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HomeMy WebLinkAbout0040 DERBY DRIVE Al k Ira UPC 3LOR ° Now, 5,_3�o,R � HASTINGS.UN .�.,..-�.. ^�.r.+-. "�'�.-..».�.�.,�....�r�.. •«fir-k.,:, - �EAr„S?..... ��--�, C9 ali; �tGv I , 1 FROWt'Brad J Campbell Electriciari FAX 110. :508 420 6161 Oct. 23 2006 08:12AM F1 TOW . Clr BARS' iA8LE Town of Barnstable 2006 OCT 23 AM 9: 10 Regulatory Services Thomas F.Geiler,Director s'eQ` Building Division DIVIS' Tom Perry,EnUding Commissioner 200 Main Street,Fiyaamis,MA 02601 D fice: 508462-4038 F ' g�'(/el� / QjZ REST EL ICAL INS ® (D ELE CTRIOALr PERWUT NtlMBER (Permit required in order process inspection) To s Date ",1�6 Requested fate of Inspection l�• 'Oc �„r,�s,a�-n I, map � ereby request on inspection under Msesechusatte General (Electddan) - Law chapter 148,section 8L and 231 CMR 4.02(3). The installation will be ready for inspection at `� U ,r e S G' Property Type of inspection requested: C] . Temporary Service ❑ Service Ite-inspeetiou Excavation .❑ - Rough Re-inspection ❑ Service�pection ❑ Final Re-inspection ❑ Rough Inspection for ($50.00 Re-inapection Fee) ❑ Final Inspection for_ - -- --- Owner or tenaz► Lieextiaee'a.naaxe, addzeaa,and phone�� U��4 7 Tuo����c� l�c�_ I�t wr�s !Mi L�S tf Z U •6!G j Licence n=ber. � � Licensee's Signature _ M sec&ca to be cempl ste a Inspector of wim In pection d OCT..2'4 2006 pproved (DNotApproved Thie•worg was not approved for violation of the followring Articles and Sections of the MA Electrical Code' Q:�VPFtie�>�rms_alacar�ur�t Q.,•�n9Rne PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT G 200 MAIN STREET HYANNIS, MA 02601 DATE: 10/16/06 TIME: 11 :48 -----------------TOTALS----------------- PERMIT $ PAID 30.00 AMT TENDERED: 30.00 AMT CHANGE: 30.0000 APPLICATION NUMBER: 20061644 PAYMENT METH: s CHECK PAYMENT REF: 3089 _J � a uttc�at Use� sah I Department of Fire Services Permit No. r,? (e /6 Y'I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] eave blank APPLICATION-FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W INK OR ALL IN 0 77019 Date: �() . /.� •06, City or Town of: ,= ,s 0/`e To the Inspector of Wires: By this application the undersigned gives nFes e of his or her intention to ptv . orm the electric or scnbed.below. Location(Street&_Number) 6 re (, ( rt e-n S f l t' Owner or Tenant e OL n Telephone No. Owner's Address 54 t4,__f a :Is this permit in conj 9 ction with a building permit? Yes [�J No .❑ (Check Appropriate Box) W. Purpose of Building l Utility Authorization No. 2; Existing Service 15 Amps !Zo / 2`'lu Volts Overhead ❑ . Undgrd[R No.of Meters WNew Service Amps / Volts . Overhead❑ Undgrd ❑ No.of Meters U Number of Feeders and Ampacity a a Location and Nature of Proposed Electrical Woik: !�'•� [�5 t/U v ti SlV,ryl I44!W4 A 2 Completion of the following table may be waived by the Inspector of Wires. _j o.of Tota 04 co No-bf Reces ed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No-of Lit aire Outlets No.of Hot Tubs Generators KVA ove - �Batte o mergency rg g No.of Lu fires Swimming P of rnd. ❑ nd. Units No-of Rece`uf�acle Outlets o.of OR Burners FIRE ALARMS No.of Zones o.of etection an x- l of Swi 'lies No.of Gas Burners InitiatingDevices >�of Ra , es No.of Air Cond. Tot No.of Alerting Devices - Tons No.of Waite Disposers Heat PmTotal? Number. Tons No.of Self-Contained Detection/Alerting Devices Mal No.of Dishwashers Space/Area Heating KW Local ElConnee ct unrction ❑ Other, No..of Dryers Heating Appliances KW Security of Devices or Equivalent o.of ater :. o.of o:o . Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of unic Liones Equivalent Wiring: . o z OTHER: (DQ� . 5 z S o vS Attach additional detail if desired or as required by the Inspector of Wires. o z Estimated Value of Electrical Work: (When required by municipal policy.) Z U =) } w = Work to Start: -06 Inspections to be requested in accordance with NEC Rule 10,and upon completion. I— INSURANCE OVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless Z o K z the licensee provides proof of liability insurance including"completed operation"coverage'or its substantial equivalent. The Q o Q� .-§ undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office. o Q CHECK ONE: INSURANCE BOND ❑ OTHER.❑ (Specify:) O 4; o J I certify,under the ains d penalties of perj ,that the i ormation on this application is true and complete. _ d g FIRM NAME: � �' - c « LIC.NO.: (57s L u lu Q _ iii 4 Q Licensee: Signature LIC.NO.: u.l I- w o (If applicable,enter"exempt" ' t e lic ns ber line.) "_�/ // Bus:Tel.No.: yZ0 - �IIIIJ Q Address: f7 �i24G�.�t7�KIlGl� Alt.Tel.No.: I �YL OC w o *Security System Contractor License required for this work,if applicable,enter the license number here: w w OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally a o_ required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner El owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: l The Commonwealth of Massachusetts N; Department of Industrial Accidents Office of Investigations 600 Washington Street \UV.j; Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ((A fl S ;, C -J �e , Address:_ C ` City/State/Zip: 4t t 1�/ Phone #: Are you an employer?Check the appropriate box: Type of project(required): L❑ laffi a employer with 4. ❑ I am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. t ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y P tY• 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LE]Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 sub-contractors and their workers'comp.policy information. 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. I do hereby c y der the i and p alties of perjury that the information provided above is true and correct Signafore: Date: 6 6 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#: 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 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 bean 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 (i.e. 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 Qfl+ice of Investigations 600 Washington Strut Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE. Fax#617-727-7749 Revised 5-26-05 w.mass.gov/dia 'Y�14 TOWN OF BARNSTABLE BUILDING P RM1T-A-PR.JLICATION 0® -- 002- Map Parcel l Ap i lication# r Health Division Conservation Division \16 Pe mit \. 1 Tax Collector �N teJlssued Treasurer I {� `� Application Fee Planning Dept. ( v Q� Permit-Fee Date Definitive Plan Approved by Planning Board a v (,�� Historic-OKH F Preservation/Hyannis Project Street Address Village Owner ���(.� 'N �S Alellnedy Address 70 Telephone ��� 3 75- U Permit Request "n y��' �� �✓ �� Gl Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Proect Valuation d 060 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supportinglll;documenCation. .7 Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) ; Age of Existing Structure Historic House: ❑Yeslo On Old King's Hi hway: tYesM ❑No Basement Type: KFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 22 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: Y]Gas ❑Oil ❑Electric ❑Other Central Air: O Yes A.No Fireplaces: Existing ✓ New Existing wood/coal stove: ❑Yes �No Detached garage:O existing ❑new size Pool:0 existing A new size Barn:O existing ❑new size Attached garage:\Xexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ]No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION C/ 2 Name J�.r�- Telephone Number ��b 31, — Address License# < yL Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE t FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE, OWNER DATE OF INSPECTION: '- FOUNDATION , ,z FRAME INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' a . DATE CLOSED OUT ASSOCIATION PLAN NO,. k j ;' •.�,s �� - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION f 00 - 00 2. C/ L Map !� Parcel ,, \ � Application# �j . 'Health Division Conservation Division / ` v" ` Permit# Tax Collector �° �� Date/Issued Treasurer ' \ . �(� Application Fee v " Planning Dept. I V �� ,� Q� Permit-FeC Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis \ n I Project Street Address Village Owner JQ�(.� sS (,014661 Address L10 M;11' Ila he-, Telephone Permit Request I r it11 60 /4�) 1J Gil O,U Gl Square feet: 1 st floor:existing • proposed 2nd floor:existing proposed Total new 7 C Zoning District Flood Plain Groundwater Overlay Project Valuation �O 060 Construction Type P66 Lot Size A69(f _ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family- Two Family ❑ Multi-Family(#units) Age of Existing Structure 011 Historic House: O Yes /6�Qo On Old King's H ghway: Yes; ❑No Basement Type: 14,Full O Crawl ❑WalkowK O Other Basement Finished Area(sq.ft,)— ��� Basement Unfinished Area(sq.ft) c 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 X5,,No e, Detached garage:❑existing ❑new size Pool:❑existing A new size Barn:❑existing ❑new size Attached garage: existing O new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review# Current Use f Proposed Use r BUILDER INFORMATION Name � Ja T K�fGvv t Telephone Number Address mil/ y G� /A,/; d A License#_ b bll Y,n .S aLt(, �+' N�N' � Home Improvement Contractor# / Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _ f SIGNATURE' 1 DATE lY , FOR OFFICIAL USE ONLY PERMIT NO. r DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL x FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a r �\ l RG IiVI/slraWr►Gs•••r• vJ a..wuuw.............. . \ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation'Insurance Affidavit: Builders/Contractors/Electricians/Pluxubers Applicant Information ]Please Print Legibly Name (Business/orpnizatiowhdividual): Address: 40 I�•lL,lm�--� i�.�. City/State/Zip: �� 0W d`� Phone#: 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 6. ❑ New construction employees(full and/or part-time).* have hued the sub-contractors listed on the attached sheet, t ?• ❑ Remodeling 2.El I am a sole proprietor or partner- . ship and have no employees - These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp,insurance. 9. ❑ Budding addition o workers' Comp.insurance 5. ❑ We are a corporation and its � 10.[I Electrical repairs og additions required.] officers have exercised their 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Phrmbing repairs oT additions myself.(No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t . employees. (No workers' 13.0 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 anew of &vit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infbrrnati in. 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of periury that the information provided above is true and correct ' Date: ram! Phone#' 1S ��� 13 . Official use only. Do not write in this area,to be completed by city or town official, al City or Town: Permit/License# Issuing Authority (circle one): 1.Boar:d of Reaith 3.Building Departmewa. 3:Cityfll own 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 deed as "an individual,pgmership, 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 alicense 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 ofpublic 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-contractors)name(s),address(es)and phone numbers)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 retuned 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 obtam a workers' compensation policy,please call the Department at the number listed below. Self-insured comes Shoald-eulw 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 to affidavit for you to fill out in the event the Office of Investigations has to contactyou regarding the applicant . Please be sure to 0 in the permit/license number which will be used as a reference number. In addition,an applicant that most 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. Anew 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 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: i The Commonwealth of Massachusetts' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. t 617-727-4900 ext 406'or 1-0077-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/aia I FINE ra Town of Barnstable Regulatory Services + BARNSTABLE, MASS. Thomas F.Geiler,Director �A�FDW1A�p,0 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 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. Type of Work: 3 f!` �lA -- yo Estimated Cost Address of Work: eS� (���' ( ' (N • �G"���1� ✓(.Ci lVt G�/ Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 13uilding not owner-occupied caner 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 Signature Registration No. "7-3- Q� OR Date wner's Signature Q:wpfiles.forms:homeaffidav Rev: 060606 RESIDENTIAL: SHEDS -POOLS—DECKS-OPEN PORCHES- GAZEBOS i FEE VALUE WORKSHEET APPLICATION FEE: $50.00 BUILDING PERMIT FEES: ACCESSORY STRUCTURES >120 sq.ft.(Sheds,gazebos,etc.) >120 sf-500 sf $ 35.00 $ >500 sf-750 sf 50.00 $ >750 sf-' 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ,y ABOVE GROUND SWIMMING POOL $25.00 $ i RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ Q:forms:dkcost REV:063004 Town of Barnstable DFtNE�p� ' P`' ~o Regulatory Services 2 snxNsrnstt„ ; Thomas F.Geiler,Director arnss. � 1639. Building Division '°Tens a 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 Please Print DATE: / JOB LOCATION: ` D 1/ I K S ��'7/1/i/ Alt number street' -7 village P� o �j / "HOMEOWNER": 7 y[�! 18'.3/S QY'3b e-it1 6or J?4� ,S y .name home phone## ,p /wwoor�k phone# / CURRENT MAIIING ADDRESS: ��� e, ` - /n�I ry es 4 ""- 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 ok 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 woik 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 requirements, Signature of, omeowner 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 persdn(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 Ls vi �77y 4 a�� Application to ®[b Ring'o joiabtuap Aegionat Jbiotoric Mystrict Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four complete sets,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 ❑Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2...Exterior Painting: ❑ 3.:Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Re nting Existing Sign 4. Structure: ;4 Fence ❑ Wall ❑ Flagpole Other I h Q Y01k P7'( p QO j N.. TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK• DeS1 rGSG1 G ASSESSOR'S MAP NO. fj6�J L�� OWNER_ N�S��k a' 4a A 2 f /f(Gl�yl ill y ASSESSOR'S LOT NO. Q O - (J HOME ADDRESS_ 0 &2511'� TELEPHONE NO. 4�3� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) aV�a��— SlcS��l t -lie,K—.. lCs/ " kh �. U n .J AGENT OR CONTRACTOR TELEPHONE NO. ADDRESS r DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of ro p posed signs. � � G�egos lN� - C a.�h l r c� SI n19d 4, �� 11 9 _ Ow ontractor gent For Committee Use Only Ii t',iTtiis�Certificate is hereby w . ate. U d APPC„e ied �(f N ® I ittee Members'Signatures:_ 2205 HT W�N OF�BArIR TS tt s_I —_ _ .r , U__�wNTIO— Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE COLOR C IHNEY TYPE COLOR ROOF MATERIAL COLOR. PITCH lei WINDOWS COLOR SIZE v CNN TRIM COLOR �To�n n. p'9�?o l 0' os v 1?RN DOORS COLORS SHUTTERS COLORS (iUTTERB COLORS DECKS MATERIAL-� S {GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS FENCE G l GU I(VI "l l T COLOR I �i 11/� (h•1/L�.G Sh Pvol -�-�i'►Ul'rq Iasi nll out Completely, including meamu ments and matariela/Color to be used. roar copies of this lomm are required for submittal of an application, along with lone copiem of the plot plan, landmcape plan Gad elevation plans, when applicable. SPZCi R. :ed 12/98 PGa i � � A F 34 Glo 5�ti� y af-e 5 i �J 6L t(4 A Ze, V A-. nh& JA� k6Ll Pal I pal x qo cvt his 4hp'`C� ZOOS /p/V 0 P -EN SPA CE v LOT J o I?1 ryrvti6 �' 19 ��otio� 2� \ \ #407 LOT ti�� 2 fig- _ 4.46 1� S 1 33 E14EENT DESIRES 1 LANE lan I RES. ZONE.- "RF" This MORTGAGE INSPECTION Bank lUseoOnly FLOOD ZONE.' "C" THE PISTANCES AND MEASUREMENTS ON THIS S OULD BE VERIFIED BY AN INSIBUMENI SURVE TO __ _-_ REGISTRY OWNER: FI7ZPATRICK HOME BLDG. CO. INC __ DEED REF: _ t0043/�B4 BUYER: 11QSF.�P1�P-�c_J�NT l_ ly1yF1�k_________ DATE: _ �7/�_________ PLAN REF: _544 ________SCALE:1"= 50' FT. I HEREBY CERTIFY TO CD PALS BAN _ OR_SA ffNG� YANKEE SURVEY _____ ___ ____—__THAT THE BUILDING t`t t►� i SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS ��ii �� CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ _ CONFORM TO THE ZONING LAW SETBACK REQUIREMENTS OF THE t a M1 40B (SUITE 1) TOWN OF BARNSTABLE_______ ___AND THAT ; ,:;r'a. INDUSTRY ROAD IT DOES_ NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD , ARSTONS MILLS, MA 02648 AREA AS SHOWN ON THE' H.U.D. MAP DATED a/-J9.�05 _ ',�` 'r;,�:✓N`- / TEL: 428-0055 C mmunit -Panel 250001 0015 Cog " FAX 420-5553 �� �[� _ THIS PLAN NOT MADE FROM AN IN SURVEY 2712E DPC ME ITHEW LS -------- NOT TO BE USED FOR FENCES BUILDING PERMITS ETC. - �� �r,- e � � u " � � d ' , - e �, p i a• 028251AFP BuyLine 8023CR) MEMSTAW A rm -ac, o�'a-' - 12 , . s Color+=Ch'atn: Liftk -Fel �'nl' ce Transport M r Chain Lin' k 'Ga' ies mg`j' �. - ✓"Yn YTw�.hf y v��,4 '®®�1'QP� ••$�' t( -fir:; -�.� .� - ��� �a��a�.,.1���' �t` i r.�� - - • • + � , ..,4,y �ww.►�was� : �]�• '�si C 0 •• ? � �� ,�j +�d,i. ,a�'�+ �•�•r����r , ox �.�� +4�� + f AEMA 00 or � Lc ® ME �.���mom"���� ����� ��y♦ jaywe N +INKA* +�'�++' r4 ,,. ON AR IWO, f ti' IV,0A1 University'of North Carolina Greensboro,NC ' Maintenance-Fre;e P.ermacoatO Finish, Over Galvanized�High. Strength Steel: net www.ameristarfence: d - --� Town of Barnstable oFWE r Regulatory Services BAMSTABLF. y MAS& Thomas F.Geiler,Director Evi a ,0 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 Check One:. ❑Shed ❑Deck Upool ❑Porch ❑Gazebo FO L APPLICATIONS: Determine map and parcel number and enter it on application. (This information maybe obtained from the gineering or Building Dept.) Completed Building Permit Application Approval/sign-offs are required and can be obtained at 200 Main Street: [Historic District Commission Old King's Highway Historic District(North of Route 6) NHyannis Main St. Waterfront Historic District(see map for boundaries) ❑Historic Preservation(if applicable) r alth Department Hours are: 8:00-9:30 AM or 3:30—4:30 PM ❑Co servation Commission Hours are: 8:00-9:30 AM or 3:30—4:30 PM x Collector Treasurer Homeowner License Exemption Form (if homeowner is acting as general contractoribuilder for project) or y of Construction Supervisor's License must be submitted(except for in-ground pools) orker's Compensation Insurance Affidavit must be submitted. Copy of Insurance Compliance Ce icate must be on file. e Improvement Contractor Affidavit must be submitted (residential only). I'll,Jit�t�s 1Ji>�eusg-(Tdii�lil it;ab� -P er caner Letter of Permission. ❑ A NON-REFUNDABLE Application fee is due upon receipt of application number ❑ Permit fee. SH /DECKS/OPEN PORCHES/GAZEBOS: a lot Plan or mortgage survey required to verify zoning compliance. Placement of proposed structure must be sketched in and the distance from property lines indicated. The location of the septic system should also be shown. ❑Two (2) sets of plans (8 1/2"x 11" or 8 1/2"x 14) showing cross section and framing schedule. ❑Prefab sheds require factory brochures & specifications. ❑Prefab sheds require a copy of the Home Improvement Specialist's License unless the homeowner is -'applying for the permit in their own name.- , OLS(250 sq.'ft.and over or 2' deep or deeper require a building permit) Plot Plan or mortgage survey showing the proposed location of pool and the distance from property lines. Plans must also show location of backwash pits if applicable. Instruction Drawings or Factory Brochure & specifications. Show placement of fence, list description of fence and materials used. Q:bldg/wpfiles/forms:shed-deck Rev:052306 • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Q^ U� Application# Health Division Conservation Division �� ' Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Ap Planning Board Historic-OKH /1 Preservation/HyannisOK S Project Street Address LJ�,S G S LA) Village W Ba-"S/4� ( Owner�AM�� JO,SUk. /� �/� Address �6 ,6614 A/ Telephone 0 �� 3 Permit Request 14574- // 4 1 e'Y- 31,' /A1040 0CA) ,57,e L Gtl�l�, (J/^1VI Gwr -suLr--- w6s; c r Doc)g /y ,9-e_,4;lir,-7 e,-- Square feet: 1st floor:existing C(3 6 proposed b 2nd floor:existing �.3y 0 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiof 000 Construction Type STeeL W 4l1, vhYL LfN0 Lot Size q Grandfathered: Cl 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: j '1'es ❑No Basement Type: Full ❑Crawl ❑Walkout ❑Other Baser,Aent 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 3 ) Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes i No Fireplaces: Existing _� New Existing wood/coal stove: Z(D Yes, to Detached garage:O existing ❑new size Pool:❑existing ❑new size Barn:O-existing O new:size Attached garage: existing O new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Co Commercial U Yes ❑No If yes, site plan review# _ Current Use Proposed Use BUILDER INFORMATION Name Plc JE/(I Telephone Number 509 .3ba ' 9 27p I Address 3 q!3 M41A) j 7" License# b O g& 3.5 Home Improvement Contractor# /06009 Worker's Compensation# AIAIC 760557 5_012O5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9-3a—0 6 FOR OFFICIAL USE ONLY . PERMIT NO. DATE ISSUED t MAP/PARCEL NO. ADDRESS, VILLAGE 'OWNER ',DATE OF INSPECTION: FOUNDATION LI)6 FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS- ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i ! ASSOCIATION PLAN NO. is OPEN SPA CE PP-op'0-5' ti !8 36 ' pooLs 1�5 4 Fr-c tI.J�( /�,ct r o c 00e- , c� 9 boob ro Be- o9Ca24eo, ���� To �S�cLoSrcJa LOT T , SePl7c OUT' ti6 o = -.#40:- . LOT ��" �S7g19 33 � � ENT� Leg 4.46 DESIRES LANE RES. ZONE.• "RF" ;AN This MORTGAGE INSPECTION Bank lUse�only FLOOD ZONE, "C" CE$ AND EA$ E PUN-SHOum BE BY - REGISTRY OWNER: E TZPATRICIf I�oME BLDG CO_,_INc __ DEED REF: _�2043/�84 __ BUYER: _ 0,FEP_I-L_� J� ' 'T�_ AINFd?�_________ DATE: _ �7��9 PLAN REF:-54�27________SCALE:1 - I HEREBY CERTIFY TO �O 50' FT. -------------------THAT THE BUILDING ��} YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ __ CONFORM TO THE ZONING LAW SETBACK REQUIREMENTS OF THE �'`•`� 40B (SUITE 1) TOWN OF __ BARNS�ABLE__ ='i AND THAT ==' �:-° INDUSTRY ROAD IT DOES NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD '' :a`` 'h TONS MILLS, MA 02648 AREA AS SHOWN ON THE- R U.D. MAP DATEDB� _ �'� � C mmunit -Panel 250001 0015 C \, r•,.•�.. �..,<; _;' ., TEL 428-0055 •f.•. - FAX 420-5553 --- THIS PLAN NOT MADE FROM AN IN SURVEY ., __ �--- Town of Barnstable Regulatory Services snruvsznBtE. ' Thomas F.Geiler,Director t�sass. 9 4 16;9 �0 39. 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 Permit no.vo. Date —30 —01 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. c , Type of Work: v W�lK 10 R Pool Estimated Cost cA—J/ Address of Work: C �Q e S �^ Owner's Name: �.1 f f 1� N�*r / Date of Application: ^3 0 — C) I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building 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 UNDE PEN TIES OF PERJURY . I hereby apply for a permit as the l:of the 9-3a -- off 106 00 Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpfiles.forms:homeaffi d av Rev: 060606 r RESIDENTIAL: SHEDS -POOLS—DECKS-OPEN PORCHES-GAZEBOS FEE VALUE WORKSHEET APPLICATION FEE: $50.00 BUILDING PERMIT FEES: Oj 5-0 ACCESSORY STRUCTURES >120 sq.ft.(Sheds,gazebos,etc.) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $ >750 sf-1000 sf 75.00 $ >1000 sf-1500 sf ' 100.00 $ >1500 sf USE NEW BUILDING PERMT APPLICATION DECKS x$30.00= $ (Number) pORCEEES (Number) IN GROUND SWIMMING POOL $60.00 $ 60 �d .ABOYE GROUND S_yynYII12ING POOL $25.00 . RELOCATION/MOVING $150.00 $ (plus above fee if applicable) • REKNIT FEE���_---/—�_ ""'� Q:forms:dkcost P,Ey:063004 The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations: ' a 600 Washington Street s` Boston,MA 02111' �•' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organi7.ation/Individual): pie 4,04iesk i , Address: 3gl3 m4 nl ST City/State/Zip: --f 3&?J5TAe,* Phone#: ,50(? - 36,� - 9 7 7 9 Are you an employer? Check the-appropriate box:. Type of project(required):- 1.t I am a employer with / . . 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7. ❑ g ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.❑ Electrical repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL ME] PIumbing repairs or additions myself. [No workers' cony. c. 152,§1(4),and we have no. 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other SWln,at 1 n/4 1000 L 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. lContractws that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'cow.policy information I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. / Insurance-Company Name:r10/CQ �IJ�(J /iQS O �•Ij `til 11fiU4-�— f�S C y Policy#or Self-ins.Lie..#: fiW� 7� j 57���DOS ' Expiration Date: 0®6 Job Site Address: 7 005IQe 'S 441 City/State/Zip: ��� �� y!�/� �a64w 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. 15.2 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 ce unde 4e &ns and penalties of perjury that the information provided above is true and correct t� Si�natnre.. Date• Phone#: . 3 6a — .g 7 7.07 Official use only. Do not write in this area,to be completed by city or town offices City or Town: Permit/License# Issuing Authority(circle one): I.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."au individual,.partnersIR,;assoeiation, 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 e the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwellling 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 L(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-libenses..Anew 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-Washingfon-Street Boston,MA 0211 L. Tel. #617-7-27-4900 ext 406 or-1,877-MASSAFE Fax#617-7274749 Revised 5-26-05 wwwmass.gov/dia i °F.WKWE ro Town of Barnstable Regulatory Services yRAMM ssBi'E'� Thomas F.Geiler,Director 0 39. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, l , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: 40 2 (Address of Job) U Z1661K Signature of Owner Date .�J IUel Print Name QTORMS:OWNERPERMISSION OW NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7005575012005 11/17/2005 - 11/17/2006 POLICY NUMBER EFFECTIVE DATES PO Box 1013 United Insurance Agency Inc Buzzards Bay, MA 02532 (508)759-6595 NAME OF INSURANCE AGENT ADDRESS PHONE Richard T Senoski 3413 Main Street Barnstable, MA 02630-1234 EMPLOYER ADDRESS 09/21/2005 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in-accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER )/.e L/047UIJ20.....11lUL Oy✓ dQ.!,/LfIJeGY.tt Board of Building Regulatiots and Standards License or registration valid for individul use only - = HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i _ - Board of Building Regulations and Standards ! Registration: 106009 One Ashburton Place Rm 1301 j Explratlon:. 7/21/2008 Boston,Ma.02108 Type_:`Individual RICHARD T.SENOSKI ! Richard Senoski 3413 MAIN ST. ':...' �. Q-°.w� - —••--- - -----_._.__.._.. ! Not valid without signature BARNSTABLE,MA 02630 '- Deputy Administrator i O �., L 1 y.. i.v i" Application to ®[bing'Ir� ig�jbuap 3aegional*iotoric Iniotrict Committee In the Town of Barnstable p� Y 1 • 1 CERTIFICATE OF APPROPRIATENESS / Application is hereby made,with four complete sets,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: i. Exterior building construction: ❑ New ❑ Addition ❑ Alteration Indicate type of building: ❑ House ❑ Garage' ❑ Commercial ❑ Other ` ems.. 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Re nting Existing Sign / I 4. Structure: � Fence ❑ Wail ❑ Flagpole Other IYl q rQ TYPE OR PRINT LEGIBLYt DATE4 ADDRESS OF PROPOSED WORK, 410 pes"'GS Imo/�G ASSESSOR'S MAP NO. OWNER ke k1 P1 e y ASSESSOR'S LOT NO. Q� HOME ADDRESS" U YES a y L N' W TELEPHONE NO. -TV�� 37S 4�3� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) avian Sou-soot 0�s _ psi Ye `GI r /-e— AGENT OR CONTRACTOR TELEPHONE NO. ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done,including materials to be used. Please include locations of proposed signs. /8">( 3(p 1 P1 q j? W h"2,C Jew Signed ntractor gent For Committee Use Only ff`` This Certificate is hereb U e-,� t , C r i� ��� I PProv IDeni r-- 1[Committee Members' 9 t s. JUN 0 2 2005 i HIS-i ORiC, PRE SERVA i ION i JY ' 77 i6a7 m OVb.O. i o 121l i=�1 N I, ���dd_p 1 0 m LNI .tt 1 Y� '• � `� Q � NI om _ s W . LI jf.v .i S I N d Q� � N I f �O- —___ 1V _ P V, 7 CO $ w � I . , 0 8 N �N � _r s ��, dh s is •� F Yl �� N N �� � eQ �N, -�� O N � � ��� ■ -�- - w . d ` QW I low qqLr o n CO W a a - I � � was Ila or ^N� r.-' H � $ • IV� �I�S *1L �N �O� N� ��W�ri�� �� �� Lm Z CO �y�I Sq l y 8Q CQ O / ° � �o � r r� (noW� �8 �G — kl �iqw — m ni Inrwr 01 k I� u 2 s s e7 1191 all „3 Classic and Contemporary m s ial Series Details R -- � , as — ----_— tNY POOL oo►1ruN 1 y -..a , eueurna. Of Wadi Mad-Whui►Now York-12110 -le a-756-1 a00 ' w 0 a I I :� ►- r ��.. Cr O 8 Bwl I 0 z zW N0 ..� Yam.;`yfr' 7 b O I J N ly�l � 'O I ,p O R w A `;' h O Lmy N hyy. N yJr I> ( YF11J 5� Y �Sa y i o 0. Cr < 8 �♦ SETTS b, � h a I p 0 L g �6 •J O g rr QQ � I F I u ��'a- ( ► O �P ' ♦ I �, U) ' -J rn Nq�gEED N I mZ d= - �j7J�x N t i5 4 t7 W7S9L 7 W 's-.°.r tip, �v 'J., � a F- o�d � p ,t m0Jd_WIN �N _S LO CC tho in mg ca w. I . 8 i o WN �Vf i c35 I , N lei e • _1 C — q .Y YK•0i d �m r�a� Classic and.Contemporary �S Serle.s Details THE POOL COM ANY ' 1 -7 o.0 ouc n.nox'� 03 Made Road•Latham,New York •11110'•(010);'i 1100 f TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 000 000 138 GEOBASE ID ADDRESS 40 DESIRE'S LANE PHONE WEST BARNSTABLE ZIP - LOT 1 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT. PERMIT 39138 DESCRIPTION SINGLE FAMILY DWELLING (BLDG PERMIT #36764) PERMIT .TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: , NE ., $.00 OkT CONSTRUCTION COSTS $.00 753 MISC_ NOT CODED ELSEWHERE 1 PRIVATE P '(* SET ; * BARNSI'ABM • MAS& BUI ' IN VI IO B -• ---- --DATE- ISSUED- 06/15/1999 EXPIRATION- DATE t r -'j. BU PERMIT PARGFT, -Ii) 000 000 138 GEC}BA431C f ADDRESS 40 DESIRE'S LANE PHONE WEST BARNSTABLE ip WT I BLOCK LOT S 14, DBA DEVELOPRENT DISTRICT PEMAI`t' 3B764 DESSC.'RIPTION "-'6-X33'EULC!A2E/10X.14MUD/'22X` 2GAR.1)EGK(SEt."W998I PE1:MIT' TYPE BUILD `I'ITLF NEW ItgS_rLENTIAL BLDG PM`I.' GONTRt3CMRS. FIT?CATRICK 110MEBUILDING CO. , IN11:. Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $403.00 BOND- $.00 CONSTRUCTION COSTS $130,000 00 1 . SINGLE FAM HOME DETACH9D 1 PRIVATH P * BARNSTABLE, • 1� MASS. 039. A�O� . ED M�► BUILDING,DIVISION BY DATE ISSUED 02/26/1999 FXPI:RAhON DATE � THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED. FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLE'POST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 fi AL 00, Id 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT /�A� GDS ro 2 �e BOARD OF HEALTH OTHER: SITE PYAN REVIEW APPROVAL WORK.SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- E ONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX N BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE P_ERMIT,.IS.ISSUED AS NE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. �' ' _ ;j I ` I , I • I I I • I I • I i I r BUILDI. NG PERMIT I I ' I I I I - I I I - I I I I I MAScheck COMPLIANCE REPORT Massachsetts Energy Code ; Permit # MASch°eck Software Version 2.0 Ylb Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-25-1999 DATE OF PLANS: 1/22/99 TITLE: lot. 4- 1 Desires-, Lane West Barnstable MA.- PROJECT INFORMATION: Kennedy COMPANY INFORMATION: Fitzpatrick Home Building Co. Inc . COMPLIANCE: PASSES Required UA = 385 Your Home = 361 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1288 30. 0 0 . 0 45 WALLS: Wood Frame, 16" O.C. 2050 13 . 0 3 . 0 146 GLAZING: Windows or Doors 209 0. 400 84 DOORS 100 0 . 350 35 FLOORS: Over Unconditioned Space 1076 19. 0 51 ------------------------------=----------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans , specifications , and other calculations submitted with the permit application. The proposed building has been designed. to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J .4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheA Software Version 2 . 0 lot ,# 1 Desires Lane West Barnstable MA. DATE: 1-25-1999 Bldg. ; Dept . ; Use CEILINGS: [ ] ; 1 . R-30 Comments/Location WALLS: [ l i 1 . Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] ; 1 . U-value: 0. 40 For windows without labeled U-values , describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] ; 1 . U-value: 0 . 35 Comments/Location FLOORS: ( ] ; 1 . Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ J ; Joints , penetrations , and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] ; Requi-red on the warm-in-winter side of all non-vented framed ceilings , walls , and floors . MATERIALS IDENTIFICATION: [ l Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] ; Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8. 0. DUCT CONSTRUCTION: [ ] ; All ducts must be sealed with- mastic and fibrous backing tape. -system tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air .and water systems . TEMPERATURE CONTROLS: [ ] ; Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ) ''Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS: [ ] ; Refer to 780 CMR, Appendix J for requirements relating to swimming pools , HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only)------------------------- Pies--- eJ P Engineering Dept. (3rd floor) Map Parcel "Permit# 3� House# '+��C5 �e�� € ' Z Board of Health(3rd floor)(8:15 -9:30/1:00- ff)rn ��� FeW ED IAI 01 5JSd V vim,}� �� Conservation Office (4th floor)(8:30-9:30/1:00-2:00) 1,� ��®I!! �Ta�5 (.� 1-0 ��NTAL Planning Dept. (1st floor/School Admin. Bldg.) RAP Definitive Plan Approved by Planni Board /19NSTA Q T QQ /t!S F t ` — 99V Ce!c: BA MASS.LE. WN OF BARNSTABLE ,�F °'EVNu►+"�� �G$ �L Building Permit Application Project Street Address a 7' / — Village �' /t _ Owner atitr. Address Ad Telephone 0 Permit Request Cell �( 1' C D v First Floor_ square feet Second Floor square feet Construction Type u -e Estimated Project Cost $ SO, l/Uv Zoning District 7 Flood Plain Water Protection Lot Size �U Grandfathered P Yes ❑No Dwelling Type: Single Family f ' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes )ZI No On Old King's Highway N11Yes ❑No Basement Type: WFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /D- Number of Baths: Full: Existing New Q� Half: Existing New No. of Bedrooms: Existing New - -3 1/ Total Room Count(not including baths): Existing r New First Floor Room Count Heat Type and Fuel: )6Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove ❑Yes No Garage: ❑Detached(size) \\ Other Detached Structures: ❑Pool(size) Attached(size) c ❑Barn(size) None ❑Shed(size) ❑Other(size) oard of Ap ea zat ❑ Appeal# Recorded❑ Commercial ❑Yes KNo If yes, site plan review# Current Use �,Q�1� Proposed Use / - Builder Information Name — r<<� /V/0,1,-ia w oJr7k Telephone Numberd' Address /��, rL 4) /Yy p License# �y b Home Improvement Contractor# Worker's Compensation# b)c(,1-7604 of 1 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ff 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��itc✓C.✓l�L, SIGNATURE DATE BUILDING PERMIT DENIED FO THE FO LOWING REASON(S) 76 - 1 FOR OFFICIAL USE ONLY .PERMIT NO. . DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF•INSPECTION: ' FOUNDATION FRAME - ���j� INSULATION. 4,IREPLACE,. ELECTRICAL: ' ROUGH FINAL PLUMBING: ROUGH FINAL GAS- ROUGH FINAL FINAL'BUILDING -DATE CLOSED OUT ASSOCIATION PLAN NO. ' i Illlllllllll SIRI ■ • • ' I�IIIII�II a HE li: 1�11� ■. ■� • t I � IIIIIIIIIIIN a� Illillfiii��� �ZV.i % k, I i :II,I i ■■■Y� r•;�ar. �Illlll�yillll °°" E ; o � I � ■■ ■■ Imo: y low LE J 10MIMIM1111 ,� i 41 If .1 ts 71. IL 73 �� ` rAIM I t J 1. 0� I s c •. - ,= � 'i 1. ' 'I , g 6 I ' I I III . i JI ,� 1 I Y � ' • I - f�l y I! � I � i .09 .41:70 .o mans r'ON 10700 a°0��31si��d dj N�1�Q�� �D 69SEE'oN NHo���� �7�6�SNa'f/� 7�O / ,,4fi2l- -�/V -5A' fk 7AV 17//78-5r, Jo Nl�d'' �N/NOZ :�;;,/`/1 �O S1/Y3l��a'/T�ch-3� . Jf� s'L 01 /1/b 7e/ 1Va1-ZAVri//ham O�/�/1d9J sly �NOJ T 'ON 107 NO 1b/11 1<=I/1d9,2 s bla i 107 \ 0 09* ,y0 ° ,pry Noy ; o �n..,.,.•vv-..�...r.y.r.-.,as..sa,�,.,,:n"�i�."+i':�.rrtl-�a^�.fs.;•.. .x.,';..+1�.s;w-..'^.a- -.i,s- - - A-'-..+s•..'o+wn�;a�4..713�?K�'4T•Ei..�:331p�1r:LMs6it;y...^.r .,r_.. �._ r- ..,1 i ��• row The Town of Barnstable BARM Department of Health Safety and Environmental Services 039. .0� Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 - Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection „ Location �;� p�N Permit Number Owner ' 0�PA-T L, ,,f- Builder f' ,fW K-t--C, V One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: , �. FEZ - . 1 P`5, It 1 IS U , L-0 up 1 A-rolk:;F (0 rc_ &A"t'a\J� 0 l Please call: 508-790-6227 for re-inspection. Inspected by - Date i �� �;; ��:�_ ,, :� r The Commonwealth of Massachusetts • �ij =• Department of Industrial Accidents -y Office 9"11yesdg-H&CHS 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit 01 name: /e_ h a <. location city tS'-t' }-��t/l S�t-��, phone ❑ I am a homeowner performing all work myself. ❑ I am a sole roprietor and have no one working in any ca acity %%/%/%/%% /%%%////t Vz zzO% ❑ I am an employer providing workers' compensation for my employees working on this job. com nnv name: address• city phone#- insurance cn. POUCV0 ///// /%////////////////%/////////////%/%/////////////////////////ri///%//////////////////////////////,%a/%////////////%/////////////%////////////////////////////% /////////////%//////%/////////////////// ❑ I am a sole proprietor, general contractor. or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: tom anv name: e v . :.: .......... :.. ::.:::..:.:::::::::.:....... . addre+_ s D�uk city t^rS"fi e lr phone#•. �I�d'Y :..:;..: .:: . . > ^d . ; insurnnce cn. ZZ olicv# C d :.. . .... cam anv name: ..... ... address: :..:, ... city- - ftone#r insurance co- Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as weft as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herebv certify under t pains and penalties of perjury that the information provided above is tru,-and correct Signature Date Priest name � Phone# � ' ��• official use only do not write in this area to be completed by city or town official city or town: permit/license# QBtdlding DD�OfM�ce QLicensing Board ❑checiciflmmediafs response is required ❑Selectmen❑Health Decontact person• phone#• ❑Other (tevum*95.FIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 thelegal 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with,a certificate of insurance as all affidavits 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. City or Towns 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 peraiit/license number which will be used as a reference'number. The affidavits may be retuch d io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 InvestlgauOns , ,4 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 6 6 v b u 6 6 f 6 Western Surety , 7 , 0 LICENSE AND PERMIT BOND For County,City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, ; 6 Performance,Maintenance,Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond. il D u KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P-4 2 9 2 9 2 8 0., ' D u That we, Fitzpatrick Home Building , Inc . G of the Village of. Forestdale , State of Massachusetts , as Principal, U and WESTERN SURETY COMPANY, a corporation duly licensed to do business in the State of Massachusetts -, as Surety, are held and firmly bound unto the Town of Barnstable , State of Massachusetts , Obligee,in the amount (Valid only when a County,City,Town or Village is named as Obligee) of Two Hundred Ten & 00/ 100-------------------- DOLLARS ($ 210. 00 ) r (NOT VALID FOR MORE THAN$25,000) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives,jointly and severally. THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has been licensed to construct a single family dwelling at Lot 1 Desires Lane West Barnstable , MA 02668 5-2 . 5 feet frontage by the Obligee. N FORE, if the Principal shall faithfully perform the duties and comply with the laws and orc ` i ° all amendments), pertaining to the license or permit, then this obligation to be void, o seQt®�e n full force and effect for a period commencing on .the 15 t h day of January 19 9 9 , and ending on the 15 t h day January 2 0 0 0 , unless renewed by continuation certificate. .juc�rayrminated at any time by the Surety upon sending notice in writing to the Obligee and to t c1ni, I� the Obligee or at such other address as the Surety deems reasonable, and at the expira- tio days from the mailing of notice or as soon thereafter as permitted by applicable law, which`i4i+e £a, '``�this bond shall terminate and the Surety shall be relieved from any liability for any subsequent acts or omissions of the Principal. Dated this 15 t h day of J a n u a r 1999 Principal G Principal Countersigned WE5 ERN S E T Y C O A N Y 6 By Resident ent By President G ACKNO EDGMENT OF SURETY, STATE OF SOUTH DAKOTA 1 ss (Corporate Officer) - o D f County of Minnehaha G On this day of ,before me,the undersigned officer,personally appeared Stephen T.Pate ,who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing instrument for the purpose therein contained,by signing the name of the corpor ' n by himself as such officer. ; -IN WITNESS WHEREOF, I have hereunto set my hand and official se ; G 9 r J. RHONE s 6 6 r �1 NOTARY PUBLIC �� f s$"n SOUTH DAKOTA S� :s otary Public, South Dakota ; My Commission Expires 6-12-2004 f Western Surety Company • 101 S. Phillips Ave. r I D Form 849-A—12.97 ''0' '�'��''�'`'` '��'+ Sioux Falls, SD 57104 • 1-605-336-0850 F ° e F U ACKNOWLEDGMENT OF PRINCIPAL (Individual or Partners) STATE OF ss County of ° a f On this day of ,before me personally appeared n f ' f ° F ° T a ° a ° f F ° known to me to be the individual_ described in and who executed the foregoing instrument and F f acknowledged to me that_he_executed the same. My commission expires :f. f Notary Public r ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) t STATE OF � ss County of On this day of ,before me, personally appeared , who acknowledged himself to be the of , a corporation, and that he as such officer being authorized so to do, executed the foregoing instrument for the pur- poses therein contained by signing the name of the corporation by himself as such officer. r My commission expires •4 Notary Public 1 ' 7 F F F � F , P ! F E ° r t" 1 ° •Q W Cd e F lvJ P+1 � 0 P . z 4-4 O z Z a n IU�I 0 O W ° n a a a 4 w b a a [ ' =1 III' I�IIID i i � i ni��n�%lf III' f:,fe.. ■cif■■' �� Im alms K�f��� r,s..4 �r m�sr� ' 0� R� HIM I�IQIII� IN .■ .■ ■e i - .■ on ME � I�1(��III �■ ■■ � .■ �■ 1,�1 I�� .11 ', Ili hI In ! �■ ■■' j INN IIUIII�IIII � '. III-I-MII I ' t1 1. g.. `. J 1 03 Al� E t t IN1 L , III - .; . � � ( i IIII ICI ilfl lI I ( i ill I J1 ,I t " II - , .- • .. 111 • � - .. -,-i � 4 Ali _ N j - Wv N rlu It ly-- l I t a � Q 1 2 tt •� " r 3 �+ g a I . 12'_P •�_ � I i J`U[ L I " � x d• 'q � Application to �/ 2 V4 3 Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id 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: [Z 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 W ADDRESS OF PROPOSED WORK ,�� L -*9nl!�j B&'fl) ASSESSORS MAP NO. 8 S' OWNER�1 T Z P t�k �io✓1'1 E�y (2D �C-' ASSESSORS LOT NO. HOME ADDRESS -Q , J.- TEL. NO.,-�adg-888.4-36 7, pZ[o4 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). v o I try 4- Mar L-4 \/\/,o I t� J✓T S;i Rd S L rd► ` �a(�O ��au.� C°ol(P2 r1Tev 1 7Es,�2Es LW , �(. 12xmn 1e,. oa(o0,8' t� N AGENT OR CONTRACTOR - 'di m- TEL. NO. �g9) .3a7S ADDRES 'U ' 0�► l���"O C-2 0- I Y1� no�0�� �` 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). oDo D d a Signe Owne ntractor-Agent Space below line for Committee use. ,�f�l j� 11 .� � �•�j Dat`N77Certificate is hereby :j t i� ;,{iLWww 1�1 k i 2A )cir-18 i �) Tim ff -217 - - _ - Approved ❑ IMPORTANT: If ificate is a /oved,rpproval is subject to the 10 day appeal period provided in the Act. Town of Barnstable ' Old King's Highway Historic District Committee SPEC SHEET FOUNDATIONN'�C« SIDING TYPE COLOR CHIMNEY TYPE---} r,C COL R ROOF ^MATERIAL f�S �/��7 ��COLOR /v PITCH y WINDOWS 6Zk1d4g4enL COLOR Va SIZE TRIM COLOR DOORS_�-�Q� _� COLORS ` SHUTTERS COLORS — GUTTERS COLORS DECKS x MATERIALS r GARAGE DOORS 9 Z-9ta-z COLORS SKYLIGHTS. SIZE COLORS r. SIGNS COLORS FENCE COLOR NOTES: Pill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11198 : The Town of Barnstable - Department of Health, Safety and Environmental Services EDAl1A'�� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner January 27, 1999 Mr. Michael Fitzpatrick Fitzpatrick Homebuilding Co., Inc. PO Box 154 Forestdale, MA 02644 Re: Lots 1 2, 3, & 4`Desires Lane; W. Barnstable This letter will acknowledge that Lots 1, 2, 3, &4 on the attached plan are buildable lots from a zoning perspective. Sincerely, Ralph M. Crossen Building Commissioner RMC/Ibn g990127a i 1� C 11, OEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: '_ '_ Expires: " -- Restricted lo: 00 NICHAEL T, FITZPATRICK PO BOX 154 FORESTOALE, MA 02644 d Town of Barnstable-Planning Department a Old King's Highway Historic District Committee MEMORANDUM TO: Building Commissioner FROM: Gwendolyn Brown, OKH Secretary DATE: April 8, 1999 SUBJ: Modification to Prior Approved Plan A minor modification has been approved by the OKH Committee to a prior approved plan for the applicant (s) named below. The modification is briefly summarized and I have attached backup material for your records . Applicant (s) Janet Kennedy for (Fitzpatrick Home Building Co Inc) Address of proposed Work dot 1 Desire's Lane West Barnstable Assessor' s Map & Parcel## 088-008.001 Meeting Date Approved by OKH December 16, 1998 Minor Modification to change from Cedar Clapboard to Natural Cedar Shingles Chairman � ^ 7 — � � Date If you should have any questions, please do not hesitate to contact me at ext . 862-4684 . IEMOBC 49" ATTENTION GWEN BROWN, I WOULD LIKE TO REQUEST AN INFORMAL DISCUSSION ON APRIL 7TH. WE ARE INTERESTED IN CHANGING THE FRONT EXTERIOR OF OUR HOUSE THAT IS UNDER CONSTRUCTION,FROM CEDAR CLAPBOARD TO NATURAL CEDAR SHINGLES. WE ARE WORKING WITH THE FITZPATRICK BUILDING CO. THE PROPERTY IS LOCATED AT LOT 1,DESIRES LANE,WEST BARNSTABLE. THANK YOU, JANET L.KENNEDY 398-4748 Application to r� 998 292 Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id 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: 9 New Building ❑ Addition ❑ Alteration Indicate type of building: q 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 ADDRESS OF PROPOSED WORK 12,4—*5 r9/tJ E ASSESSORS MAP NO.S 8 y�!CST /eitJS OWNE ' L TIC . ASSESSORS LOT NO. HOME.ADDRESS TEL. NO,,�64=90,q —,JQls FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). �� II %t Q P' ' 1 i►l1.� AGENT OR CONTRALTO O TEL. NO`: -29 75 ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,otherttWe), iridluding cl materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs'and proposed i locations of new signs. (Attach additional sheet, if necessary). `. . 1 P1 ,PIP f' 1 !' La 11 rJu Signed er-Contractor-Agent ._ S ce below line for Committee use. .' e "ITFiq'Certificate. ereby ��y/P.r�� Date NOV2 4 , d 1`time ? .......... > i a. BAl Y'. Approved ❑ IMPORTANT: If Certificat s approved,approval is subject to the 10 day appeal period provided in the Act. i The Town of Barnstable .saris AMF "� �e� Department of Health, Safety and Environmental Services % Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner January 27, 1999 S �J �b Mr. Michael Fitzpatrick Fitzpatrick Homebuilding Co.,Inc. PO Box 154 Forestdale, MA 02644 LAD Re: Lots 1, 2, 3, 4 Desires L e, W. Barnstable This letter will acknowledge that Lots 1, 2, 3, & 4 on the attached plan are buildable lots from a zoning perspective. Sincerely, Ralph M. Crossen Building Commissioner RMC/Ibn g990127a JHN-�_15-1999 17:10 REALTY EXECUTIVES iu €503 T47 0851 P.01 -S .+�►i'r �� u�Vi. u�•Zi iin ui iituc uiiVui 1'AA•JVVI lULUiJ! :A "M OF OMRSTABLS PLANIRZNG BOARD FORM 0 RCLEMV of Lm D f 8 VH ER CQVP.IQAN? Barnstable$ M400aehmaettD+ -Decemb�r_1.6- 19 98 The nmdereigAede being an aauthorised agant of the P164ning Board of Barnstable, 1"SMAchnsetts, hereby certifies that the following lots orldtd by TT OTHY HINCKLEY REALTY TRUST IX Securing t e COV'Onant Qdt 9-1k_ l9�8, an recorded rn terns able Dibttiot Aseda, Book 11728 pa e 3 S of Title no., -�-,.•s 9 .,,� 0 for registered an Certificate >Qocnmeatg 1, and shc"m on a plan FOR HA NAH DEFZNI v P - R T BARNSTABLE MASS, PREPARED FOR HAI�INAfl AND HER S..SiERS REALTY TI1iJST" .TU'NE 4 mrtd recaxde W h AS Dee s, Plan Hen 544 I997AUGUST ��. registered in said rand Be0l.atry bintrit, C.P#gg 2�..�,• for released T3rom the vestrictions as t-o $ale and bnilds,r,`g'pecffied)m are hereby said Cpvenant. Said lots Are de6xgnated on said plan as follows: in LOT 1 LOT 2 LOT OT DESIRES LANE and LOT 5 LOT 6 I. CAPES TRAIL PUDDIVISj09#�7 640 AuthorLted Agent A. Roy Fo gren, Ch Planning Board Oman of the Town of Barnstable o»eAi.�ra or mmj;ACLv8%"s ma=stable, leassaahusettar so !9� xso=dl a Then y gptaxad Q o � � P,J air 4nthorised agent of the •Planrifag Bftrd of e Town o a®kncswl gsd,tbe l of Just nt to he the f�s adt and deed of Said PlanaJx% BpdYd� before Mae aA C After Vecording# ret'ulm tog my commission expitess Town of 18"nstable Plaadag Board IM INCIA G• MACM 230 Scutb street NOTAPy pUy3UC 4hunis, Mh 02601 ' �IresDcc i3.? TOTAL P.01 Oil9EbII H 9 i AV Fit X Alin C Ay[ HrOHWAY et Rk i it i 1 Iy Y� 'gyp• aa! • X r..pprp`. � ♦ �G rgr P ♦ ., ,.• r it JOE •is� ri �`�• \�\ e � 4 fl e` � �� tr� ter,' ,�4`♦ ,,,. • •on•Y• C�( � s'� fi _i� � ' _ w S r: a qg 511! Pal p 9 i • �1G �l J GP4 rn �l9 � z-- z� T GODg9 N 4 I SS• N N 35'55'28" E 40.17' i- -i - N V• ,a�5�i ice/ a i ti N 36'10'32" E 47 156.13' Np8'35"E 125 E EASEMENT DETAIL y�. 5g•8 ...... 3l' �o O. LOT 2 41,572tsf 0.95tac v 4,e 40 32 ���� SHAPE FACTOR: 21.99 O • N `O 05' = LOT 1 r' a„ LOT 3 , l l 40,PE ±sfFACTOR: 0.R: 20.c \ SHAPE FACTOR: 20.68 9 46,148tsf 1.06tac SHAPE FACTOR: 17.51 l0• �j do Jpo. 0 tO SHAPE FACTOR COMP. LINE y N 38'13'29" E 262.15' I \ u � N rn �o°',y2.50' o m• as tvLA a rn LOT 4 DESIRES LANE 44,386tsf 1.02tac A J SHAPE FACTOR: 16.97 11 rn 0 6a 00 tp O I � I . - - " � . I .1 , I I .- *___"��"i-'� ., - ... . . . . . ­ .. I I . .- � .. .1., . . . . e ' . � I I , .� ., . -.f� .1".1-�7." ,:. , . - ­', �. i. I. I r., ,----.----� , , :. � I -. .... - I I � . � . -m I I - ., I . I . � . � �, � . -_-i �­-., � 7.:;:;:7 , - I - . .-,` , I - ._- I .. a I � � .I � I .. I , I . : -I .;.1 I., I ..:. . ,-,.. .. I .- . I.. 1., � . . I I I. . - � . . . � .- . . I . . . il . . . '. .. I 11 �, , ..� I : - , . .�:,�' N.�-�::., w : �. I . ­. . . . .�.,.. `,::� ,.6,_. :: , _ - , ­-�­ .. --. . . .I . �. ':_ . . . I I.., I t , . - 1. � . . . . . . - I . . 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