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HomeMy WebLinkAbout0178 LONGVIEW DRIVE i 78 /,�orJyview ;Engineering Dept. (3rd floor) Map �,��� Par'cel Permit# �2/®'� a - House# tjO: /79 Q,/ Date Isslijed Board of Health(3rd floor)"(8:15 -9:30/1:00-4:30)9 Fee f JT • �� Conservation Office(4th floor)(8:30-9:30/1:00-2:00) � oor/School Admin. Bldg.) TTIC SYS`T T BE . . . Planning Board .� . 19 .STALLED I NCB. WIT,H N A�E NMEN s TOWN OF BARNSTABL N REGIR Building Permit Application Project Street Address 69 16l9 l P I V-•O Village Owner I js1�� �t�(� ���'� Address /o I-e Telephone C� Permit Requester �: � c�MS •ai— �o First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ /2OGef Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family I� Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes 340 On Old King's Highway ❑Yes Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing_� New Half: Existing New No.of Bedrooms: Existing_—New Total Room Count(not including baths): Existing �� New First Floor Room Count Heat Type and Fuel: 4/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 Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name� /d�'�Q,S ,�1 i,S' I O S Telephone Number 5_C0 k 7,7/� Address (�,� 40 a A V1 i?a) DP i V-P License# 06 (n C SS ��a�©'`✓i�l� _./"�.� 6V C 3 -2— Home Improvement Contractor# Worker's Compensation# 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 SIGNATU d` DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) • b� _ FOR OFFICIAL USE ONLY 4 PERMIT NO. DATE ISSUED4, �;* /111 MAP/PARCEL NO. gg sa ` • - _ , , ADDRESS VILLAGE OWNER 1 r DATE OF INSPECTION: ° FOUNDATION FRAME INSULATION J� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: �t'ROUGH FINAL I GAS: t'-ROUGH 'FINAL 1 FINAL BUILDING -DATE CLOSED OUT ' , ASSOCIATION PLAN NO. ' ;1 ° WE The Town of Barnstable" gib Department of Health Safety and Environmental Services iOrFc r�'t" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508790-6230 Building Commissioner For office use only Permit no., Date ' i 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: �tA5 ,� AZ''r®.f 1�i�Est. Cost Zg 060, Address of Work: /1'70 �Gr?�.11/�eu) /vim ��!/t✓L'i��P . 3 2 Owner's Name /�fl!/ic� ( �°%� /jvy Date of Permit 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 Contractor Name Registration No. OR I Date Owner's Name The Commonwealth of Alassac•husetfs •�,1 �;_�- Department of Industrial Accidents Cw `� - Office ofinvestfgations ' \ t`;" 600 N'ashit►rttr►r Street Boston, Afa.u..02111 Workers' Compensation Insurance Affidavit i li an inf rm i n: PI PRINT location: f r+ &rr I� f U sits 4 l ,_z l�11_L,14 /ice , A!::� 0 phone t4 7-71'l'VlG l am a homeowner performin=a l work myself. am a sole proprietor and have no one working in any capacity 7. 1 am an emplover providing workers' compensation for my employees working on this job. comminv name: address: city: phone#: insurance co Police# G 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: comn•mv nnmc• address: city- phone#• insurance co Polio•# _ comlinny name: address: rite: phone#: insurance co nolicv a Attach additional sheet if necessary s. •=.F+- '_ 'Jr .iW...�WYSY�(. :..-l _•e%.ilal. .. '.e.i:.: .':OLtLI�Y/—..—'-��r' 'IL.L..-w..Y.....rrw'Yaf�1F'i�iY: Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 andiur unc scars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of5100.00 a day against me. 1 understand Main cope of this statement mai be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereht•certifi•under re pains and a tics 6 er, that the information provided above is true and correct. SiEmature / Date Print name _____�Phone ; ,JIrrLLYrICLY ,-'T ..''official use univ do not write in this area to be completed by city or town official city or town: permit/license# rIBuilding Department [3Liccnsing Board O check if immediate response is required c3Sclectmen's Office ►•.. [3I1calth Department contact person• phone#; rlUtltcr t NAI I Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "lacy an enrph ree is defined as every person in the service of another Tunder any contract of hire, express or implied. oral or written. An enrplol-er is defined as an individual, partnership, association. corporation or other legal entity, or any two or more the foreuoing crianued in a joint enterprise, and including the le-al representatives of a deceased emplover: or the receiver or trustee of an individual , partnership. association or other legal entity, employing*employees. 'However the rnyner of a dwelling house haying 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 hou: or on the `_rounds 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 renewal oi'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 h 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 supplvin�= company names. address and phone numbers 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 atry 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 tine affidavit for you to fill out in the event fate Office of Ins esttaattons has to contact you re�ardtnn the� applicant. Plea: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned tc the Department by mail or FAX unless other arrangements have been made. The Office of lnvesti2ations would like to thank you in advance for you cooperation and should you have anlr question please do not hesitate to give us a call. r.-w...r..,.._.... ..._- ..:...... .-...«:q....-r-r..r�..- ...s..-:+.a......-......+w•r�........w�.�..M...rK,r. ..)r F•` _. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents _ office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 e.xt. 406, 409 or 375 P6 t 37 1 � Ilas.os 19.si I I 4tf w/ ',-ptir- ! .a 40 ! wide o .,o,t 38 � N — — v 72SSO 151 deck ! o $ i o + G ito 4 tk. filet let i Xot u Jhe bwa)� shown on thi4. ptan -id. •located on the ynound as dwwn he wr& and *eets. the + 4eAack of the .gown o f 13a4mtrb.Ce, g s •Cat in ;one C as. dwWn. on pa d #25000/ 0005 C. i i (site, /-tan o? Wand in Cen to ruW.e, �jq 9o-t 3auul- N ven '3e of '•Cat 38 as ahown on -C.C,-,128749 /3 jh..2 bate 12-1-9�f She 1 rr-30( I lgtt Cap e (rnreixw-,e .►?g• 49 l�la tbo�t load l yaYwu'i,--Pi9 02601 + t C,.a.l .. --13-Z" - I T 3d- I I A 1C�C✓I R \ EY/SY/ryF /lovsE C-+}.(AGE O r 1�F$'c iE cac a- J � i VE C. PALTSIOS � SON CENTERVILLE MA.I02632 �.EE' ' �'�' �PoaOVED OMwMB 3 a[w5E0 771-1410 BUILDING & REMODELING LICENSE # 006653 OnawlgD��BER K..EFt.HD F[ReOGM�•y[S J Sl/avl v CD. i i . I Lam_-TT T'�_ P � C■ PALTSIOS E SON CENTERVILLE, MA. 02632 0;eE .°.�DrE° 771-1410 -BUILDING & REMODELING LICENSE # 006653 DB�wiND NUMBER j =M-E�G[.nb N i��'Kf 6 fIHY rCD. —� MF i I _ 1 1 _ 1 C. PALTSIOS E SON 183 CENTERVIL ELE, DRIVE a RVIL , MA'. 02632 KTIE. �vAOVED Br. DA.wry Br DATE E'nSED BUILDING & REMODELING LICENSE Dn�wiElD NU�9EP •�rw rece.,w A[q�an.n.rs a swt r m. f _.� l7. 1 .. .. go er).0 O a �1 3-�OeT / fit '.. ,✓ 99 RV + o �.. •'` ' ✓`' 'I -v i s 71 o wVim F ton cw .. ff((IyIy�.--��yj�!-� �3 ff 1 wy.1.G��•yf� J: 1 �`t7kr��{{. N � + .