HomeMy WebLinkAbout0194 JAMES OTIS ROAD �� ��� � ���� aTc 5� � ��
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Town of Barnstable *Permit o C)
I Expires G months from issue date
Regulatory Services Fee 40,_!57C)
X—P R E S S PERMIT Thomas F.Geiler,Director
Building Division '
J U L 1 3 2007 Tom Perry,CBO, Building Commissioner
TOWN OF BARNSTABLE 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 1
Property Address f meS 6)7;`
❑Residential Value of Work qi
i.. Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address v(Oqq
L/ `f
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Constructio upervisor's License#(if applicable)
orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Comp
ensation Insurance
Insurance Company Name
Workman's Comp.Policy# AA/C-+o1� 0qj
Copy of Insurance Compliance Certificate must be on file.
Permit Request(ch box)
e-roof(stripping old shingles) All construction debris will be taken to d
❑Re- of(not stripping. Going over existing layers of roof)
Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner mus igR-Pre erty Owner Letter of Permission.
A co y of ement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
' The Commonwealth of Massachusetts
Department of Industrial Accidents
2 Office of Investigations
a
' d 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers'Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
Name(Business/Organization/Individual):. (l�C(vtiUlr ®�?e
Address: ® Co fi
n
City/State/Zip: Z-111 Phone.#:
Are you an employer? Check the appropriate bog: Type of project(required):.
1.FT am a e to er with 4. ❑ I am a general contractor and I
Y 6. ❑New construction .
e yees(full and/or part-time).* have hired the sub-contractors
2. am a sole proprietor or partner-
listed on the-attached sheet. 7. ❑Remodeling
ship and have no employees 4 'These sub-contractors have g• ❑Demolition
workin for me in an capacity. employees and have workers'
g Y P t3'• #. 9. ❑Building addition
[No workers' comp.insurance comp.insurance.
" required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11. Plumbin repairs or additions
3.❑ I am a homeowner doing all work ❑ . g P
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 fin 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.
I am an employer that is providing workers'compensation insurance for my employees Below is.the policy and job site
information. P
Insurance Company Name:
Policy#or Self-ins.Lic.M l Expiration Date: �1 -40 0
Job Site Address: /�r"I�.1 ��c" �. "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 hereby certify ur r t1 't rrd p s ofperjury that the information provided above is and correct:
Signatture: 4-
Date:
�.
Phone#:
Official use only. Do not write in this area,to be completed by city or town ofciaZ
City or Town: Permit/License.4
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 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."
McjL 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 in-�ance
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,it
necessary,supply sub-contiractor(s)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 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 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 permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license 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 burn leaves-etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate tc give us a call.
The Department's address,telephone-and fax number:.
The Commonwealth of Massachusetts
Department of lndus6ai Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
plif
a *
P.O. Box 311 508-367-1679
Centerville, MA 02632 WR U C TAT®N Fax: 508-790-1856
PRO SAL SUB TTED TO: PHONE: ()ry ^ DA
0 � Q� iV1'l ll V��/ CJX
STRJEJ 4 C �I JOB NAME: JOB#:
A
CITY,STATf and ZIP ODE: JOB
�OCATION:
ARC IT T: ATE OF PLANS: JOB PHONE:
MDA, (jib Vaf "r
We hereby submit specifications and estimates for: �+ ,
9
Ve VrOPOO hereby to furnish material and labor- complete in accordance with the above specifications, for the sum of:
dollars($
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
.manner according to standard practices. Any alteration or deviation from above specifi-
cations involving extra costs will be executed only upon written orders;and will become g
an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be
accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by us if not accepted within days.
insurance. Our workers are fully covered by Workman's Compensation Insurance.
RCCetltance of prop al-The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature:
to do the work as specified. P yment will be made as outlined above.
Date of Acceptance: DO Signature. _
�_ GT�ie -Pom�rrw�useczLC� o�✓Glaaaczc�zccaelxa,
Board of Building Regulations and Standards ds License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
;.' Registration: �445356 ! One Ashburton Place Rm 1301
Expiraugn ,1/12/2009 Tr# 127522 Boston,Ma.02108
'i � � Type•: DBAtF
i
EMMANUEL CONSTRUCTION '
HECTOR SANCHEZ. ,f
i 286 STRAWBERRY HILL D p ,..e � j �s -- =
j i Not valid without signature
CENTERVILLE,MA 02632 Administrator
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1
PERMIT PAYMENT RECEIPT
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
200 MAIN STREET
HYANNIS, MA 02601
DATE: 07/13%07
TIME: 09:47
-----------------TOTALS-----------------
PERMIT $ PAID 40.59
AMT TENDERED: 40.59
AMT APPLIED: 40.59
CHANGE: .00
APPLICATION NUMBER: 200704300
PAYMENT METH: CASH
PAYMENT REF:
:,,_, ,....,,y,�,.•y..=.•..,�..+. > ,;^^:r.r�vt .*..�...,..xr,..+..:-.....-r..��re�,>aryc...��. 'c7a'a-...g7ogF3.,`b^'��";.++tr.� '""�arc�``'"r';`"""''aF"R* T - ',:z`e•r
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TOWN OF BARNSTABLE' Permit No. ..A. 158
BUILDING DEPARTMENT
a.aan I TOWN OFFICE BUILDING' Cash ................
i679• v
HYANNIS,MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to ALAN E. SMALL
Address lot #10 194 James Otis Road, Centerville
USE GROUP 'FIRE GRADING OCCUPANCY LOAD
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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
d February 1, 88
rl:
Building Inspector
TOWN OF BARNSTABLE
a, BUILDING DEPARTMENT
i sARNSTA , : TOWN OFFICE BUILDING
� rua
9 .639. HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has been issued for the building authorized b '
P Y g Y
BuildingPermit $ ......... /5 ._.. .................................................................................._.........._......._......_ . ................_..
issued to ......... P>/�L�r-... .
Please release the performance bond.
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TOWN OF,BARNSTABLE, My4SSACHUSETTS BU DING PER IT.
a
.E .0!(9pt@tObet 4 J9 87 f R3PERMIT
APPLICANT B �''' ADDRESS 015757'
(NO.) '(STR FE T)' (CONTR'S.LICENSE)NUMBER OF
-
PERMIT`TO ,Build dceellin 1 ):.^STORY Single family dWe11ing DWELLING UNITS 1
.(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
�::lot� l 1944James :Otis. Road, Centerville•' ZONING RC
AT,(LOCATION) DISTRICT
i.:`,k p - (NO ) .> .. (STREETI - _
f :t.
BETWEEN 4 AND
(CROSS. STREET). .(CROSS STREET) -
VOT
SUBDIVISION LOT BLOCK SIZE )
BUILDING is:, BE - ! FT. WIDE BY FT. LONG BY FT'. IN HEIGHT AND SHALL CONFpRM IN CONSTRUCTION
TO.TY.PE �"` t USE GROUP BASEMENT WALLS OR FOUNDATION
.(TYPE) ..
-a REMARKs l.r; M Sewage #36--868
B61ND
t ' t PERMIT
"VOLUME ° 2160 .Is f t• 150, N{"� t h 103.00'
._ ESTIMATED COST FEE
.(CUBIC/SQUARE FEET)
OWNER iy,.w.r r q .Alan E. Smalll. .i r` ro I ,�•�f
y 1Aa2 ;5 ntery e'', l BUILDING DEPT. `
ADDRESS BY r! +
n ,� ��{ A �T�f•�z� r� t ,'t,�� ri
"�THISIPE RMIT£C ONVEYS` NO RIGHT TO OCCUPY ANY STREET,. ALLEY OR. SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
9a _PERMANENTLY,ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY' RERMITTED.UNDER-THE BUILDING.CODE'; MUS7:_BE AP
Isa t,P R.0 V.ED BY1THE iril U.RISDIC.TION';*,.STREET O.R''ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC.SEWERS MA.Y'.BE"OBTAINED.•:
a -•FROM?TTHE DEPARTMENT%'OF'PUB LIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS',
4���x OF ANY APPLICABLe'SUBDIVISION RESTRICTIONS.
xr'4�....__ .. '..
�4y t'-
I'NSIMUMCOF .THREE:':CALL.. APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
" IANL1 CONSTRUCTQIONRWORK.ED R CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
y-A;�r,a,€'*#�4 .r..F ELECTRICAL`,, PLUMBING AND
A ,IFOUNDATION.S,.OReFOOTING'S: MADE.- WHERE A CERTIFICA•fE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
kSy;p " PRIiOR TO'b'OVERING''STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL '
,,i�. MEMERSdiREADY...TOYLATH). - --
3" B
FINAL INSPECTION BEFORE FINAL INSPECTION HA:S BEEN MADE,
. ..
POSTIHIS CARD SO IT IS 'VISIBLE FROM STREET
x 0,BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
{t Yam+ �r�/
I 2 k 2y G/�^r 2
Aell
34 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
�_a ��'
y OTHER., //y/
2 (► n - ^�%P2��/�'4 BOARD OF,HEALTH
7r , ,a7,rra
a26d,ktvmr ,
x*e9
�` - gar�'y _ _ - - / , , -, -. '• ,
A �r' j' PERMIT W!LL'I BECOME NULL AND VOID IF;CONSTRUCTION WORK 9NALL N07 PROCEED UNTIL THE INSPEC- INSPECTIONS INDICATED ON THIS CARD CAN BE
rTOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS,OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
.CONSTRUCTION. ,_ PERMIT IS ISSUED AS NOTED ABOVE. NOTIFJCATION.
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CER T I FI E D PLOT PL A N
,1.-CERTIFY THAT THE FouN.DA- oN LOCATION CC1&1�it-R�I( �.1,�
-SHOWN HEREON COMPLYS WITH SCALE �'�4 So ' DATE
THE SIDELINE AND SETBACK
:.:REQUIREMENTS OF THE TOWN OF PLAN REFERENCE
BAPNSTA13LE' AND IS ► 7-
-LOCATED WITHIN THE FLOODPLAIN, T�=n-\//LL�E 1�JGHL�AI�s
DATE : 8-27-8 �h -� n ��` B
AXTER I~ NYE, INC.
THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS
INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS.
-OFFSETS - SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES APPLICANT /A ALL_
Assessor's offioe,11st floor): 7 r o7/ 02 �?
. ` and lot number �' rOFTME
Assessor's maI? TO�
- SEPTIC SYSTEM US�
Board -of Health ,(3rd floor): INSTALL ® OL6P�9 w
Sewage Permit. number $ � �... .... �� i H
Engineering Department,(3rd floor): ���� ����� IL 9T
J ENVIRONMENTAL CODE 0b 9
House number •........................... �?. .. ,J S• . r'a�9
��0 YA
�. . . .. TOWN REGULATIONS
APPLICATIONS PROCESSED 8:30qq 9:30 A.M• and 1:00=2:00_P.M. only;
g. TOWN °OF BARN.STABLE
j BUILDING ,'INSPECTOR
APPLICATION FOR PERMIT TO .... ............ ......................... .........::................................
TYPE OF CONSTRUCTION ....::. .......
T ... .........................................................................................................
_ ! r
TO THE INSPECTOR. OF BUILDINGS:
The undersigned hereby applies for a ermit•a cording to the fo wings information:
"d. : . . ...... ..Location ........ . ................. ...................
Proposed Use ...: .......... ;
Zoning District ...........Fire District t :........ ..............................................
Name of Owner ............................... . ...................Address .......::
Nameof Builder .::. u.................. t )......... ............Address ....................................................................................
................. Address ....................Name of Architect �:...........................:.......:. , .....:..................;.........r.............................
Number of Roo s ..........'..:...................... .::Foundation
r
Exterior ... .. ...T....................................................Roofing ...:..� G? `/ ...............................
................:......Interior ..... 3.......
.............
Floors :......... rior
g 9 -,
rleatin '. . ...................................................................Plunibin' ....
Fireplace ... ........... .. ................... ..`...:.Approximate Cost �.�`J��.�.. '................
Definitive Plan Approved by Planning Board ____ ___:_ ______ ------ _!19 ___ l eG� p
;Area �., . ..
Diagram of Lot and Building with Dimensions Fee ....../..... ..............................
SUBJECT TO APPROVAL OF BOARD OF .HEALTH
r
OCCUPANCY PERMITS`REQUIRED FOR NEW DWEII LLINGS
I, hereby agree to conform to all the Rules and Regulations of the-Town of Barnstable regardi the above
construction. ".
Name ............................
g
- •• Construction Supervisor's License-v/. ..7
SMALL, ALAN E
-No 3115 8 Permit for One.... .4Z,y..
.. ........am y...P.W�.7„a 7.x1Q. r
L_"ocation Lot �. �. �..9 ...f7iS. .Otls 'Road
.. J......
.. 'Ca ......... .................
Owner*.......Alan E. Sma11..........................
t Type of Construction ....................... r _ Q` F
.... if ... ` ......................................
7.
Plot ............'r, ......... "Lo`t r
Permit Granted ......Septeinber...4.!...1.9 87. _
Date of•Inspection ........................ .... .19
Date.Completed .........
5 G.i..Z<................19r x• :. r K F
- re
As essor's offioe (1st floor): 02 ,p '( �l
THE• r ��
/ tOh
Assessor's map and lot n�umber ..............7�.... . ............. .........
•,,B,oard''of Health (3rd floor): ... p - __
`� 6 $ 4O
`ySewage Permit number ....................................... .,... ...
""' Z BASd3TGDLE, i
Engineering Department (3rd floor): S �o YA°a
House number. o t63q. ♦�
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 ...�`,:............ �
TYPE OF CONSTRUCTION .....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ................:.............:.......:...:................. :......................................................... ................................................
ProposedUse ......_...: :FFf..` '......... . ` .................................................................................. .........`.....................................
...........................Fire District ..........Zoning District .........................................,... ....................................................................
�c.. �
Name of caner6a ....�.................... ........Address ........................:............,..............................................
Name of Builder ......................
.............:.................................Address ...............:........................:...........................................
Nameof Architect ............................:.....................................Address ....................................................................................
Number of Rooms ..................................................................Foundation ? :....
f� r 61.............................................
Exterior ...... j!.'f E r ° Y' L�.7
....j.........................................................Roofing ................................... .... ..........................................
Floors ` ..( r .... ........
:..............................................................................Interior ................../. ......
Heating f - � ........................................................Plumbing 01— ..
Fireplace .......Approximate Cost.. .....:...... ............................... ..............................................
Definitive Plan Approved by Planning Board ----- -------19 Area
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
w
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. f
F - �
Name,. ,.. ............. ............................................
Construction Supervisor's License .........�....
SMA1;L, ALAN E. 16 A=17 0-212
oR
No 31158 permit for ,, One Story
.................
Single Family Dwelling
..........................................................................
Location ..Lot #10 , 194 James Otis Road
.............................................
Centerville
.....................................................................I.........
Owner Alan E.. .... Small. . .. .. .... .. .............................
Type of Construction Frame
.....................................
................................................................................
Plot ............................ Lot ................................
Permit Granted September ..4.,. 19 87
.................... .. .
Date of Inspection ....................................19
Date Completed ......................................19
f