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Home My WebLink About0042 CAPTAIN COOK LANE ��y,- coo �G �nl - _- ._ . __ r.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION q A4 Map O� Parcel 'Application# Health Division Conservation Division .Permit# Tax Collector 5 Date Issued Treasurer Application Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ®� 7J� -� Historic-OKH Preservation/Hyannis Project Street'Addres Gt - l.. 3 �illages:.� f�- f1cz Owner -1 L b w� :Address Lv �..,,, , Tele hone"p g1 2 Permit Request 1`� �vt- �.w 14 Square feet: 1st floor:existing proposed 2nd floor:existing proposed _ TI new: Zoning District Flood Plain Groundwater Overlay =' ) ProjectValuatioi�7t � ° Construction Type = ' t_ pl Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting'ocumentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) oco Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Hi way: ❑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 Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count E Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑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 Na a iw C�, C(&O 97W lephone Number Z Z 614 Z License# q Q1Z Home Improvement Contractor# 1 2A sZ,91 Worker's Compensation# CALL_CQNSTRIJCTION DEBRIS RESULTING FROM THIS.P_ROJECT WILL BE TAKEN TO. LA,A SIGNATURE' DATE FOR OFFICIAL USE ONLY z PERMIT NO. DATE ISSUED MAP/PARCEL NO. ( 1 'S ADDRESS VILLAGE - 1 , OWNER 7 DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL E PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL } FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. 1 - 4 t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . d 600 Washington Street Boston,MA 02111 N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le '(blv Name(Business/Organization/Individual): . 0 1 e et je, �4 C Address: I K `1 City/State/Zip: G r m o 'I. Y'l� �5 Phone.#: �" Cl�-2 Are you an employer? Check the appropriate box: Type of project(required):, 1.❑ I am a employer with 4. 0 I am a general contractor and I me loyees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2. a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees 'These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P t3'• $ . 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' .13.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am on employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: - Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of In resdeations of the DIA for insurance coverage verification. I do hereby certi =nder e p ' s and penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone#: y � Z2— 01—�"Z Official use only. Do not write in this area,to be completed by city or town of zciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,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, §25C(6)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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit 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. ISelf-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials e that the affidavit is co lete'and printed legibly. The De artment has provided a space at the bottom Please be sure p p mP PP 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. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 Indttstrial A.coidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 www.rnass.go-/dia f{ t f Town of Barnstable •�¢ . Regulatory Services a�w Thomas F.Gdler,Director Building Division Tom Perry,CBU Building Commissioner 200 Main<5treet, Hyannis,MA 02601 "w w.town.barnstable ma.us Office: 508-862-4038 Fax: 5087790-6230 Property Owner Must Complete and Sign This Section If Using.A Builder i as Owner of,the subject property _ l P Pam' # herebyauthorize e / L /'O S.SCy� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Joky) i face of O� _ Da � i Print Name i Q:Fomns:cxpmtrg (tcvi$e071,405 f r ,w f MAY-29-2007 13:00 CONDYNE LLC 781 848 3774 P.01i01 • COhdow�;w;��g 5oa.42s-111� Fax 4Z8-1605 Ceh ter VillageTRUSTEPS: SUIT rah.Pabert oakon 'J Hugligge Group,40 Industry Rd. Margaret Nichol,Robert bassdL Marie Walsh i Mardaill Mid,MA 01049-0340 05/29/2007 Sub/act Flagship Enterprises Window replacement-42 COL ATT: Mike McCarthy i Dear Mr. McCarthy, You are granted permission to replace the windows at 42 CCL, Center Village. They should be white, vinyl and be the same style as is presently there. Any questions, please call. Jim Curtis, manager TOTAL P.01