HomeMy WebLinkAbout0017 CUMNER STREET � 7 ✓�
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 3 0 b/ Parcel �`� ,.'Permit# n
Health Division -'Date Issued
Conservation Division Fee'
Tax Collector • `
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH" Preservation/Hyannis
Project Street Address 7 4-r /41u2,=,q 5 7.
Village Xw
_T, x
Owner 1V1 c/1e L,4.S Address 16�-0
Telephone
Permit Request E;', l� —
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
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
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 0 new size Shed:❑existing ❑new• size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes 214o If yes,site plan review#
Current Use Proposed Use
a
BUILDER INFORMATION
Name Telephone Number `77 5- 77 ,6r 3
Address
/. `f iL 04E, A/A) �/�' License#
e 2,y' Z7 Home Improvement Contractor# e"
Worker's Compensation# 'L
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
l
SIGNATURE DATE �c/ rl za
FOR OFFICIAL USE ONLY w
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
,ADDRESS ";. `s VILLAGE
r
' OWNER
3 •,
DATE OF INSPECTIO '
FOUNDATION
FRAME
INSULATION
FIREPLACE - -
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: - ROUGH FINAL } -
FINAL BUILDING
DATE CLOSED OUT
S
ASSOCIATION PLAN NO.
. 4
e commonweaun
a�s Department of Industrial Accidents
• �=� Ofllcr aI/mrestigatioos
600 Washington Street
- Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name:
location:
hone#
city
❑ I am a homeowner performing all work laysel£
❑ I am a sole proprietor and have no one working in any capacity
. workers' ensation for my employees wolidag on this job.
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❑ I am a sole proprietor,general contract°r, or homeowner(circle one)and have hired the c°atract°rs listed below who
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ices:
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F IIre to 11 secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sue up to s1+S00.0o and/or
one yam,imprisonment well as civil penalties in the form of a STOP WORK ORDER and a fne of 3100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMm of Investigations of the DIA for coverage vesiflcatloa
I do hereby certify th p and penalties o ppa7ury the the injormation provided above is trru and coned
Si�ature
Phase#
Print name
oilicia!use only do not write in this area to be completed by city or town ofScial
city or town: perrnit/license# ❑Buading Department
❑Licensing Board
❑Sdectmnen's OtIIce .
❑check if immediate response isrequired QHealth Department
phone
contact person:
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The Town of Barnstable
& Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 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.
Type of Work: C���'-l �� Estimated Cost
Address of Work: c;G Z-te IV LTi1l 57
Owner's Name: / c L .V s- l olp lG, : loom
Date of Application: �l
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 I PROVEIVIENT 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 th age of the owner
Z2G
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
...Jhe too mg
HOME. IMPROVEMENT';CONTRACTORS. R OISTRATIUN.
F oard of Building Regulations and tr�ndard.^=
One Ashburton Place - Room .1301
Boston,.. Massachusetts O 0i;3
HOME IMPROVEMENT _CONT- C.TOR
Registration' 10891a Expiration 08%27!00
Type - INDIVIDUAL st.6mfYlrK•:< ;...i�ura.auaclD
oa istrat:o;; ?C3"1
THEODORE.L . HITCHCOCK Eapir3 i ';!_.•'/c
PO BOX 211/ 55 LISA LN , 4' ,
W . BARNSTABLE MA ' 02668 FTr'flr
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