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HomeMy WebLinkAbout0010 SHARON CIRCLE �o �� Cam. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t/ Parcel 'Application # 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 I(-) S1!�a,(pn (2A a-L2, Vile ®�N► Orr QaXN`N Address. Tele��hone7r0()v Liao - 11aza- (50�) �Zyg 2 'Permit Rec est �r� c \C,.J�i O✓� 1nlP Gl{1n 1 < Ir SC�U YAC/� S 111 n 4►VPi1' En C101 ( V16 M(, wto I �1I� )to ,wattr, , TAP,yry�lxUyeQ��,t��j1�;����G�jrx►►C(1N1Y1�in1/��S Z"FS�K (Ia� S�fit, �3�reo�t- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,SConstruction Type_T�nSylc4:� 1Cv Lot Size Grandfathered: ❑Yes ❑ No If yes, attach{s..upportingrdoculntation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) t7;� . 1 Age of Existing Structure Historic House: Cl Yes ❑ No On Old Kings�, ighway;',0 Yew ❑ No Basement Type: Ld Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) n n, 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 ❑ w Commercial ❑Yes No If yes, site plan review# Current Use Wl e Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number to Address y� License # 1 62,z)�(p I :" I Rj UQ c,f A A 61 Home Improvement Contractor# Email )IQ{�� �'n5��(it�� , !l/Q . � Worker's Compensation # sZ_aAW.a4j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO R111M I mnS SIGNATURE �`� DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP•/PARCEL NO. ADDRESS VILLAGE :r OWNER r DATE OF INSPECTION: FOUNDATION FRAME I INSULATION FfREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING, DATEr.CLOSED OUT AOCIATIONP,LAN NO: „ r �.� t he Uommonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Workers' Compensation Insurance Affidavit Build ers/C A : licant Information ontractors/Electricians/Plumbers Please iv Print Le ilil Name (Business/Organization/Individual): Insulate 2 Save, Inc Address:410 Grove Street City/State/Zip:Fall River, MA 02720 508-567-6706 FEII.:� employer? Check the appropriate box: Phone #: employer with 20 4. ❑ I am a general contractor and IType of project(required): yees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8' ❑ Demolition [No workers' comp. insurance comp, insurance.' 9. ❑ Building addition 3.❑ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL 11.❑ Plumbing repairs or additions insurance required.] t C. 152, §1(4), and we have no 12•❑ Roof repairs employees. [No workers' 11M Otherinsulation 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have: employes. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infordeation. Insurance Company Name:Liberty Mutual Insurance Policy#or Self-ins. Lic. #:XWS 56418741 12/10/2015 Expiration Date: Job Site Address: 1 U S Y aril V'W City/State/Zip: ration page(showing the policy number and expiration date). Attach a copy of the workers' compensation policy decla 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 certify under the pains an pen Itie of perjury that the information provided above is true and correct Si attire: Dat e: 2rj Phone:.#. 508-567-6706 Offcial use only. Do not write in this area, to be completed by city or town official. I . City or Town: Permit/License # L6. OtIssuing Authority(circle one): her�__ rd of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ct erson: Phone#: ac CERTIFICATE OF - LIABILITY D>1�(tNlrT7fyYYYY, �. ILITY INSURANCE 12Yyyy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.: THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHO I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(es) must be endorsed. If SUBROGATION IS WAIVED,subject to the terrn8 and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights:to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Anthony F. Cordeiro Insurance NAME: _ PHONE (508) 677-0407 FAX N (SOB) 677-0009 171 Pleasant Street E-MAIL Fall River, MA 02721 ADDRESS: hsouza@cordeiroinsurance.com _ INSUM §)_)FFORDING COVERAGE INSU ERA_Liberty Mutual Insurance j INSURED .. - INSURER 6 Insulate 2 Save, Inc. — — - -- --- ----_ ._ _.. I NSU R ER C ' 410 Grove St. ----- �....-- - - ---• --- -- Fall River, MA 02720 INSURERD: — INSURER E:—-- -- I NSU RER F: COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CSSU CONTRACT OR OTHER DOCUMENT BOVWIT RESPECT PO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TFE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY P_AID CLAIMS. LT, A[D •SUBBR! LTR I TYPE OF INSURANCE L� •POLICY EFF*'• 'POLICY l7CP'!' I I POLICY NUMBER i MMIDO/Y ! MMIDDIYYYY I LIMITS_ A GENEJZALUABIurr Y I Y !BKS 56418741 12/10/14! 12/10/151 I i i BEACH OCCURRENCE _: 5 1,000 0.00 ! i X! CORWERCIALGENERALLIABILITY I j DAMAGETO RENTED —�—' CLAIMS-MADE , X !OCCUR ' ,(�.BEL�USE.S IF_�`om�rre�ce)_ S 30 ) 000 i •MED EXP(Any ore person) PERSON__4L8 ADV INJURY S 1,00.0 000— GENERAL AGGREGATE i b 2 000 j ...r=._.000. .1 I GEN'L AGGREGATE LCvIITAPPLIESPER ;PRODUCTS i S _ — � 2,000.000 PRO- I i ' ' i X I POLICY! ; T i LOC � 1 S - IAUTo1f1OBILEUABIUTY lBAA 56418741 12/10/14: 12/10/15�aau;�n) s 1,0001000 A ! i COMBINED SINGLELIMrr ANY AUTO j BODILY INJURY(Per person) ;S j AUTOSS O X AUTOS I SCHEDULED AU , ! BODILY INJURY(Per accidenl)1 S X X WNED I PROPERTY DAMAGE AUTOS j HIRED AUTOS j (Per accident g A ? X UIMBRELIALUU3 X OCCUR j Y 1 Y MSO 56418741 12/10/14 12/10/15 EACH OCCURRENCE S 2,00.0,000 EXCESS LIAB ;AGGREGATE —_`S-- 1i0,000 I 1 CLAIMS MADE i DED RETENTION S I A j WORKERS COMPENSATION i XWS 56418741 12/20/14j 12/10/15, X s we STATU- OTH-: I AND EMPLOYERS'LIABILITY Y/N: - T.ORYLIMI'CS:—._E8__.. _ j ANY PROPRIETDR/PARTNER/EXECUTIVE I . OFFICERMEMBEREXCLUDED7 �1NJA E_L EACHACGOENT is __500,000 (MardStory.in NM) I E.L DISEASE-EA EMPLOYEE:S 500,000 If es.describe under _ I _ I DESCRIPTION OF OPERA710NSbelow I I E.L.DISEASE-POLICY LIMB i S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Proof of Insurance. 1 CERTIFICATE HOLDER CANCELLATION j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �e.,,,, ©1988.2010 ACORD CORPORATION. All rights.:reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD Phnna• Fax: E-Mail: I , � � e a»'lam%yl.C�». c�ecr• � n C� ,a:jl a'c411el.�ef Office of Consumer Affairs and Business Regulation 10 .Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 180747 Type: Corporation Expiration: 12/29/2016 Tr# 261507 INSULATE 2 SAVE , INC. ROLAND LANGEVIN 410 GROVE ST FALLRIVER, MA 02720 _...... —:--.—. Update Address and return card.Mark reason for change. Address ` Renewal Employment Lost Card Li registration valid for individul use only Fps`y HOMErtIMPROVEMENT'CONT cense.or RACTOR�ulation _ before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation ~: `Registration: 180747 yp A q-.. 10 Park Plaza-Suite 5170 Expiration: 12/29/2016 Corporation Boston,NIA 02116 INSULATE 2 SAVE . INC. ROLAND LANGEVIN 410 GROVE ST .,.6._}c'� _- X1 _ FALLRIVER,MA 02720 Undersecretary Not valid without signature 1V vlassac. Bca-(J C'rMarucrinn Sunrr\wr d use CS-103861 ROLAND LANGEVIN S36 EASTERN AVE. _ Fall River MA 023/23 08124/2015 it I s E :;HC.fw:kr;tt+r. i at.- -'Property Adwire$S) `6 (Property Address' y� 'lErEt3y c?llit'tGf12e ./ +�,�'v (Subc-ontractor) ar, assln_)ri7e'd subcontractor for MSE t':lgineerina. iv aci on rely YiG`ha `.n obtain a buli;iiS10 .�LIr<1t�:.11•IC', tU �i:(forrn we 4fi tT;';f i';frt�:r�`l I i1?S ioffr .,> ^�'.� �cil b'Jiiii r-1 i3� ?t.�{; (1 %I"ft?';�(;i 12,641ca k-all G" 1 rn�r' C - rr r Date !S !✓Pl ll7�'C'i!i'1C j 5Dtli)C>i"t,.t�vniif,i7 `:oeiii3 Y s €iiC;it[l'1. nrlA v =65 4 ! esses ol`r"s map and lot'"number .../..a� .�.�1.3.. ,iJ{.......... ..... . .6� �d Q� •Sewage Permit number ......... Z BARNSTABLE. i House number ................................`..aAit: ldc........................., '°o "639 `e�a ;OYSTEM MU TOWN ; O F B A-R N SA' lEcOMPLIANC ViiTH TITLE a V R9NMENTAL CODE AND B U I LD I N G I•NIS P E C T 0#0J REGULATIONS APPLICATION. FOR PERMIT TO ...........................................:.....................kj............................................................ TYPEy lC/<!� OF CONSTRUCTION ......�......0..�........:......�.................................................................................. ...............11:...2.3...... .i 9.. 2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: J_0 . �.. .......................location .. .. .. . ....�1 . ..,. � I ProposedUse ....................... ............. .............................. Zoning District ....Fire District .................................................................... .............................................................................. Name of O �err7-rRV/LZ� !�2/_1_117 ' /` dL T Idd ..PD.....2 k •t� �Y wJtT" ........................................................T1�..... ddress ....................................�... ......:.�...� X�........... - Name of Builder`:DXm ..!e.... . G�f,�S' .......Address .................`..`...........................................'........................ Name of Architect ................Address ..........0.. .. ........................ .i,.. 1.¢u re ' Number of Rooms ................: /6 ..........: .........:...........................Foundation ............ ........... . ......... . .. Exterior ..... .... .......Roofing A4...rpf/.. �—� Floors c-c�trC3 C� � ......Interior .....�/�i1IG�T �l)Cl . Heating �Q�� [` .......,:1..,C'y � ................. - .......... ..... ...... . .............................:.......:Plumbing ..... ................... ... . Fireplace ............. .......'�� J'L�.....�.............................................Approximate Cost ... �.. ..................... Definitive Plan Approved by Planning Board ---------------____-----------19_______. Ar��� Q....... .......... 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 f Barnstable regarding the above construction. l ' - Name ...f. . ............................................. <2` ' `'� OSTERVILLE HEIGHTS REALTY /TRU T 3* .24780 e S t-?0.' y No ................ Permit for .... ...... .... ... ........ Single Family Dwelling ............................................................................... Location ...Lo.t...#5.5......La...Shaxon.-Circle ..................0.s.texville................................... Owner .....0.5.tex.vi.11e...lieights....Realty Trust ' Type of Constr6ction ..F.r.ame........................... ..................... ...................41...................................... Plot .............................. Lot ................................ Permit Granted .... ......19 83 Date of Inspection ....................................19 Date Completed ....... ..19 61 0011, r 1 . ;rw: i 5 D' 35 50'' E IOD•00 ' SrK 0 N U 41 { LET 5 � N rn . ' 4 p �a G T 1 �xl t A ; I o NET oIJ a QA 4 Isle Z ,� O zi L T LOT 55 76, s f srK } o nD L a 7 S Z ,�• � �; n o r s� � F N 0 o ` h �� Fou Iu Da.'('►o Ill C E RT!F IG,d►T�oIJ 6"A eoAj c(Pect-E OAZJI-5TA BCE , M A 55. 56A LE I"= 3v' DATE I2-/z8/6z . uJ M. M• u�,4 e1(,/ lG K � ,4��caG', i�1L. .:�' On the basis of ray knowledge, information and BOK 80� No, FA LMOUTN� N1�A✓S; belief, I certify tom /' that as a result of a survey made on the ground } on /Z 27 Z , I 'find that: The structure(s) are 'located on the site asshO ; .' .'Theitle wtn- Incli.nes and lines of occupation Lames � sw OF Mqs� site are as shown hereon. of the �o WILLIAM 9�s The site is situated in Flood Zone A/o�-1,�i r� c' WA WICK l= No. 197710 Community ranel No.z_<ezei ooiSA Date: s 78 pF Date: L zfAz C/STO�p� ; suRv '{ llilliam- I-- 1,larwick,ILLS iY, •`"` • TOWN OF BARNSTABLE Permit No. ________?1L 7Q.r)______._. -,Building Inspector cash • wa'g - "'Y~ ------------------ ``OCCUPANCY PERMIT ----- , - Bond -----K---_ l� Issued to0sterville Heights T:ealty Tr, Address lot #55 10 Sharon Circlejkjsterville, Wiring Inspector / Inspection date . Plumbing Inspector/ �� f Inspection date Gas Inspector f Inspection date Engineering Department Inspection date!( �► .� Board of Heal /;is Inspection date 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. —�--- �L! lg /// o�� • l_ ,.. ...Building jInspector . .�.._ _. . ._ / Assessor's map and lot number f 0 Sewage Permit number .........1� �..::........................ .............. Z BJHd9TADLE. i Housenumber ................................. ............................, '�,o,MABI TOWN ' OF -BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... d N ............ 0...................................................................................... TYPE OF CONSTRUCTION ...... ......... .................................................................... .............../.../..:...2.?:..... .i9.. 2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby-applies for a permit according to the following information: Location ..�:4...T...# .5 .....` �!/ �!1..4?... ...... .l..e.0 L .4�5 ....,��,:.r7 ........................ Proposed Use ..w. / .:.... h� �� ........ .1.l� LG �;......................... ......................................... Zoning District ........................................................................Fire District .�!yT,�O......./LL..........�Sl................. Name of OvJnerTk:RY/t: ...fc ��ry..Tddress ......�� �....... 1�........ �`� i' J✓1 ... - Name of Builder',►J. l�r' f ! .......��........................' le Address ...................:.........................................:...................... Name of Architect Address '— li/o !t/..�.................................... .................................................................................... Number of Rooms ..................................................................Foundation aa� .�..�.... �u.r.e .. ..............�...:Q1tl� .......... .....` Exlerior ....................................................................................Roofing ....t` .. A. ............................................. Floorsl J . — C.f . . ........Interior ..... .........t ........................ � Pam'(� . 1nL�t-.r7`i e Heating Plumbing ......................... ...............:.... .................................. Fireplace ..................................................................................Approximate Cost ...:................................r............................... Definitive Plan Approved by Planning Board _________ _______19_______. Area �"' Q Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i c 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 ...../ OSTERVILLE HE/IGTS REALTY TRUST; A=122-143 N-A-F 24780 One Story No ................. Per for .................................... Single Family Dwelling ............................................................................... Location ...Lpt... ..................Qst.er.zill.p.................................... Owner ..Q.5teX.Mi.110...Rej,9b.t9i...ReAlty -Trust Type of Construction ....Frame........................ ............................................................................... 'Plot ........................ Lot ................................. Permit Granted ....Febr.uar.y...3..........19 83 Date of Inspection .........................I...........19. Date Completed ......................................19 r Assessor's Office,(1st floor) Map— r 2 Lot f. -3 Y Permit#'- 8-4 b - Conservation Office(4th floor) (� J3QJ�p s�- :` Date Issued F 1 — :3 ® 9� Board of Health 3rd floor 8:30-9:30/'1:00- 2:00 Fee, Engineering Dept.(3rd floor) Hous #1 SEPTIC S -MUST BE INSTALL LIANC2- Planning Dept.(1st floor/School Admin. Bldg.) - DefinitivPPoved by Planning Board 19 EP4V@C� eA �TOWN OF BARNSTABLE Building Permit Application Project S in S hii Gt qr1 G I rG P_ ' Village S �<��` l 1 Owner Jr4a�, Address /Q Dye?/0" CI LC/e 3 � .Telephone Permit Request c 12c Total 1 Story Area(include 1 story,garages&decks) .1060 square feet kI Total 2 Story Area(total of 1st&2nd stories) hJ square feet Estimated Project Cost $ L_TOC) Zoning District Ros. Flood Plain hJd Water Protection Lot Size 61 aGrr� Grandfathered ? W� Zoning Board of Appeals Authorization Recorded Current Use Pi Proposed Use Construction Type Commercial ResidentialP�S Dwelling Type: Single Family G' d- Two Family Multi-Family Age of Existing Structure 10 s Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths Z No.of Bedrooms ?j Total Room Count(not including baths) y First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE to SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. #8160 DATE ISSUED July 3, 1995 MAP/PARCEL NO. 122. 143 ADDRESS 10 Sharon Circle VILLAGE Osterville, MA 02655 " OWNER Deborah A. Campbell 4 t DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: �; ROUGH FINAL FINAL BUILDING, /3 DATE CLOSED-OUT ASSOCIATION PLAN NO. V • 11/02.94 17:02 'C617 i2i7122 DEPT IT'D ACCID Q00: T 0- Cotjuno/i.cueatilL o 1VaJJac%racsettJ � ` a1JaPartrrtenf o��ndu�trial,�lccidenti 600 Vl/uki,-yton�trost James J.Campbell &Ion, //"ac�w 02111 Commissioner Workers' Compensation Insurance Affidavit with a principal place of business at: �. /0 S c;r C,�-c � (Js'ylcYyi �I�. (mar/St"Jzia) do hereby certify under the pains and penalties of perjury, that: () I am an employer providmg workers' compensation coverage for my employees working on this job. insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. () i am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor insurance Company/Policy Number Contractor insurance Company/Policy Number Contractor Insurance Company/Policy Number ( am a homeowner performing all the work myself. I unders[ar,d t`:t a copy of&,is s-tement will be forr:arded to d:e Ot ice of Invesdr.2tions of cite DIA for coverage verification and that failure to secure coverage:s reec:ired under Section 25A of MGL 152 can lead to cite Imposition of criminal penalties consisting of 2 fine of up to s 1,500.00 and/or cr.- years' impri<crment as well as civil penalties in the for:of a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this/ day of 19 cS Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 __ T`nT.T7 nT- 1)AD11,7QTA DTP R ITT T TITMr DFT?MTT :� MATERIALS LIST FOR 10' X 10' DECK t QTY UNIT SIZE USAGE DESCRIPTION �t DECK: 3 2 ea 2 x 8 x 10' Beam A 'N 2 ea 2 x 6 x 10' Rim/Ledger t Joists @ 16" o.c. g ea 2 x 6 x 10' r 7 ea 2 x 6 Single Joist Hangers w/nails 7 ea 3/8 x 5 Lag Screws 9 ea Framing Anchors w/nails Yy 25 ea 5/4 x 6 x 10' Decking 5 lb 16d Galv. Box Nails ,ails Galv. Box Nails 10 lb 10d STEP: 1 ea 2 x 10 x 8' Step Supports 1 ea Hangers 4 ea 2 x 4 x 6 Framing Anchors w/nails %. 1 ea 2 x 6 x 6' Treads ' at a MATERIALS LIST FOR 12'x16' DECK a USAGE DESCRIPTION QTY UNIT SIZE DECK: 4 ea 2 x 8 x 16' Beam 2 ea 2 x 6 x 16' Rim/Ledger . 13 ea 2 x 6 x 12' Joists @ 16" o.c. ' 11 ea 2 x 6 Single Joist Hangers w/nails s: N 12 ea. 3/8" x 5" Lag Screws. Framing Anchors w/nails a; 13 ea y° 5/4 x 6 x 16 28 ' Decking ea ; 10 a 16d Gaiv. Box Nails s 15 lb 10d Galv. Box Nails E. fi STEP: ails 1 ea 2 x 10 x 8' Step Supports , 1 ea 2 x 4 x 6' __F am ners g Anchors w/nails 4 ea .. —� 1 ea 2x6x6' Treads i 0Q ? xCO _ LOAu 0 M l0 I ,i9-,5 119-19 1,0-.Z t 0 0 i Q o J C� Z O . 1 o Q II x _ � O � J N � � � N tD Cl „9-19 0 l 0-,Zl °�' ' ►� Department of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 161 Office: 7 Ralph Crossen Fax: 508-790-6230 Building Commissioner Building Permit Procedures for Sheds & Decks 1. Plot plan or mortgage survey required for zoning compliance. Placement of structure must be sketched in, and distance from boundary lines indicated. The location of the sewage disposal system should be shown as well. 2. Old King's Highway Historic District Commission approval required prior to construction/demolition for any properties located in the Historic District(north of the Mid Cape Highway). 3. Application sign-off must be obtained from: Assessors Office(1st floor Town Hall) Conservation Department(4th floor Town Hall) Health Department(3rd floor Town Hall-8:30- 9:30 am & 1:00-2:00 p.m.) Engineering Department(3rd floor Town Hall) 4. One set of plans 8.5"X 11" or 8.5"X 14"(cross section and framing schedule) must be provided. Pre-fab sheds require factory brochures and specifications. 5. Construction Supervisor's License& Home Improvement Specialists License copies are required for a shed to be built on site-or for a deck. A copy of the Home Improvement Specialist's License is required for a pre-fab shed. (Unless the homeowners are applying for the permit in their own name). 6. Home Improvement Contractor Affidavit must be submitted. (Unless the homeowners are applying for the permit in their own name). 7. Workers Compensation Insurance Affidavit form must be submitted if construction is to be done on site. 8. Homeowner's License Exemption form must be submitted if the homeowners are acting as the general contractor or doing the construction themselves. 9. Permit Fee to be paid before permit is issued. PERMrr Rev V13/95 r &%PM�. • The Town of Barnstable KAM �,$ Department of Health Safety and Environmental Services 116 �► Building Division 367 Main Street,Hyannis MA 02601. Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only 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: Ve_R dj7SI�-c 6CGIL Est. Cost 17,1 Address of Work: 10 (G)^ C ��c l C7/5'T�I'U Owner.Name: Gt Ob n,-,J b G,f Date of Permit Application: I hereby certifv that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied �•ner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITHUNREGISTERED 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. OR / �0 9/ ! Date Owner's name i TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . :. ..... DATE JOB LOCATION _ `'�G e �� (Ut ��e Number Street address Section of town "HOMEOWNER" yr,g2 c<< ��'-�(Lu- 1�2 j Name tHome phone Work phone . . PRESENT MAILING ADDRESS 10 SI ►�o�-� ��i2��' oa6s'4 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Off icia on a form acgept'able to the Building Official, that he/she shall be responsibl for all such work performed under the building permit. (Section 109. 1.1) The undersigned "homeowner" assumes responsibility for compliance with the Sta Building Code -and other applicable codes, by-laws, 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 procedure and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet,. or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER' S EXEMPTION The cdiY� state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of 'a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed. Supervisor. The Home "dwher.''actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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. SITE �&AN SCAB.E A j • W .STD. o.eECAST ,• `2`�`�E�PI%�rr sf�P . 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I HEREBY CERTIFY TO FLYML U-TH MRj C0-----_—_-- ------THAT THE .BUILDING �a�`" OF '"gss9 YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN AND THAT ITS POSITION DOES —_-- CONFORM PnUL G�� CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MERITHEW C% 143 ROUTE 149 TOWN OF RARNSTABLE-------------AND THAT 9 No. 32098 MARSTONS MILLS, MA. 02648 IT DOES—MT_ LIE WITHIN THE SPECIAL FLOOD HAZARD "��s '�EGISTER``� ��` TEL: 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED 8-1.19 fi5-- s%NqL L& O FAX 420-5553 Co unit —Panel # 250001 0015 C � W THIS PLAN NOT MADE FROM AN INSTRUMENT 9038 PAUL"AL MERITh —PIS ----- SURVEY NOT TO BE USED FOR. FENCES ETC. �� f m -i ZWc o Dv� z o c cz, 3�o a C-r)� N � y C" — w o � O z m 0 28 K-90W 9X12