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HomeMy WebLinkAbout0300 TOWER HILL ROAD f� �}„ .. �� F ""^ .....�-7 f^. I.::.,. .W�_ Town of Barnstable I 6D Expires 6months rom issue date Regulatory Services Fee a, Thomas F. Geiler,Director Bu ld.ing.Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 www.town.barnstab le,ma.us EXPRESS PERMIT APPLICATION Fax: 508-790-6230 - RESIDENTLA L ONLY Not Valid without Red X-Press Imprint Map/parcel Number I d, o�� Property Address 30d .Fh I I Q C ❑Residential Value of Work -t-3t 000 . 0 Minimum fee oC$25,00 f or work under$6000.00 Owner's Name&Address Ij Cl('r2Q.s' r�l� moo1<01 ,' i Contractor's Name 1j_"V-s &Lr[,�- O Telephone Number Home Improvement Contractor License#(if applicable) 1443 Q Construction Supervisor's License#(if applicable) lpe I J g _ R � ❑Workman's Compensation Insurance C_heone: A�/ L9'I am a sole proprietor -f AID Lf. ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Worlcman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) dRe-roof(stripping old shingles) All construction debris will be a i—J t ken totr- ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Values_(maxinaum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owne t sign Property Owner Letter of Permission. py of H e I ove ent Contractors License is required. SIGNATURE. Q:Forms:expmtrg Revise061306 - ' The Commonwealth ofMassachusetis Department oflndustrial Accidents dfftce of Investigations 600 W-ashington Street Boston,2VA 021II www.mass.gov/dia Workers"Compensation Insurance Affidavit: Builders/Contractors'/Electricians/PIumbers Applicant Information Please Print Le 'bI Name(Business/Organization/Individual):• ��(v�Q � Address: 31 City/State/Zip: pj-4 w m 02-�oo I phone.#: Are you an employer? Check the appropriate box: 1.❑ I a employer with 4. ❑ I am a general contractor and I 'Type of project(required):. mployees (full and/or part_time).'" have hired the sub-contractors 6• ❑New construction . 2. I am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g ❑Demolition working for me in any capacity, employees and have workers' [No workers'comp.insurance comp.insurance.# 9 [j Building addition required.] 5. ❑ we are a corporation and its I0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions rnysel£ [No workers' comp. right of exemption per MGL insurance required.] t C. 152, §1(4),and we have no 12. oof repairs employees. [No workers' .13.❑ Other camp.insurance required_] +Any applicant that checks box#I must also fill out the section below showing mcirworkm'compensation policy information. t Homeowners who subrnit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such. tCrintractors mat check this box must attached an additionalshect sbowing the name of the sub-contactors and state whether ornot those entities have employees. If the sub-contractors(nave employees,they must pravidt:their workers'comp.policy number. lam 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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure_to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 ofhe b o e coverage verification. a fti bcertf fpIdo hereyy • pent erjurJ that the information provided a ove 's true and correct: Sienature: • Date: — Phone #: FOther e only. Do not write in this area,Yo he completed by city or town offlcfal n: Permit/License# hority(circle one): of. Health 2.Building Department 3. City/Town Clerk 4;Electrical Inspector 5.Plumbing Inspector son: Phone#: ' 1HEI .o : Town of Barnstable. Regulator Ser.V y vices a�xNsreBr�, ' • XA 9 Thomas F. Geller,Director Building Division I . Tom Perry, Building Commissioner 200 Main Street Hyannis,MA 02601 �Y 'w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Propelty Owner Must Complete and Sign This Section If Using A BuYld*er as Owner of the subject property hereby authorize J(CWs &r to act on my behalf in all matters relative to work authorized bythis building permit application for; 0o i over (Address of Job) 4Sate of Owner Date Print Name QTORM s:OWNERPERMIS s IOf so3ftYof`)�u'it int °'�fgeguf"aCioa� ds__ License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 124310 Board of Building Regulations and Standards Expiration: 6/1/2011 Tr# 284683 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Individual - , James Curley James Curley 287 Fuller Rd. Centerville,MA 02632 Administrator Not valid without signature �- Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License License: CS SL 99138 W Restricted.to: .RF,WS . JAMES CURLEY 287 FULLER ROAD. CENTERVILLE, MA 02632 _ I Expiration: 1/28/2012 v Commissioner Tr/: 99138 I i - �/ze:-�ovnmu�uuedl� b�./�aaaac/zuaelle - Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrafion :_1.24310 Board of Building Regulations and Standards Ex:pira4ign~`_ j}/2009 Tr# 130873 One Ashburton Place Rm 1301 --:- --' Boston,Ma.02108 "-.Typ04i-ddual James Curley James Curley 287 Fuller Rd. y Centerville,MA 02632 Administrator Not valid without ure I i FT � �� ` p Jl �.. - � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION hh Map Z- Parcel V3 I Application# )&10 7%7(ec(,:�7 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee • (�(J Planning Dept. Permit Fee =4 i 3 Date Definitive Plan Approved by Planning Board Ob)/67 do"- Historic-OKH Preservation/Hyannis Project Street Address Village f >f Owner � Address Telephone Permit Request poaoM Pyt&t!u K1-fthen - n o ava Ch('.YlGrie - move f &DIadLn Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �vo Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family f Two Family ❑ Multi-Family(#units) Age of Existing Structure y`� { Historic House: '❑Yes ;dNo 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 IVAA 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:O Yes` ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing O new:size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ v r- �' I Commercial ❑Yes KNo If yes,site plan review# _.,Current Use Proposed Use _ BUILDER INFORMATION Nam&tJd Piea(" N4 �. �Q.� �Ine, Telephone Number Address License#— CS oq q6-w1 �t l og(o�,v'I� u S1_ Home Improvement Contractro'r# I S` 5St3 , ©5/k/ V 1,116. AM— f li�l1 Worker's Compensation# U()C (0 D ? `t`1 Jq z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO VT-t/Gl SIGNATURE DATE ` 0 "1 6 �� s Y FOR OFFICIAL USE ONLY e' i PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE. OWNER DATE OF INSPECTION: t r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. y �� The Commonwealth of Massachusetts Department of Industrial Accidents 7 Office of Investigations 600 Washington Street- Boston,MA 02111 , www.mass.gov/dia Workers" Compensation Insurunce.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibi Name (Business/Orgonization/Individual): acncr— T, Id M •Address: j � Q ���� -�°g .SU11k -� Q & l-1 1 City/State/Zip: Elie i" ® 5'phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1. I am a employer with _ 4. [•] I am a general contractor and I 6 New construction . ✓✓✓��_. employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7. Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' 9. Buildin [No workers' comp. insurance comp. insurance,t'' Q g addition n required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.[] Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees, [No workers' 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 nf6davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. {Contractors that check this box must attached an additional sheet sbowmg the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb 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: A AA FTIV, 44bm ( , Policy#or Self-ins.Lic. #:__W • 68? 4y- G Expiration Date: zz Job Site Address:_s Td ae -A I( P-4 City/State/Zip: VW V/be_ MA A QZo 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 lip 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 c tcfy:ender th pa' sand penalties of perjury that the information provided above is true and correct Simatu.re: p Date: Phone #: `il Z�� ��® — 76. 0ther . only. Do not write in this area,to be completed by city or town of n: Permit/License# thority(circle one): Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector .son: Phone#: �ofVE� � Town'of Barnstable Regulatory Services lARNSrABM ' Thomas F. Geiler,Director 16.19.�> � wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize / act on my behalf, LY in all matters relative to work authorized b7 this building permit application for: (Address of Job) q ature of Owner Date Print Name Q:F0RMS:0 WNERPERMISSION (� � 3 � ro —� a�� 1 — ,� � e z � � �� � � � � 0 ,� 10/15/2007 PAGE 7 15:30:21 PAYMENTS PROOF SUMMARY areshrct CLERK: sheas BATCH:7829 BATCH ENTRY DATE: 09/26/2007 --------------------------------------------------------------------------------------------------------------------------------- PAYMENT PAYMENT METHOD QTY AMOUNT ---------------------------------- 1-CHECK 44 2,074.88 2-CASH 3 75.00 TOTALS: 2,149.88 ** END OF REPORT ** Y ' i /Qf THE 7(]I. Z V i, L W JL L Kl 1 1J N/i V y •'-,Y�°�. Regulatory Services Y BARNSfABLE, ' Thomas F. Geiler,Director 'MASS. 'a39• �m g � Buildin Division plFc►��", Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us n6e: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFr(DAVIT 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 a registered contractors,wita cert-zi exceptions; along nth Oth— such residence or building be done Ly reg� requirements. F Type of Work: 'R L 1 �'l Oe'm ode Estimated Cost Address of Work:. (J� l L�Wy► ! �6�� �6�1 �1�-I y��l Owner's Name: Junes - And-6-s M Date of Application: 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 bereby 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: 0 Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpfiles.fornu:homezffi d av Rev: 060606 . � ✓leB���`l�"Cj�`�`U'�ILt�ltf'�'i`�E��`i��IUN�`�T License: CONSTRUCTION SUPERVISOR Number: CS 094500 • Birthdate: 07/22/1962 Expires: 07/22/2010 Tr. no: 94500 Restricted: 00 JAMES S PEACOCK PO;JY.171 OSTEVILLE, MA 02632. Commissioner i 67 Board of Building Regula ons and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor,Registration Registration: 151853 Type. Private Corporation Expiration: 7/7/2008 SCOTT PEACOCK BUILDING & REMODELI JAMES PEACOCK PO BOX 171 OSTERVILLE, MA 02655 Update Address and return card. Mark reason fin- Address Renewal Employment L,osl Card DPS-CAI E'y 50M-05106-PC8490 A :�/�a �ne,.ii[�I[.ortrue[afl✓ r.�✓'/'(.CtJOa.�'�LIJeL�6 of 13uildin�,Regulations and Standards License or registration valid for inrlividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 151853 Board of Building Regulations and Standards Expiration: 7/7/2008 One Ashburton Place Rm 1301 Type:- Private Corporation Boston,Ma.02108 SCOTT PEACOCK BUILDING& REMODELING INC ,TAMES PEACOCK 1046 MAIN STREET SUITE 7 OSTERVILLE,MA 02655 Dcputy Administrator Not valid without signature 1 1 F �y� v 1 � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i—o-r- lot Map i 03 rl Parcel Permit# / 2 19 c Health Division 301 9 Date Issued 9 a /+ 2 �Fj 2 �i; PP — 6J Conservation Division �r K� �(v' 4.? 2] 3 SIEP — Application Fee Tax Collector SEPTeD Permit Fee �. 0 SYSTEM MUST 6E Treasurerj+`'IIU'r f� CLED INCOtlIIPLIAR,'; Planning Dept. IMITH TITLE 5 Date Definitive Plan Approved by Planning Board To,;'; �f."1J%T:.,:: Historic-OKH Preservation/Hyannis Project Street Address r ,:300 ��c�erin �11 1�o�cC Village iry_�iGlc Owner �_lm a5 ur�f '�o Address _14S l r►`�S-4 f � Telephone -- A oo)40 Permit Request J,✓Y1ld�da 10 S0 -fit :10 Square feet: 1st floor: existing /&Z, proposed '2nd floor: existing F40 proposed 0 Total new '— Zoning District Flood Plain Groundwater Overlay Project Valuation 2tf000 Construction Type wm_L4 g't� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(#units) Age of Existing Structure a ,� Historic House: ❑Yes Ukl o On Old King's Highway: ❑Yes U-P46— Basement Type: ®'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) a Basement Unfinished Area(sq.ft) Number of Baths: Full: existing / new / Half:existing new O Number of Bedrooms: existing_ new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas &<75— ❑Electric ❑Other Central Air: ❑Yes alq—o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size ' Barn:❑existing ❑new size Attached garage: xisting ❑new size Shed:❑existing ❑new size 9, Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes DIToT If yes,site plan review# c Current Use Proposed Use h BUILDER INFORMATION Name C ` Oirosb [JCS Telephone Number `565-4�M— Lit.) Address ( License# Lr3 ss(. I {vl Br�� �a � Home Improvement Contractor# Worker's Compensation# wo. (im — 105 — ALL CONS RUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :16W Ill O SIGNATURE 2 DATE �^' ��c)3 s FOR OFFICIAL USE ONLY . i PERMIT NO. 1 . DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION I e FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH` FINAL r a FINAL BUILDING r o DATE CLOSED OUT r ASSOCIATION PLAN NO. r ' ' ♦ (c.zs'1 —, _ . The Commonwealth of Massachusetts D. - .j Industrial Accidents � Department o . . office offaaestfgations . - . 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: A91e,5 P'1 V i eV`7J V1 location 1�60 16W e—r Al 96 city 4.`erutItL , MA phone# 669- —v'76S- ❑ I am a homeowner performing all work myself. I . ❑ I a n a sole r rietor and have no one workin in an ca achy ''///%��%%%%%%/%/ % /%%%%%%%%%%%%/%%%/%%%% ///%/% %/%%%/%%%%%%%%%%%%%%%%%/%%%%%%O�%%�%��%%���%%�%%%///////%%�%%/ ❑ I am an emplo providing workers' compensation for my employees working_on this job. :::.:::...........................::: :: .:.:::::::.;:<.;:.:::.;:f.::.::::::....:.. ...................:...:.:::::...:i�iii:. ..: :' an ':name:::::::::::::. ::.. :::.:;.>:. :.;:..:.:::. :atl <?:> iEG <ii ' isE}?'rise;:'.'`<'? >%' C}i'';'' > 2 E`rEl!�!$JHe—'�"-.1."-. ``' - < " '`s' `` <'s1 ':>'s` y'>E' 'sc '< <..>:": :J�.`r':rl. »:; s;::; :...... ... ::>:::<::::: : .. ...: ... ... ':;.;:.;:.;::.::.: ::. hone#..:::::::.;.:::.::........: .. :..: :`t"< :: ::: ::. � .... E :::;:: . :. :.;:.;: ✓':<:«::>::<:>:>:>:::<::...` tile::::#>:.:............ ... ... .. .......... :. ..... instinance:co.:::::::::. :.. .:. ::..: •:: :. ::.:::.:................ _............................. ❑ 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::.::::::::::::::::::::..:::.::::.::::::::::.:::::::::::::::::.::::.::::::.::::::::::.:::.:.:::.:::::::::::::::.::.:::::._::.:_::::::::::.:::::::::..::11--::. :: :an:r'Ell :::'1111t1C'.;.;.;.;.;::::::".:::::::::::,....".:I' ? ' �` c % ? <'e'i. .:.::.:;:>? ' ' ' ' i.' 2 > `:i. ':%`� :;i:::i::..isisi..i. ..i. `<' '�':?"j. .COIIID :: : :%?::t:: :::::::;:;?; tliltls S ::::::.::::::::::.:::::::........................................................... .................................................................. XXXX a:ok•' Mmm.,�,..--.-..-..-.-..--..,........--.---..--....-..-...:: ii:4i:iiii;:+%::Y.i ji:;'j;:;i:jiii ii�i:ii:.'3i::?{:?::}?;?:;:i::;::isy;iiYj:'.,';:;iRj;i:; ;i:yj�i:i':?i::?'i'riiiii iii ijS'is:i::'•`!isi::i:'j'i ii'::::i s::..-:+?i:'ii::iiiiiji:::i%..:.;i: {:j;isi:;:;isii:.:, :::i::i:: :{:i:::ii--i ti;:iijiF`4 iii:i:;:;:;`y} ............... {^is4}}ii:C}i:i•::•ii?i:Cii:•iiii:3iii::?': ....is_:i:S::.;;:v:::!iy::v.�:::::eerier :.: ...... ......m::... w::::::v.�:::•:.�::.i::{.:4:::::::Si:..................::.....:...............: ................................................. ........................n.::...... :;:::.::Lv:::::::::::;:::::;.........::::::::n�i::::.�::.:....:.::r:::JiC.:�4::4iii:JrdiJm::::::: ... v.�:::................:.�::::::::::::::::::::::.�::::v:::::::::::n:in::iiiiii::•y}i}i:i?viiiiii:�:•:i.�:::::::::::::::.�::::•:v:.: 1:11 -11 -111 :."Q �>#4::i::::.*..vi::?::iiii i:i:::i......ii iiii:?:isv::%<:iiiiiiiii::iiiii:::ii:ti::Cii:ii:W::•i:C^:•i:^:v:3i:+.ii: %''�///%%I .. :c '"';sa:nanx �E$$ :;:isi'''i i2 isi` is�6 :`:,::'""."�":::.?' i::::%:;[yi? ;;;'-',i:i:.t?:iz:.%iSii%[;::i';:r:is[i`s :i:: :[[:::...1.2:<:} : ':::i...... `:Y `::}:i <:':[:%'` :i[tie:.[i '[.:::i i'-::.5'<. ::[i[i::i::.'i :i[:---- :is'r>? :i::i::ii: ::::"; atidr "`e: . .':::.:.:::':ei:: errs'::*.:.-::. `2`. ::.:: .:.... ....."`. ? :.`%''': >:: <`''(III # X. c ` h 3::'t2:Scu: —..... .....::o::o::;:•::•::::•:•.:.>::::::::<::::•:::::::.:.;.:::::..:•::::.:.:.........:...ii.;........................:.:........... .. :::'Ali.'�'.�:N:c`:;:......;';`:'::� ��':;.`: :t;;:';s�::: :'+.i;.:% :;.`:::3' <`%::''�:'::r::;ry:;,': ii nr Fafiare to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine to 51,500.00 and/or one yeses'imprisonment as well as dvfi penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me I understand that a copy of thLv statement msy be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby ee ' under the pains and pe es of perjury that the information provided above is truegand correct . Signature l Date �� �h�o� . _ Print name � L— Phone# official use only do not write in this area to be completed by city or town official . city or town: permit/license# - ❑Bufiding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department . contact person: phone#; ❑Other (Devised 9/95 PW 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. 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 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 maybe retinmed in 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 Investlgauans 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 i I -- f �oFZMET Town of Barnstable ti Regulatory Services FMLF� ' Thomas F.Geiler,Director aswss. 1639.�a`°� 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. � o m (y 16 39 +.-to C a Type.of Wozk: � ted Cost S 4 Ulo Q!1 �rP Address of Work: _3®V J owe_Ir 4 J ti( & , (—T�roG W, Owner's Name: J-0-wi eS I J ZO w o 4e A h U e r;m Date of Application: SGQ u`e a 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: a o ®s Date Contractor Name Registration No. OR Date Owner's Name °FTHE7°,i, Town of Barnstable Regulatory Services ' BMWSTABLE, ' Thomas F.Geiler,Director 9 Mass. g 1639..I a`0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I 1ames, Aylie'r-c'o r, , as Owner of the subject property hereby authorize�64 to act on my behalf, in all matters relative to work authorized by th uilding permit application for (address of job) `� goo l®cozy � rfl0-(l A® a Dane D('f2�W--s ignature of Owner Date es Print Name Q:FORM&O WNERPERMISS ION I �' I ✓/ce i�anvmovuoeal.� o�✓�aaoac�euaeaa : I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS, 043556 Bfrthdatea,1ti1:3�1962 Expires:,1121-13/2004 Tr.no: 4902 Re§triGfeds SCOTT E CROSBY 62 CROSBY CIR OSTERVILLE, MA 02655 Administrator y-\ ✓/rr. �anurrzovuuaal�l �/�aaaac/zuaelta Board of Building Regulations and Standards License or registration valid for individul use only g Y i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 131376 One Ashburton Place Rm 1301 Expiration: 7/13/2004 Boston,Ma.02108 Type: Private Corporation PEACOCK&CROSBY BUILDERS, kbTT CROSBY 1112 MAIN STREET UNIT 7 �, OSTERVILLE, MA 02655 Administrator Not valid without signature 08/01/2003 11:49 5084571033 STEM ENG CO PAGE 01 C r Steco@adelhpier.0et 508 -457-1133 Fax 508-540-2600 ����� rl Ili r �.��`f� ��!I'l 81 RED BROOK ROAD WAOUOIT, MA 02536 1 August 2003 Peacock& Crosby Builders, Inc 1112 Main Street, Unit 7 P.O. Box 151 Osterville,MA 02655 Attn: Scott Peacock Re: Hot tub Support Deck Framing 300 Tower Hill Road l Osterville, Mass ". Gentlemen: On 7 July I received a fax from Scott Peacock giving some information about an existing deck at the above referenced address, and the rough shape and-weight of a hot tub to be placed at the right rear end of the deck. I was not comfortable with just the sketch, so I went to the site and met with several men working on the deck. At that time I gave them some verbal instructions regarding what I felt was needed to make the structure safe. The original joists under the tub were doubled up. Some of the original joists had notches in them. I told the men to triple the joists in those cases. Some of the beams supported at the columns just came up against the side of the column and were entirely supporter}by two bolts. In some cases I had, concern that the edge distances required by NDS were not being met. Rather than let them be of concern I instructed the men to take a piece of 2x material the same width as the column, approximately 12" long and apply PL500 or equal rated adhesive for P.T. use to one face of the board. Then shoot 16d 4" o.c. over its surface. The load of the hot tub plus several people calculates to less than the load that is required on the deck alone, so there is no problem in placing this tub on the 2x8s that have been reinforced. Sincerely yours, ' STECO ENGINEERING COMPANY ��P��HOFMgssgc � CNAPI.S F. FEWORE Charles F Fewore, P.E. " SNo 343se �, President FFSSIONAIENG� � ram � .. � '`�j5 F<�•i.i� .,.��': I:i._ %Noo" lu od+ LL— a R{1:Z oA q I I o a. �� I J .. w •� s o cl 4 . I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Q Parcel Permit# 01 Health Division ]` %� �r Date Issued f' 2 ` D Conservation Division L . a o& Fee Z ^ Tax Collector -- - -�;► ,DYSTEM Application Fee J U• d� a Treasurer OF BEDROOMS Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address ��� i o t,44al Anal Village Owner �� 5 � GLf/)Ne er�� Address- ' � � I� I eT�fUQ Telephone 7�� 4A 6 s_°f Per it Request Square feet: 1 st floor: existing proposed I v 2nd floor: existing I' proposed y Total new Valuation . ��� Zoning District -Flood Plain /v� Groundwater Overlakf /11�I Construction Type W_2 4CD Lot Size i`y,I- Grandfathered: ❑Yes ❑ No If yes, attach supporting docur Cation. Dwelling Type: Single Family two Family ❑ Multi-Family(#units) -3 Age of Existing Structure Historic House: ❑Yes 0�10 On Old King's Highway: ❑ es ULAI�r-- Basement Type: W-Fall— ❑Crawl ❑Walkout ❑Other /'v 6- Basement Finished Area(sq.ft.) /y'4 Basement Unfinished Area(sq.ft) vf/14- Number of Baths: Full: existing Ja\ new � Half: existing new 0 Number of Bedrooms: existing_ new 0 Total Room Count(not including baths): existing S_ new First Floor Room Count ' Heat Type and Fuel: ❑Gas 0-(Xr- ❑ Electric ❑Other Central Air: ❑Yes 0-No- Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing El new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:tre"xisting ❑new size Shed:❑existing ❑new size Other: AZoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes @-N,6 - If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address �(�� �Q,lU 'St�� a tj License# 6 4 5S6 Dc�loS� Home Improvement Contractor# Worker's Compensation# W ALL CONSTRUCTION DEBRIS RESUL7 FROM THIS PROJECT WILL BE TAKEN TO fn y"bi`e- SIGNATURE DATE /"off-6 _a 6 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 653 0Z= INSULATION O FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO'. y 1: E r Town of Barnstable Regulatory Services Thomas F.Geiler,Director MAss. 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 I, =, A AGJ � ,as Owner.of the subject property hereby authorize LO to act on my behalf, in all matters relative to work authorized by this building permit application for: 14o ej& (Address of Job) *12= Owner Date V es n Print Name Q:FORMS:OWNERPERNILSSION i 71. ,° N Board of Building Regulations and Standards9 License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 131378 Board of Building Regulations and Standards Expiration: 7113/Y006 , One Ashburton Place Rut 1301 Type: Private Corporation Boston,Ma.02108, PEACOCK&CROSBY,BUILDERS,INC. SCOTT CROSBY 1112 MAIN STREET UNIT 7 �_�� ✓ OSTERVILLE,MA 02655 Administrator Not valid without signature � �� GTE ����e� �✓1�� � ' BOARD OF BUILDING REGULATIONS i a i License: CONSTRUCTION SUPERVISOR I Nurnbenrl-. 043556 fA �,. Birthd—te—:^12/1362 ' i Ire :11: /1_/2006 Tr.no: 5008.0 R t:C d~00 SCOTT E CROSBY r 62 CROSBY CIR\� G' ` OSTERVILLE, MA 02655 '° commissioner v :w o�TM� Town of Barnstable Regulatory Services *61 ��0$ Thomas F.Geiler,Director MARA .'°rEo,�,r Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 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 butnot 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 OOD Address of Work: No f 6 wo-r rill A � - (nG ea Ucl1Z . A Owner's Name: Date of Application: l - t 6 —© I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 . 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Capacity Required: -440 GoL/0oy .: = Leaching Area 'Required: 440,�Gal./(0:74' Gol./Sq.Ft.)=-595 .Sq.Ft..- . . • 0 . . Proposed Leaching Structure: 1-.33.5'L ,X 13'W' X 2'D Leaching Trench W Lcoching Area Provided: .621.5 SO.Ft. . . . . 0* . Proposed Leoching- Capacity . 460 gpd > 44O 'gpd. req'd. .0 STREET .. .. ... ... ,.,. . ... � . . . . : . 0 I . ,. ... . .. . . .: .... ' . . . .'.: . . . "OI .S..T. ER' VIi LL..E" . . . . GENERAL NOTES . . . . 9 11 1. .ADDRESS: 300.TOWER HILL ROAD IOCUS.-... . .:.... . . . . .. . . . . - . . . . . . . 2. ASSESSORS NUMBER:. 142037 . . . . . NO ,SCALE . .. . : I . . . * . . . . . .. . I . .. . . . . 3. .DEVELOPER'S LOT.A-. ' .. .. . . . �. . . .. ' . - . . . . . . . . . . . . . 4. 10POGRAPHIC INFORMATION WAS COMPLIED FORM AN .. . .... . I - . . . . . .. . . I . . . ON THE GROUND INSTRUMENT SURVEY. . .. . . . . � I . . - . - 5. 1OWN WATER IS PROVIDED .TO SITE & SURROUNDING PROPERTIES, . _i�r_ . . . ... . . . . .. . � .. . . 6. REFERENCE PLAN: PLAN BOOK . ' . . .. .. .. . . I . I I . . 010 . . . . . . 7. NO WETLANDS LOCATED WITHIN 100 FEET OF SAS. . : .. . . . . . . . ... CP - .. . . . . -A . . . . . .8. *.NO POTABLE WELLS ARE LOCATED WITHIN.1 5O. FEET OF SAS.. ­ . . . . . . 1. I . . . . . , . 0 . . . . . . . . . . . � . . . � �_; .. . 1. . . . . .. .. . � . . . .. ' ' ' . . . , A * : - . . .1 . I - �4 .. CONSIRUCTION* NOTES - . . . .. . . . . � . . . .. . : . %-S, . . . � . . . .. . . .. . . . . . '. . . . . .. 1! . � . � 1. Contractor is responsible for Di6sqf'L� notification. . . . . _P0 - -, , . . . . .and protection 'of, all underground utilities and pipes. *. . . . . . .: � .. 2. The septic,,tank and distribution box shall be set . . .. . . .- . _Y0 - .. . level on 6 of 3/4"-11/2" stone. . . .. .. . . . . .. . . . . . . 3. Bockfill .should be clean sond or grovel with no - . . ke ce- 1 1.21". .I . . . . . - stones over 3" in size. . . . . . - * : . . . . - - . . . ie . . � .. .. . .- r . . . . 1k - 4. This sysiern is subject to inspection during installation . , '..oc . . . . . . . .1 . . . I .� . . . . . by Glen.E. Harrington, R.S. .: accordance.ordance .. .. . .. .. . - . . . . 5. The contractor. shall install this system in .� . . .. . . . . Massachusetts Environmental Code . .- . . . . . . . / . with Title V of the M . I .: . . . . . . . . . . � . .. .... . . . . .and .the Regulations of.the. Town of. Bornstpble. -Box and * -10 septic tank, 1- H=10 5-hole D . . . . 6. Provide on Acme Precast 1,500. gal. H . . I . . . . * .. . . 3 'H-10 500.gal. chambers or equal. I . . . . . . . . . . . . . . . . ... � . . . . . I . . . . 7. No vehicle or heavy machinery shall drive over the � . . . . . . . . . . . . septic. system,unl6ss noted.as H72.0 septic Components'. : . . . . . . . . ' ­ . . . . . . . . .. tee * . 8. Install .gas baffle' or equal on septic tank outlet tee end. - . . . . ... . 9. All existing inverts and site conditions shall be verified by contractor. : . . . .. . . . I I ... .. ... .1 ... -'. .. . . . . . . . . 10. Existing leach pit to be pumped. and bockfilled.. . .. . . - � . . .. . . I- b . Sher to be connected to main building 'sewer. ..' . . . . . . . . . . . . 11. Clothes washer . . . . . . .. . . . . . :. . ... . . . . . I .. ... I . . . . . . . . . . .. . . . . . . .. .p6ved driveway . . I . ... � .. . : -. .. . . . . . . . . . . . . . . � % . . . .. .. .. .. . . . . . . ..� : - . . .. . . . . . . . -.. . . . . .1 . . � .. . . . . , . . . . . . . . . . . . . I . . . . . I . . . . . . . . . . . . ... . .. . . . . . -. ... ... . . . . .. . . . . . . . .. . . . ; .. . .. . . . .. . . . . . . ; . . . . . . . . . I . . . . . . . . . . * . .b.e.0.c h) . I- .. . . . ... . ... . .. . I... .. .... . . .. ... . 6 IQN" . . . . . .....1. . . . . .. . . . . , ..q0f.�609' . . . . . . . . . . . . .� .. . .. . . . .. .. .. . :. .* - . . . ...� . . .. . . . .. . . . .: . . . . ) - - . . . . . . . . . . . i-20r OWE.ACCESS MANHOLE . I.. . �� .. . . . .. . . . . .1 . . . . . . . . . . 4 .1.. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. I . . .... . . ... . . . . . a,- .5 . . . . .. . . . .. .. .. . .. . . . . . ... .. I . . .. . . . . ..... . - . . b - .. . .. . � .1 . .. .�. . . . . . . . ­ 1. I . . . . . . .. � :. . . .. . . . . .1 I . 1. .. ., . . - . . . . I . . .. . . . . . . . . . � - . . -- I . . , . ... . . . . . . .. I• .. I . . . I . . � ., � '' .. �. � . . . . - . . . . . . . :�'. . . . . . . . I 11 .- � : . .. . . . : n_ : . ... . . . . .1 . . .. . I .� - , , , _ 1. . * . . .. . . . . .. . I . . I... . . . ..., .. - . . . :. . . . . . .. . . , ... .. : .. .. , 'w ` ':- ". ' ` , . - 1�:--, I "..,. � . .. . , : � - ... .� .. . .. .. . :.1 . " C3 * M � . , ...: .. I . . . .. . ... � . ,. . t. . . . . .. I . ­ .:' - " � i. ­­­.. 4�4.I.f.. .. .- . . .1. _. . : . .... ..: - , . . .. I' . ... :... :. . _. . . . i.. .. 1. . .-. . . .. . .. . . . - '. . . . ... . .. . . . . ... .. ",�.*` ,. ..-. , :...,:. .... ...i:.:,. ... .W. ..; ,.. ...,�... . . .. - .. .. .. .. .1 .:. . ­. .- ... . . STEEL REINFORCED PRECAST'CONCRETE- -, . . w, � - .1 .. - - . . . . . . 0. . , - ' . . . .. . I . . . . . . . .. . ... :.- - * . H, * - .. '. . .. . . . . . . .. . . . .. . . . . . . . .. . . -.3. . . .10 500 gal.. chambers. . . . ,, , * , '. . . . I .... .. . . : . . . . . . .- . . i ., . .. . PLAW -VIE ­: .: , , : * �.- ... . . : . .. . .. . .: ..�' .- .- .... . . . ­. . .. . . . . . � .. ... .. ...- : . . . .. . .. . . .. . :� a :. -�' :.. , . � .. i 6D'-�-*SEQilO -- -.. .:"_* ­ . . . ., 1. . ..:. .. . I ­ . . . . � � . .. .. .*. � .* . I ... . 1. 1 . .. .. .. .1 . . . 1, :1 I ... ... .... � � N .. .. .. ... . . .. . . . . . - . . . . I . . . � . -.��.. I . . . ­ . .. .- . . � - . . .. ... . . . . . . . . . . . . .. .. . .. . . . . I . . 1. il . . . . . ' ' . . . . 1 . . . . . . , "... . . . . . . '. '. ... . 1 . ... � I . . . .. .. ..� .. -I . . . . 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