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Home My WebLink About0015 BARNSTABLE ROAD NI - — � . t { c� Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us F Pre-application for Business Certificate Date �� / / Map Parcel V / Applicant Information Applicants Name Applicants Address 1,5 h / 11 Email Address lei r i - /f rn 6u/• Telephone Number Listed Unlisted ❑ '717 5= 959Z 56,�.94Q, 7d"1/ Business Information New Business? --------------------------------_ -----=-- Yes No Business is a registered corporation? ______________________ _. es z No If yes Name of Corporation Za/2e 6WIgfir,&&Sti e a GZT h-)C Does business operate under the registered corporate name, Yes No Is the business a sole proprietorship or home occupation? __---___ Yes No _ If yes then a Home Occupaticn Registration is required -See Building Division Staff Name of Business C� Cod P g 4L a )'f Business Address /5 /S 0h. 4W If ✓'09.6 7U1OA,1 /y', Aa aj Q f J Type of Business i' d Buildin Commissioner Officel e Only Conditions I Building Commissio Ir , Date Clerk Office Use Only YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cast$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main-St., Hyann is. Take the.completed form to the Town Clerk's office, 1st Fl., 367 Main St., Hyannis; MA 02601 (Town Hall) and get the Business Certificate'that.is, required by law. - I`I I ease: i 1 � DATE. �� ' Fill n p , �; ;'�r?:•;!:;f::•:,,ir ti"'" '� I YOUR NAME S: No(�-mrkn MIL et-n '�� APPLICANT'S / { I qL" §'i yes: BUSINESS YOUR HOME ADDRESS: 136 Te c,n L t�v.2 gl ry c I a ff'� t to 3 � . f:J; ��,.'n �►��a god-7-75- 9595 Ce V t-et'v t e oa. ` , 'y' ��i'►'y+l TELEPHONE # Home Telephone Number SFr-7�� a4 caAfi !k $o � ,it�Fdtgl�4Jr,1"'I , E-MAIL: y11c I e n o�l E' C cw1nC A t NAME OF CORPORATION: 7 . NAME CIF-. !BUSINESS m-l-ears SL z a ShU e TYPE OF BUSINESS 13At al(C S1�oP IS THIS A HOME OCCUPATION? YES NO 7C ADDRESS OF BUSINESS., 15 53aAAsfA•6ie (Zopal RmR-nmi s tM ell601 MAP/PARCEL NUMBER �ol� / �? (Assessin'g) When'starting a now business there are several things you must do in order,to be in compliance with the rules and regulations of the Town of Barnstable" This form is intended to assist you In obtaining the information you may need. You'MUST GO TO 200 Main St. (corner of Yarmouth 'Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 'I. BUILDING COMMISSION- S OFFICg * f This individual has be rme permit roquiremerits that pertain to this type of business, z T p Authorized SignaCppre_ * ' COMMENTS: ;-Xa 6��L cF- QC& cw - 2. BOARD OF HEALTH This individual has been in h permit require ants that pertain'to this type. of business Authoriz ure COMMENTS: tp - 3. CONSUMER AFFAIRS (LIl SING AUTHORITY ; This Individual s b n' f e o t li a ul nts that pertain to this type of business. Auth rized Signetu COMMENTS: T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J Parcel Permit# Health Division Date Issued Conservation Division Fee jd 0 Tax Collector �' l l /� / Treasurer v Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �'�5 :42�✓-si f� 6�� , l� Village ��_��iS _ Owner si�,A,l/-f-�/ /Ll � ��✓ Address /moo Telephone 9' 7 3 7 Permit Request ��- S rR, ' z/l o"o Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. 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 .3 Basement Finished Area(sq.ft.) 4-A Basement Unfinished Area(sq.ft) Number of Baths: Full: existing � new Half:existing new Number of Bedrooms: existing A'14— new Total Room Count(not including baths): existing new y14 First Floor Room Count Heat Type and Fuel: 2ki as ❑Oil ❑ Electric ❑Other Central Air: Oes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size off- Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size ,4 4 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ -Appeal# Recorded❑ Commercial es ❑No If yes, site plan review# Current Use Proposed Use v� 4 BUILDER INFORMATION Name /-IT 'J Telephone Number � 7 7S 3Z 3 Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PeRMIT NO. Y DATE ISSUED .k 4 MAP/PARCEL NO. , s ADDRESS VILLAGE DATE OF INSPECT144 FOUNDATION ell, FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINALµ GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. I �FIME _ . : The Town of Barnstable BAmffrnBL& 9�A mm �0� Department of Health Safety and Environmental Services rFc ►�s Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. ,fi Type of Work: -y`-�G J Estimated Cost Xl �O s / Address of Work: 13 ,oq-,o4 Owner's Name: S �,o ,ex At Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law. C3Job Under$1,000 Building not owner-occupied QQwner 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: Date { Contractor Name Registration No. iF Date Owner's Name q:forms:Affidav �� - r-..-_= — The Commonwealth of Massachusetts .._ _ Department of Industrial Accidents . 9 Off/ee of/aYestlgatfoos -.. 600 Washington Street - s Boston Mass. 02111 Workers' Com ensation Insurance Affidavit name: .5, 7-`°1�- ,Aj 1 .L--Z '9- ,;3 Q location: /S 9 4 A A)S'%19-b/C- X- • city - - �+/ .ti is A-17f - phone# 7 7J 3� 3 7 C-1 am a homeowner performing all work myself. , ❑ I am an employer providing workers' compensation for my employees working on this job. an name. : . '::`.:.:::::`:':;: address. :.::::>%:::»>:::::::>......::::::><::>:<:::::>:::>::;>::>:::>::.>:.:::;::..;:: ::::-:::--:->:-:-*%->::>.::.:>:>::<:«-----.:><:.::.............::>:;>::>::.::...:.. .........::.:. . . ..:: :.:..: .::..:::..:.:.::. :.;'.;::.;:.:....:. ::..:...: ::;::»::::::::>:::;;:::::.:::::: city:.. . ..... ;:::;:..:.;:::::.:>:::;:Qhone:#::.::.:. <;...<:-.........x::::::>::>:: .. >'>: :.>::'::::' . . oh�Y# .:...:::::::::::::::::..................:::::.:. ansurance.co.. . ::':: ::.'; :x>:;................................- : _:: ' ❑ 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: "j' _ ............................................. .. .....:......:. coniQany name:.; address:::' ...........:.:::::.:::.::.....:.::.: :.. . .__.... _....... ... ... ... .. ..... .._.._. ......... _._.. - 'a.. ,.K......... ......:::::::::....:::::::::::::::::.:::::::.:::::::.:::::::::::::::::::::::::..:::::::::::.:.:::::::::::::: ::::::::::::::::::: rid.,+.; :.<•:. };::::;:i;: V:::? :;?:;:;.................�:;j:`:i::::i::ii:-'.:;::::{:i>iii::iii::;:j};:t.i:;; :;:i:>:} {{:;:;: ;:,+'{:F;?i1iii:iii::i::: :.:;:}iiiit.::i::ii::'::i::i:iii:O:::.i:is i:::::::..::{.}•;'•;:•i:•^:::Lii::ii'::.iii:ii:.ii:.i:.i'::.:n:::.:}i::^:::•::.i:.i':ii'::jiiiiii>i:.....:;ii:;:>;:;}:;:;i.U;i:j}j}:>::{::.i ;::i:`>:::i::::::::::i:::::?::i}:::ii r':::iii:::?iiiiiiii:?i}ii:iii::iiiii:::i:`:i:::::':':.:>:ii.i:::..i'i::::::i:':i:::ii::.::..:.::is i::.i'.i:i.i}ii}iiiii}iiii:::iiiii:4iiii:':':.• ........ ::::..:::.:.::::: ... .:.. :: :>:: ...................... ......................................... ......................................... ..............:::::::::::::::::::::::................:.....:.......:.:..........:........................:............::....:�::.,.......................:...:..�....:.�: ................... —_:;:::,.:..,..•........ :�.,.,•:n•.«•;::.:�:.:;: ::,..-::.::::::::::::•:::::::::::.:::::::::::::::::::.::::::::::.:.:::.::::::::::.::::........::::...:::::::.::::::: .................................................................................: :::...:..:•..:.............. R..• _.............................................................._............. b #:,::;>::i:c::Y iSss:»::>;:;:.,<:;:;:<::<;;<:::<:;;>;<;..::>:::>;>;;:«:,;:<.;:::.;:;;:;::::;;:>=:>::;;:n: murance.co:...... _ _....... .... 1� ...... any name: ..:.:.:::::... :came :<::;>;:<;;.;:.;:.. ,.,.. :::::::-I.:::::::::::::.:::.:::::.:.::'::::::::.:::...: :. :....:::::::::::.::.:;:.:.::::::.::.:::::...:.:..::.::.:.:.:.:........................................................,.. --...._. .. . .......... address: :> cl t3s. ::.... ,:.:'..:: >::<::Q bne ::::::............ ::::.::::::::•:... ....:::.::..::.:::: .... . :;.... :<:»:<:»::>s:.,:: nsnrance:co<<::>::.: 1. :.:: ::: ::'-.::;:::::'......::.::>:::::::> ::. oli::: #< ; / �. Fall re to secare coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 Oice of Investigations of the DIA for coverage verification. I do hereby certify under�the pains aannd¢p-enact t,,i�es ooff perjury that the information provided above is trno and ccoorrect Signature I /y" �?.:. l l �'G�`—It'". Date gL11 Y , :- - Print name -'j-p^I` /y1�I-e --f -J Phone# 7 7,S- ,.3�.3 7 official use only do not write in this area to be completed by city or town official , city or town: permit/ficense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office • ❑Health Department contact person: phone#; ❑Other Oevued 9195 PJA) 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 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 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 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 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 along with a certificate of insurance 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 permit/license number which will be used as a reference number. The affidavits may be returned in 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of igllesugauOus 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 x.. .c _ own of ar < <. =_ T east of Health Safety-- Envir��r ia�. Se�iees Building-Division -- yBAMS s M i 367 Main Street,Hyannis MA 02601 ��FD MA't A Officer 508-862-4038 Ralph Crossen Fax: : 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print' DATE: S£� f 3 /p pj' / ��/ JOB LOCATION: �r J 1uS'T�d /� !t y. Iv Iva number street village "HOMEOWNER': iS K1V 'f)hc- 77.f-Fsys name home phone# work phone# CURRENT MAILING ADDRESS: a o /�R yj 19/ Cr tvT'g JL U I 1 he /it w oaf 3'— city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Hdfneowner f Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN AWN bF BARNSTABLE BUILDING PERMIT APPLICATION � - ` Map .r.:a3 Z� .'Parcel L0 f Permit# C ;7 Health Division � N OF BARiN Date Issued S a o Conservation Division � '$LE - <,1I133 NQR 24 P Application Fee Tax Collector r' 30 Permit Fee O Treasurer Planning Dept. • Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address j �tr-y►$��s-�,� r Village Owner Address Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. 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 V new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil_ ,0 Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage:❑existing O new size Pool:❑existing ❑new size 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 Proposed Use BUILDER INFORMATION Name �� , `�� Telephone Number Address ��( . wv 6•Y, License# D T'✓�(` t't: - _011 Home Improvement Contractor# xl2 to l � Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE — DATE, 2 v a FOR OFFICIAL USE ONLY • r � ` PERMIT NO. 4k: � DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. zl .1i,K ON, 00 mi 10 fO glo Af ts Ll rg IV. Ila a %d M: v Ar !Pit. a 44 Xk N.%1w .w W3 03 M 1.0 C3 0 0 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation forth::r employees. As quoted from the."law", an employee is defined as every person in the service of another under any cart—-: of hire, etpress or implied, offal or written. An emplover is defined as an individual, partnership, association, corporation or other legal eatiiy, or any two or more of or the-foregoing engaged in a Joint enterprise, and including the legal representatives of a deceased employer, or the rec.-o'er trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartmn-* and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair words an such dwelling house or as the grounds c. building appurtenant thereto shall not because of such employment be deemed to be as employer. MGL chapter 152 section 25 also states that every state or IocaI.licensing agenep shall withhold.the issuance or renewai 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 m* surance coverage required. Additionally,n�� commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work;until acceptable evidence of compliance with the insu c requirements of this chapter have been presented to the comracting authority. Applicants Please fill in the workers' compensation affidavit completely,by di!cJrmg ths.box that applies to your stuatina and supplying ccmpaay names,address and phone m=bcrs along with a certificate-of finurae as all affidavits may be _ submitted to the Departtaent of Industrial Accidents for co3fimmdnn afros rz=coverage. Also be sum'to sign and 'i date the affidavit The affidavit should be.returned to the license the applicatiaa for the permit or iicse is. being requested,not the Depatrtaea#of Industrid Accidents. Should yea Dave any Questions regarding the"law"or if you arcrequired to obtain a workers'ccmpensatioa policy,please can the Department atthe member listed below.PPRT . City or Towns _ �• Department has provided a space at the bottom of the Please be sure that the affidavit is complete and printed legibly. The prvvi affidavit for you to fill out in the even the Office of has to yen regarding the appiic= please be sere to fill in the p id cc tee mmmb&which will be used as a reference ni aber. The affidavits may be rcmriiR to the Departmeat by mail or FAX unless other aaaagemumts have bemmade. The Office of Investigations would like to thank you in advance for you cooperation and should you have env questions. please do not hesitate to give us a call. The Dep==cnt's address,telephone read faxm=ber: The Commonwealth Of Massachusetts Department of Industrial Accidents Gfflce of luvesduadons 600 Washington street Boston,Ma. 02111 far#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 I i t T Town of Barnstable ' °•; Regulatory Services + BARNSTABLE, ` Thomas F.Geiler,Director � �p i63g. ♦0 � TEn +a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, S?A V /f y 9 T1 q N ,as Owner of the subject property hereby authorize G -o Rso U.E/a R to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Ih0- ).ogN'S RbzRS Is3vqrvs7-,qb /x A Hy.y )vN�s M)F Rc� 2)L o2003 Signature o Owner Date Print Name I r t ..- � ✓/ae V�omnzo�uueacu�a��/ acltrcae�l6 Board of Building Regulitions and Standards HOMEIMMROVEMENTCONTRACTOR Registration ,126158 ExpiCafion .-12712004 I =Type in GEORGE VELARDI GEQRGE VELARd�i 151 STURBRIDGE OST.ERVILLE,'MA 02655 L'a Administrator f . t `