 Property owner's name Telephone number 10 x. Za l Size of Shed Map/Parcel G% 1,6 e5Ck9� Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway,Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30 &3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 Town of Barnstable Geographic Information System December 10, 2010 291241 0209 291218 291266. #62 #212 291242 0217 GG Z Q (9 291267 291219 Ui #2M 962 291243 9 225 2912 68 228 291220 291244 0 233 #42 291-269 0 18 Feet 291245 #236 0241 . DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:291 Parcel:243 N- boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:JONES,BRIAN M Total Assessed Value:$211900 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessors tax parcels. They are not true property Co-Owner: Acreage:0.31 acres Abutters + boundaries and do not represent accurate relationships to physical features on the map Location:225 MEGAN ROAD ° such as building locations. Buffer � f 1 r9Z o �2 ell,- t t11 1 ,i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t 1ap 4 r 6 Parcel T Permit# 1� ���a = Date Issued Health Wision S ; ; ;. ,.tq Conservation Division �S1A< Fee 067 Tax Collector 07 Application Fee S) Treasurer Planning Dept. Checked-ir Date Definitive Plan Approved by Planning Board Appr(Ly Historic-OKH Preservation/Hyannis I Project Street Address Village I----) Owner Address `z> lephonec� rmit Request �P,GYIbJ�-F � cL e ��= r •�- �p r4�ro0 V� reo r10n± or -6 et: st oor: existing prop sed 2nd floor: existing proposed Total new Valuation ZoningDistrict Flood Plain Groundwater Overlay y Construction Type�� l( c�� ('�1G44e--- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 1 Two Family ❑ Multi-Family(#units) Age of Existing Structure .�' �'S. Historic House: ❑Yes ;d No On Old King's Highway: ❑Yes to Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Op Basement Unfinished Area(sq.ft) /no CD 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 I New Existing wood/coal stove: ❑Yes Wlo Detached garage:❑existing ❑new size Pool:❑existing ❑new size (.J Barn:❑existing ❑new size Attached garage:❑existing ❑new size �_ Shed:❑existing Cl 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 2 Telephone Number ' �7,�- ems, Addres d4 License# C. 6 '(.5-S�g (1 d >Z (o Home Improvement Contractor# Worker's Compensation -7(a& HR(ec)7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Ce - �-d FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER s DATE OF INSPECTION: 1 FOUNDATION d FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL. GAS: ROUGH _ FINAL FINAL BUILDING Cad DATE CLOSED OUT b ASSOCIATION PLAN NO. ti n N _ The Commonwealth o Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Srtreet, 7`4 Floor Boston,Mass. OZlll Workers'Com ensation Insurance.Affidavit:Building/Plumbing/Electrical Contractors- name: ddress: - ci 6 _ - fate: work site location full address): _ LI m a homeowner performing all work myself. Project ype: New Construction Remodel masolepro netorandhave nooneworkin in an capacity, Buildin Additionryi •W- .•.'%1t'. .?sk3.. +r.'.''�.{�'i• �RN.I.�•.'�.N' ra .i W :iC' s�l".'xah::'ra t. �:.t•�'".. �iSF:i'•,'.'�ii.�.. �Q',+...4i � •M.+,'*n�•,o.L( ,e:.i1.7 M] I am,an employer providing workers'compensation for my employees working on this job. company name: --- address:' city: phone#• Insurance co. 13olicy ie�.'ea,�b'•��k+ �r�:ii�a:3?,�t�'�ia::�*«,�i°�3;�i§�gy'•^R;s'<�'ru:�:qr�:3e3�s��:;%ai��•`ei:1S ??�.�ga�k':4"x�`ilY�.::.+:F•ar�•r�cs:��:ii4:��ti'�•.'� ikr'a�`?."s5i�,i;`:f. . ...,�M ❑ 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: ' - " company name: address city phone M insurance co, y' y policy# }`&If;?!M'•Sr� 'i: .'•"4�`•taarr:r�G: .� ihw ?Ar�.'••7'N, .. ... .4Y�i'i'?.�`t4'�t:� �-3T;s�,r%'r:L,iU.++1T;&'`�:�f��.'.�.`�'.i:-••r%�r'.:~+�"c.�.. r.. •r �r••" y, a°.ci�t.'y*: y� 'Y i. .<.::5 9'Y'�• '.�•w?i�-•,W: i '!�f3 k bi :}ta*.11:�f<:��•`.�•`�t.•• .4.r!�"...'�_F Z:i rr Y'-''r • 'company name: address: - city: phone#:. Insurance co. oli # tla:�f, i�`d[�:.'`ia�' }r�fl����3`Sd.• �r „'-c�'•^�f�+"' if:`�3•.a1P.•�'r� •!' •;• •'�':.1.� a,;T-•y � 22•a• , t.r,.. a '" `, i�idi Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to' 1;500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a' copy of this statement maybe forwarded.to the Office of Tnvestlgatlons of the DIA for coverage verification. ' !do hereby certify der�thpidns�anl nalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# _ �—-7 Fcheck nly do not write In this area to be completed by city or town official : permitllicense# ❑Building Department ❑Licensing Board CC] mmediate response is required ❑Selectmen's Officeon: phone#; ❑Health Department0J1 ❑Other��� t 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 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 section 25 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,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. ' k 1 u �'.1•n'b Lfr •.5 .K 5 �,� :d.'i.5��3�t `.;,•+,,y h tFF:AWiR����i4' Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, 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. lw.! .e o" SSa'•+4.. _ : ;ON- i+%. a�. d�:.< g'ir;. i...`.`..fi.�. .Y� BLS ,�i4i'! :`�#Cca 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 to 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. F 4 •+»�,!�:a[D-g,� = '�'i}7+'"a4 ' ..f�� S�I'S' ,� �w °�.7` �v, �r.'x.,'���,� �fi°6�t;�.y�,14 ��^`y.;,, ^'���iirb`�.��'��''!{� n'.RS !. .�ti '.Jl� {�+: .{ i?� �( � ,`+' f,� a .:�M1^..Jt. •3�tN4N���C'�j\4Y� .\,�R� .�W J.i'..�. V' .�� le Deparhnent's address,telephone and fax number: The Commonwealth Of Massachusetts- Department of Industrial Accidents Office of Investigations 600 Washington Street,7"'Floor Boston,Ma. 02111 fax#:(617)727-7749 phone#: (617)727-4900 ext. 406 . I� t °EVE r� Town of Barnstable Regulatory Services ` MAM RAMSTABM 0Thomas F.Geiler,Director 'OlE039. s Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 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: /re"d-bp Y)-j Estimated Cost Address of Work: C:, Q Owner's Name: Date of Application: 7 — C� I hereby certify that: Registration is not required for the following reason(s): ` ❑Work excluded by law ❑Job Under$1,000 ❑Building 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: os— Date Con tracto Name Registration No. OR Date Owner's Name Q:forms:homeaffidav ROy Birow 1 Home Repair Co. Estimate Home Repair, Maintenance, Renovations Date Residential and Commercial Licensed & Insured 6/4/2005 Bill To MARK RUSSELL 225 MEGAN ROAD HYANNIS, MA. 02601 Project #2 Description Amount REMOVE EXISTING BULKHEAD..INSTALL PVC 5/4 X6" TREX ON 784.00 CONCRETE FOUNDATION WITH SEALER BETWEENANSTALL BILCO TYPE C BULKHEAD DOOR..CAULK AND SEAL ALL AREAS NECESSARY..CLEAN SITE AND REMOVE ALL DEBRIS TO DISPOSAL AREA REMOVE EXISTING CLAPBOARD AND LOAD INTO TRAILER AND 1,330.00 REMOVE FROM SITE..INSTALL NEW HOUSE WRAP..INSTALL NEW CLAPBOARD WITH S/S FASTENERS..CLEAN UP ALL DEBRIS AND REMOVE FROM SITE..PLF..DISPOSAL FEES NOT INCLUDED REMOVE EXISTING TRIM AND REPLACE WITH NEW WOOD..USE S/S 183.75 FASTENERS..PER SECTION..DISPOSAL NOT INCLUDED BREAK UP FRONT STEP AND REMOVE CONCRETE TO DISPOSAL 271.25 SITE..DISPOSAL FEES NOT INCLUDED..PER DIG TO 4'DEEP.. INSTALL 10"SAUNA TUBES..POUR CONCRETE..GET 350.00 INSPECTION FRAME WITH 2X8 AND DECK WITH 5/4 OR 2X STOCK..ALL S/S 1,092.00 FASTENERS..PER SF BUILD RAILINGS FROM 2X6 AND SPINDLES..WITH 2X6 RAILING..PLF 358.26 BUILD STEPS WITH 3 STRINGERS AND STONE PADS AT BASE..PER STEP 128.17 ALLOWANCE FOR DISPOSAL FEES 525.00 THANK YOU FOR YOUR CONT BUSINESS Total $5,022.43 ROY BROWN- 34 Horatio Lane, Centerville,MA 02632 Phone: 508-775-6582 * Fax: 508-775-1836 �l am�c All Work Cer ep1ace Fully R Re'v,vT I,- dRe,CaUlk Guaranteed Re,Gr°Ut an Carpet Roofs Wood Sheds & Siding Floors Fences l�do&vice e�� gep Custom Cabinetry Landscaping & Care Paint Trim �1°or C & Windows Window Treatments Play Areas gw5r i C a � ' � 1 1 VZ I i DATE(M ACORDn CERTIFICATE OF LIABILITY INSURANCE 5/31ANDDIYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McShea-Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE.POLICIES BELOW. Osterville, Ma. 02655 INSURERS AFFORDING COVERAGE INSURED Roy Brown Home Repair INSURER A: National Grange Mutual Ins Co 34 Horatio Lane INSURERB: CNA Insurance ca=anies 34 Horatio Lane INSURERC: Centerville, Ma 02632 INSURERD: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICYTYPE OF INSURANCE POLICY NUMBEREFFEC TE, MIDOf NE POLICY EXPIRATION LTR- DATE MM/DD DATE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $3001,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $500,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ A MPK34477 05/05/05 05/05/06 PERSONAL&ADV INJURY $300,000 GENERAL AGGREGATE $600.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY jECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ . RETENTION $ $ TA U- WORKERS COMPENSATION AND TORY LIMBS ER _ EMPLOYERS'LIABILITY g g 6X2 6 2-2-0 2 0 5/31/0 5 0 5/31/0 6 E.L.EACH ACCIDENT $100,000 B E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONSILOCATTONSNEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1.0_DAYS WRITTEN Bui 1 ding Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR VABILITY OF ANY KIND UPON TH INSURER,ITS AGENTS OR REPRESENT TIVES/ AUTHORIZED ACORD 25.S(7/97) % CORD CORPORATION 1988 GTE B e 0 s -Board.of mldmg Regu atjo s and Standards. HOME IMPROVEMENT CONTRACTOR Registr fM 126560 E '.ratio — 1/2006 ALBERT ROY B O XCIRRT.BROW 34 HORATIO LN r, — CE.NTERVILLE,MA 0263 Administrator ✓fie-fJomvnzo�uueaccs� a��/l�Ga46aclu�Je�b ' P BOARD OF BUILDING REGULATIONS h f License C TRUCTION SUPERVISOR Number S•, 065525 Birtlfd f 2(I21a9 E��tpirei02/�2f2%6 Tr.no: 14425 Rest�c-ted 0D���ii ALBERT R BROWt�t 34 HORATIO LN CENTE-'RVILL-E, MA 0263Y i Administrator ? , I 01/12/1995 11:43 91508790623E PAGE 01 T own of Barnstable *Ferudt# r.V&M d M`UIU JFon, *ewe l , R egWatory Services Fe,. _ 3 UM styo.� Th 3mas F.Geller,Director Building Division Ton i Perry, Building Comu&doaer 200 Main Street; Hyannis,MA 02601 X-PRESS PERM Office: 508-862-4038 Fax: 508-790-6230 S E P 2 2004 &Ig SS PERMTI APPLICATION - RVSIDI<;1�'I`Ia gNLY NgrVaIlddww,id�xeOX-PrmImprOr -- - I OVUM - F BARN STAB LE Map/parcel Number Property Address S- �� r residential Value of Work G Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address _ i .a Cmitr ctor's Namc �� �t ,,r Telephone Number C)Q j a02a'7A Home Improvetnellt Contractor License#(if applic able) G "1 t�__I 7or ense#(if applicable) �Za'�man's Compematian Inennrance C look oAe: ❑ I e sole proprietrn [� am the Homeowner have Worker's C mveenattion Inan nce - Workat n's Comp,Policy# -z�q �Nn _ . . Copy of Insurance Compliance Certifies�te most be on file. Permit Request(check box) 0 Re-roof(shipping old shingles) All c mst mction debris will be taken to ! �F'�• War C= ( �-I�o i��4 ❑Re-roof(not stripping, Going over__existing layers of rood ❑ Re- ide \ Replacemem Windows. U-Value (maxiam�mi.44) *Where mplred: Ismanos of tbir permit does not c tempt compliance v Ath other town depmtmcat regulations,i.e.Hisceo•ie,Conservation.ace. **"Note: Property Owner must A�Property Owner Letter of Permission. t Home ovement Con Licens d. Signature - Q:Fmr=:expnwg n..�_�.eenn♦ UAW O kwl g.�' ar.; R 1'011Ch`VIRCew=�,a i., 1331 Grafton Street *� Worcester,MA 01604 -, 508-792-8181•800-300.7274 a THIS CONTRACT made the / day of In the year between New England Sash,Inc.and ' vq,, . } AMCi'ka ssE�c. >Fw 4 L !t `v (HOME OWNERS) (HOME ONE) (BUSINESS PHONE) e? i ' sr # r• of ,5� / 0260/ 'g (STREET) (TOWN (STATE) (ZIP) ¢ _ As used In this contract,the words we,us orour refer to New England Sash,Inc.and the words you and your refer to the customer. yWe agree to furnish all labor and material necessary to install the following described windows at: 5 fIs'M _ ti Double H.P. 1}}# Total Units: P. Glass Glass Grids:Y/N Window Color: Material: ( �3� { c 11i NIBDRM (' We do not do any painting or staining. 6 3a+ .11 Double Hun Units: 6-VemS 4 6 Installation: �.� j We are not responsible for conditions or circumstances Vp + ti x 1 Picture Units: '— - beyond our control including condensation resulting from Total Contract: or due to pre-existing conditions.Our limited warranty is herein inmrporaled by reference. Sales Tax:Hoer Units: Sliding Units: 2-lite: 3-lite: E. F) Awning Units: 1-liter ;;I F ar � Casement Units: 2-life: 3•lite: 4-I Total I—GAAI KEKA10 io e y I, s Bay ow,Units D /CS I ykle 4-liite: S-liter Price: / 171P7 Garden Windows Deposit IU/9o - maK o2� q t, Exterior Finish: Roof Soffilt Total Projection:AVA tLr Knee Brackets:Y/N With Order: 1 Entry Doors: Steel Fiber Style: Add Deposit n f.j Storm Doors: Alum W.Core Style: Due Date: ir- Sliding Glass Doors: # CD or. Balance Due rr / -3 t` , Capping Y N # On Delive '2� 7 t 'F Additional Notes: 5 6L 21ill t k AL. 15 10PCy/ � 1 L .02 .DdLJS RQA4ee_ If T� Lc-li1a �6S kon ve n ,D s8 T IS S- t CO Tab .., z. r AD M D _I) s-- s 7V M QL/1 ]✓ab.b f ad v4Jy/ s nmy er c- AJns ) DEPOSIT WITH ORDER ❑CASH XCHECK#!GI7 BALANCE DUE ❑CASH WINANCE ` You agree to pay cash according to the terms shown above or,if your credit is approved,to sign a note provided by us for payment of the amount due.You also agree to sign a ' completion certificate upon completion of the work.if you fail to make payments when they are due,then we may immediately stop work.We may choose to not start work again until I 1 you are current with the payments and we feel secure in obtaining the remaining payments.If there is any stoppage of work due to the preceding,such delay shall automatically extend the date of substantial completion. NIP 'r Payments due and unpaid under this agreement shall bear interest from the date payment is due at the annual rate of 18%or at the maximum legal rate,whichever is less.In the event 11111011, i that we Incur costs or expenses In collecting such payments due and unpaid,you shall pay such costs and expenses including reasonable attorney's fees.In addition,you understand ithe by falling to pay according to the above terms,the seller may have a claim against you which may be enforced against your property in accordance with the applicable liens laws. . i The installation will begin on or about�yX&?&S and will be substantially completed on or about f-3 Sit is understood by you that the following contingencies ' could material) thane the estimated completion date stated above:customer's inability to obtain or quality for line in y g p y q fy g;inclement weather;strikes or other labor disruption; - non-availability of materials;acts of God. We represent that we carry Workers'Compensation and Public Liability insurance in the amount of$100 000-1 000 000.- ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTS ARE REQUIRED TO BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND I STANDARDS.UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR,HOME 1 IMPROVEM-1111- rTA,-._<eT_�R REGISTRATION.ONF.ASHBUR70N PLACE.ROOM 1301,BOf TON,MA 02018(617)727-8598. ) CONTRACTOR OR SUBCONTRACTOR IS OBLIGED TO OBTAIN THE FOLLOWING PERMITS:_ �(T�TJrI"1/t✓ .IF WE DO NOT OBTAIN THESE PERMITS,AND YOU OBTAIN THEM,OR IF WE ARE NOT REGISTERED WITH THE BOARD OF BUILDING REGULATIONS,YOU WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSE77S GENERAL LAWS,CHAPTER 142A. ANY DEPOSIT REQUIRED UNDER THIS AGREEMENT TO BE PAID IN ADVANCE OF THE COMMENCEMENT OF WORK SHALL NOT EXCEED THE GREATER OF ONE-THIRD OF THE TOTAL CONTRACT PRICE OR THE ACTUAL COST OF ANY MATERIAL OR EQUIPMENT WHICH HAS TO BE SPECIAL ORDERED OR CUSTOM MADE,WHICH MUST - BE ORDERED IN ADVANCE OF THE COMMENCEMENT OF THE WORK,IN ORDER TO ASSURE THE PROJECT WILL PROCEED ON SCHEDULE.NO FINAL PAYMENT MAY ' BE DEMANDED UNTIL THE AGREEMENT IS COMPLETED TO THE SATISFACTION OF BOTH OF US. YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER, WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF,PROVIDED YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED,BY TELEGRAM SENT OR BY DELIVERY,NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. BY SIGNING BELOW,YOU ACKNOWLEDGE THAT YOU OWN THE ABOVE PROPERTY AND THAT YOU AGREE TO ALL OF THE TERMS OF THIS j CONTRACT.YOU ALSO ACKNOWLEDGE THAT YOU HAVE RECEIVED A FULLY COMPLETED COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION AND THAT YOU HAVE BEEN ORALLY INFORMED OF YOUR RIGHT TO CANCEL. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES./IN WITNESS WHEREOF the parties have h unto signed their names this 7—N day of //pp ✓"��.(i) /ine the oyear of 0�� Signed Signed t /1.1 `^-' • r w""�'"�---�' AAARKETIN R PRESENTATIVE OWNER Signed Accepted:New England Sash,Inc. ey Signed AUTHORIZED SIGNATURE TITLE OWNER NOTICE OF CANCELLATION DATE(TODAY'S) YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN 10 BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURED INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TEL GRAM TO:NEW ENGLAND SASH,INC.,1331 GRAF ON STREET,WORCESTER,MA 01604 NOT LATER THAN MIDNIGHT OF: z DATE UNDAY &HOLI AYS EXCLUDED) r &0 Board of Building Regula ons and Standard One Ashburton Place Room 1301 Boston. Massachusettg 021-08 Home Improvement Contractor Registration ^s = = � :r Types 1}rtvate Corporation Expka NEW ENGLAND SASH INC "-- zl '�" -== o+t 7/132CC6 Kevin Wells; -= ';.u' 1331 Grafton Street Worcester, MA 01604 Update Address and retarn.card.312rrk reason for chana. Al 0 SOM-04iO4-GIO1216 Address. C Renewal 7 EmpleYment Lost Card ,p�, fie �OomvmancaectlCla �✓��ac�ucee�a• - - \ Board of Building Regulations and Standards License or registration valid for Wividsl use only. HOME IMPROVEMENT CONTRACTOR before the expiration date. If fnnnd retara to: Re9istratl0;,.104098 Board of Building Regulatioes and Staadards Ezpiratton: �13/2006: One Ashburton Place Rm 1301 T'e=Pnriate Corporation. Boston,Ma.02108 - YP- =W ENGLAND'SASH;ING»� :vin Wells ;31 Grafton Street' orcester,MA 01604 ' Administrator Not valid without signature CDC "'}*UCO wFRC HOMEC.R AFT,L.<5 VERTICAL 21-I013 VINYL FRAME" DOUBLE GLAZE N gal ARGON FILLED `LOW E2 CRNA 4000 REB 87 ENERGY PERFORMANCE RATINGS U—Factor (U.S.1—P) Solar Heat Gain Coefficient 0.3D 0.37 ADDITIONAL PERK RMANCE RATINGS Visible TransmIi nce 0.48 ftufacturer Opulate lWthesa Mingo contarm t)applicable NFRC procedures tar determining whole iraduct performance.NRC redinps are�datomdned'or a fixed eat of mwirbr oomal conditions and a Ipsaific product sire.Consult manufactotat's literati ra for other prod a performance Wormatlon. MR Irc.arC Assessor's map and lot number ........................................... Sewage Permit number ............... .......................... �OFTHE TOWN OF BARNSTABLE 13 TLBLE iASM 1639- ON BUI*,LDING INSPECTOR APPLICATION FOR PERMIT TO .... . ............................7............ X/44 TYPEOF CONSTRUCTION ........ ................ ............. ............................................................ ................................................19.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...!�...74......��?/......... .......... ............. ............................................ Proposed Use ...77�- .................................. ........ ....Jf .... ..... ........................... ,,................................... Zoning District ...../I ......................................................Fire District ...... ............................... Name of Owner .............Address ......e ea ........................... .................. Nameof Builder .....................................................................Address ................................. .................................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ................. .....................................Foundation ...../L..... Exterior ...... ........ n.l -7,Y,.....................;Roofing ...... I;(................................................. Floors ....... ........... .................: .Interior ...... ............... .. ....................................... Heatingiglf-1 LZ.4,1ZI ......................Plumbing ........ ....................................................................... Fireplace ............. ....................................................................Approximate Cost ..... ;'a.................................................... r�t�4 ? Area .......Definitive Plan Approved by Planning Board - -----19-2-9. .................. Diagram of Lot and Building with Dimensions Fee .........0? , .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH L/ <) c I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................... Dacey, William E. Jr. 17189 one a ' No -----.. Permit for -----'---' " ..... ' o1omle dwmlling -------. ---------. ..."---.. Rma� - ^~`~^~' ---------------------' ________.B�arox1a_____________ Owner ____W.i.111am..8�..0acey�_Ir^__. frame Type of Construction -------------- --------------------------' #2l P|ct ---------. Lot ----------'' ` Permit Granted ............ !4ly..2...............lV74 Date of Inspection ------------lV Dote Completed ...................................... PERMIT REFUSED � . � -----_--------------.. lV � --------'^-----------------' � ` ~~---.-------------.---.---.. ` . ` _ --------------------------' ' --------'------------'—'—~--' Approved ................................................ 19 ^ -------'-------------'-----'' --------------------^'---'-- Assessor's map,and lot "number .................................... L 0 ._ INSTALLED IN COMPLIANCE Sewage-Permit number .. ........... ............................... �x ... . WITH ARTICLE II STATE QyofTllEro�y TOWN OF BARI ' ' OM i B9Hi ,TADLi. i Z ~ ' t6q.`39 BUILDING INSPECTOR �p `00 r� �. 'F0 NO a' .. . D�.......�7�/�'u - ./..� ..........................c✓.... ;,. APPLICATIONFOR��iPERMIT TO' .. ................... ...- ... .... v TYPE OF CONSTRUCTION .... 1.'�......�...�� ... / a'I .,....................... ........ ................................ �-�..........:...............19.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for'�- _- a permit according to the following information: r Location .... .. ...... /% ( .gym......... ..... �'C'�.......................................:.... Pro osed Use - G�/ 1� 11-7 C_L C,cJf l<.� .........................p ®. p..../=.........................�. ,I 1K.................................. Zoning District ..... ......!...... ................................................... District ...... .................................... / l �a Name of Owner .!�/ � Address '� l ��� !v.`. J.. . ... .................��.......... ............. Name of Builder ................................ .......Address .. ........................................................... ........ I. Name of Architect .... ............................................................Address Number of Rooms ..............................Foundation .......... ....ce.104 Exterior .......G1�... .....�. ......................Roofing ......adva.z.4-I& Floors C .......................Interior ..//z ................. .. Heating �..... - <T".. ......................Plumbing ................................................................................. Fireplace /........................................................:.....Approximate Cost ..... Z �tO.... /........................... ((gy�pp/ O Definitive Plan Approved by Planning Board ____/______________ 19__-A Area .......afJ..b......................... Diagram of Lot and Building with Dimensions Fee ; �T SUBJECT TO APPROVAL OF BOARD OF HEAL H y � X C � Z /b � - r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name A111a..�:..... /�s J. .................. Dacey, William E. Jr. 17189 one story, No ................. Permit for .................................... single dwelling ............................................................................... oC Megan Road I Location ................................................................ Hyannis ............................................................................... Owner William E. Dacey, Jr. .................................................................. frame Type of Construction .......................................... 0" plot ............................. Lot ...... ................... ;Lo�Permit Granted ...........JAIY..2....... 19 74 V 6;i-AV Date of Inspection .............7////7 01T�qo.......................19 Date Completed -4-,q PERMIT REFUSED ..........................................................;..... 19 .......................................................................... ............. ................................................. ......................................................... .................... ................................................................................ Approved ........................................... 19 ............................................................................... ................. ...........................................................