HomeMy WebLinkAbout0063 WAREHOUSE ROAD ., - -�_�__�-� _ - _ -- A..,
/ //
/ ,
�1
�1
� 1
i
i
ngineering Dept.(3rd floor) Map Parcel /,�eermit# r/ ` 45"
F ' House# Date Issued
,)3qard of Health(3rd floor)(8:15 -9:30%1:00-4:30) Fee Yo
Conservation 0 4th floor)(8:3 - 1:00-2:00)
Planning Dept.(1st c dmin. Bldg.)
D in' ' an Approved by Planning o d- 19 ^y�7y U.;
• BARNSTABLE.
�
MAIM
16
CEO MAC a`
TOWN OF BARNSTABLE
Building Permit Application
P 'ectA, treet Address v5F
illage ,[,Z��Qrv�✓!�
Owner jz!/�N bo6�Lg ZD� Address Z-7
Telephone
a
Permit Request x v O/C
First Floor square feet Second Floor square feet
Construction Type
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 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zop�ng Board;��esLj
is Authorization ❑ Appeal# Recorded❑
Commercial No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name 419 5®vt, Telephone Number
Address 5-0 Y L7 License# 0a3 2,�
/7-7,�+ a (p 3 Home Improvement Contractor# IV 3,71
Worker's Compensation#
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
SIGNATURE h;; 9( DATE !lA10
�—
BUILDING PERMIT DENIED F R THE FOLLOWING REASON(S)
P '
FOR OFFICIAL USE ONLY
1 e
PERMIT NO.
DATE ISSUED - -
MAP/PARCEL NO. _
ADDRESS VILLAGE 1
OWNER { _
DATE OF INSPECTION:
' 1 E
{
1
FOUNDATION
'FRAME
INSULATION
FIREPLACE C -
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
+FINAL BUILDING
DATE CLOSED OUT
r
ASSOCIATION PLAN NO.
The Commonwealth of.4fassachusett-v
^i i ;__.-�;_ Department of Industrial Accidents
t l
600 K a.vi tr;;tim Street
AFL` •.•' Boston.Alas. (12111
Workers' Compensation Insurance Affidavit
��r►ItcRnt tnformation• _ - • Please PRiNT'ie`�jy � ,
nam •
locition-
city nhonc#
1 am a homeowner performing all work myself.
1 am a sole proprietor and have no one working, in any capacity
,.._.t UM—.=.+...- ".'!""r ''--••E'E,-'^TA.-..r=.iP.R7:.•--,....a. *lea.--�^_w* _ �► -.-�•�v_•.:Y'.!Rfrr-•--..e.a..
I am an employer providing workers' compensation for my employees working on this job.
Company name:
address- c27 F/ -
cih^ N`> /1 A 6 nhonc#• & 7
incurince co ' Policy!
,• , .._. ,,... .�.,.._.. . .;�,..._yes:n,.,......:.......�.,,.�..ry---••-•r......,.... ------- ...�. ..
I am a sole proprietor, general contractor, or homeownex(circle one)and have hired the contractors listed below who have
the following workers' compensation polices:
comp•tm• name,
address:
cin.: Rhone#•
insurance co noliev# '
.,n�. •.':_=Fri•.'f�l•....�.F _.._..ry.TZZZ
�'� 1Ti/ '.1�I::T�+i1.'.,--• .•.f(�.'7a. 11��.��Ti�!.' _
company name-
address-
city phone#•
insurance co nolicy#
,Attac_h additional sheet if necessa - 'o-- "��risfryr x:.�`1� ar.• �_+ ���•'+• +at _- "'�R= w+
Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.UU andiur
one •cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine ofS100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. '
!do hercht ce if.1 turder lie pail s and penalties of peryuiy that the information provided above is true and correct.
S i mature Date
Print name Phone#
rcity
uses on do not write in this area to be completed by city or town official
town: permit/license# r9Building Department
C31.icensing Board
check if immediate response is required C3Selectmen's Office
C311c2lth Department
contact person: phone#• 00ther
In.,,.ed,:0s NA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* cnnip-ensatian for the
employees. As quoted from the "law", an enrploree is defined as every person in the service of another under anv
contract of hire, express or implied, oral or written.
An etnph rear is defined as an individual, partnership, association. corporation or other legal entity, or any two or►nor
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 ill
owner of a dwellina 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 ILc
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employe
MGL cha.pier 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 buildings in the commonwealth for any
applicant who leas 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
been presented to the contracting authority.
_. ..�::, 71
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 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 vdU have any questions regarding the "law"or if you are requires
to obtain a workers' compensation polic}t, 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 o
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple:
be sure to fill in the permit/license number which will be used as a reference number. 77te affidavits may be returned
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 question.
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
Boston,Ma. 02111
fax #: (617) 727-7749
n�nnn !. (617) 727_49011 p.t. ltlh_ 409 or 375 __
own of Barnstable
The T' NAM Department of Health Safety and Environmental
Services
Building Division
367 Main Street,Hyannis MA 02601
Ralph Crossen
office
: 508-790-6227 Building Commissioner
Fax: 508-790-6230
For office use only
Permit no.
Date AFFIDAVIT
HOME OWR TO PERMIEMENT CONTRACTOR APPLICATION
SUPPLEMENT
wires that the "reconstruction, alterations, renovation, repair, modernization,
MGL c. 142A requires y Pre-existing
conversion, improvement, removal, demolition one but construction
not than four dwelling units or to
owner occupied building containing at least registered contractors, with
structures which are adjacent t uir building be done by
certain exceptions,along with other requirements.
�
Est.Cost d� ---
Type of Work• Oo >/1��_
Address of Work:
3 (P re�Ha✓5 o
Owner's Name
o N� z3
Date of Permit App
lication• 9
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: OWN PERMIT OR DEALING WITH UNREGISTERED
OWNERS PULLING THE
T HAVE
NTRACTORS FOR APPLICABLE HOME IlVII'ROVEMEFU ND UNDER MGLO 142A
CO ARBITRATION PROGRAM OR GUARANTY
ACCESS TO THE .
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner. O 3 7/ [J
Registration No.
Contractor Name
Date
OR.
Owner's Name
nate
pp
DEPARTMENT OF PUBLIC SAFETY r 23-s07
ONE ASHBURTON PLACE, RM 1301
BOSTON `MA,>:02108-1618 OC 13 U 1995
a
CONSTRUCTION SUPERVISOR LICENSE
Number: Expires:
r
Re='tLil.r.ed To: 00 t
PAUL J CAZEAULT =� Detach bottom, fold sign on
1580 MAIN ST � _ � back, and laminate license card.
OSTERVILLE, A'`!A 02655 r ` - ' ' Keep top for receipt and change
of address notification.
<,�.\ ✓/�e -Pa»�no�uo�lt/ a�✓�oa�aet>ra � �
— Restricted To: 00 23407
'., D-ARTMF'rT OF °0"s�TC SAFETY
S(PBR'd1SOR 1-IC6NSL 00 - None
'ulber: Expires:
1G - ' & 2 Family Horaes
W ricted 'o: 00 Failure to possess a current edition of Ch?
Massachusetts State Buii'•dinq .ode
CHI, J C-ZEAUT-•T is cause for revocation of this license.
1S`v� �1}T1i JT
OSTEN •L7, M?k 0267: Shj Sx 2yy lag �yf I�£Nfv�r x4 f tY'7T } ts _
z `�4%,, ,: "i t.�Y w a { I f�
HOME ;IMPROVEMENTS CONTRACT�QRS REGISTR TION � � r
Boar d';of Bua ldin Re Cv F
�g� g �.o;ns nand; 5tandard5
One AshburtonP'plae
" BOru't is'a r 8.. -•aim'kc�..tit,§` "02�0
.•^�S`��i#�il+,;•
Ori �.<Mppassac�ugseaMtt '
.n�, z ..&nV /'�' 1 110.y�i S y'�' etN.. M1,.. a � �.` ret f :•
4 3 �t ,.
HOME IMPROVEMENT 'CONTRACTORg � - ---------
Registration 1037-1�4 ' zirata o
Type — ,PARTNERSIZF
gym_,r� z d". RID., VENENT CONTRACTOR.
� + *tt r '�i`• � 5. ,�.a;�:2a.. anrl�F:.: z. t �•a�`�'. ry,"Sr4 r h
- p �' � ��I� �. v^4 g,eglst' t1on.'.1104114
PAUL J CAZEAULwT :3 { S"� QE�I,J � ' ri TxP' `�,PARTNERSHIP'c
Paul J :Caz6ault'", Expiration 07/09/58
t� 1 k7 �a ti �� � Y�•,+}t rk��I" v .r,•� � .#' w �.a `~�,� r }�" .'r�,•
22 Giddi°a1t Rd x .=P, 0 '�B�x,tg278:1 �. P ,� 1 �
x }x � k �y gOrleans MA 0265 a+
A & SONS 800FI L
,u F M v :1t'>t -.'� •r. �tE°'4 Ia-.'4 :+=�R `sY' �' r'!a + P.O: Box 278
;: r r. 5 ���,� "� � �,.>s .� .� .,� ,, .�'�I��n� .�, ,� � �, `Orleans MA'02653 •
"_—',_ .. ._.-_ -. ... .- � -. .,. _ _ _r..- _.�:__,.,-S.aG.,+�.+-LHe „�k----.—_. -. "r`. .�.`Y_..2.se�'3.�_._. ..•.+'..ti...,s..r�.'�.a'i...sw,.s:�s. .• ,�.3'e-.'__':`J..._?_._._.x_ .....___ .
COMMONWEALTH OF MASSACHUSETTS