HomeMy WebLinkAbout0024 BRANDYWINE COURT a
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$ Town of Barnstable Building
I Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
"'^ Q Posted Until Final Inspection Has Been Made. Permit
t63q. �6'
MarO Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-18-3374 Applicant Name: JOHN F. GILLIS Approvals
Date Issued: 10/19/2018 Current Use: Structure
Permit Type: Building- Deck Expiration Date: 04/19/2019
Foundation:
Location: 24 BRANDYWYNE COURT,COTUIT Map/Lot: 056-044 Zoning District: RF Sheathing:
way
Owner on Record: TOUKAN,VIRGINIA&ABDULLAH Contractor Name."-.JOHN F. GILLIS Framing: 1
Address: 24 BRANDYWYNE CT Contractor License: 137,746 2
COTUIT, MA 02635 { "� Est. Proteect Cost: $ 18,500.00 Chimney:
Description: Remove entire deck existing and rebuild (2)small deck with stairs Permit Fee: $ 110.00 Insulation:
Fee Paid:!
per plan � � � J
1111 $ 110.00 oui
Project Review Req: Date: 10/19/2018 Final: 1 0
Plumbing/Gas
Rough Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months aftepgMV;eOfficial Final Plumbing:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and st pctures shall be in compliance with the local zoning by-laws and codes. Rough Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and-Fire-Officialsare provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Service:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Rough:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation
Low Voltage Rough:
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
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Mld '— r r-- Total Fee Paid. .. ................. ........................................
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TOWN OF BARNSTABLE� Permit Approval
by.................................On........................
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BUILDING PERMIT ® . ..P=&..... .Y.
APPLICATION
Section I—Owner's Information and Project Location
Project Address A`y w x L _C' Village Ce - o )`f
Owners Name�-i N N O U iK N
Address �p �W � Vj e cr )f� .
Owners Legal p►
city C O State Zip Uocib
Owners Cell# dog)w 4s- • E-mail e-
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Section 2—Use of Structure
Use Grroup ❑ Commercial Structure over 35,000 cubic feet
❑`�Commercial S ,000 cubic feet
0 Single/.Two Family Dwelling
Section 3—Type of Permit
❑ New Construction n Move/Relocate ❑ Accessory Structure ❑ Change of use
Demo/(entire struct=) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alma
Rebuild 54 Deck Apartment ❑ Sprinkler System
❑ Addition ❑ Retaining wall ❑ Solar
❑ Renovation ❑ Pool ❑ Insulation
Other—Specify
Section 4-Work Description
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TAct nndsdmi-219=19
1
Application Number....................................................
Section 5—Detail
Cost of Proposed Construction /47,4-UO ± Square Footage of Project L,�-')f)
Age of Structure Yz Dig Safe Number �t7�i y 1_0 4,'719
I
#Of Bedrooms Existing / Total#Of Bedrooms(proposed) /
„
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist Design {
Section 6—Project Specifics
❑ Vn'ng ❑ OR Tank Storage ❑ Smoke Detectors
❑ Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System El masonry Chimney ❑Add/relocate bedroom
-1
Water Supply _ ❑ Public ❑ Private
Sewage Disposal ❑ Municipal On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: a, 'K-5
iS/joi `l� I am using a crane ❑ Yes Q No
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No
Section 8—Zoning Information
Zoning District Proposed Use g'o C6»,yQ Lot Area Sq.Ft. % a 1� /+e re
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes 0 No
last=aat-a:2/92018
.. .........
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Application Number...........................................
Section 9-.Construction Supervisor
Name Telephone Number
Address 1$ u,n,,_A t9 City--Vt��sl„N�. State rnc._ Trip o.-A(:6 yV
License Number C.5 o S') `f 9 7 License Type,,,,>,,, ,7 i_,z,et Expiration Date
Contractors Email J. GTll s Or,p, o,KF , xv9 Cell# Tog ako /
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Budding Code. I understand the contraction inspection procedures,specific inspections and
documentation required b 80 CMR and the Town of Barnstable.Attach a copy of your license. r
Signature Date C/
Section.10-Home Improvement Contractor
Name �-,��J ��//�s Telephone Number • -Q 9- 7-9:-v cF �
Address City 1M ash.�o� iGk� State PV,—zip v 'y 9
Registration Number i 3 7 7 9 6 Expiration Date - i - 2- ./ '
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Budding Code. I understand the construction inspection procedures,specific inspection and
documentation required by 780 CUR and the Town of Barnstable.Attach a copy of your H.I.C...
12 A
Signature 't Date /3 /o
Section 11-Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
I understand my responsibilities under the rules and regulation for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Budding Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
APPLICANT SIGNATURE
Signature Date /vie
Print Name Telephone Number S-o,�-,:2_�
E-mail permit to: 4,77. (�7., //s
T e.+....a.,.-d.n mnni 0
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Section 12—Department Sign-Offs '
i
Health Department ❑ Zoning Board(if required) ❑
IFistoric District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation
For commercial work,please take your plans directly to the fire deparbnent for approval
Section 13—Owner's Authorization
I, i R A tlA �oU , 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:
d WVII.E 6uaa 6*1 AAA
(Address of j ob) +
Si a of Owner daze
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Print ame
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Last=dated:2/92018
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decking fastened with
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system ' own 1' 3 2' �iaek white
trademark posts
with top rail and
;..; island caps and
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14'
trimboard to face
deck frame also
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Carter, Jeff
From: Carter, Jeff
Sent: Thursday, October 18, 2018 10:19 AM
To: 'J.GILLIS@COMCAST.NET'
Subject: ViewPermit, Permit No:TB-18-3374
Good morning,
I am currently reviewing your permit application for 24 Brandywyne. Please submit a complete framing plan for the
both decks that shows at minimum:
1. Location of sono tubes with distances between.
2. All attachment details(ledger to house,joists to ledger,joists to beam, beam to post(6x6 posts required), post to
footing.
3. Size of beam that is supporting deck.
4. Location and plan for any stairs that are attached.
Plans can be submitted directly to me through email or dropped off at 200 Main, Fell free to give me a call with any
questions.
Thank you,
Jeff Carter
Local Inspector
Building Department
Town of Barnstable
200 Main Street
Hyannis, MA 02601
508 862-4035
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Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
-,,-TYPE:Individual
?. )' ; R st ion Expiration
�y 137746 01/01/2019
JOHN F.GILLIS
Jack Gillis
fP 049 Unde/Mr/s ;
Massachusetts Department.of Public Safety
® Board of Building Regulations and Standards
License: CS-051497
Construction Supervisor
JOHN F GILLIS -
Jack Gulls
1 a snoremad Dr.
Masnpee,MA 02649
Expiration:
Commissioner 11/43/2018
JGILUS-01 CCOSTA
CERTIFICATE OF LIABILITY INSURANCE DA7E(YftI YID
1av1a/2012o1s
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 pollcy(les)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 endorseme s.
PRODUCER CO ACT
Mason&Mason Insurance Agency,Inc. PIIDNE 81 447{5S1 a 81 447_70
458 South Ave. E MaL
Whitman,MA 02382
INSURER AFFORDWGCOVERAGE NAIC#
INSURER A:WeStern World 13196
INSURED INSURER B:Safety Property 12808
J.Gilds,Inc. INSURER c:Star Insurance ComMV 18023
18 Shorewood Dr INSURERD:
Mashpee,MA 02649
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_
INSR TYPE OF INSURANCE ADDL SUBR INSO POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE F1 ;ft;#71I OCCUR NPP1490523 7,21102018 7/28,2019 DAMAGE TO RENTED $ 50,000
MED EXP(Any oneperson) $ 5,000
PERSONAL&ADV INJURY S 1,000,000
GEhrL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ zwolw0
POLICY LOC PRODUCTS-COMP/OP AGG S 2,000,000
OTHER: $
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
ANY AUTO 5904775 8/ =018 8/20/2019 BODILY INJURY(Per person) S
OWNS) SCHEDULID
AUTOS ONLY JX ASUCTHOESULEDBODILY INJURY Per accident $
X AUTOS ONLY AUTOSONLY OPE�RY AMAGE $
S
UMBRELLA LUU3 OCCUR EACH OCCURRENCE
EXCESS LIABI I CLAIMSMADE AGGREGATE $
DIED RETENTION$ S
C WORKERS COMPENSATION IN X PER OTH
AND EMPLOYERS'UABILTfY
ANYPROPRIIETOORRj PA/PARRTDTNUER/EXECUTIVE YN ED? N/A C05�3 1/31/2018 1/31/2019 EL EACH ACCIDENT $ 1,000,000
�e d�to EL DISEASE-EA EMPLOY $ 1,000,QO0
If yes,describe under
DESCRIPTION OF OPERATIONS bekrw EL DISEASE-POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addldorhal Remarks Schedule,may be anwhed it more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town Of Barnstable Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
200 Main St ACCORDANCE WITHTHE POLICY PROVISIONS.
Hyannis,MA 02601
AUTHORED REPRESENTATIVE
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD now and logo are registered marks of ACORD
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 n Please Print Les?ibly
Name(Business/Organization/Individual): o ,,, �� i 1 S �-) �i11`S �`,O
Address: 1L: 0 a c , rz- -
City/State/Zip: �s �v VV 0 a� 44 Phone#: 6 2- ��i
Are you an employer?deck the appropriate box: Type of project(required):
1.N I am a employer with 3 4. P I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
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
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.incnranceJ
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
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.M Other17e F.,
comp.insurance required.] d•e C-/c•
*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: 5&- _rP S u �-wwc ea dc) p
Policy#or Self-ins.Lic.#: Ar_ll,o S'A Y 1' 3 3 Expiration Date:
Job Site Address:rA(4 2 r•Ar ,A)e I,-) vV &_ Ct City/State/Zip: & ,r-f e►, 6.p b y E„
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do here un er the pains and penalties of perjury that the information provided above is true and correct
R
Si mature. Date: o - 2 0/Ac
Phone
Of ud use only. Do not write in this area,to be completed by city or town ofJiciaL
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."
J
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 commonwealthmor 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 permittlicense 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 firture 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.mass.gov/dia
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LOrCATION SEWA E PERMIT NO.
MLACE
INSTA LLER'S NA i ADDRESS
41�at�o � .
BUILDER OR W ER
DATE PERMIT ISSUEO ���_��
DAT E COMPLIANCE ISSUED
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LOCATION 94 'ae��ta�,46 Cow SEWAGE # V-,Zea
VILLAGE � 'V ASSESSOR'S MAP&LOTS-
INSTALLER'S NAME&.PHONE-NO. 14to_1 .. C013ST
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LEACHING FACILITY: (type) Di d c�u aS (size) 9— 9
NO.OF BEDROOMS 2--
- UII,D R OWNER
PERMTTDATE: 6 '3-� COMPLIANCE DATE:
Separation Distance Between the: .
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of lead ' g facility) Feet
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Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis, MA 02601
.www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Mapiparcel Number
Property Address
Rcsidcntial Value of Work Minimum fee of$25.00.for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number`L! •—
l lome Improvement Contractor icense#•(if applicable) A;�l 75,57
Construction Supervisor's License#(if applicable)_:
❑Workman's Compensation Insurance A ®�® �`�
Check onc: X �"®�ESS 6 A`�
❑ l.am a sole proprietor 2008
❑ I am the Homeowner DE.0
JI have Worker's Compensation Insurance'
Insurance Company Name
-rov OF gARNSTABLE
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request (check box)
[ fte roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)
-- rdOl 'r+ •
'Where required: Issuance ofthis permit does not exempt compliance with other town department regulations,i.e.Historicric,Conservati(m,ete•:•— �___�
*''Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home I.rrtprovement Contractors License is required. L
SfG'NA'I'URE:
' Q.'W11F1LESTORMS',building it forms\EXPRESS.doc
Revised 100608
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a 600 Washington Street
�< Boston,MA 02111•
.•�'L wyOmmass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information .Please Print Legibly
Name (Business/Organization/Individual):��O 2 6'E
Address• 10�0 X 0
I PhJo`ne.#: ,tea lcg
City/State/Zip: /Z
Are. ou an emipl er? Check the appropriate box: :Type of project(required):.
1.[ I am a employer with 4. [] I am a general contractor and I
* have hired the sub-contractors 6. ❑New construction .
employees(full and/or part-time). Remodeling
2,❑ I am a'sole proprietor or partner- listed on the'attached sheet �• ❑ g
ship and have no employees These sub-contractors have g, ❑Demolition
'working for me in any capacity. employees and have workers' 9 ❑Building addition
comp. insurance.$
[No workers comp.insurance 10.❑•Blectrical repairs or additions
required.] 5. ❑ We are a corporation and its
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,VRoof repairs
insurance.required.]t c. 152, §1(4),and we have no 13.❑ Other
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: S U/ /���✓ yN`�' —
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: �� Q N t w t �V City/State/Zip: 1'��71 Z77
Attach a copy of the workers' compeZsatiop4policy declaration page'(showing the policy number and expiration date).
Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK:ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investi ations of the WA for insurance coverage verification.
I do hereby certify un er the pains•and penalties of perjury th t the information provided above is true and correct.
Signature:
Phone
• Official use only. Do not write in this area, to be completed by city or town official.
City or Town: ' Permit/License#
Issuing Authority(circle one):
.1.Board of Health 2,Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.. Other
Contact Person: Phone#:
_1L1JJL U J JJAJL 6 tLJL JLA &CILL .L 1i JR_81,7 e✓a
1
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 hiie,
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 ehapter.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 evidenee-ofcornpl ante withtlie 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-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of
~ insurance. Limited Liability Companies•(LLC) or Limited Liability Partnerships(LLP)with no employees other than the
members'or partners, are not required to carry workers' compensation insurance, If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit.or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are 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 permittlicense 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 bum 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:.
ao Commonwealth of Wssachusotts
Di,-pa exit of Industrial Accide .ts
Office of InwSt gations
644 Washington Street
B.oston,_MA 02111
TeL #617-727;4900 ext 406 car 1-877-MASWE
Fax#617-727»7749
Revised 11-22-06
www.mass.gov/dia
i
ACORD.. mi m' ' ' 10/20/2008
PROVUCER TNI T IS ISSUED AS A MA NATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bryden&Sullivan Insurance Agency HOLDER THIS CERTIFICATE DQES NOT AMEND,EXTEND OR
88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Hyannis,MA 02601 COMPANIES AFFORDING
COMPANY
A Atlantic Charter Insurance Company VDAC
INSUReD COMPANY
George&McMahon B
MAC Construction COMPANY
PO Box 286 C
YarmOuthpOrt,MA 02675 COMPANY
D .
THI8 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LoTEO 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.
00 TYPE OF INSURANCE . POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MTNDDJYY) DATE IMWDDNY) (In Thousands)
GENERAL LIABILITY BODILY INJURY OCC S
COMPREHENSIVE FORM BODILY INJURY AGG S
PREMISEWOPERATIONS PROPERTY DAMAGE OCC S
UNDERGROUND PROPERTY DAMAGE AGO $
EXPLOSION P COLLAPSE HAZARD - BI&PD COMBINED OCC S
PRODUCTSICOMPLETED OPER BI 6 PO COMBINED AGG S
CONTRACTUAL PERSONAL INJURY AGG $
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
AUTOMOBILE UABIUTY BODILY INJURY
ANY AUTO (P&pemon) $
ALL OWNED AUTOS(Prty to Pass) BODILY INJURY
ALL OWNED AUTOS (PetseCldent) $
(Other Utan PlWele Passenger) _
HIREDAUTOS PROPERTY DAMAGE $
NON-OWNED AUTOS BODILY INJURY&
13ARAGE LIABUTY PROPERTY DAMAGE
COMBINED $
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM p $
WORKERB COMPENSATION AND WCV00159407 5/6/2008 5/6/2009 X STATUTORY LIMITS
A EMPLCrYER'B 11ABILITY
EACH ACCIDENT $ 100,000
The workers'compensation policy does not provide coverage for George E.McMahon. DISEASE-POLICY LIMIT $ 500,000
DISEASE-EACH EMPLOYEE $ 100,000
OTHER
DESCRIPTION OF OPERATIONarLDCATIONSIVEHICL.E&SPECIAL ITEMS
SEEM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Town Of Barnstable Building Deparhncnt EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
200 Main Street - .12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
Hyannis,MA 02601 BUT FAILURE TO MAIL SUCH NOTICE SHALL I OSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY,ITS AGE S OR FPRESENTATIVES.
auTHORIZED REPRESENTATIVE
6'7
Z00/LOOP] m 8L Z0 800Z/OZ/Olmn
{
Oct 17 2008 9: 15PM R. TOUKRN (9626) -5411995 page 2
Town of Barnstable. -
.g Regulatory Services
Thomas F.Geller,Director
yes " Building Division
Tom Perry,Bullding Comm loner
200 Mara Street,Hyeaate.MA 02601
www-town.barostable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
f Using Builder
i, 1V I R I hI A M' �"" ,as Owner of the s '
�9ect P PAY
hereby authorize_ VGe, e, to act on mYbehalf,
is all matters relative to work w6otized by this building permit application for.
( s oE job)
0,r-t�
SipatUre of Owner Date
Print Name
If peertv,.. Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q-.F0RM:0wMWMWWI0W
`\
GT�ie Panzmaonwea/Cf a /Glaeac�afz«del7a i t
Board of Building Regulations and Standards
'`t ( Construction Supervisor License
i rl rt,*gl Liu'n e: CS 12038.
;Ezpiratlo 7/.2009 Tr# 11908
�Restrtction=00=t
Y 1
GEORGE E MCMAHON
PO BOX 286 ��°%
YARMnTHPORT,MA 02675 s Commissioner ! ,
�ze 't�a�nmzoouue� a�./�aaoc�cf uaelt _
Board of Building Regulations and Standards License or registration valid for individiil use only . I
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return-to: ly
�6 Board of Building Regulations and Stan_iards
Regist�ationt 161755 One Ashburton Place Rm 13,01 I
Ezp atiorit 1/1 812 01 0 Tr# 277988
i �s�—� r�. . Boston,Ma.0210,8
+�"� Type_=lridividual i
I
GEORGE E MCMAHM73R _ Ia -'
GEORGE MC MAH®N.JR::= -
��
79 STONEY POINT%RD-..=-�.>"
ature
CUMMAQUID, MA 02637� Administrator of valid without sign !
i
' r) Map 65.���; Parcel Permit# �Joc 7
Y. II
Conservation'Office(4th floor)(8:30-9:30/1:00=2:00) ./MI6Date Issued 02/ 44.
'
.y Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee �_�(�(o • O 6
Engineering Dept. (3rd floor) House# IKE
BARNSTABLE.
t f 19 - 6
&
TOWN OF BARNSTABLE
Building Permit Application
Pro ct Str t Address `* ?•
Village
Owner Address
Telephone
Permit quest l o?
'First Floor square feet 2
Second Floor square feet
Estimated Project Cost
J
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of,Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family ✓ Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Od Unfinished
Old King's Highway /V D
Number of Baths v2 No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces /
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name 4' C Telephone Number Y_!2zo 0
Add ess Q - /OP40 License#
Home Improvement Contractor#
Worker's Compensation# �(''��'`l�360 --0/
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT D ED FOR THE FOLLOWIN REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
M P/PARCEL NO. r w
ADDRESS x VILLAGE t
OWNER d! '
DATE OF INSPECTION:
FOUNDATION � �� "
FRAME,
i
INSULATION r
FIREPLACE
ELECTRICAL: ROUGH FINAL
r
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL '
FINAL BUILDING �"��`!� , -
DATE CLOSED OUT
ASSOCIATION PLAN NO.
i
t . The Town of Barnstable
• ces
�'V • ' P Department of Health Safety and Envi�roninental Sera .
Binding D'ivisi0n
367 Main Street',HYamds MA 0=1 ;
Ralph C==
Office: 509-790-6ZZ7 Big C0
Faac 508-775-33"
For office use only
permit no.
' Date AFFIDAVIT
HOME �ROVEMENT CON'TRACTORLAW
IlV
SUPPLEMENT'TO PERKM APPLICATION
aization,conversion,
MGL a I42A requires that the"mcanstrumon,alterations,'rtaavad=mair, _�
reato�al. demolition, or:consauaion of.an addition to or to �#
building containing at least one but not tnozz than four dwelling with Douala tenons, along v+ith other
to such rrsidenee or building be done by registered�tractots.
rcquftcments-
Type of Work: � Est Cost
�
Address of Work:
Oar m
ner.Nae:
Date of Permit Application:
I hereby c=%ify that:
Regisuation is not required for the following rtason(s):
Work colluded by law
lob under SL000
Budding not awner-0=upic
Owner Ong own p=mit
Notice is hereby ggn'en that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING W�N���' VE CONTRACTORS THE
FOR APPLICABLE HOME
DvIPROVQvI�'?�i' WORK DO
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c I42A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the a ent of the owner:
s ntiaaar name Registration No.
Dat
OR
u` The Cuninionit�eallli of Afassacliz ctts
..' • ^••� `j ifs - t• '
w ..;, `.firDepartment of Industrial Accidents
t "
:� ` • ;s !!� . . . . OfAceall��s�lgallods
"•:`• ►;� . -y';a' 60.0 If kahing7on Street
Bimlon.J a3w. 02111
�• Workers' Compensation insurance Airdavit
Anniic�n niorm-lion
le �tion•
.t nhnnr it
❑ I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working in any capacity
`.•ti•.•--r-Rt t ---
. am an employer providing workers' compensation for my employees working on this job.
LO
asi ti rats ���6E�'" .,}`y ��� •
sttr�n
❑ I am a sole proprietor,general contractor,or homeowner(curl ne)and have hired the contractors listed below who
the following workers' compensation polices:
company n
address:
city nhone#!
inturnncc ce neiit�vt! •
177
•'e ., '-- aesran�..••sa+rn+�'r+T�•e�wsF� '�7Yr. vl�'�'r7%!.�[ ..� rcr -
n1 1n\•name:
iddres-c-
city, nhone#-
insur•tnc �� trailer$0
:A_tiach additionai'sheet iftiieessarY �; w "'v"" "'�`�r..`• -•::•: :��+••' ^�` r
Failure to secure coverage a:required under Sevion SA of AIGL 152 can lad to the imposition of erimitud penalties of a fine np to SI.500-M an:
unc •ears'imprisonment as wail as civil Penalties in the form of a STOP'%VORK ORDER and a fine ofS100.00 a day aping me. 1 undtastand th.
COPY of this statement may be forwarded to the OMcc of investigations of the DIA for eorerage verifieadon.
I dOhereAr cerrij• cr the p ' and ties of pcilmy that the infornsation is mn and come L
Signature
�Pnname ` tme#
ofliciai.use only do not write in this area to be completed by city or two ofilCW
city or town:
permitilletmse i1 nguilding Department
• OLieettsing Board
check if immediate response is required (3Sdeett Dapen's Ocoee
�Nnitb Department
contact Person•
phone ft nOtber�_
�T��
� x
Information and Instructions
Massachusetts General Laws chanter 152 section 25 requires all employers to provide workers' compensation for
employcrs. As quoted from the "law", an emplgree is defined as every person in the service ofanother under am-
contract of hire, express or implied. oral or written.
An emph rer is defined as an individual. partnership, association. corporation or other legal entity, or any two or rr
the fore=oink; engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
rccciver or trustee of an individual , partnership, association or other legal entity, employing employees. However
owner of a dweilinL 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 wort: on such dwelling,
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo
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 m-ho has not produced acceptable evidence of compliance with the in 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 chaps:
been presented to the contracting authority.
_. ...�+.��. T � ,h„�•y.•_. .. .y.. .i�r7r N..:y.�.a�era.'.`:����;.. .:ur :i�a.r"•�(,.T-'.7��i`� •a.-
Applicants
Please ill in the workers' compensation affidavit completely, by checking the box that applies to your situation an
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are requi.
to obtain a workers' compensation policy, please call the Department at the number listed below.
--- •- -• ..:.-...., - - ..•.......... _ -- .:. yn... .. ; ::._`.,,.,r._.:• :yam•• -
Ciro• or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. F
be sure to fill in the permit/license number which will be used as a reference number. 77ie affidavits may be returne
the Department by mail or FAX unless other arrangements have been made.
The Office of investications would like to thank you in advance for you cooperation and should you have any quest
please do not hesitate to an us a call. I
The Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents .r
Office of investigations
600 Washington Street
Boston,Ma. 02111 -
fax #: (617) 727-7749
l nhnnr #� (617) 727--1900 ext. 406. 409 or 375
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_sly, IoN P�fJitJCs NOTES ' —®�QTY
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ARCHI -TECH A550CIATES.
architectural design , inc.
1550 route 28, unit 4 te!: 508-771-3900
centmille,ma 02632 fax: 505-775-1945
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'Assessor's map and lot number ...................................r....... oFtNe ro
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Sewage Permit number ........................................................
Z BAUS'TADLE, i
House number ..............g.......................................................... voo MU �000
1639-
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i TOWN OF BARNSTABLE
,6 t
BUILDING INSPECTOR
f APPLICATION FOR PERMIT TO ....... 11.I ....hi 1.�:�! .....!'`.! I�.&AICt s:..................................................
,•
TYPE OF CONSTRUCTION .......................................
................... ........................19..'...:::
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location -�.........................................l.....b i.�_ �r\.... s� .�'r-a�....".....................
Proposed Use 1 ./-�t t+R�!
... ........................... ..................................................
Zoning District ............ ..................................................Fire District .......Co"T—i� -r.
3 00Z. C04,4 t.�f614As{ r l t-I .........................
Name of Owner _• !�-1S !:'. L�� Address A h_ X Aa.f t* .� r I� .
......:.............. - ........................ ........y..............................................
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Name of Builder ... �i� '....Address � 19N3 ...+. ��utl......................................... ............ ...................................................
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Name of Architect �1• ��Q ... 1 c!.a....................Address .44Vy-*?.A!:?....:........ ..........................................
............................. .............
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Number of Rooms ....................................................Foundation ....�•.nAlel d!�" nw—
j , .................... ...........................................
Exterior ��oo. ....�..*. G, &- ...Roofing ......�!.'s.��ukT-./_..g :t.....�Q ........................
.............. ......................................................
Floors l.l�nc0�.....L..�C �lb Interior ......`�A.��-T"'����...............................................
........... .............................................
Heating �s�l" Q g 1���S rt' c c71iJ>� .
.................................................................................Plumbin .........................:............... ` ................................ !
Fireplace ............................Approximate Cost 0�,�c�� . _r---
Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ....:Cl*`?......., .......................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH A/ �-
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I
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. /
Name J�.'' .:..E .c.....:...: ` .Z' .G t` ......................
` Ely' James S. &=56~44 �
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20573 � - one
No ---...—.. Permit for -----...s....��J�--.
� single family..dweIIiu�
-----.-----...,` ---..'~'------'
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� Location .....24. ..Cuort_____..
� Dotuit �
' ----'----'---'-----..-----'r--'
Jame. 3 �l� �
' Owner ---
---—'�—---------
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} Typoof[onstruction ---�����-------. '
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Permit Granted -------------]A �
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� Date of Inspection -----------zlV
Date Completed lg �
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. PERMIT REFUSED
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„o•TM"�� TOWN OF BARNSTABLE Permit No. _2097-1
Building Inspector ,
� s,usr,n Cash -----_-----
°""'~ E OCCUPANCY PERMIT Bond
"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 James S. Ely Address 3002 Cunnin&iam Dr.,Alexandria,VA
lot #72 24 Brandywine Couur't, Cotuit
Wiring Inspector ' /� -""'r- Inspection date .�� �) P 117.� ._
Plumbing Inspector Inspection date
Gas Inspector A Inspection date
Engineering.Department / Inspection date
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.. /
........... ......r..............................., 19_....� ....................... Building...Inspector.............___....._�
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! Asussor's map and lot numb r,.v47 "� y� pfTHETO "
Sewage Permit number ......t.................../.........................
Z BABBSTABLE, i
House number ................................................
flAB6
'.
�p 2639. .0 a'
TOWN �OF BAJRNSTABLE
BUILDING IN§PECTOR
APPLICATION FOR PERMIT TO O N L� P ' �-�
TYPE OF CONSTRUCTION O �
............... ......................19.�.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location c� �
.... 1 /9A�htd.2.i.+ F.± .... ° ..:.� 1..... 42. ...... '.................. ................. T. .............................. _
ProposedUse .......... .................................................................................................................................... _
Zoning District ..... . � ....�.... .-��.�............6�i.�.............................
��AA /........................ ire District
Name of Owner .....�'`.!A..�s. �< ��..�j .......................Address . . �3t Af....Qi'��.�.. �A.....................................
TT ........... �...
��e�� .R® N?3
Name of Builder .........� ...!' .....�' ' ��� ................Address ...... ..... ................ ......... ..... ................................
Name of Architect ....Address.... .Y�4J: ...:�- ................. .................or
. . ...... . . . .................................................
Number of Rooms .........io....................................................Foundation .... QAli JeLT�
..... ........................................................
Exterior �j. .....................................Roofing .................................. S........................
Floors ......... ...... �....................................Interior .......��. .�t. ;;e.r.4 .... ................................................
Heating ........� tt? ... �..!................................................Plumbing �QS�c' �u'
.......... ........... Q. ..........................
Fireplace ..........i......1,�-?Q ! �G�.. `� ..........Approximate Cost I OC�� ®� o ......
Definitive Plan Approved by Planning Board ---------------___-----------19 . Area .......................�..............
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH No,
g �
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable eg din a above
construction.
Ely, James S.
...205 3... Permit for one storz
single family duelling
Location 24 Brandywi:M Court
Cotuit
.. .
Typo of Construction ...............fram�-----.
_----.--------------------..
.
' #72
Plot ---------. Lot .............AN
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! Permit Granted ----,--- ---.]g ._
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Dote of Inspection —. / ./—�--..l9 '^ '
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K PERMIT REFUSED
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-
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- Approved
''-------^'----^-------^'—'---'
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. '
---------.---------..-----~., .
--
'
Assessor's map and lot number .... ........
Sewage Permit number ........................................... ..............
4. 1 E
TOWN OF BARNSTABLE
IBAESST"LE,
9. BUILDING INSPECTOR
a"&
163
a MAI
APPLICATION FOR PERMIT TO ..............lc..... ......... ..................................................................................
" -
TYPE OF CONSTRUCTION ..... ............ 'ic1............................r.................................
.................................. .............1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... .......... ........:u!........:.................... . ..... ................................................................................................................
Proposed Use ................. .............................
ZoningDistrict ........................................................................Fire District ..............................................................................
'Te—, , ." -, f7,- f-$I , - -, r-t, -� �C '_ :- I
Nomeof Owner ........................................................ ............Address ...................... .............................................................
IU
Nome of Builder 1........ .........Address .......... ..........................
Nameof Architect ......................�n r,err r .,:.Address ............................................... ................................................................................
Number of Rooms Foundation I . ...................... . ......... ... .................................
Exierior ....................................................................................Roofing ....................................................................................
Floors ........!.�*.,.............................................................................Interior ....................................................................................
Heating ... ...........7:....... ...................................................*.Plumbin4 ....... ...........................................................................
Fireplace ..................................................................................Approximate. Cost .... ........................................................
Definitive Plan Approved by Planning Board ------------------------------19-------- - Area ...........................................
Diagram of Lot and Building with Dimensions Fee ..............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
A,^
U
I,—
+
C, C'm r C-,
I hereby agree to conform to all the Rules and Regulations of the Town of-Barnstable regarding the above
construction. Y
Name ..................................................................................
Ely. Jrmee &=56-44 �
'
�
20015— eucI ed �
No ---.— . Permit for ----..�����---..swimmin �
' ' pool
��-- _____________. �
_
Location ....��.������!��..�����-------- �
�
Cotuit
-----------..--------------. �
James �l �
Owner ---___.���_____________. ^
�
Type of Construction ---.�raMe------..
-
-----..--------------------..
'
Plot .................... Lot ----------' .
�
'
Permit Granted .......3 tember'25—_]9 78 .
Date of Inspection ------------lA
�
Dote Completed ------------'l9
PERMIT REFUSED
lV '
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^—_...r---. ......................................................
------------------~^------''
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----~-----~---------^'----^^
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Approved .................................................. lg '
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'
---------------'--''----^'---'
�
-------------------------...
|
Assessor's map.and lot number .... rIti',`,TS f'E'M MUST BE S
STALLED IN COMPLIANCE'
WITH ARTICLE
Sewage Permit number ... ..✓...s.... ... .......................... I I STATE
SANITARY CODE AND TOWN v
REG
QyofIIETo�♦ TOWN OF BARN ' B-
i
i BAMSTIBM
;AY.a�O� BUILDING . INSPECTOR
APPLICATION FOR PERMIT TO ....Oon.struGt. ...en. ...closed. . . . Pool. . ..................................... .. .. .. .. .... .. .... .. .... ................................
TYPE OF CONSTRUCTION .,,;Guinte. Pool and Glass/metal Enclosure
.............................................................................. . ....................................
September...z5.............l 9..78.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location Lot...#72 @ Branvine Drive, CotuitBy Shores
Proposed Use . Swimming Pool.................... ............... ........ _ .......................
Zoning District ......................................................:..................Fire District ..............................................................................
of Owner James El Cotuit, Massachusetts
Nome'of ....:............,...............................................................
Builder of Enclosure: Dionne Inc. Buzzards Bay, Massachusetts
Name of Builder .QX... lac......Address ...... .............:........
Name of Architect .R:.. .:..Se:Ab.eX'g..AS.BOC. .s.inCA.Address ......................
Number of Rooms .............:......:........................................:....Foundation ..P.?....tf.Q.Qt�X1gS...fOr...Qn.0.1.QaIuX'4.......
and connector- to enclosure
Exierior ..................................................................:.. ...........Roofing ......................................................................................
FloorsP.C. .......................................`..........:......................Interior ..................................................................................
-°' oil fired warm air for enclosur
Heating ...:.....................................................................�lumbing ..................................................................................
Fireplace ............... ... .:..Approximate Cost .kiPm000.00
Definitive Plan Approved by Planning Board ___________ ___-----------19_______ Area ........`.....C� `!o........
Diagram of Lot and Building with Dimensions Fee. .................................`•
SUBJECT TO APPROVAL OF BOARD OF HEALTH
N
. .-- -- - ----- .—_ - -� v N0�
ios
Note:L. Plan for house and garage 2. Pool Plans and revised site plan
on file at Town Board of Health with Pool location attached.
and Building Inspector.
I hereby agree to conform to all the Rules and Regulations of the Town Barnsta le r or ng the above
construction.
Name ... ... ................
f Ely;ames �� _ ..•* ,
e
No .. .... Permit for ....... ...n osed
.. ......................
i
swimming pool.
................................................ . ...........................
Locatio .Brandyce Court
......................................
Cotuit
.....................................................................
t Owner .............James Ely.................................. f.
Type of Construction frame 1
........................... ................................................. 1
f I
Plot ............................ Lot ................................
Permit Granted September 25 78 +
19
Date of Inspection ....................................19 r
Date Completed ......................................19
` PERMIT REFUSED r
................................................................ 19
lit `
!J ...............................................................................
................................................................................
.. .........................................................................
i
Approved ................................................ 19
i .................................. .......................................
:3 ...............................................................:.........