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(3rd floor) Map t q �-.. Parcel - Permit# ` Houk# 40 7 PA Date Issue S-7 1 7 Board of Health(3rd floor)-(8:15 --9:30/1:00-4:30) Fee GonseFm6@wQffie6:(4th Rem) ng- -_ep-_-s-a-o-ox_ coo__ mm. tME ifikive-P4an74gpFe,v� ptannimg-Bid-... 19 � BARNSTARLE. ' MASS. lEt% Ma+ TOWN OF BARNSTABLE Building Permit Application Project Street Address Village Owner 7-0 yG ✓ Address. Telephone Permit Request�/� C'� 644 SLLx, �ooreS � 7 3' X 9'0 Ii e r tyTer2lvn W U4 rTe c!edi z • Re wov(f 4 Perot4re /9P/rOY A60i (l✓ FT /Cfd- ow 96#611E ;3 �1 2/ 5e-e of lyeGx- First Floor square feet Second Floor square feet Construction Type /Estimated Project Cost $ J` Zoning_District Flood Plain Water Protection-, Lot Size Grandfathered ❑Yes ❑No 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 i No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - ,/CCunent Use, l, {"• - ,fl K C Proposed Use Builder Information Nam /// i9is� jL��i��i Telephone Number 4,12- 361'-2-72 AddresscM 12M-11'e, &Zz �. GCIs/f" License# 4 :3 ] 03 , /'J"'Z, 2 J- Home Improvement Contractor# /9 (o 0 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 3199liv?���' �r s Po S et L rletq k)S F (2 (CSIGNATURE DATE ++++ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 1 FOR OFFICIAL USE ONLY 1 PERMIT NO. DATE ISSUED MAP/PARCEL NO. r A C ADDRESS - VILLAGE OWNER n. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: i ROUGH FINAL - FINAL•BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. NJ Is, FRow`s� .Ail t € IIAN P AlER �oAW tc away " �- t �-a�'ADMINIS •ft7H � Fa,� ;M �7'�6 ,w'� w r ZZ f tie a»vnzoozu /`o�✓�aaaacu DEPHTK91T of PUBLIC SAFETY•- CONSTRUCTION SUPERVISOR.LICENSE Bomber •Expires:. _Reifided To 00 0�"� itILLIAH F BAKER . 286 TURTLE POND PKWY { HYD6PARK, NA 02136 THE . The Town of Barnstable • enatvsresr.E, • NAM �e� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION , MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost 51-0 0 Address of Work: ,.,4,f-"/S"_/l Owner's Name Date of Permit Application: , T Z— 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: Iles o ' Date Contractor Name Registration No. OR Date Owner's Name , The Commonwealth of Afassac•husetts Dc partnunt of 111(harrial Accidents office 010MV9211811s 600 N'ashittrtott Street Boston. Ma.yx 02111 Workers' Compensation Insurance Affidavit li •tot information• —� Pla!�e PRINT Game: location: cite fGe & k-. hon• LZ 1 m a homeowner perform—inc all work myself. I am a sole proprietor and have no one working in any capacity ,� „• _..___ , .. .. .•N�w•. ... ... w•rr.r:']M.�r,/.1+.sSTI'T��'1,7►!r:..ilTTtiw►.�..w..-..R�!�^ar_ 13;��`Y.. �.'f.ww•..� :.......r. �. -- - -•:r_+...,rt..:r.Arra+a+v"-� '.t:++r:r+:.-- -_ .�:•-.._...- .. .. .:. _ __-___—..tea L .___._-� I am an emplover providing workers' compensation for my employees working on this job. contoan• name: address: city: phone,#• insurance co. policy # I am a sole proprietor. gft eneral contractor, or homeowner(circle otte) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: nhnne#• insurance co. nolicy# .;r!.::•+.... Yam....._...... .. -�.�t....- �::_ _ -�r-..'."�.::�.�. _i T..S.�wws• ^TT•2•�.::... _ ;.�_...._..._ cmmranc name: address: rite: phone#• insurance co nolic� # Attach additional sheet if net cssary ..r +'- +. �"� =_ ir..•i• '� �+:++�,� .. ••ram-""'�"" -' ia.�+...r�r�rrir�.rtr�:i%.2iL.._... .�_..._rr_�..�Y.�i.�0►�=.........�.1fi _-��.._..i_...-.a •ilY!'�.t:_i!•J.a:c'wri+L Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties ol•a tine up to S1.500.00 andiur unc years' imprisonment as well as civil penalties in the form of a STOP'WORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement mac be fur warded to the Olftce of Investigations of the DIA for coverage verification. 1 r10 herehr c• iffy titer the pains and penalties of pe 'un•that the information provided above is true and correct. -Signature Date 7 Print namc l9///i�,I 77` 0 otTiciai use unh do not -ritc in this area to be completed by wit}'or town official city or town: permit/license# rIBuilding Department C]Licensing beard check if immediate response is required ®Selectmen's Office : allcatth Department contact person: phone#: rJOthcr s, Information and Instructions Ma5saCIIUSettS General Laws chapter 151 section'25 rcquires all employers to provide workers' ccmipensation for thei employees. As quoted from the "law", aii esrptorec is defined as every person in the service of cunother�under any contract of hire, express or implied. oral or written. An rmph rer is defined as an individual. partnership;association, corporation or other legal entity, br any two or more the foregoing enga�scd 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 lefial entity, employing employees. However the owner of a dwellina 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 hog or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even.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 commonti•ealth for an'% applicant ,who has not produced acceptable evidence of compliance with the insurance.coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter hz been presented to the contracting authority. 77 Applicants Please fill in the workers' compensation affidavit completely, by checkin'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 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. City or Towns w. _..._...,,......,..,... _ _ .- ....- _....... 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. Plea be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t, the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any question. please do not hesitate to give us a call. . r•-avv.-w-.....:: . ..._...mow,....•. ...�.+wr.,..r••:��•.r.v.. - .. .. «.�,:..: �;. . ::5•.-. ...:R.. 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 ~ •_ • fax#: (617) 727-7749 phone #: (6I7) 727-4900 ext. 406, 409 or 375 • , r .. � yr: a Ad-: "rat � � !OA� Liwc Fwa. 2�a s/-soa C& a 1L c� ,RICNARU T YEN� I •_,_, ___ L n.-A.T ASS suV4� 'DATE (-/G,/j •� hl �ZFE�I GIJC.�1" � .SNdat/N .'✓EP.a�r�� �c%�4AL j ' atirlN TNT" o� `�✓I L J-5 I �%�TI�►ON +Z sTsp't4Eti1 M U 2Pr!-( ......1.� ......l�sesso.�s map and lot number ...... SEPTIC SYSTEM MUST ,BE 7L INSTALLED IN COMPLIANCE t,.y. -Sewage Permit number ....................................•.. .�......... . WITH ARTICLE II STATE r u, SANITARY COME-ANQ •TOW VWL y'ATH E . TOWN ' OF rlRNSTA 1J ` Mb a m y BU11 mulNG INSPECTOR t� O 79• �1iPY APPLICATION FOR PERMIT TO .................. +> TYPE OF CONSTRUCTION .. ......... ................................ .... 0 a ................... / ........19.`7�.: .z TO THE INSPECTOR OF;,BUILDINGS: A.�. The undersigned hereby applies for a permit according to the following information: p Location ....!(��T.................. ................................. ...... list L2.. ......... ...... ... ......... ............. : ... ..... .............. Proposed Use ,....../l..tt1�J�L Zoning District .........rG...:.1..'.(...............................................Fire District .... ......... .. .......... ...... Name of Owner `T1i/�'�/ U,PPf✓ lii /Y�" vNz3 /�� ............. ................................ ..............Address .................................. ... .............. ....... vw/wry Name of Builder .......... ...Address Nameof Architect .................................... ............................Address .................:..................................................................... Number of Rooms ... ...¢ ..................Foundation .o5'lnJ� Exlerior ............... s?�'f �l .. Roofing � Ti/UGC Floors ................................................................, ...................Interior ..................... .......: Heating .........�"v zv ....-..� `5.........:........................Plumbing .....,.......: ......:...............:.:.....:.......,......._................:. Fireplace. ...........:,t ............ ........Approximate Cost ....... a Definitive'Plan' Approved by Planning Board _ ________________19________. Area ......... ...` : ........... Diagram of Lot and Building with Dimensions Fee �- I SUBJECT TO APPROVAL OF BOARD OF HEALTH 71 I v R. "+I hereby agree to.conform to all the`.Rules and Regulations,of the Town of Barnstable regarding the abode 4 construction: • Name .... ... t Murphy, Stephen J. ' xY . 18471 No one story, x - - - ..............-. 'Nit for ............... .; s'%single family dwelling r . ..................... - Annabel Point Road z` Location` ......................................... Centerville .....Stephen. J. Murphy, ., Owner frame 4, , Type of Construction ........................................... :.; _ �,;,- 9 •.. s Plot ...................... .. Lot . ....... . 9.... ... Permit' Granted June 18 1.9 76 Date of Inspection iO.�: Date Completed ✓.�� ...�.. .............19. 1. PERMIT REFUSED t`Y ....................................................... 19, F � f A ......................................_ .......................................... - . ......... . .................................................. ........... - .................................................................. ....... Approved ................................................. 19 i t .................................................................. ....... t _1