HomeMy WebLinkAbout4740 FALMOUTH ROAD/RTE 28 _J
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel �11� o db f Permit#r
Health Division, Date Issue
Conservation Division Fee rn-
Tax Collector
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis n
• L cif/������ �6
Project Street Address
Village
Owner 1�0 ea M Pa ro o Address
Telephone
Permit Request 'e S
•
Square feet: 1 st floor: existing proposed 2nd floor: existing'- proposed Total new
Estimated Project Cost 3 4DOO Zoning District Flood Plain Groundwater Overlay
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: ❑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: ❑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 FRASER GlINSTRUCTIJN Telephone Number
Address 71'TARAGON CIR° License#
CCTU IT MA 02635
• Home Improvement Contractor# f 95�4
- ,
Worker's Compensation# AX'/`3/S eM 3 6 3 6J
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE �) f
FOR OFFICIAL USE ONLY
PERMIT-No.
DATE ISSUED - {
MAP/PARCEL NO.
ADDRESS # t VILLAGE A '
wt
OWNER, ,
A 4 f
DATE OF INSPECTIQ
FOUNDATION
4
.FRAME
INSULATION
FIREPLACE - "� f ;' • » f
ELECTRICAL: ROUGH FINAL -
PLUMBING: ROUGH FINAL
-GAS: • ROUGH FINAL f
. '
a ,
FINAL BUILDING -
} DATE CLOSED OUT
.; ASSOCIATION PLAN NO:
e Town of Barnstable
• a►.gxerwm.E. •
9 '°M �' 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
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.
Type of Work: Estimated Cost
Address of Work:
Owner's Name: bX4,tC9-/''7aa
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job Under S 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 the owner.
:I la) i C L
Dite Contractor Name Registration No.
OR
Date Owner's Name
f
1
q:forms:Affidav
I
The Commonwe"s of Massachusetts
Department of Industrial Accidents
� , - Ofllcir al/areslipatioas
600 Warshington Street
. , Boston,Marls 02111
Workers' Co m ensation Insurance Affidavit
name: FRASER CONSTRUCTION
location-
71 TARAGON CIR.
C01011 MA 026'
one#
❑ I am a homeown p ormtng AVoik myself. '
❑ I am a sole proprietor and have no one workin in aw ca acity
a I am an emploTgAVIUUgf cM tion for my employees working on this job.
companvname: �'{ TARI4aQN GID
address: : . COTUIT MA 02635
426-2292
dtv: Phone* f�' a
nsurance ca. oiicv# cl 2 il 6`12
❑ 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:
company name*
address•
. .. ...........
dh*. phone#: < >
insurance cn ;: iicv#
m anv name: ;:...,
address:
dtv: - :...: : phone
..:�..}!G::v;:?.;:.}v:.:::Ji4wvi.:.;:."...:..:. :: ....::...•.:.. -.:n{..•.{�;{{ij,.v.•.•.}:::•.:�:n.�i•.�ti:•..:... .• ..... ::; ..:i}^�?'``q' •{iv��,,::::,;•y::
FaOure to aeeare coverage as required under Section 25A of NIGL 152 an had to the imposition of criminal penalties of a One up to S1.s00.0o and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORtt ORDER and a One of 5100.00 a day against me. I understand that a
copy of this statement-may he forwarded to the Office of Investigations of the DIA for coverage verification.
r do hereby certi the truss an endues of perjury that the information provided above is trwe and correct
Si tune Date
Print name l pst,_3 C_ 1^ c� Phone# ` .X— *b Q 5�—
oindal use only do not write in this area to be completed by city or town ofibdsl
city or town: perndtilleense g Budding Department
Licensing Board
❑checki[Lnmediate response is required ❑Sdectmm's Office
OHeaith Department
contact person: phone 0.1 ❑Other
*and 9/95 PIA)
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HOME IMPROVEMENT CONTRACTORS. REGISTRATION
Board off Building Regulations and Standards
ne Ashburton- Place Room ,1301 •�:
Boston, •Massachusetts.`0210 8}
tu'x: ' t
1 HOME.-IMPROVEMENT CONTRACTOR -
f Registration 112536.
= Type. DBA Expiration ..44/.06 ;• , j,. ..::
W.' '`"•'-� p .. yam.
. > VEIR:NT CONTRACTOR
ERASER CONSTRUCTION r 4 '' Registration 112536
DEAN C. FRASER , , `. >�: �, Trae DBA
71 TARRAGON CIRr
��,�'E:Plratioa.." O4/-06199
COTUIT MA 02635 r {� r y n '•,,
FRAWA CONSTRUCTION
le�►,do 7; C. FRASER
i iARRA60N CIR
COTUIT NA 0263r