HomeMy WebLinkAbout0008 GREELY AVENUE $ :Uree �� � �T�ei
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Town of Barnstable *Permit#Y 4 0 4
Expires 6 months from issue date
BARNSTABM Regulatory Services Fee
9 ,0� Thomas F.Geiler,Director
Building Division
�d Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 X-PRESg... ATIT
Office: 508-8624038 MAY 1 2 2005
Fax: 508-790-6230
EMPRESS PERMIT APPLICATION — RESIDEN' "Q ,����T� ��
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address 41 Lid Ewe,
[residential Value of Work 61,)00 00 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 3W 5 c4 Mt12/t ut r Q ,
6q�t�', ilk*
1 c,
Contractor's Name ��f c Telephone Number Sd " 3 l 3 3`7 y
Home Improvement Contractor License#(if applicable) Q 2- Z- x 2 2 2- ®6 10
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Che one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request check box)
Re-roof(stripping old shingles) All construction debris will be taken to .��07 P� -
❑Re-r f(not stripping. Going over existing layers of roof)
Re-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Pro a Owner must sign P perty O etter of Permission.
me Imp vemeennt Con c rs Lic s required.
Signature v
Q:Forms:ex mtr
Revise063004
07
\ Board of Bu ldiug Regulations and Standards
License or registration valid for individul use only
HOME IMMVEMENT CONTRACTOR before the expiration date. If found return to:
Regis ( 135022 r
Board of Buil jiq Regulations and Standards y,
i i nF OneAshbu"on ceRM1301
22/2006 Boston ;�1
< ,Mi.
NAM.11dual
GARETH O'REIL'CY r i "
- I
GAF
ETH O'REIL �
40TR0WBRIDGER � � ,,. i 0
M ft f,iV
WEST YARMOUTH,M'A�02873
Administrator t Not valid without re
Y _ The Commonwealth of Massachusetts
- Department of Industrial Accidents
Office of Investigations
600 Washington Street, fh Floor
.= Boston,Mass. 02111
' lumbin lectrical Contractors
MAMMA
Workers Compensation Insurance Affidavit:Buildin -
name:
address:
city state: zip: ohone#
work site ton(fall address):
❑ a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel'-
y 1 am a sole proprietor and have no one working inq any capacity. ❑Building Addition.
�t�.'"�'�.+a�$ ,SE';-^F�".#„�ze va M:» :s ,d'.c :�'.'!�`�i..ew A1.r•.y;:,a 4�`}{-x:�.'':wR'. 't:.'�' �'��..r..`„'.r•.•�-"'.Ac"...,_ ,,.°_s�i:..x. .`��Y;'
❑ 1 am an employerppr�oviding workers'compensation fortmy employees working on this job. ,
address: � d
city- : } ..- .. _...-..ITT... .1... ........ _.._til one M '�4
insurance co. 2011 #
❑ 1 am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
com an name:- .
address:
city: phone M
o .
insurance co. volig#
company name:
s
address: '
city: hone#:
insurance CO. o #
e.
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties.of aline up to 31,5M.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I 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 e pa/iSand Halt' ojperjury that the information provided above is tru and correct ,
Signature Gh (/ Date • �2 ��
Print nameV. �. ►t Phone
`r
official use only do not write in this area to be completed by city or town official ,
city or town: permitllicense# ❑Building Department
C31,1censing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(mvised Sept.2M)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law",an employee is defined as every person in the service of another under any
contract of hire,express or implied, oral or written.
An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of
the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver
or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of
another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds
or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned,to the city or town that the application for the permit or license is
being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' compensation policy,please call the Department at the number listed below.
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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of In
600 Washington Street,7`h Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617)727-4900 ext. 406
r
To- n:of.Barnstable ..
Regulatory Services
Geil er=Director ,
�, �q,��a ��•� .Building Division
uil
TomPerry; Bding Commissioner
- 200 Main Street, 14Y=is,1AA 02601
Www.iown barnstable;maxs _
Fax: 508-790-6230
Offioe: 508-862-403$
-Property Owner Must
Complete and Sign This Section
.If Using ABuilder '
i
as Owner of the subject property
to act on nrfbe6lf,
hereby authorize
in all natters relative to work authorized bythis building Permit application for'
_ (Address of Job)
Date
Signature of Owner
Print N=e .,
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FRIDAY
D E C E M B E R F E B R U A R Y
S M T W T F S S M T W T F S
1 2 3 4 1 2 3 4 5
5 6 7 8 9 1011 6 7 8 9 10 11 12
12 13 14 15 16 17 18 13 14 15 16 17 18 19
19 20 21 22 23 24 25 20 21 22 23 24 25 26
26 27 28 29 30 31 27 28
JAN. 1977
8:00
8:30
9:0Q
9:30 - - - - - -- --
10:00
10:30
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Assess r ® � STEM h UST.��
.a � SEPTIC
's »map;,and ,lot 'number ... 7` ..................
r ct t INSTALLED IN COMPLIANCE
7G
.a ' • . � � � WITH ARTICLE !I STATE
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c: Sewage Permit number .......................... ........ ... .. - t SANITARY CODE AND TOWN
_ REGULATIONS..
F?HET - TOWN OF BARNSTABLE
u �rQ O W �7 } ,
i BASBSTAk"OIL
- ,1.1 .DING INSPECTOR
0 AIPY AN
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"' " APPLIC/1TION='FORPERMIT TO I '
n '
TYPE OF .CONSTRUCTION ............- One ..Fam.. .ily..... ...D�u.....e...l.li. . . ............. ...............................................
_ r
................3...'...9...................19....6..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location �.°t..#....5 ............ '�'�•G �✓ell�-...��r�G '� ... f� ..west..:HY•.annisp.ort................
.... .... ..
Dwellin ...................................................................................
Proposed Use ...................... ...................................................
Zoning District ...........Fire District ..UJ....Hyannisport F .D .
Name of Owner .Day.id. A . Te1.legen Address .....20,, Cor,Poration Road, Dennis
Name of Builder ..David A. Tq•11•p•gen••;,,••••••„••••,•••Address .....2��...�orporat on d, Dennis
......R.....•.oa. . ........
Name of Architect ........None .Address
.................................................... ....................................................................................
Number of Rooms .........N.lne•••.••..••••••••••.•„•••.••„•••••,•,•.••,,.•,•Foundation 10" Poured Concrete
Exterior .....P.l pboa rd and S.h.isg.1g5.....................Roofng ...... 3.5...�b.f.... sp.ha 1.t....:...................................
Floors 1 2" Sheetrock
1" Pine ove... ... 2.. Ply oDd..................Interior ....................................................................................
Heating ,,.Hot water• by .•.Baths PVC Waste
• G Plumbing
............................................................
Fireplace ...YeS — 8rick (Ulh�,te�................................Approximate Cost .... 0... 00
... ...........................................
Definitive Plan Approved by Planning Board ---------------___------------19--------. Area ..... o.�a:o... % ...........
Diagram of Lot and Building with Dimensions Fee /..... ..........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
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feA
b
hereby agree to conform to all the Rules'-and egulations of th n•of Barn le rem` in• the above y
construction.
_. . _.. .. . -.. .... Name _ ................ ..................................................
Tellegen, David A.
• art
No ..... 52M _Permit for ....1 1/2 story..... _
:......Si.ng1.e:`'f.'jmny..dwelling
}
Location :..... .................... ..............
[�7pct uvAnl�ispart
Owner ..............David A. Tellegen..............
frame
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Type of Construction j/�/�•y
.......... .. . ............................ .............. ! J� 4..{ ` ,�` ♦f_• +�
f^
'Plot
....................... Lot ................................ /
Permit Granted .... ..March 29 76
. ... ......................:.....19 ` ,t
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Date of Inspection ��.7�67./.4!.!..�B.C".19 t
Date Completed /-6.....................`1.19
PERMIT REFUSED _
e .................................... ........... ..` 19
................. .A........................................................ c
�}
5
,.,Approved ................................................ 19
v
...........:................................................................... ?
..................... .........................................................
Assessor's map and -lot number
y M~
.* 'Ii- +. ...................... ... .
' rh
Sewage Permit number ..........................................................
yof7HETo TOWN OF BARNSTABLE
ro
Z BJH.HSTLEPE, i
"6
o wara. BUILDING INSPECTOR
APPLICATION FOR'PERMIT PERMIT TO ...... !:' .�. !.. .........................................................................................................
One Family Dwellinq
TYPE OF CONSTRUCTION ........................................
...............................................19..5..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora+ permit according to the following information:
Location .....�r,t .....`s ......... < i�A!}?/ G C�/ll�=... � .9G, ....`'V/) !bleat...Hvannisoor�................
Dwellinq
ProposedUse ...................................................................................................................................................I.........................
1r1. Hyannisport F.D .
ZoningDistrict .....f�..l.........................................................Fire District ..............................................................................
Name of Owner David A . Telleoen .,Address ..... 0...CQrnoration Road. Dennis
Name of Builder ..Uavi,d....A..... Te.11eoen.....................Address .....20...Cor.n.o.r.a.t.z.on....Road.„....De.hni.s.........
Nameof Architect ...........One...............................................Address ....................................................................................
Number of Rooms ........v.lne .............................Foundation .1.0" Poured Concrete
................... ... ...........................................................
Clapboard and Shingles ...Roofing ... 235 Lb. Asphalt
Exierior .................................:............................................... ........................................................
Floors
1" Piny; over 1/2" Plvwood ..............Interior 1/2" 5heetro.ek
..........................................................................
Heating Hot lVater by Gas ........Plumbing 2 Batiks PVC 14a5te
.......................................... .................................................
p YPs 3rick (Ahitel ..............ApproximateCost' Z40. 000.00
Fireplace .................................................................... ....................................................................
Definitive Plan Approved by Planning Board ________________________________19________. Area ....... ., c: .....!.............
Diagram of Lot and Building with Dimensions Fee S .................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
• ov
a
lie
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I hereby agree to conform to all the Rules and Regulations of t Town of Barnstable reQwding the above
construction.
Name ................................................... ............................
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