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•. Post This Gar'.d So That�t is Visible From tFie:Stceet�=A roved Plans,Must tie Retained on Job and,:rthis Cding
ard Must be Kept
M" !Posted Uritil'F nal Inspection HasBeen�Made �:� .,, Permit
eoa Where a,.Certificateof®ccu anc pis Requred;such Buil.'dmg shall Not be Occupied until a Firial Inspection`has
Permit No. B-19-251 Applicant Name: Carl Rebello Approvals
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Date Issued: 01/23/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 07/23/2619 Foundation:
Location: 86 GOFF TERRACE,CENTERVILLE Map/Lot: 170 085 Zoning District: SRC Sheathing:
Owner on Record: LASSITER, ROBERT €p� �ContractorName Carl J Rebello Framing: 1
Address: 86 GOFF TERRACE Con#ract�Or`License CS 084358 2
CENTERVILLE, MA 02632 '
Est Protect Cost: $2,882.00 Chimney:
Description: Insulation&Air Sealing ` a�Permit Fee: $85.00
Insulation:
Fee P id $85.00
Project Review Req: klfinal:
z �Oate' �� 1/23/2019
`
t scrn Plumbing/Gas
Rough Plumbing:
Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixmonths af,er ssuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and th6pproved construction documents for which thi's permit has been granted.
X = s�.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by Iaws�and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. Is
µA Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Offc�als are,prov ed on thispermit• Service:
Minimum of five Call Inspections Required for All Construction Work:
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
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TOWN: _C_ENTERVILLE __________ REGISTRY OWNER: HE_LEN_S. HIGGINS
DEED REF: _289512Z9---------BUYER: JOSEPH F. A_jgiff ZUEANG__
DATE: _ 22/96 ___________ PLAN REF: _275�55 ----------SCALE:I"= 30'___F'1'.
I HEREBY CERTIFY TO BANK UNITED OF 7Z AS TSB
THAT THE BUILDING ��N OF R� YANKEE SURVEY
SHOWN ON THIS PLAN IS_LOCATED ON THE GROUND AS <` CONSULTANTS
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SHOWN AND THAT ITS POSITION DOES ____ CONFORM �' FAUL f-
TO THE ZONING LAW SETBACK REQUIREMENTS OF THE A. 40B" (SUITE 1) d
R MEIPITs EVV `" INDUSTRY ROAD
TOWN OF _ RARNSTARLE_____________AND THAT No, 32G98
IT DOES— NOT — LIE WITHIN THE SPECIAL FLOOD HAZARD \ yf� ��� MARSTONS MILLS, MA. 02648
AREA AS SHOWN ON THE H.U.D. MAP DATED�-J-M _ ass, $7` ' TEL: 4428-0055
Co nit —Panel. ,250001 0015 C OPV4 LANO ��' FAX 420-5553
i__ per__---- THIS PLAN NOT MADE FROM AN' TRUMENT
PA L A. MERITHEW PLS SURVEY NOT TO BE USED FOR FENCES, ETC. 19399 DPG Aq
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1 '
�TME L
The Town of Barnstable
���' Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner y
For office use only
i
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.
Type of Work:
�� �c{r�c Est.Cost
Address of Work: �� Crd f ��(r
Owner'
s Name 1100 ph 9' hard Lynn �C�.Kc,✓ana
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
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 3,1, 6-Ff TQtr.
Ceti�e✓��l,b WIA. od�3d
I hereby apply for a permit as the ag t of er.
1 -lL
Date Contractor Name Registration No.
OR.
Date Owner's Name
�'`•' Tile Cum»wnll.caltli grAtassacliuscVJ;
1 '�• '' ' Depart»rc»t ojl»dustrial Accidents
p l 6011 Ti irslungton Street
LG
Buxton.Ala= 02111
Workers Compensation Insurance•AMda itMme-
All C>/VAy"U✓1
In . 1
x Ceox er v,J(P �� ���0 3 phone � 7
cif
❑ I am a homeowner performing all work myself.
❑ 1 am a sole proprietor and have no one working in any capacity
W
C. 1 am an employer providing workers compensation for my employees working on this job.
cemQatn' l9 ` '
�« < nhene#!
insurnn co,
pelicr!! W C V00 17S 13
❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who h.
the following workers' compensation polices: y
addregs-
SlI) phone
surnnccCo. Bolin,0
Irune ""=-T:-•. �.:_�"ssPtrr.4....saw� "._T�'"sn'+➢Fsy" �svtis!JQ7 '•'l-' ---11 -�"'�•••"J'e�+�+Tr+�' `
mIfir fin
.t nhonefk
nee cn_1 s Boiler a
Atiach additionai'sheet if tieewar�; �� + '�^t"`^""` """ `` ""�`' ---'� ' 'd/o
Failure to snare coverage as required under Section'3A of MGL 1S2 can iead to the imposition of Criminal penalties of a line up to S1.SM aad/o s
une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Slue ofS100.00 a day against me. 1 understand that
coln•of this statement may be forwarded to the Ofice of ltn estigations of the DIA for coverage vuitiadoa.
do herehr �•a cr p and penalties of pcl*rr that the infotwtmion provided above it vw and cornet:
Sig nature � • �' y�
Print name ^ (5 ka x 6 Vl a none a / v -aE�
Fdtyor
only do not write in this area to be completed by city or town official
l�ermitAteease 0 nt3adding Department
n: (3Ucetning Board immediate response is required QSeleetmen's Ofia13 �11calth Department
phone tY; nOther•._.�son•
Information and Instructions
f Massachusetts General Laws chapter 152 sec•tion 25 requires all employers to provide workers' compensation for t.
employees: As quoted from the"law".an emplgt►ee is defined as every person in the service of anatlter under any
contract of hire.express or implied oral or written. }
partnership,association.corporation or other : gal entity, or any two or in
An emplm�er is defined as an individual.,
the fore_oin g 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
owner of a dwelling house having not more than tree apartments and who resides therein. or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair wort:on such dwelling
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an elliplo:
MGL chapter t52 section 25 also states that every state.or local Iicensing 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 wort: until acceptable evidence of compliance with the insurance requirements of this chaptc
been presented to the contracting authority.
«..- _ :• �!L'.\8 a..a. • RP ter: A v (5: ' n.!,r•>ir ji'-• 'Y::.•.'i.—...
.rye. .q.:iT1.'i=n.. .+ •�� .q.. •i'w..- :7 --;iY. :.µ...w!?t:.fV 4 ♦: �r.i::-•ie.•�-. p
may'••• •L �=•::i - - ...- .. .. -
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation ani
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 sibn and date the aflidarit. 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 requh
to obtain a workers' compensation policy,please call the Department at the number listed below.
.. :;s: -:.�. ...! :�.•.�..�:3::.v:• :'i_ _ 's`.•'T�,.r,,......riaa7r++y.�T IL••.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the botton:
the affidavit for you to fill out in the event the Office be used as a lrefereons �ce number.you
The affidavits may be rle caet me
be sure to fill in the permittlicense number which will
the Department by mail or FAX.unless other arrangements have been made.
The Office of Investigations would Iike to thank you in advance for you cooperation and should you have any que'sti
please do not hesitate to give us a call.
The Deparmient's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents �r
. Office of Inestigations
600 Washington Street _.
_ Boston,Ma. 02111
fax#: (617)727-7749 •.
phone#: (617) 7274900 ext. 406, 409 or 375
HOME. IMPROVEMENT S
CONTRACTOR . REGISTRATION -"` _--w--
�,
- �,,- _.
" = Board of Building Regulations and Standards y "
Room 1301 -
shbur.ton Place - - -
4 ,
_Boston Massachusetts_�O2.1O8
iAOME IMPROVEMENT-;CONTRACTOR
•
.. .Registration=-102422��_ -_ Exp�irati.on�O7/01/98
Q TYPe 7--.�IND IVYDUAL_ ,_�.._ �__ �� - ---- .y�
f } HOME-IRPROVEMERT CONTRACTOR-,,. I
Registration .102422 N
'� = - ' f _• ; • Type,.- .-INDIVIDUAL .
" � � -Expiration 01/01/"
.BRIAN W -,,SHANAHAN .•�. r� �T ��, _: ._� . .
E�32 Go ff _Terrace
-- - `NiA4..O2632� - r- -- BRIAM K SHAI�IAHIItI --
�- Centerville `�- -
- - _ - — f f Jer-race ,...,�,,r.
noMINOTRAMR enterville MA:02b32
/ae iJa�w»ra�u�eczl�z a�'✓l`a uuc/%%c eta r y - — �I o -
u:. Restrirted To: 90 24620
,° r
Gv9STR.'Cijry .=Its"yicC:-. 1.*ra,;£� 90 - !r'ouc
I
Ruraher. ry 'xp_res: :
1G '_ & 2 p3�i!V tnEs
r
Restri. -ed 6,0 Faijere to possess a carrent edition of _.e
yanahssetts State Baiilding Code
BP"ILN 'd S L?L" AIN is cause for revocation o` this
,:pia ra�t j
{
r -
VA
q3 acres I
s . .
Engineering Dept. (3rd floor) Map Parcel C�2 4!:��Permit# o b
House# �Date Issued
Board of Health(3rd floor)(8:15 -9:30'%1:00-4:30) Fee
Conservation Office(4th floor)(8:30-9:30/1:00--2:00)
' 19
QM''A $f!
TOWN OF BARNSTABLE n
L �
Building Permit Application
PW*ect,Stt ss
Village fey-Ve((-P
+ Owner -foSehh + Carolyn Cxmmatr&,. Address 86 t O ff TP2rr 0C&rXferVd(-?, -
Telephone �5-0 S- yd0- Y 0 t
Permit Request __CrJ� S t�aG f�ur. o eyedi f� -
Al
First Floor square feet Sec nd Floor 67} square feet
Construction Type d,-,a oC frc.ov-e.
Estimated Project Cost $
Zoning District (2 C. Flood Plain Water Protection
Lot Size p?4d( 5- Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure 16 rf Historic House ❑Yes P No On Old King's Highway ❑Yes R)No
Basement Type: ❑Full W Crawl ❑Walkout 6J Other
Basement Finished Area(sq.ft.) p Basement Unfinished Area(sq.ft) O
Number of Baths: Full: Existing 2- New Half: Existing / New 0
No. of Bedrooms: Existing_ New _� 5-ep bt,,
Total Room Count(not including baths): Existing_—New 2— First Floor Room Count 3
Heat Type and Fuel: ❑Gas a Oil ❑Electric ❑Other
Central Air ❑Yes ONo Fireplaces: Existing New C; Existing wood/coal stove ❑Yes .�fNo
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
., @Attached(size) 22x 7,I f la", ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ;4NoD If yes, site plan review#
Current Use Proposed Use
. Builder Information
Name ?rian 5L Anc.Ara1). Telephone Number X
V
Address 3 &-o F F Ter✓' License# 0-03d-4/-
C'at�Q/V�Kp mp. 3 Home Improvement Contractor# Co Zy22-
Worker's Compensation# WC►rad175-13
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES-ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO g �l
SIGNATURE DATE_
_ / A
�7
BUILDING PER IT DENIED O THE FOLLOWING REASON(S)
i }
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED ;
MAP/PARCEL+NO s
ADDRESS ? - VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
6
• INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: = ROUGH FINAL
FINAL BUILDING (Dli�, //13 clay avg4 , ,
— V
DATEICLOSED OUT
ASSOCIATION PLAN NO.
PDATE PERMIT RECORDS: ADD CHANGE DELETE PRINT FEES HELP END
HANGE RECORDS IN PERMIT TABLE
ENTAMATION----------------------------------------------------------- 11/30/04
PERMIT NO. 18108
PARCEL ID 170 085 86 GOFF TERRACE
PERMIT TYPE BADDI BUILDING PERMIT ADDITION
DESCRIPTION GARAGE ADD W/STORAGE ABOVE
STATUS C COMPLETED
APPLICATION DATE 09/24/1996 DATE ISSUED 09/24/1996
EXPIRATION DATE DATE COMPLETED
MASTER PERMIT VARIANCE
VALUATION 83820 . 00 BOND 0 . 00
CONSTRUCTION TYPE 438 GROUP TYPE 1
CONTRACTORS 003247 SHANAHAN, BRIAN W.
ARCHITECTS/
ENGINEERS/OTHERS
ENTER Y IF ALL ARE CORRECT OR N TO REENTER
EAVE BLANK FOR NON-PROPERTY RELATED PERMIT. CTRL-I FOR HELP.
TOWN OF BARNSTABLE �9
Permit No. -- ----- ---------- f� W
Building Inspector
ma � Cash --------------- - �
MAI OCCUPANCY PERMIT Bond ----—-------
Shy
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 B lrl;P Tirr, 5� Address Tho2'nton !►r, i Vn.*ri is,
Wiring Inspector f ( �' ./f LF� :i .� Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department _./e ,_ 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
R ,
. y �
R I i
off'
017A01--
fuVol"AREt E.
0 2/
Lcxlci4 o
7N
Vie � ,..., AY• �.
- r
to/ 33
CERTIFIED PLOT PLAN
LOCATION
SCALE . / =..3®�. . . . DATE .gip ?s.15?51
PLAN REFERENCE 4-67 va. 4T*17.A s.
pis n.0.c. . . . . . . . . .. . . - . .!`�jGGs r�
. . . . . . . . . . .
I CERTIFY THAT THE
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
. . . . . . . . WHEN CONSTRUCTED.
7 7Val Vf:i V,6'" DATE Ap rL Z3 ly7,9
PETITIONER:
REGISTERED LAND. SUR OR
N59345
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
'0 4' CAST IRON 12MAX. 12"MAX: "'°," •
PIPE (OR 4"ORANGEBURG(OR EQUIV.)
' EQUIV.)— MIN. PIPE- MIN.
' PITCH I/4"PER, NLEACH
PITCH 1/4"PER.FT. PIT
c e PRECAST
o' NV��q� o Q LEACHING
EL..F�i�?r. INVERT INVERT e : . Q e PIT OR
SEPTIC TANK EL..�i�hG?. . DIST. EL �?','�� T. EQUIV.
,ra. INVERT. hoop GAL. INVERT BOX �►- p: rr.
INVERT W w 0: 3/4"TO I V2
EL:4?�
U. �' WASHED
°ir /7� � 4 t •, W ��. STONE
/Z WDIA.DIA _
r I
, !
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE .��.�_. .,�11.7,9. TIME.V. . . . . !`1 . . . . . .. ,.,� BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 T1 !-�/i� t,lG�LC.c'}/� /0•�• : ENGINEER
ELEV. . . 6 P. . ELEV. .. .. . . . . . .
� �'DWi1�0.E•,Li•ZG�, .�.G.S.
DESIGN DATA
s 4
Sid-Soil NUMBER OF BEDROOMS 3.
30" TOTAL ESTIMATED FLOW . .33Q . GALLONS/DAY
BOTTOM LEACHING AREA B'Sv. . SO.FT. /PIT
SIDE LEACHING AREA . .�BB� 'o . SOFT./ PIT
S � GARBAGE DISPOSAL No.e%�.(50% AREA INCREASE)
TOTAL LEACHING AREA .Z4 7:ao. . SQ.FT
/ A/ PERCOLATION RATE S. .7A/a. MIN/INCH
LEACHING AREA PER PERCOLATION RATE ��`?. . SQ.FT.
A/0—WATER ENCOUNTERED `
NUMBER OF LEACHING PITS
APPROVED . . . . . . . . . . . . BOARD OF HEALTH
®r SroA•e-Pe 7;
DATE E. . . . . THOMAS E.KELLE72
AGENT OR INSPECTOR ENGINEERS—SURVEYORS
346 LONG POND DRIVE
/_ a.SOUTH YARMOUTH,MASS OF
02664
17
E.
KELLEY N
N0.24260 Q
GIs
PETITIONER
. /�/,�-,may i S /f•'t�'S.S.. .�,. � d'
A*esscPr% map and lot number... �,.P...��' �C 1�! �C✓y!? ,2�j�-7q r
SEPTIC SYSTEM MUST BE
7`1 t INSTALLED IN COMPLIANCE
Sewb a Permit number ..........................7 .... NCE
g ........`.................... � ! WITH ARTICLE II STl�TI_ .--
_ SANITARY
TOWN,
�T �) �T c COD
yoFTHEro�� JL ® W 1\ Oi /),BAR1� ►7 AND
Z BARNSTABLE,
9�0
KUL 039.
Ar. B U I L�D� N INSPE9TOR
APPLICATION FOR PERMIT TO .....C;C..•h0•'� �... .!......iL�`::./...{:.0.... .............`..................
TYPE OF CONSTRUCTION ...... ...... �1.......................
c,) ............. .... ... ...............19.7.E
TO THE INSPECTOR OF BUILDINGS:
The undersigned
]hereby app�a c:t permit according to the following informatioon::-
Location ..I.Q..1...........�....�1. . .,�irV��—t .c.��-. .j. .....1�..�.' .I4r .P..t✓../..k.....................................................
ProposedUse ..... ..... .! .1..`... ................. ........ ....................................................
Zoning District �.. .............................Fire District
Name of Owner '.`' .�u`. .... v �'l. ........... d' / A��.� �o it•�J/2 �1/h°f
n
k ..... .............Address
Nameof Builder ....................................................................Address ....................................................................................
° l � f
Nameof Architect ...:..............................................................Address ....................................................................................
.....................Foundation r�0.(J.�4�t.G........... .......fi►d.°�� .�I
Number of Rooms ........... ............................ . ...................
Exterior ......-Q*4ta11!2 .............Roofing ... P.. .`7.. - .. .......................................
4- N ,�
�..1. w .Interior '� C L'...!......... �.�.>��
Floors ........ .. : . .............:.....................................................
Heating ......Oe...l....--w..&::!..1,....�..................................Plumbing
Fireplace :........./.. ............................................................Approximate Cost ....... .....m..®. ..�............... .................
'72-tDefinitive Plan Approved by Planning Board ________________________________19________, Area
Diagram of Lot and Building with Dimensions Fee .............................................°
SUBJECT TO APPROVAL OF BOARD OF HEALTH 1Q
---------------------
i
i
! I hereby agree to conform to all the Rules and Regulations of the T of Barnstable regarding the above
construction.
Nam ............................. .�. .............................
Burke Homes
-.2.12 3UNo Permit for l �/� �����
eoi^ family dwelling.� � .. .� � -_. ..
86 Goff Termaoe .. 1Location ---..'-..----.------- -'
~-_ - ^
----.----. e-.--------
Owner -----. .Bbooeo___.______
.
Type of Construction -.-.-.-..��f���----..
~..-.-...-------.--.....--.------
PlPk I
ot -----.---.. Lot ---...-#__5___.
`
'
~ -
^
' April 24 ?g
Permit Granted --. .. ------lA � ~
' 7` .
Dote of Inspection ...����..,�../�'�.........l9
^ J '
Doia Completed -.--.---------lq '
�
^_, -
PERMIT REFUSED
~ ~
-..--.-.-.,.-.......-.-----' 19
,
-----....~.,.,.,,..,.,.-.------,.-.--..
^ , .
...-`..,..,....-------.-.'.--....~...-
/.
~ _ ~
� . ~
----- ^':~^^~-^-^~~-^^'-'-^^^---`_�`
)...-.-.....-.-^-,-............-.~~.~....,
---------------.. lV
Approved =- ~
`
-------------,.-..-..-,--..—.-.-
. -' .--.-..-......-........ '.
L '
u
- d-&&W
i�
i
Assessor's map and lot number ..........................................
Sewage Permit number ..........................................................
TOWN OF BARNSTABLE
2AW ST"LB, i
rb 9 ��� BUILDING INSPECTOR
o M I*-
APPLICATIONFOR PERMIT TO .............................................................................................................................
TYPEOF CONSTRUCTION .....................................................................................................................................
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .......................................................................................................................................................................................
ProposedUse .............................................................................................................................................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
Nameof Owner ......................................................................Address ....................................................................................
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ..............................................................................
Exierior ....................................................................................Roofing ....................................................................................
.....................................Interior ..............Floors ................................................ ......................................................................
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ..................................................................................Approximate Cost ....................................................................
Definitive Plan Approved by Planning Board ---------------_____---------19________ . 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.
Name ..................................................................................
Burke Homes A=170-85
No ..21230 Permit for ....1„1/. stor ........
single farm' dwelling
Location
...............86...............Goff....Terrace..............................
Centerville
...............................................................................
Owner Burke Homes
Type of Construction .......... frm.�a ...................
............................................. .................................
Plot ............................ L ........
Permit Granted Aril 24 79
Date of Inspection ..... ..............................19
Date Completed ..... ................................19
PE T 7 ......................
USED
.......................... . ... .... ..1Y V........ 19 Z
...... 5.......
. ... ........ Z
............................................................................... �� F
. l
...................... ..................................................... 4 r
...............................................................................
Approved ................................................ 19
...............................................................................
...............................................................................
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
'Map �7n Parcel ® 5 Permit# is- 1 -2,
Health Division Date Issued 1 ( i
-- Conservation Division - Fee
Tax Collector it
g c_ V�
- Treasurer �ti ,c.X^--
X-PRESS PERMIT
It
Planning Dept. i ' ;l A N 5 VA
?gol
Date Definitive Plan Approved by Planning Board TOWNjgLE
Historic-OKH Preservation/Hyannis
Project Street Address CP 0
VillKe
Owner L Address foe
Telephone 14,10 U361
'Permit Request _57?21 P R h-r / S /3-7 HD k_5C OtJLV
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation co Zoning Dis rict Flood Plain Groundwater Overla
Construction Type
Lot Size Grandfathered: ❑Yes 2'�o If yes, attach supporting documentation.
Dwelling Type: Single Family .0' Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes 0-N6_ On Old King's Highway: ❑Yes
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
Hegt 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 ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size - Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes d-W*� If yes,site plan review#
Current Use Proposed Use
C BUILDER INFORMATION
Name 1 ZZ I f7OYhc e e Telephone Number
Address 164S- IVCM 7dOiJ License# (2soc) 77
I
Od( 3, Home Improvement Contractor# �Od 7d
Worker's Compensations#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7 ( _ � 4 f
SIGNATURE DATE 0 /
The Town of Barnstable
MAM„►ar�sresr.E. -
�o�' Department of Health Safety and Environmental Services
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.
Type of Work: 3Q Estimated Cost C5 jor)
Address of Work:
Owner's Name:
Date of Application:_ /
I hereby certify that:
Registration is not required for the following reason(s):,
❑Work excluded by law
Job Under S1,000
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 IlVIPROVEMENT 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:
Date Contractor Name Registration No.
!✓f�P i'zi� owtE sru�,covri►�►E�ut
OR
Date Owner's Name
q:fomis:Affidav
The Commonwealth of Massachusetts
E Department of Industrial Accidents
-- -- Office OffaYesagaaens
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
�i
location-
�r ao - 4301 on
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
2-ram an employer proviidin workers' compensation for my employees working on this job.
a
company name: )►''/ �-�I �>rn� TAAAq o (/tc—}'h Q7
city_:_ C ��.e l l Al phone#: CJ-6�
insarantx>co �t-f 2�L' A-hti�e21 CA-A-1 policy#-1�� v i V 222 r 916 —00
I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who nu..
the following workers' compensation polices:
companrnatne:
I
address•
city: phone#.. .
insaranceso. policy#
comoanymame:
_ address:;: .r
city._ phone#-
Insurance to. policy#
Failure to secure coverage as required under Section 25A of A1G1.152 can lead to the imposition of criminal penalties of a fine up to SiS00.00 andnw
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. 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 and correct.
S.ignature�A,Az ,f,L --Y. ek iaa , Date
Print name -l7 IC l(' V R&S C H. LI F e He L. Phone
Ccontact
ly do not write in this area to be completed by city or town official
permit/license# rlBuilding Department
mediate response is required QLicensing Board
PQSelectmen's Office
QHealth Department .
n: phone#; r 10thcr ;n
(raised)i9S P)AI ,"
a
77
T/ze {janvnaauueall! o� / aac/%uael�a
'� BUILDING REGULATIONS
BOARD OF I:
License: CONSTRUCTION SUPERVISOR
� L
Number CS 057032
HOME INPROVENENT CONTRACTOR �5
��
r + fxpir�s 09%26/2001 Tr.no: 5742
::�1611_12131/102
, -. � .Ex iratioo Restricted,''To: oo ;
Type: Private Corporatio THOMAS X CAPIZZ)JR
280 PERCIVAL
CAPI2iI HOIfE IHPROVENEHT, W BARNSTABLE, MA 02668 Administrator
Thous Capizzi, Sr.
1645 Newton Rd. �.. — �•:_ :°
ADMINISTRATOR
Cotuit NR 02635
1
(.�' ueall/ `'�%Glir I �fft� BOARD OF BUILDING REGULATIONS
y iJ /ze dI1L7721Y921 a n- veac�iuveCld. s� se: CONSTRUCTION SUPER
" en
C SAFE
Lic
DEPARTMENT OF PU9lI yy ,
Number: CS 007454
R '• CONSTRUCTION SUPERVISOR LICENSE
r�..
r
1
RESCrIctOd''T0: 00 Restricted To: 00
jTHOMAS CAPIZZI
FREOM 5 V. flNSCH III
j ,' I 1645 NEWTOWN RD
i COTUIT, MA 02635 Administrator
a,! 4 0S B•Y,A411 OdS3-1-
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