HomeMy WebLinkAbout0090 PINE STREET 9o ..
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NO. 152 1/3 ORA
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Engineering Dept. (3rd floor) Map Parcel Permit# 20
House# �U c: Date Issu�eed 1 Z
Board of Health(3rd floor)(8:15-9:30/1:00-4:30) - - Fee Cal
Conservation Office(4th floor)(8:30- 9:30/1:00.-2:00)
Planning Dept. (1st floor/School Admin. Bldg.) r 1NE Definitive Plan A pproved b Plannin Board 19
• BARNSTABLE.
,♦X /� � MASS
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- TOWN OF BARNSTABLE 'E°'��'
Building Permit Application
Project-Street Address �'J� �/�( S 4 i
Village CtJ• 1 Cc/1 I my
Owner- GVj � /�.t// .� Address
Telephone '
Permit Request S D
j First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ C)-(n
Zoning District Flood Plain 1 Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
J
Basement Type: p Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
QP 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
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Builder Information
Name �P pq-c Telephone Number
Address '7 / %�'/L� C�� License#
tt-c,c.� rVjg Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE Z��
BUILDING PERMIT DENIED FO THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
F
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER '
f .
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT i
ASSOCIATION PLAN NO. ;
Y
�F SME —
f
The Town of Barnstable
• anxxsTnsr.E. •
9� 1659. 10�' Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
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.
Type of Work: Est.Cost
Address of Work: �' 5 �LJ
Owner's Name Ail l�/A-/ -' o)ev/x-1
Date of Permit 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 agent of the owner:
D e Contractor Name Registration No.
OR
Date Owner's Name
r
t The Commonwealth of.4fascac•husetts
-: Department of Industrial Accidents
y : - Office Of/nveSVgat/nns
\- .. FIB
\_, 'I' ':r,`'` 600 N'aslt i►i ton Street
•`
to
Boston. A1a.vs. 0 111
Workers' Compensation Insurance Affidavit
� ltc•tnt information: — TPlcase PRfNT lei 1 '"
name* s1J t=111r1`.S_A__ 7
location• _ r11
cite LSO Phone#
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity _ ^Y
.:. .+:.:...e+w-r..----•v.....7....,.:..._.^,!^•_•:.�rovr.r.-r'^.frx.�•..r•:aa!Q*c...J.s4'Tv.:/`..�..r"'^':^!++.`+e!'-'T•"';.ns.r...•.....we��n+r.;..r.....,..•�T:"`•.-.ni•�T.'.'�.y"e�. .,•wr.,. .:.
I am an employer providing workers compensation
_for
�my employees working on this job.
cons any name: -�✓l G�Ste\ �G/W�
address:
city: phone#: l/q ^� (
insurance co �-/ �� /;K/�aC Polio'# Iwo Z i,S r e / �- J� 0///
I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
compam mine:
address:
city: Phone#:
insurance co Polio'#
... .. ..:.rl'.::•+:..,.nl-'L^.............:..77.�Y....,:..�r�:-._'-._ �r^"•�%.�•.-•.Z��T:rnw�1''- �•T2c�•�x ...��1....F:.•��..-.•fit _._ _
�_..--.-...... ._._.__.�.._......_- ...I�G:..Li��:.._rr.•..:.i'_.�Y�.�i:rJ[r•.r...Jr'tiii.r.rr..� _:ram 4. _... V..iYr Yam' .a__�L
company name:
address:
rite* phone#:
- insurance co polio'#
Attach additionaf sheet ifr necessary-ry `r
Failureto secure covcraec:ts re.qu�lired. unde..-r :-...�i—.-.: [.��-—,,:,J.q.•IaLY�_"J_"�.'.."."....._".-�..:." -.1_-_t,.`-,..r...._....v;�..a�._��.i..�,J..-+_n_.�2>.r,-.:[..:.,.•van�y�,p•���-.'yt,,'wr°.���r�.,.'.,r'i"r.'i.�'tli.t-��w.l.�-..1!...L;•:.Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur
unc years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a
cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby certify ur er Nye ptr' red p alt'•s of perjure•that the information provided above is true and correct.
Sienature Date
Print name _ Phone#
YWL.LY 'y.
•official use unh• do nut write in this area to be completed by cih•or town official
city or town: permit/liccnsc# r'tliuilding llcpartmcnt
CjLiccnsing hoard
check if immediate response is required E]Selectmen's Office
ollealth Department [
E
contact person: phone#: MOlher :
Iro .scd):nc 19A)
.4.
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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 anv two or more of
the foreuoin�u, enraged in a joint enterprise, and including the legal representatives of a,deceascd cniplover, 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 chajpter 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.
Additionallv, 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.
--._.:._-.__.._..._..._..........._.._.___._.. _ - - --
_�.T F�^,!RSMMb[+s�+r^-rll�lwwo�.►!.-.�-.
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 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 Dave 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 ltas 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 permit/license number which will be used as a reference number. Tile affidavits may be returned to
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.
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Tile Department's address. telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 NVashington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
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90 Pine Street
West Barnstable MA 02658
November 18, 1988
Mr. Joseph D. DaLuz
Building Inspector
Town of Barnstable
367 Main Street
Hyannis MA 02601
Dear Mr. DaLuz:
As you know, Commonwealth Electric is in the process of
erecting mammoth new structures along their easement that
i runs through- West Barnstable. The company has not sought or
received a permit from the Historic District, and as a
representative of Citizens for Power Line Safety I would
like to..know why they are exempt from this requirement.
In particular, I would like to know the exact regulation,
section, paragraph and sentences you have used as the basis
for their exemption.
Thank you for your cooperation.
Very. truly yours,
i
William Devine
All
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1A 7/
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XX,� yam-
,�,rs®eel-' �ih
i
90 Pine Street
West Barnstable MA 02668
November 18, 1988
Mr. Joseph D. DaLuz
Building Inspector
Town of Barnstable
367 Main Street
Hyannis MA 02601
Dear Mr. DaLuz:
As you know, Commonwealth Electric is in the process of
erecting mammoth new structures along their easement that
runs through West Barnstable. The company has not sought or
received a permit from the Historic District, and as a
representative 'of Citizens for Power Line Safety I would
like t6' know why they are exempt from this requirement.
In particular, I would like to know the exact regulation,
section, paragraph and sentences you have used as the basis
for their exemption.
Thank you for your cooperation.
Very truly yours,'
W4illi Devine