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Assessor's Office 1st floor) Map Lot Permit# �1
`I Conservation Office 4th floor '1� ; `�� Date Issued
`Board of Health 3rd floor (8:30-9:30/1:00-2:00) ' E�
ll D s FeeSEP�a� ®.� tea®��.� w�
f�E�gineering Dept. 3rd floor) House 4K INSTA;LE®I LIAN CE
WIC'
ENVIRONM
Def' _ d 19 T®i��`� i �F bt u` a 2r, r
.
TOWN OY BARNSTABLE
Building Permit Application
Project Street Addre ND
Villagel�,r�,
Owner ✓ / ,� Address
Telephone✓ `7 ��7 3
Permit Request C0NJ.-5TI'Ty ri;1 Nob,/ /0 A e.0 � R/&Ess VR C- 7_iPc=�`L-47
,/Total 1 Story Area(include 1 story,garages&decks) square re feet
• E
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $;_" _,4�0(p
Zoning District Z R C Flood Plain Water Protection
Lot Size l�' 576>_52= Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use 9C� 1 c,e,- Proposed Use Ve S i E>eiOC y
Construction Type
Commercial Residential
Dwelling Type: Single Family ✓ Two Family Multi-Family
Age of Existing Structure VTo2 Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached. Other Detached Structures: Pool
Attached �/ Barn
None Sheds
Other
Builder Information
Name��y Ey CO NA5at L�cs'n Q k�) Telephone Number 175 -
Address 5'7 7��1[�� �L,� 7, License# °7Q 4 ✓�
07t 32' Home Improvement Contractor#
Worker's Compensation# (God 4 k i-t,c 0 _2
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
LIS,&4,n r) L L .40
SIGNATURE , a" DATE 1,3 9
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
r
FOR OFFICIAL USE ONLY
PERMIT NO. 9537 �/ s
DATE ISSUED -Aug. 04, 1995 i t
MAP/PARCEL NO. 189.013 ri
ADDRESS 35 Stoney Cliff Rd.� �+ VILLAGE Centerville, MA 02632ZL
} -�
OWNER Martin E. & Joyce M. Davey . ` f
DATE OF INSPECTION: j
FOUNDATION
f
FRAME
INSULATION
t
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING:. ROUGH FINAL
GAS: k 6 ROUGH i FINAL
FINAL BUILDING•-Z°;_,x '
-,
DATE CLOSED?14T;. ` f
ASSOCIATIONY—LAWNO:
�a
11%02'94 17:02 V61 7 727 7 122 DEPT IT'D ACCID zoo
Cot�vnonitleatdz. 0/ Y&IJacIza6etti
' ..Uapartinenl o�.9,tdu�triaf�cciriant� -
600 Wu�&-Shy l
iUoston ///
James J.Campbell , amaJmdalb 02 f f f
Commissioner
Workers' Compensation Insurance Affidavit
(acensw )
with a principal place of business at: '
CPfj—( U)J C k-
(QW/Seaizla)
do hereby certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverage for my employees working on
this job.
Insurance Company Policy Number
() I am a sole proprietor and have no one working for me in any capacity.
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
{) i am a homeowner performing all the work myself.
I unde:_c<r,d tat a copy of this statement will be fomarded to the Office of Investigations of the DiA for coverage verification and that failure to secure
ccve-age:s reeii,,ed under Section 25A of MGL 152 can lead to the Imposition of criminal penalties consisting of a fine of up to S 1,500.00 andfor cr
years' impri<erm„ent cu well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me.
Signed this �'® day of 19 ��
Licensee/Permittee Building Department
Licensing Board
Selectmens Office
y Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375:
TnTw, 07 R4PTTQTART R RTTTT T)TNT('_ PFRMTT #
Royal Insurance
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
a'
TYPE AR INFORMATION PAGE WC 00 00 Ol ( A)
POLICY NUMBER (6R23-UB-786K505-6-95)
NEW-95
INSURER: ROYAL INSURANCE COMPANY OF AMERICA NC-CI C•0 CODE: 80136
1 . INSURED: PRODUCER:
DAVEY CONSTRUCTION CORP. 0 BRIENS CENTERVILLE INS
35 STONEY CLIFF ROAD 259 PINE STREET*
CENTERVILLE MA 02632 P.O. BOX 610
CENTERVILLE
MA 02632
Insured is A CORPORATION
Other work places and identification numbers are shown on the
schedule (s) attached.
2. The Policy period is from 04-16-95 to 04-16-96 12:01 A.M.
at the Insured s mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy .applies
e
to the Workers Compensation Law of the stats) listed here:
MA
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies
to work in each state listed in. .item 3.A., The limits of our
liability under Part Two are:
Bodily Injury by Accident: 100,000 Each Accident
Bodily Injury by Disease: 500,000 Policy Limit
Bodily Injury by Disease: 100,000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the Policy applies to the
:
states, if any, listed here SEE ENDORSEMENT WC 20 03 06
D. This policy includes these endorsements and schedules:
N= SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
Y
4. The premium for this policy will be determined by our Manuals of
Rules, Classifications, Rates and' Rating Plans. All required
information is subject to verification and change by audit to be
made ANNUALLY
DATE OF ISSUE: 05-17-955 CF ST ASSIGN: MA
OFFICE: ROY-ORL 829 'DISTRICT: C=01
PRODUCER: 0 BRIENS CENTERVILLE INS 28SBK
i
. . °: The Town of Barnstable
KAS& gym$ Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-775-3344 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
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 6aV— Est. Cost
Address of Work: -6, 3 1`Jc y��L iruk ?mill G�.
Owner Name: Yy L 8- -:Nayc, W1 ZA C."
Date of Permit Application: f`3 f q`o
I hereby certifv that:
Registration is not required for the following reason(s):
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:
lb S /0O /
Date Contractor name Registration No. -
OR
Date Owner's name
DEPARTMENT OF PUBLIC SAFETY r. HOME INPROVFNW,-CONTRACTOR-,
CONSTRUCTION.SUPERVISOR LICENSE - 'Oegistratoo !'00191
Nuiber �'_. Expires:
Expiration., 06/&i/9i
Restrict d"To' 00
Davey=Construction Corps.
x ote/ " 'MARTIN E DAVEY Nartia.E.:Oavey
35 STONYCLIFF RD tony lllfURd<..,
ADMINISTRATOR
CENTERVILL, MA 02632 enter ille''NA 01632'
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