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'f ,� ti i {..A .r J „A! l 5 F +i { P' .1, N" d.. %c 1 4 ( {fit' ,3 :j 'r, y' .?y c s' w ���-,�." ,��. { �',iY t , r Y ' { � rf iI i H "I e + ° i"' y , ,: �+c 1 "� ( s ti i .+ i� n'" yr c.f "i � k +'i I < - .z - - l lII ,I, ,r , _ rrQ(o�13106� 10 Town of Barnstable *Permit# Expires 6moxth�om issue date y - " • = Regulatory Services Fee » HARNSPABLE, • v M"M•� Thomas F.Geiler,Director s63q.. �� T pTEo MP�a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA�0�0����-��R�I•r Office: 508-862-4038 � J�� Fax: 508-790-6230 0(�NL n� EXPRESS PERMIT APPLICATION - RES��ENTLALY Not Valid without Bed X-Press N OF BARNSTABLE Map/parcel Number A 5 Property Address ❑Residential Value of Work OL T Owner's Name&Address Eta IV, e, S. �)e_u Contractor's Name P Telephone Number q : �" Home Improvement Contractor License#(if applicable) y - Construction Supervisor's License#(if applicable) 6 Lf3 GS C ❑Worlcman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lilm the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit R7e_100R check box) ff(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. o Signature . Q:Forms: mtrg Revised121901 05/25/2006 10:43 7B1-4330930 PRINTSMITH"NEEDHAM PAGE 01/01 nam 25 05 10t40a t508J428-3353 p• i Town,d]Barnstable Regulawry Services 3 sa NMI.ue. � Thomas M.Geiior..Director , .rye._ , °79' �• ]WdingDivision Ton Trs e y Auil ..Co;ntuissleaer 20D R*a Swmt'-I-lytrtras.MA(Y)6. l Offices "50ll-862A033 . Fax: 5-38-790-6230 • Property Or11GZ Must_ Complete-axid Sign This"Section If Using A'Riiilderr; 1. ��y � .-. .- .�.. as('_f f"rhr_,sub'),tCt P 1107�*it7 2 h-rebp and:otlze ��`.. L ixi my3�a�t all rr_2ttecs Xeladvr t0 woa rdto, ed'�p this bailr�in&pcznut aFpli:.ataon gip;;; �r� - , (Add-ess ofjoF;' ail a5' Si antre of Toe. 17ate Q:i0 R Nn.0 tV r4ERPERM(S S10N .. .......... ..... w-j.— . DATE(M MIDD �,.lu•J: 3/21/2006 PRODUCER THIS CERTIFICATE 18-T"s AS A MATTER OF INFORMATION GERMANI INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND.OR908 MAIN STREET ALTER THE , .AFFORDED BY THE POLICIES BELOW. OSTERVILLE,MA- 02655 ...-COMPANIES AFFORDING COVERAGE­ COMPANY A SCOTTSDALEINS.-COMP, INSURED COMPANY PEACOCK&CROSBY BUILDERS INC. AIG P.O BOX 151 ......... OSTERVILLE, MA 02655 COMPANY C. COMPANY FID Own THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW"AV.E.BEEN.iSSUED.TO.THE.INSURED NAMED ABOVE FOR T44E POLICY PEROO INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITFI RESPECT TO WHICH TRIS V 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,.LlMFrS SHOWN MAY HAVE BEEN REDUCEDBY PAID.CLAIMS... co LTR TYPE OF INSURANCE POLICY NUMBER -POLICY-EFFECTIVE POLICY PXPIRANON DATE(MMIDO/YY) DATE(MMIDO") LIMITS _nNl;.:L LIABILITY _NF s _5�lt GENERAL AGGREGATE A B S0012466 -03112/06 03/12/07 A I MMERCtAL GENERAL LIABILITY PRODUCTS COMPIOP AGG 5 CLAIMS MADE OCCUR PERSONAL 6 ADV INJURY 5 OWNER'S 6 CONTRACTOR'S PROT I EACH OCCURRENCE FIRE DAMAGE(Anyone Ike) S MFI)EXP (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE-LfMIT -S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pa,pqrwn) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE. GARAGE LIABILITY AUTO ONLY-EAACCIOENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY R!�11.0CCURRSNCE 6: UMBRELLA FORM AGGREGATE OTHER THAN UMRREUAFORM s WORKER'S COMPENSATION AND WC195,11,40 03112/06 03112/07 T*.c.yfii:;lL"e i EMPLOYERS'LIABILITY EL EACH ACCIDENT .3 X THE PROPRIETOR, INCL EL-DISEASE-POLICY LIMIT Is -500,000" PARTNERSfEXEC TIVE OFFICEROAqE: El EXCL ELDIGEASE-EA EMPLOYEE]S too=.k OTHER DESCRIPTION OF OPr;RATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS SHOULD ANY OF THE ABOVE.DESMOED POLICitt.-Of CANCELLED-BEFORE-THE PEACOCK & CROSBY BUILDERS, INC i EXPIRATIONo DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR.Y0. MAIL .DAYS WRITTEN NOTICE TO THECERTIFICATE HOLDER NAMED TO THE.LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILJTY OF ANY KIND UPON, TMF- POMPAbLY. ITS AGENTS OR REPRESENTATIVES. AUTHOPW REPRESENTATIVJI L Board of BuildinWg Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 131378 Board of Building Regulations and Standards Expiration•.7/13/Y008 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 PEACOCK&CROSBY BUILDERS;INC. SCOTT CROSBY 1112 MAIN STREET UNIT 7 � � � OSTERVILLE,MA 02655 Administrator Not valid without signature -T1 e BOARD OF BUILDING REGULATIONS j License: CONSTRUCTION SUPERVISOR Numb'; 'E� 043556 �11iCt( { ff06 Tr.no: 5008.0 SCOTT E CROS 62 CROSBY CIR OSTERVILLE, MA Commissioner J • - f - - Engigeering Dept. (3rd floor) Map �W4�, Parcel /%c Permit# �G i f House# Date Issu d -�/+�� Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) ')Fee Conservation Office(4th floor)(8:30-9:30/1:00= Planning Dept. (1st floor/School Admin. Bldg.) THE Definitive Plan Approved by Planning Board 19 ; BARNSTABLE. _ MASS TOWN OF BARNSTABLE 7 Building Permit Application Project Street Address 4 .0&Z W :�, Village Owner Address _ G p a Telephone g q0. Permit Request First Floor square feet Second Floor. square feet Construction Type ' Estimated Project Cost $ 1 D• Zoning District Flood Plain Water Protection Lot Size • a 1 Pc Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes To On Old King's Highway ❑Yes Basement Type: ❑Full drawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1?V0 Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing 1j New First Floor Room Count 6 Heat Type and Fuel: A�oFireplaces: Oil ❑Electric ❑Other Central Air ❑Yes Existing _ New Existing wood/coal stove ❑Yes ❑No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) Al a ❑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. Telephone Number Address (`o License# ®21 Home Improvement Contractor# f O Worker's Compensation# _6o /J V,6 003 K 91 �795'_ 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 SIGNATURE DATE _3-j 0-q,-? BUILDING PERMIT DENIED FOR THE FOLLOWING REASON _ 4 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED _ t MAP/PARCEL NO. ADDRESS VILLAGE OWNER _ Lam, DATE OF INSPECTION: FOUNDATION , ' FRAME INSULATION _ FIREPLACE ELECTRICAL:' ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,t DATE CLOSED OUT ASSOCIATION PLAN NO. i ZFIE , . The Town of Barnstable • WANSrneze. - 9�A6 - Department of Health Safety and Environmental Services rEDMA'�� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. (/(/y,, �i�� Est. Cost Type of Work: —T Address of Work: AV) Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. 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 a ply for a permit as the agent of the owner: Date Contractor Name Registration No. OR .Date Owner's Name � s r i r � �✓Re ,z' p �t ADMIN }e � b ✓/LC U/09J7/I)tG�Y��%P�GLiL O��i 1��<24L'k2:( Restricted To: 00 j DEPARTMENT OF PUBLIC SAFETY 83188 CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: _ Expires: 1G - 1 & 2 Family Homes Restricted To --'A@ Failure to possess a current edition of the c �v§ Massachusetts State Building Code r t d :SC OTT.B CROSBY is cause for revocation of this license. 62 CROSBY CIR OSTERVILLE, MA 02655 - ... .. _ .-.,. •- _. ....w...._..-...._ _ .«.u...,....... _ .... _ .,,.'°_'�>^�.�:r�,z;F,+t t^r..,�,�.:�, �s�"r_„.: ._.,_.,�..,..t� .�._..._..___.._ " _..:'",v'°e`_"y".w...:.`-_.:.:.'--.,.�.f. w The Conitnottwealth of Massachusetts ►r -�'`--_`=�;_.- Department of Indttstrial.4ccidents ly l ` office of10114 19211ons •�\� ';" :r `'` 600 J1'ashhi ton Street Bostott.Ma.u. 02111 Workers' Compensation Insurance Affidavit m • - r locati n• c•tv nhone 0 I am a homeowner performing all wort:mvself. I am a sole proprietor and have no one working in any capacity • . vP-• - �'.7Mv1..� +A1[1�51+�.�.w^`IA'+.e.�.'`7Tp�w.+Mw�T7r'.Arw�w.�.�.n'�Y.'mow-..�fw.Mw..w._-.HwM^r.._.._....:. [j I am an employer providing workers compensation for my emplovees working on this job. con tam• name: address• city: nhone0: h`'� 61 ' a4 ist' tF 3 4 insurance co. plies•# [I I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: cmmnan• name* atltiress• cifv: nhnne#: insurance rn ]tnlicv# � - . •1 r:•+.. Y•" - `.:Y...::'�r•- -� -_ _fir=1: - .-.'1L i7••-T!�nw.s'�� ITT•_•-_ .....-•...�...i_... - _..._._.... .._ ...�.-....... rl.v-..�.a..r._ :ir'.r.�Jr - _ __ - ___ - _ --rww.r:Y�o-• _-� conmanv n•ttnc• addr"s• city- Rhone#• insurance co policy# Attach additional sheet if necessaty�,.:•.. ,_r;�;�+ - + «� T"r"ic '' ^�"~�• •=+�"� '`=""'�-r"' Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 andior one scars. imprisonment axwell as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a cope of this statement tsiy be forwarded to the Office of investigations of the DIA for coverage verification. 1 do herebr cerri Ruder d c pains mid penalties of perjure•that the information provided above is try turd correct. St_nature Date ` Print name phone>r ' official use . do not write in this area to be completed by city or town of 621 city or.tn%vn: permit/license# r•ttluilding Department ' C3Liccnsing Board check if immediate response is required 0scicctmen's ORcc '• C311calth Department contact person: phone#: r-IUthcr Information and Instructions Massachusi=tts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their emplrn•ees,- '1s quoted from the -law". an emploree is defined as every person in the service of another under arty contract of hire, express or implied. oral or written. An employer is defined as an individual, partnership, association. corporation or other legal entity, or ally two or more . the forc�_oin�s cn��agcd in a joint enterprise, and including the legal representatives of a deceased employer_ or the rccciyer or trustee-of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwelling house haying not more than three apartments and who resides therein. or the occupant of the d\\--cllin�41 house of another who employs persons to do maintenance , construction or repair work on such dwelling, hous or on the �srounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even-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 ha been presented to the contracting authority. 1 .. ." •... �,... `_ ._.' ... '..., • •. • .. .. :.�' .III.' :M�:~ _ , Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law- or if you are required to obtain a workers* compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to 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 aiye us a call. . r••y...-.+....., -._-._.-v,.....- ---.w.r.r.•.:a��•�:•.v+-s�....._..._�.�.•rtw.w..+_...+.ww •.w..r�a!o.werr.r.+•Trn�.�+s+..w�...�n Tile Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents �t Office of Investigations i 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 � a a t ' n. e \ Office Use Only e,h£ (r111111110111U£calill lit IaasilthlI5£rtrt Permit No. ticpartincttt Of JJublic '°itfftII Occupancy 3 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 5/92 (leave blank) _ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ,n City or Town of To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant W W dOwner's Address Tel. No, A A Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters zW New Service Amps -Volts Overhead ElUndgrnd ElNo. of Meters w w Number of Feeders and Ampacity Location.and Nature of Proposed Electrical Work W W H E-I al A A No. of Lighting Outlets No. of Hot Tubs No. of Transformers T`KVA No. of Lighting Fixtures Swimming Pool Above In grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switches No.'of Gas Burners FIRE ALARMS No. of Zones W W 0Y U Total No. of Detection and 3 9 No. of Ranges No. of Air Cond. tons Ilnitiating Devices W No. of Disposals No.of Heat l Total Total p4 u] Pumps Tons KW No. of Sounding Devices t No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices W Heating Municipal No. of Dryers g Devices KW Local ❑ Connection ❑Other I—I a No. of No.of Low Voltage tY No. of Water Heaters KW Signs Ballasts Wiring W GG >4 No. Hydro Massage Tubs No. of Motors Total HP Security System C� ~� OTHER: H E-+ INSURANCE COVERAGE: Pursuant to the requirements of-Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO ❑ 1 E-+ have submitted valid proof of same to the Office. YES O NO O If you have checked YES. please indicate the type of coverage by p checking the appropriate box. INSURANCE ❑ BOND O OTHER O (Please Specify) N (Expiration Date) 3 CHECK APPROPRIATE BOX: I have Worker's Compensation Insurance ❑ I have no Employees ❑ —I Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final W s, Signed under the Penalties of perjury: -4 FIRM NAME LIC. NO. JLicensee Signature LIC. NO. 34 Bus. Tel. No. Address Alt. Tel. No. J - :4 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- 4 o6ired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. >71 Owner Agent (Please check one) a _ Tolanhnna Nn PERMIT FFF 5 Engineering Dept. (3rd floor) Map iZo 6 Parcel .//�" Permit# o� House# ' 7 /x. Date Issued. ''hoard of Health(3rd floor)(8:15 =9:30/1:00-4:30) _ Fee �� Conservation Office(4th floor)(8:30-9:30/1:00-2:00) '� Planning Dept.(1st floor/School Admin. Bldg.) Nip, G' 114E Definitive Plan Approved by Planning Board 19 F/�� 444 01 TOWN OF BARNSTABLE V� Building Permit Application '�� ®� Project Street Address Village �n4y Owner J C�4 P.� Address `�� Telephone Permit Request LrytC- %t 21741eoi L- 0 /d X First Floor �� square feet Second Floor square feet Construction Type ( Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 3 Historic House ❑Yes fLj*o On Old King's Highway ❑Yes Basement Type: ❑Full yawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 7_01� Number of Baths: Full: Existing j New Half: Existing New No. of Bedrooms: Existing_ _3 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: OrGas ❑Oil ❑Electric ❑Other Central Air ❑Yes fU114—o Fireplaces: Existing New Existing wood/coal stove ❑Yes Nov, 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 W N'o If yes, site plan review# Current Use 0 , 0 Proposed Use Builder Information { Name �G�� P Tele hone Number Address �`�� U�L License# 0 y 1 IA -- Home Improvement Contractor# 0 $ � yy1. , Worker's Compensation# 6ti V8 ?3 6 k9 9�?&- 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 e� SIGNATURE DATE — 2 li� BUILDING P MIT DENIED FOR THE FOL r O . G (S) „ a y1 FOR OFFICIAL USE ONLY N PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ' OUGH FINAL GAS: "• RiGH FINAL FINAL BUILDC . DATE CLOSED OUT'. �t ASSOCIATION PLAM-NO., S. +. FIMEr, The Town 6f Barnstable r� r • + BABNSTABM • 1 9q, � Department of Health Safety and Environmental Services iOrEo �" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner S 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. Type of Workj4� V Est.Cost 0 0c) Address of Work• ` t Owner's Name Date of Permit Application:3 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. 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 here apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name • �' TheCU/ttn10n14'ealth of?Ifussuclrusctts Department of Industrial Accidents M• t r A oficeol/nvestIffMoas -�� 1 i 4 i. __��;=+ 600 11 usllinrton Street Bustun, Mass. 112111 ' Workers' Compensation Insurance AMdavit AEI to nformation Please PRINT'•le��l��`"�'�•~'��^ ����N ee •cock- 1(ju:n<� Isy9v t iocntion tZ-Ao T d Q 6 1:;-3 Ci�'� �1 f� nhone t! I am a homeowner performing all work myself. t] I am a sole proprietor and have no one working_ in any capacity r .. ....�.+ -..�-•►--rW -'--se-�'ra..�.x-.�..s..c_r"L+.s-r.�+��- — - -- , .`-�'�••�_`_..w'.-.-•��. 0 lam an employer ovidin workers' compensation for my employee working orking on this job. not an.•name: addres city• �✓. Vn�'y`'`rV nhone insur-ince co nolicv# I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who r the following workers' compensation polices: company nime• •tddres • ' Citv. nhone#- incur-ince co ... .R•t.::'—='-:�.�•-_ _ .—T••?' — __� � f'�'•I_i�T—�.14�T'�:.S••7• _ -.1T c. _` a--'- s .La com anA, name: address- city- Rhone 0: -insurince co neliev N 6U �)Vb K1 I ?I Attach additio_na!sheet if tiecess "�a•:�-{s �i-"JCrsf�+�'�i'�.-t.` `_f�ITZ� -.• !fK. ram. �`ti•_ Failure to secure coverage as required under Sectionf25A of A1GL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 andit one%cars'imprisonment as well as civil penalties in the form of a STOt'WOR1:ORDER and a fine of S100.00 a day against me. 1 understand that copy of this statement ma% be forwarded to the Once of Investigations of the D1A for coverage verification. 1410 hereht• y der ilia ah and penalties of peryurr that the information provided above is true and correct. • Date Si�naturc Print name Phone# �ofrcial use only do not write in this area to be completed by city or town official city or town: permitlficense# r113uilding,Department Licensing Board (]check if immediate response is required 13Seleetmen's Office k Qticaith Department contact person: phone#• rlUther Information and Instructions ,. Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for tl ce is defined as every person in the service of another under any employees. As quoted fmm the "1a++ an cnrpti�r contract of hire, express or implied. oral or written. An enrpl( lrer is defined as an individual, partnership, association. corporation or other legal entity, or any two or me the foregoing eniagcd in a joint enterprise, and including the legal representatives of a dcccasctl einplover, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However 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 f- or oft the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo\ MGL chapter 152 seaion 25 also states that every state or local licensing agenc}•small withhold the issuance or rene+val 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 tite performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to rite contracting authority. _ . --- — ---------- _ V , , �.. --_... . )' .. .... ....-.._.. . . _!" fit.. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation anc supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are reeuir to obtain a workers' compensation policy. please call the Department at the number listed below. City or 'roivns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr, the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returner. the Department by mail or FAX unless other arran`ements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questi please do not hesitate to give us a call. ._..... ...r.- The Department's address. telephone and fax number: 74x The Commonwealth Of Massachusetts Department of Industrial Accidents = Office of Investigations 600 «'ashington Street . Boston, Ma. 02111 fax #: (617) 727-7749 r� I. �t . . as gill ILA 1� I I 1 �i I, a i 'I I � f .... — — —.T � .— -�- - —-- — --- -- — — —--_ --—-—_-- .._ - -. _.. _._ � — — -— — -- — .. -— —- ——-— — -- k i ——------ — � -- —-- _._ — ——— —_—_-- — ——--- —-----T--- --_—•—�-——�_� _. � � ., __� ---T ;—— —— .�_ �_�...� _._._ ..�. —� - — — ----- —— —— — — n, .. I µ 3 lee �oovnzanueall�i a�✓�acoac/auaetta Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY 8 318 8 CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: Expires: 1G - 1 & 2 Family Homes Restricted To: 00 Failure to possess a current edition of the Massachusetts State Building Code • �.� �,d SCOTT E CROSBY is cause for revocation of.this license. 62 CROSBY CIR OSTERVILLE, HA 02655 n 10/27/1996 20:06 5087754477 JOHN L NEWTON PACE 01 .gyp �- � �' •� ALL o� a Ak t� .a, /a.r9 � }` sk LOT IfA r � Sh gzz4° r •. Flu , •� 1 oleo vda • ..r•- �G.S3 ff"'TWDWnUAKWAS rev t • : � r�vice o�.nv�t�Flri�a¢ 01's A � �, Ao��►'� .yCtoNi�y _ + 1 / Dar iE 0 0 V •v Q� CERTIFIED PLOT PLAN 1 WAL•E.!.'` F.W DATE.f'. /5.-?. . .. �I1011�6�:.7Xif P,�a y oees PLAN MMMENCE MA!D!il !!1W.Af Ws. tvNNuJ ,�sr�ti4`��7NJ�a� • � � ���z•FoA,/trM�l�gt,.�SArtr Mems`Ar 17y AWeL%V*-ZS�o�• trs!4-S�Art�'/!�f�;�p196�1�;VIt 3� . 008ViWpXevisa15�.4#4wsrit �yto; w&r,�:rw.�y.M. wa*+." alas'gY�'!�A• � s��+$�•?*i��)1ka•�!�-!o3t��fs . . . . : . . . . . . . . . . . . . . lcvfmTNAT THE $NO�N�.N�]y�oy�N� . {s M IN tocxfn ON THE QIWNO • • • • • • . . • • • • • • •• AS.�.•�11•� ~ • 194 . .. DATE r TtTIQNENx . COW. M. PROMSMNAL LAND SMEYOR Assessor's office(1 st Floor): r rr�� rr 1, r � ¢��g �a C Assessor's map and lot number r I .,,�����®��ERI������� Ea,; o o Board of Health(3rd floor): l- � Sewage Permit number �. Q1. 4 WITH TITLE 5 t Beaa9foDLL Epgineering Department(3rd floor): ENWRORMENTAL CODE rasa House number #�7 F�S ' TOWN REGULATIONS o16 9 Definitive Plan Approved by Planning Board 19 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 [//J/T//,S'�/I�(1G r A D&7uc TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information °t Location�,����� ��C L//JQ� ��"1Z:7�7'Lli/LCC� /�'lf�s. C,ZG�Z� Proposed Use35�� /T✓9� Zoning District Fire District Name of Owner Address I/ D . Name of Builder S Address Name of Architect /V//� Address Number of Rooms Foundation Exterior Roofing Floors Interior 114 Heating / Plumbing Fireplace �"� Approximate Cost ��vn Area ®U Diagram of Lot and Building with Dimensions Fee A P P R O V E D Barnstable Cor-^rvation Commission '2®-3 igned Date - 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 &:.�w 61 ALCliv6 Con ense NwCASEY, JOHN E. ` 2999 ADDITION of DECK No Permit For tt Single family dwelling i 27 Craig Tide Way , Location 4i �y Centerville f r . - r Owner John E. Casey ` t Type of Construction Frame Plot Lot r. j e r> 89 21 Y , 19; Permit Granted June ' Date of Inspection 19 Date Completed 1,19 r x, o o `t r i . p r# DA-89041 pV TH F rob C a o � Commonwealth of Massachusetts moo rb IL - 'f0 IfAY k' 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 To John E_ & F1 i nP T 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: b hand delivery to person making June 7, 1989 (date) Y ry p g request on 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): 4 This Determination is positive: 1. C. 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. 0 The work described below,which includes all/part of the work described in your request,is within an Area Subject to:Frotection Under the Act and will remove, fill,dredge or alter that area. Therefore, said work requires the firing 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. 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. 21X 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 !,lap ##206, Parcel #115 Lot#4A, Craig—Tide :Jay, Centerville, 1. ) All wooden portions of -the structure permitted herein shall be CCA—treated or the equivalent. No creosote treated materials shall be used. 4. ❑ 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) C rz� This Determination must be signed by a majority of the Conservation Commission. On this 7 th day of June 19 89 before me personally appeared Susan L. Nickerson , to me known to be the person described in,and who executed, the foregoing instrument,and acknowledged that helshe executed the same as his/ er free t and deed. October 28 , 1994 Pu My commission expires This Determination does not relieve the applicant from complying with all other applicable federal state or local statutes.ordinances.by-laws or ry ai iatio.-ss.Ills Determination shall be valid for three years from the date of issuance. The applicant.the owner,an person aggrieved by this Determination.any owner of land abutting the land upon which the proposed work is to be done.or an ten aPP Y Pe a8gr1 g Po P Posed Y residents of the city or town in which such land 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 request is made by certified mail or hand delivery to the Department 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. h Fes' t .t. Alit 41, i r i v ° � 9 Z2 q r _ x s i T �.. 1 Iv E T To/L ` cA \. O d S l4 2� 3\ P2.p le I (, nforE'T�tEAu/-US6�A5%A7 � 7 � � i �>�1.S1�hJC� ON_TX1�CoTh11102 k D 'r SA 1 h .TD -ADopl"/Pn7=GGZattl/r�1J rb m ` CERTIFIED PLOT PLAID LOCATION ClI +G-noir 54Y c 51-t'& Wr Ty ( SCALE' !'.��=. .� DATE .f-,.Z?,f �. o rr Da =s FRSc PLAN REFERENCE� /N �E�rl�r�v ccg . .L�/�J1<AJ_�.SPFG/,gt-<fi�Zs3lL�F�oD - Z9oNe.4(viv- lots St}ou-A) _dN � � 8��?4 �t�r�ASS:SD1Lf1!!tf�!2�C•�S�y Co�,maNl7y_p,*A.,Peti Na• 2seooi- G $�=7►IAP2�Yes� uGdsT�4, svnv t!Cv.✓svcrA."r-s ZNc. wy 0FM s S� 'PIA�BY 27Df�67 R Fl�;lo3PG I�F� o J hl N I CERTIFY THAT THEx/$r/�G.�wU'�� -� C SHOWN ON THIS PLAN IS LOCATED ON THE GROUND e �`xk eR— N!! N AS SHOWN HEREON .t z as� �' � -"-F� y� �p e•k f {a i�. .. j"'�ti n a' � S '� .� .. �� [,ems- .. � ^'�R��r �: PE�.Pa Assessor's office(1st Floor): Assessor's map and lot number 0(i its Q�oF THE Board of Health(3rd floor): Sewage Permit number cT U BeBa9TSBLL J Engineering Department(3rd floor): rasa House number #d� °° 1639' Definitive Plan Approved by Planning Board 19 �io?rpY d 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 s iZUC r �9/ TYPE OF CONSTRUCTION 4V,,/Q,6— Er,<7Z, 1.9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ���2• ��� � ���V/GL /�i 1'� C3Z�3�. �c� 6: _jV#) Proposed Use Zoning District Fire District O't V,'LGL�'— O S2'" s /LG Name of Owner ✓© CST" Address vg f4gg a.�f Name of Builder Sri Address a Name of Architect /(��� Address Number of Rooms �/� + Foundation 5,9/9/V ,AlG'"/L3 Exterior ,y Roofing Y / Floors �1 Interior Al 1,4 Heating �7 Plumbing Fireplace Approximate Cost � � P r, AreaD© � F ? Diagram of Lot and Building with Dimensions Fee f � tit } 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. Name Construction Supervisor's-L-icense CASEY, JOHN E. A=206-115 - - .IL No 32999 Permit For ADDITION of DECK Single Family dwelling Location 27 Craig Tide Way Centerville Owner John E. Casey Type of Construction Frame Plot Lot Permit Granted June 21 , 19 89 Date of Inspection 19 Date Completed 19 f '