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HomeMy WebLinkAbout0118 ELIJAH CHILDS LANE i .. .�. �. :de .'"�' ., 4 :, q1,d. ° •ri'� �,',.- �'� .$i .,r,y 11 i'.- v•. .n ,., �.' .x5�.. .. s ! 5 ,.a..ua....r.., u a1�;,.a� ��,T,�t, ` � ,,.,- � �5"c, c„�',{• ''p.a i L'�+� ils. .x x .�+{;p�� 411i+� 'x.A�.', � x.t,r-_':a �xs,cx' r7•' a� 'Ke. •+ r `. q eke + a r ��'` 3 '7 W F , .r?iA' a 1 z .: e ^ ° 1 ' e u '..a y'. c - 4a. ° , + ., �' a ° ., - :. ❑ , .; . ° ° u , uo n r. e a � e 1 n , ^ a : ' o h, s � w + " 0 _ , > , r ° ° , } i _ it i r /r Application number.B- /- 3-.2........33............... ................. Es! HIM) Fee................ ..................... MASS OCT 0 9 201i Building Inspectors Initials. ............................. OWO�N BARNS JML� Date Issued..... .......................................... Map/Parcel.........LV........ ...Y.i............. TOWN OF BARNSTABLE. EXPEDITED PERMIT APPLICATION: ROOF/SIDINGfWINDOWS/DOORSfFENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Ild" 0-,Q 5 Lme (?"�ervt�tc — NUMBER STREET VILLAGE Owner's Name- Phone Number Email Address: Cell Phone Number Project cost$ d5n- 6 Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property Ihereby authorize to make application for a building permit in accordance with 780 CUR Owner Signature: Date: TYPE OF WORK ID Siding E:1 Windows(no header change)# ED Insulation/Weatherization Poors(no header change.) Commercial Doors require an inspector's review Egioof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# ---(attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:OOam;9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Dnlb Telephone Number Cell or Work number I understand-my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780' CMR and the of#arnptable. Signature Date l6 g - APPLICANT'S SIGNATURE Signature G � Date 1 All permit applications are subject to a building official's fecial's approval prior to issuance. / _ -` t �` - - I l .. - .. � - .. t. _ - - ' +^' C� � � �{1 �� _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Cr1�C�5� Address: A V9 OJtL&!5 City/State/Zip: Lawokol, e &Akiohone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor.and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New,construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: . 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10,❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t - c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the'section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, If the sub-contractors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of'a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here y"certify under the pains and penalties of perjurjLthat the information provided above is true and correct_: I Si afore: Date: 0411-9— Phone#: l Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector . 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,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 m ore 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 building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le, a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your 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 Ogee of Investigations 600 Washington Street- Boston,MA 021 It Tel..##617-727-4900 e, t 406 or 1-877-MASSAFE Fax##617-727-7749 Revised 4-24-07 www.mass..gav/dla , 'Town of Barnstable errnit:. Zoe oco�t � Regulatory Services ate: oFt"E rAy. Richard V. Scali, Director t Fee: OI Binding Division Tom Perry, Building Commissioner 1639. ��� 200 Main Street Hyannis,MA 02601 ArEO MA'S p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT . Owner: !aV Jcl`I j 0 do W 5 t<t Phone: 4(3 Install at: J IS E 1 � , a Cat, Village: ...._•_.__-..-_..,-_ ..._....._..`..r.r....-n _.sN_._ r�:.•st-....._....._.Y.__.._.�.�-...�...,_....�._.._.__._�._..,R_.r_.....__�....:..._.�__.....��_.»---...+..s...�_..._.._....,..+_.-..-_._.___.... —..._.r--r.-ram___..__. _ Map/Parcel Date: /0 / Stove A. New t Used ' ��� �� 2�0� B. Type: Radiant Circulating �t!/''U O`-� t4 ,7 5- MEA 3[ 3_-00—L C. Manufacturer: ;�"c,6+jj I F 5_00 Lab. No. A NS 1--uL -7,5 7 d-A vs l -UL D. Model No.: F7 Chi ey New Existing (If existing,please note date of last cleaning) B. ue Size x ` —t d-, C. Are other appliances attached to Flue? No D. Pre-fab Type and Manufacturer " C'-) E. Masonry: Line nlined ...... Heartf ' A. Materials: B. Sub Floor Construction: i cis Installer _ 0% Name: � ' Address: _( l � ,. c ,,,'l ots [_-4,1 Phone: Location of stallation: // H.LC Registration# Construction Supervisor# OR check lomeowner Installing,no license required LICENSED INSTALLERS SIGN URl .: APPLICANTS SIGNATURE. APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 11/4/13 Tke CommompeaM of Massachusetts Deparhnent n,f buks&ia1 Accidents . - - Office of rmystigations ' 600 Washington Street Roston,MA 02L T1 wivu.mas&goVd14 Workers' Compensation Insurance A idavit:BirildersfCantractors�BectricianMumhers d �,Iirant La&rmafion Please Print Legibly a c o In dt,an_^ 1, Vi�1 'J'aAliyeuv 94- f IJ - C tyfStatrizip:. t sle, 61 Y— Are you an employer?Check the appropriate box: Type of project(reqairedj_ 1_❑ I am a employer with 4- ❑ I star a general contractor and I 6- ❑New coon employees(full andlorpart4ime).* have hired the sub=contractors. 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition woddng for me in any capacity- emP1oYes and have workers 9- ❑Building addition [N workers' comp-insurance comp-insuran=1 ed] 5. ❑ We are a corporatioaand its 10-❑Electrical repairs or additions 3_ I aura a hamouner doing all work oVe �sed their 11_.❑Plumbing repairs or additions right.of exernptioa per MGL mayset£`[No workers'comp- 12❑1Zoofrepairs •e insurance required-]b � c.152,�1{4),and weha� na employees-[No workers' 13.0 other comp.insurance mgmreti-]. *Aay applicant that cheers boa#1 mast also fill out the section below showing ilea washers'compensai ou policy iufnrmx&m T Homeowners who sabmit this sffidavit industing they are doing 2n wok sad 6ten hire outside contractors mmt submit a new affidavk indiratiog sash tCantuctors thst check this bwL mmt attached on additional sheet sb wing the name of the m*-muft2clors sad state whether or not these entities have employees- If the sub-conttacturs hwe employees,they nn, provide their warkers'comp.policy number. I am an employer that is proiaduig workers'contlmnu lion insurance far my employees. Belau'is Ste po&cy and,job site injFormadom Insurance Company Name: Policy 9 or Self-ins. Expiration Date: Job Site Address: Cityi'StatelZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c 152 can lead to the imposition ofcrirninal penalties of a fine up to$1,50O.OD andlor one-yearimprisonment,as well as civil penalties in the form of a STOP WORK ORDEF and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for inmmtt ce;coverage verification- I do hereby c under tkeprdns andpenatties ofpet�ury that the informationpra�t�ided abmre is hers and correct J'0 -/,1-7/-/,4 l me Z O f j cial use only. Da not write in this area,to be campieted by do or town ojficiaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health. 2.Buiding Department 3..Citylfown Clerk &Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Y-; Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an enployee 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 building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or IocaI 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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone nuraber(s)along with their kerbficate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees;a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of in urance 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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 Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hike to thank you in advance for your 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 CommonwWth of Massachusetts - Depatiment of Industrial Accidents Office of javestigaiiGw 600 Washingtou Street Boston,IAA 02111 Tel,#617-727-49100 ext 406 or 1-977 MASW.. E Fax# 617-727-774 Revised 4-24-07 www.mass.gov/dia IMME Town of Barnstable Regulatory Services } snarvsrAZU, : Thomas F.Geiler,Director MASS. fin Na+",�� Building Division 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 JOB LOCATION: I I I1 I�w G� �{/1 r[ p �Gl (fie 1� �P✓ ( ` r number— `� street ram• - �--- ^.�.. -�. .village "HOMEOWNER': �� ����� �f L � ` 3 name home phone# work phone#,. CURRENT MAILING ADDRESS: ,,yNclty/town -- - , state :. .. """` ziP=codel The current exemption for"homeowners"was extended to include owner-occupied 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 rnimmum inspection procedures and requirements and that he/she will comply with said procedures and re en% i gnature of Hom 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:homeexempt �TME Town of Barnstable Regulatory Services EAMSTULE, MASS Thomas F.Geiler,Director i63q. �0 Fn ►�" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 62601 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 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner. Signature of Applicant Print Name . Print Name Date QTORNMOWNERPERNOSIONPOOLS 62012 Assessors map and lot 'number �. /............ T....... � THE �74?../ t0�� Sewage Permit number ... . R �Q SEPTIC SYSTEM MUS n INSTALLED IN ICOMPLI � �a STABLE. House number ...:�..L.L(�....:..!Ri13 �:....:.............................. �9" lwrnea WITH TITLE 5 '� 2639;t ��YPY a` TOWN OF BA�RNTIVFra tRE� A L v ;, �. BUILDING I'HSPECTOR APPLICATION FOR PERMIT TO —' TYPE OF CONSTRUCTION .......... .:. ........................ TO THE INSPECTOR OF'BUILDINGS: The undersigned ,hereby applies for a permit accordingto the followin information: Location ......�1`f�.��...G?.. ...... 1 � E .� 0 ....:... ProposedUse ................................................... ............................................................................... Zoning District ............................... .......................................Fire District ... .. ... .. ........ .. Nameof Owner ...0 .. .... ........................................Address .............................................................................:...... Name of Builder ..........1! t' .............................Address ................................ Nameof Architect ..................................................................Address ............ ............................................:..................:...... Numberof Rooms .:......7.....................................................Foundation . ..:... .. ... .:....:.......:............................................ Exterior ...`..'' ; 'Nba!E! .......... ...............................................Roofing ........... ... . .............:..`...... ....................................... Floors ........ ......................................................................Interior ............ .. ........../- ............................................ Heating ................................................... Plumbing ........ ...464ZI :............ Fireplace ...... ..... ......................................Approximate.Cost .:.. .. ........................................ Definitive Plan Approved by Plannlmg Board --------------------------------19--------, Area 1: .. .t ......................... Diagram of Lot and Building with Dimensions Fee Dd ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg ding the above i construction. Name;.. . �, . ..... ...a .... ............ . ........................ SMALL, ALAN 239t 7 ' IN .. for .....One..StQh'Y....... Single..Family...Dwe.�, ix1g............. Location .Lot. 6 2....„ Lj,ah...Childs Ln. ................Centervia,je.................................. Owner ..Alan Small ..................................................... Type of Construction ..FXa Me.......................... f ........:....................................................................... PI"ot� ....................... Lot ................................ Perm �Granted ,,, March 25, ......19 82 Date of Inspection ............19 Date,..Completed .. .`' � ... .......19 PERMIT REFUSED ................. .............................................. 19 ................. ........ w..,;.............................................................. ............... ....... .................................... ....... . 4 Approved ........:................. r " t . Assessor's map and lot number .................... ... J� FTNEp Sewage Permit number 's ? Z BARNSTABLE. Ipuse number ...f. . i.:.......................................... y MA86 Cpo�i639, \e� 'Fa MPY a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............. .................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..........................Address .................... Nameof Builder r ..........Address.......................................................... .................................................................................... Nameof Architect ...................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ...................................................................'........... Exierior ....................................................................................Roofing .................................................................................... Floors .................................................... ...............................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..........:.......................................................................Approximate Cost .................................................................... t Definitive Plan Approved by Planning Board ________________________________19________. Area .. ..1....?.(:.. Diagram of Lot and Building with Dimensions Fee -- SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Name .................................................................................. SMALL, ALAN A=171-248 239� No Permit for ,,,One Story ................. ......................... Single Family Dwelling ............................................................................... Location „Lot #.62 i jah,,,Qk1jL.lds Ln. .........118..........El..... Centerville ............................................................................... Owner ,Alan ::Small. ..... .. ..................................... Type of Construction ...,Frame,,,,,,,,,,,,,,,,,,,,,,,,, ................................................................................ Plot ............................ Lot ................................ Permit Granted March 25, ...19 82 ; Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ...................1.00��................................... ..........................I.P �... ........................ , ............................................................................... ............................................................................... Approved ..................................6............. 19 ............................................................................... ............................................................................... 1 ,.�� �AnnlL.ti� - 3 �3�rtioo�K _ G���� , • . ..,. : �:�-''-: 4:,_ i 11GATZUAG6 61ZI WMIc-9-- ��Y'IG T"1 .1K = =3 o't 150 N • ��7 6.Po- _ \op•�• ; �urwALL AZT z 150 S 1✓. �� i - BortT-OAA t CEA sT N'ou".. '•.. . . TOTAL -p G SIGW L d25 (..RD.. `;' ,►ud' �� f T'oToL. t:)alL_**-f I t-OW c 33D6.w, MZGDLOTIO1.j t kT6 S to SmiLi•o¢ LrSS. ${�.-.{,► 4N OF � .. S� - AN A. m RAXT�R• ., L._ 1 .. . I. . 'ess Tor FKo IL WiT. PC.tl• i fil?.f �.. •'�-.��... i r a: s ' I ' G2D. .c IZIu#� ....• �C�v tiv'7. , r' ;� Pik :Y luvc . .. i. f X I Inc to e; :,f`•;: loo0 55 5 `,uv,opy. GAL.- lug q i •i• ;. . FIT - 1 .. t� //� �^. .. ! .,' w• ; mot_C , .. SAND , t Lo-r ;=n_ J . . . L OCAT 10" 13 44S . .s,aT M- MA1Z- . . GGt2Ttt=� Tt4AT TAG- ;PONVAMOM5"OW►J �- t-1C:f��r�1�1. Ge7r1�>,PL.�IS WITIA TOZ; weID .t-t►-�� L- T'GeZ► ' ! . Auto 'SC•TL'.ACI�. �'G41vt�CMct.ITS OF •r &4 -to W U Aar L.oGA.TEb- WI 11.1 T64r== T�LDrvtc Pt-AtS.1. ba.T • aaXTc�t �. u�E Iwc. . , .. �, �..�..� ' RCGtS•ttfLED • t.AND•- Svev�YoQ: OSTEv-v%L.LL c 14tASS• 1,5 t7 L_ 15 .J OT 064 A" ALL-t µG- lw,;rQvM�-wr '�uQ% ••YI{e.- UFC��Tr' �i-IGWLD APPL.IC_A.►-JT [1,1;•p,�..I .E•�j' MA LoT - Ll Nza•:; TOWN OF BARNSTABLE Permit No. ----- fe! t Building Inspector , s,asrruc _- Cash —----------_--- 00 �rOYPY� OCCUPANCY PERMIT Bond. "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Alan Small Address " lot #62 118 Eli ia'h Childs Lane_, Cenzt�-vi'Lle , Wiring Inspector Inspection date Plumbing Easpector Inspection date Gas Inspector Inspection date X Engineering Department ._ � 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. L/ ...............:................. ........... 19__ ... ..�........� Building Inspector __.. ..�..._ z . a" - TOWN„OF BARNSTABLE BUILDING PERMIT APPLICATION' ` Map Parcel 7 Permit# J�I7: 1 �?ivisi n Date Issued I aa:z9 ! ky rJZ1 Division Fee Tax Collector _ F Treasurer •Ptarfnmg-B�pt. ,` -Bee•Defii*ive-Ptan Approved by Planning Board -Histerie-�-6K+1 Preservation/Hyannis Project Street Address l/ I �L/T-4l �' LhS 6- ' Village P - `Owner L, 1 Z5_ BN Address Telephone Z Y 3 y q Permit Request �C. o f ,¢ 7Z s7X r o©1'sw t s r L �s 07 5 4)V,,¢i2E�; Square feet: 1 st floor: a ting proposed 2nd floor: existing proposed- Total new Estimated Project Cos 6,t OY_0 Zoning District Flood Plain Groundwater Overlay Project g Y Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family '� Two Family ❑." Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes— qJ No On Old King's Highway: ❑Yes �No Basement Type: ❑Full ❑Crawl ' ❑Walkout ❑Other 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.baths):existing new First Floor Room Count " Heat Type and Fuel: ❑Gas ' ❑Oil' ❑ Electric ❑Other Central Air: "O Yes ❑No Fireplaces: Existing New• Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size ' Pool: ❑existing..O'new size Barn:❑existing q new size Attached garage:❑existing ❑new size Shed 4existing ❑new.size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No • If yes,site plan review# Current Use Proposed Use , BUILDER INFORMATION - Name �i-+,oi z zt � ,o. /Telephone Number Address ��E�2�C�' 1?,+6C License# Z-5 4 7-) 7`z'9 �Ca2ra4J1/ Home Improvement Contractor# /DO 7Y0 ,419 TY i Worker's Compensation# D1,7 4)S 1 Z R 8oZ 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �w Fh1 y �SIGNATU �.� � DATE r FOR OFFICIAL-USE ONLY c - PERMIT NO. ' i �; ! R 4 t, #• r ' DATE ISSUED , J MAP/PARCEU NO. e t r r ADDRESS . VILLAGE OWNER DATE OF INSPECTION: x A FOUNDATION17 - - FRAME INSULATION ,. - -: ' - •f u '' _. 3; 4 \s { • FIREPLACE ~ ~M ? ELECTRICAL: ROUGH FINAL • •1 ~T __ PLUMBING: ROUGH FINAL, ~ - ` GAS: 'ROUGH + FINALc ? i ' FINAL BUILDING DATE CLOSED,OUT ASSOCIATION PLAN NO. 3 •' i ; I -.1_--__ The Commonwealth of Massachusetts Department of Industrial Accidents - ,I . ` , .= vNeCOI/OYCSI/ 20ftS . R .` - 600,Washington Street " - .`I l Boston,Mass. 02111 - - Workers'.Co ation Insurance Affidavit - name: . location: . city Iphone# ❑ I am a homeowner performing all work myself. ' ❑ I am a sole etor and have no one work in achy ///%%%///%/////� ��%////%////%/%/////////%%%%%%/O%%%////G/ /G/%%/ ////%//////////// I am an employer providing workers' compensation for my employees working on this job. ;:::.::::....::. ;:.:.:: camaanv name.... , . �"' '�... ..... r ".. :.'—, ,�11.�1�`." � ...: . :: . 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''v:%:;::::::::: :':;u;�.�;..... :..:.:........ ....... .:::...::::...�. :::::::::.::::..:.::•vv::::::•:is:!:ii:Liii:is iii'•i:•iii:i::inL:::.i?:'-iiii`.�:::::•iiiii:vY:-i i};;ii:'-ii:�:::4:ii:::•i:<};<.}ii}i.i......:?::••:::<•i:is i}iii:ii'f.::v}i:3)`,p;;•ii-- -i':•i'v':iii::;;li::isi.... >i:t{�i:i:i:ii:i{•ry4:i. .:i ii}} - . -,........:'::::::::::::::. :::::.....::::-::._:::...—,,.'..:::..:::::::::::::::::•::.::�::::::.....:.:......... of t:S!'if'.........:.:....:.:.,......:......:.::::•::•::::::-::.:::�.::_:v,::}l�,<�i:?::�:t::::i�:>:............. UTAaCe Co. Fai>mtt to seem a eovera;e as required under Section 25A of MGL 152 cm lead to the imposition of erhnital penalties of a fine up to S1,500.00 and/or one years'imprisonment as weR as dvil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand tLat a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. . I do hereby certify under the palm mid penalties of perjury then the information provided above is tru:mid correct signat� �✓L `7/ pate /z,1 ze t/9'F _ Print name Eat/G� I/ ,F,4scH � l=# �/ , -,7S`S 1 official use only do not write in this area to be completed by city or town official. ' city or town: per�Ulicense# Dig Departmev . ❑chedcif h n iediate response is required ❑Selectmen's Office _ ❑Health Department contact person: phone#; ❑Other uevud 9/95 M) . . °: The Town of Barnstable $�$jjg�ARf r • 9 K Department of Health Safety and Environmental Services 9. TFDa,� Building Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6227 Ralph Crosses Fax: 508-790-6710 Building Commissions: For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization; conversion, improvement, removal, demolition, or construction of an addition to .any pre-existing owner occupied building containing at least one but not more. than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions, along with other requirements. t Type of Work: ZDOf/kI� fF7L s7 �.ol�itilG Est. Cost Address of Work: l� �1TAtf L'�flG1bs �lt Owner's Name 61-L/ 6- Date of Permit Application: I hereby certify that: Re-istration is not required for the following reason(s): Work excluded by law Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN P£RIMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROG'RAt�I OR GUARANTY FUND UNDER MGL� 142A SIGNED UNDER PENALTIES OF PERJURY . I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owners Name ✓fe �aJrorrlanuroalC�.•c`� `lr;t.;2c�u�el73 .{ Ot+unj4E�li :iF JL:f _rcr�f :. lumbar. CS 31119 32''..i">1at iA S... ._. r, I'"^RCVE�;EN- CCN ACTCRS REC�S'R�i LCN c� i -ldimg Rec�1 0r,� As�bu_r�e,-1 Puce - Ric- 1301, Eos_o, , F��ssec�,�sa__s CZiG8 r!` 4PPCVE;`^_,�i- CCNTPA.CICR - - -- -------- -- -------- ---- - - C' 1007-C r? - F�_VATE Cvr=CRC--r-,N -v _77�- CAP_ 7- 7MPROVEMEN I , IM T '-o CCU 1..45 Ne' om ram . C2-635 ! - . • --_ -•-- � �GIJI•JJY.J•11YSC/�ii CJ ..i�i„�.CJ% H7KZ iS(;:(+acg Ses� aad To: {t _ THCX�S Z C�7IZZ' IP.