The URL can be used to link to this page

Home My WebLink About0058 ANCHOR LANE � �� .: �,. ,,.. .,, -- _ . , _,. ..,.. _ , ...r��-� ��... . .,�. M oFtM Town of-Barnstable *Permit# ,8-/7— 3 0 ,5 Tres 6 months from issue date Regulatory Services �, ee • i ..� y�BAMISTABIZ'$ Richard V..Scali,Director ai MF A63 A10 �040I y Building Division MAY p Paul Roma,Building Commissioner �Q��n 11�1� 200 Main Street,Hyannis,MA 02601 d'� �J�H www.town bamstable ma us A Rq IS[AB� Office: 508-862-4038 Fax: 508-790-6Z30 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Inorhd Map/parcel Numbern /� A _• Property Address G( ►o LT't �� 1� / '•a ' 6 2 `i ❑Residential Value of Work$ Svafl Minimum fee of$35.00 for work under$6000.00 LA "� Owner's Name&Address MLARAM�AD &HAWP FIAMID , )� �/JC Na� ZAPT `Contractor's Name n.l C) Telephone Number 6 3 t L\ I Ll 3 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Worlman's Compensation Insurance Check one: ❑ I am a sole proprietor 1/Vi am the Homeowner ❑ I have Worker's Compensation Insurance. Insurance Company Name- On �� U� rs LOLA rll e. Z Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑ e-roof(hurricane nailed)(not stripping. Going over existing layers of roof). Re-side ` Replacement Windows/doors/sliders.U-Value Uk-(3Ld F�(maximum.32)#of windows �' N #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: \ QAWPFnM\FORMS\buiildmg permit forms\WTRESS.doc 0125/17 The Camamrveakh of Maysa ttrselts ♦♦ iJ''e�aa�e�t of��Iccid�rt� • 600 Wagagim&reef Boston,M4 021H ' tvrvi�.mas�gov�Ef:a ; Workers' C Iusmr;mm AfFdavit SmfldersJCantraL'tarr FI ers AppHm#Iuftwm affiu Mmse Prink 4-Nmm t4 24 r Are you as employer?:Checkthe appropriate bozo Type of F v ject{requ'n-ed}_ L❑ I am a etaplaper ui& 4_ ❑I am a general=ffmctar and I 6. El ooaatzuctcog employees(fall a=Vor part-time * bave,hiracltbe sub•coat�trns . 2.❑ I am a sale pmptaetar orpart=r- listed oatlze attached sheet- I- ❑Remndeli,;g• sbip and Dave as emplTeea �ay�a�bave�o�s'. S' ❑Demolition waiting, forme in arty rapacity. 9.,❑Bnildmg adzizfro>: J�Towudmm'ComaIx inset mn a Camp-«+er mnce j 5.❑ We are a=rpomtmn and its 10-❑Elechic it repairs or addjtions 3.V Iamabamwzmer doing all vm& officersh=clRrcisedtheir ' 1L❑MmApingrepairsoradclitions , Myself fl TiE t of e�fiaa per M4GL ❑Roof repass L. ismm=erequimdj i c.M JIM and We bane no employees-[No was' 13_❑Other conq- requfifA] •Aap spgsaet6�sc�hecYs�fl mast also ffiothS beLonr �eheQw�cers`mmp paTcgi�u� fi ngrstaho salt c$is afedzc axe damp ag Wad aadH�eahis aatsidg ¢amst submit aacmafiidavt'iadi�taa sacT Sit checi�ir�s bmc mast s m additi—1 sired s1=d=g tb2--cf the su1Hc a=d ststP w1Mshs crnot1hwe h.n e e®lvpees.Ifti�esob c haee esaplo c5ey�srpaeside tea u ate'-mP.PGHU mMMtrex Tam an amip7apsr Eliot is prQuidurg workers'compertsrart grszirarrca for say eurplv}�ees $elviP is$ra pa8�ttu3 job sda informrdiam . T�+�*+�Compaapliame: 'Policy�ar Self-im€Lim•� �i�'iartDate~ • Job Site Address: CiLv StaWzi _ Aftach z-copy of the work.&campeasatioapolicg decharation page tshouing the policy umber and espirzHon dafs). Failure to seams coverage as requireduader Section 25A o€MjGL m 157-can lead to the imposition of ctimistal pemuim of a f m up tb SUOD OQ andfor otie-yearimprisoumezt4 as Zvi$as civil p—sllges in the form of a STOP WORK 01�=and a f-me of upla. M a day.1 aiast the violater. Be advised'fird a copy of s ew snag be ias�to the Dffii a of Isvestig n ofthe MA fat:msumnw coverage vedficafion. Ido&eraby undsr dispaina andpcna2Y'ss afpedW y fbatfhs informairbuprnaieWahm a is true and c:arrect Si*mitma- o arkid use anF; Do jwt write in Sail area,to be completed by city artown a;y7daL City or'Tawn: Pernillriceme: Issuing Amflarky(drecleone): L Board of$rani r.BmWmg Departmmd 3.f itpTmm Cltrk 4L Electrical Inspector S.Plxmbmg hispecfnr *Ofber Cont2ct Ferran: Phone . and Instructions • Mks �cff 3 GIaws M aII=P'U=m ode �eosa�i� theiF� - Pmsa= to this sb tafe,an'=V&Ylw is dcfrisd as=e�ypccsaain the smnm of ana b=nodes=Ly caulract cfIsury =qz=or aaplie:4 eml orwziff mf _ asso M.carpoffrm or other legal m3,or M two or mole An=v&ym-is•domed as aaa ,per, of a deceased I or the offfie edged m a job T@, Mdmcffidmglbe legajrep=cabiives �P o94 r.Cccivw or t mstee:of an i &611nal,pMt=Sb P,associa -or off=Iegal etity,MqAU5ng CMPIDYees. However ffiM horse natm=�fix=aPmtneots and residwfl=ch,aorthc oc ofihe- . owner of a.dwcIImg �� ,-err;�,,,� off worTc.®.such dW�g base dweIImghDu=of az�er� pm=to do ca mF or on.the groan& orbmZdmgappazitna33t �� shZnotbecanse of sorh c:n:plcymrntbe deemedto be an cuTloym„ MG'ii chept=-15Z,§25C(6)also Stafl'S that¢every stEtL-ar loc:zI ncin gency sh2R w!ffifi0Id$Ze 2==Cr-ar renewal of a Fccase or permit to open a bvsmess or to contract buHff $IA the commonwealfii for airy app&canf:�1io has notprodnced acr�ptahle evidencs of compT�anr�wifh tb�;*,�,-�c�covc�•-agrereq�-" ANY,Mal.��§25CM sbixs=Ie�rrr fhe _ nor�y ofifs pnr�ical snbdivl.- sbaIL e inn any fmrtheP�z6 ofpubIicworicmhI able evidence of campli�ceh t3ie inset .. req=cmeE[tsoflhis bavcbemprrsent�;dtntheco•_k-,u�az3ffiol�L3'-" Alp4m=ts Please fa o-c± the wcd=l cpa pcnsafion affrdavh compjcftl ,by d=cIzing the bobs ffiB±apply to Your.sRnBfraa and,rf ==ss'-Y,suppjy s)name(s), add=(es)and13b= mb=Cs)•aIongw&ffi=ems)of msurance. i m=tcd LsabtkLy Comps gff-q or Lm rdLiability'Partacmh1ps(LIX)wiftno employees other than the members or pis,'sre not to carry wozkcsa compcnsatirm ice. If m LLC or LLP does have employees,apolieyisrequft dL Bc advisedthatthis a�daYifmaybe snhn d theDeparfine�of Indmddal Aceidmts for cow ofinan M=covmmgm Aho besare tD sign and datethe a:Edagit The afhdavitshovld be retznned to the city or town that the app gre:a icm for the pcunit or licanse is being rmjacsf4 not$z D epa tned ofBadaStj ; aI A CHdMtL qDl3ldyDU havo any questions regarding the law or ifyon aiM regamuita obtain a wows' campeusatio:poficY,pl secaU-E=Deparftmem±atfernmmberlislydbelow. Self-k=rdcampM-ri ouldeafart1leir self-ixsmznc6 Iiccaso numbm an the app¢ fete. City or Town Of acials Pleasebesoretizattheoffdavitiseamplefzandpradedlegll5r TheDepatn=3thaspro ce videdaspaatthebotinm . ofthr,a�.davitfor YDutD fM 0Mt inthc eveuttbe Office - -D has to yam g apphcxnt PIeasebesereiDfllmthcpennitlLcroseTinnberwhichwiilbe sedasare:Gcnumber.7ro.•addrfion,anaPPlicant that must submit mulflpIe p=nWi;c==appliba iow in arty gM=year;nxd a3lY snlffn±one affidavit g ct policy inf�on(f nx=;EmY)and under`Job 551n Addres"iie applica shoDld wry"aIl laws in (may Qr town)_"A copy of thc•affidavitthathas bcm of:ially sfmnpcd er marlmd by.taer city or to maybe provided to the - aPPficant as�oo-ftbst a valid aff dx&is on file,for futcm pconits or ficensrs Ancw aim&mist be filed ont carji notxrlatcdP=Tb�s or commerc aly� ' year.'hero a home ownQ or ciiizsa is nbtaai�g a licm-se,or pc�if . ra . dog license orp�it to bn b=cs Ct�.)saidpemm is NOTrrgrmCdto�leta this affidavit CLDThe Office oflnvcsfigzfi=wmld Bmta ffL-mk3m-aiaa&zn=foryonr cooperalian amd shonldyamhave mygaesfions, . please do not hcshaft to givC Ds a caIL. lbzDcpFftncnfsagdress,trlephonzmd;kc cr. - - COMMOUNR2M Of Massachns. Bastm.MA Mlii Fax9 6177X7-7749 xEvised4-24--07 Town of Barnstable Regulatory Services BEAM Richard V.Scab,Director - �+�� ' Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mans Office: 508-862-4038 Fax: 50&790-6230 Property Owner Must Complete and Sign This Sec on If Using A Builder as er of the'subjectproperty hereby authorize to act on may behalf, in an matters relative to work authorized by.this buil ' permit application for (Address/resonsibility **Pool fences and alarms are the of the applicant Pools are not to be filled or utilized bnce is installed and all final inspections are performed an pd. Signature-of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMLSSIONPOOLS Town of Barnstable _.. Regulatory Services S p1rr Richard V.Scali Director Building Division n• mM r Paul Roma,Building Commissioner bs¢ �� 200 Main Street, Hyannis,MA 02601 , www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 c� HOMEOWNER LICENSE EXEMPTION DATE: —o I {� Please Print �`i l� 1 /✓� tn1 2 ? `--. -JOBIACATION: - I e a I ! ' jj le I "I r .y number village "HomEowNER7 l`'1 u ttAMMAJ) S H,4 H1 j) HfAt4ll> > of 3 0 name home phone# / work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,.provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person'Who constructs more than one home in a two-year period shall not be considered a hoffieowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building yermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"cues that he/she understands the Town of Barnstable Building Department minimum inspection proce and require ents and he/she will comply with said procedures and requirements. Signature of Homeowner r Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it'would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend amid adopt such a form/certification for use in your community. Q:\WPFELES\FORMS\btfflding permit forms\EXPRESS.doc 0620/16 NN " TOWN OF BARNSTABLE Permit No. ?I_n?9__ Building Inspector .... cash -------- OCCUPANCY PERMIT Bond __ ---- " No building not;structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to - 11%eo"-Construction Address Lot 72 #58 Pnchor Lade, Cotuit Wiring Inspector Jet G� Inspection date Plumbing Inspector f - Inspection date Gas Inspector j = w -t Inspection date I Engineering Department _` inspection date {J THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY. COMPLIANCE WITH TOWN REQUIREMENTS. ` . .- r.......................a.`,......................, 19...... y , . ....................... Building Inspector, � ,�: IL o o ,-a7 <90 � v _ a 1-9 iVcAll'o AZ L"Ilve!5' C,q i Qur11i�17 t3Y v 1 F1':FrFry G T"!it, } R.?tFY T TF,S FC`UNDA"FIC)(4 1t W)RMAN IS lOi:•1"t',• i f,!, ''LC" .AS SHOWN AND 'a CvNFFJfvi,;,- i V4 F1 OF /a9 't3 E kJj�mA'� +P.V9Ti9Q(6 121 i b REGARD.'m c SET13.AC:KS FRaQ` $Ff Ec l?-!', � AND LOI " INES. 7 Aine�P ^.. "'eor,s map and lot nu.,b ...... A/1111).4-9.4...A.?l al,11— ............... cl,2 114� THE Sewage Permit number W/ .... SEPTIC SYSTEM M • ABLE, House numberot3 /(11 ......U............................................................ INSTALLED IN COM WITH TITLE 5 1639- S not & TAL COIDE M TOWN - OF 'BARN ULATIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... .......... ......................................................................................... ##40C E............r TYPE OF CONSTRUCTION ....... —./J2. ..... ............6.......Z.6...............19J...1 .... .... ... ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby........2Z.applies for a permit according to the following information: Cr ............................... Location ...4P� ........ ......1'0(fiWE......................I OA/ ......... ProposedUse ... 6 .................................................................................................................................... Zoning District ......R. ..I.....................................................Fire District ..eo ..................................................... .....%.-.-.5.....Name of Owner 546W. 7_14A).........Address y R ................................ Name of Builder % A,6Dh)5W1,D1\S..........Address ... ..................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ....... ................................................Foundation ........................ Exterior .......... .0&-h. ...........Roofing ..-H5).0#19.47......4. A.6-4,kJ.... ....... .. . Floors ...... .....................................................Interior Y. #1:. .... .......................................... Heating 4�.... ..... ......................Plumbing ..0.................1..... 4/ q;.4..................... Fireplace ..........()IVF............... ......................................Approximate Cost .....c2.7,..,6_i*Q' 0 11111............................... ..... Definitive Plan Approved by Planning Board -J&C4_113------19-14. Area ....... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Agx /0 IV -IV \P I hereby agree' to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... .. Ak I A 7 Theo Const. 2147 a t...... ...... Permit for §ing�Ajajr '.jy.. .4 ..... . ....... ...dwelling.......................................................... Location ..lot...#-72-----5%8--An-ohor...Law.............. ........cotillt.......................................................... Theo Const. Owner ................................................................... Typb of Construction ..........frame..................... ............................................................................... Plot ......................... Lot ................................ Permit Granted ...........CTU-1-Y.....1,&...........19 79 Date of Inspection ..............................,.......19 Date Completed ....... 19 PERMIT REFUSED ................ ...... .................................. 1.9 ........... M ............................................ ........... ............................................ ru Z) .Approv�gb .......... 19 0f. M ............................................................................... ..................................................................... Assessor's map and lot number-, ....... .��........ ........�f. �� /J� �� l f'TH t/ � r tom` r�� Quo Sewage Permit number :`3 ..... ,......., .......................................::.. j ,, v Hoe number .. ... `! r rasa B9SBSTABLE, • i O� 1639• 90 ea i j1 �YAY d\ T`OWN OFF BX NSTABLE - BUI�LDING � INSPECTOR � APPLICATION FOR PERMIT TO ......; ..f,(!............................... ................. . TYPE OF CONSTRUCTION .......bY DII ......1.`.1�/� 7. ..........7-10rr. .,f, //) ....................................... . � F .........................Z6..............19.,/., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: y �y yam,, / �ry , Location f-./�/ .......1, :.........;(`7//( lJ,�r ...... !� <��.....................(. ..7��. 4r......:.....:.........................:.........:" ProposedUse lh JAf,� l // .! .................................................................................................................................... s i.f Zoning District ...... .....!......................................................Fire District ...1..,.Q, l/ .......................................................... Name of Ownerh�� ( ./1/ .. ( /1,� .........Address ....�.�J.:. C/�,0`� .rEldi�T ,• Name of Builder �,.. � (.). �A..11 l,.a..........Address ... -r',..... 91 /j� l,.l,�C. ..................................... Name of Architect ..........Address Number of Rooms ��1x Foundation �"��.� Cann/' Exterior ��, ?>. �F '.fl=� .. � � "+-�.5 ......Roofing ... .. ................. Floors ...... � 1 •5......................................................Interior .........J 1 .. W � �!.:G...S.......... .... �i�'�.. 1� (�1.....lJ'" . ............:... �"" .0 Heating . Plumbing y �Q�/7 ..... Fireplace ......... .............................................................Approximate Cost .... z. (/ ........ Definitive Plan Approved by Planning Board wa� `l• ` ______19__� Area ....... �./.... ......... Diagram of Lot and Building with Dimensions j Fee ...... .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I a�x 7 3s V I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above y construction. j Name ...... A ........... Theo Const. A=24-91 No2�:E�........ Permit for ...single..lamiay.... dwelling........................................ ..................................... Location ....l9�t...V�Z....50-Anchox-La............ ' Cotuit ............................................................................... Owner ......Theo...CoRp.t .......i............................ Type of Construction ...........same................... ............................................ .............................. Plot ............................ Lot ............................... Permit Granted .............3, .1y.....18..........1979 Date of Inspection ....... .........................19 Date Completed ......................................19 • PERMI,TAEFUSED ........................................... ...................... 19 . .. ... ............ .la�_,.. ...... .. .. ................... .................. . ..... . ...................... ...................................... ............................... ....... ............................................................................... Approved .................. ........................... 19 ............................................................................. ................. ........................................................ r _ r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o2 Parcel Application # Health Division Date Issued -712_611S Conservation Division Application Fee ."7-0-rV Planning Dept. Permit Fee S 15,•oo Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address IGNC-f/oa ��NF Village & , Owner /Ny olhol,4 0 i.D Address �e9�Gd�1 Telephone S"dbr Permit Request RF 7-14 lyl ve tJ PXg- Ao6& S�!o/w6 �oo,� /� G cf iwDoalS �in,gav Square.feet: 1 st floor: existi ngpL proposed mg—proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3- d° d Construction Type Lot Size . S 46,9 Grandfathered: ❑Yes ❑ No If yes, attach suppoiting documeritation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure JAS Historic House: ❑Yes O-<o On Old King Hg' way: OOes 'Y -P4o Basement Type: LI-Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) d ry Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: X] Gas ❑ Oil ❑ Electric ❑ Other / Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 2 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 MU h1Iy1A /D Telephone Number Address ST A1Y G Pe ),ANC" License # Home Improvement Contractor# Email .SCR-1 � m 14,2 00 6�� ,064 Jh worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,#kAl SIGNATURE DATE 6- f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER i r DATE OF INSPECTION: FOUNDATION FRAME i ;a 1• 1 , INSULATION I Y ' FIREPLACE 1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1 GAS: ROUGH- = FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. r a. • • ,GU 7- 7/ U T A16 �z zo W a 0 P Qua;L'ED C i' sc�9LE ,,=sa ' uui i97 . r�'�t1 lr.R4�t�•.. . �` a 4+�.� i•F;_; Fn(J1•.n;;�rC?f� i�•-- � ' ;.talc \� A� :i•F Ct • _�:tJr�jrt: ;,f�, � i K��f. �'�� - f ;KJ..,�n i u 5 E-f r.(?U':` vr�.,r-,� il.l, - .SIJC i �r •C.1'� �, _ c0 I/. /r FLOORPLAN Borrower:Muhammed S.Hamid File NO.: 410324 Property Address:58 Anchor Lane Case No.: City:Cotuit State:MA Zip:02635 Lender:Guaranteed Rate,Inc. FIRST FLOOR Deck 22.0' 46.0' Kitchen Bedroom Dining [Bath 2 Car Garage 22.0' 24.0' 24.0' Bedroom Living Bedroom 5 B th 22.0' 46.0' NOT TO SCALE SKETCH CALCULATIONS Perimeter Area Al 46.0 x 24.0= 1104.0 Al First Floor 1104.0 Total Living Area 1104.0 Boston,MA 02116 � , . ' Departmr�rrt°of1irduririal�cri�ifs . Office o f IAVM* r " 600 J�Yashiirtgton Street Boston,AM 92M . www.aiarssgw/pia Workers' Compensation Insurance Aft'-Lwib B"parrs/CCMtMCbrSMeetidans/Phunbers An icant Information Please Print Lee�� , Name t-f a HA M 1-1 IN 1 /n� r Amass: 5 :t\ Q p Z b �- � � Phone#: - /Ii,3 Are you au employer?Cberkthe appropriate box: Type ofproject(required): I.❑ I am a emploryw WI& 4. ❑I am a general cad actor and I employees(f a im&or part tie). * havo hired the 6• ElNew won 2.Q I am a solo proprietor or partner- lkfed on fim attached sheet 7. []Reazofdeling ship and have m employees These sob-eo rrs bane S. []Demolm= wm3dng for me in any capacity. employes and have works' [No wor]ers'cones kSM—noe comp•iusar anrr 1 9. ❑BmZdIDg addition 1 S. Q We are a corporation and ifs I0-Q Elwtdcal repairs or additions I I am a home wnea doing aII wane offic=hxm mmzrised the' -ILEI Phnnbingrepairs or additions myself[go wmier 'camp. . ofma:rgdouperM(3L IZ�Roofrepairs �-1 t a L52,§1(4),and we have 3m eoxployees.[Na woriaecs' 13.0 Over comp.fiLwrm a requird-] 'Amy gVIicmttbat ched6 box#1 mast also iM mn:the sectb L bd m showing&:i w 'oamp�po1R7. am�fi— t Somww=who snbmitlhis affidavfd inficafmg they a=doing in wodc and ih=bile mftHe wI mast submit anew arndav;t ind;czrmg such #Coafza cira fhf ebeck8th box mast ate on■tirlffia=T shmtsbnwiugt w muse aff m svb-Ccm±mctxs and staff whetb=or nntfmse a tidies havo eaxployezL imc sob-�c have rm �Pl &Y�Provide this wo<iora'camp P�9�m I am an employer that is prapir&itg workee compensation ire for W mTL7'em Below it the po&7 and job site . nr,formation, - . Insm mm Company Name: Policy f or Self-ins.Lic.#: BKpirationDate Job Sifz Address: may : Atfarh a copy of the workers' eompeasatian policy declaration page(showing the policy number and=ph-AtWn date). Fa3lrxc to s=xm coverage as required under Seth=25A ofMGL c.152 ran lead to the imposition of coal peon es of a 520:0P to$1;500.00 and/or one-year imprisoamre�as wen as civil penalties is the from of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised ffi-at a copy of this stafzmaotMay.be forwarded to the Office of Investigadions of fbc DIA for fiMM oce coverage vrrifrCatimo. I do hereby ca tyy tha pains mid pma&t a o?f, erjray that the i�rfarmr�ion pravideli abape u krae and correct Phone#: 0177dnI use only. Do not write in this are%to be conplefed by city or town VUEC&L City or Town: # Tssodarg Authority(circle one): L Board of Health.2 BmldingDeparfineat 3.CifpfTown Clerk 4.EIIedziralTnsgector S.PlambingInspector 6.Ofher . Contact Person: phone : Information .and Instructions Massachurse ft Ge=al Laws chapter M regm=all MVIU=to provide wad='ca33p=qaton for ff=e ployees- Pursuattao this st&e,an eployw is defined as a.every person in ile service of anod rr under any coact of fir, express or implied,oral or written." f An eWkV,!7 is defnud as-am individual,pmtnera*assoc 61fi cmpmatiaan or other legal eartity,or any two or macs of the fo¢egoing e.ugsged m a joinf eoir�prssr,andim4nrrm Jim legal npaascatafives of a deceased employer,or$e receiver or tmstee of an individual,partnetslup,associsiinn or other Iegal entity',employing employees- However the owner of a dwelling house having not more than three upartrnents and who resides therein,or$e occapat of the- dweIImg house of another who employs pessoms to do maintenancc conskudian or repair wane an snap dwelling house ormfheg:n=dqorbWYmgq3purft=ant1heze6o sb&U not because of such employmed be deemed to be en employer." MM chapter 157,§25C(6)also states that'everystale or local licensing ageucyshall withhold the ksuance or renewal of a license or permit to operate a business or to construct bu><1dacgs in the commonwealth for any applicautwho has not produced acceptable evidence of cdmpHamce with the insm"ancu coverage regnu ed." AdditiunaIIy,MGL chapter 152, §25C(7)states"Neiihcr the mmm9awealth nor any of its political subdivisions shall ...... ear into aay conftact for the peril=mw ofyublio wm kunml acceptable evidence of cammpL-wcewith ihe insurance., requireari fs of this cbapterhave'Sem presented to the courting anfhafy." : Applicants , Please fill out the waad='compensation affidavit caahplobn1y,by chwJdag the boxes that apply to pour sitnati m and,if necessary,supply sub-contractor(s)name(s),address(es)and pipe ra— er(s)along with their cetificate(s)of insurance. Limited Liability Companies(LT-Q.or Limited Liab>Zity Pips(LIP)wrthno employ=other f um the' members or partu=-s,are not mquirrd to caxry woda&campensatia n insurance. If an LLC or LLP does have employees,a policy is regaired. Be advised thatthis a$dayitmay be sabmitted to the Department of Industrial Accidents for confirmation of insurance coverage Also be sore to sign and date the affidavit The affidavit should be returned to fac city or town that the appli—finn for the permit or license is being regnestixt not the Department of Industrial Accidents. Should you have any questions regarding the law or iEyou are regahrd to obtain a wcd=b' co¢rrpeusation policy,Please call the Depmt=ot at the number listed below. Self-insured campanies sboulci enter fl2eir self-insurance license number an the appropriate Ihm City or Town Officials Please be sure that the affidavit is celeste and printed legihIy. The Department has provided a space at$e botf of the affidavit for you to fM out in the event time Office of InvestWfions has to contat.'t you regarding the applicant. Please be sure to fill in the pen�it/license mmmber which will be used as a ref�rmce number. In addition,an applicant that must submit multiple p®aiblicame applitafions m any given.year;need only submit one affidavit mdicaiing current policy infomatian(Lf neassmy)and under"Job Site Addres"the applicant should write"all locations in. ' (city or town)."A copy of meaffidavit that has beta officially stamped or mmimd by m the city or town may be provided to the applicant as proof that a valid affidavit is on file for mime permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizma is obtaining a Hcm=or pemk not-related to any business or cm=mm ial venture (Le, a dog license or peonit to bum leaves cb--.)said pmsaaz is NOT required to complete this affidavit The Office of Investigations would Ifim to thank you is advance for your cooperatirm and should you have any questions, please do not hesitate to give us a c$IL The Departmenfs address,trlephome and f'axnumber • Tlae �Ittt:of achnse#Is - Depeitmmt of TT;(hTcdrie1 Accidents Mice of XnvestjgaUo t�Q man S[re� Baste,MA 02111 Ted,#617-727-44QQ ci t 4.06 or 1--M-MASSAFR Fax#617-727 77� Revised 424--07 Town of Barnstable Regulatory Services �OFTHE TOtyy Richard V.ScaIi,Director Building Division Tom Perry,Building Commissioner ,�� 200 Main Street, Hyannis,MA 02601 QED www.town.barnstable..ma us Office: 508-862-4038 Fax 508-790-6230 HOMEOwNE_ R LICENSE EXEMPTION e)2 O ) Please Print DATE:0� _ JoB LocAnom- &R A A No Z-A 0 F- C b t(Ai t- number stmxt village -HOMEOWNER7: Nl u IMAM_r/�D ° Y name home phone# .9 -�! work phone# cuRRENr MA LING ADDRESS: i ve 14 (11- _C—A {" L 0 l L,it �� O city/town state 4p code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submitto the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned`.`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned``homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pr dares and require is and that he/she will comply with said procedures and requirements. Tign06 of Homeowner Approval of Building Official •_Note: Three-family dwellings containing 35,000 cubic.feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shag be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q-\VTFIIFS\FORMS\building permit forms\EXPRFSS.doc Revised 061313 Town of Barnstable Regulatory Services B"NST"IE, 9 Ames 8, Richard V.Scali,Director �p 1639. �0 r6 3+9. Building Division Tom Perry,Building Commissioner . 200 Main Street,Hyannis,MA 02601 www.towiLbarnstable.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 my behalf, in all matters relative to work authorized by this building permit application for. (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 Signature of Applicant Print Name Print Name Date Q.FORMS:OwNERPERMISSIONPOOLS No SEEM ME ME mmmom ii MM■Miii iii ` � �ii M ME MEE MMmmMmMmMM MENEM ME ME MmMMMMMmmMMMMMM MEE 'M I M BE Mmm=MmmmMmMMMM MMMM ME mom SEIM MMMMM, mi ME EMS ME ■ ■M■■M ME . ........... .. .. ... ..... .. .......... .... ....... ..... MEN No momommummommmmm MOEN NEI Effil iiiiiiiiiiiiiiiiiiiiiiiiiiii�■i�NE NEI i■iiiiiiiiiiiiiiii�iiiiiiiiiii�ii MENEM ME ME iiiii�iiiiiiiiiiiii�iiii��es�■�ii iii��i�iiiii�■iiiii�iiiiCiiMO No