HomeMy WebLinkAbout0103 MAIN STREET (HYANNIS) /03 ��/ng.N sT.
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!TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map °; ' Parcel 9 6 r Permit# C/
Health Division Date Issued
Conservation Division Fee $.fie
Tax Collector -X OcIx —a G,' o/< 0
Treasurer SQ. = Az 0
Planning Dept.
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Date Definitive Plan Approved by Planning Board '
Historic-OKH Preservation/Hyannis
Project Street Address-( �i4S- 1)?14 /All s
Village ti YVN
Owner CA� t « \rP- n— - q-L 'Al D A� 131 Address 1 L�' vjr c
Telephone
Permit Request -6Z- 01 A�0 a r
Square feet floor: existing proposed 2nd floor: existing proposed Total new
Valuation �y��' 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: 0 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:0 existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial �-,Kes ❑ No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name Z r <i Telephone Number ;z Z o
Address o S1, s r7 5-Z License# 0 3 G -70 /
CZ,)� Home Improvement Contractor#�" f 0 61�1
Worker's Compensation# It/ C '17
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO q o 3
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SIGNATURE DATE 26.L 3411 1 0
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FOR OFFICIAL USE ONLY
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3 E YF
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PERMIT NO.
DATE ISSUED
I MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
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DATE OF INSPECTION:
r FOUNDATION
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FRAME
INSULATION
z FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
Al
GAS: ROUGH FINAL
Z
FINAL BUILDING
,
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
,; - , = plllcaotlores�fpatlaos .
600 Washington Street
Boston,Mass. 02111
Workers' Compensation hum ranee davit
21M
CA
location:
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❑ I am a performing all work myself
❑ I am a sole etor and have no one worlds in anv
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an
1 workers' eosatiion for my employees worlaag as this job.
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ra • as order Section JU of MQ.I42M cm to the ofe fn a da n of IM& to S1�00.00 odlor
Failure to secure coverage as4n�t'ed
am yam,}mpaisonueot a,weR as cdvil peaaltln inthe foam of a sroPwORS ORmmandaAosof5100.00 a day against m� I mderstand t>u<a
ospy of thb sotemmtmey be forwarded to the Ocoee of Iavesdgmtiom of Uw DLUor.cove=P vedncadm
I do hrfrby calif}' Pains of p th�ttucirrfarnr�ioa p�t'r above is tr�cord coned
Dar 12 y �'
3igasriaz •
Print name
Ph=#
oindal use only do not write in thb area to be completed by city or town omdd
MuOdint Aepartmmt
city or town: P # ❑Licenun;Board
❑Selectmen's OlIIce
.h..k if lmmediafe response is required (3Health Department
contact person:
Phoneth. — ❑Other_--,
(mvj d 9195 PIA)
Information and Instructions
to provide workers' compensation for their
Massachusetts General Laws chapter 152 section 25 requires all employersperson in the service of another under any comrac:
employees. As quoted from the"law",an employee is defined as every
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
1 employees. However the owner of a
individual,partnership,association or other legal entity employing emP Y e of
trustee of an n P of the dwelling hoes
use having not more than three apartments and who resides therein,or the occupant dwelling house another who employs Persons to do maintenance,construction an repair work an such dwelling house or on the grounds or
bull app 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
applicant who has
buildings in the comet
of a license or permit to operate a business or to construct gs Additionally,neither the
not produced acceptable evidence of compliance with the insurance coverage required. of public work until
commonwealth nor any of its political subdivisions shall eater into o f�chapter have been presented to the connac
acceptable evidence of compliance with the insurance regiiirerneats
authority. MW � �/„
Applicants
Please fill in the workers' compensation affidavit comp lady,by checking the.box and
that applies to your site
lying company names,address and Phone numbers along with a certificate of insurance as all affidavits maybe
supp m cut a f ��fbr o f fie• Also be sure to sign and
submitted to the Dep or to that the application for the permit or license is
date the affidavit. The affidavit should be returned to the�Sliotild you have � the'law„or if you
being requested,not the Department of Industrial Accidents•
are required to obtain a wormers' comPensatiaa policy,Please call the Department at the number listed below.
City or Towns
1 The D �artment has provided a space at the bottom of the
Please be sure that the affidavit is complete and primed legibly. eP the applicant. Please
affidavit for you to fill out in the event the Office of Investigations"has to contact you regarding
cease number which will be used as a reference number. The affidavits may be retuned t"
be sure to fill in the permii/Ii have been,made.
the Department by mail or FAX unless other arrangements
The Office of Investigati ons would like to thank you in advance for you cooperation and should you have any questions-
please do not hesitate to give us a ca.
The Department's address,telephone and fax numbe
r
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Invesduadons
600 Washington street
Boston;Ma. 02111
fax#: (617)727-7749
phone#: (617) 7274900 ext. 406, 409 or 375
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EON�t 'p'p -ram
BOARD OF WILDING—RE .ULATIONS
Lieens* GONSTRUCTI,ON SUPERVISOR
Numbers C5ti 036701 {
1
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Ezpir s OW�Ql -2 Tr.no: 24705
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Restficted To-- G.O,
JAIIAES L CAZEAUI�T' Ai,` I
�,
,4193C LAMSH'ELL COS'
,: COTUIT MA 02635 Administrator
RE-ROOFING/RESIDING (COMMERCIAL)
❑ If located in OKH or Hya is Historic District- Certificate of Appropriateness
--� required unless same color/same materials specified on application
Map/parcel_number
Approval�Sign-offs from:
Tax Collector
Treasurer
#of squares of shingles or square footage of roof or sidewall to be shingled/sided
® Specify stripping old shingles or going over old roof.
If going over
❑how many roof layers existing now
❑what size are rafters? What is span?
[]� Owner's name & address
Builders Information
Signature
i
Workman's Comp. Form
❑ No license is required for commercial work.
Fee
q-forms:permits 1
rev. 1115101