Loading...
HomeMy WebLinkAbout0365 WEST MAIN STREET ;V g o i 1 • `' '. . `. ... L ��� ��.� /-!;ire �� ._ h. S r 4; .. - 5 - r�• -' • „ . • . ' t. .1 •y j- � A f'x'.F` � •. . .. Y . a e'a .� 7°s �-" ' •� V r ��^. + a �� y' F, - `'{. + 1. 4^' „r' - •1 (f� vJAtJL- 40 �. 1&a .r. « r. �, - - 'Y .. .. - t -- - _� �+ �,. �• �, � 1�.. a • ... .. ...'. -... .-r � _ .. ., :.. .., . `r { i � - _� f: .' ` . ' ` . ='4 ��.. y .. � ..� .. .. . �. I � t .. _. i. - .. .. �,.- 4 .: � ... r - r �' ': - � � .. w .� _ ,. ... � ; � � f. .. .�' P' ,. , ,��• � - . , , - - j -� +Y ;' �.��.. � _ y� ! y '� _ .. r �. _. �. ... r w-..:.. .. � .e.... ..:. .. � _ r..:'. va ... w -- VW a � � .. � � .. '. 1•. •: � - � •. 1 � i� .. _ �, � c' �• 1 - ._ j , F 5. G' G ` Y-.' � .. i- -, y 4. ?iy s .. CO MM O NW _A LTH OF MASSACHUSE.T � ;SETAR NTNT�OFINDUSTRIALACCIDENTS -L 600 WASHrNGTON ST r BOSTON, MASSACHUSETTS 02111 games.: Cariooel Sc-�-ss�one 'WORKERS' COMPENSATION INSURANCE AFFIDAVIT J(licensee/permiacc) with a principal place of business/residcncc ac: 006 3`�-- . (City/Bract/Zip) do hereby eercifj; undcr the pains and penalties of perjury; chat: j ) 1 am an employer providing ncc following workcrs' compcnsation coverage for my employees-orking on this job. Jnsurancc Company Policy Number am a sole proprietor and havc no one working for mc- (J l am a sole proprietor,general contnaor or homeowner (circle one) and have hired the contmaors listed below who have the following workcrs'compensation insurance policies: Name of Contmaor Insurance Company/Policy Number Mmc of Contractor Insurance Company/Policy Numbcr K2. of Contmaor lns=ncc Company/Policy Number I.am a homeowner performing all the work myself NOTE: Plcase be aK•are that wbilc boracowaus who employ persons to do raainteaince.eoastruaka or repair work on a d—c1ling of not more tban three units in wbicb ut c boracowncr also resides or on the grounds appurtcoa.nt thcrcto art not gcaerally considered to be eroploycrs undcr the Wort-cri Compcnsation Aa(GL C.152.sea_ 1(5)).appliutioa by a boracowoer for a 1ieeDSe or permit may evidence the Icgal sutus of:.:cmrloycr undcr the Gorkcrs'Cornpcosatioa Act_ i uadcrstartc tnat a copy of this statement wits ix for,,.v cd to tic Dcpa:: cnt of Industrial Acddcntt'Orscc of Insurance for.covcrarc ---crifseation and that failure to secure coverage as required undcr Section 25A of MGL 152 can kad to the imposition ofssiIM pcsialucs consisting of a fine of up to$)500.00 and/or imprisoetmcnt of up to one year and civil penalties in the form of:Stop Work Ordcr and a fine of S 100.00 a day against mc. Signed tMY day of )9 - ucnscc/Pcr trtcc Licensor/Pcrmittor i Failure to possess a current COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY _ -n A/assacbusettsStateBuild/A# P OF ONE ASHBORTON PLACE Code Is cause forrevocafloA MASSACHUSETT -1-44-y BOSTON,MA.02108 o>ftA/sflcease. CAUTION EXPIRATION DATE r ± y FOR PROTECTION AGAINST EFFECTIVE DATE LIC-NO THEFT, PUT RIGHT THUMB j RE$T�ICTIONS ; PRINT IN APPROPRIATE 6j1 BOX ON LICENSE. .. BLASTING OPERATORS MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) FEE: .. ,• .. .. '°• NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY - HEIGHT: STAMPER-SIGNATURE OF THE COMMIS TONER THIS DOCUMENT MUST BE .I « SIGN NAME!N FULL ABOVE SIGNATURE LINE .l CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE THE HOLDER C:'HEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATIOKION. R =wov i� r Assessor's office(1 st Floor): Assessor's map and lot numtier (p.Q o per' P�Of THE TO`` Conservation(4th Floor) ^-� o Board of Health(3rd floor): sMUMnr, Sewage Permit number Engineering Department(3rd floor);: / ? �o,,�o639.``�d° House numberS4 a ear Definitive Plan Approved by Planning Board z 19; APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only :TOWN OF BARNSTABLE f %BUILDING INSPECTOR ' APP.LICATION�FOR PERMIT TO �e oye C e- TYPE OF.CONSTRUCTION (9Q� fW� 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location P*J&v�— OIL&-�®mZl�s Proposed Use �h0 Zoning District S Fire District Z2 Name of Owner R-1 CV�,A �<© ��� Address Name of Builder >^V�� COQNA�''c-`V-X/ Address J? 0 L© F44* M P-'�. C-y I LL Q Name of Architect Address Number of Rooms Foundation Exterior ` UI Roofing Floors t T�� � Interior Heating Plumbing Fireplace � Approximate Cost flaDo Area (� Diagram of Lot and uilding with Dimensions Fee 0 f N 32 g OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the?aboveco uction. Name Construction Si ipervisor's License C 46flJ 9� KOPPEN, RICHARD - � 414 No Permit For REMODEL/RECONSTRUCT Roof ` Location 365 Anchor Outboard West Main Street ; 1 H)janni G -fit Owner+ Richard. Koppen Type of Construction Frame Plot Lot ' r November 8', 93 Permit Granted-- � 19' _Date of Inspection: - Frame 11116 19 r `Insulation _ 19 lace r 19 J - D to C "mpleted � 19, tom, f - ^ r ' ♦ ,ter `-.:t Town of Barnstable *Permit#;66� q&01 Expires 6 months from is d e Regulatory Services Fee ` Thomas F.Geiler,Director Building Division X-PR Tom Perry, CBO, Building Commissioner =-' .>s�t, 'PERMIT 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us NOV 1 7 2006 )ffice: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIA ONLY� L; CT'7B9kATABLE Not Valid without Red X Press Imprint (parcel Number erty Address J -S (.c�,�87- AA. _esidential Value of Work_ �(, 'Z{),o t� Minimum fee of$25.00 for work under$6000.00 er's Name&Address _5_U ov / p IF- .it ,/,� ractor's Name 1 6� 1�-' �, �L �D f-j�� Telephone Number -,I e Improvement Contractor License.#(if applicable) J 4 0 6 orkman's Compensation Insurance Check one: 0 I am a sole proprietor am the Homeowner I have Worker's Compensation Insurance ance Company Name_ A-I LA-14 I C L'Jt/,9_&7-e/ man's Cornp.Policy of Insurance Compliance Certificate must be on file. it Request(check box) U Ke-roof(stripping old shingles) All construction debris will be taken to At, ❑Re-roof(not stripping. Going over existing layers of roof] ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improve �"ritractors License is required: ATURE: oe s:expmtrg 161306 7k Pam, Board of Building Regi;lations andand Stagy HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use cnly Registrarion; before the expiration date. 116084 Board of Building If found return to: Ezp[rat[on 6�15 2008 g Regulations and Standards One Ashburton Pace Rm.t TYPe Ltd/t,iabilit Co Bost"',Ma.02108 1301 t Y rporation ALL ROOFfNG_`LLC RT TYNDALL` } _TANS WAY K, TONS MILLS, Deputy Administrator --- " _ Not valid without signs ure y t TYNDALL ROOFING , 7 3 .,_ �� �� prop osat , As 'N ",A (508) 420-4456 0.2 ; I Page No. of Pages PROPOSAL SUBMITTED TO PHONE DATE 7L � STREET ':'Y* " JOB NAME`' 1�3 s 79 (9VT ® _.D CITY, STATE AND ZIP CODE JOB LOCATION S I ARCHITECT DATE OF PLANS JOB PHONE i 77 ' 31( I i We hereby submitspecifications and estimates for: I i i Furnish and install new Class"A" Roofing as Follows: A. Strip existing roofing and remove debris. B. Check all boarding and nail as necessary. C. Check all flashing. D. Install aluminum drip edge. VEI-17£A` E. Includes ice and water shield to be adhered to roof 18" along entire lower edge of roof to prevent ice leaks i also around chimneys, skylights,roof stacks, and roof valleys. F. Apply shingle under layment- (felt paper). i G. Includes new flashing around all.roof stacks. H. Apply customers choice of shingle: I. Apply continuous ridge ventilation. i I Any unforeseen rot that maybe uncovered during construction, the owner will be informed knd made ware of the extra cost. I i III I . dollars(S > of o o Payment to be/nTde as follows: All checks-to be made payable to TYNDALL ROO G All work to be completed in a sub- stantial workmanlike manner according to specifications submitted, per standard Authorized practices. Any alteration or deviation from above specifications involving extra Signature i costs will be executed only upon written orders,and will become an extra chiege over and above the estimate.All agreements contingent upon strikes,accidents or Note:This proposal may be delays beyond our control. Owner to carry fire, tornado and other necessary in- withdrawn proposal us if not accepted within days. surance.Our workers are fully covered by workmen's Compensation Insurance. ACCEPTANCE OF PROPOSAL The above prices, specifications and condi- lions are satisfactory and are hereby accepted.You are authorized to do the work j as specified.Payment will be made as outline above. ignature Date of Acceptance: Signature rw,-rsr n,m•e-. '$.`^''°9s..'�°'��".�� 'mac� � �I Co. No.:29211 Atlantic Charter Insurance Company VDAC INSURED; Policy Number:. WGV00643001 Robert Tyndall Prior Policy Number: WCV00643000 30 Jillians Way Producer: Marston Mills, MA 02648 Federal ID Number:1745&0293 Fredericks Insurance Agency, Inc. Risk ID Number: 1046 Main Street Business Type: Individual _ Osterville, MA 02655 Other Named Insured:See WCE106 SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Work Places: See WCE107 POLICY PERIOD: The Policy Period Is From: 4/6/2006 To. 4/6/2007 12:01 A.M. Standard Time COVERAGES: at The Insured Mailing Address Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation here: MA p n Law of the states listed Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A The limits liability under Part.Two .are: e of our Bodily Injury by Accident $ 100,000 Bodily Injury by Disease $ each accident $ 100,000 Bodily Injury by Disease 100,000 policy limit Other States Insured: Part Three of the policy applies to the states, if any, listed here: each employee COVERAGE..REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States This policy includes these endorsements and schedules: )ee WCE105 OVERAGES: The premium for this policy will be-determin --�-------�----- -Rating Plans. All information required below d subjec to ve our r'ficcation and chanClassificationsa Rates & Premium Basis Total change by audit. Classifications Code Rate Per Estimated No Estimated Annual $100 of Remuneration •RemunerationPremium WC 00 00 01 ------- - -- -- ------ imum Premium: Deposit Premium: -- - ---- --.- 0 $516 - ,rim Adjustment: Annually vicing Office: Estimated Premium (Minimum Premium) \Iew Chardon Street" I Surcharge(s) $5 106 ton, MA 02114-4721 i - - Total Premium a4 Surcharge(s) _ $516 e 03/29/2006 y: cil ` Countersigned B -._._.._ ----- �a R 2 9�006 National Coun on Compensation Insurance - '- I Fnrm•9nnm Department of'Industrial Accidents Office of Investigations ' f d 600 Washington Street Boston, MA 02111 °�M s•• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plulmbers ,plicant Information Please Print Legibly me (Business/organization/individual) MCC RoD f b4a [dress: 3 O t ,/State/Zip:gftS' A45' 1LCS;Al A,_OZ&za" - -Phone #: q26. -:q` f(o you an employer? Check the appropriate box:. Type of project(required): I am a employer with 1 4. ❑.I am a.general contractor and I 6. ❑ New construction employees(full and/or part-time).` have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling These su -contractors have 8... Demolition ship and have no employees ❑ - working for me in any capacity. workers' comp. insurance. 9. [] Building addition [No workers' comp. insurance.._ 5. F� We area corporation and its required.] . officers have exercised their 10.❑ Electrical repairs or additions ] I am a homeowner doing all work. _-- right of-exemption per MGL 11.❑ Plumbing repairs or additions myself. [Noo workers' comp. - c...1521 §1(4),and we have no 12:❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.[Other 9f—,Rod T applicant that checks box#I must also fill out the section below showing their workers'compensation policy infonnnation: `. cowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. actors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy inforrnatim an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site motion. _.. ance Company Name: AT L i e c/Aw-4t y#or Self-ins.Lie. #: LJC 1) 506 .3 DD./ Expiration Date: 1469 z.D'7 iite Address: ,36S IX)W�1�1,a . S7� Ci /State/Z fi��sJ 1p:- ch a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). re to secure coverage as required under-Section 25A of MGL c:..1.52 can lead to The imposition of criminal penalties of a ip to$1,500,.00.and/or one-year imprisonment; as well as.-civil penalties in the form of STOP WORX`ORDER and a fine to$2550.00 a.day against the violator. Be advised that a copy of this statemenfffiaybe forwarded to the Office of >tigations of the DIA for insurance coverage verification. hereby cent' nder the pains and penalties of perjury that the information provided above is true and correct afore Date: dZD (3 ie#: SnSr— �/ ggS& ffIcial use only. Do not write in this area,to be completed by city.or town official. ity or Town: Permit/License# .suing Authority(circle one): Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector Other .ontact Person: Phone#.: L � � 1"�p.Nicr - � ° i__ --��- TOWN OF BARNSTABLE SIGN .,PERMIT PARCEL ID 269 098 GEOBAS-� IDi 17491 ADDRESS 365 WEST MAIN STREET PHONE HYANNIS ZIP — I LOT BLOCK LOT SIZE. DBA DEVELOPMENT DISTRICT HY PERMIT 50787 DESCRIPTION JEFF'S FOREIGN CAR SALES — 4 SQ. PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $10.00 BOND $.00 Ox CONSTRUCTION COSTS $.00 753 MISC NOT CODED ELSEWHERE 1 PRIVATE P1df. * BARNSPABLE, • MASS. 039. B IVISI�ON By lt.� DATE ISSUED 12 27 2000 EXPIRATION DATE � ' Town of Barnstable 7&7 oFt roy� Regulatory Services �•" Thomas F.Geiier,Director BARNSTABL ' Buil,dug Division 9�AT 1659. a � Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Tax Collecto . � jam►��o�_ Treasure /` �0!do Application for Sign Permit Applicant: Assessors No. Doing Business As: Telephone No. ®" � Sign Location Street/Road: �� Zoning District: Old Kings Highway? Yes Hyannis Historic District? Yes Property Own r c An rat Telephone:_ �� gzz Name: 5rk . �1-1 Address: . Village:— J�O ' Sign Contractor _ Telephone: 26 147 Name: j• � � Village: Address: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Y (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Date: Signature of owner/Authorized Agent: Permit Fee: �14) 0 Size: Sign Permit was approved: Disapproved: Date: Signature of Building Officia s►gn l.doc rev.8/31/98 F. t� +-H r. ty'' t • - "a t_ t -� any�it�I Z`x Z t UHF 2 c o 6-4 _ vi � f 2a C �- JC- pe, Town of Barnstable Regulatory Services BAM mete. ' Thomas F.Geller,Director Mess. 9`bA 1639- .,�� Building Division lED MA'S Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SIGN PERAUT REQUIREMENTS 1. A photograph showing the existing facade,'on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. i 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall,hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) Colors,the drawing may be black and white,but color chips must be attached for colors other than black,pure white, or gold leaf. 4) Materials,what the proposed sign and letters are to be constructed of. 5) A cross-section with dimensions showing edge detail. Minimum scale 1"= V.- Minimum sheet size, 8.5 x 11% Two sets. 3. A scale drawing of the bracket. A scale drawing indicating dimensions, color, materials and method of affixing it to the sign and to the building. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". Two sets. 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. NOTE: the map/parcel number is required on the application. Sign-offs are required from the Tax Collector and Treasurer's offices to verify payment of taxes. Q/forms/signreq � J b %t #,� �' .$���t" ' ses y � err " 'rx. ,,�',F^'� �:a J� `"•'.�,,:,_ WTI k•fa�, ��"'-s ,�•-'��xr-Yr�.""e", y.: L g� a ' - rY.,a�a _Y #r .y� r �#, f At x A - } go XT 4 x n awl a pwtii a x k�ti u a ws� t y r 4 „. x' eta xU .e..y - NO wa A' �,- .t`'t--nry .. i✓ u :r{ va k .Y h"'T _� +,' Kr •,T'' ,n a •a p .xa -Yt E.y i4`x ^.. r3',n•Y ,'ra�`.i 4.:e'^;z'*'' s7.*wo''8 E. Fr"iyi .i�'n'.TTM'a'•?,&�:'?4}Lr�c^/ �F "? 4 t. ,k r5,, :3-,� :-,3.f " /�, -��-0 "Z., ^' ,� T'v:. ,R bilk; , z .» �, - �,. t.. ' -T•5 x h„r'3:y.Yrs .6..- �;,<.acs m, ;f.r-7 ; i x `"�2 r +�, '.. x - ,�.t. a` ' S` P ab"K,Y✓s �"' «�r+ a2.a 1.^x ':.zm fr a r 'h`c' r w 3 : 3 ��"`�,� '. 't :T�Lxx..J gg •x x 7-`Y't 'r�a.w� 4a �, _ ;x ;., s rr may_- h Y{ � 3} .sk:. "r:,� �'.,s •:s. '# :#.,e yM1 y;k2.- "^�4r :Y a, SL ` w �x Y s Kz 1 � arsk tt r,. lfi �� ��.t. _. ,x :j�c t *r a 5, � A.�� � gn a, ,�',:� d� - r +s fis � �' �` }xr_ `��✓•�" i :.e.N ;,w� �`�'` S. - �. b ,,.. € u c 1+,-^u r ✓ �av �`wE a b., .r. 4 :at:'x'"� a r '� s.;,! °11<3t1 t u �"c'�° u ay ,., - a rrb�.��'.�r r s,,'�'az yr . �"', ,.s..`�^..t �., '� ,,.4.`��', "'yfi�? x'�✓ a �' J .fib � ,w.� :Y K � •�' y,-s;- `� A >a'v S+r '�`-". ., a'by4� ✓'Sn' " :.✓ „x ,. 1 b U-f1�}t °an. ...;s.:, + r� j*4 t r ,�^t s Qsn� i a ,'h 3;,-� ....# .� 3S r'z L uy C.'� '3 5 C 'z•.t k � :� � �x<�1 cFx +`':�� _ �, -��,rNr� w �c f 'v>�'•��},z�.� ,�ke.`� rn3��+' '�,,N'�'��a. tt'�^' (� � "'�3;-p.�,g`��n� .w a £. ;.,#? 9r s �`.•''"i*.'G�t .�� v,.., � 4� ...� v �-_. `� '� �'',�� �t�i6 &+4 }�'K "s..;_� '�6 ;>': rs�,t ���`F alh.�::._ '�.. ry, �`..F ��"S`�"'--� `�rA� r y^c5 h'.� b -:'�:� ,. fir#,,: �`• .,,Y/Se` �is`v 'i s:yz'_•A:,�54 w av'& w r'1 t ski..: c*�X. x.,.Yt': 4 3 i..:w4 r T'4 ` y s r � 4A P � t 2�-, ✓.� �.rS '�xg ra x � e a �` -.-.x r �� r���;� �m¢r _;fie .�.��'iy cam.: � � �y y:�,�. r✓.a„ a. �' 1 Engineering Dept.(3rd floor) Map Parcel ermit# 2, 3 a `7 2- House# 3 4 5 Date Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Fee f z! ` Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) Planning De t floor/School Admin. Bldg.) wE rq Defin' ' e Plan Ap roved by Planning Board 19 ; BARNSTABLE. MA85. 1Ft MAC a�� TOWN OF BARNSTABEE Building Permit Application Project Street Address R luc H 0% 0.7"6y e9 00 9 i C-ff e x_0 K_D Village 3(a6� IV, H e4 f t0 �C hV A rU nC1 i S ` "A. i Owner . C IC HA" iCb l° L Address ff 600 Telephone ``7 7 Permit Requests First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ __ 7 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) �4 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name l�l,J D rl Telephone Number L19 d Address 5-7 641 e44— >'rE License# y tp 4- 0- U t—t-C � , �a �� Home Improvement Contractor# 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 DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) >. FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED - r MAP/PARCEL NO. • " , -1 : i _ use . r f , ' ADDRESS `r' VILLAGE OWNER DATE OF INSPECTION: FOUNDATION { FRAME ' INSULATION ' FIREPLACE - ,ELECTRICAL: ROUGH i FINAL:: PLUMBING: ROUGH - FINAL • " GAS:- - ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ; - r °Erne rq� . � The Town of Barnstable &UMST"M • 6 9. ,0� Department of Health Safety and Environmental Services 10rE�u,o�°' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 1 �. Permit no. // lo��'r 1 Date Cry 7-91 t 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 pre-existing y 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: 6 1 / Est.Cost Address of Work: �O`�P !t/r4/ to Sr /fy,+fi ul,$ 6 Owner's Name /z t C /+/t ft o D P,00 G N— 14 /0 C Dvr3-64 R� . Date of Permit Application: �' f-7_ 92 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 apply for a permit as the agent of the owner: 0�, J (os 0,�7 Date Contractor Name Registration No. OR Date Owner's Name The Cunntionivealth of Afassachusetts Dc partnunt njlndustrial Accirlcnts 011ic.19"IvesMations liw 600 Il kshingtun Street Bttswit. Ma.u. 02111 Workers' Compensation Insurance Affidavit �1J7J111C'tnt information• �MiT, s PR1NTaeb&y_--�_ .._...... name P—/C 14 14f OP,PU�LJ 14 /V C.H 4 d Ur-6 of f� , loc'Ition G� , ?�/ / f4 ltJ ( � "14. 0.0 Co O cit"• nhonc 0 I am a homeowner performing all work myself. 2-1(am a sole proprietor and have no one working in any capacity Q I am an employer providing workers' compensation for my employees working on this job. cmmmam• name: address• city phone#• insurance co. 09iicv# [I 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: comnanv natnc• address• city: nhonc#• insurance ro noiicv# ........... ...�_�....... -bc..r++..r... :ar.-....sir'-_ :ry. 1�-• - .�`.rrr•_. -.� comnanv n• toe: address- rite nhnne#• insurance co nolicy# Attach additional sheet if necessary, _- .. .__... _�-�...._-.. - - fv..�rJ�h1.W� •—'-•►-_�._��s- lO•-_� Y.tiY!'i�iA••WL'wr+L Failure to secure cmerar-c as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a tine up io S1.500.00 andior one v cars'imprisonment as well:ts civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be fore arded to the Office of Investigations of the DIA for coverage verification. 1 do herehr certify tinder the pairs and penalties of perjury that rite information provided above is true and correct. Signature Print name ►�'� ?� / t,/��1' C.Z'' Phone.#. eJqD' � S official use unit do not%i rite in this area to be completed by tiny or town official city or tmvo; permit/license# r•tltuilding Department C3Liccnsing Board check if immediate response is required c2seleetmen's Office l '• [3Ilc21th Department contact person: phone#; M0Ihcr information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for ill( employees. As quoted.l1rom 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. I An empki•er is defined as an individual. partnership, association, corporation or other legal entity, or any two or mo the forcgoinu enLaued 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 tl owner of a dwelli11" house having not more than three apartments and who resides therein. or the occupant of the dwcllin�, house of another%%,ho employs persons to do maintenance , construction or repair work on such dwelling he or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be Zn emploV( MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance of- renewal of a license or permit to operate a business or to construct buildings in the commonwealth for anv 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 ng resented to the contracting authority. P ,. 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 you have any questions regarding the "law"or if you are require to obtain a \vorkers' compensation police. please call the Department at the number listed below. Cite• or ,ro"-ns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c- the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pit 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. The Office of Investigations would like to thank youu'in advance for you cooperation and should you have any questic please do not hesitate togive us a call. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 r fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375