HomeMy WebLinkAbout0139 FOX HILL ROAD ,
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Engineering Dept. (3rd floor Map Lev
Parcel � Permit# % 9y
House# L Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee _ ��� 11Z
- t—
io
servat' n Office(4th floor)(8:30-9:30/1:00-2:00)
n' (1st floor/School Admin. Bldg.) �TNE►p;_
mtiv PI Approved by Planning Board 19
BARNSTABLE.
/ TOWN OF BARNSTABLE
Building Permit Application
e "reet Address !2 Fiat i�d
Village 'l✓d�f n
Owner, :f y-e-� A eXd7-} Address
Telephone
Permit RequestQ
a�
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 // h
Name 7->eP-jvv PAag , Telephone Number -
Address �-7// �i/9n License#
Home Improvement Contractor#
Worker's Compensation# / /
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
SIGNATURE -�r-6 -JrDATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
4+x,2,-
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE .
OWNER
DATE OF INSPECTION:
FOUNDATION
f
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL .
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
°FTHE r
The Town of Barnstable
MAM
L►xivsr�ei.E,
t63
,0�' Department of Health Safety and Environmental Services
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. r
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: t Est.Cost ��C
Address of Work:
Owner's Name
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 awnffW the owner:
Date Contractor Name Registration No.
OR
Date Owner's Name
+` The Commonwealth of Afassachusetts
Department of Industrial Accidents
office oflnvest/9-Mons
�:t\ 6(!0 fl<'ashinrton Street
�IZ + Baslon, Mas.v. 02111
' Workers' Compensation Insurance Affidavit
licant information
-- .. qP
name I /!/V✓1 �✓�
c
cih 0,d o s t YYI/ F Phone#
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
.. .s:..,e,..wy .�.s�:?y 'f!..!+�.Taa.M.r�yw�s�^•"R7�Fx�r _ � �- �ww.+.��'^:�!• �...�'�+-- '- _
,�/I am an employer providing workers' compensation,for my employees working on this job.
co nt p•t m n t m c I n Gt.�•!/I ��•(/Lvz~�"
address: — -
cih•• /] phone#•
L poli
inair tree co o•fs AC'1
r... -. Y... .............. -.n---.-..�.........,..�.......T.,,....��..,. .__--- ,-- -
I am a sole proprietor. general contractor,or homeowner(circle one) and have hired the contractors listed below who hay
the following workers' compensation polices:
company name:
•tddress•
cih phone 1!•
incurnnce co nolicv 0
'. � .. - '�t.f'_-_�'�s��P•.'- _- '.T"�.^. -•�a5�.�-rC.L'r r•�r••cbT'�.�..zL�7` J'1 SS I.F. - _- �r�.. _.a.i�_
con anv name:
•tddresc-
cih•• phone t!• —
incurincc co polio•#
Attach additio_nai sheet if necessa
Failure to secure coverage as required under Section 25A of 11GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or
one i cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a dap against me. 1 understand that a
cope of this statement may be forwarded to the OILce of Investigations of the DIA for coverage verification.
1 do lrereht ce rrnrle rlr• ns a ualties ojperjun•that the lnjorntatlon prodded above is true and correct.
Signature Date _�9b
Print name e 'er C IC7✓t'Axp-'I Phone#
�iiY 1 ••
�official use unly do not write in this area to be completed by city or town official
cih or town: permit license q nliuiiding Department
Licensing Board
Cj check if immediate response is required OSelectmen's Office
C3Ile2ith Department
phone q; nUthcr
contact person: �.
ve+ised rtv
' r '
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' ec)mpensation for thei
e»►ploree is defined as every person in the service of another under any
employees. As quoted lion the "law", an
contract of hire, express or implied. oral or written.
An r►npl►n•cr is defined as an individual, partnership, association. corporation or other legal entity, or any two or more
the foregoing enuaged 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
owiler 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 ho:
or on the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe:
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renei+•al of a license or permit to operate a business or to construct buildings in the commonwealth for any
;applicant N+I�o 1►as 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 1.
been presented to Elie 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 tl�e Department it
Industrial Accidents for confirmation of insurance coverage. Also be sure to sibn 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 require:
to obtain a workers' compensation policy. please call the Department at the number listed below.
77-
7.
City or "to++•ns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c
the affidavit for you to fill out in the event the Office of Investi rations has to contact you regarding the applicant. Pie
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned
the Department by mail or FAX unless other arran`ements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should,you have any questio-
P
lease do not'hesitate to =ive us a call.
_._.�,..,,..... -.. ._ ..._... ..�, ---r.. �,,..o...�-
►^tau.r.-�.._....,......._._-..._..vn..+• ._...w..rr..rw••r� _- .. .�.
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
,Department of Industrial Accidents -
Office of investigations
600 «'asliington Street _
Boston, Ma. 02111
fax #: (617) 727-7749
hone -9: (617) 7- -' 100 ext. 406, 409 or ."75
/q•F- STY-�• - .yLCiJ+w'X li1y,�q- +t1..�'..+.J`.i K\++aZ..�tiIwY+OfYi..at� ...- - ._..
... 07
Mille Vdliwi
ll .
y• HUE'IE Ir'IPROVE',11ENT CUr�JTRAc fo+ y REGISTRAT,.ION�'
Board of BurilRegulations' Jr
:ding tions and Staridaa�ds `766
i -
r - Ro
One Ash ..uY tori Place. .- orn 1301
k.
Bostc,i, Massachusetts 02108 HOME IMPROVEMENT_ CONS - _... .
RACTOR
i Registration 112536 _ Expiration 04/06/97
_ Type - D E3 A ' OL .� laG y�.ittaoaawE«ael4
_ HOME IMPROVEMENT CONTRACTOR
'DEAN C FRASER Re gistration 112536
Type DBA
DEAN C . FRASER r`- • Expiration 04/06/97
71 TARRAGON CIF.;; Y.
Uv
COTUIT MA 026351� DEAN C FRASER
E
DEAN C. FRASER
`\` G� co 'i �stm71 TARRAGON CIR
y ADMINISTRATOR COWIT NA 02635