HomeMy WebLinkAbout0128 SOUTH MAIN STREET y
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Map Parcel fir Permit#' 3 $3 j
House# Date Issued 1
Board of Health(3rd floor)(8:15 -9:30/1:00-4:39) / °� 0 ,
} %w
Conservation Office (4th floor)(8:30-9:30/ 1:00 2:00) - t 2 otI
® V i�� G �
Planning Dept.(1st floor/School Admin. Bldg.) ��® t�i �'j�®
Definitive Plan Appro y Planning Board 19 � �v if N74
TOWN OFBARNSTABLE
_ E
Building Permit Application
Project StreLddr �7� ma.oiJVillageV i
n Lie- levy Alsl
Owner �t � Address A }t1q Al,
Telephone �p Q 7j4,a P -
-Permit Request to c�eV l E �.P
i
First Floor square feet Second Floor �� square feet
P
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure :30ae Historic House ❑Yes INO On Old King's Highway ❑Yes INo
Basement Type: ❑Full Crawl ❑Walkout ❑Oth
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New — Half- Existing New
No. of Bedrooms: Existing c;t-- New
Tdtal Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: Z Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing ✓ New Existing wood/coal stove ❑Yes I 1 o
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
,�k<one ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes q O If yes, site plan review#
Current Use N Le- o�vdl% L Proposed Use
nn Builder Information °`'S�
Name AiLiA.LJVr Telephone Number s 3-7S' �
4
Address License# 0 L
Home Improvement Contractor# 1010
/
Worker's Compensation# T.6
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
YXA,
morid h r r Sa L Ca
SIGNATURE)C DATE
BUILDING PERMIT DENIED FOR DIE F LLOWING REASON(S)
I
i FOR OFFICIAL USE ONLY
PERMIT NO.
i DATE ISSUED ` J
MAP/PARCEL NO:
ADDRESS VILLAGE -
OWNER
DATE OF INSPECTION: J
FOUNDATION
FRAME
INSULATION �l 19Q� 9'o _ r
FIREPLACE
ELECTRICAL:` ROUGH = ' FINAL -
PLUMBING: (,ROUGH FINAL, _
GAS: t e ;`'ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT - z
ASSOCIATION PLAN NO. ;
01/14/1.999 13;17 5087752887 HOP11E IMPROV SPEC PAGE 02
to ti
Av
U,cart': u� inarL oeopca'ty� ¢�hrvi
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Cros"Olt
lor 5
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i Area z 7500 z5f.
'nff C if- t
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75,001
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} ®fit
vtn r �
ref x2o.fir 4N& food, pOU
PAU�
.� h m$j certify�t MM litss�c en s-��'�r I S GROVEft
Wirs ."J'.�. , (9r1"P®Pt 340!'rL'> , Inc
cnu dwUmg Amm hie wim days wr `'� I'm a spc=' I TM ��'T
hazard, an a with+-sort- eft ve dau of 7 -2 -9z arid. Ithe IA=h0m, OP ° u
4W dwttung dor.�o"�usn "o ''Co tie Coca° Ong 6y-des in¢ Ct'
a�tthe time o+�corttrs tftor�. vvit c, rYssge��' t.or'i�orttt ddt t�iortte sCWe.
.591*Wilt m or � �rt�'�rn vtota�t-t� n M.�mU �erte Dow e .�93
a(ctwq Un� c�L�ssA� . Crouse. laws C tw4oAL-.sccrtom '7. He No:Wiz_
PLEASE 140TI; the strue4vrlA up -;hewn .on iht< pool plan war uwiy. An actual -vrvey it necessary for a preetae
determination of the huddine lotatian and encrnachmOntt if Ov exist, tither wav across prnDe►ty lines. Tgif plan muvi nol be
uved for rtcerdinp purooies or for use in oreparifte der crtptinn� ano Shutt not tw used for varsanct or huildtnd plan
pv►",%e Thitt plan muxl nail he used to) h,eate property ',-; .thfitJtuun of huildinfj 1ULAtion3, property line dtmens+one, fences
Or lut a0n4ifur64ron Can 411sly he iCWmPliyhe0 (?y sn 4ccurpe mdlruM1lentt surveY which Rear refleta dtlferenl information Man What
i* ,howrt heft+M. PlIeWilf Mott that tn,t is 'NOT A BOUNDARY SUQVEY' Anal is 'PO* MORTGAGE PURPOSES ONLY=�„^,
COLONIAL LAND SURVEYING COMPANY, INC.
i11 eaa u.�a---, c._._. r a..�.... .a... nTz"is! _ 09r✓..o.• R fi"f_R71t.71 A� Fix, 617-826-4823
01/14/1999 13:17 5087752887 HOME IMPRO'V SPEC PAGE 01
i
x neTown of Barnstable
Department ofHealtb Safety and Environmental Services
"ilding I)IVulion
367 Maier Skus,gym MA(260 t
Me: sag-
Fax: 1Qa-790�6?30 Rafph Cron:e::
BuiIdiog Coins
PLEASE FORWArW .fM ATrACRED PAGE(S) TO:
AM:
TO
DATE: 199q
PAGE(S): _� (EXCLUDING COVER SHEE7)
01/14/1999 13:17
COMER PAGE
TO :
FAX . 7906230
FROM : HOME I MPROV SPEC
FAX : 5087752007
TEL : 5087 52815
COMMENT :
� ins cCtornI�A�OWG701NCJ
Apptican ur in locatwtt of 4IMPerty: Cenftrville
Q ,
Crosbt 5
Area 7,500_+S
-nlf 2 C (4 f,_(a
�� Cross
siv
o I' ►, g
c 21± 110. l28 c
wit
I
75.00 ' ,
ou
Main5tr C
220(0 Ob ,[�0 GtnX: 250001 0008D OOd EMU C �t11 OF
1+ef —"1 0 d s�o
,o+ PAUI'
T.
hereby 4 certL'�' at t110Ctg a
� ins OCII,�11�L�5't'� " +"G�/I� u GROVER
9rice S enth , r •v • (ymou� Morrow Co, nc• u 31311 Q
qhe dwelling showtv h¢rem d= nor <fau. in a, spec;<acL 7:FXA f,00d 'S
ft
hawtc aria with am ei'ecttve date of 7 -21Z and `ttte localtorl, 0� `�/ . ` sU
welti kec �the local ,Saving by-laws imef Feet) f
vot the tum OFc011SM1Gti= Wift r¢SP¢GttD hori-,66nUd dlmert,s10 X Scale: 1" = 30
setback. reqUUVnajt5or is ewjnpr vm Vtol.atwri, a24orcernent ' Date: a.23-13
=twr , under Mass. General, laws �4o X--SectLon� 7. File No. 6so2 �s
PLEASE NOTE: The structures as shown on ,this plot plan are approximate only. An actual survey is necessary for a precise
determination of the building location and encroachments. if any exist, either way across property lines. This plan must not be
used for recording purposes or for use in preparing deed descriptions and must .not be used for variance or building plan
purposes. This plan must not he used to locate property lines. Verification,of building locations, property line dimensions, fences
or-lot configuration can only he accomplished by an accurate instrument survey which may reflect different information than what
is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY".
COLONIAL LAND SURVEYING COMPANY , INC.
269 !fi trlover Street • Hanover, Mass. 02339 „Phone: 617-826-7186 • Fax: 617-826-4823
ADDITIONS OR ALTERATIONS
If located:
North of Roue 6 - any work visible from outside- needs approval from OKH
In Hyannis - If work visible from outside - Check to see if it's included in the
Hyannis Historic Waterfront District- if so it needs approval from th
em
hem
APPLICATION PACKAGE MUST INCLUDE:
Map/parcel number
Sign-offs from
Health i
Conservation(if exterior work)
Tax Collector
!> Treasurer
Street address
Owner's name &address
Permit request-full description of proposed project
Square footage -proposed project
Estimated project cost
Complete Dwelling information for Assessor's Office
Builder's information
Signature
Plot plan
[� 2 sets of reduced (8.5"x 11: or 8.5"x 14' plans with cross section& framing schedule
Ei Home Improvement Contractor's Affidavit
Worker's Comp form must include: Insurance company's name & Worker's Comp policy
number
Energy Compliance Form
Copy of Construction Supervisor's License & Home Improvement Specialist's License OR
Homeowner's
License Exemption Form.
Fee
NOTES:
CHEWqEYS
Need Home Improvement License
No plot plan required
PIERS & DOCKS
r7Need Construction Super license AND Home Improvement License
Owner cannot pull own permit
q•forms-PERMIT'S 1
a--c—
ev 8/12198
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The Commonwealth of Massachusetts
%;17
Department of Industrial Accidents
Office 1011nlv85#919dons
l �~� 600 Washington Street
Boston Mass. 02111
Workers' Compensation Insurance Affidavit
�
name: r pp ( N�/��
e, bill9k
location: 1�� �Ow�V� C► VA t N
city 1 phone#
❑ I am a homeowner performing all work myself.
❑ 1 am a sole pro,netor and have no one workin in any capacity
-am an employer providing workers' compensation for my employees working on this job.
-- -
com anv name.. lZty✓GN'I Br✓ Ct f G
_. :
ci hone#: l
insurance co.
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the following workers' compensation polices:
comaanv name
address.
rlty
phone#:
insurance co.
olicv#
campanv name
address:
city-..
"bhbne#:
insurance co:. .. olicv#
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of MOM 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.
1 do hereby certify under the pains andpenalties of perjury that the information provided above is true andcorrect
Signature Date / / / �2 _
Print name- -Rob tetmv�r, &K L f tk.) 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 ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revved 9/95 PJA)
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 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 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, 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 contracting
requirements of this chapter have been presented to
authority.
Applicants
r 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.
j
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 permit/license number which will be used as a reference number. The affidavits may be returned io
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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investloadons
600 Washington Street ,
Boston; Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
w+e
t The Town of Barnstable
t an nvironmentaI Services
Health Safe d E
9 Department
of H
�� �e8 DeP
artme Safety
� • Building Division
367 Main Street,Hyannis MA 02601
Ralph Crosser
Office: 509.790-6227 Fax: 509-790-6230 Building Catnmission:
For office use only
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 b registered contractors, with
certain exceptions,along with other requirem u.
A
JJType of Work• �l�l t U� Wi Est. Cost
M
Address of Work: 1� F J//A e�jkl A,/
2 /
r
Owner's Name f G L4
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under SI,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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a.permit as the agent of the ownerMAC-L94,
Contractor Name Registration No.
Date
OR
Date
Owner's Name
T.G.
OfPARTNCNT Of PUBLIC WfIr '
CONSTRUCTION SUPERVISOR '.'LfNSf
Nuebtr: [Moires: Birthdste:
i CS 111351 1712311999 11''�11911
Rostrletw TO: 11
ROA[AT A MCLA00110
25 NARVARO ST
I ; �ARMOIITN, NA 1?66� . .....
— -� , �✓�ie -�o�r��uvea�i o����a�ucae�a
HOME- IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston , Massachusetts 023.08
HOME IMPROVEMENT CONTRACTOR
Registration 10103.4 Expiration 06/24/00
Type - PRIVATE CORPORATION
CAPE COD HOME IMPROVEMENT SPEC .
Robert A . MacLaughlin
25 Iyanough Road
Hyannis- MA 02601
t
1
110
-
GRANITE STATE •INSURANCE COMPANY 13102 71109 WC 354 87-65
, �r.nui.trecKr,arvivur,rvi r. ttr:
AMERIC'AN IN ERNA'I10NAI
P() ROX 401)
••••• PENNSYLVANIA PARSfI'PANY. NJ 070s4-0401I
WPI • • 'PHONE: 1-900-64�-225y
Member Companies of
HOME IMPROVEMENT SPECIALISTS OF CAPE COD INC 01M American International Group
25 I YANOUGH. ROAD -^^-�^^-^�•^�T^
HYANN I S MA 026o 1-0000 EXECUTIVE OFFICES:
70 PINE STREET, NEW YORK,N.Y. 10270
I.D#
WORKERS COMPENSATION AND ROGERS & GRAY INSURANCE AGENCY
P 0 BOX 16ol
EMPLOYERS LIABILITY POLICY 434 ROUTE 134
INFORMATION PAGE SOUTH DENNIS MA 0266o
INSURED IS CORPORATION IM-7-y-IOUSPOLIGY NUMBER WC 351 3460 (RENEWAL)
OTHER WORKPLACES NOT SHOWN ABOVE
ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's O7/O4/99
mailingaddress FROM 07/04/98 TO
ITEM a A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states.listed here:,
MA
B. Employers liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A.
The limits.of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident
Bodily Injury bV Disease $ 500,000 pollcV limit
Bodily Injury by Disease $ 100.000 each employee
C. Other'States Insurance:'Part Three of the policy applies to the states, if any, listed here:
SEE ENDORSEMENT• WC 20 03 06A
ITEM 4 The premium for this policy will be determined by our Manuals of Rules. Classifications, Rates and Rating Plans.
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cjhe d%WUutig shmm hereon,does nor f iry a speciacL TEACA jq° — / su
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=tLom . G Chctptw4oX-SectL0rV 7. File No. r5oz 93
PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise
determination of the building location and encroachments. if any exist. either way across property lines. This plan must not be
used for recording purposes or for use in preparing deed descriptions and must not he used for variance or building plan j
purposes. This plan must not he used to locate property lines. Verification of building locations, property line dimensions, fences
or lot configuration can only he accomplished by an accurate instrument survey which may reflect different information than what
is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY".
COLONIAL LAND SURVEYING COMPANY, INC.
269 Hanover Street • Hanover, Mass. 02339 • Phone: 617-826-7186 • Fax: 617-826-4823
THE
_ The .Town of Barnstable .
$ Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508. f&,2 -No3�r Ralph Crosse::
Fax: 508-790-6230 Building Conte::
PLEASE FORWARD THE ATTACHED PAGE(S) TO:
TO:
ATTN: �c -
FAX NO:
FROM:
DATE: 9
PAGE(S): (EXCLUDING COVER SHEET)
TRANSMISSION VERIFICATION REPORT
TIME: 01/14/1999 12:02
NAME:
FAX
TEL
DATE,TIME 01/14 12:01
FAX NO. /NAME 97752887
DURATION 00:01: 22
PAGE(S) 02
RESULT OK
MODE STANDARD
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