HomeMy WebLinkAbout0020 DANIELE STREET i
Town of Barnstable *Permit 6 1f 8(o l
Expires 6 months from issue date
Regulatory Services Fee c�S .
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner (/.
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us ( '
Office: 508-862-4038 Fax: 508-790-6230 �;`•
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
�j Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address --�' e
esi `j�
dential Value of Work Ey'l Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address !i0 rt/
i e
Contractor's Name c,e,11 I Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) j
❑Workman's Compensation Insurance X-PRESS PERMIT
Check one: PERMIT
❑ I am a sole proprietor AU& — 7 2007
❑ e Homeowner
Lff—fhave Worker's Compensation Insurance /J TOWN OF BARNSTABLE
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
f =-
❑ Re-roof(stripping old shingles) All construction debris will be taken to —�
s
❑Re-roof(not stripping. Going over . existing layers of roof)
- C0
❑ Re-sideEP W �
Replacement Windows/doors/sliders. U-Value ,r_-"I 1�-(maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: ;Pro7pertyPwner t sign Property Owner Letter of Permission.
he a Improvement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
Town of Barnstable.
Regulatory Services
�rB XASS. Thomas F.Geller,Director
4'AlFc n►a�A`� Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 I
of Yi w-town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using ABuilder
r1161,11 ,as Owner of the subject property
hereby authorize %�/e/WAS �cd c.� to act on my behalf,
in all matters relative to.work authorized by this building permit application for: .
r�a -1)4tiA,4' C4 d TUB
(Address of Job)
ign tore of Owner D Ae
itiY)/9 G.
Print Name
Q FORM S:0WNERPERM IS S I0N
' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
" + d 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
Name(Business/Organization/Individual):. :U,
•Address: � ,��
City/State/Zip: �Gyt 7 �c Phone.#: � '� � l`
Are y an employer? Check the appropriate bog: Type of project(required):.
1. I am a employer with 4. ❑ I am a general contractor and I
6. ❑New construction .
employees(full and/or part-time).* have hired the stab-contractors
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 za capacity. employees and have workers'
Y P tY• 9. ❑Building addition
[No workers'comp.insurance comp.insurance.#'
required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11. Plumbin repairs or additions
3.❑ I am a homeowner doing all work ❑ g P
myself. [No workers' comp. right df 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.
;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 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb er#fy and the pain d penalties of perjury that the information provided above is true and correct
Signafore: Date:
Phone#:
Official use only. Do not write in this area,tb 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#:
s DATE(MWDWYYYY)
CERTIFICATE OF LIABILITY INSURANCE 0e 06/2007
DucEa (781) 344-A578 7HI8 CERTIFICATE IS ISSUED S A MATTER OF INFORMATION
ONLY AND CONFERS NO R HTS UPON THE CERTIFICATE
C.L. Hollis Insurance Agency, Inc HOLDER. THIS CERTIFICATE IDES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFOR ED BY THE POLICIES BELOW.
27 Glen Street
Stou hton D4A 02072- INSURERS AFFORDINGCOVERAf3 NAIL#
wauRER A LIBERTY MUTUAL
INSURED
THOMAS EDWARD CORP INSURER B:
37 DOWNES AVE INSURER C:
1 REA D:
ON MA 02021- 1N RER E:
COVERA ES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTI ICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM6. POLICY EPPECTIVE POLICY EXPIRATION
INSR D'L TYPE OF INSURANCE POLICY NUMBER DATE MWD DATti MM01)" LIMITS
GENERALLIABIUTY EACI(O�CCCpUR N E 0
COMMERCIAL GENERALLIASILITY PRE 18E8 RErronoe 0
CLAN®MADE OCCUR / MEP EXP one an 0
PER ONAL&ADV INJURY 0
GEN ERALAGGREGATE 0
OEN'L AGGREGATE LIMIT APPLIES PER: PR UCTS-QQMPIOP AGO 0
POLICY 0 PET El LOC /
AUTOMOBILE LIABILITY / / / / COK DINED SINGLE LIMIT
(Ea i CQId@M) 3
ANY AUTO
ALL OWNED AUTOS / / BOE LY INJURY 0
(Per arson)
SCHEDULED AUTOS
BOE LY INJURY
HIRED AUTOS (Per ident) 0
NON-OWNED AUTOS
PROPERTY DAMAGE
(Per ocidenl) e
OARAOELIABILITY AU ONLY-EA ACCIDENT G
ANY AUTO / / / / OT ER THAN EA ACC 9
AU ONLY: AGG $
EXCEMUMBRELLA LIABILITY / / / / FACI4 OCCURRENCE $
OCCUR F1 CLAIMS MADE AG REGATE 0
6
DEDUCTIBLE
RETENTION S yyyy�� 6
jL WORKERSCOM►MSATIONAND WC2-31S-349983-02y 09/24/2007 03/24/2008 a{ TORYLIMIT�S ER
ptPL.OYERS'LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE E,L, CH ACCIDENT 9 100,000
OFFICERIMEMSER EXCLUDED? / / / / E,L, ISEASE-EA EMPLOY . .2 100,000
If yes. G
SPECIAL P R01/IS under
below E.L. ISEASE-P LICY LIMIT.4 r 500,000
OTHER / / / / C "
<: lull
DESCRIPTION OF OPERATIONBILOCATIONBNENICLES/EXCLUSIONS ADDED YY ENDORSEMENTISKOIAL PROVISIONS V T y
20 Tu►NI>emz STREET IN COTUIT, MA fir,
W
OD
CERTIFICATE HOLDER CANCELLATION c-n IT.
( ) - (508) .790-6230 SHOULD ANY OF THE ABOVE OE8CFV0FD POLIC14 BE CANCELLED BEFORE THE
ATT: BUILDING DEPT. EXPIRATION DATE THEREOF, THE IS>UING INSURER WILL ENDEAVOR TO MAIL
30 GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
TOWN OF BA STABLE FAILURE TO DO EO SHALL IMPOSE NO OSPOATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS baTS OR REPRESENTAT11 E91.
i A RH>SEN7ATIVE
BAMSTABLE MA
AACORD 25(2001108) ®ACORD CORPORATION 1988
TM INS025(oloe)m ELECTRONIC LASER FORMS,INC.-(5w) -064b Page 1 of 2
92L
Board of Building R
egulations and Standards
HOME IMPROVEMENT License or registration valid for indivi j
CONTRACTOR
Regist�t9. ion 105629 before the expiration date. If found return o only
Expiration j�20/2008 Board of Building Regulations and Standards
` t One Ashburton Place Rm
€r i i TYpe Pnvat`e One
Bostor. 1301
THOMAS EDWARD GORP'f "{ Ma.02108
Thomas Perna ,
a, t'
37 Downes Avenue
Canton, MA 02021
Deputy AsG mmstrd`fo�
Not va ' without signature rna u e 1
F
_
Asueoso/� m�pon6 k� num6ar --=�� ' ��--_
��—'--' —'~-~ THE�� /
! .� �TAL ����
Sewage Permit number _--��.�—��/n. ,=--..�—_��.�-
House number ............................ .....................................`'
NAGIL
' �-���77l�T OF
��� � l�T � r�� | ��» l� ��N �]w ��/ P� ��v��� �� P� �� ]� �� ��M��]�u
BUILDING
�� � �� �� INSPECTOR
�� ���������� ��
��00 N �~0N N ����� 0 ������ �.Nm 0 N0 ��
]
�
APPLICATION FOR PERMIT TO ......C.O.D.-st-rim".t....�eov. Tinnne�.---.--..-^—.—,_.-.--.—.-.--.—
TYPE OF CONSTRUCTION ----. .]7KQp��-----_—.--.—...—._--------._------
' �
`
�
...�ct°..3...........................l9..8A
TO THE INSPECTOR OF BUILDINGS: `.
`
The undersigned hereby applies for o permit according to th6folovvngjnformodw6'
Location ___I^�t_lO_..Daoielle..St.:_______~____________,.___.___`____________..
Use ......8FD...............................................................................................................................................................
'
R D�h� �QtQ��
Zoning District .. ---.. va --.. ~------.---.~-----..
Nome of Owner /��.��..���1.!.�.��.�������.�?���/�Wreos ----------...............—..~.------
�~ � ' |
J
Nome of Builder —Joho—Jx..���IAgg��--_-----.A66res —.]8±��°—l�8\,—y����tx��,�.%��]-l:a---.—.
Nome of Architect ...0ggg�............................................7--Address .....]Done.-----._------------..---.
Numberof Rooms ....6.............................................................Foundation .1/l�'. .............................................................
Exierior .....................Wo�.d..�S}lixigle................................Roofing ........ ............................................................
�" .
Floors -------.{kgg��''&.. .............................Interior --..^—.��he�tJ��Dk--------~-----..
Heating ------�.a.rm..A.i.r...llv... .a��-------'Plumbing .....��-----.--.—.----------.--.—..
Fireplace ------1-----------.---'-----.Approximohe Co, ............45.'�U�.J0.0................................
���
Definitive Planning Approved 6v onn�ng ouov6 19-73_. Area ......76.8... .q.....Fset—'
Diagram of Lot and Building with Dimensions Fee _______________
SUBJECT TO APPROVAL OF BOARD OF HEALTH '
l� STORY FRAMED STRUCTURE
'
'
'
'~
`
\ ' �
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
/
| here by agree to conform to all the Rubs and Regulations of the Town of Barnstable regarding the above
construction.
' Name ............. ^+="._
....................... ........................... �
'
'
| O0�g61
[bn�rwc/i�n Supervisor's License ----...~-----..
^ `
kt /
DELANEY HOME .TRUST A=27-59
No 27158..... Permit for ...l ..5 '........:......
Single Family..Dwelling.....................
Location Lot„10, 20„Danielle Street
Cotuit
Owner ..DelaneY„Home„Trust
Type of Construction .. .. x-awe..........................
................................... ...........................................
Plot ....................... . Lot ................................
Permit Granted ... October. 29, 19 84
Date of Inspection ....................................19
Date .Completed ........ ............................19
r
TOWN OF BARNSTABLE -- 5e
Permit No. _-____-
Building Inspector cash
°""r• OCCUPANCY PERMIT Bond `
Issued to Address Wiring Inspector Inspection date
Plumbing Inspector �: ( s--� \� A Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
Board of Health Inspection date
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.
.................................................... . 19......_.... ................................................................................................................
Building Inspector
Y:_a n. ,r �• �._ t'' •1 ew ,: -y,'ky .�. -; .:�� ;tlrw� ��^..; r >. t:�,. � ...c . •�� v +a; s. '�£;
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
EAMT =
MASS. TOWN OFFICE BUILDING
7� i6J9• � HYANNIS, MASS. 02601
�o r��t a•
MEMO TO: Town Clerk
FROM: Building Department
DATE.
May 15, 1985
An Occupancy Permit has been issued for the building authorized by
Building Permit # 27158
Delaney Hane Trust
issuedto ....................................._......................................... ........................................................... ......_.._. ....................................w. .__
Please release the performance bond.
t .
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o WILUAM
g C.
NVE
19334 �
C� Of Al-
�,, ,4,'�� SURVE" •
1-
aCd7/OA1 e::
,S,yOWiV yE.�?EO.( ' COMf�L SCAL �.,i.5�' pATE
r',4/E S OE.0/.�/F A NZ;:'SETBA C.,r� ,eE�E.2E�CE-
�E4U/�?FME�'"s of T.yE` rowwDF
.4.vo /s 111:52 7-- 4o
LaC.4TELL jam//Thy/N 7,4E FLOGiD,G4/it! �G�h� ZC O OG• �S'
Ti�►�/S P.L.4.t//S �vo�' BQSE �d.�c/ .4.t/
/N.ST,evi 6G-At 17- Sv,2t/�Y E Qs7 —.2Y/44C a MASS. `
A,o /C.�T�/1G1� L"��l�i►/`=j/.
QESI<,IJ (jAJA
�,�NGLL- FAM►►-Y - 3
•E3Gvcz�oM -
c�n►��( FLow s IIo x 3 = 3306•
TPNK � 83ox1�jd'/. '�9%G.P. � - o0•G /�•� ..�G� rx� F 1oo..IB
us ►000 GAL.. 7 I ;
AI_ forr ubE Ivoo SAL. x
S►DG.w/A�L APLSX �' 1 go 5•r, O _ z ) i
15 BOTTOM pRE.A l .. �0 5►F.• �P .tlO pr r. . �. .!
Sa S.r- x 1•v 5o G.Po' 0 Z '�rff. �'D �o. ` ;� 114
-toTA 1.. [7E51GN G•P
TOTAL_ PA►WY FL.01If = 33oG. f9 1�ooyR I
F'E2GoLlaT►ON RA?E, I''IN 2MIN o�.►-ASS �' i 4OF At
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loco INS! / �
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PR.oFILG 1.otA-t110W GO?"v /
B,G�EC No 5Gp►LE _ `yI
p�,p,t.I REF 6�E►�GE _` ,
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GEaT�Faf THAT THE PAP I-►�(� SNovYN.
HER�C11 �OMPL.`(S yJITN•THE S 1 PC--L%W(c �- ew T-^ /Q }
Awo 56't�e►GK R.6 v�R.EMEN'T� ��TµE• ' �L�/�.��-a ��• Z.S. � �;. �,
1owN o� 1�1AND 15
LOCATED WITNIW TNFs F�..oOD PLAiN • � !
BAxTEiZe tJYE INC•
P6
ME-6 1'ST f�i�6V'1A1�o S v iCV iaYO
Tuffs PLQ� 15 Nam' an5c p ca
03TG9-VILLFs ! MASS`
IN5.1.Q•tiMeNT -5VZV Y '0HE Q1=FSE�5 suo�►,� �CG.4N f!
o-r 1..INE- APP1..1GA►..,r
--_ .,...r n_r ��cGDTd �ETER•r^1►J� �• 5 s°
Assessor's 'mo15 and lot number ... . =.2 2.:' THE '
Sewage Permit number ....................�$•........................... .
i -
SEPTIC YSTERA UST S s BAHHSTA➢LE.
House number. ! ..�.................................. ' ,!S e !P. N4 C P S"a
p(AC i63q. 0�
TOWN OF B �RN� AgLE �
BV ILDING :1M INSPECTOR
APPLICATION FOR PERMIT TO ......GOn tx.0 t.:New...Hoaas.e...........................
TYPE OF CONSTRUCTION ,.......... .WooA...UAI11Q:............................................................................................
.....Qat......3 .....19...8.4 '
q
TO THE INSPECTOR OF BUILDINGS: t
The undersigned hereby applies for a permit- according, to the following information:
Location ........Lot....10......D.a ie,lle...St. ..
Proposed Use ......SFD...................
Zoning District ... RF.............. ...........:................. . ...:.................Fire District .........C.Otult. .....:............................
/ `
Name of Owner `/�� � �'�....A ress
Name of Builder ...John...J,,.,,,,De.lan.Q.y...........................Address ..... .,...L�IaJcs o �...Mi.�.1s................
Name of Architect ...N4.n1P.....................................................Address .....N.one....... .............................................................
" o.,.. '
Number of Rooms ....�?............................................................Foundation 10. ...p_ ............................. .
Exlerior ................:.... .......;.......:.........:..,..Roofing .......Aspha,l.t..................................................
a.'.':.
Floors ........................W..Q.Rf.�...&...C.azpet...:..................:.... Interior .Sheetxa!✓.k.............................................
Heating .............. Warm Air...kY..G s.....................::Plumbing 2
.... . .......::.........:::.:..................................................
Fireplace ....................I.............................................................Approximate Cost ............4.5, 0.0.0...O.Q,.
Definitive Plan Approved.by Planning Board -----------19 __. Area .......7..b.8::.S,q.......
FEe1
Diagram of Lot and Building with Dimensions Fee ""'�'
SUBJECT TO APPROVAL OF BOARD OF HEALTH
oo
1z STORY FRAMED STRUCTURE
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town,of Barnstable r arding the above
construction.
Name . .... .... .........................
C truction Supervisor's License ....Q.Q.9.9.6.1.................
T Y HOME.TRUST
No .271..5.8.... Permit for ,..1.3.52.°StOXy................
... S x>gle..k:anu.ly...Ih��J lznq............. ......
'' Location ,Igot..1Q.°.....2-0-DardeUe.,S,treet..
�L Cotuit
. .... .. ................................................ .....
' Owner ;Delaney,• Home••Trust.... .......
*Type of Construction .KBSI)k.............................
-�s Plot 4 ........ Lot ............................
Permit Granted .,,October 29, 19 84
Date'of.Inspection .........r�.- 1- ....:..19
Date C/oTpfeted � � � �........19
1�`�
. .