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HomeMy WebLinkAbout0073 WOODBURY AVENUE 73 jj� --- ----� z 'r o dv ._ �.� �� v� ,�,;y� i � J v "� °4 ��� �L J t S ,r� ,','�/ / � � 'j ��iO 1 i d �� ♦� /� ti G7 y ti a'�y `'a stir � ®/ © 7 ? �� Town of Barnstable *Permit# Try , Expires 6 months from issue date Regulatory Services Fee 3 s , + -3ARN5rABLF;' q� Mass. • Thomas F.Geiler,Director059. Y 1 Building Division _ p�1q Tom Perry,CBO, Building Commissioner ����� PERMIT" ��IVI l i 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us DEC 17 2012 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY_ Not valid without Red X-Press Imprint I OWN OF BARNSTABLE Map/parcel Number Property.Address .1, IN oa AVC, lk Residential Value of Work -4 (OD0() ' CIO Minimum fee of$35.00 for work unde $6000.66 Owner's Name&Address Lau r 50 t/Jc)&J u r Contractor's Name 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 %Eg.1 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 Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑�Re-roof Nurricane nailed) stripping. Going over existing layers of roof) Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum.M)#of windows ❑ Sm oke/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. ***No�ttee Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILES\FOR.MS\building permit fomis\E3PRESS.doc Revised 053012. f Y� The Commonrsmealth of Massachusetts Deparment-o, uarstal�.4�ccid tW Office.of Investigations 600 Washington Street Boston,H4 02111 . wnwv.mans govldia Workers' Compensation Insurance Affidavit: Builders/ContractorsJOec#ricianslPbumbers , Aplibcant Information Please Print 4,6bly C�tyJStater , _-:. C 1Y1\S [vor � �o 7 Are you an employer?C the appropriate box.: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6_ ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor orpartnes- listed an the attached sheet. Remodeling ship.and have no employees These sob-contractors have $_ ❑Demolitioa'-- employees and h working forme in any capacity. lave workers' 9. ❑B�udlciing addition [No workers noe'comp.insurance comp.insura - required.] 5. ❑ We are a corporation..and its 10•❑Electrical repairs or additionns 1-3` � I am a homwuner doing all work officers have exercised their 11-❑Plumbing repairs or additions �' myself. [No workers-romp right of exemption.per 1Y1GL 12.❑hoof repairs insurance required.]t C.152,.§1(4),and we have no employees.[No workers' 13.❑Other coop.insurance required.] *Ray awlicain thst checks box Al must also fill out the sectim belm showing ties workeW compensation policy infvrnmtion- I Romeowners who submit this affidwit indicating they we dying all vied sA then hire outside conlracturs most submit anew affidavit indicating such tCaat m=rs that check this beet must attached su addificEW sheet showing the nmme of the vab-cixatmczm sad stale whether ar not fhose enoitms have. emphry ees. If the SnlhCa4tARClA have employees,they IIm5t provide tbair workers'camp.policy number. lain an omploy sr that is prmidisrg aworkm-congwrrsation insurance for niy emplol em Bdosr is the pofiq and job site information. Insurance Company Name: Policy#or:Self-ins.Lic.#: Expiration Date: Job Site Addraew: 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 M1GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 andior 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&at a copy of this statement may be forwarded to the Office of Imestigations of the DIA for insurance cap-erage ver ficaticn— I do hemby a niter the pains andpenalties rrfpedib7 that the infonnation provided above is t me and correct. 5-` Date:._ �xPh;age°#= offi ai arse only: Do not unite in this area,to be completed by City or tvivu afficiat .LCity or Town: PermitUcense# Issuing Authority(circle once): 1..Board.of Health 2.Building Department 3.CitF(Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#' .r °F'THE T° Town of Barnstable ' Regulatory Services yBARN sASBEF, Thomas F.Geiler, Director fD.;u; Building Division Tom Perryf Building Commissioner 200 Main Street, Hyannis,MA 0260.1 www.town.barnstable.m.a.us Office: 508-862-4038 Fax: 508,790-6230 HOMEOWNER LICENSE EXEMPTION Please Print Ji-�OB`LOCATIO�N^a U`)o OC�Y—�U number street ill ge HOMEOWNER": name ( home pphonn-e�# work phone# CURRENT MAILING ADDRESSa � �/`-'®Q�/"'� U ' h n 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,personwho 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. , 9 The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro, res and requirements and that he/she will comply with said procedures and.requirements. Signature of Homeowne.-,t s,,=, - 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 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 imend and adopt such a fom>/certification for use.in your community. 0:\WPFILES\FORMS\building permit forms\EXPRESS.doc �pF THE Tp�� MASS. Town of Barnstable prf0 AAA't p Regulatory Services g Y Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 —Fax: +508-790-6230 Property Owner Must Cornplde,and•Sig' r This'Seciion 4If Usirig3A Builder:` r ' 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 Porm on;the reverse side. QAWHILESTORMSUilding permit forms\EXPRESS.doc oo.,: a n7n1 1 n i [ ] [R307 224 . ] LOC] 0075 WOODBURY A7v E CTY] 07 TDS] 400 KEY] 219089 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 WALKER, HAROLD C MAP] AREA] 61AC JV] MTG] 2001 MARIANNE E WALKER SPl] SP21 SP31 110 CLIFTON LN RR2 UT11 UT21 . 33 SQ FT] 2200 CENTERVILLE MA 02632 AYB11969 EYB] 1975 OBS] CONST] 0000 LAND 23400 IMP 84000 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 107400 REA CLASSIFIED #LAND 1 23, 400 ASD LND 23400 ASD IMP 84000 ASD OTH #BLDG (S) -CARD-1 1 84, 000 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #HN 0073 TAX EXEMPT #SN WOODBURY AVE HYANNIS RESIDENT'L 107400 107400 107400 #DL LOT 7 OPEN SPACE #RR 1869 0080 COMMERCIAL INDUSTRIAL EXEMPTIONS SALE100/00 PRICE] ORB13254/254 AFD] LAST ACTIVITY] 00/00/00 PCR] Y R307 224 . OP P R A I S A L D A T po KEY 219089 WALKER, HAROLD C LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 23 , 400 84, 000 1 A-COST 107, 400 B-MKT 110, 400 BY 00/ BY ML 6/88 C-INCOME PCA=1041 PCS=00 SIZE= 2200 JUST-VAL 107, 400 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 61AC ----------------------------- NEIGHBORHOOD 61AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 234001 LAND-MEAN +Oo 1074001 74880 IMPROVED-MEAN +120 25; ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R307 224 . P E R M I T [PMT] ACTS[R] CARD [000] KEY 219089 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT 96 UPC 68021- No_ SF17SA ` , IHASTINGS. MN c,._sr y t ' RESIDENTIAL PROPERTY MAP NO. LOT NO. 73 FIRE DISTRICT SUMMARY STREET Woodbury Ave. Hyannis LAND 10 O r : .y 307 224 H BLDGS. 3� 3 OWNER "'° TOTAL Ll LAND RECORD OF TRANSFER DATE BK PG I.R.s. REMARKS: T j"-,90 p LoT O BLDGS. I Enterprise—Develvpement--Corp��.-Corp;, .- . '- 11 �7( 68 '141.8 --817 ��. %) 5 L TOTAL LAND R?-Walker. Haro,j.d C. & Marianne E : 3-17-81 3254 254 $52 , 0 rn BLDGS. A•/e- TOTAL LAND y< Ci E/P V/ L L / /� O•�G�.27 O BLDGS. TOTAL LAND BLDGS. s$ TOTAL 1 LAND O BLDGS. TOTAL LAND O BLDGS. TOTAL LAND INTERIOR INSPECTED: G rn BLDGS. f TOTAL DATE:' 6 /� 7/ /C-'� O �,/t.!1�r '•� ( ..�� .l�,r _ ,,/ LAND ACREAG COMPUTATIONS O BLDGS. ND TYPE $♦ OF 7ACRES PRICE TOTAL EPR. VALUE TOTAL HOUS �� J �G 9/� 191 LAND O o CLEARED FRONT O BLDGS. REAR ' TOTAL WOODS&SPROUT FRONT LAND REAR Qt BLDGS. WASTE FRONT TOTAL REAR LAND O BLDGS. TOTAL LAND jl `I BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND U ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. FUUNUAIIViv oo�.ir. ..r . _ i ta: .;. . �` LAND COST ' Cone.Walls Fin. Bsmt.Area Bath Room 2 Base �—c�ff BLDG. COST Cone.Blk.Walls Bsmt.Rec.Room St. Shower Bath Bsmt. ' PURCH. DATE Cone.Slab Bsmt.Garage St. Shower Ext. Walls Brick Walls Attic FI.&Stairs Toilet Room /� PURCH. PRICE Roof RENT / ?; y�• 70 Stone Walls Fin.Attic Two Fixt. Bath Floors Piers INTERIOR FINISH Lavatory Extra Saint. F V 2 3 Sink / ' 'b 'h 'h Attic Plaster Water Clo. Extra EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood No Plumbing Bsmt.Fin. Single Siding Plasterboard Int. Fin. hingles TILING CC19 Cone.Blk. G F P Bath FI. Heat Face Brk.On Int.Layout Bath FI.&Wains. Auto Ht.Unit S.3 0 •�y/ 0 Q` Veneer Int.Cond. Bath Fi. &Walls Fireplace Com.Brk.On HEATING Toilet Rm.Fl. — Plumbing /S o ) . Solid Com Brk. Hot Air Toilet Rm.FI.&Wains. Tiling Steam Toilet Rm.FI.&Walls Blanket Ins., Hot Water St. Shower AD . Roof Ins.• Air Cond. Tub Area Total . Floor Furn. e?g Y✓. 2� °?k/(� Q ROOFING COMPUTATIONS. B� ' ;Atph.Shingle Pipeless Furn. / 0 G S.F. .33 0 G O Wood Shingle No Heat 0 S.F. �r d 31 `Y "Albs.Shingle Oil Burner p S.F. i"�.';I o 3/ Slate,r Coal Stoker S.F. Tile Gas Z S.F. OUTBUILDINGS ROOF TYPE Electric Cable Flat S.F. 1 2 3 4 5 5 7 8 9 10 1 2 3 4 5 6 7 8 9 10 M EAS U R E L!' Hip Mansard FIREPLACES S.F. Pier Found. Floor Gambrel Fireplace Stack I Wall Found. 0.H.Door LISTED FLO R Fireplace Sgle.Sdg. Roll Roofing Cone. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Pine Shingle Walls Plumbing ^ fL Hardwood W ROOMS Cement Blk. Electric Asph.Tile Bsmt. 1st v.1- TOTAL 336 9- Brick Int.Finish CED 'Single 2nd �j f' 3rd FACTOR REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. CONO. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.DeP. ACTUAL VAL. .DWLG QUPL ^ 3 -1/0 3 a.,3 5' �•a1 _. 'tN 2 r 3 4 5 --. 6 7 D �t 9 10 _ TOTAL AHCFL IDENTIFICATION NUMBER ROPERTY ADDRESS ZONING I DISTRICT JCODE SP-DISTS.I DATE PRINTED I STATE I PCS I NBHD KEY NO. CLASS 0075 WOOD3URY AVENUE 07 RB 400 07HY 07/09/95 1041 + 00 61AC R307 224. 219G89 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS Ty UNIT ADXD.UNIT WALKER, HAROLD C MAP— Lana By/oale S�=e o�men=�en LOC./YR.SPEC.CLASS ADJ. CONE). P PRICE PRICE ACRES/UNITS VALUE Description CD. FFDe . Agree E #LAND 1. 23.40D CARDS IN ACCOUNT 10 1BLDG.SIT 1 X 33 =10c 203 34999.9S 71049.9 .33 23400 #BLDG(S)—CARD-1 1 84.000 01 OF 01 #HN 0073 COST To—f WT0— BATHS 2.2 U X C= 100 12000.00 12000.00 1.00 12000 B #SN WOODBURY AVE HYANNIS MARKET 110400 , H #DL LOT 7 INCOME #RR 1869 U080 USE A APPRAISED VALUE C A 107,400 J _ - I PARCEL SUMMARY U LAND 23400 s BLDGS 8400o T —IMPS M OTAL 107400 _ E J CNST N - DEED REFERENCE Type�D/ATE R—d-I R I O R YEAR VALUE T Book Page Incl. vr.D S.Ies Price -AND 2 3 4 0 E s 3254/254 00 LDGS 84000 OTAL 10740C 3 BUILDING PERMIT Number Dale Type Amouni ' LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 23400 12000 C.n . Tpinl r 8 'II Norm. Ob". - Ciass Jnils L'nns Base R.I. Atli.Rate Ac u Age Dep, Cond. CND IL- %R G Bepi C-1 New Ad, Repl'Value Sloriee Heignl .--- Rms Balns .fie. Putyw.11 F.c r 02C 000 100 100 63.60 63.60 69 75 19. 80 90 70` 120003 34000 1.3 9 5 2.2 12.0 riplion Rale Square Feel Repl.Cost MKT.INDEX: 1�D 0 IMP.BY/DATE: ML 6/O E SCALE: 1/0 0.71 ELEMENTS CODE CONSTRICTION DETAIL 100 63.60 1100 69960 NST 5P: ' FWD 85 8.50 196 1666 *----14---* N STYLE 17DUPLEX 0.0 818 52 33.07 1100 36377 FWD 5 ESIGN ADJMT 00 D.G i ! ! E XTER.'AA_LL$ f1400D SHINGLES 0.0 J 14 14 REAT/AC -`TYPE 07 AS=HOT liATER---0.0 ! ! 1 NTER.fINISH 02 ANELING---------0.0 ! ! NT1_R.LAYOOT -f2 VER./NORMAL ----r.0 J ---- *----14---*----44--------------* NTER=O�IALTY J2 -AM- E E AS EXTER. 1 ! 818 F Lb11R 5DWCT 03 D JT1ST 8EAM 0.0 > W ! ! E L0 R-COVER-- -J4 ARPET---..--------N.!J D TplalAleas Aua _ 196 Base_ 1100 ! ! OUF TYP-E--- -05 -Aff9RREl--ASPH -9 E BUILDING DIMENSIONS ! ! L-ECTRI♦CAL OT VERAGE 0.0 T BA$r W44 N25 FWD N14 E14 S14 W14 25 BASE 25 0U-td6ATIbN- - -JT bURfD--CC NC __9-9.9 A .. BAS E44 S25 .. B18 N25 W44 ' ! S25 E44 .. ! ! -----NEI_G9aORH666 _6_1AC }IYANNIS------- L ! ! LAND TOTAL MARKET ! ! PARCEL 23400 107400 *-------------44--------------X AREA 2848 VARIANCE +0 +3670 STANDARD 25 �, Ik ,r z ® Cm g co N cw u- 2 I`a N , DZ r tC '1. fi rP ism lum :'• .r.:;•;:•;::•;:• ..........�........ ��LDING ..:::...:.:: L ::•: INS � .R �..' .i� ................. .t......:.....:. .:: ..............:..::::::::.::::............. AROLD WALKER � ... 0 x. 0 RYA E.:;< U HYAN}:::> NIS,:<z �ti'l:�'••'''>� :::.•:..:;:;.,:;::•••.•;:.•••':.,:..:::•.;.'..•:..•''•::.,.,•:..�::�.:.�.�`'.��:•��.n'"`:':': ��:� :<�:�: <�;% M1:r:::::::: ':;: :::::::;:�:'r:�:�:. iii:� :�:�:;�': i:':<�:� is� :: ���:%�'�'�:�::;::�:��:�:�:o:: :����'���:�: ....4/ .7:. ��..:::.::::::::.................................::. .••:::::::::.:::::::::::: :::.::::.::::.::::::::::.:::::::::::::::::::::. >� :..... . E.----B.H.A. on 1111111111 ME I ON .......::::::::............... ..........::::::................:::....................................................... ..:..................:................:....... Pam€ . r :>:::::::.. ..SEARCH 1 NOON :. �:>: TOWN OP BARNSTABLE REPORTSit LEMENTARY/CONTINUATIC&EPORT NAME LAST, FIRST, MIDDLE DIVISION /DHPT Ell 2 NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL #S ETC. 3 -e- � olsrri-4) 4(.N 2. I C, A4 e-r-e s l o a-V SUBMITTED PAGE # 0 J 11-05-1995 12:19PM FROM BARN HOUSING AUTHORITY TO 37906230 P.Oo b 4 Barnstabll Teleptsoae ma)7nl-7222 .e Housing Aut6o rlty 146 South Street-Hyanrsis,Massaehmas 02601 ZONING V=MCATI®N TO: Gloria arenas FROM: Leila R. Bruce, PHM, leased Housing Coordinator RE: Verifying legal rental unit Date: Noyember 5, 1996 Address: 73 Woodbury Ave Village: Hyannis Unit type: wlni ex Bedroom size: 1 Map & Parcel No.: 307 224 (??) The owner of the above listed property'is entering into a contract .with us Tor the rental of the property as listed above. Please verify by signing below that the unit'is legal and meets all' zoning requirements for a rental in the town of Barnstable, If it does not, please list reason here: ank yo for our assistance in this matter. err/ s Si nature Print name - Date VIA FAX: 790-6230 M" SSCtbA e Equal Housing Opportunity O Rev. 10/8G � Agency i 1 air ss UPC 68021- No. ( HASTINGS. MN I G ) Map 2 Parcel ^ Conservation Office(4th floor)(8:30-9:30/1:00-2:00). - Date Issued !b `v3- Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee ( aS d L Engineering Dept. (3rd floor) House# BARNSPABLE. ' MAS& 16 Eo tu'� TOWN .OYBARNSTABLE Building((Permit Application 3Pt ddress .3 } �000.buv tieNv 4NIVhS Village Owner ga,weiA. JCJ KIC-V Address Telephone 2" 30S Permit Request -First Floor square feet Second Floor square feet bo Estimated Project Cost $ .340Q. Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential bl*- Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure ��y,.d,�.� Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information r� Name ��►�¢1Ar1�Gp Telephone Number 3bg' 34 9' 7117 Address 71 lAuN I tNaUN Ayemo Qi- License# L, q Home Improvement Contractor# 0 3 9 Z(o Worker's Compensation# to S I(o V 3?18 0 78ft 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 P OJECT WILL BE TAKEN TO16 ; e� eN SIGNATURE✓ DATE / BUILDING PERMIT DENIE FOR THE FOLL NG REASON(S) FOR OFFICIAL USE ONLY P MIT NO. D TE ISSUED T M /PARCEL NO. ADDRESS VILLAGE . ER DATE OF INSPECTION: FOUNDATION' { FRAME INSULATION • — FIREPLACE ,ELECTRICAL: ROUGH FINAL _ OMBING: ROUGH FINAL _ GAS: - ROUGH FINAL ! FINAL BUILDING (��j'` ! F $ `' •p DATE CLOSED OIIT- ! ASSOCIATION PLAN NO. f s - The Town of Barnstable • i P DepCent of Health Safety and eviom IlleIItai Serve ces Buiijding Division 367 Main Strut,HYatinis MA 0=1 Pdph Cit= Office: 508-790-6227 Bing Comm F= 508-775-3344 For office use adY • ' permit no. Date AFFIDAVIT HOME MOROVEMENT CONTRACtORLAW SUPPLEMENT TO PERKM APPLICATION ' ctio aiteiatioas;tmovatioa,t�moderatzauou,wnvcmm MGL c. I42A requires that the"tuonstru n. ed improv�mcnt..itatoval, demolition, or aonstruaroa of an addition tom wiuchng �aie ad�ac�t building Ong at least one but not more than four dwelling units es mong with other to such residtaoe or building be done by registered ootutacx M with certain a oM togtiirtaaeats- Fret. D 00 Type of Work: — CostO Address of Worts: ✓ v O%mer.Name: ii�►w,i� d-..L Date of Permit Application I hereby certify that: Registration is not rcgtii:w for the following rzason(S): Work coduded by law lob under S1.000 Building not awner-o=apied Owner palling own Permit Notice is hereby gh'=that: COrTIItACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING W NOT � Tp THE FOR APPLICABLE HOME IM�ROVEMffiNi' WORK ARBITRATION PROGRAM OR GUARANIY'FOND UNDF.ILMGL c 142A SIGNED UNDER FENALTIES OF PEP I hereby apply for a permit as the agent of the caner: Date Contras=name Date No. OR ' w TheCumnrunx•callb uj4fas acbuse>�s Department o Industrial sidents 600 11'asi n.1111Pn Street ''+,' Ba ion.Mass. 02111 Workers' Compensation Insurance ARdavit A,RNicn—n reformation"_.�— .: Plestse 1'RiN'1'"i�tbly• - . . . . nee u�►o K 4 t Iv w U)&l k ' location- 7.3 f IS- u)eD � /,afl"G cite tt 1/"kA S d►.�Q phone g.77f'"���r ❑ I am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity ' 10-77 lop am an emplover providing workers' compensation for my employees working on this job. CAMP,an nnmc address: - w vswv•t� SO4 lA&A"d§ Ac,. 42GG 4/ phone#- 'l�DXr4 y -71'7 - . GV � saran, S f `t••� �- tr�.i •!! ❑ 1 am a sole proprietor,general contractor,or homeowner(circle c e)and have hired the contractors listed below who the following workers' compensation polices: COVIVIny-n"Inte. address: - city- phone#- insurnnce cn pellet# � • ' • -•— . .,• --- r sir s IT"1.7- Trr"s�R�s "�a�+�s' w►'r T!+'� —.1.. crMT1,1nV na e• address- phone#r --- nosier# -- :atiaeh additional'shee!iCaeco- eessar -�-: w "°"<=—+" 'r. ' .:.: :"`"''." Failure to secure covcrnpc as required under Section:SA of 111GL 1SZ na lad to the impasitioa oteritaiaai peaaltia ota litre rep to 51300.110 ant fine.•ears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and aline of SI00.00 a day against me. i oaderstand thr. MY of this statement mad•be forwarded to the 0111ce of Investigations of the DIA for coverage veritiation. I do herehr cenify umhr the pains and penalties of pedurr that the information pnnided above is true and correct Signature Print name ; t V.t: one#�D� 3y� - 7.2 7 7 [ch iv do not write in this area to be completed by city or town ofQcial pernsitAttxase# r1suilding Department pt.icea:ing hoard mediate response is required aseleetmen's OtRce C311eaith Department n• phone#t nOther�__ Information and Instrtions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for i emplrn•ces. As quoted from.the "laiv", an empinree is defined as every person in the service of another under anv contract of hire, express or implied. oral or written. An empinrer is defined as an individual.'partnership, association. corporation.c;raother,icgal entity. or any two or rr, the fore_oing engaged in a joint enterprise, and including the legal representatives,ofa deceased employer, or the receiver or.tnustee of an individual , partnership, association or othef legal entity, employing employees. However om netof a dweiIing house having not more than three apartments and,who,resideswtherein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or`repair work on such dwelling; or on,the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empio MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct build ings.in,the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionallv, neither the commonwealth nor any of its political subdivisions-shall enter into any contract for the performance of pub'lic•%v rk until acceptable evidence of compliance with the insurance requirements of this chapte a . been,presented.to the contracting authority. • .�-.-+..��-. r .......�...��. - .Z•r.. '1.�::f.t: ,� �.:� •• ='f-.a'JHr;I ffN jJ,a:,.Tar•:J.",la�':: .:i.1Yc•r,:i�a."'��«_'.`�' :w'a y t...- Applicants Please ,"I in the workers' compensation affidavit completelyt by checking the box that applies to your situation an. 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 aflidaviL 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 regearding the"law"or if you are requir to obtain a workers' compensation policy, please call the Department at the number listed below. Cis- or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne. 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 questi please do not hesitate to give us a call. �^..�•a..w...» ......•.^--........• _ - .._ •�� :fir:. .1s': The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents r. Office of investigations " 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhone #: (617) 727-4900 ext. 406, 409 or 375 AC Rv_ CERTWICA OF LIABILITY IN5 NC PD DATE(MMIDD/YY) RM 10/02/96 . PRODUCER THIS CERTIFICATE ISIM, IED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Drake, Swan & Crocker HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE Peter G Walther COMPANY Phone No. 508-255-3212 Fax No. A Western World Insurance Co. INSURED COMPANY B St Paul Fire & Marine Ins Co Thermco, Inc. COMPANY Wm. J. McCluskey C 7-D Huntington Ave. COMPANY S. Yarmouth MA 02664 D COVERAGES . .. 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 MAYBE 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDD/YY) DATE(MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE s2,000,000 A X COMMERCIAL GENERAL LIABILITY NGL713901 07/19/96 07/19/97 PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE a OCCUR PERSONAL&ADV INJURY $ 1,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50 i 000•. WED EXP(Any one person) $ 1,0 0 0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ _....................._._..... ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND TORY L MRS OER '. EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 500,000 THE PROPRIETOR/ $ INCL 6S16II8898R07896 •09/12/96 09/12/97 EL DISEASE•POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 500 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLESISPECIAL ITEMS Insulation Work CERTIFICATE HOLDER CANCELLATION :....................................:....:............_::....:......_............_.... _..... BARNSTi. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT, Town OE Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ATTN: Building Inspector 3 67 Main Street OF ANY KIND ON T E COMPANY,ITS AGENTS OR 5EPRESENTATIVES. Hyannis MA 02601 AUTHORIZE EP ATIVE27 ACORD;254(1195) tAGp D'CdRROItATIdfH 198 _ f HOME IMPROVEMENT CONTRACTOR } Registration 103926 + ' Type - PRIVATE CORPORATION Expiration . 07/10/98 THERMCO, INC. .1�jlilliam J. McCluskey ADMINISTRATOR 10 Huntington Ave. So. Yarmouth MA 02664 MASSACHUSETTS. 9FORM APPLICATION FOR PERMIT O DO GASFITTING not or Type) Mass. Date 4-/ 19 5 5/ Permit # Building Loca70 lx It '� (leCJ1 U Owner's Name I4,6rrZO , I/I IlC(X16Jl O- �-7 i s Type of Occupancy R17—=5 New ❑ Renovation ❑ Replacement o Plans Submitted: Yes❑ No ❑ N N W rq Y z N . uF' Qt p W OVJ in Z Z. p }- W O0 W¢ -O W W- F. = z FQ O W Z W O > LLVW - W uw Zp O CA W CC W O O W E O F O U O SUB-8SMT. BASEMENT 1ST FLOOR 2NDFLOOR I 3RD FLOOR 4TH FLOOR I STH FLOOR 6THFLOOR 7TH FLOOR STH FLOOR Installing Company Name U�2T4 j Check one: Certificate Address �/�'1 /2(/-(Ajim I4 8 Corporation ❑ Partnership Business Telephone IL7 S- / ✓ r p ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes U' No ❑ If you have checked Les, please/indicate the type coverage by checking the appropriate box. A liability insurance policy tJ' 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. Check one: . Signature of Owner or Owner's Agent Owner❑ 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 performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. T e 0 'censer , fie /�!� 4�iclw, 1724j, lumber Signature of censed Plumber or Gas Fitter Title Gastitter aster License Number City/Town Journeyman APPRO IC S N BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION Ll ' 8 - 9 S FEE `�'�� •Z l�•�� NO. APPLICATION FOR PERMIT TO DO GASFITTIWG r NAME& TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO, PERMIT GRANTED DATE y ^ 19 GAS INSPECTOR �``--` _ i ___ -�_ �. �� a .en a�; �`�;a+o ^fir.�„�19!• .e .�'� �� �,y�� � �.: ��.♦_ � 1J is � 7�� 4L ' Y k j.�Jir�r, atK`s� r I / J J nn 3 Goo o cX��t 2 �c)C, J� ` J 'r / � t