Loading...
HomeMy WebLinkAbout0091 LIETRIM CIRCLE 1 e V 5 -� �s) Application number........................... .................. ® ' Date Issued........... . . �. � .......................... MASS. .. " 1639. `0�' J(f J Building Inspectors Initials.... ...... D MA a L ro Map/Parcel........:�� ........O..y.............................. TOWN OF BARNSTABLE Q-5-.Od EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: / C e f���� 4§§4 Ci y--c j � NUMBER STREET VILLAGE Owner's Name: [C.'cAalrl 1XIa/ri 9 re/7 Phone Number Safi Zit'o- 7 Z g 6 Email Address: Cell Phone Number 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: 5eP <4\4c c�4 c gAtr-a c_-� Date: TYPE OF WORD F� Siding E I Windows (no header change)# 8 Q Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to rJa5�e CONTRACTOR'S INFORMATION Contractor's name ' SfiQefe tfor (A ,2' '305,�012 Home Improvement Contractors Registration(if applicable)# / 60.2 5 (attach copy) Construction Supervisor's License# O7 2-7 7 2-, (attach copy) Email of Contractor Phone number 7 911 - 5,3 Z- qP0 5 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. APPLICATION NUMBER. ............................................................ *For Tents Only* Date Tent(s)will be erected 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. 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 If food food is being served al your event please obtain a Health Department approval between the hours of 8:00arn-9:30 am or 3:30 pm-4.30pnL Commercial events may require Fire Department approval *WOOD/C®AL/PE LL ET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE TiXE1V'JL1C 1 IO Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CM[R the Massachusetts Stage Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CM R and the Town of Barnstable. Signature Date LI CANV S SIGNATURE Signature Date 7— 1 / - /8' All perms a 'ons are subject to a building official's approval prior to issuance Customer declines exterior wrap and understands painting and/or repair may be required Initial Customer declines grids on windows/doors Initial DISCLAIMER:Customer is responsible forthe following in connection with this contract:Painting,Staining,Alarm System disconnect/reconnect Building Permit fees in excess of$25.00,Homeowner and or Condo Association Approval,Historic District Approval,City of Boston parking&sidewalk Permit fees in connection with installation. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows Extra Labor&Materials $ 1 Site Set Up, Permit, Disposal.&Delivery Fees$ 389.00 Total Amount $ — Custom Order Deposit 33% $ Ck# Project Start Payment 33% $ / Balance Due Day of installation $ Amount Financed $ Window World of Boston anticipates starting this work on and being substantially completed in_days.Security Interest:Yes No Any deposit required in advance of the start of the work SHALL NOT exceed 33 1/3%of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of both parties. All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973-8700 No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. Window World of Boston under provision of Chapter 142A of the general laws is required to apply for and.obtain all construction-related permits.Window World of Boston shall not be deemed responsible for delays in the work described in this,agreement caused by regulatory,permit granting agencies,authorities.&individuals. Notice:H the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M.G.L. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later than midnight of the following'third business day. MIS I LS_T 9M®R®EFt N T FOR RE ALE! This Window World°Franchise is independently owned and operated by L&P Boston Operating, Inc.under license from Window World,Inc. Owner:Do not sign if there are any blank spaces. D e h,41 a area blank spaces. Date Owner:Do not sign if there are any blank spaces. Date Salesman: Do not sA f ' Boston 06-18 white Co Original Yellow Copy,- ile Pink Co Customer �' il gF ray' Hayes Printing336-667-1116 f Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construeon Supervisor CS-072772 Expires: 04/0712020 JEFF C STEEL 24 SHERWOOD AVE = p r DANVERS MA 01923 ' Commissioner ��IIWW 3 ' ���N�Yr/H%Jff•!(N+F(J(l�I�'"'/(fJJ.iC?(J!(IJNf'l .. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Rtgl Expiration tt 5; 04111/2M WINDOW WORLD O.KBOSTON,LLC. JEFF C.STEELE + 15A CUMMINGS PARK WOBURN,MA 01801 UrldersweWq J r r The Commonwealth of Massachusetts w� o Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 r wxw.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FELED WITH THE PERIVHTTM AUTHORITY.' Applicant Information Please Print Leeibly Flame (Business/Organization/Individual): /,,zilch ram/ /�/prld 0: ' 9DSL, C�I LL Address: /.5'H C ten,.•-�; s � K . City/State/Zip: lwb A 'o o I Phone.#: -7g I -4i 3 Z - !Ik 0 5— Are you an employer?Check the appropriate box: Type of project(required): ].�am a employer with 5-0 employees(full and/or part-time). � 7, FI New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.) i.❑I am a homeowner doing all work myself.[No workers'comp.insurance requited.]t 9. El Demolition 4.❑ 10 ❑Building addition 1 am a homeowner and will be hiring to conduct all work on my property. I will ' ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietors with no employees. - 12.❑Plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROof repairs These sub-contractors have employees and have workers'comp.insurance.? 6.❑We a corporation a co oratior,and its officers have exercised their right of exemption per MGL c. 14.F�(Other yo t e)�o,,). 152,F 1(4),and we have no employees.[No workers'comp.insurance required.l F-e {G Ct',��"_1_5 *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.. Insurance Company Name: 14 le!-t—Cb Jr E r Tn s J RA I L E Cc) . Policy#or Self-ins.Lic.#: Z Z V%1 F_ C L 2 Expiration Date:�/- Z 7— IS Job Site Address: / l 7 r l l''I cl City/State/Zip: (P,t/P/I/�l rle ✓'I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this s tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifitNtion. I do hereby cer ' under a pain erjury that the information provided above is true and correct. Signature: Date: 7 // - / P Phone#: 1 3 Z.- 49 C$ a use only. Do not write in this area,to be completed by cio) 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#: �►���''�2n�' CERT�F�C � PATE , ATE OF LIABIPTY INSURANCE WMVr T,.^ 31i15 CERTIFICATE 15 15SUED AS A Pa14TTEIt OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE`OLDER.THIS CIUMFICATE DOES NOT AFFIRMATIVELY OR NEGA7IVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIGIES RELOVI!• THIS CEI�IFICATP OF INSURANCE DOES NOT COAISTITUFE A CONTRACT EETWEEp!THE ISSUING lNSURER(5},AlITF70RIZ)=D f'RL NTATIVE OR PRODUCER,AND THE cERTo ICATE HOLDER. 1MPOR7AAIT: If the cerYifcate ImI is an ADDT110NA1 INSURES,the�o'�CyC�+nrrst have ADDTilONAL INSURED If SUBROGATION IS WAIVED.smiI to the terms andJ cflrtrJifions-of• provis OUS Or be endorsed. this c�Cd]fiCate does not confer tights YO the cergficate holder in lieu of roe I erld r n P Fides may require art ePdOmemenL A slatement oA 'RODUCER V(amh&McLennan Agency LLC m°°rrae T CaJfi vl6ttchsr,CtC,etsR_CBIA Smen .oro St. PHO 33G544 5830 3raenSbOfa ItC 2745b �•raalL AM wo:232-507-651F . AD Ess_ Gar1i.L�tz!te, rnarstrrnroa_Corn ' t INSURER(S>a oR DING coF�C-E awrcC JSt1121� �doo< INSUREA:Afteri:a Financial Benefit 9 3 i nnndoiN World o`•Boston,LLC ems:Hsriford FireL�rsivanoe C a 118 Shaver Street l9C�82 7 gO.rth lVlIkesborc NC 28659 tn`suREER c:y1assachuseft am,Insurance yarn 223D5 � IrsuRa�r: . K'SURER f :OVERAGES {N�t]REP F t i CERTIFICATE f1LI?11I3ER/03iiD75T2 RI:1/ISION NUIiABER JNDI IS TC CEP.TIFY 771AT ThIE POifCIEb OF 1NSC[RANCE`LISTED•BELOtN r7gliE B ;]SSA 70 7NDICr1TI`D_ NOTUv'Yi HSTANDIING M-T P.EQrJIP,EMEh]T,?Elii>t OR CONDITION OF AR'Y COA HE IP75UREC NAMED AEOVE FtJi�THE POLICY PER;OD CERTIFICATE MAY O ISSUED OF? MAY PE2TAlk THE INSURANCE AFFOPZEL EY THE Pp iR IES ESCP.iBEC lJ�`TtEli° SU&1rC TTO v1L071tE�i�q g. CLUSIOA]S AND CaNDITIONS OF SUCH?OLICiES.LIMITS SHMN, MAY HAVE BEEN,P,EDUCEQ BY PAIb CLACAS. s>~+ rF 1 'YPEGFLUSURAkCE `! POUcrnr�mlaea POLICYS'F poicyexa ; i X =COMERMLGE-RALLsAeturY m�avY rSd7DD.ryYYyl �yq ' I OI)6t--� G�iF� �iPl2D�{C CLAIMS-KADE C O CUR j i r+ARdRS�OREIVTID ;.coe•DDo i �PREfa1LSE5 � oSJIi.�00 . � r�IEC FAP(AT,Sut perFDn? '5.UOC �' - n^LN'LAGGP GATELiidfTpPc _ • PERSONAL8+ZV PlJiFrr :-.00tlOtw i __'PCiJCY`_I� i DER. _ ' - GENMALAOGi•-C-ATE I:2omyn-L i 1.eTHER 1 I PRODi1CTS-CC-JP;)rA9G ; ; =. � - � �ZDcc.We AUF0PJtOBLE UAe1s do ! s i � �abvse�s�clE •5 !ANY AUTO t i I �. E!7�21>r t:176�E C`J. �INGLE U37fr � ���� - s ' Ot+UIJED S^-}EDUj EC i eOD31Y 1 rrS(Pe cerac7l' i; ---7 .._._AU:O_ONLY _j AUTOS j 1 i r_;� �O�� '��idOP'-OWNED = j '-Y 11LIURY(PEscda?er,P - . ALMOS CN" I OffP11D ACJAGE i r 1 UMBRF ALMB' X - ,—! �•--OCL;.JR S ( 01]D7E0252; � tflleD:7 � � EXCESSLIAB I CLA]AQS fdA l I �l"U2D9E I cACHI�CURRENCE (£ZdoD,L ��-1 i A6GREGASf �EpppD� —� RE7ENTICN: - ! I `� i�'�ORf4.°RSCf1PRPENSA'f1UR � �tf IANDEMP133YERF,.UABTL1TV V 7T j 22bb3 J2E°9'c , j I1272D?5 "I:271�D7F PER ;OTi �ANYP;OPRIE?MPAR'DFREtEtiJi1� �— i STA. E4 CFFIC£P1MEIeEERE%CLUDED'< I + ri:G 194angMory in OlH7 —r; 1 EL FACHADCIDENr S:DD tF G { L�yy85,descllbe Ullda! I ESCRIP;;ONOt=OpEnAT7DNS�e7a�• + i E.;..D15ErlSE-EAE},iP10%E��bOo,pDD jE.L a15EA5E-FDLIGr L14U?�s�c,Doe , SCFr&TiO:t pF OP3tA7tON5 f LOCATION,S!VM9CLES CORD 9 AHrli Ir pf�l i . -. �_ _ ReII(arl�Sci:SWle;!mdbeatlacttedi,`znwspac�isregwl"p, _ 7 i s 7�''IFIGATE}IOLDER MANGE''t�.flTtOl� S'IOULDANYOF7HEAroVE•DE9CRtBEppCUCMSBECANCEL�BEFpt�; i TA f7 IMTION DATE 3?{MMF NOTiGE TNILL RE VELf11EPX-D its ° �ICCORDANCEWITNSHE�POLICYPRObI510Ns. AMOR2EDD REPIg,SEWMIUF ©99l3$�•2016 ACORD CORPORATION:AG rights reseried. :ORE 26(2D16/Q31 ?he ACORI;name an@ loge arm registered marks of ACORD Town of Barnstable pF"E A Regulatory Services Thomas F.Geiler,Director Building Division * 1AnNSTABLE, i MASM& � Tom Perry,Building Commissioner ArEo " 200 Main Street, .Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-7.90-6230 Approved: ? Pee: e oy Permit#: HOME OCCUPATION REGISTRATION Date: ��O Name: 7 C4-7q p/®/UQ Phone#: 5_®O — � J Address: 9 [ ta- 0/L"_C l< Village: Name of Business: fig ���'C �.t✓LS d F- OXYC�_ Cob ®e— � Type of Business: ✓ o Lt Yc 04-1 o(' 6r1 11 "p/Lot: E7 6111---7w-1-e-¢c INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I the undersigned, gn d,have read and agree with the above restrictions for my home occupation I am registering. Applicant: 1WDate: Homeoc.doc Re 5/30/03 i TO ALL NEW BUSINESS OWNERS DATE: Fill in please: m F APPLICANT'S YOUR NAME: 5��1/ f -T, h /oj BUSINESS YOUR HOME ADDRESS: a olke-�,e, �..�� Telephone Number Home 5 �� - TELEPHONE �' , .....�.....�.� _ NAME OF NEW BUSINESS / d� TYPE OF BUSINESS .6 6CX 6 tlb 6' IS THIS A HOME OCCUPATION? YES L�:JNO G i°d=T s 7� , Have you been given approval from the building division? YE NO= // Q ADDRESS OF BUSINESS tj MAP/PARCEL NUMBER . .When starting a new business there are several things you must do in orddVed 6e in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,-you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). You MUST go to the following office to make sure you have all the required permits and licenses.. --. GO TO 200 Main St. - (corne of Yarmouth Rd. Main Street) and you will find the following offices: 1. BUILDING CO I SION R'S OF This individual ha info r ed of i equi ements that pertain.,to this type of business. - on d Signatur _ COMMENTS: IJ 2. BOARD OF HEALTH This individual has been informed of the permit requir ments that pertain-to this type of business. Authorized Signature** COMMENTS: . 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Business certificates (cost$30.00 for 4 years). A.business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPRO VAL FOR BUSINESS CERT/F/CATEONL Y. ,4 11.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION M°ap ' / Parcel _ Permit# Health Division 00L- —f7 ' dOrA v y Date Issued Conservation Division ` s �/ 4� � Application Fee SL,a(� tiave .4;'� � -- Tax Collector Al D00, o Permit Fee TreasurerI-ko -_ M x 3F SION Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Addres �i,e(� Village Owner Address Telephone s0 Permit Request J 6 �d Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District CIO Flood Plain Groundwater Overlay Project Valuation 3��' Construction Type Lot Size Grandfathered: Cl Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes UeNo On Old King's Highway: ❑Yes wqo Basement Type: Zull ❑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 3 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: M Gas ❑Oil O Electric ❑Other Central Air: ❑Yes ®-f 4o' Fireplaces: Existing New Existing wood/coal stove: ❑Yes ®'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:0 existing 0 new size Attached garage:misting ❑new size Shed:❑existing D new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Ll Commercial ❑Yes M No If yes,site plan review# Y Current Use Proposed Use BUILDER INFORMATION _ Name 04C4A/-e<iJaIephone Number i Address License# Home Improvement Contractor# Worker's Compensation#ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 4� DATE a ZZ, `_ a FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. " ADDRESS VILLAGE OWNER j DATE OF INSPECTION: FOUNDATION "y FRAME c- Cr- t '} INSULATION ao , D FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING (�.1 �� ^ 7- 0 t DATE.CLOSED OUT ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industria[Accidents 6oa Washington Street _ J Boston,Mass. 02111 w Workers'..C4m ensation.assurance Affidavit-General Businesses rEEME: ..y'} '�. - ;,gt', 2Z1 YlxesSStlilwp,�,y� ;;y+�is+.• .:ice CIO �`'F• � _' ;,>•- address: i state / av C3�!o Lvhone# efts ?i'�'LiLC�r • work site location full address []Retail[]•RestaurantBaT/Eating Establishment , I am•a sole�iroprietor,and have no one ' Business ape: ❑0 Sales('including Real-Estate,Autos etc.)' working in any capacity. I am an em to er with • ein 1 'ees full& art time: //%/%%�%/�%//%%//%//i����///%/�%� O�//// /%%%///////// I am an;employer providin-g viorkers compensation for my p y • : g , !: ::i:,f,''•i}'1:i: :.r. .. •F,' ••r,.•iC• ,•t:,t:�;;•,y,::i'' '.�•. '�. .�_� �,:j�;Yi;':• rti�t':��•`.:,s:.?,:' '.I:.,�'•.�L '\+•'�''�1�.•.:•• .!•{,: fi L�Y.,t:\, ., i,��.,., + 1':" i}'{+:':'1\ �1 I,,;�:l. :'.+�':.::•_a yty.`,„ COm an amet. ys.: ".r: -:., +.i-s o r::�":•i,: .;,r-• i:••L t .1 �'.. •:... 1'''�;7-- , �.,_�• •.4't ' t �! y1 , .i -a r:''t''r: I'''•{',?i'in•ti.�'.f:i- r"7••�,'d;.:t f�,.F�,,••1 L .. tft �2r•r <i :. 3:• �....'. L. :1 1!L Jib, .+ .� ... •'1 Tl+ ,'�,f: �r- •' ..L'1: dd�reSs:' r..:5: :L,�.�•'-�►'•.': i�:' � t.�':•�:+ .9: ''':•'�,t•',`f'75Y•: :}'+:'Y'+•\-il.;:! '�" .. ' .,,'"i` ,i••:..X: •..1^JS+i .,x i ,tY' '.k:•. {' '�'•':'. :•,.^ '•.J'• •J' •i.• •'',' ,\. y y ''' :r1•:'', • :t-` h:• 'p .r{'':'•• hone.. .L I '.1 .\•',! r .,., •' L i '.''••. ,. • 'M'''• ••' '�•..I: ••tt:,4,'.'. •''. ':�i.4• .a. •r','IJ'Ie�'.:4k.'•.. 'Oli .#�' '" '� .irisiiratice.coi r�y:'•'1: , leers or •w .o. ,11'the fo win �e o hav / •.h g 17, elo ,w ed b wr listacto sd t contr edth e ind en en ve hir d h eP anole r o rietor a�amas p P ' compensation polices: :...,• '� :, -: , '•C'. m..�'�:. n +"f; ': y•.:�• ,..,�3i.• !: ia'` ' rF::.:•r+ t,:ice'"'::- v•.(• :: •�: •: fT .:�A;,•., ;1 r>.',( ••r •lwti i?i+1 >:•:,.•�. .`�` '•'•i�:�jt� l v�y ,;:. rS�:Ju�'y+•�.� • Ci• , �.}:•. .1';ti i�;'•,t,} tirY+;ih rl7'::• "T. 7=r:i: ), :':� t:''Ir:•:F•;j'�.,' •c 0.11C�• ''i•,'`..=o+d/. i„%^•' +:'•'' ' •.+:'� c#•'' r.;lift ti=.:•;7i.3.::• '+�.C:' i. •,'. •t: '� ';!: gin :. ,. :,,` .:`�.,, '•l.r a •.t� !¢•.: r.:• �ti5'! L :�,�.i L,:., - i;•: .:�'!.;% �;�y',:1• :• ,:;,,•;:4; '.L.�';::. •iAf,.ir;`i;`j�.' ,ti..,.•�:J'iy�t>,.- .� r .C.'. comtan. navte:.,,, .. ' .r A. .r4.., .ri. "i•lyr ' �i'i r•. ::'Lfi1'••i:+"t ,�'•' y,C:,.t' •,,•„ • 'lioiie#`s ' til. •r..�, ..r:r- ;�y,•; •.e.c .:FL...;�.e',. .(�• ih ,"`'.' :�.ti: i•, :, .•.v:�.;• L+' ,,���.. 'L'i.:e: 'r •„i O �-h•}�•.r,,w;f.::'is:• �..r :, ;;� . .":•`•'' G{:i.'S.:i:w'.r.x. �'ZiC, +': r` •.:y, fnsii'r;ence;eb:•>•��:' =' . :• .;;••... .• _;,•.:�:•M:•� •. ,,.:• '�//�.. Failure to secure coverage as required under Section io the fvim of a STOP WORK ORDf 52 can lead to theER and a fine of$00.00 5A of a day against me. I understand that Xr one years'imprisonment as WeD as civil penalties al copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce under the pai sand enalties of perjury that the information provided above is true and co rrect Date � Signature Phone# Print name officia]use only do not write in this area to be completed by city or town official permit/license# ❑Building Department city or town: []Licensing Board ❑Selectmen's OMee [}check if immediate response is required []Health Department contact person: phone#; ❑Other ovised Sept 200) II Information and Instructions- Massachusetts General Laws chapter�152 section 25•requires all employers to provide woikess' compensation foi their. employees, As quoted from the law', an employee is.defined as every person m the service of another under any contract of hire;express or implied; oral or written. association, corporation or other legal entity, or any two or rngre of An employer is defined as an individual,partnership, . the foregoing engaged iu a joint enterprise,and including the legal representatives of a deceased,employer, or the-receiver or association or other le entiemploying loyees. 'However:the owner of a 'dual partnership, ass gal ty� �P . trustee of an indiv� ,p . P dwelling house dwelling house having.not'more than three apartments and-who resides therein, or the,occupant;of the, w Ming bf who lbj�spersbiis to do.maintenance, construction or repair work on such dwelling house 6r on the grounds or another .emp. t b'ecause f such * 1 ent:be deemed to be an employer. :. , ..,. • ... building Appurtenant thcret�shall zlo ha ter 152 section 25 also'states that'every state or local licensing�agency shall withhold the issuance dr renewal MGI..c • P 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 unto ' chapter have been resented to the contra acceptable evidence of compliance with the insurance requirements of this p p authority Applicants Please fill in the workers,'eoupwsatiorr affidavit completely,by checking the box that applies to your situation., Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. - lsobe 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_workert!-compensation policy,please call the Department at the number listed.below. City or Towns . Please be sure that the affidavit is cbmplete anclprinted 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 ense number which wM b'e used as a reference number. The.affidavits^may be.retluned to be sure to fill pthe perTrn't/he the Department b,ul-it or FAX unless othei'arrangep=ts 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-calt The Department's address,telephone and fax number: . ' The Commonwealth Of Massachusetts Department.of Industrial Accidents emce of ft i estigafts 600 Washington Street Boston,Ma. 02111 fax#: 61 727-7749 t � I f ,Er Town of Barnstable Regulatory Services r aaxxTss�$ Thomas F.Geller,Director 99, 1639. Building Division ''rFD MA'S k Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Off ce: 508-862-4038 Permit no. Date AFFIDAVIT HOME Z2ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction construction of an addition tooany preexisting o�wr�er occupi conversion, -improvements removal,demolitions 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_ C� s7L � e— chag e.� 06 Estimated Cost J.�o�i�✓ C:e.rcl� r�e,Ctl��je, f�2 a c as(0 3 � Address of Work: � ) Na Owner's me: 5i4wAJ T eAr7,JZ&o'e hcation: 4-6�/—oc 6D Date of App I hereby certify that: Registration is not required for the following reas on(s): []Work excluded by law 0ob Under S1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING TEMIR 0 I- IlYLPROVEMENT ERMIT OR DEALING_WUORRY DGO NOT HAYS CONTRACTORS FOR APPLY ABI; ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERTURY I hereby apply for a permit as the ageAt of the owner: Contractor Name RegistrahonNo. Date OR Date Owner's Name �FZHE T Town of Barnstable Regulatory Services sngxsrns[.e, Thomas F.Geiler,Director MASS. 9 .�� Building Division .ojFD MAC p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION L�. C� Please Print DATE: " "—O 1 �— JOB LOCATION: /� -- number street village "HOMEOWNER': me / home phone# work phone# CURRENT MAILING ADDRESS: 9/ �— �� 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 building permit. (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 require �ts. r Signa ure 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 perfomring 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt FROM APCRN PHONE NO. 5084209201 Apr. 28 2004 10:45PM Pi E)UTIM GARAGE RENOvE rARAGE 39313R r1ND } FFA E FOR NEV WINDDW \E=DM elan FEARER NEW 7.6X4M AMEEMM Ir]NSOV DQPM CLAP'ZMD c,-uS 6 ' G 1 - t POOR— . 'r' + -� b OCR Poo 2 0 ram- V" Lj d C. Sheet1 Page 7 a ` I 0 o c r cn o° co � C N co oq - Q -{ w �1 CD CL CD CL O L , 00 .a:* lF"' s FILE. 2003-M1Ps 52;, REGISTRY OF DEEDS - BARNSTABLE COUNTY CLIEN is"RESIDENTIAL TITLE SERVICES UNREGISTERED LAND LENDER: -FIRST EASTERN MORTGAGE DEED BOOK 12566, PAGE 159, PARCEL OWNER: JOANN WEST PLAN BOOK 223, PAGE 139, LOTS 25 APPLICANT. SHARON T. CAMPIONE REGISTERED LAND DATE: NOVEMBER 18 2003 L.C. PLAN SHEET LOT(S) ASSESSOR'S MAP 169 BLOCK LOT 042 CERTIFICATE OF TITLE MORTGAGE INSPECTION PLAN scALE 1' = so• P1 LIEIR/M aRa& CEIVM?NLLE, MA 56.86' P PEE 13g Lot #25 _ 18, 360 S.f. f Lot 24 ¢� 1 o't #9 ,1 Stry, Paved 213'f 500'f To 178.540 Taramac Road L 19 CIR CLL, THIS PLAN IS FOR MORTGAGE PURPOSES ONLY SHEET 1 OF 2 CER71FICATION I CERTIFY THAT THIS PLAN WAS PREPARED IN ACCORDANCE WTH THE PROCEDURAL AND TECHNICAL STANDARDS FOR THE PRACTICE Or FARENO CERTIFY TO THE BEST OF MY KNOWLEDGE LAND SUR"NG IN THE COMMONWEALTH OF AIASSACHUSETTS 250 F, TO THE ABOVE ATTORNEY, BANK AND CUR SECTION 6.05 AND W►TH THE REMARKS SHEET ATTACHED HERE To TITLE INSURANCE COMPANY, THAT THERE SIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN, AND THAT THIS PLAN WAS •'•'="v PREPARED UNDER MY IMMEDIATE SUPERVISION. �►' �'" w� JOHN L. LIBBY CONSULTING CONSULTING LAND SURVEYORS - `- � P.O. BOX 468, ROCHESTER, MA 02770 ���; TEL:(508) 763-0179 FAX:(508) 763-2860 VonlibbyWibbyconsulting.com www.�ibb)consulting.com A kssor's map and lot number :... A Sewage Permit number � "+! ..., d r"/!l !t!z ........... yFTHE TQ�y TOWN OF BARNSTABL.E Z 33MUST"LE, i "b 9 BUILDING INSPECTOR 'Fom C............. i APPLICATION FOR PERMIT TO i�...: � .. TYPE OF CONSTRUCTION .....: ."}. `` ... ... v0 ........................................................... ...... .... ..................7...........19..:7!. TO THE INSPECTOR OF BUILDINGS: �{ The undersigned hereby applies for a permit according to the following information: Location ..... ..... .. ........./C.. 1 YJ✓i:........... .... ...... � ', 1„/ �U......................................................... ProposedUse ...............................................:.............................................................................................................................. Zoning District ..........Fire District ... A. . .) i!/ti , 1. / �r1 t'1�fYJ�/" 'F'/��! ;/ /Pf r�X��O�✓ /[ �! Nameof Owner/�...........................�......................................Address ...................,.........._...._.................,. Name of Builder „i nn T #(: f�`'1.....................Address �/ t lA) N�l�A. ................ . Nameof Architect ..................................................................Address ....................:............................................................... Numberof Rooms .... ..............................................................Foundation ................:.......................c.....:.t.........:.:................... i � iF�r J `-F 1U Exterior d.-r: .........:.: - .......................................Roofing .....:......: .. f Floors Interior ?: A ! ' ' ``- Heating r "..:.. .�........................................Plumbing t1u .. f J� .�?...................... ........... ..................... ................... Fireplace ... hJ. �.�.!.%" PP 4 a6. ez i . ...:......... ...................................................A roximate Cost ...........................��`... ...`.. . Q S.. .... Definitive Plan Approved by Planning Board ________________________________19________ . Area ................-............ Diagram of Lot and Building with Dimensions Fee ....... .. . ................................... SUBJECT,TO APPROVAL OF BOARD OF HEALTH LQ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 11 Name .............. .. •.................................. .................. I � Williams, Leroy A=169-42 t4b17948 permit for ,,,, add breezeway & garage to dwelling ............................................................................... Locatio Lietrim Circle n............................................................. Centerville ............................................................................... Owner Leroy Williams ............................................................... . Type of Construction frame .../....... ................................................................ ....... Plot ............................ Lot .......... ;'kr ............. Permit Granted ... September 3.........19 75 .... Date of Inspection ................ ...............19 Date Completed ......................................19 c: PERM/TREFUSED ............................... .............................. 19 ............................................................................... .................... ..................................................... .................. ......................................................... Approved ................................................ 19 ............................................................................... ' :,� n ®� , ssor% map and lot number ,[ ... ; ....:... Of SEPTIC Sy T �9 I T I�SrALLE �� S Be Sewa a Permit number .. ...... . ............... WItH ICLp- CC ,IAN'CE " g ATt��,,�,E II SE�TE EMIT ;Y Cod fTNETo�o TOWN OF BARNI. BARNSTABLE, i Y "b 9 O M OUILDIHG INSPECTOR CEPy a' APPLICATION FOR PERMIT TO ..... ...... ... ... ..� ....... 7....... TYPE OF CONSTRUCTION ... ... . .... . d....................................................................... ....!? ••,?.............19.71. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the (following information: / �^ Location `�.jJ ... .... l .7J�.11 1......cy.R.61, .......... .U��.�f ...................................... ProposedUse .............................................................................. ........................ ............................. .. ...................... Zoning District ... ...............................................................Fire District ........ .. ............................. Name of OwnA.E , I.Ca�....�i.l�/�:�1.:�...................................Address?2�..�.�.:..Cll3/.�??.�:wf:...����,*'r.�/.��O.IQ!Y(.�t'.�•.�.�!" Name of Builder ...:.../. •• ............•• v�.j s;f!I... ....D/.(C�.7......................Address .��.�r.... :.. /4/il�. l......./7.f .!VaJa f, Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ....,.............................................................Foundation .............................................................................. Exlerior �!.N..?..c.........................................:.......................Roofing .. �aP..fla:[�...... lY,1v+/4..1ry f ................................. Floors ......................................................................................Interior tL.. ... .... ... ... ............................................... Heating Plumbing ` ............................................... ................................................................ Fireplace ....0-0.Ai.. - ...............I.............................................Approximate Cost ...........7 ........................................... 'Definitive Plan Approved by Planning Board ________________________________19________. Area %,ILA _308 Diagram of Lot and Building with Dimensions Fee xc�..:.... SUBJECT TO APPROVAL OF BOARD OF HEALTH Zz9 S f. • 4 F l < v t. I hereby agree to conform to all the Rules and Regulations of the n of Barnstable regarding;the above construction. Name ........... .. .................. gH Williams, Leroy 17948 add breezeway & ................. Permit for .................................... f i ....garage„to..dwe11ing........ ................................ Location Liet.r.....im..Circle. . .......................... r ........ . .. . ........ f ... � i ......................Centervi..11e..... ' ...... ................................ . . Owner .......... eroy Williams ......................... E Type of Construction frame f ................................................................................. :Plot ......................... Lot .......�25................... t � September 23 75 Permit Granted 19 Date of Inspection ....................................19 ll l Date Completed .............19 PERMIT REFUSED . ........................................................... 19 s ............................................................................... r ........................................................................... . ............................................................................... . ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... pp1{{{ t �2� h �t 2�f Y i j r a - -'- — --- - — �—4 u! 1 t 4: i , CERTIFIED PLOT PLAN ) LOCATION SCALE /'t 3a DATE ®/,r If7l Ei�/lr•loT d 2 S`- } PLAN . Ri=•IFEEtEPICE10 .�. AN I,r e%�P. �iuT'lTLEIv : E" ".c" '�rs'l•��' �i oSS�^.t3v'' • , � �• : r � �.. � ram, ! oxo I CERTIFY .THAT TNE� A4 �SHOWN ON THIS PLAN IS LOCATED (5N THE GROUND AS Lt t r.%sue° SHOWN HEREON AND THAT'T;.CONFORMS TO THE ZONING LAWS OF THE T011sIN"0Fi:-letl % t P THEN °COh1STRUCTED a .i P.I.:T'I T10W E k. e. , DATE 1✓•!�'i31ka.�./j�i� S��a� '. `f�r` ,�ei`�' LAPJQ SI�RVEYOR ., M , f i • y ^" y M r y E + i • Y r , 1 1 r 1 .a t i ��QyofTHEro�°� TOWN OF BAR.NSTABLE 22 . i 11119HHSTADLE, i m � BUILDING INSPECTOR - O i639• `00 S� f APPLICATION FOR PERMIT TO ..................... .. ...... . ......11 ✓.......... ..... .. ................................................ TYPE OF CONSTRUCTION ..L � ^- ..... .............. .... ....... .......... ...:.. ................. . :.......................... q.........I9......d l TO THE. INSPECTOR OF BUILDINGS: The undersigned hereby a lies for a permit according. to the followin inTf �t'on: Location .............................................. .................................. ........ .. .............................................................................. ProposedUse ............ .... . ........ ... ..... . ...... .................................................................................................................. ---a Zoning District ...... .................................................................Fire District ... ..................................................................... Name of Owner ..V1l ..... .. ......... .A..........Address�z U Nameof Builder ..................:.................................................Address ....................................................................:...:........... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ........ .�'- ............................................Foundation .............. .....................:...................... ! Exterior ........... .tQ�d-....... ��'-';?................................Roofing ................... .. ......... ................ .. ...... ...... . . . ... Floors ............... ..............................................................Interior .....Z-.. .............. ........................................................ Heating ....... ....... ........ .. .. ......................................Plumbing ............/......................................... Fireplace ...................................................................Approximate Cost ........l d.. v .............. ......................................... Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of Lot and Building nsions Y 01,0 \ k�� 0 71 :L s gr � 1 rL hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. C Name . ..�. ! !.. .. �. ....... Dacey, .William E. Jr. DEC 31 1971 No 13??8...... Permit for ........one story'....... single family dwelling ............................................................................... Location �� Lietrim Circle ................................................................ Centerville .. ............................................................................... Owner William E. Dacey, Jr. 4 .................................................................. Type of Construction ....frame 4 eq ................... ...... . .� Plot .........................:......Lot ......#.25................... i Permit Granted ....June--7.......................19 71 Date of Inspection .... ............19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 as ............................................................................... ............................................................................... ............................................................................... 1 ............................................................................... Approved .._...,.. . . : +..... ...... 19 i ............................................................................... ............................................................................... � r 1 `