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HomeMy WebLinkAbout0168 WHITE MOSS DRIVE /�� r� ��ass ��, �'� . .� .�-.r....-.:� _ _ _ TOWN of SARNSWRLE 2013 NOV. 26 9: 20 Town of Barnstable ennit- . Regulatory Services ate: �o oyy" Thomas F. Geiler, Director P �} Building Division ee•BARNSUZLF� '3,� s i r MAM ' Tom Perry, Building Commissioner %6:19. 200 Main Street, Hyannis, MA 02601 yA www.town.barnstable.ma.us Office: 508-862-4038 TOWN OF BARNSTABLE Fax: 508-790-6230 SOLID FUEL STOVE PERMIT Owner:�D.Y f't`L �c'oy`y12 Phone: 77 q 5-21 6375-- tell) Install at: Village: 44,vs - S Map/Par'el: o y 6 iq Date.-A-13 -13 Stove A. New/ se B. Type: diant Circulating C: Manufac 0. e r Lab. No. D. Model No.: ' Chimney A. New l xistin (If existing,please note date of Iasi cleaning B. F1ue.Size C. Are other appliances attached to Fl e?NO D. Pre-fab Type and Manufacturer E. Masonry: Line nlined Hearth .A. Materials: Br l c_� B. Sub Floor Construction: Installer Name; Phone: Address: Location of Installation: H.I.0 Registration# I Construction S_rvisor# OR check_ Hom w er Installing, no license required. APPL7 =S=SIGNA3`URE — --U:=Ll APPROVED BY: Please make checks Payable io•the Town o Barnstable *This constitutes an.official stave permit after inspection. znhntnarnrlhoa —4 :______.-7 7 The Carnirtanwealth.oflYlassachuset�s Dgartment of lridustrial�cczdetsfs Office of Investigadons - 600 Washington,Street Bosi'on,AL4 02111' www.mass:gov/dirt Workers' Compensation Iusur;�nce Affidavit:Builders/•Contractors/Eledtriciaus/pinmbers i Applicantinfoiamation Please*PrintLeff-ffily 11�ess/Org�izati®/Indiyidua�:_, >/�t f')''���`'�--• �- g/aL.,,�v' . City/sta /'� Phone.#: „ A te/zsp: �`�p�c�v�s e%Aj5 oz %7.�/ - ;-a —'Cl— l3 Are you an employer? Cbeck the appropriate.boa: .Type of project(required) 1.❑ I am a employer whh 4• ❑ I am a general coiRtractor and I 6, New comgtruction . employees(full axWor part time).* • have hired the glib-contractors ❑ 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 working for me m any capacity, employees and have weiirers' 9, Bur1 ' addition [No workers' comp.insurance comp. insurance,$' ❑ . VI q�ed] 5. ❑ We are a corporation and its 10,❑•Electrical repairs or additions-33. an a homeowner doing a71 world . Officers have exercised their 11,❑Plumbing mph or additions myself [No workers'comp, right of exemption per MGL 12,❑Roofrep ' insurance required-]t c. 152,•§1(4), and we have no employees. [No workers' comp, hLnM anne required.] *Any applicant that checks box#1 must also M nut the sectiva below showing thaff wodrts'eampensation policy mtm-ma.tiou. f Homeowners,who submit fhis affidavit indicating they are domg'all work and tlica hire eutsida cantrwh=must submt anew affidavit utdicatmg such, $Cvatractors(hat check this box must attached an additional sheet showing the name of the dub-eontcaetm and state whether arnotthose cr'tities have ernpjoyees. If the sub-cnntractcrs have employers,They mnst prwidt than wori=,camp.policy number. I am anrn r arnpenk sad6n insurance for my employees. Below is.the policy and job site' fnformafion. • - I=rance CampanyNa�ne: Policy#or Self-ins.Lion.A r Expiration Date: ETob:SiteAddress:���D� �'�1 ��IOSS--��,r'IV� -W� - - S I°I Z•��l / ;AN--- R-s, Attach a copy of the workers'enmpensation policy declaration page'(showing the policy number and expiration date). Failure to secare coverage M required wider Section 25A of MGL c, 152 canlead to the imposition of*a1 penalfies of a fine tip tut V,500,00 anNorr one-year impris anment, as well as civil penalties in the forest of a•STOP WORK;ORDFR and a fine of up to$250:00 a day against the violator; Be advised$hat a copy of this statement maybe forwarded to the.Office of- luywdt*, m•Lions of the])IA far insarce coverage ymifiaaticm ' .I do hereby csrli,fy Lim fits yains•and penalties 0-rje7jury that the rnformadon provided above is ate and correct;. Phone# Q fxw use only. Do not write in this'area, tb be completed b}!.cn�ar town official �y or Town: YermitUcense# Q. I�Vho �s.responsible for making application forth ' erm -- — --- -- -- :--- h Application for a permit is required to be made by'the owner or lessee or their agent of the building (e.g.; the HIC registrant ). if application is made other than by.the owner, written authorization of the owner must accompany the application. Such written authorization shall be signed by -the owner and shall include a statement of ownership and shall identify the owner's authorized agent, or shall grant permission to-the lessee to apply for the permit. The full names and addresses of the owner, lessee, applicant and the.responsible officers, if the owner or lessee is a corporate body, shall be stated in the application. Please note It is the responsibility of the registered HIC to obtain all . ermits necessary for work covered by the Home Improvement Contractor ReQJstration Law, M G L c 142A. An owner who secures his or her own permits for such shall be excluded from the guaranty fund provisions as defined in M.G.L. c. 1.42A. Back to Top contractor told me I need to obtain the permits fo m construction. May 1 obtain the relevant permits from Amy local building. department, or is the contractor required to do that? -- While you may certainly obtain your own permits, be aware that if you do, you will fall into a homeowner exemption that will disqualify you from being eligible to-receive recourse through M.G.L c. 142A, the HIC Law, or the statutorily authorized Guaranty Fund, should a problem arise. It is the responsibility of the registered HIC to obtain all permits necessary for work covered by the Home lmprovement Contractor Registration Law M.G.L. c. 142A. If the HIC you are contracting with refuses, you may wish to reconsider using that contractor's services. g oFTME Town of Barnstable Regulatory Services IA MASS.LE. Thomas F.Geiler,Director rFn rr►a+' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA'02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i i as Owner of the subject property hereby authorize to act on my behalf, in all matters 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 or utilized before fence is installed and all final inspections are performed and accepted. . I Signature of Owner Signature of Applicant Print Name . Print Name Date WORM&OWNERPERMISSIONPOOLS 6/2012 �11+E, Town of Barnstable "r Regulatory Services • mxrtsxesrs, • Thomas F.Geiler,Director tu,►ss. i639. ,,�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 i www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print D TE:[[- ;OB.LOCATIONi IIIg WIN /V105"S D�IV� I"IlArS�v�15 LMA b1 S number I. Q street �j village r HC OMEOWNERs':�l e�N�LI,� A 5ol — i q I"6 54 1 name home phones# work phone# CURRENT MAILING ADDRESS: MarS+ONS M��IS }IJ1� 026qg 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 min;mum inspection procedures and requirements and that he/she will comply with said procedures and requirements. PI-13-13. Signature-of-Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127,0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fomu:homeexempt i r. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I TOINN, OF BARNSTABLE A lication #20 d b 5- 0 pP `- Health Division �e;S �"i� . Date Issued Conservation Division Application Fee 00 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Gam" Historic - OKH _ Preservation/ Hyannis Project Street Address Village / " ,r%4,, A, )I J.Owner ,ar^ w.-. Address Telephone 77z1 Sl Permit Request �.Jc��i-.cr j�� �' � �-��c�c� 1�.fh ,� G¢',},C 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 U/ 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 ❑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 0 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address I P® Box 52 License # West ennis, MA 02670 Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �A/I r- FOR OFFICIAL USE ONLY - - APPLICATION# DATE ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: } FOUNDATION 1 .y FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT, y ASSOCIATION PLAN NO. i -Pq • Sri•-�Z7� . "`ETorr mown of Barnstable Regulatory Services Richard V.Scali,Director mo t► Building Division Tom terry,Building Commissioner 200 Main Stieet,llywuris,2MA 02601 www.town.barmstable-ina.us Office: 508-962-4033 fax: 508-790-6230 Property Cown.er Must Complete an&Sign This Scction Yf Using A Builder as(}alter or':he suhjcc.- tropniry �I _ hcreh��audio liM" /►`C_��(Y` LeUjlsg Aj to act on nib'behalf, in till rrrattcrs relative to vvork authorized bti,this h din;permit applic:.lon for: !-LS S (.Address of fob) ' "Pool ferices and alums are the respoasihility of th;: apphcwt. Pools are not to be filled or utilized before fence is L'astalled and all 11n:1 inspections are performed and accepted_ .2 �-.-- Sigrannz of Ovmer Sit`Patumo of Applicalit Print Ntalme Print Name i Date Q:F:JW�4S'O�'+'tifRF�LZ'•t1S$IQNYCX)!ti � r i T Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC,AR PO BOX 52 W DENNIS MA 8267 Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6ntractor Registration ; s Registration: 169393 Type: Individual Expiratio /2017 Tr# 264961 MICHAEL MCCARTHY = _` MICHAEL MCCARTHYi - P.O. BOX 52 _ WEST DENNIS, MA 02670 V Update Ad Zs and return card.Mark reason for change. ID Address Renewal L_i Employment ❑ Lost Card 20M-05111 The Commonwealth ofMassachusetts Department of Inrlustrial.Acchlents ' I Congress Street,Srlite 100 Boston,MA 02II4-20I7 www.mass.govAlia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pliimbers. TO BE FILED WITH THE PERMlTT1NG AUTHORITY. Applicant information lease Print LeLyiblv Mike McCarthy Naive(Business/Organization/Individual): 2 Address: West Dennis, MA 02670 e280-6964. City/State/Zip: (~ L-5$l�n3t3#: HIC-169393 Are yoq an employer?Check Ih�propriate box: IL_1�7r/ Type of project(required): 1. i am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself. 1 9. ❑Demolition ❑ g y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole IL[]Electrical repairs or additions proprietors with no employees. 5.❑i am'a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.igsumnce.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.90(her 152,§1(4),and we have no employees.[No workers'comp.,insurance required.] 'Any applicant that checks box#I 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 contractnrs must submit a new affidavit indicating such. tContractors that check this box must attached hn additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, if the sub-contractors have employees,they must provide their workers'comp,policy number. lain an employer tlint is providing workers'compensation insrrrance for my employees. Below is the policy and fob site Information.insurance Company Name: / rM Mao T, GMa�,, e. Policy#or Self-ins.Lic.#: V�✓(r�b�-bpi���(, ae 1`( � Expiration Date: )IT )I Job Site Address:'L k � �.�Att /k->� 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 MGL c. 152,§25A is a criminal violation punishable by a fine tip 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.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. do hereby cerlify nn 1l nl s an allies r* iy that the:lnfbrmalion provided a ve is true and correct. Si nahlre: Date: Phone#: IFIsfsu'Inagg'Authority ci rise only. Do not write in this area,to be completed by city or town official. ity or Town: Permit/License# (circle one): 1.Board of health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATICIT PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. I VWC-100-6017656-20146 PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P O Box 52 FEIN:**-***3862 West Dennis, MA 02670 Legal Entity.Type: Corporation Other workplaces riot shown above: See Location 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000.each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury'by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy,including all endorsements,is herebycountersigned b 9 Y 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 Burlington MA 01803 So Dennis, MA 02660 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, V� used with its nermissinn. `, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map oqb Parcel 1 � ApP licationdOl7a4 9'Health Division Date Issued Conservation Division Dk Application Fee r Planning Dept. Permit Fee L¢V Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address (J)Lwk 1 - osS yc> Village Owner Address Telephone jog n .Permit Request A�Ldc. D� '-2u �a-usc .—v-N,1 Vy��P-off a� %Acuff VcA-_ 6U - a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation+7 000 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 sto : ❑ s ❑ No -Y, Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: �Dxisting neversize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: -o f7_oning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn 'Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) / . , Name C.(.�VL(\0,,y1& VNIA&k q,VAC.,V\ Telephone Number Address ` . ���w r��v License # Home Improvement Contractor# 1 (`J O!Y 0 Email C0wl,G:A- Worker's Compensation # --- ALL CONSTRUCTIION, DEBRIS RESULTIN FROM THIS PROJECT WILL BE TAKEN TO ,• I SIGNATURE DATE Igo �l l FOR OFFICIAL USE ONLY APPLICATION# DATE>ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION Io D e a �f ( FRAME � cAwo/S INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILD.INC�; �ATEGLOSED OUT ASSOCIATION PLAN NO, ,y 3 Town of Barnstable. Regulatory Services ` MASS. Thomas F. Geiler,Director s639. �0� 'OrE639 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 R;V # Z 0! /Vo �6Z8 Owner: /3/1 a c��✓ Map/Parcel: � zC L t[ J� Project Address /d8 v�, o�'s'�t. Builder: lzcitc- The following items were noted on reviewing: /P�-ou iie��c curs o� �E �o,Vsr�uc -�o�tl lTk-I d &S4 on Ae— 200? Reviewed by: dw7 0- ` Date: Q7�i 3 Z/Cf- Q:Forms:Plnrvw Mckechnie, Robert To: willyl0l@comcast.net Subject: 168 White Moss Deck Good Morning Bill, I am reviewing your application#201404628 for a deck at the subject property. The plan submitted does not meet the code requirements for deck construction. Please review the following publication, available for download online (I believe at no cost to you): The Prescriptive Residential Wood Deck Construction Guide based on The 2009 International Residential Code I also need an elevation plan that shows the deck height off of the grade, the connections that will be used, and the attachments to meet the wind code. The requirements have changed for the posts, minimum 6x6, and they must have diagonal bracing per the code. The post to beam connection is shown in the above publication also. Please email or call with any questions, Thanks, Bob McKechnie Local Inspector Building Department Town of Barnstable 508-862-4033 1 lne L;ommonweaan oimarsacnusets Deparment of Industrial Accidents Office of Invesdgations 600 Washington Street Boston,MA 02.111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ' s 9 Name(Business/organization/lndividuai): V(./ �,�,qy&A Address: aa.6 City/Stlwzip: c��b �v�S �3 Phone �'i �fl� Are you an employer?Check the appropriate bow Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(Bill and/or part-time).* have hired the sub-confractors 6. ❑New construction 2.CR I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees' These stub-contactors have 8. ❑Demolition working for me in any capacity. employees'and have workers' 9. El Building addition [No workers'comp.insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t 0. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infnnnation. t HDmeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $ContractDrs that check this box must attached an additional sheet showing the name of the sub-contizctors and slate whether or not these entities have employees. If the sub-contractors have employees,they mist provide their workers'camp.policy number. I am an employer that is provu&W 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 a 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisomnent as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the pains and aloes_of perjury that the information provided above it true and correct S aiure Date: 6� Phone#: Official use only. Do not write in this areg to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Ma &wbisetts General Laws chapter 152 requires all employers to provide worm'compensation for their employees. Pursuant to this st da e,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 m'a joint enterprise,and including the legal representatives of.a.deceased employer,or the receiver or trustee of ao.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 Iocal 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 retumed 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-insu ance 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 submif multiple perr it/licease applications m 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 '(Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to than 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 AoUdmts Office of Investigations 600 Washington Street. Boston,MA 02111 W.#617-727-4900 ext 406 or 1-$77-MASSAFE Revised 424-07. Fax#f 17-727-7749. xamwww gwddia License or registration valid for individul use only Office of Consumer Affairs&Business Regulation HOME 1Mf?ROvF AUT CONTi2A�Y'b .: 6efore.the expiration date. If found•return'to:. x Registration y117090 Type: Office of Consumer Affairs and Business Regulation ; 10 Park Plaza-Suite 5170 i Expifation: 8/23%2014' ,. DBA i�. • Boston,MA 02116 { WIL IAM LIIMATA�N BULLD. ft;l C ti WILLIAM LIIMATAI��JEN s /i'- 541 Fk.I NT ST . J4MARSTONS MILLS, MA,02648 UnBl rsccretary �;: Not valid wit out signature f• Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction..Supervisor Licenser CS-001414 ter,r i.S WILLIAM LIIIVIA I . 541 Flint Street 1. Marstons Mills Nf► 4 A. )i•n. Expiration i 11/29/2015 I commissioner 0 r Town of Barnstable Regulatory Services BAMSTABMASS. e Richard V.Scali,Director 039. " 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 L Der'ri c k Brow" , as Owner of the subject property hereby authorize All' j;a,H L;iyyu'ha,� to act on my behalf, in all matters relative to work authorized by this building permit application for: bg WhIfc Moss D'rw& Mwihvs t1 is. M4 0201 (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 I*ignao��fApp cant Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services N,oF�Taxy Richard V.Scali,Director P�~� Building Division Tom Perry,Building Commissioner , MAss 1639. ��� 200 Main Street, Hyannis,MA 02601 RFD a www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number strut 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`fesponsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control.•• HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. .Y Q:\WPFLLFS\FORMS\building permit forms\EXPRESS.doc Revised 061313 .•� ...•3-i 8e '7 Vr�'+E'� t ••;�=' -"•ate;: _:,�;,.:,,. e` A =Y. `•:.!Vic• {<,Ctt A. T. CERTIFY TJom.E/►� �■"�`t�^'l,•''-fit� - �' ri.1-��,y�'� �K k-T..}.�.'_^''4•rw••� = t..:i,�t� eia��ti CAS SHOWN ON THIS PLAN.Is' LOCATED.ON:THE As INDICATED em,,s.. _ �. . ;•. 3 z6 97 • �t�L:_ w a'EU)REME AssoggT ouaTTE . ''REBI i1�• � - WGINEERS-LANDSCAPE ARCHITECTS J08 ' MIEN �� 4-AERS-LAND SURVEYORS NN R BY, v o 0 �. C p C) N z� 7T Deck Framing Plan: 168 White Moss Dr. c. _ Marstons Mills plastic flashing 32'6" existing house 14'6" 1/2"X 4"lags to house 600 lb hangers at house 2'oc staggered 4 X 4 newel posts @ perimeter bolted outside w 2/1/2"bolts e@ 2 X 8 PT joists 16"oc baluster spacing 4"or less io o Li sunroom 2 X 8 PT joists 16"oc (V 6 X 6 posts notched for girt 2'diag bracing parallel to beam on posts 11'-0" 2 112"thru bolts girt to postT7.5 10"sono tube on 2'bigfoot _ ---- -------- F -------t F------1—�/ 1'6"cantilever oxer 2/2X10 girt — — Deck above grade 5'-8' 10' tre 3ds in oli st ing rs do Yn 2/y<g flush girt 12"sono tubes 3' / 6 4" .6 4" 6 4" 10'6" 19'-0" TOWN OF BARNSTABLE Permit No. .....30586 i. BUILDING DEPARTMENT { D°8; I TOWN OFFICE BUILDING Cash l , HYANNIS,MASS.02601 Bond ............��q..� CERTIFICATE OF USE AND OCCUPANCY Issued to GREENBRIER CORPORATION Address lot, #14 168 White Moss Drive, Marstons Mills 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. July 2 19 87 ....... � ................. '� . Building Inspector ; T{��M�t�i 3F SARNSTABIE, MASSACI�USE T : t .�,,� �i�(��� �k��ti 3�','`�is�' F'�k� `�''" � — �. 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A ,�.*. ri y' [I ti Y4'�,.-�j s Lf�n§ .�ys cv�-tt f�i t•�4��+..;,f`i iWrt�,..�:4'v`�'sSFi i t�''V'4>aty"JY' 0 yY.,� � ,`Y•��x�,.,.� ..� �'+ ., � ° .Y� iiFS} -v s>V• ,�>~.1!�. .4Z�. 5j',z - �. , x yY.. ? -G t'.t ,s.,+H•�t z3'31 ii� �'Ye�yL�,agyt��•{'}�a t` i�'�J�.t. ;�ry��v.+�t l'�,x�.�� '•''•�' "rA+"x'..� r;f��-�;.' �5* cc;. :� •p'�'St�v r �- '1''P n. r ,r•1�xJ'� {•r1+�r, �.c_�.,� ti.4$„'i �. :.F 1.?ri4a"r.�s%r... �'d+..'te4'd. �`rb sn�''`L9.,y .,OF ANY AP,P LI CA BL.E SUBDIVISION RESTRICTIONS. . MINIMUM OF THREE .CALL APPROVED PLANS MUST•8 E!RETAINED ON JOB:AND THtS -;wME'RE 'A P:P.LrCABLESEI?ARATE INSP.ECTIONS-REOUIREO FOR - PE'R MITS AR.E REQUIRED .'.FOR ' ALL:C.ONST-RUCTION WORK: .CARD KEPT�POSTED.UNTIL`FINAL INSPECTION HAS BEEN. ELECTRICAL- PLUMBING "AND 1. FOUNDATIONS OR FOOTINGS.' MADE.. WHERE A-CERTIFICATE' OF 'OCCUPANCY IS, RE MECHANICAL'INSTACIATLONS ' ,.-PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT HE 0C( Jr- r_u UN t iL - MEMBERS(READY TO LATH). (FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE E - OCCUPANCY. POST THIS CAR® �5'O•.IT�:OS VISIBLE `+F:RON1.':SLTRIET:` BUILDING INSPECTION'APPROVALS PLUMBING INSPECTION APPROVALS. ELECTRICAL INSPECTION`APPROVAL. 2 2 (lwc. z �/v LV ev ' HEATING INSPECTION APPROVALS' ENGINEERINGbEPARTMEN! OTHER Z Q nC�/10' � �{- ,/Gs�.,;;. 'BOARD- N . t `NORK SHALL NOT PROCEED UN,iL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION? INSPECTIONS INDICATEO;ON THIS CAPO CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX'MON.THS OF DATE THE ARRANGED'FOR'BY TELEPHONE:'OR WRITTEN': CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE.' NOTIFICATION. r 't tt Lo j' 1 24 O • o _ o ' 0758 ITE DRIvr y 1 CERTIFY THAT THE 3 SHOWN ON THIS PLAN IS AJA OF LOCATED ON THE GROUND o �y AS INDICATED .. ROBIN W. Cox 0.3134 � s' 3 z �7 DATE REGISTERED LAND SURVEYOR �EVY & ELDREDGE ASSOCIATES,-INC. CLIENT CERTIFIED PLOT PLAN ENGINEERS - LANDSCAPE ARCHITECTS JOB NO 6-3IAJWTg MOSS DRlV�F_ PLANNERS— LAND SURVEYORS DR, BY I N 889 WEST MAIN STREET CHKD BYs�. 15'T,4- L� CENTER ILLE, MA. 02632 SHEET._L_0F1,,, SCALEt_/`= 4! DATES 3 7 r 4 �1 \ r 4. j D� S��G �a o • a — IV o� q y 4'4 , O 2`1.A I ITS DSS �RI�r✓ I CERTIFY THAW THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND o��� ROB r s 4 AS INDICATED _ ; W. W _ K 4 LAV S �` DATE REGISTERED LANDS EYOR kVY & ELDREDGE ASSOCIATESJNC. CLIENT - £ CERTIFIED PLOT , PLAN ENGINEERS — LANDSCAPE ARCHITECTS JOB NO.M,3 Low .�9 1�1to-rg Moss 1)RlyF_ PLANNERS— LAND SURVEYORS DR. BY N -- 889 WEST MAIN STREET CHKD. BYE_..._._. R1JS'7;�}-$L� t CENTERkLE, MA. 02632 SHEET_L_,OFj_ SCALEt-��'��� DATE, 7 J: -� r. �- 'Assessor's Joffioe (1st floor): 3 _ Uv —Q T 'SEPTIC SYSTEM MAST 13E o*T„Ejo Asses,sal•s map and lot number ............�....�..UU,a.......�.L ,:xi STALLED IN COMPLIANC: Board of•Health (3rd floor): WITH TITLE 5 Sewage Permit number ....... 1Biaa9TanLE, ! ,e@- ?I�I#t�EI�TAL CODE A. Engineering Department Ord floo�):.................�.y.. a I�� �LATI� .,� ° 1639.° House number O ` ` �5 ° 0 ,6 :OD/y c 'FO YPY d' APPLICATIONS PROCESSED .8:30'9:30 A.M. 'and T -Z:00 P.M. only' TOWN OF BARNSTABLE BUILDING , INSPECTOR APPLICATION FOR PERMIT TO ......1:!(J(1rGt.!�� ..... I 1 .................................................. TYPE OF CONSTRUCTION ................V.�1�.Q ..................................................,:...................... 3. . ....19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ .. �?. �CJ. .....��.1�1�� .... �J...✓.L7.. 771�! ....['.1.��.!. �7......... .......... ProposedUse ......' / :... F��!l..l./..! ..............::..................................................................:............................... Zoning District ..... ...... .......................................................Fire District .. G�a�?�I�`�:.? Name of Owner ....6re.el).,br/.e1...........Care.........Address .....j��....,B�,r� Nameof Builder ..... s.'.[. ............................................Address ......., :�1'Y ....................................................... Nameof Architect ..................................................................Address .........................................:. Number of Rooms ..........b.....................................................Foundation ........ nl.-e. ......`U e- ...:......... SJExterior .W ....Roofing ( � .iJ Floors .....V /..1 e.p..... I.................................Interior ...........Z5 F PlumbingHeating /Q G / a•...... .�....... . ..................... .............. �/�........................... Fireplace ... .^^. .,, .................................................................... � ..... !V Approximate Cost ............�... • l � .......r............ ............ Definitive Plan Approved by Planning Board _------- Area Diagram of Lot and Building with Dimensions 9 g ��'�.' Fee .............. '�?'. ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 44 x Z,,q ' gA/tj�a4 W x 6A�Ac- ,0 • i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .G!..YG!4�V� Y�....r��. �......... u` y Construction Supervisor's License .......��.f .g�..... Greenbrier Development Permit for .....PJAq-...,S.t.Q.1r.Y........... sin le famil ........... v..d we.1.1 i n ............... Location ............1.6.8..Wh.i.t.e..Mo.s.s...D.r.ive......... ..........................MAS s t.o.n.s...Mills............. ........ Owner. ...........G.r.e.enb.r.ier...D.e.ve.1.9.pp��at....... Type of Construction ...........frame.................... ...................................... .......................................... Plot ............................. Lot ............11.14............. Permit Granted ............19 87 Date of Inspection ....................................19 Date Comple* ........19 ep,