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0179 MONOMOY CIRCLE
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' f ! `'tta, ._ _ , �t.4,ie ! ,�.t.F"�rr! ,r.w �u' ..,� . ''.:: ,+. _ .=sin Town of Barnstable *permit# 9 3 11 Expires 6 m'ands om Inue date i Regulatory Services Fee - s63 Thomas F.Geiler�Director 9 ie39. ,m� , Building Division Tom Perry, Building Commissioner -PRESS 200 Main Street,.Hyannis,MA 02601 �� �T Office: 508-862-4038 DEC' 2 7 2005. Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL N2 •` ,,,,, Not Valet without Red X-Press Imprint TA I Map/parcel Number Property Address o i [�Residential Value of Work \0 D Minimum fee of•$25.00 for work under$6000.00 Owner's Name&Address 1 Md Contractor's Name �`� Telephone Number S a'R- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) _p - ; Q � ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ( .I have Worker's Compensation Insurance Insurance Company Name �` \ Pf A �-�-A V '�` 'e V, Workman's Comp.Policy# G D&O . Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) n \ RRe-roof(stripping old shingles) All constriction debris will be taken to ❑Re-roof(not stripping..Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Not Pr erty Owner must sign Property Owner Letter of Permission. H rov t Contractors License is required. Signature QToras..expmtrg Revise063004 00*00 OF RIlH11NIIW��C�IeJIL�A.tilaO�N„S Licen : NS7RlJCTI''(a S se U;PERViS;®1R .' Mlu 7ber C 0-3(27 A 6 Tr.no: 13079 Resyt,_ iU DEAN F STAKE i 359 CAPTAIN--UJA� �� CENTIORVILLE, MA 0�.. l Atlrni4�trafor Board of Building Regulations and Standards License or registration valid for individul use only HOME IM [MOVEMENT CONTRACTOR +' before the expiration date. If found return to: Board of Building Regulations and Standards Re istratY®rr. 12149 One Ashburton Place Rm 1301 /2006 Boston,Ma.02108 t p idual DEANF:STANL�A DEAN STANLEY 359 CAPT.LIJAH R CENTERVILLE;MA 02632 Administrator Not valid withou signatur ' • _ The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations r 600 Washington Street, 7th Floor Boston,Mass. 02111 Workers' �'Ate r:, 1]t�•an1:L ie1•.eQ C,peo�mp�:xe:nasa'tmazio.:.�naL(�.I:.n`»a°su`.'rxan d.ce r{Aey�Sfx d�ar�vri Jt:Bui•0l's d ing/.iPlu,m. yb..i�i3'ng�/"Ele$.:c'=t?:ri'�c°��a,lr. Contractors ontractors y Dl d" name: (� � � tf address: `�J—� �l3 �� •I- , cityC et�e v IN state: S zi : d� hone#f� �i'��-�J���6 work site location full address): My tA �G ❑ I am a homeowner performing all work myself' Project Type: ❑New Construction(ERemodel ' ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition t F..� A.::,t:. rrr.:.?i:t., 5......<� !. .,:•.�::. -:>",`.•�.,.t,'.� '�•,r.+. ",+i�F..>(a 'i.X�`.'�`r:< :�'F.,.;�:L:.: ';k;�'.i.c., �=°"y:'aC7."c .-:_°•E�'O•"�'i%z':t:`naFS:'?':.�.M';cr _`t"_y.+:e:.:.:.:,,�., .. a. .. ..,.. a•. fq .-;.,.,q.,.....•',� ..:..,.: .. I am an employer providingw�orker 'compensation for my employees working on this job. t,., 7,.• ., company name address city: 'fie-(' y L\\ '� phone#: insurance co. DOl1CV# (" � �Pt7 (-G- -,urn.<5,,.a, ....t +'U-mean k - •r. e^ +'h...- .a....xa• .,.r a� cta.:Z,.:a'�:e,:�.�a.:...u�.::Y,`e:!4i`w�4..,F-;n:..>_`�''�r3,::b•„i.'s'± ,: .4:µµ ((•a.. `:K":� i:f: :t.:,;y =gy.:w'+' , rr,:'�'S:.`a•'!.(if:.:...XC.'.'•iwn'.:,1.::'::...3.0::+.Y:f1i3=A:n dStl=�`Ie y'•w . El am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: _ address _ city: phone#: insurance co. policy# ';at;tt•t,�,u..h-:..^`' dz':�•.,�s:� '..-'°.e.-,,x>1 ,�• '�r5�Yz ;• s?.. 'q�,T~ ,r:"p�� �: � ..r -`r.-:••rr.- .•>' r.� , ....i.�:Z...:f.>e..��ia?.•�..r�x:r'::�'r.ri .ihF� a .. .,.. ✓:c.n na rc� s.� , „+6.c,,;�FF � -company name: address: city: Dhone# . insurance co. ol_ic # haF.• ..::+,'an...¢ ... i.. K.... :. {:W 'r:"M1-,:, ti�:r'' L:.. ,f'r<.•t. .,y.j.> S-.� 'u:. :E��... - Marc ddttt h t. >' ?t; n; •ir..�• =i r... � .„....:......::. . ..:... 5...e.�� nece4saa:b:i .>� e°" r bpi ;..; ,;,.:..,., ,.` ." r:,,•:.,::,; r F �1 r3i>ywra8' :a.r<es;d� '`•�i�' 'a:.a :arXn 'a "! � 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$100.00 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 erti under the ns d pe Ities of perjury that the information provided above is true and correct Signature Date \C> Print name f� �`L' 3. Phone'# official use only do not write in this area to be completed by city or town official LOf n: permit/lice�nse# ' []Building Department immediate response is required �, ❑Licensing Board ❑Selectmen's Office rson: phone# ❑Health Department 1003) ' ❑Other Information and Instructions Massachusetts General Laws ch ter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the` w", an employee is defined as every person in the service of another under,any contract of hire,express or implie oral or written. . An employer is defined as an indivi al,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint ente se, and including the legal representatives of,a deceased employer, or the receiver or trustee of an individual,partnership, sociation or other legal entity,employing a ployees. However the owner of a dwelling house having not more than a apartments and who resides therein,or a occupant of the dwelling house of another who employs persons to do main nance,construction or repair work on s h dwelling house or on the grounds or building appurtenant thereto shall not be ause of such employment be deemed o be an employer. MGL chapter 152 section 25 also states that a ry state or local licensing ag cy shall withhold the issuance or renewal of a license or permit to operate a b ,iness or to construct build' gs in the commonwealth for any applicant who has not produced acceptable evi ence of compliance wit the insurance coverage required. Additionally, neither the commonwealth nor any o 'ts political subdivisio s shall enter into any contract for the performance of public work until acceptable evidenc of compliance wi the insurance requirements of this chapter have been presented to the contracting authority. w,rrz�cs +o "0 n xx r•.swrap p a we, +ry 7'.r *.'F.�:,.. ,..i:sgH''"+$K�3i�,�,:� :yY:,..`:�')'•r!.:..�. •r'tii.;•Y s,�: ',',ry lr.J:.!J Pr... - ;j,`.•55.'cy`�� ..C.�....,4i.,,'� R:z.`..r+!?7. ' {tsn�,L�u^;,' :.i•:'Fl,`+Xu4N=:;T.',:�T:;c�cr;:.d:J.:.:i. 1.S?111. ; Nr"= ''Qr�� - ",r�•oa.r.::€r.�!r. 'i � „�zSe e.- `.e�.'§`.?;':.=t&L.ti;�1- �� k.:� 'a,u'�{�;,'T�';:�?iF:Girt::"�: �7�,?i'n.i2�+izt<::��. .w.d::Ck.7sfi . Applicants Please fill in the workers' compensation affidavit completely,by Necking the box that applies to your situation. Please supply company name, address and phone numbers along with ertificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confi lion of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city o town that the application for the permit or license is being requested,not the Department of Industrial Accidents. ou d you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,pl sec 1 the Department at the number listed.below. • ?':: „ •.�. ,. ...�-:k. r •a •^,;=r.-t�, :•: .',ut�.`?;. + ""� ",�SIi.R. _k�€'�': �,f. 'a?i^:ih .:s.•* > .:8,t�:; ++�� . , ,p� .�.fkyyax:�.sc:�:c:r,e;..��. is;r,' ,x. :�.. -:�=: '�r:" ,��t.; �,:: �, .';N.�?`s=;•.";.:�....,...,.:'_,,... ;;:,• ,'�,g• ry t;�' ... '%�;1 d. _ _ �a. "?!;. ,+.,.•7.',.,: .� %`FK'.��;.$u^�*i' dS;*,u-p.,s tx. 6.,';::�4.^z f�:u n .J /. 'i}3ar: tx.,.�r,�c`�0�'$n. ::"h:,r _ .1,caw..�k�x�xt�-`t.�iJ.:�S.`;fis�;>...v�,,;t;= ^.xri•Jd:.. Sk.s.. _ _ City or Towns a Please be sure that the affidavit is complete and printed legi y. The Depament has provided a space at the bottom of the affidavit for you to fill out in the event the Office o ve gations has to,contact you regarding the applicant. Please be sure to fill in the permit/license number which will be use as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements h Lve been made. The Office of Investigations would like to thank you in adv ce for.you cooperation and should you have any questions, please do not hesitate to give us a call. _^•c:J. - ""'- :':•a+:'. .xcr_� ....._ •.�.`H-"';1 _:dLti:; zf!J: �C:' �OC6�l'i.•. :ib' a�� '.. ;...r,... "•.>''��yytt••-�� b.#. ., it`z_:v... ." ' .;.J•+�y.k.:. a;¢, ,�:^.. iolsw.sSr'i+ �.`�j` .:`P ^..� .rZi. s; ''. ,:r:a.;.:,• i:3:'' .:•n'^ :�:`.u:z.:�?..4 at �:. �:, .,.�_.' �E,�"4�v.,F?�: 'a<r�,• ��`x`. �=� �,:{.y_j.r,•, �:_�td:>5r�rk=,; s.._:.�::.:..;P.;..�...:vus•'=i ffh.; _ The Department's address,telephone and fax number: The Commonweal Of Massachusetts Department of I ustrial Accidents Office of I estigations 600 Washing n Street,7th Floor Bost ,Ma. 02111 fax : (617)727-7749 phone#: (617) 727-4900 ext.406 i .JK Town of Barnstable °�. Regulatory Services s�xrt . t Thomas F.Geiler,Director Building Division TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 w ww.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby4-autho�ze: to act on my behalf, in all rriatters relative to work autho ' d this building permit application for: (Address of Job) Signa a of Owner Date Print Dame r (lst floor) Map' Z!ZZ 'Lot _ T (4th floor) j Date Issued ��/�7IF6 Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) {� R e Fex Engineering Dept.(3rd floor) House#1THE /'l5' P i BARNSTABLE. 14 De oard 19 e q TOWN OF BARNSTABLE Building Permit Application Pr 'ect treet Ad F , Village C/V 7YRbr -e— / ;Owner / -!?�} � Address 9 //d/o©//P ,Telephone 776 76,3 1 Permit Request 'pear o (u (,(J xi i0 d w / Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ 3 Zoning District Flood Plain PO Water Protection Lot Size d /Ye-e 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 s tol f Pc 6Central Air Fireplaces Garage: Detached Other Detached Structures: Pool g'acone he Barn Sheds Other Builder Information Name Telephone Number /01— Address 03 r V ' 6( eeoo �D ab,b*� License# 1 &ZCGS /1%// Home Improvement Contractor# 9� ! 7 Worker's Compensation# 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 BE TAKEN TO SIGNATURE4 DATE �� �� BUILDING P MIT Dp4lED FOR THE F LOWING REASON(S) r FOR OFFICIAL USE ONLY } r t PERMIT NO. i DATE ISSUED _r } MAP/PARCEL NO. ADDRESS / r ti VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL ` r - , PLUMBING: ROUGH FINAL ' l r - GAS: ROUGH "FINAL' FINAL BUILDING f`. DATE CLOSED OUT ^ ASSOCIATION PLAN NO. r i • i The Town of Barnstable ' $ Department of Health Safety and Environmental Services i69. P Building Division 367 Main Strut,Hyannis MA 02601 Office: 5o8 79o-6227 Ralph Ctos Building Commissioner F= 508-775.3344 For office use only Permit no. Date AFFIDAVIT HOME 01PROVEMENT CONTRACTOR LAW SUPPLEMENT To PERMIT APPLICATION MGL c. 142A requires that the"n=nstruction,alterations,renovation,repair,modernization,conversion, improvement,. =ncn2 , demolition, or construction of an addition to any pnIaasting owner Occupied building containing at least one but not more than four dwelling units or to sauc Lures which are adjacent to such residence or building be done by registered contractors,with certain=eptions, along with other requirements. Type of Workc �W C�- vlz1 e Address of Work: Owner.Name: <-b Tz P NA 0 N-r Date of permit Application: 16 ro I hereby certify that: Registration is not required for the follo%%ing reason(s): Work excluded by law Job under S1,000 uilding not owner-0omVied Owner pulling am permit Notice is hereby green that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNRE 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 ownea Date Contractor name Registration No. OR n�tP Owner's name :M}.`x•'{:•:'xxxxxxx•::'.?;::^.?•`.^;??•:?•t.•'.k}NY•`.::xxxar.�,;.xw}}}k;;{:.xx;,}}};o;;;x}x}ty} ..,,y}}w»}};q:;:;;e}}~ti}}}»,y;ro;.ky?}}}}x;.x:{.}}xp}};�}},;�a,}}}}}}}}Yrrry}:r'.rru>r»Y}}xa,x}}}}.;, }>::Q:,tsr}}}yaa}•»}.ter}}}};.}}:{t ?i}.r•3x? tixYYx�'•ixit.;{{{•;;x{ii''.. ` N ixxxx; . 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Definitive Plan Approved by Planning Board 19 (Applications processed 8:30-9:30 a.m.& 1:00-2.00.p.m.) 'TOWN OF BARNSTABLE Building Permit Application' 4 Protect Street Address Q kq.0 vvot Y` ; Village �� I Fire District Owner n U Address i _ Telephone /,S J 4? r, Permit Request: L � - I q a L111 rFe r, Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appeals Authorization Recorded Current Use -` o Pro sed Use Construction Typq 5+,g �03t Existing Information Dwelling Type: Single Family Two family Multi-family Age of structure Basement type Historic House Finished Old King's Highway Unfinished 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 Barn None Sheds Other Builder Information v q Aywey, k -PVW < Telephone number /�'� ' �✓��� Address / LeP Vy, License# (� T=a\40�4� VV\R_ 03-36<S> Home Improvement Contrac//tor,,# G s-0 -Z— Worker's Compensation # VV yo NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. CONS U_TI N DEBRIS RESULTING FROM THIS PRO CT WILL B TAKEN TO S Protect COSt . Fee SIGNAT uk.e1/ _awl DATE_ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T PERMIT =9- FOR OFFICE USE ONLY A=191-223 ADDRESS / VILLAGE _ OWNER J 41t, L Z?- DATE OF INSPECTION: FOUNDATION ' FRANE INSULATION _ t FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSED OUT: i ASSOCIATE PLAN NO. , y � , A5bssov;:s map and lot number fry .... .?/............................... P C � Sewage uPe�mit number ............ ..........................:............. �E: SYSTEM MUST BE t3 y*THE To _ TOWN OF- BACOD • ®Id�TIONS. E AND TO ,,,� W1 Z BJSBSTAMDLE; i P� tit 9 039 .A D-U L I N ' INSPECT 0 ,. APPLICATION FOR PERMIT TO ........ ..................................................................................... Y) A. tr. P I'TYPE OF CONSTRUCTION .::'.......... .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ 1....... .... ........�.... ................................................................... ProposedUse ..........Aa.,-z ............. .. .....:...... ...................................................... . .............I......................... Zoning District ..............................Fire District ..... ................ . . . . ............................. Name of Owner .... ......... .............Address ... . ..... . . ..... .......................................................................... . . Name of Builder 'C ...................Address ........................................ ....... Nameof Architect .............................................:....................Address .............................................................................:a.... Numberof Rooms ................ ................................................Foundation ................. ..................:......................................... Exterior ...... .... .......Roofing ...... . . .. :..... ..:................................................ Floors Interior ......... ` .. ..................................... Heating ..�.... j::.. ). ....................................Plumbing ... . ... ............................................... Fireplace ...... ............................................Approximate Cost .............. ........... .. Definitive Plan Approved by Planning Board --------------------------------19________. Area ..... ... ... .. ......... r....."...... ® o Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ^., Name .41.......... ...v°..... ... ............ . ' � Small, Alan E. 18399 one / � story, ................. Permit fc;r .................................... Y�1ngla family dwelling � ---- ------------------- ` � iocoh6n —..—................----_—_____--. ` Centerville ......................................................... ' ` . � . �— Alaa 0. So�� � °�'.=�^------------ll---------.. � ~ frame Type of-Conmruchon -------------- +, ~-----^---.----------------' ~ . #78 ~�Pl` ............................ Lot ----------' . � , '/.� �a� l@ ` 7� ' ~ rerm�� Granted -----�----��---lg ' ^ . ` ~ � Dote of Inspection .......... . ` ............./.l9 ' ~ Dote Completed —� +-----lQ ' ' ` ' PERMIT REFUSED ' ---.. ' lV � _—.------------- � . ' . ............. ^ � ~ ' . ° . ~, ---.~................................................------. ' ' .-.--...�--..----`--.—.--~—.—.---. ..............' . .^ .—.--.--.—~—.------.—..--.;. Approved ................................................. lQ . . 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