HomeMy WebLinkAbout0003 MINTON LANE .�&D,i-L,nl ,40. 152 1/3 ORA
ESSELTE
w a
.�"a Town of Barnstable Building
s Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept I
Posted Until Final Inspection Has Been Made. Permit
1bs� ��
° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. I
Applicant Name: Dzmitry Labkovich
Permit No. B-19-18 Approvals
Date Issued: 01/04/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/04/2019 Foundation:
Location: 3 MINTON LANE,WEST BARNSTABLE _ Map/Lot: 174-007-007 �- Zoning District: RF Sheathing:
Owner on Record: PAWSEY, KEVIN J & LISA Contractor Name: \ROOFING AND SIDING OF CAPE Framing: 1
COD LLC.
Address: 3 MINTON LANE 2
-_. Contractor License: 170787
WEST BARNSTABLE, MA 02668 �1� Est. Project Cost: $8,425.00 Chimney:
Description: New roof 1
�
Permit Fee: $42.97 Insulation:
Project Review Req: I� /
t r' Fee Paid: $42.97 Final:
w�
Dater 1/4/2019
Plumbing/Gas
Rough Plumbing:
I s Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the�approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for;public inspection for the entire duration of the
work until the completion of the same. } f T
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
v. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel IMI Permit# 1
Health Division o u C , Dv t Date Issued (__3 s t 'S
Conservation Division �o ( Applications�Fee
Tax Collector ' yo 4 Permit Feew
Treasureri�
SEPTIC SYSTEM MUST BE
Planning Dept. INSTALLED IN COMPLIANCE
WITH TITLE S
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AN[
Historic-OKH Preservation/Hyannis TOWN EGULPTIONS
ua
Project Street Address
Village w-e5� /2NSTi4���
Owner 0��- /L/� /2O 6 elz ` Address
Telephone '
Permit Request _ /tiS 1-;9 LL- 4- �� / lN�,�p d�✓ S to I nt io �Gl �OdL
sR�e/ wall, L/C 41�-ez
Square feet: 1 st.floor: existing proposed �� 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 006 Construction Type . ' e? �qGl
Lot Size 931. 7S 0 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family t Two Family ❑ Multi-Family(#units)
Age of Existing Structure y Historic House: O Yes O No On Old King's Highway: ❑Yes ❑No
Basement Type: %Full ❑Crawl O Walkout O Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 900
Number of Baths: Full: existing new Half:existing / new
Number of Bedrooms: existing_ new
Total Room Count(not including baths): existing (9 new First Floor Room Count 3
Heat Type and Fuel: Z Gas ❑Oil ❑ Electric ❑Other )
a
Central Air: , IYes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes' quo
L
Detached garage:❑existing Cl new size Pool:O existing ❑new size Barn:O existing ❑neF__ size"
Attached garage:0.existing O new size Shed: existing O new size Other: o c�
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
co
Commercial ❑Yes ❑No If yes, site plan review# c;i -
Current Use Proposed Use
BUILDER INFORMATION
;S os, Sot-�3-U -9 7
9
Name � /� ,R2f.� Telephone Number
Address 3Y1.3 e�411LJ S,,— License# &3S
Home Improvement Contractor# / 6 00
Worker's Compensation# lbd C�76O 5373D10 02
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE < DATE G — 20 ^ 0 3
f
i
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
i
MAP/PARCEL NO.
Y
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
. FOUNDATION ioc a
FRAME
3
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
s
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL.BUILDING.
IFS . _� � - �`• -
DATE CLOSED OUT
ASSOCIATION PLAN NO.
f
i
�oI'THE1p�'� Town of Barnstable
Regulatory Services _
t aAaxSWLE, Thomas F.Geiler,Director
KASS
9�,erF p�9- 01 Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-962-4038 Fax: 508-790-6230
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. ' -/r .
Type.of Work: /16920ido S�Ii � G ���� Estimated Cost
Address of Work: 3 tOA) �4"J'e_
Owner's Name: f �C9 A 6-e&�
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
OBuilding 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 TEE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the age t of the owner:
Date• Contractor Name Registration No.
OR
n .e Owner's Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ounce oflasesmosdoos
_ 600 Washington Street
-= Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name
location: 3 Al/N RAJ t A `e--
city war- BN&m,s2 � phone
❑ I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one woiz in ca acity
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❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
workers' co ensation olices:
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yxa=to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sae up to SI,S00.00 md/or
one yam,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to e Ofnc f Investigations of the DIA for coverage veriScatlon.
I do hereby a the pen es of perjury that the information provided above is into and correct
Signature Date b p,9y -.03 —
�t<� � Phone#
Print name '
official use only do not write in this area to be completed by city or town official
city or town: perudtlliceme# ❑Building Department
❑Licensing Board
❑checkif immediate response is requited ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
ocvis 9/95 PUU
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.
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 along with a certificate of insurance as all affidavits maybe
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an
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 permrtllicense number which will be used as a reference number. The affidavits may be retumed'in
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.
�Deparement's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Me 01 Inves[IgauOus
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
FSHE Tpy, Town of Barnstable
~O
" Regulatory Services
„ r
9 BARNSTABIZ$ Thomas F.Geiler,Director
1639• ♦0
�lE039 ° Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, � Y c �TS , as Owner of the subject property
hereby authorize ` C�t.SL2D S��vS�/ to act on my behalf,
in all matters relative to work authorized by this building permit application for:
r ) o v n'10
(Address of Job)
03
Signature of Owner Date
Print Name
Q:FORM&OVRIM"ERMISSION
CIL-\
NOTICE z NOTICE
TO TO,
lop
EMPLOYEES EMPLOYEES----
The Commonwealth of Massachusetts
DEPARTMENT- OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you
notice that I(we) have provided for payment to our injured employees under the above mentioned
chapter by insuring with:
ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY
NAME OF INSURANCE COMPANY
11 NORTH AVENUE, P.O. BOX 4070 BURLINGTON MA 01803-0970
ADDRESS OF INSURANCE COMPANY
AWC 7005575012002 001 11/17/2002 - 11/17/2003
POLICY NUMBER EFFECTIVE DATES
PO Box 1013
United Insurance Agency Inc Buzzards Bay, MA 02532 (508)759-6595
NAME OF INSURANCE AGENT ADDRESS PHONE
Richard T Senoski 3413 Main Street Barnstable, MA 02630-1234
EMPLOYER ADDRESS
11/18/2002
EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish
adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act.
A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician.
The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary
and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that
the insurer has arranged for such attention at the
NEAREST AND BEST MEDICAL FACILITY
NAME OF HOSPITAL ADDRESS
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P
PLEASE ROTE, The structures as shown on this plot plan are approxinu to only. An actual survey is tteoessary for a precise
determination of the building tocation"and encroachmtnts, if any exist, either way across property lines. This plan must not be
used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan
purposes. This plan must not be used W locate property lines. Verification of building locations. property line dimensions, fences
or lot configuration can only be accomplished by an aocurate instrument survey which may reflect different information than what
is shown hereon. Please tote that this is `NOT A BOUNDARY SURVEY'_and is.."FOR INOR 4G.j PURPOSES. OAtI.Y".... .....
COLONIAL LAND SURVEYING COMPANY, INC.
• � ✓/te i�aminzovuve¢C!/ a�,�laaoa�,�uraeCla i
I
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 106009
Expiration: 7/21/2004
Type: Individual
RICHARD T.SENOSKI
Richard Senoski
3413 MAIN ST.
BARNSTABLE,MA 02630 '�✓/ '-
Administrator
I BOARD OF BUILDING REGU
License: CANS CATIONS
TRUCTION SUPERVISOR.Number CS� 009635
Expt 003
j M!&2 Tr.no: 8509
Restricted
RICHARD T SENOSKh
3413 MAIN ST
BARNSTABLE, MA 02630
Administrator
I
Town of Barnstable
of IKE ip�
.�, Regulatory Services
Thomas F.Geiler,Director OF BARNSTABLE
r +
BAMSTABIE Building Division
�A 1639- .0 Tom Perry,Building Commissioner2001 MAY —9 AN 10: 45
rEnr A 200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 DilVax-. -790-6230
J
Name
0 �/ N-en.
Title
Af
Mailing Address
Complaint location&Entity Name
Number&Type of signs
My signs have been returned to me and I have been informed
that a repeat offense may result in fines not exceeding $300.00
per day per offense.
S e Date
J:\Complaint Inv Reports\Sign Return Form doc
Town of Barnstable
IKE Regulatory Services
c Thomas F.Geiler,Director
Building Division
3ARNSPAB1E.
v esnss. $ Tom Perry,Building Commissioner
�'OlED µpl s�0 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 F 508-790
Fee:
Approve :c'
. '
Permit#: �-
HOME OCCUPATION REGISTRATION
I
Date: V
Name: 14,3 W A-f o L t'r+S Ph e#:
Address: M i 3140 N L N /I rAl
Name of Business: N t 1- u i. Y-k
Type of Business: N i -f 0 eN 111-0J'a+n'n T�,"IL S4.'Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by.such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• 'There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have a and agree with the above restrictions for my home occupation.I am registering.
Applicant: Date: V db
Homeoc.doc Rev.5/30/03
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which
you must do by M.G.L.-it does not give you permission to operate.). .Business Certificates are available at the Town Clerk's Office, V FL,367. ca
Main Street,Hyannis,MA 02601 (Town Hall)
DATE: S+ Q V G 0
Fill in please-
APPLICANT'S
.L
APPLICANT'S YOUR NAME: o W Ar o h er-f s
BUSINESq YOURl-(O ME DDRESS: 3 i.► ,,r lr�
e-4t. �A.rxi z e M,A 0a..KC $
TELEPHONE # Home Telephone Number K o � N Sr 5 6
i a3 P -6F
NAME OF NEW BUSINESS i YL Q -. ; YL TYPB OF.BUSINESS. 4 'a
IS THIS'A HOME OCCUPATION?.' - Y--ES NO
Have you Been given approval from the building:division? 'YES NO ►7
00
ADDRESS UP BUSINESS. MAP/PARCEL:NUMBER ! —-
When starting a new business.there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -.(corner of Yarmouth.
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COM NER'S OFFICE
This individ I h s en-in of any permit requirements that pertain to this type of business.
Aut rize_d ' nature**
COMMENT i ( rd 'o .5
2. BOARD OF HEALTH
This individual has e n ' forme a per. it requirements that pertain to this type of'business.
CL .
Authorized Signature*
COMMENTS: h U A�Gi, �c
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
sT�T�
sER IG��A y ,
R,so V roe Rogo ��UT�
2� 44 6
3. 79
o LOT 7
O 43,704 sf
O 1.0 acres
LOT 6 `v s9 2
HOUSE UNDER S1,
CONSTRUCTION LOT 8
TF = 121.5' O
. co
N
0
A 0.29, ACCESS/UTILITY
CCESS/UT/C1 EASEMENT
e4SEM£NT
JOB # 96-426
C'ER TIPIED PL 0 T PLAN
LOCATION : SERVICE RD. WEST BARNSTABLE, MA PREPARED FOR:
SCALE : 1" = 50' DATE AUGUST 13, 1997
REFERENCE LOT 7 PB 528 PG 84
PRESTIGE PROPERTIES
I HEREBY CERTIFY THAT THE STRUCTURE `NN Of 444
SHOWN ON THIS PLAN IS LOCATED ON THE i o
GROUND AS SHOWN HEREON. ' AHNE r
on sae Fez-ss+� �`' r
C 306 362-OW a ALA
`r No. oe
own cape engiaeering, inc.
�ti4t LAN J
CIVII. ]ENGINEERS ---- -�— —
LAND SURVEYORS
)939 main 6L yoffnv , ma 02675 DATE REG. LAND SU. OR
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-e,1P-CAF-Ct OVATION ---�L�PT C1 NATION wmHu®lu
0
TOWN OF BARNSTABLE
CERTIFICATE OF OCCUPANCY
PARCEL- ID 000 000 099 GEOBASE ID
ADDRESS 3 MINTON LANE PHONE
WEST BARNSTABLE ZIP
LOT BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT
PERMIT 27289 DESCRIPTION CERTIFICATE OF OCCUPANCY
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES:
BOND $.00
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY 1 PRIVATE Pf;4►),La:
* 1ARN3TABLF, •
- IAS&
BUILDIN., DI-"" ION
BY its-✓
DATE ISSUED 11/21/1997 EXPIRATION DATE
I
TOWN OF BARNSTABLE .
BUILDING PERMIT
I; I
PARCEL ID 000 000 099 GEOBASE ID �
ADDRESS 3 MINTON LANE PHONE
WEST BARNSTABLE ZIP —
LOT BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT
IPE&MIT 24875 DESCRIPTION SINGLE FAMILY (sew # 97-392)
IPBWMxT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT
ftrkRACTORS: KENNETH B SADLER Department of Health, Safety
ARCiITECTS: and Environmental Services
P�O;�nTAL FEES: $280.98
OND - . 1 $.00 0�
,CONSTRUCTION COSTS $90,640.0
r
10L SINGLE FAM HOME DETACHED 1 PRIVATE P:�:I
BARNSPABLF, •
OWNER 039.
EA A
. ADDRESS M►�
BUILDIN.WDLVISIO-N
BY
DATE ISSUED )08/07/1997 EXPIRATION DATE �"�
TOWN OF BARNSTABLE ; -
BUILDING PERMIT I r
1
PARCEL ID 000 000 099 GEOBASE ID
ADDRESS 3 MINTON LANE _. PHONE
WEST BARNSTABLE I ZIP
. LOT BLOCK LOT SIZE _ w
DBA DEVELOPMENT DISTRICT
PERMIT 24875' DESCRIPTION SINGLE FAMILY (sew # 97-392)
PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT
CONTRACTORS: KENNETH B SADLER Department of Health, Safety
ARCHITECTS: - and Environmental Services
TOTAL FEES: $280.98 �im
BOND. $.00 ,
,CONSTRUCTION COSTS $90,640.00
101 SINGLE YAM HOME DETACHED : 1 PRIVATE P .t;�:.Iti
' STABLE, ;
MASS,
I OWNER >t6g9.
9
ADDRESS
� a BUILDIN0G6 VISIO
r, BY ,
DAATE ISSUED k08/07/1997 EXPIRATION DATE ;
A. .
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED 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 FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
3.INSULATION. /'' OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
VISIBLEPOST THIS CARD SO IT IS
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
2 2 2
3 1 HEATING I S ECTION APPROVALS ENGINEERING DEPARTMENT
2CZ 2 A h'4I� 11 Z/-97 �F ALTH 1
OTHER: SITE PLAN EVIEW APPROVAL
I
1
WORK SHAL OT PROCEED UNT PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED E STRUCTION WORK IS NOT STARTED WITHIN SIX. CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS . TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION.
i
� �
o �
� �
- z
� �
The Town of Barnstable
% BAR-qr,I.E.
MA Department of Health Safety and Environmental Services
SS. g
0119. �0
�fo �° Building Division
367 Main Street,Hyannis, MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection( ti
Location '—C�. Permit Number
n
Owner Builder PynoI,- 4 R
One notice to remain on jobsite, one notice on file in Building Department.
e following items need correcting:
U �1 L ) �)
- b V-L e-A -�
C
Lc
C
t —6
2
Please call: 508-790-6227 for re-inspection.
Inspected by
Date
�. ,ter-_-... . . ,,.. .. - _ 'T.�,•.y' T-s.-v.f�l-' _ ._..
Ft r The Town of Barnstable
BAHNSTABLE. • Department of Health Safety and Environmental Services -
MASS.
Building Division
367 Main Street,Hyannis,MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice .
Type of Inspection Y VIA
P
i Location / Permit Number
Owner Builder
..One notice to remain on jobsite, one notice on file in Building Department.
e following items need correcting:
U 4 v
to
I YUJJ 1��L
r
I
e
Please call: 508-790-62Q27 for re-inspection.
Inspected by —�
Date 1�
004::5) -0?Z7 P117w- oP- ASS
Engineering Dept. (3rd floor) Map rT Parcel_ 7, JZCd$ Permit#
House# -'O�3 r--d9 Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fe i
Conservation Office(4th floor)(8:30-9:30/1:00-2:00)
Planning Dept.(1st floor/School Admin. Bldg.) S V$T BE
Definitive Plan Approved by Planning Board e7 3 U:" 19 - LIANCE
/�- TOWN OF•BARNSTABLL DE AN®
Building Permit Application
Project Street Address e y
Village 0 a -,-s Ea la' 4e
Owner t Pro ar Address �C vs 'a-.1 1".0-V
Telephone
Permit Request c o x s E,-vc.f A-ew
f"�4
First Floor q y y square feet,,Second Floor y square feet
Construction Type l,,".1 �=
Estimated Project Cost $ '_ %0,6 Wi
Zoning.District Flood Plain Water Protection
Lot Size Z/3, -70 Li Grandfathered ❑Yes ❑No
Dwelling Type: Single Family I( Two Family ❑ Multi-Family(#units)
Age of Existing Structure .1/a Historic House ❑Yes Li(No On Old King's Highway ❑Yes (djNo
Basement Type: dFull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 9 Y`1
Number of Baths: Full: Existing 6 New Half: Existing New
No.of Bedrooms: Existing New
`Total Room Count(not including baths): Existing 6 New L First Floor Room Count
Heat Type and Fuel: dGas ❑Oil ❑Electric ❑Other
Central Air ❑Yes dNo Fireplaces: Existing 0 New f Existing wood/coal stove ❑Yes OINo
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
((Attached(size) "'X .Z 7 ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes IdNo If yes, site plan review# -
Current Use A, Proposed Use d c �y
Builder Information
Name pr S f -c nr Telephone Number -7 1- ow
Address E" License# 0 3 9 0 IR 0
° Z V Home Improvement Contractor# G
Worker's Compensation# I j C V 00 -7(-0
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONBSTRUCTION DEBRIS RE/SUL/nTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE
BUILDING P1 RMIT D.�EED�FOR THE FOLLOWING JREASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. 17�
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION-,
FOUNDATION:
FRAME;', ( GlOv
INSULATION
G �j lam"
FIREPLACE �• 2 1 � l
N
1
ELECTRICAL: ROUGH FINAL.
}ti,
PLUMBING: }RQ:UGH _ FINAL
GAS: ( JGH FINAL
3T711
FINAL BUILDINGS
or, .a y
r' cat'
DATE CLOSED O.UXtr-
Est �,. �.:•
ASSOCIATION PLANNN- O.,.-
" ''
The Town of Barnstable
�RNSTABLE. Department of Health Safety and Environmental Services
•asa .0g
�F1639. Building Division
367 Main Street,Hyannis, MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
I
Type of Inspection1 .
q�
i
Location ` A 4\� ��-�, Permit Number Z
Owner Builder
Builder
i
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
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Please call: 508-790-6227 for re-inspection.
Inspected by -A"
Date
1► The Cuntinottll'ealth of Alassachusetts
' Ti I Department njlndtrstrial Accirlcnts
AM=o1/0yestlgat/vns
600 WashtttJ- ott .Street
BON1011. Ma.v.v. 07111
Workers' Compensation Insurance Affidavit
Ple
_._- PRIIY'T'•lebi, l,L �M' _ ---- -
Applicant information: -_.: �__ __- ase , _.-_....._.... ..
n.me
,
location• COT 7 "'" e JZ rl
City L•/ },'� r n S ila 6 Z< _ Phone# -7 t "Oi'SD 3
I am a homeowner performing all work myself. '
I am a sole proprietor and have no one working in any capacity
... .. -.v-,"?•'• --R--;:•.-:aew e..,.,�TnT. :,.y. �.,•.!o.-...oF----•---�!:9ew`--.-•rrn�•s+-r•-•^-. �T!..�,s..w .__.+ .,..
II am an employer providing workers' compensation for my employees working on this job.
comliany name:
address:
city: phone#:
insurance co. c✓ev60��-7
lie •#
,. _ —
I am a sole proprietor, general contra tor, or homeowner(circle ate) and have hired the contractors listed below who have
the following workers, compensation polices:
company name:
address:
city: phone#
insurance co nolicy#
co nJ pa ny nnin e'
address:
city: Phone#:
insurance co nolicy#
-- ... r ". . om. = '�_"; ''�"_ ' �.,».^. :^> '�t•.�_=��,--_'.s� 77
Atmch additional she' = '. ' n.
_
Failure to secure coverage as required under Section 25A of A1GL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 and/or
One years' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this Statcnlcnt may bc�fornyard to the Once of Investigations of the D1A for coverage verification.
I rto herehv certi r r J r ti r pai sand pen ti s ojperjurr that the information provided above is true and correct.
Sienature Date
Print name W Phone# -?
rT
Cil- -�,�--Cor
iaPuse uuniv do not pyrite in this area to be completed b% city or town official
town: permit/license q rIBuilding Department
C]Liccnsing hoard
I]check if immediate response is required ❑Selectmen's Office t+:
Cjllcalth Department
contact person: phone#; raOthcr
,m,scd 3:114 PJM
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 etnploree is defined as every person in the service of another finder anv
contract of hire, express or implied. oral or written.
An en►plorrr is defined as an individual. partnership, association. corporation or other legal entity, or anv two or more of
the foreuoin�u, 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
dwellin- house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or on the _rounds or building appurtenant thereto sliall not because of such employment be deemed to be an employer.
MGL chapicr 152 section 25 also states that ever' state or local licensing agency shall vvithhold the issuance of-
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for anv
applicant who has not produced acceptable evidence of compliance -,vith the insurance coverage required
Additionaliv. 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 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 tite city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have arty 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.
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 Live us a call.
y.._y,.,,-}......_,..:. ...__..,�.._v:....... .- .. .v.r.r..:_ ...-..u.w- ..,e,,,..i__.....+�rnn.+.-••.n..:a..,...m+vr�,.Tt _ ••.-.rev-�•n•ws...o»77
7'
. ... _. .. .. .. .. .. •�+.�.,.-sue _
The Department's address. telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 NVashington Street
Boston,Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
:.. . ..
'A CORD CERTIFICATE OF LIABILITY INSURANCE H, ^,� D Y
I PRODUCER U tl J���
John McAlpine THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ills . A enC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
20U post C�ffi.ce Suarc
r y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
q ALTER T_HE COVERAGE AFFORDED BY;,THE POLICIES BELOW.
Centerville , MA .02632
COMPANIES AFFORDING COVERAGE
COMPANY
INSURED A Eastern Casualty
COMPANY
Prestige Porpr?rties , Inc . 8
1645 Falmouth Rd . , StL E-1 rOMPANY
Centerville , MA 02632 C
COntvANv
„.
GAV.ERAGES
HIG IS TO CERTIFY THAT THE POLICItS OF INSURANCE LISTCU BELOW HAVE 8FFN I$Sl.i[[)TO THE IIJSIJRED NAMED ABOVE FOFi T HE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REomnEMCNT.TERM OR CONDITION OF ANY CONTRACT OR OTHER 110CUA1tN 1 WITH RESPECT TO WHICH THIS
CERTIFICATE MAY I U ISSUFD On MAY PEHTAIN, THE INSURANCE AFFORDED BY THE P'OLICICS DESCRIBED HEREIN IS SUBJECT TO ALL THE TEHms'.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE OEEN REDUCED BY PAID C'I.AIMS.
TYPE 01'INSURANCC LTR POLICY NUMBER POLICY GII!'CTIV! I POLICY EXPIRATION
DOTE(MAVDDNY) DATE(MI.UDD/YY) LIMITS
GENERAL LIABILITY
_ COMMERCIAL GCNCRAI I IAKILIrY: GENERAL AGGREISATE S
CLAIM,MAOC OCf IrH PRODUCTS-COMP/OP AiiG $
i
!$OWNER'S&1:OIJTRACT0f1'1i YHU I PERSONAL A ADV INJURYI
FACHOC17LIRRENCE I $
t _ I FIRE UAMACE(Any one fire) $
AUTOMOBILE LIABILITY ' ' ' I I MCD CXP(Any one Pcrsurl) $
i ANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS
_ I SCHEDULED AUTOS OOOII Y 114.111RY
HIRED AUTOS (Per perwn) S
NON OWNFf•AUTOS I I BOUILY INJUHY
j i (Per ecclaenl) $
I .
i
PROPERTY DAMAGE S
GARAGE LIABILITY
ANY MITI) AUTO ONLY•CA ACCIOCNT S
OTHER THAN AUTO)ONI Y
FACI I ACCIDENT !:B
EXCESS LIABILITY AOOREGATE $
EACH UCCUfU,ENCE $
UMBRELLA FORM11
OTHEfi TH.4P,UA7DRCLlA FOkr�f
AUUREGATE
WORKERS COMPLNSATION AND $
EMPLOYERS'LIANILITY WC STATU- !OTI-I.
TORY LIMITS En
'a'. THE PROPRIFTOF1 WCV 0 0 2 2 7 6 8 2 EL EAi:H ACCIDENT S .
INGL 06/..1/g7 06/21 /58 100, 000.
Pfn.c,R1 AR1', IITIVF EL DISEASE•POLICY LIMIT $
OFfICCRS ARf EXCL 500, 000.
OTHER :' EL DISEASE-EA EMPLOYtt $ 100 , 000 .
DFSCRIPTI N F P
Q 0 0 ERltTIONS/IOCATIONSNEHICL'E3lSPECIAL ITEMS
Building Contractor
............... ... _. ...._. .
CERTIFICATE HOLDER '
.. .. :. CANCELLATIpN ,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1I
Durnatablc EXPIRATION TION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL !
230 sol.1 t h St . DAYS WRITTEN NOTICE TO THE CERTIFICATE IIOLOCR NAMCO TO TILE LEf•T,
Hyannis , rM 02601 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
i OF ANY KIND UPON TOE COMPANY, ITS AGENTS OR REPRESENTATIVES
AUTMORI �RETAV�
L_ r
ACORD 25 S(1/95) C m ACORD CORPORATION 1988
r
„� .aie C":u:r�rrtrtuwulCl c�..F'l.r.;xZc6ir:::�(.!•
Restricted To: 00
F OBPARTNERt DP PUBLIC SAFETY 39422
CORSTRUCTIOR SUPERVISOR LICENSE 00 - None
µs^y Number: Expires:
16 - 1 & 2 faDily Holies estricted To: 00 Failure to possess a current edition of the
Massachusetts State Buiilding Code
%e.�.+•�►'��! : . REARETH B SADLBR is cause for revocation of this license.
PO BOB 1149/17 OAR VIEW TER / U
- HYAARIS, MA 02601 �/ '
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