HomeMy WebLinkAbout0059 ISALENE ROAD
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map � (_Parcel `TOWN OF BA s�P S Permit#
TABLE Health Division Date Issued S/"P c 7-0Conservation Division
�' 2004 MAY -7 PM 3: Mpplication Fee — C
Tax Collector f Permit Fee
Treasurer � ' OIVISION
Planning Dept.D�YI
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address`� �\
e
Village t
Owner C'_� �C Address � �_S \� r� �T
Telephone
Permit Request 1k41ZA U\\A C�
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total newAV4
Zoning District Flood Plain Groundwater Overlay
Project Valuation ' \ on Construction Type W ��„ps MCA
Lot Size 3c>a Grandfathered: ` Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family "> Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ANo. On Old King's Highway: ❑Yes �No
Basement Type: *Full ❑Crawl Walkout ❑Other
Basement Finished Area(sq.ft.) i 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 S, new_ First Floor Room Count �3
Heat Type and Fuel: AGas ❑Oil ❑ Electric ❑Other
Central Air: Yes O No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ANo
Detached garage:O existing ❑new sizeli- � Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size JAL Shed:)kexisting ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ',No If yes, sit Ian review#
Current Use �� �,An ol*q,1 Proposed Use
BUILDER INFORMATION
Name S Telephone Number
Address l; License# O e C—')
e Q v IMHome Improvement Contractor# Vba. V A
Worker's Compensation# \
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE 0 JV
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A FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
c MAP/PARCEL-NO. _
H ADDRESS s _' VILLAGE
t OWNER
* .
DATE OF INSPECTION:
FOUNDATION
j FRAME
INSULATION
4 FIREPLACE '
ELECTRICAL: ROUGH FINAL'
PLUMBING: ROUGH FINAL \
GAS: ROUGH FINAL'"
t
FINAL BUILDING
� -
DATES CLOSED OUT
ASSyOCIATION PLAN NO. -
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Wox ers9 Coin ensation,Usurance Affidavit-GeneralBusineslses
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work site iocatlolt d have no one '1$asiutess Typo. [�Retasl❑
D I ain•a sole proprietor an (]pace 0 Sare (including REal Estaie,Autos etc.)
Vvorking in anjr capacity CDAI
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/// cbm�ensatio for my employees wor]an on this
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insiiraliG 'bl
^^r osition of crlmfnallsoueYties of a tine up to$1,500,00 anh/or
Failure to secure coverage I:s required enalties inder of of of a TO 152 can lead to the imp
ent o well p the form of a STOP WORK ORDKR and a fine of�100.00 a day against me• I understand that
one years imprison c Offlee f Investigations of the DTAfor coverage verification
copy of this statement maybe fo .' £de .
i under e i s of perjury that the information provided above is fr and Correct
I do hereby Date o
Si�pature Phone# IS'
print name
official use only do not write in this area to be completed by city or town amciai
' permit/iicense# [3Buildingpepartment
❑Licensing Board
city or towns oseleetmen's Office
D.,heekif immediate response is required []Health Department
[]Other.
phone#;
contact person:
(reviled Sept 2003)
• inform A!on and Xiastructions• '.
10 ere to rovi$c•workers' c ens lion f-ofthear•.
ZvLassachusett,General L'aws ellf pter 152 section 25 requires all emp y p 01nP ./�:,
employees: As qu0fed from the `law,, an employee is.defied as every person in the service of another under anycontract
of hire''expreas or it ked; oral or written
arhaers , association, corporation or other legal entity, or any fwo or rngre of
An employer is defined as an in p hip
the foregoing engaSed'in a�joint enferprise,and including the legal re entatives of a deceased,employez, or the receiver or
pres
artnershi association or.other legal entity, employing tmployees. 'However•the owner of a
trustee of an individual,p • ship
dwelling house ham than three apartments and-who resides therein, or the occupant b�the dwelling house bf
another who•empl'. s persblis to do maintenance, construction or repair work on such welling liouse.ctr on the grounds or
•, , ♦. . hm mployer,hlb - . p . d ir e
anttheretos
building aPren ,.
. .. :
IyIGL chapter.152 section 25 also'sfates that'every state or Iacal hcensing•ageney shall idy bld the fssuaneo dr renewaI
Of a license or permit to operate a business or to construct buildings in the.con nnonwealth for any applicant who has
not produced acceptable evidence of commpliance with#h �Ce o tracgfor the*erforn�nceMldftiof public workunfi�f'
cotanonwbalthnor.any.of its political subdivisions shall en . , y P
ce of compliance with t�e insurance xbquirements of this chapter have begin presented to the contracting
acceptable eYiden •.
authority.
% . ,
Applicants
Please �erk�rs' eaensahEort a€fidavit cornplctely,by checking the box that applies to your situation.,Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted
to the Department'of industrial Aceidents•for confi=tion of insurance coverage. Also'be sure to sign and date the
affidavit. The affidavit should be returnedto the city or town that the application for the permit or license is being
not the pepartment 6fr dustrial A.ceideu#s. Should you have any questions regardii�iethe'qaw"or if you are
requested,
fain a•worlcerC rcornpensationppliGy,please call the Depaz trnent at the number listed;�elow.
required to 0) ,
City or Towns
please be sure that the affidavit's
ebxnplete,and printed legibly. The Department has provided a space at the bottom of the
affi-dayit for you to fiti out in-the event the Office of Investigations has to contact you xegardu�g the applicant Please
b e sure to fil7;iri the permitAicens e:number.which will be
used as a reference number.
The.affidavits maybe xetuzned tq
gements have been made,• `
theAepartmmt V. or FAX unless othez:arian ..
The Office of Investigations would like to tl a y'ou in advance for you cooperation and sliould you have any questions,
a
hate to us call.
please do nothes S�
The Aepartmeut's address,telephone and:fax number. . ,
The Commonwealth Of Massachusetts
Department-of Industrial Accidents
- r Bth�e of il�esens
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
E r Town. of Barnstable
Hof �sy
o� regulatory Services
asT�t� ; Thomas F.Geiler,Director
� s63 Building Division
jOrFD MA't k .
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax: 508-790-6230
Office: 508-862-4038
permit no.
Date
AF=A.VI`r
HOME MERNT TO ERMIT CATIONw
SUP
MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,ez occu ied Ion,
improvement,removaall demon bu not moreuction of an addition to any than four dwelling units or ore-exisstruct�which are adjacent to
bunding containing
such residence or building be done by registered contractors,with certain exceptions,along with o er
requirements-
Type of Work. T_o � Estimated Cost
Address
of
r
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reasons):
[]Work excluded by law
[]Job Under$1,000 .
[]Building not owner-occupied
flOwner pulling own permit
Notice is hereby given that: RED
OWNERS PULLING THEIR OWN E ME IMpROYEMENT WORKDR DEALING WIT11 UNREGO NOT�'�
CONTRACTORS FOR APPLICABL
ACCESS TO THE ARBITRATION PROGRAM
OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER?EN F PERJURY
Thereby apP y 1 Poi a permit as the a e owner:
Contractor Name RegistrationNo.
Date
Owner's Name
°F SHE Toyer Town of Barnstable
Regulatory Services
$ rr 4BM Thomas F.Geiler,Director
9�p 1639' a`�� Building Division
lfD MP�I
Tom Perry, Building Commissioner
200 Main Street, I-1yannis,MA 02601
www.town.barnstable.ma.us
Fax: 508-790-6230
Office: 508-862-4038
property Owner Must
Complete and Sign This Section
If Using A Builder
he subject
I, , as Owner of t )ect property
�e. to act on my behalf,
hereby authorize
in all matters relative to work authorized by this bull ' rmit application for:
(Address of Job)
Sig
f Own r Da
Print Name
Q:FORM S:OWNER UMIS S ION
I BOARD OF BUIIDIN.G /2r�xcclzc�Qeka
! License NST� . REGlJ,1-ATIONS RUCTION SUPERVISOR Numtier<O
035037
' BI' e �F7
0 r�.
�c9fl06
I Rey ` �« Tr.no: 13079
DEAN F }
S"TANLEX ✓
359 CAPTAIN LIJAFi
j CENTERVtILE MA 0 i cvD�
�� &1 9� .
Board of Building Re
gulations
HOME and Standards
ENT
Registra�or} CONTRACTOR
32149
P►ration 1178/2004
DEAN Type {ndividual
AN F. STANLEI� ` E
DEAN STANLEY
359 CAPT.LIJAFj Rp
J CENT ERVILLE,MA 02632
Administrator
I