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HomeMy WebLinkAbout0055 LARCH LANE �u ,C.,a.�z k, ,C..rr n�e � . .. .: . — ; p Q d o . � . Application number l. ......... .. ............. .... Fee - Building inspectors initials- JUL 312019 .............................. "� TOWNI Off- bAHN (ABLE Date Issued.:.../3 �.�`. Map/Parcel.......... . ..... .< l..(...:.......... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION - PROPERTY INFORMATION r Address of Project: I-��r�� (- (I�P,, �, tJ I I NUMBER ` STREET VILLAGE Owner's Name: C`.h�IS���� Cc ae! - Phone Number Email Address: Kam 17yyA .`, it Cell Phone Number K� � Project cost$ Check one .Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: `, h /")o 11 c—ME OF WORK-_ ❑ Siding- ❑ Windows (no header change)# ,�0. Insulation/Weatherization ❑ oors(no header change)# Commercial Doors require an inspector's review U Roof(not applying more than 1 layer of shingles) Construction'Debris will be going to 1 JQJP�*�� �'�c_IGI _-� <� ua �rJiT %il� CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) t Construction Supervisors License# . (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. I APPLICATION NUMBER............................................................ r :9 ' *For Tents Only*- Date Tent(s)will be erected V Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural Gas Yes ' No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number 5 D 36b -�`�`�( ' Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature (/h �� 4�J' -,Wo Date 17. �3 61 APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a wilding official's approval prior to issuance. Jy 1 1 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street ' ' Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly Name(Business/Organization/Individtial): 1 Address: Leech I..rvtm- City/State/Zip: &AumU_ AAPhone#: 514'K 3CO '0)091 Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with �4.-❑'I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached'sheet. 7. 0.Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition .. . [No workers' comp.insurance comp..insurance. required 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ] officers have exercised their I L lumbin re aus or additions 3. I am a homeowner.doing all work ❑ g, .P • myself. [No workers'comp: `- °- -- . right of exemption per MGL 12. Roof repairs insurance required]t c. 152, §1(4),and we have no.. employees. [No workers' 13.[1 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 fine up to$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . I do hereby certify under the pains and penalties of perjury that the information provided abov is tru and correct. Signature: �/(��1� ��-�� y 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 2.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. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer" MGL chapter 152,§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(7)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 requirements 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 number(s)along with their certificate(s)of , insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 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 permittlicense 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 on file for future permits or licenses. 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. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia INSTALLED Assessor's map and lot number �! AnSewage Permit number ................. ......' .. .. 1JIh �Q q ♦� JN p �� 3SIAH4 H9SH9TGDLE, i Jl� �I House number . ' v OAS& ................................... ®ANSrABLE CONSERVATION i639' COAMISSION VAYa A:PPROV (��N Ba nst ble Conservatio oOis�1 rt ` O F B A R N SU( EER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT ignea . Dat L D I H G •. I H S P E C # CE TO PLAN• APPLICATION FOR PERMIT TO I }................................................. ... ................... 'TYPE OF CONSTRUCTION ........................... ........ ' ..............................,................................. . ..ZJ6:................1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............. .....1f............. '� �C/!C........�� -...........� J �rc ......."Ae .0 ........................ ProposedUse ..................IJJG ............................................................ ....................... ................................. ZoningDistrict ................ ...... ........................................Fire District .......... :.^ 0................. ... ................... Name of Owner ........................� ................................Address ..,�J�....��...:` .......�3 ..G" IRIY�d ....!...... G O t• a 4 Name of Builder CL1 ,......Address Name of Architect ..... k.. ... . . ... ............Addre �?Address .... ...... . ... �1N��!k" r,�Y..� ............. Number of Rooms .................... Foundation ...........k>`�......1�4`. �...c��12.... Exterior .....................`^?.Lf-6 ......................................Roofing 9 ................................................. Floors .. ...Interior J�Z . e /' Heating A. ..................................................Plumbing ............ .... ......... .. . .. ...........,......................,.... Fireplace-.....................:. . .... ..................................................Approximate Cost ..............�.. ..................................... Definitive Plan Approvu by Planning Board --!-----------19" __--. Area �'— Diagram of Lot and Building with Dimensions Fee `pLr�— _ 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 huctVion ... 9r ....... Constpervisor's License "" S L S TRUST a 30146.... Pernivit for ............. Single Family Dwe* ...................... Location ..,,Lot #11, 55 Larch Lane .................................................... Cent-ervillel ............................................................. .................. Owner .. .....S..LS2 Trtig,t ......... .................................. Type of Construction;:; .....FrWe N .............................. ........................... ................................ Plot ............................ Lot ................................ Permit Granted .............N.o.vember 6, 19 86 .............. 7; Date of Inspection �:v....P..............19,3 Date Completed ....Z, .................19 All 4v r < 0 M cz < 3-- S 0- - MO Er hn 0 cc M W - CL� M C, V Z1. Assessor's map sand -lot number ... .... ......1... r��- ��Ar \ ��F THE TOE f0 d�j Q Sewage Permit number .................�2....... BAflH9TADLE, i House number ..................:........ 5. .. ......................... 90 Vaas Op�1639• ♦� 'Fp MOR . -TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE-.OF CONSTRUCTION ... ✓.O`.0........ . ........................................................ ..�... A*'Z:.... ..................19", TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............. ...��....... .lkC�/!...... .( CZ:. ...........i -�'d� !, ��n. ... . 1�: ... . ... ProposedUse ..................DAU)..; . ................................................................................ Zoning District .................1 g .................................................... District .......... ...... Name of Owner .C.: !,�:.1............ ......:......Address 13f.... �0 ,1 .P....�3. ... . .!.M.Nr ....!.:!..G t / a e Name of Builder =fL...-nOG�J...... ......Address ......................................................... .... a ( lT�' P �� y /1 'r � fit ; Name of Architect ..... ....(1Z;..r�!�.:. . . ....�� A_1. ............Address ......:..6. ......:.............Y', . �.. Number of Rooms r.................. .. ........................................Foundation .......... � /2ec� t dtZtft Exterior ..................... 4., M.� ......................................Roofing ........ .:.................................,...............�:t``�'; Floors ...................................Interior J� ....................................................... Heating ..........................A .................... ......................Plumbing ............ ... . ��� ...... �.....`. .. Fireplace ..........................�.�4..................................................Approximate Cost .......... P. .....� r.. Definitive Plan Approved by Planning Board -----------19/w Area 1 " Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �. f� �f1 J y d ' I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ry �s 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 ".. � y S L S TRUST A=189-006 . 4yj No A0146 Permit for „One Story Single Family Dwelling Location ....Lot #�11, 55 Larch La Centerville Own....................................................................... er S L S Trust Type of Construction ......Frame ................................................................................ Plot ............................ Lot ............ ................... Permit Granted November 6, 19 86 ... Date of Inspection.....................................19 Date Completed Ij /� -� Y A/99 i FAIA 0 fi � IV` x IN5 CERTIFIED PLOT PLAN L O CAT( ON: C� EeU/GIBE, /YIp . FOR SCALE_ � ' 3� O AT E* dcT: Z-9, /90 R E F E R E N C E: .[3 E/A�/<:!.Lp Zoo T �Lpv.g��o20�o ivT'QiJ2.vSTro3�.E i •e�G/S-�-ny a� ���5 i� DATE ( CERTIFY TO THE BEST OF MY KNOWL G R G. LAND SU VEYOR AND BELIEF FROAA ( NFORMAT ( ON ACQU RE THAT SHOWN ON THI AN ( 5 LOCATED ON THE GROUND AS SHOWN HEREON. �HOf0, �o 4WEPH Z . M. -� MONAHAN,01 H 00 J. M . MONAHAN JR . d, ASSOCIATES No. 13M .0 e ST PROFESSIONAL LAND SURVEYORS 8 ENGINEERS osuR%j TOWNE PLAZA - 900 F30UTE 134- SOUTH DENN(..S., MASS. 03 C�THE�` TOWN OF BARNSTABLE Permit No 30146 . ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash . X HYANNIS,MASS:02601 Bond .......... . CERTIFICATE OF USE AND OCCUPANCY Issued to S 1, S Trust Address Lot 411, 55 Larch Lane Centerville, Massahhusetts USE GROUP FIRE GRADING OCCUPANCY LOAD 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 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. February 4, 87 t Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT = BARNSs rrua TOWN OFFICE BUILDING 039 � HYANNIS, MASS. 02601 MEMO TO: Town Clerk P FROM: Building Department DATE An Occupancy'Permit has been issued for the building authorized by BuildingPermit #..............J.�...D/ �_„................................................................................................................_...... .......... .. ........_ .. issued to ............. Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, I DATA i n1 1G TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT DATE ii)V :_i:.uY '], 19 :Ii7 PERMIT APPLICANT So I `c �'" I .,,, i�' ADDRESS .i I 1 r �' 0 IN0.) (STR EE TI`� (CONT-R'S-LICENSE, PERMIT TO r;il'i fhr'r i '�1`. -' (i) STORY 'r A. .:a -: NUMBER OF (TYPE OF IMPROVEMEN'P) NO. (PROPOSED USE) ZONING •`-� 1 DWELJ_ING UNITS AT (LOCATION) LJ'L ifi� - 7S 3Lci°; •� � r'�.,� D STR CT" (NO.) (STREET)Y BETWEEN AND (CROSS STREET) (CROSS STREET)"' LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION + (TYPE) REMARKS. ?c.'.r':::ir,:� ii i3 C%•—ii�a•�; . is..1 L.,.. AREA OR Q. PERMIT VOLUME _).>�/4 {, i3 ESTIMATED COST .p .'iti j.titi(i., FEE ,� >•-- (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS ill 0-L i.l Li 1.r' 1SLy ';�c'!i'i'. - BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR - PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF. PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FO CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN P,ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT. IS VISIBLE FROM STREET BUILDING INSPECIVON APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APP VALS Al- 2 2 . 2— 2 — — ww N 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT WORM OTHER 2 Q�.f��Q•��, Qrj� � 4 BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC_ 1 . EYM I T 'N!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED 'WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION, I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.