HomeMy WebLinkAbout0093 CONSTANT LANE :z
oitee�♦ TOWN OF BARNSTABLE Permit No. ...30215•„
BUILDING DEPARTMENT
1 D°81 I TOWN OFFICE BUILDING Cash �.2Q: p....��?ldr•) �Iz�
uv�� HYANNIS,MASS.02601 Bond
I
CERTIFICATE OF USE AND OCCUPANCY
Issued to GEORGE TSEFRIKAS
Address lot #37 93 Constant Lane, Cottit '
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.
Se tember 23
..... 19... .......... ...
87 ! .
P ...........
Building Inspector
TOWN OF BARNSTABLE, MASSACHUSETTS
• GUILG•ING PEERMIT ..
DATE 19 '• PERMIT
C; :i Builders 1.0 �tl:�� Farms Circle
APPLICANT ADDRESS
(Nq%)ir 'WziUULS.TREEFkA (CONTR'S LICENSE)
PERMIT TO Build 11welliPg (1_2 ) STORY '�J''.'7>'i', f;.cr+ily dwelling NUMBEDWELLR
OF
NG UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) lot f37 )-� CoI: i4iN i ',;i1!'i,e. I„C:'tll` l' ZONINGDISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION 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 v BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: .;r++.: ,'l�21i._ i Ii•�/� .
AREA OR
VOLUMEE j.3Ct0 :'C . it. ` � ?);�!) PERMIT- ESTIMATED COST �= FEE $ l `
(CUBIC/SQUARE FEET) ,
OWNER (.,E'UI g(
ADDRESS 20 Gro-'_T:lC:�i): r:ii:Ii:' t..i,l'i:_ .: ..,f,.l '•.J: iiU i •y ,•� BUILDING DEPT. �• ."i �. ^ .�
BY
THIS PERMIT CONVEYSAN
,RIGHT TO CU•lrY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENC RON.•1ENTS ON �LI�C PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISION. STREW •OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMEN PUBL C Wd K!�. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
L
OF ANY APPLICABLE SU B�•D VISION 13EV ICTIONS.
MINIMUM OF T E ALL )
INSPECTIONS RE I OR ! APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
ALL CONSTRUC ;O K: t PERMITS ARE REQUIRED FOR
CARD KEPT POSTED' UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND
I. FOUNDATION OOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO C ING STRUCTURAL QUIRED,SU.CH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(R TO LATH). FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPE ION BEFORE
'
OCCUPANCY _
POST THIS CARD SCE IT IS VISIBLE FROM STREET
BUILDI G INSPECTION,APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
.7
2 i n 2 / 2
3� HEATING INSPECTIO APPR ALS ENGINEERING DEPARTMENT
OTHER BOARD OF HEALTH d
_ 9 3197 . .
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF.CONSTRUCTION INSPECTIONS INDICATED ON THIS CWD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
e
Assessor's offioe (1st floor): /
SEPTIC SYSTEM MUST ?"E
6
Assessor's map and lot number .............................................
Board.of Health (3rd floor): 3 g 2• �j �t3 INSTALLED IN COMPL
Sewage Permit number .........................0..�.':....:U.3+ VM TITLE 5 1 IMUSTA U, i
Engineering Department (3rd floor): rasa
g g 9 � ENVIRONMENTAL COD ' �39• �•
House number .:............................. ........(�.3...... rO
TOWN REGULATION
APPLICATIONS PROCESSED 8:30 9:30 A.M. -and ,1:00 2:00 P.M.,�bnly
TOWN. OF 'BARN-STABLE
;BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .......................... ............ .... ........ ........... ................ ...................... ........
TYPE OF CONSTRUCTION ............................................. .................... :.....
............IF.: RIF......................19 8.1�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..... t.°.T.......5.7...... ........ .................. /..a 7.....:... ®�°1.�`1 .5.............
ProposedUse .............. ' ./... �J4�./..1. .. ...............................................................................:.......................................
6
ZoningDistrict .................. .F.........................................Fire District ........ ..'-.............................................................
Name of Owner .�CQf-.Ge 7-$ ........Address
Name of Builder .. .... ........ . ............Address /• s.......... ................
I
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms .......................a......................................Foundation ...:../0......PO..v. A......
d. Ce.�.�,......
Ex1er for ...........1/..'yl)14.S!.P.!?�.6z.... .k7�?o..Q..�,ONc).Roofing`...........lirr/fj</�
Floors ...&O.Pe ........f......I/.�Alj:L...f.'o.dKAJgInteriar ....... /.=1...... O.f��...P�.!�.fr�.�,.....................
Heating ....F# .......
�7 .5................................................Plumbing .............DZ.lJ ................................................
Fireplace C,).. C K................. ..............I..........................Approximate Cost ..........r ram... ?........................................
Definitive Plan Approved b Planning Board -------------- ........
PP Y g ----------•-------19-------- . Area // .3 ... ...�.�....
Diagram of Lot and Building with Dimensions Fee 1s�YC.!
SUBJECT TO APPROVAL OF BOARD OF HEALTH —,On
-14
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 ... ...........
TSEFR7L*KAS, GEORGE
QK10 Permit for ............. .......... ...........1 S to r .
Single Family Dwell
............. 1...c..........
..Lot #37 , 93 C n7 tart Lane
Location ....................................
Cotuit ,
...............................................................................
George Tse'r' kas
L Owner ...................................L................................
Type of Construction ....Frame.........................
.. .. ........
................................................................................
Plot ............................ Lot .................................
Permit Granted .... November 21....................................19 86
Date of Inspection ...........19
Date Completed ... .........19
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i CERTIFY THAT THE FOUNDATION
SHOWN DOES NOT VIOLATE ANY
EXISTING ZQNKG R�GUTA`TION OF
THE TOWN OF Rai o<j l6LX.
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1 � •r '
oFINE ram, Town of Barnstable *Permit# 00 7U
~ Lrpires(inat hs ont issue date
. EMIT Regulatory Services Fee
Thomas F.Geiler,Director
lf° 0 2007 Building Division
®� BARNSTABLE Tom Perry,CBO, 'Building Commissioner
TOWN 200 Main Street,Hyannis, MA 02601
www.town.barmtable.ma.us
Office: 50&862-4038 lax: 508-790-6230
4
EXPRESS PERMIT APPLICATION - .RESIDENT14L ONLY l
Not Valid without Red X-Press Imprint.
Map/parcel Number n39 06 1
Property Address g 3 .(fc n s 1-cA n - La n-e. Co 4- o c
TidRcsidcntial Value of Work In to do Minimum'fec of$25.00 for work under 56000.00
Owner's Name&Address Rn hP r_
.Contractor's Name Telephone Number 56 q 2(F 11 1-7
.Home Improvement Contractor License It(if applicable) 6 LA
Construction Supervisor's License 11(if applicable). O 2_U 32-5
D5Workman's Compensation Insurance
Check one:
❑ :I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name T-Y�G�V Q `-erS 1JS
Workman's Comp.Policy 4_ U E6 b 9 s LA 91406
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 k-I OLCM o 941 �l f I
❑Rc-roof.(not stripping. Going over existing layers of roof) .
- ❑ Re-side
❑ Replacement Windows. U-Value (mpximum.44)
O
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e..Historic,Conservation,ctc.
"
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
SIGNATURE: �
Q:Forms:cxpmtrg
Rcvisc07i4O5
I
The Commonwealth ofMassacltusetts
l Department of Industrial Accidents
.(L Office of Investigations
2.
: 600 Washington Street
Boston, MA 02111
?" www.mass.gov/dia.
Workers' Compensation Insurance Affidavit: Builders/Contractors/El Icetricians/Plumbers
Applicant information Please Print Legibly
Name (Business/organization/Individual): VA C
Address: I�?�1 . M Q ► S�-
City/State/Zip:r,15>to-'►/ '& M 62.(o SS Phone #: 50FSL42 8 l 1
Are you an employer?Check the appropriate box:
Type of project(required): �
119 1 am a employer with 1-2— 4. ❑. 1 am a general contractor and-I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ 1 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.
[No workers' comp. insurance 5. ElWe are a corporation and its 9. ❑ Building addition
required.] officers have cxcrci�cd their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 LEJ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.RRoof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.0 Other
*Any applicant that checks box 8 t 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.
tCon tractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I run an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy 11 or Self-ins.Lic.#: �jaQ S �j b U A p Expiration Date: -7
Job Site Address: IJ CZ14oi' �- City/State/Zip:- Q 2 -;;
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 pelalties 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 certi nder the pains and penalties of perjury that the information provided above is true and correct
Si nature-
Date: D 7
Phone> : S
Official use only. Do not write in this area,to be completed by city or town officiat
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 111spcctor
G:Other
Contact Person-
I'Itonc#•
i
. ME- Town of Barnstable
vot• qy o
Regulatory Services
Thomas F.Geiler,Director
Building Division.
TomPerry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property O''V rMer Must
Complete grid Sign This Section
If Using A Builder
Zee �C� ,as Owner of the subject property
hereby authorize /r9 e—_-, to act can my behalf,
in all matters relative to work authorized by Ibis building permit application fat:
(Address of Job)
S• ature of Owner Date
Print Name
�7
y
QTORMS:OWNERMERMISSION
- Board of Building Regulati ns and Standards
_= One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 103714
Type: Private Corporation
Expiration: 7/9/2008
PAUL J. CAZEAULT & SONS, INC.
Paul Cazeault
1031 MAIN ST - - -
OSTERVILLE, MA 02658 - - --
Update Address and return card. Marls reason for cli:utgc.
(� Address .� Renewal L...I Employment Lost Card
DPS-CAI 0 5OM-05/06-PC8490
/cc '�iov)�nia�ruin.¢�l� o�✓�av��uaella
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
Registration:-103714 Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Expi,p i.ration:::?/g/2008 Boston,Ma.02108
Type::Private Corporation
PAUL J.CAZEAULTB`•.SONS:.INC:
Paul Cazeault r`
„...:.
Via•. ,';::.;::_. • ,
1031 MAIN ST
OSTERVILLE,MA 02658"• Deputy Administrator Not valid without signature
Board of Buildin egulations
One Ashburton Pace, Rm 1301
Boston, Ma•.02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959
Number: CS 026325 Expires: 10/20/2007.:• Restricted To: 00
PAUL J CAZEAULT
1031 MAIN ST
OSTERVILLE, MA 02655
Tr.no: 7696.0
Keep top for receipt and change of address notification.
DPS-CAI 0 5OM-04105-PC8698
j ✓i1C -tJ00)YI)LIYItC!/E(LGUL O�✓I�JOClGLUQC�d
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Numbt r:rCS 026325
13irthdate::;10/20/:1959
Expires;: 10/20/2007 Tr.no: 7696.0
Restric4t
PAUL J CAZEAULT'';:= a .
1031 MAIN ST
i
- ,...4's.'•.:....i.e..>. ..:.t:>... .•.>•%i',; �Si%+ :s'- .s:,. !?:�:�..�:<;"' •..g... YYj.
PRooucER' V•Tf•NS,GERTIF(CAT'E,•IS,iSSUEO rgS,•A~i2;ATTER..OF INi-LGiI(4K�gJA�,� .
;DOWLING 6 0 NEIL INS AGC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
222.WEST=1 W IIJ STRucT• HOLDER. THIS CERTIFICATE DOES NOT AMEND ND'OR
'PO:.DO:C 1990 '
,ALT.ER THE COVERAGE AFFORDED BY THE POUCIE�ElEl.f1YIL.
HYANNIS VIA 02601 . COMPANIES AFFORDING COVERAGE
2 2 LG ET COU PA NY:
INSURED
A TRAVIiI$RS PROPKRTY CASUALTY COMPANY OI' .......ICA'
COMPANY
'PAUL J CAZEAULT 6 SONS INC. B
1031'MA.IN STREET
0517-EkVILLE 14A•02655 COMPANY
C
COMPANY
D
COVE AGES;«.,. :
"
a::o:t s�z•"�
'i S TS'IU.CI"R'TI - :xH ::�:• ..>..:..
FY THAT '.r•�a�;�... •ovRs .:r....� , THE POUCIE '' �:`.^..zr;'z's:is^b�+:r•O S OF INSURANCE LISTED BELOW•HAVEBEEN ISSUED TO'THE'INSURED NAMED'ABOVE FORT le POLICY PEfDDD.'
(_INDICATED;NOTWITHSTANDING ANY REOUIREt.AENT• 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,
EXCLUSIONSAND•CONDITION3OFSUCHPOLICIE'S.LIMITS`SHOWNMAY-HAVEBEENREDUCEDBY PAID CLAIMS.* '
•'•+ CO ;+ TYPEOFINSURANCE POLICY EFFECTIVE POLICY EXPIRATION'
LTN ', POLICY NUMBER LIMITS
DATL(IA=U l\YY) UATE(M= UWY).•
'GENERAL LIABILITY
GUMMER(;IAL GtNEFIAIitAIlILIIY GENERAL AGGI IEGAI E S
MIIUUU(:I`J-(',UMi'I(jl'AUU'. f
CLAIMS MADE a OCCUR.
PERSONAL A AOV•INJUITY S
l3YJNEHS a(:Jrt71TACTi)HJ PF#OT. EACR OCCURRBNCC
- S
RRE DAMAGE(My one lire) f
AUTOMOBILE LIABILITY
MEO..EXPENSE.(Any onn person) S.
ANY AUTO COMBINED SINGLE $
LIMIT
ALL OWNED AUTOS
SCHEDULED AUTOS UOPII Y INJURY
(Per Person) 3
HIRED AUTOS '
�v
NON-OWNED AUTOS BODILY INJURY
(Per Accident) 3
`ia'` .•; PROFERTY DAMAGE S
' GARAGE LIABILITY' '•
ANY AUTO'
AU70'ONLY=EA ACCIOEN t' 3
uTiI-ATkANA(iT()GNi.Y: `' %;: <•:`'>-::;>.:`
EACH ArXIDENr, g ,
EXCESS LIABILITY AGGREGATE g
UMBRELLA FORtd
FACH O('.GURRENCE S
07HER THAN UMORELUI FORM AGGREGATE S
A 'WORKER'S COMPENSATION AND
EMPLOYERS LIABILITY'
4(UB-00951D164-A-06) 08-10-06 08-10-07 S7ATu7ORYLIMITs
'T NIAHE PROPRIETORI EACH ACCIDENTS
PARTNEF&EXECUTIVE INCL
OFFICERS ARE: EXC DISEASE-POLICY L(MI'IOTHER-
S
DISEASE—EACH EMPLOYEE g
THIS REPLACEL ANY PRIOR CERTIFICATE IZ;3UED .TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP I
COJ RAGE.
rgy rgg;
e ..;0. "" ..... .
.`��—.�..�_� ..... .,:a,,,..w.,o.... ...,...w:.rnJ::.....�i.:;.. .?:g-•,< ii2U`.�ANC$LaiIQN � s::g�fa:. :
9HOUL0 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED weBEFOgEeI THE
~' ,
Paul J.Cazeault&Sons EXPIRATION DATE TIIFREOF, THE ISSUING COMPANY WILL ENDEAVOR 70 MAIL
Roofing,l;ic, 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
1031 Mal 1 Street
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO ODUGATIO14 OH
LIAWLRY OF ANYQNB UPONTHLCOMpAK{,fTSAGil1TSGgREP 1;Ey�T�Tly .
Ostervillc, MA 02655
AUTHORIZED REPRESENTATIVE
�/fiCyr1 �1 Lift
U(�'25!g.�ysa'r.;;;;: •S:L:a,' i;5;>,:>:;;=,'::Jl:>::.;Z:::;=;f::;:<::EZ��:. :.f:.::f:�::;:c.:
PO
RA,a cni� RA,
Client# 1„389 2CAZEAUI_TPA
AC®RD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MMI DNYM,�
PRODUCER 05/19/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency HOLDER.THIS CERTIFICATE DOES NOT AM_ND,EXTEND OR
222 West Main St PO Box 1990 ALTER THE COVERAGE AFFORDED BY-THE POLICIES BELOW.
Hyannis,MA 02601 INSURERS AFFORDING COVERAGE
INSURED NAIL#
Paul J.Cazeault$Sons Roofing,Inc. INSURER A: Western World
1031 Main Street INSURER B:
Osterville,MA 02655 INSURERC:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE().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 l ERMS,EXCLUSIONS AND C 1NDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE MM/DD DATE MM/DD LIMITS
A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCI $1 000 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISESa u-:cc $50 000
CLAIMS MADE a OCCUR MED EXP(Any one p•,son) $2 500
X BI/PD Ded:1,000 PERSONAL&ADV IN WRY $1 000 000
GENERAL AGGREGA FE $2 000 0()0
GEN'L AGGREGATE LIMB APPLIES PER: � PRODUCTS-COMPt'P AGG $1 OOO OOO '
21 POLICY JECT LOC •
AUTOMOBILE LIABILITY
COMBINED SINGLE I'MIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY(Per person) $
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS (Per accident) $
I
PROPERTY DAMAGI $
(Per accident)
GARAGE LIABILITY _
AUTO ONLY-EAA((`1DENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCI $
OCCUR F-1 CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS•LIABILITY
ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDEN 1 $
OFFICER/MEMBER EXCLUDED?
If yr doscribo under E.L.DISEASE-EA EMPLOYEE $
SPECIAL PROVISIONS 11.
OTHER E.L.DISEASE-POLIt.%LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate of insurance will be issued directly by the insurance carrier.
CERTIFICATE:HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Informational purposes only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1111_ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGEN TS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25(4"001/08)1 of 2 #42866 LS7 O ACORD CORPOI •.:'ION 1988
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
)Parcel I
� � o0Yermit#
� �3�3�Date Issued OHe iYn`Division 4 5
Conservation Division h\� Fee SrT�y0
Tax Collector o ov g� `� Application Fee 0 O
V - 0 / 1
Treasurer
Planning Dept. ® Checked in By
Date Definitive Plan Approved by Planning Board �� Approved By
Historic-OKH Preservation/Hyannis
v
b t
Project Street Address - �..� S
Village 7
Owner Ul,�//r'-4' C Address -e
Telephone
Permit Request v t l r ...�r ��, �,a 0 ,j'c el._
7-e �.
1 1
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Q Total new
Valuation Zoning District Flood Plain Gil round 04e
y
Construction Type
Lot Size Grandfathered: -d-Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Z Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: 01f`ull ❑Crawl ❑Walkout O 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
Central Air: ❑'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
uetached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:O�ting ❑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
WZ
BUILDER INFORMATION
Name Telephone Number G �i,.,i �d�;.� .7
P
OW
Address i �� �'!e.1,0e �� `��" License# F �o
Home Improvement Contractor# Id d Y5
Worker's Compensation# / L� �I 3� S^Os� �
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO V r—oG�h
SIGNATURE DATE lS OS�
FOR OFFICIAL USE ONLY `
PERMIT NO.
DATE ISSUED
1
MAP/PARCEL NO.
ADDRESS r VILLAGE
OWNER
r
DATE OF INSPECTION:-
FOUNDATION
FRAME (O/ O '
INSULATION
FIREPLACE
ELECTRICAL-- ROUGH FINAL
PLUMBING: ROUGH FINAL
T•-1
GAS: ROUGH FINAL
/r
FINAL•BUILDING r �/ 1 CK Z a �•
DATE CLOSEDIOUT
ASSO CIATION�PLANNO.
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings $100.00
Residential Addition $50.00
Alterations/Renovations $ 50.00
Change of Contractor/Builder $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq. foot= x.0041=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
sl
V square feet x$64/sq. foot C-'U x.0041 d�i
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0041=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq. foot= x.0041=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00=
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable)
Permit Fee
Projcost
Rev:063004
i
IHEA Town of Barnstable
Regulatory Services
BARNSTAere Thomas F.Geiler,Director
'°jFOrow't°1�� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
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: zF S ,'✓< « -bB Estimated Cost l L�/GG
Address of Work: t .� J-4 f �9 X, �c
Owner's Name: Q c<'<
ell
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
❑Building not owner-occupied
❑Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the own
All
�J d
Date Contractor Name Registration No.
OR
Date Owner's Name
Q:forms:homeaffidav
1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of lnvestig&ions
_ 600 Washington:Street, 7`h Floor
Boston,Mass. 02111
Workers'Corn.. Insurance Affidavit:Building/Plumbin lectrical Contractors
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da>3iiat .: �. .. -:.. ) el; _ >: ; �c `. ..''' d2 ;i,`x' i;
°.�..• J-t:,. 'b:-C :l@'A�.R '-�'. ,k`. ,.4.rRe:�. w :•�rFdX?;E�+•=air}: :'�
name: ��(� CJ�I elf G''\
address: C/! ( LG f�
city state: 1 zip: phone#
work site location full address): 3 � CG d,Ls 1'H / 04 Tw 7�
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction 21femodel
❑ I am a sole proprietor and have no one working in and capacity. �Buildin Addition
�7i- .''1..,�.�.'+•r:°,.a '� '�''�•lj�::�:ri:.`c'h:'�t'��°..�`,.'�";'�T+.^`D',M'.'�3{U,�i}''q• if° V"Ftf e"?!..�JS`x- 'A...r;it.� a•r,rr: •:G+Y, 4�—n... '.rM." + :v3-.aE�..;�.�.;-�:n:r:
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I am an employer providing workers' comp nsation for my employe orking on t 's job. _ +
company name:
address:'
city: hone#•
insurance co. l�0�/ �/ /6 � �/ policy#
ei.•,..a13ka`.�#.., .'a."a;=`O+aen:rM�wT.s:ms �:v5'.•a. � .5 -�. ?s,•, „c.:, .dra a.; ,�
Krt, ss�$d'4`fJw4Y:F��i'•(u5.s� .b".�.�i`.:,,w ih� •r4:1rx�.E:., _.?_i;�•::'4aVJ:S..e'4;i:'arc•.?r,�:."m?.its.::�;.rL�!-_s'.�+isahui{�., �;N-- c•
❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address.
city: phone#•
insurance co. policy#
;Zre.4;,,:y:: Y:ih-:'rf' :3;'V"."1<yryry' - :�r�'3•T-+�' ``5`'f; ;•-t'.bs ny�l•,r�A+. .;f::: u(�:iSi ;'rl.a )-w.r...
i .-{n.+.`1''�S..w' .!f3'F�:a...>.i.A._ �..}1�.. ��r�'Y'i:..1'RtY4-i�..il�•?.'�..'ci%'l•Y'/ -'+{::'`li'�4nei.•la,.:4f.S:°52a... "itt�`�i�i`"'+n`ad:»w...:�i"i;8:'iF's?ti.i''` ftt <✓�,..: '7`:.f.
'company name'
address:
city: phone#•
insurance co. policy#
049 d405"iA.D.,get�f ueC. sa e 1 '•:�C f q '.33i fL a
B
�° 'te. a'
��'?:::ri �sn'"?�'1.a��!3+�w.�e`%g!C11���'S�a��>';�:r�°w�4a�.
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition.�'�of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day'against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under;�enalties of perjury that the information provided above is true and correct
Signature Date zG T�' /S- 0 s'.
Print name 00 ti So,-, Phone# �� .7 3 C) /
official use only do not write in this area to be completed by city or town official
city or town: permittlicense# ❑Building Department
❑check if immediate response is required ❑Licensing Board
❑Selectmen's Office
j ' ❑Health Department
p
contact person: hone#• ❑Other
(revised Sept.2003)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under.any
contract of hire,express or implied, oral or written. ,
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 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of.compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
sc ?� y�,S�,{ t. �+' _ :tv,�.�;4 HL�Cy•4't�' ;'•'f$�:✓R', FF�i1�.,.�v.;•. "'-.,,i;l%+�'+l••�':�!u:,l'.... .ak:'
�i�,F•( y�W,}�'���ma���+++ys [[, r _ups yry ,y p ter:' fl17�rk '7<.:•
+' E. 'fy:r3.P1:.� h$T7�t}"4'R .d 7C^ `�,.�j,.• .h'i 9�;•"'�'F.. F.- )'.:y. �C
a.��i�.. .4 x >-T/A{{tai ,ti� '•' ?` -pia °. �'.-."�;:1�,1i'' '•#t�''aa :`:F:c:.f�'+�rii:,�3„�•'x�k:?;."� %?'!�<uH... :,.::<.!�:�'wl:�k..
Applicants .
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' compensation policy,please call the Department at the number listed below.
tF ri:t-. �, r..,{2.. j.c::.r:$. •e`*! ri.
�'; ���.,�`e`, .i4.�•7�y°},. '.�.S L�'.t.. v .';�i'•�S` s' '. 4ti: .�•�p•..;b.; ��'.`"4.�: .,. 3'.•t.i:6.r;v'�'�'>_ :yT�:{'t°•,5'.. :(,d�,�,.�,y �4'Y �,e
'�'s` £fi Ti){,iS-jr�$ •y(,i � t.�P '91J.• �i �iy (r'ri '�".,' stA,34 "��•r..j,dsF`,�4,y 1�: .�.:,:ci;: z'S ¢.k'� +"5'S��aVrr�
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
r - ,xt. rr, p�";h*.�. qai a a;..,n:; v,t±• o i >es ,
.�,� r 'f:+,•s:�rk;;'xr;.,�•q•,ti �.ib`• "'-' rz� .: '�J ��Si -�",�; 4� .f� a...�i;r.i"_,;r.,� i�.-v:s '� .:t`rf':J�s,• '�r,57• ,• ':4i'�.
tt,•"� .�'•�4• f1 a iF �,9 �TY• F.,:t�4,•, Y° ,,�I , k.
i 'if t 4 Y)•1Cp�'J •`GX � r"tea y .1� �X..t? �- �• :.
•�ta`� �t fir'Pe,uS 'La � .��o����a'F�r ws,.� r.,ir •$cak.��i.�Eik�'�4s�",'��3udr�E sr• r+ `r � Hsta�iv�b°�tMs'S,� � f+..£�`..�ro t .�,�
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents '
Office of Investigations
600 Washington Street,7th Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext. 406
°Fz T ti Town of Barnstable
Regulatory Services
HaxtvsrABLE, = �MA$S Thomas F.Geiler,Director
y �
fn 19. p`` Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must.Complete and Sign This Section If Using A
Builder
7, �G/9 , as Owner of the subject property
hereby authorize P7 ez---3-6\N v�.3'tYt to act on my behalf,
in all matters relative to work authorized bythis building permit application for(address of
job)
f,3 TZ;
0
igna e of Owner Date
Print 14me
1
BOARD OF BUILDING REGULATIONS
nse: CONSTRUCTION SUPERVISOR
062830
umber: .c
hda -b54
lres°08/29/2005 Tr.no 2546 a:
Rests cted{00
L'. :. ::
PETE
7 PENELOPE
COTUI `!:02635 .... Administrator
. -�- � /fie�ovr�nza�ui!ed�i,,. ✓�iraaa,�./u�aelta-'
.....
Board of Buildingalt galatioas and Standards
HOME,IMPROVEMENT-CONTRACTOR
Regis
006.
tln' Ual
PETER EDW
Peter Johnson .
j 7 PENELOPE LAN
COTUIT,MA 02635 Administrator
i
Assessor's offioe (1st floor): i
THE
Assessor's map and lot number . v oT to
Board of Health (3rd floor,): 3 6 R' .�_ � T fO�
Sewage Permit number ?.. . ...... . . � i BaaasTSDLE, ?
Engineering Department r(3rd floor): ,/� 2 1 woe,039
House number ........ .....................
v..J k........`7..�.1......V-10 ✓ ��FOYPYd�0�
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 .......................................��.... ......... ............ ................/.......................... ........
TYPEOF CONSTRUCTION ..............................................................� :..............................................................
*, ............0?.......�2.'t.......................
TO THE INSPECTOR sOF.,BUILDINGS:.
The undersigned hereby applies for a permit according to the following information:
Location T.......3.7...... P...S�STAiVT !kle...................6e�/��.. ......�4.�''I.Md..s.............
.........°.. ...........
ProposedUse ..............k .s./...Pew' !o.c............................................................:..........................................................
Zoning District .-F:.........................................Fire District ......... —P
Name of Owner 6'cokGe 7 SCFrK 1 r!.5........Address e?�..t?1Q�4N.. 'AF...!`i�R�,S C/ «G••f__S��<<o�BC�Ry
s .
Name of Builder ... .... ........l31>/.LPCP-..................Address .... .!`9�`► ........ .......... r...9 .�................. i
Ay:
Nameof Architect ..................................................................Address .......... ........................................................................
P
Number of Rooms 40F
....................... ............................ .......... oundation. :.....LtJ....:..�O..v.2�.�U......co.C✓.MeT(� ......
Exterior ........... X.. f�,..SiP.( 67...0 0, ..`0.01!:-)Roofing ............
Floors oqkP.L.CP........�.....���I.l..L....Cot! 'Rl*Interior .......i ii5 .:: G .47.....P�.4A77r..—�....................
Heating o2 A .S
Fireplace W.. Q f C-I ..................................Approximate Cost s o ..........
... ... ... .......................... .... ......
Definitive Plan Approved by Planning Board ________________________________19________ . Area .....r-�....-s'..
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
G'
�o
I
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Bornstable'reg ding the above
construction.
Name .�...1..'.. ..................
!/ 1
Construction Supervisor's,Lice-n-s*e ...D.....0-
.a7.............
TSEFRIKASi GEORGE A=39-61
30215 11 Story
2
No ................. Permit for ....................................
Single Family..!?K�!�l.ing
.................................... ...................
Location ...Lpt....#.37.r....9 3...Constant Lane
.........................
.......................C.O.t.u.i t.........................................
Owner .......George Tsefrikas
.............................................
Type of Construction ..Frame
............................. .. .... ..
................... ..........................................................
PlotLot ........... ................................ ..............
Permit Granted ......................................November 21 ,..19 86
Date of-Inspection ....................................19
Date Completed ......................................19
. . . . . . . .
0