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L ] [R226 167 . ] •
LOC] 0012 SOUTHWINDAIRCLE CTY] 12 TDS) 300 CO KEY] 136800
----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0
ANDRULONIS, JOANNA F MAP] AREA146AD JV1291053 MTG10000
105 JOHNSON RD SP1] SP21 SP31
UT11 UT21 . 19 SQ FT] 1350
COHOES NY 12047 AYB] 1950 EYB] 1975 OBS] CONST]
0000 LAND 55800 IMP 76000 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 131800 REA CLASSIFIED
#LAND 1 55, 800 ASD LND 55800 ASD IMP 76000 ASD OTH
#BLDG(S) -CARD-1 1 76, 000 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#PL SOUTHWINDS CIR CENT TAX EXEMPT
#RR 1923 0100 RESIDENT'L 131800 131800 131800
#DL LOT 11 OPEN SPACE
#UP FY99 COMMERCIAL
INDUSTRIAL
EXEMPTIONS
SALE102/97 PRICE] 142500 ORB110618121 AFD] I
LAST ACTIVITY] 03/12/97 PCR] Y
f
R226 167 . P P R A I S A L D A T O KEY 136800
ANDRULONIS, JOANNA F
LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC
55, 800 76, 000 1 A-COST 131, 800
B-MKT 90, 400
BY 00/ BY /00 C-INCOME
PCA=1041 PCS=00 SIZE= 1350 JUST-VAL 131, 800
LEV=300 CONST-C 0
----COMPARISON TO CONTROL AREA 46AD -----------------------------
NEIGHBORHOOD 46AD CENTERVILLE
PARCEL CONTROL AREA TREND STANDARD
101 10 LAND-TYPE
558001 LAND-MEAN +Oo
1318001 91427 IMPROVED-MEAN -1706 200-o
] FRONT-FT
] 100 DEPTH/ACRES TABLE 02
1000] LOCATION-ADJ APPLY-VAL-STAT 1
LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES
COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC
FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?]
•r.r
R226 167 . P E R M I T [PMT] ACIW [R] CARD [000] KEY 136800
000000001
PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT
z
Sv.•�s�,- TGVM OF SARNSTABLE
'o REPORT S LEMENTARY/CONTINUAT N REPORT
_
[ o S
NAME (LAST, FIRST, MIDDLE) , i� A( 1 /IsQ((� DIVISION /O"T R
NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL SS ETC' • � ��,T
7YL
SUBMITTED BY PAGE I1� /
Conc. Blk.Walls Bsmt. Rec. Room St. Shower Bath Bsmt.
O D pURCH. DATE
Conc. Slab Bsmt.Garage St. Shower Ext. Walls
PURCH. PRICE.
Brick Walls Attic Fl. &Stairs Toilet Room[A Irl Roof RENT
Stone Walls Fin.Attic Two Fixt. Bath
— Floors
Piers. INTERIOR FINISH Lavatory Extra
Bsmt. F 1 2 3 1 Sink J r '
Plaster Water Clo. Extra Attic
EXTERIOR WALLS Knotty Pine Water Only
Double Siding Plywood No Plumbing Bsmt. Fin.
Single Siding Plasterboard 3 Int. Fin.
Shingles TILING r �• / S0.
_ v
Conc. Blk. G F P Bath Fl. Heat
Face Brk.On Int. Layout Bath W&Wains. C
- ,/ // G Auto Ht.Unit �� /3J d•
Veneer Int.Cond. Bath Fl. &Walls Fireplace D
Com. Brk.On HEATING Toilet Rm.FL Plumbing - p
Solid Cam. Brk. Hot Air Toilet Rm.Fl. &Wains.
------- —---- Tiling
Steam Toilet Rm.Fl. &Walls
Blanket Ins. Hot Water St. Shower y�
Roof Ins. Air Cond. Tub Area Total
Floor Furn. G E�
ROOFING COMPUTATIONS
Asph. Shingle Pipeless Furn. I)S. F• 3 /s
Wood Shingle No Heat S.F. 7 -
Asbs. Shingle Oil Burner S.F.
Slate Coal Stoker S.F.
Tile Gas S.F. OUTBUILDINGS
ROOF TYPE Electric
S.F. 1 2 3 4 5 6 718 9 10 1 2 3 4 5 6 7 8 9 10 MEASURED
Gable Flat
Hip Mansard FIREPLACES S. F. Pier Found. Floor
Gambrel Fireplace Stack Wall Found. 0.H.Door LISTED
FLOORS Fireplace Sgle.Sdg. Roll Roofing /
Conc. LIGHTING Dble.Sdg. Shingle Roof c"
Earth No Elect. DATE
Pine 1/ n/ Shingle Walls Plumbing q
Hardwood , ROOMS Cement Blk. Electric
ICED
Asph.Tile �! Bsmt. 1st;o ./_)! TOTAL ,� 3 Brick Int. Finish PR
Single 2nd 3rd FACTOR 3 a
REPLACEMENT
OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. CVVAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL.
S.DWLG. ! .1� c S �� C - D / 6 Jr I '� .3 2, 60
-- 1
2
3
4
5
6
7
8
9
10 _
TOTAL
RESIDENTIAL PROPERTY
MAF NO. LOT NO. FIRE DISTRICT
STREET SUMMARY
1 Craixville Beach Road W, Hyannisport 73 LAND /76 0-
226 ; OWNER C-C 01 BLDGS. �� C
167 TOTAL ,:5 ,
LAND
RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS:
Ol BLDGS.
Dennisport Farnit`illft"CQ�.,.,. .. --I/W 52 802 240 TOTAL
ac LAND
Thor Remy�orporaion 27 71"''-15T2 "�43" BLDGS.
... .:2 1 . 2-- 461 ..1 ovv. 2 TOTAL
LAND
Brock,-liouisz,Ti�-Jr'i-&-Margaret-, - BLDGS.
lio, Armand J. d. Jean M. (it tens) 6-15-77 2528 27 37,50 TOTAL
- / LAND
Ilk
BLDGS.
TOTAL
h/A V 7-E R L�/ S
11� // LAND
YV_ DR CESTe g /`�a� O/G D !y rn BLDGS.
7/Q TOTAL
LAND
BLDGS.
C)
TOTAL
LAND
INTERIOR INSPECTED: Ol BLDGS.
TOTAL
DATE: LAND
ACREAGE COMPUTATIONS 01 BLDGS.
LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL
HOUSE LOT /7 6 0-nLAND
CLE�MFRONT - a, BLDGS.
REAR TOTAL
WOODS&SPROUT FRONT LAND
REAR BLDGS.
WASTE FRONT TOTAL
REAR LAND
BLDGS.
TOTAL
LAND
c, ! 100 BLDGS.
LOT COMPUTATIONS LAND FACTORS TOTAL
FRONT DEPTH STREET PRICE DEPTH% FRONT FT. PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND
ROUGH TOWN WATER 0) BLDGS.
HIGH GRAVEL RD. TOTAL
LOW DIRT RD. LAND
SWAMPY NO RD. a) BLDGS
'� TOTAL
ROPERTY ADDRESS I ZONING DISTRICT,CODE SP-DISTS.I DATE PRINTED I STATE I CLASS pCS I NBHD
KEY NO.
0012 SOUTHWIND CIRCLE 12 RC 300 12CO 07/09/95 1 U41 JU 4: AD R22o 167. 136800
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T
Land By/Dale Sze omens�on v UNIT ADJ'D.UNIT ACRES/UNITS VALUE Descripron PLJNOWSK.I, MARK P MAP—
cD. FFDe m/Acre �LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE L A y
1 55,300 — CARDS IN ACCOUNT —
�1U 1EsLUv.S1T 1 X .19 =10 A=155 316 59999.9 293879.97 .19 556UU 4JL0,S(S)—CARD-1 1 76,000 01 OF 01
4PL OFF CRGVLE 3CH RD CEiNTIN U C S T I_*)-1
BATHS 2.0 U X C= 1001 7U00.0 7000.U0 1.00 79Ju J' fit 1923 C1i7viAFKFT 90400
— NO, :SMT S X C= 100 6.1 0.10 1350 82JJ-3 IIivIC/Jb'c"
ir, 'CALF 0 X
A C= 100
3100.0 3100.0U 1.00 31Jt✓ a �1SE
D iE FiREP.L U X C= 10U 13 00.0 1300.DO 1.OU 13J0 3 (APPRAISED VALUE
J 131,800
ul ARCEL SUMMARY
S aVn 55800
T 'L1)GS 76000
M I 1 -IMPS
Ej TOTAL 131800
N 4 C N S T
T �- DEED REFERENCE Tyr DAl E Records P R I O R YEAR VALUE
Book Page Inst. MO. Vr.D S.les Pric. AN D 55800
S 3z379/051TtI'11193 A 100 _LDGS 7600C
4351/184� I12/84 81000 OTAL 131800
35121321: 7/82 580,00
BUILDING PERMIT *LAND ADJUST.F C R
Number Date Ty- Amount L U C A T I ON.-..-
LAiA1U LAtiD—ADJ INC Mt 1 SE SP—HLUS FEATURES BLU—ADJS UJ1T ;
55';Of) �
3200
Class Un �o'as Base Rate Adj.Rate r B 'll A e Norm Obsv. -
A u I g Depr. Gond. CND Loc 4p R.G FeDI r sl New A01 Repl Value SI ies Hegbl Rooms Rms.B t .Frx. p.rtyw.11 F�
0[L 070 11J 110 60.30 66.88 50 75 19 60 100 60 95053 71500i 1 .J 6 4 2_0 _0
nplon Rate Square Feet Rep Cost MKT.INDEX: 1'O O IMP.BYIDATE. / SCALE' 1/J G-9 ELEMENTS - CODE CONSTRICTION DETAIL
1u0 66.83 1350 90288 t,
h1 —
F 65 43.47 6 1565 *-- ------- —SJ-----
---------- ---------------* T Y L 17 JPL'r.X ' 0
! ! StSl'S9-=1T'j9T 72 5 r0 � -ADJUST.--1'J.J
! ! -XT_RR VA- C's I 7GD z:R-XRE-------TT.O
1EAT/AC-TY<?E- -J 2 �AS-------- ------ 0--1
! :I:FI-t,ISH- -'7G ----
------------L `7
! �:0
INT
! IrVT-E—R LATIJ0T- -T2 V?"R:7W-JRMAL-----U.O
! ! INTzR(TVA-t TY- -f12.,WKE-AY-EXT-ER_. TT C
27
W� HASt ;7 FLDJR- ,TFfJCT- -J0 ----- -------------U.11
D E LJJ t R -:JO -------------
Tr.O
E ! ROJI -TY?T---- -r7U ------------------U.O
Total Areas Aux �5 Base- 1,350
BUILDING DIMENSIONS --
T tiAS W29 FEP SO4 E:)9 N04 W09 .. ! LECTRILF,-L-- -7 : ---------?T_(i
FOTU JAT-1UN--- -JO -----------------
A 8AS W21 N27 ESC} S27 .. 9U.9
I �
L *--_----- —2 ------\1F1 i30Rpi I- U 46AD-I�NTEWILLr--
21------ *---9---*--- 9-----------X LAND TOTAL MARKET
4 FEP 4 'PARCEL 55800 131800
*---y---* AREA 14614
VARIANCE +0 +802
STANDARD 20
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,
Map Parcel /(°7 Permit# 6
Health Division �- �� Date Issued7f
Conservation Division Fee
Tax Collector ~r�''= �� '`-' ` 7/0SEPTIC SYSTEM MUST BE
Treasurer �a7/ao00 INSTALLED IN COMPLIANCE;
—� WITH TITLE 5 ;
Planning Dept. ENVIRONMENTAL CODE AND
TOWN REGU LrT1ONS
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address ID — 12 Cl2 CLL
Village �EAJ'1 /ZIJjI:CI�
Owner Jo6gNNAy Address JcT .JWJ►JSDt R10 C®tIOFS N,Y. i2&7
Telephone ;�l 8 - 7 1
Permit Request��L,� A A K P A-0 5 LAN D 1"C_ 4 rCC8) A-71 FILo 0 i,
R6koUlt DC157r�(� Zoo-, �o2eH
Square feet: 1st floor: existing 'Y°® proposed 2nd floor: existing proposed Total new
Estimated Project Cost Zoning District R C Flood Plain Groundwater Overlay
Construction Type JAPVVD IfR44tf-
Lot Size 7 5 0® S Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family N Multi-Family(#units)
Age of Existing Structure 3 o y z s Historic House: ❑Yes �M(No On Old King's Highway: ❑Yes 34'No
Basement Type: ❑Full ACrawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing 2 new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: J!Gas ❑Oil ❑Electric ❑Other
Central Air: J'l Yes ❑No Fireplaces: Existing - New Existing wood/coal stove: ❑Yes �4No
Detached garage:❑existing ❑new size Pool ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes A No If yes,site plan review#
Current Use Proposed Use 5+1-C.�E_
BUILDER INFORMATION
Name JQ HAJ Telephone Number 0 7-7
Address License# C'S QfZ 33l
Cr�TF_1z01LLe; KA, 0Z,(--5 Z Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 6A 5—Ap
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED . .
MAP/PARCEL NO. '4
ADDRESS, ' y j VILLAGE '
OWNER;- .1-•. r
,meµ ,
DATE OF INSPECTION: '
FOUNDATION -
FRAME L -
INSULATION
FIREPLACE «re
ELECTRICAL: ROUC FINAL - <
PLUMBING: RO JGti ;, - - FINAL
F
GAS: RO,UG44 Z-- . FINAL
<: F
FINAL BUILDING 6:•, K: <
DATE CLOSED OUT -
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts�= -== Depment of Industrial Accidents
{ - OfOeeoflolresffgatfoas
600 Washington Street
Boston,Mass. 02111
a s e�osation Insurance davitORTAM MEMO' W/O
Workers Com
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phone
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'Ye]
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.............. . .y::,.rwr ..A:,�;a;tF,:::;;:;+:;•}:•Yx•:;`{Y::ii;::;:irS:�:$::�:�r::;:::}:c•7::�:.>:•Yx•:;;•}:::•::;:::"�:.�}:•::�'::;:;:::
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in�uTance:cQ: ?: ;' of a Sue up to si soo.00 or
:. �n. 2SAofMQ.L4emleadtotoe �ofaimmulpeaaWes
genre to secure coverer req�ed ��fdtm of a STOP Wpm pBDFst and a Sae of 5100.00 a day against me. I tatdentmtd that a
one years'imprisommn m weII as C'TR oithe DIA for eoverate verlSeatloa
copy of this statement stay be tLa OIDsa mid correct
mid paraTties of Palms tbat t1u infor►natian Provided about is true
I do hereby certify Date �� fp ------------
S1�StntG
Punt name
J@ � �v LLI i/�4J-a Ph=#
oNdal use only do not write in thus am to be completed
by chy ortown oIDdal
Niccwe# QBuilding Deparunent
Permidtv or town: ❑Licensing Board
❑Selectmen's Office
Q cheekif immediate response is requbvd QHealth Department
pbanefh _• ❑Other
contact person:
Information and Instructions
Laws ter 152 section 25 requires��PIO�to provide workers' compensation for their
assachusetts General L chap to defined n mP as eve person in the service of another under any cone
nployees. As quoted
u° ry
fr0m the `law ,an emp Y
hire, express or implied, oral or written.
co oration or other legal entity, or any two or more of
association, corporation
.n employer is defined as an written-
individual,Pam' legal representatives of a deceased employer, or the reviver or
ie foregoing engaged in aJ° a erPnse, including other to employees. However the own'r of a
,mee of an individual;partnership,association or other legal entity, employing
the occupant of the dwelling house of
not more than three apartments and who resides therein, house or on the grounds or
welling house having construction or repair work on such dwelling
.pother who employs persons to do maintenance, be deemed to be as employer.
wilding appurtenant thereto shall not because of such enipl°ymeat
also staves that every state or local licensing agency shall withhold the issuance or renewal
AGL chapter 152 secdm 25 in the commonwealth for any applicant who has
if a license or permit to operate a business or to construct bwldmce coverage required. Additionally, neither the
of produced acceptable evidence of comdp eenter�coact for the performance of public work'uIldl
.ommonwealth nor any of its political sub o fthis chapter have been presented to the contracting
acceptable evidence of compliance with the insurance regmremcUts
authority. ENI
A,pplicants situation and
o • compensation
ensation affidavit comple�3'�by chi the box that applies to your
_lease fill in the workers numbers along with a certificate of insurance as all affidavits may be
;upplving company names,address � of insurance coverage. Also be sure license
s�v and
,ubmitted to the Department of Industrial application for the p�°r r
should tie retaraedto the�'artown that the� �"law"or if you
late the affidavit. The aff&* Accidents. Should you have any q�0ns regard
oemg requested,not the Department of buhwa 'p� the Department at the number listed below.
are required to obtain a workers camp
NNNAM
City or Towns
The Department has Provided a space at the bottom of the
Please be sure that the affidavit is��and P� �lY• the appit Please
to fill out is the event the Off=of has to contact you mid be returned t^
e number which
used as a reference member. The affidavits may
be sure to fill is the P mftlave been made•
the Department by marl or FAX unless other
would h*ke to thank you in advance for you cooperation and should you have any questions.
The Office of Investigations
please do not hesitate toSM us a can.
�0��/�/
The Deparune017 address,telephone and fax munber.The Commonwealth Of Massachusetts
Department of Industrial Accidents
amce Of investlDetions
600 Washington Street
Boston,Ma 02111
fax#: (617) 727-7749
phone#: '617) 7274900 ext. 4069 409 or 375
. � The Town of Barnstable
Department of Health Safe and Environmental Services
°rEc �� P Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commission.:
Permit no.
Date
AFFIDAVrr
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost
Address of Work: 1 t0— / 2— 4�-r14 I AJ4 2C Z-G cE.4i
Owner's Name: ®o4-N/✓� AA
Date of Application: tv/2- �� D
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
[3job Under S 1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given.that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
17
Dat Contractor Name Registration No,
OR
Date Owner's Name
q:forms:Affidav
r -7k TOOmbAf07f[l06�D�i o�✓uamaate�sa!!a"
HOSE INPROOENENT CONTRACTOR
Registrat>,o6: :120861A . }
r _
Expiration µr 03/12/2002
Type h Individual x
-A JOHN F.-CULLIVAN
i
CULLIVAN
,:•'ADMINISTRATOR BROKEN DIKE NAY `{
i CENTERVILLE NA.. ; 02632 M.
T
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTNON SUPERVISOR
f, Number: CS 052331 '
Birthdate: 11/30/1940
Expires: 11/30/2000 Tr.no: 5123
Restricted To: 00
JOHN F CULLIVAN r
9 BROKEN DIKE WAYS, / `
CENTERVILLE, MA 02632_ Administrator
f
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pe
Engineering Dept. (3rd floor) Map,- 2 2 61 Parcel —
'..Perniit# o7a�o
J House# '12- �' $�. Date•Issued
Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) µ!L Fee
Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00)
Planning Dept.(1st floor/School Admin. Bldg.) `i tME
Definitive Plan Approved by Planning Board 19 $ �V$T BE
TOWN OF BARNSTABLE AND
Building Permit Application TOWN REGULATIONS _
Project Street Address -S utll WIVt6A G1 f ` WT gttI
Village .-Ce-l� r-ulI
Owner �?00,V%K rA A n d f 0 l i s Address L✓ '
Telephone c7� " 86` S'4 3
Pe 't Request • +
i
First Floor square feet Second Floor square feet
Construction Type -
Estimated Project Cost $ c/D
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ) No On Old King's Highway ❑Yes No
Basement Type: ❑Full `jj Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing _ New a Half: Existing Q New 0
No. of Bedrooms: Existing New a
Total Room Count(not including baths): Existing New Q First Floor Room Count
Heat Type and Fuel: X Gas ❑Oil ❑Electric ❑Other ��
Central Air ❑Yes �[No Fireplaces: Existing New D Existing wood/coal stove ❑Yes No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
XNone ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review# -
Current Use Proposed Use
Builder Information
Name 1A)CIti I l 01.r Telephone Number c�'O!F" 8'/4
Address ,G.tl`7 Lr n:,A i vi i, I1 r, License#
reiA.,1,�. j,V( ,. 0� 3/ Home Improvement Contractor# f00 /Irt/
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE 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
Vv+� fit r bA jotakmoyd )11spv5'41
SIGNATURE G�1 �� �G D ATN,,Zc3'�Jj/`y�
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
V �
FOR OFFICIAL USE ONLY
`PERMIT NO. t• -
DATE ISSUED- {
MAP/PARCEL NO.
ADDRESS . VILLAGE
'OWNER t•� € . . + r ,` - �
DATE OF INSPECTION:
FOUNDATION F
FRAME
INSULATION t
FIREPLACE r
ELECTRICAL:.. ROUGH FINAL,'
PLUMBING: ROij H ' 1 FINAL
GAS: H '� FINAL 9 ,
FINAL BUILDING ;
DATE CLOSED O
ASSOCIATION PLA O '
�v d'�� . SJvt�wi►� Ci r. � _.
zx� a�i�sr,r
f osf
zxfr Roi" 13o4•a �..
L
Fro v it
RJ k
,N �IXy P05�
X6 ec.1<lhs
►�tfu Cakcr
e exlANS com. s�Qb
, I
Li
j:
k
Tile Cutntrtanlrculllt of Aftrssuchusetts
Dc purnizent of Inditstriul.4ccidents
plfcPO//ovestlgallons
600 !f'aslri"I'lo r Street
'• Via':. , -
�;'`'� �.' Burtua. .1luss. 0?I11
Workers' Compensation Insurance Affidavit
alililicint inftirmati�n• _ Plc•tse PRINT IebLljjy,� ���-���
loci ion. Z q- G/a yiGft1 U/ =
cin• /S o� ,�! s nhonc !F✓ -1��:�
.I am a homeowner performing all work myself.
I am a sole proprietor and have no one working, in any capacity
am an employer providing workers' compensation for my empiovees working on this job.
cnntn•tnv n tmt• #Dp4 e C 4xra'Q tl��`�c9 �' ��C�✓tt�fJ►�`It�'f( .
v tv, eta/ /�! h e!!• - t� -(�
insurance cn (.�ra hA 74,fU eAha CO PMg a [�nolirc a C91d0 29V _
[� I am a sole proprietor, general contractor. or homeowner(circle ogre) and have hired the contractors listed beiow who na'
the following workers' compensation polices:
cemnnn.• nntnc•
ntirircac•
cit.•• nhnnc�•
incrirnncr rn _
• •tom ra- v..�.' — T T - r__ -__ �t`—�i��,t iT"r!7.w•y. T►': �_��i�a��•�_�_
cmmrinn%• nnmc• &Arf-
nddrecc• ��.� ��� M/�l fl�l/t•
rite• f'�vasJ/��f rhnne#! 79K 4;
0;.0
incurnnee co 1-9-,n i0 k, I'-V e/ Co M,9° noiic�•d (��� d®`fit'�a
•...�- t n_..r �.Ji".':a��.. S _...iN•.��..•�./r,.•I.✓ �i.: -.�....�.1..../w�V:Li�.Saw..�:.. •,..-...r•�•�
Attach additiona!sheet itneees_sarvN:.r_-'=,;,�, .L•�•--='- -�... -- - = -:�•=•� ••••w•�-r
Failure to secu_re cuvcrare as required under section 3SA of NiGL 152 can lead to the imposition of criminal penalties of aline up to SI.500.UO andiur
une s cars' imprisonment as well as civil penalties in the form of a STOP WORN ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be funvnrded to the Orrice of Investigations of the DIA fur coverage verification.
I do herebr cirri hider the paim and penallics of perjury lhar r/ie information provided above is true and orreer.
Sianaturc JDate
Print name Wa l/ r Jd /"t;ier Phone# 7_9611-612
w - -
oflicial use univ do not write in this area to be completed by city or town official .
cin or tmvn• permit/liccasr d rIttuilding Department
• C31.1censing Board
C:check if imtnediate response is required 05eleetmen's URce
�. C3I1c2lth Department
contact person:
phone#• nOther. �.
11 a llt1 11lltl ULLIMI.N
Massachusetts General Laws chapter 152 section '_5 requires all empiovers to provide workers* compensation for their
employees. As quoted from the "la��", an entpl( tree is defined as every person in the service of another under anv
contract ofWre..cxpress or implied. oral or written.
An emplt!rer is defined as an individual, partnership, association. corporation or other legal entity. or any twee or more
the fore�_oim_ cn,-,a�_ed 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
dwcllin�_ house of another who employs persons to do maintenance , construction or repair work on such dweliing hour
or out the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
VIGL chapter 152 section 25 also states that every state or local licensing agency shall withhold,the issuance or
-encivnl 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
)crfornlance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ila
)--en presented to the contracting authority. _
.pplicants
lease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
ipplying company names. address and phone numbers as all affidavits may be submitted to the Department of
idustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
tida�it should be returned to the city or town that the application for the permit or license is being requested.
of the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required
obtain a workers' compensation police. please call the Department at the number listed below.
in• or Towns
ease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas
sure to full in the permit/license number which will be used as a reference number: The affidavits may be returned to
Department by mail or FAX unless other arrangements have been made.
:e Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
=ase do not hesitate to __ive us a call.
W•--�._ .-__.�.VT-• .��_Art...►..•.1E�4-.�.�-��1�...I_w��T.I��w+�� - �T'r.�q.�IA..^•V
:e 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 #: (6I7) 7274900 ext. 406, 409 or 375
The Town of Barnstable
9e M Department of Health Safety and Environmental Services
& Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW,
I SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
_IXTYpe of Work: �(?�kS, Of Kn mew V6® Est.Cost 1010
Address of Work: C, h�rv�
Owner's Name 14J1 &l 107�175
,/ Date of Permit Application: 3-31- 01 7
I hereby certify that:
of required for the following reasons :
Registration�s n q g ( )
Work excluded by law
Job under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner. `
1,041 J JV /00 7�//
Date Contractor Name Registration No.
OR
_ Date Owner's Name
CENTER VILLE HYANNISPORT194
I! '
F�
RED • ;
OND 4 PLAN REF: 921135 ,
RES. ZONE „RC„ t
REBAR VALARIE H- •NEENAN
A.M 2261165 FLOOD ZONE." A-10
LOCUS A. TAKEN FROM F.E.M A. MAP
CRAIG VILLE 40 o 250001—0008—D DATED: 712192
o�
CRAIG VILLE BEACH MARK B. &
THADDEUS JEFFREY
PLO NO WSKI
Q A.M. 2261167 8
. � WALTER W. SO WYRDA
Q 0 A.M. 2261166
LOCUS MAP ti
e7 0 S&T PLOT
PLAN
OF AND
0
LOCATED IN.
CRAIG VILLE
(BA RNS TA BLE MA,
� (,� PREPARED FOP
AfH
y APRIL 11, 199 7
CHARLES PISACANO
CONC. A.M. 2261168
COVER 3 Q
of . 0 GRAPHIC SCALE
Q o�
PAU 6 20 0 10 20 40 80
MERM 32M
X FE'SS`�pQ CONSTANCE J. PERKINS IN FEET )
qNO SUAVE & JOANNE M. BURK o0 1 inch = 20 ft.
A.M. 2261169
i .
I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE + YANKEE SURVEY CONSULTANTS
IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL UNIT 1, 40 INDUSTRY ROAD
STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN P. O. BOX 265
THE OMMONWEALTH OF MASSACHUSETTS. MAX & PEARL SCHERTZER MARSTONS MILLS, MASS. 02648
A.M. '2261170 TEL: 428—0055 FAX 420—5553
PA UL A. MERITHEW, P.L.S. ATE
J1151250 GM
I
.;LLE HYANNISPORT
J
wRED PLAN REF- 921135 j
OND
RES. ZONE: "RC"
REBAR VALARIE H. NEENAN
A.M. 226/1h'5 FLOOD ZONY FROM F.E.M.A. �'
LOC P
US ���
VILL 250001-0008—D DATED.: 712192
CRAIG E
MARK B. &
CRAIG VILLE BEACH THADDEUS JEFFREY
PLONO WSKI
A.M. 2261167
WALTER W SO WYRDA
A.Af 2261166
LOCUS MAP ti /// �'
`� N. S&T PLO T PLAN OF LAND
LOCATED IN.•
,� 12;;;;;;; (EARNSTABLE ,
"O'RAIG VILLA' "
PREPARED FO
WAL TER S FYLER
// MH
. /////. O
APRIL 11, 199 7
CHARLES PISACANO
168
CONC. A.M. 2261
OCOVER
GRAPHIC SCALE
zo o io 20 ao so
s PML K Qs
MERE
No 3200
p ( IN FEET )
9o�ESs� CONSTANCE J PERKINS Q
�gIVo SU�k,*A & JOANNE M. BURK Qp- 1 inch = 20 ft.
A.M. 2261169
i
I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE YANKE'E SURVEY CONSULTANTS
IN ACCORDANCE WITH THE" PROCEDURAL AND TECHNICAL UNIT 1, 40 INDUSTRY ROAD
65
STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN sCHERTZER STONS MILLS, 2 fA
THE OMMONWEALTH OF MASSAGHUSETTS. MAX & PEARL MARMASS. 0.2648
A.M. 226170 TEL: 4287 0055 FAX 420—.5553
PA UL A. MERITHEW, P.L.S. ATE
J1 51250 GM