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HomeMy WebLinkAbout0101 WOODLAND AVENUE 10I O©cd- kylcl k¢ c,• TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel e!�6 /0 0 Application # c�U S Health Division Date Issued "�7—t Y � Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address /Of wocd_1 4 Arc. Village ��wS. Owner MqC a✓L- FeM"( O'l VuS"r Address �. C��e�� S� Cov'Ti Telephone 11( I Permit Request ,E e h4 d Ord �� frti/� C�jr AIC 7 �' Ic�t► O�f� ch Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ud 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: ❑Yes ❑ No On Old King's Highway: CYesa No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other x Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing - new Half: existing 4 new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count ', 6 ry 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� % Telephone Number SUS vSl SU� Address 413 F4 N`"h 10- N.S�f License # Home Improvement Contractor# 1140�µ i Email z� a K Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN70 SIGNATURE DATE G- tV N FOR OFFICIAL USE ONLY APPLICATION# ~DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF.INSPECTION: i FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The CtammonweaUh of Massachusetts Depar&nent of fidm rial Accidents - OiTwe of Invesagations l ` ....... : -' 600 Washington Street Besfan,AA 02111 wn*tv rntTss gomlldia Workers' Compensation Insurance Affidavit:Builders/Contra.ctois/E.ectricianslPlumbers Applicant Information Please Print Legibly Name(Fusin Oiganization&dividnal)- SVW Address: 153 I Ihw(� o ZS City/State/Zip: Phom 4-7 —S43 Are- au.ain_emgloyer?Ghtclthgapgapriatebaz u __.—_ _�— T , of a'ect- r Hire —— 4- I ant a. contractor and Z LL._ � lr 1 (eq' ---__-- l. I am a employer with— ❑ � 6- ❑New construc#aon employees{full and/or part-time)* have hired the sub-contractors. 2..El I am a sole prapfletor or partner- listed on the attached sheet', 7. ❑Remodeling ship and have no employees sub-contractors have 8. ❑Demolition w for me in an capacity. employees and have workers' �� Y _ •1 9_ ❑Building addition [NO,Workers.COnrp.irmmdnce CcmP-InSIUMEK). required-] 5. ❑ QTe are a corporation and its 10-0 Electrical repairs c:r additions 3-❑ I am a homecumer doing all work officers have exercised their I1_.❑Plumbing repairs or additions myself[No workers'mmp- right of exemption per MGL 12.❑Roof repairs ,insurance required_]I c.152,§1(4),and we have no employees_[No workers' 13_❑Qther comp-msaranw revired.1 *1�ay applicant that chedcs box#1 must also fill out the section below showing di&vla�ceis''colVensadoapvlkT infarrnafiM1- 73nmeowners also submit this affidaM indicating they are doing zA stock ead then ham outsides contractors Est snbm3t a new af5davk inrr"ink mdL ZCoa"ctors that dhect this boat must attached an additinnsl sheet dhowh3g,the nsme of&a sob-oon 2cbxS and state whedier omit timse eatifks have employees If the sub-coutmctors have employees,they nmtst pmvide their warkers'tromp.policy number. lam an employer tltat is prm iding it�orkers'conWeyLvrtion irtsurrrr[ce for rity ttnrplayees Below is the panty artd}ob site information. ' Insurance Company Flame: TR"'G den S Policy#or Self-ins.Uc-4: V q J 1 -7 0 I Expiration Date: -�O t' Y Job Site Address: IO +�� y� City/StatelZip: Attach a copy of the workers'campeasation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MUL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or Me-yeariMpfiSaMneDt as well as ci%il penalties in the farm of a STOP WORK ORDER and a fine of up to S-750.00 a day against the violator. Be advised that a copy of this statement may be farwarded to the Office of Investigations of the DIA for immnance,coverage verification- I do hereby certify u. ns n enalties ofperDury thatthe information prat*ided abm a is h uw and correct Siturature: Date- tee 1 7 Phone#: (]jkial use only. Do not write in this area,to be completed by city or town offrciaL City or Town:. PermitUcense# Issuing Authority{circle one}: . 1.Board of Health. 2.Building Department I Cityffown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 .. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,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, §25C(6)also states that"every state or Iocal 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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificatc-(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. T11e 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. Seli insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit- 'Me Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give as a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office Qflmvestigatlans 600 washingtan Stzett Bostons MA G21 I I Tel A 617-727-4900 W 406 or 1-9 MASWE Revised 4-24-07 Fax#617-727-77'49 Fvww.i-aass-gov/dia Steven Kady Phone: 508-563-2515 Ma. Licensed Construction Supervisor#059847 Toll free: 800-567-9787 P.O. Box 493 Falmouth. Ma 02541 Cell: 508-566-5087 Fax: 508-563-2516 Email: skzx12r aol.com www.SteveKadyMasonry,com fi • k _ PRO OSAL June 9, 2014 E Arlene MacDowell rr 101 Woodland Ave. Hyannis, MA, U 508-428-2633 774-338-9175 inkyem(a aol.com WORK TO BE PERFORMED: • -Construct ground staging, . • Construct roof staging • Remove gable end chimney, down to foundation base • Re-construct only the exterior portion of the chimney, to the original.size and shape o Using Boston Colonial brick o With detailed crown o Re-use stainless_steel chimney cap Labor, material, disposal& buildingpermit: *$8 800.00 p , Diamond saw-cut&replace section of concrete sidewalk: Labor&material: $300.00 Repair crack in driveway: No charge TOTAL: $9,100.00 *50% to schedule, balance due upon completion t 7�