HomeMy WebLinkAbout0190 BETH LANE ��o `�e� l�.he
�,
-- - - -
ip
r Town of Barnstable *Perm #-
'i' ires 6 months from issue date
Regulato ee
- �♦ 11ARNRP1AiX • - •
y� mess. , Richard V..Scali,Directors
MAY 0 5.2017 (/
Building Division
Paul Roma,BuildTi
a}�iq�;RATS TALE200 Main Street,Hyann>s, 02 !1 ! D
www.town.bamstable.ma.us .
Office: 508-862-4038 Fax: 508-796-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
�] Not Valid without Red X-Press Imprint
Map/parcel Number �
erty Address' ! "I
r,;,_jgResidential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Ownerame=•Bi Wddress�1(%h
Contractor's Name (Telephone Numbe�rg:�o g 2Z 1 9
Home Improvement Contractor License#(if applicable)
� _ J
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance ,
Check one:
❑ I 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(hurricane nailed)(not stripping. Going over existing layers of roof). '
e-side
❑ Replacement Windows/doors/sliders:U-Value (maximum.32)#of windows'
#of doors:
*where required: Issuance Uthis 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 provement Contractors License&Construction Supervisors License is
req e
SIGNATURE. �d. _ �� �
QAWPF=\F0RMS1building permit formsTMRESS.doc r
01/25/17 t
- lJl'G Comw2rweaM of G6Irxu!tfJ
e Viry St;kiizdom. '
600 WMbfigi c Street k
Basfoi4 MA 02111
' kv�vx�.ma��v�ifia - •
WarIMrs' InsnrmceAffid.i-Smlders/Cantradm-JM r*anslPhiimbers_
AppficaEd rma Please Print f Iv
- - I\) /LA M
}-Y 'An 15 M 1- fUL66i Phone�' _
Am you an employer?Checkthe appropriate bow Type of project(requimdD}-
I-❑ I am a etaploger wig - 4. ❑I'am a ge6mml Ca3fMdOf aad I 6. ❑New eensizuctioax
employees CHI amuorpar�).* baveitiredthe sub"ContmCton
2.El am a sole gropiietor orpartaer- listed cathe attached sheetI- ❑Remodesiug
These sub-eoa�actam have
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officers have esmcised thew 3: ,Yam a heme doing all s�adc 11-0 Plnmbsagaepaiss or$ddifiams,
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I
Job Sit�Address CitylStawrrp:
Attach zzopy afthe warkE&compensationpolicy declaration page(showing the policy number and expiration date}. ..-
Far1me fn sem m coveeage as sepired ruder Section 25A of Mtn m 157—ian lead to the imposilioa Qf criminal peaalfi cs of a
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Town of Barnstable
Regulatory.Services
rPIAMr Richard V.Sc A Director,
Building Division.
Pant Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.mans
Office: 508-862-4038 Fax: 50&790-6230
Property Owner Must>
Complete and Sign This Section
r ,
If Using A Builder` -�
- •.- �;��. - - .. -Y S- - III
I, ,as Owner of the subject property
hereby authorize to act on may behalf
in all matters relative to work authorized by this builder permit application for:
Fd�
(Address'of Job)
' 'kPool 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. `r
Signature-of Owner f Signature of Applicant
Printe Nam _ Punt Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS
4
Town of Barnstable
z,
Regulatory Services
Richard V.Scali,Director
Building Division
t s�xveres�.e. Paul Roma,.Building Commissioner
a 3 a�a� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.maus
Office: 508-862-4038 - Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
-.JOB LOCATION: Vill
�xoMEowr>Ex�:)y ,��,�) 05 tl�as�e �,�.�21 �43'3 sclrpt-e-
L.name --:w t--=home phone work phone#
CURRENT MAILING ADDRESS: / e)
The current exemption for"homeowners"was extended to include owner-oCCIMied dwellmas of six uni s or-less and toallow
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 afl such work performed under the building yermit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
byla rules and regulations.
The dersi ed"homeown 'certifies that he/she understands the Town of Barnstable Building Department minimum inspection
pr ores d nets d that he/she will comply with said procedures and requirements.
ign __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 helshe understands the responsibilities of a Supervisor. On the last page
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building pen-nit forms\EX PRESS.doc
0620/16
w '
Town Of Barnstable *Permit nsr�3 l
ti Erpires 6 nionths from iss date
Regulatory Services Fee
+ BARNSTABLE. +
9 MAC $ Thomas F. Geiler,Director
plfD MP't A ..
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
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 I �
Property Address 1 Ci o e4k_ LA I LfA✓lY1 tS /�/l7 bZ�1�
XResidential Value of Work ` Minimum fee of$25.00 for work under$6000.00
Owner's Name &Address �/L-6)-q S te/
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance X_PRESS, PERMIT
Check one: 2 Q 20��
❑ I am a sole proprietor NOV
I am the Homeowner
I have Worker's Compensation Insurance TOWN OF BARNSTABLE
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
of doors x
Replacement Windows/doors/sliders.'U-Value= —(maximum.44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.,Historic,Conservation,etc.
***Note: roperty Owne must sign Property Owner Letter of Permission.
A c py of e Io ie Improvement Contractors License &Construction Supervisors License is
re uired.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS. oc
Revised 090809
Y
The Commonlvealth ofVlassachusetts
Department of Industrial Accidents
Office of Investigations
600 IVasliington Street
Boston, MA 02111
em s' wiivw,nsass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib>l
Name (Bus iness/Organization/Individual):Vte.Wa S Y/(wo
Address: 190 1 't
City/Statc./Zip: AvA n b2LbJ Phone #: 9-3
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
employees (full and/or part-time).* have hired the stib-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 g. ❑ Demolition
workin for in an capacity. employees and have workers'
g Y P Y• 9. ❑ Building addition ,
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions
I am a homeowner doing all work officers have exercised their I LE] 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 thcir.workcrs'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.
iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
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$250.0WE,
day against the 'olator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations D A for insur nce coverage verification.
I do hereby ce' ify a der e i s andpenalties ofperjury that the information provided above is true and correct.
Si nature: Date: /�2c,�zs
Phone#-52'
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#:
cl
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, construction 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 chapter 152, §25C(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 commonwealth 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 acceptable evidence 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 than the
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 retumed to the city or town that the application for the pen-nit 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 bt.usiness or commercial venture
(i.e. a dog license or permit to bum 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
Fax # 617-727-7749
Revised 4-24-07
www.mass.gov/dia ,
r
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
+ BARNSTABLE, '
MASS.
039. ��� Building Division .
PIFb a 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: 1 ZU —/2UU 9
JOB LOCATION: '/® al
number street village ! /
"HOMEOWNER":
name � home phone# work phone#
CURRENT MAILING ADDRESS: L
1 !L)
MA 02 66 /
city/� 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 un rsigned"homeo er"certifies that he/she understands the Town of Barnstable Building Department
minim L
on ro d es and requirements and that he/she will comply with said procedures and
requir Signa re o
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 dq 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 heJshe 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.
QAWPFILES\FORM S\homeexempt.DOC
r
�1HE r Town of Barnstable
yT
Regulatory Services
aaxNrAIB LE, Thomas F. Geller,Director
So 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 Usina,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 application for.
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the rever
se side.
OYORMS:OWNERPERMISSION
e 2 /
4 — X-A
A essor map and lot number ......v...... 1 3 ^� s TH E tO
Sewage Permit number .. ..... .....:(U�.�l .............................. SEPTIC SYSTEM MUST 6
INSTALLED IN COM EAUSTADLE,
House number .. -` PUAN rnea
... ..................................................... WITH GO i639 e0''
ENVIRONM TALE 5 ' °war
'TOWN OF BARNRFX=ODE IIONANO
. s
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......... T�-Q/1 ��'1....... :.... f`t .. ............................................
TYPEOF CONSTRUCTION .....................ARU...6.............. ..:.............................................................
e y- r�
.................. ll........19.d�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a//p''ermit according to the following information:
Location ... .,, �.....geA......4.6e.. ..1K.4!. ....f. ....:.............................:............
Proposed Use ...... `t!:. !�/Y.at. .... :<(/.h ................. ...........................................,....................:....
Zoning District ......... ....�..................... ...........................Fire District .............. �. ljj S
dame of Owner .. .6,y.A(..j.....ea.Z.l��r�. ..................Address ........
Name of Builder 1/ ....J..I. ............_...................Address
.Name of Architect ...................................................................Address ....................................................................................
Number of Rooms j...................................................Foundation ... ...
j �f ` l'...�y1.Gr/.1o ./ 1.... Clcl..
Exierior .... �.0.fA........ .............................Roofing ��d..(... ......................... . ....................
Floors ... �t ......./..lL.!/�j�1.... Gad.. '� / :,Y..........Interior �4nG:f/...........................:._..........................
Jh/.. ....:.........................-......:/.............Plumbing .. a....�c?..Z .........J'.4el. �� ................
Fireplace ........ ...................................................................Approximate Cost .... .Iy. .................................. . ..
Definitive Plan Approved by Planning Board -----------_-------------------19_______. Area .............. .��..Q...s..
Diagram of Lot and Building with Dimensions Fee �i �?............. ...........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
'tl
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .....U;e1(,a..L .......................
3
C & F BUILDERS
t
6i"No -Permit for .Qne...Star.y........... '1
;•
........ding.Le...EamLl Dw.el.l.in
• I �
Location ...IO:t...#1.0...1.9.0...Beth...Lane......
'
..................H..y+ann is..........................:................
C & F Builders "
Owner '
Frame rr
Type of Construction ..........................................
.......... " .................................................................
1 r F
Plot ............................ Lot ...............................
t
Permit Granted October 23, 19 80
Date of Inspection ....................................19
f �
Date Completed ......... ........ �..'� .19
F ERMIT REFUSED
Cr
`. ...... ......... .. ................................ '19
- .......... . . ...........:................................
M w
®. .
...........�.�. -8Z ........................................
......... . .4. .... . ..........................................
M0 S
M. a _
.Approved ................................................ 19
...........................................................................:.::
..............................................................................
C4 4 �/...............................
Se�yage Permit number 4.
NAM
BUILDING INSPECTOR
TO THE, INSPECTOR OF BUILDINGS:
The undersigned hereby applies for o permit according to the following information:
� /��~-7� / ' / �
Locohon -' ��/�,��--��, �/2/-../. �{�*��--.�..�.`<.�.:-..�.xx---..------.-------------~-..-..
=
. Use .........r/^ .......... ....------------------.-----------.
Zoning District
.-,-- --, .------...---Rve District /----. .�� ��.//��.�---�---.<�--�-�-./_-'.',
. ,� - / r - ' /' �6
Name ofOwner - � / , � -`� --_:�. ,(Diagram of Lot and Building with Dimensions
SUBJECT TO APPROVAL OF BOARD OF HEALTH
/
Y `
^t '
�
' - -
` -
. _
| hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
. construction.
N ".......Name �l/�--------�
'
X-\
P7`C. & F. BUILDERS
No 2 .tj0;-:.-.,ePermit for bue...Stor-y............
Single Family Dwelling
...............................................................................
Location ..Lot #10 190 Beth Lane
..............................................................
Hyannis
...............................................................................
Owner C. '.& F. Builders
....... .........................................................
Type of Construction Frame
..........................................
........................... ................. ................................
ot ...Plot ............................/I.............................
Permit Granted ....... ..........r 2. .........19 80
.......... ...011;07
Date of Inspection .................... ...............19
Date Completed ................... ..................19
PERMIT REFUSED
.......................................... ................. 19
....................
.... ... ..................................
�-..............L*,-M'—**... ..............................
...............................................................................
Approved 19
..........I..............................
...............................................................................
................11,............................................................
TOW OF BARNSTABLE* Permit No. -----�� � —`
Bullduig Inspector w:
1 11 3TAnc Cash - -----:
°o ,ego. xx 6
''ietlaYe . OCCUPANCY v PERMIT Bona �
No, building nor. structure shall be• ereeted,:.and no land,building or structure shall'be
nse3.`for a new;different, changed, or,.enlarged; use without a Building Permit therefor
first_having been obtained'from.the Building Inspector. No building shall-be occupiedtuntil a.
certificate of occupancy l s'been issued by the Building Inspector."
C. & F By lders Falmouth •°
.Issued to v Addre'
Lot # 10 , `190 Beth-_:Lane -HvanniB
'Wiring Inspector Inspection date
�y �
.�
Plumbing Inspector ed Inspection date
Gas Inspector �� `-:.� , ` f Inspection date
y-Engineering Department. Inspection date/`
THIS PERMIT.WILL-140 `BE VALID; AND THE•:BUII:DING SHALL "NOT BE OCCUPIED UNTIL
',SIGNED,-BY THE BUILDING INSPECTOR .UPON SATISFACTORY _COMPLIANCE WITH TOWN
REQUIREMENTS _.
w .Buildih Inspector
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