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Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address V V Village Owner Address Telephone Permit Request %"i4o, Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation OVID Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Higl%way: ❑Yes ❑No i Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other a�+ Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ;Y 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 ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# —Current Use Proposed Use R BUILDER INFORMATION Name Loh i, 7154) Telephone Number Address W gD License# �w • '/ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /, ifi/L. DATE ` 1 FOR OFFICIAL USE ONLY s APPLICATION# DATE ISSUED ^r MAP/PARCEL NO. .3 {; ADDRESS VILLAGE OWNER DATE OF INSPECTION: . y. FOUNDATION FRAME Y INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING 1t,�01�s1 DATE CLOSED OUT • ASSOCIATION PLAN NO. r '3: The Commonwealth of Massachusetts " Department of Industrial Accidents _ Office of Investigations 600 Washington Street Boston,MA 02111 wrdw.mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ,k licant Information Please Print Legibly Name(Business/Orgmdntion/Individual): y. •Address: City/State/Zip: �SI /��f/��i� Phone.# Are you an employer?Check the appropriate bog: .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-time). Remodeling 2.❑ I am,a•'sole proprietor or partner- listed on the'attached sheet 7• ❑ g shi'andhave no employers These sub-contractors have g• []Demolition pemployees and have workers' avorking for me in any capacity. comp. t. 9. ❑Building addition [No workers' comp.insurance co insurance. 10. •Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ 3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Plumbing 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 13.❑Otheremployees.[ o• workers' 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 anew affidavit indicating such #Contractors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have employees.-If the sub-contractors have employees,they must providt their workers'comp.policy number. I viding workers'cornp�ensation insurance for my employees. Below is.the policy and job site' ani an employer that is pro information. Insurance Company Name: Policy#or Self-ins,Li_#: U ` Expiration Date: Job Site Address: LL �ey'' / 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 thq violator. Be advised that a copy of this statement may be forwarded to the.Office of Investi ations of the bIA for insuran e coveraize verification. I do hereby certify under the par s and penalties of perjury that the information provided above,is true and correct Date: Si tore: �y Phone Official use only. Do not wrtte 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 Phone Contact Person: #: I °f'ME Town of Barnstable Regulatory Services " SAMST"BM " Thomas F.Geiler,Director MAS& o; Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion; -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: - //I / Estimated Cost Address of Work: - U� Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): FlWork excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner:' z�& Date Contractor Name Registration No. n 1j. OR /j Date tv Owners Name( Q:fomns:homeaffidav 05-23-OT 11:52am From-AIG +9T3 331 6599 T-647 P-001/002 F-473 C-ERTt ' E ;'Sf 1200Z PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Oceanside insurance Agency Inc E DE 52 West main St HOLDER.LCOVERAGE AFFORD SY THE POLICIES S BELOW- Hyannis,MA 02601 e0MP7VN1Es AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Ralph Crosser) I Woodridge Road East Sandwich,MA 02537-0000 COVERAGE �'=' ; .� i ,. ,. �• :e -...,.:',;.,:. ,. ::.•:;;.�.;,,;- '.,:.; � '.:. .,:':•: . •.. ..1. THIS IS To CFTIFY THAT THE ROUGES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSURED`NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NbT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS SU13JECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co COLTR TYPE OF iN9URAN POLiOY NUMBER EFFECTNE OA POLICY EXPIRATION DATE A *AIOR COMPENSATION LIMITS EA7PLOTER6'LIABILIII E PROPRIETOR/ ARTNERSMXECUTFVE FFICERS ARE: TATUTORY LIMITS NaL a EXCL a 13861'.642 12/0612806 12/O6/2007 THER •Caftnoo AFPil"to MA openwm 9w, H ACCIDENT S 100,0 ISEASE POLICY LIMY $ 500'00 011 I ►SEA56-0ACH EMP YE 100 00 ESGRlPTION OF D.P',ERATIONMtVEHICLUISP. IAL ITEMS L CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE D5;CRIHED POLICIES 9E CANCELLED 9EFORE THE EXPIRATION DATE THBRI:OF,THE ISSU ING COMPANY WILL ENDEAVOR TO MAIL 12 DAYS WRrrmN NOTICE TO THE CERTIFICATE HOLDER NAMFA TO THE LEFT,PUT FAILURE TO MAIL SUCH NOTICE:SHALL IkPOSE NO OBLIGATION oR LIABILnY OF a ANY IGND UPON THE COMPANY,ITS AGWM OR REPR@SENTATNEB. - AUTHORIZED REPRESENTATIVE YM ri 1 ae November 30, '2006 Groin Ralph Crossen. . 18 Woodridge Road East Sandwich MA 02537 Re: Policy# CT -PAC6632212 (LIAB CARPENTRY/FRAMING) Effective November 6, 2006 to November 6, 2007 Dear Ralph: Enclosed is your new commercial general liability policy written with Penn-America Insurance Company effective 11/6/06. The policy has liability limits of $300, 000 per occurrence and $600, 000 aggregate limits and includes a $250 per claim deductible. Please note this policy does not provide any coverage. for Workers Compensation. If you have employees, we would be pleased to provide you with a quotation for Workers Compensation Insurance. Please let us know if you have any questions at all, or if you need any certificates of insurance. Thank you very much for placing your insurance with us. �. Sincerely yours 4'1re,t,7 Z_ STACEY L. MORAN, CISR SM(B)/pe 0 LOVEQUIST-MURRAY INSURANCE 0 OCEANSIDE INSURANCE AGENCY, INC. 0 OCEANSIDE INSURANCE AGENCY, INC. AGENCY INC. 52 West Main Street 200 Main Street PO Box 38 - 296 Main Street Hyannis, MA 02601 Wareham, MA 02571 West Dennis, MA 02670 Phone: 508 775-0500;.- 800 924-0052 Phone: 508 295-1150 - 800 696-1150. Phone: 508 398-2282 800 649-2282 Fax: 508 7, 7955 Fax: 508 291-2909 Fax: 508 760-2211 www. oceansideinsurance.00M oF�HEro,,, Town of Barnstable Regulatory Services Y A s B"'MASS,IE Thomas F.Geiler,Director y Mnss. $ ' �p 16g9. ♦� TFv�re, 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 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize � �G�hss `� to act on my behalf, in all matters relative to work authorized by this building permit application for: ress of Job) ignature o Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable �DF3HE tti Regulatory Services BARNSfAB[E, « Thomas F.Geiler,Director 9 MASS. 1639• A.0 Building Division TED MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip 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 s_pervisor. DEFINITION OF HOMEOWNER 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 farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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) 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 he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of 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 required shall be exempt from the provisions of this section(Section 109.1.1 -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." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would 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 he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:f6rrns:homeexempt F I � .. Jle'�oozz�norzu�cl/f o�✓ll�*1suctusella r� Board of Building Regulations and Standards License or registration valid for individul use only before the expiration date. I..f found return to: — NOVAE IMPROVEMENT CONTRACTOR Board of Building Regulations and Standard& Registration: 136972 One Ashburton Place Rm 1301 Expiration: 9/23/2008 Tr# 125243 Boston,Ala.02108 I Type: DBA f RALPH CROSSEN RALPH CROSSEN 18 WOODRIDGE RD Not valid without signature E.SANDWICH,MA 02537 Administrator �/ee �000xmwouuea a� aaaac/uraella Board of Building Regulations and Standards Constructing Supervisor License Llct#iiae .;C8 70029 f. 1,a/15/1947 l p1r Win?;_ '1#15/2008 Tr# 5682 y �ettion �. RALPH CROSSEN r 1 18 WOODRIDGE E SANDWICH,MA 02537 Commissioner f ! 1 1 i . f eAlt too v f ! Fab A� :. �} 122r►ev�_:a1.( cv�L� � _� � el2crrtcAL_i G<<c 1 e �ecuc� .�vo2� ►MOve. 3 W025 CRS2 ,a(( F p .✓/y _ t� I I � r9� ,_— �- _=--ram - � TOWN OF BARNSTABLB Permit No. 25355 -------------------------------- t Building Inspector ,. s�ar�aa : cash ------------ -------Bond --- - °�o rar►� OCCUPANCY PERMIT -------X---�� Issued to S L S Trust Address Lot 41, 134 Weguaeluet Lane, Centerville Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector ,/t/f Inspection date XEngineering Departmentr1� , � Inspection dater- Board of Health Inspection date /� -off✓- THIS PERMIT WILL NOT BE VALID, 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-OF THE MASSACHUSETTS STATE BUILDING CODE. j 19......_ _ ...................... .... ................... ........ ............. f Building hnspector L- y - 1 r, i r " lT 4,1 j N _t � Z FDUN PAT I U C�EaTI F 1CATION' { LOT 4.1 W <rQU,,QUc-T LA► C t j u UT g5 L1: �2VIt..I.E, P�ARtl,15TA�t..�,Ivtb. JIJL j ZZ) 1P>e� A-'`: 30' Qn tk `bas;` .s 'off zi'° igrlede. i4rmaion and certiytsto F rasult r o a iurvey seta a ox the ground VJM, V. ujA 12 W I LK i5704. I ��'he`��t_ ctnx►e�.���are looatea s on ;:the -site ,�.s - . BYa OWn.//!Cep/i�r�c 'N/�di ' ir 77a a >Tlae t t a�;lines az�d lime ,J'ation of -the tN o�F € :.site'-nre� ,� :shown ;>kee,on. x, �,�*V Mqs '�hed,s .te Zis . �.tuated., fin' F�ood'j:Lone 1 c' ° WnuAM 'I ` o un ty pane 0.2 o Zo Dates '�- WARWICK 'I z lx# a Y r R t r No..19,,' ! I Date�Y fay �?�}1vP xshi� e3 's '�4k" etas fF^. Q h yskr t-.lifrf� tY,�d"c9y'4 t•,1n�4�"}r� r!`f ,. -h _ +r :s = r f YO $Tv E � r }S 4 �tx. � � .�"♦b F n'+rtirf tY ,t�tt�il� yn�1T i p � `� � SVRv31 - � . ` p Assessors ma and lot number fJ T E OF TO Sewage Permit number' ...O.:.J/..P !................ /.. r�, .......... .� ,�=firArc NA 6 J :a` I SAHHSTADLE, i House number .....:.1 ...`..................: t r� Maea ............... , {• r i 9 ' 00 t639• ♦� , + 'SON OF31R NSTAE BUILD NG f PEC R APPLICATION FOR PERMIT TO Il...�. <........1..�..,.�...... /� . .. .. .. .I ,� TYPE OF CONSTRUCTIONf /•/•sc••••.•` •.................. ......... yy. .........,................... Jj C .,,.......... v TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordingI to the following information: Location ............. .. ....... /....(...............1 /. -= .!ll -z'�V.P.��r� .... ..� -�� 1••ti.�•�• � ProposedUse � !... .. . �, !�,�0e ,� ........................................................................................... Zoning District ............................ ...........................................Fire District .............................................................................. . Name of Owner ... .. ..��- .......... .....Address 1� / /... l�f..(.....f!< ........ 0 P f l 1 Name of BuilderZ A_�e. .I.A;.Aciclress Name of Architect 1/`.�Cj 05.....i e.q �ddress ..6,..J" .. //.Y... d . .......Number of Rooms ..................... .,�. ....................... .................Foundation ... .. .......... .. ... .... .... . Exierior .....<... A . �'?' ...A4..................................Roofing ....... . ... .. ...��h Floors y....w�a .., -. , nteriar ......�.�� .1.'.. ........... Heating \ ........................:.........................Plumbing ..C. <z t . fi- 1 ... 4/`0 - p . .......Approximate Cost ..............��� Fire lace ............ .. Definitive Plan Approved by Planning Board ________________________________19________ . Area ........... ��. ........5. .. Diagram of Lot and Building with Dimensions Fee 64.. .....•....' SUBJECT TO APPROVAL.OF BOARD OF HEALTH II D' 11� 1,� � 3 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding the above construction. Name .......................... r v S 'L S TRUST i. t Noi...2&535,5.-Permit for ...One,,,Stp-KY......... Single„Family...DMQ jj.jag............ Location Lot...41r...... . ... S ua ue.t...Lane _ ............. 0 ................................. Ile Owner .. .�I:..5..Trus: ................................. Type of Construction' ...Frame......................... � �--- /� � !' f f /7 - f , Plot ............................ Lot ..............................:. July 27, g3 Permit Granted :� 1,9 Date of Inspection f Date' Completed .....*� ............014 le-3 .. 1 PERMIT REFUSED"'" .................................................. ` 19 `.,r , `.�- •' ......................................................f..�........................ oe + .........................................................1 ....w. ........ �' 1,� ./' ✓ t«� .' ✓,.j - f f Ile r + i ....................................................... ................. Ile PP A roved � ..... 19 •y .......................................................... J �. ,f f I' i• r t� � Assessor's map and lot number � � Sewage Permit number ................:...................✓`!.........?..... Z BJHESTADLE, i House number MABa �p 1639. \00 iDlE'C YFY p,. 1 TOWN OF BARNSTABLE BUILDING _ INSPECTOR APPLICATION FOR PERMIT TO k- �................ .. !.... .........!......... ... ...... ..!.... `y y.TYPE OF CONSTRUCTION .................l ........ . i ................................... . f ..........19.4�..� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... ,� !i"a • `��...,1..............� �............... +�.�, , ^�7 �, 'r .. .... (-...:.{ 1`�/,�' /J//'C� Proposed Use y.. 1 „ 1 �. ........................................................................................ ZoningDistrict .......�...............................-.�.....-J.-................ '.Fire District .........,.,.�.............................�....�/...............�............. Name of Owner .....� .. .. ............J ...�..��..!.. f ..Add 1ress !%.. "/�f a!7 '`..! :....... � 11^lj5 Name of Builder / ?ra / ���f,/l # IF Address .................................................................................... Name of Architect ....... .,.. ... .. t'� Address Number of Rooms .2.. .............Foundation .6..'�� -! .�.,:�f-..,•!°�./� A _ Exterior ... 5'�•., ....... �. ...l.� ..................................Roofing .......r Floors ........ f' > ....` :..t ,�,t� d .:..Interior ............ r�- .......... } r Heating ......e...... ....................................................Plumbing ..<,....s.. ... ..;- i1,,,;.�G Fireplace .............'� .`'.................................I.......................Approximate Cost ..............L<... ... � .............................. Definitive Plan Approved by Planning Board ---------------_---------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 3 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / .� Name . r _.,. ... .....�. ....................... S L S TRUST A=250-20yv One Stor ° .............. Location .....Wt...41^-...1.14..We.quaq.uet. Lane ' ....................Q.ea t.p-Z\[ill��.............................. - Owner -. ................................. Typo of Construction -.FXaLzWe--------. --------------------------' Pk: ............................ Lot ----------' � Permit Granted ......July..2.7.�----.lg 83 � � - Date of Inspection ------------lq Date Completed ------_---.�-'l9 ' � � ' � PERMIT REFUSED � l9-----'--'~-r'----------' . ,_ . � --------.---------------.-- ......................'.........'..............'.........'...................... . . 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