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HomeMy WebLinkAbout0173 DUNN'S POND ROAD I TOWN OF BARNSTABLE Permit No. 33428 ....... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash i67V. ` X a�+` HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to IRENE SIMMONS Address Lot #4 173 Dunn's Pond Road, .;Hyannis USE GROUP FIRE GRADING'' OCCUPANCY LOAD THIS PERMIT WILL NOTr.BE VALID;AND THE BUILDING SHALL,';NOT BE OCCUPIED:;,UNTIL,' SIGNED. BYr THE.-BUILDING INSPECTOR, UPON SATISFACTORY--'COMPLI-ANCE=tWITH;.'TOWN REQUIREMENTS AND IN ACCORDANCE'WITH'SECTION,11�9.0,OF THE`MASSACHUSETTSISTATE' BUILDING CODE k November 1 9`0 � �' �" . 19 BuildingInspecior h THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) MA- .DTA STABLE, MASSACHUSETTS BUILDING PERMIT DATE APPLICANT 19 PERMIT NO. te? t'� -,Y _ ADDRESS IN0.) (STREET) (CONTR'S LICENSE) PERMIT TO " • - (_) STORY NUMBER OF (TYPE OF IMPROVEMENT) N0. (PR OPOSEO USE) f DWELLING UNITS AT (LOCATION) ZONING IN O.) (STREET) DISTRICT BETWEEN (CROSS STREET) AND (CROSS STREET) ..� SUBDIVISION LOT LOT .. . BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: i AREA OR § VOLUME ESTIMATED COST $ - PERMIT (CUBIC/SO UARE FEET) FEE OWNER ADDRESS BUILDING DEPT. BY "z 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 LOCATIONOF 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 NS.MUST INSPECTIONS REQUIRED FOR BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.D 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TO BEFORE 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 1 z C --- -- 2p�a ---- 2 �d� I �) . HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT t (� ��ZT TTJ CL��/(/E�Z, ` 1 �D v. L8 ,p0 � , OTHER BOARDOF HEALTH 'ORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS,INDICATED ON THIS CARD CAN BE )R HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED rO';? 6Y TELEPHONE OR WRITTEN )NSTRUCTION. l PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. n J �a T h (,/BUILDING �'E�1 IT NO. � D�• -r. 1\-- �C� _ r ASSESSORS PARCEL NO. a-7C,7 CONTINUATION OF ROAD BOND The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the E:gineer=.-:g Section of the Depar=ent of Public works: XXioa= and seed shoulders as soon as weather pe omits: 1/ other (ex-mI.ain) k)-s 2�-- ;n U )CC,s.-- max:- /�� 6 _51s 3' LOCAT=O.; 7 3 /3. (print na=e ) AC iHORIZAT=ON kl'is jq,o , I'S � Y _ c' f - P A I 4 • - Ge%A[)G�1{�/' Y TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF THE A S BUILT " PLO F PLAN SHOWN ON THIS R �' •,MAS S. PLAN MAS BEEN LOCATED ON THE J+ � GROUND AS INDICATED. . GG Lr2� i ci.i�(tk-t �'�;.Olti> >�� '� Atoll v AY $;,/COW PROI T S SIONAL LAND SURVEYOR?03 SETUCKE T R(110 SR5 C1tA SOUTH ®t:NWS� MASS. .� ,J3iFc �k01 I.. ,,iV,.•1I>,• L, II) ,.' .►.lt;l 0, GGC f i y Tf + 41 1 r� I� ty ,S it _ I kD _ - r i -• i I _ z E3 J I 5F cw �C cam, I I ,o�•� ` f- ._:'; r y1l Nam 0 \ rrr lSl'4 1,1 2 t ! 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S7-7 { t ^� •a t�,wc,l .e 1. 1 !l Joist Size Weight El x 106 Maximum Resistive Moment Ft Lbs) Maximum Vertical Shear Lbs (In) Lbs/Ft In2—Lbs 0%Inc. 5%Inc. 15%Inc. 25%Inc. 33%Inc. 0%Inc. 5%Inca 15%Inc. 25%Inc. 33%Inc. 1 Y2 x 9% 1.86 143 2980 3129 3427 3725 3963 960 1008 1104 1200 1276 1 Y2 x 11 Y4 2.64 230 3841 4033 4417 4801 5109 11186 1245 1364 1482 1577. 1Y2x117/8 2.10 262 4112 4318 4729 5140 5469 1256 1318 1444 1570 1670 13/4x14Y4 2.58 470 6087 6391 7000 7609 8096 1533 1600 1763 1916 2039 13/4x153/4 2.65 1 595 6685 1 7019 1 7688 1 8356 1 8891 11 1699 1784 1954 2124 2260 Note:Section properties shown are for GNI Joists spaced at 24"on center or less.Maximum Uniform Load (PLF) at Various Yo Increases - For Roofs A' 1 Y2"x 91/4" 1 Y2"x 11 Y4" 11/2"x 11 r/e" 13/4"x 141/4" 13/4"x 153/4" Span Live load Total Live Load Total Live Load fital Live Load fitel Uwe Load Total (Ft) Deflection Load Deflection Load '.'� Deflection Load Deflection Loed Deflection Load 11./240 L/360 L/180 L/240 1./360 L/180 L/240 L/360 L/180 4F; L/2 a L/360 L/180 r L/240 L/360 1./180 ; 12 189 127 189 "`n:. 234 197 234 248 222 248 302 302 302 335 335 335 s ry 14 122 81 147 '' 189 127 189 203 144 203 s' 258 244 258 ; 286 286 286 16 83 55 110 130 87 144 147 98 154 225 168 225 x' 249 209 249 t 18 58 39 78 93 62 113 105 70 121 179 121 179 197 151 197 20 - - - 68 45 91 77 51 98 ;. 134 89 145 159 112 159 22 - - - 51 3a 69 58 40 78 102 68 119 128 BS 131 24 - - - _ 45 30 6 79 53 00 99 66 10 - 0 1 1 ! n 26 - - - - - - - 63 42 83 tcw 1 + 79 52 93 �. 25/ hAM c , �� � �.. •'u � ' 1/2"x 9/4" 1 Y2'x 11/4" 1 1 r/8" 13/4"x 141/4" 13/4"x 153/4". Span Live Load Total Live Load Total Live Load Total Live Load Live Load Total + p Total-- (Ft) Delleet{on Load „p Deflection Loed Deflection Load Deflection Load Deflection Load L/240 L/360 L/180 ;..'�. L/240 L/380 L/180 1,k L/240 L/360 'L/180 �`` L/M L/360 L/180 a 11./240 L/360 L/180 12, 190 127 206 a 254 197 254 11'rx 269 222 269 `f ' 328 328 328 364 364 364 14 "- 122 81 160 191 127 206 ,; 216 144 220 '- 280 244 280 311 301 311 16 83 55 110 130 87 157 i 147 98 168 ` 245 168 245 271 209 271 18 59 39 78 /` 93 62 123 105 70 132 `` 181 121 195 214 151 214 20 - - - 68 45 91 77 51 103 v 134 89 157 163 112 173 <2 51 34 69 58 39 78 102 68 13D 128 85 142 4 �' 24 - _ _ 45 30 60 79 53 105 99 66 119 26 ' r+� '1 63 42 83 4,fif 79 •52 102 33%Inc �r2`1. 1/2"x11/a" 1/2"x1i. `'" y11# 1 Y2"x 91/4" �" 1 + 1 1 r/e" 13/4"x 14Y4" 13/4"x 153/4" Span .. Live load Total Live Load Total Live Load Total ` +` Live Load Total Live Load Total (Ft� Deflection Load Deflection Load `- Deflection Load Deflection Load Deflection Load L/360 L/180 .. L/240 L/360 L/180 § L/240 L/360 1./180 L/240 L/360 L/180 d: L/240 L/360 L/I80 12 190 127 219 270 197 270 M 266 222 266 349 349 349 387 387 387 14 122 81 163 191 127 219 216 1" 234 298 244 298 331 301 331 16 83 55 110 130 87 167 147 98 178 253 168 260 289 209 289 18 59 39 78 93 62 123 105 70 140 181 121 208 226 151 228 '4 20 .4 - - - 68 45 91 77 51 103 134 89 168 168 112 184 22 51 34 69 58 39 78 102 68 136 128 85 152 4. 24 - - 45 30 60 79 53 105 99 66 127 26 - - - t k 63 42 83 79 52 105 ND' efe/to a dos Flow to usa KF Tables'example „ � +, r u:�' Y ,• "u,,t.,+�;�w"�� ': 'tom.. •r>� �3.r �; ' o- .9. s., • • I • • , 1 1 • • • .. � a T �* 44 ?;`-'1-Srs "� � 4 " y a •7?F r 'w f `FtC wT w rr w i . m wy '�av r,a,I-17.,rwa �W1800,11", ,:, 4S Nailetl and`Glued Sheathing : _+ k e; %A * r Joist spans ahDwn include 2"tieaNn4 at ee'6 end < �, ' Assumes plywood(or equal)sheaths na led and tuWAD t 0 � », 119 9 op .angti of iast 11/2"x 91/4" ° 1 Y2"x 111/4" 11/2"x 11 r/8" i1° 3 1 1 San , 1/4"x 14/4" 13/4"x 153/4" jl P Live Load To1a1 `. Live Loed Total Live Load Total Live Load Total live Load Total (Ft) Deflection Load Deflection load Deflection Load iY Deflection Load Deflection Load! r U360 L/480 L/240 L/360 L/480 L/240 L/360 L/480 L/240 1,. L/360 L/480 L/240 L/360 L/480 L/240 {` is 7 14 12 132 99 165 203 154 203 215 173 215 263 263 263A 291 291 291 85 64 127 t" 133 100 165 150 112 176 249 235 249 a 224 190 224 ' 18 Y ,sr,x d 6 '•<, 91 68 125 t 103 77 134 s 1B 41 31 61 1 # s 175 131 196 217 163 217 ,�. - - - 64 48 97 73 55 105 126 94 156 157 118 171 y �� - - 47 36 71 54 40 81 1 93 70 126 117 87 136 r'!kA 24 _ - 38 27 54 41 30 61 71 53 104 ,�+;. `'�I r}: fig 87 114 x ,y xU �� 26 31 24 47 55 41 83 89 52 95 w * 44 33 65 55 41 81 q' „c �, Pa9 abIBS exam B t a u c �' v a M yy pryy 1 Assessor's office (1st floor): PTIC.SVSYEM PAU ✓" L .2(j— o Q� I E TO Assessor's -&ap and lot number ............ E LLED IN COMP '`� Board of Health (3rd floor),: MHMTLE 6tj o� Sewage Permit number ... ... . .... . Pdiaf�V71R0NM1ENlb��_ '_ t BAHd9T11DLE, i Engineering Department (3rd floor): �• jj �S, �w ® �,a �o ��g House number .... .. ....fir... . ..1 3 ' TOWN R� .. o 1 39-of . ..... . .... .:. .. 'F Definitive Plan Approved by Planning Board __ lY _ ----�-- Al APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 2:00 P.M. only ' - TOWN 'OF BARNSTABLE .BUILDING . -INSPECTOR APPLICATION FOR PERMIT, TO �k 1�, i ) IJC� ..••••.•• ••••••..•.•• TYPE OF' CONSTRUCTION .........V�x�O•D.........................._.................................................................... ....... ....--...G:>. 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .. ...... .�OIA�.5.... Ui�9........... .................�: .1J1.5,.... r Proposed, Use ........ 11t617 .... ..... .. ............. Zoning District ...... �.) ..... ......................... ......:.. .........Fire District ...................... j Name of Owner � i� N�I�(U J...............Address .....� :J...... V�� To tidy 4- C� tS... .. Name of Builder ............. -...............................Address ....�J �:....�t..!,.1. . Name of Architect ................................ . . ........ ...:.............Address ......... ............ . .�...:.............'...:... ......... ......: Foundation ......�,©�CV^..,.:.._�.................'.......... Number of Rooms .. . .............. ' r t� Exle for ................... :. P!� ............ ....,:......................Roofiing Floors ............................................Interior ..i— ...[� Heating ........... .. ��....... ..........;...........�......... Plumbing ..... V.�.J. ... �.!.1.. .a.... . ....:........... ..... Fireplace ...............`�'^ —::.`..L'� �....: g�(�' lh• APProximate Cost .....�� { .. ...,.......................... Area .. Y �....PPI Diagram of Lot and Building with Dimensions Feed" �...... ............... :............. \C11 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all'the Rules and Regulations of the Town of Barn 6 le re rding the above construction. - Name— .. Construction Supervisor's License ........ .... .... SIMMONS,. IRENE _ �• • . , x: — Story a , o, 3 3 4 2 8. Permit for :..1 .............. ........... h oN _ R Single*' Family dwelling .:........................; ` . f Lot #4 173 Dunn' s Pond Road ` .Location ................... ...................... 'annis...................................... Owner .....Irene Simmons :- ............................................................. ,: Type of Construction ..Frame............................ . �- ............................................................................... Plot ........... Lot ................................ Permit' .Granted- ,-�.....De•cem�er �2.9.1:19 8 - i- Date of Inspection .......................... ........19 Date 'Com leted . r 1 � " 4 ,�,,,;G,.Wu�,ra-;....--7'•are m..,+..s....�.r+,>: ..�.�._sar'�r��,kL�{.^::,bas?o...._.r7r �..t�.�Gx,-•�"�,.lY'�'� .-s. x.,.� ,L�.ni.,ri;:Ya!''e�k�r�._'rl:s;7-nr+rK.:.�win:y.v.,.,.Lar�r:f:+:..r .,�,. +r.ro•,n....r .�i-.^...,-.... t � Assessor's office (lst floor): _ffi .i -i- ��G - � �,,. OF T N E Tp Assessor s map and lot number - z Board. of Health (3rd floor): �� Sewage Permit number ...... r .. 3 Z $ARNSTADLE. i Engineering Department (3rd floor): w»rasa 639 House ,number. ..........................p,::!..........�..�..... ....,�..f.....�N�/�" ,EOYPr 6 Definitive Plan Approved by Planning Board Z_..______1.9________ . Z-µ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 2:00J P.M. only TOWN OF BARNSTABLE .j BUILDING INSPECTOR APPLICATION FOR PERMIT TO �m Lam. ....... ................u�. ................................................:. ... ............. TYPEOF CONSTRUCTION .........� C3. .......................................................................................... ............... ............... D.h .........1924/ I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... A........... G�.�?...... .�.................I� ....... ................... Proposed "Use ......... I-tip..• tf. 1—................................................................................................................................... Zoning District ........ ....................................................Fire District ......... i9�N.�C-?............................1.................... \, Name of Owher .....� h�. ......'`fit M. .h �..............Address .....�4..:�......! �.n ,��i.. C9 ......r4- z t.. ... ...... . Name of"!8uilder .... 's....�7 -...:44f.V7..............Address ....4�� s�7.�......�t� �.�t�1����!..! 4•.� . Nbmeof-Architect ................1 ................................................Address .................................................................................... . -,4 �' � Numberoff ooms ................. ..............................................Foundation ...... ............................................... ..............Exterior ` & 4.*. ...........................................Roofing .........F-' . Q.i'lfl. ................................................ .... ... Floors .....................C�. ....................,...........................Interior ....... .E� EST... ..', ....................................... { � Heatin ..iAIS....... ... ... .....Plumbin ..... �.0 /C.h...:..(= ..g g r.. 1 ..,.,.' ........... ... ' �L...... Ito Fireplace ............ �C%45. 0,;. .......` 0.r,^ .E. pproximate Cost ..... ).. a............................................... t Area ...... ....................... Diagram of Lot and Building with Dimensions Fee W 1 e Y ' i ai 1 f i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules an.d4egulations.of"the Town of Barnstable regarding the above construction. r Construction Supervisor's License .. ���` . ......... .........•• SIMMONS, IRENE A=270-005 o7 70 ,ev S ; ooR KA 1fVo Permit for ...U?....StQrY............ .....S.i.nq.l.e....Fam.i.l.v...D.w.e 1.1-i n-9.......... Location .... Pujaii.'.a.-Pond woad ....................H annis................................I......... Owner ......Irene Simmons ............................................................ Type of Construction ......Frame .................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .......December .29.,..lg 89 ........................ .. Date of Inspection ....................................19 Date Completed ......................................19 PERMIT COMPLETED 1/1 i le i. 6 / (e 3 DIE' 1 7 1 D Y�i vYa. /,.cd4T.� W M r 10 FID Zor Iry I ZS 5 ellCa Y Qj QQ Zo 7- V a A ---- - > 114 4- o , - I certify, that this property is located in Flood Hazard Zone C (out- side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . Date ; �� /lryo �, �,.,.,,, CERTI FIED PLOT PLAN ,. ,. LOCATION .��R,r2i�!ST.9F�LE�/?�/�r✓.v�5� SCALE . ..30. DATE !; r Red.- ur�reyor PLAN REFERENCE Q�=��/G , Co7- I certify to its title insurance . company that there are no visible encroachments I CERTIFY THAT THE IFFIS77A!t. 171.✓E�LL�i✓G or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND plan was prepared under m immediate AS SHOWN HEREON AND THAT IT CONFORMS .TO THE i y SETBACK REQUIREMENTS OF THE TOWN .OF supervision. 4'fI ?!t!-?T�t'!� WHEN CONSTRUCTED. DATE REGISTERED LAND SUR The Common i+acultl1 of.1fassachuseltr �---��t:!- Department of Industrial.4ccitients ` _ I oficeallmresilgallons �v 1 iiF - ri �� •�1 6XI 1f ashill.,tu,r Strcct ' ��`:;.,�• Bustu,r. .4luas. U2111 .,��; Workers' Compensation Insurance Affidavit *Itnlirint Inf6Fiiiati6i- Please PRINT''le,yilv'"�^��-�'- ✓ 11MC, L G. it n) 1,)A/e- L AA" C'�O u Y� / / U it1 nJ S p'X . le �C•t\• / Al A /, hnn•# f T am a homeowner performing all wor• myself. 1 am a sole proprietor and have no one working in anv capacity workers' compensation for my employees on this job. 7 I am an employer providing cnntnnny nnme- atltlrccr. cin nhnnc#• incurancc rn policy to C I am a sole proprietor. general contractor, or homeowner(circle oire) and have hired the contractors listed beiow who have the following workers' compensation polices: cnormn\• n•ttne• - atitirccc� city nhnnc#- incnrinrr rn nnlicc' __..._._ .. .._ ._.�_—....._. _I...•a�..�.•�'• - - r'•+ --_ -i � ~a _ .ir._. .ram—� cnnimns nnYnc- :tticlrccc• rite•• nhnnc#• — incttr•tnre co policy# _ 717 Attach additional sheet if neces_sary _ ^-_ "" " ` • - ,�.• .t• ..e _—Ji'..:afy yr` ..�•,. ..ir ..�"'�.'.— •.�+"+.wr.• .�r5 L'�....-...ii1l�-- •..W.w�.n. Failure to secure coverace as required under Section 3A of 111GL 152 can lead to the imposition of criminal penalties 01'2 line up to S1.5O0.0U andiur uric cars' imprisonment a.well as civil Penalties in the form of a STOP NVOR1:ORDER and a fine of 5100.00 a day against me. I understand that n copy of this statement mac forwarded to the Office of investigations of the DIA for coverage verification. !r10 herchr cerrij•trrt e .rlre prrirrs rd penalries of perjure•r/tat Ite informarion prodded above is true and correct. Si_,^.ature Datc✓ f 9 7 Print name L L Aj e- L ,1 �l C� �! ' 7� Phoney* "2 _ w - ofticiai use only do not write in this area to be completed by city or town official ` city or tnwn: P et tnit/liccnsc i{ r jouilding Department C C3Lfcensing Board t ` 1: check if immediate response is required aseleetmen's 011ice ► �. C311calth Department contact person: phone#: C30ther_ S Informa tion and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' ccunpcnsation for th employees. As quoted from the "la++•". an e»rpl( ree is defined as every person in the service of another under am contract of hire, express or implied. or.-if or written. An empinrer is defined as an individual. partnership, association. corporation or other` legal entity. or any two or me the foregoing enuaged 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 entit employing employees. However t± owner of a dwelling house ha+•ina not more than three apartments and who resides therein. or the occupant of the dwcllin- house of another who employs persons to do maintenance , construction or repair work on such dwelling he or oil the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employ, MGL chapter 15'_ section 25 also states that eyer%•state or local licensing agency shall withhold the issuance or rene++•al of:► license or permit to operate a business or to construct buildings in the common«•ealth for any applicant who has not produced acceptable evidence of►:ampliancc with the insurance coverage required. Additional[+•. 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 been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation and suppivina company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coyernae. Also be sure to sign and date the affidavit. Tl►e aMdavit 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 require to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that tile, affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Piz be sure to fill in the perm ittlicense number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. Tlie Office of Investigations would like to thank you in advance for you cooperation and should you have any questic 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. O2111 fax #: (617) 727-7749 phone #: (6177) 72 7-4900 ext. 406, 409 or 375 r. dFTME The Town of Barnstable • e�exsreacE. • ��� ,0� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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 w certain exceptions,along with other requirements. of Work: �G/� ✓Est.Cost �v 60 ,,,"-Type Address of Work: Owner's Name �1,l a _�, (/ i L L d nl d-0 u 2 ate of Permit Application: p— I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. wilding 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 THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR n hwneric Name TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ----------------------- Please print. DATE • g - .a <J JOB. LOCATION % 3 u 11/,411S /90 Al Number Street address Section of town "HOMEOWNER" �r L L E J P14 L L R ill Co Name Home phone Work phone - - PRESENT MAILING ADDRESS A/N I�S- City town State Zip code The current exemption for "homeowners" was extended to include owner-occupiec dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, 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 Offici on a form acceptable to the Building Official, that he/she shall be resnonsih for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes :responsibility for compliance with the St Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeownpgru certifies that he/she understands the Town of Barnstable Building Dep ent minimum inspection procedures and requirements and that he/she will co ly witr7, 'd procedures and requirements. HOMEOWNER'S SIGNATURE �c�' APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction. Supervisors, Section 2.15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licenued Supervisor. The Rome " wner-' actir as supervisor is ultimately responsible. , To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. le � 116 ; 311 -?1l6 Town of Barnstable oFT"E t°w Regulatory Services .. y HP o Thomas F.Geiler,Director ' B' MASS. E' ' Building Division 39.�jDt�p MAC a1 Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 - Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT D te. p? 6 Rec'd.by: :1:)eA- 1 Complaint Name:�i� ✓ 2,/? Map/Parcel c27V- 026Q Location Address: Originator ame: Street: ��� h ,►� / (�yr . Village: State: m �- Zip: 40 6 41 Telephone: Com laint Description p FOR OFFICE USE ONLY Inspector'•s Action/Comments Dater Inspector: Additional Info.Attached n-fn7s-cnmolaint n engineering Dept. (3ru� oor) Map Parcel � (� Permit# _ House# 113 Date Issued 2-L( �-9 � Board of Health(3rd'fl"oor)(8:15 - 9:30/1:00-4:30)t�cl-' del r Fee, Conservation Office 44h floor)(8:30,-9:30/1:00 2:00) ` Z A i Planning Dept.(1st floor/School Admin.Bldg.) SEPTIC SYS T BE INSTAUM Definitive Plan Ap r by Planning Board f 19 CE ENVIR©NM b AND TOWN OF` BARNSTABLETowN REG oI ' Building Permit Application Project SfreetAddress_ l�,3 �.0 n/n/S �8.c/1� R' (�cv L� T -0A Village.r'',��� N'ti/ /-s - Owner 01-L p-� aA-1 L 1- 4 AJ Cv a/e T Address 17.6 Telephone 1 - h/ 9 7 g w -Permit Requ aw 2G J G� -First Floor ° square feet Second Floor 'mo o square feet •Construction Type .. Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size lo--a X a �' Grandfathered ❑Yes ❑No P Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 'J y,eS Historic House ❑Yes ,6To On Old King's Highway ❑Yes '"\ - 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 No. of Bedrooms: Existing & New -"Aoz�/- Total Room Count(not including baths): Existing -2,� . New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes lam' Fireplaces: Existing New Existing wood/coal stove ❑Yes �To Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) 4N,one Shed(size) / ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A.- 41Z SIGNATU DATE ' a BUI D . G PERMIT DENIED FOR THE FOLLOWING REASON(S) V 6 ' A i - r V 3 FOR OFFICIAL USE ONLY Ll PERMIT NO. DATE ISSUED. MAP/PARCEL NO. ADDRESS �. VILLAGE, OWNER DATE OF INSPECTION: FOUNDATIONfws f > f ?� -v E t f =• FRAME INSULATION + - FIREPLACE ELECTRICAL: ' ROUGH - FINAL ' pv ' PLUMBING: %- UG - FINALcr GAS: FINAL FINAL BUILDINt` f � ladDATE CLOSED OB t"=: I( ASSOCIATION PM O. f + (} s 1 ,. i a? �V. e' � 3k 1 � i. 1y t ID y. ..•, � ,� � ,�,,i ±�r.��f'�/'"���'~ram � , ? a � r ! ' ; _ .. - . p{ 71 ' E - f � : 3✓o '' E i i ' l onr�lhf'� S xk P r s. - s Lfv y �ASIG PLAJ1/ fyL.CEp� F'Av, a PLUST-�u C T u.it E /Q E r»�4.�1.5 Gc X CAT'SS eGAG£/rlfiNT Wi ��dN1S R& /00-AJ E. LASS /itJ.S F.R 7—$ . �I •I I I i I. I I I I i i f I I I I i I t I I � � n,. ` I_. I �� I I ' 1 7, __ � f'. `} � � ' i Iilk I. .i j i 77 ggji 1" e. 1 Ij I , 1 } - i .1-;. 1 .._ ,i_ �'._I.-'.d ,.E.. �� .I, �,: I � ...y, I , 'i l..t. j 1 :.1 f,,_ 1 _I i"1 �1 I I I ir.n=• i', I I , ` I t —( j,, , , "i,�;( -.� ~I _��-� I- - ��. _� I _'�.l _I:� �. _ �..r— - —r. - •�—,.... _, .J -1�'� 1 - -li i_ � _ J .I.!` _ I i ..i , { r 1 t. � f I .�.. I_a a I I i i• I.., ,��•_ 1 I , , ; l' , i I t It I I .el. } -I .� ti I__..(_.�. 1 I.1 1 ; y -t .��,. ' ,I_.4; ,_. t {. .j t } t i ( ' + i 1 F•Lp�M l t ��'"G � 1 ` t j ._�.1._i I_a. I a :-+�--L- I � 1 � `s• ,.. __, y, t s._., r a. ._ I � .. I t:.f� r '.� Ax 1 � ' 1 , I t : 1 � ; � ' -1 i � i I � � I E [ f i 1. 1 I I •^ -]" ,w ..,nr �. 1. i ,t�i �Piif/f� t � l��t 1,• �,�� } i F t o TVZo 7- it o. Z /47'-- 1. ; LoT- I certify that this property is located in Flood Hazard Zone C ( out- side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . Date oc7, /� /�50 CERTI FI ED, PLOT PLAN LOCATION . A2!�!ST.�.... /Ra✓.vis� SCALE DATE !q?x6 /yyo Re' :,�Lac�,:Surveyor PLAN REFERENCE T >.,:'„'•.,"r '•- /f.S Ste?�!.c/ o n/, , Gf�?�D. . . . . . F. ri I certify to its title insurance company that there are no visible encroachments I CERTIFY THAT THE L'a �ST7•wG 1�1.✓ELL/n/G Or easements except a5 ShOWri and 'that this SIkOWN ON THIS PLAN IS LOCATED ON THE GROUND plan was prepared under my immediate AS HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN .OF supervision. WHEN CONSTRUCTED. DATE REGISTERED LAND SURVEY R. The Commonwealth of Massachusetts Departnunl ojludustrial Accidents �L �. Oficeof/nvest/ga1/ons 600 N ashhign)n Street Boston, A1uss. 02111 Workers' Compensation Insurance Affidavit i_li �int iriftirniation': Please PRINT le-iilj'""�-- name: L. i✓ 6/114- L L- A V C�O u /E'.'T� cation. / �3 �. U. N A/S }0D A1,1) -� ccitr //S nhone# l / - v 7 7 .2<1 am a homeowner performing all work myself. 17 1 am a sole proprietor and have no one working in any capacity .. ... .•.-. L.� .s ...... "- ...'�. ,�r..vr...s+s7c�s+.w�r+l7l+r'r`�T�.....r+ A!vie!x,�..._..._....,,�.+,...._.�..�.�.+....... +..-•.�......•..�''.�_�^��.�_....... I am an entplover providing workers compensation for my emplovees working on this job. enntnam• name: address- CON.: rhone#• . insurance co. noficy# I am a sole proprietor. beneral contractor, or homeowner(circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: company name: address: phone#• insurance co. Poliev# .rJr�_ -- -- — '�_ - - - __ ..�w.ri_Y•-... .a.._. cmmnanv nnme: address- city: phone#• insurance co. policy# Attach additional sheet if necessary• _- ';T'_""'"'"_''-''_"� """ 'T"---�"r'' Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 andiur one cars*imprison nt as�vcll as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that n cop} of this statcn_ may be forwarded to the Office of Investigations of the D1A for coverage verification. l do hereby 7rurdcr the itirrs and penaftics of perjun•th r file information prorided above is true and correct. SiL,nature Date Print name L L�� y t L L/�� u.�'v Phone# -7 71 — S 7 a nfTiciii use only do not write in this arcs to be completed by ciry or town official city or tnwn: permit/license# r'tBuilding Department �Liccnsing hoard check if immediate response is revolted Selectmen's Office allcalth Department contact person: phone#: MOther s: f. r - P141 u • Information and Instructions - a Massachusetts General Laws chapter 152 section"215 requires all employers to provide workers' compensation for thci emplrn ees. As quoted from the"1a��". mat enrpinrec is defined as every person in the service of another,under anv -contract of hire, express or implied. oral or written. a -- - -'An rnnpinrer is•defincd as•an individual, partnership;"association, corporation or other legal.ctttit%-. or any two or more the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tnistee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house havincy 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 hou or oft the :rounds 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 businessor to construct buildings in the commonwealth for any applicant who has not produced acceptable,evidence of compliance with the insurance.eowerabe required. Additionallv, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perforniance of public work until acceptable evidence of compliance with the insurance requirements of this chapter lu been presented to the contracting authority. ..0. -c• ':l.tid w..:1• r::�.. .tas r..:.r'.....' ..!'.. ..�,•.... Applicants Please fill in the workers' compensation affidavit completely, by checkin'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 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,ho,svn5 Please be sure that the aMdavit 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. Plea. be sure to fill in the permit/license number which will be used as a reference number. T7te affidavits may be returned tc the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any question, please do not hesitate to give us a call. . �.r_y.V.wr�._...: . ..._-.•-•NTw..- .�AIw�F•r•A"1��•.�.OA�:'�R..-.. w!-�rwM��'�+.!�� ...: ++-= •Y� _ The Department address. telephone and fax number:The Commonwealth Of Massachusetts .K. _,Department of Industrial Accidents �r Office of Investigations 600 Washington Street Boston,Ma. 02111 _ fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable • ,�axsz�acE; • 9 & �0� Department of Health Safety and Environmental Services Fo r�ax' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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:SC 2 F-E N&I C Est.Cost 9'd--o Address of Work: .v A.1 d N Owner's Name y,./ L L AA,) Cv it P_7—_� Date of Permit Application: /c a I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building 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 THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY e I hereby apply for a permit as the agent of the owner: Date 'Contractor Name Registration No. OR j Date Owner's Name • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . .. DATE 6 � . • a . . ..• JOB LOCATION Number Street address Section of town /IROMEOWNEROZ2- Z�,W) Name Home phone Work phone . . PRESENT MAILING ADDRESS �' •-.` City town State Zip code The current exemption for "homeowners" was extended to include owner-occupie dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re side, 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 Offic. on a form acceptable to the Building Official, that he/she shall be responsi_ for all such work performed under the building permit. (Section 109.1. 1) s The undersigned "homeowner" assumes . responsibility for compliance with the St. Building Code and other applicable codes, by-laws, rules and regulations. he undersigned "homeowner" certifies that he/she understands ..the Town of arnstable Building Department minim inspectjo * rocedures and requirements nd that he/she will com 1 h sa ' cedure and requirements. 30ME0 I A1NER S SIGNATURE •�� �� APPROVAL OF BUILDING OFFICIAL ate: Three family dwellings 35 , 000 cubic feet, or larger, will be required o comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION �. The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such\kome OwnE shall act as , supervisor. " . Many Home Owners,'who 'use this exemption,are-- "unaware that -!:ley are assuming the responsibilities, of a supervisor (see Appendix 0, Rules and Regulations for . licensing Construction* Supervisors# Section 2.15) . This lack of awarene often results in serious problems, partcularly,,when the Home. Owner hires unlicensed persons. In this case our Board cannotJproceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner act_: as supervisor is ultimately responsible. ,. To ensure that the Home Owner is fully aware of his/her responsibilities, ma:- communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. r' AA - --- , , 40 o LA / o Zo 7 3 0 /47'f J_' )i s 37'± I Lo r - os- I certify that this property is located in Flood Hazard _Zone C ( out- side the 500 year flood) as. ,identified by the Department of Housing ,and Urban Development (HUD) . Date /4, /yyo �, s.�..;.r..,:,. CERTIFIED PLOT PLAN LOCATION A !s7'AF�LE��?�/A-r✓�v�s� SCALE . � ....�. .... DATE.�6 /cello Red:;�`Lac , 5uOeyor PLAN REFERENCE !t°�wG , LoT `}¢ Gov, 2T I certify to its title insurance company that there are no visible encroachments I CERTIFY THAT THE .. ... .. . . . . . .. or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND plan was prepared under my immediate AS SHOWN HEREON AND THAT IT CONFORMS TO THE . SETBACK REQUIREMENTS OF THE TOWN OF supervision. WHEN CONSTRUCTED. DATE l�ig�GG��/Co u2T— �T17 io•v `��'•�f L2«7l1 REGISTERED LAND SURVEY R I a "neering Dept. (3rd floor) Map Parcel 00 Permit# House# /X3 Date Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) , 9 j I Fee 0 a's Cogservation Office(46floor)(8:30-9:30/1:00-2:00) q�L SEPTIC SYSTEM MIST BE Planning Dept.(1st-+ of/School Admin. Bldg.) _ INSTALLED IN NCE Definitive Pla A ro d by Planning Board 19 WITH � ENVIRONpME R AND TOWN OF�BARNSTABL� f F Building Permit Application Project Street Address a/A/5 /00 l -b Village A Ulf IV IV/S r Owner i'LLSAI Z,11f/ZL4A/Co4t l7— Address S'Ai)" E., Telephone '2'2/ — 1,!9 7 f Permit Request 2�£ First Floor g/II square feet Second Floor '71,� o square feet Construction Type 4.�o o 2� Estimated Project Cost. $ (o o a d' Zoning District Flood Plain Water Protection Lot Size /d o ' x a g Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure f P s Historic House ❑Yes XNo On Old King's Highway ❑Yes XNo 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 No.of Bedrooms: Existing J New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other /0,e a /00^/ Central Air ❑Yes �No Fireplaces: Existing New Existing wood/coal stove ❑Yes VNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None ❑Shed(size) ❑Other(size) Y Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes XNo If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION D RIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE L DATE BUILDING PERMXT DENIED FOR THE FOLLOWING REASON(S) ,�. / q'e '- A FOR OFFICIAL USE ONLY r �• PERMIT NO. DATE ISSUED ? MAP/PARCEL NO. - • 1 ADDRESS VILLAGE s OWNER r DATE OF INSPECTION: FOUNDATION FRAME r'; i INSULATION FIREPLACE 7 _ ELECTRICAL:, • ^ROUGH FINAL PLUMBING:, f, 9OUdH FINAL-:! GAS: . ; :) ff GH+ FINAL FINAL BUILDINf, DATE CLOSED OUT ASSOCIATION PLAPI NO. i SHED REGISTRATION location of shed(address) pro erty owner's name size of shed 17 s' ature date Old King s Highway Historic District Commission jurisdiction?. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed DLi`A ,: IN OF -,\`DUSTRLt LACCTD TjS 3 / _- . (,n� `��.'.�::ram•(; n`: C?-p 'NS I'K N-C-. AFFIDAVIT Y (licensee/permincc) with a principal place of business/residence at: (GrYIStatc/Zip) do hcrcby ecrtifj; undcr the pains and penalries of perjury, that: ( J l am an employer providing ncc following workers' compcnsarion coverage for my employees working on this job. lnsurancc Company Policy Numbcr (s I am a sole proprictor and havc no one working for mc. ( ] l am 2 sole proprictor, genc:,j coniraaor or homeowner (circle one) and havc hircd the contractors listed bdo, who havc the following workers' compcns-.6on insurance politics: N-2mc of Conir2aor lnsu.-2ncc Company/Police Numbcr I�2mc.ofCOnir2aor Inst- ncc Com an /P li m o 1`u bcr P Y c?' Namc of Contactor lnsurancc Company/Policy Numbcr Q l am a homco%,•ncr tr_rformind all the wort:myself h'O e t. picot be :w rc Let\.•bile bor:cow,-crs M•ho employ persocs to co raaintenanee,construction or repair work on d—cllinF of not raorc Ls Lrcc uaiu is _.b;c: the boraco—'cr Jso resi6cs or cc I�c Frouncrs appurtcaant 6crcto arc not FcncrJJ)• considcrcY Ic be cr•F!cycrs s G t the Workers'Corapcns:z;on ha (GL C. 152,sca. 1(5)),application by a bomcowncr for a l;cc:sc or perrr.it r-:v cvidcccc L.c IcFJ Surus cf=.=cr^^loycr uzccr the VVorkcrs'Corapcns:tion AcL 1 undcrstz-)e t!::t a copy of this st:tcr-.:crt%ViU bc forW dcc to the Deputrnent of IndustriJ Aeodenu'Oftsee of lnsurancc for eoveraic \crifu::;or.L-c th:: fai!:::c Ic sccurc covc:-2c z,--rccu;rcd ender Scc6or,25F cf I./jGL 152 can lc:d to the imposition Of_ftin ir.J pcn:Jt;es cor.:is r.0 cf: nc cf u� tc S 15�O.QC�.dlor it phi o -ect cr t to orc ycZ.: per,:]tics in Lhc form of: Stop Work Ordcr:ad : fine cf S;C;.C. c:y nc. Signcd this CQ7-'� d2y of I , 19 4' LAiccnSCC/PCTMiITC Licensor/Pcrmitror DEPARTMENT OF PUBLIC SAFETY V. scs ` ac COMMONWEALTH ONE ASHBORTON PLACE ca3=ic= MASSACHUSETTS � BOSTON,MA 02106 CAUTION LICENSE 41616, CONSTR. SUPERVISOR EXPIRATION DATE FOR PROTECTION AGAIN ST Q 996 EFFECTIVE DATE LIC-NO. THEFT,PR NTPIN APPROPRIATE UT RIGHT B RESTRIC�I�NS� 0 5�3 1 /�.9 9 4 05095 9 o BOX ON LICENSE. . NONE � M CHAEL CHRISTOPHER LASTI OPERAIRS b 117 LONG POND CIRCLE USTI�UDEPH `O- SS # 142-5r.-8359 m BREWSTER MA 92631 m PHOTO(BLASTING OPR ONL'n FEE' APR 2 D 199 4 j 0 0 OO NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY - v STAMPED.OR-SIGNATURE OF THE COMMISSIONER `HEIGHT: DOB: SIGN NAME IN FULL ATl�1 0 v 7 4iGNATUE OF LICENSEE THIS DOCUMENT MUST BE - .CARRIEDONTHEPERSONOF ¢';1 ;� tin IONER , `THE'HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. r y,- .t ,; , PRO NNE T C'Te9 strat ON`T RACIon '10p ID9860 E � L�N O.R , 1II. S HA L CHRISTOQyE -� 127LONGPONOx �� { 00,,*JA)S KAI 00 ,J g AA i P� �r 8 � l i - t 4 — � ti � / � . a J ,� _ r � ; , . - .� , . a k � �- i ± j ' �.� i I _ , - , I � _ i 1 .. 1 I i .I ` t �. - ......— —.._.— . ......wya�.. J 1Lp,� \ Sieo? � I cAz. Co j 3 1 � TO THE BEST OF MY INFORMAT ION, KNOWLEDGE, AND BELIEF THE AS BUILT PLOIF NLAI'V Foox)6 A 1 121) SHOWN. ON THIS '�'f�<.LL.'��� •,MASS-. PLAN HAS BEEN LOCATED ON THE -� L -�_- GROUND AS INDICATED. - DAT F' :KALE L " �Ur� j U-II.N T Si, �..� - o"11v IV ty/t_COX PROl I:SSIONAL LAND SURVEYOR ?03 SETUCKL t F1f1�D SOUTH DL !W MASS. m C�1/A `r t - - The Town of Barnstable MASS, �0 Department of Health Safety and Environmental Services " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only 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: 4,_tM �" Est.Cost izy'00 Address of Work: Owner Name: Date of Permit Application: lqq I hereby certify that: Registration is not required for the foliouin8 reason : s) Work excluded by law Job under S1,000 Building 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 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: qA-7 lq4l 101 0 Date Contractor na a Registration No. OR ql,:;,7 1/74 Date Owner's name Assessor's office(1 st Floor): Assessor's map and lot number L0J, of THE>o Conservation(4th Floor): - P ii1 , ��� � � `� � Board of Health(3rd floor): • Sewage Permit number ti , a t DesiAS i►Dtr Engineering Department(3rd floor):-; AND House number I s '�O M, I;:r-,LULATI N-3 air Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M'and 1:00-2:00 P.M.only I TOWN OF BARNSTABLE BUILDING INS 7VOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ,yam r 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the'}ollowing information: Location N 1vS A T r'P,UJvf ' Proposed Use Zoning District Fire District Name of Owner 61940 Y�� �l�N Address 60jt �Or4G o %1 1' Name of Builder /d/ AiL tl LdL:K 61FA Address /o,'�f �O �rC .0 G'' �2 Name of Architect �--'"' Address / Number of Rooms Foundation Exterior 0 C. r11��'� Roofing ►�.r'/� Floors Interior Heating D Plumbing 00 Fireplace �— Approximate Cost s Area 0 Diagram of Lot and Building with Dimensions Fee ���� 5 W , Y � J 9 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 Siipervisor's License VAILLANCOURT, ELLEN 173 DUNNS POND ROAD, HYANNIS No 3a Permit For BUILD SHED ADDITION. S. F. , D. Location 173 Dunns Pond Road Hyannis Owner Type of Construction ' { Plot Lot Permit Granted 19 Date of Inspection: Frame 19 Insulation 19 Fireplace 19 Date Completed 19 r • t It �^ ' 4 r t � I - 1