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HomeMy WebLinkAbout0015 KILKORE DRIVE r r'v' r � �J �/� Assessor's office (1st floor): THE Assessor's map and lot number Board of Health (3rd floor): Sewage Permit number .................... 11,3 i EAUSTADLE. Engineering Department (3rd floor): / .��oD A: moo rb 9- Housenumber ..................................:...:................................ o rax 6'.0 Definitive Plan Approved by Planning Board ________9_-___9_-_______19_ U, '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 C !I AJ -'f�.`J . C ` .......... L�f C<.t n!f ................. .... .. .............................................................................. TYPE OF CONSTRUCTION .......5�.^'�.� .jVom `c� L�lC'd'� y. F'A E ........... .......................<....................................................... /I 3L ------------------19 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: of �df �0 AFL. !• oP6 1)t? 3u( Location ....................`/ .......................................................................................................................................... A.'6- ProposedUse .................................... ....................................................................................................................................... Zoning District k e...................................................Fire District rZ�F v .......................................... /11 3 "trf or�'� Jj- �vx 5/6 CC ,,fCrr�ll-P'Name of Owner Address .......f....................................................................... ................................... ........................ Nameof Builder ........... ,v� ..........................................Address ....... y..l............................................................... Nameof Architect ..................................................................Address .........:�......................................................................... Number of Rooms ..................................................................Foundation ».......('6NCe t- ir. . .................................................. Exterior r u f{ps. u �;( :C`S - C r J)iJ Roofing � SPIJ/a C T .............................................. . ............................................................................. ................I................ .. ... t Y Floors 0 4levr.�...... V1. .L......................................Interior ......;p:t C-TK,oC K . ........................................................ HeatingWn 13 11� .... ............................................... umng .................................................................................. 1<..� .....�Fireplace .......... ✓ ..................................................................Approximate Cost ....... ;. ................. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. I 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 ...�M...:`.:W....... ��.......................................... Construction Supervisor's License ... /3 g'1 . ..................... GREENBRIER CORP. A=272-005-014' ;7, 70z c';?Or '0.7 No A. 4.94.. Permit for .......... 5i-11-91-Q...ZaMily..Dwelling.......... Location .,.Lot #30 , 15 Kilkore Drive ............................................................ ...................Hy.anni.s............................................ Owner ........Greenbrier Corp.:,................ ..................................... Type of Construction ...Frame........................... .... ....... ............................................................................... Plot ........................... Lot ................................ December 8, 88 Permit Granted ........................................19 Date of Inspection .....................................19 Date Completed ......................................19 110 *'+•.wM✓a .•1-..s.F+.*v.rd^ .. .. �,��,,,.,�_«r�,"`L,.i,rrr._._.'^"'"w--�'�'�. ,.-. `,�". .'"".����t�:"'`�"'.u,f�'"►..�Y1ss.r�-,-+.+�'w+'*`�.Tt?'"" '�"�,,y-r-v...::'�`�'+�`""*„K'Ms`+�w..,�wR,wr+! e Assessor's office(1 sty Floor):. . Assessor's map and;lot number — lS•ON, Board of Health(3rdfloor):Sewage Permit number '- Engineering Department(3rd floor) House number. .� °o s63q. Definitive Plan Approved by Planning Board 19 � o YAv d 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 TYPE OF CONSTRUCTION (AJ air) PCAITEV)eO" 7"WWA119 ' 19 TO THE INSPEC.`OR F BUILDINGS: The undersign here 'y pplaesjfor a permit Iccording to the following information: �f d Location 7 �` ! /� Q j Proposed Use CA T 142 Fs 2c�a� �� -� �A�d6,W_^j Zoning District Fire District Id N A►/.S Name of Owner Ili Tn (/ U Address I i Name of Builder Address i Name of Architect Address Number of Rooms O NE Foundation /�`` �'n vCgee7F_ PfC�gSj€►25 Exterior C W!II4d-4 0 A 14 L��L Roofing 3 'r4:"R 4 SpH, L7' Floors C14-4 P€T Interior SF1 T�taCa� r Heating Ho,7 Plu, b-_inql!� a A( a Fireplace Al iy � ,4 pp oximate Cost Area y Diagram of Lot and Building with Dime si'6nj �� Fee { 1 i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS fi. 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 VENTURA, VITO A=272-005-014 No 34527 Permit For Build Addi i n Single Family Dwelling Location 15 Kilkore Drive Hyannis Owner Vito Ventura Type of Construction Frame Plot Lot— Permit Granted August 15 , 19 91. Date of Inspection 19 Date Completed 19 PERMIT COMPLETED e� i /.9 97 /B,2a7 s:F 2 i 4o.¢ 0 I I CERTIFY THAT THE vA/DAT/ /tK oc W4`' SHOWN ON THIS PLAN IS o, •,1�� CLIENT �.. LOCATED ON THE GROUND /�r PAUL A, JOB NO.=� LEVY AS INDICATED No..lom • DR.BY: � �, c CHKD,6Y:� SHEET.LOP.. ' : abAg DATE REGIS R D .LANp .:S ORVEYOR :VY.ELDROU t WAGNER ASSOCIATE - 210T PLAN EWOINEERS - LANDSCAWtE ARCHITECTS ,Go Tao . �,c,coeE !/7,ei✓F PLANNERS - LAND SURVEYORS. — IN 889. WEST MAIN STREET 9XIWST�g4P-H,,4 CENTERVIILLE1 MA. O-2C3-� SCALE : 1 .� 0 DATE: i i jV _...NT__GJ< .. ._. :.._ r t i - 1 f i f f i t I � , { I i • { l _I I 0 � i , ( �' ,` ! ...,..._._... ..+. ..ter.. ... } .. _. _...�.�.�_.. 1 .. ..... ... .. .. ... .. .. _— I , , ....... .. i , ( s j -' 1 1 t ee ' - r i i i ! r #I , � ,fit t i a' � ,•: � ^ j ! I III e c oh De aetment f' { t i 1 , I S , e � o o . j �7-1 � z o � J r � 3 J TOWN OF BARNSTABLE • BUILDING DEPARTMENT --------------------- ---HOMEOWNER LICENSE EXEMPTION oaaaa�eaaQeaaaaaa_: Please• print. DATE ' �� ' , •S , c" JOB•, LOCATION Number Street S x address "HOMEOWNER" Section of;•town. Nameo V77 � �/Z® 2.- PRESENT 'MAILING ADDRESS , Work p Home phone hone• •�~ z .:: ity town , The` ' State current exemption for "homeowners" was extended 1 ` ZiP'Code dwellin s ' q of six units or less and to allow such homeowners uto de owner-occupied G an dividual for hire who does not possess a license, acts as supervisor• e, provided that the acts DEFINITION OF HOMEOWNER: Persons) who owns a re- side Parcel of land on which he/she resides or inte , on which there is, or is intended to be attached or detached structures accessory to such use nds li g,a one to six family A person who constructs more than one home in a dwelling, A person who homeowner. and/or farm structures., Co a form ac Such homeowner". two-year period shall not be cEpfable to the Buildin shall submit to the Building Official for all such work erformed under the0buildin, that he/she shall be res onsi The -undersigned ermit• (Section 109.11� ble Buildingdhomeowner Code and other a assumes ,.responsibility for compliance with the Stat applicable codes, by-laws, rules and regulations. . The undersigned "homeowner" Barnstable Building certifies that he and that he 9 Department minimum ins ection understands the Town of /she will comply with said P Procedures and HOMEOWNER'S procedure re uire s m and requirements. ants SIGNATURE •� ��A /' APPROVAL OF BUILDING OFFICIAL Ll� Note: Three to com family dwellings 35 P1Y with State Building000 cubic fet e Code Section 12 , or larger, will be , Construction Contrrequired ol. i o • J HOME OWNER'S EXEMPTION The code state that: "Any Home Owner ' .performi'ng 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 ihat .if Home Owner engages a person (s) for hire to do such work that '.such shall act as supervisor. " Home .Ownei Many Home Owners who use this exemption are unaware that the are assumi • . the responsibilities of a supervisor (see A y on for licensing Construction Supervisors, Sectiond2. 15) .Ru This and Regulations often results in serious problems This lack of' awarerie� unlicensed persons. In this case�ourrBoard acannote proceed n the oagaiinstme rtheres inlicensed person as it would -with licensed Supervisor. The Home ''Ow as supervisor is ultimately responsible. ner astir. To ensure that the Home Owner - is full y aware P man, communities require, as part of the permit application, thatothebHoneiOraner . certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several tow care to amend .and adopt such a form/certification for use in your�eommunity. r Assessor's office(1st Floor): /y , Assessor's map andaot number a7o7— %0/� ,`p�� Board of Health(3rdfloor): �.�/++gy�pp,, �t� artist �y p R WQ o Sewage;Permii number f - .1J N®� CJ 1V ,S�IUSTCO t� `T�bIOWN%L R� e Engineering Department(3rd floor): nation Co y DAB.lya LE S �;S ..5 House number • � ,S f �mjss ° t6}o• Definitive Plan Approved by.Planning Board 19 s gA o r�r d APPLICATIONS PROCESSED 8:30-9:30 A.M..and 1:00-2:00 P.M.only Y 7� Date TOWN-,--, OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO cl TYPE OF CONSTRUCTION L 19� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location K' SMA Lot Proposed Use Ci47:/0626 11P�V f" mr:f ('')`eetEEZO Zoning District I`-' Fire District A.f[-S Name of Owner Address Name of Build Address Name of Architect Address Number of Rooms Foundation (in,�' en rNCenp 'of C'45/^raS Exterior C, /--1-1 /,112 a L- Roofing —M41A 14 5-Ph�AL Floors �Enl" Interiori� Heating Ito /L- Plumbing Fireplace_'1 ��>� Approximate Cost Area Diagram of Lot and Building with Dimensions Feei� 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 R Construction Supervisor's License �J {' VENTURA, VITO s, No 34527 Permit For Build Addition - ' Single Family Dwelling Location. Lot #30 , 15 Kilkore Dr; ve .• ' Hyannis Owner__ Vito Ventura Type of.Construction Frame �` F r Plot Lot ✓4` ; �' r ,- .,R ems,, ., •+ .� , i Permit Granted Auqust 15 J 19 91 Date of'Inspection 19 ,- s Date C leted �19 .' A �• � to - - � � �. � ''t �f i • I 12171ff Assessor's office"Ost floor):Assessor's *THE " 6 0 0 0 map and lot number ....................... ..... cv— Board of Health.(3rd floor): Sewage Permit number .................. 213 339R39TAXLE. NA8&- Engineering Department (3rd floor): House number 1639 0 M0 Definitive Plan Approved by Planning Board --------- APPLICATIONS PROCESSED 8:36--9:301A.M. and 1:00-2:00 P.M. only TOWN� O.F . BARINSIABLE BUILDING - INSPECTOR APPLICATION FOR PERMIT TO ............................................... ................................. .............................. TYPE OF CONSTRUCTION ....... . .........bjoil�....... 3_.1,?A1q.6........................................ ............. . .. ..... ... .. .............. ......36 ....................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the ft_1,1,a w i n information: bR JYC Location ......40 r lKt c K 0 z 6 .................. . . ...................................I................. .... ... . . ...... . .. ..................................................................... f A/Cr-r-'4� /I �4,j ...... ... ............... Proposed Use ........................... .. ....... ........................ .......................................................................... Zoning District ........................................................................Fire District .................. ............................................................... .�rlz Lccq e'iz r" e-A-tCry;/I-e Nameof Owner ............................................... ..................Address .........................................I...... /K Name of Builder ....................................................................Address sc -1 .......................................................................... Nameof Architect ..........................:....... ..............'.....,............Address .................................................................................... Number of Rooms ...............................................Foundation P P.up-6 f> c6VV .................... .................................................. : 1.4 Exterior ....... .............................Roofing ......... ... ................................................................... Exlei ....O� ... ................ ....... Floors ........ ....... .............. ......................Interior,. ...... ............................ 13 A T tj Heating ..... .........11.1 .Plumbing ....... .......................................................................... Fireplace ..........4?Y4..................................... ............................Approximate Cast ............ ........................................ lz��..... ..... ....Area .... ,Diagram of Lot and Building with Dimensions /K--) . Fee 5D ........ I. . . ............. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the own of Barnstable regarding-the above construction. Nome . . ........... ............ ........................................ Construction Supervisor's License ... ................ GREENBRIER CORP. � A ! No `..2494. Permit for .,One Store ..................... J i p S.... .1n.g.1.e...Family... Dwelling.......... " �. Lot #30 15 Kilkore Drive - i Location - _...H...............................................ans ...... ............... , ........ ................ ......... Owner ...Greenbrier Cori? Type of Construction' Frame..........:.................. r .... Plot ............ ...............`... Lots-�:...... ................. December 8 88 Permit Granted .........................................19 Date of Inspection .........: ...............119 Date Completed �. .. . .............. ...19(% Y M 4A _ _ r S .fir 3� l •lB,goo 7 sF IZ w i o° I f - I CERTII=Y THAT THE + q`r, z � •v�e�:�;e SHOWN ON THIS PLAN IS p�tHo�,� CLIENT LOCATED ON THE GROUND °� PAUL A, r JOB NO. AS INDICATED No LEVY ?. DR.BY: . 30G17, . CHKD.BY '��-STi9R ., SHEET.1-.1,�f=.w,� ; . 12 7 9, �;. DA E RMS. :ED. A,!! D,S ;RYEYOR Y LEVY,E a VvAu : ►TEsuc C. t 4 ' PLA E"NORS, LANDSGAPE A CHitEC7$ ris PLkNNERS - LAAS: Mu SUI3VEYQRS, Lo g$9; WEST MAIN STREETwsT,a � . CENTERVILLE, ` MA. 026,32 SCALE : L o DATE:` 7 �� TOWN' OF BARNSTABLE, MASSACHUSETTS UILDING PERMI"'I 2 4P DATE PERMIT NO. 1, APPLICANT ADDRESS -1 ! ox (2 4 04 0 1397 (NO.) IS TREE 1 1 ICO?ITR'S L.ICCrISE! Build NUMBER OF PERMIT TO STORY ��'.;DWFLIIJNG UN!T 5 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) I � AT (LOCATION) ILI o.:" 'u'Jyf.. . . I< D:'. ZONING 01ST R ICT—i ( (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS 5-,RE,-TI SUBDIVISION LOT. LOT BLOCK SIZE BUILDING IS To BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI, TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION__ iiYPE) REMARKS: c.c lZI C� ;"t 3 ri 9 0, AREA OR 864 sa. PERMIT VOLUME .1 "5 1 1)0 0 C? FEE ESTIMATED COST 50. 00 (CUBIC/SQUARE FEET) Greenbrier Coi:p. f. OWNER P Ct-nt(,rv4 I 11 O. 5 1 10 BUILDING DEPT. ADDRESS BY M. .......... ............ MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS INSPECTIONS REQUIRED FOR 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- MECHANELECTRICAL,, PLUMBING A CAL NSTALLATIONS.ND 2. PRIOR TO COVERI-NG STRUCTURAL QJIRED,SUCH BUILDING SHALL NOT BE MEMBERS(READY TO LATH). OCCUPIED UNTIL 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 C' HEATING INSPECTION"PPROVALI, OTHER VVURK No I PRUCcLD UNIT.HALL_ TOR HAS APPROVED THE V�%RJOUUI IHL INSPLC E R M'T L `3 t'', N L)C c"'-4 I SI,%,FS OF WORK IS NOT STARTED "Y11HIN ellY THE CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. JR CO,�T I INUAT I ON OF ROAD KIND BUILDING PEF2-1,IT 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 Engineering Section of the .Department of Public Works. loam and seedshoulders as soon as t"zweather permits. other (explain) < x,g,-/-?(L_ LOC' i GAP,, ner/Contractor NGINEER:I +G AUTHORIZATION , 1 w yr , Town of Barnstable *Permit# � - � .l, Expires 6 months from issue date Regulatory Services Fee . sniuvszeBLFE , Thomas F.Geiler,Director n �639. ..� t .Building Division HIED MA'1� Tom Perry,CBO, Building=Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. ' EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ��� Property Address 04esidential Value of Work 700 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Vito tl-e d T yPk 7 CC%/3 6,04, i/-e U-01- ere/; e74A` 'OleGl Contractor's Name Z etel EC7.-t i Telephone Number Oe ff—7 7/ �4w .X Home Improvement Contractor License#(if applicable) �'� /a 5! a d ❑Workman's Compensation Insurance Che k one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name .PRESS PERMIT Workman's Comp.Policy# 00 9 2008 Copy of Insurance Compliance Certificate must be on file. TOWN OF BAR INSTABLE Permit Request(check box) la�'Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,A *Where required: Issuance 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 Permissiq i�,__r F,!0 r if s, A copy of the Home Improvement Contractors License is required. SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc Revise020108 y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/or ganizariontlndividual): �7�©Gt y1 /C L C�/'� �- VR& •�rJt.G- a27 City/State/Zip: oo�- aj Phone.#: !t? Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors 2-R I am a•sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity. employees and have workers' 9 [J Building addition romp.msurance.t [No workers' comp.ir,crrrance required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12 []Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'comparsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aff Aavit 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 subcontractors have employees,they must providh their workers,comp.policy number. I am an employer that is providing workers"compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under th pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: — — Phone M Offu ial use only. Do not write in this area,to be completed by city or town offtciaL 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#: • N 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.foregomg engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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 eha ter 152 25 7 states`Neither the commonwealth nor any of its political subdivisions shall P � § � ) 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,i.f 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 worker;'compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp Officials has provided a ace at the bottom Please be sure that the affidavit is complete and printed legibly. The Departmentp space of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit,must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to btirn 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 Ummonwcalth of Massachu$ctts Department of Industrial Accidents Mce of Investigations 600 Washington Street Boston, MA 02111 TO. #617-727-490.4 ext 4.06 or 1-977 MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia Snow Construction TRIM COVERAGE SPECIALISTS a VINYL SIDING COMBINATION WINDOWS&DOORS a REPLACEMENT WINDOWS a SEAMLESS GUTTER SYSTEMS Licensed Massachusetts Contractor 8 Homeport Drive Lic. #007855 Hyannis,Mass.02601 Member of the Better Business Bureau Telephone 771-9366 Date Purchaser's Name I I�C7 V P� �//� Tel. No 77-6— 235? " 7 2-1 Address `J C06 /xi4, A t1--e �/lJlc�C�'�f�/Y` .'�� � h-, D PURCHASE AGREEMENT - - - CONTRACT AGREEMENT I/We, the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions,on premises below described: Owner's name Tel. No. Job address l / ki7,w'F City W_ REPAIR WORK: No repair work shall be done, except as herein specified and expressly agreed to in writing by the Contractor.,. SPECIFICATIONS n �." —e G $ A � 4 57 '-..' 4-5 7'/4 (C Ge,i M 17 42101,19 -� . fr -r "t'G -e Ci t.L N'. T- Materials and labor to cost$ Down Payment$ 6 421( Balance of$ 3106 DUE UPON COMPLETION. .. Contractor will do all of said work in a workmanlike manner: Owner agrees that in event of cancellation of this contract before work is started, Owner shall pay to Contractor on demand. Twenty-five per cent of the contract price as liquidated damages for the breach. No work to be done on this property other than that specified in this contract without additional charges. All verbal or written agreements not mentioned on the face of this contract are void, and no salesman has any authority to change, alter or add to this contract in any particular. This contract contains the entire contract between the parties. A copy of this contract is hereby acknowledged to be received. tghis contract is subject to strikes, accidents, or other delays beyond our control. N WITNESS Wli REOF the parties have hereunto signed their names this d of ,20 O� 14 JL t11 Signed C� epres ntativs Owner Accepted) SNOW CONSTRUCTION CO. Signed Owner By — Business Certificate filed under Mass.General Laws with Town Clerk of Yarmouth. 00 N L . K O y Z • t Nbe 04 j a �v�Ea e pc3lc= 'mk ` _ :fl � j -a CA W 0_ i O ap d cn t Zi Z 2 Z i i O O0 _ 1 j 'I f License or registration valid forindividul use only a before the expiration date. If found return to: ' Board of Building Regulations and Standards One Ashburton Place Rm 1301 1 Boston,Ma.02108 i - _ ot`valid witho sign ure „a r INC>, TOWN OF BARNSTABLE Permit No. ..�2494...... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ................ 7 Yl ,679• ` '�ror,r HYANNIS,MASS.02601 Bond .......x....... CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. , Address Lot #30, 15 Kilkore Drive Hvannis, Mass. 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. March 3, $9 Building Inspector ( -C./T f� I\ r � 7' ' 4 24` tr oo-i y I 1 il'15 T -i�12- 1 I l L-oT - 1 ��• INITIAL ISSUE � .T I - No ATE DESCRIP770N BY -PKoP0!5-6 T �4 LOT- W4 T HAt...l, SL t-��t; Fs r l aTA L , MA 4 f OR SCALE: I = 44 JOB N0. I S 9S PAUL A. 40 0 LEVY � ,u - IG�I7 �T .A LEVY, ELDREDGE & WAGNER ASSOCIATES INC. AR el= Baas IN SUIMMMs 889 WEST MAIN STREET CENTERVILLE MA 02632