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Treasurer pJc `,//,/o-7 Planning Dept. - Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village o Owner 0- ,,,, Address Alg1 a A ice/ O Telephone 5-®q- - Permit Request J� % � 4� �e�%�� dY AV Square feet: 1 st floor:existing proposed 0 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:,�,*ull ❑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/coa�stove: 'O,Yes`� ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑elting ❑ew size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: !! ` ' Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes_ OrNo If.yes, site.Plan_review# Current Use Proposed Use BUILDER INFORMATION Name ��°��>.(7 %ti�/�/� Telephone Number " - s'1�1 `�� 5' Address :o �i>.a� �� �.� License# CS " Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r r SIGNATURE DATE if' ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED i MAP/PARCEL NO. ADDRESS i VILLAGE OWNER DATE OF INSPECTION: FOUNDATION CSC l`J °IIAQ � FRAME 1.0100 r INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 0 00 wi k. DATE CLOSED OUT ASSOCIATION PLAN NO. i Town of Barnstable Regulatory Services SA S MASS. � Thomas F. Geiler,Director y . MA g Eo;9;�a`e Building Division Thomas Perry, CBO,Building Commissioner " 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: .508-790-6230 PLAN REVIEW Owner: Sk-I h Map/Parcel: P 3 2 032- Project Address Builder: L�nrie ff The following items were noted on reviewing: 5 .1 C-) 2x10 l�eAl) M S. CIP-O uu+re S c v��$��� �T�r"� w�ea-e -Cg s4i h4 IT X1 s 2T Per Cc;4,t ,ICI Reviewed by: 001 s P�IcE cal��J� Date: uPPPsr C-- PLA4-0 Q:Forms:Plnrvw r r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'*Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual):;�(z/:o Address: 6!F 4'. City/State/Zip: Phone '.7"U '—42�91 Are you an employer?Check the appropriate bog: general contractor and I Type of project(required):. 1 I am a employer with_� 4. ❑ I am a g employees(full and/or part-time).* have hired the stub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.# required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions c 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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 am doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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.M OsC'�S �'�"`f Expiration Date: 149 - ®� Job Site Address: �/`� la 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. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 WA for insurance coverage verification. Ido hereby certi under the pains ndpenalties ofperjury that the information provided above is true and correct: Si a Date: 0 2 Phone#: si:72 Official use only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# . Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and. Instructions r 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,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, §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 finance 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-contiactor(s)name(s),address(es)and phone number(s) along with their certificates)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 o'f 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"alI-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 bum 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 Infttrial Accidents Office of Investigations 600 Washingtoii Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia I �oF t►iE� Town-of Barnstable Regulatory Services * BpRNSTPABL% Thomas F.Geiler,Director ,y bMAM g i639. Buildincr Division ArED Mp'�� b 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: /"0°��fe Estimated Cost ,kddress of Work: '�® 1 Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law FlJob Under$1,000 QBuilding 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 WORD 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: L Date Contractor Name Registration No. OR Date Owner's Name Qlb hameaffidav Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size 0 Zoom Out In " `P + " V. err}, +( ® JPG Map: 232 r R r y r. :. ,. ,r:. a xa� ,2 - 4, Location: �r- Fa Owner: 7, at s t LOCatlOrl In Map & Parce Location Acreage Ova . .. 232031 I �' Ml- -J Mailing Addi VV 030 «tl6 .ia2m aw �.. ;. ;1 232047 " p236 Appraised 1 Extra Featur 232033 Out Building ip228At" Land � f Buildings -------------------- Total Apprai 232046 232070 -232034 Assessed V N 3 0 7 ip212 N249 Extra Featur r 232025 232071 Out Building #233 'a tT. P IYry'�Y IV2t9 Land _ Buildings Set Scale 1" = 91 " April 2001 Hi Res I Total Assess Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comment: BarnstableMA V0.2.91 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=232032 .8/28/2007 tioF, ' ti Town of Barnstable °"' Regulatory Services qB Asx.E'� Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this bi ilding permit application for; , (Ad&Wess of Job) Sjnsure of er D afe Print Name QFORMSiO VTNERPERMISSION f OM L FAX NO. 5083621294 Aug.- 28 2007 03:24PM P1 UV' 'Ua d.U U I .LU.C'i .1l.:'�LUJJU'= I'15,�Lil. •. ll'V',Uf•/:I`h.Z. - N�i �l�l'i OG-27—u"T 1CI,Cem �Ium-a{c fat3 33! B6E6 i-966 �.091/A02 C-323 T. THISCERTI ICA IS II b A iMA!tER OF INFO —A IOI' N MYaook FM&Agmey ONLY AND CONFERS NO RIGHTS QP0N THE CERTIRCATE PO BOX43? I HOLDER.THlB CERTIFICATE DOES NOT AMEND, EXTEND OR C4M[t,MA OROW = ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW CO PANI A I IIVS RE !-I COMPANY A GRANITE STATL INSURANCE COMPANY David Unne[I Jr i 59 Rllebowd Ln i YA�acthport,Nlf�02BPS�ODD ~ Zrj ,�I•L. "�Ci.F�T;,!. .;, "' ;',7K Il',:i1: '�.ilY" ;... h �,�i,._, THI813 TO CRRT{AYTHAriN •:•,,,.:•5,,;:';'' ':r, 1=POi.ICIEs of{N9uRANCE uSTlrO 86LOW HAVE uWN ZaU�TO THE INSSUPED NANWABOW r*R : II THE POLICY PERM MICA-Mt;NG�T WI71-(STANDING ANY REMU REpAD4-r ; I a0d1MEM WtrH RESPECT TO WWIcH THS ORRTIFICATE M4Y BE ISSUED OR MAY R'rAj m HE INSN OF UVRANCE AF CTOR 07ia ' (((( POI.ICIE3 AESC t113ED NRREW 10 SUi31RDT TO ALL TM T&3�MS,EXCLUSIONS ANCI CONDPITONE OF$t1CFi AOLICI�S.L�IINITS S puyN I MAY MAV6 BEEN RE4UCRD BY PAID CLAIMS, _N�11 k IJCY M� .fM POLICY 7i To -- �LO`rRp�Ll4F11LRV A I umrrs FMOtSAI�f UTN� 1 8/01/2007 Ann-DRYU ry ' I �maa►orw�aoreaw. . . `' IogCI,AOCta�1T =eAb9F0AYLp4jTtmm SNSO,CO i E 1Up D L:THE IVORKEti COIUPRMNSATM POLICY 0MG NOT PROVICS QOV51uGC FOR DAVID LINAIELI JpL CERTIFICATE HOLDER 16ANCELLATJON TOWN OF 0ARNCTABL sNoui.c.iraYOFrle�aren cait rerrclessecaNceu�eEFopEn+� 367 MNN ST EXPIRATIONOATS T!for.TWE IsSUWr.CoMp4Mr WILL gNotAVOR TOnur4L M HYANNIS.MA DAYS WRTMN NOT'OS TA TIE®osRTMTE HOIa rR NAWEo TO TryL LE br,MT FAILL•RJt TO MAC.saut>ty mft=$MALL 1M00 0 NO OBu4AT?6N OR LIADA Y of i ANY NRND UPON Ti,m COMPANY.;Ts AmeNT2 eR I1lrPReeEMAyly�, AVMROM REPRMWATIVE i �i i OM L FAX NO. 5083621294 Aug. 21 2007 02:32PM P1 Board of SUIMing"alo'tlons and'S*Wsvds HOME 1IMPROVEMENT CONTRACTOR ,� � t�lutatlQ++: �20859 fmA:. 24012004 LINNELL ENTERORiMES' DAVID U"LL JIB SO.FREE raoAFin LANi �L YAiWOUT► OAT,NSA W76 Acdminhtr:ror Board of Buildi g Regulations Construction and Standards r Superyjsor license License: CS 71507 Birthdate. 8/11/1988 €xpirat,on 8/11/2009 Restriction .?G Tr# 2182 DAVID J LINNELL JR 4 59 FREEBOARD LN "ARMOUTHpORT,MA 02675 Xc `"""`�^-�'•""`"`"-----_-..�_.,w Commissioner _ I i x _ . •---- � � "mil d p �. 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