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Home My WebLink About0033 EBEN SMITH ROAD J .. .. .y.. it e v = r Town of Barnstable *Permit `�d� Expires 6 months from issue date Regulatory Services Fee anxxsrnarr:. v MASS. g Richard V. Scali, Director 1639• �0 plfD MA'S A Building Division Tom Perry,CBO,Building Commissioner Ok 200 Main Street,Hyannis,MA 02601 LT www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 5a� a5f .aI ;S 14.1l l t4- (U-. [residential Value of Work$ 0 9ao, -Minimum fee of$35.00 for work under$6000.00 I Owner's Name&Address 'Z' Contractor's Name�)AT.-i ?f ,`t.iV4 Telephone Number Home Improvement Contractor License# (if applicable)1 r9 1'1 Zfj Email: J®N� .; ��r>�a a► �d etiCf361 Construction Supervisor's License#(if applicable) 1/4 U of) ❑ � Workman's Compensation Insurance X- REn � MIT Check one: [&l am a sole proprietor NOV 13 2014 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Ai1-Mo ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .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: Issuance of this permit does not exempt compliance with 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. SIGNATUR lh-cp Q:\WPFILES\ ORMS\bui ing permit forms\EXPRESS.doc Revised 061 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 Legiblv Name(Business/Organization/Individual): --/S ooc�lj 1�_5 Address: City/State/Zip: 63.mMkuA'L qA .0o-,o3d,Phone#: 1 ,� 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 construction 2.al am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'.comp.insurance comp. insurance.# required.] 5. ❑ We 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 St, rt,;� 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 5`-ink + 1 City/State/Zip: f 2U�1� C7�h�o 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 ify under the painsandpenalties ofperjury that the information provided above is true and correct Sip-nature: Date: \G 1 t-( Phone#: 7-) Official use only. Do not write in this area,to be completed by city or town official a 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual partnership,association or other legal entity,employing employees. However the r r� r 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 itsolitical subdivisions shall p 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents t. Office of Investigations 600 Washington Street Boston,MA 0211.1 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia �A�ISSIr:t,t,Set is {J...��':,�,�.,!t :it ric" r(I r. ................. �/�./ ' .. Office of Consumer Affairs& Business Itegolation C$-014007 OME IMPROVEMENT CONTRACTOR egistratfon: 101149 Type: " John P Dunn piration: 6/25/2016 Individual P.O BOX#924 Marie Ann"I'erram JOHN P DUNN Centerville MA 02632 i John Dunn 80 MARIE ANN TERR. � � 05/25/2016 CENTERVILLE. MA 02632 [Undersecretary I q Unrestricted - Buildings of any use group which License or registration valid for individul use only contain less than 35,000 cubic feet (991 m;) of before the expiration date. If found return to: enclosed space. + Office of Consumer Affairs and Business Regulation " 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not valid without signature For DPS Licensing information visit: www.Mass.Gov/DPS i ! r� 0 ff BARNSTABM MASS. i639. Town of Barnstable `eg Regulatory Services Richard Scali,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 If Using A Builder t I, A as Owner of the subject property hereby authorize -1'tii 0. y►1.1 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QAVYTFILES\FORMS\building permit formslsmokecarbondetectors.doc Revised 050412 �, ,� a c ,��J 7'3`�� u , ` Y_V r Asessor's map and lot nu ...... ..................................... CF THE t0 C SY T Q.. S EM MU Sewage Permit number ...........�.�' ............................. SEPTI o� INSTALLED IN COMP • TADLE, i WITH TITLE 5 0 House number :. r rasa ................. ........................ ..... ENVIRONMENTAL CO® 1b3Y.a\0m TOWN OF ,-BAR.NSTWHIL It ATIONS BUILDING,:- INSPECTOR . r APPLICATION FOR PERMIT TO .•..�.:.......::..........::..................................................................................... TYPEOF CONSTRUCTION .......�- ...................................................:............................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..lam-.Z..-. ./ ............. /�...... .� .. ��.:-.... .................................... ProposedUse ..._ .................................................................................................................... Zoning District Fire District................. .......... .................................... . ...................................... Nameof Owner ..................................Address ..................... ........ ... .:............................................... Nameof Builder ......... .......G..�.........................................Address .................................................................................... .Name of Architect ..................................................................Address .................................................................................... Number of Rooms ........?...................................................Foundation Exterior ....................... ....... ............................................Roofing ................. . ................................................................ Floors c ..r'T""' ""........................................................Interior Heating / G ....... .. ::.......................................................Plumbing � . Fireplace ... . .. .................. .................................................. Approximate Cost ..... .... ... .44- &:J. '.`''............................. Definitive Plan Approved by Planning Board ________________________________19________. Area .... ....... Diagram of Lot and Building with .Dimensions Fee ....... .......... .......... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r ding the above construction. Name ......................... ........................................................ ,SMALL, ALAN t '-"No 2.236.6.... Permit for One...S.tmr. . a ....,.Single, Family..Dwelling.............. Location ..Lot...1,6.8...*3.3:••Fberi•••Smith...Road r Centerville " ............................................................................... , a Alan Small Owner. .................................................................. ' k Frame Type of Construction t r ............................................................................... Plot tot e................................ ii i Permit Granted July 24 .........19 80 ................ / c Date of Inspection { /�. ......19 +� Date Completed ..................... . ..19 � PERMIT REFUSED ' /.:.......R-W........>. ..................................... 19 ....... � ... ' .................................................. ' ..................................................... O 3..tr.. .. ?..:................................................:. I APPre, a............................................... 19 sri- . ........... .................................................................. ,... �/�� .. o Assessor's map and lot number ...... ......... CV ':..:............................ b�P�pf THE't��♦� Sewage Permit number ..................... 1 Z BA239TALLE, • y r House number ............:. rasa �p 039. 00 Aj�,p AIPY a� "TOWN OF BARNSTABLE w BUILDING INSPECTOR APPLICATION FOR PERMIT TO '` �!,- "............... ................................ .......................................... TYPE OF CONSTRUCTION ........ aDG:...................................:.................:............................................ ` /..kl.. , . ...............19. ;.... . . f. TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit bccordirig-to'the following information:) Location .: ................. �...................s..... /Yl..f .. � .1!.....1.,...� � .......................... ProposedUse .......................... .......................................... ...... f !• ... ZoningDistrict .............................:...........................................Fire District .....................................r Name of OwnerL� .....�'...........................Address ......... -G ?:'.`" :�� ....................................... . ' t Nameof Builder ..........:.........................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... z Number of Rooms. Foundation .............................................................. � �......'P...�f�....................................................................................Roofing ...........�..•'�`.- ..`.. �:r�...................... .................... 4 .::............................................................Interior ...,�' .... ............._.: .. Floors ..........�:`��...�� .°tf �.r 7 �,ir.�.^..�!-�`:............................................ y Heating !.......... ..%..:..f:...............................................Plumbing ............ /.�....� . a Fireplace ..... �'1%�..:��........>...................................................Approximate Cost .... t.. :�Zr�� o `•. ... a le—_ - . Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..?.... ..................... Diagram of Lot and Building with Dimensions Fee .................... ..................... y SUBJECT TO APPROVAL OF BOARD OF HEALTH es �,," r r' .�i"" '...• ..��.r; .�'j' �,✓"t ,•'`� .c±mil 0 r' e i J f, 7, E H ; I hereby agree to conform to all the Rules}and Regulations of the Town of Barnstable regarding the above construction. * • 1 Name ... ' .... .......% ..... r''�r'�� ....................... .-_.•-is µ. r.:s.:S."-:,a! ..rF.h.s:.w°..�f..r'=u..;tY "�.i�kt. _..45` .. -�k+�m.1w.N-�-A� l:��Ef%Y(.SM�'+ilti..y.ff. u�a....6}1.. A=171-201 SMALL,;;�Alil No 223-66.... Permit for bne...Story ....................... ......Sing�,!�Jami;�y...I�K��.jin .. ........ ......9............... Location .Lot.....16.. 8 #33 Eben Smith Road ...............................................Centerville ............................................................................... Owner Alan Small ................................................................ Type of Construction .........Framl�.................... ........... ........................................... .................................Plot ....... ................ L t ................................ Permit Granted .........July y 2.4 . .........19 80 ..... ...... Date of Inspection ....................................19 i Date Completed ......................................19 PERMIT REFUSED .................................... ....................... 19 f............... .. ... -,P/.............. ............................... ............................................... ................................................................................ ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... TOBPN' OF BfARPTSTABLEPermit No 2 3 6 t cling' In or r t n.� Btul speot ww A -Cash OCCUPANCY PERMIT. pondX Y L No building,-nor,structure shalh be,erected, andlb land, building or•structure�ahall be, used for a new;'different;°.changed, or enlarged' use �Without 'a=.'Building'Permit therefor' first having been obtained from the Building.-Inspector.:No,building,shall+'be occupied.,until a certificate of occupariey has been.issued'by the..Building Inspector " Issued to' ALA1�T -SMALL, -, naaress Ce�tervillEi T.nt �lrR 'i3 'FhPn Smith .Rct{ad: Centerville Wiring Inspector' �, n -. ✓4 _ Inspection date r�1<. 6 Plumbing..Inspector"� ''. ,f � _ r r ' Inspection.datef f �iga�v...�• s Gas Inspector ` In$pectloa'd"ate '. f !' �sr 1<Engineering Department ` ,� q//y Inspection,date ' THIS,PERMIT.--WILL NOT-BE VALID, AND THE BUILDING. SHALL x NOT'.,BE,, OCCUPIED UNTIL. SIGNED.,BY THE BUILDING.-INSPECTOR .UPON`.SATISFACTORY -COMPLIANCE `WITH TOWN REQUIREMENTS.. t livt �� 19f d Buildmg�Inspector Nr Gam=tGt�l Z��;I-A— t" 4:3 Uc MJ1( n�17 �E_PT I G �r'�s�l►C = a30.� I S G i _ zl-i j p U. - C)S�- ' L 71-'ISPC�SA�- PtT - vsE t ooc-� ��nl AA i e. (pF�C/�►l L Tie J c c)AA aiZr--v.= eo ST-. 47S ,s r lit Tor Pw t�2G�LaT101.1 tZATE `„°u rLh(°�• n2 ��f,• � 9$•/ r- � o� m } Lour.° - Ppe io00 luv. n SvU°6. 4��P 771Sf. tf IW GA•L• 9G•J - r -Box `r 9G.� sevr°c Wv. t J rAw V- — � 1000 K5 ?� GAL— 45.E `��•�. PIT WA'H1E.J • Mb G.EQTlF%ED PLc) _Ptzo-F-:"r L-E: Loc-ATI o -4 C-Gfh' lZ ►10 c�aL �CALk, I � Tr-lAT TI�r U�AT!(71.� 5.uo�ctu P� L';.�.I iZi=i-i✓Ri=V-1C_E- �l�rz•r t 1- r h-� _____�_._ t-l�.r;'t��e..l Gea��tr'�-�(S �t/ ►Tr-Z Tt-14: 5l D�.t..t►-�E= �� Aut> �,CT1 >nct! 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