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HomeMy WebLinkAbout0051 MORGAN WAY l 4 t I .(1r ;, Jff/j/!1/r�ti/ aL ,/'gyp• •(-fin/ V V 1 lA METE 1070 "�� � � 1 �� �� '/� I i oFt► , Town of Barnstable *Permit # E.vpires 6 months from issue dare $,RttsrABiiK. ; Regulatory Services Fee c2 J MASS. 6S. Thomas F. Geiler, Director fon,A�" Building Division Tom Perry, CBO, Building.Commissioner 200 Main Street, Hyannis, MA 02601 tivwrv.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number. Property Address s( /� W4) lddy Residential Value of Works 006 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) A. Construction Supervisor's License At(if applicable) S PERMIT ❑Workman's Compensation Insurance OCT 16 Z009 Check one: ❑ I am a sole proprietor TOWN OF BARNSTABLEi ;P5I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Eg"'Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side. ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Pr Owner must sign Property Owner Letter of Permission. o p v t Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\W PFILES\FORMSTxpress\EXPRESSPERM IT.DOC Revise060409 k i• ' The Commonwealth ofMassachttsetts Department of Industrial Accidents t'� Office of Investigations f� 600 Washington Street Boston, MA 02111 I•v)vw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractoi-s/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): PC�(3 Address: �( /rl7RON Pt,�/ ©�G City/State/Zip: /,4�S ����' Phone #: 5VF_ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an ca acit employees and have workers' Y P Y 9. ❑ Building addition [No workers' comp. insurance comp, insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q ] 31,&Lam a homeowner doing all work officers have exercised their 1 LE] Plu bing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. oof repairs insurance required.]t c. 152, §1(4), and.we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing thcir 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: 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 PJA for insurance coverage verification. do hereby certi t r s an enalties of perjury that the information provided above is true and correct. Si ature: Date: hone#: n — �� "'7l3 _- Official itse 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 S. 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 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, constriction 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-contractors) 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 of�►+F,� Town of Barnstable o Regulatory Services t AMSTABLF Thomas F. Geiler,Director 9�{,,, "�: ,m� Building Division lED MA'1 r, 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: (© �_ y /',I JOB LOCATION: J�� &&�0 w�/ r'L&W—Ap"« nuu�mbeer LL�� � Q��Q, street l,� p village "HOMEOWNER": Ko&&QF^�/YJZ� AY-�k-7137 name home phone# work phone# CURRENT MAILINGADDRESS: 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 j tion procedures and requirements and that he/she will comply with said procedures and re qu' e S' nature 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:\WPFILES\FORMS\homeexempt.DOC i ' 1HE Town of Barnstable + Regulatory Services B^ MAS& Thomas F. Geiler,Director 039. Mass. 1°TED MAI Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I d , as Owner of the subject property hereby authorize d 901QLIN e to act on my behalf, in all matters relative to rk authorized by this building permit application for. MW Y± (Add s of Job) S74 ignature of Owner Date hl-s C Print Name l If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:OWNERPERMISSION iY a TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 174 001 063 GEOBASE ID 38884 ADDRESS 51 MORGAN WAY PHONE W BARNSTABLE ZIP - LOT 155 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 32283 `'DESCRIPTION PERMIT T E BCOO - TITTLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS': and Environmental Services BONDTOTAL FEES: $.00 SINE -CONSTRUCTION COSTS $.00 756 CERTIFICATE .OF OCCUPANCY 1 PRIVATE P *" BARNSTABLE. •,. •.. MASS. � • 039. FD MA'S A BUILDINVISIO I BY DATE ISSUED 07/22/1998 EXPIRATION DATE • w i rL� -,,, 1 . „ , (); 01 , ll : f1E8ei +DI 0 L t if ),Mt,A { Orly CIA• W '2ARL*)1'A14LL G.I.i' r 59 di,UCtt 1 au r 01 ZL _ _ nht`< IAPMF l' ?), 'I R I C11' kqi ;uMTT 1).910d DT'SCR1 TION SINCLE YAMI uY D'dH1,L,TN('. S F.`'Tlr, D 4b j&H AIT _'YPr; fldILL T1,1.TLE NFW !)j�-Nr.'IAL BLL`G }'L"rl' :jZA0j'L)R;'_ P&YS DE hOI.L,UIR-a', INC Department of Health, Safety fv'H:i'l'::CT:. and Environmental Services INE CIO .;n"'STttU�"rTts.a COi;•'S $106,8,16 . 30 "�•� r. �. SINGLE YAM HOM,F; ll 'I.'ACHq.D i PVVi.T,,. P • BARNSTABLF, s MASS. 039. I BUILDING DIVISION WiTi it;SUED 02/2A/Igpn 1.XPIrtW10,4 DAT f. THIS,Pf.RMIT 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 M FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS FROM STREET I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I AZ ..✓IN� " �J �. ; 2 �1'�� 2 —�AJI4C � G 3 1 HEATING IN PECTION APPROVALS ENGINEERING DEPARTMENT iJ 0 r �� 2 _ BOARD OF HEALTH g OTHER: SITE PLAN REVIE PPR L VH RK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS E INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY RIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- N. NOTED ABOVE. TION. I I I I I I I I I , r BUILDING PERMIT O' lr, r - i f i / r -DATA 51N6L.r-- FAMILY 4- BEL'w-oc-,w (t/ A uo - G0i 3A&E 60WvEr- EM4I Q :.DAILam( R-oW 4YIIo-"o SEPTIC TAtJV- "o Si) % DISS MAC_ PIT 51 D E Wd =2 t� �� v ► r1 'BOTTOM VEA 'L•zZ, -sF- I �\ 2- L IV A TOTAL t)a516N = gg-L Cffi. N TCrAL DAILY SON/ =Ado GRD 17'EPr-I)C.ATt ON QATE By GIZ.A 1 i• S go2r PS a° too or ��Er= -•—,, _- ���' � � '" �� ��� � �_�,mac p.� � �`iz PETER c. .rn - SULL1`.=Afd _ �la.ep:o No. �5i33 ' 'T'T.:7r: !• Ott f,l E \ - -- — — —• -- -' ' P-lob 40 I 8b'.18 tt0��-11 �a E�=a& F6-qd- Fb-Cl 1 T = 2 t f GAL gg.g SAUD �o ,N� wv gtg g8¢ ee4, Seprlc TARe RAE s :WPC wisiur + 3 3�4-I Iz ��: ; 5TD►JES w�N� Imo: Aw- 5mcruQEs sr.T . MOPF T-MA�l 44 -DEEP C �.tlo sToNE s'lAc 1. �E �k-20 u, . 3�-- C.' --I MAP C74- IR:L 1-&3 a SQuo CU�:-FrF1® PI-OT' EPY A LE— IFu D� IJ o Lr-- -GGl�T101�1 '- L"TEi1-VIr1G �G�1 L�-: I�= 4-o DATE-; GfA1 •I,�1 FLAIL Qc-1=ERF�JC� 1 C EICT I Fy -V I AT NE S�Iow N N�zEvN -:�OM1'L, S WIN TNT SIPEUQE LeT ISS Qi�D ►5 Lo,-A-�D W Tl!1 d VE 1-LooD I�i. �� 4'3�j ► r: . 15 � TFUS FLAN IS NCT- r3Ai l�5`rLOti4ElYT" plorJdl; AIJ� SuevE/oc5 i1 Or.J AN SL2s/e / AIJv rNE oFSx uL, LG IJ P-GL5E cxx) u ar oS MACU,C1� T-o E 2lrNaL `-N �pev-Ty UN�S . / dPPL.Ic,4N7;�Py;M>r 0 o� U y Tlj PO �o CYN C H Vl L) , —4 TL ' H al H C/7 •C3, 3 .--1 q M C o � as 1 Pq lA-f O 1----1 pun O a~ pq -W IH G4 N Pn O to CG w C...3 H lIl •Cl F� m QJ PQ CL U U A 0044 cn 4-3 C1 0 U2 O r U f74 13 Q 4 \I J 1 •` _ ComnwnwealM of MaiJac4ujettj 2eparfinenf 01 Jndujfria[— ccicLnfj '• 600 VVa,hin91on Sfreaf James J.Campbell AOJton, /i'/a»achuiaffi 021 11 Commissioner Workers' Compensation Insurance Affidavit 1, -?A? /1IAv 7- �f1 C y — art ys��F a Iti (Ilcensee/permigtee) with a principal place of business at: (2 Eti'TEezV f LLB 41A. Do16 3 X (city/sate/Zip) do hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. ,013i5e:7Y MOT041- /tis. to',eaaP &)C 31a 0,-:?0 /7 X 013 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 listed below who have the following workers' compensation policies: J o'g- 19 77PV HFA S H11 14-7-5 Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () 1 am a homeowner performing all the work myself. I 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 1,500.00 and/or one Years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this day of CC 12��E�cc 19 r Licensee/Permitree Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVFRArF INFORMATIOM rAII • Ai -7_-ri-r-ennn vnn-r ir% 4 4,,r - SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 WELLER & ASSOC: (L) NAT'L GRANGE MUT.- MSP45246 EXCAVATION & SEPTIC: ROBERT J. OUR (L) U S F & G - 1MP30109550901 (W) U S F & G - 771521695 DECO CONSTRUCTION (L) TRAVELERS - 660364K8342 (W) LIBERTY MUTUAL - 312446298044 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006C0023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 .f . INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932 SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 I M & R CARPENTRY (L) MARYLAND INS. GRP- SCP30235965 (W) CIGNA PROP & CAS.- C80049997 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA - MP0021014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 TILE INSTALLER: TONY AVERINOS : (L) ASSURRANCE CO. - CFP26528977 (W) HARTFORD FIRE - 77WZCY2409 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 A i r v 1 e o , e r il , 5 r Western Surety C r e y r il LICENSE AND PERMIT BOND f ` For County, City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, R Performance,Maintenance,Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond. , KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P-42�8 5'58 2 6 Thatwe, BAyside 'Building, Inc . ; of the p i1 i1 a--v- of C e n t e rb i 11 e State of Massachusetts , as Principal, n and WESTERN SURETY COMPANY, a corporation duly licensed to do business in the State Of M a s s a b„ P t r s , as Surety, are held and firmly bound unto the T r of R a r n s t a b 1 e , State of Massachusetts , Obligee, in the amount (Valid only when a County,City,Town or Village is named as Obligee) of Three hundred ninety—two and 00/ 100********'*-DOLLARS ($ 39.2 . 00**** ) (NOT VALID FOR MORE THAN$25,000) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives,jointly and severally. THE CONDITION OF THIS OBLIGATION' IS SUCH,. That wber as t e rinci al Am been licensed to construct a single family dwell-ing at Lor- 15 Morgapn a , West Barnstable. MA 2668 98 feet frontage by the Obligee. NPRUT. E FOR if the Principal shall faithfully perform the duties and comply with the laws and orN11ulk,all amendments), pertaining to the license or permit, then this obligation to be void, 0 !jp6tae 61n. full force and effect for a period commencing on the 2 3 r d day of e 'x3 r '9�' ,g�: 19 9 8 y and ending on the 2 3 r d day =7�'- 19 9 9 , unless renewed by continuation certificate. E - ' i0 vy erminated at any time by the Surety upon sending notice in writing to the Obligee and to tF ' 1}ci ME �e the Obligee or at such other address as the Surety deems reasonable, and at the expira- tio - �) days from the mailing of notice or as soon thereafter as permitted by applicable law, whlche^veil ef��this bond shall terminate and the Surety shall be relieved from any liability for any subsequent acts or omissions of the Principal. Dated this 23rd day of February 1998 �;'.. Principal P 7 - y Principal Countersigned WESTERN S U E T Y CONknANY T ° e By By p Resident Agent President 4 ACKNOWLEDGMENT OF SURETY e STATE 0 SOUTH DAKOTA 1 (Corporate Officer) v f County of Minnehaha ss ff On this day of ,before me,the undersigned officer,personally ° appeared Stephen T.Pate ,who acknowledged himself to be the aforesaid officer of WESTERN y I� SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing ; instrument for the purpose therein contained,by signing the name of the torpor n by himself as such officer. ; I IN WITNESS WHEREOF, I have hereunto set my hand and official se � fi il o J. RHONE I NOTARY PUBLIC cREAL SOUTH DAKOTA SEAL otary Public, South Dakota , c My Commission Expires 6-12-2004 Western Surety Company fi Form 849-A—12.96 , �' ''-'-'{' 1-605-336-0850 ° m - 0 o ACKNOWLEDGMENT OF PRINCIPAL (Individual or Partners) STATE OF ss ° County of ° N>� G ° v ° y: On this day of ,before me personally appeared P P ° G il l{ G U lr, known to me to be the individual_ described in and who executed the foregoing instrument and G il G ° acknowledged to me that�e, executed the same. P � il fi My commission expires P v b v t Notary Public ACKNOWLEDGMENT OF.PRINCIPAL t (Corporate Officer) STATE OF ss ° County of On this day of ,before me, personally appeared , who acknowledged himself to be the of , a.corporation, and that he as such officer being authorized so to do, executed.the foregoing instrument for the pur- poses therein contained by signing the name of the corporation by himself as such officer. My commission expires Notary Public G P aP P P F+M o i a G z se P o z z ° a ° a o cl) r r WAY M �q = 12Soo' I I ca DRAW 1 � I: 30 • 34't Ex I STo ,t FcwJ DAToU Zv .oRA o t� G L�,T L0T' ES It l 8,576 s•F 8F •�� p�IAP� tti•'Y �� / � 6AXTER Vo 2SD18 �'� wwll U'••: Y r.al4.L�pt1?a�' T CEP-T►Fy THAT THE EiLISTING CEKTIFIED ?LoT. PLAN IJDATioIJ SHoW►J HE3i Ira#J CorypLyS LocAT'IotJ I CENTEl.v%WE /W BARNS. W iTlf THE SIDE wL Amr3 senmcjL Rag uitwf 5CALF- � �301 DATE : 4I1'1/98 of TNL T•W 0 or- SAROSTA%LE A► 0 1S ►JOT PLM3 1ZEFClLE7N CE LoCATEM W ITN 14 A SX-C-JAL FL=o LoT 155 PL.BV-. 439 PCT IS- N AZf!2-D Zo iJE. 6AATE2 it NYE, ZUC. CA 4 ►'1 4 LAOD 5kjvvEyor-s - EN(rlN EEV-S osTER-VILlE MASS. OFFSETS FROM By t-�►�GS SNoQLD NoT ME USED T5 E 5TA5U614 PR-oPEV,-N, LWE S APPLICA03T : tlAj,5%DE gv11..1?►4 --rc Assessor's Office 1st floor Ma 1 ,7 `( Lot l�� �� / Permit# ��� 3 Conscrvation Office 4th floo 3 '��-� ^�'J Date Issued -o Board of Health Ord floor Enginecring Dept. Ord floor House# N �� Planning Dept. 1st floor/School Admin.Bldg.): 'Z)� b Definitive Plan Approved by Planning Board — ��r `I .� (Applications processed 8:30-9:30 a.m. & 1:00-2:00 p.m.) 119 � Ov �N S0 �C� TOWN OF BARNSTA � Building Permit Application Pro'ect Street Address -'� 6�/ LoT lSS Village Fire District Owner Address Telephone ?-7 l Q y Permit Rcguest: &:I,� 1 C1-7 Zoning District V` C Flood Plain Water Protection �P Lot Size / 5 r? 1. Grandfathered Zoning Board of ApMls Authorization �^ Recorded Current Use PropqsedUse Construction Type !/y�P17h� �i/�ya'*" Eaistina Information Dwelling Type: Single,Family Two family p Multi-family Age of structure Basement twee Historic House , l l) Finished Old Kings Highway /" Q Unfinished L/ Number of Baths No. of Bedrooms -3 Total Room Count(not including baths) � / First Floor Heat Type and Fuel V 1 e wl ,Central Air l`e4 Fireplaces Garage: Detached Other Detached Structures: Pool Attached / CCIA 1 b)(ga- Barn None Sheds Other Builder Information Name �;✓YLt' Telephone number 7-7 `0 VO Address 5 License# Q �o L_• Home Improvement Contractor# Worker's Compensation # UJC l 3 f d= a 9-017 113 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 l�y3 x Ss Protect Cost D 'Noji 77 Fee 331° SIGNATURE DATE J O BUILDING PERMIT DENIED FOR THE FOLL�OyW�INGG REASON(S) BPERM T FOR OFFICE USE ONLY ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ( -FRAME INSULATION FIREPLACE ELECTRICAL:,''ROUGH FINAL PLUMBI JG: ROUGH FINAL° GAS: ROUGH FINAL , , FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO. - V - a C),W W IvI�II 111 r n Ql J 7 -Z ji _ I j I r: � II NLl - - _ -_ rM ........... . 1 141 1 I M I _llI Cl --CI j I � I � j i i EM (ill: IEM- ]-�IL ''•I i i � �� _ • '� r -�1 � -- -{ ..i � .-:_-, i - ,I �.:�� _ �_-_ � , . � . �' .�._� ,;,: // I � � � � , ,,;� � � , �;� a ,;. ;; . ; z i ` ' .. } � , ; /� � � --__ �, ., . � � .__ � .. ���, � � � I ��.. � ___ -_-.'- _� _. _I _ A_ ��-- - - L yVIL _ 1 al( — il I i ,J l z Y d I � I Eg i IL ► :I 1I EEB I I i Ls�� Jo J O o �. y fa, ofl i Q i y p ZuA Z J•la ('1 QI Q 77 1 19 Ci .ip .."b iS .. ..O•,O I 6 L 0 � J o L J —' IJ 0 N 0- it 0 ol0 — iii. . 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