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HomeMy WebLinkAbout0020 ALICIA ROAD �u. �® �2��� �d�. __ TOWN OF BARNSTABLE ]BARNSTLBLE. NABIL 1619. am BUILDING INSPECTOR / 77 <-/ APPLICATION FOR PERMIT .... ......................................................... TYPE OF CONSTRUCTION ...... .......................................................................... ....... ........................i 9..?3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according the following information: Location ..... ......./... )......... ...... ...... .................................... Proposed Use A0,......../z. .....<1.11............. x z. ........................................7.................................. Zoning District ....16.6.........................................................Fire District .......h�...................................... Name of Owner ddress r.... .............A ............ Nameof Builder ....................................................................Address .................................................................................... Name of Architect .....14/ .............................................................Address .................................................................................... Ip U�4 Number of Rooms ....Id.........................................................Foundation .....1............. —ZI ...... Exterior .......Roofing .............. ..................................................................... Floors ..................Interior ...A......................................................................... �7�............Plumbing .... ...... Heating ..... ..................................... Fireplace ..................................................................................Approximate Cost .....�-2 ............................................... Difinitive Plan Approved by Planning Board 19 Diagram of Lot and Building with Dimen ;r / v'`� M XX LU 00 2: Cn V LU !—:: -LjL1 8 C �Df C) ' 0 q- LQ z < LJLJ co r�- LIZ VA I hereby agree'to conform to all the Rules and Regu a ions a t e Town of Barnstable regarding the above construction. Name ....&AL ............................... Daceyv V4IliamE° Jr. , 3�84� onemtmz�/ No —�����— Permit for --.--�.����---- ..........4r4l�.. .................... ' , Location .f�xad____.._____.. ! ` . . .........................~ ... .~`.......................................... � Owner ---.Wi]�ll��..�^.. *..Jr........... frame ( Type of Construction -------------- ' ----'—^'---'----'------------' ��1m� / Plot —.-------- Lot --..�.���-----. 1 ' ' Permit Granted --. .2.9—'—.]Q 73 ! � Date of Inspection ....................................lV , � Date Completed »r 19 ` / PERMIT REFUSED .----.'--,.--.----------. 19 / ' ...--..--------------.—~----,, | ` ~^—~'—^^—^'----'--~---^^-----^'— _.—.-----.--........,......—.~...—... . � � .----.---..—.....~—...—.....-..--..- ^ ' �� Approvedlq ~--------------- � ' -------------.—~....------.... . , -------------'----------^~^''' ` ��� � Engineering Dept. (3rd floor) Map/ � Parcel ��(, Permit# ��� House# 7;k® FIs Date Issu d (© Bo 30) Fee Con -2:00) Planni g.) �t 'O Defin. 0TF1UMTMYr1annmgl3oard 19 RARiisrn H, �1E0 MP'� � T ,TOWN OF BARNSTABLE p� Building Permit Application Project Street A dress Village A N Owner l t L l•4® Address 94 try Telephone Permit Request CX(S Okt At b Aa. d 14 v First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 3 ac93, 6-o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family La Two Family ❑ Multi-Family(#units) Age of Existing Structure ti �- S� 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 No.of Bedrooms: Existing New 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) J, ❑None ❑Shed(size) ❑Other(size) C!t Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use F, Builder Information Name `.��j� '� VlJ� � Telephone Number 1 19 ? 13 1 I q 3 Address iP—t f Aj License# O S- (cS_2 vav-t�V,0 K°c Ca3 S, Home Improvement Contractor# f 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 DE IS RESU TING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 2 g 17 BUILDING PERM IED FOR THE FOLLOWING REASON(S) • ,. � .. �eraeerrv:,wsyyy�.-+refvw�n.•aartae.,m+xMw+.wwn*r;+eweaw.,..,,y„y�.,,wmmxwwvme�.rry„� ae++rno+n„� aivwn'a^srtavwr,rnr+sw�nw.,nw,Mw�,.G,, �Ct t`i r I --:a ,. The Commonwealth of ltilassachusetYs ! DeparMent Of Industrial Accidents . _ 600 Washington Street Boston,Mass, 02111 Workers'Compensation Insurance Affidavit 111cation '20 (IL k C 1.4 917 city h ❑ to a homeowner perforinina all work myself I gun a sole proprietor and have no one working in any capacity ❑ I Nil an employer providing workers' compensation for mY employees working on this job. �' ��� ehoae•}i�. � f.r'I �°I 3 � UISur ce ❑ i alas a sole proprietor,general contractor,or homeowner(elnae�rre)and have hired the contractors listed below who have the following workers' compensation polices: spa^Y�,11111e. i11SUr9rice co. .. �'; . . •poligyN. ryttl 18n • •otie . insur;ince co. oolicv#' Failure to secure coverage as required uu r Scceioit SSA of r1t;l.t52 can lead to the imposition of criminal penalties of a fine op to$t,.500.00 and/ nac years'impriganmenl as welt a9 clvi en ti iu tLe form of a STOP WORK ORDER and a fine of S100.00 a day against Inc. I understand flint a co[ry of II►is atatcment ay be forwar ' the )lice of Iavestigationa of the DIA far coverage verification. 1 do hereby certify r xhe ms p alties ojperJl+ry that tfie iaformafion provided above is true and co»cu. Signature Datc Prins numc L� hens 1t aI'licial use only do not waste la this area to be completed by city or town otfici4l city or town: perinit/liccuac# Buildi70oa Q1,ieen Q check if immediate rrapnnse is required QSclectOHcalt contact person: phoned; � -Other freviud V95 PIM 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 Coregoing engaged in?.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 6r to construct buildings in the eommonwcalth 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 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 pertnit/license number which will be used as a reference number. The 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. s The Department's address,telephone and fax number. s The Commonwealth Of Maissachusetts Department of Industrial Accidents Office of Imresdgadens 600 Washington Street Boston,Ma. 02111 fax 4: (617)727-7749 phone#f: (617) 727-4900 ext.406,409 or 375 .,,.0 4 HOME IMPROVEMENT CONTRACTOR SEEN Registration 117618 Type - INDIVIDUAL Expiration 10/26/96 JEFFREY D WEAVER � �J,EFf REY 0. WEAVER 2 CYRIL AVE ADMINISTRATOR PEMBROKE MA 02359 y �_ : . � The Town of Barnstable • BAMSP"M • 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: Owner's Name_1////�/.��/47) ow 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 O UARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PER I hereby apply for a permit th nt o the wner: Da a Contr ctor Name Registration No. OR Date Owner's Name