HomeMy WebLinkAbout0052 WREN LANE 1
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CAPE. COD
IENEROY SOJLll.Y ONS
378 Route 130
Sandwich,MA 02563
PH:774-205-2001•844-90-AUDIT
Permit Affidavit
Permit M,B-19-1396
I,Craig Bishop,confirm that the weatherization and air sealing work completed at'.52 Wren Lane
.,has been completed in accordance with 780 CMR.
Sin r 1: ` - 5/23/2019
g nature: Date.
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Town of Barnstable Building
Post This Card So•That it is Visible From the Street-Approved Plans Must be Retained on lob and this Card;Must be Kept
MA Posted Unti[Final Inspection,Has Been Made. Permit
lb3a
3► Where a•Certificate of.Occupancy is Required,such Building shall Not be Occupied until a Final Inspection'has been made.
Permit No. B-19-1396 Applicant Name: Craig Bishop Approvals
Date Issued: 05/01/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 11/01/2019 Foundation:
Location: 52 WREN LANE, MARSTONS MILLS Map/Lot:_029-024 _ �Y Zoning District: RF Sheathing:
Owner on Record: BROWN,ANNEMARIE -v Contractor Name: Craig P Bishop Framing: 1
10 Contractor License: CS= 9777
Address: 52 WREN LANE � 2
MARSTONS MILLS, MA 02648 Est. Project Cost: $433.00 Chimney:
Description: Insulation ( Permit Feie: $85.00 Insulation:
Fee Paid: $85.00
Project Review Req:
Date: 5/1/2019 Final:
Plumbing/Gas
Rough Plumbing:
,Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this ms permit is commenced within six months after-issuance..
All work authorized by this permit shall conform to the approved application and the`approved construction docuents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and st uctures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas:
work until the completion of the same.
----- — --� Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection __ , -— - Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
I
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Town of Barnstable Building
Post This Card So That it is Visible From the Street-,Approved Plans Mustbe Retained on Job and this Card Must be Kept
tz� Posted Until'Final Inspection Has Been Made. _ Permit
63P
at' Where a Certificate of Occupancy is Required;such`Building shall Not be Occupied until a Final Inspection has been,made.
Permit No. B-18-2126 Applicant Name: Craig Bishop Approvals
Date Issued: 07/30/2018 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 01/30/2019 Foundation:
Location: 52 WREN LANE,MARSTONS MILLS M_ ap/Lot: 029-024 _ Zoning District: RF Sheathing:
(T�
Owner on Record: BROWN,ANNEMARIE Contractor Name: Craig P Bishop Framing: 1
Address: 52 WREN LANE Contractor License: C5-109777 2
MARSTONS MILLS,MA 02648 ` Est. Project Cost: $ 1,455.00 Chimney:
Y
Description: Air Sealing&Weatherization Permit Fe: $85.00
Insulation:
Project Review Req: Fee Paid; $85.00
Date: 7/30/2018 Final:
Plumbing/Gas
Rough Plumbing:
g
�----- �� \Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'Six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and st ructures shall be in compliance with the local zoning by-laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for.public inspection for the entire duration of the
work until the completion of the same.
--, — Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service:
i Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy �� Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel U 'I Application # D
{
Health Division Date Issued y�
Conservation Division V'" Application Fee T V
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
,
Project Street Address 5 a (,J R, n1 )-R rJ e
Village n► R � STbtJS I'�� ��S
Owner hN N eM AAie -BRy LJN SAN +0&'� Address W2'_Yi
Telephone 50 g ' cZ S " 7 7-3
Permit Request ' 19±1oZp h e o�
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Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
F ,
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If-yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (## units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other
i
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
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 ❑ _.
• w m
Commercial ❑Yes ❑ No If yes, site plan review # -�
Current Use Proposed Use _"-�
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
NameA Telephone Number SD 8 as r 8
Address o e. License #
ImprRST-Or')s M< `i 5 tn IR Q a-� �-( � Home Improvement Contractor#
,
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE ( �'' DATE
y,
yy FOR OFFICIAL USE ONLY `
APPLICATION#
< r
DATE,ISSUED �
MAP/PARCEL NO. _
ADDRESS VILLAGE t
OWNER
DATE OF INSPECTION: . f
6J FOUNDATION - �=
FRAME
INSULATION
FIREPLACE i
J
ELECTRICAL: ROUGH FINAL '
PLUMBING: ROUGH FINAL r
GAS: ROUGH - FINAL } �-
FINAL BUILDING
f
DATE CLOSED-OUT
ASSOCIATION PLAN NO. ,
'TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ,r Parcel' �� Application # aW/r, /
Health Division r' Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board �c
Historic - OKH _ Preservation/ Hyannis
Project Street Address �-
Village A h S T 0
Owner �� N er�1 rlR�e � .� tJNjAN -F-v o Address'
Telephone o - a - �-3
Permit Request Ea a
x
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
p )
Project Valuation Construction Type
+, 6
Lot Size Grandfathered: ❑Yes LI No If yes, attach supporting documentation.
PIDwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of.Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes -❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
y
Basement.Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of`BatA" Full: existing ` new Half: existing I new,
Number of Bedrooms: existing —new
Total Room Count (not including baths): existing new First Floor Room Count
W i
Heat Type and Fuel: ❑ Gas ❑Oil 0 Electric ❑ Other
e
Cebtral Air: ❑Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes ❑ No
Detached garage: Q existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: s
Zoning Board of Appeals Authorization ❑ Appeal # _ Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
V
.APPLICANTdNFORMATION_ ---
(BUILDER OR HOMEOWNER) o y
Name �h�_AL AYL.CiAI,_Q "Z Telephone Number
Address _� L� �' �r1 N License #
) C, L 'I Home Improvement Contractor#
E
k
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
r-
G (
u = �vtl� 11� . I J Hie-0N S fit' 4 r T' 6
SIGNATURE DATE
FOR OFFICIAL USE'ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
k � _
The Commonwealth of Massachusetts "
Department of Industrial Accidents
Office jice of Investigations
600 Washington Street
Boston,MA 02111
UV. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
-Ayplicant Information Please Print Legibly
1
Name(Business/orgmizadon/Individuel):. n N N e. M R i L A ri
Address: 5� W 12 e A N1�- _
Cty/State/Zip: 1� PAS -�f k b hone.#:
Are you an employer?Check the appropriate bog: -Type of project(required):;
1.❑ I am a employer with -4. ❑ I am a general contractor and I
* have hired the stab=contractors 6. ❑New construction
employees(full and/or part-time). .
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
working for me in any capacity. employees and have workers 9. ❑Building addition
[Noworkers'comp.insurance comp.insurance.$
ed-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised they
3. iI am a homeowner doing all work I L❑Plumbing repairs or additions '
myse]£ [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 contractor;must submit a new affidavit indicating such.
tContractors 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 providt their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.A ExpirationDate:
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 verification.
I do hereby certi under the pains and p Iffes of perjury that the information provided above is true and correct.
Si tore: Date:
Phone#: D
Official use only. Do not write in this area, to be completed by city or town official
City or Town: PermitUcense#
-Issuing Authority(circle one):
A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
i
n
Town of Barnstable
Regulatory Services
MASS �, Thomas F. Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A.Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled before fence is installed and pools are not to be
utilized until all final inspections are performed.and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORM&OWNERPERMISSIONPOOLS
r
Town of Barnstable
Regulatory Services
Thomas F.Geiler,
sAxrtsTAs�, ,Director
y MA69.
i619• Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230 -
i
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: >GZ N �' /9�_ �s A-
number street Q village -7
"HOMEOWNER": J 8 Q — 2 7 /_j
name home phone# work phone#
C I RRENT MAILING ADDRESS: S �-
grw n/
/town / state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
require ts.
7
Signatu meowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
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CERTIFIED PLOT PLAN
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�ELDREDGEE G/NEE /NCs CO. n'�' '� I CERTIFY THAT THE
CLIENT �����
E0ISTERED REGISTERED �9z�� e SHOWN ON THIS PLAN IS LOCATED
CIVIL f LAND ��-�•- ON THE GROUND AS INDICATED Ado I
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Town of Barnstable
oFTME Regulatory Services
Thomas F.Geiler,Director
'"R,, Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601 V
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
PERMIT# ,DO/aQ 7 2Q a FEE: $ 3'S ,
SHED REGISTRATION
200 square feet or less
.5 0 �Ja2e o �-ft-A c M R61 o Ns WAS
Location of shed(address) Village
►a-�n�
D - � Sl
Property owner's name Telephone number
Size of Shed Map/Parcel# ZE
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wa rV1
Signs a Date
cn
Hyannis Main Street Waterfront Historic District?
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Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30 U"
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE
ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION
FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN
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LIMR lNG CO.ON& CLOEIVT I CERTIFY THAT THE"
"IS
RE008TERE0 SHOWN ON THIS PLAN IS LOCATED '
L LAND . 408 No. c9Z�B ON THE GROUND AS INDICATED AND
EER 3URVEYOPt oR.®y, CONFORMS TO THE ZONING LAWS
7t2` MAI 'N STRE.E,T+ - ��L®Yi �3.t, OF SARNSTA"L , AAA33.
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SCALE, /"=30' DATE, /2-1-7/,9,5z
GEE 0/ EE lNQ CO. I CERTIFY THAT THE �ovi✓o� 7'�>r�'
E013TERED rREISTERED IEtVT °�/^'� SHOWN ON THIS PLAN IS LOCATEDCIVIL LAND 408. No• .L2-173ON THE GROUND AS INDICATED AND
ENGINEER RVEYOR DR.OYs ,4-111 . CONFORMS TO THE aONINO LAWS-
OF BARNSTA®L MASS,
712* MAI N STREET CH.By' �_ � ��� e�
H YA N R I S, MASS. B IEET.,L,OF � 7 8
DATE @E5. LAN®
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Engineering Dept.(3rd floor) Map Parcel OZ 9 �ermit# l'
House# !14h d �1�iti►:y.". 6 �3 -17
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) GY Iwo 42_5%o a
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) �,�4 r��r. � 9 TUi L KUM
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D Board 19 .
BARNSTABLE.
MASS.
TOWN OF BARNSTABLE
Building Permit Application
Project Street Address z-- e4/44V ZO 7 43
Village w
k��
Owner Anr z &xI. 4 1AU1411 Address t� G�/R eA) L-L4
Telephone
Permit Request
rY.W. A QGr— 'D r4LA
First Floor , square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Familyo�Two Family ❑ Multi-Family(#units)
Age of Existing Stfucture Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: I~ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) // Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing I(7jNew Half: Existing New
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: Z Sias ❑Oil ❑Electric t ❑Other
Central Air ❑Yes �o Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
,. ❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review# -
Current Use r-- Proposed Use
Builder Information
Name- Telephone Number C I?,
Address 2 ( gyp�,, ��kT,� � - License# f ��
Home Improvement Contractor# �� 7
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTIO%.pEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUD GPR DEN] D F THE FOLLOWING REASON(S)
WIWI ..
~ FOR OFFICIAL USE ONLY
o
PERMIT NO.
L�
DATE ISSUED
MAP/PARCEL NQj
a �
ADDRESS '; VILLAGE
0
i
OWNER a
a .
DATE OF INSPECTION:
FOUNDATION,
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING A2
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Town of Barnstable
• ar► STAR,s. -
� �0�' . Department of Health Safety and Environmental Services
'�Fo ' Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
i
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:_ lia-el& Est. Cost
Address of Work: � ���� I - M �`
Owner's Name aez, A_j
Date of Permit Application: 6-77'�V97
I hereby certify that:
Registration is not required for the following reason(s):
Work 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
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i�r thdate.Nuobers Expires: 5441O811998 041081194�".
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NARSTONS MILLS, MA 02648
Y�/AA�p0M>INlr07�I�E O��/�GP�QPIWQ�o
HOME, IMPROVEMENT CONTRACTOR 1;
Registration j-105731 ��Y1;%;}
LsG .,/h Y j,tyTl
AY e INDIVIDUAL
URITation��=07/20/98,�� �
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;Jt 1F}Rta1
OHN C�BOYDEN ,�>"*•, 3i` x��
Licly upper Ln/P 0 �Boz{2
tons� Mills=MA 02648
ADMIN�S1R/1T0 "+ 3�s � +; yY� i
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17' 31' 174 1'8
p
52
WREN LA.
P
MARSTONS
MILLS
DECK HEIGHT IS 16"ABOVE ii
----------------------------
GRADE. WILL HAVE RAILS&
SEATS.
6'2 62
co)
DECK 2X8 PT. 16"OC.
574
SQ ea.@
BEAMS ARE PT 2/2X8'S OVER
POURED CONCRETE 12"
SONO TUBES
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I oll
PluP
31'
LIVING AREA
204 sq ft
Tlrc• C(Imino/lll r of Ahissachuscttt
?ii Department njlndristrialAcci(!crrts
1 Y
Officeoflnveafga1100S
a 1 .iw -
600 !1 aAht,tu►r Street
:'. Boston. A1uss. 02111
Workers' Compensation Insurance Affidavit.
Ali�ilic:inforrnatitin:tin
natnc: cJOHIY C ` ow a n
locatinn
city phone 0
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
.�r1.-. rv- .._r... .R1r�'y- 'rSrST;l,'1P!1�:.-/R... _ �..I���...rr�.��w.�.rryrwy�r.w..♦ �+r►..w...i�-'�M�_r���
[II am an emplover providing workers' compensation for my employees working on this job.
cootimov name:
atltlress•
cih: phnne a•
insurance co. Jtnlicv 0
Cj 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:
comminv name:
iddress-
cin•: phone#-
insurance co. pnlic,%•0
comnanv name:
address-
rip phone tt:
insurance co policy#
Attach additional sheet if neccasary :r s --+�' " - _ __�`%r '' "t_•.,y-+�" =�:•�'—
__ ___-n .eet if -.fir i..l.'d..�J,�•� �•+d-r. i14 ilY!'i .11Nt'wrfl.
F:tilurc ttt secure covcracc as required under Section=5A of MGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur
une cars' imprisonment as well as civil penalties in the form of a STOP AVORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Mice of Investigations of the DIA for coverage verification.
1 do hereht•cerrify ru r th pains and ena/ties ojperjuty that the information provided above is(rue and correct.
Si_nature < i Date —2 3 "1 2
Print nam hn G D' Phone#
`rrcrr �y
' official use only do not •ritc in this area to be completed by city or town official
city or town: permittlicense it r711uilding Department
C3Uccnsing Hoard
0 check if immediate response is required 13sclectmen's Office
C311caith Department
contact person: phone t/: rlOiher ,
information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' ctrntp-ensation for the
employees. As quoted from the an entpf( ree is defined as every person in the service of anotlicr under any
contract of hire, express or implied. oral or written.
An rmp/nrer is defined as an individual. partnership, association. corporation or other legal entity, or ally two or mo
the foregoini-, enLaged 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 tl
owner of a dwellina, house haying not more than three apartments and who resides therein, or the occupant of the
d��clling house of another who empin's persons to do maintenance , construction or repair work on such dwellim_ he
or on the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe
MGL chapter 152 section 25 also states that even state or local licensing agency shall withhold the issuance or
reneival of a license or permit to operate a business or to construct buildings in the commni•ealth for any
applicant rho 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
been presented to the contracting authority.
Applicants
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 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 tl�e Department of Industrial Accidents. Should you have any questions regarding the "law'' or if you are require
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 c
the affidavit for you to ftil out in the event the Office of Investigations has to contact you regarding the applicant. Plc
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned
flue Department by mail or FAX unless other arrangements have been made.
Tiie Office of In•esti=ations would like to thank you in advance for you cooperation and should you have any questio
please do not hesitate to give us a call.
Tile Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents jr
office of Investigations -
600 «'ashington Street
Boston,Ma. 02111
fax #: (617) 727-7749
phone P,: (617) 727-4900 ext. 406, 409 or 375
oZ a?
Assessor's map and lot number ...m........�........1.................. o*THEto I
Sewage Permit number ...............................51.......................
`�\'•" y. - Z BABd9T4DLE, i
House number .................................... ............................... ' raea
�p 039. \00
0 M AI a'
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ....:'..: c �I.4.......::�!^.::^:�:!} .... ... .. ...........................
TYPE OF CONSTRUCTION ....1!v c c............ ............................y..........................................................
............................CaN . ...........19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ............?....... .........i..t 1V���......................................................... .. . ...........................................................
ProposedUse .....?.L.�.t.::.�: u}.(...0......................................................................................................................................
Zoning District ...�............................................. Fire District L........................
�31�� Jfr LfG.
Name of Owner .. lkk �:.......:..:.........1.f .dress ..................................... .................................
Name of Builder ...... .(l4. .t c .. ... .... ...................Address ...................��Lr9!`�..
Name of Architect ....�..1. �... ?/a�� ........ .....Address ........................ .. . .C. ..... .../../Y...................................
.r.
Number of Rooms .................... ..........................................Foundation ....:�:..« .....r .!'4 v.`�............................
Exlerior ....Li.(+.................... . ...............•.)J47..................Roofing .......... }.,. ...................................................................
Floors ......'................................................................................Interior ............... : ....�5..... /.!� .�� .C .:
Heating ..................................................................................Plumbing .......... ............................�, .............................. .
Fireplace ... -- . . ........:: .................Approximate Cost .........:... :. ....... ... .....
Definitive Plan Approved by Planning Board _________________ --__--_19-------- . Area ...� d S }
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of�warnstable re7g�di the above
construction. Q.
Name ............ ...... ... ...... 9J. 9,
Construction Supervisor's License ..........:. .. ... . .........�
BARNSTABLE HOLDING CO/ A=29-24
4 =all-zy
No :.27374.... Permit for ...l?z,St ?Y...............: .
Sin le Famil Dwellin `
Location Wt..1.4.3....... ...............
..........Ma
tS?1 .. .].5.............:..................
Owner ....B43:4s.tablQ.Hgld ng..CO-.r:...........
Type of. Construction kram................................
Plot ............................ Lot. .........................
. ................ .........
January, 85
Permit Granted ........................................19
Date of Inspection.............................:......19
Date Completed .....19
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