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HomeMy WebLinkAbout1483 MEETINGHOUSE WAY/RTE 149 /y93 Alee4iz i Z 1 i L tr� �j ® Mm Z 1*O N c•) z 0 N Q •S n 6 ,i 3 • 3 a 3 y r ° ®bserUe4 Tee On 4�rtvacva� G&-rc--J e. Z"4 i coc � Town of Barnstable +Permit# F.sprres tl om irrur 4;Je_ Regulatory Services Fee RIThomas P.Ceiler,Director JAt�, "' O10 Building Division Tom Perry,CBO, Building Commissioner 70WN OF BARNSTABLE 200 Main street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-86211039 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIOENTIAIL ONLY 2Not Valid without Nis X-Press Imprint Map/parcel Number Property Address r 1, U 7 Residential Value of Worm, Minimum fee of$25.00 for work under$6000.00 ffivner's Name&Address l ILAM6a 0( d�nZ �. � • `Contractor's Name GI_ �� - Telephone Numbers L4 � I Tome Improvement Contractorticense#(if applicable)l OVt-i� I Construction Supervisor's License 4(if applicable)4 1:ram S�!q ( Workman's Compensation Insurance 1 Check one: I-am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance lnsurance Com an Name�(a U t. 0 lou ay C - rII NAq �J Workman's Comp.Policy# U Vl� 0 0 Copy of insurance Compliance Certificate must be on file. Permit Request(check box)Re•roof(stripping old shingles)All construction debris will betaken to (/ Re-roof(not stripping. Going over existing layers of root). Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) 'Where rettuirod: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation,ate.. i 11'+Note: P erty Own r si n Property weer Letter of Permission. or 1 pr emen Contractors License is required. SIGN'A'rulkE. r 1!.'W vb11.Ia%10AMMhuilding cmiit tormstEXP SS.doe Revised 100608. t 'd RN 'ON MEN[ 60OZ tiZ ,ay Construction Supervisor Specialty License R Im RF.= 92 PARK PLACE WAY Mom.MA 02W9 our-- ..eSf� Expiration: 12VM2 ('nrpmb annrr Tr#: IOWI 9L, ewdar .� HOMEoGNTRACWR # UW4 a DHA -_ cnRDNER©MNST. RICHARD GARDNER 92 PAM(PLACE WAY l MASHPE .no 02549 Admiaishvitor J OSHA U.S.DgwwnM of t bw Oompationel Safety end Health AdMMMMMM RlchaW Gardw has st>cossm%dly a 104x w Ouu ioial Safety and Health Training Course to Construction SaW&Hwkh �9 (t'rei" (Date) oAaoa+UmrrwYl ACORD CET}. ICATE 0F.� ABILITY INSURANCE 09/04/2009 nt CER TTER PRODUCER , 8CSI.8Gffi. INSOlVItiCE i. ONLY AND CO"COIU�ERS NO RlGHT9 UPON THE CERTIFICATE HOLDER. THIS SATE GOES NOT MEND, EXTEND OR 34 HAM S? ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I} ' INSURERS AFFORDING COVERAGE NAIC O Tess:. Jao► o � eeuteo I v auRER PHLNIE Rich Gardaer `1 Dwo Re TRRVELERB 1NSURM= dba Gardner COablrn •-::} YJSUfiERQ 92 Park Place ...` 1MslmRR .__......_...._... I " •} __._....._.__.— — INSUIMR IL' Mashpae, IA 02649 _ COVERAGES INDICATED, oWrA MSTANDING THE POLICIES OF INSURANCE HAVE TO THE NAKED ABOVE FOR THE POLICY PERIOD G ANY REQUIREMENT. TERM C OF ANY OR OTHER YMRM RESPECT TO WHICH TML3 CERTIFICATE k{AV 8E 1SSUE0 OR MAY PERTAIN THE 1 OROED BY THE POL. DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICES.AGGREGATE UIeTS Y HAVE SEEN PAID CLPMS. POLICY ww"mo PgtCY Cl�aIATON LOM LTII Im m Tots' ° '°'` °A7° oATP EACM000iDRfNCB s1,000,000 A oaraALLuanm k T CPP07k:' .08/20/2009 08/20/2010 $50,000 COMWERMAL PRUEYBE9 Ea ooaaaal» 65.0 omm AnawnS ouaaT '� r�DwwElar w i PERSONAL 6 AW INAIRY s1,000,000 ' �LAOGREDATE s2,000,000 I p Tn.COWOOPAW s2,000,000 GMAGORWATEIae► PO= LOC _ AUIOIIODLLR uABurrr ' , COU81119 BIAILE LAW : (Ea ecewpv ANY AUTO ALLOWNEDAUTos I F. 9004TWMTY f (p-P�OPI SCHEouIIDA"In I;' NUTUaAvros -.1 BODILYDtAIRY s € { "aodw/0 it PROPERTY DAAIAAE ------------ AU10010.T•fA ACCUEl1T f ANY AUTO AUTOONLC AGO f i la t ❑ .:._� AGGREGATE t OCCUR MADE DEWXYMA RETEWW B wom"mCoaveNeAT1ONAM „ MU807�_.s" 009 07/06/2009 07/06/2010 X TORYLD1Y18 e( �ovewLaeam � t 100,000 AW s 100,000 o �;' pSE.EAB�OYEB f aUnDlnAabr TI88 -0(EEA F--P0LI0YTWYT s 500,000 BPEUALPi6DV18�f6 TMw. 1". oT>ra+ � wr DE/CPVIM OF OPERAOOI3 I LOCA /51�LLtIOlIDA00E0'W 88PECIALFRO111E10" TIM WORims POS ZOT Doss ZDs COVESAV4 E ri0a a=CaAaD GARDNER irL 1� CERTIFI CATE HOLDER ;r CANCELLATION BNOYLD ANY OF TNB ABOVE OW1,I D POLlCM5 OR GAIMEL PO asrum iBE UPBWTION RICRARD GARDWm �!r 1 21 DAVIS VPJrMM OATS TMERSOP. lam lasum � fuL E)DFAVOY 7O I(AL 92 PARR PTa4C8 �J! `, y NO710E W Tl{E ®ITRi�TB NaDER PIATPLO TO M {EFT. OUT FALL E TO 00 to "LL NKSHPEE, NDL 02649 li;' :. ) DOME No OULIOATION OR LIAWLTTY at ANY qYD UPON THE FNIDAER, TTE AofNTe OR RGFRIIf>9iTAMIM AUTNORR®pYPIEfEYTAitVE ,��` j ...... ®ACORD RPORATION 1988 ACORD 25(200ime) U _ ARM WRiRWAnwssrs VJ s iwuaw••w......v Dognarr-40,111,9W of IJM � - lAcddw& Office ofInva igohons "o Washbigton Small Bostor�MA 02111 wwmmars&gov/aura W0RCompensation Insurance Affidavit:BailderslConti-mWrs/ElechicisnsA?Iumbers Agplicant Information Please Print Name obsaese/o—tionJlndMdoan: Address: cl*lstd Phone*. Are you an employer?Check the appropriate box: Type of project(regmred)r 1.®I an a employer with- 4- ❑ I am a general contractor and I 6. 0 New construction employees(full and/or part=).; have hired the sub-contractors listed on the attached sheet 7- ❑Remodeling 2.0 I ip a sole proprietor or partner- These Sub-contractors have g. [�Demolition ship and have no employees employees and have workers' working for mein any capacity- 9. ❑Building addition insurance comp- or additions requhul(No workers'comp. 5.❑ We are a corporation and its 10-�FleCorrcal 3.❑ I omeowner doing all work olds have exercised their I I.0 Plumbing repairs or additions myself.[No workers'comp. rightof exemption per MGL 12.0 Roof repairs insurance required-]o c.152,§1(4),and we have no 13f ]Other, employees.[No workers' comp-insurance require&] •Airy applic�t that check bo=Al must also SII cat�e sxdioa below sIlwnog their arar)<ets'oo®peasetion P°>irY�° such t Hmaeowness who submit tbs ati3da+►it �Y art doigg all wiaak dad then hise ostside 000fsac9ass mast suhmoita new afsdavitmmg fbatrbe*6&sbmstartattarbedana&Momalsbmtsbowinfheminecftbes andstalewhssfberarnathoseeatdieshave cmp&ya- Mae sub-cD s bav a tmpbyees.they must provide their wo*c&comp-pokey nsmibm Iant err employer dart is gw Micas'comp ��am�pl'�- Belowih drepow►and jnb site Insurance Company Name'TWVV1J � I Policy#or Self.Inc.#. �— Eapiuratian Date: onoo f I/��jj Job Site Address:{q ,iI / Attach a copy of ate worTaers'compansation policy dedaration page(showing the pommy muubew and expiration date). Failure to sea=coverage as required under Section 25A of MGL c 152 can lead to the hupontiOn of edminal penalties of a fine up to$1,500.00 and/or on"eari isonment.as well as civil penalties in the firm of a STOP WORK ORDER and a fine of up to V-%00 a day against the violason Be advised that a copy ofthis staftmem may be ftwarded to the Office of Investigations of the DIA for insurance MgM&e verification. I do her ofpwfivy that the information provided akm upne and avrrr4Z O�'rcial use only. Do not foriie in this wrq to be coatpleMed by War town offiaaL City or Town- PermitfLieense# Issniog Authority(cirde one): 1.Board of Health 2.Banding Departmaent 3.Cityrfown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person- Phone#- r Town of Barnstable Regulatory Services Thomas F.GeDw,Director .dam. Building Aivisiuu Tom i1i",DnUd[ng Commissioner 200 Main Sti+eet,Hy=ie,MA 02601 www.town.barnstable.ma.us Office: 509-862AO39 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sabj property hereby authorize et�L (20n 6 to act on ray behalf, in all mats=Wrivn to work authotized by this buAdirig permit application for. (Address o ro Print Name P e is applying for ern* lease complete the If, zrop_ - Owner , P P mP HomeoR+ners License Exemption ForM on the reverse side. .: I License . bef, Orr Ore BOard the expir 91strati°n Valid a �.. B ne AshbBuilding)? date f poi Ind' r= °ston,M rton Play gulations and retn use Onl Ir a•02108 a jinn 1301 and Stand��0. Y / ' R Ilali wit l �4,J • Assessor's map and lot number ... . .................................... LOX. /l . 7 - /7. 7,3 _ L b n k �wlr f /t�uceC�F� - Sewage Permit number .........1.L. ..:..l�'..�E`1..../...yy�...,.�.....5..: sr�a�c -i�� THE T TOWN OF BA1� RSTABLE ii i BA"STODLB, i "6 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ ........A..S....��!.0..... ��.�.. . TYPEOF CONSTRUCTION ............................................................................................. .......... . '"l. ..................15 . a.3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................../PiP .... .�t�.c�................... 1 c.... a.r.gs. :4.i r....... dr. .....:.................................... � 7✓ a..... .. .......Proposed Use ..................................... ..� ........ `�..,e���...................................... ........................................... Zoning District ........................................................................Fire District '. °r- , a. 2i....................................... .......... Name of Owner ..... t7A'?.,&,... �ou�c /y� J ..... ...................Address ............................. .......... ..... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..............................Foundation ..........�l,-V4................... yyam�,,.................................... ................................ Exterior ...........kY �!l...........................................................Roofing ..........Asp..k 117i .............................................. Floors ................... ..............................................Interior ..............I�wwA/...................................................... .Heating ....................Plumbing .:........ Fireplace ...........................r7....................................................Approximate Cost ........./ ®(/....................... ............ . ...... ��.. s. Definitive Plan Approved by Planning Board ---------------____-----------19_______. Area ............... .............. ........... 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 .... ... .. .. Chaput, llhlfr'ed M. & Ka E. & Myron 44. Chaput 16406 barn ...............'.Permit for ..................... ... ...... No ...... IT Location ..... A ............................�16-s�z B a r n.s.t a.b 1.e.................... ....... ......... . ... ...... Owner W. c6haput. .. ...... . .. .... 'i'�� �' /� Type of Construction ..............f rams............................ ................................................................................ Plot ............................ Lot ................................ 4V Permit Granted ............Jul.....Y..1 .........7. .. .....19 73 Date of Inspection ..... lei 9 -.................... .......it Date Completed ......................................19 r PERMIT REFUSED 1 A) ........................... 19 ............... . ........... .. ....... . ............. ................. .. ... .... ........................................ ................ ........... ..,. Ir Approved ............................................. 19 WOW .............................................................................. IL. -:00 ............................................................................ A u 1 f� i 3 � t rAn� a r tri , f - t r, F , �J t r' - - . s - .. - ,-� "r' . }fig �`�ii?.r�.�*.�� «�.T•,....r',L�alr,`:s�. / ..,.r�-.�..•R �;• .. ��; It.1�+1�'�,•'.w�v t`y3��J.i�