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r' r) Map' 0 (® ~- Parcel 1 Z Permit#
_Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00) '.D 6 WYA Date Issued 96
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) l ee
Engineering Dept.(3rd floor) House# :R S SEPTI r.
1NSTA iw.(JST.3E
P ) -
19 JENi/iEgL9�6 :
TO
LATL
TOWN OF BARNSTABLE
Buildin Permit Application
Proje Str et dress e (.,-0•� ��-
Village
.'Owner ;- Address
,Telepho~ ' / "32 - c'g ry / ca/9»2
Permit Request L/ =r�� ,� 2eku/)Ve KiR��r
�F id,i' ti Q ' e �YIet.V fL rL J x 7e )A#'7' 4 o/
First Floor square feet
Second Floor square feet
Estimated Project Cost $ 2!7S0'
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential ;O
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing StructuredLyIyO Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air �� Fireplaces :.
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
i Ber Information
Name / �i�1�� L` sj efe, , Telephone Number.� � e p
Address :V/ 4J-a Toy'7- /to*-d License# 0/6410
Lt,41 1 l e . k` we.-S owe/ r Home Improvement Contractor#
Worker's Compensation#I
C j 3 7!
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
SIGE DATE
BUI ING P ENIED FOR THEEALLOWING REASON(S)
FOR OFFICIAL USE ONLY
PE MIT NO.
D ISSUED
MAP/PARCEL NO.
.i
ADDRESS a `i VILLAGE / c
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME _
INSULATION — ~
FIREPLACE' —
,
ELECTRICAL: ROUGH FINAL `
PLUMBING: ROUGH FINAL '
GAS: - =ROUGH FINAL
FINAL BUILDING—� r,
DATE CLOSED OUT. r {
ASSOCIATION PLAN NO.
M �Or sR
1 .
a � r
tiA N�� �-
N
Boa
1•
1�IL0 7-P-7 Zry D0V's iYar r- I C tv/77�t/
CERTIFIED PLOT PLAN
{d7��,�.Z•`O/Y)MUNiTY_Pf}NGxL /�J D. 2S'Op4/ _`
LOCAT10tV C2�/�riZ�k! y,Ctn ? s!
:�i41t��GvE1U/�G Gv�4l J�/ �xisrGN�r On/ 71
SCALE _ .� °� . . OATE ..� ZO.l .
�TL?'D1�1�Do1o• vF�za ,��• y ,� PLAN
'�w,.� o� $r4✓1.r+�sr�a BLS. BA�.�s�g��,!s'I�4'SS•�o211�c1�4f1D c.�SAuy�-
p�,SS�}-s�4cE IAM sparNz,/973 �'Sr
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- . . �`��or r,� s��Pl-4�!B?�:Z7o fir.d���.�✓g3,f��f�:�
zy N t CERTIFY THAT THE EXj�Y!NC��cyEZLiIG. . .
'1! LES41F `:+ SHOWN ON THIS PLAN 1S LOCATED ON THE GROUND
. . o E AS SHCwtt HEREON
•-
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�IONERS REG. PRCPESS1CNAL LAND SURVEfOR Rr
�r �r
i
ZXS o.JT'o Movse-
r ti I
! I
i I
I
•
I i �X SST �T p e.c
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- �� AIL.� � �O �r' �e wT<-•c_✓i/l e
J
.� es
mstable
. ; The Town of Ba
'ems Department of Health Safety and Environmental Sei-vic
Binding Division
367 Main Street,HYanais MA a='
gaiph Crossen
Off ce: 509-790-6=7 Big CM=
F= 50a-775 3344
For office use GWY -
Permit no.__--.
Dau •'
AFFIDAVIT
HOME n"ROVEM A
ENT CONTRACTORI W
SUPPLEMENT TO PERMIT APMCATION
cxio alterations;renovation,repair,modesnimlion,conversion,
MGL"c 142A requires that the"tzconstru n,
improvement..iemomai, demolition. or construction of an addition tom w.� adjacent
am
building containing at least one but not more than four'dwcMng units ons, along with other
to such residence or building be done by registered contractors.with certain c=pa
rcqWr=cn 4'
Type of want: Fst. CosOA
eZ
Address of worts:
O 6mcr.Name: /
Date ofpermit Application: �D �(�
I hereb<certify that:
Registration is not required for the follming r=son(s):
Work cmduded by law
JJob under SI,000
Building not ow=-oocupied
Owner pulling own pc=it
Notice is hereby gnu that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING DO NEE 'HAVE ACCESSTp THE
FOR APPLICABLE HOME1MPROVF�Nr ARBITRATION PROGRAM OR GUARANTY FUND UNDER,MGL c I42A
SIGNED UNDER PENALTIES OF PERJURY
I bercby apply for a permit as the owner.
6"
G 6 No.
D
Con name
Date
Regtscratton
OR '
w
Tlrc• Cunrrnr,nH'Caltb of?I tassucltrzsctts
Department of Industrial Accidents
z � i �!� Ofllceolloces�lgal/oas .
60011'ashint lan Street
Bus7nn.A1usa. 02111
�• Workers, Compensation Insurance AMdavit
AF
locntion-
�..�
it ' phone 0 -
1 am a homeowner performing all work myself.
rl I am a sole proprietor and have no one working in any capacity
Al a an employer providing workers' compensation for my employees wotlang on this job.
enmann nntnr `j��L]G��a, � t�fs���� •B.t �� c d` i
address! O 1 l LD &II- t
I f- /VW t�e:'5� Ij W 1 phone 0. 4!5�xf-CMG ' 7
1 am a sole proprietor,general contractor,or homeowner arcle one and have hired the contractors listed below who
the following workers' compensation polices:
COMpInr n
address!
cit phone fh --
inaurnncccn nniiev0 _ y
•-.w .: --- VC/r.Tr+3.. save-=*�-►'S -TrPl.s� .� .y, 3 -• 1�L.��tl16I
nm onv na e•
in phone#*. -
ia�ur•tn n rn pokey 0
.Attach additional-sheei iCrieeessar, ;;,; �'�"�"' `^"'`"•`' '`.:" :"a'•" ���""
Failure to secure coverage as required under Section:SA of AIGL 152 can lead to the imposition of criminal penalties of s fine up to S1300.00 an,
une 1.Cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine ofS100.00 a day agaiast me. I ttnderstaad th-
copv of this.statement-mad•be forwarded to the 011icc of Investigations of the DIA for eorerage verification.
alas allies of periurr that the infornmrion pnvrided above is trite and cornwL
1 r�o 1�br certifj•under the
Si nature — �F,�.-� G� s�N ate U ffv
Print name „�i one# S—� ��� — 77
eiricial use oniv do not write in this area to be completed by city or town oMcial
city or town: permit4leeme fi rjouildhM Department
13ticeasing Hoard
check if immediate response is required (]Selectmen's Ofltce
Otiesith Department
contact person: nOtber.
Information and Instructions �' '•
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for
eniplrn•ees. As quoted from the "law", an emplimee is defined as every person in the service oi'another under any
contract of hire. express or implied. oral or written.
An emplorcr is defined as an individual. partnership, association. corporation or other legal entity, or any two or n
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
owner of a dweilinL 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 dwellin`;
or on.the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic
MGL chapter 152 section 25 also states that every state or local licensing agene}•shall withhold the issuance or
reneival 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 in coverage required.
Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public Nvork until acceptable evidence of compliance with the insurance requirements of this chaps,
been presented to the contracting authority.
Applicants
� workers* compensation affidavit completer, by checking the box that applies to your situ
ation ar.
Please �. ,i1 in the orl.ers supplying company names. address and phone numbers as ail 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 foe 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 requi
to obtain a workers' compensation policy, please call the Department at the number listed below.
�. .� �. .s,+.w.ss+. ''��. -�w.. -.. ':' :�::.ft ., .....:•�. ..irry •�'.�..�'a;..-r c'•Css•i�'... -
Ciry or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided aspace at the botton
the affidavit for you to full out in the event the Office of Investigations has to contact you regarding the applicant. F
be sure to full in the permit/license number which will be used as a reference number. The affidavits may be returns
the Department by mail or FAX unless other arrangements have been made.
The Office of investications would like to thank you in advance for you cooperation and should you have any quest
please do not hesitate to anve us a call.
;ate: ..:�•
The Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents r
Office of Investigations """
600 Washington Street
Boston,Ma. 02111
fax #: (617) 727-7749
nhnnr #- (617) 727_1.900 est. 406, 409 or 375
. � '` � ✓le -C�omvnzanusea� a�✓l�ac�uael(s'� - .
DEPARTFINT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Hummer: Expires:
Restricted To 00
J
JARES A BUCKLEY
-R ( 381 OLD POST RD ,
WALPOLE, NA 02081
09
aeeaw�M'-7
flON€ MpRo%M CONTRACTOR a(n�
Rt$IStC8�1oo 141D81 *�a rye.
4 Itpe R�IYAiEBttPORAiION
'
uatro
f'..y try x k w t. ..��'a�A���� c� �Ma��L F •'C'�'+p S.'.
BRCKL€Y CONSIRUCTION CO ,:ZINC
Old Post Road
k
,oUMINISTRATt7R` �NelpoloNA 02081 �
#,.
i Commercial Union Insurance Companies
Boston,Massachusetts POLICY SYMBOL CK
• �".' PICS AR WC 5
POLICY NUMBER
INSTALL-MATIC-P C B (96) H56 33 75
PRODUCER CODE ISSUED BY NCCI COMPANY NO.
20-00975 COMMERCIAL UNION INSURANCE COMPANY 14540
INSURED IS CORPORATION REX NUMBER 6A35D0 PREVIOUS POLICY NUMBER C B (95) H563375
1. THE INSURED AND MAILING ADDRESS PRODUCER
FEDERAL I.D. 04-2615412
BUCKLEY CONSTRUCTION CO., INC. DEMPSEY INSURANCE
381 OLD POST ROAD BOX 308
WALPOLE, MA 02081 NORWOOD, MA 02062
Other workplaces not shown above:
2. The policy period is from 06/27/95 to 06/27/96 at 12:01 A.M. at the insured's mailing address.
r 3.A, Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states
listed here: MASS.
3.6. Employers Liability Insurance: Part Two of the policy applies to work'in each state listed in item 3.A.,The,limits of our
liabilty under Part Two are; (
Bodily Injury by Accident $ 100,000 each accident
_. Bodily Injury by Disease $ 100,000 each employee
Bodily Injury by Disease $ 500,000 policy limit
3.C. Other States Insurance: Part Three of the policy applies to ttie states, if any, listed here:
SEE ENDORSEMENT WC200306
4. The premium for.this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans, All
information required below is subject to verification and change by audit.
r - - Premium Basis Rate per .Estimated Premium
NUMBER
CLASSIFICATIONS CODE Total Estimated Remuneration $100 of
ANNUAL 3 YEAR Remuneration ®ANNUAL 3 YEAR .
SEE ATTACHED SCHEDULES
N- 5V
oy F'E ?
S LUEM
Total Estimted Standard Premium
Premium Discount(If Applicable).
Expense Constant MASSACHUSETTS 160
IF INDICATED BELOW,INTERIM ADJUSTMENTS OF PREMIUM SHALL BE DEPOSIT PREMIUM TOTAL ESTIMATED PREMIUM S 7,782.00
MADE:
❑ SEMI- EI QUARTERLY 0 MONTHLY S 7,782.00 Minimum Premium 500.00 MASSACHUSETTS
ANNUALLY
ENDORSEMENTS(FORM NUMBER)
WC000403, G10936-1, GI26520394, G128200295, G12410, WC200301, WC200302, WC200303,
WC200306, WC200401, WC000414, WC200601
SCHEDULES 001
ISSUE DATE ATTACHED TO POLICY JACKET
06/14/95 LVL1 G12200
COUNTERSIGNED,BY: (AUTHORIZED REPRESENTATIVE)
50 0 535 20 INSURED. CMYY Page 1 G28021(11-88)
145 Railroad Avenue P.O. Box 308 Norwood, MA 02062 617-762-0042
Assessor's office(1st Floor): Pao / ' j a C SYSTrPjl PTUST of TWE T
Assessor's map and lot number lD 1 f�4������� �� ��������� � o``.
Sewage
Health(3rd floor): �ylw �� +
� Sewage Permit number a R� q �®W®I®TH�p�wYLqE!
.r MMIRRONMENTAL CODE�, Beaa97ABLL i
Eng�eering Department(3rd floor): rasa
House number 3 FJS TOWN REGULAT@om� °.�'b}9
Definitive Plan Approved by Planning Board 19 C MAY
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location C (�' ✓ Gf S6�ZZ LaT / a)
Proposed Use
Zoning District 12C Fire District CeAqL-7�&-LL-5--O-S' Z ylG6L--
Name of Owner 0 Cz��y 6�/44- Address AI,4_�I) Ji
Name of Builder
SI�i�G• Address s�J9►'1 �!9L
Name of Architect /t/�/�- Address
Number of Rooms y// Foundation N�� � Md,6S- � / S
Exterior � Roofing N�p
Floors N�/ Interior
Heating Plumbing N 4
Fireplace /��/ Approximate Cost 3 BOO
0
Area
Diagram of Lot and Building with Dimensions Fee
147M C h
APPROVED
SaMistablc r- vation Cor.1missiol
igned Date
• 1
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
("Wax,
CASEY, JOHN E.
0329-9 Add Deck
;H No Permit For
Single Family dwelling
•> na
3 Craig Tide Way
Location Y
C1
Centerville
Owner John E. Casey c
y '
Type of Construction Frame �� •L�
v
k
Plot Lot
a
Permit Granted June 21 , 19 R-9
14
Date of Inspection 19
' ��Date Completed 19 _
DA-89040
QP��F TH F
Commonwealth t 2ABIlT'um
of Massachusetts >ov rb o
'EC kal
Determination of Applicability
Massachusetts Wetlands Protection Act, G.L.c. 131, §40
TOWN OF BARNSTABLE BY-LAWS, CH. 3, ARTICLE XXVII
From Town of Barnstable Conservation Commission Issuing Authority
- John E. Casey, Paul H. Casey,
To and Elaine J. Casey Same
(Name of person making request) (Name of property owner)
69 Edgewater Lane
Address Needham, MA. 02192 Address Same
This determination is issued and delivered as follows:
%�X' by hand delivery to person making request on June 7 , 1989
(date)
by certified mail, return receipt requested on (date)
Pursuant to the authority of G.L. c. 131, § 40 and Chap. 3 Article XXVII of the Town of Barnstable By-Laws,
the Barnstable Conservation Commission has considered your request for a Determination of Applicability and
its supporting documentation, and has made the following determination (check whichever is applicable):
This Determination is positive:
1. ❑ The area described below,which includes all/part of the area described in your request,is an Area Subject
to Protection Under the Act.Therefore,any removing,filling,or dredging or altering of that area requires
the filing of a Notice of Intent.
2. ❑ The work described below,which includes all/part of the work described in your request,is within an Area
Subject to Protection Under the Act and will remove, fill, dredge or alter that area.Therefore, said work
requires the filing of a Notice of Intent.
3• ❑ The work described below, which includes all/part of the work described in your request, is within the
Buffer Zone as defined in the regulations, and will alter an Area Subject to Protection Under the Act.
Therefore, said work requires the filing of a Notice of Intent.
MAR I
X FM
III
This Determination is.negative:
1. ❑. The area described in your request_is not an Area Subject to Protection Under the Act: .
2. ❑ The work described in your request is within an Area Subject to Protection Under the Act, but will not
remove,fill,dredge,or alter that area.Therefore, said work does not require the filing of a Notice of Intent
provided that the following conditions are met;
3 The work described in your request is within the Buffer Zone, as defined in the regulations, but will not
alter an Area Subject to Protection Under the Act. Therefore, said work does not require the filing of
a Notice of Intent provided that the following conditions are met;
Re. property located at Assessors Map �206 , Parcel #112
LotnlA Craig-Tide Play, Centerville, !A.
1. ) All wooden portions "of the structure permitted herein
shall be CCA-treated or the equivalent. No creosote
treated materials shall be used.
4. J The area described in your request is Subject to Protection Under the Act, but since the work described
therein meets the requirements for the following exemption, as specified in the Act and the regulations,
no Notice of Intent is required:
Issued by the Town of Barnstable Conservation Commission
Signature(s)
This Determination must be signed by a majority of the Conservation Commission.
On this 7th day of June 19 89 before me
personally appeared Susan L. N i c lc e r s o n , to lne known to be the
person described in,and who executed, the foregoing instrument, and acknowledged that'helshe.executed the same
as his her aot and deed:.
October 28 ,, 1994
N My commission expires
This De
termination does not relieve the applicant from con with all other applicable federal state or local statutes,ordinances by-laws
PP PIY�g PP cr!eg.rlatinns.''['hisDetermination
shall be valid for three years from the date of issuance.
The applicant.the owner,any person aggrieved by this Determination.any owner of land abutting the land upon which the proposed work is to be done,or any ten
residents of the city or town in which such.iand is located.are hereby notified of their right to request the Department of Environmental Quality Engineering to issue
a Superseding Determination of Applicability,providing the requesvis made by certified mail or hand delivery to the DepartXnent within ten days from the date of
issuance of this Determination.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant.
T
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K�F 'gZ�t� fG°°1� Z°"'E• .�zo"'� 'B��> �}s CERTIFIED PLOT PLAN
LOCATION CiG- /1k/�iy,Ci?Viu / sS
SCALE . ./. .n30 . . DATE ..7/.Z tI87
� JZZDr1 �Ds'�fE_ tDaPT10•J�� za✓��✓�.By 7 t�. -. PLAN REFERENCE 4.-PVA,,�eeA49 IA4F-
Tbw,•i o F ,Biq�lL�S7748L�, - $Af?w!-S7�B�ff►!i�1A•SS'�02.lUtfl�Ilp c.�`SAZ[,Y E.
SVjZ��/Co,✓SvcTi¢�TS•2'qC: lti�/gtl�n0��/yi9►
N I CERTIFY THAT THEFrX/.�T./JylC�py/.f.ZL� �r. .
LES E -4 SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
o E AS SHOWN HEREON
{,* 1730 �
r
O� ..`yet . ..y.
PETITIONER MR
y �! f� :rri
REG. PROFESSIONAL LAND SURVEYOR ^ �.
:Y
Assessor's office(1st Floor):
Assessor's map and lot number �oF THE Tod
Board of Health(3rd floor):
Sewage Permit number '3 +
Z BAHd97'ODLL; •
Engineering Department(3rd floor): �o MA IL
House number ' -JS °''�t6}9.a`�'
Definitive Plan Approved by Planning Board 19 rAv
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.onlytr
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TOWN OF BARNSTABLE
BUILDING INSPECTOR
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APPLICATION FOR PERMIT TO C'd/► S°�'j?,�/Gy�I��C�S 25*r Z-/7'+0' /Z&-27/Z G,—#-
TYPE OF CONSTRUCTION bV6147J� /i T '�jQ/,� �✓/I E�S- AZ&-Ml/�
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: P
f
Location ?7
Proposed Use /Z(sS/�JE�yL b6eK
Zoning District Fire District
Name of Owner e*• 6:F7-14t- Address
Name of Builder S/ /G-J Address
Name of Architect /y//� Address
Number of Rooms /V/4 Foundation MI-4 ( 50--VOM 9-S f lens
Exterior N/� Roofing !
Floors Interior
Heating Plumbing ` '
3 S®U
Fireplace Approximate Cos`'
t
Area b
Diagram of Lot and Building with Dimensions Fee
/�Al 14IM 047'97b
.4
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
---Constructien=Supervisor's-L-icens_e
CASEY, JOHN E. A=206-112
No ` 3 2 9 9 8 Permit For ADD DECK
Single Famil)z dwelling
Location 3 Craig Tide Way
Centerville
Owner John E Casey
Type of Construction Frame
Plot Lot
Permit Granted June 21 , 19 to 9
Date of Inspection 19
Date Completed 19
PERMIT COMPLE rED 1/1/=