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Home My WebLink About0056 BOXWOOD DRIVE W '��/'E ` �� '.�F�%��/,_ .ire ~4r n .,. _ .. ,. .�. _ ., .. . . ...... _ . . _. e�ra.�a.._.._ ++v�a.at,Sc._ ., J24REGYClrDCO llll g UPC 12543 No..,,,.53LOR lobiT-CR°� HASTINGS, MN Town ®f Barnstable Permit: C Regulatory Services Date: OF r Thomas F. Geiler, Director �( ti Fie: Building Division BARNSCABLE, Tom Perry, Building Commissioner Y MASS. 039. 200 Main-Street, Hyannis, MA 02601 �AlFD MAta www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: 25*///) AK,aiW_Yz Phone: SIDC- ,367 - 4/elo Install at: _5-11 r'R axWQ07) Village: 73AoVM9J6 Map/Parcel: CQ I� 0� Date: Cj Stove ` A. ew Used o' v C B. !hype: Radiant Circulatin C. Manufacturer: v Lab. No. D. Model No.: r~ Chimney m A. New/ I-E-xisting (If existing, please note date pf'la.st cleaning) B. Flue Sire C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer ,;-; Masonry. Lined/Unlined car A. Materials: B. Sub Floor Construction: Installer Name: _7M40 J" 1!4A1Wad£ Address: T G �3wt /S Cy. C'"��%�/R�t Phone: ��Sv8'- T3/ Location of Installation: H.I.0 Registration Construction Supervisor# /jo/ OR-.check— Homeowner Installing, no license required APPLICANTS SIGNATURE _ APPROVED BY: 0 ZD le Please make checks payable to the Town of Barnstable This.constitutes an of stove permit after inspection, photographed, and approved by the Building Inspector f Q:forms:stove Rey 103107 a i I Boa�o of. Construction,SuPegU a ion "n`i S[a _ L/cens Cvisor Licens _ .!! ar s f Ex1701 piration rtl 11.%112009 i Restricti-09 Try 765 ll _--OQ r $ JERAL'D J ELQRID°� PO gpx 15 GEC �S W HA A r, _ CHAT M.MA 02669 Co!nnlissrpn —__ er ✓&.�jarnmca�uveai o�✓� c' uiaelta Board of Building Regulations and Standards before the expiration dateLicense or registration ! If founds return to vidul use only HOME IMPROVEMENT CONTRACTOR Boat`d of Building Regulations and Standards Registry ion;\101316 One Ashburton Place Rm 1301 Expiration 6/25/2010 Trtt 267611 Boston,Ma.02108' Type._.DBA� ��1 J.J.ELDRIDGE CQNST 9RUCTI.ON�c� Vic--�� '�` • J id a t �fi.—N 67 George Ryder Roadl_Box>1 of vali it out.si ature W.Chatham, MA 02669 Adm'►iiistrator � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street �< Boston,MA 02111• ww'w.mass.gov/dia ' Workers' Comtpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �/�,T',E�i�n/ �y.(�CTiPdNT/y�/ Address: City/State/Zip: A). Ce.41-/644Y 0 246 Phone.#: Are.you an employer? Check the appropriate box: .Type of project(required):. 4. I am a general contractor and I 1.❑ I am a employer with � 6. ❑New construction . employees(frill and/or part-time).* • have hired the sub-contractors listed on 2. I am a'sole proprietor or partner- the•attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition 'working for me in an capacity. employees and have workers' y p ty. 9. [�Building addition [No workers' comp.insurance comp, insurance, ' 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 affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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.thepolicy 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si j afore: Date: G _ Phone#: rOf�ff��i�cial use only. Do not write in this area, to be completed by,city or town official ity 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#: intormatl®n ana instructions q 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 hiie, 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, §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 ehapter..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-contiactor(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 maybe 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 fo 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,CommonwWth of M.as.sarhusetts Dtpartmvmt of ldusWal Accidents Office of Investigations 600 Washington S#-eet Bastona_MA 02111 Tel'. #617-727-000 ext 406 ar 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia f � o _ r � '��1 ._- ,t 1 '� vzi��-✓ III ftft y rs� v, I 1n , vt 'k S Ay-Gt/ODd jL 1 V(F 110A /D 2-0 od' i S �j ,� � � � . . � � ��_ � � � - � �� . . TOWN OF BARNSTABLE Permit No. _ =G14F1 I � Building Inspector Cash � �YL OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure—shall) be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Barbara l-'elite Address Box. 195, 14est Barnstable 56 BoMod Drive, West Barnstable Wiring Inspector r c� J / Inspection date f ` r1 i�� Plumbing Inspector r � r�` � Inspection date 4' 111s J 01c, Gas Inspector Inspection date Engineering Department_ , /�� Inspection date ' 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. 1 �'� '' 19 _................_...._.........._.......... _._, ............. �"'Building Inspector f r �XISrt7�,G (2 t 34 �flU�AdTI 14 Q� t C ) .Bo)(WOOD DRIVE .400VE EIVAD L OCA T/OA/: W.BARAIST-AaL£LA�4-S. SCALE PLAN 2EF�Q.ENC�: SL�tn/� .10 .44 5 qo .BOCe. /,7/ PA6,6 /33 {' GfORGE �cN, I 94R646Y C6JPT/FY 7AVA T THE 4EXI57 tires. JR. /,V6 .4C'oOVDAB/DN GOC•AT/dn/ /SQ7� CR t S 6W-OWV Q.vI7 7A E 8U/4.D/NG S,ETl�3.4C.�.�EgU't'Eti1F,�t/1 E6. urz V2- ae i� t�J j N/f�JTL C-rc:pOuw6" i 7,4yc40lW Cow Assesso'r's`ma and lot number 21C :�+ ... 77S� SEPTIC SYSTEM MUST BE :.; INSTALLED I Sewage Permit number ..............77� N COM ............................................. PLIANCE WITH ARTICLE II STATE ° -? ? SANITARY yof.1HE To TOWN O F BARN r A o D TOWN SA �` i��Q �� t . i 9ABESTODLE, i z BUJLDING INSPECTOR n t APPLICATION FOR PERMIT TO ......... . ...... .....5 7,0 .......................................................... TYPE OF CONSTRUCTION t'JOO D / R�M� W G G LAJ . � f.�.Q.�.. rL..........19.f1. TO THE INSPECTOR OF BUILDINGS: The undersigned herebyapplies for a permit accordding/ to the following information: ' Location`s ...R..O..!�..�✓�.0. ..... F�(/C ........1 ./ ST 499E /VX-Eer' ............... ........... .......................................................... ProposedUse ........ (a-............................................................................................................................... . 1�/ . Zoning District ........./�.Q..ff...................................................Fire District ... !...6�}.-:pq.V nl.Pj. ........................ s/ L Name of Owner �ti�j� '.914{Q Address .. Q ...I �v..W.i-�� . lt��/ /�� Name of Builder ZOW V'?-O (At f C l •r ...............................................�.Q................ .................................................................................... pI�. ' Name of Architect PC /�{Q,P....�e5�l�l��E......................Address .................................................................................... Number of Rooms � ..........................................FoundationaO - ....tg1.V�A?A-7. ................ Exterior ... L/9'<'•� /�/p�S..........................................Roofing .....,,P"/,SJf ................................................. p Floors ....1'.(�.r.T.�...4-7..j <<4!. ..............................................Interior .....i: .1..................................................................... Heating .... .��.---7 .�.G.............................................Plumbing ./•U�• r�[�C..I�. T/?T 'D� ............................... �/ 9 "U v d• Fireplace .......Y.. ...... �/1� �.......................................Approximate Cost ...�.'Qi......�.............................................. Definitive Plan Approved by Planning Board ________________________________19 . Area . . ......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �. of �a 0 IS �l2rl I.hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .... ......... ................. ... ..... . ...................... � 3 White, Barbara 20196 two storyV/11� 1 1. .................. Permit for .................................... single fpm ly dwell dn ` 1 g 56 Bmsi Location ............................................... ......... . D West Barnstable .................................................... ........,�° ........ _ Barbara Whitie � Owner .................................... .... .... ......... Type of Construction ......fram.......................... ............................................................................... - Plot ............................ Lot ................................ Permit Granted Ma....10..............19 78 Date of Inspection ... .�... .�l...'.......19 Date Completed Ae� �3 .....19 6Q PERMIT REFUSED ................................................................ 19 F ............................................................................... ............................................................................... ............................................................................... s ............................................................................... - Approved ................................................ 19 , ............................................................................... K" _A- _