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HomeMy WebLinkAbout2481 MEETINGHOUSE WAY/RTE 149 0 0 �. ..f. ,._�Y�-' ,r �� n .. �- .. _ _ ,., -.. I I ' I a i I I I Uu fill NR �� HAS►INQC MN ° ._..."tel5�d7i&ei�'r:Y� .::_..,�.n6:tie6..: - --_.,.. �lrec.':be�r=rete3ic�i.,ltrr�� .:�.�'.�r.�..raL.,;:.' - - ........_..aa,�n.:�:ta•:a::eaxW ,.2,.._....:r,....,...�,�,...z..:ta-=. o oF� Town of Barnstable *Permit# ylbg & Expires 6 months from issue date Regulatory Services Fee Aaccc • anatvsraaLE. mass. Richard V.Scali,Director 1639. AjE�MAC A Building Division Tom Perry,CBO,Building Commissioner 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 ( p- ]� p r /�/ Property Address *a`"1 D 1 r� I 1" 19 W, 8"Ai. ) d 1.:� Residential Value of Work$ 4d0r O"O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address D 1A G- PA C l UO -a-. 01qu 1111 M W, Contractor's Name U kk - yvL�`� j Telephone Number <<jC�_5166 s,.?�C 9 Home Improvement Contractor License#(if applicable) f q � Email: © 1113 .-®CMAJ L o COW1 Construction Supervisor's License#(if applicable) ® -1- ❑Workman's Compensation Insurance Che ne: R , I am a sole proprietor ❑ I am the Homeowner DEC ❑ I have Worker's Compensation Insurance To c 4 2glS Insurance Company Name WA/ 8A Workman's Comp.Policy# OLE 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-roof(hurricane nailed)(not stripping. Going over existing layers of roof] ❑ Re-side o 3 Z ❑ Replacement Windows/doors/sliders.U-Value (maximum:45)#of windows j #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 requir SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 e �1 The Cornniomvealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,M4 02111 iviviv.niassg ov/dia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/EIectiicians/Plumbers Applicant Information Please Print LegibIy &i Name(BitsinesvOrganizanon/Indual): D, t wz—'� Address: F O, 00>X LI L 1 City/StateMp: C—, /V,1+ 0,95 3(, Phone 4- 3_O —_5 6 �•2- Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. �a general contractor and I 6. ❑New construction employees(full andtor part-time).* have hired the sub-contractors 2-❑ I am a sole proprietor or partner listed on the attached sheet. ?. ❑Remodeling slip and have no employees These sub-contractors have g_ ❑Demolition working for me in an capacity- employees and have workers' � any t5'- 1 9. ❑Building addition [No workers' comp-insurance cam-insurart 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 ILE]Plumbing repairs or additions myself [No workers'camp- right of exemption per MGL 12.❑Roof repairs insurance required.]T c. 152, §1(4),and we have no employees.(No workers' 13.❑Other comp.insurance required-] ;Any applicant thai checks box#1 mn9t also fill out the section below showing tbeu workers'compensation policy informstim Homem% ers who submit this affidavit Lu&cating they are doing all wcA and dum hire outside contractors most sttbnut a neur affidavit indicatig such. Contractors that check this box must attached an addssional sheet showing the name of the sub-couanctan and state whether or not those entities have employees. If the sub-contractors bate employees,they m sr provide their workers'comp.policy amnber. I atn ari employer that is pros idi►ig tnorke.rs'coutpettsatioti itts ira.itce for city eniplol!ees. Below is thepolicy grid job site informadom Insurance Company Name: Policy#or Self--ins.Luc.#: Expiration Date: Job Site Address a �� / 1 i City/state/zip: IV y 746 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 S 1,500-00 andlor one-year imprisonment,as well as cMl 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 DLA.for insurance coverage verification. I do hereby c " r under the ins aitd penalties of p 'ury�tltatthe itiforittation provided above is trite aitd correct Signature: rr Date: f Phone?#: JOR �2_�. Official use only. Do not write in this area,to be completed by city or ton i official, Citv or Tom : 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#: t. Town of Barnstable � Regulatory Services BMtNS ABM Kass. g Richard V.Scali,Director 039. A Building Division T-om P-er-r-y—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 Paff'f C o , as Owner of the subject property hereby authorize �� (,�� to act on my behalf, mall matters relative to work authorized by this building permit application for. (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 J� Signa e of Owner Signature of Applicant L)AV4-0 Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOIS - T wn of Barnstable Regulatory Services ���ixe TOtyy Richard V.Scali,Director Building Division r 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: 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. DEFINMON 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. Q:\WPFILMFORMS\building permit forms\EXPRFSS.doc Revised 061313 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY.INSURANCE POLICY Information Page We 00 00,01 Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV01243700 1. INSURED: Prior Policy Number: New Robert Tyndall Producer: 80 Brigatlne Avenue Miller McCartin,Inc. DOA Hyannis, MA 02655 Federal ID Number:999100972 Doenrcg &O'Neil Insurance Risk ID Number PO Box 1990 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured;See WCE 106 Other Work Places: See WCE107 2. POLICY PERIOD. The Policy Period Is From: 7/15/2015 To 7/15/2016 12:01 A.M. Standard Time at The Insured MaIllig Address 3,. COVERAGES:. A. Workers Compensation Insurance: Part One of policy applfea To the WorketS Cbinpengation Oaw of the-states Este - - here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each slate listed In item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C, Other States Insured: Part Three of the policy applies to the states, If any, lisled here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy Includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifiea(ions, Rates& Rating Plans.All information required below is subject to verificailon and change by audit. Premium Basis Total Rate Per Estimated Code Class(ticatlons No. Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $550 $8,830 Interim Adjustment: Annually I Total Estimated Premium $8,373 Servicing Office: Surcharge(s) 457 25 New Chardon Street Boston, MA 02114-4721 Total Premium and Surcharge(s) $8,830 Issue pate 07/21/2615 Countersigned By:_ �Q Copyright 1907 National Council on Compensation Insurance Form:100mv i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration--1.1' y rm119766 Type: r Expiration-­_ 8%2g�20.1s7 DBA Office of Consumer Affairs and Business Regulation j 10 Park Plaza-Suite 5170 WEBB CRAFT DE SIG Boston MA 02116 DAVID WEBB 25 MEADOW VIEW EAST FALMOUTH, MA Undersecretary Not valid without signature 9L0Z/6Z/0l �Jauolsslwwoo uoi;ejidx3 `X TfJ' fill bsZQ VW-,[on spooM PON aq[rI'I 3 Z£ HHTM H QIAYQ 69L9b0 SO :asuao{-1 . iosmladnS uei;xu:suo- spiepue;s pue suol;eln6a8 6uippng;o pjeog I(;a;es oygnd;o;uawpedap- sQasnyoesseyy oFt►�,� Town of Barnstable "o Regulatory Services : Thomas F. Geiler,DirectorBARNSTABM pk "`" 1639. Building Division �0 ��Ep►+�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-623( PERMIT# � `j^7 0�3 a FEE: $ a SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# . Al Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM. MUST BEXCCOlVIPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 L.400C,ft`IrIC30M CIF FDMC30PEFrLT" V F-ENE-IS AA^' r NC31_F ME ACCUMAkT_E''* LEGEND ' .' —•• — EOOE OF WATER # 905 � ,.;1 •i. ,� ---- STREAM l '�� (���•, I(��,, C -- _ DRAINAGE DITCH 1. MARSH AREA FY2000 PARCEL LINE { u 1, \'t MAP 326 ASSESSOR MAP NUMBER O, Pit i ,\O I J I ,� , #367 STREET NUMBER 16 STREET NUMBER i' 90 BUILDING STRUCTURE 3 4C.� Z BUILDING/STRUCTURE _-..- ` BUILT AFTER APRIL 2001 5�Rq!STAR LE COVSI_RVAT1�61q, _ DECK/PATIO SWIMMING POOL FUEL/WATERTANK PAVED ROAD t. � i• '•..'� Q� '�c '�;.._- J �' r— _ UNPAVED ROAD �.36 ° ---'-� -_--_- RAILROAD TRACK -- DRIVEWAY ...5� /f oC I \ !_ �,`•.\• —l: `/I. PARKING AREA - H+H�H+f PARKING LINES y SIDEWALK/WALKWAY }� � 4 ..I....,-- — — — UNIMPROVED PATH 15 BOARDWALK MY EXTERIOR STAIRWAY i �/ •`.. "" RETAINING WALL STONE WALL FENCE/HEDGE - - GUARDRAIL DOCK/PIER . \ /•,/1L1 _ _ _`� ,,i �._:_.� STONE JETTY / \•Lf ° .� :y�y�: �j'�^_ ^�._• `i , ' ������(((( i:_T'= — SPORTS AREA/UNES // 40 10 FOOT CONTOUR UNE i,: �� ALLUlVAl10N�Wm W 110Y0r� ------ 2 FOOT CONTOUR LINE 53.1 SPOT ELEVATION — CATCH BASIN 0 UTILITY POLE @ MANHOLE •�• LAMP POLE 5 __[�,[�A�. �� O�FlAO POLE � SIGN I ' `{ I OPOST V' TOWER 1 .,` �• /n�/�SATELLITE DISH • PILING �t1 ' # 99 9 ` � �STATUE ❑ LIT,LITV BOX . �-c'k,`•. �. a�xr rod R `NOTE: PARCEL LINES MAY NOT BE ACCURATE. DISCLAIMER:This map Is for planning purposes only. It may DATA SOURCES: Planimetrlca(human-made features) The parcel lines on this map are only graphic representations not be adequate for legal boundary determination or were Interpreted from 2001 aerial photographs. OS Assessor's tax parcels. They are not true property regulatory Interpretation.This map does not represent an Topography was interpreted from 1989 aerial 1 INCH-60 FEET boundaries and do not represent accurate relationships to on-the-round survey. Enlargements beyond a scale of photographs. Parcel lines were digitized from FY2006 "`T physical objects on the map such as building locations. 1°=100 may not meet established map accuracy standards. Town of Barnstable Assessor's tax maps. 0 25 60 TOWN Of BARNSTADL! O.I.e.