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HomeMy WebLinkAbout0079 PEACOCK DRIVE �� ,. rr` I ok � q ( i 1 I i 1 oFIME rp� Town of Barnstable *Permit# Expires 6 months from issue date e * Regulatory Services Fee 13 9.0 5 * BARNSTABLE, Richard V.Scali,Director a �s SS PERMIT FD MAC Building Division Tom Perry,CBO,Building Commissioner AUG 2 02015 200 Main Street,Hyannis,MA 02601 D c fl p www.town.barnstable.ma.us TOWN OF BARNSTABLE Office:: 508462-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 4 a a Not Valid without Red X-Press Imprint Map/parcel Number . r Property Address �CX vow. Residential Value of Work$ 7S7x:7) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Z-uor)CCtz kC� Contractor's_Name (k eXkV-- " [ K(Ax-\LLZtX-,j ; Telephone Number .Sv&—7 79-073-� Home Improvement Contractor License#(if applicable) L9 Email: �IvnC_MC,:T'�CLJ VlL� C;oConst uctioli Supervisor's License#(if applicable) Workman"s Compensation Insurance Check one: ,.I am a sole proprietor am the Homeowner have Worker's Compensation Insurance Insurance Company Name UO C. vc$lm�ti Workman'sComp. Policy# 5 - 3�5� Copy of Insurance Compliance Certificate must accompany each permit. Permit Req«est(check box) 0 Re roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to EI R -roof(hurricane nailed)(not stripping. Going over existing layers of roof) e-side tt Replacement Windows/doors/sliders.U-Value . 3) (maximum.32)#of windows #of doors:--C9— ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *W here 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 Permission. A.copy of the Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.OUtlook\2PIOlDHR\EXPRESS.doc Revised 040215 4 Ile Conintorrrvealth of Massachusetts Department of Indrtstrial Accidents Office of Investigations d +600 Waskington Street Boston,JVA 02111 w;vw.mas&gov1dia Workers' Compensaf on Insnrauce.Affida-vit: Buiilders/Conti-actorslE.lectricianslPlumbers Apphcant.Infoimafion ( Please Pr ut Le ibl Na ne(Business/Orgauization/Individuai): c.- r1l-(, Cx-)L+. . Address: 1 BCD Q"L �A, uy),-�- �y City/State,'Zip: t A,, �. Ci)6 ) plione g_ —4b - 7, Y—U731 I Are VAUan employer? perk the appropriate box: T} of project(required):1. I am a en lover with :. 4_ ❑ I ant a general contractor and I es(full and/or part-time). : have hired the sub-contractors 6. ❑Nevb,construction employees 2.❑ 1 aiai a sole proprietor or partner- listed on the attached sheet_ 7- ❑Remodeling slip and have no employees These-sub-contractors have 8. ❑Demolition. working for me,in any capacity. employees and have workers' 9- ❑Building addition [No workers' comp-insurance comp.insurance required.] 5. ❑ We are:a corporation and its ME]Electrical repairs or additions 3.❑ 13111 a homeoixmer doing all work officers have exercised their 11.❑Plumbing repairs or additions my elf:[No workers'comp. right of exemption per MGL 12.❑ c 152, 1 4,and w e have no oof repairs insurance required-]i � ( ) employees-[No workers' 13- Other k%-U comp.insurance required.] 'Any appticaw tnar,checks box R1 must also fill out the section below showing their workers'compensation policy information. T Homeoorne4>who submit this affidmir indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContracton that check this box must attached as additional sheet showing the mane of the sub-a mtractors audstate whether or.not those entities have employees. I`tLe sab7contractors have employees,they must provide their workers'camp.policy number- I ant an eittplover that is prorzding iiwrkers'conrpertsadon itisrtrairce for ntv employees. Below is the policy and job site inforination. .. Insurance:Company Name Policy,"or Self=iris Lic.4• Expiration Date: Job Site Addre,�- CLlr�4 vJ�� City/State/Zip:14 Yoh•+ — 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 foe up to S1,500.00 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 beret'certi to to pains and penalties of pei jrtry that dte information provideabove is an correct. Sienahtre.. Date- 1 Phone r: O,,(ficial rise onit,. Do not.write i►t this area,to be completed ky city or tottvt.ofji'ciaL Cit<,.or ToNvile Permit/License Issuing Authoiity(circle one): 1.Boa rd.of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 3.Plumbing Inspector I' 6.Other Contact Person: Phone#: f A6 ® DATE(MM/DDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 8/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SULLIVAN GARRITY. & DONNELLY INSURANCE NCONTACT AME: 10 INSTITUTE ROAD PHONE FAx WORCESTER, MA 01609 ( ac No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC d INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: MARKWOOD CORP 110 BREEDS HILL RD UNIT 10 INSURERC: HYANNIS MA 02601 INSURERD: INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 25974443 REVISION NUMBER: _THIS.IS TO-CERTIFY THAT-THE-POLICIES-6-F_INSUR.9NCE-LISTED BEL0.Vt_HAVE_BEEN-ISSUED TO THE!NSURED-P_IA.MED-ABOVE-FOP.THE POLICY-PERIOD - INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT-OR OTHER_DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE-INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS'SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR _ POLICY EFF POLICY EXP LTR POLICY NUMBER MWDD/YYYY MM/DD/YYYY LIMITS HCOM MERCIAL GENERAL LIABILITY _ EACH OCCURRENCE S CLAIMS-MADE OCCUR _ _ DAMAGE TO RENTED PREMISES Ea occurrence - S - - - q MED EXP(Any one person) S - PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS,-COMP/OP AGG S OTHER: I 5 AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE s HIRED AUTOS AUTOS _ Per accident - s UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ A WORKERS COMPENSATION WC5-31 S-319674-045 6/6/2015 6/6/2016 /' SPER TATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N NIA A E.L.EACH ACCIDENT S 100000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) - E.L.DISEASE-EA EMPLOYE S 100000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) - WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2O0 MAIN ST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 25974443 1 1-319674 1 15-16 WC 1 Kar[ik Wali 1 8/14/2015 11:52:03 AM (EDT) I Page 1 of 1 I� oF�rqr i f*i * BAMSTABLE, MA SS. z6;9. Town of Barnstable �0 �fD MA'S A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office 568-862-403.8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize I Vet �ClkfsLu) C+� to act on my behalf, in all matters relative to.work authorized by this building permit application for: UVWIh (Address of Job) Signature of Owner Date a\f\ 0 KO'Z Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 cf/Xe. 0/- ". Office of Consumer Affairs and Business Regulation -= 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100871 Type: Private Corporation Expiration: 6/24/2016 Tr# 250303 MARKWOOD CORP TIMOTHY PEARSON 110 BREED'S HILL ROAD UNIT 10 HYANNIS, MA 02601 - Update Address and return card.Mark reason for change. Fj Address Renewal Employment Lost Card SCA 1 C 20M-05i11 License or registration valid for individul use only �Oft-ice of Consumer Affairs&Business Regulation before the expiration date. If found return to: ?.,FOME IMPROVEMENT CONTRACTOR- Office of Consumer Affairs and Business Regulation i� �tegistration: 100871 Type' 10 Park Plaza-Suite 5170 �. xpiration: :.61241201i . Private Corporation Boston,MA 02116 MARKWOOD CORP TIMOTHY PEARSON 110 BREED'S HILL ROAD UNIT 10 HYANNIS,MA 02601 Undersecretary Not valid without signature f De artment of Public satety ft Massachusetts P' V Bcard ct Building "e9ula,ions ,and Standards Consn-uctii:�n Super isor _lcnse: CS-005.86711 PEAR5 �. TIMOTHY 0N ;. . P.O.BOX#519 Centerville MA 61632 11112/2016 ror.nmissiooer `s FTC t Town of Barnstable �--�-� - ' Regulatory Services • [NOV g ry'"x`'„. Thomas F.Geiler,Director 1 9 2001 `� Building Division Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ 62 C SHED REGISTRATION 120 square feet or less 75 R A,6Z)c< Dt. l YAM&jT 5 P,�>9--V Location of shed(address) Village Property owner's name Telephone number � xt Size of Shed Map/Parcel# ✓J. /Vov l`1 � Zyol Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. 5 4 THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:083001 c 01/22/01 12:J38 FAd 1 508 862 0384 PATRIOT FUNDING 01/22/01 06:43' FAX 508872.18.34. PATRi;C,T FGNDING' � STEVE. PIZZUTI 0002./002 {a✓. .' _ - . . 1, - y.PATRIOT CAPE 'o I- (it-002 -Iti1Qt -za -lot rn 'f' 10c (?(o O� p'J Pi 79 L_o 12_ A I � ����H DF• �,� ���RC�C fC aFZ 11p Lc +� JOHN S, 4 LAtIRt=TANI # 34311 ES JOHN S. LAdJ A PROFESSIONAL LAND 9URVQYp�y. - DO HEREBY CERTIFY TMgT THE AMERICAN SURVEYING ABOVE MORTGA �F SPECTION 1264 M i REP D a n 5sr CGM PANY N �,'Walthlam, MA 0245�CON N (781) 893.6477 EC'7ON WITH A NEW MORTC;AGE 4NO IS NOT INTENDED OR REppE. ` SENTED TO6E'A LAND OR PROPERTY ` MOB �LINE SURVEY. NO,OORNERS W ge Inspection Plan 3ET. IT ERE THE LOCATION OF THE ORIGIN X BE ISED FOR Ea- DWELLING SHOWN yEpgON E1T}i�' REC09DED A 3UIL ISHING FENCE, HEDGE OR WAS IN QOIypUgNCE � BOpK_ COLNTY REril^?RY OF pEEOS 3UILDINGLNES.7HELAIYDASS THE LOCAL 1'LAIJ REFERJ�ICE�AGE LC 1EREON IB BASED ON f�WN APF[JCAHLE ZONING BYLAWS IW EF- vISHED INFOR/NAT101V ��NT FUA• FELT WHEN CONSTRUCTED DRAWN P>_R TOWN pp 3UBJECT TO FU ANG MAY BE SPECTTO WrtH RE. PA L� --ASSESSOR'S RTHER OUT-SALESHORIZdNTA rREMENTS .DIMEN5101VA1 DRESS: �AIQNGS EASEMENTSANDRIGHTSOF FROM OLATioN ENFORCE ONLn OR is TEMPT NAY_ m RESppNS181L►Ty IS EX- TIONUNDERMgS,G,G•L 1 A?II AC- BORROWER: •"I OCCHERE1NTOTHELq)�yOWNEA iOA, SEc_ 7 .C41 p•0 OCCUPANT, IT 1S NOT INTENDED IYOT•HD OR SHOWNUNLESS OTHERWISE AS H T DWELLING UES IN FLOOD ZONE 'A HE FdECOADEb. FIRMaTO NTI'+MENT . U CON- ASS TOWN ON NATIONAL FLOOD INSURANc.P p :ATE ! o� IS ADV18 FiY INSTRUMENT SURVEY INSURANCE RATE L4Ap D,Tw ZR PAM FLOOD ;LINT ED WHEN S BS ARE +%OMMUN]TY °4z 1 = SHOWN TO a TRUCTUR _PANELe „ �C=.DENT , PROPERTY B V OR LESS FROM sue, REQUIRED ZONING BY FIELDED RA t0iTIP cl SET�ACK.UN�_ FTED CHEClClrp lO I zltrld al G.. A--2r 4:(ns NII I atgwe WQau TS:L0 Z y 4 m 3 I TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION . r Map Parcel Z I Z Permit# Health Division Date Issued bolgaz, Conservation Division �• - Fee ch Tax Collector Treasurer 0 . 7z "SEPTIC SYSTEM MUST BE Planning Dept. l INSTALLED IN COMPLIANCE p; WITH TITLE 5 Date Definitive Plan Approved by Planning Board 11 RONMENTAL C06E Asti Tol Historic-OKH Preservation/Hyannis Project Street Address I e cl.co&U, Village S6Z A449\^l JQ o r"-v- Owner v Address Telephone .So 6 - 1 S 1 Permit Request ^3 %I Square feet: 1st floor: existing 15-1-- proposed A2.± 2nd floor: existing proposed Total new . Valuation Zoning District Flood Plain n(7s Groundwater Overlay Construction Type Lot Size 10/ 36,E Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family IN Two Family ❑ Multi-Family(#units) Age of Existing Structure 16 Historic House: ❑Yes S No On Old King's Highway: ❑Yes ®No Basement Type: ® Full ❑Crawl ❑Walkout ❑Other I- X 4 C wo'^fir _y^o-V Ae-s ' Basement Finished Area(sq.ft.) earl 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 6 new�_ First Floor Room Count Heat Type and Fuel: ®Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes M No Fireplaces: Existing s-A New Existing wood/coal stove: ❑Yes W No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:®existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded D Commercial ❑Yes 0 No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ��-�c �-P DATE Alit 200 9 r r FOR OFFICIAL USE ONLY PERMIT NO. ►j'l - pt � w�• DATE ISSUED MAP/PARCEL NO., • ^ , is _. - ADDRESS VILLAGE -4� OWNER i DATE OF INSPECTIOT141m, y - d FOUNDATION ' FRANJE - co Ir I 9-no INSULATION a _k FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH °; ,•; FINAL GAS: ROUGH FINAL f FINAL BUILDING DATE CLOSED OUT =`' -' , •�r j w R ASSOCIATION PLAN NO. • r e j - t Ize Lommonweauu or lmassachusa= Department of Industrid.4cridmrs. -__•��� � O�t'rafl�s'll�0as 600 Washington Shzd «� Boston,Mass. 02711 Workers' Comoe=ation I n==ce Afridavit na.Itc. %Ivn , i�lerf� 11C�u lottiii= 5i Pe,c,C De, t I am a hm&=Wncrpew an work=pseif I am a soie mMaetnr and have no one wor3:i=is w caascit, ❑ I am an empiover :.v..::::F:..:: . ovens ,. ....., tm riot fob. ........ ....:.�:::.•. ........... ..,;w,LN..L•,..........pr.:x :...:.;'• .Lw.a,v:...;.;,;,,,o9^.cc��^�Y�o+tx-"""'e°obty�!S:?�!�,., wac^r:;w:::: tt1ZQII8IIV'Tia�C.': :::.}::•`:�:4t�""??;:c•: ..,. .,...'L...•...... v°•��" . .' 3• }uw+Yx'��,�"�.`2';..':.<::•:•... .::a:. .:•. <•. .....::.....:� ..... ...:.w;:.N.:•.:F..r::•,':, :• �s..�,`�:''�,.•a,.,. • r,�.�,�'�,.�..d;2:`iit�N.+'Y.'�.'i:;:w�c� , .. ....:::.::. .�::�.:. . .,:.::::.::`r;M.}•:::::.,,r,.:•:sot:,:;.:.....::: \k w'�?. •:�::rxa<;t,„ •.y..Lx<...,:,•:::.....:..:.:.... ..... :,;•xv.,xx{; :..:: :•... 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Itmdw= ept of this srarsmsm msr be torwarded to tba OIDte otlarnd;sottoas ot!>ba li>ITAtareotraa��ar�atstaa. [do hm7hv cmt(y wnie thegaKt Ltd Fraaldcs ofFmjkr,y,kai-,heiaformUiox Fmvi&d abvwit trtrr aid rorrrrs Si_�Ta _...Dar: 4 1 a-l J o lIIdal W a oniY da IIot writs is this am to be com*ted by city cr town cWcb d Ctv or to+.n: p issue • QBtsQdlat Depsr� check if sa=eolate response it requited QI.leeams;Board ❑Sdee=ra's Olsltr QHeslth Deparsrt:a'' coma person: phom0. •1• • 1• • •1 • .69foi-04OL4•if• ••• -1•to jai • •• •t• •It • • •.• l: w•1• • • • • • ••• • • • tJ: • • •• • 1.1 w•1 �• •of Pat Eel l..i • w.w••✓t• • • • • of• •1 •.• •• w • 1• •« .•• •1•v•Ogg•1 •.� ..1•a: w•1• _ 1 w••1• • • 1• • w•I•• • ter, • • .• I• • • • • •• •• • N • •• ••• •• .t• 1.1 .••r'.t •••w•11. .1• • 1 • w.`I •w, ••w wU •1 •• •« 610.t•1 • • • • / 1• •• • • •• .40•16 • • •1• I• • • •t -•1IlIw•Yl• « .••U Av• • «• •11 •1 w•Y.1• • •1•. •11 ♦• • • • f - w••1• • w • • • •11 • Y.I{� •tr-.1 •,• •:1{' 1 1 r: r-11 V11 • Jl • � 1 1 1 1 1 • r' • • • • • •1 II r • a • 1 'ill •-+A 1 r1 rl 1 • 1 M 1 1 • 1 1 J. /1 II r• 1111• • i 11 1 _11 ' • • •• • • • • • • • • • 1 r 1 rr1111• :11 r late I 114ii 11 :11 r- MI ' • 1 • I• 1••UY I••y • • • •• .•• • ••. • • 1••K `I• • •1 ' A't •1• yr - 1 w11Iw Irl/• .lr • •••1.1•.: M /•/ /• • • •Imm •t• • t•• •• uAv•t•arN �• {u �••rw•14 •r •u «r•-.0 aw •/: 1 1• •• •1•.�-•w .••r••••w•♦.n •r• .•�• •r- / •r••1• -1• t «1•�.•..1• •• • •r: Itr.•_ .•• • � r• • vluru •u .•• • •r•n• 4 • ••• ••• ...y .r• • • u•u. •u••• •ww •nl• nr ••w ••• ors •1 n ••ru � •r. 11. • • � s.• •1• •1 •1 It •1{AY•••'. w ••w•r•. I.1 «•rr••••n r.r• •11 •1 Ub1N1C rJ1� .•• •.��: • • ••• ' 1 1 • 1&Igo• �.•r•••_• •• •l. MI • •1 1• ••/1 U✓.I •• .0 • •mot• •n 1.1 •.•/t •i ' • 1 t✓ ' .rl • • •wl• •It •111 • • •1 • • •• ••n•o •r•.•ww ••r••1• •►. ••1•.l . • • 1 1. %/////////%%/------ .... • • r. . ./...1._• • • •,' ••• U U w•1 It � •• � •• •• w• •Y 1.1•nA •• / •11•• mow• •1.1•t •w ' 11 M• ' IA\_• _ • •• • ••• X • I•.•. .•.I--•• Imo••• •rA •% •ts.••r• . • h. . • .11 • . . .. . . • ... • L - •r. 1 / 1 11 11 • 1 1 1 1 1 1 1 1 1 1 . 11 • 111 • • EST/MA TEO PROJECT COST WORKSI-IEET Value LIVING SPACE square feet X$1151sq. foot= (high end construction) (above average construction) square feet X�96Isq. foot= (average construction) square feet X S57/sq. foot= GARAGE (UN FIlYISEED) square feet XS251sq. foot= square feet X 520/sq. foot= PORCH DEC K square feet X S151sq. foot= OTHER 3 s S .ono ►M square feet X S??/sq• foot Total Estimated Project Value 10 yU U The Town of Barnstable '� � ReQulatorp Services Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street.Hyannis MA 02601 Office: 508-862-4038 Fax: 508-,90-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION . MGL c. 142A requires that the'reconstruction,alterations, renovation.repair.modernization.conversion. improvement.removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors.with certain exceptions.along with other requirements. Type of Work: 3 See son 5o,,ro o "J^ Estimated Cost J,o o 6 to Address of Work: "T I Pe.e-z k ,Dr- Owner's Name: �cv r'�► '(1(�Q��r�' cvu Date of Application: - 'f T o I I hereby certify that: . Registration is not required for the following reason(s): []Work excluded by taw []Job Under S1.000 QBuilding not owner-occupied [Zowner Pig 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 fora permit as the agent of the owner. Date Contractor Name Registration No. OR Date -. Own Name • e o • ansxsreer.>+ - 9� 1 Regulatory Services Thomas F. Geller, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: t S I0 1 JOB LOCATION: '�'� number street Mage r �2- "HOMEOWNER": <CVt'A ttaztte home phone# work phone • CURRENT ADDRESS: �� �2"`G�(C �f '�c4C,E) t�� �.(A 60 city/town state ap code The current exemption for"homeowners'was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signal of Homeowner Approval of Building Official Note: Three-family dwellings containing 35.000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the Provisions of this section(Section 109.1.1-Licensing of construction Supervisors):provided that if the homeowner engages a person(s)for hire to do such work.that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors.Section 2.15) This lack of awareness often results in serious problems.particularly when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the se P P Y unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities many communities require.as part of the permit application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page,of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. i Q:FORMS:EXEMPTN Assessor's Office 1st floor Ma r Permit# �4 Conservation Office 4th floor ,s n r` Date Issued 2 /6 —nj- Board of Health Ord floor Engineering Dept. Ord floor House# °R Planning Dept. (1st floor/School Admin.Bldg.): i „MSTASa, 's � ..� Definitive Plan Approved by Planning Board 19 - SEPTIC t6 MUST BE (Applications processed 8:30-9:30 a.m. & 1:00-2:00p.m.) INSTA MIN COMPLIANCE � s L EN VIRO A( -/o TOWN OF BARNSTABLE TOWN R ULATIONS Building Permit Application ?3 Pro ec ddress l mC.(3Gk Villa e A NNi S Fire District Owner Me, e(Ae S.�Q lQn► �A E // Address SG,41 Tele one , /��"�- ' �Li Permit Reauest: T, Od Reyfnefeiz 1AIIS t,GOSH Alit /y&m 54 ey oA U//S 5,,s 6 Li n. Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Existing Information Dwelling Type: Single Family Two family Multi-family Age of structure ! Basement bN Historic House Finished Old King's Highway Unfinished Number of Baths 2 No. of Bedrooms 3 Total Room Count(not including baths) First Floor � Heat Type and Fuel �k S �'� W Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds �x Other Builder Information Name Tele hone number Address nEO License# " ► ' " l I/Ir',t c. o � Home Improvement Contractor# I Lib Worker's Com nsatiori # O 3 ij 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 BETAKEN TO Q Mo Kt jAf*4d T Proiect Cost r Fee `� v SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T F FOR OFFICE USE ONLY ADDRESS VILLAGE OWNER ; DATE OF INSPECTION: FOUNDATION #. FRAME r WSULATION, r FIREPLACE tY e " ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING: �"�• � ' a DATE CLOSED OUT: ASSOCIATE PLAN NO. 4RM r im p;! i f °Fn+e , ., .� The Town of Barnstable • snaxsTABM • Department of Health Safety and Environmental Services rEo�,�,►+A 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. _ 99 aW Type of Work: �.w d��si o+ti-, Est.Cost �d Od �_ Address of Work:�T�a Gd C, JC �✓� Owner's Name .✓ 2 4 S Date of Permit Application: Z — L� T-Y i 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: G D Qf Date Contrfictor Name Registration No. OR Date Owner's Name The Cont»tonwealth of Massachusetts -. 1:_ Dc artnun!of Industrial Accidents 1 _ Office of111FOS 211ons 600 11'ashinl;ton Street Boston. Ma.u. (12111 Workers' Compensation lnsurancc Affidavit �11�plis.tnt information• Ple•tse PRINTIe��j m • /ZlAJj Inc,1tion• &C, cock city yQi✓N[ S nhone 1 am a ho eowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity • .. ;,w. .�.+.-�-+�•—+tr^•...-.....-...��.�.•.;�fevs+r..s:fr+:7+�„ll�:R+.:•.Y�n�..'...w...�f ,.ww4..+....• ,�.-+...w..�.�.w�,...-^......^....-:. I am an emplover providing workers' compensation for my employees working on this job. cnm lam• name: �I Pi ✓ P a(I(I res M M Ar city: .t/'!t/G Gl f hone#: insurance co. C0#tAm� — -- — 1 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: city: phone#• insurance cn. policy# _�..__._.. ._. �1_c..�aai..^-:� r,.�:ir'.rr.1d-_• -_. ._ �..:r.• .._ t ...1 ..... _ .. - a.� .' companv name: address: phnne#- insurance co. 11olicv# Attach — ,•�,•-->_ _ __ --�..,...-..r..�; additio_na!sheet if n .: eces_saty -• .r•• •� ••,+% a ;L,-• __ _�'_"-•_• �•'••'-__ _+•�•-•'��'�-'�'�+�-_ � __ Failure to secure coverage as required under Section t�ion 25A of AIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 ndiur one%cars•imprisonment:is well as civil penalties in the form of a STOP WORK ORDER and it fine of 5100.00 a day against me. I understand that a cop} of this statement may be fornvardcd to the OMce of Investigations of the DIA for coverage verification. 1 do herehr c•rtifj tutuler the pains and penalties of perjure•that the information provided above is true and correct. ✓�j Signature Datc �2 Print name CI-Lt S�✓q (' Phone# l 5�2, 'rofricial use only do not write in this area-to be completed by.ciry or town official Y� city or town: permit/license# r••tlluilding Department Licensing hoard check if immediate response is required 0Sciectmews Office ►_ (:1I1calth Department contact person: phone#: rnOther information and Instructions Massachusetts General Laws chapter 152 section '_5 requires all employers to provide workers' compensation for the employees. As quoted from the -law an empinree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An emplurer is defined as an individual, partnership, association. corporation or other legal entity, or anv two or nor the foregoing enzaged 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 th owner of a dwellina, house haying 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_ ho or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or reneival of a license or permit to operate a business or to construct buildings in the commonm•ealth for an 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 h 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 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 cin• 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 requires to obtain a workers' compensation policy. please call the Department at the number listed below. City or'rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o- the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plez be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned 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 question please do not hesitate to Live us a c-^ll. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts _.. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 LICOSE qw�iciel Pw� L 1 gik WE 0 6 2 4 Pri-A- CAPE rot, li fps ovrf 02601. 'L V#4 �j ri Hat 21� Oy "N?104T, Mvads mAt :--jZ7 C— Z,L r i ti TOWN OF BARNSTABLE 277p 1/� Permit No. - __ ___ {,�,� ; s Building Inspector Cash —— —1019. '+o n-f . OCCUPANCY PERMIT Bond _-_x___________ f issued to Bayside Buattlding Co. Address Lot 12A, 79 Peacock Large, West Rvannisuort Wiring Inspector zz f C � Inspection date �l,g---�-- Plumbing Inspector Inspection date 7/ -Ilk 3 1 Gas Inspector , F % Inspection date / J Engineering Department `' }�; Inspection date .- , Board of Health it Inspection date 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. 1 � i E ..... ............................ ..._.__ ......,.... ............. ... ff.. .._.. Building Insp ector t ��..� '°•.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT = rAUST TOWN OFFICE BUILDING HYANNIS, MASS. 02601 J' MEMO TO: Town Clerk FROM: Building Department/ l DATE. f An Occupancy Permit Chas. been issued. for, the,building authorized`bye Building Permit $k........ � '3. ... .. _ ...........r _................ ...... issued to ...................». 4;�9...1�,.Lt' Please release the performance bond. Alf- sessor's map and lot number /� f c c ,3c3 _. Sewage Permit number ............. . �...................... ....... SEPTIC SY a �i�lST C %Z'-BARBSTAKE, i House number ...................... .. .!' 'u INSTALLED IN DC. MPLI,AC+ 90o Mb 9 ma............................. WITH TITLE 5DC �c NAY a�0 r TOWN OF B ARIA; C�i 0 m 3 BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO .,CrVXL.e,,!!'?::U.L` *...... ? f .... .:.... TYPE OF CONSTRUCTION .:....I Jf?:19.�`.,...`. ................................................................................... a ............//,y�/"1 ...,l.y......19..g..,3 ' TO THE INSPECTOR OF BUILDINGS: v The undersigned hereby applies for a//permit ,Daccording to the followinginformation:( Location ..:.. .s �C.�(.GlDC ! ....C` .1 ..............!!`��...... . ...�s '.....!!.. ................................... ProposedUse ..........` .l. l.C....` ........................................................................................................I......................... / Zoning District ..... .................................................Fire District .... !^ ................................................... Name of Owner ......UJ. ' '4....k?... .`. (...........Address .................. Qom. (3 �k....`?4�........... Nameof Builder ......... ........................................Address ................0 .................................................... Name of Architect .....:.�...0 ....�a �e......................Address ..............V .......................................................... Number of Rooms ..........!�....................................................Foundation ..!..li R.C)......................................................... Exierior .(.!�. ... ....�.��..r ems................................Roofing ......... 5 ......... Floors ....C.... . . ��.........................................Interior ...... ?. A ...................................... Heating ...... ...t4....A.........CY.otS..............................Plumbing ..... 1�.:. � .......... '(��J?r...-.....a . ? .'T..... � ......... 1.� `- ...A Approximate. Cost Fireplace ..... ....... .. ....... .... .......................... pp ............ .:. ..........................//../..................... Definitive Plan Approved by Planning Board ___!�US__�------------1.9t1__. Area //(/0, (� 00 Diagram of Lot and Building with Dimensions Fee �............... .. ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � T 3 � 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 ....... .......f`. ... .................. Construction Supervisor's License ..... 1).7.' � ` ' . ' . / . . 0:-)AYSIDE BUILDING CO. . " - Single Family Dwelling -----.�-------�-------.,`----. ' - Location ...Lot-I.2���--79_����/�dok..Laue Weot io t ---.,------�u�a���-���z��.--`---. . Ba�oide �oiIcli C Ov,ne,'------- ---.. -.. ��' o. . _ � ' - -----' Ty pa of Construction ..�� �� �� � --------.� - ..----- ... .-----:.�--------- Plot .......................... Lot -.---------. / Permit Granted J1�z�'J. �J�° ' ��V 85 � '� ----- � Date of Inspection ............. ............. - .lV ^ ' - ' uo"c Com ' . . . . ^ . / ~ ~ � - / . «~� . . . . / . _ ` | ' ' [ =_~~=~~=-- -- -_ �_ -- --- i • y '' LD T t d1 Y. • M1 ' : A-ca e 467- S�011 al/ a asp : A 55 vex E� Go i �Ro 7)C7a ' CERTIFIED PLOT PLAN OF Z A PEA G oC,C D ✓L } R08tRT Pv OR T ELDREDGEI IN s Y'. - a'o NO. 19367 �� e Y ®�crJ./9f61$T�R�� � CALEs f"— . D DATE -q k� N� 6AY I CERTIFY. THAT THE f CLIENT �--`---� -�---- SHOWN ON THIS PLAN 1s LOCATEQ oil T_ERED REOISTEREO 8 d4%6 ON THE GROUND AS INDICATED A".CIVIL LAND JOd NA. , 34 _ 'ENGINEER SURVEYORS , BY, .' CONFORMS TO THE ZONINS I,A�9 .' OF: :DARN3TABL , MA88.. 7.12` M Al N S T R E.E.T' ----�-- *AE HYANNIS, MASS. SHUT�OF,_.,_ REG. LAND SURVEYOR +� '7 e J Assessor's map and. lot number /''/��5 a`�� �`.� �`r` � �v7 111E r c 35 3 5P a �e ( P.,o` Toy K Sewage Permit number ~ Z BARNSTABLE, i House number ......................../...( � '!.'...........:............. 90o Mb 9 0� �0�,a MaY a• TOWN OF BARNSTABLE. BUILDING INSPECTOR _,_, APPLICATION- FOR-PERMIT TO ... ;,(7 v L,<;,`i( t2(..........,,,S ld.S n t 2„ .. '-r.�!-v✓,t; -�...W.. .. v , e' TYPE OF CONSTRUCTION ......6k.)4? ....... ......................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Pcu.cvc ' r Location .....,)..r�..�........... �.....�!ts2..t.K................�. � ..%i.....tar�5-............................................................ ProposedUse .... ......................................................V............................................................................. ZoningDistrict ....... .�......�'�.................................................Fire District ....I'F(ln� .................................................... Name of Owner ..... v I � ...........Address ........... . QGt ....... � . .......... .. Name of Builder ........5 1.k✓t—Q..:......................................Address ................C......::`.........................I............................ Name of Architect .. ��:...-1�ad«i..�'.. .Address .............. :.......................................................... 0 Number of Rooms ........... ................................................Foundation ...... _ 1 Exterior .1....!. ............�1. 1..r�%. 'S................................Roofing .........r`?. 5:. .... .................... i C� 5 ! ' t Floors ....�.4:'.a.u?.:�.�..�.....�.�.�I(..........................:................Interior ...........�.i�.............1...�..&�,..................................... Heating ... .....� .......... � !f Plumbing `� • V�- �D-+i, -..... .J......... .............................. �. ......... Fireplace ... ....`" Y"? � G�` .Approximate. Cost Definitive Plan Approved by Planning Board ___���__J________ ------19&---. Area'•................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ...... f.... `1. .::-.................. Construction Supervisor's License ..... ........ BAYSIDE ,BUILDING CO. A-24.8z249.7204 No .2�17 6 3... Permit for ....1 2...S torY........... ........ ingle...Fami.lY...Dwelling............. Location ...L t...12AJ.......79..P1Ye.GOGk...I,ane .................... ................ 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