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Home My WebLink About0800 BEARSE'S WAY (56) �� s ��-y _ � o 6/ 081 7t1f61a6;W r r) Map Parcel O 61 Permit#- 3/ 6 Z .4: House#,• rw Date Issued Board of Health(3rd floor)(8:15 9:30/1:00- Fee 0 0 ` Conservation Office(4th floor)(8:30-9:30/1:00-2:04, Planning Dept.(1st floor/School Admin.Bldg.) tllE►p,•_ lilect Plan Approved by Planning Board 19 BARNSTABLE• MASSTOWN OF BARNSTABLE Building Permit Application eet Address b c� �• Village '� r Owner �, c Address O �' s�, Telephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District lood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No r Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: ExistingNew Half: Existing New g No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of A peals Authorization ❑ Appeal# Recorded❑ Commercial Yes ❑No If yes, site plan review# r Current Use Proposed Use Builder Information Name�'� 1/t-� � C� t ( Telephone Number -] -7 S — -2 7 Address O ] License# (.rr }-7� k o a6('f Home Improvement Contractor# Worker's Compensation# TO cy ��7 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 SIGNATURE i DATE BUILDING PERMIT Dff ED FOR THE FOLLOWING REASON(S) A. ,- • r , ' FOR OFFICIAL USE ONLY .,PERMIT NO. DATE ISSUED t MAP/PARCEL NO. ADDRESS — -.+ t VILLAGE OWNER DATE OF INSPECTION: p _ f L t i FOUNDATION FRAME _< " •''i. t INSULATION FIREPLACE — — ELECTRICAL: ' ROUGH FINAL t PLUMBING: ROUGH FINAL - t • t GAS: ROUGH FINAL t F FINAL'BUILDING L s DATE CLOSED OUT, - ASSOCIATION PLAN NO. ' The Town of Barnstable . .. : 9 19AWL Department of Health Safety and Environmental Services ` r1079. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioae For office use only 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 cxccptions,along with other requirements. Type of Work: t' � � Est. Cost o Address of Work: 5-�00 r3 Owner's Name Date of Permit Application: 7Z� I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,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 ofthe owner- 9l Da Contractor Name Registration No. OR Date Owner's Name ..r The Commonwealth of Massachusetts Jrl �l'� Department of Industrial Accidents _- Office 0"HIVOSMS&VOS 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insu�ratGn/ceAffidavit iiaiiiiinr�r�r�r rr ri ri sill, Wwwww��/m/m name�I t��t L C� I location �� /�"�' ,c-�''� city big t�}✓l/l_i S phone# � � 7 ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I alit an emplover providing workers' compensation for my employees working on this job. campnnv name: address y l city C✓ �.�i � j.� t/k r� phone insurance cn. V �� olicv# �kO ❑ I am a sole proprietor, general contractor, or homeowner(circle one and have hired the contractors listed below who have the following workers' compensation polices: company name- address: phone# ity c ...... insurnnce ca. company name: address: city phone olicv insurance co # /// Failure to secure coverage as required under Section 15A of MGL 151 can lead to the imposition of criminal penalties of a Me up to S1,500.00 and/or one years'pnproonment as well&3 civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the pains and pea m that'-the-injormation provided above is tru*, d eorred Date Signature Print name•T L Phone# C official use only do not write in this area to be completed by city or town official or town: permit/license 0 ❑Building Department d ty ❑Ltcensmg Board response is required (:]Selectmen's Office check iflmmediatetesp 4 ❑Health Department contact person: phone#; ClOther�� ........ !mvaea 9:93 PIA) 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 c 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 renewf 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 peimit/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 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 Office of Imlesugations 600 Washington Street '" Boston,Ma. 02111 fax#: (617) 727-7749 ;.. phone#: (617) 727-4900 ext. 406, 409 or 375 RE-ROOFING If located in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application Map/parcel number .� Sign-offs from Tax Collector J #of squares of shingles or square footage of roof to be shingled specify stripping old shingles or going over old roof. / If going over how many roof layers existing now what size are rafters? What is span? Complete dwelling information for the Assessor's Dept.-if known Workerman's Comp. form Home Improvement Contractor Affidavit(RESIDENTIAL ONLY) Home Improvement Contractor's License OR Homeowner's License Exemption(RESIDENTIAL ONLY) COMMERCIAL WORK-No License is required. Fee / q-forms-PERMITS 1 Rev 2/10/98