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Home My WebLink About0052 HARRISON ROAD i � � .. �. ,,: .. � .. .., M. .. .. f ��. .,� .r ;. .� .. 3 �. . o � - � . f - - �' � -. y o ,. - � , ,. ,. _ ., .. ... � .. � ., a 0 � l, ;, � r ,; ® - k 4 A _ ,_:, t. �� ` ' � � 1 v t `. r ,t� i., i i. _ t U 7Y �. q�2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t r k Map ,Z�� L Parcel 07 Application# 1$78 Health Division 321 " Conservation Division 2 6 Permit# \ 1 Z � Tax Collector eQ 4 Date Issued Treasurer �� Application Fee �Sd a6n Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board EXISTING SEPTIC SYSTE#OF BEDROOMS LIMITED TOE Historic-OKH Preservation/Hyannis Project Street Address �Z ism Village w� Owner bm)n-7 A -F,40. -t— Address Telephone �O Permit Request � f1vrT�j� � �i�n�a- �.r�,lj�� il rllnl IoNl WkmAjp av Square feet: 1 st floor:existing proposed 136� 2nd floor:existing �" proposed _�Z Total new `=` Zoning District Flood Plain Groundwater Overlays ; Project Valuati,2 rn - -cu"- Construction Type Lot Size = 2-2-0 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. s Dwelling Type: Single Family 2r. Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �o On Old King's Highway: ❑Yes 4No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Areas .ft. Basement Unfinished Areas .ft Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existingnew (pe�� ,1� _�o �en�urAn f71 Total Room Count(not including baths):existing new. First Floor Room Count Heat Type and Fuel: GtG"as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes to Fireplaces: Existing New Existing wood/coal stove: ❑Yes Oo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:CKexisting ❑new size Shed:❑existing ❑new size Other: i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ s Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use 5 BUILDER INFORMATION Nam Telephone Number ��• ,Py) ? 4: Address License# �1S U4Sg L �t if 11,V, A- "3 2_ Home Improvement Contractor# 13 50' Worker's Compensation# /�A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE a 0� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER- DATE OF INSPECTION: , FOUNDATION FRAME �GI2'CIL INSULATION FIREPLACE ELECTRICAL: ROUGH :' FINAL m PLUMBING: ROUGH K a FINAL GAS: ROUGH S S FINAL N FINAL BUILDING rr n 0 r� m• DATE CLOSED OUT 0 ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations a 600 Washington Street Boston, AM 02111 www.rnass.gov/dia Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r Please Print Legibly Name (Business/Organizationadividual): '"f�z t► A-t44(- _ ,�1T _ )►1=h t�6 (' �L L Address: <'_FU �� City/State/Zip: Phone#: e) Are you an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 1 4. ❑ I am a general contractor and I 1 6. ❑ New construction employees (full and/or part-time)"* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on.the attached sheet $ Remodeling skip and have no employees These sub-contractors have S. ❑ Demolition working for me in'any capacity.' orkers',comp.insurance. 9. ❑ Budding addition o workers' comp.insurance 5. We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL I I.El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. (No workers' lg [lOther £' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure.coverage as required under Section 25A of MGL c. 15.2 can lead to the imposition of criminal penalties of a fine up to$1,50Q.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify the pains and penalties of per ury that the information provided above is true and correct Signafore: Date: -3 d C) Phone#• a Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Deoartment 3.City/Town Clerk 4.Electrica.i inspector 5:Plumbing luspector 6. Other Contact Persou: Phone#: n ®i- ati®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, 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,parmership, 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, §25C(6)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,MGL chapter 152, §25C(7)states"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 Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry.workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials - 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and-under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your 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 1avestigations 600 Washington Street Boston, MA 02111 Tel. ; 617-727-4900 ext 406 or 1-1077-NIASSAFE Fan �617-727-7749 Revised 5-26-05 W-W-W.Mass.gov/dha icensure BOARD OF BUILDIN REGULATIONS license: CONSTRUCTION SUPERVISOR Number.'Zs 080591 t 'Birtiidate:06/28/1972 . Expires�O6r282007 Tr.no: 11534 Restricted,00 ��I } S RICHARD A PRCHLIK F' j I: PO BOX 346 t CENTERVILLE, MA`02632 F! C k i _ _ Can missloner ;/ira�avmxn�trtrerrl!/o�il�rw�ez/uaafb` 3 S Board of BoBding Regulations and Standards 1 HOME IMPROVEMENT CONTRACTOR ' z c Registration: 135897 y Eapiratlon: 5/172006 ,. Type: individual RICHARD ANDREW PRCHLIK RICHARD PRCHLIK 292 FULLER RD re----4 CENTERVILLE,MA 02632 Administrator Main5tt)ldg@aol.com Phone....508.280.6295 Fax... 508-771.5371 www.Main5tE)uilding.com . Y °FINEr, Town of Barnstable ° Regulatory Services � r M�g Thomas F.Geiler,Director p,59. Building Division Tom Perry,Building Commissioner 200 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: 1 .T-1t22 Estimated Cost t9 Address of Work: 'I 2 .:: N l r✓t it�Iit cT -2- Owner's Name:Date of of Application: -5'2v-0 6 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 `e owner: 94. oG Date Contractor Name Registration No. OR 06 Date Owner's e Q:fomislomeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 �, a Change of Contractor/Builder $25.00 .r FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x .0041= plus from below(if applicable) I ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot x .0041= 6, p us from ow(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x .0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x .0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 f Town of Barnstable regulatory Services i v�AASSS. Thomas F.Geller,Director �''°>fc►�a►�',0 BuRding Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8,62-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauthorize,'R. 41, �_�y,��,,�; h A 1A 6-F. !atbb. to act on mybehalf, in all matters relative to work authorized by this building permit application for. 51 Viet rr t�.610 <Rnph , C(,-,nT-crd,we" (Address of Job) 0 o6 Signature of Owner ate Pn��tl,D nt Name Q:FORMS:OW MERMISSION EXISTING 1ST FLOOR PLP 15'4" 7'3" c M 7 11" 4 0" - cn- bed/[oo#i cv liwlig AooK. (n hi 2'-11" N 9 � cn m &omigq hoosK Y ° 1T-0" t - r o 3'-1"— C.14 w 2-1" � bedaoos� I -- s °'- bothooM s'-1 rn 4�4" 7.0 2' �rtC�ceu i N 13'-5" - ;n rn � -3'-3" 3'-7"-j-7 10'-5" 31,_2,. I v? CD i� I N SMOKE DETECTORS REVIEWED � �O � ulylo� A, T E BUILDING DEPT. DATE 5%g 5'1" FIRE DEPARTMENT 0.4TE g,-3" BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 2W-0" PROPOSED CHANGES TO FIRST FLOOR PLAN 43=11" 9'-7" 3'-2 3'-2" _15'-7"BD ' T-3" o �C J- -=C N ' c _ A �.N 1-5" i V / N N a cn d' N Cn v 11-5" - 2=11" �-a/p2iey Aoolpf of, r CloseIq t i + i i O i 9 batRwoM ' �if1�V h/�� A tip v �7j/• t� ;�.• oi; I i �3'-3" 3'- "04 -10'- 1,_8„ 2'0" ------- +d`' 31'-3" r � w :o a 5'-8" 9'-3" j5�-17J 20'-0" i r � I ^ ~ .20 (.Guq10 .longPond — cv/�taxe ti I; J / r 70 wid.lot 6A1 ,5 e i t i ' fj o z� cSCQ�.B !"a 20 , 5 7c bate 8-24-85 -- ----- - = - __... _.. ►__---_ RU Cape $7 i 4R lda :bot 9Zo .lo•t 6,�! � Afan^i.4, Ma. 02601 i Skztcfe /fit= oLna)-d .land .in Ce.zte4l,i tk, Ma, 90-t mle t l9ei.ng tot 6R1 aa- dlwwn on a p�,,-c in Book l2/ 1 .Page 87, and deed in rook 1274 Page 23. EO IL \• � L��' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel - Permit# 2 Health Division 5 It W 41 k ja3 Date Issued Conservation Division I 0 3 ® Application Fee ` 00 Tax Collector. Permit Fee ` 'SEPTIC SYSTEM MUST 2�:Treasurer INSTALLED IN COMPLIANCP Planning Dept. WKTEE S i Date Definitive Plan Approved by Planning Board Et'IVIPONWENTAL CODE X%:TOWN RECUP Historic-OKH Preservation/Hyannis Project Street Address Village l LAf ,_F•'. �Z 1fi5 4 Owner Address r� Telephone - Permit Request &4&2E c- /D Square feet: 1st floor: existing I3 C 6 proposed L36 2nd floor: existing _ C� proposed �_ Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size ZZ U Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W'_ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Vlo On Old King's Highway: ❑Yes WrNb 1' Basement Type: 0 Full FkrC-rawl ❑Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ s Number of Baths: Full: existing � _new 0 Half: existing ( new 0 Number of Bedrooms: existing_ new O Total Room Count(not including baths): existing 5— new_ First Floor Room Count (, Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes 4 o Fireplaces: Existing T New U Existing wood/coal stove: ❑Yes 'i;1Vo Detached garage:0 existing 0 new size Pool:❑existing ❑new size Barn:0 existing ❑new. 'size Attached garage:dr'e'xisting ❑new size Shed:O existing ❑new. size Other: err, Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use .1; 1 L- �L'Wfi az Proposed Use BUILDER INFORMATION Name p c, N 6k Telephone Number Address `'T , j-- - Tim �qZ ✓�cc�2 Odense# GS (0)C�S7/ �2j 7_ Home Improvement Contractor# I Worker's Compensation# 1A �,4Lo- rim ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO v.� , ►uu� SIGNATUR DATE # r FOR OFFICIAL USE ONLY PERMIT NO. DATE.ISSUED MAP/PARCEL NO. :. ADDRESS- VILLAGE � OWNER r �t DATE OF INSPECTION: FOUNDATION , FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH.z . FINAL jFINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq. foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 160 --square feet x$64/sq. foot= 17 R ZD x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) 4 Permit Fee ~ 5 1 proicost Tfo Chin Appead'ac J TAU J6-Llb(continued) Fossil Fuels presariptivg pagkagea far'Oar smd Txa-F=mi1y Resideatisl Huildiap Sated with r ' MINYM Henting/Cooling M,�xfMUM Welt Floor gjscrneat SIab C3laring Glaring Ce111ng , P Egttipraent Efficiency' Area'('/.) U-value R-vatuc, R-value A-valuas RW� a RvalueT FakzBc 6701 to 6500 Hesting I?egrre Dam' Normal 13 14 10 6 0.40 38 14 19 l0 6 Normal 0.52 30 6 85 AFUE g 12Y. 0.50 38 13 19 10 N/A Normal 13 38 N/A b Normal 15'/. 036 T 0.46 38 19 S9 10 NSA 13 AFUE U 15/. 13 25 N/A 0.44 38 6 iS AFUE 0.5Z 30 19 14 10 NIA NonnaF W 38 S3 25 NIA N/A Normal aAA 1425 NIA!A. 38 40 AFUE 38 1390.AFUS 1919 ADDRESS OF PROPERTY: F ? i5VVJ 1. 5,J �� . 2, SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3, SQUARE FOOTAGE OF ALL GLAZING:- v 4, o/a GLAZING AREA(#3 DIVIDED BY#2): 5, SELECT PACKAGE(Q--AA'-see chart above): S OF"METHOD DETFRYJ&qN _ GY REQUIREMENTS V0Ts: OTHER MORE INVOLVED OR THIS INFORMA L ENER ARE AVAILABLE, ASK U _ F BUILDING INSPECTOR APPROVAL: YES: q-forms-f980303 a 780 CMR appendix J Footnotes to Table J�,2.Ib: lass doors, skylights, and ; Glazing area is the ratio of the area of the glazing assemblies (including sliding-g itioned space,but excluding opaque doors) to the gross wall basement windows if located in walls that enclose cond area, expressed as a percentage. Up to 1%.of the total ilazirig area may be excluded from the U-Yalue ign with 300 ftz of glazing areaquirement. For example,3 ft1 of decorative glass may be excluded from a building des 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized Truss construction. If the insulation achieves the full insulation,thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof, 4 wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding, structural sheathing, and interior drywall.For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R 6 insulating sheathing. Wall requirements apply to woad-$anie or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. s The entire opaque portion of any individual basement wall with an average depth less than 50%below eo conditioned meet the same R-value requirement as above-grade walls. Windows and sliding glass basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b, 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' if the building utilizes elgbtric resistance heating use compliance approach 3;4,.or 5. If you plan to install more than one piece of heating equipment-or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town secTable 15.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels, R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0,35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b.If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0,35). c)If a ceiling,wall, floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels,the component complies if the edoar comped onents come R-Yalue is if the area-weighted d averager than or l to - the R-value requirement for that component.Glazing P P y value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors), m, x f Town of Barnstable Regulatory Services 9 BARNS r'E'g,' Thomas F.Geller,Director 1679. .0 Building Division ' �plED pAA'I R - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, _. .: ..:...::........:_...;as..Owner.,of the.subjectpzoperty.. ........:._ .. . hereby authorize to'act on my.behalf,. in all matters relative to work authoiized.b7 this building,persait-application for: (Address of Job) Signature of Owner 1pate Prin N e ' r0 .f O:FORMS:OWNMERMISSION x. �� _ ..✓,�ze �'omvr.�,u�eaCl! a�✓�laa,czc�uaetla _ — Board of`Buitding.Rggulationsand Standards HOME IMPROVEMENT CONTRACTOR Reglst!`P ion 1335897 ExpJrafion 5l1'7104 Type Intlividual RICHARD ,NDREV.V, L',IK . RICHARD PRCHLtK 70 MAIN STol r, CENTERVILLE;,`MA,02632 p:dminisYrato.r r BOARD OF BUILDING REGULATIONS . :License: CONSTRUCTION SUPERVISOR Number. .CS 080591 Birthdate' 06/281,1972 �P 1�> Exprres 06/28G2605 Tr.no: 80591 • Restncted D0 RICHARD A FRHLIK 70 MAIN ST CENTERVILLE, MA 62632 Administrator �oFtHe, Town of Barnstable P y Regulatory Services sAANSTABr.E. • Thomas F.Geiler,Director y trsnss �* ' Q',,lFo;9 �m Building Division Tom Perry,Building Commissioner 200 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 owr}er-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: Estimated Cost000 Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the age)t of OV6 Date Contractor Name Registration No. OR Date Owner's Name The Commonwealth of Massachusetts M - - - Department of Industrial Accidents • ,� '=_ - - Oftice of/a�estigat�aos • 600 Washington Street Boston,Mass. 02111 `�--� Workers, Com ensation Insurance davit name �'u. 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I : ..... {:{:.fi:}}}h,t:%Y't??;;•}}}Yx$;t:...:...... oli :#fi:::,.r Yl]IlTSnCPi'lbi}:;:;::::�;x,,ta{:}$fti53.,«,r.•y,t;.y:;:t•?:•}..:#. ,Y,t... .....,}.,,.»•t:::?::;,{...t.,,,...4.;• •::.. :..... / 4,::::{:.}.n•r.v}:::. :;•:4Y:L.:•}:•:{rrn•Y::?•rr.: xxx Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of ccfaninal penalties of a tine np to 51,500.00 andlor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Sne of$100.00 a day agairnst me: I mmderstand that a copy of this statement maybe forwarded to the Office of Investigations of the DU for coverage verification. I do hereby cerd airs and penalties of perjury that the information provided above is truce correct signature Date - Pont name i1/�k -11� Phone# ^mod/ 1 b official use only do not write in this area to be completed by city or town official .. city or town: peradt/ficense# ❑B�dhng Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑HeaithDepartment contactperson: phone#; _ 0Other_ tensed 9195 Pray 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 jointenterprise, 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,neitherthe commonwealth nor any of its political subdivisions shall enter into any f��er have beenfor the to the cone of public tk until racting acceptable evidence of compliance with the insurance requirementsp presented authority. r PP A licants . Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and 1 ' company names,address and phone numbers along with a certificate of insurance as all affidavits may DPPYmS mP Y 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 Accidents. Should you have any questions regarding the"law"or if you being requested, not the Department of Industrial are regiu 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 peimit/license number which will be used as a reference number. The affidavits may be retumed*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. VNNE The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents once of Investigations . 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 . - - T 43'-10" — . 9-7" 3'-2" 3'2" 15'-7" 7'-3" N N I Cn i 7=11" 4'-0" co bEC�JCOOHf cn N Bioiag ROOM. N C O ti [2- 2'41" I N } - 12'-0" ll� 4 `O -- - °D 2-1" o bedQ om W-1" bat�ooxr 4" 7'0"—�=Z. " iv hrtC�eH "' a 13'S" botboo .. LO Cy. {`—3'-3" 3,-7.,iv -10 ' otBJ� Q (�z^i?p 6'-0" f3'-2" daf- 31'-2" -ciIoJS LP Bra �4fiS(rro� . 2.q Wrnch R 19 INSJ � Y Gyrsv� w��ws Lx t "itAC-71 to- - - - t-578" T-3" 5=1" 20=0" T-4" 34'-0" v 8"block oa 12"(-ootiag. 11'-11" total high o'k block exclud"ag b-ootiag, 24" east Rea to 0 � 6 add troR ;! - 2'0" �-oaudatiott V-6" 1 6" ® a'� 1'- " (PouAed) 4'-10"1 Oct) 0 eaRtRea&looR i, 20'-0" itr f 12'-3" 1� 31'-2" r w 1 (AaO _ .-. t� /y �DUA'�4l1drJ�L, 20'-0" e • I Assessor's map and lot number, ..... .o .g`....../..'7 .... .... SEPTIC SYSTEM MUST ?METO�y Sewage Permit number ......................... �... � 1 4, INSTALLED IN COMPLI o� ,�� WITH TITLE 5 A "TOILE, i House number 39.5..2...Eazr .saoxi...ad...Q.e a.t.erville ENVIRONMENTAL A P P P 0 Y F D . T � � a�� TPO � oyar.a`0� Est .Mle Conservatio:rta " 'p F B A R N S T A B L E igk®d pat0 BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ........ . . .. .... ...................... ............................ TYPE OF .CONSTRUCTION .......... `..................... ?f .2J..8��.............It/............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....52...IIa::'x:a 5.Qyi..R.d...Cr.e-At.er:3Iil1.e........................................................................................................... Family Rm Garage ProposedUse ................................................................................................................................................................... ...... Zoning District ........................................................................Fire District .0exLtex.viale................................................ Name of.Ownerl o.n Miller • .. .......•„••.••. .... •...•Address52. Harrisson Rd. ................................................................... Name of Builder Gla:Uoe...0.0.r.r veau..........................AddressXO,XM0.1,.t)...�Pp.:'.t...Ra..a.......................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation T.0.1=...Q.03aQXate........................................... Exterior .......................................................................Roofing A.qphal.t................................................................... Floors Wood .... ...............................................................................Interior ....JDY'pI.,9,1 .............................. o . e ............................................................. F Heating ......H A .............by.....Gas...........:.-.............................................Plumbing .... ..... ....� ... ,... ................ ,Fireplace ....... ,l 39,000.00 f. ............... ......... ....... ....... ............Approximate. Cost ................................................................... . .. Definitive Plan Approved by Planning Board ____________________-----------19________ - - Area ....J� /...s..:.' D CJ Diagram of. Lot and Building with Dimensions Fee .................. ......................... •SUBJECT TO APPROVAL OF BOARD OF HEALTH 3 l OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all,the Rules and Regulations-of the Town of Barnstable regarding the above construction. Name . ...a...,f .'F..... ....... • �P Construction Supervisor's License -. 011265 Permit for AA ?DD DWELLIj G ag.= r t ' mgl% pFa Yt;Dwellin ......... 6 Location .................. e `. .. .... .. ...... i; Owner ... 8 ®n x..P der:.................... - Type of Construction Rftama....................... ....... .....a...... ....................................... - Plot ............................ Lot ................................ Permit Granted May 86 Date of Inspection ....................................19 Date Completed ......................................19 M � V r 73 r s tr 00 Assessor's map and lot number ...... ... ..` ......... ..,............ Qyo�TNFro Sewage Permit number ........................_ — 1 .. �' d� °+► House number °"'..c%'....'Y?r,r cgr?ra BJSBST4DLE, . ...::...................................,:.............:.._......:.......: . s rasa �p 2639• \0� M A" r OF BARNSTABLE �- BUILDING INSPECTOR S ECTOR APPLICATION FOR PERMIT TO ....... ° r � ! ...................:.................:.......... f r r~ TYPE OF CONSTRUCTION ..................f t�#. � . � 21 ...................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: i Location .... rr.iI' e.................................................................... ................................... gamilyRn Garage Proposed Use ............................................................................................................................................................................... Zoning District ........................................................................Fire District ffn-.t!,:n-•7: :lp................................................. Name of Owneru i......�l' E'r ...........................................Address�2 Hc'''xtrisson...�:d::............................................ Name of Builder C I a,i?,d C�1Y,'T?_RTR iia...........................Address Y!A.*.r•1 1a.',I ••1'cs•rt.. :�s:-'• ......................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation .0.1=...goac:mt.e.................................... Exterior ...Roofing A:��a,T�•�'3.£3..L........�...............................................................•... ;crud Floors Interior ....: Heating ............. ..�:..............•...................•..........................Plumbing ......4 ................'?`:......... ..................................... Fireplace ................f...'.....?......................f........'....................Approximat C t ....:i39#J'JO�,On ................................... e. os ., Definitive Plan Approved by Planning Board -----------_______-----------19___ Aw ____. Area ............................. Diagram of Lot and Building with Dimensions Fee �—...........==................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �r u } , t J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Nor /� Construction Supervisor's License �� ` � yMILLER, :DON No ... 933 Permit for ADD'?T0;`TIWELLIiNGr'� , 4::S: nple_Fafi l� :Dwelling.......:........... 5 2%Hair r is on,-Ro ad Location ...................z:......... ................................ y%Centervi lle ............................................................................... Owner ...'. :DanL�Iil�er .::.:.:: .......................... Type of Construction �'F.rame ................................................................................ Plot ............................ Lot ................................ Permit Granted ........ '1 ;..................19 86 Date of Inspection .....................................19 Date-Completed ......................................19 I