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HomeMy WebLinkAbout0112 SIXTH AVENUE (HYANNIS) t [ � S� x� � �e. ��� ; �r _ - ___ -- - -- - -----.� - - - - -- __ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ys /'e, Map s� `/ 5 Par I Permit# S- Y/ TABLE.. Of Health Division Date Issued O p �Conservation Division �` 5S`'' 9: 06 r Application Fee lb Tax Collector Permit Fee �- Treasurer sloim_ "`----- Planning Dept. Date Definitive EXISTING SEPTIC SYSTEM Plan Approved by Planning Board LIMITED TO_,_#OF BEDROOMS Historic-OKH Preservation/Hyannis Project Street Address Village Owner Address 0 Telephone �'� 7/ Permit Request C �r ,�L ✓t�a� `� �-f— ��,ti Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: U Yes ❑No On Old King's 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 x Number 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 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 Proposed Use BUILDER INFORMATION Name,a'? _ ephone Number °� .� � ✓/ �! Address o ,mot. ®License# 00 � Home Improvement Contractor# 0 67 Worker's Compensation# 41C,9= 3 17 56G 0,;?y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PEiMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS ' VILLAGE " OWNER X. r DATE OF INSPECTION: - y FOUNDATION FRAME INSULATION � FIREPLACE ELECTRICAL: ROUGH FINAL , ,Fy PLUMBING: ROUGH FINAL - 0 ti GAS: ROUGH ► j FINAL - FINAL BUILDING m ��. n a N tr" rn i DATE CLOSED OUT ASSOCIATION PLAN NO. r opt r Town of Barnstable Regulatory Services s ns Thomas F.Geller,Director 9�6 161q. ,� :, Building Division - A�fD Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permitno. Date ` AFFIDAVIT HOME Ly2ROVEMENT 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 pie-existing owner-occupied t ntaining building co at least one but not more than four dwelling units or to structures which are adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.. 6mated Cost T e of Work: % s 23,G 3'P , Address of Work: owner's Name Date of Applicatio1- 7 n: I hereby certify that: F; Registration is not required for the following reason(s): []Work excluded bylaw ❑Job Under$1,000 []Building not owner-occupied []owner pulling own permit Notice is hereby given that: GISTE OWNERS PULLING THEIR OWN PERMIT ORDEROVEMENT g� tNRORK ' RED NOT HAVE CONTRACTORS FOR APPLICABLE HOME IMP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A.. » SIGNED UNDER PENALTIES OF PERJURY T I.hereby apply for a permit as the agent of the owner: ate on act r Name Registration No. OR Date Owner's Name • Q:forins:homeaffidav - ... ` The Commonwealth of Massachusetts Department of Industrial Accidents 0 ' I 7jj Office of Investigations `A i A 600 Washington Street, 2`"Floor -L? Boston, Mass. 02111 WDrkers'Com ensation Insurance Affidavit BE RnBuildin lumbin /Electrical Contractors 47.PI�r iti'n. 4�� name: 11 67— address: city state: � zip><!A-�i1,9 phone# l e O� jG•9. 1-1 / s4 work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction Memodel ❑ I am a sole proprietor and have no one working in any capacity ❑Building Addition'-_-' H:e'3.�`.".e�a.a'� s'_. '�. ..-t4, r "• •cfian .,u't{-^+ ''.:'!'-. x ::. ,i _, r b.F. .. _c .._ ,-f ...... �_is ❑ I am an employer providing workers' compensation for my employees working on this job. company name- !sL. LGC� t t address: city 9/��/ phone#: .��� ��`- /l 7 insurance co. lit # 49C . 3% 7 360 CJ y, ' > . ❑ 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: comamw name: address: ` city: phone#: insurance co. :policy# pp� 1.J'.n. .� .. � .....-. �,.� .,.. _ .. ;.. '� ..� ...�.�!tt�i 'a. MaY�-•Ts,,,LY.=,f'�'�.i.,�''d�,•�.n:hi �%M1�-:+:':XY".�9a"e, .��Y2':Y�`��'e company name address: city: phone#• insurance co. Rolisx M. 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 penalties in the form of a STOP WORK ORDER and a fine 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. I do hereby terrify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name r� Phone# S 3 7 Econtact nly do not write in this area to be completed by city or town official : permit license# ❑Building Department ❑Licensing Board mmediate response isbrequired ❑Selectmen's Office ' ❑Health Department on: phone#; ❑Other3) 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,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 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. NOR!- MARINE 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. e Office of Investigations would like to thank you in advance for you cooperation and should you have an uestions, The 0 Y Y P Y Y q g 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,7te Floor Boston,Ma. 02111 fax#: (617)727-7749 phone #: (617) 727-4900 ext.406 04/26/2005 TUE 10, 27 FAX 617 723 7563 "OGAVII4 6 WAYSTACK 2002/00:. Fi a �i e 3 MON 68: F- PM P. 02 j Regulator' Services Te omas Vm Quer Dfraeto� 1 Pei Bull dbg,D.lVl,-Aon eJutr� xjs3 ILIA G.2.601 i pax, r y) Hype Ow II us � p yte auk Sign This Section 11'"Usbago ABuilder I KI 0 -to act Ou r o6lai `n 1i1 o re..^"&€i to" S2S authori 4 Yt�S b,�1��etl9y tP®�a7CiiC a�7�j�CGfi1C1n fSST; elm ;f l�.tie4sfs,J `j �...F a•j° ,w Ps d;linfr i.Rre � J .r.—a •' '�cy,.K was•.s en.n�trnTCiL�BT�'D'h,T7:.�`i(`(T+� ! r a RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 .S Q Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= 1 JS'0 x.0041- plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.seq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00. Relocation/Moving $150.00 (plus above if applicable) Permit Fee � Projcost Rev:063004 Boad o ni mg ega andop {>" HOME IMPROVE sand Standards. 4' ' r., MENT CONTRACTOR01 Regist at.0 •„ 104499 E't �F 14/2006 to Corporation ART DOLGOFF �olgoff 19 McCormick Dr: W Barnstable,MA 0 . i Administrator �. Ile '. 14. old, �� 1 ' t Assessors offioe (1st floor):j ". Assessor's map and lot number :.. ... .:: ... .. ...... .. . . .. ������ ��� °fTNerO� ; ; 1. ©MPL IA Board-of,Health (3rd floor): } ; ������'`'�® '� �' fO 1C�`1°I WITH TITLE 5 • Sewage Permit. number ........<���............ .. r- � i easas'rsnLt; S Engineering Department (3rd floor) ; ENVIRONMENTAL COOP � 'oc "e39• House number ................. ... ..... .... .......�/...Z...:.... ..d�[•/' ® �a ",� e, MAIN REGULAVO 'FOYAYa\ APPLICATIONS PROCESSED :8:30-'9:30 A.M. and 1:00.2-00' P.M.-only TOWN OF , 'BARNSTABLE" ' BUILDING . ` N"PECTOR APPLICATION 'FOR PERMIT TO .. : .�.e' .d .C.. ...... ..urJn..e...�.. Gr1 .�':;Ia�l. ..�.:C:� ,S,?- �t!� • TYPEOF CONSTRUCTION ....:. .:..r:..... ....:... ..:..................................................................................... TO THE INSPECTOR ,OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following information: Location ......C.1.1 .......5..`d..T..�-�...... 1.e.......t /�/.�,7../..�.�.:. .?t-...............:. ProposedUse .............. !!. .. ..... 1 .�e.P�,f............... ....................................................................................... Zoning District ......:........ . Fire District 1��!/ /..�}.........:................... .................................. .................... Name of Owner aJ 1�-.....�1...1 .1.,L..l.........:::.. ' . ..vc.f'!l. ..J:.......................... e 4....�- ` Address .. ..>�i.. . Name of Builder ..J�i.ein.�1.. ��`l'►iL c.4�....................Address t/. '��TGn/... Lc/�..`?'Tluc?l�.J...... 1 Name of Architect �— .Address Number of Rooms ..... .......................................'.......:...........Foundation .�ls•e I-Z . ................................................................. Exterior l.Crl % i L"T /............... �/.�..I�.. �,.� .....:...Roofing ...f�S.f� ........................................................... Floors ..................::.....:::.................... � 6t...S..T.....b1<.................., Interior �........................Heating .............Plum .5........... ..�.p...�./.�:.�.1.�., ................ bin ` ...g .... r Fireplace ....../.....p :.........................t.::.::........Approximate Cost ...3.��..Gt r�� Definitive.Plan Approved by .Planning Board ,------------------------_-------19-------- " Area Diagram of Lot and Building with Dimensions Fee („ ��.............. ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby,agree to conform to all the Rules and Regulations of the'Town of Barnstable.regarding the above s construction. Name s r2 . .. .4............... . ' Construction Supervisor's License .................................... ' ° HILL, JERRY + µ' 3.019 6 ' Remodel No . ..................Permit for ........................ ......... Single' Family Dwellingi _ r 1 ........+....................................................... 'f . Location 112 Sixth Avenue T ........................................................... +# V ,k `Hyanni.port.. r` •Jerrry fii1l� � - t .-' "'• � 1� ,�; . r ,� �� r� ° Owner ..................................... ��' ♦ Frame Type of Construction ....................... 141 s ..'............ .............: ,Plot r` .....e........... Lot .... .. ..... Permit"Granted November 18 .,1,9 86 • ;r` T� f. > r�. i, Date-of arisp"ection ....... �...19 ` Date Completed :..........„jL...� .19 ; = - ffV Ilm— q per' 6 • ♦ . I• . .- 'f• _a ` n t { « y , f�` - � � � � 0 -.� ' ram. � �• lie .% 4 < 'r as T-` w•r � �� + a 4 ♦ • � '4 �✓ yr"- r Y . ^ •