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Home My WebLink About0039 TOWER HILL ROAD (27) 3 q E: l �- f E. t 7 r ti: Q; � 4- ii� Cy��_ .+ �. :! i } -- r p(� 1 0 0 � � �S ,., ,� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel Permit# l� o Health Division Date Issued 2 (� Conservation Division r �a /fig Os-- wu� e Tax Collector - f�p 3C)�d 0 Treasurer Planning Dept. Checked in By 4P__1_9 Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address '_3 ci /o c.z��/z f�i L C �� r;/N T 2 I C Village Cis?E2c��L l Owner (�2AC c- V Sim/ fi`i 2 1 L Address 3 /dc.�J�.2 ��1� R./ Telephone Permit Request?r5e! 9e VE i s 1_61/a 'EC '/?C 6 v / 0/ U,'/X qESC/�Z�_�C—'A �&� f�� f�/1!!} � S', i/U//�hOr,A�(. �n'� F lZ �C 2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation -'/000, 0 O Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. C c, Z. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) - Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway ❑Yeso ❑ o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) cn CD r— Number of Baths: Full: existing new Half:existing new o I n Number of Bedrooms: existing new Total Room Count(not including baths): existing - new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use l BUILDER INFORMATION 1 Name 2,60/C/ U. �.5 dj Co,✓S f'e ucfio&ephone Number f%SO R /Y Z 0-3 g Z Address 6 1 License# g Z Z 3 ,ilg/z S f o"S 17171 L L s 44,q o Z G Y 47 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 2 & A �,v c� �i 4- c-SIGNATURE� DATE �'Z •-O�- FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEC NO. f ` a ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION //� ) FRAME lCJ 4firs 3 K• I INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING .7�9�c, DATE CLOSED OUT ASSOCIATION PLAN NO. 3ti �5 /^r Cie-ma P AcWty 3r7 9 Lxxke.5�or c- -D �23 C5 0 o� Gl-ek) �j Nsc �Iy�59� 39 —lower D&A ✓kf hs �JO TvS�Er'�oas 7io SOr�e i CAOCS arnstable Services r,Director ivision Commissioner is,MA 02601 stable.ma.us Fax: 508-790-6230 ❑Porch ❑Gazebo '•r pplication. (This information maybe:obtained from 0 Main Street: ay Historic District(North of Route 6) Waterfront Historic District (see map'for boundaries) ion (if applicable) 0-2:00 PM The Commonwealth oj'Massachusetts Department of Industrial Accidents Office°of Investigations 600 Washington Street s Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit- B 'lders/ ontractors/Electricians/Plumbers A licant Information / Please Print Lesdbl Name (Business/organization/Individual)• �! �C=` �ie�. ��. Address: '/h6F44eC/ kXJ e s-t 0",e / �OZG�Z City/State/Zip: Phone#: C1-0 F/ el d 3 Fr3 Z . Are you an employer? Check the appropriate box: Type of project(required):.. .:. ::..;;. .. 4. ❑ I am a general contractor and I. 1.El I am a employer with 6. ❑ New construction .... employees(full and/or part time).* have hired the sub-contractors 2.�I am a sole proprietor or parizler- listed on the attached sheet t ? ❑ 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• ElWeare.a corporation audits 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeownerdoipg'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' 13 ❑ Other comp.insance required.] *Any applicant that chicks box#1 must aisb 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. tContractoTs that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.4mlicysnfonriatiorL I am an employer that is providing workers'compensation insurance for my employees. Below is the policy aid Jbb 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 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 certi der thepains andpenalties ofperju that the information provided above is true and correct ,Cgi atur Dater " —2 —.O Phone#: ,�6 ��2 CI 3? Official use only. Do not write in this area,to be completed by city.or town offi ai 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 Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Mass person in the service of another under any contract of hire, Pursuant to this statute, an employee is defined as"...every express or implied,oral or written." or any two An employer is defined as`.`an individual,Partnership, in the legal rpepresentativoration 6r es of legaler deceased�employer,o�theore of the foregoing engaged in a joint enterprise, and g . receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner a dwelling house having not more than three apartments and who resides therein, or the occupant of the do maintenance, construction'or repair work-on such dwelling house dwelling house of another who employs persons to ant thereto shall not because of such employment be or on the grounds or building appurten deem7enVlayer." 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 opetate 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." ter 152, 25C 7 states"Neither the commonwealth not any bf itspolitical subdivisions shall Additionally,MGL chap §:.. ( ).. 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 ' compensation affidavit completely,by checking the boxes that apply to your situation and,if Please.fill out the workers necessary;supply sub-co naine(s), addresses)and phone number(s) along with their certificates) of insurance. Limited Liability ComPanies(LLC)_or Limited Liability Partrierships(LLP)with no'employees other than the members or partners; are not required to carry workers' compensation insurance: If an LL;C or UP does have employees;a policy is requ sure to sign and date the afired. Be advised that this affidavit may be submitted to the Depatmient of Industrial Accidents for confirmation of insurance coverage. Also befidavit.' ould The affidavit sh be returned to the city or town that the application for'tbe 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 which will be used as a reference number. In addition, an applicant Please be sure to fill in the permit/hcense number that roust 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 burn 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 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia °F Town of Barnstable Regulatory Services enxr�sTr►BM • Thomas F.Geiler,Director mass. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 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 adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �J UE c k (o ds�eucf N Estimated Co Type of Work: A 611dVe* /S /' , Address of Work: `3 9 76Ge/�/L l�<< Owner's Name: Date of 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 p=r the agent of the owner: Date Contractor-Name-- Registration OR D Owners Name Q:fm=:hamiaffidav Town of Barnstable °-^ Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I� 0 as Owner of the subject property hereby au onze G LE•vc/ 1?S�i �� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) I Signature of Owner Date Print Name Q:FORM&OWNERPERAOSION :, . � , i t a �. 1 r � 1 k • � ,' .. � '' ' , f•� N l 1 . l:� , `"`=? �� _ V .r--� I \ ��_�� _:::�_.. ___ . _ __. :A ,. • i A.. - r-. _.. _—_. ....... • :Jfie TDdII1/IIl0'I7 : ii�Q<ZddKZCIlUOCL[O•. BOARD OF SWILIVING' REGULATIONS..: License: °NSTRUC41tON SUPERVISOR Numbe 082236I Bi�Vie_;• 63 � ,u 0•/207 00� Tr.no: 82236 ;: Res I.. GLENN P ASHLEf, 379 LAKESHORE a M� SANDDWIEH, MA 02— Administrator �• s �p - Board of Building Regulat'ons Standards One Ash rton Place oom 1301 Boston: assa setts 02108 Home Improve o tractor Registration Registration: 136164 Type: Individual Z Expiration: 6/19/2006 DAVID V. ASHLEY W DAVID ASHLEY ' 69 EMERALD LN. MARSTON MILLS, MA 026 8 �< a a� S4 e` Update Address and return card.Mark reason for chang Address Fj Renewal Employment Lost Card BPS-CA1 10 50M-W04G101216 i ' • . _ e _62 Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 .Home ImprovemeC�ontractor Registration Registration: 148596 Type: Individual it Expiration: 10/11/2007 GLENN ASHLEY; =r - T GLENN ASHLEY 185 KINGSBURY BEACH RD. EASTHAM, MA 02642 Update Address and return card.Mark reason for change. BPS-CA1- ra 80M-04/05-PC8698 ❑ Address Renewal Employment Lost Card ✓�ee -�arnmzo�ziaea�c o�✓�aaaac/zuaeka ` Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrafion: 148596 Board of Building Regulations and Standards F== -� One Ashburton Place Rm 1301 Expjratior%:_1.0/11/2007 =- ;.—_!0_; Boston,Ma.02108 T e== 6vidual GLENN ASHLER _ f u J GLENN ASHLE -1 ; 185 KINGSBURY EASTHAM,MA 02642 Administrator Not valid without signature The Town of Barnstable i Department of Health-Safer and Environmental Services Building Division 0 367 Main Street,Hyannis,MA 02601 Office: 508-867,4038 Fax: 508-790-6230 PLAN REVw Owner: Map/Parcel: Builder: �.�s�v ►',� e In L Fro*t Address r The following items were rioted on reviewing: ' e <Z -� e • Lam , � � l � �D I e- �, � r GV t tZ Reviewed by: Date: VP ul Id p ' (�'.'a'sw'�•amr-ii_.:'�9,.a:w^ti:.:.;..�a.:,/�'•" �r+Ylea;..��....r.....::s-5-.r.�.�v-.ex_:-r.....e-.:r-.r-�'�.r.ar..ae.w.n•....�..y..,w...r^t.r.:....-^_u..n.rri.•':':nwea..�em.,6.....Mvr.-w p :. yr C