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*Pe "It
YD
0*1Hk Town of Barnstable
yti Q Expires 6 morr(lis jroar 'sue[late
= Regulatory Services Fee
BARNMBLE,
M & 1$$ Thomas F. Geiler, Director
3 Building.Division
Tom Perry, CBO, Building.Commissioner
200 Main Street-, Hyannis, MA 02601
www.town.barnstab le.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number V(e co
Property Address �"'� -
/l p4 .
p
[?(Residential Value of Work�, J"J(J Minimum fee of,$25.00 for worlc under$6,000.00
Owner's Name&Address.
Contractor's Name7�? Cilr jPe Q/ S' Telephone Number �1 �
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) 7CAMIT
kh aww
❑Workman's Compensation Insurance SEP
Check one: _ �Q09
❑ I am a sole proprietor (Q /�
❑ I am the Homeowner OF 9ARNS 1_AE3LE
Y*1 have Worker's Compensation Insurance
Insurance Company Name �� / �'- �it A. A 4., G�of
Workman's Comp. Policy# It/[' �
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
)?fRe-roof(not stripping. Going over existing layers of roof).
Re-side
❑ Replacement Windows. U-Value (maximum .44)
*Where required: Issuance of this permit does not exempt compliance with other-town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License& Construct Supervisors License is required.
SIGNATURE:
QAWPFILES\FORM 'xpress\E PRESSPERMIT:DOC
Revise06O4O9
The Commonwealth of Massachusetts
Department of Industrial Accidents
y Office of Investigations
i
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LelZibly
Name (Business/Organization/Individual): /fig' i° IV (J
Address: 7 s Q: e
City/State/Zip:. R dM,+ 0AM 1 Phone.#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
,workingfor me in an capacity. employees and have workers'
Y9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
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 I LE] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.VRoof 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.
tContractors 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'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 and penalties ofperjury that the information provided above is true/hand correct.
Si nature: Date: / T
Phone#: Y! -3 � o��I l C)
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#:
�°.
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 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 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-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of
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 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 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
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax # 617-727-7749
www.mass.gov/dia
II
ILIA #-157567 CONN HIC # 061$916
THE RIGHT CHOICE EXTERIOR INC .
Windows 0, Vinyl Siding 0 Decks
Sun Rooms Remodeling
j Licensed 0 Insured -
' 375 Springfield St.* Palmer, MA 01069
Ph: (413) 589-0881 0 Fax: (413) 283-4910
CUSTOMERS NAME - DATE
STREET �- HOME P PNE
CITY,STATE,ZIP OFFICE
DESCRIPTION ;AMOUNT
e r ow ,
®`c
Buyer agrees p amount owed of balance upon completion of installation. Buyer may cancel above agreement of purchase at place
A
's place of bu mess provided you nalify the seller in writing by ordinary mail postage or by telegram not later than
u ' es d �l.J(Signature ..� _.
Spouse
Massachusetts- Department of Public S. *
Board of Building Re!„ulations and Standards
Construction Supervisor License
License: CS 43178
Restricted,to 00 -
JOSEPH"C GAMACHE JR f
375 SPRINGRELD'ST -
THREE RIVERS, MA 01080 -
Expiration: 12128/2010
Commissioner Tr#: 9448 ---
✓fze �aria�noruvea a��/�aaeac�u�ael�a
\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR.
Registrat o:, 157567
Erxp ration —j0%16/2009 Tr# 260110
Type Pn ate Corporation
THE RIGHT CHOICE EXTER1.ORi1NC'
r JOSEPH GAMAC
375 SPRINGFIELD`ST
PALMER MA 01069 Administrator
i
i
a ,
_
_) License or,registration valid for individul use only ;
' before the expiration date. If found return to: #
Board of Building Regulations and Standards
t One Ashburton Place Rm 1301
Boston,Ma.02108 r
Not valid witho t signature f'{
r
Y yy'• yE
O�tMF TOWN OF BARNSTABLE Permit No. ..32�9.2......
BUILDING DEPARTMENT
t "a'n I TOWN OFFICE BUILDING Cash
x67V•
HYANNIS,MASS.02601 Bond ..... ..........
{
CERTIFICATE OF USE AND OCCUPANCY
Issued to Margo Foster /_ 0b,,=,-+-a GO„rrh
Address 7 Weauaauet Lane
Centerville Mass
USE GROUP' FIRE GRADING` OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID AND THE BUILDING SHALL -NOT BE OCCUPIEDrUNTILttt
SIGNED BY"THE�BUILDING..INSPECTO,R UPON 'SATISFACTORY COMPLIANCEr';WITH'TOWN-
REQUIREMENTS'AND IN ACCORDANCE:WITH:SECTION 119 0 OF THE MASSACHUSETTSSTATE' a
BUILDING CODE `"
' Bbilding Inspector
TOWN OF+ AitjdSTABLE, MASSACHUSETTS BUILDIt�:�G�
DATE 19 PERMIT N.O.
APPLICANT ADDRESS -
�' - .• .(NO.) (STREET) !�'{
MBER OF
f PERMIT TOE- ''S "� �•' (_) STORY %-�• i DWELLING UNITS
IMPROVEMENT)'. NO.- _�y_.r•' - (PROPOSED USE)
S.;
/ �,l 1� ZONING
AT (LOCATION) DISTRICT`
(NO.) (STREET) +
BETWEEN _.__._.. AND_.
i (CROSS STREET) - .. =ACROSS STREET)
SUBDIVISION LOT BLOCK SIZE
i
BUILDING IS TO BE FT. W IDE BY FT, LONG BY FT. IN HEIGHT`AN6:SHALL CONFORM IN CONSTRU
fTO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA OR PERMIT
VOLUME ESTIMATED COST $ FEE $ --
' (CUBIC/50 UARE FEET) -
OWNER
- BUILDING DEPT. '
ADDRESS BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER T<EMRORARI
® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED ENDER THE BUILDING CQD'E, MUST E
'I PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION.OF PUBLIC SEWERS MA.Y,.BE OBT
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT.FRO'M THE.:CONDI
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS =WHEREAPPLICABLE_SEPAR<
INSPECTIONS REQUIRED FGR CARD :cP- POST_E f�_UN.?IL FINALINSPECTIOfJ HAS BEEtJ E .REQUIRED,. F
LL CONSTRUCTION WORK: - 2L,U.1. FOUNL'ATION.S TINt.S. - �,NDE - Y: 4� i,- +: '�' �^.T I 4=`(�?F-iP ,~.. 574J..1_ASdDt+L`"
`.2. PRIOR TO COVERING STRUCTUPALICU!RED,StJC!{^BUIL7ING SHALL NOT BE OCCUPIED UNTIL
s
MEMBERS(READY TO LATH).
3.-FINAL INSPECTION BEFORE I FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY. •!'-;f k��:
r POST THIS CARD SO IT IS VISIBLE FROM STREET` _°"Y:
i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS,
1L. ao
3 HEATING INSPECTION APPROVALS ENG114EERING DEPARTMENT
I
SAS—
y
_OTHER BOARD OF HEALTH
WORK SHALL.NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND f 'i ,T 10 N INSPECTIONS INDICATED ON THIS CAF
TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED W I T II I ;.. „(j _ M THE ARRANGED FOR BY TELEPHONE.OR
CONSTRUCTION. E R M I T IS ISSUED AS !•�;'T' a: !\'I:, NOTIFICATION.
(� 6
0 V
3
,
,
C-
n a P
CERTIFIED PLOT PLAN
y
iyr3,r. h LOCATION
SCALE . .�.'.'=.`��.�.... DATE
PLAN REFERENCE . .. . . .. . . . . .. . . . . . . . . . .
•,:
26100 e 5,' 1 CERTIFY THAT THE E��.S.T . . f"OU�!Q. .. . . .
"zIPSTEa ���� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
L,,N,4 SETBACK REQUIREMENTS OF THE TOWN OF
./ . .WHEN CONSTRUCTED.
_ - DATE
ETiTioi�E.� — oL.19s,,49 /ee, ,gj7ti' T/L'UST REGISTERED LAND t
,.
Asse'ssor's office.(lst floor): �'`` o(: - ' THE
Assessor's map and lot number .... ......... STEM Mu
�,..SI��� SY of toy
f '` t m 'T 5L
Board of Health"(3rd floor):
Sewage Permit number . BaBa9?oDLE,
Engineering Department (3rd floor) M1.7J�... TOWN� ECAV(A _� +oo�j�o pv- \e�
House number PP y 9 _ — ---1"9-----
APPLICATIONS • Tf� a
Definitive Plan=A roved .b PI nnin Board --
APPLICATIONS PROCESSED •8:30'-9:30 A.M. 'and 1:00-2:00 P.M. only
'OF BARNSTABLE
TOWN t
BUILDING, INSPECTOR
APPLICATION FOR PERMIT TO
' TYPE OCONSTRUCTION :_
F ........................................•..................<.........................
o .�: . ...............19..L+��
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for-'a permit according to the following information:
Location .... �. I L�,lt.7..i�-P�.1/{z��... .... .. �.:G .. /1�.. ......... .. ............ .
.Proposed ,Use ... ���. ... ......(,t ...... ISP �... �G. �[Glfti�L,/. �,a,,. ...... ,
ZoningDistrict ...,. D.. ... Fire District
f� '-�'
Name of Owner :M4., laa.... ems../ ........ .......Address �. : ...�i.�GCC�....: Grl�i', . So
/ G.! �
Name of Builder 1�. C.....Addr&ss
Name of Architect L_ ..;./L....K✓ e.&I . ..... ........Address ......... . ........ ............
Number of Rooms ........7................................... ' � ...._........Foundation .• a41zl..�e4.I.....�1�.�� ............ .....
'—Exterior ..:CLv39>.t34' ........, ........Roofing .... /�..1� ..T•.. .��/.7 /tL L.
Floors - ' ......Interior
Heating � .1 .. �' . 6-4--•51. *.....Plumbing .......( ..�?/�`� ..' ..:/�i/nC':... .
5;
7.Fireplace ... ......... .Czc!'t ...7�..�...�.—.Gi✓ App'roximate Cost ....... ... s'Q:,.L�O
a Area l. ./..�? � :.....
iogram of Lot and ,Building with Dimensions Fee -, v.v
OCCUPANCY PERMITS REQUIRED FOR' NEW DWELLINGS
I hereby agree to conform to all the Rules and:Regulations of a Town f arnstable re ing'the ab ve "
construction.
Name ............... ....... ....................
Construct' n Supervis is License 4;.......`.`
J �
s FOSTER, MARGOO
►3. 1°J�+ Y,32492..:Permit for ...l.z...StorY.............
....... ingle•••Fami.lY..Dwelling.........
Location :35...W.Q I4Aq.z.Q.,. :....... Y tj
r. G. n vi I I.Q.............................. 17
~' Owner^ MAK.c cQ Foster.............
a Type of"Construction k Z 1A1�..` .....
.. n -
.. T
,Plot ................ ... Lot .......
f
Permit Granted .........Decem
....... ber...8....,......19 88 - � ,, ' -' _ • .
Date of Inspection � '7. ... 19' ri -
/ 4 _
Doote Comple gd ...... /J7.Q/.. ............19 _
w{ i
.. � / .:4 it �,. � • • r. .. � ,Nf - - l "+� �
,. tit 1 -
.�.. - a.t.,.-,._r�t..t�:s,,,'a.! ���$X�.�u}ge..4'rvnf:..::ba-S�i-.,...::.i`:e�.!??�..4.n:�.r'w::iKS'��'L'-«�r+,�4'8a.;d?w^re":�S+Jt�,a'•;.:1-�3i�'r,Ya�'F-.�i.r'..��.r+itrr�.. ��.ua['.cc�rar-m::a;v:,.r;ar:.._c^a..L'� ,,,:a�,s...w-�_
Assessor's office. (1st floor): a SG G 13S U Q / Sr. 00
Assessor's map and lot number ....... ..�. F THE T
.�
.. .......................... _
Board of Health (3rd floor): fO�P
��.
Sewage Permit number ...... ..........0.. ..<. . . ......
. J Z Bl$d_9T11DL6. i
Engineering Department (3rd floor): 7-5 �o rasa
� O ;i679• 6�
Housenumber ........................................................................ 0 YAY a\
Definitive Plan Approved by Planning Board --------------------------------19-------- .
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only
TOWN OF BARNSTABLE
BUILDING INSPECTOR rl
/J q
APPLICATION FOR PERMIT TO ......./T...�t/V ........ �t����Cu�l�
....
TYPE OF CONSTRUCTION ....(! ? li6......!`.-!?:f}� ..........................................................................:............
......... �.�..!. 19..<..?. �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ......... f ...........(� ,��!I T/-lllr./1 . .....A% ............................................
Proposed Use ..Cam, ,ST/? :T7G ........ !`'.....���//` .�fi..... yi'It' .........................
• r �'1
Zoning District ....... .. :. ........ ....Fire District ` CJ i.......................... f../t............ .. �..;'•.
Name of Owner ....;�
� .C.G?.....1 ..-? . .......................Address ....... .!./L. ,
Name of Builder .4-.t.....�z.....bcs—z-61(-t....T; .r......Address ?�?.... �7�D.... .[ .!'t2.1.!�'ld s..l.�.!�...../ ,,,
Nameof Architect ................Address ....................................................................................
Number of Rooms ......7......................................................Foundation ../.-Gr r?F�>�....(,.....�i�ct,"L1� .5...
Exterior ... �!4 13c......�./5 /.N...�r.:(.lf.......................Roofing ... / 7-....-�i�l�l��/.. .....................
t
Floors ...................................................................Interior ....................................................................................
Heating ..... ..... ! ..................................Plumbing .......`..° t1. ?..../PV! .. a .N %7
a ST
_ ...............Approximate Cost Fireplace ... ..............l.�2�•� � /...!...(.�,.>..�........... .......747/...00,h-�,,........... ..'?
Area ...`..:.......t�...... .. ./.. ........... .2.-
.s
Diagram of Lot and Building with Dimensions Fee ..............!a.. ...�" "
N ...............
a `
Y
1
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
. ,� If I hereby agree to conform to all the Rules and Regulations of the Town Barnstable reg.oxcling the above
construction.
Name
,r.......................... ............... .....................
Construction Supervisors License ....:..............................
i
FOSTER, MARGO 250r - i 1
4
No Permit fo ...!'?...S: q.-u............
Sinsl.e...Fami.ly..Dwelling............
Location ..75. Wecluaguet Lane
...................Centerville `
Owner ......Margo...Foster............................
Type of Construction .F!A]Aq
...............................................................................
Plot ............................ Lot ................................
Permit Granted ...DeCembeY....8,,,,,......19 88
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT COMPLETED 1 f1/9�- •