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HomeMy WebLinkAbout0164 SANDALWOOD DRIVE S'Q12Y4F/wa0 4/ i �I i i I I u o Application number . Date Issued ..... .!�. sue. g Building Inspectors Initials •- O ap/P el I II o's I� . z TOWN OF BARNSTABLE ° p f EXPEDITED:PERIVIIT APPLICATIONy ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY I OR- A'ON ; 4 Address of-Projecf,.. 6. "t�C//Idd//J( V C� �! �"1 Gu f ._. NUMBER STREE II.I T YA E Owner's Name: � � J -Phone Number= � =7 7 f' . . Email Address: C bli'(5 e!'11 i C-Ui''• ,�„ ,.: .. . _ �` � - U Cell Phone Number Project coast$35 C)L9 -Check one.: Residential Commercial.. -, . OWNER'S A-UMORIZATTON As owner of the.above property I hereby authorize to make application for a building permit in accordance with.78 MRe Owner Signature: Date s. TYPE OF;WORK r; w, - - ..F a k ,,i . ",:- .v .s hL s' ' R _ ,$': ,3Y3`i��': ' ,N•`i r.,.x,-y'+c 3 � ❑-Siding Windows(no header change);:# d h Insulaixon/Weathenzatton , ❑ Doors (no header change)# Commercial.Doors require an anspector'srevieiu .. v ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going.to ~ ;� TCONTRACTOR'3;INFORMATION Contractor's nameMArn&hve- Wi&& •yc, Hdme1hnprov6hent Contractors Registration(if applicable)# / ��i (attach copy); Construcixon Su ervisor's License# // .V. V (attach coPY). Email-of Contractor G �'Q,/"r/G� / GL)QjW71 Phone number ALL PROPERTIES THAT*VE.STRUCTURES OVERJ5 YEARS OLD OR IF THE=SUBJECT PROPERTY IS IN` ,A HISTORIC-DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE APERMIT CAN:BE ISSUED. APPLICATIONNUMBER ............................................................ *For Tents Only* Date Tent(s)will beerected Removed on number of tents total Does`the"tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. . Signature Date APP IC ��iS IGNATURE Signature (/ Date All permit applications are subject to a building official's approval prior to issuance. 5 114E l� :z Town of Barnstable * Da ; L Building Department Services bass Brian Florence,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Louise A Miconi as Owner of the subject property herebyauthorize 1`fiea a4l-Ve- 24 10- to act on my behalf, in all matters relative to work authorized by this building permit application for: 164 Sandalwood Drive Cotuit (Address of Job). Signature of Owner Signature of Applicant ZL Print Name Print Name Date f , l . I The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia AVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeLxibly Name(Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): l.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. El Demolition 4.M I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑f am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F_�Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6. We area corporation and its officers have exercised their right of exemption per MGL c. 14.�✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins..Lic.#: XW/OO((l9)58867158 / Expiration Date:6/8/19 Job Site Address:/ VL��r l &)/)(�Cl City/State/Zip: eakill-f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify�ud,?Vain a p lti s f perjury that the information provided above is true and correct Signature: Date: Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact.Person: Phone#: .'.t � - �` .t� 'f''��"'-�'�^"x°'�.r ;`n E� ✓;+u > � "r Y N��,..�.r r�sss,��,�` a 1 h 4� WTI ;'�"' ,L�.' .�" ks- - -u €t ' x � ,:-.. ' �✓ �$lf�✓ f/ ',./�Ff'If L9i�iI�L��'.yl L/���11���7�r�?��/ie'!£.' ��`.���/���i;/iii/a%�5�ir���/'�r�i��/7Ns�����'�/!V✓ 7 5 Office of Consumer Affairs and Business Regulation w 10 Park Plaza- Suite 5170 Boston, M usetts 02116 Horne Improverrietractor Registration r � Type: Corjmitinn "} Registration: 1756W ALTERNATIVE 1NEATHERIZATION,INC Explratl:n: 0512$l2019 2 LARK ST p: FALL RIVER,MA 02721 � r . Update Address and return card. Mark reason for change. ..._....... �__..,.__,........................................_,_................. .._..... ti Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only ,7YPI :Ct3r»ora;ion before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 05/28/201 A 10 Park Plaza-Suite 6170 ` AL7ERfdATIVE Vd-,T. RiATICaiV;INC. n,MA fYd116 TIMOTHY 2 LARK ST FALL RIVER,MA 0272l Undersecretary retaGp tit V Bi 8tt7rti • , ® DATE(MMIDDIYYYY) ACORV CERTIFICATE OF LIABILITY INSURANCEF��. 06/11/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). GUN[AUT PRODUCER NAME: PHONE Anthony F.Cordeiro Insurance Agency A/C,No Ext: 508-677-0407 FAX No): 508-677-0409 171 Pleasant Street -ADDRESE-MAIL E-MAIL s: HSouza@Cordeirolnsurance.com Fall River,MA 02721 INSURERS)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization -INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7R TYPE OF INSURANCE IN SD WVD POLICY NUMBER MM/DDY/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence S 300,000 MED EXP(Any one person) $ 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE S 2,000,000 POLICY❑PRO ❑ PRODUCTS-COMP/OPAGG $ 2,000,000 HJECT LOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accdent $ 1,000,000 ANY AUTO BODILY INJURY(Per person) S B OWNED X SCHEDULED Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY Per accident S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y USO58867158 06/08/18 06108/19 AGGREGATE $ 1,000,000 DED I I RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT YIN UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMBER EXCLUDED? n NIA XWO58867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary&Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NGRID USA 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT AI. v.W_.....� ©19Q-2015 ACORD CORPORATION. All rights reserved.s ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD E YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, (VIA 02601 (Town Hall) DATE: Fill in please: APPLICANT'S YOUR NAME/S: I BUSINESS YOUR HOME A DRESS ii �� > i.�r r, l�l fi �'`kiz TELEPH NE # Home Telephone Number ` c) NAME OF CORPORATION: NAME OF NEW BUSINESS 6 s TYPE OF BUSINESS IS THIS A HOME OCCUPATION? Y S NO ADDRESS OF BUSINESS ( MAP/PARCEL NUMBER 010—Q {Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. GUILOING COM SIO ER'S OFFIC MUST COMPLY WITH HOME OCCUPATIOP This individu I h n info m of a y: rmit requirements that pertain to this type of business. RULES AND RECtUIrAATIONS. FAILURE TO . MY I4T IN FINES. Au e i e** O MEN S: , 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: . 3. CONSUMER.AFFAIRS (LICENSING AUTHORITY) This individual has,been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Tovvm of Barnstable k 0�p Regulatory.Services oFtHe rod, P� ti Thomas F. Geiler,Director Building Division + BARNSTABLE, y MASS. $ Tom Perry, Building Commissioner fo �a� 200 Main Street, Hyannis, MA 0260 rvww.toxvn.barnstable.ma.us Office: 508-862-4038 0 = -6230 Approved: Fee: P S. — Permit#: o?O / d l HOME OCCUPATION REGISTRATION Dale•Ayi/ !; e C <� Nance: Address: It Gt.�(;A k� r —�� GsfTintz Village: Name of Business:__ ------ Type of l3usiness:���� (.✓O r�L S Mali/Lot: INTENT: It is the intentof this section to allow[lie residents of the"T n•vn of Barnstable to opertte a home occupation ri itlrin single family drvelliiigs,subject to the provisions of Section�(, 1.�6 of the Toning orclivauce, provided that the activity sliall not be discernible front outside the dwelling: there shall be no iucre;rse Ili noise or odor;no visual altei•atioit to the �. premises rvlrich Would suggest auytliing other than a residential use;no increase in(raffle above normal residential volumes; r and no iicrease ui air or grouttclri,�iter pollution. After registration rrriili the Building Inspector,a customary home occuriation shall be peintittecl;is of right sub..ject to the Following Conditions: The activity is carried on by the perrnuient resident of a surgle,f unity residential dwClling unit, 10(';Lted rvithiit that dwelling unit. ,Z) • Such use occupies no more than 400 square feet ofsliace. ,Q • 'There are no external'alte.r:itions,to the rlrvelling.is�ltich ai•e not customary iri i•esiderttal huildirigs,<ind,tlrere is no outside evidence of.such use. .No trac rcall be generated in excess of uornial residentialvolunre fli s., • The use does not.intolve the production of offensive noise, rdbration,.smoke;dust or other jarticubir ,martter, odors,electrical clisturbance,heat,glare, humidity or other objectionable effects, • "These is uo storage'or use of toxic or hani-dous ni'ateri;ds,or tlartiriiable or e:xplosive.rnateri>ds, in excess of norm rd household nu;uitities, • Any need for parking generated by such use shall be ntet on the same lot containing t(re Customary Home Occupation;and not'16thin ehe required front y;ird. - • 'There is rlo exterior storage oi•display of materials or equipment. There are no commercial vehicles related to the Custonary Horne Occupation, other than one ran or one pick-up truck not to exceed one ton caliacity,aiid one trailer not to.excecd 20 Feet in lengilr and not to exceed 4 tires,p;u•ked on the same lot containing the Customary Home Occupation. •, No sign shall be displayed indicating the Cuslornary Honie Occupation. • If the.Customuy Horne Occultation is listed or adver(ised as a business, the s(rcel address shall trot be included. r • No person shall be employed in the Custont;uy Horne Occupation who is'not a perniaucnt resident of(lie dwelling unit. 1, the undersigned e uI and a e-"4k4h we restrictions for city home cicrupation I am rt_gistering. Applican(: r. Date: Jc • , a Xs3 "� 35 f • 0 a ' *` 24 IJrJDA7no 32 a P�o�QSE� L07 3 A4 M'v 44 of P�AnJ DA7`P—t�GIORGE __ _ •r �, 4 i•L 1R7,/! h�•4�t� i. h . ' �• , .� - Y pr, 3 y y,.+� °}.a y J r: Y. C#� .3✓'+ ;� s'- r r i �".a M :; • 1•r 1. c .yr � .. .. ...+ . ..+.- ,P ,.ln.... t.�S`CY+Fw` r •e r t T �• ! .. 41'�. Avessor"s, map and lot,'number ..:.:L.1::L..v ..61�`...... ..� I EP C SYSTEM�M T BE f `' y 77 � INSTALLED IN COMPLIANCE ,. WITH ARTICLE II STATE G; Sewage Permit number ..............._ ...:..........;...............� tom. y SANITARY CODE AND TOWN G' 0 S. . THE TOWN OF BARNS'T I 3"NSTAAL i f't r' "�` "' BIJJLrDI'NG � INSPECTOR 1639. ♦� r, tit } 0 NPYa' �? lk� -11 fj 00 _i APPLICATION,FOR PERMIT TO .:.....tn < TYPE OF CONSTRUCTION ... .GU.�?A�'('..' !� t'!CJ......cj'.: !?P t?_:: N �C. .................................................... Co TO THE INSPECTOR OF `BUILDINGS: The undersigned herebjr'Iapplies for'apermit according to. the following information: / Location ........141 ... � .......... 1 G./...co._tl� .... .oa�Le ..e.......... t:+ lEclA[?t:�.. �..... Q% ... f l..}....... Proposed Use d fvg .l.f.?9.......... Zoning District ...........V ......:........."................................Fire District ..................(f6._ it J......................................... Name of Owner ./.a) -efi -1�'e ro ?E �SS.GX:....X,"c:....:..Address .... o .......... ...........C..ef'G1 Name of Builder .......1. .`� g EI�Z........................................Address ...........................!94 e......................................... Name of Architect .........: :2!/�Gye-!!t..................................Address ......:.................. .4?. .e......... Number o (r....... ...0 .1. .... " �cf.Roof,ng ..........2% ...11 ........... SIQ�Exterior � �I�..... ........................ Floors o�...../r!/.�!:. f >f? Q......:.........Interior ........��..........:�/ e�� .v\.......................... 1� .. ,'. .... Heating ......E/ .k?..........C?.!a.................................-Plumbing ...;!..:............................ Fireplace .....U$.&...... !!(S. !/y Approximate Cost ....... ...... Definitive Plan Approved by Planning Board ______________________________19________. Area . a-......5 Diagram-of Lot and Building with Dimensions Fee ...........a............... ... S SUBJECT TO APPROVAL OF BOARD OF HEALTH o A) / as 60 QJ At I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �. .............. �+ �... ............... Tellegen-Ferrone Assoc. , Inc. - } 19329 -. -- two story ; 0110 ............... .Permit for .................................... i single• family •dwelling .......11 , r. Sandalwood ice' ,,�,� ✓' Locatiofi ..`......... .• cdtu i t r ........................... .................................................... } � Tellegen-Ferrone Assoc. , Inc,. t' Owner .....'............................................. ........... u, r frame_' - Typ f Construction .................. .....;........... .................................................... ..................... ' ✓• dT� 1f� / `4 �f Plot f .......r ........,. Lot ...................#32..... .June 23--' F: 77 � Permit Granted'.'............................ -.......%19 Date of Inspection 7 ....©.4... 19 d a -Date Completed ....� .�..�. ..........19 _T - PERMIT REFUSED ..................... .1 q ... . .......... .F.. .................................................. •r ' — F ` ` �/ p 4 / -J. .............. .......................................... .../ ...........................^.................................................. Approved ... .............4...... ................... 19 ...............................:.........................................i...'1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ` Map n . Parcel 0 �!f Permit# +leattITt fvision Date Issued Censzsrva`tion 6ivision Feed Tax Collector 2 0 �& A Treasurer_r� Pfarmirtg`Bept. R Date itive-Plan Approved by Planning Board Historic-@KH Presseery ti y&yannis Project Street Address r Village &41/1 Owner kl 2_i P4 N Address Telephone Permit Request S� `' ` -� c�.4�- 5 Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Cl�/00 0 Zoning District Flood Plain Groundwater Overlay Construction Type r,4& Lot Size�� Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ • Multi-Family(#units) Age of Existing Structure ,2 J � '� Historic House: ❑Yes U-N-o On Old King's Highway: ❑Yes Eo Basement Type: Y Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing . � lz— new Half:existing new Number,of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Z Heat Type and Fuel: ❑Gas YOiI ❑Electric ❑Other ' Central Air: ❑Yes I�-1�10 Fireplaces: Existing R New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing 0 new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes A3/No If yes,site plan review# Current Use Proposed Use (� BUILDER INFORMATION Name 0 MAC,/�'i AC, e,u Telephone Number Address License# If I �9� �''�� A Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �'i SIGNATURE ��'`�� DATE �� i 7 ' FOR OFFICIAL USE ONLY PERMIT NO. a f DATE ISSI(JED MAP/PARCEL NO. ADDRESS VILLAGE OWNER?rr `a DATE OF INSPECTION, i FOUNDATION _ FRAME INSULATION # FIREPLACE ELECTRICAL: -ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ;' F • i f DATE CLOSED OUT ASSOCIATIONTLAN NO. T : : The Town of Barnstable • ansrerns� • A�,�' Department of Health Safety and Environmental Services 059. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IN PROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNIIT 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. A A Type of Work: 'VV C?C� w IhItIl Estimated Cost Doc) Address of Work: `� 7� G Coo O✓ Owner's Name: _e I C,�A,�F—j `t- � Q v pa Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 ❑quilding 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 E"ROVEMENT 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. 7 O Da Owner's Name q:forms:Affidav ine Lommonweaun Department of Industrial Accidents 600 Washington Street -"" Boston,Mass. 02111 ` Workers' Com ensation Insurance Afridavit r location Z e eod ' mtvD UlEg-- bhone# OP P I am a homeowner performing all work mysellt ❑ � �or and have no one working in ❑ I am an employer 18. 'compensation for my employees working on this job. am e mD any n isl.:?>i'is isi'ii:....j:....riJ:}:j:}((}:i?:•T isv:isi<{: :::::{:::j;%:ij;%:}?:::::iti ii:iii'ry'r'{%'::}:j :}:iiti:�iii: ?:i:•>i:;X is+:%}j <4k:t:::i:TSi i........ ?•:... address.. .. : } .:> . ....: : :..:.:. ::::.insurance ..... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have lured the contractors listed below who have the following w.orlcers'.. ensation polices:................. ...::.:.::.::::::::.:.:::::::::::..:::.::::::,.:::::.:..::::::...:::::::::::::::::.:::::::::::::.:....v:..: comyanv na _.. ..... ::.r•:i+i:i:{:;i•iiii`?:i::'vt!i}:iiii}:�:::ice'iii::i};%:}......................::: .: . :%:;.....ii'i'siii':ii`S?j:<'>'::'>}::tii{:{Ci:i'rii'i'::tti ii::}i;::iiii?:ti:ii>:Tiii ii::;:i;iy>i}i:;:•:}}'.ti{:;:{%:{: ii v i ;:yii;:y;•,;: ;i: i:;:jv: res ...................:...................... r:{ :.. ...........:......................................................:... .. ............::v:::::::•.v::::.:::::.....:.... ........... ;.:. ....................... ................ .... ..n..w........................................{....-..-. f.........r:..................::::::::....-........:•. +�k I.,^•}rTi'}?.rnv?C}YRy{Mb ;.4{C8.-F.:.^:{,,:S.v::: ................ -....................................... ..... ::::::.}i:..iv:.:.::::::::::......:.}•:w::::::.v::?:};}'yr.••}:yri:.;:;i::�:•:i�i:>?•::i::ii:�<i::i?ii::i:::: .::.;::.:::•isi;tivvx::i9}?:{�}}:i•}:•}::i•}:{+ri}'•:i}:•}}:v•: r{•.?,?•{:A.:?:r::lilt :r}•r tt tiyi:�G.?}},r::ti:':%i}ii::,:;:;%:;{;2>.ti%Otiy :;:;:•:::;%:i ':i<:•':::>'�}::iiiiii:ritiyti{Stiff}r};^:{+.::::::i: ..•.,�•w•: .... . .............. ...Sr..r..... {... ................•:S.r.,:.......:.....tr.-...............:.:::.:.... � : :: ......... ::::::::•• ....ft:.�?.'r`.+iri!.���..t�ru!!...•..?:k:'^:%::%��`�:�i: I3nsurattce.ca;:.::.... ?r....... ........ ........ .,,.:.. .. _ .. . a1it:�# ........ - .n..................................v........,. .............:•rw::,:w:;;....................::::::::::':....................}}}::?{•Y...n..n:.........x...n..rF. ?.•?:•�i}Jci}lt::':Yf'iti;'+.Cy:4if;X•i:;i:; namte:::::�}:�:•}:•}.:%:w::::::.v:•::w:::::•::::::::.v::::::::•._:::v:i}:•}i>,:.rr_::::::.y..::::..:..:..::i!{<{i:::.:....:.....:..........:.::.,;:.::.::.:.v'.:.... .v.- "" II I .. ? ? ............ ........:............................................................. ..................................... ................................................................. .......................... .................................v:n........................................... -.......... ......................... .................................................................::.,w::?:.::.:.::n::::. . ........:..:.:...................rr::.••;{:{ri:{::•:;......;:..... ._ bne: :: >:::::::<:::::::: ....... ................................. >�>?s%< {ar+ .................................................. .. -a{{,r:r......u?r.,....rr:..... .............. ..........-...................:...:.,.:::.�::.; ...................r...:•:::x•,.,.�•}:t�•o. .• ...h:}}'w•,,}k,:}:a:•}:::�y:::::•}:•??:•x•:::;.. Failure to secure coverage as regdred under Section MA of MGL 152 can lead to the imposition of criminal pensides of a fine up to 31,500.00 sailor one Yeats?imprisonment as well as dva pensides in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I m lerstsnd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby cerd-&wsddr the p ' penalties o perjury that the information provided above is trrw and correct Signature 1 G�C 1�-- Date A Print name �v ��� l #,JOF elz6P n7V3 f only do not write in this area to be completed by city or town official town. p��# ❑ D�a� l]Idcensing Board immediate response is required ❑Seledmen's Office _ C3Heaith Department on• phone#; ❑Other (rAnd 9/95 Pltq - Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the camtracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/liceose number which will be used as a reference number. The affidavits may be rctaci d io the Department by main or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a'cakl. y The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Ottice of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 Department of Health Safety and Environmental Services Building Division 367 Mann Sheet,HY=Ws MA 0=1 MM Office: SO8-86Z-4038 Ralpi�Crossm Fax: 508-7904a30 Building CammisSic BOMEOwNEBLLZ plesee�riat m � `; lqq 6 el J�h dz a 6- ,oe ioc�►1mN: •� _ swu - rUT) "®D11gowNER' tioms pimaa V wadc�d o� CURRE MAa nJa : 0.1-,/, �— M,�- �6 3 dpGo& caareat was attmdedto include ofsizunits or ten sod to allow ho ww=to=an iadividusi farWmwho doesmotpas m ariomsS OVIalrrro av$o 0 MR pftwn(s)who aw apamd a land anwhich hdsbo nmlcs cr"mmulsso � �� A to be4 acme ortwo4m* attadad or d sameo n�a p=n who cm ar more dM M hams in atwo-yawpododdanna beconddaadahowvaer. Such ��am sbaiisubmit to dw BwIdmg Official anafoa:d "dr 109.M) - Mm ——---,Zumm fpqp° g9jrMFfOrcCMprjM=vfttbsSt=BWI&g Code and other applicable codes,Wkyos,ndes aadrephdom Mw=dadped — aatifiesthathdsbe uadaM=&the Tawn ofBamstable Building Departmew M;nimumkqmcdmptocedum mdrequuemcm mci* thdsbe wdl c mggyvah smdpm wad A�doPHnildia6C�t Note: •tla+~ 35.00 c obit feetor ixWwdiberrquiredto co*Y with the State Bugft Code Section W.0 ComaronCAnucL ROBSEDWHEWSEMWTM jMwCodess=d= •Aafhomev*aQpa�aa�� Abow" oe�empctmmt�e PMwdMeffhseobM(8eedoa 1094.1-u==MOfea� �imM*PMr"dM ftbehomeowna aP slfor Mmmdomrbwoek*tsnkHOmmwoessblgseas ,• �r 6omeoasetaLsmetbh�a��w�ef�td�f of aaopeWsor(seeAppauft Q• RdesdtRezaist�sta �0° $e�0°� ��af awame�tothatesdlsiusaioaspaobteaw. ,wl�steeimoeawaset� � 1atb4a�.wr 8osmdeasoscptooeeda�ffiaudicrosedpeaoa as itaodd widt a lioeawd SapariwL �6omeowuer as Supenaw is r :omf ��oftme permit mpP °0A' Toemate>bstttmfm�seoaaai�8dlt►sweeo afst Oathslmtpa�aoftbisiaocisafomzaateatiY� liystthefi t6athdshs the forawinYow by stvaai towns. You may com to amend asd adopt sorb a fxz loeed8cldm 1 a �OT- . 1 0 �isrFNG �� Z � �, p� • _++ �4 GCSE Uti©Arlo T 3 2 r L.__1 �'�•� � �•p l ,__.s�� pTcOPO•s�a " J 11 � r•- ' 7 2 LOT- • P PL,4 N D.4 IF C E ee 'r�-I', T A l /l I /`.•" .� y ..'. /'"/` `,,Y " .ifi'Mn, 2` "GEORGE I V 5 low, tJv1 - ,�� My.� y.r•�P.e7�✓�_l� 4Y`i"�1';V`��./ ✓"�"'��••iriw. �5#�'� 7,7 'r�ip,7l�h.r -�YI�M����� K�+ 4?77 ,. :_ ... -- _. ... - -; _ .. " d,..: .�*.� r'r" •'i ,. aiM,d �y.r yye}t A���i1MR �;r {'�, a S _...r -e,iik.-X"�"'a_ ovt UNARM Assessor's ma and lot number Sewage Permit number .......................................................... TOWN OF BARNSTABLE i MARIISTODLE, i o aY.a�,� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... lC/.................................................................................................... TYPE OF CONSTRUCTION ............4o.04) I.....i.mWe......�!u�e :.. + ...................................................... .............S/ .../)...................19.? TO THE INSPECTOR OF,BUILDINGS: The undersigned hereby applies for a/permit according to the following information: Location .......ja.f.....&.�Z.........cv(,1.... Q u:.f..... .c%�c ........�.l!a/Kj orl.XX Q........ ...S..-./`/ a/a.i.S....... ProposedUse ...............,l.Nl.dl i. 5. ....................................................................................................................................... Zoning District ...........e.E................................................Fire District ..................66.j1r4.x.-1......................................... Name of Owner ..Te.11E�.rn.. error..e..�(SSUC...�irc........Address ... Q ...........��.7 ...........C.�iZ.I�rUi.lG'P..... Name of Builder .......-2JIA 4,0.......................................Address ........................ rGtj'I ......................................... Name of Architect r.7k �`J1(?geA..................................Address .........................S.G?!.�j.e........................................... Number of Rooms ..................... `��/.........................................Foundation ......I!�../........... Q. Exterior .5 .. ........L..II,......C.! ...�,CZ�CL�� ...a�< 4s�Q�����Roofing ......... ..�JS...��?............��S f1Q.. ....................... / / Floors /.... l�r..........6.4.. ......... ......�.i.0..'................Interior ........Z,14� .......... 5� pep l Gr- ........................ / ...................... Heating .......EAw........... n./.................................Plumbing .....PLC Fireplace .....U..5.ed......��9Cf��U.U�t.< ..................................Approximate Cost ..............G�� 6................................ ,....... Definitive Plan Approved by Planning Board -----------____-------_-------19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH PAI ei P�f � � J Q � a � � 11 a S o S�,/a/w«cd Rd I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name � .. `7-� .e15502r ZAIc Tellegen-Ferrone Assoc. , Inc. A=10-41 No ...1 .2.9 permit for ....two story single family dwelling ..................... ...............................................f.... Location/�://..Sandalwood R��,. Cotuit Owner Tellegen-Ferrone Assoc. , Inc. ............... ................................................ Type of Construction .............frame .......................................... ................................................................................ Plot #32 V ........................... Lot ................................ Permit Granted ............June_..23.........19 77 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... .............................................. . ........................... Approved ............... .D .{. ............. 19 1............................................................................... ............................................................................... yam^