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Home My WebLink About0321 PITCHER'S WAY Engineering Dept.(3rd floor) Map ,%�,Q_ Parcel crmit# 0'9 House# , 42 /Z±2� Date Issued 10 -1S Fee cs or - . -TOO i P p . (Tst tloorMcffo—olmin. g. 1HE rq BARNSTABLE. MASS $' s639• TOWN OF BARNSTABLE Building Permit Application , Itreet Address Village fi_Alr a, ..�-� Owner 2� Address j / Telephone Permit Request S First Floor square feet Second Floor square feet Construction Type ` Estimated Project Cost $ j e7rA. 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 Kings 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 /i Builder Information d Name Telephone Number Address �� , „� 4�; License# :0 Home Improvement Contractor# f 0 2 f a d, Worker's Compensation# C V 0 d 12 16 a? 1 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 Ld / BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT ls.O. 1 �� DATE ISSUED MAP%PARCEL NO ADDIRES$; ` VILLAGE . OWN R DATEbFANS ON: FOUNDATION x FRAME INSULATION FIREPLACE . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ` ROUGH FINAL FINAL BUILDING ! DATE CLOSED OUT ' ASSOCIATION PLAN NO. ` The Commonwealth of Alassachusetts Department of hidustrial Accidents 600 WitAington Street Boston, Alas. 02111 `-' Workers' Compensation Insurance Affidavit �p��ltcant mf`ormation• Please PRINT.... y s, , nam loci ion• 312 i City 12hone# I am a homeowner performing all work myself. a1 am a sole proprietor and have no one working in any capacity 77.'f�`..nr,M"!!'{ 'x'P�'."'•'.T .r .� ,.�mgvx."y �7ta.., .rt w.w�X'B�,T;o—::,�¢�'1 yl9�PY`. �T»+-�!?`"""^°.gl� al^rn. t+..grTlrr......,er.vg,• 1.:..:..:d::a...., �.v... .:.ra.,,n..mx�ra:...r.u. wa •-' 'k.il.w.0 ri.:�..:s�,r .• . .o—,-,..,... .:R:s_ti. -��la�..�...r..:'...�..:�..�.�..•:�. .1 am an employer pproviding workers' compensation for my employees working on this job. comp any mime f!i/�rt(.[n-ha.».1' ��?K'��i�r✓c .w.� pdtlrecs• 00? e �.cc�-•srd� cit �.. G?° io-w.�s� phone#• 7 '7/ 's.2(0 6 T 1 insurnnce co policy# W C. G f 5"2"Z kpr ..�.. ......'? : V Y rv� ;:y� .:_ .. !!O.!.:a',Y�+o,I.t�fYYYM+wT°i�»?'!1�';Y:,•N��!P,�._ p�, ,�� ....:•"a+i�j_L•.�2 Y.mi.�w�+s•-,.ar..vy. ' {.a.._-.a...w{n.�r:..n.H.u»_"... -- '.,r_...4.�."r'r._Wt• - L i 1 am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comijany name: ' cites phone#: insurance ce policy# _ .. Ire:.n•:. -s�wati=•^r^r "^T•.Ye.a .f;'t,,. ..y✓'T^•-Marc., I yY".:.--.: �7`",1"'q'r ��,'{''g�rr,:.`t'� .' w .t'94s 4^t_ `1""�[^'is:' �c�a.i:a.� �._»�.-..,.._...ram. +..._�._.-.dl�n• �... .d::t:ir.lr� -wG»�.i b:.itls:..iYJYF company name: .address: city: phone#• insurance co policy# Atfac_hadditional`shcefifriecessary�nr.� �� "+"gJ"�s;'=�Y�r,g�o'S„�q�: nfc,£"� 4. 'c,R' 4��•+pt_��6� ,:,t �'+^ Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1»500.00 and/or one years'imprisonment as%vcll as civil penalties in the form of a STOP AVORK ORDER and a fine of S100.00 a day against me. 1-understand that a copy of this statement may be forwarded to the OMcc of Investigations of the DIA for coverage verification. I do hereAv ce under the pains and penalties of perjury that the information provided above is true and correct. Signature d� Date /d/ a S�4 Print name i Ct E ig a J q d t ti,44 rn i Phone# official use onh• do not write in this area to be completed by city or town official city or town: permit/license# r'1Building Department C]Liccnsing Board check if immediate response is required OSdectmen's Office C]licalth Department contact person: phone#; nOther = a: (n'ised V95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted irony the "law", an emplitme is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An e►►►pl(tver is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foreaoino 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 dwcllin�o house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the ,rounds or 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 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, 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. a 7' Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation and supplying company names. address and phone numbers 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. 7777 Citv 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 permit/license number which will be used as a reference number. Tile affidavits may be returned to 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. zz <:. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 CF IME Tp� �O The Town of Barnstable snxMMM 9q� 1e� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. Type of Work: n Est.Cost 2 6dU. Oe) Address of Work: 3 / 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$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR; DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby a ply for a permit as the agent of the owner: d,7 3 �2 ,� Date Contractor Name Registration No. OR 1 Date Owner's Name -.t�= �19y„ti�-•� •z�oa •�.•��•�4 . ,fie _ 013, ln7 mar Iv • �� 1 5 yy;3'i}2O'0""`.�._V'r•"ri°$tf°�g��"�,,�.` t � .` •f) w�"k�i � .{-jr'lY�k'a5f, ,may, s3: ��