Loading...
HomeMy WebLinkAbout0306 BUCKSKIN PATH 3 t� 3�.�� Paa� s M TOWMOF BARNSTABLE BUILDING`PERMIT APPLICATION Map Parcel ' Permit# Health Divisor Date Issued o Conservation'Division - - / � Fee � _ Tax Collect .. / Treasurer � ° b Planning Dept. Date Definitive Plan Approved by Planning Board r Historic,OKH Preservation/Hyannis - t • Project Street`Address -,Village ', ���� P2�t tt . 1r. 1 ►�# c �0' �..��.?'i" IU 1 .Owner 1 F7hA dr ss` S Telephone " ,Permit Request Square feet: 1 st floor: existtiiyng ,proposed 2nd floor:existing proposed Total new Estimated Project Cost 0 � Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes 0 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 0 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 O Oil O Electric ❑Other Central Air: 0 Yes ❑No. Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:0 existing 0 new size Attached garage:❑existing ❑new size Shed::0 existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use yD ft(, C) 0 F.I k-)`EUILDER INFORMATION Name 17 �� '�Telephone Number Address ��i . �- �Lf-L License# vtp r 05T-r--P-0I Lu t "(4' a��-Home Improvement Contractor# ( i CAP 'Workers Compensation# a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ::rD U' 0-� ►J L9 f SIGNATURE DATE +� 4 FOR OFFICIAL USE ONLY r PERMIT ITO`�. :/ DATE ISSUED � r ~ ., f ". ,,,z: •} ,.. _ �,` - r ,, y . .. :� � +- ' . - • ` MAP/PARCEL NO. � 1 t ADDRESS - <.. VILLAGE' OWNER DATE OF INSPECTIOM * FOUNDATION FRAME INSULATION FIREPLACE y ELECTRICAL: ROUGH 'FINAL: i F PLUMBING: ROUGH FINAL' , GAS: ro ROUGH FINAL " '. :- - iL. . 1 FINAL BUILDING — DATE CLOSED OUT ASSOCIATION PLAN NO. _ f - 4 ' S _ The Commonwealth of Massachusetts IMP LP t-� (fie Department of Industrial Accidents l - 1XI — 0/flceof/oYesd9at/ens 600 Washington Street ' Boston,Mass 02111 T Workers' Compensation Insurance Affidavit name• ,q.�,— location �� �� + ,o� ` P r 1 I t Q , ®e city f�l.� L L6 I tL-04 . phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job company name• address: city tl hone-#! I am 4,sKle proprietor, neral contractor,or homeowner(circle one)and have hired the contractors listed below Who have the following wor ers' compensation polices. d� �— ,. comp nv name: 1'I address, CIS P '.09. phoneff _. . • company n m - ,: .... _ .. address! city phone insurance co ' policy# �ttacdtlilionals�e'et�'f necessnr�;� „ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the sins and penalties f perjury that the injorn ation provided above is true and correm Signature Date _ .ii � Phone# �� . C�y�✓� Print name A official use only do not write in this area to be completed by city or town official city or town: permit/license# oBuilding Department _ i., OLicensing Board `d O check if immediate response is required Selectmen's Office pHealth Department contact person: phone#; -Other A• (revised 3/95 P]A) r 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 fo 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 policy,please call the Department at the number listed below. 4- City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of he 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 levesdgadolls 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 In accordance with the provisions of MGL c. 40, s. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c. 111, s. 150A. This debris will be disposed of in: i (Location of Facility) Signature of Permit Applicant Date *** ***** IF A DUMPSTER IS-USED IN EXCESS OF 7 CUBIC YARDS ********* A PERMIT FROM THE FIRE DEPARTMENT IS REQUIRED. AWE The Town of Barnstable • ■nRrrsTnst.E. • Department of Health Safety and Environmental Services 1°rED MA�� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. P Type of Work: J Q I " 9 C—4 ��� Estimated Cost � �I YP Address of Work: ""n LO !%J L)LK-5 V i Jr i C, e y(_�( 6 P_01..-CUE.) Owner's Name: C_t)L) Date of Application: I® � 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: (,- I G) -Cl q Qs�r, o��-tics l 1 te Cl) Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav 3HOMPIMPROVEMENT CONTRACTOR Registration -116064k� `. a P Type �1 DBA �..TYNDALL�ROOFING' `ROBERT F.'TYNDALL moo. .. �c6RIAR:PATCH 7 ;R " O OSTERVILLE 1 025 i5 °`THET TOWN OF BARNSTABLE 6�Q i i BABHSTA MILE, i ib 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO . .e:*z-a _ . ................................................................................................. TYPE OF CONSTRUCTION ........ .... .. ,:,,..?iAIOZ... ..................................................................................... .° :............... ...........19�.� ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the follo ing inform�ajtiion- Location .. . w "" ...... . . �.................. r... f�� ��P'.V..:.... .6¢/ d..... . .. . ..� ProposedUse .....�� 140 .. ..................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................. .................. Name of Owner ... :. ..............y.................:. .......Address ......... ' "....................... Nameof Builder ............1.......................................................Address ......................................:............................................. Nameof Architect ..................................................................Address ....................................................................:............... 6 Number of Rooms Foundation ............. + r« .... ........................................ " .......................................�'Exterior ....... . ...Roofng "4! a 6 � Floors .................................................Interior ................. ........................ Heating ........ .........................................................Plumbing .......e...........,. .,.:................................... Fireplace ..... !t ... ......................................Approximate Cost .... ..-V-1e1 ..................................... .. Difinitive Plan Approved by Planning Board ________________________________19________ , lq4? Diagram of Lot and Building with DimensionsOe 0 0 c i U- m w Lu U LLL`' \0 c ) a Q- W 00 0 Lap ;7 LQ w cn 71 rZ ELI LIJ b _j U) lam , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. f Name .. . .:t!Kzne?: ".... �. .... .: ... Small, Alan No ..1 39.... Permit for .......one story........ 1 single family dwelling ............................................................................... Location® .Buckskin Path Centerville ............................................................................... + ` 1. Owner ............. ........flan ..........Small frame 4 Type of Construction .......................................... ................................................................................ j Plot ............................ Lot ....... 4 ................... � C December 13 71. Permit Granted .......................................19 '� Q Date of Inspection .............. .......... ..........19 Date Completed ........ .. ... r...19 2G(0 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... + ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................