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Home My WebLink About0179 LOCUST STREET n. Application number....... Fee......................... ....... sn NAM � Building Inspectors Initials.......... , BESS A ....�.Date Issued..:........✓..... � f OCT 2 B�►RN�Tf��E Map/Parcel.... . .. ........... . :....................... TOO O. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 9 NUMBER STREET V LAGE Owner's Name: k d.42 A LB rr-j 5 o to x, Phone Number Email Address: 5 u S&*LM0T ri Son 1 as 1-Gp�Cell Phone Number :,gm6e .Lus "a u�o_ Project cost$ f o d o Check one Residential k Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with hO CMR Owner Signature: `� . �9.��2I/Sdh Date: 10hda TYPE OF WORK €vJ Siding ED Windows (no header change)# ® Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to '--T—ow„, Dc- CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# 3 2 7-7 (attach copy) Construction Supervisor's License# 10 Li 7 '4 -7 (attach copy) Email of Contractor ;, bo-relgmg Vguk, -) , Phone number �-, �Zg 2 —C�y7� ALL PROPERTIES THAT AVE ST UCT S OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN H/STOR/CAPPROVAL BEFOREA PERMIT CAN BE ISSUED. I APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number.of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9.30 am or 3.30 pm4.30pm.Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab. Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CAM the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date 1 l All permit applications are subject to a building official's approval prior to issuance. Office of Consumer Alf s&Business Regulation pegistretion valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. N found return toc ulation ? TYPE:`individual ,Office of.Consumer.Affairs and Business Reg RedistsR' -. One Ashburton PlAe-Suite 1301 158277 ti,=_= Ot/02/2020 Boston,MA 02108 JOSEPH BURGUM 5 JOSEPH BURGUM:::. '' � Q No�Vali withou ignature 213 PITCHERS WAY ' F,ANNIS,MA 02601 UndersecretarY. E less fhan ct 0 cubic - CO ed- construct. Su 35 00 bic re of any u rvisor ►eet(991 c e group w Commonwe ub h alth of i � Ma s c which ssachu set pace, meter cOnt DrorailoR°#-ar°fessional L•icre s)°jenc/Osed Board of Building Regulations and Standards Con sZiP4bPqtrvisor CS-104847 Fail - ttpires: 11020 re i t°- JOSEPH R BJ _ State guildln sass a curr I,JRGU For iWe is cau nt edition o HYA N S MA b �Y % ~.Call(s17)727 32 ati0 abo�eyOcaii®e Massach' 00 or visltut this liC n Of this lic setts Oi 4 �W��9 v/d eryse. n � ✓1 p�� Commissioner (/��. /� gQk The Commonwealth of Massachusetts Department of Industirid Accidents Office of Invesdgadons 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Afdavit:Bnflders/Contractors/Electricians/Plumbers Applicant Information Please Print Lettlbly Name(Bus1ness0rl;wdzadcm Indh idual): � Q��( �U IfZ.P L-L n Address: 7-13 F1+C)A Q rS wa u --- City/State/Zip: ec n In'eNAA OZ(o 1 Phone M 56 8— — 1 X-2, Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I llftployees(full and/or part-time).* have hired the sub-contractors 6. []New construction 2.12 1 am a sole proprietor or partner. listed on the attached sheet. - 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor mein aci employees and have workers' �y capacity. 9. ❑Building addition [No workers'comp.insurance cDMP'insurance.!reqtzired. 10. Electrical sits or additions l 5. ❑ We are a corporation and its ❑ repairs 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions of exemption MGL ❑ reP . myself [No owl t comp. c�152,§1(4�and we have no 12. Roof sus instumnemployees.[No workers' 13.❑Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Fro 2:11i rs who submit this affidavit indicating they are doing all worts and then hire outside contractors must submit a new affidavit Indicating such :Contractors that check this box must attached an additional sheaf showing the name of the sub-contractors and spate whether or not those entities have employees. If the sub-contractor;have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.M Expiration Date: Job Site Address: City/Stawnp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for hm=oe coverage verification. I do hereby c under the pains and pencldes of perjury that the information provided above h true and correct Si Date: Phone#: �l'�!`� 2 R•2—`j 1 Z, O,Jj`i W use only. Do not write in this area,to be complded by city or town ofjk1d City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person id the service of another under any contract of hire, express or implied,oral or wriiben." 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 or trustee of an individual,partnership,association or other legal enti%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 anothea 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." MOL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal 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,MOL chapter 152,§25C(7)states"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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-coimactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town,Officials 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 time 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. In addition,an applicant that must submit multiple peraincense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Me to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax mmmbw. . ' The Commonwealth of Massachusetb Department of Industrial Accidents OMM of bnvesttiptioas ` 660 Washington Shvd Boston,MA 02111 . - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 424-07 Fax#617-727-7749 www.m .gov/dia : . My File Edit Tools Help YearjTypejBill No, Customer Account Information History 2018 FT777] 19621 430497 C3 Detail Property Information _ _ _ MORRISON,SUSAN M 179LOCUST STREET Parcel ID 310-128 HYANNIS, MA 02601 =0rigBill Alt Parc i i Apply Pmt Prop Loc 179 LOCUST STREET Special Conditions jNotes Scan Bill l Quick Entry -Installment Information --- - — - Int Dt Billed Abt jAdj Pmt jCrd Interest Unpaid bal __ --� 1 r Effective Date 08j02j17 271,43 0. 001 271,43 0.00 0.00 11j02j17 271.42 1 0.00 271.42 0.0011 0.00 Utility Aat -- 02j02j18 429.07i 000 429.07 0.00 0,00 Customer 05j02j18 429.07 0.00 ! 29727 27.61 160.41 Name FeesjPen 0.00 ( 15.00 0.00 0.0011 15.00 Totals i,40 1.99 15.00 1,268.19 27,61 175.41 Parcel l NotesjAerts Prop ID Due 10125/2019 175,41 0. 55 .Mist Receipt ]AN 1 Owner; MORRISON,SUSAN M Per Diem Int Paid 0.00 View-Rev bi d - Total Paid 1,268.19 Y'i� p�G?t> p�adl id Bill Dates _ 10 view ce'stu pta anpaid bOLR Bill Audits Bill Events SH ❑CHECK Reprint c� Preferences OCT 2 5 2019 Diagnostics Batch Information Batch# 75042 Department 3301 C itRa Deposit Current Receipt 0.00 Receipt Count 0 99LE i Attachments(?� _ Display trans :0 ll action history for the current bill. I n Assessor's office(1st Floor): :-- Assesii sor's map and lot numb l oZ� THE t SEPTIC SYSTEM MU Conservation INSTALLED IN COMPL Board of Health(3rd floor): _ seu�rant to Sewage Permit number, '✓ WITH TITLE 5 Engineering Department(3rd floor): L '° �IRONMENTAL COD o•`��d° House number t TOWN REGU TiON Definitive Plan Approved b _Planning Board , PP Y 9 `x"��I `�• 19; APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION SEPT 29 19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor ation: Location -T 1 A)IV 1. Proposed Use �� C.}� ,2 X•11 -5, -- Zoning District Fire District_ _ _ - M WIMAWK Name of Owner 15�U56 W V )Of—P—nn V Address Name of Builder m�5 "N Address 20 Rye Name of Architect 't V Lk Address Number of Rooms-1 Foundation RU IN b T1W Exterior /-5L�" dy Roofing A AL Floors I �- , F,71 Interior Sc--24—. � Heating NZ Plumbing N /A n o� Fireplace / Approximate Cost �a�� Area -2 3�ea �Diagram of Lot and Building with Dimensions Fee da OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License f MORRISON, SUSAN No, 35422 'Permit For Build Deck Single Family Dwelling 1+ Location 179 Locust Street r Hyannis Owner. Susan Morrison Type of Construction Frame Xj Plot Lot t Permit-Granted October 5, !a` 19:.92 Date of Inspection -a = 19. ; Date Completed "f� 19' ! n _ r is-> - n. .• _. T-q- + F �. r �3 1 Sir 5 53-574 PERSONAL MONEY ORDER ,{� ,,a 7 C'APE . COD `"BANK- AN � 'TRUST N0,�279,62 IC'."0; ;M , .'P ..A. N ' Y o rs Nor vACC.B&T. 'uo r : ET.TS•HYANNIS <.� ;+ �,,<rAA.. a �a .x,, t.n .r„ W. MAS Cn y F (TO THE ORD R OF "byflgQf�\ s �F•. IfL iIi.l�llf - 111{Ir+I��l'.��IIIII,+`I+IfIIh 1'lll' i 2{ � { i1 n � {��I,I�IIH►...�lllll��l�. 1� 1.. `�III�f= IIII��-',I'1�I� ;�IIIIII II�I�IIII• _ � 1ri�' C0 O EG TIABLE -< NOTICETO.PURCHASER �sr, This check is NOT subject to a right41 of stop Payment fi ; q ia • 5 A , ;y-VOID SIINIONTHS FROM DATE ISSUED , ' �Y�� s " c { f �{ d { t :l- ;✓ < �xaark `,rfarN "gYa ;i �i �i F! 3 a} f I, j P � 1 9 FENCE ll' W � 1. 4 II'3"X11! ITl/XIZ10 be .16 33' z - __ ! 4x6 RAAIERS y t :h !c1 � x x v r 4Xb ?DST 16 Or 1�(Y 2"S i 3 2xa 1o1Sj V 4 J� I+Lance 179 L-DGU.S"7 STF TEE. NEw� E i NGLAM) VADME zmpoVbl\ s 4 - _ 3APKE5 UV-10'0 '1-)12n;L9