Loading...
HomeMy WebLinkAbout3512 MAIN ST./RTE 6A(BARN.) (3) 35"I c M cti n S4. a/ Gt I `7 ail TOWN OF BARNSTAB LE BUILDING PERMIT APPLICATION t t Map Parcel Permit# Health Division n Date Issued Conservation Division f-�J o /G'b� Application Feeler 400 Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3. M l ® All T!' Village ZZ Owner 4:�Wate , ,.Address .9 X. -5 AM1 Telephone Permit Request Woo e*z _a y�5 CAILI _7(2 tt)o ry � Square feet: 1st floor: existing proposed 2nd floor: existing proposed LVal nab Zoning District Flood Plain Groundwater Overlay = W i Project Valuation Construction Type , Lot Size �.� Grandfathered: ❑Yes ❑ No If yes, attach supportin docurnotatio Cdi?dD 0 cv 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.) WAVE. Basement Unfinished Area(sq.ft) A16 Number of Baths: Full: existing o2, new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing 15� new First Floor Room Count 3 Heat Type and Fuel: Gas ❑Oil Electric ❑Other Central Air: A. Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Xpxisting ❑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 *N/o If yes,site plan review# Current Use Proposed Use IY- W"17�/ `. BUILDER INFORMATION Name Td Telephone NumberOD, Address SLl PPS l ty License# G 0/�62a! �A�S� III NVEQZIo `�� Home Improvement Contractor# Worker's Compensation# p ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY "t. PERMIT NO. DATE ISSUED MAP/PARCEL NO. t i ADDRESS •VJLLAGE'- OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE �r, ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL fir' f• ,q..^ f,� , FINAL BUILDING f' E r . i . i DATE CLOSED OUT' t ASSOCIATION'PLAN NO. 11 :�� 1 .: _---_ The Commonwealth of Massachusetts ,R — Department of Industrial Accidents ` X = ` = Olflce o1117YO tiISMIs . . . ,. 600 Washington Street Boston Mass. 02111 ; . Workers' Com ensation Insurance Affidavit . name: J 6 H'P( C I `�V\f DF—f-11 location: Z9 L-" SL1 FYt;z LJ"J . city A*k.5-M r`f M f�S ILIA- D Z 6 48 phone# 508 #',4 4 O J5 9! - ❑ I am a homeowner performing all work myself. . ❑ I am a sole r rietor and have no one workin in an ca achy / %%%%%%%/ %/%%%��%/%/%%%%%%%%%/%%////%/////////%%%/��/%%%%%%%%%%/G�/%/%/%%%%%%%///%%/�%%%%/�/�%�%%%%%%%%%%�%%%%%�/ I am an employer providing workers' compensation for my employees working on this job. ...:::, ,2��� :com an',name :':.:.' ".. .. .. 1.: V :<::: .:.. ...... ,: .. 11 .:.:u�r.I�h'::.+.,.,�,.,. ��i:::�:i'i::�.(: : ":: {::!:j:::� r�r::i::::::::::::�:::::i':::':::i::: i::C4i{:is�::::�i�::::::v::::+!::::•'.:::'.':::•::?:i::i:•'r:':.):?:::::::<::4�C!'::::', 'MAW W' U e. »:. �€ # Q hn CItV� :j::':::!:�:i''Y�i::'::':+':::::} :'::::��'•':`:::::i:ii::::::v:%..:.:.:.:i::::::i i::`i)::ii:::.-.—.—i::S::i:i:ii�: :.•`.:....: ?i:;::.�'i:: � ;S:•i:,j:',: ':I::;:i.i::' i`'!}'�, ::..:.::..::. .. :. :. .. ..:: :::. ....::.:'::i:.;.::.i:..i.:�.:i.ii::::.iiiii..::..:.i:i.i: .i:.:i. . .::: :.:: :: :..::. .:mM: ::N:�; . :.....::...•::;•:::•:•.::.:.r.:::i?: : :.:.: .... '•iii:•::is•::•. :•i:• ^'. :. ':•• � .:•i::. is:•::::.:�::::::•. •. :. ::::: ::rr.••: :i : �:'.::.:•:i:'•.i :•::.:^::•:''v.ti::4:. . ❑ I aim a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have . thefollowing workers' compensation polices::.:::.::.:..::::::.:::::::::::::.:::::::::::..:::::::::::::.:.:::::::::.::::::.:::::::::::::::::::::::::.:::::::::.::::::.::::::.::::::::.::::::::,::::::.:.: i::>a}ne..'. ::: :: t3?>`::::;::;;:a%::#3f !::%::?:? %2; a `:'5 y :......::' i < > >i::y s%%:.:.:.. as <2?<? ??<c Sr iz >'i:%:+:i::'? >' < .t£ :..;:::.;:::;.:':..::.::: ::':i:iS=::I . ..:.:.:......:::. �Gily".... Q .11 �. ii:5:ii�:! �?:y:::::riii:?:iiii}ii:::isi::iii:'v::i?ii:iiii:<:ii:ii:;:if:i=i::isj,:;:_:!;i:;:j}::;:'i'::!:iii?iiiii::::ii::::::::;:�i:i:i>:1 t:: Y;ii:;:.", ':iv iviiil:...i:C:::::jij:::;:4{:!--.,,.i:::;-`::,.---:: ::iii:i:+.i ...:............................... ............. ............:::::::i:vii.............:............. :::::.:::::.:n:.::::v...::::.�:..:::::: ................. ...................................... ....::.....:.:.:.......n..............::.......:..: J...... .........:.............::i .i.. ......................................................... ..... .....:............:.... .�.��:::::::i:}"::::j:.... .. ...................................................:.......... :::::::::::::.::::.:::•:':•i::.i:.:i"::}isi•:i:;•i::.:;:;yi}:�i}ii}:4;C:.i:p:-:r:�:G:Xu;.>}.:+C;::.:.i:... illrailC ...... %////%I%✓%/%�%. c aii ;gym address...... . ...... ..... .. .. .......... .... .... :::':.:':.:::: » hn # 3 �:i\:iiijiii :i:::is:iii::}J;}:ji;i:;:; ;::j'?i:;;^}v}ii'v'.}:•}•"ii:i:h>})ii:::}:v':'i:::iiii:iiii::?'i'i:::•:v:.Jiii}iiiii}:':: }..:::::::::::::.•:::.i'!.:'::::::^:'::::.:::: :}:•i.};<•>i:f:::i'i}:•'•:::::-}".}}:i$}`}}}i;•i}}:}:;?i}:::}}:•}}::p}:i}ii;;•i}}::�:•:.::4:'}ii:S.ii:i.;ii}y;... :...... L}iiii:tit::::::::}.;;ry;:.}}};:::4ii}i}i:• %% Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and s fine oP 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. . I do hereby certi a pains enalties of perjury that the information provi I d above is true and correct Si tune - � Date '5,o? - . 1� c7 . Print name L' . i� I Phone# 5d y° 7 02 X, g"51„ ? am official use only do not write in this area to be completed by city or town ofndal city or town: permit/license# - [3Buffding Department . OLicensing Board . ❑checkif immediate response is required ❑Selectmen's Office ❑HealthDepartnent . contact person: phone#; ❑Other (tevised 9/95 PJA) Information and Instructions r r- Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"taw an employee is defined as every person in the service of another under.any contract of hire,express or implied, oral orwv ritten. 1 An employer is defined as an individual,partnership, associatio corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the leg representatives of a deceased employer, or the receiver or trustee of an individual,partnership, ssociation or other legal ntity, employing employees. However the owner of a . . dwelling house having not more than th�ee apartments and w resides therein, or the occupant of the dwelling house of another who employs persons to do mahn, ance, constructi or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not beca�e of such empl yment be deemed to be an employer. MGL chapter 152 section 25 also states that' very state r local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business r to cons ruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compli ce wit l the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivision s enter into any contract for the performance of public work until acceptable evidence of compliance with the insuce equirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affida 't comp ely,by checking the box that applies to your situation and supplying company names, address and phone umbers ng with a certificate of insurance as all affidavits may be submitted to the Department of Industrial A idents for c tion of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be eturned to the ity or town that the application for the permit or license is being requested, not the Department of In Accidents. Should you have any questions regarding the"law"or if you are required.to obtain"a workers' compens on policy,please the Department at the number listed below. City or Towns Please be sure that the affidavit is comp ete and printed legibly. The epartment has provided a space at the bottom of the affidavit for you to fill out in the event a Office of Investigations has contact you regarding the applicant. Please be sure to fill in the permit/license n er which will be used as a refer ce num_ber. The affidavits may be returned to the Departmentbymail or FAX unles other arrangements have been mad The Office of Investigations would ' to thank you in advance for you coope tion and should you have any questions. please do not hesitate to give us a c XXXXXXX The Department's address,telephon and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Offlce of Invesnusuons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °FINE r Town of Barnstable Regulatory Services r r B'` MASS, Thomas F.Geiler,Director y nss. ,� 039. m Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. I Type of Work: I g51ALU 1 I CXIF_910P_ POOi& W i 11 Estimated Cost 1N©0 �( STEPS USING Ex1S-nr&- WINDOW OM"ING� f �X7�kiGo2 1�Ei-iT Address of Work: 3.1;i Z MA ice( .ST D W i T !tj LF--, "A- 6Z&S Owner's Name: PAMGlA MUgPtj j C-PPONr Date of Application: 57'ZT d A-- 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 WO IRK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PE IY I hereby apply for a permit as the agent of the Date tontractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav - � 1� 44 o , QUTV t I gOARD:Of BUILDING t License C4N$7RUCTION SUPER VISOR l 014224 ��� Number Bithh * ��r .. 0 21656 � �l TT n sy BOW�ENf,,�-,w 28 Lp;DYSLIPPER LN�A ', 8 pdmml§motor ILLS. 0264 MARSTONS w .� pr m - ve ....,....... PAN wiww • I ML MNlBDW /7 Yb:$ SIP FNO t 427.59'_1 - sl. IF w J er i b _ ALLAN HL CHASE AND S Zj DAND P.t NOEILA.K.MUNSELL 3 ILY , _ P.O,BOX 431 BARNSTABIE•MA. 026W w:.... LOCATION MAP N8T41'1,'E `yr ✓.0(2,"K 42,.59' O/DH/rI10.1R10 '�,.�`:^'4`,i✓ v pg JOHN MARK THOMt D PHYLLIS BECK ,,.....+ . Tafst'K`TKrr .. q ;Y 1111 LAM'TLN ROAD tfM 6T NEEDHAM.MA. prs i 4 ,S l4 �MiL1F'� L" S I 021N a `�`;;t NOTES(1)OMNEIt RICHARD ROUTE 28L TERRY . 14E4e -p• YI. P.0.BOX 560 1'R/ 0 c MASIPEL MASSACHUSETTS 02849 Lor 3A LC PLAN Ua (z) � RICHARD J HOOD,PlS i1p44(M�t U I m 21 NAUSET STREET SANDWICH.MASSACHUSETTS 02563 e! gyp JOIN MARK 1HQAA5 AtO ,V H>!/DII/RD s i : g P11YW5 BEON (3)LOC15 IS SHOWN AS LOT 27.SHEET 31;ON THE r w BSI lAN'TOfI ROAD.•= 5093Sb'p fnM WM Was4I-, d` . lOYN OF BARNSTABIE AS4SSOR'S MAPS NEEDHAM.&M .. . b. 02I04 1 (4)DEED TO LOWS IS RECORDED AT THE BARNST49LE L Ti't COUNTY REGISTRY OF DEEDS IN BOOK BOOK PAf ,n,--' ' F (s)Lows Is zaNET+RF-z Y( Via) g� (6)PLAN R&ERENCER PLAN BOOK 335 PACE 24 LG PLAN m17994 n1 1 CERTIFY THAT THIS PLAN HAS BEEN _~ ° PANG AREREODIN 1COOONFONS OR THE REGISTERSWITH THE OF DEEDS tTg.� 164.54' ¢ 1N`S4' ' 1H.4! I SHEREE P KOPPELS' OF THE COMMONWEALTH OF MASSACHUSETTS. 1 Ou Y H; -0.tY u� r 1 imar ,y \ 1 I 0�STABUE,.MA HL�•' ,' I fYF I g_ R I. DATE Ei/r.i° 1141 LINES SHO)A" ARE THEEUNNES DIVIDING E7UmDNC OWNERSHIPS. AND �' I 1 AND THE LINES OF STREETS AND MAYS SHORN ARE 11 7y. I THOSE OF PUBLIC OR PRIVATE STREETS OR RATS CAPE COO ART ASSOCATON ` 1 -1 �l 1 l y ALREADY ESTABLISHED,AND THAT NO NEW LINE'S 9AR BOX LE 'N J�,ii FOR DIVISION OF EIDSTING OWNERSOP OR FOR NEW 02630 STABLE MA. - 'e 'S I 1 _ ` 1 ;e.00 SW/SET 1 �' WAYS ME SHORN. �1 R �•� WU'• �S'►5'B— --T S —; __D.oe' —DATE:=fs.y.=L41I a— C= , 1 Al A �'a I CERTIFY THAT THIS PLAN FULLY AND C= Ad TES 6 ACCURATELY DEPICTS THE LOCATION 3ND c IS « R l+ DIMENSIONS OF THE BUILOINGS•AS BUILT.AMOI �A ty.,f •. 11 FULLY LISTS THE UNITS CONTAINED THEREIN. OT LA �/r) 5{A , FO s+a I E I I . ► l.a' PLAN OF LAND MB IN (ODNOETETT MHB/FTIDAIEID(L9IIOSKU C ) (Curm ADO BARNSTABLE, MASSACHUSETTS a!j PREPARED FOR TOTAL AREA OF PARCEL 91 RICHARD L TERRY �O_LeIBoBp��e1•' MAP 317 = 3.57 +ACRES (INCLUDES LOT 39) RICHARD J. HOOD GRAPHIC SCALE N FEET Aaa'rr. LNICAU aR' 2/)J/!71 T/xI•'J1. P94m587ONLL Wum R'N 801YiT0A .. - r '°r.�nv♦D: 00? �ti..•"��' SANDWTOB.YA9SAC0096TT6 0M$3 sr002 aar 1 aF J PB_(508)530-1201