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Home My WebLink About0311 ARROWHEAD DRIVE 3 � � �r-owt�ga ��. _ \ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel'. a70 �.._.Application # 6I6 A. (4 t! Health Division 'Date Issped Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis ProjectS,treettAddress 31 i A rro W 2ciu r v-er A ® of CVillage-1 -S MR 0-44 ® JY4,&W��, Owners & f1 cla- 04 f fy Address < < hi-row 40-d gnh j5 Teleph e 50 r7 9 0 5946 Permitmit� R q t low v.rin-q 2.X1s4lirnq ce► linj ►n k14-cheh Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total,new Zoning District Flood Plain Groundwater Overlay Project Valuation §d® Construction Type t Lot Size 10 SF Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family.;.$ Two Family ❑ Multi-Family (# units) Age of Existing Structure yrs Historic House: ❑Yes ❑ No On Old King's Highway: UiYes 0 No Basement Type: ❑ Full OCrawl ❑Walkout ® Other Pa-4icd u4lkdown 4 h n crawl Space. Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 1 new Half: existing new Number of Bedrooms: 01 existing _new Total Room Count (not including baths): existing 4 new First Floor Room Count Heat Type and Fuel: �d Gas ❑ Oil ❑ Electric ❑ Other Central Air: 0 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 APPL-ICANT"INFORMATIO (BUILDER OR HOMEOWNER) Name" _ `�= ¢" pu w-Telephone�Number- .... 7.96 (o Address- ( � /9 P�<St��Q 0-d A r i Vim- Hy 4nn),5 MA o�,Gol F� � t-H�ome�lmprovem�en�tGo�n�trac Worker'sCompensation{:# ALL nCONSTRUCTION-DEBRIS-RESULTING-FROM_THIS PROJECT WILL BE<TAKEN-TO SIGNATURE r — si t 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED "L L. MAP/PARCELNO. - r S ADDRESS VILLAGE s OWNER- DATE OF INSPECTION: FOUNDATIOW ' =. r r s FRAME INSULATION ' FIREPLACE 'c •f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i . t 'GAS: ,,y- ROUGH FINAL ;',FINAL BUILDING` ; fta-�4 Sri, { DATE CLOSED OUT ASSOCIATION PLAN NO. f .. The Commonwealth of Massachusetts i Department of Industrial Accidents ' Office of Investigations r!- tl tilis 600.Washington Street Boston, MA 02111 1- www.mass:g ov. /dia Workers' Compensation Insurance Affidavit: Builders/Contraciors/Electricians/Plumbers Applicant Information Please Print Legibly ,Nam-Bus ness/Organization/Individual): n C1a' 0 ('t Address: 311 A rroti beo.A Pr ' v 2, CityLS_tate/Zips }-� yc�nn i 5 MA • .� 7 a�(p 61 Phone #: q0 ' 5 8 y � Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with ' 0 1_am.a general contractor and t 6. El New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. $' T. 0 Remodeling 2.❑ I am a-sole proprietor or partner- . ship and have no employees These sub-contractors have ' 8. Demolition working for me in any capacity, workers' comp, insurance. 9. ❑ Building,addition [No workers' comp. insurance 5. ,❑ We are a corporation and its required.] officers have exercised their ]0.0 Electrical repairs or additions ��ro am a ho owner doing all work right of exemption per MGL 1 1.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' I J 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.- tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 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 (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 certify under the pains andpenalties ofperjury that the information provided above is true and correct._ 'Signature:�.�--• CDate: / 1 5SF .� —-----. 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#: Information and Instructions 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,Yoristruction 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,6hapieri:152, §25:C(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`comrnonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 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 acceptableeevidence of compliance with the 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-contractor(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 thanifhe�, 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 Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of 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 burn 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 do not hesitate to give us a call. The Department's address,-telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia �pFSHEr Town of Barnstable. Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director v Mass $ =639. Building Division rEn �s 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: I I J 2,0 U JOB,LOCATION: 3 1 1 PW ro w k t(L d D e- V y60/7/S number street ! _ village "H�Eov��L inC1 o- D(.4 7 q0 name home phone# work phone# CCURRENT MAIi rNG ADDRESS: 3 I 1 r rUW n Q-C-ot r 1�- HyG.nn► s MA. 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 buildini?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. S�gn�ture_of Homeowner j 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:fomrs:homeexempt 1., oFtHE ram, Town of Barnstable Regulatory Services yR`' 'E$ Thomas F.Geiler,Director �p 1639. rev�u.�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 rProperty Owner_ Own Must Complete and Sign This Sec »on 'If Using"A-Builder AV as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorize this building permit application for: ddress.of Job) Signature of Owner to f Print Name If Property Owner is applying for permit please complete Homeowners License Exemption Form on there Q:FORMS:O WNERPERMISSION CI r _{- � •—_.ems._�q�T-_7._. �.� `__t��.-..+..-!- 1 i— -.""'.�;.�{{1 E _,.,._..�-.� ' - --.-r�-�-{-- .� __.j—-.�.- _i. - } { --,- _ _ - ► i i f i `tTC2' _ _L J -LI it F I I. I. F� LL E4 - FT --° 17 � ► - - - _ _ 7-1 LT L -- TI � F r { III { � � � .�'"_ �..._ _-,..i_ I (. � •�t7��,.. _ r [' 'I I > Town of Barnstable *Permit Expires 6 mo from issue date nth Regulatory Services Fee ,. tKass Thomas F.Geiler,Director Building Division K� . Tom Perry,CBO, Building Commissioner'z ' r t '__.0 n k 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 r ljVA,I (� �ir��,n Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONEY, P Not Valid without Red X-Press Imprint - Map/parcel Number KA-if 2-7 ,1 Property Address --3 d 1 I gi2(Lc1 W R AQ (Z-1 V 1E 11' A [Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address k \Ae_d1`tL(T'q E FF,-' b lO oA 5 - 0 2k o / Contractor's Name f�l�. L. ..1) z�y 1 C S Telephone Number `I-7�t-L3 6 Zip Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 4 7�3,q I ❑Workman's Compensation Insurance Chec one: [911 am a sole proprietor ❑ I am the Homeowner ❑. 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) - ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurr#cane.nailed)(not stripping. Going over existing layers of roof)' ❑ Re-side _ a [R #of doors eplacement Windows/d4ors/sliders.U-ValueCl,t55%C D K. (maximum.35)#of windows t- •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 required. SIGlIiAq'UIaE: hex -' C:\Users\decollik\AppData\L.oca]\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc i r ' NThe Commonwealth of Massachusetts Department of Industrial Accidents u Office of Investigations ' .1 '� 600 Washington Street Boston, MA 02111 r`;N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): DA'(.>r Address: 23. � �✓�. V`� City/State/Zip: D-,,j cd,. Phone #: 77 '� { _Z3 g - Z 8 t 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.' ❑New construction �mployees(full and/or part-time).* have hired the sub-contractors ,�,�^ 2. I am a sole proprietor or partner- listed on the attached sheet. $ 7. tv Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their. 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t 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. I 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-contractors and their workers'comp.policy information. 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 certify under the pains and penalties of perjury that the information.provided above is true and correct. Si ature: C� D iate: b� 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#: f ennrsr�,.e, 9. & Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I „g ,as Owner of the subject property hereby authorize �Cc-Q¢- oo yv-t,2 to act on my behalf, m all matters relative to work.authorized by this building permit application for: 3/l NA (Address of Job) 2 o i/ Signature of Owner Date Linda -S Duffy Print Name If Property Owner is.applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\dewllik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc - Nla�,Yachusettti Department of Public Safet, Restr to: 00 Board of BUild�m 2e tt it t:ai 4�trd. .. 00- Unrestrided Gonstru&idn-3uperV.isor License '1G-1 2 Family Homes License: CS 76391 etricted to:. 00 DALE C DAVIES - Failure to possess a current edition of the 23 NEVIJT0INN ROAD - Massachusetts State Building Code SANDWICH; MA 02563 ' is cause for-revocation of this license. Refer tor. WWW.Mass.GoWDPS ��: _�.y � ` EXpii�tiow 323/2011 i ( rmgiissiuner Tr#: 12841 77 ce a or rctg ra F�vahJ r ind�IctuL s L.'I o uiYing gulatid,a�xl .tang s. before the expiration elate: If fouiud return t '. HOME IMPROVEMENT CONTRACTOR . Board of$dilding Regulations and Standards i One Ashburton Place Rin.1301 Registration: 154345 Boston,Ma.02108 Expiration-_228/2011 Tr# 280927 -` Type Individual . { M.;DALE C:DAVIES - �t a DALE DAVIES _ �lEWTOWN RD; og .•` Not valid ro c txc U411Ct 1,J 02563 ftZ+liinrfl ct a -� .