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I �Yi�:��;'�-J'j'j'��,,i��;i,��A�;;�'�'i �I i� f:''.', I" , ��. ���, !%' I li, , - I ;�;I� I -,�-,� f " , , �,,, �­, � ,,,.­'�,,,�,1,�­,,,, " , ,��, .:", �11( ""j'.',',.�,�:;,.�,,--i; .:4 1, ; i���, �­,, ,,,,,, I � ��,, . - I ,� " I ,!;��6 i?',',,l',�i,:,,',,,,li& Q �,,,-, ; &i��,!,y�1 j",r�......i4, " , , ,,-�;"�;­ , , �, ,,,, Ij�,, , , , t;� ,. i 1­ltnst�a�:":,,,�,,,�I',�,��i'l*h'l�4 i_,�":"� ��iI� ,�i.;� ",�,�e,,;�i,,,.,,�:-,,,,t,�t;,,'�,',:��,�,i�,.,li"O'm�,'All,� , �,-��!�� ,i,let!",�, " 11 � ,v,,. ,��J i��;11., �I.W�l�,`.,-, ; "4­­; �,,;:" I ��,:���"P�6, ; , 444" , ,,?",!, � - "?.�,I'o�,,��, ,,,,;,,,�,,,�',�q ilTIo!j"I!�L1 !"'.�", ,-��,,�,, , 1,, ; ,ij�,`I,�LI,l,� , 1 '4� e,, � i k"""'?, i-,�i i . A&;4L , M _!��,q'l , , K�f 1�I�­ 4 Town of Barnstable Building Post P T, phis Card So`That,it is U�sible,From the Street Approved PlanszMust be,Retamed on ob and,this Car.,d Must be Kept ' MASB,ABI.E. .' %o .. ,.. '' 3e , sted Until<Final Inspection Has Been Made Y �z 34 ,° i,:� ... a ,. l .': . , �., yam - R Where a CertificateiofOccu anc Re wired suchBuildm shall Not be Occupied u'ntit:a Finatanspection:'has,been made.r el lijl L Permit No. B-18-240 Applicant Name: SEAN M. COUTINHO Approvals Date Issued: 02/12/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 08/12/2018 Foundation: Location: 29 NOTTINGHAM DRIVE,CENTERVILLE Map/Lot. 172 252 Zoning District: RC Sheathing: Co tra�Cto�Name•SEAN M.COUTINHO Framing: 1 Owner on Record: WILLIAMSON,ANNE %b g c (! Address: 29 NOTTINGHAM DRIVE - Contractor License 173837 7'7 . ..' V =—ram CENTERVILLE, MA 02632 a Es Pro ect Cost: $10,000.00 1 , Chimney: if Description: building new fireplace in existing poured foundation a Permit Fee: $101.00 Insulation: Project Review Req: FeePaid $101.00 Date 2/12/2018 Final: � y `_ Plumbing/Gas ` Rough Plumbing: S r W -� • - e � �� Building Official Final Plumbing: s This permit shall be deemed abandoned and invalid unless the work authorized,by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the"approved construction documents for which'this permit has been granted. � ; Final Gas: All construction,alterations and changes of use of any building and str'ucturesshall be in compliance with the local zoning by laws'and codes. This permit shall be displayed in a location clearly visible from access street or4666d and shall be maintained open for<pubIic4inspectionfnr the entire duration of the work until the completion of the same. a° Electrical , e Y'p The Certificate of Occupancy will not be issued until all applicable signatures by the Bu Iding and.�F ire Offiaals�i 'I on this permit. Service: Ng Minimum of Five Call Inspections Required for All Construction Work e x Rough: 1.Foundation or Footing _ - _ '_ •;v. = 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT THE V Application Number................................... ...........J 4 BARN Permit Fee...... 0 .............Other Fee......................... MASS. 1ING TotalFee Paid.......................................... .................... ...... TOWN OF BARNSTAB&-q,&4, Permit Approval by...... ...... :....... On...... BUILDING PERIVHT 1 -7 Map........................................Par,,l..................... ...................... APPLICATION Section I — Owner's information and Project Location /P I Project Address -Pi,oafyiom Dr', Village Owners Nam Owners Legal Address &a_rne City State L141 Zip Owners Cell# a _M -77(0:7 E-mail Section,2— Structural Use Single Two Family Dwelling Fj Commercial Structure over 35,000.cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit F] New Construction ❑ Move/Relocate ❑ Accessory Structure E]. Change of use El Demo/(entire structure) El Finish Basement -E] Family/Amnesty El Fire Alarm Rebuild EJ Deck Apartment El sprinkler System _F Addition —Retaining _Solar ❑ Renovation Ell pool. El Insulation Other—Specify Section 4 - Work Description nu-0 d I AA Q _o -b ff-ONCO La tkl A, 0/77 02d,_ ri \J '-K 1* qa 0 A Ctaslcn Tact 11niJqtj-,+ 1)/)R0nJ 7 Application Number.......... ............ ..............: = Section 5—Detail Cost of Proposed Constructi V 00 quare Footage of Project Age of Structure Dig Safe Number j # Of Bedrooms Existing Total# Of Bedrooms (proposed) 11-0 MP-H Wind-Zone-Compliance Method EMA Checklist ❑ WFCM Checklist ❑ Design i- Section 6— Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System Masonry Chimney ❑ Add/relocate bedroom WQ+er supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway I am using a crane ❑ Yes No ili (� I Debris Disposal Facility: TC Section 7--Flood Zone d Zone Designation gnation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8— Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed i Has this property had relief from the Zoning Board in the past?.. ❑ Yes ❑ No E r..... _A.+.A• 17/7R/�M7 Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) ` 1 Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number 173837 ISearch You must click the "Search Registrant" button to search by name or location. Search by Registrant Company name Search by Registrant Last name �. ..---- _v.__..._ City/Town i !Search Registrant State Zip code Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund historv. The list is current as of Wednesday, January 24, 2018. Search Results RESPONSIBLE REGISTRATION EXPIRATION RegistrantName INDIVIDUAL NUMBER ADDRESS DATE STATUS SEAN M. COUTINHO COUTINHO, SEAN 173837 21 PICKEREL WAY 07/24/2019 Current FORESTDALE, MA 02644 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. I, https:Hservices.oca.state.ma.us/hic/licenseelist.a'spx 1/25/2018 Commonwealth of Massachusetts.. Division of Professional Licensure Board of Building Regulations and Standards Constructipn�5%Mia?s3f Specialty CSSL-079315 � I Q�pires 06/06/2019 SEAN M COUTINHO w� N 21 PICKERELAY1 FORESTDALE Commissioner l Restricted to;Construction S CSSL_Mq Masonry upervisor Specialty Failure to Possess State Buildinga current e Code is edit' of t For infor cause for revocatlp�Massachusetts Call(6171 727-3200 0�visit se t i incense this license. ass.gov/dpl r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Leizibly �on/Indiv Ce (� S OJL f Name(Busmess/Organlzai7 idu�[_a�)) Address• CC ("��-1—�`(VL ---I----- _ - City/State/Zip: ���� V,�k0 Phone#: p 7,) (o- g Are y an employer?Check the appropriate bow Type of project(required): 1. I am a employer with o� 4. I am a general contactor and I have hired the sob-contractors 6. ❑New construction employees(full and/or part-time).* 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. El Building addition No workers'comp.insurance comp.insurance.: required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof-repairs insurance required]t C. 152,§1(4),and we have no ,/ employees.[No workers' 13.[]Other Add*Any applicant licant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �Contnctors that check this box must attached an additional sheet showing the name of the sub-contractors and state vybether or not those entities have employees. If the sub-contracfnrs have employees.they must providq their workers'comp,policy number. . I run an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information.In , `nsm-ance Company Name: !qr,�ti xm `� � O'` / Policy#or Self-ins.Lie. Expiration Date: U l Job Site Address: 0 4 � r (m '�A [ L-City/State 4: K r 671 Attach a copy of the workers'comperklation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fne of up to$250.00 a day against the violator. Be advised that a copy of ties statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfify ignder the pains and penalties of perjury that the information provided above is true and correct Si afm•e: Date: ��� des Phone#: Official use only. Do not write in this area;to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#• r _ Application Number........................................... Section 9-.Construction Supervisor Name C )1, � Telephone Number j l Address City 25� �� State V" `1 ` Zip C License Number 31License Type' r��5 Expiration Date ( l9 �6 1 6 Contractors Email—� 0 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation requ' ed by 780 MR and the Town of Barnstable:Attach a copy of your license. Signature Date a I j J1,(9 t/ Section 10 -Home Improvement Contractor Name Telephone Number S0 6- Address l G'C ��� ��city ` ��� �- _ State Yhq.( Zip Registration Number IN Yl Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re We by 80 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date o1�~ 'AO I iE IR Section 11 —Home Owners License Exemption r Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date r APPLICANT SIGNATURE Signature ( Date 22 42 LA J _ V JPrint Name � � V v ` (9 I v ly Telephone Number � ��(.� E-mail permit to: �� (�/k CCt S Last updated: 12/28/2017 I - Section 12 —Department Sign-Offs Y;' Health Department Zoning Board(if required) Historic District Site Plan Review(if required) ❑ Fire Department ❑ Conservation 1 For commercial work,please take your plans directly to the fire department for approval. Section 13 — Owner's Authorization I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit ap lication for: e. (Address of job) Signature of Own r date Print Name I T.ast undated- 12/28/2017 :tq�ti Town of Barnstable. *Permit0O- � �{ol(o PR!E '+ .b EVires.6 months from issue date Regulatory.Services Fee. �A i639 Richard V.Scali, Director -TOW� .� ABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601. . www.town..bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6234 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �—I ..L� a 1 ) 'l)&144—M Cesidential. Value of Work$ JQU Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4A /,l r7G /�©" TINY/� r✓' �J2 CwLTt�ic Contractor's Name _ /Yi l ,a���� ,��L 1. Telephone Number G� �3 7-� /o� ; Home Improvement Contractor License#(if applicable) j 7 Ca Email' r/j'I bw y G/t.Co % Construction Supervisor's'License#.(if applicable) ❑Workman 'ornpensationInsurance r.. C ck one: I am.a sole proprietor ❑ I am the Homeowner - ❑.I have Worker's Compensation Insurance Insurance Company Name Al A— Workman's Comp.Policy# Copy of Insurance Compliance.Certifi to must accompany each.permit. ; Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) RrRe-side ❑ Replacement Windows/doors/sliders.U-Value (maximum:35).#of windows` .#of doors: . ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. : - - A copy of the Home Improvement Contractors License&Construction Supervisors'License is ........._ . ... ._ _ ..- -- - required l SIGNATURE: Q:\WPFILES\FORMS\building permit rms RESS.doc Revised 061313 1 Massachusetts.-Department of Public Safety , Board of Building Regulations and StandArds Construction Supervisor ' License: CS-076393 IS F NUCHAEL DW�ER 55 SACHEM DR = a CENTERVIL.LE MA�02 32' ,,,,u�� Expiration 06/13/2015 ' Commissioner k cPo�naeoniaea � aaclu�ae _Office of Consumer Affairs&Business Regulation License or r `ME IMPROVEMENT CONTRACTOR egistratiOn valid for indi, ul use only i gistration before the expiration date. If found return to ;. 177265 TyPe Office of Consumer Affairs and Business_Regulation pw iration: 1U18/2015 �� .individual lO Park Plaza-?'F1 a 4._ .. Suit e e 5 F. 170 MI � ,..G HAELDINYER, ' Boston,MA 02116 F. MICHAEL D t x r f 55 SACHEM DRIVE. z CENTERVILLE, MA 02632 Undersecretary Not valid witho _._ signature_ } •. L.xxscesLg. _ .. . i639 Town of Barnstable�e . Regulatory Services - Richard S cali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,-MA 02601 www.town.b arnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 `t _ -Property Owner Must Complete and Sign.This Section If Using A�Builder. t 4 64a/¢/► ' S Owner of the subjzct property hereby authorize 10 K-f- D to act on my behalf, in all matters relative to work authorized by this building permit application for:. (Address of Job) Signature of Owner Date --�1✓N� Gve e C l.?rr4 S u/� Print Name all, If Property Owner is.applying for permit,please complete thc'Homeowners License Exemption_Form on the reverse side. QAW. PF1LES\FORMS\building permit fozms\smokecarbondetectors.doc Revised 050412 - 1'own of Barnstable Regulatory Ser�ices } pF Richard V.ScaIi, Director ]wilding Division t ILUMSSAsr.E Tom Perry,Building Commissioner MHASS. 200.Main Street,,Hyannis,MA 02601 www.town.barnstable,ma.us Office: 508-862-4038 Fax .508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 'y numb e street village "HOMEOWNER': �. name home phone# work phone# CURRENT MAILING ADDRESS: !city/town state .. zip:code The current exemption for"homeowners"was extended to' elude owner occuied dwellings of six units or less and... to allow homeowners to engage an in 'vidual for hire,who.does not possess a license,provided that the owner acts as supervisor. DEFINITION F HOMEOWNER Persons).who owns.a parcel of land on hich he/she re ides or intends to reside,on which there is,or is.intended to., be,a one or two-family dwelling, attache or detached tructures accessory to such use and/or farm structures: A person who constructs more than one hom in a two-y ar period shall not be considered a homeowner:.:Such "homeowner"shall submit to the Building cial o a form acceptable to the Building Official,that he/she shall be res onsible for all such work erformed unde the b dina ngmif. (Section 109.1.1) The undersigned"homeowner"assumes response ' ity for compliance with the State Building Code and.other applicable codes,bylaws,rules and regulations: . The undersigned"homeowner" certifies that he/ a erstands the Town of Barnstable Building Department `. minimum inspection procedures and requireme and at he/she will comply with said procedures and requirements. Signature of Homeowner. Approval of Building.Official Note: Three-family dwellings co taining 35,000 cubic feet r larger will be required.to comply.with the,. State Building Code,Section 127.0 Cons ction Control. _ HOMEOWNER'S EXEMPTIO The Code states that: An b eowner performing work fo which a building permit is required shall be exempt from the provisions of his section(Section 109.1.1-Li ensing of construction Supervisors); provided that if the homeowner enga s a person(s)for hire to do such ork,that such Homeowner shall act as.supervisor." Many homeowners who use is exemption are unaware that they a assuming the responsibilities of a supervisor(see Appendix Q,Rules Regulations for Licensing Constructio Supervisors,Section 2.15) This lack of awareness often results i serious problems, particularly when the meowner hires unlicensed.. persons.:In.this.case,our Board can of proceed against the unlicensed person as would with a licensed Supervisor. The homeowner,actin.g s Supervisor is.ultimately responsible. To ensure that the homeowner is fully aware.of his/her responsibilities, man ommunities require, as part.of the permit application,that the homeowner certify that he/she understands th 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. The Commonwealth of Massachusetts y Department'of IndustrialAccidents " Office of Investigations 600 Washington Street _ Boston,AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(gusmess/Organization/Individual) f�1�«wlm-e- 7 Address: City/State/Zip: .( e -i- yI kIX P� Phone#'. Are you_an*employer?Check the appropriate box:.,.,. Type of project(required): 1.El I am a employer with -4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. .0 New construction- 4 El I am a sole proprietor or partner- listed on the attached sheet. T .2-Kemodeling These sub-contractors have. ship and have no employees: 8. ❑.Demolition Working for me in any capacity.. employees and have workers've wor 9. ❑Building addition [No workers' comp insurance comp. insurance.# : required.] 5. [�-We are a.corporation and its 10.El Electrical repairs or additions 3:0 I am a homeowner doing all work ' officers have exercised their `1�1.0 Plumbing repairs or additions, myself o.workers' comp. right of exemption per MGL y [N P 12.F Roof repairs insurance required:]t c. 152, §1(4),and we have no employees.-[No workers 13.E Other comp:insurance required.] *Any applicant that checks box 411 must also fill out the section below showing their workers'.compensation policy information. t Homeowners who submit this affidavit indicating they are,doing all work and then hire outside contractors must submit a new affidavit-indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. t I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site. ' information. Insurance..Company Name Policy:#or Self:ins.Lic.#: Expiration Dater � /- Job Site Address:-- 0 �'! f✓d r7� LI*J,01 . �,� �>=✓l�nJeri City/State/Zip: t✓11� Attach a copy of the.workers'.compensation policy declaration page(showing the policy number and expiration date) Failure to secure coverage.as"required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties.of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00.a day against the violator. Be advised that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. x.+ I do hereby ce u d r th and penalties of perjury that the information provided above is true and correct S ignafore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official i Ci or To wn PermitlLicense# - Issuing Authority(circle one): L Board of Health 2-Building Department 3.City/Town Clerk 4.Electrical3nspector 5.Plumbing Inspector 6. Other Contact Person: Phone#:- Inf®ratio and, Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract.of hire, eXPres. lie oral.or written." or implied,� An employer is.defined as"an individual,partnership,association,corporation or other legal entity,or any two.or.more of the forego' g engaged in a joint enterprise,and including the.legal representatives of a de eased employer,or the receiver or ee of an individual,partnership,association or other legal entity,employ' employees. However the owner of a dwe'Ong house having not.more than three apartments and who resides there' ,or the occupant of the dwelling house o another who employs persons to do maintenance,construction`or re work on such dwelling house or on the grounds building appurtenant thereto shall not because of such employm t be deemed to be.an employer:" . . MGL chapter 152; §25C(6)also states that"every state or local licensing agency all withhold the issuance or renewal.of.a license WPermit to operate a business or to construct buildings the commonwealth for any applicant who has not produced acceptable evidence of compliance with the' surance coverage.required." Additionally,MGL chapte 152,,.§25C(7)states."Neither the commonwealth nor y of its:political subdivisions shall enter into any contract for e performance of public work until acceptable evide ce of compliance with the insurance . requirements,of this chapter.h ve been presented to the contracting authority." Applicants Please fill out the workers' compe sation affidavit completely,by checking a boxes that apply to your situation.and,if necessary,supply sub-contractors) ame(s);address(es)and phone number s)along with their certificate(s)of insurance. Limited Liability Comp s(LLC)or Limited Liability Partn ships(LLP)with no employees other than the members or partners,are not required t. carry workers' compensation' ance. If an LLC or LLP does have. employees,a policy is.required. Be advi ed that this affidavit may be s mi{ted to the Departnienf of Industrial Accidents for.confirmation of insurance c verage. Also be sure to si and date the affidavit. The affidavit should ' be.returned.to the cityor town that the app ation for the permit or lic nse is.being requested;not he Department of Industrial Accidents. Should'you have any q estions regarding the la or if you are required to obtain a workers' compensation policy,please call the Departme t at the number liste below. Self-insured companies should enter their self-insurance license number on the appropriate ' e. City.or Town Officials Please be sure that the affidavit is complete and prime legibly. e Department has provided a space at the bottom of the affidavit for you to fill out in the event Office f Ines gations has to.contact you regarding the applicant. . Please be sure to fill in he permit/license number which ill be ed as a reference number. In addition,an applicant that must submit multiple permit/license applications in an .giv year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Addre e applicant should write"all locations.in (city or town). A copy of the affidavit that been officially stampe or marked by the city:or town may be.provided to the applicant as proof that a valid affidavit is on file for future pe or licenses. A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or. e t not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is OT equired to complete this affidavit . The Office of Investigations would like to thank you in adv e for yo cooperation.and should you b ve any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwe fih of IMassachu. tts n Department of. dustrialAocidents Office of vestigations 600 V�ashington Street Boston, . 0.2111 Tel. #617=727-4900 e �406 or 1'-877-MASSAFE Fax#61 727-7749 Revised 4-24-07 wwwinass.govfdta Assessor's office(1st.Floor): ,,,,pp Assessor's map and I le numbe z�1z - SEP�C SYSTEM 1AWq C�TNf l0 Conservation CO e� ABoard of Health(3rd floor): /'/ Wgri�i rL �L . Sewage Permit number , �'' d"f ���' J �T�� rua Engineering Department(3rd floor): Tolq/ EN TAL C�� o°39'`��� ' House number: ��rc � �► '�'� Definitive Plan Approved by Planning Board 1g APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2,00 P.M.only " TOWN ' , OF BARNSTABLE -4+ BUILDING INSPECTOR APPLICATION FOR PERMIT TO Lk u C x &V o 4 Z>p e o Al TYPE OF CONSTRUCTION //d 19_Z:22 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 11 Location D ei; LIZ Proposed Use RI�► �o o M ¢ /J c D 20 Zoning District Fire District C, A-Al / Name of Owner & W 5 V. Address 5,41"7 6 rr l3ci 0,0E, Name of Builder _ _do /-/n/ F-el1c LP s Address YD / /,4A6/� ld►/y4r. fk), AdAWT/� Name of Architect Address Number of Rooms c�2 Foundation �Df l& Ce o-V exr Exterior r�� d if D/Q1f. Roofing i9s�t�� r Floors Interior L rg 5- e T 2 b E Heating � � / Plumbing !fib/� ' Fireplace No A 6 Approximate Cost i Area. 1. Diagram of Lot andBuilding v ith Dimensions Fee O Z � 4� 3 y � Sd C R� 7 17 OCCUPANCY PERMITS REWIRED 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 9 7 e WILLIAMSON, PETER No 34875 permit For BUILD ADDITION C- Single Family Dwelling Location 29 Nottingham Drive Centerville Owner Peter Williamson Type of Construction Frame Plot Lot Permit Granted March 10 , 19 92 Date of Inspection 19 Date Completed s 9S � 19 t ; Assessor's map and lot number .. .../�� ' ��* �. ; - s� Sewage Permit number L V �f �3 k3C F Q ..... ......... t .r 9 `�.¢ k�93� :'�°� ♦�w r g . . s Y Z S8SB3TSDLE,, i House number, .. .�........ ..�...:.... :.. -�ter' ��j v � � '°o rb 9• c r. sa a +s �a �EpYpya• as ism R SA'S off TOWN ;OF BA°RN-STrlk � °� T PUANCE V-JIT14 TITLE 5 B-U I L D I H G I N SFP E C T'0 NTAd0DE AND EC APPLICATION FOR PERMIT TO ............................. ...............l.......:.... . ...... ............. ........................:.. TYPE OF CONSTRUCTION ......... ` .....:.. ` .lk.,.�.1 (.: ........F.1q. ............................................ J ..............�..(.: ,�f(... �19. TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the fo�llloofwiing�`inform/aAtion: Location ........................................ �? ..a.. .....��!.1....!.. �.:YF '� ... � ..C: . ............ Proposed Use .................................. ..... /. :.......... ' .. . .. .... ................. Zoning District ....................... .. �'...0...............................Fire District........................ ..... ..................... Name of Owner .............. if f'�: lZ�. .....; :..,,.Address ....... ...... ..:. :........ 1 :: .G..t. z Nameof Builder .........:............ �� ........... ....Address ....... ............ ....................... ..................... Name of Architect ..................................... Address .._:::....... . ...... Number of Rooms .......................4�........:........ .....:..............Foundation' :.. :........ ... �...C(��-�2�iD...4. Exterior .......�!�....�}.. .;5,,t�-,`ji2�Ya. ......................................Roofing ........ ........./ /,(� (/.....Z ��. . Floors ......................U9r t! ...............`:�%`r............Interior ......... :..S��l. ? /�:f�.f! .. Heating .. ......F.R..+............--....... .�..11IV....(h..� ....Plumbing .. .... —..` ...291.2... ............................ 11 Fireplace ............................................................. ......... ......'.Approximate Cost .. f� i9C� ..... 4 .... ... .. . .. Definitive Plan Approved by Planning Board _'__�I 19_ Area . . Diagram of Lot and Building with Dimensions Fee t. r� SUBJECT TO APPROVAL OF BOARD OF. HEALTH0��/ 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 /` t.. .. rC� ............ �. " Construction Supervisor's License .......... _ � ... ...... ('iRFENBRIER CORP. �. No Permit for ..One..Story.............. , ........ ingle- WrilY..Dwel Wig...................... Location J4 t...!$/.....29..tN�Qtt n�gaj;rive, . ...................................... y Owner ..... ........................... _ y{ ' Type.of Construction ..FraMe......... ........r............ ....................................................... Plot ........ ............ Lot j .' December 20 84 Permit Granted .......19 - Date of.Inspection .. J .............. ..19 Date Completed f F�' i'T .19 Z. `,r � • _ .. / .. !f. � / '. _- r Y •mil S '' • Kam._. Gae_� e_� , t ' s TOWN OF BARNSTABLE Permit No. _273�� Building Inspector su,rr.at Cash -------------------- �YL OCCUPANCY PERMIT Bond _-_-_.---c4y�"r Issued to refaxwrier Coi p. Address f,r) :18, 29 Nottinghan Drive, l.ertp-zv'Llie --- c Wiring Inspector Inspection date . Plumbing Inspector 4 �� { 1 ' Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. . fir....f.: ...... , 7 9......_.... ..............................................f/' .. .. ... Building Inspector FROM TOWN OF BARNSTABLE .: BUILDING DEPARTMENT y We Francis Lahte xe �.,,„� . „ � 367 MAIN STREET HYANNIS. MA fl2$M Town Clerk Phone: 775.1120 • • 4 •ice, • • SUBJECT: ---FOLD HERE DATE. - February 28, 1985 M E S S A G E Work has been.Completed under#Per€nit27350 (Greenbrier Cc?r r) ., • .p% Tease Bow. SIGNE DATE r - V, /// . SIGNED - N87•RMI - • ' p'RE.EIPIENT:RETAM WHITE COPY,.RETURN PINK COPY • PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. - - 1 (3avZ`S � N73�'ss5�1T' 50 40 . 37 LOT �. 3-2 NIf 25 uoo w l60 G�l7�7Z/ IDD.D v (6b CERTIFIED PLOT P .A Z—(J' ] l 6° /VO l 7-/N�o BRUCE 'ry �le ELDRED ' 8�0� r IN SCALE= "-°- 0' DATE= CLIEI T 4 1' CERTIFY THAT THE F°vN�,a rev ­ V SISTERED REQISTEF SHOWN ON THIS PLAN 19 LOCATED CIVIL- I.ABd® �� 9�Q«�`f..,..,U..�,,, ON THE GROUND AS INDICATED A .0. ;� ,� . CONFORMS T4 THE ZONING LAWS E�18I1dEElt 8UIZVEYAR .8'i(e. OF ®ARIBT'A &6 /-- .T 12- MA I N' S T RE.E.T' �Y` �NYEANNIS, MASS. 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