HomeMy WebLinkAbout0145 GREAT MARSH ROAD o •�k e r •i,�:: i,�.. r -�3 t• .G"'_ 1 n s r.. �yf �n. a ,6 tr ae',
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0-*1KET 'Town of Barnstable *Permit#
Q� Espires'6 nrowhs from issue At
* BARNSCABLE,
-regulatory Services Fee
Thomas F. Geiler, Director
s (�
plF°^�'�� Building Division
Tom Perry, CBO, Building Commissioner,.
200 Main Street, Hyannis, MA 02601 (�q 10111jo9 A-a-
www.town.barnstab1c..ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 240,149 403
Property Address Z/5 L> '��7 " � /3 Y�(dl ��✓1�1 ��'11t)�f'� fT62,
/Residential (� o0 inimurn fee of$25.00 for work under$6000.00
Value of Work
Owners Name&Address
Contractor's Name1, 1°!A' � fj . Telephone Number �n'1� - i _
Home Improvement Contractor License#(if applicable)--06 aL _3 /+qo .3 _
Construction Supervisor's License#(if applicable)
dw"orkman's Compensation Insurance -PRESS PERMIT
Cheek one: C C T 1.6 2009
❑ I a sole proprietor
❑ am the Homeowner TOWN OF BARNSTABLE
I have Worker's Compensation Insurance
a �� - I
Insurance Company Name �l✓ ,/1�1 ��1 �'t`' 1/✓ L) _
Workman's Comp. Policy
Copy of Insurance Compliance Certificate must be on rite.• '
Permit Reque- check box)
Re-roof(stripping old shingles) All construction / `I
debris will be taken to fop rc,X e/J.
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum .44)
*Wbere 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.
Improvement Co ntr rs License& Construct Supervisors License is required.
SIGNATURE: -
Q:IWPFILESkFOP IAS\Express\EXPRESS PER M IT.DOC
t
i
1 he corrtmon wealth.of Massachusetts
Department of Industrial Accidents
Office of investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/did
Workers' Compensation Insurance'Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Legibly
Name(Business/Organization/Individual): ` v
Address:
City/State/Zip: G��'` , 3 C,S 3 Phone#: ' l
Are you an employer?Check the appropriate b 4 F
of project(required):
1. I am a employer with 4. Lam a general contractor and INew construction
employees(full with
part-time).* have hired the sub-contractorsRemodeling
2.❑ I am a sole proprietor or partner-
listed on the attached sheet. ..
These sub=contractors have ]Demolition
ship and have no employees employees and have workers'working forme in any capacity, ]Building addition
comp.insurancea[No workers' comp.insurance [],Electrical repairs or,additions
required.] 5• ❑ We are a corporation and its
officers have exercised their 11.❑PI bing repairs or additions
3.[] I am a homeowner doing all work g p p 12. Roof repairs
rig of exem tion� er MGL
myself.[No workers comp- c: 152, 1(4),and we have no
insurance required.]t :, § 13.�Other
employees.`[No workers' ,
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.
tContractors 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:
Pw l s - S
Z2 J_ C�j Expiration Date: 3 101 .
Policy#or Self-ins.Lic.#:
Job Site Address: 4 6&,41
City/State/Zip: 2
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). .
of criminal penalies of a
Failure to,secure coverage as required under Section 25A'of MGL c. 152 can lead
00 and/or one-year imprisonment,as well as civil penalties in the form'of ae iosition STOP WORK ORDERtand a fine
fine up.to$1,500.
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 certify under the pains and penalties of perjury that the information provided/above is true and correct.
Date: l
S i onature
Phone# �O
Official use only. Do not write in this area, to be completed ty o'r 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
Phone#:
Contact Person:
r
ACOR® CERTIFICATE OF LIABILITY INSURANCE105/27/2(MMMDNYYYI
, 009
PRODUCER THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION
JOINT BERGONZI INS AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED; BY THE POLICIES BELOW.
75 F STREET
HULL, b9L 02045 INSURERS AFFORDING COVERAGE NAIC#
INSURED --�• - INSURER A:
Michael Viola
INSURERS; GRANITE STATE INS CO
® HaClaseah Way INSURER C;FIAEMANS F= INS CO
INSURER D:
Hull, MR 02045 INSURERE: -
COVERAGES
TI)C POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT. WITH ,RESPECT TO WHICH THIS CERTIFICATE MAY BE .ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS.
SR — Ob CYEFFEC POUC/EXPI —
LTR 11%SRDI TYPE OF INSURANCE POLICY NUMBER DATE IM"DrrYj OATS JMVJDWM LIMITS
CINERAL LIABILITY - _ - _ EACH OCCURRENCE 6 `
COMMERCIAL GENERALLIABILITY - OAMA�OET0_RENTED'--"'
,PREMISES p eccurence) f �`--•-- —
.. . � '. •.-_
CLAIMS MADE u OCCUR - MED SXP(Any one person) I
.. PERSONAL A AOV INJURY I
GENERAL AGGREGATE f
0EN•L AGGREGATE LIMIT APPLIES PER: - - PRODUCTa.-COMPIOP ADD I
R POLICY JECT ' LOG 4
AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT s'300000
C R ANY AUTO VZA12508407 3-1/25/2008 11/25/2009 (Eeeccldenq
ALL OWNED AUTOS BODILY INJURY Y 110000D
SCHEbULEO AUTOS �. - (Per person)
HIRED AUTOS
BODILY INJURY s 300000
NON-OWNEO AUTOS • (Per ocUdent)
PROPERTY DAMAGE 7100000
(Per secldsm)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT f }
— ANY AUTO < OTHER ThUw EAACc f'—
. AUTO ONLY: AOG S
EXC[18NMBRELLA LUIBILITY - EACH OCCURRENCE 1 -
...... ....
OCCUR CLAIMS MADE AGGREGATE 1
DEDUCTIBLE
RETENTION 3
B WORKERS COMPENSATION AND - WC-742-79-20' - 5/26/2009� 5/26/2010 X TORYLIMITs =ER
ENPL.OYLRB'LIABILITY •- - ._...
ANY PROPRIETORlPARTNER1EXQCLMVE - - - E.L,EACH ACCIOENI S100000
oFFIceRWEMBER lI{cLu0ED7 EL.DISEASE-PA EMPLOYEE 1 500000
II yes,EesCODO under ... _
SPECIAL PROVISIONS below - E.L.DISEASE•POLICY LIMIT 1 100000.
OTHER
OEBCRIPTION OF OPERATIONS I L OCATIONA I VEHICL93 I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
TRD AT-ROHE BEAVICE8, INC. AND TEM HCHR DEPOT ARE INCLUDED AS ADDITIONALINSURED WITH
RZBPBCT TO GENERAL LIABILITY INSURANCZ. ,
CERTIFICATE HOLDER CANCELLATION
TEZ AT-ECIa 8H7tVICZS, INC: SHOULD ANY OF THE ASOVE tlESCAIBBD POUCIQS BE CA21GdLLED BEFORd THE EXPIRATION
DRA THE HQPrM DZYOT AT TICAn SFAVICPA OATH THEREOF, THE I58UING INSURER WILL TNOFAVOR TO MAIL GAYS WRITH-H
2690 CUmBER.LAND PKWAY SUITE 300 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ®UT FAILURE TO-DO 30 BRALL
ATLANTb+, GA 30339 IMPOSE NO Op LMATION OR LIA OF ANY KIND UPON THE INSURER, ITS AOENTK OR
" RSPRESENTA
AUTHO RIP NTATIVE H
Ak.UHLI 29(200 fOB) 0 ACORD CORP RATION 1988
'VA W0 0 60OZ/SZ/90
One .shbunio>n Place Room. 1301
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Home Iaprovemer��.. r R W
R"istabon: 140�993
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t�►�F;= _=a• fir•e � : 9?l?rh t1f) TWO 26241I
f�lCt�AEL J. V!®l.�0
MICHAEL VIOLA j�l �=e -%'��-.' _.. ._-
8 HADASSAK WAY
HULL.,MA 02045 }v
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before the expttutWa 40L If ftGW rg""
BOMrd Of BYiMIug Rftu sdow sad Standards
One Aabbvrtoo Place Ras 1301
Boatoa,eta.02108
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T-010 P-001/006 F-994
OCT-06.2009 09:54 FROM-HM DEPOT
110ME IMPRUVEMENT CONTRACT
PLEASE READ THIS
_ Sold,F shed and Installed by:
Branch Name: Boston Date:/U a THD At-Home Services,Inc.
d/b/a The Home D t At-Home Services
Branch Number:
345A Greenwood Street,Unit 2, orcester,MA 01607
Toll Free(800)657-5182 Fax(508)756-8823
❑North 33 &fSouth 31 Federal ID#75-2698460;ME Lic#C 02419;RI Cont.Lic#16427 I
(/re,Nk CT Lic#5655552-2-;MA Home Improvement Contractor Reg.#12G893 t t�
installation Address: / ycr�r.4T�27 �iy/l� / '�` �'"a d.2_Z
City State I Zip
Parchaser(s)t Work Phone: Home Phone: Cell Phone:
Home Address:
(If different from Installation Address) City S Zip
E-mail Address(to receive project communications and Home Depot updates): C
❑1 DO NOT wish to receive any marketing emails from The Home Depot
Protect laformation: Undersigned("Customer'),the owners of the property located at the above installation address,ogees to buy,
and THD At-Home Services,Inc.("The Home Depot")agrees to flunish,deliver and arrange for the installs ion("Installation")of
all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated in
this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached hereto and any Chan a Orders(collectively,
"Contract"):
Job#: trm�t xrr.—o Products: See Sheet(s)#: Pro'cct Amount
oofing []Siding Windows ❑insulation , $
QGuners/Covers ❑Entry Doors ❑ 1QJ/y1
Roofing [ISiding Windows ❑insulation $
❑Gutters/Covers r]Entry Doors ❑ �fo
Roofing Siding❑Windows UInsulation $
❑Guttcm I Covers ❑Entry Doors❑
Roofing ❑5idinb Windows ❑insulation $
❑Gurters/Covers QEntry Doors ❑
yMinimum 25%Deposit of Contract Amount due upon execution of this Centruck Total Contract Amount- $
Maine Purchasers may not deposit more than one-third of the Contract Amount
Customer agrees that, unmediately upon completion of the work for each Product,Customer will exeeu c a -Ompletion Certificate
(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,ear Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Produc s)included herein,at
its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obliga ons due to a structural
problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pr ing errors or because.
work required to complete the job was not included in the Contract.
Payment Summary: The; Payment Summary #.2y 7CG�___-.
mciuded as part of this Contra t, sets forth the total
Contract amount and payments required for the deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Complet on Certificate(note:
there is one Completion Certificate for each fisted Product as de£med by individual Spec Sheets)before I
ork an that Product
is complete.
In the event of termination of this Contract,Customer agrees to pay The Home Depot the Costs of mate als,labor,s n penses
other
and services provided by The Home Depot or Authorized Service Provider through the date of termin lion,p Y
amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WiT BOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS ;MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acceptance and Authorization: Customer agrees and undmtands that this Agreement is the entire agrecm tit between Customer
and The Home Depot with regard to the Products and Installationsices cannot ther
be assignrsedes ed or arnr ndcdt�xc by aew'riting signed
oral or written,relating to said Products and Installation.This Agreement
by Customer and The home Depot.Customer acknowledges and agrees that Customer has read,understands, oluntarily accepts the
terms of and has received a copy of this Agreement.
! Submitted
Accepted lLy: r b P�rO �y X Q o+ d
X / Sales Cons tant's Signature ate
Customer's Si azure Date
X Telephone No.
Customer's Signature Date Sales Consultant License No.
- pplicu6le)
(ANCELLATION: CUSTOMER MAY CANCEL THIS
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE TO THE HOME
DEPOT BY MIDNIGHT ON THE THIRD.BUSINESS
DAY AFTER SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY
PRESCRIBED BY LAW. IN
CUSTOMER'S STATE.
NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATrn on TH E ttEvEttSE SIDE AND aRF.CART oF'rtns coNTttaC't'
lath te— Satas Consultant
6rench r-ae Yellow—Cult—r pink—
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates.COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town
(WHICH YOU ,MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary
at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, I" FI., 367. Main St.; Hyannis, MA 0260 naowns on this form
the Business Certificate that is required by law. Cl Hall) and get
INS
* m Fill in please: DATE:
x APPLICANT'S
YOUR NAME:_
BUSINESS YOUR HOME ADDRESS: . /ys (rR T � 2�, Cf iiiCv,L[� 026
.. SOS_ J7S �5�37 5O - 7 3 2
TELEPHONE #. ?S' S�7 ,
NAME OF NEW BUSINESS Home Telephone Number
IS THIS A HOME OCCUPATION?
YL� NO YES TYPE OF BUSINESS 4 E/}Sf- -D �2�
Have you been given approval from t e building division? YES NO
ADDRESS OF BUSINESS /41,5-(j 0Z13z MAP/PARCEL NUMBER 2I — 2 � ^ 006
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of th
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO,TO 200 Main St. _ e Town of
Yarmouth Rd. & Main Street) to make sure you have'the appropriate permits and licenses required to legally operate our business(corner of
town. y business in this
I. BUILDING COMMISSIONER'S OFFICE This individual has b infor d of an rmit quirements that pertain to this type of business.
MUST COMPLY WITH HOME OCCUPATION
A °i Sig e*COMMENTS: MULES AND REGULATIONS. FAILURE TO
COMPLY MAY RESULT IN FINES.
2. BOARD OF.HEALTH
This individual ha�' Ormedhe mit re it ents that pertain to this type of business
COMMENTS:
Authorized• Sign, re** G; /
3. CONSUMER AFFAIRS (LICEN$1f G AUTHORITY) }
This individual has bee iy i for e f lice in it ts.that pertain to this type of business.
Authorized Signatur
COMMENTS:
Town 'of Barnstable
Regulatory Services
o Thomas F. Geiler,Director
Building Division
+ tAxrrszA13M
r 1M6"�5 �� Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 E 50 -790-6230
Approved:
Fee:
Permit#: 5'
HOME OCCUPATION REGISTRATION
Date. 0 /
Name:_ g"LG y �v-r6KD Phone#: 7
Address: .r, _ 6-9 i4'r MAT} (0, Village: C Ely I�V1t_t_F
Name of Business: I .1 L 6r, 66 R—I) _
Type of Business: Map/Lot: :kl D - 29- 00,3
DV ITI�T: Ins the intent of this section to allow the residents.of the Town of Barnstable to operate a home occupation
within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the-
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution:
After registration obith the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carved on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space;
• There are no external alterations to the dwelling which are not customary in residential buildings, and there is
no outside evidence of such use.
No traffic will be generated in excess of.normal residential volumes.
• The use does not involve the production of offensive noise., vibration,smoke,dust or other particular matter,'
odors, electrical disturbance,heat,glare,humidity or other objectionable effects,
• 'There is no-storage`or:use of toxic or•hazardous materials,or flammable or explosive materials,in excess of
norinal household quantities.
• Any need for parking generated by such use shall be m 'Loin the same lot containing the.Customary Home
Occupation,•and not within the required front yard.
There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation, other than one van or one
pick-up-kuek•not-to•exceed•one ton.,capacity, and one trailer not to exceed 20 feet in length and not to -
Mrs.d.4 tires,parked.on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business, the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit .
I, the undersigned, have read d� e th e e restrictions for my home occupation I am registering.
� Engi.eering Dept. (3rd floor) Map 65KO Parcel �� rmit#—L
House# �j� h Date Issued
.Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) -2� Q Fee^, �S ,av
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 3
Ist tloor/Schoolmi
19
BAR
t619-
RFD MA'S s`�
TOWN OF BARNSTABLE
Building Permit Application
Project Street Address ' 7 S 1���-� /�'(, S H
Village L�e. U
Owner - r J+c� -�
YW �• GfJ � Address
Telephone _7 .7 c 3
Permit Request
First Floor square feet Second Floor square feet
Construction Type
>4stimated Project Cost $ 10-d o-d
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Familywo Family ❑ Multi-Family(#units)
Age of Existing Structure e�o Historic House ❑Yes pro On Old King's Highway ❑Yes Imo
Basement Type: ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing 3 New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: pas ❑Oil ❑Electric ❑Other
Central Air ❑Yes 0'&o Fireplaces: Existing "-_� New Existing wood/coal stove ❑Yes Z]-145
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
L)144one ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name / Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
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
SIGNATURE )b6� DATE ldAl
BUILDING PERM T DENIED FOR THE FOLLOWING REASON(S)
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12/12/0
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12/12/02 145 Great Marsli Rd.
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FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.',
41
ADDRESS 1, VILLAGE -r
• n
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL _
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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c.?�o►v;. .�.._ _ - .. .,k,, ,E-, �r .. .i _ r , .,,. r,;.,..wi- ^^il+a-^.'rv5ir.,
The Town of Barnstable
BARE. Department of Health Safety and Environmental Services
MASS
i67q• �0
prEoy Building Division
367 Main Street,Hyannis,MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230� Building Commissioner
Inspection Correction Notice
Type of Inspections
Location 14 C-,,c r,7V l \ S t x iQ Permit Number to � O h q
Owner Builder
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
to o 4 .
1 Fr~Lc A-C r a v n d 0� lx a �� '�c� ( 1 V� � n k 4 \11\ �G C_e_
`'t) R 8.v,^ ,a e o u C)v'a CA Vn r m 6 ' 0-yr;c' I - v-r Yv+ U V1 d Q-r
fAn a to
i icZ nN4 ufir- -0nc l)r1 \rC'1nq( `?.0 0
Please call: 508-862-4038 for red�-i.'section.
Inspected by�� _ �L n.
Date
n
f
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map f Q/�9�0 Parcel 0.07 3 Permit#
Health" Diu on � s ;Date Issued
Conservation Division
Tax Collector 2—
Treasurer
Planning Dept.:
Date Definitive'Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis"
,
Project Street Address / YZ0 0 1XARSAY" Q fl.
Village LLIE
Owner (�H ou D 4 �' u/E L C tii Address 3 4 jnE'
Telephone -S'o 8 -77S"'- GS"37 r
Permit Request w►L3 A 7_4 "c` 3y o Arb N ' Z Qq it &.49AGE
r GW TN- .S lid P AggV 9
Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new -
Estimated Project Cost 7 y,o00•oo Zoning District Flood Plain Groundwater Overlay
Construction Type ' Fu 6 f elv is r�
Lot Size S . i. Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ` ❑No On Old King's Highway, ❑Yes -0 No '
Basement Type: ❑Full ❑Crawl '❑Walkout ❑Other St_4 d o xt tv +oS 1`
.Basement Finished Area(sgJt.) 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
. i
t
Heat Type and Fuels ❑Gas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:0 existing 4 new size 'LVV-%`fPool:0 existing ❑new size Barn:0 existing ❑new size
Attached garage: ❑existing O new size Shed:0 existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded El
Commercial ❑Yes 0 No If yes,site plan review#
Current Use Proposed Use "
-, BUILDER INFORMATION ,
Name 3Ames md&�")W Oaf-iigCsoi "oo0 f"O, Telephone Number - Soa 430 -L800
Address 2RS_9 ' o ggdp.� 4MN A License#' 073 8(a 6'
{-fi4&Lagoa MA$5, -Yr Home Improvement Contractor# /329 3S
Worker's Compensation# C-5V 67x i So 4a
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4*&,ah,a,4 t~0 Pi 44-
SIGNATURE wlu� y DATE _ to ts./e Z
- FOR OFFICIAL USE ONLY `
PERMIT-NO.
DATE ISSUED
MAP/PARCEL NO:
ADDRESS t. t. VILLAGE
; OWNER ' i F; _ fl a„ . '; - - _+ ,• � °-
DATE OF INSPECTION: T,
FOUNDATION Cs j 2 J
: FRAME °
INSULATION
FIREPLACE '
F ELECTRICAL: ROUGH FINAL _
PLUMBING: ROUGH FINAL
GAS: ROUGH f FINAL
•t
i FINAL BUILDING
DATE CLOSED OUT .
ASSOCIATION PLAN NO. r yz'
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b
NWP.ofIHEr The Town of Barnstable
BARE. * Department of Health Safety.and Environmental Services1639
„
prFD MA'S Building Division lj
367 Main Street, Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
�.. "
PLAN REVIEW - F
Owner: 1 Z u G` 4 Q C- k Map/Parcel: 2 I p 12 o U 3
Project Address: 145 C^,U-eCJ M\GY S � Builder: c y-r\e 1 'Cq VCL� �
The following items were noted on reviewing:
Cdvy�����►L)Y'\
f,J P �` �l\ ro U q 3
2) U evI 4- C s p k rJ, `� I )neat
_
1 r
c r IA
1 '
Reviewed by: 0.
ii
� uCJ
Date:
q:building:forms:review
r
Y
r ,•t
IE .
••�i
# r
•. .. �. G�. 6�x�0 ~ Septjirenkder el J�
LEGEND
1$TIN(� SPOT ELEVATION Ox0 , '�F`It- _, � CERTIFIED PLOT P Q a :
XISTINO CONTOUR -- - O - - - A� =toe« T,e
;. FINISHED SPOT ELEVATION 0.0 I / 2C �' `� ° re4
I~ib6tS�9ED CO T �� P. \' wd, rr-
N OUR O V BUNIKIS -
hc.22162 Q
" PROVEDr SOARD OF HEALTH ��p�� sTfP� �4� IN
F� CHAt.�� / S Al?31 S•1A - d gi M ASS,
o(. HATE AGENT -- SCALE: ��= YO DA Ac� /Ife .
►. L�R�'l�GE EN6/NEER/NG CO. IN
- — - _ - ---1 CLIENT&--kic.� I CERTIFY THAT THE PROPOSED
E(iISTERE REGISTERED OJOB NO. .09.-_ BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
I`NGINEER SURVEYOR DR. BY _ .— OF BARNST4
712 MAIN 'ST, C,H. BY: J
/9
HYA
NNIS, MASS. SHEETS OF _ DATE REG. LAND SURYEYO-
f
-
..,. .. .. P r' r ii3 t ,.'L• 3' 3 r n k 4 .c.y
'r
x.:';�«: ML, £.rt, # i rrTE HC n 'vs ^'�,-;}„. f .
;tr.. «> 'ao, �d.ha :�°.✓•' .'€.
y. A t
Pine y, � About Delive s .SON STOID�v
SCREENHOUSES ►. Sheds USA will acknowledge BY > apart "' G'C• "
f ' other
f MAIL the receipt of your order. F hnsnMii4 , . •
_,4�ove�i� additcon to anc� c�ar�� ; f ► Sheds USA will schedule delivery by I ( I f ' I I '-UNFINISHED FURNITURE • wOODENwARE • CRAFTS
` contacting customer one week in ! DENNISPORT•.W.HARWICH •W.YARMOUTH • PLYMOUTH
advance. UNSURPASSED CUSTOMER SERVICE! �� r ; 4^ ^►,BEORD FALL s UA,NH CANTON SCARBOROUGHi ME',"'"
► Please know in advance an important ' ' `F {
r ^ y portent r ,, ,� � r°�
Mere w�at our cwtomer_4 jay:
fi }y details (location of nearest electrical I� }
outlet, directions, etc.) "Outstand
ing..: (the crew) wont out Of
s = -`�. µ ► Skilled craftsmen completely their way to show the utmost courtesy, d
:res ect and considerations
assemble shed on site. p
R T, Nashua, NH
Many thanks... the quality of your Ii A
{h^ r product will be brought to the attention of
neighbors and others. . {
{ 4 a
Shed Construction
I R.C.,Pembroke MA
Site Preparation ('17ie office sta_ ) was eery heipfui and' ^ 4 �'friendly
WALLS �* ,a V.N., Tiverton, RI
•;..
• 2x4 construction,24"on center When selecting.your site please consider "Your construction crew left the yard r °.j
• Pine&Cedar.1"tongue 4&groove
(horizontal) the following factors: immaculate.
'
• Texture-111:exterior aiding(vertical) I CLEARANCE. E P., Plymouth, MA
-{ y �Nr3yt.•' —_mac
ROOF Remove tree branches or other obstacles UenJ competent, neat polite and+
• 5/8"plywood ; 3' around perimeter of shed and 9'above. Rdly R.P Franklin 8 A
{ itxaY
• 2x4 construction,24"on center I , Square, NY
• Self-sealing asphalt shingles w/15 year I LAND GRADE `�'Jianlcs again for your follow-through
I Land must be less than a 6" slope,with and diligence."
• Heights—8•wide standard-8'3" I no protruding rocks or stumps in the L R, Nashua, NH
—8'wide gambrel=9'
—10'wide standard-8'11" area. ORAGE
.'COUTteOus, efficient aiid professional"
—10'wide gambrel=9'5" I +
—J.M. Ocean Bluff MA
ACCESS ,+
FLOOR Shed is delivered in prefab sections; clear
• HEDS
5/8"plywood access to site is necessary—stairs,nar- UNIQUE 10-YEAR WARRANTY
•. 2x4 construction,is"on center for row walkways, fences,gates, shrubs, etc. Sheds USA, Inc.warranties labor, materials direct
1o•wtde unitsare difficult to maneuver and should be and structural soundness for 10 ears with } G>LCtON t0 OGG/
• Pressure-treated floor joists optional ;I y
i noted. proper maintenance. This warranty does not f
WINDOWS I include fire,flood,windstorm or neglect.
• Functional windowsw/flower LAND QUALM Customer must stain or preserve building � 1 � s�DS USA
boxes and shutters Consider other factors when choosing within 60 days of.delivery. ` {
• 8x8,8x10 and toxic units include one I No other warranty Pressed or imlied is r .
window.All others include two. your site, including proper drainage, R "r h P•0. Box 6622
including
firmness of earth, etc. by any employee or sales agent.
FINANCING Portsmouth, NH 03802
coons PERMITS z (603) 431-8489
• 40"double door,standard
• Optional single and double doors up to 78" I Permits are the sole res onsibili of the 1 'financing available at selected locations. ! F'
:,.
I I p LOW interest rates, 90 days same as cash with .
homeowner. credit approval. See salesperson for details. *Ask about our 100% financing
3fi r. Standard Features
HA ► Custom Placement of door(s) and
window(s) at no charge
Shown in 8x10— , , k.,, —Shown in Sx12 — —
y Y: ice of siding. Texture-i i i. Pine or
'4
wn ► Cho
Cedar - n _. •,, ,,
r ` .' ( s { .I °.' ► Choice of roof styles: Peak or Gambrel •`
t ' at no additional charge
— —•....� .C�►./ �"-a—.sr r p r:: ..: --tea„_ _—•c�i= .._yz—+P,� � , 1 ,fir` ., _ •' _. �...
y ! ! F' �' ► Asphalt shingles—choice of 3 oolors
► Functional windows— 12'wide sheds and
1 ' 1 t , � 1 -. _ � � � ' larger have two windows with flower
boxes and shutters
1 ' � •� ` ► 5/8" exterior plywood-floor, 16" on center
� J �' �}, � ! ��''� ¢ ��:'� � ' -� ff -`�• ;.' "- _ - _.. i !� r i ► 5/8" exterior plywood roof
► Heavy-duty 40" double door
► All galvanized nails&hardware included
for foundation
' � ..,� �..<: .•. �^, a �,t s. �r - .Concrete blocks used
- r ^=F: __: „• s ► Free delivery&setup to most areas,
r �f�oDe unit dhOrun witch a rel le. x
► Vertical exterior plywood siding ► Most popular material- / aa oo / y
' goo and o Eional26"din le door. WHOns.
► Durable ►r Withstands all types of weather P
Upgrade to 54" Double Door $50.00
► Same all features as cedar ► Classic ton a-and--and-groove a
quality r a�' ...,, Upgrade to 66'.' Double Door $95.00
and _pine models �, a �, construction. ► Durable and weatherresistant t,
P Upgrade to 78 Double Door $125.00
'
► Economical 3,-p
yr ' ►t Affordabl riced V ►T Pleasant aroma naturally repels insects` 26" Single Door ' $70.00
and s rotting ', �' Window ........................................ 0.00
fists x (dudes window box and shutters)
0. s;iw; ► r Vents (pair) ... ......$30.00
rr: Ages beautifully
a:s.
3. r stainspaint ,,:, ,} Screens ........ ea $15.00
- ► Excellent base for in and
Olti IZP.�GL Q. �� • • • ice' SL _ r1' Extra 40" DOOr .........$90.00
"'
1 _ One of the most stable types of lumber;
r _ resists warping and buckling tAl Extra 54„ Door � .......$115.00
your car has never seen the inside . �,. ; �, _ �, " Extra 66" Door $145.00
1 $' 1 ^,
of your garage ' r _ _ s Extra 78" Door 2 ....$155.00
' hh ..
...passers-by�look at your lawn and -�', j �1,'s ;f�; - - - — S,T pressure-treated)• $50.00
Ramp (4'
ask if you're having a yard sale. ` 1 t�, b - -- ..
! 1 r I �; j 1 ^, y ��- _ Custom Pool Filter Hole (in-house)'..: .$75.00
l� _ ; 1 .�i ! _ - Zar Exterior Stain $24.99
...your basements storage capacity �� 1 �„ ;!1 =: - . .
* � (We'neproudto Zarstatnforthetneabnetoofour
ends 1 Shed Uses
at the last step 1 =�- sheds
4 ',# �' � , j � _. _ -auailnble ut clear cedar,gray,brown&redwood)
.the condition of your workshop/ 4X-�� { { C 6 z r
Craft room i8 affyour yOtlr.mari7age. �e n Y Poo a ana, gar nerd eEreaE, ,
r , fig F * 15Z4j. p B / B� / �/1 re-Treated Floor joists
Pressu
you've been inured tri over ��` . one o�our modEPoPular 6ac�0uEd" /uGd d C�ub�ude, �trtcdE d ca PIOP y
••Y injure, PP � wx {" D / „/� / Ox10 ..$55.00
children's to f .,.a'= ;,. ;..- o/. 4s '• a.;. 0 s war'
; %G,,.wt �u�leor on.the able end an�an_ �tudio, uedt .(,akin 80 .
$30.0
.r =.avalanche.• `,, ..r.>M1,r..,. +«+: a,': •�-: %• t:> 5;x; x12 .:.$4
0 0 Os12 $60 00
..opemng the garage door +a D Q s 8 0 0 i0x14 $70 00
kA o na[26 .�i 6e c`oor in/
ronE. eat fit. ' Y ' `J'acfor ar a , „r.
r. � ,.` r F;. 8%14 .$40.00 iOx16 $75.00
' t .. 4
k
..,�. . .. -;,..::_ ... _ . �',a a a _.•: �. 8%16'
�ces�jD[/r ri lawnmower and downer
,.. ... :. .:-..:-.2. ,,:. ....n. r+:,,4 ,�w.. , rho .R.`. �°.:. 5..,.. :r:` �:+"::. �.y�:i .acr �. 'i.. m ;Y' �♦ t
.. -. Y.. ... .. 'C .; •-.t 1h.,.-..t. .. ._4r.-.4,
�:z.
•..:.. .. ..... .. ry, ,.�f..,h .:,. r.a. dr%x .....v.- ._a ,..: {. a.. 1 • .e'm� Y �4 •��
I
;1 Department of ludtrstrial Accidents '
�' ;. , - O�ceollm�estfgat/oas -
+�. y 600 If inhingron Street
y` Boston.Musa (12111
' Workers' Compensation Insurance:Affidavit ... _
AFMI
Inentinn- Pa
G CS �n 3 LJ
aha
1 am a homeowner performing all work myself. l
1 am a sole proprietor and have no one working in any capacity
1 am an employer providing workers' compensation for my employees working on this job.
comninv
address:
city phone f!-
insur•Ince co Policy a
I am a sole proprietor. ;eneral contractor, _r homeowner •rcle one)and have hired the contractors listed below who have
—'-_ ---
the following workers' compensation polices.
m •Im n•Imc S A e-'A �S
mldress: 6SS7 PO 1-f5 MO-46 )aO
n-: r a /+-/u V,) f D 3 $ � - J 3
-nsuran ird 1� Utz �7J fo •!l Gl�d 3 ��
- .. - --• -•- — ur •.sees--rr�'�•ea-«f-+;a =_•---a..—+ng-�-�t�.`:.!,....,t,,•..cl�::-��"`•�SSV�:�'. e.'•'.-'.�q.-"==.'^'°".
cnm any name!
•Iddresc•
rite,• phone ft•
incur•Ince en policy 0 - �w 77!77_
.Attach additional sheet if neeessa i+='v,.ry1'•.`i!eaeaHf-.•.•:. :•x:d. .• ,.�r.. ` ' C +�•""'y`y`:��..;
Fuilurc to secure cm erage as required under Section 25A of hIGL 1S2 can lead to the imposition of criminal penalties of a fine up to 51.500.00 andiss-
une tears'imprisonment as swell as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that:;
copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. '
1 do llerebr certi., cr t/te ants aWd Wallies of prrjun•that the information prodded above is true and correct.
q - 1 JAhVSignaturc Date _
Print name Yv��-`� ----.Phone* -7 7� —a J 37
' oRcial use only do not.write in this area to be completed by city or town official
city or town: permidlicense q r9Building Department
[3Lieensing Board
p check if immediate response is required 13Selectmen's Office
>__ Health Department
contact person: phonefY. rnOther
um and 3M5 PIAI
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation.for
employees. As quoted from the "law",an empinree is dcfincd as every person in the service of mother under an%
contract of hire, express or implied, oral or written.
An emplitrer is dcfincd as an individual. partnership, association. corporation or other legal entity. or anv two or r
the foregoing enca�_ed in a joint enterprise.and including the le-al representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. Howeve.
owner of a dwellin__ house havin` not more than three apartments and who resides therein, or the occupant of the
dwcl ling, house of another who employs persons to do maintenance, construction or repair work on such dweIiing
or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an emph
MGL chapter 152 section 25 also states that even-state or local licensing ngene}•shall withhold the issuance of
rencival of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant Nvho has not Produced acceptable evidence of compliance with the insurance coverage required.
Additionally. neither t►te 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 chapt:
been presented to the contracting authority.
Applicants
Please full in the workers' compensation affidavit completely, by checking the box that applies to;your situation ar
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance covcragr. Also be sure to sign and date the affidavit. Tice
affidavit should be returned to the city or town that,th;application for the permit or license is being requested.
not the Department of Industrial Accidents. Should yott have any questions regarding the "law"or if you are requi
to obtain a workers' compensation policy, please call the Department at the number listed below.
.__ ._ . .
Cin• or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne
the Department by mail or FAX unless other arrangements have been made.
y u i advance for you cooperation and should you have any quest,,
The Office of Investigations would like to thanl. ,o n fo p .
please do not hesitate to give us a call.
The Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industtrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
°F VE r
The Town of Barnstable
Department of Health Safety and Environmental Services
MAME15", Building Division
367 Main Street,Hyannis MA 02601
Ralph Crossen
Office: 508-790-6227 Building Commissioner
Fax: 508-790-6230 '
For office use only
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.
` ��y.�J � � Est.-Cost ��� J�-`J
`Type of Work:
Address of Work:
Owner's Name -S,
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
7 Orner pulling own permit
Notice is hereby given that: UNREGISTERED
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
CONTRACTORS FOR APPLICABLE
OR HOMEGUROVEMENT WORK DO ARAN>'Y FUND UNDER MGLO 14ZA�
ACCESS TO THE ARBITRATION P
SIGNED UNDER PENALTIES OF PERJURY
I hereb •apply for a permit as the t of the o r.
1 Registration No.
Dat Contractor Name
OR
y TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION ecc�� �
-Number Street address Section of town
"HOMEOWNER" O" SCs�C� 7? ��7 7
ame H r
nnome phone Work phone-�
PRESENT MAILING ADDRESS c
City town State Zip code
The current exemption for "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER
Person(sj who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner"- shall submit to the Building Official
on a form acceptable to the Building Official, that he/she shall be responsible
for all such work performed under the buildinq permit. (Section 109. 1. 1)
The undersigned. "hoiiieowner" assumes responsibility for compliance with the Stat
Building Code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minimum inspection procedures and requirements
and that he/she will comply w' said procedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner performing work for which a building
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that. if
Home Owner engages a person (s) for hire to do such work, that .such Home Owner
shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it{would with licensed. Supervisor. The Home "dwner• actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities, man
communities require, as part of the permit application, that the Home Owner
certify that he/she understands the responsibilities of a supervisor. On the
last page of this issue is a form currently used by several towns. You may
care to amend and adopt such a form/certification for uselin your community.
i
B. OARD OF BUILDING REGULATIONS
License PONSTRUCTION SUPERVISOR
Number ^G-& 045135
Birtdae; OS/ 21914
I. EXRiMp 05tt21A' 04 Tr.no: 23520 a
Rered�
JAMES D MCGRATh�- ,al
f r-
259 QUEEN ANN R �
�,M
HARWICH, MA Administrator
1
r
Board of Building Re ulations
One Ashburton P ace, m 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE a Birthdate: 03/14/1970
Number: CS 073865 Expires:03/14/2004 Restricted To: 1G
JAMES R MCGRATH
204 CRANVIEW RD
BREWSTER, MA 02631
Tr.no: 18918
Keep top for receipt and change of address notification.
i; ;Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 132935
Type: Private Corporation
Expiration: 10/31/2002
McGRATH POST & BEAM CO..
JAMES McGRATH
.259 QUEEN ANNE RD.
HARWICH, MA 02645
Update Address and return card.Mark reason for change
C Address ❑ Renewal Employment ❑ Lost Card
.� ✓hie T�ar�manu�eal� a�✓t�aavac�uc�el�t _ ,__ - -_ _ _..-- -
m Board or Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to:
Registration: 132935 Board of Building Regulations and Standards
Expiration' 10/31/2002 One Ashburton Place Rm 1301
Type;
Bostoni Ma.02108
McGRATH POST&BEAM CO.
JAMES McGRATH /� 1
259 QUEEN ANNE RD. �
HARWICH,MA 02645 Administrator Not valid Without signature
The Commonwealth of Massachusetts
1 W Department of Industrial Accidents
a
Mcd 81IMSMOR&ONS
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: PleasePRINTTetit� _
nam•:
location
1tL� ohone#
I am a homeowner performing all work myself.
I am a sole proprietor and ha,.e no one working in any capacity
t am an employer pro,.idine workers' compensation for my employees working on this job. l
company nam
p
address
cit ( C #• 3C)
C �fitab7��XI�Of�a1
insurance co. _ • y policy#
I am a sole proprietor. general contractor,or homeowner(circle one) and have hired the contractors listed below ho have
the following workers* compensation polices:
company name:
address:
city:
phone#.
insurance co. policy#
company name:
SliX� phone No
insurance
poliev d
it
Failure to secure coverage as required coder Section 25A of MGL 152 can lead to the imposition of erimind penaldes of a tine up to SIAM0.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of investigations*(the DIA for coverage verificatim
t do-hereby certify under the pain an p malt•es f p ' ry that the information provided above is true and eor►eet
Signature ate
Print name
Phone# LA 3 0 ^a
- omcial use only do not w rite in this area to be completed by city or town official
city or tows _ .u. _ permiMieense# -Building Department
❑Licensing Board
0 cheek if immediate response is required oSeleetmen's Office
Health Department
contact person: phone#;_
-Other
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
Job Location:
Number Street Village
Owner of Property:
Construction Supervisor: 9 C
Name License No. Phone No.
Address: _
Licensed Designee:
(If other than Supervisor) Name License No.
2.15 Responsibility of each license holder:
2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising.
He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration,
repair,removal or demolition involving the structural elements of building and structures only pursuant to
the state building code and all other applicable laws of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any licensee who shall willfully violate subsections 2.15.1,2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons,the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section'109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the-requirements of MGL Ch.152
Yes Na
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 54 Other type of indemnity ❑ Bond.
OWNER'S INSUPANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of)fie s .GqLaws,and.that my signature on this permit application waives this requirement.
Check one:
Signature of Own r r wneves Agen Owner ❑ Agent
Signature: Building Official Approval:
µ For Office Use Only
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the `reconstruction, alteration, 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 structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: J Est. Cost=h��0(�
v Address of Work
`/Owner Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000
Building not owner occupied
Owner pulling own permit
Other(specify)
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:
I ereby apply for a permit as the agent of the owner:
fbo—r- 13293
Date Contractor Name Registration No.
�a� r�:
OR:
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION:
NAME STREET ADDRESS SECTION-OF TOWN
"HOMEOWNER
NAME HOME PHONE WORK PHONE_
PRESENT MAILING ADDRESS
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended
to be,a one or two family attached or detached structure assessory to such use and/or farm structures. A person
who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"
shall submit to the building official, on a form acceptable to the building official,that he/she shall be responsible for
all such work performed under the building permit. (Section 108.3.5.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes,by-laws,rules and regulations.
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent,which meets the requirements of MGL Ch 142.
Yes❑ No 0
If you have checked. yes,please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the Mass.General.Laws and that my signature on this permit application waives this requirement.
3 .
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent
h:homeownflicexemp
PLOT°PLAN
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool)
well
(lot. ... . . ..ft. rear)
uttor s f Abuttor'
ne Name
I Lot #
t # ,
REAR YARD
this is a If this .
mer lot, ..ft. corner 1
ite in name .
write iz
street. name of
1: other
,a street.
: SIDE YARD SIDE YARD
HOUSE
L/
•
1
j
SET BACK
t 4Z>
(lot...... ............ft. frontage)
,
(NAME OF STREET)
Information
/ Supplied by --
i .a
Assessor's map and tot number . ... .... ' / ��
OF 7N E t0
» Sewage Permit number ...��.. f .1t'�.......... ................ w
l BARNSTABLE. i
House number ) .......� r MAB6
.......................... Apo,039. �00
'F0 No a\
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......
TYPE OF CONSTRUCTION ... •. ,..... .A ..................................................................................
•..,•ba.r<$ ...... .......................19��1a�.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit
_jaccording to the
-following information-
Location .....L.Q. .... ... ......... :.s.�.Ar!L...... .. .ATM�........ ..........-A.^ `.. ............ ..................0,Px
ProposedUse .... t�.k4o_- .................................................................................................................
Zoning District .....,2,..c........................................................Fire District ... ..?. ?:.........................
Name of Owner ... �.��n:^.. . ........Address ..H5-.a...... ..... �,�•�1;�'C�
1 P �_Ll ->.k..... ....Address tZ 9 �•� (?�"�
Name of Builder .....:..:.................................. �[v.�• ........................ ....�.... .... ..........:C....,,._.......�............�
Nameof Architect ...:..............................................................Address ....................................................................................
Number of Rooms ......j(�.....................................................Foundation ,.� ,�,�,�,�.+,�.r.'�;>�� ..,............ ......
Exterior .CJA .....�n Ac. ........L o ...Roofing .. ,S.P.!!t ? ............................................................
Floor ff
s �t r .Interior ....... d..x
Heating .. ........................................................Plumbing ...G. ....:�:...... J. .................................
Fireplace ...... .............................................................Approximate Cost ..... .Q�:.�.�.Q.......................................
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 Barnstableregarding the above
construction. /
`��
Name .... .t�l....�:''•a. ��' �. ..�t:�.,:>.� ...........
MC,KEON, JOHN C. A=210— "29-3
No .2.3.2.2.4... Permit for .0n.e...1-/.2....S.... ...Y.
A=210— 29-
3
S 0......... ..Y.
Single Family Dwelling... .... ..........
............................................................... .. .........
t
Lot #3 145 Gre t. oar Rc...
Location .......................................... . .... ........*.b. Rd.
..................C.....entervil le
........................................................
Owner' ....John C. McKeon
..............................................................
Type of Construction ...F.KAIAQ.........................
................................................................................
Plot .............................. Lot ................................
Permit Granted .............JU n.e 23, 81
.............................19
Date of Inspection ......../............................19
Date Completed ......!...............................19
PERMIT REFUSED
............................ ................................... 19
................................I..............................................
........................ .......................................................
.................. ................. ..........................Approved ................................................ 19
...............................................................................
...............................................................................
� .� TOWN OF BARNSTABLE Permit No. _._________
�.i ---
Building 1 Inspector Cash
00�0 YPY•� -�/
OCCUPANCY PERMIT sons
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 cVh n C, Address
4.
Wiring Inspector Inspection date -71
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. /
........................................_............, 19..._._ ........................................................................................_._...._.
Building Inspector �.�•_
;r►
G)�ZA i Mi44 R51-/ Ro^D
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CERTIFIED PLOT PLAN
06 yy s
gyp. _ s., •
�C77" 3
VIEW CONSTRUCTION ONLY
TOP OF FOUNDATION 18 3 FEET "°"' / IN
ABOVE LOW POINT OF ADJACENT
ROAD.
SCALEi . - yoDISTE� � 9 - � �
B CLIENT _ I CERTIFY THAT THE
�� $MOWN ON TH13 PLAN 18 LOCATED
oIiTERE�' REGISTERED roe NO. go ZO ON THE GROUND AS INDICATED AN
CIVIL LAND _ _
BEN®INiR1lEYOR DR.EYE P CONPORNS TO -THE--ZO.NINO- LAWN
^OF BARNS ABLE, MASS.
R 13
• TIZ MAIN ST. CM.BYE w /a F/ /
11
s NYANNIS,"MASS: E1�EET..LOF., ,
(DATE RED.
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, LEGEND
�TQ(dE� SPOT. ELEVATION ®x0 ,: -r ,h�`,� v CERTIFIED PLOT P AN
I;
IST11ING CONTOUR ——— 0 /+�`'�!�ONFc2T \ dG'/. s' a M drsA
: , 6N13S l�D SPOT ELEVATIOI�B T (�� P• ,. ,-
5 :FQ11SNED CONTOUR ® 'v BUNIK1$' �^ ----- �.. �+ �� a- e�®fic - -- -- —
w 22162 0 IN
E ROVED t BOARD OF HEALTH T6������;� e
`S""CNAL E"/� � All III S 1A J
a E¢• ' HATE AGENT - SCALE = 1� SATE
�OEDGE ENGINVEE'RIN CO. l6V J CLIENT �e��
�. I CERTIFY THAT THE PROPOSED
EGISTEREL RE ;ISTEIRED JOB No. "0 p� BUILDING •SHOWN ON THIS PLAf�
C9VIL i LAND CONFORMS TO THE ZONING LAPS.
' �NGI.NEER LSUR E QR DR. BY . OF SARNST L IAA S.
712 RAIN ST. CrH. ®Y _
HYANNIS, MASS. L—
z SHEETS OF DATE REG. LAND SURVEYOR t
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CODE AND
TOWN `OF BARN T RETi 'ws
BUILDING INSP-E-.CTOR
APPLICATION 'FOR PERMIT TO ...... ..........................................:..........................:..........
TYPE OF CONSTRUCTION ... A......c i?..I ... . ......................................:............................................
.,�. .......�....................... �.
TO THE'INSPECTOR OF BUILDINGS:
i
The undersigned hereby applies for a permit according to the following information:
Location ..... .. .......... .......... ..............................................
ProposedUse .... �. ...................................................................................................................
Zoning District .... .........................................................Fire District ... sue. <�.t ,�a. .. .........-...-...........................
Name of Owner ..::di. .....�,.,....�'��.1.�K, :.� .........Address ..95.....!!r—..
Name of Builder �^ (/ C� C } �` Kr-< y
.... Address .....6 Z... �,.......e..,..... ....�6::. ... .. .............
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms.......�.......................................................Foundation �< :� �.. .......................................... .... .................
Exterior .....�?��?���:'. � ....i:1`v„c.C`L .`� :^!...Roofing .. .Via.............. . ..............................................
Floors :.....:..........:t..., :. :..................................Interior ...S ....... .i ...................................
....,.�—. Plumbi g ..:.C-q- , ...:.:::...................
Fireplace ..:....�1 ,.: .........................................................Approximate Cost ..... .r :.. :Q .......................................
Definitive Plan Approved by Planning Board ________________________________19________. Area ... ....
Diagram of Lot and Building with Dimensions Fee c .�—
....... ...................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH JIV.D'
U�
f
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
` Name .... .... ���. ..... ✓C.ae. ".................
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One 1/2 S ry
4ar/iRl�o)a�d
Centerville
Frame
.Permit Granted ..................................
June ��� l� o�
- .
Dote of Inspection -------.. l9
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