HomeMy WebLinkAbout0505 MAIN STREET (HYANNIS) (12) ST
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YOU WISH TO OPEN A BUSINESS?
For,Your Information: Business certificates (cost$40.00 for 4"years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary.signatures on this form at 200 Main St.,.Hyannis.
Take the completed form to the Town Clerk's Office, 1 st. Fl., 367 ,Iviain St., Hyannis, MA 02601 (,Town Hall) and get the Business Certificate that is
required by law.
DATE: Fill in please:
F #' APPLICANT'S YOUR NAME/S: J��� KItLr(ti/1
€�; z BUSINESS YOUR HOME ADDRESS:
&° TELEPHONE # Home Telephone Number � jh'- YSIy4� 4/
NAME OF CORPORATION:
NAME OF NEW BUSINESS TYPE OF BUSINESS ` MUM
IS THIS:A HOME OCCUPATIQN? YE NO
ADDRESS OF BUSINESS—,5G S on ' 0 MAP/PARCEL NUMBER 3U cY'" " (Assessing)
When starting a new.business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST.GO TO 200 Main St. - [corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OF E
This individual has been i 6r d of an rmit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual has ben inf�t �t permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIW.LICE ING AUT ORITY)
This individual hrm (Vxs ofyg re em nt artai to this.type of business.
COMMENTS: d i Authorizegnature** �
2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel d Application # 3
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee L.2�
Date Definitive Plan Approved by PI anning Board /
Historic - OKH _ Preservation / Hyannis 1112-Vt
Project Street Address Sk` Pn,. 7 �
Village
Owner �' c\�J ?'� � \� �� AddressL�`%
Telephone �� �1 0 , 0 QI 9_._
Permit Request
• i�.Z\L� `�_. --^9.'�'C?i�.t.- t�y�'' S\sc��'�" ��" ��`�yV�' ��, Q ICJ —�' �C= ,
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Q 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
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq fts
Number of Baths: Full: existing new Half: existing . n
133
Number of Bedrooms: existing _new ..
;a
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ 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
APPLICANT INFORMATION
�- (BUILDER OR HOMEOWNER)
Name t���v \� Telephone Number
Address License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE '
r
of
FOR OFFICIAL USE ONLY
APPLICATION# '
9'
S � '
DATE ISSUED
a
MAP/PARCEL NO.
M
ADDRESS h VILLAGE
OWNER
1
K
4
4
DATE OF INSPECTION:
_—_riFOUNDATION...
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL 1
R GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. —kj
4 - 1
The Commonwealth of Massachusetts
Department of IndusizialAccidents
ra
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information `1 Please Print Legibly
Name (Business/Organizarion/Individual):
Address:
City/State/Zip: Phone
Are you an employer?Check the appropriate bog: Type of project(required): '
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors
6. ❑New construction
ral
2.pL I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling
ship and have no employees . These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp.insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no 13.❑ Other
employees.[No workers'
comp.insurance required]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors 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-iris.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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$1,50D.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 insurance coverage verification.
I do hereby cerd u r the paitu andpenaliies ofperjury that the information provided above is true and correct
Signature: Date: � 1
Phone
Official use only. Do not write in this area,to be completed by city or town officiaL
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#:
ZNETown of Barnstable
Regulatory Services
Issas r, Thomas F.Geiler,Director
s63q. 1�
Building Division
Tom Perry,Building Commissioner
200 Main Street,.Ryaunis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax; 508=790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder.
as Owner of the subject property
hereby authorize to act on ray behalf
in all matters relative to work authorized by this building permit
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
-Signature of Owner Signor Applicant
Print Name Print Name
o ,
Date
QFORMS:OWNERPERMSIONPOOLS 62012
Massachusetts- Department (if Public Safct%' `
Board of Building Regulations ant) Standards
Construction Supervisor License
License: CS 98849
—..,•. v
RENATO DA SILVA - M
20 WOODLAND AVE .-
HYANNIS, MA 02601
N:v.v..^2 ca+.wawaeo reMwlai
��"�• -- Expiration: 6M12013
( nuni .ioncr: Tr#: 1906
N. �amrna�ausec�l(/ a�✓/�aaaac`uraet�a
Office of Consumer Affairs&Bddsmess Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: 160124 Type:
Expiration: 6/25/2014 Individual ,
Ile
R" TO F DA SILVA"
2=
RENATO DA SILVA
288 HUCKINS NECK,RD
CENTERVILLE,MA 02632
Undersecretary
YOU W 1SH TO OPEN A'BUSINTESS?
For Yourhform atiDn: Busiiess ceztF=abE�s (cost$40 .00 fbr4'years).A business certEcat:e ONLY REG:STERS YOUR NAME n tnwn WhLhyou
mustdobyM GL.-sdoesnotgaeyouperm ssnntoopexate.) You must first obtain the necessary signatures on this format 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601, (Town Hallj and get the Business Certificate that is
required by law.
DATE.v(7y1 Z FffLiiplease:
a APPLZAN T'S YOUR NAM E/S: Q 1�Gam/ S 1wt �►
W.
BUSNESS YOU HOMEADDRESS: �(� �tlPir�2✓Y� L7/ (a ,p
:.
TELEPHONE # Hom e Tesphone Num ber
2:
NAM E OF CORPORATDN
----- --- —-- ------...-------- -- ------- - ----------------
N ------- —
NAM EOFNEW BUSESS Y1 /l ,• '
- �C �� --- ----- =----- TYPE OF BUSN dCUr✓LSl
ESS. � l�p- - - l/L�tCC �CGdf
IS THS A HOM E OCCUPATDN . _ YES NOV _
ADDRESS OF BUSNESS SDIX4Qj✓1 ti MAP/PARCELNUM BER assessing)
W hen staxtng a new business daere are severalthings you m ustdo ii order to be in corn p]ance w ih tine nos and reguht bns of the Town of
Baxnstabs.. Th-b form s intended to assstyou in obtahhg the iiform at hn you m ayneed. You M UST GO TO 2 0 0 M an S t.- (corner of Yarm ouch
Rd.& M ah Street) to m ake sure you have the appropriate perm its and licenses required to legally operate yourbushess in the town.
1 . BU]LDNG CO M DSD ERR IS- 0
Ths h ofan p requ>rem ents thatpertah to tins type ofbusiaess.
u
COM M EN TS
2 . BOARD OF HEALTH
Ths indirilualha en infDrm e o e p p �1 ` >rem tints tizatpertaii to tizs type ofbusness.
Authored S
COM M EN TS
3 . CONSUMER AFFA]RS (L�ENSNG AUTHORITY)
Ths indirdua]has i }zn d ofthe kenshg xequaem ents thatpertain to tins type ofbusiiess.
Authorimd Srjnature*
COM M EN TS:
w
YOU W 1SH TO OPEN A BUSINESS?
For YourhfDnn at bn: Busness ceitfcates (cost$4 0 DO for4 years).A business certfrate ONLY REGFTERS YOUR NAM E ii tDwn Whihyou
mustdobyM GL.-tdoesnotgiveyoupenn ss�ntr�operatea You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall)and get the Business Certificate that is
req u i red by law.
DATE: p�� 2,0 F>Ilin please:
E APPL>vANTS YOUR NAM E/S: Ir S ( AAY1
r BUSNESS YOUR HOM EADDRESS:
,• r TELEPHONE # Hom e Telephone Num berA Z� Z
NAM EOFCORPORATDN _ 111C,�S O(Ci_'b'^' PI'10fG
NAM EOFNEW BUSNESS0Ic� -nvn , PhC+0 �_�Yl,POVIl�✓Y1 __ TYPE OF BUSNESSQld 'to ss fJ(g�
S THS A HOM E OCCUPATDN? YES No J
ADDRESS OF BUSNESS Q e YJ✓! MAP/PARCELNUM BER 3 [/ $lssessng)
W hen startng a new business theme are se-\,emaldiJags you m ustdo n ordertD be in com plane w 3n the rules and regunt has of the Town of
Barnstable. Ths fonn s intended tD assstyou n obtanng the nfDmm at hn you m ayneed. You M UST GO TO 200 M an St.- (comerofYarm outh
Rd.& M ain Street) to m ake sure you have the appropriate perm its and h.;enses required to legally operate your busness in this town.
1 . BU=VG COM SSD RIS OFF
This ndivii e intr d 11 ype mequirem end t3natpemtan to this type ofbusness.
u mh ed-S mtume* ^�,�
COM M EN TS:;' J / K_]t- lee 0
2 . BOARD OF HEALTH
Ths indiridualhas been
' l ed �trequmem enter thatpertain tD the type ofbushess.
Authored S' time*
COM M EN TS:
3 . CONSUM ER AFFAIRS LDENSNG AUTHORITY)
This hdirhualhas b the 1censng mequxem ents d-iatpertan to tins type ofbusness.
Authom»d(S'
COM M ENTS: C�n 01
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