HomeMy WebLinkAbout0131 CAP'N LIJAH'S ROAD a
-
'I'o�va� of Barmstabl z c) 10C>S-7C,-�
�o °ttte _ Permit#
e O - lirpi ti res ma+lhs ronr '• e dole
Regulatory Services Fee
B ARVSUBLB,
� MASS.
Thomas F. Geiler, Director rbjz� ►0)Zyl16
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
Vvww.to wn.b arns tab le.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valirl tvitkout'Red X-Press Imprint
Map/parcel Nunber ► 1 l 7
Property Address ' V�cc, � ,y�1 ��\t � �� (�eV(��Y'� t l( �
— /Vlk
Vesidential Value of Work OQ® Minimum fee of s35.00 for work under$60
00.00
Owner's Name & Address R�n f`ln �►r�B(
bey CJ �
1 31 Ca P� L C' .� r�o N , �
Contractor's Name —J r, Gl if Pluh`I—\ • // `
• Telephone Number ��R�`77,� — b�J�3
Home Improvement Contractor License#(if applicable.)
Construction Supervisor's License#(if applicable)_
❑Workman's Compensation Insurance:
Check one:
Vhave
I am a sole proprietorX,, E IT
am the Homeowner Worker's Compensation Insurance g.
Insurance Company Name U�`�4w� 1yt S utl */ OCT
-----7T01WN OF BARNSTABLE
Workman's Comp. Policy
Copy of Insurance Compliance Certificate must accornpany each permit,
Permit Request (check box)
❑ Re-roof(hurricane nailed) (stripping old shingles) -All construction debris will betaken to
❑Re-roof(hurricane nailed).(not.stripping. Going over existing layers of.-oof)
N/Re-side 1"b+ re�e���
#of doors
❑ Replacement Windows/doors/sliders. U-Vahle (maximum .35)# of windows
*Where required: Issuance of this permit does not exempt compliance wish other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License & Construction Supervisors License is
required.
SIG RE:
NATU
Q:\Wpr.ILESIfl)RMSlbuildingpert-nil forms\EXPRESS.doc
Revised 072110
i
5
They Conutioirwen..111r of-Afassachuselts
--- Devar'lrnerit of Iiidrrslrinl..4cciderrts
Dice of rnve'sfi:,aT ons
600 Washinglon Streel
Boston, M4 02111
ivry t.mass.goni'din
'Worlte -s' Compensah.on 7nsux-.Ince Affda-,it: Builders/C.ontractorsJEilectliciius/Pl:umbers
Apphcant Information Plellse hint Le 'blN
Name(Busine&-,rOrgauLationgndividc:ai): 1` Al
�Y-
Addre-ss: 6 Z c i L, 4'3
City/StateJZi.p.uiq+e 1 i l/`` 44, or63 U Phoile #: S06"7 7� 6 q13
Are-you an employer? Check the appropriate boa.: Type of project(required):
1.. employera am I tivith 4• ❑ 1 atu a gen•eritl contractor and I
�"
etuployees(full and/or part-time)-
* have hired.the sub-contractors 6- ❑New constriction
iisted on the attached sheet. 7. ❑:Remodeling
2..❑ I ant a sole proprietor or partxt-e5
slop.and have no employees These sorb-coatrac.:tofs have. g. E].Demolition
working :for me in any capacity. employees and Have woilcers'
.[No Ivorkers' comp,instrance consp_insurance..
Y 4. .Building addition
5. e are.a co .a.corporation i0:[]Electrical repairs or additions
required.] ❑ We
3.❑ :1 am a.homeowner doing.all work officers have exercised their I LEJ Plumbing repairs or additions
No workers.self m 'com right of exemption per GL
3 ( p• NM 12.0. of repairs
its-urance required.]t c- 152 §1(4)„ and we have no
emp.lo fees.[No workers' 11. #her -V
cotvpAusura4ce.required-)
'Any appticaut that checks box C.n uv also fill out the section below sbuwing 2beir Tml ers'compenss.d.on policy infonuation_
t Homeowners who submit this affidmrit indicating they are doing s11'work and then hire outside contractors must submit.a new affidavit indicating such.
"Contracinrs thgt check this boa[trust attached an sdditionat sheet showingthe:name oftbe sub-coutrscbors an.d state vrhether or not chose eotitses•haue
employees. If the sub-c.ontuctars:have enployus,lhey.must provide their workers'comp.policy number.
I'art mr eurpiol�er tltrrt is prvt�r'di>rg►trorkt?rs'.:cor�rlreatsrzh`an ins�:rtvcrece for rriy r?r�rpla��e;�s. Belawt�is tltR policp�t7rad jvb szt�+
lnforNta6vf4 Insurance Company Name: ► (��� �1;5 Lf '7"l CO
�
Policy#or.Self-ins.Lic. Expirn Eon Date.-
Job Site Address:1 U � Ca r&q L%6441'� CG City/State/'Zip:Cel4eru xe( ,Ok 0F,6 3
Attach a copy of.the workers' compensation policy deciaratioa page(:sho'itdng the policy number and expiration di te).
Failure to secure coverage as required under Section 2.5A of MGL c. 152 cari lead to the imposition of criminal penalties of a
fine up to S1,500..00 and/or one-year iuipn.sonmen.t,as well.as civil penalties in the form of'a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this stitemeut may be;forwarded to the Office of
Investigations of fhe D.IA for insurance coverage verification.
I do he"by et�
fy uAder the. scuts nd penalties ofPevjvey f)tat the is fortnation prai idi��d above is tret.a and correct
Si a ore.: 44Date: V Z�` Znl
Phone#: U(96 776
Q(-rhil nse.vnly,. Do not write in this area,to be cvutpltrted b,;ci��or tvtvit o�cia1
City or To)3-n: Permit/License#
issuing Authority(circle one): .
1.Board of Health ?. Building Department 3. City/Town Clerk 4. Electrit:al Inspector 5.Plumbing7nspector
6.Outer
Contact Person: Phone M
I
Of 1HE Tpk�
- BARNSTABLE,
9� MASS.
16j 9: Town of Barnstable
A p��
rfD MA'I
Regulatory Services
Thomas F. Geiler, Director
Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannis, MA'02601
www.town.barnstable.ma.us
Office: 508-862-4038` Fax: 508-790-6230
Property Owner .Must
Complete and Sign This Section
ff Using A Builder
. . ... ..... ..
as Owner of the subject property
herebyauthorize �GCGrU (D l`� to a-ct on m behalf,
y ,
in all matters relative to work authorized -by this btuldingp'ertrit application.for
(Address of Job)
/L 00 -
signature of Owner ate
71
Print Name
If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the f
Ceverse side.
QAWPFILESV0RMSIbui1ding permit formsTXPRESS.doc
a
r
ot rowy Town, of Barnstable
Regulatory Services
a
IEL°`I$tass6LE$. Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 518-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER"
name home phone N work phone N
CURRENT MAILNG ADDRESS:
city/town state zip code
The current exemption for"homeowners" was extended to include owner-occupied dwellines of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) Who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-yearperiod shall not be considered a homeowner. Such "homeowner"shall submit to.the Building Official on a form
acceptable to.the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws, rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with'the State Building Code
Section 127.0 Construction Control.
IIOMEOWNERIS EXEMPTION
The Code states that: "Any homeowner performing work for which a building permii.is required shall be exempt from the provisions of this section(Section
109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as
supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisbr(see Appendix Q,Rules&Regulations for
Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons.
In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately
responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner
certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and
adopt such a form/certification for use in your community.
Q:IWPFILESIFORMS1b61ding permit formslEXPRESS.doc
Revised 072110
Nlassacnu,�:t(N - Depm uncut of Public
'Board of Buildin- Red-ulations and Star dal-ds
Construction Supervisor License i
4r P + Office ot�ons mer airs ifsiness egu a on
License: CS 73142 I - HOME IMPROVEMENT CONTRACTOR
Registration:�131427
rat Type:
Expiration: 7/20/2012 d
Indivi ual
RICHARD D PLANTE III
R RD D. PLANTE`JU1- �
62 CAP'N LIJAH'S RD
CENTERVILLE, PAA 02632 RICHARD PLANtE
62 Captain Lijah s Rbad�
Expiration: 7/30/2012 CENTERVILLE, MA —
Commissioner _ Tr#: 449 Undersecretary
rs
t
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and.Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
Not v id without signat
f
RightFax N2-1 9/8/2.010 1:14:03 PM PACE 2/002 Fax Server
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(&W/DO/YYYY) 09/0&20f0
THIS CERTIFICATE IE ISSUED AS A IIATTWR OF NPORMATION ONLY AND CONFERS NO RKMTS UPON THE ckIMFICATIE IfOLBER. THIS CERTIFICATE Dols NOT A"IRMATIVILY OR NEOATTYSLY AMEND,LTTENOOil ALTER THE COVERAM AFPOROW eY THE L ft'fT BELOW.
IIHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE.dMNG INS Ult AUTOO TNF OLIC E$BELO 1E
OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the aertflkeue holder le an ADDITIONAL INSURED,the WoT(be)must be endereeQ If IUBROOATION Is WAIVED,eL&Jmt to Ilie ter—and oo•dltlone of So poDay,wrteY,PoIIdM May mquire And endoreentonL A•t•Iea1e1H on th(e e•rdflute doe•rqt eonNr r10 to to the
aerMRey■holder In Sao o1 such endenerheht(e).
PRODUCER CONTACT
NAME: '
PHONE FAX
UNITED 1N3 AGCY INC (A/C,No,ERN): FAX
199 MAIN STREFP [MAIL (MC,No).
P.O.BOX 1013 ADDRCU
BUZZARDS RAY.MA 02532 PRODUCER
28.1110
CUSTOMER ID S.
INSURED [ {h
'` F.t'1 } NS URER(S)AFFORGINO CDVEIIAOC NAC!
^I ICI .) (.(.v��
INSURER AI AMF-NIC:AN zLIRICN INSURANCF,COMPANY
RP PLANTE BUILDERS INC INSURER B,
INSURER C:
62 CAPTAIN LIJAH'S RD NaLIKER O:
CENTERv1U,E,MA 02632 INSURER[:
INSURER F: .
COVERAGES CERTIFCATE
NUMBER—REVISION NwslR:
T►"re TO CERTPY THAT THE PONDER OP NSLM& C!LWED flELOM HAVE SEEM IBIIRYD TO THE INSURED NAL1EO AfOVE FOR TNL POUCY PERIOD INDICATEtt
DRNOtINrMeTANBIIO ANY REOU?R(XI JxT'TERM OR CI111DMDN OF ANY COKTRACT OR OTWR DOCUY6R 111TN REAVlCT TO Ynel91 TMe CERTRICATE bUV DW OOHED -
WAY PYRTAM,THE MRIIRANQ FJCMW-D MER0/
Wre SHO"MAY NAVE BEV"REDUCED By pAND CLANM/•A"ORDED IV THE POLMER D IS 90 ALL 111E TEIIYD,LL[CLUBIOMe AND CONONTNe 1Q OFSUCH►OLIGER.
M!A - AODLeURq POLICY l'fF DATE POLICY fxp DATE
LTA TYPE OF INSURANCEPOLCYNUeBER (IeI,DD,r WY) (111nDOMVYYt') ITS
IASA erD
O[NCRAL LIABILITY
COMMERCIAL GENERAL UABILITY EACH OCCURRENCE S
CLAIWO MADE OCCUR. DAMAGE TO RENTED j
PREMISES(Es o unence)
MED EXP(Any one potion)
Ouri.AGGREGATE LIMIT APPLIES PER; PERSONAL A&AOV INJURY =
POLICY PROJECT LOC - GENERAL AGORCOATE
PRODUCTS•COMP/OP AGO $
AUTOMOBILE LIABILITY COhfBTyED SINGLE ANY AUTO $
ALLOWNED AUTOS LIMB IE•eccNent)
SCHEDULE AUTOS BODILY INJURY S
MIRED AUTOS (Per person)
BOO ILY INJURY L
NON-OWNED AUTOS (►W eeelden PROPERTY DAMAGE' 3
. (Per u6clDnl)
UMBRELLA LIAR OCCUR
EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE g -
DEDUCTIBLE AOOREOATE 3
RETENTION 8 S
WORKER'S COMPENSATION AND IOC STATUTORY LIMITS OTHER
IMPLOYER`3 LIABILITY YM UB•Q990N520-10 06/D5/20I0 OGM5(2011 E.L EACH ACCIDENT S 5DD.000
ANY PRDPERITOwPARTNERIXICUTIVE Y - - -upn
0MCERW LINER EXCLUDED? E.L.Or-EASE-EA EMPLOYEE ? 500,000 --
(f yft. wT d Ie asol.NH) E,L,DISEASE-POLICY LIMIT $ 500.000
u yes `
DESCRIPTION OF ONSRATtONf boar
DESCRIPTION OPO►ERATIONB/LOCATIONSVENICLE!!/REBTRICMONS/SPECIAL ITFIRS
THIS RPPLACE5 ANY PRJOR C[7tTIFRCAT'E(SSVW TO TN6 mnywAn KOLAFJi A Pf1CDW wOR KERS COMP C0 vCRA0G
CERTTF1CATE MOLDED CANCELLATION
TOWN OF RARN9TAHLE SHOULD ANY OF THI ABOVE DOSCRORD POUC&s pi CANCELLED 6MRr6
THE EXPIRATION DATE TIIEIIEOF,NOTICE WILL etf DELIVERED IN ACCORDANCE
'200 MAIN STREL•T WITH TnE POLICY PROVISIONS,
AUTHORCMD REPRESENTATIVE
HYANNIS,MA 02601 W A Rolinder
ACBRO 25(2000I09) INN-2009 ACOM CORPORATION. All right!rmrved.
� I
.�...\.�ti.....'M.✓.`a.s-d.:..�. �.�H."f s..Vv..'.e+"i.f:V+`Y.-+w.N''T..ra-r/�4�'r�..i•.w-.�.yr..'w.�•.'r'..�.'�-!"a.d rM •+`.•rw'*MQ"...":.'+...'vM�-+.ti'y.".^'ri.'+.'+.`s'1'.'^�w'..wi
Assessor's map and lot number192 #166 �C'/ — (� �,�-/r'�c•
SEPTIC SYSTEM MUST BE
INSTALLED IN COMPLIANCE
w Seage Permit number .°...................1`�'2 `
WITH ARTICLE II STATE
t N)ITARY :^C E �i�JD TOWN
TOWN OF BARN" B�E
�pF'THE t0
row@ ti you BAHB9TODLE. i
01N BUILDING , INSPECTOR
APPLICATION FOR PERMIT TO ........Bu i 1 d
.........................................................................................................
TYPE OF CONSTRUCTION One F a mi ly..Dw e l 1 i n g.........................................
.................. .. ......................
.................... ............-...... .19..7 6.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location Lot l2 Capt !n.... i.,jjh Road.,...Centarvi.Ile
ProposedUse .Dut.elI. ng............................................... ...................................................................................................
Zoning District RC Fire District . Center.-Osterville
...................................... ............................................................
Name of Owner ...TelleQen-.Perrone Assoc SncAddress ...U...C,orp,ora,t ,on Road.I Dennis
Name of Builder .Tel,le[�2, -.FE.T. .Qf1.t�...A.5.TOG......Imodress ...2.0...J,•Q.&p.A.r5.t.iA.O...RQa.d.v...Q-erin.i.a.........
Name of Architect ....None Address ....................................................................................
Number of Rooms ....S1X Foundation 10" P'q,ured. .Cancrete
Exterior .5.�s."... '1.Y.�....Cedar...+....Clapbo.a.rc1...........Roofing ......235....0 ...A.SP.halt.......................................
Floors .................................ne over 1�2!!„P1UlOQ,L1,,,,,,,,,,,,,,,,,Interior ......� [.�..'....S,ftee, TO,Ck.,,,,
....................................
Heating .FW.A........�a.s.........................................................Plumbing ....1....l/2...gaths„P .0 Ulaste
............................................
Fireplace .Yes.........Used MIasOnrY ,,,,,,,,,,,,,,,,Approximate Cost ... 20.:000.00
Definitive Plan Approved by Planning Board _ ___ ___ ___l�___�____19_7 _. Area� ... ...... ... .. ...... ..
Diagram of Lot and Building with Dimensions
Fee .... ..!..............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
�Dd
8
I
,7
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re a ing the above
construction.
Tell Amaociotmm° Inc.
No —18665 �^,~ 1'1/2 story,
--.--� prm..�", ------- -'
'
' ll .
~ ^ ^.........
����
Location/~�..........
^ —. '
`
. ....................... ..........
/ ^
Ovvne, --- Associates, Inc.
---._---------..--.'— '
� �
| �
`
� _Jypepcf(Zons,roction .............fraMe............. | `
.............................
` � ,�!
---------. Lot .���r��
Plot ------. -
�
�
�
' �� ��
� 'Permit Granted ��eptember
/ ~
Date of Inspection 17—�
' Date Completed —/� .......,... ----lV `
�
`
�
� .
' ���&&U� �������
.
�
/ -----_—.------------.. lg ^ �
'
-----.----.----~-----.------ .
. ' .
^ ' '
—.-----..--^-------.—,.----.--. .
�
._----------- ........................................ '
. �
� .-----..`-----.—.----..--.--... '
, r
` .
' Approved ................................................ lA
^
/ ^--------------^^'---------'
'
'
................. .............................................................
40 M6
ssor's map and lot number ........1......2..................0
..........
... .................... .....................
Sewage Permit number ..
IN E
T 0 WN4 OF BARNSTABLE .
NAB IL
1639- BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .........9Y.i.1 F...........................................................................................................
TYPE OF CONSTRUCTION ................cn.p ...................................................................
9................................................19.1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby-applies for -a 'permit according to the following information:
Location .... t 712 C ap It In Li i,,h Ran L in t a r v a
..............................................................................................................................................................................
ProposedUse ...........:..................................................................................................................................I.........................
Zoning District ... R"
..........!�........................................................Fire District ...q.qR�ri r.-Qs t v ry 1 1 p
.............................. .................................
Name of Owner .. Tulla-,en-Pprrana Assric ..In�,dclress ...�01 CorporalAcin Ro,,; & D-arw,1:s
............................................................. ..............................................................................
Name of Builder 'Address ....
................................:............ ........ .....................................................
Name of Architect ........0....-1
... .....................................................Address .............................................L.......................................
Number of Rooms .....bix Id" Faured Ctincreto
.............................................................Foundation ..........jin......................................................... .......
Exterior jA ... ..............Ct. do...r...-�...0.I a c...o..aa r ...........Roofi ng 35 Lb, Asuha.lt
.............................................. 2................................ t...
Floors ... V.lil:....j./2.11 Plyviond
...............................................Interior . ....... ..............................................................
1/2 Heth3 PVr NaFto,
HeatingT............................................................................ ..Plumbing ....I A............................................................................
'i-;s � Used 11,asanry 120r 1100.OC,
Fireplace ..................................................................................Approximate Cost ... .................................. ... ................
9 10 IR "/_5
Definitive Plan Approved by Planning Board ------- --- --- E Area ...... ..................................
Diagram of Lot and Building with Dimensions
Fee ...........................................-
SUBJECT TO APPROVAL OF BOARD OF HEALTH
Psi
1 hereby agree to conform to all the Rules and Regulations of the To_wi%of Bcirn;s�tabregq��4 t e above
construction.
Name ..................................................................................
Tellegen-Ferrone Associates, Inc, A=192--�G6-'—_`�
8665 1 1/2 story,,
::...... Fj�rmit ror ....................................
sLtI,le family dwelling
............rr.. ................................................................
Location�..1aa..l..Capt'n Lijah Road
................ ..........................
Centerville
...............................................................................
Owner .........Tellegen-Ferr ne Associates, Inc.
.......................................
Type of Construction ...frame
.............................................. .....
�612
Plot ........................ ... Lot ........ / �
Permit Granted Septumbe 15 76
..........19
Date of Inspection ..................... ..............19
Date Completed .................... .................19
PERMIT RE USED
................................................................ 19
...............................................................................
)kfi7 ffuwlv�;?
....................
...............................................................................
Approved ................................................. 19
.................................. ,,.. ..................................
• t • LOT / 3
7-LE 410
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