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Home My WebLink About0175 ARROWHEAD DRIVE Q 1 iuR ,a°.ya..•�.c�3iY-a,.ii'�_c, A,,n„:y } .. „ pa+.tir:...,,,.e .r.3Y•=,:A;. r:i.aa. "-y .:s+r:,.- .- -. -,. Town of Barnstable F t Regulatory Services - � : . Thomas F. Geiler,.Director I • BARNSPABLEd r b, °Bu lding:Division'l . AlFpr�a+" Thomas Perry, CBO Building Commissioner 200 Main Street; Hyannis, MA:02601. www.town:barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 EXIT ORDER q DATE: 1 LOCATION: ' 9_0 WHn4b UNDER THE PROVISIONS OF 780 CMR. THE STATE BUILDING CODE, SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES. LOCAL INSPECTOR SIGNATURE OF RECIPIENT ODEM DE SAIDA DATA: LOCALIDADE: DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO I ESTA_DO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE�DEIXAR DE USAR, IMEDIATAMENTE,A AREA DO PORAO/BASEMENT PARA 0 PROPOSITO DE DORMIR. INSPETOR LOCAL * � r ASSINATURA DO RECIPIENTE y� j S sessor's Office(1st floor Map, 270 _ Parcel ®[J.e/ Permit# Conservation Office(4th floor)(8:30-9:30/ 1:00- 2:00) 4 Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) r�g{ Fee7s,®a .Angineering Dept.(3rd floor: House# D a d 9A81VAS& E '� MA96. 19 +esa i TOWN OF BARNSTABLE Building Pe 't Application 'Project Stree ddress , Village Owner ' . w Addresses-c�__� / P e Tele hon r Zermit Request — 9L First Floor square feet /Sd d Second Floor square feet ,,�Stimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old Kin 's Highway g g Y Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number Address License# 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 BE TAKEN TO SIGNATUREJYAZFE ( 2� - BUILDING PERMI ENIED FOR THE FOLLOWING ASON(S) FOR,OFFICIAL USE ONLY PERMIT NO.' _ DATE ISSUED MAP/PARCEL NO. a. t ADDRESS 'yy f VILLAGE OWNER DATE OF INSPECTION: } fi FOUNDATION + _ FRAME INSULATION } - FIREPLACE YELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL ! FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f f 4 The Commonwealth of Afassachusetts Department nt of Industrial Accidents office 0/10FOSM211010 600 fl•ashitt;;ton Street Boston,Alas. 02111 ' Workers' Compensation Insurance Affidavit vlll�ntiob r/ L 31 9�/ ,Z..# -7 -2 S7-— V/Z I am a homeovAlAr performing all work myself. I am a sole proprietor and have no one working in any capacity L.....-'•--. ..yy,y�yf _t••.u.�.,..yyW.1.0 '._�..__..�v...�.•►: -. ...._. .- �.'•"�Y.ISRiW•.-.. - I am an employer providing workers' compensation for my employees working on this job. company name: . address: - city: phone#• insurance co policy# :,. . .: ."... .,. .... ..y..,.•, -:...fir_...., -e: ..�uY,:p'x: Y": J..-.• ..... D 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: — ad-dress: - cill. phone co. #- policy# insurance7• - 3�! sa> ??> 4' .ter-?ar —. T comnanv name• address• - city phone#• insurance co policy# .Attach additional'sheet iftiecessa �::: :1.: _t `J'" � t�dx.1�'`":"; x`?{. jaw.• �"` +~Maowsai0� Failure to secure coverage as required under Section 25A of 51GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or oneyears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do here •certif y u ler the p nsd d penalties of perjury that the information provided above is true and c rrect. XSnature Da i 'l_ Print name �- Phone# official-use only do not write in this area to be completed by city or town official }' city or town: permit/license# nBuilding Department Licensing Board O check if immediate response is required Selectmen's Office [311calth Department contact person phone#• rlOthcr •4 (revised i195 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"Jaw", an ennplt i�ee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrplt tver 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 `;rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL cha.pter 152 section 25 also states that even,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 leas 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. .. .. 7 City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of P P .. P 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. 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. r,'au«.e+.,- .c, „r.n,.;.*+777- v^•+.! 7777 .v:nr.a..w.v.��•.aw�nn+ The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 : The Town of Barnstabler, NAM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Cmssen Office: 508MO-6 27 Building Commissioner Fax 509-775-3344 For office use only Permit no. Date AFFMAVTT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A that the"reconstruction,alterations,,renovation,repair,modernization,wnversion, �T� ed improvement,.removal, demolition, or Construction of an addition to any ptz-das��t building containing at least one but not more than four dwelling units or to Wucdurs to such residence or building be done by registered_0=traCtOM with Certain=gdons, along with other, enm- T of Work: r Est Type Cost �� . Address of Work: G Owner.Name: Date of Permit plication: / /,v — ` S I hereby certify that: Registration is not required for the following rcason(s): Work excluded by law ' Job under S1.000 ng not owner-o=upied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WrM UNREGIS I ElUftV FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATIONPROGRAM OR GUARANTY FUND UNDER MGL,c 142A F SIGNED UNDER PENALTIES OF PERJURY I hereby applyrfor a permit as the agent of the owner.,A ' • - a - r f P i .. Date Contractor name Registration No. OR • owner's name Date '