HomeMy WebLinkAbout0152 TIMBER LANE ItA
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel \ Application #
Health Division Date Issued �(
Conservation Division iOC� Application Fee J
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board A�
Historic - OKH Preservation/ Hyannis Rl�"
Project Street Address � _Z, ` LA
Village kNips �
Owner. V L CFX2,Q Address 2 r11N1 Z IYIJ V1'k1R5 / O'uU.
Telephone
Permit Request` k?Ltk& 51N!N, (jiu S Mf+u_ &WA,
'Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay,
Project Valuation Construction Type
Lot Size ' ' Li Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Ik Two Family ❑ Multi-Family (# units)
I
Age of Existing Structure 3 Historic House: ❑Yes RNo On Old King's Highway: ❑Yes XtNo
Basement Type: XFull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (scky
Number of Baths: Full: existing new Half: existing nd*
Number of Bedrooms: existing _new C cv C
Total Room Count (not including baths): existing new First Floor Ro CounN
ZZ
-n
Heat Type and Fuel: ❑ Gas . 14,Oil ❑ Electric ❑ Other
Central Air: ❑Yes �&-No Fireplaces: Existing New Existing wood coal stogy: ❑As No
• v
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 )kNo If yes, site plan review#
Current Use � Jl` v<(; Proposed Use � Z
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name A y�� C��17 20 Telephone Number
Address 15 License #
W�RS�bN� A i LLB Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE-1 WMI k AWN—TE—W&
rr
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
ISM FO_UNDATIQN: ..:.
Y P
x .
of FRAME
}
INSULATION
FIREPLACE
`t ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL`
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
eh 7e ev
70-/VQ�jlf-c9L�
l/�a,- rZ4- 5 S
sN>r,e<o�z Sor�icc�- ,
ir�uR�S/
�> /31Z _
lne uommonwemrn uj i.nassuuat"mt
�.\ Department of Industrial Accidents. .
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation:Insnrance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Infor�zation \ Please Print Legibly
Name(Business/Organization/Individual): Ilk,
Mlb 11�t- wzo _ -
Address:
City/State/Zip: YwobTm � t1 j K* • q6- Phone.#:
Are you an employer? Check.the appropriate box:. and I :Type of project(required).:.
1.❑ I am a e to er with
4 ❑ I am a general contractor
mP Y _ 6. ❑New construction .
employees (full and/or part-time).* have hired the stab-contractors
2:❑ I am a'sole proprietor or partner- listed-on the-attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have -g. ❑Demolition
working for me.in any capacity.ca ac employees and have workers'
9. ❑Building addition . .
[No workers' comp.imutance comp. insurance.$
5. We are a corporation and its ' 10.❑Electrical repairs or additions _.
required.] ❑ -
3. ;I am a homeowner-doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.] ,
*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 work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors 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 providt:their workers'comp.poiidy 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:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site'Address: City/State/Zip: _
Attach a copy of the workers' compensation policy declaration page-(sho'wing the policy number and expiration date).
Failure.to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/oi one-year imprisonment, as well as civil penalt#Es in the form of a STOP WORK ORDER and a fine
of up to$250.00 da gamst the violator. Be advised that a copy-of this statement may be forwarded to the Office of
Investi ations o f r insurance coverage verification.
I do hereby ceIdr e penalties of perjury that the information provided above is true and correct.
r Si store: Date:
Phone# JA�
Official use only. Do.not write in this area, to be completed by.city.or town official
City'or Town: Permit/License#
Issuing Authority(circle one):
J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
:. Iifo�rna anon and Instructions
ter 152 r es all employers bo provide workers' compensation.for their employees.
Massachusetts:General Laws chap e4 erson in:the service of another under any contract of hiie, :.
Pursuant to,this statute,an employee is defined as"...every p
. express-or implied,oral or written."
" arin association,corporation or other le entity,or any two.
More
g� or m,o
An employer is defined as an mdrvidnal,Partnership, -lo er oz the
of the foregoing engaged in a Joint enterprise,and-including the legal representatives of a deceased emp y ': :
artaers ,association or o legal entity,emp oYmg employees'. owever e
receiver or trustee an individnal,.P aT
owner of a dwelling horse having not more than three apariments 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, §25C(6)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 fhe•insnrance coverage required
AdditionaIly,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any,of its political subdivisions shall
enter into any contract fmthe performance of public Workuntri-acc olIIevidence of complimi s�zththe ms�'*�nOe
requirements of this chapter have been presented to the contracting t3'"
Applicants .
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contiactor(s)name(s),addresses)and phone number(s) along with their certificate(s)of
anies L or Limited Liability Partnerships,(LLP)with no employees other than the
insurance. Limited Liability Comp . (L � .
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that ibis affidavit 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'
at the number listed below. Self-insured companies should enter their
compensation policy,please call the Department
self-insurance license number on the appropriate line. .
City or Town Officials.
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 pemiitllicense number which will be used as a reference number. In addition,an applicant
ens applications in any given year,need only submit one affidavit indicating current
that must submit multiple permit/lic
policy information(if necessary)and under"Job Sile Address"the applicant should write"all•locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
ense or permit not related to any business or comm ercial venture
year.Where a home owner or citizen is obtaining a lic
(i.e.a dog license or permit to brim leaves-etc.)said person is NOT required to complete this affidavit
The-Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call
The Department's address,telephone-and fax number.
jb.e C.Qmmoawe,a%of Massaohusats .
DQPartmqCt
MCC Of luvestiptiom
6QR ash n o€
Boston,MA 02111
fel.#617,' ' -dam ex�4Q6 a�1 �I�IASSA�
Fax'#61 T-727,774 . .
Revised 11-22-06 .rriss.gQdia
IKE r : Town. of.Barn'stable .. .
Regulatory Services
>�xrtsTABM : Thomas F.Geiler,Director
1639. &��� Building Division .
rEv � Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
i I Please Print
DATE: 1 P 23
JOB LOCATION:
number ^` street.cc����,,yy�� y� �7 p,/ village
.HOMEOWNER": `l�vW4 _C ZD :Y6 (! ( (b� .SDB -760 Zo&tl
name �'jhome phone# work phone#
CURRENT MAILING ADDRESS: 15T. 1 `t"�q 1 SI ` L,)ILr-
1Ar(Z!jV-VQ5 M 1�� M A 0211 L113
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 pemut (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 and ign "ho wrier"certifies that he/she understands the Town of Barnstable Building Department
minim sp tion o edures and requirements and that he/she will comply with said procedures and
require n .
Signature o omeo
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 S,
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:forms:homeexempt
Town of Barnstable v
Regulatory Services
HAMSrABI'E' Thomas F.Geiler,Director
039.
'°TFn 14 Building Division i
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
wwwaown.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner ust
Complete and Sign his Section
If Using A uilder.
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work autho ' ed by this building permit:
/ala
dress of Job)
Pool fences and are the responsibility of the applicant. Pools
are not to be filled ed before fence is installed and all final
inspections are perand accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORM&OWNERPERMISSIONPOOLS 6/2012
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71,
mom
CODE MD
TOWN , OF BARN
BUILDING INSPECTOR
..............-)Uqj� ---C7
The undersigned hereby applies for a permit according to the following information:
Diagram of Lot and Building with Dimensions Fee 7c��. h........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
| hereby agree to conform to all the Rules and Regulations of the Town of Burnuhz6|e regarding the above
,construction.
|
! - Non�e' .....................................
:Flanagaii, Francis A=149-62
",14o .21325.... Permit fol5ingle..£ami,l ........ '' \
} .........C�Weui ................................................ .. Ilg.. t
Location ...lot..#39....152..Timberlane..........
} .......Mars.tans..Mills.........................................
Owner .......Fza=is••Flanagan.......................
Type of Construction ...................FraMe............ a
...............................................................................
S �6
Plot .............................. Lot ................................
Permit Granted ..............May..29.............19 79
Date of Inspection 19
} Date Completed ..' .:... . ....................199i v
l
o o
PERMIT REFUSED
. ........ ............................... 19 T
i .........................................
rn N
Approvemm. ................................ 19
...............................................................................
...............................................................................
Ass'essor's map and lot number ........ .. `T,/....... �.'' `� ✓ �� �C/` - ;j �y 7r THE
o 0
Sewgge� Permit number
•
. i BlBH�9eTABLE, •
House number ............. -7197
........................ _....... soo 639• m�
\e
4MAY a'
TOWN ' OF BARNSTABLE
BUILDING __INSPECTOR
2
APPLICATION FOR PERMIT TO ......................................... .....................................................
TYPE OF.CONSTRUCTION ...............................................II'U!yy>'( ....................................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
1 q
L ( - i �1 3((Z / l4 4 l4 p bM IM �LI G
Location ..F........................................................�.....:......� ......v�t!.:..................�`'.: Z...........,.......:...:.:.,..:.....:....................................
ProposedUse ... ........ ................ 4 ................ ;d..................
ZoningDistrict ...............................Fire District ...............................................................................
Name of Owner FROV-1.5 5- N.AA70 .....Address P' n l�n u S l q Y1'11A R.�?t?�`�..tM .•C•
Name of Builder .. .n.l .4F...9�"...1-'oM.. TW............Address ...
Name of Architec,tl.. T7.N�G isn..1(.....................................Address .. .Fi .Y�•Rf .
Numberof Rooms ....°7..........................................................Foundation ...CON1...(..FF....................................................
Exierior ....G.1,,,.. ...Roofing A S N'PMr+c 1
Floors .d.Q.7.......................................................................Interior ....(A.,.,... ......
Heating F..l_...;.�� 1�..1..'.......................................:. ........:. .C .. ..
C C_ Plumbing .::......c....p�,..
Fireplace ... !!!�47. ............................................Approximate Cost
I
Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area :...... .d.........................
Diagram of Lot and Building with Dimensions Fee. ...............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH N
V
!
S! .
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ! .........................................
Flanagan, Frzubcia A=149-62.
No .21325'—. Permit for ....Sin�1�.. — �
~ '
�
----.~~~~~~.g---------------..
~
Location .lm±.i&39.....l52'�imber1ane............
'--- e------------
�
� Owner ----3rancis.. ------
'
'
Type of Construction ........F.uame.......................
�
' .
--------------------------'
�
Plot ---------� �t ----------..
' �
�
Permit Granted ........... ...3g...........lg 79
�
Date of Inspection ----^-------lP
,
' Dote Completed ...................................... '
`
� ~ �
^
PERMIT~ ~E �
.`
9
---- 9 . /
`---------��-----.----------.
^'
—.-.---.~..--.-------.--------.
�
----'—'—'--'' '--'^—~----'
'
..................................... ' .
/ �
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--------.-------.. lA �
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--------.-------....--------.
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................. ....................................................... .^��
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The Town of BarnstableKv-
milI
V
dp Permit#
Massachusetts
�xxgrAsM Date
NAB& SOLID FUEL STOVE PERMIT
039.
Fee
This constitutes an official stove permit after inspection and approval by the building inspector.
Owner CLAI&� Telephone no.
i
Address of Property J,�:> Village on ki ) /QI
Location and Stove Type ke ,A
Date: 2) at C?r
Buildinj Inspector
The solid fuel burning stove at the above locatio Cpasse� failed: inspection.