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HomeMy WebLinkAbout0069 ARBOR WAY U-) Town of Barnstable 0S- *Permit#�2� Expires 6 months issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner �+ Q �,,,Lf200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us )ffice: 508 �4, - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 'parcel Number erty Address 9 A(Q 6R WA y/ . I,Y A/YAIJ S Al A .esidential Value of WorA Cp O- — ' o G ' 114, Minimum fee of$25.00 for work under$6000.00 er's Name&Address E12 W A ll p ITr f y�C L'AR T y 4 9 AS pU A. WA V , /P YA AI Ad S A11A zactor's Name , lJ L AXaaAa� Telephone Number 63r— Z73— 5 73 ie Improvement Contractor License#(if applicable). - T*(appb� Jorkman's Compensation Insurance Check one: - ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance rance Company Name kman's Comp.Policy# y of Insurance Compliance Certificate must be on file. nit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-r of(not stripping. Going over existing 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 Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. NATURE: -� irms:expmtrg se061306 t The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations a 600 Washington Street Boston,MA 02111 www.mass.gov/dia ' Workers -Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): W la Wd �,. . e 31r`�Y Address: 4 A Y-b o t V igt City/State/Zip: l��/ o�ty�vL��S /WA, 41401 Phone.#: 62)f--77S=U 14�f Are you an employer?Check the appropriate box: .Type of project(required):• 1,❑ I am a employer with 4, t© I am a general contractor and I 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. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition: working for mein m capacity. employees and have workers' [No workers' comp,insurance comp.insurance. $• 9. ❑Building addition' required.] 5. ❑ We are a 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,❑Roof 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. la m 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I•do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct. t� CDate: -v Signature f 2 _ Phone#: SZt;`- 71 r0ffl.cialnly. Do not write in this area, to be completed by city or town official : ' Permit/License# gority(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�lUI'lil�.t,ll)11 A.11t.l. lil�l,l ��;l,l�lll� Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as".,.every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a' joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every 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,MGL ehapter..152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public�.work until acceptable evidence of�compliani. vx+ithtlie insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members•or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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 any questions regarding the law or if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or TowiR Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom cf the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in - (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please c10 not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth.of Machusetts Dgpartmi ent of 1udwWai Accidents Office of Investigations 604 Washington Street $.¢stop;.MA 02111 - . Tel. #61 7-7270Q.fl ext 406 or 1-877-MASSAFE Fax#61 7- '74 749 Revised 11-22-06 www.mampv'fd€a t. 4 The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations ' d 600 Washington Street Boston,M4 02111' www.mass.gov/dia Workers'Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information n _ Please Print Le ibl Name(Business/Organization/Individual): . TA )�Kbp r- t Z5 ' Address: �.J ' City/State/Zip: k A r' A• -s-)�.j�Lew: 6 - Are you an employer? Check the appropriate box': .Type of project(required)- • 1,❑ am a employer with 4. I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* • have hired the sub-contractors 2. I am a hole proprietor or partner- listed on the-attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have g• Demolition working for mein an capacity. employees and have workers' g Y P tY• 9. Q Building addition [No workers' comp.insurance comp.insurance.$' required,] 5. [] We are a corporation and its 10.❑-Electrical repairs or additions officers have exercised their '3.❑ I am a homeowner doing all work . 11.❑Plumbing repairs or additions . myself.[No workers'comp. right of exemption per MGL 12.❑Roof repaits 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 anew affidavit indicating such. XContractors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide theiF workers'comp.policy number. I am an employer.that is proti,iding 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 Investi a' the DIA for insurance coverage verification. ' I do he bye .cent un er th pains-an,d pen, It ies of perjury that the information provided above is true and correc/. e: WV�'' W� Date: ' �— 20 0U/ _ Si star Phone# � J � � `� ✓ Official use only. Do not write in this area, to be completed by,city or town official. City or Town:' kermit/License# . Issuing Authority(circle one): A.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I JUIUI' UIL1U11 UHU 11INLI UULIU113 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every 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,MGL ehapter.152,§25C(7)states"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 withtlie insurance requirements of this chapter have been presented•to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members*or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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 any questions regarding the law or if you are required to obtain a workers,' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Towli Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom cf the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please' o not hesitate to give us a call. The Department's address,telephone-and fax number:. (�CommonwWth of Mmnhusetts Dtpartmwt of lndwWal A.ccidlmts Office of Investiptlons 600 wasbingtoli Stme't Boston,.MA 02111 Tep.#617-727 40-00 ext 40,6 or 1-���MASSAFE Fax#617-727-7749 Revised 11-22-06 ww,.mamgov/dira ' r 4 Assessor's map and lot number .... .��........ 'a,... .. THE t0� Sewage Permit number ........................................................ row s Z BAR35TADLE, i H 9, number ............................ f �ris1 ff Fl L/.... r MABa .................................�.: 00,0�i639 00 CFO MPY a� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO . .�................................... ..........f........................................................ TYPE OF CONSTRUCTION ...................L 1 r.. .............r`. :rxr...................................................................... .......... /.....: ....................19 .f —TO-THE INSPECTOR OF BUILDINGS:_, The undersigned hereby applies for a permit according to the following information: Location ..............� �...................... .! ....!.1 f4 i ............./%� `! �l�svf. ..:...�� �•Y��. ........... Proposed Use ..............'`......................... .......... ,rz-fi ... ....................................................................... ......................... ... p Zoning District ...........�}.. Fire District -`!�' Lw,' C .....�......... ........... v .............................................................. Name of Owner ...` �fJ '%f ..' .....:� sVlc c .. Address P. e..7 GCX� i............ F �...tij..... /9 .Address .... . ... .........:. '. ?/ti...........................................•� J ✓f:Name of Builder ............................................ Nameof Architect ..................................................................Address ............................:....................................................... Number of Rooms FoundationC? / ............... .....J.......................................... Exterior ......� , f ............................ .................................................i Roofng ......... Floors ................ .......................................................:...........Interior �. /`�. ......................................:............................................ / f 1 Heating ....................(...........................................Plumbing .......................... .......................................I............... Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board --------------------------------19--------. Area ...... .`3.. ..... ........................... Diagram of Lot and Building with Dimensions Fee .... . . ' 3 D ... ... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � fZY Ia r I I �,� `1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name............rt .. X: �'f� G;.� McCARTY, E.DWARD & VETI, -50 1 t No .�.� .:'. Permit for ADD Single„Family...AW.eLocation ...69 Arbor Wayi f Hyannnis 1 Owner ................Edward & Janice McCarty„ : ....... , 11 Type of Construction Frame ............................ .................................. r Plot ............................ rot ................................ 1 t Jan ary $ Permit Granted ..... ..............!........ 19 81 Date of Inspecti:on .......... ........................4.19 Date Complete ............. .................. ... 19 . x P 1 REF SED i ....... .. ...... .... . .... .. ... ............. 19 ..................................... .......................................... . ................../(./.�........................................................ lv- 1 Approved ..........................................I...... 19 ............................................................................... .............................................................................:. •�' ' Assessor's. map and:lot number 8 ,k L i........................ n THE Tp�y Sewage Permit number ........................................................... Hoe number ......:.CJ..:C�...:'...17 �-�GIZ L(/t� 9eaaa r E, O 1 39• \00 A,' TOWN , OF+ BARNSTABLE BURDIHG INSPECTOR �] nn n r, !I`L ld:Q ..� 4 y APPLICATION FOR PERMIT TO .............................................:.. 'p TYPE OF; CONSTRUCTION ...........`.....1......aCv...... ::.......................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..............6..��................�.�..��.. G!z. if� ............G!, mil// ..:... ................... Proposed Use ......... . �..1. .......... ................................. Zoning District ........... .................................................Fire District ........1�`, vlvG. ......................................... Name of Owner : ........ &V4-- Address �� n...GC!�4�! .J�.�!}it�sv� .. Name of Builder ..r blvl.. � .�!v�Address I ? �4 '4449 Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .........../.............................. Foundation .......................`-�.\............ Exterior ......s`l.le'!j-A.4. .:.................................................Roofing ......... ............................... Floors ................/............................................. .....................Interior ....................................................................... Heating C a 4 `.........................Plumbing IVU Fireplace ......................../f/�!(/P.........................................Approximate Cost ...........306)0... .. ............ .................................. / Definitive Plan Approved by Planning Board ________________________________19________. Area i �!' Diagram of Lot and Building with Dimensions Fee ` .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 Ld , i /2x 13 r 112 I hereby agree to conform to all the Rules and gegulations of the Town of Barnstable regarding the above construction. Name ...: .. ..... ........... -McC'.ARTY, EDWARD & JANICE F No ..2.2afAN, P_e it for .,:..�T3IL'.. ADD IT OI�� _ ......... X3g.1Q..Fame.a..y..Dmell.ijl(j............. Location ....69..Arbor..Wav............................ s t i .......HY.annis...................... ................... Edward & Janice McCarty Owner ................ ............. Frame ' Type of Construction Plot ............................ Lot ................................ January 8, 81 Permit Granted T r Date of Inspection ...;.[. . ...R19 t Date Completed . ..................... .:%2.19 6;2- PERMIT REFUSED . 1 ........................................................... '19 .......................... ................................................ ............................................... ............................. .;5 s ............................................................................... Approved ...:....:....................................... 19 l ' ...................:...........................................................