Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0328 PARKER ROAD
Oxforcr NO. 152113 ORA MME N use. ►sue A I ^ � �k � a k t i t CA i J i _� ��-.. l`Y"'tr,•�-.-�'1r��.�\!`-.iT-••. ,+-.lti _,^..�r. r'"'r-+t.,�r-,'."mow _ —rl. r J.�. _. - /. {y L r�r.___,_�i-. .. ,- r . .. -•. � �,._:�,..�-s;r.�y "�.�_a�—_ ._.. �. .... - _'- -- --'.•s`m..,.,� h -•..dsaa5 dri':WtimvdS��•.,W..�.. -.ate�._.�.... - ..e._,..a..:..�at. ®PRESS PI MAY 14 2015 . a ti I —0 Town of Barn' . *Pernut# 10F BAPS N64.4-Ag` fro��e da a Regulatory Services Fee . EAMMM4 Mma Thomas F Geller,Director 16"3 ' " Building Division Tom Perry,CBO, Building Commissioner _200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /n Not Valid without Red X-Press Imprint Map/parcel Number Property Address 32$ 7GL,,1�-ev- Z� w• urw S '"-'4J� [residential Value of Work Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address 1 e e i— c ik, gag pal (G49 Cj Contractor'sName �� �� Telephone Number 150K -fo 4b Home Improvement Contractor License#(if applicable) 04 S( f Email: 'V� ee"aAk Novo-Cows Construction Supervisor's License#(if applicable) fS?S qb - ❑Workman's Compensation Insurance Chec ne: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Rke6of(hurricane nailed)(not stripping. Going over existing layers of roof) FeMe-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where required: Issuance of this permit does not 6mrnpt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is req Q:IWPFIL.FS\FORMS\buiIding permit forms RFSS.doc R" .� s l the Commmwddth of Massachus&Ys Depanntent�v,f l'irus l Accidents Office o,f1mwstigations ' 6001Ym*ingtonStreet Boston,MA 02111 www.?nass gav1dia Workers'CompensatianIusuranceAffidavzt:Budldens/Conn-actorsMectricianslPlumbers Applicant Infm-mation Please Print Legibly Name tRb✓ �(.cv ISM tv w Address- City/Star-z : cl�l. (K. 5 t_Q-16 L(8 Phone 47 2JO ' Are you an employer?Check the appropriate box: Type of of ect a 4. I sin a contractor and I yip �' 3 � (��d}= . 1-�Fl a employer with ❑ l i5_ ❑New lion oyees(€ullandlorpact�me)_* havehredthesub-conftwiors2_ a sole proprietor arpartner- ship and have no employees These sub-oontractomhave g- ❑Demolition working forme in any capacity. employees and have workers' 9- ❑Building addition (No workers'Comp.insurance comp.M MW2W 1 required-] 5-❑ We area corporatic nand its 10-E]Electrical repairs or additions 3_❑ I am a homeowner doing all work officers h a�-e imweised their 1 to Plumbing repairs or additions myself [No worb='comp. right of ememption per MGL 120 Roof repairs insurance required-]I c-152,§1(4} and we hnne,no employees-[No wodms' 13_[✓]'Other Srk comp-insurance required.] �Auy app�nat rant checks box#1 mmstalso fMaw the sectioabeiowshow*theirvedcea'rnt V-1iaapaNcy Sameaamers trho sabaut ties a$davit is dic4Gug they atE doing aII ADd[sad diva hue aatade coatsctors mast snhari[s aeeP a�datr$u infawndcm- such. ctos that check this bax mast attached as additioxw sheet showing the name of the sab-amff2chon and stde whether tarot thasa ma&Jes hme emp>iyees. Ifthe soh-cont mctm have empicyees,they m,ut pMVide their warkers'comp.poluy atm>ber, -Tam an employer that is providing workers'comperrsrrfian irrruraace for my errtgloyees: Below is the paTicy and job site information. Insurance Company Name: Policy if Cr Self-ins-Lic.# ExpirationDate: Job Site Addttss- ..City,State P: Attach a.copy of the workers'compensation policy declaration page(showing the policy number and ezpir-A%n date). Failure to secure coverage as requireduuder Section 25A o€MGL c. 152 can lead to the imposition oferiminal penalties of a fine up to$1,500.0D and/or one year impris ament as well as civil penalties is the form of a STOP WORX ORIXER and a fine of up to$250-00 a day against the violator- Be advised that a copy of this stet may be forwarded to the Office of Investigations of the DIA for insurance coverage verification- I do here under th 'rs artd penatli'es oj'perjury that the information provided above is tnm and correct i ttit8: Date: Phone#: Offwial use vuly. Do not write in this area,to be corapieted by city or town officiaL City or lown- e Issuing Authority(circle one): L Board of Health 2.Building Department 3.CUpTown Clerk 4.Electrical Inspector 5.Plumbing hapector If Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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-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 lime. 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 obtammg a license or permit not related to any business or commercial ventrae (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 Commartwealth of Massachusetts Department of Industrial Accidents Office of lavesaptions 640 Washington Street Boston,MA G2111 Tel.#617-727-4944 ext 406 or 1-977-MASSAFE Fax#617-727-7749 co oFmET Town of Barnstable Regulatory Services MASS. g; Thomas F. Geiler,Director 9. 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 I, eV4 �� ,as Owner of the subject property hereby,authorize pug t, L At, to act on my behalf, in all matters relative to work authorized by,this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of 04er Signature of Applic erL ay� Z6 A-'J I b Print Name Print Name Tea ' d e F Town of Barnstable Regulatory Services f ASRA7�T�Ri�F._ MABS Thomas F.Geiler,Director 1DrEo 1 ► Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 50 8-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAZING ADDRESS: cityRown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code _ Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community, C:\Users\decoUlc\AppD=V.oral\Mcrosoft\VTmdows\Temporary Internet Files\ContentOudook\QRE6ZUBN\MRESS.doe Revised 053012 I Town of Barnstable *Permit# /3-/ 7- a Regulatory Services Fee 6monthsjrom issue date • anxrrsrnat4 • y3 -3 S MAas, Richard V.Scali,Director i63� ♦0 Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press Imprint �.�(¢ © � � nn Property Address ��►- �U�. T ,,.g ,� esidential Value of Work$ �t °� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 13ab `E' Ve,1( , ��cA. Contractor's Name Pei"a t Y Telephone Number �G 0 a V0-G-O`(a Home Improvement Contractor License#(if applicable) f 14 5-10 � Email: ee, ` u%A0-tjg'^ Construction Supervisor's License#(if applicable) M 7 S`Pb ❑Workman's Compensation Insurance Che one: W I am a sole proprietor ❑ I am the Homeowner AUGO 4 ❑ I have Worker's Compensation Insurance lga 2017 Insurance Company Name TOWN OF BARNS ABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑R -roof(hurricane nailed)(not stripping. Going over existing layers of roof) rg"ke-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require . SIGNATURE: Q:\WPFILESTORMS\building permit forms\E RESS.doe 06/20/16 The Commomveakh qf Maysadrusd& Department&f Iud-kvfria!Acc ids Office 0f b"Vsligafions. 600 Washington Street Boston,CIA 02HI tarvw�.mas��ovfiilia . Workers' CoffipensatioxtL u -anceAffidavit B�miIders/CmtmctomMedHdanslFIU3nbers Applicant Infm m afian Please Print v -Na=(Busmpt, ca Gam; Address: City-/st&tj. plwne-,w- Are you an employer?.Check the appropriate bom Type of project(required): I-❑ I ant a employes with. 4 ❑I am a general confractar and I 6. ogees(finatxdfor part-fiime). * have lured Me sub-contsactoss I ❑Id oaasfroctiori 2. I am a sale proprietor orpartner- listed on the attached sheet ?- deiiug. sip and have no employees . Mese sub-contractors have g- ❑Demolition worldrig for mein employees and havewodms' a��t3`- 9..❑Building adtiitiDfn [NO Worms,ODmp-insi-r a comp- r -I 5. ❑ We are a corporation and its 16-❑Electrical repairs cr addtions 3-❑ I aura homeowner doing all work officers have exercised their 1L❑Plumbingrepairs or adc5fions mysefft-t�t,a work=' p right of emmipfion per MGL 17 ❑Roaztr repairs inJ�rend-I t c.152, §1(4h andwebaveno employees.[No workers' 13_❑Other cam-mstuance mquired.I 'Amy WHczatfttcbedm box 9lmastalmM out*esecionbdow showing tbeawadceeappeesat; aparkyinEmntivan_ I Hameoamem vdw submit ibis afbdaeft imdacat p they axe dais alf wook aid thin him outside camtxac m amct submit a new affidx&iadi—;n sacb ICaretiseton Salt check this boot aezast attached as additiansl sheet sbowing flee—of the snb-coo>tscmxs.and state vrhmhet ar not fbase entities lin e employees.If thews-am d have emgiapee-%theynwstpmvidetheir wudmm'a=p.paliLT aumism I am air Bdoev is tJtr panty curd job rite fncformatiam Insurance Company Name: Policy,4 or Self-ins-Lic-47 lxpiration Date: Job Sate Address_ CitylStafeQ�p: Attach a-copy of the workers°compensation policy declaration page(shoving the policy number and expiration date). Fannie to serum coverage as reguiredunder Section 25A of MM m 152 can lead to the imposition of criminal penalties of a fine up to S 00a 00 andlor orie-y e-a-r iumpdso x ment as well as riidl penalties in tile,form of a STOP WORK ORDER and a$me of upto$250-00 a day against the violator. Be a&ised that a copy ofthis statement maybe forwarded to the Office of Investigations,of the DIA for ms=ce coverage verificat ion- IaFo&¢rmiiy aertify u, nd¢r flits " and pslwhks afpedW7 thatfhe iraformagmprmvriedahmre is trim and correct Date- Phone �C76' - 0 (oCJr/a Of'kiat use only, Do not write in fids area;to be campTeted by tip artetcn afrciaL City or Town: Per aWLicense;9 Isstring Anfiarity(c:,rk orie): I.strand of Health r. g Department 3.m own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othe�err Contact Person: Phom#- 6 •afofmation and Iastruefions Ma carnets CTCb=3i Laws chapter 152 req==all=:,gloycrs'fn prv'vide wa 3o=s Compton far ibefr employees i p �ibis ,an eag�layee is deed mr¢.every person in file sea vice of aaotb er ceder nay ca�rart ofhac, caqnmw or impHeCL oral or wrh=f " An eznpTayEr is defnad as"an indrQidnal,partnership,asso�on.corporation or other legal easy,or any two or male of the foregoing=gaged is a joint CntZprise,and inclndmg the Iegal represetafryes of a deceased empIOyer-or ffie receiver or trasEes of an individual,p�ship,association or otheslegal entity,emplaymg esaployees. However the owner of a.dwelling house having not more than three aparhnents and vvho resides iherem,or the octet of the - dwelling house of an who employs pmsrms to do mai tma =,cansf uc t on or repair work on such dwelling house or on.th grounds or groun orb on m7d"mgapprafeuant$eseto shaIlnotbecanse of such employmea±be deemed to be an employer." MQ,chapter 152,§25C(6)also sfatrs Clad=eve:ry state or local licensing agency shall withhold fhe zsSaance or renewal of a license.or permit to operate a business or to construct buildings k the comrmonwealth for auy applicant Who has not produced acceptable evidence of compliance,with the insurance.covexage,require&- AdcaionaIly.M(H,chapter 152,§25CM s dEz-Neither the r=Tn mweahh nor;�ay of its political subdivisions shall enter inb any contractforthepmDvance ofpubho wmkmzhl acceptable evidence of comphanceTnth$e msmance.. r euiemts of this chapter Dave been presented to the co—tcting auihodty_" Applicants Please fill otzt the wod='compensation affidavit completely,by chmki g the bones!hat apply to Your situation and,if sub-contractors)name(s), addresses)and phone xuanber(s) along with their c�dficafE(s) of necessary,supply s wi$no Io ees other than the insurance. LinnitedLiabiIity Comparaes(LLC)or I,imitedLiab�iip�Partre�hip (IZP). � Y members or p are not required to c:m:r-y workers'compensation insurance. If an LLC or LLP does have employees,apolicyisrequired. BeadvLmd that this a$dayit may besnlmittr-dto the Departmentof Industrial Accidents fur conE mafiM of m nip cove:aage. Also be sure to sign and date the afudavit. The affidavit should be ret=--d to the city or town that the application for the peonit or license is being rmquestA not the Department of l A� ' e� Mouldyou have any questions regarding the law or ifyou are regasedin obtain a wo�ess' compensation policy,please call the Department at fie number listedd be.Iow Self-fimurd eampanies should em`er their self-insarnce license amber on the appropriate line. City or Town Officials Please be sore that the affidavit is comple#s and priufEd.legIly. The Department bas provided a space at the boti= of the affidavit for you in fill out in the event the Office ofInvestigations has to coutact yam regarding the applicant Please be sure to fill in the pen iLWlicease Dumber which will be used as a reference muaber. In-addition,an applicant $at must submit muliiP � e le pit/Iicens applications in any given year,need only submit one affidavit indicating comet policy information Cif necessary)and under`Job Sifn A &m&'th a applicant should wLity--"all locations in _(City or. town)-"A copy of the-affidavit that has been officially stamped or ma lmd by tie city ar to th town maybe provided to e applicant:as-�roofthat a valid affidavit is on file for EAM perm ar licenses A ncw affidavitmust be fIled olt ea h year.Where a home owner or citizen is obtaining a license or permit not rr.Iat n d to any business or commercW ve ±Lle (ie_ a dog license or pence to burn leaves etc.)said person is NOT r�Ed in complete this affidavit u in advance far your cooperation and shoplld you have any questions, The Office of Investigations would Him to thank Yo plmse do not hestafe to give us a call. The Department's ad&ess,telephone and fax number ' tip of ahntfs . Degartbamt cif Ii d i Awid t% Of acs of Invedkktimm �man t Ragbzi.,YA EMI I I Tel..:#617E-727-49W Wt 406 Qr I-&77 MA q9 Fax:9 617-'27 7M Revised 424--07 - ww .ma i�vfdia I • Town of Barnstable Regulatory Services MASS. Richard V.Scab,Director qua Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �lct-V I to act on my behalf, in all matters relative to work authorized by this building permit application for: 32 Y Pa ACV (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S' tar of erf Signature of App I cant k-R,uy bOLy-b Print Name Print Name g + ? J7 Date QTORMS:OWNERPERMISSIONPOOLS • Town of Barnstable Regulatory Services , clFt Richard V.Scali,Director Building Division BARMAINE.E. t Paul Roma,Building Commissioner MAM 639. ��i� 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 LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two'year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Officia'1,that he/she shall be responsible for all such work performed under the buildin&pgrmit. (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 permif 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,Rubes&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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILESTORMS\building permit fonns\EXPRESS.doc 06/20/16 I - Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-057540 Construction Supervisor 1 & 2 `• Family ��, _ t DAVID J GADY 217 A TIMBER LN. MARSTONS MILLS MA 62648 Expiration: commissioner 12/28/20.17 C1�e Woaw»zarecuea/C� aaaac�ccrc%�t 0t7ice`of Consumer Affaies&Business Regulator a License or registration valid for individul use gniy H^° E IMPROVEMENT CONTRACTOR ! �u.e the expiration date. If found return to: — > REgistration,�!'114561 T i' m� ype: OflUe of Consumer Affairs and Business Regulation Expiration, 10/4/20:1;7 DBA 1.0 Park Plaza-Suite 5170 . " "i_•GADY CARPENTRYd ANNE Boston,MA 02116 217Aly Timber Lnw, Mirstoris Mills,MA-02648 Undersecretary —~ Not valid withot signature Town of Barnstable *Permit� � ab a Permtt# Regulatory Services lee - '"`�f issue • snxxsrnsta„ y� nsaea. Richard V.Scali,Director '01i639 � X.©PRESS KRMD Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 2 9 2016 www.town.barnstable.ma.us rl OWN I\� n L Q/, ' Office: 508-862-,4038 IlHV" lJr DI�i §�&630 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ��ID d � Property Address 3 2Y `; ear ZR'66_sidential Value of Work$ Q ei Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name �*_b Wj1_t:. C ti4 dJ Telephone Number A T—OF_2 00- Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#*(if applicable) ❑Workman's Compensation Insurance ChKI be: a sole proprietor the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re- of(hurricane nailed)(not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms XPRESS.doc 06/20/16 " r The Commompeakh gfMassadmset& B'epartrrrett of ludrrsfnd Accidmir Qjrwe of rations. 600 Washhwlort Street Boston,MA 0211I ' �vrvit�r�rass:�ov/ilia . Workers' Can2pensafion Iusmrance Af5davit B:oadersiCun&actursMectr=imrJPhunbers AppHcan#Infkm=t an Please Prints E.e lly Name Address: Are you an employer?.(Meckthe appropriate bow Type of project(required}: I.❑ I am aemployez with 4 ❑I am a general contractor and I 6. ❑Ides boa yees(fiill as for part4me)* have hired the sub-contmctaas 2.P1 am a sale prop:detor orpastuer- listed on the attached sheet ?. ❑Remodeling. ship and have no employees . Mese sub-contractors have l- ❑Demolition wo king forme in any capacity. employees ardhne workers'Comps 9..El Budding addition [No svotimrs' inur ance comp. I m��. required-] 5. ❑ We are a corporation and its 10:❑Electrical repairs or additions 3-❑ I am homeowner doing all work officers have exercised their 1L❑Plumbingrepairs or addrifions rayscif o worlaers' - right of won per MGL epairs , c required-]1 C.152, §1(4�andwe have no L.❑Roafr employees.[No workers' iJ-❑Other cam-insumance,mquireA] *Any sWHczat&st chedsbos in—st R—Im Moutthe sedionbeIoa shotdn thekwodes�compensad upaHcy imff3EmxQmL �6mPOG+IleCS whD Sabmit doer afiidadt iudu g 9Ie tidln�8g WO13C sad d7ea bite duiside rmA.vrenre Est submit a new affidavA indite sorb_ ican=ctm iff=check this bas mast attars, as additional sheet stowing the name of the sub-com=um s and stile whether or not those ent fin b.zm empicyees.IfthesvTataahadashave emplay--%dey—, pmvide-tkeir—dam'-mp.pdhcg mm3ber I am an eztipInpr fiiatis prauidiry itrarkers'compensrdian Below is fize pa cy rind job s&e irtformrdiars Insurance Company Name: dlicy 4t'or Self--iris.Lie.# l pir n Date: Job Site AA&e= CitylSta au* Attach a-copy of the workere compensationpolicy declaration page(shoving the policy number and expiration date). Failure to seem-e coverage as required under Section 25A o€MW—m 152 can lead to the imposition of criminal penalises of a face up to$L,SOa 00 indlor oni-yearimprisosrsneak as well as civil peaahies in the form of a STOP WORK ORDERand a fine of up to$250-00 a dap agaiasf the violator. Be ad-dsed'that a copy of this statement rnay,be forwarded to the Office of Invesdgations ofthe DIA for insmmee coverage verificabnn- I do kerzby cerhft under die pains and psmabies ofper,jrrty natthe info rm a go npm i&d abmv is 6 attd correct Phone Orichal user ant Do tint arrtta in this area to be armpTeted by city crrtorcn ojorciat City or T'uww Permiff tense;ff Issuing An6writy(dude one): L Board of Health 1 I uWng Departm mt 3.CRyfrown Clrrk 4.Electrical Inspector S.Plumbing motor 6.Other Contact Person: Phone#- - - — — 6 formation and Instructions Massachaseds GrberalLaws chapter L52 reqrares all eurplay=to Ike WM'10&cQMPetIun for then'employees. PMVI=ttD this StEtUf5.an Mplay�is&fa ed as"_.evesy person iu the sir vice of another under any cart:act ofhire, CxP=W or ffipliecl,oral or vvriffi=_" An.ernIoya is deftncd as"an indrvidual,parinexsh�,assor cm;corporation or otheg legal eddy,or airy two or more of d=faregoing engaged is ajoint Vie,and inchrdtng the legal representatives of a.deceased employer,or ffie receiver or trustee:of an individual,parU=mhip,assocradioa or other legal entity,employing emPIDYem Howl ver the owner of a.dwelling horse having-not more Chun three apartme:ats and who resides them or the occupant of the - dw ffiag house of another who employs persons to do maitmmm,construction or repair wok an such dwelling House or on the gmmads or bmd"mg appurtenantthereto shallnotbecause ofsoch eunploymeutbe deemedto be an employer_" MCH,chapter 152,§25C(6)also stirs that everysbdo or local licensing agencyshaIlwiff1hold ffie Lssaance or renewal of a h[cense or permit to operates:business or tia mnstrart buildings in the commonwealth for any a-PPlicanfwb o has notproduced acceptable evidence of compliance,wfth the insurance.coverage requited-" Additionally,MGM chapter L52,§25C(7)states¢Neither the nor 91y ofits political subTivisions shall an info any contract for the prance ofpnbho wok•anal acceptable evidence of compliance with the in smM ce.. rec�enfs of this chapter have Been presented to the mot-acting authozity." AppHcants Please fa out the worl='compensation affidavit completely,by g the bores that apply to your situation and,if necessaxy,supply sub-contractor(s)name(s). address(es)andphone nnmber(s) alongwithfheir certiticate(s) of nimzaace. Lmuted Liability Compames(MC)or Limited LiabilityPartnersbips 9J2)Wifhno employees other than the members or partners,are not reqaired to cagy worke&cmapenssafion insmamce- If an LLC oar LLP does have employees,a.Policy is required. Be advisedthattbus affidayitmaybe submitted to the Department of Industrial Accidents fur conEumatim ofinsarance coverage Also be sure to sign and data the af-ckvit. The affidavit should be retuned to the city or town that the application for the permit or license is being regnested,not the Department of You have .� the law or if you are required in obtain a workers' Irrhasttial Ac©.d�ts. yo any gi'IPCI7 �"�� compensation po&cy,please call the:Department at the number listndd below. Se-If-insured companies should ear their self fi since license nn ber am the appropriate line City or Town Officials f - Please be soio that the affidavit is camplet m end prhtrd legRly. The Department has provided a space at the,bottom of the affidavit for you to M out in the event the Office of Inv�-,g� s has to comact you regarding the applicant Please be sure to fill iathe pen zitAicrose number which-will be used as areference Umber. In-addition,an applicant that must snbmit multPIe peunittliceose applications i a any given Year,need only submit one affidavit indicating cur cat policy infozuration(if nmessaiy)and under`Job Site fi ess"the applicant should wz> "aII locations in (city or. town)-"A copy of the-affidavit that has been.officially stamped or marioed by the city or town may be provided to,the _ applicant as-proo-fthe a valid affidavit is on file for R:d=s permits or licenses_ A new affidavitmztst be filled oit cads year.Wherre a home owner or citizen is obt doing a licause or putt not rt:Iated to any buc;nesc or mmmmm al vcufrn e (ie_ a dog license or pemmit to bum Ieaves etc_)said person is NOT requited to complete this affidavit: to t ;ink- u in advance for out co eration and should you have any questions, The Office ofInvesfig�innswouldlr� you Y oP please do not hesifato to give us a call. The Departmenfs address,telephone and fax M=bm: CDDMIO�th of M&3sachnseftg Delta dmmt cif1udr Accidents Rostm=MA 01 111 Tt,-L 617 727-4.900 ed 406 ar I- Fax9 617 727 7749 Revised 424-07 W Town of Barnstable Regulatory Services RARN&MBLEy ems. Thomas F.Geiler,Director rid 39. A 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 &6)linas Owner of the subject property T- hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. 3a� � . (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections are performed and accepted. r� ign e of O n , Signature of Appli t 2( � lJ� ✓� /BD�b'e-p'n ��ty Print ame Print Name 4 . ► � Date Q:FORMSDANERPERMSSIONPOOLS 62012 7 . -grxe j License or registration valid for individul use only ` \ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to'. �' HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Type: ; i, Registration:..'..114561 yp 10 Park Plaza-Suite 5170 i Expiration:; 1074/2017 DBA Boston,MA 02116 DAVID GADY CARPENTRY < David Gady 217A Timber Ln Marstons Mills,MA 02648 Undersecretary i Not valid witho signature Construction Supervisor 1 &-'Family Restricted to: i Failure to State Building a current edition of the mldmg Code is cause for revocation Of this Massachusetts; DPS Licensing information visit; of this license. - ....` WWWMASS.GOV/DPS Massachusetts Department of Public Safety Board of Building Regulations and Stand License: CSFA-057540 Standards Construction Supervisor 1 & 2 Family DAVID J GADY 217 A TIMBER LN. MARSTONS MILLS MA 02648 Commissioner Expiration: 12/28/2017 r I 1 r , r PROJECT NAME: ADDRESS: PERMIT# PERAIIT DATE: MJP: LARGE. ROLLER PLANS ARE* LN: . SLOT Data entered in MAPS program on: j� f Town of Barnstable *Permit# O l A/38 OExpires 6 months from issue date P Regulatory Services Fee Thomas F.Geiler,Director Building Division L> SEP 1 9 2006 Tom Perry,CBO, Building Commissioner ' 200 Main Street,Hyannis,MA 02601 TOWN OF LtiRNSTASLE www.town.bamstable.ma.us a Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press imprint Map/parcel Number Property Address S 464✓A S�b sidential Value of Work ��U Minimum fee of$25.00 for'work under$6000.00 Owner's Name&Address 13 _Z an O Contractor's Name I fitlM. Telephone Number .�� ©�lS� HometImprovement Contractor License#(if applicable) no Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 9—"M'a sole proprietor ❑ I am the Homeowner ❑,I have Worker's Co e a ' n In suran/c'el_ Insurance Company an Name J Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) - oof(stripping old shingles) All construction debris will be taken to /C�1�✓�OV� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope er must roperty Owner Letter of Permission. co the om vement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 Sep 06 06 07:42p Gallagher 508-362-2883 p.1 Gallagher -Roofing ' Siding "M appreciate.your business" U Corporation'Rd. Proposal Yarmouth.Port,MA02675 • (505. 362-0265 Proposal ed to Work to beer£ormed at Street '3 <- S «-, L l LLd City X ttin State City. .V a- ',ts ��[ !e State Date 9 /,�,. Phone / VG'Ce qz*r propow10 mist allthe materi and�perfQlm allthe�labo 'necessary for-the completion of't! is l i j��[L�� ��v1/•� �'t,!��f Y� C E .:� �1.�4:1G1"L ['Nw•.J Ltti:i Vt r!_l"••l�•P �-r• �_C' rt/i� t`Ze'�a;.t�•[{, :'tl .'..lA�.'.�uti•�� c?,l"t :�—fi•.✓ .r�'�Li,,.i',�7.5 /�/�Y3�c.' l�•'t •�d[�i^�'✓ C:.C«i:s:i .,�_Ci�-.� �`.[t fi' L2 I .; 1 tLi"f:.� C .n1 4 � �l�'� �/.�•fi�f 1� � '!�_!!!i•>' '!%.ilfi _.,� �(�' 't.:`�."'.1 .�i'- L.l .'✓'b\1<�t /.G�<<• (..I.LV!-c tl G. I I �\ .'.c.} L.n.t� `� Gtr ..�.5 l.:N� .Nv, [.le A-i.; V ✓-) 1L�. II f ) /I 1 L t J C't,lS �'Glif 1/l�i F1 ° /• �" ,� 'r. r o',., S Jet rf ,llY\ ,,/�!"h, A- ALA, l '���1" fl [•t[\ C'['�l!9 �t _t:t.v •>i.'l.� t v �'vi Lt!'•s.tt. � �.�• /r Gl'T[' ,'l/' i 14, ��A "�.� J�L l / f i �'�r'C� ti LC>IL.•Y_] �/�C'' r �� r 7/_1'r t a•�[ 7 /lily.: Lis �►�( -�. � : 3rr' L I istl/ rii/-vY':", ,, " :'v\. :5 li yt. !�C( �:d + e,4 ^'ke,l —&-I(. All Material is guaranteed to as specified,wid the abov+d wo&to be performed in accordance with the drawiEV and specifications submitted for above work and completed in a substantial wrnananittIm manner for the sum With payments .as made .follows: •f(/� //_,, J �. 5. G=;. ' .�ySf• l:,vCi ��hi-t. n.! •-•'+' �Cw� �/C !�%a. .f :l :•/[�� i� ��" S�'� .�-:a",� Acceptance of Proposal ' The above.prices,specifications and conditions 2r a sans dory and are hereby accepted.You are auth to dot the specified Payment will made as outlined above. ' Accepted ' Sigdature Date Sisnatnre r Department of b dasti ial Accidents Office.of Investigations: ' a 600 Washington Street y� Boston,MA 02111'. www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kpplicant Information Please Print Le 'bl name (Busine4 k_1 ss/Organi7ntondndividual): (� t• Address: /U city/State/Zip: Gt✓ �.c °l Phone#: ►re you an employer?Check the•appropriate box:. Type of project(required):• ❑ I am a employer with' 4. ❑ I am a general contractor and I 6. ❑New constriction employees(full*and/or part-time).* have hired the sub-contractors 7 Remodeling a sole proprietor or partner- listed on the attached sheet t ❑ g ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance: 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are.a corporation and its 10.❑ Electricals airs or.additions required.] officers have exercised their ep ❑ I am a.homeowner doing all work right of exemption per MGL 1�1.❑ PIumb' repairs or additions myself.-[No workers' comp., c. 152, §1(4), and we have no 12.❑ Roof insurance required.] t employees. [No workers'- 13.❑ Other camp.insurance required.] oy applicant that checks box#1 must also fill out the section below sbowing their workers'compensation policy information: �, iomeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such )ntractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp,policy information. . !m an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Formation. ;urance Company Name: licy#or Self-ins.Lic..#: Expiration Date:, b Site Address: City/State/Zip. tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). iilure to.secure coverage as required under Section 25A of MGL c. 152 can:lead to the imposition of criminal penalties of a e up to$1,500,.00 an one-year imprisonment, as well as civil penalties in the form of a STOYWORK ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of restigations of the DIA for insurance coverage verification. 0.17 'o hereby certi fyu r s a s of perjury that the information provided above is true and correct atum. � Date: one 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.Electri 6. Other cal Inspector 5.Plumbing Inspector Contact Person: Phone#: Information and Instructions -- lassachusetts General Laws chapter 152 tequires all employers to provide workers' compensation for their employees. arsuant to this statute; an employee is defined as"...every person in the service of another under any contract of hire, xpress or implied,oral or written." �n employer is defined as-:.an ipdivid►ral,partnership, association,corporation or other legal erltity,.or any two or more f the foregoing engaged in a joint enterprise, and'including the legal representatives of a deceased employer,or the eceiver or trustee of an individual,Partnership, association or other legal entity,employing employees. Howev.-er:the .wner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the welling house of another who employs persons to do maintenance, construction or repair wont on such dwelling house �r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." v1GL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or enewal of a license or.permit to operate a business or to construct buildings in the commonwealth for any ipplicant 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 ,nter into any contract for the performance of public work until acceptable evidence.of compliance with the insurance :equirements 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 cerdf cate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. l§e 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 lime. 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-libenses..Anew 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 hl�e 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 jhyestigations 600 Washington SIreet4 . r Boston,MA 0211 L•. : Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-7274749 . raised 5-26705 www.mass.gov/dia a f 7t..4 'i °pIME rod, Town of Barnstable Regulatory Services y = B" E ASS.Muss Thomas F.Geiler,Director c 9`6'O�Ep 339. �`�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 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 authorized by this building permit application for: (Address of Job) - Signature of Owner Date Print Name Q:FORM&OWNERPERMISSION g Rebulaiions an d Slatr"d'!, HOME IMPROVEMENT CONT. � r CY O ��a gr�cl;islratio►rva6d,o`lf`inc!nic7ul ,`, ;Registration: 1 e t7,e eri��xhoa f109250 L. v 005 006 ildig Regu , ►ard at Bun # it.:,ound rc.gi n try• ;`' 1 lations'aiid Standards. �i One�Shburton Pla _'sI3Gston,"Ma.03108 Oa - Nil chaet"Callagh 10 Co. R .. . . YARMOUT H.bOR7, q 26 � . .. _ Adinioisir ur.: - - _- .... ....: Not valid " ' - wiftiout si n` U - r ' GALLAGHER ROOFING & SIDING SERVING THE CAPE SINCE 1984 10 CORPORATION ROAD YARMOUTHPORT,MA 02675 508-362-0255 OR 1-888-325-1611(PH&FAX/ {I 1 THE COMMONWEALTH OF MASSACHUSETTS. Registration: 109250 Board of Building Regulations and Standards Home Improvement Contractor Registration Program Expiration: 9/8/2006 • One Ashburton Place,Room 1301 Received: Boston,MA 02108-1618 e Application for Renewafof Registration •� Home Improvement Contractor or Subcontractor V MGL Chapter 142A,780 CMR R6 (PLEASE READ INSTRUCTIONS CAREFULLY) - - - -- -- -----' —--- -- - -- - - Business name can not change on renewal form! 1. GALLAGHER ROOFING & SIDING Michael E Gallagher 2. 10 CORPORATION RD. 3. YARMOUTHPORT, MA 02675 Please note changes to mailing address. 4. Street Addresss(if different): 10 CORPORATION RD. YARIJICUTI 1PORT-10A 02675— _ -. - - - - ---- --- - ----- -- --- -- Please note changes to street address. g. Applicant type:[DBA. 6. Federal ID No See Instructions to change Application type. 7. No.of Employees: F-O]No.Employees 9. Individual responsible for Home Improvement Contracts: Michael E Gallagher First Mid Last 10. Title of Individual responsible for Home Improvement Contracts: Owner Please note changes to title. Phone No: (508)362-0255 11. Does the applicant or responsible person hold any other construction related,state,city,town licenses or registrations? 1'es %<, NO Construction Supervisor License: 0 Expires: Motor Vehicle Repair Shop: 0 Expires; 12. List all partners,trustees,officers,directors and ,f major owners(10%or greater of ownership)of an applicant partnership or corporation below. Use additional paper if necessary. Check here if you wish to receive an application for additional ID cards for key persons. LO First Mid. Title in Applicant�Busiriess-_--- `io Owner Address 13. Is the applicant claiming exemption from to registration fee?(See the instructions) ,ti� Yes No 14. Registration fee enclosed:$/o y Guaranty Fund fee enclosed:S C/ If necessary,include two separate certified checks or money orders-one marked"Registration Fee";one marked"Guaranty Fund". See instructions for amount of fees.Make all certified checks or money orders payable to"Commonwealth of Massachusetts". NO PERSONAL OR BUSINESS CHECKS WILL BE ACCEPTED UNLESS THEY ARE CERTIFIED. Pursuant to Massachusetts General Laws Chapter 62C§49A,1 certify under the penalties of perjury that 1, to my best knowledge and belief have filed all state tax returns and paid all state taxes required under law. Signature of applicaidor applicant's representative Title held with applicant Date A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration. GALLAGHER ROOFING & SIDING SERVING THE CAPE SINCE 1984 10 CORPORATION ROAD YARMOUTHPORT•MA 02675 • 508-382-0255 OR 1-888-325-1811(PH&PAX) i y0 H E r0�1 The Town of Barnstable 1 1 )AI ;1,. t 3 Inspection Department � u a � �0 YAY A' 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner August 27, 1993 J. Kevin & Amy E. O'Haire 328 Parker Road West Barnstable, MA 02668 RE: A=176 011 328 Parker Road, West Barnstable Dear Property Owners: Enclosed please find a copy of Section 4-4 .3 of the Town of Barnstable Zoning Ordinance entitled RECONSTRUCTION OF DAMAGED NON-CONFORMING BUILDINGS. Any lawful non-conforming building which has been damaged by fire or other cause to any extent, may be repaired or rebuilt, providing the owner shall apply for a building permit and start operations for restoring or rebuilding said building within twelve ( 12 ) month after such catastrophe. If I may be of any further assistance please contact my office. Peace, epli D. Da z Building Commissioner JDD/gr enc. l R176 011 LOC 0328 CHURCH STREET CTY 05 TDS 500 WB KEY 104336 ----MAILING ADDRESS'-------- FCA 1011 FCS OO YR 00 PARENT 0 OSAIRE9 J KEVIN S AnY E CHAP AREA SOAC JV MTG 2012 328 PARKER RD SP1 SP2 SP3 UT1 UT2 1 .17 SQ FT 2081 W BARNSTABLE IAA 02668 AYB 1940 EYB 1970 OBS CONST 0000 LAND 56000 IMP 80700 OTHER 3700 ----LEGAL DESCRIPTION---- TRUE N T 140400 REA CLASSIFIED GLAND 1 56,000 ASD LND 56000 ASD IMP 80700 ASD OTH 3700 ##BLDO(S)-CARD-1 1 SO,700 DESCRIPTION TAB YR CURRENT EXEMPT TAXABLE !#OTHER FEATURE 1 3,700 TAB: EXEMPT {#FL PARKER ROAD U BARN RESIDENT'L 1.40400 140400 140400 #RR 0308 0133 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE 11/8S PRICE 190000 ORB 0537/1.01' AF O I rn r Y ivrl /C R r LASS ACTIVITY O1�.� ���.:� PCat .� j 4-4 Non-Conforming Uses 4-4.1 Lawful Non-Conforming Uses: Any lawful building, or any lawful use of a building or premises, or part thereof, existing at the time the Zoning .Ordinance was originally adopted in the area in which i such building or use is located, may be continued, although such building or use does not conform to the provisions hereof. 4-4.2 Change from One Non-Conforming Use' to Another: Any change of a non-conforming use, any alteration, relocation or increase in size of an existing non-conforming building or structure to extend the non-conforming use on the same lot, or use of existing or construction of a new building or structure, shall only be allowed provided that: 1) The proposed change is from one non-conforming use to one other non-conforming use only; 2) The proposed change is no more objectionable or substantially detrimental to the neighborhood; and 3) A Special Permit is obtained from the Zoning Board of Appeals. 4-4.3 Reconstruction of Damaged Non-Conforming Buildings: 1) Any lawful non-conforming building which has been damaged by fire or other cause to any extent, may be repaired or rebuilt, providing the owner shall apply for a building permit and start operations for restoring or rebuilding said building within twelve (12) months after such catastrophe. 2) Any proposed increase in floor area of such damaged building shall not commence unless a Special Permit is granted by the Zoning Board of Appeals as per Section 4-4.2 herein. 4-4.4 Re-Establishment of Certain Non-Conforming Uses: Any non- conforming use which has been abandoned or not used for five (5) years shall not be shall not be re-established, nor shall it be replaced with another non-conforming use. Any subsequent uses in such insta9ces shall conform to the requirements of this ordinance. 4-4.5 Non-Conforming Lots/When Exempted: Any lot lawfully laid out by a plan or deed duly recorded, or any lot shown on a plan endorsed with the words "approval under the subdivision control law not required" or words of similar import, which complies at the time of such recording or such endorsement, whichever is earlier, with the minimum area, frontage, width and depth require ments, if any, of the zoning ordinance in effect at the time of such recording or endorsement may thereafter be built upon for residential use (notwithstanding amendment of the zoning ordinance changing such requirements, including yard requirements or more than one such requirement, in excess of those in effect at the time of such recording or such endorsement). if: 70 a PLEASE NOTE: THE FOLLOWING CONDITIONS MUST BE SATISFIED TO VALIDATE YOUR COMMITMENT. ANYTHING REQUESTED " PRIOR TO CLOSING" MUST BE PROVIDED TO EAST/WEST MORTGAGE COMPANY, INC. FIVE DAYS PRIOR TO SCHEDULING YOUR CLOSING. ADDENDUM d CONDITIONS TO BE MET PRIOR TO CLOSING: 1 . You must obtain hazard and fire insurance for the market value of the mortgaged property, or 100% guaranteed replacement cost . The mortgage clause must read in favor of : COUNTRYWIDE FUNDING CORPORATION Its successors and/or Assigns ATIMA P.O. Box 7137 PASADENA, CA 91109-7137 Once a closing date has been established please contact your insurance company and advise them to fax me a copy of the insurance binder, and a copy of the paid receipt showing policy dates, when the policy is paid up to, and yearly premium to Raymond, the fax number is 617-595-9978 if there are any questions call 617-596-3000 x182 . 2 . Satisfactory title work prepared by attorney (East/West to provide) . 3 . Complete 1991 1040' s and Orginal Signatures op 1992 extension only. 4 . Letter from the city or county stating that if the subject property was destroyed, it could legally be rebuilt as existing. CONDITIONS TO BE MET AT CLOSING: 1 . TYPED SIGNED AND DATED 1003 . i 2 . DEBTS TO BE PAID AT CLOSING: BANK OF BOSTON 135, 802 . 00 3 . THREE DAY RECISSION 4 . UNDERWRITTEN AS 25 YEAR FIXED AT 7 . 75% (FLOATING RATE) . 5 . CORRECTED 1008 . SIGNED. 6 . CREDIT SUPPLEMENT: REMOVING VCI DUPLICATE. 7 . NO CASH OUT. 8 . ALL PAYSTUBS, W21S, AND BANK STATEMENTS TRUE & EXACT. I I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map Parcel ) Permit# TU ` I CP P'Afcfq � fi+ Health Division 2003- 01� 5 $120(A33 '3 �t K Date Issued iF 1I OO Conservation Division. e� ' � i r, , 2( A fApplicat4on Fee i �►�r�a - - �c-- 6/a61a� 5, Tax Collector Permit Fee Treasurer o -- �(- '_ I O��d3 _ v 1;,� :ri�>jNST TEN MUST BE �4LLED IN COMPLL4tXE Planning Dept. Date Definitive Plan Approved by Planning Board ENVIRONMENTALOOE AN[ Historic-OKH Preservation/Hyannis TOWN REGULR4i0ftfS Project Street Address Qar k-r"- Village Owner ►S G bC--+h C S S CYL Address 13 K Sfiu�e ,�, C Telephone C l L4<-r U �'J 9 Permit Request �S �ri(rl � �-� vim S+FA I C�06(5 _ J Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 14 �bU 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: 0-'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/co/al stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing O new size Barn:f�ezisting ❑new size Attached garage:❑existing O new size Shed:❑existing ❑new size Other: t Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes VINo If yes, site plan review# Current Uset��S�_ ham n Proposed Use BUILDER INFORMATION I Name Telephone Number i Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - �el-4-7 -- DATE E FOR OFFICIAL USE ONLY N PERMIT NO. DATF'ISSUED .. MAP/PARCEL NO. ADDRESS, VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION FRAME INSULATION e FIREPLACE ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL GAS: ROU.Gfo ° > FINAL a i FINAL BUILDING ;5g; s DATE CLOSED.OUT i ASSOCIATION PLAN NO."., ' s" , _ 1 r ` —N . = The Commonwealth of Massachusetts ... . Department of Industrial Accidents -= . . . ONCO of/nsestfgat efts . . . 600 Washington Street _ —1J • I I `Boston,Mass. 02111 . Workers' Co ensation Insurance Affidavit . D) SaVDCA-41, O} o S S&.2 . name:location: ,�) 95( l'(� c�Y k--e- ' K� . `� . city Ll.� , JC&Y' n S� 1-D1 r-- phone#� 0 - 19, ^0 S-� 1 ❑ I, a homeowner performing all work myself. . - ❑ I am a sole r n for and have no one workin , ca achy /%%%%%%%%% %/��%%%���/%%%%%%%%%%%////% /O% %///%%%//��%/%%%%%%/%%%/%/%%%%/%%/%���%%%%��%%%�%��%/�%�%%//G%%/ ❑ I am an employer providing workers' compensation for•my employees working on this job. . name,.... ame •.. •;:.;:.;:.;:.;:.;:.;;:•;;.........;:.;:.::.; ::::::::::.::::: ::.;:.;:.;:.::.;:>:::.:;;:•;:.;:•;;; :company ..:::::::::.:::::.::::..:::::: ::;.::.;:.;.:;:•;.. ::::::: ;:.;:;.;:.;:.;:.;::.;:.; ::. address...:.::... .....::.::::::.:.;:::...... " .: .`.I.-.`.`..---,-,1.--*. M: .. :e<: og Iris t pan ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have . thefollowing workers'M. polices:polices:::::::::::.::.:::::::.::::::::::::::::.:::::::::.:.::.:::::::.::::::.::::::::::::::::::.::::..:::::::;::::.;;::::.::.::::::::::.::.:::::::::..-....::::::.::. :compan :name :::::.::::::::::::::::::::::.:::::::::::::::::.::::::::::.................:.. ::;::.;:.;; ;:.;:.:;.;>:.;;::::;:.::;.; v ::::::::::.::.::.::.::::::::::::::::::::::::::.::.:.:::.:::. :;.;:.;..;::..:;.;:.;:.;;:.;:.;:.;::;::.;:.::::.;;,;:.;:.;:.; N , . adti.......- im..................�.............- ... .....4-%............. - .....�.�.�.�.�.�.....�.............�.....,.�.�.....�....-... -*.... t•:. ft :::i;::i:: tlT......................................,.::....... hone. #:z?:§:; i ...................................:..... ..........................:..:::::•:::.:.....:................................................................... ..�..:.. ... ,. Ce:cos:>:<::<:::?:<:>:::<<««:<:>:::>,::»<:>:>:>::>:<:::>::: ;::>:>:::>::>::>:<::::::: :::::.`::'::::'::i:::::::::::;::::::»::>::>::>::»::>::>::><»:>::::«::::<:>::>:;:: ltt�nra�t c an;:nam t adtlr <:<ez<>: c ......................................... ;;•;;;:.;:.;:::::::........... ..................................:..................................::::::::::........:.........:............. .........................::...................................................................... _........._ .....:... :::::::::::::.::::::::::.::..::.: ...................................::::::..:.:::.:::::::::.::::•.:::::::::::::::::::::::::::::::::::::.::..........................;::::::::::................. . :::: : •::: •::::::::::::::::::•::.:.::::::•::::::::.............:•::::::::::::::•:::::::::::..................:::::::.:::::::::::::::.:::.:.::. . . , ...,:::;:;::;::;<::;::;:::;:::::';:::;;::;;::;::::::: is5>;::•:::4;::::::.%%%%::5::::::::i ;:'S:::::::;::;:::::::::::.;:.;:.;:.:;.;:.;:::n;::•;:;•::•;::;:.:;:;::;:; nsaranre.co�:::::.::..:::::::::,....::: :.:::.:.:::::.::..:........... ................_.. __.... o :. Failure to secure coverage as required order Section 25A of MGL 152 can lead to the imposition of criminal ����� r copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penaltiesM of perjury that the information provided above is truo and correct Signature / ' y ,`�'— Date . - . . Print name C_�i,S G`��d r 1 I QSS"�� Phone# mmmm official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Buffding Department ❑Licensing Board i ❑checkif immediate response is required ❑Selectmen's Office Li cont act . contact person: phone#; � ❑Other Onised 9/95 PJla 1 1 l Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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 obtaina* workers' compensation policy,please call the Department at the number listed below. City or Towns 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. The affidavits maybe retuaied'in the Departmenrt by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 fax#: (617) 727-7749 phone#: (617) 727-4900 egt. 406, 409 or 375 pFtME�ok, Town of Barnstable vti Regulatory Services _" 'ST" Thomas F.Geiler,Director ass. > 94i'°lEo6 9;�p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to- such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: 3 S�rA S Estimated Cost H, t•-•{ wtYl p ll pp _ . -. Address of Work: Owner's Name: 1 S (A _b74 O SS Date of Application: 11�U I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 �%tgowner-occupied pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. � OR Date Owner's Name i Application to ®Yb RinQo('o -J�igbbjap 3&egional 3�iotor(c Mi.0tritt Committee TOWN, OF BARNSTABLE In the Town of Barnstable ;n 2003 FEB 19 PM 3: 26 CERTIFICATE OF APPROPRIATENESS Iicat� io t MW de, with four complete sets, for the issuance of a Certificate of Appropriateness under Sectien G� Chapter.470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on platys, uings,.or photographs accompanying this application for. t� ECK CATEGORIES THAT APPLY: ,-,� :xtedor building construction: ❑ New ❑ Addition IZ Alteration ,_2/ idicate type of building: ❑ ElE House Garage ❑ Commercial Other _'b01y Y-1. -5 ke-1 :xterior Painting: ❑ signs or Billboa s: ❑ New Sign El Existing Sign ❑ Repainting Existing Sign structure: Fence ❑ Wall ❑ Flagpole ❑ Other sE OR PRINT LEGIBLY: DATE )RESS OF PROPOSED WORK 3 acS 90Y-k f5' V,CX4 ASSESSOR'S MAP NO. NER 1 UDC�'�) E OSSC.(z 40n vex-' n CCA It, �4SSESSOR'S LOT NO. Il T✓V st d IIE ADDRESS 13%.S aG_15100<'_ K�• Ay/yi ff)A or;b33 TELEPHONE NO.so'�-qy5-bS a� L NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any is street or way. (Attach additional sheet if necessary.) Feu 5, anA Cavrolun f►1urjnhU �L-160 C.hvrc,I,Sfi,,t,J , Au,/nS+U b1- , mF- o a bM6 u C' Q ej ISon j a PC A o a b i; �arl�s AY.Ana vxunnC COvrn, )5 , 351 PuI'k-e_� n,�• , %,J•Sc-ms,�tole-Mfl DAL�� .t-,ur�A_ J CAu43 Q cd 3 3 3 On X_k cr LA.) C ,nn5 otc ; ,n-114 Ua bL NT OR CONTRACTOR I- CAU-�-U'1 2]L)SSfg= TELEPHONE NO. '�1 $'9WS-0 RESS I U G �S1U �Y✓M n'1V4 O-1b r�l � 33v- Oq a� CRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please de locations of proposed signs. 1 mac,,S e CA4+o c.Pn , . Signed ner-Contractor- gent 'omrnittee Use Only This Certificate is hereby Date 3 O AAproved/D nied Committee Members' Sign i i Certificate of Appropriateness Description of Proposed Work A. Barn Alteration 1. North side rear: Add two Dutch stall doors and move two existing windows to allow for doors. (See Elevation#1 and Photo#1). 2. East side perpendicular to street: Add two 6- pane windows,one 12-pane double hung window, and one Dutch stall door. (See Elevation#2 and Photo #2). 3. West side perpendicular to street: Add one 12- pane double hung window. (See Elevation#3 and Photo #3). 4. Dutch stall doors and windows will be of natural pine. Window trim will be white. Dutch stall doors will be red with white trim. (See photo #3 for existing red color to be used). 5.New windows are for ventilation and light. New Dutch stall doors are for safety and access to shelter for horses. B. Fencing 1. Remove old existing arena and paddock fencing. 2. Add three- board eight- foot section, natural oak perimeter and paddock fencing. Perimeter fencing is for safety and containment of horses if they ever get loose from paddocks. (See photo#4 and plot plan). C. Riding Arena 1. Relocate riding arena along west property line and enlarge to make it regulation size for training(75x195). (See plot plan). D. Landscaping (See plot plan) 1. Remove two cedar trees at south-west end of riding arena and replant. 2. Remove cedar tree at north- west corner of riding arena and replant. 3. Minor brush clearing on east side of property for paddocks. u hh��nylez . 1-, \y�1 t . S i m G � 5� 30 on e (�O or on �..e�� ►�I� car aA— C A,r, ur ,v OLAD ► fie. e� ,�h 4�— 3 f Town of Barnstable Old King's Highway Historic District Committee SPEC SHEETJG�r' FOUNDATION SIDING TYPE COLOR :HIMNEY TYPE COLOR ZOOF MATERIAL COLOR ?ITCH VINDOWS .• �7 O CA n C COLOR l�n� �" SIZE a 3 PRIM COLOR )OORS 3 j)LA 4"(\ ,StC41 1 HD OYS COLORS iHUTTERS COLORS ;UTTERS COLORS >ECKS MATERIALS ;ARAGE DOORS COLORS SKYLIGHTS SIZE COLORS ;IGNS COLORS 'ENCE 3-�000fa : W Sec.-k�CX1 CYA COLOR r1G e-Gj )TES: )ill out completely, including measurements and materials/colors to be used. Your copies of this form are required for submittal of an application, along with Your copies.at the plot plan, landscape plan and elevation plaza, when applicable. PECSHT evised 11198 i Town of Barnstable '= ' Old King's Highway Historic District Committee SPEC SHEET Sht�G ?OUNDAT I ON CA SIDING TYPE CG&U 5 jv 1- _ COLOR CHIMNEY TYPE COLOR ROOF MATERIAL_ hCA 1 -1- S hi✓1C,, irS COLOR G 4-t,rU 1 PITCH T /i WINDOWS COLOR a L I ISO 1 TRIM COLOR �� T DOORS 6l1� 3, UnC� �� b� C)Cj�,t)n COLORS rC2:-.,. SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS FENCE COLOR NOTES; Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape o lass elevatiwhan. applicable. \` l y BCDxig \ g ..�. /� p I• •- � IL W \�\ ?� Lao Lj Ix die ' _ W zS /+ � \ � 1 1 W Z4 1 r Z�W ct� ' , \ m Z W l 3 • �W/f C ♦ k' 1 ♦ Cr 4M �a L-4 I ` i 4----1,- ICA : I I j I I i -i -- t IL ¢-� .� _ ._...iell , 71 _ i ZI IF- .. . - - - - _ _ 41 LA 1- I I } i , t i J . i I ' - I I , i : i I I i I • I I i I I • i I I 4-----+_t_ L : II� i I I , , I : t I: i I I i I - I t_.d. I__ 1-4 ----ram .�. __..�.._._r_..--f--�--- --j--'--�. .. i. .,...__ ..-� -- ---{- --;. ---�---I�--i---- - . �. ..--L_-� -�---j-}-. --- ........... i The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: V JOB LOCATION: 3 2,,Fr PC,Y— rn number street village "HOMEOWNER': �� 5 c of ' V` m©SS � Jy�—1 y � C)�a—� . name home phone# ` •work phone# CURRENT MAILING ADDRESS: 0. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more.than one home in a two-year period shall not be considered a homeowner. Such"homeowner"'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. �1 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 liceased•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 fnrm currentiv used by several towns. You may care t amend and adopt such a formIcertification for use in your community. vlk Assessor's office(1st Floor)! K. - Assessor's map and lot number Board of Health(3rd floor): � ll• .�T/ fy(��� l �• G� _ ' l f-� Sewage Permit number n "1 (�Q o / t Baaa9TenLL . t F.�s' Engineering Department(3rd floor): /y 3� C reea House number '�+ {�t°c„ rb3.1 b- ' Definitive Plan Approved by Planning Board � APPLICATIONS„PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE r BUILDING - INSPECTOR APPLICATION FOR PERMIT TO 4 t pCY �?d" A D'b t-rl O d ( O E TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .Location 3a PARKe RoAb. vies QArzNVAl3L.E M Proposed Use Zoning District : Fire District kA1R ST 18!' VAj i Name of Owner Kev l rJ P►I Address" Sag QA2 k e p— RO P,z y Name of Builder.C,6,WP(,Z, Address " Name of Architect Siq"' :Tjot ►e, Po r P-A, Address 11 9 O 1204re lv A W C ARg J gi A 1312 Number of Rooms Foundation z C' Exterior e 5 Ft nl q L eS Roofing ( v c�\ A S pk A O1 * Floors woo t� / Interior ` -e 'y 0 r' ;<• Heating )(L1s( f NCh Plumbing, Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of,the Town of Barnstable regarding the above construction. (LtkiName Construction Supervisor's License �f�ln W HAIRE, KEVIN J. A=176-011 No 3 30 4 4Permit For ADD TO 'DWELLING Single Family Dwelling Location 328 Parker Road West Barnstable l Owner Kevin J. 01Haire, Type of Construction wood frame Plot Lot Permit Granted July 7 i9 89 Date of Inspection 19 i Date Completed 19 re B y1 a PERMIT COMPLETED 1/1/-2L U tiU ..-Wk a IYi bt" C.ae�na fo' adQy '3pc S e� RCAp PAR K R_ -- ------�— .,. c�er_hen .T.Siec�l Jr. A REGISTERED LAND SURVEYOR, 00 HEREBY CERTIFY IHAI THE ABOVE KORIGAGE INSPECTION I 3LOI PLAN WAS PREPARED FOR «q%rUR'V ISANK i TRUST F_n. IN CONNECTION WITH A NEW NORiGAGE AND IS NOT INTENDED C•R REPRESENTED 10 BE A LAND OR PROPERTY LINE SURVEY. NO CORNERS WERE SET. I1 CANN01 BE USED FL•R ESTABLISHINS FEkCE, HEDGE OR BUILDING LINES. NO RESPONSIBILITY IS EXTENDED HEREIN TO THE LAND OWNER OR OCCUPANT. 11 IS NOT INTlNDED TO BE RECORDED. ✓''FEZ✓" "Of F Mq•_. a`' r STEPHEN MERICAN SlRVEYIW COWAW f SIEOL• 1R. ' LEGAL DESCRIPTION: Pri to 10365 .'BECE�cL of Boston, Inc. y 1 KARNSTA6L; TTEGISTRY or D6605 506K '1155 PAbF I63 I 135 Beaver Street �qN vo0.�' ADDRESS: 32A PARK eQ RnAD � .� Waltha4, NA 02154 SUA:1� � vJ• gARN57A81E � MA (617) 893-6477 O oURCHASER: p• uAiei;- / THE LOCATION OF THE DWELLING AS 5U0JECT PROPERTY IS N6T '( ;I IlE CO. !IOCATEO IN A FEDERAL INSURANCE SHOWN HEREON 1S. . IN COMPLIANCE. WIiH •N AD91NISIRAI109,0CS10ATLO III(- LOCAL APPLICABLE : ZONING' BY ' , �.C..4' Tpo )4-188 TAWS TN .jFFECT. WHEN•. CONSTRUCTED, FLOOD,NAtAaO AREA '� } J WITH RESPECT TO HORIZONTAL OIRENSIONAI AS PER NAP '_tSnoDl -........� PANEL DATE DDIS f3•I_ °f'95 Assessor's office.(1 st Floor): /\' t Assessor's map and lot number •/ D ` 1 R I � (�SY � �o�tW E TO Board of Health(3rd floor): f_ �(� { /�{? ED Sewage Permit number Engineering Department(3rd floor): House number -k 3,;�g,r � o %639. Definitive Plan Approved by Planning Board r '19 ®� fie, ��CD o r d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:60 P.M.'only' v��ON� TOWN OF , BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO . g 4't L Z OO r M e V- A D b til Q N U 6 iC TYPE OF CONSTRUCTION �e tQ vY') (I- .V J L y 7 19,?J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location -308 PARKeVk ROA'b WeS QAi?Ns`rAvaLS n, f-t Proposed Use ��%1-,V,y Zoning District 4:7- Fire District 'Q- Name of Owner -T Kev f+q 0 r7-f AI CE Address 3 a g PA2 k e►- PC 61A,z I ' Name of Builder Address �®t - 153b Name of Architect S19V'A :TANe, P0%'lei Address 1 1 rl O PON4e to F1 W Qi�y2�s7A i31Q Number of Rooms Foundation C. Exterior \&/ c 5 h t qL eS Rooting A\r Lh A 5 pk A L`1' wvna l sLep y,•o� k. Floors Interior • � - a i Heating F--K1St 1 Hq Plumbing i (23rA+tn Fireplace NIA Approximate Cost e d Area Diagram of Lot and Building with Dimensions Fee ��O??� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. d 1 Name Construction Supervisor's License 12tTttj O"HAIRE, KEVIN J. Ic ' "No 33044 Permit For ADD TO T)WFT.T.T G �I - single Family DwPll ; ng Location 328 Parker Road t . West Barnstable Owner Kevin J. O'Haire Type of Construction Wood frame Plot Lot Permit Granted July 7 19 89 -Date of Inspection 19 Date Completed- 19 C)� � 000 -