HomeMy WebLinkAbout0012 DEEPWOOD CIRCLE i� �9 � ��
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Map Parcel Permit#
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Health Division Date Issued
Conservation Division Fee - 00
Tax Collecto/�
Treasurer C
Planning Dept.
Date Definitive Plan Approved by Planning'Board /' J
Historic-OKH Preservation/Hyannis
Project Street Address _1A3e,0 "J e X
Village
Owner Address
Telephone 7
Permit Request trS 3 d U��' Y1'�-
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Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
~ Estimated Project Cost Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: 0 Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
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 Cl 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
BUILDER INFORMATION
Name` ���di ����/ �d� Telephone Number
Address License# OS *;7
ell 1A, Home Improvement Contractor# fL? ln�Q
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE . DATE
FOR OFFICIAL USE ONLY
ON
P0MIT NO.
DATE ISSUED ;
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER. .
DATE OF INSPECTION:
FOUNDATION
'FRAME f
INSULATION
FIREPLACE '
ELECTRICAL: ROUGH FINAL }}
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL _
FINAL BUILDING - '
DATE CLOSED OUT r
F �,
_ AASSOCIATION PLAN NO.
- cC1—\
. _'__ The Commonwealth of Mass
achusetts
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Department of Industrial Accidents
IOI/ICe of/OyesffoatiOOs - -
.� -% ( r6O0 Washington Street
`, T Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
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I am a sole r rietor and have no one worlds in achy
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have .
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Fafimx to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a .
copy of this statement may be forwarded to the Oice of Investigations of the DU for coverage veriilcation. -
I do hereby cerli the pains and penalties of perjury that the information provided above is tri correctL .
. Z. . Signature �- ��� . Date _
Print name a t2j'-/ \�� Phame# �o7C` —d�r R
official use only do not write in this area to be completed by city or town official
city or town: peradtNcense# rIBufiding Department
❑L1censing Board
❑checkif immediate response Is required ❑Selectmen's Office
. []Health Department
contact person: phone#; ❑Other
Ocyind 9/95 PJA)
Information and Instructions .
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Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or
trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority. -
Applicants.
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names,address and phone members along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested,not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Departmenrt 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 applicaa L Please
be sure to fill in the peraih icenm mmmber which will be used as a reference manlier. The affidavits may be retunued tr
the Department by mail or FAX unless other arrangements have been made. -
The Office of Investigations would hike to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Imce of IMIU029083
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 eat. 406, 409 or 375
IKE tql,_
The Town of Barnstable
9� MASM& �m� Department of Health Safety and Environmental Services
059. Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
f ;
Type of Work: Estimated Cost 3.' j
Address of Work: / fez
Owner's Name: lf'
Date of Application:
I hereby certify that:
Registration is not required for the following.reason(s):
Work excluded by law
Job Under$1,000
Building not owner-occupied
❑Owner pulling own permit ;
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner: may,
D e Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
DEPARTMENT OF PUBLIC SAFETY
ONE ASHBURTON PLACE, RM 1301
B0STON MA 02108-1618
CONSTRUCTION SUPERVISOR LICENSE
Number" Expires: B ir_t.h.da.t-ems
CS 057710 03/05/2004
Restricted To: 00
BRIAN D CLIFFORD ' _ r
10 GOFF TERR
CENTERVILLE, MA 02632m;
Keep top for receipt and chan�
of address notification .
T... ..
. 'Y J4�4
'1
4e
hPY
HQ IMPROVEMENT CONTRACTORS REGISTRATION I'
oaof Building Regu'la'tIons and Standards
One Ashburton Place'" ''Room x1- 01 ?
- Boston , Massachusetts 102108tS
z• - � al �x cats�"��t°'g���` °t si��.�r5- `X°F},�. 4{ Fel c;t+�xi,�,tom: I
HOME IMPROVEMENT CONTRACTOR
Registration 106566 Expir6tion «07/24/00
Type — INDIVIDUAL
vz,gatr *� �a: �-n" HOME.IMPROVEMENT
fey
ti* s �, �' Registration 10
BRIAN CLIFFORD Type - INDIVIDU
����yy.. Y L F fig Tiff j f�4-t.`"' d
Brian D . Clifford = � _ �. Expiration 01�
10 Goff Ter -
I
Centerville MA_ 02632 BRIAN CLIFFORD
¢� L Brian D. Clifford
-ijImo off Ter
ADMINI s AMR eenterville MA 02
TOWN OF BARNSTABLE Permit No. __2 $g_______________
. i Building Inspector cash
.. ________
MYL
O r►Y
OCCUPANCY PEf2lVIlT Bona
Issued to David Building Trust Address
Lot A, 12 Deenwood Circle. Centerville
Wiring Inspec Inspection date
Plumbing Inspector Inspection date
Gas Inspector �`, Inspection date
' Engineering Department pection date
Board of Health Inspection dae
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.
3 13 fO' �.,��
Building Inspector
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
asaa NASAL S TOWN OFFICE BUILDING
i639' HYANNIS, MASS. 02601
`
MEMO TO: Town Clerk
FROM: Building Department,//-10- �
DATE:
An Occupancy Permit has- been issued for the buildingaauthorized by
BuildingPermit $......... ......;2- ......................................................................................................_................._
issued to��lj.!. ....�✓„��l rr..�✓s.,...X, e's ....1.. /..'.................
Please release the performance bond.
THE FOLLOWING
IS/ARE THE BEST
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APP� /C,Q/l/7� %�.t•.. rW{�
Assessors map and lot number j....... .....
t CF 7NE 7 Ali TITLE Q�.
Sewage Permit number �,.>�.....� �.. ....�.. ... . �4 VIRO NMENTAL 1 OE AN'C)
PF ONb Z B8HB�9eMULE, i
House number ............ .. .. ..........................................::.. 900 1639 0�
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MPY a'
TOWN. .OF BARNSTABLE
BUILDING - INSPECTOR
S - -
APPLICATION FOR PERMIT TO ..���:� Q' s!"'p G' �h'i'?!Gy ':n
........ ..................................................
r
TYPE OF CONSTRUCTION ..........r'. ?.......���"?: '......................
...... P .'.�.....%/.....................19..�s......
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ........ram?..... ......... ..... e"4>r. ."........�-�^'r .........................................................:....
ProposedUse ...:.... iv ....... .......... ..............................................................I.........................
Zoning District .......! .....................Fire District ....�!2.uT:...?-s-.,?.................................................
..................................
Name of Owner ��'u� E u�:.C4` y4....rK� .....Address ..P4....4f�?:� � !� ""� 6
............. ...... ........ ...................... ....................................
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..'......................................... .Address `...................... ....................................................................................
Number of Rooms .. .!.Y.�?t.................................................Foundation ..Pvu�ea' L'B•�.C�
.....................................................
Exterior ..... ed ..:... ..........................................Roofing .... ..........................................................
FloorsA .....Interior did! .g G L
Heatingw ...... �Q ......................................Plumbing .......a....�x....�......9..sit5...........................:..
Fireplace ... ....................................................Approximate Cost ....9V,.0a!:R................................� .........
Y U ��� .r¢ -
Definitive Plan Approved by Planning Board __ _ _ Q________19_______. Area ,... .................................
Diagram of Lot and Building with Dimensions Fee ....� �� .....
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I
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. "
i
Name . ........... ....... ......................................................
Construction Supervisor's License ................
__ 1
D�V' LDING TRUST _
No ..2$459.... Permit for ...One Story ..
Sin le Famil Dwellin
Location ....Lot 4,.... 12 DeepwRAS�..�zx.C.l e..
... Centerville
Owner David Buildin Tr
................... .........g.......11 .C..................
` Type of Construction .....FxaMe............................
...............................................................................
Plot ......................... .. Lot .................................
Permit Granted ............Sept...2.4...........19 85
Date of Inspection ...... 19 1`
1
dte Compl e l , -� .: ............19
ems' •' _ - .
F
Assessor's office(1st,Floor):
Assessor's map and lot number
SEPM SYSTE
Board of Health(3rd•floor): / l INSTALLED
tN
Sewage Permit number 'k
Engineering Department(3rd floor): �Z �� WITH 71
House number s ENVIRONMENTAL
Definitive Plan.Approved by Planning Board 19 TOWN ry a' a
_;:,�. ,
APPLICATIONS PROCESSED 8:30-9:30 A.M..and 1:00-2:00 P.M.only
TOWN , OF BARNSPAnBb PROVED
BUILDING INSPEC
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION O 6
19 ►.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location
Proposed Use J ° R-V,,ed
Zoning District-
Name Fire District ������:1 OS`moo t I
of Owner ko r f,vn CCAO-r'.lft Address o l"
Name of Builder V o�L4 , Address on
,
v �1
Name of Architect Address
Number of Rooms FoundationDIA.
Exterior ` 60& �''n C n Roofing r l �-�'(^S� /Asp A I
A
Floors ` Interior v e�
Heating ,v Plumbing
Fireplace VY%k Approximate Cost V'U'h • f?t�
Areal SG. •A t,
Diagram of Lot and Building with Dimensions Fee
099-
�2- I z
79 '
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name "``a� .
Construction Supervisor's License 6115 C�
GARRETiT, LORING
c! No 35646 - permit For BUILD SCRE'NED PORCH
Single Family Dwelling _
f .Location Lot #4 , 12 Deepwood Circle
Centerville
Owner -Loring Garrett -
Type of Construction Fpame ,
Plot ' Lot
Fuar � -
Permit Granted Y -.2 , 19 �3
Date of Inspection 19
Date Completed 19 f r _
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MORTGAGE SURVEY. PLAN:.
SCALE.1 IN.= 30 FT. DATE'. S:..Z9=8lo PLAN:REFERENCE: BEING.LOT 4 ON A PLAN BY
IJvE $ BAxrE2 Tn.; �lS DATE® ?'utJc i to i 9 8�/ RECORDED IN ___ BA",eGrA L
REGISTRY OFDEEDS75�sr, Le .BOOK'41,&0 PAGE' 3�Z Lr3i< 387 P69
I HEREBY CERTIFY THATTHE BUILDINGSHOWN ON:THIS.PLAN IS LOCATED OUT GROUND AS SHOWN,
AND-CONFORMSTO:'THE ZONING-LAWS OF'THE TOWN OF_ BPQpsT,48u: i
1 CERTIFY THATTHIS LOCUS DOES,NOT-LIE . Rap
WITHIN'.THE.FLOOD HAZARD ZONEAS /.07-4/ �EEPthloofl �l./L,
DEL'INIATED F��ON MAP �j. D ��//� YERNE T. PORTER
�/ � - --"-
COMMUNITY �1�57-,+)51.� N292 EWTON,NGLEY02159
ROAD
THISPLAN NOT MADE FROM AN INSTRUMENT SURVEY, NOT TO BE USED i �� e,•�,,
FOR FENCES, ETC.. FOR USE OF.BANK OILY.-
L
Assessor's map and lot number ...... ... ,`.. ... . ' y FT NET
Sewage Permit number d� y�
Z EARNSTADLE, i
House number ............ .,....: .............................. ... 9O M486
1639• -.
0 YPY a'
TOWN OF BARNSTABLE
q
.a
BUILDI-NG INSPECTOR
APPLICATION FOR PERMIT TO ..��° c ""� .... '�''��l .�me
TYPE OF. CONSTRUCTION ............'X.elP...... °
.....�P.. 4: ......//....................19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ........: V' l!&�CG - CIc�.Y/��c�,t' [a
Proposed Use ........:�u r�n F�m.t.si..... r f' .......................
Zoning District ....... n .......v 7�� :...IJ..S. . ......................................................................................Fire District �....... r..:..................... II
Name of Owner .�t��� r�3 ..�c�' ..,c� Tisr......Address ..f�a... oX >v�....... .2.rjP......;.. � .............
Nameof Builder ....................................................................Address ............................:.........................................................
Nameof Architect ..:.........'......................................................Address ...................................................................................
Number of Rooms .................................................Foundation ..P..`u�r��' c"a•.l2.nX.
Exterior .....nP�Y•9 =;,bi .....................................Roofing ........ �:9.!...'.'........................:.................:...............
..............................
,vim ��,,o i
Floors ...................................................Interior ......�!Y"ws
v
Heating .... K-7Y......G �C Plumbing ....B�T'`'`S
Fireplace ..�P.¢-`c.rQ / .........Approximate. Cost .'f Ci.;csnc..................................................
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
hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name . ,/, �,t. � ., `� ..................................
Construction Supervisor's License .................
DAVID BUILDING TRUST A=169-13
1�9-0/3 -goo¢
No ...U45.9... Permit for ...One Story
...................
Single family Dwelling
................................................................
Location Lot 4, 12 Deepwood Circle
................................................................
Centerville
...............................................................................
Owner .......Dauicl....Building..Txust.............
Type of Construction .......Frame........................
................................................................................
Plot ............................ Lot ................................
Permit Granted ......Sept.....24.................19 85
Date of Inspection ....................................19
Date Completed ......................................19