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Home My WebLink About0039 TOWER HILL ROAD (4) 3 9 -T>we--c- 14 1 11 LL n r e a i c i a { E ° j s �3 —... —� Q f �', •�, 1 E� a 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (/ 064 Application# Health Division 0 .` Conservation Division. I 8 P19 05Permit# Tax Collector �-�g,. Date Issued P� Treasurer (J plication Fee U Planning Dept. = Permit Fee ^y Kd I00 Date Definitive Plan Approved by Planning Board r k. f O1Ly1 o b Historic-OKH Preservation/Hyannis Project Street Address =:R 9 /dGcl-e—+e X/i Village 9S fZE2ew &6,0 Owner �cJ L�� J Address 3 �} ,/O��/��/l />i G /T Telephone r� Permit Request i�T7�, c� � [rsoo G✓ �"�, / .T Cr/ q era>q cP �C Peck-c 12 Z1� Square feet: 1st floor:existing proposed', 2nd floor:existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuation" �IW6P 0 a Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count J �IHeat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other + Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:0 existing ❑new size Pool:Cl existing ❑new size Barn:0 existing ❑new size ; Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: r Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes ❑No If yes, site plan review# {' Current Use Proposed Use BUILDER INFORMATION A -S�Name Telephone Number Address kt h C1 f License# C S 01 a M irgS�"� Gj ! Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 161/_7,�®lo FOR OFFICIAL USE ONLY PERMIaT NO. r t DATE ISSUED MAP/PARCEL NO. • :ADDRESS, ' VILLAGE r OWNER I � DATE OF INSPECTION: [' FOUNDATION FRAME INSULATION r ' FIREPLACE - Y _J Y ' t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH' FINAL , GAS: ROUGH FINAL -- FINAL BUILDING i - DATE CLOSED OUT ASSOCIATION PLAN NO. 1 Department of Industrial Accidents . Office of Investigations ' d 600 Washington Street Boston, MA 02111 `�M s�•"� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers \pplicant Information Please Print Legibly Same (Business/O pnization/Individual) C1'elil 17 address. -ity/State/Zip: t oc St4 q m Phone #: ®$ Y7 G g re you an employer? Check the-appropriate box:. Type of project(required): 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 _ I am a sole proprietor or partner- listed on the attached sheet $ El Rein -ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9.-❑ Building addition- [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 17. I am a homeowner 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' - 13.❑ Other comp. insurance required.] ay applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: .)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ntractors that check this box must attached an additional+sheet showing the name of the sub-contractors and their workers'comp.policy inforTnatim. m an employer that is providing workers compensation insurance for my employees. Below is the policy and job site �rmation. urance-Company Name: 'icy#or Self-ins.Lie. #: Expiration Date: i Site Address: City/State/Zip: :ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). - lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e 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 ip to$250.00 a day against the violator..Be.advised that a copy of this statement may forwarded to the Office of estigations of the DIA for insurance coverage verification. ®hereby certify under the pains and penalties of perjury that the information provided above is true and correct oe ature: Dater C6 !7 O.lp . one#: 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): 1.Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#.: a. Information and Instructions [assachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. ursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, cpress or implied,oral or written." .n employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more. f the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the ;ceiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the wner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the welling house of another who employs persons to do maintenance, construction or repair work on such dwelling house r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." . AGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any 1pplicant 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 Inter into any contract for the performance of public work until acceptable evidence of compliance with the insurance equirements of this chapter have been presented to the contracting authority. kpplicants ?lease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if iecessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of nsurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the nembers or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have -inployees,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 [ndustrial 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 pemuttlicense 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. Anew 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 :vised 5-26-05 www.mass.gov/dia °fIME,�. Town of Barnstable Regulatory Services SAPJ AZLFe ' Thomas F.Geiler,Director r •iawss. � 1639• .m Building Division Tom-Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us )ffice: 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 adjacent to such residence or building be done by registered contractors,with certain exceptions,along Rath other requirements. Type of VJork:�_ 'j !/.c �L Gl timated Cost G Z Address of Work:. / Owner's Name: _�� y �/�✓ Date of Application:_L/O,,// U(2 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law 0•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: Date Co actor Signature Registration No. OR Date Owner's Signature Q wpfiles.forms:homeaffidav Rev: 060606 F ►�, Town of Barnstable ti Regulatory Services 9' 'MASS. �, Thomas F.Geiler,Director E139. & Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, l/V-�)as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho ' e�bys building permit application for: ///�( '3 05 e-��eo (Address of Job) c Q Signature of caner Date 1113CAtQ -r v ILA Print Name QTORMS:OWNERPERMISSION f Village Square South Condominium Association P.O.Box 598 Osterville,Massachusetts 02655 10/18/2006 Mrs. Margaret Mullin,the Owner of Condominium 3,has the permission of the Board of Governors,Village Square South Condominium Association,to have her deck rebuilt by Mr. Glen Ashley. Sincerely, 3 �j� Walter�&anchi,Treasu�'er Village Square South Condominium Association BO OF��! icense ACO BUILDING I e .NSTRUC'D1 REG(UL i Nurnber :;Cs, N SUPERVISOR S Birt �a,- 082236 1 R=��e_�OS1241-1� �.` ,963 �IPre .,.0 A, /^ /20/2008 GLENN P Rest}h.to " i Tr.no: 2547 � Op �, l 185ItINGBURSYLE1�l 5 EASTI IqM MA 02 co' ��J mmissioner �J -� v vtl � I J � � Z w-� L V 7 Q J I C� N - . x � � 0 4 aDO&39�/ N895820'E 138.58' 00 - S89 58;?O"W 100.00' .1 a m j o coc o L A/N STREET O 9 O PLAN REFERENCE.- � tq by SITE PLAN nY OF VILLAGE SQUARE SOUTH ' PLAN BOOK 263 PAGE 1 DATED OCT. 31, 1972 ` LOCUS MAP iT1 PLAN REF` 263-1 lye ASSESSORS MAP- 117—72 ►� ZONING. BA" SETBACKS- 20'—O'-0, O FLOOD ZONE.- 'C" �1 PANEL NUMBER- 250001 0016 D �O DEED.- 10444z 299 2 � o c c c c UNI&4-B r, PLOT PLAN OF LAND UNIT 5B y y y y UNIT 4— O FOR ADDITION AT.• NIT U 5D a i `' a �' EXISTING UNIT 3 d VILLAGE SQUARE CONDOMINIUMS SOUTH PAT/O PROPOSED 39 TO WER HILL ROAD m ADDITION EX/STINC OSTER VILLE,, MA Pill EXISTING EXISTING 12,17. PATIO PAT/O PAT/O R. S86 52 62'E PREPARED FO 291.26' _ 45.90' ,. N83 44S2 E EMMETT DELA Y UNIT 4-B .P..®* MARCH 21, 2006 & I 1S ��ZF\0 igs� �. UNIT 4-D :o��a��°\S �F�°5,E v REV m P ri\ s ® STEPH=V ® o �. P. REV U DETAIL a DOYLE a js7s:;a � e REV- NOT TO SCALE EXISTING PA TIO o UNIT 3 YANKE'E LAND SURVEYORS GRAPHIC SCALE -ob & CONSULTANTS PROPOSED P.0. BOX 265 —�L _ _ ao o zo 1 eo 160 UNIT I, 40 INDUSTRY ROAD ADDITION 1z 0' MARSTONS MILLS, MA 02648 12xl 7 TM 508-428-0055 FAX 508-420-5553 ( IN FEET ) 1 inch = 40 ft. SHEET 1 OF 1 JOB �¢! 54047 LM E