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J 12; 01
sy S�P�TIC SYSTEM
!INSTALLED IN COMPLIANCE
WITH ARTICLE I! STATE
SANITARY CODE AND O
- OF THE t0� TI
TOWN . ' DARN `TABLE
i EAR34ADL&, i
9� QpYa`e�, l BUILDING INSPECTOR
APPLICATION FOR PERMIT TO &dd AMi,li GI6... .!/..... �........ .1N......... ....................................... .. .... .....
TYPE OF CONSTRUCTION .....:.......................LLI.P.(J.0 :.. ..rQ, /n.`.:.....................................................................
....... ......................19. .73
TO THE INSPECTOR OF BUILDINGS:
The undersigned herebyapplies for a permit according to the following information:
Location ........... T.�..IQa- / �v Ili
. ....................6.�...e...... ........................................................
ProposedUse ....................... ..........................................................................................................................
Zoning District ....................1F.D..Z...................................Fire District ..4'.�'!V. .C.�'Y<���'.. ...t s- 1 /�
Name of Owner .. . 0. ?!7?��. .....pp.!}.^.,rf...... ......Address .....�:.....!..r!....�............. /V��r�, rl C............
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ..........�.........................................................................
Number of Rooms ....................Foundation FV 11 ).Q....... Gf �
.............................................. .................... ..... .....................
Exterior .......................... ........................................Roofing . ................ ........................................
/
Floors ......................................................Interior ..................d1.�j�' !al .1. .........................................
Heating ....................:....:............Plumbing .......................... ..................................................
Fireplace ......................</.........................................................Approximate Cost ........... V.� ��
...........................................
Difinitive Plan Approved by Planning Board ---------------_---------------19________ .
7/ 70 8
Diagram of Lot and Building with Dimensions Fee,
` - e
t Jo
ky JL4
1fo Ito
�0 U
hereby agree to conform to all the'; u es. .wnd Regulations of the Town of Barnstable regarding the above
construction. I .
Name .. -0,41-4.. lk<l ...............................
! ^ ,
Nmzmmst Ionuao^ Inc. .
.�/
. ~ ^
i
��?��
�-�' ' one story
No ................. Permit for ................................
----...........--
single family dwelling - '-�—
............'`..........,,........................,,...'.................' �
Inj M '
u I����
----'_ --------.---.—.-------.— �
Centerville
,.--.—..---..---.--.--^—.--------
/
D�oroa*st Homes, Inc.
� Owner ---....---------'--------'
! .
frame |
Type of Construction ------.-------..
.................
Plot ............................ Lot ................................ .
�' ��
Permit Granted ---����-----.--]V ^��? .
Dote of |nspection ............... ....... ..........lQ '
�
""'= C" "p==" "~ '
!
~
� .
. PERMIT REFUSED
............................................................ 19 ~
�
m '
..��_----.--------.----------..
'
_----.--.—.-.-------.----------.
_.__..___._.___..______~__.____.
!
---..~.---.--.---.—.^.,.-...^~----....
�
Approved
/
/
.................................................. lQ
| � �
'
'--------------^^'—`—`—^-----'
`
�
................
/
� >
/ '
______-�-T -_ �I
� ��
. �
��� ��
,�
��
. .
� _ . �
, -
Assessor's Office(1st floor) Map 1 17 2- Lot OS`�'I
it# _fw2 ff
� n
Conservation Office(4th floor) Date Issued
Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Lem
engineering Dept.(3rd floor) House#1 SEPT
F�, . ,��
�v� - BE
Pla ng D (1st or chool in. Bl ` ALLED 9 HCE
f W1�' .
De i ti a Pa proved Tannin oar � `' .,.
TOWN OF BARNSTABHONME
E ANDWN REGULATIONS
Buildin Permit A lication "F
g 4. �.._, Pp ,..
Project treet Address ZZ-6
Village (,2fo/i - -E: �t� `,
Owner LI�,/�: `'" Address (JA
Telephone Poo 6 '
Permit Request /02� /U Rot) lhve
�r__ .
Total 1 Story Area(include 1 story garages&decks) square feet
Total 2 Story Area(total of 1st&2nd�,sttoories) �,� V square feet
Estimated Project Cost $ 6d ie
d 0_,-(J
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family L/ Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.o`€Bedrooms
Total Room Count(no 'ncluding baths First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name � /J �� : Telephone Number
Address/-& dA O a e -License# (),3c •O
0,:77, Home Improvement Contractor# f
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS PTQUIRE 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
.422
01
SIGNATU DATE
3
BUILDING PERMIT DENIED FOR THE FOL OWI G REASON(S)
`° i
FOR OFFICIAL USE ONLY
PERMIT NO. 10299 ► ,
DATE ISSUED Sept. .13, 1995 1
MAP/PARCEL NOZ 172.054 r
110 Guildford Rd. I V Centerville MA 02632 i
ADDRESS VILLAGE ,
t
OWNER Helen Mullins & Agnes.- Mullins
i
4-, i
DATE OF INSPECTION: dv
'
FOUNDATION
FRAME Ir cl'��
INSULATION
FIREPLACE I- _
ELECTRICAL: ROUGH;,. i FINAL r
PLUMBING: ROUGH, I /FINAL
GAS: ROUGH: '"' ' FINAL
OfFINAL BUILDING
DATE CLOSED -
ASSOCIATION PjAN O. ''
f ��
5 ,��
i r
697
�" - rsr'1 `-.^":;gb� tr�e•.m •yhA
h:•'f ����W4W10llWetfO
Za�HooeaG�of
;z�� �•r,�� i��"�-�R a�`Pi.(c, ��ily r�t;::c=&n j
,IlIPROVEMENT.CONTRACTOR A,
v,v,108245 '` ;
N�r �TYPe ;INDIVIDUAL �� ��t _�w j
:i'.,� �� x remit��t�'vY ��`'•r-�Gry'�'iE'�`'< ;`
�u `E�zplration 08/14/96 p A1
Earle A TO e
vrW
o r8assett,Rd ,
Ckton MA 02401
ADMINISTRATOR
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY Failure to possessacarrent
OF Nassaehusetts Stateealidi"
ONE ASHBORTON PLACE Code is cause forroMparlon
MASSACHUSETTS BOSTON,MA 02108 of this//60nse.
I C E N a E CAUTION
EXPIRATION DATE T R. $U P F R V I S 0 R
09/25/1995 FOR PROTECTION AGAINST
RESTRICTIONS EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB
NONE o Cti/ J/1 993 03172r 4 o PRINT IN APPROPRIATE
BOX ON LICENSE.
L RL 7 4 LOV ELL o
Z 10 !N 0 3A S 5 E T T R D � BLASTING OPERATORS
m 3ROCKT N MA 024C1 Z MUST INCLUDE PHOTO.
m
PHOTO(BLASTING 0PR ONLY( FEE:
10 0.coo
NOT VALID UNTIL SIGNED 8Y LICENSEE AND OFFICIALLY 1 t
HEIGHT:. STAMPED-OR-SIGNATURE OF THE COMMISSIONER J U L •^�'
_
THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABO S�I�GNATURE UNE -
CARRIEDONTHEPERSONOF I EE - ; -_.I h,
THE HOLDER WHEN EN-
OTHERS-
RIGHT THUMB PRINT GAGED IN THISOCCUPATION. COMMISSIONER
,
The Commonwealth of Massachusetts
2. :j;:�, Department of Industrial Accidents
t /
` Office ofinvestiyations
600 11 ashitrglon Street
Boston Muss. 02111
Workers' Compensation Insurance Affidavit
Anplicarit information: �""� Please PRINT I'etbly`""•'�`�' '�"' `�"�"�` "`'""� �'•-'�
tam
location: 6
city phone#6t Y d
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
S :Z'«3„`" s--• z ..xw:w+ifi*5 ... _. ,. �'.. 'T"'.°sn'nT'Tf^L""'�2:T., u'�+�- s+rrc'�.C,.r..,^. xr:,.va,�v:
t._.....r..,:»...,..._.._.:�-.L »_:ot.,.z»ti. �'»w»'ar�:�,aecr�v:�.::. .5.r�..s�»:.,. ..,.z rc"�u':sy.: ;r:7dasee::.xa�:::.mars.�.i>:�x,s ��:;. na.+.»,.. .,- s � •r.,..,:�..s..,..,�:::s•...Ac._...:,..._.��;..:
I am an employer roviding workers' co5p5nsation for my employees working on this job.
con) any name: joO05 a61
address:
cit' hone#• �j
/t finsurance co. f olic•#
, ...+ :.- :_.sue* '...w x 3gc:t 4dn :fl'�YfCa,�S•.n ., �. .. ?y�W .r�wW�v.xuq^%w x a rtr-.r-
1 am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
comrany name
address
cih•: phone#•
insurance co. policy#
p�•rr�'` ,„ a r-
»..�...._»"a......_.-sue .-_. �... .t. .,..
company name:
address
city: phone#•
insurance co. . ...., police#
'Attach additional shcef tf necessa t:� �`f�.�� � � �` ��` '".`• �M""�""'�""°'^'
Failure to secure coverage as required under Section 25A of A7CL 152 can lead to the imposition of criminal penalties of a fine up to SI,SUOAU and/or
one years'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
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby cerd nder the pains,and enal ' s of perjury that the 'tformation provided above is true and correct.
Signature DateV
Print name Phone# 211-
official use only do not write in this area to be completed by city or town official
city or town: permit/license# 0Building Department
_ pLicensing!Board
I]check if immediate response is required [3sclectmen's Office
oliealth Department
contact person: phone#; r 1Othcr
�''''�as _.., s .aa.my , .,.. ...-,•.__ ::•, _. .h., ...� - r� "�=_ tip`.
(revised i'T 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", ail einplovee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An enrpl(►ver 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
d\velling 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. `
1
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.
Cite or To-*vns
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. Tile 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.
tr Ya�eT';v-+ ^'^- r m�a+icr. ,e rn mw,R �n•^�?e:'sue 7�•sv.�q.m•.:x+raaaexaa�•;�v.+sRx,^-sri:r.fir+.,u X".. >s�*v>:aa^rz-�+�.lra '.rr. er,+uc�.w.r+ +vsran�
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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
TheTravelers"j''
The Travelers Companies
Gateway Center
1000 Legion Place
P.O. Box 3556
Orlando FL 32802-3556
August 9, 1995
LOVELL, EARLE W JR D/B/A
LOVELL CONSTRUCTION
10 NORTH BASSETT ROAD
BROCKTON MA 02401
Policy No: 7PUB 809K937995
Effective Date: 07/25/95
Dear Customer:
The Travelers has been assigned as the Servicing Carrier for your Assigned Risk Workers'Compensation
Insurance.
We have received your application and check. Your policy will be issued within the next 30 days. In the
meantime, if you find it necessary to file a claim or communicate with our Orlando Service Center,please note
the following:
For Claims Reporting: For Policy Services:
1-800-832-7839 1-800-842-9886 ext2937
Travelers Insurance Company
CL Residual Market Division
PO Box 3556
Orlando FL 32802-3556
Safety and Loss Prevention are critical concerns to any business. We have long been a pioneer in the field of
accident prevention,having the experience, resources and capabilities to provide a complete range of safety
services. Your policy will include more details regarding these services.
Please make a record of the above policy number and include it on all your correspondence.
WELCOME to TheTravelers! If we can be of service,please call.
Sincerely,
STEFANIE SPELLMAN
Account Specialist
CL Residual Market Division
Orlando Service Center
cc: CELIA INS AGCY INC
84 WEST ELM STREET
BROCKTON MA 02401
The Town of Bamstable . .
Department of Health Safety and Environmental Sez~�
Bufldh g DivisiOII
� e
367 Main Street,Hyatmis MA M 01
Ralph C
Off= 508-790-6227 Buddin{
F= 508--775 33"
For eftce use oaly .
Permit no.
Date
AFFIDAVIT .
HOME 3wROVE=NT CONTRACTOR LAW
SUPPI To :1111 'T APPLICATION
MCI.c. 142A=quires that the"taoastrnaron,aitemrioas renovation,rtpaiz; °a'coavc
imprvveanextt, temmal, demolitim or aoa of an addition to day p owner occ
bOiIding cOmaining at least one but not mote than four dwaMng netts or to strvClures which are adt
to such residence or building be done by registered oautzamom with aatain c=cptions, along with
Type of Work:
n / r
Address of Works//C
0
Owrter.Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following imson(S):
Work c=iu fm by law
Job under$1,000
Building no,owneswocapied
OwncrpullingamMmil
Notice is hereby given thac __ COI�I'['R.AC!
OWNERS PULLING THEIR OWN��T W�OIutG DO NOrf HAG�CESS 'f0
FOR APPLICABLE HOME 2
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A
SIGYED UNDER PENALTIES OF PERJURY
I hereby apply for a as the of the a ester.
Date �j 9
C.ontractar name No.
OR
it