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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 t° i x e G I T 3 p "E Z _ la c 2 -�---� G fy �y. rL C r, Y. f � a C f C L. I _, a— r -s ail e /It "1� � M 0 P c� 71 .-s fia 4 WE . 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 � a � s j. .. � • � - � ._ ,, � ,�- � ,►; ' �� ,, Lam,./ � � ;� �