HomeMy WebLinkAbout1283 SHOOTFLYING HILL RD _.
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 4 fQ � , A: Permit#
Health Division Date Issued
® 25,
Conservation Division S J� 12. 28 Application F e
�s I
Tax Collector Permit Fee f -P1 o
Treasurer 0
1 V1 S f pU SEPTIC SYSTEM MUST 9E
Planning Dept. INSTALLED IN COMPLIANCE
WITH TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND
_Q
TOWN REGULATIONS
Historic-OKH Preservation/Hyannis
Project Street Address /, �, �7 /c1./ � i`�� AV
Village C t'elleKV/ //
Owner /71llU�2ecti lldldery Address ,®, f Ao v aw
Telephone(�5®9l°qd;--75`/b ' C50,06-63--99IS _
Permit Request
/a/awe CXGM'! Llve ar ,e,eee,- `I'a >1 llo 4y�1d
IO�JGS //
�,!k> /tyv-&A-
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 40•OM Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Er'*— Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes �o On Old King's Highway: ❑Yes ❑
n �
Basement Type: ull ❑Crawl 0 Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) `
Number of Baths: Full: existingnew Half:existing new
9 I
Number of Bedrooms: existing is new
Total Room Count(not including baths): existing 7 new_ First Floor Room Count
- N�:v, eastz5 zl��rlc
Heat Type and Fuel: g Gas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes 0 No Fireplaces: Existing / New Existing wood/coal stove: ❑Yes ❑No
Detached garage: 0 existing ❑new size Pool: ❑existing ❑new size Barn:❑existing 0 new size
Attached garage:❑existing 0 new size Shed:❑existing ❑new size. Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ .
Commercial ❑Yes 2 o If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name `Celir�SillP' Telephone Number
Address License# _e!?S' 6:&09'z
/�i4 Home Improvement Contractor# %DO
Worker's Compensation# 3/mo 6/D/6sn 7
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO we l/®s�P `exr,
SA W /90 62
SIGNATURE � P DATE o?�`
FOR OFFICIAL USE ONLY
!PERMIT NO.
DATE"ISSUED
,i IMAP/PARCEL NO. "
ADDkESS VILLAGE
OWNER
E
DATE OF INSPECTION:
r
FOUNDATION
FRAME +
} INSULATION Q
FIREPLACE
ELECTRICAL: ROUGH _ M FINAL
rr .- I-
PLUMBING: ROUGH- '�o O FINAL
S
��pn � �
g.
GAS: ROUG9 m lx FINAL
FINAL BUILDING ~
��
� u, tu00
:3 4
W S Q N I
's DATE CLOSED OUT fr.n
ASSOCIATION PLAN NO.
}
03/25/2005 11:28 FAX 508 759 0695 BOURNE MIDDLE SCHOOL 2001
508 775 2848 P.02
,"E' Town of RarnstabIc
•
_ HAP.NSMLX r Regulatory y Services
'"' Thomas F.Geiler,Director
Building Division
Tom perry, Buflding Comtnisslonex,
200 Main Street, Hyannis,UA 02601
Office: 508-862-4038
Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Ow=t Of the subjectpropazty
hereby authorize ��'<°A�/r,;p ��lc,
to act on my behalf,
sn all matters rehtrve to wozk authorized by this building pelt;.,pp1jcation for.
(Addz ss of Job)
f-Sture of .er
Datc:
4tge
Name
Q:F0RMS:0ViNBRP=U�,WsroN
TOTAL P.02
9AL -6o1r✓rr r� v��i� aac ivae
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
ration 100121
Expiration 6/9/2006 One Ashburton Place Rm 1301
Boston, Ma. 02108
Type:, Private Corporation
OCEANSID ,
Richard Clark
217 Thornton Dr � i�
Hyannis, MA 02601 Administrator Not valid without signature
I
BOARD OF BUILDING REGULATIONS
fh License:sPONSTRUCTION SUPERVISOR
r
Number:CS 073097 '
5
trlthdatel 3/1957
Expires. 1�1/03" 06 r.no: 5900.0
Resri�tedr00 A=`
PE ERA LA 'f
f
18 C IC ROAD
CENTERVI 026'
Commissioner
/
-'_ The Commonwealth of Massachusetts
Department of Industrial Accidents
Office 010yestfgatfaos
_ 600 Washington Street
-_ Boston,Mass. 02111
Workers' Com ensation Insurance davit
Nil
location. %a�3 s�Jcby�.�rS �Y/
city �di� le /,V hone
I am a homeowner performing all work myself.
❑ I am a sole rietor and have no one workin in ca achy
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rs' co ensation for my Fe.... working on this job.
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aired Wider Section ZSA of MGL 152 can lead to the i„rposrtioa of erlminai penalues of a fine nP to S1,500.Q0 mdlor
Fsaure to secure coverage as req
one years'imprisonment as weR as civil pe
nalties in the form of a STOP WOE ORDER and a Hue of 5100.00 a day against ma I mrderstaad a
copy of this statement may be forwarded to the Office of Investigations of tht DU for coverage verification•
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Date Q3�a?/
signature t�
ame P ,e yJ Phone#
Priut n
official use only do not write in this area to be completed by city or town official
perndt/Ucense# ❑Building Deparbnent
city or town: ❑Licensing Board
❑sdechnea's Office
❑check if immediate response is required ❑Health Department
(
phone#; _ ❑Other
contact person;
OVVAd 9/95 FIN
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 bregoing engaged m 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. a
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal
ermit too erate a business or to construct.buildings in the commonwealth for any applicant who has
a license or operate
of P
h the insurance coverage required. Additionally,neither the
not produced acceptable evidence of compliance with g Q .
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
liance with the insurance re�ements of this chapter.have been presented to the contracting
acceptable evidence of comp
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situationand
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Departmentof 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 To
wns
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 Pe]mit/license number which will be used as a reference number. The affidavits may be retarhiAlo
the Department Y
ent b mail or FAX unless other arrangements have been made.
D
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600'Washington Street
Boston,Ma, 02111
fax#: (617) 727-7749
nhone#: (617) 727-4900 eat. 406, 409 or 375
e Town of Barnstable
oF� talk, Regulatory Services
HFrAB ,� Thomas F.Geller,Director
1639. ,m Building Division
'OTEc r�►a't°i
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax: 508-790-6230
Office: 508-862-4038
Permit ao.
Date
AFFIDAVIT
HOME EgTROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,addition tion,repany pre-existing owner
owne-occupied conversion,
improvement,removal,demolition,or construction
betiding containing at least one but not more than four dwelling units or to structures which are adj acent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
pp Estimated Cost
Type of Work' /����— •
40.
Address of Work:
Owner's Name:
Date of 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
[Downer pulling own permit
Notice is hereby given that: GISTERED
OWNERS PU�,LING THEIR OWN PE MEO�R YINENGEE�NI WORKDO NOT HAVE
CONTRACTORS FOR APPLICABLE H
ACCESS TO TEM ARBITRATION PROGRAM OR GUAI?.ANTY FUND UNDERMGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner;
Contractor.Name Registration No.
Date
OR
Owner's Name
Date
Q:for=-.homeaffidav