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Home My WebLink About0045 RED OAK LANE �s d NO. 152 1/3 ORA , o 0 _ 3 DATE •- - 19 ;i PERMIT Pill •� �I��i / ADORES$• (NO.) (STREET) (CONTR'S LICENSEI .MIT 70 - _ NUMBER OF ` ( ' I - - DWELTLING UNITS (TYPE OF IMPROVEMENT) N0_) STORY. IPR OPOSED USE) t _ -AT (LOCATION) ZONING- DISTRICT '1 (N0.) (STREET) ' BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT, /ONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) 3 • REMARKS: ---- - AREA OR PERMIT Ii VOLUME `- _ ESTIMATED COST $ - FEE - (CUBIC/SQUARE FEET) OWNER .. .. I ADDRESS BUILDING DEPT, -• r' �.:.J� .. BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY Off•. PERMANENTLY, ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED •.FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITION] OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE : INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL OUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET tBIL�DINIG INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS !� ` 0 ! �/' 4 2) 2 2 7. HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT y. LZ OTHER BOARD OF HEALTH rl 1p WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'w!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN 8E TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEn CONSTRUCTION PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. ' , 1. _.. _.•.� _ - - -.t� �� - - _ ! ' _ ...... �j(] Qom. f�� :, '�!'.• DATE_.. Ap i1 •. /•, 1 .9.. 87•- ...PERMIT �I�' •�46�i +r �.:J 1.. s: APPLICANT ' --':•1.- `!t'.T',il-l'tt ADDRESS 'ld_;tc,d' lic low #006324 (NO.) (STREET) (CONTR'S LICENSE) . _ C t NUMBER OFF;,..•.. PERMIT TO J (=) STORY - �•�(=-�-`' ��'-�.Lt1ilOWELLING UNITS .. y.i (TYPE OF IMPROVEMENT) N0. "(PROPOSED USE) t + t ZONING AT (LOCATION) t• ;:�'(, l•ci _ .�., t_a.il Y'ii':�i:Ilf' DISTRICT `\I• (NO.) (STREET) ,hiilf;-• BETWEEN AND (CROSS STREET) (CROSS STREET) y LOT SUBDIVISION LOT-BLOCK-SIZE �•= BUILDING IS TO BE FT. WIDE BY FT.I"ONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTIO�ry1��'-__' ..�. 70 TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) _ :e REMARKS: lc -: AREA OR _>VOLUME "lug "'1• . ESTIMATED i . U`-lll , PERMIT � ��U 9r (CUBIC/SQUARE FEET) FEE OWNERLyn ;N: 44 i V,L .. 1S.,. l:1_V _ s i :1.., BUILDING DEPT. -y. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY ---PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE -PROVED BY THE:JURISDICTION. STREET OR ALLEY GRADES AS WELL AS .DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE 0BTAINE[Y-z+'�`'�'��"- _FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITION r-'"OF,ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE '•i•; �+ CARD KEPT POSTED UNTIL FINAL,INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR S- ALL CONSTRUCTION WORK: "Y ELECTRICAL, PLUMBING AND l:,FouNT)R iTo tfS%arr ooT,Ncs: -:-; MADE. WHERE yA CgR �ZI, ATE_OF OCCUPANCY-IS;RE- MECHANICAL_INSTALLAT-IONS 2. PRIOR'TO.'COVERFNG�STRUCTURAL ` �" `"' ! MEMBERS(READY';TO LATH1. QUIRED,SUCH-BUILDING SHALL NOT BE OCCUPIED UNTIL Ali?` i ;,3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. c_,j OCCUPANCY. '. �}lx•w. POST THIS CARD SO IT IS VISIBLE FROM STREET " ' tBILDI�NG INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION AP LS ( V 0441 ''tam-;•' • .3 ly ) HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT OTHER BOARD OF HEALTH 1 WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCT ION INSPECTIONS INDICATED ON THIS CARD CAN TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRI- CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. ? j t.; .. � y. ..,�t k..�, y-.4•,��art. rw�� 3_ CONT1NUAT1ON Of ROAD' BOND BUILDING PERMIT �/ �� L7 7 I The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items -are completed to the satisfaction of the Engineering Section of the Department of Public Works. i C/ loam and seejshoulders as soon as ' weather permits. '�-other (explain) LOCATION ; L,�s £ 0 �J . ISA ,c AL ri-07 -t'/. 7 S GNED Owner/Con ractor ENGIN RING AUTHORIZATION ' 1! 112.00 1316-r& L Qlsees bs TOXIN OF OAF ►JlbTA LeA55E5SOR5 MAP` IZS LOT IF 160 20,MIN. �' N EGE�AQ'{To r32lw-.L 1 top OF IOIMIN. , CvVEfLs "(D I'dF C�RAr.� ZONING : �I% , /i \'I FOUND. SETBACKS FRONT- SIDES SEPTIC TANK ZO DIe,T. BOX. I5 LEACy146 FACIL17Y -3D I% .REA,R� �1O•(�� .I'MIN GROUND GOVE.2 � '1 .' . ----- ----------- �------2-n—pEASTOWE WASHEuL� Soo I �To WE IO'I-1 Z GAL. {O(0.s0 . 10(0 o q 10(0.00 REMOVE. AN U►JSUITABLE o . oVLi'1'� Mp.TERIAL `NImAIN A l0 c --. RADIUS of ;LEkI4 PIT.:.:. _ a I(LED tr- SECTION- SEWAGE W , PLbGE� l.Il.l.f��: - BoTZ•oNq aF� tf I �,.'• AHi OLE TEST HOLE LOGS DESIGN FOR` .`B1-0Ro0Ms E OE TE5T 6Y: Jim z %d •�' � PERG.FZATE '�,SMIN. IN. DATE FLOW RATE- GAL./SAY 440 ! � o 14ITNE5.5: SEPTIC TANK 440 (l.$) ColoO "�'� ' ��, may✓ r REQ'D. SEPTIC TANK 1000 L X ,. .. . I LEACHING FACILITY S/DEWALL 4 'fi'ro=1251 S.P.(2.o )=2ti1.4 G/n! rTo 52 7r =1s.5 5I=. � - - BD M (o.e3)' IoS.Z G/rJ �� G 1-- . TOTAL Zo4'Z 5F. - 31ro..rcG/b; �✓ ��T PITS = C s,7i..Z G/D U5E oNE LEACHING F�,vr 4' to P x <p- D1A_ Y:. W ITN Z. oI= s-To► F ALL AVk0U%jD TOu 7 MOTES ' �T I ��P`� IN (/I 11 II T6tii1. 1. DAruM(MSL)* TAKEN FROM ljA�l17►tilIG+-i QUADRANGLE MAP t �•, I 13 _ �✓A►.I►� 2. MUNICIPAL. !,/ATER I�j ►��AVA/CABLE M I LI V EN1 'PfKoX. 11 3. OE516N LOAD/N! FOR ALL PRECAST UW5:AA5140 iW44T M� nr ro,. 4• PIPE ✓wnre, SHALL BE MADE WATER TIC,HT, "� ► r-��G� ` 5. CON5TRUCTION DETAILS TO.BE IN ACCOR17ANCE WITN EI,.1C��N�E�ED CO/JM.OF MA5S. STATE EA/VIRONMENTAL- CODE TIME 3L 6. TH15 PLAN FOR PROPOSED MORK ONLY AND sHOuLD MOY 16E USED FOR PROPERTY•: LN. STAKING. �. ,SCNEDUIfi 40 PVC TO BE USED THROUGH O13T.%pTIC 5`(57jtMfl -: OF � - MINIMUM SPAC LAC 5 T ,, — � I HI�Eus 8 MIN IIJG BE'TVJE'E1J E H PIT o B 20' nRnlE N. ,`�l ��;�N v I :SITE...AICl`:$EIJAGfr. PLAN. OJALA �+2%4'? �. t'ri.\�•r/� .. h. � If tLEGEND:vr cape ehq�neer�rq,VIL (Ex►5T.)---o---o_-- LOCUS : LOT A7^'��0* W- C61KEa,�loa_ CONTOUe5 , ' 16343 CIVIL ENGINEERS IREFERENCE: FE3 2sq 0 &T(DROP) LI ,MPS• LAND SURVEYORS II ; DATE 92G main st.yarmouth,ma�P 3 JALP y P; 1.�RaL CONC.BOUND ® C8 PREPAR1 ED FOR. I TEST FfOLE APPROVED: DPTE.: S{'aLE : II�.&O, DATE t -- I - BCo �— SA.Qv.��r ,MAShow!u. K %ur �I ise.. 231.30 9. W O 0 4 .L-O+ 17 �. �( o to O om om - o0 - ¢ e 2a W hh JOB # 84-36OAf CERTIFIED PLOT PLAN PREPARED FOP. LOCATION: L.-17 RED .OAK LN C ' VILLE SCALE: 1 =60 ' DATE: 4/8/87 REFERENCE: PB 398 ,PG 64 RUSS HAMLYN I HEREBY CERTIFY THAT THE BUILDINGS SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. BUILDINGS CONFORM TO SETBACK REQUIREMENTS OF THE TOWN WHEN CONSTRUCTED. Of flan ARNEG,r down cape. -engineering pJALg.e CIVIL ENGINEERS LAND SURVEYORS l ROUTE 6A YARMOUTH MA DAr PEG. L PVEYOP ° No Assessor's P. &tics offioe (1st floor): = Assessor's map and lot number ....../ .....a ...... B��A`wLIS pfTNEl�`� Board of Health Ord floor). MEAL COD o" Sewage Permit number .................... `�7 �� / G�IU 1 �,�vl�® R�G ,Tto�J BAS�9'f11DLE, Engineering Department (3rd floor): i L -TOWN 'oo NAB House number ................................... ... ys....... .. o, 'EO YAy d• -APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-'2:00 P.M. only AGNING ENGINEER MUST Slyit' y p✓; ` A A '10 . AND CERTIFY IN WRITIK' . TOWN OF B A R N S TsACB 1- 1 VVAS INSTALLED IN STRIG BUILDING INSPECTOaRr3ANCETOPLAN. APPLICATION FOR PERMIT �O .?....... .......'S`/../T!......../... ....... /?....../.... . TYPEOF CONSTRUCTION -..w .O..p................................................................................................................ l3. ....,f.ra........................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...4.�!..T..../...`.7..........zz.- ........0./t�l�......G .�}./V.1.. ; iL�r. J �...........l�L.l.... .1....... .�f.............T..H../. .�. .z....... ProposedUse .....f ? .................................................................................................. Zoning District .....KE...........................................................Fire District .............. !...t ..,.............................................. L � Name of Owner 4.5.F./ Lt:..... ...................Address ..1../.�.......0...C.D...... Z(11.. :./.ti/..�.w ............ Name of Builder .c.1 fi.ic.C........../-!i�17G�.µ-...............Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .....//....:..................................................Foundation ...... ... ................................................................ I Exterior ,?1-G,=/�.....GKA ........G.G.Jt.G'........................Roofing ........ .............................................. Floors H ✓i-!0....`.+ , .O..l.?.............. ......................Interior �V.......l.._J .. ....................... '................................. ....c .....��./...L................. �.. .1 Heating .. ..z�. .... ..............Plumbing•'�„/......... ............................................................ Fireplace .9...... . ...............................................Approximate Cost ........../..`.�...O..v�"c..G..°...... ... . ` ... fir" C` \ Definitive Plan Approved by Planning Board _____ _ 19 5 . Area ............ ..... .... . Diagram of Lot and Building with Dimensions Fee \./ ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH5+= OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... �^ �'- r.s�................................ Construction Supervisor's license 3 KAYILYN, Rd6bhjA, tt .. .. .. .... .. �,4q ....3.0..6.6.7.. P6;rmit for ...2...S.t.or.y............... Single Family Dwelling .......................................................................... Location #.1.7.........4.5....Re.d...O.a.k...Lane .. . .... .. .. .. .. West Barnstable ............................................................................... Owner .......Russell...H......am..l...y.n...................... .. .. Type of Construction ..Frame............................ i .... ....... ............................................................................... Plot ............................ Lot ................................ Permit Granted .......4Pr.i.l...?:T...........19 Date of Inspection ............................ .......19 o e Date C mp I t d X .... . . .......19 ......... a � TOWN OF BARNSTABLE Permit No. ..3 67 • BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .�. v.. g� .659. HYANNIS,MASS.02601 Bond .....X CERTIFICATE OF USE AND OCCUPANCY Issued to Russell Hamlyn Address Lot #17, 45 Red Oak Lane West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. I `March..?............ 19.......88...... . � .. ' IL Binding Inspector ��..o � °•.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING � rua g 1639. �� HYANNIS, MASS. 02601 �o Old MEMO TO: Town Clerk FROM: Building Department DATE: ~ An Occupancy Permit has been issued for the building authorized by Building Permit $kG,) ...._, .................. � ........... ..._............................._................ _M issued to .......... �A�ll �!1 �-... w� L� 1f ./. /................. Please release the performance bond. -,Assessor's o COP --Afioe�--(Ist. floor): W THE tO Assessors map and lot number ............................ W................ • Board of Health (3rd floor): -:5V 14�� I • Sewage Permit number ............................ ............................ 9TAML9, Engineering Department (3rd floor): 1639.NAB& House number ........................................................................ 0 MAI APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTO R APPLICATION FOR PERMIT TO r, (-'\ *--**,—*—*,?............................................... TYPEOF CONSTRUCTION r... ................................................................................................................ ..... .... . ................................. ....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... /7 41) .........".. ............................................................... ............. 5 ........................................ ... . . ......... Proposed Use ....../ .. . ................................................................................................................................................................. ZoningDistrict ..... ..............................................................Fire District .............. ................................................. S , /r Name of Owner ............ .............Address ................... .................................. Nameof Builder .......... ...............Address .................................................................................... Nameof Architect ..................................................................Address ..................................................................................... Numberof Rooms ....... ......................................................Foundation ....... ............................................................... Exterior ........ 4e........................Roofing ........ ..................................................... Floors .... 0......ol ..... .........................Interior ........................................�! Heating ...............................Plumbing ............................................................ .................. ....... Fireplace ..............................................Approximate Cost .......... ....0.:0' PF............ .................................... Definitive Plan Approved by Planning Board --------- -----19 Area .......................................... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the aboveconstruction. r 7 e— Name Construction Supervisor's License/ ... .... ...... HAMi,,YN, RUSSELL A=128-22 No A..0.6.6.7. Permit for ....2....S t.o.r y............... Sin le Family Dwelling ................- .......................................................... Location ....,.Lot #17, 45 Red Oak Lane ........................................................... West Barnstable ............................................................................... Russell Ham'l Owner ................................. ...yn ... ........................... Type of Construction .Frame................................ ....... ............................................................................... Plot ............................ Lot .................................. Permit Granted ........Ap.r i.1....2..7..............19 87 Date of Inspection ....................................19 Date Completed ......................................19 Engineering Dept. (3rd floor) Map..- Parcel-0 ;'-2-- Permit# ,j Z- House# Date Issued —Te•T_ Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Conservation Office.(4th floor)(8:30.- 9:30/1:00-2:00) d19, BARNSTABLE• TOWN OF BARNSTABLE Building Permit Application Project Street Address�5� ZT_p - t/) A Village �/_�/i /� R n E / A 6 L 1, /l Owner�� ` ± ,dll 16&1 v /S�A +E Vs—RED V/ \ k I- A---' Telephone & 3324 T Permit Request p M First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ /opo Zoning District Flood Plain Water Protection I Lot Size Grandfathered. ❑Yes ❑No 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: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half- Existing T New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing_ New First Floor Room Count j Heat Type and Fuel: as ❑Oil ❑Electric ❑Other ICentral Air ❑Yes o Fireplaces: Existing New Existing wood/coal stove ❑Yes Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) QLAAttTe—d(size) ;2 (1Q r ❑Barn(size) ❑None Q-8 iv (size) SX5C r ❑Other(size) i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes, site plan review# - Current Use Z :Z�,/�, / j�� Proposed Use Cy2 n E p, Builder Information Name Q� Telephone Number L �j 3;3 Address 1 f� 0 ��-)-A k /L�,�t/ License# r� -4 �IV T� �� L / �/ (� Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE DATE �O d BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) � 3d6�7 FOR OFFICIAL USE ONLY — r PERMIT NO. DATE ISSUED •s MAP/PARCEL NO. ADDRESS ' VILLAGE, OWNER- DATE OF INSPECTION: FOUNDATION FRAME INSULATION y FIREPLACE - ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Ig= 231.30 'A r f �O O goy dos 8 J C ! c v 4 OZ7±SF � Q o� O om om 00 ti w r r a a '22 _ W by CERTIFIED PLOT PLAN JOB # 84-36OAt LOCATION. L-17 RED OAK LN C ' VILLE PREPARED FOP.- SCALE: III ' DATE-, 4/8/87 REFERENCE. PB 398 PG 64 I HEREBY CERTIFY THAT THE BUILDINGS BUSS HAMLYN SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. ' BUILDINGS CONFORM TO SETBACK REQUIREMENTS OF THE TOWN WHEN CONSTRUCTED. Of I down cape. engineering AHNE �= i OJA 3 CIVIL ENGINEERS / f, LAND SURVEYORS ROUTE 6A YARMOUTH MA yk.� 1 +% DAT REG. L RVEYOR r °Frne A The Town of Barnstable • •naivsTnsc.E. • 9� " �e� Department of Health'Safety and Environmental Services 'OrFc ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. R 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 rtain exceptions,along with other requirements. Type of Work: Est.Cost � L Address of Work: Owner's Name N ctj c`l_o INKY %d1Yl n r rv► ie r Date of Permit Application: .64 6 19 - I hereby certify that: Registration is not required for the following reason(s): Work excluded.by law a _ Job under$1,000. Building not owner-occupied Owner 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: r Date ContrVik Name Registration No. OR Date Owner's Name The Commonwealth of Atassac h usctt v .: , ;; • . -•-. 1:_ Dc partnunl of ludurtrial.9ccidcnts 0lfice81/110st19211817s 600 11'a.0in;;tun Street Burton. A1urs. 02111 Workers' Compensation Insurance Affidavit �pPltc:tnt information: Please PR11VT lebl(� name: ",7r- Lx�, C!§,VVL& location: 44,E k,-i m., , c't �.A� P�IJV I ho tt I m a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity [)Tim an emplover providing workers' compensation for my empiovees working on this job. comma- name: address: city: phone#f• . insurance cn. policv t# [I I am a sole proprietor. neneral contractor, or homeowner(circle one) and have hired the contractors listed below who have ft the following workers' compensation polices: comnam• name: atldress: cir.•: phone N: insurance ro. nnlicv 0 ._..__._.... .._ ...�._....... _I_V_...�L.__._wrw._ ..—:iY-'._:..r1r •_— _- � -I �4 � _may, ,.— �`...� v__� compnov name: address: tits: phone##: i insurance co. policy#! .Attach additional sheet if necessary -_ __.... ....____....__.- . Ir�.a�rWY�f� —+:1..lZY►' �_ �..._�."-_'J.`�'._ '-."'ri4_` l{t'iJ.��E•Jwai�rlL F:Iilure to secure coverage as require)`under Section 25A of AlGL 152 can lead to the imposition of criminal penalties ol,ajline---upi to S1.500.00 andiur one N cars' imprisonment a.Well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that n cope of this statentcot mad be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herehr certift•nlnder the pains and penalties ofpc'rjurr that the information provided above is true and correct. r ,- Signature .� Date la _---, Print name Phone i; rcitval use unh Jo not write in this area to be completed by tin or town officialr town: permit/license i# rIBuilding Department Licensing Board O check if immediate response is required �Selcctmcn's UfGce r' [311ealth Department contact person: phone t!: r'IUthcr Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the employees. As quoted front the "law-. an entplt gee' is defined as every person in the service of another under any contract of hire. express or implied. oral or written. An eynpinrer is defined as an Individual. partnership. association. corporation or other legal entity- or and, two or nor the foregoing enzaged in a joint enterprise. and including: the legal representatives of a deceased emplover. or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. Ho\vever th owner of a dwellinu house having not more than three apartments and who resides therein. or,the occupant of the d\\cllin house of another who employs persons to do maintenance , construction or repair work on such dwelling, ho or on the gsrounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that even, 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 been presented to the contracting authority. Applicants Please Fill in the \vorkers' compensation affidavit compietely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers 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 an} questions regarding the "law" or if you are require-, to obtain a workers' compensation police. please call the Department at the number listed below. Citv or,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department 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 questior please do not hesitate to uive us a call. �...y.., rf -. ....-.� .-�.....w.....••-. -''ter'.-.. �..n+.raw!-`-+�+�a.......+�rv.; ..: w-•�•..!�..•..w..r.+vwhfs^r."rrw�+`Tvi...-.-,: The Department's address. telephone and fax number: The Commonwealth Of Massachusetts "r Department of Industrial Accidents Office of Investigations 600 NVashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . DATE (jh27 JOB. LOCATION ] OAK f 14/ Number Street address Section of town "HOMEOWNER" 14 J Oo R on i E 2� 2 ,K Name Home phone Work phone PRESENT MAILING ADDRESS R E D �) A K ILC _64EIV _� City town State Zip code The current exemption for "homeowners" was extended to include owner-occuDi dwellings of six units or less and to allow such homeowners to engage an ir dividual 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 r side, 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 structure A person who constructs more than one home in a two-year period shall not b considered a homeowner. Such "homeowner" shall submit to the Building Offi on a form acceptable to the Building Official, that he/she shall be resnons for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirement and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL, OF BUILDING OFFICIAL Note: Three family dwellings 35 , 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control.