HomeMy WebLinkAbout0034 CAP'N CARLETON'S RD 3� � ��n <
Town of Barnstable- *Permit#a6O6 i 7d6
Expires 6 months from issue date
X-PRESS PERMIT Regulatory Services Fe�0�5.moo
Thomas F. Geiler,Director
JUL 0 7 2006 Building Division (/
Tom Perry, CBO, Building Commissioner
TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601
www.town.b;im table.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint ,
imp/parcel Number 6 38 057
roperty Address JT r4k / C.,1115w
Residential Value of Work Cddy Minimum fee of$25.00 for work under$6000.00
owner's Name&Address W �I9i ' u�• �e_�C
:ontractor's Name Telephone Number
come Improvement Contractor License#(if applicable)
:onstruction Supervisor's License#(if applicable)
]Workman's Compensation Insurance
Check one:
I am a sole proprietor
(�.I am the Homeowner
❑ I have Worker's Compensation Insurance
insurance Company Name
Worlman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
®$e-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
'Where required: Issuance of this pemrit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improveme Co rs License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
J .._»...,.....--------
Department of Industrial Accidents
•� Office of Investigations
600 Washington Street
�t Boston, MA 02111
. www.mass.gov/dia
Workers' Compensation•Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/or nizationandividual): �:/�, z,,. "4e
Address: 3� 6 �y3i�✓o:,� S>-
City/State/Zip: Ag /9£•— • 6Phone#: J'a P K.) }—. 3
Are you an employer? Check the-appropriate bog: Type of project(required):
I.❑ I am a employer with 4. ❑ 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 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
o workers' Comp.insurance 5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
required.] officers have exercised their
3.T-1-am a homeowner doing all work night of exemption per MGL 11.❑ Plumbing repairs or additions
Myself.(No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t . employees.[No workers' 13.❑ other,4
comp.insurance required.] -aT
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonnatioa
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such
tcontraatomthat.check thisboa.must attached an additional abeet showing the name of the sub-contractors and their workers'comp,policy information.
I am an employer that is providing workers'compensation Insurance for.my employees. Below is the policy and job site
information.
Insurance Company Name:
Y Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: 2f°'— �.�, City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required 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 hereby certify u er t e pains an pen a of perjury that the information provided above is true and correct.
Si ature: Date:
Phone# s aC
Official use only. Do not write in this area,to be completed by city or town official. 1
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of#health 2.Building Department 3.City/Town Clerk 4.Electrical lnspector..•5.-Plumbing Inspector
6. Other
Contact Ferson; Phone#:
Information. and Instructions
Massachusetts General Laws chapter 152 requires all employers to.provide workers' compensation for their employees'
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the .
receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or.on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic work untiifacceptable 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 lime.
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 contactyou 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 ning submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that.a valid affidavit is on file for future permits or licenses. Anew 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:
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
Fax #617-727-7749
Revised 5-26-05
www.mass.gov/ciia
o
S 51 ,15'20"W
160.00
0
o a 4
LOT 37 m O
20, 322 S F. �, Q
B7 2' Su 00
EXISTIN 'r
all FOUNDATI c
a ti
24.00
? fV 46.00 �.
'7
cn
P ,
63.56
- N 49'14'17"E
CAP 'N CARL ETON 'S
PLOT PLAN OF LAND
"TO THE BEST OF MY KNOWLEDGE, THE FOUNDATION L OCA TED IN
SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS AND BA RNS TABLE — MA SS.
THA T I T CONFORMS TO THE TOWN OF BARNSTABLE ZO N OF&
REGULATIONS, REGARDING YARD SETBACKS" �� q`�sq PREPARED FOR
4 DAVID y
C SW PEPS �i DI CKE Y
DA TE.• OCT.22, 1986 � SANICKI ANICKI
4 --q � �,� 28085 <) H DATE.• OCT.22 , 1986 SCALE.• 1"� 40 FT.
1 R.L.S. �,�, C/STEM O�
y CAPE 6 ISL ANDS SUR VEYING
FL OOD ZONE C .,�U Ry
^ - ° TEA TICKET - MASS.
r ,
DRANETZ, DUBIN & STEPHENSON
ATTORNEYS AT LAW
456 BEARSE'S WAY
HYANNIS. MA 02601
MARSHALL M. DRANETZ
RICHARD S. DUBIN AREA CODE 617
JOHN C. STEPHENSON 775-4020
September 16, 1986
Building Inspector
town. of Barnstable
Main Street
Hyannis, MA . 02601
Re: Lot 37 Capt. Carleton' s Road, Cotuit
i
Dear Sir:
This office represents Robert M. Dickey, Trustee of S.D.
Trust, owner of the above described premises. The conveyancing
history of the adjacent lots is as follows :
LOT 31 Conveyed to Separate Owner on Sept. 8, 1980
LOT 37 Conveyed to Separate Owner on Sept. 8 , 1980
LOT 36 Conveyed to Separate Owner on June 9 , 1979
Accordingly, it is the opinion of this office that the
premises qualify as buildable under .the Town of Barnstable Zoning
By-Laws .
Please contact me if you have any questions in regard to
this matter. Thank you for your assistance.
Very truly yours,
RICHARD S. DUBIN, ESQUIRE
RSD/db
r ( t} IV 8
,,4"t�ssor's offioe 0st floor):
Assessor's ma and lot number ....d:4� ....05
p .. C.�_ SEPTIC SYSTEM 7
Board of Health (3rd floor): � �" INSTALLED IN C
Sewage Permit number .................. r '". WITH TIT t�aas•renta. i
Engineering Department (3rd floor): ENVIRONMENTAL d
House number ........................... . . .............. . gynw
��; TOWN REOA-JLA
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only
TOWN OF .'BARNSTABLE
BULDING,.,INS .WT 0 R
APPLICATION FOR PERMIT TO .............. :................:.................... ... ......................... ................................
TYPE OF CONSTRUCTION ......l J' , . ....... .............................. .... ............................
f�...T...LO..............19.. b
TO THE INSPECTOR OF BUILDINGS: v
The undersigned hereby applies for a permit according to the following information,,:/
® �� f4.1.1-1........ r / ...:r.1..C!.... ....................
Location ... ..........�/��?`�. . .............................
/ r
ProposedUse 'eJ./../LfoP.. ..... .... .. ......................................... ...............................................................
[ r
ZoningDistrict .................. .e. ..............................................Fire District ..... ... ..................:.................................
ear
Name of Owner, .. ....` .... ...... .. . /`.T......Address ...e � ..... ..fix. ,2<Px..QP......A)
l � c
Nameof Builder ...... . .....h.:z....................................Address ......... g..A ',....71 ...........................................
Name of Architect ............................( ...................................Address ......�elle....... ..'-.c� .�..5..............
Number of Rooms ............46.......1(-'eC;C..h!L ...............Foundation .....( 1rq-.,0-7....LO.x.. ..................................
4 4-42......................................
Exterior .......W...=..L......................................................Roofing �
Floors ...�� ...X. 1.0..............................4...............:......Interior . .... ....(.�.i. .`l..
Heating 1�?".. ..T.....�:-11.� L...........................Plumbing ...
...4...................................
__.._ Fireplace ..........................................Approximate Cost ...... �ZJ............ ...........................
...............................
Definitive Plan Approved by Planning Board f oeT /5____19_3 Area ... 1.'7...1...4;.;�......... .!
Diagram of Lot and Building with Dimensions Fee /z
! '
SUBJECT TO APPROVAL OF BOARD OF HEALTH
V
1 �
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
/ Construction Supervisor's License ..6..I/. .
--- � T
l7iCKEY, & SWYERS
N�
iV6 ..30089.... Permit for ...1. ...StorY................
Famil Dwelling... Y.................za......................
Location ..Lot ;'�37.......3A..Cagtain• Carleton Road
Cotuit
...............................................................................
Owner ......Dickey..&..5wyers.................. ........
-sr Type of Construction ....Fraine
...............................................................................
Plot ............:............... Lot ................................
_Permit Granted ......October...27.,..........19 86
Date of Inspection ............19
Date Completed '
Assessor's offioe (1st floor): _
I
Assessor's map- and lot number OS f cFto
Board of Health (3rd floor):.
Sewage Permit number ` �( .-. /... `
Engineering Department (3rd floor): 2/� . moo -
.J 7 rma
,,.,, i639 9
House number ...................................:.. c o, `
. - 'FO Yf1Y a'
• �R
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only
TOWN, Of BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR .PERMIT TO .........:....,.m,2r........................ ........................................
TYPE OF CONSTRUCTION ...... �..(..".......:.,/. �. `i'l...................W. .......................... ..........................
TO THE INSPECTOR OF BUILDINGS:
The undersigned,hereby applies for a permit according to the following information:
Location ... d...:!....... .. ... ...!: .L.t'! '+.•• ,l� p. /1�1...1 (.1..........1i/...................................
Proposed Use ^�•.�.,�t.�";1.4 ............ �I .//h....g........................................................................................................
J............
i
Zoning District ......�.......:.........................................................Fire District
Address Name of Owner .. ................ h•Q S. .C.:.. P. .q ..... .�. ....
��. / -
Name of Builder ...: .. ............................:................Address:........ C!•• �. .!.. ........................
r
OL
Name of Architect ............. '. ...................:........Address ....... ........�- 1.. 7.. ..... / S
Number of Rooms .............6......... ..............Foundation ....(..:. .. ...1® P... ...................................
Exterior .....1.!L cG.. ........................................................Roofing• ........ - ,......................................
Floors,/...!.....f. .........................::.i..........................Interior /.../-2 4�...1,•. .GQ..�!................
/ r ,
�.—�....... ..f, .
g t/ C � a- -�-C g -r`rt�a�+'. .................................
Heating ...,..r............................:.... .........Plumbin .........`.'
Fireplace ........... ...................................................................Approximate Cost ......P ( O—G7 & CJ
j..................................................
Definitive Plan Approved by Planning Board G� C'Z" !w�' 19__73 Area .......................:..................
Diagram of Lot and Building with Dimensions Fee. .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH w
^k
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules Viand Regulations of the Town of Barnstable regarding the above
construction.
• � � Name
Construction Supervisor's License ..4...?..�.. L!
ti
DICKEY & SW,YERS,,,/? A=038-057
30089
No ................. Permit for ....1LAMKY...............
...........Single...Family...Dwe.1.1.4�lqg...............
...... . . . .. . ...... ...... . .
Location .............................34 Lot #37. .......Ca. .p:�Ain......Qarle.ton Road .
.
Cotuit
................................... ...........................................
Owner .......IU.rzkey.. Swy. p-x.s............................
Type of Construction .....Frame..........................
...............................................................................
Plot ............................ Lot ................................
1
Permit Gran October 27,led ..........................................19 86-
Date of Inspection .....................................19
Date Completed ......................................19
; x
DATr �
CONTINUATION OF ROAD BOND
5
.4
BUILDING PERPIIT # _30��'�
b'
The.undersigned owner/contractor hereby agree to maintain their road I
bond in force until the following work items are .completed to the
satisfaction of the Engineering Section of the Department of Public
s
Works.
z
loam and seed shoulders as soon as
weather permits. f
other (explain)
3
LOCATION ; �� _ a C2� Cr
SIGNED Owner/Contractor
I
NGINEERdIG AUTHOR IZA ION
i
i
3
d
i
f
OF BARNSTABLE, MASSACHUSETTS -�_ BUILDING P�� , ,.
• � I � T
DATE 19 PERMIT NO)_ F>r?S1
FPERMIT
T ADDRESS '
(NO.) (STREET) (CONTR'S LI;N-
O '^' NUMBER OF(_I- STOR DWELLING UNITS(.TYPE OF IMPROVEME NTI HO. (PROPOSED USE)ATION) ZONING
(NO.) (STREET) — DISTRICT—
BETWEEN
AND
(CROSS STREET)
(CROSS STREET)
SUBDIVISION LOT
LOT BLOCK SIZE'
BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION{
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION �.
(TYPE) '� Y
REMARKS:
AREA OR
PERVOLUME ESTIMATED COSTS FEE
MI7 ? .
(CUBIC/SO UARE FEET) �•
OWNER
ADDRESS
BUILDING DEPT.
BY �
► FROM"THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLIC AN I-HUM IHG CUNUII IUNS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I- FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINA INSPECTION
70 LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL •NSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
UILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS cLECTRICA NSPECTION APPROVALS �
2; t
/ � r
I
2 2 } ��G — ----_'---- 2 ---
�c. a � a�
3 HEATING INSPECTION APPROVALS ENGINEERINGSEPARTMENT
Si' L2T 7b 60A-lV2_- _,
05•
OTHER
BOARD OF HEALTH
WORK SHALL NOT PROCEED UNTIL.THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SI.! MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCT101, PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION.
,.IMF TOWN OF BARNSTABLE Permit No. . 30089......
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
wa
�cou+ HYANNIS,MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to Dickey & Swyers
Address Lot #37 , 34 Cantai.n Car.lp..tnn Road
Cotuit, 11assachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
February 15I 19 89
..................... ...
Building Inspector
S YS TEM PROFILE
NOT TO
SCAL E
TOP FON.
FINISH GRADE ¢`
EL . ��`� _ FINISH GRADE OVER
°;'e. FINISH GRADE OVER
°.°. "). SEPTIC TANK r r" DIET. BOX ?. FINISH GRADE OVER
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L EA CHING PIT
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1. ALL EL EVA TION SHOWN Ah`- c ASED ON
2. ALL PIPES ,It ' {E Y.z'T`=M Mi1S T BE CAST IRON
� , . OBSE 'VA TION PIT
THE BOARO OF ��S A L TH MUS-7• BE NO T.I F. ED
` WHEN CLANS TRe; C-110A' 15 COMPL E TE� PRIOR
s 51 '15'2o"�'_ —_ _ _ TO BA CKFIL L.ING PERC�A TION RATE:
seo.oo 4, ANY CHANGES I ;PHIS PLAN MUST BE APPROVED MIN. /IN.
. ._._ .. ..� s _ #I TNESSED B Y.-
t e BY THE 80APD i'��- HEALTH AND CAPE' & ISLANDS
NA NC Y L EI TNER
a
SURVEYING VE Yc Ns� �'� .I NC.
�'` 5. MATERIAL,S . A117, ' .PVSTAL;:ATION SHALL BE IN BARNS.
p HE S TA TE SANI TAPY zoyF TH 1,��'S�''GN DA TA
`OMPL IANCE" I TH T
' , ''- Z j CODE _ TX TL E V --- AN() LOCAL APPLICABLE_ DA TE'
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RULES A�v�°� �'�CeJ A T.d i.)N.�+' .�"r., ,3
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