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HomeMy WebLinkAbout0131 LIETRIM CIRCLE ,�� � � .� f ��� �, \\s V.�'A OF 104Q g° d Ric►+ARD R. ., OVERLAY DISTRICT: FLOOD ZONE: i WP - Wellhead Protection District Zone X L'HEUREUX Based on Map # Nmbert O4 Lo3 25001C0561J wad f 4 at T ��'• July 16, 2014 ZONE: RC 1 �o Setbacks ya`a �s3s OpcF p Front:20' ROAnROUfE26i e Side:10' o00 4Sop; o� Rear:10' LOCATION MAP: O G9 f 30.6' 'O /r y° Scale: 1" = 2000'f •` pp)bbs REFERENCES: -'`qj Assessors Map:169 49.1' ��F �e`� �y Parcel:038 2 Q 'IN 41, °"� Plan Showing New Foundation As-built Approx Septic Q p At 131 Lietrim Circle ii::i:iYri:%?: . System as Per o BAR/VSTABLE B.O.H.-Card '° Q;. New Concrete ?s<.:,"`'``' �� coT2> "�:'_ (CENTERVILLE) 2,* ` ;`: MASS m / 16,475t SF Foundation- �-�j7-�� , 88.0' �'.o� NOTES: ti �ssr.. ./ e� DATE:081JUU20 SCALE: 1"-30' �q°j 0 15 30 45 60 FEET O ^h 1.) The structures shown were located on the ground eN by conventional survey methods on 05/FE8/20 and �topo�'o.y �F 'Z'o° PREPARED FOR: 06/JUL/20. 's9 S ���Q Michael M. White 'o 2.) The property line information shown hereon was Ao�cPo°39 �! o compiled from available record information. �ti PREPARED BY: CapeSury 3.) This plan is not for recording and is not to be 23 West Boy Rd, Suite G used for construction layout or deed description Osterville MA 02655 purposes. DWG #:C918gl cpp3 FIELD BY. WHK/ASK (508) 420-3994 / 420-3995fox oFSHE 1p o Town of Barnstable • k Inspectional Services MUMSTABt'E p Brian Florence,CBO Building Commissioner TED;MA<a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT Address : 131 LIETRIM CIRCLE, CENTERVILLE Case# C-19-288 Inspection Type : Violation Inspector: lauzonj -.- ...... .......- -. ... - .._. -- .... Description 1Date Unit Status .. ...._ _..--- Comment r .Violation 12/31/2019 PASS No business activity observed. ...... _..-- . ....... . ... ......... ......... ......... i w a�' .°M�$ Complaint CallReportm . y, G i I dam �- *e.rY rery r agar=i1,kk: ° b� a GrFq i7: r�I,x' -�"- a 3�'3" `" 8.,.�#' r a.p'.�' • z L i'�trn `t:-w 1 r� #� .i� .:3; rr<.rF.sy Y�x' ',,+.14 '''„"�"� "�' �:. ,a� � 'Sy s,"r"*' a ,�: y 50 m c �x _ = 131°LIETRIM CIRCLE CENTERVILLE •=S". 7 w .� G n;'�6 �- 4: �°a �'l''` � ��,r"a z•: s xx„s rEDA ,x*``yswR S,�'M1:. 1'v n4' x �, r p ''4 s x�,-'b Kai�; �n �k� .. ;: fCase#,ggC:-19 )�ry:l!�� Y °+ e qGk,, �w �i1 � � ' Case#: C-19-251 Address: 131 LIETRIM CIRCLE, Date: 4/5/2019 CENTERVILLE Owner Info: Property Info; WHITE, MICHAEL M MBL: 131 LIETRIM CIRCLE 169-038 CENTERVILLE MA 02632 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Zoning, Unlawful Commercial Activity, Medium Priority Mail Complaint Summary: Operating a business (tree work/landscape). Many trucks and commercial equipment. Concerned about wood chipper noise and reduced property values for neighbors. Citizen wants to remain anonymous but asks they the property owner is made to relocate his business to a commercial zone. Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: lauzonj - Filed by: andersor Comments: Comment Date Commenter. Comment t - 1fiDate �z. rx£- z,:�...a2s..,»>„.+.�.f,«..,��.i.��*:;.s:��. rh�.•,.�. ���`2$.: c�.�:-..•.',..`..�,.+ 3�,..M,�f�:t»,.C^aa..,uS..�.�,r a...arC�,�a:.+..'..«�::.,��.«,yda�:amp.w,.,..�w,:,�«wudaN»�''. ..».H�� •� aye„ 'g a,t++*^» ¢'�w '° a s #. a `+" Ea';`' ofther t x ` a ' =�Pnnted On'.4/5/2019 ` � � ±� x 4.. aap i�ia�a„� ,'- �,4�",Eg�P�7 ""a ,�„, °�a "= n ��i"4�a i d,•as o�r�,�I"9� a� P�� ���ti� �°M w: v,�a, ' Ott�` �� �a�`� a amr� c, i' " m�a `," 9w�x, a §a .,. ;+,a a41�$n ii 'a "; z"w'..: a,rra P ..'-:� .:au;, i.' .y � df:: 'aiia '� '"�ia a`�� o'aNa,�p4�M�i3: a z= ��i :Fa ,,...�u,.a„ r { a, � [ ,� a ..4/5/2019 N A aN Town of Barnstable sDate � F IS VIA S' a n; r I April 1, 2019 Dear Mr Paul Wackrow, As I understand from inquiring with the town, you are the person to contact in regards to zoning issues. I have a neighbor who lives at 131 Lietrim Circle, all I know is first name is Michael. I live close to this neighbor and my concern is he appears to be running a landscaping business out of his house. At any given time there are 3 to 4 trucks in his back yard and a trailer. He's also recently built some type of tarp garage that I can see over the top of his already established shed in his yard. I have young children and there are times his wood chipper is going and can be quite disruptive. My concern is should I want to,sell my house at some point having this many vehicles and this LARGE tarp covered garage will be a deterent,to any potential buyer. I look out my sidewindows and this is all we can see. It frankly looks like we're living in the industrial park in Hyannis. PLEASE, take the,time to visit the property and request he move his company.to another business location, NOT resendential. I don't feel comfortable approaching him as I don't really know him and don't want any uncomfortable potential fall-out from this. Therefore, I'd rather remain anonymous. ,5 Your assistance in this matter-will be greatly apprecitated.:. Application number``...... ..... .—.... .a. Fee ...............3..✓..................................................... MAMABi�' Building Inspectors Initials... . A Q���� �- �I�tNS���LE Date Issued....I�...../................................................... Map/Parcel........ �.�..D....--��..�...................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/W INDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 1�) I i0 1en melt- NUMBER STREET V LL GE Owner's Name: l ( a;� Phone Number 1) S 1 -S Email Address: * L["D-e 14 6 Wj, Car— Cell Phone Number � Project cost$ zal .06 Check one Residential _i/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize •a e to make application for a building permit in accordance with 780 CMR Owner Date: TYPE OF WORK Siding 021 Windows (no header change)# 0 Insulation/Weatherization 0 Doors (no header change)# ;Z Commercial Doors require an inspector's review 0 Roof(not applying more than I layer of shingles) Construction Debris will be going to Jvs� �stsf, � �v CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# 1.2 7azd (attach copy) Construction Supervisor's License#®7.2 .3,S 41 (attach copy) Email of Contractor�� V ,64ia ePjA, Phone number J-dg--f"-5 5 6:;�0, ALL PROPERTIES THAT HAVE STRUCTURES O ER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. f APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT9S SIGNATURE Signa a Date 11—.,2G All permit applications are subject to a building official's approval prior to issuance. Office of Consumer Affairs &'Business Regulation-Mass.Gov Page 1 of 2 ®j 1 Commonwealth of Massachusetts Division of Professional Ljndad Board of Building Regulations ConstrctforSiipery CS-072354 E BRIAN P COWHLIN 82 PRUDENCE LANE M a s s.g ov 5094201970L, o COTUIT MA 02 01. CommissionerCj Office AffCa% i r,^-:) ce I i&,fti d Construction Supervisor Unrestricted-Buildings of any use group which contain • less than 35,000 cubic feet(991 cubic meters)of enclosed H a S I Los% #=IF& S BU ' I Itj ti space. Regu1d---'-ti,U1 OCABR Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl HIC Registration Complaints Registration # 127006 Registrant Brian Coughlin Name BRIAN COUGHLIN . Address 82 PRUDENCE LANE, City, State Zip COTUIT,. MA 02635 Expiration Date 08/18/2020 ComplaintsDetails_............................._..._._.._.._.__..__....__......................_-_._-._- No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. _ Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=127006 11/26/2018 The Commonwealth of Massachusetts Y Department of IndustrialAccidents Office.of Investigations .. 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name(Business/Organization/Individual): ,^-An Address: City/State/Zip: P3,f Phone#: ,� �a J' ��lv T Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.RI 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' F insnranpe,x 9. ❑Building addition • [No workers comp.insurance com P• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1.1.❑Plumbing repairs or additions m self. o workers'comp. right of exemption per MGL Y P 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13. 9ther 3/� employees. [No workers' 4.4 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 a new affidavit indicating such. $Contractors 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.#: 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. 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 maybe forwarded to the Office of ` Investigations of the DIA for insurance coverage verification. I do hereby certify nder the pains a penalties of perjury that the information provided above is true and correct Si afore: Date: l ~-2! �O Phone#: D 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 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 xwho resides therein,or the occupant of the y` dwellinghouse o f another who employs erson'sto do maintenance construction.or repair work on such dwelling house P � P g 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•permkit 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 number(s)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,dpolicy 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: '9 _ The Commonwealth of Massachusetts Department of Industrial Acci'd.eri ss Office of investigations 600 Washington Stet Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 wvvw.mas.s.gov/dia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q Map , �` Parcel �� 30 Permit# t Q Health Division Date Issued Conservation Division Fee 'o2s.ar3 Tax Collector I Treasurer I D /2 &TV Planning Dept. V P Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address G�le Mew Gl1.2 C-11< Villagee ���% � Owner INS"/ bmwW Address Telephone �� 9�70 Permit Request M/;�/ G©/G71W 1*fr Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 7 Zoning District Flood Plain Groundwater Overlay Construction Type �J Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family J 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 Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: El Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing Cl new size ZAttached garage:❑existing ❑new size Shed:❑existing Clnew size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use �f BUILDER INFORMATION Name �G /^� Telephone Number Address 1 /V SG License# Home Improvement Contractor# Worker's Compensation# ��� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Gl�Psj'7�d/� SIGNATURE RAW &YZ B/G` DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. r ADD RESS , VILLAGE OWNER DATE OF INSPECTIONT FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL L GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r , Department of Health Safety and Environmental Services 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. Type of Work: 1/fit �l�l/ Estimated Cost Address of Work: Owner's Name: Vy Date of of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law blob Under S1,000 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 apply permit as thWCAtr—a=r owner.I hereby PP Y fora P 'i�� /a Date Name Registration No. OR Date Owner's Name q:fb ms:Affidav f The Commonwealth of Massachusetts • Department of Industrial Accidents °°_��• — Otllceof/osestigatloas _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit xxxxix name : s location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in anv capacity 11,7111 I am an em 1 rovidirig workers' compensation for my employees working on this job. : ._..:...... : :.:::........................::: : : : cum any nam ::;:: address. :. cttvw insurance co. olicv#:: ... ❑ I .00 am a sole p etor,general contractor homeowner(circle one)and have hired the contractors listed below who have the following ensation polices: ::::;:>: comoanv name. '"`` - . : address.: � . .. .....::.. . ..;. a.. hone ................ lei XON ..................... ........... - ............. ... insurance:Ca.,. . . xx Siam address: :... "" >:>>:.;;:.;;:•:.:;.:.;:::.;: city.. :::....................:.:::.. ........... n1nranc W. olii v Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sae up to S1,500.00 and/or one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby c pains enalties of p ury that the information provided above is trw.and,correct Date Signature /� Print name � �U �lC Phone# official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Seleehnee a rtmen ❑Health Department contact person: phone#; 00ther_ (rAnd 9/95 PJA) J� T9 GGl2 O��iGGc�GCZCiili'6e�Zd HOME IMPROVEMENT CONTRACTORS REGISTRATION UVlf. Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 120456 Expiration 01/01/00 Type - PRIVATE CORPORATION BIL-RAY ALUM. SIDING CORP JOHN O 'NEIL 40 ELMONT RD ELMONT NY 11003 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 2a f Permit# 41V,2 Health Division Date Issued to, .3 ` 4 Conservation Division Fee Tax Collector .kJ �m. 04 //3/1r1 - ✓ Treasurer X 1", -J3 Planning Dept. Date Definitive Plan Approved by Planning Board 26 Historic-OKH Preservation/Hyannis Project Street Address / Y, L , Village 4v Owner Address f .Telephone _ Permit Request / Square feet: 1st floor: existing proposed 2nd floor: existing .proposed Total new Estimated Project Cos$ Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 3---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 s 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 ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑'new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name lao Telephone Number S—d E E K, !a Co G Address License# YAC Home Improvement Contractor# /a l 2 Worker's Compensation# / "L (9 a r" 2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN 1`0 SIGNATURE DATE ar FOR.OFFICIAL USE ONLY r PERMIT NO. DATE ISSUEDlei p MAP/PARCEL NO. ► ADDRESS ��` f VILLAGE OWNER DATE OF INSPECTIO is FOUNDATION ' FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL ' FINAL BUILDING t DATE CLOSED OUT . ASSOCIATION PLAN NO. ; °i r °F IME The Town of Barnstable 9� 16 9. `m�' Department of Health Safety and Environmental Services prFDNlo'�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 r Ralph Crossen Fax: 508-790-6230 Building Commissioner i 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. ev Type of Work: S Estimated Cost P Address of Work: Owner's Name: AL4 L-4 Date of Application: 14;7 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 th to the o 7ne bat ontractor Name Registration No. OR Date Owner's Name q:forms:Affidav r ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE square feet X $55/sq. foot= GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X $??/sq. foot= Total Estimated Project Cost F-arK 2" I g990915b - The Commonwealul of Massachusetts Department of Industrial Accidents � ��:�:, ,t-._�� Olfrcr nllnyestigations � - �`` 600 Washington Street Boston,Mass. 02111 Workers' Com,pensation Insurance davit UrAw,rZ3r! ��%%%�////////%/////%//�///%�%�%//////��/. ' name: location: city ohone# ❑ 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. comnnnv name: address- City. hone "Su. l�c�►.� niicv# ❑ I am a sole proprietor, gene contractor, or homeowner(circle ne) and have hired the contractors listed below who IIIO have the follo«ing workers' compensation polices: comnnnv name: dtv. phone#• imurnnce crt. ......... comnnnv name- ;... :: ....... . addresr. ciri- phone#- __ insurance co. FJ117A %/ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a lineup to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and aline of St00.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verillmdon. I do herebv nder�fti°p mud penalt'et o that the information provided above is tale and coned Si=ture Date ZY- - Print name Phone# oincial use only do not write in this area to be completed by city or tors otncial dtv or town: permitilicense# OBuilding Department LILlcensing Board checkifimmediate response is required ❑Selectmen's Mee ❑Health Department contact person: phone#; ❑Other. ;r yxyca y,93 PJAJ Information and Instructions a. Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th:.: employees. As quoted from the "law", an employee is defined as every person in the service of another under any cam- 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 rec:.�•e: 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 c: 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 Iicensing agency shall withhold the issuance or renewa.. 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 1=tU acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the cotraeting 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 along with a certificate of insurance 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. 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 pernutllicense number which will be used as a reference number. The affidavits may be retiuned to the Department by mail or FAX unless other arramgemeats 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 0mce of Inesduadons . 600 Washington street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 7HEtp�i TOWN OF BAR.NSTABLE roe" r o�i BARNSTABLE. i "6 �•� 0 u BUILDING INSPECTOR ar a } APPLICATION FOR PERMIT TO ... ................. ....r 1 !... .. ....... ...................... .............. ......... .. .... .. TYPE OF CONSTRUCTION �...... ......... ..;! r.,.�.....:............ ....: . ...:. ................ ..........:............. . . .... .! ' .,.. .. .........19."X1� TO THE INSPECTOR OF BUILDINGS: a The undersigned hereby applies for a permit according tot a following information: Location .. ... `............... .........��'!.,! ;....................................................................................................... ProposedUse�'°�. ...., 1...... ........ . ..... ................................................................................................................. ZoningDistrict :. ....,..A..................................................Fire District .................................................................... Name of Owner ........ _ ..t':... t...Address .... ....J*1. .........1"1,,... .. .. Nameof Builder ....................................................................Address ................................................:................................... Nameof Architect ..................................................................Address .................................................................................... i Numberof Rooms ........[.........................................................Foundation ....�®......... * ................................. Exterior �.. ....... L ! .........................Roofing ... .. .. .. .......... .............................................. ' Floors ..... Interior;:. ........ ...... ....... .................................................................... Heating ...... -.6............` ... ........................................Plumbing ........ ...................................................................... l ✓ DAD Fireplace ...................................................................................Approximate Cost ...... ..................................................... Difinitive Plan Approved by Planning Board _____�_________________________19________. ? 1- Diagram of Lot and Building with Dimensions 100 x .J p < � Q ca O < w Lei W ¢' X < 0 0U) <\0 � w 1<1 � 1 � IF La0 iiUl zz U LUz 0 � Q� LU C- Q � LU .�.�. t � Qz Q oCj- /LL /a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..�.�� ..., .--;-:. .............................................. l� Willia m eou E. Jr. , � . DEC � � ���Y ' __- "� � "�' ^ - 13927 one story, No ................. Permit for .................................... sin le ______~. _ ' . I��trim �Cizt e Loco*on ---------------------. - Centerville *� ............... --------------------..' -- William E. Daoey* Jz�. Owner .................................................... ' ' Type of Construction ----------- ......... - ^ ' -----.------_..----.—_----.-. Plot ......................... Lot ................................ ^ Permit Granted ��ras 7 l�7I ` » ------''^------' Date of Inspection .. .` .............. Dote Completed ----------.--lg ' \ ; - ' PERMIT REFUSED ______-_-------------. lg \ ---------..---------...--.-.--' ^-----..-------------,-..--.--., -^'-------'------^---^^---'--^' � . _.--~~' ............................................................ ^���� . �� ` � �� ��� �����. lg Approve , ~ ,--V^'� -�r- ----'� -------.-------..--..--.-~.-.- -----------.--------..—..--..- | / ^