Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2429 MEETINGHOUSE WAY/RTE 149
—I c->\,cl__ i 1 I'� o �1YlP�m 3� 6y. UPC 12543 No. 53LOR •� r^'`o- .'".�.'t".`w•-. ...,.,,,.,....:-- ... ..�,.--x.. '�'-•.+ -.rn+... ,.-.- cr... �...c�,..- - - _ - ^^r......e-.��,......_ 1._..,-.....+,...� .. . ..� ..........,.....-.�Y, w.�w��.y —�..R.•+-;.,�-.+fir,..: �! albs thsir- 1 L 6 03 o r°d&e4r.1,u yOWOA)r V)X �, [ • "4r\�S�l �~�e$�{i'"j-: �\ "ems'`,�'•�`-•-\�����c- • 1 }4�4 MWIll 4 Tr r -•' �' �' -Ky6J tr �R�v ��'�" rf 1 � • r i 5t - t A *r`r,t t.i ryy. ••„I.1.. a 1 L E. M 1 � �. a '. ��..a �::�` J - � : '�� fi- } -fi• "= 'ye q ;t �#� - i - -M.1n Y •r Jr-4T��s�� �yc tY' f� �5. r y ><- •I k�'yr '�� � } J 'sC�l2 ^+l./c• ,I `�'V i c •rSr' a kti .,Ic f 7y�j •G'7K.S3 J l 5 y +'"ter$ '�"_ '• 'tl��t + t f� 4�" a• - r :fs�. 5a+r f. ,�f�ti 1� { Y h - M s. .Y?ri_3fi }_.�`fi' �'! { :•f"c?y�.sNi :� f Y1Eu ras Ln � � .Si fX a• G\. 74h-. .f''.. .`t� �.4..- 1 ' t.� Ir rit. 7\w. 9 ha t-:i .I r..t-. � �. r f 1 J 'TF Jtc"kJ�T�r ti r � �a �1 ; r i �T S •�,. ti s s 1 1 {r 2 fi € imfit c s r E£ o r1 >t .�..M i t!: and �1 t P 1 IIR�k f F"'x_ "� -�•,<L 1 -cam a�7 ._- R I 4'�' a ."y t $ irvz el �..73f^, •,.. 3 N �� .F ri ( 5efi D t r n ✓ G z' s 1 rf1 a. 1 I v,c'fclX�r.'G°..(a-4.:.eir ate e' \15� s! 4 ��y� E x FK Y -, ; f t'� yy +�♦ B m".19.` 1 I � I c° a. s��.+lr 7� ��� � 17 � ,�° , � �M�j a PPSa�j �1h•,,��{�"'�t 3 t l�=r' � � �I'4t 4a��M1x ��n'13� �,:f�� �� -1� , n ( 9 •' -`����'€?' r t ti:�.. ° i' �6 j. � � 3 S 6 T i t y -or�c4.r 97�rj. :e, c. •'" b, r* !c 7 1 + a - �. �i s' � - r 1 6y 1 I .t 4 � , s.'f• r'0 n r v t <1 �. }� � 1 5 _ +. v1. ZT. �. ° > g I 'I 3� ` tle ., `�sr'r`"i.r�i i r� `'z,:,q�;}•t J' ,ei I '4� l��: ,> ., 9. t >� r...a,•< sir � I, s tj. ',> �. rn, "y�`�J"sa�1� sq,�,�a �'a y !11 4� y, y.t. �F �f^ !r`a�3 a �y r; I :'•jf ..FS-�,� '7 ?s �� ,tr.ia. y, ,i.EJ Shlr tad 3•x,' , .e� y 1 .�.�tl sI' 1 s 7 { a r i � �{ tr ll.,i. .. it., +� •y t �ir c f: '"^tl rl f r ! p I Y ,z •�+'-r � � J,4�� Pf ysr-}, Y A r�� r ,y� h'. r� � 1�+• f) r 11a � \ r t I l '.s -r r �><�: a. �>.ii r - .1' s W ! a+t Ir•1 f s t '' 'IC'k _ � Y 7 `x.-t A � S a ri .uf' t ev � a .3':- Vw�II'v.' i ti P j n,,,.,�•��;� r l� 4 r,.?'s ���I a7�p "1j r�'r r t ` �. rr '' °. •^f� �'� rch>. 'y •v �'t�"z,� r '»•�,..- f _z ,__ .:..: ,..�a,.i�' ,.z.r :, :• r ;�.�,.:: t-. � ,a r .a r' 'r3, , .. �. > �;�`�vS�{ r>4�' r y ° _T2% w sj lie -1 :S Y r • ''r Otis Hall, West Barnstable, 11-Iass. • ,pq ::�. .... -. t; .'- _ _ _ — it F,•F: �..,p;}, .. -.;:.-• .;fir ... ".: .r 4.xr -rt"fir`+� u7 •4S" � 'f a y '.3p? ,0�c'vt'2r' -•ern lt: r".�i:tiH'Y• v�tv i - t' "'3 � _ c A'+:--+Z�, +a•K r�+•4_ ?�..... :.?"<• .fir 3s y.;6A' ��f.. 'Qs°.:,. ;J':" ) �r ..Y r"�:d„ .:} �.+ ;�.•5''� }. j.:' gig,.-'.'� .�)�•::. •.✓��tfx' .a.. .F wA �7•-w :;�e...-�!' - '!'''. ).44}�� :o•.,. x»•%yr .-i �`�`::l.,'r":1.13.::?:..C`:1.. �C�.`a•:•,. �.5::,. `3'«•.�. �: fit' �.. ,y-.•.jam� �'.k'"•"- .F:.1i' `•5 :rl;., ��':.:. _ i'.,- t.., .,+.J;iu+`'" r.`' �` 4 �S•'. ;{+ � ..`c .,4.ts. .G. d .y,. .3c.w. .�''''�::nk o-Jr :air':.::° _ i�`•...31�.w�, ..}: .at:•''i;:. .�`•'`a s „! . 'S.t" $, �ar. cr3;i it,:�'i`' p a;s.,.. '2 ..:a:::r°� ",£„ t.. -:'P=.• .:� y� - `S' ';:Z ;�`tsrc. :fir.,r�� }¢:.,r.4x.F:- !. t:• :'d :'..i' :.i'::x.�'`:� ^',Fr.+:.T.' •d, ;:`off: s�Y .c-�:�:`F• ^v'v:` ..� s'sz��` �.f,��}} '`�� :� .a - ,.Jv .. #,'.�:.,�r<r::,-: _ :•e'._ ��.��'�.: -�..�. ..ri.Y,•. � %i5.: .aG'3� -t "4.'•t:._.l.:; rrc:: r.v, ": '.i.. _`%kk• ....:,?L .x ..r::Zr'7�:.t.:r: •d� Pa '(cv, y:. .n' ^`d'i:t3=,'.Sr�f.` s'Jw^ ».+ :o- :`E.-• -��:,�r.+.i' .f- s'£�:v. - T'� _eJ� . . '- ;L,a.«'1•u.Yb•::-_.�., ...s�"- ,:a�' JJnnii;.. 's.':!: � $ .:Jar 1:�3�...,;„d•d„ -p.¢$ :,Ji..a ..�:^c:S..:..sw•r�;`•i''s ,yam-c.r .,may <�'; +.rX 1:�::::_<r;�i:' - •.b.:",_ - y,JJ':+;'t�- A•.w:5d".".�.�'j-Fra.. 03- Cyr•�,ri .,Y�si .4.JS`.'..�:�F_r:u1:f ':•]r1{T-,. .�\}:4�}r.'(S :�A�'- .:T iT.. -,-:;.:1-1:T5:; .F .. rl., f., .:.:'::r./ �:�'<�:'S:AY-F.�+,. �S';�f,.'bin..t. �a•�i. i.. .�.:1%a.•..� •niwa. ::✓=. T.."'.:d�: y+�.. .:�i c>&... 1<a' '7 7;-a..zt. r244�. .;7�> .•r - -.R.y''r;Gq�� .�'.�,Y-�� _ ,.:�,{§='.s a.r.,: ':�,.,;f)',.:- ,�P"�.:. Y.s .{'.� :f�..3?� ,k.3.; ..:�. rx•. inry„,�%�. ->ii,..Y at;" 'F .:`�•. ,s. •::r,; r'v':?_ �.t'" ,_�;;.�`.. s'2- '.;F: ••33 .� ^,.�e, y[ �..�. .,.�,- -��.�rr.x4:F• +,'r�sa.,:,,�., .,,�`�'a�e:ra�.'_i,_+: .,•«, I,. .s +-:'i=!'�... :y��;,`.�. ,.tj.�/ .+.�., 1' �^C.•{4.,: '{.`-ya x:fJr »:y.:.- a.T,.-l::a. 'd ;a� .i�l�r .L*:.$�t4.T��:.tF.••J'ia`�fV � ..'aM:�:i :�.•y: r.�:,.��,�yw:y:D ..2i�1:,,� �6�. .Z^� :k.!:t;3��.,x.�,4.'...�. :o'.. °-�'}w ,'j,�x.,q...s:-y%"a;,+ca.,ic•�'.. -0;3�F"i. .,., �.r. ..u:;.. :•�v`'-'.o-:^�Y:...2. _ .r �',`•.s.. -r .(, :5h a7r.. '.5..�#var:. a.,.:.-;r, r a' e] JC'L.Y:'L�, N Y �3:5' e.�•i�, '3. n ,x:�a�., ,,�...,... ;.'sT?:' vG.,: "tk. F.s �;. ,ti _ _.f• _5;'a. +I',. .,.�, •;� ,�,:_ '•£k`� ,•,�?..rn. sL`:. <' �3:'";�;,'e-':cai-?%a*3';; k; ::.t� :s' •..�iF;y',s ...•, ��tt«.}w�;.���,..:- ''�+:.� ,.J,.i�.'s�,.^a�as<a�w''y��;�;.�ay^�,'- �s:-!'. =5,r..F.x.ia,.r�r;3''i�.x ,�{:'r ,r3 r4: ..,,k �,�_2 `�'�'.;az? -,''3.M.�:.a:,•ke i .:ah•-„�'x u,��en ,� s'6`q..*.-re`"y4b: "'+;.. •s-4+i�ti,�'=E r#';3.a ,f. <sx:3:s SaF» ;a;:'s�!`t.� •;;, is �','&a.a4tY•.#,�.,�z. :.a.-.T „i, p�!Pd`r� emu: :'? '"^ _ a� uit< ,� ,"ram; ..8-s7,-� .,¢,.>s, ;tJ�+ �i:i-�.gi'�� `sRs-�`'�- - ](7,.'^+"Fku"�!�garr�.i•+`t:i'.s f�"--�ha •ejdh.��`�;-T�t,,•sf•. 3�5'�'..a'•arF�',.s:t`�.��t�ui,Y�,t3?il•!'i`':v ';r�y_,.d`9� �.e�. 7'�}d`i-�.y � �:xx�+ p';�� E�c:���.�+��«"-��- x?41r'„`�' E-_ ..•�!;, ,��' G�+.�,��?.,,.:�+..-r�s�,�a..±i;�•-:�.,ati:.��y`-1,�;pn•4=:�;ti�,�,;as�;��.�;:�+�F`-�' vr,,w�� .'> ,�.4�:,!.r�•' �,��'•A.s'..:x.a �'i 's . :�vrs,vy„�-��S„„,J.0�?�`9".�..-,��.•'.:s": �y ,'k�'1lxf �zsr�i.`s.j,''rr�„Y_'.�r�e�i(i?,J' :.�s+ �.,.,i.�4�#`+7z4'.'"ar,��"i�';�,,•'a*c'f'i -r Ei ':�:.3<V;� ..t,�,, .`fdS. }a,.,....t._�y"4: .,lv�••, (�+.,?_nx��c,: jtir:'['J .irk {..Y .,$:�?'.�tr 'y, •b - s�: .�`sli. rJ.:.r t3} ,7:= ,p .5�: &ii. �FSr".°' Y.'"b �� '`3�' ,i� ,'i'�.�. ��wr .. -. ; i''r _� ,-"iY.� kr,• •,s, •.'�.. .�.�`.2-i sP�gr::�, �p;:�•�^'�%;�'1�'.. ��.:� x-�iF a sa?�,3,'�"�:�.. �!. v,• syL._ •' ,-�a:� ..�.r-. s.:z•4:� �:` ,'. -z. .•M�c__.y- ��"a_� , t,.�.r..<:".�xr:�x<-, �_, 3/�: ;s�i _°_�' . :.•.•.,�..yy=--...4+, -.J- ..»...,..,r:• .f::ar.-'..,,.;,_- _:a-r: :�.r,} { •.?':'-( -�{a u;g.. ..e`; �r s�.Y,� .Y'i.+�':.a'°:;'.=`�..._,i';..y".f�..+. �.>� .�gr•Y, �:.. ry'`?:d'"'iFf::-�" .._.�. _�J _. 3,:.•Y<.+�,:C.JF�rv:rl`... ...-..;✓,".i•-...,]g..�)x ti!',t�:�'-F .S'3r- .{�•fS:�a.-�:Y.u;,C.r , ?.,N.,»,f..l.�_k:•� .�.2!.-t_- # - . :6i t... ..t �. �:.. r✓ dot r .�, -a•, ^r1.'.:N. ..,J;F,v , s..i._ °�'b _ .. - - rJs a, `•s>�rk PLAN VIEW EXISTING BUILDING ENTRANCE DOUBLE DOORS PLATFORM 42 X 72 TREAD 11=1/4" TYP. 2: FRONT VIEW 0 T RISER 8" TYP. SIDE VIEW FRONT VIEW a ,w ...._,. .''a max•..: u".L_�r' � - ..:-� sm:,���. ` T 5- ..... Y c ... •�4. 1. '1r .'Lk_ •iFt .�_ PRO FJ F - I ...... ........ F-1 F-1 ..W. F.-I ❑ F-1 F-1 _ Fr ............ - .ice - i ST • r — �1 SIDE VIEW ------------ .......... ... + . _. .._ l �� a � �r� ® 04/19/2011 20:39 FAX Cz31001/001 Town of Barnstable` ' ^nt f f n� r lJ i.}� V• �6. Regulatory Services i i Thomas F.Geiler,Director NAM �ttrerws� � Building Division Tom Perry,Building Cominisiioner. 200 Main Street,Hyannis,MA 02601 Office: SOR-8624038 Fax: 508-790-6230 REQUEST FOR ELECTRICAL INSPECTION � ELECTRICAL PERMIT NUMBER 0 (Permit required in orde o proceAA inspection) 1'ocl�y';c late �' Al/ Requested Date of Inspection r, (1 1 hereby request an inspection under MaAsachusettek General (glectrk an) Law chapter 143, 4eCl:ion 31,and 237 CMR 4.020). The installation will be ready for inspection at 9 d elm f aas'e Vtq 6v,1f� e (i'roport Location) Type of inspection requested ❑ Temporary Service: Service Re-inspection ❑ Ex(`avation ❑ Rough Re-inspection ❑ Service Inspection ❑ Final Re-inspection Rough Inspection for�t°�UP/a� ($100.00 Reinspect' n Fee) s �o� -oZ' You I A S p e.c: 'fh iS dt)r/ /t y Siff-V lee 1h ,5JOedio A v K ❑ Final Inspection for ❑ Other Owner or tenant Licensee's name, address, and phone Q ��� sd - yllyIee// License number /,�-3 q �TiQ Licensee's Signature i 2U sewan to be stable Inspecctar of WIZIM Inspection date APR 2 1 2011 proved ❑Not:Approved This work was not approved for violation of the following Articles and Sections of the MA Electrical Code: Q:W PFi1c9:forms:ciccvcqucst. i Co,nmanwealth ol Mamacltwetb 0f�cia�Urfa,l y r 2cc�� Permit N . 1eparltmenf ofcc77 ire N BOARD OF FIRE PREVENTION REGULATIONS Occupancy [Rev. 1p/07j and Fee Checke dT � leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEQ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: JrARA1=QW L4,V-+l 5,--) To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical wor escribed below/ l Location(Street&Number) //j l///f : 5a,,-r� latlam' e Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Ff No ❑ (Check Appropriate Box) Purpose of Building �u/e/Ar CJ Utility Authorization No. Existing Service!`� Amps /p� Volts Overhead ��Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Lf s rr Num`ber of Feeders and Ampacity 1 :=Loca on and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. L•_ No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA ' = No—of Luminaire Outlets No.of Hot Tubs Generators KVA b No. Luminaires Swimming Pool Above ❑ d. B In- ❑ o.o Emergency Lighting rnd. rnatter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones ! No.of Detection and No.of Switches No. of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. TotaTonal No.of Alerting Devices No.of Waste Disposers Heat Pump umber Tons KW o.of Self-Contained Totals ............................................................................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent o.of Water Kam, No.of No.of Data Wiring: a Heaters Signs Ballasts No.of Devices or Equivalent Z No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 01 . 1 it Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lect ical Wor : 4t��� d (When required by municipal policy.) gg Work to Start:2 1 /K Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OV RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge CE O is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANND ❑ OTHER ❑ (Specify:) I certify,under the in and p naltie of perjury,that the information on this application is true and complete. FIRM NAME: Q P /� / /� LIC.NO.: Licensee: Signature t/ LTC.NO.: J✓� G (Ifopplicable,a ter "xempt"in th��nse nu ber Line) �� Bus.Tel. Address: IcDCQA Alt.Tel.No.: *Per M.G:L.c. 147,s.57-6 ,security work r uires 6epartment of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: S l �49 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma J Parcel.0 r p 'Application # � c5 Health Division Date Issued l Z� Conservation Division Application Fee Planning Dept. Permit Fee 5 a Date Definitive Plan Approved by Planning Board Historic - OKH Preservation /Hyannis Project Street Address Z V� Village VVtQ_ Owner Address Telephone Permit Request C- I V'O UVV\ 2 Square feet: 1 st floor: existin4oproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatiorM i Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 0 c o 4 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ o Commercial ❑Yes ❑ No If yes, site plan review # ►—' �" Current Use Proposed Use APPLICANT INFORMATION -t m (BUILDER OR HOMEOWNER) CO Name 161d/" TnU Tele ho e Number (D (Oa' � � Add se ress is se # W . Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE " ( U ' FOR OFFICIAL USE ONLY APPLICATION# B =DATE ISSUED- ;. _MAP/PARCEL NO; -ADDRESS.. VILLAGE OWNER- t DATE OF-INSPECTION: -FOUNDATION FRAME b <l/tnc l . -INSULATION., nwat/m,-ri- �hc '{ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS;; FINAL _ ,61NAL_BULLDING f" \C F DATE CLOSED..OUT. s ASSOCIATION PLAN NO. R i ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 sy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� ( Please Print Ise ib1 Name (Business/Organization/Individual): 6 4 VL V 9- Address: City/State/Zip: `•'`ZVz lQ Phone #: Are you an employer? Check the appropri e box: Type of project(required): 4 I am a general contractor and I ]. ❑ I am a employer with !!�� 6. ❑ New construction * have'hired the sub-contractors. employees(full and/or'paPt-time). . - -- -0------ -•• - - • - 2-Elm I a a sole proprietor.or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, 0 Demolition workingfor me in an capacity. employees and have workers' Y P •h'� 9. ❑ Building addition No workers' comp. insurance comp. 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 11.0 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' ]3.❑ Other comp. insurance required.] 'Any applicant that checks box 4) must also fill out the section below showing their workcrs'compensation policy information. t Homeowners who submit this affidavit indicating they arc 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 stale whether or not those entities have employees. If the sub-contractors have employees,they must provide their workcrs'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-IDS.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 c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 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 c rtify under the pains and penalties of perjury that the information provided above is true and correct. Si ature. - 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#: hformation and fnstructzons Massachusetts General Laws chapter 152 requires all employers to provide workers' compensalion for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hill, express or implied, oral or Written." An employer is defined as "an individual, partnership, association, corporation or other lcga)entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of a❑ individual, partnership, association or other legal entity, employing employees. 140-Wevcr the owner of a dwelling house having not more tban three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on Lbe grounds or building appurienaot thereto shall not because of such employment be deemed to be an employer.' MGL chapter 152, §25C(6) also states [bat "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) stales "Neither the commonwealth nor any of its political subdivisions shall emei into any contract for the performance ofpublic-4ork until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out.tbe workers' compensation affidavit completely, by checking the boxes tbat apply to your situation and, if necessary,supply sub-contraetor(s)name(s), addresses)and pbone numbers)along with their certificate(s) of insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employers 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 ]ndustria] Accidents for confirmation of insurance coverage. Also be sure to sign and date th-e affidavit. The affidavit should be returned to the city or [own Lhat the application for thr permit or license is.being requested not ibe Department of rk s' Industrial Accidents. Should you have any questions regarding the law or if you.are required to obtain a,woer compensation policy,please call the Department at the number listed beloW..Self-instved 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 FtI the bottom of the affidavit for you to fill out in Lhe event the Office of Investigations has to contact yoti regarding the applicant. Please be sure to fill in the permiUlicense number which will be used as a.reference number. In addition,an applicant that must submit multiple permiUlicense applications in any given year, need only stibrnit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"a11 Jticaiions in _(city or town)."'A copy of the affidavit that has been officially stamped or marked by the city or town niay be proJlc ed to the applicant as proof that a valid affidavit is on file for future permits or licenses. A.new affidavit rust be filled nu l each year. Where a home owner or ei6zrn is obtaining a license or permit not related to any businesspor commercial venture (i,e. a dog license of permit to burn leaves etc.) said person is NOT required to complete this a$6davil. The Office of Investigations wog 1 e"kTO Lll-aYrkynnri�-dva 1�rLOLZp'ratinn and should shave any questions, please do not bcsitate to give us a call. f The Departmcnt's'address, telephone, and fax number: The Commonwealth of Massachusetts Department of lndusbT a) Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te). 4 617-727-4900 ext 406•or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dies g �1 � o I i Town of Barnstable pf IKE rpk do ReguTato•ry Services BAMST,BL Thomas F. Geiler,Director 6 ,�� Building Division Tom Perry, Building Commissioner 200 Main.SfreetHyannis, MA.02601 WWW.to wn.b ar nstab l e-ma-us Office: 508-862-4038 Fax: 508-790-6230 IiONIEOWNER LICENSE EXEMPTION Pleare Print DATE: JOB LOCATION: W number /; '^^ Q str t vi age '^ "HOMEOWNER": d® •1.yta— Y V l `� " name �J home phone# work phone# CURRENT MAJLING ADDRESS: 1 city/town state zip code J Tyre 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- DEFINMON OR BOMEOWNER 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 constrgcts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Of5cial on a form acceptable to the Building Official, that he/she shall be responsib)e for all such work performed under the building permit. (Section 109.1.1) 71�c 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 urn insp6ction procedures and requirements and that he/she will comply with said procedures and rcgrniir ents. Sign 're 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 homccrAm r performing work for which a building permit is required shall be exempt from the provisions of this section.(Scetion 109.).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 supevisor." lvi^any homeowners who use this exemption an unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Wes&Rcgvlations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it Mould with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsnbilitirs,many communities require,as part of the permit application, that the homeowner certify that helshe 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:forms:homeexcmpt I_ T"ET°�ti Town of Barnstable Regulatory Services sAxxsresr..� p Haas Thomas F. Geiler,Director j6`� . Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Yeym.town.bamstable.ma,us Office: 508-862-4038 Fax: 508-790-6230 i Property Ovrner 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 rob) r Signature of Owner Date Print Name i If Propierty Owner is applying for permit please complete.the Homeowners License Exemption Form:on the reverse side. Q:FORMS:0 WNERPERMISSION T t From: "Bill Deutsch" <bill@trussus.com> Subject: quote and truss profiles floor project Date: August 30, 2010 8:58:55 AM EDT O To: <jayne.wilcox@comcast.net> 3 Attachments, 31.4 KB Morning Steve P� Forgot the attachments first time Bill Deutsch Trussco,Inc. N. Kingstown,Rl 02852 T:401 -295-0669 F:401 -295-5760 E:bill@trussus.com 1�6I i PDi� l Steve profiles.pdf (15.7 KB) TRUSSCO, INC . P.O. BOX 839 NORTH KINGSTOWN, RI 02852 401-295-0669* FAX 401-295-5760 R.I. 1-800-879-0669 NATIONWIDE 1-888-TRUSS20 Quote Date: 8/30/2010 Ship To: Bill To: General Bid Steve Wilcox Order ID Account ID Salesperson Order Date Required Date Shipped Date Ship Via JOB10807 ACT00565 House Account Flat z From: "Bill Deutsch" <bill@trussus.com> Subject: stairwell floor truss Date: August 27, 2010 3:41 :59 PM EDT To: <jayne.wilcox@com cast.net> 2 Attachments, 9.5 KB Steve Plz. Verify dimensions j Bill Deutsch Trussco,inc. N.Xingstown,Rl 02852 TA01 -295-0669 F A01 -295-5760 E:bill@trussus.com 14'-81'center 10'-0"center O 1-6-0 �— Ho 1-6-0 1-6-0 18"deep— L166].] stairwell 01]]1 d headout q brg wall fl ]CI 7-4-0 l 7-1-17 1 2-1-17 1 7-1-12 17-1-17 17-1-17 I1-7-11 7-2-17 17-1-12 1 7-1-17 17-1-17 I1- -01917 7 1 l7 7 1 l7 1 7 0 ec� fi ] 17 - _ _ Td9S=T7 tt 32-1-4 steve plz. review and comment Scale:0.250•-r - Steve Wilcox 1QiTelc® Online Plus" ]on r.ra Quan Type Span P1-HI Left OH Right OH Single Dm wing 10807 F3 2 x100 320104 10600 0 0 Oi Pl -0CoPWQNWTIMIW&7J10 v.N1177AW1 SkVY DMAV p.P.y.H47n0107:37'S7 PM P�y.1 it Quantity Category Description 1 Coastal 1-3/4 X 18 PRO-LAM Length=8 46 SimpsonHan HU412 2 SimpsonHan HUC410 2 Truss 10807 F3 M100 32-1-4 0/12 2/2 ® 2 Truss 10807 F2 M100 17-3-8 0/12 2/2 21 Truss 10807 F1 M100 32-1-4 0/12 2/2 i Subtotal: $5,235.51 Tax: $366.49 Deposit: $0.00 Total: $5,602.00 Price good for 7 days. �4. 1/1 Pages PDF created with pdfFactory Pro trial version www.pdffactory.com I •�a SMOKE DETECTORS EVIEWED BARNSTABLE BUILDING DEPT. DA E n FIRE DEPARTMENT DATE W BOTH SIGNATURES ARE REQUIRED FOR PERMITTING IMPORTANT-UPGRADE REQUIRED U W STATE BUILDING CODE REQUIRES THE UPGRADING OF W SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN I= ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. = O NOT-E: A SEPARATE PERMIT IS REQUIRED FOR THE ^ INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL uQ PERMIT DO N T SATISFY THIS REOUIREAIENT, O CARBON MONOYJDE ALARMS MUST BE INSTALLED PER } co NIASSACHUSETTS BUILDING CODE O W 3Z z o 0 o ® �Q 0 0 3 F a o 0 ® U LL i U=� O 3zin z Q w m tu � w FRONT ELEVATION N w SCALES 1/4° 1'-0° Q'3 C4 SHEET I OF B DRAWN BY, KW ' DATES 9/9/10 i I ' I I I i I i i ` 1 Nxffff a� e �I o ❑ 0 i 1 p PROJECT i 2429 MEETINGHOUSE WAY (FINE LANE ARCHITECTURAL DESIGN mm WEST BARNSTABLE, MA 8 WEST BAY ROAD 05TERVILLE, MA 02655 0 ELEVATION (PHONE: 508-420-1296 I � I i I I I N m I � A i , � = I O I I j i i i fff I p PROJECT, r�.T n m � i 2429 MEETINGHOUSE WAY FINE LIN ARCHITECTURAL DESI N m 4 WEST BARNSTABLE, MA 8 WEST BAY ROAD OSTERMLLE, MA 02655 ELEVATION£ L, bHONE: 508-420-1296 t i I I I I I 8° I I = imrq { C El � z c I� I r t I m � � ' I p 1 b � I Z ; I I 00 00 I -� lz i i cu I �I � I i r !3$1 I� I I b 1 B3'-o 1/2. p p PRCUECT- 2429 MEETINGHOUSE WAY m WEST BARNSTABLE, MA FINE LINEARGHITEGTURAL DESIGN 8 WEST BAY ROAD OSTER-VILLE, MA 02655 m PLAN PHONE: 508-420-129ro 1 I y I \ i \ , HULL \ 1` 'LINE __4_ ____ �_______ i 7p0 / T-4 1/a' I y ___________ _____; / I I I i I I N 1� �G I Z 1 m I , I � a- Z 1 iw s \ I - A e , / ---------- L / � t . •'I.I I I I / L D WEPRaJECT- MEETINGHOUSE E W A 1'I E LI E ARCHITECTURAL DESIGN WEST BARNSTABLE, MA WEST BAY ROAD OSTERVILLE, MA 02655 0 PLAN HONE: 508-420-1296 Y S z 8 0 a o } ul F o i N o o � � N rn n � s e P o t;o Alz If-e 3/4' zlv ag . yp off . N o (p Z o� Ali PRO.IECT• T Z' £ 242q MEETINGHOUSE WAY. FINE LINE ARCHITECTURAL DESIGN WEST-BARNSTABLE, MA m 8 WEST BAY ROAD OSTERVILLE, MA 02655 0 S SECTION PHONE:508-420-129ro o , a I I I . N x I x � � l n Z I r O .- m I - a r o P I � � I 3 Z � IIIIIVIIIIIII � -14 a-d ss�-o in• D WEST BARNSTABLE, MA ARGHITEGTURAL FINE LINE DESIGN 8 WEST BAY ROAD OSTERMLLE, MA 02655 a$ N STRUCTURAL PLAN PHONE:508-420-1296 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V - Application �:. Health Division Date Issued Conservation Division Appiication F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board L Historic - OKH Preservation / Hyannis ' Project Street:Address 2 l Twn/ e_ Village - Vv Owner Aevma_ w J" Address Telephone Cl V1 q ( 6 S f` ooi? :.6C� G 11iYL Permit Request C6f, tom. �Mtx -�• Nwo a.KNPRv 1,�� IIIA-0+0-n C 1p" iltJll�, Gi Joe S X Square feet: 1.st floor: existing proposed 2nd floor: existing pr p Vos fd otal new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 6D 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: 0 Full ❑ Crawl ❑Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing newt Number of Bedrooms: existing new o Total Room Count (not including baths): existing new First Floor=Room Count Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal st ve: EfYes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing'❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use .Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name UYl/V1'0, m O v S Telephone Number Address Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �. v C-. SIGNATURE DATE ` O I FOR OFFICIAL USE ONLY �APPLICATION# -DATE ISSUED i < UAP- PARCEL NO,, -ADDRESS--: VILLAGE OWNER i DATE OF INSPECTION: � 001',=FOUNDATION:�b � ` i FRAMEk" 4 �3, (A ,:`INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' . t , GAS:H —o ROUGH FINAL a FINAL.BUILDI 4 DATE.CLOSED_OUT }� ASSOCIATION PLAN NO. f • Y o�TM�r Town- of J�arnstabl ' Regulatory Services F. Geiler, - I �„srAgr� � Thomas , Dixector rsls-z ,6yg, uilding Division rya Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 wwtiv.town.barnsta ble.ma.us Fax: 508-790-6230 'Office( 508-862-4038 PLAN REVIEW /?/l li �r/S� •- � Map/Parcel: Owncr: uilder.- LNG Project Address rn-s were noted on reviewing: The following ite 1/u n e s i/~5 . f f 3 o1. &o Reviewed by: i Date: �/:......n � -.•J r.:.....�.......�n'�. • ..r-� ...,...r..-.�..n.....�..n4...Y.._L.IiM.-.,... .�.i.......n - _. ..r ..u.�..�1..a....�.� �.-..I. Sy w�. ... �. ...��1>.Mw e. .. I— The Commonwealth of Massachusetts ! ,Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 y y_ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information please Print Legibly Name (Business/Organization/Individual): Address: 94 20t l b City/State/Zip: V7 hone �►`� g ` 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 erriployees(full and/of'patt-time).* have`hired the sub-contractors.. . . _. _ __ _.__.._.__.. _......_ . _ listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor.or partner- These sub-contractors have . ship and have no employees 8. ❑ Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition No workers' comp. insurance comp. insurance.1 5. ❑ We.are a corporation and its 10.❑ Electrical repairs or additions required.] 3�I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workcrs compensation policy information. t Homeowners who submit this affidavit indicating they arc 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 cntitics have employees. 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 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 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 and penalties of perjury that the information provided above:trite and correct. signature: Date: Phone#: Ct (1 16 k ke V 6 Z` 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 d.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: information and bstructzofs Massachusetts General Laws chapter's 2 req ires'alle mpl peers toinrihei-w'oekof anoth P Lmderoany contrac oplhire, Pursuant (o this statute, an ea1ploJ e express or implied, oral or written." gal eDtItY, or any An employer is defined as "an individual, parinershiP' association, legal represent lives of aon or other edeceased employer, ooLheore of the foregoing engaged.in a Joint enteipnse, and including g 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 main tenance,•constniction or repair work on such dwelling house or on the grounds of b61lding 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 ice t ingenc agency the commonwealth the issuance any r renewal of a license or permit to operate a business or to cobuildings eptable evidence of compliance with the insurance coverage required." applicant who has not produced acc 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 ins�vance apter have been presented to the contracting authority." requirements of this ch Applicants Please.fill out.the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone numbcr(h) log with with DOemployees other than the of in Limited Liability Companies (LLC)or Limited Liability Partne s p ( ) 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 submitted ub itt d t.o the the affidavit nt of ndustvitlShould Accidents for confirmation of insurance coverage. Also be sure to g m ffid r [own that-the application for the permit or license is.being requested,not the Department of be returned to the city o Industrial Accidents. Should you have any questions regarding the law or if you are requ ire d to obtain a workers'ill the Department at the number listed beloyr._Self-insured companies should en compens ter their at on policy,please call 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. icense number which will be used as a.reference number, In addition, an applicant Please be sure to fill in the.permiUl that must submit multiple permit/license applications in any given year, need only st�bmil one affidavit indicating current or policy information (if necessary)and under"Job Site Address" the applicant should write"all locations in town),""A copy of the affidavit that has been officially stamped or mar e marked by the city or town may be provided to the, as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each applicant year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e, a dog license or perm kit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations woulfilike to rlFia-n—k-yo-u-in-ad-ya-nce-T-o-T--),ou--T--co.pera.6-on 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 # 617-727-4900 ext 406 or l-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.inass.gov/dia. i - Town of Barnstable OtIRE ti� o Regulatory Services srAB Thomas F. Geiler,Director MA-9& tbs¢ Building Division lf0 µA't ' Tom Perry,Building Commissioner 200 Main.Sireet,_Hyannis,MA_02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: lq � Ib JOB LOCATION: Z-1�L q JC IJ� V" '✓ 02, 6 616 number I,� street village •'HOMEOWNER': d-omka. Y u(n'c gMe name L home phone# work phone# CURRENT"MAILING ADDRESS: J Mvk� 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 be/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. �.61n/VL�iI, Signatiirc 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 homeovYmcr engages a pa sons)for hire to do such work,that such Homcowna shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(set 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 responnbilities,many communities require,as part of the permit application., that the homeowner certify that helshe understands the responnbilities 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 forrn/certification for use in your community. Q:forms:homccxcmpt j zTti Town of Barnstable ' Regulatory Services ♦ aM t.e AS& ♦ Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property OwrierMust .� Complete and Sign This Sectio If Using A Bu°ilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorize y this building permit application for: dress of Job) Signature of Owner Date Print Name If Propea Owner is applying for permit please e Homeowners License Exemption Form o e reverse side. Q:FORMS:OWNERPERMISSION at� 5.' sH � �F�� �. is �`^. •..x t `• = 7 F _ ! � N � R4,r s 1 • 1.. ! �S T � , i! .� � tt F,y 1 h � ��2QSS t.e.4 g• .Cs�j Syr y r.• Iz.. 1 :adz 'i R.r �`� ' �.`KF'err•„ate •' �o'.� c. � �`� w �•s � '• µ. � �' •. yam.. � .a� ,E � �' '� _ "� �� � �'! Ai' �3tq r•. � �j�rA.aw' ,,}� gy,, � • f•t. £. y�+ k � a' ram ' •,.r, ' Sol Am r /, �ti '� f E ��s ¢ � rr 0.i� j�1ks�s,.���'�`y � ,�a •. �e�.. • . C'rC+�;S^,,p e.'f 5,�.3•�t ��tt �� h S/`i. � �i �• t' 3 s. c= S ;ar C l� s Kt: � $.� � � �ftW� r. S' �` •t •t - 'S t s + W y b t j 't i i u. R c'f Sscy c •s t Y c �`'ds S F ,� F_N ` _ar.'z3wictt�.(iL�.e Qd� .. Rill� r � ! r r f tro a �-•.,,_' '��"} �� r"s�1•�y.~ ?t , r :• - t t by ?' ��, t T�.,i� ! � � ti •rrr M�•� �r,�'`• 9i. '�yt,� � � ''-�. y fkf wz .0 �,:sirt:p at• +� x F s � i lz L y '..iA kr... y ; �*�MYRr.JCLc �.r ' • � .. •.. f Ki y�,v^.+r''•,. .;,. LLk�k � �'�t 1" y � •''Y ti A t 'Cr-� i* `�':a���'`F•',,.'��H� '��{ p� ,u Y~< y 1 w j r 5 � .'�' �+� ` + .,tr•• ;��5 •. t-'; r.-,cuL�.. ( `. i, �f h »�yt s-!3 f*j �, � � a t .i-t s •{'* '�c., ` R� •'�-�� r `rat- •r r .fi s • t t 4 R •w ).• , S f 'f? ->"o' 0'it ,t`',.."" r ,yts:s,+�j , st C .mo � ; t < . 4 r ! , Ar b Sr r.• s ������ �S,] -° t•�.Ni rr r•• - t L� :L4 ! .. 5 t: /r/�� li: �`r yi"� T LZ •,�- h r ! _� -�,h !. w`�t7 ,�at f ✓!° C } F-x^t+rr«,•1 ;' �. - �!` \T .r'° ,fit - � ' �'-• ,-. d �_ 7t p ."I d + E r.- €' Aii + r.: r x,C '°x �.X•`"l.� �• Pi'�A` r�: .+�yrW�.! •. �'�, �n f a Y � i SJ 1'y! t,�s..} crr�,-�'Ft � �• �K�� �� is �P• ,;,"7' � •, 'i! d ' � ��/' , ( w.w{ f• i ..,,.�5 -r +l s' � � •ITT ,Jt�,.F r�hr. ��� � °Y. '+; �r r ,r a y , , ;; r .,•�� �R'�� '`2: .;D .,} �,�"; .L t 7M.-' - y�`• �'y. i 4 S:, . �,` �•, s5 r' +�.. �� � _! t</,k�T.1,, ,��C a r r � t 1 � . •r,r+ R C �1'•' '' s "�]r.., a �..YG rtr. �. �Z^"�9'kk••.� •.Mary •�• }� � ''•I t s..i�rt= ,.� .?h. �„ sit��5�,: "' I ;r"��'S•w���. " m'. low * e !a Otis Hall, West Barnstable' Alass. J/ i a , _ J S h'��f'�`3 3 c ,• V �r 4„ r�aa '` � t •v Twe>•.1�.#'r*� ce�+rY G';� �}.,r. 3, � � d f wxt`av .k4f"'^ ry 3..�s�� '.•�ty.�a ...f `.d f a p .li F [ t= •.o,a-. .nl.r^ 9.: `/ `,?r'. ;:a -:c;'�. .FYr:�- '�/;:"�':;=>�'f'+:?.='{ /S't s � .��... 3'1 � ;/i�4M1 1:"',.� 7�{� '�1'� s F_.; �j S�< -c':•r.:�;W ..:...y_5:7, x J .f �.j � ..y5 s��d;-Y;;r e'F�' ,.[. :.....,)e ,.=a s d� 'y:¥r V a 54<�a::�:J:i.�,, i" F ^t f�_.:•i:'1' l�f }; + r, ,r 13 _ �.$�r`pt f. ytvr: •;i'-'•;�'..'�,i rd�s sI yr 4:lf e'u �/ C.a- :' a'�'ase�, d hr'�':4+r �. 4 �,t k9�V 4,ref}5. X r a -�y. i ! � sY.:' tr+ yr.✓_:'-^tr � .<..1e;.;.,��"� si' x� 9� ,:w<"�'n,sf,t�` �i'i,..,_.�+.F :fit tie', r z?f y.r �g�En c,t2 �7, :g1 >'t.;r,�.y� ,.73 ,` .t� ,P.�,:, ? !,,,�,'�,'T..•tsr•, .i-5y .rr's.,, !1 ;? q yor.... f° :7—.=':..J,, _ bE,.1^pF�c3�i+r.�? _�x- dn��`r...y y .x�' ,n fi ..a :t+.._ ay -..*>.� t at,- :•.' $'l` r r• .e •J��. f :�' •U.., ti• M•F r d.;�e�. +r -n$ r •a..� d ®R, � kq aas.3 s..,,n :� e,� : 1 +e ,�rvz•) d ��' ': 1'E+7 .$rt. 3• 1s't'.,�,:jt.t�'+ �-�� F 1:fe,. .V"ss .!''ffiViY.�Y�'tp..iik �:el.K.. Q'�.�t ?��y�'{�.ul��. .yt fF M AS?.5 .r:'nT�a F^a� ���•' �A`dY �t'�g f yrf�AkAK+`2!�,y�,+��•:?" .. , I ..ss �,� •-s F :4A'� �as�t r•Y�` ;,,�;,. �f`v �i �.t •„•. �'�:�,t:� ��•�°�rij ' +;:?�eya:2:t. 7rii� �i��, ...'�;iyj.� c..�ptk ..g �,�`s -�.�: fF.�ii�`j�'S t6ficE.'r 7'`�4�e r.�i y:�X'e_�-�17� s a ���y L`,.�i 'L� ;A b a.�;�' _.!Y.fx•..g': k�-- :r• ncd..� S ,;s s�h4�. a[ <"T.'a::�,m t,;s.l.F'1'°.,•pn. 2� tn_--f >+�,��se:+.a ,�s vx�s�'�k 5� �-�a�.;�c5� mas, ,�]yaf.�: r.,t .'2 a -<.:�„ •� a+x r f�,� .;r���'�-��' aZZt� ,, �,��'�:, �,.,,�.�'` �':a,'�f'.� .,F7;r..�.-,�yc�d'F;y�`���&�;` r) .,s!;-e5,�..�,'�t¢!!F�.��..,.����rs-_s,��e�tt;n.,sutiw:�Ft=: �;k rsr iae{` �r�t�ar�F 35 k.4 r��a r`,:> ,mar � ;,r&�ft^%�rzai•,>!.,t._ , -�1a::-,.��ita._`e.'",-'� ' ['s<„aaa_,.��S�s�l:'y...,..rw;1Y:'#"n.��rGi w•,,,w y-r.,n�'�;.���,��."S �:'w. �Y-.�. ''`�.,��" � :�•g��;�7 �'.of5'.v^t%-ry^' ,a,�'�s•yy l0gr•; .� �a'rS"'� — ,.�xt S: t, �-rz"x1�.:. '%:.n`:''p'F a?,3! `�f�)��, x3x•s h,.f� 3N'�.�L /':y< � ° �xi!�.Fj�4 'aY'".y,�u�x�$y r�.�Qn a.0 d i�f 5 � � Y^¢ht���•...,+.: il•±''��S.d'3�9};i� a. ���!''-�3�).'� `:_'�';�':v sr�.,�3:,» ' r x'7 t'�'�'�,::•:a='r"'•';:"r$...r'�.t*; ,�•� —r. �'Y�. '4.,r.t���.Y. .� '�� .''> _ ':>�'� -,:ee.,.k:.�, �iT.r�,a_�,`�. .. � .,�'•"F .. ... �i_„Fafz.. ...,,G�. Y � PLAN VIEW EXISTING BUILDING ENTRANCE DOUBLE DOORS PLATFORM 42 X 72 t TREAD 11=1/4" TYP. t FRONT VIEW ....._..... RISER 8" TYP. SIDE VIEW f , FRONT VIEW ff"So a,m no,MM, a win a MAN u; ' ......._. _ t ' > wmml e MOM 2a d y FJ FF-1 F ___ ❑ ❑ y SIDE VIEW 77, ........... ......... ------ I I I f �S 1" O sp ITT ---------------------- LEE I e D g ;p i N dp � 0 i 1 i -oo- Im OO1 � II Z i k Z i r i gyg, I� O f i I cd N U3 �@ i 2429 MEET GNOUSE WAY FINE LINE ARGHlTECTURAL DESI4GN = ` / m WEST BARNSTABLE, MA ` 8 WEST BAY ROAD OSTERMLLE, MA 02655 o PLAN PHONE: 508-420-1296 i 1 --- ------------------------- ---------- --- -- ' F m , / I / I �03 ; b I pyp ; e i I i i I o ' I ' , i � LI II11II iiii I J 2429 MEETINGHOUSE WAY FINE LINE ARGHITEGTURAL DESIG�T , m 8 WEST BAY ROAD OSTERVILLE, MA 02655 o£ PLAN PHONE: 508-420-129ro WEST BARNSTABLE, MA i 42'-0 V2• u�-�• - 17'-31/22 T_g• b � x f L T = 0 � � Y b t m d. d 10'-0• 13'-0 1/2• 101-d 3'-0 1/2• O O PROJECT, m ' 2429 PROJECT, WAY FINE LINE ARCHITECTURAL DESIGN m WEST BARNSTABLE, MA 8 WEST BAY ROAD 05TERVILLE, MA 020-55 Fig 0 EXISTING PLAN PHONE: 508-420-1296 y�Op THETpti` Barnstable Old Kings Highway Historic District Committee eARNSTABIE 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 • y WA.S a �p 16)9. �0m rE0 MPi APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans,drawings, or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition ' 'M Alteration 2. Type of Building: House ❑ Garage/bam ❑ Shed ❑ Commercial ❑ Other I Exterior Painting, roof new roof N color/material change, of trim, siding, window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ Other 6. Pool ❑ swimming ❑ Other man-made pool 1"1 t` I vIZ0t U Address of proposed work: House# T 2_q Type or Print��L��egibly": Date: y � p p j f �D . Street: M e&ng V A-LV. � I Village�, &N-VI S' UULAssessors Map Lot# 1vJ e) 5 Description of Proposed Work: Give particulars of work to be done: Agent or Contractor(print): 6&X.,�/ F �� Telephone#: Address: Contractor/Agent' signature: NOTE All applicallps must be signed by the current owner Owner(print): Ol 00 G Telephone#: G� �3 Z Owners mailing address: ��2 Cj fi'' ` Owner's signature: For committee use only. This Certificate is hereby APPROVED/DENIED t` Date Member i natures i MAY 2 0JJ A'n condi s of ap o 1 r_ JUN o Town of Barnstable Old King's Highway Commmee 1 i Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18" exposed) (material -brick/cement, other) Siding Type material: Color: Chimney Material: Color: Roof Material: (make & style) CZrt`c y1n Tce-A - Color: - L') LVJ4 . pp U Trim material w o O A Color: Vl Roof Pitch: (7/12 minimum) Window: (make/model) material color Size(s): Door style and make: material Color: Garage Door, Style Size. Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: material Vy 0 o Size Color: Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color: Fence Type (max 6' ) Style , material: Color: Retaining wall: Material: Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufactur-ers-br:ochure_of style of windows, doors, garage door, fences lam p posts etc APPROVE® ADDITIONAL INFORMATION: •::`< -- -::- Ili.Li Old•Kinn's Hinhu — Committee Signed: (plan preparer) print name tel.no. Location of application: Street no. Street Village 2 4, I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i . . Map \ Z Parcel° 20 '.Application #70 Health Division � � ` Date Issued Conservation Division_��� :Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis 19. Project Street Address Village Owner U�t Address S 0,y►_� Telephone "I 1 Ql g Z Permit Request ,be c V X Z ezw UJI-e— J�_�ItV94�L h-d0W.S - 00 ors . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new . Zoning District //��Flood Plain Groundwater Overlay Project ValuationJqq 01-nstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 1 1 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 7i new Half: existing new Number of Bedrooms: I 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: _listing 0 newer size_ t Attached garage: 0 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -t= , r Commercial ❑Yes Nq No If yes, site plan review # 0 'n Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) D ) Nam(' V VNck V"L VL�s�t/�/' Telephone Number Address 7-4 2,01 e Yv icense # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V LoVS ._. SIGNATURE DATE FOR OFFICIAL USE ONLY k__'�NPLICATION# DATE ISSUED 's MAP/PARCEL NO. z ' 5 ADDRESS VILLAGE � OWNER DATE OF INSPECTION: FOUNDATION: aq3 i� — FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL— . � GAS:- -_ROUGH FINAL 5 4 DATE CLOSED OUT ASSOCIATION PLAN NO.-' 7 t r Town of Barnstable Regulatory smdces "X IRfl37ABr r- Thomas - Geiler, Director Building Division Thomas ferry, CBO,Building Coxumissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnsta ble.rna.u.9 Fax: 508-790-6230 'Office( 508-862-4038 AriTRF,-V-MW o 00�o�C tl�S� Map/Parcel: Project Address o?T�`� tit/SIG Builder: The following items were noted on reviewing: ,4� osr f�oG?s fiL .. e ed b Reyi wv Y Date: �� 02 The Corrtmonwedlllt of JdSSdchllSeltS Departmenj of lndustridl,4ccidentg Office of Ircues6ga2ions 60D Wa-�hrneon Street Boszon, AL4 D2I11 • 'r www.tndss.gov/did Workers' Compensation YngaranCe Affida�,it: Builders/Cobtractorg/Ele iciz lease F9 . deber bl P Applicant Information X3D1e (BusinosslOrganizationlLodivi Ot OK dual): � . -------------------- Adaress: (� © / City/s tate/Ztp W � I%Lt{r!�S � 1'�'lX-- Phone.#: �l. �� D- � � 10 6 ZI Arc you an employer? Check the appropriate box; Type oEproject(required): 1.❑ I am a employer with 4. ❑ 1�am a gcacral contractor and I 6 ❑Now construction * havc hired the sub-contractors Rt cmployccs (full and/or part-fimc). -cling IistLd on the attached shcct ❑ 2.❑ I am a'solc proprietor or partner- Tbcsc sub-contractors'havc g, ❑ Dcnnolition ship and ba.vc no cmployccs worIing for me in any capacity. cmployccs and havc workccs' 9 ❑ ddition Building a comp. insuraucc.t [No workers' comp. insurance ME]•Elcctrieal repairs or aM . required..] S. ❑ We are a corporation and its 3, I q a homeowner doing all work officers ha-vc exercised their 1I-❑Plumbing repairs or add: scLf [No workers' comp. rigbt of exemption per MGL 12_❑ Roofrcpairs c, 152, §1(4), and we bavc no I3.[� O thcr . incnrancc rcgiiiscd_]t cmpIoyccs. [No workers' comp, insurance required-] tl,:oy applicant thzt clicchc'box ff)must also fill out the meson below rhowing their workers' eompau-4on policy infu i?iabon. t Homeown&rt who rubrnil this uI6davit indicting tbry arc doing all work and thin hire outside conb-aL or5 must submit a new;'LT o t indicting Net tiLontraetors ihzt cheek this box must atb zbcd as additional ncctt rhowing the name of the sub-conh�ctars and stoic wbether m not those enh6cs h¢ve cmployccs. if the sub-confractnrr havc employed,they court prwidb their workers'comp. policy rumba. lam an employer Oirrl is provWng workers' compensalinn insurance for my employees. Below Is the paLiry and job sit ' inforrnatiort. ' lasuramcc CompanyNamc: . Expiation Date: Policy# or Sclf ins. Lic. M Job Sitc Address: City/StatclZip; Attach a copy of the workers' compensation policy der-laration.page (sbowing tbepoticy number and expiration da Failure to sacure rovcrago as roquired under Section 25A of MGL c. 152 can Icad to'thc imposition of criminal penalties t Eno up to 3I,500.00 and/or ono-ycar imprisonrncnt, as wcu as civil pcnalti'cs in the form of a STOP WORK ORDER and of up to S250.00 a day against the violator. Be adYiscd that a eopyof this stat-mci t may bo forwarded to the DE5cc of Investigations of the ID LA for insZrrdncc mvora c veri�eatiorL ue and correc> I'do hereby ce fy under thepains•and penalties ofperjury eAof the irrformadon provided ave is Date; Q Pbonc # 6t � � 6 YJ 7A Official usE only. Do not write in this area, to be cotnpleled by 6.1y or town official City or Town: 4 Issuing Autbority (circle one); X. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other . Formation alad histructions A ' l efts Gcncral Laws chaptcr 152 requires all employers to provide wockocfs' om p natLD Go Via` l Yccs;' Massachus crson in the scrn Pursuant to this statute, an employee is defined as "...every p express or implied, oral or writtcn- co oration or other legal entity, or any two or mote arbncrsbi association rp or file Aa erPtOyer iy dc6ncd as "an individual p p' the lc al rc rescntativcs of a dcccascd employer, of the foregoing engaged in a joint cntLrprisc, a.nd including g P c to ccs. Howcvcr the receiver or trustno.of an individual, partnership, association or other legal entity, employing rap Y owner of a dwcllirrg'bousc having not more than three apartments and wbo resides therein, or the occupant of the dwelling house of anotbcr who employs persons to do rnainicnanc`of s h ccm lony cnt be deemcd to b den cmpgo o 'c or on the grounds or building appurtenant thcrcto shall not bccaisc P uaacr cha ter 152, §25C(6) als,�statrs that "eYery sLate or-local licensing agcnsyn hae coznmonrPealth)Tithhold the sfor any r MGL p. renewal of a license or permit to operate a business or to construct building applicant fYho 4M not produced•acceptable eYidence of coo nw t�hn r ny,fits po ti alggad visiow shall Additionally, MGL ohaptcr 152, §25C(7)elates 'llrcithcr the c enter•into any contract for,ncc performance of public work until aceoptablc evidence of eo�plienee g2th ° urarscc rcquircmcnts of this chaptcr havo bccn prescatcd to the contracting authority. Applicants• cEag the boxes that apply to your situation and, if . Plcaso fill oitt the workers' eompcnsatio(B�dd.rress(c) and phon nnmbcr(s) along with Li.r ecrtific�c(s) of noccssary, supply sub-contractor js)name s insurance, Lja—itrd Liability Cozopanics.(LLC) or Limitod Liability Partnerships (LLP)with no employees other than the rnombcrs orpsxtOers, arc aotrcquircdto carry workca�� l� y bn uubb�mi.ttcd t thancc- If hoD Pa-r�n°f Industrw should employees, a policy is requ%red B c advised that this Accidents for confirmation of insuranec coverage. Also be sure to sign and date.�eucsltrd, u6t the D�artmcnof bo rotumod to the city or town that the application for.the permit or hccns is ou arc rq od to obtain a workers' lnd�str:ial Accidents. Should you have any questions regarding the law or if y �I"'r co ensationpoXiey,pl c c�ib0 T)cp�ent a.tthe )aw-4brr listed below. Sclf-insured compomies should,cntcr their self-insuraGo license number ontho a ropnatc line. n City or Towle Officials Please bo sure that the at5daYit is'eon-jplctc and printed legibly. The Department has pro udrd aiding thcaPPli'ant of tho affidavit for you to fill out in the event the Office Of Investigations has r- contact y g an a Ecant Pleaso bo sure to fill in the permit/lieensc number which will be used as a refe ally s number. In addrlit i in current tbat must submitrrnrltiplc permrt/llccnsc applications in any given year,need. only submit onG affidavit indicating Da P. olic'y information(if pcccssary) and under"Job Silo Address" Lho appl cdabt sthhoc d wrztoom 1Y b provided' or town)."A cbpy of the affida nt that has bccn officially stamped of mark) musap lie-ant as proof th8t a valid affidavit is on file fD' future P° t n t r latcdAo any incss or cot min al Yc P a liccns c or c`DW year.�Whero a home owner or citizen is obtaining P. (Lc. a dog license orpermrt to burn leaves etc.) said persop is NOT rcquircd to complcto this affidavit Th0 Office of Investiga-dons would L7ce to thank you in advance for your cooperation a.nd should you heYc any Questions, _ plcaso do Dot hesitato to give us a call The Dcpa mcnt's addscss, t0cphonc-and fax number. The COrl1Il7l)r WCa).th of Massachusetts tmW of Jad-us z O A mdQJats Office Of Tj;lvest-igatjans . 600 Washington StMet Boston, MA 02111 TGI; # 617-727-4900 ext406 pr 1-877-zvIASSAFE Fax# 617-727-7749 Revised 11-22-06 Www.ma-5.3-goV/di8 A., Town of Banastable y�v of1HE r ye Regulatory Services 1 Thomas F. Geiler, Director B J RNSVJ3LZ, . MAs� Building Division ser9• �� A Tom Perry,13uilding ComrrT ssioner.. 200 Main Street, Hyannis, MA 02601 n,w.SY.town.barListable.m'a.us Fax; 508-790-6230' Officc: 508-862-4038 --- _ f30h4EOWNER LICENSE ExEh4PTJON Please Prin( • 1 ✓K S DATE:. " �O � � Wo- J0J3 LOCAT)ON: 1+2- •`/ Pillage s!reef number Cam& mtlh ql� • 8 tb (082�. "HDMBO"Sp,": home phone work phone# N name CURRE14T MAJL[NO ADDRESS: . stale zip code city/town The cutTent exemption for,"homeowners was extended to includeot }oss cense}�roYided that the owner acts and to allow homeowners to engage an individual for hire who does n p suver6sor. DEFINITION OF HOhiEOY,'NER Person s) who owns a parcel of land on'Which he/she resides or ace d soo reside,touch us hich and/o ere is, farm t uciures,dA to' be, a one or two-fannily dwelling, attached or detached structures rY person who constructs more than one home in a two yaaf p1�eLrta d ehtab)c to the Bll not bo uilding Official, that he.//ssbo shall be "homeowner"shall submit.to the Building Official on. P responsible-for all such work crformcd under the buildin crmif. (Section 109,1.1) onsibility for compliance with the State Building Code and other The undersigned "homeowner" LLssumcs zcsp applicable codes, bylaws, rules-and regulations, in Th•e undersigned "homeowner"certifies that he/she un fat he/s �hc �Town pj Ilmth saaid proccdurges�and ncnt rrii imuLn inspection procedures and requirements and requirements. Y_ signature of Homcowner Approval orBuilding Official . e Note: Threc-family dwellings containing 35 000 cubic feet or )arger will be required.to comply with th State Building Code Section 127.0 Constry on Control. HOMEOWNER'S ExE,lKFTJON The Code state that "Any homeowner performing work for which a building permit is required ah cla�c crson(st)for hi from re ordo'su hs of this secdon(Section Io9•l,l -Licensing of construction Supervisors);provided Thal jf the homeownu cog g P work, thal such Nomco)vncr shall Act as s,UPc^''sor." the Many homeowners who use this axe SV1O sorry See LioawiLre n 2t Itire5)yThis la k of ire �wsrenesooften7re'sultsf in s�'ousspr(bl msscc PpArl�culix �ly Ru)cs &'Rcgu)a•tions for Liccnring Construction p cryiwhen the homcowncrhires unlieenied persons.. in this exsc,our Board cannot proceed against the unlieensd person as it would N�Lh s license• Supervisor. The hdmcovmcr acting as Supervisor is ultimatc)yresponsible. To ensure that the homeowner is f ully aware Lhc reosp is/hcr T ss ofsi Su1perri or.y0n the)as,lUpage of this aisssue is a pari of tform he cRen Y us d by Lha.t the homeowner certify that he/she and - rti�e+lion for use in your community. oFr"rr�s 'own. of Barnstable Regulatory Services' M BA"STADLH, Thomas F. Geiler, Director y MAq& `619, - $gilding Division Tom Perry,- Building Commissioner 200 Main Street, Hyannis, MA 0260) www.toiwn.barnstable.me.us Office: S68-862-4038- Fax: 508-790-1 Property QW Co,Ihple e at.ald.,S... g.p TES section if Using .A. B, udder. r , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit applicatiotl for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete, the HomeoWamers License Exemption l DMi on th'e -reverse side, Epp THE Tp�y Barnstable Old Kiln g s-ffi h wway Historic District Committee ,�AB,� ; 200 Main Street, Hyannis, MA 02601;TEL: 508-862-4787 Fax 508-862-4784 R&M o {,p 039. `gym 'Eam APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: El New El Addition' L�Alteration 2. Type of Building: House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Si n : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ Other 6. Pool ❑ swimming ❑ Other man-made pool Type or Print e ibl - Date- ( � Address f proposed work: House# Street: E H, Assessors Map Lot# S Descr' ion of Propo d Work: Give p rticulars of work to be done: o 4 OYtt � Ulu Agent or Contractor(print): Telephone#: Address: Contractor/Agent' signature: NOTE All applic ' ns ust be si ned by the current owner �' ] Owner(print): Telephone#: I Owners mailing address: ,Q,� VA Owner's signature: For committee use only. This Certificate is hereby. ROVED/DENIED J;L� Members signatur pc� c� c� a � � AUG 31 201 00 Any c ndition appro TOWN OF BARNSTA LE HISTORIC PRESERVATION SEP 2 2 2010 Town of bat n„<,,. 1 Q:I GMD-Groups101d Kings HighwnylOKH New ApplOKH Cerl Appropriateness 07.doc Old King'c Highway Committee Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18"exposed) (material -brick/cement, other) Fn) Siding Type material: Colo �10 Chimney Material: Color: rm TOWN OF B. Roof Material: (make &style) RIC PRESERVATION Trim material Color: Roof Pitch: (7/12 minimum) Window: (make/model) material color Size(s): Door style and make: �-���1�'WV 1. C�GV�� 'O�ma�eriai� Color: Garage Door, Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: _ Collor: rW, C Decks: material t,� Color: �} Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color:. VV Fence Type(max 6' ) Style . material: R�Color Retaining wall: Material: SEp �'�'JA of gacnst�ale Lighting, freestanding on building I nqs illuminating sign Please provide samples of paint colors and manufacturers brochure of style of windows,doors, garage door, fences, lamp posts etc ADDITIONAL O TION: C"a - SiVL j (pler) print namete Location of application: Street no. Street Village 2 Q:I GMD-GroupsDid Kings Highway10KH New AppIOKH Cert Appropriateness 07.doc ao❑ X N D m Z oz oo®®® rn r rn p O� PROJECT, m _ m 2429 MEETJNGNOUSE WAY FINE LINE ARCHITECTURAL DESIGN j WEST BARN5TABLE, MA 8 WEST BAY ROAD OSTERVILLE, MA 02655 ELEVATION PHONE: 508-420-1296 I z-0 4'-a 24'-a G m s • n � g t sp 1 to f r r j { � t i ® LLD D m _ _ b � � Z t I I 0000 r t b ti , HHH ' a � b $- E 2429 MEEPROJECT- TJNCNOUSE WAY WEST BARNSTABLE, MA FINE LINE ARCHITECTURAL DESK N m 8 WE5T BAY ROAD 05TERVILLE, MA 02055 PLAN PHONE: 508-420-1296 d , Q ° n � 6 Q 41 9 r m 2429 MEETGNOU5E WAY FINE LINE ARCHITEcTuRAL DESIGN ro WEST BARNSTABLE, MA UJ ' 8 WEST BAY ROAD OSTERVILLE, MA 02655 STRUCTURAL PLAN PHONE:508-420-1296 ' v I El o ' N � Z ■ m nrn 1r Iz O a000a oaoaa N aaoaa O � m a m Ell 70 < PROJECT- D 3f 2429 MEETINGHOUSE WAY FINE LINE ARCHITECTURAL DESIGN m P WEST BARNSTABLE, MA A 1 0 8 WEST BAY ROAD OSTERVILLE, MA 02ro55 ICJ m ELEVATION PHONE: 508-420A200 I i N 74 m LX DIM d � b 0 F d . rn n , I p O PROJECT, mU 2429 MEETINGHOUSE WAY FINE LINE ARCHITECTURAL DESIGN m WEST BARNSTABLE, MA 8 WEST BAY ROAD OSTERVILLE, MA 02655 o ELEVATION PHONE: 508-420-129ro Rig HHH! X_ Lo M J� • m _ a — 0 . rn r- rAH-Ho f n 4 D £ 2429 MEETINGHOUSE WAY FINE LINE ARCHITECTURAL DESIGN m WEST BARNSTABLE, MA 8 WEST BAY ROAD 05TERVILLE, MA 02655 o ELEVATION PHONE: 508-420-1296 °F,NE r°wti Town of B arnstable �:w: . r" . - r Regulatory-Services ,. BARNSTABLE. 9 MASS. 039. Building Division �p1E0 MPS n, 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection. Location to R Permit Number a o I ro p o(1 Owner A 4AJs6-y Builder ::SfiAt1J1:: j One notice to remain on job site,-one notice on file in Building Department. The V111ing items need correcting: : c oCk C o 7" (f&,og �{ t "g! 60 qm AN t/ / EAJ !fi?471005' f'l�I�/LL�/�� W Ve -4D4 f A_ lil SccLQ �syf c.�r • l°U c Ao I d 0-K To L�s c) vg--z—f— t r ' , f Please call: 508-862- for re-inspecti`ori , r �r , Inspected by /1dz--"o'/*` �''�� `;�,f:.;�,. .,�'�'` • Date .� .. r r 33�z- oF�rt�,Oxc Town of Barnstable -*Permit# Expires 6 months from issue dale ' Regulatory.Services Fee vv �$ �e S. ,0$ Thomas F. Geiler,Director pTfa r,�a•t a . Building Division Tom Perry, CBO, Building Commissioner w 200 Main Street,Hyannis, MA 02601 www.to wn"b arnstab 1 e.m a.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL-ONLY y� Not Valid without ped X-Press Imprini Map/parcel Number /�✓ LU Property Address esidential Value of Work �— Minimum fee of for work under$6000.00 Owner's Name& Address ool d'11195Y Telephone hone NumberSw J6/0 '91.2-7 Contractor's Name_z�'_'za _4)- P Home Improvement Contractor License#(if applicable) /)i zlottlb Construction Supervisor's License# (if applicable) C S 0`S7— 67 ❑Workman's Compensation Insurance rod° PERMIT Check e: e� am a sole proprietor JUL _. 2 2010 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance OF BARNSTABLE Insurance Company N ame Workman's Comp.Policy# q) 3 2-Q Copy of Insurance Compliance Certi irate must accompany each permit. 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) e side # of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)# of windows *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 Rome Im rovement Contractors License & Construction Supervisors License is, re u' d. SIGNATURE: QAWPFILES\F0R.MS\building permit forms\EXPRESS.doc '0-..:,.,,a nnnonn R The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 7 600 TYashington Street l Boston MA 02111 yy www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information . Please Print Legibly Name (Business/organizatiorJIndividual): � t--T� JoGtY� Address: City/State/Zip:(/✓' AA Qkt6 Phone #: 36o - 0 5 62 7 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 e - oye6s(full and/br,paft-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 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. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.) t c. 152, §1(4), and we have no employees. [No workers' 13.© her d comp.insurance required.] 'Any applicant that checks box#1 must also rill out the section below showing their workcrs'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. lContraetors 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 Ihesnb-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: /f'LdC 6 �9,92_0 2 L — Policy# or Self-ins.Lic.#:VIV �o D 1 24 S 10 1 ti D l D Expiration Date: Job Site Address: d 2�-t�~ City/State/Zip:( Attach a copy of the orkers' compensation policy declaration page (showing the policy number ad ex ir ion 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. 1 do hereby certify tinder the pains and nalties ofperjury that the information provided above is rue and correct. Signature: Date: �r�- Phone# 'J jU 04;0 Official use only. Do not write in this area, to be completed by city or town official i City or Town; Permit/License# Issuing Authority (circle one): 1. Board or Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone il: r � r information and InstructiOES Massachusetts General Laws chapter 152 requires all employers to'prihe�sery Ice�of another compensation contract pflhire, Pursuant to this statute, an employee is defined as "..,every person express or implied, oral or written:" ty, or any n employer er is defined as "an individual, partnership, association, corpofeseon or other ntalives of aedeccased empl very Or the A p Y Of the foregoing engaged in ajoint entmpnse, and including the lega . p . employees' However the receiver or trustee of an Individual, partnership, more hhanal s6cl-rce apartments or hots and who res des herther legal entity, oein, or the occupant of the lling house Owner of a dwelling house hay g dwelling house of another who employs persons to do mainlecause of sucth employment be�de moed to bea`neemployer," or on the grounds or building appurtenant Iherelo shall not b hol the uance L chapter 152, §25C(6) also slates that "every state °r local trust licensing agency in the l colmmonavealthsror any r MG p g renewal of a license or permit to operate a business or to construct applicant who has not produced acceptable evidence of compliance onvnonwea'th the insurance coy lth nor any of its Political_ragsubdvusioas shall Additionally, MGL chapter 152, §25C(7) states "Neither enter into any contract for the perforri�ance of publicwork untiltiac aptable. Cv�dence of compliance with the rnsLuance requirements of this chapter have been presented to the o Applicants ply 10 Your S' Please fill out th e workers' compensation affidavit completely, by checking the boxes [batL h it certificcate(s)Iof on and, if necessary,supply sub-contractors) name(s), addresses)and phone number(s)along vn with no employers ins urance; Limited Liability Companies (LLC)or Limited Liability Pa Ps(f an)LLC or LLP does havother than the To or partners, are not required to carry workers compensation insurance. of IndLISt Cm a policy is required. Be advised that this affidavi ume to siy be snb nldtdated a he the affPdat niThe affidavil)should Accidents for confirmation of insurance coverage• Also be s g be returned to the city or town that the application for the pennit or licenseor ifei are z9qu red to obtain a Workers' t of Induslnal Accidents. Should you have any questions regarding the law y corn tnial on policy,please call he Department at the number listed below..Self-insured companies should enter their P self-insurance license number on the appropriate line. City or Town Officials applicant. Please be sure that the affidavit is complete and printed legibly. Investigationshe b snto contact yoraed a spa rcgarding the of ot. i of the affidavit for you to fill out in the event the Office In addition, an a lica.n Please be sure to fill in the.pciTnj/license number which wi)1 be need only csubmibone affidavit ndicatP g current that must submit multiple permiUlicense applications in any g Y y _-(city P olicy information (if necessary)aad under"Job Site Address" the marked by shoe caty ortiown maytbe provided of the °r town).''A copy of the affidavit that has been officially stamped out each a licant as proof that a valid affidavit is on file for future Perm] is or licenses. ter laced onany bew usdiness or commerca 1 venture FP year. Where a bome owner or citizen is obtaining a license or perm (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. ueslions, The Office of investigations would like to thank you in advance for your cooperation and should you have any q please do not hesitate to give us a call. The Deparlment's'address, telephone and fax number: The Coinmon,,vealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02 11 1 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE R nx # f 17-727-7749 i pfZHFTo Town of Bar stable Regulatory Services a,txrisT�si.E, Thomas F. Geiler, Director b 9 N Building Division Tom Perry, Building Commissioner 200 Main Street;Hyannis,MA 02601 WWW.town.barns to b l e.ma.u s Fax 508-790-6230 Office: 508-862-4038 Property Owner Must Complete' and Sign This Section if Using ABuilder as Owner of the sub)ect property hereby authorize > �� to act on my behalf, i � -� in all matters relative to work authorized by this building pernmt application for: 2q / "[ moo- ' .(Address o Job) Signature of Owner Date Mh&— P t Name If Property Owner is applying for permit please complete the Homeowners License Exemption Forth on the.reverse side. r Town of Barnstable P Oi TRtE Tpk O ' Regulatory Services Thomas F. Geiler,Director uartsraBLZ j,r�S4 Building Division ' plFD �p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax.- 508-790-6230 Office: 508-862-4038 _ H OMEOWNER L]CENSE EXEMPT]ON Please Print DATE: JOB LOCATION: village number street "HOMEOWNER": ' home phone 4 work phone#1 name 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 indiyidual 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 be/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 be/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. e Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be requued to comply with the State Building Code Section 127.0. Construction Control. HOMEOWNER'S EXEMPT]ON 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]09.1.1 -Licensing of eonswction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeovmers vvbo use this exemption are unaware that they arc azsurrung the responsibilities of a s s (see Appendix Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness oflcn results;in secriouious problems, roblcri�s,•parti.cularly when the homeowner hirrs 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 forrn/certificalion for use in your community. )1 isscichusetts-.Departmed!4WPUbfic Sakm `ii�ar Y 4f;Bt t dirid gu1<<tions:artt�' i Construction Supervisor License License: CS 85267 Restricted to: 00 ; RICHARD D ,SOARES °° 18 SPRUCE ST W BARTNSTABLE, MA 02668 Expiration: 2/22/2011 `�a• i'umruisinner` Tr#: 10727 1 ,,pper� �fze Tpanvnxortuseal�a�✓�aaaac�ivaeCCa • 8L\ Office of Consumer Affairs& usiness Regulation t HOME IMPROVEMENT CONTRACTOR Registration':' egistration N164040 Expiration: _8/14/2011 Tr# 287864 Type: Individual RICHARD SOARES RICHARD SOARES 18 SPRUCE ST W.BARNSTABLEy MA 02668' Undersecretary r I }Ii►SSachus�tts-Dtpartrt��r�tot Putil c-SAN Construction°Supervisor License License: CS 85267 ° Restricted to: 00 I RICHARD D SOARES 18 SPRUCE ST W BARTNSTABLE, MA 02668 Expiration: 2/22/2011 �. �'onuni�si�roer` , Tr#: 10727 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ,. 10 Park Plaza-Suite 5170 i 9 ' Boston,MA 02116 � r i, Not valid without signature t �1 r i TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map I � 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 PrrojecfStreet Address nA Village �-Qwn A aFer s-2-- Telephone! �PermitTRegi,��s't (/Y1 G�� �N su,L�4 Y�oil Square feet: 1 st floor: existing . proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay �ProjectValuation GV 4�;�"'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 RoomiCount :M CD 0 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: Ye§r-O No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ exi)ting ❑ w 711 e_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) `�cNarne y K'LO- my �Tele hone Number ` Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ---- t ` 1 ' '� 'DATE- f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP II PARCEL NO. _ ADDRESS s ` � � ° g VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT `} `� ASSOCIATION,PLAN NO '' ,.� The Commonwealth of Massach usetts Department of Industrial Accidents Office of Investigations Y 600 Washington Street t Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ''^^ //`` '^^ 1 '/1 Please Print Legibly CName'(Business/Org�aniization/Individual): e oil "l/� V Y , V Y ` Address:. �`! Z e, ` City/State/Zip: W Phone M 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 * have hired the sub-contractors . . 6 ❑New construction employees (full and/or part-time). - ° - listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- 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.# el 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ 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-#] must also fill out the section below showing their workcrs'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 cntities have employees. If the-sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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. 1 do hereby ce fy under the pains and penalties of perjury that the information provided above i true and correct. SiznatTre":`- Date: 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#: information and. 1pstructiOns 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." i 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.representa.hves of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,•or the occupant of the j dwelling house of another who employs persons to do maintenance, constriction 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 slates 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-contractors)name(s), address(es) and phone numbers)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 reformed 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' artment at the number listed below;"Self-insured companies should enter their compensation policy,please call the Dep 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 permMicense number which will be used as a.reference number. In addition, an applicant That must submit multiple permitflicense 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 frllzd out each year. Where a bome 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 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. 4 617-727-4900 ext 406 or 1-87.7-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.inass.gov/dia Town of ]Barnstable ' , Regulatory Services B►xrrstest a Thomas F. Geiler,Director MAM 9�A 1639. `0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 'n Please Print 4'_DATE:=;7_- `' s ]0WU0CATION: �Zh " nu er r^^ str t village HOMEOWNER":= V''y name home phone# work phone# ,GURRENT-MAILING-ADDRES S: 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 buiidinl?permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the St;te 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 require ents. ,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:\WPFILES\FORMS\homeexempt.DOC oFt r Town of Barnstable Regulatory Services " 9=^R'AM. Thomas F. Geiler,Director Eo;o.� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho /md by this building permit application for. (Address of JA) Signature of Owner Date Print Name r If Property Owner is applying for permit please ebm e -th Homeowners License Exemption Form on th�,Veers:ets= de. Q:FORMS:OWNERPERMISSION i oFt t Town of Barnstable 4� Expires 6 m lis from issue date Regulatory Services Fee ,2C� MUMSPABLE. ' v MAss. $ Thomas F. Geiler,Director �A t639. ♦0 rEG MP'I A Building Division Tom Perry,CBO, Building Commissioner V 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 106 oZV Property Address / �f" ) Le - �"ntial Value of Work l a©0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address DIVA ,/gs j y2 �i Contractor's Name Telephone Number� � Home Improvement Contractor License#(if applicable) `7 Vo Construction Supervisor's License#(if applicable) �S Z -7 ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: [ a sole proprietor JUN 0 4 2010 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance �/ AWN OF ggRNSTAg�- Insurance Company Name .�}�� /�t`Lc�t 4z— Workman's Comp.Policy# o 7 0 3 C7 00 3 d Copy of Insurance Compliance Certificate must aeg6mpany each permit. Permit Request(check box) D—Rt-foof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑- Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *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 Contr o s License& ons uction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial-Accidents Office of Investigations 600 Washington Street Boston, NIA 02111 fv1vw.inass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Businesss/Orgaannization/Individiial): 0 errY41 Address:l0 City/State/Zip: /dl Phone#: (,0260 O�� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ 1 am a general contractor and I 6 ❑New construction em ees(full and/or part- have hired the sub-contractors 2. Jam a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have g_ ❑Demolition ship and have no employees e workers'h employees anav • working for me in any capacity, 9. ❑ Building addition [No workers' comp. insurance comp. insurance.# 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 _. . right of exemption per MGL, ^ _ _.,.12.[ eel. airs........... . . insurance required.]t c. 152, §1(4),and we have no employees. [No workers' l3.❑ Other 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 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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job S.ite Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 and penal ' perjury that the information provided above is true and correct Date: l Signature: 00, Phone#:,—rT8 —? 0 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 ' q r� � t Informati®n 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 representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more 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-contractor(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 ^' Y members or artners are not re uired to c workers corn ensation insurance If an LLC of I:T:P 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 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 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 (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. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 4-24-07 www.mass.gov/dia oFIKE)' Town of Barnstable Regulatory Services 1ARNSTABLE. ' Thomas F. Geiler,Director MASS. 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 Us ing A Builder as Owner of the subject property hereby authorize X'a ,,2 to act on my behalf, in all matters relative to work authorized by this building permit application for: a � (Address of Job) rT Cam • c-f- , / c� Signature of Owner Date 0 Vick V►� U 1/1. Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:FOR1v1S:0VMERPERM1SS10N 1 cF-[HE r Town of Barnstable r . o Regulatory Services Thomas F.Creiler,Director BARNSTABU, Mass 1639• ��� Building Division Alffly n Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATI her street village age ImEOVMJER : name home phone#1 work phone#1 CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling f six units or less and to allow homeowners to engage an individual for hire.who does not possess a license,provided th i thrt,owner acts as supervisor. DEFIAIITION 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 intenddd to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such . "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules-and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing.35,000-cubic-feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be'exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)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 srnbui 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 AWPFILES\FORM S\homeexempt.DOC � I 4 N r' ►yllO.SadIU.ctt..-P,, j)al-rn)'sttt� Al� rMi� _} erase: C11 21 — 5 keWicted,t: .t a I ].8 SPRUCE ST 68 _ - �y RlgTgf�41p`-026 ti -' Ex P n 10727 1 �� . 'rf'� •Poo .u,�i� oo��✓llirooua(�uoeda i &•Basaess 1tePalativ� j'. •'' � pfliee,alCwAaQer g'<>: IMPRoVg* TFiAGTQR \ 8 11 Trf 287864 ~ T1 — -� _ WCHAf�D SO RIC,HAF,tp 18 SP.Rt1 ST'; r Uadersecreta -r7 r e ' '. e '� f'j,� �._"_.�'�'•'-T�.,.�r-�^-.�.----:rents:,=.`.. Illf .T 4v ~ { O 02 13 1 ta 101101 - f i AIM Al 51 Now A.t. � «� :,•,,f tr- 4 �� `z ;�",�,•r•[b „.�,/ �y� �� f `.....� yp�- �a.�'.�'4rye�flfiK�. r' ,�T.•r ��», 1 �. �•.T�(�. ' ,yr Ar 7.tAC j*�'r'A" `R�� �':�'vy'��y� •k �� I 1 �'���,��'. '� '(�...w � �' G '�?j�'n�`4•i RJR �r�S��.+'�II�C�L. ..x. a -� TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map Parcel � ;2-6 -Application Health Division Date Issued L4 l- Conservation Division Application Fee =K Tax Collector Permit Fee 0© Treasurer Ok v8 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village W-Qe1-17-- FQ (-nS*(aVAJ6L Owner �I QG�4 C-I Address a,-e, Telephone 1 �}— Permit Request u, Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Q r Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: - f 1 � Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ = _ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION OD =� Name L (iza b 2 r d 1 Paf-l<3 Telephone Number 60 �A% ,;;J Address nse# 61 H me Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE :r _ ! FOR OFFICIAL USE ONLY �'�'PPLICATION# P DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER �. i y r 1 DATE OF INSPECTION: , FOUNDATION FRAME ' INSULATION FIREPLACE k ELECTRICAL: ROUGH ~= FINAL - - r PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL , FINAL BUILDING DATE CLOSED OUT' -�^ ' ASSOCIATION PLAN NO. t, i fj 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston, MA 02111 y�c ►vww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ( n Address: r City/State/Zip: AJaS 130 r.jai+& f Phone.#: � Q k: ' 75t 11 (37 Are you an employer?Check the appropriate bog: Type of project(required): 4. 0 1 am a general contractor and I 1.El I am a employer with 6. ❑New construction 2.jemployees(full and/or part-time).* have hired the sub-contractors I am sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and Have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9 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 I LEI Plumbing repairs or additions myself. (No workers' comp. right of exemption per MGL 12.❑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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. tic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 WA for insurance coverage verification. I do hereby certify u er t pains• nd pe alt' s of erju that the information pro vidid��above is true and correct Signature: Date: J D 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#: Information and. Instructions 4 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 employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more 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-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 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 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 permittlicense 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 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 to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of lndustrial Accidents Office of Investigations ; 600 Washington Street Boston, MA 02111 TO, #617-727-490:0 ext 406 or 1-877-MASSAFE Fax# f 17-727-7744 Revised 1,1-22-06 www.mass.gov/dia I oFt►,Er Town of Barnstable Regulatory Services BARNSTABLE, Thomas F. Geiler,Director y MASS. ' 16yg. ��� Building Division ArFD MA'I a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: .J�.�O O JOB LOCATION: ov"t Gam/ tt L 1,8��'C/ !N VT ?)a 1 yL..5+6/`%L`C� number, C treet village "HOMEOWNER": '7 name home phone# work phone# CURRENT MAILING ADDRESS: ,5 am city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of siz 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. Thetrrrderngned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and uir ents a d that he/she will comply with said procedures and requ' e 01 Sign re o H eowner Approval of Building Official i 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. FIOIMEOWNER'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:forms:homeexempt u , 1 pFI ET Town of Barnstable Regulatory Services a" ' S. Thomas F. Geiler,Director y MASS. �, �A s63q. �� rF16.19. 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 s° I, �I as , '� erof the subjectproperty hereby authorize to act on my behalf, in all�matters relative to work authorized by, ',-b ding permit application for: ( ssofJ ' (Signature o er bate Print Name If Property Owner is applying for pernzit please complete the Homeowners License Exemption Form on the reverse side. Q.FORM&O WNERPERMISSION PROCEDURE * DEMOLITION OF EXISTING STAIRS & LANDING * CONSTRUCTION OF 12' LONG & 3' WIDE ENTRY LANDING WITH 3 STEPS • MATERIALS: ALL WOOD WILL BE PT. EXISTING PT DECKING WILL BE RE-USED WHENEVR POSSIBLE -- •-•--- - * LANDING JOISTS WILL BE 2'X 8' PT PLACED 16' ON CENTER AND INCLUDE HANGERS * STAIR STRINGERS WILL BE PT PLACED 24' ON CENTER * LANDING WILL BE LAG BOLTED TO BUILDING 2' ON CENTER WITH FREEZE BLOCK SPACERS I Page 1 E Cf- Apa a yoot1 +` 0a C .` 1 r o 0 i x i f P. v yo lit t.. La t r i Ni cz I r~ Z � N N /\ Mh1,~ o �!(�� J•� s 0 �.J1 - \ ✓! GTI C� % � lv a V' e� S113S��� - T Iu �' -71 r lZ 1 _o IdedlL �� 113s�a