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HomeMy WebLinkAbout0026 ATLANTIC AVENUE (2) a� �. c�,. cFIME lob, Town of Barnstable *Permit# 2 Expires 6 months from issue dale e „STAB Regulatory Services Fee © a 9! v �• $ Thomas F. Geiler,Director lFc MPS Building Division Building Commissioner S Tom Perry, g IT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 - ACT 1 ® ?001 . Fax: 508-790-6230 TOWN OF B STA EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY BL, Not Valid without Red X Press Imprint Map/parcel Number t�6—so 1,4004 &or C� r Property Address �C t0 rl �— ��' 8*x)l ",4 Residential Value of Work < 00� Owner's Name&Address Lq&t1k P, T12-5 r X 9Sg 12I � Contractor's Name Telephone Number t1 .21.6 33- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 3-Lam a sole proprietor / J.I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to lbUM M f E V® EL ❑Re-roof(not stripping. Going over existing layers of roofl 2/Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. N i Ho O-LI, Aakl(Ub 1?tVr Signature Q:Fomis:expmtrg , Revised121901 ti eering Dept. (3rd floor) Map (o Parcel ermit#__` 02 House# �� Date Issued Board of Health(3rd floor)--(8:15 -9:30/1:00-4:30) Fee Conservation Office.(4th floor)(8:30'-9:30/1:00-Z.-00) Planning Dept.(1st floor/School Admin. Bldg.) Defi ive Plan proved by Planning Board 19 aj . 5 .-.. .. BARNSTARLE. F B �.Eo� 'TOWN O ARNSTAELE Building Permit Application Prole treet Address Village AMA i ,, n 'm a i Owner �j/ S R i/UO�C Address Telephone Permit Request First Floor square feet Second Floor I square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes Q 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 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 I 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) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name. E.e P11i tc✓�G�w) Telephone Number Address 7/ �Fgnwa<G� � //( License# /� t�0AUX-1r Home Improvement Contractor# //D S (S't/ Worker's Compensation# OX/`,/3 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 SIGNATURE - DATE j S BUILDING PERMIT DENIED FOR THE FOLLOWING AS S LIM ��6�� 4 FOR OFFICIAL USE ONLY i PERMIT NO. . DATE ISSUED" MAP/PARCEL NO. ADDRESS VILLAGE c OWNER y DATE OF INSPECTION: t - FOUNDATION FRAME s INSULATION FIREPLACE • F 1 •ELECTRICAL: ROUGH FINAL i .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING ` i F DATE CLOSED OUT F ASSOCIATION PLAN NO. t ' OFF . The Town of Barnstable • axsra n� H� • "�"� Department of Health Safety and Environmental Services 659. J0 FD nno� P 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. t 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: 2Est. Cost Address of Work: 4 � GriYI/I !L — Owner's Name (�G'�ti/J 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 iY for a permit as the agent of the owner: Dat Contractor Name Registration No. OR Date Owner's Name r• The Commonwealth of: fassuchuselty Dt.pftrl»rcnl of ludustriul.4ccidents 0>lice8111 YOU1yallo»s •�\�='l; :=r 600 f f asltinl, Street �'•��.�•• ��� Boston.A1u�s. U2111 Workers' Compensation Insurance Affidavit _ �hnl c�irit information• — PliTmi PRI'NTlebiiily"�""'-'�•y'�� •'�- __ name* Incntion- 2 _Za(7 �rM C/✓� city' (6 AAA d�`� nhnnc 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity _ . .• l �—..,,.w•_ �• .re.-'r ..fw-.RT��/}'R'•�.i`7Tw...w.+w....T7�'P���ww��w�•�'•r�w.��.w�.. ` ►•..wr.�r..�_�. X-J, am an enipiover providing workers' compensation for.m,% employees working on this job. emmn•tm• n• rne• •tddrest• city: nhnnc�!• -- /J — incrtr:tncc rn. •'�/���'�1 /���••(/J y� nnlic�•!! �.�/['���3 // � / �`' [� 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: cnmrmn%, n• tree* •tdriress• cit.•• nhnnc+�• - insur•tnrc ro nniiev 0 1 •i r: '�. `w"" _ — �•-t.. �. __ —' . i.��lt iT••T!'w.w'1••.�!' ,w ZT �--.��i •` �.��� ennlnnn— nitne. address' rite nhnnc It• insur•tnce co nofic�•d __ .Attach additional sheet if neces_sa_rv_` ^- `��• •%r "�'�'-""•" ~'^ ''"= �"'==:a'ue �cr:y.;:::::,;. Failure to secure coverage as required under Section 3SA of n1GL in can lead to the imposition of criminal penalties of a tine up to 51.500.00 andiur one cars' imprisonment:ts."'Cll:rs civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a dap against me. I understand that a Copy of this statentcnt may be furirnrded to the Oflice of Investigations of the D1A for coverage verification. 1 do herehr semi Inc the ains and !tics of perjure•that the information provided above is true and correct. Si=nature Date 7 _ l Print name Phone>r w - - .y+r�rurr otT'icial use univ do not write in this area to be completed by city or town official ` sin or rown: permit/license# riBuilding Department aUcensing Board o check if immediate response is required selectmen's Office ► �- 011cailh Department phone fit; r•lOther s contact person: - i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation for their emplrn ces. s quoted from the "law". an emplitree is defined as every person in the service of another under anv contract ofaire. express or implied. oral or written. wr.E An entpinrer is defined as an individual. partnership, association. corporation or other legal entity. or any two or more the foregoin�u, engaged in a.joint enterprise,and including the legal representatives of a deceased emplover, 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 hour or o» tite ;_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 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 i-t•ho 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 tite insurance requirements of this chapter ita 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. Tite affidavit should be returned to the city or town that the application for the permit or license is being requested. not tite Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a %vorkers' compensation policy•, please call the Department at the number listed below. Cite• or'rowns 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 tite event the Office of Investigations has to.contact you regarding the applicant. Pleas 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. Tile Office of investi=ations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to __ive us a ca11. . Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents ,. Office of Investigations 600 «'ashinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 r phone #: (617) 727-4900 ext. 406, 409 or 375 .