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Home My WebLink About0675 MAIN STREET (HYANNIS) ��, . ., -- I li APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Named Telephone Number /0� <f� 77 Address ( � T /� I'1 �� Y Home Improvement Contractor# 3 �� Email�M/P� ��l1/P �� /i/ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /� " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel_ ``" €"`' '` 31A RNSTABLE Application # Health Division 4 Date Issued Zd-/ Conservation Division Application Fee Planning Dept. . , A � Permit Fee �' W)-o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street A. dress 7 S kKQ)t!l 9+-, Village tin 15 Owner Ca)I Address Tip f� Auk A Telephone Jf� 3 b7 -7 b `7 Permit Request bc.9 Cd tv, r m -- Square feet: 1 st floor: existing 4Wproposed 2nd floor: existing 36 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio* i d 1200 Construction Type Lot Size , Grandfathered: ❑Yes w_rlVo If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) _ /. Age of Existing Structure 6 S Historic House: MIQ ❑ No On Old King's Highway: ❑Yes QHQO Basement Type: 2<Ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 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 7 new First Floor Room Count Heat Type and Fuel: ❑ Gas � ❑ Electric ❑ Other Central Air: ❑Yes a'Naso Fireplaces: Existing O New Existing wood/coal stove: ❑Yes ®�<b 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 11�1es ❑ No If yes, site plan review # Current Use re , u>�r h fl` Proposed Use APPLICANT INFORMATION nA (BUILDER OR HOMEOWNER) Name V c7 Telephone Number _6-0 8 J3 0`7— 7 6 7o Address VOMHIS cen e# CZ_L .5 a x " ome I prove nt Contractor# Email i t oa&. rker's pensation #ALL CONSTRUCTIO BRIS RESULTINGOJECT WILL BE TAKEN TO ZQ r,Ad4itke SIGNATURE �� DATE ? �� t FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL G PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t� 1'lie Comrtroinvedtth of-Massachusetts -Massachusetts Deprrtrrreut c�,fIndustrialAccidents Of cue o,f 1mskgadons. 600 Washiiigton&reef Bastva,?CIA 02111 rntm- nra_,mgov1dia Workers' Campensafran Insurance Affidavit Budldex/CantractarsJElecfrriccianslPhunbers Applicant Information �- n Please F`Fint Legi�al N�(BusmesstlCrgaaizatioaftint *Itival} ENS Address. Q / City/Sta& / 5/ Kati Are you an employer?Checi€the appropriate iron Type of project r I.❑ I am a employer with ❑ I am a general contractor and I ❑New consfructioaz loyees(full an&or part-time)-* 1�ave hired the sub-contractors 2A I am a sale pmpdetor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees. These sub-contractors have g- ❑Demolition vra '+na forme in any capacity employees and have wodiers' [No odmrs'comp.insurance comp.insurauml 9_ ❑Buil �- ding addition. required-] 5- ❑ We are a corporation and its 16❑Electrical repaim or additions 3.❑ I am a homeotmer doing all work officm have exercised their 11.❑Plumbing repairs or additions eel€ o workers' right of exemption per MGL �` � �- 12.❑Roafrepairs insurance retired']1 c.1,52,§1(4)�andwe have no employees.[No tvmkers' 13.❑Other - comp-insurance required.] 'Artyapp€i dh_tchecksbox#lmastalsofill out the secdoubelowshoiringthe¢wo&eie compensation policy iaformaiiouL t Homeoataers who submit this dt3dacnf m&,catmg tha-y are doing all v¢oak and d m biro outude conductors nmst submit a new affidavit indicating sack fCoatzactmlhzt check this boat must attached on additional sheet sho the of the sub-camdgctaaa and state whether or hh6't Those a entities have employees.Ift3hesub-cootactors lure employea%theymustpm-v- etheir wurkEn'camp.Policy aumbm Ian[art erripIoy�crr tlerrt isprmRtiing workers'conrpettsrrtzart uisurarrca,�or m�*entploy�ees .$etoav is iihe policy ru�td jab sites informa om I Insurance Company Nama /�S ( ��, Policy,or Self-ins.Lic. 6 8` Expiration Date: Job Site Address: � M /Y" Citylstatelyrp: Attach a copy of the workers"compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c I5—can lead to'the imposition of criminal penalties of a fine up to$UOD OO andfor one-yearimprisoument,'as we4l as civil penaltces.in the form of a STOP WORK OEDERand a RM of up to$250.t1O a day against the tizolator. Be adidsed&at a copy of this statement may.be 5xvmded to the Office of Itnrestigations of the DJA for insurance coverage 'on_ Ida hereby e��under the 's o,fFerfitry diatiliz ut,formatiortprmzrled ab/ot ` true `td correct Sit nature_ / 9 Date: Phone OBkial use anry. D47 not write its this inert,to be campTetcrd by city artetrn ojok&L City or Town.: PermitEkense# Issuing Authority(tdirle one): L Board of$edth 2.BuffTmg Department 3.Nolen Clerk 4.Electrical hmpeetor rr.Plumbing Inspector b.Other Contact Person: Phone#• Information and Instructions . Massachusetts Gehe.a Laws chapter 152 rmpire:s all empIoyem to provide workers'compensation far their emgIayees. pmMranttO,this Vie,an nnplvyr�is defined as."_.every person in the service of another under any contract of h re, e2press or mzplied,oral or wrhnnf An employer is defined as"an i adividral,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged k a Joint entrrprise,and including the legal sep.L m afives of a dwrased employer,or the receiver or trustees of an itudividnal,partnership,associafion or other legal entity,employing employees- HOw'eyer the owner of a.dwelling house having not more than tbree apa dments and-who resides therein,or the occupant of the - dwelling house of another who employs peasons to do maintenance,contraction or repair work on such dweEing house or on the grounds or building appr rfe thereto shall notbecanse of such employment be deemed to be an employer." MGL chapter 152,§25C(�also sues that"every siafen or local licensing agency shalt withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applic as who has not produced acceptable evidence of cdmpfiance with ins urance.surance.coverage required" Additionally,MGI.chapter 152, §25C(7)states'Neither the commonwcahh nor jay of ifs political subdivisions shall enter mto any corn Tact for the performance of pubho work until acceptable evidence of compliance with the in srT*an ce. re, err'e:nfS of this rhaptnrhave been presented to the contracting authoz" Appiica-uts ' Please fill out the workers'compensation affidavit completely,by cherT�R the boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers) along with their eertificatE(s)of insurance. Limited LiabilityCompames(f.LC)or LimitedLiabi-litY Parinerships,(LLP)with no employees otherthantho members or parfraeas,are not required to carry workers' compensation insurance, If an LLC or LIT does have employees,apolicy is regoired. Be advised that this affrdayit may be snbmitte-d to the Department of Industrial Accidents for conformation of msaraace coverage Also be sure to sign and date-the affidavit The affidavit should be ret=ed to the city or town that the application for the permit or license is being requested,not the Department of lndastrial A_ccide:nfs. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compemsationpoliey,plcne,call the,Departiamtatthenumber listed below. Self-inslmredcompanies shouldentertheir self-i sorance license number an the appropriate line. City ar Town Officials Please be sure that the affidavit is complete and printed legibly. The Departmeuthas provided a space at.thz bottom of the affidavit for you to fM out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pen it/licrose nu rnber which will be used as a refbrence number. In addition, an applicant that must submit mubiple perniitlIicensa applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"lob Site Address"the applicant should write"all locations in or town)-,,A copy of theaffidavit that has been officially stamped or m ke;d by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for fain Pennits or licenses A new affidavit must be fiI1ed out esach year.Where a home owner or citizen is obtaining a license or per it not related to any business or commercial ventm (Lt. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The 0fa=of Invesiig-,dons would like to thank you in.advance for your cooperation and should you have any,questions, please do not hesitate to give us a caM tel hone and fax number The The Depm-imenfs address, ep - The C -ffiE of Mamarc ustf_-tts- Depaitnentref Indust l Accidenta fie of�e�f?g�tia� EGG wasbivoa St'tf-t ost MA 0�1II Tf,-L,4,' 617 727-4 'Q�rt4-06 car I-977 MASSAFE Fax 9 617-727-7M Revised 4-24-07 mas �agf�a IME t � a t SAMSMBLE. . ' ,0� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder IIaAgCD GDw� ,as Owner of the subject property � l P P rt9 hereby authorize�/�J /�'�q,K1, F r Weo to act on my behalf, in all matters relative to work authorized by this building permit application for: b`75 14qIA17 b&Z 6-Cl 5 (Address of Job) Signature of Owner ' Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 ACQRDDATE . CERTIFICATE OF LIABILITY INSURANCE 11/12/2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Barbera Insurance Amen ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, 1no• HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 175 Market Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE Bri hton MA 02135- INSURED INSURER A:SaLfety InGUranCO COm axi Fine Finish Contracting Services, LLC INSURER 9:Travelers Insurance CoE22ML P.O. Box 461 INSURER C:The Charter Oak Fire Insurance Company INSURER D: N.Eastham MA 02651-0461 INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY IBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGAT5 LIMITS SHOWN MAY HAVE.BIw1;N RE:DUCEO BY PAID CLAIMS. NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS L DATE MMID DATE MM/DW GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any er+g fag) $ 100,000 A CLANS MADE FiloCOuR BMA0023442 04/09/2015 04/09/2016 MEOEXF(Any oneDmm) $ 10,000 PER$QNAL&ADV INJURY S 1,000,000 GIENERALAW7REGATE 3 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000 POLICY I JECT LOC C AUTOMOBILE LIABILITY BA-6F51941A-15-AUF 02/24/2015 02/24/2016 COMBINED SINGLE LIMIT ANYAUTO (Eo aoddmt) $ 11000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) , $ HIFIED AUTOS / / / / BODILY INJURY X NON-ovma AUi03 (Per acddent) S PROPERTY DAMAGE Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAIJTO / / / / OTHER THAN EAACC S AUTO ONLY: AGG S A E%PESSLIAWLITY C400005865 04/09/201S 04/09/2016 EACH OCCURRENCE g X OCCUR CLAIMS MADE AGGREGATE S 1,000,000 s DEDUCTIBLE / / / / S X RETENTION $10,000 $ WORKERS EMPLOYERS'UASIUTY ON AND / / / / TORYUMfUTS ER E.L.EACHACCtDENT $ 100,000 B Bryan Byrne is 61 -2E74821-8-15 02/21/2015 02/21/2016 E.L.DISEASE-EA EMPLOYEE$ 500,000 Covered E.L.DISEASE-POLICY LIMIT $ 100,000 gTteER / r rr DESCRIPTION OF OPERATION8(LOCATIONSNCMCLMt;XCLUSIONS ADDED BY ENDOR5FMW U8PECIAL PROVIVION8 CERTIFICATE HOLDER FTADD,TIONAL INSURED'INSURER LETTER: CANCELLATION SHOULD ANY OF THE AROW DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT The Town Of Ba=stable FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE Attn: Dave INSURER ITS AGENTS ORREPRESENTAMV2S- - F SENTA /1 ACORD 25-S(7197) ACORD CORPORATION 1988 *rai INSOM plo).a9 ELECTRONIC LASER PORMS,INC.-(8W)327-0W Pape 9 of 2 ' i Massachusetts-Department of Public Safety board of builcUrig,Regulations and Standards : Construction upen° isor y r License: CS-102587 v I .• yr-;� BRYAN F BYRNE= w r PO BOX 461 North Eastham Na 01 Expiration e Commissioner 01/29/2017 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE:-4/3 Lo Fill in please: �1 APPLICANT'S YOUR NAME: L-OIA r K"t Co toKth U. BUSINESS YOUR HOME ADDRESS: 5 S S a.i k SO I _&C05tfe AA a TELEPHONE # Home Telephone Number ,50$- 2- 1- 5 5!o(y NAME OF NEW BUSINESS ` eC Zloss,61PA TYPE OF BUSINESS Ori S k G IS THIS.A HOME OCCUPATION? YES -NOS.,_ Have you been given.approval from.the building d1 ision?. YES NO ADDRESS OF BUSINESS 45 Mu l C0%w CS LAA MAP/PARCEL.NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMRs LER'SOFFICE This in.divid al hr of any permit requirements that pertain to this type of business. rzed i nature* COMMENTS: � 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BAR-w 4 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ( •� � ., � Address of Offender (� �Y My/MB Reg.# Village/State/zip 1� _ , Business Name ( �41 4_C� � �.° ��f+ � ,t�F..am/pm, on 20_ !Business Address lo-7 a,/'t�,,.,, � � J �'An� A , Signatur`e"of/Enforcing Officer---- Village/State/Zipt'�flf v f, Location of Offense/„ (, /r C" a, 4 Enforcin;g)Dept/Division Offense - JP-A { ( 7 a�, Facts V - n "VA 01 This will serve only ass a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. A E f 675 Main St. , Hyannis 4/19/2010 e Engir.,eering Dept. (3rd floor) Map �� Parcel / 3 Permit# (p 0 House# Date IssuedCQ f� ( )( _11� Zlialzre,-'k Fee goo -0� Board of Health 3rd floor 8:15 -9:30/1:00- Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) �tME Definitive Plan Approved by Planning Board 19 p B T 9 EWER l z1 G61`eRZ) OWN OF BARNSTABLE. ��— Building Permit Application Project Street Add ess 675 Main St Hyannis ( Art Store) Village Hyannis Owner Don & Anne Stucke Address ' 49 Stoney Cliff Rd CentervillE Telephone 775 3785 Permit Request Strip & reroof 20sq Replace existing exterior stairs new stairs to be 4.2 inches to out side of tread. Stairs exist now. First Floor square feet Second Floor square feet Construction Type Wood Frame Estimated Project Cost $ 7 , 500 . 00 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 5 0* Historic House ❑Yes fJ No On Old King's Highway ❑Yes L�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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial �j Yes ❑No If yes, site plan review# Current Use Retail store Proposed Use Retail Store Builder Information Name Bill Croston Telephone Number 771 3891 Address P. O. Box 138 License# 014112 o s t ery i l l e, Ma 02655 Home Improvement Contractor# 100023 Worker's Compensation# 8 9-7 6 9 0 6—01 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 B urne Landfill SIGNATURE DATE 211cl per BUILDING PERMIT DENIED FOR TH OLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. . DATE ISSUED a A MAP/PARCEL NO. ADDRESS VILLAGE rF . OWNER DATE OF INSPECTION: FOUNDATION FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN Nd ^�! f i 7 - ,j i iil�„ � � I► i � i I � 1 d. ...� EAST E L EVA T;O N •BLit:-= a, �I 615 I�A�N 5�., ��,:tilvNt� , ►�lL� . rT=M I-F-7-P dill/ Ell SOUTH STREET ELEVATION :L\ — �s �__._ The Commonwealth of Massachusetts t' Department of Industrial Accidents 9 _ -- office olloresdoodoos 600 Washington Sheet --~ .I Boston,Mass. 02111 -- Workers' Com ensation Insurance davit r i name: location: city phone# ❑ I am a homeowner performing all work myself ❑ I am a sole rietor and have no one worki>1 in anv achy /%%%%%/%%% %%%%/%%//////%%%%%%%%��%////%%//////%%%%%//%%///%%// %%%%%%%/G%O////%%//////%/%/%//�i�"/i. ////%///%%%//%%%%%/%%%/%%%//%%%�%/%///%/////%/////%%/%///i, I am an employer providing workers' compensation for my employees working on this job. ........ ........ a :ct►mDnnyname _.._...... ....g . . ...... :::. . * jrtss. :;<::::: :::>:::.......... 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' 3r :s r.... c a :.::...........:..: okiev; ...:,. 8 :: :..{ . ... :.... .... ...:.:.:.::.::.:.>.:::...... �/. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: fame n n may CO D : :: :. : N ..X . ............ :•...::: :.: adi#re s3 . ::': %<S{iiii'r::+:}ii:iL+`v::::iiii:4:<iiiiii:}:i iJt�:::is�iiii�i "rij$ii:}::�`i'riiiii::}:`viiiiii�:}iij::i::jLi?::.n{: r:a{::;:v;: if .i}}}i:w:.�:.�::::::::i is�:}:....:.................... .........................................:.......:.::..:......::.::::.�.:...::.....:........ 1. ..........................w::::.v:::::::•:::::::•.v:::::•::::::.�:::::::::.�:::::.�::.v:::::::...........:•..�.:............•w., 1� lore ........................................ r.3L..{i:;:;:;:::ii}::?+j:?::}:j}:i i:'��:it v'i:.::.i:.: �j�ii"i:::.:?:y::::::::j:is�i::i:`vii:i��.....-.--.-.-: :;':i)};i:;:v:;.;:;:}.:.:?:>�y..:..:':`i.': h..r. •{n;{:•}}:fi:•:}}:i+.{:{h:�:•}:.}}:�}}}i:::.v:•}:�::v:•}:•}::•T}i}ii}}i}::.+v}.}}:{{•}::::::::::w::.v::v:::•:::::•.v::::i:i i::';.}}ii:v::..... :::>i4?:viiiiii:ii ij:viiiii:;:::; vi{�ii:;:+;ii:,::�{iiii$.,"I..:.................i:4i>:vi ii ii:{?: {:Yi:ii:'ci::tiii::`;{:; :;:;i:� ::;:2iiii;:k`'iiiR;r,.;t;:;:;h;:i::ii:} :.i:i:;:�:v{;;:':}:.v .................. ..................................... ......................................... :•::.v::::::::::m:::::. .... .........................................................: ... .... ........................,...�[.. ....,... :.......:.:.................................. .............:......................................... ..:..:.. .........................................::w::::::::..}.v: ...... .................................................... :. .:;!;.::.;;. i>:!.>:.}:.;.`:?iii:i:;:;;}: i}:;:;$:i::::;?:ti::{.ii.....:ni}}i;:.i:::i:-:-X i.—:::;:••}}:.>:ii:i:::: h9flrallC�tQ .. :.:.:::......::.:::::.........:... ..: .:....::...::..:.. ..:... ::::.::.:::::-.;::.....:. 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Ifafhn a to secure coverage as required under Section 25A of MGL 152 can lead to the innposifion of criminal penalfles of a fine up to$1,500.00 and/or one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Invesligadons of the DIA for coverage verincatlun I do hereby certify under the pains and penalties of perjury that the information provided above is trw•and correct Sigciature Date _ _ Print name Bill C r o s t on Phone# 771 3 89 l official use only do not write in this area to be completed by city or town official city or town• permif/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office []Health Depar�nent contact person: phone#; ❑Other Urined 9ro5 PIA) 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 contract 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 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 section 25 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. 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 requires 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 i submitted to the Department of Industnai Accidents for confirmation of'insurance coverage. Also be sure to s ga 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.worlm' compensation policy,please call the Department at the number listed below. NAM 911101A 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 contact you regarding the applicant. Please be sure to fill in the piiii icense number-which will be used as a refimice mimber. The affidavits may be retmnR in- 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. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts .Department of Industrial Accidents Olflco of IwestlWons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 ME 1, The Town of Barnstable • snxxsrnsM • 9� "�; �0�' Department of Health Safety and Environmental Services ArFc �A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date-2/1 0/0 0 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: Reroof/ Replace stairs Estimated Cost 7, 500 . 00 Address of Work: 675 Main St Hyannis Owner's Name: Don & Anne Stuck e Date of Application: February 10 2000 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: February 10 2000 Bill Croston Building Cont. 100023 Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav T�.7• N =0 T t,A( DEPR VENT OF PUBLIC SAFETY i I .TRI�l1 SUPERVISOR LICENSE CONS {xpires: - --- F �ROSTBN _ 51 SUONI RO HYANNIS, NA 62601 ' _ ..- .."'-v'.ws..-"`-`m.ms�r.^��vr. - .._::ss r...�.w"-�.r•s..«_--+� Q�ofI E TOWN -,OF'BAMSTABLE BA"ST" M"s. LE. 0 Office of the Building Inspector 039. Ift M Date J'une 4* 1986 Fee ........$.50....0.0............................ Permit No. ....................... PERMIT TO ERECT SIGN IS HEREBY GRANTED TO .........x:K4nn.i.s...AK�t...Su.....ppli.e.s...*......................................................................................................... ... .. D/B/A ............................Same ............................................................................................................................................................... LOCATION 675 Main street ....................................................................................................................................................................... ..............................................Hyannis............................................................................................................................................. ANY VIOLATION OF THE SIGN LAW WILL CAUSE IMMEDIATE REVOCATION OF THIS PERMIT I e Building I A 011 TOWN OF BARNSTABLE ,•� }1 BUILDING DEPARTMENT MA"n } TOWN OFFICE BUILDING ■Y• HYANNlS, MASS. 02601 �•ul►. DATE t'"� Y APPLICATION FOR SIGN PERMIT 2 19�b Application is hereby made for a sign permit in accordance with the description and for the purposes hereinafter set forth. This application is made subject to. all Rules and Regulations of the Town of Barnstable ,now in force or that-may hereafter be enacted affecting or regulating thereto and which are hereby agreed to by the undersigned applicant and which shall be deemed a condition entering into the exercise of this permit. INSTRUCTIONS 1. This application must be filled out completely. 2 A drawing, in duplicate, showing the shape and dimensions of the sign, lettering on same, height, method of securing to building, or if freestanding, method of erection. Drawing must show sizes of structural supports, and size and depth of foundation. SIGN LOCATION (� J L ,,� , I -.Owner-_ � �1(S - S(�f`t'l.l :::.,:. Street- Rd.��J� wVtf1� JT-•i �"TTI�-��fS -- Zoning District Fire District CiVVNER•�OF PROPERTY w� N a m e iJ *(� TU CL� Address Lt"1 Tfl l�.� CL t t'� rt-', pp City t LLLL St Zip Tel No. 1 '�) Area Code SIGN CONTRACTOR Name _ .._-_ �•' -tom __ _ Address City St. Zip Tel No.( j Area Code Type of Construction Free Standing or Attached T r •-*=46cl ! - DESCRIPTION DIAGRAM OF LOT SHOWING LOCATION OF BUILDINGS AND EXISTING SIGNS WITH DIMENSIONS LOCATION AND SIZE OF THE NEW SIGN TO BE DRAWN ON THE REVERSE SIDE OF THIS APPLICATION. Is there any electrical wiring-required for this sign ? Yes No -%e If "Yes," who is the electrical contractor T FOR OFFICE USE ONLY Area t0 ff DATE DATE II DAT t ' Permit Fee dV DEPT. ROUTE RECENED) APPROVED 1RElECTEDI INITIALS ! PLANNING II Mail permit to: & ZONING ELECTRICAL INSPECTOR BUILDING INSPECTION 7 j 1 hereby certify that I am the owner or that I have the authority of the owner to make application, that the informatio- given is correct and that the use and construction shall conform to all the Rules and Re ations of the Town of Barnstoz! which are imposed on the prope'.vy.,_; 77S t,!_? Phone S,gnaru I sign owner 1 suthorited agent - art & (Ira fi; inc�..� rr , ate rials Cus�. � rn picrture framir�. - _9 - y - art tius)VILes , G ' p � ris Y41 n im It s �� • yannis art sap�lieS �y ar// ,001 �plies /3 tl �3 0 , hya�s 8 s��t�•`s _ � i � s d , } a NO k anti S � .pkINVVa a,� svr�i as