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HomeMy WebLinkAbout0036 STARLIGHT DRIVE � � ,,� � � 0 .. :. .F_. ..... 4 - ._..r.... � _ ��_ .: "'�=_I_ -.�....s.__�,,"f •1�a NWT i^- "� ^.3_.. u. +�. ... .._ ..:,.. ..... ..:..m u.Y.t.. � _--:...__ .;ems._:.:' _ - ;.: rh ,. , ACTIVE I tME 'awn of Barnstable *Permit#a occ(ol pEx Tres 6 r onths jron is, jlate ' ~' Regulatory Services ■natvsrABM v� MAS& eRMIT Thomas F. Geiler,Director LIAR 3 0 2009 Building Division Tom Perry,CBO, Building Commissioner .OWN OF B.ARN$TAS�.�. 200 Main Street,Hyannis,MA 02601 www.town.b arnstab l e.ma.Us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number :7Re rtyAddressc.Jsidential Value of Work 3 UO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 10yNG,4IV �� J/Y} •lan �J ,1 �/�� �pil/S y/ , Y/C, 44, (,2,)- Contractor's Name JA-lne.S ©On/ Telephone Number 400 Home Improvement Contractor License#(if applicable) M9,53,5 �Coostction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑� Ism the Homeowner have Worker's Compensation Insurance Insurance Company Name I J' c c y I tI104 Workman's Comp.Policy# 8 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ R/ed Replacement Windows/doors/sliders.U-Value , ,�,�j (maximum .44) *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 is required. SIGNATURE: L QAWPFILESTOR.Mbuilding permit formslEXPRESS.doc Revised 100608 f From:Slisunna Robinson,Hunter Insurance At:Hunter Insurance,Inc. FOOD: To;Denise Geode Qato:snoiaa 11:18 AM eage:a oT ACC&D CERTIFICATE OF LIABILITY INSURANCE MOOPI OA001MI NYY"B PRODUCER THIS CERTIFICATE;IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 399 Old P-iver Road, P.O. BoX 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOW. tdanville RI 02838-0001 Phone; 401-769-9500 sax:401-769-9502 INSURERS AFPORDING COVERAGE NAIC friGUFtED moon .As:,ociates Inc: INSURER A,' nas44a4al Aten'a tnstmanca co 00A Gutter Helmet 111SUK-Ra I A*sang I'.utual zn»xnc* co. DBA.Aenewal bt�tt .Anderse of RI INSUREAC: DBA Gutter Helmet Roofing 1137 Park East Drive INSURERD: Woonsocket RI 0289S IN�aUT1f R Ei: COVERAGES n-E POLICIES OF IN.SURAAICE LISTED SCLO`N HAVE:BEEN ISM=TO 11-E IPISILIRED 9ANM ADOVe POR THE POLICY PERM INDICATED NOTWM-I$TAJdO K3 ANY REOSAREMENT,TERM OR COMMON OF ANY CONTRACT OR OTHER OOCLINIENT WITH RESPECT TO%WCH THIS CERTIFICATE MAY BE ISSUED OR WAY PERTA614,TF4R—h�AFFORDED BY THE POLICIES DESCRIBED HEREIN IS%"CY TO ALL THE T0*4.e=VSIDNB AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SK"MAY HAVE KEEN REDOCED 9Y PAID CLAIMS. LTA NSR . TYPS OF INSURANCE POLICY NLIl3BER D3.. MbStE3 DA y buvDDI UhITT3 ., O[NERALLiABILrTY EACH OC UMENCE $1000000 A X COWA(ERCIAL GENERAL LIABILITY MPS26619 09/16/08 09/16/09 pR�AISeS EooacwwTce $500000 CLAIMS MADE Q OCCUR GM EXP JAW orm norson► S l o o o o PERSONAL R AOV INJURY 11000000 004FR AGOREdATS _ &2 0 0 0 0 0 0 —` GEUL AGGREGATE LIMIT APPLIES PER. PRO(x1CTES-COhiPtOP A06 S 2 0 0 0 0 0 0 POLICY LOC AVrotAOBILE LIABILITY CCb aNED SINGLE LWIT 41000000 A X ANY AUTO F31S26Gy 9 09/1.6/08 09/16/09 (Eaoceid�l ALL OYMED AUTOS BODILY MA RY SCI-IEDLt ED AUTOS {Tor gsr&onI HIRED AUTOS FIODILY IN.lU12Y $ NON-OVOIFO ALR03 (Per accithzni I PROPERTY DAahAGE � GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ ANY AUTO OTHER T N EA ACC $ A=Ott Y ADC' S EzXCESSMISPELLAUASIUTY EACH OCCURRENCE $ 1000000 A. X O=V F-1 cummshom CUS26619 09/16/08 09/16/09 A00REGATE $ ^ _ s _ JJX RETi3Jd= $10000• $ WIORKER.COWT-,*b', nONAND EMPLOYERW LIABILITY TCtRY Lih41 F1i 8 ANY PROPR(ETORIPPARTW-P)EXECURVE 28586 1.0/01/08 10/01/09 EL EACHAU;D w S 500000 OFFICERtMEMSM EXCLUDED? Et D*V3 .SE-FA EMPLOYEE S 8 0 0 0 0 0 SPI UVw ECI ROV S below I:L DISEASE-POLICY LIMIT $S 0 0 0 0 0 OTH)Yi aescRIPTION OF 5PERATI0N5 LO TIONi1 I Ve GLEE I EXCLUSIONS AO ED Y Ec`NDORSEM t SPECIAL PROMa O S CERTIFICATE HOLDER CANCELLATION BUTLDSft $1-10"P ANY OF THIS ASOVE DESCRIBED POLICIES SE CANCELLED DCFORS THE EXPIRATION VATS THE R OF,THE I35VIE0;INSURER WILL ENDEAVOR TO&W1. 10 DAYS Y PJrrEN Building Cont, Reg. Board NOTICE TOIHECERTIFICATEHOLDERNAMEDTO THE LCFT.8UTFAILURGT00000SMALL Dept. of .Axtniu is trat Lion IMPOSE NO OBLIGATION OR LIAMITY OF ANY KIND UPON THE WSUReR.ITS AGENT.OR one Capitol Hill Providence RI 02908 REPRESEIOA111160, U �' O REPREb'ENTAT1Vc ACORD 25{2001108} 0 ACORD CORPORATION 1089 l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): / //bC/"/l Address: �� _� 1�� G/�ti r �It': err' City/S te/Zip: Phone.#: VIeyu an employer?Check a appropriate box: Type of project(required):m 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 .2.El I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' o workers' co co insturance.: 9. �Building addition [N comp.insurance comp. 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 I LE]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12 oof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 23. Other Crih OW comp.insurance required.] "My 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 subnrit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: !:;��Tf �✓ '��L� Ur` f J,l✓s - Policy#or Self-ins.Lic. Expiration Date: Job Site Address: �6 �T�/ lY�� 0 J0' City/State/Zip:4,t N S // oa6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration'I e). 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$1,500.00 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 statemetit may be forwarded to the-Office of Investigations of the DIA for insurance coverage verification. I do hereby certifynder the pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: 3 �d —eI Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Li.cense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ✓/. e771/1![6'1LUlF.Q.GC/G f1S✓UGC761QULIfDE License or registration valid.for iudividul use only Board of Building Regulations and Standards before the expiration date.,If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards One Ashburton Place Rm 1301 Registration: t 19535 Boston, on Expiration: 7/24/2009 Tr# 130185 Type: Private Corporation MOON ASSOC INC JAMES MOON _ 1137 PARK EAST DR. Not valid ithout signature WOONSOCKET,Ri 02895 Administrator �ia"a�hu�cft, Dclt;trttvienl f (�uhlir �at'ctti Restricted to: RF,WS ! Board of Builtlitt_ ReCularitn+.> and '�tantlartl- l.A- Masonry only �v -:�nJtif C.sCn aUae"rIsCP t?t�ei-flvy ,cersce RF- Roof Covering Ucer,se: CS SL M40 WS-Windows and Siding Restricted to: RF,WS SF- Solid Fuel Burning Devices DM-Demolition Only JAMES MOON . .; 48_PAI�NE ROAD Failure to possess a current edition of the-, COMBE.RLAND, RI 02864 Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Xass_GovfDPS 3(23T2012 .� f -[I ......1, cCusromcr Name- t*4 7WJ-k kA F7 D VA(41Y Year .Bt i1r. 1� -� /yidetsen of RI B[Cape Cod Renewal Address-31 S tan t-*6N:Z JD el. Customer ID#: 1137 Pack East Drive ��� Sales Agreement C;ty,State,Zip: �,Ar Jta.S-r�AL S_.w alb•Order Number: Woonsocket,R102895 attwoow weers eMt aennd.,.etc�P.er Pbose-Home ,S-OIF V).;—t9: Phane-Worie Page. t of—L Date: —�f3 0 license#RI-12259.MA-119535.C'T-562725 EmaiL• 90%)/JCPJ i 1c t m-Lt.,� UNITS T a CdUltfS E a u o` a' a Room ! $�$ g E t 'E• g' 35 �a a De:etpua. AE �g � z 5ka �e sag ca �ja g ;9 leA N �E s.lnees . Q >i 4. 1 21 y �7c L- U, t,. I 2 .70' 7. ^ 'I t' I I tto 37 37 �`l �' ( I F 37 37 CD CD C3- �• I I 1 f 37 3 a-2 1.. I Gv L/5 (1�/1A 32 C j 'PropoeaL•�ara.� —aa—o,n.p.00ara �.nd.onoa..rooamdc P� T - Credits or Ex s�bwml�n N .a➢d(or �du.vtrlon a�.ccqmc<geoi+.e,mine•.naxmemil q" oA deem�Mmn (Sntosop eORor R�a;c Pmm n.etc] PdY111ftitMetfwd N - C Sub Tara lam.,.) ?o- a� ❑ Check o < sots s�,;, sig ¢ IC.1 ToyS�B; 7S9PPL1 sib local w Pall.) 3 39 Q Customer You vz LvbT awaadzod o -ah.8.dndo.e.ed dsoo�mea m ow¢a d,u _ GeBe eaed d -V—fs.aQiidi ague m P..doe atnoone.old is sus ga®eoc..d.ocoodbg m die.em<mac Mks Credits a Experim. /D Sec Reverse S for Terms and Conditions of Sale.You,the buyer,may cancel total Rttand�g this ttaaeactioa at arty tlme Wporm midnight of the third business day after �s( the date of this traasactiam Please see attached notice of cancellation for as salesiax M.d w o.7 explanation of dtis t- $ ed Ciediu Total M4..fiaseouc or Exp— xaa..t ced e torro Am�dtd AceeP„a3D 10-d°1 J /1-!/JL��.ts� ca„r arttmotm mir..aaa;t,epenx adu,nnn d�tt w«t Pet.dt east fPlm.e.r.aw,t J�t Spedsl 0.dc N tts Total AtmwM of Agtmttatt i Z la'1 Rtta coo. stela o,orn O Dace s�.,rgnoa®mhf,,,.g.:s�on,2 Deposit Required p sP=Ldty"idol. Cl) A"1 Py+b4 tGlsMa IMrrd A'bdesm NenvnlaM rtistlaGon Plaar ro4 Uet,n>re t.uelew Dldm�ai6g y� z�•C N M:d,.nar ase,at gtrarQtlr ed,ab,w mm.eer�a.gg uee��r amye nu+eRsv.nr vseen d,nst¢ rneDueon Completion 1 0eseeddhnetl.&dt d Bal 6ofa,gml t6,dt. $tide tits rtsp.eLaryd ad'e[o.,ad duinginmal4dm.e waloxndeae ft1 ay unless meingt die rite ants tM Otslun,x Wet< and Na�tsu for U+e ode WtYw tiPO.at � ta.sic.IMno e.tw.r. .n imalkd. eu,e.menxet �ta+e and aFs,e isa�'att�,tma,mod.wN e. Pci¢incl„da la6m,mutcials,inselhrion. ' eaatomty Custo.ta eastataer melim+l�u nau� sx� WMe-RmmlEyAdasen Yellow-t= llatoa pink-Romeoww «nw.•al.and digmal of pwdu nplaoed.. CD athlalc Cn 0 tnhlals: /M' Idtia 7/49b —. •yt�n'ddc ee..v�hAn4,anl7sadov6dA,dm C�ponm.OSea A.tm CnN'<.em.Atd�o�..d lM1Y Rmid�RR)m1a 00 wwIlIllyl No +..( l ,A"eo R ,� ,,i,y,.c � �+ r •� �, it t_....:� ,ram� .mil .. , ... � �;..p ... w,,,�.,� . r t'r"' ♦� !pr kid►'"�� .�a �/r� >..._ !� � ea-aft. ""�"'�r'e'""�+wwu,�� ����a"�M�t��� Tx M 1 i "" • �! f 9�' -, i' +fit .:i - ` w ' ,Z .'-*Z '.w •• NA, #. � ,�;�, +• ,♦ 0 x AaaAW , r � <, � T�„,_, i -:� � Sri • �a t ` w :r+�,f . a "` Ri"a� r • ' s ems-t '8 s r � irk- now UIL w ' , 'U+ .. .+ •1 • w4e'1'' x t 1 • „ *THE TOWN TOWN OF BARNSTABLE tom . i BABBSTAXE. 0jul BUILDING . * INSPECTOR APPLICATION FOR PERMIT TO .rN l �✓.C.%.... ..... .. G.��?r ........................... TYPE OF CONSTRUCTION .....:..... it�It1 ..............................................................:..:.................... .................................... ........19........ TO THE INSPECTOR OF BUILDING �6 The undersigned hereby applies fo a permit according to the following information: Location ...C/.v..T... ..r ..... 11�'ll?��.?��/. ....! Proposed Use \ . !la.. .4.4 f!Y..E.......... ....../Fff?'l. � 4 ................................... ......................... ZoningDistrict ........................................................................Fire District ................................................. .. ........................ Name of Owner, %?�rJ, /.1..... .��.°`v1!C.Addressb... !` �5�?!.Q.4f'�+... �.�(/.Sc-/iV c Name of Builders S�C'.a.Address Name of Architect ���,1=57..........................................Address .. �................................,......................... Number of Rooms .........................................Foundation r..............., 1.��........ ..... r�E"T '... , ... ............. Exterior ..�1/!.Y..4�;,�-.,C.5......f''�.c?.�..'� ..... ........................Roofing „l"YS' GT //V6'L4 Floors Interior ..V4/ G d .. ..&`1. T..(/Z:o_C'L Heating /`./O.i....... 1.......................................Plumbing ..�............. Gr�„�,L,.........'�J................................ Fireplace IV�5.. ............................................:...................Approximate Cos1� j.....D-e..................................... ..... Definitive Plan Approved by Planning Board ----:------_______-----------19 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEA kl THE PROPOSED METHOD OF t��t�7VI�DlNG EAR SANITARY WATER SUPPLYl�C V5,�E--B19P6-�AL AND RAINAGE IS E 7- P O 'ED TOWN„ R •OF BARNSTABLI BOARD OF HEALTH A VICENSED INSTALLER MUST OBTAIN SEWAGE PE 1M11T, AND INSTALL SYSTEM. —V111 �8 0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . .... ..................................... / + � � ' ^ j \ ! . � . ` ' ^ ' ' � { ' ' ^ J ' Cammett Builders, Inc. single family Cammett Builders Permit Granted ............(P;46.... i .�"-^ u /e Completed —..�.������.��/�---lV ' w |PERMIT REFUSED ' . ( —~--''~--,.'..-,�r--.----.,. 19 . . � ' ----.---...--,----.-----.---`-- ) , | ^____..____,___,____',,_.___._,._ / ~---_.—..---.—.—,....--..—....^--. � � | | '----^----~'--^^--`—^^...---...- ' l ' @� Approved ,--------------- 19 ----------.----,.~------___. - / | -----------------^---^^^^^^~`' ' ; ! ' � L AT O N O F R TY LI N'E M NOT BE ACCU ATE STANDARD LEGEND Z74 100 NOTE:not all symbols will appear on a map O � GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH r i ORCHARD OR NURSERY v—V—V—V EDGE Of CONIFEROUS TREES l MARSH AREA — — EDGE OF WATER � DIRT ROAD DRIVEWAY v � I �PARKING LOT PAVED ROAD 9cr<1� DRAINAGE DITCH PATH/TRAIL PARCEL LINE** AP 100 me ito ---MAP# 21�—PARCEL NUMBER 4 4 #teso F HOUSE NUMBER 2 FOOT CONTOUR LINE # 36 MA — TO FOOT CONTOUR LINE Elevation based on NGVD29 >/4.9 SPOT ELEVATION 1 .1 coo STONE WALL # -X—X— FENCE RETAINING WALL � F RAIL ROAD TRACK © STONE JETTY SWIMMING POOL PORCH/DECK �] BUILDING/STRUCTURE MAP100 1 DOCK/PIER _ HYDRANT 5 6 VALVE OO MANHOLE o POST p" FLAG POLE T O W N O F' B A R N S T A B L E O E O O R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N I T o SIGN ® STORM DRAIN H PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines ar only graphic representations DATA SOURCES: Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James e1"=I OD'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted hom 1989 oerial photographs by GEOD 0 UTILITY POLE n TOWER we 0 20 40 National Mop Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetria,topography,and vegetation were mapped to meet National Map Accuracy Standards s� 1 INCH=40 FEET* enlarged scale. on the map. at a scale of I"=100'. Parcel lines were digitized from 2001 Town of Barnstable Assessor's tax maps. 4 LIGHT POLE O ELECTRIC BOX ��Qy�FTNETO�`ow TOWN OF BARNSTABLE I PA��RIISTAU Z ,639. BUILDING . INSPECTOR APPLICATION FOR PERMIT TO C.10 5.lW..U.jZ.Z .. ...4. ........................... TYPE OF CONSTRUCTION ..........._,15Z/.1 ....,,, ................................................19........ TO THE INSPECTOR OF BUILDING _-5r6 The undersigned hereby applies fo a permit according to the following information: Location .... . .T.............................�:. ! L(l�..y..� .s "�Il s. /. /.>wf� ,`�............. Proposed Use !�1.1.. .4.4...!Y�............ ..r.!Ycic;�....../.� '1../.�:. .............. ZoningDistrict ../....................................................................Fire District ...............................................Fa Name of Owned..,.-"-/--7, /1.,,.,&:.4,0C.5.. ;C,Address6... !`1��Sf�O �' �.. SC,IiV�c!(zf- Name of Builder OVO-YtV-457 - . �4.L,?1.2...S /.1�.(.'...Address .... ....................:......................................... Name of Architect ???F..........................................Address ... ......................................................... it Number of Rooms ......................Foundation l4� Exterior .r-l/;.Y..4,4.jc.:5j.....� .......................Roofing .�5�?�5�!/fi.��.:.:..�/Y.��Y��-E �... Floors .................................................................Interior ..Y4l. .r ...Y ..�..t.�'/..R�.�7iz. C Cam............ Heating `.(QT.......lN.l4../.. ........................................Plumbing ..�../Z-.......... ......... .........`'l.................................. CW Fireplace ./' ....................................................................Approximate Cost . j.. ... ........................... ........ Definitive Plan Approved by Planning Board ________ 19 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD.OF .H gLTH .i fair PROPUbEL) IVILI HUD Ur t %VlombV t•yt9 SANITARY WAI'ER SUPPLY += 1VE4)&6SAL: AND jMNKU IS HLRLB 'APFR V ED ,_.. TO WN OF BARNSTABL., BOARD OF HEALTH 77 A ' ICENSED I1,STALLER N1US- �BTAIN SEWAGE T PERrvll , AND INSTALLS C . . 0 � /to 71 J--B O I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . ....: ...................................... r TI 6c 1I 1 � l e-V5 D6(i (Z Q fk---d 00 IWA --NCB • s � � - _ _ _ _` ! ,r��—�— �'..� •.—yam' � ,� i �� i �, f /r� � '. 1 � _ .� ., , �• .� �- � � — 'h ' -- T ,� i 4 .1 �. ? � _ _ �e_ ''� • _ `� "Y' J ;^, � ,� _�, � � � �•t ' � 1 1 �i , ��� f fi � �, ` � � f, J i � � '� �� .'e ��,�, ,•. � � • � ���� � - �,� I r i . t ( i�S I�{'•�� � I r .. :y _ .� - _` ' ._ y 'e y I .. t r ' f ' 1 � �.+. r ' s # t i � .. i y t'- t rti J� y � ', t ` �. _ � ., ' i - i' ' t { F ._.._ � 'S ..! t f I -; � r i ,t � - .� J� , • ��. Y,' � I � i 1 . • 1w - / + 1 • • i � k, i � ' -t � � � . r Cp THE The Town of Barnstable �3wRrtsretat L - 9 MASS, g Regulatory Services �i679. Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION �n Please Print DATE: "'� � �(� , `' JOB LOCATION: v village number sweet 716 -HOMEOWNER": home phone lk work phone# cud— name CURRENT MAILING ADDRESS: � �\`i /� br` nn 1 �szip code 9 dig city/town state The current exemption for"homeowners"was extended to include owner-occuoied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provi 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 ing ial on a a homeowner. Such"homeowner"shall shall be resubmit to the ponsible onsible ceptable to the for all such work tcerformed under the buildin ermit. Building Official,that he/shep (Section 109.1.1) ibility for compliance with the State Building Code and The undersigned"homeowner"assumes respons other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 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 iulti r quire,asppnsi sibllf the permit e. To ensure that the homeowner is fully aware of his/her responsibilities.many o application.that the homeownelocefyYo is care[damend and ads the rdoptosuchta form/certifties of a pcation forOn the last use in yourcomm nits age of this issue is a form currently used by several Y 4 Q:FORMS:EXEMPTN y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map` Parcel (� "/ Permit#c56 q aZ Health Division Date Issued 611WO Conservation Division V S co ---,_ Fee 5-5,OG Tax Collector ' "9 C_ 16-7,�s"T � C S Y4M I ST et It LLE®11� ® rLfi � Treasurer ��t _ - ��� /D�,�®� 1° Planning Dept. ENV1110 1o141T� ITU 5 NMENTAL CODE Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address A Ac A,�jw\- Village M04 S46m,5 M: ) 15 Owner LAh Address 36 Ac�b� Dr-_ Telephone I Permit Request ?A11K )5, Jeck, 4- mmc� CX1 Square feet: 1 st floor: existing 0 proposed 2nd floor: existing proposed Total new Valuation '2;2-0 0 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathbred: O Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family j Two Family O Multi-Family(#units) ,Age of Existing Structure Historic House: ❑Yes lid No On Old King's Highway: ❑Yes ®No Basement Type: A Full O Crawl Cl 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 )a No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O No Detached garage:0 existing ❑new size Pool:O existing Cl new size Barn:O existing 0 new size Attached garage:A existing ❑new size Shed:0 existing ❑new size Other: � C (� � � T � Zoning Board of Appeals Authorization 0 Appeal# Recorded O $EP 5 2001 Commercial ❑Yes W No If yes, site plan review# Current Use Proposed Use 113y BUILDER INFORMATION Name a cJ Telephone Number Address, 0(lo f- 6 G!//yC&� License# Home Improvement Contractor# 36 S4-,4-Irfr✓k_bn m-ezt,�, j fir`/b Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO j SIGNATURE DATE FOR OFFICIAL USE ONLY � e PERMIT,NO. DATE ISSUED MAP/PARCEL NO. . = ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME � INSULATION FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL Y GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN-NO. s RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.( >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck 4 _x$30.00= 3 O 1�t � (number) oR5 Fireplace/Chimney x$25.00= bi (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 i Relocation/Moving $150.00 (plus above if applicable) Permit Fee �� 1 projcost Y� �l1 Perf01"I ante'tlOnd pCf fOt)t (lf marl f.,.... __� _--- , ,• ------- .._ r FEE VALUE WORKSHEET LIVING SPACE (2000 sq ft or greater) square feet x$115/sq.foot= (less.than 2000 sq ft) square feet x$96/sq.foot= (affordable housing) square feet x$57/sq.foot= (4013 or low income) GARAGE(UNFINISHED) square feet x$25/sq.foot= PORCH square feet x$20/sq.foot= DECK square feet x$15/sq.foot= no ALTERATIONS/RENOVATIONS OF EXISTING SPACE . . . . . . . cost=. . . . . . . . . . . . . . . . Total Project Fee Value s® 0-o Office Use Only Permit Fee t s© ot projcost . `�\ ' • _ -_-� The Commonwealth of Massachusetts _ - — . Department of Industrial Accidents _= = OfIfCCOffOYe$9989offs . - - . 600 Washington Sheet :._-.- Boston,Mass. 02111 I . Workers' Compensation Insurance davit � � , name: f c A ke-zr Z)b ny C F'x-/ . - �/ . _ . .......- -- ---- ----- -:---. . - location: S 6 S/C/ I fy!' �r city/-1Z/-f�tiS A"Ilf phone# Jr I am a homeowner performing all work myself. . - I am a sole r rietor and have no one worki>i in ca achy ❑ I am an employer providing workers' compensation for my employees working on this job. %an'name ':< ':': '<'<`:'.>':> >`:> > > > > > `=> > > > >`�' ':> > ?«< <>« ':': ' `' ;'> «".. >> > ><> <:,:,.-<i< ': ><> ': >>> > < < : :. >`: &46n Y ::::: ::::::::::::i:::::::;:::;:;;::;;:::::;::;;:::::...;:i::;:i:;::::::;::::2::i::.:::::::::::::.: :;:::;:::;:::;::;::;::;::;:::;;:>;;<::;::::;:>::::>::::::::::;::;:i:::::2::;`::: ::;;:;'.::;;::;:>:>::::::::::::::::::::::::::::::i::i::::::::::i::i:::::::::ii:.:::G:::::i:::;:i:::::i::::::i:::::::::::::::::::::::;::;::; i:::::::ri::::::::%:::;:i::::::::::::::::i::ii::i::::::::i:Y::::i :::::::::'::::::::i:::i:': Cl ................. .. jjLL ............. :::::: :::i::;::::::::::i:::::i::::::::::::::.....:.....:i::i::i::i::i:::::::;:i::i::::::::.:::i:::•:'::::i:::::::::::i:>`:::':::>::::::::::i::::: :::i<::::::::;:::::::::::::::: :.::: ::.....::::::::::::::::::::::::::.::::........::::.:::::::::.:.::.:::::::::.::::::::::::::::.::::*... ance::co:::::::::::::::::'::::i:>:':<:::;::::;::;::::s:::::::::::::::>:<::;::::::::........;::•::':>':<::::::::;::::>:.;;:.,:::::::;':;::;:;: >::><::>;:::>:.::<:::>.:::: ........ ........ lnsur ❑ I.am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have . .. n ollces: the following workers compensatio p .............. bmpanv'name. :tl keSS :< :?::::?%:::: `:::::::2<::::::: -' :::::::':� ? :::::>: 2 ' � <� ' � ` r'.`? `' '5 >;'><'' Y '? 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'' ::......... ...... ..................... ... ............................ ................................................................................................................... ,•:.�:::::u>::•:s>. :::::::::::::::::.�::::::::::•::::.:..... ....................................... .. ::....:::::::.::::::::..............:.::.::...........: ...<.::.....:i::•:.::.r:•.::: .. .............................................................................::..:::........................:........•.�:::::::::. :::::::::::::.::::"",.,::.::::::::.:::::::::::::::::::Cv:::::::.�:.,W..n n,Y.J}:T,...,&,.,v„e y i^}'ri: . :.iiiiiiiiiiiii:i•i:!:L:•i:•ii:.isvp}:•Y:.i:•iii*,.:i:.............::4:::......:^?:iL::::.:::; :;:_::;:!i;:;:jt;;:;:i:::v;y::;:::.:::.iii:.i... �l� M..iiiii:.iiiii:.iiiiiiiiiiiii:.ii:^:^is.i:4i:.iiiiiiii:i.iii::•;i{:•i:iiii:vvi•iY.vii:?iii:4::•::i::::::::::•::. nHti'rHnCC:CQ................................................................................ . ll/llll - as .name:::::>::::>::::::::<>.::::::;::«::::::::<::::::::::>::>:>::::::::::::::::«<:::>:::>:>.:>:::::::.::::.::................................................................................................................................ . 11. ::>:::;: :.. . . .. address: ... ....... .% ..... . ,.,.....,.;...i..:.. ::::::::::..::::::•.::::.::::::::•:::::::::.:::::::::::::::::.::::::::::::::::................:::::::.:::::::.::::•::::::::::::::::::::::::.:::::::::::. ............................................................................................... titine Cl p :::::::::: ::as>:�. ::::::::::::::::::::::::::::::::::::::::::.......:........................................................................:..................... ::::::::;: :..%..........................::.......::....................:.....:::::.:.s •iiF^i}iii}i::w::::.�:::::::::..:::.�:.�::::::::::i.•::—...:::::::::::::....�::::::.:�:: 11 ::n�:::---- :::..... ............ ..... ::!j•:?;:;:i;:;:;:;i:;: 'i:�ii:hiiJii:i:ti^:6:hi:•iii:iii:•i: �y� N ?:'::::isisi::Ji'::::::::_:iii::ivv:v4i:^:!: wu _ :'..... - ?iii:':•i::t.i:v%.:Ciiii'vi•?:.:j.:j;i:.i:.i:.i:.i:.:i�:ii::•:�:<h:.i: j/ Fallure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a throe 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 One 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 hereby certi fy,under the pains and penalties of perjury that the information provided above 7Z1,7, ,,;,,r,r' d si tore 9� x � � Date - - . Print name Phone# official use only do not write in this area to be completed by city or town official - city or town: .• permit/license# * ❑Building Department . . . ❑Licensing Board C ❑check if immediate response is required ❑Select men's Office ❑Health Department contact per-son: phone#; L ❑Other 1. Owned 9ro5 PLa . .,.. . - ' Information and Instructions _ i i 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. \Y a 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 deemed to be an employer. 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 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 peimit/license number which will be used as a reference number. The affidavits may be retur6 d*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 Me of lavesdgallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 i