HomeMy WebLinkAbout0045 WATERSHED WAY
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ACTIVE
1
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map O'�q Parcel 6 CJt TOWN OF BARNSTABLE
Application #
Health Division -c �''') '-�} Date Issued
_Conservation Division i2n Application Fee
Planning Dept. Permit Fee 0 D�
+?1 vra�i�lV
Date Definitive Plan Approved by Planning Board
Historic- OKH _ Preservation/ Hyannis j�►'�'
Project Street Addressi�lf��
C vvner Address ��
Telephone=TQ.• .2sy'
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation / Construction Type
Lot Size 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
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_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
p� (BUILDER OR HOMEOWNER) l!
Name �1�-' �
DIN OV�`�Y �Te le"phorieNumfjer � �- 7
Add ess J ������ License #
Home Improvement Contractor#
Email Worker's Compensation #
ALL CGNSTRU-TION-DEBRIS- SUL-TING-FROM THIS PROJECT_WI[CBE-TAKEN-T_O_-
A
SIGNATURE'— DATE
FOR OFFICIAL USE ONLY
V4 - 7�
t APPLICATION #
t DATE ISSUED
3 MAP/PARCEL NO.
w.{ ADDRESS VILLAGE
OWNER -
7
t DATE OF INSPECTION:
P FOUNDATION 'nv�VDS Sa of tSj�ybt- - �w9
FRAME l� .t�l�J4h1 17�� Q�rn�irn !4 z•5`s ft sdr9
a�
INSULATION
w
FIREPLACE -
,{ r
x ELECTRICAL: ROUGH FINAL
3
PLUMBING: ROUGH FINAL -
GAS: ROUGH FINAL
FINAL BUILDING
;r
DATE CLOSED OUT' -
ASSOCIATION PLAN NO,
t
r
27ie Comarornvealth ref Massachusetts
Deparbuent of lfirdustrid Accidents
Office of Investigations
600 Washuigton Street ,
y Boston,4 02111
future.massggovIdia
Workers' Compensaf on Insurance Affidavit:BlEdiders/Contractors/Elecfri:cians/Plumbers
Applicant Infarmaf'on G; A'/ Please Print 'bI
Name(BmsmessiorganizationlFndividaa y ® U7K
M&ess.-
a-&ZZr
City/St AJA/LS72-')/V 1 /L�- S Phvne 71�' 1961
Are you an employer?Check the appropriate box: ' Type of project(required)-
L❑ I am a employer with 4. ❑I am a general contractor and I 6. ❑New construction
employees(full andfor part-time).* Have lured the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling
ship and have no employees . These sub-contractors have 8. ❑Demolition
working for me in any capacity employees and have workers' ❑Building addition
[No workers'comp.insurance comp_iusuranmi
��ed] 5. ❑ re We a a corporation and its 10_❑Electrical repairs er ad�tious
3. I am.a homeoumer doing all work officers have exercised their 11.❑Plumbingrepairs or additions
myself-[No wosk=s'comp- right of exemption per M-GL 12.❑Roofrepairs
insuranceregaired.]T c.152, §1(4)6 and we have no
employees.[No workers' 13.❑Other
comp.insurance required.]
*Any sppBcsad that chefs box Pl mast also fill out the section bdow-bowing thek vmIkere compmuatioupoliicy irt5ramutm-
Hameaarners who submit this afMm t m&cat ng they arg doing all weak and then}Hire outside contractors mast submit anew affidavit indicating saclL
fCoauact.rs ffist checlr this boa mast attached as additional sheet shoring the name of Coe sub-camrrrms and state whether at not those entities ham
employees. Ifthe sub-contractors have employees,they mustpmuide their workeW comp.policy number.
I am art erttpLapr tliat isprniding workers'cortgmnsatiatt inmirarrce for my encplayees. $etory it the policy and job site
information.
Insurance Company Nam:
Policy g or Self-ins.Lic.g: Expiration Date: /�
Job Site Addt� &�� � W �1/ City/Statelzitp:/—* Q? e1445 `
Attach a copy of the workers'compensationpolicydeclar tion 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$1,500.00 and or one--year imprisonment as we.11 as civil peualties.in$re form of a STOP WORK ORDERand a fine
of up to$250-00 a day against the violator. Be adidsed that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification-
I do!emery car)3,Hader the paves andpenatties ofperjuty that the utfonna#iott pnot-ided abm a is true and correct
Sitntahtre: Date:
Phone g- —721 ' ,S( L /2)f
Official use oily. Do not write in this area,to be completed by city ortbim ofaciat
City or Town.: Peru tUcense#
Issuing Authority(circle one): ,
1.Board of Health 2.Building Department 3.CitylFown Clerk 4;Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
-Information and Instructions
Massachusetts Gehexal Laws chapter 152 regaires all employers to provide workers'compensation for their employeet.
Pmsuantt o this statute,an mplvyr-is deed as.°`_.e=y person in the service of another under any contract of like,
express or mapped,oral or wry."
An employEr is defined as"an individnal,partnership,association,corporation or other legal entity,or may two or more
of the foregoing engaged in a Joint entmcprise,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 flum three apartments and-who resides therein,or the occopant of the -
dwdTing house of another who employs persons to do maintenance,construction or repair wOrlC on such dwelling house
or on the grounds or budding 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 Been a or permit to operate a business or to construct bufldmgs 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)stars"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the pP ante ofpublicworicuntsl acceptable evidence of compliance with the it surance&
re,;mmients 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-contraetor(s)name(s), address(es)and phone number(s) along with their cerlificate(s)of
msm-ance. Limited Liability Companies(LLCM or United Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation iuso:ralce. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of insuinance coverage. Also be sure to sign and date-he affidavit. The affidavit should .'
be retuned to the city or town that the application for the permit or license is being requested,not the Department of
h2d gft i al Accidents. Should you have any questions regarding the law or if you are regon ed to obtain a workers'
compensation policy,please call the Department at the mombea listed below self-insured companies should enter their
self-insurance license number on the appropriate lime.
City ar Town OfUcials
f
Please be suu-e that the affidavit is complete and printed legibly. 'ITze Department has provided a space at the bottom
of the affidavit for you to till out in the event the Office of Investigations has to coact you regarding the applicant
Please be s :re to fill in the pennitllicense niunber which will.be used as a reference ntmmber. In addition, an applicant
that must submit multiple pennit/license applications in any given year,need only submit one affidavit indicating cmrent
policy infbination Cif necessary)and under"Job Sib,-Address"the applicant should write"all locations in (city Or
town)-"A copy of the•affidavit that has been officially stamped or naked by the city or town maybe provided to the
applicant as proof that a valid affidavit is on file for fit re'permiis or licenses" A new affidavit must be filled oirt each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial veatse
(ie. a dog license or pennit to bun leaves eio.)said person is NOT requdred 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 as a call.
The Department's address,telephone and fax number.
' - 'I� ltir of I�Sassachr»tis - •. " •
Department c&lnd ial AccidentI
ice ofq�efrgntioa
�Q��ashingtan S
Boston.,MA G21 lF
Tf,-L 4 617-?27•4900 ext 06 or 1-977-MA.SSAFE
Fax#617-727-7M
Revised 4-24-07 mast gQgfdia
Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
• RARNSTARM Tom Perry,Building Commissioner
1639. , 200 Main Street, Hyannis,MA 02601
�'rFD ► www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
DATE: Please Print
�
JOB LOCATION: �✓� / 6v i y ///,9V2Z—mzy
number street village
"HOMEOWNER": /Ao en i uITNA/LeY -78( 334/36a? 79/-,RSY l9'61
name /-� / home phone# work phone#
CURRENT MAU ING ADDRESS: �C E�I�.��/ (�A/
Lev-Nrika_Ld ,/ ��� C1 (9 yo
I . city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow.
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any•homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that.he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit fonm\EXPRESS.doc
Revised 040215
�"WE Town of Barnstable
Regulatory Services
�rrar�su.
MASS. �, Richard V.Scali,Director
o '� 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
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)`
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections.are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS
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°Ft r Town of Barnstable
Regulatory Services
a
98AMNS. Thomas F. Geiler,Director
�A i63p. �0
�Fo",osA Building Division
Thomas Perry,CBO,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
PLAN REVIEW'�020/5-0 7 57! 7
Owner: Map/Parcel: 6 S-7 UO C/
Project Address Builder: :S'09-M6
MA
The following items were noted on reviewing:
PREScR/P7C OF />•'E5 I, NT/i¢L
- Gt/Qov s Cvnrszr�ucz'«v 64i&c— -f-eke 2c
i
Reviewed by: L' cG
Date:
Q:Forms:Plnrvw
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o jo` TOWN OF BARNSTABLE Permit No. 32132
• �'llli� " BUILDING DEPARTMENT
I a.■a a I TOWN OFFICE BUILDING Cash
t639 L1
9�a■ar HYANNIS,MASS.02601 Bond ................
CERTIFICATE OF USE AND OCCUPANCY
Issued to James K. Smith
Address Lot #17, 45 Watershed Way
Marstons Mills, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
December 8, 19 89........ ......
Building Inspector
o'�� ••'., TOWN OF BARNSTABLE .
BUILDING DEPARTMENT
= 1°$MU& ' TOWN OFFICE BUILDING
ua
HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has been issued for the building authorized by
BuildingPermit #.. Z�->..Z.........:.......... ..................... ........................._..................._.........._ ...._...... ......... »._.. .»».
issued to .. !... .. '...:.� .:............ ........ »fv �i�-�_"'
�»
Please release the performance bond.
L
TOWN OF BARNSTABLE, MASSACHUSETTS OUILIJIlivu
!.a6`5I-009-001 DATE August 2, t9 " 88 PERMIT NOM • 92M
PPLICANT -_ James K. Sinith ADDRESS_ Rarnntmhl P #005190
1 INO.) (STREET) (CONTR'S LICENSEI
'ERMIT TOull.C�, DW.�11 7 p 7 't NUMBER OF
(_.�) 'STORY _ Sing E'> r'aT(1"f 1C1 IUWE:> > n9VELLING UNITS
(TYPE OF.IMPROVEMEN NO. (PROPOSED USE) ,
AT (LOCATION) Lot #17, 45 'dat ershoci way, m trL toyin Mi .( 1E ZONING
CT R��
(NO.) (STREET)
BETWEEN AND
(CROSS STREET)' -(CROSS ,STREET)
LOT
>UBDIVISION LOT BLOCK "SIZE,
WILDING IS TO BE FT. WIDE BY FT. LONG BY: FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
rO TYPE USE GROUP` BASEMENT WALLS OR FOUNDATION
(TYPE)
IEMARKS: GQWi aQ OW3-422 '
.. ♦ Bund
%REA OR/OLUME 2000 sq. fL'. � 150 00 FEE MIT $ 100.00
ESTIMATED COST I 0 0 0
(CUBIC/SQUARE FEET)
OWNER
James K. th
bartistabie BUILDING DEPT.
4DORESS BY ,�bqkA`hf- �4 x
PHIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
,ERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
,ROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED•
-ROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
)F ANY APPLICABLE•SUBDIVISION RESTRICTIONS. c.
AINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
NSPECTIONS REQUIRED FOR CARD KEPT POSTED.UN PERMITS ARE REQUIRED FOR
ILL CONSTRUCTION WORK: TIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND _
FOUNDATIONS OR FOOTINGS.
MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH).
FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPR'VAI6 ELECTRICAL INSPECTION APPROVALS
Mul
2 TI vi (q I 2
Dec - 7- 91
HLAIING INSPLCI'ION APPIIUVALS ENGINEERING DEPARTMENT
a
OTHER - BOARD OF HEALTH
99
NORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
OR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR,BY TELEPHONE OR WRITTEN
:ONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
111 ;�
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• i
oK P(
' `—AsN.ssor's offioe•Ost floor): 09 0,v/ A 11" s
J (/ �F TN E TO
,Assessor's map and lot number ............................................ SEPne -SYSTEM
R� �AL�.�'�i IN MU.
Board of Health (3rd floor): MR STALLED
COtP:PL, . .
Sewage Permit number .............................
Engineering. Department (3rd floor): WITH TITLE 5 � rasa
#� .. ................. Eli'it s 9NME NTAL �� ��"'��e pv 6�0�
House number ........................................ ..
APPLICATIONS PROCESSED .8:30-9:30 A.M r and 1:00-2:00 P.M. only TOWN REGUUTIGOq
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ....... o�✓S-7.G c/CT..... yt/c L.G/^/
.......... ..... .....
TYPE OF CONSTRUCTION .............. .!...P-C?®...... ✓J, ..................................................................
...................�°.,...06...........19......
1�14 , t yam .
TO THE'¢INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ......e4nT......e��1. ........►!✓flTE.2S' s!G� ....J �`?.y......../✓�FJ To il'.../ /.L.GS'........................
Proposed Use S'/NG.G E.... A..✓j ..Y.............................................................................................................
..................
Zoning District E-s'..bENTj..9.........20Z:..............Fire District ........(!�.7...�/. m.!..!.,................................
Name of Owner J "`��..... .....�,[..t /....1. f7............Address .........� � 5T.19"��.G.. .., ..........................
.....................
Name of Builder .-� �S �Sitt,.(..(..4.........Address ..............X"/V.:S.'..!�"��i..�.......................
...............................
Name of Architect ...................... Address .....................
Number of Rooms ............. .. .............................................Foundation ..... Q .......�r .��(..!/ ......
Exterior .......CL ...��"2.t�.....�...��.C. . 5.............Roofing .............. L. .....................................
Floors ............. ..`. 9. J... `...�...................................Interior .............7���ecJ f}C_
lR Heating L5> .....W. ✓ c.....+.Vg.. g 6 ���.IT S
.............. Plumbin ....................................
Fireplace ..........................�....................................................Approximate Cost .......�.3v.. .................... ...............
f ��i Definitive Plan Approved by Planning Board 9� 1 ________ . Area ....�r�J..'�r..�......................
Diagram of Lot and Building with Dimensions Fee �!��
' . ............. ..............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
w Name ........... ...... . ........../1 ............
Construction Supervisor's License .......Q. .(). ..�.`� .
,. SMITH, JAMES K.
32132 One Story
No ................. Permit for ....................................
Single Family Dwelling
.........................................................................
Location ......LQ.t...#17.........4.5..Watershe Way
.. ........... .................
Owner ......James K. Smith
............................................................
Type of Construction .....FXAMQ........................
...............................................................................
Plot ...*.......................... Lot ................................
August A-
Permit Granted .......1............. 2. ...... 19 88............
Date of Inspection .....................................19
Date�omplqed, .............i 9,Y7
Town of Barnstable *Permito �
X-PRESS PERMIT' Expires 6 m onths from issue date
Regulatory Services Fee OCT _. 2008 Thomas F. Geiler,Director .
Building Division
TOWN OF BARNSTABL. '5m Perry,CBO, Building Commissioner G'
200 Main Street,,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address
S Residential Value of Worl �(Llyp Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address S, (ik�/
Contractor's Name; L W f Lt— % t44•7'7j c�i r- ; Telephone Number
Home Improvement Contractor License#(if applicable)_ (7�'
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
�e-.roof(stripping old shingles)-All construction debris will be taken to �1Y�+�
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum,44)
*Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
SIGNATURE:
Z:Forms:expmtrg
kevisc061306
Douglas L. Williams Custom Building Co.
P.O. Box 1069, Centerville, Massachusetts 02632
Since 1972 .
Centerville, 508-775-1500
www.capecodhomebuilder.com
e-mail homebuilda@comcast_net
lce�ommw�u�eal!/,:o�✓�.Craaaa/uce!!� 'el
Board of Buildidg Regulations and$tandard"s
ConW.4609n.Sypervls6r License `
� ���\: CS 1698'I k •
2010 Tr# 20414 l
I tot — ti
� d !
i DOUGLAS,L WI~
PO BOX 1069
I CENTERVILLE,MA 02 Commissioner 1
✓1. 'Ciomrmwvuuea i
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
,13'\ -Board of Building Regulations and Standards
Reglstration:\102227 One Ashburton Place Rm 1301
Expiratlorr_7/4/2010 Tr# 271106 Boston,Ma.02108
(�j— ype: DB``Ag
DOUGLAS L.WILLIAMSQUST M BUILDING
Douglas Williams '�3:
• 222 PINE ST. '�:\ / -- ,
CENTERVILLE,MA 02632 Administrator Not valid without signature
oFra,,ti Town of Barnstable
Regulatory Services
BARMABLK
NAM �, Thomas F.Geiler,Director
�EDrr11•'I&`� 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
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, I<ev,n 94�, '3/t--✓ A- ,as Owner of the subject property
hereby authorize W t k—c— to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
�o /c>-
,.Signature of Owner.: D te
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
QTORM&O WNERPERMISSTON
Town of Barnstable
'THE Tp��
y�P Regulatory Services
sarwszeaLe Thomas F.Geiler,Director
MASS.
i639�- 0� Building Division
AlFo ° Tom Perry,Building Commissioner
\ 200 Main Street, Hyannis,MA 02601
Rwiv.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a fomr/certification for use in your community.
Q:fomis:homeexempt
i
' IWe Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111'
www.mass.gov/din '
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name 9usiness/0rgaoiz&tion/1n&vidW): j C� 0, 3•r
Address: -
City/State/Zip: ,` Phone.#:
Are you an employer?Check the appropriate a: :Type of prof act(required):.
1.❑ I am a employer with 4. [] I am a general contractor and I 6. ❑New construction .
"employees(full and/or part time).* have hired the sub contractors
•
2.M I am a'sole proprietor or partner- listed on the'attached sheet: 7. ❑Remodeling
dip and have no employees . These sub-contractors have g. []Demolition'
for me in an c act employeey and have workers'
;avorking Y aP tY• 9. ❑Building addition
[No workers'comp.msuuance comp.insurance.$
5. We are a corporation and its 10.❑Electrical repairs or additions
requn ed] officers have exercised their 11. Plumb' repairs or additions '
'3.❑ I am a homeowner doing all-work . � � P
myself[No workers' comp. right bf exemption per MGL 12.f!*of repairs
insurance.required.]e ]t c. 152, §1(4),and we have no .
. employees.[No workers' 13.El Other '
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers,compensation policy information.
t Eomeownera who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such.
tCont actors @tat check this box must attached as additional sheet showing the name of the$ubrontractun and state whether or not those entities have
employees, if the sub-contractors have employees,thrytmust provide their woakere comp.polir.'y number.
I ant 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.Lie.#: 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 tip tb$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK•ORDER and a tine
of up to$250.00 a day against thq violator. Be advised that a copy of this statement may be forwarded to tie•Office of'
_ Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains•and penalties of perjury that the information provided above.is true and correct
Srenature —� c _ Date
Phone
Offtctal use only. Do not Witte in this area, tb be completed by.city or town:officlaL
City or Town: ' Permit/License#
LIssuing Authority(circle one):
J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
pFiME Tp Town of Barnstable *Permit
'f p� Expires 6 months from issue date
,,,�,,�,�� : Regulatory Services Fee , UD
to
1e59. ,0�' Thomas F.Geiler,Director 1 3 101)/D f -n,1
�''O�Eor�t• Building Division
Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601w
Office: 508-862-4038
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION
Not Valid without Red X-Press Imprint
Map/parcel Number Q yr q 0
0 q - odlf
Property Address L — t4
[g-Ke-tidential OR ❑ Commercial _ Value of Work O j
Owner's Name&Address
Y�- W Ar6m-00 l *y
Contractor's Name C� /�i�/� Telephone Numbers
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
F]Workman's Compensation Insurance
Check one:
I am a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance f� J
Insurance Company Name
Workman's Comp. Policy#
Permit Request(check box)
Re-roof(stripping old shingles)
❑ Re-roof(not stripping. Going over existing layers of roof)
ff"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
expmtrg
. 1 1-2001 TUE 01 : 28 PM P, 002/002
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FOR THE POLICY Fe
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............
........................
Y
Assessor's offi.oe (1st floor):
Assessor's maand lot p: number ............................................'..
Board
rd
o Permit(3numbefloor)-
Sewage d� o
....�� .
f`............................... ....... Z BASd9?GOLF,
Engineering Department (34,fIoor): NAM
� �� � � � 7�o 1639.
\e0�
House number
APPLICATIONS PROCESSED 8:30-9:30 A.M. -and 1:00-2:00',.P.M.'only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
' APPLICATION FOR PERMIT TO .......C'Q.�/s"T.Q c%C ......... 2>.,.PV ...................................
TYPEOF CONSTRUCTION ..............WP4o 4)...... ...................................................................
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TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ......e4PT.....e��.......... j............/.✓�A2.ST..4. ✓�4'..../ l .G.S'........................
Proposed Use ........5i�/G.GE.... is+.✓t .C• ...........
..................................................................................................
ZoningDistrict ........................................................................................Fire District .....:.. ..... .... ./ ..............................
Name of Owner ..........
J° ....f 5.....1�....... .i�Lt..1....!...! ...........Address ........ e STj �.. ..,. �..........................
f Name of Builder . .5:.............. ...!. .........Address ............... ! ,C�/U.s.�.!4 G..�C —:.......................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..............Foundation D.0 7 C'O,UL'•/2•¢-/
Exteri P� .2. .... ....� .. . . ............Roofing ............. ...0. .. L
Q.�f .!.Jv.....J....J.. . ...................................Interior .............
Heating �o. .5_....g).A-efi�._.... .:�.r.......Plumbing...............�..... .IT.-S..................................
._ ...
Fireplace .......................... .. ...........................................Approximate Cost .......�/�Z�..Q��
..................................
....
a T- 19
Definitive Plan Approved by Planning Board __ ___Ie�LL ___ __ _ � Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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i
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... ....c!.../`C....... ..... ..... ..... ._...............
Construction Supervisor's .License
SMITE, JAMES K. A=059-009-001
0 0
No 32132 Permit for ...One....St.o.....ry..........
.. .... .... ..
ingle
. ...........................y dwelling....
........ .....
Location ..Lot #17 , 45 Watershed Way
.........................................................
Marstons Mills
...............................................................................
Owner James K. Smith
.................................................................
Type of Construction ..Frame
........................................
.......... ................... ............... ................................
Plot ........... ................ Lot ................................
Permit'6ranled .......Au9.1A,5.t...2............19 88
Date of Inspection ...................................:.i 9
Date Completed ......................................19
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