HomeMy WebLinkAbout0273 SKUNKNET ROAD �-ZJ�3
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Town of Barnstable
OFI"E Regulatory Servicts OF ARNSTAB E
Richard V. Scali,Director ,0 „� ., k►� +�� _
snxxsTnsi E I r � .1,ul
9 Building Division
� 1639. �0'�E ► Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.uD v l t2
Office: 508-862-4038 Fax: 508-790-6230
PERMIT# (q6 L l l(P FEE: $35.00
SHED REGISTRATION
RESIDENTIAL ONLY
f
200 square feet or less
273 ,5 Kur) k n e-� Rd
Location of shed(address) Village
l=real ,`Vers � r 771 5 �b
Property owner's name Telephone number
Size of Shed Map/Parcel#
176 o `�
Signature Date
Hyannis Main Street Waterfront Historic District? Af 0
Old King's Highway Historic District Commission jurisdiction? .O
If over 120 square feet,you must file with Old King's Highway
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30 "
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
_ COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY
PLOT PLAN ,
AAAQ-forms-shedreg rZ-19-1
REV:040914 J
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Boa # 85-42C
CERTIFIED PLOT PLAN
- _ PREPARED FOR.
LOCATION LOT 18 SKUNKNET .RD BARNS'
scaLE: 1 "=40 ' DATE: 11/13/86
REFERENCE:
PB 403 PG 27 LEBEL-SOLLOWS
I .HEREBY CERTIFY THAT THE BUILDINGS
SHOWN ON THIS PLAN IS LOCATED .ON THE
GROUND AS SHOWN HEREON.
BUILDINGS CONFORM TO SETBACK REGUIREMENTS �� OF �cy
OF THE TOWN WHEN CONSTRUCTED.
i..�o , ARNE G�
H.
down cape engineering 9 °zs348 0
CIVIL ENGINEERS / SEC
'LAND SURVEYORS
i
mni ITF FA VAQmni IT 1-4 MA nATF oFr_ i A citovcvno
o*THE r Town of Barnstable *Permit#
OExpires 6 months fromissu [e
Regulatory Services Fee
awnrrsTaet E,
v� MA3S. Thomas F. Geiler, Director16
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstab l e.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.
Property Address
❑ Residential Value of Work ����_ Minimum fee of$35.00 for work under$6000.00
Owner's Name &Address , +
Contractor's Name �� 1/`P/ S fC� Telephone Number i5
Home Improvement Contractor License# (if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance -PRESS PERMIT.
Check one:
��o
❑ I am a sole proprietor SEP. '�
R—T—am the Homeowner .
❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE
Insurance Company N.,ame -'
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof)
❑ Re-side
,,�,/ #of doors
Replacement Windows/doors/sliders, U-Value �°/7"'(maximum .35)# of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License& Construction Supervisors License is
required.
"SIGNATURE:
Q:\WPFILESTORMS\building permit forms\EXPRESS.doc
Revised 072110
They C'Qntnroirivealth of ivassrrchuselts
Departrnerrl ofInditstrinl Accideia s
F--{: Office ofbivestigrrYions
Ate- 600 Washington Slreer
4 J 'B,osfoii,Af-4- 02111 '
3`�-�' Y6'f471'.TJlCrsS.g01d✓!�](r'
Alrorkers' Compensation Insurance Affidavit: Builder:s/iC'anti-�gctorsJElecti-icians/Plumbers
Applicant Information Please hant LegiblyName. atsi'ness/'Or auizatiou'Lndividrtal :.
Address: 7
Clty/'Stat&Z'.p s; P110I]t'
Are you an employer? Check the appropriate box: Type of project(required).
L❑ I am a employer with. 4. ❑ lam a general contractor and I
en*loyees(full and/or part-time).
* have hired the sub-contractors 6- ❑.1'�lew constraction
2..❑ I am a sole proprietor or p:atiner- listed an the attached Sheet. y:z❑Remodeling
s1up and hate no employees- These sub-contrac:torshave
8. ❑ Demolition.
ivorliing :for me in any capacity. employees and have wiorker.s'
[No workers' comp:insurance comp.insurance..I 9• ❑.Building addition .
required] 5• ❑ We are a corporation,and its 10.0 Electrical repairs or Additions
officers have exercised tb..eir
3.�iYaru a.hotxreotiiv;er dotng':a11 work 11.❑Plumbing repairs or additions
Myself. [No ivorl=s camp, right of exemption per NIGL
12.❑Roafrepairs
insurance:required.]a � 'c.-152, §1{4), and.rave have no • . �" ��,(
t - e,trnp:loyees. [No Workers, 13,❑Other A(pl i7e.,,/ ,
corvp.:ins-orance required.] �T
Any applicant that checks box#].must also fill out the se€tima below showing.their rvnrkeis'cozmpevsstioa policy information:
Y Homeown-ers who submit this affids"in&`rating they are doing atl work and then him outside contractors must submit a new efidas,it indicating sudL
tCon'traciors that check this box inmt Ynacbed an sdditionsl sheet showing the name of the sub-cmtractnrs'sud state wh2ther or not those entities hate
empdoyees. Ifthe'sub-c.ontractorslave employees,lhey,must provide their wurkers'comp.policy number.
I sort an enrpioyrrr that.is prosliding iwrlrers':Conrpensahoit hx-yurarrce for n.ty en ployeas. Below is thR policy and job site
1!lforxr'ation
Insurance Company Name.-
Policy or Self-ins,Lc. Expiration Bate;
Job Site.Address: citylStateizip.
Attach,a copy of the.workers' compeitsition policy dvcl,aration page(.�I oirdng the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the intpasihion of crimunal penalties of a
lint:up to$1.,500.00 andfor one-year imprisonment,as well-ts 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 s'taten nt m ay
be forwarded to the Once of
Investigations of the DIA fbi m:ssurance coverage venfica:tion:
I do-hemki certify nirder the pains and 1,attiss r?f jrerd►iry that Ylte information provided.a.bove is true vnd correct
Si attire: Date:
LBoard
e ont v. Do not write'in fhL rtrea,to be completed by.citt?or tort�rt official
City3m. Permit/License#
thon ity(cii-rle one):
Health:2.Building Department 3, CItYIroiin Clerk. 4.Electrical Inspector 5.Plumbhi;g hnLTector
son: Phone#;
0 Town of Barnstable
Regulatory Services
sa>iA"'S ' Thomas F. Geiler Director
�. Lass. $ ,
ab;9,, Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.ba rn s to b l e.ma.us
Office: 548-862-4038 Fax: 508-790-6230
----------------------------
HOMEOWNER LICENSE EXEMPTION
G� �S Please Print
DATE: �Y /
JOB LOCATION: vz/� r� /y,�/!� �'l W 74 �
number l streeett,r� 7 / village
"HOMEOWNER" ::2/ /��S >i� Jv�I �� �S —2) v
name home phone# work phone#
CURRENT MAILNG ADDRESS: _C%yJ�1�'dr� If—e.
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-
family dwelling,attached or detached structures accessory to such use"'d/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws, rules and regulations.
The undersigned"homeowner';certifies.that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirem s and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or.larger will be required to comply with the•State Building Code
Section 127.0 Construction Control
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section
109,1.1 -Licensing ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do.such work,that such Homeowner shall act as t
supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for
Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons.
In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately
responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner
certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns.'You may caret amend and
adopt such a form/certiFication for use in your community.
Q:IWPHLESIFORMSIbuilding permit formslEXPRESS.doc
Revised 0721 10
of THE Tom.
w BnRNSMELE, y
MASS,
1619. Town of Barnstable
�m
plfD MAC p
Regulatory Services
Thomas F. Geiler, Director
Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property ®wrier Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building pertrut application for:
02123 �N
(Address of Job)
Signature of Owner Date
Prilit Name
If property Owner is applying for permit, please complete the Homeowners License Exemption Form on the
reverse side.
QAWPFILMF0RMSlbui1ding permit forms\EXPRESS.doc
Revised 072110
Town of Barnstable �� ��(� 3`f
�oFrr+f rOkt, *Permit#
regulatory ServicesEvp Fees 6 thsfin issue(lateU
DI
# Y
j3ARqs1NX LE,
Thomas F. Geiler, Director
®9h h
� O
ra%MP`f
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www,town.barnstab le.ma.us
Office: 508-862-4038
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid withoul Red X-Press Iinprinl
Map/parcel Nurnber =
Property Address X
— 2't del i (rr e1 A
[0 Residential Value of Work� �t,)gd Minimum fee of$35.00 for work under$6000.00
Owner's Nam e & Address Njdj,r_.j CCxLe �cso�r u► r
l S�'_►�
'7 VlaP A„en ,p fir-• o i,Jl? \�1 I'(ag, 0 1- -,J,l 1 e , va�,3z
Contractor's Narne Telephone Number
Home Improvement Contractor License #(if applicable)
Construction Supervisor's License# (if applicable)
❑Workman's Compensation Insurance X-PRESS PERMIT
Check one:
❑ I am a sole proprietor P `M
[S I am the Homeowner
❑ I have Worker's Compensation Insurance 'TOWN OF BARNSTABLE
/mil
Insurance Company Name A .T/� ft -a al
Workman's Comp. Policy# V \/t [) 0 f
Copy of Insurance.Compliance Certificate must accompany each permit.
Permit Request (check box)
( C„ Re-roof(hurricanenailed) (stripping old shingles) All construction debris will be taken to e-1 1 '
!ram
❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof]
Re-side S('CA e o `koU S
# of doors
Replacement Windows/doors/sliders. U-Valtie (maximum .35)# of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. .
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy"of the Home Improvement Contractors License & Construction Supervisors License is
required.
3IGNATURE: 4&�Vz&�ga1-2e��
?:\WPFILES\FORMS\building permit forms\EXPRESS doc
Zevised 072110
The Commonwealth ofMassdchitsetts
r-- Department of Industrial Accidents.
1 _ Office of Investigations-
600 Washington Street
Boston, MA 02111
yy www.rnass.gov/dia
Workers, Compensation Insurance Affidavit: Builders/Contractors/Electi-icians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):_'& Ali �0 P o c, Aaaaz D �
Address: g ��r�e ,�tyGf?Ge
City/State/Zip: �errle jE M 42Z&3 2 Phone #: �� = 7 - .5-67
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction
have hired the sub-contractors
employees(full and/or part-time).*
listed on the attached sheet. 7. ❑ Remodeling
2.El I am a sole proprietor.or partner-
ship and have no employees These sub-contractors have g, ❑ Demolition
working for mein any capacity. employees and have workers' 9 ❑ Building addition
No workers' comp. insurance comp. insurance.
5 W are a corporation and its ME] Electrical repairs or additions
. ❑ e.
required.] .
3.❑ I a homeowner.doing all.work officers have exercised their- 1 1.❑ Plumbing repairs or additions
myself. [No workers' comp. . right of exemption per MGL 12.❑Roof repairs
insurance required]re t c. 152" §1(4), and we have no
q employees. [No workers' 13.❑ Other
comp,insurance required.)
*Any applicant that checks box#1 must also fill 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.
tContractors 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 W
Insurance Company Name:
Policy# or Self ins, Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers',dcomp.ensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under.Section 25A of MOL 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$250.00'a day against.the violator. Be advised that a copy of this statement may be, forwarded to the.Office of
Investigations of the DIA for insurance coverage verification.
Ldo hereby certify under the pains and.penalties ofperjury that the,information provided above is trite and correct.
Signature Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one);
1. Board of Health 7.,Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6, Other
=Contact Person:' Plione#'
IM�T Town Iof Barnstable
o �
Regulatory Services
sA>f� B�'$• Thomas F. Geiler, Director
,639• Aim
ra�,t Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 5D8-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Printi•' `
DATE: it) /� �J" lGlS`:1��e
JOB LOCATION: in;e A yen 4.16, , 'I P4►J.�p�!'liC 1 /yl a
number street village
"HOMEOWNER" Nan us W. ,To si 77s
name ►. home phone# work phone#
CURRENTMAILNGADDRESS: J -�/�h'e AVPnr•P
�er-14erv, 41le M
city/town state zip code
The current exemption for."homeowners"was extended to include owner-occupied dwellings`of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not.be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws, rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
and requirements and that he/she will comply with sal procedures q p y d procedures and requirements. ,
Sijnature oji'Homeowner
Approval of Building Official y
Note: Three-family dwellings containing 35,000 cubic feet orlarger will be required to comply with the State Building Code
Section 127.0 Construction Control,
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section
169.1.1 -Licensing ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do-such work,that such Homeowner shall act as
supervisor.
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for
Licensing Construction Supervisors,Section 2.15) This lack of awareness often results,in serious problems,particularly when the homeowner hires unlicensed persons. .
In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately
responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner
certify that he/she understands the responsibilities of Supervisor: On the last page of this issue is a form currently used by several towns. You may care I amend and
adopt such a form/certification for use in your community:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc .
Revised 0721.10
r� •
of THE A
a t
+ BARNSI'AHLE.
'SS Town of Barnstable
i639• ��
�TFD MAy A
Regulatory Services
Thomas F. Geiler, Director
Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder,
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the
reverse side.
L
QAWPFILESIFORMSIbuilding permit forms\EXPRESS.doc
Revised 072110
,M CERTIFICATE 108/31120 OF LIABILITY INSURANCE °" °"'"'
10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT • CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cerilReate holder Is an ADDMNAL INSURED, the policypea must be endorsed, it ATION IS WAIVED, subject to
the torts and conditions of the policy, certain policies may require an endorsement. A statement on this.certificate does not Confer rights to the
eertiiRcaft holder In lieu of such endomement(s).
PRODUCER -
NAME:
Sehlogol a Sehlegal Insurance Brokers Inc PHONC
• (VC,No,Erg (AIC,Nay. _. ...
34 MR= STxNET
ADDRESS:
PRODUCER
CUSTOMER ID e: •--•_
west XarmouCh, MA 02673 INBURER(B)AFFORDING COVERAGE NAICM
INSURED -- tNSURBRAWESTERN WORLD
PAULO VITORSNO DHA OLIVLIRA CONSTRUCTION
INSURERB)ILIM MUTUAL
26 Compass Circle , pasuaERc:
" ' IN9VRGR D:
Hyannis, IA 02601 • InnuRSe C:
COVERAGES CERTIFICATE NUMBER- REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED- ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM 'OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSION5 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR LTj( TYPE OF INSURANCE INBR PND POUCYNUMNER _ •• .'-- LUSTS
(MMIDDIYYYY) (MkaDamrrYl .
GENERAL LIMB ITY
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CLAIME-MADE LiD OCCUR MED Ea-("one*am) S5,000
PERSONAL S ADV @!JURY $1,000,000
. GBNERALAGGREGATE s2,000,000
OEN'L AGGREGATE LIMIT APPUE8 PER: ,. PRODUCTS•coMPA7P AGD a2,000,000
POL(CV l= LOC _
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ANv AUrO •
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SCHEDULED AUTOS BODILY INJURY(Par ftWOM) $ -
PROPERTY DAMAGE ldREpAUTpS (Per accident) E
NON•OWNED AUTOS
UMBRELLA Lute OCCUR _ EACH OCCURRENCE f
EXCESS I" EACH
AGGREGATE S.
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If Ion.020b$under E.LOR3EoeE-EAEMPLOYEE $ 100,000
OEscRIPT1oN OP OPEItAT1ON8 oft, - EL DISEASE-POLICY UMr( $ 500,000
DESCRIPTION OF OPCRATIONB I LOgATI0101 VEHICLES IAtdM ACORD W.AddRIa04)Remarks eclwdare,if more spaco Ie"Wred) +
'TR$ WORKERS CONIPENSATION POLICY WAS NOT PROVIDE COVERAGE FOR PAtTI.O VITURINO
CERTIFICATE HOLDER CANCELLATION
ROGER EIMSEN
7 VIN1; AVE SHOULD ANY. OF THE ABOVE 00SCRINED POLIC&G.B£ CANCELLED BEFORE
TN£ EXPIRATION DATE THEYt£OF, NOTICE WILL BE DELIVPRED IN
CENTERVILLE, MA 02632 ACCORDANCE WITH THE POLICY PROVISIONS.
. AUTHORIZED RBPREB
FAR# 508-7719-1160 .
al
01988.2009 ACORD CORPORATION. All rights Deserved.
ACORD 26(2009109) The ACORb name and logo ale registered marks of ACORD
2009-09-27 13:20 Page•1
Assessor's map' and lot number .....
THE TO
U �
Sewage Permit number .................. .t!. .. :...
f Z BJHB9TODLE, i
House number !
r 90G Mb 9
'Fp YFY Iwo
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .............................................................?e' ...:..............-...................:....................
TYPE OF CONSTRUCTION ,j���
.......................ice.. '.0. ........ lZ.(Crf'jam-........................... ..................................
.................... .G :.:..�.�......19. ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .. .... ... / .... ............................ ........................... ................. ..............
ProposedUse .........1-1KJ.l.ati]. 5. ........ ............................................................................................................................
Zoning District ................."t,-r''...............................................Fire District ......... ..��................................. ..............
Name of Owner S......................................................i.. v a T' Address `U .. � �•...... ........
Name of Builder .. P.>t.f w ���`'�S D-CL.l............... .....Address S./7 `
..................... ..................................................................
Name of Architect .. . :`.... .•: ..... ..........:%......�,`tf.Z.........Address ...... ?....:. .........
c
Numberof Rooms ............ ....................................................Foundation ...................V!i.V.. .(�......................... ............
Exlerior .............. .......................................Roofing ................. ..................................,
Floors ..............................�� r 1 t`J<?.C`` `>�..C f 2v Cr��
Interior ....................................................................................
Heating ................ . ....... .`.... . '........Plumbing .......!��!�� ............................5...........
�`
Fireplace - �.� ...................................Approximate Cost .....................�....,. �� .`1 ..............
' Definitive Plan Approved by Planning Board ________________________________19-------- . Area ...... .._......3,,,a .............
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable-regardi �he above
construction.
r Name .................
Construction 2up rvisor's License .� ....... .r,-t ..
S L S TRUST A= 9
/ 70 Z,5 j
No .30180 Permit for ....... Story
Single Family Dwelling
................................................................................
Lot #18 273 Skunknet Road
Location .............V+'............ ...............................
Centerville
...............................................................................
Owner S L S Trust
. ..................................................................
Type of Construction Frame
................................................................................ I
Plot ............................ Lot ................................
Permit Granted ........November 13, 19 86
Date of Inspection ....................................19
Date Completed ......................................19
/—ov�✓�Ar�orc/' Dryer �/®,
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TOWN OF BARNSTABLE Permit No.30180
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
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HYANNIS,MASS.02601 Bond ....`�....�
CERTIFICATE OF USE AND OCCUPANCY
Issued to S L S Trust
Address 1,Ot #18, 273 . Skunknet Road
Centerville, Massachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL- NOT BE OCCUPIED UNTIE'
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
June �........ ' i � ....
.......................... .................
Building Inspector
`�°�°•.ew TOWN OF BARNSTABLE
BUILDING ; DEPARTMENT
= a�1°T� ' TOWN OFFICE BUILDING
� rua
HYANNIS, MASS. 02601
i
h.
MEMO TO: Town Clerk
FROM: Building Department
DATE: -IfU 'v -e_
An Occupancy Permit has been issued for the building authorized,.by
BuildingPermit # ............................... ....................................._......._.......... .�._...... . ... .w
issued to .... ./,,t ...G�' ....... J�....� i � G
Please release the performance bond.
e
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.TOWN �?� BARNSTABLE, MASSACHUSETTS
%`� As171-229 r ,
DATE ATn�tapyb�X-137---19 A� PERMIT
a APPLICANT T ehml f:nl 1 nT4J3��V•__� ADDRESS y> 101 9 F2 a
y. �.
W > .(STR EE T)' : (CONTR 5 LICENSE)
PERMIT:TO Y y �, NUMBER OF
STORY Ringlp "(iam{lv �Tapll{rspp DWELLING UNITS
PE 0 IMPROVE NT)i' N T'.,,y. ,(pROPOS D USE). bl
ATy(LOCATION( r Ti Q y�� skunkncit RnaA ('e�ntrarci�1 7.- ZONING
lsTR1E'ETj D STRICT RC
p AND
(CROSS STREET.) (CROSS STREET)
SUBOIV1510N LOT
T
LO BLOCK
d
SIZE
.777
BUILDING IS TO BE ',
FT WIgE BY FT, LONG BY FT. IN HEIGHT.:AND SHALL CONFORM IN CONSTRUCTION^
yb
TO TYPE USE GROUP . y�
BASEMENT WALLS OR,FOUNDATION
.. .. '� c (TYPE).
AEMAR'KS.. ♦ 1
�.
AREA OR BO1ICI r
\VOLUME 1 i 1+ -�Ck• t• +r* 111 Sn n�n On PERMIT Iw
(CUBIC/SQUARE FEET). C057 m P FEE 9'9:'nQ
.ESTIMATED `� ,d�
A BUILDING ADDRESS
B r..%
BY
I
DEPT
,
1{t 4r r i r Kum
0g�y
77
AN:Y:APPLICABLE SUBDIVISION RESTRICTIONS.,
MINIMUM OF THREE' CALL . APPROVED PLANS MUST BE RETAINED ON JOB AND.THIS 'WH'ERE APPLICABLE SEPARATE
INSPECTIONS'REQUIRED FOR"- --PERMITS ARE:. REQUIRED FOR
ALL'CONSTRUCT:ION WORK: CARD.KEPT:POSTED UNTIL FINAL INSPECTION HAS-BEEN
s ELECTRICAL,:'PLUMBING AND
I- FOUNDATIONS OR FOOTINGS. MADE. . WHERE_ A ,CERTIFICATE OF OCCUPANCY:IS. RE- MECHANICAL INSTALLATIONS.
2: PRIOR TO COVERING STRUCTURAL QUIRE SUCH BUILDING, SHALL NOT BE OCCUPIED UNTIL �.` -
.. MEMBFINAL I SIRE INSPECTION
TO.LATH). FINAL INSPECTION HAS BEEN MADE,
.-3.'�FINAL INSPECTION. BEFOREI -
...
.. .. .00CUPANCY:..:
I ` POST THIS CARD 'SO IT IS VISIBLE FROM _STREETF'
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
�'.
/V
LG VV/
2 01
2 / 2 —
3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
olf
OTHE 2
BOARD OF FIEALTH
134-
i
WORK SHALL NOT PROCEED UNTIL THE INSPEC PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS'CARD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIR MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
t4, CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
1
= LOT 17—
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=LOT Z l=
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=Lo-r 19 -
!-'JOB # 85-420
CERTIFIED PLDT PLAN
PREPARED FOR.
LOCATION: LOT 18 SKUNKNET RD BARNS
SCALE: 1 "=40 ' DATE: 11/13/86
.REFERENCE.-
PB 403 PG 27 LEBEL-SOLLOWS
I HEREBY CERTIFY THAT THE BUILDINGS
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON.
BUILDINGS CONFORM TO SETBACK REQUIREMENTS OF , �
OF THE TOWN WHEN CONSTRUCTED.
o� !ARNE G,f
H.
OJALA ^
down cape engineering #26348 0
CIVIL ENGINEERS LANDSURVEYORS / L o��s��f�
ROUTE 6A YARMOUTH MA DATE PEG. LA SURVEYOR
sso:r's map and lot number .....A ....... � �-e?2 SEPTIC SYSTEM MUST THE
0 STALLED IN CO
AIIPLI
To
Sewage Permit number .................. . �..yr�.�- .�.
. � �/ITFi TITLES
. .
.� 'DIVIRO NMENTAL C®D' Z STABLE, i
House number ...................7.3.....i9!his-r......................... T �=��� e3L m�
o MAYAr
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .18
................................. 5 ..........................................................
TYPE OF CONSTRUCTION ...................... D..................,ztc�!' -.................................................................
...... .............si....�. ...19. �
TO THE INSPECTOR OF BUILDINGS:
The undersigned
/hereby applies for appermiit according to the following information:
Location / 1... .. Tl/V. .! l Y. .........................................................................................................
ProposedUse ......... . .........................:...............................................................................................................
ZoningDistrict ..............` ...............................................Fire District,..............�O...........................................................
Name of Owner ......S..L 5......'�c/5.�..........................Address .......�U�.`1...°�t�.... '� .Z:... -�/O !?�% 5.......
Nameof Builder .......: ...........................................Address ..........:..5 ..... ...................................................
o rLrFi.. i
Name of Architect,.. ..................�®-... es.y,�l ..........Address ..... T'Y�Lhcc/U7-g`/�l
Number of Rooms ..........:�.............................:...............Foundation `. tln" +1-�a -11- .
s� /�
Exterior ...............!'? `t`....5:.................................................Roofing ..........:.....G....5Y.........:.................................................
Floors ��C f.( 17. � ..........................................Interior .........� � el Z.v C-
. ...e...................................................................
Heating g Z� ................
Fireplace Y. .........................................................Approximate. Cost ................. 0 CD����...... ..............
Definitive Plan Approved by Planning Board _________ ___Si____19 Area 5.... 0.'r"- 1
Diagram of Lot and Building with Dimensions Fee � '
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstab gardi he above
construction.
Name ..................
Construction u rvispr's License .\ �..
S .L S TRUST
:30180` / l� Story.... Permh for .................................... ^'
'
, __..Sin 8.le..F amiIy._Dwel ling
__.__..��__
~~ � .
� Lot #l8, 273 Skook�et Road
` Location �' . .
f ---^------'' ---------''
Centerville
-
' ^,
' -------------------.------- ^
' Owner .� S-� �S-'��r'u�.a�� - -. ~^ ` ~
� Type of Construction ----��ame----------
I Date Crileted kf�:�... .........A.�
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