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Town of Barnstable '
0 .� REC�E�I �f:
'" CAet'� ' 200 Main Street Hyannis MA 508-862-4 2601 -7 s
0 03 8
Application for Building Permit ,
Application No: B-16-2864 Date Recieved: 9/30/2016
Job Location: 20 LESTER CIRCLE,CENTERVILLE , ' mi
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Permit For: Building-Siding/Windows/Roof/Doors 3.
Contractor's Name: TROY A THOMAS State Lic. No: CSSL-099913
Address: CENTERVILLE, MA 02632 Applicant Phone: (508) 328-1635
(Home)Owner's Name: KNULL,STANLEY H&DELORES Phone: (508)428-6930
(Home)Owner's Address: 20 LESTER CIRCLE, CENTERVILLE,MA 02632
Work Description: Strip of existing asphalt roof& install GAF/Elk 30 yr.Timberline architectural shingle
Total Value Of Work To Be Performed: $7,695.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Troy Thomas 9/30/2016 (508)328-1635
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost,: $7,695.00 Date Paid Amount Paid Check#or CC# j Pay Type
Total Permit Fee: $39.24 9/30/2016 $39.24 X)M-XXXX XXXX-1 Credit Card
3286
................. .................. .......................... ............. ...................... ...........
Total Perin it Fee Paid: $39.24
P WINNE
�µ �HISSp PPS ITT f � N f
` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 5 - Permit#
Health Division f Date Issu o
Conservation Division = Fee ,
7-
Tax Collector aa
Treasurer 1) • C�:
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address - LC-51 e le—
Village l � 2,V"i i 0
.Owner S dU L-G i� l� L?I_L_ Address 1�
Telephone
5-r i2--( P l�-eio 0
Permit Request _ •
41
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Estimated Project Cost J, JD Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: 0 Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes 0 No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
,,Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil, ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing . New Existing wood/coal stove: ❑Yes ❑No
Detached garage:O existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size' Other:
t
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑'
Commercial ❑Yes' 0 No If yes,site plan review#
Current Use Proposed Use
„ y
IZ iZT BUILDER INFORMATION
Name �� .L� obi Telephone Number
Address ua �� �' �'� J License#
U SSG C// c.0& Home Improvement Contractor#
D Worker's Compensation#
'ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE ��l
- - FOR OFFICIAL•USE ONLY _ a
PERMIT NO.
-DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER E � - - _ • i i � Y • • '
DATE OF INSPECTION:
FOUNDATION
FRAME -
INSULATION
FIREPLACE -
ELECTRICAL: ROUGH FINAL '
PLUMBING: ROUGH FINAL - - -
GAS: - ROUGH FINAL
FINAL BUILDING '
DATE CLOSED OUT F
ASSOCIATION PLAN NO.
�THE
The Town of Barnstable
• s�xnaresi,E, •
1b 9, Department of Health Safety and Environmental Services
'OoMo�" Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: � �P �`' r Estimated Cost 360
Address of Work: 69 0 Z-c—STD /Z_ C l- 6-L-C—
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job Under$1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
I ,(?- 0� P e 0-6� , i V
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
—
The Commonwealth of Massachusetts
" r: ` Department of Industrial Accidents
-= Office of/�esdofflees
_ i� 600 Washington Street
-" :c,,,> Boston,Mass. 02111
_ Workers' Compensation Insurance Affidavit
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❑ I am a homeowner performing all work myself.
❑ I am a sole netor and have no one' kin in ca achy
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❑ I am an employer providing workers' compensation for my employees working on this job.
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sole roprietor, al contractor,or homeowner(circle one)and have hired the contractors listed below who
have .
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Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine rep to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a f e of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Otflce of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is trw.an4 correct
Signature10� C L- Date /�/ �/ (3p _
Print name 2 b 6 6 4 7- �Y 6V -� phone# 4 f�-- `t'`�
Efth
of vial usIRML
e only do not write in this area to be completed by city or town official • Im
city or town: perndt/license# ❑Building Departme*
❑check if immediate response is required ' ❑Licertme ��
❑Selectrnen's Office
. _ ❑Health Department
contact person: phone#; ❑Other
(�evited 9195 Ply
I
Information and Instructions -
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any con --c-.
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 c-
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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority. y ,
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance 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.
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 io
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 imrestIoNons
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 eat. 406, 409 or 375
/ /S-� model: 07sterville
° 4�
`?"Er TOWN OF BARNSTABLE
S
i I STAB E. i
9� O�Ya`��, BUILDING INSPECTOR
Build One Family Dwelling
APPLICATIONFOR PERMIT TO .............................................................................................................................
Wood Frame
TYPEOF CONSTRUCTION ................................................................................................................:....................
......... ! G/�1................i973
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies ",for-as permit according to the following informati6p "
Location ......A-, "'.JJ........ .....(.tl e.........................................................
ProposedUse .Residential..........................................................................................................
RD-9 Centerville-OstervIlle°
Zoning District ..............................Fire District
..:::........................
Name of Owner Normest Homes Inc., Ashley Dry Centerville
.....................................................................Address ..................................................:.................................
Normest Homes Inc: same
Nameof Builder ....................................................................Address ....................................................................................
Name of Architect none
..................................................................Address ..........................................................,.........................
6 Poured Concrete
Numberof Rooms ..................................................................Foundation ..............................................................................
Siding. . Asphalt
Exierior ........................P........:....................,............................Roofing ....................................................................................
Carpet Drywall
Floors ... ........................................................................Interior .....................................................................................
Warm-Air - 2 baths
Heating ..................................................................................Plumbing ..................................................................................
Yes $
Fireplace ..........y Approximate Cost ....................20...............�000..................................
Definitive Plan Approved by Planning Board -----------_--_—----------- 3,o
Diagram of Lot and Building with Dimensions C2
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
b'I�C. L Gt.�
Name ... ... .................... .......................
N~zxoest Hones Izm:°
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No - - perfmk for ......one-Story'--'' .
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---������. ----..--.SO .
Lester Circle
Location— --''---'------'-'-----'-'-'-
Centerville
�
...........................................................`....................
' � (Dormast Hmnawm Inc. - ]
Owner ---.-----------..---.---.- `
frame
Type of Construction ..........................................
(
............................................................
�9�
Phu -.--------. Lot ---........--.---
. �.
. �
. �
March 2� ��
Permit Granted ..........March ^- �
Date of Inspection ...... . ` 19 . .
oota Completed
� ' �
'
PERMIT REFUSED -
----.-_.------.--------- 19
-
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x.. Approved ................................................. lA
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