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HomeMy WebLinkAbout0072 QUEEN ANNE LANE __ . _ �� Q � �-- „1 � ., - � r` I i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel Ilk Application#1-:1 2—1" Health Division Conservation Division Permit# ' • Tax Collector - Date Issued 7tG Treasurer Application Fee 0� . 1 Planning Dept. Permit Feed VV Date Definitive Plan Approved by Planning Board =a ,�✓ Historic-OKH Preservation/Hyannis "i Project Street Address -71Z O f-eO AWM C L-AN t -Village 0 T U 1 T . ,t7 _ Owner f/kcK fhA-Li a� �v2�d'�L Address 14Aw#/m 4vL 4per t- e Xf Telephone 01 "71 Z. �- 4 0 S 0 ®7�Cl /32S Permit Request f t1 s r N c— S?'ot/ U 1/< ,h end tAl NCLOSe door wAY, 6yel_a.(Pd 5P -r2wxy a Q'4{JD stt F-r Square feet: 1 st floor:existing 11-. proposed 1,K2-1 2nd floor:existing proposed -n- Total new Zoning District Flood Plain Groundwater Overlay A 1" Project Valuation Construction Type W000 ARAM Lot Size .747 Acres Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family %I Two Family ❑ Multi-Family(#units) Age of Existing Structure I V v's Historic House: ❑Yes ®No On Old King's Highway: ❑Yes NNo Basement Type: X Full b Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /, Number of Baths: Full:existing Z- new ® Half:existing ® new Number of Bedrooms: existing new 0 Total Room Count(not including baths):existing new ® First Floor Room Count (a Heat Type and Fuel W Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ®No Fireplaces: Existing New b Existing wood/coal stove: ❑Yes Q No Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:®existing ❑new size Shed:2 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes " IKNo If yes, site plan review# Current Use r1AJGfie@ r—.41"tL y A'S/Vell-CC.Proposed Use ,ShVVI C_ --- BUILDER INFORMATION ` Name L _ Te ephlaumber Address License# -� Home Improvement Contractor# -£ Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO r3A-�LNSIL C TiS�-� SIGNATURE DATE FOR OFFICIAL USE ONLY w 4 PERMIT NO. DATE ISSUED : MAP/PARCEL NO. ADDRESS, VILLAGE OWNER t l t Y h DATE OF INSPECTION: w , h FOUNDATION FRAME �N { ' INSULATION �f i FIREPLACE ELECTRICAL: ROUGH FINAL ' + r PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDIN U4� D 3/d�e/ `• . i ? µ s f DATE CLOSED OUT . a, ASSOCIATION PLAN NO.' Y f IR o � ` l F f l � � � 03/06/2006 11:50 5084201536 ALBERT J SCHULZ EP PAGE 03/05 O PARCEL A O� O LOT 88 379105 SF PARCEL B + - TOTAL O p K N \ }06 a \ 87 ASPHALT `DRIVE SS QO _ QUEEN - ANNE LANE ML12736 MORTGAGE LOAN INSPECTION_..... SAGAMORE SURVEY ASSOCIATES SCALd: 1 IN 60 FT. P.O. BOY 28 DATE- FEBRUARY 4, 2006 lda," . s SAGAMORE BEACH, MA. 0256.2 (508) 888 8667 / CERTIFY TO 1 ; THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS .a 34314 TO THE ZONING OF THE TOWN OF BARNSTABLE I CERTIFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD HAZARD "J s ZONE AS DELINIATED ON MAP 0021 C COMMUNITY NO. 250001 PLAN EFERENCE: BARNSTABLE REGESTO 3 0 DEEDS REGISTRY OWN .R: BOOK PAGE; PLAN BOOK 400, PA LOT NO.: 88 INC. BUYER: PLAN BY: CAPE & ISLAND SURVEYING, DATED: APRIL 16, THIS INSPECTION NO MADE FEST BLISINLOTULINES.SUFORYUSEDOF BANK ONL7.' USED FOA FENCES, HEDGES OR TO i Jack & Thalia Gonzalez 72 Queen Anne Lane, Cotuit Project Description: Replace steel bulkhead with woodframe enclosure and exterior entry door per 780 CMR chapters 14, 15, & 23. Specifications: • 36" 2 light steel door, opens out • 2x4-16" O.C. frame on PT sill • 2x6 rafters, 2x8 ridgebeam, 4/12 pitch. • Corner boards all around, white cedar shingles t match existinghouse. o t I Existing Exterior 0 Wall i 1� 7' 5 ' I �oF'ME t� Town of Barnstable P � Regulatory Services STASLX BMAM g Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 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: kw4(,e hie I kh e.4 J JC/Vn?y_Q100rEstimated Cost 500. Address of Work: 7 Z a u r-C N AIJ nr f- INN C Owner's Name: JAcr- d- '1�19�f�L t A 6-6N-LA-Lc Z Date of Application:,d 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 r Date V Owner's Narugm Qhmislomeaffidav �sHE Town of Barnstable Regulatory Services • Atoms. Thomas IF.Geller Director tu►aN Building DivislGn ' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA-0260.1 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5108-790-6230 HOMEOWNER LICENSE EREMPTION Please Print DATE: _.__ JOB LOCATION: 7�2_ ANNe- LAN e- D fy l number Street village ,MM&OwNw.)/0C f M A L I A ,,, ?Art _ 2-01-71?--It os-0 name bome phone# work phone# CURRENT MA1LIl G ADDRESS: a S Z M ANN I N 9 Ave .., 41,ict 6?461- 13Zr city/town state zip code .The gent exnr cation for"homcowacrs"was Mended to.include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license;pWvWed that the owner-acts as- Epgrvisor. . DEFOO'ITON OF HOMEOWNER Person(s)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 tlwellin&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"sUU submit to the Building Official on a form acceptable to the Building Official,that he/she Shall be resnonsrble for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes resporumNlity for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned`homeowner"certifies-that he/she understands.the Toxin of.Barnstable.Build ngDepartment minimuminspection procedures and requirements and that he/she-will comply with said procedures and r Signature o Hon Approval of ufld ng-official Note:-Three-family dwellings containing`35,000 cab c-feet`ot larger-will.be requ=' d.to comply-with the- State Building Code Section.-127:0 Conatruction Control.. HOMEOWNER'S EXEMPTION The Code stag that "Arty homeowner performing work for which a building permit required shall be exerr�it'from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors),provided that if the homeowner engages a person(s)for fife to do such work,that such Homeowner shall act as supervisor." Many bomeowners who use this exemption are unaware that they an assuming 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 nsli mstble. To ensure that the homeowner is fully aware of his/her responsibilities,many comrrauaities require;as part of flue patruCapplication, that the homeowaea ca*that he/she understands the responsibilities of a Supervisor. On the last pop of this issue'is a'form currently used by several towns. You may care t amend and adopt such a form/catification for use in your community. Q;fanu:homeexempt t ne t,ommunweairn of,[vluasucrauartw Department oflndustrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electric ians/Plumlbers Applicant Information Please Print Legibly Name (Business/oro nization/Individual): A-C- �ty �O�,UnIGR Address: 7� L/Ituj IAtyy E LA-NE ity/State/Zip: • CO T v i T Oa 6 3 s—3oa,3 Phone#: Are you an employer? Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time)." have hired the sub-contractors 2.❑ I am a sole proprietor or paler- listed on the attached sheet t 71 © Remodeling ship and have no employees These sub-contractors have 8. [) Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their eP 3-k I am a homeowner doing all work right of exemption per MGL 11.❑ 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' ❑ comp.insurance required.] 1 3.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their wofkers'compensation policy information' t Homeowners who submit this affidavit indicating they are doing all work and then bite outside contractors must submit a new affidavit indicating such tContractons that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infor nation. lam an employer that is ovidfng workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the work s' 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 iraptisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to,$256-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIk for insurance coverage verification. I do hereby cert �i&under ains and penalties of perjury that the information provided above is true and correct. Signature: Date: a Phone#: -- Official use only. Do not write in this area,to be completed by city or town official: City or Town: Permit/License# i Issuing Authority(circle one): I.Board of Healih 2.Euilding Department 3.!City/Town Clerk a.Electrical Inspector. 5.Plumbing laspes ®r i 6. Other Contact Person: Phone r: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I Application# 'Health Division � &1 �Es►isprvation ivici n� Permit# 3 Tax CollectorAsz> Date Issued zy Treasurer c—M Application Fee 7��6 - CYJ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board = p(ISTING SEPTIC SYSTEM Historic-OKH Preservation/Hyannis LIMITED TO #OF BEDROOMS Project Street Address -7 9 Q U e e A/ AN N e LAW e Village C O -F 0 l T Owner JAW S . JACK 6�0,j2AL&L- Address Ave. K9;V(4J- JC 1yJ Telephone ;2 U I 71 Z _ y OS-� a b 6��t 3�Y Permit Request C 2eAIe- 0002 WA-f IN /yoN-Lo/h0 aeAtzi c, i�r V W .-LL P e,2 A--ITA-C i+e 8 0 2A i N 6-, 1�.:11 i C-> Square feet: 1 st floor:existing 1, c/ proposed S-2.'t 2nd floor:existing proposed i Total new!-0— Zoning District Flood Plain Groundwater Overlay 1 Project Valuation .0 4-/6-6 Construction Type Lot Size ,75' AC ICeS Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. r Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Abe of Existing Structure I y rS Historic House: ❑Yes LANo On Old King's Highway: ❑Yes &No Basement Type: aFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) S7_L`f Number of Baths: Full:existing oZ, new v Half:existing 0 new Number of Bedrooms: existing 3 new & Total Room Count(not including baths):existing new O First Floor Room Count 6 Heat Type and Fuel: N Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes 5tNo Fireplaces: Existing I New a Existing wood/coal stove: ❑Yes W No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:U existing ❑new size Shed:&existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes W No If yes, site plan review# Current Use S-,1A16 L P /:; 1/4 y Ae-010en c.,<_ Proposed Use Sf tile � ►yr�`�y -/-Ps-i.�Pn��e - BUILDER INFORMATION _ Name II l' Telephone.Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATES I FOR OFFICIAL USE ONLY 9 �+ PERMIT NO. DATE ISSUED 1 MAP/PARCEL NO. r f\ ADDRESS VILLAGE 1 OWNER DATE OF INSPECTION: FOUNDATION FRAME F INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH F-—FINALt GAS: ROUGH p FINAL �i FINAL BUILDINGeco�_� 6 3 �O DATE CLOSED OUT fo fit j. ASSOCIATION PLAN NO. t `� • I I I A Town of Barnstable "a Regulatory Services auuvsTnar.e Thomas F.Geller,Director a 9 Building Division ATEo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE ®/Z�L 13� 2 O O JOB LOCATION: ()j e ejj CoTv� number street village (;7oNj_,44-2- avi- a bi-61a 9 cP©/- -7/a- 14050 'HOMEOWNER'°: �" name C home phone# work phone# CURRENT MAILING ADDRESS: 02✓ oZ �'Y/�MNi N9 /9 y't ' ./2i vE,2 cvgt �� n 766/ 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)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 constructs 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 109.1.1) - - The 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 he/she will comply with said procedures and re ments. �Si-- e�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 EXEMPTION The Code states that: "Any homeowner 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 the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming 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 personas 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 responsibilities,many communities require,as part of the permit application, that the homeowner 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 t amend and adopt such a form/certification for use in your community. Q:fomvs:homeexempt Town of Barnstable ti Regulatory Services r + BAB MBLE " Thomas F.Geiler Director MASS. g ' . Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: Zf P -a LOA/ — Iiyt<r%oQ PASA6L'G</A' Estimated Cost 1,�16D Address of Work: '7 -Z (2 U e.e N A NN e L 14 Ne, C O T U /T Owner's Name: TA C /< 4• -r#A _14 d-0t/7—ALC 2- Date of Application: D C I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑JQb Under s1,000 ElBuilding not owner-occupied [KOwner 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. I 0 OR � � GOtI L (Q X Date . Owner's Name Q:forms:homeaffidav The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,K4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contr-actors/Electricians/Plumbers Applicant Information ]Please Print Legibly Name(Business/Organization/Individual): C2✓� �CZ-- �ddi•ess::� City/State/Zip: ;Ovvc-A �e lY✓�OTG b/ Phone#: Are you an employer? Check the-appropriate box: Type of project(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ (� 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. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3[2 7 am a homeowner doing alI work right of exemption per MGL 11.❑ 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.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new a$davit indicating such :Contractors that check this box must attached an additional sheet showing the name ofthe subcontractors and their workers'comp,policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and ob site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/2:4r Attach it 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 cent' nder t ins and penalties of perjury that the information provided above is true and correct CSi azure: , •D ate:.. 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.Bop-rd of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b. Other i Contact Person: Phone#: it 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 it business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work unit 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 permit/license 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 obtaining a license or permit not related to any business or commercial venture (i.e. 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. "617-727-4900 ext 406 or 1-877-KASSAFE Fax- 617-727-7749 Revised 5-26-05 vvWw.mass.gov/din E' i 4- An l,D 'o �> TOWN OF BARNSTABLE Permit No.. -------__/�B'2_1'7-- ----------- Building Inspector WAS cash --- -- OCCUPANCY PERMIT ----- - '�toar Bond -- -------L ----- - Issued to John McShane Address lot #88 72 Oueen�Anne Lane. Eotui_t r Wiring Inspector � �� � �^"� Inspection date Plumbing Inspector v Inspection date �d Gas Inspector lw Inspection date g g P Engineering Department Inspection date/ • �.�j� , t� Board of Health �- y Inspection datei 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......__ . .......................... ................ .�...._...._ w_._- Building Inspector of '°•. TOWN OF BARNSTABLE BUILDING DEPARTMENT t saaasr : TOWN OFFICE BUILDING riva HYANNIS, MASS. 02601 '''ao apt�• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Perm t $�`._ � »,........:.......».............................»....». .. ». .»....».�. ...» ».. . issuedto ......... .. . ............» .......... ....C. .. . ..» »...... .......................... ......... .......». Please release the performance bond ] Assessor's map and lot SEPvc sysTEm mu HE TO .//. ....... INSTALLED 114 COA4 Sewage Permit number ............................... IHnE 5 STAXLE,House number ....................... .............. - NTAL Co Of . ..... 39. ypY TOWN 'OF BARNSTABLE BUILDING INSPECTOR A APPLICATION FOR .PERMIT TO / � �! II__•.�� n .. .. ...... .. TYPE OF CONSTRUCTION .............. ............. ... . .. ............................... ...................................... ............................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .....0.4eoy...4vol.4,4a .......(fze. ........... ram Proposed Use . ........ .. .... Y................................................... .. ................. Zoning District ........................................................................Fire District ......... - ................................ Name of Owner .... ...........Address /0e.P..(al..7 2..... ..................... -71V Name of Builder ..... ..144.... .1444.... ........Address A..(...... ................ Nameof Architect ............................... ..................................Address .............................:...................................................... Numberof Rooms ..............7.............. .. .....I..................................................................... ..( I ...Roofing ...... .Exierior ... ... .................... ............................................ Floors ........ ........................Interior .....I.1;,44"-I..f.-..,.,.-Z.11.l�i.� .................................. Heating ........r7........'t"r mbing ........ ........ . . . ........................................... ........ ... .........................Plu . ....... Fireplace ........... ..........................Approximate Cost ......7 C)49 C9 Definitive Plan Approved by Planning Board ----------19 Area ...I-4-R7 Le A Diagram of Lot and Building with Dimensions Fee ......:1�5�... SUBJECT TO APPROVAL OF BOARD OF HEALTH /52 C�1' � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... .........A .................. Construction Supervisor's License ........ ZA MCSHANE, JOHN No ................. Permit_rmit for ...QT!AAt.QX.Y............. Single FamiTy..pM�q�jjin ................................ ....�g...................... Location ....botA8.......22...Q 14.P,.q.U..AnuP-..L ajie. %..............Cotuit ........................................ .................. 01 Owner ............J.O..hn......Mc.....Shan.........e............................... . 4 Type of Construction ..FK4W.P........... ............................................................................... 'Plot ............................ Lot ................................ . Permit Granted .......July...........31.....,............... .19 85 Date of Inspection ....................................19 Date Completed zs N 56'98 "20"'E G 950. 07 W m 0 d o) Ln ti m do to D p2 vl p0 c° I CERTIFY THA T THIS FOUNDA TION " ; wood P'65 os CONFORMS TO THE KING 'S GRANT 22 a,65. 00 CO VENANT T. "3s. 21 JUL Y 24. 198.5 2� "I CEPTIFY THA T THE FOUNDA TION .SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS AND THAT PLOT PLAN OF LAND I T CONFOPMS TO THE TOWN OF BARNS TABL E ZONING L OCA TED .IN PEGUL A TIONS " Z" ,�g BA PNS TA BL E — M.A SS . OFS� DA TE: JUL Y 24, 1985 �4 DAVID 9�y PPEPA PED FOP g CHARLES SANICKI N Mc SHA NEE CONS TPUC TION CO . ANIC .. '-+ 28085 y • _ �P s�® � DATE. JUL Y 24 998.5 SCALE 1 "= 50 FT. �• R. L . S. �FQlST,•g �o ,yQ FLOOD ZONE C RV� CA PE 6 I SL A NDS SUP VE KING TEA TI CKE T - MA SS. I 71 y j MYCOCK, KILROY, GREEN & MCLAUGHLIN, P.C. ATTORNEYS AT LAW 171 MAIN STREET BERNARD T. KILROY HYANNIS, MASSACHUSETTS 02601 ALAN A. GREEN OF COUNSEL C HARLES S. MCLAUGHLIN, JR. AREA CODE 617 EDWIN S. MYCOCK MICHAEL D. FORD 771-5070 JAMES M. FALLA ADDRESS ALL MAIL P.O. Box 960 MARK D. CARCHIDI HYANNIS. MASS. 02601 i ' l R March 26, 1985' EFER TO FILE # Mr. Joseph Daluze Building Inspector Town Hall - Main Street Hyannis, MA. 02601 Re: Lot 97, Queen Ann Road, Cotuit Lot 88, Old Kings Road, Cotuit i Both presently in the name of John J. McShane Dear Mr . DaLuze:. As you know, both of the above lots are now undersized under the present zoning by-law. These lots were shown on an approval required plan endorsed by the Planning Board in 1973 at a time when the lots met all of the then zoning requirements. On September 2, 1975, Lot 97 went into ownership separate from that of adjoining lot and on September. 23, 1976, Lot 88 went into ownership separate from that of adjoining .lot and both lots have continued in separate F ownership to the'. present. Our present zoning by-law grandfather clause gives buildability to- both of said lots notwithstanding the increase in zoning. Very truly yours , C6�rnar_d T. Kilroy BTK/djw CC: Mr . John McShane Assessor's map and lot number .......... %THE Sewage Permit number ......... 0 .............. MARX34AILE, House number ........ 7 NAGIL 1639- TOWN OF BARNSTABLE BUILDING INSPECTOR A-ez�r APPLICATION FOR PERMIT TO L^..... . ..... �Xl?�J� L,—,.),l , A ..�rl............. ..... ...............T TYPE OF CONSTRUCTION ............... ...................................................................... . ........................ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......44? .......C,.�9-74 ...........�j�.f .....4.�. ....... .............. ....... 7 ....... ................................................... .........................Proposed Use 1� (AA, Zoning District ........................................................................Fire District .......... Name of Owner .... ......... ............Address A. .....4...zo.....ia4h�.. ... .....i.............. Name of Builder .......................... ........................... Nameof Architect ...................................................................Address .................................................................................... Numberof Rooms .............. ...............................................Foundation ;;,......... .................................................... Exterior .........................................Roofing .......44 ................................ . ........................ . ...................................... ................................. Floors ...... Interior ...... Heating ....... ........................................... .....................................Plumbing Fireplace ........... Approximate Cost ......7 ................................ ............................ Definitive Plan Approved by Planning Board - ------ all --------19 Area ....... Diagram of Lot and Building with Dimensions Fee ...... 6P SUBJECT TO APPROVAL OF BOARD OF HEALTH Rd"`"r /1��� � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... :4..........& -4,t�• .................. Construction Supervisors License ...... ^~~.^.,_, _--_ — -- -- -_1 �J 28270 One Story No ................. Permit for .................................... ' Single Family Dwelling -------------~---'--------- ^ / Location —..Iat..8a..—.I2-..Qoe.eM..Aj=w'Lnjae ' l�otuit _ —.�------------------------. . ~' . John McShane ` Owner ---------------------- . Frame ^ ' Type of Construction -------------- . ^ --------------------------. ' . Plot Lot .. ............................ '.'�.--------� | ' Y Jolv 3l ' Permit Granted ---^--.�------'l9 85 Date of Inspection ------------lA , Date Completed ------------�lg ' .. . /�- ��� - 5��� — ��� �r / | ' ��> . ` . . ' . . \ . - .. . - . ` ^. . . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel // ; /3 08 ' A Permit# w Health Division Date Issued Conservation Division Fee-. Tax Collector A Treasurer• cQe.� Planning Dept. y ' Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis, ' Project Street Address01)-e�e n =Village C� ;Owner (a'1 L "A 1� 1� I� Address V �Q ;Telephone om��' ' � _ l .Permit Request3 17-ff 6' / e' �_ .� l Aa. 4 Square feet: 1st floor: existing proposed 2nd floor:existing —'proposed Total new Estimated Project Cost av ' Zoning District Flood Plain Groundwater Overlay 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 King's Highway: .O Yes ❑No Basement Type: ❑Full .,•O'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 Room Count. ; Heat Type and Fuel: ❑Gas • D Oil O Electric ❑Other Central Air: ❑Yes O No Fireplaces: Existing 'New Existing wood/coal stove: ❑Yes ❑No Detached garage:O-existing ❑new size Pool:0 existing O new size Barn:❑existing O new size Attached garage:O existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O° Commercial ❑Yes ❑No r If yes, site plan'review# ' Current Use Proposed Use, BUILDER INFORMATION Name Telephone Number t Address License# 0 . Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE r' FOR OFFICIAL USE ONLY J M I PEWMIT NO. DATE ISSUED : MAP/PARCEL NO. t w ADDRESS f VILLAGE OWNER DATE OF INSPECTION FOUNDATION FRAME _ INSULATION FIREPLACE " ELECTRICAL: ROUGH 'FINAL' PLUMBING: ROUGH FINAL 4 GAS: - ROUGH FINAL FINAL BUILDING DATE CLOSED OUT F ' ASSOCIATION PLAN NO. ` =='' lfJ 'C�111 Illi��� ;i1Tl!®pY� 600 Washington Street M. Boston,Mass. 02111 Affidavit ",ncnQt- zz"ire'%///////%%%%%// e��sation Insura� /�///%///�/�/��%///%%� name: location- city hone 0 ❑ I am a homeowner performing all work mvseif. ❑ I am a sole nroDrietor and have no one workin in any ca achy I am an employer providing workers compensation for tnp employees working on this job. comnnnv name: PAUL T. CAZEAULT &' SONS address: >::, :•.::.. city- MARSTON MTT.T.S . MA "hone#• 428 1 177 insurance cn. oiicv# 1 9941 3744 I am a sole proprietor, general contractor. or homeowner(circle on and have hired the contractors Iisted below who tie the folloning ivorkers' compensation polices: omonnv name: `. ... N r... •:};Ml: .rw Giro:•.. :. l Y hone#c .. ... , ::. Lnrnnce cn. .. . ......... eiiiv# c.: ... :.. ' •^. ":::::e:. . ,. ;... rm�:-jnv name: .. ... Mau•: ts- hone . , svrnnce co. :....:...:.::..,.:.;;>;.:ss•. .:: ` oiicv# ure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of eriminni peaddes of a Me up to SI.500.00 and/or e years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of 5100.00 a day against me. I understand that a v of this statement mar be forwarded to the OMce of Investigation of the DIA for coverage veriIIeatiotL hereby cenify the pairs penalties of perjury thus the information protdd-ed above is In.mtd correct t , tore "ate �'�' _ Phan°# fncial use only do not write in this area to be completed by city or town oJM21 city or town: ;permit/ilcenset! Muilding Department P check if lmryediate response is required []Licensing Board • ❑Selectn ens OMce (:]Health Department ,outset person: phoneff; csvuea v•JS P AI . Of,o , The Town, of Barnstable • ERARMsreac.E. • 9� '& �0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02661 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. UEX/ Type of Work: ��"� — Estimated Cost G� M A Address of Work: Owner's Name: " 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 age, of the owner: Date .. Contractor ame Registration No. OR -Date Owner's Name q:forms:Affidav I HOME IMPROVEMENT CONTRACTORS REGISTRATION � - Ioard of Building Regulations and Standards I One Ashburton Place - Room 1301 Boston , Massachusetts 02108 I HOME IMPROVEMENT CONTRACTOR -------------------- Registration 103714 Expiration 07/09/00 I Type - PARTNERSHIP -071. HOME IMPROVEMENT CONTRACTOR ! Registration '103714 PAUL J . CAZEAULT & SONS ROOFING Type - PARTNERSHIP Paul J . Cazeault Expiration 07/09/00 22 Giddialt Rd . P .Q. Box 2781 I Orleans MA 02653 PAUL J. CAZEAULT & SONS ROOFI Paul J. Cazeault & , iddialt Rd. P.O. Box 278 I ADMINISTRATOR Orleans MA 02653 \ ✓ TGY nnnr2h _l- ,� i?i�;'r111 I h1i:hl E. OF 111lI3L1(, `.;r1'r ;`.I`f - orll , �,I I•`til,-r�;ld I>I r� r, ( i1 J :;c,;. , P , l.11j'•.I ,l i::l.11: (T(.?I'd lli)i�i;''v.l�:if)iC. l LI.i:.l�!':ik: . «. _ ._ - . i`•I i I i n i�:;•L.: c�?:I)] i"��:: -I:Li 1.1 ;�.ki++-kR ' ,1 1.�. L'), �).i,+�_ ;I�+r;-,��I`�ca(,C� 1 bLl,�.:ySJIJ Ci"J�. " • �:� ��''(t�,T •)j ,� ga. � - " 111 I r r_tr,ut"I � s - i-or ,I(.)1 roc i.1:)t. YU'E o A(I I . . _. 1 1 i,'i.i.'1 (.:I'1'.,i-o i I., 5 ' % »tu>taAra n f �l ta�acl rrJn,CIJ a, OEPARTMENI I T CONSTRUCTION SUPERVISOR LICENSE ,. Number: FXQj resI; CS P16325 1Oj1O!i�+�� i�l,'gl:n5u ', a . : Restrict'ed To: HN f.Al J CAZEART 15I!5 MAIN ST OSTERVILI.E, MAV A' SHED REGISTRATION 72 C� L4 if BENNe LdNC ► � Tu!T, AA, 4-- location of shed(address) property owner's name a "xizl size of shed signature date Old King's Highway Historic District Commission jurisdiction? /xv 41 THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / � �G�"- IL DATA LEACHING PIT ' INS TALL ON LEVEL BASE PIT �A TE.' V. Y HE rH DESIGN DA TA 1 o NUMBER . OF BEDROOMS GA RBA GE DISPOSAL DA IL Y FL OW �? GPD SEPTIC TANK REO 'D. GAL SEPTIC TANK PROVIDED GAL LEACHING REOUIRED GPD SIDEWALL AREA = /ST S. F. /37 S. F. X oF.1' GIS. F. _ R2 GPD. BOTTOM AREA = S. F. I 'b S. F. X /. 0 GIS. F. _ /�' GPD L EA CHING PRO VIDED = GPD SINGL E FA MIL Y RESIDENCE 8 OSED SEW GE DISPOSA L S YS TEM PPEPA RED FOR Mc SHA NE CONS T. CO. LOT 88 OUEEN A NNE LANE 4RNSTABLE - COTUI T - MASS . �� CAPE 6 ISLANDS SURVEYING, INC. ED� P. O. BOX 334 TEA TICKET, MASS. JNT GENERAL NOTES w 1 . ALL EL EVA TIONS SHOWN ARE BASED ON ABSufs�[� 2. ALL PIPES IN THE S YS TEM MUS T BE CA S T IRON LOT Lf i' OR SCHEDULE 40 PVC. OBSERVA 3. THE BOARD OF HEAL TH MUST BE NOTIFIEDsue- �y "' WHEN CONSTRUCTION IS COMPLETE PRIOR 7 ' <� TO BACKFILLING PERCOL A ' 4. ANY CHANGES IN THIS PLAN, MUST BE APPROVED "�� %�' ` `� BY THE BOARD OF HEALTH AD CAPE 6 ISLANDS WI THE SURVEYING CO. , INC. OMN 51 PRECAST CaVCRETE 5. MA TERIA L S AND INS TA L L A TION SHA L L BE IN LEACHING PIT A COMPL IANCE WI TH THE STA TE SA NI TARY CODE - TITLE V - AND LOCAL APPLICABLE DA TE.' / RULES AND REGULATIONS ��✓. Per 5. NORTH ARROW IS FROM RECORD PLANS AND 1=r�-'� )Cv- I S NOT TO BE USED FOR SOLAR PURPOSES 7. FLOOD HAZARD ZONE B. WA TER SUPPLY f• --- �� 4� PRECAST CONCRETE _. SEPTIC TANK LEGEND = PROPOSED ELEVA TION - - - !-- EXISTING CONTOUR OBSERVA TION PIT ❑ DISTRIBUTION BOX So . LEACHING PIT -►•- / - O „�—r"^'�'• _ t it.. `la`s i-. SEPTIC TANK RESERVE PI T A PEA � �t f 49.40 PIPE INVERT ELEVA TION a ' 1 DA TE' \ \ Y PLOT PLAN SCALE SCA L E.' 1 `\ PLAN �, MAP � EC PCL LOT HSE j i NO w ALL /-J S rZ` 1A T// a.® L P4 SSA G WA CL I lv r 13 Z`P 00R 2 BL�D��Din 3 O R L CL 2.2. 1. Homeowners: Jack iand Thalia Gonzalez t - Location: 72 Q:ueen.Anne Lane, Cotuit Project Description: Create passageway in non-loadbearing partition between family room and living room per _ 780 CMR 3606. - �,., Key: ° -Loadbearing wall Non-loadbearing wall ti ; s 0 A 0 C ou.NTER A10 WALL ,e. Sr R K i TC yZ�'Al D /N / 0A 711, z® I - 1 :. C L � � t L / � � V//V y G �� - FD Cif` . 1 fi 6 x Homeowners: Jack and Thalia Gonzalez Location: 72 Queen Anne Lane, Cotuit Project Description: Replace steel bulkhead with woodframe enclosure and exterior entry door per 780 CMR chapters 14, 15, & 23. Key: Loadbearing wall Non-loadbearing wall