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Home My WebLink About0674 MAIN STREET (COTUIT) e"en ineerfi g Dept.(3rd,'floor) Ma 1 Parcel �� erinit# � _ p �3 -05Jnn House# Lc Date Issued 1 1:00-4:30) - FeeJ :30/1:00-2:00) 19 BARN STABLE. • _ J I� MASS 16 TOWN OYBARNSTABLE i Building Permit Application Project Street Address Village Owner 'Ile Address jr2Fr _Telephone Permit Request I First Floor 36 �( _® X1,L/1, square feet Second Floor square feet Construction Type r� Estimated Project Cost $ Zoning District � Flood Plain Water Protection Lot Size Grandfathered &VeS ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic'House ❑Yes ZJNt'__ On Old King's Highway ❑Yes ' 4N-0 Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Ile Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other 1710 A/ F Central Air ❑Yes ❑No Fireplaces: Existing &i,/�ew Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes UO If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address jPt License# Home.Improvement Contractor# Worker's Compensation# 1�1e(oe` 7:2:D 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 � r . SIGNATURE DATE BUILDING PERMIT D IED FOR THE FOLLOWING REASON(S) S C FOR OFFICIAL USE ONLY r pt PERMIT NO. DATE ISSUEDr; i `' f _ ► J _' MAP/PARCEL,NO.' F• l� r f a t :l r ADDRESS iy VILLAGE ' OWNER DATE OF-INSPECTION: FOUNDATION T FRAME � ' . � , ' � , � • ! - ..- . .r 4 INSULATION FIREPLACE ELECTRICAL: ' ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 'DATE CLOSED OUT, ASSOCIATION PLAN NO. j ( r • dFTMe rAry�o "• - . - . : The Town of Barnstable uma $� Department of Health Safety and Environmental Services r�,r, • Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione 4 For office use only ` Permit no.__ i 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: Est.Cost S r�• Address of Work: Owner's Name Date of Permit Application: I hereby certify that: Registration is'not required for the following reason(s): Work excluded by law Job 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 SOME 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. Date s ontractor Name Registration No. OR The Connnoin 'ett111t of Atassuchmetly Dc'parltnent of Industrial Accttlents j oficeaffavestlgal/offs 600 «u-vh n�lrl/l Street �•�� '� Bustutr..11uss. UZlll _ Workers' Compensation Insurance Affidavit i ii :in inr6rm io ._.. pl_R 1'R I NT I er i - _ _ c, i ,t�r ho •# I am a homeowner perfornAng all work myself. 1 am a sole proprietor and have no one working in any capacity ,man emplover providing workers' compensation for my employees working on this job. cornn:rnv name, C a '- atlrlress• slit phone#• ,�y+� insurance co. [i 1 am a sole proprietor. general contract r, or homeowner(circleAfire) and have hired the contractors listed below who have the following workers compensation polices: cmmiam• nnmc• adrlresc• cin•. Shone#- insurance rn noliev# _ .. •'--.- --.. Vim•.^..� _ .-=.�._ ...�_ -_ ='.�'�::�.�'1L iT"f•1ww•y. .�7T._.-_ .....�....�....�.....�-_ comnanx• nntnc- arldrescr . city phone#• insurance co policy*1 Attach additia_nal sheet if neces_sa_ry`..:•.. ►;,�;� -^+�- _ __ =:';' '�~ " _•.yam+~ "~'— ::'• —^ Failure to secure coverage as required under section 25A of n1GL 152 can lead to the imposition of criminal penalties 01-2 lineup to 51.500.00 andiur unc%cars' imprisonment:rs wcll as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. I understand that a COP)'of this statement may be forwarded to the OMcc of Investigations of the D1A for coverage verification. 1 do hereby ccrrif r •r the pains and walli s 91perjuly that the information provided above is true and correct Si=nature Date Print name Phone#. ' ofticial use unlp do not write in this area to be completed by tiny or town official city or town: permit/liccnse# r•tlluilding Department ❑Licensing hoard [, check if immediate response is required C3Sc1cetmen's Office t `• C311c21th Department phone#: rJOther contact person: � t_ Information and Instructions Massachusetts General Laws chapter 152 section '_5 requires all employers to provide workers' etnnpensation for ;i employees. As quoted irom the "law-. an etnplt ree is defined as every person in the service of another under all,., contract of hire, express or implied. oral or written. An enzph rer is defined as an individual. partnership. association. corporation or other legal entity. or any two or me the foregoing cn�ua�=cd in a,joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tnistee of an individuate , partnership. association or other legal entity, employing employees. However 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, !: or oft the <_rounds or buiiding appurtenant thereto shall not because of such employment be deemed to be an empio% MGL chapter 152 section =5 also states that et-cry state or local licensing agency shall withhold the issuance or renewal of a license or hermit to operate a business or to construct buildings in the commonwealth for any :applicant who has not produced acceptable evidence of compliance with tite in 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 been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation attc supplying company names. address and phone numbers 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 tiie 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 "taw"or if you are requir: 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 the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P' be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returner unless other arrangements have been made. the Department by mail or FAX Tlie Office of Investigations would like to thank you in advance for you cooperation and should you have any questi please do not hesitate to -aive us a call. �.�.wr.-►�••.s�.v.�.sue-�-..�.. �.��..�nn.....•�.�. ... .. _ -*.�.�vw��•�..�•. 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 Nr: (617) 727-7749 ULFIN11101 Ul l'U6LI( '.'AlLif HOME IMPIRM01 AI RAC IOR CONSTRUCTION SUPERVISOR LICENSE Registration 110485 Nulber Expires: Birchdjtl.: Type — INDIVIDUAL Expiration. 10/20/98 Restricted To: IG STEVEN P MCILHENY GROVER & MCELHENY BUILDERS PO Cox 2t2 STEVEN P. McELHENY MOX 1058/523 MAIN ST COT011, H 0 635 ADMINISTRATOR LOTUIT MA 02635