HomeMy WebLinkAbout0351 CASTLEWOOD CIRCLE .�i � ���
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/sessor's Office 1st floor Map_ 3 Parcel b�.� Permit# Jr7 y r
/Conservation Office(4th floo (8:30-9:30/1:00-2:00 1 6 Date Issued 5
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Xngineering (3ard of Health(3rd loor)(8:15 -9:30/1:00-4:45)7 -'= V7 V ti`� Fee Dept. rd, d floor) House# L 5� 0 o
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TOWN OF BARNSTABLE � ��'��
Building Permit Application
P et Address r 51 6as-Hr W ood C«G� v' ��Ae
Village
quon►�l`S
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.Owner ���)h►-) ` 0 A r")a rDI Address l _C-S4i)G d d �/rC
Telephone ' ICI b ' L� �'I •''
Permit Request 7Rtlf i l U add!-k6i'1
_ ate
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First Floor 1 C/o2 square feet
Second Floor square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use 6Q. Proposed Use _
Construction Type ZO
Commercial Residential �—
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
a
Historic House Al/d Unfinished
Old King's Highway A/o
Number of Baths / No.of Bedrooms 9
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 �'�,����,nG� ,A �ra PC� lI»S 6010 Telephone Number , 4 Y_
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Address{ S) u G,$�_n,�J S�� Y, License# U(p G(o o�(�
/U !ti _ Q 4 Home Improvement Contractor#
Worker's Compensation# 36�,/ 6a3 71-�)--00
�«rnper' 1os .
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRn DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
Yl*)
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE F WING REASON(S)
i FOR OFFICIAL USE ONLY
PERMIT NO. t Z
DATE ISSUED
MAP[PARCEL NO. < '
ADDRESS r r VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION ..
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH # FINAL
FINAL BUILDING:.` • . ` '+ '} P
DATE CLOSED OUT
P
ASSOCIATION PLAN NO.
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• The Contnionwealtli of Massachusetts
a• % �� -= Department of Industrial Accidents
` 011fceol/ooesllgal/oas
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600, !f aslttngtun Street
�.�� Boston.Altus. 112111
Workers' Compensation Insurance AMdavit
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ARniica�n—t_ r��_'fn••n+_ati�n�' - Please PRiN'i'`,e�ly -' ��
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nhaneaL226 2 9 —A iq
13 1 am a ho eowner performing all work myself.
[3 Lam a sole proprietor and have no one working in any capacity
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1 am an employer pr
oviding workers' compensation for my employees working on this job.
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address (�
insurance en i, Qc—r polices•# ' 1
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:
company name:
address:
city phone#:
insurnncc co. peiicv# '
� _ -r - _: �,. c .:,a•e.-?-ter►-•'-r.ee-ems - __ +os *=►aL:-W:fa��.•�•!r�-s�+�-*e..+----ter
ctimnam•name:
address:
tits•• phone#: .
insurance co. nolicv#
:A_ttaeh additidnal sheet if need =: w_ f''-,++ Y'• *.: min" „- ��•'
q.MM�......
.1rl.w`liiY
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penatties of a fine up to SI.500.00 and/or
one years,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this stet ent ay be forwarded to the Office of Investigations of the DIA for emerge verification
i do herebr crtifj• ndcr tiro r* s d p r /ties ojperjuoil
t the iajornutdon pro►7ded above is true and correctSignature ate
Print name 4 c �� Phone .1�C' l(0 O J / 7
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official use only do not write in this area to be completed by city or town official
city or town: pet mit/licettse# nDuildiag Department
(3Licensing Board '
O check if immediate response is required [3Seleetmen's Office
Health Department
contact person: phone#; MOther
Irt Sed V95 P1A►
The Town of Barnstable
NAMP Department of Health Safety and Environmental Services
9. Building Division
367 Main Strut,Hyannis MA 02601
Ralph Ctossen
office: 508-790.6227 - �
Building Commission
Fax: 508 775-3344
For office use only
Permit no.
Date
AFFIDAVIT
HOME WROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERhffr APPLICATION
MGL c. 142A requires that the-reconstruction,alterations,renovation,repair;modernization,conversion,
improvement,.rcmcn-4 demolition, or consttuaron of an addition to any pm-cdsting owner occupied
building containing at least one but not more than four dwelling units or to stun**I -which we adJaoent
to such residence or building be done by registered oontracx M with eettain exceptions.along with other
requirements.
I
of work: AA�,41 Est.TypeI 1 .
Address of Work: '
Owner.Name:
Date of Permit Application:
I herein certify that:
Registration is not required for the following reason(s):
Work emcluded by law
Job under SI,000
Building not owner-occupied
Owns pulling cam permit
Notice is hereby given that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING WrM L7NREG
FOR APPLICABLE HOME 54PROVagNr WORK DO NOT HAVE .ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c I42A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
�1�11 �a
Da a ctor a Registtation No.
OR
_ c?wner's name
- � ✓fie �o�n�n:oauuea�� o��.���aQaa�c�e�
PEW
HOME IMPROVEMENT CONTRACTORS REGISI"RA1"IOPI
Board of Building Regulations and �i:.andarrJs
One Ashburton Place - Room 1:301
Boston , Massachusetts 02108
HOME IMPROVEMENT CONTRACTOR
Registration 118209 Expiration 02/12/97
Type - DBA
HOME IMPROVEMENT CONTRACTOR
Registration 118209
RICIdARD P GAGNER JR , BUILDER Type - DBA
RICHARD P . GAGNER JR Expiration 02/12/97
P 0 BOX 667 -- 44 SIASCONSET DR
SAGAMORE BEACH MA 02562 RICHARD P GAGNER JR, BUILDER
RICHARD, P. GAGNER JR
BOX 667 - 44 SIASCONSET D
ADMINISTRATOR SAGAMORE BEACH MA 02562 ,
Failure to posssas a es►rent
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY MassacArsettsStAtOBrildin9
N PLACE TO n
A HBOR o ONE S repo atl O •for r
F ears
O �is
2108
Cod
T N MA 0 BOS O se.
® SETTS Iic es
ACHU s_.. MASS !Af
o>t
L-I C E N S E= CAUTION
EXPIRATION DATE 02/04/1`. 97 CONSTR.. :'iLlPL"~RVISK)IR
FOR PROTECTION AGAINST
EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB
RESTRICTIONS PRINT IN APPROPRIATE
00 0 o8/01/1`93 060620 o
6 BOX ON LICENSE.
0
0
filCHARD P GAGNER :fIR BLASTING OPERATORS
Ss It 015-••60-6 70`j m 89 SUIYIIYIER S r m MUST INCLUDE PHOTO.
PH: _WTING OPR ONLY) FEE: KINGS•TON VIA LEI C?,:164
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
5. � ..\
--�` •p\,��. PED-OR-SIGNATURE OF THE COMMISSIONER
HEIGHT:
.N�C.I
DOB:
e y" 02/04/1.970
t` ....+ SIGN NAME IN FULL ABOVE SIGNATURE LINE
?...`` THIS DOCUMENT MUST BE` Iii
RE OF SEE
CARRIED ON THE PERSON OF
THE HOLDER WHEN EN-
' - �TC1:H.FJINB PRINT GAGED IN THIS OCCUPATION.
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