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HomeMy WebLinkAbout0349 SHOOTFLYING HILL RD � S���i i ���1 � � �� r ���, .ra�u.�.....mv4��l•.•�� _ .:... .er o- ... ,...._... ,:snaW::a��iuy..+ '. _...__,.���..��_ _ � - -- __ —__ — -..anti—• 4�1.�.a�.e.�.i+.a..a - _ - �. �_— _ �, .. uu ® 5 UPC 12543 No. 53 LOR wAc��Nr,S MN • _ _._-....r-:�rvr.. ---��-_..�.e..zi-.s�—_T-�_�.e�...c.-_.�....�:��,.v,........-_.�.� -.�-..._tea.=_..�..�. __.� ,v.'.btia�+ Fit, .. .. . . . .. oFzr ,�, Town of Barnstable *Permit# D 9,027 Expires ti months from issue date Regulatory Services Fee j f od • BARNSTABLE, v� rrnss. Richard V.Scali,Director Uff 1639• ArED N1 Building DiviAnPRESS PERMIT Tom Perry,CBO,Building Commissia�ne 200 Main Street,Hyannis,MA 0260,1 Il'C( 5 2015 www.town.bamstable VJN OF BARNSTAR� F Office: 508-862-4038 �`>�: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number a-� 0j � �a.W D� Property Address 3 L i � esidential Value of Work$ 10 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L-J(,1 m r / Contractor's Name� a �/2 ri � /li(L [ A" Aj kve )Telephone Number )Z7%7�� Home Improvement Contractor License#(if applicable)/V J-63 Email: 114011 ; , 41' © "11 U�„a12' Zorkman's ion Supervisor's License#(if applicable) Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner have Worker's Compensation /Insurance p Insurance Company Name lit$ I (F Ua•�r/� Workman's Comp.Policy# eAL-1c 59-7 (9 2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) Z Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to A/ Wa f T e, ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side e37i replacement Windows/doors/sliders.U-Value 0, jy (maximums#of windows G #of doors: 2 ❑ 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 RMS\building permit forms\EXPRES Revised 061313 - .. .. ...... ..... The Commonwealth of Massachusetts T Depar'tment of In&strial Accidents �; . . Office of.Imiestigations 600 Washington..,Street Boston,M4 02111 wlivw.ntasmgovfdia Workers' Compensation Insurance Affidavit Builders/Conta,actorslElectizcians/Phunbers Applicant Information Please Print Le 'bl Name(Susmesv'OrLgjaniz/aaionrinditiidual): L �L Address_ Z City/Statc,'Z p.- Phone#_ C!g 7- �l/ Arezam employer? Check the appropriate boz T of,project(required): 4. I am a general ronfractor and I l'T�' p J 1. employer with� 6- ❑New construction employees(full and°or part:-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on.the attached sheet. 7. EJ R! modeling ship and hate no employees These sub-contractors h,,n a 8- ❑Demolition working for me in any capacity- employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp..insurance-1 required-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work offceas.have exercised their 11.❑Plumbing repairs or additions myself- [No workers'comp_ right of exemption per MGL 12.[_1 Roof repairs insurance required.]T c-152, §1(4),and we have no employees-[No workers' 13.0 Other comp.insurance required.] *Any app&ant jai checks box Rl*mast also fillourthe section below showing their wo3lees'coropeumhon policy information. #Homeowners who submit this affidmrit indics-ting they are doing all wmk and den hire antside contractors nmst submit a new affidavit indicating such. Gongtors ihs check this box roust snached an sddidowl sheet showing the nave of the sub-contra'ctm sad state whether or not those entities have employees. If the subcontractors have employees,they mustumvide their workers'comp.policy number- lain an employer tlutt is prot,iding it�orkers'congwnsaliort insuratrce for city eHIplot ees. Belo» is the po&cp and job site h7foratalion. Insurance Company-tame: &,.s (�v Policy I or Self--ins.Lic-9- L ) C Expiration Date: C /J Job Site Address: .�Y y S� t" � f'kt�� City/State/Zip: 9✓A� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure,coverage as required under Section 25A of hfGL c 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 andfor one-year i npsisonment,as well as cizril penalties in the form of a STOP WORK ORDERand a.Em of up to S250.00 a day against the violator. Be advised that a copy of this statement maybe fDmwded to the Office of Investigations of the DLA.for insurance coverage verification. lido Hereby0deenr the rtalties of perjure thatthe informationprotzdediabot,s is true and correctSienature: 3 �— Date: // 1s Phone � l/1 Z II Ofj`icial use only. ➢o not write in this area,to be completed by city or ton?n ofcia£ City or Toren: FermitUcense 9 Issuing Authority(circle one): 1.Board of Health ?.Building Department 3.CitytFown Clerk: 4_Electrical Inspector S.PIumbing Inspector 6.Other Contact Person: Phone#-_ PROF THE lti a� + BAMSMBLE, "� ,0� Town of Barnstable ATEO�,t A Regulatory Services 1 Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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 If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 i Town of Barnstable Regulatory Services °FTHE l° Richard V.Scali,Director Building Division BARNSTABLE, ' Tom Perry,Building Commissioner S. 1639. ,�� 200 Main Street, Hyannis,MA 02601 prEO MAC p 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 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/hgr responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 -- U/ze cponvnaarzusP a�Caac�iccoelt OExpiratiofi.R—.671'9120-16- ice4d'ftoiisumerfAffairs"!-.,Uusivess RBt9ilititi*.. ME IMPROVEMENT CONTRACTOR., i egistration; :10050.3::, Type;,`f. Supplement .l CARE.FREE HOMES',':JNG.::=,= :'s>` j DANA PICKUP JR. 239 Huttleston ave ^`~- Fairhaven,MA 027..U9 Undersecretary Massachusetts Board4of' Department of PSafety Buildin `: Public 9 Regulations-arfd S.tarid;) Construction Super.%.,, ards or License: CS-095228 DANA JPIC 9 HuttlestonKq¢ Fairhaven MA 11P719 l ' iComrimissiDner '.:. Expiration 03/22/2016 r Unrestricted-.Buildings contain less of any use group which than 35,000 cubic feet(group. hi enclosed space. of Failure to Possess a current edition of State QuildiB Code is n the Massachusetts cause for revocation of this license. For DPS Licensin ' g information visit: www Mass.Gov/DPS I ;Licerwe or"registration vaha.for iadi idui use only before the expiration dote. If found return to: I office of Consumer Affairs and Business Regulation { IO Park Plaza-Suite 5170 ;:id Boston,MA 02116 :• .: . Notvajid.wi ou sign iiie' i%F7P. CAREE SInc. 239 Huttleston Avenue Fairhaven,Mass 02719 Telephone 508-997-1111 Fax 508-997-1297 Website: www.carefreehomescompany.com To the Town of i �, S`T�✓-���`� 4- —z v IC C Job Address: 14, f le I, U ( n I SO 2 , owner of the home Customer Name at the above location, authorize Care Free Homes,Inc. as my agent to obtain all necessary permits and to perform all home improvements to my home as stated in the accompanying contract and application. Customer Signature Date �_ r a COMMONWEALTH OF �SACHUSETTS —E� DErAK:MFNr OF r.NDUSTRIAL ACCIDENTS Goo WASHIT`'GTOI�' STREET BOSTON, MASSACHUS=S 02111 jarnes.: CaMODe 'c--nrssione• WORKERS' COMPENSATION INSURANCE AFFIDAVIT i 1, Joh v 1) 6002Q cJE (licensee/permi ctcc) with a principal place of business/residcncc at: _ ,q/ 9 J�, Zc le / (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: 41 am an cmploycr providing the following workers' compcnsation coverage for my employees working on this Job. . M4 v-e lie 2s l,,us o ]nsurancc Company Policy Number i ( j 1 am a sole proprietor and have no one working for me. m a sole proprietor, general contraaor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compcnsation insurance politics: Name' of Contractor Insurance Company/folic% Number .N'amc of Contractor Insurance Company/Policy Number Dame of Contraaor insurance Company/Policy Number Q 1 am a homeowner performing all the work myself. NOTE: Picric be aware tbat while homcowacrs who employ persons to do maintenance,construction or repair work on a 'd:yclling of not more thaw three units in wbicb the homcowacr also resides or on the grounds appurtenant thereto are not gcocralh• considered to be employers under the Workcrs'Compensation Act(GL C. 152,sea- 1(5)), application by a bomcowncr for a liccosc or permit may evidence the legal sutus of 2m cmploycr under the Workers' Compeosation Act i uaoerstano that a copy of ties sutcmcnt will a fon+•ardcd to the Dcpa:t ncnt of industrial Accidents'Ofiiec of lnsurancc for.eover2;c wrifiution and that failure to secure coverage as rquired under Section 25A of MGL 152 can lead to the imposition oWm+nal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil pcnalrics in the form of a Stop Work Order and a fine of S100.00 a day against me. 'Signed this day of 19 ccnscc/PcrmirEcc Licensor/Pcrmiaor I p W r U O Q = co Z � N W O W 1 w In Wc J O _..I CD Ce d b a .� 0a CO C= O 1--• v� a a a ` O a K p p R , S CC 1— W cc ti c 1 1 0 � J l / j wig Assessor's office(1st Floor): , I // L Assessor's map and lot number ee0 C22 e r of THE Conservation(4th Floor): Board of Health(3rd,floor): ' r ! , • ssaJISTUL Sewage Permit number MASK Engineering Department(3rd floor): _ ' i639' \off House number y� r r �o Definitive Plan Approved by Planning Board 19 + APPLICATIONS PROCESSEDr 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE i .BUILDIiNG IN. SPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION _ 19 TO THE INSPECTOR OF BUILDINGS: ,The undersigned hereby applies for a permit according to the following information: v-7 'Location 9 Vh/tD f 1�/✓/N4 /'ti�/ Tl7 Proposed Use i DPAI ii.4 Zoning District Fire District Name of Owner re&V /I;A)Q,-,Je Address Name of Builder���19rt2�1J F Address Name of Architect Address Number of Rooms Foundation Exterior Roofing :Z�Fq ,Wh&/T Floors Interior Heating Plumbing Fireplace Approximate CostSoo. oa Area Q T4Eq© ®o 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. c,l�_ lov�ww'/!F1" Name Construction Supervisor's License 6,5 7 V K.INGSLEY, EVELYN (0'z No-3'�� Permit For RE-ROOF Single family dwelling Location 349 Shoot Flying Hill Road , . . --C-e:ri-ttira-�le- CcSfUtFf-FFl.I� Owner Evelyn Kingsley Type of Construction asphalt Y ' Plot Lot Permit Granted October 8 ^. 19 93 Date of Inspection: Frame 19 Insulation 19 Fireplace 19 y. Date Completed 19 y.a 1