Loading...
HomeMy WebLinkAbout0126 HIGH STREET SMEAR No. 53LOR UPC 12543 smead.com • Made in USA y w f�IR®NMfg10011CT1►i S1 I �SRgIOORAM SpU�R iG YV'A/Si1PROGRI�MOIK'3 6 4o0; ST Town of Barnstable *Permit# `�. Fxpir ;!,g, s ron ' ue date Regulatory Services F • Mass. g 2014 Richard V.Scali, Interim Director t6J¢ �0 70 Building Division 13AR NSTAgLE Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 13 3/0 2 7 Property Address 126 High St W. Barnstable MA 02668 - FA Residential Value of Work$ 5006 (9-P Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Joseph Wittenmever P.O. Box 77 W. BaRnstable MA 0269A Contractor's Name Northern Col one Builders I,L,C Telephone Number 5()8-400-707s Home Improvement Contractor License#(if applicable) 1 67739 Email: clanwhrc @c'nmrast not Construction Supervisor's License#(if applicable) CS 0 5 3 6 3 8 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner S I have Worker's Compensation Insurance Insurance Company Name AIM TnaLrannP - Workman's Comp.Policy# S 01 2 2 8 0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) rI RL Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to G,\JuS ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. '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&Construction Supervisors License is equired. SIGNATURE: TAKEVIN MBuildingChanges\EXP PPESS.doc Revised 061313 ti 0� � BARNSI'ABIE. 39. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director 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 Property Owner Must Complete and Sign This Section If Using A Builder I, Joseph W; ttPnmTPr ,as Owner of the subject property hereby authorize Northern Colony Builders LLC to act on my behalf, in all matters relative to work authorized by this building permit application for: 126 High Street (Address of Job) ;J .4 1 -10-2014 Si ature of Owner Date Joseph Wittenmeyer Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_D\Building Changes\EXPRESS PERMITCEXPRESS.doe Revised 061313 ACORDDATE(MMIDD/YYY`() CERTIFICATE OF LIABILITY INSURANCE F 07/30/2013 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),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms 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 Karen Bernier NAME: Southeastern Insurance Agency, Inc. ac°No EXc: 508.997.6061 a/c No: 508.990.2731 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 PRODUCER CUSTOMER ID tl: North Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC® INSURED INSURER A: Arbella Protection Insurance 41360 Northern Colony Building Co LLC INSURERB: Merchants Insurance Group P.O.Box 278 INSURERC: AEIC W. Barnstable, MA 02668 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2013-2014 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MM/DD P LIMITS GENERAL LIABILITY TBI 07/08/2013 07/08/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM SES E oGE TOr cur ence $ 300,000 CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PEa LOC $ AUTOMOBILE LIABILITY MCA7013965 01/05/2013 01/05/2014 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIARI CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION TBI 07/08/2013 07/08/2014 X WC STATU- X OTH- AND EMPLOYERS'LIABILITY YIN TCRY LIMITS ER C OFFICER/MEMBERANY RPAR ER/E CUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd $ 1,000,000 li yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 1,000,000 -7 , T- I F DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION FAX: 508.790.6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable Attn: Bul l dl ng.Dept. AUTHORIZED REPRESENTATIVE 200 Main Street Hy nnis, MA 02601 lKaren Bernier @ 1988-2109 ACORb CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations WJ 600 Washington Street Boston,MA 02111 wmv.massgov/dia Workers' Compensation Insurance Affidavit: BuiIders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Lezibly Name(Busmeem10zganizatianllndividua1)_ Northern Colony Builders LLC Address: P.O. Box 278 West Barnstable, MA 02668 City/State/Zip: W Barnstable MA 02668 Phone#_ 508-400-7075 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 1 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. ❑Remodeling ship and have no employees These sob-contractors have g_ ❑Demolition working for me in any capacity. employees and have worlmrs' 9. ❑Building addition [No worlaers'comp.insurance camp.insurance-1 required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions Lysel£[No workers'comp. right of exemption per MGL 12.[R Roof repairs insurance required]I c. 152,§1(4X and we have no employees_[No workers' 13.❑Other comp.insurance required] •Any applic�rt thst checks boa 01 amst also fill out the section below showing their voikers'compensation policy infar�tiob i Hameoamers who submit this affidavit indicating they are domg all wait and then hue outside contracmrs wart submit anew affidavit indicating sash. IConttactors that check this boa must attached an additianal street showing the name of the sib-camaraceors and state whether or not those entities have employees. If the subcontractors bare employees,they must provide their workers'comp.policy number. lam an employer that is pmt idWg tporken'conrpemadon insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Insurance Policy it or Self-ins.Lic.#: 5012280 Expiration Date: 0 7—0 8—2 01 4 job Site Address: 1 2 6 High s t West Barnstable Ma City/state/Zip: 02668 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby cerd&under th rains and penalties of pedury that the information provided above is true and correct Si lure: Date: 1 -1 0-2 01 4 Phone#: r,08-400-7075 508-744-3362 Q,Quial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(drde one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cunsir'-wiun Supervisor " y� License: CS-053638 DANIEL J GALI—e-tHE PO BOX 278 s West Barnstable 16IA 6 Expiration Commissibnef 10/27/20.15 a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration za Registration: 167739 Type: LLC Expiration: 10/25/2014 Tr# 234303 NORTHERN COLONY BUILDERS LLG;, DANIEL GALLAGHER 1694 FALMOUTH RD #135 : CENTERVILLE, MA 02632 � Update Address and return card.Mark reason for change. Ej Address Renewal Employment Lost Card SCA 1 0 20M-05/11 �e T(iamunzaracu a�C/l/�caaric/cr�et/4 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g ME before the expiration date. If found return to: IMPROVEMENT CONTRACTOR — egistration: 1'67739 Type: Office of Consumer Affairs and Business Regulation till10 Park Plaza-Suite 5170 xpiration:. 10/25/2014 LLC Boston,MA 02116 NORTHERN COLONY BUILDERS=LLC. DANIEL GALLAGHER rip. .. 180 HIGH ST W. BARN, MA 02668 Undersecretary Zlot Val thot t signa re oF1Ht , Town of Barnstable *Permit #` g���� Expires 6 nrnnl6s from issued y Regulatory Services Fee BARNSTABLE. ' v� MASS. Thomas F. Geiler, Director Building Division (/ Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Officc: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address _�`oL, CJA -XIJ:5^4,�1L`— Residential Value of Wort.. a-Q— Minimuin fee of$25.00 for work under$60,00.00. Owner's Name & Address_ (� ' ��� �`� i Contractor's Name Telephone Number _ I Ionic Improvement Contractor License# (if applicable) _ Construction Supervisor's License # (if applicable) ❑Workman's Compensation Insurance gVl�NAdB 30 NM0.� Check one: ❑ I•am a sole proprietor 6��Z 8dV RL I am the Homeowner ❑ I have Worker's Compensation Insurance jj t3d SS 18d-A Insurance Company Name �Y� Workman's Comp. Policy 9 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof') 9,Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation, etc-Note: Property Owner must sign Property Owner Letter of Permission. A c y of We' Home 'provement Contractors License is required. SIG'NATI:RE: (.)'V I'I II.I:S\POR '\huild g perrnii forms\EXPRESS.doc Revised 10060 I ' ,per The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 15SG2 -Address: c!5�1 City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. U-I am a general contractor and I employees(full and/or part-time). * ve hired the snb-contractors 6. ❑New construction 2: I am a sole proprietor or partner-' listed on the attached sheet 7. .0 Remodeling ship and have no employees 'These sub-contractors have g,' Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'-comp.-insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 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 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 employees. If the subcontractors have amployers,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 information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 io 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, i a' ir- penalties ofpeijury that the information provided above is true and correct Si tztre: Date: 0 _ Phone Official use only. Do not write in this area,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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. ` Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more - of the eas foregoing-engagedin ajoin enferpnse;d inelu3�n he legal-represenfa�tiiieb�f- deced-employm,=uirthe receiver or tiustee of an individual,partnership, association or other legal entity,employing employees.'However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),address(es)and.phone number(s)along with their certificate(s) of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly.._ The Department has provided a space at the bottom of,�1- arm___.c__-Y-V--L-a_ Cli a:_aL., a 11Fr,.e lT....e..ti n4Y lrp_c hn rnnf��f•rnn rraarr�inv the gpnliraa t. ' the auiud VLt IU1 -Y-V-LL ll/ull Out ua'a`C C-;c—Ul a r%4=--V, VOub o:s tr- Please be sure to fill in'the permitflicense number which will be' used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to-thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4000 ext-406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass-gov/dia DATE M CERTIFICATE OF LIABILITY INSURANCE 04/21/2009) PRODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 43�9 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0—Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Gallagher Shields Building Co Inc. INSURERA: Central Insurance Companies 20230 1694 Falmouth Road #135 INSURERB: Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMMIDD[YYI LIMITS GENERAL LIABILITY CLP7997489 07/08/2008 07/08/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 RE CLAIMS MADE ri] OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 rGENGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ICY PRO LOC JECT AUTOMOBILE LIABILITY 7AM0277013965 01/05/2009 01/05/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) B HIRED AUTOS BODILY INJURY .$ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC799749012 07/08/2008 07/08/2009 X WC STATu- o R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Karen Bernier ACORD 25(2001/08) ©ACORD CORPORATION 1988 „i Town of Barnstable Regufatory Services t = Thomas F. Geiler, Director �'PrEo ►.�e� Building Division Tom Perry,Building Commissioner 200 Maiti Streeter Hy�ni MA-026D1 _.._. www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMCEOWNER LICENSE EXEMPTION z f q q G Pleace Print DATE: JOB LOCATION: l3 _ : de-15<5”r co number // street village "HOMEOWNER": J_oS Y ��77E �its 0V `A- — name home hone# work phone# CURRENT MAILING ADDRESS: Re), lZ �_7. r� n �ia,•�S i�ia /Slfr /'y1 ff O 6 gj city/town state zip code The cturent exemption for"homeowners"was extended to include owner-occupied dvvelli-ngs 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. DEFWMON OF HOMEOWKER 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 structur6s. 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) I'he 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 Barpstable.Buildipg Department minimum ins? ction p ocedur d requirements and that he/she will comply with said procedures and re. , cments a ' of Homeowner Approval of Building Official Note: Thrce-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 cxcmpt from the provisions of this section(Sectian 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner erigagcs a person(s)for hire to do such wort,that such Homeowner shall art as supervisor." Many homeowners who use this exemption are unaware that they am assuring the responsibilities of a supervisor(see Appendix Q, Rules&Rcgulations•for licensing Construction Supervisors,Section 2.15) This lack of awamncss often results in serious problems,particularly when the homeowner hire 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 bomcowner is fully aware of his/her responnbilities,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 cam t amend and adopt sveb a famvicertifieatian-for use in your corrmiunity. Q:forms:homccxcmpt T►Er, Town of Barnstable Regulatory Services vim $ Thomas F. Geiler,Director 16 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. '(Address of Job) Signature of Owner ti; Dam Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. n.cno. c.nt n.rro ory nocinwt • Town of Barnstable Zoning;Board of Appeals [ I � 2 0 "►1= 19 Decision and Notice Appeal 2001-36 -Wittenmeyer Variance -to Section 3-5.3 Resource Protection Overlay District,Minimum Lot Area Summary: Granted with Conditions Petitioner: Joseph H.Wittenmeyer and Cathy Wittenmeyer Property Address: 126 High Street,West Barnstable,MA Assessor's Map/Parcel: Map 027,Parcel 028.004 Zoning: Residence F, Resource Protection&Aquifer Protection Overlay Districts Relief Requested& Background The petitioners have requested a variance to Section 3-5.3 Resource Protection Overlay District, Minimum Lot Area of 2 acres (87,120 sq.ft.), to create two undersized lot from a land area of 5.06 acres of which 3.56 acres is upland. The property consists of two lots. Parcel 27 is a 3.47 acre lot and Lot 5B as shown on an Approval Not Required Plan, a part of Parcel 28-004 is 1.58 acres of which 0.23 acres is upland. The applicant is proposing to unite the properties and re-divide the 5.06 acres according to a plan submitted with the application in to two new lots. Procedural &Hearing Summary: I This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on February 12, 2001. An extension of time for holding the hearing and for filing of the decision was executed between the applicant and the Board. A public hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened April 18, 2001, at which time the Board found to grant the variance with conditions At the opening of the hearing,Acting Chairman Gail Nightingale stated that only four members of the Board were present to hear the appeal, and if the appeal proceeded a unanimous vote would be required to grant the relief sought. The applicant's representative,Attorney John Alger agreed to proceed with the four member Board. Hearing this appeal were Tom DeRiemer,Ralph Copeland, Richard Boy, and Gail Nightingale,Vice Chairman. Attorney John Alger represented the petitioner. He stated that the property has been in the family since 1713. Mr. Alger gave a history of the land and its'ownership over the years. The petitioner seeks to subdivide and convey the vacant lot to construct a single-family dwelling. The petitioner acquired the property from her grandmother in 1969. An adjoining parcel was acquired in 1985, and a preliminary plan to subdivide the property into three one acre lots was drawn by surveyor Edward Kelley. They are now requesting to divide the property into two lots that would be buildable. Public Comment: Joe Wittenmeyer, 126 High Street, spoke in favor of the petition. Members of the board and Mr. Alger discussed whether or not variance conditions existed'and if the petitioner had a hardship and determined that the topography, with the wetlands caused a hardship. • i • Findings of Fact: At the hearing of April 18, 2001,the Board unanimously found the following findings of fact: 1. Joseph H. Wittenmeyer and Cathy Wittenmeyer have applied for a variance from Minimum Lot Area of 87,120 sq.ft.,to construct a single-family dwelling. The property is shown on Assessor's Map 133,Parcels 027 and part of 028.004, and is addressed as 126 High Street,West Barnstable,MA, in a Residential F Zoning District. 2. The petitioners have requested a variance to Section 3-5.3 Resource Protection Overlay District, Minimum Lot Area of 2 acres (87,120 sq.ft.),to create two undersized lot from a land area of 5.06 acres of which 3.56 acres is upland. 3. The property at issue consists of two lots. Parcel 27 is a 3.47 acre lot developed with a 1.5 story single-family dwelling of 1,999 sq.ft. owned by the Wittenmeyer's, and Lot 5B as shown on an Approval Not Required Plan recorded in Plan Book 561,page 57. This lot is a part of Parcel 28-004. The Lot contains 1.58 acres of which 0.23 acres is upland. The-lot is vacant and unbuildable under zoning. It was created by the Planning Board on July 24, 2000. 4. The applicant is proposing to unite the properties and re-divide the 5.06 acres according to a plan submitted with the application entitled"Plan of Land in West Barnstable, MA for Joseph H&Cathy A.Wittenmeyer" dated December 04, 2000 drawn by Edward E. Kelley. 5. In that plan, Lots#7 and 8 are being proposed. Lot#7 would be 1.68 acres. All of the land area is upland. The lot would be created to include the existing Wittenmeyer residence. All of the setback requirements, frontage and lot shape factors are met with the new configuration. Only the lot area is • deficient by just less than a third of an acre. Lot#8 would contain a total of 3.38 acres, of which only 1.78 is upland. The lot is vacant of a structure. The configuration meets the required frontage and lot shape factor. It is deficient in lot area by approximately 1/5th of an acre. Although there are wetlands, it is possible to site a structure on this lot in conformance to zoning setbacks and outward of 150 feet from the edge of the wetlands as delineated on the plan. . 6. From the evidence presented,the requirements of MGL Chapter 40A, Section 10 have been met by the site, location of wetlands , shape of the site and topographic features. Those features establish unique conditions that affect the locus but not the zoning district in which it is located. 7. In this instance, a literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial and otherwise to the petitioner. 8. This relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Zoning Ordinance. Decision: Based on the findings of fact, a motion was duly made and seconded to grant the appeal with the following conditions: 1. Creation of the two lots shall be as shown on a plan entitled"Plan of Land in West Barnstable,MA for Joseph H & Cathy A.Wittenmeyer" dated December 04, 2000 drawn by Edward E. Kelley. 2. This variance is issued to both of the undersized lots shown on the referenced plan. The relief granted is only for the minimum.lot area of the lots. • 2 � II I 3. Development of both lots shall confo rm to all zoning setbacks requirements. 4. On-site sept ic shall conform to the requirements of the Board of Health without variances. The vote was as follows: Gail Nightingale,Acting Chairman AYE: Tom DeRiemer,Ralph Copeland,Richard Boy, g NAY: None Ordered: been ranted with conditions. This decision must a exercised in one Registry of Variance 2001-36 has g Deeds for it to be in effect. The relief authorized by this decision must Section 17,within twenty A f this decision, if any,shall be made pursuant to MGL Chapter 40A,Sec Appeals o a date of the filing of this decision. A copy of which must be filed in the office of the (20) days after th Town Clerk. Date Signed jGigh'ting Acting airman Massachusetts,hereby I,Linda utchenrider, Clerk of the Town of Barnstable,Barnstable C peal'filed this decision and that certify that twenty (20) days have elapsed since the Zoning Board of Appeals appeal of the decision the office of the Town Clerk. ion has been filed in no pp p and pains d penalties of perjury. • a o Signed and sealed this y j w / Linda Hutchenrider,Town Clerk' i i 1 , Ii i 3 i Town of Barnstable Zoning Board of Appeals 1: 19 Decision and Notice Appeal 2001-36 -Wittenmeyer Variance-to Section 3-5.3 Resource Pr''otection Overlay District,Minimum Lot Area Summary: Granted with Conditions Petitioner: Joseph H.Wittenmeyer and Cathy Wittenmeyer Property Address: 126 High Street,West Barnstable,MA Assessor's Map/Parcel: Map 027,Parcel 028.004 Zoning: Residence F, Resource Protection&Aquifer Protection Overlay Districts Relief Requested&Background The petitioners have requested a variance to Section 3-5.3 Resource Protection Overlay District, Minimum Lot Area of 2 acres (87,120 sq.ft.),to create two undersized lot from a land-area of 5.06 acres of which 3.56 acres is upland. The property consists of two lots. Parcel 27 is a 3.47 acre lot and Lot 5B as shown on an Approval Not Required Plan, apart of Parcel 28-004 is 1.58 acres of which 0.23 acres is upland. The applicant is proposing to unite the properties and re-divide the 5.06 acres according to a plan submitted with the application in to two new lots. Procedural &Hearing Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on February 12, 2001.An extension of time for holding the hearing and for filing of the decision was executed between the applicant and the Board. A public hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened April 18,2001, at which time the Board found to grant the variance with conditions At the opening of the hearing,Acting Chairman Gail Nightingale stated that only four members of the Board were present to hear the appeal, and if the appeal proceeded a unanimous vote would be required to grant the relief sought. The applicant's representative,Attorney John Alger agreed to proceed with the four member Board. Hearing this appeal were Tom DeRiemer,Ralph Copeland,Richard Boy, and Gail Nightingale,Vice Chairman. Attorney John Alger represented the petitioner. He stated that the property has been in the family since 1713. Mr. Alger gave a history of the land and its'ownership over the years. The petitioner seeks to subdivide and convey the vacant lot to construct a single-family dwelling. The petitioner acquired the property from her grandmother in 1969. An adjoining parcel was acquired in 1985, and a preliminary plan to subdivide the property into three one acre lots was drawn by surveyor Edward Kelley. They are now requesting to divide the property into two lots that would be buildable. Public Comment: Joe Wittenmeyer, 126 High Street, spoke in favor of the petition. Members of the board and Mr.Alger discussed whether or not variance conditions existed and if the petitioner had a hardship and determined that the topography,with the wetlands caused a hardship. I 1r Findings of Fact: At the hearing of April 18, 2001,the Board unanimously found the following findings of fact: 1. Joseph H. Wittenmeyer and Cathy Wittenmeyer have applied for a variance from Minimum Lot Area of 87,120 sq.ft.,to construct a single-family dwelling. The property is shown on Assessor's Map 133,Parcels 027 and part of 028.004, and is addressed as 126 High Street,West Barnstable, MA, in a Residential F Zoning District. 2. The petitioners have requested a variance to Section 3-5.3 Resource Protection Overlay District, Minimum Lot Area of 2 acres (87,120 sq.ft.),to create two undersized lot from a land area of 5.06 acres of which 3.56 acres is upland. 3. The property at issue consists of two lots. Parcel 27 is a 3.47 acre lot developed with a 1.5 story single-family dwelling of 1,999 sq.ft. owned by the Wittenmeyer's, and Lot 5B as shown on an Approval Not Required Plan recorded in Plan Book 561, page 57. This lot is a part of Parcel 28-004. The Lot contains 1.58 acres of which 0.23 acres is upland.The lot is vacant and unbuildable under zoning. It was created by the Planning Board on July 24, 2000. 4. The applicant is proposing to unite the properties and re-divide the 5.06 acres according to a plan submitted with the application entitled"Plan of Land in West Barnstable,MA for Joseph H&Cathy A.Wittenmeyer" dated December 04, 2000 drawn by Edward E. Kelley. 5. In that plan,Lots#7 and 8 are being proposed. Lot#7 would be 1.68 acres. All of the land area is upland. The lot would be created to include the existing Wittenmeyer residence. All of the setback requirements, frontage and lot shape factors are met with the new configuration. Only the lot area is deficient by just less than a third of an acre. Lot#8 would contain a total of 3.38 acres, of which only 1.78 is upland. The lot is vacant of a structure. The configuration meets the required frontage and lot shape factor. It is deficient in lot area by approximately 1/5th of an acre. Although there are wetlands, it is possible to site a structure on this lot in conformance to zoning setbacks and outward of 150 feet from the edge.of the wetlands as delineated on the plan. 6. From the evidence presented,the requirements of MGL Chapter 40A, Section 10 have been met by the site,location of wetlands , shape of the site and topographic features. Those features establish unique conditions that affect the locus but not the zoning district in which it is located. 7. In this instance, a literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial and otherwise to the petitioner. 8. This relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Zoning Ordinance. Decision: Based on the findings of fact, a motion was duly made and seconded to grant the appeal with the following conditions: 1. Creation of the two lots shall be as shown on a plan entitled"Plan of Land in West Barnstable,MA for Joseph H&Cathy A. Wittenmeyer" dated December 04, 2000 drawn by Edward E.Kelley. 2. This variance is issued to both of the undersized lots shown on the referenced plan. The relief granted is only for the minimum.lot area of the lots. 2 c setbacks requirements. 3. Development of both lots shall conform toan ri1T1he Board of Health without variances. 4. On-site septic shall conform.to the requirements ' The vote was as follows: o C Gail eland,Richard Boy, Nightingale,Acting Chairman AyE: Tom DeRiemer,Ralph P NAY: None Ordered: been ranted with conditions. This decision must be exerrecorded ci ed in one year- Variance2001-36 has b g Deeds for it to be in effect. The relief authorized by.this decision must coon 17,within twenty shall be made pursuant to MGL Chapter 40A,Se Appeals of this decision, if any, P of which must be filed in the office of the (20) days after the date of the filing of this decision. A copy Town Clerk. Date Signed jG ,qighting Acting airman Massachusetts,hereby I,Linda Hutchenr'der,Clerk of the Town of Barnstable,Barnstable n of Appal filed this decision and that certify that twenty (20) days have elapsed since the Zoning e appeal of the decision has been filed in the office of the Town Clerk. no p and pains d penalties of perjury. eelSigned and sealed this y o Linda Hutchenrider,Town Clerk 3 TOWN OF BARNST.ABLE BAHH9TeDL&, i Mb 9. BUILDING INSPECTOR �F0 MAX a• 0 �v APPLICATION FOR PERMIT TO .. �° ��'' .......... .%...... .. ............... �?-�.�...,..,.,;........, . r' TYPE OF CONSTRUCTION ..............I .r1�.�......:%�..®?°P.........D. �....: v. .......................19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereb applies for a perm ccording to the followi g i f motion: Location ... ... � ...:. ............... ...... .l�r�� ... ......................................................................... ProposedUse ......... .. ...1 ....................................................................................�........................................:. ............. Zoning District ........................................................................Fire District .�'�'b/........�CCo a/ «tis Name of Owner ... �! a?�G - Address ... ✓.� G ......„ � Nameof Builder ....................................................................Address .................................................................................... Name--of Architect ..................................................................Address .................................................................................... Numberof Rooms .......`1 ..................................................Foundation ............,................... ...................... ' Exlerior �. Roofing . . .. . . .......................... Floors ..� . � . .....................................Interior . ........!&^?����,............... Heating ... .. .....................................................Plumbing ........ j°." .................................... c Fireplace .... ............ .................................Approximate Cost ,r....... O GAD".................................... Difinitive Plan Approved by Planning Board -------------------------------19 . �� 7 Diagram of Lot and. Building with Dimensions GQ 7�- C . THE PROPOSED �7r SANIT THOD OF P}�Ot;l , AnY UJATER SUPP ( FOR AND DRAINAGE IS Y, SEWAGE DIgPWA hE;cr_ 31�:� =D �' A� , r,. d� TOWN OF GARNSTA BOARD OF HEALTH I/ 7� — r,,�— 39b/V13S N(d1g �W3LS,CS H1S N� �� 0 1SnW l� NI 4Nb' '11�i�3d �3llb1SN1 a3SN30n v y� Via= lam . , 7 I ereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above ,construction. �� Name . ! ".... %� .` n� ^..~^~~�~^ " Joaa^�� H. �~ � «° < No .— Permit for --.t«��..story,-- --. ---- sin dwIllin �----^^----.^`"..=`��===�-------- ' Location �i�� . ..~.�.=�� =---------.. ...................... ...................... � Ovvne, I{ ........... ' . Typo of Construction ...........jxauoa................... � � / --------------------------' Plot ............................ Lot ................................ , � � ' Maroh 18 70 Permit Granted -------------.lg �� � . Date of Inspection .� ��� ��'�"�'��--.lV ^r��*~�� Dote. Completed ...................................... � PERMIT REFUSED � ` --'_—_--------------- lA ~v -------------------_------'' —_-----------------------.` ^---.-----------..—.---.----- ' ---------,—_______,,_______. � ; Approved ............................................... lQ � � . ----------------...--------. ' ' ------------------------..—