HomeMy WebLinkAbout0213 WHISTLEBERRY DRIVE ��� 1��
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of +E Town of Barnstable *Permit# a o0
Expires$months from issue
• Regulatory Services. . - . ... .._._ F 0
...._; _
Geiler,Director
Building Division
-Tom Perry, Building Commissioner To� 9 �, �O a
•200 Main-Street,- Hyannis,MA 02601 f�/�� OS
Office: 508-862-4038 _
Fax:•508-790-6230 �(� :....... ...
• "EXPI2ES :��Ii MT AY'PUCA-TION - RESIDENTIAL ONLY.
Not Valid without Red X-Press Imprint
Map/parcel Number 0 /
Property Address 1%5 G
Residential Value of Work '6® Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 4 �iq�
a/--$ ,ov/ V�//_Zc-I g�e(z
—�'�� ��° ` Telephone Number
Contractor's Name
Home Improvement Contractor License# if applicable)
Construction Supervisor's License#(if applicable) n� ® ,
❑Workman's Compensation Insurance
r,heck one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation'Insurancee
Insurance Company Name > J '�7✓
Workman's Comp.Policy# �/�/^ Z/v � 3 e�e
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)
X 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 Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required. ,
Sigaa e
Q:Fo=:expmtrg
Revise063004
1 ,� fie TOruuea �✓ TIONS
BOAR O OF BUILDING
NS RUCTION SUPERVISOR
License. �
'Z. 3
M.
i - -QSO 19,
Birth e ,' 14085
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1aXpi�s' d$/922Q05 r.n
KfcYett`�:�=:� ; ;
THOMA TURC,K <Tf ;; . _
65 RED
TO ^w�`� Administrator
BREVNISTER, MA
071. �omv�noo o�./�aaoac�ivaelt2
Board of Building Regu and Standards
HOMEI OVEMENTIONT TOR
Re
/2006
YANKEE BU '
THOMAS-TURC. -
65 RED TOP:R[?
BREWSTER,MA 02631
i .Administrator
- The Commonwealth of Massachusetts
Department of Industrial Accidents
Office oflnuestigntlons
600 Washington Street, 7rh Floor
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit: Buildin /Plumbing/Electrical Contractors
:A .lic --.infariMafio Mr a/'
name: �l�� c5 77e / /}
address:
city state:-� zip: &ZA�,�phoone#c3rie.19
work site location(full address): Vv V��� ��Jie�1 ✓'�' �'eJ �s ���� t�(_(p��
:ill am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel
I am a sole proprietor and have no one working in any capacity. ❑Building Addition
t
❑ I am an employer providing workers' compensation for my employees working on this job.
comnanyaname..t�:.;..,.;�...�.:.v,,�a�:-�:a�s�.•�r •�'aN...._Ys.,�`.L_ai_..,k.y,.�'<,,.1'�...r,:ti_ .i.l.....,..(a 1... •
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r.tnsurance:cb, ,r �,,.�. .L#+:�t4.�+�«s�:.�.�� a�,t.>�,,wr''.Y�'`u_..«.3S�...•Yi.,?'S_se3:..-� '0"�1C..97i.3<.,_._',�".�s�:ue• <t..�.
e H. -g"• _ ,� *a. '•2. __ .may
I am a ole proprieto ,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the followi compensation polices:
.INPO� y.,e g ,� 3. h. 6
91 T
�com an name,
4
.:1 T. a z e. t rye, tia t y.
x y
address., <a ,� �_.. s
city,
• ' �/�t J i x
msura'nce..co. .�%4_'ate:_._ .�� 4 �_,. ,,,�✓,_,,,,is,,q .. et.i..�..T.,�.`a OIIC,x#....��.'.1,C-�.
companv:natne.. `
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d-
:address..:,.e:r . r.:: M�.F.. �.,•:�,:, ' 7
aII'`6ee flii�ecs � a -n. '
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the.DIA for coverage verification.
I do hereby certify un he pains and penalties of perjury t at the i1prmation provided above is true and co reef
Signature Date �
Print name C/•45%C' Phone#
officia7ck
do not write in this area to be completed by city or town official
city o permit/license# D
ment
rd
❑chediate response is required fice
entconta phone#;'
(revised
Y
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any
contract of hire,express or implied, oral or written:,: n
An employer is defined as an individual,partnership, association,corporation or other legal entity,or any two or more of
the foregoing engaged in a joint enterprise,and including the legal representatives of a'deceased employer,or the receiver
or trustee of an individual,partnership,association or other legal entity,employing employees.•However the owner of\a .
dwelling house having not more than three apartments and who resides therein,or the,occupant of the dwelling house of
another who employs persons to-do maintenance,construction or repair work on such dwelling house or on the grounds
or building appurtenant thereto shall not because of such employment be deemed to be an employer. '
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance.coverage� Also be sure to sign and
date the affidavit. The affidavit:should be returned to the city or town that the application for the permit or-license'is
being requested, not the-Department of Industrial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' compensation policy,please call the Department at the number listed below.
.4IN wf(. _ +s"•^.vi ::?15 ` .3-fir j L b -� ...
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:.-
5
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street,71'Floor .
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext. 406
AGREEMENT
Thomas L. Turcketta
d/b/a/ YANKEE BUILDERS
65 RED TOP ROAD
BREWSTER, MA 02631
508-385-3972
Construction Supervisor Home Improvement
License #029893 Contractor Reg 9 110 124
DATE:3/7105 JOB NAME Same
SUBMITTED TO:Brian Childs&Jan Epstein JOB LOCATION Same
ST'REET21.3 Whistlebetry Dr. JOB PHONE Same
CITY, STATE, "LIP Marston Mills, Ma. 02648
PHONE: 1-508-4284044
APPROXIMATE STARTING DATE: 515/05-or sooner
APPROXIMATE COMPLETION DATE:8/1/05
Description of Work/Project:Replacement of cedar shingles,and reattach the existing deck.
SEE ATTACHED SPECIFACATIONS.
We propose hereby to furnish material and labor—complete in accordance with specifications provided, for
the sum of: THIRTY TWO THOUSAND--TWO HUNDRED&NINTY SIX DOLLARS
Payment to be made as follows: DOWN PAYMENT OF $11000.00 PRIOR TO START. $5000.00
AT THE END OF THE FIRST WORK WEEK.>3 < PROGRESSIVE PAYMENTS OF$4355.67 TO
FOLLOW UPON REQUEST OF THE CONTRACTOR UNTIL A BALANCE OF$3229.00 IS LEFT AS
THE LAST PAYMENT TO BE MADE UPON COMPLETION.
All material is guaranteed to be as specified. All work to be completed in a workman like manner according to standard practices.
Any alteration or deviation from specifications below involving extra costs will be executed only upon written orders or verbal
agreement and will become an extra charge over and above the estimate. All agreements contingent upon strikes.accidents or delays
beyond our control. Owner to carry tire,tornado and other necessary insurances. Contractor to carry necessary insurance.
` Authorized Signature:-.- _ +_
Note: This proposal may be withdrawn by us if not accepted within 15 days.
Cancellation: Owner has an unconditional right to cancel the Agreement,without penalty or obligation,until midnight of the third
business day after the Agreement was signed. Cancellation must be done in writing. Upon cancellation,any property traded in,any
payments made under this Agreement,and any negotiable instrument executed will be returned within 10 business days following
receipt by the Contractor of cancellation notice.
Acceptance of Agreement
A(ITMORIUDSIGNATIIRE DATE WNE SIGNA E 'fAPT Fglye'
029893 /
CONTRACTOR LICENSE NO. SIGNATL A
�pFt roh� Town of Barnstable *Permit# 75 Soo
p� Expires 6 months from issue date
�nnxsrnste, : Regulatory Services Fee SM , 07
Thomas F.Geiler,Director �®�
t639. �0 ,
A'EDN10`� Building Division
Tom Perry, Building Commissioner. NJAPER U
200 Main Street, Hyannis,MA 02601 7-0VvIV R � �.2004
Office:508--790-6 3038 OF
Fax: eARA1S FA t
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY TABLE
d 6 2 Not Valid without Red%Press Imprint
Map/parcel Number � Lo /4:�—.
Property Address 36
Residential Value of Work 1,�&
Owner's Name&Address iv/tJal,00�
000,
Contractor's Name, Telephone Number
Home Improvement Contractor License#(if applicable)Construction Supervisor's Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
ti l am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
L+G
Insurance Company Name
Workan's Comp.Policy#�C� �
m
Permit Request(check box)
_,ErRe-roof(stripping old shingles) All construction debris will be taken to
El Re-roof(not stripping. Going over existing layers of roof)
Re-side, spa sn �je� "�p
❑ 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 Owner must sign Property Owner Letter of Permission.
'11ome Improvement ct se is require .
Si e
Q:Forms:expmtrg
Revise053003
AGREEMENT
�e•✓��•gG�,� �� Vfjomas .�e. 'Furcftetta
d/b/a YANKEE BUILDERS
65 Red Top Rd. Brewster, MA 02631
508 385-3672
Const.Reg#110124 Const. Suprv.Lic.#029893
DATE: Oct.20,03 JOB NAME Childs&Epstein
SUBMITTED TO:Brian Childs&Jan Epstein JOB LOCATION 213 Whistleberry Dr.
STREET: 213 Whistleberry Dr. JOB PHONE 1-508-428-4044
CITY, STATE,ZIP Marstons Mills,Ma. 02648
PHONE: 1-508-428-4044 Q
APPROXIMATE STARTING DATE: l93
APPROXIMATE COMPLETION DATE:02/28/04
Description of Work: Contractor will famish all materials,permits and perform all labor in a good,workmanlike and substantial manner for the following described
project upon the following described property:
Description of Project.Replacement of all roofing materials,and tlashings.To replace siding on all roofs cheeks.To replace all aluminum gutters and wood
facias.To install round louver vents in soffits.To vent the ridge.To step flash under the existing chimney flashing and seal the existing tlashings down To seal
the chimney with a masonry sealer. SEE SPECIFACATION sheet
i
I
We Propose.hereby..tafui'nish material and labor-complete in accordance with specifications provided,for the sum of:
dollars($25612.00 )
Payment to be made as follows: $8500.00 down prior to start,3 progressive payments of$5000.00 each upon request,and the
balance of.$'2112.00 to be paid on completion.
All material is guaranteed to be as specified All work to be completed in.a workmanlike manner according to standard practices.
Any alteration or deviation from specifications below involving extra costs will be executed-only upon written orders,and will
become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our.
control. Owner to carry fi tornado and other ne insurance. Contractor to carry necessary insurance.
Authoriz e
Signa..
Note:this proposal may be withdrawn by us if not accepted within 30 days.
Cancellation: Owner has an unconditional right to cancel the Agreement,without penalty or obligation,until midnight of the third business day after the Agreement was
signed Cancellation must be done in writing. Upon cancellation,any property traded in,any payments made under this Agreement,and any negotiable instrument executed
will be returned within 10 business days following receipt by the Contractor of cancellation notice.
Acceptance of Agreement:
14 5_00
AUTHORIZED SIGNATURE DATE OWNER SIGNATURE DATE
CONRACTOR LICENSE NO. G ATURE DATE
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Reg. No. Applicant Street City State Zip Name lExpiratio7n
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110124 YANKEE RED BREWSTER MA 02631 TURCKETTA, OWNER 10/6/2004
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BBRS Privacy Statement
http://db.state.ma.us/bbrs/hic.pl 3/12/2004
03/11/2004 18:52 5083853672 TOM TURCKETTA PAGE 01
AR WCIP Liberty
ISSUING OF•FiC:E 3$4 IP mutwu-- Workers Competsation and
INFORMATION PAGE Employers Liability PoUt:y
ACCC)UNT Nn SUB ACCT NO. Liberty Mutual Insurance Group/Boston
>-32132 t.y INSLRAINCE CORPOWLTto� - -----___-- .—Y—
I� POLICY NC). �TD/CD SALES OFFICE ICC.)DE SALES REPRESENTATIVE C:ODE�N/R ST YEAR
I WL5-31S-3215234)13 XX X WESTON 102 AQ ll(;NED 31i00 2 20010 --
ltcm 1.Name of THOMAS TURCKETTA
insured DBA YANKEE BUiLDERS FEIN 04-3033887
Address 65 RED TOP RD
RISK 11) 137841
BRE;WSTER.MA OZ611
Slatus 01 INDIVIDUAL
Other workplaces nut shown.abclvc: SEE ITEM 4 ------�----� --Al. Year hay Year Mu iT,ay Vel,
Item '_.Poliry Period: From 04-14-03 10 04.14.04
12:01 AM standard timc at the address of the insured as staled herein.
Item 3.Coverau.c
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of t.h%r
states listed here:
MA
B. Employtrs Liability Insti rance: Part Two of the policy appliesto work in each state lisl.cd in item 3.A.The limits
of ottr liability under Pan Two arc:
Bodily Injury by Accident 100J" each accident
Bodily injury by Disease 500A60 policy limit
Bodily Injury by Disease 100,000 each e:rnployec
C, Other States Insurance: Part Thrce of the policy applies to the states. if any,listed here:
SEE END WC 20 03 06A
D. This policy includes iheso eadorscmchis.and schedules: SEE EX-rENSION OF INFORMATION PAOiE
twin 3. Premium - The premium for this policy %vitl he dctermimA by our MantlalS Of Rule`, C lassificaiions. Rairs and
R;Iling Plans. All inkirmation required hcllrw i., -,uhjcl,t iover•i1•ication and chemise by uudit.
• !' ':ninmk:c.p. ._..Itrtl_._-. � i-in� t 1U
� I;,hmrlt;J 1 1'c•r�IOfI t..,urn;:�aW
I'Aat,\ wal nl K'.-.
CkoNiflcutioIII' — `a. j Krmunmuur.n rouncruiian I ...Vrcmium,
-- -------- ----__--- - -------...-- t-----t— ----- -- ....,.1._....._....__. --.....................
SEE. EXTENSION OF INFORMATION PA(iE l I
t
I '
Mio.imum Premium $ 500 ( MA) Total Estimated Annual Premium $ 517
Interim adjustment of prcmiumshall be made: ANNUAL
This lloliev,including allcndorsemcnts issued lhe.r.with, is herehv countcrsiuncd by SEE ATTACHED FORM 1710
- ............. nr7V0 R.l'tlrrr.a'41 A11a 11xlY IN.lr l-ell
i u: Code j TCPIU. (Iprr. JAudil Hmj% I F4ri�alil Pflv1De111 j R.glny.I;MSh Plrl.:If.i. I t•1!rtl1E.l'wi1C !)IviJcaJ RENEWAL OI•':
1 05.02.03 1 I I NR I : MA J WcI.31S-321511-01.:
QP0 44)30 R.1. Copyright 1987 National Council on Compensation Insurance wcoo wi,I A
ry3U11NU v0A'r
03/28/2005 13:21 5083853672 TOM TURCKETTA PAGE 01
vo;toicVva QV:u4 FA1 508430-n12 ROSEWOOD FAX
03/29/2035 12:36 5883853673 0q1
TOM TUZCKE T TA p 81
I
TOWU of Barnstable
'�o�8erty, � alp •.
Fax: 501400.6230
506462-4033
Ptopedy ownerMust
Complete and Sip.Tbb Section
if UsWZ A Builder
Owwx of ehe subjed pzAp2�7
�,eaeby�►u�hes�s; .
mlaftouf0r, .
e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map dG.?D// Parcel �-r Permit
Health Division 2J.21161 S Date Issued
Conservation Division Z ZY to.3 Application Fee J
Tax Collector Ai A 3 Permit Fee
SEPTIC SYSTEM R`,UST BE
Treasurer a;iajJ INSTAL LED IN COMPLIANCE.
Planning Dept. WK TITLE 5
CNViRONMENTAL CODE AND
Date Definitive Plan Approved by Planning Board TOYYM REGULI-TJONS
Historic-OKH Preservation/Hyannis n o 0 qd4o^A� 14.C&Ah S
Project Street Address ✓� e.�� i
Village
Owner �iQ�i9�C/l�e �/���5'r��� Address���`��s'��
Telephone /d 8 ' f�Pc 0
Permit Request �o}-�
S���iG i.tJ7'1C�L3�i (//�S � �o r✓J o
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
r Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
'O Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
v Age of Existing Structure Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _
Number of Baths: Full: existing new Half: existing new
2 Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
d
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
----�� /> BUILDER INFORMATION
Name //Pods_._ T.�o-�� i� Telephone Number1�1��� �= _
Address T/J � License#
&-a. 16' c //J D A/ Home Improvement Contractor# Ile/Z
Worker's Compensation# /,5-3z g3-D/Z
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNAT DAT ..� D
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED '
MAP/PARCEL NO.
41
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL,'.
9
PLUMBING: ROUGH FINAL .
GAS: ROUGH ' FINAL ,
FINAL BUILDING
r
DATE CLOSED OUT
ASSOCIATION PLAN NO.
y
The Commonwealth of Massachusetts
°Department of Industrial Accidents "
office 01/nyesti9ati8ns ,
600 Washington Street
Boston,Mass. 02111
J Workers' Compensation.Insurance Affidavit
name: T /U
location:
city .6ecv
am a homeowner performing all work myself. '
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
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gcom an mine. -G... A Js: Lr�' r,r '"''..A. '�'�°�'r+ �s ' tc `FG? .srn ;W'ti'� e$ i•ara�;.. h.,,o-��ro'fid`r" •F..`xau•jP,r� `' '
.p ys ,lv- ... fy; +, As'r y. .'may„" 1 4 + 1 ot.. 'err a +t£+�`ro`,-� E ,eg[�,�i '4-i `''`."-S„}*�;, �'"
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p9c`����.Fl �$'�ai4xt" .z�r�*E,y?h�al��r�,'Jc ��A �k�.+r,�''SFt sYv"2�urtw'-4.�`t � �` '",.1.�' �, .G.•'.}r � ei �-
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'losurance�co��� I „.� .k�'" �.•r::.+e.U3 � i"�,".•"7� �Jn�.�«�£'1� �, 1:. .PO.IICV,t#�.,,:�, h3x ��i'-1�wy ' �s``F. c.�,!rr':�c,.�_.s BEEN
I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers compensation polices:
`•,' n ., u-•r r P.. 'a
Y V•' ,: ^5F ,,,�Eytf,'S} r;'E3C i; cC+� v ." v-p¢ ..(-vs c� '•r
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p +: "�' >yhyhr ".rC{"�j�3,¢'�yrb+',ti` ;�.'c x1,�' �' +� }f yM}.'J','` yes �Y
.p?•3 :' a .»...S 9 R J4u� t�"x�7fi�"bec��%�'�C�7�v1./i >�%� e4 *L.,. yx{� 'N ��^ k_" 7� ��L•'iE �^� _, k. �:
co.m an :name -1 ME x -�
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�.� ',fix r L� - 7� �wx�''7 r c, �,.r"'K•.mu'��z.ai.'F'c�"�+ta� a 3 ��� � � c�` ! - x'� .? �, ..�'-y�� i�'_ �;.
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�Insurance�co � �,�"���TM �.�' s�v�'.`,,,, �, � ���.��s�, -li��w•,.z;P Ilcy#��:. .�,��c.:��,._. ,�� �b.� �;..v,..�s .'t`,...,,r.....;
mom
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition o[criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under t pains and pen° 'es of per' that the inj mation'provided above is true and correct.
Sign Date
Print name S '� Phone# Z-
official use only do not write in this area to be completed by city or town official
city or town: permit/license# nBuilding Department
❑Licensing Board
check if immediate response is required ❑Selectmen's Office
Health Department
contact person: phone#; nOther
I
(revised 9/95 PIA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any
contract of hire,express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of-this chapter have
been presented to the contracting authority.
_s
Applicants
I
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and'
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out.in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not 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
-fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406
I
°FINE Tp� Town of Barnstable
�-��
Regulatory Services
RAW�9 Mkn Thomas F.Geiler,.Director
`bprE16 o.�6. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-403 8 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type.of Work: Estimated Cost c O
Address of Work: a�' '1 De '000 �, �9V9 , 5 /V//5
Owner's Name: A4�1
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
OWork excluded by law
❑Job Under$1,000
Building not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date ===Contractor Name Registration No.
OR
Date Owner's Name
i
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONSIRENOVATIONS OF EXISTING SPACE
ode •
square feet x$64/sq.foot= 964 x.0031=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0031=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0031=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00=
(number)
Fireplace/chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable)
Permit Fee � Q
710 C2AK Appmiix J
Table J5.2.1b(continued)
Periptive Packaged far One and Two-Family Resfdentiai Buildings Heard with Foas►1 Fuels
rn
MAXIMUM MINIMUM
�VaII Floor Baseraeas Slab •Heating/Cooling
a�g Olaung Ceiling - perimeter Equipment EJEciencys
Aron'(%) U-value= R-value' R-value' R-valuor Rvaluues R-valuer
Package
5701 to 6500 Heating Degm DayO Naruial
6
Q 12% 0.40. 38 13 19 10 6 Normal
R 12% 0-52 30 19 19 10 85 AFUE
6
g 12% 0.50 38 13 19 10 N/A Normal
T 15% 036 38 13 25 N/A
6 Namtal .
U 15% 0.46 38 19 19 10 --- 8S AFUE
y 15% 0.44 3E 13 25 NIA iS AFUE
�y 15% 0.52 30 i9 19 10 6 N/A Normal
X 19% 032 3E 13 25 N/A
19 2S N/A NIA Normal
y 18% 0.42 3E 6 90 AFUE
Z 18Y. 0.42 3E 13 19 10 6 90.AFUE
AA 18% 0.50 30 19 19 10
1. ADDRESS OF PROPERTY: �v C
2. SQUARE FOOTAGE OF AL
L EXTERIOR WALLS: —&7
3. SQUARE FOOTAGE OF ALL GLAZING:
4, %GLAZING AREA(#3 DIVIDED BY 92),
5. SELECT PACKAGE(Q --AA-see chart above):
NOTE: OTHER MORE INVOLVED A INF DETERMINING
ORGY REQUIREMENTS
ARE AVAILABLE. ASK U OR THI5
i
BUILDING INSPECTOR APPROVAL:
YES: N0:
q-forms-580303a
780 CMR Appendix J
Footnotes to Table JI .2.Ib: lass doors, skylights, and
•1 Glazing area is the ratio of the area of the glazing assemblies (including sliding-g
basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall
area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement.
For example, 3 f?of decorative glass may be excluded from a building design with 300 ft of glazing area.
= After January 1, 1999, glazing U-values must be tested and documented bythe manufacturer in accordance with
g Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
the National Fenestration Ratin
whole units: center-of-glass U-values cannot be used.
3 The ceiling.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 may be 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 placed between
the conditioned space and the ventilated portion of the roof. used includ
4 Wall R values represent the sum.of the wall cavity insulation plus insulating sheathing ('if ). Do not
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-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction.
s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements,
or garages).Floors over outside air must meet the ceiling requirements.
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
d-rscribed in Note b.
'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes electric resistance heating 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 15.2.1a
NOTES:
a) Glazing 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 0.35. Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available,include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
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(0,35 for doors).
AGREEMENT - .. .
�'fjomas�. Q�urc�ctta
&Wa YANKEE BUELDBRS,
65 Red Top Rd. Brewster,MA 02631
508 385-3672
Const.Reg#110124 Const.Supm Lic.0029893
DATE: 12/1 /02 JOB NAME Same
SUBMITTED TO: Brian Childs& Jan Epstein JOB LOCATION Same
STREET: 213 Whistleberry Dr. JOB PHONE Same
CITY, STATE,ZIP Marston Mills,Ma.02648
PHONE: 1-508-428 4044
APPROXIMATE STARTING DATE: I/13/03 -2/ 1103
APPROXIMATE COMPLETION DATE:6/ 15/03
Description of Work: caooada will fitram all matariala permRs and perform all tabor in a good,woriananlike and substen al mumer for the following deer►bad
projed upon the following daerabad prrope .
D"04*0o of Pwjeet: SEE SPECIFICATION SHEETS FOR DETAILED EXPLANATIONS OF KITCHEN&
DININGROOM REMODELING INCLUDING KRAI�TMAID CABINETRY AS LAYED OUT ON PLAN,WITH
DUPONTS ZODIAC COUNTERS,AND CERAMIC TILE BACK SPLASH. FIRST&SECOND FLOOR BATHROOM
REMODEL EXTERIOR& INTERIOR DOOR UNITS,TRIM INSTALLATIONS,AND PREFINISHED HARDWOOD
FLOORING ON FIRST FLOOR INCLUDES ELECTRICAL&PLUMBING. THE BRANDS AND CODE NUMBERS
ARE LISTED ON SPECS. NO PAINTING IS INCLUDED AT THIS TIME.
We Propose hereby to furnish material and labor-complete in accordance with specifications provided,for the ram of:
EIGHTY THOUSAND TWO HUNDRED&TWENTY THREE dollars(S 80223.00 )
Payment to be made as follows:DOWN PAYMENT OF S 16223.00 PRIOR TO START. S 15000.00 AT THE END OF THE
MST WORK WEEK. PROGRESIVE PAYMENTS TO FOLLOW UPON REQUEST OF THE CONTRACTOR
UNTIL A BALANCE OF S 5000.00 IS LEFT AS THE LAST PAYMENT TO BE MADE UPON COMPLETION.
All material is guaranteed to be as specified All work to be completed in a workmanlike manner according to standard practices.
Any alteration or deviation from speffmations below involving extra costs will be executed only upon written orders,and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner.to carry fire,tornado and other necessary insurance. Contractor to carry necessary insurance.
Autho '
Sigaa
Note:this proposal maybe withdrawn by us if not accepted within_10 days.
CneeUSUMV Owner has an unconditional rift to caned the Agteanma,withoad penalty or obligWoo,until midnigrt ofthe third business day after the Agreement was
signed Cancellation must be done in writing Upon canodlation,any property traded in,any payments made under this Agreement,and any negatiable Wtruma t eraartad
will be retained 10 busiam days following receipt by the Contractor of cancellation notiea.
Acceptance of Agreement;
1 5' t3
AUTHO OU&NAMURE DATE OVINERSIONATURE DATE
CONRACTOR LICENSE NO. SIGNATURE DATE
• ��ze T000rvnzaruvea`lli a�./�aaaac�iuoP,lYa
_ BOARD-OF OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR f
Nwmber&LC3 S� 029893
tom---
B-irrtfidaYe`0�8/4._-2�95r p
Ei-prres: 02 2003 Tr.no: 1464
Rest\\\rlcted t00=
a; TH;OMAS L TURCKKE
65 RED TOP RD
BREWSTER, MA 02 Administrator
c
✓�ie >°omvrnroruaea�l� a�✓�aaaac/ucaeka�
s.>
Board of Building Regulations and Standards .
HOME IA&PF OWEMENT CONTRACTOR
Re ss?r f_W-n_p�24
1
Expan=r0P%2004
~�
Y; ti�fCLE$UILDE�,
-V.!-i`AAS'TURCK.
r z:N'S7 qR;-MA 02631 NN IT,g
i
�F1HE Tpk Town of Barnstable *Permit# G S 9
Expires 6monthsfrom issue date
y
BSrAB Regulatory Services Fee o
v X"SS• Thomas F. Geiler,Director
TED MAC Building Division X P
Tom Perry, Building CommissionerRes'sPsnjr
200 Main Street, Hyannis,MA 02601 JAN 2 2
Office: 508-862-4038 TpVj ?��'�'
. A1 OF BA
Fax: 508-790-6230
EXPRESS PERNUT APPLICATION - RESIDENTIAL. ONL STABLE
e) 6A / Not Valid without Red X-Press Imprint
Map/parcel Number �/ Al/S�
Property Address �&•3 �'•S'T/GQ�G�P� �/��P �I/S �i�/ ��� 0 ��
EVResidential Value of Work
Owner s Name&Address
Contractor's Name.�/pgs�/y�Ule `�� ��C��'i� —TelephoneNumber
Home Improvement Contractor License#(if applicable) "age���oC.,
Construction Supervisor''s License#(if applicable)
❑Workman's Compensation Insurance
Check one:
1 I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
.Insurance Company Name / �+ '
Workman'sComp.Policy# �4 -0ZIS_'Z3—
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. U-Value (maximum.44)
❑ Other(specify) ifYiS/'N •� '�
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signatft,e
Q.Forrns:expmtrg
I 01/22/,2003 09:54am From : KATHL_EEN W . KENNEY, INC. Page 001 of 002
AC®RD,m CERTIFICATE OF LIABILITY INSURANCE DATE
' 07/25/2002
PRODUCER THIS CERTIFICATE I8 ISSUED AS A MATTER OF INFORMATION
Kathleen W. IC=ey IRCOrpOYatOd InsurariCe Ag0n0 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
120 Main Street, Suite 101 ALTEr THE COVERAGE AFFORDED BY THE POLICIES BELOW. _
P.O, BOX 1 INSURERS AFFORDING COVERAGE
West Harwich MA 02671-0001
114SURED !Fi;;IRrRn ARHELLA PROTECTION INSURANCE _
THOMAS TURCAETTA NSU!•:t1:N:LIBERTY l+JJTUAIL INSURANCE CCNRANY
DBA YANKEE BUILDERS Nsr•!at1:c _
65 RED TOP ROAD IN_:u::I•.I!U:
BRE'WSTER MA 02631- --_--
COVERAGES
THE POLICIES OF III SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR'THE POUCY PERIOD INDICATED.NOTWTHSTANDING ANY
REQUiRE49JVT,TERM OR CONDITION OF ANY CONTRACTOR OI-HER DOCUMENT)PATH RESPECT TO VIHICH THIS CERTIFICATE MAY PE!SSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNti4. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS
LTA DATE MMlDCrYY' QA.TE MM/DD/YY
A
GENERAL LIABILITY I-A:ll:_ccuF rJr:r_ 1^1 1,00t,000
t-UMN hhA_UA8iU iY I i•I I{-i,A.6+.At-t 1Any 01B nfd) r 100,000
Cl niN-LJnr,r O,:G),{ 8500013"80 08/07/2002 08/07/2003 Nrr rry(nvr:,•m Ia:r,rr) 5,00C'
_ I'1:160NALt-A:VINAIRY 1,000,000
/ / / / lrur,nl Ar,:iaric�Tr 2,000,000
i:tutrCl_:It:1AI_uvn;AlPuaSPtN RFi,nuc.Ta C.i•N�JiIPr r, 2,000,000
PP6
AUTOMOBILE LIABILITY
C i,MRIIIi'i;INtii r I IMIT
ANY AUTO, Ir•,:u•ritl::ni)
ALL WV111:1)AU IVS / / % / --
DODII'r iN•IIIG"
snimU1 rr..AUTn^ r�•i pi.ra,n!
HI!tL;A)IG& / / / /
PFOP-RTY")"WAG-
GARAGE UABi LITY Al.I U ONLY•to M C'I)L'4 1
ADY.AU10 / / / / r)IMI:R THAN tAA�•C.. :+
Al.100NLY' �—
,ili::
EXCESSLJABILITY / / ,/ / �AGH OGGCU=I+tNC _
i is f:.1R i.!•tl 11 F.wkr,r AC:G{tt,n t
9-TrtITICItl
8 WORKERS COMPENSATION AND 04 19 lYI'S1p.RI• 01r'.•
EMPLOYERS'LIABI�ITY / /2002 04/14/2003 !t)I'YLMIIL t�!
TO BE MAILED FROM / / / / r! mr-i W I-A-MFICPrr-S
COMP.NY -L.DI`t4;t•I'ULICYUMI! --
OTHER
DESCRIPTION OF OPERATIONSA.00ATIONS/VEHICLSS,EXCLUSIONS ADDED BY ENOORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER, CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE 16SUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAKED TO THE LEFT,BUT
Town of Barnstable FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AM:'KIND UPON THE
Attn: Building Department INSURER,ITS AGENTS CR REPRESENTATIVES. _
862 Main Street AUTHORIZED REPRESENTATIVE
Hyannis MAL 02601- "-
ACORD 25•S(7/97) x ACORD CORPORATION 1988
INS0255(y:i U)Vi tLtCiR-')NI:.LAL' !! Q RM`_,INC.•(tl9UW1/-i:vC;•. PL;Je 101:
t
— BOARD OF BOIL•DING REGULATIONS
License: CONSTRUCTION SUPERVISOR
ERVISOR r e
Number-frC.S� 029893
r
{ Blrt.d asia.�
' - - 5
s _
E fires 08`02 003
P.,; Tr.no: 1164
TH.OkfAS L
1 65 RED TOP
BREWSTER,
Administrator
i � ✓�ze �omvnwouuea� a�./�aaoac/ucaeCla
Board of Building Regulations and Standards
HOME IIVEMENT CONTRACTOR
Re is7
72004
.ARK* EE AUILDE~
NIV
WAG-t-iff CIC 's^ je,r
�*r'�.,;L11SR',:M3�02631 '�;�vn`eii9�tc" r
Assessor's map"-and lot of ber/.f'j.�o ....L
S - 14/1 .. ./y—j,v Q�OFT EtO�I
Sewage Permit: number .........`...............................................
13AHB9TADLE, i
House number. ........................:............-....... ro NAB& �9
O a 39• �0
p MAY f►
TOWN OF BARNSTABLE - -
BUILDING INSPECTOR
'APPLICATION FOR PERMIT TO ;`..1...>�,J..1.............................................................
............................................
�'�6 ��
` TYPE OF CONSTRUCTION` .........�.........�......... ...........................................................................
........................ /�................19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for/a permit according to
, -- tafollowing information:
.C4....Location 1 I I
...;....:.. .!.l l.......................
Proposed Use ...\. .1 ....}..�aALY.1.!... .ul...... ._.X� . ...............
ZoningDistrict �u ... . .,...... �...,.... .... . ..-., ............................Fire Distract ..........�..�......................:................................
/�C��t/ ��... ., ` Address /d 7 ./.: / OU, �1 ��J. *WI-7
Name of Owner ......... ............... . ........... .............. ............... ........ ...... <..
Nameof Builder .............Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ........ ...:...............................................Foundation ,/ (� tY � .....�I.^..v_..(............... ... ...........
Exlerior .' � 1Q. .. r... �� .......Roofing ........ ...........................................
Floors ....... �{�c�. ../a.!!CS�../`....Interior ....... !... .. .'..`..............................................
Heating ..........Plumbing .:../-.....6 .......................
Fireplace ...�%� � f U..........................................Approximate. Cost ... .. ..........................,...:.............
Definitive Plan Approved by Planning Board -----------_.-__-_-----------19-------- ° Area ....... .... .. :....,.... .... L
Diagram of Lot and Building with Dimensions Fee ........... ........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH )/�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 .. :... \:.. ''`' ............................
Construction Supervisor's License .................
CREATIVE HOMES' A7--62-11
No ..... Permit for ...:AR t9-KY............
.......................
..Rglq..E ly..��Ij
Location 2i5W1U5.tjeb-e);xy..Drive
................Vbxs.torls..k4lig................................
Owner
Creative Homes
..................................................................
Type of Construction Frame.........................................
................................................................................
Plot ............................ Lot ................................
Permit Granted .... 151..............19 84
Date of Inspection ....................................19
Date Completed ......................................19
I"g
� M
TOWN OF BARNSTABLE Permit No. ---26843_
= Building Inspector cash
- - --- - -
OUL
OCCUPANCY PERMIT Bond ___________� � ?
ls.,vrd to Creative Homes Address
,ot 15, 213 'Whistleberry Drive„ Marstons IRills
Wiring Inspector Al �f��,� Inspection date
Plumbing Inspector:- / Inspection date /
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.
/ � � r
Building Inspector
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..�� '�• TOWN. OF BARNSTABLE
°`��� BUILDING DEPARTMENT
s �T TOWN OFFICE BUILDING
t6J9. � HYANNIS, MASS. 02601
�OIIAY M.
MEMO TO: Town Clerk
FROM: ' Building Department
DATE: /A-;27$.�
An Occupancy Permit .has been'xissued for the building authorized3b
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BuildingPermit -3__....._......._.............................................................................. ..._..................... .
issued to ......_. __... __. .......a_Z40 ... ...................._.......... .................:. . .
Please release the performance bond. j
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-AAbssors map and lot u ber4U .................1........ �THETo .,
- y- � Is - ��� . �' _ �y- � SEPTIC SY E
Sewage Permit number ........................................................ '. _ 1NSTgLLED
W T LE, CE
House number ..........................a./....... ........ .................... , . EN�RONME
TOWN PEO c AND
TOWN OF BARNSTABLE �
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .`4l.JL�.�..1l .. ........................... ............................... ........... ...
TYPE OF CONSTRUCTION ......Zi~?.C?...... f = ............................................................................
.............19. .
ti l
' TO THE INSPECTOR OF BUILDINGS: ` 't
The undersigned hereby applies for a permit ac ording tot following information:
Location ....�L C� �. ...
ProposedUse '.6'...E". .►..V. ...... 4`.1.n- ............... .................................... .............
Zoning District ...... c
.���(J V' � ............................Fire Distract .......... ... .......................................................
'lam-Tf ,... ?� ,�. /d!.�
Name of Owner ..... ............. .............Address ......... .... .�..
/
Name of Builder .e C�5,41 ..Pe...4AOV.7,.............Address `.................................................................................... .
Nameof Architect ..................................................:...............Address .....................................................................................
Number of Rooms ........... ...................................................Foundation
Exterior ......Roofing ........5=4 \ ...........................................
Floors ....... I. ..rLl(.�.t�- .. .!! ./......Interior ....... .... c...................................................
�,G r
Heating ................ /�/.. ...,1.....�....t/..................Plumbing ....C.,.r.... .. ................................................
Fireplace ..../).r. . ............................................Approximate Cost .. ,��..�..� . ....................................
r
Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area ..........
Diagram of Lot and Building with Dimensions Fee S
SUBJECT TO APPROVAL OF BOARD OF HEALTH
't
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 ............................
- � QQ q
Construction Supervisor's License Qf/.. a.................
\7
CPZkrIVE HOMES
•
26843 TWO S
No ................. Permit for ................�93
.T.............
Sinsrj,e..E ly..pwgl! g.....................
Location ;PLI .e.....;?0. t!e]X.n;y'..Djkve
...............Mars s Mi .................................
Owner ..Pe4tiW..HO.W.P.................................
Type of Construction ..aaM.............................
................................................................................
-plot ............................. Lot ................................
Permit Granted ...Augus.t 15. .............19 84
..........
Date of Inspection ......................................19
Date Completed ...... .... .....0................19
.