HomeMy WebLinkAbout1443 MAIN STREET (COTUIT) � �
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"neering Dept. (3rd floor) Map _ 191 Parcel Permit# I
House# Date Issued 0YT
. Fee
oor - . /1:0 -
P oor c oo
47
- - 19 4
i BARMATABLE.
FeltAddr'ess
oMA95.Building Permit Application
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Village —
Owner Address 150 1,i9 VOA' OWvef�4W
Telephone O 6a1 7
Permit Request
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First Floor square feet Second Floor square feet
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 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
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
Central Air ❑Yes ❑No Fireplaces: Existing New 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 ❑No If yes, site plan review# -
Current Use Proposed Use
Builder Information
Name Telephone Number
Address 401 �f���`CP- License#
Home Improvement Contractor# q'7a�
D.p !r-*5 eit- JLpiseraAde- < Worker's Compensation# WC-- Rcl X
Z q-!2
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
SIGNA DATE G t��= 'G
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
I
R FOR OFFICIAL USE ONLY
PERMIT NO. . 9
DATE ISSUED.
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER : "r -
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION a
FIREPLACE -
i
ELECTRICAL: ROUGH FINAL a
PLUMBING: ROUGH !FINAL
GAS: ROUGH FINAL
FINAL'BUILDING
DATE CLOSED OUT
'ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
�. Officeo/Insestlgatlons
�� \ 'f' 600 11144thi wit Street
Boston.Alas. 02111
Workers' Compensation Insurance Affidavit
Appltcantinformation: PleasePR►NTle�11j ^••"' �
name:
location:
sit. T 1Et2.V lLL6—� '" Ltd bafoS S" rhnne#6.
O 1 am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
. ,�f / "T .. Y:7 'vw�lfi!�s+�!+;J.�i°!;,a'���R'!P.^••nwr �•.►r..+...�} •.x+._r...._...•..
1 am an emplrov'er�providing workers' compensation for my employees working on this job.
ontnariyname:
q
address: \
city: C—_ ST'Get ILZ.F, Pr 6oZL5'S nhonc#:CS'bg�yZ.Ss-1xic3
insurance co.WG1Q�C�•5 t��2.r`N5. Lib. Policy a
1 am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
comniny name•
address• '
cih•: Phone I!:
insitraner co. Pnlicv a
� .. .,r2'.::•+_ M•':^ .-1,.��....:'•. ....- .-- _tr••-�c�:�-�.��iT"I':tww:1' •--_Tq.2,�, __._...,�r.�u••:.5�...��..._.,. ..
comPan.• name:
. address•
rity• nhnne#:
insurance co, policy#
Attach additional sheet if net cisary�•',•._ _: __ r .; ,.�:.w:. �`r -^
Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal pcnalties ol•a line up to 51.500.00 andiur
oneyears'imprisonment as well 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
cope of this statement may be forwarded to the OMcc.of lm•cstigations ofthe D1A for coverage verification.
l do hereby certifl•under the pains and penalties of perjure•that the information provided above is true and correct.
Si M
gnature Data { ' 1IAtao-w St 1CLT7
Print name L•11✓ Phone# SoL 4ze— I7-143
oflicial use unh do not write in this area to be completed by gin or town official
city or town: "permit/license ii ' nBuilding Department
oLiccnsing Board
check if immediate response is required OSclectmen's Office
contact person: - phone#: MOlh Department
l'c'
I re.NaO J:I,I PtAI ". -
. - � �iEe -Poom�xon.�ealD( off(✓�,aaoaae�uaetla
D$PARTHENT Of PUBLIC SAFETY
'-' COpST&UGThl:AUPERVISOR LICENSE
luet Expires:
Resiste4�-77qdU WOOD
d 00
49 BLUE HERON DR
OSTERVILLE, HA 02655 '.
HOME IMPROVEMENT,CONTRACTOR
Registration 'I08144
Type INDIVIDUAL
Pir}ation 08/24/98 r
^y 4 5 Y� ' S 1 ���tltltl111
GUILE ROOD
4 `d
94ville ue Heron Dr. .
ADMINIS7pgipq Mp 02655 `
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