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Home My WebLink About0046 GROUSE LANE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 Parcel s �• '� Permit# .SJ FS 7 Health Division Date Issued i �15-M Conservation'Division F Fee Tax Collector *° ` Treasurer 1 � 2 L� Planning Dept. q. Date Definitive Plan Approved by.Planning Historic-OKH Preservation/Hyannis Project Street Address r G �✓e ys e r Q Village Owner le P. Address Telephone l 3 2—� ' Permit Request e et,� aS�i ivy' f S 2_< 3 I S�`, it ate{ �;� e- I/&C, Square feet: 1st floor: existing proposed 2nd floor: existing*E proposed Total new Estimated Project Cost ° Zoning:District Flood Plain - Groundwater Overlay Construction Type Lot Size Grandfath-ered: ❑Yes ❑No If yes, attach supporting`documentation. Dwelling.Type: Single Family a--` Two Family ❑ Multi-Family(#units) , Age of Existing Structure Z Historic House: ❑Yes �2 �'On Old King's Highway: ❑Yes ®'No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Areas .ft. Basement,Unfinished Areas .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: 0 Gas ❑Oil ❑Electric`- 0 Other Central Air: ❑Yes ❑No Fireplaces: Existing r. New Existing wood/coal stove: ❑Yes ❑No s. Detached garage:❑existing, ❑new 'size Pool❑existing ❑new size Barn:❑existing* ❑new size Attached garage:❑existing ❑new size 'R Shed:❑existing O new size' Other: Zoning'Board of Appeals Authorization ❑ ,Appeal# 'Recorded O Commercial ❑Yes ❑No If yes,site plan'review# Current Use Proposed Use - BUILDER INFORMATION Name ASP(( >q r` �5�� Telephone Number 36 2 — 617 Z7 Address 2 L yl�J I r pld�` License# C_ 5 001 Home Improvement Contractor# Worker's Compensation# �� Z7 6Y3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY PERMIT NO. _ r c DATE ISSUED MAP%PARCEL NO. }, ... , i • ) n ~ADDRESS - VILLAGE' OWNERt DATE OF INSPECTION: « • . . µ? y t. , a ` FOUNDATION FRAME INSULATION « r j• , t. j FIREPLACE ELECTRICAL: " ROUGH FINAL PLUMBING: ROUGH FINAL- FINAL, •r -• _ i ' GAS: 'ROUGH - - r t. • FINAL BUILDING 1 DATE CLOSED OUT s ASSOCIATION PLAN NO. .. i T_% The Town of Barnstable 9 �m� Department of Health Safety and Environmental Services Eo ' Building Division 367 Main Street,Hyannis MA 02601 - f Office: 508-8624038 , Ralph Crosser 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: e- o'k S` Estimated Cost L O v m l Address of Work: ,/-/t/, 622 f c_ (u�t-- Owner's Name: Z_'1_y101_c LI Date of Application: 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 00wner 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. 11 Z ( �l� -eff _(_1c,,62w 2-F Date Contractor Name Registration No. OR Date Owner's Name q :fortns:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents — - OflICCOf/OYCSU�SlIOOS 600 Washington Street " Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: 1XvSS�Y r r�SaN locations city phone# 3e� 2 " q 7 7 7 ❑ I am a homeowner performing all work myself. ❑ I am a sole nprietor and have no one wow in act ❑ I am an employer providing workers'compensation for my employees working on this job. SA�Q Y ireldreS r;:>>: uaaran i oil" I am a sole propriet ,general contracthomeowner(circle one)and have hired the contractaris listed below who have ` the following workers'compensation polices: �:;;::::: i...... ;S; :::::i:;:;2;::::::? S:ii::<<.......... ::iiix;iii:::i:::f S;::;`i: :::;::::i::::::::•?:{:•:r:-:�:.::{{.x•?:•?:a:4r:•::.::: i f......:;::%:+?::Y:2?:iris: :U.j i?i::::::>::.:T:4ii:::::::::. �::'.::::::::::i)i: �'•i ii: /• ............:.:..:.................................................:::::::...::.....::...............................:::..n:::n w:....................... comoamf n > f .................,:::.::...:.....:: ...:::::.::::::.:... .. .address.... ,...... ..................:::.:.... ... .:..;::.::::::.:.. ��r� K . .....:...:.:.... f.,.::{::.......... ...K....... {4'fv:•>?:•i:4iriiiii::�ii:4:i'rin.. ... •:.•••• ...•. .............• .v.v::::w.....::::n.::vi•:.:::•r•?:•?:^:^:{•:{•`.�i::i:'?•'.::is : ...... :::::....urancL ... ...:::f1D-•::::R?t�.r•.;_:{iiiiiii`iii�: ............................... ..: .v v ::::::::::::n ..... v... wv.....•.......v..v:•'r'i v:..:v:::::::::.•»:•>i:4:{yi....v::::::v:;{ .. .. v::::.•}} 6. ........ ....i....:i:•::. v }�}lii.....• ...,.... ..v.•::•..... ••. :?::{v:............t...........::{•:4::•?}%•?:{+.•i:+riT?: ::? :i f:'i;:-• . xr�r > < < =>»< +r ,,. ;- .... � > address. ..... :. . . X. ... ...: :::::::•. .............................................. ............ ..........,..;.. .............::........r.•:r??x.............. ................................ Ax �:ifis� :; ::$:�:�:; � :�•r.S:: :�r��$:. :�:�:: i:.:.:'•'3>::{.;::.:i.'�:i.r:.i?`<. :':::.iff :�i:%':�:�?:�ffiii::;'+.'<?:f: nSQrBnC Failure to secure coverage as required order section iia of MGL 152 an lead to the imposition of aimimd penalties of a fine Up to s1,S00.00 and/or one years'hnprisomnent as wen as civa penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against nm I understand fiat a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verifiation. I do hereby certi the pawns mid penalties ofpajwy that the informa don provided above is trace mid correct Signature Print name �SS�<< Gi �5a�� Phone# 3Gz—617�7 official Use only do not write in this area to be completed by city or town official city or town: pumit/llcaue# LCO3 �g Depa� Mcensing Board ❑checkif immediate response is required Sdectu m's OnceHealth Depatfmmtcontact Person: pha®e#; Otiret keina9195prn) 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 con== 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 c: tnastee 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 renewai 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 Investigatiions 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 redaned io 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. i The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents emce of Imtesugallons 600 Washington Street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 •,Z -_ ., . _. _ - ``�� Vi aninzaiuuea,�i a�✓��ac�ivaelt DEPARTMENT OF PUBLIC SAFETY CONSTRU 11ON`=SUPERVISOR LICENSE Nyber Expires: RestrlctedSTo Be RUSSEII A 6I8,SON JR its V'yl✓PO BOX 118 BARNSTABLE, MA 01630 :y.! n9.� .r- «::,-.•�rnr'.-..., :r r fft 'sF•"'c ' 'E� i :. •3. ' *SrsT.` vr. .. �ydszY e e,. _. � ,.an rF;;r' ,r „`� t'� ir'�'�v��k"�ks�y�,•��...�sx �' � �:�`�"4�� ,�r''t��r��4 t�? � � e�'4 r � .. HOME IMPROVEMENT CONTRACTORS REGIS1yRATIONj � � � r Board of _Building Regulatioris �and 'Standa'rds �� , g , .4} w 3 t ik, }` One Ashburton Place Room •w=2301`�;3 u 3 9ag �� c `Boston Massachusetts 02108 � fit. • a,,. a „� a ,r rx�..M 2, .,y`> sy .. �` .µ&•v`�,.'9 Jx y s'sn,-2`v1.r•y...i ✓yr'•c+i'zw• r�.) ^3-1 t ,y+ yUG �dh:+(�. _ s�. °` a r- } .. HOME` IMPROVEMENT .CONTRACTOR t!t �� L- �x 3� �£ � � ---- A Registration 104428 ay Expirataori 07%14f40r�� ,�" Type —��INDIVIDUAL"°� ffr �,�`�� ,�,v,, •' �v ��,��-c,//�� l�x�.�tl,�� n �.,rr r .., "f '� $r`.7 °`",.f' <r t x __.ems\ '•yx '- YP � 6" ' HOME IMPROVEMENT CONTRACTOR r N s § Registration Y 104428 �a ,:. type INDIVIDUAL RUSSELL A 7JR GIBSON y x 'xGt m . �,F3� axw• .Y.. . Russell A Gibson Jr {h tt1 � �� u � " ' ^� �� EXpiration 07/14/00 7 y -.M' ,r.�x,'#o ty, a. ,.`� �t `F=^�,h . 32 MID PINE >��' � .� �•� �'�k �� F �r��-- �• ,� ��.��1 �� x ;�,.�� _ k s YARMOUTHPORT MA 026755 , Y RUSSELL A. 6IBSON,JR 'b-+ aKrewSS` ,'n' ,'„^ /y1 b` - zrc . , } x r� �s° r o r Russell A Gibson, Jr. ... ID PINE 4 ADMINISTRATOR YARMOUTHPORT MA 02675 . ._ .. � : true:;, �...t,. _I ,;' •c a �' - ._ yof7HETo�° TOWN OF BARNSTABLE EARNST"LE. 639- 0 M BUILDING INSPECTOR ............. .................................... APPLICATION FOR PERMIT TO . .. ...... ... ...7..e..... .... .. TYPE OF CONSTRUCTION ............. ...... .................................................. ................. ..........ig..7/ TO THE INSPECTOR OF BUILDINGS: The'undersigned hereby applies or a permit according to the following information: Location .....6..1 ....... .. ........... ./' ....... .. ........'&444 /e� Gi ProposedUse .........k.72.61ti. . .............................................................................................................................. ZoningDistrict .........................................................................Fire District .................................................................... ..... Nome of Owner .. .. .. .. .... ....... .... . .............Address ......... ....... Name of Builder ..............e'*1................. ..........................Address ........... ....1.. ................ Nome of Architect Address ... .......... Number of Rooms .................... .................................Foundation ......... �o Exterior ............. . ..... .....................................Roofing .................... ..... ...... . . .................................. Floors ..........0 ... ...................................................Interior .... Heating ....... .....Plumbing ....... ... .. ....... ................. Fireplace ............ ....................................................Approximate Cost ........... .................................. ....... Difinitivie Plan Approved by Planning Board --------------------------------19--------- Diagram of Lot and Building with Dimensions LLI U- co < M 0 < I -— < M < a- U- 0 e- o LL'lij 0 - 1'- /00 0 (U/') 7Z 0 U) 0 =) > < 0 --1 X CL F- n- LU Ld LU < < F F LIT V) U) J.—W k Cr Uj F < I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction, Name . / ' Regal Construction " ' DEC � m�� 3 1 1971 11415 one atoz~�* ' `.No ----�—. Pern�k6x ....................................- —` � � / single fumilyc�Te1ling —.--..—.-----.---..---.-.—...--.' Grouse lane Location_ ............................... ................................ . . ' , --��..�^--..�---------- ' 1 ' Regal Con otrootion Owner ----.'.--,.--.,----^.—~''— - frame Type of Construction -------------- ----'—'^--------^^—~--------'' Plot �� .. . . ^ ^—`---'---'' ----------'' 1 � � October 8 71 Permit Granted Gronte6 ........................................ �� r� Oo�e of In -^��—=_---..lQ^ x Dote Completed ......................................l9 \ ~�� PERMIT REFUSED �' � � ^,?� --.—.,_--..—..---.------.. lA ' ---------'^^^~^~^—~--.—.—.—.--' ' \ '...~~.~..-.^...----.—.......--~.—.~—. ' �^.^....—.—...--........--.....,,..,.—.—, .,.---.~.---.--..--~.--...—..--...— �—.. lQ Approved� � _,-----------. ^= � --''r' ---------~----'^''~—^--` / ^---------~^---------'^^^~^^^' � �