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HomeMy WebLinkAbout0056 HOLLY POINT ROAD t VE r, Town of Barnstable o *Permit# Expires 6 months from issue date MMMSTABM ; Regulatory Services Fee , 1�639.0��� Thomas F. Geiler,Director FD N1A� Building Division Tom Perry,CBO, Building Commissioner / O� L& 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 Property Address (Residential Value of Work F . Minimum fee of$25.00 for work under$60 00.00 Owner's Name&Address } i Contractor's Name �1C�C I i9 fy¢�t l7U�S r Telephone NumberyZ Home Improvement Contractor License#(if applicable)_ 1 A L/fl U At Construction Supervisor's License#(if applicable) A dWorkman's Compensation Insurance Check one: -PRESS PERMIT El am a sole proprietor r� bp❑ am the Homeowner �SEP 11 2006 i have Worker's Compensation Insurancepo_ Insurance Company Name 1477 "', ` TOWN OF BARNSTAE3LE � Workman's Comp.Policy# 3s 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 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side d [✓]Replacement Windows. U-Value_ , 3 3 _( mum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,conservation,etc. ***Note: Property Ownrfmust sign Property Owner Letter of Permission. Hom Improvement Contractors License is required. 2C SIGNATURE: % � Q:Forms:expmtrg Revise071405 The Commonwealth of Massachusetts j Department of Industrial Accidents Office of Invesdgations F 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Lnsurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly I s Name (Business/Organization/Individual): Address: City/State/Zip: c ) one �7, >Ph #: � s —4zb=4017 . i Are you an emp appropriate loyer?Check the aiate box:. i Type of project(required). 1.Dq I am a erne over with _ 4. ❑ I am a general contractor and I I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors ' 2.❑ I'am a sole proprietor or partner- listed on the attached sheet. t 7• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition l [No workers'.comp:insurance `5. ❑:We are a corporation and its j required.]' officers have exercised their. 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of:exemption per MGL I I.❑Plumbing repairs or additions myself [No workers' comp. c..152,§1(4),and we have no 12,.0 Roof repairs insurance required.] t1.employees. [hIo workers' comp insurance required:] 13 ❑ Other •Any applicant that.checks box#1 must also fill out the section below.showtngaheir workers compensation oh ino p cy frmation. t Homeowners who submit this affidant ndicanr g�liey are omg all work aad�theo hire.,outside contiactois must submit a new affidavit indicating such: 'Contractors that check'this boz must attached ai:addidonal<sheefsliµoyving the'nameI of.the sub conhactors'and their workers'comp.policy information: Apr I din an employer that is providing workers'comperisatton insurance for my.employees. Below is the policy and job site ' r itiformatian.-4 w .. - .. x y :, Insurance Company Name:__, Pl CGII/� �Y1 irirVla-ham( �°(1 Policy#or Self ins. Lic. # Cy 74 Expiration Date: 1 1 Job Site Address: City/State/Zip. ►I� 1M4 Attach a copy of.the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure.'coverage as required under Section 25A of MGL c.. 152.can lead to the imposition of criminal penalties of a tine up to,S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of k Investigations of the DIA for insurance coverage verification. fy P p' f J rY f p , do her n under a pain iid uialt. o er u that the information provided above trot ar:il correct Sig*nature: 9 rS75A Date: Phone#: # y �7 Official use only. Do not write in this area, to be completed by.city or town officiaL I City or Town: Permit/License# ! Issuing.Authority(circle one): °i 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone# Y r oFt"E'er Town of Barnstable • Regulatory Services saxivsTnsra, + 900 ,' ; Thomas F.Geiler,Director Building Divis ion Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I._ 'U0�2i'YI fZOS//lf as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: ,! l Address of Job) Signature of Owner Date Print Name WORM&OWNERPERMISSION ✓!ze �o„vinanureall�i 0�✓1/laaaac�a.�aeka' :.: -, . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 012653 Birthdate: 07/16/1954 Expires: 07/16/2007 Tr.no: 316.0 Restricted: 00 f. NICHOLAS A LAGADINOS - + - 13 THANKFUL LANE COTUIT, MA 02635 Commissioner i i Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Reg istrato'ri; '104804 Board of Building Regulations and Standards Expiration 7/g512008 One Ashburton Place Rm 1301 `Type Pnvate Corporation Boston,Ma.02108 LAGADINOS BUILDING&_D,ESIGN„INC Nicholas La admos 9 13 Thankful Lane �CLa Cotuit, MA 02635 - - - ----- Deputy Administrator Not vali i tou signa ure 07/26/06 WED 14:04 FAX 1 506 420 5406 LEONARD INSURANCE AGENCY 10 Oo2ioo2 AOW1. CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNyrf) PRDDUCER 1LS08 4Z8-69Z1 [508)420-5406 07/ZS/2006 Leonard Insurance Agency Inc THIS CERTIFICATE IS ISSUED AS A MA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFER OF IN ICATE ION 7 Wianno Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTE P 0 BOX 494 ALTER THE COVERAGE AFFORDELI ND OR 6Y THE POLICIES ND OR , Osferville. MA 02655 INSURERS AFFORDING COVERAGE INSURED Laga Inos But 01n & Des n NA1C# 13 Thankful Lane 9 9 =nc' INSURER A: National bran a Mut INSURER g; g Ual Ins Co. 147$$ Catuit, MA 02615 Brokers Insurance Agency INSURER C: IN5URCR 0: INSURE E COVERAGES ANY REQUIREMENT TERM OR CONDITTHE POLICIES OF INSURANCE LISTED BION OF ANY ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTA MAY PERTAIN,THE N$RANCE AFFORDED BY THE POLICIES DESCRIBED CTOR OTHE�DOCL MES SATE RESPECT TO TERMS,E POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDHERE CLAIMS, ICH THIS CERTIFICATE MAY BE ISSUED OR DING INSR DD• EXCLUSIONS AND CONDITIONS OF SUCH TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION GENERAL LIABILITY MSB87460 Ol/Ol/2006 01/01/Z007 EACH OCCURRENCE LIMITS X COMMERCIAL GENERAL LIABILITY S 1,000,000 CLAIMS MADE a OCCUR DAMAGF TO RENTED S A MED EXP(Any One pereen) 3 50,000 PERSONAL ADV INJURY 9i 1D,0OO GENII AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATL 1.000,000 POLICY S 2 000,000 PRO- PRODUCTS-COMPlDPAGG $ JECT Loc 2, 000,OOO AUTOMOBILE LIABILITY ANY AUTO COMBINED SINCLE LIMIT ALL. $ A OWNED AUTOS t) SCHEDULED AUTOS B ODILY INJURY HIREDAUTOS (Per Pere-) S NON.OVI AUTOS BODILY INJURY (Paracc+denl} $ PeaedTY GARAGE LIABILITY (Pei S ANYAUTO AUTO ONLY-EAACCID[NT S OTHER THAN EAACC S EXCESSIUMBRELLA LIABILITY AUTO ONLY: AGG S OCCUR D CLAIMS MADE EACI I OCCURRENCE S AGGREGATE S DEDUCTIBLE RETENTION S S WORKMC COMPENSATION AND WCG9Z9641 0 OZ 2006 i EMPLOYERS'LIABIUI 3. I 01�02/2007 Vv STATU- B ANY PROPRIETORIPARTNEWEXECUTIVE �[ OT,r" OFFICERIMEMBEREXCLUDED? ElEnCHACCIDENT If 9,daeonbe under $ S00,00 SPECIAL PROVISIONS Delow E L DISEASE-EA EMPLOYE OTHER S00,00 E.L.DISEASE-POLICY LIMITS S001 00 DESCRIPTION OF OPERATION$!LOCATIONS/VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS uilder on Cape Cod or building at 82 Coolidge Rd, Catuit, MA 711FCADL=R TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B EXPIRATON DATE THEREOF,THE IS WORE THE SUJNG INSURER WILL ENDEAVOR TO MAIL f Barns tabla DAYB WRITTEN NOTICE TO THECERTIFICATE HOLDER NAMED TO THE LEFT, n St BUT FAILURE TO MAIL SUCH NOTICESHALL IMPOSE NDOBLIGATIONpRLIABILITY , MA 02601 OF ANY KIND UPON THE INSUR ER ITS AyENTS OR REPRESENTATIVES, AUTHORIZEDREPRE$@NTAnVE AcORD25(z0o1/o8 FAX: Milissa MacCormick LEOMMI } (508)79O_6230 CACORD CORPORATION 1988 2 j-7- fs'setqr's map and lot number ..................... ...................... ��4— OFTHETO SEPT Sewage Permit number .... .......................... ...... tC'SYSTEN1 MLjsT B INS ED IN C f) F, ALL r),rv7 P 1 1 P,N, A�WSTLBLE. WX ARTICLE 11 House number ..............4�....................................................... IV4 SANITMRY CODE &44' E 639 A, REGU "'TOW 11 mo TOWN OF B A R NS_1 T hLE SUBJECT To APPROVAL OF B.UILDING "INSPECTOR ""STABLE CONSERVATION, COMMISSION APPLICATION FOR PERMIT TO ............................. ... . . ........................................................... TYPEOF CONSTRUCTION ...........I..................I....... ................................................................................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........../ / L4. ....../...n.,Ai ................... .................................. ProposedUse ..... ........ .................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ............................Address .... e.. Name of Builder ...24,r,�. ...�. ........ .......................1:311... ....................... 4 Name of Architect .. .... ...... ..........................Address ......*922.4,4.64-4�.1. ............................................................ Numberof Rooms .............. .................................................Foundation .... .............................................:....... Exterior ....t-4.—Z�.... c. rl....................................................Roofing ..... ........................................................ Floors ......... ...........................................................Interior ...... /-./................................................. Heating ....... Kvrx��............................Plumbing .... ...................!.......................... Fireplace ......1A.—t-n..............I...............................................Approximate Cost ......... jq.!q�v.....................I......I........... Definitive Plan Approved by Planning Board -------------------------------19--------- 'P� Area ...:TF�!�r..... .................. IZL Diagram of Lot and Building with Dimensions Fee ....... . ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH f 57_ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ...................................... Lewis, Herbert 21217 1 1/2 story No ............... Permit for ............................ single ,family .. .................... ..................... Location ..........5.6...Holly. Point...Road .............. . ...... ... .... . .... . ...... .......... .............C..e.........n t e r..v.......i I l.e............................... .. . Owner ...........Herbert Lewis ....................................................... Type of Construction ..................frame„.„........ ...................... Plot ............................ Lot ............... ........... April 20 Permit Granted .........................................19 79 Date of Inspection ....................................19 Date Completed ........19 ^0- PERMIT REFUSED .. .... ... ................ .... . . .... .... ......... .. . .. . ... ....... ...................... .. ...... ... .... Y.A... .................. ............................. . ............................. ................................................. vl Approved,......................... . ........ 19 ............ ............... .............................................................. .............. .................................................. Assessor's ma and lot number t "r4 ff' /�_ 7 � p r'-)......................................... d t. r�./ ypF?NFt0 Sewage Permit number t � , 1? ................................................ t Z 31AWSTAILE, i House number K ......................................................... 'pp raea 039. •� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ..^.. .../../........... /:.`�'... ��/!�!;T......;il, .' .............................................................. .7. - ProposedUse .....S, �,_ v.........:....... ............................................................................................................................ ...... ZoningDistrict .........................................................................Fire District .............................................. ............................... • Name of Owner ... Address ...L ..................... ` ....!g. ..: ��....... d , Name of Builder �' ::d *.......... +"r,'....4" .:4Address r .... - Nameof Architect ... ..... 1 . ..........................Address ...... h... :............................................................ v Numberof Rooms .............. .................................................Foundation ... -t--.............................................................. Exterior ....4` .....f:air .......................................................Roofing .... :;. r ...................................................... Floors �� Interior - ��---1 r. ................................................................. . .................................................................... Heating .....' :-^-::�......�?'.j....!�R: :............................Plumbing ... r.^.... �..... L'.� f:................ ............................. A Fireplace .....�!�' �^ ..............Approximate Cost.......................................................... ............ .................................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH JA .S -F I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . ....... .... ..?.......`...... ............................... Lewis, Herbert, A-232-45 ~ No ` � �!?4/ for ll2 — ' |` �K p � � ______mio�I��.�\� �y—.d��11 — Location ................56. ..Point..%&uad...... � ' ----------~ ........................ ' Owner ----- t`.ILeWia------- - ' Type of Construction .........frame...................... ) --------------. / ( ' ncx ' 9 ` Date ection ^ 19 uoto Completed . . � . ' ERZIT REFUSED ............................ ----------- 19 ' ° ' ........................ .................................................. ' J � . --..—.— ..---.. � � y ' ----^—''^',^~~~~~^^'v�''^—\�—',---^'^' Approved ................................................ 19 ' - --------'-----^--'—'—^—'—'----' ' / -------`---.—.--------.—....—..' ' ' � | TOWN OF BARNSTABLE Permit No. --------_—--------- Building Inspector � Cash swim ---------------------- � OCCUPANCY PERMIT Bond _---.---___—__-_ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. K) ....................................................... 19...... _ ...................................................................__........_..._.... Building Inspector L w,. M Q' ao ;Dr- w 4 � :► N `F� c� c., to � a , /N Y 5F- M ?'NG� 3; t 18 2� t o . h� �l <) Ly IFOo1N i ,OAZ NORINIAN ►..It�MA�I r'C���SSca� t?is Gg EQ EP.AL.. N OTF-5 - a--AL.t_ Et_ l SeA - - ---- 15A SE'D O U.S.G. G-i .S . VATU►.� PU�►�l E —�- -�-�- t 20• --' P lTG(-� ,41-.� t�.t ►J ES /� M I rJ t M U 1� o>=' %P>"�F�T - 1 ALL. 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