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0016 SHORT BEACH ROAD
fir 4 '• fYi iY FY � �i' a. ' i 5 + �{ �Q � , p.,, q r b� 4n y� 1y)�r4•,X��' S9 p.SA,,;M}� ��3 W� �' t: 1,Y�� �� ,m rr �� '.f e �. .., :1.�r •q°19 Y Z VHt15= ��i�`4R'.'"�f���! �,�,++, �El��, ��5.r'Is'fi �aql�'`9. `t�'JiGr t�+'.��� q' '� }, cot, 4ai ,•N,.:9 _4 i�i.a. • n ra . i c . iT♦M ^i S� k ,� 4, a , r u ` 5, OK" � l� ��w� l��t ,i, ✓Cd�C�?o � 9. 3�> �3 � T\) su �JK I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `f�1-2 Parcel 0 V3 Permit# Health Division « ��� cJ �r~" OF 8"" STABLE Date Issued 2- 1 010 ?003 FEB - Application Fee , _Conservation Division4 Pf'� 1: 23 Tax Collector A Permit Fee 60. 7 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address lb adef" 4R4N(�lL �E?c✓ Village M Owner 4�<kAe,, f�a¢4N Address Telephone (20/ Permit Request Square feet: 1 st floor: existing 'I i i c3' proposed — 2nd floor: existing — proposed — Total new r- Zoning District Flood Plain Groundwater Overlay Project Valuation 2e 000. — Construction Type &4ry l Lot Size %va0 # Grandfathered: ❑Yes i(No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure y0 Historic House: ❑Yes Ulho On Old King's Highway: ❑Yes UAo Basement Type: ❑Full Ercrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing f new Half: existing ! new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing 6` new First Floor Room Count �^ Heat Type and Fuel: ErGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes El"'No Fireplaces: Existing ✓ New Existing wood/coal stove: ❑Yes ((No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:dexisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑.Yes ❑No If yes,site plan review# Current Use Proposed Use _ BUILDER INFORMATION Name //4/?1 / y, <D*W6t.�o Telephone Number(51�)T7S'3�48 Address JOS' 1 k. ,,Siq 4 License# (9 V 6 3 3 � Home Improvement Contractor# 112 0I Z 7 Worker's Compensation# fi 016 h W� 12,0D 3 5_7ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOi��� C!/��D �� SIGNATURE CU DATE 21VIe3 1 _ FOR OFFICIAL USE ONLY PERMIT NO. DATe- ISSUED MIP/PARCEL NO. ADDRESS VILLAGE e OWNER DATE OF INSPECTION: FOUNDATION FRAME O S , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t.. BOARD OP EllILDING REGULATIONS t . License: ONSTRUC.TdnN SUPERVfSOR I•= t Numberi Q833 ': 4 Tr.no 1373* .0 N aktA UAICfiAEL J DAN �� V L.I 105 HORSESHOE�►yE7, 0 .. CENTERVILLE, MA M j� A—Ml i st°rator r °FINE l° Town of Barnstable rr Regulatory Services v BARNSTABLE, Thomas F.Geiler,Director 039. 'OtEp39,.(A Building Division Tom Perry,Building Commissioner { 200 Main Street, Hyannis,MA 02601 i Office: 508-862-4038 Fax: 508-790-6230 r' Permit no. Date AFFIDAVIT ` HOME IMPROVEMENT CONTRACTOR LAW s, SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the."reconstruction,alterations,renovation,repair,modernization,conversion, t improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied i 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:�.'M4,w L 4 i'1 a 0wC �/7'ek s Estimated Cost Address of Work: I k 54,4,eT h£'! 'E'—lr (rGr! lie y,Zf- Owner's Name: Date of Application: U 3 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied El Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED 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 apply for a permit as the agent of the owner: Z 3 'y/i li 1 2, 77 Date Contrac or Name Regi tration No. OR Date Owner's Name Q:forms:homeaffidav The Corrimonwealth of Massachusetts R --� ,Department of Industrial Accidents --- Office CRIMs119,11 S.. - 600 Washington Street /* Boston, Mass. 02111 Workers Com ensation Insarance Affidavit 11 name: �� location: - -V• Wq ci . . ❑ •I am a homeowner performing all work myself [] I am a sole r Iietor and have no one worldn in ca aci�p a sol %% %%%/%%/%///o/%e%%//w%/Q/%//////////an//this om ensation for mp em 1 y $ }:<,. •:: ,.;:;., ;{,�,}, ers c ork t:4r•: 4:!•}: :^Y.•:{.}:;}}}.4.:. is{>}i :::\:n:'.�:�:i:ti:}h:i.L•:i}}:•.}:•::)�!:n }:}^:+�:}t�#T}{::•,:.{}:t:ti:v.:;{:�Y IQV1d1II W .�... :•:A:!. rT:;4•`•.?ta•s n:i~:' •.ti.,•. 1 er- g :rS4:?:�1;:CYY{�ii�}4:4{:ti:.:: '•'�.{.., am •rJ •t{:O:Y':L{}`''?is�:Q�?:-i>:�}•i-:-:i+'i:r{••iti:''•: n:'jS:.. 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FaIIure to secure coverage sY required under Sectlon25A of MGL 152 can lead to the imposition of ctintinalpenalties of a$neap to 51,500.00 and/or one years'Imp �weAas civn pennities in the form of a TO ottheDIAfwoiuco�or�covengeveeaIIcation.00 a dap againstma Itatders{smdthat a' copy of this statement=y be forwarded to the Of$ce of Tnvestig _ nder the, cdrts and penalties-of-perjury-that-the-informations-proatidedaboveas-iwo-sd.coirect I do hereby- � p � •- Date Signature ;• v8 Phone ' print name . oMdal use only do not write in this area to be completed by city or town official ' erntit/iicense# (3Building Department P oard d� or town: ❑Licensing B ❑selectmen's OtHce ❑checkif immediate response is required ❑HealthDepartment phone#; ❑Other contact person: t..•ri.:ti 9I95 P1A1 •• 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 every person in 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 more of An employer is defined as an individual, partnership, in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or the foregoing engaged trustee of an individual,paztnership, as or other legal entity, employing employees. However the owner.of a ..•N dwelling house having not more than three apartments and who resides therein; or the occupant of the dwelling house of another who employs persons to.do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto'shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal 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 commnonwealth'nor any of its political subdivisions shall enter into any contract for the performance of public work untfi acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and suPP1Y company names, 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. Also be sure to sign and d to the city or town that the application for the permit or license is date the affidavit. The affidavit should be returne of Industrial Accidents. Should you have any questions regarding the"law",t.9,Y9u being requested, not the Department arer equired,t'o obtaina,workers' 6inpensitioupolioy please calltlie Depaitirierit at the numlier'listedbelow:. City or.Towns •- Please be sure that the affidavit's complete and printed legibly. The Deparf rent has provided a space at the bottom oflhe you to fill out inthe event the Office of Investigations has to contact you regarding the applicant. Please affidavit for y , .e� cense number which will be used as a reference-num'6er. T1ie affidavits maylie'rtE? be sure to fill intiie.P have been e. the Department b "niaiT of FAX unless other arrangements mad ti v Y' . The Office of Investigations would like to thank you in advance for you cooperation and should you have anyguestions, . please do not hesitate to give USAcall. The Department's address,telephone and fax number. ThCCommonwealth Of Massachusetts ::.. Department of Industrial Accidents ' � Office of Initestigatloas . 600 Washington Street , Boston,Ma. 02111 fax ff: (617) 727-7749 : phone #: (617) 727-4900 eat. 406, 409 or 375 RESIDENTIAL BUILDING PERNIIT FEES ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE 30 6 square feet x S64/sq.foot x.0031= S�� 7/ Plus from below if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf S 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$961sq.foot= x.0031= STAND ALONE PERMITS Open Porch x S30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving S150.00 (plus above if applicable) Permit Fee projcost • Told IS!, F046 p acripth•e psckzty fordaa"d Tws•F'AnulY am"mdal BdidL*V MB'(IMTTM ' ••14asiagrC.oaling. 1y1,UaMUM ' s. Watt Floor Bs� F�Scirac7� ' Ql g . G1a�iag WingRrvstud Arras(•/.) U-value= R•vnlue� R•vssua� pacicaae rmi to ds40 Hntf Dam 13 6 Nmml 13 19 10 . Q tzs'. D.4a 31 Noriml 19 10 6 g 12Y: 03Z 30 19 6 i?AFUE • g 1Z:'. . OSD 3i 13 1.9 IO ' t�rraai l3 23 WA lilt T 13'/. O.Ib . 3i 1D 9 Noim�l 19. 19 is AFUE U• 1S8/. 0.46 1i u WA WA =P. v tr/. 0.44 33 13 ` >ts ARM w 15Y. OSZ 30 19 14 10 WA Now 13 WA 19 2? WAWA .31 6 90 AFUE y 90 AFUE lar. o. 13 19 10 z 4Z 31 19 19 10 6 AA t E•!. OSD 30 T. ADDRESS OF PROPERTY: Q 2. S QUA RE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4, °/GL GLAZING AREA(#3 DIVIDED BY#2): chart-see shove): a . . S:�SELECT PACKAGE(Q— .AA • . . . G ENERGY'REQUIREMENIS • NOTE: 'OTHER MORE INVOLVED METHODS OF DETAIN . ARE AVAILABLE. ASK US FOR THIS INFOFiMATIOrI• BUILDING INSPECTOR APPROVAL: YES: N0: q�farms-f980303a • Footnotes to Table J5.2.lb: t Glazing area is.the ratio of the area of the glazing assemblies (including sliding-glass,doors, skylights, 'wall basement windows if located in walls that enclose conditioned spars mabb�xudirig opaque doors) from the U--value requirement. area. expressed as a percentage. Up to 1/o of the total glazing example;3 ftm ofdecorative glass may be excluded fi;om a building design with.300 f 2 of glazing area, For ex January 1, 19 99, glazing U-values cum = ' be tested and documented by the manufacturer in accordance with. the National Fenestration Rating CuunciI (NFRC) test procedure, or taken fromTable 11.5.3a. V-values are for whole units:•center-of-glass U-values cannot be used. The ceiling R-values do not assume a raised or oversized taus construction. if the insulation achieves the full for R-38 insulation thickness over the exterior walls without ccmprmsi°onR-..30e�R umay be su t of caviry itisulatian and R-38 insulation may be substituted for R-49 tasulats g sheathing represent the sum laced between insulation plus insulating sheathing (1f.used). Far.ventilated ceil%ngs,•��g. p the conditioned space a.ndthe ventilated portion of the roof. if use Do not include Wall R-values represent the sum of the wall eavity.ittstilaiiaea�pluss I R 9 ==t could be met EI?HER requ exterior siding, structural sheathing, and interior drywall. Sheathing- Wail, requirements apply to by R-19 cavity insulation OR ity.R-13'cav insulation Plus K-6 instzla S wood-frame or mass(concrete,masonry,log)wall.conmtnictidns,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(stub as unconditioned erawlspaces,basements, or garages).Floors over outside air must meet the ceiling requiremeass- I-r1 a entire opaque portion of any individual basement wail with as average depth less the 5daorse cf e�nditioned ntc_t the same R-value requirement•as above-gradeHas ent doors must meet sliding walls. Windows and m the U-value requirement br.,,ernents must be included with the other glazing. d-scribed in Note b. The R-value requirements are for unheated slabs,Ada an additional R Z for heated slabs, 4, or 5. If you plan to it stalI more If the building utilizes electric resistance heating use compliance approach 3, en the equipment with the loi3rest than one piece.of heating equipment or.more-than one pieta of cooling equipment, eq P efficiency must meet or exceed the efficiency required by the selected package• For'HeatingDegree Day requirements of the closest city or town see Table JS•Z.la. NO TES: iccc table levels. a) Glazing areas and U-values are maximum accdptable.levels.Insulation R-values are minimum p eau R-value requirements are for insulation only dad do not of include structural c°mpon .�0,3.5. Door U-vaIues must be tested b) Opaque doors in the building envelope must have a U-value no greater cede-1°r taken U. the door U-Value and documented by the manufacturer in-accotdattee with U- rig far that door is not available, include the in Table J1.5.3b. If a door contains glass and an aggregate glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may 6e excluded from this requirement(i•or craw space wall component includes r than twoor more areas with c) if a ceiling, wall, floor,basement wall,slab-edge, P to different insulation levels, the•component compli�f the ed�We' Mgcomponents�� comply m the mare weeghted averagelU- 1he.R-value requirement for that component. u Glazing . uirement(0,35 for doors). . value of all windows or doors is less than or equal to the U-value req 43 Engineering Dept. (3rd floor) Map Parcel �;71 Permit# o�J House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) " Fee Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) 3k,109 -4old t . 00 ---SEPTIC SYST E - - 19 INSTAhLED IN E �S W 1 9• �� TOWN OF BARNSTAfI ONMENTA AID® Building Permit Application T®�� I�ECalll_d�Tl®�� roject Street Address /(a C%r,4 /3e Village Owner Address/, 6re ye Q �¢ r Telephoner s Permit Request e/h011R ELYIAILZaci ¢tom e 4J 9?;c First Floor . SGp, f,J� square feet Second Floor square feet Construction Type_?6a Estimated Project Cost $ ew, — Zoning District . Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family RJ( Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes t�/No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing Z New Z Total Room Count(not including baths): Existing New First Floor Room Count i-Ieat Type and Fuel: l�l tiGas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Gar,ge: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information NameA"C,/,/e / V 31 ,9,76 a A Telephone Number 77=�:- 3 74 9 Address /p r /wYSec%l oto 4,7. License# O 5�g3 3 3 8 r 14 e� oQ21 Home Improvement Contractor# //a q?-7 F 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 I�j.-din S ik�!2-01KII SIGNATUR DATE B DING PERMIT DENIED FOR THE FOL OWING REASON(S) pKI &s 7� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED c -r MAP/PARCEL N t a ADDRESS ' VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION FRAME . INSULATION' f FIREPLACE ELECTRICAL: GH »_ FINAL PLUMBING: O ;• FINAL ca GAS: _FINAL FINAL BUILDING Mks..' DATE CLOSED OUTf v �� ' I ASSOCIATION PLAN NO. f Ile/f1 �i JD s}n 0,-de,- .7�--sucdi' f=haw t 2.3 � .z — GUT/9• L"xish•ny � ��UCO .�F L.Jocc�c., FX/.ST/.VG L�4 1i 4 Sherd �.� I4_I V I -Op aF FA,)AJ Q EXISTING Q '_ I L,ntir car- Wo�¢vc h .3 DEDRoonJ _ f I 4 s- Wax�- I 3 rjCr`UICL _— � vtvt Box lot f I AVAILABLE v«ka Q IC AGENCIES T P I /NED IN THE l /4.2� i G 3 I PAVEMENT 6145 Z 14C PRIVATE 6 .q NOT SHGWN S/WOK i L3�iyGH /2d!`�D ME NO (TIES TY COAIPA,YY S CA L L IN ADVANCE 4fE CENTER ;,Our 60 G.artc.rcirr tuck Atop 5cvhc Tank — Usc. (ox & We-tc(, Crack- Caitr w-,l l M a ni G OVG r• yy 1 I i i I I 7-1 Jill T 'v/e it i i�<ST�t I.IJ Off_ + — �-�t' I �J� Sf',�.n I I i I _ r � I - -_ 1 I ' a .$ I I 1 I _ _ l k.. OME IMPROVEMENT CON1 ACTOR R'egistrati=n ��.� V 212971 � ' r� 7yPe� �D�UALfiI :�� .._F Exp ,atloa, D5%07/99 ` � MICHAEIY° D1N6ELQ. ;y � � ' :MINA4 3MICHA4L : DAN6EL0 HORSESHOE LN _ � r^'e �,�ADMINISTRAIUR G ar+x r°•.,�a F�ara� 3 z sCENTRVIILE MA 02b32 ` I' , .t.�'b s �� �,(ie ��no�uuealC>/i o�✓ ac�ivaelta DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuber: Expires: Restricted 16, 1G .� Oil"* ',111CHAEL J DANGELO 105 HORSESHOE LANE CENTERVILLE, MA 02632 �TFIE 1py,_ The Town of Barnstable 'RAM � Department of Health Safety and Environmental Services ArEDN1o►'�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no., Date AFFIDAVIT ► HOME IMPROVEMENT CONTRACTOR LAW 1 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-existing 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. S�ad/ Type of Work:Klotxo/e S ' e4lve`e P t.Cost 8� Address of Work: /(o c�holT 62G/j G� C .���i-4'11 Owner's Name (.'6Tq /4f• l Date of Permit Application:T h I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED 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 apply for a permit as the agent of the owner: Date tractor Name Registration No. OR Date Owner's Name The Catinnottirealth of Massacbusefts Department of Industrial Accidems 1 Ofice8"flyesV9171/ons hOO ff'ashinhtun Street Bovon. ,Huss (12111 Workers' Compensation Insurance Affidavit AjljliFiiTt information•' Plc•►se PRINT Ie-Nj e Iocitin /& /7c r f I m a homeowner performing all work myself. k _I am a sole proprietor and have no one working_ in any capacity .,....,- -..-•-- .....-...-..........R+.cs.-�.w,-,,err++--�`�`^----:-...-+�-s-n+��.�.•.�.�...-..,---.....,j,...•-..-.....`-....,..--..___.. ..... _ i. ..-.. � --- ..�. - - - ' - - - •ate" -' —�-�'� - I am an employer providing workers' compensation for my employees working on this job. enntn•tm• name- address, /o J citil. 71e r v I Ile U�/�'^ nhnnc#• S o e- - 7 V- 370 6 incur�ncc cn Gt JD��� �l �r ��l / nolic� tt Q�Od�[ 30_3�5� ,G I am a sole proprieto `e or homeowner(circle one) and have hired the contractors listed below who ha% the following workers compensation'polices: cnm am• Warne: -- /v atitiresc• � nhnne Of, i incur-incc�cn�� niicc d ...ram •-..Wy-^'.-- - +�••:t•- ` -- -- r�----'�.-_-,;-;z••-r-•....;s,.•.. - —•rc--•- �..•�.-,...�.-..�-- cmmnin," n•ttne, — addrecc• city• phone#• i2cur•tnce co nolBc�•# Attach additio'n21 sheet ifneccasary� 777= =-' Failure to secure rtn cracc as required under Section 25A of A1GL 151 can iced to the imposition of criminal penalties of a line uP to SI.500.00 andiur One N"cars•imprisonment as wcfl:ts Civil penalties in the form of a STOP WORK ORDER and a litre of 5100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the Once of investigations of the DIA for coverage verification. 1 do liercht crrtijt'tattler the pains and pettaUies of pci jury that the information prodded above is true and correct. ' Signature �' Datc Print name&t 6�4��&� (/_ �/��6t�/D Phone>* •official use univ do not write in this area to be completed by city or town official city or tmvn• permit/liccnse# Mouilding Department • CILiccnsing Board � I]check if immediate response is required aseieetmen's Office C311c2ith Department phone#: nUthcr�— �. contact person: — r° Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' ctmtpensation fo employees. As quoted from the an emploree is defined as every person in the service of ;another under an contract of hire, express or implied. oral or written. An einplctrer is defined as an individual• partnership. association. corporation or other legal entity. or any two or the foregoing enuaged in a joint enterprise.-and including: the legal representatives of a deceased employer, or the vi receiver or trustee of an individual . partnership. association or other,legal entity; employing em,plovees. t of e 1 ` ownerof a dwelling_ house having not more than three apartments and,who resides therein. or the occupant of the dwclling house of another who employs persons to do maintenaaice, construction'or repair•work on such dwollin or oat the ;,_rounds or building appurtenant thereto shall not because of such employment be deemed to be an imp .' MGL chapter 15'_ section 25 also states that ever•state or local licensing aIV gency shall withhold the issuance c reneil•al of a license or permit to operate a business or to construct buildings in the commonwealth for an• :applicant who has not produced acceptable evidence of compliance v�itti tlae insurance coverage required. Add i:ionally. neither the commonwealth nor am of its political subdivisions shall enter into anv contract for the performance of publ'rc.%vork until acceptable evidence of compi•iance with the insurance requirements of this chac been presented to the contracting authority. s Applicants Please fill in the workers' compensation affidavit completely, by checking.the box that applies to your situation c supplying company names. address and prone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date tlac 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""i'aW"or if you are regc to obtain a workers' compensation polic}•. please call the Department at the number listed below. City or'1'owns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc the affidavit for you to J-111 out in the event the Office of Investigations has to contact you regarding the applicant. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retufT the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any que: please do not hesitate to give us a call. The Department's address. telephone and fax number. ; The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 � - P 229 805 269 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for Intema'onal Mail See reverse Se o Street&Number Po Office,State,&ZIP Code Oa:c N- Postage $ S� Certified Fee Spada]Delivery Fee Restricted Delivery Fee L rn ReturnReceipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address Q TOTAL Postage&Fees is .2. � rf Postmark or Date E 0 a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 11. If you want this receipt postmarked,stick the gummed stub to the right of the return j address leaving the receipt attached,.and present the article at a post office service m window or hand it to your rural carrier(no extra charge). L' i. 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the tgummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. 000 " th 5. Enter fees for the services requested in the appropriate spaces on the front of this l receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 0 " 6. Save this receipt and present it if you make an inquiry. a i The .Town of Barnstable ' • BARNgrABLE, • 9� 16 9. `0�' Department of Health Safety and Environmental Services i°rFc Nw�" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner March 21, 1997 Anna H.Healy 194 Grove Street Wellesley,MA 02181 RE: 16 Short Beach Road,Centerville,MA Map 206 Parcel 043 Dear Ms.Healy: Please be advised that the recently erected accessory building on the above referenced location required a building permit. Contact this office if you have any questions regarding this matter. Sincerely, Alfred E. artin Building Inspector AEM:lb CERTIFIED MAIL#P-229-805-269 g970321a i _ — i I h :tea 27 r.4QN UPC UNI � No,. I A '�sr HASTINOB, UN _,:.�y_.e�.:,_... ,.�,tdr, � ,,,„..:.. r�..:...��:. -•-- �..a.,;- _. � ,,_,.��•�y.�c..;.�-�,.�.;.ul�muo.aa•�-- ,,..,.�e....�.. TOPER?Y ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHO KEY NO. 0016 SHORT BEACH ROAD 11) RD-1 300 10CI) 07/09/95 1041 OJ :35WC R206 043 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T,, UNIT 'ADJ'D.UNIT Lantl Ry/Dare T Sze Dime ... ACRES/UNITS VALUE Descriplion H E A L Y. A N N E H P?A p— {LOC./YR.SPEC.CLASS ADJ. CONO. P PRICE PRICE L A N 1 6 9 i 7 O U CARDS IN ACCOUNT CD. FFDeplhlAcres E 15 1WAT=RFNT 1 x .1 D=12C 387 99999.9. 464399.95 .15 69700 4JLDU(S)—CARD-1 1 42POGO 01 OF 01 ( #PL SHORT 3—ACH RD CENT COST BATHS 1 .1 U X C- 100 I 6000.0' 6U00_00 1.00 6000 U #7L LOT 19 LC9288—L !MARKET 173100 NO V-{SMT S X I C= 100 .6 6_50 1140 7400— 4Rk 1466 J 5 �Ir CONE HEAT S X C= 100 2.3 2.35 1140 270U—.3 (LSE A ;PLACE U X I C= 100 3100.0 3100.00 1.00 310ii J FPRAISED VALUE D , ! J ! A 111.700 PARCEL SUMMARY U LAND 69700 S �^LDGS 4200C T ' M v—IM,PS E I I [TOTAL 111700 N I I I _ _—ATE T�_ d C N S T T I DEED REFERENCE TYpa D M Rawa�y R I C K YEAR VALUE Book Page Insr. MO. 111,Dl Sales Pripa LAND 69700 S � C110412 I04/37 A 1 6LD61-5 42000 C8900'1 107/82 80000 OTAL 11170C I BUILDING PERMIT INumber Dete Tvpa -- Am nl LAttiD LAND-4 DJ INCOME �15E 5P—ELDS I FEATURES c LD—ADJS UNITS 6970E I I I I 1000— Con- Total year Ruin Norm. Obsv. Class Umis Units Base Rale Atli.Rate A 1 Aye Depr Contl CND Lpc �ro R G Repl Cpsl New Atll Repl Value Stories Height Rooms Rm 11 Rmlhs a Fia. Pmrtyrvmll Fx. 01C— GUO 105 105 5.3.95 56.65 57 65 29 66 100 66 63581 42UJJ 1.0 4 2 2.0 9_0 ption Rare Square Feet Repl.Cost MKT.INDEX: 1-O 0 IMP.BV/DATE. / SCALE. 1100.75 ELEMENTS CODE CONSTRUCTION DETAIL 1GG 56.65 1140 64581 G - SS AREA 1 14 G SINGLE FAMILY DWELLING r,NST JF:"JO N *-----16----* STYL?= 03 �ANCH 0.0 6 ! DE SI•S NCJ"1T )1 )c5 [G i ADJUST :.l'i *---------------44---- ------ * + - - --- - -- I TE R.;7.4LL i J1 tUOD F.4ii 0_G EAT/AC TYP"e =J1 JONE- ----- 20 ih a R.FItiISH JU -- - 0 0 ! ! IINT=:R.L.AYJ+JT 12'a°VER./NORMAL 0.0. ! I c 3A� t .AS EXTER. u.Ul EASE *--1G--* ! i1ti z.:.'JALTY -�;-- -----=i- ! 8 6 ! LJo 2 STP;JCT u7 400D JOI ;T----- - 0.0 T 114E t1 k------'G------* *-----16— R0;J�-- TYp-t- J - -- - 0.0 E plat Areas Aux Bass _ ---* ] 0 ^jI .T BUILDING DIMENSIONS ! =L_L I �'.li-_,_L___ _)V _____-..____________ =,`: ;AS iJ3il E44 N06 El S20 '�116 N06 + + _-. - T1 - - A W1J AS S08 W20 S14 W14 vUiJDATION JG --------99.g ______________________ L + + JLi<;NsORC 35WC SHORT BEACH CENTERVILLE � � • + + LAND TOTAL MARKET PA2CEL 69700 111700 X----14---* AREA s �T.a`JDARD 25 RESIDENTIAL PROPERTY MAP NO. LOT NO. STREET Short Beach Rd. Cant erville FIRE DISTRICT SUMMARY 2o6 43 C-0 73 LAND BLDGS. 13 OWNER yi- cZ-,-.�.Gt.vzr w TOTAL c LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: _ BLDGS. Sullivan Joseph W. 7/20/59 180 18 B ^ TOTAL e `d aL LAND Ft CIE, , a /ir .1 a 1 I BLDGS. Of TOTAL LAND rn eLDcs. 7 TOTAL s LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: BLDGS. r ^ TOTAL DATE: „� �I ,. _-1./ ;* (� LAND ACREAGE COMPUT TI NS A Q �.2C, G: ✓ BLDGS. ND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUS T 3 9)o o o LAND CLEARED FRONT BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR � BLDGS. _ WASTE FRONT TOTAL REAR LAND a) BLDGS. , TOTAL LAND �S m BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH q6 FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND BS ROUGH TOWN WATER � BLDGS. HIGH GRAVEL RD. ^ TOTAL LOW DIRT RD. LAND SWAMPY ma gn BLDGS. FOUNUAIIUIV 1 oarvir. ..a — - I i ICI� .r� . LAND COST e.WaIU Fin. Bsmt.Area Lt. Bath Room / Base PD 13LDG.COST e.Blk.Walla ! ? Bsmt.Rec.Room St. Shower Bath Bsmt, PURCH. DATE e.Slab Bsmt.Garage St. Shower Ext. Wells PORCH. PRICE. k Walls Attic .&Stairs Toilet Room Roof RENT y, s Wells Fin.Attic Two Fixt. Bath Floors --- � a INTERIOR FINISH lavatory Extra t. F 1 2 3 Sink / Plaster Water Clo. Extra Attie z1 a 6 XTERIOR WALLS Knotty Pine Water Only 1•� �3`y as �a /arr Ibis Siding Plywood No Plumbing B smt. Fin. , (' , Int.Fin. O le Si ing Plasterboard 5 Shingles TILING — 30 Blk. G F P Bath Fl. Heat Q '�O , Brk.On Int.Layout Bath Fl.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath Fl.&Walls Brk.On HEATING Toilet Rm. Fl. Fireplace Plumbing /y d Com.Brk. Hot Air Toilet Rm.Fl.&Wains. t' Tiling Steam Toilet Rm.Fl.&Walls , ket Ins. Hot Water St.Shower If Ins. Air Cond. Tub Area Total , Floor Furn. S ROOFING COMPUTATIONS h. Shingle Pipeless Furn. S.F. , d Shingle No Heat S. F. s.Shingle Oil Burner S.F, ' e Coal Stoker S.F. Gas S F OUTBUILDINGS ; ROOF TYPE Electric S.F. 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 ME SUR•ED le Flat Mansard FIREPLACES S.F. Pier Found. Floor P11• brel Fireplace Stack / Wall Found. 0.H.Door LISTED f t FLOORS Fireplace Sgle.Sdg. Roll Roofing , C. LIGHTING Dble.Sdg. Shingle Roof h No Elect. DATE e ' Shingle Walls Plumbing dwood ROOMS Cement Blk. Electric / " AW h.Tile Bsmt. lst,�� TOTAL / 7 J� 0 Brick Int. Finish P gle 2nd 3rd FACTOR ��/-- I REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. LG. = S" — 757 /c / 0 7 �1 /'� 3 ba L/ 'e- /O0. 2 3 4 j 5 6 a '7 8 10 TOTAL , Yn � FTEv.. \invtir t 1 1 p _ �•U .. IIII lilt... r-T- -16 I a t•'y 0 N- 1„i�K4 o It E L.�V A T'1 e N a - i tk � j!{,tt�5 Berg lite Jk N �. ..�"� T ... o d niesYc/tt2 ce..rEue Fksya-_ Ef cc YIA.. �-+-----� - 10•-1°--- - -- I t t4let- Dam I F • _ 59P WA oi v I � i_ I O _ 1 s. •o� 1 1 I , l.cL Era11 - • -- - 1�Z? Klew /'mN5TR1�-T to rvS b F— b3A•it'>�S�Y t lr►-.fLh�©r�T._ s _ ' - SCALE:. I'-O" APrROVEO 61: bRwwn BY t�f,�,t; - - OATS: q - 11-a 2- - - _ - --- --- -_ - • 4FFew n. � B! ' L r V A. j- I--p h4_-- t_ ,.!..,„ter r. s e. F- le I -- — —- 1+O t/S Ull..- ;�-,tMoDEL.W/ 4DiTI6A4S )4-E - - --- - HE a L y 41 LI G _...- 4 i 2�• ➢.T R 16$4A!1'7---pia- _-_ b L3Fac Tt,>=MOVE $I-AC,K•TDI9 I. ... .-_ _ 1 i - - _ --.. KALE S I -OT APPROVEDaY; �O R. 2p.a D D G ORAwNN ey T3 i_ I q F H 44 �,zzy - w rv�nT'.o'►.+5 - DATE: - +lao- 72 '1._V A 1A 1.-1 - ' L�Pr ,slos fit F L fnU�P I H S 1 Gt nl ' � 1' •. , .� _ DRAWING NUMBER .