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Home My WebLink About0276 OCEAN STREET �'�� ..-- c _ � � `� �, � -- - - - "--' The Cunfrrlomvealth of Afassachusett-r Department of lfrdustrial Accidents 1 i ' i Office ofhestf zaaffs 600 ff ushin-ton Sired! •' ,;+'` Boston.Alas OZlll Workers' Compensation Insurance AflTdavit _ James E . Moriart LQCII on* 24 Plant Rd . #3 nhonc# 5 0 8-7'71 1017 Hyannis MA 02601 - t [I I am a homeowner performing all work myself. ® I am a sole proprietor and have no one working in any capacity I am an employer providin; workers' compensation for my employees working on this job. ornpativ name: itlr � • nhnnciq• • ,. cir� • insurance co, ------*- I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who hz the following workers' compensation polices: COmrIlriv nn nhonp et• - noiicy N I n c u r n n c f [o ,a,-�,--v..-.. n. r�•raf+o�v.�c�—+�r�ss7 �*o �"Ta'*a's'�'� — rim env na e: nhnnr cm- in5urincc co.cu aoiicti•tt .. - 77 :Attach additional sheet _ Fuilurc to secure coverage as required under Section 25A of MGL 152 ua Ind to the imposition of criminal petulucs of a fine tip to S'1•SOO UO aait/c VAC Vcsn' imprisonment as ..cll as ciyii penalties in the form of it STOP NVORK ORDER and a fine ofS100.00 a day against me. 1 understand that copy of this statement may be forwarded to the OMcc of Investigations of the MA for coverage verifindoo. l do herebr cc ify rider the pal enahics of perjurr that the infori=ion prm7ded above is true andfcco�rrem �7 /rd Sicnaturc Date Print nam J Phone# 508-771-6768 7cir, se only do not write in this area to be completed by city or town oMcW o��n: permit/llcenn r•1 f3uilding Department E C3 t iccasiag Buard check if immediate respunse is required �Seiectmen's Ofliee r 011eaith Department i contact person: phone q: —Other �- y Information and . Instructions cttan ?5 ra` u`ires all employers to provide workers .compertsation for th cr 15_.se q , t�h , General Laws chat tv Iv1a�s u. ctt. G P �n�pl��cgs. As ducted from the "la��": all-inirhdii,c is defined as every person in the Scn tcc of another under r at iv or hire. express or implied. cull or1A'ritten: kn rniphwer is defined as an individual. partnership. association. corporation or other legal entity, or any two or mo the forcping enua�_ed in a joint enterprise, and including: the legal representatives of a deceased employer, or the I'Iccci\,er or trustee of an individual , partnership, association or other legal entity, employing employees. However tl h\\ncr of a dwelling, Itctusc haying not more than three apartments and who resides therein, or the occupant of the ��c I I ink, boost of another ��ho employs persons to do maintenance , construction or repair work on such dwelling he r on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employ( GL cltaptcr 152 section .'S also states that every state or local licensing agency shall withhold the issuance or encw:d of a license or hermit to operate a business or to construct buildings in the commonwealth for an. I �plicant N%•ho has not produced acceptable evidence of compliance with the insurance coverage required. dditionally. 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 teen presented to the contracting authority. %pplicants 'lease •i;l in the workers' compensation affidavit completely, by checking the box that applies to your situation and luppiving company names. address and phone numbers as all affidavits may be submitted to the Department of Industri;:l Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit The ffidavit should be returned to the city or town that the application for the permit or license is being requested. iot the Department of Industrial Accidents. -Should you have any questions regarding the "law" or if you are require 0 obtain a workers' compensation policy, please call the Department at the number listed below. -- • ....- __ !`-�>. .. - _. . :,,.:. ...,.,.:.._.. ::=-ice... -irA or Towns ?lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom he affidavit for you to fill out in the event the Office of Investigations has to contact number.you regarding T7ie affidavitsl applicant. may be returned )e sure to fill in the permit/license number which will be used as a reference lie Department by mail or FAX unless other arrangements have been made. ilte Office of investigations would like to thank you in advance for you cooperation and should you have any questio lease do not hesitate to give us a call. ie Department's address. telephone and fax number. The Commomvealth Of Massachusetts Department of Industrial Accidents r Office of Investigations 600 «'ashingtan Street Boston, Ma. 02111 fax #: (617) 727-7749 Rhone #: (617) 727-4900 ext. 406, 409 or 375 4 r Certif icate of Slame Re.515tance REGISTERED ISSUED BY �' �'`"`'•.� FABRIC Date NUMBER SNYDER MANUFACTURING CO. manufactured +. 3001 PROGRESS STREET 5/12/92 ��'F•�••+°moo F-140.01 DOVER, OHIO 44622 AIN F-1d0 This is to certify that the materials described on the reverse side hereof have been flame- retardant treated (or are inherently nonflammable). FOR Top Tec _ ADDRESS 1905 NF Main StrPPt CITY Simpsonville _STATE SC 29681 Certification is hereby made that: (Check "a" or "b") (a) The articles described on the reverse side of this Certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used..................................................................Chem. Reg. No............................. Methodof application...................................................................................................................... ... ® (b) The articles described on the revhrse side hereof are made from a flame-resistant fabric or material registered and approved by the State Fire Marshal for such use. Trade name of flame-resistant fabric or material used PRV Reg. No. F-140.01 The Flame Retardant Process Used WILL NOT Be Removed By skiing SNYDER MANUFACTURING CO. By Tom Kelker Supery s r Q y Control Name of Production Superintendent Tile ##921972 201X 30 ' Canopy White Assessor's office(1st Floor): > !/4 Assessor's map and lot number J �.D 7!1 p`THE>p Board of Health(3rd floor): " �p �� .-��- '� o _w-"Sewage'Permit number Engineering Department(3rd floor): - —7 Dlu�AB snt� House number � / + , �r oQ�0}q.6`�� Definitive Plan Approved by Planning Board i a 19 tl c��r APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only f TOWN --. OF , BARNSTABLE ` BUILDING INSPECTOR APPLICATION FOR PERMIT TO _ t TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use /!�l/4'G �i��y �yv �L✓�� Zoning District Fire District �V y Name of Owner r�i('1�� .t`i'� ��091. Address G'�' / / �✓ Name of Builder 10�-011 11m' 4�_zd'r/4� Address Name of Architect 'J �� 6_e6a,4� Address 1,I'My 76) Jam' --�.e� J /��✓ Number of Rooms Foundation ✓U�� i M Exterior aJOC) o Roofing Floors `r Interior 'Ex S Heating ' t�� Plumbing ' Fireplace Approximate Cost doU� U� Area J ®�1 Diagram of Lot and Building with Dimensions Fee fc ,q w Doi -t *&Zk ie 11,6A1 ti� x✓STD c,�� , ` x�sT�ly WN&.5 Ilk a 7' J ! OCCUPANCY PERMITS REQUIRED FOR NEW DWELLING 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 TtASCAL, CAS LOS � • -�`-��j��. Add Porch � - c- No -;Permit For I Single Fdmily Dwelling tE; ✓ i Location 276 Ocean Street a.. Hyannis Owner Carlos Marascal, i. Type of Construction Frame oct Plot Lot 5. Permit Granted' �;Ap r i L-2 9 , 7 '19 ,91 Date of Inspection ' .19 + w t Date Completed 19 _ } — y ` ;.!' ! is , { ' f•-,i f r+'^,dy,�t-�4-ei�nii�r•.(�.ti. ,rlwi•L-,,,"Nr+.r •.._",aY .rrr'.. ..:e.v�.*��,,.....---^-i.n .<s,.•--.•'•.-5.�..,-rn.��...�M:,,i..rs-7'.,.:�,...t+':.,tr.,•.,,•,,7''t`�'�C`•FCC}�1,�,,{s`..r'8R^;Ax.F-.+•7f'r�3hza.�ti�., Assessor's office(1st Floor): ,/ � Assessor's map and lot number J �f `` t., ' pf THE>o Board of Health (3rd floor): �p •- � e�y ` Sewage Permit number 1 Z. DdH39TSDLL i Engineering Department(3rd floor): ,L^.�1!��' �,,. . WAS& House number, �i dC T4 i63o• Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:36 A.M.and 1:00-2:00 P.M.only TOWN ..: OF BARNSTABLE BUILDING INSPECTOR ; APPLICATION FOR PERMIT 70 �j// P v TYPE OF CONSTRUCTION / 1-7 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location t , Proposed Use Zoning District Fire District 1# Name of Owner�i(��/�s � s�e/� Address �� Y,. �i �3✓ Name of Builder 6� h �T� ��n`/E Address, Jai Y Name of Architect (/L d�JS%� (S-P ejLl/z-Z Address 7,,) ��J'o�/ /��✓ Number of Rooms Foundation Exterior 1-B Roofing t Floors t' Interior >C f 5 Heating I s �• PlumbingX�S Fireplace Approximate Cost Area / Diagram of Lot and Building with Dimensions Fee �i..� k i(/o �.•X✓STD '. Cy�/I/ ,� / ,�.XI7J(J�Cvp1Gs CY ✓�✓may I k I�f OCCUPA CY PERMITS REOUIREWFOR NEW DWE G 40 s I hereby agree to conform to all the Rules and�*,Regulations of the Town„of.Barnstable regarding the above construction. t Name _. _ Construction Supervisor's License >�/��L/ MARASCAL, CARLgs- A=325-044 No 34307 Permit For Add Porch '- Single Family Dwelling Location 276 Ocean Street Hyarini s Owner Carlos Marascal i Type of Construction Frame Plot Lot Permit Granted April 29 , 19 91 Date of Inspection 19 Date Completed 19 f r e PERMIT COMPLETES Am41" , 1///V Engineering Dept.(3rd floor) Map Parcel �01� at-Permit# House# Z2 Date Issued —,2 oard of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation Office (4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) TaE rq Definiti an Approved by Planning Board 19 BARNSTABLE. 4 TOWN OF BARNSTABLE Building Permit Application Project Street Address Z �Tr Villageyyi�i�s Owner Address Telephone Permit Request go' t) 7IZ`�c First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 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 p 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 s 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 Auth rization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# 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 PERM DENIED FOR THE FOLLOWI REASONS)