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Home My WebLink About0088 VANDERMINT LANE 8S Va.�rrri��f L..vl. � - --- -- = • /S Map (5t Parcel tj Permit# L?r House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-�a39) Fee �.25 Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planninlive D (1st floor/School Admin. Bldg.) �.�rq DApproved by Planning Board 19BARNSTABLE. MAIM TOWN OF BARNSTABLE Building Permit Application Pddress A e VAPVCQ?A } Village —vPv J IQU h I I^&h R ?Ci f Owner fu( t Addre -Telephone Permit Request vaZ94 slna:,� 4c, -40 First Floor 13 square feet Second Floor square feet Construction Type Estimated Project Cost $ 011.E '—' Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Z Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑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 No.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 y Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(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 a4n C✓l.Gc4M Telephone Number Address License# CC) / YVl y9- Home Improvement Contractor# Worker's Compensation# /,00 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 A(O7/ ✓� SIGNATURE ` DATE f BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) r- FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. " Y ADDRESS VILLAGE OWNER DATE OF JNSPECTION: r• j i FOUNDATION FRAME r INSULATION FIREPLACE 1 - ELECTRICAL: ROUGH - FINAL-. ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL = FINAL BUILDING 1 + i DATE CLOSED OUT ASSOCIATION PLAN NO. ', low The Town of Barnstable sum �$ Department of Health Safety and Environmental Services E1 . Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosson Office: 508-790-6ZZ7 Building commission!Fax: SOS-790-6730 For once use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT•CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 142A requires that the "reconstruction, alterations, renovation, repair, moderni=don- 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: Est.Cost Address of Work• n Owner's Name & Date of Permit Appilcation• I hereby certify that: Registration is not required for the following reason(s): Worn excluded by law Job under S1,000. 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 AR131TRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A \ SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of the owner. 0 D Contractor Name Registration No. OR Daze Owners Name c� The Commonwealth of Massachusetts ;;,� Department of Industrial Accidents _' _ Office 01101V95 98YOos 600 Washington Street +r Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name cF_,'�ef7w �Ao_�� location / ( t / 914cc4_�Un Col city rn4— phone i{ ❑ I am a homeowner performing all work myself. ❑ I am a sole ropnetor and have no one working in any capacity %/ am an employer providing workers' compensation for my employees working on this job. comonnv name address: city phone#: insurance co. 22aA)� olicv# //% /%////////%//////////%//////////%//%// //////%// //// ////%///////%%/////////// ❑ I am a sole proprietor, general contractor. or homeowner(circle one)and have hired the contractors listed below who have v, the following workers' compensation polices: _......... com anv name: address- phone phone#: insurance cm olicv# cam anv name: address- phone phone#: insurance co. oliev# / / %/////// Failure to secure coverage as required under Section 25A of 11GL 152 can lead to the imposition of criminal penalties of a One up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby eerti th sins an allies of perjury that the information provided above is truo and correct Signature Date Print name �u C �.� ^ Phone# official we only do not write in this area to be completed by city or town official city or town: permitilicense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Se a rtm n ❑heal t th D Deepartment contact person: phone#; ❑Other (Mined 9195 PIA) i` l 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 connrac 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 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 o: 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha 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 tion policy, please call the Department at the number listed below. are required to obtain a workers' compensa 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 fo 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 Investlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �h fi 10 ]` +�-r!s• I � ,A,�///i G,� ��5�1 �J � r 44 Ss ol +� ': �I - d aJ.L �rar 1 nip' • i.�.�,� (4an~ic E' �Sy ��,✓h�� A$ �7^3 s ��z0.i • ..{r{y��"�Y-2� �a'� kt t. wz7't�.`t .a^�h4 w ?r'� :� /.C. � �)�y