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Home My WebLink About1070 IYANNOUGH ROAD/RTE132 - STAR MARKET (2) ( C)-70 rxou9k Pa. l_l i. 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map OZC Parcel Permit# J Health Division ��(11� Date Issued ak Z_ Conservation Div sion _ o� L Fee Tax Collector Treasurer h1115T OPTAr d.�FVvTR Planning Dept. ` 1: TION PFRMIT FROM T>;F ERING DI 5g)N pfU,). 7,),;,Ta 1,;+3Ctiti Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address � -• �3a. � 5 ✓►�-L- Village ;T�Aq 01- .f c U "Rdl� Owner !:Saewe1eu ,ff-_J,,Address '150 WZ( S4- S7<ea4-, Telephone L!;- 'Al 3�"4 630 Cz3ct='Bz>4_ %-off f5�- oz3;" Permit Request Foy ts.14%a•o.• ay s 4-& :w44-�gyz.: �Elcc_,� A„Agw, x, b 6rZ4 9-7�+•�' V,S pw S ukR I c 0 D ez c C L 0�.. ��c.'�e i z- U, S �d��Dzw►o L,��•rJ T�,�-�-jc Ste;.,,k.Cae_s l4LSa r�.x�`� �yyt-�lc�' bias-r i►� �'1,G.1 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation -k-JLS co Zoning District Flood Plain Groundwater Overlay Construction Type OA l -Sdt�j Lot Size Grandfathered: ❑Yes Cl No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure dag6& 1,T L1". 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 Number 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 Detached garage:❑existing ❑new size Pool: Cl 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 - �- 1�►� -�' Proposed Use \%SpOry"F_ L.)S a BUILDER INFORMATION 1 Name r12-TIC,., Telephone Number Sag a-so—a±100 Address <gzD LAA 1&-A J �` -� License# CS 4v or'q qs3 NU2LA E-SA*%Z!, I'Lt 4- Oa,356 Home Improvement Contractor# 1N�W,We., C.qjg-,.o' e ,cl - Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s SIGNAT E DATE a ' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED � r MAP/PARCEL NO. ADDRESS VILLAGE OWNER- DATE OF INSPECTION: `a FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT' ' t. ASSOCIATION PLAN NO. __ The Commonwealth of Massachusetts NE - Department of Industrial Accidents �a --- — met 81/0rest/08ONs 600 Washington Street Boston,Mass. 02111 x Workers' C sation Insurance Affidavit name Jr7 ' � -�- ��`r2. ' -a$ it ►��ja4�1��- location- G"f14 city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole etor and have no one working in ca achy yr/p ❑ I am an employer providing workers' compensation for my employees.working on this job. :.:::::::: :::::::::::::::::::::::::::::::::: �:-. :<:::::'aa n o:z:nr Y to D address ^. 0. < >N. <> _..... cites � . .... .......................phone#.::::.:..« .. .......... .,:..: —;;:.;::.;:;;:.;;:;.;;;;;: ............... :.t ❑ I am a sole proprieto general contractor, or ho wrier(circle one)and have hired the contractors listed below who have pyio;,oGt � , R.�• the following workers' compensation polices: :: :»:.....:: :..... :{:>::>::; >:::::::>:<:.::::::::: :>::>:<:»>::::»::»:: comaanv n ��Ti`:v��:stiJ is ifjii}iii:;i$K,v',:;{ii:;: :;i:;i}:;:;:•F;:;; .,'.;i.....}i:Lii:�::'::: ii:;v':::;':::;'r,':;ii?i <:;:!:: :::::;:'}{i:;i:,i:S'<'::i>::�'n'{';:;i::{i.:i?: j;i: :i.....::........ ii:n<iii:is}ii::ii:vj;i:,'vi::iii:iv>}:: L :{Tess.:• :...,:......::. :....:..::.: .. .. ....::... ....................................................................................................................................................................................................................................:::.:. ......... .............................:........................................... :.:..................:::...................................................................,.•:::............ ............ .......................................... {:..::.e>.�::;`;:•s>........ :<vrie`tih ..................... :.. ......................................... • :insnraneeca:.;:.;::.>::.;::::-:::::.« :::::::::.::::,:.: :::.:: ::.:.............. ................................... ol+rev ,:::::............... .......... :::::::>::><:::><:::::>: <::;:<::::::::::.:.: .... ...... ....... ...... c an .. .....:.:..; address.:.. ..... ><afibn x. X. :^�iiL�.�l{;'•:jY!%:`::i:•i:;:?�$:;isv:Ly: T7.7111�1tCe 1N I1 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One to 51,500.00 and/or one years,Unprisomnent as weR as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 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 h eby the pains and penalties of ury that the information provided above is trues and correct Signs Date Print name �'t-1-;io•tw G• i�/l�e�1'� z Phone# Econtact do not write in this area to be completed by city or town official permit/license# Building Department ❑Licensing Board diate response is required ❑Selectmen's Office _ ❑Health Department phone#; ❑Other,�,� Or-ad 9195 PJA) Information and Instructions 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 contract 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.receiver or 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 or building appurtenant thereto shall not because of such employment be lccmel tobe an employer. r yer. MGL chapter 152 section 25 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,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 04n 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 maybe 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/ ense number which will be used as a reference number. The affidavits may be rearch d in- the Department by mail or FAX unless other arrangements have been made: have you should any questions. The Office of Investigations would like to thank you in advance for you cooperation and y 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 Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 --- - _ - _ �lze iiomvnaoowrea.�,� o�✓�/�aaaac/u�ael� `. BOARD OF BUILDING REGULATIONS leense- COIN'STRUCTION SUPERVd'SOR i Numhe CSC 054753 _ tByhdafe d b6112/1+98 Esc �rOk/12/2602 Tr.no: 24902 Restricted Too' 0 _ W,IL.LIAM C FARAD(E�II 236 PLAIN ST M "" NORTON, MA 02766 Administrator