The URL can be used to link to this page

Home My WebLink About0010 ATWOOD AVENUE 7*45 �. I -' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma q®g3o® Parcel `®� � p 1 Application# Health Division Date Issued—ald-0 I t Conservation Division >' Application Fee Tax Collector Permit Fee �S Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Q' Historic-OKH Preservation/Hyannis Project Street Address /0 tw Village A^ IKA- Owner __ �f iw xA.+v r•ts Address 1 o 10 W 'OWAA6 404 ®ZQI Telephone 5-o g 1'7.!r !yrl( Permit Request elwi+,e 4- C-14-Ji.,,s d-VI O1u S'Ja Ro-,: Square feet: 1 st floor:existing proposed 2nd floor:existing proposed t Total new Zoning District Flood Plain Groundwater Overlay 's - ,: Project Valuation yp ✓ �^ U �,�� Construction T e rcP�u,��- a..Jm s tclac" Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporti g documentation:' K.E? 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 O_Yes. -❑-No- - If-yes, site-plan review Current Use Proposed Use BUILDER INFORMATION Name W&I kr kwr+,s Telephone Number 9 7 7 S 9�S� Address /a 4�200.1 License# 026O/ _ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ° ' DATE 912 tv I� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED I; MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - FRAME RJE94 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r - r3 - DATE CLOSED OUT y F ASSOCIATION PLAN NO. t The Commonwealth of Massachusetts Department of IndustrialAiddents —; Office 9f Investigations _ d 600 Washington Street , Boston, MA 02111 . www.mass.gov/dia Workers"Compensation Insurance_Affidavit;.Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print LeeiblY Name (Business/organizatiowhdividual):, y, If or K.,,pt>S Address: 10 > o 7"1 Ci /State/Zi ,n �.. e9 Phone#: � 8 S � S P� n, �. rv+A�- tea/ Are you an employer? Check the appropriate box: -Type of project(required):. 1.❑ m I a a employer with 4.•❑ I am a general contractor and I employees(full and/orpart.time).* have hired the sa.b-contractors 6. []New construction. 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8 ❑Demolition working forme in any capacity. employe Cis and have workers 9. E]Building addition [No workers' camp.insurance comp.insurance.$' 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbin'3:VequiTed-] am a homeowner doing all work ❑ g repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance sequued.] 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 or not those entitles have employees. If the sub-contractors'rave employees,they must providt their workers'comp,policy number. , I am an employer that is providing Workers'compensation insurance far 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 tip 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. Ido hereby certrfy under the pains•and penalties ofperjury that the information provided above is true and correct: SiEiature: �m4l1 ..Date: 9�7.g/o7 Phone#: ?7 S s 9 y S y Official use only. Da not write in this area,'to be completed by city or town o.17cial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector . 6. Other Contact Person: Phone#: °fTEro Town of Barnstable Regulatory Services �a $ Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW f SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Su N CW1 w:tinCa v k Jeer -f poT - Estimated Cost Doe Address of Work: 0 / d�cV 1y gA4 is Owner's Name: lea,I lr K,V'ri Date of Application:_ I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law y ❑Job Under$1,000 ❑Building not owner-occupied @6wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR g�zs�o7 wx l ; - Date Owner's Name Q:forms:homeaffidav �OpTHE,p� Town of Barnstable Regulatory Services sMMsreBLE, : Thomas F. Geiler, Director MASS. 039. .��IN Building Division ATFD�� Tom Perry,Building Commissioner 200 Main Street,. Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 -------------------- HO.MEOWNER LICENSE EXEMPTION Please Print DATE: '7/Z4 -7 ,w, II n 1 JOB LOCATION: to J� -W KU 6�,O Ari l$ Ynhh o-tc c9/ number street village "HOMEOWNER": w.'1 -6� k-joe' ,,IC68 17-5'—cr'y_V y S-08 83,0—?OF F name home phone# work phone# CURRENT MAILING ADDRESS: rC / ey ,Q jPeT va4n13 `�►1 �26�,/ city/ wn 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. minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ' Iv v 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.