HomeMy WebLinkAbout0131 SEVENTH AVENUE (HYANNIS) ? �� � �
�7
,.
�,
s
i,
ql,
f
Assessor's map and lot number ...........`7` ............... S-EPTIC SYSTEM MUST BE
INSTALLED IN COMPLIANCE
WITH ARTICLE it STATE
Sewage' Permit number ........... ..
••�'�•`• SANITARY CODE AND TOWN
CE ULATIONS. -.
y�FTHETO�♦ TOWN , OF BARNSTABLE
Qn '
BARNSTAI1LE, i
"6 9 o w °'' BUILDING INSPECTOR
ar .
APPLICATION FOR PERMIT TO ......�/1M Gh...:.... .. ..................................................
TYPEOF CONSTRUCTION ......A ....D...../.. . . .qe..............................................................................................
. .. .........6..............192.y
TO THE INSPECTOR OF BUILDINGS: ) s
The undersigned hereby applies for a permit according to the following information:
Location .7 ....'... ... . . . .. ..
Proposed Use .... E .. .` " ....................................... .......................................................................
GSf�
Zoning District ........................................................................Fire District
Nameof Owner ./.!. .... .............................Address ....................................................................................
Name of Builder .....aj. ........ ..... . .. .Address .....P�.l. ... .......� (••.. �... .:.... ,e
Name of Architect ..................................................................Address ................ .................................
..................................
Numberof Rooms ......./............... ........................................Foundation ........................ .................................
Exterior ........U`�..!!....�`'..................... ....................Roofing .............. ... . . . ..:.............................a. ...........
.Interior
Floors ..................................................................................... ................. ...�.............................................
Heating ..... .... .. ...................................................................Plumbing ...............:....................................(3 .........................
Fireplace ..................................................................................Approximate Cost .............?r4
..........
------19--------• Area ...... `. .,.�.. ........-
Definitive Plan Approved by Planning Board ---------------_______ �•
Diagram of Lot and Building.with Dimensions �1
Fee ............: ........................ i
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I Al
�r
Re UI_
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... .. Gt�L.!.. .. .
Belt, Robert
�� �����������.............
{
C)wxna, ....................Robert..B8It................ ............................ !
| '
Type of Construction ...............x.r?am�----.. �
`
-----.--~------------------ .
'
-
Plot ............................ Lot ----------.. '
-
�
�
Permit G,onh*J — 7 74 '
�Date of Inspection '..`/�A.
�
'
Date Completed .&��0. -
PERMIT^� REFUSED (
`
'----'----------------.. 19
( . �
'
'--------^'----------------'
—_---.--'.---.---.—.—,------- .
--,.-------..---....--..—.----- `
-
'�—^-------'---'-----^—^-----''
� ' ^
r ~ ( ^
� ,--------------- 19 '
'
-----------------------~--'
-------`--`------------^---
Assessor's office(1st Floor): �s� 0 S.s3 ' �' �, ZALLED IN COMPLIANCE F TN E t
Assessor's map and lot number Quo
Board of Health(3rd floor): WMI n�"E'S
Sewage Permit number �'-! - ,� VIRONNEWAL CODE AN®
P ( ) �A TOWN REGULAMOHS = BJHMASIL LL
EngineeringenuDe Department 3rd floor): / kdA-, rasa
House number °o +639• \
Definitive Plan Approved by Planning Boar 19 �p M0 a•
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
A p R ° V,� OF BARNSTABLE
11.11DING INSPECTOR
�AP�LICCATION FOR PERMIT TO <-, ' . kz(,o L � r ale �dr K
TYPE OF CONSTRUCTION ( `?lho
V3 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby.applies for a permit according to the following information:
Location / ti 1 Z6 d 419-, 60 z�.z9 AU/r• I
Proposed Use
Zoning District / Fire District
Name of Owner icy = 1 �- % AddressJ�/ � CK, A>/� 0f (�0
Name of Builder E2,2t, :) Address 'Z 1 _ W i NA 1/2)
Name of Architect Address -
Number of Rooms Foundation 66 c JUT A& c,
Exterior�111��T Roofing
kIM-
Floors V . 61V Interior /N!
Heating N / Plumbing /v/
Fireplace �1/ Approximate Cost CIZV
Area 40
Diagram of Lot and Building with Dimensions Fee
:
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I'hereby agree to conform to all the Rules and Regulations of the Town of Barnstable rega ing the above construction.
Name
+ Construction Supervisor's License 040176
` BELT, ROBERT
No 33110 Permit For ENI; DECK
Single Fami1 DweU;"Iincr
Location 131 7th Nvenwe
ta o
ot W. Hyanngsport
Owner Rober !B'elt rA
k' Type of Construction ram Q
}4
Plot Lot
y
Permit Granted August 1 , 19 8 9 .
Date of Inspection 19
Date Completed 19I
C II91! P
I-
�•Y0
.. r
_g
f
-N,
#JAI
Assessor's office(1st Floor): z
Assessor's map and lot number
Conservation(4th Floor): oZ EPTIC SYSTEM MUST BE ��P��`•:
Board of Health(3rd floor): q ; . ; ' t STALLED 1N COMPLIANCE
Sewage Permit number /:_` * '� VViTH TITLE S 'ssasy aat t:
Engineering Department(3rd floor):. 6 (( r �N�f�®(���NT/��C®®� aN®
House number 131 J ILJ , - Rio esr
Definitive Plan'Approved by Planning Board TvU� �� ��"���®��
APPLICATIONS PROCESSED 8:30 i 9:30 A.M.and 1:00-2:00 P.M.only
6
l TOWN QF BARNSTABLE
;BUILDIHG r. INSPECTOR
l 3 (
APPLICATION FOR PERMIT TO r
i
TYPE OF CONSTRUCTION I
t —
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location / 3
Proposed Used
Zoning District Fire District
Name of Owner may% /Y -C Address �7ol
L
Name of Builder L:2,� 'FJ Address
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing �G�
Floors Interior
v �
Heating, Plumbing
Fireplace Approximate Cost
_ f
Area
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform.to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Si ipervisor's License _ G a G
r "
BELT, ROBERT & LOIS
No 3-6-4-0f Permit For BUILD ADDITION -
Single Family Dwelling _
,l
Location 131 7th Avenue (Lots 566 & 568) +
W. Hyannisport
/: ,
Owner, Robert & Lois Belt
k
Type of Co-nstruction Frame
Plot Lot
Permit Granted December '22 , 19 93 ,>
Date of Inspection: °' x
r r�
Frame q�X-t _ 19
>'insulatiott �3�1f9 19
trir6i5lacdn 19
Date,Ctrnor d,-, 19 - ;
gbn y�•.yf,M. f g" " v r •.
0-1
7 aw+ z'
vt-
i
J
e A •} TOWN OF BARNSTABLE BUILDING•PERMIT APPLICATION
Map Parcel Application# 60&/
Health Division
Conservation Division. 1 by Permit#
Tax Collector Date Issued
Treasurer Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address �T�iA.
Village 141 Alq/1//l,/
Owner L (�/� �� Address
Telephone
Permit Request
0 �
7. SO 44;,ed
Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation% Construction Type ? '
Lot Size Grandfathered: 0 Yes ❑No If yes, attach supporttng documentation:-'
r G-)
Dwelling Type: Single Family ❑ Two Family Cl Multi-Family(#units)
f
Age of Existing Structure Historic House: ❑Yes ❑No On Old King'JHighwayw❑Y s ❑No
t Basement Type: Full Crawl Walkout Other CD r;❑ ❑ ❑ ❑
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 Cl Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes. ❑No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
_ Zoning Board_of Appeals Authorization ❑ Appeal# Recorded❑ -
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name elephone Number � � l�2 7�2 —
Address,� �Crn4oe_�,4 License# 049 yaeae
Home Improvement Contractor# /p3�Vc7� -
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
1
{ FOR OFFICIAL USE ONLY n.
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO. R i
/
ADDRESS . VILLAGE
OWNER ;% }
�^ J .,
r
DATE OF INSPECTION:
FOUNDATION
FRAME ,
INSULATION
FIREPLACE '
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
f '
GAS: ROUGH e� FINALpJ
FINAL BUILDING `C9
DATE CLOSED OUT
ASSOCIATION PLAN NO. '
rIhe commonweatth oj massa.cmuserts
Department of Industrial Accidents
Office of Investigations
600 Washington Street a
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/organization/Individual):
Address:_/9 /-7 �
City/State/Zip: ��� Phone #: �����v2 /� 7 0?
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
employees (full and/or part-time).*
have hired the sub-contractors ❑ New construction
2.;k I am a sole proprietor or parmei- + listed on the attached sheet $ 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
(No workers' comp. insurance 5• ❑ We are a corporation and its
required.] officers have exercised their 10❑ Electrical repairs or additions
3.❑ I am a hoineo;t per doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other&"l!�e✓/�
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information'
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
I am an employer that is.providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Poli, #or Self-ins.Lic. #• jji C
cy .,� ���f.5��°� � G Cj�Jvl� Expiration Date: /' a
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 up to$1,500,.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fane
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 certify under the pains andpenalties of perjury that the information provided above is true and correct.
signafore: ve Date:777
4
Phone#: �O�6 e 2
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one):
1_Bo2rd or Health 9.Building Department 3_City/'tf own Clerk a.Electrical lnsoect€:r 5.PlumtaiaQ InspecsoT {
- e - I,
6. Other
Contact Person: Phone#: I�
{
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: 4
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 foregoing 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 chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. United Liability Co----man;es(—LQ or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials .
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom.
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permittlicense 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 I (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 bum 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. _ 617-727-4900 ext 406 or 1-877-MASSAFE
Fax + 617-727-7749
Revised 5-26-05
ww-w.m.zss.�o v/ciia
Town of Barnstable,
Regulatory Services
RAMr s�rE� Thomas F.Geiler,Director
163. 6. Building Division
Tom-Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost d O li
Address of Work: f `
01
Owner's Name:
��� _�
Date of Application: Q
I hereby certify that: ,
Registration is not required for the following reason(s): -
❑Work excluded by law
❑Job Under$1,000
[]Building not owner-occupied
❑Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
&
D e I Contractor rgnature 77 Registration No. ,
OR
Date Owner's Signature
Q:wpfiles.forms:homeaffidav
Rev: 060606
.a
Town of Barnstable
Regulatory Services
vMASS, Thomas F.Geller,Director '
Building Division:
Tom Perry, Building Commissioner
200 Main Street, Ijyannis,MA b2601
w ww.town.b arnstabl e.maxs
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and �i n This S ction
P .g � � .
-If Using A Builder
I, d/15 ,as.Owner of the subject property
hereby authorize4
A to act on my behalf,
in all matters relative to work autlorized by this building permit application for.
(Address of Job)
ignature of4amer ate
L Z- f
Print Name
Q:F0RMS:0wNERPERM1SS1QW
�fi�o-P ur rng e"` latidns a Standards License or registration valid for individul use only
Boa before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards
R rat�bnl 104499-�� One Ashburton Place Rm 1301
Boston,Ma.02108
poration
ART DOLGOFF.H
C1 -
�rthu�601goff -
19 McCormick Dr. A ,r,inistrator Not valid without signat e
W.Barnstable,MA 026
�✓�aaoaclu�aetla
w BOARD OF BUILDI"G REGULATION$
License: CONSTRUCTION SUPERVISOR
e
'�p
Ndrnbe'r` 'CS 004276.
sI BIrthdategt2/41.1947
PEW yes 12/1412007 Tr.no: 14357
°� Restricted r�0�.
I ARTHUR L D:OLGOF a
19' 1 MCO cRMIOK
W BARNSTABLE, MA�fl2668' C ��
I Commissioner
F
,,I`
rA � �. �,�
� � _._,
.:
:�
•'
__..
_. ..
�.�. ..
,,
..:_n__...�---..�. �:__..__.._..
�....
� { l _ . . � � `"_ r _ _....�._...
;-+
., �. :��
_ ��
' � `
M1 `. -
-`-L.,
� i �
`�
- � �
:. ] �
1
k r
.� ..
�,t- ... ..._. ._
.�utr:.rre( G�(s�-�E I
�'� i
I� _ _
_ Town of Barnstable
Regulatory Services
Richard V.Scali,Director
�.1
IA�p Licensing Authority
200 Main Street
Hyannis,MA 02601 .
www.town.barastable.ma.as
Office: 508-862-4674 Fax: 508-778-2412
Licensed Premises'Zoning Approval
To All Applicants:Zoning approval MUST be obtained BEFORE an application can be accepted by this office. Fully dimensional
floor plans,with egresses, fixtures and furniture marked, must be submitted to the Building Commissioner's Office; along with a
fully dimensional parking plan, prior to, or along with, this document. Plans must be initialed by the Building Department and
submitted along with this form, completed and signed by the Building Commissioner or his representative, with:a completed
Licensing Application. No applications for a license or hearings on a license application will be accepted or scheduled until the
above requirements are met.
To Be Filled Out By Applicant-
Uses/License Applied For UN'I5YZG�QBvN L PE` RA?--e e5l
Location _1W� 1 y- _
Business Name
Business Owner -- —
Address VtA -- ,L � Telephone:
Property Owner_.:1 �i y A& v� ...
_ -.............
Town of Barnstable Maps)and Parcel(s)No(s) -
List All Uses Of: r
Basement _ ., (Area) __ First Fir. _ (Area)
Second - (Area) __ — -- Third —
------ ...,...,..._. (Area)_
Fourth ___ ---
_,...._._. (Area).._ .....--- Roof (Area)._:.._
Decks, Patios, etc. (Area)
---
Date yl/s2/ Signature of Applicant
To be completed by Building Commissioner's Office:Zoning District: - —
Is Site Plan Review Necessary?................YES NOO
t
Are the above uses permitted? YES NO
Legal Nonconforming Use YES 17--1 _ NO
Variance Granted YES r—I— NO —
Special Permit Granted YES M_ NO
Total number of occupants permitted , Total number of earking s aces exclusively dedicated to the proposed
business use and available at all times an business is to be operated
r
Signature of Building Official Date
F.
ti
R
3
Q:IWPFQ ESV ICENSINGIFORMSIZONIN0APPRVLFORM.DOC =
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
A-
DATA
U9?0 VW ;1Ods?uuenu '!? ao.LVaiswlwod
07 1?sunS
i�06T00 'l an'„aH
TTapouay/6utpTTn2 1;06To0 ;�V .
56/5t/N u0tje!Tdz3
NOI'_Vy0dy00 3iVAIJd - 'dA'
I:E.550t uoT.;e.,sT6a�
y01 1VKNO3 .N3W3AUdW 3W0P
7).1"wpl—wh Rvanxcau 1-191i ay� .
gAfiurotoposs"O's to rreat
... State Buildin4
S I DodNsoausoforrovocetioo
WEALTH DEPARTMENT OF
PLACE SAFETY _ AlsasaabsseNe
� COMMON ONE ASHBORTO i ` �ftbisiiconso. 6
OF BOSTON,MA 02108
�. MASSACHUSETTf1,��� � I CAUTION
EXPIRATION DATE i! FOR PROTECTION AGAINST-
EFFECTIVE DATE LIC NO. THEFT, PUT RIGHT THUMB
PRINT IN APPROPRIATE
RESTRICTIONS BOX ON LICENSE.
BLASTING OPERATORS
°• '. MUST INCLUDE PHOTO.
r
z I
PHOTO(BLASTING OPR ONLY) FEE: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY +) -
STAMPED-OR-SIGNATURE OF?HE COMlAISSiONER s
HEIGH
T: JUL
0 9993
DOB: }J AT N G VE N U RE
SIGN NAME FULL AB
SIG p�UR F L E SEE LJ '
THIS DOCUMENT MUST BE 14"NEIA
THE HOLDER PERSON OF 999
HOLDER WHEN EN-
GAGED -
INTHISOCCUPATION.
OTHERS-RIGHT THUMB PRINT ----_---_-- f ^—^-- - - - .
p COMMONWEALTH OF MAASSACHUSETTS
DETA1 MENI'OF INDUSTRIAL ACCIDENT'S
600 WASHINGTON STREET
games.: Camaoei
BOSTON, MASSACHUSETTS 02111
e��rss�one WORIRS' COMPENSATION INSURANCE AFFIDAVIT
(licensee/permincc)
with a principal place of business/residence at:
(Gry/State/Zip)
do hereby cc,-6 % under the pains and penalties of perjury, that:
[ ) 1 am an employer providing the following workers' compensation coverage for my employees working on this
job.
l nsurance Company Policy Number
�am a sole proprietor and have no one working for me.
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance policies:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
1
Name of Contractor Insurance rCompany/Policy Number `
c
0 1 am a homeowner performing all the work myself.
NOTE: Plcasc be aware that while boracowners who employ person: to do maintenance,construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be emplovcrs under the Workers'Compensation Act (GL C. 152,sea. 1(5)), application by a homeowner for a license
or permit may evidence the legal sutus of 2m employer under the Workcrs' Compensation Act_
f
1 understand that a copy 01 tius statement w; ix t0 tnC Drpa: irnt of]ndustri-' Aeddenu' Ofnee orinsu,ranct for eovera=e
verification and that failure to secure eovcragc as required under Section 25A of MGL 152 can lead to the imposition of rdminal penalties
consisting of a fine of up to S1500.00 and/or imprisonment of up-to one year and evil pcnalues in the form of a Stop Work Order and a r
fine of S100.00 a day against me. P,
Signed this day of 19./ .
Licensee/Permince Licensor/Permiaor
APPROVED
I _
TOWN QE BARNSTi ABLE
A \
L-v.l G
i
� `r _ ' ;rA;N'(��,v►;+.ac>� tea' f
+�L
i EauITO V - ' 'Z �( � C� l S 7s ;---- --
�
xx
I
T
s I N�:. •►
� a
^! t r L5T Nv I� I'lATCLI
r
I
i
SALT MflF�SH
SALT MARSH
i NORTH
8 4'
1 _
1
EXISTING
DECK
TO BE
n J DETERM INO
EXIST i
ECK — !
Lo 12 I 1 l
37"3 1 SHED. ADDITION TO
EXISTING HOUSE I BE REMOVED AND
I HOT WATER HEATER TO
i 1 40' BE RELOCATED
l
12' 14'—}
i NEW TITLE S
l SEPTIC SYSTEI
AREA
8a'
1"=25' SCALE � S =.-. RaBER�i BELT
131 SEVENTH AVENUE
W.HYANNISPaR T' ASS. 775-7358
. • SCA.f3 FPPA7'lED gee [AFlVY A
S.M.LEBAAON 9/6/93 `
— G
'�._:.• - - - - DESI NER Pia � SITE PLAN ..
_ rt_
W.YARMUOTH,MA. 02673 — v
l
i
I
i
PEIICI
Ifill
EXISTfNG HOUSE
Pl-
24210 , I6436 6436
1 1 I i
DECK ARER
CD
1 ® i STORAGE ROOM DOOR
i - - - - - - - - --- - - - - - - _- - -- - - I I I 2' I I rllILRO.1111 TIEFI
— 2" CONCRETE FLOOR I I- - - - - - - --- -- - - - - - - __- - - _. - - - 1 - _- =_ _.------- -- - _ -.-_.-
24"0„
j SIDE VIEW NORTH EAST VIEW
N_ CD 3000 LB,
MIX
d—. CONCRETE
t. i -
LED -
00
l NORTH
2846 2846 �'
PLMNS FOR:
1 _
1�
ROBERT BELT
131 SEVENTH AVENUE
{ ELf118 4u_ 2u i1PPA0VED 9Y:. N rt
FRONT p�.
� 8/19 1993 9/6/
m . . oAOPosE>r/ADD I?i0N/Al_?FRAY IONS
S M L BflRON 93
.,>. : a W:�flRM DOTN Mfl02673
B6' 394-8146 000100
i
I
• I
i
i
`SALT �4fl[�SN
SRL_T MARSH
1 !voRTN
EXISTING
DECK
i
• 7 TO BE
DETERM L. E
EXISTING i 1
DECK
i I
M !
Lo 12"
1
37'•3, EXISTING HOUSE
1 SHED-:ADDITION ?0
1 BE REMOVED AND
HOT WATER HERTER TO
i 1 40' II BE RELOCATED
l
" 12'
NEW TITLE 5
SEPTIC SYSTE
AREA
- 1"=25' SCALE � s -}_BaBEpT BELT
131SEVENT� flVENUE 1
W.H":l ANNfSP0R 1 ASS. 775-7358
SGflF v i"=12' FlPPf77:'60 BY; G`Mlvr! h.
S.M.LEBARON 9/6/93
DESIGNER
PP SITE PLAN
W.YARMUOTH,Nq. 02673
86' � 394-8146 �0�100
1 ., I
i
EXISTING DECK
:GG4:3 6 6436
m �
9
POSSIBLE DECKED N
AREA
FAMILY ROOM MASTER CO
CLOSE UP BEDROOM
WINDOW CID
Ti
TUB HERTER ii
? (i
ii Uj
iz Ull-10
ii
f( ¢ Q = i i AEMOVE
7 s 3v N i1Wt3LL i
(Y) KITCHEN 1 I i 1
if (i
x _ f
4 4.41, �1 _�.
LINEN TUB A
CLOSET CLOSET CLOSET
BEDROOM 1I
LiViNG ROOM
I
N i 1 CD
�-, iIREMOVE WALL -
C� �1 1, l '' 11 BEDROOM
T 1� 2 �I o ,
(; v r
i(
_ _ _ __ ,
-- — — — --——————• 2846 2F346
NEW FRONT DECK
17'4 12'4
NEW ADDITION
a 1
PU112 F°p-ROBERT BELT
FRONT 131 SEVENTH AVENUE
W
_ ED ffy: a"N tom:
S.M.LEBARON °qT98/19/1933 �9/6/93
m
DESIGNER �RDPDSElY ADDITION/ALTERATIONS
co W.YARMUOTH,Mfl. 02673 �
86' 394-8146 000100