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HomeMy WebLinkAbout0295 WESTWIND CIRCLE o���. ��� i�r��r � � Town of Barnstable *Permit#l on Expires 6 months from.issue date Regulatory Services y. Fee \ 0� Thomas F. Geiler,Director S r'�,�/s106 Building Division S p Tom Perry,CBO, Building Commissioner' ommissionr 4AY 3 ��4111, 200 Main Street,Hyannis,MA 02601 011/ty 0 ?046 www.town.barnstable.ma.us OF&A �.� RN Office: 508-862-4038 �0.8-.790-6230 �F EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY � ( Not Valid without Red X-Press Imprint . Map/parcel Number ET1 l e `1 Property Address " t�l r OResidential Value of Work\,T- C/ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address . Contractor's Name .P1/� � u �j'/�, Telephone Number Home Improvement Contractor License#(if applicable) /T%/)��rZ Construction Supervisor's License#(if applicable) VWOikman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner `have Worker's Compensation Insurance Insurance Company Name ;-7W� I Workman's Comp.Policy# 5 Copy of Insurance Compliance Certificate must be on file. Permit Request.(check box) VRe-roof(stripping old shingles) All construction debris will be taken to /it/ipi �� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side , ❑ Replacement Windows. U-Value (maximum.44) r *Where required: Issuance of this permit does not exempt compliance with.other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors Li nse is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth ofMassachusetts Department oflndustrialticcidents Office of Investigations 600 Washington,Street Boston,AM 02111 www mass gov/dia' Workers' Compensation Insurance Affidavit; Builders/Contractors/Electridans/Plnmbers Applicant Information Please Print Legibly. Name(Basiaess/organizadowlu&yiduaD: 7 X/ei Address: z/_,_V CitylState/Zip: e t l Phone#: 27 =r 3, 9 . Are u an employer? Check the•appropriate box; Type of project(required): 1, I am it employer with_ 4. ❑ I am a general contractor and I 6, ❑New construction employees (fall and/or part time).* have hired the sub-contractors �• 1l4 x VR em°delmg 2.El am a sole proprietor or partner- listed on the attached sheet 3 ship and have no employees These sub-contractors have & ❑ Demolition wonting for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' Comp,insurance 5, ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electricalrepaus or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Pbambing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs •insurance required.]t . employees. [No workers' 13.❑ Oiher comp,insurance required.] ' *Any epplicaat that cbecka box#1 mast also fit]out the section below showing tbea workers'oompensatiou policyiaferrnatiow ' t Homeowners who submit this affidavit indicating they are doing aII work andfen hive outride comb ctors must submit anew affidavit indicating each ZContracton that check this box must attached an additional aheat ehowiag The name of the sub-eoatrnctan and their workers'comp,policy informaiicn. I om an employer that is providing workers'compensation Insurance for.my employees. Below is thepolicy and job site tnf brnn�dtan, • •;' InsuuanCdCompanyName: policy;nor aei&i.Lic.4M Job Site Address:-7 ��i�ST�//���: �iJ.��1�� CitylState/Zip Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure-coverage as required undef Section 25A of MGL c. 152 sari lead to the imposition of criminal penalties of a fmc up to$1,500.00 and/or one-year imprisonaent,as well as civil penalties in the.form of a STOP STORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance eoveiage verification. 1 do hereby certify under he pains and penalties of perjury that the information provided above is true and correct. r tore: Date: � Phone#; roc a�use Do n& e M ifs urec,to ik t e al,&Y cif'or tM eicid City or Town: PermhtLi tense# Issuing Authority(,ircle one) 1.Board of Health 3.Building IDepartmeut 3.Ctty/•i own Clerk 4.Electrical Inspector 5,Plumbing Inspector l 6. Other i Contact Person: Phone#: Ynformation and Instructions MassagbuseM General Laws chapter 152 requires all employers to providewbfken' compensadunfor7ffieir employees. J Pursuant to this statute, 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 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. Howevrr 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, cotstruction or.repair wcTk on such dwz.Uing house or on the grounds or building appurtenant thereto shall not because of such employment be deemed tobe 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 it 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,MGL chapter 152, §25C(7)states'Neither the commcmwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of commliance wi8i the insurance requiremecds of this chapter have been presented to the contracting authority." Applicants Please fM out the workers'compensation affidavit comVletely,by checlemg the boxes that apply to yom situation and, if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their cmtif eate(s)of insurance, United Liability Companies(LLC)or-Limited Lia ATRy 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 Industrf al Accidents. Should you have any questions regarding the law or if you are required to obtain it workers' compensatimpolicy,please call the Department at the mmiber listedbelow. Self-insured comps nim a-houild ter fhea self-insurance license number on-the appropriate lice. City or Town Of iciah. Please be sure that The affidavit is complete and printed legibly: The Department has provided a space at the bottom. 'Qf tl afirdavk far you to fill outin the event the Office of Investigations has to contact you regarding tare applicant - Please be sure to fM in the permifi/ficense number wbich wM be used as a reference steer. In addition,an applicant that mmst subm t multiple permit/license applications many given year,nerd only submit one affidavit indicating event policy information(if necessary)and under"Joh Slte 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 fhe applicantas proof that•a valid affidavit is on file for future permits or licenses. A new affidavit mustbe filled out each ' year.Where a tome owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (it. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like 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 numb er: The Cnriam.onweal. of MmichUettS Department of Industrial Accidents Office of Inveftafim 600 Washington Street Boston, IviA 02111 Tel,#617-727-4900 e--t 406 or 1 c77-MASSAFE ' Fay#617-727-7749 . Revised 5-26-05 wwwmas5.gov/dia Town of Barnstable Regulatory Services snMMASS. E' = Thomas F.Geller Director 1619. MASS. � , �pTEDNip��1e ,, Building]Division. Tom Perry, Building Commissioner 200 Main Street, Iiyanais,MA b2601 www.town.barnstablearia.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, 7 i7* /�/0--eA6Z1 W ,as.Owner of the subject property hereby authorize �.U//Ih��,k to act on my behalf, in all matters relative to work authorized by this building permit application for. • J. (Address of Job) 421 U- d S tore of Owner ate Print Name Q:FORMS:o WNERPERMIS S10N Boa • = s gula;ions and Standards ?<`! (1.. PRO HOME'S..... .. f - MVEMENT CONTR2 C TOR J ReAist�alk _ or.�, 10049�: 2006 COX, I ' Q: �w�/a DAVID �te Corporation N David Co� 19 ENDER'LN :. >4 T W. YARMOUTH, MA.02673 yV• �-� -• Administrator Assessor''' map and lot number ........;�........ . . .../ oFTNetc Sewage Permit number LJ1...� Z AR33T11D ' E i -ems B a Z House number, ......17........ 1A° 1639. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... �..r.A.�. ..... .... �� TYPE OF CONSTRUCTION ...........�4A.Q DA........ c ,..,............................................................ ...... ... .. '...... ............19.may' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby-applies for a permit according to the following information: Location ...L7.1;A... 1-4`...... ....... ....................... ProposedUse ....... ........ ............................................................... C O 1 _ ZoningDistrict ..................:.., ......................::........................Fire District .............................................................................. Name of Owner ...Address... 4...... Y..a!: ..... ,.... .��•..:s0; ,uCMotl}y Name of Builder .... ....Address a,.4... ...C.....:�..C........................e............. ... I Nameof Architect ..........................................................:.......Address .........................................................:. �� e �z � �.c... Number of Rooms >�...1�..:�...e...:..................:.�.Z,.:............�,��:.Foundation .......�........................................................ .... Exierior .......CY..k•�4. Roofing .. 5 \!R ... ......... 1 Floors l al.J�....'k�•W,�?,:I I..... <<!�.�..Y.`C_. .................Interior ..... ?.1�..11..... .. `.`...................... Heating Cn.....IF:t...... .,.....1!1 .....:...............................:Plumbing ...........a ........... ", Fireplace ............. .........................................................Approximate Cost ....... .e Definitive Plan Approved by Planning Board ------------_______---------- 19________. Area .......................................... Diagram of Lot and Building with Dimensions ,�- Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH v\ Ar 1y ' 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, !U,,...4A4..... i .R ..... Construction Supervisor's License .............. THEO CONSTR. Co. A=121-11-47 No ......a:NA4Permit for ......1...st!?.ryv...§ingle familv dwq.11 ' .......................... dwelling AjAg........ ................... Location W;....U......2.95...Ve.Pt...Win.d......... Circle , Osterville .............................................................................. Owner Theo. Construction Co. .... ......................................................... Type of Construction ..........fra.me........................... .... .............. ................................................................. Plot ............................. Lot .................. Permit GrantedL 1 ..2 ........... ./.?�il...2.1.....1985 .p ..... Date of Inspection ... ............ ...................19 Date Completed ........................................19 y Assessor's map and lot number ........ .................... .. .. THE TO�r Sewage Permit number /t /... ... l..l......✓4!.1fV . ...:... Z 33AWSTAMLL i House number � .. ............ y YM6 0 �0 YAY d' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........11U.AAA.....- .....C�11r1°,J.``e.... �M.�...1�I..... u?. ��1�V►� TYPE OF CONSTRUCTION ........... .. ..Q.. ........ ............................................................... ..........t.T..` '...... ............19.B.4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..Lo. ....c .. . ..W. . .°4.. 1.��1.�......c\.��N,.......Q., `��C.ASS .1►��`ST........A .5.5...................... ProposedUse .......5.. .v15`. ,..,....... .......... ................................................................ ZoningDistrict .................. .......................................Fire District ................. ..� .............................................. Name of Owner ...Address ...k4...... Ott. .... ... ...5o:..I.c► ►►.c�cr} , P Name of Builder .... ...Address Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..1 :iZ.►... .....L.\� :...�,�.Z.. ►i1-.Foundation ....�� ...©.V.C -� C�V��-C� �.,, ................... ............ . Exierior w�.1: le...... ......Roofing ....!' .5.. �!1r\. .....cS.."��.�!1:5.\ ........... Interior ...... Floors ..1 ..%Ak....vk.�►.CJA.....Ckk.�.'O................ ` ..... -.-?.. �........................................... Heating �7.....}'. .....t'7.:..:. .....:................................Plumbing ......... ......................................... Fireplace ................:-4.............................................................Approximate. Cost ...... 3 o�.Q.O.���. ................................ Definitive Plan Approved by Planning Board -----------_______-----------19________. Area :. Diagram of Lot and Building with Dimensions Fee . .....l..t.-5�............... SUBJECT TO APPROVAL OF BOARD OF HEALTH l e 1y ° i i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINU75 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name—l... 46. ........ ..... Construction Supervisor's License ..�..bf?.Q.�.............. CONSTR. CO. A=121— 1-47 No .2.7.6.a.4.... Permit for ...l...st..rY.............. sinJle...family'...5 We1.7.a.n.g................. Location Lot 38 295 West Wind,,,,,,,,, ........................... Theo Construction Co Owner . Type of Construction , frame P(ot ............................. Lot A;'farmit Granted .................P...r ........�.�.....19 85 • .` MCA - oflnspection ............................ .� �. ., ate � . ......19� Date CompI t d .07�.- ......1'9 }IWINFREN"RrW!rW NNAS 44r/,7 ' T 004 W /M r W F4000-/AkWRAWf R4M A4.0, OW FINE mwm ". WMNIrY PA�14, �ViA. s �FIF�°GT/�E ' ? ; NOTE: NORTH ARROW NOT TO Q �. 4 BE USED FOR 5040 PI POSES k y L•QtiI�Z) f .. � I a5 -S� . a N Z Qt Z r f �q 89, 98,' 39.O' y EX/ST O _ /3.6 FOUNhs(T/ON C '060T a o '• o ,39Cb yo .GOT. POW 38 Ilk -J(h `k tu r 7 P�►OT A4AWWAO AarAWW MW MUNNTIAN 4004T/ON PLAN. r A# /WTRzlweIVT /RVgY SNP /,S Fag'T*f �Q.T �J///YD C//� U$E Or THE' OINK OV44Yr IMPER NO O1RC41f#f$r4 NCF$ AMC OFF%2eT%l TO BF OS TEIA�Y/l,Z E(8,4R1Y,5749 )71#4- L/,W'A �'l�Fi' FFIII "iE , ,FY.1�,!„�9, *f pW 9, " r ' QJ�YN 0 BY: T�/EO CDNST. 00,. Ok of M46,,1 AW� OJW if, N RING INC. r7 o` ROBERT G� G� H I•�I/IGNWAY E. t-AlT FA1 vN #-4. OZS-36 + RAYMOND p No,2158340 + //, i,/ 'A x"rpp o.•/ � S .tr�T. + . �N I STD''" j ,�1►Y(/ 4AP41l 40Y.. P4AN IVO, �'gy •�'. TOWN OF BARNSTABLE BUILDING DEPARTMENT ssaaIT = TOWN OFFICE BUILDING ' rua t619 �� HYANNIS, MASS. 02601 '�o rur►• MEMO TO: Town Clerk FROM: Building Department DATE: An .Occupancy Permit has been is-sued for the building,authorized;.by BuildingPermit #...... . ..0 ... L !!. . .............................................................. .._.................._.__..._.. issued to .................. -1M.LA _.... -- D'4r '.......... - .... ._... ...._. .. Please release the performance bond. 1 1 7 TOWN OF BARNSTABLE Permit No. --------L7684 • Building Inspector Cash OCCUPANCY PERMIT Bond x Issued to Theo Const. Co. Address lot #38 295 West Wind Circle, Osterville Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date .Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WELL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.10 OF THE MASSACHUSETTS STATE BUILDING CODE. ...................... Builaing- Inspector