HomeMy WebLinkAbout0661 MAIN STREET (COTUIT) �.�
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel O 1 Permit#
Health Division Date Issued
Conservation Piyision Fee. &-�
Tax Collector
Treasurer .0,-
0 2
Planning Dept. `
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis }
Project Street Address 1 Yy)cLk f S-r
,Village CO►U cr a�
'Owner M pirk-Au n -T Lf A Address (0(0 1 iMaih S1- CnT ), T', M0.
Telephone 5 0%. H 2 0 &0 4 5
Permit Request 10W29 � u!✓iY� ��%�Y
Square feet: 1st floor: exi ting proposed 2nd floor:existing proposed Total new
Estimated Project Cost f 40 'C;v - Zoning District Flood Plain Groundwater Overlay
Construction Type o
Lot Size l Y3 QOW Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
R
R •
Dwelling Type: Single Family (2r Two Family ❑ Multi-Family(#units)
Age of Existing Structure Sri Historic House: ❑Yes Ga'No On Old King's Highway: ❑Yes ❑No
Basement Type: mull ❑Crawl ❑Walkout ' ❑Other
Basement Finished Area(sq.ft.) 44 ✓ Basement Unfinished Area(sq.ft)"
Number of Baths: Full:existing i new 0 Half:existing new
Number of Bedrooms: existing 1 new r)
Total Room Count(not including baths): existing new n First Floor Room Count q
Heat Type'and Fuel: Gai Gas ❑-0il ❑Electric ❑Other
Central Air: ❑Yes Cl No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes @oNo
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing Cl new size Shed:•❑existing 0 new size Other:
Zoning Board of Appeals Authorization ❑ .Appeal# Recorded❑ .
Commercial ❑Yes 9 No If yes,site plan review#
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Current Use Proposed Use
Q GU /Z/ '� A- BUILDER INFORMATION
Name Telephone Number SG 8 — 8 S 6 -2 3 9-5
Address -k Q M i a"sla el i Lv► License# L2G gi I Z
Jt.p:tvS t�i► 1"� 0�(.3 f Home Improvement Contractor# .CS NSu 7 S
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
�ar hstc„b �C LAhFI �vtl
SIGNATURE DATE _ �._1Z Qg mg
f
FOR OFFICIAL USE ONLY
PERMIT.NO.
DATE ISSUED
, <
MAP/PARCEL NO.
ADDRESS c,�;�<, 1 _ f~VILLAGE
OWNER' �Z<
1. .+ate • . 3 '' ' • i • _ • t. y• � -..p * I •ff,
DATE OF INSPECTION
FOUNDATION €
FRAME
INSULATION =
C yp;
FIREPLACE
.ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL t rt r 1 c'
GAS: ROUGH FINAL , :_ _ _ • k -�; '
FINAL BUILDING
DATE CLOSED OUT `� 4
ASSOCIATION.PLAN NO. 5 t } = e
• j
Department of Health Safety► and Environmental Services
Blinding Division
tUOL 367 Main Street,Hyannb MA M601 _.
s�
Office: 508-8624038 &dph Crossen
Fax: 508-790-Q30 Building Commissia:
HOIVIEOwNE8LUWW SON
AnsePsbt
DU11E: I 2•- �
021,
roe LoCA ON: ViIIW
number :
,>ln,tie' (lggr y 2 e'6 0 qs,-, 30��
CURRENTMARMGADDRESS n r M t �� S 1'
A zip axle
The current exemption for was extended to include ied dweffin=of six units or less
and to allow bomeowam to engage an individual fax hi re who tm not p�a License,n�tevid that the outset:
Am M
Pers*S)who auras a parcel of land an which helshe srsides or inoeads to �fmm msrnctmes. p io
be,a one er two-fm*dwel b&auached or d sao� �aY to etch use andl
pMM who cansti=more than one home m a two-year period shall not be cmndemd a hOm ow Such
."horneorovnd'shall Submit to the Aufl t Official as a form eZOPMble to the Building Official,thathelsbe shalt be
MMCUMP- .- forsuceditor 109.1.1)
. ` t uner"assumes 'bWfOrCOmPIiM=wftft State Budding Code and other
applicable codes,bylaws,roles and re8nlatioas-
The lmdasigned"bameawnet"artifice that helshe under=&the Town of Barnstable Budding Department
minimami inspection ptocedum and reqimemems and that helshe will comply with said procedures and
Apptovd of BniWiog Ottldai
Note: Thee-fm*dwellinp comahliag 35,000 cubic fees ar larger wM be required to comply with the
State Building Code Section W.0 Casncdon Camol.
ROMzuwMMEUMWrMN
I teCodestace d= 'Ant,bomeownerpa5oammawadcforwhich abm'idnFemkis pipOWdM shall bet fmm the
Ofog MdM(Sedm 109.LI-Unusing Ofc=Wzd=St );Pul dm fthebomeowna apostate for
bho to do zwhvodr.thst=ch I a®eowaersW Mu zWffY Oe rn donqms&Mtks ofa (s=AQpmdtx Q.
Mauy iromeewtteaatbo=d&auto@ vmtma, dtatl
Ruin&Rosaia m far Liceaft S=d0°215) s P ablo=
pudadWy when the hom'I hkn udWc=d petsotas. In dds aae►oar Boat"atuatt ptooeed aSabuttbe tmiiceased person as it world
widt a ff=m ed SupeeTb= '1be homeowttor ar S as S,.imr is tdtittt WfY
MWMWL
To emtae thatthe ltomeow=is tbity ttwate of bislber '?� ttslaue.as pact of'tbe Peaait appa'
that the m*that bdlsbe aud- t the of aSupe:• Oa the iatipa0e oftbis ittae is a farm "
Used
try seretal town:. Yon mar care to amend and adopt sack a fatmfoa rase is yveeiq
The Town of Barnstable
9 Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Cressen
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: Estimated Cost 5,
Address of Work: (9�11 I M c,V% S Cb rt)vf M G 0z(� J
Owner's Name: Mclir-1 lL� :i,-% s r h e r''
Date of Application: g 9
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
E3Job Under S1,000
Building not owner-occupied
28wner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME EUROVEMENT 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.
Date Contractor Name Registration No.
Date er's Name
q:forms:AfSdav
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. in e ommonwe
Department of Industrial Accidents
Office 811firu saidans
600 Washington Street
Boston,Mass. 02111
-- Workers' C lensation Insurance Affidavit
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I am a homeowner performing all work myself. capacity
❑ I am an employer providing workers'compensation for my employees working on this job.:. :::: ::: . •::-»>:•T:-;»:?:.......
comnanv nam
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[]'I am a sole proprietor,general contractor,o homeo. -(circle one)and have hired the contractors listed below who
have -" Vt
the following workers' compensation polices:
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Faiiare to secure coverage assequired under Section 25A of MIL 152 can lead to the impnsitim of crhuipal penalties of a ene up to$1,500.00 and/or
one years'imprisonment as well as civic penalties in the foam 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 Once of Investigations of the DUfor coverage verification
I do hereby certify der Oe,�1 p ofpelurY that the mforniation provided above is&w.and coded
`Signature
,print named�' i ` 4 ''� y ► - Phone#
oindal use only do not write in this area.to be completed by city or town official
city or town: permft/licaue# (]Building Department
�Liceu�g Board
❑cheekiiimmediate response is required ❑Selectmen's Office
_ ❑Health Department
contact person: phone#-, ❑fir
(Devised 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 gfaunds 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!ecal 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 requirements of this chapter have been presented to the contracting
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 retumed 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 permitllicense number which will be used as a rd rence number. The affidavits may be rem to
the Department by mail or FAX wdess other arrangements have'ev.:i 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 Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 eat. 406, 409 or 375