HomeMy WebLinkAbout0171 CAP'N CROSBY ROAD 1;71
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Application #Map- Parcel
Health Division Date Issued 210' 66d
Conservation Division Application Fee
77
-
Planning Dept. r Permit Fee, 7Z •
Date Definitive Plan'Approved by Planning Board UK
0
Historic - OKH Preservation Hyannis
Project StreetAddress 171
Village
Owner Ad d$ ress 1 171 jog/
Telephone
Permit Request rema;-c ZZ2�olle
0 LV
Square feet: 1 st floor: existing Z2&proposed /7_;&/,L,, 2nd floor: 'existing prop osed Total new Pm
*—
Zoning District C Flood Plain 2v. Groundwater Overlay �W
Project Valuation Construction Type
Lot Size Grandfather'ed: LJ Yes` U No If yes, attach supporting documentation.
Dwelling Type: Single Family, )9 Two Family Q Multi-Family(# units)
Age of Existing Structure 197? Historic House: LJ Yes )(No On Old King's Highway: LJ Yes 2(No
Basement Type: LJ Full U Crawl XWalkout LJ Other
Basement Finished Area(sq.ft.) 274ye Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing .anew —1
C)
Total Room Count (not including baths): existing 7 new a First Floor R 0 rn Count- Z-;
Heat Type and Fuel: U Gas XOil U Electric LJ Other
Central Air: Q Yes )4 No Fireplaces: Existing
New 0 Existing wood/boal stove: Q Yes XNo
Detached garage: LJ existing L) new size—Pool: LJ existing U new size Barn: L3 existing g ne\V,size—
Attached garage:,wexisting 0 new size —Shed: U existing U new size Other:
Zoning Board of Appeals Authorization Ell Appeal # Recorded U
Commercial LJ Yes No if yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER),
Name 4C Telephone Number 42 e-eg 2&
Address 9,?7w A,, License # C44, alzdY-4
W6 53, Home Improvement Contractor# I-M737e
Worker's Compensation # .411W
ALL CONSTRUCT ON IS RESULTING FROM THIS PROJECT WILL BE TAKEN TOR,2�?
SIGNATURE DATE
FOR OFFICIAL USE ONLY - - Use
APPLICATION#
DATE ISSUED
MAP/PARCEL N0.
ADDRESS 'VILLAGE
DATE 6F INSPECTION:
FOUNDATION -
FRAME �,h�, c
A _
ant
INSULATION ��'���"A
FIREPLACE
' / y�.ti• � �f'i A '
ELECTRICAL: ROUGH FINAL ,.
PLUMBING: ROUGH FINAL
' GAS: ROUGH FINAL
FINAL BUILDING 11112,1!6 I
r 1
DATE CLOSED OUT
ASSOCIATION PLAN NO.
l a
The Cornmonivealth of Nlassachirsetts
Department of Industrial Accidents.
Office of Investigations
dOO Washington Street.
t r Boston, MA 02
111
}vfvivr mass.gov/dia: • '
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le i blY
Name (Business/Organizati on/Ind ividual): 4
1
Address: .,
City/State/Zip: �� 0 Ll.� A. O Phone
Are you an employer? Check the appropriate box: Type of project(required):
contractor and I
4.:. I am,a gene
ral on
1.❑ I am a employer with 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2. I arn.a sole proprietor or partner-,
listed on•the attached sheet. 7; ❑ Remodeling
s ip and have no employees These sub-contractors have g, ❑ Demolition
Working for me in any capacity. employees and have workers' 9 .❑ Building addition
[No workers' comp. insurance - comp.insurance,t F -
5. ❑ We are .❑a corporation and its 10 Electrical repairs or add]tic
required.]
3.El I am a homeowner doing all work; officers have exercised their 11_❑ Plumbing repairs or additic
right of exemption per MGL
myself. (No workers comp: 12,❑Roof repairs
insurance required.]f c. 152,§1(4),and we have no „
employees. [No workers' 13 ❑ Other
comp-insurance required.]
*Any applicant that checks box#I 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.
tcontractors 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 thepolicy andjob site
information. a:
Insurance Company,Name:
Policy# or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip: '
Attach a copy of the worke'r-s'compensation policy declaration page (showing the policy number and expiration date)
Failure to secure coverage as required under Section 25A of MGL c.i152 can lead to the imposition of criminal penalties of
fine;up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK.ORDER and a f
of up to$250.0 a d the ay against violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigation the DIA for insurance coverage verification.
I do hereby ce i e sand pen ties ojperjury that the;information provided ab a is rite and correct.
Si ature: AA Date: [
-.i
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);
11 Board of health 2.Building Department 3. City/Town Clerk 4, Electrical Inspector. S. Plumbing Inspector
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)siates"'Neither the'conunonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublicwork 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 tha
t the affidavit is comp and d 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. In 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
citizen is obtaining a license or permit not related to any business or commercial venture
year. Where a home owner or city g
(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
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
www.mass.gov/dia
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fypef'-s P7-iaa e-Gorpocation
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GE2YPHON.BUILDERS° W.—
STEPHEN BRITTON,� {rp
500 MAPLE STREET ..'
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LE rtMA WEST BARNSTAS , zOZ668 Undersecrefary
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IKEY `Fawn of Barnstahle
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Regulatory Services
BA-RNsV.LE�$ Thomas F Geiler,Director
Building bivision.
Tora Perry, Building Commissioner.
200 Main Strcct, Hyannis,MA.02601
www.town.barnstable.ma.us
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Office: 508-862-4038 Fax: 508-79[
Property Owner Must
Complete and Sign This Section
if USiny A.Builder
as-Owner of the subject.property
herebyauthorize to act on my behalf,
is all matters relative to work authotiwd. by this building permit application for.
(MCIMSS of Jo
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signature.of Owner Date
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Print Name
If Pro ems Owner is,applying for permit please complete the
'.A; Homeowners,License Exemption Form on.the reverse side.
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508-428•BB28,
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�.O A� SCALE:��'r.�.J l';o APPROVED BY: DRAWN BVA I�Gky
DATE: MaR ZOIO REVISED
a r'•.;801960 ayQ'i
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a. DE��� K.:IfiCkI�N. "(zEMopE1L Cj- VAI ioF 15
O iW+TS SIWKB4$E DW$PAGE 7RAS1'� Lk--f.SU.SA" _ _ DRAWING NUMBE�
171 cAp� . cVa5BY RV, M �zvi_ . .MA,_
Assesspr�s map;and .lot number .. .../. ..:�..�%. ..�:./�. `
C%TH E t0
Sewage Permit number '.. . .....:.. 6.. .:.......
Z EAHHSTAXLE. i
j 7 - M1186
� House number ............/...:.......:.........:.......:..................:...._..... 90
t p t63q. \�00
. TOWN F B WN A R-
TAB l�� LE
BUILDING "' 'INSPECTOR
APPLICATION FOR PERMIT TO ....... ....... ..r......................................................
9
TYPE OF-CONSTRUCTION :......wR.Q .:.. �r9 ''`f...........:.............................................................................
......�2s�........................19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .......... �........... ? '`'....... rrys bx.....� C�v>E'�tii.� lP. :........................
ProposedUse ...... ......................... ...............................................
Zoning District......... . .................. ..Fire District 6�-tiT...:.....a,2:e' .....................
Name of Owner . .!9.1/.s..�7....... ........................Address .... ........�:''�".'..... iE'c%
Nameof Builder' ...........:..................................:.....................Address ....................................................................................
Nameof Architect ..................................................................Address ..........::........................................................................ '
Number of Rooms ......0 .................................................Foundation .....f 40. ................................................
.::...
Exterior ....OG 9P. ..e'.................................Roofing ..: ...... 54i•!'rQ s .....................
Floors .....C'. .o.e-.7..........................................................Interior ....�lYo"
......................................................................
Heating' 'T.. c..................:. ............Plumbing .....77.............. .........................................
Fireplace .........::.....................................................:.................Approximate Cost ... . .......:.......................:.... ...........
Definitive Plan.Approved by Planning Board -------------------_------------19________. Area ........1.4. ................
Diagram of Lot and Building with Dimensions
9 9 Fee ................. ...........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
tax i6 -
Sv,��e ooM
4 �
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations�of the Town of Barnstable regarding the above
construction.
Name `` 5...... .........................
SAURO, DAVID
r =
'i " 24235 ADDITION
k No] ................. Permit for ................:...................
Single Family Dwelling
Tn.............17I4.�n...Crosby..•...Ra.:. � •• � • .
Location '...,.... .... n.................. ..........
Centerville '
i ........................................................ ................. 1
Owner David Sauro
.........................................I.................... `
Type of Construction
Frame
.............................................. .............................. .
Plot . ......... ......... Lot. ................ ........
t Permit Granted- ..... .Li Y... ................19 82 , .
r Date of Inspection ...,/. 19
1 y
Date Completed ......
� 1 1
i
I/
A sessq map and lot number
THE l�
Sewage Permit number .. ...........
......
Z 33ARNSTAFILE, i
House number ......�.?Z... ................................................... r rasa
�p 039. 9�
oil
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...........:5�'."��e0.�� e2 q�,............................... .....................................................................
TYPE OF CONSTRUCTION .......��� ...............................................................
.:....s a.........................19.�T`�a?.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ........ `.?.t............ `!`'.":......... "r``i.` '. !...... ................ ...;.. F?.. .. ...... °:r>r.`.............................
ProposedUse ..........:�7 ...:.........'.....................................................................................................................I.........................
Zoning District " .... "-
. f�................... Fire District �.�:.:..:...........?.. ..........................................
Name of Owner Address ...Z. / " � _ .. /-'e./ %. T
. ........................................... .. ................ • ...
Nameof Builder' ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ......4?�v..................................................Foundation ....c��o r Ac.......................................................
Exterior C�o �)�...... `��?: -Q.lp.��.................................Roofing ../�.S%; `1�..�......`"l%`.:. .5 ........
h..
Floors .....(? ......G'.' .Interior ... % !"Y. `'.'`'. .. ......................................................
.....Plumbin Heating :... ................................ .............................. g ..................................................................................
Fireplace .....................................................Approximate Cost .. ..(0o .....................................:.
Definitive Plan Approved by Planning Board -----------____---------------19--------. Area ............ .. .. ..................
,....
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
F•
r��
."�
f/a C), C-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name......a..`....`.`...... .-:G'
SAURO, DAVID / 9�_ /I�? A=193-167
24235
ADDITION
No ................. Permit for ....................................
i. Single Family
g y Dwelling........
..................... .... .......
Location 17..,,,Ga,,,,,, n,,,,,,,, Crosby...Rd
............ .
Centerville
...............................................................................
David Sauro
4
Owner ..................................................................
i
Type of Construction ....Frame
..............................
a '
................................................................................
Plot ............................ Lot ................................
July 22,
Permit Granted ........................................19 8 2
Date of Inspection ....................................19
Date Completed ......................................19
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TOWN OF BARNSTABLE Permit No. ?OOY,..
Building Inspector
I saaBx►a Cash _—_--
/YL
°VIN OCCUPANCY PERMIT Bond ----___
"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 uf'2olk Realty Iru5L Address Box 308, Centerville
'1 'a t. Crosby Road, Centerville
Wiring Inspector /- Inspection date
Plumbing Inspector
Inspection date
7
Gas Inspector + Inspection date
Engineering Department , r- a!�/ 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.
.....................................................1 19......__ ............................................._...................._.� ....:__:_:......_.... ._.._._._
Building Inspector
Assesso€'s_map, and lot number
SEPTIC SYSTEM MUST BE ,
INSTALLED IN COMPLIANCE,
Sewage Permit number ............... ' WITH, ARTICLE li STATE
r�r �.g ............. SANITAW CODE AND TOWN
1 'THE
�aF,T-:.�„r,
` TOWN OF ' BARN,,,ST' BLE
HAHBSTADLE,
o ayr �� 1 B.UILD,ING�f:. INSPECTOR.
r
e" (J.
APPLICATION FOR PERMIT TO ...............................................
TYPE OF CONSTRUCTION ...... ......................................................./
........ ..:./.. ..........................19XV.._
TO THE INSPECTOR OF BUILDINGS: -
The undersigned hereby applies for a permit according to the following information:
Locationr..............
ProposedUse ..... eso). I V-}L.........................................................................................................................................
Zoning District .....................................................:..................Fire District L l�21z. !�<�f: ..:�r�4r%% l/ll .................
Name of Owner ..'So..f. . 1..CI �.,.US.L.............Address 0�1�............................
Name of Builder U. t�.//\./.�Ffl.1/.� �/�uI(.............Address
Nameof Architect ..................................................................Address ..................nn.................................................................
Number of Rooms ... ,PQ.n?....................................Foundation .. •...t ...:............................................................
Exterior :_ ../ .... cN!`' .....................................Roofing 4S'Jlrtu.l. .....:.............................
Floors .,� z'�/�1 .............................Interior T.11W.l.els...................
Heating .... �- �etl6F -e v ................ umng .....�.� �
.............Ct .......... Plumbing ....... ..................................................................
Fireplace ..................................................................................Approximate Cost,�a'1.Q.0.q..............................
Definitive Plan Approved by Planning Board --------------------_-----------19________. Area ... (�t.�.
Diagram of Lot and Building with Dimensions Fee ....
SUBJECT TO APPROVAL OF BOARD OF HEALTH �®(a
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1 �• 1z ayXYG = 46
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2098
I hereby agree to conform to,all the Rules and Regulations of the,Town of Barnstable regarding the above
construction.
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Suffolk Realty Trust
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PERMIT REFUSED
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Assessor's map and lot number ........................................... l/
Sewage Permit number ..........................................................
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TOWN OF BARNSTABLE
BARNS ADLE, i
° oY7� BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......:S,-Y ..:54V!A...b.z4l/�:11rV ..............................................
TYPE OF CONSTRUCTION ... ....... ......... ......... ....................� ......... ...........r�................................................
c -1..............................19? ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .�......'....... �{ --�'` �a , +(SS�aro +''nd„1! '7 i`r i ��i/ 1�:�':!r r...5.' .t a!{//.;��:.............
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ProposedUse .....F,..G...c,...V}.✓: ..../...........................................................................................................................................
Zoning District ....................................................................... ....�:..........................f ......................................
.Fire Districtp:>. �
Name of Owner ..C'...� t !� = l/�, c r /..............:........... :................Address
......... .....
Name of Builder f� �:. ?. :.".... ":.�'�.............Address �:���: .r k 5��4 :vUl ere ul.r:�................:........
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Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ...................................Foundation ..10:...r�..:................................................
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Exterior .....v. rA l- : ' ........Roofing ....> i:r.�°. ....................................
.................................... .... ... ...
Floors
' .Interior �'�.... ..rr.�
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Heating
....Plumbin ... r'
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Fireplace ............Approximate Cost
Definitive Plan Approved by Planning Board -----------------------_---------19________. Area � 1" r
Diagram of Lot and Building with Dimensions Fee . ,
SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 s G
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. c� -
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Location ....... .. ^_CrzQnbn..ROad..
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� Type of Construction ........±zrams.....................
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PERMIT4 .
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