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HomeMy WebLinkAbout0022 ENSIGN ROAD �� �s� B c .o ��c Q 0 3 gl�lQy �OFINE roy� Town of Barnstable *Permit# rnol Expires 6 months from issue date ,,, , : Regulatory Services Fee 9 MAS& �� Thomas F.Geller,Director �p i639� 1 Building Division X-PRESS PERMIT Tom Perry, Building Commissioner 200 Main street, Hyannis,MA 02601 AUG. 1 2004 Office: 508-862-4038 TOWN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red%Press Imprint Map/parcel Number , 5 Property Address Ora Cry. n Q00.A C 2 Mfa na co 3,;t, .� idential Value of Work " (A,5yS Owner's Name&Address �a El,�ign RoA Can f ev-A(e m 02(e3z Contractor's Name Soi.'A de �Ma-- Telephone Number sbii -77 S - 171 rF Home Improvement Contractor License#(if applicable) 162,757 Construction Supervisor's License#(if applicable) rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner gli'ave Worker's Compensation Insurance Insurance Company Name �� `�-✓It�'4 - Workman's Comp-Policy# Permit Request(check box) ❑'Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) to-side' ❑ Replacement Windows. U-Value s (maximum.44) "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. nt Contractors License is required. Signature Q:Forms:expmtrg Revise053003 necessary. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner sign ture Ontractor Si atur Date Date a e i c 4I T The Commonwealth of Massachusetts " - Department of Industrial Accidents officeo/%rIRsupauons _ 600 Washington Street y3 Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location: city phone a ❑ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. coninsn3*tifine: I2 [iC 'It? VYIafGLeVYI P dl " adifcssa:;;;� I�QY YIS ��g.•. . .l'S f�.Q'..': .....,: , . . 11II , t It l�JCt01 Vl6S MA (�0��0� phone#• �bg " 7 7S ' 1371 �`f�y� /My� I Ianr-seeso.:-. .L1/ 111!_•,Tt.I.Clc.Q M—UH.`-4 01achy ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who hu,: the following workers'•compensation polices:. ........:. .. companrparne- addtesaF phone4e liisor:inee��os po�Y'#: .. Failure to secure coverage as required under Section 25A pf MCL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'Imprisonmem as well as civil penalties in the form of a STOP WORK ORDER and it fine'of S100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of,the DIA for coverage verification. I do hereby"4 alties of perjury that the information provided above is true and correct Signature tu p n pen Date '!2a Print name hone# . UPS' 3 -75- l?7 official use only do not write in this area to be completed by city or town official city or town: permitAicense# nBuilding Department OLicensing Board (7 check If immediate response is required oselectmen's Office ❑Health Department contact person: phone il;_ nOther (mizW 3195 P1A) 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 and supplying company names,address and phone numbers 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. I 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 may be returned to the 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, please do not hesitate to give us a call. vi The Department's address,telephcne and fax n+A�nhi-r. The �:oltZ:� ti: v�.;s��tYt j T:iass:.cl4el:►�¢:.. Dewartrne`.ltof"!�2(113�ti!':w:f'lC_:': aEe'�J dtfice of fnuesdoations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 ,� nhnne 0: (617) 727-4900 ext. 406. 409 nr 37.19 TOWN OF BARNSTABLE Permit No. ----------_----------__-______ { JA"n.0 Building Inspector Cash -------------- --- °"'+� OCCUPANCY PERMIT Bona 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 therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date 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. .....................................................1 19......_ ............................................................................................................._._ Building Inspector • I ,i I I • r, l? 7" 2e a FI � fo14. m 0 M N ?N 3-7 4 I F E A� I S,000 %7 r F. 5 FS. 2.o ' o� HN ELL . r-. le ST��yp� j s uCERTIFIED PLOT PLAN f NEW CONSTRUCTION ONLY :- TOP OF . FOUNDATION IS L' FEET IN ABOVE LOW POINT OF ADJACENT 13f11?1\1S7—/1 `Y ` ROAD. ' SCALE: DATE > � lia% LOREDGE ENGINEERING CO.IN G2c N'R'T*? I CERTIFY THAT THE CLIENT HOWN ON THIS PLAN IS LOCATED EQ13T D REGISTERED JOB N0. N THE GROUND AS INDICATED AND �\ CIVIL I LAND CONFORMS TO THE Z INO LAWS' ` . ENGINEER SURVEYOR DR.BY1 OF fAtisrr�g� M S I 712 MAIN ST. Cw -y- HYANNIS, MASS. SHEET OF DATE '-E LAND SURVEYOR . r . �fl ;N/F Pic►•-�a�Dso�.l 13 2. CI g L_OT 2 20 405? S. Zoe je r P%r im7 exRv+s-ca ; . D6rW 8.Jf1O.J OoX i000-miu. > 4SRtG 9 TANK '� a .� �. J as, SET/rPS�n � - �L ZF 43, 5 15,000 S, F 1 J[�TE ; LoTr L EvI=L,W Ca`1`c>P(::>-TA V-El-i 100 Fr. w DTN FQo�T 5,g. : 2a LEGEND OF EXISTING SPOT ELEVATION OVID CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 JOHN FINISHED SPOT ELEVATION (� E17T LC�T 2 - sIG►,! Q.c�A►v c MAGZ'STc)wS M I LLS FINISHED CONTOUR ®---=- - --- APPROVED, BOARD OF HEALTH t9 ��sTEa :t IN DATE AGENT SCALES I � ' ��� DATES ELDREDGE ENGINEERING C16 INS R CLIENT �*+ 1 CERTIFY THAT T-HE PROPOSED EGISTERS EGISTERE JO® N0. Ito BUILDING BUILDING SHOWN ON THIS PLAN C1V1L ., LAND C o CONFORMS TO THE ENGINEERS SURVEY R .SY� +'� Z NING LAWS OF Bt3ssriAtt IM A S 712 MAIN -ST. CH.BY, 2.f3.e HYANNIS,MASS. SHEET,!.OF� DATE" � 0. LAND BURVEYfl i 1. � assessor's map and lot number ............................................ THE 4� Sewage . ............................................... SEPTIC SYSTEM MUST BE Permit number ....a�—e5r Z�3 INSTALLED IN COMPLIANC House number ... ................................................. IL WITH TITLE 5 MAS I-ENVIRONMENTAL CODE A;'''D D Mo A, 3JLA T1 0 . TOWN, OF B ARNS"TA9 E A BUILDING - INSPECTOR APPLICATION FOR PERMIT To .............. ............. e- . ............... .. .................. TYPE OF CONSTRUCTION .......... ........... .............. ................... ................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followin information: 7- ............ Location ...................................... .. ..... ................................................................................ ProposedUse ....................5 A_........... ................................................. . . .................................... Zoning District ............a.......................................................Fire District .......C...............z......C9............................. Name of Owner .......6r 11e/—��.......Address .......Ad/,...R2.......... .... .... 0, Nameof Builder ...................5. ................................Address ......................... ....5,1e. ...................................... Nameof Architect ...................;..........................I.......I............Address .................................................................................... Number of Rooms ........................ ....................................Foundation ............ldi-uz--e�j.....c ..... ........ C...................Exterior .......... ........ ....Roofing .................. Floors ........ (A .............Interior ................... ....................... Heating ..............F� X..... ...............Plumbing .................. ...... .......... Fireplace ..................................................................................Approximate Cost .......... .................................... Definitive Plan Approved by Planning Board --------------a-CE-----I Area ........ Diagram of Lot and Building with Dimensions j r—�00,0,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 thebove construction. Name ...... .. ... .. ................. .... ............................. REENBRIER CORP. 1236 54 One Story EE 23, 0 ................. Permit for .................................... . ......Single Family.. ............... ..................................... Location ....AQ.t...k.2...... ....... j Centerville ........................................... Owner ....G?�e.enb.ri.e.r...9.9?�R?..................... L ... ....... .... .. .. Of Construction ...kX4MP.......................... Type 4- ............. .......................................:......... (............ Plot ............................... Lot ................................. November 20 , 19 81 Permit Granted ............................ Date of Inspectio ......... ............19 mpleted .......Date Co ............ 19 '01, PERMIT REFUSED ................i .................................... !;'-I 9 < ...........:.�......... ..............................................;•........... CY ................o................................................................ A . . .......................................................... ......... . ...................................................... ..................... Approved ................................................ 19 ............ 4.............................................................. .............. ........................... �y� � - Assessor's map and lot number .......................... THE Sewage Permit number .......I..................... BARNSTABLE, House number ... ........ MU& 1639. U**......*--,.... a TOWN 'OF BARN-STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ................................................ ............. — H- TYPEOF CONSTRUCTION .............................. ................ ............................� ...................................... ................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ..Location .............. .. lee..... ........ iE ..........4/ ............ ..... .... ..... ....... ........... .............. ProposedUse ..... ............................. .............................................................................I......................... Zoning District ... ....... ...............................................Fire District .......r...................i,.......... ............... Name of Owner .......CI? n< ......Address ....... ..............................Y11...........Address ............................................... Nameof Builder ................. ................................Address .............................. ................................. Nameof Architect ...................7..............................................Address .................................................................................... C/ ��4t Number of Rooms ..................................................................Foundation ............ 6k. .................... ....... ....Roofing ................ Exterior ........... ................................ ..................... Floors ............ .4................Interior ................... ........... ................... ... ......Heating .................... �!........ ..... ..........Plumbing ................./&.(............................ ................. Fireplace ...................................................................................Approximate Cost .................. ....0 .................................... 0 Definitive Plan Approved by Planning Board ---------- ------19 W------- Area .......... .................... ..... .. 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: V Name ............. .................... C. ................... GREENPRIER CORP. A=147-51 No 23654 permit for One Stor .....................�'............ {Single Family. Dwelling.............. Location .,Lot ��2 22 Ens i gn,,,Rd......... ... ........ ...... Centerville ............................................................................... Owner Greenbrier Corp. Type of Construction .... ......................... ............................... Plot .... ........................ ......�....................... .. November 20, 81 Permit Granted .........................................19 Date of Inspection .............. ...................19 Date Completed .......................I..............19 PERMIT REFUSED .................................. ......................... 19........ ` .................................. .................. .. .......... M P . �.� .�......................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................