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Home My WebLink About0063 GARDEN LANE �� ' \ _ ,yQ �_, ��/V � � / � �� - f rT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel C9"?S` 0 Permit# 7J Health Division Date Issued Conservation Division Fee_ Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board :Historic--OKH Preservation/Hyannis Project Street Address N n. Village P AI r L!h i 1` Owner _,)�� CZ Amp- Address CCU ��6R &i Al-- I CIO Telephone Permit Request �! IC y� Square feet: 1st/floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes; attach supporting documentation. Dwelling Type: Single Family 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 1�%sement 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 0 Electric ❑Other s Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn:0 existing ❑new size Attached garage:❑existing 0 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 � yr �,�R T o / (��.s r�c ��%�yl� I phone Number 7 �4 7/ (� Address License# �Z " C) �4 C 14 f 4 Home Improvement Contractor# Y V Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE — /-- mac'ao FOR OFFICIAL USE ONLY w PERMIT NO. DATE ISSUED _ 02 MAP/PARCEL NO. a — ADDRESS ` VILLAGE; _ OWNER � :, � • DATE OF INSPECTION-1j . FOUNDATION • "� _ i f - FRAME INSULATION t FIREPLACE — ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL,— — + f GAS: ROUGH,. FINAL ' ' FINAL BUILDING — k DATE CLOSED'OUT ASSOCIATION,PLAN NO. E ; 5 THEI", he Town of �arnstable . . T �.: srnat�. - 9 A ULM De partment of Health Safety and Environmental Services �� ° Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 Permit no. Date L L AFFIDAVIT HOME IMPROVEMENT CONTRACTOR w SUPPLEMENT TO PIItNIIT APPLICATION r, MGL c. 142A requires that the"reconstruction,alterations,renovation,reps,modernization,conversion, improvement,removal,demolition,or construction of an addition to aay pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structj m which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ! WV - t,... Estimated Cost Type of Work: Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law OJob Under S1,000 Building not owner-occupied (]Owner pulling own permit Notice is hereby given that: G WITH UNREGISTERED OWNERS PULLING THEIR OWN PERMIT ORDEALIN WORK DO NOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply f -ape it as the agent of the own _ Date ontractor Name Registration No. OR Date Owner's Name q:fb=s:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents ' '�—� _ Otfice of/n�estigations 600 Washington Street = �. Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: hone# city ❑ I am a homeowner performing all work myself. ❑ I am a sole pro rietor and have no one workin in anv capacity ❑ I am an employer providing workers'_compensation for my employees working on this job company name: address: one#. city: olicv# insurance co. ❑ I am a sole proprietor, er contrac r; or homeowner(circle one)and have hired the contractors listed below who have the follo«7ng workers' compensation polices: company name: address: hone# city: + `b0. }c insurance co. ...///////// 777 cpmpanv name. »: ..... address: citv- CV Mile#. insurance co Wad / i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Lnposition of criminal penalties of a Hne up to 51,500 00 and/or one veers'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 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. 1 do herehv certify under the pains and penalties of per' ry that the information provided above is true and correct c - Sienature q Print name Y� n ,� Phone# t• � , F' oiliciai use only . do not write in this area to be completed by city or town official permit/license# ❑Building Department a city or town: ❑Licensing Board ❑Seiecanen's ce h ❑ check if immediate response is required ❑Health Department • ❑Other. a:• phone#; contact person: Ir�'u[U 'QJ D)y.'.. Information and Instructions r 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 comic of hire, express or implied, oral or written. An employer is fined as an individual, PP,artnershi association, corporation or other legal entity, or any two or more of de the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver 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 c 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 renef of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h: 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 contract: authority. i IS 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 for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial Accidents or town that the application for the permit or license is date the affidavit. The affidavit should be returned to the cam' have any questions regarding the"law"or if y° being requested, not the Department of Industry Accidents. Should 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 ace at the bottom of t affidavit for y the lica:it. Please you to fill out in the event the Office of Investigations has to coo=you regard aPP __- In be sure to fill in the permitllicease member which will be used as a reference member. The affidavits maybe the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in adva=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 0mce of Imlesugations 600 Washington Street Boston;Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 eat. 406, 409 or 375. ✓i�e �asrirxanuroalDi r � C�utde�d HOME IMPROVEMENT CONTRACTOR Registration: 102418 Expiration: 711102 Type: Individual FRANCIS 1. EATON Francis Eaton 26 MADDIGAN In An A ADMINISTRATOR Middleboro MA 02346 BOARD OF BUILDING REGULATIONS Uc9n9e:..,GONSTRUCTION SUPERVISOR •:Number.--..p$� 011279 gk*d�-Q3ltMt938 0 Y} p1 .03/14/2002 Tr.no: 19560 Restrl�TYw � � � FRANCIS W EATON`- 26 MADDIGAN WAY711?!T'a' Administrator MIDDLEBOROUGH, MA 02346 07/27/00 THU 11:50 FAX 617 328 8282 ALLIED AMERICAN QUINCY (MU �001 CERTIFICATE OF LIABILITY INSURANCE o /z7 D7/27N00>zo0 s oo PRODUCFR (309)651-7700 FAX (50B)651-7701 THIS CERTIFICATE SSUEDAs A MATTER OF INFORMATION Allied American Insurance Agency, Inc; HOLDER, AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 233 W. Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760-3714 INSURERS AFFORDING COVERAGE INSURED Step ill P AntO&ttl INSURERA; Hartford Insurance Co. Antonetti Construction INSURER& Continental Casualty CamOany 61 Washington Street INSURERG Weymouth, MA 02199 INSURERD; INSURER E; COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS T A TypgpF Ap(OE POLICY NUMBER PDATE FWbbP V OATSMW WMIT9 GENERAL LIADMITY A 09 21 2000 09/21/2001 EACH occuaRENcE $ 1,000,000, X COMMERCWL GENERAL L"IUTY FIRE DAMAGE(Any o u fire) S 54 040 CLAIMS MADE �OCCUR MED W(Anyone person) S 5,0001 PERSONAL&AOV INJURY $ 11000,000 GENERAL AGGKOATS $ 2,000,000 CEN'L AGGREGATEppLIIMIIT APPLIES PEEL' PRODUCTS-COMPIDP AGG S 11000, O4 POLICY J6CT LOC AUTOMOBLA LiABWTY COMBINED SINGLE LIMIT $ (Ea&=Went) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per Perton) SCHCDULED AUTOS — HIREDAUTOS BOO ILYINJURY S (Per eoelOent) NON-OWNED AUTOS PROPERTYDAMAGE S (Peracmenn) GARAGE LUU31uTY AUTO ONLY-EA ACCIDENT a ANY AUTO 07mgA THAN EA ACC $ AUTO ONLY: AGG S EXCESS LIA90.1TY EACH OCCURRENCE $ OCCUR Lj CLAIMS MADE AGGREGATE S a DEDUCTIBLE $ RETENTION S S WORURB COMPENSATION AND ISSS9UB639X864500 06/03/2000 06/03/2001 TORYLIMdI S EMPLOYERS'LIABILITY E.L.EACH ACCIDENT a 100,00( B E.L DISEAS&-GA 6MP s 100,0( E.L.DISEASE-POLICY LIMB'$ S00 00 OTHER - NWRIPTION OP OPERATIONS&=TIONSIVEH)CLUMCLUSIONS ADDED BY ENDORSBMLNTISPECIAL PROVMONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURCRLETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EArIRATION DATE THBRISOP,THE ISSUIN0 COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE cERTiFtCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KM UPON THE COMPANY,ITS AGENT$ RESENTATII'BS. MP Classic Exteriors - AUTHORIZED AC VIM FAX. C617)471-33W � CACM CORPORATION'1988