Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0067 CARRIE LEE'S WAY
'o-I h Asses,4or's map and lot'-number ..� .....�.. �! �dC '�G'` w ; SEPTIC SYSTEM MU ST BE . .� f' 7 r> INSTALLED IN COMPLIANCE. 0 Sewage Permit number .................. g .......... ;;.. ;......' WITH A NTI6LE II STATE SANITARY CODE D TOWi CfTHETO." TOWN" OF BAR STLN-tr,N S� r s o� t2 00 BU.] LDING INSPECTOR a �: C1 �•. ...'�ARPLICATION FORSPERMITPTO o .CoS....�`1 :..............!....! . .. ........................................ TYPEOF CONSTRUCTION .............................................. ...................................................:.......................... cx: .................l. 1< ........ `..19. TO.,THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: C nr-�'k viLL Location ......�.o..T 1.1a � ....L- t:.. ?...... ....�.......................:.... .. y.�....... ................................... ProposedUse ... 5.!.. FAQ.��. .............................................. .......................................................I......................... 1C.1 1 1) 1.� 1 t�7 2 i ...............................Fire District ...........,,,.,........... V. .Zoning District � '�. Fa. .... ..... ................................ .................... ....... ... Name of Owner rbC—..ti r!.1 .......4���.�.4�� �� ..............Address ......... c..Lk-C...................................... Name of Builder 1���� .......KC ..::.? 1!A..............Address �P'�.!...A�L,�....................................... Name of Architect ............................................................ ...................:........................................... .................... ..................... Number of Rooms '...........................................................Foundation ec�.......Cw�. ..LI`.............. .6. ExieriorQ.. Q.................:.............................Roofing .1 .Q.�.: �...... ............................................ Floors ....Vif ...VAAK :........................................Interior ....�ey1..�.��L. ...... ...................................................... Heating �1t`...... .1�.....c"" ....................................Plumbing ......,...... ! i ................... . ..................... �:�.?Fireplace ....... .1��.........`...................................................Approximate Cost ... . (.�)tn.................................... .t...... Definitive Plan Approved by Planning Board -------------------_-----------19________, Area ...../................. . ....: ; Diagram of Lot and Building with. Dimensions Fee ?S SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby, agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �..... ...... ........�:`............... Ruggere, Dennis I 20236 one stor • No ................. Permit for ..................X............... S ,A�g1..e:. ml� ,dwelling...................... Location ..... ..a..WAY................. ....................Centerxil.le................................... - Owner .........D,ennis..Auggere......................... Type of Construction ..............frame................. - Plot ............................ Lot .........16....................... -' -May 22 78 Permit Granted ................................ ....19 Date of Inspection ........:.. ..ry......19 Date Completed ..... .L/ ..19 SED - x .........4r .. ........../..RF....r�.C+9,t�1 1d�° ............................................................................... " ............................................................................... 1 " tApproved ................................................ 19 ............................................................................... ............................................................................... G' `• Asses§or's map and lot number ....................................... t Sewage Permit number .......................................................... °FT"ET° TOWN OF BARNSTABLE i i 13JHH9TAELE, i q BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... ..n s ' t��C -r -O VJCL�:t QCr ....................................... ..... .................................................... TYPEOF CONSTRUCTION ...................................................................................................................................... ......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accord ng to the following information: . _ L Aw ?t r a 14 A`!Location .........^ ......... ...................................................................... ........�......_t..`...r....t......!..�...�..-..i~........................................ Proposed. Use ....1GL S.t .... t..,T.1,A L..................................................................................................................................... Zoning District ...0-.>✓st ,aF 'N-r IA4 Fire District CEW 1EIZMLj-r- ................................................ .................. ......................................................... Name of Owner ..............................................1't�5G4.t't 4 t. t�1� �'"1 !�' �.� ..............Address ..............:.........r................ jj Name of Builder , At�'1�S � • V\I T!4..............Address �.� r E ............................ ...... ... Nameof Architect ..".............................................................Address .............\......................................:............................... Number of Rooms ...�2...........................................................Foundation � rF.A.......C: `,4a G.T Exterior .��..�.:i P 1�.� Il................................................Roofing ;�5- kli I I Floors .... .. A Y..1" CAl1. Interior ................ .......................................................... Heating .... i ,u f „1 g 12 �. t k. ..................................................Plumbin .......................,.............................................. Fireplace .......!...:........; .........................................Approximate Cost .................... ..................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ° c�'�s rj -II I".......................................... Diagram of Lot and Building with Dimensions Fee ................! ^............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................. ' ................. Ruggere, Dennis A=168-8-- I No ..... 0236 permit for ......One story. . ......... d .. . ...... single family dwelling ............................................................................... Location 67...Carrie. . . ..Le. .e..s..Way ................. ...... . . .. .. . .. .. ....... Centerville ............................................................................... Owner Dennis Ruggere . ....................................................... Type of Construction frame ....................................................... ........................ Plot ............................ Lot ....... .................. Permit Granted May 22 78 Date of Inspection ....................................19 Date Completed .................... .................19 PERMI REFUSED ............................. ................. 19 ...................................... . .......................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............I............................................................... 8 101JI Town of Barnstable *Permit ' 6 e out om isst V8410 iV - Regulatory Services . : M01 g ate. 9 Thomas F.Geiler,Director 6 ', Z d3S �( Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY i Not Valid without Red X-Press Imprint M ap/parcel Number%4 s 1 �_ C-Z ul l le- tM A Property Address � � Co-r�I� Lees � [+Residential Value of Work$ t,® Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L C' �� Contractor's Name 1,� }— I) P�V TelephoneNumber Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑� I a sole proprietor 1 mt the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ,f�u- �► , 1% �0 r ❑�,� f) -roof(hurricane nailed)(not stripping. Going over existing layers of roo -side ?,1 ❑ Replacement Windows/doors/sliders.U-Value 2? (maximmn .35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required. suan Isce of this persmt does not exempt compliance with other town departinent 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 re aired. ' l 0AWPFMM\F0RMS\bW1ding penrrit formsTMESS.doc The Commomuealth of'Vassacbuuse is Deprsrwtent of liubutrid Accidents Boston,MA 02111 w%h' anamgovIdia Workers'CompensatiouInsarauceAffidavit-Builders/Cantractorsf.F ectricians/Plumbers APPEcant Information Please Print Legibly OAAJ t estylstate/Zip_ f� s 1,('�i� f�\4- Phone Are you an employer?Check the 2ppropriat3e bow: Type-of o:ect .r 4. I am a contractor and I � Pa' 1 (required): 1_❑ I am a employer with ❑ 6. ❑New 6311 tuctioai employees(full and/or palt4ime).* have hired the subrvntraciors 2❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-contractorshave 8. E]Demolition wording for in,any capacity. employ and have workers' 4. ❑Building addition LW R jomptnwxatire COIDI3.mc�va+xr I L I 5- We are a corporatioaand itslt}..❑E]t'ctrical repairs ar additions 3. I ammeowner doing aII woric officers ha��e esrscrsed their 11�Plumbing repairs or additions myseM[No workers'comp. right of csemption per MGL ❑Rnof � 152,�l(4),and we IMM,na s insurance�d,��' 13.❑Qti7ei� employ-[No ' comp-insurance require&] I I - . . *Amy alrptiaat that checks bowl nmstalw fill outthe sectianbeIowshowing ffiSwardcers'mrVensatioapnlicy inFM T Hameawners who submit this LZdxvit mffk3 rag they art:doing 2n wm-k sad then hire omsitle contncmrs mast submit a new afd3vk mdu-sting sash. tors that check this bax mast attached an additional sheet showhz the nme of the stets-c�mdstate Vheticer ornot thnsa r dtks have employees. if the soli contractors have empIogees,they now pmvide then•workers'comp.policy atmmbes I lam an employer that is pravh&g ttrorikers'campensafion in mrmce for nzy empfoyen Before is fife paHi7 and,job siiu in forma-twit. Insurance CampazsyName: Policy#or Self-ins-Lim# Expiration Date: (Jnb Site Address (� --�.G%i a= L ei` -.,V Iv -----City/StatelZtp: C eti..l Atfach a copy of the workers'eompensaf=polies declaration page(showing the policy number and ex*ation date). Failure to secure coverage as requireduuder Section!25A o€MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to S1,500.0a and/or one pear imprisamnexx,as well as civil penalties in the form of a STOP WORX ORDER and a fine of up to$250-DO a day against the violator- Be advised that a copy of this star meat maybe forwarded to the Office of Investigations of the DIA€or inaw me coverage verific ation- I da hereby n ke ' sand penalties ofpe uty that the informa en provided above is true ant!correct Si tare: LDate: L / Phone#: �3i 'owl Q,fficial use only. Do trot write in flds area,to be campieted by cdy or town oficiaL iff City or Town- eff Issuing Auffiarklr(drde one): 1.Board of:ffe9th 2.BuRding Department 3.Cita(1 own Cleric 4.Electrical Inspector S.Plnmbmg Inspector Information and Instructions Massachu§ettssGeneral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iocal 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 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 numbers)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 priated legibly. The Department has provided a space at the bottom of the affidavit for you to M 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 permitllicense 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 bike 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 Massachuscib Depai meat of hidustrlal Accidents Office of kvest bons 640 WashiVon Street Boston,MA 02111 Tol.#617-727-4900 oxt 406 or 1-877 MASSAFE Fax#617-727-' 49 Mass. Corporations, external master page Page 1 of 2 William Francis Galvin Secretary of • • of h 1�� HOME DIRECTIONS CONTACT US Search sec state.ma.us Search Corporations Division Business Entity Summary ID Number:001007869 Request certificate I New search Summary for: E&B DEVELOPMENT,LLC The exact name of the Domestic Limited Liability Company(LLC):. E&B DEVELOPMENT, LLC Entity type: Domestic Limited Liability Company(LLC) Identification Number:001007869 Date of Organization in Massachusetts: 07-09-2009 Last date certain: The location or address where the records are maintained(A PO box is not a valid location or address): Address: 1020 PLAIN STREET,2UITE 170 City or town,State, Zip code,Country: MARSHFIELD, MA 02050 USA . The name and address of the Resident Agent:` Name: ERIC LIMONT Address: 1020 PLAIN STREET SUITE 170 City or town,State,Zip code,Country: MARSHFIELD, MA 02050 USA The name and business address of each Manager: Title Individual name Address MANAGER ERIC LIMONT 1020 PLAIN STREET MARSHFIELD, MA 02050 USA MANAGER ROBERT]. BRADY 158 LAMBERTS LANE COHASSET, MA 02025 USA In addition to the manager(s),the name and business address of the person(s)authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY ERIC LIMONT 1020 PLAIN STREET.MARSHFIELD, MA 02050 USA SOC SIGNATORY ROBERT J. BRADY 158 LAMBERTS LANE COHASSET, MA 02025 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver,and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY ERIC LIMONT 1020 PLAIN STREET MARSHFIELD, MA 02050 USA REAL PROPERTY ROBERT J. BRADY 158 LAMBERTS LANE COHASSET, MA 02025 USA r Consent r Confidential Data r Merger Allowed r Manufacturing View filings for this business entity: ALL FILINGS Annual Report I Annual Report-Professional Articles of Entity ConversionXNi Certificate of Amendment View filings Comments or notes associated with this business entity: http://corp.sec.state,.ma.us/CorpWeb/CorpSearch/CorpSummary.... 9/26/2013 ,Mass. Corporations, external master page Page 2 of 2 t New search ................ William Francis Galvin,Secretary of the Commonwealth of Massachusetts Terms and Conditions http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.... 9/26/2013 °F Town of Barnstable Regulatory Services Thomas F.Geiler,Director XUBM ;9.,{•`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION y Please Print DATE: JOB LOCATION: :/! 1 +LJ number f{� street village "HIOMEOwNER^: .1-•) Av . f�y o e -7 name ii home phone# work phone# CURRENT MAILING ADDRESS: 1 V y�-7 y P c.ar. f T le city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings 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-year period 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 Rerformed 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 pro ,d re ements and that he/she will comply with said procedures and requirements. 11U-1r Y Sighaforrrofreowric, . 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. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit 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 supervisor (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 Iast page of this issue is a form currently used by several towns..You may care t amend and adopt such a form/certification for use in your community. C:\Users\decoUil\AppDafaVocaIMcrosoMVrindowskTemporiry Internet Files\ContentOutIook\QRE6ZUBN\EXPRESS.doc Revised 053012 oFTME T Town of Barnstable Regulatory Services BARNsTABM y RAM � Thomas F.Geiler,Director �pl16.19. Aim Building Division Tom Perry,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 If Using A Builder as Owner of the subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature_of Owner Signature of Applicant Print Name Print Name ate la/vl3 �nPpaa�� V �� fd }def /set_gstate { AGMUTIL_GSTATE begin AGMUTIL_GSTATE_clr_spc setco AGMUTIL_GSTATE_clr_indx{AGMU /AGMUTIL GSTATE clr indx AGM AGMUTIL_GSTATE_fnt setfont tl AGMUTIL_GSTATE_lw setlinewid AGMUTIL_GSTATE_lc setlinecap AGMUTIL_GSTATE_lj setlinejoi AGMUTIL_GSTATE_ml setmiterli AGMUTIL_GSTATE_da ACMUTIL_GS AGMUTIL GSTATE .sa setstrokea AGMUTIL_GSTATE_clr_rnd setcol AGMUTIL_GSTATE_op setoverpri AGMUTIL_GSTATE_bg cvx setblac AGMUTIL_GSTATE_ucr cvx setund AGMUTIL_GSTATE_r_xfer cvx AGM AGMUTIL_GSTATE_gy_xfe AGMUTIL' GSTATE_ht/HalftoneTyp { currenthalftone/Halft { mark AGMUTIL }if i I i i I 1 �t ,6 K n tt�� EOCC-UWpancy se Only �nunoewaa o�Ma6.6ac"ff 3dra Jrvicad hecked �� `5 BOARD OF FIRE PREVENTION REGULATIONS nk) L ORK CATION FOR PERMIT TO PERFORM ELECTRICA APPLI sz�clv>R lz.00 All work to be performed in accordance with the Massachusetts Electrical Code(IvIEC)%L�h y J3 0 Date: �n t/ T pp (PLEASE PRINT 1N INK OR TYPE ALL INFO To the Inspector of Wires: � City or Town of: ' � B this application the undersigned gives notice of his or her intention to perform the electric work described below. 06 Location treat&Number) C- ✓z �` Telephone No. 04S' -9 Owner or Tenant �b Owner's Address ® No ❑ (Check Appropriate Boz) Permit? 1'� Is this permit in conjunction with a building P Utility Authorization No. ��� Purpose of Building o Amps ,�-,/ � Vlts Overhead❑ Undgrd� No.of Meters Existing Service Z� ) Undgrd❑ No.of Meters New Service _ Amps / Volts Overhead Number of Feeders and Ampacity d e f r Location and Nature of Proposed Electrical Work: 2 e • o: a c Co letion o the ollowin table m be waived b the 1 Total ector o Wires. t r L No.of KVA No.of Ceil.-Susp.(Paddle)Fans Transformers No.of Recessed Luminaires KVA Generators 40; No.of Hot Tubs o.o mergency ig ng No.of Luminaire Outlets Above In" ❑ Bane Units Swimming Pool d, ❑ nd. No.of Luminaires FIRE ALARMS No.of Zones No.of Receptacle Outlets Z No.of on Burners No.U1 JVV1&----and No.of Gas Burners InitiatingDevices No.of Switches Total No.of Alerting Devices No.of Air Cond. Tons No.of Ranges umber T_ons�__ '._ No.of Self-Contained Heat Pump ,..__.___ -- Detection/Alertin Devices No.of Waste Disposers Totals: Local❑ Municipal ��• Space/Area Heating KW Connection ❑ No.of Dishwashers Security Systems., o o Heating Appliances KW No.of Devices or Equivalent � 6 No.of Dryers No.of Data Wiring: a W No.of Ballasts No.of Devices or E uivalent = No.of ater , Si s Telec ommuni cat Heaters ions Wiring: U'N z No.of Motors Total HP No.of Devices or Equivalent N �o� Z No.gydromassage Bathtubs o Q w OTHER: E" N Attach additional detail if desired,or as W required 6y the Inspector of Wires. LL w ¢ d t-, (When required by municipal policy.) ®it d upon-OmPle on. w � Estimated Value of Electrical Work: �� �� ti Ww n �' Inspections to be requested in accordance with a of electrical work may issue unless o an LL 5 Work to Start: l ) Z 5 y permitno for the performan a INSURANCE C V RAGE: Unless waived b the owner operation"coverage or its substantial equivalent The —ao m W insurance including P P office. o W the licensee provides proof of liability o undersigned certifies that such coverage is in force,and has exhibited proof of same to the ermit issuing LL w CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (SPecify:) fete UJ co enaldes of perjury,that the information on this application is true LIC.NO.: a o a I certify, under the pains and p - �AGy:.r')1� FIRM NAME: " t r�� L tcof (-� S LIC.NO.: Z — Signature S bg ��.. �hrn<��nn Bus.Tel.No., Licensee: , (If applicable,enter "exempt"in the license numberlk�.)5� r,�� / ,��Y �� 0z j7q Alt,Tel.No.: I�cSEn"i c �i tKi� I'S„License: Lic.No. . Address: work requires Deparlment�f Public Safety *Per M.G.L.c.147,s.57-61,secunty q insurance coverage normally OWNER'S INSURANC E WAIVER: I am aware that the Licensee does not have the liability ❑owner's a ent, required bylaw. By mysignature below,I hereby waive this requirement. I am the(check one ON PERMIT FEE: $ &� Telephone No. Signature EMC �® - M Flle '�Edlt- Tools r h {. ,,,a ": :.- ^ � , B't'�?,...,,. '_... `."... -' � -'� w.�,�.r.,..��.& „ •� .� Amm vm�.,::;: w�"'," "m "+r.o'4ae 'omgm!Aiyp�lw,!N.rP. 1 - „ , ... t"R: App11 ondm� 1 7,77"Wil ::„ - .,.::nxwa-�.rc wr.'r• -; ,. ice: �.. °9} 6:vau uvn w� ,:,rd. :_-�,n U L?�et-a ll,,.:: .:�,v m.,-,Am[J d+�4M1 t.r,P.;Ly,_,�r'�R��.•s t,�y.I�Ja;,em,",aa�«t.��+r�a'i.v.r4,';n,xr«.s.n*T ar,,:,mVMa 5-q#^""^,"!':,:�..a�i.r0W�A,s,,L.:�0 r3 ,. -I�-�J:,'G- ��,a,,„.,.,,.c.,:,„,u�v 4«._7...:.�.,.,,F;:'�.,..;•,,��1r i>h w�,:.r:h'oU.:T,,1,.n,,S,,;,,m'rn"~�,,,ra�:.�r.nK,4n.:butY_!:°{.p,�s,,�•.*n�,�{,'k,^.v,,,�.,�..".:.,n.n:., �,m r7i�,o,G w'U,-:w,� ���•-,:r .Fi ,rz ,Su-0`�'c w: ' y 47, „ Owner . n. ,:,rnY ,;� aN i^ MCCAR74,DAVID\J�PaT RICI U '%"' M hb �•Collect��t � ,. �,. . ;a De artment. 6 Q T p . _3_0'-9ELDING DS? „ k gCaritrattvr m ,u ym,. „'': , J ,$i.&*a ' ,., z: •.. • .. �,, rort"a Clasei!beny, _. .r. h w ect ettw 801-G� w S�RESIDENTIA[ ctive.r a,.a*.+'„s cx« <Y•r'-rti _ 'c- Bus il_e spbsm.sa%esQip CCOK STfovED 1 k � - ®Fme„wC—,�In.9r mE.:A P..wP,LICATI7` d 4h e, RGTf "g„De sc- t-o o ff -3sumo a: 8 ° a 1 r - --.�-», r^, - xned.,ty` , - �Reacfi+ate � - � Estimated eost'� �: •.. r:�;�0 ;-,Fees efFectn+e 10�03>fZ0139� .� ;, a ,�^r GSA 13 Sk - `. .. '�'': ,i t , : :u :.,:,, � '""�'.:., „. .,r.' , . ..: -t ear">.:.: ,., r,<, '� ,..., .� ,.e.., ..,_.. • ::.4 ,.,.„.-. .� , ,,g, 5,�,.''r;,� .... . •�'' re. ,«. , ?.. mow ' r •, ...'w_; .� ,;,, o .-.,. i5. ,,.,.:,,m .ws'Smr..,:: M , ,. , _ '. .t:., , �.,.,, w _-.. 9,, a ... maFees r .�_....r. k. ust r r' ,. n„< :. =;a;-;•� s s ,w Fropertyse, t�lvn Cvnfann�ng x 4 ` .i +� -k.. avn. .:�,�i �., �,. b.,:, .., a .., .k -,.«,. ....sr. _ ,�S•.,:h. - e , «. : w,::�. !.' k:,e., .E , `, n:w ,:�. :..:i a„ �:..W •'s-" `%,: ti`" �f ^^ :.., ... .+ Eid tin +use F4M YtidME x;, Mlsc s fiL 9 1010 SINGLE IL 67 CABBIE:LEES tNAY ..,«,» :{.,. u..> , - -y G,•'mail lb w. :.ra�%:m�„•,n,. r,..a� ,•�`s.,,::'f�" >u ,{;i. 7, .„, ' >fa '2. r ._�`', CENTERAILLE.h1 ,. .r } _ .',y STRICT .m _ .. zvnmg RCESIDECC{ PaymtHlstory. 4 ,. , .. _ Mucuopal>ty CENT CENTERVILLE i .' ._ _. �,7_ h�•_ »�„ � m -� , ,_ �° ~ , >~, �.� ,;'' .3 r , , -, �,.» ...:...,. ,,.,., � .,�?� r< .� . _� Win, w y. � ry, ,. .,t«,t � r � ,-� ,.�.e„ ���x '�� „rf <. , ,u:... .. a,�..,,-, .$.. .. ,, s- .„.;, ,m�-:,�,a,.m:,.. ..u,r «.�. , ^, ,��. s�'' �, €. €�... :.m« ,.'a ., ::, i M,w,. � .r. .� _r.. i. ....�..._ .�... ;.�...„i, �,- a�fi, k,..� �Y.. - ,,. CS.#rt"�" .� ,.�CF ..'3 .,.0 .ni, ... ... ."£ .. .ltv.. •, l.:.n.t :, 1.V ..., M ,. � �... , :--�.. �:.",.. 34, i.. ,...... ':......:...s .+.., :...5 7 .. a. v „ ,,.. ..:d.«x ^�. .,k`• '. .1: y..-._ ,'. .i, ^. as ,iMN r V�•,^r ' -' •- : � SWbdl'a+l$lan '�' r -,:.: ," ,=E.:,�.,r. xy.�`Y. .:. -+' '. +,r a,.�.Q ,.. �.. . .,4,*�,,., s«..y,;,,.:. � _.r, �, ,,:,s..:«+z fi ., -.,.,.. ..f. ,,:_ .: r�.-a .'�:"_ '' .m.,�'3. ., .:a., �:. '+e:! AWdlt i"i{`�ut)()r�(- _�°`�' .•:'-< 4 ,:.* a ,; .k:�i'a:. � -,4�'ffi3 �& ��" .-+,'€+'a�?�, .Y«': r ,r �w-�,.t�- .,�' x asr<^� �` #, flood zone ; ,:r ' 'r,-� ."fi+. - _. : a :. u. . _,..- ,s:.ter. ., sr.�sz rs• - ., W -� *,:r! a.:�: � ..: _ r 7�:. - ',.;.-: . w' *« ..:,, r.,t t,.. ,,. .; c-. :.xa. h ` .�r!.»,.. gas_ .. 4. , .�, -.s--•W, - ,sa ':a.?,_,. �€ rM.;-.,,.., 1 s.-{�;, ;,,_ _ F...,• ,,.. .�., ,... ,� �...a_. � .....ram,= .: �, ,�,y �" _ .3•+ .. ",N, _ n.. e ., e—.+.+.. _,ew .... P:;'P .i. r�..=.v. , F',_ -.}. ii +:: 7+ }.. ` Nd A' ^, r : .,-.- - �. •,r ,a ,.. :,Pra sad use Qs x g SINGLFAMILFt7ME= s , r ; LO: eft 6h' Kase Q SQ �P . a. 8 k ' wr .< .....,,,a r 4s. r K —:,.: .� #�•..,a r'$ ✓3T;' ,•;e"',.n k4�• e ,v„. zoniri RC RESIDENICE [�ISiRiCT „ z k. .,.. 9 _.,*.. e v..... ._". Betseen, d,,. aBk -a..., ., i�.r ,..-•�,.: ir,. 7. ., ,:YJ -_. , e % =°-si '.4=k::r ,ne^a : . a,a- ...,.r* ,e.., .s, rv*,:, -a_ ". -„ 4h,?".,,:e- .,n::: ''�,:t`� >E ..... ae�'. .+r- ` ,r,x:. •- :, .. !« ,w,=-,�»,n €:. ,:,_: q.,,--- _-.-zt,*.. .N....,., ..rt .t, ,.a. .`� :*, a" �U n. ;,- r >n ^t �, r. # r.:-_s_-€,eu.;s` ,::.. , tti s�,: .? A»,w #.v '' "«<,.. ia" x;.,s45' "" ' e.. ,,` -s«rr merT mo :, : �:,} }• and: ^: Permlt Alerts. _. •. ,, 4'... r,.i,^. Laca v dasc �,._ a t..s_ s» „fink ; ` a `" 'c. # .. .,-.ar.�; .e .:. .:g, B. fir^'a � � d� '" ..' :`t^' �a, .,o-.. -y �. , ,,,.,, •`=v. s � ;i.c. � ry ,n r ,y i« s..,.+� s ,'�', �» lc�_Prere Wtsltes:. ,ti [.�:Hazard estr, ,z IL Names., 1e Bands _: (&P Sub ddrs. f Text ._ [ Pian ttev eau,' C%3 Flnd y,Pare= z r ], vn sutra„ y� My�y g• =.' rk�n � Related,=. ... -4„�«. �d=,, t, w... �..r r, gym. ' M w *v• ?rear Hlstor (a In, ectans- I Violations ` r y SP Gpen ngs�' ,, b fa Baard Reines itemsfami , r, ':44K, a1^'r, _ "'aa ::r�'i„c aruz�{ J , xrV.. -> R `rr ."Y' .,,:.: _ „a ?m * s .,,�i,, ' ...u,:•�rra,.x ,..,} .-:.--�,,, ..;. ...;•.�\�- .r ��'`�k-"-" t .,., c�•G$; C'�'^..P. '�.<a 2�. .� � � ���'a- �� _ � ,�4ttaCElment5.:� ' .dam _ti. • «rx„, ., : -- t ._ ,Q ' n,. i, am +. B,n :::: 3 Ma ntaln pr a act�vl ,datall,fior the cWrrer YapplIc vn.°•A :.n ,.n,a .,,. .« s , , : ,. „,n a: - _ �>�r .y. ,s;„"ae e -, � . r aM Mart as. sCr o�� ti©ris'ext.: I Main S yes_te.i,n. M ., , apR s;° �a ''AppGcatior-i;,Entry;[7unls;:r= Appyifivn Entey enuT . l<cativn Entr _ 'ure a r ;10 i8'AM �� � R yy rjo My hie, Edify �r r 1 �.l ,n�„ m� 'nn. :�� r.'.':�u,z ,,� '.���,uAi&'�n ��•� Sm by � f4rp `.fiV^ wd^nN�m�P n»ti '�_ ° a�,�:;, P.,,.�,.. :m � ,.; .P, d an �r,r �,t�i.. �n �*«w ..: w - Clfw�tM3R ^ Detall .. PR . „t.� Owner r. �----- fn sdt i StatWS Collect `y•y' 4 n , . K `, Y,D PATRICiA, ,a ACTI�IE � �' TH �Departmenti b 6300- 'BUILDING DEPAR EI+iTi m MC *R CAR VID J CloseJDeny iPirojectfA 802=PLUMBIIJG RESIDENTi-L ctive , Cont�actdr� �. w ` Bu ss � 5 sine �, , Descry do 1• ' "' 4Mldfkfia'+.„ P . 4 BATHTUB CRLfSS'C{Nlr DE�IGE;�'DISHASHER�"KITGMECN K °> 4 ��= Status code;',ACN,_�CTT1E'APPLI'GATLO1 'I: a ' ' scnpti n LAVkTORIES(3)TOILETS' 491ATER PIPING ' a' Status.memo. s °ProPer't+ '3 .x.. •�-,•- �r-l .- z", v. -• a.; °'< ' c.. -• a. , ems;: '+ ;,. ss�,-'.. ',m ' .` "" �- Appfican s PG f'Lt1MBII COf±iT} 4CTflR_i. � Y, c. Y 8 iq ssl Wed s' ' x �r 0•. 4 a.a .°. •� :i ._._ �' k wm. `*H 4a A to : �4: � r�?'m ,,. ,�•:,_ * a, x � P1. `5 '" - - ", �6n �i eSr..�Fe ,� ffn ..µ.. ! :";.k ., s><• --„-, t" `.-'""`}`.-. .: as. .;5 . > PropertyfLise you Ccnf&6r I -`Dates Nlisc_� ,.Permi�� ,_�,_;. e,. v 'k.. . e _ _ .x x.-.a, ,.,, r2•.��: M!�t o- .e..::. ,.. .,. ,. ..,..., .-., rs��,:- ,.:_:5 ,.: •�, v :,ma f .,y�1,. e.., �__..a ,� ,,'M .. �. � .!.."c¢„�"K #', jg # . .., a. R i+� k,-..s m ,. >...s �' %wre! .. ,�,. .•.:.. .. ..,... .. .-u 6»..x, ,�9 .:�. ,g'* =f� �+? .r.�wi:.z # i��.>. a''i: p� y a ,. .};�,a` '.; m ...� a... 's,r _ :�., >`��; .".,.�`�." 2 M,�.:-.-,'� .i�'.. .f„ ��•," .�, � ,. aa «,�,.Y:.,.F�; '. Z= :,:d`}' � �';. �,6+�» PafCEi :ate: � •'.a�. 1��1�{�'}Q�.1-. w :r..�,.'T-, .. ,F, �r .,= :s p �J a. � M. .4 :_^:�'. - _ w •.`. Enos,n use�®. � .. ,:� . r ti `: 9. 10I0��Imo'' SihJGLE_FANIILY.4iOME-: � r ;. t ,. n O�q MI 67 CABBIE LEE'S t1A _ w g ,w> ,'CEIYf ERVILLE WI u -_- ,'_, -� - zones-' R �RESIDENCEC DISTft3CTr �* F3 ,�.: �,..:.,.w _ .r�- i�9uma all "� � '-:;^ .... -•=",- >�x ,;�'�'� rt-''�,b „a.. - �':,�, m. 'rtL '.,}�^' 'u # v ,- i, k;+.,:,ym�.sw,•:.Fb.. fir:. .,_-.,M,. w.a E, x ., ' ,. '.w &- ry°i=' c t x "1 m.�r?t - _` mr .. ;� p' {, r xs"' ,rs n4 .".'' ` ,,:r,; ,=3-: - ..:" - --:: ----.u,.• ._ '::;-.s- -a s� z _, =. -- -3. � .,.. -r,-e�`.A- , `�- a4..:- a _ �K"y hL, z.�. -�•r.e :Aa... �.-rv�a8•�,A:.`4 :Audit-l�IStDf ��SWbdIVfSIOn.s-a�*„ . ._ x� ' .. ,}�, '"»r�.:l�.,. �7 �, _';< ,�,"� ,� ,a„ •- - P- .:- x? '�`' i>+z - ., [ •.. .. ,. .... . ;,' �s x ..a::5-� «' may;:�c -, ?.,; n,. e .`k�..,".'� 7>. -;"•- „ `k n ,m,.x, _ ILA SWm i-Pe'. x _ <_ ;Prpou.e'- �'.1•� 10R E_S I__I SENC.- -. -_ 6ui OME ase;'_ b r,d n SNGLEFANILY H LdtISecti-on/P ,G DISTRICT zoning R Ueleen' " * rrc :.,,�:• "' T� r -zM .._. ..'i.. .CC�L, a. ._-... .T. 5t rv- Y ,b:r y,. ._a .$, 4.: + m ...._ s., .,,15-ni,. n?h-.. :,hp4 4 Y"s"eq:.�,-..,. r?r'.K,•F.. .r. -, .:, _. _ . .,.. ..,, P .. _ .8 s. ?.:., s i. _+"," , ,.I 4 ,... �. :., Hz w..:i ». '�. r. 7' ,�.n mem0 ,�, b.,.:, a �' ., &� 2 �"r- " k +{Uwm' ' .si}'i�,y,.: __ �t , Location-deK. �n. >a Y. , a,. >, � ,.�� ,,. . :���. :,. ��,�: < �� . w,. - __ ,K ," ,. yak. a. let „t .._ ... , �,,, {,, ;@".�td ='' �,". , in....., aY :,,....� a ,.q r Llnkf tSpS # c. i z m Estimate i=ee -sp; , . ,:,- ti_, . ,:, - ...,,.«..::- :{; , s i ( PlanpRevie�u: ( .,F�nd by Parcel I?'Prerequip s a� (�+�azardJRestr , ��iVamesi �[�SWb Addrs . A, . - �-- r, + M [ -. ,.. r.. ,.:� .. E < .....r. �, ..,r.,. r<... :., e., .:., " „ .?,., b ..'4".. �a ..;i „., -.£. ^h .,, a "3i:.. w ..ar ,y, r. !h - "y. x ..., t f ,_-_.., ,.. .,, >-: ,-;.. 7 s� -eaF .L. n, .. -.4. ,. n ', ,., F , �i a -« a, mr ,.. ,�.,.,. r ,.,aY b?.-<,.< �SE.h,:,w ,.:x r .».. [ N "�i, a� # s _ , ,: }k rr . r..._ Y .t. ,. x„a e, , findela'bed Bu�enng, , r�� Parlongv: :, feSepbc,�.� � f��ilell r,,�.�'• ,.,.aye ' �..,� ,.� � .:�.�,� � .� ��, p ��i-,._. •: Eq. .,-s, �� _m. # ;$:,. � aF (3.,Rndr Hlstaf. Ins ec#tans ( olatidns ,, 8dard Revieuus, �,0, en Items lv'+ arn rt9s F., .. azi, 3 c> 6 _: 'Attact meets.(03 ,- ,' r.. _�..s . 'C s> y" .'r 6.: ra , .:.:: ie a e>a. t,r• z r "u . a _..,, .. r`"a7r,r...:,,. > = r.+3 �; m'. 4 ., ,'+w, 9 .p kf 'iF - t nN�r i s.. •gk y,MY7�::: .,. �,r ,".�r ;.;_.r -yzr ,.,,.. .,..... ,�..,.F �"' .r .a«� ,a, '-,. a . ,'m;:m:-t. �-+�. ',•:g '-es"�...p" 't.,,w ^� ��x,r, ''� r,x!.' E _+ Maintain Jer activi" ;detail for the current applications;,_ p ' _,- e .�„ , < r;' v -,,:e .�'. -S" Y ,r ry , ,_:. ,T., :r: ;._ :, ..,:-.:. .- A4 ,. ,. ..: ,.,-.� .h,i .,& x... .:�dm ..:, rt -m> .,,: wa w.., ,:` ,':"f,$', aC •r:t, 'uxq.. ,.�,ti. »_m^� '> L l} � -%Start Mass.CI3e rtionsj'ext.a., Ntairi Systemenu TO Application Entfyr, Mums,:; Application Entry Musts:".. Application Entry'-Tunis... 1019 t1M' RN my r ; "Wl� Ilk Q I - , E118 ................ W In�Ba 11 ;Z KOF ,V;. W if A.,, 0 �MCI xW MV17=Z7 7, 71 77Pv 77 "Y"t Nq P�Rt3442M!Q"" I %VtL —WNW RP MW ow A ` - 11 �� R A, '— ���ire, 4,, love, �W bf! qfbn 0- 11-411 1 "t? W ent :_PSMq�WA 22180123M MR21 A" 0 Ml , 4113 3 KJ wan WI ERiAN 'td'W7,,E8=--' , so W� �,F WT gap-amp, "'IF 1,EX+jAbtT'tATC DIN I 10"BAPI K,Z=4 WTWVTMM� 111�Z � ��OjjACMMS_ PL Qm- W OIS! Au �O N_ 4 WMIC-L, all OUR Macy ISLAND'Sye4v milli lot ' 5XII N't CIA 011,11 F'� �,ak i ci,,�- 1, 71 ".1, A VAJ coo "ST, 5�4 LIU-4/2 F 1"I'M MIR umalz R_ 49, lia WW�Uwl=� a -18 A M . .............. 3 IN is limp- _v I W-g-ft, _7 V4 Sil Sao WOW. t _10 taff IF u n t,, u qh qq)a_ An- S; j� mom E Al !jg, ir Mr-11.1 MIr", PHI Is k. - �6 �Mll Oil 1 v WRIF11 V MIR opt Pip W TW LmNIewmm T, MWO vig _W.M Nq OT1,13 i MUM _i: i MUM& nODO 5 1 MR te",V1 W-7, A Kziax 71., P K-4-2 A IS F, Mum" WO 11] W immu GOT W I TIF �7_7- k My so 10 " 1 0, 1 A, A HAW 2, ON QW., R77�'�!,:1, g�-L-jr:! es M rp SON Suvwx We v 12 �4 "IF 'f� 31 ON A"i 1 1.1-1 .W 3 EVER r7 "71 A M� �,J` W, AE12- W I_-Z I AW SiAl MIR f WIP Ma ta c ='FAA 1 WE Rig W IRA' t, 6VI he' 't 1-51�Mfr�Tv�Ilf A 5. jury PW TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 166 Parcel pp d ( A lication /ItV 7 S-_ Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address i,� C ar Village < <e� { ,Owner ¢.v a o p MG Address e)kLr%_ f"I ! r 1[VS'k 0\ Telephone�o �'_ 6 667 Permit Request C 1. C �f� (� e,l e- -}- V Square feet: 1 st floor: existing proposed 2nd floor: existing proposed', dal nv 'Zoning District Flood Plain Groundwater Overlay ` Project Valuation Ito 6uo Construction Type, Lot Size Grandfathered: = ❑Yes ❑ No If yes, attach sLpporting'GbcuR�entation. o rn Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION —- — --� — -(BUILDER OR HOMEOWNER)�- c `Name L-UV 0 ��� Telephone Number D -Address I C) l S I -S(m ha_ 1-7o License # 11 t W'S�w�� (M �'OS� Home Improvement Contractor# FM A i I � � �� e_ ��� ��, C o Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE e k FOR OFFICIAL USE ONLY APPLICATION# r` DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE f r OWNER v r DATE OF INSPECTION: _ -FOUNDATION fi FRAME i INSULATION z FIREPLACE I ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT F ASSOCIATION PLAN NO. f ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston;MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): .�.- �-P��lo h�w� L C. Address: u 1, (o l►1 f j. M ar-f h FZ oh CY1.0 S , City/State/Zip: f�lW 4 pw�V Phone#: S • ?"' P Qbo7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New constriction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These b-contractors have g, ❑Demolition working for me in any capacity. emp yees and have workers' 9. ❑Building addition [No workers comp. insurance p•'ns"'anCe• required.] 5. a are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work. officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑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. $Contractors 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 the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 hereby ce nder the p and penalties o perjury that the information provided above is true and correct S( i afore: Date: 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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,associaticu 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 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-contractor(s)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 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 De parb:ncnt of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4940 W 406 or 1-877-MASSAFE Revised 424-07 Fax##617-727-7749 __,. www.mass.go�fdia f Town of Barnstable 0 Re to„ gnla rY Services t BARNSUUM Thomas F. Geiler,Director AFM Y� r i65¢ Building Division `erg' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma-us Office: 508-862-4038 Fax:•508-790-6230 HOMEOWNER LICENSE LXENIPTION Please Print DAT& .( LP r�.JOB LOCATION: C `? �.0 rr C— L��I C Tzv V 1 number ,n street village EO:-HoMWNFR": -E "� �/Xs✓i��� 1'0� _-�P f— name home phone# work phone# --CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to'include owner-occupied dwellings 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. DEF *?rnON OF HOMEOWNER Persons)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-year period 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 m7n7mrrrn inspection procedures and requirements and that he/she will comply with said procedures and requircrpnts. Signature o om caner Approval of Building Official Not: Thee-fandly dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control - HOMEOWNER'S EXEN=ON I The Code states that Any homeowner perforarmgwork far which a building permit 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 am assuming the responsibilities of a supervisor(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 carrot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure t3raT the ho=wner is fatty aware of his/her respmsibtlities,marry communities require,as part of the permit application, that the homeowner scruffy that hdsbe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t.amand and adopt such a firm/certification for use in your cDmrr=ity. Q:forrr>s:hom=mnpt • r oFmEti . Town of Barnstable 04 Regulatory Services t BARN.CPASI 1 • y� MASS, g Thomas F.Geiler,Director s6g9. ♦�' Building Division Tom Perry,Building Commissioner 200 Main.Stwt,$yannis,MA 02601 www.town.barnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in an matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWMMPERMISSI0NP00L•S 62012 Mass. Corporations, external master page Page 1 of 2 William Francis Galvin Secretary of the �a Commonwealth of k t�� HOME DIRECTIONS CONTACT US jSeamh seo.state.ma.us Search Corporations Division Business Entity Summary ID Number:001007869 Request certificate I (New search Summary for: E&B DEVELOPMENT,LLC The exact name of the Domestic Limited Liability Company(LLC): E&B DEVELOPMENT,LLC Entity type: Domestic Limited Liability Company(LLC) Identification Number:001007869 Date of Organization in Massachusetts: 07-09-2009 Last date certain: The location or address where the records are maintained(A PO box Is not a valid location or address): Address: 1020 PLAIN STREET, 21JITE 170 City or town,State, Zip code,Country: MARSHFIELD, MA 02050 USA The name and address of the Resident Agent: Name: ERIC LIMONT Address: 1020 PLAIN STREET SUITE 170 City or town,State, Zip code,Country: MARSHFIELD, MA 02050 USA The name and business address of each Manager: Title Individual name Address MANAGER ERIC LIMONT 1020 PLAIN STREET MARSHFIELD, MA 02050 USA MANAGER ROBERT J. BRADY 158 LAMBERTS LANE COHASSET, MA 02025 USA In addition to the manager(s),the name and business address of the person(s)authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY ERIC LIMONT 1020 PLAIN STREET MARSHFIELD, MA 02050 USA SOC SIGNATORY ROBERT J. BRADY 158 LAMBERTS LANE COHASSET, MA 02025 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver,and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY ERIC LIMONT 1020 PLAIN STREET MARSHFIELD, MA 02050 USA REAL PROPERTY ROBERT J. BRADY 158 LAMBERTS LANE COHASSET, MA 02025 USA r Consent MA Confidential Data Merger Allowed r Manufacturing View filings for this business entity: ALL FILINGS rZ Annual Report j Annual Report-Professional Articles of Entity Conversion Certificate of Amendment View filings Comments or notes associated with this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSumm,gry.... 11/5/2013 Mass. Corporations, external master page Page 2 of 2 New search William Francis Galvin,Secretary of the Commonwealth of Massachusetts Terms and Conditions http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.... 11/5/2013 t Clctor C � P Q �� �� < < f 1 . q l�/�/l Official Use Only cannwnwaaUh o�M aaa Permit N ' , 1JaParfrnant of 5'm Sarvicad and Fee Checked �j (� Occupancy T BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRI�CA 12.00 ORK Q K OR TYPE`All work to be performed in accordance with the Massachusetts Electrical Code(NEC), L�h 013 Date:/�fl y T p IN Q (PLEASE PRINT IN 1NF� To the Inspector of Wires: City or Town of: ' � B this application the undersigned gives notice of his or her intention to perform the electrical work described below, y s Gc/ -UDCJ 010 Location(Street&Number) �� G�r/i Telephone No. 117 Owner or Tenant 30� Owner's Address ' Yesro �v. (Check Appropriate Box) Permit?Is this permit in conjunction with a building p Authorization Purpose of Building /Z ,a'�r r ��eEMZ No.of Meters Amps u-,/ -, Volts Overhead❑ Undgrd� Existing Service 2QX? Undgrd❑ No.of Meters New Service Amps / Volts Overhead 0 Number of Feeders and Ampacity c i G . r . et J Location and Nature of Proposed Electrical Work: e �e a �2 aye Cam letion o the ollowin table m be waived b the I Total r o wires. No.of KVA No.of Ceil:Susp.(Paddle)Fans Transformers No.of Recessed Luminaires KVA Generators No.of Hot Tubs o.o mergency ig ng No.of Luminaire Outlets Above In- Swimming Pool. v ❑ nd. ❑ Batte Units No.of Luminaires F1RE No.of Oil Burners ALARMS No:of Zones No.of Receptacle Outlets � No.o etection and. No.of Gas Burners InitiatingDevices No.of Switches Total No.of Alerting Devices No.of Air Cond. To No.of Ranges Number Tons_ KW_._ No.of Self-Contained Heat Pump, „_ ..__.._ Detection/Alertin Devices No.of Waste Disposers Totals: Local❑ Municipal Oth , Space/Area Heating KW Connection No.of Dishwashers Security Systems:* o Heating Appliances KW No.of Devices or E uivalent J J n No.of Dryers No.of . Data Wiring: SA No.of Water KW o, Si s Ballasts No.of Devices or E uivalent Heaters Telecommunications Wiring z a s Total HP No.of Devices or E uivalent W�'Z N No.of Motors Z No.Hydromassage Bathtubs OTHER: detail i desired or as required by the Inspector of Wires. `yam - Attach additional f • ?�Q N ... ��yLLw 4 en required by municipal Policy.) ®� o w Estimated Value of Electrical Work: �� �� �' f � Rul oLU LL g Work to Start: ( ) C7 5 Inspections to be requeste no aermit for�cth p rfMECannce of electrical wok may issue unless a INSURANCE C V RAGE: Unless waived by the owner, P. insurance including"completed operation"coverage or its substantial equivalent. The ii o a the licensee provides proof of liability permit issuing office. x undersigned certifies that such coverage is in force,and has exhibited proof of same to the 4 o CE BOND ❑ OTHER ❑ ( P fy:) LL W W CHECK ONE: INSURAN ®` er u that the information on this application is true and complete n �Y� Q o o a I certify, under the pains and penalties of p I rY, �� LIC.NO.: /2 �-C'tr' r�� ,-tcoi r ,C - FIRM NAME: LIC.NO.: Signature �?ar� • Bus-Tel.No.• Licensee: applicable,enter "exempt"in the license number line.) 1, p 7 Alt.Tel.No.:" ff Address: �'r '� I work re t s Department�f public Safety S License: Licce coverage normally *Per M.G.L.c. 147,s.57C-E1WAc� � ❑owner's a ent. OWNER'S INSURAN R: I am aware that the Licensee does not have the liability insurance required by law. By my signature below,I hereby waive this requirement. I am the(check one El owner Telephone No. PERMIT FEE: S Signature Emalle C • r 8'5. 3 T5 PROP I.. p !III t ER #�.�` T . 7 PA., t_ M U R g A Y. � ' -INSPECTOR ' .:.�i-I P�'_C T O R ' LINE TES T 76 �QL 6 + > ;� � ELEV. 13. 5 NDLE ,! �5;{s LOAM ANC SUBSOIL F SEArIC ` .� rANl< ' I Go MEDIUM SAND T-i Na Lo N E _SAID FOUNDATyotj 4A, g$ s rye"-. '✓• �. 5 NC ATw.K. 'SUN T R } LOT 1 (o TGUN WA7ER- 15 AVAILABLE P? 54t 5.u/LD/1VG S E7-0ACA--- A2f�U/Re—AIFw7Z5 SC:4 L E I = 90 0 F"20/V 7- SEPTIC 5 YS TEM CONS T2 UC T/OAl SHA LL CONF02M TO MA SS LIES[G/V FL.O bl/ r' GAL./j;A Y ' E N 1V/,e On/M L-N TA.G CODE T/TL, y { ?.7 Q R 1�l 5 TA r- L-..E A C 4 2 A TE c /�/,V/-4) /A/C/-/Q L..e. j� h/E�1 G TH Tz�GL/L:.4 7"/0 A/S RECPU/RL-U LEACq A,0fG� c-; 1 a 47 TOP OF F>20p05 E Z7 L.EAC14 A.2 E A 2 OF TCE,4 S70AUE -to, 00 MS5u'l-tk-�) MAA/Al0LE �CO✓6.0 7Tp C-x TEnlD Tp //✓I/oE2✓/DL/S CO VET? W/ TN/A/ /' OF F/A//5/-/C-,D 0r2.4 DE. TO Ia2E✓Eil/T .�1X1, S .c20M /iVF/L Ti2.G 7 ,.Co�/Uz5 DJS T. i ( STowE n�/Nin�JU,t,J co CZ ' BOX I Z/"W/Ac- Ol%e,� .4 CA57`/iZ0^J —„ —— r._ I I P/T — c Nf/Ni -6 M�e.l _✓ 3.,MIN- 4., D/A., �i7r-A/� FL Ow LINE �,� P/r � M�N .orrcy -^_ . / /O"M/N 2" 4 FOOT /4" �4��FooT /ircy. „ i D/A. 5jQ / Y 1�.JDL/ M /Nl/E.ZT Z STONE GA L L O N/ /IV VE,eT /NVE CA P"A C/ TY ,420Un/O. SE ,oT/G 7-A ti.e E1 EV. j:. ZC-270A4 OF, (W.4TGTZTIGNT). /A1 V ,�T. 1 )Q/7- /IVVEZT ND GA,e8A6E GR%AJzDE,2 5, 5 C. r LO<f A7-/O/l/ 3A EV T� is^� (CEtV'T 1 V°�LLl MAS 2EFE2E /�/GE: LOT r ` �c 1 EPT/G TA&IA;f .r>/ST'.2/6CJT/ON 80X L # 00ARTHUP 7`LETS� AND �aAc.l,%i,vG sir 1Q. '^FGR' ' s 3E O,� QE/tiFO,�CED G3iVC/zET A j{�y/Jj� ra.}t, OI�/G-2E TE ST.2E.VGTr�� .3000 ;C Mfit/ T �. fl. LT 1`t: ���_.r�'�./ TEFL 20000 " TiafZlr 7-AYL C�,e C OR P. H- /O LOAD/NG lSi/97 r�s5 tom`/C- L�J' t.�/ '. r-))C VE WAY /,10T TO BE LOCATED Y,4 .��C)L/7 L/ r n Ae 7- �-4:,5 . O V E,2 TE/✓I Un/•L E 5 5 Al- 20 / y ,,y� + or q E S/GAJ L 0A D/IvG /S USED. _L CERTIFY THAT THE r0UNDATION. 3#&t.,j 1 � ON rHl5 PLAN IS LDCA T ED .0 N, T H vs- TO 1- - Jr l;L Tt,�,,,;! OF L7/;ls< H T'/lj:Y 4.5 Y��'�•���5�� U 2 0A TE A/E-A4-7A AGEJc/T August 23,1979 -"'6^ Clen4eT-v*1/^^ Mr.Dennis C.Ruggers 67 Carrie Lee*s Way Centerville,MA 02632 Dear Mr.Ruggers: Recently you appealed to the Board of Appeals for a variance to allow a family apartment in your present dwelling. Since your appeal was denied I have had a complaint through the Board of Appeals that the apartment exists in violation of zoning, I would like to set up an appointment to review the property in order to avoid any further action. Thank you for your cooperation. Peace, JDD/gr CO!Board of Appeals Joseph D.DaLuz Building Inspector