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HomeMy WebLinkAbout0227 SEA STREETPpe�eining Dept:(3rd floor) Map 07 Parcel . b�,P-} _ Permit# OU House# Date Issued o2 Board of Health(3rd floor)(8:15 -9:30/1:00'-4:30) Fee. Conservation Office(4th floor)(8:30-9:30/1:00 2:00) - Planning Dept.(1st floor/School Admin. Bldg.) THE t Definif Ian Approved by Planning Board 19 _ - BARNSTABLE.pp• TOWN OF'BARNSTABLE Building Permit Application Project Street Address a,)n SZA 's`TmeCT Village 1-I YI9 N N i s Owner 3Anoe%AGwZ HDUS%N$ i9VA0r_ TU Address f144 Sovsti STcope.i 8YAAJNi�_ Telephone S"a Permit Request 1'L4 A o o P►,,2% C'N o rn,re.EYA. Awn,,o S-O o First Floor - square feet Second Floor 3 r y square feet Construction Type Woo* Estimated Project Cost $ S-o o .o o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No s Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes XNo On Old King's Highway ❑Yes No Basement Type: -A Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 7 6 F Number of Baths: Full: Existing d New Half: Existing P New No.of Bedrooms: Existing y New Total Room Count(not including baths): Existing t.. New First Floor Room Count Y Heat Type and Fuel: ❑Gas -@ Oil ❑Electric ❑Other Central Air ❑Yes `W No Fireplaces: Existing New Existing wood/coal stove ❑Yes V No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) a. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes IdNo If yes, site plan review# Current Use Proposed Use 9,0sN p� V!LA 1. Builder I formation Name aNi A.� Ar\ft1 ro.,-1 6s! lioviik, Telephone Number Address L iLLh,,A fj• License# 0 i 1 0 3 ]�in.�w: �`^ 1, _ o�► r Home Improvement Contractor# Worker's Compensation# CO/0 3 O 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 b!j •tU.S o IN,-. SIGNATURE DATE t BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) i F R OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED MAP/PARCEL NO. ADDRESS , VILLAGE - - OWNER DATE OF-INSPECTION:' ' a FOUNDATION FRAME y - a INSULATION FIREPLACE r ELECTRICAL: ROUGH = FINAL i a t PLUMBING: ROUGH FINAL _ GAS:Y ROUGH FINAL t 4 r FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. ` *Permit# o�j„e r Town of Barnstable Expires 6 months from issue date ..-:=Regulatory S ery lees Fee -L r�0 DAM ' Thomas:F.-Geller,Director _ . ••-•— - n "Divas o _ ....• : •'�Bwl g - - '— -Tom Perry, Building Commissioner 200 Main StFeet, Hyannis,MA 02601 �. q� kPR ES _ Office: 508-862-4038 __ - Fax.'S08-790 6230Ig�SID�NTIAL ONI. 2 • I' . •S:S:��RtVIIT �XP Not ValidwultoutRedXpressimprint TOWN C) BARNSTABLE Map/parcel Number ' Property Address KResidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Telephone Number? Contractor's Narae—o"�� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Worlanan's Compensation Insurance Check one: ❑ I am a sole proprietor I amthe Homeowner have Worker's Compensation7nsurancg Qp ce Company Insuran mp y Name Folic # � � l�� � n�2 "� •P' ® �• — Workman's Comp. y �--_ Copy of Insurance Compliance Certificate must be on file. permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to C K ❑Re-roof(not stripping. Going over existing layers of roof] ❑ Re-side Replacement Windows. U-Value (maximum.44) regulations,i.e.Historic,Conservation,etc. *Where required: Issuance of this p t does not exempt compliance with other!town department ***Note: Pr Owne must sign Property Owner Letter of Permission. me rov ent Contractors License is required. Signature Q•porms•e L— Revise063004 The Commonwealth of))Massachusetts _ Department of Industrial Accidents -- Office of►nuesagatfons 600 Washington Street, a Floor Boston;Mass. 02111 Workers'Compensation Insurance Affidavit:Buildin /Plumbin /Electrical Contractors name: address: city state: zit): phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition I am an employer providing workers'Gom�ens tion for my employees working on this�ob d4 t Y• i:: ..I i '+ F�,�i2 �.F �4� f O «:f !. 7777777 r .. "C'- dV d J��,.N S. 'r't.'Y•f Clsi 'NY 1; ...;� -:.t t T R 1w416Y} Iry aC,M/ 9 ❑ 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 .. � x .fir:- fi ;'•. � - �'re a�}.t aµ `r r'j. .,' �.. E,: E .4 0 . coin an name City D'Gone T { y TY { a y ; wsuranee..co. M,.. . .. . 111,11. r.... ..__. t y 1 �omt)anv tihme ,f Y t 4' T; _ ms�irance'ctf� � - - -Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil p alties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forward the Office of Investigations of the DIA for coverage verification. I do hereby certi u the pa' an enalties of perjury that the information provided above is true and orrec Signa Date r Print name t Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department' ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; []Other - (revised Sept 2003) 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 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, �artnershi , 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 thereto shall not because of such employment be deemed to be an employer. or building appurtenant th MGL eve chapter 152 section 25 also states that state or local licensing agency shall withhold the issuance or P I'3' 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. PP P P P 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 permit/license number which will be used as a reference number. The 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 t , IL 03/01/2005 11:05 5087789312 BARNSTABLE HOUSING PAGE 02/03 MIKE I1 ONGEA►U (508) 778-9797 PROPOSAL 77 Traders Lane Cell (508) 367-2645 W. Yarmouth, MA 02673 tic. No. 006670 Date: Proposal Submitted To: Mailing Address Work to be performed of: " Name: {we'C Street; treet; City: _ t City; r State: ---7 Zip Cade: State; Zip Code; Home Phone; _r ' } �.,, _,.�. Work: NOTES/SuggOestions: /,2__�13 T A 5­1 L . We Hereby propose to furnish the materials an d perform the labor necessary for the completion of: 1 . (b) Removing old roo , 'install new roof with a Lshingle estima'e ( sq. This price will include. a 5 ear warrarity on workmanship, now alumi- num drip e/ , 15# felt underlayment, roof vent collars, Install ice and water barrier around chimney, valleys, nail loose bo s, cl an gutters and total clean up and removal of all d bris. Color of roof ' to be _ R 2. Venting —car be critical on certain h es (a) Install I,- ff. of-Cobra continuous ridge vent $ (b) Install ff. of Hicks vented drip edge or, soffit. 7� M S (c) Do not wan to upgrade venti g. Of er ry or—�.�� w�-7� �t AI ate-iuI guaranteed to be as specif!Eld, and the above wor ..to be perfc med in a con ante ' with the specificotions submitted for above work and completed in a professional workmanlike moaner for the sum of $ h payments to be mad a Ilows. Deposit of $ r--­775aiance due upon co 10 , Respectfully subml�te ACCEPTANCE OF PROP®SAL We rqdgirve the right to r p any rotted o, broken roof or trim The above privet, specifications and conditions are boards This will be an exrr ost above the quote roof price, The satistoctcry and are hereby :occepteid. You are charge for this will b-,,if needed. $50/hr.plus moteria!s.Ail agreements authorized to do the work as specified. ?aymont will contingent upon accidents or delays beyond,our control. Outetand- be made as outlined above ing balance over 30 days will incur 1.5%finance charge per month. above-o be taker,nut Owner to remove all valuables from walls. Licbility Insurance on all :y: Sign07ure. �"' ' mike Mon:geou Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City,Name, or License number Select Search type: OF; AND r OR Searclid' Search Results g. No. Applicant Street _��City Stat Re e! Zip Name F lExpiration Bryan's i + Maintenance 405 North I1010851Mongeau, 129353 Westfield MA ; Owner 8/17/2005 & St Bryan I Restoration77 126178MICHAEL TRADERS r W. MA F026731 MONGEAU,�OWNER1 4/29/2006 4 MONGEAU YARMOUTH ' MICHAEL E ROBERT F. ! 350 Black ' Mongeau, 114557 11 MONGEAU, Brewster MA 02631 Robert Builder 10/4/2006 Y Duck Ctw Jr., Target I 241 E. � Cleaning & Mongeau, 1 124168 MAIN ST Westfield MA 1010861 Owner E 5/20/2005 Disaster Gerald Restor. #145_ _.__ _ i ........ __ Total of 4 Records matched. Back to Home--Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl 3/3/2005 Town of B arnstable Permit Expires 6'months from issue date' Fee 2207 Regulatory Services 9 NSTABLE Thomas F.Geiler,Director TO �F 6ARNSTABLE Building Division Tows Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEPJVHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red%Press Imprint MaP 1P arcel Number .3 0-7 `©a 4 - a S 01 sea �"I-� � c,l lht�� t r �—�� Property Address ' �sidential Value of Work (�,Soo. 06 Owner's Name&Address �v u h ' VYV_ r-, (y IJ&VJ , �' Aelephone Numb Contractor's Name - Home Improvement Contractor License#(if applicable) 6 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner { I have Worker's Compensation Insurance � rut -1-45 Insurance Company Name I�1R V Worknian's Comp.Policy# �j( a.0 61 — Permit Request(check box) ❑'Re-roof(stripping old shingles) All construction debris will be taken to 4 ❑Re-roof(not stripping. Going over existing layers of roof) Re-side' t ❑ Replacement Windows. U-Value _ (maximum 1.44) *where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro must sign Property Owner Letter of Permission. provement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 The Commonwealth of Massachusetts - _ Department of IndustrialAcciWnO Office of Investigations a ~ 600 Washington Street Boston,MA 02111 e www.mass.gov/dia Workers':Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information , ` Please Print Legibly Name(Business/Organization/Iudividual): c.)�R 11o;``,,Le- t`t u me Q-.J`3T .WC Address: 5 t' .� d City/State/Zip: Phone#: 6S 77 :5— j:� �$ Are.you an.employer? Check the appropriate box: Type of project(required) l:U t.arh a em to er with '7 d• ❑ I aim a general compactor and I P y 6. [:]New construction employees'_:(full.alid/or part-time}.�: Have hired the sub-contractors 2.❑'I am a sole proprietor or partner- listed on the attached sheet.: 7 [1a'f�emodehng ship.and have no employees _ These sub-contractors have g ❑Demolition.,. employees and have workers' working for me in any capacity. 9. ❑Building addition [No workers comp,insurance comp.insurance.- .t. trical repairs o.addi lops 1.0. Elec or additions aired. 5: ❑ We are a corporation and its .. ❑ P , 3.❑ I am a homeowner doing all work officers have.exercised their 11:❑Plumbing repairs or additions' m right of exemption per MGL ..yself.'[No workers' comp -- 12.❑ Roof repairs' insurancereguired.J t. c. 152, §1(4);and we have no, employees. [No.workers'.: 13.❑ Other- comp.insurance required.] *Any applicaiifthat 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 affidavitindicatina.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. lfthe 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 poliey_and job site information. Insurance Company Name;. Policy#or Self-ins.Lic.#: bb-�1913 '3 0 1 Z 0.0'7 Expiration Date: Job Site Address: City/State/Zip:. .. _.. Attach a copy.o the workers'compensation policy declaration page(showing the policy number an 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 c Qvera.Re verification. I do.Hereby cerf u r penalties of perjury that the information provided above is true and correct Si ature: Date: 1 — Phone#: Q — 1 r1 T7�S Official use only. Do not write in this arezy to be completed by city or town official. City or Town: Permit/License#_ Issuing Authority(circle one): 1.Board of Health 2..Building Department 3. City/Town Clerk 4.Electrical Inspector 5.'Plumbing Inspector, 6.Other Contact Person: Phone#: 4. Contractor is not responsible for existing conditions of residence. 5. Contractor is not responsible for damage to such items as, but not limited to: sidewalks; driveways; patios; lawns; shrubs; sprinklers; and other such appurtenances. However, reasonable care will be taken. 6. All agreements are contingent upon strikes, accidents, or delays beyond Contractor's control. 7. Homeowner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. . f 8. Fencing, carpentry,painting,plumbing, electrical,dry wells, etc., and all other work necessary that is not contained in this contract, shall be the responsibility of the Homeowner. RIGHTS TO CANCEL The Owner may cancel this Agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office, or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in-workmanship for a period of two (2) years following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within two years after completion of any job, including clean-up,the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced such damage or such defect in workmanship as long as the owner has paid their agreed contract in full. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for product supplied by the Contractor under this Agreement shall be those given by the manufacturers of such product, which shall be and hereby passed directly to the Owner. Such manufacturer's warranties,the Owner may be required to register or mail in a warranty card or other evidence of ownership, and use of such product in order to activate such warranties. The Owner's failure to send in or register such documentation,which failure voids that manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such product. Note: Any changes in the contract during the duration of the project which results in additional monies due will be paid in full to the contractor at the time of the change. CLauthorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be _. performed on this job(i.e. permits, applications etc.) if necessary. Barnstable Housin, Authority x Date Brad Sprinkle Date Celeb acing.61 yeats in business 0 a owl" , I" I � � ®°� I1� �m ISSUE DATE 0512112007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Bryden&Sullivan Ins Agency CONFERS NG RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Inc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 88 Falmouth Road - -- --- ------ — Hyannis,MA 02601 COMPANIES AFFORDING COVERAGE INSURED ------- --- Sprinkle Home Improvement Inc 199 Barnsfalfl2 Road""" COMPANY A A.I.M.Mutual Insurance'.Co. LETTER Hyannis,MA 02601 tC®VisRA 5 �� � 4.• ��t � E � •., �� � "�� " � �� �� �� ��`� � �� ���, �` r� � THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. — T-T TYP E OFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS DATE(MM/DD/YY) DATE(MMIDD/Yl') GENERAL LIABILITY ' GENERAL AGGREGATE r� PRODUCTS-COMP/OP AGG. u COMMERCIAL GENERAL LIABILITY - - PERSONAL&ADV.INJURY $ =CLAIMS MADE=OCCUR - EACH OCCURRENCE 4 , OWNER'S&CONTRACTOR'S PROT. ' _ FIRE DAMAGE(Anyone tire) n MED.EXPENSE(Anyone person) AUTOMOBILE,LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO - BODILY INJURY $ ALL OWNED AUTOS (Per person) SCHEDULED AUTOS H IRED AUTOS :BODIc Y INJURY ---- — _ GARAGE.LIABILITY PROPERTY DAMAGE EXCESS LIABILITY _------- ---- — - -' EACH OCCURRENCE---_K — --------------- �UM BRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATUTORY LIMITS OTHER EMPLOYERS LIABILITY X HE PROPRIETOR/ EL EACH ACCIDENT 500,000 A PARNERS\EXECUTIVE " OFFICIERS ARE: 7004943012007 05/13/2007 05/13/2008 EL DISEASE--POLICY LIMIT 500,000 INCL EXCL EL DISEASE--EACH $ S00,000 EMPLOYEE COIVIMEN"1'S/UESCI2IPTION OF-OPERATTONS OR LOCATIONS: - ��I?�`I`F�I �` FI LD R�ti s.�' � ➢��� ate; � I �, � a �nx ,.,.. -_,. :._,,, ,�,z- ,,�", .,.�,„rPa, ,..«,r. ..:. . .. �'.��_.,, „�,.•� ,. ,,sx <,�.. „'`CA7• �LGATION � -ti.`�-,.,: �^`t�%:�u�L�a+`�.�� � 6 z� s . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE BRAD SPRINKLE HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 199 BARNSTABLE ROAD HYANNIS,MA 02601 AUTHORIZED REPRESE14TATIVE s Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR `I Registration 10.3757 Expiration 7/9/2008 Type Private Corporation : F= SPRINKLE HOME I:MPR'OUEMENT INC. Brad Sprinkle 199 Barnstable Rd. Hyannis, MA 02601 Deputy Administrator `� �✓� �ar>zr�uy�auna�� ��4,��a..�lczr�i��oeC��s 1a BOARD OF BUILDING:REGULATIONS License 'CONSTRUCTION SUPERVISOR Number CS 006643 Birthdate 10/08/19.55 Expires 10/08/2007 Tr. no 6638'0 Construction -CS Restricted 00 BRAD K SPRINKLE 190 LOTHROPS LANE W BARNSTABLE, MA 02668 _ Commissioner- � THE TOWN OF BARNSTABLE mp"I Ar" BUILDING INSPECTOR' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location —' —=).7�'— .� .n--------------------------' Proposed Use '. ...... —.--------------------------------.. ' , Zoning District -----------.------------Five District ----------------------. ---. � � � Nome of Owner —.����?���.....-------.Address .................... | Nome of Builder ----' A66sss ......................... -��� -------- � It " � a ° ^ Nome of Architect ----------------------Ad6reo ------------. —- ' �-------------' !Number of _________Foon6oti ` Ex�rio,' --�����./� -------_—�Roo�nQ —_-- = Floors ----------------------------..|nte,icx --------__------____________ ' Heating ----------------------' '~ —.Plumbing ------------------------___. R,ep|000 .................................................... ..............................Appnoximo^p Cost _........... x DKlnitive Plan Approved by Planning Board l9--------_ =' Diagram of Lot and Building with Dimensions | `-~ W / | ^wv,0 WAP � . G FOR OF- OAR OF, /u^ / / � | � � | 6e,e6v agree to conform to all, the Rules and Regulations of the Town of Barnstable regarding the above construction. Nome —...---------/Y- � / - Carew, Grace No ...12562... Permit for dormer .................................... ............................................................................... Location S Street ......................ea.......................................... Hyannis ............................................................................... Grace Carew Owner .................................................................. Type of Construction frame t Plot ............................ Lot ................................ 1 Permit Granted August 20..............19 69 j to of Inspection .. A. ....19 ` -.Date Completed PERMIT REFUSED ................ ............................................ 19 ............................................................................... i f ............................................................................... j ................... ........................................................ I Approved . ............................................. 19 ................................................................................. ............................................................................... Z EngiTI T"Ll T The Town ®f Barnstable U Department of Health Safety and Environmental Services .F 9- BuiIding Division 367 Main Street,Hyannis MA 02601 Ralph Crosser- Office: 508-790-6227 J Building Cain. Fax: 508 790-6230 's 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 ce o be done b registered contractors, with structures which are adjacent to such residence r building y certain exceptions,along with other requirements Type of Work:— dZovF°'� Est. Cost 4010. �v Address of Work: ap. 7 SF-A Si xfel Owner's Name— Date of Permit Application: I hereby certify that: Registration is not required for the following renson(s)t Work excluded by law _Job under S1,000. _ Building not owner-occupied Owner pulling own permit Notice is hereby given that: DEALING OWNERS PULLING T�ID HOME IMpROWN PERMIT OR T WORK DORNOT EHAVE CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGINED UNDER PENALTIES OF PERnMY I hereby apply for a permit as the agent of the owner. Registration No. Daze XI-My0 Contractor Name w T/1c• C11111I11o1rwea tlr of.1fassachusells Departtmlrt of Iirdirstrial Accideirts OfliCza gresilgatlons •�1 j=;tit ::, : h(h7 !1"asltin;;turr Strret X. Btai r.Mass. 02111 Work en' Compensation Insur'hnec Afridavit "D-1icint inttirntaiinn _ Pic'tSe PRINT'1e�i�i1,V , name• , Inc^tinn• � r rite. nhrnr I am a homeowner performing all wort;myself. 1 am a soic proprietor and have no one work-ins in anv capacity _. ...... ;— -•---.---_ -,�........_.�r '_,_ -- --- - - _"sue--.,.._...------------ I am an empiover providing wori:ers' compensati/o�n for my empioyees`work-ing on this job. ennrn rn- n tmt R Af1.M.r•3tabO t I l&P ut-1 Tl 07L&AAT�2 atltl rrac• N& 9®u0k \T nee y r11A nitnnrft• (,S'OS 7d-�%L in-mr-i nrr n n/ lad M0 W C, &rt.ov Q Tf►t'-T nnliey 0 Li i o3 ® I am a soic proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed beiow wno nit the Following workers compensation polices: cmmmrm' nnrnr• 9tlrtrrcc• fit n�10nr�• incite-nrr rn nnlier if cmmninv nim... arid rr— rite nhnne it• in�nr^ncc cn Holier _ Attach additional sheet if necesaary '�:�' di'':•�• - •�• •r '•• _rr..u�—._ _i�+'•�.-�`iyy..�:-`,,.r�i..:-.. _ �a►.ii..— .�n Fmiurc to secure cm'cmac as required under ziectton:SA of NIGL in can lead to the imposition of cnmrnai pennities of a tine up to SI.:OO.00 anuiur unc-cars' im{rrr>nnmcnt as %%ell as civil penalties in the form of a STOP"'OR ORDER and a fine of SI00.00 a day against me. I understand that cop) of this aatctucnt mns be furwnrded.to the orrice of invcstirations of the.DIA for coverage verifreation. 1 uo hercnt•crrri&turtier the pairs and penalties afPrjjWT that the information prorided above is true and correct. As.�� Si^_^.zturc Date Ill Print name �hvt4N yy7'1Yt1�►1'✓� Phone 7}'VZ'' - ' ufRciai uc unl�• do Hitt�s•riu in this area to be completed by city or town olTiciai -`• E. citt,or tmwn. permibricense tf r"itluirdin;:Department ❑Licensing Board [_ ❑ Serectmen's Once m t" cttcci;irimedinte respunse is required C' ❑ticaith Department � contact ncrsrrn: phone rt• r�Vthcr=�— Information and Instructions • �r Massachusetts Generil Lars chanter 152 section 25 requires all employers to provide workers' ctonper7s.4 :111 emnlo ecs. .4s quoted f rcim the "ta��'". an emplurer is defined as every person in the service of :11lother und::r:::: contract of hire. express or implied. oral or written. An entpla.rer is defined as an individual. partnership. association. corporation or other legal entity, or aft%, two or the farr_oing en�-a__c:d in a joint enterprise. and including the legal representatives of a deceased employer. or tltc recen,er or trustee of an individual , partnership. association-or other legal emity, employing employees. Ho«•e-.•c oWlIer of a dwelling_ house having not more than three apartments and who resides therein. or the occupant of the dwelling !louse of another who employs persons to do maintenance,.,construction or repair work on such dwc1lin_ or oil the __rounds or building appurtenant thereto shalt not because of such employment be deemed to be an MGL chapicr 15? section 25 also states that even- state or local licensing ngency shall withhold the issuance o, 11 11-:11 of a license or permit to operate a business or to construct buildings in the commonwealth for sn`• is::rlt who ltas not produced acceptable evidence of compliance with the insurance coverage required. oil nor am• of its political subdivisions shall enter into any contract for:lie �.., 7mot P ,-�a onalli•, neither the con Chap:of public work until acceptable evidence of compliance with the insurance requirements of this ,.,7a, : P P ' been prezc:,ted to the contracting authority. a{llilic::nts Please till in the %vorl:ers' compensation affidavit completely, by checking the box that applies to your situation a: sucpiyin_ company flames. address and phone numbers as all affidavits tnny be submitted to the Department of 'ndastrial ,-accidents for confirmation of insurance coverage. Also be sere to siren and date the affidavit. Tile it should be returned to the cin• or town that the application for the permit or license is being requested. r? :he Dcrarmient of"Industrial ,-accidents. Should you have arty questions regarding the "law" or if you are 0 obc�in a ��ori:crs' compensauoi1 Polley. pie-se call the Department at the number listed below. A. City or Towns Pie-"e ie -ure that the affida%•it is conipiete and printed legibly. The Department has provided a space at the 5or`cr. the �• Qa�it for ou to full out i11 the c%,ent the Office of Investigations has to contact you regarding the applicant. F be _ : to fill in the permit/license number which will be used as a reference number. The affidavits may be rezurne "ae Departi77ent by mail or FAX unless other arrangements have been made. The Office of Im esti=ations would like :o thank you in advance for you cooperation and should you have any quest: pierse do not hesitate ro _give us a =11. Tile Depaminenr:s address. teiepn ne and fax number- The CommornveaIth Of Massachusetts Department of Industrial Accidents =ju` _• Ih Office Uf investigations 600 NVashington Street Boston. Ma. 02111 fax ®: (6177) 7Z7-7,749 n h o n e =. 61-)i 27-=900 exr. 406. 4013 or , - .;� t".` ao, - A =: O L N Y N N � �C '~ •.• W �` Ff T C J O� � tf .-� N 0� _ W V) •d �� m m } X N C'! �.. �.. \0 d W S N 4� d O m p � �C) y N fn p � H� m O LC 6 C Z 2 1-� OC p ]C � C � � Z m O S F— H Ci p y U L 2 �� C G� .-� C C �� L H• N �L S � V'Y •. C N_ C FJ H W � ' !� U 2 U CY m .--� m ' _- F..� 1 l��,r .,� . 7 J � " - f„"'" __ m . c-_-" Y �• _ o+ O N C .. 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