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Home My WebLink About0081 ANGUS WAY � �' 1 � L '`.n«W c•- a o � �. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION •Map Parcel oy Permit# �J Health Division Date Issued 2 —® Conservation Division Fee � VIPTax Collector (, Treasurer cam . Planning Dept. t ' Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address _ / Q�� Village Owner A�C.0 r i e h J7,,C'Ze Address Telephone Permit Request Iin/� IA-10/� /��.5 � 7 K21-1 Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type X Side,�.e 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: ❑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 Number 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 Detached garage:❑existing Cl 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 BUILDER INFORMATION Name- / Telephone Number -74 U Address - o �/ m,-,��„�r- 1/ License# QA� a > �� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE FOR OFFICIAL USE ONLY _ L PERMIT NO. - DATE ISSUED :- . MAP/PARCEL.NO. t ` ADDRESS VILLAGE „ OWNER , _:F _ 'I DATE OF INSPECTION: i FOUNDATION r ` FRAME INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL Zi GAS: ROUGH FINAL FINAL BUILDING 4 ' DATE CLOSED OUT ASSOCIATION PLAN NO. a GF TF1E� p : . The Town of Barnstable Regulatory Services �Fc �A Thomas F. Geiler, Director Building Division - Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 ' Fax: 508-790-6230 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: �o o�ie !.✓a Estimated Cost Mod o U Address of Work: Owner's Name: C /S Date of Application: /a, /19 0.0 / 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 downer: Jx V //9 C -Ile Date Contractor Name Registration No. OR Date Owner's Name q:fomis:Affdav 4-^- "-SM The Commonwealth of Massachusetts =l . . ` • ' Department of Industrial Accidents ti f. xt , �3 . ONCC 0I//lruffAB!/OOS -- .. 600 Washington Street -•-•-�. Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: /'J&e, . Sc-4.e IJ location: .3V AG g244 5/)i^e- 140-C city cc.v.rv/ 'S /pia oa60 / Dhone# S-7OD . bCl,?Im a homeowner performing all work myself. a sole etor and have no one workin in aav acity %%//R1 1 1 0 1 9///%///%/////�%///////%/%////::::::%/%":----% �// �,/////////!O ❑ I am an employer providing workers' compensation for my employees working on this 'ob. :..>::::::::>':::.:.:..:>.>:.:: : .:. :::::<:::.... : :: comaanv'name.. °? dress::s ......."".... ; >:;::.:::.:::: :.:.;::;:;::..:.::::.: insrerante ca: :::;;:. '.:: ..::;;:>>.... oiit v#..:. ❑ 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: COnlD t1V �SddTelf' '' '��''� �'��I'll` �`:�` ''�`:�'`' �'" � 5 �zS `��' ��t� ��'��<�i��''�� % k� r` .:......:p:::;;:;?::'::...�:;..................................::: ::::::::::::: :::::'::::'::':....:....::::::::�:?;;;. :::.:::::::::.::::::::.:.:::........................................... ......................:............................................... :,.::. .::.::.K{.;{.}•.,v{r..r.•rr.,:::..::•:::•>...............:>:->?x:�:.. {.a'Ga, M•K .?.,•}+:•.a-:a•:rz•::•.:..• .:::?:ro:•}r{•}......: ....... s.�: wws�j� :t rY-;,i:::::::i iiiiii:::::-i:-:+iJii?i:.::: y�jj...'VI.V:�/'i.:�: <i:�hti�ii'::..i.....I...;:{}i::' Div:;::;:;:i,^•�i:!i1<:::::}F�j.'•'';:;>:;:�:'v:<y iji:;:;:_:;::;::'?}.V II ........... .. 1. ............................................................. .......:.. .......:• .......................................................... ..:..... .. :.......::.:...............:............................::..:..::::......:.:::::.:. :v:::::::.v:.:::::::.:................................. .. ::::\ }}?i?:{•??:^i?}is f:}:•'F.•....:':'%•}::i:•?:ij:{:iT:::ijiCy::::::i::i:i'::i::! :}: :ijij:::. •?:} i:•:•:{O:??}:::•:::•n:v.......................................................................nv::::: :;.}:•?:•???Y.•}}:p.?:{;:i*'?:{.?:•::v::::::i:•�.':{ -'v::•:••::.::..:i .. ............................:.w::::.�:::::::.�.}.. i:?:v::::::::::.:v:::::::::w:v::::nv:.v:::.v::. .........................:..................................................................................:..........v,r.Q•:::.vxv n...... ..,r..n.xn v:w::::::•.�.v:::.�: ::::.:::::v:..........................................................................:... :::• , •.vr{•i.......................,�.. ...... ................n.......{v;:.030:•...v.}................... :... h... .. :::.,:.::,......:..................................:................ 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Fafime to secure coverage as required under Section 15A of MGL 152 an lead to the imposition of cdnduai penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against ma I understsad that a copy of this statement may be forwarded to the Mce of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is&a,and correct I _,/--;,1--0 - Signature - Date ��a,/�o o J . Print name c..�lo..-. /7 S X o .e /� Phase# ?�5- - � 6 0 V — Echeckff do not write in this area to be completed by city or town official town: permit/license q • ❑Building Department ❑Licensing Board te response is required ❑Selectmen's OMCe ❑Health Department phone#-, ❑Other (tented 9/95ZJN ' 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 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 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 or 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 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. �;�Ap�iicants �ile se fill in the workers' compensation affidavit campletely,by checking the box that applies to your situation and liq lying company names,address and phone numbers along with a certificate of insurance as all affidavits may be ' u 6hitted to the Department of Industrial Accidents for capon of insurance coverage. Also be sure to sign and late the affidavit The affidavit should be returned to the city or town that the application for the permit or license is icing requested,not the Department of Indust dal Accidents. Should you have any questions regarding the`Uw"or if you iri required to obtain a workers' compensation policy,please call the Department at the number listed below. --ity or Towns 'lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the Eiidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please e sure to fill in the peimitliceose numb&which will be used as a reference member. The affidavits may be mariR-to se Department by mail or FAX unless other arrangements have been made. he Office of Investigations would like to thank you in advance for you cooperation and should you have any.questions. lease do not hesitate to give us a call. ' WAM: SEEM he Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of 10VOSUBB000s 600 Washington Street Boston,Ma. 02111 0 fax#: (617) 727-7749 - phone#: (617) 7274900 eat 406, 409 or 375 n Yi�ME IbPROVEMEMI o1�fiR CT6R"� . egiatratia��'` �xt ht i A !/?Tl1001 4oa a oFiEEo koeE 1tAIM xo w ( lilIPSNIE 9V� TOWN OF BARNSTABLE i BANISTpIiLB i 6 9 �•� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,7�5 -e--.............................,�........................................... TYPE OF CONSTRUCTION ..... CC'fJ✓O 2 ► 94-- ........01..........9... � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appl,iees�for a permit according to the following information: Location ..... ....................... 1.N... R/...... �' ...T............`.-�-/�I TELL L,/L LC F ............................................ ProposedUse ......... s '7-...... .�.g. ........................................................................................................... ZoningDistrict .........................................................................Fire District (.j............................................................................. Name of Owner ......✓... .1T IGfK��C ...Address ....!.! 4='US.. "¢y.'.. �—�{crT is v,LLF.... Name of Builder -L � .......Address !/�� /� f7 a-no a7'� ............... ................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............1...................................................Foundation iel PZ �? .....`�'�..... ........................... Exierior T—.Za........ Roofing ....eq 1,.p eq�mz! .................................................. Floors �n ... .r'r. .Interior .....111, iNf��!/ .............................................. ......................... ................................... ....... Heating .............. r .h� '...................................................Plumbing ........ .4.I.',........................................................ Fireplace D M ..................................................Approximate Cost . ` .BCD C2. ................................. .................................................................... Difinitive Plan Approved by Planning Board ---------------_---------------19--------. Diagram of Lot and Building with Dimensions ot4 Q U 0 ` Co N ok'. � V � Q a a. Q Q W � � � Qa I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . ��; ...: . .................. ..`.",.'..."`.`....................... otickells, Austin T. No ...14.066. . ... Permit for ........a.dd to. gara.ge .... . .... .. ........ ............ ... ............. ........................................................ ' i Locatio $.....Angus Way ... ... .............Way.......... ...................... enterville................................ + Owner Au.stin. ..T. ... . Stickells. . . .............. .... . ...... .. . ...... . ...... .... Type of Construction frame ............................................................................... Plot ............................ Lot ................................ July 19 71 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed .... ............19NO M PERMIT REFUSED ................................................................ 19 rb ........................................ ................................. P ........................................:....................................... ............................................................................... ............................................................................... Approved .................................................. 19 ............................................................................... ...............................................................................