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Home My WebLink About0139 CAP'N CARLETON'S RD /39 (�aorY Cn�/e�cr� Town of Barnstable T _ .__ Building ' lPost This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept • SAM M (Posted Until Final Inspection Has Been Made. Permit naat" (Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.. I Permit No. B-19-732 Applicant Name: Carl Rebello Approvals Date Issued: 03/12/2019 Current Use: Structure Permit Type: Building- Insulation- Residential Expiration Date: 09/12/2019 Foundation: Location: 139 CAP'N CARLETON'S RD, COTUIT Map/Lot: 038-038 Zoning District: RF Sheathing: Owner on Record: HILL, GREGORY J & EMILY R Contractor Name:`ti.Carl J Rebello Framing: 1 Address: 139 CAP'N CARLETON'S RD } Contractor License: CS-084358 2 COTUIT, MA 02635 Est. Project Cost: $5,313.00 Chimney: Description: Insulation &Air Sealing. +. Permit Fee: $85.00 Insulation: / Fee Paid: $85.00 Project Review Req: J I w Date: 3/12/2019 Final: Plumbing/Gas I Rough Plumbing: - -- ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withinsix months after issuance. All work authorized by this permit shall conform.to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. A - Final 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. --r Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site LP- Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 0 �N !�' ,••.•3 ,f� � r_ -.._I_-_..• ..,-� -.........:yam. • ... ••� .. , • ,- '- _..__.._''�'�'"'� ..•,._j...:.� •ice-�.f' S .,._, - .._.. ..�.�_ .. ( �, . f I �..�..•..•.r�.�._ \ � ....�..�..r.......wf�... ...._.....ht [, . < \ ' . III fir; ;�;,.'•' . • I t�.�EAT'.,. �. �S%i'_��'_�•.._.� � .�. '�... _. 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"( J / � t i. I I Assessor's offioe (1st floor):• f/_ p THE Assessor's neap and lot number .. . ...............................:....... Q�pF Board of Health (3rd floor): 3 R` Z cD Sewage Permit number . _ 9 3.... (,eAc.}A pit g ;.. Z BAMSTADLE. ,f rhea i R�sER�E2�4, Engineering Department (3rd floor): •. c �a 9• House number 1.31.1 c ra9.oIlc _ SEPTIC SYSTEM MUST ®E APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only, INSTALLED IN COMPLIANCE TOWN OF, BARNS, ITLE5 �AL CODE D BUILDING- INSPECTNREGULATIONS APPLICATION FOR PERMIT TO ..... Z .!�c� L(,L '... .. ..... . TYPE OF CONSTRUCTION ........ 01F ... „C�................................. ....................................... . ........... . . ..� .................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .../.31�......,;W-44!-_A.... .. ...........C(7&'(1;6..... *2.6. 5................................. ProposedUse .......... . .............................. :....................................................... Zoning District ................. ..t..'...1............................................Fire District ........... Nome of Owner ....... .... Address ......13/ . 0 ................... Name of Builder ti�= �v ... .:.I CG 2. ..........Address .... .'.. Q (..... .��.v.:..yaxt/�.X Name of Architect ..;�.J. , ,7.u� � / �� .Address .................................................... y e f Number of Rooms ...). .�.G .G � .. .. ...Foundation % -....�.1��L1 ... .....�.�, � Exterior .... .cJ ..... Roofing ........ Floors � .. X... .��r�C[1 Interior ..... Heating ......... ...................................................Plumbing .......... ......................................................... Fireplace ............... .1 .................................................Approximate Cost ..... ..................... Definitive Plan Approved by Planning Board -------------------------------19-------- • Are t�.5.,.��... f Lot and Building with Dimensions Diagram o o g Fee .... .....�................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH.) - ��/� V I l 0 Co (4 3$ PGA 3h 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. Name ... ...........r��fr1�. .. Construction Supervisors License ........t ¢ 7�,/.. r� PARETTI, JOE No .30.1.89.... Permit for ...BRE.E.Z.EWAX...&..G.ARAGE ........SingleDwellingjamily.. ...................... ..... .... Location .....1.3q..qUtq.i.n...Qa.r.l.t.on.................. ........................Cotuit ....................................................... Owner ........M.r........&.....M.r...s........J.o...e.....P.a..r...e...t.t..i. ........... Type of Construction .....EKARP........................... ............................................................................... Plot ............................. -Lot ................................ Permit Granted ..............................November 14 A........19 86 Date of Inspection ....19 Date Completed ..... ...................19 114 �4 Assessor's offioe (1st floor): i1 Q ��fJ�a � p ��;`� �rNE r Asseor's,. rraap and lot number / �J O Q o off` Board of Health (3rd floor): -S _ Sewage Permit number . . .. .. .. .3... ��`� pit >; Baaa9TenLE, S Engineering Department (3rd floor): o rhea o i639 House number' `e APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BAR NSTABLE BUILDING INSPECTOR �L.. Z"al. .zz ,�..".�......116��AAPPLICATION FOR PERMIT TO .....�f�.•�./�..G.l,�'>��r....... �P.......�!.�w ..QF/14411..Q...... TYPE OF CONSTRUCTION .........Zl-jo—rfe.... . —'-e..................................f...................................... ........... /../..v................... 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: i Location ..../,.3?.....� �f�N.....(a I'4ri....-0........... .__..✓.../. .:.... ,) �o., ............................... Proposed Use .........., 1a9.PA V�L��..�. J..�................................ .....�....................................................... (.11ti).- ZoningDistrict ..... ......;..�...... ........................................... District .... ... ....................................... iv Name of Owner ... .. Address .......1. .1... .... Name of Builder .........Address .... .U.... C�.X....>.3'�,;f...V... �./1. !I(/.Yj(Ill. // �• ;. k Name of Architect ...,4J/�/ .......... ,.,`. � Address ...... . Number of Rooms ..:.�/ ./ � rl� .. l.e.... . .I.�..,. .... / e�..... ....Foundation ��lf��! Exterior ......!..?GC.E.... .c,),/(C'.. ................................Roofing ........!.... I C..,..(..... .�............. Floors ��f.., 'tv..tl.../ ..._!J.A .X!<!...... Rl!Yflnterior ..... �(!z ?1- /1.Al.. )/..�..�..�,..4 .............. Heatingf�.l /' .Ci.....................................................Plumbing .......... ,......................................................... Fireplace ............... 1.f tM..................................................Approximate Cost .....................1 . ,.1�.. � Definitive Plan Approved by Planning Board _ __________-----------------19-------- . Area .......................................... Diagram of Lot and Building with Dimensions` Fee SUBJECT TO APPROVAL ,OF BOARD OF HI A`LTH _ � _ `��,�,!Ply • - ej 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. Name ... ........... ..f�..:S.....I.... ... -... .......4?��Zlv'tz J 'j y Construction Supervisors License ........ /. � / !� .. � PARETTI, }0l, & MRS OE A~038-038 � .�� w' 30l89No�---- ....................................Br & Gar Age -� Permit for ' ! , Siomle Dwellio8 `---'_-----^------------.� , � Location -l39_Cun��io_Carltoo______.. ,. . ` ^ `______.Co�ui�_______________. ` ^ Ovvne, .....Joe_�ar��ti____________. , . ^ � Frame ^ Type of Construction -- e --'�. ! --------' ' ~� --------------------------. , ~ ' � P|c� �» � ---------� ----------' ^ ' ` November l4, 86 Permit G,on*a6 ------------- ' Date of Inspection -----------]g ' DoK* Completed ...................................... ! ' , - ' '^ - . , ~ ' ^ ^ ~ ^ , ^ /�//��/, / " _- __' � _� �� PE -g Town of Barnstable. *Permit# �- ERMITExpires 6 months from issue date OCT. _ Regulatory Services Fee 4 2007 Thomas F.Geiler,Director' TOWN OF SARNSTAgL-E Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint , Map/parcel Numbers c) Property Address ` i)`" C]� �� Q wz, Residential Value of Work Minimum fee of.$25.00 for work under$6000.00 Owner's Name&Address �L EDP, ?5�F `\\ Na C WLSQq. Vs�� W E6SS Contractor's Name 7� �� t� Telephone Number /�`�11 O�r'jdk Home Improvement Contractor License#(if applicable)_ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: .XI am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman'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 ❑Re-roof(not stripping. Going over existing layers of roof) XRF-nde j�i'FK0� Replacement Windows/doors/sliders. U-Value o� (maximum..44) *where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.. A copy o the Ho aLIvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 ,.r �.•' E.�'i4 The Commonwealth of Massachusetts Department of IndustrialAecidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Plea`se�.Print Legibly Name(Business/Organization/Individual):. Address: City/State/Zip: \)=Q. C2�L6R% Phone.#: `�`11-��`�0a&_0 4'R Are you an employer? Check the appropriate box: -Type of project(required) 1.❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2KI am a'sole proprietor or partner- listed on the'attached sheet. 7 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9 []Building addition [No workers'comp.insurance comp.insurance.$' required.] 5. Ej We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[:1 Plumbing repairs or additions rnyselL [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' ..13.❑ Other comp. insurance required.] , 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating•such. 44—'6ntractors 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 pravidb their workers'comp.policy number. Iam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: 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 rtify under the pains doenalties of perjury that the information provided above is true and correct: Sienature: c— Date: Phone #: i`��' (�(`/: VVI"\ Official use only. Do not write in this area A7 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 CIerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �QF 1ME�p�y Town of Barnstable. Regulatory Services BAIiNSTABLE, � y »sass $ Thomas F. Geller,Director 19. Building Division Tom Perry, Building Commissioner 200 Main street, Hyannis,MA 02601 wvr w.town.barnstable.ma.us Office: 508-862-403 8 . Fax: 508-790-6230 Property Owner Must Complete and Sign This .Section If Using ABuilder Pa" ,as Owner of the subject property y J P P riY hereb authorize . Y ��M�In��'�C e-�� to act on my behalf, in all.matters relative to.work authorized by this building permit application for: . (Address of Job) Sign'atEre of Owner ate d L." Print Name I QTORMS:OwNERPERMIS S ION T R t� e' 7 f ` Te �an:n�caozurec a�✓�ir? a�u�ael� - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration;,142108 .,Exporation:f /15/2008 6 & JIMTWITCHELL'`ALUMINUM, YNYL JAMES TWITCHEL�L 1364E0RGE RYDERRD', GG__„ ✓ CHATH AM,MA 02633 Administrator Town of Barnstable *Permit Expires 6 m Ahs f�Issue date Regulatory Services Fee XmP E S P R P�bmas F.Geiler,Director Building Division JAN 3 1 2007Tom Perry,CBO, Building Commissioner TOWN OF BARN STARVIlain Street,Hyannis,MA 02601 www.town.barnstable.ma.us ffice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION 'RESIDENTLA.L,ONLY Not Valid without Red X-Press Imprint Uww )arcel Number 03ffO 9 �` rty Address—.-A / 1 CI L7a d ;sidential Value of Work D 5'd, Minimum fee of$25.00 for work under$6000.00 a's Name&Address �3-0 A PA-92 F_7j-1 actor's Name n 19f je l— ��N�/1�-[� Telephone Number Improvement Contractor License#(if applicable) / (f M-Supel vi ably'; orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [�rThave Worker's Compensation Insurance ince Company Name /-�-T( f►'1`�T�C Ct�/�/1� man's Comp.Policy# 1-1t)O V OO(y (( 3 DO I of Insurance Compliance Certificate must be on file. it Request(c eck box) Re-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) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope Owner must sign Property Owner Letter of Permission. A of the Home rove actors License is required. IATURE: ns:expmtrg 061306 i ✓lie �omvnzbmcuea�!/ o�./�aaaac/ucae�a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR beforcithe expiration date. If found return to: . :1�14 Board1lof Building Regulations and Standards , Registrations, 116064 One 4hburton Place Rm.1301 Expiration g/15.'2008 Bostoij,Ma.02108 Ltdihiability Corporation TYNDALL ROOFI'N LLCr � ��t-.-:�r r• ROBERT TYNDALL�Jr =. ; 30 JILLIANS WAY 'i" `^ --` - •`�..:�/ ;' .Not valid without signa ure MARSTONS MILLS,MA 02648 Deputy Administrator i TYNDALL ROOFING ::Pf 3 0 I`cL%AuS W,f/ /Y�ns709s11A-cs Moz.&q8, Proposat (508) 420-4456 CLf CL Page No. of Pages PROPOSAL SUBMITTED TO ( PHONE q/ — DATE So I _7�7 J 39'-267 -6C3 9 f ao 0 STREET # 7,�3_5 U E L Em ` D / JOB NAME To 97-7-iP CITY, STATE AND ZIP CODE W 1 JOB LOCATION � rie Fr- -, 3 39 0 ff 13 9 ClfPT• 6Kt,70/V A. ARCHITECT DATE OF PLANS j JOB PHONE Ce7`ra i{- Inh. Oa&.3 S 79-42— ®Y7 9 We hereby submit specifications and estimates for: ap- Roof 9,0 u SC Q- Furnish and install new Class""A" Roofing as Follows: — A. Strip existing roofing and remove debris. B. Check all boarding and nail as necessary. C. Check all flashing. D. Install aluminum drip edge. yFN77F-.D E. Includes ice and.water shield to be adhered to roof 18" along entire lower.edge of roof to.prevent ice leaks also around chimneys, skylights, roof stacks, an oo valleys. 3 CT- F. Apply shingle under layment - (felt paper). G. Includes new flashing around all roof stacks. H. Apply customers choice of shingleCMfNW0 (t�ooAkHr- D yR.ARC047igerot- S:kM—CotD/Q I. Apply continuous ridge ventilation. �:im)LI �} 6 f Any unforeseen rot that may be uncovered during construction, the owner will be informed and made aware of the•extra cost. Payment t be made as follows dollars (s O y 66A c6Tfo All checks to be made payable to TYNDALL ROOFING All work to be completed in a sub- stantial workmanlike manner according to specifications submitted, per standard Authorized Practices. Any alteration or deviation from above specifications Involving extra Signature costs will be executed only upon written or and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or Note: This proposal may be delays beyond our control. Owner to carry fire, tornado and other necessary in- surance.Our workers are fully covered by Workmen's compensation Insurance. withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and condi- tions are satisfactory and are hereby accepted.You are authorized to do the work //ice► as specified.Payment will be made as outline above. <Ignatur Date of Acceptance: �12,/ [ 617 Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aunlicant Information r /J �,� " Please Print Legibly � Name(Business/Organization4ndividual): ! /'C oarl/� 6- Address: 30 cZ U_i14-ivS City/State/Zip: J 0-_2,(Pq?Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[Z14"al a employer with_1 4. ❑ I am a general contractor and I employees.(full and/or part-time).' have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p Y� .; 9. ❑ Building addition [No workers' comp. insurance comp.insurance.4 required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]; c. 152, §1(4),and we have no �� employees. [No workers' 13. 910ffher or- 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 thepolicy and job site information. Insurance Company Name: .4M,4'Lt Ti'C C-11-.1i'I27ea Policy#or Self-ins.Lic.#: tyo V 0 O& y 300 I Expiration Date: q 6 -7 Job Site Address: l g C W-, C'i-t&MY City/State/Zip:t&p740T;/!/If , G2,63s 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 Investi¢ations of the DIA for insurance coverage verification. I do hereby certify u er the pains and penalties of,erjury that the information provided above is true and correct. Signature, /! L Date: 3/ D 7 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#: . Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP.does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of. Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 11-22-06 www.mass.gov/dia i i ". „�•`NN TOWN OF BARNSTABLE 20466—_ ``. Permit No. Building Inspector »USTARL Cash OCCUPANCY - PERMIT Bond _ X 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 Robert Hague Address Bridge St. , Beverly, MA lot #ltl 119 Cant'. Carleton'a Road. CAtuit Wiring Inspector Inspection date Plumbing Inspector Inspection date// Gas.Inspector� Inspection date Y Engineering Department >,� Inspection date//- -/ O 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. 1 g �.G Building Inspector -' /6z7 7 :«At ? "'' •�a is ay ^.Z � �-nT Zo. S8"S SF. � • ,� , r ' � �0 � et•. r, i 00 • � - h. ^ . -� ,- l.� F1. fret <. S74-0/ s 38 W / -A ZS3z t H006QT P. ell Na 8t20 .. • OIaTS'R6 Q. •• ''•"' 'I CERTIFIED PLOT PLAN GO TcJ/7` NEWT CONSTRUCTION ONLY TOP Of FOUNDATION IS 3 FEET IN A86VE LOCI POINT OF ADJACENT 11AithS IASJaJ% -W 0 ; f° R 0 A D'. SCALE: 1 40 DATES , `EL`OREDGE ENGINEER/NG CO. IN�C S/G VA I CERTIFY THAT THE ` 3 ti1STERED REGISTERED CLIENT SHOWN ON THIS PLAN IS LOCA D; _Alt'. JOB N0. 790 6 ON THE GROUND. AS IabICATLO'. S '' `CIVIL I LAND y ENOfNt:ER SURVEYOR DR. BY: - CONFORMS TO THE ZOR�tP10 1- OF SARNST SL MASS. ' r `u.. 0, MAIi ST 712 MAIN ST. CH. BY: Iz.�. �• �/ r r�jS.O ARMOTH, MASS. HYANNIS MASS. SHEET / pF n A �.+ N ` 3 ...,TE REG. LANDr' Stfw1/ivo—�` r..� �. AAsser's map and lot number ... TME Sewage Permit number .... �f .!�............................... :"Pj'I(; SYSTEMe� o� MUST BE INO l ALLED C Z B9BH4T&DLE, House number ........`#......1-3-9............................................ 'WITH�i ARTICLE B°ST LIANCE 90o M6"39&. - �_ �ANITAR n ATE TOWN OF BA,RNOST�'AX ftr T°W" BUILDING It" APPLICATION FOR PERMIT TO K /.�?........&a.ve-xl z ® / /P/y TYPE OF CONSTRUCTION ....................�Q.....�...................�............................................................ 41 ..... ....... I...........19..7-'.P.. TO THE INSPECTOR OF BUILDINGS: The undersigned/hereby applies for a permit according ttto� the following information: Location ............ .... ` 4.............. . ........`...r!tl�.. .. ... ...0 Proposed Use .............y-,z .A.....�&1/ ....... .a.�61 16....�.� ...............................,.... Zoning District .......... �.�`� 1...!.....................Fire District .......... . ...................... Lo �. ... .�. ... Name of Owner .... .. ...............Address ..... �... U Name of Builder A4,411 ....V.I./............................. ...fl�../.�.....� L(! r ......6 Nameof Architect ..............`..................................................Address ........ t............................................. Number of Rooms ......... ..............................:.....................Foundation �d UeP� Exierior ...... `�. �'.!. .... 4� .... /� �l�J.Roofing .....A> .......................................... Floors �u f llN��ice .......Interior ....... � 1..................... ............. .......... . ................ ........ . ..... ............ Heating ............Plumbing ......................................... . gj�6% 1 . y..... g ....................... zw*mee Approximate Cost .......... .lf..�.i .................... Definitive Plan Approved by Planning Board ---------_________.____,_____19_______. ✓ a ................:............. co Diagram of Lot and Building with Dimensions Fee (O.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I'hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . ........................... ^ ^ � ' . ^ - - . . . ` . � ' . . . ' � ' . , . ^ � ` .�� , � � � . , . . � , ^ ` . ' ' . �ague, Robert single family dwelling Cotuit Robert Hague frame PERMIT REFUSED � ~ - .. --. -------------. ^ - ---.^C.�?� -------------. ~ �� .~ . ` ~ Approved .........................................�-- lA � � � . . -------------`---------^--- � . -----------'--------~'''----'' � ' Assessors map and lot number ........................:.............. . Bpi TH E Sewage Permit number .... ...........�'.a ��Q ♦� �... •" Q............................................ Z BABMASIL E, i House number ........:�...:�.; �`� r YAea �0 WO p. TOWN OF BARNSTABLE / a BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................:. .............................................................................:..:........... TYPEOF CONSTRUCTION ..................................................................................................................................... ...... ........ -. .......................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' Location ............................................................. .................................. .................:...................... .......................... Proposed Use .............................................................................................................................................................................. Zoning District Fire District................................................ ......... ................................................................. Nameof Owner f r Address............................... ....... �...... ... ............................................................................ Name of Builder '.........................Address '• ............ ....................t:.......................... ....................... Name of Architect ..................................................................Address ...... Number of Rooms ..................................................................Foundation ..... ..................• .................................................... Exterior r " .......Roofing ........' Floors ..................................... ...............................................................................................................Interior ::.................... IL� s Heating ..................................................................................Plumbing .................................................................................. Fireplace .:...........................:Approximate Cost........................ .. .. ....................�t............................................ Definitive Plan Approved by Planning Board -----------_______-----------19 . Area f Diagram of Lot and Building with Dimensions f Fee ..................0 SUBJECT TO APPROVAL OF BOARD OF HEALTH A I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ; Name .................................................................................... Hague, Robert ' A=38-38 No !....20466.......... Permit" for ......1-142-at.Qry...... single family..!�VqjjiXjg ................................ . ................. 139 Capt. Location .........................C.arl.elon.lg;..Road...... Cotuit ............................................................................... Owner Robert Hague.......................... ......................... Type of Construction ..........fnap.w.................... ................................................................................ Plot ............................ Lot ........... .............. Permit, Granted Aug\a....................19 78 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED) .............................. . ........ ... ............... 19 ....... ... ...... .......... .... ........................ . ................................. ........ ............... ..................... ................... ........................................................ .................................................................................. Approved ................................................... 19 0 ............................................................................... ........... ............................................................. T01111I OF BARNSTABLE: BUiLDtNG IDEPARTWNT Mr. Francis Lahten#-Ii � Toth Clerk 397 MAtN STREET t WY AAfN�S, MA O M1. T a,-- t Phone: 775-1120 j SUBJECT: FOLD HERE F ' DATE .• - _ - J)ecember O3 1978 M"SAGE s _ "\0ceupan6y Permit bas been issued for work done_under Buildijig.. Permit #20466 (Robert 'H ague). Please release Bond.. Ir . ' •.Fj _ A SIGNED R .PATE WEPLY; ' •� - SIGNED I Ne74RMI RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY o _« °�� F _ • PRINTED IN U.S.A.