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HomeMy WebLinkAbout0062 COTTONWOOD LANE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O Application# 037( Health Division Conservation Division Permit# Tax Collector Date Issued i 1 � Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 6K rl/23/oF-r Historic-OKH Preservation/Hyannis ((fJ Project Street Address b ;L 0,077 D 1JDad6 1-4-NE Village 6� Ja/LL n Owner �f�'ie- /�1'i CrD K/ Address S07Y%� Telephone 6-D 80'— -7-2 —,5,P 7 Permit Request o2 D X.-_'Z / r::::�4 � &&Y Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, att supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#u Age of Existing Structure Historic House: ❑ s ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Othe 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 bat :existing new First Floor Room Count Heat Type and Fuel: ❑G ❑Oil ❑Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coaEsstove: ❑�es :�]No Detached garage- existing ❑new size Pool:❑existing ❑new size Barn:❑existi ig ❑ngyu size Attached g ge:❑existing ❑new size Shed:❑existing ❑new size Other: Zoni Board of Appeals Authorization ❑ Appeal# Recorded❑ C mmercial -❑Yes ❑-No If yes,"site plan review# Current Use Proposed Use BUILDER INFORMATION Name�i� .1V ry�Lg, /�C Telephone Number 1>� Address �•Q► 3Dx—l 3VP License# HkIjiSl2 AS 0 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO )O)A---- SIGNATURE DATE !—/,0 D8 z FOR OFFICIAL USE ONLY `PERMIT NO. + DATE ISSUED MAP/PARCEL NO. " ADDRESS VILLAGE OWNER DATE OF INSPECTION: ; FOUNDATION FRAME INSULATION it I' FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL ' r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' y ASSOCIATION PLAN NO. r r. f The CaMxnorlweefth of- assachitseft a! �' Departtt nt of Indus&WAccidents _ ; Orwe of Irtvesttgatiorts `L• 600 Washy rrgten street. H a Boston,M4 02111 H'.w+.trtas.-gov`dia Workers' Compensation Insurance A vit:BuMerVCoimtractors/ElectriciamMumbers A_p®licant Information Please Print Leziblv Name(Businessiorganizatiori,Individual). T Address:_ City/State/Zip: t _ Phan#: Wi `J_/ A reyou an employer?Check the appropriate boa: Type of project(re l am a employer with 4. 1 am a general contractor and I employees(ful and/or part-time).* have hired the stab-contractor*; 6 Q I�iew constrtacti I am a sole proprietor or partner- listed on the attached sheet.a 7- Remodeling ship and have no employees These sub-corMacto€s have 8- 0 Demolition working for me in any capacity. _ workers'comp.inmuunce. [No workers'comp. insurance 5. j_( We area � ©Building addition IO corporation and its � .Q Electrical repairs or additions officers have exercised their 3. required.][] I am a homeowner doing all work right of exemption per MGL 11.11 Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no !2. Roof repairs insurance required.); employees. (No workers' comp.insurance require&] r 13. erg' J'd *Any applicant That che:ks box it! must also fait our the section below sbo f wing their worker-*compensation policy irtfogrrtation. Homcownm who submit this affidavit indicating they are doing all work and tbm hire outside Mars trust submit a am affidavit itrdatair3g sucat_ *Contractors that check this box must attacked an additional sheet shoFaing the name ofthe sub-co�ors and their workers'comp.policy information_ l am an envloyer that is pmW ng work Co on insurawe for my enp&reex Below is the inforawdon' p Ficy and ob ske Insurance Company Name: �� _ r Policy#or Self.-ins.tic.#:_ �-�� `(f`7 � �?�, Expiration Date: Job Site Address:_ D (� ,gy p _ Cit istateiZip- Attach a copy of the workers'compensation pokey declaration � (showing the poky number and epars date}. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the itil fine up to$1,500.00 and/or one-year imprisonment,as well as"civil position of eritniiral pollees of a of u to$250.00 a da • penalties�the form of a STOP�tQILI{ORDER ar�c1 a fine P y against the violator. Be advised that a ropy of this statement may be forwarded to the Office of Investigations of the DI.A for insurance coverage verification. d do hereby certify under the pains and penalfies 00erltrry&at the MOMMUOn prmv&d above w&ue and co ffea Si e: Date: 7 Phone#: ��— — ! OfJaeW use only. Do not write in this area to be ronrpletedky city orilown oiCeiat City or Town- Permlitli.ic e# Inning Authority(circle one): 1. Board of Health 2.Building went 3.Cityft`owe Clerk 4. l Igor 5.PlairnStas� r b.Other Contact Perm: #. C1!!1riI/-UCIO 7: AcaRU CERTIFICATE OF LIABILITY INSURANCE OP1D nG DATE(MM1DDrYYYY) ANORT-2 07 XO O8 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Berry Xn,eurancea Agency HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Franklin MA 02038 Phone: 800-824-5201 Fax:508-520-6914 INSURERS AFFORDING COVERAGE - NA1C0 INSURED INSURER A: at aani sire F Msrlm■ inn. Co. INSURERB., One Beacon XAs _ AmeriCan Tent & Table, 11RC. INSURER0: Allen Sylvester P.O. Box 1349 INSURER D: Marstons Mills KA 02649 tNsuRER E, COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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, _ OR PSR TYPE OF INSURANCE POLICY NUMBER DATE MM(DO ATE MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE _ 31,000,000 A S COMMERCLAL GENERAL LIABILITY CK00220040 01/21/08 01/21/09 PREMISES aeewrence ^ $100,000 CLAIMS MADE ®OCCUR MED EXF(Any one per„pn) $ 5,0 0 0. PERSONAL&ADV INJURY $1,0 0 0,O O O GENERAL AGGREGATE $2,0 0 0.0 0 0 GEN'L AGGREGATE LIMIT APPLIES PEII_ PRODUCTS-COMP/OP AGG $1,0 0 0,0 0 O POLICY jE� D LOC AUTOMOBILE LJAEILITY COMBINED SINGLE LIMIT B ANY AUTO PRIBOR133 01/21/08 01/21/09 (Eaaee,d-1) $$1,Ooo,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per pt man) $ HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (P9r ACtldenl) $ PROPERTY DAMAGE $ (PN. aeddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S —H EXCESSM III%MLA LIAIMLITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND TORY LIMITS ERA _ A EVIPLOYERS'UABILJTY ZK85919Y97S08 01/21/08 01/21/09 E,L,EACHACCIDENT $100,000 ANY PROPRIETORIPARTNERIEXECUTNE - OFFICER/MEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYE $10 0,0 0 0 rc yea deambe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $5 0 0,0 0 0 OTHER A Equipment Floater CX00220040 01/22/08 01/21/09 Limit $450,000 Deduct. $2,500 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations usual to equipment rental CERTIFICATE HOLDER CANCE"TION MARTEA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Martha Golenski IMPOSE NO 02UGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 62 Cottonwood Lane REPRESENTATNES. Centerville NA, 02632 AUTHORI nFPRE ENTATIVE ACORD 26(2001/08) O ACORD CORPORATION 1988 3 :?�.P ;�`;" '' �. �' a IV ELO'ertif i rate ofjr1ame VA"5t nce01 } Data treated or 1 T REGISTERED ISSUED BY: manufactured 1 APPLICATION AZTEC TENTS$EVENTS Cal � CONCERN NO. 490 ALASKA AVENUE & r TORRANCE,CA 90503 CAL COMB F419.01 (310)328-5060 This is to certify that the materials described below hereof have been flame retardant treated(or are inher- ently nonflammable). mi x FOR AMERICAN'TENT&TABLE ADDRESS- 381 OLD-F.ALMOUT.H ROAD.,_STE 41 ' CITY MARSTONS MILLS STATE MA.62648 _ « „ .� :, :. Certrficadon is hereby made that: (check a or b ) '.. (a) The articles described below this certificate have been treated with a flame retardant chemical approved ti and registered by the State Fire Marshal and that the applicationof said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal." Name of chemical used Chem.Reg.No. Meathod of application 4j f " (b) The articles described below hereof are made from a flame-resistant fabric or material registered and s approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701-96. I ` _ Trade name of flame-resistant fabric or material used..Coated Fatrrrc _ Reg.No....................... � The Flame Retardant Process Used .WILL NOT Be Removed by Washing.... , (will or will not) David Bradley Chuck Miller_-...President_ � `._.� Name of Applicator or Production Superintenderd Td1e ��f CUSTOMER.ORDER NO. 0134713 - R134713 ITEMS MANUFACTURED: 2- 10 X 10 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 2- 10 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2- 15 X 15 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3-20 X 20 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, ti 3-20 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2.-30 X 30 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3-30 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE. Town of Barnstable • anxrisrnsi.E, • $ Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,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 Go as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for Tr (Address of Job) Signature of Owner D to Nnt Name Q:\WPHLESTORMS\building permit forms EXPRESS.doc Revise020108 T Town of Barnstable �tMME �. Regulatory Services syszwsM Thomas F.Geiler,Director Building Division ArFD AMY A Tom Perry,Building Commissioner 200 Main Street;"Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelliMsrs of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a liomeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 1 The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. _ Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly' when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 9 Maya A5,_A, Parcel W H OO Permit# Health Division UA�5 OZ L_—) 36 Date Issued " ° «®�- Conservation Division Application Fee A_J Tax Collector Permit Fee e—P Treasurer kS_7. 7 E� EWST r E r T , ( ;6`F&24!_L7D IM �OIt4�LIANC Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AIND Historic-OKH Preservation/Hyannis TOWN' REGULATIONS Project Street Address b CDTTUN wood Lid Village ID`f'w�LL6 Owner HAIL MA L GOLON S L Address b). U TT d N POP bo) CffIJ i� V I Telephone Permit Request IZ EANIV Kouot 0 �-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type CD Lot Size Grandfathered: O Yes ❑No If yes, attach supporting documentation. I_ f Dwelling Type: Single Family M Two Family ❑ Multi-Family(#units) f �` Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Higwiay: ❑Ye"s Q EV b Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other r `2 10 rn Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing o 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: 19 Gas O Oil ❑Electric ❑Other Central Air: ❑Yes Cl No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:O existing ❑new size Attached garage:O existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes O No If yes,site plan review# — -- Current Use Proposed Use BUILDER INFORMATION 0 Name_ HakAk C • bD W-Q� ITT Telephone Number S05— T79— gDX-f Address b CO M W W OOd License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE -7 I sr U FOR OFFICIAL USE ONLY � s PEk&lIT NO. DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER l DATE OF INSPECTION: ' I FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL'; FINAL BUILDING ' DATE'CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts i Department of Industrial Accidents ?NCO Of 1,70MOOffORS 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name µA72ZThA Lt • �� �•L location: b LdfT`f m ci 66P-176 hone#c7 6$ 7��V g• - I am a homeowner performing all work myself. ❑ I am a sole r n,, or and have no one workin in c acity % % % /%%%% % an em 1 er.. rovidin workers' compensation for my employees working•on this job..Y.: :?;i;:-i:.;•:::::::r:rr::::r:.,••.,,,;•,,,,•:•.,,.+.:•:•,:;:..{.;{{•, ' I am P oy P ?is y%;{r'%:v ti::S i'•:i:5';: :?:ii::+:i;: v:yii::,:; :?;:'::;i::?:iii:i:>±t:ii i:i%?:i:S: i:'::�::{:;i%iii::;i>!}ii:`i:;:yF,i:;:;:::>%::ni:j::::::;::;;: j�,::>;}:;%:.::::�:;%y. 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Failure to secure covers;e as requited ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a 8ne up to S1,500.00 and/or one years'imprisonment as well as civrl penalties in the form of a STOP wORK ORD R and a fine of 5100.00 a day against me I m►derstand"t a copy of this statement may be forwarded to the Office of Investigations of the DlA for coverage verification. I do hereby certifyunderfhepains andpenalties-of-perjury th�the-information pr-avided above is trus and Signature Date Print name C 66(a [ Phone# .h(��i' Z SUS official use only do not write in this area to be completed by city or town official city or town: 'permit/license# OBuilding Department ❑Licensing Board ❑checkif irnmediate response is required ❑Selectmen's Office OHealth Department contact person: phone#; —OOther (revised 9195 P7A) 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 pqptract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation orpther 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 M' 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 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 Jndustrial 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".o �if you are regnired,fo"666 .a workeis' compensation policy,please call`tlie Departaieirt at the numlierlisted below:. City or.Towns " Please be sure that the affidavit is complete and printed legibly. The Depar meat has provided a space at the bottom of"t$e affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please.. ...... y._...—...+•Tv �..-__.sue.....Y...--.�.-.......i. ... ....�. _.. .. be sure to fill in the.Penn cease number which willbe used, a reference number. Tlie affidavits may lie're t the Department tiy'maiF 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 an)� stions. . please do not hesitate to give us a call. The Department's address,telephone and fax number: The'Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727A7749 phone#: (617) 727-4900 eat. 406, 409 or 375 N m Lij • Resistance ISSUED BY REGISTERED Date o1.ManulacMe APPLICATION ANCHOR INDUSTRIES INC. 31t)4l'4'7 NUMBER EVANSVILLE,INDIANA 47711 prdes Number MANUFACTURERS OF THE FINISHED =F121.4 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been fiame-retardant treated (or are inherently noninflammable) and were supplied to: UNDERCOVER TENTS H 8() MID TECH DR UNIT 3 12_ WEST YARMOUTH MA 02673 Certification is hereby made that: The articles described on this Certificate have been treated with aflame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code, equal to or exceeds NFPA 701, CPAI 84, ULC 109 t he Ffl chemical The method o t application Is: Serial : 8108800 (0001) Cr Description of dem certified: CD CENTURY MATE 20W X 40 VL W W ©CD - CID Flame Retardant Process Used Will Not Be Removed By L {Hashing And Is Effective For The Life Of The Fabric m o a, -- Signed: , m -- • -- ---- _ --do -- e TENT 1`hACNfi:ANCH0_A INIOUSTRIES NC. .. m fi CV I CO i . 4 I ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, cul Parcel fo 6 14 00 Permit# y Health Division 7 U - d Date Issued ;7,cr- Conservation Division f'�-�i �� Application Fee Ar Tax Collector �.g � Permit Fee. ��� Treasurer ,e -7�.��yV t :'YTfb%lT iNSTALL�13 IN C0r0,PLIM,,r Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE At,,' Historic-OKH Preservation/Hyannis 101YIN REQ U'LAT10,t Project Street Address 6O l l oN tOOD Village Owner Address Telephone D 5 Permit Request T-D R67ftjq e,6 0150,K 1 , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District h Flood Plain Groundwater Overlay Project Valuation oL 000• Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) pp Age of Existing Structure R _ Historic House: ❑Yes ❑No On Old King's Highulay: ❑des No Basement Type: dFull ❑Crawl ❑Walkout ❑Other r Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) <1 ! G: Number of Baths: Full: existing new Half: existing o newo J? Number of Bedrooms: existing new CD r— Total Room Count(not including baths): existing new First Floor Room Co nt w rn Heat Type and Fuel: VGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes VNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes eNo Detached garage:❑existing ❑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 E(No If yes, site plan review# _ Current Use _ Proposed Use _ BUILDER INFORMATION Name I �(�12Th/� - rjt) Lr;�5t t Telephone Number Address �A UT TO k) U QQ� Lk License# rJE50TFJ WfUr.V H& 0 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE - I s-I Oct, FOR OFFICIAL USE ONLY PERMIT NO. r DATE ISSUED - - M'AP/PARCEL NO. ADDRESS` VILLAGE • ' OWNER DATE OF INSPECTION: - FOUNDATION 7 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r r DATE CLOSED OUT ASSOCIATION PLAN_ NO. r r pfIHfTp���,y „fY The Town of Barnstable '• BARNSTABLE, - Department of Health Safety and Environmental Services 9 MASS. 0 t639. �0 °IFOMAy Building Division 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: G 1. �/� 1 Map/Parcel: �- Z-- a Q Project Address: GcI `C)" j) j Builder: i The following items were noted on reviewing: t mr n?D S OIF t S7T ( IF LC-J'l O n un V��/J' +� S t3 c 4A %IC ^ OU dldU t,oL' u rvt rGCed C41 f lid 1. Y Reviewed by: �► Date: 6a, q:building:forms:review _—_ ;. 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I understand that a- copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. Tdohereby-certifyu thepains and-p/e�nalties-of-perjury the the-information-pr-o-sided-above_is�srue_ta-it. correct A�/V7�t/ l� 1.Y�.,. Date __F_o_�'Do� Signature .. :,•. d Print name (}(2T�'1P 1q p}ione#�0 official use only do not write in this area to be completed by city or town official permit/license# C3Bunding Department city or town: OLicensing Board ❑Selectmen's Office ❑checkif immediate response is required ❑HealthDepartment contact person: phone#; Onued 9195 PIA) 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 b g 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 ar renewal a of a license or permit to operate a business or to construct buildings in the commonwealth for any pplicant 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 perfonuance 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 Depart nent.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 7 he,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`haw".oi_�fyou �. . are required,to obtain a workers' compensation policy,please c. the Department at the number listed below:. City or,Towns ted legibly. The Department has provided a space at the bottom of tie Please be sure that the affidavit is complete and prin affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple�se+ �.... be sure to fill in the.permttthcense number which willbe used as a referencb:number. Tlie:affidavits may�i'e'rurned to the Department by mail:of 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 number: The Commonwealth Of Massachusetts Department of Industrial Accidents _ Me of Investigatlons 600 Washington Street _•, Boston,Ma. 02111 fax#: (617) 727 n7749 ` .' phone#: (617) 727-4960 ezt. 406, 409 or 375 °FZHE l° Town of Barnstable Regulatory Services BAMSTABLE. " Thomas F.Geiler,Director 9 MASS. g �A 1639. �0 a 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. Ji Type of Work: WLA69 Wood Mr, Estimated Cost 4000 Address of Work: bi, 60T Otj t000C /+ Owner's Name: HPtand t Date of Application: 7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑ uilding not owner-occupied [V]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. 9 ..d OR , Date Owner's Name Q:forms:homeaffidav The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: I I I D JOB LOCATION: number street village "HOMEOWNER': MA-yhA C - g g- name !'home phone# work phone# CURRENT MAILING ADDRESS: P D 8 o K L� ifftN46 PoAr city/town state zip code The current exemption for"homeowners"was extended to include owner-occuied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures d requirements. �'� �&, c Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often.results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit, application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN 9 r CZ r� a , ac ARDA. y tee,T a CE.�T f'1.A� - .L o OCQ •vvNATio r�oyaJT �/�c CE.2r��y TN�tr THE - jf�OWit/iyEr'.2EGu�CGiMf�LY-x k�%�Y Sc�_�E �.r�o OATS "N� /�N0 AAAC- SETB.4Ck iEglvi eEMENf'�' o 7,VC 712�W✓41- 714' c/, ryE %� P�/�! _ G :G� 20-Z 3I ATE• OT BASEO aN i(/ .e�6/STE•�E� .C.��O SveYSy-vr� rAb�ls �,c.4Ao'Af ot/ �1/.3'T.�!/M,Eic/�''S�/•Q'✓�y � THE QSr"F21i�/.pC�.C�6' �'�lf�SS• P�`31 /I@W1/4 ' t 16'-0" s HOUSE WALL _ z - � I • Im 2x6 WOOD RAILING DECKING I, CM q EL DN— co DKI / / / CONCRETE `t PAVERS(IF REQUIRED) ;€ RAILING EL STAIR QUANTITY --1— BASED ON SITE CONDITIONS F 4'4" 8'-0" 4'-0' V S6& 4 , I www.homedepot.-com 11 w;� .JUL-05-2002 01 : 16 PM TREK C.r_.rvoralion 508 771 9504 P. 02 r� �+ LA Elevations OF RAILINGTOP r*' O I � 11 + TOP OeDECK cr C V AT ®� SIAS CUANTIIN � FRONT GL _��—��� �� CONO MON,TE i E 1 II r_2XTOP RAIL aXMAXLSPACR g N f 2XE UPPER I ACK1 RAIL li 11 " ' I II 11 II 1i11 It i1 tt If I�1 I �,i �� . 77-"�"'� iwt Il f III 11 II f1 ll 4 i1I1111III I' I I � IN I111111'.f1h1!HIIII ItI I III _ _ _ FIGHT ELEVATION 2 1 04 RAILING POST EFT ELEVATION �,, www Drwem11--S j d1t.c�r� ' Assessor's ma .and`lot' number'` �6 r ` ,f%! - p f ... ...... ......�.. � �.. j I E tp� Sewage Permit-:number .....1�:....................... lG !!1� �, �j� ABB TAB E �.............................. 'Q--! it i-a ' NAB 9 L •Z B IOUSe number :....................: 9pp 163 `e0o' TOWN OF , BARNSTABLE BUILDING INSPECTOR S/�JC)LO ��/YJrL� /f0 W C= APPLICATION FOR PERMIT TO ..................,............................., ......................................................................... TYPE OF CONSTRUCTION .....4 u 0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ ......... GTTort1 ulOP�i �lr9�P....... ��-vTPivrG ................................................ .......................................................................... ProposedUse .... /.v./a��............i.......7i �/............rJr� ............................................................................................... Zoning District .... �...�........... ....................Fire District ..C.. !!fir" -� Name of Owner !9U e� �e Tl FAddress .... � �"1 G' [�FUTa�/�r� /mil ..............................V...... ........ �...................... ..................................... Nameof Builder .............:......................................................Address .................................................................................... Nameof Architect .................................................................Address .................................................................................... Number of Rooms �' .Y...............................................Foundation O �!e,.P�......�..... .............. ............... ................................. Exterior ......... , ... s........................Roofing ...... .......... 7` •SfI 5D Floors O e i(... /N 9.............................Interior .... / Gt/� C { Heatingfib .� ....................Plumbing ......a —' .... ........................................................................ 1 Fireplace " �( .. 8�0(..... .............................Approximate. Cost 6 ae Q�G ........................................ .................................................................... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area . i.yOO S� Diagram of Lot and Building with Dimensions Fee77 SUBJECT TO APPROVAL OF BOARD OF HEALTH /57S 2P l >49� 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. j Name .:... ...................... Construction Supervisor's License ....................................�`� DAVID BUILDING TRUST A=252-168 No ...26310... Permit for .... ne Story........_... Single Family Dwelling ............................................................................... Location ...Lnt..1.7.7.,...62 Cottonwood.Lane, Centerville ............................................................................... David Buildin Trust Zc52 `I( Owner ..................................rame......................... + Type of Construction .......................................... �4 c)� ................................................................................ Plot ............................ Lot ................................ Permit Granted .,,.April 17, 19 84 Date of Inspection ....................................19 Date Completed ......................................19 s TOWN OF BARNSTABLE Permit No. ___ o Building Inspector Cash - — °o +ego. 2P / YRY► OCCUPANCY PERMIT Bond -----------_..... Issued to id Building; ,L Address lot #177 62 Cottonwood Lane, Centerville Wiring Inspector f,; Inspection date Plumbing Inspector , r� _mod Inspection date Gas Inspector may) j/� Inspection date r. Engineering Department '✓�U,J Inspection date (� f Board of Health ,% f/` 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. I ......................................................1 19.......... .............._................................................................................................ Building Inspector FROM TOWN_OF BARNSTABLE, W. `Franci Iahte ne' BUILDING DEPARTMENT Ry�-�,. �7.'�h,,,, - .-0.�.:.� .:�w' '.*--t-367 MAIN STREET N�YANNiS MA 02MI - 'x+`w r r.,r,*s:..�F:�.,.,o rsw rir•r'+s,¢,:o�tlr Phone: 776-1120 SU13JECT: FOLD HERE DATE - . .June 28, B84 MESSAGE Ty"����? }`}mac �/"�p�p,}_��.'.. ���pa���} ��(!���yy� �y�{� }a�^{p`� '/may (David �'{'��[yam��� ^�•�`�Q Y - ork bas b iwii Y �'4�+a.^li �iin/4PG.i�,gi t.#2631V (Dav d�BuiJdincr Please release Band. SIGNED _ �j •��.� S.a=�.�.""�' DATE R E P'L,Y I Lp( 1 r SIGNED Ne7.Rml RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY t _ - • PRINTED IN.U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE-AND PINK COPIES WITH CARBON INTACT. « 31 } ...a- O ,+ 6 . l v RICHARO BARTER v Na VGMO, 4rfo suit'?��-s. t� s LLS T/,'=Yti THAT Ti/E. �;04 D14 T7O,J f•/ow"v leg4-12- r•-,yE ,�2E41�/r2EMENTS OF 7,449 Tot�t�it/� , tS ARAJ5TA BLS .4,vc�./s A/Or" C-•r-�r" t ° LA/ . I OA TE• .;. Tf✓/S �.C.4.�//S �(/oT BAS�"O D.�/ �/ .2EG/STE•2E1� L•�1�/� SU�Y6yt�r� 7-y� asr.E,2�ic.t� Moss: ; Q,�FvrET.�'..��ob✓�1/.S vc� �/oT' ®� _ APP4/C�i✓7" -DAVIl.-D >A U(ZU Assessor's map`and lot number'_: .V!`P�.. .. fj'. .., {�D�/,G(Gf� s i cMel *THE t0� Sewage Permit number ........ .................. S 9TADL House number ........:...... ......:: .. .::. ................... :=^� • oB �� ♦HB OM MABa h� �a r- 11C 'OWN OF BA R;NSTABLE IN i.�LLE J COS ENNAR BUILDING INSPECTOR towt ¢ APPLICATION FOR PERMIT TO :..... �.c�r. ' � '��.................. ..................... ................................................. TYPE'OF CONSTRUCTION. GlJO� _rry'•� , .. .... .......................................................... , ...��4 G f'�.... �j.... .....19.. .�� TO THE INSPECTOR OF BUILDINGS: 47 The undersigned hereby applies for a permit;-accord ing to the foltowing information: Location ........ E..�2 7......... 1 c !'�r�'r,J • d ....:�. - .. ... .................................................. Proposed Use 'IY7� Zoning District ..::..Fire District �• ..0S7................ ..... .........'ti=S,�,'9. ......... Name of Owner .��/.!9G!��7 .... f1fC Q�i .....`l�r.S ddress �O...../�...............��� ..... ..?.......�..J..� A Nameof Builder .......................:............................................Address ................'............................................ Nameof Architect ..................................................................Address ...........:....................................... ............................... Numberof Rooms ................... ..............................................Foundation ... ....................................................... ' Exierior ......... ..` ' !�%+�!?5........................Roofing ...... <.:`J ................................-Z/.... i( �i �........................ Interior ✓ ..........................:... ..... .... Floors / .... .. .� `Heating ....... /......� s!......5.....................Plumbing .............................ohs :... ... I Fireplace /�, J c�s'yCOI' .................Approximate. Cost ....!?QQ( .............. .................................................. .. Definitive Plan Approved by Planning Board ___________________-___1.9:_______• Area 2� ....`.: ....:......:: Diagram of Lot and Building with Dimensions Fee ..�I........ .... SUBJECT TO APPROVAL OF BOARD OF HEALTH6N,�. 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 �............. ...... .......... ...................... - Construction Supervisor's_,License :...:�.:...... .............. BUILDING TRUST .,; 26310 One Story, t ?` No . .. Permit for ..... ' Single.Family Dwelling.: Location ..,..Lot 177,•• 62 Cottonwood Lane Centerville ..... ............ David BuildinA t Trus Owner ................................ ........... .. ? ! w~ . . t rame - rr .. • Type .of Construction ...F................... .... _ f � ............................... .............................................. Plot ... ............. Lot ............................... Permit Granted1?r ]...1.7.... .. 19 84 Date of;Inspection "...:.19 Datet Co plete 4 . ............Z .....'19 sly loor r/{•�' a r. '. # t �� ti