Loading...
HomeMy WebLinkAbout0133 MAIN ST./RTE 6A(W.BARN.) OxfordNO. 152 1/3 ORA 0 0 o 1 ki. _....,..�..........�... .,..._..,,�:a�ia►eivYNG�6a..r.c_arr.......x..�ea.uinQvyw..�evnrc.::a�e , - .. _ �.. ��i _.. — - .;mc!�-�.f cam=•,1�4 h - Application number O O i Q Date Issued.......t/..... .. ........................................ 6"3g4(/G 1 Building Inspectors Initials....l ........ Ilk Map/Parcel........&I..... .......................... TO F BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 0te ©c�%L NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number ZO 3 So7Z Project cost $ '¢ODO., o o Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a bu' permit in accordance with 780 CMR Owner Signature: Date: �, 1 d. �6) TYPE 13F WORK ' I ❑ Siding O'Windows (no header change)# ❑ Insulation/Weatherization ED— Doors (no header change)# Commercial Doors require an inspector's review El Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Xeb&J i Z;4— CONTRACTOR'S INFORMATION Contractor's name e P4 Z ;P�t` e,d� Home Improvement Contractors Registration(if applicable)# / 70 3 (attach copy) Construction Supervisor's License# C.5 f/Z Z 36 (attach copy) Email of Contractor `'e hlq /... 2<e V61- Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATION NUMBER........................................................... , 1 *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X 9 X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date g 7 /S All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A eIi,P,t 6 Z/f % Tef� ,0`Z mac'®-t-) Address: z 5- 3 44 +/ti S T, City/State/Zip: 7- IPhone#: S-D 57-6 �� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.EQ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance) required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions 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.❑ Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be,forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and ies-ofperjury that the information provided above is true and correct. Si ature: Date: g 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#: a S 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 be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (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#617-727-7749 Revised 4-24-07 www.mass.gov/dia l 1 Commonwealth of Massachusetts ®� Division of Professional Licensure Board of Building Regulations and Standards Construct'66%ilpervisor CS-112230 J_ Expires: 0410712022 RANDAL W PATTERSON' 4% PO BOX 61A BREWSTER MA 02631 LS r Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual. Reai44tton Etc iratian 03 10/22/2019 ll�' RANDAL PATTEEiSON•, �> +' RANDAL PATTERSON 2539 MAIN BREWSTER,MA 021' Undersecretary Regisbatlon valid for Individual use only before the expiration date. If found return to, Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid wit1hout signature I I r?SAk) TOPPER CONSTRUCTION CO.LLQ 798 MID-TECH DRIVE,WEST YARMOUTH,MA 02873 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.TUPPERCQCOM Date: 2 9 Town of Bamstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 ® LAJ (508) 790-6230 fax -Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # �© Issued on b has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. 7cense per S-69058 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map f Parcel / M Application # Health Division Date Issued 3 Conservation Division Application Fee Planning Dept. Permit Fee ?J� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Village Owner AddressIJ Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ,Zoning District Flood Plain Groundwater Overlay Project Valuation 1.D 50s°�� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas AOil ❑ Electric ❑ Other i Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size Barn:❑ existing o ne8 size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Others � � o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ � a Commercial ❑Yes ;KNo If yes, site plan review # = Cn q9 m Current Use Proposed Use _ 00 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V(,�99 AN 3`f1211�i('�� Telephone Number d8 �� P l >l Address �7q0 H I [IFZ_44 License # 0 'J — 0&q 0 E5 9 A P--M o UTH H'A 0 2(a 7_Z) Home Improvement Contractor# l Z I e>4 5 Worker's Compensation #WCC5005 W 1701 Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i �a f' FOR OFFICIAL USE ONLY APPLICATION# y DATE ISSUED F r ` MAP/PARCEL NO. c ADDRESS VILLAGE t; OWNER DATE OF INSPECTION: -FOUNDATION I� • f' FRAME s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ' FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UV, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information :Please Print Legibly Name(Busioessiorganization/Individual): Tupper Construction Co. , LLC Address: 79B Mid Tech Drive City/State/Zip: West Yarmouth, MA 02673 Phone#: 508-778-0111 Are you an employer?Check the appropriate box: Type of project(required): 1.[@ 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. + Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL i I.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.F Other comp. insurance required.] 'Any applicant that checks box it l 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 subcontractors and their workers'comp.policy.infomtalion. lam an employer thai is providing workers'compensation insurance for nn=employees. Below is the policy and job site information. Insurance Company Name: AE I C Policy#or Self-ins.Lic.#: WCC 5005593012012 Expiration Date: 10/03/2013 Job SiteAddress: 133 Route 6A, City/State/Zip:W• Barnstable, MA 02668 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ain d nalties of perjury that the information provided above is true and correct Si nature: Date: 8/8/2 013 Phone it: 508-778-0111 Official use on1v. 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 M .. i OWNER AUTHORIZATION FORM r 4"6Nv-- (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize 4l- ( ` (Subcontractor an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's ign e Date i WILVING VXFW HMANL`E IMT117 UTt,INC 4 Massachusetts-Department of Public Safety 1 107 Hermes Road,Suitor 110 , , �; Board of Building Regulations and Standards, (877) N t2`02D Construction Suiwr+-isir wwbpi.com License:CS469058 RICHARD S TU�PP�ER f � f E 79 B M U)6TECH BR l WEST 1lARMOU'I'H Elri wd Tuppa ; BPI I00.5040"o CERTIRED PROFESSIONAL `�,.�.• ,�.,6t�. ''"`+' Expiration ; 0(SEE MIME SW FOR DENUT101S,tHppIPIR, MN DATES) Commissioner 12/31/2014 *Z110mccofCooeumtcAsf,tixBiB sio�ceaRetal�ttan People Helping People Build a Safer World- HOME.IMPROVEMONT CONTRACTOR Itir DietRegiatrsilon: wl 5 Type: COOECOIRitII• ?'!~xpiration f312 t4 Individual MEMBEk RNOM.R DT Richard Tupper ' RICHARD TUPPER_ Tupper Construction 29 Roberta Drive _ ate, Building Safety Professionpt W.YARMOUTH.MA 02613.`. Vaderseeretory ;'Member#:81.5$1'19 Exp:4130/2d14 Dec. 19. 2012 4:37PM No. 8524 P. 1/2 ' AC;ut{uI. CERTIFICATE OF LIABILITY INSURANCE DATE(MhUDDKYYY) 12/19/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER CONTACT NAME: Lora Lowe Southeastern Insurance Agency, Inc. HONE (508)997-6061 (508)990-2731 {UC No: 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 P CUSTOMS DN• N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC0 INSURED INSURERA: Arbella Protection Insurance Tupper Construction Co LLC INSURERB: AEIC wsuReRc: CNA Surety 27 Roberta Drive INSURERD: West Yamouth, MA 02673 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 12/13-2 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP rA TYPE OF INSURANCE INSR WVD POLICY NUMBER M!DD MMOD LIMITS GENERAL LIABILITY 950000874311/01/2012 1110112013 EACH OCCURRENCE $ 1,000,00X 1 COMMERCIAL GENERAL LIABILITY i?REMISES E ' $ 100,00CLAIMS4.4ADE JOCCUR 1 N ED EXP(Any ale person) $ 5,0Q PERSONAL&ADV!NJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP,'OP AGG $ 2,000,000 !POLICY Q JECT El LOC $ AUTOMOBILE LIABILITY 56662400002 12/01/2012 12101/2013 COMBINED SINGLE LIMIT $ urr AUTO (Ea accident) 1,000,000 BODILY!NJURY(Per personi $ ALL OWNEDAU'TOS BODILY INJURY(Per occident) $ A X SCHEDULED AU OS PROPERTY DAMAGE X HIRED AUTOS I� (Per occident) $ INC X ,NON-OWNED AUTOS $ $ UMBRELLA I" HOCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-1viAO.E AGGREGATE $ DEDUCTIBLE I i —' It RETENTION $ P $ WORKERS COMPENSATION ' WCCSOOSS93012007 10103/2012 1010312013 X I We=TA } X GT:�+ AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER I _ B ANYPRORIETOP/PARl ER/EXECUTIVC DEDO I NIA; RICHARD TUPPER I EL.EACH ACCIDENT is 500,00 (Mandatary in NH) INCLUDED FOR WC COVERAGE E L DISEASE-EA EMPLOYEE$ 500,000 If yes,describe wider DEoCR:PTION OF OPERATIONS bekm ! E.l.DISEASE-POL ICY LIMIT1$ 5001000 Pond or theft of money & ,or 71068913 02128/2012 02128/2013 Limit of $10,000 C property. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addklonal Remarks Schedule,If more space Is required) ill.julio@csgrp.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Conservation Services Group Attn: Bill Sul i O AUTHORIZED REPRESENTATIVE 50 Washington Street We tborough, MA 01581 Lora Lowe O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Assessors map and tot number .....l..f..1..�..�..4..��....4!`:.....1 `� /� P G ' �"�-•— � �- 7 ` � ZEPTIC SYSTEM z^, aNSTALLS M MUST BE "c Sewage;Permit number ................... WITH ARTICLE COMPLIANCE `' SANITARY COD II STATE �L�QyofTNet TOWN OF BA1�. 11'In� 'vN B9HH9TA11L8, i r� ~r-i A "6 >•� BUILDING INSPECTOR ° am APPLICATION FOR PERMIT TO C.�?Zi..!:F t C��....J. {-e2 v Qcs.cX ..................................................... TYPEOF CONSTRUCTION ....(�v.r!?t�. .................................................................... . ..................................... o .�/... ...........19�. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location--,W—al . .. ......... `�� �4��f��/i,1./!!.. ..'^........................................................................................... ProposedUse .........../.4� C .: ..... r i.../...!.C' !-cf?:.a ................................................................................ Zoning District )) Fire District ..(l ..... �� /�/✓.�.G...�l'�J .�... . ................................ Name of Owner Mae..../ve. ..44.....................Address����:�f....��/�llf7��� Name of Builder 0.Yl/1�./.../� 3 �/"...4?.. .��.5/.........Address ..... /C;CC � .. �ff (�1/��te�( ....... Nameof Architect ........=. ....Address................................................ .................................................................:.................. Numberof Rooms ............ ..................................Foundation .............................................................................. . ... .......................Roofing . .............................. Exterior ..... .Interior ......Ls: ie-:r...:..................................:. Floors �...5;:.��..... ...-lp..�..................... d' ...................... Heating .........:. .. ...................................................Plumbing ....n .Urt :...............:...................................... Fireplace .................................................Approximate Cost ...� Q ...................................... ............. Definitive Plan Approved by Planning Board -----------_-----—-----------19_______. Area ........ V...... .S............... Diagram of Lot and Building with Dimensions Fee �.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Tow of a?nstoble regarding the above construction. Lam/ Hayden, Nan 19333 add porch to No ................ Permit for .................................... c,t,we 11 ing ............................................................................... Location ...............................Main St.................................. 'Vest Barnstable ............................................................................... Nan Hayden Owner .................................................................. Type of Construction .........frame................................. ................................................................................ Plot ............................ Lot ................................ Permit Granted .........................................11 June 24 9 77 Date.of Inspection ....................................19 Date Completed ........ .......19 '-OERMIT'REFUSED ................................................................ 19 ............................................................................... ............................................................................... ....................... ....................................................... ............................................................................... Approved .............................................. 19 ............................................................................... ............................................................................... X tltlP V 0 14 x T j � E ° i / i ' INN \ n X � n � � f N x t s F r f �� r Application to 6PE o � Old King's Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATION OF EXEMPTION Application is hereby made, in triplicate,for the issuance,of a certificate of.exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Mcssachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo- graphs accompanying this application. —g _I i TYPE OR PRINT LEGIBLY DATE/ "' C' �c / 9 77 ADDRESS OF PROPOSED WORK LA ASSESSORS MAP NO 'L' 7 OWNER eZ N' 1� ASSESSORS LOT NO. HOME ADDRESS+ �I N l/L1' �//d!!��� / �ZC''6P TEL. NO. ���2- trod fl3 AGENT OR CONTRACTOR ADDRESS 22 eCW1:ec rIl� l'YIQjG� Iti�L �I��JlJZ�G�' TEL. NO. :>62. YcgG This ap is for exemption of proposed exterior construction on the ground that: 11) It will not be visible from any way or public place. ❑ (2)'It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and, if an addition is involved, show- ing location of existing building. I A -5&a r- c� U '�P'Ct, lQ�� ✓ ©� �1� i tdt "Vij( ►'`G +v e GG f C,%- 'n SIGN Owner-Contracto. gent Space below line for Committee use. Received by H.D.C. The Certificate is hereby Date /{'l Qom+ .avrrr�✓•� \\� Time By Date Approved ( The categories of work entitled to exemption are listed on Disapproved ❑ the back of this form. 4 y EXTERIOR ARCHITECTURAL FEATURES SUITABLE FOR CERTIFICATES OF EXEMPTION FOR RESIDENTIAL USE ONLY FENCES: 1. Post and rail, split, half round or round,-natural finish 2. Square rail;white or natural finish 3. Stockade;natural or gray stain finish; not forward of face of main building 4. Picket;white only, (Maximum height of all fences, 4 feet) HEDGES: natural, not to exceed four feet in height DECKS: constructed of wood,on single family dwellings, built after 1900, at first floor level, at the rear only, railings not to exceed 30 inches in height, not over 50%to be visible from a way;natural finish or color compatible with building involved - BREEZEWAYS: enclosure of existing breezeways, consistent with style, material and color-of house,excluding sliding glass doors facing street,way or public place FLAGPOLES: on residential property, not over 24 feet high, not less than 20 feet from way, constructed of wood, with natural finish or painted white;or of aluminum,or of fiberglas or metal painted white ARBORS AND TRELLISES: of lightweight,wooden construction;not over nine feet high ROOFS: natural cedar shingles,or asphalt shingles per approved color samples;not over five inches exposure to weather t SIDING: natural cedar shingles, or wooden clapboards natural or approved color;not over five inches exposure to weather STORM SASH,STORM DOORS,WINDOW SCREENS,SCREEN DOORS,GUTTERS AND LEADERS:.permissible if consistent with style, material and color of building LIGHT POST: permissible if consistent with style, material and color of building AIR CONDITIONERS: portable,window units at side or rear of building STONE WALLS: construction of field or split stone, not exceeding 30 inches in height NOTE _. 1. All prior bulletins hereby superseded. 2. Conditions contained in certificates of appropriateness shall be binding regardless of any exemptions.contained herein. � f f I I 1 r t _ • 9 � r • � a' x'Q Q 1, , N V • U v • t Assessor's map and lot number .....!„1,.�.. . I t+`r/...�� Sewage Permit number ....................'v'," !:_r............................ TOWN OF BARNSTABLE BARNSTSDL$ i ;pYa�•� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......................................................` /..................................................... r TYPE OF CONSTRUCTION ....!*::-�: ?..:. ................................................................. 7. ! ......... ; >.. ............19 . TO THE INSPECTOR OF BUILDINGS: U The undersigned hereby applies for a permit according to/the following information: Location .....ri!i.... r .l.......... ....... .�........ !.L.. ....:.. "..:^............................................................................................ ProposedUse ...............r..........!/......r... �...................::..:.................. ................................................................................ Zoning District ......... �. .. f Fire District .............................�....:.r... ..'.......................... ...... .. .... ......f....... ..... ..... f Name of Owner ..�...'..�!..'........ .��: .fL: .! ....................Address .. t...�/�.......J.. . ......................../ .'. :.:' ...�f! Name of Builder / �' .....,...Address r :�= `�:: r ..............................:`..........�.........� ................... .................... �. Name of Architect Address Numberof Rooms ......................................................r - Foundation .............................................................................. Exlenor Roofing ...........................I....... ...r ' Interior ...... . Floors .........................::...................................:...................... ....................................................................... i Heating ............................................................Plumbing . ..................... .................................................................................. Fireplace ...............:..................................................................Approximate Cost ....:......... ................................................... Definitive Plan Approved by Planning Board -----------_."_""_-----------19-------- . Area .........�..........`?................. C Diagram of Lot and Building with Dimensions Fee ........ . ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. %� Name �! i.jJi .. %' ?�...... .. .............. Hayden, Nan A=ll -7 19333 add porch No ................. Permit for .................................... to dwelling ............................................................................... �35Main street Location Location ...................................... p .... West Barnstable ............................................................................... Nan Hayden Owner .................................................................. frame Type of Construction .......................................... ..................................... .................................. Plot ............................ Lot ................................ Jun\e ,24 77 Permit Grant�d ...........19 c Date of Inspec.ion ............ ......................19 Date Completed .....................................19 PERMXTiFUSED ........................................\.................... 19 .. .............. ....... ......... . .. ........ ... ..... ...... ....N.................. .... ... ...... . ... ..... ........................ ............................ .................................................. ............................................................................... Approved ................................................ 19 ................................................................................. ............................................................................... Y Map /H 4197, Parcel (DO`7� Permit#'����<Q r House#} ._ /��_��-� Date Issued �.�a�G / Board of Health(3rd floor)(8:15 - 9:30/1:00-4�0�m Fee �o�J • o'D Conservation Office(4th floor)(8:30-9:30/1:00=2:00) Planning Dept.(1st floor/School Admin. Bldg.) ef' 'ti d by Planning Board 1 19 • BON$iABLE, ' a MAt639- SS TOWN OYBARNSTABLE Building Permit Application 4ec*ddress Village [ 1561 7 A S t2aC Q Owner A,9 Address Telephone - -Permit Request Q S �Q¢Any,c� n S c.�I,-o .p,k j rz (,. s \ / n (��. c �e�s-� Saowyc�QX '�� C r�cw���c/J Ce-& D r'VIrt7-�uac.Y .First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Soon, Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑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: ❑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 QQC.-vA (C FA�� Telephone Number Address �11 1 e9-2 kil oA Cr 0?— License# Cu Home Improvement Contractor# Worker's Compensation# (1Z/&/,S 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 DATE h6hg, BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. .1' >y ADDRESS VILLAGE : - Sw. OWNER ! DATE OF INSPECTION: FOUNDATION FRAME - - INSULATION FIREPLACE + ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH - FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 12[-ZocfD , ASSOCIATION PLAN NO. The Town of Barnstable; . : • a�atvsrAat� • &•��� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: SOS-790-6227 Fax: 508-790-6230 Building Commissione For office use only 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: S'I'c Est. Cost $0 O Address of Work: 33 (L�' Pi W �Z.n►�S•4, 1 Q4 Owner's Name -- Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: .OWNERS .PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of the owner- Date Contractor Name Registration No. OR Date Owner's Name Tile Commonwealth of Massachusetts Tj- _ ro Department of Industrial Accidents VffiCB 0f//IYBSI%gZ&VJ7S 600 Washington Street Boston,Mass. 02111 Workers' Com ensatiuon Insurraaunce Affidavit � i�si�'�e�flr����������������������������������������'',,.. � n�ican nDir�/ name fzL 12&/ location 471 ZZIALL4 d v— city C61Wa— phone# Cl I am a homeowner performing all work myself. ❑ I am a sole roprietor and have no one working in any capacity ,, I am an employer providing workers- compensation for my employees working on this job. camannv nnme address: ... . ...... ......: city nhnne#- insurance co. P,lieu# Oyxxx ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: .......... eamnanv name: N. address: city phane Insurnnce ca. cons anv name, address: city- phone#: instirance co.. %%%/%/%/%%%%////�%�%%�%%%�%%/%�///�//// Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a Copy of this statement may be forwarded to the Of lce of Investigations of the DIA for coverage verincation I do herebv certify under the pains and penalties of perjury that the information provided above is tru.-and eorrem Signattue nate Print same Phone# otncial use only do not write in this area to be completed by city or town oftleiai or town permit/license it Mudding Department cit y Ql,tcenting Board response is required ❑Seleednen's Omce ❑check if immediate resQ []Health Department contact person: phone4; ❑Other�� (revum 9,95 P1A) ' 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 coact 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 c 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, construetion 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 renewz of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter.,into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants i Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding theapplicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesugadons 600 Washington Street =- . Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 I . 4 tit , .. ` .:. '," r - .. � ' .... .• ... .. . Ap Sr 011ie • q ` rti�r -rP�� -�t � '`fib _' Y'C`�.K ''� ��''::_ OME xF t r Boas, PROVEMEN .�CON ' ti 4 , tom, x EGI' R . O r� �. eUiZcli ne ��. �RS� R TRATIO O 9atcY � n' hra• - �> fiOME ROVEMENT Registration . 4dCONTRAtZ TYPe DBA 1�2536 , T ti !� 1 Y ' � .Y r"Y a� t � i'�L t�t t•~�� - gr. fit(, � s °4 ° f r {3�i 5s F L 4 �5"sT i 1xvL `F y? <f xT }'� < :A R �p DEAN. t 71 ':ERAS `t TA 4 RRAGON p C TUIT 02 MA 635 it ,iy YQrgr t' u r� " . : h. r 6`� a-r�� � 4 an �<ia, ,k ..� .,I,v.K,t..'�'• L.. � ! � LSl7.g .a� .w ♦L'a�"(5 4r! ��f�r�`. �4 ��>{� � �f \