HomeMy WebLinkAbout0287 ARROWHEAD DRIVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
37,
Map 2QO Parcel lJ Application #
Health Division Date Issued C( .(4
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board 1
Historic - OKH _ Preservation / Hyannis
,ProjectsStreet Address - (? ') (2 oa cs PIZ
Villag_ /I YA"`,v aS tiI A-
Owne��,Df)ajA Address 2 V7R�I�C a 1+ E°�i� 0 i2
Telephone- 912-' y
Permit RequestT iIC��G AG� ►45 C��`�,�.1 ;'�`+C,- e C(�y���c.J c�i,�C)
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total,new.
Zoning District Flood Plain Groundwater Overlay
Rroject,_Valuation)�)W Cb Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Nam me�� DotJAL c) A Telephone Numbers ��r �9 2 - _l 7 L
�Addre _�`? /i A)LL) �`f�>> 00/L License#
x
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE— ` SATE °
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
r
JI ADDRESS VILLAGE ,
OWNER
r `
t
' DATE OF INSPECTION:
i' FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
l/Lli IiVIILlILVILIYGLLLLIL VJ 111 LWJLLL.I LLLJ L.LLJ
Department of Industrial Accidents
t Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information PIease Print Legibly
CNam B inesdor- nizadon&dividual): •-�. f� L O� L tA nl Qe�2-S
�Ad ss: 27 A2 9�
s Ci ;/State`-/Z-ip: C ty =1�J���N�S . � �' . Phone.##:
.,Are you an employer? Check the appropriate box: Type of project(required):-
1.❑ I am a employer with `'4. I aiu a general contractor and I
employees(foil and/or part time).* have hired the sub-contractors ' 6• ElNew construction .
2.❑ I am a-sole proprietor or partner- listed on the-attached sheet 7. 0 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 ers' comp.insurance comp.insurance.
#
aired.] 5• ❑ We are a coiporation-and its 10.❑Electrical repairs or additions
f3. I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions'.
�/. 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 hue outside contractors must submit a new affidavit indicating such.
XContractors 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-contactors have employees,they must provide their workers'camp.policy number.
'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob 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(shoving 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 certi _ nder the pains•andpenaldes ofperjury that the information provided above is true and correct:
tSi�attue:" _� <►" CD at—end 13U
Phone G 92
Off cial 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..PIumbing Inspector
6. Other
Contact Person: Phone#: .
. i
Op THE Tp�
Town of Barnstable
vim, Q� "r Regulatory Services
t
snxtvsrnBLE, Thomas F. Geiler,Director
y MASS.
q, i639. .�� Building Division
ArfD rytp'I A i
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
' i /� Please Print
CpgT�
JOB-LOCATION.F!7 A/tRcwAG41> Pfl--
number street
C village
t c!)
OWIVER� S �U� �2 2 r "�
name r� home phone#' work phone#
CURREN-T—NIAIL�DDRESS: 1`'F•�
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
rru urn; spection procedures and requirements and that he/she will comply with said procedures and.
require
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:forms:homeexempt
i
oFtH�Tom, Town of Barnstable
Regulatory Services
y MASS.. Thomas F. Geiler,Director
AIEo��a 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.
(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:PORMS:OWNERPERMISSIONPOOLS 6/2012
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. The Town of Barnstable
9 MAM
,• Department of Health Safety and Environmental Services
rFt639. IN Building Division
367 Main Street,Hyannis MA 02601
Office: 508-8624038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
SHED REGISTRATION
-7 Af-Rot,) he-a� DIZ 4Z4,0 ry iS mA d 2-6cz �
Location of shed(address)
Property owner's name Telephone number
F-X �2- a ?o - 0 6 7
Size of Shed Map/Parcel#
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required)
THIS FORM MUST BE ACCOMPANIED BYAPLOT PLAN
- Q-forms-shedreg
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