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HomeMy WebLinkAbout0105 STARLIGHT DRIVE �9 SEPTIC SYSTEM MUST 13E '56, e/Z- INSTALLED IN COMP A / o © 3 WITH ARTICLE It STATE SANITARY CODE AND TOWN:_ 6 ://-73 ULATIONS- e�QyoFTME TOWN OF BARNSTABLE i 33ARB ABLEMAM . i 90 39 �0� BUILDING INSPECTOR 0 a APPLICATIONFOR PERMIT TO .............................................................................................................................. TYPEOF CONSTRUCTION .............................................................................................................:..:.................... ...................19.73 TO THE INSPECTOR OF B_UILDINGS:... The undersigned hereby applies for a permit according to the following information: Location ✓ l.. f ?q�L/ G4 ......... ..... .......... ........................................ / �cc�J'. ., .......... ................... ProposedUse .1.W..t-LUf.V..Ga............................................................................................................................................. Zoning District ................................................... ........Fire District ........ i6�Y.. !-j'v'e..7W�,E'sra�v Name of Owner .....Cew,.W...ezr.. P.1(.A. j1t .Address (.,/f` n.. .t'.1�.�.sS.... .��................... Nameof Builder ........:..c5 .,./w.e:............:....................Address ...... ..................................................... Name of Architect ........... ........Address Number of Rooms .......�J.../.Z................................................Foundation .... Exterior ........W-0.......Sit:�)��.�...s.................. ...Roofing .........ice-.S.�.ta.!�! r`f' ................ .. ............................,................... Floors ........C-v,4.P,.h,,?4................................................. Interior -:1.4 t.Z. r t Heating ........!..!:F. ...!!4�...... .........�. ..-..........................Plumbing .........�...�'t-........ ....... ^r. ...................................... Fireplace .........•.. Cr..................................................Approximate Cost ............. d...�.Q.4... r... .................. / S Definitive Plan Ap proved by Planning Board ------------_______------------ 19 Diagram of Lot and Building with Dimensions l SUBJECT TO APPROVAL OF BOARD OF HEALTH YL i I 30 �.. ;.0 Soo D7 - - - 130, I hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable regarding the above construction. a Name ...... ................. - � Cammett Builders . ' ' 16295 one story No ................. Permit for .................................... � single family dwelling � ................... , «x� Starlight > Location .[U�J. e~.° Drive_.___.______. � ` � Narotxooa Mills .----.-----..--.—.----------.. Ca000ett Builders Owner ................................................................... � ' ' / frame Type of Construction -----____,____. / ^' i ^ ' . --.—,—..—.-----.—.—.--.----.---.. ' .` Plot ............................ Lot ......... ` > ~� . Permit Granted —.. � Date of Inspection .—'� ^^ , � Date Completed — PERMIT REFUSED � ..~._,,,~--_.—~.--------. lR � '-----------'—^--^~'^'�—^-----^—' ^----^^^----'—^''—~`^--^—~-------' � ..~—.-_....---...—.�.—........-.—,_—., �' -- '`--.------..—,....~—.—..-..---.,..` . Approved ................................................ lg ' ---------'-------^^^---^---^- v v ' . . � ----------------------.—...— � ' ` r i Town of Barnstable erm;t,� Expires 6 marths fr m one dateQ� Regulatory Services Fee 1�oz� r BARNSTABM v MASS. Thomas F. Geiler,Director ATfD MAy A Building Division Tom Perry, CBO, Building Commissioner 0� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.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 �— Property Address JD S ::� e^�' r)c i �C)o , J� �� ,/�/�i���`d►'15 � uS [Residential Value of Work A ¢Q(7 Minimum fee of$25.00 for work under$6060.00 Owner's Name&Address `,,e-cV _ L-2 Y1 4*1 e-\ Contractor's Name "DozN�n e Telephone Number Home Improvement Contractor License#(if applicable)-)e, act 1 Construction Supervisor's License#(if applicable) �� ► f - 10Workman's Compensation Insurance Check one: -PRESS PERMIT ❑ I am a sole proprietor ❑ I am the Homeowner MAY 14 2010 91 have Worker's Compensation Insurance Insurance Company Name A.0 o— q TOWN OF BARNSTABLE Workman's Comp.Policy# 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) ❑ Re-side #of doors_ '[Replacement Windows/doors/sliders.U-Value 13 (maximum .44)# of windows_ *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: h 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). Address: - 12 City/State/Zip: Phone Are ru an employer?Check the appropriate box: Type of project(required): 1.L10 I am 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees ees These sub-contractors have P y b. [] Demolition working for me in any capacity. employees and have workers' comp.insurance.*. y• ❑ Building addition [No workers' cotiip. insurance P• 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 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] { c. 152, j 1(4),and we have no 12.❑ Roof repairs employees. [No workers' 13.g0thcrR�,,,. _;Ic.Cr t- comp.insurance required.] 6)"' d- & S- �oacS "Any 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 wodc and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Re I U 5 A Policy#or Self-ins. Lic.#:_ C 4.15'R )D\)6 Expiration Date:_)/�/8 ��DJ0 Job Site Address: )per S ficL'l � i 4�►t i J� City/State/Zip: 11lLfisi n1)S i►1 �,5 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify f under the pains and penalties of perjury that the information provided above is true and correct Si ature: ��''1 Date: _) Phone#: .x��- (^ ' Official nse only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: r , - •. �+Q IC'►.f�r—. —a GUs:.11 IlIIIC 1VJ1 n I II_ .J lU •� _•JJO.J�C)!IIQG (1 �/l ACO D, CERTIFICATE OF LIABILITY INSURANCE DRTE(MMiDDR"MY) 12/02 RGG9 P z00JC5R 413.534.7 3S5 FAX 413.S36.9286 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I DOSS & McLain T.nsurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ` HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 474 .4opl eton Street '' I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 1121 I Holyoke, IAA 01041-1128 i INSURERS AFFORDING COVERAGE _!N_A!C 4 ,FNjL7R_ED_fhe Remodeling & Maintenance Corp —?,Iy;I_-�a�; National Grange Mutual — 29939 —I 12 Sparrow Way :L �-ACE USA_— — _ -- South Yarmouth, MA 02664-1655 a�7-zIJIER Cr COVERAGES _ THE POLICIES OF,NSUP,ANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOi1MTHSi"ANDi1NG 1 ANY P,EQUIRE?;TENT.TERM OR CONC'ITION OF ANY CONTRACT OR OTHER,DOCUMENT W11-i RESPECT TO WHICH THIS CERTIFICATE MAY EE iSSUED OR MAY PERTAIN,THE NfEIRANCE AFFORDED BY THE POL!CI=S DESCRIBEC HEREIN IS SUBJECT TO ALL TH—c TERMS.cKCL'JSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LHMITS£HOIAA MAY HAVE BEEN RECUCED BY PAID CLA,:MS. INSn!NSP.4 --.—k— T-"---- ------'T�0L re E;r CTIVE 'RhICY EK tRAAP.ON-7 - �R IrJSP• TYPE�JF! 'URANCE a POLICY NUMBER I DATE RrII✓JDDMYri I CATE(MAVDD;1'Y:M I UMITS— I GEN-ERALLIASlLrrr IMFS5904R' 11/38/2009 ! 11/18/2010 i 1,000,00 cc 3E:i{ta_;u'%r:aa 500,000 : ;K' _._:r I r`=_I= ?ran,/:nS F•ers ct 1=__ 10,00C A i i i i,r-rn;~. — 1.000,00 ATE I: 2,000,00 2,OW,DO A.r�;rauoar_E.}ABILrTY !i TBDi 12/01/2009 121011,1010 j 1 I 1,0.30,00 j !X I -a a^r : :='oi2i•if Teti GAKA��E:W3!LI rYiT:)�r,. - f• ..a...:rIEIT I�3 :EXCESSiUPISRELLALLA&LITY j ; I_._ — i JJORKEQSCOMFcNSATrOM —�-- --t_— ✓ Y—' 1!:_•,,.: y n I C45871C10i 11,18/2009 11/18/2010 ; �,;..,•Llef;-.,: i`Lr, ----� AND+EMpL0YEF5'LIABtLi c_ _ Y,N I — ---�-_ ' B g•- _ ;f n•:=_=•:r �--r...L r 100,000 PI<nJstory in NHI100,000 c: C•i''E --(''LC•i L I!,;'" 5GG GG OVER - . j I j 1 i f DESCRIPTION OF OPERATIONSI LOCAT;ONS I VEHICLES I EX LL'SIGNS AUDED BY ENDORSENENTI SPECIAL PROVISIONS C ( CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T4_=ABOVE DESCAGE7 POLICIES BE.CAICELLED BEFORE THE EXPIRATION DATE THERErT,THE ISSUING INSURER WILL ENDEAVOR TO IAAI•_ 10 DAYS WRrrrEN s NOTICE TO THE CERTIFICATE HOLCEt NAMED TO THE LEFT,BUT FAILURE TO CO SO SHALL IMPOS=10 OBLIGA-ION OR LIABILITY OF AN(HIND U?CN THE INSURER.ITS AGENTS OR I The Remodeling & Maintenance Corporation REPRESENTATIVES. - 12 Sparrow Way AUTHORIZED REPRESENTATIJE — South Yarmouth, NA 02664 ]Cynthia S Tres ACORD 26(2009r'01) FAX: 508.398.7866 O 19e8-2009 ACORD CORPORATION. All rights reserved. The.ACORD name and logo are registered marks of ACORD �� .. Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home hnprovement:'retractor Registration Registration: 164591 Type: Corporation Expiration: 10/26/2011 Tr# 289959 THE REMODELING AND MAINTENANCE THOMAS .DOWNEY 17 SPARROW WAY SOUTH YARMOUTH, MA 02664 ;..: 4> Update Address and return card.Mark reason for change. Address Ej Renewal Employment Lost Card Dpr-cm 0 BOM•04104-010121E �/ie 1Ppo�,mao�ucreca�o�✓�.Craaaa/useell2 • License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: i HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registratl00;r;,,;;184591 10 Park Plaza-Suite 5170 Expiratlp.w 10/26/2011 Tr# 289959 Boston,MA 02116 Type', Corporation THE REMODEI.,JNGA:�D`MAINTENANCE CORP THOMAS 17 SPARROW WAY` SOUTH YARMOUTH MAjO$6t4 Undersecretary_,, rY 'Not valid without signature �`lassacttu ctt. - !)cparfrttcu.t fit'Public S:ifet` Buartl trC l3uildin% Rc��utatiurts and Stanitar Construction Supervisor License ii License: CS 671 Restricted to: 00 a . THOMAS E:DOWNEY 17 SPARROW WAY S YARMOUTH; MA.02664 Expiration: 3/9/2012 (urntui:5i• ic•r Tr#: 25589 OFIHE r Town of Barnstable Regulatory Services anxNSTnBLY- ' Thomas F. Geiler,Director v Mass. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwvy.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder V e� Vg ,as Owner of the subject property i hereby authorize / W LAJ Y !j to act on my behalf, in all matters relative to work authorized by this building permit application for: t <' �- T e- (Addrea of Job) Signature ofrOwner Date Print Nam If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:FOFJYI S:0 W N ERPERM IS S I ON Town of Barnstable Regulatory Services BARNSTABL.E Thomas F. Geiler,Director MASS. �� 1639. ,�� Building Division AlfDy a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ynyw.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street .village "HOMEOWNER": 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 homeowner. 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 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 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 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:\WPFU,ES\FORM S\homeex empt.DOC