HomeMy WebLinkAbout0041 SIMPSON AVENUEry >ffiCtntpund
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___Dept.(3rd floor) Map 3 Y 7 Parcel o / Permit# cO/1/5—
/
House# � d./ 5//hra.J .4' gyeyb/9 Date Issued /02-/�l
' Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 75- '1 Gitik aP ' Fey 3 7,
Conservation Office(4th floor)(8:30-9:30/1:00-2:00)
Planning Dept. (1st floor/School Admin. Bldg.)
SEPTIC SYST w`����E
Definitive Plan Approved by Planning Board 19 INSTALLED IN " ' _t:,,:dE
WITH
TOWN OF BARNSTA ONMENTAL =•, AND
•
Buildin Permit A lication TOWN REGULEATIONS
oKlu) g PP--P-iejeddress 41 Simpson Avenue -,
Villager :_. r `l vt9sk
Owner Linda Conaway Address 89 Harbor Point Road, Cummaquid
Telephone 508-362-2344
Permit Request Remodeling of existing kitchen and bathroom• no new foundation work,/1
no change in present footprint of structure "( f& k �,,,,A.1
ce e� c.,
200± s .ft. topbe remodel
First Floor sq. feet Second Floor N/A square feet
Construction Type wood frame
Estimated Project Cost $ 12,000.00
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family LS Two Family ❑ Multi-Family(#units)
Age of Existing Structure 100+ Historic House 8 Yes ❑No On Old King's Highway ❑Yes j No
t Basement Type: ❑Full j Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) none Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing one New Half: Existing none New
No. of Bedrooms: Existing 2 New
Total Room Count(not including baths): Existing 5 New 5 First Floor Room Count 5
Heat Type and Fuel: ❑Gas ❑Oil ®Electric ❑Other
Central Air ❑Yes ®No Fireplaces: Existing New Existing wood/coal stove El Yes ❑No
Garbge: ❑Detached(size) N/A Other Detached Structures: ❑Pool(size)
, ❑Attached(size) ❑Barn(size)
't4
�1 ❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
✓vt i o - K A16S71)14 , Fz Builder Information Name CA/F % &44 )S%?1.( A ( /(.4%1 S Telephone Number SO ' 3 60 2,' 7 6 L/ 7
Address / . 0; CLI( S-16 License# 0 Z? 2- / I-
li 7 v iZj7 t-, 4 Home Improvement Contractor# / 2-0 7 8
(jL 'D i'WJ s- /! i Ai 4-CS". Worker's Compensation# UJC 1/ C7 0 I ? 7 (p(o
0 6 �
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 AV —sl oun/i/'s �.
SIGNATURE / •I DATE Z ' 3 76
BUILDING PERMIT 1 NIED FOR THE FOLLOWING REASON(S)
� �} FOR OFFICIAL USE ONLY
/ t -
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P
PERMIT NO. ; ! 11 1+ -
DATE ISSUED _'
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MAP/PARCEL NO. ,r
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ADDRESS VILLAGE -
OWNER
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DATE OF INSPECTION: "
FOUNDATION
FRAME 2- 5' 17- PUS
INSULATION L�?r;. 7.'L.
FIREPLACE
ELECTRICAL: ROUGH1 FINAL
PLUMBING: UGi FINAL.
GAS: rt%t = FINAL
fig. Iwoo I t'-
FINAL BUILDINGS }<
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DATE CLOSED QQTi '- %`'a
ASSOCIATION PrAMNO.--
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+` The Cottztttonwealth of Massachusetts
-%4:i _._ 1;_: Department of Industrial Accidents
} ` F- Office of/nvestigations
7..:- !
_ ; '' 60(1 II ashinl;ton Street
`- Boston, Muss. (12111
Workers' Compensation Insurance Affidavit
Applicant information; '" Phase PR(NTlebiblY ._._, .__.__..........._.
name: L /NDI 0d AV t'Le), A /
location:nt ' 211 S' i !M p co 61 A J'et'tu 'e_
cite /T y Mn' 1 S phone# 57 j--3!a - 3 y4
0 I am a_homeowner performing all work myself.
D I am a sole proprietor and have no one working in any capacity
..-... ...:".n «--•_T �� ... .,,r,...•-,,,,r.,J78."!' wa-9!r"'^.r^n +a -aew�. —..rw ym...,.+•7,..u... ...�}4q..s,7_..ors+.._._*...Tr,.._.--.."-.......-.
.... .-...i-""ram{ -- '.liy..:_.;r r :t ':,k:�:.�-r.�.... .�.,-... .._ �,.,. �,:_..�.�......__.._.__..._..._
am an employer providing workers compensation for my employees working on this job.
company name: lit.)Es f PD(AF2N5119 3t- E gcitL-DEPZ-S , .LiUc__,
address: /' 7 U Re LI 1E. 6 A j O BoX S lL •
•
city: U /{I. Sfi 8aYV1S tdbl`e phone#: 5--O6 3 60`2 7 1717
insurance co. 6 AS 6It'-3 ei4SU AL.7 J/ S ' e0 • polio.# GV cV D 0 1 O 76(p
.. r n. ..»... ..,.�... +....ram..�., ..� .._,. _. ._.».,.._._
[ I am a sole proprietor general contractor r homeowner(circle one) and have hired the contractors listed below who have
the following workers con a ton polices:
company name: l,n/ Vl Ott F 1e: Tri
address: / Ray b-er kdd PO i o�/1` 6 p
/ 7 SOrtedt S O.? te,6 �-•.
cite: 6 ki,141J S 0) t'S^-3 phone#: S—D,—..2I/0 — 70Q t1
insurance co. ie. 14S rtte IJ C.AscugLr" t/ ...nos • `. O • policy# UUCP d 0 i gsl
i_..----..... ...,.....:7 __.-..--- ...:2::-.i ..''!r•.w7I_:ra,..,:iw�. �..:.. . ...a• -......., �.. �_i. y'►'' 2':, �'`�, ........c..3.u..ar-: .a_ a..�
company name: P'f- k P Iv 0,1 bi'll r{
address: O l3 O /` �0 3 J l
city: West .6drh STD b ke phone#: . �b�-3/4 2
insurance co. So I 'e- pr .prl •poltcv #
:Attach addition al:sheet if necessarx< . J' x rF "'9V'::".,. ^7^?`" :•5't
_ ---_... .--'------ . . ...mar y.+...ra.:.- ....:sr.L �� l•,»�in:� ., wFzti•:zw .,L:,s�..�r.: ;:..:
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 andior
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against mc. I understand that a
copy of this statement may be forwarded to tie Office of Investigations of the DIA for coverage verification.
1 do hereby certify tit lcr the 'is and penalties of perjury that the information provided above is true and correct.
1 —2—? - �6
Signature Date
Print name "C e ti P G�/-- N l 6.1 I1' b J Phone# SV • ?(e9---Z • 7 (0 `( 7
,
official use only do not write in this area to be completed by city or town official
Icity or town: permit/license# °Building Department t"
iOLicensing Board
check if immediate response is required °Selectmen's Office
°Health Department '
contact person: phone#; °Other ,
r.
1res,sed 3.,15 e).v
information and Instructions
•
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", 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 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.
V
MGL chapter 152 section 25 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, 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 insurance requirements of this chapter have
been presented to the contracting authority. '
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits 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.
City or Towns •
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call. _ - \1
y.....y,.v.,-.,.._.,:. . ._-.•....v ,-mow,..m-•.v....:n�r.--...s...- +.e.....s-......+.r..rx.sete+.-.n+.:e,....�sw,� n..+..— ..�!�.�,.s.�..r-ra.wnS'•?' . ..-
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
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
R347 001 .
L000000 YARMOUTH TOWN LINE CTY04 TDS 100 BA KEY 251113
-----MAILING ADDRESS PCA1091 PCSOO YROO PARENT 0
YARMOUTH CAMP GROUND ASSOC MAP AREA65AD JV MTG0000
%MILLER , ROBERT N TREAS SP1 SP2 SP3
P 0 BOX 639 UT1 UT2 16 .43 SQ FT 870
YARMOUTHPORT MA 02675 AYB1950 EYB1975 0BS CONST 28225-
0000 LAND 170600 IMP 393000 OTHER 4700
----LEGAL DESCRIPTION---- TRUE MKT 568300 REA CLASSIFIED
#LAND 1 170 ,600 ASD LND 170600 ASD IMP 393000 ASD 0TH 4700
#BLDG( S )-CARD-1 1 23 ,400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#BLDG( S )-CARD-2 1 23 ,100 TAX EXEMPT
#BLDG( S )--CARD-3 1 36 ,900 RESIDENT 'L 568300 368300 568300
#BLDG( S )-CARD--4 1 36 ,100 OPEN SPACE
#BLDG( S )-CARD-5 1 20 ,200 COMMERCIAL
#BLDG( S )-CARD-6 1 43 ,600 INDUSTRIAL
#BLDG( S )-CARD-7 1 40 ,000
OTHER FEATURE 1 900
#BLDG( S )-CARD-8 1 53 ,400
CONTINUED
EXEMPTIONS /
SALE00/00 PRICE ORBC61390 AFD
LAST ACTIVITY09/18/96 PCRY
RCV F Window PCR/1 at BARNSTABLE ( 28 ) 1p
' fill*Tp�
y The Town of II;arnstaffe
BARNSTABLE. *
s,11 �$ Department of Health Safety and Environmental Services
ArF p m�" 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
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: r d 2 1 P1 Est.Cost
Address of Work: 'T 1 l DSO - a Y1 S Y C v I
a la lj{A- 1—
Owner's Name C U` )1g114 711 %<"/lv(o 17&lU / (). P
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$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:
1L -23 -1 V I .r t io )s- 78
Date Contractor Name Registration No.
OR
Date Owner's Name
PROPERTY ADDRESS_:.._.__. ....._S:r.._.
I I ZONING 'DISTRICT CODE 'SP DISTS.I DATE PRINTED I CLASS I PCS I NBHD . , PARCEL IDENTIFICATION NUMBER - KEY O.I
0000. YARMOUTH:JOHN=LINE 04:: • . INDt • °100 . 04BAt - - • 07/09/95t.1091. 00. • 65AD R347.001z' 251113
LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS I
Land By/Dale Sea el:
'Y UNIT ADJ'D.UNIT ACRES/UNITS VALUE Description YARMOUTHC CAMP T GROUND'ASSOC` 'MAP- +
/ICD. FF-Depth/Aaes LOC./V R.SPEC.CLASS ADJ. COND. PE' PRICE PRICE
CARDS IN ACCOUNT -
LBATHS.A 0 U' • Xt D= ' 100 2700.0C 2700.00: 1:00 2700 8 03 OF111 '
A --NO BSMT: S : X; • D= 100 : ' '6.95 - =5.42' •934'. 5100-8 LU3r • =539000
N MARKET` 409600 .
D 'INCOME
A • 'USE
D APPRAISEDtVALUE
D • A 539.000
A u PARCEL' SUMMARY'
T S LAND '170600
A T • BLOGS ,364000
• • 0-IMPS ;4400
M 'TOTAL 539000.
F E N'CNST' 28225
E N - • ,• 'DEED REFERENCE!Typ, DATE o R.... PRIOR' YEAR;VALUE
A T Book Pag ! S""e
net Mo.. Yr.D S PP" 'LAND 170600
T S :BLDGS ` •368400
•
U • TOTAL 539000
R
E
BUILDING PERMIT
S Number Date Type Amount
LAND LAND-AD./'• INCOME USE : •SP-BLDS-. .FEATURES BLD-ADDS; UNITS..
r � 2400-
Class I I Units I Units I Base Rate I Ad! Pale I'AcYgg�u71 11179 I Age I Depr. I Contl. I CND. I Lot I%R.G.I Repl Cost New - I Ad1 Repl Value Stones I Height Rooms 1121ed Rms..Bathe I e Fla. I Pariywall Fos.
016 000 .1005100 . -46 95 ;- 46.95 00's751980.; • '100 `80 46138 . "36900:1.0 4" 2'1.0. 4.0
Description Rafe Spuare Feet - Repl.Cost KT IND X: 1.00. 1 BY/DATE / . ' 'SCALEM 1/00 45 ELEMENTS CODE. CONSTRUCTION DETAIL
8AS 100 46.95.- . 934_:_ . -43851IGMR055-.AREA. -. 34. S'INGLE.,FABiLr uwtLLINd, ' LNsr: Far:00
S •FEPt '.65... 30.52' . 42 - -;1282 *-10-* -N' STYLE."... ' -. 09COTTAGE 0.0
T FFG .30 '14 09-. 200: ' 2818• .*FFU-* DEBTGN-ADJMT-"-00-- -EGO
R FEU'. 25-- 11..74: ' 50 587-' • ' ! - _12 EXTE-Rat-A1-tS----01fiOQD IFRAME U:0
U
U 20 : '! ' HEAT/AC-'TY PE---090IL-ROT7-WATFR----0-:0
! ' -*-*--- 27. , * ' INTER;FINISH-�--04D1fl ALL -0-:0
T • ' !FFG' !`14 ; 10 . . INTER:LA-YOUT-':-t3BEt06-'AVE RA-SE 1T:0
U . *=10+FEP : " INTER:91t1CtTY 02SAME`A ;'-EXTER UFO
R
,,*_7,T FLVffR ST`RUCT-._--01if00-D.JR?ST: VO A _ -. . .. U . - . , 1.1 _ _ ! EFLOO-RT.COVE R.-•-O.1H-ARDIiOO-D V:0
D ! - R001`..TYPE
L E To,alAreae IA.._ °292 B05B v 934 ' ! " �--OtG7t8tE=7i-SPH-1S)i---U:O
BUILDING DIMENSIONS .
' . . !' BASE .28 ` ELEC-TRICAL -A
y1AVERAGE- tr.0
T BAS Y13.N32`Y07/N14 FEP-N06°FFG-;. -32 ` ' ! -' . M-FOU-N-DA T1QN:--'-02C-oNCRETE-BL-0TCK79$.9
A S08..-Y10;N20:FFU'N05'�E10• 'S05 1.W101* - " _ ' , ! , ! a -
. ,,FFG:'E10,S1,2 . �FEP' SO7`='E06 -' '!! - ! _
L N07L..- BAS;E27.S10.w01kS287H06: " • . ' ! ` :*6-*" LAND-- :TOTAL- 'MARKET'
S08'... - ' ! - '8 PARCEL
* 13=X AREA,
VARIANCE -+0 +0.
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HOME IMPROVEMENT CONTRACTOR. worm /. Registration 120878
-- -Fri--_
0104071 Type - PRIVATE CORPORATION
‘Z----it--‘, Expiration 03/13/98
WEST BARNSTABLE BUILDERS INC
MICHAEL KINGSTON .
•
Z..Z___ ,...e..:0-7*-0-"A" at70 RT. 6A/P0 BOX 516
ADMINISTRAroi WEST BARNSTABLE MA 02668
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