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HomeMy WebLinkAbout0018 MURPHY ROAD f B 1Y1krPh� �G1.� Town of Barnstable *Permit# Expires 6 months fern issue date inxtvsrneLF, ' Regulatory Services Fee '0� nines. M9. �0 Thomas F.Geiler,Director prED'"a`t. Building Division m� , Tom Perry, Building Commissioner O c ; L 200 Main Street, Hyannis,MA 02601 A N 2. Office: 508-862-4038 005 Pax: 508-790-6230 TOLivN Off. SAR;N������ . EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number _30W25Z Property Address /mee" ep, residential Value of Work f!4,20 ' ,Owner's Name&Address -rUMe -86rrrYA' 60 61ie/ �_a r, Contractor's Name /�/ V ell? d��,11 Telephone Number ,!�21�v 99 7�/�� Home Improvement Contractor License#(if applicable)_������ Construction Supervisor's License#(if applicable) VorL's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 12 r IF, / Workman's Comp.Policy# ' Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-r f(not stripping. Going over existing layers of roof) Re-side ❑ 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. ***Note: Property Own must sign Property Owner Letter of Permission. t Signature Q:Forms:expmtrg Revised121901 s a , °F,KKE r° Town of Barnstable Regulatory Services M s�iE Thomas F.Geiler,Director 1 39. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete`and Sign This Section If Using A Builder as Owner of the subject property hereby authorize NArz:f�ll to act on my behalf, in all matters relative to work authorized by this building permit application for(address of . job) x 12 � d Signature of Owner . at PrkiVNanie Q:FORM&O WNERPERMISSION - _ The Commonwealth of Massachusetts 07Department of Industrial Accidents V 600 Washington Street Boston,Mass. .02111 �. Workers' Com ensation.'Insurance Affidavit-General Businesses ir y:r i� :N.fy+N 1%1� ''v.Rtivi / address: C S7 V ; G citV MJQ JIM, state: �0 Zip: phone# A 9971111 work site location(full address): ❑ I am.a sole proprietor and have no one Business Type: ❑Retail❑ RestaurantBai/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,.Autos etc.) ❑I am an t em to er with m Tees(full& art time): ❑Other I am an.employer providing workers' compensation for my employees woFIdng on this job.. 1. ti... sompifiViiii e e _ - i��.:�•>� -�' .fir.. • L`L c" •It L/'�� . . hod e:- -ell 5. msurance.co:::.. ::a�..._.. I h e t r and v hired,the'jind- �d, a 1 ro rie o •.en ent contr ctor li ed am a so e s st belo I a w who have "e -.th f 11 0 owin worker F P eP g s compensation polices: P company name: eadress: - e i p on insurance co....,. . '�,...::-_,.�.. :. �;::: :..;• : >.; � Tic _#.': - - 'G. coman. name •. ..,:.............. ..: ...... .. p Y - address•. • - eltvi .nhone:d#E .. .. y.:ti,.. ..• insurance cb. olicv:#"> - Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a&;up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and pp ties of perjury that the information provided above is true d corr cL Signature Date I .2 Q 7. Print name 26to r* !e—(<U in Phone# 5 Q 9 7 ILZ MOM official:onlydo not write in this area to be completed by city or town official city or t permittlicense# ❑77Building Department ❑Licensing Board _ ❑checte response is required ❑Selectmen's Office ❑Health Department contact phone#; ❑Other (noised Se Information and Instructions Massachusetts General Laws.chapter 152 section 25.requires all employers to provide workers'compensation for their.. employees. As quoted from.the i`law", an employee is.defined as every person in the service of another under any contract of hire; express or implied; oral or written. oration or other legal entity, or an two or more of ed as an individual,partnership, association, core g tS'� Y An employer is defined 'pint ent rise and including the le al.r resentatives of a deceased,employer, or the receiver or fop-going engaged in a� erp g g eP the g � 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 bean 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.cor=onwealth 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 requirements 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..Please supply company name, 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 you 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 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 pernit/license number.which will be used as a reference number. Tbe.affidavits may.be returned to the D epartment 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 DP e artm ent.of Industrial Accidents elfin of wesfl®atlens 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406 �� to , .. .. �..JQ q / � !� Assessors map and lot Ym er ..........:.......... ..... -'>. . ( TNer I ✓ Sewage Permit number ..� .... _ v, o ro / Z HAUSTADLE, i House number ..............:..................................... ....... rasa 9 OQ i639. \0� ��MPS Or TOWN OF BARNSTABLE 1 s, BUILDING INSPECTOR APPLICATION .FOR PERMIT TO .......... .r ......................:,....................... .................................. ` 'TYPE OF CONSTRUCTION .........'� C,� J....:r ..."171 ,V./Ci4�...:............................................................ .- mot' .......�.::.. '.:.............................19:':rf N •, TO THE INSPECTOR OF BUILDINGS: The undersigned hhere"bye applies for a permit according to ;the following information: Location ........�. .....�!1,/ ! ' ......� ... �/......... . .r !"t r�c . .... //' .��� t................................................... ProposedUse .................... ... ..........,...............................................,......................... ZoningDistrict ..................... .....................................Fire District ................ ............................................................. Name of Owner .... 1/r19.... ..../' .�gff. AI�U�', Address ? ........ t1... ., �......r, :....... Name of Builder �.rl?ta7r/f'a.r(.�. �1 cki.:�?'�.. ..........Address e��.���..��C� „��f1'I�Ei.ld?.. �C�.........'9��?�... Name of Architect ...........Address `.�. 1 Number of Rooms ..................1...............................................founcla.tion �����d!r....;!�!(��t h Exterior ...... a, V)..........................$Roofing a Floors ....nil�'/r��......................................................:..Interior .................1.................................................. ........:w .Plumbing .........: (2 1 Fireplace .........................................:....................................::Approximate. Cost ::..:.,.............., ,.:................................ {v S Definitive Plan Approved by Planning Board -----------------------_--------19________. Area ........................................; , 0to Diagram of Lot and Building with Dimensions Fee ................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t GAIW I t ) f iIvrohY w,ay OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � _41 Name !.........7//?� /!P .............//�Q�! l/1 !J ..........s..... Construction. Supervisor's License ... BETTENCOURT, W=IAMP F. A=309-179 No .... Permit for 'd...Garage ge......... ........ .... Accessory to Dwelling ............................................................................... Location ..18..Murphy..�W ...U-C.................. .... ............. Hyannis ................................................................................ Owner ....Wil.4am..F....Be.ttenc.ourt.................... . ...... •.... .... .......... ........ Type of Construction Frame............................... ................................................................................ Plot ............................ Lot ..................................... August 8, 84 Permit Granted ............................... .......19 Date of Inspection ....................................19 V Date Completed ............... .....................19... i3'k 4• _'.. _may. r. .. ..��., r.a.. r K' �,:-e 1 r '� :M1`y .f:iF.. Ih'.m^T." al �✓ , � L3 Assessors map and lot num er ...................... .. ..... ., THE ✓ Sewaje Permit number l 89H39T11X i Housenumber ...._. ..................................................... rasa • O i63q. `00 �O MAR A,. TOWN OF , BARNSTABLE BUILDING '... INSPECTOR APPLICATION FOR PERMIT TO ..........: PAIKA.G.11:........:....fig........,............22 .............................. TYPE OF. CONSTRUCTION �aao....`-"...`b/ .........::. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inffoorrm/ation: Location ........�.7.. � .... .a. ........ .tali /'L<..5°. ........ 4............ ........................... ProposedUse ..........CA :.G?...E.....................Gl'1. .... .4 .......:...................................................................... ZoningDistrict ..................... .....................................Fire District ........ .. ... ...................,..................... Name of Owner .....W�I�.... .....� ����t��'ll� V�'. .%• •• rAddress •�.:.i.Orpd;1 !......Val.... .���,�:....... Name of Builder .f�[ / ✓ ./ . . 11:� '�f .III..........Address o' �'�..0 I...ler'��C1Qlli......Rd......... ... Nameof Architect ?..�..........................Address 1 ...................................... .................................................................................... Number of Rooms '..................I...............................................Foundation 0AWeAr..../7/.d ............... 99.. /©� • ', .rr/ ...Roofin ...f�9c�l, .... /�l. P3' Exterior ......�••..>..6�..............: ..� . �.�.Oi ...................... g � ......:...................... P- Ci O'71�.C'.........................................................:Interior ..................................................................................... Floors .... ..dam.. ..... Heating ...................................................................................Plumbing .......... ............................................................. .... 641 Fireplace ..................................................................................Approximate. Cost ....,r.,L......... Definitive Plan Approved by Planning Board ________________________________19_______. Area ! 3� . �- Diagram of Lot and, Building with Dimensions Fee o SUBJECT TO APPROVAL OF BOARD OF HEALTH ' 1 t � 22f-0, I �� � �R, � . Od OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License ... l �jt. . BE"I'TEIVCOURT, W=IAM F. No 26818,...„ Permit,for B Garage t ...... ......................... 1 Accessory to Dwell ........ Location ..l .MOW.�014................ .Hyannis................................. .. ......... William F. Bettencourt Owner �- Type of Construction ..Prat......... .... ..... fT Plot ............................ Lot ................................ � •[- '�� � If Granted ...Au�t..8'... _... _9 84 'Permit (3 p Z Date of Inspection f. . !? �.....1.,.......119�7 � Date Completed A) , r r�