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Home My WebLink About1849 MAIN ST./RTE 6A(W.BARN.) �Ll G�� . � s �- .� r .. .....;. I i ii 7 o i tl} A d d�t�r 4 9 M M $ ra Inc) `t pw�M0 r 1l, 7 0 1 0 c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 0tPS Health Division Date Issued Conservation Division Application Fee b Planning Dept. Permit Fee a Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis p{�` Project Street Address ISLI01 AID./ ST(Z EF i ��i (o Village WtS 1 Owner ::C n&cs �_ypL T-P��0a- Address SAm Telephone&o E) 2!J7-N/L1 S_ Permit Request gedlarz ,�5r+;Ar, cLmae _ S:� v`�� er�a,`n IL sg,&_x-- QS IfX-5h AG Uln;T I q �q I ) it g—J iA 4Ve- Gt Ai"', ICL veneer. Square feet: 1 st floor: existing proposed �2nd floor: existing�{�roposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type_R0.Q �A( Lot Size 1.A5 S Grandfathered: ❑Yes ElNo If yes, attach supporting documentation. Dwelling Type: Single Family C// Two Family ❑ Multi-Family (# units) Age of Existing Structure ;95Legish Historic House: Q Yes ❑ No On Old King's Highway: ff' es ❑ No Basement Type: if Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) 9 Ia Number of Baths: Full: existing 3 new Half: existing p new Number of Bedrooms: existing ---new Total Room Count (not including baths): existing new First Floor Room Count _5— N —a Heat Type and Fuel: dGas ❑ Oil ❑ Electric ❑ Other c' Central Air: 0 Yes �No Fireplaces: Existing New Existing wood/coal stovey ❑YesErNo Detached garage: ❑ existing ❑ new size—Pool,: ❑ existing ❑ new size _ Barn: O'existing .Llnew3!size— Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: rya Zoning Board of AppealYNo thorization ❑ Appeal # Recorded ❑ __ n Commercial ❑Yes If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)) Name T-AmES -'-1AVAj, Telephone Number ko 1 2 S 7 e-I/YS Address In j MA-Id LAW CL-j License # f -- r M-A 026/off Home Improvement Contractor# } Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE t., FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED i'f4 MAP/PARCEL NO. +St t t ADDRESS VILLAGE ,# OWNER-, s DATE OF INSPECTION: FOUNDATION `t i 4 FRAME INSULATION FIREPLACE y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ' FINAL -' ` -GAS: ROUGH FINAL # FINAL BUILDING DATE CLOSED OUTt ASSOCIATION PLAN NO "•' ; r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,M4 02111 :. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): y�c S --J�j e.l -Address: N 9 ;n S4,,e_,-r City/State/Zip:Ve,+fZai sj,� ,'M A n,21. Phone.#:&o�� a 3 7. 1-/ Are you an employer? Check the appropriate box: -Type of project(required):. 1.❑ I am a employer with 4. -❑ I am a general contractor and I 6. El New construction . employees(full and/or part-timel.* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- • listed on the-attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 'g, ❑Demolition working for me in any capacity: employees and have workers' [No workers' comp.insurance comp.insurance. • -9. ❑Building addition Xquired.] 5. ❑ We area.corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions . 3. I am a homeowner doing all•work ❑ g P myself. [No workers' comp. right of exemption per MGL . 12.�of repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below.showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractois 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 ce fy under the pains•and penalties of perjury that the information provided above is true and correct Signatar e: Date: Phone#: Official use only. Do not write in this area,to.be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): .1,Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: . IME Town of Barnstable Regulatory Services ' BARNSTABLF f Thomas F.Geiler,Director 9 HASS' 1659. A Building Division rED µp't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: /"I A1 I Sfi- number street village HOMEOWNER":_ Vie S 37^q/Y name ?come pilone# 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 re cements. S gnature 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 permii is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt °FEE r Town of Barnstable ti Regulatory Services * BARNSTABLE, 9 MASS.. g Thomas F.Geiler,Director �A i639. �0 lE039. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 s ` 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. (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 Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 Town of Barnstable Old King's Highway Historic District Committee 200 Main Street,Hyannis,Massachusetts 02601 1650 (508) 862-4787 Fax(508) 862-4784 CERTIFICATE OF EXEMPTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts, 1973,as amended,for proposed work as described below and on plans,drawings,or photographs accompanying this application: Date Address of Proposed work, Assessor's Map and lot# )(c D AID, House# _Street A,•n s+".,l- Village: 00tn5fiu4� This application is for an exemption of the proposed construction on the grounds that work: 'l ] Will not be visible from any way or public place ❑ Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other j Description of Proposed Work: 9 Aace 1 ey; „c, `�aVr CA) e �n{ ?%e �v� ++I5' (G`� �( _�c�.� f'h•m vi r-� G 1nct SE c t l�1 In�, 00A tyA( b6 Oct I-L J- WA, 61,j Agent or contractor(please print): Tel.no. Address Owner(please.print): T e S � ,n t- Tel no. � , a 37-v/<f- Owners mailing address: n Signed,Owner/Contractor/Agent ,.tikl For Committee Use Only This Certificate is hereby Approve&Venied Date: It 20 kZ� Committee Members Signatures: RZOgED owTD; T�MG01 JUL. 112012 aR Town of Barn-iariie Any conditions of approval: Old King's Hi va Committee C.(Documents and SettingsldecolliklLocal SettingslTempormy Internet F11es10LK110KH Exemption Form 07.doc z W x � x , 3 LLI y -a, ,E 05 i t • a E4 z LU C-i x y r N G: is= r--4 m m E 0co _3 CCU 01 pt Sf u ? kt 3 3 r ,x 4� Page 1 of I RECEIVED JUL 10 ZOIZ GROWTH MANAGEMENT APPROVED JUL 11 2012 Town of Barnstable Old Kings Highway Committee http://brickit.com/images/450/RUSTIC.jpg 7/10/2012 Town of Barnstable Geographic Information System July 10,2012 7013 #1960 ;r 1960' 217033 217009 217002 g 820 #1834 01809 217001 cult 217010 . ffi 1950 217011 11868 ��y 217012 216050 `rA 01894 W#231 216033 ♦ 01837 G� . 216021 ffi18 1781 0 216031 0 1781 216051 01856 01912 198007001 218052 01721 i #445 • *18030 to 06804292 ffi 1071 4 rfawa4 216032 ffi 1851 216063 216025 196007002 0 67� ffi 1895W ffi 36 AD • 216029 216066 ffi 1919 ffi84 211�87020 2ffi 2160716024 0280 IP/OGERD 2 so , ffi 96 216056 216061 2IW71 8 C � 21 6047 i l ffi30 216082 � 022 0991 216OR ffi20 21602S 71 Feet 040 216083 024 216028 218086 ffi 10 ♦ 0 ffi952 0961 DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:216 Parcel:022 .Q boundary determination or regulatory Interpretation. Enlargements beyond a scale of owner.TABOR,JAMES A&LYNN A Total Assessed Value:$443600 Selected Parcel V-100'may not meet established map accuracy standards. The parcel lines on this map •, 1111 are only graphic representations of Assessor's tax parcels.They are not true property Co-owner: Acreage:1.25 acres Abutters .8: boundaries and do not represent accurate relationships to physical features on the map Location:1849 MAIN STJRTE 6A(w.BARN.) • such as building locations. Buffer % ' 4- -o TKIPLE HEAW- - TK I PLE HEADER �i ii ' - ( rP T �I li V2 blot• aF�� 7„ TYP i (2 PLc5�. li Ii a i l .111� I I "To cctD HoAt Bol:Teb To FAZE K6 z x 4 STu p5 it ,I I I `l . _rAVX CHiMlu '( JIpi 'A 15+9 �tjA Id 3T zX4 Pt. P�arE� �J�oT aAIZ�.�T�gl.�, Ml�, CrAftG Gud V' Bkk hGA 6 1" - I`O . Town of Barnstable *Permit# Expires 6 montits from issue date Regulatory Services Fee Thomas F.Geiler,Director ]Building.Division ` RED Tom Perry,CBO, Building Commissioner y �RMY 200 Main Street,Hyannis, MA 02601 ��t ; . www.town.bsm table ma:us `- 2011 Office: 508-862-4038 r �UUN tJl~a8;; 3 EXPRESS PER 41T APPLICATION - RESIDENTL4L ONLY Not Valid without Red X-Press Imprint Map/parcel Number ( � Property Address I U 1 IV) r ► 1 0 Residential Value of Work I t • Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addressno YVI11 ��-• Contractor's Name Telephone Number � ` O T J Home Improvement Contractor License#(if applicable) 0 Construction Supervisor's License#(if applicable) I I ❑Workman's Compensation Insurance VmI one: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name W orl man's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) /Re-ro.of(stripping old shingles) All construction debris will be taken to VyS QS� ❑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: Property er t 'gn Prop rty Owner Letter of Permission. A copy the H e rove nt Contractors License is required. SIGNATURE: Q:Fonr,s:expmtrg Revise061306 -T m 1 t r'THE 7 'Town of Barnstable. . r Regulatory Services BARNSTABLE, y MASS. Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,hJA 02601 w�'w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section Tf Using A Builder as Owner of the subjectproperty . J herebyauthorize to act on my behalf, in all matters relative to,work authorized bythis Molding permit application for: . (Address of Jo ) I I Iq i f Sig ature of Owner Date Print Name WOILM S:O W NERP ERMIS S ION I - The COMMDnweaUh of Massachusetts t Department oflndustrialAdcidents Offtce of l"nvestigattons 600 W,ashinbdon Street Bostoit,AM 02-1-11 Mww mass..gov/dia Workers" Compensation' Insurance Affidavit: guilders/ContractorsX]ectricians/Plumbers Applicant Information Please Print I.,e 'bi Name(Business/Orgaaization/Individual):. Address: �� 1)3 City/State/Zip: ft�nots-, mr! -0ZvoI phone.#: Are you an employer? Check the appropriate box: 1.❑ iia a employer with 4. [] I am a general contractor and I Type of project(required): oyees (full and/orpart-time).'" have hired the sub-contractors 6. 0 New construction•sole proprietor or partner listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub--contractors have working for me in any capacity. employees and Have workers g' ❑Demolition [No workers' comp,insurance comp. insurance.t' 9. 0 Building addition required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions -3.❑ I am a homeowner doing all work officers have exercised their 11 Pl berg repairs or additions anyselE [No workers' comp. right of exemption per MGL insurance zequired.] t c. 152, §1(4),and we have no 12 Roof rep airs employees. [No workers' . 13.0 Other ------------- comp. insurance required.] *Any applicant that checks box#1 must also fin out the section below showing thcirwurkcrs'cumpenaation policy information. t Homeowners who submit this Lf idavit indicating they ar name doing all work and tbcn hire outside contractors must submit a new a$idavit indicating such. FContracturs that check this box must attached an additional sheet showing the of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have eorployecs,they must providt:their workers'co Policy number. • r"P•P Y i o an employer that is providing ft�orkers'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 fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of the bIA for insurance coverage,verification. I do he eb ,ender t e pains• penalt es of perjury that the information provid d ah ve is true an'd correct, Sienature: I( ` Date: Phonc Official use only. Do not write in this area,'to Te completed by city or town oliciaL City or Town: - Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3. City/Town,Clerk 4.Electrical Inspector S.TlumbingInspector 6. Other Contact Person: . .Phone#: .,_ � - )..r:. , .. .,; _ "u."-."✓' .y -:i"«�,.i�:-` •±+`•t'r�,i+�'�,:�:�s �r�:�::'�3 n' Y"�*K3+'. �y-t3"§dl�ea r y .�Xt}.,�''3 �':.. � / r vi''r Y .c.`.+,raxt ,/3'd=tip �, .._r .y° �` -�rf•�'+�r �f `?� taw.�5' ;:{�,+�"'�+� .Y'�, ° � Ir y .sy;r!t.*� ••' � - :x, t � a VK �''°��- i� ..'der na '�<'�'Z�"� I +e1 r "�'%c 1 "5��3-� ar��, ti 1_. � .f•A `�': Q�'i��'�°' r,r a y,�a '?l5't'.r �,:'Sry ''�+,�'+.��.��-}?r+�• fit,S. '1 7 :.z.,x�}.w', ,��* K..eS�i�.ail• �,�y..ti-:. � ,�- a ;f;7 s. . ., - �iJ{'a�.:t �t��i+r�� s:}i,?.C-1.f:31B�.4ut;t�tisllr�fr'�..x,.,,hx�.F.11a; s�Gie��yts�:��1!t a -�e "r'-��-`'_-ti_:..1;� �{...�a.3 ff�"-'r_.c.i.- -.t xt:r�u* h -J••- ;�c r.1-i:f i�+;� �k�.yi..v„ �.C��N`!'a�.. ::�4!�l.�L: 4.. 1� " .Y.•7.•. \ti i `Yl.n �. .11,. �'. h .:.W±w, .i.^ l- •'�l� �'°�.Trt'±f��t. ; .:,r"�`;M'',r`3F ;•Y�wv�,X�t u',? l: ^` Y•' �'� q. ' r �-��•-t + ' ,�' �'a�r�, .. � +t v i.,�''}`• ,, t �°.�` s.. " "ate P�_ �'9`,.;,rr '{-::: � .. , ? ,. - � - ,. i ... w � 1 s at i .,� soh t t"--n.'� -k,s•r y fr * �;=L7` t r _ .-.- F:. - .� ,y . . + .- F x e.a` F i_i"y:�' ,..,t ��.1� � r ry y - x' j)?. ;.d�•s^ � � -,y. v � �. ,-.Y.'+ fir_:?. ,.'a( t5 ..} . .�. .t_' y r x. � +¢.. }•> -. � _ --. - s-..--- '--- �-� , ..+�- � a ,.. R �+t: ` t t'i..c 'ti 'c � i-� c r t....'� k'. .�'� z v3.. rF c `'^•-++• ,tc • tty>ar ...� .+,�_... ..e.,. � .. -). i3 .t .S- .•L-�v ..<'. •Lr �`i 1 4-. -'"v .3 sG. .� M: i.-. ,i_.-v S �-r_�! ' �•K r ., ...:,..,, •..- _•:.:e:�' ._.. : :.j.:1 .-p.:.erv. ��t-r.�-;.r"!.' a - «.+'3=� .:*.+it'Y Y t `'-�` �-i:�'a`',T3��, s:h'� k. •.:y :s. .r:3'•4.i7 c�; �'•--a" :;�+x,: .�` �'4"' ntf"- '7��..(„'"".c"'��tn'w •-.T.s+- -.t<�_ac,-•�t;3;...'},.�.�A•�.''`,''r�,5�."'•'%��"r-s'.. .:) Y �_; �=4.-�.- ..:1^. -5-. _,•f`; _ • • 1' 1.. • 1 1 1 �•- Massachusetts- Department of Puhlic Safety Board of Buildin- Re;*ulations and Standards Construction Supervisor Specialty License License: CS SL 99138 Restricted.to: ,U.N.S. JAMES CURLEY I j 287 FULLER ROAD. CENTERVILLE, MA 02632 ' i r •.� j ��- �y�"�� Expiration: 1/28/2012 t: Commissioner Tr#: 99138 ' lie;"t� a�,�aeaacfu�deGYa r' � .„..zx..in.i2 ;dards—Boa doCBuil I ul use only r Xistaion �aliqforind-j4 HO E IMPROVEIY NT CONTACOR before the a ;iration dare. found return to:Re E'stirraaEi Qon.:.1y�g Board- Bi di�bReg ? _ . � 12 "fio sanr-S andards - —Tr# 1 0873 One Asbburtop Place Rm 13 ems:andWid al Boston,Ma.0 108 YP, James urley James urley ,. =-�-C e, A 02632 Administrator __• _. Not_yali,:without �e ore ' I t •�r ,i q' [ reFN •.I a. r _ ! �r w .fit -!- -"r ':'!r �° .Jim: M+�. Y,� _.£i �.,,� „_� '�.K„«ku'S•,.,�i'�CPt. .+1�.1`.-= k.4 rc. "�cC�.�� - i -�! :-, ;,Mak./4Y�. � _ k' ••.� ql!'F�., � w i:`•Ka �.,7'[, 4 �- .� `•'t,� _ �fi,''{t1".��vtv�,v �`" ? r;- �` a �T".:4.�,.+c.' 4 :'ar^�� ;� �'' '�ra'*�.��' `P:s•� � v�+-?•r' :.�.+5•, � .'.�.-�'�4� \ � .�!" ~ -{ S•;.•nyit.rF. r y" v ,� -.iwr ,r. rR, .. -`� •• :'� a ,�-� _'�. R�+o.�« _ r�.: o_'t `'�,. ''.� `:- 'e'�..=. 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"� �F.r r. �.•,r:.yam ' -yr' f . r . a atl• r d ��r _� ,� `.. tau y"`h 1 �a .� ,� t`w' d _ t S � � y r ..: � w iM��•.va � �'�i ,F„�".R.`� J� � ,t �� _ �� i ._ rJ� yet• � a� - _ .. � .. ±s r 1�^ y. vy a �T K w � ,�,�:z r�` yi` "`9C•'w\ � ��,� S" j # '� ,'1. •fie _ i 14' t� Town of Barnstable P—* ermit P C�3�� 3 of rq�, Expires 6 inonlhs from issue da e Regulatory Services Fee 7, r r BARNSfABI.E, + 9� MA38. Thomas F.Geiler,Director 1 39. �0 'DTFG MAC p Building Division Tom Perry,CBO, Building Commissioner ,Q kill 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number noa Property Address �� 1 1 Eg,Residential Value of Work A -Zoc�_— Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name //�� Telephone Number Home Improvement Contractor License#(if applicable)�,1 A Construction Supervisor's License#(if applicable) /A e ore wo.r r, M. . _ ❑Workman's Compensation Insurance JUL 2 3 2010 Check one: ❑ I am a sole proprietor (�I am the Homeowner TOWN OF BARNSTABLE ❑ 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) E�_`Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. I ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement.Contractors License& Construction Supervisors License is required. I SIGNATURE: QAWPFILES\FORMS uilding permit forrns\EXPRESS.doc Revised 072110 The Corrrrrrorrivealth of Massachusetts Department.oflndustrial Accidents Office-of Investigations a 600 Washingtorr Street Bostm, AM 02111 ``�=� vi�:�-nt�.rrrass.gov/rlirr Workers' Compensation Insurance Affidavit: Builders/Contractors/E-lectiicians/PltLmbers Applicant Information Please Print Legibly Name(Bus-iness/Organ?ationllndividwl): _Tryy S CZLf Address:JSl4c't .Jlfa;A S}, "- — City/StateJZip: oy4- a Phone g: 5'O 3 Are you an employer"Check the appropriate box.- Type of project(required):. 1.❑ I am a em to yer vnith 4. ❑ I am a general contractor and I p } * have hired the sub-contractors 6. ❑New construction employees(full and/or part time). 2..❑ I am a sole proprietor arpartner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑:Demolition working :for me in any capacity. employees and have workers 9. ❑Building.addition (No workers' comp-insurance comp.insurance., required.] 5. ❑ We are.a corporation and its ME]Electrical repairs or additions 3.(t4d am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers'camp. right of exemption per MGL 12.�oof repairs insurance required.]r c. 152, §1.(4),and we have no employees.[No workers' 13.0 Other comp.insuranoe.requir-ed.] Any applicant that checks box#1 must also 5ll out the section below,showing their workers'compensation policy information_ 1 Homeowners who submit this affidavit indicating they are doing a.0 work and then hire outside contractors must submit a new affidavit indicating such_ FContractors that check this box must attached an additional sheet showing the name of the sub-coffiracrors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer that is proiidutg rporkers'cottrpensatiatt irtstrra.ttce for itty employees. Below is the policy and job site utforti atron, Insurance Company Dame: Policy A 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. I52 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one- . year imprisonment,as well as citnl 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 leerebv c. rtii under the pains and penalties of perjetry that the information prm ided aboire is trite and correct Signature: Date: - —/ Phone#: —Wy Official use only. Do not write in this area,to be completed bye cite,or torten official. City or Torn: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/To,"m Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: v. ' , ' O�IME r, A L/V T 11 111 JLJ Cal 11J 1•94 RJAV -~ o Regulatory Services tvszns> Thomas F. Geiler,Director 1 ,0� Building Division AlE p�y t. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 19 y ' ✓� ram— s L�rnS �(.� number street village "HOMEOWNER": name home ph ne# 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 reqtkx, ments. - Sig ature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILESTORMS\homeexempt.DOC MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 12/22/2009 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.3B BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: MARY E ALDRIDGE Property Address: 1849 ROUTE 6A, BARNSTABLE,MA 02668-1120 Policy Number: 0827826 Type Loss: Fire(including Fire caused by Lightning Date of Loss: 12/19/2009 Claim Number: 269308 Claim has been made involving loss,damage or destruction of the above captioned propert,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division J CMA00021 v YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L-it does not give you permission to operate.) Business Certificates aim available at the Town,Clerk's Office, 1`FL,367 Main Stredt.Hyannis.MA 02601 (Town Hall) DATE: Fill in please: j APPLICANT'S YOUR NAME: inji &at BUSINESS YOUR HOME ADDRESS: t`6Lf TELEPHONE # Home Telephone Number `i O� (P �i 1 cj NAME-OF NEW BUSINESS'. HL t4 /�L-o TYPE QE l WSINESS. Ci. V---\ IS THIS:A-HOME OCOURATION'.O .:Y-E'9 NO_,K_ H .ve You been given appr ival from zhe:buildit�g.:clivision? XES NO } ADDRESS OF BU§INESS �6 `�1 �- g'AROEI;:NUMOER (2 When'starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST-GO TO 200 Main St.-!...(corner of Yarmouth Rd.&Main Street)' to make sure you have the appropriate'permits and licenses required to legally operate your business in this town. 1. BUILDING COM NER'S OFFICE This individu 1.ha, (e n 4qf a any permit requirements that pertain to this type of business: wt Aut oriied ' nature* COMMENTS: Ph ean 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature**. COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: