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I, .,''4, ",-4 � �, h",�; -,- ­ ,.,."It'�' "'L"I'', ,; 41" " ;m,�,�f,,f,,,;� .11 ,,,,,,,, --,", l�',4�1'q't!I,'�; ,;;.�'Ijjoj�`44 X, Y .. �ti!/,�l.i,-'�,-,�,�4�/����,...,'���,,,'-�',�',�'l�'�,��".�i�i';'Rfifl�j,?,�Zlf, ,,�'��1A11;'1qt , v ,, , �-4 ,� I "E. . , � ., I,,� ,��,,� , 1. .I- I . 1�,, Engineering Dept.(3rd floor) Map �� Parcel 14 56 Permit# 1 1 q V House# Date Issued & - /Ql Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee as-, Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) �t Definitive Plafl�pprjoved by Planning Board 19 RNSTARLE.� 6,j9• TOWN OF BARNSTABLE Building Permit Application Projec Se e Address A-i J U S Village�� '`7 /Va �'1/ U 1V1H. , Owner bn_ e/Gv Address Telephone '•:+' ` Permit Request S c�o:0 (Are.a� gl n G�C..P 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) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name T,,e AIJ Zap <,0 Telephone Number �— Address '7 1 7- d2a��CM C" ,(Z License# u c k' /lil/4, D2'G'sS` Home Improvement Contractor# fl 1 s_` 6 Worker's Compensation# /, ' a)�L, q5�UILQ& 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 / G3wn,s SIGNATURE Je -, DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) f ` a III J R , I r The Commonwealth of Massachusetts Department of IndustrialAccidents � -= � 0/jiCeo/Inyesageliens . 600 Washington Street Boston,Mass. 02111 workers' Compensation insurance Affidavit I�catic�n• ��� �/y� l2 city U VYI✓-1 ht — 3 65 2- ❑ 1 am a homeowner performin;all work myself. ❑ lam a sole proprietor sand have no one working m any capacity MMMMMMWOTlani an employer providing workers'compensation folr try employees working on this job. l�ll� Mupany name, � �r!✓1 S"J-/'ZcJcl'ly;�-� 1s14►rexs• .7 ( .%�� :ram` : ��:_. '— resu tit � ..r�j /�} •: �. ❑ I itm a sole proprietor,general contractor,or homeowner(cIn le one)and have hired the cotrtractors listed below who have the following workers'compensation polices. ss. h nr#= i fpltt tan �n9urance c ... . F"allure to secure coverage as required under Section 25A of d1G1.152 can iead to the imposition of criminal pen altics of a flue up to I i—'360.00 aad! or noc years'impriSonalenl as well a$Civil Penalties in the furm of a STOP WOkK ORDER and a Tme of$100.00 a day against me. t understand flint a copy or this statement may be forwarded to the t)tfee of Investigations Of the DL►for coverage verification- !do lte�rfiy cerf y t<nde the pains a td pen(W' ojperjgry Mal file information provided above is true and correct. Signature atc Print name ,qQ2/9_0j hcnc ii official use only do not write!n this area to he totttpleted by city or town official city or town; perinit/liccmvc q Building Department Q1,iCensing Board Q check irimmedinte rchponsc is required pSdectmen°�Oirtce QHcalth neparlmcnt contact person phonet+; _ Other heviccd.1/95 PW Information and Instructions r . Yi 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 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 en-aged 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. MOL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business 6r to construct buildings in the commonwealth for any applicant who has 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 coutraet 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 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 required to obtain a workers' compensation poi icy,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 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 to 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 Iellew"Bus 600 Washington Street Boston,Na. 02111 fax N: (617)727-7749 phone#f: (617)727-4900 ext.406,409 or 375 ..,, a.V 4 e� r �°F SNE 44 The Town of Barnstable • BABxsTABM • 9�A ' � Department of Health Safety and Environmental Services rEDMA'�p Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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 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: S, Est.Cost Address of Work: S U s �-t Owner's Name &,q sh C 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 apply for a permit as the agent of the owner: D. to Contractor Name Registration No. OR Date Owner's Name