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HomeMy WebLinkAbout0112 CAP'N JAC'S ROAD �� Ca.�O'� �c�cs �c.C, ., . ._ .� .. a .� ., a r a �, � ; �, � ; , '� .. -. _ '.. ,.. d 0 ., `. -. � ., u'. a �- n D .. . _ e .. �i .. o .. - ...� - :. ., e n ��. � a u v. e :, ._ � e - � a _ Town of Barnstable Ruilding aaivrrnePost,This Card So That rt�s Visible"From the Street Approved Plans Must be Retained on 1ob,and this Gard Must be Kept Posted Unt�leFinal Iri`spection Has Been Made a z, ° t639a`` .Where a=Certificatesof Occu anc is Requiired,such guild hill Not be Occupied until a Final`In'spection has been made e rm __ p y Permit No. B-19-554 Applicant Name: DAVID J.ANDERSON D'BA CAPE ABILITY Approvals Date Issued: 03/21/2019 Current Use: r Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 09/21/2019 Foundation: .t{tA Location: 112 CAP'N.JAC'S ROAD,CENTERVILLE Map/Lot 194-076 Zoning District: RC Sheathing: Owner on Record: GARLANq, ROBIN L Contractor Name = .DAVID J ANDERSON. Framing: 1. Contractor" License: CS 069188 Address:. 112 CAP'NJ�AC'S`RD 2 CENTERVtLLE,NIA 02632 ; Est ProJO�ct Cost: $3,147:00 Chimney: R Description:, replace existing deck 12x12 with new deck 10'xT Permit Fee: $ 145.00, replace kitchen`window in'same r.o. with anderson`window Insulation: Fee Paid $ 145.00 Replace basment slikder in same r.o. with harvey slider Final: r� Date �` 3/21/2019 Project Review Req: ENSURE PROPER SUPPORT CONNECTIONS AT HOUSE AND 'Plumbin Gas OUTSIDE BOX. g/ ' Rough Plumbing: Building Official y - Final Plumbing: -This permit shall-be deemed abandoned and invalid unless the work authorized by this permit is commenced within six rrionths afterJssuance. All work authorized by this permit shall conform to the approved appl cat -and f`he;approved construction documents'for which this permit has been granted. RoughNGas: All construction,alterations and changes of use of any building and structures`shall be in compliance with the local zoning by lawsiand codes. This permit shall be displayed in a location clearly visible from access street or:road;and shall be maintained open for public mspeption fo[the entire duration of the Final.Gas: work until the completion of the same. - Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building a`nd'Fine Officials a eprovided on this,permit. Minimum of Five Call Inspections Required for All Construction Work:jl Service: 1.Foundation or Footing e 2.Sheathin Inspection -Rough: - 3.All Fireplaces must be inspected at the throat level before firest,flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) - _ s. � _ 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). Fire Department Building plans are to be available on site .. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final- p Application Number. .. I, * BAMMABLE, • . MASS. Permit Fee.......................................other Fee........................ 163 Total Fee Paid.............. "(.. ..................... 1 a TOWN OF BARNSTABLE Permit Approval by..... . .......................on... � .l�.l....... BUILDING PERMIT Map................1...... ............Parcel.................D%o APPLICATION ` Section 1 — Owner's Information and Project Location Project Address&, 2. Village Owners Name -> Owners Legal Addresyi,�— City. z-� �rii l/ ' State Zip 1' Owners Cell E-mail J,//,�- Section 2 -Use of Structure Use Group ❑ Commercial Structure over 3§ 0 cubicet Commercial Structure under 35, 00 cubieet s ❑ Single/Two Family Dwelling w co Section 3 — Type of Permit ^' ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild - [Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑- Insulation Other—Specify Section 4 - Work Description 12 i127 'i Last updated: 11/15/2018 Application Number....................................................: „ Section 5—Detail Cost of Proposed Constructioner',` 2!�Z Z w Square Footage of Project Age of Structure Dig Safe Number �( # Of Bedrooms Existing , , Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist YWFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ,J ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom - c Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site f Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility:4fz L/,/a/ �"✓l��i� I am using a'crane ❑ Yes �"No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ll Section 8—Zoning Information Zoning District G Proposed Use Lot Area Sq. Ft. Total Frontage/2-1 S Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes F1 No Last updated: 11/152018 5 t4t t Application Number........................................... Section 9_ Construction Supervisor Name Telephone Number 2 5 Address Zf,2 r,1'21X11/7W City./,-� A,Z- State Zip License Numbext!!�f OG'a/Fe License Type Expiration Date 6; Contractors Email �� � O� �,'�/�. �.r�Cell zo, I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I,understand the construction inspection procedures,specific inspections and documentation req ed by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature , Date 2 Section 10—Home Improvement Contractor Name ���� ti �,�, Telephone Numbed; 2a2 27-21— AddressdZ� City/--,5' � State I Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re ed by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date -2, Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. u Signature Date APPLICANT SIGNATURE Signature Date _ Print Namez2u2ZL ���✓��,>� Telephone Numbers E-mail permit to: Last updated: 11/15/2018 Section 12-Department Sign-Offs Health Department Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization i as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) 4L 404, Signafore of Owner date Print Name r li -N 1 4 Last updated. 11/15/2018 Vlte COrn�anyzoazu�Ba� a��%/Lcr�i¢c�c[6n( — - --- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only :... TYPE:Individual before the expiration date. If found return to: =Reg stration Expiration Office of Consumer Affairs and Business Regulation 124091� 05/11/2019 � 10 Park Plaza-Suite 5170 F - = ��. DAVID J.ANDERSOIy' •;1=---=;r�.�; Boston,MA 02116 DB/A CAPE ARIL`IfY 'ti DAVID J.ANDERSON 13 FORT HILL RD 4.,----n Not valid without signature E.SANDW ICH,MA 02563 Undersecretary- 9 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrofl15{??NISOr .> 3 CS-069188 �: {,. ��pires:06/05/2020 DAVID J ANDERSONf 13 FORT HILUARD EAST SANDWICFJ MA 02537 4 Commissioner ------------ The Commonwealth of Massachusetts Department of IndustrialAccidents t Offke of Investigations, 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anylicant Information Please Print Legibly Name(Business/Organization/Individual): ,7i/ Address:Z5 �� �� City/State/Zip: Lllr _ l? h Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I ployees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2JA 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' Y aP n'• $ 9. 0 Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its: 101❑Electrical repairs or additions 3. I am a homeowner do all work officers have exercised their 11.ElPlumbing repairs or additions ❑ myself[No workers'comp. right of exemption per MGL 12.0 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. 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 I am an employer that is providing workers'compensation insurance for my employees Below is the poluy andjob site information. Insurance Company Name: Policy#or Self-ins. gal a Expiration Date: Job Site Address: l City/State/Zip: 1� �iJ� 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 herebyrnder the pains and penalties of perjury that the information provided above is true and correct: Signature Date: Phone#: r[ kid use only. Do not write in this area,to be completed by city or town official 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 iii 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 hin=ce 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 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 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 burn 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 Inveslagatiow 600 Washington Street Boston,MA 02111 Tel.#617-727-4400 ext 406 or 1-8 77-MASSAM Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia IiJG� FAMILY cz►NOEa. �22.� O G AQ5,,n.c c G P o Tg I ,.EPT1G TA►vK : 33oxi5o% =A9iG.t?� �� Slog Per A uSE ►000 GAL. yzo (V 70 (SAL. 5 50TTOM A2EAt . p Sit"• Q. . - �ouNb, I. So SF vE51GN : ,425 (�PD. of 4. t -roTA I.. Lovt = 330 T Y oTA�- 'PA%I- F F'ER.LOLI►TIOIJ RATE: oz H A �•. ',r t7 3 ! SN Of MAS�'�t o PI TER ftICHARD R Vo p 8 j BAXTE j!; 24048 Top FWDRnsl = A D1ST. INV. tss I'C. 3vt�So� 0�x /ZZ .fAt�K 3 1000 �Nr Mo SAS Goa-. /ZZ L6AG1t INY. INd. WIT" r vromror ,�i►uo., l!L San6 �1•� .---•�1'� CEQ.TIFIGD QLoT PLAN �vrtL PRoFiL� L.oL4"e1oN CVJTmVIL-La A-o '• /tz- p�p,N Rt✓FEQENGE. 4 WA-7m 11 'THAT 'TNE T-ov►J�AT�o►J SNoVtiIN ( A. '' NEQ.Eo N GpNIPt-Y 5 1r+t tTN-T NE S 1��>s1N Aup SE-tBAG ZR- PQ' AN'o 1S �T µE pLA�1 �02 �� AUT-AUL WILD. W4 � ToWM. OF � �� frocp.TEfl W1TN1� 'TN•E FLCOD PLAIN G BAxTEiZ:E NYE INt. • j� {SAT E� � SZEG i'S't tc�6�`t,Au O 5 v f�V�eYoiZ'S A Id AM ...--ri �••w..aT � w ee sue __��,.�. _� _ �—;.�:_.__I__._� +•�-�—w—�--•--���----�---�—.----�--�—s—, . ,--�---;:f--.--�:--�---�— I i i I t t _ ' r 717 t �table'Blct� -Dr-( • { L if p�� L b.:: 7 ate' 4 t i }.g'� • _ � P + - �'t I � ��� } �..._.. i 1 � Permit`#: -f i - it TIT # , r y � i � l I � { 1 � t i + r i � ._ «..,. � _ _ i I. __•_._ t h i - j Ir r f � , Y i :� jM9 �' "`* TOWN OF BARNSTABLE i�' S► Permit No. __r__ZLO-1!,I _____._ Building Inspector"" a Cash 'ay 'e o ,� OCCUPANCY PERMIT Bond _x L Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector 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. ................................................1 19............ .................................................................................................................. Building Inspector �f TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 SAUSTAW, = TOWN OFFICE BUILDING MUL a 91 HYANNIS, MASS. 02601 �0 MAY MEMO TO: Town Clerk FROM: Building Department DATE: June 11, 1985 An Occupancy Permit has been issued for `the building authorized by Building Permit 27018 issued to .................................... ».James »...K... ...Smith .» ». ............................................................» Please release the performance bond. t l� t I� �aPN �._IJ A WSJ , BGOQopM ` u o GaRec►GE G p 22•� i fi�-. c�Al� r-%.ow a llox 3 - B30G.P Y �EP71G TP�K = 33ox15&% = 4996Yo \�,� f��' af'}' USF I000 GAL. /4PArAl I ot5Po5At_ PIT usE 1000 6AL. Poi BoTYoM L1REAa �o fir. / I.I� a S.F x I•o � 5 o . U•P o• � "' _ a J To7At.. 1'AtLY .F'<..Owl '= 330G.PD �, .►. ." -^,,,,. '' ``� _�$ /' �%..J 6 (. E'E2GOt.L►TtON RATE: I.'IN 2MInt or,.t.e5 -y'fi:�,./� OF tH OfAsstc� <° PETER RiCkARO,, y°,r�; o Su! BAXTEIa �sQ�S78�Q. i"• �FIN r t �1 TOP FWD ( t7 IT6'�T 3Z�1 - ZY/`Y WOLF 12� -rr �`� 1 , �" Imo• /2 3 . 40A+M . loots INS• �vaSO� DIST. INJ. GAL. h2•b Box Ps�� Ssvr�c 3 1 000 INV. TANK Mm A& Gal.. /Zz g LC INV. INV. PIT Z If.Z ,L /CI B WA SNG D ,�i►uo 6Tv N t3 40AVO. CE¢TIFIGC PLoT Pi-AW PR.OFIL G LotA-T lot� i. CWTMV,� Wo SCALE SCA.LM Flo GUa7�t p A N RED 6�tEN GE .� GEQ•TtFY .THAT THfc '�"'ov►JDAT�o�1 SHOhYN LOT ( A NER60N GOMPL`t'S WlTN'THE SLfl�LI1JE A►J� 56TelA►GK RF,gvIR-�MEN`i'> oF 'TNE yl 'TovVN. OF N`YT"P131.a3 ANC IS I�OT pLAI, �2 IG n • t,� ITN1N TN6 �LooD PL&IW A�UL WW XMS II� '&; Locp.TED W I� DATE G 1�c�G -- BAxTE�L� IJYE INC. j j R.EG I S't 6.rt6V 4Au Sv zv irroe'S Tuls PLc�N 1'S NoTlw E'snSc3n oa AtJ c�sT'E2.vILL� 5• NoT P�F uSEDTO 0e-Te?-/I\1 t. o�' I-1NE�j aPPL1GA►-�"r Jl`,Vb1$j K.� `'7M , .sessor s map�-and lot number, ... .. Cal 'I AV Sewage Permit-'number ......: ...D...1 WW 1....,.. .... �4 BA E House number: .... .: .....11�..'7�4 ........ ................ 'I: IIc SYS A too 'B rb a I IN COMPLI Aj�0 YPY a` TOWN OF BARNS,T "7111 BUILDING . . INSPECTOR APPLICATION FOR.PERMIT TO> Construct Dwelling TYPE OF CONSTRUCTION .............. Wood Frame ............................. September 14, 9 84 ................................................1 ........ TO THE INSPECTOR OF. ,BUILDINGS: . a lies for a permit according,to the.following information: The undersigned hereb g 9 9 y PP P . Location ......Igo.t J.A...Cag...u..hlj.ah..s...Rd....Centelx:yi..11e........................................................... ..:...... ::.:..... Proposed Use ..:..Siagle..k:amily..................................................... Zoning District ...lies.iidenti.al.............................................Fire District .....,Cepitexville=Qs.texuill•e.......:..........:.....". Name of Owner .,Fames..K....Smith...................... ..Address' Barns.table................ ....„ . ..... Name. of Builder James..K....Smi.th:..... .............................Address ...........Barns.table.................................................... Nameof Architect .:........................:..........................::....:.....:Address ......................... :...:...::................... five poured concrete Number of Rooms .... ... ....................................•...... Foundation Exterior •clapboard &` w.c.s: ...................Roofing asphalt shingles.:.......... Floors hardwood dr all ............................................................Interior ................'t"'....:......:.:.:...................................... ......... Heatinggas warm air .....,.Plumbing ........ 2 baths....... ....... ..... Fireplace ..............:....one............ :.........................................Approximate. Cost ....$5.,:Q.�Q........ .... ........ . ..................... . Definitive Plan Approved by Planning Board ______________---------- ________. Area ....•.... ....... Diagram of Lot and Building with Dimensions - Fee q SUBJECT TO APPROVAL OF BOARD OF HEALTH OA,JO, 14�. garage 28x50 3 w - 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 ....�...r A.. . ... . . .... Construction Su ervisor's`License P .. 5190 _4 , 1�LTTH, JAMES K. No Permit for One Story....:.. e Sin le Pamil Dwellin `T `.. ...............I .�A. .r9,� 1S. 4 Location Iet..A't.. .�- :' aci - Centerville. _ } .......... .................. Owner...James..K;...Sh??aY?...... :.......... Type of Construction' ......F't ............... ..:.... .; .-_. .................................. 1 t Plot. ............................ Lot ................................ ; September 26,. 84 r Permit Granted .............................. .......19 "Date of Inspection ....................................19 ; Date Completed ..... .....-19�� , r _ 2.G 9 .. Go Assessor's=ma:pyand lot number .. ... THE �. u..................... .. Q�oF toy r - Sewage Permit number .........:........ I..`. ,........................ BABHSTABLE, i House number`'':,. .'.......T7 ...;T .J........1. .............. ro roes `. t p,e�i6}9. \00 a� Or' r TOWN : OFr � BARNSTABLE BUILDING INSPECTOR Construct Dwelling APPLICATIONFOR PERMIT TO ............................................................................................................................. Wood Frame 'TYPE OF CONSTRUCTION ..................................................................................................................................... September 14 84 ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......ThOt:..;1A XAP..'n...Trt i ah 1.G,R4m,...centex:ya.Ile.. ...................................................... ................:.................. ProposedUse .....5 ........................................................................................................................................... Zoning District ...R;0,S10.C-, tna.I.............................................Fire District ...... ........................ Name of Owner .. aMP-6.. ......................................Address ...........B. r*?s.table.................................................... Name of Builder ?amen..K.,,...aml th......................................Address ...........Bar*+s.teble.................................................... Nameof Architect....................................................................Address .................................................................................... five poured concrete Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ........ coapboard & w.c.s.........................Roofing asphalt shingles...................................... Floors hardwood dr ..............................................................Interior ...................wail Heatinggas warm air....................................Plumbing 2 baths ...................... ......................................................................... Fireplace one .........................................Approximate. Cost 55 000 Definitive Plan Approved by Planning Board ---------------_-_____ / � - -------�9--------. Area ......... .... .. ........................ Diagram of Lot and Building with Dimensions Fee (� SUBJECT TO APPROVAL OF BOARD OF HEALTH 14x* garage 28x50 � l 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. 3 Name .... . .......... •, # 5190 Construction Supervisor's License .................................... SMITH, JAMES. K. A=194-25' a76 No 27018...... Permit for ..9ne Story..... ........ ' .......... tnilY....Dwell'ng....... ... ... .�... 4- s Road . Location ..Ia4 .. �.....4+ ��.... .... .T.. .. ........... .................renw '..vine................ ...... ............. James K. Smith _ Owner ................................................ . .............. Type of Construction ....FXaIM.......................... ; ................................................................................ Plot'............................ Lot ................................ - Permit Granted ...September 26' 19 84> a Date of Inspection ....................................19 • f Date Completed .:....................................19 t :;1'iJ�G�.C-. FAM11_Y - � BDUQnplvt �/���I�1 •_IJAI-�`> ICE FLow .: Ilo x 3 = 7301G.P0 5EPTIG TASK = a3ox15 /. - U5� l000 GAL. ; ;3!'f � AAAA ,Ec i i too 0 GAL. f�/�1►,., DI'5POSAL PIT V5E �y.,�� � j...,. / I>>G ' ROO 5%DCh/ALL T 15o 5.r-. x BOTTOM ASZEAt �0 5.r• ik 5O S.F• x I• o 5 0 Aov a. -IOTA 1- �ES1GN : .42�1 G.P. D. -TOTAL. DAtt-N' P -OVA( = 3306.PP _ f'E2COLAT10�! RATE I��IN VAIN OI`LE5 r:. n Uf M-4 �� T _ -- V et F?4CHARh i .AX T ER j Off P- , Pk-i 2404�+ Vr p- Al1► 3 it p.o C.D.. l p1\l:...__.._....,.. .. .. .......,.. SvQ50 E- �J. M ST. I Nd. 0 o%-. _.- 5 /�2+G �6PTiG 3 1 ovo 1NV, TAMK MaV Sa,� Gam. /Zz LC.Acl1 5 PIT INV. INV. µ/ITIJ /IZ•Z /Z2•� V.1A MSID ,fPrJO _. 6Tv N i✓ . . . , .. I-. _ �Av�, � M _ _ - CE�.TI`�1[�-C 'Pl.oT , PL.A►.l 3 Wo SCALE SCALE II SAT E -� cJ p L p,ter R E F S ZE►J GE 1 G� Q'�IFY TFIAT TNE �-ovU�A-r �o�J 5No4YN � a`, I NERSO►.l GOMFL%(5 YATN-THE S 1 Ct=-L%W r LOT A►JP SETbAC, R.6QVITLEMENI"> C)T N� n -TOWN OF �2 AN rJ`�T A I'�(-t� C IS . PLAW Fo2 LOCATED WITNIQ TNE GLooD PLAIhI DIhT E G ���� -- B AXT E tZ e N`{E INC. � - - - � r`� R.EG I g'T>eQ6r'D'►•At.e�S u�V E�o�s -Tull PL&N IS KAO'T (�n��C n Z>Id AN osT�2.vILL� • Mi�S• tu5T9-UfAaWT ',V2VeY -TNE nI=FSETS 6WOUL1D 1 r/ ►.lo-T C'>F VSEDTO OE-TER-'^I►1� oT �. INE�j ADPLIGA*a'r �1� �, t,�% ILr e,j,l/1r1j�( Assessor's office (1st floor): ` // � tN E T Assessor's map and lot number ...........l.. .....,.O :�........ EPTIC ISY�0 ELM MUSS' � Q°f °�♦ Board of Health (3rd floor): WSTALLED iN C®MPLIA� Sewage Permit number .:......_. WITH V ITLE 5 1 BasasTAnLE. ...................................... EAgineering Department (3rd floor): ENVIRONMED17AL CO SE d.'00 ,639 e� ` use number .............................................................. ...:.... n (" . ?a r+ I r� Al a r' ( - e 0 MP APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... ............. ... .. ......1- . ..........:..................................................... TYPEOF•CONSTRUCTION ................... ......................................................................... ........' G .. f.7..............low TO THE INSPECTOR OF BUILDINGS: f The undersigned hereby applies for a permit accding to the following information: 1 .. Location ..:..... ......... :...................... .. ...... .. ...... .. ............................... Go- r......Pa.r.T......................Proposed Use .................................................................................. Zoning District -" .....................................Fire District .......... � t-1- Name of Owner ... vs!it� ...................Address .�.�z.. .. ........... . .... 4'5............................ Name of Builder ....e1. .. -!( , .:..,...Address .Z ..c -(iv ` �. Nameof Architect .................Address ......................,....,........................................................ Number of Rooms ............................................ ...Foundation .......a-v,-. ,. . . ....-Z- :..... Exterior ...........:........................................................................Roofing ..............7 „ . , , , ................. Floorsa"X-0,14 .....................................Interior ....................All ................................................... Heating ZP ..............................................Plumbing .............A Fireplace ..........!................................................................Approximate Cost ..........� .......... ................ Definitive Plan Approved by Planning Board ________________________________19-------- . Area ....���'..................... Dia ram of Lot and Building with Dimensions 7"� 9 g Fee ............./.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH . I OCCUFRANCY-'PERM ITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above ` cOnstructi,6h.'•" Name .. .4 ............. . ................................ Construction Supervisor's License ..�Q.:/..T....G. .::..... FIPdN, RICHARD No ••.2904 ... Permit for Build Car Port a °...... Single' Family, Dwelling° Location ..112, CaPt�...L ..Road................ z- r Cent,pry lle Owner Richard Finn ; r ;.Q Type of Construction JKai1e.............:.....=:...... r .................................................... ......................... Plot .................... Lot .................I� s i , x 4 t March .18, 86 Permit Gran ed :.......................................19 .x , m Date of Inspection ....................................19 = Date Completed ...........:...19 .r e ,•'.err - Ct_ • - �e — BLS � - ,, � •�4 .� ` + y 'fir J •. - j f f• , ? 1 Assessor's office (1st floor): /��/� r i Assessor's map and lot number cF THE to ...... ....... ..................... ., f► Board of Health (3rd floor): Sewage Permit number ..........g ................................................. � Z BBHBSTeDLE. i Fgineering Department (3rd floor): .... �N O YPY a� use number ..................:......................:. � t tr PLICATIONS:-PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M.`only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �....... TYPE OF CONSTRUCTION `i �.................................................................................................. ��, r ? ............................................:...19---_.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 4-4 / /Z;......0a-.9 7 ...... . ..........� ( .............:�. - `? ? co- j e T V........L ocation ...........................n f} Proposed Use .................... ... ..` �. ......1.: ................................................................................................................................... . Zoning District .............. ...............................................Fire District ..................::.:. ....... 1,: (. J Name of Owner .... ....�,.F'...?�i.t�; r..... 'T��t!vvt.....................Address �............................ Name of Builder ....J. ? .. !4�-c,.......� .?1.........Address . ...........I..................... Nameof Architect ..................................................................Address .................................................................................... Al. . ....:.. fj Number of Rooms .....................................Foundation ...... :�� C,_,`zC .0._... .. ....., � ...... .^ (7 Exterior Roofing +. Floorsr -�A........e4z.... ......................................Interior .....................IV114.................................................... a //.9 i Heating ............... !.: ........................................................Plumbing .............vvi.? :.......................................................... Fireplace ..........! ./�..............................................................Approximate Cost .......... ..........�.�..G?O. lY,..............I................. Definitive Plan Approved by Planning Board ________________________________19________ . Area :::.<................................. . Diagram of Lot and Building with Dimensions Fee - ! SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 .................i,;...rf............ ..................................... Construction Supervisor's License .. .. .� Q........ FI00, DICBADD A~194-070 '29040 � `' Build Car Port � No.-'--.. Permit for ------------ to Dwelling ................- . . -112 C�. .�� ..Do� ` Locohon -_-- �� �'--�� ''-- ' ' Centerville --..^----------------------' � Owner -'Richard_Finn ----- -------------. ' ' ~ . � Type of Construction ._--�rume- ..........--_-.. �= ^ � ~ . ................................ _ p .Plot ---------. Lot .�.�..---.'----' Murcb l^'' 86 Permit Granted --__--.....!.----.lP ` Dote of | --.- lP . � ...........................- ^ � . Dote Complete6 ..r---'-��-----lV � ' ' ~ - ` ^ - . � ` ~ ` ^ . . . . . . _ ' � ' ` - ` Town 'of Barnstable Permit: Regulatory Services � 2 'j ate: oFTHeT°►r. Thomas F. Geiler, Director Building DivisionRARNMELF, MASS Tom Perry, Banding Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 5 08-862-403 8 TOWN OF-BA.RNSTABLE Fax: sos-�9o-6230 SOLID FUEL STOVE PERMIT Owner: ROBL 1 C-AR A.4J )k . Phone:, Install at: T)yctS Rd . Village: CEty -- __�tz v �� w►I'r N4ap/Parcel: 1014 —' b Date: Stove A. ew Used © . B. e: Radiant Circulating C. Manufacturer. 'T - v,L } ,, r �I ab. No. 3 t{Fr D. Model No.: ]; C Chimney A. New/ xistin (if existing,please note date of last cleanin 01 B. Flue Size 2 x 11-" F — C. Are other appliances attached to Flue D. Pre-fab Type and Manufacturer E. i onry.l ' Line nlied cLAy FletoS Hearth , 6s S-1�m L u FRO M I;n ve. �'IV- Q c��rltic 4 A. Materials: l\ f B. Sub Floor Construction: Installer. h OW�Z� - 10�9,,pAD Name:irinn I Ldl�ddress: %% I q q 2yVM1 S Phone: _ �� 3 of Installation l Z Ctj p` ht k�' "A- Location H.I.C Registration# /o 6-S-J (fl Construction Supervisor# 14, _� OR check—Homeowner Installing, no license required APPLICANTS SIGNATURE--\ �.-A .I,\rN,t.4 V3 - APPROVED BY: Please make checks payable to the Town o Barnstable L*T1is constitutes an.official stave permit after inspection,photographed, and approved b the - Building inspector. Y - ?'he Comhionvealth ofMassachusetls Departme?zt aflndustriallccddents ' Office of IrzvestraQations• •H ' ' 600 Washington,Street } Boston,MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Eledtricimm/Plumbers Applicant Information r 1 PIease Print I,eml I\ra=e(BusinessiOrganimtion/Individual): Address: o 15 6k Ili 31-o uwOE"Rs S . City/State/Zip�l Are ou an employer? Check the approprzata,box: :Type of project(required); 1,FI am a employer with 4• [] I am a general contractor and I T New c employees (full and/or part time),* , have hired the st b-contractors ❑ �' o� on .. 2.❑ I am a'sole proprietor ox partner- listed on the:attnched sheet 7. Remodeling ship and have no.eniployees These sub-cofactors have 8. []Demolition �orldng fox me in any capacity, employe' and have workers' [No workers' comp•insurance comp. insurance,$' 9, j]Building addition 5. ❑ we area corporation and its 10.[]•Electrical repairs or additions 3.❑ I am a homeowner doing all-work . officers have exercised their , 11.❑Phm±ing repairs or additions myself: [No workers'comp.sur right of exemption per MGL 12,❑ oof repairs insurance required.]f . c.'l52, §1(4), and we have no' employees. [Na workers' 13.gother 'fib M comp,fierce required,] *Any applicsnt that checks box#1 must also M qut the section below showing their wc3rlters°compensation policy jnformafi®. t Eorneo-wmcmlvho subffit this ai�davit mdicAting they are doing'an work and then hie outside contractors must submit anew afdavitindicating such, ' tCdntractors that check this box must attached an additii nal sheet showing the name of the yuh contractors cad state whether ornotthose entities have employees. Ifthesuh-contractors have employcrs,tbey must grovidt their wm-3mm'comp.policy number. , 14M an employer that is providing xVarkers'cornpensatinn insurance for my employees Below is.the policy=d job site' informaiwn. :`--yy�� Insurance Company Name: Policy#or Self-ins. Lic.#: -� '.3 S 3 S 3 S8 t 2 Expiration Date: l 3 Zb 13 lob Site Address: R��� J At- Q'J City/StateJZip; CO 721� Attach a copy of the workers compensation policy declaration page'(showing the policy number and,expiration date),. Failure•to secure coverage a4'required. nder Section 25A of MGL c, 152 can Iead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year hnprisa==e as well as civil penalties in the form of a-STOPWORK;ORDER and a fine of up to$250.- a day against the violator. Be advised that a copy of this statement maybe forwarded to the.Offiee of Trmli lions of the DLL.for iris�rrarne covera verification.. ' . I do hereby Gertz fy under the pains and penalties of perjury that the informatiari prnvided above is true and correct:. Sinature: � �► � 1/;ll, Date• S. z-$ - 1 _ Phone# So Off cial•use only, Do not write in thin area to be completed by.crty•ar roam affcial City or Town:' Yermit/License# Issuing Authority(circle one): WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE. Liberty POLICY = Mutual AR INFORMATION PAGE Liberty Mutual Group 175 Berkeley Street Boston,MA 02117 Issued by LM INSURANCE CORPORATION 27243 Policy Number WC5-31S-383581-012 Issuing Office 181 'A° RENEWAL OF: WC2-31S-383581-011 Issue Date 12-26-12 Account Number 1-383581 Sub Account 0000 1. Insured and Mailing Address FEIN 043036650 ROSE FORGE INC RISK ID 302715 320 UNDERPASS ROAD BREWSTER,MA 02631 Status 03 - CORPORATION Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE 2. Policy Period: The policy period is from 12-03-2 012 to 12-0 3-2 013 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10D, 000 each accident Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per$100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 500 (MA) Total Estimated Annual Premium $ 7,442 Premium will be billed ANNUAL Producer 0004-059180 FRANK L HORGAN INSURANCE AGENCY INC 44 BARNSTABLE ROAD P 0 BOX 250 Sales Representative 3000 Sales Office Name WESTON 01987 National Council on Compensation Insurance,inc. WC 00 00 01 A All Rights.Reserved , Ed. 07/01/2011 Broker Copy _ _ x 'Town �f Barnstable . Regulatory`Services , MAM Thomas F Geiler,Duei tW Eon s gu` It I - DIVISIO'Il, Tom Perry,BUd- Commissioner 200 Maui Street,Hyannis,MA 02601.. w.wvv town barnstabiem�:us' . office:.5 8 862=4038 fax SOS-79(1=6230 Property Owner Most Complete and Sign T�s Section „ If Using A.Builder 09,�v. ' � c� �( .',�--�� C� ,as Owner of ire sub i. ro 'e ) . p' i herebyautbonze act on iybeha f,;_ . in all matters relative to work au,thaWd by tkus bu�ldng'permt application.#or t�ddreSs of�ob Sgnature.of Owner Date V,, Pit Name If T'rop Ovv�er is applyuig for permat,please complete: he 1 lorrieowriers;License Exemption;Form on`the re�ers`e side s Q.TORMS•,OWNERPERMISSION C//ae'Oow&gnoauuealaz,o'C 19ajaarh we0 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: :;;1�06816 Type: Office of Consumer Affairs and Business RegulationW.egistration: ' xpiration 7/27%2014. Private Corporation 10 Park Plaza-Suite 5170 eA Boston,MA 02116 I ROSE FORGE, INC' I John Halvorson 320 Underpass Rd Brewster, MA 02631 f-� Undersecretary valid without signature . - I F i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor " License: CS-040427 JOHN H HALVOI3)SON r. PO BOX 358 BREWSTER MA=02631 I Expiration Commissioner 02/12/2015 w