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0060 CHEOH ROAD
�oG��a � �� .�. �� ?��, ��� , Zo �� ,. f t t t f. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r _ Map Parcel s ,. U.- B ''Application# �P Health Division ©g .V t. Conservation Division Permit# Tax Collector Issued j�/� Treasurer r Application Fee Planning Dept. Permit Fee o7,k. 70 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis 3 Project Street Address Q Village Owner c-�� Address Telephone b C. Permit Request02 67 Square feet: 1 st floor:existing proposed 2nd flo :existing p posed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation= .ODD Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes Cl No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other . q, -central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name / Telephone Number k Address License# Ole/l � Home Improvement Contractor# /DSO 7 / Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'Lid O®� l� � SIGNATURE DATE 1aC ` FOR OFFICIAL USE ONLY - ,,PERMIT NO. DATE ISSUED MAP,/PARCEL NO. +` ADDRESS VILLAGE 'OWNER P DATE OF INSPECTION: ' FOUNDATION 3 r FRAMEAft/ 616 Pg&4= ,W)611149 A&t INSULATION i FIREPLACE i 4 ELECTRICAL: ROUGH FINAL .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' t r' ?! FINAL BUILDING i j? t DATE CLOSED OUT ASSOCIATION PLAN NO. t The Commonwealthh-ofMassachusetts [ 6 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 Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: �'�� �, ��co Are you an employer?Check the appropriate bog: Type of project(required): ❑ I 1. am a employer vvrth 4. ❑,I am'a general contractor and I 6, El New construction employees(full and/or part-tune).* have hired the•sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and have no employees ' These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ I am a' homeowner doing all work right 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 comp.insurance required.] «Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. l am an employer that is providing workers'compensation insurance for my.employees. Below is the policy and job site information. [nsurance Company Name: Policy#or Self-ins.Lic.#: (2 Fye;/ �4 06(- Expiration Date: 02 (9 fob Site Address: , City/State/Zip: 4ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a :me 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 )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office.of nvestigations of the DIA for insur e?Zverage'verification. I f do hereby certify under,the a' n alt'. per' at the information provided above is true and correct 3i a tore: Date: ?hone#: . 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 Ll Contact Person: Phone#: -Information and Instructions .V 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 udder 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 bean 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 pf 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 numbers)along with their certificates).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 UP 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 Departrment.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 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 OfraCe of InvestigatiGns 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 W 406 or 1-977-MASSAFE Fax#6�17-727-7749 Revised 5-26-OS www.mass.govldia -1 V rrll VI llalilaL."1J1v,;+ :~ Regulatory Services s�xxsTeetE. ' Thomas F.Geiler,Director 9 ass. `bp,FD ,► Building]Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Rce: 50 8-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL a 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, irnprovernent,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adj scent to such residence or building be done by registered contractors,with certain Exceptions,along v«th other requirements. Type of Work: Estimated Cost �v Address of Work:. Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []work excluded by law ❑Job Un e Sl,000 CBu' g not owner-occupied V,Oweer pulling own permit Notice is hereby given that: OWnRS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. G i GAL -Aner's Sign Date 0s e Q vpfnes.forms:homeaffi day Rev: 060606 f' 1 �t►+e rq,:, , ti Town of Barnstable WtMASM v MAss g .09. Regulatory Services �EDe Thomas F.Geiler,Director 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 Property Owner Must Complete and Sign This Section If Using A Builder 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: (Address of Job) Sign dofOwner Dat Print Name Q:Forms:expmtrg Revise071405 -- -- fce�ons an"d gtapdards Board of Building R g CONSRACTOR `. I HOME IMPROVEMENT � . - gistra ion_a 40620 E Co on `p HAYDEN SLOG Hayden Ro bed Administrator ��°•v DCQn�' PO BOX 496 MA 0263 . i COTUIT Mills, - _.. ...._ .._........ M 07. � 0/ i BOARD OF BUILDING REG,ULATI a� License: CONSTRUCTION SUi?ERVI:S9 01616'1 fir Numb4-.1CS 07 Tr.no: 4359-AKit .< BE -RC F HAYEIs .r I 0 CHEOH ROAD iCOtUIT,: MA 02... :Co-b.'mniissionei .r .-r r:•i .Ni n,wn.i?'v^.'"r'`"";7p�. i�'�'k°p?,,�" '1'�7!�'^v�i;�va�"xn{•w',.+.+twL:apY.y r�-'w�-< ': "'f�J11�°4''A!►`5rwt`r'i';✓YSt4'F'%i.fr `oF,HE row Town of B arnstable BARNSTARLE. - -• Regulatory Services-- MASS.t639 - �prED MP'� 0 Building Division 200 Main Street,Hyannis;MA 02601 V Office: 508-862-4038 Fax: 508-790-6230. , Inspection Correction Notice Type of Inspection ' Location �� Zlki C F, Permit Number Owner Builder 'One notice to remain on job site, one notice on file in Building Department. The following items need correcting: znsrr� Ty oP�i� LNG- ro??'ou.� �F T JIFF Fnl!5 IAJCaGA�'fC17u -r/e!A-N[rC-'C l sew VENT G► p�l. � O Please call: 508-862-4@#-R,for re-inspection. t'l by P spected ate AL ��� 10/02/2006 08:47 FAX 508 790 6226 TOWN MANAGER BUILDING Q 002/003 - ]PERMIT TO MOVE BUILDING APPLICATION#(if applicable). FEE ASSESSORS MAP&PAGE NO.OF CURRENT LOCATION MAP&LOT NO.WHERE MOVED TO THE TOWN MANAGER OF BARNS" ABLE The undersigned respectfully requests written permissiortto' move a building over the public_ways in the Town of Barnstable under the provisions of General Laws(Ter,Ed.),Chapter 85,Section 18. The building (nuthiple move,see reverse)shal?be moved: FROM: i ROUTE: �o G' eA )U) G�®ru.T BUILDI.NG SIZE: Height(loaded) Z Length Width __,C 4�__ Weight AL& (See reverse for additionai buildings) DATE OF NIOVE: raez 4- TIME OF MOVE: �_ TO zQ_1-a 141%,0�/w ALTERNATE DA APPLICANT DATE �l�eG ADDRESS ✓ PHONE. OWIN'ER I TE ADDRESSPHONE The de rtment hzaids listed below do hereby approve the granting of the. e: T E N D TE ERIINTTE NT 0 vz�OG F OF POLICE DATE C MM TH I 'DATE- 744 � r (X) NEW EIS L H1NE DATE IL ING COMMfS F R ]� E i &0 KINGS IG .VAY(if applicablg) DAT _ Z a� CA LEv N AT CHIEF OF FIRE DEPARTS T, DATE OWNER OF ROADWAY(private) DATE LI GNSING DIVISION(callec!fee) An original certificate of insurance shall be provided to the Town Nlanager's office regarding workmen's compensation, public liability,automobile liability and any other applicable insurance including subcontractors. The name of the insuring _agent will also be supplied upon request. The Town shall determine the specific insurance limits through consultation with the Administrative Services Director. On building moves over 18 feet loaded height where there are additional time requirements for the raising and lowering of wires(utility company assistance) the applicant shell be responsible for notifying a daily newspaper as well as at least two on- Cape radio/TV stations to properly apprise the public of the impending moving activity (i.e date/s of move,hours of move and' ,roa_tjs,affected). COMMONWEALTH OF MASS;building moving permit if applicable)has been issued on Permit# 10/02/2006 08:46 FAX 508 790 6226 TORN MANAGER BUILDING z 001/003 IDate �o/a jo Number of pages including cover sheet TO, FROM: � lnOf 91101 -75wn HanW"l-- /� Town of Barnstable l�'r m �C�.��. 367 Main Street � �� ��I Hyannis, MA 02601 T ie errn - -C�rt Phone. DI !&& -� �� !"¢" Phone 508-862-4610 Fax Phone Pax Phone 508-790-6226 LCC., REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please Comment our r� C� do 1.0/02/2006 08:48 FAX 508 790 6226 TOWN MANAGER + RTILLDTNG -j003/003 TOWN OF building permit(if applicable)has been issued on for the new site on SEreet/Road, permit# TONA,N OF Demolition/Removal Permit(if applicable)has been issued on for the existing site on Street/Road,Permit# SECOND STRUCTURE Dimensions L W H,L ._ WG,r Moving date alternate dens _ THIRD STRUCTURE Dimensions I _- W__ H.L WGT Moving date Alternate dates _ FOURTH STRUCTURE Dimensions L W H,L WGT Moving date _ Alternate date PERMIT 1, the undersigned Town .Manager of Barnstable hereby give written permission to to move a building in the ways specified above upon the terms and conditions as set out in the application and as li-sted below and upon the vote of the Town Manager. Witness my hand this day ofj 2C1 JOHN C �NAGE M TOWN R TF,RMS OF PERMIT This permit is issued tinder the following terms: I. That the moving of the building be date promptly and in a skillful manner with no unnecessary inconvenience to the traveling public 2. That proper warning signs and fights be set-up to guard the public safety and such:police protection be provided as the Chief of Police may require. 3. That the nnoving be done under the supervision and direction of the Chief of Police and the Superintendent of D. P. W. 4. That this permission be given upon rite express condition that the Town shall be held harmless by rite applicant against all liability, statutory or othetivise,for personal injury or property damage. arising out ortl:e moving of the building. S. if the move involves more than one structure, an addenda will be attached to the back of this form indicating the dimensions of each structure and the number of units to be moved on a given day, as well as alternate dates necessitated by weather and uncontrollded circumstances(accidents, etc.) 6: Notificatia:shall be made to the Town hWanager and Departntent Directors not less than 48 hours prior to moving date or alternate move date. 2 PERMIT l PAYMLN r (EMP luf T BAaRNuTOLF BU '_i 1N UEF'APTM Nx 40 MAIN STREET A W1 41 . HA 02601 �� w JA'F; 06/20/08 ; IME. ti:9 , _.___,_ -TOTALS__ . ._ _ Pf:t 117 $ PA,TID 61 ,50 AM! IENGEAwP: 6?.50 I iPP'L d; 61 .50 APP!.l,"ATION NUMBER: 2LuP1333 PA o N i If l; D4E._K PAYVENT PREF 3248 t i ? 0 Town of Barnstable- *Permit# . ,g c Expires 6 months. issue date Regulatory Services Fee 9� �v �PRNcj� Thomas F.Geiler,Director CNN Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 6 1 Ly(C Property Address j V / e-0 I, kca Residential Value of Work Q 0 Minimum feg of$25.00 for work under$6000.00 Owner's Name.&Address O n r L4(416A Contractor's Name V ill Telephone Number 0? 246 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C3 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ the Homeowner have.Worker's Compensation Insurance CGS �( C ,,1 > o2�3z, Insurance Company Name Cby" '� Dt k-�ir� tMA Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) L Re-roof(stripping old shingles) All construction debris will be taken to B07yryl� �2 ALL L ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side 3eplacement Windows. U-Value W - (max;mum.44) *where required: Issuanc.c of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. k ***Not1kome rty Owner must sign Property Owner Letter of Permission. Improvem Contractors License is required. SIGNATURE: e i Q:Forms:expmtrg Revise071405 t . L °FINE r Town of Barnstable Regulatory Services BARNSTABLE' Thomas F.Geiler,Director 16 9.'O�EDMA'I�,O� Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA b2601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, µ A ,as Owner of the subject property hereby authorize CDRi A 9.`04 ���G to act on my behalf, IJ in all matters relative to work authorized by this building permit application for. l 4 (Address of Job) c OG' ASmof Owner '4ate 4 N F-I Print Name I I i Q TO RM S:O W NERPERMIS S ION 06/19/2006 09:47 FAX 17818372800 CHAS H CAHILL INS AGENCY @ 001/002 ACORDL CERTIFICATE OF LIABILITY INSURANCE DATE(MdMODNYM 06/19 2006 PRODUCER (781) 444-2306 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Charles H. Cahill Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P.O. Box 321 Duxbury MA 02332- INSURERS AFFORDING COVERAGE NAIC A INSURED INSURER A'Penn-America Ins, Co. Galvin Brothers Painters INSURER a.American Zurich Ins. Co. 16 Stevens St. INSURERC' INSURER D: Hyannis Mh D2601— INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR AD R TYPE OF INSURANCE POLICY NUMBER DATEYMM D1DI EFFECTIVE POLICY MM/D��N OMITS IN R A GENERAL LIABILITY FAC6361402 05/08/2006 05/09/2007 EACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE Go oca r sots ! 100,000 CLAIMS MADE OCCUR / / / / MED EXP onu rson) 5,000 PERSONAL RADVINJURY ! 1,000,000 GENERAL AGGREGATE S 1,000,000 GEHL AGGREGATE LIMIT APPLIES PER' PRODUCTS-GOMPIOP AGG 6 1,000,000 POLICY Pe LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMB : ANY AUTO (Ee eccMenl) ALL OWNED AUTOS / / / / BODILY INJURY 6 SCHEDULED AUTOS IPe/peleon) HIREDAUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Perecelaenq 6 PRO PEATY DAMAGE (Peres m) 6 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 6 ANY AUTO / / / / OTHER THAN EA ACC 6 AUTO ONLY' ArC 6 EXCESSIUMBRELLA LIABILITY / / / EACH OCCURRENCE >I OCCUR CLAIM$MADE AGGREGATE S S DEDUCTIBLE / / / / 6 RETENTION S S B WORKERS COMPENSATION AND awaiting issue 09/14/2006 06/14/2007 X ya3j EMPLOYERS'LIABILITY ANY PROPRIETORMARTNER/EXECUTIVE E.L.EACH ACCIDENT 3 100,O00 OFFICER/MEMBER EXCLUDED7 / / / / E.L.DISEASE-EA EMPLOYEE 6 100,000 $yea,4esalbe urger SPECIAL PROVISIONS aeloo E.L.DISEASE•POLICY LIMIT 3 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES Be CANCELLBID BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT BOB HAYDEN FAILURE TO DO 30 SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 60 CHEGH ROAD INSURER ITS AGENTS OR REPRESENTATIVES, AUTN D REPRESENTATIVE � 1 COTUZT NA ACORD 2S(2001108) 0 ACORD CORPORATION 1906 *T,INS025 pop)os. ELECTRONIC LA8ER FORMS,INC.-(WQ)32T-QN5 Page 1 of The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lesibly Name (Business/Organization/Individual): 44LU/I\/ PbZO�/-� Address: ( � �)�V�NS �7- I—LAPELL/ S City/State/Zip: Phone#: 24, 6 /o2 Areu an employer? Check the-appropriate bog:. Type of project(required): 1. am a employer with�, _ 4. ❑ I am a general contractor and I 6 El New construction employees (fuff and/or part-time).` have hired the sub-contractors 2.❑ I am'a sole proprietor or partner- listed on the attached sheet t 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 [No workers' comp. insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or.additions required.] officers have exercised their eP : . 3.❑ I am a homeowner doing all work right 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'- comp.insurance required.] 131:1 Other Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: �e 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 their workers'comp policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site aformation. murance Company Name: 5 /� l,f/il�j i ✓�Sr,�u�Cam. 'olicy-#.or Self-ins.Lic.#: Expiration Date:_ ob Site Address:0 Cf,eA L City/State/Zip- Mach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify n er the pains and p aloes of perjury that the information provided above is true and correct: afore:. cC Date:*C3�n-e . / 2_oP14 hone#: IS CIS 2- O W use only. Do not write in this area to be com .�x l y , completed by p y 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 In 6.Other spector 5.Plumbing Inspector 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 dual,:pa]Uelliip,,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/hcense 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 maybe 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 Ille 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 rInvestigations 600 Washingfon Street. . . Boston,MA 0211 L Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia i i • i r i is I i f Board-of Building Regulations andiStandards HOMEIM�PRONEMENT-CONTRACTOR, d n.`ylk Registratr;on:, 10620,7 pIrattibn`742/2006, 75 s9jype `Pnva v Corporation• HAYDEN}BLDGa'MOVERSfINC Robert Haydn f PO BOX 496 ^ ` COTUIT yift{MA 0263i" ' a ka ,. a AdHunNtra�oi � �;�s�,!i7o �xn.,C@�4W.eA1• "tierf•.�..�M'i.P-.w 'w1. +a �'Rd�' 1 6 .ek�#'�arp�:. ¢nth•'wn�lll�N'ha ..�,�Kr..ri.,r.�?kl •�r it,. k .o..:_r � -.,,,r,t_•• -.tr........ ' 1 i f I i I J . I I f 1' 1 f i h !' I THE COMMONWEALTH OF MASSACHUSETTS Board of Building Regulations and Standards Home Improvement Contractor Registration Program Registration No: 1 Ashburton Place,Room 1301 Boston,MA 02108 Effective Date: Application for Registration as a Home Improvement Expiration Date' Contractor or Subcontractor-MGL Chapter 142A,780 CMR R6 (PLEASE READ BOTH PAGES-CAREFULLY) Date Processed: BXTSINESS NAME: �(;dL V 1!U 1L7�o l� Print the name in which the applicant is conducting business ,SEE INSTRUCTIONS) / Mailing Address: v ��1��� OJT ( SOT ) Z4f p- L c� ✓ 6O Area Code Telephone Number City r2Ay'1 State: Zip: Street Address(if diffeient): (Print street name and number,a P.O.Box is not acceptable for address)City State Zip i. Applicant type: ? Individual BA ?.Partnership ? Trust ? Private Corporation ? Public Corporation ? Limited Liability Partnership ? Limited Liability Corporation Please Check One (See instructions regarding enclosing a city or town registration under DBA or"fictitious name"law-MGL c 110,§S&6) i. (see back) 7. Number of Employees (See mstruchoos) 3. Have you registered previously under this law? If so,under what? Name: . PADQ,�!G -J— G�ALV l •Registration No: �. Individual responsible for Home Improvement Contracts: ` Il v P/'�D 7j JAmcS (See instructions) Last First Na 10. Title of individual responsible for Home Improvement Contracts: 11. Does the applicant or responsible individual hold any other construction related state,city,town licenses or registrations? 7 es ? No Type of License or registration Issued By License or Expiration Date Name of License older registration number o;l_ ©i /z ba0 G J- GAw1N 12. List all partners,trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below. Use additional paper if necessary. (See instructions below) Check here if you wish to receive an application for additional ID cards for key persons. ? Last First I Middle Initial Title In Applicant Business %Owner Address G ) AUL M d L o 6 S > - ;V 13. Is the applicant claiming exemption from the registration fee?(See instructions) ?.Yes No i 14. Registration fee enclosed:$ (see note#1,of instructions). Guaranty Fund fee enclosed:$ (see note#2,of i instructions) If necessary,include two separate certified checks or money orders-one marked"Registration Fee";one marked"Guaranty Fund". See instructions for the fee amounts.Make all certified checks or money orders payable to"Commonwealth of Massachusetts". PERSONAL OR BUSINESS CHECKS WILL BE ACCEPTED BUT WILL REQUIRE AN ADDITIONAL TEN(10)DAYS TO PROCESS Pursuant to Massachusetts General Laws Chapter 62C§49A,•I certify under the penalties-of perjury that I, to my best knowledge and belief have filed all state tax returns and paid all state taxes required under law. Signature of applicant or applicant's representative Title held with applicant Date �FTHE�o Town of Barnstable *Permit# Expires 6.monthsfrom issue date snxtvsTABI .�'. _,.. . . - =: ::R�gulatory Services ..... Fee... . . aa39. ,0� --.Thomas:F.Geller,Director - - -- "- ---Tom Perry, Building Commissioner �RESS .. � • 200 Main Street,- Hyannis,MA 02601 DEC 14 2004 Office: 508-862-4038 Fax: 508-790-6230 ;...,,, ....__:.-.._ .._.... TOW' Off' BARfVS-TABLE:........ _.. EXPRES&PER&M A PI,ICATI.ON RESIDENTIAL ONLY. v + Not Valid without RedX-Press Imprint Map/parcel Number n t Pro Address © Or)� a C P�h' Residential Value of Work 1� 0� Minimum fees of,,$25.000 for work under$6000.00 Owner's Name&Address o Contractor's Name OC', d'-A _Telephone Number Home Improvement Contractor License#(if applicable) Construction 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 �+ � X 6 /1 Workman's Comp.Policy# �7 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) ❑ Re-side ❑ Replacement Windows. 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: Property Owner must sign Property Owner Letter of Permission. rnvem tractors License is required. Signature QTorms:expmtrg Revise063004 Fraser Construction Roofing & Siding Specialists Possible Extra -After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation be not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed: by removing the plywood sheathing installing the panels, turning the plywood over and then re-installing the plywood. If needed,this would be charged for as an extra at the rate of$4.00 per panel including Materials & Labor. There are 6 panels per sheet of plywood. Possible Extra-Any rotted,or otherwise deteriorated trim boards,plywood sheathing, lead flashing,'or other carpentry needing replacement will be done and charged for as an extra at the rate of$4..00 per hour,plus materials,plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against Blow-offs for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the first 10 years, and then on a pro rated basis for the Lifetime if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full, 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We,if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Warkman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: D (� SUBMITTED BY: Homeowner se ction r Boa►doC Building Re gulat►ons and Standards Regi IM-' '\ ENT CpNTRACTpR Licent e st6&O' .. -EzpjEat+on ta2536 before 2005 Board One p�NEF CONS7RUGTIOIVfco ;i Bostot BASER 71 TARRAGON CIR `? COTUIT,MA 02635 Administrator r The Town of Barnstable Department of Health, Safety and Environmental Services • . = Building Division 659.16 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Cmssen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: � /i &� Name: ffe a Address: 6z> c'4 ed �i� Village: C6 Type of Business: G u i Map/Lot: © / 9/ 1 _� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor, no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton opacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the sum address shall not be reet included • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. -I, the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: i LoT 9 1^ / LOT !O / 60 LOT s 1Z & 8 / Ti SEPTI C ?rr NEW o WA&e L o r CONC. FND, SEfYfIL TANK ti Lt:X SriNG DWELLiNG X u60 0 OW�"E!P- P-O&SeT q;o�f,MQ 'o o L��cATio..i = Coru�'r MA 02635 PI-AO REF. : L ors 79t $ v R O A D 90.Oo i PLN. 8 k, 18 4 PG.33 EOUNDATeON AS - eUiLT n I ce�t�fy a f �I�e I'ERIti9ETER LAND SERUICEsox I iG the setback f epl rements ;'_`'` 6, S a A G MORE ����- � MA. 02s6l 1 PJo. f le- flown o� PQrnstoble, 833- $y60 Fd' 9FCISTERF� 0.� a S CA LE A92 3 O'vdl LA1��S Z8-9y I RE• Pp. LArjb SUPVEYDR DATE L Assessor's office(1st Floor): p 1(� Assessor's ma and lot nu ber THE o` ( ) �� �d �� Conservation 4th Floor Board of Health(3rd floor):Sewage Permit number r � Q �t1 ' 3 t�`¢ °�']' rua tisas3rant Engineering Department(3rd floor) ` � :x�oo�t670'a��� House number to O 1 tr�r Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED,8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN ' OF BARNSTABLE 'BUILDI.NG INSPECTOR APPLICATION FOR PERMIT TO , TYPE OF CONSTRUCTION 46 t i 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permnit acqordingjo the followingormation: Location r/, 0 Proposed Use �`��� Zoning District Fire District Name of Owner Address Name of Builder Address Name of Architect / Address Number of Rooms ` Foundation Exterior Roofing Floors Interior �7�rt1t� Heating G -P Plumbing _ � — Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee �. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the a ove constru n. Name Construction Siipervisor's License HAYDEN, ROBERT No Permit For BLD. FOUNDATION/MOVE GARAGE Accessory to Dwelling Location 60 Cheoh Road Cotuit Owner Robert Hayden Type of Construction Frame Plot ' Lot Permit Granted March 28, 19 94 Date of Inspection: Frame" 19 Insulation 19 Fireplace 19 I Date,,Completed 2 19 - w�,�Y I, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4K4ap a ' 9 Parcel L4 Application# Health Division Conservation Division �' aD, sAeM I-S �� �� Permit# ! I Z- Tax Collector t� D Date Issued Treasurer Q Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board EXISTING SEPTIC SYSTEM ED TO--.a—#OF BEDROOMS Historic-OKH Preservation/Hyannis Project Street Address 6' Village / / �— Owner Address Telephone r�������� C 9 Permit Request iti�dt/� O I}} Square feet: 1 st floor:existing pro osed 2nd floor:existing proposed I Tota new Zoning District E{I d P ain Groundwater Overlay l -r_ P`olecfValuation 119, 00 Construction Type L� Lot Size /� Grandfathered: ❑Yes ❑ No If yes, attach supporting documental on. - r c� r— Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) ,,_�ge of Existing Structure Historic House: ❑Yes o On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other BaserAnt Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) `_"I uijr of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILPER INFORMATION G� Name ` Telephone Number 6 (�� �l,�b Address License# 61164V D C Home Improvement Contractor# Worker's Compensation# AC �7��2jD��l3t G aoze� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �'�G —'' FOR OFFICIAL USE ONLY ' PERMIT NO. DATE ISSUED MAP/PARCEL,NO.' ADDRESS VILLAGE � e OWNER DATE OF INSPECTION: ,s FOUNDATION u FRAME INSULATION , FIREPLACE ELECTRICAL: ` ROUGH m FINAL PLUMBING: ROUGH 0 0 FINAL GAS: ROUGH CO FINAL FINAL BUILDING DATE CLOSED OUT I �` ASSOCIATION PLAN NO. i °FWE Town of Barnstable Regulatory Services 9BMASS AMSTABL&g Thomas F.Geiler,Director o;9.�A�O Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date 0 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the."reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition;or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work: Estimated Cost 6fO 4 Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the.following reason(s): ❑Work excluded by law ❑Jqb Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner* Date Contr ctor Name Registration No. OR Date Owner's Name Q:forms:homeaflidav i IKE Tpty� Town of Barnstable Regulatory Services San?s�I'E ` Thomas F.Geiler,Director a679' �0 pyE039. a Bullding Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �Z(. -r to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) "Z O� Signa a of Owner Date i Print Name Q:FORMS:OWNERPERMISSION i �9) �h. MAP 19, PARCEL 141 20.00' 60 CHEOH ROAD COTUI T, MA �s�?• PROPOSED GARAGE ADDITION LP O �h GARAGE ° 91 TAW 00 ,�o EX.DWELLING ti 'po �o SEPTIC SYSTEM SHOWN i IS DRAWN FROM AS-BUILT PROVIDED BY OWNER. ' 90.00, CER TIFIED PL 0 T PLAN HA YDEN RESIDENCE 60 CHEOH ROAD ' 1 CERTIFY THAT THE IMPROVEMENTS SHOWN of v ' HAVE BEEN LOCATED WITH AN INSTRUMENT �P` Ass90 COTUIT, MA € SURVEY. o�� yJ, DATE: MR. 30, 2006 DRAWN: RBS ROBE JOB A E00696 c SYKES SCALE:1"=40' DWG. CPP No. 35418 Ar EASTBOUND 30 F` � -d6 LAND SURVEYING, INC. P.O. BOX 442 ROBB SYKES, PIS. DATE FORESTDALE, MA 02644 508-477-4511 4 � i `oo:0S'. 1kiT an ` ' - ' a�zo9a�q •�zt� na��aaA � /n� _ � 3'SAFrA�� •�t' . *, 1'stt19-2A MOS13 vaVA�VC 2f 3�N3CI1235� V130Y AH - - • _ _ f � .a 41�t,,K.. �'i Vl��t►3V04191d,1 3NT �ANT Y3IT5�30 l j: Akh ;C�ISTOJ �z`'A yj 7113MVWMA 'AR KT1W IM A.OQ3 WBS 3VtU2 AH �a SEAR, .. , g'J �VCI OA="t:3�A�c � 23>iY2 0 .OVi�. .�VLI`i'Jtdi�s'2 t�VIA,I \ °,� `�,��� 1.r�.� , ',� ,+ �Q,,, C. �+�a�0 Ash .3:lAOT23AC� '►�."�-. J_______ T Mi IA alao t r� i .re;-w.�:�;s,::,....,. �i Tpomv�narzcuea�i _� , • atto sMIA Stan r AllBoard of Bu Rdit Regul HbMiE IN6�Et.OVERWT CpNTRAZTOR, Regi 106207 ra on 2212006 ri -te C'drporation IfiICYUEN BLDG • iFtohert:•:I«Ca�td'sn _ •� 130 gp'X 496 ^�° ' MA 026 5 Aaarin3sfrator :� e B-.OAR&OF BUILDING REGULA4 S .. License: CONSTRUCTION SLJP6-,'Ak Numb h 016161 - >,:. ;.Moto 07 Tr.no: 4359:c p . " ,( R`trtrs d ROBERT F HAY'.`, 60 CHEOH ROA rA 0 M- COTUIT, MA Commissioner sa l + TOWN OF BARNSTABLE Permit No. _2482i:_ . i Building Inspector cash OCCUPANCY PERMIT Bond _____-_-_�-� , Issued to Robdrt F. Hayden, Jr. Address ')0 Cheoh Road, Cotuit ��1 Wiring Inspector ,� i Inspection date ' Plumbing Inspector Inspection date > L Gas Inspector �; " Inspection date Engineering Department , � C/mil �� Inspection date Board of Health ,-_ `f �. - 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Building Inspector i i � .'` h- 9,.r `!•.�:'�'.�r'ca���.� {�:. i- �4i- *' .2�',4� ��c .. - v�- � aii�N�'�i-�i.Y.�,. i r• TOWN OF BARNSTABLE f BUILDING DEPARTMENT rASa = ss8 TOWN OFFICE BUILDING u HYANNIS, MASS. 02601 '�o r�r►' MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit ha�s/ been/issued for the building authorized by BuildingPerm' _.....••............ ........................................ ..........._.......... issued to ........................................_...... __.._ .._.. .. �_ Please release the performance bond.1167 ,�Assessgr's map and lot number ....... �.... °*THE tO� f Sewage Permit number .......... ...... .....!..G/................:...... s C^-4 O �• -=''' w B9HHn98TSDLE, � House number ....:".... ...... .................... ....................... 900 0b q. 3 �0 �0 YPY 6 TOWN OF ' BARNSTABLE BUILDING INSPECTOR -' APPLICATION FOR PERMIT TO .. .................,. .. �:.... . ? ........................................................ ?.. .... i - : TYPE OF CONSTRUCTION .........................z` iY!`�f ...................................................................................... ' G e%/vzi.....1 ......19. TO THE INSPECTOR OF BUILDINGS: *� The undersigned hereby applies for a permit according to the following information: Location ............................... -�?.! ;::�! �'/......// !J / .......1........0........................ .� � c .J ProposedUse ......................... . - �............................ .......................................................................... Zoning District .....................•. ...................Fire District Name of Owner �r�lC�.V / �.�...�....Address .......�,.: ��.1.....��.!�. � / ...��..!�.w............... .......... -..... Nameof Builder �/ �-�+.............l.f.f.. .............Address .............................. . . . . ...................... .............. • Nameof Architect ....................... `.`.:`:`..................................Address ................................................................................... 1 � , Numbeeof Rooms ............................. -...............................:.Foundation .............................................................................. Exterior .. ..............................Roofing ................!.:..; .rt<.;.: ........................................... . Floors �.......................................Interior .............. ........................ Heating ��it i crimt�f4 ...:. ......Plumbing ............................................... Fireplaces".............................................Approximate Cost ..... ....... 1.7.U ...................................... .... / Definitive Plan A roved Planning Board ____________________ /v J pP y ------19--------. Area ............................ Diagram of Lot and Building with.Dimensions Fee ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH i i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ` I hereby agree to conform to all the Rules and Regu lotions.of the Town of Barnstable regarding the above construction. i 1 � Name ............................ ........../.............. . ................. Construction Supervisor's License �'"• ................o . HAYJ)EN, ROBERT F. JR. A=19-141 & 140 J/ 24826 One Story - Permit ................................. No.................. for ... Single Family Dwelling ............................................................................... Location Lots 7 & 8, 60 Chdoh Rd................................................................ Cotuit ............................................................................... Robert F. Hayden Jr. Owner .................................................................. ' Type of Construction ..............Frame............................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ...MAr.gh...3.,................19 83 Date-of Inspection ....................................19 Date Completed ......................................19 Asssar's map and lot number .... ..... ......... F THE T 3 Z�Sewage Permit number ........ �/'/(�1�4X r( / Qom° °`♦. .... . BaaasTanas, House number �() .. y Mnea r Op s639. 9� TOWN OF ;BARNST `VIT % , BUILDING INSPECTOR s 'sVPM MUST 13E �. � � �� EEpTIC CMp�IA� CE APPLICATION FOR PERMIT TO ........ ............ ...... .... LLED.�N.0 INETA WITH TC - p® p,�,D TYPE OF CONSTRUCTION �N fIAL .. . .�� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to t/he following information: &...Location ...............................!��.. .... .................... .......1.......... .................Proposed Use Zoning District ..................... . .......... ............... ....................Fire District ................7........ ' Name of Owner .........../......f/.C. �.r....:. �. ..Y�...Address .......1 � .....�!G..�` !`. .... ....... I v� I Name of Builder `f i U—.Address ^ tr Nameof Architect ..................................................................Address .................................................................................... • Number of Rooms ..............................�................................Foundation .............................................................................. Exterior ....................... ...........................................Roofing .................. .. ......... . .............................................. Floors :Interior ............... .................... ......................... t � ' Heatingg ...................................... Fireplace ......................... ..........................................Approximate Cost .............> y�.................. :•..:.: : .......`::. - Definitive Plan Approved by Planning Board ________________--___-_ /� f 19 —- Area :.........::.........:. Diagram of Lot and Building with Dimensions Fee :.:..............., a SUBJECT TO APPROVAL OF BOARD OF HEALTH or/l fj 1 v7 i •.erg'' � L kl ' .l! 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 . .... ; ' ( Construction Supervisor's License .. `. ,1�(0� .. HAYDEN, ROBERT F. JR. 24826 ................. Permit for One Stor ..........................y .......... Single Family Dwelling ............................................................................... Location cation ....Lots...7....&....8....6.0....Che.oh...Rd... ....... .. .. . . .. . ....... ..... ..... cotuit ............................................................................... Owner ...Robert F. Hayden Jr. ......................................................... Type of Construction .....Frame........................ .. .... .. .. ................................................................................ Plot ............................ Lot ................................ March 3, 83 : Permit Granted ........................................19 Date of Inspection 9- '-17...I-ry ......19 Date Completed ... ................19 -/ezz a - aQ ` Zc.oO gyp• 1 � o — M • RIC-`ARD p BAXTER 7; "' :.,04 8a CEQTtFIEO PLOT P - AV J ?: LOCATIOt4 CURTIFV THAT T14a F-ovMT*1-1�5WOWQ Pt.•AQ R6FEIZE►.JGE � -IEQ .MW GOAAp%_%eS WITH TN6 StDE.Ll►-r6 �.cry "'1 ANo SET$�CK RE4t�IREMENTS. OF THE _ ... .�►...� 3tJ .18�{ tr'c5, 33 'jc W N OF 6a21J STht�3L-� ACID tS 1-tOT" Lv�o►T� w l-rI-11�a Ttrl� F• R.e.l N e Q XTM% • W Yf=' %&J C-- OSEQV1L.tl= o THIS P(-AN lS UOT BASES vN AN Toccr3s2,T ' /XEYlC- t&1 IWynCUAAEWT. ' iZVG`{ 4 'n4C OFgrSr--TS 5"C"'J ' APPL.1CA-I Jr ' KIC,y HC% USCG rC.# De rc-V- l0 NC LOT LI i-4i.'5 1�A• 1..� . 6 1 V N. N. \` �v 86.3 9 G 78 .9 ZZ, gZO G3 `�b ly " \ 8 9•�4 \ � 7 0.C� - SANG E � ►M1Lti - a8-.D Room x 3 s 33o G.P. D. oc� h.�. 4a EpTt.0 TPtiN K 33� K tv0l/o Z. 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