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Home My WebLink About0105 BERKSHIRE TRAIL Ui:lC 12543 i,4o.5 RR H„STINt3S.14" .. ,� ,.�..,�-�_.��.i..r..�. � ��uu.u.�_:.s_a�wh:a��;�1!'ln^v.,..;.fb`rlu�ec,v::uorl�-.itAJt�:a:v.�:�c".t•�.w.�n.rratY�iie�LL�..•[dtife\ �— — "i�a�YW9`.IL•'L."��' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel lJ Application # Health Division Date Issued 2_�> l Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board v Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address Telephone -J✓"v � ��' Permit Request -24 �a I/i/i'�� (� vl�o (,1�1✓ GUfV �w (��! ' Square feet: 1 st floor: existing proposed 2nd floor: existing ° proposed Total new 'Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type t vW Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U- Two Family ❑ Multi-Family (# units) o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King es Highway--- ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other rD Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. ) Number of Baths: Full: existing new Half: existing n Number of Bedrooms: existing _new W 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 ❑ Commercial ❑Yes C/No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION �. (BUILDER OR HOMEOWNER) Nam �V Telephone Number �U Ab�" 3't'Z Address UU! 61-V G� License # I Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� FOR OFFICIAL USE ONLY APPLICATION# DATE,ISSUED , Ir, MAP/PARCEL N0: t . ADDRESS VILLAGE OWNER ; I DATE OF INSPECTION: FOUNDATION I^ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t GAS: ROUGH- FINAL FINAL BUILDING D�4 &CLOSED OUT Au-C TION PLAN NO. " I , 1 Mar, 11. 2014 7:05AM No, 7764 P. 2 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) w� f�y�i'S �� y�� • GAG �• (Property Address) t � hereby authorize (AA" 6'O tt (Sub ntractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. / Ow er' Sig9eture Date r Massachusetts -Department of Public Safety ` Board of Building Regulations and Standards Construction Supervisor License: CS-100988 .``-1:.L Is HENRY E CASSD,)V '; - 8 SHED ROW s WEST YARMOVrH 'I "'F� Expiration Commissioner 11/11/2015 .. _ (�.��61�' �", > t / / / J �C�-'!•"L:t'..1.;1J 1.�,C'!1•'ll..-,1l''��J .;�:;:1:,::=t,., �•'G��l•�i'l:C-i�G(L.-C'Cll•r�`l- C C)t:tice 01. 'Con,ui ner Affillfs and Business Regl.11ati`011 10 Aark Plaza - Suite 5170 Boston, Massachusetts 02116 -tome Improvement Contractor 1Zegistratian Registration, '153567 1 vile: Private (.Ull.)01'cI11011 Expiration: 12/15/2b14 fri✓ 2J:mJI i;APF: COD INSULATION, INC HE N R Y C A S S I D Y _...._...__..__._...... . _..._....... _ ... hi RFARDON CIRCLE _........ ............. .............. . �l? YARMOUTH, MA 02664 Update Address and return crud. Mark rcasuu for clutrlge. 1.� Address L I Renewal 1....� 1!:nllrloyntunt I I I.usl L:nril 4 `i ariicr irrrrir((/i r`i::>'��ru.rrr.'fi«u:f� uu;,„J t'„n.wncr Affuivs * Ltusiness Itegulatiol, License or regisrr-atio❑ yalitl for indivitiul use unly 1 Itlur.�r IMHKOVEMEN•I- CON'I RACTOR bclurc the cspiratiun date. If Ibuud I-etUrII to: 1535CI7 Office of Consumer Affairs and Lusiuess ReguluCiuu1 !'I''i/?074 Private Cor oraucii 10 P:u•Ic Plaza-Suite 5170 P liustuu,MA 02116 ur.tn INC, I)uclersr.r:rc[it ry of v;11 lyitho t I)at re r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211.1 www.mtass.gov/dia Workers' Compensation Insurance Affidavit: Butilders/Contractors/F-Iectriciaris/Plumbers :�ul,licant hiformation Plesise Prittt >L e1ibly N,i.litc ll3usiLcs�lOrgarairatiort/Lndividual): ��'�f�c' , C/ /JVJ, y / l'iiy/5t ttC/Zi G�,�r /.r . lG Phone #: Z /4/- :4J-c you au eruplray r7 Check the appropriate box: ' Type ot'project (required):L.&I .u;a a employer with. j 4. ❑ I am a general contractor and I I ctttpluyms (fitll anw9e part-time).* have hired the sub-contractors 6. ❑ New construction i -' l ant a sole proprietor or partner- listed on the attached sheet. 7. (] Remodeling Ship and have no employees These sub-contractors have g• ❑ Demolition wurking for me in any,.capacity. employees and have workers' [Nu workers' comp. insurance comp. insurance., 9. ❑ Building addition required:] 5. ❑ We are a corporation and its 7 0.❑ Electrical repairs or additions 3.❑ 1 din a homeowner doing all work officers have exercised their ,�l,:l..❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12,❑ Roof repairs ra insunce required.] .r c. 152, §1(4),and we have no 3u.❑ 1 am a homeowner acting as a employees. [No workers' 13.aOther f,iu 4-, gencrul contractor(refer to #4) comp,insurance required.] ' Y applicant that checks box*1 must also fill out the section below showing their workcw compensatioif Po iafonnunion. t Huuicuw=3 who submit this affidavit indicating they Luc doing all work and then hire outside contracton must submit a new affidavit indicating such. :Cunutu:tuta shut check this box must Lamchcd an additional sheet showing the aama of the sub-couaw-tors and uato whether or not those cautica have employees. if the sub-contra ttus have employees, they must provide their wurkav comp.policy number. /um an employer Char is providing workers'compensation insurance for my employees. Below is the policy and job site ;nfurrrraliun. • Insurance Company Name:_ Policy#or Solt-ins. Lic. #: vl pC � / Expiration Date: �� Job ss: I( (/ �J /'� `'ZD t/VIV�i 1 City/State/Zip: W rI q �D� �l 1 yG%�C-r WO Attuch x copy of the workers' cornpeasatioa policy declaration page(showing the policy number and expiration date). Failure to scci,rc.covcragc as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a rinc 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Otfict; of lnvcsti8a6or,s of the DIA for insurance coverage verification. 1 do hereby eern# nder the nd penalties of perjury that the information provided above is t e and correct -iz Date: OffUal use only. Do not write in this area, to be completed by city or town ofciaL City ur•Town: Permit/Llcense# Issuing Authority (circle one): 1. &►aril of Health 2. Building Department 3. City/Tiiwn Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other l'outact Per3ou: Phone#: CAPECOD-27 MYOUNG CERTIFICATE OF LIABILITY INSURANCE ^ DAr7/8/2013 DIYYYY) ails CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _._..-----.._._—.._....------- -- IMPORTANT`. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS TNAIVED,subjuctto IUIu terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to tho cerlihcatu holder in NOLI of such Bndorsernent s . CONTACT' LiClntir PC-51406�O Margaret Young NAME: ------- Ruguls 3.Gary Insurance Agency, Inc. PHONE'— FAX ._-- 434 R(u 134 IAIC.No.Exit: EMAIL 15uuth Dennis,NIA 02660 'A 'ss:myoungerogersgray.conl _.._..__.. ' INSURER(S)AFFORDING COVERAGE _- _—_ _ NAICd_— j _._. .. .._._....._......_......__......_....__.__.._. INSURER A:PEERLESS INSURANCE COMPANY_ INSURER B:COMMERCE INSURANCE COMPANY Cdpu Cod 1rlsulation, Inc. INSURER C:Eva nston Insurance Cornpally_.___.__._.................-....._-.-- —_T •10 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUNIBER: .._..........-....... - -------- __-----_--—- — _----- _— MIS 15 I U CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTVVI'I HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CtKIIHCAIE MAY 19E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED.BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS, 1,ELUSIONS AND CONDITIONS OF SUCH POLICIES,LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS'R ...._... --- -'---'- 'K=ac SDBR— -- POLIC EF P6TCY E3[ LIMIT'S I fR I"YPE OF INSURANCE VVVP POLICY NUMBER IMMIDDIYYYYI IMMIDDlYYYY1 j UCNtMALLIAUILITY ^--- — EACH OCCURRLNCE $.____ 1,000,000 A X l:t)MMtNCWL UENERAL LIABILITY CBP8263063 4/112013 4111•,0�14 �AMAfE TO RENTED-ce _ --- 100,00 PREMISE F.a ocadre, I b CLAIMS-MADE X OCCUR MED EXP(AIIY w1n Lrorwtq b S,UO PERSONAL S ADV INJURY-- y_—__.1,000,000 GENERAL AGGREGATE ....___.._. "�— 2 000 000 i I ut•N't AG6REGAT.F LIMIT APPLIES PER: PRODUCIS-COMP/OP AGG b —_ — lPOLICY I AUtOWbILE LIAOILITY - IF a DM�IITtD SITTGTE LlM-TT— —1,000 00 `B ANIAUIU 13MMBCKVMK 411/2013 4/112014 BODILYINJURY(Parpanon) b — ALL.OWNED SCHEDULED BODILY INJURY(Par accident) b _— .AtITO5 X AU'ros NON-OVVNEO F�ROPE�'1�T1 PAGE---- _._........_.— X Inhkl)AU'f0S X AUTOS ' PE ACCIDENIT , b )( umn(eLLA LIAl3 X OCCUR EACH OCCURRENCE b 1,000,00 C i.Xi.t»LIAtI CLAIMS-MADE XONJ453512 411)2013 41112014 AGGREGATE UtD II X II IiET'EN I"ION • 10,000 b l—_.1_ ... —.__—� .. _— --- VVt STA�1 OTH• ---....I WORKERS COMPENSATION _ I AND ENIPLOYERS'LIAOILIlY YIN _ ^1,000,000 U ANY FK011KIETOHIPARI'NERYExEcuTIVE '—"' WCAU0525904 6)3012013 613012014 E.L.EACH ACCIDENT b __ OtHCERIMEMBER EXCLUDED (� N 1 A -- - 1000,00 E.L.DISEASE-EA EMPLOYEE S w>,dnacnUo undyr 1,000,000 I :nIiSCRIP'nON OF OPERA'I'IUNS Uelaw —_E.L.DISEASE-POLICY LIMIT b—,_.•., j U.SCRIN1'ION OI-OPERATIONS I LOCATIONS I VEHICLES (Alta 01 ACORD 101,Additional Rom arks Schedula,If moro spuee Is raqulro d)— — Workers Compensation includes Officers or Proprietors. Adduunal Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. I ' I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EIE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod losttlation, Inc ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I 01988-2010 ACORD CORPORATION. All rights reserved. ACORp 25(201 U/05) The ACORD narne and logo are registered marks of ACORD I► f CAPE COD l INSULATION IFed f q N® F-MpI.ASS S[AMSSSS SYMAf FQAM Sp$PS 040 SAM SORSYS INS.S FIQN CSIIINOS 1-800-696.-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: � / . Dear Building ln'spector i Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed &. completed the insulation and weatherization work at the property listed below. Cape Cod Insulation. did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village g A-4} 6144ca /m r Talc- AAA Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( X) X ( 2r) ( ) � ) I Slopes ( ) ( ) ( ) ( ) ) Floors art fSK ( Y-) Go � Walls ( ) ( ) ( ) ( ) ( ) N Sincerely Fie ry E Cas y Jr, President C: e Cod I , ulation, Inc. 1 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION D �� Litt Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis "Project Street Address 11110 t 4 _-- A4l St Village ^' .yam _� VvYt T `Owner - l.�- V, Address ,Telephone [-U— 1. ,,:Permit:Request-- (✓V b ✓ , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 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 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: LIR, i ting ddew -8e_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ? rD o --n Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ o Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Telephone Number 5 0?2_ I 2_E ' l q(0 b CYddressA� kJ ( (P License # Vl4 M 0&5'4 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTIOY DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY -.. .� 3 F APPLICATION# "3 DATE ISSUED MAP/PARCEL-NO. ► ADDRESS VILLAGE r 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.. 1" .. . .r•IC.+ ,1 i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass govh a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/lndividual): AddressA Pv_� X 2 �, City/State/Zip. Phone#:, U 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 1 employees(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.X' Remodeling' ship and have no employees These sub-contractors have g. ❑Demolition working for me in anycapacity. employees and have workers' $ 9. ❑Building addition [No workers'comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10�9 Electrical repairs or additions 1M I am.a.homeowner doing all work officets have exercised their 11 R]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 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 contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sob-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide 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.M. 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 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 hereb c under the p d penalties of perjury that the information provided above is true and correct Si`mature: Date: f Ll CJr -Phone#: . Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all*employers to provide workers'compensation for their employees. 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 or other legal entity,or any two or more of the foregoing engaged m 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,§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 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 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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability 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 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, 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 as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to burn 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 number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 Tel,#f 17-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#f 17-727-7749. www.mm.gou/dia i � �r Town.-of Barnstable Regulatory Services t 13MMSTAMM : Thomas F.Geiler,Director . MASS. &.�� Bnilding Division. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.townbarnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEmarriON f Q � Please Print DATE: v �1 ` JOB LACATION: tu1jC� MA14- numbelr B street village "HOMEOWNER": i I (.l) [� t, - [ name V A home phone# work phone# CURRENT MAM NO ADDRESS:& X 2— city/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 ona 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 re ments. Signature of Homeowner L 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.Controt 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 oFTME Ian. Town of Barnstable Regulatory Services t R�R70'4TART= �r ass Thomas F.Geiler,Director .Building•Division Tom Perry,Building.Commissioner' 200 Main Street;Hyannis,MA 0260.1 wWW town.barnstable.ma.6s Office: 508-862-4038 Fax: .508-790-6230 Property Owner Must Complete and: Sign This Section. •If Using A Builder I, Owner of the subject property hereby authorize to act on my,behalf, in all matt=relative to work.autho=ed by ding permit. (Addre . of Job) Pool fences and,alarm are the responsibility of the applicant. Pools are not to be filled or u ' ed before fence is installed and all final inspections are perfo ed and accepted. Signature of Owner Signature of Applicant Print Name Print Name. Date Q:PoxMSDWNERPEx1UsSIONPoors 612012 TOWN OF BARNSTABLE,AUIL-DING, PERMIT APPLICATION . -9 LA_ Map Parcel... Application #t)(Y4 Health.Division "Date Issued Conservation bivig16n _,�Apr4icatio, Fe Planning Dept', Permit Fee: Date Definitive Plan Approved by Planning Board Historic OKH Preservation Hyan his Cnipr6jbct Street Address IL4 Village ----------- Owner Address :/O�r)& k 4,1t- 1, 4,, ( , ,--Telephone 6 ) D,? 3 6,2 Lc 0'ofl' 727 '---7W/. L rPermit Request 10W ZA( or S'�bare feet: 1 st floor: existing -2nd floor: existing proposed Total new j proposed Zoning District. Flood Plain Groundwater Overlay Rop�c-t Valuation 410, 000 —Construction Type Lot Size Grandfathered: L]Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family U Multi-Family(# units) Age of Existing Structure Historic House: L3 Yes L3 No On Old King's Highway: Ll Yes Q No Basement Type: Ll Full Ll Crawl Q Walkout Q Other �%kment Finished Area(sq.ft.) S7 9/ 402 Basement Unfinished Area(sq.ft) jf�tn C—_NGm_-ber of Baths: Full: existing. new C? Half: existing 0 new C Number of Bedrooms: existing -Qnew a Total Room Count (not including baths): existing new First Floor Ro m CoUg ZiE Heat Type and Fuel: Q Gas 'Ll Oil U Electric Ll Other Central Air: Ll Yes U No Fireplaces: Existing New Existing wod-%coal stoye: Y�Yes Ell No Detached garage: Q existing 0 new size Pool: Ll existing U new size Barn: y 26bxisting.,,,C] ne- size— C11) Attached garage: Q existing L) new size —Shed: Ll existing U new size Other: 00 CD Zoning Board of Appeals Authorization Q Appeal # Recorded Ll Commercial Ll Yes Ll No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) (C )6W 727- 7Y01 4r t /Ifiwob &jco -,%Telephone�Numb -2W -00,f,)--- �24 cWd'dress 4 License # AAW A Ih,4 0,),661 Home Improvement Contractor# ' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z.,q, Z�3 _ .3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE DATE OF INSPECTION: - . FOUNDATION :FRAME {' o INSULATION. 1 0 Oti FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL -.GAS: ROUGH FINAL FINAL BUILDING dC �l Ylo9 Rai ciz /3i�i✓ (oK al9/n9Rm� DATE-CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f� Please Print Le 'bl e-Narrie(Business/Organization/Individual): t:w--Address: ,City/State/Zip:�. (�n1S/�� 0,�66)7 Phone A-T-`S-69 361�91��) �- �,32- 901 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. EJ I am a general contractor and I employees(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. T. 0 Remodeling ship and have no employees These sub-contractors have g,"Q Demolition workingfor me in an capacity. employees and have workers' Y P tY # 9. ❑Building addition [No workers'-comp.insurance comp. insurance. quired.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3. I-am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions self. [No workers' comp. right of exemption per MGL 12.Q 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 contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. If the sub-contactors have employees,they must provide 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.#: 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 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. Tde Irereby� ains and penalties of perjury that the information provided abo a is true and correct. Signature: Date: Phone#: e �6�-04. �' 737 7 , Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town 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 workers' compensation for their.employees. 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 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 tiustee 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, §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 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 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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-con&actor(s)name(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability 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 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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 permittlicense number which will be used as a reference number. In addition,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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. 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 number: The.Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 61742777749 Revised 11-22-06 www.mass.gov/dia - i ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: print Town: Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the following two o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab QO tion l: Basement p Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of 35 R-38 R-19 R=19 R-10 4 ft. 1987 as.amended,minimums or eater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: `� RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2) REScheck—Web which can be accessed at http://www.energycodes.gov/rescheek/ ADDITIONS ORALTERATTONS,TO EXISTING BUILDIlVGS.OVER:S YEARS OLD* *Buildings under 5 years old must.use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) SF 100 x — _ % of glazing (b) Glazing area equals SF b . a If glazing is.<40%.use the chart below. If glazing is> 40.1/o,' roceed to "SUNROOM"section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Fenestration Ceiling and Wall Floor Basement Wall Slab Perimeter U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .3 9 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a -R-30 ceiling insulation maybe used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total ❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form-(found in Appendix 120.P i 1 . Town of Barnstable of THt:ray Regulatory Services y Thomas F. Geiler,Director + BARNSTABLE, ! .� MASS. $ . 4, i 19. Building Division pTF10) a Tom Perry,.Building Commissioner . 200 Main Street, Hyannis, MA 02601 yr ww.toym.barnsiabl e.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 HOMtOWNER LICENSE EXEMPTION Please Print :1A/;- 09 -- numbe//r-�'I�/' /I street/ ry \ p villa7ge H01virOW__NER_: ' L 1��co .5vt,26.2- Q0,V.� C J snJ 737' < J l name p home phonne# work phone# CCURRENT MAILING-ADDRESS: �� /LJCI[ ks4f& city/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 Persons) 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 rn=murn inspection procedures and requirements and that he/she will comply with said procedures and re. u � 5'gn rc� cowncr 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 perfomring,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 parson(s)for hire to do such work,that such Homeowner shall act m supervisor." Many homeowners who use this exemption arc unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Ucensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this cue,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 n-sponsibihtics 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 forrn/certifieation for use in your community. �oF cHefO�s Town of Bairnstable Regulatory Services ua S arE,MASa � Thomas F. Geiler,Director �ArE0;�,�a Building Division Tom Perry, Building Commissioner 200 Main Street, 14y.annis, MA 02601 www.town.barnst"able.ma.us Office: 508-862-4038 Fax: 508-790-6230 Ptoperty Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work authorized s building permit application for: ddress of job) Signature of Own r D to Print Name If Property Owner is.applying for permit please complete the Homeowners License . Exemption Form on the reverse side. i I VO MCI tCSI I11 t1 1 fall aa5ei it'ei lL nai l 28FT v 15 FT 14ft 7 Laundryroom & Storage o N' �. --5 ft- 6" . 13 ft 89' I oG 5ft 6:5" ob opening o� 8ft 2 )IN 32 F Oft , s� (D'- ` \ v0 25ft 6" 5 - �o CO N O � cn 35„ - rough open CD (D Utility Roomcn x t 3 fta� =* I O ` 0 LO i i .. V- existing o �� \`� window # 3 ,4 10 ' I .r. r t ,y ? � t .. f /oS ,c5��/PKSr�E Lcl,C3 �a/a �/off' �i 1.. ,,- J r '•fit �� ny yfi +t t S - „a P 40 A WIL `5c �O� a�ieK 5Efi/ZE Tfz�'l� �� /�I� y/oe .� §fit } - � ,._..._ .. - , vt, }'"r .. ,. "`; -� �., � .. ,. �. � � ,. �a. � _ - _ ., _. �� —. �; r ! i �� :, � t I f .. �.. � � I � t � � ) rt Fi � � :. 7 r � �' y � ,t ��„ )' � `` � � � � }•5 � V �. �=. � i I'.: 1` �. I ��' � 1 f I 1, i I,` : g �_ r a� �� f r' 1, i A., e , i � r �i � t.t,� f'� �;, - _------— a i � <<; � ,, �, /OS ,BERK� SfflR� T��L l()� < � l • r r � b•� ti n W t ^; • i 3 +,q F .•wcf`_`_y.4r4MEY+wm-A.. /r /o S d�aK�fii�2E Tire�+-�� u�8 �a/a 9/0� • , �� Town of Barnstable BARNSTABLE. Regulatory Services MASS g .63q. <0 Building Division prEO MPS A 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Coe ` 6—VCe; S !O Fax: 508-790-6230 S Inspection Correction Notice Type of Inspection Location A06' 7xwe �-)Permit Number Owner (e 14- Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: fUo �fwG P ot ? *40 Please call: 508-862-4038 for re-inspection. r Inspected by o. Date Parcel Detail Page 1 of 3 THE - ,- � ae5le \•1A5ti, ,�• Y ��/'7 !J' +jam .,,•tom+7�r,' li�i) ..fed �ac Logged In As: Parcel Detail Tuesday, Decemb Parcel Lookup Parcel Info Parcel ID 109-015-010 i I Developer"LOT 15 Lot Location r105 BERKSHIRE TRAIL I Pri Frontage Sec Sec Road Frontage Village 'WEST BARNSTABLE ARNSTABLE _ I Fire District W BARNSTABLE Sewer Acct!� �^� Road Index 2190 Asbuilt Septic Scan: Interactive ` ~ � 109015010_1 Map - Owner Info owner BLANCO, PEDRO A & KARA M` '! I Co-owner Streetl 105 BERKSHIRE TRAIL I Street2 City W BARNSTABLE I state MA zip 02668 Country US - Land Acres 11.00 ` use'Single Fam MDL-01- I zoning ,RF I Nghbd 0107 Topography,Level I Road Paved utilities I Gas,Well,Septic I Location i - Construction Info Building 1 of 1 Year �992 --� I Root"Gable/Hip I Ext WoodJShin le Built Struct` wall g I Effect 1787 Roof Asph/F GIs/Cmp I AC None Area Cover Type Int Be Style rCape Cod I Wall Drywall I Roomds 3 BedroomsIn Bath - I Model`Residential I Floor'Hardwood I Rooms 2 Full I Grade Average Minus I Heat Hot Water I Total:6 Rooms I Type Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6174 12/30/2008 Parcel Detail Page 2 of 3 r• ,,r. 17 Heat und .t ^y"WUIC Stories 11 1/2 Stories I Fuel iGas I F anon ,Poured Conc. 6 GAR � kgsg`:. � Ait Permit History -- Issue Date Purpose Permit# Amount Insp Date Comrr 8/1/1992 B35297 $65,000 1/15/1993 12:00:00 AM WB 11 Visit History Date Who Purpose 7/25/2006 12:00:00 AM Paul Talbot Meas/Est 10/13/2005 12:00:00 AM Jason Streebel Drive by inspection only 8/22/2003 12:00:00 AM Paul Talbot Meas/Est 3/2/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 1/15/1993 12:00:00 AM ML Sales History Line Sale Date Owner Book/Page Sale P 1 3/31/2005 BLANCO, PEDRO A& KARA M 19673/160 2 9/15/1992 BROWN, GEORGE R & NORA B 8213/308 3 7/15/1992 NICKULAS, DONALD W 8139/204 4 8/15/1986 PRINCI, MICHAEL J & 5232/097 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2009 $153,700 $2,800 $0 $198,000 2 2008 $163,300 $2,800 $0 $216,700 4 2007 $190,500 $2,800 $0 $216,700 5 2006 $195,500 $2,800 $0 $238,000 6 2005 $180,800 $2,800 $0 $212,500 7 2004 $144,600 $2,800 $0 $144,500 8 2003 $128,300 $2,800 $0 $60,000 ; 9 2002 $128,300 $2,800 $0 $60,000 10 2001 $128,300 $3,000 $0 $60,000 11 2000 $101,700 $3,000 $0 $40,000 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6174 12/30/2008 Parcel Detail Page 3 of 3 12 1999 $101,700 $3,000 $0 $40,000 13 1998 $101,700 $3,000 $0 $40,000 14 1997 $91,600 $0 $0 $35,000 15 1996 $91,600 $0 $0 $35,000 16 1995 $91,600 $0 $0 $35,000 17 1994 $108,100 $0 $0 $40,500 18 1993 $0 $0 $0 $40,500 19 1992 $0 $0 $0 $45,000 20 1991 $0 $0 $0 $70,000 Photos +++sYt i n } ' i i http://issgl2/intranet/propdata/PareelDetail.aspx?ID=6174 12/30/2008 tl l z�. Assessor's office(1st Floor): !. Assessor's map and lot number , dLj ZU l ai tw >o Conservation �f 'SEPTIC SYS.Trgl !�UST � .. Board of Health(3rd floor): -INSTALLEF." >s Sewage Permit number 2 �rr�nt �i�.� - ' a r �o rua j Engineering Department(3rd floor): /O�i ENVI�®Ntd "' AND e�V&�� House-number PP Y g 19�YYN REr 0.4�.."-ab.sa't;Definitive Plan Approved b Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M. d 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPeFCTOR APPLICATION FOR PERMIT TO S//L�y �il✓/ TYPE OF CONSTRUCTION C,! 19 9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocationZ /�� / �' �J' 2i� �'' Proposed Use f Ile Zoning District 1 Fire District Name of Owner /�lr G�ci! V_ ✓ Address Name of Builder a. J Address �✓ /' ,� `Z Name of Architect Address Number of Rooms Foundation Exterior Roofing 42 or Floors. Interior 1Z,!^ Heating Plumbing ' / %,M Fireplace 7 -V Approximate Cost Area .S Diagram of Lot and Building with Dimensions Fee o iq �y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the ab ve construction. .� Name ?� Construction Supervisor's License y NICR'ULAS, D. No 35297 Permit For •12 Story Single Family Dwelling Location Lot #15, 105 Berkshire Trail fj West Barnstable Owner •D. Nickulas �z Type of,Cons'truction Frame - v Plot; Lot Vi y e Permit Granted August 19 , 19 92 a' Date of lnspection'5�.-Sy-q, 19` ,Pat e C m I ted `/ 19 Qr t > ,! • „ p a y Application to 9P NS lHH`StE P'M•�N - 0p!'M Old Ki4s Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Apprication n hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs _accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: New Building ❑ Addition ❑ Alteration , Indicate type of building: House Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY LC T Ir gjE__-leKew I#Xr 11?_dl L_ DATE ADDRESS OF PROPOSED WORK lam! • MA, 02�(0o21 ASSESSORS MAP NO. 1 0 OWNER e_KU L6.S ASSESSORS LOT NO. 1s O HOME ADDRESS P0. 'gc�'A i1 . D Z(arp TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). f VIA 1�1� ka-� .l.l��! 1�� , �bT�l GI d ZS �"as I��S �a-Gt-a w t�►ea-1. s YM p s c4e_o recTr 1 S o,•k-(I-I ST• az(.o I AGENT OR CONTRACTOR h•K-t:H T Tt--, e- + bSSoL• TEL. NO. -77 1- 3'P ab ADDRESS Ic' "ram 05, L41 3 j DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Signe ner-C n acto nt Space below line for Committee use. Received by H.D.0 ►(5 D he rtificate is hereby � ��► 'l Vto 6 y 'G— Ti I1992 n j , n ,VNjuvwl I, BY Or OLD KING'S HI HWAY J _ - L Approved IMPORTANT: If Certificate is approved, approval is subject to the TO day appeal period provided in the Act. Disapproved ❑ ,. . . ' BUILDING PERMI' or 7 ;;��'O�'�N OF BARNSTABLE, MASSACHUSETTS A-109-015.010 F APPLICANT Nickulas Building DATE August 19 esty--Sarnstab�e IT& W. 3529-7 ADDRESS f (N0.) (STREET) (CONTR'S. LICENSE) PERMIT TO Build dwelling ( 1} Single familydwellingNUMBER OF t. 1 STORY g(TYPE OF IMPROVEMENT) f` NO. (PROPOSED USE) DWELLING UNITS , AT (LOCATION) lot p15 105 Berkshire Trail, W.Barnstable ZONING RF (N0.) (STREET) DISTRICT. ;:. BETWEEN AND (CROSS STREET) .. (CROSS-STREET) ' SUBDIVISION LOT BLOCK LOT SIZE BUILDING IS TO BE FT. WIDE BY'' FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION -, {REMARKS: Sewage #92-352 (TYPE) ..BOND, AREA VRLUME 12HS a . ft. 65.090 ESTIMATED COST 93-.00 •`, 9 (CUBICYSOUARE;,FEETt, ' .FEE'•. +,.� '' cOWNER D. Nickulas. ADDRESS. Box 507 , West Barnstable, MA BUILDING DE PT. i BY tIi T � i {{ •ri'rs•. IC WORKS. THE•ISSUANCE OF PHIS PERMIT DOES NOT RELEASE-TME APPLICANT FROM THE CONDIT•IOI 9F ANY+APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL gppROVEDSPECTIONS REQUIRED FOR PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE IN ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I: FOUNDATIONS OR FOOTINGS. MADE. WHERE A ELECTRICAL PLUMBING CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.D 2: PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI 70 LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE ' OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS' ELECTRICAL INSPECTION APPROVALS 1 t t 21, 2 j api 3 I HEATING INSPLCI ION APPNOVAI ti� ENGINFF NG DEP TM T 4� e5j _ BObOF HEALTH OTHER 1 SITE REVIEW APPROVAL C 1 WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN TOR..HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CONSTRUCTION. LPERMIT IS ISSUED AS NOTED ABOVE, ARRANGED FOR BY TELEPHONE OR WRITT• NOTIFICATION. t� ,I• iI *.M. TOWN OF BARNSTABLE 35297 Permit No. . BUILDING DEPARTMENT l ""'� TOWN OFFICE BUILDING Cash ,ew �v++' HYANNIS.MASS.02501 Bond .......X ..... CERTIFICATE OF USE AND OCCUPANCY Issued to D. Nickulas Address Lot #15, 105 Berkshire Trail West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED.UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE. BUILDING CODE. Se tember 21 92 ..... .......... ....... .... ! 19................. ...... ......... . BuildinYnspector ��..� °•°ew TOWN OF BARNSTABLE BUILDING DEPARTMENT 11ARI0s TOWN OFFICE BUILDING . riva HYANNIS, MASS. 02601 �o rnr►• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $�............ � / .. ........................................................................_.........._.......... _ .._._... ...... ... . issued to ..„. .....1.. _. a% G ....._.......__...................................................................... _.. .�. »_ ..._ _._.........�..._� Please release the performance bond. 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