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Home My WebLink About0234 EISENHOWER DRIVE �.�� r�E��-� �� i f PEP 'Town of Barnstable- *Permit# RMIT Expires 6 nmon fr tic issue date FES W � Z�� Fee Serv� es TOWN OF NST Thomas F.Geller,Director ABA Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable ma.us Fax: 509-790-6230 Office: 508-862-4038 EXpRESS PERMIT APPLICATION - RESIDENTIAL ONLY _Not.Valid without Red X--Press Impri- Map/parcel Number Properly Address3�I ElSENMOWe►� Dr, djv'T Z63.5 [�Residential. Value of Work ., ©0.� Minimum fed of$25.00 for work under$6000.00 Owner's Name&Address I C2 -r n1F` -5iqm Telephone Number Contractor's Name Home Improvement Contractor License#(if applicable) Construction Superyzsoi s License#(if applicable) _.._.. ..._.. ._,_ . .._. ❑yJorlanan's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. permit Request(check box) ) Re-roof(stripping old shingles) All construction debris will be taken to �rn►Te7� ��rr►PST�'/'�/iSyE�XP<�� ❑Re-roof(not stripping.. Going over existing layers of roofl 5� r (' AeAbice ce dAo,Sti+��lPs ,1r7'ST/,� So74 50W&.S Df e Re-side . ❑ Replacement Windows. U-Value (Maxi= .44) *Whererequired: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 Department of 1pidastiial14ccid'ents ' p Office.of Investigations- d ; 600 Washington Street r' Boston,MA 02111 awww.mass.gov1dia Workers' Compensation durance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Worination - Please Print Legibly Name (Bnsiness/orgmization/individual): �C i C•2 �C rN 5Rnlz .Address: 2,34 L S e�HawPs / City/State/Zip: Go-m; m/9 09635' Phone#: SQ. g q18- 6�yy7 Are you an employer? Check the-appropriate boa:. 'Type of project(required): 1.❑ Z am a employer with 4. ❑ I am a general contractor and I ' 6. ❑New construction employees(fbr and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or parser- listed on the attached sheet$ �' ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition Working for mein any capacity. workers' comp.insurance. 9. [] Building addition o workers' comp.insurance 5. ❑ We'are a corporation and its [N 1 10.[:1 Electrical repairs or.additions required.] of5cers have exercised their 3. I am a homeowner doing all work right of exemption per MGL 11.0 Phnnbing repairs or additions myself..[No workers' comp. c. 152, §1(4),and we have no 12.[9 hoof repairs insurance required.]t employees.jNo workers1 3.(M Other $�d�n�✓��Plar�S camp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: 4 t Homeowners who submit this affidavit indicating they an doing all-work and then hire outside contractors must submit anew affidavit indicating such " tContmctors that checkthis box trust attached an additional sheet showing the name of the sub-contactors and their workers'comp.policy information. am an em information. ' Insurance.Company Name' - Policy#or Self-ins.Lie.#: Expiration Date: Sob Site Address City/State/Zip: Attach a copy of the workers' copensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP'WORK ORDER and afire of u.p 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 of perjury that the information provided above is true and correct. Signature: C Date: Phone#: b 0 W use only. Do not write in this area,to be completed by city.or town officiaL City or Town: PermitUcense# 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 w r of another under any contractkeTs' compensation for their eiu flhi* _ ' pu•�t to this statute, an employee is defined as "...every person in the service express or implied,oral or written." M to er is defined ag"au M�4ua,...pa_rtper tip,•,association,gwporation or other legal entity,or any two or more An emp y of the foregoing•engaged in a joint enterprise,and inchiding the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. HowoV.er:tlae 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 woiYnn such dwelling house or on the grounds orbuildiug appurtenant thereto shall not because of such employmentbe 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 iequirements of`this chapter have been presented to the contracting authority. Applicants Please fill out the workers' condensation affidavit completely,by checking the boxes that apply to your situation and,if, supply s necessary, sub-contractor(s)name(s),address(es)and phone numbers)along with their certificates)of C .or Limited Liability Partnerships(LLP)with no employees other than the insurance. Limited Liability Companies(LL ) members orpartners; are not required to carry workers' compensation insurance. If an LLC or LLP does have . endployees,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 dlt or town that the application for the permit or license is being requested,not the Deparf acht of Industrial Accidents. Should you have any questions regarding the law or•if you are required to obtain a workers' lease call the Department at the number listed below.. Self-insured companies should enter their compensa& pohcy,.P._. . _ —.. — -- - self-insurance license number on the appropnate 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 savi to fill in the permit/license number which will be used as a reference number. In addition, an applicant' that must submit multiple permMicense 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 is (city or tom)"A copy of 1he••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 affidavitmust 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 bum leaves etc.)said person is NOT required to complete this affidavit 'lye 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 Departzneut's address,telephone and•fax number: The Commonwealth of Massachusetts . • ' Department of Industrial,Accidents ., • '. . . . .. .. ,, ..Office 9f JAvestigations r. b00-Washingfon S reet� . `-' Boston,MA 02111 Tel.##617-727-4900 ext 406 or-1477-MASSAFE Fax##617-7274749 Revised 5-26705 wwwmass.gov/dia ��•,i TOWN OF BARNSTABLE Permit No. -----26`'7 _._____.... +� Building Inspector Cash �iw+s�o • OCCUPANCY PERMIT Bond Issued to T C Address r _ Wiring Inspector j('r Inspection date Plumbing Inspector Inspection date Gas Inspector77,i 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........... .............................................. ./ ..c_�.. K,,........._......._...... Building Inspector ST v r. tn7 b j, . v r / Ile if CP?o o CoMzr �'. a Sf r , e j �IEYIOpgj _ e f- u 4 sA RO nf�Y R`R*- no.( 1977 1. .31341 Y o••N• •tom! a � csc�sTE�F•OQ; S,� •••• S b ,r t .;ft1, uu AS SUILT _ ' TO THE &EST OF''' MY I NF "TIOt i KNOWLE.069, AND :BELIEF THE L c � . 71 S,_MA. SHOWN ON THIS 0 M&AftI PLAN HASEEN LOCATED ON? THE 1346 ROUTE 1$4 �~t p' p .� l T EAST DENNIS, MASS., . •; DATE; -1 n ' $, S CALF t .'-.- t 1 R STE#E0 70I0 EYOR JOB NO. CLIENTS . . DR. BY : SHEET 4 • -. •.. _ ♦. .. .. .....5: .,.., .,e.,i ... .. �_i H.., .,f i 1i �1•.4�F.'yZ1At�b w ilk....r'i'r4(a ,n-'�S�a9f,.:A t , a3�4 ais 'tiAssfl~5sor s map,and lot number ................................. 7HE 4:. li Sewage Permit number ............................. IIA"STADLE. : s House number rasa F.. .. .y.................. r 3� +' Q y YPY .ter TOWN OF BARNSTA; IEy 1 B U I L D I,N.G IN,S P E C T 0 R y,Y APPLICATION FOR PERMIT TO ........................................ c ........................... ...................................... t ` TYPE OF CONSTRUCTION ,...... ...c. �L.Y... .......................................................f.. . . � • TO THE INSPECTOR OF BUILDINGS: 4The undersigned hereby applies for a permit according to the.following information: Location:/ ' G .... .`S�w jiG.v�^✓L .... �`t,l/C U ....... .... ... ............................/ +Proposed Use ............................................................. .. ........................ .................. .......... ....... ... Zoning District ........... ...... ....... Fire District '�p �!.... '2.. iC ....... Name of Owner ............ LGU... ... ........ ..... jsVSlz.....•-.Address .. . ®....IOC!T/ /O�iK..: .................... Name of. Builder Address .......... ' tf ,..., .f. . ,. .......... .............. .......... Nameof Architect ..................................................................Address .......................................,............r................................. Number of Rooms ........... .....................................................Foundation ........ ............. `=Exterior .....c"}.L.L ......... C............................Roofing ...._... 7L/... .......:................................ Floors ...... . . .7... ...!f!ti y.,(..".............. ' .......... .Interior .. / ..................:.................. . 'Heating /t/ l� ✓✓ Q/ ......,.Plumbing .......................................oZ ................... G� . c... 'Fireplace ............ :.: c ..UL..Z.........:...................................Approximate. Cost .............. ... Definitive Plan Approved by Planning Board ____ ___�____ ___ •_ 193___. Area •... .. ..! ".... ................ Diagram of Lot and Building with Dimensions s Fee .............. 7 �. SUBJECT TO APPROVAL OF BOARD OF HEALTH ! Q� .. J, \ s a a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 4 ' • 41 I hereby agree to conform to all�the Rules and Regulations of the Town of Barnstable regarding the above ` construction. Name ... ........ Construction Supervisor's License ...................... .. GALLUS CONST. INC. t i� 4ti i Igo ...26078, Permit for One„Story.............. - - .. , Single Fajrj4 ..Dw I;L ng.................. T Location „Lot. 20. 234 Eisemhowes Drive Cotuit�,. ........... ................................................... Owner ,Gallus Const. Inc.,. .... Type yof Construction .....Frame.... .................. iN ... ... ` . ... ................. +........3.................. • :. ':� • .Plot:.....:...................... Lot •................................ Permit Granted ..�Fehrtla.ry 14. ..... .19 84 e Date oflnspection" - ' - ...19 a Date Complete :.! '." .............19. �� `�� ate•. . `;•�V .- �- t _ !� `J - , Ile k ' 1 Assessor's map and lot number. ...... /( THE ...................,wry.�...... V �O O� Sewage Permit number Q r Z 13 STAKE, i House number r * ""�a.......................... ...r.. ..:,................:.............. �p,o�NAB& 00 039- TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO SI.u�G L` �hlwi/L y ,ees , TYPE OF CONSTRUCTION G.� O ..................................................................................................................................... ...................... .C.....Z ....19..��.3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r— °T KO......6 `�'�ti,�/�w6;rZ ...b e�UE; . .........02 // !9.......................�........... Location ............................. ..................................... .... .. Proposed Use ........... �C ��S ................................................ .......... .......................... . . ICI Zoning District ................................................Fire District ...C6Z1 � 2 /S7rz�G?" 67y zG 5 4 l7a °C,7. l/lo6 K" �d-• ( o,O/ j Nameof Owner ....................U..........::INNS.I�..................Address ....... ... ............. ......................................................... Nameof Builder ....................................................................Address .................................................................................... t / Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms t.... ..........................................Foundation ' ..............................................................C /El Exterior ......wl.L SffiNC�GGS -...C'L/9 ./;C fL..�...Roofing .................................................................................... Floors �� u�ti y� .Interior ........................................ ........................................ .................................................................................... Heating !.. ....�F�........ . . L......... - .Plumbing ...................... . .5.......... �.... .. i'rC .... A2 06: � o ( Fireplace .. ......................................... Approximate Cost ......................... ........................................... Definitive Plan Approved by Planning Board _____________ J� 19 7s___. Area ...........""..�....................... �------ Diagram of Lot and Building with Dimensions Fee ..............Z2.�....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH' 1� 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 ... ... .......... .. ......... .............................. Construction Supervisor's License �I� 3U / --. One Story No ................... Permit for ------------ . . ' . ` --��..�°��v�—' - ^ ' Iaot 20 334 Drive Location -----.�----.��.��---.. , ' Cotoit -------------------'--...---. * ' - Owner —. .�Couot�..Iuo�.�__..�__... . . - ` Type of Construction ....... ........................ . . ^ ^ ----r--------------'------'' Plot --------- Lot ................................ � . . . " ^Fe�zcna—�y I4, 84 Permit �,onu�J --—-- —'------l� | ' , Date of Inspection ------------lV ° � ^ Date Completed —~--------.--.lg . , ' ~.~ ^ . - ' - . / . . ` ' ' . ' ' ~ _ .' . ~` . . ' . .