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Home My WebLink About0178 TURTLEBACK ROAD �_ � � �J 4 s. I 0 c - -- — — _a. _, �,.._._.___ _. , - - ..., ... ...�_._� s B l r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 1 _ Permit# 7 Health Division Date Issued 1 Conservation Division < �v �� Fee Tax Collector Ud ��5 3/ Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE / 1ftYt1 TITLE 5 Date Definitive Plan Approved by Planning Board ' P ENVIROMMEH NTAL CODE A,sD Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Stree S ��ss' f �' f�f / /! / / c /�� /fir��,��c_c6C IZcQ• L� ��1 Village Macs nl7s_ Owner �Yll ) l� ��Yl{�l l�f Address atog Telephone 10�f T Permit Request rr7`►� n or One,— Square feet: 1 st floor: existing proposed _ 2nd floor: existing 9 S 2 proposed Total new t p Valuation 66,�y Zoning District rx- Flood Plain Groundwater Overlay Construction Type Lot Size CA 0 r Q Grandfatfiered: ❑Yes dNo If yes, attach supporting documentation. Dwelling Type: Single Family LY TWO Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes OW�o_ On Old King's Highway: ❑Yes CP45- Basement Type: ,Lit Full ❑Crawl /❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing a new Half: existing new Number of Bedrooms: existing new 1 Total Room Count(not including baths): existing new First Floor Room Count 5 Heat Type and Fuel: MGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ��Ct�1Vo Fireplaces: Existing ` New Existing wood/coal stove: ❑Yes UM-6Detached garage:0existing ❑new size Pool:Cl existing ❑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 OXqo_ If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name —Brl CLn DL2,kL4 Telephone Number —�-_j o q-�9 Address �`� ��ee4 �c�7� License# S /59- MZ11S Home Improvement Contractor# 72 4� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOC1l � SIGNATURE ' DATEZoe- I FOR OFFICIAL USE ONLY J PERMIT NO. z4A DATE ISSUED MAP/PARCEL NO. ADDRESS- .• _ VILLAGE" OWNER DATE OF INSPECTION: I FOUNDATION FRAME -t( gjOf INSULATION `'t VeL�Z 00 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGHS T FINAL FINAL BUILDING DATE CLOSED"OUT ASSOCIATION PLAN NO. --a. --.....-s x-..--_-- .'+._. "oTES • RECEIPT DATE 4542 REC ED FROM r � AD RESS U�'J ' _ FOR` r _ v _ AMT.OF CASNy ACCOUNT "' I AMT. CNECK \ l —PAID. e ? BALANCE ' ONEYA BY .M DUE BORDER fm1898 _ ®BL808 RECEIPT DATE ]-- /�NO. 4544 RECEIVED'FROM �TT ADDRESS J ' FOR $ y i O d AMT.'OF ACCOUNT ' CASH: PAID. CHECKS BALXNCE 'MONE 'i V c,FDUE,. [ORDER 13 v .01998 RBI ®BL808 r 099V � SQ FT � �.T Duffy Construction Phone: 508-420.9394 UNMOOR 133 Fleetwood Path FAX: 508-420-9394 Marstons Mills,MA 02648 a-mail:Duffyconl0@aol.com Re: Change to Building Permit#49447 Contractor:Brian Duffy Home Owner: Arthur Hapenny Address: 178 Turtleback Marstons Mills,MA Contact#:508-420-9394 11/05/01 This is a copy of the changes to the current project being done at the above address. Please contact me with any questions or concerns. Thank You Brian Duffy Duffy Construction �3 Hapenny town letter pg 1 I j y :f r f i i i -i ! ! I i 17 1 Fl F I IL-. 2 c 12ri Ige I 2 12v ll X 1 01 after 2x1 U rafters A i -.a .�; �� " � _` �, ��; �� --�_�, �� '�`� '� �� ; ��, �� _ --. i i i � I, i � � � � � � jI � ' l � i i j � I ..�•,,,�, "�.�� t71�3�� .'�45'..1�7+L�vC��ems. �t `,� ,7 ��j,,y "'��µ:�•�� 1'7jL'°"i�i'i�' k:�„�9F�,y�y `T!J•`�"'`1t W , �FSNE ' The Town of-Barn-stable. nnexsrABM • ' Department of Health Safety and Environmental Services Building Division ' 367 Main Street;Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: �% v Map/Parcel: ()q 6 - j} 1 1 l 1 Project Address:-]6�(A b4j-Q D(�c,iC Builder:l / _d I'A The following items were noted on reviewing: i Please call 508 862-4038 for re-inspection. �.eui fit,,,, �.,,, • -Inspected-by: Date: /o q:building:forms:review LIVING SPACE Value (high end construction) square feet X$115/sq. foot (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot= PORCH square feet X$20/sq. foot= DECK .square feet X$15/sq. foot= OTHER square feet X$7?/sq. foot= Total Estimated Project Value o For Office Use Only Housing Fee Residential Commercial" Property Owner's Name Project Location Project Value Permit Number "Existing Sq. Ft. "Proposed'New Sq. Ft. Fee $ IAHFORM 1/3/00 M CIM App melt i T&bleJ&=b(mmfo d) huc iptiTe PukaW for Qae sad TwaFamilp Rn d 8a W Snmd�"a Fob Foals MAXIMUM MIHQHUIN Wall ELM Baa, Slab Amz'(K) U valwi gwalmi Rww o- R.vaBri. wall Flemsa EaWpmm EMd=r padcaae Brvdrle Rrvdtrd 5101 to 6500 Deseee BMW � Q 12%. 0.40 31 13 19 1 t0 . 6 Nomw R 12% G 52 30 19 19 -.t0 6 Now s 129A 0.50 31 13 19 to . 6 is AFUE T ISMS• 036 31 13 23 WA WA Normal � U 15% OA6 31 19 19 10 6 NOS i IF i�ri u�ad 1• �o !3 WA :5:: !s AIVE � w IS'S 03Z 30 19 19 t0 6 lS AFUE x 130/4 0 3Z 31 13 23 WA WA Norma! Y Jz@A 0.42 31 19 2S WA WA Normal Z IV/. 0.42 31 13 19 to 6 90AFUE AA Ir/4 0.51) 1 30 19 19 to 6 90AFUE 1. ADDRESS OF PROPERTY: v 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 7 j 3. SQUARE FOOTAGE OF ALL GLAZING: Lh5 Z o 4. %GLAZING AREA(#3 DIVIDED BY#2): Cy d 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a •• I 780 CMR Appendix J Footnotes to Table J5.7_1b: ' ind Glazing area is the ratio of the area of the glaring assemblies (including sliding-glass doors, skylights, conditioned space, but excluding opaque doors) to the gross wall basement windows if located in walls that enclose area,expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure+ or takes from Table JI.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ailing R values do not assume a raised or oversized truss construction• If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R 38 insulation maybe substituted for R-49.insulation. Ceiling R values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be paced between the conditioned Sparc nuts is vm''_•.. Y�son of thC:oof. r 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,-and interior drywall.For example,an R-19'requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating.sheathing. Wall requirements apply to wood-flame or mass.(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspz_es, basements, or garages).Floors over outside air must meet-the ccftg requiremeam- :_< The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements-are for unheated slabs.Add an additional R 2 for heated slabs. ' If the building utilizes electric-msistance beating use compliance approach 3,_4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a) Glaring areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the-building envelope must have a U-value no greater than 035. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC_tst procedure or taken from the door U-value in Table JI.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the and use the opaque glass area of the-'door with your windows que door U•value ao determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U•value greater than 035). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R=value is greater than or equal to the R•value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). :1; :..:r�YGf..t-..ram=-�':.,�....�-.•'�.�'' ;_'..'�•,::r»r'f»2-%�'."`. .. .m:._-t.,. ,. _.. ..� .-.. -+�-+.. ..:a-.a...3'�_rF.».. .... ,. :.L�.. -:.-.. .,:,..,;.*..:.- - r,. � �. °F.HE► ti The Town of Barnstable SARNSTABLE. Department of Health Safety and Environmental Services 9 NASS. 0a rEo Mpg Building.Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location .z7 ll7 L iY ,IC Permit Number Owner Builder . One notice to remain on job site, one notice on file in Building Department. . I The following items need correcting, i rACc 5 SO-"' 2 � ; q S2 �yl`� �l'' v 'I Ins �C, !V.�,�,g�A Yam.�a 't,�- � . 0 Please call: 508-862-4038 for re-inspection. Inspected by Date f ltql6 w� A ilk 11) 4L f 1.� ! 4 r '+ CEZI.La J1 Al •' _. .fit ' --.,..- --f �- � _. - � - . 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I/IM IM t 44NO COOMP .• ` �� ♦A►e*#*r ccAr/pr ?,,At rope P440 r�+Iiw ts.:iNMO jb�►YNrOR J«o�N oA► �M�1 Ise M si tit ffo .oN rp r •wo r A iN oar& MOSWO0 'ir0 roar I r 0N0II0 r' to .•rA/s POI&VONf sullies *,*w*RNAIeAirj 'rNt row►N II Aiow�iu�ria�it ,a ►,.;, _ r L"AA a� t� — o i P 10 . a 00 LIVING AREA 64 Sq ft I I i I I I I DECKLE I I I ---I -� u Z2 97 610 8'5 I I i I ' I 57 55 I � I I � I I I Public Health Division Town of Bamstable I in PO Box 534 Hyannis,Massachusetts 02601 I FAMILY Fax(508)775-3344 Phone(508)790-6265 i I I I I L---------------------------! I 9 {x �S MM tP { t t4 yt }` s c9e' s4 ,f.,�4,1 � �.3g•:5 gf' a ��?cCd.�S". a�'+�, ew .uw w"a, ,.,n z k �' �' �a+¢.Jt � �� , '•°�-'e ��4�^.:, S i�'•'� fe'io.ullCnrA�"=Y�ld+f�"",.,a •r*,s-.� -aa w-i-�w -rv^:.� �.�.- wow aes .-.. a -tea- �. rr �xs- �{ Y t - �' ;� <1 c n � +'i �,Its � o t .r � �, r i �° � ��', t I '� �•' zY ar_. 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L: -.h L4 f ',P ;'V� r .'ye y..;�` i ..^-.. yy, !M �'r• ,,,.i,Y:. f -.ri - y �'�O < � .:C ° �V�ti� C '�'., r�ti I-J . .a i IN r�� •, �.. t � �� 4 f r,5 �.i, ' � Tim °�� 1 r fi' T� y i �'� t � , f t �i ,§`:. .�• � � z 1'i,` �' j%�. t+ � C S` c `u`�"° SI1}E 1:°' '1 ,�j f Town of Barnstable Department of Public Works Engineering Division 367 Main Street, Hyannis MA 02601 Office 508-862-4088 Thomas J. Mullen,Director Fax: 508-862-4711 Robert A.Burgmann,Town Engineer SUBJECT: Numbering of Buildings Map No. Parcel No. 10 Date: Apra L }a.000 Dear Property Owner, Notice is hereby given in accordance with the General Ordinances of the Town of Barnstable, Chapter III, Article V, Numbering of Buildings, adopted March 3,1931_, revised July 21,1994, public conveniencpand necessity requires the assignment of numbers 75J for your,property` located on r -I u 2TLE Pwck� oA-0 •62 6as'Mm S M I L .S— , STREET NAME VILLAGE This number should be affixed to your building so that it is visible from the street as outlined in Exhibit"E", Town of Barnstable Rules and Regulations for Numbering of Buildings. Please contact the Engineering Division at(508)862-4088 to verify E-911 records when the change is made. Robert A. Burgmann, P.E. Town Engineer encl.: /T'.O.B. Rules& Regs. _✓Common Questions v"Site Map r/Assessors Change Form i i l T a _ 076 Z7 ' Go 7` so't V rt, N tv • '� e 3�` a i39-' � a y . Q ' 5° 8a i ., iza.�g • - � d iP£r�EREN„GE� •BEING LOT 3'¢ S I KNOWN ON A PLAN Wi-CORDE'D IN 7'ME SF� 2G, / 977 *ARHS. COUNTY RE:a. OF DEE0S Cl. AN0 DArE �V� couRr SfCrION ON L ANO COURT 'PLAN NO.`20 S smer r NO . . RE6. LAND SURVEYOFr �. ! NERES-Y CERTIFY rtifAr THE FOUNDAr•lON .S'HOWN ON rHIJ PLAN IS L OCArco ON rHE GROUND AS SHOWN HERCON AND THAT ! T �dE,l CONFORA! rO THE ,., y►�P��NOFira'N.\ sill. LOING SETBACK ReavlREMENTS OF 'rN E TOWN O F )CEOR J6f L O W .4 SOVrN YARMOUrN, MASS. �40 L'RIA F . Ass 4sor's map and lot number ... O ff 14 C 4,;01 7-77 �Z SEPTIC SYSTEM MUST BE Sewage, Permit number ��'� INSTALLED IN COMPLIANCE WITH ARTICLE II STATE � ��Qy�FTHETO�yw TOWN OF BARNS GI ��' Ll AND TOWN i HA"STAI)TA i o aY-a� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .agle#W. vl f'.�grrt� ......�1��.��r�T5y '....................... TYPE OF CONSTRUCTION ....4 QW. l?fof-Ile............................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies/for a permit according to the following information: Location a7 .sa?Y/..... ... .1 /�,els 7..��f �r.f�4'! ..........,Ofe?.K'cf S...�15.............................. ProposedUse ..... �f'!�..... '��t� ...... �f�? ............................................................................................ ZoningDistrict .........................................................................Fire District�............................................................................ Name of Owner ...............................Address ....4.-P.. 'lrrv/.Z�....r?1�5. ............................ Name of Builder s /.Y...'�.............Address .e!.,.Erg. -fit- /.1 ..../.,rY✓.r,�P....1/.!�Sf�,t��f'T Name of Architect ......... 47*. ........................................Address .........XV-Wr.:f.......................................................... Number of Rooms �.............................................Foundation . lQ.. ..f�tur ..�Qrt�t' r!......... Exterior .. r�i��r ..... .......................Roofing ...... rrig%T�.............................................. Floors .......:c gf�,R"T�.....................................................Interior .... ... �r� r7/. .................................... Heating ...�z......... .....................PIumbing pe.....r�.,/��=. Fireplace ......s. ...................................................................Approximate Cost ..........1.7��Q�Q�.. ..... ........./................... Definitive Plan Approved by Planning Board -----------_______-----------19________ . Area �o. .a.......s'...:...... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Wfl, 3 0 ub I hereby agree to conform to all the Rules and R,gulations of the Town of Barnstable regarding the above construction. � Name ........ ..... . . w...�� .......... Robetts, M. $. w 19678 two story t1; ................. Permit for .................................... single family dwelling ............................................................................... Old bill Road Location ................................................................ Marstons Mills ............................................................................... M. E. Roberts Owner .................................................................. Type of Construction ................ frame ............................ ................................................................................ #341 Plot ............................ Lot ................................ Permit Granted October'18 77 ........ ... ...................19 Date of Inspection ll �.r�../.!... ....19 Date Completed 6�l a7/7 .........19 ..... .................... PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's!map and lot number ....................... - %! /0 C 7— 77 01 r 7 •; �evirage :Permit number T"E�°�o TOWN . OF BARNSTABLE • = s BAHH9TADLE, 39 :. BVILDING INSPECTOR � y APPLICATION FOR PERMIT TO G?y4 .�� ?� s��/a / ,,�� /�.�P �,.. ..... .... TYPE OF CONSTRUCTION .:a....... - TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ✓t •, Y/.... ... ............./ . �� /�i�� n�� ..... y„S. s / ....... .............................. ProposedUse ...... f �. `�.....% �.��.y ............................................................................................ ZoningDistrict ........................................................................Fire District . ........................................................................... Name of Owner ......1';F,,��'�, sw5.........................Address ...�.:P ?�Pr v. ...... 11 :r.S............................ Name of Builder ./S'! ! , ?f.�a �/�� .............Address .�r•'>��r� i?,o....% .�??�.... i� Nameof Architect ......... ........................................Address .........SQL. :.....................................................:... Number of Rooms Foundation ��.......................................... .................................... Exierior .......................Roofing ..... 3b / .............................................. f — 7� Floors ............................................................Interior ...... ....Zs ....................................� Heatin ... .�'.:.......�/� 7� �si'7l�/' / •'�_. i , � ..� �.� •�• - g ....,. ...:......................................................Plumbing .....,......................:r. ....... ..,.. ..... Fireplace ...... ... ..................................................................Approximate Cost .l.......`...................�!? ... .... Definitive Plan Approved by Planning Board ---------------____-----------19________- Area .....±�. . .9~!...... ..:..... Diagram of Lot and-Building with Dimensions Fee ` SUBJECT TO APPROVAL OF BOARD OF HEALTH �!?� a� .A I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Name .. � �..:`z,,,,,,fix ,....... ':..... '.:........ ti o 4 .` Roberts, M. E. _ .- --- . ` . . N�°�t~'~'- parm�� ~~~ ......... ` T. sing , l f ''�W---��-^-_—''�-.'_ ...��---.---. ' . ' Old Mll Location ---.---..��_________.. ' � ' ' Maratoom Mills ~ .............................................................................. . . . ' M. E. Roberts '------ � � Type of Construction ---. _-----.. � . ' .. Plot ...............:............. Lo/I...........#34.1............ . ' � [ rennx Granted ` Date of Inspection ^ Dote Completed . ' ` ' v= . � ^ ........... -. ' . . '-------' '' U. A -_-=- . ` .. ' . [ '--'''K--'' '-'- --'.�--.. ' 0 � Approved ................................................ lQ ' ' ^ --------..-----~.-.,,----~.--- ` -------'---------------^'^^^'' | I Assessor's-office (1st floor): ` oFTNETo Assessor's map and lot number ... Board of Health (3rd floor): ��♦� � `77 1 .:.��1.a2.. 1'1 38k Sewage Permi4 number ......... L 9AHdsT&M. : Engineering Department (3rd floor): 1639 House number oL� oy�6}9. \0 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 — .......G..:............................................................... ................. ...............:...... TYPE OF CONSTRUCTION .... (. ..... ........... ....+ ............ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following iin�foorrm'ation: Location .. 1......... �C11..� m..........�1fi.................l..A.J./.T. \ ?.. ProposedUse ... -A le 5 ..........................................................................0' •"•••••...., /....................................... Zoning District ........................................................................Fire District Name of Owner t..n ................................Addre-ss �P.(....n D.......�I�d Name of �A�dres�s ....6?�—v% ..� .N..��1 .....`1� ii✓CTT=1 �.fT Nameof Architect .......41 .......... .....................................Address .................................................................................... dumber of Rooms ...... /� Foundation . . .... Exterior .... Qsl.YL ....`7t. !N. n...........................................Roofin .......... 5f L' ....................... ..................... Floors .......... ...........................................................Interior Heating }. � +A.................:...............................:...:.:...Plumbing ...... .............:....:................:.........:...........�. Fireplace /At.................................................................Approximate.Cost ....... ....�2 �1.................. .... .... r j- Area .... ................ ` Diagram of Lot and Building with Dimensions 'pt��/ Fee d...l....�................. I 27 Z-7 N J C �p'. °� �, � � O M 4- 0 c K F�OA- D OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I herebyagree to conform to all the Rules and Regulations of the Town f Barnstable g g o a stable reggrdi.)ng the obove construction. C Name s-7z, ...', • cc ruction Supervisor's License. --(!�.: ........ -ROBERTS, M. E. A=046-103 .� No ...322.13,. Permit for ...B.Vild...G.ar.age.. .....Ang............ Location '.....2.6. ...Qld...M.11...Road.............. ......................Mars.tan.s...Mills.................... Owner ....M......E......Robe~x.:t.s............................ Type of Construction ......F.r.ame....................... .............:........................ :...........` .................,......... Plot ............................ Lot ................................ Permit Granted ...... ugus.t.:.2.9............19 88 Date of Inspection ....................................19 Date Completed ......................................19 010 l� to L0MM0nWCUUJz Department of Industrial Accidents -�� _�� Olflce oflovest�gatloos • � 600 Washington Street �', ` 7 +r Boston;Mass 02111. � z.ry..•' -Workers' Com tion Insurance Affidavit :10cati*0 city . hone# ❑ I am a homeowner performing all work mvsei£ _ - � V:. .�._, . I am a sole fro rietor and have no one woridzi is anpcaVaMtV - I am an fins Toyer rovidin workers' compensation for my employees working on this job. ❑ P P ....:...:.� :.. ::... .:.....:::..,..:... .. ,...:::::...:::::..:. .:.::.:..:.:....,..... comr)nnv name: ......... ....:•:... . .:.....:....:::.:...:•r{}:-:}:.:;.::}}••}::ar:,::-}>}::::;:%;::.+'^•r.•:::'t•>'}<>::,,} :•}.}:•%;}'.>:•-:}:.....::; •<:•:;i.'is%ai :�:•:a:''•:i.. address: r..r..::.:v city: .... . � nolieu#-: insurance co. .. --• / ////////////.:�ii.. am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below whc have - the folloN�ing workers' compensation polic ::..,<:::: .:.:::::.:::::...... : =< ,.:::. .. omoanv name: JP ... :.:..::..... :::. address- :.:..:.� res { ....... ..........:...:.. '}.�:v:;...rnv:yr: v.}:4r v:y,.�p....;,.:. :J. ::: .:• .::n.::•v: .,k.{. :.::. ........... .....:...... ::...... .. . ., �j �:J:j�:i$:4,:Yd::j:�'" V:.',Jr•,}'.i:i$:}+{;.::;.;{•:{•;}:<i:.::::::.. e co. 51 insaranc comr3gy name, address r ....................,...,... .. ........:.: . . ottrittooal p etuilti Failure to secure coverage as required es of a fine up to S1.S00.00 an o: under Section 2S A of MGL 157 can lead to the impositiona well civil penaides in the form of a STOP WORK ORDER ands fine of S100.00 a day agaimt me. I understand that a one tears'imprisonment e copy of this statement may be forward the O rce of Investigations o[thsfllAfor coverage verification. I do hereby e`if under t and pen es ojperjury the the information provided above is tru.and eorreat Date SJg=Mr _ Phone# Print name Mil •'` official use only do not write in this area to be completed by d or town ofntialry Y s. permit/license r# ❑Building Department a city or town: ❑Licensing Board _ ❑Selectmen's 0111ce r ❑ check if immediate response is required -' —• ❑Health Department contact person: photte#: Other_---. Information and Instructions provide workers' compensation for thy.: Massachusetts General Laws chapter 152 section 25 requires all employers to p employees. As quoted from the"law";'an employee is defined as every person in the service of another under any cc ye 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 c_ the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec„�,er trustee of an individual,partnership, association or other legal entity, employing employees. However the.owner of a dwelling house having not more than three apurtameats and who resides thercin, 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 thereto shall not because of such employment be deemed to bean employer. budding appuitenaat .. . . .. ......_... __. . . . . MGL chapter 152 section 25`also states that every state or local licensing agency shall withhold the issuance or rene'F of a license or permit to operat6a'business or to construct buildings in the commonwealth for any applicant who h: 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 urrt acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the coatrac*—=-= MEN Applicants ... - -•' box that applies to your situation and Please fill in the workers carap_easation affidavit completely,by o f pl as all affidavits maybe supplying company names,address and phone numbers along with a certificate Also be sere m sign and to the.Department artmeat of 7ndustrial.Accideumts for won of insurance coverage• submitted eP that the application for the permit or lice is date the affidavit. The affidavit should be rem to fine city or town being requested,not the Depaittnent of Industrial Accidents. Should you have any questions the 'law II or L rc are required to obtain a workers' �P�On Polic9,Please call the Department at time nummber listed below. City or Towns .... Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of t affidavit for you to fill out in the event the'Office of has to contact you regarding the applicant. Pleas e be sure to fill in the pei iiitllicense mmmber as which will be used a reference mmiber. The affidavits may be retiiraed t^ the Department by mail or FAX unless other. have been made. The Office of lnvestigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call." / gy The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0111ce of Investigations 600 Washington street _ Boston;Ma. 02111 . fax#: (617) 727-7749 4 phone#: (617) 7274900 eat 406, 409 or 375 _ 27a, Z7 ' so' t Lo 7" 3,q-/ 39Z o• h� a 139_r \ Q AO' Z� i33• . SCA [ E� �_� R.CrCRENGE: BEING LOT SHOWN ON A PLAN RECORDED .IN rHE sFp 24, / ,9 *A R H-T. GO UNr' Y ; RfG. OF DEED s CLANA' couRr srcrION,) ON L AND " Cot/Rr PLAIV NO:`�O S ' SNL' � r /v0 . .. REG. LAND SURVEYOR / HEREBY cERrirr r4lAr rNE i0ONDAr./ON SHOWN ON THIS JOLAN IS 4OCA,r4ro ON rNf GROUND .4S SHORN HEREON AND TtIAT / T C'OAIFORm rO r/IE r ' BLI/LDING SErS.ACIt REQtJIREME/VrS OF .THE T D.WN OF yEOR�GE . L O W A ND j S071r.N VARMOUrH, MASS. Assessor's office (1st floor): / w C�T M E TD` Assessor's map and lot number ....�. 7�r/w.. ...�D..�..� V S�M ` Board of Health (3rd floor): �J� �j ,�(�Y gyp' ��/}l� ! T ° Co Baae9r' Lo. Sewage Permit number �..../... .✓f .. � �....1�/dQ. .�.0..�'Uit Engineering Department (3rd floor): E�' � � House number p � NAM �' rb a. \e� .......................... . . ........... TC)O�ifAl ��GU �� a. Definitive Plan Approved by Planning Board ________________________________19._______ . 'LATIOhjc.) 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 �rx24..••.••. ` ''// TYPE OF CONSTRUCTION ....dCCQ.......... .... .. ... .. .. .......... ............19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .Z(P/......... ....... ...............% 4Vl.Y�..1... /................................................. ProposedUse .... ... .. .... .................................................................................L�� ,,�• ZoningDistrict ....'....................................................................Fire District ..........................................................................•.... Name of Owner .............Q ...R I�.................................Address .��P...(.....OX�........� t..Ml.C..�S Name of Builder....k+�C .M �-.. l��a...(,C�, . ....9? .. .N.. -......T74�� ' Nameof Architect ......INI ................................................Address .................................................................................... Number of Rooms ...... / .................................................Foundation .4...T�1 C-, .Wia�...�.�.�P��C.`�.� ....t�l�.�S• Exterior ....yl R!�. ......5!0(V.S.o..........................................Roofing .......... G�{- ............ .................. Floors ..............f,A/.,ib............................................................Interior ........ Heating ..........��! ........................I..................................Plumbing M/A� Fireplace .........N�0...............................................................Approximate Cost ....... 1.z y.. ... ...................... ............. Area .......�4....... ................ Diagram of Lot and Building with Dimensions Fee ...... ................................ y t -Z-7 SO I ' c It ;1X 14- o J M �0R4,1 / N o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I ! I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re g the above construction. Name ... ...... ..... ........ . C str tion Sup isor's License aZZ j ........ ROBERTS, M. E. No .... Permit for ...Build. Garacj�e. ........ ............ ...to Dwelling.............. .......................... ocation ....Q.1....d.....M...i.1...1.....R...o...a.d........ . .....................Mar.$.t.Q)as...Mi.11.s...................... .. ..... .... .. Owner ....... ....Ro.b.e.r.t.s......................... Type of Construction ..F.K.4M(P........................... ............................................................................... Plot ............................. Lot ............................... August 29, Permit Granted ........................................19 88 Date of Inspection .......................................1/9 Date Completed ........ ...... .........19 0 ILI C