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HomeMy WebLinkAbout0263 OXFORD DRIVE .. _ . ,.�_. r. �,^ � `\- � - t �. ��_ lei( - 356 � � a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION' az� 0 33 Ma Parcel Permit# Health Division 'Date Issued Conservation Division 15 9• g - Fee �U Tax CollectorTt%,:�1*5_Olvk-,NSEPTICSYSTEMU)ST BE STALLED IN COMPLIANCE Treasurer r` � - VVlTH TITLE 5 ENVIRONMENTAL CODE AND Planning Dept. :.... .. { TOW REGULATIONS t Date Definitive Plan Approved by Planning Board Historic OKH Preservation/Hyannis f G Project Street Address .2 K3 -&r0RD DRI+IE Village C 0 ru T Owner fEEFER kYNZr° a Address 99`01,Liu64WRTHAu 804y ge-1 -?14 Telephone—/ Permit Request 7�© /a,e"_ �.ro,, l4.'-(-1 `.tdrLf.X d,J An .oft PL D Square feet: 1st floor;existing /5­/2 proposed 2nd floor:existing proposed Total new /Z'6 Estimated Project Cost Q570190 Zoning District Flood Plain Groundwater Overlay 'Construction Type WQM F RAA C Lot Size •S•�Ac!0c,f Grandfathered: O Yes '❑No If yes, attach supporting documentation. Dwelling Type: Single Family t0l Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: W Full ❑Crawl Qq Walkout ❑Other Basement Finished Area(sq.ft.) 600 Basement Unfinished Area(sq.ft) Clla Number of Baths: Full: existing new Half: existing new:. Number of Bedrooms: existing 3 new Total Room'Count(not including baths):existing new First Floor Room Count i Heat Type and Fuel: ❑Gas 40il ❑ Electric ❑Other }t Central Air: ❑Yes W No Fireplaces: Existing New Existing wood/coal stove: ❑Yes go No Detached garage:❑existing ❑new 'size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:-k 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 BUILDER INFORMATION Name ict,,¢E L 0Aif c Ed/ Telephone Number L7.0) 33 — C2 9-7 Address_I/ PA&A License# 0 A62 0 N o a W ELL Home Improvement Contractor# © 0 4Q RA Worker's Compensation# 39d.34 ` cicl ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO n SIGNATURE�� �,� _; DATE � /�A 6 - FOR-OFFICIAL USE ONLY #�' 45'ERMIT NO. ^r F F ... 7 t .. V.• DATE`ISSUED MAP/PARCEL NO` ADDRESS - -} `;VILLAGE OWNER$$ :I• '' -~ ,r`�-°` •t , - �; F _ ` ._ - �'_ �,-: ' DATE OF INSPECTION: i 4 r .FOUNDATION FRAME ;4 — �'�;.; • - � ;`� .. _ . - � - `x. ' • INSULATION �i�, _ `-J - t_• � � r � ... .. .. ,FIREPLACE ELECTRICAL: ROUGH ^'~ P FINAL PLUMBING: ROUGIj ~• k I FINAL GAS: ` ROUGH i~ FINAL ky 'tt FINAL BUILDING DATE CLOSED OUT : or ASSOCIATION PLAN NO. r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�J LI DATA Al CA mil i - SASI LOT 'rf r CORRllC�rep �s7l7RAI r i I fi'�S �, ;'!.'. +�.1 �. }i i �' � ru ._.. .w���a..rw►�,.mydwr,.._.......a.....a.... wrr ff, 7 :SB SIIo1V.V C)N TH!" c_ •�, i� gUil.�JN''r'rPAU tJM : ,1�tiO 'I'tf i 'i.� I,(,�l•:I ,. ` i. ..� 'fOW �' .1'fU Jt wl':flr; . 'il . :A ac,, 32 M ;!\F AS S �►. ia,ll..atl: 1� O/ i.in}i. 7. n�7,7 r r..S..- 0' -✓� t'.l i 1 , . RC k .0 I f , ,, MlyJf�IMIX�1�,/�7�(�u3E'lrJ . kOME IMPROYEMENi; OD17 ' caa Regitrakion 104942-: . o, - r TYPe PRIVATE 'CORPORATION Expiration 0700., � MICHAEL O'BRIEN CONS O 'NSTRUCTION Mic ael O'Brien ' A�MINfSTR4TOR Oana Road ' Norwell MA 02061 BOARD OF BUILDING REGULATIONS t License: CONSTRUCTION SUPERVISOR Number. CS 048620 Expires: 10/16/2001 Tr.no: 7255 Restricted To: 00 MICHAEL OBRIEN _ 11 DANA RDA ! NORWELL, MA 02061 Administrator y J - °F THE 1 � The Town of Barnstable * * * r * BARNSTABM 9�A Department of Health Safety and Environmental Services TEp5.la Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. Type of Work: Estimated Cost,- �Ooo Address of Work: �6' ©��oan DQc ve Owner's Name: juZ Date of 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: -5-�� 10(,C? Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav The Commonwealth of Massachusetts --= Department of Industrial Accidents office 0110859989offs 600 Washington Street Boston,Mass. 02111 Workers' Cop ensation Insurance davit name: location: ci phone# tV ❑ I am a homeowner performing all work myself. ❑ I am a sole n, or and have no one workiz in anv apacity %%/%%%%%%/%% %%%%/%%///%%/%%/%%%%%%%%%%%%%//%% %%/%/// %%%l////%%/%/%/%///%////%/%%%/%%%%%%%%/%%/%%%%%%%//%%%%%%%%�%%%/%/�%%/�%%%/ an employerrovidin workers' compensation for my employees working on this job.:<;:.:;:.;:.;:.><.;:.;:.;:.>:;.::.:.:.:::.:.<:;.;::;::;::<.;::;:::;:;:<:;::::;<::«:::>:<::«<: I amP ............g.................::.::,::::.::::.,:.:::::::::.:.:::. :::.::::::::::::::::::::::::::.::::::.:.;::.::.;:.::.;. :.;::::::::::::::::: t ompanv name f 1 � it ftli ' 't�J d s s '8 tl re :. ............ cftw � e. ........... phone#. fI ,> ahsuiance ❑ I.am a sole proprietor,general contractor,or homeowner(circle one)and have.hired the contractors listed below who have the following in workers' compensationoces: . . : : ........:: : : . .::.:::........:.::.`•<' '` iii: , :`:?:' •;:5-::•::;;: :::`i;is�:�:::isi: :;,• y�::::::.i..::+:::>::::>::.;:..;::::::.;:::.:;..::�:�-::.::::.�::::.>::.�.:::<;:::. ::ii:�::i�:�:i:::2::ii: >:�:::t:::i ::i:::i:`:;:i::;ii:: ?<::;::i::::;?::::i::i: :<3 .:.: .:: .:...: .....::>::.::... .:::: i. ::.t... .... ::::::::::::::.:................... X. oiiR a... ... c sa n adiiress.' t;i ... eA :.:;:.;::.;::.;:.;: :::..:............................... .....: 1/ Failure to secure coverage as required under Section 25A of MGL 152 can had to the imposition of criminal penalties of a fine up to s1,500.00 and/or one yam'imprisonment as well as dvfi 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 do hereby certify under the pains and penalties of ped guy that the information provided above is true.and correct � Signature _ Date Print name C H �/�iP i 6a Phone 4E official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board �ecgif immediate response li required ❑Selectmen's OtIIce _ ❑Health Department contact person: phone#; ❑Other 0evued 9/95 PIA) achus �StateBuiIdingCo e��.80",C1VIIt,'' PPendia�= ,.-_ectio� L .231) 77 The Massachusetts State Building Code (780 CM) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size,configuration,orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructinglinstalling a"sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation-Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual RmRerty owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. a Signature of Actual Building Owner Date D Qe`F A), :2 d 3 OYFaRD 0&iu Print Name Address of Permitted Project Owner Address(if different than project location) Own is telephone number TOWN OF BARNSTABLE .. y Permit No. --- --------- Building Inspector � rwnuo Cash - ------------------ OCCUPANCY PERMIT Bond -----------------------_----- Issued to C4'w::. Address Drive . r.-yt Wiring Inspector .� Inspection date Plumbing Inspector i 1 �, 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 ho TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 seaasr ! TOWN OFFICE BUILDING rua 1639• `� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: June 10, 1985 An Occupancy Permit has been issued for the Building authorized by 27316 BuildingPermit #............................................................................................................................................._....................»....................................... issued to .................................Edward....Corey . ....... ........ ..................................................... ......... „.............................. Please release the performance bond. f MYCOCK, KILROY, GREEN & MCLAUGHLIN, P.C. ATTORNEYS AT LAW 171 MAIN STREET BERNARD T. KILROY HYANNIS, MASSACHUSETTS 62601 OF.COUNSEL ALAN A. GREEN AREA CODE 617 - EDWIN S. MVCOCK CHARLES S. MCLAUGHLIN, JR. ' MICHAEL D. FORD 771-5070`i - - ADDRESS ALL MAIL ANITA J. MCCARTHY-DREW P.O. BOX 960 JAMES M. FALLA HYANNIS. MASS. 02601 KEITH W. KAUPPILA REFER TO FILE # MARK D. CARCHIDI - • November 19, 1984 ' Mr. Joseph DaLuz Building Inspector Town Hall Barnstable, MA 02630 Re: Lot 29 Subdivision, Cotuit, MA Plan Book 271 Page 56 Dear Mr. DaLuz: This is to certify that the above referenced lot has at all times material to the question of buildability under zoning been held in ownership separate and apart from that of adjoining lots. y trul / James M. Falla JMF/eas _ - C• ` I 00, 46 +v O Z / 0.4 ,max/s•'/.�✓c;: '�� i O T �L Air/ OF L.9N0 —0. y'°O I-c".c:i ".! .-,/�L-VOO! ! L O C,Q7'EO iN ,opE,o.gpEO F'O.Q •� CESE'7 F"Y 7"t-/E Fp41-'Y40 ate', .5'/y'Os✓N ON ����/�i9/✓'� �r�.IS�/•�� T.i//S .oL.57N /S .S7S /7- EX/STS' A7AAD Ts-/.477 /T pgrE. O. '. ;/9$¢ sc.4tE /'_ . • CONFO.�i'MS TO .��'v`S' �� / ,q,.ips su.e✓FYin� r 4 T-&-f:'T/C.rE T i �6 +�r.�_ I �� �� ,� � � �� �� ,. .� i Assessor's:.map and_ lot'number ..r...�9 1.j.......r.�....}:....:.,, ~ Sewage Permit number ...... ...... ..........:• SYSTEM MUST/$ dy .� SEPtIC .....:.......... ,Z.... ..3......�L. .................,' li�1S°+�L.It�D )IN COW# L.� : �STABLE, ' House number 9 B TOWN 'OF BARNS�TABLEr�r At,BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ......c ..! ..�P". . -.:............ ........... LI TYPE OF CONSTRUCTION ........ . ..... ...`........... ................................................................................. .........f 1 ................19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Zx CO.ion ........�d..............�.........�............................��.............(...... A !............................................................... Proposed Use ........ 1.!l!' ..l.Q........" .w........ �.. .................................. . ..............Fire District Zoning District ....................... ..�........................... ......... .. . ................................................... Name of Owner ....L W ....... .�J.. ...`............Address ... ?.... � C Name of Builder ..:`..`....s .......v.�.R . .........Address ... :..C.f...�j ® '�Z�C l�f. ?.... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..............?o................................................Foundation ...... ...... ....% . ............... Exterior ......... / .. ......................................Roofing .........�� . ................. .......................................... ...... Floors ...................................Interior ....................... HeatingJ1.��...............................................Plumbing .............z.....eCoe .✓....................................... Fireplace / .� zf��aN- ter....................................Approximate. Cost ........... ' .. ...................................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area /4,06 Diagram of Lot and Building with Dimensions Fee ................. .... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTHY 1 .-D P- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. • Name,...... ....../� C .... . ........ ................... t Construction Supervisor's License .....0-0.& .... COFEY, EDWARD 06-)B One Story mit for ......................... ...........140 ................. Per Sinle ....................... ............. Location- Wt...2.9...... ......... ................Q=4.t.................................................. Owner .......FdW4)Xd...QQMY.................................. Type .of Construction ...Frame................ ............. ...................................... ................. .......... Plot ............................. Lot.............. ................... December 10, 84 Permit Granted .... .......I........I............ ... 19 Date of Inspection .... .............. ......19 Date Completed 119.................................... -N X- T- w \ ..,...... ®��r. CATCH BASIN LO T �?8 .i CORRUGATED '— 'S �' ✓ PIPE DRA IN) Y If LA f .p� L 0 7' � 30 AES, zolvr,. Ni' This "., 1 , r�: :k� 1 HEREBY CER'1'YY `110 - FIRST A1MIE'RIC A' rll� ",�,�, G� ` I -- _ �v— -�i�— M THE� ;1�1 �F a -�`� ,IiOWN ON THIS PL,\N 1S LOCATE—) A. ��• ���'i {''f \ :;Il`JWIv AND 'I'[i. 'I' ?': 1'r)Sl'.'1C) I PAUi, \� l'0 '11'I1L ?UNi\ MER1 A. 1 TOWN OF Yi'i Al, i(-�/� 32� L[lu w1THlj'� 1i)'. I J rIl,L,,'r;D j.\ " �Q/J., MAR— AS SHOWN ON THE fi .' D. ",' .r' !"''f _w��'.___.. "si��05J`� ;'c,l_. i, c Corr r u~ i —Panel z ;,_,C0�1 J %.:'j �•VAL '�Aro F�X: [ i' ti+Af,I: FROM AN AL'l. 4 ',fE. tit' PLS ..... ..... .... .............. ._ ..._ ... ---------- F Engineering Dept. (3rd floor) Map 6� � Parcel :. �;�� Permit# 3O(60 Co % House# Date Issued Board of Health.(3rd floor)(8:15 -9:30/'1:00-4:36j /0�(7 `��z` ee G S c� o ., U Conservation Office(4th floor)(8:30-9:30/1:00-2:00) ~ Planning Dept.(1st floor/School Admin. Bldg.) ,k a*t n t UANCE Definitive Plan Approved by Planning Board 19 i MsIAL� a E AND D "` '' TOWN OF}BARNSTABLLN°°T� N ►oNs ,1 Building Permit Application Project Street Address o76J 0XJee,,-.-,e Dr Village l 6 X(/ t Owner E,r ✓1J G 116v✓ Address Telephone V-O ' Permit Request .First Floor square feet Second Floor square feet •Construction Type Estimated Project Cost $ 4G o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family [ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes W- o On Old King's Highway ❑Yes 9IN'0 Basement Type: 2Tull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count e Heat Type and Fuel: ❑Gas ❑'Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑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 p Builder Information Name�OvVct,l�( CCLli1t,G� Se. Telephone Number `o� 7�01 Address G 7 j E Z a, I �441-K, License# G 15r/61 16d Home Improvement Contractor.# /®8,7� /P 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 SIGNATURE 46& DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) T ' FOR OFFICIAL USE ONLY , PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF` NSPECTION: a - - s 7• s s FOUNDATION t ` FRAME INSULATION,, M - FIREPLACEf 9 --° ,• _. ? �, :. _ ., , r . ELECTRICAL- ROUGH FINAL PLUMBING: ROUGH ;' : FINAL - GAS: ROUGH;= ~• FINAL ` - � .,3 g FINAL BUILDING ' .:; ►� �.' ��` � . � + DATE CLOSED OUTf rn' ASSOCIATION PLAN N,O� _ .. {•• ,' The Conttnonivealth of Massachusetty ti z •-_ Department of 111drrstrial Accidents office 01=95MMONS \�'•;� :i �'' 600 11 ashirrrton Street ;- Boston.MUSS. 02111. Workers' Compensation Insurance Afridavit _ d-pPlici:nt infnrniatitin• P^lc>Tse PRINT'pler�Ij]�"'� /� name ��-/lU � (C��i✓ / ✓O�/Q.('a( �( lit,�o �P✓(�/� (�iALG location- - fS V (J//r�.f' 'd�� (•2�Q city ea Y61/ nhnnc# y;.�_ I am a homeowner performing all wort:myself. I am a sole proprietor and have no one working in any capacity [� I am an empiover providing workers' compensation for my employees working on this job. enntrtanv name: address- city "bone#• . insur�nccCo. fie # [j I am a sole proprietor. general contractor,or homeowner(circle one)and have hired the contractors listed beiow who hat e the following workers' compensation polices: cmmr?7nv nnrne* addresc� tin r nhone#• incur-incr rn "alley# -_...—_ .. .._ .�-�....._. 1..��.�'a.��w'•--__ T'r.�+��ir.r+w.rLdl'C t�7"-��w.y'. _ _ 'ncs __ �� w�� cmmnnnv nnmr- addrecr rin r nhnnc#• insurance co "offer# Attach additional sheet if neM_S rM_ : c - --r% :S: - +•-+--r _ _:._. --r Failure to secure coverage as required under�eetion=5A of 111GL 1S2 can lead to the imposition of criminal penalties of a line up t SISOU.UU aadiur one}cars'imprisonment:ts well as civil penalties in the form of a STOP WORK ORDER and it fine of S100.00 a day against me. I understand that a copy of this statement ma% be forwarded to the Orrice of Investigations of the DIA for coverage verification. I do herchr c�erri�j►'ruu/cr the pains and pcttallics ojprrjan•r/lar the information provided above is trot and correct Si=nature Date Print name v/r��y� /l.I L%� "e l Phones; 7F :2.7 ofricial use on do not write in this area to be completed by tiny or town official city or tnvwn: permitilicense# nlluilding Department Licensing Board L C check if immediate response is required QSeicetmen's Ufricc F C311ealth Department contact perstrn• phone#• nUther i. < L- information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th employees. As quoted from the an etnplt,ree is defined as every person in the service 01 another under any contract of hire, express or implied. oral or written. An emplorrr is defined as an individual. partnership, association. corporation or other legal entity, or any two or me the foregoing CnL1Led. in a•joint enterprise,and including the legal representatives of a deceased employer. or the ssociation or other legal entity, employing employees. However rccciv er or tntstce of an individual , partnership. a owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the d\vclline house of another who employs persons to do maintenance, construction or repair work on such dwelling, he or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioy; MGL chapter 152 section 25 also states that even-state or local licensing agency shall withhold the issuance or rencir•al of license or permit to operate a business or to construct buildings in the commonicalth for any applicant Nvho 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 eptable evidence of compliance with the insurance requirements of this chapter performance of public work until acc 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 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 require 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 the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P1 be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returnee 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 questi( please do not hesitate to give us a =11. 77 Tile 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 9: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 375 y� °FTHE r The Town of Barnstable • .,►axsr�at,� • MAS& �' Department of Health Safety and Environmental Services .erED�� 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. Type of Work: �l' Est.Cost Address of Work: ye,/_,4 Owner's Name rrc Date of Permit Application 9 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 o Contractor Name Registration No. OR Date Owner's Name Y ' i_ � �1t6 �O�Itt/1720/t!llCULCIL{Jt mil CILJJU.CI7,UdP.C(1�i+,- Restricted To: 00 DEPARTMENT,OF PUBLIC SAFETY 81011 CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: Expires: 1G - 1 & 2 Family Homes Restricted To: 00 Failure to possess a current edition of the Massachusetts State Buiilding Code DONALD G CAMPBELL is cause for revocation of this license. 479 PUTMAN AVE/PO BOX 1371 COTUIT, NA 02635 Y� 7^ V. t �' IONE INPRO RENT CONTRACTOR .P tra�ion� 108199 iw r o rYaINDIVIDUAL s�} EzpiTatp?m�08/25198' {{ 5 q N 1 / x y}S ig h anti DONALO ANPBELL 10 zc k�u } 1 ° _.. __ f�.6 . 1. d+ ..i._ � + _ � `.` �✓�V`-4`��, .i,.d � .. t t. t!n-.'e.°6,..ry. uy�w"'t+.i.e++ti+ t - � ... , _.... .. {_ � - -• �.. _ "�1.w -. e.L. .�.+•.T ..^...�4,.,�. r>� Syr-�,* '.� _ . - .-y. �. _- - �' _ ._ s _ t t "- -•.. -• +-,..... •`. l��'t.F F ... ..+.. _y. -....a...... ...,b,..�� ,t„_„•.y,s�.s. � Y�4''„r- y .. .. .. _ .. .. ... - _.... - _, _ .w _ ._r -.r,-,.. .. 1'_•. _ .. _.. i -.-__�... ..__...... _.�� Y� �t.. 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',.. ,�--'F_ :. ..Y"""1Yn,•--•--"I._ .'.._... :r ..,-y..-.- I _:,..r+.-_.y.l,: i--.,,..+-..-.-t,y-�..�..,:.-.-.•+'......,., ;,,. , _ .. ,• .. ¢ CIS 3 ` � _- .. .. - r .. n /l /X Assessor's map and lot number ..................._ y .... ..�.......... Oi TN E Tp�� Sewage Permit number ........ ...........G�'...� 6 r 1; BABHSTABLE, i House number Z. . 0MU& ................................................. p t639. \009 0 Mix a' TOWN -OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......L�,..'.1 �. .. a e ...... :?� f �..!... .. ...°�....... ........... g_ n TYPE OF CONSTRUCTION ��1 9 . .................. ..................19.F6. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies foorrja permit according to the following information: Location ........ G. ..... f.........C./....tC O.�t!....... j) .............(....1.�....................................... ................................... ProposedUse ........�1.!l!. ....��� ......... -'- ...:.... ................... ............................................................ ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner - .UJOt72-Q' 1..../C. ............-ay ....Address G� Z' rli// .US ......... . . wC c��1.lQ ii!�,.......( 0...... L�...........Address . .f .`� .�./.. �•......... a U� ��� .f. . Name of -Bujlder ` Nameof Architect ..................�................................................Address .................................................................................... Number of Rooms ..............!4................................................Foundation ...... 4f-ll .............................................. Exterior ......... /A��.. 7d.. ....................................... ..........a..�... ............ Floors ................/`'!. .... q!......................................Interior .................................................................................... Heating �`� zv` Plumbing ,6j c Fireplace ............� .j.(.!.. C 1.. ((....................................Approximate Cost ............� G..4:a g..............I....................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t z 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. x ' Name ..... ..............................v. ...... :...:-................. Construction Supervisor's License ... Q.l.e�!�. ..... COREY, ED1n1ARD A=21-33 J 27316 t No ........:........ Permit for ..........One....S...........ory........... Single Family Dwelling ............................................................................... Location Lot 29; . 263..Oxford..Drive. . ......... ..... .............. .... . .... Cotuit ................................... ........................................... Owner.'..Edward..Corey... ............................................. Type of Construction Fram h e ;.............................. _ r ................................................................................ Plot ............................ Lot ................................ Permit Granted December 10, 19 84 .. ......I....... ............. Date of Inspection•....................................19 Date Completed ......................................19 T t# ---- EYES�r fX� fT i G� F�uK �Pei A� �. 6k10� QEAM S • "•���� � PG{l 4 s PRaPasEq FNcL.csen POPO4 WOO acCK - { D R SAAI,ORA cf t�F UNZ. 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