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0027 MAY LANE
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'., "" � :,',�,`l , I ,,,AJ��,�,,,,,��,�N !�:,�n,�,,l` !�!;.� -,�","4::i,i,.,Ie""i".,��",;;�;�IP.�t�,2.......�'i I i;�tV.1?V,�I I ,� �v, " ,i'��tli)4i�_,, ; �, ;; ,?0'y'- ,, r. ;Aq 11 Ll�* �i", ! ll �%��,�-"tk`,"',i",i�,�,1��4h-"= , -11 '!�161 , �,� �,� �,� , � � " ��,,�,,,�'�'�'�'�'�'�'�'�'�'�'�'�'�'�'�'�'�'�. , �111.'i e��I , "I - LL I ��,, ,e-,I-l�l!,!,!,!,!,!,!,!,!,!,!'!'!'!'!'!'!'!'!'�I A 1, .1, 61� 1111�) . F t Town of Barnstable *Permit#8 3 4% Expires 6 months rom issue�te 4*1 RUMSrABM ; Regulatory Services Fee v MASS Thomas F.Geiler,Director p s039. A1� . Building Division Tom Perry, Building Commissioner -PREP 200 Main Street, Hyannis,MA 0260i. APR 2 7 2005 Office: 508-862-403$ Fax: 508-790-6230 TOWN OF BARNSTAKE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint' Map/parcel Number r 1 V Property Address ' ❑Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 3 ❑Workman's Compensation Insurance r Check one: ❑ I am a sole proprietor. '® I am the Homeowner ❑ I have Worker's Compensation Insurance > . urance Co p Name 7 Wor s Comp. olicy Copy of Insurance pliance Certificate must be on file. A Permit Request(check box) _ Re-roof(stripping old shin le' All construction debris will be taken to f ( PP g g ) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows.,U-Value (maximum.44) *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. <` Home Improvement Contractors License is required. - Signature ` Q:Forms:expmtrg Revise063004 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street, 74h Floor - Boston,Mass. 02111 workers'Compensation Insurance Affidavit:Buildin lumbin lectrical Contractors nab mddres ci state: If— zi : 6.3� hone# work site location full address): I am as lomeowner performing all work myself. Project Type: ❑New Construction❑Remodel I am a sole proprietor and have no one working in any capacity. ❑Building Addition �"a�A •. z.a,r.e :S s `� ,y...n.r .A:t�o:�V:.. �d...c,}•;,... .:a�.c'ag.._ :.t-.,a' i�e...a.:' e.Y. ❑ I am an employer providing workers'compensation for my employees working on this job. company name: address: __. . .......... __..._...__..._... ..._................:....__............. ` .. _ .........phone#: city insurance co. 11 # I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have e following workers' compensation polices: company.name: address: phone#• insurance co. Dolig comipany name: address: 2 city. phone#: insurance co. 01 # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties.of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of M00.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of p 'ury that the information provided above is true an corre t. Signar``tur`e — " Date Pttnt-name �E—,5�� /` Phone_# 7�0 —` z f l official use only do not write in this area to be completed by city or town official ' city or town: permittlicense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (rcv'iscd Sept.2003) Information and Instructions Massachusetts General Laws chapter 1,52 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", employee is defined as every person in the service of other under_ any contract of hire,express or implied,oral or An employer is defined as an individual,partne hip,association,corporation or other legal ntity,or any two or more of the foregoing engaged in a joint enterprise,and '. luding the legal representatives of a dec sed employer, or the receiver or trustee of an individual,partnership,association r other legal entity,employing emplo ees. However the owner of a dwelling house having not more than three apartme and who resides therein,or the o upant of the dwelling house of another who employs persons to do maintenance,co truction or repair work on such welling house or on the grounds or building appurtenant thereto shall not because of su employment be deemed to b an employer. MGL chapter 152 section 25 also states that every state local licensinIsha all withhold the issuance or renewal of a license or permit to operate a business or t construct bhe commonwealth for any applicant who has not produced acceptable evidence of c mpliance wrance coverage required. Additionally,neither the commonwealth nor any of its politic subdivisier into any contract for the performance of public work until acceptable evidence of compl ce wice requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by chec ng the box that applies to your situation. Please supply company name, address and phone numbers along with a cert' is to of insurance as all affidavits may be submitted to the Department of Industrial Accidents for conrmat n of i surance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned.to the city town th t the application for the permit or license is being requested,not the Department of Industrial Accidents. S ould you h e any questions regarding the"law"or if you are required to obtain a workers' compensation policy,pl ase call the De artment at the number listed below. City or Towns Please be sure that the affidavit is comp/hb d legibly. The Department ha provided a space at the bottom of the affidavit for you to fill out in the evf Investigations has to contact ou regarding the applicant. Please be sure to fill in the permit/license numbe used as a reference number. a affidavits maybe returned to the Department by mail or FAX unless ents have been made. The Office of Investigations would liken'advance for you cooperation and s ould you have any questions,. please do not hesitate to give us a call. The Department's address,teleph r e and fax number: i 1 The Commonwealth Of Massachusetts j Department of Industrial Accidents i+ Office of Investigations !. 600 Washington Street,7t°Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 . -`` `- �°� ✓ Parcel lJ "A_�rmit# / 4 9 3 Y Conservation Office(4th floor)(8:30-.9:30/1:00=2:00) S 'G Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fj , L,�, ,"o ;Y Engineering Dept. (3rd floor) House# t �1ME led�Paism , t 19 TOWN OF BARNSTABLE ` Building Permit Application Project, et Address 27 L �t4, , Village P --�— / t � Owner �.1 o Address Z_ c t� ,,Telephone Permit Request ` a } ` `a t •First Floor �j square feet Second Floor square feet Estimated Project Cost $ � Zoning District Flood Plain Water Protection f Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use , Construction Type Commercial Residential Dwelling Type: Single Family ! Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces (� Garage: Detached Other Detached Structures: Pool Attached a Barn None Sheds Other Builder Information Name Telephone Number (a — 9S Address License# 2951919 C_c 1y 70y U;! 4e />.)-�a?j Z Home Improvement Contractor# 10 D 1 O_j Worker's Compensation# C / S 3/ 1p•,j NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. / // ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Ra11il,S?d�6/P L aiiJ/' SIGNATURE ,� DATE a' l BUILDING P RMIT DENI D FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY ' P MIT NO. D TE ISSUED , P/PARCEL NO. - - VILLAGE DRESS ` - - OWNER # ' DATE OF INSPECT N: FOUNDATION FRAME'. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 1 ` PLUMBING:-, ROUGH E FINAL GAS: s TROUGH FINAL FINAL BUILDING DATE CLOSED OUT - - ASSOCIATION PLAN NO. 1 f , 3 E M �fpvdTia �/ � `f� 4' T� . : The Town of Barnstable ,g Department of Health Safety and Environmental Services 1619 � Building Division 367 Main Street,Hyannis MA 02601 t Office: 508 790-6n7 Ralph Crosses F= 508 775-3344 Building Commission For office use only Permit no. Date AFFIDAVIT HOME E"ROVEMENT 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-adsting 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: Est Cost,,,, O 6 Q Address of Work: 14- 0%mer.Name: Date of Permit Application: l I herein certify that: Registration is not required for the following rrason(s); Work excluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WrMUNREGISTERED 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 3711),for a permit as the agent of the owner: ° Co t to Contractor name Registration No. OR r_._ Owner's name . T. twulus Assessor's map and lot number "a � Y , NSTALLEg� id �!4 � '� ..°F tHF T0� ^-� .. TITI-S Sewage.-Permit. number } .. gNii� �A�0.J#'YV� 'IT s - e Z BAHB9TODLE, i House number ..........Z ................... :..".:...................... = -�®� - M; rp rasa Ti �� pow i63q. `00� TOWN OF BARNSTABU BUILDING I INSPECTOR APPLICATION FOR PERMIT TO (P f�9 L: .... s�;t�&-1-7. .. Z . TYPE OF.CONSTRUCTION ..... ... r, .t .a ...: /h' •yJf......................................................:...... . :...:..... .... ................19. TO THE INSPECTOR OF- BUILDINGS: _ - The undersigned hereby applies, for. a' permit according to the following. information:' Location..-.. C.�1. ...: ��' l/. , e. '. .. . ."...'::� ......................... .' ProposedUse :.. ,....."...°.... ... .. .......... ............. ....... .. :........ ............. Zoning District �� ��� i Er' � o S7 . ............. ..... ... ......... .. < .Fire District Name of-Owner w!a...:.� ��LQ�i/!,c ,7- ?:7.Address Ae6b....:�Vo?(,s................................. ......::...:9: .... Nameof .Builder ................................... ........................:.....Address ..................... .. ............ .. .Name'of Architect .. .............Address ...,........ ' . ...................... Number of. Rooms -5evE?:' .....:.................:..................Foundation ..,z;?o. ! :.............0 Exterior: ................. .....Roofing fe.-........................ Floors �,. r�?............. ..... ............... ,:..�!........................Interior ......Z..r Heating ..���-:. '���.c...... .}�.... 1�Z........ ...................Plumbing .....:..w .......ti..................................................... //C �0 '........Fireplace ........ .... !C ................................Approximate Cost .... ��. ��...:,..........................,..:.:...:.:.., ..... , ... i.::.. Definitive Plant'Approved by Planning Board,--------—----- _-________1.9________- Area 6 ©... ..............I....... Diagram of Lot 'and Building with Dimensions Fee b..�.... . ....................... ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH ��` - d 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 .. ...... ........ " DAVID BUILDING -TRUST , s - 5230 One Story ' ,i N0 .��..::........... Permit for ....................:............... ; Single Family. Dwelling .... ......................................................... _ Location Lot• 2 5,.......2...7. May Lane • ,Centerville ?' `` ,� ✓ f• _ ........ �David Building Trust , t. Owner r t: . r y " Frame Construction •••••••••••• : „.••,•• ............. ...... .................... Plot :........................... Lot ................................ t s June 22 83= Permit Granted ................................ ...:1,9 lr Date of Inspection ....................................19 ✓ Date Completed f..- ./................ 1.9 { 71 TOWN OF BARNSTABLE Permit No. __ c' Building Inspector »n� Cash 1670. 00CUPANCY PERMIT Bond Issued to d i dir1; list Address ^� 25 r 27 May lane, Wiring Inspector ` f L ' Inspection date Plumbing Inspector - Y Inspection date Gas Inspector t Inspection date Engineering Department Inspection date ?) Board of Health �! , �,;f �-- l Inspection date 42 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. ........�... .................................... 19............ .................................. ._ r•�-�r�-,ice... Building Inspector lSlaI 47 ,&Lr,- 8P-A�M�I L i;6dZ1 t.I'SDESM2)W MO S.. .. -j, ._�.._..._.._ ,. . . T. 'My •7 6AQ �$ ><.1lO a o &pUarc. g ['tc -rar.ik 330 xlsoy d95 (pc ' , :, ia' '� ; •_I U6 (000 Z3oYR^ . j �ppoyo a77�� i E r r ' FIELD -- USE:'2- FLm/ vIFFUSK5 5o . 5l bE.WA.L-I- ,a1Z MA t -1 a SFr: �zd+48�1.o8)C2•S) - 194: 'Borrcm' A¢F-A - 188 SF • j t �: s , �. . b 4 t ..: :. �lZ'x?�:��I.o� - 2B8 G•PR. •.:. ' � �O � ,. � -I- + � t f To-CAL- IDe St 6 W A 82 (P.U. : : ! �',f t;.s ' -ram 1 , , j i= r t ` PW-C-O .A.TI o Q , V-&Tt= I U Z MI0. 09.his. war : eo d 8 S d 24x I Flow ,j . . 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