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Home My WebLink About0006 NOB HILL ROAD ~ " r M p 3 Parcel (c9 L4 Permit# 3/ 9`319 House#' f!i Date Issued `7lr, Board of Healt 3rd floor)(8:15 -9:30/4:00- 3l � Fee Conservati I Office(4th floor)(8:30-9:30/1:00-2:00) Plannin ept.(1st floor/School Admin. Bldg.) �TME►p;_ DXveApproved by Planning Board 19 ��: _ BARNSTABLE. r r - MASS TOWN OF BARNSTABLEF°"�+'� Building Permit Application ddress klaia- �A Village Owner `Y. Address Telephone '7'2 FN- Permit Request . 'A �.►\e Sa,�,��G�e�► t &i 54100 i rl/!L_✓ 11 kmx f o First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Jo450 . 60 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑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 i 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 M A C S A e eb A Telephone Number Address C%( \e License# (�5 14 Home Improvement Contractor# 1 a b d® Worker's Compensation# 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) s, r - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ~' MAP/PARCEL NO. ADDRESS - . Y + i VILLAGE OWNER +14 DATE OF`INSPECTION: ` FOUNDATION' FRAME r , i INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL a GAS:. ROUGH FINAL ` 7, r FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. , 1 io- 1 aF tt,t±r� ' D The Town of Barnstable • ttnsnrsrast,t • 9� tee$ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Building Commissic= Fax: SOS-790-6230 For office use only Permit no. Date 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. ��''� Est. Cost —2 6a� Type of Work: + Address of Work: QSQ% ` � 'A Owner's Name yA,)� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,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 ner- Date Contractor Na a Registration No. OR Date Owner's Name The Commonwealth of Massachusetts r, S j _ Department of'Industrial Accidents . _.. 91M.o!/nYestigadons 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit 7 �'in6asttta arstl�r%��%%%//////��%��//%�/�/��€'�".�`€��1�'C�'///////��%%%%�%%///��//O/%%%��////%<% ,,,,,,.. name \11A0\L— _location U 4 A\4�n city ❑ I am a homeowner performing all work myself. [ I am a sole proprietor and have no one working in anv capacity ❑ lam an employer providing workers compensation for my employees working on this job. cam any name: address: hone#- city niicy# insur:tncc cn. ❑ 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: - - tom nnv name- .... address. hone ft. city insornnce co. catn anv name' I address: hone#: city: ....... .: ... poiicv# insurance %%/% Failure to secure coverage as required under Section 25A of MGL I52 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. !do hereby certify der th parses an��Ifrjury that the information provided about a tiuo and carted signature GAL Date 2-(,- Print tr name Q�1� E�� A, Phone# fficial use only do not write in this area hi to be completed by city or town official o � permittlicense a - psuilding Department city or town: ❑Licensing Board QSelecnnews Office ❑checi if immediate response is required ❑Health Department phone b., ❑Others_ contact person „ty��9,95 P)A) - 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 contr 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 o the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receives 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 rene,, 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 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 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 yoi 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 permit/license number which will be used as a reference number. The affidavits may be retariR 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 Me 01 Invesdaidons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 HOME T ROVf;MEf�IT..C(1NTq,�C:? Registration 126480 ' Type - INOTVTDIJAI. EkplratIN O6/08/QO MARK HERBST MARK 0:-HERBST-- T-AVALON CIRCLE ADMINISTRATOROSTERVILLE MA 02655 License or registration. valid for individual use only -before expiration date. If found return to: One Ashburton Place Rm 1301 Boston Ma.02108 . - --- - . _ :� " fee �omvawn�ea>!bi ✓�ac/zude%� DEPARTMENT OF PUBLIC SAFETY EONSTRUC.IION,SUPERVISOR LICE)SE Nutber,__ Expires: ° Restrkc�ed Ta 00 MARK '"BST, 49AVALOp:GIR'" E OSTERVILLE, MA. 02655 Restricted To: 00 00 - 35,00o cf enclosed space (MGL C.112 S.600 1A - Masonry only 16 - 1 & 2 Fatily Holes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license.