The URL can be used to link to this page

Home My WebLink About0091 COBBLESTONE ROAD (4 1 Cab blg Stbn, V, a ..)(--- • • • rt • • , • a 40 F .� F* 1. ! r v. t, A ^w. a v p 0 ^ • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION(, A�& 14 ` dlv l O dblAki Map Parcel _ Application # 1 ( �- 1-1 O Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 7S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address ! / de,6 /3 le Arm f) _ /J f}r^),I%A Ole i'kr / Village O ? o Owner 6 r7 T/2 i4nvi-S' a ,J Address 97 Co 012 Telephone (JZ ) Co O — 3 y 1- Permit Request OD , 1 , . °XT.- O fC:fJ pc'rrt C. OD 'ndS.A< k fk�T-1 6 A-l-c- c3/4„,4 U e &Al �� r- S(�ilk c r" . re L.v-�s J1 G PaSe `L OAF Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuation a 6 1 _ o&onstruction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0' 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 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: I Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use 00 r- ,r, c� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name JQe ' /( � Q'�-a b1--- Telephone Number(re)� ) Ct -6 13' (� 7 Address P 0• 'J OK (0 License # /0 01 --"? 2 I GON1c A 01"77 / Home Improvement Contractor# / 6 Email )l o e(e. J l l-7 Ct' cr /7 4�y�,cA . I ( av lWorker's Compensation # ( ?(-4.)C ac_ / v, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rtd c ��lnd.11l l /2-v r� .f � � Gl/, 6�c 0,, 044 SIGNATURE 11 DATE 3 C 3 b /(� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED • MAP/ PARCEL NO. ADDRESS VILLAGE OWNER • • ,DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts 1 -Mr-A. ` _ 1,, Department of Industrial Accidents 1'- 1 Congress Street, Suite 100 _:ij=_ Boston, MA 02114-2017 www.mass.gov/dia us- Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):RetroFit Insulation Address:PO Box 105 City/State/Zip:Seekonk, MA 02771 Phone#:.508-989-6436 Are you an employer?Check the appropriate box: Type of project(required): 1.�✓ I am a employer with 1 0 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOf repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other Weatherization 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:STAR Ins. Policy#or Self-ins.Lic.#:V9WC802160 Expiration Date:8/2/18 Job Site Address:91 Cobblestone Rd City/State/Zip:Barnstable, MA 02630 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the ' s and penalties of perjury that the information provided aove is true and correct Signature: 7 Date: - / ?b )( - Phone#:508-989-6436 Official use only. D of write in t s area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 1 Contact Person: Phone#: • 1 frA iyyq . ••arMr . . d... _"(am ' ,,4 W � Regulatory Services v � 0 . x.. r* 4F fi 1 :Y f Y i .Pau1 Ro11a .,p $ 4f' ✓ / Gs/ 4T .wg y^t 1 & $ate `S d^+ .S , ) tttiidlneeiimmiisioner *'a ( e . .f„ .,. F "• ;200 Maui StY eet, ka.Yn il VI. 0260p 1 ' ,L" a •-. R X^}'xA,- . b"j " ,:� town barnstable;ma p. 1 Dffice; 508 $62 403 . „ �38 a� f Fax 5084904230, - Property � ba Complete anal Sign Thus Se 4.ction;• �. f.: fir',._ s.,+ ? ;. ,t • a �� as w: . :. ;f< k- k3'k Mrs L. 1 1 Y 1G7:1 �7�n ) • 4:1 f,£ J' -„, ,. j, Vt g 0' '.'� I f4"Jf I aS Qvune ot t 5ll pep f I'. hereby authorize 0 C i r r� .Z.0 r 1,11 : ,,, to act on my behalf, in;:all:matters relative to.work authonzed by this building;perry t,applicatton foi k h, 'T "' s fi 91 Cobblestone Road Barnstable,MA 02b30. , i. �` if ix :; - ,. , ,. (Address of Job)` , • x 3 8% t i � : N ::kg,'*"- g t 4l J .-fie dam. �. �'; E Signs e Owne fr . = a pate , b rint Names 3 ;..i x 9 a sS,�k� •tx z r : k x e e z 4" yA • 3. ,gr `r` i . . y { . ',t t.,. . .• x«°�. 1 " .zap 7 ^ xE s^."� : .^a x �. i, �X `.,, 4 ,:' Tf Pra s$riy -—'" ''- ---- - g for peinn-t,p16ase complete the Homeowners L t tl a Exemption Form :: P • • kL d . ..• 1 jF 4 F'.a- x` '. ,ram' $ • Nsi°_ t.r :Z, e . - __ "k'�< s azi, �.. v� etCaheCcte�ttut1 � '�V. :. ra ',, .:"‘.."..7.•:. ''''\4:4,1: fl , - c BEY /"��9� 1�;.