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�DF1HEr Town of Barnstable. *Permit#
y�P ti� Expires 6 months from issue.date
Regulatory Services Fee
* BARNSTABLE,
6.3 ,�� Thomas F. Geiler,Director
prEOMP'ta �N=AIL?Ios �
Building Division
Tom Perry, CBO, Building CommissigePESS PERMIT
200 Main'Street, Hyannis, MA 02601
www.town,barnstable.ma.us AUG 2 5 2009
Off ice: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESILP AF614B JSTABLE
Not Valid without Red X-Press imprint
Map/parcel Number_.._
Property Address - so. �/I//V �T_ CCAA/C'f'y lik- AA, U ;L C 1?
Residential Value of Wort. Ej CMG' "— Minimum fee.of$25.00 for work under$6000.00
Owner's Name&Address Yve 1/'i�/V ell 3 so, A,A/ 1�.
�a.4,4CP VI I7e. : .02�'�
Contractor's Name_ J o-/Yie s _/a ciyp.`✓ Telephone Number LfOl—tJ 71-6460
r
I tome Improvement Contractor License#(if applicable)
Construction Supervisor's License# (if applicable)
[�Workman's Compensation Insurance
Check one:.
❑ 1 a a sole proprietor -
❑ 1 the Homeowner
have Worker's Compensation Insurance
Insurance Company Name e tyc l :. 64A f" -�,AlS Cd7
Workman's Comp.Policy#
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)
❑ " -side
Replacement �dos/doors/sliders:U-Value �: .(maximum:.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
"Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
SIGNATURE: rt�t.
Wl'f 11.1-MFORMMbuilding permit forms\EXPRESS.doc
Revised 100608
The Commonwealth of Massachusetts =
-"- -Department of Industrial Accidents
Office of Investigations
tt
600 Washington Street.
Boston,MA 02111
=?-=" www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ®Q�f v ('j e
Address: �137 Park ees
City/State/Zip: ��/� fRT d , 5 Phone#: 40—w7/ 0 0'
Are
am a employer with � 4. ❑ am a on an employer?Check the appropriate box: Type of project(required):
1 I l d I
. d- general contractor an 6 ew construction
employees(full and/or part .=time).* have hired the sub-contractors' ❑
2.❑ I am a sole proprietor or partner- listed on the attached sheet. -T ZRemodeling
..shipand have no employees These sub-contractors have 8.
❑Demolition
working forme in'any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.
t 9. ❑Building addition
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 o workers'com right of exemption per MGL
Y � P. --12.❑Roof repairs,.
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant 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.
$Contractors that check this lion 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.
I am'an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AV6
Policy#or Self-ins.Lic.#: �p Expiration Date: /o
Job Site Address: / / 1 AI. City/State/Zip:
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.-
I do hereby certify under..the pains and penalties of perjury that the information provided above is.true and correct
Signature: Date: o
Phone#:
Official use only. Do not write in this area,to be completed by city or town official'
City or Town: Permit/License#.
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3�City/Town Clerk 4.Electrical Inspector 5.Plumbing lnspecto.r
6.Other
Contact Person: Phone#:
Jjawe or mutraflauof onsumer,Affairs a usinm Regulation
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Town of Barnstable Permit:69,66
Regulatory Services Date: `q/dr
�01*1HE TOk Thomas F. Geiler, Director
Building Division Fee:a5 •60
�BnMASS. ,�* Tom Perry, Building Commissioner �yZj�J�`U�
1e39. �� 200 Main Street, Hyannis, MA 02601 Lv%
AlFo �a www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: 1���� ��;�: Phone: 608"7:3- g37(
Install at: 3 l �c�G`� . J�- Villager
Map/Parcel: 22 _ Date: 2S 1 Z2' 0sy
Stove
A. New/ se
B. Type: Radiant/Circulating
C. Manufacturer: �p�e� , Lab. No.
D. Model No.:
Chimney
A. New/ ,xistin (ff existing, please note date of last cleaning)
B. Flue Size
C. Are other appliances attached to Flue?
D. Pre-fab Type and Manufacturer ��E. Masonry: Lined/Unlined en
Hearth
A. Materials: GI1t/"�
B. Sub Floor Construction:
Installer ' ""�Q -J
Name: �� Address:
Phone: 5C>k 73`7 - 3 qC0 C e- Vk&jA
Location of Installation: S ,PJygC 62(� ?j 2
H.I.0 Registration #.
Construction Supervisor
OR check_?L Homeowner Installing, no license required
APPLICANTS SIGNATURE
APPROVED BY:
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection, photographed, and approved by the
Building Inspector
Q:forms:stove
Rev 103107
I
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October' 3; 0 r
3 d .. s • ,
Attorney Donald. .Chas6n
:Mr. 'Guy..:Co let:ti.-, p :�
` The Centerville'Corporation r. , -
31 ',South Main' St.
":• Centerville, Mass. '02632.,
" , - •' yr �r- '". ,. ,.• � a - `ti {" ! 'C - ++
.-Gentlemen:.
Several,. complaint's to my�office have been .received
`'.• concerning. the opera ion' at'this address.' A phone call .to
,, ,
. =775-.4099-_ was verified,'by your 'secretary.
This address is located in ,a RD-1 district, The'
permitted uses are;-a- detached one .family .dwelling. and renting
,bf- rooms T.for' not.'more 'than.six (6) lodgers .•by. a''faznily.res_ dent 4>-
�'• ` in the -dwelling. 4
,k.
a `It -is therefore' not ,surpris'ing that`- a,. flagrant viola-
ton o zoning. `indeed exists: : This'office' is -citing= thist:vigla y
'tion:and directs-that this "operation ceases;`to operate at, this` ' #
. location seven '(7,) working' days .from the 'receipt .of this ,letter:
I .,trust that« noFfuxther .action will be necessary. ` _
Peace'`
'• r 4 f.I r, S` •.�f . t� ' rx - ac t' ,r,% t` .�"' S ,b s ^f�. " n«f' i
• '� gip: • ' t}` 'H••.'•' + � .� , ""} c ~• ��` - e
,.j s + _ `• F 'y�' t 3 . a a h .� � �'U V Dep 'iD' •Da
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-J{ cc: Town Counsel
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UNITED STATES POSTAL-SERUICE
' OFFICIAL BUSINESS
` SENDER INSTRUCTIO OCT D T
Print your name,address,and ZIP Code i tNe apa�ejb�eolw. U. I
Complete items 1,2,and 3 on�ie tevrse
o At to front of article if spa peJmiIs{
r ry otherwise affix to back of article. 6J
• Endorse article"Return Receipt Requested"
I
adjacent to number.
RETURN
r TO Joseph D. DaLuZ
I
Building Inspector
I
I (Name of Sender)
Town Office Building J
(Street or P.O.Box) i
Hyannis, Mass. 02601
(City,State, ,otd ZIP Code)
,
co 0 SENDER: Complete items 1,2,and 3.
o Add your address in the"RETURN TO"space on
0 reverse.
m 1. The following service is requested(check one.)
EZ Show to whom and date delivered........... A. Q
❑ Show to whom,date and address of delivery..._Q
❑ RESTRICTED DELIVERY
m Show to.whom and date delivered............_
❑ RESTRICTED DELIVERY.
Show to whom,date,and address of delivery:$_
lt . y11
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO: r
m Atty. D. Chasen & Guy C61etf-I 4 1
" he Centerville Corporation
z 31 South Street
s Centerville, Mass. 02632
3. ARTICLE DESCRIPTION:
m REGISTERED NO. CERTIFIED NO. I INSURED NO.
a 13716562
m
Gl 'Always obtain signature of amdressee or agent)
Tn
'+ I have received the article described above.
m
m
SIGNATURE ❑Addressee ❑Authorized agent
4.
1—is NCO
c
y DATE OF DELIVERY POSTMARK
T
S. ADDRESS(Complete only if requested) /
®
Z: Y L 1
a. UNABLE TO DELIVER BECAUSE:4 t:LERK'S
(INITIALS
D ZI
*GPO:1979.288-848
r
JOSEPH-D. DALUZ TELEPHONE: 775-1120
Building Infprun,
EXT. 107
TOWN OF,- BARNSTABLE
BUILDING INSPECTOR
TOWN OFFICE BUILDING
HYANNIS, MASS. 02601
October 3, 1980
Attorney Donald Chasen
Mr. Guy Coletti
The Centerville Corporation
31 South Main St.
Centerville, Mass. 02632
Gentlemen: ,
Several complaints to my office have been received
concerning the operation at this address. A phone call to
775-4099 was verified by your secretary.
This address is located in a RD-1 district. The
permitted uses are a detached one family dwelling and renting
of rooms for not more than six (6) lodgers by a family resident
in the dwelling.
It is therefore not surprising that a flagrant viola-
tion of zoning indeed exists. This office is citing this viola-
tion and directs that this operation ceases to operate at this
location seven (7) working days from the receipt of this letter.
I trust that no further action will be necessary.
Peace
0 eph D. DaL z
Building Inspector
JDD/df
cc: Town Counsel