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Home My WebLink About0023 BAIRD WAY tM �wiPIi�"r��j� `t r �{� � S �, �y 1 ! ._� �' i " ttt' , ,t r ': {� >;n ,pk' iy.'lt :IiNJ! .•y i i� 'i ��+��P �� i a �{x ° 4 � q � tF 1 sE • ' P i � �ol Y 9 1�•4.� Yk 1 1 ; e. Q I ) Y1 Y t 4 , F f' �' y •�. 3 a � 1� !F aw 'y ;. � ,; s. 6 d 911".p a �� O ° i •y �1 X a a: o r w a _ • F _ f Barnstable Town o Il This Card So&That rt is:Uisible Fromthe Street-.Approved Plans,MustbeRetaing%don Job and this Card Must be Kept 6 MBARNSUBLF Posted Unbh',Final ln5pection Has Been�Made # 1639 .d TFY a S 1 n Permit Wire a Certificateo�f Occupancy�Requred, ch Buildmgshall Not be Oupied until a Final inspection has been made Permit No. B-19-3192 Applicant Name: Keith Cliff Approvals Date Issued: 09/26/2019 Current Use: Structure Permit Type: Building-Stove Expiration Date: 03/26/2020 Foundation: Location: 23 BAIRD WAY,CENTERVILLE Map/Lot: 171-089 Zoning District: RC Sheathing: Owner on Record: BEARD,CHRISTOPHER A Contractor Name ;KEITH A CLIFF Framing: 1 Address: 23 BAIRD WAY Contractor License: CSFA-058557 2 CENTERVILLE, MA 02632 Est Project Cost: $2,075.00 Chimney: Description: INSTALLATION OF 6"STAINLESS STEEL LINER AND COMPONENTS Permit Fee: $35.00 INTO FIREPLACE CHIMNEY FLUE FOR USE WITH WOOD STOVE.: Insulation: Fee Paid` $35.00 �. Final: Project Review Req: installation manual should be on site •Date 9/26/2019 0) �7)1`t r Plumbing/Gas ., 4 = y r, Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six monthsjafter;issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for0which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and stedeturesisha I be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street3o4 road and shall be maintained open for public Ispect�"o,;n for the entire duration of the Final Gas: work until the completion of the same. £f ` 3 Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Bu'ild�ng and Fire Officials are pro ided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection " 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-'ISSUED RECIPIENT Final: .TOWN OF 'BARNSTABLE_' Permit No. -----22030 i Building Inspector Cash OCCUPANCY PERMIT K Bond _X_____ \J "No building nor structure shall be erected, and no,land, building or structure shall be used for a new, different, changed, or enlarged. use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued .by the Building Inspector." Issued to Jobn Delaney Address 113 Samill Rd,$ Mi ri lls; lot 4`27 .23 Baird Way, 0-ntpruilip- Wiring Inspector ✓ Inspection date f' +rs• Plumbing DMector f•° � A ^ ` Inspection date Gas Inspector � ��: � Inspection date - /Engineering Department � ,'!i1/� �r Inspection date THIS PERMIT WILL NOT BE VALID,)AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL �D SIGNED BY THE BUILDING INSPECTOR`. UPON SATISFACTORY COMPLIANCE WITH TOWN \\ REQUIREMENTS. _k ............... _ ...�, 1s_........ ............ ........................ f Building Inspector '*�s eiblor's map and lot number4..��/ 4f ...... C�THE t0 ,�,� SEPTIC SYSTEM M Sewage Permit number ............ ..�."::.... ...�............:..... 3 INSTALLED IN CQM '�•'. TITLE BABB5T LE, i E NAG& House number .. ... so �- tWI1RONMENTAL Z ` ` T. " rULATION TOWN OF BARNSTAB"� r _ BUILDING IN-S�PECTOR �,� APPLICATION FOR PERMIT TO ...... ... ..... .............................................................. TYPE OF CONSTRUCTION ��-d- -� .. .., ..........................................................1? LC✓e�G, ...... ... . .......... ...�............................19. TO THE INSPECTOR OF BUILDINGS:' The undersigned hereby applies for a permit according to the following information: Location ...�.7....��. 7.... ! I (.�� .... ...... ....... . C �............ ProposedUse ....... ........................................................................................ .................................I......................... Zoning District .. C-L......I........... ..I...............................Fire District ... ...` .'. ........................ c ... ...... . . Name of Owner .. :.. ...., V..Address .�.l ..Sl �..................... � ..�?"` Nameof Builder ....................................................................Address .............................................................:...................... .Name of Architect ..................................................................Address ............:........................,,............................................ Numberof Rooms .........(.....................................:..................Foundation ..�Q...... ......................................................... Exierior ...... �.. .................................Roofing .....�.p . .. .................................................... (, Floors ... 1. .................Interior .....it/ . Heating �/ r.........::....................................Plumbing ..........)...................................................................... 1 Fireplace ..:............. .................................................................Approximate Cost ... :.............................................. Definitive Plan Approved by Planning Board ___________19 7�_. Area .. .��." ............. Diagram of Lot and Building with ,Dimensions Fee .........../ ..... ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and RegulationsAtheo "Bartgablgarding the above construction. No ................................ i DeLANEY, JOHN Single ` ` Vo 2203 ....... Permit for .................................... t ...........Family Dwelling............................ Location Lot 27 House #23 Baird way` - Centerville ............................................................ Owner ......John Delaney...... .^ - ..., Type of Construction Frame ' ............................................................................ Plot ............................ Lot ................................ Permit Granted ....M.r.Ch...LQ..............19 80 Date of Inspection Date Completed ...............................19 -5 R� - PERMIT REFUSED _ ........ . . .... ...................................... 19 S `-► _ ,. ..................................................... y T e$. .Z..-r��-....................................................... '^ ...................... . ....................... ...: .. .................................... 19 App........... :... . .................................................... ..:.. ......................................................... _ O'dwU r 6r 7q �� S/�•� ��v•;------- -`�; Leo✓ �.>nAD SCALD _ �/ '�17 _L'-a to 15 3 'E42rl l- y� -4A T T `,•- 1 :iF+r -//V� FOC/NDA i/ON ,__,? ,:1 T ON AND i7 �?�Q✓/�E^�r�/TJ -4-A �`J/-J � /�,i f�.•� C.7ZOGtJELL � T�YG/J2 C'Q,�C? f✓j's-- s r ,G �-.S�e�. B G9//LLOLt/.�T. YA/2M0 uT1��O•e.'T M4. l 07/10/2011 17:10 5087785010 TUPPERCO PAGE 01 01 ) TUPPER 7/�1rs CONSTRUCTION CO. LjLc 79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673 PHONE! 508-778-0111 FAX: 508-778-5010 WWW.TUPPERCO.COM Date: ca Town of Barnstable Thomas Perry CBO cr- 200 Main Street Hyannis, Ma 0260.1 �•, ,(50$) 790-6230 fax co Re: Insulation Permits Dear,Mr. Pent' This affidavit is to certify that all work completed for permit application Issued on 7 a-:5 - has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Rich rd Tupper Licen e # CS-69058 S i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 10-wt4 or a., � ]j ITap Parcel " �� Application ® (J 2013 w# Health Division `" -Date Issued ' Conservation Division Application Fe Planning Dept. IV J -.« n Permit Fee efi s,- I �� c Date Definitive Plan Approved by Planning Board C 7)' )/-3 Historic - OKH _Preservation / Hyannis LOW_ Project Street Address 1 26 �� 17_1&)A q Village �,)TE 121J 1 1.1 Owner��DA N H01)0NA L.D Address ? 0A I R D IA � Telephone 1 ` .4 ciq 4 -Loo o Permit Request W FA-:H E2.1 ZA11 Qf3 M SU LA- Di�.� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation . �4Construction Type 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 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name l Telephone Number On `Address �q � ��uII ew dl�I V�' License # W IZ80 0114 HA 0 2-(oJ 3 Home Improvement Contractor# Worker's Compensation # InI6L- 50b 55R 301 Zd 12 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1�epcg= O 1 011 MoU SIGNATURE DATE A r FOR OFFICIAL USE ONLY APPLICATION# S C DATE ISSUED •f " MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: _,EOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL " FINAL BUILDING r r' r. . K DATE CLOSED OUT ASSOCIATION PLAN NO. t r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElettricianslPlumbers Applicant Information Please Print Letzibly Name(BusinessiOrganizationilttdividual): Tupper CcinstruCtion Co: , LLC Address: 79B Mid Tech Drive City/State/Zip: West Yarmouth, MA' 02673 Phone##: 50.8-778-0111. Are you an employer?Check the appropriate box: Type of project(required): 1.FX1 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑New 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.k 7. ❑ Remodeling ship and have no employees These sub-contractors have h: ❑Demolition working for me in any capacity. workers'comp.insurance. 9. n Building addition [No workers'comp.insurance 5. 0 We are a corporation and its officers have exercised their I0•(�'.Electrical repairs or additions required.] • 3.❑ I am a homeowner doing all work right of exemption per MGL I Ln Plumbing repairs or additions myself. [No workers'camp. c. 152,§1(4).and we have no 12,0 Roof repairs insurance required.]t employees.[No workers° 13.0 Other comp. insurance required.] *Any applicant that checks box#] must also fill out the section bek)Nv showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subinit.a new affidavit:indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing-workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: AEIC . Policy#or Self-ins.Lic.#:_WGC 5005593012012 Expiration Date: 10/0 3/2 013 3obSiteAddress: 23 Baird Way CityiStatel7ip Centerville,MA 02632 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 66varded to the Uftice of Investigations of the DIA for insurance coverage verification. I do hereby certify under t a and penalties of perjury that the information provided above is true and correct. Signature: Date: 7 8 2 013' Phone#: 508-778-0111 Official use only. Do not write in this area,to be completed by city or town offieial. 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 b.Other . Contact Person:. Phone M { Dec. '0. 2012 4:37PM No, 8524 P. 1/2 AGUH CERTIFICATE OF LIABILITY INSURANCE DATE 2/19/2012 12/19/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS r; 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: tf the certificate holder is an ADDITIONAL INSURED,the policy(ies).must be endorsed. If SUBROGATION IS WAIVED,subject to the terms 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: Lora Lowe . Southeastern Insurance A enc Inc. p"cN 508 PAX y IC No (508)990-2731 AIC.No E C 997-6061 A 439 State Rd. E-MAIL - 'ADDRESS: P.O. Box 79398 PRODUCER - CUSTOMER ID 0: N. Dartmouth, MA 02747 INSURER{S)AFFORDING COVERAGE NAIL& INSURED INSURERA: Arbella Protection Insurance Tupper Construction Co LLC INSURERB: AEIC INSURERC: CNA Surety _-..................._................._.:.:..._.._....__.._......_..___._._.......__...__......_......___.__._.__.._� 27 Roberta Drive INSURERD: West Yarmouth, PIA 02673 INSURERE_ k!-SURER F: COVERAGES CERTIFICATE NUMBER: 12/13-2 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 CONTRACTOR 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. LTR TYPE'OF INSURANCE INSR 4WD POLICY NUMBER ? M" TMM dD LIMITS 8500008743 1.110112012 11101t2013 EACH ?E^CE $ 1,000,000 GENERAL NECRALIABIL 6EPlERAL LtTt#ILIl.Y I .. •--•---------_._._._ I vac=r Rc TE < 100,000 ._.......1.... i ' I xrE'A C S I accurrer•ei.. .-C AiMc W DE �1 OCCUR - ,. I MEC EXP(Any one p9rso ki $ _-___.___5,000 A _ =ERSOW &AOv NJURY 1,000,000 i GENERALAGGREG.>ATE , $. 2,000,000 6ENt AGGREGATE 1.1%41T F.FPL(ES PER: RODI CTS-COMP,OP"AGG $ 2,000,000 j. vP IOC .. $POLICY ET __. AUTOMOBILE uaeiLnv 56662400002 12/011512 12/0112013 cc tEINED SINGLE L MiT E 'E I f$ 11000,000 , aacc�of? i ANY AUTO i _._-..._____._... _ SOD LY.NJ,iRY(Per parsnnl I$ AL.QWNE AUTOS i �_ eOU Lv t JuR'f(Per acCidan) A X ;SCHEDULE:AJrOS PROPERTY GA:MAGE . . F'er aceide�t) I$ X INC H RED auro • ._. X NCNGJTlE A :'VS . ' ! $ $ __.......... OC%t1R. i EA CI,I OC. P.RC lC.E +$ UMBRELLA LIAR j EXCESS UAS ' HCLAftAF-1Ak)E i ': AGGREGATr ,_ f$ , DFrn:TIELE I I $ RE1EN"rlON :$ WOR)tERSCOMPENSAT1oN WCCS005593012007 10103/2012 /0/0312013 X I OR`TAni' X cT-1-.; AND EMPLOYERS LIABILITY YIN 70 Y L,MITS p ,........_........__... ANY PROPRIETORPAP-NER/ ! 1 RICHARD TUPPER I FA iACt:,IO III $ 500,000 B .a-FICERA-IENISEPEXCLUDED? NIA . INCLUDED FOR WC COVERAGEE..DIS�E-EA SMPL�?1_E$ 500,00 {Mandatory In NH) If yes descn;undo" ....... .. ._ DE GR Pi l N OF QPERAT!QtdS Galaw E DISEASE-POLICY LIMIT $ 500,00 Bond or theft o money or I 71068813 0212812012 02J2812013 Limit of $10,000 C property. DESCRIP710 OF OPERATIONS!LOCATIONS]VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is requlred) ill.- io@csgrp.com" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . ACCORDANCE WITH THE POLICY PROVISIONS. Conservation Services.Group AUTHORIZED REPRESENTATIVE Attn: Bill Julio 50 Washington Street Westborough, MA 01581 Lora Lowe 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009108) The ACORD name and logo are registered marks of ACORD OUIU) ,s tObHIF4J "t . 111 UT It,INC t a5 his etts- 3 p trn nt of P bl c Safety 107 Hamm Road.sae 110 Board of 86ildingRegulations and Standards NIM : ,NY 12MO (.on., Yt3Cf.lE391 £il,tl:['it�tfa' nv, � RY�Cyy gg R 1l.. P+� i.r .. 79 a �t-TECH ttl �, �9 r WEST VARMCit fiH RkhWd TupW ICEsEYf S € t tt�D# tsr t ESQ. commissioner 124/12014 �112, " "ree nfsaurarrtria'rrs. i. vt� u v�5uttd a �ler iirld � H6�ME IMPROl fMEN`t CONTRAOTOR ROV itlon Type: tfilT€#f2$tl Y . Exxrloratior� 2 14 Indivi lUal BER � FtiCl AftD TUPPER r� p IV, , KARD TUPPEFt t x z � Roaerta Drive I� r' W,VARfifOUTK MA M13. t�+dcrucretar+ ' i OWNER AUTHORIZATION FORM (Owner's Name) y owner of the property located at ' ZJ Bai r-c� • (,va (Property Address) (Property Address) hereby authorize t/;IA (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on,my property. Owner's S' n GAqA C� Date Assessor's map and lot number�..�...... �. . . / AO R��? y�i?N E t��♦ `. Sewage Permit number ........... ...........� Z BAUSTADLE, i House number ........ - :o :rasa a t639- 0 MAI a� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION F E7,�,�1 OR PERMIT TO ................... ......... ,..:....................................................................................... ,.R. TYPE OF CONSTRUCTION ...... .....,? ..............................: ................. . ...........................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....�Z.,�2- ................................ �1<: ................... � , t.� ,^.: ........ r . f. ProposedUse ........ ¢ .. ............................................................................... Zoning District .... .........Fire District ff Name of Owner '' s' „_�.a,... �\.).��:k- ,<fd.. ......................Address �, i ...>. t.�9 7��1,�,t1,. f....��. i/ ( T!;r<:� tl�l/�( 1 11 1l Nameof Builder ....................................................................Address .................................................................................... Nameof Architect .....1 ..........................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ..!.Cj..... .1..................................:......................... r Exterior ......�e .?�(" fk.>!t.. 1 ,.��.... a..................................Roofing ....� . �,,:.....�, �. ..................................................Interior .....�./.:�.(it........,...�:!"'.,. ..................................... Floors �.r! . 'J..t',• r-7 � ....................................... .Plumbin ............................................................... Heating ...... ..::......................................:.....:....................:..... g .....:.............. Fireplace ...............Approximafe Cost .G!?!..:�j.+ ............... .................................................. f ...................................................... Definitive Plan Approved by Planning Board '�f�� — - 19?_�_. Area ��:.. 4D 15 t _. ... ...... .......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL'OF BOARD OF HEALTH ;V y � G\ I hereby agree to conform to all the Rules and Regulations of the Town of Barnsfi ble regarding the above construction. jZg�x-1 l-` 7Name...................... ................................ DeLANEl!, JUBN &=17I-89 . No — Permit for —. 4a- ' --- ........ —za,��ly...[.ws� ........................... ` _ Location Lo±...3I.J�azlme''4...2-3...Ba-Ird'.l�al' ______�eotezviIl��__________.. Owner ..Jobn...Del ___________ . . ' Type of Construction ....��-------- ...................................... ...... . � lot. _ --------- ot . ^�� Permit Granted . Do of | 7 ' D"'= Completed PERMT REFUSED � ` ---- .� .. lV ---- —' ']F' __�/. _,_____ ---- — --'f—''f----------- ^^ U / ' N -----. ----~.—.---~--.----... . -----....—'-------..-------.--. ' K ^ ^—^ A ................................................ l9 ' ''— -- ` --------~--------^---'—^'--~' ............................................................ ^ � � _ Engineering Dept:(3rd floor) Map Parcel $Q Permit# .. �9il House ate Issued �� 3 Board of Health(3rd floor)(8:15 --9:30/,1:00-• .M_ ) Conservation Office(4th floor)(8:30-9:30/1:00--2:00) 71SrT, �,WP6 _ <�, 3 ►a� to Planning Dept.(1st floor/School Admin. Bldg.) 11 ANCE nrH Definitive Plan oved by Planning Board ' i y 19, ' E " AND 1 TOWN OF BARNSTABLET WN RE s Building Permit Application Project Street Address- �j OTC oZ r], Village l A e P J A e Owner Address • 2 'jr �� -eOJe�"v+�6 Telephone 23 ' L A'^ ' -_Permit Request f=(�r,M (`�` �b(\c l"�- �j Y. 6 i First Floor square feet Second Floor square feet Construction Type W yV 0 P--/j l 1yt'. V__ Estimated Project Cost $ ,�Uy. �J Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family f Two Family ❑ Multi-Family(#units) Age of Existing Structure /S'yrS Historic House ❑Yes LLIXo On Old King's Highway ❑Yes ®'1lo__, Basement Type: Meull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing C)Nes New Half. Existing New No.of Bedrooms: Existing_�2 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil lectric ❑Other Central Air ❑Yes 2' oo_ Fireplaces: Existing ()A., 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# Current Use Proposed Use Builder Information Name �'' ��- c�✓ Telephone Number _r D F- U Address '� 7 �,r,� 1 x, � �i,l�o^�`,f f License# 06 �o 3& Home Improvement Contractor# 10.>off/ 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 REESSULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE c / UILDING PERM"_ ERM ENIED F R T /0QqOWING REASON(S) ' I ., FOR OFFICIAL USE ONLY _ PERMIT NO. t _ DATE ISSUED. _ r ` MAP/PARCEL NO. ' ADDRESS - VILLAGE' r OWNERY C T • DATE OFINSPECTION:f FOUNDATION- FRAME r INSULATION FIREPLACE 1 ' ELECTRICAL:) ROUGH FINAL ' ; 6 a 1 PLUMBING: ROUGH FINAL GAS: ROUH� : FINAL FINAL BUILDING = ' rn ' DATE CLOSED OUT ry ® :3 n1co - ASSOCIATION PLAN N ta . o ` The Cunt»tuntt'ealth of:ltassachusctn �s `--- t•;.:. Dcpartnu nt of LiJitstrial Accidents ' �Offlceoflnyesfigzaans •:\ �':;�. ___i.=+` 600 !f a-vNI!, ► r Street Briton.,11uxs. O2I11 Workers' Compensation Insurance Affidavit appiic�int information _ PfiTmi PRINT le;t N ""�'�'-'— past:• ( �� IgPP Inc•ttion• i '7 GY9 t ro city 'P T e�1f' lit I L�- !/� C�. b 7 nhonc —`/'2 -> ie�!� I am a homeowner performing all work myself. rl m a sole proprietor and have no one working in any capacity • _ ...tee.-_.mow-•..........._ �.�+aw..f+�.�es-�••�1T�^�"3'.`......+w.•w-!.��..�w..�.�.�.�.+.-� ..w,wr�....•�. ►•ww+��-..��... .. ..... .r.`.L. ..� ...,ter-.....►...�+�lr c .r-••-�.,_ - - -- ----�� .r 7 1 am an emplover providing workers' compensation for my employees working on this job. cernntim• n•tmr- iddrect- city phone tt• incurince cn pRhCy# -,.... -- ._..__... ....�_Y.�.. _. C: I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed beiow who have the following workers' compensation polices: commirn• n•ttnc- •tdrlrccc• city phone a• incirr•tnrc rp .—.. •i., .�w.^ _ _ -r..r... _ _ -r_ - � rw.w:i.' _- Tom_- -- r `• rr�� cmmn.lns• nnmc• - addresc� wiry nhnne tt- nniicy# inwr•tncc co i additional 'Attach a o goal sheet if neecssary-�_ • ��;= -^'�"=�;3.:: �—-� "=�-_� - �=�'•"`�=•%��='�� F:tilure tit seeurr cuwcraee:ts rcqutrcd under section ZSA of,%IGL 15::an:"u :u the imposition of criminal penalties of a line up to S1.500.U0 andiur uric wears imprisonment as well as civil penalties in the form of a STOP'1'OR1: ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement mac be forwarded to the Office of Invc5tit:auons of:he D1,1 for coverage verification. I do herehr cerrij under he pains cord attics ojp•rjun tlrar the iris or,--anon nrorided above is true and correct. Si_aature Date /�- -T_T Print name /� `��do� Phone N C/Z a ' ofricial use unly do not write in this area to be completed by tiny or town official permit/licensc it i"IBuildint;Department cite or tmvn: ` ❑Uccnsing Board L t Selectmen s URce �check if immediate response is required ❑ �- ❑1lc2lth Department contact person• phone=: r•1Uttter c. information and Instructions Massachusetts General Laws chanter 152 section '_5 requires all employers to provide workers' ctrinpens:ttion for employecs. As quoted lroni the -law**.an cmplt{ree is defiled as every person in the service of another under any contract of hire, express or implied. ortl or+vrinen. An eynplurer is defined as an individual. partnership. association. corporation or other legal entity. or any two or Inc the foregoing emuaued in a joint enterprise, and including:the legal representatives of a deceased employer. or the receiver or inistce of an individual . partnership. association or other legeal entity, employing employees. Howevc. rn+•ncr of a dwelling, house having not more than three apartments and who resides therein. or the occupant of the d++cllin� boost of another who employs persons to do maintenance, construction or repair wort: on such dwelIing or oil t --,rounds rounds or building appurtenant thereto shall not because of such employment be deemed to be an empiov MGL chapter 152 scciioll ::5 also states that even•state or local licensing agency shall withhold the issuance or relie+wal of a license or hermit to operate a business or to construct buildings in the common�•ealth far any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth ilor any of its political subdivisions shall enter into any contract for the perforilatice of public work until acceptable evidence of compliance with the insurance requirements of this cilapter been presented to the contracting authority. Applicants Please fill in the .vorkcrs* compensation affidavit completely, by checking the box that applies to your situation and su"'I" �in�_ compally names. address and phone numbers as all affidavits may be submitted to the Department of Industri:J Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile 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 require to obtain a workers' compensation policy. please call the Department at the number listed below. City or I-owns 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'. which will be used as a reference number. Tlie affidavits may be returnee be sure to fill in the permit license number 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 questic please do not hesitate to _give us a cz-11. 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 u- iz,-� ionn -.•« in.< sn4 nr 174 The Town of Barnstable z+aiver,+st,E, • AlAfik �m�' 'Department of Health Safety and Environmental Services ArEo�• Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissio: 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: � ��`C�`� �� Est.Cost Address of Work: e::P 3 19;fQ LA' Cr wy e�" I Owner's Name t&4(r y Date of Permit Application: �� /9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 a agen of the 3112-19 5atv 7 Contracto-riNaine Registration No. OR Date Owner's Name 40 .,L o T 0 33 . f 7y,x ti P 77. �� S/L� :l.r Y�:--- � -r�F�% 4r30✓E �'nvD .T.-1A T 7-;/6 E.a.-5 T. /NG FO%INDA T/ON JCS 1 T/ .4S -A-lowAl AAlo �;.t- ! TflE SGU%LD/tip SET��•!� e L�EQu/c�EM,�/7J ! OF THE TOWAIIv- �E��• �1 17 .�u�Z✓E Yv � YA,2"0 7;f/POZ-'T M4. .. 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S .: -, t now '7'., it'. � ,..,.- .f.,.t � .u.. #, *I :-,u Y:$'. q. rcr ,..D ^i.,_.,,:. "tte..,..,. . ,.. ., ,. �. .,..:•. f.A .:�..i:;^ A� }1 ! art• "— —f. .,:��_ -;,:-_r_ !- . -1 ,-r-'_•'r'-- ., `"(•-' r ,t^" t 1 , a -. , .... • , .. .. _. . f_-. _._. ......:,.•�1ce �uminza�uaea�i a�,/�aaoac�uraelld t .. DEPARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: .5 Restricted To: 00 01w PETER d APPLETON 37 BAIRD WAY CENTERVILLE, NA 02632 \ L � HOME IMPROVEMENT CONTRACTOR rRegistrat�on '103218 4YPe s ��,,r�� Expiration �'47/06/98 ram' -APPLETON CONSTRUCTION 1 :Peter`]: Appleton % 7 Baird Yayt ADMINSMMR :4-:Centervllle MA 02632 ''°" i •��r � ! �,`®' , `ram � �� ` ,» �� I s 4x.' r .::{., .....:::::: ::::;•J;a:J•;;•]]:;];•]:;y.{{;a:•:{.]::c{;;{•r:Jrrrr::i'e;•.Jr:;ar:::;J::•;{{.]:...... :{(:v DATE MM D 4;0 '' . / D/YV CORD U.v .. r.44o. '4�l o�iRi:{{�;:Yi{iir::�Sr:::�i:? :;.;F.]]:4]: {M1. TM :• : :' 4 :v :.r v:\�rcaa:�:{{:4:::.v:u v....,;:..............::.:.:....w:::•:::,v, \v]:rr:' \..v]:;;{:•.v..+.................r\.......................... .v..:.v»....n......... .n4...v...+...»J..t......... ......\...........vn....� ... ..vv•. .. .. u.p;,,n4:::.:..u:r.>.pv:::;..... ...v.............].. 3-12-98 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE W. H. Eshbaugh Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 805 W. Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE COMPANY A IISF G INSURED" U 0! - COMPANY B Peter Appleton dba °°M Appleton Construction `PANY 37 Baird Way COMPANY Centerville, MA 02632 D J.kJ .. :..........n... .v by,xt,:::•v; ,t:].:v::v::vv:kv•�;:J}:IX;rv:v?i:i:: ::F+::i::i>{4 ..n»x..,. {...]}..rr. ............. ........ .. ..v........»r.n:. ,,..n..............:].:::•:ntv::::r.�:'v�]]]];;;•:•aa;i.:{ #3 . h 1= .. . . .. . .............. ..... ....... .........Jo-....:................. ...�.......� ..M...... v.v.........:J.J+. .. ......... ... .... ...... ..h,,... ......... ...... nY:{n:{{Jr:{{rr}r}:ii>i]]]::::vr{n:nir:{{v.. :n.. r..,.vn.. ....J.u..:.r.nvr�n.......:...::•::::::::;.]..9..:.......]...n....vt............. i:vJ,;i$i;J...............:::::::::.....:...::.::::.v:::::nv:n.:n....:u::v.:.:..t..:J.,.::::}.:2vv,,.:.,.;a•::.\,::..J..:•:.t..t:: ..<.......ttt.:..:.:.:............:a\t.a....vlv,�..........:14:.......w..n\»u.......n....J.:v.::...:::::v:.::W..::.::n,v:::nvn:ap:.{:pvtta::v::n„Y.:::::::�:::::rrr:.:.nvw:::::n.:::.v::}:an]::{Y..rri::::.:::'::'::`:{ 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. CO TYPE OF INSURANCE • POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DDNY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE s2,000,000 A-T COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $2 000 000 CLAIMSMADE1XI OCCUR BFS00000050097 5-7-97 5-7-98 PERSONAL&ADV INJURY $1 000 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1 000 000 FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ 10,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) 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 WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE-POLICY LIMIT $ OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS :.CERT'fFICkT.. ..HOE.#�Ir�..,.:•,........ ,.,........................,,.,..,...............:..:.... .....,...............:......r..,..t...,..........................:r..... ...........:......: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Barnstable EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Building Dept. _?0___DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 367 Main St. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Hyannis, MA 02601 of ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 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