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Home My WebLink About0062 FOREST STREET �a a TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION Map yS' Parcel Permit# 7 72 Health Division Date Issued Conservation Division Feed y Tax Collector Treasurer ane ibil/d�q°l Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address f o2 ��`f7.r7. Village Owner ��rrSlU�l�r �iu�.� y Address _ArP Telephone 77/ S'-,f(F Permit Request Sr/�'i�' e k(S7lti rl PPcy e // `t �P S 4 zs le- z mac. Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Costt,3ZO,ov 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 umber 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 BUILDER INFORMATION Name 1,i Telephone Number 7el0,VJ'1V Address YA P` �� License# 0() /7y 71 _ iS wyw, 0/ Home Improvement Contractor# Worker's Compensation# W 3- a Pr P 7 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Phi SIGNATURE DATE /a��yZ�� i 1 � FOR OFFICIAL USE ONLY - PERMIT NO. 1 DATE ISSUED `9 MAP/PARCEL NO. e ADDRESS ,. VILLAGE <, OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION - 1 FIREPLACE s ELECTRICAL: ROUGH FINAL' ' a PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING, DATE CLOSED OUT ASSOCIATION PLAN NO. F w a , _ The Town of Barnstable Department of Health Safety and Environmental Services Eo Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissione: 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: Jf%/ A-S S't T>�✓e /6 Estimated Cost 22O U,e- Address of Work: (o a /Z P s7 ST w. :L&r �7 Owner's Name: 1!f�/I/Syo Date of Application:_�/9 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 MUROVEMENT 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. /D �7-y- Daie Contractor Name Registration No. r OR Date Owner's Name q:fomu:Affidav The Commonwealul of Massac lusens Department of Industrial Accidents �s � .�-_= � Olfrca nllnyestigauons � - ��: 600 Washington Street Boston,Mass 02111 davit �� W.��V�/��j /Sl1 nInsurance j�j��jj��jj�j�jj�////// icsnt rrrfarurtuasr.,..i. n // name: location city ,tl v hone it ❑ I am a Aomeowneiperforming all work myself. ❑ I am a sole aronrietor and have no one workin in aav ca achy I am an employer providing workers' compensation for my employees working on this job. comnnnv name: �r 11 y �. ��t 7 k�� U 1�?'�' , lS�r b I>P !/<v`3 P6 i3f�� Est_ city: 1-�a phone#: �'rQ•!/r�s/, r insurance co. /d w� nniicv# 4je. o2e,. p7 3 r ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the folloi%ing«•orkers' compensation polices: comoanv nsme• addrei!r Cjty: ohone#- insarnnce ca. camnanv name: ... ::. ..:............. address ci tN- .. phone#� ..: :<::• .:::,,::. ..:. .. ituarnnce co. ............. : Fallurr to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a Me up to S1.500.00 andlor one vears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Me of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Omce of Investigations of the DIA for coverage verification I do herehv certi &r the pains and penalties of perjury that the information provided above is true and correct Sigrunire � Dam Print nae # m ofticial use only do not write in this area to be completed by city or town offidal city or town: permit/license tt ❑Building Department Licensing Board ❑check if inunediate response is required ❑Selectmen's OMce ❑Health Department contact person: phone#; ❑Other�� ;mssec y-oS PJA1 ------------ Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the:- employees. As quoted from the "law", an employee is defined as every person in the service of another under anv co 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 the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recrz� 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 renew 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,neid=..the commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work =t1 acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the co=ac^ng 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 ins+ara cc 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 caU 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 camact you regarding the applica= Please be sure to fill in the permittlimnse number which will be used as a reference mamber. The affidavits may be renamed io the Department by mail or FAX unless other anangements 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 Office of imtesduallons 600 Washington street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 f 4. + 1 71. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR . x Y., Number:ZS 009975 Birthdate 08/13/1942 E 40vvs 0.8h3/2001 Tr.no: 4334 Restricted To:. 00 j. BILLY E CAUTHEN 86 BETH LN : HYANNIS, MA 02601 Administrator