Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0019 LAFAYETTE AVENUE
R TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map A W Parcel Permit# 3 Health Division �� �� n Date Issued r� c �� to �� y Conservation Division Fee� l .� `�, y 10 Tax Collector ti Treasurer Planning Dept: Date Definitive Plan Approved by Planning Board Historic OKH Preservation/Hyannis Project Street Address I ct L A L&!erZrA 61: Village - L<(ekgoi-s lej� Owner T" A u g s'g- l lsaf mr-A 6�2+y 2� Address r ? L&F_A.�e ar 6I' Telephone 2170 —10111 Permit Request I'a ... �sJaf lr cclJ� eZ541#40.4E EXTE 12. 0 P Square feet: 1 st floor: existing 3fZ1.2,fproposed5M, 2nd floor: existing MA proposed AM Total new Estimated Project Cos; Zoning District Flood Plain Groundwater Overlay Construction Type b3crmq Lot Size Grandfathered: ❑Yes 0 No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure C1_1> Historic House: ❑Yes `V No On Old King's Highway: ❑Yes j No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other. Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 0 new C Half:existing 0 new 0 Number of Bedrooms: existing 0 new Total Room Count(not including baths):existing / new ® First Floor Room Count ! Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other 401+e ' Central Air: ❑Yes ';4 No Fireplaces: Existing NeWC New 40"E Existing wood/coal stove: ❑Yes ;►No Detached garage:0 existing ❑new size_ Pool: O existing ❑new size 44 Barn:Yexisting Cl new size S"m Attached garage:0 existing ❑new size PJA Shed:❑existing ❑new size_j_Other: Zoning Board of Appeals Authorization ❑ Appeal# N 4 Recorded❑ Commercial .❑Yes )4 No If yes, site plan review# Current Use �W Proposed Use f�`Re R&DA4 r BUILDER INFORMATION Name T rk Mi gase_— Telephone Number Address hAki$0 8 License# C5 0Q/&I ' 5_Irurar=Mh.. ADquo Home Improvement Contractor# fa*,tiZ+ i- F41 cgsf=5 Q_ . Worker's Compensation# We e—g ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO F A L4�-Ab r—L1 SIGNATURE � DATE 1f1/ol-11 r^ III FOR OFFICIAL USE ONLY _ PERMIT NO. i 1 4 DATE ISSUED ` MAP/PARCEL NO. ( ,a VILLAGE` ADDRESS , f� OWNER` DATE OF INSPECTION- FOUNDATION t FRAME .f INSULATION FIREPLACE w ELECTRICAL: ROUGH FINAL �t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING~ DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Ir Department of Industrial Accidents •� � °°-°-�- -- Office of/orestlgatloos - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: city vhone# ❑ I am a homeowner performing all work myself. , ❑ I am a sole proprietor and have no one working in any capacitv I aman em 1 rovidin workers' compensation for my employees working on this job.: ;::>::;:;;;::>:;;;:;:::;;;<>:<>::::<:»;:><:; <: ><'' �r ����;'�}ail. '`'� "' ,t� ``:.:..Alt company name address ,::: oiicv#;,ih7 i�Via:< .ice;. ., insurance co. Wilda ' ,;. .... ///%% ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ..::.;:.;:.. ;:.: con any name. :......:::..... .... ... ....... .......::.:.... ss . . .........:::....... ....... ... . :.:.............. r�3:•::.: .................................................. ......:.......... ��...:::...:......:...::. .. hone » <> :D city ,a..s:•,.......... J ..:................... ........................................................................................... ........:......... ii:vi:::iL{lilt............................: : : : j'riv.:iv:Ji:_ii:C i^i:iiii:i......:........... is...iii.iirii}i vv:h'Si?;?v':•Y:ti4;;;ry'}:{v:•i:•:?:ryii'::•::::.}wry::.:...... .............. .....................................�:iviii:i4.,.:,,:...:::::•..._:::::•::•.�::.�::::i::.:!iti?iry;:w:::::::.}v:.:�::::,�:::::,i: .. 0...................• ............................... •i'fi^ii+.i^i:4iiiii:0ii:{.i:vi:•ii?ii:::?::^:CC:.iiii::iv^:ryY:.�.is :'::i::::>:;':":y::i:::::::':{{i}: iesnrance :.�.:.; ;.; :.. .:.:::..:. . ... c env name >::»>::::>:: ;: address: ...::::: ::..:.:::.: .:.:.:::.::::.:......... d _. ........:.. ........... 0 rence-,co Q= 11,5,1�1:: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of erhnimai penaitia of a fine to 51,500.00 and/or one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of investigations of the DU for coverage verification. 1 do hereby certify under the pains mid penalties of perjury that the information provided above is true.and correct Signature Date/1��9 — Print name ;SAC K m i LL.5 Phone# ►7 el�'�4�i —----------------- official use only do not write in this area to be completed by city or town official city or town: permitAicense# ❑B�dlding Department ❑gDepwtment g Board ❑'check if immediate response is required ❑ a Office (] contact person: phone#; �- (towed 9/95 PIA) ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE square feet X$55/sq. foot= GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK square feet X$15/sq. foot= OTHER F?AR-r-g A R- square feet X $??/sq. foot= Total Estimated Project Cost I 1 trv�v g990915b uF tom.r� The Town of Barnstable • anxivsrnaM - 9� M�; ��� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 50&790-6230 Building Commissioner 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: A RAJ Rk_=D 412 Estimated Cost i 1,, au Address of Work: 1 Q L-a4rr Aer--im A�/� b-1 V Axmft s floy-1 Owner's Name: ;IA M 9; -tat A-4Ga(Dbr� �3 E S Date of Application: 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 I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR , Date Owner's Name i q:forms:Affidav r�^ 1-7k �orinwouuea/l� a�� �. DEPARTMENT OF PUBLIC SAFETY s CONSTk%CJ.I�O,N SUPERVISOR LICENSE Nu�ber - Expire e: Restricted JOH N MIiIS.I 202 FIW P'RRISH RO SCITUATE, NA 02066 l k � s , 'NM } • F Y'S tfi�L"4"'•;��4"� �� ^{c§�brY`4T�� c+. #'rir'`^I b .1 . _)I YSaD CONTRACTORt } HQME�INPROVEMENT Re isstration 104224 ,y M� L zpirationY 07/13/00 P r 4? ♦ mF' � l�^ YL ?i tz JACK MILLS-CARPENTER f BUILDE ack LA illsAll ♦a��3 First Pari§fi Rd ru goMlNlstRnmR r « Scituate MA 0206E 1 . AS/LOT 45 NB,2 43 l BO• pp' LOT AS/LOT 44 W 4650 AS/LOT'50 ,r,r,rr,,,,ri, , PORC r 15,2• '�' �+ 18,E 05' r„rr,,,,,,,,,r .rrrrrr COTTAGE I � 79.03' ti N84'0120 LOT B NOTE.- PRE-EXISTING, NONCONFORMING RES. ZONE. "RFI" This MORTGAGE INSPECTION ank Usc.-Opix an is For FLOOD ZONE "C" ._ _ REGISTRY OWNER: BW RZ_ Jf �7�ARffE III- r..T LIL a4F DEED REF:��►;�V/Q6j�-71240- _ - -BUYER: .�lAMFs w&&eB Dmq_G.,BAYF. F- DATE: _JTA:.V7�77��.. _ _ PLAN REF: .3 /47 .�,,. _ SCALE:I"- 0 � FT. I HEREBY CERTIFY To B�s1�.� Sir ._n�P� IZ�:�1'RII,�ZFQMIn�Z'.� car ;�r YANKEE SURVEY 11S SUGr6SsoRS�OR i5!AA_ AS fN61R_INPdRr. r tAL AO0fA2#T H AT T H E B U I LD I N G SHOWN ON THIS PLAN 1S LOCATED ON THE GROUND AS e�,�e� ' CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ _ CONFORM ! 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE TOWN OF 8B$1YSL9,9 Z--ti__________AND THAT Nu INDUSTRY ROAD IT DOES_M-_ LIE WITHIN THE SPECIAL FLOOD HAZARD `^'��r#., .,����` .: MARSTONS MILLS, MA, 0284 AREA AS SHOWN ON THE H.U.D. MAP DATFD_7/_Q _,9, ii",.'; ;,'. '�� 2 TEL: 426-0055 THIS r''LAN NOT MADE FROM AN I 'S'1'R F;NT �' �-� - SURVEY.' NO HE US F1 F'Uf NC rS �4f101 DC.I� TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION Map aoo? �. Parcel O y a�� Permit# Health Division /�� Date Issued / -J, G Conservation Division Q u,,.. . t C4 = ' + Fee LT 29 Tax Collec EPTIC SYSTEM'MUST BE 3 7,r—0 ' �yINST IN COMPLIANCE Treasurer,7 I^ TITLE 5 ' E III N NTAL CODE AND Planning Dept. ', I CULATIONS Date Definitive Plan Approved by Planning Board Historic-OKH -Preservation/Hyannis 4 I/ Project Street Address ' Iq L_AWE7te A�F_ ''Village Owner S&Ars-S MI&Q CPSTtl COY iY i Address 'I33 M�A�iJ 1`T, t�©t�wt[t.,,Wpt. OW&I M1 Telephone Ip-` 6 t^(v5 ^ (off+s f Permit Request .x'r>~jtp ��S11�cJ•�G F7.r. AT' iE�CrS7'►*tG L!lV�Tr�QY -'o iAPeLc�p1� f�47Z �reY ,&aD- WcsAlE L,�4�1At�R�'. F.i. T d1 f2AY Wl"Dog-,J { N kiTcREyf , EP(ACE -DI",,.► P.n e'aa S ubu�a. Pam 51,06 m c- wades e�14r u.��E+"S �21 tiI�fl(� !5 CM:2F S� Square feet: 1st floor: existing proposed. 2nd floor: existing proposed Total new S Estimated Project Cos' AA04vV*!?oodoning District Flood Plain Groundwater Overlay Construction Type Qopp -FF12,A►1 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 �o .On Old King's Highway: Cl Yes a o Basement Type: ❑Full 9/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 t, Central Air: ❑Yes, C*No Fireplaces: Existing I New Existing wood/coal stove: O Yes Flo Detached garage:'❑existing ❑new size Pool:❑existing ❑new size Barn:E+ existing. ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes 9/No If yes, site plan review#` { Current Use d�c.►QE Proposed Usei PcP,. BUILDER INFORMATION Name_J-Ac.tc-M►U;� �e� — j v i Telephone Number I"7 l-545 "V.�4 Address aoa, r,Q•sf A s,+ ED License# GS, 0/3/(a ;5c r r v P•TIZ , A4 I* t)24)4P(e., . Home Improvement Contractor# . i o Al Z2.-J4 ter®+J XP5. Cv. ` s Worker's Compensation# %,oC.t©r1 to!) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE -`P"UZo DATE _ /,ZZ2,Z!2 r FOR OFFICIAL USE ONLY - . PERMIT NO:•s DATE ISSUED - '... MAP/PARCEL NO. K ADDRESS S , i �� :VILLAGEi' = OWNER �l t x 'h ? -y DATE OF INSPECTIOI FOUNDATION FRAME INSULATION 7 �` Y`, k {�.. • _ ,• __ � i . ;;, • r FIREPLACE ' ELECTRICAL: ROUGH • PLUMBING: ROUGH ,k FINAL R GAS: }� ROUGH —, FINAL' - i ..�� ► F FINAL BUILDING ti•; ! ' :kj (." ,a� � :s• ,• - _ * ems. ,:, � DATE CLOSED OUT _� y ASSOCIATION,PLAN NO. • y �O : . The Town of Barnstable • a�srwmi. _ 1m� Department of Health Safety and Environmental Services Eo ' ',Building Division 367_Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner 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 containirig 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: ADPm,01a tz a*rD co W+ Estimated Cost nt 0, avo ♦ It,ow i Address of Work: iq LAFAYETIF— AJC,Owner's Name:Name: iAmc-5 M eam e:Tw tozi aAsl E,; Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied [30wner 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: �,i4Cfji-7)'I�,Q.Q�S CA�D�t�TE/Z gi9���YL. l 04112 4 Date VContractor Name Registration No. OR Date Owner's Name q:forms:Affidav M CUR Appada i TableJS=b(condoned) Prescriptive Packages for One and Two-Family Residential Buildings fleeted with Foasii Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor I Bu mm Slob Hating/Cooling Area'(-A) U-value= It value' R-value' R-values Wall h mew F.4uipmeot Effidency' p R-valuef R value' 5101 to 650011 dug Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 WA WA Normal U 15% 0." 38 19 19 10 6 Normal V 15% 0.44 38 13 23 WA WA 83 AFUE w 15% 0.52 30 19 19 10 6 8S AFUE X 18% 0.32 38 13 25 WA WA Normal Y 19% 0.42 38 19 23 N/A WA Normal Z 18% 0.42 38 13 19 10 6 "AFUE AA 18-/. 0.50 30 19 19 10 6 "AFUE 1. ADDRESS OF PROPERTY: )-A FA?ETrir 4 JE 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: Z 3. SQUARE FOOTAGE OF ALL GLAZING: ' S oe 4. /o GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a 780 CMR Appendix J Footnotes to Table J5.2.Ib: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 W of decorative glass may be excluded from a building design with 300 ft'of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R49 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. 'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 --=:. - The Commonwealth of Massachusetts Department of Industrial Accidents _ ONCe 011HY85 i018afts � � 600 Washington Street Boston Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one working in any capacity ////ENE//% tom'I am an employer providing workers' compensation for my employees working on this job. company name: J" K AA►L(s (°IV-Df-s6-W— ' bij r� _ . .. address: , city: 'XiTyAM—= kiAt 62-o" phone '181-,.YUS—To3& insurance co. 1_.E(gpt 4wr" a t olicv# U)C lQ l l to NpQ ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name• - - address: dtv phone#: insurnnce co. ///,%O%/%/////; :... .:..... company name: address: city phone#: .:.. insurance co. :.:: olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature 2&x A— -rm t Date Print name JA C-le— M►L-L5 Phone# I—r781— -46-- Q03i9 official use only do not write in this area to be completed by city or town official city or town: permit/license# Mudding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other ....: ......:::.::: ..... (remm 9i95 PIA) f Information and Instructions f Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law",an employee is defined as every person in the service of another under any conzr.z-, of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver c: 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 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 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance 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 Towns 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. The affidavits may be retuuned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesugations 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 'L f• 7 • 96 of'paaaiaasa8'w: •' ,:saatdx3 =z .aaqumN � � x � - 3SN33I1. 80SIA83dnS N0I1DnU SNDD AARS 0I19nd 10 iN3k18Vd30 � � warn jr �,�� j/�amumu�u,o . HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of .Building Regulations and Standards One Ashburton Place - Room 1301 . Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR - Registration 104224 Expiration 07/13/00 Type - DBA _ JACK MILLS CARPENTER & BUILDER Jack K . Mills 202 First Parish Rd . Scituate MA 02066 JACK MILLS C:,^."CATER-&ulC.ti�Ft• T PAP,-' Rm IVIA _ � _ _ ��•`CI3TrNG �'+DJNDgTIo,a }c1'J1 i�!G 3r-ter 7�oil �I v�[1>Jb4-y sr DN EX15T[mV Krrc-te-s! �oR Z-.AYouT A c 13 5� EXt7tr.14 i r r,J-P3 y1�DLfl- i - c Cohi �RYE� o�oS�b kITcHIE.,4- T+f�ooM- A2 �aiT�l' 3 inn ► iFP-IPE ri4 C-.R+4d65 Iq l A�a�ts �►' >huE. +tygw,,�rS �oRT M+175. I L i wo - - a E-NI-irimi KITG HEI•J— LAV,6,`foeY _ .. _e�c ,_ ftougE - �EYou- Day I� INTicK,afZ �NattlL£� I �i,�e ZNPfi'tocti'Z - �4 sE lo,NP.— SILL - •. A I I - I - �,t1�NDo CoksJER. OF e �Q.Baps 1 wk'� c'f CiE�)kR._ 54ir1C7l.£5 I I �Rupo ADD,TIo 4 6a-r�20o eti !, �z� Scgt� oJElt- b �ci.T 1 j' •. � k - �SCDiC SttE�lTl►� KE .w4r£�z 1/ Q-30 d7Ta�l - 2,t C- Tc io r b'� / oc p X /L �fiF- l2ncr<- S+tIx4 3 oJee T�JEK WOUeaTo�! w� �oLY Af. I 2X`i STUDS �Z CDX , 2x$' Soror '�ro''oc 'i —3f�`CDx 5uti�t. -- ---- uEl10VJETlONS fop- CRgv7L. Ace- CoveeED .�t )Af.g r * Jim � ME W D6TF4 G"vf--3 4-0 LhFAYP-rfE AVE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Properly Address; 19 LS SYette A". Hyanniaport Ma. Owner: R.Clork III Date of 1nePOWW: 7.13.08 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes Into house Lfl�'RyE'�'1'E AVG. .•treV106d 04/25/07) _ .. Page a:.o! 10 Assessor's mapi"and . lot number .........r .....,r........... .... Sewage Permit.number . .P:....................::............. �C TOWN OF BARNSTABLE Z EAHHSTAXE, i "6 9 BUILDING IN.�SPECTOR O G MPY a APPLICATION FOR PERMIT TO remodel existing building ............................................................................................................................. TYPE OF CONSTRUCTION ...........wood ...............................................................................................,................. r Qec emmber... .a.....................1975.... o TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lafeyette Avenue, Hyannis Port, Mass. ....................................................................................................................................................................................... ProposedUse ...Resident....................................................................................................................................................... Zoning District RB ...............Fire District .Hyannis-Hyannis Port i Mass. Name of Owner Robert Clark, jr............................Address ..... afeyette„Ave. Hyannis Port, Mass. Name of Builder Ernest B. lVnrris & Son! Inc.•Address ..,385 Sea Street, Hyannis Mass. .......... ............... ..... ..... Nameof Architect .......Same..................................................Address ........Same.................................................................. Number of Rooms 6 Concrete block ..................................................:........Foundation .............................................................................. Exterior Asbestos shingle Asphalt ..............................................................................Roofing .................................................................................... Floors ........Har.dwood...........................................................Interior ...Drywal.l...and..p.l.a.s.te.x.......................................... .. . ..... ...... .. ....... .. . .. . Hot water - radiators 2 bathrooms Heating ..................................................................................Plumbing .................................................................................. Fireplace ...Yes........................................................................Approximate Cost ...........$8000..00 ............................................ Definitive Plan Approved by Planning Board _____________________________19________ . Area .... .............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Remodeling to consist of; Enclose existing porch; install sliding glass door; Remodel kitchen � l F —23 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam /1 r�fr� ir..? 2. .... !1?!1�i: .................................. x Clark, Robert Jr. A=2 8 7 Permit for ......r.emo.d... .... No ..18078..... . ...... .el f.r.a ..... dwelling .............................................................. ..... .......... Location A.La.f.a.ye.t.t.e..Av.e.nue...................... .... . . .... . . .. .... . ...... Hyanihisport ............................................................................... Owner .........R6b.e.rt C.I.4R.,—ir...................... ...... . .... .. . ...... . Type of Construction .../ frame ........................................... ....... Plot ............................ Lot .. .................... Permit Granted ........De c.e.m b ex)..........19 75 Date of Inspection ........ ...............19 Date Completed ......... .....................19 PERMIT REFUSED ........... .................................................... 19 ............................................................................ ................ ./....... .................................................... /. ... ....................................... .........../ . ......7 ......................... .... . . . .. ... ........................ Approved ............................. ................. 19 ............................................................................... ................. ............................................................. `\•.�`.. ,.�1... ..f �.^^.f"-+..�•r+w'+'�•'.1r�Y.'YK�." ....�i�`.�w.'�l'VYY'Y•w11.....�.•�^ �...+�.'S.+..Y1..«'..V.�_.'ty�,... Assessor's "map" and lot number �?.7 ' o-�t. y SEPTIC SYSTE.^4 MrIPST, C INSTALLED IN COMA - IA Sewage Permit number .. .. c � FV.0 WITH ART!^;,,E II STATE Qyo*THE ro�° TOWN OF BARNS R;T Bt"'K TOWN • i HASB$TAILE. i BUILDING : INSPECTOR YFY A• . ' ' APPLICATIONS 3FOR PERMIT TO ,.,remodel existing.,building........ ..... ....................................... TYPE OF CONSTRUCTION ............ ood ................................................................................................................ "`December 2......................1975... .......................... _ TO THE INSPECTOR OF BUILDINGS: -The undersigned hereby applies for a permit according to the following information: Location Lafeyette Avenue, Hyannis Port, Mass. Proposed Use ,,,Resident Zoning District RB Fire District Hyannis-Hyannis Port, Mass. Name of Owner Robert Clarkr Jr. Address .....Lafeyette „Hyannis, Port.,,,,Nlass. ............................ Name of Builder Ernest B. Narris & Sony Inc..Address ..,385..,Sea Street, Hyannis,„Agass, Name of Architect .......Same.................................................Address ........Sm e a .................................................................. Number of Rooms .......6.........................................................Foundation Concrete block .............................................................................. Exterior Asbestos shingle Asphalt ..............................................................................Roofing .................................................................................... Floors Hardwood .Interior ...Drywall and plaster ..................................................................................... ..... ................................... Heating •. Hot water ....radiators Plumbing ......2 bathrooms ............... ..................... ................................................................ Fireplace ...Yes.......................................................................Approximate Cost .............$.8000..00 ............. . ...................................... 0 Definitive Plan Approved by Planning Board ________________________________19--------. Area ..../ .Lt.�!.... .............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t Remodeling to consist of: Enclose existing porch; install sliding glass door; Remodel kitchenrl 2 rM zs" i` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �,.. .. ., ... :G................................. Clark, Robert Jr. No 18078 Permit"for ....,remodel...frame.. . ........... dwellin> ........................ QA� Location�.:.l.Lafayette• Avenue...................... ............ ..... HyaRpisport.................. .......... " ' =s ,ty 4,1 ,- , Owner .....:..Robert Clarke..Dr..................... H. frame " - � - Type of Construction Y ^ .. w , Plot ............................ Lot ...................... ...... ti v • Permit Granted December '3 75 `+ .......19 k Date of Inspection I Date Completed GG y '* PERMIT REFUSED ........................................................ .... 19 y `` a Jf Li t ........................................................... ................. i Wa.^ ........................................................................... , ............................................................. ................. Y •' ti Approved ................................................ 19 � �. •;. -�,, ...............................................................................