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HomeMy WebLinkAbout0117 TURTLEBACK ROAD ....., a.y'. .�.__ :. ,. '.. .., . :: .. ..., �.. ..•\.Lf' - "— - - ��I:i..4ars.....d�.�+�.,:r4S3 '.+.!a�imY'-' . _n.�.L._.____.. d - -InkF.- t ok Application number j`L! D.7..3.J Date Issued........./.Z�//. ................. MAM Building Inspectors Initials... � AUG 22 2018 . ap/Parce Uv �� H����N�� Ml........Q..y�...........cf.1 ....._....... ..... S �? TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION ..Address of Project: / arrz t 11-C K- ILO kolrs4w // aZG Vff ER STREET VILLAGE Owner's Name: Mq-tj 1,2 4y/L Phone Number Email Address: li 4/yS N•Cot,Cell Phone Number 5 �/ Project cost $ zp-UD•a O Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above prope eby autbdQe to make application for uilding p rmit ' acco dance with 780 CMR Owner Signature: Date: �� TYfrE OF WORK ❑ Siding U Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors (no header change) # Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # (attach copy) i Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED. APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each'tent If food is being served at your event please,obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: L tl& Telephone Number -5'-19 2k-7 F_0 ':�/ Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accord 780 CMR the Massachusetts State Building Code. I understand the construction m* spection pr cedu ,spec is inspections and documentation required by 780 CMR and t �Town Barn ab . Signature i Date v APMO-47S SIGNATURE Signature Date Af—Z Z:& All permit a lications a subject to a building official's approval prior to issuance. I 4 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: 7 vl v l-e 09 City/State/Zip: i 40S l9 DZ Phone#: "—D,�, — 2f 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 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.❑ 1 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. employees and have workers' comp. insurance.# 9. ❑Building addition [No workers' comp.insurance P• 3.Vequired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions am a homeowner doing all work officers have exercised their 11.❑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 13.❑ Other employees. [No workers' 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 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure covera a as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.0 d/o one-year im r. ment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.0 day ag t the ato Be advised that a copy of this statement may be forwarded to the Office of Investigations f the D or ins ance co erage verification. 1 do hereby certi and r the ins and p enalties of perjury that the information provided above is true and correct Signature- Date: Phone#: ( J_ 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions " Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be 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 the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 this affidavit 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. Self-insured companies should enter their 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site 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 year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax##617-727-7749 www.mass.gov/dia Town of Barnstable Building Post This Card So That it'is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept '"" Posted Until Final Inspection Has Been Made. Permit t63p ' Whene a Certificate,of.Occupancy is Required,such Building shall Not be Occu pied,until,a`Final Inspection has been made. Permit No. B-18-2588 Applicant Name: STATHE, ELAINE Approvals Date Issued: 08/17/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 02/17/2019 Foundation: Location: 117 TURTLEBACK ROAD, MARSTONS MILLS Map/Lot: 046-090 Zoning District: RF Sheathing: Owner on Record: STATHE,ELAINE Contractor Name'.� Framing: 1 Address: 117 TURTLEBACK RD Contractor.License: 2 MARSTONS MILLS, MA 02648 I ( - Est. Project Cost: $ 10,000.00 Chimney: Description: REMOVE KITCHEN LIVINGROOM WALL AND KITCHEN BREEZEWAY Permit Fee: $ 101.00 Insulation: WAL Fee Paid: $101.00 Project Review Req: _.��' Date:J 8/17/2018 Final: • Plumbing/Gas 1 � Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siix months after issuance. g All work authorized by this permit shall conform to the approved application and the approved construction documents for,which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fog public inspection for the entire duration of the Electrical work until the completion of the same. r - Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. r►'t'�'�c Pt Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �Im I Z- )R- zs'08 Application Number..... ......... ..................;.................. . K 'a s • * . s NAMPeffiidFee......... ............................Other Fee.................:...... TotalFee Paid..................................................................... TOWN OF BARNSTABLE Permit Approval by.................................On.......................... BUILDING PERMIT MV...._...D. �p................Pa�......In�._....................... APPLICATION Section I—Owner's Information and Project.Location Project Address I 'T-J O�CiC- 12 fl VMage'IT Owners Name tZ � Owners Legal Address -7 -Z �q �'✓ yl City. 4V wI l/e State 'I V�-- . Zip 0?-6 ZZ owners Cell 090 E-mail 1111�o- ,-) I'Y to - Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet OSingle/Two Family Dwelling Section 3—Type of Permit o ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement _0.Family/Amnesty ❑ Fire AlarmCo �, o Rebuild ❑ Deck Apartment ❑ Sprinkler System o ❑ Addition ❑ Retaining wall ❑ Solar m Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -/Work Description T Act tmdated:2/9201 S i Application Number.................................................... 'Section 5—Detail Cost of Proposed Construction /�,OP,00 Square Footage of Project Age of Structure zl� u:�A-S Dig Safe Number i # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wmd Zone Compliance Method MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics [/Wiring ❑ Oil Tank Storage ❑ Smoke.Detectors [,'Plumbing ❑ Gas "❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water supply Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility. I am using a crane ❑ Yes El No I � j Section 7—Flood Zone I Flood Zone Designation t\,/,J Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last imdatcd:2/9/2019 Application Number........................................... Section 9—.Construction Supervisor Name Telephone Number Address City State zip License Number License Type Expiration Date Contractors Email Cell# I Understand my responsibilities under the roles and regulations for Licensed Contraction Supervisor in accordance with 780 CMR the Massachusetts State Bolding Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section-10—Home Improvement Contractor Name Telephone Number • 2-Y7 8--0 9'- Address 27 422�ny /moo City &fct /f, State�Zip r2-6 3 Z Registration Number Expiration Date I understand my responsib ' ' under Tales and regulations for Home Improvement Contactors in accordance with 780 CMR the Massachusetts Budding C de. I e construction inspection procedures,specific inspections and documentation by 780 Mt the To of B le.Attach a copy of your EUC... Signature Date Section 1 —Home Owners License Exemption Home Owners Name: Telephone Number Z$ ci Cell or Work Number 2& 7 e?Q CJ F I understand my resr7by780 er th Tales and regulations for Licensed Construction Supervisor in accordance with 780 I CMR the Massachuing de. I the construction inspection procedures,specific inspections and i documentation R/ the wn of amstable. Signature Date O8—d 9-/,r t_41C�NT SIGNATURE Signature Date V g-(75�— Print Name Tf is 112 F-0 �Z fi C--S Telephone Number 5_0 Z a77 '0 c/ E-mail permit to: 'Pa ; io 1 1 b ryl S T L n/n nn-e o .. ._ .... ..... _ .. ... ........... .._.. ... .... Section 12—Department Sign-Offs - Health Department © Zoi ing Board(if required Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization I, , as Owner of the-subject property hereby authorize to act on my behalfy in all matters relative to work authorized by this building permit application for: (Address of j ob) Signature of Owner daze i Print Name Last mdatD&2l92018 i 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: r 7 Ere L k e�l City/State/Zip: aL4 41/0 1/l e Phone#: S�� �� �� G Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 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- wed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers'comp.insurance comp.insurance.: Sequired.] 5. ❑ We are a corporation and its 10.EMlectrical repairs or additions officers have exercised their I L umb' 3. I am a homeowner doing all work �repairs or additions p 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.inc=ce required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner;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 provide their worker;'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: _ A Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 3 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' coverage verification. I do hereby ce and th pains an penalties of perjury that the information provided above is true and correct Si afore: L� Date: O S Phone#: 517 9y 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be 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 the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 this affidavit 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. Self-insured companies should enter their 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site 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 year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia . C►�Ewl �jpk'm.l p C��cE N Gfl¢ r �s�►�i .mow I-o 3 S Q'weY l blow Iq µ V CrIo 2 1 E t e✓' l ISYPe5evu*y OF 'c Robert W. Dennis Jr _ 0 Registered Structural 11'1 \ �2s��d3�ck Qa .o o Re,yam � Engineer Mf�QS'� J M%LL S IS JR. t P.O. Box 534 UCT C-,) � No. 13834 East Bridgewater, MA Fois P`� . 508-326-24" •�Sj� ENG