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HomeMy WebLinkAbout0039 TOWER HILL ROAD (8) Lt y a {. • #' !� i �� ' � i - � S f .� a. F. - �_ _ � t • 4: t. t_ i. .. ;. -,, J i t 1 1 O j O C ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _ �y • a Map I I ? Parcel D Permit# Health Division 3 -2 -Oa Date Iss Conservation Division � dZ Fee Tax Collector �d SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Treasurer L c3 �� _ac4/ WITH TM S Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address :3 s :T_,� ; ,L� �, )L e D. Un/ Y-A Village Q S�Lf 121 I Owner &/L p/ey � i-� Address 7? 9 Telephone ��S Permit Request l`7Q L4 I.,J'a Square feet: 1st floor: existing proposed 2nd floor: existing proposed 0 Total new�Z Valuation L O,C)o o Zoning District Flood Plain Groundwater Overlay Construction Type W WD FRAM 9 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) o0 Age of Existing Structure Historic House: ❑Yes blo On Old King's Highway: ❑Ye�ID �f,J�d0 Basement Type: Full ❑Crawl ❑Walkout ❑Other N m Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) co Number of Baths: Full: existing new Half: existing new DO D— Number of Bedrooms: existing_ new © m Total Room Count(not including baths): existing new First Floor Room Count 7 Heat Type and Fuel: ❑Gas ❑Oil ®'Electric ❑Other Central Air: dYeS ❑ No Fireplaces: Existing New�C _ Existing wood/coal stove: ❑Yes �No Detached garage:❑existing O 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 Iy No If yes, site plan review# Current Use A, L.T 1 y!�n(b s. L„ Lam)L lL m Proposed Use ,{/�� ^ l BUILDER INFORMATION Name____ ! &nCo Telephone Number Address f [�_ go X is I License# 01-,1 ►✓ 6�' MA Home Improvement Contractor# I Z 1 :3"7 15;1- Worker's Compensation# 76 !D o of oa a S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L.,O JV Z� PV l_ SIGNATURE DATE 3 A_1 - /� a z FOR OFFICIAL USE ONLY , p v J r � "PERMIT-NO. , f £ DATE ISSUED MAP/PARCEL NO: r' t ADDRESS VILLAGE OWNER DATE OF INSPEC4I0N: .. ' FOUNDATION ' FRAME . 1 _ INSULATION FIREPLACE ! i ELECTRICAL: ROUGH r-a FINAL ? r, co �^ _ ' PLUMBING: ROUGFI FINAL GAS: R UG= FINAL t l' r � ,4 ? L3 FINAL BUILDING_ 1-1i,= as J t DATE CLOSED OUTS.., ASSOCIATION PLAN NO. t i -_=__ The Commonwealth of Massachusetts Department of Industrial Accidents - Ofllce o11fiYU M989oos . 600 Washington Street Boston,Mass. .02111 Workers Com ensation Insurance Affidavit . name location ? Q W�� 1Y l L�� K.�� t 4 ,, -4 A city t phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole etor and have no one woiki>i in ca achy I am an em Io er roviding workers' compensation for my employees working on this job. X. A com An y, e-r— �. ,'a'•''•: �fi •.':;;3:"" ': :'>i��t::::'::''.•'::::is.>::::}:::i:: i::.:.....:ii:> ::i:i:::;j:;::::.:':::%2 i:2:•':i::'•:?2;:is `:':`:•'':: ':?k'f•:`%`:::<i::':: :-::...... ci ,tv� '' Ql ::...:::.......:...::...::...::....:::. ❑ I am a sole proprietor;general contractor,or.homeowner(circle one)and have hired the contractors listed below who have the following warkers' co ensation olices: :com an.<:nam ...... ....... ....................................................................................v.v.vr4}}:::}}:ii:;;:$v::.v}:•}:.v:v: x: 4:}';ii.+:::�{::v v.vr.v:. <`lriin t� •r.4r.::.v.:::.:: ............ ...............::. .. .. ...........................:.:.......4................................v.::::. }::.... ....................i•::L:..,....nv:::.tw:::::::.v::::x::.:iw::.v�.. .... .:::...............::...:................v:::}:� :::.::::::n.n.::�...................v:::nv::::w:.v.v.v::::::::w::.}}}i::C:•;:.::::::::::•.:. � :: �::•i:•}:i::ij::::::i:}::t::•}?}}::4+:.:•}}},:�i}}:}:: iiiii.}}} hsnran¢e:ca:::>::»>:::»>.>:<::<.}:.:.:.:.}}:.:::.::.}::.}:.:.::.::.}:;;:.:.}:.;.:;.}:.;}:::.}:.::.}:;.::::.::::::::::::::.::..:.:::::::........................... oprcv#....... e$5i'is '?2 ?>'>` 5 ? > i ' }<> < >ti< i> ` yas'ii :a: ? 'Ei >i'iii ' i:<:> isii: isisisi>3ii ?> adiir ��h n s#tJ .>.y�' a:�•:1l:�iiYl.:":'+`j'r%?�:`::t;:5'';:;.;.i;Y..:{;i:.<5;:+{:}Y:?.j:::.:.i??:'�`:'�'n:'.?i:L.�.::}?i�.�:::n�::::.iY.::.i: .��-�:`y.:>>':�:�:•:;i:'`^�r:;isj:`:�';:�:;{.`:i4::•`::`�:;:�:;'.r;:�:;:;:j�(i::;:�:j^:;i:;��:�i:;:;:;i:.:y:�:::::j}:;:}{::�i}i}J>:�::�'r'::::t{?:�:�S:�:j�{:;s:�:�:�:::::�:;:r?.+;::�i:t�:: �•+ �nrsact; Fafiare to aecu a coverage as required under.Section 25A of MGL 152 can lead to the imposition of erimival penalties of a Sae up to$1,500.00 and/or one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a Ste of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties ojpeJjury that the information provided above is Gri;anddcoect Signature_C"` .+ Date print name 4S Phone# oillcial we only do not write in this area to be completed by city or town official city or town, permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selecbnen's OSim _ ❑Health Department contact person. phone#; ❑Other__ 0evind 9195 PJA) 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. MGL chapter 152 section 25 also states than 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 ins,*a*+ce 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 along with a.certificate of insurance as all affidavits maybe 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 perm license number which will be used as a reference number. The affidavits may be rettnmed to the Department by mail or FAX unless'othef arrangements have,beenmade.- 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investleadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 r q The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 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 adjacent to such residence or building be done by registered contractors,with-certain exceptions,along with other requirements. � I Typeof Work: �2 --� /YI�l �IJfJ 1 _Estimated Cost I'1C>1 6 DD Address of Work: i Owner's Name:' f—AT2-1(�yJ � U Date of Application: T Tc I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law FJob 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 theAgTt of the o j I v I _ Date Contractor N e Registration No. OR glorms:Affidav :rev-122001 .._- ..._.._ _---i✓�zeTOomvrno� a�✓�twaczc�u�elly `.i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:.CS. 043556 B�rtr,aac�:':12/.13/196,2 13/2002 4782 Expires 12/ Tr.no: t r Restricted To:..00 f SCOTT E CROSBY r i. i 62 CROSBY CIR - - - t I OSTERVILLE, MA 02655 _Administrator xe iJomvrrzaruuecz`� u`'.il�rwoc�;/r�zaetla Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131378 /. Expiration: 07/13/2002 Type: PEACOCK&CROSBY BUILDERS, SCOTT CROSBY 1112 MAIN STREET UNIT 7 �� r OSTERVILLE, MA 02655