HomeMy WebLinkAbout0025 DERBY DRIVE -Da kM bL -
UPC 12543
Now coNS°���
HASTINGS, MN
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 00211 Application# 0 70 50 5-1
Health Division
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fee
Planning Dept. Permit Fee & Ig q0
Date Definitive Plan Approved by Planning Board OK
9 �— 07
Historic-OKH Preservation/Hyannis F�f
Project Street Address A,
Village 250A�4�
Owner—i'G'&C"� O-- Address
Telephone 6o .
Permit Request � a^'-lk
A&( ov
Square feet: 1st floor:existing d proposed 2nd floor:existing proposed �� Total newz&�o
Zoning District Flood Plain Groundwater Overlay
Project Valuation 2 Construction Type
Lot Size Grandfathered: ❑Yes *o If yes, attach supporting documentation.
Dwelling Type: Single Family_X Two Family ❑ Multi-Family(#units)
Age of Existing Structure 021 Historic House: ❑Yes kN0 On Old King's Highway: ❑hes I-,WNo
1 �J a,
Basement Type: kFull ❑Crawl IValkout ❑Other IC'
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Caw Y'
J
Number of Baths: Full:existing new Half:existing I anew
Number of Bedrooms: existing J,` new �9
cn
Total Room Count(not including baths):existing new First Floor Roo Counter n
Heat Type and Fuel: )(Gas ❑Oil ❑Electric ❑Other
Central Air: 'Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yeslo
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:,�Oxisting ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use ---.-n r�,._..._J.. ..._... .. _ , __, .Proposed u`se. ' _ A `.
BUILDER INFORMATION ���- 15�3
Name Telephone Number
Address lei �' . � License# _
-- Home Improvement Contracto
Worker's Compensation#
D
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0-411)
YP
SIGNATURE DATE OR' I l _ O
FOR OFFICIAL USE ONLY
,P„ERMIT NO. ?
i5r
DATE ISSUED -
}
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION (�
FRAME
INSULATION ® tom i o-
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
• t
GAS: ROUGH FINAL ,
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLANNO. '
•�• \ 1/LG VV!/L/!LV/L IYGWLylL Vj 211 WJJ1:I.W LL47 GLLV I /
Department of Industrial Accidents V
_ Office of Investigations
600 Washington Street'
Boston, MA 02111
www.mass.gov/dia '
`4Porkers' Compensation Iaasurance Affidmrit: ]Builders/Contractors/]Electricians/Plumbers
Applicant Information -/ /I ) I/ Please Print Le ibl
Name(Business/Orgmizationtbdividual): . I CiI l� . Ote I {(
Address:
City/State/Zip: �j �V v l D��Gg Phone:#: 5O
r
Are you an employer? Check the'appropriate box: 'Type of project(required):,
1.❑ I am a employer with 4. I am a general contractor and I
employees(fall and/or part-time).* have hired the sib-contractors 6..[)New construction .
2.0 I am a We proprietor or partner- listed on the'attached sheet, 7. ❑Remodeling
ship and have no employees These sub-contractors have g, Demolition '
working for me in any capacity. employees and have workers'
. 9. E]Building addition
[No workers' comp.insurance camp,insurance.$ 10.❑Electrical repairs or additions
equired.] 5. Yt a are a corporation and its
I am a homeowner doing-ill work officers have exercised their 11.❑Plumbing repairs or additions
self o workers'' co right of exemption per MGL•
y n?P 12.0Roo f repairs
insurance required.]t c. 152,§1(4), and we have no ,
employees. [No workers' 13: Other_/i2v� � .
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.
$Contractors that check this box must attached an additional sheet sbowing the name of the'sub-contractors and state whether ornot those entities have
employees: if the sub-contractors have employges,they must provide their workers'comp.polidy number.
I ain an employer that is providing workers'compensation insurance for my employees. Below is.the policy and jab 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 Off ce of
Investi ations of the CIA-for insurance coverage verification.
I do hereby cent a pains-and penalties of perjury that the information provided above is true and,correct•
.Si afar Date: _
Phone#:
Official use only..-Do not write.in this area, to be completer)by city or town official.
City or Town: Permit/License#
Iss-sing 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#:
Inf®rn�ation anal Instructions
Massachusetts General Laws chapter 152 requires all employees 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
ie�P+vPr nr tr�ctee of an individuals 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."
MCiL chapter 152, §25C(6)also states that"every state or.local licensing agency shall withhold the issuance or
rene*al.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 m. th 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, it
necessary,supply sub-confractor(s)name(s),addresses)and phone number(s)along with their certificate(s) of
..,insurance. Limited Liability Companies(LLC)or Limited Liability Partaershipa(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. B.e 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 requirea 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. e;: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.
i that must submit multiple permit/license applications in any given year,need only submit onp affidavit indicating current
policy-information(if necessary)and under"Job Site Address"the applicant should write"alldocations'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 penmits or licenses. A new affidavit must be filled out each
year.Wheie 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 questio•La,� -
.,please do not hesitate to give ns a call.
The Department's address,telephone-and fax number;-
Jbe CvznMOUWI a th of Massa' tuWtts
Department of lidustdal Awi.d mts'
- • C�f�ce of�ves�g���� .
Boston,MA Q-2111
Tel.9 617-727-490.0 ext 446 or 1-0 77-MASSAFE
J Fax# 617-7Z7-7 749
Revised 11-22-06
www.mass.gov/(dia
P�oFTME rDK�o Town-of Barnstable
y Regulatory Services
' BARJ?STASM ` Thomas F.Geiler,Director
M16 9.ASS
�ArEDMC'�p Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,-
-improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
0�✓,< �� l 9�O
- Type of Work: � � Estimated Cost
Address of Work: oln ���� o'—pm'?
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
E]Work excluded by law
❑Job Under$1,000
OBuilding not owner-occupied
(Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. .
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
Date Owner'
Q:fomis:homeaffidav
'THE l Town of Barnstable
yP� Regulatory Services
sARNSTABLE, = Thomas F. Geiler,Director
y MASS•
16
3.6' Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
� ./n� 1 Please Print
—DATE: o / V 7
JOB LOCATION: 0 � �N t (�y e'1 &
number street
/� ' i I/� •�, village_ �/Q
..HOMEOWNER"A�1\Q Il/�i
name home phone# "work phone#
CURRENT MAILING ADDRESS:
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 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
minimum inspe n c ures and requirements and that he/she will comply with said procedures and
requirements.
Signature ` om
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 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
r
Taa1e asaiD(eoatinae� .
I°sneriptive Packages for One and Two-Family Rcsldeatial Balldlag'I•Iemted wit9'Fro+I1Pei
AIAX11HUhY MINIMUM
Glaring Glazing Ceiling Wall Hoar Rase cw Slab HersinglCooling
�r C,0) U-value= R-valuer ' R-value R-vsluc, Wa1I p=imcLer Equipment Emdcacy .
Psr.'zage R-value' R valuer
1701 to 6500 Heatiag Dew Days'
13 19 10 6 Noaasl
R 12% 0S2 3D 19 19 10. 6 Ydorr..e!
S' 12/a 0.50 3B 13 19 ( 10 6 13-AFUE
T I5% 0=6 33 13 29 NIA NIA. Normal
U 15% 0.46 33 19 19 10 6
y 15% 0.44 311 13 25 NIA 13 ARM
pJ 15% 0.52 30 19 19 10 6 13 AFVE
13% 032 33 13 23 N/A NIA Normal
y I E%, 0.47 33 19 23 N/A N19 Normal
Z 13% Q,42 33. 13 19 ]0 6 90 AFUE
12% 0.30 30 19 19 10 6 50 ARM
•1. ADDRESS OF PROPERTY:
SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
^Tv 3, SQUARE FOOTAGE OF ALL GLAZING: A r 1V
4, %GLAZING A.REA.('3 DIVIDED BY'42):
5. SELECT PACKAGE(Q--A.A o see chart above):
NOTE' OTI ER MORE INVOLVED NIETHODS OF DE i E�UNG ENERGY REQUIREMEIN'TS
ARE AVAILABLE. ASK US FOR THIS INFORMATION;
$CTILDING-INSPECTOR APPROVAL:
YES:. NO:
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4668
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closet '
1010 °�,I: ;L
a
26 '
YOU WISH TO OPEN A BUSINESS? �
For Your Information: Business certificates(cost$40.00 for 4 years). A business cart ificate ONLY REGISTERS YOUR NAME in town (which you
must do.by M.G.L.-it does.riot give you.permission to operate.) You must first obtain the.necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to.the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 026.01 (Town Hall) and get the Business Certificate that is
required by law.
DATE:—2( D ��a Fill in please:
'''i" -"''I'``I=�lh.•, Q.:I APPLICANT'S YOUR NAE" 1
F"!"L''"`+?t�' •P lhii BU ES YOUR HOME ADDRESS: s
a�'=�1!'1'�. LEPHONE # Home Telephone Number -1
,< .61L Jt4i ��1 'd ] ^ E-MAIL: X�.1 - C " 1� coral
'
NAME OF CORPORATION:
NAME OF NEW BUSINESS TYPE OF BUSINESS 9 A I Q 1'
IS THIS A HOME OCCUPATION? YES 0
ADDRESS OF BUSINESS. S MAP/PARCEL NUMBER (Assessing)
When starting a naw business there are several things you must do in order to be In compliance with the rules and regulations of the Town of
Barnstable. This form is inten'd'od to assist you In obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. :BUILDING CO is ER'S OFFIC pertain MUST COMPLY WITH HOME OCCUPATION
This individ' I ha se infdFme a rmit uir, is that to this a of business.
RULES AND REGULATIONS. FAILURE TO
I!
ri Si nature CC�[\/!P1_d MAY RESULT IN FINES
MMEN,Q' u,
f -
2. BOARD OF FaLTH ll
This individuala_ .for:Qed, thelpermit requirements that pertain to this.type of business.
Authorrz dSignature** f_ ag
COMMENTS: J I Gr r,l SOA ^Awv. 1-)0 e- `
3. CONSUMER AFFAIRS [LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
r
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oA Mn '50rnz a,,�
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v-n a Y) 0r J'e,f Y-Y �rQ_n
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U AOkAA
�OrJ VYIC'.L� +U.sK \n � C(d y �,y
Town of Barnstable
FTHE
Building Department Services
Tp�
.�, Brian Florence,CBO
Building Commissioner
t RARNsnAars. 200 Main Street,Hyannis,MA 02601
Mass.
9 03g. ��� www.town.barnstable.ma.us
ATE �
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
Date: - �$
Name: WU(2 n(A 0 �r CQ�JZ(Qj 9' Phone#: 6 I
Address: S 6 (� lam. Village: W n r Yl_ Q6
Name of Business: Q)0A 90 Q1 UR r
Type of Business: la,1JU ______Map/Lot: '1 00?1
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the.dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing-the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall by employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above estrictioas for my home occupation I am registering.
Applicant: - Date: 1 -
Homeoc.doc Rev.06&0/16
r
Town of Barnstable
I':..tYkmQmohihsf)vnLsjue.fait
61Z)._
MA89.
i099 ThOIIl:iB F. (iL'rtCr,Director
toT
Building Divisioa X-PRESS PERMIT
Tom Parry, Building Commissioner
200 Main Strect, Hyannis,MA 02601 AUG n 8 2003
Officc: 508-862-4038 -
Fax: 508-790-6230 TOWN OF BARNS TABLE
EXPRESS PERMIT APPLICATION - REST[UEN' W-, 0NLY
Not Valid without fled X-Frees Imprint
Map/parcel Number
PlopoM Address 2 S Le Rt b �� --
(�Residential Value of Work_ l n„on
Owacr's Nause&AddressnwN aELE — _ 1 O_____
Conte actor's Name
Home improvement Contractor License 0(if applicable)_.�
Construction Supervisor's License#(if applicable)
ulWorlanan's Compensation Insurance
Clock ono;
❑ I am a sole propriotor
❑ I am the Homeowner
[ I have Worker's Compensation Inst:;ance
Insunuice CompanyNasne
Workmen's Comp.Policy#
Permit Requost(chock box)
Re-roof(stripping old shinglen) All construction debris will be taken to 'r U _
❑Rc-roof(not stripping. Going over exiadng layers of roof•)
❑ Re-side
❑ Replacement Windows. 7J-Value (maxirnun>..44)
❑ Other(specify)
•Whoro required: Issuance of this pcuixit doe not cA"t conVliancc with other town dcpartrtunt rcgv1&aoi,a,l.r..Historic,Conaerva6on,ctr..
Stgna �
Q:Fon-ns:0xpmtr8
Revised 111901 /I
Q�:� c_. 'li�/Q%Jt1 tr.�;�`�L�:J�-��•
Board of Buildin R(.'" 11a ions and Stanckirds
I„ t: t' 1
b
One Ashburton Place - Room 1301
Boston. Mas.>achusetts 02108
Home In1prOVemelll. Contractor Reglstral.1011
Registration: 103714
Tvl)c: Private Corporation
Expiration: 7/9/2004
PAUL J. CAZEAULT & SONS, INC.
Paul Cazeault
P.O. Box 2781
Orleans, MA 02653
Update Address and return caul. M.1I-k reason fur chanmc.
Address I I Renew:1 i ; t{ngiloyurenl Lust (':ud
rj�r% 1JIl•//L///.!//LIIII CGCC/L !J/.,/(G(,Itk11/A;�(GJG'C/w1
Board of 6
Buildin 6 Regulations and Standards ►_,iccusc or registrakon valid for iudivi(lul rise()III),),
HOME IMPROVEMENT CONTRACTOR lkl*ore the expiration dale. If fount) return to:
Registration: 103714 l3u:ud of Building 1{ckulations and Standards
Expiration: 7/9/2004 Onc Ashburton Place Rnt 1301
Bwdon, Ala.02108
Type: Private Corporation
PAUL J.CAZEAULT&SONS, INC.
Paul Cazeault
22 Giddlah Rd. Chi >r. ;�/b:• ( nt,u/u/;,.n.vli/ii /. �rii irr. 1
Orleans, MA 02653
AdminisU:rtur Finn• r r - BOARD OF BUILDING REGULATIONS
t License: '.ONSTRUCTION SUPERVISOR
Number: CS 02632.5
f
Expires: 10/20i:1003 Tr. no: 7310
ILL4: ,
Restrictec : 00
PAULJ CAZEAULT _
1585 MAIN ST
OSTERVILLE, MA 026',5
a�
Administrator
0/
Board of Buildin
� g Repulations
One Ashburton Place, m 1301
Boston, Mra 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE
Number: CS 026325 Expires: 10/20/2003 Restricted To: 00
PAUL J CAZEAULT
1535 MAIN s"r _
OSTERVILLE, MA 02655 --
Tr. no: 7310
Keep top for receipt and change of address notification.
ACORD- CERTIFICATE OF LIABILITY INSURANCE 5... M/2-0-0)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
J y� HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Osterville, Ma. 02655 INSURERS AFFORDING COVERAGE
508-420-9011
INSURED Paul J Cazeault & Sons Roofing Inc. INSURERA: Western Heritaae Ins- Co
INSURER B: TraVejerS Indemnity q of Illinoi
1031 Main Street INSURERC: �
Ostervllle, Ma 02655 INSURERD:
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 INSUPANCE AFFORDED BY-THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE MM/DD/YY DATE MM/DD/YY
GENERAL LIABILITY EACI4 OCCURRENCE $1 ,000 .000
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $
CLAIMS MADE ®OCCUR MED EXP(Anyone person) $
A TBI 04/30/03 04/30/04 PERSONAL&ADV INJURY $
GENERAL AGGREGATE $2 0 0 0 OU
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
POLICY PRO- LOG
JECT
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
'ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
S
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND TORY LIM TS OER
EMPLOYERS'LIABILITY
. 7PJUB-922X653-502 08/10/02 08/10/03 E.L.EACH ACCIDENT $100,000
B E.L.DISEASE-EA EMPLOYEE $100,000
E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
I
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
' "; -' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
A.F. Haul ton & Company Inc DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL L_ DAYS WRITTEN
P.O.Box 164 6 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Wel l f l ee t, Ma. 02667 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
fax#5 0 8-4 87-13 0 3 AUTOO ED REPRESENTATtVE
L&
ACORD 25S(7197) 0 ACORD CORPORATION 1988
r
PROPERTY OWNER MUST COMPLETE AND SIGN THIS
SECTION IF USING A BUILDER
as Owner of the subject property
Hereby authorize Paul J. Cazeau.lt & Sons Roofing
To act on my behalf, in all matters relative to work authorized by this building
Permit application for (address of Job)
ignatu. of Owner D t
Print Name
(Please return this form. to Cazeault Roofers with your signed proposal/contract)
Asseksa s map and ,lot number ... 7..............:........... ......... THE
yoF toy
Q� Q � •
Sewage Permit number ..................... � �..A....Y..........................
61 Z BARIIST"LE, i
House number '
:..c........: ......:,..:...........................:............, 90� MAM 9.
amPYa`
r TOWN OF BARNSTABLE
BUILDING INSPECTOR
' APPLICATION FOR PERMIT TO- ...:.�. ...�.... ............. ...: ........ Jll. ........................
(''' `.
TYPE OF CONSTRUCTION .. ..... .!_. ..>.. ...... ............ ...................1../.................................
s
............ .1 ' ......19 ..
TO THE INSPECTOR OF BUILDINGS: F
The undersigned hereby applies for a per it according to the following information:
i
Location ........Z :.......... .... ....................
f
ProposedUse ............ . .1 .. ..!... .......................................................................... ..........................................
Zoning District _ ..................................Fire District
Name of Owner ........` +�..!..-.. .......). fi � � ..Address .......:.......;��f.. /../ /.. .\ ............................
t..... ...
Name of Builder ...A`.'�.... �. ...........� )//?.t.:Address .:..............................................................................
....
Name of Architect .....d`..,` .. j /. .................. !. `.. !�..1...• �.. .��.'�'' .......Address .
Number of Rooms ......Foundation /.. !( '�
'......�" .f .............................. � - �.�..
?..,... ..h-.:...... ..........................Roofin ":... .? T.: ...r.�`.r.ExterioIv
r6 r.. g �� ....,.....�i....; tit
Floors8' ........................................................:Interior Y.. !...... .. Y t► x ................ :" €.... / .�...
f
g g r } e ..°cam/. ' �.�'.
Heatin .. .....f ........................... .......Plumbin !/.......„... ..... C .� '�........:
Fireplace .............. ...•! --^ '"-...............:.;.......... Approximate, Cost ......... �
Y. .. ... .
Definitive Plan Approved b Plannin \Board m_ -; �__ 19___ Area ............
PPE y 9� � . ��y -- ----- �.........�.. .
. ,.� ;
Diagram of Lot an :B,uj.lding wrth Dim�ensio'nsf„ �,� Fee .............................................
r, :d
SUBJECT TO APPROVAL OF, �6b
f a ;o'
<. r
A
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regafclin the above
construction.
✓.�Name rYSri:........... . .C:. .... ...........
�i "
Construction Supervisor's LicenseO �J
e�. .�� .......
S L S TRUST A=151-004-006
0 of
No .....29095 Permit for .... ...............
.......Single Family.....Dwelling......................... . .... . .
Location Lot 63, 25 Derby..Drive
.....................
West Barnstable
...........................................................................
Owner ......S...L..S.....Tru.s.t...................................
Type of.-Construction ...Frame,,,,...,,,....................
................................................................................
Plot ............................ Lot .................................
Permit Granted .........March„2 ............19 86
Date of Inspection ....................................19
Date Completed .........................................19
fnuN-{ `:"',i,.:*..,,,._. -ti:. :,mi-t_`'_ -r�r q _r r ....._ :a-;i--.•v----rev z. 's..,i. . :.`+c t. i
. � 3
rs°
• i TOWN OF BARNSTABLE Permit No. ------29.n45
Building Inspector Cash
•�wr ,
OCCUPANCY PERMIT Bona
Issued to S L S Trust Address
lot #63 25 Derbv Drive. West Barnstable
'Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
.................u
..............9... �9._ _.......
Building;Inspector
z !
i-�. •�'tvr-... •1.' ...rfc...�� � - .. � r ,L 44 �'� .. . Y ._ n n, ..'�... .,. _.1
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
»IT = TOWN OFFICE BUILDING
rua
HYANNIS, MASS. 02601
'�o rnr►'
• MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit' has been issued for the building authorized-by
Building Permit »._...._. 0 _........_...».. _........
2� 5�
issued to ...»............»_..»....._.»_.,..»_..._...»»... _,,���.»�?scc�!1................................................
......_.».__._.........» __......�..__._..
Please release the performance bond.
a
TOWN OF BARNSTABLE, MASSACHUSETTS
PERMI
t JOB WEATHER CARD
DATE <-!' 19 PERMIT NO. � � 3
•PLICANT _ iit ADDRESS
(NO.) (STREET) (CONTR'S LICENSE).1;
•'ERMIT TO 1) OF
STORY ` •-•1 NUMBERNG UNITS
(TYPE OF-IMPROVEMENT)
NO. (PROPOSED USE)
4T (LOCATION) "IL 1"'> ---/ ''^r+� �=•-���> - _ __ _ ZONING
DISTRICT
( (NO.) (STREET)
- i
BETWEEN AND
(CROSS STREET) (CROSS STREET)
:1BDIV1510N LOT
LOT BLOCK SIZE
2JILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
) TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
P..EMARKS:
-:REA OR 1..'.�'1 (/:�.� t•,- PERMIT s
OLUME _� ESTIMATED COST ° FEE 1 =
(CUBIC/SQUARE FEET)
-WNER ,
BUILDING DEPT.
40DRE55 BY
HIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARJLY OR
•-ERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
"ROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
"ROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONF
')F ANY APPLICABLE SUBDIVISION RESTRICTIONS.
41NIMUM OF THREE CALL 1 APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
+NSPECTI TR REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
SLL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL
MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE.
s. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS !VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
/ I
vv
S HEAT:NG '.NSPE_-Ti,NG/APP OVA`LS REFRIGERATION INSPECTION APPROVALS
" U V
aoma� zS86
12
—::QL !' 4
u/tol ec, —
"ACnK SnA.L_ NCT =RO=EEC UtJT;L TF+E PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION iNSFECTIONS INDICATED ON TH!S CARD
NSPECTDF SAS AP=R0V70 -tiE '; q+SUS WORK 1S NOT STARTED WITHIN SIX MONTHS OF DATE THE ^' 9`- ' - OR 9Y TELE
PHONE
STAGES F CONSTauCTiJN. PERMIT IS ISSUED AS NOTED ABOVE. ^N•
A
C�P c--=rl
'O6 l3
�^ 15,-74(= FT Z
a•
0
e
_GONG.
x
�0 5o g
Rio
9 goso ,x 90
ys O Ile-
. •T o
0
JOB #. 85-215
CERTIFIED PLOT PLAN
PREPARED FOP.-
LOCATION: LOT-63 DERBY DRIVE
SCALE: 1=40 DATE: 2/27/86
REFERENCE:
LEBEL / SOLLOWS
I HEREBY CERTIFY THAT THE BUILDING
SHOWN O THIS
LLOCATED ON THE
GROUND AS SHOWN HEREON
i � ARNE yGs
H.
o�A�A
down cape engineering N
+ CIVIL ENGINEERS R ISTE • �`
1 LAND SURVEYORS
ROUTE -6A YARMOUTH MA DATE REG. LAND SU EYOR
r
-
SECTION SEWAGE
L.. _ .,D?'BOX.. .. Lf- -LEACH=SEPTIC TANK - low
TOP OF FON
l4�
.12.1 OF i/eT0 Jh'•
.\WASHED STONE
1 1 ' - I OCR. ""1__. - vq�•/(J�
IN• OUT• IN• IN•
! / IDOL OUT
SEPT
G 33
TANK J' 9�
ELEV. ELEV. ELEV. ,
I ELEV.15
xr' rr. ELEV. ELEV.
WASHED STONE W I-
to p
TEST MOLE LOG = �2
TEST BY N r /mil'
r ' WITNESS �g
TEST DATE DESIGN BEDROOM HOUSE j
T.H.- • 1 T.H. +� 2
ELEV. ,J ELEV. NO
•; j� 2 DISPOSER ) DISPOSER
PERC RATE MIN/IN.
FLOW RATE 33o (GAL./DAY) - c-7 +/ /
SEPTIC TANK
RECI'D SEPTIC TANK SIZE %
LEACH FACILITY
SIDE WALLP. ( G/D.
/ 2-
BOTTOM
i ( Ie/?_., T = 7�i"'., 1 p m _ G/D.
TOTAL
USE: `-= LEACHING
f Irk" ✓ llt. 1✓ ��' j-'
WATER ENCOUNTERED '
7 ._.I
NOTES: (UNLESS OTHERWISE NOTED) 3
!- I
;.DATUM(MSL) TAKEN FROM•� '-`` - "w-QUADRANGLE MAP C(/�
2.MUNICIPAL WATER ___AVAILABLE
_AVAILABLE
3.PIPE PITCH:Vr"PER'FOOT i6) 0? ^�f
4.OF-SIGN LOADING FOR ALL PRE-CAST,UNITS:AASHO- �' -44
3.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1)FT.
6.PIPE JOINTS SHALL BE MADE WATERTIGHT /~ ARWE H.
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. i��` OJALA Of SITE PLAN
SYATE_ENVIRONMENTAL-CODE TITLE S
8. T�-A�� ?1_A. i Fo1L 72A7t>"�c7 �DiLeL C7►J�.`C / �L� ej. .`� /^ - - -- - -. .._._.. - _. .. -
r c uD r=aZa'�-::z�•`� l-.�s` s�-1+.�3+._aG� ARNE
'�� Y� fir"• i �:l- —
_ E
R L NGINEE �Q/ _
%•.. ... . ._-, .:r... ':..t'=^,�C,^�,...� :ti ' r� i ✓1_.�,i' .; -ri'ri, ..- - ..... ._._- . . _ _.__._..._ .._ ._ -- .. .. . ��a., - +, �
E R; 1 O'1 1d8 REF:
!_ ®�II t�.��P� �.I,��I���.�®A� J},ckr:)` PREPARED FOR: I
CIVIL ENGINEERS
i LAND SURVEYORS
BOARD OF HEALTH- �� '?3EG,LAN_SU y£v'OA SCALE I 1 of I(� l
CONTOURS (EXISTING)--•--------••- L7
(PROPOSED)�-0 -- O- APPROVED GATE. - MA DATE 1,43 - '!i
o o X3)o o QPTIC
0iC �
ySYSTEM MUST SEAssessor's map,and lot number ........................................... THE T
- � )s TALLED IN COMPLIANCE f
r f TITLE 5
Sewage Permit number .........:. ...............,............................. WITH, .
y ;? _ �i t� ENVIRONMENTAL CODE AN t Basa9TABLE,
House number -rn EGUL AT�00$ 9°o,,�r639.
00�
....... .......................................
a N
ft
TOWN OF BA-RNSTABLE
BUILDING INSPECTOR:
APPLICATION FOR PERMIT TO ... ...t�.. ............... .... .... ..........................:..
TYPE OF CONSTRUCTION .............. .. ... ...................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a per it according to the fol wing information:
In ✓ W r ..
Location ....... ..Q�y...� �....... V....(�...�............ ......��.Yl ....�.�... . .................�..............;/,�. ......
........: Uv.P��..l.. ........................:.............:.:................................ ..........................................Proposed Use ...
Zoning District ............ .... .................................:.Fire District.. .... ..................... ...... 00
..........................................
Name of Owner ....... ......) .......Address d.. .(.4 ...........................
Name of Builder ..................................� �gr: od ress ............................ . .........
Name of Architect ....Y /Y Q...��..11�.�? f Address ! : ......�...�........ .................... !/ 1
Number of Rooms .................. ..........................................Foundation ...... ...�..9/ .4 I01.�..�.7�
Exterior .............��... .f.. .........................Roofing .......... .��.. .�............................................
ll
Floors ............P.!' ............................................................Interior ...................... .....P....................................... .......
Heating ....................6 .�....1!! ...............:.................Plumbing P...`�.....��. .. .....................� .........
Fireplace .............. . ......................................:.................Approximate. Cost
Definitive Plan Approved by Planning Board ____ _ _ __7__________19__ Area ........ ........ .0710
Diagram of Lot and Building with Dimensions Fee c�
. ....... ...
SUBJECT TO APPROVAL OF BOARD OF HEALTH
�7
I
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of BarVegn the above
construction.
Name .. .... . ........... ..............................
` Construction pervisor's License ao ......
'S L S TRUST
No ...29095... Permit for Ai...5tPxy................
Single Family Dwelling
.......................
Location ......Lot..63, 25 Derby...Drive._...._..,
.....................West...Barnstable.........................
Owner .....S L S. Trust
......... ...................................................
Type of-Construction ......Frame. .........................
............................................. ..................................
Plot .............................. Lot .............................
Permit Granted March.r.c.h...2.6.?...........19 86
Date of Inspection .................................. .19
Date Completed ..... 77L ..
—.!�(o..........19 4:
11 0-
0
rj
pit
o• e* TOWN OF BARNSTABLE Permit No.
Building Inspector cash
•�1639
OCCUPANCY PERMIT Bond
Issued to S L S Trust Address
lot #63 25 Derby_ Drive, West Barnstable
696
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
11-2 G
Building/Inspector