HomeMy WebLinkAbout0048 SHORT BEACH ROAD 7-7 �� L
F r
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Parcel Permit#
Health Division Date Issued
Conservation Division Fee 41 s— d a
Tax Collector /3a�.��� eel
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
_-
Project Street Address
Village
Owner, \1\1 Y\ P h Address '
Telephone 95
Permit Request !i�s
_f
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ' Total new
Estimated Project Cost 0-08 0,6 0 Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family a Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl O 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:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑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 \^n P y_ 1A 6Z<,� Telephone Number 9 'act L 9\ y
Address .� ice a A 3� C License#
e�n� Yy1 Home Improvement Contractor# a keti qz
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,5�Ab� Y1
SIGNATURE DATE 3-30-00
FOR OFFICIAL USE ONLY
NO.
DATE'ISSUED •. -
4 MAP/PARCEL NO. ,
S
ADDRESS VILLAGE
OWNER • r
DATE OF INSPECTIf
FOUNDATION
FRAME :-
INSULATION
FIREPLACE
r
ELECTRICAL: ROUGH FINAL i
?r PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL '
FINAL BUILDING
DATE CLOSED OUTj �
ASSOCIATION PLAN NO.
n '
the C,ommonweaun ui inusautajuat:cLa
_
a -- =! Department of Industrial Accidents
' -=� �-, :� OfffCr Of/OYBSlig8llOOS
" — 600 Washington Street
Boston,Mass 02111
Workers' Com ensation Insurance davit
name
location ���� \� 1 t 4
city
��n� phone#
❑ I am a homeowner performing all work myself.
0—I am a sole vroprietor and have no one worlds in anv achy
goll
I am an employer residing workers' compensation for my employ=.working on this job.::::
com anv name:
address.
;nne...:...........
......
.
insurnnce co: ....
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the c on=ctors listed below who
have
the following workers' compensation olices:
e: .
com anynam
`aye s s.
ad
:.;
•::nhon
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insurance co::..
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address:.
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Fallare to secure coverage as required mtder Section 25A of MGL 152 can lead to the imPositl°n of aimioal penalties of a thu up to 51,500.00 and/or
one yeah'imprisonmeat as weII a'dull penalties in the form of a STOP WORK ORDER sad a flne�of 3�10oa00 a day agaiatt ma I uaderstsnd that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for t�verag -
I do hereby certify under the aims pen Perjury that the infonnadon provided above is tru-and turfed
signature
Print name vn fl u A Q N(A Phase# '-f a8 b a 1 b
official use only do not write in this area to be completed by city or town offldal
city or town: penny icense# ❑Buffding Department
LJLicensing Boerd
❑check if immediate response is required ❑Selectmen's Office
_ ❑Health Department
contact person• phone#: ���
(tenser 9/95 P1A)
�TMe rqy�
The Town of Barnstable
, AM Department of Health Safe and Environmental Services
0
5
o16 Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME EWPROVEMENT 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: -C p Estimated Cost a 8 a 0
Address of Work: Li r6 C 1
Owner's Name: `f\ Q, C P n A j A r'
Date of Application: —� —
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded bylaw
❑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 5TROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF P RJURY
I hereby apply for a permit as the agent of the own
Date Contractor Pame Registration No.
OR
Date Owner's Name
q:forms:Affidav
s
HOME IMPROVEMENT CONTRVT'�^
Registraticn 1264g
Type, - INOTVTOU!�I.
ExPirat cn 06!^R 00
MARK HERBST
MARK D. HER8ST
VALON CIRCLE
aoMiNisrRaToa OSTERVILLE MA 02655