HomeMy WebLinkAbout0040 STUDLEY ROAD Y� �u'�� -- - - -
Engineering"Dept.(3rcfloor) Map Parcel Permit#
House# S"` Date Issued
.a
Board of Health(3r oor)(8:15 -9:30/1:00-4:30) Qec�, # 1.1 UA[ , ee. o S 0 "
- 7
Conservation Office(4th floor)(8:30-9:30/1:00 2:00)
nun. .) THE iZy;.
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`Defirritiv �Iari� oa 19
BARNSTABLE.
f >- MASS
TOWN OYBARNSTABLE lEDMAr
Building Permit Application
Project dress y� �`ert"/J/,���i�9 m) 12 Lat 3F
Villageif
_ _ I�.9.c,•y�:5 ,
Owner ���d, G�, /l�� Address
w
:Telephone 4�57
Permit Request 9-Lu 1346LRL6
s
c5r,� c lL.
First Floor square feet Second Floor square feet
Construction Type _ XI-K
Estimated Project Cost
Zoning District Flood Plain Water Protection
Lot Size %��}�� Grandfathered ❑Yes ❑No
Dwelling Type: Single Family '� Two Family '❑ Multi-Family(#units)
Age of Existing Structure 0a Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full Nf 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_ f` New
Total Room Count(not including baths):Existing New First Floor Room Count
Heat Type and Fuel: )KGas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
pkAttached(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
Builder Information
Name 5c e ri i/ia co u-'Y2i Telephone Number
Address '' P,B$t�`'�
_ �c tAti� License#
Home Improvement Contractor# c9- ,
Worker's Compensation# 1117Q� � _
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 BETAKEN TO
SIGNATURE (J DATE � �Yd
BUILDING PERMIT DENIEDAFQ :THE FOLLOWING.REASON(S)
' FOR OFFICIAL USE ONLY .
PERMIT NO.
DATE ISSUED'
MAP/PARCEL-NO:
ILL-
ADDRESS i VILLAGE °
OWNER
DATE OF INSPECTION:
,
FOUNDATION
FRAME .4- ,
INSULATION-
FIREPLACB F _ N •°
ELECTRICAL: = ROUGHS _ FINAL_.
PLUMBING: ROUGH m s FINAL,,-., a _i •<' " 'A
GAS ROUGH FINA `
. L ;•
FINAL-BUILDING
DATE CLOSED OUT'
ASSOCIATION PLAN NO. -
D�e1z s1 � Z F
Z �
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MINOR
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The Town of Barnstable
. B AS •� .
921AM.
�0�' Department of Health Safety and Environmental Services
fo nn9" Building Division
367 Main Sireet,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissione
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 preexisting
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. I
Type of Work: 6eL K S AV 01.4-elO SiZV//Est.Cost ®s QQ
Address of Work: tic) -s nz&��A v_d
Owner's Name
9
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 pply for a permit as the agent of ,e owner:
1 I--)- 13�1
Contractor Name Registration egistration No.
OR
The Cunrmunll'elrlt/i of Atussuc•/iuscttt
. ; ;; :-•-. _ Department njlndustrial.9ccirlutts
_ Oflict811,7 SUgJ11nos
h00 li'a.vNii, tin Slrcc�t
".
Z.
Boston.Ma-yx 02111
Workers' Compensation Insurance Affidavit
�initcant information: Please PR(NT'
J cat' n: ® d .
61%. 14- 4,4,s¢ L,hnnc
1 am a homeowner performing all work mvself.
I am a sole proprietor and have no one working_ in any capacity
• '-'�... ..ww•.....��e_'...r-........-t�+�.r'llrvw•iR'A! Try .�.4_.w._..MwM'...r..__.......
..... _.�.— —..r RT.�w�wr-'��r 7n�1����r.'�.�rw+.w•.wy�+w..a� ` _
Cj I am an employer providing workers• compensation for my employees working on this job.
cnn„ins• name, 1 tbu d27i
ells.. r ll,44iP ,/yi4, in-x&tpbphnnc#• L 7`�S-q•s-
insurnncc co 9&!rn�2w 14- policy#
[) 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have
the followin_ workers compensation polices:
comnanv nnmc:
addresr.
ells- nhnne#•
insurnncc cn. Holies•#
I •i.::.'r.. Va`•.. - _ -�.t••r: ••r•_�.= -_ _�r�^"'::�.�•ZL iT"s^,.ww•y. "�T�..•-- ....ti.._..��_i—.- -
cmmrnns• nnmc:
address:
tits: nhonc 9-
insurance co nolicy#
Attach additional sheet if necessary; ..-... :i e r -Ji_:"• _ -_ ��.�. ..r-
- •- __Y_.._._ 'ram �:Ii - :e► --.��..� :yie..r_�ae•w(rr:.s.
Failure to secure cm-crage as required under Section 25A of NIGL in can lead to the imposition of criminal penalties ol•a tine up to S1.500.00 andiur
une,'cars' imprisonment:ts well as civil penalties in the form of a STOP«'ORK ORDER and a fine of S100.00 a day against me. 1 understand that n
cop} of this statcnteut ma% be forwarded to the Omce of Investigations of the DIA for coverage verification.
1 do hereby ccnift filer he pains and penalties of perjure•that the information provided above is true u d co rect.
Si_naturc Date 9'
Print nnmc Phone#
.r.+.��Wrr-rr "
' ofliciai use unl� do not -rite in this area to be completed by city or town official
cin•or tn,'n: permit/license# rtlluilding Department
oUccrtsing hoard
t 1] check if immediate response is required 0seleetmen's Office t"
}'• C311caith Department E
t•
contact person:
phone#• ►nUther 5:
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th.
•d from the "law*% an etn loree is defined as every person in the service of another under an%•
i employees. As c uc t� p '
1
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 me
the foregoing Cnl;a�- in a joint enterprise. and including the le ,al representatives of a deceased employer, or the
receiver or trustee of an individual . partnership. association or other legal entity, employing employees. However
owner of a dwelling house haying 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, the
or oil tile ;_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio\"e
MGL chapter 152 section 25 also states that even.state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildingi in the commonwealth for any
applicant m.-ho has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally. ncither,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
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 as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to si-n and date the affidavit.' Tine
affidavit should be returned to the cifv or town that tine application for tine permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are require.-
to obtain a workers* compensation policy. please call the Department at the number listed below.
City oC rowns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned
the Department by mail or FAX unless other arrangements have been made.
Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questie
please do not hesitate to ulve us a call. .
The Department's address. telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents �. ..
Office of Investigations
600 «'ashington Street
" Boston,Ma. 02111
fax N: (617) 727-7749
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