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HomeMy WebLinkAbout0028 WIINIKAINEN ROAD F 6 , UPC 12543 NoNo HASTINGS MN oFWr Town of Barnstable *Permit# pErpires.6 months j iss�da Regulatory Services Fee ` • BARNSTABL.E, MASSv� , � Thomas F. Geiler, Director m E SO PERMIT Building Division Tom Perry, CBO, Building Commissioner MAR 11 2 I)11 200 Main Street, Hyannis, MA 02601 _ 11 . www.town.barnstab16.ma.us TOWN OF BARNSl ABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �1l� ( Not Yalid without Red X-Press Imprint Map/parcel Number Property Address 1;� fwr;7 t CQ,`�� :� ;� �,A.D e :'.J`\ ©-Cesidential Value of Work.J-t ; 6o Minimum fee of$35.00 for work under$6006.00 Owner's Name& Address �01)e,.(4 �A C� j&yy\ 4- Sl,t_C,1, h'r._, 4t. , c vv-�_ �b St'v\,V,` Contractor's Name 6YY,4 Telephone Number_ J-04? Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 0-1 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(stripping old shingles) All construction debris will be taken to ❑ Rye-roof(not stripping. Going over existing layers of roof) E Re-side. #of doors replacement Windows/doors/sliders. U-Value r 6. (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required. SIGNATURE: �. Q:\WPFILES\FORMS\building permit formslEXPRESS.doc Revised 070110 The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 low . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): l d C ( /-{- l ✓�-(�t/L Address: 2 (.,(.lXA[ �VI-e81 V� City/State/Zip: (.,)eS S-'� ��V"� Phone #: — G Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y p h'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: _, required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.[,lTl am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other Sk)e comp. insurance required.] wLKG)qq 0U) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cent er the pains penalties of perjury that the information provided above ' true and correct Si ature: c Date: 3 /a // Phone#: 3 6 z d 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 Town of Barnstable �ofixe r�� Regulatory Services Thomas F. Geiler,Director . asA.ss. � - 16S9. Building Division PrED AMt F. Tom Perry, Building Commissioner 200 Mairi•Sfreet,_Hyannis,MA_02601 www.town-b arnstabl e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOT11OWN'ER LICFNSE EXEMPTION Please Print DATE: JOB LOCATION: wb�l1� L(ti�e.l� �•(`_ w? � ►JCI r� S numb�e_r street / village "HOMEOWNER":�C�`aJ�� � �Za h 1�-� �(A: (� �� -3 name home phone# work phone# CURRENT MAILING ADDRESS: O To S 1 C i I- _s city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEYBUnON OF BOMEOWT\'ER 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 constrycts 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 buildinl?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. Signatbrc of o=o'wncr Approval ofBu�lding.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 scction.(Sccoon 109.1.1 -Licensing of canstruetion Supervisors);provided that if the homeowner atgagcs a person(s)for hire to do such wort,that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they arc assurrring the responstbtlitics of a supervisor(sec Appendix Q, Rulcs&Regulations for Licensing Construction Supervisors, rn Section 2.15) This lack ofawaress bftrn serious in sous 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 ultimatc)y responsible. To ensure that the homeowner is fully aware of his/her lzsponnbilitics,many communities require,as part of the permit application, that the homeowner eeftify 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 forrrJccrtification for use in your community. TTy Town of Barnstable ` Regulatory Services. vsAxxi %& Thomas F. Geiler,Director 0 � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign,This Section , If Using A Builder as Owner of the subject.property hereby authorize to act on my behalf, in'all matters relative to'work authorized by this building permit application for- (Address of Job) Signature of Owner Date Print Name If Property Owneris applying forpern-itplease complete. the Homeowners License Exemption Form.,on the reverse side. Assessor's map and lot nu er I r \ . ....... 4' SEPTIC SYSTEM MUST BE 40 INSTALLED IN COMPLIANCE ` . . Sewage Permit number :........... . .... /���%1%1/1.! � WITH ARTICLE it STATE SANITA4y CODE AND TOWN �Qy�F THE 'tp�0 - TOWN OF " BAUSTODLE, � NAM c BUILDING INSPECTOR war°'• APPLICATION FOR PERMIT TO C.QI7lSt UQA..J..gixigle...G.gr..°gs�x'&g2°....20�.R.20... TYPE OF CONSTRUCTION Wood October 17,...1976.....19.................................. ......... TO THE INSPECTOR OF, BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Wiinikainen Road, West Barnstable, Mass. Proposed Use Garage and storage .............................................................................................................................................................................. Zoning District R.E............................................................Fire District Trlest Barnstable Mass. .....°°.E. .............................................................................. Forrest W. and Wilma e. Lamb9 Same as above Nameof Owner ...................................................................... ress .................................................................................... Stanley E. St. Peter Address Main Street, Barnstable, Mass Nameof Builder .......................................... ................................................................. Name of Architect Owner same ........................................................Address .................................................................................... Number of Rooms Foundation Poured concrete %X1XK 0M(&UX Cedar shingles Roofin Asphalt shingles Exierior ......,.........:................................................. g g Concrete Unfinished Floors ......................................................................................Interior .................................................................................... None °......Plumbing None Heating .............................. ..................................... ............................................. Fireplace None................................................................Approximate Cost $ j500.00 .............. .................... ..................................... .. ..... Definitive Plan Approved by .Planning Board -----------___________________19________. Area /.... . ......5............ Diagram of Lot and Building with Dimensions Fee ......... .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH \9 0 JWC 1/ 1N v-Q qe, i . MI I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ,C....<<.... -y..... ............................ La~~~.^" .o^.==. W. ~^ _~^.~.i E. . . No —. Permit f�. ����Q�� ' + ^ ,�.. ------ . . ------^---.---------------- ����— ' ' _ � —----- — ine�— --- . -- ------.. �. ............... )I;.. ...................... Owner .............F; ..0... t ' frame Type of Construction .......................................... ' ^ --------------------------.. Plot ............................ Lot ............ . ^ October 18 76 ` Permit Granted -------------]V ' Dote of Inspection . —.--l9 ' W Dote Camo|ete6 .u�/�'. �—`----'l9 / ' ' . . . PERMIT REFUSED ' ' '—'—'--_---.----------- lV ^ . . ' '------------^-------------' . ' ^ .—.—.-------.------.-------.�— � � ^ .-----.-------.—.----...-----.. .---.------....---------.—..--,, - Approved .,------------.--. l� - ' ^ ' - -----------------~----..---. . ` . ------------------------.—.. . ' -� . Assessor's map and lot number .......... . Sewage Permit number ...... 0 P�OFTINET��♦ TOWN OF BARNSTABLE SAWST"LE, i o�Yae�� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....................................!:................. ......... ... .... .. ..1............................................ TYPE OF CONSTRUCTION .............................::.: : :................................................................................................ ....... ...... .:..... ...:......19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: L,pcation .... .................... ......... ......... ....... ......... ......... ................................................................................................ ProposedUse ;.....................................................:....................................................................................................................... Zoning District ..........................................................Fire District .............. .............. ..............................:::::..:......................... .....:... .:.....: .......... .......:........................Address ........ ...... ... ......... ...... . ........................................ Name of Owner .. Name of Builder ......... ......... ......... .....`...........................Address ........ ......... . Nameof Architect ............'�... ......................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ......................................................................................... Exie for .... .......:: .......:. .......:. :.:. .......:.` .....................Roofing ........ .......:. . Floors ......................................................Interior .................... Heating ..........:.......................................................................Plumbing ........................ ........................................................ Fireplace .,:,,,. ...............................................................Approximate Cost Definitive Plan Approved by Planning Board _______________________________19________. Area ,:::.....!................................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name :... .................. Lambert, Forrest W. & Wilma Fes .; A=132-16 �1= 18742 \garage No .................. Perm or .................................... ........... �� `.• .......................... ........... Location_7. A***�„Wiinikainen Roa West Ba onstable ............................................ .. ........................... Owner Forrest W. & Wilma E. Lambert Type of Construction frame _ ........................................................... Plot ............................ Lo ................................ 0 tober 18 76 Permit ,Granted ............... ............:............19 Date of Inspection ......... ... .. ...................19 • Date Completed .................19 PERMIT REFUSED ............ ...... .. 19 ........................ ................:..... :..:........... Approved .........................