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HomeMy WebLinkAbout0039 TOWER HILL ROAD (5) I --Roil + �7 r F s i S E F - � `_ i R i. s; E. r m [f. �a F v �,. f — '4'�=" —= — — -- -- — —'— .i :� 1 i �� �} 1 "3 7 o �� �� (� 1 O V J f ~ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel o"-? Application # SCE Health-Division ' Date Issued lDq Conservation.Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �k �/��o� A'W Historic OKH Preservation/Hyannis o Project Street Address 3 9` U;/f f2 d Village Owner L O w S Address Telephone-6- - Permit Request t,✓O C t'� lice N�iYYa�,✓ ,hew' �ar�r�� ins sti A-•e s e. ©di Squar feet: 1st floor: existing proposed 2nd floor: existing 7.S-O proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation O® Construction Type Lot Size Cdh O /' i Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) 60�672s_ Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: W 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: a existing _new Total Room Count (not including baths): existing _ new First Floor Roo Count• C Heat Type and Fuel: , Gas ❑Oil ❑ Electric ❑ Other C? _' Central Air: XYes ❑ No Fireplaces: Existing New Existing woo 4 oal stof: ❑ es ❑ No � z Detached garage:existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: J26�' isting7 new; size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: co r M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use 'APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name iqt-\l L o 14 Telephone Number 51-0 - k0 70 Address �9 �i��T �� e1 License # / y 1 Gl Home Improvement Contractor# Worker's Compensation # �L/ / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A/�/ 4 ll TTS kdkabhlie SIGNATURE 10M DATE I-b�0 M1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE :1 OWNER DATE OF INSPECTION:: FOUNDATION FRAME INSULATION `? FIREPLACE ELECTRICAL: ROUGH FINAL 5 - PLUMBING: ROUGH 'FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. x � - ,per The Commonwealth of Massachusetts �\ Department of Industrial Accidents Office of Investigations 600 Washington-Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation lnsurance Affidavit: Builders/Contractors/Electricians/Plumbers kwj Applicant Information Please Print Lesribly Name (Business/Organization/Individual)�:1 Address: 39 l✓�� T//�� �� City/State/Zip: {���f II� Phonc.#: S 00 - Iva? 701 n� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet 7. X Rrmodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. $employees and have workers' 9. ❑Building addition • . [No workers' comp.•insuraucc comp.insurance. 5. 10.❑Electrical repairs or additions required] We are a corporation and its - 3At 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 re t c. 152, §1(4),and we have no 4d] employees. [No workers' 13.❑ Other comp.insurance required] *Any applicant that checks box#1 must also 0 out the section below sbowing their workers'corripcnsation policy snformation. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :C'mb actors that check this box must attached an additional sheet showing the name of the sub-contractun and state whctha or not those entities have ernployces. if the subcontractors have employ=,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(sbowing 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 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$250.06 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the!)IA for insurance coverage verification- I do hereby certify under the pains•and penalties of perjury that the information provided above ins true and correct .lcu� Date: Si afore Phone Official use only. Do not write in this area, to be completed by city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical,Inspector S.Plumbing Inspector 6. Other Contact Person: •Phone#: Infoarmatiou and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire; express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing.engaged in a joint enterprise, and including the legal representative's of a deceased einployer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable eczdence 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 numbcr(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 Bq advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtainn a workers' compensation policy,please call the Department at the nun1ber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for.you to fill out in the event the Office of Investigations has to contact you regarding the applicant'_ Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit onr,affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A ebpy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i_e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance.for your cooperation and should you have any questions, Please do not hesitate tc give us a ca1L The Department's address,tcicphone•and fax number. The UmmonwiWth of Massachusetts Department of Industrial A:ccidemts < Office of Investipti.uUS 600 Washington Street Boston, MA 02111 Tel. # 617-727-49-00 ext 4-05 Qr 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia oF-(HEr°w Town of Barnstable r + Regulatory Services ` BA"ST"BLE + Thomas F. Geiler, Director y MASS. $p i639 rF1639g 7 . 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 h N rze L/ 7fe'.-r/ to act on my behalf, in all.matters relative to work authorized by this building permit application for: . 3 Tow-e� Z// (Address of rob) Signature of Owner Date. lia. -Print Na If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. _N Town of Barnstable ' THE>•�o Regulatory Services b • Thomas F.Geiler, Director BARNSW LE, Q MASS. &6yg. Building Division PlFOl a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, NfA 02601 Wmy.town.barnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:- JOB LOCATION) �VL✓t�� ri/T// �C� number street village "HOMEOWNER"; d 'e 'P name J�[� home phone# work phone IF CURRENT MAILING ADDR)�SS: 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 Persons) 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 r 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&c 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 e m '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. . I „ The Village Square South Condominium Association is aware of Mary Freeman's intention to have windows replaced in her Unit 7 at 39 Tower Hill Road, Osterville. We are in agreement that this work should be done. TA N . Jean Ellis, Trustee Date