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HomeMy WebLinkAbout0086 MARSTON AVENUE Ida rs+on l 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0,-- ((1'►. A tT l e4 Map v� Parcel BUILDING DEPT. Application # I Health Division MAY 0 3 2017 Date Issued Conservation Division Application Fee TOWN OF BARNSTABLF 5 0 Planning Dept. Permit Fee .Date Definitive Plan Approved by Planning Board Historic - OKH, _ Preservation/ Hyannis Project Street Address !nR i�Si®,r/ s9 ✓ Village ,A44IIS Owner Address �GI� Telephone, Permit Request /�'��i3/� l ,(Ay�e,� x1 f 5e,4�� 14051�4// /a "I Jew ,/� �7 G�✓9S� / 4, ��� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3,'7Q6r h 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 A No On Old King's Highway: ❑Yes VNo 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 stove: ❑Yes ❑ No 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 ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 40 o� /.►,/S,� �� Telephone Number 5 77s Address ��CIE 94,&Z2& License# /d d Home Improvement Contractor# ,l�F' Email 2 F�� f 1� ���/�1 �� �D °� e l� Worker's Compensation #` /'1=� f z1v ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6y 2 SIGNATURE DATE 17 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ', ASSOCIATION PLAN NO. 41 Town of Barus able ; 3 tr i639r• i�� _` A l�udxag1VI�lt3k] E Tom ferry,Bua9:f3bmn"oner ' 200 Mem Street,Hymtk MA 02601 .^4 WWWAPvvu barastablema.= S� office: 508-862-403$ fax: 508-790-6230 ri 4 r� Property hex Must mplCb� d Sign This Sect ion .. If Um ; DW der ct 44% ra fle( ,'0 ometofthe act proms ; Cir" �e Ca /�f�Ac�0nhem atrthoiizeY _ c L �at�on-arybe�talf, 3 M A matters Mk1iM to work a=ho ized by this buRdiag permit applicariou for +.� �1 4 Address off jpb) Pool fences and Lu=ire the r+espons i rof tie.apok=t.Pools ° �. .are uot.to be.fled or utind before fence is installed and ail dal inspections.axe perfo med-and.accepted. 9,41d/If 10 It .9 A I /�� F� Of VWII@L of•Apphraut L 4. k�lizQ�,th r `�� •t �r Name Print Name Dade 6 cx z�.t v-'•. 'f�tr r Q:SORMS:OWNM MIOVION WLS # `,._ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investlgatlons b 1 Congress Street, Suite 100 s° Boston,MA 02114-2017 www.mass gov/dla Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aunlicant Information Please Print Legibly Name(Business/Organization/Individual) Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip:South Yarmouth, MA'02664 Phone M 508-775-1214 Are you an employer?Check the appropriate box; Type of project(required): 1.9 I am a employer with.48 4, ❑ I am a general contractor and I employees(full and/or part-time),* have hired the sub-contractors. 6, New construction 2,❑ I am a sole proprietor or partner- listed on the attached sheet, .7, ❑ Remodeling shipand have no employees These sub-contractors have 8, ❑ Demolition working for me In any capacity, employees and have workers' 9. Building addition [No workers' comp, insurance comp.insurance,= g required,] 5. ❑ We are a corporation and its 10,[3 Electrical repairs or additions 3,❑ 1 am a homeowner doing all worK officers have exercised their , 11,0 Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12,❑ Roof repairs insurance required.] t c, 152,§1(4),and we have no 13,©.Other.W. eetherizatlon�, employees.ees, [No workers comp, insurance required,] *Any applicant that checks box#I 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, tContractors that check this box must attached an additional sheet showing ft*riame of the subcontractors and state whether or not those entities have employees, If the sub-contractors have employees,they must provide their workers'comp,policy number. I am,an employer that is providing workers compensation tnsurance for my employees, Below Is the pollcy and job site Informatiop,, Insurance Company Name;Atlantic Charter - Policy#or Self-ins,Lic, #;WCE00431902 Expiration Date:6/30/2017 Job Site Address: ;5�4 /W, 14 Z/ll City/State/Zip, o Z G o/ 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 penalises In the form of a STOP WORK ORDER and a fine of tip to$250,00 a day against the violgtor. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certo under the pains and penaltles of perjury that the Information provided above is true and correct, Signature: Henry Cassidy 7 WIo7.n�i°ie'ti'-- �4W MIWy. yyMPli //f Date- phone#: 508-775-1214 Officlal use only. Do not write in this area,to be completed by city or town offlclal, 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#; CAPECOD-27 KDOYLI A�ORL7" CERTIFICATE OF LIABILITY INSURANCE DATE 03(MM/30/roD/YYYY) D/YY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER gRAJACT ', Rogers&Gray Insurance Agency,Inc. PHONE _ FAX 434 Rte 134 ac No Ext: A/c No: 877 816-2156 South Dennis,MA 02660 mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC p INSURER A:Peerless Insurance Company 24198 INSURED INSURERS:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 1B Reardon Circle INSURER D:Atlantic Charter insurance company. 44326 South Yarmouth,MA 02664 INSURER E t, INSURER P t COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN9R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFFLTR POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILrrY EACH OCCURRENCE $ 1,000,001 CLAIMS-MADE QX OCCUR R/O CBP8263063 04/01/2017 04/01/2018 DAMAGE TO RISr ENTED 100,001 MED EXP(Any oneperson) 5,00( PERSONAL&ADV INJURY 1,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,001 X POLICY F7 J`POT LOC' 2,000,001 PRODUCTS-COMP/OPAGO OTHER: 13 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO HH 6232707 COM 01 04/01/2017 04/01/2018 BODILY INJURY Per person) AUT08DONLY X AU0TNOSSyU�LEEDD BODILY-INJURY Peraecldent 1,000,00( X ANNS ONLY X AUTOS ONLY Pe�acEcRde t AMAGE X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 2,000,OOl EXCESS LIAR CLAIMS-MADE R/O EXCIOOO6635001 04/01/2017 04/01/2018 AGGREGATE DED I RETENTIONS Aggregate 2,000,001 D AND EMPLOYERS LIABILITY Y/N' �( PER STAT OTH- ANYPROPRIETOR/PARTNER/EXECUTIVE WCE00431902 06/30/2016 06/30/2017 11000100( and FICE MF(M� iEXCLUDED? N/A E.L.EACH ACCIDENT s ary n ) If Kee deaeribe ender E.L.DISEASE-EA EMPLOYEE 1,000,00( DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00( DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additlonal Remarks Schedule maybe attached If Workers Compensation Includes Officers or Proprietors. Y more apace Is required) Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board ohf Building Regulations and Standards License: CS•100986 Construction Supervisor, HENRY E CA6811)Y• i 8 SHED ROW WEST YARMOUrH Expiration: Commissioner 11/1112017 4 C � • b Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma brtusetts 02116 Home I rove me ,'Vlea.tt ractor Registration �s �.• - _;;i.:�-: {i".'`.''"::'•.• Type: Corporation r,, .��ii;..•.:::::;�.-..:: ) �?' 1 Registration: 153567 Cape Cod Insulation, Inc Expiration' 12/14/2018 18 Reardon Circle W So, Yarmouth MA 02664 "`�•—yI. Update Address and return card, Mark reason for change, soA-1 o 20M•06/it ----......:-._.._........—............_..-....._.fn7 ✓V/ts �po?1t77to18[va000tfG o��GC[OJrlC�tu/eGld• V Office of Consumer Affairs&Business Reg Well on HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only i Tlbe: Corporation before the expiration date, If foun urn to: : .61stretlon Expiration Office of Consumer Affairs and al es Regulation 10 Park Plaza. 95170 ,,S` :Jtki74t367 12/14/2018 Boston,MA 11 Cape Cod InsUlotf' , 11. Henry Cassidy 18 Reardon Clrc'�4:� t .;" V 2 CG So.Yarmouth,M � �3�' C ~'f ho t ut ''•.' Undersecretary al sl atu 19 Engineering Dept. (3rd floor) Map Paicel Permit# S -To D13 House# Date Issued - S- "p Board of Health'(3rd floor)(8:15 -9:30/1:00-4-39 j ee 0� D� Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) l 31 Planning Dept.(1st floor/School Admin. Bldg.) t SEPTIC SY UST BE INSTALLE IANCE Definitive PI roved by Planning Board 19 WI ENVIRONM E AND TOWN OF BARNSTABLE. TOWN R � IONS Building Permit Application Project Street Address �. Village Owner f /� � An , Address .� ,Telephone S'G 7 5-- ,? 3­1 O Permit Request L .. 4 'First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ %f O Zoning District n Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family f 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 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 Q Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use /� , Builder Information Name &0l; ` .�C��-�z Telephone Number 4 (,C %I 7 a Address f License# Q O 1/ 976 Home Improvement Contractor# /a `!'4/ Worker's Compensation# W G h G O 1 �1 / 7 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 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ', f a FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED t MAP%PARCEL NO. ADDRESS i VILLAGE � ' ? � ... fir � • ~ f , OWNER s - DATE OF INSPECTION: t 4 =; i FOUNDATION- r 4 FRAME F , INSULATION FIREPLACE 2 ELECTRICAL: ROUGH FINAL - -r PLUMBING: ROUGH Y.FINAL t GAS: f ( :ROUG FINAL FINAL BUILDINGS sa DATE CLOSED OUTS , ASSOCIATION PL'AKNO. i; a � E a w le . The Town of Barnstab � ��$ Department of Health Safety and Environmental Services Building Division 367 Main Stress,Hyannis MA 0260I Office: 30&790-QZ7 _ Ralph�� Building Ccmmissio::: Fax: 30&790-6730 For office use only ' f , Permit no. Date AFFIDAVIT . HOME IMPROVEMENT*CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION ` } air, modernization. MGL r- 142A requires that the "reconstruction, alterations, renovation, rep conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than tour 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. N a . /Le/ Est.Cost �/5 G o Type of Work: _ ��- Address of Work:•'' Owner's Name �-�/-/' � Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): . Work ezciuded by law Job under SI,00L _Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS .PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED ACCESSCONTRACTORS FORR I�TION APPLICABLE OR GUARANTY FUNDWORK DO NOT UNDER MGL 142A � ACCESS TO THE ARBITRATION 5044ED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 12131 '9er__�Date P.uatractor Name Registration No. OR Owners pJame Date • - �'�"� The Commonwealth of Massachusetts • Tim. -•-.��� Department of Industrial Accidents - Office ot/osestfgat/oos 600 Washington Street _.. A A.:,>1 Boston,Mass 02111 �� Workers' Co m ensation Insurance Affidavit name: /4/�/v U L r C Cr/_F location: / q /l C C o c city ohone# e, ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have,no one worldrig in any capacity I am an employer providing tivorkers' compensation for my employees working on this job. . compnnv name: G address: Ar _. .. dtv: phone 2, insurance co. P01iCV# L!i C 00/ / ❑ 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: comvanv name: address: .... .. . .:...,.....:..::.. dtv: phone#: insurance co. _ :. ;:.. .::.<::.:::; olicv# companv name: address• - dEv: :... phone#: inuprance co. cv# Failure to secure coverage as required under Section 25A of.%IGL 152 can lead to the imposition of criminal penalties of a Me up to 51,500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP NORK ORDER and a One of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the OOlce of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true.and correct 'Signature -- Date Print name Phone#�-3 G a2 / 7 -2 olfida!use only do not write is this area to he completed by city or town o03dal city or town• permiNOcense to ❑Building Departirtmt 0Llcensing Board ❑drecklf immediate response is r egnired ❑Sdecatten's O1nce CHealth Department CC person: phone ft; ❑Other (MIM 9195 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the=: employees. As quoted from the "law",an employee is defined as every person in the service of another under any cc=-- 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 the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recewe: 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 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 rener of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h. 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 requirements of this chapter have been presented to the contrac=-- 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 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 yc-, are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of th 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 permidlicense number which will be used as a reference number. The affidavits may be returned io 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 Oluce of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406,409 or 375 I __ I`` �1ee �am�nw7uuea� o�✓�aaaae�ivae%�s DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION.SUPERVISOR LICENSE Number Expires: -` __ Restricted Ta �9 eg S V ART.KUR 1 DOI�OFF 19 McCORMICK OR w W BARNSTABLE, MA V666 ✓`b ��"�•'�O==IUEQ�IR�viwWf[C�L W.T14 �i Tye xy aiiMi u �MOME IMPROVEMENT CONTRACTOR, , . .; Registration, 104499 _ t ` YPe PRIVATE CORPORATION Ezpirati'O.nn ..0 07/14/00 x ,1e ;F CART DOL60FF BUILDING/REMODELI anoMiNi �iiuRtle� r s� do )s r f�44) r,ERs fir F- D© R tj0 sr F(VDs Nei/_s 04N1,7ED /`' fts7'C N eP©S r S Mlg-X 7 ©,c, . . t',, = 1000 Ins i L = 1.,300,0UU psi 131pic,al V,11L1CS r0r SODUIerii-Yellow Pine #2 (P1'eSSUrC; 'h1-e,'1tecl) Exterior use (e.g. (leeks) oist Size Joist --�-- Spacing i 2x6 W 2x10 2x.1.2 12" �9-G I 1 :14-3 17-4 16 7-4 1 U-U - 12-4 15-0 2U" G-7 g-1 i. 11-U 13-5 24" G-U 8-2 :lU-1. 12-3 �JgEIV IS 3� f�U OR LL_ �01ST 4lUGE'�S N MA A �Engineeaasftqbt.(3rd floor) Map Parcel 1)C7Q ` Permit# L3/0 Qlf House# Date Issued 9S Board of Health(3rd floor)(8:15 9:30/1:00-4:30) Fee Conservation Office.(4th floor)(8:30-9:30/1:00 7 2:00). Planning Dept. oor/School Admin.Bldg.) ��►�rq, Definitive an A pr ved by Planning Board 19 SAMSTABLL MAM , FO 9- TOWN OF BARNSTABLE Building Permit Application Project Street Address Village - j/ W4.)/5 R T Owner Y\ U_{ L_4� (Z Address Telephone Permit Request �l Ci a CRP First Floor _ square feet Second Floor square feet Construction Type Estimated Project Cost $ $Oo 4 Zoning District Flood Plain Water Protection Lot Size GrandfatheredQ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths):Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# - Current Use Proposed Use Builder Information Name d-e04 W 0 6101S:Z 7 Telephone Number Address 4R A avi C'/Gl License# Home Improvement Contractor# j/o25� 6 Worker's Compensation# /3/,5 3d73 Oj� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 440 e) SIGNATURE DATE Jar 9 Sf BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) f FOR OFFICIAL USE ONLY, * FRMITNO. (>> � DATE ISSUED'. MAP/PARCEL NO. fit„ - , ' # � t f � � ' � G~ •.. rT^ � •a v+l + t E { " �" .. Ir ADDRESS + ' .� ! VILLAGE OWNER ` � � �# 'Ms t `' + f ¢ •• t .,1 1 t _ •T �t + r `: 1 DATE OF INSPECTION: FOUNDATION FRAME INSULATION �` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH } f FILIAL GAS: ROUGH FINAL FINAUBUILDING t - i DATE CLOSED OUT. F f ASSOCIATION PLAN NO. e f The Town ®f Barnstable • sssxsrA3r r • tee$ Department of Health Safety and Environmental Services 1"9. BuiIding Division 367 Main Stye=4 Hyannis MA 02601 f Ralph Crosser- Office: 508=90-6227 BuiIding Comr�- Fax: 508 90-6230 t For office use only Permit no. Date AETMAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 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 nets least ne ce or building be done by registered contractors,its or structures which are adjacent to s certain exceptions,along with other requirements Type of Work: Est.Cost 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 5I,000. BuiIding not owner-occupied Owner pulling own permit Notice is hereby given that: DEALING OWNERS PULLING THEIR OWN PERMIT OR HOME MOROVCMENT WORK DORNOT SHAVE CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL ca 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. D to Contractor Name Registration No. ~�` •+`'' Tllc• C�Irrr�rluitli•eu11/t of:311IS1uc•11utiClls ' Dertirtlllelzi of IlldiarrialArt:ctdents gf!CgOf1nyeS&gallonS rx •y\ji ii:{ :-�'.:�, ;, 608. if•uxhillgrulr Street - 4-; •,: .a- ' �: � Bistirr. .11rr�i: (1Z111 Workxrs' Compensation Tnsurmnee ARd::v it `1liPiic nrinfrirntatinn plc•tse PRTNTIe�+NV �-�-Y._.--r__•-- InC ill" '7 / / /T C%„ r Ctit 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in an} capacity I am an empiover providing workers' compensation for m, employees working on this job. uitlrrvc• cwm- nhnne#• L iin•t! f a G ��'� [ I am a soic rroprie•er. ;cneral contractor. or homeowner(circle olre! and have hired the contractors listed be. x nc the "Oilowing workers' compensation police:: cmmn:rns n trot cir • "hone d• in<nr-nrr rn -s--.—. r_ rnmr,�n� ��rnr• ntirlrr<• rirs• "hone#• in,qnrnnrr rn. nnfic � • Atticn 3udition2i sneer If nec=2nrti' �,r,f....ar�� •..•�. •r......�.. ..��..�.�..—�v: .�....=.. __....— te impositionF:uiurc to%ecure cm•crnce ::s required nuer tectron_SA of h1GL 15-1 ran lead to of enmtnal penalties oi'a line up to 51.!OO.UU anur�: uric •.cars imprisonment as %sell as civ ii penalties in the form of 9 STOP NVORK ORDER and a fine ofS100.00 a day against me. 1 understand that : cop, of this statcmcitt nta% be furs nrdru to the or icc of lnvcstitstions of the DIA fur coverare verification. 1 do rrerchi. r-;i� wrrr�r t'lviu attd pcnalt' s njperjun•'tlrat the informarion prorided above is true uurr/d correct. Datc //S 7 7 _ aflic-1 :uc unt%• do lint write in tttis area to be compictcd by cityor town ofrciai permitilicense ,Uuildin_Department cit} or tnt%n: Licensing Board t.. — cheek itimcuiate rrspanse is rcuuireu aJeiieimen's Ufricr m �• E:Ilenith Department . Phone 0: r•Uther_.�— Massac.':u.scns Gusted Liws chapter 152 section 25 requires all employers to provide workers* colllpcns>;Fi;:rt etnnlovees. As y110ted Irani the "tau".an c•»rplurer is defined as ever}, person in the service of allother unc�:r contract of hire. =press or implied. oral or-written. An einpim- r is ciciined as an individual. partnership. association. corporation or other Iegal entity.--or any my cr the Furc__o cnua__ud in a joint enterprise. and including the left 1 representatives of a deceased employer. ar rccciVer or tnrstee of an individual . partnership. association-or other legal entity, employing employees. Hc%%e•. . owner of a dwt:llin__ house having not more than three apartments and who resides therein. or the occupant of:!:e c!lin�_ !roust of another �%-!to employs persons to do maintenance ;construction or repair work on such dtir�eii:::_ or on the __rounds or building appurtenant thereto shall not because of such employment be deemed to be :,.n er NAGi_ . ia.ricr !5= section :5 also states that CAW%• state or local licensing agency shall withhold the issu.:nc_ of a license or hermit to oper•nte a business or to construct buildings in file conimonivenith for ::1-.1- ic::rrt Who lens not produced acceptable evidence of compliance with the insurance coverage rcquirc:i. neither the comtnonwenith nor anyof its political subdivisions shall enter into any contract for aie pc-tUrmz::cc of public •.earl: until acceptable evidence of compliance with the insurance requirements of this cl:ac: pee:: presz::tec to the contracting authority. Appilc::nl.s (!ease ill in :hc workcrs' coinpensation affida%'lt completely, by checking the box that applies to your situatic-1- c: suczivine cotncany names. address and phone numbers as all affidavits may be submitted to the Department of nc triai .�cc:'ecnts for contirrnation of insurance covem`P. Also be sure to sign and date the affidavit. Tire :cti is --houid be -true red to the cin• or town that the application for the permit or license is being requested. idents. Should you have any questions regarding the "law" or if you are c :he Jcra;tine::t of Industrial acc rec �.'-Crkcrs" compc::sztloll poiic}'. plerse =11 the Department at the number listed below. City )r Fw ns :ha: the zffida%•it is complete and printed legibly. The Department has provided a space at the bo:.: the :: • aa� it for %•ou to fiil out in the event the Office of Investigations has to contact you regarding the appiicznt. be _ : to fill in tite permit/license number which will be used as a reference number. 11e affidavits may be -:te Department by mail or FAX unless other arrangements have been made. Tit: of IliveztIazrjoils would like to thank you in advance for you cooperation and should you have my que_: piease ao not hesitae m uive us a ca11. -:e=r=n,ent s address. telephone and fax number. The CommomveaIth Of Massachusetts Department of Industrial Accidents N-M Office !If Investigations 600 «'ashington Street Boston, Ma. 02111 fax T: (6I7) —, Z;-7749 46. .411) �r _ �- (�Y'� S � r.•� Y ; j r *'�-'i�tr[ ram* ,t d ? t.✓f V� �s°:�[ •�..�C No, �l�r^':[Mr"�`i4 %�• '��'efi "� .i.: x� -isad S _ 2 ME IMPROVEM ��t � } B°ara of EN , CONTPgC'TO "_ ` > - �, Buljdi n RSdREGI RA f' tOne �gsf�burt ,n e9ua iois anct. t - TiOf� ; h ru z ,:Boston � �ace }; oom andards ssaIV ch301 of r HOME 4-7 uset IMPROVEMENT ' r c Registry ��CONTRq N �fi r °T tion 112536 . }� TOR � ;� YPe OBq r �`EXP1r � s�aY { i� 4/0 atio 6/ a a"` °R x tS "Ax. ,°a •fa„- ls�0 c� i'.+.� �u•� r f 4'� � if" t` Z4C �4 E '� q 4�1 '°.'3_A' 4"+' •:. ERAS F. �"� t,ER CpNs DEANTRUC 7'IO is ti. F "71 TARRAG')N COTUIT .� MA 02635 ti