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Home My WebLink About0194 BEARSE'S WAY I Epgiaeering Dept.(3rd floor) Map ;Parcel JV Permit# - 33 ,2 1 House# A Date Issued _ - 1 `T' / Board of Health 3raoor 8:15 -9:30~ 1:00 ��7 Fee l S I � Conservation Office(4th floor)(8:30-9:30/1:00 2:00) � L Planning Dept.(1st floor/School Admin. Bldg.) *MC 1ST EE Defin' ve n Approved by Planning Board �= 19 6-44sTALDANCETOWN OFBARNSTABL NVIR® DE AND Building Permit Application i TOWN REGULATIONS Project Street% ddress Village Owner Address i rTelephone Permit Request o J- F F a First Floor CZ square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection ` Lot Size Grandfathered Id Yes ❑No Dwelling Type: Single Family Two Family El Multi-Family(#units) Age of Existing Structure Historic House ❑Yes 2io On Old King's Highway ❑Yes ONO Basement Type: ,Full ❑Crawl ja Walkout ❑Other asement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) umber of Baths: Full: Existing New Half: Existing New o. of Bedrooms: Existing New Votal Room Count(not including baths): Existing New First Floor Room Count eat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other entral Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No arage: ❑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 , ,gUAg c,:�/ &1.4 4,/,c Telephone Number ] :2,=QLC. ! t�_ Address ��/9 License# ,,1'l A V,1-e ri 7—LA Home Improvement Contractor# /ZJs'plae 2�-S Worker's Compensation# 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 1 SIGNATURE at DATE BI.IJLDING PERMIT DENIA FOR THE FOLLOWING REASON(S) e �. FOR OFFICIAL USE ONLY-' PERMIT NO. DATE ISSUED MAP/PARCEL NO. = i _ ADDRESS VILLAGE i OWNER DATE OIj*, SPECTION:, 4 FOUNDATION _ FRAME { INSULATION FIREPLACE FINAL ELECTRICAL: , ROUGH _ n ELECTR , f PLUMBING: ROUGH • FINAL _ GAS: ROUGH == FINAL - r _ �a . .FINAL BUILDING . I.7 *. u.A DATE CLOSED OUT" W" � x _ Cr ASSOCIATION PLAN#N ._ rr _ i �0��iOlj�� =1�'ilIIY �,• _ �a �► ��' °fir ,. � tlllill _ �� :♦ ti. �n_�� .� '{`.Sri ��'�� `\ q V\ I • ' ems. �,, � �� ,�:��►�� i / `�� , ��►� ��, Imo, '�•�i. 1,`► ®,`'� •�cL;wr�, � �\�• � �a �� ,�� ♦ � �. � I � ►tea I � i`�'1\��.-� j �Sc� 7�4 r9• �i k t #x t 1'� X�G4lFw' R e� w r9- 3 arnn tj 1-4 o 0 u ;q �F;,° � �..fp"tom �r�.�� _ �C q� •+i P?r.�a��e I-N-� r" � -� - a`.x rn rn Z ruN e•► -t ji..,. K i ? = m .x t�i,�t c,F E'. _ .. zo <c m, a •o .-.• �o �, pie; I i o� 1 �r r c THE The Town of Barnstable SLAM rM1Z AM 1` Department of Health Safety and Environmental Services A'Fonwa't° Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 1Ralph Crossen Fax: 508-790-6230 Building Commissioner 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 thadfour dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other ZType require of Work: �f � Estimated Cost • : --Address of Work: �wner's Name: ate of Application: 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: 9�2 1,�P- Date Contra r Name Registration No. OR z Date Owner's Name q:forms:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents .^ ::::�'.. i �,� ::- - , _-.-_ � Office of/nrestigations - ' 600 Washington Street Boston,Mass.. 02111 Workers' Compensation Insurance Affidavit " location: ❑ I am as homeowner performing all work mvself I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers compensation for my employees working on this job. company name: address: city phone#: insurance co. olicv# I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the folloi.ving workers' compensation polices: com anv name: .address: city' phone insurance cm golicv# company name: address: city hone#: :..... olicv# insurance co. ' /// /%��% /// / Fafiure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a One up to s1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One 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 DIA for coverage verification. I do hereby certify under the pains and penal:��M the information provided above is tr 'end correct / Date 9,e _ Signature ✓ —�,,//�/ - Print name a AB2 �`f d �7` f>l`P Phone# ofIIcfal use only . do not write in this area to be completed by city or town official city or town: permit/license# ❑ wilding Department ❑Licensing Board Office ❑check if immediate response is required ❑Se alth Department rtmen ❑Health Departinent contact person: phone#; ❑Other (mvina 9/95 PJA) i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers 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 coritrac of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, coiporatiomor other legal entity, or any_two grsriore of the foregoing engaged in a joint enterprise, and including the legal representati ves;of a deceased employer; or the receiver . trustee of an,individual„ partnership, association or other legal entity', emplovuig employees. However the owner,of a dwelling house having not more than three apartments and who resides therein, orithe occupant of the dwelling of o....a,...� rn do maintenance , construction or repair work on such dwelling house or on the grounds o: aUULL1Gl YYllU wL&k—..a Y........... -- ... ....__ reto shall not because of such employment be deemed to be an emp building appurtenant the loyer. 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 ha 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. _ • ' ', , _ n ", gglmm IN IN 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 ed to the city or town that the application for the permit or license is date the affidavit. The affidavit should be return being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you , compensation policy, please call the Department at the number listed below. are required to obtain a workers' 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 referen r number. 'The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made number. 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 Deparmmt'-s address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0Mce of lovestlgadons - y 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 RESIDENTIAL ADDITIONS OR ALTERATIONS If located: North of<e6 work visible from outside- needs approval from OKH ❑ In H nnisible from outside- Check to see if it's included in the Hy, nnis rfront District-if so it needs approval from them APPLICATION PAC GE MUST INCLUDE: Map/parce number Sign-offs from: 0 He th Conservation(if exterior work) [ /Tax Collector 4 T asurer Stree ddress �wner's name& address ermit request- full description of proposed project quare footage-proposed project [�stimated project cost omplete Dwelling information for Assessor's Office —guilder's information ignature _ Plot plan 2 sets of reduced (8.5"x 11: or 8.5"x 14")plans with cross section& framing schedule Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name& Worker's Comp policy number El qtEnergy Compliance Form [Copy of Construction Supervisor's License & Home Improvement Specialist's License OR Homeowner's .E License Exemption Form. Fee NOTES: CHIMNEYS Need Home Improvement License No plot plan required PIERS & DOCKS ONeed Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMITS 1 Rev 8/12/98