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HomeMy WebLinkAbout0043 STUB TOE ROAD Y3 3k6 T ,�i Town of Barnstable µ *�ermit# :Expires 6 months om issue dale Regulatory Services Fee BARNS rA= Thomas F.Geiler,Director 16 Building Division o�c �114't 3 Tom Perry,CBO, Building,Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION G- RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number o r1T Property Address ��j ► ;P/ esidential Value of Work$ s%td Minimum fee of$35.00 for work under$6000.00 0 Owner's Name&Address 1:2 e �� G, ` Tel hone Number Contractor's Name ep Home Improvement Contractor License#(if applicable) E _ A . ar r Construction Supervisor's License#(if applicable) S 0 �^t' S 3 ❑Workman's Compensation Insurance AUG 15 2013 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE I.have Worker's Compensation Insurance 4 i Insurance Company Name n l i e- A. Workman's Comp.Policy# Copy of Insurance Compliance Certificate mu s accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders.U-Value (/ (maximum.35)#of windows #of doors:—�7-- ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Proper Owner Letter of Permission. A copy of the Ho ve nt Contractors License&Construction Supervisors License is ed. SIGNATURE: QAWPFILESTORM building permit forms�E)2RESS.doc Revised 060513 I r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street s' Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 4& 4Z Z a!2 City/State/Zip: ^ Phone#: � � Z 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 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, ❑Demolition working for me in an capacity. employees and have workers' g Y P ty. 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I 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.❑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 him:outside contractors must submit a new affidavit indicating such. tContractors 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: Kll-& v Policy#or Self-ins.Lic.#: e )/ Expiration Date: Job Site Address: City/State/Zip:z� 7,1!.,l 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 ve - ation. I do hereby certify un t e a' n en t{ rmation provided above is true rd correct. Si nature: 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.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Otlier Contact Person: Phone M. • it . The Commonwealth OfMassach t� tts - ID Departinent of d aal Accident, Office of Investigations 601 Waskington Street Boston,:M 02111 www-InWorkers' Compensation Insurance Affidavit: j3uv/dia , licant Information �Iders/Contractors/Electricians/Plumber � s Name(Business/or Please Print Le ibl ganization/Individual): Address: City/State/Zip: _ e#' P Are you an em Ier? Y Check the o appropriate box: I ❑ I am a employer with employees(full and/or # 4• ❑ I am a general contractor and I Type of project(required); I 2 I am a sole proprietor opart time}, have hired'the sub-contractors 6• ❑New construction v p partner- Iisted on the attached sheet. # 7. ship and have no employees ❑Remodeling ' working for me in any- `These sub-contractors have y capacity. workers com . $• ❑Demolition j[No workers'comp.insurance 5, P msnrand i required.] ❑ We are a co g• 0 Building addition 4 corporation and its 3• I am a homeowner doing all wor(c officers have exercised their m right of exem tion 10.0 Electrical repairs or additions ' yself,[No workers' P Per MGL I LEI Plumbing insurance required.)t comp c• 152,§1(4},and we have no repairs or additions employees.(No workers' 12❑Roof repairs l "Any apprcant that checks box#t comp.insurance required.] 13 ❑other 1 t Homeowners must also fill out the section below showing their workers• __, who submit this affidavit indicating they are doing all work and �Contrdctors that check this box must attached an additional sheet showin t�ensation policy information.then hire witside contractors must submit a new I aKt aK employer thaf is g lire name of the sub-�it>ra���d affidavit indicating such. � providing workers'comp their �>�P•Policy information_lo�rration. eKsatinK tKsurance for m _ y�pj°yees Below is the policy and job site Insurance Company Name: Policy#or SeIf-ins.Lie.#: Job Site Address:��/�� Expiration Date: Attach a co ,� py of the workers'compensation policy declaration;page(showing the o � '. Failure to secure coverage as required under Section 25A of MGL'c. I52 can lead to th g e Policy number and expiration ate) fine up t$ 50- 00a d and/or one-year imprisonment,as well as civil penalties in the Of up to$250.00 a day against the violator. Be advised that a co a tmposltion of criminal penalties Gi a copy this statement may be forwarded of a STOP oRK to theffice of a a Erne Investigations of the DIA for insurance coverage verification. I do hereby certi under the pauis and penalties of penury that the iK orm , Si ature: �:,V l ataoK provided above u true and correct. hone#: -�-- , Date- Cl I P i �� Official use only. Do not write In this area,to be completed b c' y �y or town official City or Town: Issuing Authority(circle one): Permit/License# I. Board of Health 2.Building Department 3.City/Town Clerk 4• 6. Other Electrical Inspector 5. Plumbing Inspector Contact Person f f 1fjtj S i T. r'��+- �nita:Jzr.•»ru�rl/r n�^!'r�z,;;ur,�u,;r/%; Office of Consumer Affairs&Business Regulation p License or I o valid for individul use only OME IMPROVEMENT CONTRACTOR { before the espi ate. If found return go: �.- stratiO^: 168M7 Type: Office of Consu airs and Business Regulation xplrat►on _.112T7/2014 DBA 10 Park Plaza 170 KENNETH KENDALL Boston,MA 021 KENNETH KENDALL, ` 5 WELDEN PL. FAIRHAVEN,10A 02719 Tom' Undersecretary Not va thout signature r and Standards I H� Construction Supeneisor License: C"75153 KENNETH D y ry. 5 WEEDEN PLACE s FAI HAVENr MA Expiration Cor"issioner 01/1 9?12015 t I[ i, I ✓TZe T�oirvrrzorrtvea� o� ac�uoeQ4 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVpAENT CONTRACTOR before the expiration date. If found return to: :F ... Office of Consumer Affairs and Business Regulation Registration. gg Type: 10 Park Plaza-Suite 5170,p P! :: 13 Supplement C d Boston,MA 02116 LOWE'S HOMES";_ ('`• ROBERT 136 TURNPIKE R&,$8'W' SOUTH BOROUGH,frlfA:'&lh Undersecretary Not vadd withou ignat e I i . i I .r ; 5 .T MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT . . 4 INSTALLED SALES SPECIALIST{ NUMBER7�j/ CUSTOMER 0 162 STORE NO // ESSSTREET ADDR ADD RESS 1 t.: if•r" . L 13 .. .STATE ZIP .- CITY TATE CITY , Sr ! S/ ZIP , , / GJ! �CIt ffI z Q if /J i ri 1' Uv°C�.� 1 � ._ TELEPHONE - - -y TELEPHONE A i' DATE LOWE S HOME CENTERS,INC's MA HIC NO..148688 x: CASH BANKE. FEIN 56-0748358 _ Ifi Y CARDCHARGE P 1 This s only a quote for the merchand se and se ices pnr le,below This-becomes an agreement upon payment Upon$Ornent,the entire agreement including the spe�caily completed pages bf thii document,the Terms and Conddions mdutletl'vnh this documentand.any other addenda and attachments hereto,shall be referred to herein as this"Corit"'ti. .'-'� PLEASE READ ALL-TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING a INSTALLATION STREET ADDRESS �CITE` /[ STATE ZIP 2 I - Ci ir , J1LA!A'Cr lt2.54: t,-ryV? a 1 F•'; )c`_.i ,rG fGr J /;?/i/ i i '-GF=,?: 0 d*� �f} `�-:^:I t�"ttTie i % / T- Contract Total n c /Are permits required for this installation?:[-Yes [ ]No *applicable tax included "._� f ( - 1G1 NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for an lawful purpose, including, Y p p nc uding,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees tc the foregoing. [Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be X-job "f 3 [fiIle in date].Estimated completion date is F- 1/ "`_ [fill in date]. Said estimated substantial completion date is not of essence. A statement of any contingencies that would materially change said estimated substantial completion date is as follows: otl!the r , (if applicable,insert-a statment of such contingencies). IF THE CONTRACT TOTA IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTICN ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1.000.00: ( Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and (2)Payment of S to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ )Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ !Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and j(3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M G L c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION IAS PROVIDED IN M.G.C.c-t 2A. BY: '`fir-- ,. ---.-^ -e"'i-- Date: i"! i— )3 LopJe H-bme Centers,Inc. I re By \ i d L"� E .. Date' Owner Sigpatbre 1 ~ THE SIGNATURES OF THE PAI#IES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWES PURSUANT TO M. L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT-SEPERATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS j;-s DAY OF t.! J Y ? 0j, . Lowe's_Mome Eenler n __ _ Il F f^— j^•- S eciali6t,'orAbove Owner `f' Co-owner or Witness Customer acknowledges receipt of a true copy of this contract.which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. FILE COPY 02004 by Lowe s.®Lowe's and the gabte design g0981(REV.12J10) are registered trademarks of LF Corporation. _ �3. 2376- CrMbary . 1 Al Ap f Y Sags AAL koy,,-/ cs-# oq ?a vz l c,# �c�5 �k n i I f A3'aessor's map and.lot number f Sewage Permit number ............ •..,•� o o House' B 9SH9T A BL`E�, number .................................. ch/ 0 � M6a ';W11 i war a 0 ; TOWN OF B N} �� -A LE BUIL�bIHG . INSPECTOR4 APPLICATION FOR PERMIT TO ..............................................................................:...................................:.......:.. y TYPE OF CONSTRUCTION ' .. ........................................................................................ ' . .................19. i2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby.applies for a permit according to the following information: Location .......Lot 28.utte .......G.. ele,...Cotuft,..Ma'...................!.o...... .....70 ..��! ..........:........ ProposedUse ............Residential.......... .... .......:................................................ ........................ ......................... ZoningDistrict ...........RIC ..................................................Fire District ........ Otuit........................ .......... .............. Name of•OWner ..Dennis Star Construc .. .. 24 Great Pond Dr..,... Yatmouth ......... ..................tonC ., Address .... .. .. ... . Nameof Builder I.......5...��.....................:.................................Address ............ .................:.................................. Nameof Architect .............:.........................................Address :................................................................................... Number of Rooms .....5.....................................................:.....Foundation ,.......poured concrete ........................................................... Exterior .......cedar• shingle......:..::..:...: Roofing .............asphalt shingle.... ...........:................... Floors pl1wooc.............. ...............Interior ska��tx 4� ................................................... Heating ........................................................Plumbing ....'.......13/?...bAthS................................................. Fireplace ......One. ..... ................Approximafe Cost ....25. 0.Q.Q........................... ..... Definitive Plan Approved by Planning Board ....... 21__------------19_73-__. Area ...../SO... 5. ..... . Diagram of Lot and Building with.Dimensions Fee �+ ._........................... SUBJECT TO APPROVAL OF BOARD OF.,HEALTH 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 ... ..................................... ..... .................. 016681 Construction Supervisor's License .................................... :k . -.-LnNNIS STAR CONSTRUCTION f - r -� One Story F No .25'7..... Permit for ........................ ......... Single Family Dwelling s. Lot 28, ------- Location ............................................................... Cotuit ........................................... { Dennis Star Construction Owner ........ ......................................................... _ k Type of Construction „Frame p ........ .1........;1... .................................................... _ . • . Plot f .....I,- ............ Lot,* ............................... f October 28, 83 Permit Granted ........................................19 i t _ J Date of Inspection ....... ................19 -Date Compl ed , Assessor's map and lot number ..,140......... ... g t.... y�FTNET� �y Sewage Permit number ...........�........� ... .... . :.:......~� F� Z BA"STGBLE, i House number .................................. . ............................ yO .J NAB& 1639- - •Fp M{1Y Ar• TOWN OF BARNSTABLE BUILDIN,G_,_I_NSPECTOR APPLICATION FOR PERMIT TO Construct TYPEOF CONSTRUCTION ....................... .Fr ....................................................................................... .... ....................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location x.� .....lot 28 Butternut Circle, Cotuit, Ma. ............................................................................................................... .... Proposed Use f ........Residential...................................... ............. ............. ...... ............................................. S Zoning District ...........� .......................................................Fire District ....... otuit...... t Name of Owner ..Dennis Star Construction CO-,...Address �4,_Great Pond Dr., So./ Yarmouth, r1a. .............................................. ...... ..... f..�. ........................... Nameof Builder ........�...�............................... .....................Address ..................................................................................... Name of Architect .....N/. ....Address { r Number of Rooms .............Foundation!{E' ...poured Crete t Exierior Cedar shi.nc�le Roofing .............a-spha.lt Shingle r{ i" r; Floors .........P.1W .........................................r...................lnterior .............SheE'.trOCk Heating. ......kM..-.:9as............................................................Plumbing f2. baths- ............................................... Fireplace ......MP........ :..... ...................................Approximate Cost ...25goQ4................................................... Definitive Plan Approved by Planning Board S.ents-_—1.______________19_Z3__. Area .................................... Diagram of Lot and Building with Dimensions w Fee ......274...........: SUBJECT TO APPROVAL OF BOARD OF HEALTH i F 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. Nam ................................ ............ 016681 Construction Supervisor's License DENNIS STARJIINSTRUCTION CO. A=40-96 = qo 96 No 25711 permit for One Story. .................... Single Family Dwelling ...... . ......................Y�"..z...T�. Lot 28, �5ernu Circle Location ................................................................ Cotuit ............................................................................... Owner ...,Dennis Star Construction Co. ................................................. Type of Construction ......Frame.a.me .............................................................................:.. Plot ............................ Lot ................................ Permit Granted ..,, October 28, 19 83 Date of Inspection ....................................19 Date Completed ......................................19 TOWN OF BARNSTABLE Permit No. ----_---- ' Building inspector I ruueTw, Cash ---------_--OCCUPANCY PERMIT Bond 1,,sued to �nis Sitar 1.jit� Address lot f?R t,.n Ct 1, m,,,. 1c)ad, 0.-, Wiring Inspector Inspection date Plumbing Inspector 1 Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. /l(%/..:... .. L'1............ ........... /. ............................ Building Inspector FROM TOWN GE BARNSTABLE . BUILDING DEPARTMENT ,: ors Iahteine -,367 MAIN STREET HYA14141s, MA 02W1 Phone: MY-#120. SUBJECT: FOLD HERE - DATE - .. 24, 19$4 N1 E S S A G E . ". - _ •. �Work has b,,ee..f'�©g'E 3�;, . d YuiMtn dF 14e4tir+N v.P N.e rKmt^J 0 2�7 1vTe 1.�;(Dveim"b nf-iQs# S e.t..aThr r�1A L�1cm) p Please release ]4nd.• ._ _ ��rr •�..wrW_M'iY3 tl bias.M.yn pVe'�k E4/R @44'fi m•.er . .. 't 61 - SIGNED . `DATE REPLY r 11 - • _ ,, • SIGNED - ' N87-RMI - RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY- - ' PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SENDMHITE AND PINK COPIES WITH CARBON INTACT. �+�.•i �i' � r' ". 3 - �. ,x r r , i � tr �'_•� rt a ]°yr -. �_ .. '1a �`,R, !. 8 ♦P wr '#. E. N w. - ! r# i y - I r jjj\\\',,,,,, • j. 41. Y , -' ` + -'fll+' � ..it A � 7`. 'F-J i 6'"•+� 1, 4•_'� i y: ' +� —S ,A{��.�} IL if •,f. '- a (� - . L ". , } a - �� _ , ✓y it, q�li'�°•�•A•� ,(�`(�,yJ'r r�LJ.+f, f f Lam. r 4 , .. . '!• '1 f ti ` rp f ,' F' !t ._ r ` i . LAN r•SHOWIN : t I• +r�L ' rAr1 - •f�. �+ ^, a � f n - i "FOUNDOCATiO µ LL CTt11 T" 1ASt �tUS ' , ' : . r L+ ► ;,_ �;. , ( '" A 'bW1V Q $Y,= t • - ` , '' loi SCALE f• - i •` , »..NORMAN 4ROS$VAN:— =.:' 'RECrlSTE'REL1�l.A)VD' f MER BY �CERVF'Y THAT` THIS ATION tS'LOWEb, ,< y` �f�f. � of, , py• QN'T1NE �.Dt.AS SHOWN,AP)D'60HFOI�AIS TO''TfIE s,TOWNr �,- Q�• �o�, �,..OF; ARIVSMAOLE f0NINO REGUILA-�IOMS REGARtI1HG SMACKS�-fPf3fM STREFr' OAIES AKU, t01` LIiV��'`� nnbp � NOR#AN BROSISMAM DATE, , ,