HomeMy WebLinkAbout0583 LUMBERT MILL ROAD L u m f ro II act,
M
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y
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Town of Batnsta61-e
Ezplres 6 months from issue date
Regulatory Services Fee
Thomas F.Geiler,Director
Bvild.ing.Divisi0n
Tom Perry, CBO, Building Commissioner
200 Main Street,Plyan- is, MA 02601
www.town.barnstable,ma.us
Office: 508-862AO38
EXPRESS PERMIT APPLICATION R-ESIDENTTAT,ONLY x' 508-790-6230
y� Not Volid without Red X-Press Imprint
Map/parcel Number 1( �f
Property Address U 3 LtAl' igcr� MI l( ! 0i,n4cru i I.e,
[Residential Value of Work 5, 00 Minimum fee of$25.00 for work under$6000,00
Owner's Name&Address
�IlI w Moore
P.O. a®x U V, I I
Contractor's Name Ij e.a� C/V�1rI{� one Number
h Tele Q
. - P
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) q I L
❑Workman's Compensation Insurance
Ch ck one:
I am a sole proprietor -PRESS PERMIT
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance O C r
Insurance Company Name ---- TOWN OF
_BARiVSTABL.E
Workman's Comp,Policy#
Copy of Insurance Compliance Certificate must be on file,
Permit Request(check box)
[ Re-roof(stripping old shingles) All construction debris will be taken to Ann ® G��
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*Whcre rcquire.d: Issuance of this permit does not exempt compliance with other town department rcgulati e.Histori4, nsc"ation,etc.
'Note:. Property caner must sign Property Owner Letter of Permission.
A co of . e Home ement Contractors License is required:
SIGNATURE: 9- Jjog
goo
.� 3 -ti
. Q:Forms:expmtrg c'; rrr0
Revise061306 zlo F'j''n' i
- The Commonweafth of Massachusetts
Department oflndustrialAecidents
Office of
Investigations
600 Washington Street
Boston,MA 02111
www.rrt ass..gov/dra
Workers}Colripensat�on Insur,'Me Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Le 'bI
Name(Business/Organization/ludividual):• J Q S .
Address: a3
City/State/Zip:_ �, -OU-01 Phone.#: ! O40t
Are you an employer? Check the appropriate box:
1.❑ I am a employer with 4. ❑ I am a general con]sh
r and I 'Type of project(required):.
employees (full and/or part-time).* have hired the stabctors 6. ❑New construction .
2. I am a'sole proprietor or partner- listed on the-attachedet, 7. �Remodeling �
slip and have no employees These sub-contractve
working forme in any capacity, employees and havkers' 8' ❑Demo lition
[No workers' comp.insurance, comp.insurance.$' 9. []Building addition
required.] 5. [] We are a corporatio its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercieir .nr self • i l.❑Pl bing repairs oz additions
y [No workers' co ri t of exemption pLinsurancerequired.] t c. 152, §IN,and w no 12 oof repairs
employees. [No wor •13.❑ Other
comp. insurance req
*Any applicant that cheeks box#1 uwst also fill out the section belowsbowing thcirworkers'curapensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
en1plo ac s. that ehcck this box must attached an additionaIsheet showing the name of the sub-contractors and state whether or not those entities have
etrtp]oyees. If the sub-contractors lave employees,they must providt their tyorkcrs'eomp,policy number.
Xam an employer that is providing workers'com
information. pensation insurance for my employees Below isthe policy and job site
Insurance Company Name:
Policy#or Self-ins.Lic.#:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach acopy of the-workers' compensation policy declaration page(showing the policy number and expiration date),,
Failure•to secure coverage as required under Section 25A ofMGh c. 152 can lead to the imposition of c '
fine up to$1,500.00 and/or one-year � � z�inal penalties of a
y 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 here y ce - :rn er t.a pains an penalties ofperjury that the information provided ab ve 's true.and colrec
Signature: !�
O r • Date: I U
Phone #; `j - C+ --
Official use only. Da not write in this area,'to be completed by city ar town official
City or Town: Permit/License#
Issuing Authority(circ
le on
e);
; ,
L Board of Health 2,Building Department 3. City/Town CI
6. Other erk 4:Electrical Inspector S.Plumbing Inspector
Contact Person:
Phone#• .
- - ` tioF�HE' ti 'own of Barnstable.
• Regulatory Services
i lARNSTASLE,
MAC $ Thomas F, Geller
$ 1639, ,Director
A ��
lEo �A Building Divisioll
Tom Perry, Building Commissioner
200 Main Street; Hyannis,MA 02601
"IY-town,b arnstabl e.ma.us
Office: 508-862-403 8
Fax: 508--790-6230
Propexty Owner Must
Connplete and Sign This Section
If Using A Builder
i I I a n Mom,
as Owner of the subject property
I�. hereby authorize \J W�g to act on rn bhalf
ye ,
in all matters relative to work authorized by this building permit application for:
' Address o��'
� Job)
'
10 U
Signature of Owner .. Date
��I I lur►n VYIu-�-,ram . .
Print Name
Q TORM S:OWNERPERMIS S 10N
- � ��ie:-Pam�mzarzurea�i o�✓�aaaczc�u�aella
Board of Building Regulations and Standards License or registration Valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
`
Registra Board of Building Regulations and Standards
tion 124310
Expiration 674/2009 Trla 130873 One Ashburton Place Rm 1301
Type individual Boston,Ma.02108
James Curley fl
James Curley =
287Fuller Rd. �4 ^`
Centerville,MA 02632 Administrator Not valid without re
Massachusetts- Department of Public SafetN i
Board of Building Regulations and Standards
Construction'Supervisor Specialty License
License: CS SL 99138Y
Restricted-to RF,WS
JAMES CURLEY
287 FULLER ROAD. ,
CENTERVILLE, MA 02632
Expiration: 1/28/2012
Commissioner Tr#: 99138
�. y.';�..rrtl. l ;. ..1�, .:� �lR +s.�{:; �tit: � .r, .,,,Ili Yr�-:A'_.'•. a.'li.e ,... u""-^... ����
lrJTO,WNyOF,BARNSTABLE ' permit No. 27540
-Buildin Inspector g
.: Cash _
X
OCCUPANCY PERMIT; Bond
Issued-io Larry Nickulas, Address , - ,
` lot_ 48 5.83 Lumbert Mill,Road, Centerville
Wiring Inspector �-� G!�/.,u, �- Inspection date.
Plumbing Inspector :� �{ Inspection date
Gas Inspector Tj 1 Inspection date
u� �// �
L Englrieering DepartmentIZ/ /' �/ df(d/� Inspection date
~
Board of Health Inspection date
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.
G Building Inspector-
a
..� '�• TOWN OF BARNSTABLE
BUILDING DEPARTMENT
Y rsaa�r = TOWN OFFICE BUILDING
rua
HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE:
3
An Occupancy Permit has been issued for the building authorized by
Building Permit $�...... . .... .: � .. ..................#........................................................ . .....................
» . _.
issued to ......................... i!vI ...... .,..........: 'J_.. ......_.. . ..
Please release the performance bond.
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Assessor's map and lot number ......... ......... THE
ropy
Sewage Permit number .....
........................ S E F S Y 3-1 E hA Rfi,U
INSTALLED IN Cw,,,r-,-i;,
House number .......... ......................................
WITH TITLE 5 '639-
JENVIRONMENTAL COc-
TOWN OF BARNST'N1BtREuLa.T,r-j,-,t;3'
BUI'LDINrG INSPECTOR
APPLICATION FOR PERMIT TO .......... y �L ..................
... .
TYPE OF CONSTRUCTION ............. .. .. . .....................................................................................................
...............................�;gz.......19.....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following infqr a ion:
a
..........................................
Location .......... .... .. ....... ......
4/
Proposed Use ....... .......................
0 I
Zoning District ......... .4 .................................................Fire District .......................... .............................................
...... 6
.
Name of Owner ....... . ..... Address e.!q...... .C? 7.. ......................./I...
4/
Nameof Builder ................................. ..................................Address ....................................................................................
Name of Architect ....Address .....................................................................................
Number of Rooms .................7 .......... Foundation ..............6f......:....................................................
7--
Exterior .............. fing .............. .......................................
0/.............................................................Roo
Floors .......................919�....,e
....I ................................................Interior ................................................. . .............................
Heating ................ ...............................................Plumbing .............:�11 .....................................
Fireplace .................... ......Approximate. Cost .............tom'
Definitive Plan Approved by Planning Board ------------------—-----------19--------- Area ............................. ..........
Diagram of Lot and Building with Dimensions Fee .................o..3-00
SUBJECT TO APPROVAL OF BOARD OF HEALTH
................................
-73
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 . ............ ...... ....... ..... ..............................
Construction Supervisor's License
LARRY
`' la 27540..... Permit for 11-, story
....................................
Single Family Dwelling
...............................................................................
Location ..Lot...48, 5.8 3..Lumbe.rts..Mill Road
...... . ... . .... ........... ...... .... .... ..
Centerville
...............................................................................
Owner Larx Nickulas
y.....................................................
Frame
Type of Construction ....................... ..................
................................................................................
Plot ............................ Lot ............................
February: 22, 85
Permit Granted .............................. .........ig
Date of Inspect' ...............................:19
Date Complete .....
tv
.. .-.. a Assessor's .map and lot number ........./. A)............ THE
41<1
Sewage Permit number ................,.............................
t a
t Z BAHH9TADLE, i
House number ........................................................................ : ruse
0 MAY a•
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ............ � � �. !L .. �...:/........................
ram......................
TYPE OF CONSTRUCTION .....................
......................................................................................................
...........` 6.....g:�z.......19...
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: �—
Location ......lif /f / �� �� I� � /
�. ......................... ......................... .............................. ..................... ...................................
Proposed Use � i
�p y /1) , 5
Zoning District .........!ll,.�.................................../..............Fire District ......... :t�....�e.......... ....T..........................
Name of Owner � :!t- /lJf l!..���y//.?Address �' �, �7. . � .... ...... .................... ...............
............. . .......... �r �. .
fr
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ................... ..............................................Foundation ..............�..............
.............................................
i
Exierior ....................................................................................Roofing .............. I� i,pL.� ....................................
Floors (oe!& .................................................Interior .............................................
........... ::� Tl���
�. ..... .... ................... 7 ..............................
Heating ................ ...............................................Plumbing ............ .��1 /, .5.....................................
Fireplace ....................(J� ..............................................Approximate. Cost .................<—c) crCS. Q1
.,......7. ..........F.�P.6. ..�„y.....
3oS"
Definitive Plan Approved by Planning Board ________________________________19________. Area ................. .
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
f- 1�7
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS t
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Construction Supervisor's License ...Q�pZ,2
NICKULAS, LARRY A=146,-102
,4 jr �1,o,;
No .... Permit for .....1�2..Story.............
Single Fan-Lily Dwelling
. .............
. . .... .......
Single.................................. ...
Location 583 Lunberts Mill Rc)ad
................................................
Centerville
...............................................................................
Owner ......��KY.J�i(Aulas.............................
Type of Construction ..Fram..............................
........................................I......................................
Plot ............................ Lot .................................
February 22, 85
Permit Granted ........................................19
Date of Inspection ....................................19
Date Completed ......................................19
C#- #,._
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