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Home My WebLink About0004 LINDEN STREET NID cN F, o 1 Q C T H yofTMEro�° TOWN OF BARNSTABLE BARNSTABLE, M MASI ,639. M BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........e-� A1.ez.--2,fe.........Ae�-7 jl�......................................................... TYPE OF CONSTRUCTION ............ .......................................................... .............................. .................19.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...h.4...... ...... ........ -/00✓/X.....A .JV ......................................... ProposedUse .............Al. �.......................................................................................................................................... Zoning District ..............�7=............................... ........... Fire District ................ .......................................................... YA/61-- Name of Owner ......Address ... A&S y Name of Builder /�?A62—e-197^. . ....... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............... ...................................Foundation .............gole: .......................... Exlerior ........0��5-0Z,0�......%v� Y............Roofing ...... ........................................... Floors ......... ........... .................................Interior .................................................................................... Heating ........... ...................................................Plumbing ........... ...........1—....... . .......................... ? 00 ... ...... ............ Fireplace ............A��..................................................Approximate Cost .........i............ Definitive Plan Approved by Planning Board --------------------------------19--------- Diagram of Lot and Building with Dimensions AL OF BOARD OF SUBJECT TO APPR 7i SUBJ HEALTH / � , V , "S/4- 7 - . 0A1 71-11T 4tXf a 7—6 e 4 ;A� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name,;.. ........... ....... ..................................... � I��, . &�.ss —u=° / No I�g07 . Perm for encloseopen ..� -- ...................... - orch ��''��.......................................'..........................'' � 4- �brmmt ' ��h� ��...... � .--.. ---.--------.. ' _ - ------..��aru�rm'----.--------- 8�.mm I�`+� � | ��n -~~~ ��` �Owner --��---_. =______.. ��a�ma ^ � Type of Construction -------------- | ' ' ' | -------.---------------.---. ' - Plot ---................... Lot ................................ . ~ ' | . � . Permit Granted. -- ........ 73 ^ Date of |nspeoion ..... ' ......' ------..lq ' . . � -�r--�� ..x� . --------lv / � ! � � . . � ` ' | PERMITREFUSED ` ' lV ' |� -----'------^^—~------- / � . --------------------------. . .---.---------------------- � ----..--.-----.--..----.—.---, � ----.-----..~—..----...—.—.----. ' � � Approved ................................................ lg ^ � ---------------~~^--~--'---' ---------------------.--~—.- , } ' / ^ � � BapiERM14T Town of rnstable *Permit# ` 3 Expires 6 months from issue date APR 13 2006 Regulatory Services Fee Thomas F.Geiler,Director TOWN OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wit/tout Red X-Press Imprint .Map/parcel Number 310 UCH Piceperty Address 1-4 Residential Va1ue of Work/ 006 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Telephone Number S Contractor's Name � ��'��''''�' Home Improvement Contractor License#(if applicable) L " Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) �yg Re-roof(stripping old shingles) All construction debris will be taken to Itm6%J*ft ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement C ctors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth ofMassachusetts Department oflndustrial Accidents F Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu>3alber9 Applicant Information Please Print Legjbly Name (Buskess/organizationa&vidu4: Address: �,j �j'►� r� S LW City/State/Zip:Cew\- \ NIA 0DL6 32 Phone#:s,17bco- ?'71—T 9 Are you an employer? Check the'appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.06 I am a sole proprietor or partner- listed on the attached sheet. t ❑ Remodeling ship and have no employees These sub-contractors bave 8'. ❑ Demolition working for me in any capacity. workers' comp,insurance. g, ❑ Building addition [No workers' Comp.insurance • 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doipg all work right of exemption per MGL 11.❑ Plumbing repairs o3 additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.[]Roof repairs bnrance required.].t , employees.(No wcakers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing ibeir workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such tContractm ffiat check this box must attached an additional sheet shouting the name of the sub-contractors and Their workers'comp.-policy iu#brma tion. a I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy andt'ob site Information.. Insurance Company Name: Policy#or Sclf-ins.Lic.#: Expiration Date: Job Site Address: City/state/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to securoe coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50000 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for innumce coverage verification. I do hereby certify under the pains and nitre of perjury that the information provided above is true and correct Si ature. Date: t hone k S0 (K— 2--7,1 Tel- 7 5) Official use on(v. Do not write in this area,to be completed by city or town official City or Towns: Ferrnit/Lleense# Issuing Authority(circle one): 1.Boord of Health 2.Building Department. 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 1 Contact Person: Phone#: Information and Instructions . _ ers to provide workers' c ensation for their employees. t 5 wires all to vl � Y Massachusetts General Laws chapter 1 2 requires employers pr omp Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express orimplied,.oial 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, §25C(6)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." AdditionaIly,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone u miber(s)along with their certificate(s) of insurance. Lire Liability Companies(LLC)or Limited Liability Partaenhips(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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 theDepartrnent 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 member listed.below. Self-insured companies should muter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly: The Department has provided a space at the bottom• , :fir: 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 permitllicense number which will be used as a reference number. In addition,an applicant that mist submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been off cially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e. a dog license or pennit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax comber: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1 o77-MASSAFE Fax#617-727-7749 Revised 5-26-05 W"W-W.Mass.gov/dia °FtHE, Town of Barnstable °* Regulatory Services vXsS& Thomas F.Geiler,Director �"TEa►��aim Building]Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA b2601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, J0 aril Go ocKev - ,as Owner of the subject property hereby authorize ; 1��q', to act on my behalf, in an matters relative to work authorized by this building permit application for: YJ Hz cs/UN c� (Address of Job) Signature of Owner Date of cQ�i eo v GK e Print Name Q:FORMS:OWNMERMISSION `v .- `. . . for indiv►dill use one. S` ;Y registration r If found return to L icen-t►�e expiration date- tandards k before Regulations and S of jiti tlding Reg ✓fze v�anvrru�xw '�.end Standards Board . F zrton Place RT,�]30] : one Ash Boar)of i3uildmgReg. NTRACTOR $oston, i` { pVEMENT CO. _..._ t ►TOME IMF� Registratjbn M __ 001 _- .• f 1 ture 1=1 - .'.a ti tchout si a _ Conrad Rem -- Jeifcey Conrad 53�PHINNEYS N CEN,ERVILLE,M._ A Q2632;V� Am!n►�ti ator oFtME A Town of Barnstable *Permit# Expires 6 months from issue date ssT�t Regulatory Services Fee 'As o r 1659. ,m�' Thomas F.Geiler,Director Building Division p� Elbert C Ulshoeffer,Jr. Building Commissioner X-PRESS PERMIT 367 Main Street, Hyannis,MA 02601 w F E B 0 7 2001 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION /b Not Valid without Red X-Press Imprint Map/parcel Number Property Address L_: .� l=`(� � ��e�— �� Lof-. i3 t�1ti `D AW-N, r� eo [ �Residential OR ❑Commercial Value of Work _�),44 00 Owner's Name&Address L w 0T2 tti Contractor's Name �� -cam rn Co rU f-vow-3 Telephone Number(5otn j Oci 7 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) a 5:Z ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name C.,e Si Co. Workman's Comp:Policy# Permit Request(check box) Re-roof(stripping old shingles) 4 00�7 F47 ❑Re-roof(not stripping. Going over existing layers of roof) r171 Re-side i-loo Sg ❑ Replacement 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 expmtrg