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HomeMy WebLinkAbout0502 WAKEBY ROAD� sdaG� �` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map z c�f5 Parcel"COLS Application # o?0 06 a Health-Division Date Issued Conservation Division .Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic.- OKH Preservation / Hyannis - Project Street Address Village 4 r IGVI G V �S II Owner &Md Address lephone rl Permit Request / CL2 rsa, V1 Square feet: 1 st floor: existing proposed 2nd.floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay FrojectValuatio Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑ Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other_ �,, C, � Basement Finished Area (sq.ft.) _ Basement Unfinished Area (s ,ft� '" : - Number of Baths: Full: existing new Half: existing fD ne�vv Ca Number of Bedrooms: _ existing _new Y CD Total Room Count (not including baths): existing new First Floor Room Count" t 00 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑.Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) too Name Telephone Number A.ddress License # Ajj Home Improvement Contractor# �i Worker's Compensation # ALL CONSTRUCTION DEBRIS RE ULTIN FROM TH PROJECT WILL BE TAKEN TO ? ' r-3-7 AO SIGNATUREDATE �—O i fr - FOR OFFICIAL USE ONLY APPLICATION# f • DATE ISSUED Y � , MAP/PARCEL NO. -ADDRESS VILLAGE n OWNER h DATE OF INSPECTION: FOUNDATION! 3 FRAME #I=Oe Os )kotc& i �. INSULAT10N.AWi I - . FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS ROUGH FINAL `FINAL_BUILDING` f r R r pDA CCLOSED_OU_T ASSOCIATION PLAN NO. � r Tdwxx of Barps. table -Regulatory-E6ndces Thomas F. Geier,Director Building Di-71Sion rho.Mas Perry,•CB 0,Bm7diag Com,,,;.��over 260 Mara Str64 Hyannis,MA D2601' • �pW.Eawn.barcu•tahl�ma_us O�iccc 5D8-8624038 Fax: 508-79M23D' FLAN RE' W "Z Owner • piojeet AddreSS SIeZ 4f- A Builder- The f6IIowin9 i'tetos were noted.on reviewing: -5Flh�=N7- !F e ry ReYie�ed by� . . • • � •�fi Date: The Commonwealth of Massachusetts Deparfrnent of Indusfrial Accidents tjTxe of Ii vestigations 600 Washington S&eet Boston, l4 02111 www.mass guvA is Workers' Compensation Invarance Affidavit: guilders/Contractors/IIectricians/Phunbers AP li t Information Please Print Legibly �Nv 1ame (13nsiness/Otgamzation/lndMdu2D: Address: qhy/State/Zip: WVI b T,5 ►(1 �� 0 Phone ne#: Are you an employer? Check the appropriate bow 1.❑ I am a employer with 4. ❑I an a general contractor and I Type of project(required): . employees(fnIl and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed.on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8 ❑Demolition wor3�g for me.in any capacity. employees and have workers' [NO workers'COmp, rncrrranre Comp,insurance.# 9 ❑R*„7—drag addition required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions a homeowner doing all work officers have exercised their 11. Phmzbin l! e1� ❑ g 1epairs or additions rays [No workers comp. right of exemption per MGL 12 Roof insurance regirir j t c. 152, §1(4), and we havb no ❑ repairs employees.[No workers' 13. ]Other comp,insurance required] *AUY applicant that check box#1—st also fill out the section below showing their w 'compensation policy infurmaflon Eiomeowners who submit this affidavit indicating they are doing all work and thm hire outside contractors most submit a new afiidaw m1 icating such. 1CaatImj:t s that check this box mast—,hcd an additional sheet showing the name of the sub-contractors and state whether or not those entities have empLryeer. If the sub-conhacters have employees,they mast provide then workers'camp.Policy Cr.numb Ir fOr�o�foyer that is providrng workers'cotrrpensadon insurance for my employees Below is the poTrcy and job site Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: City/Stata/Zip; . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fataore to secare coverage as required ender Section 25A Of MGL c. 152 can lead to the imposition of criminal penalties of a �e up to$1,500.00 and/or one-year imprisonment; as well as civil penalties in the�mz of a STOP WORK ORDER and a fine Of up to$250.00 a day against tine violator. Be advised that a co Of this statement may be �'e �t ons Of the DIA for insurance co copy y fD�ed to �e Oce of coverage verification. I do hereby It e pains and as ofperjwy that the information r P ovided above is/Pr S ue correct Date: ! 2-0 f Phone Official ase only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Issning Authority(circle one): L Board of Health 2.Building DePartment 3. City/Town Clerk 4.Electrical Impictor S.Plumb' 6. Other mg Inspector Contact Person: Phone#: Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division 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 Please Print DATE Jr0B LOCATION: 1A )a'IC— c if nu ber street village l/ i V e;e--TA7- L�.ng,4(-7_h.MOA "HOMEOWNER": In me home p e# w k p ne# CURRENT MAILING ADDRESS: r1(Z/U�G 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 req r ��j Signature o Homeowner f 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 ifthe.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 fonn/certification for use in your community. Q:forms:homeexempt . Town of Barnstable Regulatory Services ► R�RwcrAR_T•F s M+ea g Thomas F.Geiler,Director 1639. 1m o. ` Building Division - Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Oifice: 5.08-862-403 8 Fax:_508-790-6230.._: .... ...:..:.:.... ._ Property Owner Must Complete and Sign This Section � If Using A.Builder as Owner of the subject property hereby authorize to act on my behalf, in all,ma.tters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:F0RMS:0 Vn TFMERMIS SIONP00M � r � N � � � . c� `'� � �� % I � 10�1� � � �i � � r G 1 ��� , � � l �sR � SMOKE DETECTORS EVIE E BARNSTABLE BUILDING DEPT. DATE L I � FIRE aRSART DATE SOT SIGNATARE REQUIR D FOR PERMITTING L -r 77 I /93� -7� �_'ofC-0 G � ���k L lock \ . �i � 5 � d ���� Ji � � ��� IJ �\��� - �� S '� '' r r� Town ofBarnsta 'Permit�D.166�� ag �oFrru row ermit# i�� 0a$ Lrpires 6 inowlts froar issue flair 38 P�°Regulatory S'erviees Fee 1 j � BARVSfABt.E, $Ar�6 YA,0� UVV/V 0 6 )01(?Thomas F. Geiler, Director op BuiIding Division To e r}!�CBO, Building Commissioner. 200 Plain Street, Hyannis, MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid)vithoul Red X-Press Imprint Map/parcel Number (9Z GCJ�j Property Address L-j Q 2�- /!A-1 A fLE �7� ��G-r- � Ilia it U/ XResidential Value of Work_ (�Z-) a.� Minimum fee of$35.00 for work under S6000.00 Owner's Name & Address - ��z Contractor's Name Telephone Number `� L Home Improvement Contractor License# if applicable) ,6 ` Construction Supervisor's License#(if applicable) Lt2 — ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(trtrrricane nailed) (stripping old shin les) All construction debris will be taken to ❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers ofr000 ® Re-side l #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .35)#of windows •Where required: Issuance orthis 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 quired. Q� �, r t The Commonwealth of Massachusetts r Department of Industrial Accidents r Office of Investigations �` ii►i � 600 Washington Street Boston, MA 02111 r`;:• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): ].❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ I ❑ Remodeling ship and have no employees These sub-contractors have 9. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.� I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12, Roof repairs oC insurance required.] t employees. [No workers' l3. Other re i 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 their workers'comp.policy information. 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 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 ce �Ihepains d penalties of perjirry that the information provided above is true and correct Si nature: Date: l (o O Phone# Official use only. Do not write in this area, to be completed by city or town official City or Town: Perm it/License#. Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. 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 Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia 0(HE Town of Barnstable Regulatory Services >�gsTAstE' /Ass. l Thomas F. Geiler, Director a°;9,. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.tow n.b a rns to b l e.m a.us Office, 5d8-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: / /fin `� /� -�—y� M JOB LOCA'r10N: �/ O'Z--- � k_"S �� (/ V ` for 1'_5-t CJ/�/, 1,< numbber(/� street Q village „I-IOMEOWNER" �" 1 �I�T �'(`�'_ Z� <oaVL-e__ name home phone N work phone H CURRENT MAILNG 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 toengage-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 perrnit (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 ' ned"homeowner"certifies that.'e/she understands the Town of Barnstable Building Department minimum inspection procedures an quirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of BuildingOflicial 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 orthis section(Section 109.1.1 -Licensing ofconsiruction 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 ora Supervisor. On the last page of this issue is a form currently used by several towns. You may care I amend and adopt such a form/certi5cation for use in your community. s 4 of THE 1p� BARNFrABLE. MASS. To' '� of Ba><-Instable t619: �� �rFD MP'�A Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bnrnstable.mn.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) signature, of Owner Date J Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable THE` Regulatory Services 1p� Thomas F.Geiler,Director • Building Division 9 NAM Tom Perry,Building Commissioner '°ten {►`0 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 50 -790'6230 AnIDroved� Fee: a® Permit#: 42 M)l 6 if Id HOME OCCUPATION REGISTRATION Date: ZOo Name:_ ' _ En XE: Phone#:__ Address:. Village: VO L L(_5 Name of Business: L I 1-7 UL G RZZ�(� -Ff C_K—C ' Type of Business: �N T� Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity. shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: o. The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. e Mich use occupies-no-maFe than-400-square feet of space. u There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic.will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. o There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. s Any need for parking generated by.such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. m There is no exterior stoiage ur display of materials or equipment. There is no commercial vehicles related to the Customary Home Occupation,other than one van or one. pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. o No sign shall be displayed indicating the Customary Home Occupation. e If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. 9 No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the enders v end and agree with the above restrictions for my home occu ation I am registering Applicant Date: Homeoc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS?. . . For Your Information: Business certificates (cost$30.00 for 4.years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis, MA.92601 (Town Hall) 0 . GATE: ae9t�cxea sWCH Y196E '- . 1-�myp7wnMME s� Fill in please: WN APPLICANT'S YOUR NAME: " � BUSINESS YOUR HOME ADDRESS: P6j�?>ti-, W V 101P) Ms M>'�45, ' =�." ..:' .�. , • � � �o� `F�8 Soz� i��ESTb�(�T, rYF� . ©Z��T_ � /)'J�'_ TELEPHONE # Home Telephone Number Zsr - 5075 CAje g S I Ti= NAME OF NEVN BUSINESS- TYPE'O.F.BUSINESS 1417-F_6 ./ IS THIS A:HOME OCCUPATION? . YES. NO . Have you been given appr2Val'.fi-6 -the building division'? YES NO ADDRESS`OF BUSINESS Z L J AK-r-- : W ILL�NIAP/PARCEL NUMBER' V 54..� When starting a new business there are several things you must do in order-to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you-in.obtaining the information you Mpy need.. You MUST OO'TO•2010 Main - (corner of Yarmouth Rd. & Main Street).to make sure you have the appropriate permits and licenses required to legally:operate your business in this town. 1. BUILDING CO ONER'S OFFICE This indivi ualrb erf r e o any permit requirements th t pertain tothis type of business. MUST COMPLY WITH.HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO thprize ature** COMPLY MAY RESULT IN.FINES. COMMENTS: 2. BOARD OF HEALTH This individual has been • rme f the ermit.requirements that pertain to this type of business. Ahor¢ed Signature , COMMENTS: 6 wz 3: CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type,of business. Authorized Signature.* COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2, . Parcel © Permit# 7 C7 Health Divisio Date Issued Conservation Division �e c� � 1 s�3�o Application Fee Tax Collector by ;54&7 Permit Fee Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGLUTION3 Historic-OKH Preservation/Hyannis a� Project Street Address60c Village —' Owner AddressS Alm — Telephone 2 r m Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed � Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Ole ��IAIO o Grandfathered: %Yes ❑No If yes, attach supporting documentation. ' Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes /No On Old King's Highway: ❑Yes �No Basement Type: Full 0 Crawl 10 Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) b� 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 ,D�Oil ❑ Electric El Other Central Air: Yes ❑ No / Fireplaces: Existing New Existing wood/coal stove:")'es ❑No Detached garage: existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:Cl existing O new size Other: Zoning Board of Appeals Authorization Cl Appeal# &A Recorded❑ Commercial ❑Yes 4NO If yes, site,plan review# Current Use�CZ�,;� Proposed Use ,' I A �Q BUILDER INFORMATION Name 0W rvu a---- Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE v 6 f FOR OFFICIAL USE ONLY ` t PERMIT NO. - i DATE ISSUED r MAP/PARCEL NO. r ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: - FOUNDATION J3'FOp 3 SO-wo OA/ r � t FRAME 13 gi2A( A14. INSULATION FIREPLACE' ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL, GAS: ROUGHS � FINAL � icy' Q � � - FINAL BUILDING aft/ . � ' _� t • } © tom-- � � + • DATE CLOSED OUT ASSOCIATION PLAN NOS' n ' Ws Qe0 E m 0 s r a Commonivedth oflVlass Th ,Departnt nt of IndustriaTAceidents ' . 6a0'ypasf�ington Street Boston;Man . 02111 worker si C m ensation.usurance Affidavit-General Bnsinessea • address: �• G?� #•• O� ��� • . site locatiCd full.address :' : ' e. Retail Restaurant/BaF/Eatirig Establishment wor d bavd no ono $a ► s tl`YP 0 dt Antos etc. ain•a sole proprietor an • ' Li p� [� sales(including Rt;aYBst e, an capacity . .ywrldng m f 'lo ees full&' art time: []Other I amcin an em to er with ' //%//% %%%%%y%%%�%%/%%%//� %%%%% 01171 • 'ob. //� > ers, compensation for my employe - �� .• ;• es yvorlan on this j•.,•;. •;• •, ': , • . .. er pLO�iC�lII ,*L7'.': �'f•s •M1 �a .•.r.i;•Y •i• arlr 'em�3loy . .t.. 1 j ••r: , r 1• r: t •;,:' .+. y•r... .e i''.•;!, :tr:7�`,.+'• _;1 r lr 1•ys''? +, r,:•h• a t .',,•�C:j'1.i••, .�. }. •',.,. r;1: .rr r:•. ( .. 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'�• t+. . ••tr••r ai13,->'P+y��• r vf.�n'., ..M1• / �.,. f r' anee'co. :;r v: w ;q t q,t°+ , it f••. 'i't'`;: 'r flisur ,. .•. . ONMW t , .,. .(i:i'r •i ,t.� •t :t= , is :i94t,.� .t,.a 1',t,,L,otr•iyn•f.s.il.l,f{f,(t^1;.• • +4:' j••.'+�.' tiE�.••f'"�+t,:•:w��t t•.Yr.:'.:�••••:�Y�.`•t•s,�:r•y`tt'±•tY.•t��.ior...•:i,• ' ••'t•+•'a.' ' (' L~•'ti+i.�.ti•Y�i..i+3tt1 .� ':i•:';i rrit4"% CgII ri8e t .. ,C a.,,�f.`'1:...•'st,,•t•:.'':-1•!..v'v',a�i•.• :•tt•.•.�• .. �:i ,�s. .(•� s. , ( ,fyiy. address:.r + ' 0 r0..r .7. "}i;.tIr�a,}�•:,.+;'1; r jl:•1�+�f ••�i'sN7s ,ti:; �;.•,1 ,,1. .. r,•.,,.•,f:• ,.' •.r' ••,! } /.' 'r ;.tt• Oa7EF: ;} s,••t1.1' at• •t .;, ' s• t..•' 1'. r 1 r ', .•:'• .. r.•..��.5':,•'rti7:r•u,a: r::•` 1'::tl+.:i-.,, '•'E.• •5 r •Cf• ,f••• : :t: .•% , '•n.t•4i - + L'(r•'.11:atf' .t•rtits:' •' , '• a �.+." 1 '•}t.• )7.r.� •,t'r ••},.hs...t.i\, t•11�•., •r •y. ,. ,�•. ��• sit a• ,t: �' r_ •'.i t '�j • t:�t�', :/,••r'I�r•:-�i•: ':••�i;l:a� ..4 fs ,:. ,t�{r'�f, �•��,•sa t •S..� C,':ff'i..ti, Y ;1s•'t�t}ttiw.� i° .tf• ;3'i ,s.: r-i: 'F• -f•'ti�'t' r•:•' :f� r. t'::'V :`trtiJ.i•ati1;: rr:;t,l}j''•�L'/.i« 0'll •"�� :r ••:5••• •, ••• insiirancdbt'{{:'' ora e coverage as rcqulred under Section 25A of MGL 152 can �impnd a fine oftion of criminal ea�y ag�''tmee- I understand that} Failure to secur penalties�n the form of a STOP WORK one years imprisonmettt as well u etvilp ` copy e f this statement maybe forwarded to the Office of Investigations of the DlAfor coverage verii'ication• I do hereby certi pains and penalties . er'ttry that the in f orm atinx UFO 'ded above isfrue and ortecQ Date Cr . C�Sipanature �. : - �j°—Z?U. hone# print name �+ official use only do not write in this area to be completcd by city or iown official ' permit/1lcense# ❑BuildiaSDepartment ❑Licensing Board city or town: ❑Selectmen's Office (3•checkif immediate response is requircd QHealthDepartment Other. phone#; contaet person: (1,vised seyt 20) ' Information and Instructions ' eral L'aws chapter 152 section 25 requires all employers to pr'ovidc workers' compens�tidn f ftheir. Massachusetts Geis ` crxfployM, ,As quoted'fromthe f`law",, an employee is.defined as every person in the service of another under any contract of hire'express or implied; �ira1 or written. ,An employer is defined as �'individual,partnersl4, association, corporation or other legal entity, or any two or rngre of the foregoing . aged•in.a�joint enferprise,,and including the legal representatives of a deceased,employer, or the-receiver or artiiersbi association or other legal entity, employing tmployees. 'Howevei.the owner of a trustee of individual,P . Fx dwelling house having.,nonnore than three apartments and-who resides thereh or the occupant of the dwelling house bf- ' another who.e�lbys•Persbns to a main.•te�nance, construction or repair work on such dwelling fiouse.csr on the grounds or bg appm tenant thereto shall not because Qf suchemployment be deemed to be arimployer .... : • : .t' 't 25 also'siaery state or local licensing agency shill withhold the issuance or renewal MGL chapter'152 section tes fhat'ev of a license or pet'�?f to operate a business or to construct buildings in the.cornmonwealth for any applicant who has not produced acceptable evidence of coimplian6e with the insurance coverage reilu7�&ce Additionally;neithbr'the' ' cozxanonwbalth nor•any.of its political subdivisions shall enter into any contract for the performance of public work until of oompliarioe with t�e insurance requi ements of this chapter have been pre acceptable evidence to the contracting authority. . Applicants : s'' erisatitxr affidavit completely,by checking the box that applies to your situation.,Please Please fry inr the w eOmp an name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted supply comp my. to the Depar�eIIt'of Industrial Acei dents-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 perarit or lieeuse is being requested, not the peparhnent o fwustrial Accidents. Should you have any questions regardi the'"law"or if you are btain a•workere.compensationp9licy,please call the Departrfimt at the number listcd.belOW. required to,o. , City or Towns Pleasebe sure that the affidavit is complete andprinted Ieggibly. The Department has provi4ed a space at the bottom of the to fill uat in-the event the Office of Investigations affidavit for you has to contact you regarding the applicant, please afffdi be a to fill ip th the pe partmentby e permit/licens a number which will be used as a reference number• The.affidavits maybe returned tQ, Mail FAX•unless othei'arrangements have b em made.• �; °r, . - • • . , ' : ' .. .. .:.• . .•. , The Office of Investigations would like to thank y'ou in advance for you cooperation and sliould you have a questions, please do not hesitate to give us a'caTl. The AeparEment's address,telephdne and:fax number: . ' The Commonwealth Of Massachusetts. Department.of Industrial Accidents . . emce of latitss�st�ens - , 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 TME r Town of Barnstable of °isy o� Regulatory Services • - Thomas F.Geller,Director w asr $ , Building Division Tom Perry,Building Commissioner ' 200 Main Street, Hyamnis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date AFFIDAVIT ECOR LAW SWP N O MNT T ERMTTN APPLICATION MGL c.142A requires that the"ree oconstructioa of an&adn,alterations, d tion toon,repair,modernization,anypre-existing owmeroccupied ion, improvement,removal,demolition, b g torte inirig at least one but not more than four dwelling units or to strictures which are A&cent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements, ed Cost Type of Work Address of Work: Owner's Name' Date of Application: I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law ❑Job Under$1,000 []Building not owner-occupied Mwner pulling own permit Notice is hereby given that: OARS PULLING TE MIR OWN PEOM, UNREGISTEREDLING WITH ZUROYEMENT WORKDO N�Y CONTRACTORS FOR APPLICABL ACCESS TO TE.E AMITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDERPENALTIES OF PERJURY Ihereby apply for apermit as the agent of the ovr4er: Contractor Name Registration l�io. Date 0 ® Owner's ame I of„ > Town of Barnstable Regulatory Services + a BAMMBM : Thomas F.Geiler,Director mass. �p i639. 01�1 Building Division RFD W1A� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax:.50.8-790-6230 HOMEOWNER LICENSE EXEMPTION- - Please Print _ DATE: 3 JOB LOCATION: number street - �p �� �p�,,, � " / c ,�-., village "HOMEOWNER":T p5&L(� ( ac �Z$— O name home phefie# work phone# CURRENT MAU-ING 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 Homeown 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 Code states that: "Any homeowner performing work.for which a building-pemrit: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:fomis:homeexempt LOCATION OF.'RROPE TY LINES MAID NCO=T BCE CCURi+ E STANDARD LEGEND w m NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES _ EDGE OF BRUSH ORCHARD OR NURSERY _- - `--' .EDGE OF CONIFEROUS TREES MARSH AREA EDGE OF WATER DIRT ROAD C DRIVEWAY PARKING LOT �—PAVED ROAD ------- n � DRAINAGE DITCH' "- ————— PATH/TRAIL pQOC,�d PARCEL LINE** 0` rvw 326 — MAP# 021 PARCEL NUMBER 1 *367 — HOUSE NUMBER 2 FOOT CONTOUR LINE —!0 AP. 028 10 FOOT CONTOUR LINE •�(�� Elevation based on NGVD29 4.9 SPOT ELEVATION STONE WALL 0- 0 6 -X—X- FENCE 502. RETAINING WALL --I RAIL ROAD TRACK STONE JETTY SWIMMING POOL PORCH/DECK 0 BUILDING/STRUCTURE 's - DOCK/PIER HYDRANT .e VALVE O MANHOLE o' :!POST 0 FLAG POLE T O W N O F B A R N -S T A B L E G E O G R A P N 1 C 1 N F O -R M A T 1 O .N S Y S T E M S U N 1 ,T -,a.. SIGN ® STORM DRAIN M PRINTED STAIE:IN FEET *NOTE:This map is an enlargement ale **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James ❑ TOWER ,W, 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD ?� UnJn POLE w ° 0 15 30 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Mop Accuracy Standards LIGHT POLE O ELECTRIC BOX 1 INCH=30 FEET* enlarged scale. on the map. at a scale of 1"=10D'. Parcel lines were digitized from FY2004 Town of Barnstable Assessofs tar maps.' l}� 5rr 1 it r°F1NET°, °� The Town of Barnstable BA Department of Health Safet14 y and Environmental Services 019. �.o►AP� Building Division 367 Main Street,Hyannis,MA 02601 508-8624038 508.790-6230 ' PLAN IaEVIEw Owner: � � �/g�lYtf Map/Parcel:_: Project Address: Builder: The following items were noted on reviewing: • r / li h - 7-1Pe �D ydyDr�T atar/ '��1�'0S� la '�O'rl/o 7tl' P , �� � /�.G r�T ./�-�aue •�rz v✓W,� �'--� � oy�� � � ��6' f o ST i • Reviewed by: dL Date: �OFTHETo Town of Barnstable *Permit# hP O` Expires 6�the from issue date + BaxxsTABU • Regulatory Services Fee �� D YKASS9 s ' Thomas F. Geiler,Director ArFD MA'1 a`. Building Division X-PRESS PERMIT Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 JAN 1 0 2003 Office: 508-862-4038 - Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number, Property Address / I CAIV `'ErY I esidential Value of Work c>25 0(r . Owner's Name&Address v� Contractor's Name Telephone Number��" Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel 0 Co Permit# '4 0 2_ 7 Health Division Date Issued -q Conservation Division Fee Tax Collector �C /G�y� ,�r OW reasurer (Lao r Planning Dept. Date Definitive Plan Approved by Planning Board Historic-'OKH Preservation/Hyannis " Project Street Address J�o �- U� A 1<EZJ Village Owner f A fVQZ E�(1�12 60-1T Address Z7�M Telephone $ _ c6® Z. Permit Request Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay j Construction Type Lot Size �J Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure '�^ '7 _58 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes vo Basement Type: ❑Full Cl Crawl ❑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 $Oil ❑ Electric ❑Other Central Air: Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage),existing ❑new size ool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes >3 No If yes,site plan review# Current Use AAk Proposed Use //�� BUILDER INFORMATION Name — t`Y8m6n � Telephone Number Address � � License# Home Improvement Contractor# Worker's Compensation# - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Z43Dom SIGNATURE _ TE rry R I FOR OFFICIAL USE ONLY e PERMIT NO.NO. DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTIO : �€ FOUNDATION FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r -. FINAL BUILDING, �'� � -DD DATE CLOSED OUT - x ASSOCIATION PLAN NO. The Town of Barnstable FHB ; Department of Health Safety and Environmental Services 639. �� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner TOWN OF BARNSTABLE Permit: d(2o7�. SOLID FUEL STOVE PERMIT Date: . /� 101a8(qF _ Fee- Owner: t LPhone: Address:_sjO—"'— 6�M KF gN iP-\D Village: l l/jqyLSMPV M/t_C_S Map/Parcel: ©© Date: /0 Stove A Ne Used B. Type: Ra ian Circulating C. Manufacturer: V e42M onP I r_A$ 7 N CAS Lab. No._ AtO ►° 0$i LAC L-E-- �, — Ow D. Model No.: gF-5pC-00 Chimney A. New/Existing (If existing,please note date of last cleaning) Ale4y _.._. B. Flue Size 6/, C. Are other appliances attached to Flue? /Lq D. Pre-fab Type and Manufacturer E. Masonry: r/ Lined/ d Hearth A. Materials: i�ry 4 B. Sub Floor Construction: Installer Name: Address: Phone: Location of Installation: APPROVED BY: Please make checks payable to the Town of Barnstable This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Stove.doc I w - ._ rep[.. gels► i --6 9 4 9�Z9 1 3 9 P(�I Li PIC 1� _ �oF We tp� The Town of Barnstable &UWSTABM A3S. Department of Health Safety and Environmental Services 116 ,�•� g Buildin Division Fo�r 367 Main Street,Hyannis MA 02601 1 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner TOWN OF BARNSTABLE :?-9 I SOLID FUEL STOVE PERMIT Date: z-2 9 -00 Fee:,'?5.00 Owner: f—EE l ( Phone: 0Z R Address: J0 K Village: A.51 JS k � l C S Map/Parcel: b © `D Date: p �3 Stove A. New Use B. Type: adi /Circulating C. Manufacturer: 1 J.Q,�M w4 A- Jt�GS Lab. No. ,(yam es-J-o`�� D. Model No.: t?'CE-5a Lv�-�F—Z Chimney A. New Existing (If existing,please note date'of last cleaning) B. Flue Size C. Are other appliances attached to Flue? /y D. Pre-fab Type `d Manufacturer E. Masonry: ine nlined Hearth A. Materials: rt CA,— L.O N B. Sub Floor Construction: Cp Installer Name: . Address: I�! Phone: 2z — Location of Installation: , v5; APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Stove.doc TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map z Parcel Permit# J-1aQ P7 1 Health Division Date Issued Conservation Division Fee ? Tax Collector Treasurer 0 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis " Project Street Address Village -- l.t�y Owner 9 `4 7 �+-KT—Lit I Address S� E Telephone X 2-9 Permit Request ,�l� L-1/� / - To �X1 5 T1/�/�6 Square feet: 1 st floor: exis ng proposed 2nd floor: existing proposed Total new Estimated Project Cost � —Zonin District Flood Plain Groundwater Overlay 1 9 y Construction Type /YIA4tfy Lot Size s Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes )b No On Old King's Highway: ❑Yes No . Basement Type: Full ❑Crawl ❑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 Z Heat Type and Fuel: ❑Gas >3 Oil ❑Electric ❑Other Central Air: Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes No Detached garage:$existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization Cl Appeal# Recorded❑ Commercial ❑Yes ex No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name LIPIM&i )Af =__—k Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PtRMIT NO. e DATE ISSUED J MAP/PARCEL NO. ADDRESS , VILLAGE OWNER 4 • DATE OF INSPECTION' t FOUNDATION , rf FRAME ' INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL _ .` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL { FINAL BUILDING ' f DATE CLOSED OUT e ASSOCIATION PLAN NO. i i e Department of Health Safety and Environmental Services Building Division 1=. 367 Main Street,Hyannis MA 02601 Off/ce: 508-862�038 Ralph Crossen r rax: 508-790-6230 Building'Commissione: Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Cam` G.l/I/I l\l1 L Estimated Cost Address of Work: ,50 `'A 9&0K,— Owner's Name: " 1 Date of Application: /0 —z`i3 — I hereby certify that: Registration is not required for the following reason(s): Work excluded by law (21ob Under S 1,000 Building not owner-occupied (Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME H"ROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. . Date Contractor Name Registration No. l� Date Owners Name q:fbr ms:Af day The Commonwealth of Massachusetts Department of Industrial Accidents Office 011085MMaaMoos 600 Washington Street Boston,Mass 02111 Workers' Com ensation Insurance Affidavit location �-- E� citV Y ► 6 442—C,?7-61\J`5 V t �'�S 7"r ohone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capachy I'am an em toyer providing workers'compensation for my employees❑ working on this job.:::::::.::.:.....................:.. :...:..::.::::.......:::.:::::::::..:::... ::::::.:.:::::.::::::.::::...........:::.:::::::.......:...:.. vn ant . an co a iidre city... .... .............. .............. e insurance co: :. >:�>: «::<:>:::>::::::;:;;:;';:>:<:<:::::>:::»::>:::>::':':: oli ti am a sole proprietor,general contracto or homeowner( ' cle one)and have hired the contractors listed below who have the following workers' compensation polices: COTlIAanV naQ1e � Sw addres ix :;<•. ::•:::.�::.�::.�.�:::•:.�:.::::••:::.�:. ........... ::::v:::v:::;: •:•::•n: ;.:.::::?:vi• ::::::::::•:..�.�:::::::.:;v:;:.:ii:v:hi:i':.;:4:i.i•i;ni:•::�is �'4:::r:vis ii .'�i:::•:::.:::::::.�::ni:•::.}::• yr ..... ... ....:�•:• .....:....:.�::: �:is}ij!i:�i:3:ivi:� i:i�iii..........i:�:i�iii:ii�iii:^.iii i•:iiiii:4:ii:•:i•i:•i:•;3iii:4::i'v't:::v::::::::::�: �:::.<::.;;;:.>:: >';: ::: :: ::.;:.;::;.;::.:::'::;; �•:�:'>:;:<:::�>::�. .<' :::::�.::::<:> :::'`>:«<:;<:��::;. :;:;. :..:::.::::..::,:: . ::::::.::.:::::.:::::::::::.:.:::::::.::.:::::;>»:<: :::>::�>':':: nn�� :•Y.i.. �C: ). ..ti:.. ������)yy,,99, Vi! .................................................... ... �w::::..:is ....... ::.v:.. :......... .isd . ..... . ... ................ ........... 0 ........ ........ ........ ...................................... ........................ .......................... .. ................ . ....... .......................... .............. ............................ ................................................................ ....... ....................... .. ........... 1.. ......................... ........... cenv e;:.:..::::..:,..:.:::.:.:...::..:....:..............::.:...:,....,.... dyes3.ad :>::>::::::>:::: :<>: :......::: .....::>::><<»>:><':<».>;::::>:<::::<>?::< ':: .;;:gene .. ......::::.....................................:. ::::. :.......... ....:::::: :::::.p d - Failure to secure coverage as required>mder Section ISA of MGL 152 can lead to the Impositlon of aiminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as wag as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verincation 1 do hereby certi� r the pains and penalties ojperjury ih�the information rovided above is try and eorred Signature Date AQ — Print name /"�) f—i'1�l Phone# official use only do not write in this area to be completed by city or town ofndal city or town:r -- permit/license# Mudding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Ofilce ❑Health Deparnttent contact person: phone#; _ ❑O�u�� Urvised 9/95 PJA) g 367 Main Street,Hyannis MA 02601 NAM Office: 508-862-4038 Ralph Crossen Fax: 509-790-6230 Building Commissic- HOMEOWNER LICENSE ExEMPTION Please Print 10B LOCATION: A�-2_, mnmbe stela ,J village "HOMEOWNER": Zj!L1 F0 A—-� 7�� cJ 0 2A reamer home phone# work phone a CURRENT MAILING ADDRESS: ,1�'n'L f? Guyitown state zip code The cmrent exemption for"gym `"was extended to include Own_ied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,Rmvided that the owner acts as cuuenrisor. DEFT NMON OFHOMEOWNER 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 personwho constructs more than one home in a two-year period shall not be considered a homeowner. Such"honieownee shall submit to the Building Official on a form acceptable to the Building Official,that he/she than be res>aonsible for ail such work performed under the buildingnenrit. (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 owedures and requirements. Signature of - b Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the Stare Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION the Code stasis that: "Any homeowner performing work for which a building permit is requited shalt be exempt from the provisions of this section(Section 109.1.1-Llcertsing of construction Supervisors):provided that if the homeowner engages a pcmon(s)for him to do such wort that such Homeowner shau act as supervisor." Many homeowners who use this exemption ate um mm that they are assuming the responsibilities of a supervisor(see Appendix Q.Rules&Regulations for Licensing Construction Supervisors.Section 2.15) This lack of awaremess 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 litxnse d Supervisor. The homeowner acting as Supervisor is ultimately responsible. To erasure that the homeowner is fully aware of histher responsibilities.many communities require.as par 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 severai towns. You may care to amend and adopt such a formicertification for use in your community. Q:FORNIS:E.YEMPTN �TMe The Town of Barnstable • a�sxerw�, • Department of Health Safety and Environmental Services Building Division ; 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME E"ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost US Address of Work: �— l/v �' v Owner's Name: Date of Application: I hereby certify that: Registration is notrequired for the following reason(s): Work excluded by law Job Under$1,000 oB�ui ding not owner-occupied MOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. . SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. Date Owner's Name q:fortns:Affidav ' The CommonweaUh of Massachusetts Department of Industrial Accidents -_ Office of/mess ooffoos 600 Washington Sired Boston,Mass 02111 Workers' Coma ensation Insurance Affidavit name: t'Z M DN D NoZC)OA-Z Eft(ZTL F i� location: city V ►4 �'�-rC)PJs P ►' ' L V7 i ! ►'1 P1 phone fil I am a homeowner f; andpner performing all work mysel capacity c� an employer providing workers'compensation for my employees working on this job. any n ............ x. `> ::. . :::::::................,...............................................................................:.:::::::::::..::::. .:::.. ....... �::iii:4i::'i:i!-i}}:{4}•iv}i}}ii}}i}}}}ii}Y4}}is4}}y;:{•ii:{:.?{:.:•:i;.}}};•.;yv.}•:+r:v::•;:. ::A:`:C{nX4iiy:{{{•}:C4:{•}iii}}:v:._::::::i::::4}i'r4}$$i$�.:i:::$•}:�}:•}:4is4:•:O;•}}}:{•}}}$:;$$i::$;(::Y$i$$'i:�:4:4;{•}:4:{•i$:i}�:;:j?...v. ................................:...................................................... X. X. :..............::...e hoe e�#':>::: :`: <<.<:�`>:.:: '.�>':< >><::>>�::�<>`<':��':: :{`?>>`.>:>:<:>?:�<�:< I. vy{.:::::::::•::. insuraX. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following woticers'compensation polices: comosav iiam ..:.:::.::::::::...................:...:.................... {.. adress.:.. ........::.......::.::. . .......:...:....::.. :.... . .... { ......}:::.:•• ..:::::::.:::::::•:::....v:.:....................;.v:vv::.:.v..r.. ........ v:::......................... v.........r :::nv:.{:+:•$:}:v:}::tv v;:...................$$::.. •..r.:{}i ..\..v v...n:::::�v.v:::nvv w.x.v..•v:::.v::•• ...,.....r....,.}ii:::x:r::r.{.....:n.}}:h:,v:nvrt•.v::n,w:::::.•.v v:xnw yk ...r.... #:: ':;:;iii:;:is;::%>'? ?;.;.;.}:!::::$::::;}i.:%?;;:,:risiii$$$$$$$$:;ii::$;:ti:$$l$:!:$:•:$$;:y;$;:i{;:$)•}:$$$'$$:i::J �:?�blltlilt i;i;i;i;ii;: '[ii}?i;i;':;i_i;:;3ii ;:;i+i�i;:;isi:'�i` `$`?? '%''i{,i;:y:ii;`;i`:.'•.iio :?pi;:i:i:i� 3i' i� %� ..: .._ _:-r: ::f:,•::>::--.� ::CO:>.:$:::{:;i:;$:<;$$:j;:;:yi:;+;$:::;$:':;:i,>.;y:; ..+;:}}{';}$';$:•$$}'{}.::•:L.'$: :::;:?j::•n!$:;:}:$i:$$C'}: ?'i:f4h$$$:::<::ii:{:'....''':L'v:$:r $:rii:Y:$$$$i$ri• ..................................... ....................................... ...........................5,.:4+..........•.✓.•::::.:::........................ ...... c+•.r....,,.. r:::.:::::}::+:...:.. ::c;r..,. ,.....r::}}•••}••:c 4n•}. .{E .. .....:::•.�:...:...:r..................:.�•:::}::•:::�::•:•::••::::. ::{•::,;;r.};.;$oh:;•:..:.o:::•:::::............:.::....... ::::.:<,{..�:•.{.}.::r::c•:.......,•.:...K-....;.;:........a.,,c...v:r .wve3:k4ar}:4:•::{. insnrance.co:::.............:. .,.:...:.,:..:..:...:::....,.:..::,:::,::.....:,::::..:. bli'ty# ._....... . ... ...................:...........................................rr:.v:v::::::::v.v:::::::::::::::v::::::::{{4}}v:::.:i{4:4:-}}}}}}'•}}'{;•!h:•.w:•.v::C:$$$$. r.: 4 . tiff•+CS'i'?'•'f`Siyvf<:T' $$$$$?$}:':'•:3$$$$$$$$:i:$$$$$$$$$$$$$$$\4:i!i;vii::iiiiiiii$'}::�$i'ti4iiiii$i?$is�t:$$$$::;>:�ii}j$ji�?':i?iii`:vi$ii?i}>is4ii::vi:i:}$i$$}:::k'v$$$i$$:i:$$ri<:}{:}':i}w.:4:•{,•{,+,{$M1-f:Y{{{::{4•:.}w.}}v:{:}:{.:{• ......................:::.:::::::......... .;�:::::......... v::::::::3:C.::::.:w:::::•.v :•:w;...........................>.v:::::.:v.:: .....::•.::...::..::.::.:..v:.::n..:•..Yr.S..v}}}}}...4}....,.......... camoanv name:;:.:{.:{:.}:.;'•$:..........................:..,...... ...:::..::.::{:::......... ..... :;:::::::..:::.:::,:.:::::::::....,.............,...........:._::.::..:.. ��<;• . ,.......... ..................................................�:•::::::::. ;:M:{...w. .v. >s ::>: ddres a ................ re FWlure to secure coverage as required under Section 25A of MGL 152 can had to the imposition of criminal penalties of a fine up to$1,500.00 and/or -one years'imprisonment as well as civil penalties in the form of a SrOP WORK ORDER and a fine 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. 1 do her w the pains and penalties of per,jury that the information provided above it trw_and correct SiPature _ Date Print name —I\ " ` ft-BLT L�(7— Phooe# / ,J;k)2) 2 - SO z aX o use only do not writs in this area to be completed by city or town official city or town: peradocense# aLIcensing Bond Department ❑checkif immediate response is required ❑Sdeetnm s Office • _ ❑Health Department contact person: phone#, ❑Other (nriised 9195 P7A) Information and Instructions 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. . _ 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 mmmber 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 ant in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peiii t/license number which will be used as a reference number. The affidavits may be returned io the Department by marl 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 Offlt;e of Invesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 ' Department of Health Safety and Environmental Services Building Division 367 Main Sheet.HYamis MA M601 rues Office: 508-862-4039 Ralph Cross= Fax: 308-790.6Z30 BlIffiffn �� HOMEOWNEBLU== Atm��t waLi2el-a QKrE 9 10H LpC.A•nOri• Viam � o -- sum �� � Et oaa:a homephoasd wa�icpha>:ed �rcMAQ.n�taAc�R>�s: cS Gt,�� o`a0 The csurtss- ac=don was extended to incWd W dweffigm ofsac units ar fees aadto allow how to=jp =&div&ni farhitt *AO doesnotp==a 1Icc=, Ct30L pg.F'II�A@1 GFIgn pis)who owes a pa rcd of laod an which hdshe resides ar iatmds to:ndclk an which thm is,or is to be,arms ortwo-fmmgY dwaab8. ar ddached a =s=Yto=chum andlarfarm sue. A who smote thaw ama hatoa in a two rwpcdod s�not be camsidemd a ho®eowaw. Such peastm to tbo nMI&Mg Offish that belsb ARli be . ...._ slm0 sa�itto tba 9aJdiag Otliciat an a form 109.L1) The �mP��Y£or widtthO 3t ft Bw'Iding Code aad other applicable codes,bylaws,rates andiegala wnL The tmde:si "boimeowae="ts3ti = bat hdshe tmdesstaads the fawn ofBamstdbk Buddiag Dega:Omeat miaiumm iaspsxdcn pt'oPP 'r and requhmmem and flo haWw wM c=piY with said prop P 1,ces and AMMVd of Bail"10Zbd Note: ' Y dweftp 35.000=bic feet ar urger wd1 be regrvh 0=mply with the State 9uiidi tz Code Secthm 127.0 C.mM ctim�s�M desamatmr 'AaYfiomeownerpe£oamftVIMkf"�sbmt d=flubea f outhe MMCo oftbiatraviMOCCdM LOW•�gCf ptvnaedtmtitt6ahsmeownt:m�Bes aPMVI�t=1 for bjm=dosaebaa-*K=ChHMPM aerate Maattaanboe ats . dW CtfaM=d=(=AVPW%ftQ, bMy rahea the homeawaahCmieOnatmhha�� °SsP�aWhM seam tmt SM ftj@*ofw �a® a � aoaidRuin ARembdMf2t In�dscMO° Boidcmopoxd mtmiicaedpanasit with a lioas:od Sctpa+►'s~� The 6OmeQwomtaaisg n Sspenisor a n aM s as ofthe pemat Q0' Toeo�eimttmfiamoowaaiCMMft�eaftd;lha ofs Oaths im"Fafthb ism isUfatsa�' tmathe�to��thaafarittsm�thst f�naiayvor�y. . by awad tawa:. Yoa msf to amend aad adopt snrA a fomslaa