HomeMy WebLinkAbout0012 SHOREY ROAD ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Permit#
Health Division Date Issued
Conservation Division Feed ®�
Tax Collector
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address S Ll_� 'S /f ed-
Village
Owner �� �o tf.p Address ��i
Telephone �S I? / 6.Z�P`t
Permit Request � Sf rl'�jG� N ��Ct /Y6 ��®! S
r—
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
n?(Estimated Project Cost Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family L/ Two Family ❑ Multi-Family(#units)
Age of Existing Structure r Historic House: ❑Yes ,t2Ko On Old King's Highway: ❑Yes 6<oo
Basement Type:c2rFull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) G Basement Unfinished Area(sq.ft)
Number of Baths: Full:existing Z new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: lkas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes t No Fireplaces: Existing New Existing wood/coal stove: ❑Yes t1`ko .
Detached garage:❑existing ❑new size Pool:❑existing, ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use ,/eL�G C _ `� � � Proposed Use
BUILDER INFORMATION
Name�c% �-KJ l�F�� (1/1//l ' 4 Telephone Number `� r
Addresses � � ��� ��� License# Q a
� �` �' O Home Improvement Contractor# �®�
�
Worker's Compensation# "y
ALL CONSTRU N DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
aQ
SIGNATURE �—�— DATE _ '��� ` Vic'
FOR OFFICIAL USE ONLY
PE9MIT NO.
�. DATE�ISSUED ,�, -.. R1. ' � - -:- `1 ` • �!'� _."
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
ti-
DATE OF INSPECTION:
FOUNDATION
K
F FRAME
w INSULATION r r
FIREPLACE -
ELECTRICAL: ROUGH FINAL ;
PLUMBING: ROUGH FINAL rn'
GAS: ROUGH `FINAL-`
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
}
t •
L'
e commonweaun
Accidents
`� j- —Z- Department of Industrial
,� ==�-_, ; .� : Olflcr ol/onestfpatioos
600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Afridavit
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name: nn
location:!/1 L� ®� �/(!�( hone# � 622` (
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❑ I am a homeowner peffofming all work rnyselL
=jja sole p etor and have no one worldn in any achy,,,,,� , / �y r,
workers'
ensation for ffiy employees working on this job.:::::::::.::.::::::::.:..,.::::.::::::.?.:::;::::::.:,:::.::..::...
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❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below w
have
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corn workers compensation.p
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NO
Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of erhniaai penalties of a Sae ail to S1,500.00 and/or
o�yam,imp�omnent as wen as civil penalties is the form of a STOP WORK ORDER and a fine of S100.00 a day against rue. I understand that a
copy of this statement may be forwarded to the Office of investigations of the DIA for t�vera;e vaificatlon.
I do hereby c e aims en#fiff ojp that the information provided above is true and eorred
Date
Signature
Print name
of tidal use only do not write in this area to be completed by city or town oMcisl
city or town: permit/llwue 0 C3Budding Department
oLIcg Board
required ❑Selectmen's Office
❑check if lmmedlate response b ❑Health Department
• - ❑Other
contact person: phone#:
(trued 9195 PIA)
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�twe t
The Town of Barnstable. .
9� UX
� � Department of Health Safety. and Environmental Services
59.
oy��0 P Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: . 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME 1WROVEMENT 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. R—:? "IT e of Work: �/�� �l WlAr Q �S Estimated Cost
Address of Work: 1
Owner's Name: / 6�11 CIF
�G
Date of Application: T �a O G o
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 UVIPROVEMENT 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 a e�t of the owner ,� \
l Registration No.
Date Contractor Name g
OR
Date Owner's Name
q:forms:Affidav
✓Te anwea o�✓�laaoac/u�aelCa R
BOARD OF BUILDING REGULATIONS
License _CONSTRUCTION SUPERVISOR:,
Number GS _ 000998
r,
BfrtJdafe<09/%29/1940 a:
Ezptres.,09/29/2001 Tr.no: 4330 3
Restrietetl To: 00
VICTOR J WIINIFCAINEN
PO BOX 69 �
W BARNSTABLE, MA 02668 "
Administrator F;
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