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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Map Parcel r'a/oSa
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Health Division 200 0 'Z 3c{ SI Zq 03 C� b Date Issued
Conservation Division 2 Application Fee . ,.
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Tax Collector --_ .Permit Fee �
`3i'►'fSlpn� 1�/`'iS-%`'
SEPTIC SJSTE BE
Treasurer
Planning Dept. INSTAUED IN COMPLIANCE
Date Definitive Plan Approved by Planning Board Wffg ME 5
EWRONMEN9TAL CODE AND
Historic-OKH Preservation/Hyannis TOWN REGUl. TIONG
Project Street Address , 7f
Village re,7tr
Owner 4VZ_TE1 Y_ Ce4iSE Address
Telephone J�Gg- yak -el
Permit Request
Square feet: 1 st floor: existing y5e proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation �S�a Construction Type wa��
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure A f R S Historic House: ❑Yes 5(No On Old King's Highway: ❑Yes &No
Basement Type: 0 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 00il ❑Electric ❑Other
Central Air: ❑Yes >d No Fireplaces: Existing l New Existing wood/coal stove: ❑Yes ZNo
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:Xfexisting ❑new size Shed:O existing O new size Other:
Zoning Board of Appeals Authorization 70 Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name ATe't Rak"ex Telephone Number S�GS- VIPs -o/ W
Address 1 o4tf"t- G4-r41 License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
ol 0—
SIGNATURE DATE ?
21 ,
FOR OFFICIAL USE ONLY
PERMIT NO.
a
DATE ISSUED
MAP/PARCEL NO. '
ADDRESS VILLAGE ;
OWNER
DATE OF INSPECTION:
FOUNDATION 57h0
FRAME
y
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL'
PLUMBING: ROUGH FINAL ,
GAS: ROUGH: ` ' FINAL
FINAL BUILDING
f
DATE CLOSED OUT
ASSOCIATION PLAN NO.
_ The Commonwealth of Massachusetts
Department of Industrial Accidents
=_ office 811=85008fts
600 Washington Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
name: ®f
location Tf
city tlG/rN 17 phone# 92 g-G/fe/
I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working m' capacity
I am an em foyer roviding workers' compensation for my employees working.. this job.
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>' oli:: .❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the followingworkers' compensation polices:
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Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crianinal penalties of a Hue to S1,S00.00 andlor
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 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 verification.
I do hereby certify under the pains andi7enalties of pedury that the information provided above is ow.and coned
signature •.0� Date
1ag
Print name '4 /rex �°'hot, Phone#
of idal use only do not write in this area to be completed by city or town official
city or town- perndt/license# ❑Building Department
❑Licensing Board
❑dw&if immediate response is required ❑Selectmen's Office
❑Health Departrnent
contact person: phone#; ❑�e'�—
(/seised 9/95 PJA)
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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. �L.��: '+ 1v . :.,;N
An employer is defined as an individual, partnership, association, corporation or,other'legal'entity;or
any two or more of
` ed in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or
flue foregoung engag j rp g g eP j .
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.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation:and
supplying company names, address and hone numbers along with a certificate
'of insurance as all affidavits maybe
supP Ymg mP Y P
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
to the city or town that the application for the permit or license is
date the affidavit. The affidavit should be returned
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 permitllicense 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.
'lye Departunent's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Imlestlgatlons
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
Town of Barnstable
Regulatory Services
t snax MLE, ' Thomas F.Geiler,Director -
MAM
16 39;.�a`0� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date -5-/6 '
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: Estimated Cost
Address of Work:
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
[]Job Under$1,000
OBuilding not owner-occupied
El Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME 1MTROVEMENT 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 Contractor Name Registration No.
OR
le li.vE,t
Date Owner's Name
The Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner
200 Main Street,Hyannis MA 02601
i I
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
// Please Print
DATE: 3
JOB LOCATION: 9 Z AIfe,e t C y re
number .�1 street village
"HOMEOWNER": /1f T �d2 Iv.e'Je
name home phone# •work phone#
CURRENT MAILING ADDRESS: �ta� /!/P�Lt' e /iT,e
' ('Gi a�T I�-i� �•z� ?T
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.
DEFINMON 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
iBuilding 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.
�� /�� •-
Stgnature 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 1.15) 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 N poiistbilities of a Supernsgr. Op the last page of this issue is a
by V5
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oFt ro,,, Town of Barnstable *Permit
QY Expires 6 months from issue date
�+ Fee 4
ttnttt�isTnete Regulatory Services
9� t►uss. Thomas F.Geiler,Director 7l {p`6 ( ky)Z —
s63q. ��0
Buildin Division
A-PIRcss
g
Peter F.DiMatteo, Building Commissioner pErRMIT
367 Main Street, Hyannis,MA 02601w JUL 1 2 200,
Office: 508-862-4038
Fax: 508-790-6230 TOWN of BARNS
rAeLE
EXPRESS PERMIT APPLICATION
Not Valid without Red X-Press Imprint
Map/parcel Number C-7
Property Address
Residential OR ❑Commercial Value of Work �� O
Owner's Name&Address
Contractor's Name Telephone Number 0
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ Lprirsole proprietor
am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# 1
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 (maximum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation.etc.
Signature
Q:Forms:expmtrg:rev-070601
s�„o•�'.e TOWN OF BAR.NSTABLE Permit'No. ____ 20898
1 •�n� Building Inspector
' Cash
OCCUPANCY PERMIT Bond _ 9�
"No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Raymond Cronin Address Wellesley, MA
lot P65 84 Abbev Gate Cotuit
Wiring Inspector �' Inspection date
Plumbing Inspector< � �. Inspection date
Gas Inspector / Inspection date
t/Engineering Department —
��� ! �{�� Inspection date �Y
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.
19
Building Inspector
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�~ , SSsess6r"-s map and lot number / "� � / � �� ��— �.... ....................................
• �FTNET�
• pp 8 Sewage Permit number ....7......f. .............. SEPTIC SYSTEM MUST
f, jN,15'ALLED IN COMPLIA •
House number WITH ARTICLE II STATE 9�aaasTenLB,
....................... .............. ................................
MAE6
1639-
!WNITAV CODE AND TO OYPY�``e
TOWN OF BARNSIT"AI SSE
BUILDING-' ".1-NSPECTOR
APPLICATION FOR PERMIT TO �/go. .!! �� �� l%� �- �
f�/..:l.�a
�V1 _
TYPE OF CONSTRUCTION ..ZrLtY.1 .....t ... '.................................................................................
................ ....�.....19 .
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby
�applies for a permit according to tthhe� following information:
Location �j .' .C&�J....... .. 1 1. .. ....f..e.D./..f��..................................... ..........................
Proposed Use &...............................................................:...........................................
........................
ZoningDistrict ... ...........................................................Fire District .ru .. .......................................................
Name of Owner h.Y/VO.......� lY. !14J.....Address ......................
,•�,�
Name of Builder `fG:.�l1.` .P�I .t�N, 'f�.........Address ' r/.1,�1/t... .���5��... ..........................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..... ...........................................................Foundation .....��!.�k��� ..
Exierior W.O.-OP.......—�IY/. .....V....' /. .....................Roofing /1.SJ"/.)......1-7...... -IN64teE.........
Floors ,� lT!.�.1-1...... .......................................Interior .,Y,6?�. .................................
Heating '[,�1.....Gt!.�i " ��...., . .... .L4...........Plumbing
e ... .. ................................
.
' - (00
Fireplace ���..�. ........................................................Approximate Cost ./`07 ........._.....
h�USG �FT.s�
Definitive Plan Approved b Planning Board gA ,
pP Y g ----------------------------19-------. Area ...l �.. ..l��......�..
Diagram of Lot and Building with Dimensions R-d7 R/-A/1/ _11V
Fee ..............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH®�
447
as' �
a f
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Nam ...... . .... ..... ,...� ..... . . ............................
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Cronin,
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2UU�& one story
................. Permit for .................................... �
'- � aiugIa family dwelling
.
9104 Gate
Location ........................... .
Cotuit � .
--------------------------'
Crouio
Owner ----.�.�������------------' '
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Type of Construction ..........................................
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. --------------------------. '
Plot __�______. . ____#85
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8 ?8 ' '
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uo/e or Inspection
Date Completed ,.. . -- .......19
PERMIT REFUSED
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.............................................................. 19
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............ .*�...... ............................................... . . .
Approved
---------------- 19
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Assessor's map and lot number '! �' �G - /� " �y....................................... �pf THE t0
Sewa a Permit number
` G Z BARNSTABLE, i
Hpuse number ......................
MAOa
.:................................................. s
�O i639
a'
TOWN OF BARNSTABLE
BUILDING INSPECTOR. -
APPLICATION FOR PERMIT TO r�:.......:.. .........................................................:......................................:........... C�
TYPE OF CONSTRUCTION ,...... i4/t!.i..................................................................................
/�/ 1/r 9 . Sr-
.................. ..... ...............I9
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
location /.�3T.A" . 1x�1 ,!C'V../'i4�"� - /'/) 77l/. ..................:............................................ ----.
ProposedUse /'���/ / / /�............................. ................................................I.........................
77
Zoning District ... ...........................................................Fire District /'/) Tt//.. .....:..............................................
Name of Ownerp ���144� /:RI):l/.....Address �J /: �.. /.. �d S'�. ......... �. ....... .....................
Name of Builderh�,!C`t4 "'e..:�7, A A/.4/1/�'/ir�........Address W I P,,q�/4/ C 7�� / /-`................
-Name of Architect ................................................ :...................Address ....................................................................................
Number of Rooms (�' Foundation ..�� Q/1!('.; r1
.............................................. ...............
Exierior ?AM7?n......:S.:NA 7L �'_ Roofing A iQ.,L: ......................................................
.... ...
Floors l !4/�7 14 &770%7 ....................Interior .:. 'f LF T "./c!...................................
Heating AL"7"IIJA77-)?
.. ... ..•.. .... Plumbing Q) R ' _� V IN / T
......................................................
Fireplace .............. Approximate Cost .. /S /...1?...................................... .. j....r.
Definitive Plan Approved by Planning Board -----------__________________19_______.
Diagram of Lot and Building with DimensionsPGQT PLf}/v 7V Fee : +�............ ........... ............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
,LQT
_ 1 •
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JAI
T�
A8$ cy 6i3rC
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
NameiALi'1'
- . . .
. Cronin, Raymond A=21~52
` 2 ]09 8 one story
No ----.. Permit-for -----.,----
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Location ---^-..������------------
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Owner - �
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ypa of Co----
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Plot .....................
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Permit Granted ]
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. Date - 'Inspection-_ �
� ~~'^ Completed ......................................1.9y -
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PERMIT REFUSED /
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Approved ................................................ 19 �
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