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Home My WebLink About0123 ANSEL HOWLAND ROAD a-s P&%L t tinA 1. a a Application number...6.......................................... BUILDING DEPT. ' II �► Fee................ .l-aa.............................................. DAUMAUX OCT 02 2020 _ Building Inspectors Initials...... .................. F BARNSTABLE I I TOWN O Date Issued.......16 . ........................ Map/Parcel.......171.-232. . ..... .............................. TOWN,OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVE S/WEATHERIZATION PROPERTY INFORMATION Address of Project: 1 a 3 t� I"x L 4ts k^fL&" kv NUMBER STREET VILLAGE Owner's Name: A �L LA ,(L. Phone Number_at-7- 9 vU Email Address:= C ,e o l ��k e �c .d ell Phone Number 91-7- 910-3.71 r Project cost$ f a oyj•w Check one Residential Commercial OWNER'S AUTHORIZATION — 7 As owner of the above property I hereby authorize k,J oc�-- to make application for a building permit in accordan with 780 CMR Owner Signature: - i� —�. � z� Date: 'Y IL G ..jcry TYPE OF WORK 0 Siding EP'IWindows(no header change)#_❑ Doors (no header change)# OInsulation/Weatherization F-1 Roof(not applying more than I layer of shingles) ED Coir mercial doors require an inspector's review Construction Debris will be going to 0 Certificate of occupancy with no construction(complete below) Occupant/family relationship or business name or Existing amnesty apartment(attach a copy of recorded comprehensive permit) CONTRACTOR'S INFORMATION Contractor's name ,,�, -�'l �ti-�'4�✓ Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (� S � Y (attach copy) Email of Contractor ov*1�4Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY 1S/N A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL-BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ,*For Tentszpnly* x Date Tent(s)will be erected Removed on,_ number of tents total va Does the tent have sides? Yes No 3(Ifiyes,please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No . Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs.,or> Yes No . , if yes,*a gas permit is required. Natural Gas Yes' No if yes, a gas permit is`required. WOW is beingserved'at your event please obtain a Health Department approval between the hours of 8:00am:-9:30 am or 3:30 pm-4:30pni Commercial events may require Fire Department approval, . . . . *WOOD/COAL/PELLET STOVES * ' Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under' the rules and `regulations for Licensed Construction Supervisor in accordance with 780 CAM the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date t- APPLI T'5 SIGNATURE , ~ ' Date / % U Signature a All permi ap tc tons are subjec a building official's approval prior to issuance. a s '.` •< S 3 -�'w' . +��y'J C...�r Sad �° .�`.,��g i,�. r ':a Y; The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 'Applicant Information Pleasee Print Legibly Name (Business/Organization/Individual): rr✓ C4 Address: 3? 1�1 rn �.• City/State/Zip: CVt('J t_[L�e_ 0 4hone#: ry S 1 r4AU 5- Are yo 4.an employer?Check the appropriate box: . Type of project(required): 1. am a employer with_� ❑ I am a general contractor and I (. 0' w construction employees(full and/or part-time).* have hired.the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [D,Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' � 9. ❑Building addition [No workers'comp.insurance comp.insurance. ; required.] 5:❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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 the policy and job site information. _ Insurance Company Name: /�S 5 aC &J vv r3 A-4 C 0 .-Pi Policy#or Self-ins.Lic.#: IwGL-R6_S U 1 t`1-v201Qg Expiration Date: 3 Job Site Address: J If A, e/ �� L ✓j✓-1 City/State/Zip:cn�`/t/ e vud OV�_ 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 c unde the pains enalties of perjury that the information provided abov is tree and correct. Si atur . Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also'-states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. 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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a refeierice number.. Irr 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,'telephone and fax number: The Commonwealth of Massachusetts ` y° Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 , Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 wvvw.mass.govldia Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Const! [%% *;visor .J CS-005414 ,M " [cpires:06/08/2022 PETER J AP,PL'ETO �• :, x 37 BAIRD WAga CENTERVILLIDMA*02632,#� 0/S5'1dU Commissioner d . >✓i' D�vncQea - , . ✓� Goiniiraiziae.U��o-../�lii�J�cc/�1iJc//3 - _. . ' � .. ` - Office of Consumer Alfalfa&BusineSSL Regulation - HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:individual before the expiration date. If found return to: ate) "anon Expiration Office of Consumer Affairs and Business Regulation �103218 07/05/2022 1 . 1000 Washington St�"g -Suite710 PETER APPLETON4, f`t Boston,M��1 f8 PETER J.APPLE,TON `G' 1 37 BAIRD WAY t �o( '�'(�•�.G�oc01 CENTERVILLE,Ma o2s32.' Not valid witho nature Undersecretary J TOWN OF BARN$TAELE Permit No. Building Inspector Cash OCCUPANCY PERMIT Bond ---------_______. _ Issued to -ic >r11 i Address :'P-O.OTV1_lis Wiring Inspector Inspection date Plumbing Inspector . Inspection date Gas Inspector 1 Inspection date Engineering Department Inspection date Board of Health inspection date 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. ...................................................... 19......_. .................................... .. __. _ ..._.....»_. _... Building Inspector ' SI►.�G1.E FAMt�`T' - •�B�oRooM II p IWY FLOW s 110 X 3'= 330G.Pp ISSPT%G TAWK =. 330XI54>% =-4956.Pa Use- logo o1•SPoSAL. PIT vSE IooO GAL-. rZ 5tVGWALL. AV-SA- 0 1505A 00 \ ` ego b.F x 2.5 375 G;i.p 50TTOM AQE.A t • �O S�F, 1 00" ., �f o $.F x 1•o R �j�o Ca P Q' k ILA.t I. lee -ToTA I.- O E516.N * -+Z 5 6-PR 'TOTAL TEA I L,( FL-DIf•� = 33o G.Po, 1 �our►DAno►�1' ;. i j Pf;2G9>L.AT10N RATE_ f- '`rtd�toL � " A, _ �-4•�1•cp 11f,��,y,� , . ��y V � CH A A. JON @AXTER Na 21,048 �STfc p .. ;�• r ' 4Mv suRv�� T65T FG.S i ToP FWD r.\T4 O s�,s s//z/el ��•�,- Imo' � -a ►ooa MV. S�(3So1>_ ptST: INS: CAAI.. o,S tea% PTIG , 'L l ovo Ir00.1. :•rAMK M43> . Gc►�.. 49.5: 1 F ACu f SArI� + PIT" 61zAu� wiTN a 49.8 WASKGD 6•TvN6 R CE2TIFIGC ' PLOT PL_A1J i PSZ.OPILE ' o N G C- Z*•39,g NO SGAL.E 50l '',< - . VA-TE //(do P,-A r•1 REF E2.Ert GE GE RT1FY ?NAT TH7~ FOUNDANtON SNo1KN N6,R�o►J COMPL"?S WITN'THE LOT 11 I A► P SETe.GK R.6•Qv19-6lASWM, DF'TNE- CENTER-�/1 LLE 1- IG�I-1LANDS ' OWN oF• `gAR-46T/ SI- AND 1� O T T . L0C.#.TE0 •WIT IW TN6 F 000 PLAIN SECT.IUIV .I� . DAT 3 Q , �, . BA-ATEize WYE INC. -_ iZE61 SZ f�QG'D'11Aw o s u r-v m'*Z'!S ;TKIS PLQN Ifi NOT Bk,,5r D Gld AN osTEiZ.ViL.LE• • MA`S$• IN5•�,uMEN"1 SV2.VGY �THE•oF�'SETS Sucut� APPL.►rA►�T No-t• pC v,c �-co oc'Tr:.c� 1�C Lc�-t' LINE, .,ssessor's ma a'r d lot:numler .................... r.. _""Sew r � p '^ �••;d Sewage. Permit number';. ...... ' / �� m�Q ♦°� 4 d ,}¢ � = DiUSTA X H /: 4e " � E ue rasa........ .. . .....:ouse number :.. fi tirLt 1� TITLE 5 i -T &- �-' , OF Z Al N S a:Atl L E 0 ' e Jul , BUILDIIN INSPECTOR APPLICATION FOR PERMIT TO /� �.. ... t .............. . ............................................. ........... TYPE OF CONSTRUCTION ......... ............................................ ................................................ TO THE INSPECTOR OF'BUILD1NGS: The undersigned hereby applies for a. permit 9ccordipg to the following information: Location .....: /!. ...1� � 0� � Gc 4..c` ..................................... .......... X� . 4 Proposed Use - � ........... .. ....................... .......... Zoning District Fi(e District ............... Name of Owner .. .......Address .......................................... Name of Builder" ................................ ......... ... .Address .....:........... ..................... Name of Architect ............................................... .............. Address ..............:.. ...... . ......... .. . Number of Rooms ................................ ..... ........:.:.:......:Foundation .......... Exterior ...... .`�'. �.. . Roofing � %/ ,... s �J^� ................. . ............ . ... ............ .... ..Interior .. �.....� f Floor .. �- v�.. Heating /lPlumbing, Fireplace •1�✓� � ` ....................... .........Approximate. Cost ...... w. ...lr�—'�.....................`L �. Definitive Plan Approved by Planning Board; ________________ ---------19--------. Area .... ..... ..... ................. . Diagram of Lot and Building with Dimensions Fee s� . SUBJECT TO APPROVAL OF BOARD OF HEALTH ' '0000,1/ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ?16 Name �.. ........................ ................ MALL, ALAN E. ' a 2476V One Story ► ) a ..............:.. Permit for .................................... I Single Fami1X Dwelling - !w. �. 3 .................... Location .L�o.k...#�.1]..��:3- Ansel Howland goad ,t Centerville r ............ ....... ................ .......................... .... t Owner Alan...E ... Small............................... Type of tiConstruction ...Frame....................................... t ... ..;.f.............. ........... ........ ........ r ,; . Plot ...... .-' F,• - Lot :... .......:........ f/ - • K Permit uarX Granted Jan :2 r. ......19 83 a'te,�of InspectionM ............. .......... . ....19 ; Date'C mp •ted rf' $ ........... - �T - - - - -