HomeMy WebLinkAbout0274 ELLIOTT ROAD a
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Town of Barnstable ` it
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Post;This Card,So That it isyis�ble From.the StreetApproved Plans Must be Retained on Job andahis.Card Mustbe Kept •'
�+^ �$' Post�el Until Einal Inspect�ori Has BeenMade Z�
�b ,, Permit
7 ,
� a Where asGertfi date of O�upancy is Required,suchBuildmgshall Not beOccupied untila Final Inspe on.habeenmade�
Permit No. B-18-4111 Applicant Name: todd leduc Approvals
Date Issued: 12/18/2018 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 06/18/2019* Foundation:
Location: 274 ELLIOTT ROAD,CENTERVILLE Map/Lot: 227-090 Zoning District: RC Sheathing:
Owner on Record: Taylor, Kimberly Contractor,NarTi ,TODD LEDUC Framing: 1
ry Contractor License:'CSSL-106019 2
Address: 274 Elliott Rd ,.;
Cenerville, MA 02632 Est. Project Cost: $2,413.00 Chimney:
Description: Insulation,See contract Per=mitFee: $85.00
Insulation:
Project Review Req: Signed installers certificate required to close Fee Paid: $85.00
(i RDate 12/18/2018 Final:
77 � � �
" r �crn Plumbing/Gas
n � Rough Plumbing:
Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized byAhis permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved applcati and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or roadand shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. W
- Electrical
�. £. • ,� x ,-.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and�rire Off,icials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work
1.Foundation or Footing X Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Town of Barnstable . 166 g)
C Expires 6 mo rom'sue date
Regulatory Services Fee
• BARNSfAB14 •
3� Mass $ Richard V.Scali,Director
Building Division. '
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPREss ERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property/1Address � �� �� . C,�U���J �L�� V\L-N O 1"aW-Z,3 .ar.
Residential Value of Work$ I Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address (�� �y` u (�
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email: -
Construction Supervisor's License#(if applicable) ,,
❑Workman`j s Compensation Insurance.
Check one: AUG
j
I/I am a sole proprietors a
I am the Homeowner_ TOWS O�Cyn 20is
i r❑ I have Worker's Compensation Insurance DAR 4
IVSTA
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Re st(check box) G
qLRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to�u W
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows '
#of doors:'
❑..Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required. -
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
fir,
?lie Comrrtorrivealth of-Vassachusetfs
DVar bwent of Industrial Accidents
- - Office of Investigations "
. - 600 Washington Street
y Boston,CIA O21II
wipmmass grrvfdin
MTurkers' Campensation Insurance affidavit:Builder-s/Contrac-turs/EIectticianslPlumbers
Allplicant/Inforwatian Please Print 1,M-bly
Address: a r\y ®
Acity/sta&zip-��,�-- k) �rr- QNA _ 3 J Pbcne
Are you an employer?Check the appropriate box; Type of project(required):
I.❑ I am a employer with 4. ❑I am a general contractor and I G. ❑New construeti(m
employees(full and/or part-time).* '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
ton tins forme in any capacity. employees and hnre waAters` 9. ❑Building addition
IN o worloem,camp.insurance comp-msuran�f
�equired 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions
3.[ I am.a homeowner doing all work officeas leave rcised their 11.❑Plumbing repairs or additions
€ o workers' right of exemption per MGL'
�� � - 12.�Kpofrepairs.
insurance required-]'s c.152, §1(41 andwe have no
x employees-[To workoers' 13.0 Other
comp-insurance required-]
$Any aPptic=ffiat checks box P1 Est also fill outthe section belawshnwing their wodere compensation porky infncmation.
I Homeoaraers who submit this aftidax ft indicating they axe dGma-all w A and dunx hire outside contisctars avast submit a new affidavit indicator.such
fGan=ctors that check This bond must attarhad an additional dheeet showing the name of the sub-conuxcto-rs and state whether air not those en ities have
employees.Ifthesub-contra,ctaeshare employees,theymnstpmvide thew worken'comp.policy number-
lam an etteploper tliatispr4nt ding itrorke-rs'congmisalzo'ti iris irance}or trry�¢ntployees BeIoiv is dice policy acid jab site
i►tforraation
Insurance Company Name:
Policy 4-or Self-ins.Lic-4 Expiration Date:
Job Site Address: CitylStatel7.dp:
Attach a copy of the workers'compensationp.olicy 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 penahaees of a,
fine up to$1,500:00 and for one-year imprisonments as we It as civil penalties.in the form of a STOP WORE ORDER and a fame
of up ta��250-00 a day against the taolator-'Be advised,that a copy of this statement may be forwarded to the Office of
Investigations pf the DIA for insurance coverage terification-
I dhiereby certify rudder the pains and penahYes o,fperyury dial:the utformatio r pm ded abm e i burg and carrect
Date:
r
x
P�home#: 0
Official use only. Do not twite in this urea,to be completed by cif} ortoorn officiat -
t
City or Town: Perznitll icense#
Issuin Auttsority(chile one):
1.Board of Htalth 3.Building Department 3.C ity{Town Clerk 4.Electrical Inspector S.Plumbing Inspector
b.Other
Contact Person: Phone#:
Inform�afzou and las&wfions _.Y
.asses husetts Geheaal Laws chapter 152 reganes all employers to provide woikers'compensation for their employees.
p to this sbtutq,aa.e77playre is defined as."-.every person in the seavice of another under any contact ofhire,
express or implied,oral or wriftm.."
An e7pplayB-is defined as"an mdividnal,partnership,association,corporation or other legal entity,or any two or more
- t e and inc the le e .
om
of the foregoing engagedmaJ �pris , Indzng �� sentatives of a deceased employer,or th
e
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 -
dwPT�house of another who employs persons to do mah tprtance,construction or repair,work on such dweIlmg house
or oa the grounds or building appT e 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 bindings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the era n ce.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 ofpubho wont until acceptable evidence of compliance with the insurance..
req=ements of this chapter have been presented to the contracting ardhoizty_" -
Applicants
Please fill out the workers'compensation affidavit completely,by checltmg the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificates)of
hisu:rance. Limited Liability Companies(LLC)or Limited Liabi-lity ParEnersbips(LLP)with no employees other than the
members or partners,are not required to cagy workers' compensation insurance. N an LLC or LLP does have
employees, a policy is required- Be advised that this affitdayit may be submiftDd to the Department of Industrial
Accidents for confirmation of mstaance coverage. Also be sure to sign and date the affidavit The affidavit should
be reiummed 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 ifyou.are reed to obtain a workers'
compensation policy;please call the Department at the number listed below Self-insured companies should enter their
self-in� ce Iicer se number ou the appmprlaty Ime.
City or Town Officials .
Please be store that the affidavit is complete and printed legIly. 'Ihe Department has provided a space at the bottom
of the,affidavit:for you to fPl out in the event the Office of Investigations has.to contact you regarding the applicant
Please be sure to f M in the pen�iVlicense number which will be used as a reference number. I•a addition.,an applicant
that must submit multiple pcnnt icense applications in any given year,need only submit one affidavit indicating current
p olicy hif6 nation Cif necessary)and under"Job Site Ad mss"the applicant should write"all locations II-(City or
awn)-"A copy of the affidavit that has been officially stamped or marked by thD city or town maybe provided to the
applicant as proofthBt a valid affidavit is on file fbr fufnre 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 vendee
a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would ae to thank you is 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:
-Tht�.mmmwmj&of Massachnsatts
Delta cf ment of 1a ushiak A000enta
CLffice of f- ve&tigatfo=
��-�ashiz�Qn Sint
Bost MA G2111
T6-L 4 617 727-4900�xt 4-06 or 1-977- SAFF,
Fax 9 f 17-727-7749
revised 4-24 07 zaas5.gaWdia..
Town of Barnstable
Ry' Regulatory Services
oFVE T yr Richard V.Scali,Director
Building Division
r •
s MASS.M Tom Perry,Building Commissioner
Mass.
v� i639• ��� 200 Main Street,•Hyannis,MA 02601 Al� www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
n .
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: ft ��. L� u l C� �-
number street village
T �
.•HOMEOWNER"R�.���t��� J��"��0""'�y�\
name home phone# work phone# .
CURRENT MAILING ADDRESS:
city/town state zip code
iThe 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 minimum inspection.
procedures and requirements and that he/she will comply with said procedures and requirements.
k1t.-
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which'a building permit is required shall be exempt
from.the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot .
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:\WPFMES\FORMS\building permit forms\EXPRFSS.doc
Revised 040215
i
,. L
oFT"e rq�
RAM- rust s, •
9� MASS. Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section.
If Using A Builder
I, , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
t
QAWPHLESTORMS\building permit forms\EXPRESS.doc
Revised 040215
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"AS BUILT" PLOT PLAN
' o THE BEST OF MY INFORMATION, 1-709 e ar'r4ac q", MASS.
NOWLEDGE, .AND BELIEF THE LoT �9 �, B�. 7 IX:�. /3�
ON THIS
PLAN HAS BEE OF ON THE R ✓ OHEAR/V /NC.
IN y� SWAN RIVER PLAYA
ET ROUND AS IN E . 35 ROUTE 134, UNIT 2
WILCOX SOUTH DENNIS, MASS. 02660
N .31341
Z
DATE : /yJ.q /� SCALE: /' = O
Z- 8� t tat JOB NO. CLIENT: vao. r
SKEET OF
DATE REGISTERE ND S RVEYOR DR. BY:
SEPTIC SYSTEM M
AssessAr'--� office (1st floor): oFrNEto
Assessor's map,and lot number .... ..�.../......................... IN COIVIPLIA�� �
. - t�aTALLED �Q o
-'Board of Health (3rd floor): . WITH TITLE 5
g �� � �-�.
Sewage Permit number .............................................. .... ... {PICNMEioITAL CODE A 'f'BaEaSTI►DLE,
Engineering Department (3rd floor): �- L�,T{® J
House number •• -••• ••••••• • p�aY a`
APPLICATIONS PROCESSED 8:30 9:30 A.M. and 1:00-2:00 P.M. only
TOWN, OF BARNSTABLE
BUILDING IN$PECTOR
�
APPLICATIONFOR PERMIT TO ... ..�.......:�....! !!?. .......... ..................................................................
TYPE OF- CONSTRUCTION .. A.. ...�I.�FC.....4a,ELT.r4....a..(:�f. .......6'0 ...........................
Y- .................. 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a ermit according to the following information:
Location .. °. - ..�..(....G. (,IQ .:. .....6 ............................................................
ProposedUse ..>,.��jck........ .[.I.... �� <�N ..................................................................................... ...
........................Fire District .......
Zoning District ..... ,.. ...........:................. ..................................
Name of Owner /7! � ... ...................IAJ AV.. +'!'.:..... ...Address 1.1 � ... �J� :A �/f f r6?4
�................ . 1...
t e 0¢ l2 rU /2MfJC , /�Aq
Name of Builder ...... ... ..... Q:fl.� �.. dress �lV ,�....
��I I�.A �4X...c�`r�.��. ....Address ...SANNJ��"/.�
Name of Architect . . .
�/ Foundation .. 6.��...11.!1i41.� ....� (1
Number of Rooms ...... . ................................................. �.
... ............
Exlerio, ` 4 & Roofing �� S �/ �iL
r ...................... k.(Z....................................... ......' ...................... ................... .....................
Floors ... e �� iq 1PV.....Interior ® BI mY ...... . ..........
^� (`
Heating � �. Plumbing .....G. ! .. &i.vl45
Fireplace ........�...................................................................Approximate Cost 45 9,D0�, 4
Definitive Plan Approved by Planning Board --
_______ _____� ___191V__ . Area ....l.. � S
Diagram, of Lot and Building with' Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH �N4
�� II
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.
Nam ......................................................
r
Construction Supervisor's License .0 8. 2
LAND RY, DANIEL & RONALD
No .... Permit for ...Two Story.............
...........Sin le Famil Dwellin ...................
Location ..L.o.t..#1. .......2 J,�liott Road
..........................
Centerville
.
Daniel & Ronald Land
Owner ................................................. .............
Type of Construction ..*.:.Fram.e............................
................................................................................
Plot ............................. Lot ..................
Permit Granted ........May...?.,...................19 86
ti
Date of Inspection ...C.:4Q'A"9-s�
T Y- -- ..
....19 Date Completed ....................
LAW OFFICES OF
PHILIP M. BOUDREAU
390 NORTH STREET
HYANNIS,MASSAGHUSETTS o20o1
(617)775-1085
PHILIP M. BOUDREAU
PHILIP MICHAEL BOUDREAU April 4, 1986
MARK H. BOUDREAU
Building Inspector
Town of Barnstable
Main Street —Town Hall
Hyannis, MA 02601
RE: Lot 19, Elliot Road, Centerville (Plan Book 239, Page 131)
Dear Building Inspector:
I have this day examined the state of the record ownership of all the
abuttors to the above referenced property as of February, 1985. Lot 20, as
shown on Plan Book 239, Page 131, has been owned since 1979 by Richard
Setterlund and his wife. Lot 18, as shown. on the same plan, has been owned
since 1984 by Linda A. McKnight and Rosalie L. Giannini. Fran 1978 to 1984,
Allen J. White and Janice M. White owned the property. Both of these properties
abut Lot 19 and are located on either side of the said Lot 19 on Elliot Road.
. To the rear of Lot 19 are three abutting parcels of land located on Lake
Elizabeth Drive (formerly Strawberry Hill Road Extension) which are shown as
Lots 7, 9 and 8 in Plan Book 118, Page 3. Lot 9 has been owned since 1979 by
Kevin B. Shearer and his wife. Lot 7 was owned by Alice T. Smith from 1955 to
April 26, 1985 when she died. Finally, Lot 8 has been owned by Louise A.
Pillsbury and Leonard H. Pillsbury since 1954.
Lot 19 was owned from 1974 until 1985 by John E. Barnard, Jr. He sold the
property on January 31, 1985 to The Nowak Family Trust which in turn sold the
property on March 28, 1986 to Ronald and Daniel Landr . It ids y, express
opinion that as of February, 1985, the owner of. Lot 1_9, Elliot Road;-
Centerville, owned no other abutting parcel or. parcels of land:-
Sincerely,
!Mark H. Boudreau, Esq.
Law Offices of Philip M. Boudreau
' 396 North Street
Hyannis, MA 02601
775-1085
Assessor's office (1st floor): ]
oRr / �F 7N E TO
Assessors map and lot number ............................................
Board of Health Ord floor): C ,................
Sewage Permit number ........................................ 3 Be8a9T/1DLE, t
Engineering Department<(3rd floor): -� s rb 9
House number �0 39'
,sue
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 ......................�� .kd� �N� ...................................... .. ..
TYPE OF CONSTRUCTION ....... .. .J.t .... ./7 rC.... � � �T
..... ....................... ...� ...........................
/
Z Ea 'i
....�................ ........................
TO THE INSPECTOR OF BUILDINGS: '
The undersigned/ hereby applies for a, perm:Lt according to the following information: j
Zo
Location ...................................•.................;.....................�..,...........................................�'........................................................(r..
�/^� 1 ......���ii ..... ..�v
Proposed. Use ....................:....
................. .......... ..................................................................................
...............Fire District ......
Zoning District ......�..�.:.................................... ........................:...............................................
....
A44)?Mj/+/i.4��Address y�r' �� !— , • iV fa.� N ✓/� • � I�Y J j/1 9 M 1"'I �
Name of Owner ..Address ............. ....................��......................dl..11114MI.... , �!? /�!`�,...Address ..
Nameof Builder ; ........... ................. .)..............................................
Name of Architect ................................Address ...................................................................:.ti....:.........
.................................. /`
.................FoundationU/I s
Number of Rooms / ..................................... ..!..`s.........�d P /
- t'i! iA/ ' L'5
Ex1e for ...Q-/A e&A R ` ......Roofing ...t...................................................`................... ...
Floors ................. Interior ........................................
Heating .. ...........................Plumbing f_.
....... ...........................................
Fireplace . .............Approximate Cost J
Definitive Plan Approved by Planning Board __ ____ _________19 /___'__ . Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
f�;y
t C1q
. A .
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 ........... / ...............................................
0C>t3282
Construction Supervisor's License ....................................
LANDRY, DANIEL & RONALD A=227-90
No ...29288 Permit for ...Two Story
.................
Single Family Dwelling
...............................................................................
Location ..Lot #19, 274 Elliott Road \ ',
Centerville
Owner Daniel & Ronald Landry
Type of Construction ...Frame
................................................................................
Plot ............................ Lot ................................
Permit Granted May 2, 86
Date of Inspection ....................................19
Date Completed ...................I...................19
P
,
c
./ �
r) Map Parcel c?P� V Permit# �:?
House# a JS Date Issu Z V
Board of ealth(3rd floor)(8:15 -9:30/1:00-4-50 � � �iQ Fee J
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) al&Pik SEPTIC SYSTEM MUST BE
Planning Dept.(1st floor/School Admin. Bldg.) INSTALLED*NINCE
. WIT
Definitive P ed by Planning Board 19 ENVIRONMEAND
01
1.
TCti�' M Rs
TOWN OF BARNSTABLE
/`� Build' Permit An ication
Project Stree ddress 77t, F///D A�
Village di /
Owner -rkla+,-le 1/0 Address
Telephone 7YO
Permit Request 0Ln d!af t1gVr5�j y =fk�1f�
7ti 1 Leo /a C1-4
First Floor square feet Second Floor square feet
Construction Type l/l�®aq� ;�`�rd��
Estimated Project Cost $ 5-0 4D.0-6
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑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
No. 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 ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name`` ��� /� Telephone Number !��D 02S__3
Address /D Carol License# 00 �7/d
4Ur l0 . Home Improvement Contractor#A25QW0 &45�d'1r
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRU ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0
SIGNATURE C% `� DATE / A14--
BUILDING PERMIT DENIE FOR THE FOLLO G REASON(S)
�-ef
FOR OFFICIAL USE ONLY
PERMIT NO. ' �J � � , ..= , _ ,„ - ! , - .'' '- • f .
Dr►TE ISSUED: ,' .-- ..�rt ^� �y a f �. - ,' ,• • _ ^, .. ' . . • f'1 :- �• � ,+
MAP/PARCEL NO. 41
` rS° f MM1 i �,�_{t Y-t •• � t r� •• _ ; a N yr � � •` P.r ..• ,E .
ADDRESS VILLAGE % .
OWNER
DATE OF INSPECTION:
FOUNDATION= / ps / { " ► I ` i _ y.
FRAME
INSULATION,
FIREPLACE
ELECTRICAL: 3 ROUGH FINAL '
PLUMBING: W ROUGH FINAL a,
GAS: , e —�IiUGH FINAL
FINAL BUILDEbN'C'r X : �?✓1, — /j
r I
DATE CLOSED OUT f '
ASSOCIATION PLAN NO. rJ
77
The Town of Barnstable *
De artment of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Ralph Crosser
Office: 508-790-6227
Building Commissioae
Fax: 508-790-6230
For once use only
Permit no.
Date W
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 Work: �/ � Est.Cost
Address of Work:
Owner's Name.�d�' �� '` a//a �
Date of Permit Application: % �Y
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under SI,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 agJapermitastheagentofthe ner:l �Y
Date Contractor Name Registration No.
OR
Date Owner-s Name
The Commonwealth of Massachusetts
n;l Department of Industrial Accidents
Office 9UHMS99affalls
600 Washington Street
,oston Mass. 02111
Boston,
Workers Com ensation Insurance Affidavit
a���vr�rr�r���i r nrrri�rrrra��rviiiiiii����������������������� :� raii�;�rr�'�'r�%����������������������������������%:���•,
name:
location o27V /o
city 6,4,y( / c" phone#
❑ I am a homeowner performing all work myself.
I am a sole roprietor and have no one workin in anv caparr
city
❑ I am an employer providing workers' compensation for my employees working on this job.
com anv name:
address:
city phone#:
insurance co.
olicv,#
//////////i/////////////ai////////////i/i//,/ai/i//i%/%/////%///////i////////////%/%//i//%/////////////i////i////////%i/i�///%/%///////////////////////////
❑ I am a sole proprietor, general contractor, or homeowner(circle one and have hired the contractors listed below who
have
the following workers' compensation polices:
company name:
address:
city
phone#•
insarnnce ca. olicv#
F//////////ii///////%/////////////m///m///////////////////%D////%//////////////%////i////i///////////////////////////%//////%///////////////////%////////////�/%/////////////////
cam anv named
address.
city-
phone#r
: .
insurance co. olicv# '
FFMM
Failure to secure coverage as required under Section 15A oCMGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against ma I understand that a
COPY of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification
1 do hereby certi der the pai anti penalties of perjury that the information provided above is try,and coned
SignatureJ6�
Date G/M—M _
Print name `t�'"(�ti ` I i !-� phone#
official use only do not write in this area to be completed by city or town ofndal
dty or town• permit/license is Budding Department
❑Licensing Board e
response is required ❑Selectmen's Office
❑check if immediate reap ❑Health Department
contact person phone#; ❑Other��
(tensor 9,95 P1A)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers.to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity,'or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
` Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
subr::itted 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. Please
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 give us a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents ,
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
rr
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c.
WITH A Nr'" MnRTGAGE AND IS NOT INTENDED OR REPRESENTED TO BE A LAND OR PROPERTY LINE SURVEY.
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The Town_ of Barnstable
'• 9A ARR6
MASS. Department of Health Safety and Environmental Services
039. �0
�Fo�►�. Building Division
367 Main Street,Hyannis,MA 02601
Office:' 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of.Inspection
Location Permit Number
Owner Builder
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
Mt
Please call: 508-790-6227 for re-inspection.
Inspected by
t
Date t�,