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HomeMy WebLinkAbout0044 WATERFORD DRIVE � W ���, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map OS ( Parcel a Health Division r� © - Date.Issued Conservation Division/7yQ Or S�.�d P�r•K�t ` �`' Application Fee Tax Collector d Permit-Fee— Tax t�0 �lq Treasurer ° SEPTIC SVSTEM "LIST BE Planning Dept. INSTALLED IANCE Date Definitive Plan Approved by Planning Board ENVIRONNK-o`i: AND Historic-OKH. Preservation/Hyannis TOWN REGUuA i iUiUS Project Street Address �— Village k_o."4-4-,�� Owner E�AY C-4 �•-�v u, G/lo.,C_A1 Address 75m im-c Telephone Permit Request (AC-1 Ao k—Lc4-- CA Square feet: 1st floor: existing proposed ­79, 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1500 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: 0 Yes ❑No Basement Type: ❑Full O 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:O existing 0 new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes Q No If yes,site plan review# Current Use Proposed Use n // ,,,, ll ` BUILDER INFORMATION Name CIU I \r^ 1n,1 i w% G i�n�✓l Telephone Number S—OS 9,3L — 1303 Address S4 pp License# Oa/q/ IVA Home Improvement Contractor# ' Worker's Compensation# (f lyq 0Q6U_?, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO a SIGNATURE ATE (5 0 FOR OFFICIAL USE ONLY PEkMIT NO. I DATE ISSUED _. MAP/PARCEL NO. r' ADDRESS VILLAGE i OWNER DATE OF INSPECTION: FOUNDATION - FRAME ~ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH":"' FINAL , GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT" 3. Y r., r ASSOCIATION PLAN NO. f Town of Barnstable °^ Regulatory Services HARNSrABLE, " Thomas F.Geiler,Director 9`bArE039, 6. Y Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. Estimated Cost ! d Type of Work: � s 1 Id�'C� Address of Work: �"'K `r ✓� . 7-V� Owner's Name: 1�aAc r-,i Date of Application: CST ©T I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: .f , Date Contractor Name Registration No. OR Date Owner's Name Q:formsihomeaffidav The Commonwealth-of Massachusetts Department of Industrial Accidents of lnv~Aff$ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit-General Businesses r cur raiiair . , , . , , MIN/ jeAAAA 1/19G� name: address: City Is% � LI!1ti state: MA t A zip:0Q-6VY—nhone# S-S ad- —I P3 work site location(full address): ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. p ) ❑Office❑ Sales(including Real Estate,Autos etc.) ❑ %% %er %/ Othe %%%%/%%%O/G%%%//%a//r//t/%%%/%%/O%%//❑///�%�/%% [� I am an employer providing workers' compensation for my employees worldng on this job. company name: address: ..:. city phone# instrance.co:: < I am a sole proprietor and have hired the independent contractors listed below who have the following workers'. compensation polices: company name girls address' city: phone .; insurance co. ° + 'olic' # combany name:: aaaress� . Insurance co. <. olicv# Faflure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civilpenalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DlAfor coverage verification. I do hereby certify un er pains a e ai 1 of hat th information provided.above is true.and orrect Signature Date Print name W i i k re YV� L 1 i,1MalJ��cl�L� Phone# .i O <E� S''�� 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 E; contact person: phone#; ❑Other K? IL (revised Sept 2003) - - 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 corrmonwealth 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. Please supply company name, 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 pernrit 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. T"ne 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 to 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 WIN ofImstlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 I �tME r Town of Barnstable ti Regulatory Services BAPN"nai E,MAM • Thomas F.Geiler,Director F1639. 6 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,T�4w_ �� &1)N4E7LL— ,as Owner of the subject property hereby authorize �AA Lt- ' to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) ignature of Owner Date Print Name QTORM&OWNERPERMISSION r- 72, el Board of Building Regulations and Standards HOME I MPROVEMENT CONTRACTOR Registj'?-i`olug ar 1 z /2�1/2006 WILLIAM LIIMAT �j WILLIAM LIIMA , 541 FLINTST ,t"b MARSTONS MILLS,MA 02648 `` "� Administrator .. 4 fTA;i ........_�_......-�_�_.�a�w•�_•-..�..e�..._a..a.v'3)i.s'S'3✓a.__.::LT - _ .,� r ✓fxean�xeon`svecrllf a�� aaaaclua�I4.. rt 1 � a,� �O G n L + "3 Nu 1$ 001°4�14 I ' F 05, r;no: .14561 Res �"•..�.�, ✓,- ' -- ; fl WILLIAM ' � 541 FLIINT S�' ��•.a.�-•� �` �i ':_� '� ' MARS'1 ONE IUUIUS I1i1' 2fi4;8 pip in!stralor f i A6 a 0 1s eC.- . cqv J I �_ Town of Barnstable p1NE�� Regulatory Services Thomas F.Geiler,Director MQWSTABM 9 MASS. Building Division s639. �0 ArEo Tom Per , uilding Commissio 200 ain S e 's,MA 02601 .town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMT# �`/�fQ� E: $ SHED REGIS ION 120 s eet or less CIA Location of shed(address) Village ?eAC �. � wA-s-A,� Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? l Old King's Highway Historic District Commission jurisdiction? c G� Conservation Commission(signature is required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN . 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