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HomeMy WebLinkAbout0086 VALLEY BROOK ROAD `�f� Via-a �� ��o k T�o�, y. � - � �� o � _ .. Y .. - � - _ j ,. •. - II .. .. z _ . Lo� ., ,. - -: ,, . V , � lli o `q .. _ e � .. .�. - i :. -. a & III e ii I t o ,. ., E T Town of Barnstable *Permit# Expires 6 mondrs from issue dale ` Regulatory Services Fee BARNSPABLE, y MAss.039. Thomas F. Geiler, Director �AlF p'�0 ® RESS PERM, Building Division TomTerry,CBO, Building Commissioner MAR 2 7 2009 200 Main Street, Hyannis, MA 02601 n N www.town.barnstable.ma.us Of'f icc: 508T8rtiW4t P BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint klap/parcel Number-1V_1b7 n�I�f� �✓ Property Address RL >Aential Value of Work �� . Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address Contractor's Name V Telephone Number I Ionic Improvement Contractor License#(if applicable) Construction Supervisor's License # (if applicable) :/ yW rkman's Compensation Insurance Check one: a sole proprietor am the Homeowner ❑ 1 have Worker's Compensation Insurance �]� Insurance Company Name. Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) -roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i-e.Historic,Conservation,etc. ***Note: Pr erty Owner must sign Prop rty Owner Letter of Permission. A c py of the Hom 11 pro meat Contractors License is required. SIGNATURE: _. i r.'U FI-ILLSi. ORMS\ ilding permit forms\EXPRESS.doc Revisedd 00608 fl, �'''s''�*yam t�;:A�s ���.a.e ��f•'?' - nI David Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Date Proposal Submitted To: Work Place: 3� Strip,Remove, and Haul Away all old roof and or sfdew- ah shingles. SUPPLY AND INSTALL: COLOR: � 1 7 _ Acd Shlil �l �f CLEAN&REMOVE ALL DEBRIS FROM WORK PLACE AFTER JOB IS COMPLETED. ALL DEBRIS TO LANDFILL. TOTAL INVESTMENT FOR MATERIAL&LABOR:$ Tr"-, All materials guaranteed to be as specified,and work to be performed in the accordance with the . specifications submitted for the ab ve work complV in a subs tial workmanlike anneT. Payments to be made as follows Any alteration or deviation from work specifications involving extra costs will a executed—on Ty upon written order,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Please remove and/or secure any fragile household items. Not responsible for broken or damage household items. 5YEAR LABO WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY. This oposal may b it rawn by us if not accepted within 30 days. Respectfully submitted ACCEPTANCE ROPOSAL The above prices,specifications and conditions are satisfactory and /rehereby accepted. You are authorized to do the work as specified.Payments will be made as outlined abq ve. A 4 o `t Signature The Commonwealth of Massachusetts Department of Industrial 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 f Name(Business/Organization/Individual): Address: City/State/Zip: Phone.#: / yU :177 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(fulrand/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. .❑Remodeling I am sole proprietor or partner-' and have no employees These sub-contractors have 8.'❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'•comp.-insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LF1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs 1 insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing then 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. tContractoms 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 tip 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 y against the violator. dvised that a copy of this statement may be forwarded to the Office of Investigations o DIA for insuran co erage verification: I do hereby c under t,a pai and aloes ofperjury that the information provided above is true and correct Si Lure: Date: _ - Phone Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Insttuctions 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,partnership,association,corporation or other legal entity,or any two or more of the foregoing engag in alom -enterprrse�f7un`g=the legal represen�tadW6W -ofa-deceased employer,-ar..rthe --- - -- 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 of public work until acceptable evidence of compliance with the in-prance requirements 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-contractor(s)name(s),address(es)andphone number(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 for 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 permit 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 Department at the number listed below. Self-insured companies should enter 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 Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext-406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Board of Building Regulat Kos and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvemen'`.C-ntractor Registration =x , Registration: •134313 Type: DBA 1rj,.j Expiration: 10/24/2009 Tr# 259907 DAVID SAWYER CONSTRUCTION DAVID SAWYER i J L 318 MEIGGS BACKUS RD. : SANDWICH, MA 02563 Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card IS-CA1 0 50M-05/0EPC8490 L a Massachusetts- Deportment olPublic Satoh Board of Building-, Re-Fulations and Standards ; Construction:Supervisor Specialty License License: CS SL 98859 t• Restricted to: RF,WS DAVID SAWYER i t� ` 318 MEIGGS BACKUS ROAD SANDWICH, MA 02563 ` Expiration: 1/27/2011 (`onunissi oil Cf. / Tr#: 98859 `t JSMITH, JAMES K. 24460 One Story , - �,No ................. Permit for ............................ ... �`.�.....Single Family,...Dwelling.'. ...... ~ Location ............... .2 4.....$�....V.aJ.�,sy. x.Qt�k RGd .r, S Centervi.�.,1e...:. + Owner .....James K....Smt11.. :... Type of Construction ..Frame........................... ~ ` ji- 7 .................... .. ........... •+.;: ...... . ...9... ......... Plot ............................ Lot_............. .. Permit Granted 14, 4 rT Date of Inspection .....................................19 , ' Date Completed .....'....1 IC�'6 ...... .1 . 1 1 } it �_• � • � - _�, . fGL B'DL� 1® 7 ess 's map and`lot number/ !!01111( o !2/J /o°z. ..... .:..�/ JD �0FtN F T0� O Sewage Permit number ........:.� 2- .�$ '8 ...................... E � d (� a4 gyp. G: Eby COMPLIANCE w �� � a lQ STA D 1N C O B9BaSTenLE, i House number' ........................... .....�............. ...:...._ M WITH -� � �� 90o rb 9 ' TITLE 5 TOWN * O-F .BARS N�S•TA �� � p N. t BUILDING :INSPECTOR ' ...........�.*.v.. .. ............. APPLICATION FOR PERMIT TO �'Ot�. .�v ...... n ! ..... Z: TYPE OF CONSTRUCTION .. ............ ......::.. .v! ........................: ............................................ Fr .............. .............................19.....?... T INSPECTOR F* IL Ny TO HE INS OR-O 'B U DI GS. The undersigned hereby applies for a. permit according to the {following information: Location ........ .. . V..............CM e,"A CD. `!— . .................. .)�� v.. 4.�-...... .. ... ...... ..... , Proposed Use ..............!J. 1 ........ .q. ). �.E'..\`.`:r!Il...... ZoningDistrict ...... .................................:................... ........Fire District .... ........: ?�................................................. Name of Owner ..�:�GM4'. ...... '.:...S n'!.�. ^.... Address .............. S..TP ....................:.. :.....: �. Name of Builder ..J. M �. ..... :....�m.i ^........... ,Address .. .............................................................. ........... f h Nameof Architect ..................................................:...:...........Address .......... ......... ......... ..................... ...::..,: ..........:... ..: Number of Rooms �6'Ll`�e... CO \S ................................... .......foundation ...... C • OQA �C S ..Roofing \ r Exterior, ..C.`�."�.�C?.............4?..............��r..................... '.......... Qo.��G�-�C'........5:�'.!.^.`.'� ......... wa `` Floors: .....qet ................................ ..............Interior ........... 4. . .\.................................................... y. Heating ...... Q4Q:.......4...............l ?+......................:Plumbing ........QZ..'... ..: ......................................° . i� OOO.. 4. Fireplace .......... Y...........................................................Approximate Cost .............�`�..c'��... ....................... i •• Definitive Plan Approved by, Planning Board ------------_-----------_ ______19--------. Area �4. ....................... ' Diagram of Lot and Building with Dimensions Fee a2 7,..... ................ SUBJECT. TO APPROVAL OF BOARD OF HEALTH AC— r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above` construction. , Name .... C .... ....... .'r!'�............... 1cl-7r6Z, Assessor's map aridolo number f ............................ p r.4, A 4 ar � Qy� TNE......... T0� Sewage Permit number .........49;2 :.•` 4a lr........................ BAHH9T/\DLE, i Housenumber � "639•........................................................................ 9,sue 'ED NPR a` TOWN OF BARNSTABLE BUILDING INSPECTOR t APPLICATION FOR PERMIT TO `� 4''J�_ � ���� �A`1, �. .............................................................................................................................. TYPEOF CONSTRUCTION .................................................................................................................................... ................................................I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... .':?. ......... ,: ......................... + ,1r, �t'� ........ .� .....�;�.;.....'.:.....:... `-................................... o ProposedUse :............................ .................................. Zoning District ......�' ':............ .........................................Fire District 0 ............... �.................................................... Name of Owner ... C?:�'�.�.'. ......: .....:.�.!.1- VV ..............Address ..............� t �;;...... " ........:........................... Nameof Builder" .........:arr,e;.I ... . +�:.-M...............Address ..........................)....................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .Foundation C—U C Exterior c` 2� .C) .A �� l�> �� `-� Roofing .......... ne. c".. - *- .................................. tA . ...................................... .......... ........... Floors .....oCh .....................................................................Interior .......... ,�'A, CA .\..................................................... Heating ......' Ct. ?..... `:.'= ..... M ram . ........................Plumbing ........... -......�?'": ... ......................................... Fireplace .......... �­:......................... ...Approximate Cost :......5. ..`'c '''.... ....; ..' y Definitive Plan Approved by Planning Board ___________-__________________19________. Area ............................... Diagram of Lot and Building with Dimensions Fee ..... fir. SUBJECT TO APPROVAL OF BOARD OF HEALTH e� Yyi 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. Y Name ... ....... P!;1(Yt�`1;..................... A=188- SMITH, JAMES K& / S� No ... Permit for .9!��?...S.t. Single... ........ .. ........ ............ Location j4j�.A2A......8:6 v 1��YLbok Road i-1........ .... ............... Centervii'le ................................................................................ /A=11 e Y. . ........... j 9 �y rool Owner .....James....K1. Smith . ..... ............. ..................... Type of Construction ......ff.amlp/..................... ............................................. ....... . .............. .......... Plot ........................... L(�t ....I....................... Oltobl'erJ14 , 82 Permit Granted ...................... ...............19 Date of Inspection .... ....... .. ................19 Date Completed .......I ..........19 IU U6 SINGS FAMILY{ BEDROOM WO GARBAGE 621NDr=P— DAIL"( FLOW : 110 X 3 = 3306.Po 1 SEPTIC- TAkJK = 330x15C>% =-4956,P. R U5E- 1000 GAL. 02r 0%,SP06AL PIT u�SE . too0 GAL. 5%DG�WALL 15oBOTTOM AREAr ,. YO �F•Sa 5.F-TC;TAI,- D�51 GN • .¢2�j 6.P a 4CP-TOTAL pA►�-K FLC)V4 330 GPo pIT bcR PE2coLATI0N RATES 1"IN 2 94� J%A Of ALAN 1"CHAR0 A, JONES a BAXTEA w . , 24we o. Ysl 4�o sua+�'i T�sT�•IZZ3 - r 4 ,¢p , TOP FkV*4.0.1 NoL.� 6-23-�'s.• fo• � '�.aT�JJ� �Y/v� �� F 7 loco j SJBSp�.. Bax INJ. SENT I Z I000 INY 36'G TANK � _ _ -- ,. GGyZSt3 LEALu 3!s . , „ s ,. WITH 1•/3/4-I�L ` WASNGO ,.• r. CI_2TIFIGD. P1-oT P1.-A.•J PRZO P I LE= �t ?Ci• N p 5 CALF o W ATW. P ti-A t•� REF E2EN GE I c E ctT I F Y T N AT T H E 5Ko wti - HEREON GOMPL�(5 y11lTN•THFs SIp�L1N>c _ AWD 56Te%&GK 6QU12EP�l�.N'f5 F-tµE �T' TOWN. OF.$� A, L& AND L:OCATED 'wlT 11J, BAXT61Ze Wye INc. R.EG I ST EQ6V'1.A1I o ISu MYi�r�� Tu15 Pi&KI-4,1� No*T B1%51=D oa Am 1N5TRuMEN�'- 5v2vG�(��'TNEoFi=SE"r5 guo�t,� / �. QCT[.t�J�II�C :L,c-T LINS15 APPLIC"AW"r e Y� „off"IF TOWN OF BARNSTABLE Permit No.--,. 24, Building Inspector I sa�rru,�D• .. ^f' � Cash -. ----------�kE/s �CY4Y ` OCCUPANCY PERMIT Bond ___ No building nor structure shall be erected, and no land, building or structure shall be r. used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Jams Kt SIl itb Address lot Valletbrook Road,, Centerville wiring Inspector /�'` Inspection date Plumbing Easpectoi, l4 Inspection date „?,� Gas Inspector Inspection date-11q Aht r s A 9 X Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. " ..I�-.7......-de�.......:.............._., Building Inspector ........_ Assessor's map and lot number ......,!.S1. ... ............ ` �QyOF'THE r��O Sewage Permit number �t�-c{ ,...�. ��...........: Z BARNSTABLE, i House number ......... 6...................................................... 9 Maas k 4p 1639. \0 �f p YPY a. TOWN OF BARNSTABLE r ki BUILDING I•NSPEtT0R APPLICATION FOR PERMIT TO .... .... ©j ..t ��...... 1 !. .....f��`�! ................................ TYPE OF CONSTRUCTION .. .................................................................................................................. ..................... v. ............19.pJ . l TOE THE INSPECTOR OF BUILDINGS: The 'undersigned hereby applies for a permit according to the following information: .` Location ........ ......v. ..... ....... „/...........CV�IL .U. . !4�............................................................................ Proposed Use .......�o2.1 . Zoning District ........Fire District ...G/.......................................... Name of Owner ..!J.l'lJi��?1�I.d .L►.! .�J�?' ................:......Address .�!.G....v�.:L�... �......!:'`1............................ Name of Builder .l 00........ i�-�.................................Address Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ............................................................................... Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..............Plumbing Fireplace .:.................................................................................Approximate Cost .............................. Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ...... ......:.......... Diagram of Lotfand Building with Dimensions Fee ( � `�` .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 r 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 ..... ......................... Construction Supervisor's License ..O.oi,.0.............. TOMUNSON, ARTHUR A=188-165 No ...?7068... Permit for ...ADD... OOF... ........... EXISTING BUI:LDINr'- ..................... . .... ....... .............. Location 86 Valley Brook Roa .......................................... Centerville ............................................................................... Owner .....fur Tomunson ..................................................... Type of Construction ...Fr .............................. I f Plot ............................ Lot ................................ 1 Permit Granted ..October 5, 19 84 Date of Inspection ....................................19 s Date Completed ......................................19 / qq / Assessor's map and lot number ......1..�1.. �to5.. ........ Q�pF TH E r�� Sewage Permit number SEPTIC SYSTEM MUST BE t nwSTABLE. House number .......... 6 ..................... INSTALLED I C0A1.!DLA,C' 900 1639. WITH 0� ..................................... TITLE TOWN OF BAn4 ` S1T-A1B1LE� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... V.....KJ4 T. ... ...... TYPEOF CONSTRUCTION ...f .................................................................................................................... uu ..................... . ... ............,9. .1.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........%......v. 1 ..... ....... .........0 G .(/.1m........................................................................... ProposedUse .......& ............................................................................... ......................................................... Zoning District ........ . �...............................................:..........Fire District d V Name of Owner ..!1.V{l.��..d�.�.!�.��........................Address � � �C !�0/......................... ........................ ... ............................. Name of Builder . ......�...77�t1/�-p ........Address .................................................................................... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. � Fireplace ..................................................................................Approximate. Cost ........2�" ......................... .................. Definitive Plan Approved by Planning Board ---------------_---------------19________. Area .....C/... .. . ............ Diagram of Lot and Building with Dimensions Fee G- 0e......Y.... 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 Barnstable regarding the above construction. Name ..�9...... 621�/L-C7........................ q . Construction Supervisor's License ..O.9.1.3...1?.,�.............. TQMUNSON, ARTHUR No .... Permit for ..AI)D..R.DOF.......... ....... EXISTING BUM'�INQ ................................. ................................. Location Brook Road ......................................... Centerville Owner .....Arthur-Tcly.MSOn............................. Type of Construction ........Frame....................... .. ........ ................................................................................ Plot ............................. Lot ................................. October. . Permit, Granted ................... 5.....................19 84 '.Date of Inspection .....................................19 Date Completed .................. .19