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E ) Map �_70 \ Parcel a49 Permit# � 08
u \ House# gate Issued 5 -"f
Board of Health(3rd floor)(8:15 -9:30/1:00-4-�4) 6-zl
Conservation Office(4th floor)(8:30- 9:30/1:00 2:00) ST
rd 19 INSTALLE E
4 _ R IANCE
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TOWN OF BARNSTABLE�141,`rtON FEE ODE AND
Building Permit A plication
Project Street ddress
Village
Owner Address
Telephone Q 3
;Permit Request e Z X I
First Floor - square feet Second Floor square feet
Construction Type 46t�
Estimated Project Cost $ ��, ;�0 0
Zoning District,, Flood Plain Water Protection
Lot Size y�, oil' Grandfathered ❑Yes 041-0
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure &C Historic House ❑Yes Uo On Old King's Highway ❑Yes p No
Basement Type: V ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 90/-1-f"f 000
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing-7New First Floor Room Count
Heat Type and Fuel: �s ❑Oil ❑Electric ❑Other
Central Air ❑Yes IUlo Fireplaces: Existing New Existing wood/coal stove ❑Yes 2<o
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name co�> Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUREUA,,.�VjUDATE S l�
BUILDING PER D NIED FO E FOLLOWING REASON(S)
=' FOR OFFICIAL USE ONLY
PtkMIT NO.
DATE ISSUED
MAP/PARCEL NO
ADDRESS VILLAGE' I
1 a
1 • - {.,
OWNER
DATE OF INSPECTION: '.
FOUNDATION i r
FRAME
/
a
INSULATION t '
FIREPLACE
ELECTRICAL: [ ROUGH FINAL -
PLUMBING: ROUGH FINAL :
GAS: ROUGH FINAL
FINAL BUILDING r
, F
DATE CLOSED OUT r' ;
ASSOCIATION PLAN Nj0
t r
o.3sK F 1 TiT
0.1s it
OSIK 65
—... 258 f 59 i 0151 9S ;
252
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—I333 _t� 157
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office 91111yeszf9ations
. 600 Washington Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
name:
i
t cation: ed
city
hone#
ka
I am a homeowner performing all work myself.
❑ I am a sole ro rietor and have no one working in anv cis acity ��„�„
❑ I am an employer providing workers' compensation for my employees working on this job.
com anv name•
address:
city
phone#:
insurance co. olicv#
❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who
have
the following workers' compensation polices: ................ .
com anv name:
address:
city phone#:
olicv#
insurance co. -
cam anv name.
address:
city.
phone#
insurance co:.
of icv#
/
Failure to secure.coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Otte up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
cC
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify der the p and penalties of perjury that the information provided above is tr�uo and co►reeLt
Signature
.. Date ✓ J ` _ .
AIL
Print name Phone#
official use only do not write in this area to be mpleted by city or town official
city or town permittlicense# ❑Building Department
❑Licensing Board
❑checkif immediate response is required . ❑Selectmen's OMce
❑Health Department
contact person: phone#; ❑Other
(revised 9/95 P1A) ..
I `
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 cow:,
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
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 a
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 renew
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha
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 contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers 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 yot
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 tlu
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. The affidavits may be returned io
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
'The Department s address,telephone and fax
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Imlesduallons
600 Washington Street
Boston; Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 eat. 406, 409 or 375
r�
The Town of Barnstable
9�A & Department of Health Safety and Environmental Services
rEcnat• , Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissione
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization.
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
T Est. Cost
o[Work: n®ri� `
a Address of Work: t
Awner's Name
—444k— 14e-(A V\ VI i A-f 4--
/Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
ate Owner's Name
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE �� ..... ,
JOB. LOCATION S C_ev, er -63 .
Number Street address Section of town
"HOMEOWNER" jU e-u - SU ) 3 3 01� -7 7� 21 o _
Name Home phone Work phone -
PRESENT, MAILING ADDRESS <G W]p_ 0.S ri Ab LIP—
City/town State Zip code
The current exemption for "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
e
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one or two family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building OfficiE
on a form acceptable to the Building Official, that he/she shall be responsib=
for all such work performed under the building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes responsibility for compliance with the StE
Building Code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minimum inspection procedures and requirements
and that he/she will comply ith said procedures and requirements.
HOMEOWNER'S SIGNATURE _
APPROVAL OF BUILDING 0 F CIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION '
The code state that: "Any Home Owner performing work for which is"building
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if
Home Owner engages a person (s) for hire to do such work, that such Home OwnE
shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for licensing Construction Supervisors, Section 2. 15) . This lack of awarene
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it would with licensed Supervisor. The Home "Owner actz.
as supervisor is ultimately responsible. ,.
To ensure that the Home Owner is fully aware of his/Fier responsibilities, ma
communities require, as part of the permit application, that the Home Owner
certify that he/she understands the responsibilities of a supervisor. On the
last page of this issue is a form currently used by several towns. You may
care to amend and adopt such a form/certification for use in your community.
r Assessor's' map'and .lot -number ....
C `" '•' "O�C> q �C V �6 7 slwle
Sewage Permit number ,�!.......•••••" .. % .-
ofT"Er° r TOWN OFF BARNSTABLE
Z BlHHSTAIILE; i vM
9,oM6 B�UILLDING ` INSP=ECTOR
n.Mar �� c-� •�
APPLICATION FOR PERMIT TO• ....'..... . ...^./ .
oy TYPE OF CONSTRUCTION .......... /L Oa..0 � � P...... ... .... .. ...
TO THE INSPECTOR OF BUILDINGS:
The undersigned, hereby applies fora permit,according
ato Lthe following information:
Location ....... ... .R...... .... .� r/� ., .` �r�' ...........
1.. �� .. .
Proposed Use ........... .`/. !...:....6' .a...��f......................................................................................
' i .. .
Zoning District .Fire District ....
........ ...................
Name of.Owner ...`. 1/Jy.... ..,.l./'� . . :1 � ...............Address Lp/ � i� lvC /lCa...........
4
p•••C!C • .. .....Address
Name of Builder .. ../ .... ....... .../f 4.....
Nameof Architect .............. ...................................................Address .........................................., ...
Number of Rooms ................./............................................Foundation ..... .... u' C1J ��� if ................,
•
�Q
Roofing /..�..!� . . . .. .........................
Exterior .... .................................................. g
... ....d�... ....... . . .. ..................................... .
��'��........................:.....:.....................Interior ..........�,� .—
Floors ............ ......... ...... ,
/ �1 ` .......................'Plumbing �a
Fireplace ....Approximate Cost ly�a n....
Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ...
..........
A.,.............
Diagram of Lot and Building with Dimensions Fee .......... A ..................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
,
f.t .
y ♦ v
I hereby agree to conform to all the Rules and Regulations of the To of Barnstable regarding the above
construction.
Name ...... ...... .. .. ......�...... ...........
I
Bingham, Henry c
Noi't 239 Permit�.for L.....add to single t y
�.
family.`` dwelling - A
Location Chawaqu`iddik Road
Centerville T. ,• I �, T
Owner ... .......Henry..Bingham... .. .................. r. .. V /ryl� +� {/4y✓� M - '
]• {... .. ' 4/ i!^. •.dam../ jI _J/tYJ ' 4• .. - '
Type of Construction .........frame . ! ,1J /` f� .,/
........ ................ ..... _ .................
=Plot ................
.... Lot ..........*.`....................
T `' 76
Permit Granted .... March 161.............. s .19
•
nDate ofInspection .....
_. . .......'f......;,!........19
Date ,.CompletedWl. 5
PERMIT 'REFUSED,.,-,
........................................ ........ ........ 19 j�.�
... ... .............
.................... ......... .............................Ile
t,~ • J{'/~�' !�L'" n,q, . �.. µ L .� y,
................. ...................................................... •,. X %�
.1 ��• �. may_. ^y y/. � '�" � ,
........................... ................................. ......... yt 71,r. ,+''• ;}' -
If
r h
Approved ......... 19
...............................................................................
J
Ay
61
MUL
1639.
a M BUILDING ' IN..SPECTOR
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
e-Z -AC 44
, �- _Y/(�� k do�(
47
SUBJECT TO APPROVAL OF BOARD OF HEALTH
| hereby agree to conform to all the Rules and Regulations of the Town..of Barnstable regarding the above
construction. ~ .
' Noma .. � —. —. _—__—_—___.,
��^^,v'— — --�'--
�
/~ ° |
_
add to
No ----.— Pennitfor -------.../ng�...l�
fam1lydwe.111ng____'____ ..�. .
'
Location C6appegoid
��"f—' aik..Boad_ __
Centerville
-.-------------------------. .
.
.^
Henry Bingham
. .
Type otConstruction '
'
.
______________
6 Plot
.
. . .
&r��� 6 '
Permit Granted-- ---' — -
'
.~.. of Inspection.
. .
Date Completed
. . . -
. �~~~ . .
. .
...............
`
� / / /�� q
T�l � '� ��.. — — -- --- —..—.----....---.--..,.— --.—Y&.....-----..
�
`
. ,
Approved -----' ---------- lA
-----------------'---------''
'
' . .
-------`----------------~... .
'
��QyOFTHE'TO�y� TOWN OF BARNSTABLE
i BAHBSTADLE, i
"b 9 BUILDING INSPECTOR
C
APPLICATION FOR PERMIT TO ... ...... .. ..........................................................................................................
TYPE OF CONSTRUCTION .....—P :-'",�' ........ ................ ................ ..............................................
. .............. ��........19..
TO THE INSPECTOR OF BUILDINGS:
The undersign hereb applies for a 'pe it accordi g to the following 'nformat'on-
t
/p ..�
Location ................ / .........................
ProposedUse .... .... .. ..... ........................... .........................................................................................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
Nameof Owner ........................................ ....... ..........Address............ ........... . ...................
2
Nameof Builder ... .. . .. . ........ ... ...............................Address ....................................................................................
Nameof Architect ........�.p..................................:....................Address ................. ... ..............................................................
Numberof Ro ...... 7 ................Foundation ............... ... ..........................................................
............................................
' c
Exterior..... ................... . .... - ...............................Roofing ..........S..............
Floors .........................Interior c/ .................................� ..........................
.. .......... !L .................Plumbin ........... .
Heating ........;1...�...... ... g ... ..........................................................
Fireplace ..... ........ ............... !�:...............................Approximate Cost .......y.
. ......................................
°?........... ..................
Difinitive Plan Approved by Planning Board ________________________________19________ . / 1
Diagram of Lot and Building with Dimensions 1160
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a.
a.
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hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the a
construction.
Name ......... .. .... ...........:a...........
Small, Alan E.
DEC 3 1 1970
No ...131.9.. Permit for .......,one story....,_.
single family dwelling
......✓..UU...............................................................
Locotion-1A...�? n� iddick Road
.............................
Centerville 1
............................................................................... }
i
Owner ........Alan E. Small
..........................................................
Type of Construction frame
..................
........................
................................................................................
Plot ............................ Lot .......#.6....................
COY June 26
Permit Granted '70
Date of Inspection
Date Completed ......................................19
PERMIT REFUSED
................................................................ 19
...............................................................................
...............................................................................
...............................................................................
e _
Approved ................................................ 19
...............................................................................
...............................................................................