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HomeMy WebLinkAbout0016 ROSEWOOD LANE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Conservation Division Permit# _ Tax Collector Date Issued Cq Treasurer } Application Fee 6 Planning Dept. Permit 46 tSS Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address C,pv� Atl Village Owner s 2:21 C !c r_ A7 Address Telephone Permit Request c�/_ q 11 Se C040 MaxNot h �CjN e 5 4w: `- Square feet: 1st floor:existing . proposed 2nd floor:existing proposed =j Total y 1A 4C� n.. cr` > Zoning District Flood Plain Groundwater Overlay fY Project Valuation g a Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting do umentatr(M. ran 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.) 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 ❑Oil ❑ Electric ❑Otheri/ l���- Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing new size Yol:❑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 D No If yes, site plain review# Current Use Proposed Use BUILDER INFORMATION Name 46, L r Vz- Telephone Number ct' y/ Address �) //�w�s�. tl�� j^al License# 0S0 l/ SfrC Home Improvement Contractor# 19-( Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 4 - 5` ` C7 ly n� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS' VILLAGE OWNER l - I s DATE OF INSPECTION: FOUNDATION Ala 7(- t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL Y FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. gR i S r t►+E r Town of Barnstable Regulatory Services RARNffTAIDis Thomas F.Geiler,Director ` •63q. �e� Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW !CO c SCE O Owner: ?f Map/Parcel: 2 Project Address ���©SEkba) bit/ . Builder: G/C o S/ The following items were noted on reviewing: &W,07-5 I'f-T I"P,l c7-40 N;;C 4W Z ,c i"v f 62Y a" �Y,fl-ty/0G Sf,�t.J f t.)G- Reviewed by: Date: ?/d 7Zn-7 Q:Forms:Plnrvw ZHE rol, Town of Barnstable. t Regulatory Services _ BMUMAMSUBLE, Thomas F.Geller,Director �ATf 619. A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 5 0 8-790-623 0 Property Owner Must Complete and Sign This Section If Using ABuilder Tp M brS RovC e-v- ,as Owner of the subject property hereby authorize Z- to act on my behalf, in all matters relative to work autho ' d bythis building permit application for; . (Address of Job} 7 Sign of Owner Date Print Name QF0PMS:0 1,TEERPER?viISSI0N AW-R M CERTIFICATE OF LIABILITY INSURANCE 08/21/20o Pr DUCC!t (508)•997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Shawn Gllfoy INSURERA: Arbella Protection Insurance 123 Davi svi l l a Road INSURER B: East Falmouth, MA 02536 INSURERc: Liberty Mutual INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,E)CLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENEIM LIABILITY 8 500015069 09/29/2006 09/29/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE FX OCCUR MED EXP(Any one person) $ S,000 A PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WC STATU- X OTH- EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? TBD 08/21/2007 08/21/2008 E.L.DISEASE-EA EMPLOYE $ S00,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Project: 16 Rosewood Street, Cotuit MA 02635 F OMAJO CERTIFICATE HOLDER CANCELLATION � SHOULDCANY U,f TUE AUBOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THIER14,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Barnstable $�s���g-a 10 /DAYS yWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ItR i' �- Building Dept BUT'FAILURE`TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 367 Main Street OF ANY KIND UPON THE SURER,ITS AGEN OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENT E Scott Lowe ACORD 25(2001/08) "1kX4rC)A. CORD CORPORATION 1988 � � yehG9� �� -- 2 . Jun. 25, 2007 1 : 04PM No. 8247 P, ..1/2uoolYYYY) A(:umuM CERTWICATIt OF LIABILITY INSURANCET ]06/'z5/2007 PROOUCEI(508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION r Srouthreastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,•EXTEND OR 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Shawn Gil foy _ INSURER A: Arbella Protection Insurance 123 Davisville Road INSURERB: Merchants Mutual Insurance Com 23329 East Falmouth, MA 02536 INSURER C INSURER D: r - INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. INSR DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR DATE MMIDD DATE MMIDD GENERAL LIABILITY 8500015069 09/29/2006 09/29/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE a OCCUR r MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC, JECT AUTOMOBILE LIABILITY 7AM0277013768 01/12/2007 01/12/2008 COMBINED SINGLE LIMIT ANY AUTO - (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ X B SCHEDULED AUTOS (Per person) 250,000 HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) 500,000 PROPERTY DAMAGE $ (Per accident) 250,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ - OCCUR ElCLAIMS MADE - AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- X OTH- ORY LIMITSR EMPLOYERS'LIAB ANY PROPRIETOR/PF'ARAR TNER/EXECUTIVE TBI 06/25/2007 07/25/2007 E,L,EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $` 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ¢ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Barnstable Bldg Department OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Barnstable, MA AUTHORIZED REPRESENTATIVE Joanne Bretton ACORD 25(2001/08) ©ACORD CORPORATION 1988 °FTMEr° Town of Barnstable Regulatory Services '* STAB Thomas F.Geller Director y Mass. g � . MA. 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: a C OW 6 /ram,./`<-a og,_ Estimated Cost 3a J Address of Work: �� �j o (✓o cc� �'+' �C/r Owner's Name: 117 b G (C r T Date of Application: rlieieby certify iha: . Registration is not required for the following reason(s): OWork excluded by law Job Under$1,000 Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Registration No. OR Date Owner's Name QIomvs:homeaffidav The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a d 600 Washington Street a Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): T Ccr-,7 0 Address: `3 0C,-Vf-5 C, r c Fw�rroe�% City/State/Zip: �ta _ eJ a S 3 6 Phone.#: 5(2 _IrI Are you employer? Check the appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 6. El New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P t3' 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions f oficers have exercised.their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work h i P myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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.affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 5 L,0-14P City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).Co5-;6 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and p nalties of perjury that the information provided above is true and correct. S� i 41, =Date:__ — 5 —O _ Phone#: Official use only. Igo not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-cont mctor(s)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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number:. The Commonwealth of Massachusetts Departn2ent of Industrial Accidents Office of Itnvestigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia iv i�v�cwvvu pia, 3 Cotuit,MA 02635 / P 01 July 26, 2007 Town oz Barns able=Bundmg Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Rine izItt-o 16 Rose vvo3u 1ACM-1 U1 i viuii, �%uiC uiui iuC r'iuu C iauu Livia C room above will be unfinished and unheated. If in the future I wish to finish the space, I will apply for the proper permits. Thank you, 4 James A Rockett ��b13li�191 rltt,;� s S � 07WX � J v CO N > c4 N Judith Rebello, Notary Public Commonwealt rat Massachusetts My Commission Expires 4123/2010 Board of Building Regulations, �. on e Ashburton Place, Rm 1301 Boston, Ma 02108-1618 Birthdate: 09/12/1960 License_ CONSTRUCTION SUPERVISOR LICENSE • Restricted To: 00 Number: CS 050489 Expires: 09/12/2008 SHAbC\ D GILFOY — 123.DAVISVILLE RD — E FALMOUTH,.MA 02536 Tr. no: 2910.0 ` Keep top for receipt and change of address notification] - DPS-CA1 it 5GCd-05'G6-PC849G Board of Building Regula ions and Standards I� i) % One Ashburton Place - Room 1301 . =� '� Boston. Massachusetts 02108 Home -Improvement Contractor Registration . • Registration: 126858 Type: DBA Expiration: 7/30/2008 SHAWN GILFOY CONSTRUCTION SHAWN GILFOY _. ... 123 DAVISVILLE RD _ FALMOUTH, MA 02.536 r ' Update Address and return carts. Mark reason for change. Address I Renewal _ Employment Lost Card .• 4, jP$-C.�.' ii Glvl.f7•J.'CSFl;3c5f. - .. - _ - The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations d 600 Washington Street Boston,MA 02111 , www.m ass.gov/dia Workers'Compensation Insurance.Affidavit',Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual):. si ` oc�, �-- 205 6woo.li c-A-, Col-L, .-i-- O Z-6 3f City/State/Zip: co IV t.'t Phone.#:_ 5 Y Z.8'-- STol Are you an employer? Check the appropriate bog: Type of project,(required):. 1.❑ I am a employer with 4. [] I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9 F]Building addition [No workers''comp.insurance comp.insurance.#' required.] 5. We are a corporation and its 10.SBlectrical repairs or additions '3.21 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance,required.]t c. 152, §1(4),and we have no employees. [No workers' .43.❑ 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 affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must providt their workers'con-ip.policy number. lam an employer that isproviding workers'compensation insurance far my employees, Below is.th e,policy and job site information. Inslv-ance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify:ender the pains•and penalties of perjury that the information provided above is true and correct: Signature: lov"/`/ Date: 20 S ifc,''v 13 2qG'­17 IV Phone#: YZ.y •- S7 0/ Official use only. Do not write in this area,'fb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone 4: n-.r.x=..r•.-y:.-...-w..^- +i:�.... •'a�i�:.r._ n:'.L:.+..:w,., -a L}+-,n _ > .Ja �Ff3w �y''k-. �r 4'Rxr�vk:-,,.r„y,�.� n. �. a, �. �, -.,&. ..A.uta✓ .3:s:.r...:�,. Ar A�.:s+a`'t;'kS-.F-�,.,.fi<.�.�.___�"`t.:F..-„r : .„.•., ,.fry �^_ Assessor's map and lot number ........ ,: ? vK C: ",Yl �/ 5 - 7 � q. Sewage�Permit number .........,�:...........:..............:.........:...... � • yDi?HETO� r TOWN OF BARNSTABLE 33"isTeDLE, i +` ONABIL 9 am .e� BUGrILDING INSPECTOR a' APPLICATION''FOR PERMIT PTO ... ! ............ ........................................:.................................................... ' TYPE OF CONSTRUCTION "� r Y � ....... "?.�...............19. �. TO THE INSPECTOR OF BUILDINGS: f•'`�} O� �t The undersigned hereby applies for a permit according to the following information:, (' S� �t✓ ' ' Location .......... � e!.5�-7i�✓ f,��i�� ...i//��-?:................... �`..v.► � o ProposedUse !,/. r/ ......................?............. ........................ F.:.........................:........................................ Zoning District ..... /`""............................................Fire District ..... .:......: ......................................... r Nameof Owner .........................:....................... :.....Address ..,........................... .................................................... ��r�- �.��.............................Address ............................. e Name of Builder .......... .....`<........ ��...................................................... Name of Architect ���."....:J...............................Address f:. ....................... . ................ ............ ...................................................... Number of Rooms ............<................................................Foundation �� ... ?�.� v .aerie- �f. . ............... . Exterior ✓'�... *�� .- �i''���:�...... /�- Roofing ..:.....:...................... Floors ..... ..... ...................sa.. .....................Interior ..... ,,�. '!?`oc/.................... �`lC_ Heating ��r Plumbing ...:... ': `.................................. g ................. Fireplace �.�/1'/� '........ .................. ..........................Approximate Cost ..��''.O 4 Uv............................X�........ Definitive Plan Approved by Planning Board _______19? Arearc?'....,.:.�`�.: Diagram of Lot and Building with Dimensions Fee ............................................. ,p SUBJECT TO APPROVAL OF BOARD OF HEALTH U(--- i we 1 t / I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........:............... ... .... --...... T. F. Associates, Inc. A=25-46 J No . 19171 Permit for 1 1/2 story single family dwelling .............../f................................................................ Location/r Ros ewood Lane ✓ ................................................................ Cotuit ' ............................................................................... Owner ...........T. F. Associates, Inc. ...................................................... Type of Construction frame ................................................................................ Plot ....... Lot .........#24 v ................ - '• Permit Granted..........M..A 3..ay.........................19 77 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................. 19 ............................................................................... i 71. ............... .................................... ......................... t Approved ................................................ 19 ............................................................................... ..................... ........................a............. .1. .............. A map and lot.number .:.... ... ..... C ",vc �/- S"-.7? SEPTIC SYSTEM MUST- g ' Sewage Permit number I-I q ........., WIT q L! o SANITARY ICLE It STATE E r_ CF?NE;Tp :. TOWN OF B A R l I1Br TOevrl �UtLLDIHG ` INSPECTOR ATE p MPY f►\ Z .r, v`' APPLICATION FOR PERMIT :TO ... -! .. ................................................. ............................... v TYPE OF CONSTRUCTION � � ....... .�...............19.?.a. TO THE INSPECTOR OF BL'XI)INGS: LAI The undersigned hereby applies for a permit according to the followings information:y�6s LocationC?4.f.... v� ... /�i�.:... . � /.. .. ..�C/.1. ...... .... .Y ` y - � ProposedUse ........................................................ Zoning District .......... . ...:..`...�..................... Fire District ......4..P � ` Name of Owner ........Address ...............C..�//�........................................... Nameof Builder ......P�� 47_ee­1.............................Address ............................ ...................................................... Name of Architect �e"��``,�l `'`J ...Address............................... ..s................................ ` Number of Rooms ............ .....:.................I............................,..Foundation ......:.. a........... .�.. ............................ . —�/ ��.�" ...Roofing v 5- ../G�.......�rf�F .. Exterior ...... . .. .� . . �,/J:r.... ... g .�. , .............. .. ......:...................... t Floors G�....:�.�.................1............� ....:.......lnter'ior .. .. ....... .................... Heating ................. dl. ....................................Plumbing .., �!L .. ..1�G..:....... .... ........ _ ..... Fireplace ...G1... "✓ �a'�'�'�` Approximate Cost ®� ,. ✓...��... ��......F.......,/.....................:.:. ................�../..°.................... ------ to Definitive Plan Approved by Planning Board -___ ______ __ _ . ... .�........ �9-----� Area �(j � • ....- Diagram of Lot and Building with Dimensions Fee .....`�f.............................. .SUBJECT TO APPROVAL'OF BOARD OF HEALTH o ff- IDS Pr 1 o - �' 01 Y W014 Ft hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above: ,,*? construction. Name ...... ......-......... .... ....�- ..................... . - T. F. Associates, Inc. . ` . 19-171 ' ' 1 1/2 story No .................. Permit for...--,...--____ - . single family dwelling . -.----- _—.�-----..�--.--.-----. . ' ' -. - . � . ���e ' ��� �mmav�w»m Location .—.—.-.--, .............. ' Cwtmit —...--------'------.—,--.'----. � ' g[ F. ��m�o���e� Inc ' ~ . v . . ��vvner ---.,.—.---.------------ ' frame Type of Construction -------` ................... . ' -----.--....,---------------. . . , . P�� ---------. Lot --.���.-----' . ' _ 77 Permit Granted lg -- -. .� —� . / ,Date of Inspection --lA ' ^ | ^ ~ Comp�ta6 �.��/.���/�,�.^�----]g � - ' . - ' . --PERMIT / ^ _ - �������� ..----_—. ..� . lg . ............................. .�—. .----..--------------------.. .- . ~ ^ .�.-----.-..--~---.....—.-------..... ` .—~..—.~.~'.--..~....—..—...—.—...--.. � '�`------- '------'----�^----'7' . . . ` Approved ................................................ lg . - ^ --------------~...-----..�—.—.. , . . . -------------------.—.—.---.. ' � � . . -Z,BN-- (-l-550;:�7 P607— s (2c �'-off L q 2 5-6 o V � A Page 1 of 1 3 the 2007 optional standard Ong an automobile for business, Pe of a car(including vans, es; and nization. nts per mile for 2006. The new 2006. The primary reasons for g the year ending in October. purposes are based on an tomobile. Runzheimer for the IRS. r a vehicle after usino anv A TOWN OF BARNSTABLE Building Department - Foundation Permit Date 7 07 07 permit#eZOO7O $ 9yL Name RectcE 'R � � � �Foy CousfItKcYtod Location 16 RoSE WooD Lftmf. CT. � Insp. of Bldgs. r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) Im A DATA r, lb PL 0 / , C� E AJ FE .�-����- d. .16 tZ A4A,OE 41 'CIA ? All .(� R����j� � #; �;®i b�`-��°�� ��; f"iµ F"�� �. Fes' J�' d• a F 2 § �. r .,,� t �.. n Yi S��'C"..,�,(.Y;a �r �t •£+� :t ,•"sa * ry£-` '�x r ft su ? ra- t '� � �y ..� w l.r"^i�Gt`G �e . +��;.;re t� }?irt'a� �^�+; t4. ' s�T .£.T_ .i� m. :,:.3 S. r,.:;ti.—�n�<_�..x.;.s. ...sa, �` � �'rr i• ,c ;A..4.aa�i. d d � LOT 21 A.M. 25-43 oo, o� LOT 23 A.M. 25-45 FOUNDATION r DECK LOT 24 A.M. 25-46 AREA=23,750fS.F. LOT 25 RA VEL p A.M. 25—4 7 . �j DRI VE �l0 FLOOD ZONE "C" FOUNDATION CERTIFICATION RES ZONE "RF,, TOIYN.• COTUIT SCALE: 1 30' PLREF.` 284-42 ELEV N/A SETBACKS.- 30'-15'-15' OF lls.. YANKEE LAND SURVEYORS rtG` -t���CyGJ� & CONSULTANTS I CERTIFY THAT THE sTEFi;Ery i P. O. BOX 265 "FOUNDATION" IS SHOWN DOYLE UNIT 1, 40 INDUSTRY ROAD ON THE PLAN AS IT EXISTS =37 : MARSTONS MILLS, MA 02648 ON THE GROUND. :;__- o� e TEL• 508—428—0055 FAX 508—420—5553 � � - _.�� o� �a'� SURD JOB ? �,o DATE.• 08-13-07 NUMBER 54232FND �h. i (2) 2x1O - JOUW Joint / / / Rim Omni 2 x 10 RaRerz_ frimmers @I6o/c - - 2 x 8 Flour Jaizt 16 0/c rr Steel beam 2 x 12 Ridge; " �, 217aMe Raf�erz 2x10'scaere @16 0/c - - 5 . L[I]] LU-11 ----- 24❑ --- -------- hoof Framincq Floor Framincq E In 1 —� - A--- in i JE O � N 10 it 13 9070 9070 - C5igt1q; I Name, Rans�crd�3axa. I Jim Lockett 1 Boa "___.---------:t-------6�-43/4------ __ I� --..._._....... --- -- z4❑ ...___....- -- ----- i Scale, 1/ �' - I ' Address, cam°N N 5h No Proposed rloor Plan n ; 6 - 10 -200 AspMt Roofing Shw4c5 s Asphalt Rwfirq Shingles Asphadt Rooflmg 5hugles 5akt elevation North elevation ao El 0 0 � 0 �a5t Nevation �a5t elevation ' - resign(3y; Name; Jim E?ockett p�6�ad�aXa. yc� r�sb 5cal e; 1/ 4" = 1 ' Address; Ib Rosewood LN 5h No cowit,Ma bate; 6 - 10 -200-7 2 • 2 x 1 giclge -- —2 x 8 Pafters @ 16 o/c 2 x 8 Cedinq.brit @16O/C Vable Plate 2x 10 P.afters @16 o/c/' 2 x 4 Plate 5/4"f&G plywood, -----'2 x 8 Plate /r 2X4 5fUd516 0/C 2 x 8 Floor Joist @ 16 0/c Steel beam P-0 WA IneulaWn TMK HOU5M AI' - -- o ��.10"M Header 1/2" C19X MVIOP \\ i \' WALL 5HMTHIN6 a" CONC,SLAG 4"Conaete 51al, 2X6 P.f.51LL Grade Grade �INISN�n ``—_ e( Fu G.AF� A > I/ 4� as Cro55 5ect ion 1CID 112 XIO A!3 5 .A..._.. I I \ 1 ! FILL o CONC,FOMNG co o I I !I I a I I \ 11 I 14" ! ° -'Anchor Odt 6'mmin---- N 11'I'. 1-5fM @ 64MA6� I I !I ji Jill 77, 1�,1i Ij•�i I I .; Name; Pan fo d 13awa. Jim Lockett rounds tion plan Scale; 1/ 411 - 1 ' Address; 16 Posewood LN 5h No coi:A,Ma bate; 6 - 10 -2007 LOT22 A.M. 25--44o�T o LOT 21 " r QOIQ- A.M. 25 43 COTUIT LOT 23 LOT 24 LOCUS MAP A.M. 25-45 A.M. 25-46 PLAN REF• 284-42 �S.F. DEED REF- 9061-22 AREA=23, 750 ZONING.• . 'PR-F., SETBACKS- 30,-15"-15, FLOOD ZONE.- "C" PANEL NUMBER: 250001 0015 C •�� DECK �`�� ` 00 DATED.- 08-19-85 iPROPOSED/ GARAGE ti� PLOT PLAN OF LAND """""' • / / LOCATED AT ;;;;;;;;;;1fIs:;;;;;;;;;. ` j�l 16 ROSEWOOD LANE COTUIT MA. ,D0 LOT 25 PREPARED FOR., A.M. 25-47 JAMES M. ROCKETT DRIVE ,� .AAAA.4 JUNE 20, 2007 EHEN `^� REV- REV- REV YANKEE LAND SURVEYORS & CONSULTANTS GRAPHIC. SCALE P.O. Box 265 30 0 15 30 60 UNIT 1, 40 INDUSTRY ROAD MARSTONS MILLS, MA 02648 TEL 508—428—0055 FA.1C 508—420—5553 1 inch = 30 ft. 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