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HomeMy WebLinkAbout0047 MAGGIE LANE t 1 a r. .a , 'i t 1 Q ° 0 Q T C\l C ° P- T O7 , ® L rrLU� O pG J� LLJ l�Fyy/Dq� l f r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map p-'•� � Parcel ��1� Permit# • C 6� Health Division 9i-S?3 ���! s/j� ��� Date Issued Conservation Division �� 3 v DU -- � Fee �� co Tax Collector a � SEPTIC SYST e� Treasurer 1 EM MUST BE INSTALLED IN COMPLIANCE Planning Dept. ENVIR ONMENTAL CODE AND Wff"TRLE b Date Definitive Plan Approved by Planning Board { TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address ` d V_--e Village Owner }Aid, f i��`1-t a �z e Address 2 Telephone 13 to — d 5 Permit Request UC j 1 Square feet: 1 st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost gi 0061,,d e) -Zoning District Flood Plain Groundwater,Overlay Construction Type t9 D d Lot Size Grandfathered: ❑Yes .AINo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure / 7 Historic House: 'es ❑ No On Old King's Highway: Wes ❑No Basement Type: YkFull ❑Crawl , ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing �J2 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 Q�0il ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing _ :3 New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑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 Name P Telephone Number Address h e 1 License# C e!, Home Improvement Contractor# l D C) O S Worker's Compensation# 2le GU /� TG Ia 27 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO k 14 SIGNATURE DATE S ® O FOR OFFICIAL USE ONLY PE-kMIT NO. DATE ISSUED MAP/PARCEL NO. d ADDRESS VILLAGE - OWNER ' DATE OF INSPECTION FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH .,", FINAL x GAS: ROUGH F- FINAL FINAL BUILDING S17, DATE CLOSED OUT ASSOCIATION PLAN NO: , R 2 ono , o9 ' Application to 4 � Old 's Ffi5tork Muict Committee in'dw Town of 8an00,11,1e for a co CERTIFICATE OF APPROPRIATENESS 5 o Application b hareby nmk id wiplieata,for the issuanoa of a Cuff kew of Appropr law tNIS under 9i`�eicrtrd of d7fi�. Acts and Rasoba of Mas:adltlaettt; 1973. for proposed work described bolo r and an OhM drarrir0,or wxVX" own elo n paring this for. r CHECK CATEGORIES THAT APf•LY: _ 1. Exudw Building Construction: ❑ New Buihfim_ ❑,Addition Altwradan IndI=wtwo of building: ❑ House D Gerw ❑ Co merda& Oter �h /d 2 Exterior Pain** ❑ 3. S;Ww or Billbowdu ❑ New sip ❑ Existing sign ❑ Rawly th exktbvdgn 4. Structure: ❑ Fam Q wen Q Flagpole ❑ Other 1111sase read other side for aotplonation end rsgWnMWIW. TVIPE OR PRINT LEGIBLY DATE o ADORESS OF PROPOSED WORK 7 AAGG191-4• W I RJAMAL9 FRS MAP NO. OWNER �i L4TR/ /A 4• ASSESSORS LOT NO. HOME ADDRESS , V,� /9B �0�4 TEL NO. D� �Ioo�-0 (o.S FULL NAMES AND ADDRESSES OF ABUTTING OWNEfM Inch, nano of adjewd props W.tlwrgns scow any Public street or way. (Attach additional stlset if nscluw* A),, RcC, ✓�� o a� �` f 9 ~Mg Ovlci�rn rJR �.J1� � , i�o Aecnl DRlve,•�•� Ns1���c,/�la;oa66� AGENT OR CONTRACTOR C?APC- LS�44S L�CrK( , 4�oL NO ADDRESSI •�AG�Ci d�•. n 121//(,L1 /i/A. oat DETAILED DESCRIPTION OF PROPOSED WORK: Give all partindws at work to be doro(ace Na B,odor dd8l.lnduAng nwteriahs to be usea if spxif edois do not aeoompeny plans. In to cm of signs,give locations of existing signs and proposed locations of new signs. iAttsch additional shw%if mcesswyl. / OF6 �C S-;r- Z:�XTENDin16 PREsEA/>15FC1� 0uT4N �j�T�oNgG G DD i QC 0 V h W 0 r14G9 S'MAcc.F►2 ncCK w l f f4 A' �P DoWk) �'!�m THC 1gz6� LS rA,q L(-CK bEcK WJ LL 1+AVa .4.�`� 7 ' y Or rum SC-7 i�J -o d� FcK �/L,(, 3� 3ff"x/J��. -TOO Sf9PS lv%/l Cho m� �wee c/� P��� a� 7WC FkO c--,O66r OF T;fE 140Us —r_ -IV0 TzCCs WI GG RAU6 -ro Q C JCI�(o (t7/l.(, �O/0 C I� r11/� 02��'2C�3�� �2treeaoaAgllK S k"Ab) wline for s. Received by H.D. �ft0 Date s M is hereby '6' �W DM Timejee ' F11 ZZ-6a, V 8y TOWN OF BARNSTABLE .-Proved If Cerdffeate is approved,approval is wMect to the 10 day appeal period W.MmalAglai In tha At* Town of Barnstable - Historic Preservation Division 4�.Y11 0FtHE tpk�p Old King's Highway Historic District Committee 230 South Street, Hyannis, Massachusetts 02601 BARNSrnBLE, : (508) 862-4684 Fax (508) 862-4725 9 MASS. g 1639• .erFD MA'S A May 24, 2000 To: All Interested Parties From: Old King's Highway Historic District Committee RE: Patricia Farrell, 47 Maggie Lane, W. Barnstable, (Map-Parcel217-049), House Alteration- Deck Extension --------------------------------------------------------------------------------------------------------=----------- The Committee voted to approve the Certificate of Appropriateness under the following conditions: 1) the complete deck should be drawn on the certified plot.plan as there is a change in the footprint, and: 2) two more drawing are required for the application and those drawings by prepared by Cazuks Architects Graphics, Hyannis: 3) the grace period shall not commence until the addtional drawings and .the revised site plan have been submitted, and be approved by either the Chairman or the Vice chairman of the Committee. I.1 IV • AM— --I-OT .:.._ .l A:... . s mrau.7a�� srg.cPcp2�,4 : ..' 4LOT A' Q� • P-1 9 105�t d- 1 i y1EA/41 •''�.�, �, •••'«•••.•N ids �i11 OF �t WI_.IA i CUX . '+ .31341 �n � ... 4 %• .• tea �, �O sa•G Hu S► .5���,Ir 'wti fAl a SUrxcNa PLOT PLAN A. � ;MASSY TO THE BEST OF MY INFORMATION KNOWLEDGE, AND BELIEF THE J..c�T�� SHOWN ON THIS R. J. O HEARAi, INC., RLS, RS''`' x ' ROUTE 134 1348 PLAN • HAS BEEN 'LOCATED ON THE EAST DENNIS, MASS. GROUND AS C EO (�!J. G✓,, _. _ -- - NO. _ �__ � 3 -- ALE:. =SC DATE MOT:J08 — - Town of Barnstable *Permit pExpires rrt rs jr !1 sue date Regulatory Services Fee • sysrtsrna>e v mass. Thomas F. Geiler,Director Building.Division 2008 _ DEC Y 8 Tom Perry,CBO, Building Commissioner 0� TOWN OF BARNSTABLE -goo Main Street,Hyannis,MA 02601, www.town.barnstable.ma:us Office: 508462-4038 Fax..508-790-6230 EXPRESS PERMIT APPLICATION .- RESIDENTIAL-ONLY /) Not Valid without Red X-Press Imprint Map/parcel Number OLf Property Address . esidential Value of Work /2,Ot) C) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address tiA } �lj Irk/ Contractor's Name(�,���f,y •jl�'�P��� j � ,, � L� TelephoneNumber�jc�. Home Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I ar3Ae Homeowner ave Worker's Compensation Insurance Insurance Company Name lA ••� Workman's Comp.Policy# - 15'-0 Y Copy of Insurance Compliance Certificate must acc mp ny each permit.. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will betaken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑fie-side ry-)P, 'C L, r x/.S 11-3 tr tr �r � � Replacement Windows/doors/sliders U Value �� (maximum 44)� `i` r�y7r ` `"'ti ' _� �y e +n�rFsjl �*`�i(�'<R3a�k A Y'YL'Y , 1c..A. i}3'.aY•la�. lr r� vg aC *Where required: Issuance of this permit does not exempt compliances vrth other;town department regulatwns,i e+HistonciConservahon etc x� 71 �s ti Y* -`� r7 ";• �r! �.r'''tr1 +' F i-��{r,` r'r+t! �•-.',F.!' 'i_Y"'. -ti tiY7�''t �Fx •e�. ��: _ ;'r ***Note: Property Owner must sign Property Owner Letter ofPermissionr r�r-a asY.;L2 '`i 'z :r fi ^•casr tt°` �,t A'copy of the Home Improveiiient Contractors Ucense is requiredWA ` ; ,i s� � •� W TURE:SIGNA Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 100608 t r rr f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations` 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaus/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiordlndividual): Address: zz n/ ,�%dc� City/State/Zip: Phone.#: Are you an employer? Chick the appropriate box: Type of project(required): 1. am a employer with 4. Q I am a general contractor and I 6. Q New construction employees(full and/or p -time).* have hired the sub-contractors 2:Q I am a sole proprietor or partner-' listed on the attached sheet. 7_ o eling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'..comp.insurance comp. insurance.$ required.] 5. Q We are a corporation and its 10.❑ Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Q Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.Q Other_SjP���f c 1 T. 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. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: eVZ /� Policy#or Self-ins. Lic. #: L/ �� y j l Expiration Date:�1� Job Site Address:4 ' ' k- f r City/State/Zip: Attach a copy of the workers'c nsation 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 crimirial penalties of a fine lip 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 un er the pains and pen ies of perjury that the information provided above is true and correct. Si ature: Date: G. d _ 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,-oi receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the-eommonwealth 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-contiactor(s)name(s);address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy rs 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 Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-72777749 t. Revised 11-22-06 www.mass.gov/dia v _ Town of Barnstable Regulatory Services. BAZ' BM n B& Thomas F.Geiler,Director 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 Property CXrner Must Complete-and Sign This Section If Using A Builder I, , as Owner of the subject.property e y authorizej['� �� �F�z��/�/ to act on my behalf, in all matters relative to work authorized by this building permit application for. ( ss of Job) S na of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION c Hof TKWE r .. To Wn of Barnstable- Regulatory Services RA ST,,B Thomas F.Geiler,Director tta.9s. Building Division �PlED µA't A Tom Perry,Building Commissioner 200 Maiti:Street; Hyannis,MA,02601 vr".town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 BONEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 04/)p 4AyL--p l/t/ ° 134 7 Zb� number street village "HOMEOWNER!':� (add—k '�+L0 A��/.J Sqq "/' �� / � 7I��� w�fJ/ name - h/ome�lphone# work phone# CURRENT MAILING ADDRESS: e,ty/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. .. , e t C-- ',i,DFF1N�iEO1V QVP0, EFR `. Persons)who owns a parcel of land on which he/she resides or intends tti reside, on which there is,or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for conq)liance 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 reqweyffents. gna of Homeo er 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 horneowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such wofk,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 cornmunity. Q:forms:homcexempt i i S*-l\ . HOME IMPROVEMENT CONTRACTOR Registrat on: 107239 0 Expira on30/2010 Tr# TyP}-Indivjd ual . yy� .. RICHARD DESMARAIS :6abd De 115 OLD.TOWN HOUSERD� 1 utisti'.itor SOUTH YARMOUTH�MA664 se Board of Buildmg�:Regulatio s and Standards � Y •� Construction Supervisor License Le : CS 49883 Expiration 3°31/2010 Tr# 19648 \' ?Restr�,0` RICHARD E DESMARAIS_ ; 115 OLD T0INNHOIJ.SE—'RD f S YARMOUTH,.MAO 6 Commissioner , License or registration valid for individul.use only before the•expiration date. if found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not`valiil withoutsigna lire c - 00 3S,000 cf.e IC_Masonry only space r 2 FamilyRolfies Failure to Possess Massachu .. ess a Current is cause for etv�'at oauilding Codeditioa of the y�!! n orthi e s license, . r - n:Leigh Prall, HUB International New England, LLC To:LP00T'5_950338.pdf(15087906230) 10:48 12/08108GMT-05 Pg 02-03 Client#: 39626" RICHARDEDE ACORD. CERTIFICATE OF LIABILITY INSURANCE1 1DATE 2/08/080rrYYYI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB International New England ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 265 Orleans Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Chatham,MA 02650 508 945-0446 INSURERS AFFORDING COVERAGE NAIC# INSURED Richard E.Desmarais INSURER A: Hartford Ins Co INSURER B: AIG - 115 Old Town House Rd INSURER C: S Yarmouth, MA 02664- INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD/YY DATE MMIDD/YY LIMITS A GENERAL LIABILITY 08SBADZ2809 01/18/08 01/18/09 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $3OO OOO PREMISES E occurrence) CLAIMS MADE 51 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY S1,000,000 GENERALAGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 X POLICY. jE O LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS - BODILY INJURY NON-OWNED AUTOS (Per accident) 5 PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ . $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC6715961 12/15/07 12/15/08 WC I IMITI X FR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 X OFFICER/MEMBER EXCLUDED? Sole Excluded E.L.DISEASE-EA EMPLOYEE $500,000 If yyes describe under SPEG�IAL PROVISIONS Wow _ E.L.DISEASE-POLICYLIMIT $500;000 OTHER j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS _ 47 Maggie Lane,West Barnstable. lr7 ( CD Z CERTIFICATE HOLDER CANCELLATION C,.±b n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEE�,C�LyED BEFORELTKE EXPIRATION Town of Barnstable Attn: Sally DATE THEREOF,THE ISSUING INSURER,WILL ENDEAVOR TO.MAILLLURE �I n DAYS WRITTEN • ' O Ss ;ci Shea NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT TO:D.O SO SHALL --4 Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE IN URER,ITS AGENTS OR> Barnstable, MA 02630 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S211515/M211513 LP001 O ACORD CORPORATION 1988 E. , The Commonwealth of Massachusetts - ( Department of Industrial Accidents r _ _ Office of/nresUgaUoos 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit MIMI .2 Q L a .P P 1< City phone# ao �� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity D51I am an employer providing wofkers' compensation for my employees working on this job. company name. d city Ce l44,P I, L tf((_e /C 1.ia� phone g; C � c\SGtd/ S pow. 7to _1VB G. 16U � 7 O I am a sole proprietor,general contractor,or omeowner(circle one) and have hired the contractors listed below who hu.: the following workers'compensation polices: comnanv name: address: city phone tl.; insurance.co. polio* comnanrnamr. ONE- city: phone#• isl4arance>co. policy# Failure to secure coverage as required under Section 25A of DIG L 152 can lead to the imposition of criminal penalties of s fine up to 51.500.00 andno one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby certify nder the pains and pens ' o p jury that the information provided above is true and correct ��^^ Signatures Date V Print name r t Phone# Zd l official use only do not write in this area to be completed by city or town official city or town: permit/license# OBuilding Department �- oLicensing Board F. check if immediate response is required C)Sdeetmen's Office 011ealth Department N contact person: phone#; I—(Other I revised 3/95 PIA) i 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 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 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. <r 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 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 permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. i 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. 'V1 The Department's addn!ss, t;1ep'ic and f;ix :�_.... r. f h 1)Ct3:�!t"r?^'1`_ ii: ".^(IL•L'e!':i� i-1CL''_`. 'c::;i difice,of Mvestioatiolls 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 375 i`�wa�L'..iati...e:G....y�c1•%sei??l.:spp�............._.. .��..�.//_ ..._,./.� .. / • '. .' t — ✓�TOGIJl9Jt4ftll/@QL!/b o�✓[4Qddof/LttdE BOARD OF BUILDING REGULATIO1 Ucenser,GONSTRUCTION SUPERVISOF 3 _ Numbem:CS':.. 028899 - BIrthd4* 081.16/1936 -i— r—:-; Expires:08.02001 Tr.,no: 327", "�'-tcbed To: 00 GEORGE J ALLAIN~� . 116 SHEAFFER RD CENTERVILLE, MA 02632 Administrator . . .�_ �'i,`V..•� Z• •✓/ta�GHVINOOftlAN6�O�✓�W�'�ic HOME IMPROVEMENT CONTRACTO= .::.: Registration 100105 Type - INDIVIDUAL : Expiration 06/09/00 6�EOORGE ALLAIN flce�ao�i k 'E� (i SHEAFFER 1 Rd. terVille MA 02632 ..ADMINISTRAMR' i i The Town of Barnstable BA UMA= 9 � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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:_ ye-w D C� � _Estimated Cost C�+ do to , Address of Work: (� (1!\d �/ `� / P L Owner's Name: Jed Fd 1 Ham. /J Date of Application: S 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 MOROVEMENT 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 3 permit as th gent of the o` d ® ,g Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav r TOP OF FOUND. EL. = 17 D 10 FT. MIN. ' �'A CONCRETE rZOVT� _---—---__ COVERS 4 CAST IRON 12 MAX d- PIPE- MIN. PITCH 1/4. PER FT. of '• Z i I I FLOW LI - I`' i �- EL.= 87. '7 10 MIN. 'r LOCATION MAP II SEF i TA 1 SEWAGE E NO' DESIGN NUMBER OF BEDR( i GARBAGE DISPOSAL L TOTAL ESTIMATED ry� I GAL./BR. s ? REQUIRED SEPTIC. � ,_ \�;• �.L End '` ACTUAL SIZE OF S LEACHING AREA RE SIDEWALL AREC } s\ BOTTOM AREA o ^' @1 LEACHING CAPACITY RESERVE LEACHING �; - f, .N /• ��'-„ � pp n , kh 1 a AD I.ALL WORKMANSHIP TO D.E.O.E. TITLE j rr RULES AND REGU ' i p(t� q' s� - OF SANITARY SE 2.COMPLIANCE WITH DETERMINED BY wo 1- I- pIP SF N "" COMMISSIONER h1�; FtiENIz� r. fleavG CEP N �" .9 •p,T ®st3 �• - 3.EXISTING AND FII O `i `A `f THE SAME . U ` -t To * f.t' tE of o �E r1 o >v�Tii4 a� es l\ 1 Hsu 00 tVf-� uJri LE( EXISTING SPOT E EXISTING CONTOUi FINAL SPOT ELI FINAL CONTOUR SITE PLAN SD1L TEST LDCE SCALE ' 20 FT. MIN. CONCRETE 4' SCH. 40 PVC CLEAN SAND COVERS PIPE-MIN. PITCH CONCRETE 1/8' PER FT. COVER 2 LAYER OF 12"MAX. 1/8"-1/2" WASHED STONE FLOW LINE Z � I MIN. 7 EL.= S 7•Z EL. 8Cn•3 EL.= 8G. I DI ST BOX °oo P �v� i-x 3/4'- 1 1/2 WASHED STONE D W 0 0 4 W G G J Cl GAL PRECAST LEACHING °u° —EL.= 9. £3 BASIN OR EOUIV. SEPTIC TANK PROFILE OF GROUND WATER TABLE EL. = EWAGE DISPOSAL SYSTEM NOT TO SCALE DESIGN CALCULATIONS SOIL TEST 4BER OF BEDROOMS...................... DATE OF SOIL TEST 7�-'� IBAGE DISPOSAL UNIT................... WITNESSED BY J. 'AL ESTIMATED FLOW ( '-2 GAL-/BR./DAYx�L BR. )........ '`O GAL./DAY PERCOLATION RATE IN./INCH ioJ C 5 UIRED SEPTIC TANK CAPACITY............. GAL. OBSERVATION HOLE 4 OBSERVATION HOLE 'UAL SIZE OF SEPTIC TANK................. ��6 GAL. ELEVATION- 160 •o ELEVATION= 88 o .CHING AREA REOUIREMENTS O' O•: SIDEWALL AREA GAL./S.F. BOTTOM AREA J,o GAL./S.F. (CHING CAPACITY (BOTTOM + SIDEWALL). c o7,S GAL. 1(D Y!.��: 2, id , �,, i l )x y/li�L ) ^KLLLAj I V.i/C,I,I''.`•( SERVE LEACHING CAPACITY.............. -(•....... r• .J `J GAL. •. CI..•77.7I M F.D. In,1,N12• (%I rile <XLND f NOTES L WORKMANSHIP AND MATERIALS SHALL CONFORM / ;,'•'i D.E.Q.E. TITLE. 5 AND THE TOWN OF 'r .1ZNSYAE'-t jp t.1/TES' GL IJo Ilfalfk' .�[lIID LES AND REGULATIONS FOR SUBSURFACE DISPOSAL SANITARY SEWAGE MPLIANCE WITH ZONING' REGULATIONS- SHALL BE TERMINED BY BUILDING INSPECTOR OR BUILDING BUILDING SETBACK REGULATIONS PER BUILDING MMISSIONER INSPECTOR OR BUILDING COMMISSIONER MIN. FRONT SETBACK ISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY MIN. REAR SETBACK 'E SAME tNf tF'..' Oia>= N(D�NhTaN + rNoIAL�d� it�>✓�E MIN.' SIDE SETBACK =� tJo ExI TN( �hCtl 'FITS %R tIEL i`:IT-Hjw too APPROVED : BOARD OF HEALTH (r r +S.• ;')rl:i'11 r-^•;._F. per'-"iER-IL-�.. !r1hi.L �E� CF;r�v>VFT) GATE AGENT ~i PROJECT LOCATION! ' :i APPLICANT: LEGEND SCALE: �e� �b DR. BY, DATE: LISTING SPOT ELEVATIONS OO,o JOB N0: APPD. BY: REV. 7 9/r3 (ISTIN,G CONTOUR ------ 00---- NAL SPOT ELEVATIONS 00.0 i R ✓ 0 HEARN INC. T ING NAL CONTOUR 0 / > ,j , )IL TEST LOCATION / �. REG. LAND SURVEYORS-REG. SAN/TAR/ANS�' i 1348 ROUTE 134 - P. O. BOX 1263 EAST OENN/S, MASS. _L .-COT A:. Po t t j 1 T 1 �• 1 9 e/y�7 •n �t ���� tN,o ll aA c I 7 = ti� ' 60x 31341 AS - ` BUILT." PLOD' PLAN • TO THE BEST OF MY- INFORMATION + MlASS. KNOWLEDGE., . AND BELIEF THE L nT r. lyg- -2.Lll1,2ZZ SHOWN ON THIS R. ✓. OWEARN, INC, RLS, PLAN HAS KEN' ' ''LOCATED ON THE 1348 ROUTE 134 ` GROUND AS II C 'ED EAST DENNfSo MOSS. ,� `Z c��' ,/—� � G'✓�.� / DATE • ,S �'�T.�_ l`� - ` SCALE ,.... — - JOB N0. . .� f7� CLICP�T: :. %��.. U TE REGISTERED LAND SURVV OR DR. BY SHEET L OF - 1 _. =.Assess'&'s•map and lot number .c�.) `�...".��.01...�:' !.......... ®"� D f</f hL �Z/�/ ' i THE t0 3- 5�$ �a�e-a .o� �Q.. �o y4..Sewage Permit numbe ............. .......... d � Q� Z BAUSTABLE, i 'L177�170USe number ...... .. .. ......... .......... .. 9 MM6 SEPTIC SYST• ��� E , o �.'�• SCE TO N OF BARNSTAB'���WTH TITLE 5 ENVIRONMENTAL CODE AND • � • BUILDING'�� I-NSPECTOR TOWN REG��Tt��IS APPLICATION FOR PERMIT TO .......0. . ....................................... Al ................................................. TYPE OF CONSTRUCTION .........jt)1D.4 ........ AAjmv....................................................................................... F J.°1.....:..�.ULq..............19M. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....40..1...... ........MA.Caq,.!.( ..... N.0..........In.?C. .i........6.Ai ,AVS7.`f.&Ce........l. H.66.............................. ProposedUse ......SI 4.......FA.?A14 �/............................................................................. ...................... ........... ................... -Zoning District .....R.. .........................................................Fire District ..(„ eU ........:....... Name of Owner ....W.0 HAC-r.0....Z....1aATAL,.ANAAddress ...I&.(0..... �, 4�.0 ....5� ......................................... Nameof Builder ............ ..................................Address ...........S!V46............................................................ Name of Architect MICJAC.1r., Y' .. :.-PACIL.Address .......... /�fL�'............................................................. Numberof Rooms ...... ..........................................................Foundation ....Co4q i§T9.................................................. Exterior ....rXA.10....60A.Z>...............................................Roofing .......FA dIT,P G(As ........................................... Floors ..CAPS'.1?..T1.A... ...QA K..............................................Interior ..pax...................................................... t/� Heating ...�..1.<...................•:............................................t.....Plumbing .....�. .p(�.................................................................. Fireplace ...�61.ILRTUP.. ..............................................Approximate Cost . .4ao ........................................... � S. Definitive Plan Approved by Planning Board ------------___,_____________19 Area ........A...r. .................... Diagram of Lot and Building with Dimensions Fee .� SUBJECT TO APPROVAL OF .BOARD OF HEALTH l °A/ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of t e Town of Barnstable regarding the above construction. Name . ..... ,li.9LIL ... ... .Ur.. .. ....................... 1 pp. Construction S)upervisor.'s license ...W/OEI .............. , No .................25496 Permit for ....2. Story Single Fami 1..y .p... W.ej jing......... , .. ............... Location ..Lot 2?.r.......4.7..A'aggLe...Lane. ................. ...................... ; owner .Ml.chael..J......Qatalana............... i Type of Construction ....F r-ame......................... ............................. ................................... ........ Plot ............................ Lot Permit Granted ..September 2.........19 83 Date of Inspection ........1 7, y .......19 ' Date Completed ..R'?O/. 19 ; ©t, FROM TOWN OF •BARNSTABLE 't BUILDING DEPARTMENT W. Francisahteu�e •, �.- , _ 3ti� MAIN STREET HYANNIS, MA Zbwn Clerk �._,_,.»..�.�.,•>..,,�� ........ mow. Phone: 775-1120 SUBJECT: FOLDHERE DATE August 29 1984 MESSAGE pN • i Work has been ampleted under Pemit #25496 (Ri.cha Demerjian) Please release Bond. • +•A.� •^Aw1Y..•. 4 .C_ M1 {v>•MMlLT�:.•,-*R1Y..w.Mi i,•1•#•T . . SIGNED DATE • per• I' J REPLY Jf/ • SIGNED N87•RMI •RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY ♦ - PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.'SEND WHITE AND PINK COPIES WITH CARBON INTACT. 1 25496 TOWN OF BARNSTABLE --- ��•• ' o�� Permit No. ------------ Building Inspector Cash -----_----- _--- OCCUPANCY PERMIT Bond _____ ._ Issued to Richard Demer j ian Address lot #2A 47 Maggie Lane, West Barnstable Wiring Inspector �/ c_/ � Inspection date Plumbing Inspector f,f/ 1�.�1� _ Inspection date Gas Inspector zl� � ) � Inspection date Engineering Department;�/,, Inspection date Board of Health � h/; �;C Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0.OF THE MASSACHUSETTS STATE BUILDING CODE. ig - / Buildina'Inspector l I fir. , o .i . 2.A� ��3��� ;4 fAssgssor's map and lot number I`7 1Qi � � 6 f</Y !�h�� �G�r—THE l '�,• . .. � � � � ` s I431a-0 00 �� Sewage Permit' number .'. ..: J` ;`�........................... 7 • � • t� • :H RARd9TULS, i s ' ! MM6 j House number ... `.:.; .;..:I,......._............. 03q TOWN .. OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....;. .Sra N! S 1 w . A rv�. I-1 a u S r;...............................................:.. ...... .:............................................ TYPEOF CONSTRUCTION ......... ......!M&ft........................................................................................ �...............I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....�mQ..:......R..°`.......MA,ICr6!.G ..... ...........�.?�.5.i....... M. ,.TAB. .......e6`6......................:....... ProposedUse ...... .I. I...... A M .± /........................................................................... . ...... :.......... Zoning District .... 7.: .........................................................Fire District .............. r:.. Name of Owner ....!M.«':NA r(...... r.... P�1.�?.(AN...A.Address ...IRG..... !!A.,yJ.(, ::.. T......................................... Nameof Builder ............ 4N..\.� ..........................................Address ............ Nii. '.............................................................. J Name of Architect %!!l.!�HAr.L...CgiE1t.�lN.. l„ ...�2,,.: RA({( Address ,lN.. Number of Rooms .... ...................:.......................................Foundation ....�k... .-?;T ................................................ Exterior ...............................................Roofing ...... ..R. T, /QS��............................................. Floors (4R" PT.(5...£...QA..I(..............................................Interior .. N. fsl"..2 :!C........................................................ Heating ...E.U_.....................................................................Plumbing ..... .............................. I.UR.. ..............................................A �Approximate Cot .� � ........................................................Fireplace .. ! pp e. s � Definitive Plan Approved by Planning Board -----------______-----------19_______. Area .......................................... 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 oil the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . I�.... � �A ...> ................... ... ... ... .. .. Construction Supervisor's License ...OtA)Q.r:. R................ -CATALANA, MICHAEL J. A=217-49 217-41 No ... Permit for Story........ ....... `.Single...Family. Dwelling...... ................ ................... Location Lot ......A7...NaKggi.e...Lane .. .. .. .. .... West Barnstable .............................................................................. Owner ..�j.i.q.ha.e.l...Jm...C.at.a.la.na............. Type of Construction . .....Frame........... .1........... ................................................................................ Plot ... ........................ Lot ................................ eptember Permit Granted .......S........................2.........19 83 • Date of Inspection ..:......................................19 Date Completed ..................... ..................19 i a c� b � O O O � /v �G_ � N o (� T N U d Q R' � N ~ Z W Z H Q LU � � �� III I l �� l li i � I � II If IIII II ILIA � J � i�iiillll111V11lIillilillillillVllll �i� � I oo I " II �� ` � IIIII !!' a IIIII� 11B��II i �Illllffllillillluu ii o � � a o N O m ADDED EXISTING 1 PROPOSED141-00 a Q z FRONT ELEVATION LEFT ELEVATION SCALE. I,e . V-o W DDED �iP a 0 -011 off EXISTING DECK W � UQ � m p N co Us tl z pLO � - EX ST NG � W J W - STRUCTURE - � yu W IL SPEET PROP�E� pD A , IDEGK PLAN