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Home My WebLink About0950 FALMOUTH ROAD/RTE 28 3> � L*ngineenng Dept.(3rd floor) Map `off S Q Parcel 031 Permit# j House#' 950 � Date Issued Y ;A 3ear-d of Heal4h (3rd floor)(8:15 - 9:30/,1:00-4:30) Fee- �2 S' e(4th floor)(8:30-9:30/ 1:00-2:00) wing Dept (1st floor/School Admin. Bldg.) ' THE rq Deft i e D' pproved by Planning Board `- - 19 . .e BARNSTABLE. i ' MASS TOWN OF BARNSTABLE 'F°""i'� Building Permit Application f Project Street Address 96'0 F�9kMuv r)i D2t)�9 is Village ffi&A"IV) Owner 12ar NJ'o .3 si 61 C Hou 'lJy��IjL,�� ,��. Address .I'y&,. &oul'h S`Ynee-T lj�em we Telephone To F -7 7 7? -2 Permit Request noul;J 5, ' alsoa.�y cT.A..b fk%ILIA�� Aon.d,a ly J'R , First Floor - square feet Second Floor square feet r � Construction Type - Estimated Project Cost $ g y O .00 Zoning District Flood Plain Water Protection Lot Size o 3 y Grandfathered ❑Yes ❑No 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 1 New Half: Existing i New No.of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes --UNo Fireplaces: Existing New Existing wood/coal stove ❑Yes -gNo Garage: ❑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 'dNo If yes, site plan review# Current Use IU s\-D,�Aj vc,qti Proposed Use V-e,r,.p if r, vi t. Builder Information Name Zw" N n P(i ll I. £•�I��'�+�'� t3.l� Telephone Number -7 Address 1'L License# ® /1 0 3 9' �MEw r a'f V,, PIA Home Improvement Contractor# Worker's Compensation# &j 10 Z 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 BETAKEN TO 6i 1 > I SIGNATURE � ., DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ` - - FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED. - ` MAP/PARCEL NO. I t • i = '' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION { FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' - GAS:- ROUGH FINAL " FINAL BUILDING t + DATE CLOSED OUT f . ASSOCIATION PLAN NO. Restricted To: M 3 80 - 35,800 cf enclosed space r: DEPARTMENT OF PUBLIC SAFETY lA - Masonry only r' '�� CONSTRUCTION SUPERVISOR LICENSE 16 - 1 6 2 family Homes failure to possess a current edition of the ,,. Number: Expires: is cause for revocation of this license. Restricted To: BB C-gjU/BRIAN D HARRISON 12 LELAND ROAD BREWSTER, MA 02631 The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 , Ralph Ctassen Fax: 508-790-6230 Building Commissic 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 exceptions,along with other requirements Type of Work: ?LIE "vE,N4 Est.Cost Address of Wont: JR-6 4;! Owner's Namec�ti�s4�bl� Date of Permit Application: I hereby certify that: Registration is not required for the following reasou(s): Work excluded by law Job under SI,000. __uilding not owner-occupied _,_Owner pulling own permit Notice is hereby given that: _ GISTERED OWNERS . PULLING R THEIR HOME IMPROVEMENT WORK DO NO CONTRACTORS FO 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. Anini!'04-0 Date Contractor Name Registration No. �r T/tr Cuttt»tottivealtlt of:ltassachusctn Department of luduvrial.9 ccidenn ` Offfccaflayestlga11ans . rG •�\�=l i.. __� 600 11 ashingiorr Street Bovwn.Marv. (12111 w. .V Worken' Compensation Insurance Afridavit Allpli mntinforniation•' Ml T PRM7led'ily nunr e IOC'fil(ln' rift• nhnnc Z I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity _ I ant'an mpiover providing workers compensation for my employees`working on this job. cnntnlnvnarne- Ili&r-NrTmbAC HnV.rtN-c uitlrcca• ��b t�Ov'�1� t]�sai•' city 1"f VA AIWl A ' A nhnnc N! c �}� `ice !�. li C�l�fJil �+Ryr� nnlir, # G p ® in nr-tnce�n 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below Who h2% the following workers' compensation polices: cmmclnv nitne- 1dtlrrcc cit— nhnnc ir• incnr^ncr rn entnnlnv nlmr• ldtlrrcc• trey• nhnnc f+• incnr-tnce cn nniie�• _ __ Attach additional sheet if neceiiity_ 7 7777 v=. +.�••v_ .iYr2••-�" ;.iwya�+�. Fnrlurc to secure coverarc as required under Section 25A of AWL 152 can lead to the imposition of enmtnal penalties of a line up to S1.500.00 andiur unc cars' imprisonment as W01 :ts civil penalties in the form of a STOP IVORK ORDER and a fine of S100.00 a day against me. I understand that n copy of this stacerncut ma. be fur.varded to the Office of Im•estigntions of the DIA for coverage Verification. l do herehr cerrift•uutler the paints and penalties of pctiuly that the information prorided above is true and correct. Si^..^.aturc Ia �Ceew✓t,� Date a' Print name Phone# `2x-X 7 w - ' official use univ do not write in this area to be completed.by city or town official city or tmvn permit/licensc rY r-Itluilding Department ❑Liccnsin;:13urrd [• S i 0cheer:if imrnediatc response is required ❑ •electmen's Office tt ❑1lc2ith Department L contact person: phone#: r'tUthcr i Information and Instructions Massachusetts General Liws chapter 152 section 25 requires all employers to provide workers• compeltsatioll for ;. employees. As quoted irom the "la\V_- In emplitree is defined as every person in the service of ancrthcr under am contract of hire, express or implied. oral or written. An rmplt rer is defined as an individual. partnership. association, corporation or other legal entity. or an}, twe) or ,r, the foregoing cnga_ed in a joint enterprise. and including the legal representatives of a deceased employer. or the receiver or tnistee of an individual . partnership. association"or other legal entity, employing employees. However owner of a dwelling house hawing 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 or on the __,rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio., MGL chapter 152 section 25 also states that even-state or local licensing agency shall withhold the issuance of r,f:r license or permit to operate a business or to construct buildings in the contmonivealth for any icant who has not Produced acceptable evidence of compliance with the insurance coverage required. Adc::ionalIv. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perforn=,,ce of public work,untiI acceptable evidence of compliance with the insurance requirements of this cttapte- been presented to the contracting authority. .applicants Pease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation anc supplying company names. address and phone numbers as all affidavits may be submitted to the Department of industrial .-accidents for contirrnation of insurance coverage. Also be sure to sign and date the affidavit. The iawit should be returned to the girt or town that the application for the permit or license is being requested. I tdustrial Accidents. Should you have any questions regarding the "law- or if you are require n ;he Department of Industrial - 0 obtain a workers* cornperlsation 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 the at=ldavit for you to J-111 out in the event the Office of Investigations has to contact you re`arding the applicant. Pl:. be : to fill in the permit/license number which will be used as a reference number. The affidavits may be returnee .ne Department by mail or FAX unless other arrangements have been made. The Office of Investiarations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to _ulye us a czll. ...�..._._ ...--._-..,.-.. ...._...,,�...+-....ems.... .. .. . ._. _-._ .. ... .. _ _ - _- •-'�b^-., ...:i' Tile Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents kr. Office of Investigations - 600 Washington Street Boston,Ma. 02111 fax 1: (617) 727-7749 phone =i: (617 727-4900 est. 406. 409 or 3%5 a r Restricted To: of - BB - 35,888 cf enclosed space DEPARTMENT OF PUBLIC SAFETY 1R - Masonry only • CONSTRUCTION SUPERVISOR LICENSE IG - 1 6 2 Family Homes �; Number: Expires: is cause for revocation of this license. Restricted To: Be (rrv,,,BRIAN D HARRISON 12 LELAND ROAD BREWSTER, NA 82631