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Home My WebLink About0034 HARVARD STREET'r TOWN'OF BARNSTABLE BUILDING PERMIT'APPLICATION Map 30 7 Parcel " F r' Permit# Health Division a Date Issued / _y _9 0 Conservation Divisions,�. Fee Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board y t , Historic-OKH Preservation/Hyannis Project Street Address .Village ..Owner Address Telephone Permit Request v v , Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost -'n,510 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 LINO Basement Type: ❑Full ❑Crawl 0 Walkout ❑Other 4 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Halt existing new Number of Bedrooms: existing new Total Room Count(not including baths): ex'Fsting new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other M Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing I]new size Pool:Cl existing ❑new Msize Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes O No If yes,site plan review# Current Use Proposed Use ' BUILDER INFORMATION x Name Telephone Number Address 5`—� /��f ��.�— License# 71J0 Home Improvement Contractor# 1,_w r Worker's Compensation# e-- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � �= SIGNATURE DATE • FOR OFFICIAL•.USE ONLY ,t PERMIT NO. r ,• -+ F DATE ISSUED ',� ' t •. •'. `' + r j _ �� - ,i rs + '. it �"� _ MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME f INSULATION " - ' � - , • , _ - — A FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s GAS: ROUGH t 'FINAL FINAL BUILDING + ° AN DATE CLOSED OUT ASSOCIATION PLAN NO. ZHE : .�. : The Town of Barnstable • sr►xrrsresie. • ' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 1 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 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: ' Estimated Cost J/;7610 Address of Work: `7 Owner's Name: Date 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: Date 4ontrIcto,Name Registration No. OR Date Owner's Name q:forms:Affidav The Commonwealth of Massachusetts _ Department of Industrial Accidents ?� -=` � Ol�lce of/o�estigadoos 600 Washington Street Boston,Mass. 02111 e-nsation.l=rance Affidavit V/p name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workili in ca aclty am an employer providing w rkers' compensation for my employees working on this job. m anv;name.. ,:.. address.. . - "...:: a �S-ie . ' MY # ::.:: insurance co: ❑ 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: cotuoanv:name. ::: address. WXK »;.: . ...:.:..:.:.:.::::.. cltv:' Whine#: •:•isi iY.i�i`:i::•i:!•isf:::.,�:::i.:;;:{is sS;''ri:^::i:?{:i:•i+:'i:::: :;:;i:iii'.:!:-:i:%:�:...... >.•'..�:tiv.;:::4."Y•i:%i tLi'•>ii::i:{iL: .. ........... ....... ....... .......... .:..... ......:.:is iiii::is::; .v..::::::...:::::.:.::.. :.:.:::::::: ::.......................::::..::..::.:::. . :::::::::::..:.:::..:.:::::...:....................... .....:..................... n::: :::::.�:::::.�::::::.v-.J::.::.v.r.i.J.:..�..n.......... esnrance co... ::.:.;;.;....;::.;;. opiev#: :>,.::; :.< « >; .;:.:;:;. •:.;:::......:•......:.::: ::•:::::::.:::::..:::..:.:....:.::::::.::•::..:::::::.....::•::::::::::::::•::::•::::::..::•.::::::::::.:::: c any Warne: :::.:::-::•::•::.. :::::::::::.•:::.::.::.:....: .::.:.::.:..:.:::. address. X. .... .....'::::.«w> cltr: hone ii: ........ .... .... :.. .... .........:. ... .. ::... '': e3nrance.co,... ,::::. ..: _...... . . ... ,. ... olicv#" Fai>ue to secure coverage as regadnd under Section 25A of MGL 152 can lead to the imposition of"b nihW penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as dvfi penalties in the form of a STOP WORK ORDER and a fine of$100.00 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 hereby certi the and n ojpeUury that the information provided above is ow.and correct Signs Date Print name name �Ji4l//✓ �i�vJ7//r// Phone# oflicial use only do not write in this area to be completed by city or town offichd city or town: permit/license# ❑Building Department CILicensing Board ❑checkif immediate response is required ❑Selectmen's Once contact person: phone#; _ O der Deparia►ent (mud 9195 Ply Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the':r employees. As quoted from the "law", an employee is defined as every person in the service of another under any corgi- 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 cf the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec-N- 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 reneWL' 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 permit/license number which will be used as a reference number. The affidavits may be returned fo 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 amce of Iwesugatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 i ' J¢�9a�q�'c►.�%- se- �O�0.�7.3. � q � -J� rn ,fi( r et p}.: � � a �.°� .. - �_ ,+� _hp��t70 p R1a �1.; #,�TfA •.�,�7 .�'�f o a r::wc 1 a m }rr rn- - 1'r1 6,.49 r� '�i-•{fi= t _ S._ �_ —1 0 _'. A�O~� ti�# � � z � i T ��{zy£.m # f�'flt' O�•° ryL�_� �.w'S �.'i .J = m., �.(;� ! �..�-c T s rn ¢ �`t.^~'D�Z:s�� .,Y•- ��{sm-rx +.tu."°_��' m �o �° o ��.,� �'.;s .. r\ ?�t e �f4�t '��' p r; ;- s �' •o .moo