HomeMy WebLinkAbout0020 CRYSTAL RIDGE ROAD �, cf
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Town of Barnstable )/D�
"Permit#
i -Regulatory Ser-vices ).mires 6 monrlis from ii-sue(tale
F 3115-, —
v 1659- Thomas F. Geiler, Director
i614- ��
Building,Division X P E S PERMIT
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601 OCT '� 1 =U;G
Office: 508-862-403 8 www,town.barnstable.ma.us, 'i OVVN-OF BARNSTAKJ�
'
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Nol flaiid without Red X-Preys Imprint
Map/parce l Number L9�76 ,&T 0
Property Address 61,0 ('a fc�'4 err itsc. CyTv;T
Residential 'Value of Work Minimum fee of$35.00 for woric under$6000.00.
Owner's Narne 8 Address
Contractor's Name
Telephone Number
Home Improvement Contractor License #(if applicable)_
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole.proprietor
W1 am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp. Policy{I
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request (check box)
fz/Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to 1�
❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of roo0
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders, U-Value _(maximum .35) # of windows -
*Where required: Issuance of this penmirdoes not exempt compliance with other town deportment regulations, i.e. Historic,Conservation,cte.
***Note: Property Owner must sign Property Owner Letter of Permission,
A copy of the Home Impr• vement Contractors License & Construction Supervisors License is
l quired.
f i
SIGNATURE;
r
Q:\WPFILES1fORMSlbuildingpermit forrnslEXPRESS.doc
Revised 072110
The C'onurtorrivealilr ofllfassachusetts
- - -: Depart7neritofIrrdrrstrial-4cciderrl's
" - Of ice ofInvestigafions
600 WashhIglorr Street
t - BoSt@rl, :'V 4 02111-
s n-wi ,inass.govldia
`Vorkei-s' Campensation Insurance Affda,,it: Builders/Con:tr,-tctorsJElectricians/Plumbers
Applicant Information Please Print Legibly
Name(Btt"sinem'01-gaLuza6on.gndividaal): /�t`��n��-�� C,-"L Re @tl
Address: A
C1ty/state"Zlp. Ak.k-X,.6 Phone? #. 15�,o 9—qc->,o "2? IFq
Are you an employer?Check the appropriate box.: Type of project(required):
1.❑ I am a employer with 4. 0 I am a geileral contractor and I
employees(full and/or part-time).* have hired.the sub-contractors ❑New construction
I❑ I am a sole proprietor or partner- 'listed on.the attached sheet- 7. ❑.Remodeling
shF and have no eat to Tes These sub-contractors have
p P ) $- ❑.Detuo.lition
working :for me in any capacity. employees and have worke•s'
[No workers' comp.ins;utance comp-insurance..? ❑.Building addition
equired.] 5. ❑ We are.a corporation and its 10.❑Electrical repairs or additions
3. I am a.homemimer doing all work officers have e�cerc.ised their 11.❑Plutzibing repairs or"ddi;tions
myself [No workers' comp. right of exemption per iMGL 12.joRoof repairs
ins-uraiice requited.] ? c. 152, §1(4),and eve have no
employees. [No workers' 13..❑ Other
comp.:insurance regarued-)
*Any applicant thatchxc};s box#1.must also fillout the section below,silo-wing their works'cotiTevsa:tion policy infor=tiarL
I Homeowners who submit this.affidMrit indicating they are doing all-wxoA and then hire outside contractors must submit.a itew affidavit indicating such.
yConlracturs that check ihrs box crust attacbM an additions[:she.et showing the:name of the sub-contractors an.d state whether or not'ihose entities have
emp0oyees. If the sub-canttactors:have employees,they.must provide their workers'comp.policy number.
I ant an;eutplo sr that is providing ii or,kees'corrrpertsation insurance for ray,errtplayevs. Belon,is the policy and job site
if form ation.
Insurance Company Name:
Policy#or Self--ins.Lic.#: Expiration Date:
Job Site Address: City/state/zip:
Attach a copy of.dre workers'compe»sationpolicy declaration page(strolling the policy number and expiration da.te).
Failure to secure coverage.as requu'ed under Section 25A of MUL c. 152 call lead to the imposition of criminal penalties of a
fine up to 81.,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP'WORK ORDER and a fine
of up to$250.0,0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of file D.IA for insurance coverage verification,
I rho hereby certify .r er the pain d at ` of pedury that the ii forttiatiort pro hied abotpa is trite and correct.
Simature: Date: 0
Phone#:
Q,�cial use only. Do not.trrite in this area,to be completed by citf or tottyn ofcial
City or Tovrn: Permit/License#
Issuing Authority(curie one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4, Electrical Inspector .5. Plumbing Inspector
6.Ot1te1.
Contact Person: Phone#
:x
of IRE Tp�
+ HARNSrADLE, + t
MASS. Town of Barnstable
Regula to ry'Serv;i ces
Thomas F. Geiler, Director
Building Division
Thomas Perry,, CBO
Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property ®wrier Must
Complete and Sign This Section
If Using A Builder .
I as Owner of the subject propeity
hereby authorize to act,on my behalf,
in all matters relative to work authorized by this biuldingpern-ut.appbcation for:
(Address of Job)
Signature of Owner Date.
Print Name
If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the
reverse side.
QIWKILESTORMSIbuilding permit forms\EXPRESS.doc
Revised 072110
4`
{
P�olKWE Town of Barnstable
Regulatory Services
* B.AFrSTABLE, Thomas F. Geiler, Director
lass. $
am,, Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnsta ble.ma:us
Office: 518-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: r 1
I e
1013 LOCATI(DN: �}� ��2 ►4[ �1 sC� 7)/ui:)e,
number street village
"HOMEOWNER"�� __` �� ✓
name V home phone N work phone N
CURRENT MAILNG ADDRESS: S
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 supervisor.
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.
4undeigned"homeowner"certifies that he./she understands the Town ofBarnstable Building Department minimum inspection
and requirements and a he/she will comply with said procedures and requirements.
oreowner
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:IWPFILESIFORMSIbuilding permit formsTXPRESS.doc
Revised 0721 10
<tM� 36342
TOWN OF BARNSTABLE
Permit No. ......... 3 ....
BUILDING DEPARTMENT
I TOWN OFFICE BUILDING Cash ......
.6}V
HYANNIS,MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to HORST DORNER
Address lot #7 20 Crystal Ridge Road, Cotuit
,
USE GROUP FIRE GRADING OCCUPANCY LOAD
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.
April 25 94
.. . .. . I... ... .. ....... ...... .
19................. J ...............
Building Inspector
��P.,�` rO•`� TOWN OF BARNSTABLE
BUILDING DEPARTMENT
! ssaaeTAIM : TOWN OFFICE BUILDING
'"'L
a6J9• � HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department .
DATE: '/w
An Occupancy Permit has .bbeen- issued for the building authorized by
Building Permit #.. t._1.G! ,_ »...
issuedto ....... , _ 4� .. LA........................................................... ................. .: _.... ._..... .;�:f� _ ..... . .
Please release the performance bond.
TOWN OF BARNSTABLE, MASSACHUSETTS
-A=55-.2-11 :
t DATE : NnyernhP_r 1g 19 PERMIT NO- F`
.APPLICANT Bayslde Builders - ADDRESS"". Centerville
INO.I (STREET) (CONTR'S LICENSE)
Build Dwellin 1 Single Family Dwelling NUMBER OF
PERMIT TO g ( i ) STORY g Y 7 DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) Lot V. 20 Crystal Ridge Road, Cotuit ZONING
" .(N0.) (STREET) _ -O ISTR ICT -
F. .BETWEEN ANO.
'.i (CROSS STREET) (CROSS-STREET) -
LOT
.SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO 8E FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKs: Sewage #92-51
Bond
AREA OR 2287 S . ft. ESTIMATED COST s FEE � 170.75
VOLUME q 250,000. PERMIT
(CUBIC/SQUARE FEET)
OWNER Hurst Dorner
ADDRESS Germany BUILDING DE PT.
Ur
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
ONOITIONS
MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBFINAL INSPECTION
TI TO LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY. -
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1 1
c7�f�lls C 1
I
2 2
3C�✓r ����� H ING INSPECTION APPROVALS ENGI ERING PARTMENT
dJr t
` BOARD OF
HEAL H
OTHER SITE PLAN REV W APPROVAL
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION, L PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION.
APPLICATION TO INSTALL A FIRE ALARM SYSTEM Y
❑Barnstable ❑Centerville-Osterville-Marstons Mills fi� Cotuit ❑ Hyannis ❑W. Barnstable
To: Head of the Fire Department: Permit No.
Application is hereby made in accordunce with the provisions of Chapter 148, and regulations made under authority thereol
to install for the person or persons and at the location named herein, certain equipment for a fire alarm system. This
application is made with full knoK•Icdgc of the current requirements of the regulations governing such installations, which
will be made in compliance therewith.The installation of said system shall nform to plans reviewed by the Fire Dept.
Owner/Occupant Name: �,r XJ
Street Address(House Number Rey trcd): _
Person To Contact For Inspection and Phone: rI Se,
Installer Information/Description Of i� ent To Be Installed
Manufacturer Name & Model Number:
Type: [ J Photoelectric vionization [ J Other
#of Dwelling Units: # of Detectors: c� Bsmt. _1 Ist 2nd 3rd Total: _
Other Devices& Number: eat Detectors Pul -Stations Horns Other:
Installer's Name & Company: - t. c'
Installer's Address: c1JL
c.
Installer's Phone: '� License Number:
Final Inspection By: 1 Date:
�L/lyP0�,
Assessor's office(1st Floor): 1
Assessor's map and lot number
SEPTIC SY$TEVA MUST BE o���fMt T011
Conservation LL ED IN COM3;5LIANCE
Board of Health(3rd floor): .
Sewage'Permit number ^t] l a pOVEO
l �,p rua
Engineering Department(3rd floor): NVE� ` �Y17 °° '63�'
House number - �D enmenr
��.
Definitive Plan Approved by Planning Board % 7 a I 19 ! n" .""` / — 7_
APPLICATIONS PROCESSED 8:30-9:36 A.M.and 1:00-2:00 P.M.only =.•�,t1J
oete
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ( ��%�
TYPE OF CONSTRUCTION �"/f ✓fjjJ.�ylc.�_
i
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location 7 6a42V 2� r�-1,C .
Proposed Use A<-14—
Zoning District R Fire District �a s
Name of Owner Hru-t baz/11W Address
Name of Builder 1L�� Address
Name of Architect Address
Number of Rooms Foundation
Exterior- ( �. /✓ Roofing
Floors v �`" Interior 4� ✓�/ ��
Heating 0,41 /7 2 Plumbing 1z,y 6 cj!�� 49 02 tDaZv
Fireplace—a Y /64&C4 Approximate Cost 02.54 ar0
8�D 4 4 , Area
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License a C) 5 a 415
l� •R � l
DORMER, HORST
No 36342 permit For 12 Story
Single Family Dwelling
Location Lot V, 20 Crystal - Ridge Road' -
Cotut
Owner. Horst Dorner _
Type of Con§tructionf Frame
Plot Lot
r
Per "November^ 18 19 93
mit Granted
Date of dnspectign 19
Date Completed " 19
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APPROVED
01 N NGES
TOW F BARNSTpg,9.E
Building Inspection Department
CONCR CPS
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( COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY
OF
ONE ASHBORTON PLACE
MASSACHUSETTS a --B08TGF� '."-_�'""�'-='•�° '.:' -"s� ,�Hlf �tY.
LICENSE r CAUTION
EXPIRATION DATE CONSTR. SUPERVISOR
04/19/19 96 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
RESTRICTIONS THEFT, PUT RIGHT THUMB
NONE eF"r" T 06/30/1 993 005645 PRINT IN APPROPRIATE
"`� o o BOX ON LICENSE.
BRIAN T DACEY
CENTERIrLIKiNAA02632 z BLASTING OPERATORS
m MUST INCLUDE PHOTO.
PHOTO(BLASTING OPR ONLY) F x
0.
0 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: STAMPED-OR-SIGNA/OFOMMISSIONER xF,
2 2 1993
THIS DOCUMENT MUST BE . « SIGN NAME IN FULL ABOVE SIGNATURE LINE
° CARRIED ON THE PERSON OF IGNATURE OF LICENSEE
THE HOLDER WHEN EN- `�•
OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. fI■% �ER
'a
�s COMMO TH OF MASSACHUSETTS
c
P DEPA�';ENI.OF INDUSTRIAL ACCIDUIT S
600 WASHINGTON STREET
CanDpei BOSTON, MASSACHUSETTS 02111
ssrone WORKERS' COMPENSATION INSURANCE AFFIDAVIT
/zc
cons«/perminee) —
z principal place of business/residence ace
(City/Staremp)
rcby certify, under the,pains and penalties of perjury.Char.
am an emplover providing the following workers'compensation coverage for my employees working on this
3 /mot ��0 1
nce Company Policy Number
am a sole proprietor and have no one working for me.
am a sole proprietor. ncral contractor r homeowner(cirdc one)and have hired the contractors Iisted below
vc the following woe ers compenntion insurance politics:
of Contractor Insurance Company/Poliry Number _...
of Contractor Insurance Company/Policy Number
of Contnaor Insurance Company/Policy Number
m a homeowner performing all the work myself.
NOTE .Plcuz be aware z:zt wbilc bomeowpers wbo empiovpenoas to de mucteaaaee, eonstruetioc or repair••orx on a
r of not more taaz three units ,o wa,c� the bomeo%+ver also resiaa or on toe Frounas appurtroaat thereto are not eeeer-Z
red to be er_oiovers uaCrr the Woritc*n' Comoemauoa Ace(CL C 152.sea. 1(5)). application by a bomeoweer for a license
it may evacencc tde ico sums of an employer under tat Woricen'Compenution Act
rand :hat : cDov of thus scat=.rnt will be Forwarced to the Deaar-ncnt of Industrial Aecdents' OF= of lnsurane lot aster
,on ant :ha: faiium to secure cc cmrc as mcuircc uncitr Sccnon 25A'of MGL 15: can lead to the imposition of cri=uzL VCr-2j
ne of: r,nc of arc to SJ SOO.Ov andior impnsont:c:.t of up to one vn ant c%v per:aiucs in the form of a Stop Mori Ore=' and a
1 2 cav a€a:ns-. mc.
FRONT EI.EVAT10i�=�
CEILING ASSEMBLY < .
TOTAI-f* R
t /2
TC? SU F.C^ U '� Yt'IIIDOWS
R= 0.6t
qv !r•FIBcRGLASS
INSULATICtI_ + ��;•
R3®'
• sy
r�
SHEETROCIC DOORS '.� . :y `'
' R= 0.45.
BOTTOM SURFACE
R= 0.61
PLYWOOD INSIDE. SURFACE
o ;+ ..
REAR'
. s2 R= o.6s ' .. .• � EL'E1/ATION.:_`-.
WALL AS
SEIriBLY c.w.A:.J
)D Ile SHEETROCK
OGLES R 0.45. TOTAL R o't/•79.0.87
.. 7 s,T :.,�•
SIOc 3 1/2. F19ERGLAS'S
;FAQ WSULAi ION
0.17E t R=11 r ��.. . ..;��•
!., SURFACE RESISTANCE
Rs0.61
DOORS:. .♦ .r' _"<' :
FINISH FLOOR
Re 0.91s. s
FLOOR ASSEMBLY •.•
,_:..
I/2" PLYWOOD R
TOTAL.
II susFL:ooR RIGHT : Si^E.:ELEVAT
IIDE 1a •G.WA:1:.
acE Uv t1(/U
.17
• 4•f< ,
•+�• Ste" FIBERGLASS
•` �=�nr �.: fit,e' INSULATION
:1C. FOU1v DA T 101! I
VIAL� WALL- ASSE _ ..
F/,SLY
: s '� S SURFACE RESISTANCE MAY BE .use N/
D f1 ccor:S: •:i;�,..•:
0.61 INSTEAD OF FLOOR � �-• .` ~ "
is '�• INSULATION )
..� .., • •; TOTAL. R I L:Er.T 510E :EsLEV,"�Ti : '
. _It IDE SUR aCL U=
'+ R- o.so
't:ic1'u0'iY�:
f—
R = o I
:• R= 5 - DOORS.
ES
cRMAr:ENTLY INSTALLED •STOP �tdSUL�1 T iC�;�J SECTION R"
IN1D01'!S To, eE _ t�1 ,
^wJ ti�lall UScJ ,ILt,CAI.,rl_
Afj
INN DOV/
OCR AREA
/o `F rS T RA,;011