HomeMy WebLinkAbout0447 LAKESIDE DRIVE WEST F— I te
�,MIX
X 4
Y I Ar
it
W
io,
Y7
E V,1, 1: Pi (i
A�t "i AM
41
6 4i
§_,jg g.4� "n
Nillff,,,q,,,�i,�:,.w
li, It 'AN
IV, Ufy�
Nii, 4,214 9 Y,��z,
'M N,"N'
1"'14 i�'TY'
.,W-" i�
Suck",
"04 CTA
ON N
wk VN,
6�
eq,*
20 4�4r[l
Ki A
Will
il
iV .... ....
ill,R ti
I'S .,,1 1
'TI N"I'.Mll N.
`Ri la
kv
v M
M iq
lip
IM,
�gja j.
All,
Ce�W
X,
re
"Noy
IF
Ay
6EN A
p"'o,g"I ; il IIAI�
gllg ��J� I IAO"Mir ��tg
Fy
11, 1� Of R, Ali
uo
-p
UR j-'k Rt'11
U IR
WIN, tl%i m
'i ny .,t
m�'Is7"WAt 'j?f rti" C Ul 441i
kk m
j,11 J,
pw
i'l U '4 ''t,
gl m,
i �i 'j, t
R-M� A A.1 'MA" �1,I�')5;
"Pe
UIN
ZM
A
.,It -wig kOW TV�,4 -m
m iqi
FIN.-
mwl"
V
it 114
if Tli It"i
pwj I q
JOR
"S (URY M i�
vp J F
aqmv -k�
1'4FD 0 1
P I awl T�"TA
t-11 ),f�ilt f-:�jj
TAR,
YOM
ASO j,
!t G)OP41
U11
Jf WA 11
IT 41131"
gm �w)
usion
p �t
jg"
AIR; 11, P-1 5W UP �Wl I
g,,gi tog, N� 11
"pan jyi!y�q
t ARNIN CO
P�
'K iT,
Mi _"On
xqv
S VT t
PA
t'l
i 1�A
ru� r k-11 iAlA,t� It it"I,, , " , , I; Iii 1�
ct
91"iN
�jrq�
Iifwl, I
tj Of WN 'Y. �,,, ` 4 1 i . I, .
w,lq
TH
;l� N,
q,
"VI1r,jq`j11el,,� l4�I,� �:I Oil'
At'
ttf&,�U, 1.31W
R7P ;j,
1107
Ak
q If
14�
If. 'w,%p
44, N;
1344Aji3.,`A0W4A4
.4m
k'y
vi4,
Al,I 'Ail I
i,7y
AAA
3W
f,;�"g
T"T",
'A �3,
An,
g Na
�)W'A U
a h'A' 19 Z.11
r
TOWN OF BARNSTABLE BUILDING PERMIT{APPLICATION
Map y7 31 Parcel O n k 4 Permit# `3`�
. . , i i
i'#eaft!-Dir� Date Issued (`{
'on FeeoZ, 9d g
Tax Colle �jLf/Q�
�Treasur • - � .
apt• � , y � ,
`Date Behr MVTPlan'Approved by Planning Board ✓ `
HjrAerte--•AKH P%iowa#tonfhMnis • ~
Project Street Address y y� L_A_KCS
.Village k.L_
Owner l� s.La `t Rig ST� or�TEi t�oS Address ` q"7 f-�4��Siy��2c✓� w
-Telephone08) —
Permit Request-1 w 1AJ 9owSckJ_Poo rZ' I_QL,E C_VMp1 1A+ >T LJ/gg6o,064�,
' W L•J o J,) &%-to-LE H-TTAC:if 6.D V=o t- A-C.L w, v,�s s o0 2 S
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .
Estimated Project Cost�q,630d0 Zoning District. Flood Plain Groundwater Overlay
Construction Type wOea-5,e,
Lot Size. �r 2- Af-kF-S Grandfathered: ❑Yes ❑No, If yes,attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)'
Age of Existing Structure" 2 S vr-S V Historic House: ❑Yes d No On Old King's Highway: ❑Yes (4 No
Basement Type: ❑Full ❑Crawl - J4 Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing ` 3 new: Half:'existing new
Number of Bedrooms: existing 3 new
E
Total Room Count(not including baths): existing new First Floor Room Count (�
Heat Type and Fuel: IdGas ❑Oil ❑Electric ❑Other
Central Air: Yes ❑No Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size PoolT❑existing ❑,new size Barn:❑existing ❑new 'size
Attached garage:❑existing ❑new size Shed:0 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 Telephone Number (5ce )
Address W6-e1_LGA DM OIL License# - 0 L O 14 Z�
tn/6-N4 , M^- 0 00( Home Improvement Contractor# 1 10g S2 •
Worker's Compensation# L(LA
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL•BE TAKEN TO '760 f J b t Spb�ff4 :S 17.-6
fi
SIGNATURE DATE
d - FOR OFFICIAL USE ONLY —.4r.,. •-
PERMIT NO.
, ppp 1 I _ _e ,
DATE ISSUED'
MAP/PARCEL NO. _ L t
ADDRESS v VILLAGE
OWNER ji"'
,.
` � i � •{[ T i T • { '�., �. r• it ` • ..
Y DATE OF INSPECTION.
FOUNDATION f 0 1 i t i
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL'
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL!
FINAL BUILDING t
DATE CLOSED OUT
ASSOCIATION PLAN NO. + '
9 es� Department of Health Safety and Environmental Services i
Building Division
367 Main Street,Hyannis MA 02601 '
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building'Commissione:
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: t ri�nc,J &, \�o op, ?Z E-P►--�iv\L,`rT Estimated Cost��,(0 0 0, Ob
Address of Work: `�'}"l I -•A-i<�S( OV D/z-L J t C.J 6,S I
Owner's Name: t-*�i=R(. E-_-L)C K4E TR uST f� -uy -r am o
Date of Application:4f q q
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
r]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. _
cs I oYa6
Date Contractor Name Registration No.
OR
Date Owner's Name
q:fomu:Affidav
+ Department of Industrial Accidents
office 01110estigatfaos
600 Washington Street
Boston,Mass 02111 `
nicaatarar3tla�tr // davit
%%///%/ % / 'satin "`&'Y'///n Insurance%%%%%%%/////% �//////�/////�/�/////////�/%/'�
name:
location:
city '`gym"���'�"^i M It- Q i ?C-1 phone 0 S—Q F 8
❑ I am a homeowner performing all work myself.
®,.;I am a sole�ronrietor and have no one warising in arty ca icily
❑ I am an employer providing tivorkers' compensation for my employees working on this job.
comnanv name:
address:
city: phone#:
insurance cn. 2011cy#
////////.%//////////////.11//.l%/////////////,���'/////(l!l///////////////'.G.IG!//.c'/////////.%//////.G%///,ll/�l�llll/✓//%// //.cG�/l//.l%//.�////// .r////.///i,.
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors Iisted below who
have
the follon'ing workers' compensation polices:
comnanv name•
address:
dtv phone#-... . ... ::.. . ;..v ".
msnrnnce ca. offim4.. :.:...
.l(/i�i/ri%G/.////.//i//i///,GG/.�////.d///////////////�////.11l�/��lGi•� !✓//i///////iGl/////i////////////G///,�/////.��///.:K6%�i/.W .%/,l/ � //ice ..
comnanv name:
address: ^^ .. . .. .
phone#'
inuurance co. :.:::.. .. oils,# :.... z•<.::.z "'-:=:`':•:•�.:•.. ^ <} ;'::: : ::=:c;<.,
.... ....:. �..W.:;tit•.r:::.: �.vxJ..•CO:{Ji};ti:....;..:::?:•i:: ..,.
Failure to secury coverage as required under Section 25A of MGL 152 can lead to the imposition oictiminai penalties of a due up to s1.s00.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a time of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of Investigations of the DU for coverage verideation.
1 do hereby ce • under the pains an a of perjuq that the information provided above is&zw andC,correa
signature Date
Print name �� �1` ([�C- Phone iJl �l� �'7�t �o
official use only do not write in this area to be completed by city or town official,
city or town: permitAlcense it QBuilding Department
OLlcensing Board
❑check if brbnediate response is required ❑Selectrmen's OMce
contact person: phone 0; av Department
Other
ltrnea 9,95 PJAI
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation forthei-
employees. As quoted from the "law", an employee is defined as every person in the service of another under anv cc=--:—
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 c.,
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec.,ve:
trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartmerrts and who resides therein, or the occupant of the dwelling house of
another who employs persons to do e, construction or repair work on such dwelling house or m the grounds c:
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 renew
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 returned 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 permit/license number which will be used as a reference number. The affidavits may be returned io
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 day 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
Me of Ieuestloatloes
600 Washington street
Boston;Ma. 02111
••• fax#: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
[r E c' i,. 'H�..,' '��..�C wEc•...• F+y_ yC i-2's zl .ham.-. -..
a _
WN
" �. .-� _ GTfie Vr ammw�zusea�i a��Z�aaacrc�iu:�
OEPARTlAENT OF PUBLIC SAFETY
CONS TRUCiIN\SUPERVISOR LICENSE
Nueb' Expires:
_ Re try e'd�t 00
F
ALAN`K-4I11'ER
i. FRAMINGHAM; MA 01701
r
i
k
HARVEY INDUSTRIES- INC.
Rv® 43EMERSONROAD/WALTHAM,MA02154 (617)899-3500, MANUFACTURING
ACKNOWLEDGEMENT
Quality Building Products for the Professional Contractor
* U 0 T A T I 0 N * * -
f
SANAL.Y.`7E PROPERTIES CO ., SANAI-Y7E P OP ?•1.1'E co :, neKa ; n'?9..
°15 T' BnSTnN F:nFID SLITTE 7 "1 `; BOSTON ROAD SUTTE 7 DATE 4frlT,�%
D PPAGE#
TSOI.IT1 6-0R0 MA n1.772 .:.1)000T`01.1T!-IR0R0 MA 7 f3) .1?r? .-2227 L,
O 07L)nTE
JOB i. SALES
NAME REP
,-CUSTOMER. CUSTOMER ORDERS SHIP,: PHONE `,,
' NUMBER'' P.O.#:_=' $YVIA ,' AFDER
QUANTITY COLOR PRODUCT i. F h DESCRIPTION
4IIITE 24 X 53 . CASEmENf./ANN %C
I T T .. Y
4H f ... ' r.1 17 ;F T n ?oI nn F,n 4 0^ ntl
CASEMENT L.ON...F C H G LIP TO 101 0 75 1,7•. 5C
$210 , �� -1-'420 , r0'
1 ,.!{IT.T{: X `,^ CAFAENT!{�NN!",1 i
t
. f
Q! r. T file f.t { r. rt- nn! n n t1 ct9 n ' tl !--I I)
FiSEMENT 1.n4! 'E CEIO LIP TO 101 17 , 90 17 . 50
(( 1 t 7 f
I .ir. r
'ASEMENT L.nu....0 Cl.{0• LIP T.n ._ 101 1 7 o :'tn 17 .510
1. 4{ITTE 7"7.....1 13 CA SE 11 T/A!4I'll/C
qt EXI — r
t -,q n S •t- n2 12n n cni.- c�tc
.A1.3EMENT L.CIO--E CHO UP TO 101 26 25 26 25
Yhf�al{k�iv e e $1)�k'db1Sd!(i a�ie2�n$nf�e(w�eXit1�3�IF{rldApiVXlNt}�l3$1fII SL�, lfu�iYT'Ifei t wup.!(�,is . T ! n7dti4 cNheag6 r F�I'j Jt r�' !•1 t'1 ti F�r'i•{ L! E
e -'pj %y IYing `� '9f z`py.�^P 4141 t'i!t ' t` ' 2 74 CN Y n R K it V C N'IJ
INer9 0}IhLse chsrom'pretlC�c1!immBt@lypon no171icBNon ofcMnplEtton••-'-'. ... *.
FRAMINGHAM , MA .t1.701 00010
HARVEY TNL LII.—J .. TEc' Tk1c
CUSTOMER SIGNATURE -
CUSTOMER COPY
HARVEY INDUSTRIES, INC.
RV® MANUFACTURING
43EMERSONROAD/WALTHAM,MA02154 (617)899-3500
ACKNOWLEDGEMENT
Quality Building Products for the Professional_Contractor
***** Q U O T A T I O N *****
SANAl,_YZE PROPERTl'ES CO , SANAL..Y 7 PROPERTIES CO:, ACKpr � . .t2�:..;
°1. 5 Et0STOT, FDAD SUTTE 7 ", iG` F()cTL1N E'. ?ADUTTC. ; oATE .. 4 05
D P PAGEt t
TSOUTI-1130RO ielA ;t772 ._n000TS0IJTH30Q0 14A t. '.1.72 47^ -.2227
0 - 0 UOTC
JOB SALES
NAME T`n IJ F REP. ' '1� if!. r!I•r NT Hf-p!4 ' -
CUSTOMERj' P.O.#CUSTOMER ORDERE,, SHIP,; PHONE'3
; NU.MBER' BY VIA rORDER
QUANTITY COLOR PRODUCT' ti DESCRIPTION ` t�4
2 14I41JE 21 t X 72 CASEiiEI�T ;AWN:I:.,J
HN T T EXTENDED
CASEMENT SPEC TEMP LIP TO 101 '11 „ r}0 61.11 00
? �14HTTE 24 X 72 CASEMENT/AWN/CO
Ilt .. rY TrMDFD
lat..l r I r• r rl ::, r{_ rr ` t c 111 ryr- .1n cf�
i'ASEmEAIT I. 00 4-- E CHG LIP TO 101 0 75 17e50
tl=2'7 0, 0Ct $41 6 e 00
9 �IIITE .7 3!T X 7'y ^i, : OI_I"O V,INYn PAT DOOP
!WTT EXTENDED
17WIT 1,T•t n r4 T p .p cric ci1 c nc. 5A
;0L. .t1TN 1-.AT DR WOOD HANDLE ^0 ,5t) 1 4.50
;Of S ? 'P1IL. "AT DF: . ADVANTAGE 1 t'1 a 7`; 1 275 . 75
.. . 1•7'713 . 2 $7 :,004 , 2c
ThiY�aEk f�veet}� ,ol{iidfi@l'�j(e'alna(niet<vd(e�ttt¢ Itr�r MA�VffNAN liSlY+l&S SINS' ld it(e.du? rY1>te
Z(eempg$, uy� . �� �� sr`hap;w r � `I ' Iq sgi i C i s t FR AT N r I Ii a P r' i r_I :..
rP 1 5Pr9E�2� nQ 9l°l"4� i'Yi`�?�''�IiSe'�n� y r),r.: 1; t'�v E r4!.)r
eh y o7 ttiese custom pr dOd4 me t y Cporc not icBN rc 11 Com eI& -
'('.AmTmGFIAm mA 01701 ...)000.
HF'tP', F.Y TNDjiSTRI-ESq 'I NC ,
CUSTOMER SIGNATURE -
CUSTOMER COPY Y
_ r...I_I S T 0 M E n PIls�rt!r. 140 _ !7,:I 7 7
A WE
a-eARVY HARVEY INDUSTRIES, INC. MANUFACTURING
® 43EMERSONROAD/WALTHAM,MA02154 rs»>e9e-3soo ACKNOWLEDGEMENT
Quality Building Products for the Professional Contractor .
***** Q U 0 T A T I 0' N *****
C rr nr t r ACK;#"
SA�dA1_.'�'► PROP _QTTF':, I:;il ,. sA�lALVZE . .�11; ,_•f, 'fT,:.�y I�I:] o �,. { 5 ._r�`�';9?.
0155 DWO TON, ROril) SLITTE 7 "15`I FOSTO�E ! OAL) SLITTC ?
D p PAGE#. ^t
7 i f3 0 1 1 Il '3 i n fit^' r S
T.`:;171_IT�-I�OF?Ll i¢A C)1. , f^ -t. Df�D T.., _ . T�i" �' M. ( : ., � :� ... •?'? ..
0 0 DOTE
JOB, SALES.
�-%NAME° 1� `REP.
CUSTOMER CUSTOMERJ[� ORDERS SHIP , PHONE
NUMBER P.O.f BY' VIA ORDER °
QUANTITY COLOR PRODUCT DESCRIPTION
r I fr, n I I ,
?n1 tCef!ent 1411;jt?w :t -iii'a1:?11 it 7 ('1 Mi.-?S ii�I'1Ll. :'t:t sw Mit.:.xt: ep 1 •±CI?lii 11tS ..!4711 j0'4S yhlued
PIJF - - a
•r T In n ( r ; r r •rrr 1- rr•-r•. W 1,11 I I
E^ , ^1; : E'?, r`� IEId';;Tll' '3 Yea??:? TIIT'f�I...�ia '1NT? S:-`1'T.FT'1ATTON SHOULD BE
EPTETE ) AV THE CnNIRgrfnR PRIOR 10 HIS /HER BIDDING OR ORDERING OF MATERIALS -
5r r+ ; r+ r;•r+ r r rIr r ir�40U,;T� T _.•., T"N'C, 11' R,- F`O7-,M'BL__ 0.1'41...,' :' OR THE TT ''S W. t�Ll0T1: ? A�=DV+:.I r• n rl Il r !�1 •p ;,� 0• r r n t! E I r•r T pJlppj ,
HC iriAT r' 1.A1._S 'IS D SCR1'e..ED 1000E r; .IP;1 C TO T'1I C T7.R,m^ .a?!0 C0N'0 . 1•10?4S An
,r r+' it j17 5 1 T 11r-2/+r > r -r+ ^ {fir n�! rr r 90 i0 r
HE OAT -- OFT�'i : Q.lJOTA•rTON :, !fit lad' ?rr.Tia'tr: T�..�1- Or,r,R,''ru,,41'TY TO QUOTE TE-ITC JOB
1 a 1 1 n x I f` n; r•/• �+r• I t! 1 I 14 f 1-,r.1!11 11 4-• ;
Xh!X?k!ti 6*!+Sit. !Sb�l +lte.Aln4h!'�+�w�e it}g gl(�r..Ali 1?t1 16'Skl ..'6,.4 .�i�7Ef4TKe. ..
sB�lIer,}s reg�q s�e�iQ�1Qr��T}�(uf�`c���Vur� �,�g �e c�stgm pr act tQ.t ea I
:2g/keTne 1 w tt�ykr�r rz2Ur1 D1@� a �pp?ode a ese�p ll� o a�` .�?t` �'� r rI n vi:r ra G I-;A V, W1 REHOUSE .
a�i I ai qp qy r c i t sp f t t n r!I r N 1 r 11 r- -
i}e!;erj o se cuelom`pro cPs;mmle rely upon ho f anon bh ornp etwrr. - -
HAPVE:V TtlDLISTF:. FS , Tt-11C
CUSTOMER SIGNATURE -
CUSTOMER COPY"
—_i-1_ r+ i r;_;�r r, In_i_1 n m r _to i7 t q?0 1 •I ry
g Date Issued
Board of Healtb(3rd floor)(8:13-9:30/1:00-4:M /j/6197 '� Fee-, 2 d d'61
Conservation Offiar(4ih floor)(8:50;0,9:3011:00 i;2:00)
Planning Dept.(lot floor/Sobool Admin.Bldg.)
Definitive Plan Approved by Pleasing Board 19
rNa
TOWN OY BARNSTA BLE
BandWg hr *Applkation
Projsa Street Address LAicr_::S w re U2c
Village t LLB - -
Owner Low Address �( tEsi�G D�ZI ✓�%��ST
Telephone
Permit Rcgtttst 1 NZZ
First Floor square feet SeooW Floor square fee-
Construction Type
Estimated Ned Cott on oo
Zoning District Flood plain Water Protection
Lot.Sin Or atherod D Yes 0 No
Dwelling Type: Single Family Bf Two Family Q Multi-Family(N units).
Age of Existing Structure Historic House U Yes QNo On Old Kings Highway O Yes Q Nc
Basement Type: Q Full Q Crawl la Walkout Q 01ber
Basement Finished Area(sq-ft.) Basement Unfinished Area(sq-ft)
Number of Baths: Full: Existing New Half: Existing Now
No.of Bedrooms: Existing New
Tbtal Room Count(not including baths):Existing Now First Floor Room Count
Heat Type and Fuel: G10as DOB Q Electfic D 0thsr
Central Air Q Yes Q No Fireplaou:Existing_New ..r.�__ Existing wood/coal stove Q Yes O N(
Garage: Q Detached(size) Other Detached Structures: Q Pool(size)
Q Attached(size) Q Barn(size)
None Q Shed(size)
Q Other(size)
Zoning Board of Appeals Authorization Q Appeal#i Recorded Q
Commercial Q Yes a No If yes,site plan review N
Current Use Proposed Use
Builder Intormatim
Name I-►W M ILLE Tslephone Number S00_2 -50al-I
Address 5,4Pv6-6t-t CA D rz i J& License k CS O 1( `f 2(y'
AzM1„96 M�k C�i'>�f Home Improvement Contractor# I INS 2
Workees Compensation N
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL A
PROPOSED STRUCTURES ON THE WE
ALL CONSTRUCTION DEBRIS RESULMNO FROM THIS PROJECT WILL BE TAKEN TO
® F CAfk 6AMOP-A L,)A-SDr� :mac.
SIGNATURE DATE •/�(,A 7
BUU.DINO PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERM[f NO.
DAZE ISSUED
MAP 1 PARCEL NO. _
VILLAGEADDRESS
=
'.
O*NF1t
- D.JfIB 0 F.IIWS�VPECT[Oi�I; _ 4
FRAME
�,.
FIiM ACE \
EMCIRICAL: ROUGH ` : FINAL-
_ ROUGH FINAL _
GAS:-* ROUGH FINAL.
FML BUILDING
D AM CLA)M OUT
Ak*CM ION PLAN NO. `
10115./1997 10:34 5087750992 MARSHALL M DRANETZ . .' PAGE 03
� The Town of Barnstable
NAMDepartment of Health Safety and Environmentalervices
Building Divbion
367 Main SUM Hyaaaia MA M601
Raiph CtvMM
Office: 508-790-=7 Building CGMILr
Fax: 508-190-MO
For ottlee use only
Permit no.
Date AFFIDAVIT r
HOME IMROVEMENT CONTRACTOR LAW x
=pLEMENT TO P>'1 drr APPLICATION
MGL c. 142A requires that the "reconxtrucdon, alterations. renovation, repair, modtrnisndon.
conversion, Improvement, removal, demolition,one construction
is a t morof anA�ura to any
units owner occupied building cout2ining at less
structures which arc adjacent to such residence or building be done by registered contractors+ With
certain exceptions,along witb,ather requirameats.
00
Type of Work:
� 2�0 SInJ Fit,cast
Address ofwor*:
Owner's Name
pate of Permit Application:
t hereby certify that:r'
Registration is not required for the following re on(s):
Work euluded by law
___.Job under$19ML
-� Buiwag not"Me"eenpied
�_Owaar palling o"Pa'mi#
Notice is hereby given that:
OWNERS PULLING 'Ism OWN PERhIIT OR DEALING W;TH UNREGISTERED
CONTRACTORS FOR APFL I ABLE HOME MOROVEMEN'T WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 14ZA.
SIGNED (11vDEi1 PENALTIES OF PEltJt y ;
I hereby apply for a permit sur the agent ai'the ownes:
�cL Daa >� Y� P � - � � I IDS 5.��
don NO.
Data
Contractor Name
10/15/1997 10:34 5087750992 MARSHALL M DRANETZ PAGE 84
ne Commonwealth of Alasuchwettt
Oc�porrntctit of&ALTIF&I A inci ernes
.! 0llflc�ollaj+l�sttl�tlOas
dull If=, kington Street
4 + Bttetatr.hf".V 112111
%a.dito Worl:ws' Compensation Wuurance Affidavit
Iecatiam s N- I
Q 1 ant a homeowner perfonnin all work:miselt
•
l am a sole proprietor and have no one working in am capacity
tR�1 PAP �
.�`�. .�-«�—.�-w��.....w..�Mww■^w.,�ww�..ww+ .r-..r.-.r■w..-Srww.^-.=_�.
Q 1 am an employer providing workers' compensation.for my employees working on this job. �
r�nanl•nnntrr w
addre•�r ,
rites .� �... ohnne tM• .,__��
in�rrranrr rn. nnliry M
«.
Ci I am a sole proprietor. general contractor.or homeowner(circle o#V and have hired the contractors listed below who h:
the.following workers' compensation policts:
rmm�sm' name• ���.�� ' .�.. �+----■�■
ad�irr..• _ -
city• � nhnrt Mr � „�,i�,
Ina MDrr M. ' n_ 119 _ .•-......•.,...�.,�.�......
� rr a ry :•+. �rd•.•t^..� w!'r1r�. r.ti :- �.yr��`t���r tT"�'1�w+N4�T •ww �.i't��.
.w __.. . . ._r..�....... .d.r�r+.Mw.wrrrrw�r+�.�r.•�+.i• -•1�.�AY■rui - ■4�.rr�
ennmsnv rimr•
atltlrr�e•
nitnan too
•
S�s••��nr0 re Rai n•r -
Attach additional sheet irnect arY.:: .:. •ice., , .•,:r:�•.• .»+• _- _.,.... ..... -.�.:.-.L.. ,...... S �..
F;durc 1u>,ecure cu.er' at:c As regwrcd under Session:SA of NIGL 15-9 can lead to the imposition of cnmtaal penttltin ci's line vp to$1.500A l attd/u
war%seers iro B pranment rs well as civil penalties in the form of a STOP WORKORDER and a line of Sid0.00 a day spinal
r. 1 ttedtritaad that
rep;•of ibis statentrm mat bt funrarded to the Ol ice of lavcttiaations of 1be DIA fee tevenRe rttrilicatioe.
'do herrht•ccrrif doo,die p fists and penalties of prrjs##v that rile infonwrion prorided above ir rnre wed comes
Print name IwO_ /`''"�`�- � _..,— ..r__..,�%one N
eAkial ism only do not write in Ibis mrML to be tastopieled by th'W IWO WU'11l
div or town- ptmaidllreose N rttluiidlna J)"Mrttnent
• p1.lcantlog guard
0 check if immediate response is required asek"mco's(M{cr
. plltattb Dctwremet►t
contact pentlar - phone M:.`�,�_ww"_�Ulblr�,..��
e.
J