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HomeMy WebLinkAbout0142 CARLSON LANE 4 �R a I Q 1 ®j ftW ° NO.152113 ORA �._ a � _._+..�..�. �r�.`..�.n.�...� r•w +_.�+�....T n ._ � ..'.+^�r.s+.�'+ti'� .�_ _ _ �^,^I'�+/1" ,.�h �.M�1.rw�. . -- -..,- _ .. .. �'w-�ww^^.. .t ", �..'� _ _ '.mow-'^..�•�i.r.r Town of Barnstable *Per it#� G Expires 6 months from issue Regulatory Services Fee q . II antuvsTna�, +' Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I � Not Valid without Red X-Press imprint Map/parcel Number Property Address qz �ls` Yl L uole� @zAAAJ$-T*&LG7 08 Residential Value of Work$ �2,OCO , Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � � Contractor's Name S( IA%Qk9Q'la CZ --.t- kvac-C%rl C,CrCS Telephone Number 3`V476Ca3 Home Improvement Contractor License#(if applicable) \`Z2c b Email: sy,-\Q @ �i�Q Le�O(�X CGWN Construction Supervisor's License#(if applicable) \0 kO( k ape-PRESS PERRAIT �dWorkman's Compensation Insurance Check one: DEC U 5 2013 ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# 5y fz,. O LM kI(06 -g'V3 EyP S-- Zolq Copy of Insurance Compliance Certificate must accompany each permit. f �, Pe 71pe- eck box) SAP �nY�c / roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 1 -7s �`p 04�� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. '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. A copy of the Home Improvement Contractors License&Construction Supervisors License is r e SIGNATURE: T:\KEVIN D\Building Changes\EXPRESS PERMI'REXPRESS.doc Revised 061313 I I . I the Connttonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,lLA 02111 Iff ftm i7.niass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectizcianMumbers Applicant Information Please Print Legibly Name(&tsinem/Orgauimtiondndioidual): G4\ow N `T> L 4), cws Address: City/State/Zip: w fflla- 1 k-*-d?.l Phone#: ;: 3 Are you an employer?Check the appropriate box: Type of project(required): 1A I am a emP 5er uith to k \l 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. ❑Building addition [No workers'comp-insurance comp.insurance.t required.] 5AFA We are a corporation and its 10.0 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. Of insurance required.]i c. 152,§1(4),and we.have no employees.[No workers' 13_❑Other comp-insurance required-] *Any applicant that checks box Al maast also fill our the section below showing their woriie&compensation policy information. Homeowners who submit this affidavit indicating they are doing all worts and then hire outside contractors must submit a new affi&vit indicating suci- Contracmrs that check this box must attached an additional sheet showing the name of the sub-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 ant air employer tltat is prouidittg workers'eotupertsatiorr insurance for mtv employees. Below is thepolicy mid job site information. Insurance Company Name: Policy#or Self-ins-Lic-#: Expiration Date: -p2A)k u Job Site Address: L�Z �- Z� ?`�\ City/State/Zip: L3 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 ci%al 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 In certi ?n nd t pa�sandp�enalde,s of perjury that fire information prmRded abm_e is bite and correct Si I Date: Phone 4: U'--73 Lk —_�G6__3S Offid'nl use only. Do not write in this area,to be completer)by city or town official. City or Tosvn: Permit/Ucense# Issuing Authority(circle one): 1.Board of Health ?.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 SCHIENT-01 HWOODS �coRO' CERTIFICATE OF LIABILITY INSURANCE I DATE 61612 D/YYYY) �= /5/2013 TvilS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS I 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 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the I certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME 4ogers&moray Insurance Agency,Inc. PHONE 3344 FAX (AIC No Exit: (A!C No South Dennis,MA 02660 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A:WeSteM World INSURED INSURERS:ARBELLA Protection Schiappa Enterprises,Inc. INSURER C:TRAVELERS INSURANCE COMPANIES DBA Cape Cod Roofing&Siding 111 Hathaway St INSURER D Wareham,MA 02571 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTV41THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLISUBP POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE _ POLICY NUMBER .(MM/DDIYY (MMIDD _ GENERAL UABILJTY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY NPP8015494 5/14/2013 5/14/2014 PREMISED E occurrence) $ 50,000 CLAIMS-MADE [K OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JEC LOC $ AUTOMOBILE LIABILITY (E acddeD)INGLE LIMIT S B ANY AUTO 1020019209 5/14/2013 5/14/2014 BODILY INJURY(Per person) $ AALL UTOS OWNED X AUTOS SCHEDULED I BODILY INJURY(Per accident) $ 1,000,000 X HIRED AUTOS X NON-OWNED PROPER DAMAGE $ AUTOS PER ACCIDENT S UMBRELLA L14B HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION o STATU- O R AND EMPLOYERS'LLABWTY C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA 7PJUB-0499N66-8-13 5/14/2013 5/14/2014 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? u (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Certain Teed SELECT ShjngleMaster THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 20126 Lehigh Valley,PA 18002 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD OFF s WWWABU& 1am� Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 'ikur Ls-- R1" ,as Owner of the subject property hereby authorize gxk— kVV-_ C,C q5; to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 161 iA e Owner i FturDate. Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN Mudding Changes\EXPRESS PERWREXPRESS.doc Revised 061313 STATE O �' I. I��� ������ ISLAND Commonwealth of Massachusetts CONTRACTO. REGISTRATION Department of Public Safety AND LICENSING BOARD Hoisting Engineer License: HE-086392 EMO R SHIAPPA III HATHAWAY SO WAREHAM MA 0257 ' )f 141\ • J-'�� Expiration: Commissioner 10/15/2015 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-101061 EMO R SHIAPPA= ' 111 HATHAWAY,S s Wareham MA 02371 \ Expiration Commissioner 10/15/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 112280 Type: Private Corporation Expiration: 2/10/2015 Tr# 236188 TRADE CONSULTANTS/CAPE COD ROOK ,- EMO SCHIAPPA 111 HATHAWAY ST WAREHAM, MA 02571 Update Address and return card.Mark reason for change. Address ❑ Renewal :] Employment Lost Card SCA 1 v 20M-05111 r.%�e`�anrrrrairroerrll�n '�llcrurrc�rr�c•(/� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - registration: 1122g0 Type: Office of Consumer Affairs and Business Regulation r xpiration: 2/10/2015 Private Corporaticm B Park A 0-Suite 5170 1 Boston,MA 02116 I TRADE CONSULTANTSICAPE COD ROOFING EMO SCHIAPPA 111 HATHAWAY ST Ij WAREHAM,MA 02571 Undersecretary of valid w hout signature 1 '^"''%��5��'v'�'Yi.:��.frS`+W7.'Y�--F"r'G�.rnr..r.�/��" TR*'�Y'���, ' ��t'S+.+r'i71-��( ��'���"+���rrw-"f`Y'�{7�,�'�"[ •t' �'C '�"'�'v`U'►b'f'i�('�.,�•��1.rw I TOWN OF BARNSTABLE Permit No. ...... 30381 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash �'���►+' HYANNIS.MASS.02601 Bond x CERTIFICATE OF USE AND OCCUPANCY Issued to JOSEPH C. POLCARO Address lot #12 142 Carlson Lane, West Barnstable 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. August 16 91 ...................... 19................. .............. ......... Building Inspector °�.. TOWN OF BARNSTABLE BUILDING DEPARTMENT �• ! >AHIYl TOWN OFFICE BUILDING r►�a HYANNIS, MASS. 02601 �OIIAY�. MEMO TO: Town Clerk FROM: Building Department { DATE: An Occupancy Permit has been Jissued for the building, authorized by BuildingPermit #......... ............ .. .............................................................I................._.......... . .................. issued to ..._.... _... _.�..l ` (1 (,,:.(1J� ................._................................. Please release the performance bond. G P�RM1 + QWN O •BARNSTABLEABLE, MASSACHUSETTS BUlLDIN: �� t:3'r•1Ci�� � ��7 .. :,' .-i. �;.1:�:2if,�s�ty��'�";f��Jyltii,�':�i. x,. DATE PERMIT APPLI NT u `"lam ADDRESS l + "'�fr4:7 �1t . . .�I O.1 S REET n - "cal u7�r {CONT R�•IS}I,�E�N. E1�4 e PERMI TO Y''• — �• ; TP f•i,i �1y M's" la1 4 fef i✓{ F I pE ( of 1 STORY C ' .n NWELL'RNG UN)TS .Gt..,t 14 N. ry (PROPOSED USE) "{ e • 'ta+1N 1+ ,.'.nf •.3w,Y r � •.s: `' ,�"r l �t� + �wi AT (LOCATION) f + R. .r. <_ 7 - r• T ', T. 7rZ_ C• _ ZONINCn�9'+'.ir 4 +y�,t�fh 3T 7 �• >, (STREET) DISTRfCT� �44 Sy` ,I I y 'S i'+�' �4 Yr r �• { BETWEEN AND .t t" 3�[h � t .ax{�a_I rr ^•;�.', (CROSS STREET) (CROSS•STREETf•' t' SUBDIVISION ! LOT 3" ¢ 3R a LOT BLOCK j SIZE r BUILDING IS TO BE FT WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL.CONFORM 1N.CONSTRUCTiON k, �F act•+ / r ly` `'� a 5..�, s TO TYPE USE GROUP 37c v a BASEMENT WALLS OR FOUNDATION !. •t•'t. 1 '(TYPE0 r r ` 1 5 ,• REMARKS iEtwa TQ' � , k { t. t . $t � n �e AREA OR t j *DQh�tt ti9 "d�tt 1�; VOLUME I SC PERMLT4 s IFt'J. Say r (CUBIC/SOUARE FEET) ESTIMATED COST .,� C' + s FEE : t 4w. " f f 1l„At �1 ?eif1:ADORES 7�R .;/ry s•h3r�iv 5 y[S t' n-iE.F 7 rf ^ .•.t... '-'—i,,-,stz 2 a. . ING DEPT. BY >d ta'y i'w t )r§�� � .. ... '. - _ f �1x�1 t°�r�' ` ,� `Sb'�•+'. i i } "�li{ta.2Tl�'f...� f ,1t 3 jj •�, h .. ) � ae,yf� li'�'rrrk�3'` 1. ��-.. { E r 4 � s •-fit. ,zt•i*tV�h .{.�:o .t a ,t'• f•.-y . .,;. :. - ., FROM THEE[SE•PAR'TME NY'"O F'P'1'Jb"L`I'C"wLtsna'."i hi d'r»,x.f,v.;c yr :., ,, ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS`•; APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE. APPLICABLE'SEPAR#ATE�' �ECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR,'-, f ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN z's ' ELECTRICAL, PLUMBING I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLAT IONS. ''-'?"�`"� 2. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL - * }"•tea y: MEMBERS(READY TO LATH). y ,..3 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. i ) �• �'.fi •' 'x• • OCCUPANCY. i •i/Cr , f_t, POST THIS CARD SO IT IS VISIBLE FROM STREET,, '04 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS zoir �I I 3 HEATING INS CTIO APPROVALS ENGINEERING DEPARTMENT ! ; taS , OTHER BOAR OF HEALTH �' + WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION r •• TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN N CONSTRUCTION. PERMIT IS ISSUED AZ t'O'f ED ABOV ARRANGED FOR BY TELEPHONE OR WRITTEN E. NOTIFICATION. • mac: _ ,•�� p�A�,�,sC� "9.".0 OLD Y.ING ' S 1il(;}iW1,Y REGIONAL 111STORIC DISTRICT BAR)4STABLE HISTORIC DISTRICT COMMITTEE 367 MAIN STREET, 11YANNIS , MA 02.601 FORM: "A- SPEC SHEET FOUNDATION TYPE: POURED CONCRETE SIDING* TYPE : RED CEDAR CLAPBOARD AND WHITE CEDAR SHINGLES CHIMNEY TYPE: COLOR: NATTTRAT, ROOF MATERIAL: _ RRT) CF.T)AR SHTNC;T.F.� COLOR: NATURAL PLTCN: 12112 (PAINT BRAND: MARTIN SENOUR) WINDOWS : TO BE FABRICATED BY DON ROBBINS, HANOVER ' SIZE: VARIES ERR PT,AN TRIM COLOR: NICOLSON SHOP TAUPE W83-1083 COLOR: W1083 DOORS : MoRr,AN wnnn PTNF .PALACg JAR14rs:2 ur4j — SHUTTERS : NONE GUTTERS : _mnNF DECK: YES WOOD PRESSURE TREADED NATURAL OVER HEAD PANEL WITH VERTICAL WOOD COLOR: W82-1080 GARAGE DOORS :. ngATN APPT.TRn nVF.R _ TWO COPIES OFTHIS FORM IS REQUIRED. FILL OUT COMPLETELY REGARDING MATERIALS, MEASUREMENTS AND COLORS . LANDSCAPE PLANS.-PLAT PLANS-ELEVATION PLANS. LANDSCAPING WILL BE NATURAL. I 142 CAR LSON LANE,- W. BARNSTABLE, MA lot 12 JOSEPH C. POLCARO Catch BENCH MARK Bann 0 sarvey ova at LOT ca 13 lot tamer. '^ on Elev.=86.60 a � m L 0 T 10 t ^ fiJiam.(IooOGal.) LOT 14 3 Z 2 fl.of sttlonne all lT around. o We\ts 1,) - Garages a �A1 os-N . t \50 � ..r �.� m� O i� - 3 j° T11eMsePRESERVE i t o' x� - 92•o.i.. ti ti ♦ a �/ I 25 laDIST BOX ' 12 _ Proposed SM� J2ESERVE. LOT I5 HOUSE.. •' TANK 1 43, 9± S.F. 9' j tiz o ,• � Aso. i A J ,�s oQTrs, 6•diam.(1000C 11 o W PARCEL "A" LEACHING PIT 2}t.o}stone all �• oround. �i �2 ♦-A$ 1 LOT 16 Existing o Wei I 2 LOT 11 i .OExisting. Q Well Application to PP �P N�NpStEP Yn��a • 0 °E E�5�Pp E � ' Old King's Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is 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: D 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 DATE 9 23/Rh ADDRESS OF PROPOSED WORK 142 Carlson Lane, W. BarnstableASSESSORS MAP NO.110-34 OWNER Joseph C. Polcaro ASSESSORS LOT N0. 12 HOMEADDRESS 11 Jan Sebastian Way, Sandwich, 02563 TEL. NO. 888-8797 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). ;Z 6 :5Al/"C' d�/�P�faG/1724)"Z� AGENT OR CONTRACTOR Joseph 0 Rolraro TEL. NO. —888-8797 ADDRESS ,11 ,Tan Sebastian Wad, Sandwir'�TMA 09561 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). J Owner-Contractor-Agent jipace,below line for committee use. Rrr'ec`eived b 'H,D.:.C. 'Date he Certif' to is hereb ate Time B&G V J Approved IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period r provided in the Act. Disapproved ❑ v , --- AL�"r's�map.and lot number .....1,1Z..`,(. ..�... . Q� �kH I'3I�L ��J/,���� %:= ! CF TN E Sewage ,Permit number ... ..................... .... ........... { TIC S YSTEM MIDST B . STALLED IN COMPLIAN BaSBSTADLE, House number .........:.......: �` "................. a BAR WITH TITLES °°moo 39. 0•� ��' ONME '. TOWN OFF BA1�.N � oNS "°� BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ....ele:� , �1 ........ TYPE OF CONSTRUCTION .........:...:./. /. .. C ......................................................... ....... ./................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....� 1... A/�........�� . .......�a r.. .. .... .. ............. ProposedUse ... . .......................................................................................................................... Zoning District ....... .........................:......................Fire District ........,�,�/_a4t...r�� t/. ..:.............. Name of Owner .1S .............Address a� W,� ...(- �..�.. ....... 6 Name of BuilderXv- . A Name of Architect ��G /���G � r��� A, ..........Address�G 4e� /s�f/ �.... ... Number of Rooms .................��...........................................Foundation .... . ��/ ............. Exterior ......4r .....!/� G'4r.�7!..........Roofing .....G4-�. ...� ..4 q. Floors ......(0.4 A�G11 Vey..................................Interior ........ . .- ,�I.a�.G.l.:................................................. Heating � L ........................y.......................Plumbing ............. .1�`. .................................. Fireplace ....................6?........................................................Approximate Cost .....�i����..�1.�f�:. �........................... // l Definitive Plan Approved by Planning Board --- 1__ 19 __-- , Area //G��'.2-.... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name rion . ..... .......ti.r.:. 4y�G! Constrpervisor's License ........ i,*,POLCARO, jOSEPH C. 30381 11 Story Nn. ....... ......... Permit for ........ ...............t........... I SL'42ngle Family Dwelling ............................................................................... Location Lot #12, 142 Carlson Lane ................................................................ West Barnstable ............................................................................... Owner Joseph C. Polcaro .................................................................. Type of Construction ...................Frame....................... ................................................................................ Plot ... ........................ Lot ................................ Permit'Granted ........J4jaqzjry...1. i,g 87 Date of Inspection.....................................19 Date Completed ....... ..........1-9 i-o • - � �'� 'X1-INCH f j/j'�y���d�%`�� Assessor's ma and lot number ..... �...p ��..—,, _ .... Q.� oft �3�l ia�i�2� THE Tp` QQ Sewage Permit number ..>.l.� �.I.�. ... ..... . ...e.A........... F�l Z I STSDLE, i House number .................. �` ..............`.......:.. .. rhea 9 Apo,1639. 9� ;6 " �Ea Mix d. ti TOWN OF ' ' BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....�. .�y�t!> �1.�/.��f/Lc�..i.�r /��/�f� �.GG���................... 2/ TYPE OF CONSTRUCTION ...............� ....;,: l!��:................................................................... T4...&21................19.. E� �p TO THE INSPECTOR OF BUILDINGS: The undersigned hereby) applies for a permit according to the following information: Location ..... .......... ........ ..... P..�',. .. C �/f,� YrtN- .............. ProposedUse ...X !1 .. 1.-a..'t I......................................................................................................................... Zoning District ......... ................................................Fire District ........ 4!.�............... Name of Owner .� �{:QQ,C� �.. .,r� �1�2r�.............Address .7..��1.� 1t ....`���.... <........ . Name of Builder .,/. .. r��7G1.../..�. �2 �..:�..�. i..Address .��. . i�P..,. �!.� Lr<ty... �! j✓,.�; �/ �rc�G Name of Architect f _...........AddressAi'� f `.:� ... � d..�nl......`f%f% .. Number of Rooms ................./ ........ .........::,...........::.........Foundation �,�%. /.�f.✓���� ............. Exterior /JL/ * '':.../7 ;/I �� ic. !..........Roofing ...... 1 �l- .... ..1!.�?............. 3 Floors ...... c .. /./�l.A? ..................................Interior ........ / /-!, Z/.............................................. g .7��C1/... !�..........................................:....Plumbing .............: . . .. �f/. ? .....................:............ Heating ....... ......................................Approximate. Cost �� / �_Fireplace ...................... .................... ..... ...;,�..� ��..l..l...�:C?............................ Definitive Plan Approved by Planning Board --- l_____________19 _ . Area •.......................................... ° Diagram of Lot and Building with Dimensions JJJJ Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i (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. 'iName .. .... ,. 1..C,. Constr I ion Supervisor's License ./ ���`���r,�........ 110 LCARO,, JOSEPH C. A=110-034 1 1 No Permit for ......,,.Story ..... .................. . ........Sin le Dwdllincj............. ..... .................................. . Location ....Lot„#J.2.(..... 1.4.2...Carlson...Lania West Barnstable ............................................................................... Owner Joseph C. -,,Polcaro ..... -. . ..........................(;A....... ..................... Type of Construction ................Frame.......................... .............................. ................................................. Plot ............................ Lot ................................ January 15 , 87 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed .......................................19 ,*IWF TOWN OF BARNSTABLE Permit No. . 30381 BUILDING DEPARTMENT I ' I TOWN OFFICE BUILDING Cash 7 .ML ,6�9• p '�rour HYANNIS.MASS.02601 Bond A CERTIFICATE OF USE AND OCCUPANCY i Issued to JOSEPH C. POLCARO Address lot #12 142 Carlson Lane, West Barnstable I 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. i August 16 91 19 Building Inspector i' C( Co °FIHE, Town of Barnstable . *Permit#/�c °�'b� Expires 6 nro it from issue dole Regulatory Services Fee BARNSTABLE, • ® 41 7 v 639: Thomas F. Geiler„Director �ArFD MAt A. lOR` �� PR' Building Division 0 5� Tom Perry, CBO, Building Commissioner C)��P 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-8,&-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint .Map/parcel Number l o �L Property Address _L� C1.�1 ► Vy �� �/V " r IC/Residential Value of Wort. 4 y 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address Dow AL Contractor's Name Y����� �,�(�/�(!_��,`1�(�,vLL�1�t r� Telephone Number�� Home Improvement Contractor License# (if applicable) l(�3 Z uction Supervisor's License# (if•applicable) GAV �rkman's Compensation Insurance Check one: ❑ I am a sole proprietor UlKarn the Homeowner. I have Worker's Compensation Insurance Insurance Company Name ;'$r�v ri.(; )8I Workman's Comp. Policy # 100 q I Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ff,I I e-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. 'Note: Property Owne st sign Property Owner Letter of Permission. cop ome Improvement Contractors License is required. SIGNA'fI;RE: �:'.WP1 1L1{5\I t)RMS\huilding permit forms\EXPRESS.doc Revised 100608 sro,,ti Town of Barnstable ° Regulatory Services 9s""M Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.t o w n.b arns tab l e.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize f� n�`e 1,+m1� !-ffipt7)L)O.f &f t- to act on my behalf, _ —t in all matters relative to work authorized by this building permit application for. L4 Z �w l'Jon �Gt1 L,W -- (Address of Job) Signature of Owner Date TPri.nt Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. (1•Fl1RMC•rlVJNF.RPF.RMi.CCInN "-� do tr'ct of l3uil'tiini Regulations.turd Stan"(Iprcls urc; Consft�ucLio'n SugerS.Csor°LiC'e':nse r< L.i:c:efls :. CS 6:6"43 Er2t'Ion:zpF 1.6I8/2009 Trif` 94'.2;7 i Restri'ctiont• 00. BRAD.K &FR-1NKL-E 1'90 LO'1-M:R;0FS LAME .. ._ w B°f#RNST-ASLE.,:M'A 62&68 CoiiYrljY.�siVVCl- 0'0--A-1.09QcO naE ii pace i 1'-A-1VIas6n�ry±o';ndy �• i g: •. kG 1'_2`F'eirnlay Ioati'es F:g•ilure:@ocgo'$ Cs,s,;Cur�reii[ llion/of.Fhe 4 iklassa�hytb is Statd$ullding iide i is c`e:use for k.voea iVn of.thls!tieP>?s:e: r • �/'.tic' C%r:;vr.n::cn�:ect��. >�'✓2�lca:nt�aae�,lG Bo8`r 6 f-TuiIBi'rig•Regula{ions anil-Sfanil'urds { HOME IMPROVEMENT CONTRACTOR X, z Registration: 103757 �� f=Xpifatdon 7/9/2010 Tr# 27T03`3 �a TKpe private Corporafio.n S.PII'NK.LE HOME=fMF:ROVEiv1E�1T,fNC. B�ad: Sprinftle • Hyahnfs;:MA�Q260=1 'Alri�n.isfr.'akor License or registration valid for individul use only before the expiration date. If found return to: F Board of Building Regulations and Standards One Ashburton Place Rm 1301 i Boston,.Ma.02108 Not valid wit out sig ture Gar* MEMILIMMUM11 i � Irk�� :nl;�r�:Ululs�ul,:i�► T ,,.- ,#.12/3-1/2008 14:18 Bryden & Sullivan Insurance Donna Seviour-►Margo 1/2 ACpRy. CERTIFICATE OF LIABILITY INSURANCE o SPRINP -1 12 DATE1(MMV/31/08OD/YYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 62601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A' Associated Industries of MA INSURER a Spprinkle Home Improvement Inc. INSURER C: 199 Barnstable Ra INSURER D: Hyannis MA 02601 INSURER E ' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS. INSR ADD, POLICYEFFECTIVE POLICY EXPIRATION LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YY DATE IMMfOD/YY) LIMITS GF,NERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LtABILITV PREMISES Ea occurence S CLAIMS MADE a OCCUR I,AEO EXP(Any one penon) S PERSONAL&ACV NLURY $ GENERAL AGGREGATE S GEN'LAGGREGATE LINT APPLIES PER: PRODUCTS-COMP/OP AGO S POLICY SCOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per penbn) . H1REOAUTOS ' .-BODILY IWURV S ( NON•OWNED AUTOS Per accident) PROPERTY DAMAGE $ (Per irwident) GARAGE LIABILITY AUTO ONLY-EAACCIOENT S ANYAUIO OTHER TWIN EAACC $ AUTOONLY. AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S L OCCUR D CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND WC STATLL OTH- TORYUMTS ER EMPLOYERS'LABILITY A ANVPROFRIETORMARTNER/EXECUINE AWC7004943012009 01/01/09 OS/Ol/lO E.L.EACH ACCIDENT S 500000 OFFICER/MEM8ER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500000 e Ye3,oeRcnbe Under SPECIAL PROVISIONS below E.L.DISEASE•POLICY LINT S 500000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLE$!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVIEIOWIS CERTIFICATE HOLDER CANCELLATION SPRNMo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Sprinkle Home Improvement, Inc NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Fax #508-775-1350 Margo Mack IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,RE AGENTS OR 199 Barnstable Rd, REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE lKelley A.Sullivan ACORD 25(2001/08) O ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmization/Individual):_��{(li��-L� UxmLe_ `j m ni Address: �� T`7f1�(1l� Obeid' City/State/Zip: Ma Phone.#: Are yo a employer with employer?Check the propriate box: Type of project(required): 1. am 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the subcontractors 2:❑ I am a§oleprpprietor or partner-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition [No workers'-comp.-insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I an a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL 12.53"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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employecs,they must providt 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 Naive: 1�1i V t VQ, UA s Policy#or Self-ins.Lic.#: 1�VUat� � Expiration Date: J I 1 Job Site Address: I LiZ C w-'M City/State/Zip: (,k) Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure fo 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 of the DIA for' ce coverage verification. I do hereby c un r pains•and penalties ofperjury that the information provided above is true and correct - Si e: Date: Phone 0: Officialwse only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# IssuJag 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#: i 1 t I Bas r, BENCH MARK ` — O i Survey Disc of 3 LOT 13 j lot corner. `� a, Elev.=86.6() a CJ LOT 10 �� , . a a s <1 Z 90 ( 6000a1 ; LOT 14 3 -E HCH't%" t T �b ac�nd.O _ . -- - ' _ l 4 �� _N we 0 Fad s 4 3/ lest C m Hole 14 1�1 3f.nin N DIST Box 11 EXIST. / i500Ga1, _ 0 �� FDN. W `_ SEP'K ; ,�2E`ER'vE " LOT 1 5 L`'O1` I �. 43, 569± '\•S. 1=. t` s �S O 11 \« a !" G Co ; E'dla r. (600 Gal.! '0 f J r PARCEL 'IAII ��, / LEACHING FIT P,�s eft cf stone all } around LOT E xls+,nq " — iy vVel � �� � `wr r• l 9E:X,4Iog I �� 1 Q � N certify that the foundation is ;located in Flood Plain Zone C as .shown on Flood Insurance Rate Map 1/6/87 Add Offsets a Ce_rt_ifica_tions__ PD.H. Community Panel No. 250001 10/22/86 Changed size of leaching pits. — i R.s.J 10005 - A and that Flood Plain Zone DATE DESCRIPTION Drownby Checkedby N 0 T E S C is not a special Flood Hazard Area. --�- ------- -- - - - ------------- --— -- R E V I S 10 N S 1 . ZONING DISTRICT: RESIDENCE F. 2 . FLOOD HAZARD ZONE: C , Date Registered essiana� CERTIFIED PLOT PLAN 3 . ASSESSORS MAP NO . : 110- 3 4 Land Surveyor PREPARED FOR 4 . HOUSE NO . : 14 2 . 5. THE NORTH ARROW IS DERIVED FROM RECORD PLANS POLCARO CONSTRUCTION COMPANY, INC. OR DEEDS . THE NORTH ARROW SHALL NOT BE USED I certify that the foundation is ' located on the lot as shown and that FOR LOT 12 C A R L S ON LANE FOR ORIENTATION FOR SOLAR HEATING PURPOSES . IN S . REFERENCE: PLAN BOOK 389 PAGE 5 . fits location conforms to the minimum WEST BARNSTABLE SASS 7. CONTOURS AND ELEVATIONS FROM AN ACTUAL ON THE GROUND INSTRUMENT setback requirements of the Barnstable SURVEY BASED ON THE NATIONAL GEODETIC VERTICAL DATUM. Zoning Bylaw. I SCALE: 1 "= 401 DATE: SEPT. 17 1986 h. holmes and mcgrath, inc civil engineers and land surveyors 200 main street Date Registered Professional ma . 02540 '.f almouth, Land Surveyor A DRAWN: R.S. J. CHECKED: Q , JOB NO 86343 DWG . NO 39-4-6 SHEET 1 OF 2 0o a-R I