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HomeMy WebLinkAbout0021 KEEL WAY l� �F1NE Tp�, Town of Barnstable ~°^ Regulatory Services BAMSTABM ' Thomas F.Geiler,Director 9L MASS' `vA 1639. `` Building Division lFD�'t s g Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SHED REGISTRATION 120 square feet or less 11-1e l Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# Signature ' Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) / ' �P 711-7/61 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg sdow zoI s,ioss e o swo o umo wa an i6i aiam saw wio o a ox o o dow a uo t X08)INll313 O 310d 1N911 s io uo A)om» do ou01 o IJaaw oI addom a am uoi o o6an puo'A dw6odol'smj2 mluo 11uo Jwad10 steal o misA d oI sdI suol o a�on 0 uasaidai Sou o sI o s m uo A�wma adous pouooloa *1333 06=H)NI I . 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Geiler, Director O D MP A� 2009 / F� Building Division T Tom Perry, CBO, Building Commissioner '4QC� 200 Main*Street, Hyannis, MA 02601 www.town.barnstable.ma.us - Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ( Not Valid without Red X-Press Imprint Map/parcel Number _ v� f �nential Address Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address �1( -;#"4/V0 �'/C)/v� J 1�L e I 1 AtA Contractor's Name_ ��/{� �(2!" JAIL Telephone Number . �C)I—C• Y/ 6 `7'0 I Ionic Improvement Contractor License#(if applicable) Construction Supervisor's License # (if applicable) ❑Workman's Compensation Insurance Check one: ❑ 1 a a sole proprietor ❑ 1 m the Homeowner have Worker's Compensation Insurance Insurance Company Name (,o/1/I/ Z/ �, Workman's Comp. Policy# j� k7 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) Ve cement.Windows/doors/sliders. U-Value Oc S.S (maximum .44) *Where regsired: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property.Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: --- �2��--- Q. µl PI-II.IS%.F0RMS\build ,iiild g permit forms\EX PRESS.doc Revised 100608 r 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 Lezibly Name(Business/Organization/Individual): ' '` SBGtct ilV G Address: 113 7 �a s pl i v�Z City/State/Zip: WoyNS 6G4" a�7Q Phone#: e�cl - 6 7/ b y0 Are you an employer? Check the appropriate box: Type of project(required): 1.91 atn a employer with 6-© 4. ❑ I am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction .. 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. . Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.} 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL. 12.❑ Roof repairs insurance required.]' c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their 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. $Contractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: GLGc-ri) / "l 1> Policy#or Self-ins.Lic.#: S O 1b Expiration Date: © / Job Site Address: k�r, um- City/State/Zip: ; P rS A. a ccl 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that-a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is tW and correct Si Date:ature: a�--�— l � � _ Phone#: - Official use only. Do not write in this area,to be com 1p eted by city or town official. Cih'or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Y. From.4�1 au n o ZoWno�HuMer Iftsummce At pU n}t'p' u no e,Ina. W-D: Del")* el"* 31=1 CERTIFICATE OF LIABILITY INSU RANCE moo m- o AY CCU#11 AND CoUpERS 14o gjGjJTa UPOu THE CERTIFICATE U t z i auxa k on Inc. HO E M THIS C RVICATH DOES KOTAM Ntt eXT"END OR d giver z Ito ad, .C Box ALTER TH=-CCr'� t AFFORDED �14 POLICIES BELOW. 3119 II�SUAeRS AfFC3F t Ttlf COVE-RAGENAM to 'He met 3�'3t3: s�aaxa 3a, xiram> USA.Pone ax b 'or.dor o T�of T out x He moofla s 0 Vo 3P�atF R: AM MAY MMAX TM Sucm AIM& jWjT$V,47WN WAY M SM.RMU=DY PAID QAM nqw T C1s VI Tom% k ftt t tA,:C iSks11`Y�d��fPs 4, s`Pl"3 01M AL G3fcQll ry 0040 GEWRALAMR—m Tc�C owcr MLOC (Pwows 1 "RED Affoo, DOMY WAY i�'er rscn'sd�Rtj ANY RiUM P dx133t8a T L-xf3P� FY t EACIROCCL NOW= ocom QUPWYERW l fRE3€L t1' 00 YaPat S €IooAQ s°K?IIi3`�t°�}lC3t G�'xsY t�3f f;CR€f Q k 0 Y1C3Ak k.00A.0 4 442 F 3 €4$%3�R t E , G s P PR CERTIFICATE HOW ER CANCELLATION DATE WEr 2 f.7K -UNO WSURFRWILL OVEAVOR TO&M 30 DAYS WIMW-4 BUildinq Cut, Reg. 110,Mrd r>amfjTC3l'"BG�n"LATE+ttkWERMMEDYt3TWEUT.QVrFAkUFMTO0060StALL Dept, of Administration IMPOS9W10 COUGA ON OR UtDUTY OF Ar4y too UpON INO r izM AORMS OR one cwpit*l Hill ip Mt_ Am, ACOO 2 { f# f 0A oR r-oR—F RA�"OR99918 " ~`tire'(,St%t#sz�tcx�rtr„a�„rxti#x ey�. �csFs:cre/fr��s�t l leerssr or rr Tstr atfnn vaiid;for intllvidul use only ` ' Board and Standards Before the,expiration tTzte.t Tf found return to` HOW!IMPROVEMENT CC?NTR1tCTOFt Board o€Tint Sing RM ulatlons and Standards One Ashburton Place Tim.1301 11953 a Boston,Ala.02108 � Expiraflnt': V 4/200q Trt1 130185 T e: Pdvatn C4, attrrra MOON ASSOC INC NAMES MOON 7t et yalici-- 1137 'ARK EAST'D . .�•.-t..�r�� N ithont signature 'NOO SOCKET, RI 02895 Adminlstratlor �lat��.t�ltas tr4 • B,,I�,aEteotcatt ot'1'1tltlas Restricted t ,l+lS �5?#2td'S# a)l iitJll�t�4€`„' �4�"„',til I$Sitt4�. �ttatl �f;�t4ff,2t'f€� 1A- N.avonry only FtF- Roof Covering L merle, CS SL 99840 AgIbL WS-Windows and SiJin Pe.,tr tforl te, IRE.WS .; SF- Solid Cruel Burning Devices T Dm-Demolition only ,TAMES MOON 48 PAI IE ROAD Fallon.:to possess.a current edition or the Gt1M iTE i , 1 1 fassUl'.lattsctts State BuildingGrade is Cause for revocation of this lk nse. Refer to: WNVN'V N4amGov/UUTaS » zr xwrmon- 3f"�s'y327'w,012 ---------------------- 4 C towma Nu=- A 0 C9-04.n P .J2AQ tMtr V6ar Binh: Renewal byAndewm aRenewal by Andersen r' padtess: 'L/ � M.91r Cus*oma I[�Y: of A18c Ca God 0) e Sales Agreement cim Ssax,Zap niL e/ older Numbeo Wooasncker >u 02895 a �� c er �Ja--3/b3' WINDOW enawolJw ate.oAad.esaC�wnpmy � P6oae•Homr. Phocc-11Porlc licwc*Ri 12259-MA 719535-CT Etnatl: 0562n5 uNRS it I'mg j{ ,wan is r 9jk �` �: �i I p" �a X. fr is 9g { i N at 9f 1 32 j,f rr ► � t 3 �- sz � t3- ► 3 1 1 t 3 Z 4� c O S L, 1 7i.. S7 3 2 A A � R 4 ��a "twel awv O PaYEt 't Method rnz:� �: amwwe��a. :aparae.ma.wwwaa..w..mema� rbe eQ sAe tnul ar..ew.� ._ - '�.abw7 ..lid iew .®e i. w exeppwa 6p Laeb Cs.eome ewd Amend py° te.a.�u ..�—+ _ 69 ueeaEpdonlld o., hemmer :Yaaac uehodeee a 6adrn i� a d.mome 7� 3 C o V ifi J�-� BL AQsr o du.a Eq Je oAdh tnd 4% Q eeewmme roe atib .g.m.fo pep a,emom<maed In ads egmmxm,ea �o aemem eemos `�••— l � 2 See Reverse Side fart rns and Coodidone of$aLe.You.flu b fJQ➢ uyer,+naY � o�IQr Tip IYSI F"Tw2 1C p v Of two trsnsacdon w a�ryupw p mdaigL�of r6e dui busmeas da9for an p dsu rreraenr i'K • 7'{//1�'►�AS�S Toad!di.od sows CAM"er Fspee.a a 1 s' Ylak pE.mlt Cost A/�awrares.sw.Atndrt ca.nrr.«taadmame eeditlegienxe.imou 1aa.re..ataM 4ecidord-Now mmlanb+..eaf .e �' 9-pow 8"D- �i `ie"v"s dam Rrneo d bpAadasm M>o�gpslpm /9 L(— ie./[f l3ot.. 1=sSi t n D N_� sp�erwt ro. N p aenasml a all,= adm.e a.dnsrmwxm Pleaeanole tlu.waaeuwMrmbldmngM.g by ieJ'7 � O/� o t3f .3 AAlnnea Due an to..4hdse C) aloes- aaaea pracae 6+e Gled'ldOr mw�sAw rr�p�emae.mnegeBarnwY+el�tendrnpr J —! p borw6d �riac ffid +idww wMp6o d hd.a.sawddmw.g Ystlbtlwarre elBmwpkm Pda brrlude.l.bor.�wawarlala.Iowliadom. p IN{wpaetren MewwdM rtembw "s wwddrp¢pae/renp..s n0aalor Ww+e �e�r rabuled. odrwebe owr.d A7Mr.wM.T1i.JOb�maua.amdeld..ciBM removal.and di.pout ofpmdu.L nplaad. mnoeenard.rwO dsa+yae nsMdows eM trauta•aerreu.i 6pAndeaen tldba.•Letaialiaa Pink•Nmre.vmer O=taw.e. dWOpnN Ce.teertl lfe hemtwdm am. p dEtl.ls: �IelAalr: �4ltlele _�,,..�..�• O o►�` N � •w...+h n...er..a m,a®..rer n�uac..�aee.mo�am.a me.as...G.we.d�u+le�.m..t ueewaw er- 247167 ,TOWN OF BARNSTABLE BABBSTABLE, i ` M6 9 ,,� BUILDING INSPECTOR a o wnr°'' APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .......... ....... i '.6..!J ......:................. o>e:y.......................................... ...................!'............... '.......I 92:iz TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ' .rfty ._......:....... /< tips ITv�-� ProposedUse ,!�isJ. !c ..................................................................................................................................... Zoning District ......... ...�.�......................................................Fire District ...... .x.!4�'!�ce�J ................................`...................... Name of Owner ... .r!it/irTor7� u�sv�.o` c o Address ......................................AIP /� '� ���.tis.�"/o• ../:lamSJ ....................... :................................ �r .r �.�Name of Builder .........................................................:..........Address ......:......................................... ................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............. ...................................................Foundation ..... �? ... rercg :..�.r`v � f ExteriorS /.iV ..............................................Roofing s��i,a f"":.................. ...................................... Floors ,1 .. n,.Li�. ...................Interior ................................................................... .................................................................................... Heating �� G �/. '........... ..............Plumbing ......... . z.-....b.e .. Fireplace t ......Approximate Cost ........................................................... ............:.:......................................... Definitive Plan Approved by Planning Board -------------------____________19 Diagram of Lot and Building with Dimensions Z b SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 p -=� m �1 V d l y = cn a � czn vi C7 - -icnrrr rr > O � u �a v yM ® y r`-I O cno ►- - �. �. m _ r co oma � _ `. gym �r) ca ,; y. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �l NameC ��... ,.... "- ../G% ..... ................. D"rnisport Furniture Co" ' ' l �Rbn onestoryNo —���.'.�— Permit for —.----..�...'��--.. ` . ---...�i!����..�azo�4y. ------ '�/ Loco�on~��—�maI..W��____________.. .........................West.. ______ Owner �u' ----''`"==�§�=�.�—=:�'���.�—'"`' < '' � Type of Conotrucion ............. TRQ.------ ' �~ � ---..----------------------- Plot ............................ Lot ....... > ' . Permit Granted ............................�arn���� �2 ---...lg �� � ' . ^ ` x ' � Date ofInspection —.--.—'--- lgDate y } . Completed ....... ...19 ' v \ PERMIT REFUSED � ^ .----.._—.---... ........................ lQ ' ' --------.----..-----------... . - _—.----..---~------~--....--.' . . ' � . .—.----.--...----'--.—~..-----.. � ---------..~.—,.--....--...~.—.— ' Approved ................................................. lA ^ { ^ . ' -------------.—.--------.---. / . ` -------`------~-------^^^'~'-` '