HomeMy WebLinkAbout0630 PARKER LANE ,1
„
wm�
M EMUE
`=- - r,►- m-=r.»�.......r - - - _ ._ _ _ .:.sue
r
Town of Barnstable *Permit#
Expires 6 months from issue date
X-PRESS PERMIT Regulatory Services Fee tom? S , 60
AUG -, 1 2007 Thomas F.Geiler,Director
Building Divisfon ,o�
TOWN OF BARNSTASLE Tom Perry,CBO, Building Commissioner �•
1 200 Main Street,Hyannis,MA 02601
www.town.bamstable,ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
=I Map/parcel Number 601
Property Address
Residential Value of Work®p Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 1c�
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
' ❑ I am a sole proprietor
Q--ram.the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping, Going over existing layers of roof)
�Re-side
Replacement Windows/doors/sliders. U-Value t�7 (maximum.44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of e Home Improvement Contractors License is required.
SIGNATURE: �—
Q:Fornu:expmtrg
Revise061306
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' d 600 Washington Street
Boston,M4 02111
www.mass.gov/dia
Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /�►/ Please Print Lezibly
Name (Business/Organization/Individual): . .�/--��^^ t Cgtj . 1`-7_P
Address: (p 3 ?arkz,- C.u�
City/State/Zip:Irk Act Phone.#:
Are you an employer? Check the appropriate bog:
general contractor and I 'Type of project(required):,
1.❑ 4.I am a employer with ❑ I am a g
. employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction .
2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7.,kQ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp,insurance 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 11.❑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.
I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site
Information.
Insurance Company Name: -
A ,:_�
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 coveragre verification.
I do hereby ce fy under th pins andpenalties ofperjury that the information provided above is true and correct;
Si ature: l Date: a y
Phone#: Ir6
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.BuiIding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two.or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the
receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the
j owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
! dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to*operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C()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 complfauce 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 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.
. r
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 fo any business or commercial venture
(i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel.#617-727-4900 ext 406 or 1-$77-MASSAFE.
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
oFtKT Town of Barnstable
Regulatory Services
BAMSPABM 2 Thomas F.Geiler,Director
Building Division
ArFO AAA A
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
'T
"HOMEOWNER": dC7�`� ` �C� h"e 2 6 S 1�(
name / home phone# work phone#
CURRENT MAILING ADDRESS: lD U (�L,C�< ( `—C-
1.,..). t�c f ti S����-� U1L, y Z L 6 49
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one 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 compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable.Building Department.
minimum inspection procedures and requirements and that he/she will comply with said procedures and
req irements.��
S gna re of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the.permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
1Cr/ •� \31\
Assessor's Office(1st floor) Map 5� Lot Permit# gY 7�
Conservation Office,(4th floor) Date Issued "a2 3 9s
Board of Health(3rd floor)(8:30�,9:30/1:00-2:00) 7- 513 Fee J d��
Engineering Dept. (3rd floor) House#1 6 3 0
Planning Dept. (1st floor/School Admin. Bldg.)
Definitive Pla by Planning Board 19 � e v
TOWN OF BARNSTAB9 ��, ®����
'� a
Building P rmit Application `Project Street ress l���•,lP/� Z eY47 Ifhf
Village
Owner rt/ Address
Telephone
Permit Request t/1/f�j-7�.1///�/y�
Total 1 Story Area(include 1 story garages&decks) square feet ) ,4
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $ O'D
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
r
Construction Type � �
Commercial r Residential
Dwelling Type: Single Family Two Family Multi-Family
' Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway T 22 2,t- ,
Number of Baths Z_ No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name Telephone Number
Address/ V 1� License#
Home Improvement Contractor#
i
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. #9872
DATE ISSUED August ;23, 1995.
MAP/PARCEL NO. 152.007
630 Parker Lane
ADDRESS ` VILLAGE West Barnstable,. MA 02668 '
OWNER John C. & Chrystine LaPine - a
DATE OF INSPECTION:
4
FOUNDATION a
FRAME
INSULATION
FIREPLACE'
ELECTRICAL: , '.R'QUGN. FINAL
PLUMBING: `:'.:RO�U�GM. d `.FINAL
R
GAS: ROUGI� " FINAL
FINAL BUILDING
-4
DATE CLOSED OUT
ASSOCIATION PLAN NO.
.w.- ._ ' .. R it ...1. _ .w.. - w_ i".".^r`.i'. .�:r•'-:.Wit--w*..a-n .. r°F�"V' _..47......,.ti^-ram...-ru*•� •rnrr ,
TOWN OF BARNSTABLE
. � Permit No.3]......125..........
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash ��
7 N�
o " HYANNIS.MASS.02601 Bond .....X...
CERTIFICATE OF USE AND OCCUPANCY
Issued to Swift Realty Trust
Address 630 Parker Road
West Barnstable, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
.......April. 8,.... ...., 19...6........... ....... .�,n._ �................
(Building Inspector
..�•. TOWN OF BARNSTABLE
BUILDING DEPARTMENT
2 MAN IT :nut TOWN OFFICE BUILDING
�
°+ '639• �� HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has been issued for the building authorized by
BuildingPermit #...... ........................................................................................_..............._.. ......_..........�._....._.�
issued to ...................... `...._._./ .............7.......... ( _.................................._..............................._._.. _.».. ...___.........
___..
Please release the performance bond.
r
(TOWN OF E:ARNSTABLE, MASSACHUSETTS 6 BUILDING PERMIT'
O.
-' DATE 19 PERMIT NO. �•1
APPLICANT ADDRESS '
(NO.) (STREET) (CONTA'S LICENSE)
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEM 1 NO. ( 0POSED USE)
ZONING
AT (LOCATION) tjo O DISTRICT
(NO.) (STREET) ,
BETWEEN AND
OSS STREET) (CROSS STREET)'
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS'OR FOUNDATION
(TYPE)
REMARKS: /
AREA OR PERMIT s
VOLUME ESTIMATED COST $ •FEE
CUB) /SOU W�ET) '
OWNER
BUILDING DEPT. '
ADDRESS BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED p. FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
OR -F'CiCTiNG S.-- --]APPROVED
MADE. 'WHERE 'CERTIFICA-T-E GF-'OCCURANC`�--iS--RE-- MECH.Ap!IC-P:L;(NSTA.L-�-ATIC.NS-- c---
2. PRIOR TO COVERING STRUCTURALIQUIRED,SUCH BUILDING SHALL-NOT BE OCCUPIED UNT,ILI
MINAL IN (RE INSPECTION
TO EFOR). FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POSY THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING SS'PP�ECTION APPROVALS PLUMBING INSPECTION APPROVALS /ELECTRICAL INSPECTION APPROVALS
I
HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
OTHER - 4RDALTH '
F7- S61 "0 s
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON'PHIS CARD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
4
Z
7z,
¢,
7
14/ > ��
q6
/ -78,
dlIN
7L37-
1 �
/
zz 74 5 s4>Fr �' N
hN
32 \��sTIN� � � •
S4'
CERTIFIED PLOT PLAN
/ LOCATION
SCALE . . �,._ .� .... DATER . . .. .�.l�87.
`g PLAN REFERENCE
.S/A)A/AJ o iv f!. Se.. 23 Z
Of
o EDWf1D
E
i� LLEY No. 26100 . 1 CERTI FY THAT THE 8u!�?J_ vN��� �onisT• , .
,o
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
`^ssiAils`NOSE AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK.REQUIREMENTS OF THE TOWN OF
g �✓ST�9dG� WHEN CONSTRUCTED.
DATc
�•�.:_..�� ......� .. : - - .. .. - , •l.. . . _.%"�" >lza`-�t,t.,1���1 Wit.
77-" 7-- ���Tiv�JL--7Z REGISTERED LAND SURV 0
IL
SNP T z o c L SHE�YS
TOP OF FOUNDATION
CONCRETE COVER
° CONCRETE COVERS
e e 4' CAST IRON 12!n MAXI 12"MAX
OR SCHEDULE 40 4"SCHEDULE 40 P.V.C.(ONLY)
• ' P.V.C. PIPE PIPE- MIN. LEACH
' PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST
° LEACH I N G
INVERT a
•o EL..7._�. INVERT INVERT ? • q:
PIT OR
o , SEPTIC TANK L.oZ DIST. Z , - ;�� EQUIV.
o INVERT ... GAL. EL..7.. INVERT BOX EL.7/..7... ;. 6 a 0 ::i: " ,.
`o; EL..7.Z•.!l`•. EL.7/89 INVERT �� w0 0. 3/4 TO
WASHED
W .r'� STONE
V'DIA.
—t
—+-I � NONE.
D IA
PROFI LE ' OF diR155NY WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
Gi 74-'
SOIL LOG WITNESSED BY :
DATE . T 3i8� TIME.!��j�.A"'� . • • BOARD OF HEALTH
TEST HOLE I rz TEST HOLE 3 G7>WiI?p .�-, /<&246-,! ENGINEER
ELEV. . . 77.70• • ELEV 73,4o
�,7S.rJo
ii
erq i° 41 'b
3G.. '3 h .36 DESIGN DATA :
3
4 470 c m NUMBER OF BEDROOMS
3�► 740
7a `� TOTAL ESTIMATED FLOW . . '33a. . GALLONS/DAY
l�xt Q h h o
yc BOTTOM LEACHING AREA �s3.y . SO.FT. /PITH 76-,R P.
Alt SIDE LEACHING AREA 2� 3.,9 . . SQ.FT./ PIT/-33o C PTA
�08 c�Z.GB7 ykZ o /20�� kv [2,e3,40
CC ; GARBAGE DISPOSAL .N4^./L .(50% AREA INCREASE)
TOTAL LEACHING AREA �3- . SO.FT
? PERCOLATION RATE GCs )N E76NT MIN/INCH
i5b All 228'i �2 G-2.S¢Qro
�z.b47o C2.Go. o LEACHING AREA PER PERCOLATION RATE 4Z?.. SQ.FT./C,Pp
./Vo.WATER ENCOUNTERED DA/E. /?T dN!7?�
NUMBER OF LEACHING PITS . . . .
APPROVED . . . . . . . . . . . BOARD OF HEALTH 77W4--Zl'
DATE . . . . . . . .
AGENT OR INSPECTOR - —--- — —
OF
o EDWARD
o K L&Y
1
26100
rs, QFC/SIER��J�J�" /STE�rc
PETITIONER
.. i
WILLIAM P. SWIFT
ATTORNEY AND COUNSELLOR AT LAW
49 ELM STREET
HYANNIS, MA 02601
TEL. (617) 775-1577
December 31 , 1986
Barnstable Building Inspector
Town Office Building
Hyannis, MA 02601
Re: Christopher-W. Campbell
Land _ Park-r Road;- West Barnstable, MA
Assessor' s No. 152-007
Dear Sir:
Christopher W. Campbell is the present owner of
a parcel of land totalling 22, 765 square feet,
which..is shown on a plan recorded in Barnstable
Registry of Deeds in Plan. Book -232 , Page 79 . I
am enclosing a copy of this plan dated July 30,
1969 .
This lot has been in separate ownership since
1949 . The Mid-Cape taking caused the creation
of this lot, and it has been in separate owner-
ship since the Mid-Cape Highway taking.
Very truly yours,
WILLIAM P. SW FT .
WPS/h
Encs.
I
Assessor's offioe ,(1st door):
o� Asa PTM SYSTEM MUSS' En �iTNE,o�
Assessor's map .and lot number ............... .......... ..........,.yam Q `
Board of Health (3rd floor):' QQ COMPLtOW,1�0-2
Sewage Permit number ......C1.. . [a..J.............................. VVITH TOTLE 5 L 13AUSTODLE,
Engineering Department (3rd floor): 3 �JS' 'RPIA RONMENTAL COVE AG''-� '°o M63Q• e0�
House number ......................................... .......................... `OWN REGULATIONS ''�0"aY n`
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only.
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...Ad. 214. ....... ../Z.....�.59T1�1' .. ...................................................
TYPE OF CONSTRUCTION ........ /�1Q... i! 7 ................................................................................
G/�:........ ..........19.8�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ../...... ..../ Q ��1/ �.� .. f�c Y ��/��j44.:.......................................................
ProposedUse .... _.......................................................................................................................................................
Zoning District ............ i-i. F............................................Fire District ...0 '/Ls ..........................................
Name of Owner s�� 1 .�, c .Address ..(.%.��1-
Name of Builder ...e /4�— .......................Address
Nameof Architect ............../...................................................Address ....................................................................................
Number of Rooms ............h...................................................Foundation .
Exterior . .... . /d ...................................................Roofing ... �'. ..1�..................................................
I
Floors .... ................................................................Interior ..... ....
G�Y �I��9..............................................
Heating ...........................................Plumbing .....�.. ��� �
Fireplace ...... / r � V.5.........................................Approximate Cost .................. ...... ..... ..... .
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 all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........ .. ..�. ...
I
Construction Supervisor's License ...�� + ................
SWIFT REALTY TRUST
��#C No Permit for ......1.19%... ..........
Single
................
630 Parker Road
Location ................................................................
West Barnstable
...............................................................................
Swift Realty Trust
Owner .................................................................
Type of Construction .........Frame....................
...............................................................................
Plot ...................... Lot ................................
Permit Granted ......A!4.ciqit...?.Qr........19 87
- Date of Inspection ....................................19
Date ompletgd/......................................19
117
Assessor's offioe (1st floor): // �'rr.. y fI"r
Assessor's map and'lot number ...1. .... .,.......... Quo
Board of Health(3rd floor): �� o
Sewage Permit -number .....�. :. l.l�r..�?............................. 2 BAUSTGDLE,
Engineering Department (3rd' floor): / 3 �✓S N moos,16 9. \eeo
House number`. ........................................................................ •FOYAYa'
APPLICATIONS PROCESSED 8:30•-9:30 A.M. and 1:00-2:00_ P;M. only
TOWN OF BARNSTABLE .
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .4�14-0 ............... S74e
i t. ,
TYPE OF CONSTRUCTION- ........ ................................................................................
11 '
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ../...../' ate.... ���9 ./...�.1� �...... .`'.� �/1� .....................................................;.
.Proposed Use ...?��. ,.................................................................................... ...........................................
n
a
Zoning District E. .................................Fire District
�.: 1- '. /lS .Address J. /�'l�`� T
Name of Owner ._. � .........................
-;..................
Name of Builder .......................Address ..;'� ��ft% ..)�. `
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ...........6...................................................Foundation ...............
Exterior ... .........................................................Roofing ... ..........................
........................
iFloors .... ................................................................Interior ................e.'e's�i �..............................................
j
Heating Plumbing......................:.....:...............Plumbing ....: :. T �. ........'.......................................
Fireplace .....��.!1''.1��. .ZST4
.t . e� PP 6�
A roximate Cost ...........:
Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ..........................................
j Diagram of Lot and Building with Dimensions Fee ....................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
r
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS.,
I hereby agree to conform to all the Rules and Regulations of the Town off Barnstable regarding the above
construction.
Name ...../ �. ' ..........................................
Construction Supervisor's License ...,
.SWIFT REALTY TRUST 152—'007
/sue L�r
No .3.1125...:Permit for ....l.z... .to..ry...........
.........S.inyle..Fam ..........WQ ng......
Location ...... 3.Q...P4X .eX.. >.�.�...............
A................. B�zns.�.ab].�
...................
Owner ....... . .... ...Re. y...'Z'x.u, i-t...........
Type of Construction ....F.x.am
Plot ............................ Lot ................................
Permit Granted.......August...2.6..........19 87
Date of Inspection ....................................19
Date Completed ......................................19
(commonwealth o f Va�-Ia'cku-Utb
- �L./¢ParL»iBltl O�Jna1L�LriLi��CCLGBR[.7 j.-' ,
600 W jj fon Str¢et
r
James J.Campbell /-)oston, Waieacliw¢tb 02 f f f
•Commissioner
Workers' Compensation Insurance Affidavit -
ceesee/pesmiaee)
with a principal place of business at:
(city/sawzip)
do hereby certify under the pains and penalties of perjury, that:
Q/ 1 am an employer providing workers' compensation coverage for my employees.working on.
this job.
Insurance Company Policy Number
() 1 am a sole proprietor and have no one working for me in any capacity.
() I am a sole proprietor, general contractor or homeowner-(circle'one) and have hired the
contractors fisted below who have the following workers' compensation policies:
s
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() 1 am a homeowner performing all the work myself.
1 understand that a copy of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure
coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,soo.00 and/or ene
years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S)00.00 a day against me.
day of ,��fr/ 19
Signed this y
Licensee/ ermittee Building Department
Licensing Board
Selectmen Office
Health Department
TO VERIFY COVERAGE.INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375
. The Town of Barnstable
• MP.N ASM
NAB& $ Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 mph Crossen
Fax: 508-775-3344 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME E"ROVEMENT 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: Ad��bW,":f Est. Cost
Address of Work: ,3 PI
Owner Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000
Building not owner-0ocupied
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 hcrcby apply for a permit as the agent of the owner:
41/ma.
Date Contractor name Registration No.
OR
Date Owner's name
I . I
: HOME IMPROVEMENT CONTRACTORS REGISTRATION
I (
oard of Building Regulations and Standards I
.One Ashburton Place — Room .1301
Boston, Massachusetts 021.08
• I
HOME IMPROVEMENT CONTRACTOR I ----- �
--------------------
-Registration 100740 Expiration 06/23/96 I Jk�9!
Type — PRIVATE CORPORATION i _HK INPROVEMENI CONTRACTOR..
I -Aegietrltiom 400140
I
Capizzi Home -Improvement, Inc . I Type -...PRIVATE CORPORATION II
Thomas -Capizzi , Sr . I "ENpiration • 46/23/96 1
I
1645 Newton Rd . I I
Cotuit MA 02635. I Capizzi Home IeproveeeAt, Inc
Thomas Capizzi, Sr. i
-9 f4L4645 Newton-Rd. I
I "wmTRMR -Cotuit NA 02635 j
Restricted To: 10
DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE I 10 - Noxe
tuber: .. Expires: lirlldile: lA - lisoxrr oily
CS 146189 10/21/1976 10/29/1148 16 - 1 1 2 Falily Holes
Restricted To: 10
DAVID N IEBB
•100 PLUN HOLLON RD
I E FAI MOUTH, 1A 02$36