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Home My WebLink About0044 EBEN SMITH ROAD EBEn� Sgrvdi k� Q U Town of Ba stable *Permit#�� q, Expires 6 months from issue Regulatory Services Fee 4& �- r snxxsrABM MASS, g Richard V.Scali, Director AIfD MAC A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6D0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number �� r �` oo Property Address . t�[Residential Value of Work Minimum fee of$35.00 for work under$6000.00 $ ��n-. Owner's Name&AddresslU� y� ��u SLR rM �Zr� � C�►��2.J� t� � �C�d v�-�3�, c _ Contractor's Name ,_�t t �� Telephone Number Home Improvement Contractor License#(if applicable) \(j Li Email: %jN t l A Q r►e.ASc a ti'e"t Construction Supervisor's License#(if applicable) q CX-Q ® ❑Workman's Compensation Insurance MIT Check one: OCT 2] 201� kL I am a sole proprietor ❑ 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ®--Re-side 'V%�4 YL Sk4c c.1( .❑ #of Replacement Windows/doors/sliders.U-Value (maximum .35)# d windows 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. SIGNATURE: Q:\WPFILES\F S\b 'Iding permit forms\EXPRESS.doc Revised 0613 3 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): 0'JQ Address: !✓ (� `�'�c Rr3L� ANnV- t3-2iZ City/State/Zip fit'i, Ak Yf k. 0063c_;�, Phone#: �&Qb-7`l 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 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2., I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑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 l l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other IAA[ comp:insurance required.] 'Any applicant that checks box 41 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.Lie.#: Expiration Date: Job Site Address: M UaF—I'l !!g7mI` R- f-1 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 inthe 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 here certify utl er the pains and penalties of perjury that the information provided above is true and correct. Siana �-4/J Date. Phone#. �� ✓ Official use only. Do not write in this area,to be completed by city of 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#: i Mass achusetis C)ep<,rtment Of r'ubh,,_ ,.,te;:ry`r — I Board Of Building ,Regulations and Standaros OfriccofCansumcrAffairs& ISusincssltcgulation t "n lru li„n Sul rr i.,,r OM IMP IMPROVEMENT CONTRACTOR ce"'se CS-014007 registration: 101149 Type: i xpiration. 6/25/2016 Individual John P Dunn P.O BOX#924 JOHN P. DUNN Marie Ann Terrain ` Centerville MA 02632 John Dunn I ,tll 6G�_ 80 MARIE ANN TERR. ,,,,,,,,. 05/25/2016;,,,,,_.CENTERVILLE, MA 02632 i Undersecretary License or registration valid for individul use only Unrestricted -Buildings of any use group which i before the expiration date. If found return to: contain less than 35,000 cubic feet(991 m3}of r Office of Consumer Affairs and Business Regulation E' enclosed space. f 10 Park Plaza-Suite 5170 + I Boston,MA,02116 ' fI Failure to possess a current edition of the Massachusetts ---- P P State Building Code is cause for revocation of this license. Not valid without signature CFor DPS Licensing information visit: www.Mass.Gov/DPS f J�1J�I s I .sr rs .. X. BARNSTABLE, i i6;¢ peg Town of Barnstable Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I /1vL s , as Owner of the subject property hereby authorize � � to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) /0 a/ / Signature of Owner v Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\smokecarbondetectors.doc Revised 050412 oFz„E r Town of Barnstable *Permit# 10 ,y Expires 6 months from issue date v Services Fee tiAMSrABLL Reulatol'y b 9 M"S& Thomas F.Geiler,Director059. f,�-},,,,. ��/ '�Eo►�y' Building Division �/ Elbert C Ulshoeffer,Jr. .Building Commissioner _ 367 Main Street. Hyannis,MA 02601w Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION Not Valid without Red X•Press Imprint Map/parcel Number Propert Address 17"/ F 8 6N SA117-14 Value of Work 43 � �`y4�� Residential OR ❑Commercial Owner's Name&Address M, 1 K L .S'®Al ®-S - 14/V F— 8 lAt _94A LUt IUD. Contractor's Name 9049it'14��- Telephone Number _ Home Improvement Conisitctor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor %r nnl=sS PERMIT ❑ fi4am the Homeowner ff``�` 1�� ave Worker's Compensation Insurance MAY Insurance Company Name. Lib ri T Workman's Comp. Policy# 1 r Permit Request(check box) e-roof(stripping old shingles) Des nB s c ❑Re-roof(not stripping. Going over existing layers of roof) ` ❑ Re-side ❑ Replacement Windows. U-Value (maximum..44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservauon.etc. Sisnature expmtrg Asssor's map and lot number .. .:7/-7.��:/E pf tp 7N E es P i Sewage Permit number ........°Gv... l ............................... . SEPTIC SYSTEM M ' "STALL D'IN COMP s TAM LE�, .....House number ............................... a WITH TITLE •e ' ENVIRON 5 o MaY a' TOWN 'OF_ ZARN�S LATION TAB ` TION _ �.. , S j BUILDING, INSPECTOR APPLICATION FOR PERMIT TO '' ............................................................. TYPE OF CONSTRUCTION ......... ........ ... ...... ............................................ .... ...............19. ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit. accor ing to th following inform ion: Location .......L: ! ...........`' ......e-�(.......... .. ...... . .................. ProposedUse ... . ... ........... •................................................ . ....................... .... ........................................... . ZoningDistrict .................................. ....................................Fire District . .......................................................................... Nameof Owner .. .. ... ................. ......................Address .. ... ............ . .. .... ..............:............................... rl Name of Builder ................................ �.......................~......Address ............................. Nameof Architect ..................................................................Address .................................................................................... .Foundation ..Number of Roo s ................................................................. :......................................................... Exterior .... ........... ..... ..........................................................:Roofing ..... .................. ............................... ... Floors ..........................................................Interior ... 4 ................................................. Heating ..........ec..a..l7..:.............................................:.Plumbing .................. Fireplace ................. ...............................................Approximate Cost ........................... Definitive Plan Approved by Planning Board -------------------------------- _______. Area L ''"e......................... r� Diagram of Lot and Building with Dimensions Fee e�, '� SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby .agree to conform to all the Rules and Regulations of the Town of Barnstable regar g the above construction. l0 i— f SMALL, ALAN Permit for One StQKY.......... Single Family Dwelling.......... ................................................................ Location ...Lot...#.?:Tj....4.4...Ebeyj...:5T ............... ................................ Owner-*- Alan Small...................................... ...................... Type:of Construction Zrame.............................. ............................................................ Plot ............................. Lot .......... ..................... Permit Granted ... December 9—..............................r 19 80 Inspection .19 Date of I .... ............. ... .. Date Completed ............ 19- PERMIT REFUSED ...... ....�..45Z...................................... 19 .......... ............................. :> ...........V, > ................................................... T .° . .......... ................................................ ........... ............................................. -A Approved .................................. 19 ............................................................................... ............... ............................................................... Assessor's map and lot number .. ,fj� Bpi THE T0� Sewage Permit number ... . 71tom ............................. Z ]BAUSTABLE, i y House number ............................... ..,.................................. 90o rb 9. ♦� TOWN OF BARNSTABLE tr �, BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ �..'. :` a err sr :.................................................................................................... TYPE OF CONSTRUCTION ............ ............ ..................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......................... ............. ..................:y..::............ .'.. !r..:`:....................:....:.`..:'..:... r.................... ProposedUse ................l............A ...............................................................................................................I......................... -Zoning District ........................................................................Fire District Name of Owner ...... ..: :........................ °..f........................Address ...........'.:..:..:...:':........................................................ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ......... .......................................................Address .................................................................................... r Number of Rooms ..................................................................Foundation . �. .............................................................................. Exierior ...Roofing n'? ' Floors Interior ........................ ................................................................... Heating ..................................................................................Plumbing .......: ..................`... ..... ...................................... F'f• Fireplace -J f...:.. :� «. . ..................................Approximate Cost ............................ ..:: �T. �. ............ : . � ................. Definitive Plan Approved by Planning Board ---------------_---------------19________. Area °...,..''Y"'`.. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH s I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ .:' :..............................`................................. SMALL, AI,AN A=171-158 No ... Permit for ..,One Story,,,,,.._„ Single FamilX Dwelling Location ..Lot #2 71...4. ... 4 Eben. ....Smith...Rd. .. .. .. .. ....... ............ . Centerville ............................................................................... Owner ....Alan...Small.................................... Type of Construction .k:xanlQ�....................... .......................................... ............................. Plot ...................... Lot ................................ Permit Granted ...Dec_ember ..........19 80 Date of Inspection ....................................19 Date Completed ............�!.....................19 PERMI REF U D ,U .. .,�,1. ... ..:�...�. ....i .......................... fs�i... ............................ Approved ................................................ 19 ............................................................................... +j� 1 J '✓ '... .r :�,i^- 1 -.' .'}. `� ''y�......,..r--.-�.-.e"4 - '_ - . IVY _",/' _. • .S Awe � t �� `�'� 'TOWN. OF 'BARNSTABLE _No 227G2 - Permit- Bulldsng Inspector'' r nPoa Cash- - OCCUPANCY PERMIT . Bond Z No building nor structure shall be erected, and no land,.building or structure;shall.be used for a:new,:different, changed, or enlarged,use' without: ,a Building :Permit `th64 . first having been obtained from the Building;Inspector._No.building shalLbe occupied until w certificate .of occupancy has been issued by'fthe Buildmg�Iispector:" 'Issued to Alan Small " !,Address Qdntervi le r lot #271 .44 Eber1-19mzth load, Cente:-v Ile, r X Wiring Inspector' ;`� /�� Inspection date' - -Plumbing inspector. 9 �� - ±y Inspection date G'as Inspector t� l Inspection-date_. /Engineering Department T / Inspection`date j 7If'rt1 tl•/a'�//fit' f�'/ � / THIS PERMIT WILL-.NOT BE VALID, AND THE BUILDING-.,SHALL NOT BE. OCCUPIED, UNTIL SIGNED,BY THE BUILDING INSPECTOR. UPON SATISFACTORY'.COMPLIANCE,"WITH: TOWN— RE QUIREMENTS. 7 Building Inspector ►.ao Gar-_�.�c� r_,��I��. I b�rarer �; 7 tt-�4 F-I-Ow tIb = 3 o G PD. ��PT-1Ght�11C = 30 r (�7G % U Ste- l ooC:�, G A L-. 9& 98 0 SPC?SAt_ P(T Irmo SI✓ A $OT-l-OA/l 5r A t .cam 5f7 ra.F?17. 2'iD t.: \ ,1 P,r TOTAL .425 G.P.a. f�roP To-[T,6 t_ U d t t-`f r--��c� = 330 6.w. 91 o � ` _o Y K•'tv G�fZGt7l.t\Z"tOt.l C7_l�TE✓ l��It.l �L�4tIIJ� 0t� LASS. � _ • 99•0 /D _ 257 f "�y ••�. t�i �-�+' Wit.� °+� .yM f t to A tt+( 2 tug. Snc� loon �c:9.c tuv. t(?V• .. - ! PST a' WITt.1 •i � �VASi/ED I STOWS- CGS�D ►�4 c.ECTtPtc U -0-r Pi ol:-t t_E-- t_oCAT I O t-.Z �'&G► /3" u o Sc��+r �r..�i~t= � I I:. ,t�j ��.�-t=- i 1 �Z# ��v l.'r AT . c_m Iz-r t t=� T t4 A r T t-t E; v � �r t n 5 uo.,v►� _t t� �?: r'� ��.t cE� W iTr 4 TI--t LOT lovaw GCS= u UrtJ A.eJ 11.1 ry('[?:�1✓i t�t.l (,�fjCJt.\�t�y +�{Tt1�LJ�. `I✓h't-..tj�tY�y 1JI�T/�F-V l,.t�l�t...l tr��1 It A i � �lt'1��,,.�e i��i,�r�