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HomeMy WebLinkAbout0197 GLENEAGLE DRIVE S' »e _ �� - { R s . �; `o _ o . r - �- - - - _ __ -- _ - _ _ _ -- -=u r to IVbI d 1)14 ® // VE Town of Barnstable *Permit# `� Expires 6 months issue date �7 Regulatory Services Fee snxxsTneLe. • . v� 16 Q. `0� Richard V.Scali,Interim Director QED MA't� � Building Division ®m® RESS Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 4` 2.. www.town.barnstable.ma.us Officer 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTR h S M13LE Not Valid without Red X-Press Imprint Map/parcel Number /C/ y/� Property Address * ' l 7 (y'u—P F—A-6-Er cr— D 1i, Residential Value of Work$ &0 0 a d U Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address X/y APV A-M e i$N f l 7 7 6�F-rP ,6h iw-z-F— x� 'C - rf-r V11,cF Contractor's Name—D Telephone Number ;j 08 S` 6 3 31-21 � Home Improvement Contractor License#(if applicable) ] q 6 Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque heck box) - ® u016STTij2 f �,4C-CVM BC KJ O AR Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 061 h' ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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 requ . SIGNATURE: � CJ QAWPF'ILEST'ORMS\building permit forms\EXPRESS.doc Revised 061313 ti a _ .7'he Camrnonwealtrli of Massachmetts Department of Indushid]Accidents Office of Investigations 600 Washington Street Boston,MA 02111 n,mv.mass gav/dia Njorkers' Compensation Insurance Affidavit: Builders/Con i s/Plumbers Applicant Information Please Print Legibly Name gks nessrD pnizationllndividuai): - Address: City/Stag! :E- - Phone,�- o(9— (ply--3� Are you an employer?Check the appropriate box- Type of project(required)_ 1.❑ I am a employer with 4- �am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-cmtaactors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- w❑Remodeling ship and have no employees The sub-contractors have g- ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition. [No workers'camp.insurance comp.insurance.I 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 11.0 Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required.]F c.152,§1(4X and we have no employees-[No workers' 13..0 Other comp-insurance required-] *Any applicaar d ut checks boa#1 mast also fill out the section below showing their vm&ers'compensation policy inim maticm I Homeowners who submit this affidmv mdicatmg they are doing all woo}and then hire outside contractors must submit a new affidavit iu�i"�smcbL f Contractors that check this boat must attached au additional sheet showing the name of the sib-contrscton and stare whether or nut those entities have employees. If the sub-contractors have employees;they must pmuide their workers'comp.policy number. -Taman employer that isprmidIng workers'conUmnsation insurance for my enrplo;ves. Below is the policy and,job site infor id on. Insurance Company Name: A—,LAW7-7 c- �f/��i'•�iZ"7'Z' Policy#or Self--ins.Lie.#: WC/DD'7 2 02OU ' Expiration Date: Job Site Address: G 7 �9-� City/State/zip:wrx i f-L4,F Alf� 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 pe to ties of a fine up to$1,500.00 and/or one-year imprisonment,as well as ci-dl 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 a DIA far insurance coverage verification I do hereby cfj4 under th, 'ns and pen " re7dury that the information prarRtd abmv is lure and correct Si Date: — Phone 9: 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 3.Binding Department 3.Citylrown Clerk 4.Electrical Inspector 3.Plumbing Inspector 6.Other Contact Person: Phone#: 6 WORKERS':COMPE A31ON ANC�tPLOYER CAB L� �N lRAtVCf PQt CY _ Atlantic Charter Insurance Company VDAC NC'-Cl Co. No.:29211 Policy Number. WCV00730207 1. INSURED: Prior Policy Number. WCV00730206 Tyndall Roofing, LLC Producer. 30 Brigantine Avenue Fredericks Insurance Agency; Osterville, MA 02655 Federal ID Number.204616445 Inc. Risk ID Number: PO Box 427 Osterville, MA 02655 Business Type: Limited Liability SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Otu er Named Insured: Other Work Places: A. POLICY PERIOD: The Policy Period Is From: 7/11/2013 To 7/11/2014 12:01 A.M., Standard Time at The Insured Mailing Address 3. COVERAGES: Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500:000 policy.limit Bodily Injury by Disease $ 100,000 each employee C. Other States lrsured: Part Three of the policy applies to the states, if any, listed here: j y•yf' ;COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B This policv includes these endorsements and schedules: Sae WCE 105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium:. $500 $500 I Interim Adiustment: Annually Servicing*Office.- Estimated Premium (Minimum Premium) $500 25 New Chardon Strut Boston, MA o2114-4721 ZYI� !slue Date 06.,24/2013 Countersigned By: Date Copyign 19£'National Council on Compensation insurance Fora: 100mv Town of Barnstable 0 Regulatory Services • �.;texsTas[.� Thomas F. Geiler,Director wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862 4038 Fax: 508-790-6230 ,i Property 0-vmerMust Complete and Sign TlLis. 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 application for. a2 (Address of Job) Ze t 4S,*gnatuxe of Owner Vate' OI . V1 Y14 > 1(1C 1 Prat Name If Property Owner is applying for perrr� t please complete. the Homeowners License Exemption Form on the reverse side. i r a1n;8u-2ls;noy;!A&p!IzA ION CJeaaJaas�apufl 9E92J bW 'H1novfly-�1Sd3 80 M31A MOad3W 9Z (/ 983M'QIAda >YTZO V uo;sog NOISIC]13b'yO gum I OLIS aj!nS-eze[d)I1ed Of H94 o60Z/8Z/8 .,uol;eJldx3 s uol;e[n2ag ssaulsng pus sne33-V Jaumsuo�ro aag3O :adltl 99L6 C4 uogeJ;si6a .. I :o;u1n;a1 puno33I 'a;ep uol;ea,dxa ay;6lo3aq ;d01Ob211NO3 DJIMIGAO2icl l 3W0 i[vo aSn[nplAlPUI•JOJ pgeA uol;eJ;sl2a1 10 asuea!j ❑ot;ejn2ag ssantsng 7p sne iawnsno o aa� '��F772NJ;t7FF7YJ//� 33.E . ' 3 330 ���yvn D2lG2LG0 �a Unrestricted Buildings of any use group which contain:less than 35,000.cubic feet (991m3)of enclosed space. , Failure to possess a current edition of the Massachus St e State tts eB Bu ilding'Idi ng Code is cause for re vocation oca 't io n of thi s 'li ce n s e• For DPS Licensing information visit: ::www.Mass.Gov/DPS 9 Massachusetts - Department of Public Safety Y Board of Building Regulations and Standards Construction Supen isor License:.CS-046189 DAVID H W EBB '. r. 24 MEADOW VIEW DR ' E FALMOUTH MA 0 536 Expiration Commissioner 10/29/2014 Town of Barnstable ar stable Permit# Fxpires 6 months from issue date H Regulatory Services Fee M BARNsrABLE. MAss.39. Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address IV 7 G�er1 GHQ : pr%JQ [Residential Value of Work ,5(jv v. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address : lot')04ne MaAf"n� (17 Contractor's Name S a-V^ On W—S Telephone Number ?1 `/ 3?63 2 7aiZ Home Improvement Contractor License#(if applicable) 105 7i!� Email: 9l Vva r n%T gt(na ,44, Construction Supervisor's License#(if applicable) C5 - X-PRESS E 'T ❑Workman's Compensation Insurance NOV 18 2013 C eck one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Re �Replacement Windows/doors/sliders.U-Value J� p a� (maximum.35)#of windows #of doors: L ❑ 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 ed. SIGNATURE: QAWPFILES\F0W8t ding permit formsEXPRESS.doc Revised 061313 27m Co rants altth qfMassachusem .I? Ott of 2ndhst6d A+cd ts' O c fin"atrgntiem 6W WkhingtvnSbwt stars,M4 02111 WWMWaM2V Workers'Corawnulim Lnurance vit-.Biers/Cwh-A nrs �dan&Plrut)dnbers Applicant Infannation Please:Print Lm*b Name � picr%S Aess CitY/StaftzP-JAZtc"e,,,j!az #: 7?H 353 �7o Are you au employer?Check the appropr to btu TRm of pnJect lr t tdl: 1.[ 1 am a employer with, 4. ❑I am a VmeW contractor and 1 6_ ©New cros ucfim emsplo (fW an&,or * have hared 1he sub-rouftac tms ama ale progrio or on ft attachl , WRouWalin soul has�e roo a Sloy Thor have 8. 0 Demolition woelcing for me in any employees and have [No wodm'comp.ice comp.at=x*W*.1 n*drefl 5. ❑ We are a coqxmtfionand its 10.n Elechical repaim or salftons 3.[]I am a homeowner doiag all wok officers har,e Wised ter 1t.[]ambit& o myself ° camp. of 1v GL ac]Roe l [No wmbeW 13.0 Odd camp-inwanm reTAred•] *AU q?Y it etesb=#1=W sw till am the wtim belowsbowagt a wo&*W=Veamn polky jnk=S&& , a tt�y +i stl croak aunt ttreab9le ttmst submit a snth, k%Att "I check teas bu mast Mcbed asaddhoul%beet aww*themm oaf @t subcasnamn=4 sun w taes*ase sadtksbm -vbrym lithe-b4camcwnhwe wqamesthey muupvYw&wwwkm'Wmp•VoIky=tbw lam on emPk'frtiWisPm"Wworkm'cvMmmfionimumneeformymwloyom Btu Is thopoficy a►sd,lob site in o a imL lnuuance,company Nam: Policy t1 of min:Lac isa Date. Job Site Addtess• Ciitpmuftzip. Attach a copy of the Workers'tomiwAmtfan policy dedwation p (shoes.the palmy number and expiration date). Failure to secoae cove a as rimed tamer Section 25A of MOL.c 152 can lead to the imposition n of criminsl penalties of a fine up to$1,50D.00 an&orione-year imprisonment,as well as civil penalties in the fimn ofa STOP WORKOMM and a fine ofup to$250.00 a day spiust the viblator_ Be add fat a copy of this statement way be forwarded to the mod of hmstigaticas of the DIA.:for insursom anwW verification. deter hereby ceW, pan pr vf 'dot the Dorm r WAW ohm is true and conad Silmalum �l 0RWsd aw ortt3. DO not inim in this MM to be"MOW 1W t*orto City or Tov= PermitfLiceme Issuing Authority(ale one). 1.Board of Health 2.Building Departutent 3.City/Town C t Eleictrical hqmdor 5.Plumbing Uspector 6.Other Contact Fersony Phone l 6 at�vs'raa�, • . Town of Barnstable ........... _-_.....................__ . Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must lComplete and Sign This Section If Using A Builder IE v C ,as O-,vner of the subject property hereby authorize �V 1A C�At'C\5 to act'on my behalf, in all matters relative to work authorized by this building permit application for: 19r7 AID ao -. J (Address of Job) Sigilatute of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. " T:IKEVIN_B1Buiiding ChangeslEXPRESS PERMIT+EXPRESS.doc� Revised 061313 �,lZe�anrineo�racueaCC�a�C�/�/ltWeac�icureGty \ Offic%of Consumer Affairs&Business Regulation License or registration valid for individul use only �'OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 163578 Type: Office of Consumer Affairs and Business.Regulation -Expiration �7/7:%2015. DBA . 10 Park Plaza-Suite 5170 `— Boston,MA 02116 HARRIS CONSTRUCTION'. F =, SHAUN HARRIS 77 23 HORSE POND RD W.YARMOUTH,MA 02673 Undersecretary Not valid without signature ' Massachusetts— ; — ----- __ ---_ — Board of Build' Department o wild f Public Safety Construction ing Regulations and Standards Supervisor License: CS-097W6 i . SHAUN 23 HORSE PONIYRO =s` WEST YARMOH Commissioner Expiration --. 04/11/2015 Assessor's map and lot number C\ � .. `.. —�T y 5 � 7 Sewage Per number `-......!..s�...................................... �� Qyo�TeE toy � {�COftiIIPLIANCE o TOWN OF BAR,NST- I II STATE 4 6ANITARY CODE-AND. TOWN Basa9TsnLS, o REGULATIONS.. . """` KAGL 9 .e� BUILDING INSPECTOR �0 m Or• APPLICATION FOR PERMIT TO .........�R ....... !'� 1�! i .....�L/ ...... A.11 .d?........................ TYPEOF CONSTRUCTION ........ ...................................il.............................................:..:.................... .....cA/j.. . ..` ..................19.73. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- LLocation e w /9 cat 4e )Ai-2. 1 .......0!�lve...... �° e+ . ro 11 .......&,q.gs.............. ocation ..................�:....................................... ............. .. // ProposedUse .....)S:.a.VI a.e ....... ..�.�.fR1��.�'�.................................................................................................................. Zoning District ....................... ... Y . ..t............................Fire District .... �.tt✓�'�P.! .!!/,�1. ..;:..�.1" .! .h,..! Name of Owner .......I ......�..41�l..�:/�..............Address ....DA.A-, ...... .....fvt.Ao .. C���`'�.�€,.�4��fc� Name of Builder ...AA.'.1d......... ...........Address ...'1�1.k.�P..!"?......5 .......... s..... Name of Architect .....�/.....�m.. w... 1.�.�s�� 9�L. ...Address ... ..................................... 1 / Number of Rooms .7.........v......3..la�i�l!/[ ....................Foundation .. * ....... ................ Exterior .....�.A.i.&?l...*s...n;.c . q..M...........................Roofing .....14.SIA. .............................a......y............... 1 0 Interior ....Qlf! ...... �. ��........� Floors ........ .. . .�,(...................................... (j Heating �. f C °°�: .I.. ..............................................Plumbing .....�. .E ........................................................ Fireplace 3 ........Approximate Cost f!.s.�. �d� Definitive Plan Approved by Planning Board -----------_-------------------19________. Area ........j................................. Diagram of Lot and Building with Dimensions Fee ` ��. ............................................. SUBJECT TO .APPROVAL OF BOARD OF HEALTH e i �r Cil Elre— Iq ��4 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. �`�.t.. Butler, Albert T. �wm No -����/��.. Permh for .-----.Sto............ -.-������..�az�����sv�u��z��---.----. � ` ��/ / �I�� �xizra ��conon ------..��.....-----------'Centerville ' ) --------^^----^-^---^------- - � Alfred Johnson ~ Owner ------_____--_________ � 1��zo� � Type of Construction -------------- ' ' ^ -----.--.-.----------------. � Plot ............................ Lot .....I8...& 39____ ' " � � � Permit Granted --.! P �� ��e------.-.]g ^ ~ Date of Inspection lV Date Completed 73.......19 � ' | l � [ ' PERMIT REFUSED . . -----------^----------'' 19 --------------------------. . - '--.-----...~-----------..---.. « ^ , � / -'----'~'-------``^^--^^-'----- ` ^ ' -------^---''r---'-----^-'---'' � ' . ` - ' Approved ................................................ lA ' ------------------.--.--..--.. . � -------'-----------`-^-'---- � � � Assessor's map and lot number .�g.. ...../91.�4"� �oT�� g Z. " 'ZP77C SYSTEM e� TA LED DST Se • Sewage Permit number .... ... ,..�...................................'�`-�G'�( c t�" A�7•pl;t � C "�r',LIAN c � �.AN 1rARY � r' �r!.IT� f ^!6! A- CQD� AND �PyofTNETo��o TOWN O BARNSTABLE`�"'S TD�N re +� Z 9AUST"L&, i 9� Dp9a, � BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............ ... . .......... ... . . .. . .. ... . ........ ................................................. TYPE OF CONSTRUCTION .......... ... . ... .. .. ....... ....... . ... ......... ....................................... ....... ...............C...... .........19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for�a permit according to the following information: q Location ....... ............... °4!/a�'S- �.r.... ..... . .... ......... ............ .................... Proposed Use ....... ... ...... .. ......................:......................... _ ......... ... ................................... ......... .. ...........,......................... .. .... ... . .. ...... ..... Zoning District ..... ........................................................Fire District .......... ....... Name of Owner ...�. Address �' �..... ... �........�9. ............ ...... ". .. .� Name of Builder ...G.,...... Address ......:...................................... �k�'[�'�.. Nameof Architect . .. :.... ...................................................Address .................................................................................... 't /1 Number of Rooms ...................................................................Foundation ....... ... Exterior ... ✓.tom.. .................................Roofing ... ........................................................ Floors ... ..................................................................................Interior ....................................................................I................ Heating ..................................................................................Plumbing .................................................................................. Fireplace .......................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board --------------------------------19--------. Area .....� ...5............ U Diagram of Lot and Building with Dimensions Fee ................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r4,ok 3�r t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. „ Name ... ... ..../.....:.. ................... ....... .......... Butler, A. T. No .A§648.... Permit for .......add breeze ............... & Sara.. to dwelling n dwelling . .......... Locatio i9 t Gleneagle Drive Centerville ............................................................................... d Owner .........A. T. Butler ...............:........................ Type of Construction frame .................. ........................ ................................................................................ Plot .. Lot ......18..&.19.......... .......................... October 11 ?3 Permit Granted 19 Date of Inspection ............... ......... .........19 Date Completed ...0 U.....19 ef /)We E PERMIT REFUSED ................................................................. 19 f ............................................................................... s ..........................:.......:............................................ Approved .................................................. 19 ...............I...._..........................................................