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HomeMy WebLinkAbout0098 BRANT WAY 9s /�� e A ! � Towri of BarIIstabi0 *Permit# p� Erpires 6 months&M is ue date. l • s Regulatory Services Fee a RARNSTABLEs �cb 1D 3� Thomas F.Geiler,Director Bid1ding Division Torn Perry,'0$O, Building Commissio5er 200 Main Street,Hyannis,MA 02601 ww W.to w n.b am s tab[e.ma.us Office: 508-86 -4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Preis Imprint , Map/parcel Number I �� Property Address yt/T (,•�'{4 N `✓w-C residential Valul of Work '�� OP ;Minimum fee of$25.00 for Work under$6000.00 Owner's Name&Add ess n tz?1 1 U R kl 77 Contractor's Name I � M Tele77 phone Number Home Improvement Cc ntractor License#(ref applicable) j f 3 ' Construction Supervisor's License#(if app)icable) `/d y Workman's Compen,pation Insurance PERMIT Check one: ❑ I am a solt proprietor ❑ the H imeowner 0 C T __2 5 2010 : I I have Wo ker's Compensation insurance 70VVN OF B/aRNSI"ABLE Insurance Company Na e L ' 21 !an✓ VA f Workman's Comp.Poli y#_ Copy of Insurance Compliance Certificate must accompa�ty each permit. Permit Request(check I ox) i ❑ Re-roof(st ipping old shingle.si All constructi6i debris will be taken to Re-roof no stripping Going oer_L_exis ng layers of roo fl` ❑ Re-side I #of doors ❑ Replacemint Windows/doors/.sliders. U-Value ! (maximum,44)#of.windows "Where required; Issuance of this permit doh$not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: I Property Owner t'ust sign Property Owner Letter.of Permission. A copy of the Hone Improvement Contractors License& t onstruction Supervisors License is re i ed. I 1 ` C SIGNATURE: QAWPFILES\FORMS\building permit forms\EXPRFSF dnc The Commonwealth of Massach usetts Department of Industrial Accidents d Office of Investigations l 600 YVashington Street r Boston, MA 02111 fvfvw:mass.gov/dia Workers' Compensation Insurance Affidavit: ]Build-ers/Contractors/Electricians/Plumbers Applicant Information Please Print Lep_ibly Name (Business/Organization/Individual): 111c.r1 fip►^"' Address: L �QAn�T INCH City/State/Zip: �`� 6 A4+ 1 s Mo- DAM Phone #: S09- Are you..an employer? Check the appropriate box: Type of project(required): 1.EY<am a employer with 4. "0 I am a general contractor and L —P_ 6. El New construction employees(full and/or part-hme).* have hued the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet.- 7. ❑Remodeling ship and have no employees These sub-contractors have g, E] Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance.$ required.] 5..F] 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.worl�ers'_comp,. right of exemption per MGL 12. oof.repairs P P _ 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 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. lContractors 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. Q Insurance Company Name: L t Policy#or Self-ins, Lic.#: Expiration Date: . Job Site Address: G1 1 Qe4";I: i.`A City/State/Zip jj!'i/9tvnvi 01,0I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a der the pains and enalties of perjury that the information provided above is true and correct. '. Si nature: C' Date: 10 I y ID i. . Phone#: ���, '7-1���y�� Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk_4. Electrical Inspector 5. Plumbing Inspector -6. Other Contact Person: Phone#: 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 numbers) 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 LI P 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 of town maybe 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 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 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia r o�IME Tom. Town of Barnstable Regulatory Services uRNSPABL.E, Thomas F. Geiler,Director 9 M^ss. $ Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwwaown.b arnstabk.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder UG ,as Owner of the subject property hereby authorize �� &ZA A . to act on my behalf, in all matters relative to work authorized by this building permit application for: 13 i r (Address of Job) ., 0 Signature of Owner Date r. Print Name If Property' Corner is,applying for permit please complete then Homeowners License Exemption Form on the reverse side. Q:FORNIS:OWNERPERMISSION -. .. ,:0 s+`'t;.y'Lfy,.�•w yr'L .,r wee.,,rnt5, y Town of Barnstable �0*Ywe rq�� o� Regulatory Services 4 Thomas F. Geiler,Director BAMSrnBLE, 9� 1639. ,�� ]Building Division ATfD^u'�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02.601 wtivw.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /t Please Print DATE: ✓V 10B LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 requirements. Signature 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 homeownws 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:\WPFLLES\FORMS\homeexempt.DOC ® .. DATE(MMlDDlYYYY) A�>o CERTIFICATE OF LIABILITY INSURANCE 7/26/2010 PRODUCER FRANK L HORGAN INS AGENCY INC THIS.CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LE ROAD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 44 BARNSTAB HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HYANNIS, MA LE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)775-5830,. 508.775-6688 INSURERS AFFORDING COVERAGE NAIC# INSURED GARY GRAHAM - - - INSURERA: LIBERTY MUTUAL GROUP - DBA CARPENTRY SPECIALIST INSURERB: 66 BRANT WAY INSURERC: HYANNIS MA 02601 INSURER D: - - .. INSURER E:. - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS:SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD' - POLICY EFFECTIVE POLICY EXPIRATION LIMITS T POLICY NUMBER DATE D DATE M D GENERAL LIABILITY _. - _ EACH OCCURRENCE $ COMMERCIAL GENERAL IiABILiT'( - DAMAGE TO RENTEDP REWSES'Ea occurrence) -$ CLAIMS MADE. OCCUR - MED EXP(Any one person) -$ -- PERSONAL 8 ADV INJURY $-GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT. ANY AUTO - _ (Ea accident) - $ ALL OWNED AUTOS - - - - BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - - .OTHER THAN - EA ACC $. AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY- - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31S-328005-020 3/23/2010 3/23/2011. `/ WGSTATU- OTH- AND EMPLOYERS'LIABILITY - Y/N - ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT- $ 100000 OFFICERIMEMBER EXCLUDED?. Y - (Mandatory in Nr:) El.DISEASE-EA EMPLOYE $ 1 !. non00 If yes,describe under SPECIAL PROVISIONS below - - E.L.DISEASE-POLICY LIMIT $ 500000 OTHER - - .DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - Workers Compensation Insurance:Part One of the policy applies only to the Workers'Compensation Laws of the State of MA. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR GARY GRAHAM CERTIFICATE HOLDER CANCELLATION - - - SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS'WRITTEN 200 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,.BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE JQ Jeff Eldridge )46 ACORD 25(2009/01) ©1988-2009 ACORD CORPORATIuN. Ail righ:� ;a3a^�e '. CART NO.: 7.92_324 CT T-NT COD-: 1235006 Anne C`•:anal' 7/2E/2010 2:SF M Page _ C: _ f License or registration valid for mdrndul use only, before the expiration date. If found return to P Board of Building Regulations and Standards '. ;- One AshburtoniPlace.Rm 1301 - a i .-,Boston,Ma.021,08 Abi -- - - Notva I withoutsignature — --- i , CA ✓fie a��l� lclluaeC7v — \— Board of Budding Regulations and Stand :rds HOME IMPROVEMENT CONTRACTOR Registration; 123659 r'y n; 3 25/201.1 7 1' TYpet' Individual }+J Exp�ra Tr# 28164 Gary C. Graham Gary Graham 66 Brant Way � Nyannis,•MA 02601. Adininistiator i r � •INIassuchusetts- Department of Public SafetN BOMA of Building Re'lulations And Standard. - Construction Supervisor License License: CS . 42246 Restricted.to: 00' _ GARY C GRAHAM 66 BRANT WAY HYANNIS, MA'02601 ? Y Expiration: 3/20/2012 ('unuuissiuYcer, Tr#: 18292 ry Town of Barnstable Expires 6 months from issue date Regulatory Services Fee s• © z5 Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 Ft www.town.barnstable.ma.us =:.'ems K;.._„S PERMIT Office: 508-862-4038 Fax:�08 710-2006 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint . `�V V IN OF BAR NSTABLE Map/parcel Number 5 of Q Property Address ct $ I `�^t A`'� y 41.Q'•S il�✓k gResidential Value of Works Zia ' ° ° Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Lop, tJ- S ~ . Contractor's Name Telephone Number S Or Home Improvement Contractor License#(if applicable) 13 1 ( (a Construction Supervisor's License#(if applicable) C S U 7 6 7 KWorktnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name it-�N r Woikman'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 tt-,As-r+ t ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) .Where required: lssuance 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. Home Improvement Contractors License 's required. SIGNATURE: Q:Fomu:expmtrg Revise071405 The Commonwealth ofMassachusetts Department oflndustridAccidents a' r Office of Investigations 600Kshington Street Boston, MA 02111 y mm-massgov/dia- Workers' Compensation Insurance Afliidavit; Builders/ContractorsXlectricians/Plumbers Applicant Information Please Print Legibly. Name Pu9ness/0rgadzation/1x&vidual): t 0 e 1.f�ta.,ti • o a Address: l2. City/State/Zip: �o�;^S K �fl ° Phone#: 441z1 t S 0 Arn employer? Check the-appropriate box; Type of project'(required): a Mpmyer yy jth Z 4. ❑ I an a general contractor and I empleyees(fall and/or part-time).* have hued the sub-contractors. 6' El New construction 2.❑ I am a sale proprietor or partner- fisted on 1he attached sheet 1 8. ❑ Remodeling ship and have no employees These sub-contractors bane Sc El Demolition worldng for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' Comp.insurance S. ❑We are a corporation and its required.] officers have exercised their 10.❑ Electrical repass or additions 3.❑ I am a homeowner doing atl work right of exemption per MGL 11.❑ Pbimbmg repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12/ ''Roof repairs iasnzance required.]t , employees.[No warkers' 13.❑ Other camp•insurance required.] *Any applicant that checka box#1=mat also fill out the action below abowing tbeir wor3mm'eompeasation policyinformatioa: t Hosueowncn who submit this affidavit indicating they am dams all work aadthen hire outside comb ctors mast submit anew affidavit mdicstamg such Irmtraeton that check Ibis box must attached as additional aheat showing the acme ofthe sub-contractors sad their workers'comp.policy infosao+atioa. ram an employer that is providing workers'compensation Insurance for.my employees. Below is thepolicy arrdjob site Informadton. 'Im;rice CompaayName: Pakcy or .Lic.0 w C_2 - 3 I s - 33 ! ls� -o i tea : -2 d o(v lob Site Address: ok Z 74-2 A T W City/St3te/Zlp':' A U Q, s Cyl fl' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fail=to secure coverage as required under Section 25A of MGL c. 152 oari lead to$te imposition of criminal penalties of a fine up to$1,50090 and/or one-year ia4rrisoamea t,as well as civt penal'des inm of the.fa .a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify under the pains and penalties a pe 'ury that the information provided above is true and correct: Si taro: Date: (, ' z o (. . . Phone k 6 L{ officia'k u36 • Do *ft,lk IMS Ma,-to&coe d.4, 'of tPM ejjnad City orTown: 11ermi4/Litense# Issuing AithuM (circle one); I Boord of Health 3.Building De artmert 3.Cit /Town Clerk Q.Electrical inspector 5.Plumbing Ins e&n or 6.Other I Couact Persou: Phone#: Information and Instructions � } L Massagbusetts General Laws chapter 152 requires all employers to providev leers' compensatimfor-tbeir employees. Prmmt to this statute, an employee is defined as"...every parson in the service of another under any contract of hire, express or implied,.&0 or written." An employer is defined as•"an individual,partnership,association,corporation dr 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 . reuerva 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, cotstruction ar repair worts ear sash dwelling house or on The grounds or binding appurtenant thereto shall not because of such employment be deemed tob a an employer." MGL chapter 152, 125C(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 152,125 C(7)states'TTeither The commonwealth nor any of its political subdivisions shall enter into any contract for the performanct ofpublic work until acceptable evidence of com::�liance with the insurance requirement of this chapter have been presented to The contracting authority." Applicants Please fM out the workers'compensation affidavit completely,by cheeldng the boxes that apply to your situation and,if necessary,supply sub-comtractor(s)name(s),address(es)and phone numbcr(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 re este 'not theD ariment of that�e application for the permit or license is being tt d, ep beret<unedto the city or-town app p � q Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compeasat1aupolicy,please can the Department at the member listod below. Self-insured companic.s shoaZ3 saber their self-insurance license number on-the agpnrpriate line. City or Town Of eldls. Please be sure that the affidavit is complete and printed legibly; The Department has provided a space at the bottom. of the sMaTh for yom to fill adia the eyedthe Office of Inves*tiow has to contact you regarding the applicant - Please be sine to fill in The permit cense number which will be used as a reference somber. In addition;an applicant that umst s Amitmultiple per-mitAiccme applications in any given year,need only submit one affidavit indicating mnrent policy information(if necessary)and under"Job.Sits Address"the applicant should write"all locations in_ (city or town)."A copy of the affidavit That has been officially stamped or markcd by the city or town may be provided to the applieantos proof that-a valid affidavit is on file for future permits or licenses. A new affidavit mnstbe filled out each year.Where a home owner or citizen is obtaining a license or permit notrchted to 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 Investigation would lie to thank you in advance fox your cooperation and should you have any questions, please do not hesitate to give us a can The Department'a address,telephone and fax mimber: = Tke Commonweahh of Mnssachasefts Depar� ent of Industrial.Accidents (mmce of IMM*26M 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 e t 406 or 1 077 MASSAFE ' Yu.#617-727-7749 Revised 5-26-05 vWyy.nlass.crovldia °Ft►,�r Town of Barnstable Regulatory Services MA� '� Thomas F.Geiler,Director 1619. 6. ,r Building ]Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA Q2601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section, If Using A Builder I, i 4-ea L �• �� `P ,as Owner of the subject property hereby authorize e5 i;XO / T- e!�o Orl v�)"i� to act on my behalf, in all matters relative to work authorized by this building pen-nit application for. (Address of Job) Signature of Owner Date Print Name Q:F0RM5:o WNERPERMM11Q11 4 License: r �a13r A icen 8 O7 NGGONSNunbeI RTIO 1U.EGEV�A T1O NS RVISORtj 076757 7 LA :i 1 Q/28 WREN Re t Tct� pr 7 Tr,n ' - R MIN23 HopDER AIv� �kff� c' 6p62.0 w i GHAM Mq 002z C I i 1 Board oh, � _ Building Regul 7 l HOME IMPROVEl�,1ENT ations and Standards Reglstraio`rw� CONTRACTOR 4 .p _133169 xP(Cc.8t-1 n -�20o7 yyREN al LA / du LAWRENCE MC 23 HODD n Gx- FRAMIN ER LN. ij GHAM,MA 01702 Adrni��sator . i ofTxE,b oil TOWN OF BARNSTABLE 30411 � Permit No. ................ BUILDING DEPARTMENT '"811 I TOWN OFFICE BUILDING Cash .wa '�P�eiuv HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to CAPRICORN REALTY TRUST Address Tot #20 98 Brant: Way, Hyannis 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. riay 7 19......$�....... /. �✓..... Building Inspector { ��,,� 7 '�•`w TOWN OF BARNSTABLE BUILDING DEPARTMENT t ssaasr : TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department 49 DATE: An Occupancy Permit' has been' issued-for the'building authorized by BuildingPermit $k........... ......_......... _.:.............................�!...............................�.�,.s.........................................._................................... issuedto ..........:.......: ..z .' ' 'L.-..f .......» .................. ._. ._. ..___ Please release the performance bond. DATE APPLICANT Franco Real Estate D4y. t„C). .1"I"ADDRESS (NO.) .-,a e'<�i• ;COvr R'$ LICENSE) -- 1 PERMIT TO _ Build dwelling 1 Si, ..._ EIER UNITS 1 (_) STORY r;�f'- y'niifl.l.V dW, r ... 3tR OF (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) =v AT (LOCATION) lot #210 98 Brant 'Way, '{' 7 1!_ ZONING (N0.) (STREET) DISTRICT RIC i BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOTell LOT BLOCK SIZE ' BUILDING IS TO BE FT, WIDE BY FT; !- LONG BY FT,. IN HEIGHT AND SHAL CONF M IN CONSTRUCTION I I TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ` REMARKS: .Oicwage TOWN S:EWEK t<�1ND AREA OR VOLUME 174 sq. it. - ESTIMATED COST $ 40,.000 FEEMIT s ( .1.Y 5 (CUBIC/SQUARE FEET) OWNER Capricorn Realty Trusc BUILDING DEPT.ADDRESS 765ilEioUt1 ZOiCf f1yu7Ij3f 02601 BYl•; r /, i . f' 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 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 APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL.CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR F -'OUN-O P;T F IONS OR- OO T-INc S.- MADE. WHERE A -CERTIFICATE OF OCC UPA NC.Y_ AND IS__RE- ELECTRICAL, PLUMBING _MECHANICA.L INSTALLATIONS.,.--2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH.BUILDING SHALL NOT BE OCCUPIED UNTIL' MINAL INSPECTION TI To LATHI. E FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD, SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 ` '/ --- 'e f� 3.- :. - _ r A,5 HEATING INSPECTIO AP ROVALS ENGINEERING DEPARTMENT _ _ ClUggo BOARD OF HEALTH ' WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF LlW ORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. ERMIT 15 ISSUED AS NOTED ABOVE. NOTIFICATION. IM �, C•.. / i -� mpp and lot numb ..... ... � 7 S �. . ... ... ......... ,,. �pF TM E r0� �. Sewage Permit number Z, 33A"STAM E, House number ) S 9�O M6 9 , 3 �0 'Fa MAI TOWN, OF *BARNSTABLE BUILDING .� . -119 ' CTOR • APPLICATION Co'nstruat Single. Family Dwelling ION FOR PERMIT TO .. Wood Frame TYPEOF CONSTRUCTION ..............................::...................................................................................................... �' September 6 1985,` "' 1 t 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following. information: Lot•# 20 .Brant Way, Hyannis 1�7A. Location .................. ... ..,:::... ....................... . ...............................: ...................................... ProposedUse .................................................. ..... ' .................. , ...... ................... RC' �- annis ZoningDistrict .....................I............................ ......:..........:.Fire District ....�.............................................................° ..... rigq- Real 6 Fa Name of OwngP...........:.....:...........:.�..:�'.X'.�•�t................Addres�..�:::.....�?ID,Q11�S�.:BHA.soda...Hya.YlYlj.$.p..-.Ma.•88 Name of BuW(pL?pq. .Real, Est.Dev.CO.. i I21Q....Address ..........5=e—.............. i .............................................. Name of Architect ..................................................................Address Numberof Rooms .5 ...............................................I........Foundation. ....P.X................................................................. Cla board-.=an or S i r Exterior ......P........................ ............. ....?�gl.e.a...:.:.............Roofing .........Alpha]..t...Sh1,ta�gha.8......................�,:..:.. :t ;5 s FloorsCaY'ppt.......................................................................Interior ..........Sheatraok..................:................. HeatingGa•8..............F...W.A.11!..... ...........................................Plumbing. ...... .T.wa...... .. .Cp ................................... ; FireplacvOne.................. ...............:.............'.......Approximate. Cost .. A�.QQO..QD.....Q...:.... ` 2?s/s. Definitive Plan Approved by Planning Board --------------------------------19-------- . Area 3.or6••SCi.•:•f' r`�.•.....•... Ir,� Diagram of Lot and Building with Dimensions Fee 63 ..: IT ......... . SUBJECT TO APPROVAL OF BOARD« OF HEALTH 'V' _ .. 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 . ... .. . Construction Supervisor's License ...b9 . ... .......................... ,; ooB9 CAPR-ECORN REALTY kUST A=272-003 30411 Permit for ...One_. ..Story ........... .... .. C ...........Single...F.am.i.1v...Dw.e.1.1.-' .. .... .. ... ..... .. . ..ink... 'Location .....:�!?t...#.2.Q.j......9.8 Br' nt...Way. a .......... ..... ..... ................. ..... ....... AyAmgis................. .................... Capricorn Realty..TK:�j�.... Owner .........I................................. Type of Construction ..........FrAMP.................... . ................... ........................................................... Plotit ....................... Lot ................................ Permit-Granted ....February 3..........19 87 .......................... . Date of Inspection ...... ................19-97 Date Completed ....... .... .. ...............147 Assessoa's map acid lot `..�';,...,...... II . +... THE Sewage Permit numbet #Cj f i BAfiaSTADLE, • House number ........................................................................ 9 NA66 1639. pO a• TO1Nj: OF" BARNSTABLE . BUILDING INSPECTOR - e ........................ - N TYPE OF CONSTRUCTION ......Wood••FXaMe................................................................................................... • I Septemb' 16 ....19£35 - __ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: t, Location hot..#.24.... .Brant ...11yaurds.1,1A............................................................. ................................... ProposedUse ............................................................................................................................................................................. Zoning DistrictR,C 11.:.............................................................Fire District ..... ap Name of Own(cr'i ...Real' Addres „ ,- corn Realty ............... Name of_->Buftgneo--Rea$....Ea•twDer Covi-In-c ,-Address ........... ......................................... Nameof Architect ........................................................:.........Address ............:....................................................................... Number of Rooms .. ....Foundation ..... Exterior-Clapboard--an /crr--Shin. . .e.s................. - W g], - Roofing ..........A.Bp'�131'}y...�tlillgl@g.............................. . t Floors ..........................................Interior ........... Carpet............................ Sh",etrock HeatingGas.....:,+......FL;-ti1f-�A.;.................................:.........:...:.:Plumbingr ................................................�0......e.... FireplacVo.Tie..................................................................:........Approximate. Cost Definitive Plan Approved b Planning Board ------------------------- ---19---___-- . Area 1056 Diagram of Lot and- Building with Dimensions - f'' _ . Fee ........ .. ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH fY. 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. t , Name I .. ....... .......................... y Pres. 1} t Construction Supervisor's License .................................... I 000989 CAPRICRON REALTY TRUST A=272-003 No .30411................ Permit for,...,One S foxy.„..... Single Family Dwell,in, ....................................... . . ......... Location .....Lot............ ......c...:.. .....HXa........................................... Owner Capricorn Realty„Tr.ust ................................ Type, of Construction FraMe........,\...... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....February 3........19 87 Date of Inspection ....................................19 Date Completed ......................................19 C'. t _-S 1 S 7 'OS "E S 76063 ' /<o" E 63. 23 -- p . 8q C)D p 1a o I 3 N i c o�pP y D A• W t d I � . /8 �o(o / �`%_3 F..- Al 781, © 3 ' /Co '' !N �! 1\/.4/L. /N 7`A �=2-r O L.� 7- 20 E LC V. TOWN OF BARNSTABLE ZONING BY-LAWS DATED FEBRUARY 19B6 'ONE: RC-1 o`er PAU L y� R. c°ETBACKS . RYLL No. 32448 FRONT = 30' 9��Fs �FcisTEa�° Q,�A SIDE 15' s��NAI LAND SJ " REAR 15' PROPERTY LINES SHOWN HEREON WERE COMPILED FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3-1348-05 AN ACTUAL SURVEY ON THE GROUND. THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON FEBRUARY 2 087 in AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: i" ­20' FEBRUARY 3 1987 SHOULD NOT BE USED FOR ANY OTHER PURPOSE. BSC / CAPE COD SURVEY CONSULTANTS 2 3 8 7 3261 MAIN STREET DATE' P OFESSIONAL LAND SUR YOR BARNSTABLE VILLAGE, MA. 02630 (60) 362-8133 4