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HomeMy WebLinkAbout0018 STERLING ROAD' �c� .. �� h I it i oFt r Town of Barnstable *Permit#2 ►5Z �o�0 p Expires 6 months from issue date Regulatory Services Fee • naartsTnBre. pal 639 `�$ Richard V.Scali,Director is �0 MA'I s Building Division i Tom Perry,CBO,Building Commissioner DEc 212015 •► 200 Main Street,Hyannis,MA 0260•b-®W 1 ��15 www.town.bamstable.ma.us 1 aF Cy Office: 508-862-4038 ®��I �796230 Map/parcel Number EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint nn pp�� Property Address / 54t4-1 1✓Iq JV�, �U�h/ S, i� A 0 Uo of `['Residential Value of Work$ 600 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �f-P1 t►g � C(r l l 5+ l 9/" -� 18 Sfu-I�yi al )Z j�n i r. �oz / Ij Contractor's Name �I p Sen h 13(.t ra&cm Telephone Number Home Improvement Contractor License#(if applicable) / !F a17�Z Email: , . b I t t"G l.(rl^i'QJ G/G �D D•c o rv� Construction Supervisor's License#(if applicable) In!y gq-7 ❑Workman's Compensation Insurance Ch ck.one: I am a sole proprietor 9I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ t(check box) [ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 6XC0 Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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: P�. C:\Users\Decollik\Ap ata\LocalWicrosoft\Windows\ mporaryInternetFiles\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 7bte Cort moitwealth of-Vassacliusetis 1I epaphneptt oe f Industrial Accideftls' v Office of Investigations ` 60®,Washington Street Boston,.+4A 02111 ' i mpti:mass gow/daa Workers' Compensation Insurance Affidavit: Builder sIContractors,PE:le.cttzci ins/Plumbers Applicant Information Please Print Legibly Name(BusinessiorganizatLow dual): � raut'YI Address: a 13 P14Gs Qty/statefZip: WoLn n IS M 0 26 0) Phone#- SU Are you an employer?Cteck the appropriate box: Type of project(required): 1.ElI am a employer oath. .. 4 ❑ I am a general contractor and i y s Have hired the sub-contractors 6. ❑New construction 2.[�employees(full.andfor poet-time}. ,! I am a sole proprietor or parer listed on the attached sheet: 7_ E]Remodeling ( slip and have no employees These sub-coutractom have $ ❑Demolition working for Hoer in any eapacily. employees and have workers' 9_ Building.addition [No workers'comrp_instuance. ctlmnp_instnance_ required-] 5. 0 4tJe:are a corporation and its 10.❑Electrical repairs.or.additions 3.❑ .I am a homeowner doing all work officers have exercised their 11.Q Plumbing repairs or additions. ' f[ o wrorkers N 'co tight:of exemption per MGL :1.2.❑A-oof repairs insrtraace reauired.]s. c_ 152,§1(4),and we have no employees_[No workers' 13.❑Other comp.insurance required.] 'Any zpphc=that checks box N must also fill am the sectaonbelovn,showing dL-ir wwkens',conupemetion policy infonnateoa Homeowners who submit this afiidmit inditating they are doing all work and then]Hire outside contractors mn t subunit a gem afdavrt iodicabag suacb::. =Contractors thst check this box trust attached sm.additional sheet showing the name of the sub-commcton and state whethsr or not those emities have employees. If the sub-contractaes have employees,they rmast provide their markers'comp.policy number_ I am an employer that is prmifffitg workers'compensations insrarancEe for racy enipkryem Below is flee poUty and job site . information6 .. - ... .. - - Insurance.Company Name: Policy;or S pelf ins.Lie:.4: li piration Date: Job Site Address: CityfStatelZsp Attach a copy of the.workers'compensation policy declaration page(shoving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.1.52 can lead to the imposition of crisuinaI penalties of a fine up to$Il 500.00 and/or one-year imprisonment,as well as civil penalties in the form,of a.STOP W,O K ORDER and a fine. of up to$250.00 a day against the-solator. 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 mider tkepains andpenalties of perjury that true information prmiRded above is trite and correct: Si tore: 1 Date. 1 Phone': D a a Official use onty. Do not write in this area,to be completed by+city or town of ciaL City or Town: - Permit(License 9 Issuing Authority(ch-cle.one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspectors 6.Other Contact Person: Phone#: NE Tp,_ * 11AMSTABM ' . MAS 039. Town of Barnstable ♦� °`gyp 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: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, `l0 � K as Owner of the subject property hereby authorize '7OP EI. CQ l -w�' to act on my behalf, in all matters relative to work authorized by this building permit application for: I8 S-herf'✓La Ad, 9LA.k101` 02!ool (A ess of Jobj SPature of Owner Date Print Name r If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\DecollikUppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PI01 DHR\EXPRESS.doc Revised 040215 Massachusetts-Depaj&rert,of public Safety Board'of Building Regulations-and Standards, Constractiion Supeirisoi - License:CS-104847 :Joseph RBurgum'r` 213'rJitchen•Wny _` Hysnnis;MA 02601' A '`" Expiration - commissioner ' 11/02/2016 - bmv�rLaruueall�i� �-.- lei 1 f€cue s" nseier Affairs iSc Busi ess flee; ME IILA000VEMENT CONTRACTOR ' t�distration:... '158277 j t xpiration: =A12016 DBA i UM HOME iMPROVEME(�T JG FH :8URGUM 1} � 2'[o PITCHERS WAY ;HAN 18,MA 02601 � Uodersec.Ra � ZL� 7v5cense or registration valid for individul-use£only 7 ^ bsfore the expiration date. If found return to h sOffce of Consumer Affairs and Business Regulation f� �10?Park Plaza-Suite 5170 k gBoston,MA 02116 oivalid without s ature - Unrestricted'-Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. Failure to possess a current edition of the Massachusetts . State Building Code is cause for revocation of this license. For DPS Licensing information visit: www,Mass,Gov/DPS Town of Barnstable *Pe Expires 6 moa[hsfrom f e dot Regulatory Services Fee aueysrners. , A Thomas F.Geiler,Director B Ullg Dlvislon Tom Perry,CBO, Building Commissioner 200 Main Street,.Hyannis,MA 02601 www.townbamstable.ma.us Office: 508-862 08 Fax:508-790-6230 EXPRVSS PERMIT APPLICATION RESIDENTUL ONLY Not Valid without Red X-Press Imprint Map/parcel Number. Property Address - 1 i iA . —v T'1 h h i S . 0�L-(o Qj Residential Value of Work 00�, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ``To k e\ R _ 119-5-k:O i ig�r R8. 14 u o,n ni Sr VIA 02 6 01 - Contractor's Name �ToSe�n k U-ty, Telephone Number 50% a°(e)-- R 1 a-a-. IioiIIe Irapro"v ement Coriu actor License#(if applicabic) I-C�q)L,—] Construction Supervisor's License#(if applicable) 10 4'% 4 7 XmPR ' FlWorkman's Compensation Insurance Check one: 'APR 04 2012 I am a sole proprietor Q I am the Home.-}NTer 1 have Worker's Compensation Insurance TOWN OF BARNSTABLE t Insurance Company Name �4 SdG)A,�eA cw,w,D Workman's Comp.Policy# PLC SO'l o 2S lJ� Z C1� ' Copy of Insurance Cc mpliance Certificate must accompany each permit. Permit Request(check box) �] Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to t G Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value 3 6 (maximum.35)#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.th#Home Improvement Contractors Wense&Construction Supervisors License is. . required. SIGNATURE: C:\Users\decollik\App \L cal\Mlcrosoft\Windows\Temporary et Files\Conient.Outlook\DDV87AA_Z\EXPRESS.doe Revised 072110 MASS Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, s �6Lt /t ' G ,as Owner of the subject property hereby authorize J0.S 41'1 &r to act on my behalf, in all matters relative to work authorized by this building permit application for: s4?4--1 VLq Re(, tat"-vtni S 07-60 I (Mdress of Job) �. •`5�`y��-2 vim- ?��!2 S' ture of Owner 6ate , 49- 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\Tempordry Internet Files\Content.outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Y i I ate!C'aurrsi��'�r���rasse .�ase�lts '600 33mkingim street Boston,.MA 02111 srseni ;u�rr.�;gr���ala� nrlaei�'?�i�fnens�tit��:�n�enra�n�e.�ffi+d��iit::�nal��ersJCoIIi�ra�m�Elec�ri"�xians��l�a�nbei� AmpficantInfematim F4ease:Primt7Le l'v Nme : sb ntLnc ui l :,To5e�O k. &4x-g U 4yL /?-,WravxK fl oyo p 1►1il t_V V2071.&e* -City/statafZip: WSA8 0 Zb© pini .#: so<S a x- R 111 a Erne 3m an e=pWyW.,e6rk flee a ppropriate'box: .. T3Peof Proaeat ire4 sdred) 1 ❑ 1. ❑ Iara. ic*ntsactoraredIamaerpM wh : 6. [f+7ew oonstuction eiiaplsi�e�jfall�ndt�r�t t�se�* 3iaw:liiied Etas sutradrs 2. I:am.a sole propiretor orpaiaier•- lasted-on the attached sheet 7- ❑'Remodeling These su b-coutrciotw.lase . sky and he no�eru�ilo}�ees �. ❑:Deitaolition vwUmg 1br me $as ew&yees and lure vvdmir ��- fi. ;Bzsi3 - addition s I[No woike 'oomp.imurance camp-is>:suraaUM.'r ❑ ;ice•, .5.. [] We:are a vo?poiataon:and its 10.❑Bect&calmpairs or additions 3..01 ama.bomeourner doingx l u of'icers:hweeseieised their 11[]iPluuxingv�pst or.additions aaf*s E[Io azs wkers' fightof exemption per MOL 12.❑'Roo1':regaias irisurancerequired.]t c.M,§1(4) -n and iaue:no employees-I[No wodwrV 1319 0,tker 0ki COP-:aauraaae reguued.] '.0.ap,agpltmt�cb�ks heq�l: t,et�a�11 1�aec�:ost'bm shn�ria�"�Zirm�ens'e�eig��tQa:lroT�Y �a %o 'rort3 submireat if fiftvir indicating they we,dwA;ift mft.md an have wa;ii a cmwwzwm mua utrmt a mm affutnt ieffi cq%sue �Go�ttrauiocsr'�ra2 chet�'ihtS C�cx swt uttat]art4� i met ati�u�;s�e:uame®f rt"t�e�ttb-oz ►t6 mad s�ate"srlatrl�tEs ors�arf6nse eut�tEea:hahx mPio xs."; sdb¢o o�:Fm�e.ei ilag 4'Ri ': r marideth2r workme cagp..pagV=mbgr. T;soar,ir�rafare,�pilnn�� l�rlurm��fiwg�:crr.'kc�s`�r�#aur;rr►arw�nwrs,�f�r•uu�'.;�r.2o�'ecjs ;�B�6�v;vs,E�,Pu���a�rT,�a�b itr;�rarrafiavi. ifn AvwCe I1crizipaaY N e:__tV IPNG�►GIM"[5 tn�hnr�.[ Polec}r�nor�e1f-ins.'I.�s�.#: ���O��ri�tn W Expiiatiori I�fie` Ab Site Address: Atta&ai Loopy of the workers'comperassdonpolicy diedaration page(sko+rring ithe porky uumbet and a on dat.r). . Failures to secure coverage as regdued snider Section 25A of MGL c. 1:52 can bad to the irWosiam of crkniBail Mies of ,d, :fore tof1.;50Q.9D.aiidtofr+ne=} r: oniareiit,asav�ell,a�ci+�ilpeiinitiesiri fforruc+ aSAP3.�rG1 KI�ItDER;aud.a;fine of up is$250.00 a day agaimt dhre%iblatar. Be.addvued that;a rcopy o`f&is statement snag be;for warded to the-Office of tln;.ems of dre I�I�:for ius ro>re��e ceri�f'i�catiian. ,f;da i►,et8b,��r-et �a��r�iie psairrs�;p�as►ur�/sss.n,��+,�r�.v5v;t�eaai,fihef�rj�vuvrr;p�di8ed;�t,��a.as,trree;nrr�aarr . s Date: Phone. ,fs?uwai nsc vRty. -Do fivt ar,rfte in dis,am,M,fw cout}Pk,eei,tbj•. .or tow'",o n1 City or'Tmn: Want id%'c*we.# 'Lisufng�ltrf9ic►rs�•[EinNle�on�e�: 1..Baicrd of iElmkh �Birifffing Depurtment 3.City/Town d0a* 4.)Electmiaa]luzpector S.1Plunm x Invector 6.(?flier - Contact Paerson: pliorre 9: 6 J Mar, 12. 2012 3:58PM No, 2725 P. 1/2 ALuKu CERTIFICATE OF LIABILITY INSURANCE DATE 03/12/2012) MID3/1012 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 terns 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 CONTACT NAME: Southeastern Insurance Agency, Inc. PHONo Ext: 508.997.6061 FAX No: 508.990.2731 439 State Rd. E-MAL , ADDRESS: P.O. Box 79398 E CUSTOMER ID M: North Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC6 INSURED wsURERA: Merchants Mutual Insurance Com 23329 JOSEPH R BURGUM INSURERB: ASSOCIATED EMPLOYERS INSURANCE DBA BURGUM HOME IMPROVEMENT INSURERC: 213 PITCHERS WAY INSURERD: HYANNIS MASS 02601 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2011 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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. LTR TYPE OF INSURANCE INSR D POLICY NUMBER MMiLDD MMIU YW DD LIMITS GENERAL LIABILITY BOP909456 05108/2011 05/08/2012 EACH OCCURRENCE $_1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED o ence $ 500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 15,000 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M jEa LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-O'A+NED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS AND EMPLOYERS•COMPENSATION e LiTY WC OH Yf N WCC501012 501201 06/10/2011 06/1012012 ORY STA L M S T ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICERJMEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yyes,describe under DESCRIPTION OF OPERATIONS below JOSEPH BURGUM INCLUDEC E.L.DISEASE-POLICY LIMIT $ 1.000,00 DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,Umore apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE For, display purposes only Joanne Bretton O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 2012-03-1219:05 SOUTHEASTERN,IN Page 1 i r Office of C�onsu�ier tTa►rs Busiuestioo License or registration val d for.ind vidul use only i � nl.. HOME IMPROVEMENT CONTRACTOR before the expiration date, It found return to: Registration: ,458277 Type, Office of Consumer Affairs and Business Regulation Expiration: ,660,14 Individual 10 Park Plana-Suite 5170 Boston;MA 02116 �s 13 M HOME IMP &V—,- R-f JC7SEPH BURGUM 213 PITCHERS WAY 1< ) l HYANNIS, MA 02601 tit f s Undersecretery tvalidth�ure , • t ;,Iss W,i►Ll�llt� � t,�9,d ( 1tkt� (7i i'0i►iit SiF►i dC Yi, Bi►aYli fll 13U11(ilil ll�ltr t►1 it►an, ►ritl 5t:a►.tc4 ►� �„ t QT Can. truction.Supervisor t_icense . I.icerise:,cS 104847 . 'JOSEPH SURGUM 213 PITCHERS WAY HYANNIS, MA C2601 I cri„ ��s' s:(p19 tlort►;,11 W201 4 a `i i"r�aami.,ill s r'€:, 104847 I. —- - r Town of Barnstable Regulatory Services Thomas F.Geiler,Director L """"s''""KAM # Building Division 639, Tom Perry,Building Commissioner .200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT G4-l1 �1 �. FEE: $ ZS , oD SHED REGISTRATION 120 square feet or less i�1U,oV 5 Location of shed(address) Village JDkliU f GIeVs7.4Z FLUE , SOg- 7 29, G6'75 Property owner's name Telephone number Size of Shed Map/Parcel# i Sig a .Date Hyannis Main Street Waterfront Historic District? � ,. Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required)` Sign off hours for Conservation 8:00-9:30&3:304:30 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. THIS FORM MUST BE ACCOMPANIED BY A' PLOT PLAN S 1� Q-forms-shedreg OJ REV:042506 "vv l�c�art BLOC 'Uocabbm of,.vgxrtY: H his 'r n1 • � Cpyc/Z�� NioNl1�-l�T i ,. l � . s o WaAlvlq lor 1 one 5/o Qr/8 porch t� Lr ✓A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION' �. . Map ` ��� .Parcel ,��� .cr�` I � Permit# Health Division Date Issued Conservation Division / Fee Go Tax Collector Treasurer 5 l 60 Planning Dept. Date Definitive Plan Approved by Planning Board s Historic-OKH Preservation/Hyannis Q Project Street Address ��C�Y. Village , `""`"`� ��'1 X4 SS -zsOwner ,��,e;� ,...�,o-c ; Address ' ;;., / , S Telephone Permit Request' u� s `^Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new r�,Estimated Project Co Zoning District Flood Plain Groundwater Overlay Construction Type 4 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing ' new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count y . S r Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other . Central Air: ❑Yes ❑No . Fireplaces: Existing New Existing wood/coal stove: .0 Yes ❑No a Detached garage:❑existing .❑new size Pool:LI existing ❑new size Barn:❑existing ❑new size j ` Attached garage:❑existing ❑new size Shed:❑existing'O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# ` ' Recorded❑ Commercial 'Q Yes ❑No If yes,site plan review# Current Use Proposed Use. - BUILDER INFORMATION Name Telephone Number Address' 02 ./ G`J' License# Home Improvement Contractor# Worker's Compensation# u./-C r y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE �� - FOR OFFICIAL USE ONLY PERMIT NO: DATE ISSUED may. y - ' • - - MAP/PARCEL NO. - - `< ADDRESS 3 - �VILLAGE , F OWNER DATE OF INSPECTON: FOUNDATION . FRAME INSULATION ; 4 FIREPLACE - - �• ELECTRICAL: ROUGH FINAL A ,PLUMBING: ROUGH FINAL h GAS: ROUGH FINAL t 'FINAL BUILDING, - DATE CLOSED OUT ASSOCIATION PLAN NO. - , 9 N Department of Health Safety and Environmental Services rEo � Building Division _ 367.Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 BuiIding'Commissione: Permit no. I Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNIIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: <-a -Estimated Cost Address of Work:_ Owner's Name: tt Date of Application: : I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied [30wner pulling own permit ,Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME B"ROVEMENT 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. X:2 0 Date Contractor Name f Registration No. OR Date Owner's Name q:fomu:Affidav The Commonwealth of Massachusetts -_ Department of Industrial Accidents oll�estlOatloos 600 Washington Street Boston,Mass 02111 Workers' Co ensation Insurance davit m name: �� dL•d- t�v.Gc%G r location: ci .e�.e,.� ,C.la9 hone# v a ❑ I am a horniofnier performing all woik myself. ❑ I am a sole Un,tor and have no one worldrig in any caoacitv I am an em 1 rovidi>i workers' compensation for my employees working on this job.:_ : ::::.:::::: :::::......:...... .......:......... con anv name.. :.. 9. icv 4. a dazes: 1 .......:.:............... .:,..:.. :....... . ::.:..:::..... insurance co. ❑ I am a sole proprietor,general contractor, or homeowner(circle one and have hired the contractors listed below who have the following workers' compensation polices: con anv!name: :.::.:::::. :::::::...::. ... .......:.:..:.....:,.....: 'dare s s . ::.,.�.:........:.:..:::...:. ... ::::.::.::.::.::.::.:. ........ ::,.. ....... ...:::::•:=":v..?:•iii3:•isitii.i:s?i:i::i4::•::�i:i::J:v:•::�:i::}•:?vv'Lv:i.:.4::4i i6i:i:i4i:i�i:i i:Liiii!tii}?•:i : ............;.. ..........:..:.....•. } ..:v. : iv •ivii • � : : ; ..:.:.:. ct tv� ><>`: .......................... ......................... ................................................................ ......................................................................................................... ...................................................................................................................................... niliev ...... address. -. one : >:h p +y. ...................................................::.:............. ............... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a 6ne up to$1,500.00 and/or one years'unprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Once of investigation of the DU for coverage verlflcation. I do hereby certi the pabiffand penalties of perjury that the information provided above is trw•and correct Signature ~ '`` Date Print name `• 0 Phone# otHcial use only do not write in this area to be completed by city or town official city or town: permit/license# (]Building Department -Licensing Board C)Selectce ❑check if immediate response is required 3neal h Depensartment r men '-Health DeQardnent contact person: phone#,----------------- (mviud 9/95 PIA) ME:TN UEl1EPITU Re st anon - 0211 :., • !f Type �INDIVIDUK . } Exp`ir�tion, 07/01100 y MOLINARItR00FING : . lferoZ oinar ,� f -�- �1;;Castleagod' Circle -_ eJ Assessor's map and lot number .......................................... Sewage Permit number-O.....����...................................... ypfTNEt��1 T® rY N OF "DAIRAST ABLE BARNSTABLE, i : 9 "6 nPUILODING INSPECTOR cm v APPLICATION FOR PERMIT TO ........ .. .. :' '` '�... �....................... TYPEOF CONSTRUCTION ...............bh vu:e:.............................................................................:....................... 73 ................................................19........ TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit according to the following information: Location ........ .... ............ ......1.d7 J h`Q..iti.7........ � ........I.- ��:�:... Proposed Use J. .-�lM�� ..Q Q����•.•.......:........................................................... .... .................................................................................................. Zoning District ............... .B................................................Fire District ...............�'-.�..ga!Yl!Y�! ......................................... ` t" �.e �Gtiu ......�`'i..................Address ... ... .Bx....�. :U.�...... . ................................vt Name of Owner ....z............................. . Name of Builder .e4.Vv°...........Address ..................................................................................... Nameof Architect ......A4.Q.. w...............................................Address ...................................................................................I Number of Rooms ......................................:...........................Foundation I �AtieC� .....?...eau—Q� ............................. ............................................. � e Exterior ......... . ... ................✓•d'�!`�^ ..............................Roofing ............. 1 k ......................... . ................................. Floors .............�C�.l..�..... .. .................................... Interior ........ .. �................................................... Heating .....................................................Plumbing ...... ...C..?�...A.............. �;�1 ................. t� / Fireplace ......... ,,!�....................................... Approximate Cost .........2.....t..........�...U..............-.�..-....-.�.........L...Qa� Definitive Plan Approved by Planning Board ________________________________19--------. Area f �' ... ................... ............ .. Diagram of Lot and Building with Dimensions Fee ................... . SUBJECT TO APPROVAL OF BOARD OF HEALTH •�r Cu G C f �-G7:�I v 23 %� �I / J,� Z?, �— Lot floc-i+ 36t fl, Rl� � 30 3 6 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... Q ,,� ............................. . .�..................... DePamphilis, R. L. - 0 No ...16737.. Permit for ..,, 1 1�2 story single family dwelling s .................................................................. Location J� Sterling..Road........................... ................. ......... .......................Ra -s ............................................. f h Owner ..........R.. L. DePamphilis d ...................................... r ' Type of Construction frame ..... ..................... ................................................................................ Plot ............................ Lot .......... k 1 ......bloc - November 16 73 Permit Granted ............I...........................19 y l �1�e/7� Date of Inspection II .. ................................ Date Completed ...... 19)( ..... ..'.1 ,................ PERMIT REFUSED . ................................................................ 19 i. a - ............................................................................... ............................................................................... 4 Approved I ` ............................................................................... .............. ..................................................... s Assessor's map and lot number .......................... —, SYSTEM MUST BE I COMPLIANCE I� Sewage Permit number ........71'-iJ.�71'-i�...................................... II STR,-E CODE AND TOWN TMEtRELUIAT p�� TOWN OF BARNftABLE. • F BABBSTABLE, i "6 9 BUILDING INSPECTOR • y APPLICATION FOR PERMIT TO ...COL.Sir uct..5. .t.�e... ;C�Ut. .... w¢, l.:..................................... TYPE OF CONSTRUCTION .......... tt,tu.r.............................................................................................................. ................................. ... .........19AA TO THE INSPECTOR OF BUILDINGS: -_ The undersigned hereby applies for a permit according to the following information: Location ..........L 0 T A S 2-rej L I N t; 2 b 4 t1 a A ;96 ..................................................................................................................................... ................................... • j T ProposedUse (�ies�ac.\kce vwel( i%I.............n............................................... . ........................................................................................................... ,\ Zoning District ......................B .................................................. District .............................................................................. Name of Owner R!ct4AR.D U. bC- PAMPKILLS ofc'l ss ..�.4....�.0WNtiou-S£ lT �!�eJWtllS............ Name of Builder t�.APfSID4 �EUCLDPEPS Address ..Po...BOX 120�( rT �c11� wl5 e,I(P .... .............. ............. ............................. ................................... TQVtrtG �• �Al�� Wu1ST Address �Et2olT ! C�{ Name of Architect ............................................ ................ ouRtiD o T ti•OMc PLANN4. l�5 C. Numberof Rooms ..6.............................................(...............Foundation ................... (....K...JU....c................................ Exierior ....V.J.. .n.CA...�rd.Y�g -:...cl!'.�t 1 aofing ....o1 S�J N J�f...s!1�.µq.1.!o................................... Floors .....�..QV..4(.p..a.....C(M.Ca. ..:%U�.......................Interior .......0 V.`{..w. ................................................... HeatingQ.?.e. lL.........................................................Plumbing Per c-PAe................................................... Fireplace 4'. .......�.v�t"eV.!.V ................................Approximate Cost ......�a` .'.. .�v.................. ................ Definitive Plan Approved by Planning Board _yLol___rQ1-IXd---19________. Area .... ....................... Diagram of Lot and Building with Dimensions Fee 3 9 7— SUBJECT TO APPROVAL OF BOARD OF HEALTH n -A1 �0.1U �(1� ��2Q I�(V �17 i fj a VA N051ALUM �s A 077 � 31' 31 38 r tab I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ��Name . L _ - DePamphilis, RiohardI^~ ` qrma \�4 | No —����.�— Permit for -----..�����--.. ( ~ --- ^�--....c......�—..c..............------.. " 4 Road ' Loc���m .--.��������------------.. � ` -------. -------------. Dvvnar --- ..��.. __ . � � r Type of Construction .---'j��J�k------ | . �� � ~~ ' | ~ .. ....... .^--------------------' �% Plot ............................ Lot _ .________ / 8 . Permit Granted ..........October � � 7....... g 73 ' . - -- of Inspection— —T—'r--------' -`�__ ` _ - \ Date Completed ~ ............... � . + , PERMIT REFUSED � -.----'_—.----.--------- 19 P ^ x�� � ---�:'/~)'°~,f�-------------------' —._------------.-----------.. � v . ' | —^^~--^------'—^--------~---' � � m .—..---------.~---.--.------,— \ ' { ' ~ . ' " Approved _--------------. lQ . . ' � --------------------------. . � ----------------------'---- > ` � ' _