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0080 GUILDFORD ROAD
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I . . Engineering Dept. (3rd floor) Map Parcel _7,Armit# 1q9,24 House#• Date Issued ,hoard-9f-He i L3rd floor)(8:15 -9:30/1:00-4:30) Fee Conservation Office(4th floor .6a- .00) Planning Dept.(1st c ool Admin. Bldg.) THE D v pproved by Planning Board 1 �; HARNSTABLE. MAS& TOWN OF BARNSTABLE 'f°"`''�� Building Permit Application Project Street Address K2 &y� Village 026L _ - j Owner ( ��M�P�. t'F(v�cSi C,Vt��� Address 6 ,� e Telephone Z®l 5-r l( Permit.Request r Q__ First Floor square feet Second Floor square feet Construction Type - Estimated Project Cost $ . 2 S-Z.-1Z1 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 r 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) �J ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ • Commercial ❑Yes ❑No If yes, site plan review# Current Use flu rc-&l Proposed Use Builder Information Name 2U( d�-+ Jam^ - 7 SS - 5 Telephone Numb � �- � � p Number Address ?O ��Jn.fir� ( � �✓�,J� License# C S 00z- �` wJ S Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,,.s 4�4-- &Jqr"/i SIGNATURE U DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. �; 24 DATE ISSUED MAP/PARCEL'NO. ADDRESS VILLAGE a , OWNER - DATE OF INSPECTION: FOUNDATION FRAME _ INSULATION ~ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ?2 ASSOCIATION PLAN NO. -�HOM£:�M ROVEMEN CONTRA yF,GISTRATION Board .o.f.._. Buf1dinae equ.,� ne 301 45tandards Roo1 One-Ashbur.ton;Plac . i Boston. Massachusetts: O2108.; i HOME IMPROVEMENT CONTRACTOR Registration 104428 Expiration 07/14/98 ! K. c Type - INDIVIDUAL. HONE INPRQYEfIENT CONTRACTOR ;� i Reaistratioo- 104425 RUSSELL. A. GIBSON.JR. ! Type - INDIVIDUAL Russell A. Gibson , Jr . Expiration 01/14/48 70 Country Club Drive =` Cummaquid MA ;02637 i RUSSEIE A. fiI850N,JR. &"411 A. Gibson, Jr. 70 Country Club Drive AOAM*MAIOR Cussagvid MA 02637 �FTHE P, . . °: The Town of Barnstable axatvsres�, � . 9q� 16 5 96. ,0�' Department of Health Safety and Environmental Services prFDMA{a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only, Permit no. a Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: R — R.,o'r-,✓i, Est.Cost er Z) Address of Work: Owner's Name L) t"Ci,S �- Date of Permit Application: 1 hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 apply f a permit as the ageylt of the owner- Date Contractor Name Registration No. OR Date Owner's Name The Commonwealth of Massachusetts •+ i� `'-_-_-=�; :: Deparlment of Industrial Accidents �6; 4lfice of/ffyestigations 600 11'a.vitin,won Street .- - Boston, A1uss. 02111 `- ' Workers' Compensation Insurance Affidavit •A�inlicantrtnforrnation• `� __ �"�'�'�'� � •'' - '" _ •' /!/ •Please PRINT lebi lv ,� ,-'� name• S SG Y� l9-c �Szs CN location: city nhonc# ❑ I am a homeowner performing all work myself. �m a sole proprietor and have no one working to any capacity ,•« - ss! ,a ax •'�-�. -.a:a�-..�7'r.imxa..:r-s .7�a+^�53+'a�^^�sB:Y?'��=,r+,y.,.! .,�. rrea�'p"'.. ..�?�'�'. T` �r --- .e.�:,.«:,«.a:�.�a:�Mv:..,,�:r.,....,� ,_ .A:b..�:v.�ra+sii..._.s�.r-z `..rw���1R�,„��ss::_:���.,���i :..s..ah��:a�.�.".'.,'t.�.i... ....•,..__�._�.�...... I am an employer providing workers' compensation for my employees working on this job. r: company name: ef= .. address Q` X city �•-- �.5�C �!/"�7 phone#: L Z - ee?Zia inurnnce co �` '? �.�` policy# O -2_56 t:,_.,..._:�..�....:.�__..._.a.;.•�.:...._..`....._,...ice.:..,.... .. �_..;.i,,'"�"i�°�..-,,, .. ,.; ..y...s.` -_- - - -�.r.1w�.,r.Wv,....:��srn:.ues,:,>�r. ; -_ . . ..:+.:._.��_ 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#• insurance co policy# _ � .. an:.T,;, .r`�- •r. '-S �' ..... .. "'T ST nty.�...^n;.rsa;;fr rv,"�'�'�a� �' "��' rr 3::-.w,:i•',T •"c"" „" '�' _...y._...._-..._.,...�.,..�..._.__ ......s_n• - ....- -...u.�a:sW�:s.:.z.'�.S.�;i�:t.iia.r'87L "�.+.+�.an++r�u• .a.:�.�::rs. company name: add ress• city: phone#• insurance co policy# _ 'Attach addthonal sheet tf neccssa��I ._.:�#w.il��. �J,•'••^�•f t•W3cvLY ""�' 'v�rJL111 Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or oneyears'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certi r under the paiin,^s,A,Aand^^penalties of perjuty that the information provided above is true and correct. Si-nature ✓4A IG ��V' Date Print name Phone# .: official use only do nut write in this area to be completed by cih•or toH•n official city or town: permitAicense# rilluilding Department oLiccnsing Board check if immediate response is.required c3Sclectmen's Office to C311calth Department contact person: phone#; nOther ,revised 514;P1.A) _ i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an e►►►ploree is defined as every person in the service o1 another under any contract of hire, express or implied, oral or written. An e►►►p/oVer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of t:he 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 ,rounds 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 rene��-al 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. -r 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 as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. 7-7 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. r au+:-„•+,. ..,...,_. .._.,.•_.,.,..-,,... ,--. ..:.>µ.s-r+t •.�... w-;..,,,e,,. ,,....+r..ra;••n+^na+o,.x,.,;..•«:r.se?..:i.�v+�....,-.,-•• n v. �rnnv'e.ava. .sroszrr. -rr- -+�+wwwf�^�..swr' The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations - 600 NVasliington Street Boston,Ma. 02111 fax 4: (617) 727-7749 phone 9: (617) 727-4900 ext. 406, 409 or 375 Assessor's map and lot number .....�. ...... .A:-.` ........ . c THE o F t� Sewage Permit number .............................. r. :...... Z EAWSTADLE. i Hasa number 900 MU \0� 9 am TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ����✓ �,.................................... ................................................................ . TYPE OF CONSTRUCTION .......r-vO0.� �iE?A�7� ..s.......................................... ........................ ............................................. ��/�1�� `�S .:. 19. E.... ............. ..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location C� „t- Ui .�,n �7 �! -.�.a-. . '�/�r-/�= - .:��''.:s.. '...................... .. ..................................................:.. _. . Proposed Use ..............................5/ �,rt •................................................................................................................................... ............ Zoning District ' y Fire District .r. ............................................................... Name of Owner .C�G-t' G�....`� `E'TG Address . ..�:{./a� `�.t?/� . .. L"c�"h'�L-�'L�C � ..... ........................................ .............................................................. Name of Builder �...��1�-sue .......................Address ............/` ...4 -��;�..:......................................... .............. ..................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..............................................................Foundation ./ Get..C......................................................... Exterior �L=X7'L�P� S"�''# ,9G?' .....................................................................Roofing ...,::.......:....................................................................... Floors ..... .....................................................Interior... Heating :�D.vE .r,/.a .........................................................Plumbing ....... ir, - Fireplace .........../D.ves�........................................................Approximate Cos��.40 .. ...................... ... Definitive Plan Approved by Planning Board -----------_-------------------19--------. Area -`...... ................................... A Ga+ Diagram of Lot and Building-with-Dimensions 'Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 1 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................ ``..................... ' ' N0 y72 _ �?' Bartley, �e�a�d � � No '.aQU.J..�. reNnii for ..Additm..tVdwel. � _ —^---------~---^—'----^Locohon .��'�u�]'�az�i.Jl�.----------------------------- Owner ----..�eraId..Har.tley.`------. � Type of Construction —�ood-Fcaoua-----. � --------------------~----- ' � Plot 2.72--'�?........ Lot ----------' Permit G,on*yu A, IT REFUSED EF US ED ......................................... --. .......................... °� � —.—/-��- ....................' �� . --.. � - y / / / � .............................................................. ............... ` ----~----~—^~'----~^^—'— '--'' Approved ................................................ lg -------'-------^--'---'-----'' � ------------------~—^^~^—~'— Assessor's map and lot number .......... ������ C /0 THE Sewage Permit number ...........G� ...0!l.! .4t.���./✓ G SEPTIC SYSTEM MUST BE = ]SAWS-TABLE, i INSTALL Co ;'6 Ho number ...............................................`........................:: INSTALLED IN C LIANC 90 WITH ARTICLE 11 STATE o oeara�e SA TOWN Of BARNISTIiI.X1 ��'D TOWS BUILDING, AMPECTOR APPLICATION FOR PERMIT TO :..... .................... .... r..�...yt.�............ ..........................:. ...... ...�. TYPEOF CONSTRUCTION .......� ��� ���'A��................................................................................................................... mo TO, THE INSPECTOR,OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... © �7.U/.Gr'"'0�� �� 4305 !v �// -S' �. .. ............ s r................... ProposedUse ......�ES/;G.Cy....-:.................... .. ............................................ .......................................................... Zoning District ........ !....0..................................................Fire District Name of Owner ' ...................... .........Address ;,,, fvTL 'L1G4✓ Name of Builder ' /Gy... Hi!fS�ir1........................Address .........../` Y.? N.c.....s............................ ................ Nameof Architect .......`..........................................................Address ............`....................................................................... Number of Rooms /.............................................................Foundation .ASAL '! '........................................................ Exterior /1/...........................................Roofing ..., -5 �?...` iit/�r� ................... Floors C�}iE'/��`T•.....................................................Interior .................................................................................... ......... ................... Heating .........lvjei^.. .........................................................Plumbing ....... .4. ......................................................... 010 4 .. Fireplace ..:....... / ........................................................Approximate Cos .. .................................... ................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ..,2 3�........................... Diagram of Lot and Buiftling vvilh Dimensiens Fee O SUBJECT TO APPROVAL OF BOARD OF HEALTH 01 b r �FSS moo Sc. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...........................`.`...................... r � � 172 57 ' Bartley, Gerald y i � � [ � No � P61knitfor Add.!.n..to..DwelIing � � / -------------------------- \ Location 80..Guil.ford..Rd_---------'' ^ ' , .................Camtmxn;ille................................. Owner -Gau:ald-.11art1ey................................. � Typo of Construction -.�ood.'�xarrie............... ---�-~--.--.�--------------- . . � . . Plot -�.72......§>7....... Lot.. .............................. - | Permit Granted --..Jel��-���----._lp 78 ` ^ � . Dote of Inspection . ...---]g . .. Dote Completed - ���----.]9 ' PERMIT^ �~ REFUSED � ' ^ l� - ................................................ ' �---'' '' � ' ...-_'�-....`--.'.�--.-----------.. -..--.�--......`..--^--..-------. ' --.r...�`-----..~-..--....---.. � .. --------^'~^^'-''--'--~-^------ / ' � zr _ -_.�------------- lQ ^ - ' -------.-------.--.-..---�.---. - . ` ................�,............................................................. - ~ -