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HomeMy WebLinkAbout0073 MICHELLE AVENUE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 1 �� V Health Division Date Issued Conservation Division Application Feed Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 7!5 A11a10ur 57 607744 i IMA Village - Ownerft 1BAA11-ZX605AA4'►t PE ✓17-0 Address 73 A41! 6 QLE ST Telephone Sob 7 3 7 30 6 2 / Permit Request 1K laf P). U-- /fEW k171 'A Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new C7 Zoning District Flood Plain Groundwater Overlay a Project Valuation l Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2(/ -Two Family '❑ Multi-Family (# units) Age of Existing Structure so Historic House: ❑Yes Ef o On Old King's Highway: ❑Yes dNo Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roorn Count'°2 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other h- C Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/:coal stove:]Yet❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑:new s e_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: r _ � r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use I 0 -j AeL/ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)_ Name Telephone Number 6 oR a67 15�0 Address .3. ,0 4WAJ aT- License# 6 ,5 1 Q 3 74�;6 ;�A&k_CS/ kd L&— Home Improvement Contractor# 6 0 26 ,3 d Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L-1&6V5 &b SIGNATURE DATE 7 Z 7 6l 5 FOR OFFICIAL USE ONLY k APPLICATION# DATE ISSUED MAP/PARCEL NO. 1 s - i ADDRESS VILLAGE OWNER' s DATE OF INSPECTION: FOUNDATION z FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 13F/N o DATE CLOSED OUT 1 ASSOCIATION PLAN NO. f -The Commonwealth of Massachusetts f t.. Department of Industrial Accidents l .j Office of Investigations 600 Washington Street Boston,'MA 02111 t }'' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: .32 6,", . MA-1A1 o'l City/State/Zip: Phone f5_0 8 367 46m�0'a Are you an employer?Check the appropriate-box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.MI am a sole proprietor or partner- listed on the attached sheet. t %7, Remodeling , ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. ' workers' comp. insurance. 9. Building addition [No workers' comp. insurance S. El We are a corporation and its required.] officers have exercised their I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work 'right of exemption per MGL 1 I-El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.E Roof repairs insurance required] t. employees. [No workers' comp. insurance required.] 13.0 Other_ *Arty 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 submita new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers`.Comp.policy information. ram 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 andpenalties ofperjury that the information provided above is true and correct. Si ature: V A Date: 7 27 l / Lhonr 570"a 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: r 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( )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 permittlicense 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 obta,n ing a license or permit not related to any business or commercial venture (Le. 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 r Department of Industrial Accidents f)-ffice of Investigations 600 Washington Street BQston,MA 02111 Tel. # 617-72-7-4900 ext 406 o* r 1-B.77,MASSAFB Revised 5-26-05 Fax # 617-727-7749 www.m,as&.gov/dia Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration _ Registration: 167464 Type: Individual r Expiration: 9/23/2012 Tr# 203706 t KEITH MACKENZIE - BETTY r KEITH MACKENZIE BETTY " 3286 MAIN ST BARNSTABLE, MA 02630 • ,;;.�, �• /t1 Update Address and return card.Mark reason for change. '-?✓✓ Address Renewal Employment Lost Card DPS-CA1 Co 50M-04/04-G1�0O1216p Office 6fcod6? ��iY'S& ii�� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: W)MPACKEN7,4-EWITr Registration: ,-167464 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration: `9j2312012 Individual Boston,MA 02116 KEITH MACKEN2k 3286 MAIN ST BARNSTABLE,MA 02634T= ,;:`'?' Undersecretary Not valid without sig tune y. Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 103766 Restricted to: 00 KEITH MACKENZIE !. 3286 MAIN ST BARNSTABLE, MA 02630 Expiration: 6/19/20121 ('ununissiuner Tr#: 103766 T r ti Towns of Barnstable Regulatory Services urtxsrAs[.E. q u�as g Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: S08-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, rA --pb- V 4'rb , as Owner of the subject property hereby authorize "H j�i�("^f to act on my behalf, m all matters relative to work authorized by this building permit application-for- (Address of rob) 7-a7- /1 Sig tune of Owner Date USQIAK� �V l•� Print Name If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. o.FznRv.Q.nWNFR PPP A TQ(zin" -.. _.. �afTHE ray , Town of Barnstable o Regulatory, Services N •a rtnttxsntst> Thomas F. Geiler,Director P ,a� Building Division rFoµnia • Tom Perry, Building Commissioner 200 Mairi.Sireet, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-403 8 Fax: 508-790-6230 HO)\7EORWER LICENSE EXEMPTTON Pleast Print DATE: JOB LOCATION: number street village "HOMF,OWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code 7be 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 Dotpossess a license,provided that the owner acts as supervisor. `DE)u1T'1T�OhI O.F.•)�OMEO�EI2' :"•.: ` Persons)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 constrgcts 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)) Th,e 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 be/sbe 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 EXEMPTI6N .The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this SCCtion.(Srction 109.1.1 -Licensing of construction Supernrisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor.- Mar)y homeowners who use this exemption an unaware that they arc assutrring 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 responnbilifts,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the rrsponsibilitics 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 forrrrlcertification for use in your community. Q:forms:homccx cmpt 4 a � � . -igloo - Y fIk towz 4 a � tr. �� .�w �... L `.. � ,� - +�: ,,� „� _ � � : �" ... .- ' �. It .I_� �i �. � . � � � �� /' T� � � � ��� �_�___,_ ..., I � il� • V��''G '� x;"'r .�.���. i i j '. - � .. ' 1� • �� �i y �, Y4Y � 6a � _. br � •• • 4, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0V Map Parcel Application # Health Division Date Issued Conservation Division Application F e Planning Dept. Permit Fee eA Ll 3 . 3< Date Definitive Plan Approved by Planning Board !/ Historic - OKH _Preservation/ Hyannis Project Street Address Village CO Owner 475,6z-� < 1�)z � Address 73 T Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations 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 Kind Highway, ]Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq)i Number of Baths: Full: existing new Half: existing never s 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 XNo If yes, site plan review # Current Use s Proposed Use ZeY APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 0MI-4 4-t Telephone Number J*Oy- 2-98 SZ 3 Address � y CK-WI License # 9TOoCQ Home Improvement Contractor# /6 y 4!4 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ; SIGNATURE DATE ��• �3 �071 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS 1 VILLAGE ` OWNER c DATE OF INSPECTION: FOUNDATION FRAME 's INSULATION FIREPLACE 'r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,t DATE CLOSED OUT ASSOCIATION PLAN NO. It y • :1 i Office of Consumer Affairs& usiness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR ` before the expiration date.'If found return to: Office of Consumer Affairs and Business Regulation Registratioh' '064148 Expiration t 9/1/2011 Tr# 288409 10 Park Plaza-Suite 5170 Boiton,,MA 02116,- Type ,,L-- Private Corporation .. i BELPORT BUILDING&REMOD{{FLING, LLC. I MAZHEIKA DZMITRY,t F 1 262 SKUNKNET'RD a /V CENTERVILLE, M&9-2-6r -Undersecretary -o f valid ------ without signature j Massachusetts- Dcpartmcnt of Public SafctN" Board of Building; Regulations and Standards Construction Supervisor License License: CS 97029 - DZMITRY MAZHEIKA �I P.O. BOX 2881 ;V HYANNIS, MA 02601 ,I Expiration: 10/8/2012 Tr#: 3936 Commissioner W- b iWr+ t Ll { t d tl R a awl �l a P r -lop I L+ i 7 1 � � 1 -i .. ,. ,r_ ,` � .. .� • � � �+�rr�� � i ` �- � �_._-- �<<. i�� pqn, gig--- „�; t ®�3,1 -_ Y 1 • ow( i i I, 7 Jun. 9. 2011 9:30Ar:4 No. 0890 P. 1 Town of Barnstable ► � Regulatory Services - Thomas It.Geiler,Director sbfp, ti - '�� ► '" Building Division Tom perry,Building Conunfulonet 200 Main Strcct,Hyaugs,MA 02601 '+scs'rv.tovY�,barnsta�le.ma,us Office: 508-8624038 17ax:,508-790-6230 Property owner Must COMPlete and Sign Tla s Section; zf Us in .A.ftxlder e as.Owner of mbiect ro e J .P P ny hereby authorize �{i'� . to act on my behalf, in all matters relative to work zuthorized by this bdding permit application for: (At-d-ess ofrob) - S' of Owner Date - PriQr�ame �je- if Prove Proverty Owner is applying, for permit please coMplete the Homeowners License Exemption Form on the reyene side. Q:FO R M s:O W NE1tt�11tM ISS 10k The Commonwealth of Massachusetts 1 - ( Department of Industrial Accidents A Office of Investigations �,� rl 600 Washington Street �` Boston,MA 02111 e www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pltimbers Applicant Information 1 Please Print Legibly Name(Business/Organization/Individual): /7�//�'T oiozel A0 C Address: ste y v�0;4 .g7` ' City/State/Zip: 1�&Eenf1`"A_ Phone Are you an employer?Check the appropriate box: Type of project(required): L❑ 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 sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5.V=1.We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work 'right of exemption per MGL 1 LEI Plumbing repairs or additions myself. [No workers' comp. c. 152,<§1(4), and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' .13.0 Other / 10 comp. insurance required.] *Arty 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 their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my,employees. Below is the policy and job site information. ®Q / Insurance Company Name: 67oe ,7 titi� 7(w cL / Policy#or Self-ins. Lic.#: f' 3�S� P"Jr- — OZ� Expiration Date: Job Site Address:-- -73 A '" z 4;X A4'-1 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 ta' and penalties of perjury that the information provided above is true and correct. Signature: Date: 04;�. Phone#: 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 whoxesides therein, or the occupant of the dwelling house of another who employs persons:toPdo`matenance, 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 bofla,licerxse.or'permit to ope� business or to construct buildings in`the°commonivealtl 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.th'e;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 policyRis required:, Be advised that this affidavit may be submitted to the Department of Industrial ,t-cidents for cortfumapQn 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 totfill out in the event the Office of Investigations'hasdtocpntagt'you regarding the applicant. Please be sure to Tilt to tfie"permit/license number which will be used as,a reference;number. ,:In addition,an applicant that must submit multiple permit license applications in'.any:givenayear,need only'subrnit obe.afdavif,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 bum 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 Massachu4et1ts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877,MASSAFE Revised 5-26-05 Fax # 617-727-7749 wwwmass..gov/dia THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M A�C(, F DATA f 0,97 Olva .� 73 M[cN6L LE by • t 7n Y ru Department of 4 Y = Regulatory Services: I * )l3ARNSTABI.E, MASS. :iV4 v f 1b39. ry w Fv � { ' BUILDING DIVISION BY 'k'�,'�THIS,P,ERMITCONVEYS NO RIGHT TO OCCUPY,ANY-STREET.ALLEYOR SIDEWALK OR`ANY PART THEREOF, EITHER.TEMPORARILY OR PERMANENTLY. EN CROAC FAENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING`CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR I A.LAY GRAPES,AS;WELL AS DEPTH AND LOCATION PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS HERMI F- T DOEAOT;RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUI4b fOUR CALL INSPECTIONS REQUIRED 'x FOR ALLCONSTRUCTION WORK:,, APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDAT,IONS�OR'FOOTINGS '' THIS CARD KEPT POSTED UNTIL FINAL INSPECTION i 2. PRIOR TO COVERING STRUCTURAL MEMB_ERS"- HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU= PERMITS ARE REQUIRED FOR' " , N F4NCY IS REQUIRED, SUCH BUILDING SHALL NOT,BE ELECTRICAL,PLUMBING AND MECH +': (READY TO LATH.I t, 3.INSULATION. ryrl ` " `y OCb,JPIED UNTILFINAL INSPECTION HAS BEEN MgDE. ANICAL INSTALLATIONS. r, 4.FINAL INSPECTION:BEFOgE OCCUPANCY. 1 , • j = e -0 a BUILDING INSPECTION}APPR; VATS, ,r; PLUMBING INSPE"C"iTION APPROVALS ELECTRICAL INSPECTION APPROVALS r� L O kill AL 'V. -0 - �eo I Ito A 2 gF d I ,oZ - 2 "Gv 1l 03 3 1 ' HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 7 '�'`5 2y BOARD OF HEALTH i 1 OTHER: fij-0 SITE PLAN REVIEW APPROVAL _ WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. k �~ /r r t $ � • at "�•„ Y;f ..n A t .. y i � wh.. � —.�+•1�''s j• �.'. �f , � .• . . t t . ;t.�� .t�t` �o rz j ��• *u�4{k.. f s �' �rt-�{ rl, tr �. � '_, • �».,+ �.4.."• , • ,*t re..`�kk #ie--> >Y1 ��S.a t �. a '� $$���,•. - '� + T iy 1 t * Y' u ,{ �- r � ,,yr s (fin w,P �� i � P,,.... � t• S.w.,C.. f r \ 5�°y* - ts • .. . 1 +�'- ,.stir � 9 �:, ' .� M r 4 s BUIL N G PE •( ` SP. , v t •'t , s a Y Di vv� 4 ♦r• � �i_..' .. rI ��'-.Yid, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map — Parcel Permit# ' 1 h Health Division D 9- N 5 312t 103 3 -B-mpt aj bate Issued 3 ad'03 —per Conservation Division 3 Z f 03 9+L Application Fee eip Tax Collector J Permit Fee Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE V=TITLE i Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REQUU.'.IaNS Project Street Address 1 L�{ ' Ave- Village C Owner C' f N Address �3 ►tV l ;C w1l e [-� &Df )f T Telephone Permit Request k -zZ x- zn i Wo Si6i�v �H�v►, w1 D Square feet: 1st floor: existing proposed 2nd floor: existing proposed Z Total new Zoning District 4 Flood Plain Groundwater Overlay Project Valuation � y dJ Construction Type Lot Size 70 j q� Grandfathered: O Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes XNo Basement Type: 4 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) k Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new I _ Half:existing A new N Number of Bedrooms: existing new Total Room Count(not including baths):existing new�_ First Floor Room Count 5 Heat Type and Fuel: 2kGas ❑Oil ❑ Electric ❑Other Central Air: Yes J(No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes No N Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size I A Attached garage:❑existing ❑new size ShedAexisting ❑new size xI Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes i No If yes, site plan review,# Current Use Proposed Use BUILDER INFORMATION Name _3TZAV&t rfa< Telephone Number_ Address License# 7Z1 Zlt� Home Improvement Contractor# Worker's Compensation# [l/� " —V,-i��l (D�G. ✓ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GL N M�A V SIGNATUR DATE __ �-/Z.19 `05 FOR OFFICIAL USE ONLY PERMIT NO. DATJ ISSUED MAP t PARCEL NO. ADDRESS a VILLAGE y OWNER DATE OF INSPECTION: ,rA FOUNDATION 0 K FRAME ff ff U -7l-21p5- g ie�di INSULATION BSASiA 7/1110 FIREPLACE 1 f' ELECTRICAL: ROUGH FINAL m PLUMBING: ROUGHS €i n FINAL . GAS: ROUGH, ,,. . t FINAL FINAL BUILDING '. 3, • (� Syr �l i.'!, 4 . y DATE'CLOSED OUT ,'-: ,..,., -. em t ASSOCIATION PLAN NOS`" , C k f SMOKE DETECTORS O.K. NEW MOKE ACTOR RE©VIREy TS HRNSTAB9'= ARE NOW LAW. EVEN THEApprryON OF/►„u„� , tNEW BEDROOM WILL TRIGGER AAB BUILDING DEPT. UPGRADE OF THE S OKE DETECTORS a103 FOR THE WHOLE HOUSE. YOU MUST PLAN ACCORDINGLY AND HAVE YOUR ELECTRICIAN TAKE CA1T 1 HE APPROPRIATE PERMIT AT THE FIRE ARTPPR NI R/ yyy.::+ A• ,� .©xwcjvcis-i�w._ _ __ _ a q S i '1dW ONIa-une msvi s ..rniEVEL :sF�+ ad_ 1 w b ---- — ')1'0 S80103130 of . ro !' ....f�lR�FL9.F..lCY_:A?oSC-.:_. i� - .�•s It 508.948.6191 e ev _ __ In us om o esigns _ ..mmtcxu"i 7 ^F of eeov.fem o tam Z= !•title �'. L _ II � � 41 - 1 U; .FlRcr:EtoaR q•.Aai..._.._ �I g 3 Prenm.n,y P,an.ena rayouri eybCD a"e ror tni•ne err y'n. < Y Preni ere 4114, min! Huh YHI1;J 1 _ 3LT .(�(�-!...... ...... .....n••<<:,w..:,.,YCa1c- . .___ W. Y:` :'ftsrtxtwlnYra<i'Yc'sA45GEF1�_' .•. . F. - - -- - - --. • i. I� I t. I Y•o - .i - 1 b 'OB•928.61 3 I a 5 N F, CVI111 lesigns Wft r y-� . .C m 9. W All AIBM wa - _ f . �. INla<mt;mr e<.ne.•<m<emm eNy.A,x:'o.'rnp uirl,urmq pienleh E _ T t u r , rTTI 608-428-6191 r I Ifeviln ustorn signs rvM d y � i 3i .s2. 3 `• �' nary'Olena a layeyti'by O<U.ara'fa.Irit uie RI In ontYwrry other uae 1.rtrlruy'proMelt �. _ The Commonwealth of Massachusetts Department of Industrial Accidents _ office o1/nyesti9atiofis 600 Washington Street y Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit name: ® -I-+- t31 location: -C city G0-rUim /'y uhone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an semployer providing workers' compensation for my employees working on this job FFFF Nll coin an nQame K rr i�,,,.,4'",�.�5.'��,kt,�n�{�,tiuFa s•.. Apl - #y ,t,,,,,n m z i � �,, --s -`_- � 7 ty�y# ; c ��r,✓r[r3 cy,rs rr.t'z Ess* "�- !?x IlOne tt i� � � .�t4.� k ,���7a3 y�yX . `F4 y s�' 2 $'x.- ""€..' r. .ta t k a 7 { '•'..f'°.t - +, `.- Ak, Ks fIQSUCBQCCO a t' r JuX I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: _ �� u 'Cx r t: r r x s' ,g r t ? 1�' �eL �ti x�' 4" fr.,..- tt r ui 8 f f 4� - A✓1+ -h C a i a i� zyp����s i"t .,; 'v+fn• a ,}"� t�f � Y?5�5� it'�,�'y a a��v �2 r7 r,:. s,,,�r a .,ri,+ri i qC ! ir. ✓'z 3 t tr zh+t y �'�2'4 ,,,�'.,s/" 9 ffwYr�S}}�.���.e.! ",�r+�t.,�` L �fib:`. .�"'3• b,r-`t"'° J x fj� � v r y��kv �: �A'wi£r+��a.3'�y $ t v.. ,.j y,t a�s�T34u�.�ti¢is �' h�+a 4 {� .�:^����,,�'��A�,�.tQ `�a�f 3#t��' �.zv,�Y t�- _t -' y�.:'� s���.:,r��fSx s r� ,s:'Y � u "3` .+ •'.k.�-�s��.�;���, M�`i C0111 8QQame >lfyi f r N m SLC� X^; = �„e?'"'�vtfr a '}'rT 4 •��' t. t� t � �"t aF e �. t a°# r !r 3 s f-r y1: ,n � �a .s t �° 3 xa'..:.e,�+xk �."a* �' f��i%:� L. ��`L.1''`3" '`�� � � � e5��'� �. L. x , Ph olle# t r '� �+,•.k.,_':4� cr�.�1-�y#h��, .c K'txu3z'e,r, v �.{ � Pollcr•# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I d ereby I u er the pains a penalties of perjury that the information provided above is true and correct. Signature Date 15 Print name Phone# �q /�V official use only do not write in this area to be completed by city or town official city or town: permit/license# F—Building Department ❑Licensing Board []check if immediate response is required []Selectmen's Office ❑Health Department contact person: phone#; nOther (revised 9/95 PIA) r c . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their" employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 7w CMR Appemda J 'fable J53.1b(eontlaned) pmeriptive packaged for One and Two-Fsaoily Residential Bnildixio Heated with Foassl Fuck • MAXIMUM MINIMUM Wall Floor t3asemeat Slab Heating/Cooling Glazing Glazing Ceiling perimeter Equipment F.tIicieney' Area'(%) U-value, R-value' R-value' R-value, Rwa R-val►>er par3cage 5701 to 6500 Heating Degree Days' Normal 6 Q 12% 0.40. 38 13 19 IO 6 Normal R 1Z% 0.52 30 I9 19 10 �' 6 85 AFZJE S 12% 0.50 38 13 19 10 N/A Normal T 15% 036 3E 13 25 N/A 6 Nomtal U 15% 0.46 38 19 19 10 NIA 83 AFUE y 15% 0.44 38 13 25 N/A 6 85 AFUE w 15% 0.52 30 19 19 10 13 25 NIA NIA Normal X 18% 032 38 NIA No mal y 18% 0.42\ 38 19 25 N/A 6 AFUE y 18% 0.42 38 13 19 10 AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: �L Z'm . goo Sao 2. DARE FOOTAGE OF ALL EXTERIOR WALLS: L-Dco 3. SQUARE FOOTAGE OF ALL GLAZING: 2-VO 4. %GLAZING AREA(#3 DIVIDED BY 92): 5. SELECT PACKAGE(Q --AA-see chart above): 32, 'U Vs4KUe7 NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ETER iI ING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS BUILDING INSPECTOR APPROVAL: YES: N0: q.fours-0 S 0303 a 780 CMR Appendix J Footnotes to Table A2.Ib: Lass doors, skylights, and 'I Glazing area is the ratio of the area of the glazing assemblies (including sliding-g basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example, 3 f�of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with Council RC test procedure, or taken from Table J1.5.3a. U-values are for the National Fenestration Rating Coon (NF ) P . whole units. g • center-of-glass U-values cannot be used. ] The ceiling•R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation•thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. used Do not include 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing ('if ). exterior siding, structural sheathing, and interior drywall. For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. 'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see-Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). Town of Barnstable Regulatory Services 9 BA Mass.B '� Thomas F.Geiler,Director fo;a. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, S2hti-e as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Sigiiature of Owner Date �AQOVI-e- Print Name 03/04/2003' 15:29 ' 97137410759 STAPLES 217 PAGE 0B/11 ACORD CERTIFICATE OF LIABILITY INSURANCE HRODR DATE ( M04� 1 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Benevento Ins. Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 497 Humphrey Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5wampacott, MA 01907- Phone: 781-599-3411 FAx:781-581-7200 INSURERS AFFORDING COVERAGE NAIL# _....._ , INSURED IN SURER A: Hartford Unerwriters Ins. Cc . Broderick Building INSURERS: Patrens Mutual Ina. Compan G Remodeling summerfield park suite 309 INSURERC: 800 Falmouth rd INSURER 0: Mashpee MA 02649 ..... _. INSURER F; COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SFF,N ISSUED TO THE INSURED NAMF,D ABOVE FOR THE POLICY PER100 INDICATED.NOTWITHSTANDING 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 BY THF,POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED AY PAID CLAIMS. POLICY NUMBERS TIvE P LI VUI) ' ......, LTR NSR TYPE OF INSURANCE DATE MMIDDIYv DATE MMIDD/YY LIMITS _GENERAL LIABILITY EACH OCCURRENCE I S .500,000 FO — .... B X COMMERCIAL GENI-AAL LIABILITY CTR0003264 12/04/02 12/04/03 PREMISES(Coaocurnncel _I$ 100,0-- _ CLAIMS MADE L,X�OCCUR MED EXP(Any ono pnreon) S 10,000 PERSONAL 6AOVINJURY $ 500,000 ._... ___._.... GF.NERAL AGGRE GATE $ 1 Q00 000 GEN'L AGGREGATE LIMIT APf LIES PER; PRODUCTS-COMP/OP AGO 1. 1,000,000 POLICY PRO• _ JECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _I ANY ALITO (EA Accident) - AIA OWNFD AUTOS BODILY IN.IURY $C,HFDUI.ED AUTOS (Per earn—) 5 HIRF•0 AUTOS BODILY INJOHY NON.OWNFn AUTOS (Per ac idrnl) -- ''" ----- PROPF,RTY DAMAGE $ (Pnr eraldent) GARAGE LIABILITY AUTO —,_ONLY•EA ACCIDENT $ ........ ANY AUTO .., OTHER THAN E•A ACC $ AUTO ONLY. AGC 5 EXCESS/UMBRELLA LIABILITY EACH OCCURRENff; $ OCCUR 17 CLAIMS MADE AGGREGATE g y $ DEDUCTIBLE RETENTION $ I $ WORKERS COMPENSATION AND . EMPLOYERS'LIABILITY x TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXEC,U'flvE 6S6OUB-976X5B9-7-02 12/04/02 12/04/03 E.L.EACH ACCIDENT $ 100,000 OFFICERIMFMRER EXCLUDED? ,... II yyne,d9ecribe undor E.L.DISEASE-FA EMPLOYE II$ l00 000 3 EC OTHER PROVISIONS nnlow OTHER E.I. DISEASE-POLICY LIMIT x 5 DO 000 ' DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I F.KGLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS JOB LOCATION 73 MICHtLLE AVE COTUIT MA 02635/BOB ISANEZ 6 ROSANNE DEVITO CERTIFICATE HOLDER CANCELLATION TOWNOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN TOWN OF BARNSTABLE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BARNST .BLE MA REPRESENTATIVES. AUTHORIZED REPRESCJWTY11rIV ACORD 25(2001/08) �/' ' OACORD CORPORATION 198 1 Board of Building Regulations and Standards s HOME IMPROVEMENT CONTRACTOR RgstratiOn__133498 I Y Expiration 06/29/2003 hype '�(ndividual .. t 4 BRAD BRODERICK BRAD BRQDERICK,, I CAI-, s 21_^UASHENET WOODS ( MASHPEE�'(�4,�02649 "�,; - Administratt�r � BOARD O BUILDING"'REGUL,q*tOMS'r ( Uicense �GONSTRUCTI;ON+SUPERVISOR ':v Numte- CS 073,12.6 t E>�pines0�f / Q04 Tr.no 1RON 7022 BRAOLEY�E 21's >VASHN,E(rs�Wb©� DSDR ( w..�r a "">A�dmirnstra#or "' Mar 25 2003 4: 46PM Broderick Bruilding and R 508-539-4900 p. l IMF► 'Town of Barnstable Regulatory Services sL►se Thomas F.Geiler,Director Building Division Town berry,Building Comrnissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-740-6230 Permit no. Date AFFIDAVIT HOME IMPROVE.NI ZNT CONTRACTOR LAW SUPPLEMENT TO)PF1UYZT APPLICATION MGL a 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, impzovement,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 suchresidenee or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work:-, Bstimated Cost J� 12 Address of Work: R f Owner's Name: �S� rV rV a Date of Application: I hereby certify that: Registration is not required for the following reason(s): ®Work excluded by law [3Job Under 51,000 []Building not owner-occupied DOwner pulling own permit Notice is hereby given that: OWNERS PULL NG TIMM OWN PERNfIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARJBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERMMY I hereby apply for a owner: Date Contractor Narne Registration No. OR Date Owner's Name • 1 � RESIDENTIAL BUILDING PERNHT FEES APPLICATION FEE New Buildings,Additions $50.00 ,��� d Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE y square feet x$96/sq.foot= 0 x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 1 (plus above if applicable) Permit Fee '�- P`Op I14E fp The Town of Barnstable BARYSTABLE. ' Department of Health Safety and Environmental Services 9 MASS. a, i639• �0 prFOMA+p Building Division 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 I Inspection Correction Notice Type of Inspection I: 1 Location `� t'Y) f r e A y e Permit Number 7 3 Owner Builder R poli cods'f- r—k One notice t6 remain on job site, one notice on file in Building Department. The following items need correcting: L 4 5 110 1E'S f(1 "�Gwt'n4 W f Mt fr-S LOV Q n it MA J ' or (�' 11 J C far^-I 4 r-S Please call: 508-862-4038 for re-inspection. Inspected by Date i A A L TOWN OF B RNST B E Permit No. _ . _.___________ Building Inspector cash al OCCUPANCY PERMIT Bond _.______._ Issued to Address 14 4- Wiring Inspector Inspection date Plumbing Inspector 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 FROM An A r TOWN OF BARNSTABLE i�ir. Francis Laliteir�e- -- BUILDING DEPARTMENT Town Clerk � rt a a�_ 367 MAIN STREET HYANNIS, MA 82e01 Phone: 775-1120 L SUBJECT: FOLD HERE DATE March5 MESSAGE Work :ias been cmpleted under Permit 27D63 Delay _Realty Trust) . Please release Bondi v raas•w..Ra.�s s3 r•-Ilya•»+. SIGNED i DATE REPLY SIGNED N87•RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. Assessor's map and>I'ot number ...... ...... �..... .......... THE Sewage Permit number t BAUSTODLE, i House number ....................................7 .. :��...�.-........:..... 9 rasa �p s63q. 0� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ` TYPE OF CONSTRUCTION ....L .. .. ................. ...................... .19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit -ccording,to the followip ftion: Location ............ .1�. .. �..!.'..I.e IU... 6�..........��za.......................................................... ProposedUse ....S..�.<<!.......................................................................:.................. .... ....... ............I......................... Zoning District Fire District...... ................. ...... ..................................:................ Name of Owner �* 1�Z�/{..!�� ,... ... !t .......Address ..�.�. ....�1-{�(�jiLl�ll rc�C I �/� �.......... i .... "Name of Builder ....................................................................Address ................................. Name of Architect ..:. .......Address Number of Rooms ..........�............................................:...Foundation ..lv :�!. .Gfl"h Exterior ....................� . ... .''` `'!i'i.............................................Roofing .... �. ✓�N............................................................ 1IZ r+-4 Floors ............................Interior ................. ...................................... ................................................................... Pleating AAA, .................... ..................... 1 ' Fireplace Approximate. Cost ...... ..U. ......................+.................... Definitive Plan Approved by Planning Board ------7------------19 2L Area 6 Diagram of Lot and Building with Dimensions Fee ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH o- ZC, 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. J4444 Namer/.... ............. ................... Q , Construction Supervisor's license ..................................... DELANEY REALTY TRUST A7--27-62 No ....2.706.3... Permit for .....12. Story y.............. . ...... . . .. ........ .. Single Family Dwelling ............................................................................... Lot 13, 73 Michelle Avenue Location ................................................................. cotuit ............................................................................... Owner Delaney Realty Trust ................................................................. Type of Construction ....Frame.... ................................. ..................................................... Plot ..................... ...... Lot ................................ October 5, 84 Permit Granted ........................................19 Date of inspection .....................................19 Date Completed ......................................19 VV0 Assessor's map,and,lot number ...�....... ...... l's, THE Sewage Permit number d E BABH9TADL . .s .House number ......................... r rasa T OF ,X 1639- RNSTABLE OWN BUILDIN& .1SPECTOR y APPLICATION FOR PERMIT TO f . .................................................. TYPE OF CONSTRUCTION .:. ::...'... ✓�-.....: r .............................19.. TO THE INSPECTOR OF BUILDINGS; , • The undersigned hereby applies for a p mit ord the,folio g�'nform ion: Location ...... ......... .. .............................. ..: �.......... ..�. ProposedUse ....S f.D.,...... .. .... ................ ...... .......... . . ........... ........................................................... 61 Zoning District ............................... ... ..................Fire District ....`-"... ``^'` ............................. . ....... ......... Name of Owner �7$�1.�. /' �►!!��''"1 ......Address ..1. .. 41+� 14 ... v / 1. ...... �""I' ...r.l.............1.,... ' r Name of Builder . ............. .......................... :...................Address ................... ...............: Nameof Archite t• ..................................................................Address ...............:.....:..................................................:........... Number of Rooms ................:..... .....:.... ,....,.............. .........Foundation ........ Q�� :......................... ......:......... Roofing ....�'LI�.vYh. .. .. ............ ......... ... . . • i Exterior ............................ .... ............................ .. . .. ..... Floors .......................................................Interior ...... .. ✓J Heating j ....... ....... ....... ..Plumbing Fireplace .........1............... ....................:........... ....................Approximate. Cost ..............p.V....!v............. ....... Definitive Plan Approved by Planning Board _� / -___3___________19_? _. Area / -Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD.OF HEALTH. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town X�ns.ta reg ding the above construction. Name ........... .......... ..... Construction Supervisor's License ..v'.v. ..1..................:. .� .. _- ` T. - .'ri � 4 _ f ...cr.r`.•� .�,.r� .t. ,.. 4 � [�,y:�3 �t 4$i n .. _....a- 4 D REALTY TRUST, } 270&3 : 12 Story w�ONo .. Permit for .... Single Family Dwelling t s tl ; ', •... ....... ............ _ .... ..... °'S - •. u - Lot 13, 73 Michelle Avenue f: Location ..... .. a - COtuit Oli .................. . n r * Owner Delaney Realty Trust - , . ........ . .................... ...........' . Frame .� _ --. f ,.. Type-of. Construction .............................. ....... -"s ` .... . ......... .... ........... ..... x !" .. -hi t s Plot ....... ......... ....... Lot•.................. ........ .; .,. October 5 4 84 Permit r .. erm t Granted ..�................. t.......__...,..19 r>Date`of Inspection/!� / :, 19 Date. Complette/.�,/QJ�/ ��.. .... ,]9 .r Aek t•yy. �• Fly, - � { .. « 'w'^'L� J. 17 `aft v " J 13- Y L0CA7-/OA/ 7'6--,'/ 7" / CE2T1.,CK TNAT Tf/E ism ,��✓J 7-mEr S l o,,c,C/.t/E AA/v SET8.4 PL Ail! ,2E�"E.2E'.t/G'E l �2ElJvi eEMEN��' of T/,rF TowOV 4--- may. AMC' /.s A4/ ' 40CA rEo f I _ BAXTE�2a 40/ / /NC. I OA TE• I Ti�.�/.S P.C.4.�//S �t/oT BA.SEO D :4�t/ �2E6/STE•QEO 1-.4oL/O SV CeGyGg /N.S're�i�1ENT,sveYEY€ �' �sr'��/.c1�a M.4Ss. j ,O�"•45E'TS.Sh�Oy✓�✓,ff,(ALi[� it/oT 8� A�O4/C,4N�" �j �,►W6Lr-_ 1FAM1t_Y - ;5 BGOR0oN1 j ►JO.`6ARBAGE (j2tNDE2 � I C1-� � QJC � , pn►4.Y Ft.OW .: Ito x 3 = 30 56PTIG TA►uK = 33Ox15C>% ' '4956.PC> u5E t000 GAL. DISPoSt�L PIT v5E I0oO GAL_ S t Dc.WAI.0 A2Ct► - 15o S.t= x a.5 = 5OTTOM AREA r �� 5�• 1 5 o S.F x ► o 5.o G.P o as�' �' �><Cr,i' 44 'ToTA 1, ESIGN a .4 2 5 G.P D• Idtxl`,�.. 'ToTA1_ 'DA 1�-`( F►-otr! = 33o G.Po � �� F�EIZLoI,ATIoN RATE ; I"IN 2MIN ot`t_E$5�, N IUUO 6kt S Irl I V,AoK66 Yo �, I i o n�nH j '1 No. 19334 �� 5 ch it To P FWu= GG�/1J 10 SuSSG��- DiST. BOX IG( I Ooo I N Y TANK t , Gam-• 1cX��5 LEALl1 ' PIT INV. .15 INS/ Adj'ru 4ToN6 5 a CE2TIFIGD PLOT PI-A.W Ll FRDP1LE SCALE SGJE `'_ c�' VAT� r— h tik p L A N R G F 6 cZE rt GE r ► �>E RT�FY TNaT TNT P�p• k�LF�� 5No H!N µER f�It GOrAPt-`(5 1rl lTµ"T H it S 1 v E t_I N E ' A►.1D SETaP.GK 6 �>Q>rMENT� ! - O-VO4 OP °BA ' ANC Is t✓ �iJ Z Pv Z � t.00 E.D WtTNt►J TNsG G1.00D Pt..Q.IN i DAT E �'I i) �� � BAxTEcz.e N`{E INC. i REG t S T EQt�U't.AN o S u e v EYoTCS -t'uts P�o.N t5 NoT E3n5c p ob AN osTEt2.Vt�t-E• • MASS i ., 11J5•'>"�,uMEtitT 5�2v> Y � -rNE n►=FStT'S Suau 'D No-T i3E U5 D'TCb 0eTePM0,4 t`.cT t. INE APPLICA!-�7" a 6' Proposed New Construction in Cotuit MA. Prepared For : Robert E. Ibanez Assessor's Map : MAP: 27 PARCEL: 62 LOT: 13 Baxter, Nye, & Holmgren, Inc. Community Panel Number Registered Professional F.I.R.M. Map Zone: C — 250001-0015 Engineers and Land Surveyors Plan Reference. : Plan Book 280 Page 25 812 Fain Street Deed Reference Deed Book 8540 Page 43 Osterville, MA., 02655 ftm — (M) 428-9131 I= — (508)-426-3750 Owners : Robert E. Ibanez & Rosanne Devito Job Number: 2002-103cpp.dw9 Scale 1" = 40' Date 11-19-2202 cp ty �`V , h' Op, 10, 01 111,91 61 A9 h� A`) 10 � � � ,wry Sj° �7S• / Q°� 6S C CB/DH CB/DH FND �O FND /16) `�69 36' 19 \\ CB/DH `7 FND N/F WHEET -A� O Y �6\ 0 0 1 1 14 , Is, ---- _ - - - - - - �. 2 0, tx `S°' 9 l ti � o, S' � l 9° OF PROPOSED 0>1 70, OC'�r ADDITION 13 00N � � J� J \ °o • S66� 1rO O � � PARCEL AREA 0,7' 20194t SO. FT.' 0.46t ACRES N/F PERRIN Ln W, O � AO/ � � S o 9S, 0No O O m z ` g a_ Mgs orb yG�� I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING FOUNDATION AND PROPOSED NEW CONSTRUCTION_ SHOWN HEREON ARE IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND SETBACK REQUIREMENTS, ARE LOCATED IN RELATION TO THE MON MENTS bP4 ARE NOT LOCATED WITHIN A SPECIAL FLOOD H Q EA. STERED ROFESSIONAL LAND SURVEYOR DATE s uao 1 I o•o ............. ...........: . ............................ .... ..... . ... ......... .............. ............................. ................ .............. .:........ II ..... l� :........ ..... . . . ..... .............. .............. ............... ............... ..... ..... .... . ... ..... .. ................ ..... ................. .................... .............:........ .. ................. .................... ................ ............. ................ ..... ... . .. .................... ...................... .. . .... ..... . .......... .. ............. . .. ........ ..... .........:.. .. . ......... . . ............... .............. .............. ......... .... .............. ............... .............. .............. ......... ... ..... ..... ... ......... ............. .............. .............. .............. ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 < , ...... ... . . 14?44ttttt-� . . . :4.44:404:�`��fl t u u u i o o t i y II - LL LL t e24 LL oU rG(1 WON C 13 Michelle at eARNSTAeLE KITCHENS IST 00 AN 9Ga Uol 9 BOO .. .... ..... ... .............. .... .. ............ . . ............. .. .............. :.:.::.:....:. :.:...::.....I. . :. ::...::.::: ..:. :... ... ........,....... ......................... .. ..... ..... .... ..........:........ ...::'::'.:'::'.:'..'::':: :.'::'::':.'.:'::'.:'. f " ..... ... ... ... .. .. .... ' ..'.: .':.'. :. ... .'..'... ...... '. . 8 . . .............. . . . ...........:... ................. .'.....'... . .......'..'.... ....'..'.....'...... ...'.....'.... ..:.::. . .:'..' ....... ...........'.......... .'..'........'..'.. ............. ........:.... ................... ............ .. .............. ............... ............... .............. .. . . . . ...'..'........ ... ... . ...'..'......... .............. ............... .............. ...... _.... ............. .> > ; < < ............ ..... ... .... .... .................. .................................. . ................................ .. .. . . ; . { u u u u uI o o all LL I °o o o 13 Michelle at IBARNSTAIBLE KITCHENS IST FLOO :=LA