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Home My WebLink About0430 WIANNO AVENUE d D O ° O v UPC 53LR HASTMOS,MN v i 'OWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map > ` * Pbrcel 6o2-cv 002 Permit# • 3 R-7 q q Health Division Date Issued Conservation Division rl I P Fee d12 Tax COII /` / Treasu 6— � �q Planning Dept. Date Definitive Plan Approved b Planning Board i pp Y 9 Historic-OKH 1111A Preservation/Hyannis (N \ Project Street Address �J O i Pt-Y-% n 0 rt�J Village MI O S 1 iS5 Owner Address Telephone ' 5 G HISS{ L)7 t-(n_e, Permit Request iU E \,3 P►-1\ Square feet: 1 st floor: existing' proposed n 2nd floor:existing 01 F! proposed _ Total new Estimated Project Cost 36 t UD Zoning District Flood Plain RE Groundwater Overlay Construction Type 06A �t 4�v ►c Lot Size 1.63 Rt._ Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family' (¢I Two Family ❑ Multi-Family(#units) Age of Existing Structure i" 6S6 Historic House: ❑Yes �I No On Old King's Highway: ❑Yes No Basement Type: ❑Full �Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) n1 lA Number of Baths: Full: existing n t;n G new Half:existing new Number of Bedrooms: existing 0 f)e new Total Room Count(not including baths): existing 25' new (\ I A First Floor Room Count l Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing (\ Pt New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size (1 ' 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 rn r1L Proposed Use _ filar\ i BUILDER INFORMATION Name Qc^R Telephone Number Address CL `tp -,16er�z W1 License# 8 � 0 Home Improvement Contractor# y 3 9 Z Worker's Compensation# 4) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE —\J(N�_ \�� FOR OFFICIAL USE ONLY / PERMIT NO. DATE ISSUED ► • MAP/"PARCEL NO. f i ADDRESS ~♦ VILLAGE , ~ OWNER � Via` "', ,• ._ , , DATE OF INSPECTIO FOUNDATION FRAME INSULATION r - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. The Town of Barnstable 9 � Department of Health Safety and Environmental Services Building Division r 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 M_GL 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. Type of Work: 6VX�:neN �'Z-. Estimated Cost Address of Work: `( C, L1 3 �a/"rNb o " Owner's Name: W� > �. Date of Application: i 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 ag ZT er t e 0� Date Contractor Name Registration No. OR Date Owner's Name q:fomu:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents IW M L n- • � •-• -_ . �� Offict of/o�estigatio�s - o 600 Washington Street Boston,Mass 02111 ensation rance Affidavit ' /gV///� MGM ,, /i name: location city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proDnetor and have no oneworldng in any capacity71 Al I am an employer providing workers- compensation for illy employees working on this job. comnnnv flume: address: city: phone#: insurance co. 1.bW� 8011cv# �0 MOMMI i,///L ///// 111".////// ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have . the folloning porkers' compensation polices: comnanv name: address: city phone#- insurance co. . ....::.>;. comnanv name- address- city phone#' .................... ..: ..:.. ..: insurance co. ............... / / Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of ertminal penalties of a Me up to S1.500.00 and/or one years'imprisonment as well as civil penalties in-the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Ounce of Investigations of the DIA for coverage verification, 1 do hereby e y de007dpenaltiej of perjury that the information provided above is true and correct sismanire Pate `L C k.,STS - Print name cA\ Ph=# '-710 3 %S U official use only do not write in this area to be Completed by city or town of Lcial dtY or town: permit/license q ❑Building DePartmmt - l]Lteensing Board ❑check if Immediate mponse is required ❑Selectmen's Ounce ❑Health Department contact person• phone#*, ❑Other_�, (muca 9,95 PJA1 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 coat-= 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 receive: 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 an the grounds or building appurtenant thereto shall not becau a 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 renews: 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 contzact for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the coanacang authority.------------------ r 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.4long-with a-certificate of insurance as all affidavits may be submitted to the.Department-of IadusGnal_Accidents foe confimtation of insurance coverage: Also be sure to sign and-- - date the affidavit y The affidavif should be rct unEd toifie aiy or town tkiatIbb#plication for the permit or license is. _ being requested, not the Department of Industrial.Accidents.:_Sbculd you have any questions regarding the`law"or if you are required to obtain a workers' compensation policy,-please' call theMcpartmeut 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 permittlicense member which will be used as a reference number. The affidavits may be returned io the Department by marl or FAX unless other arrangements have been made. The Office of Investigations would lice 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. ..:.,. r � ' . The Commonwealth Of Massachusetts r Department of Industrial Accidents Me os InVestlpatlons 600 Washington street Boston;Ma. 02111 fax#: (617) 727--7749 phone#: (617) 7274900 ext. 406, 409 or 375 Y k ML fie T��io�ad HOME IMPROVEME .;A "-RACTORS -REG'ISTRAT,ION Board of BuiIdinr:R -'' 3ations and: Standards One AshbQt ! a"ce . Room 130,E Bost°orr Ma , :-ijhusetts 021�08 " HOME IMPROVEMENT -GONR` Registration 103928�' , ,").ration 'O7/1"0/0-0 Type - INDIVIDUAI_ , w � -t. , w PETER .E KELLY ti"`T t ;�'• 93 Pheasant' :Way Centerville AMA 026{ . . " 92. �, aaaac�euve� DEPARTNENT OF PUBLIC SAFETY CONSTRU4I01UPERVISOR LICENSE Numk- .Expires: - - ResttedT 68 .`� 93 PHEASANT WAY CENTERVILLE. NA 62632