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Home My WebLink About0336 WIANNO AVENUE �� r �.. ..�/" - � - n �. r o .. i 0 i, � �. n' � .� ` „ ' A 7 r .� i ih ... .. ��'r'�^r^•�,-�..+.. ter,..^/T^►'��n ..wt.,..;� ..,i, ,w•r.-...... ...Mn+�. .�1we{S.ri,_�a..�,�-v„"/r?�!"`� .I� ?�"�...fM'�.. _ rh - ..w may. _ C 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P • Map /4 0 Parcel ')A _ Permit# Health Division Date Issued � 99 Conservation'Division , Fee Tax Collector �� /af �`� - Treasurer � � C A= Planning Dept: Date Definitive Plan Approved by Planning Board i � ' Historic-OKH Preservation/Hyannis Project Street Address /3, �O %,k),t3 n - A(l� Village -�� I O. �t9i•�' Owner Address \A)rn E' Telephone 1-Roo �kl;i- ' 7&g X 1 D,6 Permit Request kemouE -f^XIS j A i KlS'.n Sti i Oa lEs I Us 1-- -Pelt, ➢41 Mr�� 0 �CE� A 2,En&(5 — -TAlLIA-11 mmL) -Asp 6)Qnlc- . �IGI(',a ye-ml— Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total ne Estimated Project Cost OA 0 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Cl Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑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 Heat Type and Fuel: ❑Gas Cl Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No, Detached garage:❑existing ❑new size Pool:Cl 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 BUI ER INFORMATION [y Name Telephone Number — ` Address U License# (J Cl Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE a FOR OFFICIAL USE ONLY PERMIT NO. to DATE ISSUED � + MAP/PARCEL NO. " ADDRESS ,to,µ.. VILLAGE 4 OWNER DATE OF INSPECTI01mk i FOUNDATION y FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Y� _ r _� e ommonn e —` _ _ -- Department of Industrial Accidents " . 51 ,-.-. - :-- VMCV of/firesaffat/oos 600 Washington Street - `I Boston,Mass. 02111 . Workers' Compensation Insurance Affidavit name: —,,� location: Z a /`' city JW phone# !W-7a4L'_- VVp El am a homeowner performing all work myself. ❑ I am a sole net and have no one worlds in ca aclty %/�///�/////////�% %%%%%///%/%%%/%%%/%%%////////%%%/%/%/%//%�//Z;/�/////%///////////////////%0///////�/%%////////////�/O�%%%/O%/�//%///11,0I////%%///G/%//, ❑ I am an employer ding workers' .mpensation for,my employees working on this job. .coM an :aem .0 n" . U.. V� MW.......... .. .. :.::: ::. ;:i.;i:.;:.:..v. ...:::: :.:: :):.. 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':::.�:::::::.v.v:::::::•::.�:::::::::::::::::::w::v::::::::nw::::.v::w:::r.v::::::::w::::.v::::::.v w.v.•r.vv.v::.v:::::w:::.v:::x.v::::::::::::::::::::::::::::.:v.v::::::::::::::::::nv.v:::: ..........:.....::::lfti�::::v:.v.v::w::Nl:):v)):4)$:v:i:•)):•)iii:•))'J:•)":.,ii:•i:•isi•i::{•i:{.;:-:{-,.-,,))):iir'isii):))}):^:4i:i:::r)i):•ii:•ii)):J:y}iiiiiiii::•.:. ::•. :v:::::::::::......:.v::::::.v:::: ........ ......:::nv,{. :..X.:4ism)ii)):..'..:G:{ih}:{?{•:•i:..............v:{•:::v::::.v:;v.; .;l...v.v:::::v::•::::::::.:. .: •:••:•.v:::•::::::.:::::::::::::::::.�:v::::v.....:...................:........................... <::> olicv# . 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$1,500.00 and/or one years'imprisonment as well as civil penalties in the forth of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oice of Investigations of the DIA for coverage verification I do hereby cerdkfiMF the pains penalties of per* that the information provided above is truo and correct Signature au-/ Lz��I��-A-f , .n Date --/I?— — _ Print name 140L- & U Phane# AL F ,/,/ - - official use only do not write in this area to be completed by city or town official city or town: permit/llcense# ❑Building Department ❑Licm�g Board ❑check if immediate response is required ❑selectmen's Office . . _ ❑Health Department contact person: phone#; []Other (revised 9/95 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 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 along with a certificate of insurance 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 peiinit/license number which will be used as a reference number. The affidavits may be retuned io 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. , FRI The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Initesd ations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 I °r The Town of Barnstable • &42Nsrest.&_• 9� � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. vE Type of Work: C � — Estimated Cost �— Gv/ Address of Work: O/4 AJ 4)6 J 1 F 44�2 cui ��- Owner's Name: �lal l 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 permit as the age of the owner: 5 Date Contractor ame Registration o. OR Date Owner's Name g1orms:Affidav fie �a�n�n anurea 00�/ a� I HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards I One Ashburton Place — Room 1301 1 Boston , Massachusetts 02108 , I HOME IMPROVEMENT CONTRACTOR 1 Registration 103714 Expiration 07/09/00 ! Type — PARTNERSHIP I oLe. ! HOME IMPROVEMENT CONTRACTOR I I Registration 103714 PAUL J . CAZEAULT & SONS ROOFING Type - PARTNERSHIP Paul J . Cazeault ! Expiration 07/09/00 22 Giddialt Rd . P .O.. Box 2781 I Orleans MA 02653 PAUL J. CAZEAULT & SONS ROOFI 1 Paul J. Cazeault I G�ceM�o &src&lliddialt Rd. P.O. Box 278 ADMINISTRATOR Orleans MA 02653 • - �, -\ ✓YG� � cam/l�IiL7 n n i� r�l �^ f i19i•.W OF1 1-I81 :f.i: 1'1 f.(:i.:, I?i'; Y10.1 f:ili'!:;11'•.1J(: I .f.OP! SIJf'i:1;V:r"4W L.f.(;I:W:J. i'•fl!uli,::'r'. ( xpJ.r� y R -- - _)99 1'.!:{A:f� ra1�"��5(nn J a i G.a Ac.- C 11' W`v'I.1.1..1_, I'1(-1 0,, 6�) K;Ji.'1) 1.:U1) ' IOI' ' :��f. U09�1)FLU>tId!'p�� 0�..•�(.gJJ[7C�f/JC�IJ OEPARIMENT Of PUBLIC SAFFTY I CONSTRUCTION SUPERVISOR LICENSE I Number: fzeile�: CS 3.I632S 1012011`.09 iil,:?lieu 'I Reskricl'ed To: BO I ""CAL J •CANART 15851 MAIN ST i - - OSTERVI(I.E. MA 0;65S I 1