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o�tHE r Town of Barnstable *Permit# 8! -/ 1
Expires 6 months from issue date
• i
snrwsrABLE. Regulatory Services Fee _
M^ Thomas F.Geiler,Director
039. Building'Division
Tom Perry, Building Commissioner MAY I
200 Main Street, Hyannis,MA 02601 '
Office: 508-862-4038 TOWN OF 13ARNSTABLE
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address
[7Residential Value of Work tt W.4 Minimum fee.jof$25.00 for work under$6000.00
Owner's Name&Address vtA QriSLG SQ � rV 1 l"l A
Contractor's Name U1t� ,at
Telephone Number 5C�g-7,Al 6 9 53
Home Improvement_Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
i
❑Workman's Compensation Insurance c .
Check one: .+
❑ I am a sole proprietor m
M
c
❑ I am the Homeowner d
M-Yhave Worker's.Compensation Insurance �„j M `ro
>
` ( M ss
Insurance Company Name I ,
W orkman's Comp.Policy# W C C 00 S t0 1 Z0 O
Copy of Insurance Compliance Certificate must be on file. -_j r
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Permit Request(check box)
2Re-roof(stripping old shingles) All construction debris will be taken to f barh
❑Re-roof(not stripping.. Going over existing layers of.roof) ,
❑ Re-side
❑ ReplacerAent Windows. U-Value (maximum.44)
t .
*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.
Home Improvement Contractors License is required.
Signature
Q:Forms:expmtrg
Revise063004
The Commonwealth of Massachusetts',
Department of Industrial Accidents
Office of Investigations
600 Washington Street, 7`h Floor
r` Boston,Mass. 02111
Workers'Compensation Insurance Affidavit:Buildin lumbin /Electrical Contractors
name -oL)t�+
address --
city Sc w t state• /� A- mr) d Z 6�� ohone# ,5Qe"�Z 3Y 1�
work site location(fuH address):
❑ I am a homeowner performing all work myself. 'Project Type: ❑New Construction[]Remodel
I am a sole proprietor and have no one working 3n any capacity. Building Addition
'`'�°'.�e:KN ':: �: .,i�;-.�v,:#' �. ..r,. .� :S11F ;y ., .. 1%''%;d'�t;:�Yl. "�'..��R.i)..'t`:. .::,`:y.�.t tt �`_ '.:`G4'.1'::�•:'.. L�•'
[j�1 am an employer providing workers'compensation for my employees working on this job.
� t
comnanv name \IJL.tL)/� ��®a� ,
address Z u�� bk)l��➢�E �a r °:
-- o one#• SFa�_L7�/— 6 7S.L .
city Scat , NI.�:� ����/� �, .. _.. .. .
insurance co. e C; ATe. l ROMM tN Gt: 6 d L
❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
city phone#•
insurance co. polig
am
co an name:
address:
city phone#•
insurance co. 011
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true andL(9
correct.
1 Signatwe AL Date Sh2 5
Print name Oct ut I M J� 1 Phone# SU?— Z 7(-f—6
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building DJ
❑Licensing❑check if immediate response is required ❑Selectmen❑Health De
contact person: phone#; ❑Other
(revised Sept.2D03)
,.i
1
Information and Instructions
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. Please
supply company name, address and phone numbers 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.
Now
City or Towns
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. The affidavits maybe returned to
tl:e Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,.
P.ease do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street,7th Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 7274900 ext. 406 .
1
. :.. : .:.n._of.B arnstable - �:::.. .. ._:.. : • ' . .
. . .. . .'Tam
Reg- l.atory Services :. . ... .. . .
er-Director
snattsrast�. =T�iomas�F.Gei1 ,, .
ate•
Division
-TomPercy; Building Commissioner
200 Main Street, yaanis,_MA 02601
www.townbarnstable;ma.us
r Fax: 508-790-6230 .
Office: 508-862-4038
-Property Owner Must
Complete and Sign This Section
: if Using ABuilder
►� n �1 ,as Owner of the subject property
to act on mybeha
'hereby authorize
,G cP lf,
in all rriattexs relative to work authorized bythis building pernit application for;
(Address of Job) _
Date
Si a e of Own
Print P�ame • • •
evl
+',Assessors map and lot number` ....,�.7................. „o%THE to
SEPTIC SYSTEM
�� „ 7 Sewage Permit number .........:.......... � ... INSTALLED IN CO
...................... ....
WITH TITL
8,S BAHH9TADLE, i
House number '................................. ................ ................ ENVIRONMENTAL C �M�a m�
U «' TOWN REGULATI
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .................4��:/..... ....... 5�`P.... ........................
TYPE OF CONSTRUCTION ..................?oq .....r2 ..........:............................................................:....
t x
.................�. .....4 .......19... �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
- ...Location .......�.1.......... ........ .... .... ..................... ...............................................
ProposedUse ......... .!�l'�� .......................................................................................................::....................................
Zoning District ...............V-1t-..............................................Fire District
Name of Owner ...........S.VS....T .r............................Address °`"t"1.:.5.........
��0 S �2.t^2J S ir1�,
Nameof Builder .....� .�.ti�....51�?...................!..............Address ............................ .....................................................
tioQ.r(-ES � ..S .........Address .................�P l�l......'.v-z�. .
Name of Architect .........................!.�-�....................SG-.� ...... ��- 0✓ Ri�T............
Number of Rooms .........:5..................................................Foundation ......��........�.U.a.l�-..�-�.�.....�.'�..�...C'.�...`e:�-.................
Exterior ........................Roofing S. � 7.le.5................. ..................... .............................................................
Floors '���� .Interior `S
X........................................................... ?tY 4..................................................
Heating .................Gr�........................................................Plumbing ......�� C-/Ca(�? ?P:!Z .......... .
Fireplace .............. ...........................................................A Approximate Cost ...........
P �•• pP •�Qom ............
Definitive Plan Approved by Planning Board --Z-- 4�-------1 s _gS Area ...... .. ......!...'- Z
Diagram of Lot and Building with Dimensions Fee ...................................... ....
�_
..
SUBJECT TO APPROVAL OF BOARD OF HEALTH
b Fes'
3 �
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g the above
construction.
Name
Construction Supervisor's License �/ ...
S L S TRUST
0 ... Permit for ....1 ...Story..............
..........Single..Fagjjy..A,��f�jjing'
..... ..... .....................
Location ..... ....... XQ.ad
. .....................Centerville t e.r.v i 1..1.e...................................
.......... . ...... .
OS L S Trust..................................................................
Type of Construction ......VXAMP..........................
•
................................................................................
f
Plot ............................ Lot ................................
Permit'Granted ....,,June ...................19 86
Date Inspection.,/e ...... 9
Vf
Date Completed ....... �4/.............1S,
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103.00
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LOT 5 =
W =Lo-r L1
103.00
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JOB # 85-420
CEP, TIFIED PLOT PLAN
PREPARED FOR:
LOCATION. LOT-4 EBEN SMITH ROAD CVILLE
SCALE. 1 "=40 ' DATE. 06/11/86
REFERENCE.,
PB 403 PG 27 LEBEL-SOLLOWS
I HEREBY CERTIFY THAT THE BUILDING
SHOWN ON THIS PLAN IS LOCATED' ON THE
GROUND AS SHOWN HEREON AANE
•..,OJALA .
down cape engineering d�
CIVIL ENGINEERS n �s�� f ► Tf����
LAND SURVEYORS lAlh'1
ROUTE 6A YARMOUTH MA DA E REG. LAND SURV R
t -ILDInu
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1i TOWN•OF BARNSTABLE, MASSACHUSETTS PERMIT
Aml'/1-229 JOB WEATHER CARD
DATE June Zit 19 cgs PERMIT NO. f. 9551
1. APPLICANT Lebel/SOl10WS Development ADDRESS 10 9 Route 132, Hyannis, :'A 00__i23.
(STREET)(NO.)
) ( ' _ (CONT R'S LICENSE)
j PERMIT TO Build dwelling' ( 1� STORY SiagI family dwel.lingNUMLLR BE OF
NG UNITS �
L (TYPE OF IMPROVEMENT) NO. (PROPOSED USE). '
i
'• lot 4 85 Eben Smith road, Centerville. ZONING Rc
AT (LOCATION) DISTRICT
- (NO.) (STREET) '
BETWEEN
AND
(CROSS STREET) (CROSS STREET)
tt SUBDIVISION - LOT
} j LOT BLOCK SIZE
ma
a
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
'j
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
1 (TYPE)
REMARKS: Sewage #85-997
I
n 8 ON,il
AREA OR 956 sq. t t• 50,000 PERMIT 57.50
VOLUME ESTIMATED COST $ FEE .�
(CUBIC/SQUARE FEET)
S L S Trust
M •
I OWNERlei9 Route
ADDRESS �� "� BUILDING DEPT. 0,�••.} ' °
Ilk
{{
' THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART TFIER.EOF. EITHER TEMPO,,I�ARILY OR
.� PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED'.UNDER T}}}}{iiiE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB THIS WHERE APPLICABLE SEPARATE
KE
INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: CARD PT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
I 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
AI MEMBERS(READY TO FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEEFOREFORE F .'
.• OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
! BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
a
i
" 2 2
"i 3 - HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS
INE RING ' .
I
OTHER 2 12
BOARD
OF HEALTH
WCRK SnAL_ NCT PROCEED UNTIL THE- PF?MIT u"1.' RF,COME NULL AND',VO.ID IF.CONSTRUCTMN iNSPECTIONS' IN ICATED ON THIS CARD
NSPEC"OR HAS APPROVED HE VAr71CUs ",'iIN SIX MONTHS OF DATE THE CAN BE ARRA14'1317D FOR BY TELEPHONE
STAGES OF CONSTRUCTION. - OR WRITTEN NOTIFICATION.
Al-' i
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
_ rAR1°T ' TOWN OFFICE BUILDING
rua
r�9 �•t639' HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE: /D//G, 1pCv
An Occupancy Permit has been issued for the building authorized by
BuildingPermit #.... 2..»2...�`~.».��»..._..................._..........................................................—...............»»....._......»»........»...
.»...»»
issued to-5 S—ZS✓s"4' —....... 'D» ......#
Please release the performance bond.
d
n A�
v � TOWN OF BARNSTABLE Permit No. . 29551
BUILDING DEPARTMENT
{ NAM I TOWN OFFICE BUILDING Cash' t639 I /
Four HYANNIS,MASS.02601 Bond .../.
CERTIFICATE OF USE AND OCCUPANCY
Issued to S L S Trust
Address Lot #4, 85 Eben Smith Road
Ceriterville, 1Ias5achusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
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.
October 16,
................... 19. . ........... .........,... .. !......0 '
.............
Building Inspector
AA
,94
Assessors ;map. and lot numbe :......"f.. ...,....................... THE
j of toffy
Sewage Permit number .... 71
333 ST11DLE, i
House ...number ........9........................... ...................................
� �O i63q. \00
i°TE•Q NAY Or•
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ✓i�c�...... ........ ............................................................:..
TYPE OF CONSTRUCTION ....................... Q................:
................. � ......./.).........19..8 ,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to tFLe following information.
Location ..... ..! ... .A.............. ?�.t z.................................................
Proposed Use ......... -'. � ��n�......................
Zoning District ,+...............!
...........................
.. ..........Fire District ..............................................................................
5
Name of Owner ..........5....5.... ... ........................Address .......... .........
Name of Builder I ( - S-oI1aw5 Pelv'e-/• .......Address � �4
...................................................... :...:.................................................................
Name of Architect -C 'k� i' `..... t..S.l .�v..........Address ...... :.............
Number of Rooms ........... ...................................................Foundation ..... (....... .t.��l/1C' C .... .}C: <--.................
Exierior .............................................
Floors u7 OC ,Interior ........... 1�P..�'. ZULfC..............:.....:
......................Y...... ............................................... .....................................
Heating '�5........ Plumbing t'c1 C C. �?!�lk./�... ....... ?...�?� ..S.....::...
Fireplace Ut. ..........Approximate. Cost '
Definitive Plan Approved by Planning Board _1_ X__ _ __ . .......� `�
---' -------19-- - Area . ..........
Diagram of Lot and Building with Dimensions Fee T".............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g the above
construction.
Name !'!. f. G .<........
Construction Supervisor's License if y ....
B� y _
S L S TRUST A=
/71-z�'8
1 No ..29551.... Permit for; ..........Stor..........y................
...........S.7.rig�e...Eami l�Z..Ae11.ig....................
Location Lot #4.......8. ... ...
5 Eben Smith. . . ..Road. . ... . ........ .... . . .. .. . . ..
Centerville
...............................................................................
Owner S L S Trust
..................................................................
Type of Construction ......Frame
EXAMP.........................
................................................................................
Plot ............................ Lot ................................
Permit Granted June 24,
Date of Inspection ....................................19
Date Completed ......................................19
ee'v Pl-
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TEST`HOSE LOG f' ac�2g -
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O WITNESS ..BEDROOM HOUSE
TEST DATE �� -
®ESIGN P �
T.Li+ • 1 T.H. +� Z f s
ELEV.'S7,00 EL".
NO {�
G 2' DISPOSER DISPOSER ll \ N -�
2�u I.GAH l!6 /00 PERC RATE MIN/IN. p `�?•
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FLOW RATE 33D(c ►wDAY) t; . s
GOd Sl SEPTIC-TANK 3'? O
REQ'DSEPTIGTANKSIZE'
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LEACH FACILITY - . .
SIDE'WALL =/SZJ,'�J: (Zr bD �, {
Zo _-7r oo Z 2 _-=f
BOTTOM -
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TOTAL Zvl1 -
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USE: O LEYkCHING �T
WATER ENCOUNTERED
20
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- NOTES: .(UNLESS OTHERWISE NOTED) '
1.DATUM(MSL)+ TAKEN FROM `5 `I_1�'�!G QUADRANGLE MAP. -
2:MUNICIPAL WATER -AVAILABLE
PE PITCH:?A"PER FOOT _
4.DESIGSN-LOADING FOR ALL`PRECAST UNITS:AASHO-
S-MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT.' {ice
6:PIPE JOINTS SHALL BE MADE WATERTIGHT ARNE H
-- --7:-CONSTRUCTION_DETAILS TO BE ACCORDANCE_ WITH COMM.OF MAW. OdALA.: PLAN
STATE ENVIRONMENTAL CODE TITLES -" - '--" _ - _ _ SITE
$. TWtb Pt►I►.�J FoL �i'�d�?i'�_+c..7 hi0'Z,}L Gjira�C �....►0-�+�iOaJ`� -- - _ _. --- --- -- -'—
tilor �E t15E� raZ �cao ��•f t_.vC— -�c-d.�wt� .
�ocvs. -�:-o? �'l �1'3�N s-1'1►�'rl l�f�l:1.� .
OFws
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REG. �4 INEER} O� ARNE
REF: 'T�06K '/03' ' PAlSr'o27
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. . - gOWIL. CQ a P+I�gIII�er � " � -PREPAREO'FO T 1,�s�'1"- SQLL(�1/�5
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;t CIVIL ENGINEERS P �'
R
ALE
BOARD OF HEALTH fir
)............: --- - - Y - - yao.
LAND SURVEYORS •�
a�.� - OR.
CONTOURS._(EXISTING --_ APPROVED GATE ATE
(PROPOSED)--lD- "O---O- -' - ,'','