HomeMy WebLinkAbout0722 MAIN STREET (HYANNIS) (14) Y_
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TOWN OF BARNS);,ABLE BUILDING PERMIT APPLICATION
Map r Parcel Application# c(` c
Health Division
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fee /00 _
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Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address `� M&�+J S r (tih i r A
Village i
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Owner 0,2 fykw n 6yZ- <-T LLC. Address s _Bamoyi_ Sr '�S N`( . /V�l 10013
Telephone Q 1`7-
Permit Request To C - E A 8E-tt SAzari�s — q1-_116u+ A rd r lc,t�' C, �' NON- bc.r)^5
_�Gr i I-�o r,: Acid ��� t h�� Stn�s ►'1eU: 5 icorin� C�� d �iCn, -1 C�-stiLke_ iucrV�.
Square feet: 1 st floor:existing �C13 proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 0 G 0 Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No. On Old King's Highway: ❑Yes ❑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
Number 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 stov ❑Yew ❑No
Q
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑newize "
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
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Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review# n, Co
Current Use Proposed Use
BUILDER INFORMATION
Name t.G iLt_'%> Telephone Number .�D? 38z 0k6c)S:
Address ,2 0 06 k 12. 1`j License# CAS O(S 3 `3h
�s Mrs C26(,0 Home Improvement Contractor# i6aS?o
Worker's Compensation�fU
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
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SIGNATU DATE
FOR OFFICIAL USE ONLY
t _ a
` PERMIT NO.
DAU ISSUED
MAP/PARCEL NO.
i
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
' FRAME
INSULATION
i
'E FIREPLACE
x
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
F
GAS: ROUGH FINAL
p rz,
FINAL BUILDING O
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
I Office of Investigations
V
rIF 600 Washington Street
\ S Boston,MA 02111
1 www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #: ,d8^ g-� c)
Are you an employer? Check the appropriate boxes.. Type of project(required):
1.El am a employer with 4. b am a general contractor and 1 . 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.W- am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. workers' comp, insurance.
Y P ty• 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions .
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.❑ Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-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 secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify der the pai s penalties of perjury that the information provided above is true and correct
Sg
?PhoLne
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions ,
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, 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."
• I
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."
Additionally,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(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 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. Self-insured companies should enter 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
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 permit/license number which will be used as a reference number. In addition,an applicant
that must 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 officially 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. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial,venture
(i.e.a dog license or permit to bum 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 number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Wasbington Street
Boston,MA 02111
Teal. #617-727-4900 ext 406 or 1-8.77-MASSAFE
Fax 9 617-727-7749
Revised 5-26-05
wwwmas.s.gov/dia
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Map Page 1 of 1
Town of Barnstable Geographic Information System
Parcel Viewer Custom Map Map Size ® Zoom out fl E n E I In
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Copyright 2006 Town of Barnstable,MA All rights reserved.Send questions or comment!
BarnstableMA v0.2.7 [Production]
http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=30828300A... 10/23/2006
From: 11/02/2006 16:21 4009 P.004
11/02/2006 05:02 5063B52605 SEMINARA U NSTRUCTIO PAGE 02/03
�• Town of Barnstable
Regulatory Services
BaAd►ass, t Thomas F.Geiler.Director
sQ Building Division
Tom Perry, Balding Commissioner
200 Main 3t,=L Hyamis,MA 02601
e: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If 17sing,A.Builder
�Qna� oar'
yoke ,as Baer of the subject property
herebyautboaze LQUIS J0J"JJJaIEGL to act on my behalf
in all mttets relative to worts authorized by this building peaait application.for.
% In
(Address of Job)
Signature of Owner &*p/JIrA Date
?Zq malt, sfrmf
Riz9-tN hake
Print Nasae
�•.tm�rs:cR��Mrssrox .
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 or 44 -ears). 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)
%N1 S `04.021 DATE: /Z O
��M FA .. .. Fill in please:
MME
APPLICANT'S YOUR NAME:
B SINESS YO HOME ADDRESS:
"w TELEPHONE # Home Telephone Number D 7 -
NAME OF NEW BUSINESS a . TYPE OF BUSINESS 4 �� Cu
15 THIS A HOME OCCU.PATION.. .. YES tJ
Have .::...
ADDRESS OF BUSINESS u4 MAP/PARCEL NUMBER O 2 Oj
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 usiness in this town.
1. BUILDING:CO NER'S OFFICE
This individ al h s jen irifor d o y permit requirements that pertain to this type of business.
A hprized S ture** i
COMMENTS:
2. BOARD OF HEALTH
This individual has e infqrinpd of th p rm require is that pertain to this type of business.
UA
Aut ized Signature*
COMMENTS: . Nb j}aA�_ nn AX
3. CONSUMER AFFAIRS [ C ,� NG AUTHORI )
This individual h b nfor e the li enRr'h' re e nts that pertain to this type of business.
i
Au orized Signature.*.
COMMENTS:
TOWN OF BARNSTABLE
SIGN PERMIT
PARCEL ID 308 283 001 GEOBASE ID '22266
ADDRESS 724 MAIN STREET (HYANNIS alu -,6 PHONE
HYANNIS ZIP -
LOT lA , . BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT HY r
PERMIT 73688 DESCRIPTION 7.5 SQ FT SIGN-MCMANUS, NORTON & MACNAMEE
PERMIT TYPE BMISC TITLE MISCELANEOUS PERMIT
CONTRACTORS: Department of
ARCHITECTS: Regulatory Services
TOTAL FEES: $25.00
CONSTRUCTION COSTS OND $.00
753 MISC. NOT CODED ELSEWHERE
E L EWHERE 1 PRIVATE
+► B WSTABLE,
Mass.
i639. �
BUILDI G DIVISION
BY
DATE ISSUED 12/18/2003 EXPIRATION DATE ""
V -
Town of ]Barllstable
y�P°F1He T°w Regulatory Services 1,,• -
F .' 'a E
Thomas F.Geiler,Director
+ mmsrABLE,
v� 1639. Building Division . feu 3 nu DC I .I P,°i 2: 12
'jFo MAC s` Peter.F.13iMatteo, Building Commissioner
.200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Tax Collector
.Treasurer C�0 O
Application for Sign Permit
Applicant: Piw (3t c f 1-, �ih Ln n L' • Assessors No. �/(J ���
Doing Business As: Telephone No. _°S-Q Z V'
Sign Location
Street/Road:
Zoning District: Old Kings Highway?_._Yes6:)Hyannis Historic DisiricO' Yes/ To
Property Owner
Name:�(',I'1`IGL.I'1�fSV°�"DYl "l t1C `��4Ylee Telephone:...
Address: .. .. .
�7Zp ' f �GL� n �Iree Village:�t6x_nn1,3 —
Sign Contractor
Name:_ �I W M MWI �f C r) C n Inc . Telephone: 7S(7�- �q '
Ad dress:
(6 ?) (')kj U(2 a) 7—Village: -
u-�-
Description
Please draw a diagram of lot showing '� ''gr o ing location of buLdmgs and existing signs with dimensions,location and size of �
the new sign. This should be drawn on the reverse side of this application.
Is the sign to be electrified? Ye . o (Note:If yes, a wiring permit is required)
I hereby certify that I am the owner or that I have the authority of the owner to.make this application,that the
information is correct.and that the use and construction shall conform to the provisions of Section 4-3 of the Town of
Barnstable Zoning Ordinance.
Signature of Owner/Authorized Agent:
Size ,� --fin X ✓to . �Sas �d
--�� ermit Fee:
r . r `/
Sign Permit was approved:_ Y S Disapproved:
Signature of Building Official: Date: �� a
Signl.doc
rev.122301
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& Main-
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at,.NAMEE P.C.
ATTORNEYS
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NEW SIZE DEC, 12, 2003
30)0 X 36"
83 OLD MAIN ST: & YAF�AApIJ"fH, MA, 02664 lign Ccx0608) 398-2721 008) 760-3130 fw^K
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prerequisite' Action Dept Weeded By Approved rBy fSkatus Ins Comment I
HEALT APPROVAL 6500 11/03/2006 DMIO APPR
Audit Hiskory
OM APPROVAL 4100 11/03/2006 TBRO APPR
SITE APPROVAL 6303 11/03/2006 ESWI APPR Sep- 'b
TAX APPROVAL 6300 11/03/2006 DBAR APPR
WORK SUBMISSION 6300 11/03/2006 DBAR APPR
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` ... Prerequisite FIRE FIRE DEPARTMENT APPROVAL Needed by
Inspector VAL'APPRO _� e� � � qPROM � ,r ROMA,PAUV
Responsible.dept 6300 BUILDING DEPARTMENT Inspection
type e
1' reference Stetus�,. 1APPR1771
` APPROVED
Applicant resp Y} _ . date 11�06I2006p �
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Comment code d Approved 11 I0612006 10:29`
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YOU WISH TO OPEN A BUSINESS?
Far Your Information: Business certificates (cost$30.00 for 4.years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must d❑ 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)
art; ;; . _ _ DATE: —Q
Fill in please:
tlfik NAWRIN WS 0.10APPLICANT'S YOUR NAM ,e?S 1Gl /t
BUSINESS
YOUR HOME ADDRESS: dti
�� A )5 AJ176,17
Elm TELEPHONE # Home Telephone Number d 3'
NAME OF NEW BUSINESS TYPE OF BUSINESS_ /
IS THIS A HOME OGCU;PATION? .. YES. NO
Have you been given approval fro the building:di°ision�? • :ES NO L�
ADDRESS OF BUSINESS 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 CO IONER_ 'S OFFIC
This-indivi ual h eeP i m f any permit requireme is that pertain to this type of business.
A thoriz gaature** i
C MENTS IPit
fill S�Pit
2. BOARD OF HEALTH +
This individual has n i14 ad of� Rer t requirem s that pertain to this type of business.
Au rized Signature**
COMMENTS: . f
3. CONSUMER AFFAIRS (LIC NS AUTHORITY
This individual has be ' - o 'ed.oftholiden3ing ui e ents that pertain to this type of business:
Authorized Signature.** G`
COMMENTS: