HomeMy WebLinkAbout0501 COTUIT BAY DRIVE �� � � �
��:� . �,
,.
n
(<
f
� � f
I
i
Y.i+w�
1
I
-�'�..
PROJECT
NAME: vh;
ADDRESS: . .
21.
PERMIT#. �
PERMIT DATE:
: . . M/P: '
LARGE ROLLED. PLANS ARE IN:
pox
.SLOT1,2
: : : . .
Data entered in:MAPS program on: 64
BY: -�
� .. "�Jr�:T.1...t•+- 7ti''��l-...'4.rY'!�'��ryJ'ti w...�Lr�i"s'•r'v`4� r t'�l.n' ivy., ti..-M�..-.-.n .-i�`.•.rv��'>'•i'Y('Y�!'�"�.'Y ii•j�'_''1�t{ "'''f`y�S��'\.,,, ..L.
,*INV>, TOWN OF BARNSTABLE Permit No. 35839
BUILDING DEPARTMENT
I """ } TOWN OFFICE BUILDING Cash
N/A
�'�t°r►rr� HYANNIS.MASS.02601 Bond
ADDITION
CERTIFICATE OF USE AND OCCUPANCY
Issued to RICHARD SCHAEFER
Address Lot #36 501 Cotuit Bay Drive, Cotuit
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.
October 27 93
......I..................... 19................. ............... .........................
Building Inspector
o�+wt>, TOWN OF BARNSTABLE
� Permit No. .
35839
BUILDING DEPARTMENT
I Cash
TOWN OFFICE BUILDING
•M9
.9 ,asa. N/A
HYANNIS,MASS.02601 Bond ................
ADDITION
CERTIFICATE OF USE AND OCCUPANCY
Issued to RICHARD SCHAEFER
Address Lot #36 501 Cotuit Bay Drive, Cotuit
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.
October 27 J 93
19................. ..........................
Building Inspector
��lllv�mua��"�
Assessor's office(tst Floor):
n
Assessor's map and lot number -� �P� SS /Q� J TN[
Conservation
�+ SEPTIC SYSTEM MUST S T�
'�� ��\�� ��- (o Y11W1 �1'3 �,
Board of Health(3rd floor): INSTALLED IN COMPLIANCE { s�srant t
Sewage Permit number 3 3 f Q Q`� �ITH TITLE 5 ru•
Engineering Department(3rd floor): ;� I a _ ENVIROM 9ENTAL CODE AME vo�o.639.
House number ��1 TOWN REGULATIONS
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
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO Add h Oki
TYPE OF CONSTRUCTION
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location J C O v i Ck 0-r
Proposed Use _6q-m <1// [10ni
Zoning District 14:2 Fire District
Name of Owner * U qk X-14,01,e ' Address 66/ CO-�UV- 0,2u
r (off ��35
Name of Builder I ZA0 l� Address
_ S�
Name of Architect )21r r IR!2 qj tj Address �� SQIJ'�l �� S+ �, s
Number of`Rooms Foundation (-F to17/*
� Sin ' �- pg/-- �
Exterior.W�v� Coq �' r� Roofing
Floors 3�C� G t� VN Interior
Heating (3 g S e ®a Plumbing
Fireplace 'G. s Approximate Cost y ooj
5
Area
Diagram of Lot and Building with Dimensions Fee
�Q
t
I
f
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re rd•ng tr he;abo construction.
Name
/0r
Construct' n Supervisor's License
SCHAEFER, RICHARD.
No 35839 permit For BUILD ADDITION
Single Family Dwelling
Location Lot #36 , 501 Cotuit Bay Drive
Cotuit
' Owner'
Richard Schaeffer
Type of Construction Frame
Plot Lot
Permit Gran d May 6 , Lry19
G 9 3
.Date aril spection
Date Completed 19
Aid yj'19
to'; r; 1 .
`r ` ✓t�` t, ,f'_1 �r DEPARTMENT OF PUBUC SAFETY
s r 1010 COMMONWEALTH AVE.
Nat $Y i COMMONWEALTH ` t
OF I BOSTON,MAS8.02215 e 4r NCLOSE CHECK OR MO E Rq
4X_N 'LMASSACHUSETTS {:
y� t� +k3�7rt s +r Ism v ' � LICENSE x FORREQUI'RgDFE '
r f r, , ,, ,M CON.S.TR� SUPERVISOR + I$,`
x�c11 �� r {{_
EXPIRATION DATE + MADE PA1fABrT,l!LTQ
I fC I, �hwL to }e ,,3 ! !i�+ e';ti ri T;:Ar
" O6fO1-1993 ',y(�' � a' EFFECTIVE DATE L114301 I� l� ONIMISS[O�E�9 �UBl.IC$
f ay t tI {isr .' ,RESTRICTIONS, ' 0 6/3 0/19 91 0 y w� {,A .,
i;l��"� F•`( + f NONE:),, s: y. (DO.NOT SEND CA 4
t`iIIMirr } ; m TRUE'T DAVIS'
64 HAYWARO-�'ST'
,.. —38-882
70; MILfORb MA 01757 ' c
1 -..�
r
p°rtlii� ��Y t y TO(BLASTWO OM1 ONLY) FEE: { C I VV CIA
,(., ?100.00
I it NOT VALID UNTIL SIGNED BY LIC SEE ANO OFFICIALLY r t h 2 r , ,L"<,�'X},
I�PrlVl Pr Mrtf`�k. } S v .t. HEIGHT: ' STAMPED GR fM�ji lUAE• F HE COMMISSIONER t1Y t X' (�f;5 'o 7TeFd"
AA
DOB:
L5/195 �
gA�HIIENS,.61 T . g TR C� . / > �
SIGN NAME IN FULL ABOVE SIL ATUsL ;F!
THIS DOCUMENT MUST-FE 1 SIGNATURE OF I.ICENS I -._r
••CARRIED ON THE PERSON''IF D t�'�'y
I; '4 J i 7 j..,ry{N I +.,THE HOLDER WHEN ENGA9
y AK(Ht,THUMB PRINT AD 'IN -THIS lOCCUPATNN rift ,�1 uY t&r' y i sib
},r�4U(�t a�I"J�ttr' `•S r ,Y+ ram, ��t' �7�.A+.�/r�L..�/� \ •' ..:i I� .Film:d �;; , ��•�.
II,.a�+,17+•�4F y t429 � :/ w•.... 1 t s�Gt �'
�/
Ilrlr'rrX
HOME IMPROVEMENT CONTRACTOR
Registration 101426
l
-- �: Type - INDIVIDUAL c
°`• '� Expiration 06/2 6/94
la�nY.r irue 1. Davis t . :
64 Howard St.
Ia ����; 4 ADMINISTRATOR Milford MA 01751
,�i'17•AW�'d� r �• ` ... .i1' ` f �Ssr'L '�1 .:{.
t�l fir,;.�.I�.�. 'i�• � � •'T' ." J
W
+{��t� Fr W�Df
T,
�,h� f• D � �s 1
ip'sty , - >• ',: r �,��• , I �:
St�Y�ivS!
I,;t tyyi r c
W�i�n�aT, ,• ._t J.T r t4' :i.i.�ti.. ,.�; i
y
a,}k!p
RV,
K. sir
F
�K �+ 1 • r 7 R {t�li.
� '. �,�„ :��.,.. - � �'r%.rE<s, -.:,.� ,�Q�,�-- /•%% fa-A' U;��c_._ ---fin/�'I/,� ..1�����. -�-- -��,�. �_ , �,
Assessor's map and lot number ..................... ...............
Sewage -Permit number m �� `1''....
t. . .. ................ d w
Z BAUSTLELE, i
House number ........ .............................................................. ".�; ro Mb a
?Lr C,oj� 39
D YPa`MA-1
TOWN OF BA.RNSTABLE �.
BUILDING INSPECTOR
4,
APPLICATION FOR PERMIT TO .......... .........�.. ...... ............. ........ ... ..... .\.............................:..........
TYPE OF CONSTRUCTION ......... �Gv Q v��
................................
.............. .... � ..............
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
location .....�' .�....!" ... ................'... .6'H.! . :. :.. fib:.. ........... ...... .......... ...................................
�. y
Proposed Use ..............,......., �.R.f a6„?'.........� '�. k..U�G..I......� ..... �?....! ..............................................................
Zoning District .......le, ......................................................Fire Districts "' � �
Name of Owner 9 Address ...... ��v � ....... .......................
Name of Builder � .��`'..�•. :....F�...M*Y . ... Z� :.Address ... 'f ��b' R '. ...... 1. . ........................
Name of Architect �$_"z `��� '£ ....Address +�' M ��............................................
................................:. h:............ .....................
Number of Rooms ...i ......................,....................................Foundation ......ice'. k11 ........................................................
R
Exterior F4�i.2.19r��` ...`.G'f Dl�F°'r„ .......4'.�:�� i „ � ................................................
:....... ........ ..............................................Roofing .....
A.
t
Floors ..... r ` � ... ` }.. .....t k :�......�'.......
..........:...............:..............................Interior ................... ...................
Heating . ....."Itl ......°� �' g .. ..r' ......... �;h ................................
............. ....................................Plumbin ...........
Fireplace i .......Approximate Cost 0o 0
.............................................................. ..........................�....../....................
Definitive Plan Approved by Planning Board ---------------------- %
9 ---- . Area ,.....,. �........ ........
Diagram of Lot and Building with Dimensions Fee L�
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS.REQUIRED FOR NEW DWELLINGS
C c
1--hereby agree to conform to all the Rules and Regulations of the'Town of Barnstable-regarding the4above
construction. qq i
Name ... .......... .........�� 'r ............................
6s
Construction Supervisor's License....................................
ROBERT F. HAYES, NC. A=55-z2
No 25253 Permit for ....1 z Story
Single Family Dwelling
.......................................................... ................
Location . a.01...Cat.uit...Hay....Driue........
Cotuit
Robert F. Hayes, Inc,
Owner .................................... .................
Type of Construction Frame
................................................................................ P
Plot ............................ Lot ..............................
Permit Granted .June 2 7 ...................19 83
Date of Inspection......................................19
Date Completed ......................................19
,/ �k3
Assessor's map and lot number ...�..�......... THE
6'& ®S - /,L • 73 roe
Se Permit number ...g .'310. ,d'.:.................... OW ®03 lV1N31
3 � 9 31111 H11 EAHBSTAnLE, i
House number .......................:............................................... 33NVndiN®3._NI Q \e�
_. S 15nn`USAS
TOWN OF ,BARNSTABLE
BUILDING 'I.N'S,P EC-T-OAR --=•....
APPLICATION FOR PERMIT TO r Y
/.......... �f�.........?:........�/—..... ...............0..... . .....
TYPE OF CONSTRUCTION ........ �. .'V... .0 �.�v . .7- t .........................................................
4
I
...........................� ...........I9
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .....0 07..1.;. .....�-- q l.. .Y.l..l�. .:............. �O..T�I ..T.......... ��..................................................
.../.........
Proposed Use S'.�.t� � ..........! �?./??.L..! ...... .... '2
�.r o .................................
ZoningDistrict .....................O...... ...:. ......................................................Fire ................................................
Name of Owner ......Address ...... /17.ITS'/......� (.� !.✓...2....... ..�. .......................
b. .
Name of Builder .1.1,4. .L�i�. �.. c..T! �47 ...I� .Address ....1���� `�.� //
Name of Architect C�G 5.....�.!.....!✓ n� e. e 2hT ey v/�I e:..... ./9..............Address ....................................... .....
Number of Rooms ... .............:.........:..............................Foundciti'on C .�YJG.r e."�
f / /�
Exlerior ..��O�U.......'5111.* pl.e.....................................Roofing ......1../.. h..Qll...�...................................
Floors .O �......... .......✓C .......................Interior ...... ....URIO'rdl......top'51f�
...
Heating ....P.�.........�^�!�.t ........................................Plumbing ....... ... . .. ......................................................
Fireplace ... .r/..C.! ...........................................................Approximate Cost .... 0p.Q...........................................
Definitive Plan Approved by Planning Board -----------______-----------19 _ Area /l�L .... ...l
Diagram of Lot and Building with Dimensions Fee ......... ...../ '
........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
a
P
1
, J
} 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 ..1..1.p .7 .....F......Wvfs............................
Construction Supervisor's Licem, .. . ................
ROBERT F. HAYES, INC.
1�2- Story
No ....25253.............. Permit for ....................................
Single Familx
Dwelling..............
Location
501 Cotuit Bay Drive
................................................................
Cotuit.
...............................................................................
Owner ....RQh(�.K:t...F......lkky.e.�A.... .......
Type of Construction .......Fxame......................
................................................................................
Plot ............................ Lot ............ ...................
,
Permit Granted ...June..........................19 83
Date of Inspection
.. ................................19
Date Completed 7&. .......19
d
;TOWN OF BARNSTABLE Permit No ____25253_,
{ Building Inspector t Cash ---------t
...A . . Z�
,b,°. Y
°"'1b OCCUPANCY PERMIT Bond
Issued to Robert: F. Hayprg� 'iI C» Address
501 CotuitA Bay Drive, 'Cotuit _
Wiring Inspe r f � � Inspection date 1
Plumbing Inspector: ,�t.�,/� �' Inspection date
Gas Inspector Inspection date
XEngineering Department � lG�irC ? t/Yll�L Inspection date
!// is
Board of Health - -�* ,��441 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.
................................................. 19......_:. ................................... ........ry..........:..................................................
BvL i �inl Inspector
FROM
TOWN OF BARNSTABLE:
Mr. Francis Laht�ine 13UILDING DEPARTMENT ' .
e'.•�M N P p4A.Y M,1Ri 4Y r*46�7 MAIN STREET HYANNIS,'MA 026Town �wf.G�il r O i Awl-T'J 3I$•�k Y 6+11
• L.;c,.aaww:l¢,SteKwyw�'c•r'�'NYSK.�m . .
Phone: 775-1120
s J - _ i •
y
SUBJECT:
FOLDHERE
DATE ..
F' 23 1984 'MESS-AGE
kw.
M it•'+ 1jn t.�yr M�ii4'y•!'QI•
Work has been cc1etec1' tSt2i. ,. - �,Tog
}';�y� �, .,
Please Ittelease Bond. «=..........
s rv—,a,s.94"►h R'`:i•t 9.41#T 4r,twpt list
.
r SIG ED
DATE
REPLY
•~ SIGNED
Ne7•RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINKCOPY
�.
PRINTED IN U.S.A.
SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.
`%W 6 LCG FAMILY B C- 0 2 3 4a ( s
No GARBAGE
c) F%.0W :. IIv X 3 = 33o G•RQ '1 '11 . .
SEPTIC TP�K = 330x15D%
USE- loon GAL. 5513
ol �5E lvo0 GAL. %36 I
5Po5AL PlT ` .
I5►pr-WALL AV—S -
i 150 S.F, X 25 r 375 G.l'4
BOTTOM AREA= . �O 5•F, ,
-To-TA" G.P. D.
-TOTAL DA I L.Y FL-(>W - 330 G.PO. Pf.
cr
.• �,
1
PE2GOLATION RATE 1''IN ?—&hJ Ov-LE55, N. 94.5 �•:
Nqo"L i .
Pup. t "L �.
') tN Of.Mq 43•f a.(. qo.I
�,'A 0 ass ��P� ssgc 95. 44 t►1 �qa Taak i
ALAIV y� q�.p
c, RICHARD TiW.
70fJ v. Ae A` PIT 9G•o S•OO
BAXTER v, N . 25100 ($pg•Z 0 4l..v 5
Na 24048
`��sTQ 4r� F Na 94.3 9�.4 q�,� 4G•G ..
4�o SUR'�`y� Alt ,
rN' '
W0LF d/$/83 ��• q�o '�;
i�T�
LW (00a INS•
SJPISO�I. BuX INS. �a6PTIG 8 1
2 I aoo INY, 44'L TANK � ,,
Ga>.. q4
PIT INV.
WITQ
�1ntvT WASKCD
6TvN6' ;
t GE2TIFIGC Pt.oT Pi-A-W
Izl¢ PRU F IL� LoLA'TICN � -u 17
NO. SCALE I SCALE �'I_ Go� .. V ATE S -4L-83
�o WArWz. P>r ry REF EVEN Cos
CERTIr-Y THAT THE P20P 5"ow, tj
NE.REON GOM?U,?6 WITH IHE LOT
AWP S6;7teAGK fL6QUlR.fcMEN'f� F 'fµE I r~
'TOWN or- i3 AR F1,:,rAf3IA ANv I ,:- ►' CovR'� PI.A 1J 321 Cam-
LOCATED -WIT
1J µ6 G ap P AIN
DATE -4-$3 gAXTEiZ.a I YE INC
REG I Sz>✓QEr D lj,A 1 O.5 u PLY 6` 6r-6 I
Tul�j PLQ►�I lfi IJ�T E3tn5E•D old ANJ ®5TE2YILLE
T
IN5-rR.�MEN�' Sv2YEY �zNE oce^SETS Suou� �h��5 • ,
PC PC' �&�a�:'Tc:.c'-/l�I11( Ln't L 111r � APPLICANT.
N N '
- - ,lao.� - s5�c)
<fo- 'TZ k7 Q A.,-
1,A OF [4449C ,
q� WILLIAM
C. C-aZTIFIED 13LC) PL.aw
NYE
,p Nu. 19334 O
LOGATID 4 C�GTt-,\ 1 , �AA
/Vp sut:V� S CAL -
rr G6RTIF THAT TI-ME-: �u�Q 5uotiu►J Pt-A1J R�FE�E►.IGE
1
Wsj?G0 i W ITN THE SIUE.LI► &
AND SETBACK �EQUIREN«�TS OF TNT
-ro W►J of (�p�1.�i Y7 C� A�.1 D I S L . C • 1 �..�}N 3Z 1
LvG ATE W t TI-A l . L00D FLA I KJ i
GG BA)(TC-.;Z
DATEt �o'Z1 ' v3 REGISIC-1ZLD l�I1p SUevi=YO1zS
THIS PLAN IS �..IOT BASE'S U W OSTEiZ�/ILt-G o �rtl�SS�
ll.ly-MOAAF-WT 'SvizVc`f TtaC UF�S�TS �illoevt.�
Kk,T' gc Uscp To Da rceMlwc Lc)x, t_t, `5
�. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,{
Map 4-� Parcel Permit#
Health Division Date Issued
Conservation Division r —�j Fee -
o val
Tax Collector y
Treasureror
• �
Planning Dept.
Date Definitive Plan Approved by Planning Board '
Historic-OKH Preservation/Hyannis
Project Street Address C-A C OTU fr 6"
Village C Do11—L7 (T
Owner �u% }
Address
Telephone
Permit Request
I ,
Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new
Estimated Project Cost 7 D ad.Go Zoning District Flood Plain ; Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ ulti-Family(#un
its)
Age of Existing Structure istoric House: ❑Yes 0 Id King's Highway: ❑Yes ❑No
Basement Type: ❑Full• ❑Crawl ❑Walko t
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
Detached garage:❑existing ❑new size Pool:❑existing O 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 D�� t �'J Telephone Number - f O
Address ��J�� _ P License# Ce (7LP
Home Improvement Contractor#
Worker's Compensation
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0
SIGNATURE DATE �.
FOR OFFICIAL-USE ONLY
PERMIT NO. �T
DATE ISSUED ,
MAP/PARCEL NO. r
• -ems;. _ s
ADDRESS --„- VILLAGE
OWNER
It
DATE OF INSPECTION
FOUNDATION
FRAME _
INSULATION e '
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
v
DATE CLOSED OUT
ASSOCIATION PLAN NO.
1
The Town of Barnstable
M�a " g Department of Health Safety and Environmental Services
Building Division
367 Main Street,.Hyannis MA 02601
Ralph Crossen
Office: 508-862-403 8
Fax: 508-790-6230 Buiiding'Coinmissioner
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: ,� �) � ��a Estimated Cost bOo,00
Address of Work: 50 1 C a—f U,I 7 13-12(Y D A9• <-a rU,, % A
Owner's Name: MAR ),/:_�y% 5C #A ,6 / f 9
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
C]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 owner.
'9—'��— <v"'4d --( �/,G
Date Contracto ame Registration No.
OR
Date Owner's Name
q:fomu:Affidav
The Commonwealth of Massachusetts
0Department of Industrial Accidents
'�- OII/ceml/of+estl9atlons
600 Washington Street
Boston,Mass 02111
`— Workers' Compensation Insurance Affidavit
location•
,5-7 62l f9-4 PprrGf� . .
city O f)�V 4%JI (.(-,e- f 4A-• 0;) phone#
❑ I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working in any capacity
[ am an employer providing workers' compensation for my employees working on this job.
c ine. _.: ::. ..
address:
e
I =prop;rnietor l contractor,or homeowner(circle one)and have hired the contractors listed below who have
the ensation polices:
I� �/ . t Cx` .:; '<`............ .i f { I�-..: Cif l0
companyname: �.. Q .. �.:. a: ;..<,::::,::..:.:::::::: .:...:. ......._.......a .... .......
AT
address,
:..:.......:.:::
city: .. . ...... ... ...
insurance co
n ol�ex
address:
:..:.:::.... ........ ........ . ...
insurance co " !?
0 1 v
t n IMBUE; :g'�heet�f iiecessa ,
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 S1.500.00 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 certi under the pains and penait�atfpe rjury that the information provided above is true and correct
- d-b
Signature
Print name
C T 'J Phone# J I
official use only do not write in this area to be completed by city or town official
city ortown permit/license# nBuilding Department
r 0Licensing Board
'{ 0 check if immediate response is required OSelectmen's Office
OHealth Department
contact person: phone#; nOther .•
(revised 3/95 PJA)
Information and Instructions 1
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.
Applicants
_ Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names,address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the•affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested,
not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required
to obtain a workers' compensation policy,please call the Department at the number listed below.
`. I N� G._
City or Towns
I .
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 besitate to give us a call.
The Department's address�teiephRne
d fax number: WY �, `
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-77.49
phone #: (617) 7274900 ext. 406, 409 or 375
J ,
HONE-IMPROVEMENT CONTRACTOk
xitegistration
#z K Ezp rati6n .05%15/00 t �;
'UXNDALL ROOFING Oyua
. ROBERT F'�TYNDAII i A
RIAR'PATCH RD ^ter
wus[Rarga MfOSTFRVI11F HA 026
.�t5cwtiw"9C.ti'fit�.+_Y-'�� �`,�.!y.wic�s+ai�...i i:► -1^,w. �_4.., e 1'
r
• 1.
SENDER: Complete items 1 and 2 when additional services are desired, and complete items
3 and 4:�
y Put your address in the"RETURN TO" Space on the reverse side. Failure to do this will prevent this card
'from being returned to you.The return recei t fee will rovide ou the name of the erson delivered to and
the date of deliver . For additiona ees t e o lowing services are avails le. onsu t postmaster or tees
ii1. Show t10 whom delivered service(s)
and addressee's address. 2. ❑ Restricted Delivery
(Extra charge) (Extra charge)
3. Article Addressed.to: 4. Article Number
P 650 798 544
Mr. Richard W. Schaefer Type of Service:
145 Woodhaven Road r❑ egistered— El Insured
Glastonbury, CT 06033 VJ C 41fied ❑ COD
press Mail ❑ Return Receipt
f; press for Merchandise
Always ain net e�of addressee
or ag DATE i VERED.
' S'gn re A essee 8. res e's Add s i(ONLY if
X ��� eq a pnd fee pc��
6. ign ure — Agent `��/e
X �
7. Date of Delivery +�f` $
PS Form 381 1, Apr. 1989 *U.S.G.RO.1989-238-815 DOMESTIC RETURN RECEIPT
r
UNITED STATES POSTAL SERWIRE^O r
OFFICIAL BUSINESS ��J C +►,_ -
SENDER INSTRUCTIONS
Print your name,address and ZIP Code
In the space below. I•L r
• Complete items 1,2,3,and 4 on the
reverse. ^-.• .. -U.S AIL
• Attach to front of article if sc
permits, otherwise affix to back of
article. PENALTY FOR PRIVATE
• Endorse article "Return Receipt USE, $300.
Requested"adjacent to number.
RETURN Print Sender's name, address, and ZIP Code in the space below. ~
TO
Mr. Alfred E. Martin, Building Inspector
TOWN OF BARNSTABLE
367 Main Street
Hyannis, MA 02601
tiii:iii:ii.i:i
R- 655k 798 544
Certffl 'Mail Receipt
No Insurance Coverage Provided
Do not use for International Mail
��*•VC (See Rev e)
ws
Sent to
Mr. Richard W. Schaefer
Street&No.
145 Woodhaven Road
P.O.,State&ZIP Code
Glastonbury, CT 06033
Postage
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
O Return Receipt Showing
rn to Whom&Date Delivered
14
Return Receipt Showing to Whom,
c Date,&Address of Delivery
TOTAL Postage
p &Fees $
C0 Postmark or Date
CO)
E
ti
N
1L
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
1.If you want this receipt postmarked,stick the gummed stub to the right of the return address
leaving the receipt attached and present the article at a post office service window or hand it to
your rural carder(no extra charge). ai
m
2.If you do not want this receipt postmarked,stick the gummed stub to the right of the return a')
address of the article,date,detach and retain the receipt,and mail the article. I
y o
3.If you want a return receipt,write the certified mail number and your name and address on a % rn
return receipt card,Form 3811,and attach it to the front of the article by means of the gummed
ends if space permits.Otherwise,affix to the back of article.Endorse front of article RETURN c
RECEIPT REQUESTED adjacent to the number. 1 ��
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, p
endorse RESTRICTED DELIVERY on the front of the article. Go
th
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If E
return receipt is requested,check the applicable blocks in item 1 of Form 3811. rQ
CO
6.Save this receipt and present it if you make inquiry. *u.S.c.P.o.1990-270-153 a
r
* A=055-052 —
,A, . : The Town of Barnstable
NAGIL Inspection Department
'�a��+�• 367 Main Street, Hyannis, MA 02601
508-790-6227 Joseph D.DaLuz
Building Commissioner
October 28, 1991
Mr. Richard W. Schaefer
145 Woodhaven Road
Glastonbury, CT 06033
RE: A=055-052
501 Cotuit Bay Drive, Cotuit
Dear Mr. Schaefer:
This office is in receipt of a written complaint alleging that
your property located at 501 Cotuit Bay Drive, Cotuit, is being used
for automobile repairs.
Please contact this office immediately re the above matter.
Very truly yours,
Alfred E. Martin
Building Inspector
AEM/gr
cc: Town Manager
Certified mail: P 650 798 544 R.R.R.
1 J[R055 052. )
LOCJ0501 COTUIT RAY DRIVE CTYJ01 TOSJ 200 CT K-EYJ 31726
----MAILING ADDRESS------- PCAJ101.1 PCSJ00 YRJ00 PARENT] 0'
SCHAEFER, RICHARD 0 9 MAP] AREAJ09AL' JVJ274492 MTGJ0000
SCHAEFER, MARLENE SP1] SP2J SP3]
145 OOODHAVEN RD UTIJ UT2] 1 .06 SQ FTJ 2296
GLASTONBURY CT 06033 AYLJI984 EYLJ1984, 'OLSJ CGNSTJ
0000 LAND 105800 IMF 158400 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 264200 REA CLASSIFIED ,
BLAND 1 105,800 ASD LND 105800 ASD IMP 158400 ASD OTH
#BLDG(S)-CARD-1 1 158,400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#PL COTUIT BAY DR COTUIT TAX EXEMPT
#DL LOT 36 LC3216-C RESIDENT'L 264200 264200 264200
#RR 0359 0235 OPEN SPACE
* UN-REG 4345/103- COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALEJ06186 PRICEJr 220000 ORBJC106857 AFDJ I
LAST ACTIVITYJ07114187 PCRJY,
r
t
i
ROSS 052. F E R M I T fFMTJ ACTION[RJ CARD[000J KEY 31726
PERMIT-NO NO YR TYRE VALUE CM-BY NO YR %CMP NEW/DEMO COMMENT
fS25253J Ca6J C33J C J J J f J f'051 f85J [1001 [NEW J fCO 1112 STJ
[ 1 f J f I C J J J f J f I J C I J f l
C J t J £ J t J J J £ J t J [ J t J f J [ J
t 1 f J f J £ J J J f J f J f J f J C J f J
f J t J f J t J J J f J C J C J C 3 C J f J
C JC JC .JC J .1 Jf J [ .1 [ JC J [ J C J
t J f J f J £ J J J C J C J C J f J £ J C J
C JC JI Jf JJ JL Jf Jf I I J f J
C J C J C J C J 1 J t 1 C J C J t J C J C J
C J f J f J C J J J f J f 1 C J C J f J f J
f Jf J [ Jt JJ Jf Jt Jt J [ Jf 1 C . J
[ J C J C J C J J J f J C J f J C J C J f J
C 1 f J I J f J J J f J C I I J f J [ J
I J C J f J f J J J f J C J C J [ J C J f J
[ J f J C J C J J J t J C J [ J f J f J f J
f J [ J C J f J .I J [ J C J C J C J f J f J
C J C J [ J f J J J f J C J f J C J f J f J
f J [ 1 f J C J J J [ J C J f J f J f J C
C i
1
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
.d COMPLAINT/INQUIRY REPORT
Date 16 Rec'd Bv Assessor's No.
CoTu tT Kovzt S Acsoc
Last Name First Name
;�
ORIGINATOR Street cdt �� �► 7 a.—j J V .y f�
Town n,o-ru .r State Zip 0
Telephone: Home Work
Description:
ZCOMPLAINT 2 d N l N C, V l 0 !„ A'r 101)
` S R 4 OL c OQ
INQUIRY
r
Requestor's Signature
� -71 - 00 0
COMPLAINT Street Address 5�U ty��- �,_, 1 �/' y�
LOCATION
A= O 5_5 ,o S2 �
OFFICE USE ONLY
INSPECTOR'S Date Inspector
ACTION/.
COMMENTS
FOLLOW-UP
- U
ACTION iac4
f
/DDITIONAL
INFO. ATTACHED
COPY DISTRIBUTION: WHITE - DEPARTMENT 'FILE YELLOW - INSPECTOR
PINK - INSPECTOR (RETURN TO OFFICE MGR. )
MISC1
� ,�
u
�: " - .
�'—f�'
„�L` . �` `:y L
h ��z �" '+
1�v`i tY�u
� f
2 4
iV -� ' - o
u ?
• � .. F� �>
��
Ci-iw C�c.c,t.� cum
a
I '
i