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HomeMy WebLinkAbout0033 HAMPSHIRE AVENUE 33 re- InJL. 1 .. - Map Parcel ® - Permit#- _�� 3 Via° 'f House# `�` Date Issu Board of Health(3rd floor)(8:15 =9:30/1:00- )P Fee P, Conservation Office(4th floor)(8:30- 9:30/1:00-'2:00) Planning Dept.(1st floor/School Admin.Bldg.) DIME Definitive.Plan Approved by Planning Board BARNBTABLE, ft TOWN OYBARNSTABLE` Building Permit Appli ation ' Project Street Address �^ r Village �Qc ✓` /�.S J , Owner � ���� �/� Address ��� +e Telephone 'Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family a Two Family ❑ Multi-Family units) Age of Existing Struct e �r Historic House ❑Yes 3- o On Old King's Highway ❑Yes 340/ Basement Type: Full ❑Crawl ❑/WalkoAut ❑Other Basement Finished Area(sq.ft.) ✓ Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing_� New Half: Existing New No.of Bedrooms: Existing a New Total Room Count(not including baps): Existing New First Floor Room Count Heat Type and Fuel: ❑,Gas Oil ❑Electric ❑Other Central Air ❑Yes o Fireplaces: Existing oZNew Existing wood/coal stove es ❑No Garage: �Attached. Deted(size) Other Detached Structures: ❑Pool(size) (size)—Gz4tc6m ( / ��hed size) ❑None size) ❑Other(size) Zoning Board of Appeals Authorization' ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �0�7� BUILDING PERMIT DENIED FOR THE FO WING REASON(S) s nA FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED • F 1 11 MAP/PARCEL NO. ADDRESS 1 ; VILLAGE a +fE OWNER rz 4 $ ► - �; Z l ! r DATE OF'INSPECTION: FOUNDATION FRAME 3 ,'INSULATION FIREPLACE ' '�� 1 � ,� � �- _ _ ' •- - ' E , ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH _ FINAL : FINAL - _ • •, _ 4 t GAS: .% ROUGH _ J FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r t The Town of Barnstable • ,Aatrs,.nai.� . 9� KAM �e� Department of Health Safety and Environmental Services ATE1659. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission: For office use only Permit no. 1 r r Date AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION r 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: w1PBf� Est.Cost s t J Address of Work: Owner's Name � ��'� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied r _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: Date Contractor Name Registration No. OR ZI-7 L Date Owners Name 1 ,THE COMMONWEALTH OF SSA T A t .ua.4.?'I� t`k" r�t�' Board' Uldtng Regulation," n 'O--.Ashburton Place �toom 130E Islta O11 .�, `Boston,Massachusetts 02108 Appltcahon for rnewal of Regtstra on s"s a Home Ln' covemen Contractor or ubcon ,'+ RiV1GL Chapter 142A,'f80 CMR Ro , T ire a >xrr { � •+ rt �.�hY,y^f- � "+d-�2'+ '��.k� �� � �-: ,y 4i�gt tt � PLEASE READ CARE .q' Y f'y 6 r Z 7d� x r R�Px i i g a.i �r'rc�,•. yt v� n>Crime.�3;a� Je } $wF! 04 ,��� P�r"r:•`�.Y:d lt',a;,a«� 4 _ .,.d�n� � �x " � :. Jr✓,. �'N�`ii:t. � v��. ri1 B mess Name Y. Prmt the name m which the appltcant is condiicttn '„•r li'M r Tt,4ct5'�.,,n hY{ 1 � 1:, 'P'z." -'G", t`6 $r n - '•� ` �. Y �BL11.11c©i"; h �. i>' 2 IVtatlmg Address � � r m , �,, jQ�h ahon@!Number y _ 4 4 4 j'M1�19:f .3 CI �+e�'c✓"'St8tC �' � 1 "4 a r. 6� �.�x 4. ,Streit Address(If different ,'any t, yizKt ;Prmt street and Number,a Qox"is ti13 f Applicant type- drviduiil '`DBA Patttteishtp o bhc it on ' r/� A � "� "?��� �'w-t'4:�=� � ra.?'Sw" y o-}Js+•��ti YFY VtIed One �e .� �a QtI NaWYRi a cdy or!Own _ _ 5 -�'••� 4. 'M+.x+z v... e ' a; 8 Have you regtstereal�revtous y under this law?: -�'' ntL xM i f 1 ..of"Y ri r +}�x _• � . Its under what? 4?dame _ of pr ���'' a' •�` - z "IS .Title of individuai nstble forHome Improvement 1. ): ee */ PERSONAL OR BUSINESS CHECKS WILL BE ACCEPTED UNLESS THEY ARE CERTIFIED ,<t y a tiKrQQ>"t{ t'iF�> .5 a , _ v Pursuant to Massachusetts General Laws Chapter 62C§49A i'certify under the penalties,of r ury that I, r =Y s r r"i-re. .'aor,� i-,t �--.` �,x.x'0'b`i ios r i .. to my t knowledge and belief ave filgeyd�sll fate turns and aid.al[state taxes requir sinner law: RY"',; .. .a-,7t ,. EM... "P"p: _f store o applicant or applicant s represen ve �, .�F 1#nF r Title held with applicant a , A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration f The Commonwealth o.f Massachusetts 2j Department of Industrial Accidents Office allalvestigatfalls `- 600 Washington Street Boston,Mass. 02111 Workers'Com ensation Insurance Affidavit ���/ r name: w location: r � / 7� city ' � � ✓ hone# I am a heifieowner performing all work myself. I am a sole ro rietor and have no one working in any capacity %/% % %%% %/%//////%%%%O%///%%/%%%/%%%%%%/%%%%%%%/%�/%/�%%/�%%%%%%//.'%;' ❑ I am an employer providing workers compensation for my employees working on this job. com anv name: address• city phone#- insurance co. policV# ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors Iisted below who have the following workers' compensation polices: company name- address- phone city hone#- insurnnce co. . company name: address: city- phone#- oiicv# $... .. Insurance co. %%/%%%%�%%%% / %%%%/ //G/%/// %/ // // Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a ilne of 3100.00 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 verincadon. I do herebv certify under t e"pains d penalties of perju that the in rmation provided above is true an correct Signature),,, / Date Print name Phone# E y do not write in this area to be completed by city or town oMclal permittUcense# QBuliding Depat�anent ❑Licensing Boa�d mediate response is required ❑Selectmen's OMce❑Health Department: phone#; ❑Other��.:. . (tevfsm 9,95 PJAI