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Home My WebLink About0098 CHANNEL POINT ROAD ys c4, .�,.�e /�k-. r �e l - E- Engineering Dept. (3rd floor) Map „? (o Parcel d 76, .. Permit# a2,& House# �� Date Issued A0 7 — 9 Board of Health V(3rd floor)(8:15 -9:30/1:00-4:30) Fee Oda Conservation Office(4th floor)(8:30- 9:30/1:00 2:00) Planning Dept. (1st floor/School Admin. Bldg.) 114S Def PI Approved by Planning Board _ BARNSTABLE. MARk TOWN OF'BARNSTABLE - Building Permit Application , _ o'ect reet Address i Village 4t4 cL AA nvlvo An 6 Owner ct"S. SCUCQ&A/-L Address Telephone 'Permit Request gaX4 CN , . 1 First Floor square feet Second Floor square feet .Construction Type Estimated Project Cost $ �®0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑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 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 Lecdj�l 0 rq1t(,4,,Q gel Telephone Number . Address _7 j License# cc) Home Improvement Contractor# // 6 Worker's Compensation#GGt"1 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 dA A BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) w FOR OFFICIAL USE ONLY _ PERMIT NO. s ' f • a - f.- 1 » DATE ISSUED 5 MAP/PARCEL NO. 1 ! { ADDRESS - ; VILLAGE E , ✓ y OWNER t _ •« _ �� # - . .�- DATE OF INSPECTION:/ Y i FOUNDATION FRAME _ INSULATION - { FIREPLACE + - ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t1 FINAL BUILDING � DATE CLOSED OUT ASSOCIATION PLAN NO. ' f , 4J" R&EMMUZ . The Town of Barnstable '� �0�' Department of Health Safety and Environmental Services ��► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissior. For office use only 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. Type of Work: 4Est.Cost ZooD , R14 Address of Work: T• Owner's Name X(CLI,_0 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 MWROVEMENT 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 �v Eat/ Contractor Name Registration No. OR The Commonwealth of1fassachusetty -!:i Department of Industrial Accidents ' OffIC. /IVMS& 21lons 6(lfl lf'ashil'trton Street Workers' Compensation Insurance Affidavit Applicant intormatinn: Please PRINT leg �lv natnc: � cite. (s'�� /s/�• nhnne 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity —.�- ....._..�,,.,�.�:•fw.wr.s+�srca+ 7..�l'T� �r.+. . .��.w�. .. .•ram+...�+�.�..+....ww._.r•ww..- .. g,I am an employer providing workers' compensation for my employees working on this job. en Ill nanv name: S%�7LG address- city nhnne#- insurance cn. licv# � 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: comnam• natne- addrrsct city phone 0, insurancr ro. noliev# cmmrmn% nnrnc: addresc� cin^ •nhnne insurance co. nolic`•# 777 Attach additional sheet if nect sary� - + :� _ — _ %'T ''�`"^�•• y--+— ^'�`•' - Failure to secure coverage as required under section 3SA of AIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur one Nears' imprisonment:t.%wen as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that n Copy of Misstatement mat be forwarded to the Office of Investigations of the DIA for coverage verification. l do1lerchr ccrri under t c un gird pctr s o rrjun•that the information provided above is true and correct. Signature �^ Date Print name Qit Phone 'Iofficial Ilse only do not write in this area to be completed by city or town official city or ttnvn: permit/lieensc d rttluilding Department C]Liccnsing Board � check if immediate response is required selectmen's Office ► 011c21th Department _ contact person: phone#: router_s. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* compensation for the enployees. As quoted from the "la\\• an entpturee is defined as every person in the service oranotlwr under any- contract of hire, express or implied, oral or written. An cnrph rer is dcf incd as an individual, partnership, association. corporation or other legal entity• or ally two or ma- the foregoing enpged 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 owner of a dwellina house having not more than three apartments and who resides therein, or the occupant of the dwclfin�, house of another who employs persons to do maintenance , construction or repair work on such dwelling he or on the `,rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic"'e- MGL chapter 152 section 25 also states that ever}- state or local licensing agency shall withhold the issuance or renewal of a license or hermit to operate a business or to construct buildings in the common11•calth for sn• applicant Nvho 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 :-. been presented to the contracting authority. .4!.7777771- 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 tnay be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit sliould 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 requires ,o jbtain a workers" compensation policy. please call the Department at the number listed below. City nr rowns Please be sure that tite affidavit is complete and printed legibly. The Department has provided a space at the bottom o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned -he 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 questior please do not hesitate to uive us a call. 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 1 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 375 ! Eli � ew µv f s "'�'y' ?4 •tu, S. M1p ,r•s yv Y s � + F.: fir: �fi+E w , , �.� .;, r "i":m "`':r ke ' A 'f5 R G �SsT A NO I PROVE EN' fi f ` GTE ' �'� �°O^1;'1S' R �;gixatd�irat7 NONE MPROVENENT� 0�1 RACTOR Negstra}t on�li'2536 g" Y r � �YPe BA 2A5ER. NSTR.L �I0, - '• 'Eitp.iratlon i �04/06/99 � - - � ` - -� DEANC�.�;�.F�2ASER• q yy� 47.' - � ..•- r ,�,;. ". ,�$, � ';,�, .. ?x-r.M1, � +�, § fir'. `s �, y.. �. �.•.:.>,, ; ,1 i•_. �71�T.ARRAGONCIR 5 .. d �, ,� FRASER-ONSTRUCTION ,y. y+� CO.TUZ'fMA026'35 ,� �#w,. ,.,��' :3� sn; :rS� �w: .� t,�t �. � a ;.r; �• fir '. t -�TARRAfiON CIR s ;',• 5 >c4x,. .. ,."�sr',,r r' s ,..F' r�- .,3,�♦•t iy, g ,tb :�'';'s P "��' z�- n'-'.ADMIN Rtr T; : kPy+. .rn' 2S -y.;,t. ..,ir ",,r- t v^t,Tagx',+F ;:1, r ! ., ISTFtATb . .� .la ,.a. x rw, :< x� ss ;C91UITHA,,.r + aA. w{r$�JI.A. Y 1v'-a P a. -� , _ r _.c4i ♦t ...iK e L a £5 r R r 3 .c k" - 9 IF„ . " 2 $ G7A, r ztL* �i{ . Vn`{;,a .f