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Town ®f Barnstable *Permit#a666 607/
Expires 6 months rom is a date
RESS PER4 egulatory Services Fee 5 -
X P 6
4V k APR 2 5 Thomas F. Geiler,Director
APR 2 5 Building Division
TOWN OF SARNSTSp,
-TOWN OF BAR NST rry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
y Not Valid without Red X-Press Imprint
Map/parcel Number c�P26 d
f
Property Address 'jL [i`r'✓</ . 1T� � i��� ✓ C�LZ���
Residential Value of Work ;�Za _2_J0_CX_6 Minimum fee of$25.00 for work_under$6000.00
Owner's Name&Address _ � �` �` X�/�c/_2
10,
Contractor's Name � � '*O Telephone Number 27 9
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
.�❑ I am a sole proprietor
i9 l am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
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
❑Re-roof(not stripping. Going over existing layers of roof)
XRe-side �x �� ( 6�/ /��✓
❑ Replacement Windows. U-Value (maximum.44)
*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 operty Owner 4tter of Permission.
o e Improvemen o a ors Licen s r quired.
li SIGNATURE:
Q:Forms:expmtrg
Revise071405
f
The Commonwealth of Massachusetts
�. Department oflndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/oro nization/individup:
Address:
City/State/Zip:�0'0'J�V/ 1)wlle)23�_ Phone#: 50F ^ 2-25 5179J6
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
employees(full and/or part-time). have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet $ Remodeling
ship and have no employees These sub-contractors have 8: ❑ Demolition
working for me in any capacity. workers' comp.insurance. g, ❑ Building addition
[No workers'Comp.insurance 5. ❑ We are a corporation and its
egud,] officers have exercised their 10.❑ Electrical repairs or additions
3. I am a homemvner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees.[No workers' fJ/�S `
comp.insurance required.] 13.0 OtherC54P6
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policyinforaration.'
t Homeowners who submit this affidavit indicating they are doing all work endtheu}lire outside contractors must submit anew affidavit indicating such
tContractors that check this box must attached an additional sheet showing the name ofthe subcontractors and their workers'•comp.policy information.
ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zipi:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,50Q.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.
1 do hereby certify r the pains and en a ofperjuwthol the information provided above is true and correct
Sign afore: Date: O �
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):
I.Board of Health 2.Building Departrneait 3.City/•!own Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as."an individual,parmership,association,corporation or other legal entity,or any two or more
of the foregoing engaged 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
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal 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,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requiremerds of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone umber(s)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial
Accidents fur confirmation of insurance coverage. Also be sure.to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the p ermit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Deparmient at the number listed below. Self-insured companies should mister their
self-insurance license number on-the appropriate line.
City or Town Officials . <
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom.
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job.Site Address"the applicant should write"all locations in , (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that.a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Departments address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-077-MASSAFE
Revised 5-26-05 Fax#617-727-7749
wwtiv.mass.gov/dia
To
Date v Time
WHILE YOU WERE OUT
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of
Phone
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TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILL CALL AGAIN
WANTSTO SEEYOU URGENT
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Operator
AMPAD 23-021-200 SETS
�� EFFICIENCY® 23-421-400 SETS CAR ONLESS
Assessor's Office(1st floor) Map ZZ41 Lot 06�1 v Peimit#
Conscrvati n Office th floor AL A- -A--V-:� a1 Nov�' . Date Issued I
�O Sc6'2 ,��f
-Board o Health 3 floor L �w �✓ I SEPTIC MUST SE
Engineering Dept. Ord floor House# INSTAL PLIAfl9CE
Planning Dept. (1st floor/School Admin.Bldg.): 5
Definitive Plan Approved by Planning Board ' 19 °�� o39—
,, a At
(Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.)
TOWN OF BARNSTABLE
Building Permit Application
Project Street Address V
Village - Fire District
Owner ���/UV(i► Address -�
Telephone
Permit Request:
Zoning District !t' Flood Plain U"o Water Protection
Lot Size 2-aw Grandfathered
Zoning Board of ApMls Authorization Recorded
Current Use Q�-34�1*L- Proposed Use t�vmj _
Construction Type Ct j I)ln 4ZAI l4t1-
Eaistine Information
Dwelling T Single Family Two family Multi-family
Age of structure Basement I kf 'P
Historic House Finished ,RD
Old Kings Highway Unfinished i7o
Number of Baths 3 No.of Bedrooms
Total Room Count(not including baths) First Floor
HeatTypeandFuel 645 Central Air Fire laces
Garage: Detached I Other Detached Structures:W
Attach_ ed�_J�kC,19S� 1A.4&L Barn
None Sheds
Other
Builder Information
Name Telephone number ` '1
Address ww License# D f 24
p
Home Improvement Contractor# ( 12
Worker's Compensation # AJo F.�l(DGr9`',l"l?iL
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS I'
PROPOSED STRUCTURES ON THE LOT.
ALL CO STRUCTIO D SULTING FROM THIS PROJECT WILL BE TAKEN TO
S Project Cost 1�;40W
Fee
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
PERM T
I
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#3,7s247 ��7 FOR OFFICE USE ONLY
ADDRESS 4 Valley Road, VILLAGE Centerville
OWNER ED LYNCH j x
DATE OF INSPECTION:
FOUNDATION'
t-
FxANE
INSULATION � Z�' II✓�J r _ ,
FIREPLACE -
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL ,
GAS: ROUGH FINAL
r
FINAL BUILDING: _
DATE CLQS;EDjOUT:
ASSOCIATE PLAN NO. ,
&- .VA i
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TO TIME / DATE
ie:x�� I�GNNt1C[ oned
M R$huned �{ G,il� in
OF PleasexItnMstn
PHONE
MESSAGE
L Uc�- (e v
OPERATOR:
O� 23-024--400 SETS 23-027-200 SETS
General Notes r
1. Existing House elevation to be mstotalned.Contractor sb&B Verily ag dimensions
before bidding work. -
2. Relative Elevations and LAC Bee will be verified and slaked by star myor before work Is -
to begln.Sarvryiog will be provided by owner.Foundation Contractor to be ' -
-possible far maintaining the integrity of the adjacent owner existing grades. -
3. Foaodatloo Coutractar mot to are any par of adjaceol properties,and will be
responsible for nay damago 10 the -
4 Extra fig to be removed to location provided by owner,within Clo—we NM
S Site to be raogh graded by foundation contractor to accommodate Temce Plan and -
grades to be coordinated with General Contractor and Architect.
6. Location and elevation foundation steps sod steel bum type and size to be approved by - -
Architect - -
7. New sheathing and siding one.by adaptation of wood walk to new foandatiom wag to
be provided by general contractor.Deck an north side and stairway on south side to be - - - •'
rebuilt by General Controclor. - - -
8. Exterior Shower on scout►side and entry roof om west aide to be maintained by
Foundation Conlraaw. - �..
9. Foundation Contractor to be responsible far retaining wens indicated on Foundation
and Ter-cc Plain elevation to be determined to tidal by General Contractor and
Architect � -
10.Concrete Stairway on north side to be maintained by Foundation Contractor -
11.Dryset brick terrace on marthside to be removed by Fonadatiom Contractor for reuse '
by General Contractor,nortbside terraces to be graded to existing donations. - - -
12 W oodem Fences and La its
to be removed by Foundoldom Contractor - rTTr't
for rase by General Contractor.Existing sacess door as crawl space to be maistatoed. - ® iIL_i16�lIIfL'1T1
Material and Assembly Notes
Rebuilding of Wood Framing at existing ground floor and
framing of new bay window on first floor;
1. Walk to be wood framed 2x4s 16"o.c.with 5/8 plywood sheathing typically with 2
layer of 3/8 exterior plywood at curved skirt end sided with tyvek barrier paper and -
white cedar shingles to match existing house. Sill to be pressure treated 2x6 with 1/41p
m n.thick sill seal,anchored to foundation wall.Header over garage door to be(2)
2a10'3 supporting ground Boor,header over windows and door to be(2)216s
2. Insulation to be 3 1/2"fiberglass batten R12.5 min.with vapor barrier on interior face.
Garage ceiling to have one hour rated fire code ceiling. -
3. New Doors and windows to be insulated glass. Mani.and style to be approved by
owner.
\ _
4. Floor Joist to be 2x101 16"O.C.from new Sltel Benin in basement to front(ear)wall, s
with 5/8"plywood decking and finish Boor to be approved by owner.
5. Beam to support gable end of main hour to be A36 steel wi0x1L5 supported by 3 112"'
steel]ally columns fuslened to wood sill at foundation wall
6. Hoof to be 2x10's 16"O.C.w/5/8"plywood sheathing,and rubber membrane roofing
with slope away from main building 1/2"l0 V-0"to 2x12 perimeter frame -
7. Deck to be tapered 2a4 pressure treated steepen w/514 pt decking.
8. Deck milin posts to be me wrapped ��
8 D p� pped 4:4 pt pork bolted e.w.to perimeter 2:12p1 J /
frmne bulled to side of north and south walls and projected beyond existing east wall
18",diagonally braced with brackets back to wall to be approved by architect. l 1 II
9. Day window to have is o.jd header(9'-0"opening)Ill Into cabling wall. 14�II1}�n*T-1� -
wish(2)2x4 coot.posts ea.side. I _ K I�Y g�y
10.Existing Bourjoisk at bay to be cantilevered 1;-6"beyond existing wall with new jobs
to mulch existing sislered to existing and extended 4'-6"toward center artisan.
11.Details and finishes as per drawings,per approval by architect. f y - Z®t/1u ,t
East Elevation 1/4"=1'-0" ��
Renovations Lynch Residence Chaunce He Powers Architect
Ground Floor Extention Rebuilt Craigville Village, Craigville,MA Orinber 15. 1994 29 Arlington Street,Hyannis, MA 02601 (508)775-9724
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Ground Floor Extention Rebuilt Craigville Village,Craigville,MA : 29 Arlington Street,Hyannis,MA 02601 (508)775-9724 .
October 15,1994
, 1
Ltd
211
Assessor's map and lot number .................................. ::..
- MTEM BUST BE
INSTALLED IN CO OLIANCE
. AT ARTICLE STATEber .....Sewage Permit num + �
SANITARY CODE AND TOWN
°`7MET° TOWN OF BARNS `
i BABBSTABLE,`i`
NAM 9 BUILDLNG INSPECTOR
a M a e
APPLICATION FOR `PERMIT TO. .............build wood deck over existing. roof
.... ........ ..... ..... _ ...................
TYPEOF..CONSTRUCTION .....................WAOd...............................................................:.........................................
August
...5..................19.....74
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
1;
Location VALLEY AVE. CRAIGVILLE
.................. ......................................................................................................................................................
Residence
ProposedUse .............................................................................................................................................................................
RB Centerville-Osterville
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner Mr... .. Edward. . . ...Lynch. . ........................Address ..........93..Fensview. . . ..Dr. ....., .. Westwood, Ma. 02090
.... . .. . ...... . ...... . .. .... .. ........ . .... .. . . .....................................
Name of Builder ....,,R. Arthur Williams, Inc. ;..Address ..Blak St. , Centerville
........ .... ............... .
of
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ..............................................................................
Exterior ....................................................................................Roofing ....................................................................................
Floors .............................`.........................................................Interior ....................................................................................
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ..................................................................................Approximate Cost ............ 850.00
............. ...................................
Definitive Plan Approved by Planning Board -------------------_-----------19--------. ............ .�.Q... a... s.. ....
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
c,
£ r
V s
4
1 f
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg rding the above
construction. , 4�� G�i�,t„�
Name ..��tl ...:C. ,r. ..G 1- ^�! ��
Iunzchv 8dnmur8
\
'
' No — ... Permit for ....deck_______.. '
' ^
`
! ---------------'r----------' '
� Location . .............................. '
.
--------. o�. i
. . -
� [hwne, ............EAmA r.d. ---------
� Type of Construction ---�j��uua------..
^ . �
_----...---------------..—.--.. .~
� ' Pk� --��--.---_. �t ---_—_____.. � ^�
`
^ .
~'
, .
( Permit Granted --- '5.r--'lg74
'Date of Inspection .....................................lA
Dote ��'��� 7�/
Completed ..~/—*--_.—..~—... .
'
. . '
/
PERMIT ... .` .-
'~~ ~_~�
'.�------r—.----------- 19
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' 'Approved lg
,
~�.................. ...........................................................
� -
� ______________________.,,,,�._
,
'-
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Assessor's map and lot .number �..a
Sewage Permit number .... ..................:..:::.... .
`T"Er°�y� ff, TOWN OF BARNSTABLE .y.
BAHBSTABLE, •
"6 9 BUILDING INSPECTOR
owara•
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APPLICATION FOR PERMIT TO ..........bui�d...wood. . ..dick. . . ..over. ...existing. . . ..roof. . ........................................... . .. .. . . .. .... .... ........ . . .... .. . ....
TYPEtOF CONSTRUCTION ...........:.........W....ay
--' August 5 74
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
.M
Location VALLEY AVE. C€tAIGVILLE
Proposed Use Residence
Zoning District RB Cznterville-Osterville
...:........................................................Fire District ..............................................................................
Name of Owner Mr.•...Edward. ... ........................:Address ..........
Lynch 93. ..Fensview. ..Br..., ..Westwood. . . . .,...Ma. .....02090. .
.... . ........ .... .......... . .. ............. .... .... . .. .. . . ........ .. .. . . .. . .
Name of Builder .....R, Arthur Williams, Inc. „Address .1>k St. , Centerville. . . . . .......... . ...... . . . .......................................
n of
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ..............................................................................
Exterior .....................................................................................Roofing ....................................................................................
Floors ............................................. ........................................Interior ....................................................................................
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ......................................................Approximate Cost ...........
850......�.00
.... i
.. , ...............................
Definitive Plan Approved by Planning Boarc _______________________________19________. Area d
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH +
t�
1
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. f��e�tc_.^�
Name/.1 ��`! :�-� .............//
Cf
Lynch, Edward
.{Ceg����
�
_.a - 7 ,
No J7. � Permit for 4��
----------------
Location W�#T.AVA^.. �
...................... °
�
Owner .........3d����' ----------
TypeofConxtrucrion ............ft.4pu.e------.
-`----^--~-----------------''
Plot ............................ Lot ................................ .
5
Permit GrantedGranted --..�9������— ..............lg 74 _
Dotaof |nspachon ------------
'
Date Completed ------------..l9
�
PERMIT REFUSED
----.,--.._-----------. lV
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