HomeMy WebLinkAbout0010 KEARSARGE AVENUE 0
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tIlgineering Dept.(3rd floor) Map aczZ p Parcel ZZ 3 Permit#
House# � Date Issued CPA 1
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Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)�J-%�p� �U �.�,� a 5`.dd
Conservation Office (4th floor)(8:30- 9:30/1:00-2:00) q Z?&k
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TOWN OF BARNSTABL WN REG ��
Building Permit Application
Project Street Address LO c`(' S C.G Q RV -.
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Village
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;.._Owner i�ef\ n � rAC.\ rr\0.1r\ Address i0 K2G,:c, 9OI.Qe Ave-, 20 Box a I r
Telephone 50 B — g C I ~ �.Ll 'Z 0
Permit Request AA 'To SC'(ct'n ?8c-0h 13c.Ck p-(— �kovS e
First Floor t 0 S square feet Second Floor square feet
Construction Type ( oo&
Estimated Project Cost $ 4900 , CO
Zafting District �C , Flood Plain C, Water Protection won-,,
Lot Size 10? .4312 X 160-�0 O Grandfathered ❑Yes ❑No
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Dwelling Type: Single Family U( Two Family ❑ Multi-Family(#units)
Age of Existing Structure 7 y_k"S Historic House ❑Yes ULNo On Old King's Highway ❑Yes ELNo
Basement Type:.®Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) '5 40 Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half- Existing New
No.of Bedrooms: Existing Ll New
Total Room Count(not including baths): Existing_ 2 New First Floor Room Count
Heat Type and Fuel: CdGas ❑Oil ❑Electric ❑Other
Central Air (JYes ❑No Fireplaces: Existing I New Existing wood/coal stove ❑Yes Ig No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
9Attached(size) 3 4 4 ❑Barn(size)
❑None ❑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 �Qn G \& 7p(I UJ f\ �41-1 Telephone Number S G g " �6 3 - 12 9
Address 3 3 \Tw y ry r-c,a (<, I c%\/�_ License# Q C�; S (,CG,`),
&LAckv +v,,0 u' - r\ (04. 5 Home Improvement Contractor#
0 IS 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 DATE
BUILDING PERMIT DENIED FOR THE LLOWING REASON(S)
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Y FOR OFFICIAL USE ONLY
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-PERMIT NO.
DATE ISSUED +
MAP/PARCELINO.
ADDRESS f f VILLAGE
OWNER
DATE OF INSPEON:
FOUNDATION s
FRAME a
`INSULATION
FIREPLACE.
ELECTRICAL: ROUGH FINAL
PLUMBING: ''` s,-.ROUGH FINAL
GAS: 'mOUGH FINAL
* N
FINAL BUILDING.;,
DATE CLOSED OUT"-
ASSOCIATION-PLAN NO.
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CRIG VILLE . BEACH ROAD
N89 0735"W 160.00'
IN
---------------
scte
`'`� 36.f �- ✓2 DEC �' ��� h
9'x IrL. y
Iv89 0735"W 160.00'
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RE,S. ZONE- RC� This MORTGAGE INSPECTION Plan is For OD ZONE.• C
TOWN: Bank Use J
- ---=------ REGISTRY OWNER: _L_ 'TTv.E1FMAN-----------------------
DEED REF: _,3_4B_91�F._- ----_BUYER: �I_�LQITILI�6NIIELMAI�_TE�JFT_------ -- -'-----
w DATE; _a,2ZZ95---------------- PLAN REF: _310-51__-__ _____SCALE:1" 40__ FT
I HEREBY CERTIFY TO ATWRNLY-JEFf9EY_:_OPPEN LEM
__-_ _!___________THAT THE BUILDING a YANKEE SURVEY
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS AMIL CONSULTANTS
SHOWN AND THAT ITS POSITION DOES CONFORM 40B (SUITE 1)
TO THE ZONING LAW' SETBACK REQUIREMENTS OF THE " INDUSTRY ROAD
TOWN OF �fIN�TE1� _____________AND THAT
IT DOES_ N_Ofi_ LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS, MA. 02648
AREA AVSHOWN ON THE H.U.D. MAP DATED-J,12,ZJ2.__ tf.Ms TEL- 428-0055.
25001 0011 D FAX: 420-5553
_44 _ _ THIS PLAN NOT MADE FROM AN INSTRUMENT 17379 JF
PAUL A MERITHEW PLS SURVEY NOT TO BE USED FOR FENCES ETC.
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p�o- hoof �o ON0, CN, 1Exo A,i TS5 ?orcN 900-Q
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. ��,� .• f Barnstable
The Town ° ental Services
mum• 1 d Environm
ent of Health Safety an
' � Departm Building Division
161¢ �1
too 367 Main Street,Hyannis MA 02601
Ralph Crossen
P Building Commissione:
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office: 508-790-6227
IF= 508-790-6230
For office use only
Permit
Date AFFIDAVIT
? CONTRAS-'rOR LAW
HOME MVRO�
SUppLENiEN'r TO PERrWx APp3,,C®='aO!`I
"reconstruction, alterations, renovation, repair, modernization,
that the reC re-existing
MGL c. 142A requires snits or to
rovement, removal, demolition, or construction of an addition to any
conversion, imP containing at least one but not more than egi four 0o tractors, with
owner occupied building be done by registered
structures which are adjacent to such residencer building
certain exceptions,along with other requirements- $1 d10 0
Est.Cost
'type of Work:
/0 ar sa e Il'e .
Address of Work•
Owner's Name l
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
O�et pulling own permit
. 1J1�1ItEGIST>�
Notice is herebyUi�Ghat: OWN PERMIT OR D PING WORK DO NOT HAVE
OWNERS FOR APPLICABLE HOME IIViPROvEMENT
�TDER MGL 14ZA
CONTRACTORS TION PROGRAM OR GUARANTY
ACCESS TO THE ARBITRA `
SIGNED UNDER PENALTIES OF PER=y
for a
I hereby apply Permit as the agent of the owner.
O 1-,1, ~ Registration No.
Z Contractor Name
Date
OR.
owner's Name
ni,P
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The Commonwealth of Alassachusetts
Dt.partmutl ojlndustrial.4ccidcnts
} - Office 8110 SM19tions
-i, ` 600 ►iuAington Street
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+ Boston, Alas. '(IZIII
Workers' Compensation Insurance Affidavit
i_�.....�.r=11cant inform.......��atio.......n• ..�� �..._:�_�.
. Please PRINT lebtbly_a„S �
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name: 1\6Y-'rA, ly tm hUl
I tion
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City FcA ry ou"s mo-sc, phone# 5C3 J? 71
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity _r
^'a"'�§- ,^ ,qa a� s �scss^ ra+�.�.e.. s•+'ae". f x vRrr �rr '^wnn7"�• �d
**^ a �
i._...�::.._,_sr.:.sL .,va,;.,�«m�..3.,'.nm��.cs �r. s�•s"., ,.:..�.v�::. �"�"'a:ss,s :;� . �:L _..._....�
I am an employer providing workers' compensation for my employees working on this job.
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company name: W 4 (b c,-V s Ccls Oe r�C lk
Idt, lress; oil *w1 c� oc�k� '7cr Je-
city: GSV `-0A I-1 O V YNW75 Phone#: �b 7
insurance co MQUUI �& police# Jc e '1 1 00 t4
I am ole proprietor general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
cih•• phone#•
insurance co policy#
a: rx:'i>« "?v�rw-_.,.�••.r.,. ^^�•.c�'a{;:-r: r ^c. •^..rm ti7,,;.'-^�i�51'�"'t,C;vwsnr•..�.::.� � 5s.a:x„'T+�^'_�::,�ft �""""_,
�'._».�_.....-.s:. - ....._�._.:..7_a•.,;,'•a.u.:'«.'a�..i+`ti..:.a.J.�w.ir►+lg�aSwLi' �i'�.�r87tt+ii Y "" ar..iiLr s.i+:x�us
company name: --
address-
city phone#•
insurance co. Policy# _
;Attach additional sheet if necessary 7,774 ;T' }^ r SwF S' i e y l�. �`•�;r • y�•?� zl sr"R «� h
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that.a
cope of this statement may be forwarded to the Office of investigations of the DIA for coverage verification.
1 do herehP certifj•under the p ins and penahies of perjury that the information provided above is truce and correct.
Sicnature Date 7 0--7
Print name "O't\CA& O `n��l�cl Phone# �`o 7 7 q
i official use onh• do not write in this area to be completed by city or town official f}
city or town: permitAicense# riBuilding Department
C)Liccnsing Board
check if immediate response is required 0Scicctmcn1s Office
LJ OHcalth Department
contact person: phone#• MOther _
On iced 3;95 PJAI' .
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted irom the "law", an empinree is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An emph rer is dcf fined 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 dwellinu 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 cvcn,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 and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to 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.
... �....:.p yy o-xtry. -.�� "•`".' .0 1i` v.++....+>'.A�'M�.tA7N:j'R.0 � .' 'qpa•-a+.."'T
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.
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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
DEPARTMENT OF PUBLIC SAFETY'
02176 ONE ASHBURTON PLACE, RM 1301
BOSTON, "MA .02108--161Ei
CONSTRUCTION SUPERVISOR LICENSE
Number: Expires:
i
Restricted To: 00
RONALD 'D DOWNING Detach bottom, fold sign on
33' TWIN OAKS DR b"ack, and laminate license card,
E FALMOUTH, MA 02536 Keep top for receipt and change
�: ,of address notification.
' .__' - ✓92G' 1J��177/I92�Y17000'CL(/GfL r7, ✓` JCZG17.fGIP2 �-
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- HOME IMPROVEf°1L-NT CONTRACTORS REGISTRATION
/^ Board o1' Building Rc gulat:,ions and Standards
'One Ashburton Pkpce -- Room 1301
Boston , Massachusetts 02108
HOME IMRROVEME:N.T--CONTRACTOR ;.
Registration 113146 Expiration 05 20/97,
Type - DBA ;
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t TWIN OAKS CARPENTRY �
RONALD D . DOWNING
33 TWIN OAKS DR -
` - ,,= E FALMOUTH MA 0253E .
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Assessor's map and lot number ,._................. ,
Sewage Permit number ...........6�11;�.�?.:............. ............
THEtO TOWN OF :BARNSTABLE
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Z BARN TAME, i
"b` BUILDING . INSPECTOR
O 39• `00
S1G'.�L
TO ..... .. . ............ .......................................
APPLICATION FOR PERMIT ... .....�. .....
TYPE OF CONSTRUCTION ......................................
ry ..........................:.....:.�..:.-3.....191
TO THE INSPECTOR OF BUILDINGS:
The undersigned
�hereby,applies for a permit according to the following information:
Location ...... /YC!!9 Ar..S � ....../ ' S�.............
...�'G4I�/'Ul`...... ..........�..................................
r.. �Wit./,'„Lu, �EeA 1r'SU qe � �
Proposed Use .. ....................................... ........ . . ..... .,�............
.. ..:. ..... . ..
l;
Zoning District I Fire District
....../......... ............ . .
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Nameof Owner ............:........................................................Address':....... ...... ....�.......... :.......:........,......................
A11%1,V,V
X � � S
Name of Builder .:.................. ...........•........................Address ..:5............ ...............:........
C, ��-oG
Name of Architect .............................. �................................Address �'/z�!` L _.
Ave
Numberof Rooms ..................................................................Foundation .......:...............f...��O. ..........................................
Exterior .....(///.�f.�...:................................................................Roofing ...../....J�K;,,............�................................................
Floors . ..............................................�.......
In terior ...... �
a la U � �
i Heating �iP....................................................................Plumbing ......... .......................................................................
.................................Approximate Cost .......`:-7
Fireplace ......... ................................... ...................................................,
$/Definitive Plan Approved by Planning Board ________________________________19________. Area
....>...............;. ..........,......
Diagram of Lot and Building with Dimensions. - Fees
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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i Ago
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstablvregarding/the above
construction. C '
Name .........:/. ...............` ....................................
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Alden Homes, Inc.
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l-90@7
No — —.--. Perm�'for ---.. '
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a1og1e family dwel,1�9
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\ sage Avenue
Location —!.���....—.--------------
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Aldeo Ho�aa, Imc. �
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zTame �
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Plot
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Date of m^peomn
Date Completed
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