HomeMy WebLinkAbout0415 OLD CRAIGVILLE ROAD 0lot CVI*- 7?rtt
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Application number �. . °
- fee !.1:0..:.25.. ................
Building Inspectors Initials...41-1.1-
Date Issued........./..6.�!(..9....................................
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Map/Parcel................................ ......�. . . ..........
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
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PROPERTY INFORMATION
Address of Project:4a,alol
NUMBER STREET VILLAGE
Owner's Name: eery �_t-5`5` Phone Number 761 76� —?6 3��
Email Address: CS- y , Ve.r1�•' ' :ell Phone Number
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Project cost$ 1 Check one Residential t// Commercial
Y
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize ��'� ��
to make application for a building permit in accordance with 780 CMR
Owner Signature: C_" �,.� -�!► Date:
TYPE OF WORK
U Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization
❑ Doors(no header change)# Commercial Doors require an inspector's review
❑ Roof(not applying more than l.layer of shingles)
Construction Debris will be going to.
CONTRACTOR'S INFORMATION
Contractor's name ✓a'n- �eG 1 Q
Home Improvement Contractors Registration(if applicable)# �'I (attach copy)
Construction Supervisor's License# 0"7715& (attach copy)
Email of Contractor �PJi c\�,c���3�� �m Phone.number jo$ a,--k1 75-2�q
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
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APPLICATION NUMBER............................................................
*For Tents Only*
Date Tent(s).will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each`Tent X. X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread"Sheet of each tent must be attached. Provide a site plan with-the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required.
Natural Gas Yes ° ' -No '
, if yes,a gas permit is required. r
- If food is-being served at your event please obtain a Health Department approval between the hours
of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type ,b Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date
All permit app iia�ftons are sub ect t uilding official's approval prior to issuance.
e� tr i zetrcl 6� ussaa t set ;
'Department of Industrial Accidents M
� �br gt r .
600 Washington Street
Aston MA 02111,
"G�_orke& Coia%pens tion;Ansuramce iavit =Builders' .ntra.ctorslE ectr ieianwm" ers
Y mbeant F�il�fl'r`m _ '01eaS�E
Nam( "snasm zaitus
Address: &r5c, i 11� S
1► GJLrI1. 1 i ' 1� iJ ` e
Are yow;w em{Ieyer9.Cheekthe a ba _ I ypofProjct( 4�tered� ,
1.El I am a employer with 4 am a enerar contractor and I
g 6.. ONew cons _
euaployet*(fall and/or pQTt tp��.* kayo Is `t seeb-eor�a�t
2. I am a sole.proprietor or partner- listed on the attached-sheet. T Rema�Teling=
ship lb. sub contractors have
and have no employees [�Demohtion
g
a employees and have workers'
regvue j
.. �lTe;a ,tzvrporatson Arad tt .l,.jectresat rgaairsxzr,avuons
;G] i m a h oaav r all av rk,'_ ,, i officers haw exerexs�d then t[]�lum�ng repairs or•a drrtitms .
:;...
t of
tion per MGL
myself 1No workersa comp. c gY 52, y,t paz we Ave no I2,0.Roof repairs
msurapce.requn .ja e �
employees. Vo workers' 13 ther
comp.insurance required.j
'�:xr5r * �a' � ats.' aavgzh �a �sm UEcs4sa err
0'J' '$ 14E�'S '^ � ,[t ?Jtl.,Fl�.'`.Y3: lr�wr..� +,..rt. s.. `xz.:^'..'.x .•',.«: °s'.T 5:�',l- xr=q.'spa'�. �4> .""tT»4za+xr�.&-•.., _
=CoMmE tw3tmst d=k thixkk must o <shee siia in the non ;oi .subrcQmr�rYtnes: er ;n .ti a h h .
empioyce5 Efthesub-�cantr�ctucs•hav�et la3cers.xhwmuaprovide,tkeu woek�s"ec:►�s pQtic�?.na�eF.
l am an employer that h providing•workers.'c6no M_ aamr Lwimancafim MW;a M &alma b tie papAXX and, b`slxe
ln,�orrnatisr�. '
Insurance Company Name � cC�
Ala S�teldress:� I Gr 1�� r sa#yfStafclZip: f CI�V� 1
Attach a copy of the workers'compensation poCcy declaration page(showing the policy number and expiration date).
F91=, s==, �covwgge as.Tequired�under Section 25A.of MOL c.I52::can lead to:the imposition of ctlmmal penalties:of:a.
fine up to$T,500.00`and/or one-year imprisonment;as-weii=as-civil`pena dt s in-the-form-ofaS`i'OP`WORiz ORDER=andz
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 ofthe DIA for insurance.coverage venfication
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f F EY tt fajY a /cfJt nr�ar'i'ar3 jxti" �g2fi, F4�W�tCB V•t' �i40j .3 c'0 ': p�ra,
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Ph one#:
[7kial use only. Do not write this area,to be completed by city or town official
Is�uinjgAnthonty(�ctrCle
Hof: Department 3. lTMB atrk 4. ctrizd for .I',',tum€bing'Inspeetor,
6.'Oth�er_
= Contact Person Phoned:`
: � ��' t' va forur aooes.
Pursuant to this statute; employee is defined as"..,every person m t ie service o anot'her under any contract of Hire,
express.or,implied,oral or written."
An en rta e.r is defined as"an a div pa iershio associatioaai,corpcaration other legal entity,.or a two or more
of the foregoing engaged in a joii Venterprise,.and including the Iegal'repres fives of a deceased employer,or the
receiver ,of"t tee s f an tndi ciduat; e on: cue;:legal loyu a plgy a. I j vevet the
04&of aftellh* lam, ate a ah t esei er
.i .P +•e'.d '4-3c�t�;:s '�R'r` -�r �ti. ``yafk . 'a°.� h" ' `a.+(;``o "' : cc+.'4?` `�' n? � Y7;;.� °t _
or on the grounds or building appurtenant= \shall not because of such` pioyment be deemed to be an empTo}%er
MGT,chapter=152,-§25C(6)-:alsostates=that"er y.state,-or-lacallicensin = gency-shall_withhold-thenissuance-or
eneai-df a.ace o rral8 tv; ern e;n s a�f�a" Crag 1i g t sit cinea dor y
applicant Whahas not produced acceptable evidence of compliaece in the insurance coverage required.'.'
=Addititly 1CvL.ishp: r"11' ,§257) .atas�"rfei�eitluroinrnanw ;nor +of rts: calvist s}aall
»r v�*,*A A"r&PmaAce ofi lala c vt�rk sari act. x�# to1�With e
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Applicants
Please fill out the workeW"compatsifi otr. d i cam' tFie bGxes'that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)anthone n ber(s)along with their certificate(s)of .
insurance. Y.:b Cited Uk lity a i I T i�d platy : �slaips(I I.P) i r e plo3� other tl tb e,
members �rs or panc� ,are n�r�'ta °wort�e msee I€an o&�l"Idoes ham
� "^e�;�'�w�,
Accidents for confirmation ofinsurance coverage. ALsv be sure toy iga and date the atl avit. The affiiiavit should
be.returned:to the City or.townahat he application for the permit or c e is being requested,not the Department of
Industrial Accidents. reg#ed-toQbtain-a workers'
cempeiat'ton polsy,;p ?leaa tlu'u� et Se1lsured companies should enter their
self-insurance license number on the a line.
w or`lcertvnofficiat
o Sst5 UAW
of the'affidavit far you to 6 out in the event the Office of lnve ' ations has to-conta you regarding the applicant.
Please be sure to:fill in the permi0icense number which will be ad as a reference num er: In addition,an applicant
that must submit multiple pem�itllicense.applications in any gtv year,need only submit. a affiiiav�t indicating.current.
policy infortrratrorr r>ceess fat d.undue t dd s�' applFa t'�a td I &— (city or
town.''A copy of tfie affida it that leas b rt oRficialty eta ged marked}ey a city or hawrr, _be.proviilecltati e
. applicant as proof that vali d a€fidait a file fobe>pew s:0p license, A vu aflisl t beF filed out.
. ,.J ';t��lY,ri�:'X11JttLi�RI;!IvX3�W�s�r1�Js�MJ:ia ia.ZIANUJJta�',u:aiwiiswtif` tiui�aaaat-ivit�vvw wau a vvuuay.Ja vvaaaiaa.v�i.,tl..�..ws'...w• .
i.e.a`ov rcen$e or emzn ro aum.eaves ems.: s n r9 d ro cam :arc EW
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The Office of Investigations.would lice to thank you in advanc for your cooperation and should you have any questions,
pease onit tat to giveUs;a.oall,
The Pepubnent's address,<telephone and fax number: _
-`1'he c.ommanurrea @ 1 assa us M
0flavestigadons
600 Was ltan. t
Commonwealth of Massachusetts
k vision-of Ar'ufssio Y41!Aacen e'
Soa&oliBuildih4,14j6Batrocss and Staetttatd'sr
Consir�t �t'isor
cs errs . �� 115 i.Tes- 1,ro1/2020
iCE1i�111��,. �
Sr 3+tt3RSE Ptl �f6t ;
Qttice oYCansumer Affairs&Business Regulation.
HME MPROVEMEWCONTRACTt)Fi; RegarNat3onrratidrtor' +
TYPO`. It lr bmd ]f�i#e r.tm'
Ex atlion O/ice of onsumier.Aftim arm.. n�s:Fdeg on
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KEVIUKEEGA4V .
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,:... 9 NOfiSE PIPIES Df� _; N rd.. ut signaWr�e
E.SANDWICH,MA 02537 .Undersecretary
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Assessor's office (lst floor): • �jJo�_a� Q e*THEro
Assessor's map and lot nu er .... ..:...77..................... Q r ,
Board of Health (3rd floor): 3 _ , � 0 ���-FIC SYSTEM MU
Sewage Permit number ............................ ........................... COUP! ..
9 INSTALLED IN C 89SHiTAMLE.
Engineering Department (3rd floor): % , �( H TiT 3 900 �9
House number ... � J �'�ENVIROM _
APPLICATIONS PROCESSED 8:30-9:30 A.M. andl 1:00-2:00 P.M. only' TOWN RE "+'Pi' 3. . ?
TOWN- 'OF ;BARNSTABLE
BUILDING INSPECTOR 2.
APPLICATION FOR PERMIT TO ............ :�. ....e ...... ................ 'sJ ?..... z .. �4'Srm os 5.......
TYPE OF CONSTRUCTION ................ :::C2o:..LY ...: ..............................................................
................................................19......... I
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the follo i- g information:
Location ........ /.. 6.)L......... :............ ... . .. .... .. .. ..t(!......A.z,...........................................
Proposed Use .............�::1.?...p............. .. !!`.9. ?..✓w.S...... .n.'..^..s�...R..'o-P...............
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Zoning District ........ E. ...........(... ..........Fire District ....... ......... `e
Name of Owner >.S r e,`.. ::: .m i.,l?...............Address ................. �r
Nameof Builder �L^?.!!� .....................................Address ....................................................................................
Name of Architect ........U.'r� t"'e ...................................Address.......... ....................................................................................
Number of Rooms 3...............................................Foundation ............ 0.0. .'C-
. ....................................................
Exleyfor ........;,!..ln.. ...:� .�,s,✓..S.Ln� 1PJ.....................Roofing ...............!7.5.��,,ct.,..-�..... .. .?.r,�. 5...................
Floors ................ �.......................................Interior ............... k-.e.+,�.....r�.C��..:................................
Heating ........!`.-t.1.✓'.............: g..............................Plumbin .................... ... ...:_.:.....;;'......;.......................
a. /
Fireplace d 4.e'i.......................................................Approximate Cost. Q .........................................
Definitive Plan Approved by Planning Board ____ __________________________19________ . Areo„ 'ZQ
.< ......... ...................
Diagram of Lot and Building with Dimensions Fee -5/
SUBJECT TO APPROVAL OF BOARD OF HEALTH
f
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 .1.. C,It .....................
Construction Supervisor's License .............� rUe ........
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Q'MALLEY, MICHAEL B.
Flo ..29.746.... Perm it`for-' ..:.td...t.o..Dwe.1l.i.n.g
.... ...... .. . .. ...... .... . . ..
:. ..........Single...Family Dwelling
...........................................
Location ..4.15 Old
................ ..................................
.............
....................J-................ .................
Owner .........Michael......... ....B.....O'Malley
.... .....Type' of Construction ....... ........................
......................................................
Plot,............................. Lot ................................
Permit Granted ...... August 5,...•.••••.19 86.
Date�of Inspection .....................................9
rid
Date Completed ......................................19.
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