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Home My WebLink About0041 BACON ROAD j„E r Town of Barnstable *Permit#C)( F.acp f 6 the from isle date Regulatory Services Fee i ior BMWNrAB MASS' $ Thomas F..Geiler,Director 2013 Building Division Tom Perry,CBO, Building Commissioner rOWN OF BARN 200 Main Street,Hyannis,MA 02601 Afte www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY " Not Valid without Red X-Press Imprint Map/parcel Number ; Property.Address��/� �J ❑Residential Value of:W._ork_ a O0 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M f?'c�rC_s �� " 4.�a ✓# Contractor's Name—dn d;npz✓-- ' , Telephone Number Home Improvement Contractor License#.(if applicable) x Construction Supervisor's License#(if applicable) [❑VJ'orlosian's Compensation Insurance Check one: ❑ am a sole proprietor C am the Homeowner ❑ I have Worker'T Compensation Insurance Insurance Company Name , Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ st_(check_box)._n �[�Re_-roof_(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side .�-� #-of--doors=_ Replacement Windowts/d oors/sliders.U-Value (maximum.35)#of windows 0 Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. �SfiGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 053012 ' r + ?'Tie Caminonnealth of Massadinselts Deparhnent oflndusb al Accidents Office of Investigations 600 Washington Street BostonMA #21II . wnwv.mass govldia ordcem" Compensation.Insurance Affidavit- Buidriers/Contractor-slElectric ins/Phi mabers .Applicant Information f Please Print LewbI Naive{Birmess ,,: tiQnflndividul):1:1 !7`12i l�ev Vc)h/td(,TY�i t �Adilress: `7 l c! Y�C✓� 7''s/ ,1/1 r S CityfStatef�ip: v Phone# $ C� 721�"l 3 Are you an employer?Check the appropriate box: Type of project(regiomd) I.❑ I am.a employer with 4. ❑I am a general contractor and I , 6_ *.• have hired the sub-contractors ❑New consEn�ctiora _ employees(€ill atsdibrpart-time). y. Remodeliar 2_❑ I am a sole proprieI&or partner- listed on the attached sheet ❑ g ship and have no employees These sub-contractors have g- ❑Demolition. worldng for mein any capacity. employees and have wodcers' g.- Building additiah o workers' comp_insurance comp-msurance.x 5. ❑ We are.a corporation.and its 10.❑Electrical repairs or additions _requred]7 officers have exercised their 1 I:El Plumbing repairs or additions _3--L__I am_a homeowner doing all . right of tioar r NIGL myself [No workers'comp_ � L.❑Roafrepairs . insurance required.]r c. 152, §1(4),and we have no employees-[No workers' 13,❑Other comp.insurance required.} *Any apphcaut that checks box#1 must also fill ow the section below showing their woman e compensation:policy information " Homeowners who submit this affidsvit indicatag they are doing all wad and then hire outside connectors avast submit a new affidavit indicating such_ ;Contractors that check this box must attached 23 additional sheet showing the name of the vib-cantrsctnr3 and stare whether or not those entities har-e - employees. if the sub-conta actors have employees,theym ist.pmvide their workers'comp.policy number. I am art employer that is pr viding workers'compertsafion insurrrtnee far aty�,amplayfees. Below is then pof icy andjob e inforttta on. Insurance Company Name: Policy#or.-Self=ins.Lie.#: Expiration Date: Job Site Address: City/StatelZip: Attach a t.opy of the workers'compensation policy declaration.page(showing the policy number and eipnrttion date). .. A Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1.,500, n�m .00 and/or one-year imprisoeat,as well as civil penalties in tare form of s STOP WORK ORDER and a fore of up to$254_Q{f 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 kemby jay tinder the petits emir penattiss rrJ�P�luq that the infonrta#iart provided above it hrtxs and correct. Date: - FQF�=only. Do not write in this atom,to be completed by city,or town o,�"rcirat City or Town: Permit/License Issuing Authority(circle one) 1.Board of Health 2.Building Department 3.atyrromm Clerk 4.Electrical Inspector 5.Plumbing,Inspector 6.Othes Contact Person: Phone#� 6 �F ZHE Tp� * &U MS'rABLE 9� MASS 9. ,�� Town of Barnstable ArFpN1A�a Regulatory Services Thomas F. Geiler,Director Building Division f Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 026 I www.towri.barnstable.ma. Officer 508-862-4038 Fax: 508-790-6230} Property Own r Must Complete and Sig This Section x ; k : If Using. Builder ' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by:this uilding:permit application for: (Address of ob) Signature of Owner - Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form'on,the reverse side. Q:\WHILESTORMS\building permit forms\EXPRESS.doc Revised'070110. 1 �pp1HE ray, Town of Barnstable P �°^ Regulatory Services BARNS TABLE, " Thomas F. Geiler, Director . 4'prfn �A`� Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m.a.us Office:. 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:'— `C-/----__ L a ! d '(k" /Y'✓r 1�1 P 1 r S nnumber-�� r` street village �-- name home phone# work phone# CURRENT MAILING ADDRESS:"'//�—/qr -)i,1 (C -� r`y city/town 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 a/she understands the Town of Barnstable Building Department minimum inspection pro dures nd,requi eme�Zd that he/s ill comply with said procedures and requirements. 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:\WPFILES\FORM,S\building permit forms\EXPRESS.doc Town of Barnstable Regulatory Services Thomas F.Geiler,Director anxxsrABLL 9� MASS. �0� Building Division i°TEn.39. ° Tom Perry,Building Commissioner 200 Main Street; Hyannis,MA 02601 www,town.barnstable.m a.us Office: 508-862-403 8 Fax: 508-790-623 t PERMIT# 3 FEE: $ > 00 d SHED REGISTRATION 120 square feet or less GG/ 11,qa`l�If Location of shed(address) Vi age Sa' ,o-,7ZO J S-d-T —3 6-7 -2 6(1- Property owner's name Telephone number 307 ` Size of Shed Map/Parcel# . �G7- Tina Date Hyannis Main Street Waterfront Historic District? Old King's Highway.Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 I PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. ` PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. - s fl THIS FORM MUST BE ACCOMPANIED BY A - PLOT PLAN .rZ Z N M Q-forms-shedreg REV:042506 - V 1 I'LORAL ASSOCIATE Registered Land Surveyor Registered Professional Engineer ( 9 Broadway Wakefield, MA 01880 T:(781)246-9345 Fax:(781)246-4333 N/F RICHARD P. i COTTER ET AL. �vaY L0 T7S s0 S v �33 tiR� 9.6 M -� _) NO. 41 S� . ac b. • p- 193.17 BACON ROAD ari OF�.... E . Cn € OMANO �b 13977 � a THIS IS A TAPE SURVEY BASED ON SURVEY MARKERS OF OTHERS AND THIS PLAN WAS DRAWN FOR MORTGAGE PURPOSES ONLY.THIS PLAN WAS NOT MADE FOR:RECORDING PURPOSES,DEED DESCRIPTIONS CONSTRUC77ON VERIFICATION OF PROPERTY LINE DEMENT7ONS,BUILDING OFFSETS,FENCES OR LOT CONFIGURATIONS.ONLY A PRECISE INSTRUMENT SURVEY CAN Mortgage Inspection Plan DETERMINE ALL OF THE ABOVE. THE PREMISES SHOWN ON THIS PLAN ARE NOT LOCATED WITHIN THE FLOOD HAZARD ZONE AS I n DELINEATED ON THE MAPS OF THE COMMUNITY. 250001 0005 C 1 HEREBY CERTIFY THAT THE BUILDING(S)SHOWN ON THIS PLAN ARE APPROXIMATELY LOCATED ON HYANNIS, MA THE GROUNDS AS SHOWN THEREON AND THAT THEY CONFORM TO THE ZONING AND BUILDING LAWS(DIMENSIONAL REQUIREMENTS)OF THE CITY/TOWN OF HYANNIS WHEN CONSTRUCTED AND TO RESTRICTIONS ON RECORD. Owner STEVEN SANTOS 8/15/2006 Scale 1" = 50' Date 8/15/2006 Signature Date X.pR �y Town of Barnstable *Permit# v Co 76 3 - !7� �C Expires 6 months from Issue iflate OAT Regulatory Services Fee T 3 2006 Thomas F.Geiler,Director Qw�OF BgRNS Building Division 7A8LE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma.us ice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint BR_ rcel Numbers y Address V/ Az C a, 1��z lr' 6 �r� idential Value of Work 1�~y��.-� Minimum. flee of$25.00 for work under$6000.00 s Name&Address ��T�l/-E'�'! `cJ ;tor's Name Telephone Number :mprovement Contractor License#(if applicable) -kman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance ice Company Name Ian's Comp.Policy# if Insurance Compliance Certificate must be on file. Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roofl ® Re-side Replacement Windows/doors/sliders. U-Value i 3�' (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 th Home Improvement Contractors License is required. kTURE: :expmtrg 51306 Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 °�M s�•J www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluiribers plicant Information Please Print Legibly me (Business/organization/Individual): � l/�2 c/ ,�� j�GJ - [dress: ty/State/Zip: phone #• you an t employer?Check he a o rate box:. . _ PP r_-P - Type of project(required): I am a employer with 4. ❑ Lam a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors ] I am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These: ub=contractors have 8....❑ Demolition - working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance.__ 5.-❑ We area corporation and its officers have exercised their 10.❑ Electrical repairs or.additions required.] am a homeowner doing all work. -right of-exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'. comp. c...1529 §1(4),and we have no 12:❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: '. ieowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforrn$tion an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site motion. ance Company Name: #or Self-ins.Lie. #: y Expiration Date: ;ite Address: City/State/Zip: ch a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). re to secure coverage as required under-Section 25A of MGL c :.1.52 can lead to the imposition of criminal penalties of a ip to$1,50Q.00.and/or one-year imprisonment; as well-as..civil penalties in the form of STOP WORKDRDER and a fine to$250.00 a.day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of aigations of the DIA for insurance coverage verification. hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. ature: � Date: le#: fficial use only. Do not write in this area,to be completed by city.or town official ity or Town: Permit/License# 1suing Authority(circle one): Board of Health 2.Building Department 3.City/Town,Clerk 4.Electrical Inspector 5.Plumbing Inspector Other .ontact Person: Phone#.: