HomeMy WebLinkAbout0087 OLD POST ROAD (CENT.)r87 Olcl�'os�F�Rd � ✓
l
Town of Barnstable *permit# a4
;,: ,� "el►ti Expires 6 rmonths from issue date
MNAMrRe ulato_ a •Ces Fee b Regulatory Services
z631�' Thomas F.Geller*Director
m
Building Division
Tom Perry, Building Commissioner X-PRESS
PERRAIT
200 Main Street,.Hyannis,MA 02601
Office: 508-862-4038 MAY 1 7 2005
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESEDENMAIRIMDARNSTABLE
Not Valid without Red X-Press Imprint
mapiparcel Number
Property Address
i
®Residential. Value of Work C Minimum fee of•$25.00 for work under$6000.00
Owner's Name&Address ,J-C- O j 4 C K
Sd3-at,�
Contractor's Name 02CAAA Telephone Number
Home Improvement Contractor License#(if applicable) 6
Construction Supervisor's License#(if applicable)
VWorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name � �t
Workm `l
aes Comp.Policy# -7� X�
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
Re-roof(stripping old shingles) All construction 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 thus permit does not exempt compliance with other tows department regulations,i.e.Historic,Conservation,etc. '
***Note: erty Owner musts' erty Owner Letter of Permission.
Ho rs License is required.
Signature
QForms:expmtrg
Revise063004
_ The Commonwealth of Massachusetts
Department of Industrial Accidents
- — Office of investigations .
' 600 Washington Street, .,th Floor
Boston,Mass. 02111
Workers'Com ensation Insurance Affidavit:Building/Plumbing/Electrical Contractors
i11pI1C`d'}11n8i1pIl `� ' �. "MR-0
a' ." ' tySS°::g '� C3 x v�
name: C A-6-4-9/1
address:
city state: zip:L/ :3 0 �6 7J phone#
work site location(full address): v✓t I CQ. C` ' lV/(/-4:p
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel
❑ I am a sole proprietor and have no one working in anX capacity. ❑Buildi
n Addition
his: •�£•.[... ..��. ,t.: ��•d^-�,4 ,� ?�5;:r'r��°;:' ;�`�l;;A.:.�' �.,-: r.•:
.. ...ti:. ... c ..."'„r.':�:. .5;t:„�`a+,�r.. •• :}':�.`�f�,`:.>.r.: ':x�vd; ..,;.•�:s:;.'ac»�'c• .rro--9•x�,,-. -sr:rr:=%a,�•.�3'-.f.;,;;
❑ I am an employer providing workers'compensation for my employees working on this job.
company name: .
address
city. phone M - nn
insurance co. olic # w
e ii5�• " e 5� .t. _� 5 LL_.�T .4..a.,i, n•-*oZ...s#•,ab:1S b.F::. . :Y 4. ..1•., +d,!.�. aa:',-' s...:u... ,cihiEm .F"I:«.•'s Y46:�••:.x•'n".J;`� �l� :'•t'� �F;+ "'G..�'ec+�'•:... .... w.. •.o:•`)`-ar�A•r:a,,...�:•t.<.;'..:".':rc..:-_,is'.:,:c:i«?:��`.`:Y'".•f'�_tid��°cxn•�f. ..
❑ I 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. olic #
;�'; ..;ai°:�1•''ldc: .- '.�' .."e.' � a, `'x"E'y,� F• ':�' '+:si::�'tY ":Fig ca•.:N. ..�}Y:�.�3'E+i••'..•-'i.�i—_%��''i�. .N,1.iA;t....t:.:Td t:n...3i���..b"=� ,.i .�ti.' t'.9.j .7%L:),^w l.:••::.a:NJ.�.. art..' ,
,. :.:,,r."1:{�:'�/ra,=i7E, ....5,. :.�.:. .,tip; ,.. ...... cu. r.,..,5: .a5.��i1i-'.'... r,r.•• "l.l'r.
-company name `
address:
city phone M
insurance co. policy#
�`�t#a M altl a4;1t e J ('%'tH x� ice. ::rt•.: ,ry;.,x:Yy.:e.'i®L*. 'titscsr'i; K,ca•'.:
. ...,�,s�.,._.o�n.._�,.eeti;�nece�sai n ti �' rr'�.• ?:z��:� :�:�_,. ,,,•, ;T,�=::,,.,,::..:,._:,:•. ,,...- �`��'t -:ms' :4:A,ua�Y.4S�;iaS '�s�!:ai�i+.'�'t ::�.��!•�F�+?�:e�:,::�-.�hi'� «.*��'!4�firf;�i.' i; °ira'`�w:wit' .
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 s1,500.00 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 may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby cerd nder the pains ► es er- that the information provided above is true and correct
Signature Date
'Print name Phone#
IMINofficial use only do not write irt,this area to be completed by city or town official
city or town: �// permit/license#
❑Building Department
'
❑check if immediate response is required ❑Licensing Board
❑Selectmen's Office
contact person: phone#; ❑Health Department
❑Other
(rcviscd Sept.2003)
S `ar5
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law",an employee is defined as ev ry person in the service of another under.any
contract of hire,express or,implied,oral or written. .
. i.
An employer is defined as an individual,partnership, association corporation or other legal entity,or any two or more of
the foregoing engaged in a joint nterprise,and including the le representatives of a deceased employer, or the receiver
br trustee of an individual,partn rship, association or other leg entity,employing employees. However the owner of a
dwelling house having not more an three apartments and w resides therein, or the occupant of the dwelling house of
another who employs persons to o maintenance,constructio or repair work on such dwelling house or on the grounds
or building appurtenant thereto sh llmot because of such a loyment be deemed to be an employer.
MGL chapter 152 section 25 also s tes that every state local licensing agency"shall withhold the issuance or
renewal of a license or permit to perate a business o to construct buildings in the commonwealth for any
applicant who has not produced a`ceptable evident of compliance with the insurance coverage required.
Additionally, neither the commonw alth nor any of it political subdivisions shall enter into any contract for the
performance of public work until ac e'ptable evident of compliance with the insurance requirements of this chapter have
been presented to the contracting au ority.
iyl
s UM
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3"r'-.r .�'a .` <'•A.';.:'u>~tea... P. .:t.' a'-1 Y' �� s 1:,4`2:,t1'g't{:s: `:f4 min iP 'Y Nni1 W!r
o-. u. �'
Applicants
Please fill in the workers' compensa 'on avit completely,by checking the box that applies to your situation. Please
supply company name, address and p one mbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Indu trial ccidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit shc A e returned to the city or town that the application for the permit or license is
being requested,not the Department if ndu trial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' mpe ation policy,please call the Department at the number listed below.
r.a• .,v.. 'E's- -..h r'"_4r�.h.^,:7" x,f�T_ z. i'"��9eas-+9E: inn3r. :s:.., lyirki'J" ;.'y;¢re-•F
.r,*R.rT.r - sx=t ,,'&.."''� yr• 'tt.t" a .n.... .t:t;::'
�', .i'�' .,xn,«. .!�,.�t. ?$•. r+ r�•;. "�`r�y.� ,,.,� r. 's��,;F"�:'.:^..4;•
gar •:4:. ,'.. y.,pG"� .,.i..]:$. '.�..:•Grha:•.'x" .a�' � •...jt',• sr •,:a'E;='.':y,c?•'yri�" ,.�,.. ;.r�`.1� 'zwt'� L ,
:.�1:�i��: ;�!?,�..���,��'�"•��._.cfi; „a'S.,:,.;.�cS..e: ::ar.�ri�cC ;,. �`
>ia>r:9: �nc�"e'• �1. .-'�".,k�a"t3r.�w-•t'ttl:F:;vB«•a• ..�CtK e�,'- .!::iJ+':�� 'r•ti' rk..k*Y.. ".,_. �. .§:..:, �v;.S.:F.... ����
City or Towns �
Please be sure that the affidavit is om lete and Tinted legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in a ev t the 0 fice of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/lice numb r whit will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX less o ,er arr gements have been made.
The Office of Investigations wo Id like to thank}�ou in advance for you cooperation and should you have any questions,
please do not hesitate to give us call. N,
:f.w.w- •,-•r` -- •:ir'• ;r_ :ae:.ie,"` .'Y+%c=sdi`i:" 'aa:;+?sse: ::k,*_isaJ�:ri.:"f}f:"T:•:r.eF,... ,.9gt+7fi>:; 'sir,;
rd .'-t cz�?:;i. ;. ia",•''-" ,'G*�l,.i $:: ,"�.',.`. a�#. chi',,;. ;,.,4;,. �R4 '✓{`, .:yaY. {f�II�_'n.n_�vti'.;.x':,au:i,SYwu'. %�..�t'• .,:4�va.::,.fe.'c:;^aafyy'.'•.' •+,W..5.i+._.'A.l'hb''t:,�lP�'•A'Y'i'"'1Gl7wa M �2�5:r.ii";Y.4'f�:.&,:'''1�t.W::� 'ia' ? ir;�' ..�r::i'.i6 ai1?Fy_�b,..°_a.c 4.ak:•a<° C,.TMin'5+ni''w,:;
7}i.. nlrv.
The Department's address,telephone acid fax numb r:
The Comm nwealth Of Massachusetts
Departure t of Industrial Accidents
Office of Investigations
600 Washington Street,7"Floor
ioston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406
,ASP FROM:ARTEMIS-'JOHN KIRK 703-998-4117 "" TO:15084280123 P.2
Frass..ar Construction
'it 8terpooar§�'9i�o�sd mitbirx 10-days as.autuandiv 4 Star Wirmntr
Uppacle*W be kt"Hed(see ancla"d J mahure)
Payable lmm odiaaWy upon,sac upletion
NO MON eY DOWN-NO Payaner t aa4 the otarL or pawl way ll:sta
Payuml-to Aompled are.
CASH-CHECK-NI.ASTERCAID-VISA-AMERICAN EXPRESS
•Any paayme=not Made wuDaaa 30 days of oumpluim wall be da d 1 Wf6 far may 30 days
tho paymam Is lava
Passible Srtraa • After the&Ixbi i'ea are removed fararn(lic awr,we will la urn,
Shut or plywml to Tmke sure ibut for insulation Is not up against the p4wood
ebeatliing prevebting vmWatioon Rost the eaves to the ridge. If ft is,ventJlat(on
paMla will be instaned by,removing the pbmmod ebmthin& Inetalting Vw
pnbeJs, taming the p over and Men re..-inoeta Tting the,plywood: if needed,
this would be charged for as an cmt at the rate of$4.00 per panel including
Materials&tabor. There ere 6 Pawls per abc0ofplywoM. . '
Pmeibla Ta chm-Arty ny(W en-atlaeawixt det=i6nj+"1 trim bnvrdN plywt A
sisenthlog,lead 11nabing,at[sutlert:azt1mi"needing,ra:pJatctsmentWE be done
amd'charged fw as an extm el the mtc of� 7.00 per lu,ur, plus Amteri c*phre
Zi>°i6 overtteiad ntatic-alp oa mtall exfxaa. s
FRABM C0i497tJWC77CkW Warranties the labor for 10 yeasts
rmAltm cONt mucrnoti wmvwtiee the sril n&m against Slot➢-Oils for 10 yeam
CZATAbfrSSD Wa rtandee the shingle®and labor 100%for the fimt S yea,.
and tba c an a pro rated bee' for 00 ycam total if Um alaingk u t,ecome defective.
GBRTAINT88D WKtr.�tl cs We abingks to Im ALGAS rcaiasttant for a full 10
year#.
At$dkWdion or a4tera m Sum above specifica.tion will be a lcutcd upon
writica orders:and wall lac ojmc attr extra dmrge over and alcove the.estlmato. AD
uWumments conul agent aapou Stakes,sccldents or delgyo 4Lm beyond our
control. Ownsr ahould care y lire,tone do gaud other mocceawy Lawma=c up ou
Uir above work. we, if not accspicd'wIffil l"Iy dayei my witblraw this
proposal.
PnAg=C0W07RUMON!Calm 1os Werkmao's COUIPCeae>.ti[om and PUMO
idahtllty Immune on'the abw m war*.
DATZ OF AC.CZ"AKCB:
f
r
Board of Building R�
H0N1E 14, gulafions andand g��
�pVEMENT CpNrRACTpRrds
Reglstr�t�yrr� Licep is
12536
' befo►
20
- - 07
FRAS p Boa),
ER CONS" `V �� One;
DEAN 71 T FRASER r �r_ a Bost(
h '-� e
ARGON Cl CpTUI7"MA 0263
5
AdrrLnistrator
r
I
_ O • ,�Jt
Assessor's map and lot number
SEPTIC SYSTEM MUST BE
30 d�� tN COMP
Sewage Permit .number .......... F! ...J / . , �o WITH TM E 6
NCE
I
EMARO CODE AND
t"Ero TOWN. OF BARNS %%T'1ONS'
BASB9TI18L$ i •"
9 6 9 BUILDING : INSPECTOR .
Aim
a'
.� .,3 APPLICATION FOR PERMIT TO ........ ....... ' .................................... ...........................
TYPEOF CONSTRUCTION ...........`. ..... :....,. . . ..... . �................................ ......:....................................
�U4. ... .....19..!.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby�applies for a permit accordiing,�to the following information:
Location . �7......6.�"�..b�ff ...��4:.........a .,...:........................
ProposedUse ....... ........ .rr......:7.N...... ..... ... . .. ....................................................
Zoning District ............::..........................................................Fire District ..........
Name of Owner .......l.!. �.�.. ....:.. .....Address ... ...:64. kel...
. `...
...
Name of Builder .... f :.�.`.1. .. ..Address .. ...... . .. ......................
Nameof Architect ......................... ......... ............. .......Address ....... .........................................................................
Numberof Rooms ..................................................................Foundation ..............................................................................
Exterior ....... !!.! .C. .......................................Roofing :.....:..L : ..... ... .. .. ..................................,................
Floors ...........Vl✓.id. .t.. ................................................:....Interior ............... ......... ......................................
Heating ...........................................:..Plumbing .................).�.2—e................................................
Fireplace ..............AOME5..................................................Approxim te Cost .... ................ U....
,
Al
Definitive Plan Approved by Planning Board ---------------—____----------19--------, Area ....... �£ Ct G
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—a Barnstabrile regarding tlKi above
construction.
GName . :... .. ..c ......... . ..............
:Mahan, Edward
No 21910 .Prmit for,.. remod la ale T
to 1st floor'"-
..........I.... r - .i,............ ........
Location..........0O Post Road-,-
.....................................................
.....................QNh1.`Qr.v.W.Y........::(.... .............. � .r ` •� 4+� , �' `'
ej
Owner .............Z(AWAK'.d..
Type of Construction ......... W.. .. x' Sl1�......
............. ..................... .......... .. .. ..........
Plot ................ Y ... Lot ..........': ................... 4,
Permit Granted ....... December.:28 .19 79
r : .
'Date of Inspection .:t ...................19 i
Date Complefed i.V ../.p... :.... ....... .3 9 r ?t
S
iPERMIT AEFUSED c
......................................... 9 i ^'
in
in
/° .. .. Q ................................................... - • rcf tR
............................................
... /`. Y. S...................................................
-
APi .��-,. .......................... ... 19
.�...... a`3..............................................
•...............�—.. ...................... ..... .........- .......� - - -
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t IE Q t~aaa GcvkAPLVI-, \.v l"rca Tt-lt 51 v'�.�I►�
Aklr-> SETt�,nEIG WE-QUitZ(:-AA&iATr, O>= TFIr.— LOT
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-TO W►J OF 7B A2Kj.:,TA.F:�->L4�:-
--� ►�l � �1 � I �v
DATE
g A 7CTC 1Z. er !�
REGIS"tV--RG:U tAWO SUZVa`(OV-c-
TN tS V L-A" 1'S "OT tSASE'O7 0"4 AN os sErzv��� o ArC ASS.
tEJsnZUMc�.iT euczvcY 4 'Ti-ir-. 6140ww APPt
ti1vT E5r-- U5C-D TO 'DCTel`tikll4E-- LO-1- t_lWeS
Assessor's map and lot number- . .. .. a. .. v "I �f � ` ^2�" ;7
S SEPTIC SYSTEM MUST
(.
f
Se; sagePermit number .... ...........:..../:...........:,.......:....... WITH INSTALLED IN C® 'LIANCk
"� ZA, RTICLE 1I STATE
SANITA V' CCnp ,�
TOWN OF BAR� eA tit Yow�
r i
i NSIT
2 _T
A639. 13% LDING INSPECTOR
v; APPLICATION FOR PERMIT ,TO ..... ........................................
......... ..................................................................
'~ .... '• TYPE OF CONSTRUCTION ........ ....... . ....... ..... ..............................:..........................................
ti. ....... .......... L ............192
—TO-THE-INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit p�pg to the following information:
� 032
Location ................ ..... ........ ................... �................
Proposed Use ..................: ............ ............. ....... .............................................. .................................
.................................
ZoningDistrict ...... .. . ...........................................Fire District ........ :. ........ ..........................................
Name of Owner ................Address
Name of Builder ..................................................................Address
30
Nameof Architect ..................................................................Address .:..................................................................................
Number of Rooms /
.................................................................Foundation /..d....... ............................................
Exterior ..... .............:............................. .Roofing .. ....... ..................................................................
Floors . .................:..............................Interior ......................................:............................................. .
............. .
Heating ..............................................................Plumbing ........ ::.......................................................................
Fireplace ........... ........................................................ . .........Approximate Cost .....30.....................................................
.... .
Definitive Plan Approved by Planning Board __________ 19_ � . Area ...... ....... \
Diagram of Lot and Building with Dimensions Fee, f�
:f ..............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
N � �
3�
r L&
b
rho .
I hereby'agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........................ .....................................................
Coletti, Guy
--
No t.1 .. Permif for.........,•../2 story r a
..............si ng le fa.: m il dw y 61l in g.......................
Location ..®ld tPost Road.......................................
' Cente riff 1e r' s
Owner .........Guy Coletti
,. r
Type of Construction ..........'frame,
Y
- ................ . ...........
.................... r�...........
.#3 Y �.
Plot .............. ............ Lot ........ ......................
rJuly 22 77
Permit Granted ......19 4 4
Date of Inspection .... .. ... .�7........19
Date Completed-I......1. �/..............:.......19 ti
^i' _ M
n
J
-<PERMIT JREFUSED
' f
19
..................... ...... -.....................................
................ .... '........ ............................ ......... ~�
..........................: . .............................. .................
Approved ................................................ 19
.................................................................. .... . .
..............................................................................