The URL can be used to link to this page

Home My WebLink About0022 BUTLER AVENUE y.� �� - " i A - �oF� ro,,ti Town of Barnstable *Permit# 2 5 Expires 6 months from issue date '+ BARNSTABLB, = Regulatory Services Fee i - ` v� MASS. Thomas F.Geiler,Director pIFD"A0` Building Division Tom Perry, Building Commissioner ® 200 Main Street, Hyannis,MA 02601 SS 3 �4, Office: 508-862-4038A ;. mZJ05 Fax: 508-790-6230 717 EXPRESS PERMIT APPLICATION - RESIDENTIec: `-,a_. Not'Valid without Red X-Press Imprint Map/parcel Number 12-aa/QIL Property Address p�-vZ 1 l�w�� TT ❑Residential Value of Work Owner's Name&Address O vet&5 G 2 - Contractor's Name CD l�z tJ�l'N 5�y t✓CZ-'��' Telephone Number Home Improvement Contractor License#(if applicable) 164o I y/ Construction Supervisor's License#(if applicable) 01/ I 191-y [(Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name �� C Workman's Comp.Policy# 5—cb 31I S CS1 a. oo QL Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value (maximum.44) C 1 ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope wner must sign Property Owner Letter of Permission. Signaturelow �Q:Forms:eWmtrg -_ Board of Building Regulations and Standards License or registration valid for individul use only ' HOME IMPROVEMENT CONTRACTOR., before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 106141 One Ashburton Place Rm 1301 Expiration: 7/22/2006lug Boston,Ma.02108 Type: Private Corporation x STEVEN J.BISHOPRIC INC. T Steven Bishopric 1112 MAIN ST UNIT 18 , - ,rw✓ c OSTERVILLE,MA 02655 Administrator Not val' ithout sig ature` - s BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR ' Number: CS O47928 �. l I Birthdats 09/29/1948 j Eicplfes 09/29/2005 Tr.no: 2537 I F i Restricted 00" 1, f STEVEN J BISHOPRIC PO BOX 656 � MARSTONS MILLS, MA 02648 Administrator e _.- The Commonwealth of Massachusetts _ter.: - Department of Industrial Accidents OIflCe 0/IOresmost/0OS 600 Washington Street Boston,Mass. :02111 Workers' Compensation Insurance Affidavit name: 5iay-Aa location L City nS 4F Z,v �F— Wt rJQL phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole p netor and have no one workin m' ca icily an employer rovidin workers' compensation for my employees working.on this job.::::.•:,.::.>:?;..:::t}::::::t MMI, :;::;;.;:;::;:; I am ...P..............g.:::. . .:::::.. •}:.::.;..;.:::.;'.;::.}:;.:::.::.:.::::'.:t.:.:..t:: ;..:.;::.:;.::.;..... .. . . :: : . ... ......:.�::.:.:.S>;t; :3s:;;;:•+ }: : > :<;::;:;xh: :'`•i:> iiS : `?`i >tr:? 'l `CC.+ COniQ V 't 's''r?!►� } :: Y �s�f ? 2`::;:::;;:: > :::5:%%<: :`•?3 ::;: :::::: ::.. .: ....:...Y•S;>r.is{x;:;::;;;:;_ r;t.; ;:::'.:. >: ss � L�gcldre # T.. T .t tY'-�•� � Q h on �. irisiiratr ❑ I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have workers' co ensation polices: thefo o mP P ...................:...:.:::::...................,:.::..................::.:::::::::::::.::::::::::::::::.:::::. :.::.::::::{;.:.;::::::.};:.>};>:.:}:::»::>::>}}}t.;}:::>::>:::>:.;:. ............. :.:.:::.......:..:..... :.......:....r........................................................... ?i�:iiii}:�i$it i:ii" n;:;:':::i!?+i2�:?•Y:C?;t:�'i:>i:i'%; ii?:±:i:�i Yiiiii>Y�j:fS`i'y'::.{:;i:;:j:%iyi:{}vj?:;ii:�::i:;i::;ii}iiy::}:!?i�r•}:•:t?•}:•}:j4::v:;:.:y}::5:•Y::::;::.v.y•�:•. �••Ti:.'•l?ii':$: ri$:,vii:Isis+iii':�ii:::•-ii:i:':S}r:-i}i%iii'ri4iii:;i{i�iii:j:i:?i:}?iii ii: iii�::i J:i::i::j :i::+::j: iii:ii?�iii::i:.:rill::;:;:i:::v::isvjji::i+?$ii::: :ii::::r;:v:ti :isi::::tji:�;:•::{•:{•}}:'L:•}}i}:}: ........ .............. ............ ........... .........,..::.::�......:::::::::........... r.;:,.;.,•{.,•::::.,;{<r.{•Y•}:::::.:::::: rc. Sir; ..•:.t�::::•:::.� ::...... ...........::..,:•::r:.,....;:•t:R'•.r:::•::t?:i;:::}:::}}:?.}>:............r....,:......... ..::::..:,..t�r:;..:;:.�.:!.:::::...;.::. .. ..,............ .:..:•.�::::::.�• ........t...... ...................r. .. ...........:::::...........................:::.v................•:•:•w:.yv. ...::.....:..:......:.............. ...... ......::.::::.:::::::::................�:..::.:: hone. ,:::<::::..............!. :.:........:.:.::::::.::::::.:.:.........:....................... .........................................................,.........................................t.........::................vn......•. .,.t...r.:::::•.J':::::{••:r .................. .............:.. \........t.r...... ... .... .. x A.;J;.}•:•.v:.....i!:}}:v}v:::::;r}. }..:.:.... \l..\�::: Yi:�: ......... ... ....................... .....t.......,. ..........n. ....::v.v::::::n......L...v.,.......ri.v:::v:.v:•:::.:tv:v::::n:.............. V. ..........r .......... .........................r•.v....................................... .:}..... K{4:•;{::!:•:,:^Xx{.::::.::•:}:•:^.:.::.i•'v:v:n},t:..v Yr:: ....r.......... .. ...�....... ................. ................ n .,..4........... ::.v:::::' •...v:fi::w::.rt4:•i:•}::4}}!$:.i�y}:{i�i::jy;:t;:{:`v>:v:::{}}S.,v .n: .:•::::................vet.....,.n•<>.Y:..n.....,....::::........!........r.:..•v• ......L... ..{..:f:}.v.:.n.........n.:::::•.v:, .............. ..:::?.:.......................::e•:J ....:r..rt... .::x:•:•::.,..r........,..::•:J...........:...........�::.t•.:.............. - :.#::•:>:;;r,':•.;;::;::?:t:.:!?:,;:t<�•{•>}:•:t.:.::t:.;t.:,.::::.:::+•::.�::,.,:..: ....... v..... .n... ,...................,......::.:tv...r.n.............................:.v::::::::•:::w::::::::::::::::::::.v::.v,...•...........v.....•;v.•..y.,.;.y ......:.:w.v:w:::::::::.v;:{?{9:{•'r.•}i:•}}}:i.}}:•}:•:}}}'•{:}....}:..�;.X i;.}:•}::{} •YY}%:}i:':$;:}}j:•:4ii:{vi:{{•:•Yi?:•is•}:n•:y};::}:{{.y;:;i:•}:::?;.•;_::{};•?;:{t{•}}':tv.:ii:}:v:;:•:,tit<?{tom:•}::::..........:...... :. ........................................................:::lY}/:}:4:4}ii}r}:•}}i}:�}}:�}}Y}}}X�Y}ii}}}:�:•}:•iY}Y:}•:{:J}:i :�i}:}}:y... XXX ........... .. ................ ....................... .....n.............:•:::::::::::::vev:::.••::::::e•..v:ew::::::::::::::::::::n::..;{:p:}•::?:}::•:i•}:•}:•b••:t•:t'it\Y.vt`:•:}:•;;:�:::?:' :Si3:•ii:•i:�iiY:tiii:�:::i�:f:4}:•ii•:};:j•:iik t::'•}}i}•.}}:{{•}}:�i:!•;�'•i;:::.}}iv:;::{:{.}}•{4v{:::::�:::.:...........,.. a{�ll�p .......................::::.�:.v.�::::..................v::::.v.v.;v ii:�i+v i:i�iti h'r:>.�i}iF�i ............. i:=.:t::;isfir•iii?;}:}............................... ..:•.::::::::::...........::v:::.... ...:....:.....::.v.:::v.v:..............:.::... ........::::•}::•:::.v.::::::.:::e;..:.:t:::::... M ..:............................. :..{...............r..... ..:•:::::•::•:::.v:•.. ...n.;.v•.L�e•.vey...........nt.....•}:^;v.^..{.r....................... t........ ,..n......v........... ........v.;.... .... ...ty..t..........r..........:..:::::::e.::e•:.::::::•:. ::..::.:.:::.::•::.:::;:ti•}:.:::t.}:;?':> OIL <:;:,;; }:.:t•}:u•::;;;;:;::•;:d: <:}}:•:;;:;•;:;<o;};::::... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sae up to$I,S00.00 and/or one years'imprisonment as wren as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under th penalties of pedury that the information provided above is true.and cored Sigpature Date — - Phane# 70F —-114vQ official we only do not write in this area to be completed by city or town official city or town: permit/license ]00i : g Dept n;Board ❑checkif immediate response is required De a rtm n []HealthDepartment contact person. phone 0; Omviud 9/95 PJA) Town. of Barnstable P Regulatory Services SAMSTABLE, =MAC Thomas F. Geller,Director v 1639.� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A: Builder I, T h');,,� � �{z��,v�_ , as Owner of the subject property herebyauthorize 5}-zus4,\ 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 _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION w Map Parcel Ko Permit# Health Division''21 _?—I eZZ' Date Issued " Conservation Division 00 Fee 2— 07 S a I#eotc* SEPTIC SYSTEM MUST Be C Treasurer INSTALLED IN COMPLIANCE WITH TITLE 6 Pla�mtrrg Kept: E114�'a �E �g9: � a e ej5lan Approved by Planning Board - Historic-OKH Preservation/Hyannis Project Street AddressZ7,('bjT-UZ_ PAW- Village Ce K4-`r`i 1 P Owner �tQ ices r� Address nnAoLQld ✓�V'� Dt I cm 61d Telephone 0 1)- U �o -25 Permit Requesal ,�43n4_� t M I)e ►c mew I (_kc-)c 2 S 1CRS n,0 Square feet: 1 st floor:existing proposed — 2nd floor: existing — proposed -- Total new G Estimated Project Cost�3,noc] Zoning District C- Flood Plain tit A-- Groundwater Overlay b 1� Construction Type Lot Size hi/A- Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure "'70' Historic House: ❑Yes VNo On Old King's Highway: ❑Yes )�o 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 j Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric . ❑Other LV0/V Central Air: ❑Yes pl�b Fireplaces: Existing 1 New — Existing wood/coal stove: ❑Yes ❑No Detached garage:Cl 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 Cl Yes No If yes,site plan review# Current Use Proposed Use f BUILDER INFORMATION Name CSL '1�)EULt ci)w,enr (::� ICE&q Ly&cj} Telephone Number G0-,5ffRSo(40 Address License# G-XgS`N Home Improvement Contractor# 2-�4 1�65�o IN1 i C176fv Y�4 .I Worker's Compensation##((w—2 3�S�C�F�cR�7 o'LQ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO cXft.N LGvN()r-A SIGNATURE DATE FOR OFFICIAL USE ONLY , PERMIT NO. — - DATE ISSUED - - MAP/PARCEL NO. �{ ADDRESS + VILLAGE; ' 'x OWNER DATE OF INSPECTION: ° FOUNDATION Y J. FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL _ '- PLUMBING: ROUGH FINAL Fes" � _ GAS: ROUGH' ' FINAL ' r z FINAL BUILDING DATE CLOSED OUT ''` ASSOCIATION PLAN NO. - <.�-` {-- - The Commonwealth of Massachusetts n� ........r _ • - Department of Industrial Accidents . -- < . 600 Washington Street I __ _ ; . . ..1 • Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit //jj�jj��jjjjj�j////,jjjj/ name: C S(Z>L�S C C yw-nln C 0 location: ZZ 1J11A,l - 1V-9— . city ("?fig U I 0 , -e Q c- phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one kin in ca achy . %////////�////////�/%//��%%%%%%/%%%%%/��%%%/%%//%/%%/%%%//O/%%%%%%%%%%%%%%%%/��%%%%��%%%%�%%%%%%%%%%%%%//�///%%////%/ ❑ I am an employer providing workers' compensation for my employees working on this job. ...::. _ ......:. . . ... .... >:.;:::;:;::;:..:::::: .:: :,. -- `: . :... ..; sompanv name.: . ..,,.. address; ...:: :::>: »: : >:::'s:::.:::; ;:: c .:;::.;:.:..... .I..... ..... itv. . phone#. :. .....-. :::,::.: surance co: .': // am a sole proprieto general contractor, o omeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: company name.; _. �. , ::: , �,r� .::....:..:... rr^^�, ::"...... .. address::: �L'L]..: .: ,..: .:::;:::;::.:.::::::::::::::......:: .......... x� city V �f.A � tihone# ��:: � :;:,;;>;::.....:......:...... .; ;::::.;.::::::.:::. .:.:::::.::::.. ..:.:..::: ........::.....::......:::::: ..:::::::.:.:::::::::::::.::::.:::::.::::::::::.: insnran .. _. . _.... .. .. . oiicv#:.-,. .... < . . ,� a;;:.; ca any n me€: >:::.:_>:::>::::::...... <::<:::::::> mn .:.... address:< > ::::.,. .:::.. ..:.:.::::.::::.. ....... ..... . ......... ::::.:::.;:.:.:......................::::::::::.::. ..:..........:::::•::.:.;:::.:: . .::.:..::..: .. :: :::.:::::::*""*: : ::::::::::::::::::>::::.......:::;<:,:<:.: . ......::... ..:......:.::::.:::..::: ::.:..:..,::.&:::::::::::::::::.::.:::::::::...::..:. .:. :>s.::::;:z:>: ranee co :::.;:>:::;:::;:::::..:.;. ::>:>::>:'<><:::: ::' :>:>::«', .: .:. in�a ::.;:::: oli # // Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500 00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the . and penalties of perjury that the information provided above is true and coned Signature Date T/ktJCU, _ Print name Phone# 6 V)- S 9 Y,F", Q i0 official use only do not write in this area to be completed by city or town official city or town: permit/license#! ❑Buildhng Department ❑Licensing Board ❑checkif immediate response is required ❑Selectrmen's Office ❑Health Department contact person: phone N; ❑Other (revised 9/95 PIA) . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers io provide workers' compensation for their employees. As quoted from the "law", 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 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 buildings in the commonwealth for any 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 have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance 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 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 permit/license number which will be used as a reference number. The affidavits may be retuned to 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 questions. please do not hesitate to give us a call. The Department's address,,telephone and fax number: r< . The Commonwealth Of Massachusetts Department of Industrial Accidents Oftice of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 /PLOP THE TsrAo°�� The Town of Barnstable 19g Department of Health Safety and Environmental Services 9• �A s61 �� P rE Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. n cfv i Type of Work�,rx= l S opx_..n U L "AA �Cr_ Estimated Cost 7 S O� Address of Work: Owner's Name::VVW,6 4 +�-• - Date of Application: �112y�U 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. C � 12 �Stv Date Contractor Name Rezistration No. OR Date Owner's Name q:forms:Affidav } ti ESTIMATED PROJECT COST WOR&SHEET Value LIVING SPACE square feet X$551sq. foot= GARAGE (UNFINISHED) square feet X$251sq. foot PORCH square feet X$20/sq. foot_ DECK square feet X$151sq. foot= as,c)GO OTHER r S►G2 square feet X$??/sq. foot= SSG,OCQ Total Estimated Project Cost -TS,ML ,990915b i