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HomeMy WebLinkAbout0133 PLEASANT STREET i 33 7�i � ,J' _ 3�� -o sG -- ti .a1 SOP °FtHE ram,, Town of Barnstable *Pert# -y Expires 6 nrol theft-A i ate Regulatory Services Fee r . 4 y + BARNSTABLE, ` v� 63. ,�$ Thomas F. Geiler,Director AlED AAA'I a 6 (v Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 0260.1 www.to wn.bamstable.ma.us Office: 508-862-4038 Fax: 50&790-6230 EXPRESS PERMIT.APPLICATION - RESIDENTIAIL ONLY Not Valid.without Red X-Press Imprint" Map/parcel Number (, ©tom Property Address ❑residential Value of Work ': .J c�Q� D a Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address iv�V� V\ zT- � Contractor's Name .\ C �-i/�j C �JV L� � Telephone NumberS�® y�~ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) � Z ❑Workman's Compensation Insurance PERMIT ` Check one: X-PRES _ ___ I am a sole proprietor n+r I am the Homeowner ){="(-1— — -- ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑_ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over. existing layers of roof); F Re-side #of doors ❑ Replacement.Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A cop f the Home Improve ent Contractors License&Construction Supervisors License is re ired SIGNATURE: Q:\WPFILES\FORMS\buil mg permit forms EXPRESS.doc Revised 090809 pyr 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 h, � <Fy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers - Applicant Information Please Print{Legibly. Name (Business/Organization/Individual): ✓ VAC 1 l Address: City/State/Zip: Phone- Are - you an employer? Check the appropriate box: " Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction ployees (full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity.'-, employees and have workers' 9 ❑ Building addition [No workers' comp..insurance comp:insurance. w ' 10.❑ Electrical repairs or additions 5. ❑ We are a corporation and its required-] 3.❑ I am a homeowner doing all work' officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12•❑ Roof repairs c. 152, §1(4),and we have no insurance required.] t 13.❑ Other- lshk__>G employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 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 the name of the sub-contractors 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 insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy# or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy deLlaration,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 penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. 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 certify i er t e pains d p alties o erjury that the information provided above is tri"e and correct. !�t fit. 0 O Si ature: Date: Phone# �O� � - Official use only. Do not write in this area, to be completed by city or town official. - I City or Town' Permit/License# Issuing Authority (circle one): 1.Board of Health 2. Building Aepartment 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other. Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract 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 of the foregoing 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 dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) 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,MGL chapter 152, §25C(7)states"Neither the conunonwealth 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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(UP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job.Site Address" the.applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. T o e ti t'The Office f Inv s ga ions would like to thank you in advance for your 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 Office of Investigations 600 Washington Street Boston, MA 02111 - Tel 1 -. # 6 7 727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia f. �YHE r Town of Barnstable .Regulatory Services EMMSrnsLE, ' Thomas F. Geiler,Director HASvQ 9. 1%639 A,0$ Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner M st Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize��� 4' 'ts GOkANf to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. I` of r Town of Barns able VKE Regulatory Services t3nxxsrnst.e, Thomas, =?:Geiler,Director MASS9gplE a,�� Building Division Tom Perry,Buildi�tbmmissioner 200 Main'Street, Hyannis;M,A 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print r iy DATE: JOB LOCATION: number street village ;v` „HOMEOWNER": y j" name home phone# work phone# CURRENT MAILING ADDRESS: x ~ city/town state zip code The current exemption for"homeowners"was extended to include ow=r-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land,on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that-he/she will comply with said procedures and requirements. t,V Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,•, that the homeowner certify that he/she understands-the.responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. y L, Q:\WPFILES\FORMS\homeexempt.DOC i Beaf✓ltof SiY�i'r�g`>E{eg rahJds-an an a�`�4 flu sachusctts - Dclrar tmcnt of Public SafctN :HOME IMPROVEMENT CONTRACTOR ? Board of Building Re!-ulations and Standards Registration: 1,23702 Construction Supervisor License Expiration: License: CS 66582 p i6 3/28/2011 Tr# 283147 Restricted to: 00 THOMAS C WHITE ' Thomas.C.White WOODWORKER LLC Thomas White ��� ` +/. '` 415A MAIN ST 415A Main St �V c; CENTERVILLE, MA 02632 41 C'entrville,MA 02632� Administrator Expiration: 3/14/2011 . ' T.': �, �1111111111ti 11/IIPr Tr#: 13613 _ f i f 'Licenmor re igtration valid for individul use„only before'ihe expiration--date:-If found return to Board•of Building.4egulations and.Standard� ' -One Ashburton Place-kni 1301 Boston,Ma.62108 Not valid without signature a. "PROJECT ^ _ ' NAME; ADDRESS {030 / . _ r . vl'Vt lS n s PERMIT#. 4-A.; C1'3; PERMIT DATE ROLLE x r •� ¢o e S ® rr z .: Data, erteed r MAPS p'rogaran 'o. 10 a, BY f, +Yf n v Town of Barnstable *Permit# o� �U7 U�t XqPRES Expi months jr�o�m1 sue date S ► ERMIT Regulatory Services �F Thomas F.Geiler,Director NOV 2 9 2007. Building Division TOWN OF BARNSTABLpm Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number D SG Property Address ma, Q Residential Value of Work Od ,0-0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address }. � C>S,�iZ uw Contractor's Name Telephone Number sooT g S Home Improvement Contractor License#(if applicable) O o`Z Construction Supervisor's License#(if applicable) , C, ❑Workman's Compensation Insurance Check one: Q I am a sole proprietor ❑ I am the Homeowner - ❑ I have Worker's Compensation Insurance - r Insurance Company Name Workman's Comp.Policy# SDL Copy of Insurance Compliance Certificate must be on file. P eimit Request(check box) '� � ,yj i s sea ,. .` a - "t `S^-_r .i� .'-e xt1.�`• "'. 'f Fr " a t ❑ Re-roof(stripping old shingles) All construction debris will be taken to; t � €s { �" U � E. As l °fie 4 r r " � 3f r� sr vu t w -. - ,N�,.n h @-°mac g. .`,rn''z s "'IN3,:�^ e-�t vs,'rLro' �F -- ! "�# r. .M r.s t .'-4�y $ # ❑Re-roof(not stnppmg Gomg over Zextmg layers of roof); u4;, r f � . r ; {g :'„�' 4 7 :"va rz ,, �t„u. M tr t F y 4 :FTj Re side - �` 'g Replacement Windows/doors/sliders 'U-Value "°.3 (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other,town department regulations,i.e.Historic,'Conservation,etc. ***Note: Property Owner mist sign Pronerty Owner Letter of Permission. of tb Hom Impr ent Contractors License is required.. SIGNATURE: Q:Fonm:expmtrg Revise061306 r ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations• 600 Washington Street Boston,MA 02111' wtvw.mass.gov%dia Workers}Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print LeLAbly Name(Business/Organization/fndividual): tMi A Address: City/State/Zip:C�a�+.�v �A C 3Z Phone t Are you an employer?Check the appropriate bog: :Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees(full and/or part time).*• have hired the sub-contractors 2. I am a'sole proprietor or partner- � listed on the-attached sheet 7. ❑Remodeling and have no employees These sub-contractors have g• Demolition to ee and have workers' ' working for me in any capacity. � y ,s g• Fj Building addition [No workers'Camp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10F Electrical repairs or additions 3.❑ I am a homeowner doing am-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself[No workers' comp. right bf exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no employees.[Na workers' 13.[]Other ' camp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Rm=wocmyko submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating•such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees• rthe sub-contractors have employees,theymust provide their workers'comp,polio number. I am an employer that is provldu g workers'compensation insurance for my employees. Below isthe policy and job site' information. Insurance Company Name- Policy#or Self-ins.Lic.# Expiration Date: - lob Site Address: City/State/Zip: 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 tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK•ORDER and a fine of up to$250.00 a day against thq violator. Be advised that a copy of this statement maybe forwarded to the.Office of" Investigations of the t)IA for incrmrnce coverage verification. _ — I do hereby certify the p ' a pen of per that the information provided ab aliase an'd correct SiDate: ' � _ Phone#' t�J.- � Cl?�G( Official use only. Do not write in this area, to be completed by-city or fowmofficiaL City or Town, ' permit/License# Issuing Authority(circle one): ' J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: , �VE A Town of Barnstable Regulatory Services • a * BAMSTABL% y MASS. Thomas F.Geiler,Director 16.19. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property ProP a Owner Must -Complete and Sign This Section If Using A Builder as Owner of the subject ro e P P rty hereby authorize ;41 A 1 q` to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of job) i z 4 0 7 Signature of Owner ate " Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISSION ns �/r dmgut 'and Standards' --- 13nxrd-q CTOR i H E IMPROVEMENT CONTRA Registration': 23702 ' Expiration 312812 0 0 9 TO 127366 �WOR:KER LlC ' Thomas C.White gel. White Thomas C� 415A Main'St. a/ Adniinistr.3tor- Centrviller:MA-02632 f Lie or�reg�str,tio 'id for ridividul use only before the expiration date. If found return to; Board of Building Regulations a'nd Standards One Ashburton Place Rm 1301, Boston,Ma..02108 i • . 1 Not valid without signature 4 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 S� Permit# Health Division 63& ?;A1A1 ___SQL,� Date Issued ��- Conservation Division Fee �l Tax Collector Treasurer AMlCANT MIJS1' OB TAIN T AIN NIV�CTION PERMIT FROM THE Planning,Dept. N 1N�ERINQ DIMION PIZ,Ti) ' . . : 'ECTION Date Definitive Plan Approved by Planning Board AitVr . 5 Historic-OKH A Preservation/Hyannis ,Project Street Address Village '44 Owner /�Cl�s 0 AK �,�. ,�r�xTE"R Address � r­-4 Telephone sue' Permit Request coKs cor. o>� .� lit /ce w� o Exva :t. a�st�uG�frvK Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type wa o111), Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family hd -Two Family ❑ Multi-Family(#units) Age of Existing Structure /dr Arl Historic House: ❑Yes i f No On.0ld King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl A Walkout ❑Other Basement Finished Area(sq.ft.) -SQ 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 0 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:W existing ❑new size /<xa Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �if No If yes,site plan review# Current Use �S�� e Proposed Use S'� e BUILDER INFORMATION Name Telephone Numberd3°s- Address // RSS 3fwy License# CS a7L9 A* Home Improvement Contractor# Worker's Compensation# /yam ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOus � SIGNATURE �G�� `� c DATE ��� 9 FOR OFFICIAL USE_ONLY a PERMIT NO. ,r DATE ISSUED � - ..;- .> - ,➢ - ,. ,. 1 MAP/PARCEL NO. ♦ _ • i ADDRESS � -�. VILLAGE , OWNER DATE OF INSPECTION FOUNDATION FRAME INSULATION - I" FIREPLACE f 4. s ? f ELECTRICAL: ROUGH FINAL PLUMBING: . ROUGH v FINAL • _ " j GAS: ROUGH -sl:- V'c�~ FINALS FINAL BUILDING E K DATE CLOSED OUT ASSOCIATION PLAN NO. s f e r1lown of Barnstable r uuvereez.E. t Department of Health Safety and Environmental Services Building Division f 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 , Y Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date ' • t 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: e exel$ H 0 4- Estimated Cost Address of Work: 133 /��e�sa.� S�' Al a Ps, Owner's Name: 1/1u&colt/ Date of Application: --47'.r q I hereby certify that: Registration is not required for the following reason(s): Work excluded by law 0Job 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 apply for a permit as the agent of the o�wnneer. Date Contractor Name Registration No. OR Date Owner's Name q:fbr ms:Afftdav --_ - The Commonwealth of Massachuseris r l•=Si . -:�� Xt :- Department of Industrial Accidents Office ollorestfoations 600 Washington Street A Boston,Mass. 02111 Workers' Comyensation Insurance Affidavit name: ��,c�?/�✓ ��i�d�uG S location: �33 f�irts S�• city 46111 t's- A14 OdW phone ❑ I am a homeowner performing all work myself. I am a sole Proprietor and have no one woiking in any capacity ❑ I am an employer providing workers compensation for my employees working on this job. compnnv name: address: • city: phone#: insurance cn. 2011cy# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have , the folloning workers' compensation polices: company name- address: dtv ohone#: insurance cm oitcv# :... ,,.:... comany name: address- city- phone .:....:. :.. Insurance ; ///%�/%%/---- Failure to secure coverage as required under Section 25A of MGL M can lead to the Imposition of criminal penalties of a tine up to$1.500.00 and/or one vears'imprisonment as well as dva penalties in the form of a STOP WORK ORDER and a One of 3100.00 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. 1 do hereby certify underthe panes and penalties of perjury that the information provided above is true and correct Signature �/��*/a��r���v.�ics�-•ice= Date Print name ��[ j QvuaS Phone it -rams- official use only do not write in this area to be completed by city or town official city or town: permit/llcense# ❑Building Department ❑LLceming Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Departtnent contact person: phone#; ❑Other_ (=Lwa 9,95 P1A) r - Information and Instructions r- 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 coat—- 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 of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive: 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, constriction or repair work on such dwelling house or on the grounds 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 renews: 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. 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 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 permit/license 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 say questions. please do not hesitate to give us a call. IF VIENIZZIM The Department's address,telephone and fax number. _ The Commonwealth Of Massachusetts Department of Industrial Accidents Office of InVesugadons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 I _ 9 +_ ► .41 I ...... 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TYPE OF CONSTRUCTION ��'S'W....../ ................ :..... . ......:............................................. ...........................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appl�i0es for a permit according to the following information: Location 133 T ` :�pt .......... 1 (q `/k Jj A/ 1 g ............................................................................................................................................................................. G ProposedUse ........................�... ..... ....e^ ......................................................................................... ................... ZoningDistrict ........................................::......................:.......Fire District ...........................................................:.................. Nameof Owner ......................................................:...............Address .................................................................................... Nameof Builder .......( j.6.... �. Address .................................................................................... Nameof Architect ..... Is�.......... ............................Address .....................................................:.............................. Numberof Rooms ................ .................................................Foundation ....... ... ,.............................. Exterior / !�ia7.Q ..L4 ............................................Roofing ...:.................. ........... ............................... :.......... Floors ......................................................................................Interior ............. ............... -¢'C ` .................................Heating .............N............�....................................:r;.'.. . Plumbing : .................. ....... ................................................. replace ....................<".......................... -."'` .. .............Approximate Cost ......... .....................................: Difinitive Plan Approved by Planning Board ________________________________19________. f Diagram of Lot and Building with Dimensions r 2-0 W t- t f I r �he eby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction e Name ... W.. 4 �• -, Shaw, William DEC e 11856 No .................. Permit for ...add to..&............... - remodel dwelling ............................................................................... i Location ............. 133..Pleasant. . ...Street. ........................... . .... .......... . .....................Hyannis.......................................... , Owner ........... illiam Shaw 1 Type of Construction frame ............................... Plot .............. Lot ................................ • J • Y Permit Granted .......At? St..2.........:.....19 68 $ Date of Inspection ..�� .. �....................19� Date Completed ........ .....19 { PERMIT REFUSED 19 I ................................................. .......................... , .................................................. . ......................... , ............................................................................... Approved ................................................ 19 ............................................................................... .................... ......................................................... 3 All ,- wed �.a •4 - \ c \ pXl 57/MG 4 1 ` i m S+i } + [ ] [R326 056 . ] LOC] 0133 PLEASANT STREET CTY] 07 TDS] 400 HY KEY] 240199 ----MAILING ADDRESS------- PCA10311 PCS100 YR100 PARENT] 0 BAXTER, HUDSON H MAP] AREA] HY02 JV] MTG] 0000 149 PLEASANT STREET SP1] SP21 SP31 UT11 UT21 . 25 SQ FT] 1780 HYANNIS MA 02601 AYB] 1920 EYB] 1965 OBS] CONST] 0000 LAND 150200 IMP 64700 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 214900 REA CLASSIFIED #LAND 1 60, 100 ASD LND 150200 ASD IMP 64700 ASD OTH #LAND 3 90, 100 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #BLDG (S) -CARD-1 1 25, 900 TAX EXEMPT #BLDG (S) -CARD-1 3 38, 800 RESIDENT'L 86000 86000 86000 #PL 133 PLEASANT ST OPEN SPACE #RR 1283 0048 COMMERCIAL 128900 128900 128900 INDUSTRIAL EXEMPTIONS SALE] 01/96 PRICE] 250000 ORB] 10007180 AFD] I LAST ACTIVITY] 05/28/96 PCR] Y � 4 R326 056 . P E R M I T [PMT] ACTION [R] CARD [000] KEY 240199 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT R326 056 . A P P R A I S A L D A T A KEY 240199 BAXTER, HUDSON H LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=BL- B 150, 200 64 , 700 1 A-COST 214, 900 B-MKT BY 00/ BY /00 C-INCOME PCA=0311 PCS=00 SIZE= 1780 A JUST-VAL 214, 900 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA HY02 -- --MAY NOT BE COMPARABLE-- COMMERCIAL NBHD IN HYANNIS HY02 PARCEL CONTROL AREA TREND STANDARD 301 30 LAND-TYPE 1502001 LAND-MEAN +0% 2149001 IMPROVED-MEAN +00 500 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] tPDATt PROPERTY RECORDS : ADD CHANGE DELETE NOTES HELP END CHANGE RECORDS ON PROPERTY TABLE PENTAMATION----------------------------------------------------------- 09/19/97 PARCEL ID 326 056 GEOBASE ID 24019 LOT/BLOCK DBA ADDRESS 133 PLEASANT STREET DEVELOPMENT ADDRESS LINE 2 ADDRESS LINE 3 HYANNIS ZIP OWNER NAME BAXTER HUDSON H OWNER ADDRESS ZIP 02601 ADDRESS LINE 2 149 PLEASANT STREET DISTRICT HY ADDRESS LINE 3 HYANNIS MA PHONE STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC SPLIT SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 10890 OPER/MGR NAME WET LANDS MULT ADDRESS USE 031 PROTECT DIST ENTER Y IF ALL ARE CORRECT OR N TO REENTER #� 3 € z E Y _, 1025 s s )y�. � .5t '•E h '•1 ..E: ..... •, EE ��( Y €�' .. \' i K � I � � �..' _-' E?m' ,.s..� ta� 3. `: ...x:.l .... �. n..x•t:•. .a ...3.s.t ��t...:Yt • ` [[ IE.: t SE E F 133 1 PLEASANT STREET N :; AN NI, t-�`� '����. t 3 �' �iP L�1.� � re ���I � �� f � � _�A''� �t .� ��t,`�E �,t�it.•v 1• �` �a � _ � � P• � Y �EIE Y � �+1 Rf rc,�, 4 ANONYMOUS (NEIGHBOR)EE BOR) . t t `�•E �� �' �- tE� _ 'frCk € {,S E ft f ?y a53ErE yE • ry OR, h 2 E >. V [ € "MmicMamme ,..€€,�. � � .. :E.. OWNER ADDING 2ND FLOOR DECK NO •.. €;;€€E j . .. PERMIT IN FILE. L m fi �u f � .tE 4(!vE FI P Y t EEEEtt ff /!:� ,>� �.. ''f• .. ;fE ,::J'.:. xz.: .f•, v a, ti.. of �;te -s.._L� � €�! zL^ S'V 3 s u .. ,�..:�' 'E�. ;;SG',-,F � ,,.�,:`,YI,r �, 3.: ��. ��E, tEtn. ,• .�LIC ..5� .E rt�iE��