HomeMy WebLinkAbout0064 TURTLEBACK ROAD
c� Application numb ,1... .. ..ksq
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Fee...................... .................... .. ..............
xt*MNAMi►B�' �`� � Building Inspectors Initials...........]
s639. �
Date Issued..............d
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Map/Parcel......
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: 6q " ( S
E)it STREET VII.,LAGF�� �� ����/
Owner's Name: L NUMB0/V S , hone Number
Email Address: (&A4 {rK Cell Phone Number
Project cost$ t0 00 Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
Siding Windows (no header change)# 0 Insulation/Weatherization
ED Doors(no header change)# Commercial Doors require an inspector's review
0 Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable)# (attach copy)
Construction Supervisor's License# (attach copy)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
I
APPLICATION NUMBER............................................................
*For Tents Only* 4
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required.
Natural Gas Yes No , if yes, a gas permit is required.
If food is being served at.your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name: N`t n Gi r( f N'I l/Ll S
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection edures, s ecific inspections and documentation required by 780
CMR and the Town k, e.
Signature Date f
APPLIC 'S SIGNATURE
Signature Date
All permit applications are subje t to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
4 Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston,MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): N--4r&n `'l.
Address: 6 - 1 t,c-v`r<'C 2 As�_ lorl
City/State/Zip: /94 Phone #: --,-z �-s x12
Are you an employer?Check the appropriate box: Type of project(required):
LEI❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
jworking for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance.=
required.] 5. ElWe are a corporation and its 10.❑Electrical repairs,or additions
3V I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage ver'fkcatiom
I do hereby certify and e p . a e ojperjury that the information provided above is true and correct.
Sip-nature: Date:
Phone#:
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an 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,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which Will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington,Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 4-24-07
www.mass.gov/dia
Town of Barnstable
�tKE
Regulatory Services
Thomas F.Geiler,Director
F
Building Division TOWN OF BARNSTABLE
f
• ,ean,srA U, R
MASSTom Perry,Building Commissioner
''0 ►�® 200 Main Street, Hyannis,MA 02601 2013 AUG -6 Fib 1: 14
www.town.barnstable.ma.us
Office: 508-862-4038 ®' �--'Far—. 508-790-6230
Approved®N
Fee:
Permit#: `�>
HOME OCCUPATION REGISTRATION
Date: /6 l�7
Name:"-Wn U[ 1^t 'M a A h Phone#: :I-i "Y g 42 T 7
Address: 6Y— J Cd. r f te A Q.C—K 0 0 Village:
Name of Business: �rV P� ,
M,0.$ft?Ar FL-Lqort K
Type of Business:I[awl warn y?ool� /40�?'116vMap/L ot: ow-0 5
IlN7=: It is the intent of this section to allow die residents of the Town of Barnstable to operate a home occupation
Yidmin single family dwellings,subject to the provisions of Section 4-1.4 of die Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
follo«zng conditions:
• The activity is carried on by the permanent resident of a single family residential dwelhing unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dweEig v h ich are not customary in residential buildings, and there is
no outside evidence of such use.
e No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or oilier objectionable effects.
C There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not mithin the required front yard.
• Ther-e is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one �
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
e If die Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed ii the Customary Home Occupation who is not a permanent resident of die I
dwelling unit.
I, dne undersigned,have andau v ith die above restrictions for my home occupation I am registering.
Applicant: Date:
I
Homeoc.doc Rer.01/3/08
i
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this format 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: 31A61113 r' Fill in please:
APPLICANT'S YOUR NAMES Ot�✓� I C� n
*� US ESS YOUR HOME ADDRESS: — r
TELEPHONE.# Home Telephone Number A-1D;,'Yg
NAME OF NEW BUSINE TYPE OF BUSINESS (JL�-moo ✓ It.
IS.THIS A HOMEOCCUPATIO ?, j t, ` YES NO:_. i ,, :;.
AD,
DRESS MAP/PARCEL NUMBERD..'1 ".v(/J (Assessing).
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIO ER'S OFF E
This individ al i r o an per it a uire nts that pertain to this type of busin"ST COMPLY WITH HOME OCCUPATION
-Aut riz ig tar -_� RULES AND REGULATIONS. FAILURE TO '
COMME COMPLY MAY RESULT FINES.
S
2. BOARD OF LTH
This individual ha$begn�f�rrrle�i of the permit requirements that pertain to this type of business. MUST,,XMPLY WITH ALL
l• (N V�{/I HAZARDOUS MATERIALS REGULAT101 1.q
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS(UCENSINPA THORITY)
This individual has n inf r' e he licensing requirements that pertain to this type of business.
l�
Authorized Signature*
COMMENTS:
Assessor's map and lot number .....-/ryry ! - S
w /../... .... �.t :...... .
111�����• THE
` A Bpi rp1�
Sewage Permit number ... ............ ..../............................... 2 Vf 3
t' e I EAaa4TME. ir
House number `� Y HAS
...........`.... rb
39
�F�YAY 6'
TOWN OF BARNSTA,.-B"E"E�1
INVAL.LrED 114
BUILDING 1-NSPECTUnn
ARION � �
Con 5�� c,'�'
APPLICATION FOR PERMIT TO .......................................................................... ...........................................
TYPE OF CONSTRUCTION ......... ........
0 o..S............................1rr........................................................................
hIv.,ca......``:: ........................19.83
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the ofollowing information:
Location ..5.... �O? Tvc +\-e P!�?. . 1 M .S. 5?.................... ..............................
1..... . ... .............. . ......
ProposedUse t-tG2 C�,v�,..���.....................................................................................................................
Zoning District ...............................................Fire District e 0
...:.................. ..............................................................................
C T (01L{ `,j+nAM AJ CD"�J��+
Name of Owner V�nn� .......f.l. ....��.............Address ....................................................................................
Name of Builder' eak c.I ........................Address .AH5....<-T �. ..met S\N 2cj, Ce��'.
......... ................. ............ ....
Name of Architect C70re�lOr1 C�A� �...................Address ..�'. ........W ,} �R�MgJ'F�!1
.............................................. ...... ....
Number of Rooms ...S.given...............................................Foundation .......... x 3
Exterior .....W...h.� e ..... .o!\....o^.... ? y W,OOCA..Roofing ...A 5. .1. ........................................................
Floors ....(::A r I. .....A.n..... ....................Interior y..v?o-�......................................................
Heating ....0r.A.................. ...................................................Plumbing ... .o. '��.r....+...., :.vrG.....................................
Fireplace ....$ C.Ae............................................................Approximate Cost ............. . f.r ........................................
Definitive Plan Approved by Planning Board f' 7 --------19 Area �.�.'� ..+...7g .......
Diagram of Lot and Building with Dimensions Fee ��
.........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
Ax
�®&S, Iz dw
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 �.. . .. ...........
...� ..........
Ile, eo i 3 9 1z ��
PRIFTI , SAM & VINNIE
�25039 112- Story
N? ................ Permit for ....................................
Single Family Dwelling
...............................................................................
Location 64 Turtle Back Road,
............................................
Marstons Mills
. ...............................................................................
Owner......S.a.m...&...Vi.nn.i.e...P.ri.f.ti.............
.. .. .. .. ..... .... .. .. .. .... . ....
Type of Construction ....Frame.............I............. .. .... ..
. ................................................................................
Plot ............................ Lot .................................
-Permit Granted ...M.....ay 4,.................................19 83
Date of ln04W._YZ_fit3. ...................19
Date Completed ....7W�7.,> !� .........19
Q ...7.
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150 ' F(Zol-.r,Aa:>-=4- A�iTE o
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30' F,s. g.
i s s u CERTIFIED PLOT PLAN
�c A'ssumED PLo-i`ce-I Iotil uwD( p A T III , , �7/I RS 7cJn/S M/ L L .S
�r-+�P"r tel: , e-,- E , "C-�eA-�D FA HLR-
Cr�`E r. IN
f�lalC �PCGIAL �f=1=� 'rS7�•tG'�'-IG�
''co' s gr C S. 6 • SCALES /, _ 40 ' DATE, S-/2- i
6ELDREDGE ENGINEERING C0.1 Pic I CERTIFY THAT THE f,1tJN/)/i T 0A
EGISTERED REGISTERED CLIENT __ SHOWN ON THIS PLAN IS LOCATED
JOB No . ._i 3b ON THE GROUND AS INDICATED AND
CIVIL LAND CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYOR DR.BY& . ' OF BARNSTAB(�E
, SS.4'
712 MAIN S'T. - CH.BYE . R_,C,
05.02. 8 3 '—
HYANNIS, MASS.., SHEET OF DATE REG. LAND SURVEYOR
.�•�i'� TOWN OF BARNSTABLE
�. Permit No. ------
.ARBIT.X Building Inspector
.... Cash ---------------
OCCUPANCY PERMIT Bond —___.._�__-_� �/6
Issued to za £` ViTinle drift _ Address
1 n+ �►'-101 i�Lz 'i�irt�F,4 i k 12na� r*rrett- -"3 M;11 q
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
r
Gas Inspector Inspection date
Engineering Department Inspection date
Board of Health 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......__ ..................................... ._M _ _.. ._...
Building Inspector
Assessor's ma and lot number ...... . P n L tfr� �
C p _ ........ �� `\ OCTMET��
Sewage Permit number ..R: .....�..../..............................:. 2 7 S�
p y
Z BASd�9�T11DLB,
i
House number `" �A +gyp- NABIt639 �a
ce0
a�0
TOWN, OF 'BARNSTABLE
�a
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ` .. =. �• ....
TYPE OF CONSTRUCTION .......... .R � " C r'�re`�o ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..L:-x±.... ••3-- t > • .t,• , �� C � ,r? .................... ............................
ProposedUse .....E6 s :.......f.Xw: .....................................................................................................................
Zoning District ............. .. ....... ................ ..................Fire District ............ —.. .................................................
Name of Owner S A.t».:t:..�.:r,e�,� .;.....�5.�. ..}................. ...C?(.�.....`.. .:.......r........!.Q..... .a�.:t....t...............
,Name of *Builder' •"f. s� ;t .....MCA�,i, ,Pn........................Address ..1.A 5....�=:.t:.`c�.�...t'4€�C`�?f°. 4. .... .... ;a��...
Name of Architect .. ..........................tT) .Cj.f!!.....................Address ... �.........?....:?. . .5'.......................
Number of Rooms .... :C-J ...............................................Foundation ... :` ..- . ....................................................
` w
Exterior .... ....h?..f:�.:..E.` .. '€: ....c =� i3 I v�;•i;•� ..Rng F S 3 t t 1. ..........................................................
............. ...... .� Roofing ... ' .4..`...
f
Floors P 1....D 1 q ...................Interior ...05.- ...............�`w....................................................
�. ..
Heating ......Plumbing ...°.._` .
Q ...............................................................
t
Fireplace ....a?t.:. -:! ...........................................................Approximate Cost ....�°. ` �.......................................
'F•
Definitive Plan Approved by Planning Board ___7 --------19 Area �. ... .......Y?...}.......
Diagram of Lot and Building with Dimensions Fee ....... s �.. . ....................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
0.6
ev
I
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 ......................
...
Ile. CPO
PRIFTI, SAM & VINNIE/ A=47-85
No 2 5 0 3 9 Permit for ...............
Singe..F 111�,1�y...zvell.i ag. ...............
Location ..Lot...3.Q.3f...b4...Muxtla...Eack. Rd..
.................fl o to a.s...PA IIS....::...................
I
Owner 5.4M... ............
Type of Construction 4r.ame
. .....
Plot ........ ............ ...... at ............. ..............
� .. ..
Permit Granted ......Ma.....Y..14...,'.:.................19 8 3
Date of Inspection ............ .......................19
Date Completed' .....19
F