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HomeMy WebLinkAbout18/20 SUNSET AVENUE k:`�g -BCD" � ; can���= �Y E' ,• �3 q�y � � t ' iY., p :•� ����.d ��F�,u.�" �i.,i.r F v t ,. � r G � � � ., t q'• - :F' ° � .. � rid W > s ])14."(S /671/' 4iv �x v.at YY <•✓ _ a 'h w`-emu�t Y — t `:_ `_. . 'i� d . � .. a .. c•.. ., �. i o s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #�� 0136 3 Health Division Date Issued Conservation Division- Application Fee Planning Dept. Permit Fee. C " Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address -_Dd Stan Bret Village Ct�{i f L (� p Owner Address I Lo SSa l 17 0 tMi&A /)d OSPOI Telephone IOU- Permit Request - S M 6-11 &C-C L( - �/�07i'� b o 0(L -10 h- L k 5_9� 11d, � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District A Flood Plain ` yes Groundwater Overlay Project Valuation ' 1000 Construction Type Lot Size �� f3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Multi-Family(# units) Age of Existing Structure I W. Historic House: ❑Yes ❑ 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 Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes kNo 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: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - --- - ._� - ----Proposed Use - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -dUAN41ephoine Number Address r I /o ffrn (S�j License # �3 out Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING F OM THIS PROJECT WILL BE TAKEN TO &4S �— IJ 'oJ'G SIGNATURE DATE (o 30 ` �I FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED r MAP/PARCEL NO. r . ADDRESS VILLAGE r` y OWNER r i DATE OF INSPECTION: 1 4 _ FOUNDATION:.; c'"S " K &l, € FRAME t x " INSULATION r . 1, FIREPLACE ELECTRICAL: ROUGH FINAL . .t PLUMBING: ROUGH FINAL -�GAS, ROUGH S °` =ti;:z. FINAL v flNAL•B WILDING, 1 ,r DATE CLOSED OUT ASSOCIATION PLAN NO. r s s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t 600 Washington Street - Boston,MA 02111 c www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): Address: S�,UY�"1 'Ar City/State/Zip: V 6 r-11 MQj:� Phone Are you an employer? Check the appropriate box.boxr Type of project(required): 1.❑ I am a employer with 4. P5,am a general contractor and I 6. ❑ New 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 7. ❑ Remodeling , ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity.. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance S. El We area corporation and its 0.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' 13.0 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 box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 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 an enalties ofperjury that the information provided above is true and correct. Si ature: Y/ Date: Phone to: 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 Inspector 6. Other Contact Person: Phone#: �� I Information 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, express or implied, oral or written." 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 enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a 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 employmeribbe deemed to bean employer." MGL chapter 152, §2SC(6)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 s applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)o.f insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP_ does,have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the 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 law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related-to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone.and fax number: The Commonwealth of Massachusetts De-partrnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0.2111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.m_ass..gov/dia ,per The Commonwealth of Massachusetts \ 'Department of Industrial Accidents = W 0 ce of Investigations d 600 Washington Street Boston,MA:02111 -www.mass.gov/dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electri'cians/Plumbers Applicant Information // Please Print Legibly Name (Business/Organization/Individual : .�Rf� D a' ,I�� � �.l" ft ��-- Address: /q 6reP,j RYr AA City/State/Zip:. S' �L s'S Phone.#: IT1/4 r112� Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4:❑ I am a general contractor and I * have hired the sub-contractors 6 ❑New construction . employees (full and/or part-tune). �• Remodelin 2.®,I am a sole proprietor or partner- listed on the-attached sheet. ❑ g ship and have no employersThese sub-contractors have g; ❑Demolition employees and have workers' working for me in any capacity. 9, ❑Building addition comp. insurance.$ [No workers comp.insurance. corporation and its 10.❑Blectrical repairs or additions ,❑ required.] 5 We are a 3.❑ I am a homeowner doing all work ' .. officers have exercised their k1.1.[]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL° 12.❑Roof repairs insurance required.] c. 152, §1(4), and we have no q ] t ❑ Other employees. o,[N workers' 13. 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. tContractors that check this box must attached an additional sheet showing the na�c the sub-contractors and'state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workefs'comp.policy number. I am an employer that is providing workers'compensation in. for my employees. Below,is.thepoCicy and job site information. r r jj�� --• s7 Insurance Company Name: /`t L — Policy#or Self-ins.Lic. #: - Ex iratio Date: Job Site Address: Ci /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 tip 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 Investi ations 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: Ei2 L/l r `Date Signature — Phone# 7 7 Z f 7 �`S9 Official use only. Do not write in this area, to be completed by.city or town official • City or Town: Permit/Licease# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector `6.Other Contact Peison: Phone#: 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 hiie, express or implied,oral or written." 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 enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a 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, §25C(6)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,MGL chapter-.152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.'the performance of public-work until acceptable evidence of co npliariee with the insurance requirements of this chapter have been presented'to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation.and,if one numbers along with their certificates of necessary,supply sub-contractors)name(s), address(es)and ph, ( ) g ( ) Y PP Y insurance. Limited LiabilityCompanies LLC or Limited Liability Partnerships(LLP)with no employees other than the mp ( ) members-or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the 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 law or if you are required to.obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current. policy information.(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e'a dog license or pernut to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please'do not hesitate to give us a call. The Department's address,telephone•and fax number:. The Commonwealth of Massachusetts, Department of lndustrial Accidermts Office of Investigations 600 Washington Street Boston,,MA 02111 TeL #€617-72.7-490.0 ext 406 or 1-877-MASSAFE Fax# G17-727-7.749 Revised 11-22-06 wv.mass_gov/dia i Town of Barnstable Regulatory Services Thomas F. Geiler,Director � t63� ,�� Building Division PrfD µA{�' Tom Perry,Building Commissioner 200 Main-Street,_Hyannis,MA 02601 www.to wn.b arnstabl e.ma.us Office: 508-862-4038 Fax: S08-790-6230 HOrU_�OWNER LICENSE EXEMPTION t Please Print, ' iy DATE: ('� �n `JOB LOCATION: 13 —olb Ck v) nu m a street r,, vile gc "HOMEOWNER": I.0 (io�� `�� c9�✓ name (�(home phone# work phone# U CRRENT MAILING ADDRESS: �') 1`©JJ fty-X Effl;rg AT"c+Tma'A tY P code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMIEOWN"ER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or faun structures. A person who constructs more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner' shall submit to the Building Official on a form acceptable to'the Building Official,'that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) a The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that-be/she understands the Town of Barn in 16 Building Department minimum inspection procedures and requirements and that,he/she will comply with said procedures and requlmmcnts. Sign re o Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section'127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is rcquimd shall be exompt from the provisi ns of this section_(Scction 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." lrlany homeowners who use this exemption are unaware that they are assuming thrtcsponsibilitics of a supervisor(sec Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bft=results in serious problems,particularly when the homcowncT hires unlicensed pesons. In,this case,our Board cannot proceed against the unlicensed person as it W"ould with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,' that the homeowner certify that hdshe understands the msponnbilitics of a Supervisor. On the last page of this issue is a farm currently used by several towns. You may care t amend and adopt such a formIrcrtifncation for use in your corranunity. :fo ccxcm t rms:hom Q P try _ Town of Barn-stable ` Regulatory Services f f i v i f' MRN6TABL- f r v MIRQ $ Thomas F. Geiler,Director 1 yqL. . Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 0 Property Owner Must Complete and Sign This ection If Us in A B uil r I as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho by this building permit application for. (Address of J r Signature of er Date Print arne If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. `. Q:F0WS:0 WNERPERMISS)0N SOUTHW/ND CIRCLE R�oos� 0 L- X 0 �00 00 FENCE R-332.48 v GL i I I • I _ I I I , I #18 SUNSET AV. � co N 0 0, o L l APPROX. I Ln v� ca n o` I I. LO ri M I I Cn rn I I F- CB SET 68.57' SHE w FENCE S 74.10'20" E x aWALL CB SE co 3 , w 3 � o �+ I o V, LO oII I I 3 tO r�71 I i� r I N 0)+1 N I N8 SUNSET AV. I ^ n L, APPROX. I . I I I I I L-----_ J k\ REFERENCES SKETCH PLAN ASSESSORS MAP 226 PARCEL 171 #18 SUNSET AVENUE IN DEED BOOK 11407 PAGE 279 PLAN BOOK 92 PAGE 135 CENTERVILLE, MA 1 PREPARED FOR I off 508-362-4541 fax 508-362-9880 downcape.com KATHLEEN LOGAN down cepe eedieeeried,ux. DATE: NOVEMBER.8, 2010 civil engineers land surveyors Scale:1*=20, 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 0 10 20 30 -40 50 FEET - 10-228 LOGAN.DWG j 3 �q4 l�74T r r r � r 0 Town of Barnstable Permit# Expires 6 months from issue dale ° Regulatory Services Fee C` gl�4 ES PERMIT omas F. Geiler,Director C. ad FEB 0 4 Building Division 2010 Tom Perry,'CSO, Building Commissioner TOWN OF SARNSTASEt Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 7 Not Vatid without Red X--Press Imprint Maplparcel Number c2642G Property Address 0 Q s ti rs $ ]' 4V ER/Residential Value of Work'TJ (,0o a U J Minimum fee of$2-5.00 for work under$6000.00 s.. Owner's Name&Address / GT l e 03 V� a u t�a' L� a � f ��pSS6,o .sr r�Lr e7fr'sr~+yk-� IV t/ � �?0/ Contractor's Name �U y`�w z` S Telephone Nutnber r5 Q g/ > >Z L/ s� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Z5 / ❑Workinan's Compensation Insurance Ch one: m a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#_ Copy of Insurance Compliance.Certificate must accompany each permit. Permit Request(check box) Iff/Re-roof(stripping old shingles) All construction debris will betaken-to �� 5 ru/Jl l t"� 4 ❑Re-roof(not stripping. Going over •existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doorstsliders.U-Value (maximum.44)#of windows *Where required:.Lssuanee of this pemut does not exempt compliance with other town department reguLations,i.e.Historic,Conservation,etc. R"Note: - Property Owner must sign Property Owner Letter of Permission. - - A copy of the Home Im ovement.Contractors License&Construction Supervisors License is SIGNATURE: C:\UsersCdecoll kAppData at�Ibfierosoft�WindowslTemporary Internet FileslCoruent OutkwkWSTGUSQO\EXPRESS.dae Revised 090809 ffMwX4w&A(&�tion License or registration valid for individul use.only ROVEMENT CONTRACTOR before the expiration date. If found return to: HOME IMP I Office of Consumer Affairs and Business Regulation Registration: 139619 10 Park Plaza-Suite 5170 Expiration7/28/2011 Tr# 286215 Boston,MA 02116 f Type MA } ;rr . JOE POWERS HOME RENOVATIONS JOSEPH POWERS 130 FULLER RD CENTERVILLE MX02632% Undersecretary Not valid without signature i. -'� Massachusetts- Departmcnf of Public Safety . Board of Building Regulations and Standards Construction Supervisor License License:. CS -80579 Restricted.to: 00 t JOSEPH W'POWERS 130 FULLER RD CENTERVILLE MA 02632 ------------------------- Expiration: 6/5/2011 Co-missioner Tr#: 17417 t, • t * BARNSrABM 3 9. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �J10,M as Owner of th e subject property i hereby authorize J0'L 010W�P—r-S to act on my behalf, in all matters relative to work authorized by this building permit application for: /�- ao Jun s-e,& (Address of Job) Signature of Owner V Date '��P �ntNa�me If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppDataU,ocal\MicrosoR\Windows\Temporary Intemet Files\Content.Outlook\4STGUSQO\EXPRESS.doc Revised 090809 - I S The Commounw dth of Massachusetts Department of Industriaai Accidents Office of Investigations 600 Washington Street Boston, 4 02111 srmi inns >dia Workers' Compensation Insurance Affida-vit:Buikkers!Contr orvTlec tricitasi %mom Applicant information Please Print Name 130 �l�r ' C jStatLZip_ LleAi cfU I }� 0ocaose4 Alec yan an ernpl yer'Check the appropriate box: Type of o s 4_ am a al a:�eta.�r and I project�,� '�1� I ener = 1_❑ 1 am a employer with ❑ � b. Q dew construction los (fu11 andlor part4 me) have hired the sub-cont€actm I i am.a sole proprietor or der- listed can the attached sheet 7- ❑Remodeling xip and haver no emploven Thew sub-contractors have 11_ ❑Dim-.lition -wo-4zing fbr me in any ci employees and have wogs' a3' - 9- Q Building addition [No wort 'coin inmrance CMP-tus- required k 5. ❑ We.are a corporation and its 10.❑Electrical repairs or ac w 1_®I am a h ume doing all of om ha exercised dim 11-❑Pluanbing repairs of additi se f o work right of exemption per GL � c��- 1�.Q laoofrepairs insurance required]` c..152,§1(4),andwe have no enqploy -[No w&xers' 13-0 Other comp.inwrancerequired.] IAW Mhtent that checks box:#1 mna2is*falomtba.seciionbdow-4wwin-ibeirweAerV campellsawnpolmyiEffannstim o mit this sf davit i ke g are doing all.wott Qikm Bore omtside xantrsctors mn-o subnW anew affidavit m&ca=g sacb_ :C-E;&-t—that tlai box¢ate[M—bg k ate addituos+al sit showing d!,--mine of ibe sub-corsua*RGn and state whathet or W Wase en dries bave empbwe U the sub-conta_-ton have en?lmyees,fiteY rmtst pYa nde.thaw warl£lars.'cmmap.policy am bff I am are a;;Ph?tw that ispaavngdin vrorkers,enrni nsaa&n insr rance for jk emple lees- Bdow is thepvM arad jab s ae inaf armardoiL 1:nsuraace Company l e: Policy#or Selfins.Liic.9 ExpirationDate. Job Site Addre-ss: CityiStaWZip: Attach a copy of the workm'compensation policy declraratioau page.(shooting the policy aaurnber and expiration date). Failure to sec"e coverage as refired under Section 15A of 11GL c. 152 can lead to the imposition of criminal penalties of a free up to$1,5€4 -00 asidr`or cane-year ifflpfigOrMiOnk as well as ci-61 pees in the form of a.STOP't O ORDER and a fine of up to$250 0 a day against the violator- Be advised that a copy of this statement may be fora ded to the Office of Investigationa of the DIA for instarance coverage verificatiou- I do hemby ns ranrel.p€naa% Iran uri,that the inforaaraation pM14W a e n#rasa and correct Sg trine,: . tits '" Da, /U Ph=*;U: O c°iai mse a dy..Da alalt wri&in ihir area,to bat coinapl€ted by eitl7 ar tareare.of ciaL Cad or Town, permiUlAceme. Ig Authority(circlet one): 1.Board of Health 2-Building Department 3.Cityfrorm CUrk 4.Electrical Inspector 5.Plumbing Impector ti.Other Coatact Ptinew. Phone . 6 Assessor's map and lot number ....... / • II Sewage Permit number� ? .f: ! ! !x.�........�...y...? yoFTNEra� TOWN OF BARNSTABLE : BAflH3TADLE, i "6 9• 0 a•g BUILDING INSPECTOR O 3 `0� t � YPY �' i c� APPLICATION FOR PERMIT TO f TYPE OF CONSTRUCTION ............................................... ...19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: - ... .....: ..... �f V ,aLocation .............. . c tit ;�/;l r ...... ........................ke Proposed Use ....... i� ..r! .................................................................................................. ...... ...................... ................................. Zoning District ..................................Fire District ......'..: ["f1�7`'•�' /% �'�'� ... �`r l�... . CName of Owner 4-1 t, ir.. ............!....:. 1 I- tl.....Address ..............r ♦� �Q..rJni!! . ...:!?...%.. .:..... r r � Name of Builder t �fj ? - .�1�C!r ��v ,.............Address ..�...<.!pG. c r^ �. �...- I �i'.'7' 7�? / / % ... r. Nameof Architect ............6.....................................................Address ...........................................................6........................ --, r Number of Rooms .................�............................................Foundation f� 1rD .. 1C' .......................:....................................................... Exteriorc-- . ............................................................Roofing ..............r? Floors '�' ................... .. -........................................Interior ............... ... .... / Heating ` � ......Plumbing Fireplace ...................� �r"..........................................Approximate. Cost ......... 'E .............................................. ` AeU'Al Area A/) (-1 J!� Definitive Plan Approved by Planning Board ______________________________19________ . ...................... Diagram of Lot and Building with Dimensions Fee ......... ....... ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all. the Rules and Regulations of the Town of Barnstable regarding the above construction. lG 1 w FAT 1.a.,-� Name ............... .................. ........ ....................... � Traywick, Mao.t1o/Cra1gv1lle Realty A=226-171 !x -_? 1 6 fire No —.l78l9.. Permit for _repa.1r.. damage told!Oell1om -----------~—.----------.*... ion----._ ---.---- . - Realty frame Type of Construction -----------'' Plot Permit Granted �4�!I Date Completed � - PERMITFUSED � -----'-----' .............................../...................................... � -- -- --------- ----. � --...— . . .. ............. ............. ' � . � Approved ................................................ lV ' ' ' ^ -------'--------^----------' � ______________________,,___ ..----- ....,.,,.,_,....- ..-„.,_„._.--•--+--.-.-- -.r'�.�r--•.�-ti....-..•r-ti.f•-�...R 7-w. - -r..-....rv+. d.s.....•......•.�.-...r-•. Assessor's map and lot number 6-. ?. /... SEPTIC SYC?4<:7 Pr',l:1:,7 FE Sewage Permit nurn ber ��{�: . .... ........ 2 Y NUANCE7y i ��QyofTHE.r TOWN OF BARNnC . I: �L_E Z B MA86 LE�O 9�G .039. MA `00 BUILDING INSPECTOR Y W c � APPLICATION FOR PERMIT TO ..............X•1••C �'.Q. ........ .. .z................................ TYPE OF CONSTRUCTION 40!5� ....tl ........................................................ ...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies four a permit according to the following information: Location ............ . ..��9...... ..lC.®SS. ... .�.!� ....... ...4?.` / }. .... eu.� .A.+�.1��II.Y.a.S. .�. .t...... t1-eT3cad ProposedUse ..........a. .................................................................................................................................. Zoning District .................� .... ..........................Fire District ......�.�C! /.1...�. ...<..�... �/ �llt�.. . j P qq •� l�� Name of Owner lam. �.. 7 .../.\.G� "...7. .....Address ...LLI��S. .../����✓ / (.. ....9 ` :...... Name of Builder 5.�Ob,*-- t.. /4.W��. .............Address .. 5.�..�5�.!.!vf......... ... �a Nameof Architect ...................................................................Address .................................................................................... Number of Rooms �7 d ................. .............................................Foundation .........�?..�..C.'.�.............................................. Al Exterior .............sJ.�.f./ q..1�...5.......................................Roofing ...........As.i..,�.! , .............................................. Floors ............... / .. /Ct.., ......................................Interior .... et l� Oaty. ..1..................... Heating ...........r./?.0./Zr..............................................:.Plumbing .................................................................................. Fireplace ...................;Fe.11Ls..*..........................................Approximate Cost .......�.�.�.�... .. ........ ...................... Definitive Plan. Approved by Planning Board --------------------------------t 9--------. Area / �. ... ... / •• cT•�j Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / Name ....J.... .. ... . . .. .. . . ....................... � Traywick, Martin / Cra1ov1lle Realty ' No ..... Permit for ..... .. dam fll w�.���.�r . Location --' — «' -------. ..��"=�~���—��..^— ^' ^ � CJvvne, .........0&yrtiu_ lle Realty .... .� .—. ---------._---. ' Typo of Construction ..........fvam------- ' ---------.----------------' °~ - Plot �� ---------. ----------' .+ |Permit Granted ...........Jnly...l5 --'.�.i9 75 ~ Dote of|nspechon ....... — . ' --'lP/ Dote Co mo��e6 '^����]l��.,�--.��—.]A . - ' PERMIT REFUSED .................................... 19 .......................... . . '—_---.....--------------.--. . ^ ~ .—.------.----------..—.----.. � . . —.-----.--.---.--..—.--..—.--.. � . Approved ................................................ lV \ - . ' !----------------....'--_--_.,_ -----------.---------.—...~.. ' ' _