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0117 DOLPHIN LANE
3/�oJ � � ' /P!'`l G`L ��P��� �,�� ��`�h 0 II'� I I I I I i i ,� I i i i �� �<�� `� 1i 4 'i I I I ,• i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION f Z q0 Map Z �Parcelt Application _# I Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee b 77! Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board aW v Historic-OKH Preservation/Hyannis 1 :40 e04 6 ,PjectTStreet_Address�A^---.I I� L p I'll N L A"N E Owner=—' A dd ress�'I -7 DIU�IIJ Telepho �3 7 Permit R_eq b t rk nW (�14�� �u� � �� ®�� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay P-roject Valuation °S 60 Construction Type 5� Lot Size Grandfathered: .❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) :Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: 0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No' Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded U. Commercial ❑Yes ❑No If yes,site Ian review# Current Use r6 e BUILDER INFORMA ON Name - f E —t' Telephone Number— `-� ,3 5 l -2 6 Address 6 License# Home Improvement Contracto J Worker's Compensation ALCCONSTRUCTION DEBRIS RESULTING'FROM THIS PROJECTWILL BE TAKEN TO SIGNATURE— ' DATE�_ 5 1 ---- ' FOR OFFICIAL USE ONLY t i PERMIT NO. DATE ISSUED = - MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION FRAME _ ^ INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL fi FINAL BUILDING �Q (917 I07 - W09W VA5 COPKPLt c- SPA'! WVKI:r��A DATE CLOSED OUT ASSOCIATION PLAN NO._ i - ' The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations a ' • 600 Washington Street •� Boston,Mr4 02111' wwOmmass.gov/dia ' Workers}Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers _Applicant Information �p r, (� ,,, Please Print Leg ibly Na1rie(Busin'ess/Organizationadividual): K \y e �C �uP Q Address: amity/State/Zip: k6 M(R6VN Phone.#: JC�1'� ✓L37--S'-)J Are you an employer?Check the appropriate box: :Type of pioject(required):, i.❑ I am a employer with 4. [] I am a general contrattor and I 5. []New construction . employees (full and/or part time).* • have hired the sub-contractors 2.❑ I am a'sole proprietor or Partner- listed on the attached sheet. 7. ❑Remodeling Partner- ship and have no employees These sub-contractors have g. Demolition corking for me in any capacity° employees and have workers' 9 Building addition [No workers' comp,insurance comp.insurance, ' required.] 5. C1 We are a corporation and its 10.❑Electrical repairs or additions 43 'I am as homeowner doing-all;wc)&I� 'm y officers have exercised their " 11.M Plumbing repairs or additionsys ' e1f[i workers'comp:r right bf exemption per MGL 12.C]Roof repairs t c. 152, §1(4),and we have no insurance-required] 13.❑ Other employees. [No workers' 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. . #Contractors 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 providt their workers'comp.policy number. 1 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: Y Attach a copy of the workers' compensation policy.declaradon page'(showing the policy number and expiration date). Failttre•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 maybe forwarded to the Office of Investigations of the D ur IA for insance coverage verification I'do hereby certf under the ains•and penal °es of perjury thatthe information provided above is true and correct: �,� L Date: �-- S* tore — Phone#: Official use only. Do not write to 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 anther 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 employers,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 notbecause 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." AdditionaIly,.MGL ehapter..152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the perfomnance of public-work until acceptable evidenee-af compl%a*vaiththie in=ance 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,ii necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability-Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the . members*or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the"city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law-or if you are required to obtain a workers.' compensation.policy,'please call the Department at the number listed below. Self-insured companies should enter their self-insu tee 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 fo 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:. Dopatinmt of ladwW81 A.eezdents Qffte of Invesdipttous 0 Washingtefi Stmd Boobx�.1A 02111 • . Tel.#617-727-4 00 e&40,6 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22.06 www.m sovma °F'THE 'Town of Barnstable ti RegulatoU Services '* saxrrsr"erE. ` Thomas F.Geiler,Director y Mass. g �'AlfD,u+p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 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. Type of Work:x- �'1`H (V� �� �� Jv S� Estimated-C kl So o t, Address of;Woik 'I Db f L- t Owner's Date oaf Application I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law ❑Job Under$1,000 OBuilding not owner-occupied i C+wneq pulling o%p,ermit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME Il1'IPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date z er'.sNarne � QIomis:homeaffidav Town of Barnstable �oFt�l�ti Regulatory Services * BARNSTABLE, y o� � Thomas F.Geiler,Director � MASS. i639. p,. Building Division rEn Mai 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 �DA-TE:^� number street `7 village (�p �] �HOMEO\TiTrER : K `yL ' `1 T * .S�C)� ✓��JQ�✓V /b !O �— / /0v name home phone# work phone# tCUR-RENT MAILING ADDRESS: fb ✓Vy MANQU O%A- �Z 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. /� 1�. 4'&I csi t -of omeown`er -Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger Aill 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:formms:homeexempt MSIDENTTAY,BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 ' Alterations/Renovations $50.00 BuildingPezmitAmendment $25.00 r UE VALUE WORMHEET NEW LIVING SPACE square feet $96/sq,foot x.0041= plus frombelow(if applicable) : AGTERATiONS=NOYAT70NS OF EXISTING SPACE --,square feet x$641sq foot;-- x.0041= C. plus ffom below(if applicable) GARAGES(attached&detached) square feet x$32/sq,ft• ACCESSOILY STRUCtME>120 >120 sf.500 sf $35,00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00• >1000 sf- 1500 sf 100.00 >15.00 sf-Same as stew building permit• ' square feet x'$96/sq,foot= x,0041= STAND ALONE PEWYETS Open Parch x$30,00= (number) Deck x$30.00= ' (number) Fireplace/Chimney x$25.00=' (number) Inground Swimming Pool $60.00 ° Above Ground Brimming Pool $25,00 Aalocation/Mo7ing $150,00 (plus above if applicable) Prajca;t P enmt Fee Revt063004 �>� n•>� •'.;;, + ._., � .:��fi�z,a ^.. ..-.�' :. � :'.. ~m 1:",, $ ;" `�: "��* 1• > � '§`?"-'..gip .,�\r�a�,e;`. 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'• 117 Dolphin 'Ln.', Hyannis 2/15/07 4 � _ _ _ T._._,1. ,...,. __.� - - ._ . - 4 i -- ---- �- --•-� - __....�_ ..�_� _.._- - - -�_ ....r Ilt' 1 . i . �. .._.__._.� - --µ--�-------r---- � -. , . _�-_-____ �_.. ! __. _-_ ____ �... __.r __ ��_..� _ _ ....._ - ----- ------ �... _.._ ._�._.....i._.- _�.._ ___ ��_ _� .�. - f .._._.__.,-._._ I � �.�.� - � t E ft t , E i __._�_.._.. ..._._ ._ -- - _.. _ •.T----..r -_w_ ..____..".._.� _..._-- T-- - - •- _ ,_ ____._ __.._�____. ..�.�,. _._....._.._...-..r_..._. .__.._...�. ._.__... .._..,�..�.._.,_.. ..�.�.�.___w„.w__,._ �,._----.�__._�___ f F t { ...._ _._ - _- _._ _ ____..___._._..�_..._ ..�._...,...__._ ..._._._.�._..,.. ...,. __._ I __..._ r i ---- _ _ _�.... _..._......-____�-..�........_.........___ _..,._....__---- - _. �._._�.._.._ _-- -w _ .,�.�---- �..,._,. __�.__.._..�_ _ 4 i Assessor's map and lot number .......... vw # .INSTALLED IN CO'hPI PIA Sewage Permit number ....... .�� ................................... WITH ARTS —E If STATE SO]TARY halm Im ypF THE r0� TOWN OF B A i 1, L ''a TdI1LE � e�g"b RUIL,0116 INSPECTOR ., I1 APPLICATION FOR PERMIT TO ..... U.lG!®.... �/l/F.... ^��1...!I..UU. .! ................................................ TYPE OF CONSTRUCTION ......4�t40..../.:: E.......:. ... .................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1?el'4019f"2 R01414> qf�_ 44<v._ — GJ657 Location ....................................................................................................................................................................................... ProposedUse .../ .EEC'.E........................................................ ........................................................................ Zoning District ..............R1.................................................Fire District .... 5................................................. Name of Owner �5..........��'�/.�% .....Address ........ ........................ ................ Name of Builder ................................................................,. Address Name of Architect S� ?z ...........Address ....................................................... .................................................................................... Number of Rooms .........6�...................................................Foundation i?(?. CONC/SETE ............................................................. Exterior $/#ING'LE.S' W0©G�.......... Roofing ..1171PI .!A'47" 5WIAlaze-S ................................................. .............................................................. Floors D.C. !'L ®......................Interior ...#9'e. t/4A4f................................................ ...................................... . �v/2�,G.... o�` Heating .....Plumbing .................. ............................................................... �`�5 0o0a O Fireplace ... 5...................................................................Approximate Cost .................../..................................... ... Definitive Plan Approved by Planning Board ________________________________19________. Area ......1 .`7.�....:..i........... So Diagram of Lot and Building with Dimensions Fee ....... `. .. ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTHY t 24 X SIDS fluaoE YK 25�t e f 31 ± < r-e�•ru��. 100 — t � i6 OT I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ......:................... .......... Higgins, Ms. Margaret 17521 one stor No'`°:............... Permit for .................................... single family dwelling ................................111................. Location & Dolphin Lane ............................. Best Hyannisport ........................................................................... i a; Owner .......Ms. Margaret Higgins .......................................................... ' Type of Construction frame Plot ............................ Lot ................................ t - Permit Granted'':..... .Derembex...30 74 s Date of Inspection 5'� d �.C� �........fi ... I ��.s Date Completed ..[.� .. .. ......... 1 f PERMIT REFUSED ................................................................ 19 s , .............................................................................. 1 ....................................................................... ... 1 ✓, Approved ..,............................................. 19 f ............................................................................... - ..................... ......................................................... �aNSsre a1Irt " .-so w J FEE Iry a0'°°� TOWN OF BARNSTABLE, MASS jl - a :3 19, �THISaIS TO CERTIFY THAT,A- PERMITII.S'y1H.E�REABY GRANTED TO yr �., X"iiy• ,8".:Sk�'aG�W 1L7 .b�4 ` '1 S �r:•f v +W 4iS'4T-�5 - M �v ,v .. O (PROPERTY.OWNER) " (ADDRESS) bo ....: �4 a E'1 ,^ U'O (BUILD) (ALTER! „ (REPAIR) �A �ca � ... _ d r (TYPE.OF BUILDING) (APPROXIMATE SIZE),*,:.r M M c ;LOCATION �q��ir�p Rudd# ab 6 hft ;i 1�6&;t _ - nm ISTRCET AND NUMBER) - (VILLAGE) VVVVp' 4 ;NAME'OF BUILDER OR CONTRA TC OR $OB a.PO.•� ' A i d°D� APPROXIMATE COSTd� ��8 � y I HEREBY AGREE,TO CONFORM .TO ALL THE,'RULES AND `F4EGULATIONS OF THE TOWN OF BARNSTABLE, REGARDING THE`ABOVE,:CONSTRUCTI ON. � + � ..�, ... .. y '(OWNER) i(CONTRACTORI- y AC o ', .�.� t •* r„y,.�' ' .^ +P •� A.Id BUILDING JINSPECTOR Subleelrto Approval ofrBoard of Health f J .. y l � In �� �• .� Y I ` e �i � O TOWN OF BARNSTABLE BULK RATE COUNCIL ON AGING U.S. POSTAGE PAID 198 SOUTH STREET NON-PROFIT ORG. HYANNIS, MA. 02601 PERMIT NO. 2 �� + +�: � y_. ,� S. Assessor's map and lot number .....(......" . ...... ......... Sewage Permit number �� `"� '..............................................r . �PCFTHE TO�~n TOWN O "1Jtlll.l \ IJT 1-1BLE Z BARNSTABLE, i 1669 BUILDING INSPECTOR - . �a MPY�'' APPLICATION FOR PERMIT TO ......................... ... '':1�. ��''' f�..... ° '%'-`4-� T....... TYPEOF CONSTRUCTION . �•? ° i. �............:...........:...::.:.................................................:................................................... .. t%........................................ .:.:........................19�l/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................... . . ... ... . . Proposed Use �Sr',C?. w' -..+" ....................... ...................................................................................................................................................... Zoning District ............... .IR................................................ .Fire' District,'... ..... . ... .......:.. ......................I............................ Name of Owner ft ... � ii / / ,' ij =` z �L�" l1x�Gu' ............... ....Address ........................................ .... Name of Builder x' !'G' i /` PfS` �•c:' �.✓S" ,��14SS'................................. t.........................Address ......... ................. .. .......... Name of Architect .q''� .....Address . .................................................... .................................................................... Number of Rooms ................................................. Foundation `(J.�f= `G. Exterior ... / /1tf � . : ..................................Roofing ......:..................................................:............... ...... Floors gX!C ! tr�e,`.df: ... �f Yl!sv� .Interior ...,1 1+r'-.ff�'✓. .............................................. ........................ ....................... Heating ../`� GG ' // ....................Plumbing f ► a�;..... ................. ............................................................ Fireplace ....3':° S....................................................................Approximate Cost + C Definitive Plan Approved by Planning Board -------------------_-----------19________- Area � c'' ! Diagram of Lot and Building with Dimensions Fee r^J SUBJECT TO APPROVAL OF BOARD OF HEALTH Y i� Ria 0 37 ± OZZ 1l Ik I hereby agree'to'conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � • �t Name . ...... ... .. ........................ Higgins, Ms. Margaret No .17521 permit for ..... one story, ....................... single family dwelling ...... . �. . ................. ' Location ......R�ad A Dolphin Lane .............................................. .....................West Idyannisport...................... Owner ........Ms. Margaret Higgins t Type of Construction .....f.rame................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ........December 30 19 74 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ...... ...................................................... 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................