HomeMy WebLinkAbout0081 STATICE LANE l S 4<a�--4 c--,;�-
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�oFWE r°�ti Town of Barnstable "'Peimi
m- Expires onths fronissue date
Regulatory Services Feet
9 RMMSTABLE,g+
1b§ .. �e . Thomas F.Geiler,Director
2009 Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
J N}ot Valid without Red X-Press Imprint
Map/parcel Number Q �7,
Property Address
Residential Value of Work�� y� Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address �� ��� /r0/ WRAI/
Contractor's Name /i �tl����'z Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
P-T am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate musfaccompany each permit.
Permit Request(check box) ''11
Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over, existing layers of roof)'
❑ Re-side
#of doors.
Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE:
Q:\WPFILESTORMS\building permit forms\EXPRESS.doC
Revised 090809
�f
i
The Commonwealth of Massachusetts F
Department of Industrial Accidents
rn Ij`� !' Office of In
600 Washington Street .
Boston,.MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): kwzs- 6 MM v
Address:
City/State/Zip: Phone #: d
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
* have hired the sub-contractors 6. ❑ New construction
employees(full and/or part-.time). ,
2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, :❑ Demolition
workingfor me in an ca aci employees and have workers'
Y P h'• 9. ❑ Building addition
[No workers' comp. insurance comp, insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.[�I am a homeowner doing all work. officers have exercised their. I LE]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.[j Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13:❑ Other
comp.insurance required.]
*Any applicant that checks box 41 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.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lie.#: Expiration•Date:.
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine 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 fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penaltiesof perjury that the information provided above is true and correect.
e Signature: ® _ � i Date:., �� BC—T /
Phone# V ZD
Official use only. Do not write in this area, to be completed by city or town official
City orTown: Permit/License#
Issuing Authority (circle one):: ..
1. Board of Health-2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more
of the 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, constriction 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. Limited Liability Companies (LLC)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 confinnation 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 pen-nit 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 permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn 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
Revised 4-24=07 Fax # 617-727-7749
www.mass.gov/dia
v ,
Town of Barnstable '
o Regulatory Services
T
RARNSTasr E Thomas F. Geiler,Director
iKnss.
9�a 1639. ���� Building Division
lEn Mpg Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA.02601.
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: 76? OCT
JOB LOCATION: F/
number street village
"HOMEOWNER": Payy�� �eA0 v l �d(� 7f d G—Dl/G 2
name 6 home phone# work phone#
lCURRENT MAILING ADDRESS: d 5772933�
city/town state zip 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
require nts.
a rll
Signature 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 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 helshe 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.
Q:\WPFILES\FORMS\bomeexempt.DOC
ci
�1MET � Town of Barnstable
Regulatory Services
r r ,
_"R'�L Thomas F. Geiler,Director
MA&
9`b�Fo 39;.��`�� 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
�Y
ProP e Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORM S:OWNERPERMIS SIGN
Assessor's office(1 loor):
Assessor's map lot n ber J' ® a O�flSc,
Conservation e„
Board of He 3rd flo :
1 Dasrsranc
Sewage Pe umber oo3jy seu-;-e.C`" ��U O a"92
y� p rua
Engineering Department(3rd floor): �o s639.'�o aor
House number-
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION _U j O a 6
'AL, 97 19 94 _
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the,following information:
Location __�,c)t I S- -I Ce. Lo-yxe- Ahh1 S5
Proposed Use �`�: V2 f7a m i � U - L I V=Q
J
Zoning District Fire District 7- -t G V\A,k S
Name of Owner aii f,2am � A CQ K rya 4A4 I 1 US Address 308 Lt t f Qr
Name of Builder MAM uje&u-o--- Address_4S Al ak OQ.l.t Cenkyo\11-e—
Name of Architect Qew fly La,,ALI,,C! `J Address P- I I L)• aawlS4-a-6te, �L}.
Number of Rooms In '�'" Foundation 20t3Yed COVI-P 7e
Exterior a D L2 LL 1 S12 VU I P Roofing N�
Floors(1JDOiA t" p I U 1A)1Mrl Interior �r�P 1 ICL
Heating kk)aoysx d r-eea� Plumbing 9, �>O�,
Fireplace_qas I go, n r YYlCk%&IrU Approximate Cgst 1 O oo . aD
V\ovs.0- 1-7U 0
Area a e-
Diagram of Lot and Building with Dimensions
�Oyrj
(re4jrr) 10 build
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 W -9� z V
Construction Supervisor's License 0 0 9 05 6
BAYBERRY PLACE REALTY TRUST/' ,
Mb 36886 Permit For BUILD DWELLING
,Location - 81: Statice Lane
Hyannis
Owner _Bayberry. Place Realty TRust
Type of Construction
Plot t i Lot #1'2
�--gip ' I .♦ ' -I t ; f j_ t t I ...
Permit Granted t July 19:,,. ! 19_,9 4 _
' t 4 t i
Date of Inspection -- ^� 19 >o
Date Completed T ! ! 19
iY 1 Y t ;
+ - • t i _,+ 1 { 1,-%.- �i '_'?-..� �
CU
t "t
'l OWN OF HARNS I\11I'l;
SC:%Vt:R CONNECTION PERMIT '
OFFICE USE ONLY
u
Assessors Man No. P (3 (r wT�eR�1L�CO �
Assessors Pace
i
StrccPQ l S7Vls�1GQ 1.LLV�Q� Sf �1}kAC(.()UivC?c0
-- — — I
Village: n f1 Is
PROJECT CONTRACTS
i PROPERT OWNER (Mailing Address) ` SEWER INSTALLER
Y
Name: Y �1'(( CtC2 �'tJ -Name: `C aP-e lCiyyi
" l
Address:31 6P1 A.II�S AIa " Address: RA �✓t Fa
AA
A
Phone: 7 8 b o2�— Phone:
I s -
OWNER'S AGENTIENGINEER
NAATE:
-' E •}: F
ADDRESS:
s
PHONE:
PROJECTDESCRIPTION REGULATORY REQUIREMENTS _
FACILITY&LAND USE DATA The installation of all sewer connections must be done in t
1 NU?��BiriLF 't.ITEk„ ...:;..>> FIB hT R�NO accordance with the provisions of Article XXXVI.Town
y .
w excavating
wit
hin
a Before ez al By-laws.B fo
f anrstable Ge nr B R
o B
Y
.:::::......
/ a Town Way the sewer installer must also obtain a Road
RESIDENTIAL ✓ 5` ? Opening Permit and must comply with the Construction;
Standards and Specifcations outitned.theretn€'At least 48"41 .
COMMERCIAL hours prior to the installation.the applicant-must notify- ,
t }` the Department of Public Worts.Engineer ng:for the
RESTAURANT purpose of inspectingthe installation +The Inspectorw•ill 'I
complete the Compliance Sketch locating the installed r
INDUSTRIAL lines and connection: By signing the Application,the +"
applicant acknowledges and undei stands the regulatory
NUMBER OF BUILDINGS requirements and understands that failure to complN pith
NUMBER OF BEDROOMS shall be grounds for revocation of the Sewer Connection
a - SIZE OF PARCEI ACRES. Pcrmit.and the denial of any future permit applications
ESTIMATED DAILY SEWEAGE GALLONS -
.PIPING:LENGTH DIAMETER
EXPECTED INSTALLA'PION DATE ,
---
iNOTE:A Copy of a Scµ'cr'Iic Replaur`n is Attached
SI GNA i U R I:(I N STAI.I.ER/AG EN n DATI_
AIURE(I)I'WAPPROVAI.) C/ D:�II: v/ G _` - - --- - ----
STi9 Ti
Ile /3 .
04R.AC 6-
4
N p
/ C�NDE7Z
CoNST2ucTio•�/ � 0
/��./8
CERTIFIED PLOT PLAN r
LOCATION
SCALE . .�.n..`5��. .... DATE
PLAN REFERENCE .B�?^!G" Low"K/Z
OF �! .
DRD yes
KELLEY H
No. 26100 I CERTIFY THAT THE D,. 1'.'v 4eY-T77• ,
�s �fCigtER�� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
siAl Log AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
�A7?�✓SYi/aG�?. . . . .WHEN CONSTRUCTED.
DATE /99
2�' �vs7- P ;4G�lS�TERED�LIIID";IS�U�NVE�KfOR
�9YB��l� ��� /
COMMONWEALTH
OF
DEPARTMENT OF PUBLIC SAFETY s
ONE ASHBORTON PLACE
s rers co
MASSACHUSETTS lop
�`" fi CGtP(gpYB
BOSTON,MA 02108
j G1 F�czZ5af rre-C.,tJan
EXPIRATION DATE ! LICENSE of this MCC' d,
CONSTR. SUPERVISOR CAUTION
06117/1995
RESTRICTIONS . EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
NONEIi.U.� o 06/30/a 993 THEFT, PUT RIGHT THUMB
U PRINT IN APPROPRIATE
X MARK A' W E N Z E L BOX ON LICENSE.
SS 333-4�-43$3 0.45 WHIDAH WAY O
.CENTER V I l E M A. 0 2 632 BLASTING OPERATORS
PHOTO(BLASTING OPR ONLY) FEE: m MUST INCLUDE PHOTO.
00.co
I NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT- STAMPED-OR-SIGNATURE OF THE COMMISSIONER
DOB: ,
afsl17/TM S
• - �; THIS DOCUMENT MUST BE;"� ��� a :I •
" CARRIEDONTHE PERSONOF I %rd; &p?' ' ^•� -
SIGNATUR F U SIGN NAMEIN FULL ABOVE SIGNATURELINE
THE HOLDER WHEN EN ! NSEE
OTHERS-RIGHT THUMB PRINT GAGEDINTHISOCCUPgTION.�
600
BOSTON, MASSACUSE'I I� 02111
1i
fames J Canooe` .�
-or::nssione- WORKERS' CONII'ENSAMN INSURANCE
'2J I,
(licensee/permittcc)
with a principal place of business/residence ac
`, s l� � O, 00 to 3
do hereby certify,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.
elf V �
Insurance Company Policy Number
( J 1 am a sole proprietor and have no one working for me.
( J 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 politics: -
Namc of Contractor Insurance.Company/Policy Number
Namc of Contnaor Insurance Company/Policy Number
Namc of Contnaor Insurance Company/Policy Number
Q l 2m a homeowner performing all the wort:myself.
NOTE.Mist be sWue t^at while horneo•wners wao eraaiov persons to do Caintenanee.construction or,rcpairwork oa a
dwciiinc of not fore than t rcc uniu in Wbid the horaco•wcralw resiccs or oa the Erouncs appurtenant thereto arc not tcocrall}'
considered to be cr::aloycrs tracer the Wori`cts' Compensation Act(CL C 152.sect. 10)).application by a bomeowoer for a license
or permit may cviccccc 6C kcal surus of an cmplovrr uodcr the G'orlcrs'Compcosation AcL
G.,t:..s:_rc:ac n.Will be forw::ccc to trc�co::n c.tof Ineust:i:iAcadenu' Office oflnsuranG for covera;c
..r.c -- ice :c c.mac:. c: rccui:cc uncc. Scc�ca 'c-.'o:�SG�? c:-.ic:d to t:'i_ imposition of mr:ice:]per.J�
ccn:iscr.t of c fiac e{er sc c i�OQ.00�.uo:i^prison- �.t o:uc to one y�::.0 c•: pcn:i;i:s Ln the form of a Stop Work Orde:and=
fine of S 100.00. cav:f Z rnc.
Sicncc this 3 3 day of 19 9 7
Lice rPc......._c L:cc:aor;Pcrrn�.
f
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EXHIBIT A — KINCH — LOT 12 � A
lot
. i
I
3 ,
llool�
00!
Li
Lol
i
I
;
! � h
ONIT ELEVATION
SCAIX. 174' Y-O'
J�•
�T
DECK
MASTER BEDROOM
DINING
BATH LIVING
dw°p
0 0
g Q i ° BREAKFAST
-�
BATH NOOK
w
HALL KITCHEN
D O O RCP.
O w. A
o
BEDROOM^----------- -----------
GARAGE
1�r
Lop
aa�
r -
I
REAR ELEVATION
S
x � �. .. ws ..?, � '.,'y*.• .ux, . .. � � .E '��',.�,s' r z - ,},; t � ,�''''. v `'�"�`" h Si «:.�y .�:.'�:.
LEFT SIDE ELEVATION
SCALE• 1/4' - V-O'
0t/I
. � Cull 6 ,G2 was y
sy. .
.x z •r r F{. ry a,r L1=VAT10
SCALE- 1/4
RIG�tT SIDS
TWE TOWN OF BARNSTABLE 3 5
1Z
Permit No. .........
t I BUILDING DEPARTMENT cash $536.00..cash
TOWN OFFICE BUILDING ... "'
HYANNIS.MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to Bayberry Place Realty Trust
Address 81 Statice Lane (Lot 12) , Hyannis, MA
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE. ;
� .�
I
OGcaber.19. ...... . 19..9.............. .......... ................................
Buildi g Inspector j
i
TOWN OF BARNSTABLE, MASSACHUSETTS
A=273 110 001 36886
DATE uiy 19, 994
PERMIT NO.
APPLICANT Piark Wcn.zell ADDRESS 45, Wlt Jviay, Centervi-Lilc-, 0 0.9
S T4�E T I
CONT F"S I C E':SEA
UMBE
I STORY (TWECLING UNITS
PERMIT TO L5u i,.0d uvJ,Z�__L, 1- 1 1 1 R OF
(TYPE OF IMPROVEMENT) NO. (PROPOSED JW)
<� 7 Cil :tZZt ZONING
SMU-1 i, DISTRICT
BETWEEN &ID IN
(CROSS STREET)
I C R 0 S t2i'�Z
T)
0,E
SUBDIVISION a LOT
LOT 'BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG FT. IN HEIGHT AND SHA I CONFORM IN CONSTRUCTION
TO TYPE SE GROUPBAS
ALLS OR FOUNDATION ���
(TYPE)
REMARKS: Town se -r #3888
(Bayberry %i�ldiiig Co) $536.
AREA OR 2244
ERMIT
VOLUME
ESTI. T $ $
AR E FIE
r)er-
perimi ee $112,25
OWNER Bayberry Pl arty Trust
BUILDING DER
BY
ADDRESS
THIS PERMIT CONVEYS NO RIG", O. CUPY ANY STREET, ALLEY IDEWALK OR ANY PART THEREOF EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTyyS O P'BLIC PROPERTY, NOT SPECILLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION.qsT E'"OR ALLEY GRADES A I
DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC R KS. THE ISSUANCE OF THIS PE MIT DOES NOT RELEASE THE APPLiCA I rT FROM THE CONDITIONS
'
OF ANY APPLICABLE SUBDIVISTO TRJCTIONS.
MINIMUM OF THREE CALL SPP40VED PLANS MUST BE RET J.NED ON JOB AND THIS WHERE AIPPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR L A PERMITS
ALL CONSTRUCTION WORK: Rb KEPT POSTED UNTIL FIN NSPECTION HAS BEEN CARE REQUIRED FOR
ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. D.E. WHERE A CERTIFICAT F OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. .....
PRIOR TO COVERING STRUCTU ?RE,O,SUCH BUILDING SHALL BE OCCUPIED UNTIL
MEMBERS(READY TO LATH). -
3. FINAL INSPECTION BEFORE NAL INSPECTION HAS BEEN
OCCUPANCY. r ,
POST TH CARD SO IT IS WISIBLE FROM STREET
-C
,A
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APP�*LS ELECTRICAL INSPECTION APPROVALS
0&
,ON
I It
'y
2
3 HEATING INSPECTION APPROVALS .ENGINEERING DEPARTMENT
2
jt /0
OTHER SITE P N VIEW APPROVAL
�t,4�4'
pyf 4n
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIOULIS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. I PERMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION.
* R
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUI
(Print or
TOWN OF TYPe) �q � 'J j b �001 Date 8/8/ 19 94 `
- Barnstable 4�
Permit # �2, OI
e Building Owner ' s
AT: Location Lot 12 - House 81 Statice Name Bayberry Building Co.
Lane, Bayberry Place, G&A4eww,
Type of Occupancy: Residential
New Renovation ❑ Replacement ❑
_ Plans
FIXTURES '
Submitted: Yes No ❑
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39 R M O
BASLYPHT -
1ST FLOOq
2H0FLOOR
1RO FLOOR
<THFLOOR
aTH FLOOR
41TH FLOOR '
TTHFLOOR
Check one: . : t;crttficate
Ja minas Plumbing & Heatin Inc' ` Co
Installing Company Name g b g '
Address 110 State Road P. O: Box 1.61.3. ❑Partnership
N. Sagamore, MA 02561 Buzzards Bay mA 02532 ❑Firm/Co•
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Buslnes�Telephone 508-888-3221 r
Name of Lkensed Plumber .-
Eugene R. Jagminas
Ir4SURANC.E COVERAGE: ec one -
I Nava a current ilability Insurance policy or its substantial.equivalent Yes K No ❑
if you have checked yes,.please Indicate the type coverage by checking the appropriate box
A liability Insurance policy 'Other type of Indemnity ❑ Bond ❑
Yy
OWNER'S INSURANCE WAIVER. I am aware that the licensee does not have the.insurance coverage_required by
Chapter of the Mass General Laws, and that m; signature on this permit appiicatlon_ waives this requirement
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- _:. ....: Check ;� . . '
Owner4❑ Agent ❑
Signature of Cwner or 0,k-ne(s Agent --
I, ce�-tify that all of the details and information I have ov
submitted for entered)in abe application are true and a urale to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be_in com. f: '-n-ca Mttt all
pertinent provisions of the Massachusetts State Plumbing Code and Chaptet 142j the n r laws
By ...- _ gn u e o sad umber
Title - license Num �8a
Giy>rToven \ g Uc�nse.Master: ,
_ _ T
yge of Plumbin
I urneyrnan ❑
�oPRf3VED tOr"1lC>=.USE.ONL1� -
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C�UgE TT� Uh86F® N! APPLICATION FOR PERMIT M DGASFITTl�
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n .}} jjF(Prmt'or Type) `] 1 C7
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Y _ dB`axns _Date 8/8:%t >� 19_94 Permit NO.
s� MA , 3
4 Building Location Lot 12 Tiori e K ci�t:'9 e� 3owner's NameBayberry`Bui1 ,no rn
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aaLane,.�Bayberrky Place, Centervi RE�ide'ntial
f Oncy
�` _ Type o ccupa s ` .
• New _ X Renovation ❑ µ Replacement ❑ - Plans Submitted Yes C No ❑ k r
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—_-- SUB—asMT.
BASEMENT
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1ST FLOOR I -
ZND FLOOR
3RD FLOOR
4THFLOOR
STH FLOOR
6THFLOOR I
7THFLOOR
STH FLOOR
Installing Company Name a Check one: Certificate
Address PLUMBING&HEAT) IN& Corporation
01147eRDS ❑ Partnership _
Business Telephone 888-3221 —""A ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter E. R. Ja mi
INSURANCE C VERAGE:
substantial equivalent which meets the requirements of MGL Ch. 142.
I have a cur en liability insurance policy or its
Yes. No D
If you have c cked yes. pI se Indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity❑ Bond ❑ .
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
n _ Check one:.. _
Owner❑ Agent D
P Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations this application will be in compliance with all
performed under the permit issued to
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Generws.
By 7 e of License: Signature of Ucensed Pturn or fitter
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Title Gasfie License Number 3
City/Town Journeyman
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