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0045 WATERSIDE DRIVE
�/ � `{A �� %� ?� Uc.�'cS/cC..� �l t/lL _,_ a* 9 S Town of Barnstable Building t Post_This Card So That rt is VisibleFrom the Street Approved Plans,Must be>Retamed on Job and, his Card Must be Kept �ssx tPosted Until F mal Inspection Has Been Made ; A : Where a Ceriificateof Occupancy,is Required;such Buildmgshall Not be Occupied until a Final;lnspection has been made er it Permit NO. B-19-495 Applicant Name: JOHN T STRUMSKI Approvals Date Issued: 03/19/2019 Current Use: Structure Permit Type: Building-Deck Expiration Date: 09/19/2019 Foundation: Location: 45 WATERSIDE DRIVE,CENTERVILLE Map/Lot: 207-160 Zoning District: RC Sheathing: Owner on Record: DORE, PATRICIA A ContractorName' ,CAPIZZI HOME IMPROVEMENT Framing: 1 Address: 45 WATERSIDE DRY INC. 2 -"""-"• ContractorLicense 100740 CENTERVILLE,MA 02632 Chimney: Est Pro ect Cost: $37,000.00 Description: Remodel of 2 Deck area at rear of home. New Decking and Railing � •;4 J (12x14) and 11x10 remove the long deck to left of work area. 7x55 P,ermrt Fee: $ 110.00 Insulation: lower deck removed no replacement. s ' Fee Paid: $ 110.00 Final: / r ' Date; 3/19/2019 12 square of wcs at rear of house. . Plumbing/Gas Project Review Req: •, , kxrf .f ay-- Rough Plumbing: a P. uilding Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months—fter"issuance. g All work authorized by this permit shall conform to the approved application and the approved construction documen&fo&which this permit has been granted. - - final Gas: All construction,alterations and changes of use of any building and structures•shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clear) visible from access street�or=road and shall be maintained open fors ublic ins`ection for the entire duration of the PY P p P ti,4,f work until the completion of the same. " � Electrical 3 The Certificate of Occupancy will not be issued until all applicable signatures,by the Building and Fire Offici acre provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:l ': g Rou h: 1.Foundation or Footing �... , -- 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT dN � • �Ml� S�'�T !a! ' 4 � � Tpr,� Appliceif6aN=be[..i . .......... ..... �i►O; YVIL D(I�il,�E€� �r •.i rr''a • ss8r * t ; Perms Fee.. r _ :offier F � .: TOWN OF __ To aIF Paid......... .. -fi ........... . TOWN OF BARNSTABLE - �'` _ 4, `; lf ' Pew Approval by.. ........ . . ........On.... 11.4:[.1.9 - BUILDING PERMIT • . ::. 02 ....................1a..... . . APP_LICAT'ION ........:.........:..... .. G, G+tvx,,� s cov I— Section I . - Owners Information and Project Location Project Address 6- .VVATE?5iDE -,PT)Ve, y- 1 e CZ-0J4-eAye'11-e Owners Name PAT ZZ t'c.t'A —DO Y-e- • . Owners Legal Address /}T-P vJ t.ie� zt i✓e city -zip0 2 G 3y, Owners Cell# a 3 01 7 Q S"6 Frmai1 ?D O R e 31 a YA W y o . Goti! Section 2—Structural Use Single/Two FamsZy Dwelling Commercial Structure over:35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3-Type of Permit ❑ New Construction ❑ .Move/Relocate ❑ Accessory Structve ❑ Change of use ❑ Demo/(entire structure)• t Finish Basement 0 Family/Amnesty ❑ Fire Alarm Rebu 4 tad Deck DA C�'Cf` !� TApadfft.ld� 0lV lI In Sprinkler System ❑ A 'on ❑ Retaining wall ❑ Solar L-KRenoven-n 04 ❑ Pool ❑ Insulation Other-S 'sec J0J a&.t# t'�ecktx F 'u/A �l , f Section 4—Detail - -_ — Cost of Proposed Construction- '' -6/ Square Footage of Project 4U a2 D�Cev Age of Structure 1 q Dig Safe Nunnber .Y PL #Of Bedrooms 3 Total#Of Bedrooms (proposed) 110 MPH Wind7ZDnC-:omptcee Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last upditd:1117M17 . �-ec�c•IK� MA►Te✓i�►I Sly Section 5 -Work Description e �. 'R r-Mo -D e L o f o2 'l�e e,k, iARE,4.s . -R gax. e14 kol4e w "D e- e,V fKJ ARIA 'RAiLly► (' � 2`X ,y ° , ago (llx-la , 'D eC 1C7'�c �, -�'-4 o f=R- w OvIG ,a✓r�s _ l�-i �-�► ��. w is READ ® I- L; 0vS Section 6—Project Specifics -Whing - Oil T Sto e .` Smoke Detectors (] Plumbing ❑ Gas ; ❑ Fire Suppression ❑.Heating System ❑ Maso ey ❑`Addhelocate bedroom y Sewage Disposal 0 V Municipal " l�'On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility I am using a crane C Yes aN o A N A Fi LL Section 7-Flood Zone Flood Zone Designation ' Within or adjacent to a wetland,coastal bank? - Yes ElNo k `: Section 8—ZonMi TIIfOrination Zoni g!Dikrict Proposed Use S c NI l i Fa hi 1 1, Lot Area Sq.Ft. O 3 7 A c-r. Total Frontage ;8 ' Pie of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Proposed. Rear Yard R Propoka- w { Side Yard equired Proposed Has this property had relief from the Zoning Board in the past`? ❑ Yes No Last upddD&117=17 Y ACIORL�® CERTIFICATE OF LIABILITY INSURANCE FOATE(MM/°°'""' �.� 12/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC A°NN Ext: (508)398-7980 AIc No: E-MAIL ADDRESS: mail@rogersgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED - INSURER B: - CAPIZZI HOME IMPROVEMENT INC INSURER C: INSURER D:. 1645 NEWTOWN ROAD INSURERE: COTUIT MA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER: 348068 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP - LTR POLICYNUMBER MMIDDIYYYY) (MMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR - DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ]PRO-JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED (PROPER DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR HEACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - X I PER'STATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA WA NIA R2WC921272 12/25/2018 12/25/2019 - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of BarnstableACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601-0000 C Daniel M.Croyy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD WA-TP vd i a 1 _> R;V P- Page 1 of 1 C -pw-to✓�e'tle •" WUK REMo PEJ wirm New '© Ece.tk� A Jv RRiti 14 i 10 ca�E -Wu W, '21` . . DK -60 . 4 l� 8 0 )BAMT is-, 28 <. 8 32' 8 �, •18, 4 GAR 2 i .� emovc L e- http://townofbamstable.us/sketches 18/14648_15146.jpg 2/7/2019 N Construction Supervisor Commonwealth of Massachusetts sure Unrestricted-Buildings of any use group which contain Division of Professional lice Stan less than 36,000 cubic feet(991 cubic meters)of enclosed Board of Broiirfing Regulations tsnct Standards space. Cc�rttrctiaatf' iatlarvis+ar CS-064817 Expires'.061181202C JOHN T STRUMSKI s' 19 ALDEN AVE-- ppp*** BuzZARDS BAY MA OU32 r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. ry For information about this license Ran vaitd for return� �(t earcE-WPR�EK COtiTp GdV gC1OF1 irethe o eld a*m •�:S� ca<a Emamom �°� 100740 CAPIVI HOME IMPROVEMia". JACK STRUNSIa - ( Not t#I�totit sigrgtbtta 1M NEWTON RD. Under ► 00'1'UIT,MA 02036. . Supervisor Unrestricted-Buddings of any use group width contain less thn 3111;1 11 cubic fed(991 cubic hers)of enclosed spac v r t Fame to possess a c meat edition of the 11111148sedmseft State Building Code is muse for netrocalbian of this 11100mr- ' '!'baron about this fte1se a Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I/WE a1n oc pie OWN THE PROPERTY LOCATED AT -i^ �'' �IN {� h jfi^�!� {� • ,MASSACHUSETTS. , I HAVE AUTHORIZED , CAPIZZI HOME IMPROVEMENT JO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. s I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: x= ' OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: T'he Commonwealth ofMassachusetts Z Deparhnentoflndust alAccidents i3 I Congress Street, Suite 100 Boston,MA 02114-201 T *a "� www.massgav/dia "Porkers' Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plumbers. TO BE FILED WITH THE pERMITTING AUTHORITY. Applicant Information Please Print Legtbly Name (Business/Organization/Individual): - C A p i Z Z a Home T M pyey e N rni#- =N t, Address: 1645, Ne4!-1'nuv n 'kVA a City/State/Zip: e a Tu i+ , iY( o 26 3S Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[Z1 am a employer with�o + employees(full and/or part-time).* 7. New construction 2.o I am a sole proprietor or partnership and have no employees working for me In any capacity.[No workers'comp.insurance required.] 8• tRemodelilig 7a Gk i 3.a 1 am a homeowner doing all work myself.[No workers'comp_insurance required.)t 9. ❑Demolition + V-4 1 L 4.a I am a homeowner and will be hiring contractors to conduct all work on my property. i will 10 Building addition. ensure that all contractors either have workers'compensation insurance or are sole 11 Electrical repairs or additions proprietors with no employees. 5.Q I am a general contractor and I have hired the sub-contractors iisted on the attached sheet 12.a Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.* 13.[]Roof repairs 6Q We are a corporation and is officers have exercised their right of exemption per MCL c. 14.r7Other S t Pi,Nt, b y 152,§1(4),and we have no employees.[No workers'comp,insurance required.) N'-e ele�— /_0 v j� **Any applicant that checks box#1 must also fill out the section below showing their workers'.compensation policy information. �'l Homeowners wito submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit,indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether,or not those entities have employees. if the sub contractors have employees,they must provide their workers'comp.policy number. I am an employer that is prodd1%workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: i4 H G uA P p =0 Su F-AwCe Co M pg.4u y Policy#or Self-ins.Lic.#: 2 2 W C 8(0 31 Z Expiration Date: 12 ..� 2019 Job Site Address: wad P✓/�' 2 ✓� a Nfe✓L/a ll Attach a copy of the workers'compensation policy declaration a e(showing City/State/Zip:thepolic � P cy p g wing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. - I do hereby fy under the pains and penalties of perjury that the information provided above is true and correct Si atur (J L1 ` / `f Date: Phone S� `t a 9 S' 1 $ Official use only. Do not write in this area,to be completed by city or town ofllcial 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#: S1 l� ♦ If �7 PPP//t 1 - \�'J —� -,.__ ;�^• _;a� _. _ � 7�.:� �� - 4 L[ S,tea A Air ���J �f i. .a✓fayf - r (d R�/ K ;Qd ��_x r_ IV .�'�41y t�t'1-.. y ��K\�� �S.y,.�,\ � I +� // ter'• ��6I n� � :1 �Ri�+ � ,�t� � � �s Ali �: `�\� _ ayr .,• a � 4 ��. � 1 � 6'S tl 't 1 A'= •�� �ll�/�iaY 7.�.:i�/��,, f.lf %a'r� 4..„►�<� � a..�r - ;� r. ���,:Ya� l �`_ ,.,�; � � i � I , . �IV -------- V fAYv , S ii AA 3 i v1 At Section 9—Construction Supervisor _ Name �o u tit - S4VUM d lei Telephone Number y 4 4 4 Address Ca pt*zZ1 l40ke ZK Py®✓City C-OT-U/ ' State Hit Zip License Number G.S License Type y Expiration Date d to l ►� zo e Contractors Finai1- -Pe R Kl" t e Cx?;Z-Z 64e, Coat Cell# 17 y I understand my responsi'blities under the rules and regulations for Licensed Construction Supermor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedares,specific inspections and doc�mmeatati quired by 780 CMR and the of Barnstable.Attach a copy of your License. Signature , D Section 10—Home Improvement Contractor Name fh# StyvKrlri CQ !_2?� Ume TelephoneN=ber Sad fo `�oc 02 G y 14gf Neu�'law Address �! Citp Lo T U t`l state MA-Zip- _ 04 3 Registra�io L Numb��6`t F�pir an Date l Z. l 7-a 7-0 Iunderstandmyrespamsibilidesunder the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Mass usetts State Building Code: I understand the construction inspection procedm es,specific inspections and eum doe�on by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date d 102 I q Section 11—Home Owners License Exemption Home Owners Name: U Telephone Number Cell or Work Number c - I understand my responsffi ides underZthez�regulations for Licensed Cansirnction Supervisor in accordance with 780 CMR the Massachusetts State Build n the construction inspection procedures,specific inspections and docnmeatation required by 780 CMRwn of Barnstable. • Signature Date ` APPLICANT SIGNATURE Signature Date Print Name C� � _- Telephone Number E-mail permit to: Te, e CA 122! �i0 M-e • j 0 N C 122i o MG /`� P16%le q kEAGr, TJU'C- i.ast� :ilnrzot7 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ FTstoric District ,. 0 Site Plan Review(if required) ❑ Fire Depdruacm A, Conservation y, ' ' ❑ For commercW work,please take your plans&ec*to the,firw deparkrient for appr'ovaL Section 13— Owner's Authorization I �lti5- -f#Q'� C , as.owner of the subJectP�Y hereby authorize to,act on my behalf in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name - Y _ •' Lastupdat=L Il/7/2017 - 'Fy:eve letl„ STy It F '..:. Tg � _ s� ToK . A e A IV.. . . TO : Barnstable Bldg.Dept. FO D`f i N Approved by: to c 4 r- Pexmlt 0:'` I y Town of Barnstable - *Permit# Expires 6 months from issue date Regulatory Services Fee Thomas.F.Geiler,Director Building.Division Ce G/1 d/Z Tom Perry,CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstab le•ma.us Office: 508-862-403 8 Fax: 508-790-6230 )EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 45 tCe t—N `-ei Residential Value of Work t 0 0. 00 Minimum fee.of$25.00 for work under$6000.00 Owner's Name&Address 46 Vi a-�,die, FDr � � �►� e Contractor's NameW. U Lu�I Telephone Number Home Improvement Contractor License#(if applicable) I r S 1 Construction Supervisor's.License#(if applicable) I'� (� V m ❑Workman's Compensation Insurance Che one: JUN 2092 Q I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation•Insurance -TOWN OF BARNSTABLE Insurance Company Name Worla an's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Fl/ke-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders: U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property O t sign Property Owner Letter•of Permission. `copy f the Ho e Imp mt Contractors License is required. SIGNATURE: ( \ 1 . Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts.. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wM SJe'eW www:rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): amS Address City/State/Zip: QMS MA" OdUO f Phone#: '46 Are you an employer?Check the.appropriate box: Type of project(required): 4. general contractor and I 1.❑ I am a employer with � I am a - 6. ❑'New.construction ployees(full and/or part-time).* have hired the sub-contractors 2.53 AI am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub_contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers comp.insurance . comp, insurance.$ required.] 5, ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have.exercised their 11.❑Pnbing repairs or additions myself. [No workers'comp: right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. $Contractois that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. .. I am an%employer that is providing:workers'"eompev�sat�am:nsura�ice for:my .employees Below.s 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>yeah:impnsonment as.well as civilpenalties:in the::fonn of.a_STOP WORK<ORDER:and.. nq. ; 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-ffffu—rauce,coverage verification:: I do here un er the a" d penalti of perjury that the information provided ab love true and correct. SipnaLure: Date: Phone#: _1 Official use only. Do not write:in this area;..to be completed by cio.�,or town official. 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Geiler,Director IL AIEn �a Building Division Tom Perry, Building Commissioner, 200 Main Street, Hyannis,Mk 02601 www.fown.b2rnstable.ma.us Office: 508-862-403 8 Fax: 50B-790-6230 Property Owner Must Complete and Sign This Section if using A Builder as Owner of the subject property hereby authorize dal S U1 r It to act on my behalf, in all matters.relative to work authorized by building permit application for: Ce4-ry I Ie (Address of Job) f —Yon, l� �I Signature of Owner Date f olyi eAa— DUre. Print Name Q:FOAMS:OWNERPERMIS SION �� � t �•'"} , TOWN OF BARNSTABLE permit No. 2635Q • I Building,Inspector - 'r •unn,r. t Cash , - - 1619 OCCUPANCY. PERMIT Bond '-- ----- 0-Z2� Issued to Nei1j1F fter Address * iot' �5 watereide.Drives Ce itervi Lie- g P Wirin Inspector / Inspection date Plumbing Inspect r� Ar A ?� J +Inspection date Ir Gas Inspector � `1 Inspection date ,Engineering Department �✓ F Ins ection date Board of Health I Inspection'date THIS PERMIT WILL NOT BE XALH), AND THE<BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY,THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH_TOWN REQUIREMENTS-AND IN ACCORDANCE WITH_SECTION 119.0 OE-THE MASSACHUSETTS STATE BUILDING.CODE. ' ..�. .. 19.. ,.. .......................... Building Inspector A, - _ ! - FROM k' TOWN OF BA RNS*AB E- Mr. Francis .Iahteine BUILDING DEPARTMENT Town Clerk w-ffw-"7 *&4A1N STREET , .MYANN#S, MA 028M Phone: 775-1120 SUBJECT: FOLDHERE - - DATE October 22 1984 .E S S A Q E _ ,._M r,.R;. Work has been ampleted under Permit #26360 ;( Farmer) Please i' a«Bud:-w-- r DATE _ f E RPLY - �f SIGNED - - Ne7-RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY r `'PRINTED IN U.S.A. -,SENDER: SNAP OUT�YELLOW COPY ONLY."SEND.WHITE AND PINK COPIES WITH CARBON INTACT. i vo lao,A ~� RlCHARDA. - r^ I ( t BAXTER. W.2iO48 Ali T�/AT Tf/E2- Wit/yE,QED�C/COM.�L YS k//T� SCA L ,or ENE S/AE.C/�/E A�/�SETB.4Cf� �L��t./ .2EFE.2E�C� ;eE4Ui.2EMENi's; of THE �"aw�✓aF . . . Lb 2 E*A T 1? 'r,! ,�-H/. T 2 90 G OA TE ,BA XT,E.2 Tip✓/S �•L•4•t//S �l/®�" BASEO zul AA/ .E?E'G/STE2E.0 //v.ST—,2Uis/,E.c%T'„$'U.ei/EY� Tf•/E_ QSTE.2✓/.CL.�'a �''l.4SS• - ,� Ers sya��:.S,sr•�v��:�c%T a� � oti/S r . . �AssiE's'qcr s map and lot number: ; c7.. .�"�i ��a _3 (� ✓ r� /� �� THE Sewage Permit. number .... . ....... ....... lU '!. ..... T IL' i r ..L!.1 } 4 E D i i ' Z BAHH9TADLE, House number. ............... ` so + y rasa' MAY Ar, TOWN . OF' BA ASTABLE BUILDING: • I:N'SRECTOR ` APPLICATION FOR PERMIT TO I.... .......... .. .... . .. ..... .............:® ..... . TYPE` OF CONSTRUCTION' .... . .. . .. 4 ..... `..... ... ............. ......................................... k { 4 ..... .. ..d...........:.... ..Z TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap lies for a permit acco�di,ng to the' f owing ynformation: .. Location .................... ��.���.��.-fit,,, . ..�.�� .. .'1� �l. �.. ...,... Proposed Use \ 1 .,. ..I�1V✓i.. :... . .. .. ..... ..... ................. ....................:................ ..... . Zoning District ...... ..... .1.......... Fire District-!...`% % � .. . 'i. ?... ..i.�,.'...... f Name of Owner ..... . Address Name of Builde . ..... .. .. .Address aV .. �.�0.. '...�.:.. .... �., rr.""".. lr.�c- ' Name of Architect ..... Address ...:.............i...::......:....................................................... . ... ......... ......... Number of R oms ......... :... Foundati n ........� ..................... . •3 .... ......... ...�.. ...... ............ Exterior !L ..............: ..Roofing `\V ... ... ......................................... Floors �.. :.......... .Interior ...................... ..................... I........ Heating .... ... ...... . .......................Plumbing. . . .. ....................... :,' •• , Fireplace :. . ....:............:Approximate: Gost �. .............. .... .. .......... . Definitive Plan Approved by Planning Board '________________________________19--------r Area ............ ,......,:,... Diagram of Lot and-Building with Dimerision,s- Fee .............. SUBJECT TO APPROVAL OF -BOARD OF HEALTH. ,.. } _ Iv / r r: - OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of a To n f Bar stable rega ding the above ' construction: Name ........ .. ...................... Construction:Supervisor's License ...........� ........ . VEIL • No' .... ........ Permit for ..PPf ; tWKY.............. Single Family Dwellinq,Ldt Location ....... . ...45 Centery I ..... le...................................... Neil Farmer t . Owner Type'of Construction ....Fra lam...... ........ j(r{dam Plot ..........i....... ...... .... Lots ?.... �....... . PermYit'FGranted ....t Tpxi1..30,{ ., G9 Date of:Ins ection .. ..............................? 9 p r Date Completed ..... ! !/.•1 19 t! s• '=� ......... 71 i 1 Asses or'shma 'and 'lot number. .....�a.�.. �,.��r. ! *, _ - .,map',and ��- �p*THErO� Sewage Permit number .. .��:'........� llll!1!f. .......... ..... r,``P ♦� Z SAWSTODLE, S House number .............................. ....... !�..........j...... 90 Maea I O 1639. \00 0 MAY a' TOWN OF. BARNSTABLE BUILDING [INSPECTOR APPLICATION FOR PERMIT TO lr .: .. TYPEOF CONSTRUCTION. , . ....Y........ ......: ................................t......................................... 1.. .19 '1................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the fol-lowing information: u ;� / 'P 4 ` ter ` � ��r /J Location .1`� 41 ....... ... r .. '' ) !.!....... .4. . o ,.��. r� --------- ProposedUse ` _ ............................. .....:................,......................... Zoning District...A...............:....................................Fire District ................ Name of Owner ..... ..W..... ............ ....... ... .....Address .................................... I ....... �. �.. J... ......Address..?.!.. .?... l�.V.a. .. .. .......... . ..�3...... ........Name of Bui der��.! o � ................. Nameof Architect ....>...,...: ' � ...................................Address .................................................................................... Number of Rooms .........................................................Foundation [ .... ....!�t� �� . Exterior ... ... .... .... .......................................Roofin � ............. g ..y. .... . ......... ................ Floors �\�� ' .. .?........... Interior ..... ....... .. . ...:`..tL........ ...........................................A. ,. y.. .... Heatings'. ..'.... . '..A . ,.,.la-.......� !........ ....... Plumbing ... ....... . . ......................................................... r 11�Fireplace ..1 /" ...................................................Approximate. Cost �4 •��. ................ ......................................................... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH vo a .1 , i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ �\\ J=' ..........�.. ...................... ;r Construction'Supervisor's License ...................:................ FARMER/ NEIL A=207-160 26360 One Story No .................. Permit for .................................... ....... ....................... ...... Location ...Lgt...7.......45-WatersiAe-DrIva.... C . "L..................cm I;p Ville..................................... O-W� ner ........................................ Type of Construction ....Frawt ................... ............................................... ................................. Plot ............................ Lot ................................ - Permit Granted ...IV-�il 30.........../.................19 84 Date of Inspection. ....................................19 Date Completed ......................................19