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SENDER: COIWP�ETE THIS SECTION nia OCU I 1UN ON DELIVERY
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(Transfer from service labE 7002 2410 0003 8425" 3782
PS Form 3811,August 2001,1 ' Domestic Return Receipt i ; M I 102595-02-M-1540
UNITED STATE�S.',R ��?. wcgr-�.;r.` ' � -:; {J �Y ."w"° w'"'�^° ErFsi�as
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TOWN OF �01`�I5 OIL
RNSTABLE
]BUILDING
200 MAIN ST.
HYANNIS,MA 02601
RM 70
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U.S. Postal ServiceTM
CERTIFIED MAIL. RECEIPT
(Domestic Mail Only;No Insurance Coverage Provided)
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Streor PO:; : . • 1
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PS Form 3800,June 2002 See Reverse foj Instructions
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oFt�E Town of Barnstable
do _
Regulatory'Services
* an M t g AS& Thomas F. Geiler,Director
'0rfo�,,►�" Building Division
Thomas Perry,Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Notice of Zoning Ordinances and Building Code Violation(s) and Order to
Cease, Desist and Abate:
John R. Gannon,and all persons having notice of this order. As owner/occupant of the premises/structure
located at-70=Stoney Pond=C-i ccle,°Marstons=Mills=Map-083=Parce1.021,,
you are hereby notified that you.are in violation of the.Town of Barnstable Zoning Ordinances and the
Massachusetts State Building Code and are ORDERED this date,January 29,2008 to:
1. CEASE AND DESIST IMMEDIATELY,all functions connected with this.violation on or at the above
mentioned premises.
SUMMARY OF VIOLATION:
Violation of Town of Barnstable Zoning Ordinance Chapter 240-7 Section A
Chapter 240-14 Section E_
Chapter 240-17 Section L
Violation of Massachusetts State Building Code 780 CMR 110.1 and 5110.1,Failure to obtain permit.
2. COMMENCE within seven(7)days,action to abate this violation.
SUMMARY OF ACTION TO ABATE:
1.) Submit a stamped,certified survey of this property to the Building Department showing the
accurate location of all structures per Chapter 240-123 section D of the Town of Barnstable .
Zoning Ordinance.
2.) Upon compliance with zoning,obtain appropriate building permits.....
And, if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by
filing an appeal with the Town_Clerk of Barnstable,a Notice of Appeal(specifying the ground thereof)within
thirty(30)days of the receipt of this order(in accordance with Chapter.40A.Section 15 of the Massachusetts
General Laws).
If,at the expiration of the time allowed,action to abate this violation has not commenced,further action as the
law requires will.be taken.
By order,
Robert,McKechnie
Local Inspector
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,*THE 1p Town of Barnstable
Regulatory Services
9anxxsznaIE� Thomas F. Geiler,Director
16
;e. Building Division
Thomas Perry,Building Commissioner
.200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Notice of Zoning Ordinances and Building Code. Violation(s) and Order to
Cease, Desist and Abate:
John R.Gannon,and all persons having notice of this order. As owner/occupant of the premises/structure
located at 70 Stoney Pond Circle,Marstons Mills Map 083 Parcel 021,
you are hereby notified that you are in violation of the Town of Barnstable Zoning Ordinances and the
Massachusetts State Building Code and are ORDERED this date,January 29,2008 to:.
1. CEASE AND DESIST IMMEDIATELY,all functions connected with this violation on or atthe above
mentioned premises.
SUMMARY OF VIOLATION:
Violation of Town of Barnstable Zoning-Ordinance Chapter 240-7 Section A
Chapter 240-14 Section E
Chapter 240-17 Section L
Violation of Massachusetts State Building Code 780 CMR 110.1 and 5110.1,Failure to obtain permit.
2. COMMENCE within seven(7)days,action to abate this violation.
SUMMARY OF-ACTION TO ABATE:
1.) Submit a stamped,certified survey of this property to the Building Department showing the
accurate location of all structures per Chapter 240-123 section D of the Town of Barnstable
Zoning Ordinance.
2.) Upon compliance with zoning,obtain appropriate building permits.
And, if aggrieved by this notice and order,to show cau"se as to.why you should not be required to do so,by
filing.an appeal with the Town Clerk of Barnstable,a Notice of Appeal(specifying the.ground thereof)within .
thirty(30)days of the receipt of this order(in accordance with Chapter 40A Section 15 of the Massachusetts
General Laws).
If,at the expiration of the time allowed,action to abate this violation has not commenced,further action as the
law requires will be taken.
By order,
Robert McKechnie
Local Inspector .
Parcel Detail Page 1 of 3
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Parcel Lookup
Parcellnfo
Parcel ID 083-021 I Developer LOT 9
Location 170 STONEY POND CIRCLE I Pri Frontage
Sec Road l Sec
Frontage
Village IMARSTONS MILLS ( Fire District C-O-MM
Sewer Acct I Road Index 12119
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Interactive �^`~
Map
Owner Info
Owner IGANNON, JOHN R I Co-owner
Streets 61 GRISTMILL PATH I Street2
City MARSTONS MILLS I State MA zip 02648 Country FLS
—
Land Info
Acres 0.83 use Single Fam MDL-01 ( Zoning RF Nghbd 0107
Topography I Road 17
Utilities I Location
Construction Info
Building 1 of 1
Year 1994 I Roof Gable/Hip I Wood Shingle
Built Struct Wall all
Effect 2547 I Roof Asph/F GIs/ I AC None l
Area cover Type
Bed 1
Style Colonial I wall Plastered I Rooms 3 Bedrooms
Model Residential I Floor Hardwood I Rooms Bath3 Full In
,at Total
Grade Custom Minus I Type I Hot Water I Rooms
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nttp:Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=5008 1/9/2008
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Parcel Detail Page 2 of 3
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Stories 2 Stories I Fuel Gas I Found-3tion Poured Conc.
Permit History
Issue Date Purpose Permit# Amount Insp Date Commei
9/1/1994 B37018 $10,000 1/15/1996 12:00:00 AM MM GAF
10/1/1993 B36234 $120,000 1/15/1996 12:00:00 AM MM 2 S1
- Visit History
Date Who Purpose
3/6/2006 12:00:00 AM Paul Talbot Meas/Est
Sales History
Line Sale Date Owner Book/Page Sale P
1 2/25/2004 GANNON, JOHN R 18250/242
2 2/23/2004 GANNON, RICHARD P & 18242/099
3 12/27/2001 GANNON, GREGORY J 14630/102
4 9/15/1995 GANNON, RICHARD P II & 9851/047
5 3/15/1991 GANNON, GREGORY J 7468/156
6 10/15/1990 CAPE COD BANK&TRUST CO 7327/304
Assessment History
Save# Year Building Value XF Value OB Value Land Value Total Parc(
1 2008 $293,300 $2,900 $20,800 $208,800
3 2007 $292,400 $2,900 $20,800 $208,800
4 2006 $228,000 $2,900 $21,300 $229,200
5 2005 $210,600 $2,900 $21,800 $204,700
6 2004 $176,300 $2,900 $22,000 $163,700
7 2003 $168,000 $2,900 $22,500 $117,100
8 2002 $168,000 $2,900 $22,500 $117,100
9 2001 $168,000 $3,000 $22,500 $117,100 ;
10 2000 $136,900 $3,100 $23,200 $74,600
11 1999 $136,900 $3,100 $19,600 $74,600
12 1998 $136,900 $3,100 $19,600 $74,600
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=5008 1/9/2008
Parcel Detail Page 3 of 3
13 1997 $137,000 $0 $0 $64,300
14 1996 $102,700 $0 $0 $64,300
15 1995 $0 $0 $0 $64,300
16 1994 $0 $0 $0 $56,000
17 1993 $0 $0 $0 $56,000
18 1992 $0 $0 $0 $93,300
19 1991 $0 $0 $0 $50,700
20 1990 $0 $0 $0 $50,700
21 1989 $0 $0 $0 $50,700
Photos
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http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=5008 1/9/2008
Building Detail Page 1 of 1
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Building 1 of 1
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Code Description Gross Area Effective Area Living Are
BAS First Floor 1220 1220
BMT Basement Area 944 170
FUS Upper Story 944 868
WDK Wood Deck 344 34
UAT Attic, Unfinished 944 236
PTO Patio 192 19
Extra Features
Code Description Units Unit Price Year Built Value Commen
FPL2 Fireplace 1.00 3,000.00 2002 $2,900
Out Buildings
http://issgl2/intranet/propdata/BuildingDetail.aspx?PID=5008&BID=5202&N=1&NN=1 1/9/2008
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TM[)� TOWN OF BARNSTABLE -
Permit No. ................
BUILDING DEPARTMENT $152..00 (owner)
I """ I TOWN OFFICE BUILDING Cash ................
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HYANNIS.MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to GREGORY J. GAN NON
Address lot #9 70 Stoney Pond Circle, Marstons Mills
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' s
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
November 10 94 4�
Building Inspector ;
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. BARNS I Au...., .`... 1.4 0.I V....
DATE - 19 PERMIT NO.
,1LICANT t"'-'`• ' ADDRESS
(NO.) (STREET) (CONTR'S LI CE':SE1
Build dwe_11-Ling E�7 _;lam :`iii : C:ir.:"li2i:' NUMBER OF
PERMIT TO (_I STORY £ �' DWELLING UNITS
_,✓ (TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
{ t Circle, - T• ' n<^ I l" ZONING
AT (LOCATION) -..-a lot #9 70 Stone R= Pond C.i_cle, L`lc:.:;�tC•.. +., -L _ DISTRICT_
(NO.) (STREET)
BETWEEN t 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 BASEMENT WALLS OR FOUNDATION
p (TYPE)
REMARKS:
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1
AREA OR 1008 ,• �.
VOLUME ESTIMATED COSTS S
(CUBIC/SQUARE FEET)
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OWNER Grebory J. GArmo;t R ...
BUILDING DEPT. In a
ADDRESS 01 Grist i•lili Y iCI'i� !ltir5l"01T.S :L i� t t U�646 BY
THE DEPARTAAE WT OF PUBLIC WORKS. THE ISSVANCE OF THIS PERMIT 00ES NOT RELEASE TH E_'AP PLIC ANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: - ELECTRICAL. PLUMBING AND
1. FO.UNOATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED.SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH). (FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
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HEATING INSPECTION APPROVALS � 1ENGINEERING DEP TMENI
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OTHER / SITE PLAN REVIEW APPROVAL
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WORK SHALL NOT PROCEED UNTIL THE INSPEC. PERMIT N!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS_C+RD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONL OR WRITTEN
CONSTRUCTION. f PERMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION
BUILDING PERMIT NO. 3 (a 3 DATE_ 4,-V /0 . /9 9
ASSESSORS PAIRCEL h0.
CONTINUkION OF ROAD BOND
The. undersigned owner/contractor hereby agree to maintain their road bond in
force until the following work items are completed to the satisfaction of the
Engineering Section of the Department of Public works:
loan and seed shoulders as soon as
weather peraits:
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1 MARSTONS MILLS,MA 016'!8
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TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE �D/�&193
JOB LOCATION lot 9 U*1-2e(_1 490/7d 011-Cle Aldrj491-7 s MI)IS
Number Street Address - Section Of Town
—
"HOMEOWNER""HOMEOWNER" ( n_)goiu
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
City/Town State Zip Code
The current exemption for "homeowners" was extended to include owner-
occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does,-not possess a license, provided that
the owner acts as supervisor.
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family
dwelling, attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such - "homeowner" shall submit
to the Building Official on a form acceptableto the Building Official,
what he/she shall be responsible for all such work performed under the
building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and
regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minimum inspection procedures and
requirements
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127 .0, Construction
Control.
MISC5
HOME OWNER'S EXEMPTION
The code states that: "Any Home Owner performing work for which a building
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if
Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q
Rules
for Licensing Construction Supervisors, Section 2. 15) . This alackeof lations
awareness often results in serious problems, particularly when the Home
Owner hires unlicensed persons. In this case our Board cannot proceed
against the unlicensed person as it would with licensed supervisor. The
Home Owner acting as supervisor, i,s ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner certify that he/she understands the responsibilities of a supervisor.,
On the last page of this issue is a form currently used by several towns.
You may care to amend and adopt such a form/certification for use in your
community.
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FIGURE-6: GROUNDWATER CONTOURS
LEGEND
i ® OBSERVATION WELL
52—'GROUND-WATER CONTOURS
—► DIRECTION OF GROUND-WATER FLOW '. m m
SCALE 1:1320 1 I?inc.
SI-I a ET 3 o F 3
gohn 9 Delaney ,
,Teal Cslale
230 Toule 149
J(arslons lKlls, Jrassachusells 02648
(50"8-0100
i
1 •
CO MM O NWEALTH O F MAS- $ACH USETTS
D rAI,'Jvi1NT OF rNmUSTRIA-LACCIDFNTS
600 WASHI-NIGTON STREET
�y
fames.: Gamooel BOSTON, MASSACHUSETTS 02111
WORKERS' COMPENSATION rNSURANCE AFFIDAVIT
1,
(licensee/permincc)
with a principal place of business/residence at:
(Ciry/Sta(e/Zip)
do hereby certify, under the pains and penalties of per)ury, that:
[ ) I am an employer providing the following workers' compcnsation coverage for my employees working on this
job.
Insurance Company Policy Number
[) I am a sole proprictor and have no one working for me.
[J I am a sole proprictor, general contractor or homcowncr (circle one) and have hired the contractors listed below
who have the following workers' compcnsation insurance politics:
Tame of Contractor Insurance Company/Policy Number
Namc of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
1 am a homeowner performing all the work myself.
VOTE Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dwelling of not more than tbrcc units in wbicb the homcowncr also resides or on the grounds appurtenant thereto arc not generally
considered to be employers undcr the Workers'Compensation Aa(GL C. 152,sect. 1(5)),application by a boracowner for a license
or permit may evidence the IcgaJ status of as employer under the Workers' Compensation Act_
i unoerstano that a copy of ties statement wits be forwarded to the Dcpar::ncnt of lndustriaJ Accidents'Oftiee of Insurance for.eoverate
verification and that failure to sceure tovcragc as required under Section 25A of MGL 152 can lead to the imposition ofStiminal pcnaJtics
consisting of a finc of up to S)500.00 and/or imprisonment of up to one year and civil penalties in the form or:Stop Work Order and a
fine of S100.00 a day against me.
Signed this ay of - ; 19 -3
Licensee/permincc LiccrtsortPc:.:, �.or
'Assessor's office (1st floor): 4,
THE
Assessor's map and lot number ..C i,3...... SEPTIC SYSTEM Rll�U-! �
Board of Health (3rd floor):
Sewage Permit number .... � ..�.
Z BARESTADLE. i
Engineering Department (3rd floor): 0 �� ; .; `k#�L C ; +oa r63}9
House number ...................................... . ......`7....... 't..... TOWN Rfl:GU'LAT10i'� MAI6\
Definitive Plan Approved by Planning Board ______`s--__'a3__._______19
iAPPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ,Construct New House
TYPEOF CONSTRUCTION ....V QQd..F.r.=Q.......................................................................................................
June 13 , 8'8
.............................:..................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location Lot•••9•,•Stone•y••Pond• Circle, Mill
Location 02648
Proposed Use .....5•ing•jp... amily..Dwell•ing...............................................................................................
Zoning District .....RF.......... ..... ... ..............Fire District ...C.-O-MM
..... ........... ......
Name of Owner'.Pl.t.. .. .. u � MA
....... . ............... z . .,.. --__.....
r T} i a —r._. .Bela — -P—�--B Name of Builder—._.................... .. . .. Address t»
Nameof Architect .......................................:..........................Address .......................................................................
Number of Rooms ... ..............................................................Foundation $.� Poured Concrete on Footing•... ••• •
Exleyfor •Wood...ahin.g pe..................................................Roofing .Asphalt.................................................................
Floors ...Oak..&..Carpet...................................................Interior ....�s��...S.hee.troc:k................................................
Heating ...Qas1,s........................................................................Plumbing ..2..............................................................................
Fireplace ...1..............................................................................Approximate Cost .$.J 2�.,.0.Q.0..............................................
/Z)0 S>
Definitive Plan Approved by Planning Board 4-13-87 Area ....f.t.....2.—.S.tory
Diagram f Lot and Building with Dimensions Fee .......
Q..�cS
C9�lr►�p.�
� q
mA
q�
�1
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name y........0..}2.........
• fAl�-l�i-am—�:Brow•r�—
Constructio Su�r's License
GANNON, GREGORY J.
BUILD
5-6244 DWELLING
No ................. Permit for ....................................
70 Stoney Pond Circle
6 Location ............................................f Lot...9.)...
Marstons Mills
...............................................................................
Gregory J. Gannon
Owner ...................................................................
Type of Construction Wood frame
........................................
................................................................................
Plot ............................ Lot ................................
October 13 93
Pei�(ifGranled......... ..............................19
• Date of -inspection"-:?..... . .. .....................19
•
Date -Completed . .......................19
051
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USED 7-a of Y�,�itl/�� .LIST /i!/�S AP>/ /CA/�T"
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TOWN OF BAR14STABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print. f G
DATE < G��
JOB LOCATION -76
Number Street Address
t��
Section Of Town
"HOMEOWNER" ��
�o a 33 )C) Q 3
N Home Phone Work Phone
PRESENT MAILING A191
DDRESS 1pl l�S �- M, N 0 4
r f da.
City/Town State Zip Code
The current exemption .for "homeowners" was extended to include,-owner-
occupied dwellings of six units or less and to allow such homeowners to
engage an individual for hire who does not possess a license, provided that
the owner acts as supervisor.
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended to be, a one to six family
dwelling, attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the' Building Official on a form acceptable to the Building Official,
that he/she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and
regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minim spection procedures and
requirements
HOMEOhTNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
I
KISCS
.r y
y
HOME 0 ER'S EXEMPTION
The code states that:
permit is required shallAny Bome be exempt. from provi work for which
(Section 109. 1. 1 provisions is a building
Home - Licensing of Construction Supervisors) ; section
Owner engages a person(s) for hire to do such work,Owner shall act as supervisor. " ) � Provided that if
k, that such Home
Many Home. Owners who use this exemption are unaware t
the responsibilities of a supervisor (see A that the
for Licensing Construction Supervisorspr ( Appendix Q �' are assuming
awareness often results in e ,- Section 2 15) Rules and Regulations ..
-Owner hires unlicensed en serious
problems, particularly hwhen is atheof
against the unlicensed person as it wous case our Board cannot Aome
Home Owner acting as supervisor is ultimately responsible.supervisor.
• To ensure that the Home e.
The
many communities require, er is fully aware of his/.her responsibilities,
Owner certify that he/she understandss part of thehe _
On the last a application, that thepl.;Home
You may page e this issue is a form currently bused lby several es of a pt wnsor'
y care to amend and .adopt such a form/certification for use
community.
in your
4 , I
I
ONTWEALTH OF MASSACHUSETTS
NIT-N-T OF -, \`DUSTR-L iL ACCIDENTS
SUJU NCE AFFIDAVIT
(licensee/permtncc)
with a principal place of business/residence at: ,u
Al
`W
(Gry/Statc2ip)
do hereby certify, under the pains and penalties of perjury, that:
( J l am an employer providing the following workcrs' compcnsarion coverage for my employees workitg on thii `
job. .
4
Insurance Company Policy Numbcr
[ ) 1 am zsolc proprietor and have no one working for mc.
zm z sole propricror, gcne:,i eontraaor.or omcowncr circle onc) and havc hired the contractors listed bclo\%,
who havc the following workcrs' compcnsarion serzncc politics:
Namc of Contraaor lnsu ante Company/Police Numbcr
t.. r
Namc of Contrzcto! lnsu,ancc Company/Policy Numbcr L..+
N2me of Contractor Insurance Company/Policy Numbcr
Q 1 am a homcov,p.c, performing all the work myself.
NOTE. Please be :.+a c L:;%.•bile borrcowners�.bo cr•ploy persons to do maintenance,construction or repair work on
c'wcllins of no: rsorc t.L;= three units 6c bornco--cr also resides or on Lc grounds appurtenant thereto arc not Fcncr:.11)-
eonsidered to be er_p!eycrs —der the Gror.•ers' Cornpens:uon Act((;L C. 152,see.. 1(5)), application by a boraeowner for a lieeasc
or permit r..:v evidcaec t^e 1eg:J Sur,:$ of as ern--toyer uncer the"Workers'Corzipcnsation Act
1 understand that a copy of tris seatcrrcnt will be forwarded to the Departnerst of Industrial Accidents' Ofisee of Insurance for covcrarc
vcriric:t,on an fa:!crc tc secure co-cr;.�c a< rcouircd er.ccr Sccuor,25A of MGL I52 e:_n lead to the imposition of'minJ pcnJucs
eor.;i:cr.�of: nc of to S 1 500.00 and/or ir-ari onncr.s Of up to one ye.:-: and c, : pcnJucs in the form of a Stop Work Order and
OC
fine of S 100. 'a c:v 4a c.; mc.
S
Signcd this day of , l 9
Liccns /Pcr irtcc Licensor/Pcrmirtor
Assessor's tfffice(1 st Floor): yDC / r-,
Assessor's map and lot number (/(�1,7 0*TMf>O
Conservation(4th Floor): i s _ ��Q�w `•.
Board of Health(3rd floor): - •
Sewage Permit number
DAH13T►Dt L i
Engineering Department(3rd floor): i o +e39.
House number r �o rnr a
Definitive Plan Approved by Planning Board ► 19
APPLICATIONS PROCESSED18:301 9:36 A.M.and 1:00-2:00 P.M.only
TOWN ,' OF BARNSTABLE
t 'BUILDING INSPECTOR
I
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
t ' ) 19 �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location �' 6 �J j
Proposed Use
Zoning District Fire District
Name of Owner A 61` Address-
Namelo
of Builder ir Address
Name of Architect Address
Number of Rooms Foundation C WCQ 7T2
Exterior Roofing
Floors QDNCI� Interior
Heating Plumbing
Fireplace "LJ - Approximate_Cost_;
Area
Diagram of Lot and Building with Dimensions Fee J�D,
ell
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
7
Construction Si ipervisor's License 0z
GANNON, GREG
`I No Permit For Build Garage
Accessory to Dwelling
Location 70 Stoney Pond Circle
Marstons Mills
Owner GrPQ Cannnn
Type of Construction Frame '
Plot Lot
j Permit Granted Sept. 12 , 19 94
Date of Inspection:
Frame 19 1
Insulation 19 xa
Fireplace 19
Date Completed / �Z19
fi
7