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HomeMy WebLinkAbout0121 SOUTH BAY ROAD 0 � � __�� ._ � . Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee g� Thomas F.Geller,Director e Building Division �ePft�� ��R Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 kAPR 2 8 ��08-7 117* www.town.barnstable.ma.us ,. FF Office: 508-862-4038 OwAl pF e Fax EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY NSTABCE Not Valid without Red X-Press Imprint Map/parcel Number V -ZQ )7Prope Address QV =S Residential Value of Work_D U U 00 M inimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name (/ d i Telephone Number Home Improvement Contractor License#(if applicable) `2 3 Construction Supervisor's License#(if applicable)_ 3 4,1 ❑WorkVIsam mpensation Insurance e: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name �� /3 Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-ro not stripping, Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum.44) Q ef(,lC e Z0-L1,1'Xe111J 6,-/ A 4113V L "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservative ***Note: operty Owner ust sign Proper Owner Letter of Permission. ome Improve ut n tors Li ease is required. SIGNATURE: eA Q:Forms:expmtrg Revise071405 04/25/200� GCG T �}.. I^Z'Ai • v F • �`-� . lac� .l_ - �• l c 'J..t - \ —.. =ti _ ' ; ffi 0 I Barnstable Regwatory Services NAM Tbo�F,teller,p •ector �? us Bull ing DM910A. ry .Tom parry, jjadWg Calnmleeloner 200 M&%Stwle 14vmik MA D2601 ww4vtoWnb�aatable.xeaus , Offioe: 509462403a pans 505-790-62H Property Owner Must Complete and Sign This Section If Using ABuylder it. S'„ -�b�A . "� S__,as owner of the subject prop= to act on my behalf, is an roamers relative to work aphorized by Ws buiI&q permit application for: 1,1...,1..E (Addass of job) S• � . r J2 in5:Q—,sA t52 Pax l�dsaaa - Q:PO�:C�V1! SSI©N 9.4 eomwwwweaa Board of Building Regulations and Standards One Ashburton Place a Room 1301 Boston'. Mass husetts 02108 Home IrnproveifterviQ tractor Regis T = _ eplstration: 123067 Type: DBA Expiration: 12/2/2006 THOMAS E®L®R.IDGE GONSTR IN 138 SPRING ST. =`'� YANNIS MA 02601 �� "r "n t Update Address and return card Mark reason for change. Address Renewal ;J Employment [J Lost Card nocrn+.;A a,ne.neua.lt+n+�+a r:- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# QW 6, 6,' S a CHealth.Division-� —��O /���� zoewpov-N cove c cb�m be Conservation Division J a © (� Q b Permit# Tax Collector �� e�1��-� 0. 'V��Date Issued ,�55jcx k C 100 Treasurer �� Application Fee 22 • O C' Planning Dept. Permit Fee q 11 a Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ci I CAI1 Village ' e r L111 `Q Owner ck, ,fv 10 of Address Telephone �� I 1 J Ll oQ —-7 Permit Request 3 U s w� 2 Square feet: 1 st floor:existing l proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay j 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 O410 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 Number of Bedrooms: existing new ,Total Room Count(not including baths):existing X new First Floor Room Count Heat Type and Fuel: ❑Gas C9'Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes _,O No Detached garage:❑ex' ting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size.' Attached garage:Uexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes' ❑No If yes, site plan review# n) rri Current Use Proposed Use BUILDER INFORMATION \ Name :E�G k"a s - I � ��w Telephone Number/sG�' I 7 7/ S� L Address 5 3 L cj" ? Aa P A U C License# Home Improvement Contractor# Worker's Compensation# / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO < s SIGNATURE 6zo DATE L FOR OFFICIAL USE ONLY 2 PERMIT NO. DATE•ISS,UED MAP/PARCEL NOE' � ADDRESS VILLAGE OWNER 1 t, DATE OF INSPECTION: i FOUNDATION ' FRAME INSULATION FIREPLACE = o ELECTRICAL_: ROUGH FINAL 3„ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ca lklog e i DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 _ www.mass.gov/dia' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiidans/Plumbers Applicant Information Please Print Legibly. LA Name (Basiness/Organization/lndividuO: 0 w. LEc� rAJOk Address: CA rl" cAc., P 14 U City/State/74:_H r) Phone M 7 71— Are you an employer? Check the•appropriate boa: Type of project(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(fan and/or part-time).* have hired the sub-contractors ?. Remodelm 2.d I am a sole proprietor orpmtaer- listed on&attached sheet t ❑ g ship and have no employees These sub-contractors have 8� El ]Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' Comp.insurance' S. ❑ We are a corporation and its (i'1 10,❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL ME] Mmbing repairs or additions myself.(No workers' comp. e. 152,§1(4),and we have no 12 ❑Roof repairs msmzaam required.]t . employees.(No workers' 13.❑ Other camp.insurance required.] *Any applicant that checks box#1 mast also rill out the section below showing their workers'o=pensation poticyinforsnation: ' t Homeowners who submit this affidavit indicating they ere doing all work and then hire outside coatraotors mast submit anew aMdavit indicating such. 2Contrnctors that check this boa must attached an additional sheet showing the name of the sub-contmi:h s cad their workers'coW.policy information. ram an employer that Is providing workers'compensation Insurance for.my employees. Below Is the policy and,fob site information. Insurance Company Name: policy#or Self".Lic.-: Empfiation Ike: Job Site Address: City/ststr-Lip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sec ro-coverage as required undei Section 25A of MGL c. 152 sari lead to the imposition of criminal penalties of a fore up to$1,500,.90 and/or one-year b4nismmxm,as well as civil penalties in the.fa m 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 fiance coverage verification. I do hereby cent r the pains p na 'es of perjury that the Information provided abov is true correct; Si tore: \' Date: 2 —;7 Y" / Phone#: r Cl ff ria6?gsE vr4. Do #wt a in At ama,to c6m#eed by coy or City or Town: Permit/License# i Issuing Authority (circle one): 11.Board of Health 3.Building Departmeat, 3.Cit'yffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions , Massachusetts General Laws chapter 152 requires all employers to provide wbrltere compensatitmfortbeir employees. pursusnt to this statute, an employee is defined as"...every person in The service of another under any contract of hh e, express or implied,.offal or written." An employer is defined as•"an individual,partnership,association, corporation dr 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,6r 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 worrk=such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to-be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of commliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fM out the workers'compensation affidavit completely,by cheeldng the boxes That apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone mnnber(s)along with•Baca certificate(s)of insurance. Limited Liab37ity Companies(LLC)or'Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that The application for the permit or license is being requested,not the•Deparfinent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy,please call the Department at the mm3ber listed below. Self-insured companies slow safer their self insiaance license number on•1he appropriate line. City or Town Offldah . Please be sure that the affidavit is complete and printed legibly: The Department has provided a space at the bottom. • off affidavit for you to fill out.in the event the Office of Investigations has to contact you regazding.tle applicant. - Please be sine to fIl in the pm=dV1icense number which wM be used as a reference number. In adilition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_,(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant es proof that•a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each ' year.Where a dome owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e. a dog license or permit to bun leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of M- usachasetts Department of Industrial Accidents Office of layeftafim 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877 MASSAFE ' Fay.#617-727-7749 Revised 5-26-05 -vrW Mass.cov/dia °ar Town of Barnstable Regulatory Services ' STAB . ' Thomas F.Geiler,Director �Eo rl+►9.a+°i`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 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: dui rpai I�I r GEstimntedCost �Q D:d Address of Work: ISou` -'-\ 0 12.4, Pd V Owner's Name: �!1 i ti4 �� P✓7 Date of Application: 4 (Z, 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: 15�e Contractor Name Registration No. OR Date Owner's Name Q:fo=1omeaffidav 05/1Y/2006 15:50 2123405340 GCG PAGE 01/01 MAY--1,1-2008 02:44 PM CCH SuPPor! Servicas 508 862 7976 P, 01/01 5 ( Town of Barnstable Regulatory Service's Thomea O.Q @W.Aireclor BWdJag Difvfston. Tom Perry. heeding Com budoner 200 Maus ShV4 $YaImis,MA 02601 rvww.tawn.bara�etableaaa.tu Office: 508-862-4038 Fax, 508.790-6230 PrOperty Owner MuSt Complete and Sign T)* Section If Using ,A Builder as Ofter of the subject pmpeatp . hereby andxoxiu is a,=tam relative to Work authozi=d by Wld appRution for, a9 0 Job) Sitm of owner Qe-:� YZPJ-bts,(�7 r\ 043 \ #291 MAP 093 4✓ 041 ���... #275 MAP 77 #265 v 058 005 #29 P 09 04 #32 MAP 093 058-008 #46 MAP 093 ❑ i. 058-006 #43- O 6 5 '�', MAP`09� ` M059 059-001 # 121 066 #93 #77 # 107 MAP 093 ;...... 058-007 #45 \Desktop\Conservation.dgn 4/27/2006 4:11:37 PM i Board of Building Regula ons and Standards One Ashburton Place - Room 1301 Boston. lea s. hUsetts 02108 Dome Improvemen a tractor Registration -= _ --_- Registration: 123067 � GTi� oPo�.eosw�ealN�,ilta Board of Building Regulations and Standards License or registration valid for individul use onty HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ReQlstrddlaa� 123067 Board of Building Regulations and Standards -_- One Ashburton Place Ru 1301 ~ l?�2006 Boston,Ma.02108 THOMAS EDLD 1 - WWAS 1:LDR1 ' =1 138 SPRING S7. HYANNIS.MA 02601 .a,,,,,;;,;a.�. Not valid without sianoture i BUILDINGxREG0 M- ULADs. �,O�SRUCTION�S�PER VISOR• License Bi h'd" a 7r.no 2Z19;0_' L� T,W ? •�. a . fires e / c, THpMAS t, 3 i ING SO,' i Comrn�ssio.:� f 1.�8'SFIS; MA 0260%I).• --' �al,�-� HYANM.. Assessor's offioe (1st floor); 9-3� Assessor's ma and lot number ..........................................6.5-- 4'l� h h' cF THE ro B and of Health (3rd floor); wage Permit number ...... .7-:,C�2o........................`-'' '9 TI` LE 5 ^®®� M i1 1: B6BWAG&DLL, i Engineering Department (3rd floor): �3g�� �pT p V rnsa :.L e tH9��V�NB@3B��1B�7 9 ep��b p p P Open t6}9. House number f REGULATIOMS 'FOYpY a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00. P.M.�'on y� TOWN OF BARNSTABLE BUILDING INS'PECTOR APPLICATION FOR PERMIT TO ... ! g.4 1.�. �.... UI�. �Q ....SItE t�................................ TYPE OF CONSTRUCTION ...FRF�.M...�!.NN ............................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... `'�-� S a��( t�7 �. � OFF l� L 1 ,......... .......................... .....�. ..... .-.,.... .... �1................................... ...................................... Proposed Use ....... �� ...W OO D . t ODL_S .................................................................................................................................................... ZoningDistrict '`I= - G` f`�T� t � - ......... ................................................Fire District .................. .......................... �1/................. Name of Owner qCk1�nl� •....!:- p .........Address ..........1 ....,. ..........t........1�.. �y. = Name of Builder ............�.....f`ldS.............. ..... . ............Address ...........�`�....A-�l.. i' . ................................................................ �.:..`.l�t"lpC?.T\-1 Name of Architect .......... ..��..... ... -Q � ,�. c........Address ............... y.......... ..................................... Number of Rooms ...............................1..................................Foundation ........ . ....................................................... Exterior ................................�- POP..................................Roofing .............. ..................................... Floors 'P4V)PO,.-P..............................Interior ........... k•9RQ1y"� ......................................... ............................................................ I � HeatingNOnI.E...................................Plumbing ............................... � Fireplace N.�...................................Approximate Cost ...... .. �� do .................................. Definitive Plan Approved by Planning Board ________________________________19-------- . Area A .2:..0............. Diagram of Lot and Building with Dimensions Fee ......�..+.............. SUBJECT TO APPROVAL OF BOARD OF HEALTH iv �Z 7 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 .................................... GORDY,, JEANNE M. No .31514 Permit for Tool Shed .......... .................................. Accessory to.. Dell ' ...... ......w.........�g.............. Location ....1.2.1....Sou.th...Bay,,,Road,,,Lo.t... 9 . .. . ....... ..... ...... ..... .... ..... .. ..................0.s.texvill.e................................... Owner Jeanne M.....Gordy..................... ......................... .......... Type �of Construction .....Frame .......... ............... .. .... .. ............. ........................................................ Plot ............................. Lot ................... .............. Permit Granted .....Piecember 17,....19 87 r. Date of inspection .............. ........19 Date Completed ............. ............19 Assessor's offioe (1st floor): FTwET Assessor's map and lot number ............ .. '3 G o off`Board of Health (3rd floor): ,� G,zo S Z BABd9TODLE, ,Sewage Permit number ...... .................................................. ' Engineering Department (3rd floor): oo 2639* MABEL \0� Housenumber ..................................................................:..... APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1.00;_2:00 'P.M. only TOWN OF BARNSTABLE BVI`LDIHG INSPECTOR APPLICATION FOR PERMIT TO ...� 5Tc.Y 5�jr.....!l) UL�. T � .. 5. t7................................ TYPE OF CONSTRUCTION ... ..... .�`�E............................................................. ....... .a....` ....1...........19.$. TO THE INSPECTOR OF BUILDINGS: > The undersigned hereby applies for a permit according to the following informati Location ...... ...S....B&y...fZc i7..........1-OT ..�....OFF...3RI V6t...57.:�.....�-�T LC�.V LW.E...................... Proposed Use .......�.!.f2e....WOOD d1 TDOL,S ............:......................................................................:...................... ................................ Zoning 151 .. istrict ................ ..�..l.�,.,.........................................Fire District .........Gt r`lT�r�(f Name of Owner ...... ��1l�lL....I .�...GP.R.Dy........Address ..........�. -�...��...g P::; .............. �............. � � �yName of Builder ............ ..... �........... ... ..............Address ...........`J+4M�........................................................ Name of Architect ................... .... ..� .0..7�1.!LI.D.. r........Address ............5. ....`.' ! P51T I..................................... 1 ' Number of Rooms ,,. • .....................�..................................Foundation $.l- C ..... Exterior ............:..................` u?.o0....................................Roofing .............. .................................... Floors ............................... uew0. �..............................Interior ...............:. RA10 > . ... .................................................... r. ._ Heating ................................ ..................................Plumbing �0(�l . .................................................................................. Fireplace ' '�V ..................................Approximate Cost ................Lto ,t�.0 ................................. ................................. .... .. . Definitive Plan Approved by Planning Board ________________________________19________ . Area .......�CL. ...�;r!.............. Diagram of Lot and, Building with Dimesions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 P OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to co`form to all the Rules and Regulations of the Town of Barnstable regarding the above construction. • Name .................................�................� . ................ Construction Supervisor's License .................................... e GORDY17 TEANNE M. A=093-'065 .3 31514 Tool Shed No .............. Permit for .................................... ..........Aq.q-es.sorY...t.Q-...P.We.1.1in.q........ Location ... .......Lot 49 Osterville ............................................................................... Owner Jeannie M. Gor�y... .......................................... . ............. Type of Construction Frame ....................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted De.q.em.b.e.r...17,19 87 Date of Inspection ....................................19 Date Completed ......................................19 ozz sr , �. � f i�+s+s'Kr am�anr�.4w?r;#'•cr_r .. .r-- ,r••<-.,,-�., _� � .. .. i _. � - i i . 1 ,ems 71 woo 40 Aom i r s. y ' � i ,..t..-� ._ .- , .. ry...-." � ., r. .1 r»r1nr.:.Y..�••� .:.rq, 1 ' ' � I ' I •I i ., ..� - snow I -