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Home My WebLink About0022 OXFORD DRIVE '/ /1 i�l� Y � / 1\ ..- ' _ �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T Map 0 2,1 Parcel B(o 1 Application # 13 D a a ag. Health Division Date Issued 4;/ Conservation Division Application Fee 0 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board p{a Lill zfl3d-j4 Historic - OKH _ Preservation / Hyannis Project Street Address 2-� OX, FbRb DR, Village Owner .'}�Pt�(121 C 1A `P P5 L-M M Address 2"- 0>ei� Telephone Permit Request W aA-n+E1 , rz-AM ON Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation t S D-b Construction Type Lot Size Grandfathered: ❑Yes , ❑ No If yes, attach supporting Uumetation Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) r ZMW Age of Existing Structure Historic House: ❑Yes ❑ No On Old King ghway::C5 YeRLI No, i CTJ Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other :._" Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 03 Number of Baths: Full: existing new Half: existing ne o Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Cy `)ty� (V1 LI kynbj ei Telephone Number Address (2-p VTR ` .c �� License # 10`Z,rl�1 t5 .,N-Ab WA GO tM OAS 6�S Home Improvement Contractor# Worker's Compensation # '� C 1 15 6GY1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO g®uYZ. SIGNATURE DATE f FOR OFFICIAL USE ONLY APPLICATION# .t . 4 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i E OWNER S 5 } DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i . . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. OWNER AUTHORIZATION FORM' (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize 0 , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a buildin permit'and to perform work on my property. Owner's Signature Date, I CONIENE41 MVAUGHAN ACURJiT _. ;oATE(MMmonwr) CERTIFICATE OF LIABILITY INSURANCE 312e12013 THIS CERTIFICATE IS ISSUED AS A MATTER:OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON`THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND; EXTEND OR ALTER THE°COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: fi the Certificate holder Is an ADDITIONAL INSURED,the pollcypes)must 6e endorsed. N SUBROGATION IS WAIVED,"subJect to the terms slid conditions otthe:pollcy,ceAalnpo8otse may regulre an endorsement,A statement on.this certiflcale:does not coMarrights to the certificate holder in Ilea of such endorsements PRODUCER N u>_: "Strate ie.Business Unit'. RoaeIs&Gmy.lns.-Dennis Branch PNONE, 608 388-7980", 434 Rte 134 rio 877. 818.2168 South Dennis,MA 02880 _:INSURER "AFFORIM COVERAGE NAIC 9 e11W11:1RA:.Selective inS:.Co.of the Southeast INsuaeo IxsuRElte: Coa,Senie Energy.Iac. _ INsuREac e . dbq ConserVlskn Energy' 607 Main St ulsilREno; Hyannis.MA'02801 INSUREREz COVERAGES CERTIFICATE'NUMBER: >. - REVISION NUMSM- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTEO BELOW.HAVE BEEN ISSUED TO THE INSURED NAMED:ABOVE FOR"THE POL dy'PgR)OD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,.TERM OR"CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WRICHTNIS CERTIFLCATE'AAAY BE ISSUED OR.MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED,HEREIN I"UBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS:- POLICY LIR IMOFINSURANCE POLICY NUna,ER ._ F LIMITS GENERAL UABILItY _ EACH.000URRENCE A X COMLIERCNL GENERAL L'AN TY 2011299 3114Y1013 3/14/2014 -- _ PREMISES em s 100,0_ CIANIS►UDE�X OCCURi mEXP c"perwo S 10,00 PEasoNALaoDirlH�uRY s. . 1,000,0_, GENERAL 3 3.00010.0 .. OBrL AGGTUMTE LAIIT APPLIES PER '; PRoniiGls-COMPIOPAGO s 3;000, X POLICYLIM AVTOMOSIJELUe1LItY sodden ELIMIT ,. ANYAUrO e001LYINJUUw(Pe('pmw) S AMOM&O SCM�t1LED AVIOS RUfOS BODILY INJURY(Pe eoddmd) $ IY MARO6 AUTOS UMBREL ALIAS HcLw 00" EACHOCCURRENCE; EJe�SeLNaS' .... n 'A(IGREQATE -$... _ OED RETENTION 5... WORIO'AaOOYAl1Qr _ - __.. ATU. OTH AMD BdPLOTEIIb IMIellTlf 1FR A ANr"PROPAIETORAvmEitlEv mNEY/N C7fl68639 3/14/2013 :3N412014 E.LEACHAGCIDENT; s S00,0 I_ O EXCLUDED? ❑y NIA 1 ti E.LOMEASE EAEMMOYE S.._ 500,00 OEOPERATIOInitlebw E:L(ISEASE•POl1CYUA1IT OEEg6P710NOPOPEn11=WjLOCA7ION$IV ACORG'I01 Addis"ki o"'Schadul%KU *SPUAItipidn41) -EXCLUDED OFFICERS UNDERV1110 ERS COMPENSATION.CONOR B.COURTNEY MCWERNEY"NOTE THAT BLANKET ADDITIONAL INSURED COVERAGE APPLIES TO THE COMMERCIAL GENERALLIASILITY-(IFA'WIUTTEN CONTRACT IS W PLACE):, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIC188 BE CANCELLED 60,OFiE Rlae Englneeling> THE FxP1RAnoN DATE. 'THEREOF, NOTICE WILL BE` DELIVERED W_ 1341 Elmwood Ave. ACCORDANCE WITH THE POLICY._PROVISIONS. Cranstch,0 09010'. _. 101888-2010 ACORD:CORPORATION. All rights reserved. ACO.RD 25 20f11166? The ACORD name and " F ( logo are roglsteTed marks of ACORD The Commonwealth of Massachusetts Pnnt Form = Department of Industrial Accidents Office of Investigations I Congress:Street,Suite 100 Boston, 411A 02114-2017 www ntassgov/dia Workers' Compensation.Insurance Affidavit: Builders/Contractors/:Electricians/Plumkers AwAca, %Information Ptease Print Legibly Name(sus;Hess/(Jrgati zaiion ndrvidual):Con-Serve Energy lnc dba C,onsOVi.slon:Energy Addressi M Route 130 Sandwich,,Ma 02563 City/State/Zip: Phone Are you an employer?Check the appropriate box: Type of project(required)': 1. 1 am a employer with 8 4. ❑Tam,a general contractor,and 1 " employees(full and/or par[hme), have hired the-sub-contractors '0 ❑,New construction 2.❑ Lam a sole proprietor or,partner Itsted on the attached sheet: 7. ❑ Remodeling These sub-contractors have ship and have no employees 8. ❑Demolition working, for meinan c ae ry' employees and'have•workers' uilding addition '[No workers'comp.insurance', comp tnsurance.* required,] S". We are_a.corporation and`:i. ts 10:❑Electrical repairs or;additions officers have'exercised their. 3_:;❑ 1,am a homeowriet doing all work 11.❑Ptumbing,rgpags or additions, myself.[Noi workers'com : right df exemption.per:MGL p 12-0 Roof repairs, insurance required]t c. 152,§1(4),and we have no employees; [No workers' 112 Other Weath itization 2013 _. comp.insurance required.] *Any applicant that checks box-#I must also fill.ourthe section below showing their workers'con peiisatioH policy ioformanon: t Homeowners who submit this affidavit indicating the Air doing ill work and'then,hire outside contractors:muif submit a new affidavit indicating such. . =Contractors that check this box must attached an additional sheet showing.the name of the sab,coutractots'aad state:whether or:not-th--- . _....� 'employees. if the.sub-cunlractors.have employees,they must provide.theu wo kers.comp."policy number, I am an employer that is providing workers'compensation insurance for myemployees. Below is;the policy aad job site information. Insurance Company Name:Selective Insurance'Co of the Southli8t Policy#or Self-ins.Lc:#:WC7956539 Expiration.Date 3/14/20:14: Job Site Address: City/State/Zip:: Attach a copy'of the workers''compensation pohcydeelaratlan a e showin the oHe number and ex"iration date), p..g ( g P Y P• Failure to.secure coverage as.required under"S'eciion 25A of MGL c; 1.52 can lead to ttie imposition of:criininal penalties of a fine up to$1,500>00 and/or one-year'imprisonment,as well as;civil penalties in the form ofa,STOP'WQgj,( DER and a fine of up`to$250:60 a day against the violator. 'lie advised that a copy of this statement may be.forwarded to,the'.Office of Investigations of the DIA for insurance coverage verification,; 1 do hereb rerti under the pains and penalties o er u that the in ormation provided`above is true and correct _ _ Signature: �. Date ?J 2 `201 Phone-#.508-833-8384 - O&cia!use only. Do.not write in this area o he,.com leted b ci or, official P Y tJ' .� City or Town: PermiULicense:#> 1-o-Aing Authorityfdrele one): 1:Board of Health 2.Building Department 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector_ c Other. Contact Persofti Phone Ma CSSL 10" CONOR D MCllYERNEY 39 SIASCONSET-D'RIVE SAGMIORE BEACH MA 02562' ✓�,ate` • 08/1:9/20:14' Offce of Consuiner'A :Bbsmess Aegulahoo` HOME IMPROVEMENT CONTRACTOR Registration. 1712511 TO Expiration:. 3/1/2014: Partnership C6E7-SERVE ENERGY CONOR MCINERNEY' 37.6 ROUTE 130 SUITE It SANDWICH,MA W503 Uddersecretan. License orregistraton valid for individul use'only before the'expiration.date:If found return'to: Office of Consumer:Affairs-;and Business Regulation 10 Park P:1aza-Suite 5170 Boston,MA 0311'6 T_ 047 Not valid wtthoptsgnature: 1 F . r Its..,•.a;�''. �,�::�.:.._,i, SOWN 0,' PARCET, Tl) 01:1. 063. GEOMSE ID 971 ADDRESS y:72 OXFORD DRIVE PHONE.. z COTUIT ZIP LOT so BWCK LOT SIZE �DBA DEVELOPMENT DISTRICT CT PERMIT 25609 DESCRIPTION ADD FAM_ RM/2CAR.-GAR./MUD RM./2 STORY ADD. PERMIT TYPE BREMOD TITLE _ RESIDENTIAL ALT/CONV, CONTRACTORS: PROPERTY OWNER Department of Health,Safety ARCHITECTS and Environmental Services TOTAL FEES: $I55.00 BOND $_00 �TNE CONSTRUCTION COSTS' $50.,000-00 434 RESID •ADD/ALT/i3ONV 1 P'RIVATF. P-f**`> *- STABM MASS. �►. 1639. OWNER PALMER, FREDERICI� I� & ADDRESS- PALMHR PATRICIA Y 2:2 OXFORD DRIV`E P - COTUIT MA BUILDING DIVI}S'ION " BYE if ( f�l DATA; ISSUED 09/12,/I.997 KkPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED, APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARAT PERMITS. ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS l o 2 2 AJ[ 2 op 30 8' 3 1 MEATING INSPECTI APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: 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. v � Lt2v 22 to Engineering Dlpt. (3rdRoor) Map l) / Parcel D(o / Permit# z 9 House#, � 6 Date I, }ed / 2-- / Y/ Board of Health(3r oor)(8:15 -9:30/1:00-4:30) �a / Fee n Conservation Office(4th floor)(8:30-9:30/1:00-2:06) -_ Planning Dept. (1st floor/SchoolAdmin. Bldg.) .f �aE. . Definitive Plan oved by Planning Board 1 l-19 , �' ` ` SEPTIC S B T BE STALLED \ D ' TOWN OPHARNSTABLf WITH ANCE 5 v' BuildingP'ermit Application ENVIRONMENTAL CODE AND Project St et Address °�o� ® D r' I'1'V`�— TOWN REGULATIONS -,Village - Owner m ill. d" roQ �61 A 7� � Address ,Telephone Permit Reque , A c A!` ,wxom' .;eil X..7 /6 -R3 8 X A�'- S - l.Au-N� 8'X 7 ' First Floor J/ .)) C> square feet Second Floor 7 i� square feet Construction Type �G. Estimated Project Cost $ 56 NO Zoning District Flood Plain Water Protection Lot Size , 50Z) Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes No On Old King's Highway ❑Yes *No Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ' Lot) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing �_ New 0 No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas C] ,Oil ❑Electric ❑Other Central Air ❑Yes YNo Fireplaces: Existing XNew Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) -Attached(size) aq ,C r�V' ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Jl� SIGNATURE J -- -y r DATE L7 BUILDING PER�IVI� E�ld)n'r# 1L OWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. vl DATE ISSUED - _ r MAP/PARCEL NO. - _ ADDRESS i VILLAGE; OWNER { ' • _ t " DATE OF-INSPECTION: FOUNDATION FRAME INSULATION - 7'7 - - _ FIREPLACE ELECTRICAL:\ ROUGH FINAL PLUMBING: ROUE-QHX S FINAL _ GAS:,- _ RO GHQ tm� FINAL •. ^ FINAL BUILDING a F� " ! DATE CLOSED OUT g tr min ? � M :�: r ASSOCIATION PLAN N iti m 5 0 HOME OWNER'S EXEMPTION The code state that: "Any Home Owner-_performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1. 1 - Licensing of Construction Supervisors) ;_ provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for . licensing Construction' Supervisors, Section 2. 15) . This lack of awarene! often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home '•Owner� actir as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION --------------- ---- Please print. DATE �.� l JOB_ LOCATION � .. . •. -- Dx,-ford �� / Number Street address Section of town HOMEOWNER Fr cL4T6c� P � Name Home phone Work phone - - PRESENt MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Offici on a form acGP-ptable to the Building Official, that he/she shall be resoonsib for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the St Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comp y i h said cedures a d requirements. HOMEOWNER'S SIGNATURE 41i_ , 4, <-APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. c1FTMF The Town of Barnstable • nAsivsrABI,E, • UASSL �m Department of Health Safety and Environmental Services 1619. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. LI�Type of Work: eSI ,� g t.Cost Address of Work: �rA cJ f v�AP, CAt-y-T 64 k crbb 5 Owner's Name �'��.(� ,A /Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR h Date Owner's Name T,- Information and Instructions ; - • *". tip:; '" �°:� z ,. .. ._ Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thei employees. As quoted from the"iaw", an enrplomr is dcfincd as every person in the service of another under any contract of hire, express or implied. oral or written. "An etn/h rer is dcfincd as"an individual. partnership, association. corporation or other legal entity,-or any two or more -the foregoin*_ engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tnistee 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 dwellin- house of another who employs persons to do maintenance , construction or repair work on such dwelling hoc or on the ;,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section '_5 also states that every state or local licensing agency shall withhold the issuance or renewal of:i license' or permit to operate a business or to construct buildings in the commonvealtli 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 hL been presented to the contracting authority. Applicants Please fill in the workers compensation affidavit completely,'by ilieckin the box that applies to your situation and supplying_ company names. address and phone numbers 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. Clty or•rown5 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. Plea be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t, 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 question. please do not hesitate to Live us a call. . ►•-a►.v!,,....._, ..._ ,� .. .—_.+w1.••+q•.r!�r�•.�.v-rfr-!�r••i. .....+Trr7!!w�'n_a ...: w—.�.w�wA!.�.I�ONL'717f'•.'L^r.�l•wslw�-."� 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) 7274900 ext. 406, 409 or 375 The Commonwealth of Massachusetts Dc artnunt of IudustrialAccidcnts s _ office of/VMS V9211ons 600 If*a.hington Street '�`�r • '" Boston, Ma.u. 02111 Workers' Compensation Insurance Affidavit i It ant information: � Please PR11VT lei`J-�)�"V """"""' "'�"�'��•••�-"M�� an A Ze) CO CR— I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity .. ,...,..-..--.s........-......._n-r�..;t'err.a.sw7lr+:s.-.++mow++/.7�!+'�.:,XT�...►•..•w..7„�..a�s.r w..y..+•��;+..wr.-.►.•.—.y.w...��....-_....... I am an emplover providing workers' compensation for my emplovees working on this job. coutttao• name: . address• city: Rhone#- insurnncc co. nofic� # I am a sole proprietor. general contractor, o omeowner 'rcle one) and have hired the contractors listed below who have the following workers' compensation polices: company nnmc• address: � �� Oi✓la a cin: �� n �. �d O 1S "I one#• insurnncc co A �b S�AIN)e,e— # . ri 1:•+.. VrC - - 'Z'a'^ � = '-__ _1r�^.�:�.�1;`iT"L!7�w.S•1.�p„ ._:�._._ _ ..•�.y._.i_.-._..__"•. .__._.... .._ ._.�.�._..._. �I.i�.•a L.r_..._w..ww.rr_iw''.rr...Jr - _- - � - _..�`:.�.s.er�-... .a.__� su_�conipinv nnmc: I �"S0 �Cc, 'it".. in: w" hnnc N. CnCO. ) /i b .Attach additional sheet if necessary F::iiurc to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 andiur one wears' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hercbt•cerri-r a it the pains and�s ya1 ics ojperjun•that the information prorided above is tru'and corre . Siinature Date / J Print name Phone# �4-17 ' official use unly do not write in this area to be compacted by city or town official `+ city or town: permit/liccnse# r-IBuildin"Department Licensing Board rl check if immediate response is required E3Selcctmcn's Office C311calth Department contact person: phone#: rJOther r:: ' 19 X , a I T/ 4{ LOT 80 ` i :I. 0� q 1fVILLIAM n I R Iu WAHWICI( t . `.� No. 19I11 A , AL On the bajis of my knowledge, information and belief 1 certify or— nP4 .. that as a result of a survey trade on the ground , on ►5/Pg, I find that: 4077- 80 Q O�C'.D '1'hn r,tmn-hirn(n) tern lnn.ni'rrl n , Ili, ; I XF D,e t V C P M 5 t`I E r z of z PAr. - F¢Eo ! rOIC/4 P,4LM&, 40 AEG. zz, n M4P 21 PcL. 6/ tJ -qo//s//s �3 0 M � � rpo1J TA11Y- 1 z�sr 1 f. � \ �► \ ��ti� 29 'DwEtL. � � 4 OF C�K�o�►> UYJ�l� �� R*API1 3 STEPHE r A. -+ ALLYN 6AX7ER " q WiLSOPd S 'b 2ilOW ,�No.36Q 16 A • 8/�G_7 �►� " ' �tSt�T t o� 2 �t �� F��t-Y 3 Qt�ac� r�E �� U Ib DXF 1�/t✓ CoTU lT VA.I L.:, Ftow = 3 x Ito =33a GPp SZFjtG TANS. ` *0 x-zoo 6�D • a'PvG P�P� v�& 1 Sco 6At USE 4- CuLTSG � CCI�AiNBwS/ Si DUG FIST. 3 no GPD s o-N- SF= SF .36 APPL 64T►,04 AlZ N PLAN V1t=1u - L�GN'It� G4�AM8Ee5 5«wAu- 1A Y�"l�x�x2�ig5 sF oTToyi = �5 sl2 � FiNls�l 4�a�. ow -ro . , SF , .� „ ..�. ...w w PELOLJLT04 Q sra+E 0 SOIL. e-U 12 Z r o f CULTeG w" u5�N�. 9 OF .STEPH N ,. �r •r J RCHARA ALLYN -40 ; f EAXEli WILSON c Is, ,-1 L TER No��226�,9 Y.. 3r (7�0`f�-SEG�p►.i G ht/�M� Is . Fb=2S r PVC ¢i SG lML n Zio r• OK� ,►u I►a z5 a 5 - �= 23 `r�t•IG r WGTLA14b @ YOMD l t(, tJD tJ� F rf=FllRG D FtOT PLA�� ED PLAI.I R�t.1C� I L'F.SZTi FY 1 k&-r Tia rz A01)Irl oIJ L 110w1 go V-B2`1 `�(o• �F N c�wcPl-yS YJ'TU "M s1 �-0T MAp,oF nsE P "I- �J B�QaJ SraP A►=V 1,61 101" LclGATeD W I T-1 I { Nym I hiG 5p�u4L FtsnD gA71AY-v 7ZHE" �A,�.tD SVQVPsYG�S • zw4,1 E GG4 A� 2Z,I�q1 1L1 .CQ)� vsr>Qevtli.� Mti• rQ. QPFLJ G4N'1�. T►�I�I P� ►��- (yStD Tb t;fT1A,5L4,&%A PRcpe=-ry Ir _ I � I&➢j � =, � l�Ir '� � l� k � � �ilf�ElSr� ter+, i � r � F �� I�utr'gli � I Y = lal&RJ��iJ�l�i io 23'-10" 8'-0" I I 14'-2" O 2-8" STEP ICI EXISTING WALL REMOVED F-- 8" STEP I p MUDROOM II DINING Room] El II I I FAMILY ROOM II I II I WASHER AND - _ _ _ _ DRYER TO — — — — — — — BECOME PANTRY PORCH Lfa--- =E; 21'-6" i� EXISTING CLOSET TO BE REMOVED N LIVING ROOM 7 � 4' CASED OPENING TO , d BE FRAMED IN - EXISTING DOOR TO BE REMOVED GARAGE 00 r �N FIRST FLOOR ELEVATION 9' X 7' GARAGE DOORS \ 2'-0" �I 33'-8" y 72'-0" 7'-0" 91-101, 11'-0" 12'-2" 8-8" 6'-10" N 0 5'-0" 8'-8" 12-3" � � I . , LAUNDR Pro NL co M_ BEDROOM o � I 9'-6" 5'-0" 9'-4" 01-0" OCTAGON WINDOW BEDROOM 2'-6- - - - - �, 2'-6" BEDROOM 12'-0" 12'-0" ❑ . Cll 'I a { SECOND FLOOR PLAN t - 3/16" = V-0" 3 RIGHT SIDE ELEVATION i t t .' 1(( f I ( J I REAR ELEVATION p5\t6l TOWN OF BARNSTABLE BUILDING DEPARTMENT t Asa rut : TOWN OFFICE BUILDING � g t639' �� HYANNIS, MASS. 02601 A MEMO TO: Town Clerk FROM: Building Department ` DATE. 0 (7 c An Occupancy Permit has been issued for the building authorized by BuildingPermit ............... �.. ............................... ........................................................................... ....._...... ........ ... ..... _.. issued to r............. 1� ! V, ..... Cl/1.................................................................................................................................... .. _. . Please release the performance bond. ' a� fj ` ' '�,I""`q„,....; 's,�i• .,YF:,s,•.R,�?,%'�''�^,Y`r�L.'�>j{�F'_"�.�I," 'p�Wk` ,�'�`� y� '��. �� •Y� +"l' � .. TOWN OF BARNSTABLE -I 32016 Permt No. ................ BUILDING DEPARTMENT I """ I TOWN OFFICE BUILDING Cash 7 �Nl 9'R HYANNIS.MASS:02601 Bond ......X �J CERTIFICATE OF USE AND OCCUPANCY Issued to Gerald Antis Address Lot #80, 22 Oxford Drive Cotuit, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE,MASSACHUSETTS STATE BUILDING CODE. rL ' April11.�. l9 89.., ........... .................... ...................... Building Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM A , DATA .)OWN OF BARNSTABLE, MASSACHUSETTS �.3, J J / DATE C O/V C. -�& 19 PERMIT NO. APPLICANT / / /.S ADDRESS IN0.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO STORY DWELLING UNI"FS__ (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) DISTRICT--- (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TVPE) REMARKS: - AREA OR PERMIT VOLUME ESTIMATED COST S _-_ FEE J (CUBIC-SOUARE FEET) OWNER - BUILDING DE PT. ADDRESS BY .. FROM THEDEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF'THIS PERMIT DOES NOT RELEASETHE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS - - ___PLUMBING INSP CTION APPROVALS, _ ELECTRIC<\I-INSPECTION.4PrRCVALC X&V 6 i L� c� l A ; , r_y� I HE LNG INSPEC?IJN APPN ALS ENGINEERING DEPARIMEN1 _ I OTHER - BOARD OF HE.ALI'H WORK SHALL NOT PROCEED UNTIL THE INSPEC PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPLI:I IONS INDICA IED ON THIS C:\RD CAN TOR HAS APPROVED THE VARIODUS STAGLS OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF GATE THE ARI'iANGF FOR R' TELEPHONE OR VJR11 CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOIIFuCnIIUN Assessor's office Ost floor): /�a f D o 4EPMC SYSTEM MU T BE ' o�THEtO Assessor's ma' and .lot number ......LJ.../... ... �. . Board of Health (3rd floor): _y ! y g pppp �n 1e S a g r TITLE J Sewage Permit number .....V.Lt.^ sr�.. r:1.� .................. i IRAWST"LE, ` Engineering Department (3rd floor): 'moo 'ENVIRONMENTAL�ENT��. ®E � r a House number ................ ..... ..F_z_ qlC�............. Y 6�0 ..... T011VN REGULATIONS o„a l Definitive Plan-.Approved by Planning Board Y____�YJ_ 19 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 2:00 P.M..only TOWN OF B•ARNSTABLE . BUILDING ' INSPECTOR ' w , APPLICATION FOR PERMIT TO .......J�...�.... .. ( v; G� .�'; ..�.�-u. ... .�. .............. TYPE OF CONSTRUCTION` .: G'. .. ..... .. ...... L .fl ...........19.....:? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: , Location ..`.B1.._:.... ...........(% .,.. ..... !^..........:� .�u:.r:j........ .�.:................ :..................... � e Proposed Use. ....0 Zr1 a....�d... it .��.�.L. ......................:................ ✓ Zoning District ..... .( ......1....:. ............. .... ..... ......Fire District ,.... . . ....... ................. ...... Name of Owner ,... ��} ..` 11.1.. iS .. ....... .Addiess .CL�. Name of _Builder .:,r,�z°.c.�.Gc�..... .T'S............Address § .1 /........ ..J /� .......... Name of ArchiteU.. .....<...a..�'.�.� Address Number of _Rooms .......... .. .......: .......... Foundation " `�0. .....G,....CP Ir?^2.�^C........,......... ExteriorL:ti �.. :. .. k � nr... 00fin �.. ....el . .. ..... .. .. ...... g • �/ Floors le ._e.l......e-�1,1i!!`�✓' 1.••.. ...... r .4.. .......Interior .....p � .�fi'?t:c'L-.... ...... ......... .. Heating ...01_4n...................................................:. .........Plumbing ................... ............... ..............-..-...'...... 4epe .....Approximate Cost . .,..� .... ......................... .... Diagram of Lot and Building with Dimensions '. Fe? . ! • •. X . • �" �. IBA ,. � . � . � • � . �� (�D PO ca -e. .... OCCUPANCY PERMITS REQUIRED FOR'NEW DWELLINGS ' I hereby agree, to conform.to all the .Rules and Regulations o/theT of Barnstable regarding the above. construction. Nam ..............:.......:.............. �'' p °1F 77 Construction Supervisor's License . ....,:.. Y. ANTIS, . GERALD No 32016 .°Permit for ....1z Story............ ........ ..-Si � n le Tamil Dwellin�J.:.... .... ........ ........................ ....................... t Loc Lot #8.0 22 Oxford' Drive ; ation :.......... Al Cotult' _ ......... ........................ .................. k Owner ..Gerald .Antis.......:..... L , Type of sConst�uction 'Frame .............. f 3L Plot - ...... Lot'............... .. ' ......... • - 'Jun,e :23, 88 ' s Permit Granted .........;..............................19 Date of Inspection ..j,. ...0.0 r . �!Date Completed 19 ? IPr 6- * f l �• ••i'4i11//„ '� �,� /ter ^ � �.. g e. z 10 of .� .. "4 .. .;* i,:3^'. �� *`� . ..x•`:�"`2� �4^.' �..-.v2;i.�:..iat, d,��`-+rl'k;,'�Ah:..t.�k�F,:., z.t;{.�,�..-:_ -} .,..�. .�,�; `�y.: r,w �fF_;. .',t i' `tom:' r ';�:�'ri• :x'c,.s,;� . -V�'� A:,.,s��u:+�.��•�Y.. . / .2 ��_ I ' Assessor's office (1st floor):. / r O*TNEto Assessor's map and lot number .....1..�a. ...��&?..1............. ��—� �`♦ Board of Health (3rd floor): Ci .�Sewa a Permit number ....... ...........��. .................... Z BAHd9TADLE. • Engineering Department (3rd floor): rasa House number ��o 039. iu..�....t'�i«:............ '•�0MA-1 ..................... Definitive Plan Approved by Planning Board --------19 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-200 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR# APPLICATION FOR PERMIT TO . /-� r' l��'-i LC.� „ �......................... �.................... .... /..................................�?............. TYPE OF CONSTRUCTION .. ..!.. � .:>..'......... Sim ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...//.N.. ...... �/�.......... r`G c,�..t .....4�,............ �r l..: ....... ?>. ......................... ' _ ...................... Proposed Use Zoning District .......1 �........ ...................................................Fire District ..... ./.../1.... !... Name of Owner .... '. ...c �1..t. ... ra.. ..............Address �/G l' !.r!f.r •,l r i.,+/� �f... .......��'. ,T ...,.r..'.. ... ............. r ✓ Y r / ......� 7 •i.:.5............Address ..................�.....................r.....1............e�................ Name of Builder �`�:........... . v Y ., r' Nameof Architect .G..•........Fa: . ..: ..........................................Address .................................................................................... Number of Rooms .............��..................................................Foundation .%�, ? !'. .... r"� F^�'.s-.r. ✓ . / ........................ EXleiiar � E' ... ^.. ''?...'!5 <�Roofing .....> rj.f...:c:.4".�..:.'..s! Floors , !� �'�� Fr; «� �/ � . 1,-.................................................y....-,.�.........:..........� ..........C. + �....�...........Intenor ............ ?�.tt. sY c Heating ... :. ............... ................... .............. ... ...Plumbing .... ...... ..- - . .LL,y. r ... ..... ' ... ...... M p .Approximate Cost Fire bace ................................................................................. ........ ................. �/✓ .......... Diagram of Lot and Building with Dimensions FeeC .....:�.......��.1/ � /..... / �..- . ........... / to ' � I 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. -- .. - � ��'✓ " "`fit_ �' rn �t Construction Supervisor's License/. ANTIS, GERALD A=021-061 f No ...32016.. Permit for ......1....Stor............. Single Family Dwellin ............................................ �.......... Location .....Lot...#80 , 22 Oxford Drive .............................................. Cotuit ........................................................................ Gerald Antis Owner .................................................................. r Type of Construction Frame ............................... / .................................................................. . .... . Plot ............................ Lot ................................ Permit Granted ..........June.. 2.3............19 88 '• Date of Inspection ....................................19 ' � 4 Date Completed ......................................19 r `' 02OxroRD �2 Sj4af#1 .16 rl�O - 6 3RAf rr/Z I 1 2- 110ur-S � � r 1�- �vN� ATroAr ,ALL ' 1, - r • � a FQ 10 !Atl6S pot Awnf BarnstablerC'�a� o . Smith Barney 1513 lyanoujih Road, Hyannis,MA 02601 FAX Date: Number of pages including cover sheet; IdPw To: J� /�; //' From: ! ��U `i llo tar J Phone: Phone: 508-375-8011 Fax phone: "?30 �' �3 4ti Fax phone: 508-375-8042 CC: RE11Z4M: ❑ Urgent For your review ❑ Reply ASAP ❑ Please comment A Q1 rr �r3� ... .. _�_ IV 1 4 f� 7 ge 4 4, ' j �t�iZ'L�sA r• ��"'+t 4: -ha IRS 1 e Yy ° r 9pz . m 1 0101 LOT (50' 4 '[ dy6 zi i 1M-f M qw §� �•mot. R � 3 yi eft��t��A 1 Pk fF 47 J sy. rht �.7 jj, 41,�:��F�4ff IfYik4�4 F 1,04 WOr V rA, 4 V\ t OF r$T�SLISIA �fi! tl§IIAPH I �� U.) M. $ � WfQFiW�CIC y u ITM k , t� On the basis of my kno ledge, information and belief, I certify toTvw01J o r that as a result of a :purvey made on the ground oil t.5/88, I find that: _ 8O 'The structure(s) are located on the site asU shown. The title lines and lines of occupation of the C/ �f_._/ site are as shoitti hereon. s %, t ft it The site is situated in Flood gone NDIJAMA�1�2�� .I/��. - - - Community panel iio. Date. I�� _ _ Z.�_r_ %�. �M_-- - p Date: Cfl z (�I//�I.Al. Gtaiq�2Gt//G� d �) 1��(� y. � , tl illlaTl 1l1. /td 1�2�J rwickr