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Home My WebLink About0790 IYANNOUGH ROAD/RTE132 - NEW ROOF Rd - i Map c� j 1 Parcel Z1 6 Permit#' House# �= 7�® 3 Date Issued f Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee Conservation Office 8:30-9:30 - :00) Planning Dept.(1st flo o Adrain. Bl g. r 111E D ' ' e Plan Approved by Planning Board i BARNSTABLE, MARS- • '�lED MA'S�`� TOWN OF BARNSTABLE f 7 FO Building Permit Application ; Project Street Address = yqh 04g� 4w N t/q�l�l i T , /L��f O260/ Village . Owner Coot 144rdor 4s5ocig1e5 Address 1303 5. ron+gle A 54r.4 14gs41,,s MN Telephone I/1- y3B- 9.Z88 - SSo33 ;Permit Request ( - First Floor I l 2 square feet Second Floor square feet Construction Type on Estimated Project Cost $ /$y 688 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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.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: ❑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 n Builder Information Name AZOAf 14meoli c..+ 40!2�r n Sv Tnc. Telephone Number ANEW 9W-4w-776jf Address .3 4(Amei C rclr- License# Arden ., 41C Home Improvement Contractor# Worker's Compensation# (A/C /OW W317 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 SIGNATUREY LATE BUILDING PERMIT DENIED FORT LOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS +' �f VILLAGE OWNER DATE OF INSPECTION: 1 FOUNDATION FRAME + INSULATION t F FIREPLACE ,. ELECTRICAL: ROUGH FINAL — t PLUMBING: ROUGH t FINAL GAS: ROUGH ''= FINAL — 3 f 1 FINAL BUILDING r DATE CLOSED OUT `w s ASSOCIATION PLAN NO. 1 _ The Commonwealth of Massachusetts _:�: Department of lhfdustrial Accidents •-�.,,�. � Olfice of/nYesligaUans �= 1 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit �� / name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a'sole ro rietor and have no one workin in any ca acity II am an employer providing workers' compensation for my employees working on this job. c �C, . comaanv name: /1/0/,� �MlriC„ � ►`.�0 irs�MJ address: 3' Wietift�`LG ..: ..:.... city: 141-41 416 .Z 87 V nhore insurance co. C NA policv# ❑ 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: company name: - - address: city: phone#. insurnnce co. Xolicv# comnanv name. -. . address: city phone#. : olcv#insurance co. Failure to secure coverage as r.quired under Sermon 25.E of MOL 152 can lead to the imposition 911 ceuninal penalties of a tine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 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 vetiflcation. I do hereby fy under the p and en i perjury that the information provided above is true and correct p (� Signature Date l 1 L g`�/, /i AQPrint name Phone# 1 ��'2� S��t� official use only do not write in this area to be completed by city or town official city or town: permitAlcense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (mused 9/95 PIA) CR Information and Instructions c4 Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any corm- 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 of the.foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the reserve: 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 c: 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 renew of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who ha< 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'eviderice of compliance v:ith the insurance ro-quircmezts oZthis chapter have b n presented to the contra 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 io 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 0mce of Investigations 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406,409 or 375