HomeMy WebLinkAbout0067 JENKINS LANE Oidbrd NO. 152113®RA
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Operator
AMPAD 23-021-200 SETS
EFFICIENCYe 23.421-400 SETS CARBONLESS
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Town of Barnstable Permit# V ((V lV
Expires 6 m nths,from issue e
F . PERMIT"Regulatory Services Fee
' Thomas F.Geller,Director
JUL - 2 Z007 Building Division
OF 0
To Perry,CBO, Building Commissioner
}�Lv' °� 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
ap/parcel Number ej�n</in
operty Address K 7 (12.u ..0 3 f�a.�t L✓. r c- ;; /a 5 �� S
}Residential Value of Work 3a,T n bU Minimum fee of$25.00 for work under$6000.00
wner's Name&Address n
ZI' ��s/,h1
ontractor's Name Telephone Number-So 9- ;72 S'-7w�l
:ome Improvement.Contractor License#(if applicable) 519ff3
'onstruction Supervisor's License#(if applicable)
]Workman's Compensation Insurance
Check/one:
am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
asurance Company Name
Workman's Comp.Policy#
:opy of Insurance Compliance Certificate must be on file.
?ermit Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to ,O
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy o the Home Improvem nt C retractors Licens is required.
a -
SIGNATURE:
Q:Forms:expmtrg
Revise061306
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Carbonless g'�.l, adams MC 3818-50 3 PART
PROPOSAL
PROPOSAI:NO
,SHEET NO:':
,50 F / J `_ /e 0 y DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: vb
NAME
ADDRESS^ f.
f
ADDRESS
DATE OF PLANS
T
PHONE NO.- ARCHITECT
�So8 6780 - 7224
We hereby propose to furnish the materials and.perform the labor necessary for the_completion of
p a
e
a
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi-
cations submitted for above work and completed in a substantial workmanlike manner for the sum of
� 9� �__4 A I /c ,O /I�.cao�r�/ f�� Dollars ($� S� )
with payments to be made as follows. f ��U vCO
Respectfully submitted
Any alteration or deviation from above specifications involving extra costs `
will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac-
cidents,or delays beyond our control.
Note—This proposal may be withdrawn I
by us if not accepted within days.
i
j
ACCEPTANCE OF PROPOSAL .
The above prices, specifications and conditions are satisfactory and are hereby accepted. Y utho ed to do the work
as specified. Payments will be made as outlined above.
I
Signatur
Date 0:2 Signature
c s NC381850 PROPO.W
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ADplicaut Information l Please Print Legibly
Name(Business/Organizatiowlndividual): . /
Address: O �. p �✓✓ �/hav t�
City/State/Zip: �0,a D,267 3 Phone.#:
Are you an employer? Check the appropriate bog: -Type of project(required):.
1.❑ I am a employer with 4. I am a general contractor and I
6. ❑New construction .
loyees(full and/or part-time).* have hired the sub-contractors
,gmp2. I am a'sole proprietor or partner- listed on the-attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers'comp.insurance ��•insurance.$
required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11. Plumbin repairs or additions
3.❑ I am a homeowner doing all work ❑ g eP
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' . 13.0 Other
comp. insurance required.] .
*Any applicant that checks box#1 must also tin out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have
employees. If the sub-contractors have employees,they must providt:their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imtprisomnent,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 certify under the pains-and penalties of perjury that t e information provided above is true and correct
Signature: Date:
Phone# t W— 7 — 7,
I
Official use only. Do not write in this area,tb be completed by city or town ociaL
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."
MCTL 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()states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract foz the performance of public work until acceptable evidence of compliance with the in_curance
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-confractor(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 member. 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 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
Dcpartlnent of Industrial Arcidonts
Office of InvestigatiQns
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 11-22-06
www.mass.gov/dia
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Town of Barnstable ermit:
THE T / V
of Regulatory Services D ate:IpIZ.314 I /
Thomas F.Geiler,Director.,BARNSTABLE.g Building Division Fee:
J OD
MASS.
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�iiegy. 61 Tom Perry, Building Commissioner Q
TEn � 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us 'I r
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Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: ✓ d Phone:
Install at �7 kd lvv Village: G�/ ��r',, 446 -x
Map/Parcel: / 0V z—az/ Dater `0 — p —o
—�
Stov o
A. Ne ' /Used C
B. ype: Radiant Y1rculatin
C. Manufacturer: Lab. No.
D. Model No.: (p
Chimney o
A. New istin (If existing,please note date of last cleaning) 3 O
B. Flue 1ze
C. Are other appliances attached to Flue? D
D. Pre-fab Type and Manufacturer dt/
T aso (aeDJnlined
Hearth '
A. Materials: S-to ft C_
B. Sub Floor Construction: o a .v 2_
Installer
Name: G`j1�fPl �'ltg�t, Address: Sty✓►
Phone: P- 7 27 7
Location of Installation:
APPROVED BY:
Please make checks payable to the Town of Barnstable
*This,constitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector
Q;forms:stove
Rev 122801
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TOWN OF BARNSTABLE Permit No. .. 3 39.7•••••
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
01
ouv HYANNIS,MASS.02601 Bond ......X........
CERTIFICATE OF USE AND OCCUPANCY
Issued to Greenbrier Corp. .
Address Lot #10, ' 67 Jenkins Lane
West Barnstable, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT. BE OCCUPIED UNTIL
SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
jDecember 14, 8 9....... .......4. .......
Buildinvnspector
! v
pf TOWN OF BARNSTABLE Permit No. .. 3339.7
BUILDING DEPARTMENT
Cash
TOWN OFFICE BUILDING
t6fq.
HYANNIS,MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Greenbrier Corp.
Address Lot #10, 67 JenAins Lane
lhf st Barnstable, Idass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING•SHALL NOT BE OCCUPIED UNTIL '
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
December 14, 89
... 19................. ...
BuildinVnspector
N
OF BA"RNSTABLE, MASSACHUSETTS BUILDING"""PER'K["
128-004 pf
DATE Novembef 30, 19 M)
APPLICANT OWile3:' ADDRESS L t c-,d L� PERMIT NO. 3 3
-- -)w 4001397
build Dwelling (NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO
(--l-i STORY Single Fzimii,,, NUMBER OF
(TYPE OF IMPROVEMENT) No. DWELLING UNITS
(PROPOSED USE)
AT (LOCATION) Lo: #10, 67 Jenkins Lane, W. Barnstable
(NO.) ZONING RF
(STREET)
DISTRICT—_
BETWEEN
(CROSS STREET) AND
(CROSS STREET)
SUBDIVISION LOT' LOT'
BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTIC
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
REMARKS: g -718 (TYPE)
AREA OR Li
orld
VOLUME 768 sq. ft. ESTIMATED ED COST 4 5 , 000. 00 PERMIT
FEET) FEE 61 . 50
OWNER Grecribaier Corp.
Bo
ADDRESS x 510, rvjilic BUILDING DE PT.
By
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. Th 4.-r*-r-6 WID--l"T 1-0 1,
INSPECTIONS REQUIRED FOR ON JOB AND THIS
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED WHERE APPLICABLE SEPARATE
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PVRMITS ARE REQUIRED FOR
I:Li-CTRCAL. PLUMNG
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE. MECHAN: INSTALS NSTALLB I AND
ATIONS.
2 PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH).
3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS
PLUMBING INSPECTION APPROVALS
� ELECTRICAL INSPECTION APPROVALS
2
2
2
All
3
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HEATING I PECTI APPROVAI NGINI I RING,IIIA'ARIMFNI
OTHER -/y
IN AI 41)()1 111 Al II I
WORK SHALL NOT PROCEED UNTIL THE INSPLC- PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUC-1100
S 0,THS 0_ N IN-:44 I'l IONI;INI IICA I I I ON I I W:(./\I jj)I*.,,I,,.I
TOR HAS APPROVED THE VARIOLIUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THr: ;:iIIIAMGI 1)
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. � lll,.All( 1(Ill IiY 11 1 On 'i'llal if
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�. BUILDING PERMIT N0. 3`3
D'i`
ASSESSORS PARCEL Ir'0• I
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CONTINUATION OF ROAD BOND
The undersigned owner/contractor hereby agree to maintain their
force until the following work items are completed to the road bond in
Engineering Section of the Department of Public works: satisfaction of the
• t� loam and seed shoulders as soon as
weather permits:
v other —(explain)
19?/k'j -3777)
SI" .D /
�` (OivivrR/CONTRACTOR)
(print name )
LG1VEE '';G AUTHORIZATION
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THIS PLAN IS NEITHER INTENDED � �" ISSUEsc.
Ko. o�h o�noN I By
FOR, NOR SHALL IT BE USED FOR AS—BUILT FOUNDATION PLAN—LOT /D
MORTGAGE LOAN PURPOSES. JEn/FciniS L,4u�
���.VS%A9LE, NJA.
An _
i aW 0 Mp �y�+��/�kfL �T4�G-FJ/B2�/pC"y��
I CERTIFY THAT THE FOUNDATION h P"4liL A. `•� o
SHOWN ON THIS PLAN IS LOCA D LEVY `'%
ON THE GRO INDI "I No. 10617 y,
um, 0II 1 & TAGm 1�90CIA'18S QiC
DA REG RED LAND SURVEYO �,r �t��' �` ureu�[a�4 �' us
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l Assessor's offioe (1st floor): (AI rjt!IS' ¢
BE a
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Assessor's map and lot number
.. .
Board of Health Ord floor): e� + •' fO� o"
Sewage Permit number ......�..�. �.. ....................... PARISTAMLE.
e
5�`,y� 7 6
Engineering Department (3rd floor): ���± A o .b
House number ...............................................7..................... TOWNMU�Il441'-9 orav a•�
APPLICATIONS PROCESSED 8:30�-9:30 A.M. and 1:00-.2:00 P,M. only
TOWN. OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION ,FOR PERMIT TO ........ .l.I.t.� ........ ...........................................
TYPE OF. CONSTRUCTION ..................VV 0..�.C��:......
> ,l! ..............................
I
................................ . 'I1V..19..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fo a permit according to the following information: .
Location .,... . .... 6......•{ 1. . ........ .. ....t JQ..a...�'� '���.....................................
ProposedUse ....... ......: ... ............... ..... ............................
Zoning District
Fire District .:..........:.C/
Name of Owner .... .{. .....l. y. .....Address .....:6o-.... ��.�.. ��.�i..(! ........
Nameof Builder .......................... .........................................Address ....................................................................................
Nameof Architect ............. ....................................Address ..........................................................
Number of Rooms ............(�.?..................................................Foundation ........
&&-1 ...... .........
,� �,� ��
Exteiior ....C�� `- k...•,i . .. .... ......... ... ...... ...Roofing .............. : ..... ....: 'C.. .... t. . .... ........
Floors .V.. ..�..../..... . ....... . ........ ......................Interior ............. .......................d
Heating ....!!lJ ...... .....
�........................Plumbing ............� ...647--
Fireplace ......... .....................................................Approximate Cost .... 1. J.�-
...........................................
Definitive Plan Approved by Planning Board _______�a2__�7._--_--_19 97 . Area `......��w�..... .....Xi
Diagram of Lot and Building with Dimensions Fee /
........... ..!..... .. ......... ...
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to-all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........ ...14 �-! . �L .
Construction Supervisor's License .........Cr��l.. ..
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GREENBRIER CORP.
iy
iiNo,..qU.U... Permit for ..... 12L... .........
........Single Family, Dwelling,
..Dwe.l..lin I........
Location ... ....... ..LLLne
West Barnstable
...............................................................................
Owner ....... .... .. .... ..Greenbrier...C rp.,...
... .................
Type of Construction ..Frame............................ .. .... ..
................................................................................
Plot .......... Lot ................................
Permit Granted ....1NPV.e-Mb.er...3.0.......19 89
Date of Inspection ............................:.......
19
Date Completed ..........................P.-.(......19
J
Assessor's offioe Ost floor): itHEt
Assessor's map and lot number .... .....
4........ .Q..�
' Board of Health (3rd floor):
Sewage Permit number ........`....:.....:.:........: ?...........:......:..... t BlH39TSDLE,
�.,
Engineering Department ,(3rd floor): F7 r �o rb
House number 00, 39•
9
0 MAR
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only, f`
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO l' All .-�1� C .....: lN1..! ./!!''1....................................s..................
TYPE OF CONSTRUCTION ..................
. '1Y(.i..19..
TO THE INSPECTOR OF BUILDINGS:
r The undersigned hereby applies for a permit according to the following information:
R
�.. Location ...... ....�.(.../............... .......... -/1- 1.:....y�,�../1..!/�, -/sf(h..`'(.......................................
......
ProposedUse .......... .`-t ....... ...................................................................................................................................
Zoning District .....................................Fire District .......
ofw ...... a� l Name .....Address ...... .. -�
..._ Name of Builder :_....'.............................................................Address
Nameof Architect ............. ".... ....................................Address ..................................................:5.
Number of Rooms ............10..................................................Foundation ......... ... ....� ...?�(....(7- .........
Exterior ....�..� �. vl �...Roofin /.IX ! Q...i✓`�l(Ci
Floors V,• .I... (� � ....................Interior /. ...da
...............................
Heating . .......,VoJ1 ...... ........................Plumbing. .............. ... f
1
Fireplace ........ /T...��1! .1......................................................Approximate Cost .......!. .I ........................................
Definitive Plan Approved by Planning Board _______� ._`-_7._______19 Area '.......1 Al .....:. .. - ,
Diagram of Lot and Building with Dimensions Fee ...............!..n. ........
SUBJECT TO APPROVAL OF BOARD OF HEALTH ; l
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform'•.to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. Si /�
Name .........1.).0:1..
Construction Supervisor's License ............ .!... ...!..... .
GREENBRIER CORP. A=128-004 -11
No Permit for ... ............
Single Famil
Single......................y...Dwelling
....................
Location .Lot...#1.0.f......67 Jenkins...Lane
.... .. .... .....
West Barnstable
...............................................................................
Owner ....Greenbrier....................................Corp.........................
Type of Construction ....F.r.am.e........................... .. .... ..
...............................................................................
Plot ............................ Lot ................................
Permit Granted ....November 30'
............................... .....19 89
Date of Inspection ....................................19
Date Completed ..................... ................19
Assessor's office(1 st Floor): { �`
Assessor's map and lot number
Board of Health(3rd floor):
Sewage Permit number
i_ AHISTADLL i
Engineering Department(3rd floor): !. rus
House number "a 1639,
Definitive Plan Approved by Planning Board 19 y �, o Nix
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only n
TOWN OF BARNSTABLE
BUILDING INSPECTOR ;
APPLICATION FOR PERMIT TO b v t G( � Y c r f
TYPE OF CONSTRUCTION 0 y
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:)
Location C, 7 fiGm k t rNs
j Proposed Use CT A ea°I 2..
�., Zoning District ' ! � Fire District
Name of Owner C►1 a fl es A VO. )),a Address Co 7 :fi�—r��t nos �a,•� �... �l/. 11 At�1 � .
0
Name of Builder Address
i
Name of Architect �` Address /�qq�
Number of Rooms I Foundation PcVft4 C'OV I rrrT
Exterior P Y) Sr r Roofing A S I
J °�
Floors ,�f � Interior �� � &
i
Heating Plumbing
Fireplace Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
j
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y ,
I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Narne���"
Construction Supervisor's License `
MILLIGAN, CHAR.LES A. A=128-004-01-l! a
�. • /��=-ooy,oil .
No 33857 Permit For Build Gara4-e
Single Family Dwelling
Location 67 Jenkins Lane
West Barnstable
Owner. Charles A. Milligan _
Type of Construction Frame r
Plot Lot
Permit Granted July 12, 19 90
Date of Inspection 19
Date Completed 19
j
l •
•
Assessor's office(1st Floor): - TWE c Assessors map andlot number ��� as yai/ SEPTIC SYSTEM MUST BE o`
Board of Health(3rd floor): INSTALLED
aIIN�COMPLIANCE
Sewage Permit number ) �� /l a I`7 7�Z�Q� WITH H ���`E 5
.
Engineering Department(3rd floor): ENVIRONMENTAL CODE AND t DeaNAS& L
rus
House number TOWN REGULATIONS �o �s,o•
Definitive Plan Approved by Planning Board 19 ��r�r
APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2:00 P.M.only
" 'TOWN OF BARNSTABLE
f
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO but I a ff-a r a S, e---
TYPE OF CONSTRUCTION �/✓�
19 �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: 11
Location �� 7 tell,I:f `tns arA F- a r,-n-gAa b ��
I
Proposed Use G-A r'a!_4e_
Zoning District Fire District
e
Name of Owner clia/lpS 4 Address-n 7 Je b.v-& f! (1j.RAnJ�y.
Name of Builder 1 r Address f
Name of Architect Address
Number of Rooms i1 Foundation CVkj coo C re I P
Exterior zt Roofing A S O a
Floors jQdt red Interior yyyyC=1
Heating e — Plumbing
Fireplace Approximate Cost aaa� r�7
Area J /�
Diagram of Lot and Building with Dimensions Fee 0�
fe
S- o h0 -r
c�
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
A
Na
Construction Supervisor's License �G�(
MILLIGAN, CHARLES. A. I
1
No 33857 Permit For BLi_ld Gararra
5
Single Family nwPllinq � .
Location 67 Jenkins Lane
West Barnstable
Owner. - Charles A. Milligan
Type of Construction Frame
Plot Lot
Permit Granted July 12, 19 90
Date of Inspection 19
&aWomoted u 19
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TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please ,print.
DATE 2 — q O :._ ._...
JOB..LOCATION (P S L9 GUI a yr►-r,j� �, I e_
Number _ street addressSection of town
"HOMEOWNER" i1a r1 e5 M, [[(A w. `Ze-? 7 10- z L/ V
Name Home phone Work phone .
PRESENT MAILING ADDRESS Q
0. :<o D
ity/town .
State Llp code
Thd' tUtrentexemption. for "homeowners" was extended to include owner-occupied
dwellings. of six. units or less and to allow such homeowners to engage. an in-
ivi ua ,for hire who does not possess a license; provided that the owner
acts• as' supervisor. (State Building Code Section .
:DEFINITION OF HOMEOWNER:
Person(s-) who owns a parcel of land on which he/she resides or intends to re-
`side; on which there is, or is intended to be, a one to six 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
The undersigned "homeowner" assumes responsibility for compliance with the State
Building Code and other applicable codes, by-laws, 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.`
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cVcfeet," or larger, will be required
to comply with State Building Code Section 127.0, Construction Control .
8
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HOME OWNER'S EXEMPTION
The 'Code state that : "Any Home Owner performing work for wh•Ich a building
permit Is required shall be exempt from the provisions of this section
(SActIon .109.1 .1 - Licensing of Construction Supervisors) ; provided that if a
Home Owner engages a person(s) for hire to do such work, that such Home Owner
shall act as supervisor . "
Many,Home Owners who use this exemption are unaware that they are assuming.
the responsibilities of a supervisor (see Appendix 0, Rules and Regulations
for. Licensing Construction Supervisors, Section 2.15) . . This lack of awareness
often-results In serious problems, particularly when the Home Owner hires
Unlicensed persons. In this case our Board cannot
u:1lltensed person as It would with licensed Supervisor.. The'rHon'etlOwnernac"ting � ►
V,su�ervisor Is ultlmat:ely responsible.
To-ensure that the Home Owner Is fully aware of his/her responsibilities, many
communities require, as part of the permit application, that the Horne Owner
certify that he/she understands the responsibilities of a supervisor . On the
lastpage of this Issue Is a form currently used by several towns. You may
ca.re:�to;amend and adopt such a form/certification for use In your community.
a• 5
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�a Eflgineering Dept. (3rd floor) Map Parcel el Permit# 2-5 4-I 2
House# tla- 7 B Date Issued — -
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) If Fee t TC$y
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 9 �y ��A
Planning Dept.(1st floor/School Admin. Bldg.) �p�� ►+E
Definitive Plan A roved by Planning Board 19 rio ;'. w".--�
RARNSTARLE,
MASS
TOWN OF BARNSTABLE 1
Building Permit Application
treet Address �i P iJe- /0
Village (,J. 1eLq C i-a is (�
Owner ('�s �'Pa�(�_/�`�l yeti Address G 7 `�w,G I 104-
Telephone 7
Permit Request y -mo \ S OR^
First Floor square feet Second Floor square feet
Construction Type 222 e) 7"al We U 1 v► 2r
Estimated Project Cost $ t 2, o -
Zoning District Flood Plain Water Protection
Lot Size S�"� �'�C, Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes QR/No On Old King's Highway ❑Yes [/No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: -Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: 9/pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review# -
Current Use Proposed Use
Builder Information
Name o b� u�--. Lc.�, o`�Sb N Telephone Number 3G Z G2•�
Address Vo t License# 0
(Snn C r 01 e C � 6 Home Improvement Contractor# 10 7 bro
Worker's Compensation# 7 P u Q - 2 0 I ,� Si I - S - ?7
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE L. DATE
BUILDING PER IT DENIED FOR THE FOLLOWING REASON(S)
fl ,�
f FOR OFFICIAL USE ONLY
PERMIT NO.
Ph•
DATE ISSUED
MAP/PARCEL NO. -
ADDRESS - VILLAGE
OWNER .
• r t
DATE OF INSPECTION:
FOUNDATION '
FRAME `
INSULATION
FIREPLACE '
ELECTRICAL: ROUGH FINAL -
PLUMBING: ROUGH FINAL '
GAS: ROUGH FINAL
FINAL$.UILDING 1 I -
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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,.=ar OCT CORNER = \�' ; 4TM x AT MOTOR 13 L T1P1CJ1L WHERE SHOWN 3
a MOTOR � f1�L,
1,3 = Ep FLTER RETURN Q 900 _ RETURN �� 2 �TYPICAL Ar — ►— — ► TYPICAL
Cor�s
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a AT 700 2 SERIES 1 AT9°D
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.� A AT M 3 SERIES AT
a t SERIFS *. .,y„y ? L k 2 IR'ETL FM '
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SAFETY LIME eK `� PER
REPRESFMS 3 PORT ICYL4 1 I ATLY +� r E I ;, r ; 1 FLAT AREAS REPRESENTS., �.
SHADM
FLAT AREA311 " SAFETY LlNEY 4
v REPRE30ff LA
a Y. FLAT AREASHADED
F is y' L y
s SICIAMER REPRf5E1(TS a: 9\
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SIZE SHOWN ALSO MS24'-LW Sl. SLA9>F.AREA a ' STARS AR£ I S10dhER1 r ," STAIRS ARE
Y L_ AWULABLLL 16=3t zw 9JRi AREA s �'CM. OPTIONAL LSUCTION OPTIONAL OR
r stk3s• S.F. 9". AREA a C�d1 SIZE 9"M M-10 MY!W SJr 3LNR ARIA a GAL,CAR MAY BE LOCATED
SRC - 20'114W 000 SP SARI. AREA a 29000 SAL � A�•�r• �,r gq• 3W yf SURF.AREA a Is4 GAL.CAR � AL PO ITION3�r'•Y'FOR
f SUCTION STARS ARE OPTIONAL z1+4a sp sI[ st+v AaFa a s 1 e oo w L wt L——. —— FORM��Ionj7�a prT;.
1] 'A FRAME ASSDABLY OR AWAY BE LOCATED \
TYPICAL WHERE SHOW /ra\ AT POSE ONS'x.'r OR'� • SERIES 800 a 850 INGROUNp SERIES 900& 950 INGROUND 3= 94OWM A`SO 17'"'' �s-""`rr'�"' a�la� GAL-CAp.
,�- AWULAAMA I V t 3r f A{ SF.SLW. AREA a ZS]00 GAL- CAP.
A' %OWN AL".��' SA SUW AREA a GAL.CAP VIC41' 44"..3URR ARLAIL 30100 GAL..CAP.
ada4-171X ' � LF SLR AREA EA ` &AL-L.CAP
P. SERIES 1000 a 1050 �INGROUND
j 20=4{' {6{ fJ. StJRI.AREA L�aAL.CAI. .
17'x3T 51n S.F SURF.AREA 68440_GAL CAP. SOUARi FOCTAGIES AM &MIDWAal SHON)1 ARE APPROwWTE,AM ARE LASED
• _SERIES 700 a 750. INGROUND ON POOL °Eno Sao" $ A � �1
FlLTE]t
I . 1 �� � � =►— ►-- FILTER -1►--- ►- - -►--� — —► —`
AT OCZ rR£TLii11 r 2 TYPICAL AT
2 CORNER 2 I 1 CORNERS RET®ULN t p?r a w"vR z 1�
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I z MOTOR AETA PERMANENTLY
F :zy d MOTORPLINP
J :< ? PERMANENTLY .� a . `� � �� AT 600
t e ' ATTACHEDZK
PERSIWENTLY z �� 2 io SERIES
3 SAFETY LrNE f `�M �6 F SAFETY LINE AETMCHEDI
Si.'ADID PORTIONS
• t AT 630
F
i K :�-•^ :,`w` . - SEMS ..Orr K 3.. 3 a SERIES
i SHADED PORTIOHi� 8 x nK ° 6 "" I _ FLAT AREAS ' bds C
o REpRESEA , ,�.� <. _
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\ LFLAT AREAS e� $; —4- e r�aa Apr I REPRESENTS
//-� '�'" ;. ''`-a., w `C`."t'•a,"Y'`"� _ S)OMER
�
FLAT AREAS •c
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S Q TOO t Z rs'nut3 ARE
.o S701RIER AT 79D �A'FRAJE ASSE)ABLY _ c o r v* + 1 LOPTIOPIAL
SE3wS
n_ SUCTION sxr SERIES• TYPICAL WHERE SHOWN t
I A'FRAME ASSE30SLY � ' n_ SIIL
O opTYPICAL WFE7iE SH01lf}I RETURNX FRAME ASSEIELY
02_ SIZE SHOWN 1w.ze'sm,90'EL=is L TYP C WHERE
SURE AREA fl�GLL.CAR '`" ,x..... L— —— ——�__——.,
a n SIZE SHOW" 20'1 43•EL CLEFT OR RWAff HA10) 8 CA SA wRF AREA a-rT GAL.C.ue J17►IR3 AM i�AT 800
v m ALSO AVILAELE f7'a 3Y�t10.EFT OR RIGHT HAA70)837 SIC St"AREA a 21400-&U-CAI. � OPTIONAL 2 SE SIZE SHOMM ZO't3Z� 4i�SJ. SURF.AgPa!!
12't 2! EL(LEFT OR RIGHT NANO) 281 SF SURF AREA ASAT- G,�CAP• STARS ARE OPTIONAL �*600 C./�L-��p
o m a SERIES 700 a 750 INGROUND OR MAY BE LOCATED SERIES 800 » 1350 INGROUND d s 850 -
o. - AT PosITLONs 'x:'Y'aR Y SERIES 600 a 650 INGROUND
► — ►——-►—— --►— — All.— �ERETL1FtN _ —r
— �- FLTEIt — ►--r IMMER �— PIAW —�i 1 RETURN
f PIAP A� ,SSUCTTON T R - 2
IPLIMP s > 5
MQ TOR �dc>a/ER t � SU IRS ARE I I A'FRAME A S S E.%49LY
1 _� SZMCT7pM I OPTIONAL I , TYPICAL WHERE
u TYR SERER I •�y SHOWN
P£RlIIANE)1TLY . Ai"T)1CNm
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SA E T f L tC t S\ i l Y • P£�I4A/QITLY ♦ I -!' SAFE T7 LAC
(t"J�'s
SHADED POITTIgtgs £ s ISAFETYAT 600
' REPRESENT$ Y`,'a',' ` I SHADED PORTIOINS ! AREAS SERIES
1 ; �' FLAT AREAS t `o «ea REPRESE7iTS - I 2 CSIAO
FLAT AREAS AT 530
RE-TURN 3 SER'c-
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Se.•.r'i.�);, e,�,�Rii �� I 1 RETLRK � -1 •-
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A FRAME
M——►-- •FRAME ASSOdSLY 2
RARE ASSE]LXY• f'i�,• 'A (__� RETURN
TYPICAL WHERE SHOWN �4' c�Y:'i TYPICAL WHERE SHOW"
Scm
IWX44 EL LMea►wo) u SLoa Ati,EA a �'F)Owl ALSO 1a•=3,r 457 SF. SLR AItA a 19800 `P ` _�Q GAL CAp
221£Qfl aAL CAR N. _ sx _ _ aIIL. GR !;4 'Jd SIZE SHOWN )6'X3� 4
'�E_ .1t� yE � � I- mGGAL.� Y ALSO AVAILABLE 16'X3Or_41Q SF- SSURF.AREA 13800GALCAp
SERIES 1000 8t 1050 INGROUND SERIES 550 INGROUNCI ALTERNATE 600 a 650 SHAPE
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to 101 W!JUM.
V.; !LY
ROYAL & PRIME
STEEL POOLS DETAILS.
,74
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The Connytonlivealth of fmoachuseffs
Mi -•-. 1:= Department of Industrial Accidents
A � I � Ol�iceollnvestlgat/ons
600 Il kyhin-ron Street
Boston. Maas. 02111
Workers' Compensation Insurance Affidavit
-i It an in rtn i n• — -- PI P �`-.- .— ��..• .,_.____—
I am a homeowner p ormin_ all work myself.
1 am a sole proprietor an 4ve no one work-in,_ in any capacity
..... I L
Q . ..`....-..•.- �.. -- - - yr. - -�.. - -- —•�.�' •— -
am an employer providin_ workers' compensation for my employees working on this job.
snot tam• name: &G h
address• ���vl ���^ J I. .
city: (�-� �C✓�•�� I.e,��, �IJ' lthnnc#• �� Z � �1
insurance co. noiicy# -7 1
[I I am a sole proprietor. beneral contractor, or homeowner(circle one) and have hired the contractors listed below who have
the following workers compensation polices:
comnan%• nitnc:
- .titiresc•
insurance co. policy#
.• •'ter •-.. Y.... �•_Z-••::.. ..�._� -� .r�.`��::�.�1t iT••I!•►��,5�• �T�._._. ...w.� .i��.-..__.�_
_..._.-.... .._ ..._.-....... �.• �+..�-... :ar'.�..-ter.._ - __ __-� __ - _- _ __ __ - —._�.:�.� - -.`.�-�
comnnov name:
address:
city: ahone#-
insurance co. policy to
Attach additional sheet if neccssary� "�_ �_ -�+ y.- _�_' %'�'''="""-�••� —. �• -� ,. -'
Failure to secure coverage as required under Section ZSA of t11GL 152 can lead to the imposition of criminal penalties of a tine up to 51.500.00 andiur
une ycars' imprisonment as well as civil penalties in the form of a STOP NyORK ORDER and a fine of 5100.00 a day against me. 1 understand that a
copy of this statcntcttt mac be forwarded to the OlTice of Investigations of the DIA for coverage verifica[ion.
1 do herc��!V
runs and p�ena/ties of perjun•that the information provided above is true and cone .
Si^_nature � �°'� �•• Date 11
47
Print name l�`e a S'old Phone 9 ",z "y 210
official use unh• do not write in this area to be completed by city or torn official
.' city or town: permit/license# r'ttluiiding Department
Licensing Board
C]check if immediate response is required 0seleetmen's Oflicc
rJ h Department
contact person: phone#: rJOther
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for tile:
employees. As quoted from the an cmpinree is defincd as every person in the service of another under an\•
contract of hire, express or implied. oral or written.
An emplorer is defined as an individual. partnership, association. corporation or other legal entity, or anv t%vo or nor
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased emplover. or the
receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However th;
owner of a dwcllinu house having not more than three apartments and who resides therein. or the occupant of the
dwclliii house of another who employs persons to do maintenance , construction or repair work on such dwelling_ ho.
or oil tile `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empiove-
MGL chapter 152 section 25 also states that every state or local licensing agency shall witliliold the issuance or
reneival of a license or permit to operate a business or to construct buildings in the commonwealth for an•
applicant ivho 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
been presented to the contracting autliority.
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 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 require;
to obtain a workers' compensation policy. please call the Department at the number listed below. .
City ot- rowns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o:
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie.-
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned
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 questior
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 «'ashinaton Street
Boston, Ma. 02111
fax #: (617) 727-7749 '
phone 4: (617) 727-4900 ext. 406, 409 or 375
y, rtic 57
L _
MEJMPROVEMENT:CONTRACTOR
' Reg stution"101W
Type, INDIVIDUAL,}
.'Expiration` 01/29/98 b� A4
� �• I' r.
< RICK THOMSON
` '; ► Rick�J"Thoason 4`
` A�Boz1611 t 450 Pleasant a
ADA"IN Ra`Attleboro MA 02703 ' : .
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The Town of Barnstable
MRNSTABLE. Department of Health Safety and Environmental Services
1639.°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 ,
QF-
Location la.. kt�S keep-ermit Number
Owner C Builder
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
NIS
Please call: 508-790-6227 for reeinspection.
Inspected by 21
Date Z-`l `
Assessor's Office(Ist floor) Map Lot 0o -, 0 ,(/ it# `7'7 3
(Z'Conservation Office(4th floor) 2( r Date Issued (a
Board of Health(3rd floor)(8:30-9:30/1:00- 2:00)Ll �`�``���7'✓ ee sb r n
�GEngineering Dept.(3rd floor) House#1 ,7 ST BE
SEPTIC elf IAI'�CE
P •) INSTALLE .
71A
rngand 19 NCENVI +®NIA ®E ANC
OWN OF,'BARNSTABLE TOWN RBuilding Permit Application
Project Street �1 l�i tiS /QTk_
Village fAl d/ b P
Owner C Y i/�
e ,Y Address
Telephone �� 2 7 2:2
'Permit Request
r�
Total 1 Story Area(include 1 story garages&decks) C9 square feet
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $ —_2_ rA/V ,
Zoning District 0, Flood Plain (/ Water Protection
Lot Size Z &t3=v- Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use S' 4;,
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
i
Historic House Unfinished 4---'
Old King's Highway
Number of Baths 3 No.of Bedrooms 3
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name Telephone Number
Addr s License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATU DATE
BUILD MIT DENIED FOR THE FOLLOWING REASON(S)
i
i
- FOR OFFICIAL USE ONLY
PERMIT NO. #7993
DATE ISSUED June .29, 1995 -
?
I MAP/PARCEL NO.. 128.004.011
_ -
ADDRESS 67 Jenkins Lane �' VILLAGE West Barnstable, MA 02668
OWNER Charles A. Milligan _ f
DATE OF INSPECTION: -
FOUNDATION •
FRAME+11��� G `' G'l �/ iW" SCG��{c
INSULATION `
FIREPLACE.
ELECTRICAL: ROUGH -FINAL
PLUMBING: ROUGH- FINAL
GAS: ROUGH- -FINAL
FINAL BUILDING
DATE CLOSED'OUT
ASSOCIATION PLAN NO.- .
11%02'94 17:02 #CO177277122 DEPT IND ACCID 0
Jr
COrn2lYbonwe,afilt 0/.YWa -1ac1zuJettJ
• ..UaParfinenf o�..J'nc�uafria�.�lccic�nfl
600 Wafon S'fneaf
James J.Campbell &Eon, XwadwiA 02111
Commtssrar►er
Workers' Compensadoq ftsumuce Affidavit
(aoeasec�permazee) .
with a principal place of business at:
' (�a1NStsreJZia) .
do hereby certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverage for my employees working on
this lob.
Insurance Company Policy Number
() I am a sole proprietor and have no one working for me in any capacity.
I am a sole proprietor, general contractor o homeown circle one) and have hired the
contractors listed below who have the foil ow workers' compensation porcies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() I am a homeowner performing all the work myself.
I under<_Lend that::copy of&.is slte rent will be forv:arded to the Office of Investigations of the DTA for coverage verification and that failure to secu:
ccve-age=recai;ed under Section ZSA of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or
years' imprLcnment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day apinst me.
Signed day of , 19
Licensee/Permittee Building Department
Licensing Board
Seieti tmens Of ice
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print. ;-
DATE :.
JOB LOCATION 1 afi �ias -�..o� /j/1 01,174ALm St-70
Number Street address Section of town
"HOMEOWNER" ( , arl4s A A/
Name Home phone Work phone--
PRESENT
MAILING ADDRESS Co 7 WAV
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 such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six 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 Stat
Building Code -a:hd other applicable codes, by-laws, 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.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner performing work for which. alZilding
permit is required shall be exempt .from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that. if
Home Owner engages a person(s) for hire to do such work,_ that such Home Owner
shall act. as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of ,a supervisor. (see Appendix Q, 'Rules and Regulations
for licensing Construction- Supervisors, Section 2. 15) .' This lack of iwirenes
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed. person -as•: it would with licensed. Supervisor. The Home "Owner actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of -his/her responsibilities,. man
communities require, as part of the permit application, that the Home *Owner
certify that he/she understands the responsibilities of a supervisor. On the
last page of this issue is a form currently used byeseveral towns. You may
care to amend and adopt such 'a form/certification for use in your community.
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UNREGISTERED LAND
FILE NUMBER: 81601 DEED BOOK: 6990 PAGE:90
ATTORNEY: CARTER & ASSOCIATES PLAN BOOK: 465 PAGE:45 LOT(S)•t0'
LENDER: GMAC MORTGAGE CORPORATION OF PA PLAN NUMBER: OF
OWNER- CHARLES do KATHLEEN MILLIGAN REGISTERED LAND
APPLICANT: SAME
REGISTRATION BOOK: PAGE:
DATE: 04/28/95 SCALE: 1"=50' CERTIFICATE OF TITLE:
FLOOD HAZARD INFORMATION PLAN NUMBER:. LOT(S):
FLOOD MAP COMMUNITY NO.: 250001 ZONE: C ASSESSORS MAP
PANEL. 0015C DATED: 08/19/85 MAP; BLOCK: PARCEL:
MORTGAGE INSPECTION PLAN IN
BARNS TABLE, MA
N
LOT 11
N/F JENKINS ?5�10,
hh DECK
1 1/2 STORY
D LLING GARA E
LOT 10
43,584 S.F. 1 1
TEMPORARY \ f 1
CUL-OE-SAC \ I PROPOSED DRAINAGE EASEMENT I O
03 �6
JENKINS LANE MORTGAGE LENDER
USE ONLY
THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT
OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE
INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER: kDES LAURIERS & ASSOCIATES INC.
THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED 50 0 50' 100'
DEED -OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED 130 WEST STREET, WALPOLE, MA 02081
ON THIS LOT EXCEPT AS SHOWN. TEL.:(800)287-8800 FAX.:(508)668-4512
THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN
A SPECIAL FLOOD HAZARD ZONE: EP`tND1< ads'
THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER oe� EDWARD
WAS IN COMPLIANCE WITH THE LOCAL ZONING BY-LAWS IN I ENO 31 0
v E 91d90 o
EFFECT WHEN CONSTRUCTED (WITH RESPECT.TO STRUCTURAL Q
�
SETBACK REQUIREMENTS ONLY), OR IS EXEMPT FROM VIOLATION 74,E�By CsP
ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII. CHAPTER 40A, S
SECTION 7.
7J,
GENERAL NOTES: (1) The declarations made above are on the basis of my 4owledge, information, and belief as the result of
a mortgage inspection tape survey made to the normal standard of care of registered land surveyors practicing in Massachusetts.
(2) Declarations are made to the above named client only as of this date. (3) This plan was not made for recording purposes,
for use in preparing deed descriptions or for constructions. (4) Verifications of property line dimensions, building offsets, fences,
or lot configuration may be accomplished only by an accurate instrument survey.
f