HomeMy WebLinkAbout0137 TANBARK ROAD on bar)<-..,
i
Town of Barnstable *Permit kl 77
y� Expires 6 months rom issue dale
�T Regulatory Services Fee .
Thomas F.Geiler,Director
�b 163q .� SS Building Division plFC MA'S► �� �"Perry,CBO,' Building Commissioner
AUG. 5 Z008 200 Main Street,Hyannis,MA 02601
TOWN QP www.town.bamstable.ma.us
Office: 508-862-4038`'4RNS7,48�E Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
r—+
Property Address
❑ Residential 'Value of Work (� OOO Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
Contractor's Name�(' �Ss�C 1 GS 1.V1 G. Telephone Number
Home Improvement Contractor License#(if applicable) y
VWorkman's Compensation Insurance
C�h k one:
L1 1 am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's(Compensation Insurance
Insurance Company Name ASSOC% aAeA
Workman's Comp. Policy# Lk)CC b603 49 4o 12+ OO
Copy of Insurance.Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/door slider .U-Value (maximum.35)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
a
'()�
SIGNATURE:
Q:\W"ILESTORMS\bui]ding permit forms\EXPRESS.doc
Revise020108
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office.of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Businesslorpnizationftdividual): �QC' � f�C 1� C✓�YLG .
Address: Q
City/State/Zip: .-C Phone#: �J.08-_SoD
Are u an employer? Check the-appropriate box:. Type of project(required):
l. am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(fulland/or part-time).* have hired the sub-contractors
❑
listed on.the attached sheet t 7. ❑ Remodeling
2. 1 am a sole proprietor or partner-
These sub-contractors have 8. Demolition
ship and have no employees
working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition
o workers' comp. insurance 5. ❑ We
[N are a corporation and its 10.❑ Electrical repairs or.additions
required.] officers have exercised their
3.ElI am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. C. 152,§1(4),and we have no .12.❑ Roof repairs
insurance required.]t employees. [No workers' 13.2f Other ` 14 Lf N lacew►61b
comp.insurance required.]
. Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: �•
Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
ram an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site
nformatiom
nsurance Company Name: C L 'LA V:��J)IA&'jats 16�,MOCQ Co.
?olicy#or Self-ins.Lic. #:��� 5A. ]�bd 5- Expiration Date: /9 ��7
fob Site Address: City/State2ip:�C�t.[_��.�'1' l A1S Oa(AS,
kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
ailure to.secure-coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine up to$.1,50Q.00 and/or one-year imprisonment, as well as,civil penalties in the form of a STOP WORK ORDER and a.fine
)f up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
nvestigations of the DIA for insurance coyzQF verification.
' aatare:
u er he pains d pen ties of perjury that the information provided above is true and correct.
ii Date:
?hone
Fonly. Do not write in this area,to be completed by city,or town officialTown: Permit/License#
hority(circle one):
Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
rson• Phone#•
Client#: 9742 2BAKERAS
'' RDr CERTIFICATE OF LIABILITY INSURANCE 05/05/08°"""'
PRODUCER 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 AMEND,EXTEND OR
g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
973 lyanough Rd., PO Box 1990
Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Harleysville Worcester Insurance Co.
Baker&Associates,Inc. INSURER B: Associated Employers Insurance Compa
P.O.Box 923 INSURER C:
Centerville, MA 02632-0071 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
S TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO
LTR NSR N LIMITS
A GENERAL LIABILITY CB831748 04/19/08 04/19/09 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED occurrencel $1 OO OOO
CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 000
X PC
Ded:250 PERSONAL&ADV INJURY $1 OOO 000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000
POLICY PRO LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND WCC5002454012008 04/23/08 04/23/09 X WC SUM FR-
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 OO OOO
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $100 000
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Officers are included under the workers compensation policy.
Insurance coverage is limited to the terms,conditions,exclusions,other
limitations and endorsements. Nothing contained in the certificate of
insurance shall be deemed to have altered,waived,or extended the
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Town of Barnstable ` DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1() DAYS WRITTEN
Thomas Perry NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Hyannis, MA 02601 REPRESENTATIVES.
AUTHORIZED R PRESENTATIVE
ACORD 25(2001/O8)1 of 3 #S51922/M51911 LS1 @ ACORD CORPORATION 1988
91te
ar o ui in e ula�fiitons an an ar s
Bo g g
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 118494
Type: Supplement Card
Expiration: 2/1/2009
BAKER CUSTOM ALUM & VINYL I�NC; -
BRETT BUSSIERE
521 SHOOTFLYING HILL RD.
CENTERVILLE, MA 02632 Update Address and return card. Mark reason for change.
Address [I Renewal Employment Lost Card
DPS-CA1 0 50M-07/07-PC8490
Board of Building Regulatio s and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
_ Registration: 118494 One Ashburton Place Rm 1301
Expiration:_ 2/1/2009 Boston,Ma.02108
Type: Supplement Card
BAKER CUSTOM ALUM&VINYL I
NPETT BUSSIERE
521 SHOOTFLYING HILL RD. C �?
�� g.._.......... .......
CENTERVILLE, MA 02632 Administrator Not vali without si nature
d uI liuihli,+t KcRulaliuus and Slaudard�
1 i�c+ne u+ tc +sl+dllun :dull lu+ 111(11%Wul ,It ,„,l%
HOME IMPROVEMENT CONTRACTOR before[ht'rxpiratit+u date. It linwd rclu;u ru
Registration: 1IL3494 Board of Building; Regulations alld 51and.f+d+
Expiration; 2/1/2009 Tr# ;?6302 (hw Ashburton Place Rrn 1301
Type: DBA Boslon, 1Ta.02108
ti
BAKER Cti:,1(XVI ALUM R VINYL INC. t'
MARK BAKER
521 SHOOTF-L YING!-TILL RL)
CENTERVILLE. MA 0263?
Adminisrra+�"+' Not valid without siglialill,
H,;ard 01 t3+;ildi,: t2el ulanun.,nd auindard
• _ -- Construction Supervisor L,cPnse
* License: CS 1447/
. Sidhdate: ;)0:i.;7;
Expiration: I1f2005 Tr# ++
Restriction: 0t;
!;l' F!T,i BUSSIERE
�'V,VI EHAtvl LAKE SHORE is
T 10VAi:EIiA60. MA 025.'_.8
r. r+nr+u.�itm,'r
v0 IQ 12001$ Tut 1 Q: 33 PAY j
Pnnt i xit
Y
BUSSIERE BRET'T J M L f 0 ;
T _
e ':'• �{�(t
s f� nX A r l' �y�: P.y
Trl
+fir
'�' tk.5:lt�. ;` � p "� 5 y b�' r� Y �1,. "•k `+'�jz X a `fin� �n -
Town of Barnstable
Regulatory Services
SARNWABi'e Thomas F.Geiler,Director
i639. `0�'
39 ' Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, A 1 eX -Pv Yl d t k , as Owner of the subject property
hereby authorize If„e(' $ ASSOC I G'-�CS TV1G. to act on my behalf,
in all matters relative to work authorized by this building permit application for.
13-1 TaJoac-L�� . ona aAfn , I IS
(Address of Job)
/4
na -.off
Si er Date g o
V,d, I�
Print Name
If Property Owner isapplying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORM&OWNERPERMISSION
Town of Barnstable
VE Ili
Regulatory Services
-.� Thomas F.Geiler,Director
• SARNSTABLF-
MABS.
A 019• .0� Building Division
lED �n Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4.038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT 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 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 or two-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 buil'dine.nermit. (Section 109.1,.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner 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 the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor." 't
Many homeowners who use this e9emption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner 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 t amend and adopt such a fomi/certification for use in your community.
Q:forrns:homeexempt
i
I
Town of Barnstable ermit. ?{j(
Regulatory Services ate:.
pF1He rpk, Thomas F.Geiler,Director
Building Division ee:
saxxsTAst.e, Tom Perry, Building Commissioner
MASS.
019.� 20.0 Main Street, Hyannis,MA 02601 A�ED MA'1 A www.town.barnstable.ma.us '
Office: '508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: Fu tj 1 l.,- O t- (r Phone:
Install at: �3'J -rAPisAP-K Village: -009 l�tLr!S
Map/Parcel: Date:
Stove
.A. New Used
B. Type: Radiant/ Circulating '
C. Manufacturer: a N U 1-0-�-'� 5 l DV R Lab. No.5 e 44 W H-1 00 12- I$
D. Model No.: 2 G—
Chimney
A. New/�xisiin (If existing,please note date of last.cleaning)
B. Flue Size
C. Are other appliances attached to Flue? YkA
D. Pre-fab Type and Manufacturers R/ S'bve— wo r—" 'i Nc, Ro, k o)�Z0 6
E. Masonry: Lined%Unliried
Hearth
A. Materials:
B. Sub Floor Construction: C-d f,I&- �-
Installer
Name: Address:
Phone:
Location of Installation:
H.I.0 Registration#
Construction Supervisor#
OR check-�, Homeowner Installing, no license required
APPLICANTS SIGNATURE D iv
APPROVED BY:
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector .
Q:fonris:stove
Rev 103107
i
�OFTHE,p� Town of Barnstable
Regulatory Services
HAIMsTeer.e. Thomas F. Geiler,Director
MwSa.
v u..+A � Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 509-790-6230
HOMEOWNER LICENSE EXEMPTION `
Please Print
DATE:JOB LOCATION: ' r-7 TA W A P-(L R b M A-P--STO" M I L S
�nnuumber / street p village
"HOMEOWNER": T wKr>iFL OI��C9 CSag)y20 ��8�6 �(21)V �7�7� -�800 6�O
name home phone# work phone#
CURRENT MAILING ADDRESS: 13 7 T&/A 4-9- 2.1�5
MAP-5 iow WLCs M A- 02- 61f 8
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 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 or two-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, bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable.Building Department.
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of HorfOwner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner 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 the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The hoineowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner 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 t amend and adopt such a form/certification for use in your community.
Town * ~ 5�
PRESS HERMIT of Barnstable Permit# ,
Expires 6 months from ' e date
DEC 12 2006 Regulatory Services Fee
Thomas F. Geiler,Director
TOWN �F BARNSTAB�E Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �W
++ Not Valid witliout Red X-Press Imprint
Map/parcel Number
Property Address J � +�^� ►� �� ���-�1 u +`'� "��"
[Residential Value of Work �/� 1 V Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address O �Uul Kph
Contractor's Name l X- Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Che one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to ppr 01-4 -d du N� L
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property wner s ign Property Owner Letter of Permission.
Ho e Improve ent ontractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
The Commonwealth of'Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mas&gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizationadividual):
Address: PO kX asi
C
City/State/Zip: O.x1�1 IS I V lei O O� Phone #: O
Are you an employer? deck the appropriate box: Type of project(required):
I.❑ I a employer with 4. ElI am a general contractor and I 6. ElNew construction
employees(full and/or part-time).,- have hired the sub-contractors
2. I 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. 9. ❑ Building addition.
[No workers' Comp. insurance , 5. ❑ We are a corporation and its
required.] officers have exercised their ME] Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ PAGiibing repairs o-r additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12. Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp.insurance required.] r
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.'
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractors that check this box must attached an additional sheet showing the neme of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,50Q.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 certify uncle he p ns d penalties of perjury that the information provided ab ve i true and correct
Si ature: Date:
Phone#: q
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6. Other.
Contact Person: Phone#:
i
I•
I'
Board of Buildin
g Regulations and Standards
HOME I f?�OVEMENT CO License or registration valid for individul use Only.
Re Istration CONTRACTOR
�=_— 24310 before the expiration date.
_ _ Board of Buildingg If found return to:
} 007
_ r One Ashburton Re ulations and Standards
place
•y1�ividual jRm 1301
3mes Curley ( ! I Boston,Ma.0210s
Imes Curley
17 Fuller Rd. "\
mterville,MA 02632
Administrator
Not valid without signature
Il
1 �
apTME ro,�, Town of Barnstable
Regulatory Services
sn ASS, E H � Thomas F.Geiler,Director
y nsnss. $
039.1�,0 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
Property Owner Dust
Complete and Sign This Section
If Using A]Builder
I, Punk , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorize ythis building permit application for.
(Address of Job)
10q 11 a o
Signature of C61ner Date
Prin-fName
Q TORMS:OWNE"ERMISSION
Town of Barnstable *Permit# B
Expires 6 months from'lssue date
® Regulatory Services Fee
X-PRESS PERMIT Thomas F.Geiler,Director
NOV 17 2005, ,p Building Division
Tom Perry,CBO, Building Commissioner
TOWN OF BARNSTASLF 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Fax: 508-790-6230
Office: 508-862-4038
BY PERMIT tAPPLICATION„ ress imprint
ONLY
lap/parcel Number
'roperty Address G
Residential
Value of Work O�— Minimum fee of$25.00 for work under$6000.00
' TC VI
Dwner's Name&Address4
'n^t
VV'% Telephone Number
.tor's Name_ C Ss
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
Q1Workman's Compensation Insurance
TT Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
® I have Worker's /Coompensati. Insurance
Insurance Company Name
P
Workman's Comp. olic Y#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) {
Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof),
❑ Re-side
,fttvkheTe
Replacement Windows. U-Value (maximum.44)
required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Pr erty Owner must si r perry Owner Letter of Permission.
e mprove t ontra ors License is required.
SIGNATURE:
Q:Forrns:expmtrg
Revise071405
Town of Barnstable
Regulatou Services
t Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-623 0
Property Ovmer Must
Complete and Sign This Section
If Using A Builder
0 Vu A/G{ f (e— ,as Owner of the subject property
hereby authorize
0 O`pact on my behalf
in all matjers relative to work authorized by this building permit application for:
(Address of Job)
Signature Owner Date
u�1 l k—
Print Naive
0:FORMS:OWNEMRMISSION
: /4
Board of Building Rem
MPROV gulations and Standards
HOMEI EMENT '
Re ` Co Y r
9istrato`n:,_11 RACTpR License
8494 b or registration
�or��--•- efore
2!1/2007 the ex valid for i
KER C jl i Fr Board of date. Iffoundtvidul use only
SA Ype,pOX n retu USTpMY_ " i__ One gshburton g Regulations and r°to:
MAR AJvt !�� Boston place R Standards
ICY, n,Ma. 210 m 13
ERidNC.
BAK a �' 0 Ol
521 SNOOTFLYIN ^ � 8
CENT�RVILLE
MA 02632 GG.. �
Administrator
Not valid%athout si
r gnat
,•
TOWN OF BARNSTABLE Permit No. .32832...... l
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
;6)D•
HYANNIS,MASS.02601 Bond ..,,N/A,,,,,,'
CERTIFICATE OF USE•AND OCCUPANCY
Issued to Greenbrier Corp.
Address Lot #121, 137 Tanbark Road
Marstons Mills, Mass.
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.
August 29.... 19 89
....... ....... .............. .................. ....,...........
i Buil ng Inspector
I
TOWN OF-BARNSTABLE, MASSACHUSETTS BUILDING
PERMIT
DATE—.t-.,pr:Ll 24 , 19 89 PERMIT NO.NO 32832
APPLICANT Greenbrier Corp. ADDRESS P.0- box 510 , Centervillcl #001397
(N 0.)
(STREET) (CONTR'S LICENSE)
PERMIT TO Build Dwells (-Ll-) STORY Siri(jle. Pamily DwellilIgNUMBER OF
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) DWELLING UNITS
Lot #121 , -.4-�'- . Tarjbark Road, miarstons �llills ZONING
AT (LOCATION)
(NO.) /J7 (STREET) DISTRICT RF
BETWEEN AND
(CROSS STREET) (CROSS STREET)
SUBDIVISION LOT
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
2.
(TYPE)
p. REMARKS: Sewage
Z AREA OR
VOLUME' 768 sq. t- • PERMIT ESTIMATED COST $ 45 ,000 . 00 FEE $ 61. 50
(CUBIC/SOUARE FEET)
jr
OWNER GrecrAbriec Con:).
BUILDING DEPT.
ADDRESS 0. Bo,, 5).0
By j,
/7
-A -C"
A: PLICANT FROM THE CONDITIONS
-m E-70`F--TOI'S-PjWj�y-t-t�` P
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL
INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ELECTRICAL, PLUMBING AND
1. FOUNDATIONS 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
MEMBERSIREADY TO LATH).
3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
2 4iooF 2 ll�
lo!!
77
3
G AS HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
OTHER
19 89 BOA OF HE T"
a 1 _ 9
WORK SHALL NOT PROCEED UNTIL THE INSPLC. PERMIT 'OV!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIOUUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN BE
CONSTRUCTION. ARRANGED FOR BY TELEPHONE OR WRITTEN PERMIT ;5 ISSUED AS NOTED ABOVE. NOTIFICATION.
f
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85
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32� �86
�2 F No LOT 122
0_
LOT 121
LOT 120 0 0 10200 SF
g5 p�
I
I
1 4 13 9 INITIAL ISSUE I CF
NO. DATE DESCRIPTION 1 BY
AS—BUILT FOUNDATION PLAN—LOT 121
MARSTONS MILLS WOODLANDS
IN
BARNSTABLE, MASSACHUSETTS
Fm
0- �,� WOODLANDS ASSOCIATES REALTY TRUST
1 CERTIFY T THE FOUNDATION PA A. ri``l`� SCALE: 1' = 50' JOB NO. 1338�iaxww
SHOWN 0 T IS AN I L CATED o LEVY # 0 50 100
No. 10617
ON THE G ND AS IC TED.
4(11S rg r�� IVY, ELDMG2 Ic TAGNE OOCIAM INC.
AT REGISTERED LAND SU V YOR ° �O� ram UB °—�
889 WWT MAW STRM CEMIR II U VA OU32
a SEP71C S P _ Sao vd �r),Ike��
. . _ �8B
Assessors office (1st floor): �/ f,�Q�
Assessor's map and lot number .....�..�.?I vl�—Qa..h �J' � ` �o�TNETo`
. ...... ..............
NS
Board of Health (3rd floor): v �� WQ o
--
Sewage-Permit number ...... ..... ..�:.�.,.d�...... .�� .... = g�gTSDLE,
��`a-. /3 7 /�-. . - 'TOWN
Engineering Department (3rd floor): . -- �o rasa 0,
House number .... ............... .... amo
Definitive Plan Approved by Planning Board _______________V'i--------
.
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only
TOWN - OF BARNSTABLE
:f BUILDING INSPECTOR
0OAfS-rzuCT ')wCC LIn/G
APPLICATIONFOR PERMIT TO .............................................................................................................................
TYPE OF CONSTRUCTION ........... s^ .C` ,u
...... ..... ......... ....................................................................
.........:..................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: U
Location
,� D i /a I 1-.OA//3A/Z k • le 0 A>> Jt.(/�,�5 rU,CS M,!C c.'s � 3 /
Proposed Use c
Zoning District .. //.-.r..........................................................Fire District �.
/ .. �... ............................................
4Name of Owner v�F6'J31Z-1� COtZ� 7.�, 5/D (� t v��,eV-f CE'
.:.............Address ...�............»!'............ ..............................................
Name of Builder ...........5.�0.X.£.........................................Address .......:SP
...........................................................
Name of Architect ............ ...................................................Address
Number of Rooms ......... ......................Foundation ...?bu,eEJ C&wCrZ�'l�
Exterior .....C.C. /1QS / e6-bAr� ...........45ldo["�T.......................................................
/ .........................................Roofing/ g I
Floors ........ ET � Interior .............5... 1..�....... ....... .................................:..�........
oc
Heating wA .....Plumbing ............ I -
.......... ................. n..AfN.......... .....................................
Fireplace ............��..............................................................Approximate Cost ......�S do
Area ...... ................//.....//...........
Diagram of Lot and Building with Dimensions Fe ...........
3a x a�/ C''�✓/�F v.�1�.iN.�sv� c/ f7
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I' hereby' agree to conform to all the Rules and Regulations of dthe Town.of..Barnstable regarding the above
construction.
Name ........ .. ....... �.............................................
Construction Supervisor's License ��13��
. . .......................
GREENBRIER CORP.
Story
No Permit for ...�3.............. .............
.... S.i.nq.l.e...F.ami.ly..!?Ko�.incj
.. ....... .. ... ..........
►
Location .Lot.. #1.2.1.,,_=*- 2•i=..TaPba.rk....Road
.. ....... ....
Marstons Mills
Greenbrier Corp.
Owner .........................................Corp.
Type of Construction ...Frame..........................
............. 11..........................................................
Plot ....... ..................... Lot ................................
Permit Granted ........:N?.r.il.. .2.4............19 89.
Date: of Inspection ....................................19
Date Completed ...........19
! , `
tL
Asses5or's office (Ist floor):
Board of Health (3rd floor):
Engineering* Department Ord floor):
TOWN. OF BARNSTABLE
BUILDING I N S.P E GTO Rv
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Area
Diagram of Lot and Building with Dimensions Fee
|
' - OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
| hereby agree ,o conform to all the Rules and Regulations ofthe of Barnstable regarding the above
| construction.
Nome -�-----'--�i`^-------'^-----'—
//
u
�Supervisor's License /^�.^,.^......................
- '
GREENBRIER CORP., A=100-026 ,p
No Permit for ....1 z....StQXY. ...........
Single..Fd?� 7Y.... .j.ling......
Location �.........1 .Tanbark-Road
.................Ma.Kst.0n.9...Mills.........................
Owner ....Gre;�i� r 1.�x...Carp......................
Type of Construction .......Frame......................
...............................................................................
Plot ............................ Lot ................................
1
i
Permit Granted .....April 24, 19 89
Date of Inspection ....................................19
Date Completed ......................................19
1 I
44-Vt4 Z�14
t /4
1
PERMIT COMPLETED V 9
0 i � (
v
I
i
tMARSMNS
SHEET 7 OF 7
1
i LOT 130
LOT 129
LOCATION MAP
i101 \�
4.
do
nor0.9
. 9f .i
LOT 31
Tt,1144
LOT 137
i 16A r4 f 1067"w { pit / • �S LOT 124� �_ 4
.. !*0
`4! � •LOT 108 . . 1�1 �� ylh, � v `lam � lil :'S � T �,6 ���� ``���
-111 �\ -'L01 423•' LOT 123
.KA r a r r44 .\ ;O�'g nsn s'
.�i 1 y �i'�' /1. !F �` L_ f �kA 111
�' LOT 13 eta
� � d �� k �� w } t �-�1ao t► � � i
-''
LOT 149
47 LOT 136
14,0
LOT 122
/ If\\;�EOT 107 LOT 110 lot140
>� LOT 119
-LOT 141 t` - --' �o} ��>c •.; 1o>ew s
. 4,OT
IL
----�I it, , I 1; ' m= �tM l' LOT 120
�\ ..1y \ -�'� - t
` -,11-r- - loco s LOT 117' a x� 1os s
a�w 1 • / �' -1 H�,O --' LOTA43`t- - � �, ` h y�lams s \a• � � *0
'�- Pt, ` li1
'
• _..�� , '' �.'1,0 �tA 'LO -l1A Iwo
I.b" O~T 7A 011 11 Swt- vtr� A%40
7A'I LOT 11s a —7eRLtauMTL�J �ttcr
! iM s . ulwt.rtc.
-�
LOT 14[3 - -,�� ��- '1>�1'�toso ,a t•0 , r�T fr►7 PDIt •tJHisNDS
1 LOT 10e Iv-
lei
•� .1r/ S r' �•
"� \� \ r✓ -� �� 1�d : `' r IlkLOT 116
11 �. - �' + LOT 113 Et lam s j
�� I• as. �%� ° �' 1�ar'�1o>tw K ` "{a•� 'Pk'! I�1 I
LOT 111 •`t LOT I sd , 4- b.LO -114
.. ,a0 ,�, .a i 41' 10. I _
r 14p I 1�1 3 111 29 BB FINAL BLDG. AND SEP C LOCATIONS PAL
-l- II/a/m BUILDING LOCATION PLAN DON
1 10 2 ES INITIAL IS ELK
NO. DATE DESCRIPTI By
BUILDING LOCATION PLAN
MARSTONS MILLS WOODLANDS
LT
LOT 109 1lw0110 s r
BARNSTABI.E, MASS CHUSETTS
rw
�`� 6'• WOODLANDS ASSOCIATES US ,
SCALE: 1' 50' JOB NO. 1338 433-10
too
UK EI WG8 & TAGNU AMMTt INC
is
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