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0054 LAKE DRIVE
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A rr 1� �" Y da ^° 1. v k 1, a w" n Y. u .. .Y "1,+H,r'1 y'.l '' '1•'' hrr, 1�"t r� o r,t w b ' m e ..W a' T t aal' ylp,^ 'fA' y1� �r s .n�. r 5 ,M.'.,1 If,. r r' �:..P4 + .'a { ,+,r "M f!u �, ;w w Y 1 ". air '; ❑�sQ nk,•b q, N ° ,�1•A ,£i: ..p :il ' {; ,:.: y A _Town of Barnstable Building BAtNSI•ABLB, Post This Card So That-it is Visible From..the Street-Approved Plans Must be Retained on Job and this Card Must be Kept '"". $ Posted Until Final"Inspection Has Been Made. ID •bsa m G JJLL o rt°.. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made: JE Permit NO. B-20-1523 Applicant Name: Roland Langevin Approvals Date Issued: 06/18/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/18/2020 Foundation: Location: 54 LAKE DRIVE,CENTERVILLE Map/Lot230-078 Zoning District: RD-1 Sheathing: Owner on Record: EATON,AUDREY P ET AL TRS Contractor'Name: Framing: 1 Contractor License: Address: 54 LAKE DRIVE i 2 CENTERVILLE, MA 02632 y Est. Project Cost: $6,423.00 Chimney: ' Permit Fee: 85.00 Description: 10 mil ground cover and R-10 wall Rigid Board to crawlspate, R-30 $ fiberglass and Rigid Board to overhang, access door to crawls ace Insulation: g g� g� I p � Fee Paid', $85.00 Date: _ ' 6/18/2020 Final: Project Review Req: _ . " Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit.shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the. work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed` Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final' 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: ; Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set.forth in MGL c.142A). . Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ,,/� Final: Insulate save Weat .her 'iza 'ti`on & Insulation 410 Grove St.Fall River.Ma 02723 Insulate2save.net 9/24/2020 To whom this may concern, I am writing as a confirmation that Insulate2save Inc. had completed the work for the following property: Permit Number: 20-1523 Audrey Eaton 54 Lake Drive Centerville MA 02632 508-775-2924 Completed on 6/26/2020 Please close out the building permits on file for this property. With sincere thanks, Insulate2Save, Inc. Amber Bergeron /Scheduling.Coordinator Phone:(508)567-6706 Fax:(508) 617-8092 r Town of Barnstable *Permit# Building Department Services F.xpires6moVefrom issue date auzrsr,,Bi E, : Brian Florence,CB .MASS. A�O Building Commissioi� rEn t 200 Main Street,Hyannis,MA 0lS www.town.barnstable.ma.us , Office: 508-8624038 411G'8 Ir 508-790-6230 EXPRESS PERMIT APPLICATION - RESI Z ONLY Not Valid without Red X-Press Imprint p Map/parcel Number '3 y 0 -1 g `c Property Address 4-y [�Residential Value of Work$ ©0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A-D nt— L5 y , 45a6 3 '2- Contractor's Name IA JA JAI 4D F Telephone Number Home Improvement Contractor License#(if applicable) (03 Email: Construction Supervisor's License#(if applicable) c5 — b 1'7 E a0 ❑Workman's Compensation Insurance Check one: N I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance.Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over ' existing layers of roof) ; ❑ Re-side Replacement Windows/doors/sliders.U-Value �;? (maximum.32)#of windows #of doors: Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: �' k QAWPFILESIFORMS\building permit formsTYPRESS.doc 08/16/17 ,A, The Comraortfrealtlt gnjfMassadiusetts Deprwtirreutcrfludrfs&alAcdd Bice a,�'1�ns. ga�rms . 600 Waskington Slfiewt _ Boston,MIA 02111 4 tuFvtutrl gOvIdict arkers' Campensaticm.Tnsurance Aff davit:Bider-JCu.ntradarsMectdcians(Plumbers APPRe.ml Please Print Name. ,� R�rr C JStaxe-M-F ANN'(S � 0�- 0/ Are you an employer?theckthe appropriate bum ' Type of project(required): I.❑ I am a employer with 4. ❑I am a general contractor and I 6. ❑New construction employees(full andfor part-time)-* bave hired the MtP-CoabMctQfs daHng 2.Ep I am a sole proprietaff orpartaer- Usted on.the.attached shheetr. 2- ❑gP'�'o These sab-co�ractors have drip and have no employees 8.,❑Demolition: woritin„ forma in any sty: •_ en3pla �andhave vtodxrs' 9. ❑Building addition,[No wpdm cflmp.*nicer comp-insuranm$ • �ed j - I El 07c a area corporation and its ME]Eleet�ical repairs oz ael�ous 3.❑ I arms homeorumer doing aid work officers have exardsed tires I❑Plumbing repairs or additio s. myseM fight of exemption per MGL ; ce retpired j Y comp-o V40rmm, c.f52,§I(4k and we have reo lT 0 Rflafrepairs � employees.[No workers' 13.❑Other cones.m m mcerequired_] '8L.ay apg&�t&at[hed3Soa K most also Moutthe secdonbekwshmdag iti-k workexe compeasefinnpo�Yi�rmzIIaL #ffameowaersurho sabot r�ris af5davu ia�r�ing they axe wing slf;eoxic sad fbmbiie avd9decoa]xsctoismnst.submit a nemaffidaelt indicabnflsacs_ TCaasxaclors$�sCebeciciiris6aocmustattadwdsir.addi6analsheershawfngthenuaeofthe msadststavrIxegmarnotihoseendksbwe e33p1mlees.If the saj c=t xct=k vP mnptoywsi aleymastgmvi&thek uvrke&c=p.pally mmebez I am wi employer that is prai idint;workers'compemat`imi insrirmfce jor arty emprgw-r 3efoty is fhwpvHcy and jab site infbrmrFtf m InsuranceCompanyifame: _ ' 'Policy-,I*L or Self--iw,Iic.4 f EspitatiauI}ate: Job S-iteAddres-s: CifylSt9dZip: Arch a copy of the workers'comper satienpolkrdeclarati m page(showing the policy,number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL a 157—can lead to the imposition of criminal penalties of a Fide up to$L54t}OU andlor one-year imprisonment,as well as civil penalties in the fame of a STOP WDRK ORDER and a fine of up to$250-O l a dap against the violator. Be adidsed t3iat a copy of this ztatement maybe forwarded to thB Office of Iavestigatioms of the DIA for imsmance coverage v tion.. Irtakersby a ertft�rmsand fFe�crlrf�fitsi�r�armatzvitprm�dafim�aislb�rsa�rdarrrecat $it?rrature' Bate- r phwe it,:. ,,© 031 tr?,�rciat firs aarFg. Da fiat etrrtta are tI�.axes,fit be cmnpleted by city arfan�r n�rizat , City or Town: PermiffIcense;ff Issuing&udwr4(drde one): L Board of$ealih I Building Deparfraicnt 3.fSt�Mwn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 0 information and last ructions Macao 7,nc s General Laws chapter 152 req=es all=gAoy=to,provide-WUIIa s'=13P sati m far ilieir employees. � this�,an�Iapr�is defined as-.ev eaY pesos in tixe sea vice of--other under any contract ofh�; express or implied,oral or wsift=.7 Aa Moyer is defrmed as-anindIvidmal,perfne�,awDdafion,corparatton or o1 legal�Y, �3'two or more of the foregoing=gal m a joint catmTtim,and mch&ng the legal aepreseandves of a deceased employer,or 131e receiver or ttvsEee of an indimidual,par�-mmc)cfif Dn or other legal entity,e=&Ymg emploYees- However the owner of a dwrUing hose having not more than three mtxaeot�andwho resides or the o of the- dwej i house of maff F who employs pem=to don, ,constracti on ar repay work on such dwelling house or on the grounds or budding a2pnrtnzjtth rein shallnotb=anse of such employmedbe deemed to be an emploYer_". MGL chapter 152,§25C(6)also sites that¢every slate or local HcenZ01g,agency shall withhold ffie issuance or . renewal of a Jicease or permit to operate a business or to construct bmldmgs in the commonweaith for yap ce co era r Y xtot rodnced acre table eYiden�of c6mpTiance with,the i,T�,-aT� � � e4� Iicantv�ho has p P - aPP d�.o MCrL tea 152,§25C(7)sus-Neither fhte nor gay ofifs poIrtical subdxvnsions shall. A n�Y, fable evidence of liaD.cewhb.&a msmaa�.. enter into an coatract fior the penance ofpnbIic work mmI arxep comp . .9 reqmremerfs of this chapter have Be=preseni!:d to the mrtr cting.anffiozitf-7 Applicants Please 01 0-atthe wow'compe mfi.on affidavit completely,by cbeck ng the boxes ffizt apply to your situation and,if necessary,supply sob-conftmAar(s)name(s), address(es)andphonemrmo ar(s)alongwiihffi=cerifficate(s)of ms rrE ce. LmmitedLiabilrLy Compamies(LLC)cr L=tedLiability PmtnersbiPs( U)' no employees 0t3ier thaix the members or ,pmt a=r,ate not rimed to cony winicc 'cotopensation iosounce. 1f an LLC or LLP does have employees,apolicyisregnired. Be advisedthatthisaffi&-yitmaybe submitted try the Depadmentof Industrial Accide for confiimafion of msnr�mce co4emg Also be sire to sign and date the of-davlt The affidavit should beetr amcd to the city or town that the applicafion for the penuit or license is being regnestad,not the D epartin of Ld=tdA A r-a =,ts- R=Hyou have any questions regm-dmg the law or ifyou are requaed to obtain a workers' M=LP=afion pplicL please call the Department at ffij--number Rstsd below. Self-rosin-edcompanies shouldentrz.1ieir self-insurnce fic rose number on the appropuaim line. City or Town Offldals - f Please be sore that the of idavit is complete and primed legibly. The Deparlxnent has provided a space at the bottom of the affidavit for you to fill oit in the event the Officemo oflnvm ons has to contactYouregardmg ire applicant Please,be sure to fill in the perm3 cenae number which.will be used as a mfarence nTxmber. Tn addition,an applicant thaw:must mbait uniltiplo pennWlicense aPplications M anY gM=year,neei only submit one affidavit M&mtng cat policy infos3ati0n(if necessaz3')and under"Job Site 14_dDress"ffie applicant sh oud wxhe-all locations in (c"Y or town):'A copy of the off davitf at has beta officiaRY stamped or nim3md by Ahe cry or town maybe provided to the applicant as prooftiiat a valid affidavit is on file for fuinre'pennits or licenses. A new affrdavitTmrst be fEed out dash. year.'Where a home owner or citizen is obtaining a license or putt not ielatmd:tn any business or commetQal Ore e or pew to bran Ieaves etc.)said person is NOT regmred c to ourplete this affidavit (ie_a dog licens The Office,ofa i 'nr wovldIib--to.tbankyouinadvance for yomcooperationandshouldyoubaYeMYq2eshons. please do nothes�to&e ns a call The I}epatimes address,telephone and fax Depaltm ent af11 r Accidenta M,Oil 11 Te,-L 41' 617- -4 (=t 406 or 1-977 M &� Fax#617-727 M xevised4-24-07 m asg ga-T T� T r Town of Barnstable Building Department Services RARNSTAMM Brian Florence,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 r Property Owner Must Complete and Sign This Section - If Usi=A Builder I J&6_ �`o� ,as Owner of the subject property . hereby authorize a- A- to act on my behalf; in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of 96ner SignatL4e of Appli,/int Print Name Print Name z9 //7 Date Q:F0RMS:0WNERPERMISSI0NP00I S Rev:09/16/17 Town of Barnstable Building Department Services Brian Florence,CBO ; Building Commissioner 200 Main Street, Hyannis,MA 02601 DAM MAMA rA www.town.barnstable.ma.us 1639. Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE- JOB LOCATION:. number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 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 buildingperm (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,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 with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner 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 the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many, homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certi5cation for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 08/16/17 V�ee tPomamancueaCC�IlC�/�&6ac"� office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual j k}e'a'is_ tration Expiration j OF 02/07/2019j1dersecretary WAYNETLOFTI D/B/A LOFTUS CQR N, ;JM WAYNE T.LOFT78 ARROW HEAHYANNIS,MA 02601 Massachusetts Department of Public Safety �t Board of Building Regulations and Standards License: CS-077800 Construction Supervisor WAYNE T LOFTUS , 78 ARROWHEAD DR - HYANNIS MA 02601 Jar" - 4 ^,� r 'Expiration: - Commissioner, 06127/2018 .. I Registration valid for individual use only .; before the expiration date. If found return to- Off ice of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston MA 02116 .. i h . Not valid without signature I , ------------- Construction Supervisor' Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space: ��— Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS r' ,� 4 . VIM . . Town of BarnstablIR R. e BU11Cilil :. . 1 PosTh�s fard.SoThat�t,•is Visible.I:rom the, tteetA roved.glans,Muste Retained on Job and tlais;Card Must beKetl t ►. tAENtTFA6lSr. a'a `'.„�'�.<`'.a�,� �s .,., �x, ?. "`, pl' • PostedUntfl inal:lnspection Has�BeenMade Permit ` ate R_,: Where a�Cert�ficate�of°Occu ,anc its,Revered such?Buldi, shall:Not be Occupied until a�Frnal,lnspect�on`has been made Permit No. B-17-2968 Applicant Name: WAYN£T LOFTUS Approvals Date Issued: 09/05/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 03/05/2018 Foundation: Location: 54 LAKE DRIVE,CENTERVILLE Map/Lot 230 078 Zoning District: RD-1 Sheathing: N. tA Owner on Record: EATON,AUDREY P Contractor Name WAYNET LOFTUS Framing: 1 Address: PO BOX 393 Con#ractor License 132463 2 CENTERVILLE,MA 02632 ` � _"" E'st Protect Cost: $2,800.00 . Chimney: Description: replacement windows Uvalue.29(3) permitFee: $35.00 Insulation: Project Review Req: replacement windows Uvalue.29-(3) Fee Paid:` 5.35.00 Date 9/5/2017 Final: ` Plumbing/Gas �? Rough Plumbing BuildiI. n Official g Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixWonths,after issuance. R.,. �. Rough Gas: All work authorized by this permit shall conform to the approved applicatian'and the approved construction documentsfor whichsthis permit has been granted. All construction,alterations and changes of use of any building and Alucturesshall be in compliance with the local zoningby laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for�publld ins ction for the entire duration of the work until the completion of the same. All, Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Offic Is areprovided onFL111s'permit. Service:' Minimum of Five Call Inspections Required for All Construction Work: _ 1.Foundation or Footing 4 Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame.lnspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I i ., .X CRESS PERMIT Town of Barnstable- *Permit# ,.. JAN 2 5 2006 Fires 6.,�41gM iqw4ate -Owl ]Regulatory Services Fee OF BARNSTABLE Thomas F.Geiler,Director Building Division Tom Perry,CBO, Build}ng Commissioner 200 Main Street,Hyannis,MA 02601 www.townbamstable.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 230 6 7 Property Address &Residential Value of Work" Minimum feo of$25.00 for work under$6000.00 Owners Name&Address co ntractor's Name u w ��— Telephone Number Home Improvement Contractor License#(if applicable) / .Ppomv�zarua � cuweea. Board of Building Ytegulations and Standards Comttr iction Supervisor's License# if applicable) HOME 1 PROVEMENT CONTRACTOR [4 _ �Workman's Compensation Insurance Registr ti 12065s Check one: q �1�.9/2006 sole proprietor 1 'y ❑ I am a P p 1- ,z' � s l ❑ I am the Homeowner P , .�-I have Worker's Compensation Insurance LINNELL ENTE F 1SI - DAVID LINNELL ;s- $9 FREE 30ARD�L�Af`t ,x', Insurance Company Name YMMOUTHPORT,.MA ! Adrninistrato► -s 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 ❑Re-roof(not stripping. Going over existing layers of roof) 4Re-side �ReplacementWindows. U-Value 33y (maximum.44) +Where required: Issuance of this pmmit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign operty Owner Letter of Permission. Home Improvement Co actors License is required. SIGNATURE: QTorms:expmtrg Revise071405 i . Department of bndustrial Accidents Office of Investigations' 600 Washington Street Boston,MA 02111 wvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricimis/Plu>abers Applicant Information Please Print Legibly Name (Business/orpnizationdndividual): /�it c./l-,d,z Address: 5.9 ...� City/State/Zip: Phone#:_ Are you an employer?Check the appropriate box:. Type of project(requiredy l�E i am a employer with - / . . 4. ❑ I am a general contractor and I 6. ❑New constmction employees (ftff and/or part time)-* have hired the sub-contractors 7.2.El am a sole proprietor or partner- listed on the attached sheet $ 'Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. 9, ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing iepairs or additions myself.[No workers' comp, c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t erployees.[No workers' 131-1 Other ' comp.insurance required] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infotmatioa t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that cheekthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. - Insurance.Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: <-Y City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiratton date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,500,.00 and/or one-year imprisomnent, as well as civil penalties in the form of a 8TOP-WORK ORDER and a fine of up to$250.6 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the wins and enalties of perjury that the information provided above is true and correct Si afore: Date:• Phone#: Official use only. Do not write in.this area,to be completed by city.or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health L.Building Department 3.City/Town Clerk 4.,Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. V an em to ee is defined as"...every person in the service of another under any contract of hire, lute p Y t to this statute, . Pursuant. . express or implied,oral or written." association,Farporation or other legal entity,or any two or more An employer is defined as:_arl indivi¢t�al,;pa?rbaer53�up,: .engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the of the foregoingassociation or other legal entity,employing employees. Hovt�er.. e- receiver or trustee of an individual,partnership, 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 woikvn such dwelling house appurtenant thereto shall not because of such employment be deemed to be an employer." or on the grounds or building MGL chapter 152, §25C(6)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,MGL chapter 152, §25C( )states"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 1equirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if.necessary,supply sub-contractors)name(s),address(es)and phone nunber(s)along with their certificates) of ies an C or Limited Liability Partnerships(LLP)with no employees other than the insurance. Limited Liability Comp (LL ) members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bom 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/hcense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or town)."A copy of the.•affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that•a valid affidavit is en file for.future permitss•or•liceeses..A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit like to thank you in advance for your cooperation and should you have any questions, The Office of Investigations would please do not hesitate to give us a call. The Department's address,telephone and,fax number: The Commonwealth of Massachusetts . Department of IndustrialAccidents . . .. .. �, >: ice Q;fvestigations .600-Washington Street- . Boston,MA 02111. Tel.#617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727r-7749 Revised 5-26705 www,mass.gov/dia 1 ` . r w �• ties . Town of Barnstable " Regulatory Services . '•'' Thomas F.Geiler,Director 26 � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma-us Fax: 508-790-6230 Office: 508-862-403 8 Property O�v mer Must Complete and Sign This .Section If Using A Builder I ,as owner of the subject property hereby authorize /�,Q J ����� to act on my behalf; in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of er Date Print Name Q:F0M9:0VNE=MMSIGN I Assessor's offioe (1st floor): �3J7� l/J �*TNETO Assessor's map and lot number ............,/ ..................:........ 'De - D j2Q Board of Health (3rd floor): Sewage Permit number .............. . ... ..... .. .... .......... I / �/ t DA"ST►nt � rrua Engineering Department (3rd floor): r 1/ -M os� °�''1(S�' M Hose number ............................:. ........ ...._.( ...................... I� C D PL APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only ';'ITN TITLE 5 ' TAL CODE API- TOWN OF BARNSTABLj. ULATIO�,, BUILDING INSPECTOR APPLICATION FOR PERMIT TO � �' C�C� B. l�lJ� ..................... .... ........... ....... ........................................................................ TYPE OF CONSTRUCTION ...!^!. !�.'/.... .............................................................................................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: L Location .................,fir. ..^....1-..A-.K.9.........��—r..✓.�.......C.�.r►fi fir..✓...t.�.�.`�.,t....YY�.A�.s........�.�..�.3............... ProposedUse ? S 'd " '"L............. ........................................................................................................................................................... rv���r OS ������� „Fire District C T O<7` Zoning District C h ........................................................................ .................................................. ..�— � e .! h1'A pt Name of Owner Addr � ...l�...n.n...... ..... ✓ A e 1�p,v.�c-(}-�— •i��e ... .. . Name of Builder ,: . ....C.... ....Address � . • Name of Architect Address .................................................................................... .................................................................. Number �}— of Rooms ..................................................................Foundation J .......... o c /L C.c. t. r....... . .......................... Exterior r--- 1 1"I (....................................Roofing ....................VIA, S h p Floors j, / dl..................................................................Interior ,.A / It HPnting ......................................Plumbing ...................N..............................0........................ Fireplace ... 7�.�(,.. ...............................................Approximate Cost .............. ............................................ Definitive Plan Approved by Planning Board --------------------------------19________ . Area ....�.S�. .....s9.f Diagram of Lot and Building with Dimensions Fee —45O SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ............................ ............... Construction Supervisor's license .... .. � EATON, ORRIN J. & AUDREY P. • r 3137`L ' '� ADDITION No ................. Permit for .................................... mingle Family Dwelling ......................................................................... Location 54 Lake Drive ................................................................ Centerville ..............................................................I................ Owner ........Orrin. . . ...J...... ... & Audrey. . . ....P... Eaton... .... .. .. .. . .. .. .... .. .... . ...... Type of Construction E'rame .......................................... ............................................................................... Plot ............................ Lot ............... ................ Permit Granted ......November 2 ....19 87 Date of Inspection ....................................19 Date Completed ......................................19 M � " Assessor's offioe (1st floor): .�� _, _• � •� '-�_. . ___! _ -�'`��� ..,�.� .... �. �. _�.,....,.,,�_ ,• . ,.. Assessor's map and lot number .. ` . .... e D Q�o�THE �/}/� Board of Health '(3rd floor): ......�I...''...I.Sewage Permit number .......... . II - ���,l `�l.r�d. � .•` �7 D� 9T AL U 6aEngineering Department (3rd floor): � S � 19• HOUe, number ...........................7. .......l....... .............. `e�.APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P,M. only. E TOWN ORF BARNSTABLE BUI1DIHG INSPECTOR EIV L �� 1�0a�`1� . APPLICATIONFOR PERMIT TO .........................y......................�:.............................:...i................................... TYPE-OF CONSTRUCTION ... 100 ' ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit :according to the following information: Location.................. z�.�i�..^...1..A, .........�?✓ !!l4 ....... ........ . ,,;,, Proposed Use R A� s ��..... 7i, L ....................................... Zoning District :0............Lt,�,n�rv� e .�Or-kerw0," ..........�.r.....r:...GS'�.................................... ................................................Fire District Name of Owner .C��'f?.t�.. :. �.� rr .i�.. !? 0. .....Address .....'I. ............. Name of Builder ...... Add tA:.Address .G�,�.. / �..,. .. ? ram...:........ Nameof Architect ..................................................................Address ...............................: ...............� Number of Rooms .................................... f.....................Foundation ('.vt�..t Exlerior .. ..t!..!!.5.... .�'.�..�....... ......... . ......... .Roofing ............... .Cf..) .. .p..`.. ............................ - j.......... . 4� .. .. .. .'.... Floors .VIA �s ../.................... Interior(�'( ......................... ... .................... ... .... ....... r r ( Heating ,.... . y...... `+1 Q. .. ?!L<...........:..........4- ...... ..Plumbing ... . .......... ............. ..............'..........................: ,A T p 0 s U Fireplace .... �_..<tv. - :..SI /................................................Approximate Cost.....................f...V.......................................A.. Definitive Plan Approved by Planning Board -_ __ __ r ---------------19 ___ -- . Area .....�. �i` Diagram of Lot and Building with Dimensions, •S Fee ............................................. SUBJECT TO APPROVAL/OF BOARD OF HEALTH y� ! 4 r r OCCUPANCY '-PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to ol'Iithe Rules and Regulations of the Town of Barnstable regarding the:above, construction. ` : _ Name J / Construction Supervisor's License ..... ......... EATON, ORRIN j. & AUDREY P. A=230-078 r t ,-23c-�� No 3137:i Permit for .......ADDITION....... ...Single,.Family.,,Dwelling..... a Location ....5.4...Lake...Drive.......................... ...................... ,lle...................I......... Owner ...Orrin....) &„Audre,Y...1...... at(�n (, Type of Construction ......FIZZ e....................... ...................................................................I........... Plot ............................ Lot ................................ Permit Granted November 2 , 19 87 Date of Inspection ....................................19 III Date Completed ......................................19 Assessor's map and lot number .4�7134)...-.71F............ o*YNEro �y Sewage Permit number ..............................r....................... SEPTICSYSTEM MUST2 House number ...... INSTALLED IN CO�t'ir Li/�N"� '• t BAHBST/1DLE, ...........................:................' :o rasa plC Lr WITH TITLE, 5 r f O,e�1679. �0m � CFO Y d' TOWN OF BAR � A� 1 � ir. NO �> BOLDING INSPECTOR APPLICATION FOR PERMIT TO ..:.. ./..i..../........�� TYPEOF CONSTRUCTION- ..l�it°�..,Q............................................................................................. ................ . 19f5 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... A. .. i Ce l e�.V. .l�, Proposed Use .L.TI / 1� ..f!�1��1 ��'. ...'- 1 �/1��............................................ ....... ZoningDistrict ....j..�..,.........................................!...�..../................Fire DistnctsJ.....�...................................................................... Name of Owner �'/!/'..../I��t� ! !✓�'��oTr�.... �7f'/'.��.�.. � F........................Address Name of Builder i �f� .1�•..................Address tic•ot/4 O�3 GGS� Nameof Architect ........................................................:.........Address .................................................................................... Number of Rooms .... / ...............................................Foundation IJ S— Exterior ... L.".1. .............................................................Roofing .. � �� :. ��C �'��•• � ' Floors1119lez4 .........................................................Interior .................................... Heating ....:.....Plumbing ........... ............................................................. Fireplace ......44dI...................................................................Approximate. Cost . ao Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area ..... ... ........:............ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t 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. .!'... .27.. ................................................. Construction Supervisor's License ..alf' ......... J,0EBEL, HARRY §No ... Permit for..... .....ldAddt'On.....................Single Family Dwelling ............................................................................... Location ........54..Lake..Dri'VP............................. ......................Ceritp=. Ille................................. Owner ...... Harry Loebel .............................................................. Type of Construction .....Frame..................................... Plot ............................ Lot ................... .......... 4 March 21, - 85 P&rmit Granted ........................... . .....19 Date of Inspection .................................19 W Date Completed //7.. 1, ...19 . ................ . Assessor's map and lot number ..�..,�. ,,,,,, ¢.-� k �pF 7HE Sewage Permit number - Z BAR33TAILE, i House number ` ........,_7 9 MAB6 ,. Apo,1639. e00 (D u = ' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ., ..1..........��.��t/ OlJ/Y1....Of�1�� �., . . ///. . TYPEOF CONSTRUCTION ..,/�.i./..�✓.�..A.................................................................................................................. t. ......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....: ........ ......r�i1t� �/ /� .. .......................................................... Proposed Use �� 7��✓� /IIGl.�.. �/���..! � ..."':� ........................................................ ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner /�'t / �/�'/�f! �7C/...............Address /o".�r��`�/!�-��,, Name of Builder ,./.5'ay... !�f� �../ :................Address A111.9/ �fl/ �/� Gl � /•!G���� .. ........... ... . ...... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............I.........................Foundation — - ^'ft Exierior ...1 ".. :. ..................................................::..\......Roofing .. � � -.. �� 1 .Y/ '1!!�� Floors �l*���! ��..........................................................Interior .. ....,...��!/ i� �i��=..................................... Fireplace ..... 'v�:............................................................:.......Approximate Cost .....: ....06........................................ Definitive Plan Approved by Planning Board -------------___ .....la.L., ............. -------------19--------. Area Diagram of Lot and Building with Dimensions g 9 Fee .... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH r J JrI OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of-the Town of Barnstable regarding the above construction. Na ................2 GP ............. Construction Supervisor's License .1�...........��........�............ LOEBM, HARRY A=230-78 No ...... Permit for ....Bu.i.id-Addition. .... . .... .................. Single Farnij_v..p5�eI.J;Liag Single................ Location ......5A.. DriVe.............................. .................................. ..................... Owner ..... .................................. Type of Construction .........Frame ............................................................................... Plot :........................... Lot ................................ Mar Permit Granted ..................ch....2.1..................19 85 Date of Inspection ....................................19 Date Completed ......................................19 fit 1 f h ��� "}. .../+�41 - - -- 1. •I 1� '' L'.SCay1* 1�'{�l• y .. v`of j SMyy"C �` Pr - GM,,65 POOL. z V �F POOg - 6x10 i r�sy t �- �Ld .. i FACla - ---r S P L A N ,t � • f R C':-.6.L.�.�`�',',I`w`N�:.,'`9`+5.�';'-!M"7ls+�i7ffiI,' .�. `'4ir�`•�. i.. �QyOfTHET0�0 TOWN OF BARNSTABLE Z BARNSTABLL i 0N O BUILDING INSPECTOR 9 �p i639. \0� 0 YAy a' APPLICATION FOR PERMIT TO ............0 7� .... .`� ................................................................................ TYPEOF CONSTRUCTION .......... -0./2.1)...........................................................................:.....:..:.................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for aJ�permit according to the following information: Location .....� �!....'.... ./7r ...../. ..j.. ` ..................: �� .!/y.l�C. / �� �.��'... ............................. Proposed Use S. Zoning District ..........(� )./..................................................Fire District ....... �T£/'V/LLB'- ` .................................................................. Name of Owner .... ..........Address ..... . . ....� .V:t:.........� Name of Builder lt.l «�A �/J...C�.�'. � r'.t1 D..................Address .���:..��../7�.. %(�f�� ..�.1.+.?� :.......Qxu?(%/.!./7'.A 1)t,'f/ Nameof Architect ..................................................................Address ...................................................................:............... Numberof Rooms ..................j...........................................Foundation ......... :.��. `.. .: ....................................:....... Exterior ..�&-'AWAAP...........a..t. l.h R.�� -ff i�t�1C� /l l �d?. .Roofing ..... ..iz . ..�' .......................... Floors �:..y....w .�... ..Interior r.:�.v........... C'L.`� .:......... f ................................... T Heating .......:.... ..1 (° !. . ....................................Plumbin .�:.1.`J g ........... ..... ................................................... Fireplace .............. r?. i1. ' ................................................Approximate Cost .......11'..:?5. ��. .. ..��. . .................. s Definitive Plan Approved by Planning Board ---------------_---------------19--------. Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH "✓ _ W.. - • Sz - -- - - i a. rL�� 0 Q � 1 1a! W 1 a. LL® --ice Q �/f.f� � .�..... ��. F-- L Cf) Lu 0 � ` i-j CdA ri Q j 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .�`,. ... . ..... ✓... .....1 ���� ? ...... Goacin, Robert ' 15112 ` add to single / No ................. Permit for .................................... ^ ' ' ~ ��''�''��.���'''���������'...'............'...'........... 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