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HomeMy WebLinkAbout0016 FIFTH AVENUE (HYANNIS) �OF114E tay� Town of Barnstable *Permit# Fxpires 6 months from issue date • HaaxsTtiat.E, Regulatory Services Fee as d • KAMThomas F.Geiler,Director �EDMP,,a Building Division ,�` Tom Perry, Building Commissioner "�� 5� 200 Main Street, Hyannis,MA 02601 � � '�' Office: 508-862-4038 Jul 3 zw 01-1- . Fax: 508-790-6230 � T EXPRESS PERMIT APPLICATION - RESIDENTIAL O1 TPf aARNS Not Valid without Red X-Press Imprint ASLEF Map/parcel Number z 2z Property f(� �,�- S P p rty Address esidential ° Value of Work Owner's Name&Address 22zz%(� Contractor's Name AOn/ Telephone Numbers© Home Improvement Contractor License#(if applicable) Z l Cpnstruction Supervisor's License#(if applicable) ❑Workmn's C ensation Insurance Che ne:sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side rReplacement Windows. U-Value ° (maximum.44) ❑ Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' b Parcel P@r it# �'oi<�� O BAR; ''3TAPZ� q Health Division / G (c�v Date Issued Conservation Division e�l f3 U�,� MAY 23 � 9411cation Fee 00 J dG Tax Collector 1401, / Permit Fee 30/ Treasurer SEPT C SY TEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board VM TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN RED°1`1('"r10' Project Street Address �- Village -�����,, Owner la"n Address 4�/e Telephone Permit Request _SC,iZ perUc Square feet: 1st floor: existing proposedlku 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation / ram.a U 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 a o `� a-7 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full 6Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing z:g 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 ❑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 // n BUILDER INFORMATION Name �.�-Sl'C�u�5'��z',yay,�fi��� t Telephone Number <ca g - S 4 Address 9� �y ,-7'7 10V�e so,-" a­� -e License# n V K 0 sS c�7 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /�z�iZCyc�e:NC SIGNATUR DATE �I� FOR OFFICIAL USE ONLY PERMIT NO. F DATE ISSUED MAP/PARCEL NO. ADDRESS ' VILLAGE r OWNER DATE OF INSPECTION: 1 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL sz PLUMBING: ROUGH) : FINAL r. GAS: ROUGH: -7. FINAL FINAL BUILDING - _ DATE CLOSED,OUT, ASSOCIATION PLAN-NO. s f r f 1 RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= _ x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>12.0 sq.f% >120 sf-500 sf S 35.00 >500 sf-750 sf 50.00 ' >150 sf- 1000 sf 75.00 >1000 sf- 1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$961sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool . .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost °FIME ra Town of Barnstable Regulatory Services 9BA B '$ Thomas F.Geiler,Director .i639 ♦0 i0ren 39 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: S'C/2_e1,7-I.2 Estimated Cost O a 6 Address of Work: Owner's Name: Date of Application: m I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: o D Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav The Commonwealth of Massachusetts n^ = De artment of Industrial Accidents ' -= • Office ofinvestigations . . 600 Washington Street Boston,Mass. 02111 Workers' Comipensation Insurance AMdavit name: location: %O t AV,I c- city ;f�'T 11,21y'?S S 0 2-7 phone# ❑ I am a homeowner performing all work myself. �I am a sole r rietor and have no one worki>1 in an ca achy ❑ I am an employer.providing workers' compensation for my employees.working.on this.job..:................• .• ._••.••. ..• .. . • ..: ..::. ..:.: c1ty. "hie: rsitira�t ❑ I ain a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com}nano n ETit1 C3S 5 '. ` 2`'''>'` <> ` '' ' Y ` 2 ; ; ` � ? < %;>': < '<<' <! y?'` ± ;? f > ` ; f jj S:a:;:y:::•: •• :}Y� '>:f:!h;::<!:;.'•;:;`5::>:;:i;:;:;:;:�i: j`�i4i':?:Y;:;:;L;y:.;:<;:::ii:;i:::;:}i'��$:'":•:''':�:4iiL'.}'i;:;} ::isisi iiii: i: ^';:::•i::ii: •i:?}iiii:v:,.•.!i:.i}ii::::•i:4::C:i::.....i...;:. .... •>L'::�::::::`::::;:::::;::`:.:;;:: ::: ::;i:::;:S::i;::;::%Y:: %%:::<::::.::i::ii::::':ii':G;;::::::::%:::Y; •::••:r.::.:::.:::r •::a: 2:s':: .... <`;t. ` :'.....: r:?::`•s<: `: <":Y'<::': '2'3;_>;_3?:::<L? ::::::.?%::::` :; ::::•,`.::?: ::: s:: '` '}' :....................:.....::..:......... :.::....:.::.. ...........:. X. .::::::.::::::.: :: •..�ST1:=:11 DIC': ?'� �:': fi :%:.... <Y' ::::'• :: :� >3:: 2G 12 :? 9 ? �3 2 2 %;%:;�`Y<: k?:?` �: tiG7: i.. ..... A.0 ::.:.:. ::.::;::;:::.:.::::.::::::.:::::.:::::.>...::::::::.::.:::X. ::..::::...:...:.:.::.:;.;:.;::::.;:.:;:::::::..:. .:::::::::..::. ::'>:::':i`:::::'::;{`;"::i:: :::::::'.......... : : <%;:5::: G:`i� ` ...... aFltl2`L`SS ..: .:...... :.....:::•::•:........ ::...... z h > ':»> lnsnranre..co:.................... Fafiu re to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify undpr the and penalties of perjury that the information provided above is true and correct Signa a --^ Date g Lbn� l S O�_ Print name Phone# '— - 0 ------------- official use only do not write in this area to be completed by city or town official City or town: permit/license# (jBuilding Department low— ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _ �Heslth Depar�nent contact person• phone#; � ❑Other O vind 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 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. The affidavits may be returned the 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 questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Oltice of Iniesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 a I t 1 k t r kv � I t / I o 0 u 5 f a Ajk Gv 1'i2dL O v o v J � O ui � F -- -e f J f - I � �'' J/e fpryz�,wnruec�l�l a�. 1�ua.�aclu�a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 051890 � Birthdate: 01/18/1960 Expires:01/18/2003 Tr.no: 9044 I Restricted To: 00 LAWRENCE D PITTSLEY _ j 508.MIDDLEBORO AVE EAST TAUNTON MA 02718 Administrator mum Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR c=' g Re istration: 110116 • 1 Expiration: 10/06/2002 Type: DBA EAST COAST RENOVATIONS LAWRENCE PITTSLEY 908 MIDDLEBORO AVE E.TAUNTON,MA 02718 :administrator u-® PERYY D—U N ES AAY XdPY BE *ftCCU R^-TE STANDARD LEGEND ..... I __- NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY ^•��^r EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY t v-V-v v EDGE OF CONIFEROUS TREES 1 1 MARSH AREA I , ' — -•— EDGE OF WATER -- DIRT ROAD 1, DRIVEWAY MAP\ � � PARKING LOT PAVED ROAD • ..... •_ ---. .\ AD DRAINAGE DITCH \\ ` ----- PATH/TRAIL PARCEL UNE MA 6 `t7 MAP# .1 U. 21 < PARCEL NUMBER t ` #'NO —HOUSE NUMBER 2 FOOT CONTOUR UNE --4�-- 10 FOOT CONTOUR LINE Elevation based on NGVD24 i `• a.a SPOT ELEVATION 1 cx» STONE WAIL 1 i -X—X- FENCE RETAININGWALL -;-;-;-;- RAILROAD TRACK - ' STONE JI M SWIMMING POOL t DECK i PORCH/ BUILDING/STRUCTURE H++=L DOCK/PIER HYDRANT IO VALVE o MANHOLE +' o POST OP° RAG POLE T O W N O F B A R N S T A B L E 6 E O O R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N I T .p SIGN ® STORM GRAIN p PRINTED SM:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are Only graphic reprewfutiora DATA SOURCES:Pianimel to(man-made features)were interpreted bom 199S aerial photographs by The lames n TOWER ' --- 1"=100'scale map and may NOT moat of property boundaries They are not true locations and W.Sevmll Comparry.Topography and vegetation sere interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE w ` 0 10 _-20 National Map Amuracy Standards at this do not represent actual relationships to physical objects Corporation.Plonimetriq topography,and vegetation were mapped to meet National Map Accuracy Standards : t INCH=20 FEET* enlarged style. on the map. of o smle of 1"=10D'.Parcel lines were digitized from FY2002 Town of Barnstable Assessors tax maps -0 LIGHT POLE O EIECfRiC BOX f:ldgnlconservation.dgn 05/13/02 11:50:16 AM