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Defin' ' e• an Approved by Planning Board 19 10 �,' RM
TOWN,OF BARNSTABLE
Building Permit Application
Project reet Address OA
Village 44 I &� '
- Owner Address
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Permit Request ties>�is
First Floor square feet
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Second Floor P46 square feet
Estimated Project Cost $
Zoning District PLCt Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use r Proposed Use
Construction Type 2 4,Z2iZ
Commercial Residential
DAvelling Type: Single Family Two Family Multi-Family
Age of Existing Structure - , Basement Type: Finished
Historic House /J 11 Unfinished
Old King's Highway AJd
Number of Baths �� No. of Bedrooms
Total Room Count(not including baths) �d First Floor
Heat Type and Fuel f. h Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
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Name frr> [_—. Telephone Number 7
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Worker's Compensation# pzk 6 zal?�
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 TOpr42" _
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SIGNATURE �� DATE 44
BUILDING PERMIT DENIED FOR THE FOLL WING REASON(S)
FOR OFFICIAL USE ONLY
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The Town of Barnstable
BAMSTAMZ
'A �e� Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-775-3344 Building Commissioner
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.
Type of Work: i�t CYor�r,��- -e CX1jJ_EsL Cost��
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Address of Work: c�
Owner Name: - 'e
Date of Permit Application: 9
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S 1,000
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
I hereby apply for a permit as the agent of the owner:
Date Contractor nair16 Registration No.
OR
Date Owner's name
r The Commonwealth of Alassachusetts
Dcparintent of Industrial Accidents
;i �-°?� . . 011/ceol/m►es�►patloas .
60011 ashington Street
: . Boston,hi s. 02111
�- Workers' Compensation Insurance Affidavit
.ARIIIIca�nfot•mati n-F — P�eA e rR119 I_lt'ilUlVrr�se +ee�1 ie e�nr�� ire-
nam • -—
location, — -- --
city nhcmc!!
(] 1 am a homeowner performing all work myself.
p I 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.
inan3:name!
address!
phone
• . lJ Ddoo
1 am a sole proprietor,general contractor,or homeo ner(chcle one)and have hired the contractors listed below,who have
the following workers' compensation polices:
comnanv nnme!
address*
dh: phone#:
laturanee ell policy#
r a•�s:.: w n- reittsn�..•sewn'awr�'ri 7:,�'«in'! +� 9'%.. - r�7t�S_TA 4� - - _;_'.^.M
cmm�ant•name• - _ - ----
address.
cih•• Rhone#:
jftsuranee co Rolla#
;Atisch additioial'shii if nee ,a r: •tom Wit+'w,�r•r..,�y�r":, » .., ' d:.
Poilnre to coverage as required under Section 25A of AIGL 152 can Ind to the imposition of criminal petuddes of a fine up to 51.500 UO and/or
one rears'Imprisonment no well as civil penalties in the forth of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy or this statement may be forwarded to the Office or Investigations of the DIA for core. ge verification.
t do here . cen •under the pains and penalder of p irm that the infornsatlon pmWded above is nne and correct
P
� Signature..
'nt name
I-Q � EzOrome0 �� - 12ZZ
Will 11 ...
oliitial•use oniv do not write in this area to be completed by city or two official
cite or town: permit/license 0 douilding bepartment
E3Ucenai"g Board
p cheek tf immediate response is required oSelectmen's Office
[INaalih Department
contact person• phone#t Y'lUther,�..,�,.,
i—nd I R'FIA!
r w _ _ �.
.........
................................. ......................
'^ : :. :: ::..; .... r .. :: : ;;::;; .:: ::: :::.:::»:::>::.::.;>.... ISSUE DATE(MM/DD/YY)
:.;: :: :.::::::::::::::::: :::::::::::.:::::::::::::::::: ::::::::.::::::::.
0 2
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
he Fair Insurance Agency, Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
g Y DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
P.O. Box 430 619 Main Street POLICIES BELOW.
Centerville,
Ma 02632 COMPANIES AFFORDING COVERAGE
(5 0 8) 7 7 5-3131 COMPANY A
LETTER MARYLAND CASUALTY
COMPANY B
INSURED LETTER SAVERS PROPERTY & CASUALTY
R. Arthur Williams Inc . COMPANY `.
Oak Street LETTER SAFETY
COMPANY D
Centerville MA 02632 LETTER
( ) - COMPANY E
LETTER
V'.•i1�iT:7'M .7 i 2 2 ? %' " ?' 222 E E ? c? 3s 2; . '' ±' 2?
{ ..:.........................................::...........:..................................................................:.:::.........................:.....::...................................................................................................................::.::::::::..
.....................................................................................................................................................................................................................................................................................................:.::
THIS IS TO CERTIFY THAT THE 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $1, 0 0 0, 0 0 0
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $1, 0 0 0, 0 0 0
CLAIMS MADE XD occuR. TBD 0 4/0'1/9 6 0 4/O 1/9 7 PERSONAL&ADV.INJURY $5 O O, 0 0 0
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $5 0 0, O O O
FIRE DAMAGE(Any one fire) $5 0, O O O
MED.EXPENSE(Anyoneperson) $5 0 0 0
AUTOMOBILE LIABILITY
COMBINED SINGLE $
ANY AUTO LIMIT
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $100, 000
HIRED AUTOS 1006759 O 1/O 1/9 6 O 1/0 1/9 7 BODILY INJURY
NON-OWNED AUTOS (Per accident) $300, 000
GARAGE LIABILITY
PROPERTY DAMAGE $1 O O O O O
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM / / / / AGGREGATE $
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION WC 0 0 0 0 4 7 3 0 0 0 4/O 1/9 6 0 4/O 1/9 7 EACH ACCIDENT $10 0
AND DISEASE-POLICY LIMIT $5 O O
EMPLOYERS'LIABILITY
DISEASE--EACH EMPLOYEE $10 0
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
CEiTI#IIrA7E:IflED :»»>::::<:>:<:>«<::::«::::»:>:>:<:<::>::»>:»::»;:»::>:«:>:<:::::»>:«::>:::>:>::<:>::<..
Ir ....................................................................................................... ......Q....::::::::::•:::::•:::.:::.::::.........................................
:,,:::•SHOULD ANY TAv::::::.................................................................................................
own Of Barnstable HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Building Inspector EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
South Street :> MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
yanni s MA 02601
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
.... .... �ti...............::::::::.:::::::
I
Assessor's Office'(1st floor) Map I -I
3 Lot t 6 Permit#
Conservation Office(4th floor) Date Issued ,
Board of Health(3rd floor)(8:30-9:30/1:00-2:60) tJ'' - ee: o • 0� w
Engineering Dept.(3rd.floor) House#1
Ut
IN$TA AhCE
D 19 EVER® ,
ODE AND
TOWN OF BARNSTABLE LATI �
Building Permit Application
Project Street Ad s `G\�cX G
Village Ce��C V 1 'e
Owner
_ Add 3
�c9.cti�J '� �o�Y1a �0.G�Ge.s Address � Q�/I hdl
Telephone 3 �a- 7 6 8 ` \
Permit Request CC)r S4e c \4Z 0 'E A
-Total 1 Story Area(include 1 story,garages&decks) 80 square feet
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size , S']S Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
M
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name h t G( ��c7 w oo� Telephone Number - 00
Address VV0 W e S ke c A ��. License# 0 Lk S 13S
S C—, r n s , ( Home Improvement Contractor# \U 9 3'( l,(
Worker's Compensation# e )N a LI O fo l 8 C A 1�
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 7 DATE ck 9 S
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
b
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED # *
MAP/PARCEL'NO: k '
ADDRESS ' T �- VILLAGE
OWNER
DATE OF INSPECTION: '
1
FOUNDATION
FRAMEd o
1 f d
INSULATION -
FIREPLACE -
_ � 1
ELECTRICAL: ROUGH FINAL
PLUMBING: .ROUGH -FINAL
GAS: - UG'H FINAL -
1 . - -
FINAL BUILDINGS
p y:
y .1
l s)
DATE CLOSED
ASSOCIATION PL'kAN1�T0. ;;,� '
$.-
ems
L-coT I Z
x
qti i
z3 -
Lv
9 ` \ tw — ' — _ 1� _ WAY LoT l l
tin`
/07-78 \
HAV I Ll-\MD w A-� \
� WILLIAM
C.
' , YE
�lei
CERTIFIED PLOT PLAN
a fiA��TE� 11
LOCATION, 'CErvTLlZx✓#LUZ-� M g S S .
I` CERTIFY THAT THE FoQQ0A- ioi.1
SHOWN-HEREON COMPLYS WITH SCALE DATE DATE 81L4/88
THE SIDELINE AND SETBACK
REQUIREMENTS 'OF THE TOWN OF PLAN REFERENCE
13AfZJ4SJ-A B L- AND IS NoT i I p
LOCATED WITHIN THE FLOODPLAIN PC.. Sy— 38` PCB, z-7
PATE :*
8 t4 88 t BAXTER '~ NYE, INC. I
THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS
INSTRUMENT SURVEY AND TH. OSTERVIL LE—-MASS.
OFFSETS SHOWN SHOULD NOT BE,
U§( O TO DETERMINE LOTL NE APPLICANT � : ��TF}�t� �,,,LL�ArvtS
i
Asf'NRLT I 6' ;Z/1Z f I'TGI4
I
�AMAI
I � •
!
I�IU i E . Ali Gv0�0 IS
f 2x4" P-PFRS,
1 Roo
IgLL RA•✓6 6A&4E 8v,4RDS
FND LOUVERS
i
Nor SMo�uN yi�W, PIAMS
C )
r, •�� I SttPPO� � 1
. Posts i 2 `I P
I j. I I I � i ! ,•
� i � ., JbO�SfiS :/b ;'O.G W/6WGJC1NCf
I i I I
IIIi � � •
ax 10 ��� �+ch1
d. ^
COMMONWEALTH OF MASSAC HUSETTS
DEI'A awaxr(DF WDUS'rRSAL,ACCIDIIM
goo WASH NGTON STREET
BOSTON, MASSACHUSETTS 02111
�o''"'�•SS�oM'
WORKERS' COM ENSATTON INSURANCE AF'F'1DAVrr
A►eenwe/Pennsince)
with a principal place of business/resid nee at
LS
(City/StaudZip)
do hereby certify, under the pains and pe"ries of perjury,that:
l am an employer providing the following workers' compensation coverage form employees working on this
X10 .
Insurance Company oli Dumber
I am a sole proprietor and have no one working for me.
E J 1 aan a Solr. proprietor, general contmaor or,homeowner (circle one) and have: hired the contractors listed below
who have the following workers' compensation insurance polities:
Name of Contractor Insuma Compani/Poliey Number
i
Name of Contraaor� Insurance Companj►/I'dlicy Number
i
Name of Contractor Insurance Cornpany/Poligy Number
I am a homeowner p"uning all the woek myxM
NOT'F: Mau be riwtn that wh&homeowners who employ perWW too do tess�ce,,conarue600 or rMrpair vrork on a
d%wlhas of not more io vAkh the 60 wosr asMD reaidau or on tie rMD&appatxteoeat thereto ut mot generally
considered w be empl"rs mailer tlae Vorken'Compeasatioa Act(GLo C. 152,aem 1(5)),apolkation by a homeowur for a lima"
or permit may evideoee the lga9 suzus of u eroplaayw oader floe Workern'Compensatioaa Mt '
I undentand tl1ant a copy of this statement,w-W be fotwarded to the Nprament of Industrial Acdc�no'Offiim of Insurance far coverage
verification and that hilure to more ccowrar as mvpAred under Section 25AeofMGL 152 can brawl to the imposition of criminal penalties
consisting of a fare of tap to S1 imarisoment of up to one year and cave penalties in The form*[a Stop Voris Order and a
fine of S 100.00 a day aeairm MM. (-
Signed th i „day o. - . -�._ _..._._._�.• l 9
Litcnser 1' r in a I.,iteaasorJPerrnittrr ��
I
I
The Commontrealth of Massachusetts
Department of Ltdustrial Accidents
011iceol/nvesUgatlons
600 {Washington Street
Boston,Muss. 02111
Workers' Compensation Insurance Affidavit
/`A�inllcant information: Please PRINT legt�lv �- s
name: A resew Pa ckss'
-11111�oc ' 34 H C, v i arA Way
1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
-•ate �-z, �a�. .,.�..,>�� r ��
AlKghiltlNSoiA - __ -..„._--._,. .. Igoe...•L'+,.
1 am an employer providing workers' compensation for my employees working on this job.
comnanz name:
address
city: phone#•
insurince,co. li #
am a sole proprietor,general contracto or omeowne ircle one)and have hired the contractors listed below who have
the following workers' compensation police .
Acomnam name• p E��
address: a\o G K- e0.�
nhone#• 7 ( - .5 6Q J
insurance co. A et-�Y\o, icy# a y S 3 S
1: .�`,^6;^.,,_:_-s.,..�� �,._:��raj'e_•��s:ay yYS't^�T^ 'j'n{eJ+t.Njrn��,+'�'m�irr ...'li w ",2ww'Yas:URa+7ri�5''yE''�r"tt.`9*air+�Rl�e'+yas"..egr"'19'�M:a,§•R�'."�..;.-.�'
comnam•name•
.address:
city: Hone#•
insurance co. policy#
;Attach additional'shcef if recess- �• ::. t; r a yr �_r�; ,��A. :.s
Failure to secure coverage as required under Section 25A of A1GL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP R•ORK ORDER and a fine of 5100.00 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.
IIdo hereby certif ulrr the pains and tallies of perjun•that the information provided above is true and correct
/SiZ .
Cnature ----Date C� . 02 7 19 9 5
tint name n A e-W ?Q C. `��� p�hone# 3 a '7 to S$
O..
official use oniv do not write in this area to be completed by city or town official
city or to%Vn: permit/license# r Illuilding Department
check if immediate response is required ❑Licensing hoard
❑ P q ❑Selectmen's Office
- ❑licalth Ucpartmcnt 's
contact person: phone#; nUthcr `t
Irevised V95 PIA)
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 ofanother und&-any
contract of hire, express or implied, oral or written.
An empinver 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-ail 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; ]louse of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the -rounds 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
perfonnance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
.., - y .'t `: 4 1Q^ i Mi,. Y 4Y a d + 'y .++ t- <�.!"'"'�,' P ''�4r 'nn•�.1!"�S'.''.�.!'�,,�
.r
� .: i .,. ... :. ..: .... ,-.. ...-,::., .- .:. ,�_._.. _«-'✓''' + 1'+Y'*3>.Sic-.'AFY,+'.. _ ':4..q Z�A I - _-.
y
Applicants .
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmatiowof 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.
z.,�,,...,,,,...�,y„� s.�,. ,a,.,t._s�...:,,..:+rrr•�-r--..+et tS.-N� q. v j,�,,eYrir �fr �7 .». -- il`.3�`Y v . L p..
... -- `r` ,... ...... ._.. :�`n+sxs.... -.. ,+�1 yr.w•, ::..
Cite 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.
.,.wsrr.�.+-.r. ..a..s sy.ca .n.+ .r ->t.., , --en:a.rpe►.�+wsanwr.nmw=
.. j
W
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
The Town of Barnstable
KAM $ Department of Health Safety and Environmental Services
°5 P Building Division
367 Main Street,Hyannis MA 02601
Ralph C.tossen
Office: 508790-6227
Commission
:Fax:
Commissio :
Fax: 508 775-33"
For office use only
Permit no.
Date
AFFIDAVIT
HOME MaROVEMENT 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-edsting owner occupied
building containing at least one but not more than four dwelling units or to structures which are adjaant
to such residence or building be done by registered contractors,with certain exceptions, along with other
requirements.
Type of Work: Covecc� Est Cost
'� 9 0 0
.O Address of Work: 3 y �wv i gv�cx ��4�/ ���� y I
/?%,ner.Name: Am Ck c e w �Q G k C-C
,Date of Permit Application: (D C a g at 5
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under SI,000
ding not owner-ooatpied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH 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 hercby apply for a permit as the agent of the owner.
Date Contractor name Registration No.
OR '
�lnA�c� ? ekez;
Owner s`name.`•.
:nm#AONWUA1LTH DePARTIAL99T OF PURUC SAFETY
Of ONE ASH8OR'TON PLACE
pnASA� ROSTON,MA AMO!
L I C F_^4:a.
EXPMA
I EE oa�T . .. Ica
3 srW. _ . 03/31/195�. � d
x
JOWES o T
Po
5 DEAQVIS YA C264
i t r B•p iatdT VM9�VR4lAPloctO l�'Ud�7a�aa�tYi�►Y .
f(' M E15l iT: ar nemao•CA•anwr"m av U14
t
pa tP
'�q� j rk$ kOIC'.EN wnBM ew•
COMMERCIAL DRIVERS t.%
0333211173 S$ !1-7 b
p !9 as-SSA S relMCGRATM
lavrSS �
vaorr!nn.r 700 A'If3 INT MAD
a ..
aw�. I
WME IMMOVER P""TOR ;
REgistra�to� t0�3a� '
E�Ar�ti�an pal%I/y3�
i
BOX'79'9/%?Q ST YES%ERM RO
$ODE IS 026AO'"' f
• TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print....
1
JOB LOCATION �CA v/.' C, ,,( �A .:: :'•_, /. '-
'Dumber Street address Section of town
"HOMEOWNER"
'J
Name Home phone Work phone
PRESENT MAILING ADDRESSeC} '-
�n M
cii.y/tolvm State Zip code.
The current exemption for "homeowners" was extended to include owner-occupi
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(sy who owns a parcel of land on which he/she resides or intends to r
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 structure
A person who constructs more than one home in a two-year period shall not b
considered a homeowner. Such "homeowner" shall submit to the Building Offi
on a form acceptable to the Building Official, that he/she shall be respons.
for all such work performed under the building permit. (Section 109.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the
Building. Code -aad 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 requiremen-
and that he/she will,p with said procedures and requirements.
HOMEOWNER'S SIGNA PX
APPROVAL OF BUILDING OFFICIM2!!?���
Note: Three family dwellings 35,.000 cubic feet, or larger, will be requires
to comply with State Building Code Section 127.01 Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner performing work for which,:-a:.IMildir
permit is required shall be exempt from the provisions of this section
(Section 109.1.1 - Licensing of Construction Supervisors) ; provided that
Home Owner engages a person(s) for hire to do such work, that such Home 0
shall act as supervisor. "
Many Home 'Owners who use this exemption are unaware that they are assumin
the responsibilities of a supervisor (see Appendix Q, Rules and Regulatio.
for .licensing Construction' Supervisors, Section 2. 15) . This lack of awar
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"Owner at
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,.
communities require, as part of the permit application, that the Home *OwnE
certify that he/she understands the responsibilities of a supervisor. On
last page of this issue is a form currently used by several towns. You me
care to amend and adopt such a : form/certification for use in your .communit
'rwf TOWN OF BARNSTABLE Permit No. ...3220.5 .
BUILDING DEPARTMENT
I ' I TOWN OFFICE BUILDING Cash
7 .ML
,67V•
HYANNIS,MASS.02601 Bond
,t
CERTIFICATE OF USE AND OCCUPANCY
Issued to Arthur R. Williams
Address Lot #10, 34 Haviland Way
Centerville Mass. . .
USE GROUP FIRE GRADING OCCUPANCY LOo k_ ,
THIS PERMIT WILL NOT'BE VALID, AND THE BUILDING,.'SHALL°NOT''BE OCCUPIED.UNTIL
SIGNED. BY: THE BUILDING INSPECTOR UPON .SATISFACTORY COMPLIANCE WITH;TOWN
REQUIREMENTS AND IN ACCORDANCE'WITH SECTION 1190 OF THE MASSACHUSETTS STATE w
BUILDING CODE
September 2'7, 19 41 '
. .. .. •• t..
Building Inspector:.
Ct
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
t asaaSrAEL : TOWN OFFICE BUILDING
erg' .639. HYANNIS, MASS. 02601
�o r�r�•
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy'Permit has been ie.sued for the building authorized by
Building Permit #...?... < _................................ .._.
issuedto ...... A .�F.:....��� ....% ! ................................................................... ............ ........._. ......_...._.. _..
d ,
Please release the performance bond.
l
R..
TOWN,OF`13ARNSTjkBLE, MASSACHUSETTS a
NG" IPA:RM1�1
19 PERM
BATE IT NO,
APPLICANT / �.� r ADDRESS
(No.) (STREET) 1 .r�' Kt'et t, ON.T S;FII CENSEI.
a3 vt.M.
PERMIT TO NUMBER OF i uY
(_) STORY OWELLING UNITS yti
(TYP[ Or IMPROVEMENT) NO, IPROI°USED USEI
AT (LOCATION) ur
ZONING Y�bw
a (NQ ( TREET DISTRICTI' , 3 r +,
-4 BETWEEN �Y'Y G#
t
f �H
AND �M v
(CROSS STREET)
(CROSS STREET)':;`: 4f1i`i7t2:'5
%m
SUBDIVISION LOT d{�
LOT BLOCK SIZE. .1s7D
5
xy, Xr Hg,
BUILDING IS 70 BE FT, LONG BY t(t�`
C FT. WIDE BY FT, IN HEIGHT AND SHALL CONFORM IN:CONSTf#UCfli'
..an
TO TYPE USE GROUP —BASEMENT WALLS OR FOUNDATION
44 TYPE).;,s yyx w
1 REMARKS:! 0
4 AREA OR e i a
VOLUME Q
ti.1a ESTIMATED COST •D—_ PERMIT y,•
(CUBIC/SQUARE FEET) FEE,'..'
a OWNER fE� f �'•?
ADDRESS
k a
BUILDING DE PT,
✓f(� rr ---.__ _ BY
y rfr
I mJ;tM 4V
THIS•PERMIT"'CONV1EYS NO RIGHT TO OCCUPY ANY STREET AI l FY OR SIDEWALK OR ANY PART ThIEREOFM EITHERnTEMPORARILYFC, Y'>
k 4 �
PERMANENTLY„•ENCROACHMENTS ON PUBLIC PROPERTY, NO1 PF'r IFICALLY PERMITTED UNDER THE BUILDING•COD Ert�� �ts
PROVED BY''TH.E ;JURISDICTION. STREET S. ALLEY GRADES WF I.I.. AS DEPTH AND LOCATION OF PUBLIC`SEWERS MAYt BE408TAINE
FROM;THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF Thus P I,MUSTriv°•13 t
i ct OF AN•Y APPLICABLE SUBDIVISION RESTRICTIONS. PERMIT DOES NOT RELEASE THE APPLICANT F.ROAt�Mu a
!: HE CO D,yy1T��1�01 r.
jtt,;;. MINIMUM OF-r EQUIE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABL FYva�tiR�'.0
�t INSPECTIONS REQUIRED FOR s i`
ALL CONSTRUCTION,WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN. ETSEP RATE{ '
PERMITS ARE,TREQUIRED YFORr'
1 FOUNDATIONS''OR',FOO71NG5, MADE. WHERE A CERTIFICATE OF ELECTRICAL�Ft F.L;UMB NG�A9
' , Z.'PRIOR TO`.,COVERING STRUCTURAL OCCUPANCY IS RE- MECHAN.ICAL;I. ,S •', TI 9$
MEMBERS(READY.TO'LATH).', QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL } i;,J�u
3 FINAL INSPECTION:BEFORE: FINAL-INSPECTION HAS BEEN MADE, YYr��s OCCUPANCY „ -3y.
- ,.d, ,,F 1ld 4itwH �Xat .
:z
r .pOST .Tl-oiS CARD S® IT IS VISIBLE FROM STREET
4C F a
BUILDING INSPECTION APP VALS _ PLUMBING INSPLCTION APPIiOVAI.S r x r
—_ ._ ._ EL CTRICAL I SPECTION APPROVALS�s'.' a °`
.� �'. 9�t x r� r � I \ �i 1�� � ��(.L'l• I // ..� +`pt n) I� '�4 h + il.:s, t"
f {
� VV ✓
-------- �� x u
2 2 -- — I. v x ,
• f
3
V G*i$ , TING INSPECTION APPROVALS ENGINEERING DEPATIIMENT t
N, '
p ,y� 'k11 4y
OTHER
BOARD OF HEALT. a d d�V;)
b.
' WORK SHALL NOT PROCEED UNTIL THE INSPEC. PERMIT WI
LL OID IF CO
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT 58TARTEDECOME yWITHINULL NSIXv MONTHS 0NSOATE THE CONSTRUCTION. _ INSPECTIONS INDICATED ON THIS CARD CAN
PERMIT 1S ISSUED AS NOTED ABOV.E, ARRANGED FOR BY TELEPHONE OR,WRITTi,
NOTIFICATION.
3
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tr u
c��. iy
WOO&
46
Wqy
— L-6T: II
p WICLlAM
E y.
kv i9o.19394
CERTIFIED PLOT PLAN
LOCATION CEniTLiz-0llaC
CIERTI.FY THAT THE FouQ0#N ' 1 sl
,
S4:O:WiTHER.EON::.COMPLYS; WITH .. SCALD lam! :. DATE
THE SIbELINE AND SETBACK
REi4UI:REMENTS 'OF : THE TOWN O.F PLAN' ,:REFERENC E
BA9.)MA a LE A IV D IS
LOCATED WITHIN THE FLOODPLAIN
oATE
BAXTf 'R NYE, INC.
THIS PLAN IS NOT BASED ON AN R EGISTER.ED LAND SURVEY
ORS
0RS
INSTRUM ENT; SURVEY -AND TH
O.STERVIILLE— MASS.
OFFSETS IS.H0WN SHOULD NOT BE
USEO TO DETERMINE -LOT LINES, APPLICANT Oz , ��`�-}vE., W,LL,ar�S
Q . 4
r Assessor's map and lot number `� / / . .. � Q SEPTIC Symman (' U
.......,........ .
Qom
Sewage Perm"it .number . ............... ...�...... .. .. ...............
r,
f TOWN REGU
House number ........... . .. 3�•. 1�2°C .�,...:..................... L a �0
'�f0 yAY a'
f�1, •
TOWN OF - BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO •.... Zr!Z/</...............................................................................................
TYPE OF CONSTRUCTION !rL/
s '..... .........I9.g$
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following informa�n,
Location .......f�c�T.. �r�.................... .. �.t. gK' ...G[/pt.. .... ......4�.!f.!.l l'.l1.l�.�C................................
�t
Proposed Use .......,.1 i41Jr f..s ..... ": �..�:...... ./l..eSf P1e.J! .,.................................................................................
Zoning District ........................................................................Fire District .....6"7e:e: !.1/P......:Q.f/.....`... a..M�>✓s�„//s
�Name of Owner .....Al..�.../.!/., ..�.�.....�' ll. �Ok,... .Vess ................P.`.7......�A��.`p��'4� K/�111................
Name of Builder
�l.Mali-l.��!�t.:..�/���rr.�...1" ...Address......�.✓�....Gi.�s':1./.....'.....C..!!e!. rf7;ie�&..............
Name.of Architect ...............Address ....................................................................................
Numberof Rooms ......3 ............................Foundation ..............................................................................
�'�� ....................Roofing
Exterior ...Xt�: �......r.�t.�!f.............................
Floors �i6?1rf�.....' .........................................Interior
F-leating ... rf,7..�0 �rl.,dG.....�... ^.�! s...��e:P.!ls�j�......Plumbing (' . !�-. /lls
........ r.� ................................
Fireplace .......)�.. ........ .�%. ................. ....................Approximate. Cost .... .. 4 ... . . ..... . ................
Definitive Plan Approved by Planning Board ________________________________I ________ - Area ` a'.. ..<4.$.......9.a(,
Diagram of Lot and Building with Dimensions' Fee d6 y.....
SUBJECT TO APPROVAL OF BOARD OF HEALTH Iota.
ycl
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. ..... X7.0................
l
Construction Supervisor's License .... .l. .�.o�.�............
WILLIAMS, R. ARTHUR
No32205 Permit far 1.12...Story...
.......... . ..........
Sinqle Family...P��-.��inc
......................................... ......j..........
Location ...Lot.....#.1..0. .......3..4...H...a..vi...land.....W..ay
Centerville
. ................................................................................
'
Owner ... Arthur R. Williams........................................................ ......
Type of Construction ..Frame............................ .... .. ..
................................................................................
Plot ............................ Lot ............. ..................
Permit Granted ....... ........19 88
Date of Inspection ............................. ....19
Date r--,mpleted .................. ......... . 119
X�t
0
C
-,j
Im
Assessor's map and lot number
.41�� (T
CF TN E TO
Sewage Permit number .. ..........:/..2i. ....... .....
6 �M P
I MARNSTADLE.
House number ............ .... 3/. ? ..� ............ 9 MA9a
00 1639. \e0
-Mix a'
TOWN OF BARNSTABLE w
4�
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ........ ......................................................................... ...
TYPEOF CONSTRUCTION ...... . ..............................•........................... ....................
,I
�1..4c+S ...............19. �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according/to the following information:
Location ... fl .................... �? ..�f� .!�.c.�r�. •.r.-:. ...% %:,. 1-11................:..............
ProposedUse .......- c>r..� ...... lr.r.:���f.......//. ���/, a. ..��...............................................................................
4 ,
Zoning District .........................................................................Fire District ....
Name of Owner ..... ll�,QCd�Tess ............../�-7..... .................
Name of Builder . ..:n.f ...Address ..... ......7• ... ..............
Name of Architect '.1!/.C! Yrs�� �1 �!..`.:f�'G` Address
Number of Rooms ...... .Foundation ...............................................................................
Exierior ... �,...�
....................... ...Roofing
InteriorFloors ��i .v ,.... `.... �::'^.�..r/. .......................................................................... .....
Heating ... ...... .../=.... z' •� %• ......Plumbing ......
.... ...: . .... ��v.�l[.-5......................,....................
Fireplace ....... .. ...................
Approximate. Cost ....~.. L'
Definitive Plan Approved b Planning Board __
PP Y 9 ------------------------------19--------. Area ...6R.>.v g.........9..`i...?�
Diagram of C� t and Building with Dimensions Fee
SUBJECT/TO, APPROVAL OF BOARD OF HEALTH a I IV z'/1
Ile
I � �
✓II
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS.,, K 1
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg rding the above
construction. � � /'� �N
Construction Supervisor's License ..... ............
. ARTHUR
WILLIAMS,' A;193-248 . Ar
r
No .32205 permit for ....1 z Story
Single Family dwelling
...............................................................................
Lot ._
Location ................#10........ .........34.....Haviland........................Way
Centerville
. ...................................................................
Owner Arthur R. Williams
...............:................................................
Type of Construction Frame.................
............... .........
................................................................................
Plot ............................ Lot ................................
Permit Granted .........AuggAt...2.5.......19 86
Date of Inspection ....................................19
Date Completed ......................................19
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