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Home My WebLink About1620 FALMOUTH ROAD/RTE 28 (6) !ks Pos`tagg e) n `3b o u- bin Gib, a e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 'v''t/ Parcel _ Permit# (� Health Division Date Issued Conservation Division Application Fee - Tax Collector i Permit Feer�0 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village 014ie (1)! Owner Address fa- . c 4 Telephone ` 0-T Permit Request 2 — roor ae Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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: ❑Yes ❑No Basement Type: 0 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 0 No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing 0 new size Other: Zoning Board of AA peals Authorization ❑ Appeal# Recorded O Commercial ®'Yes ❑ No If P ,es site Ian review# Y Current Use tmmptor Proposed Use BUILDER INFORMATION Name �Q.�D�AL- y1 u-� e- f`Sle hone Number Address '�1 I I"'Q, `y1 r1 �� f/1 6 `� License# 6 Home Improvement Contractor# 3 '] Worker's Compensation# k/L ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO PLi n S A s'►��r�l : SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. t " DATE ISSUED MAP/PARCEL NO. - - ADDRESS ,-- , -VILLAGE S OWNER DATE OF INSPECTION: f FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL J FINAL BUILDING } DATE CLOSED OUT r i + ASSOCIATION PLAN NO. - ' `oF Town of Barnstable Regulatory Services BARNSTABLE, v MASS Thomas F.Geiler,Director 79' �0 Building Division E i6D MA'S A . Tom Perry, Building Commissioner Y 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 j Property Owner Must Complete and Sign This Section If Using.A Builder 0 O as Owner of the subject property _ J P P riY hereby authorize EuLcc 6 to act on my behalf, in all matters relative to work authorized by this builAng permit application for(address of job) UIU4 (" 64 Signature of Owner Date) Print Name u C „! ; ✓�ee �ovnmwiwieall� a�✓uaaaac�uraeaa I BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR i Number ,.CS, 043556 Blrthdat6 12/1-3/1962 a Expires 12/13%2004 Tr.no: 4902 Restricted^;q0:. .! SCOTT E CROSBY`,.. ;r. 62 CROSBY CIR OSTERVILLE, MA 02655':' Administrator i (��za, i�anirrrarwrrd�i o��.�aaoac/uiaP,tla Board of Building Regulations and Standards License or registration valid for individul use only pI-,Ii: HOME IMPROVEMENT CONTRACTOR before the expiration date: If found return to: Y Board of Building Regulations and Standards . Registration: 13137g — One Ashburton Place Rm 1301 � Expiration: 7/13/2004 Boston,Ma.02108 Type: Private Corporation PEACOCK&CROSBY BUILDERS, StbTT CROSBY 1112 MAIN STREET UNIT 7 -�i ri*�✓ - __ OSTERVILLE,MA 02655 Administrator Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office ofluest/gatioos t 600 Washington Street -� Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location hone# city ❑ I am a homeowner performing all work myself. ❑ I a sole r netor and have no one won kin in ca achy workers' co ensation for employees working on this job. .}YI am an era 1 �............... t.::::.... .r r•:,�'iti�i: sn... .... 0-a .name.... . ...•:::.:..:::.... .. tom ........... ...:•:.. ....::,•..... , ..........:::................:..............:........:v.,....... ....:::::n, OUR,- .......... ......t....,. .....v::k:• ....:v:::•v. ... 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I understimd that a this etatemeat may be forwarded to the Office of Investigations of the DU for coverage veriffeation. I do hereby certi under the pains penalties of perjury that the information provided above is trey fined carted Date o Gl Signature —� Print name e i9 Phone# � _ Official we only do not write in this area to be completed by city or town official permitzeerse# ❑Roding Department city or town: ❑Licensing Board response is required ❑5electrncn's Office ❑check if immediate q ❑Health Department contact pen on: phone#; _ ❑Other (tevi+ad 9J95 PJIa 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. ✓ Applicants the the box that applies to our situation and Please fill in the workers' compensation affidavit completely,by checking PP Y supplyingany names, address and phone numbers along with a certificate of insurance as all affidavits may be 4. company submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and Cs: date the affidavit. The affidavit should be retumed 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. 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 t^ 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 Invesugations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375