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HomeMy WebLinkAbout0061 BISHOPS TERRACE L�G%�� / _ a �7 ���� i I I r f� Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 8/3/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 17-2097 Dear Mr. Perry This affidavit is to certify that all work completed for 61 Bishops Terrace,Hyannis,has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey BUILDING DEPT AUG 24 2017- SOWN Ot SA NSTABLE. Town of Barnstable-__ , . u �� W wilding ha .t s'Uis�ble .romahe StreetA roved Plans Must I�e Retainetl nJobsa' d'.th�s Card Must'be Ke t PostThis Card So T t F ,p rr Mader. Posted Un:l Final-Inspectio Has Beye�ne , s �� „ 1b f'x4.< .� : Permit s u ,' : �ficate of Occu aric is;Re iir�`tl- uch B,uild�n Mshali Not be=Occu iediunt�t a Final lns ect�on has been made .... Where a sect p y t>) ,s. gE p p Permit No. 13-174097" Applicant Name: William McCluskey Approvals Date Issued: 07/07/2017 Current Use: Structure Permit Type: Building=Insulation-Residential. Expiration Date: 01/07/2018 Foundation: Location: 61 BISHOPS TERRACE, HYANNIS Map/Lot 251-205 Zoning District: RC-1 Sheathing: r �� � W. Owner on Record: CROWLEY,JAMES C _ , Contractor Name William 1 McCluskley Framing: 1ft . Address: 61 BISHOPS TERRACE Contractor�cense 102776 2 .. x 171, HYANNIS, MA 02601 � _ E'st Protect Cost: $3,500.00 Chimney: Description: Add R-37 cellulose and 2" rigid insulation to the i rye cAil the attic att Permit Fee: $85.00 Insulation: plane with expanding foam.General weatherization T: �Fee Paid: $85.00 Final: Project Review Req: Add R-37 cellulose and 2 rigid insulation#o#h'e attic.Air seal 3 Dated' 7/7/2017 the attic plane with expanding foam. General wea#herizatron - Plumbing/Gas Rough Plumbing: .em uildin Official Final Plumbing:u . , •�, 'B g This permit shall be deemed abandoned and invalid unless the work authoried y this permit is commenced within six months after issuance. � Rough Gas: All work authorized by this permit shall conform to the approved application and thapproved construction documents;for which this permit has been granted: All construction,alterations and changes of use of any building and structures shall tie incompliance with the local zoningby laws and.codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,publl*4inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures`bey t�e Building and�FireOffic Is aretprovided on is permit. Service: Minimum of Five Call Inspections Required for All Construction Work.Rv," 1.Foundation or Footing 2.Sheathing Inspection . „ .,.-. k. ...�_, Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction., Final: g g access tq the guaranty fund" (as set forth.in MGL c.142A). Fire Department Person contractln with unre istered contractors have Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Qry Lz4j I f Town of Barnstable *Permit# .,6-1? -0?« Regulatory Services Eee Richard V.Scali,Director ` Building Division 4 —Paul-Roma,Building Commissioner---® --- 200 Main Street,Hyannis,MA 02601 JULwww.towmbarnstable.ma us .2017 Office: 508-862-4038 F � M 508-790-6230 EXPRESS PERAHT APPLICATION - RESIDEN �V 81 A B L E Not Valid without Red X Press Lnprint Map/parcel Number � ® �f Property Address S K A T-/ A/G 1Z V K R D, �f'� 6V OU / a e C� , l O'kesidential Value of Work$ / Z 11©0. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �f� !! (_ �5 41 e f Z-5 0 A.) S NG Z Wk Y A /U /0 / -I& Contractor's Name D Ld/L) 6— Telephone Number y- / 4f - ee 7 l Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑�a sole proprietor Lr l am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Rest(check box) BqueRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to C9 1-1 N ❑Re-roof(hurricane nailed)(not.stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFII.ES\FORM.S\building permit formsEXPRESS.doc 0125/17 The Commummmk7t 4r ' 600 Wash&gfon&rea 6-2 fp V1V.MMMg P/a7l Workers' Ouv@IISfiw Insu mc$Affid t Buflders/C mhers �QpECat3TII73a p Please priest Ar&e l 5- S K 4 T/U6P Are you an emplayer?Cheekthe appropriatebm: ' Type of project(required): L❑ I am a employs wffi 4 ❑I am a general conimetm and I 6. ❑Idevg comtruction employees(full andfor part-time)* bav*e 7siredflse 2.0 I am a sole proprietor orpsrtaer- Riled oath attached srheeL. I• ElRemodeling slur and have no employees Theme sub-c�have 8..Q De=16bn andl=e wogs' wo�dtiag :Forma in any � 9. ❑B.viOng aci3ifion ' jIN* ' camp- camp.+msm +a-1 j 5. ❑ We are a coparaiimand ifs ill_❑Eleclticai repaim or aci�ons 3_ I am homeovmer doing Ali Work af�sc$rs lrave exam=ed their iL❑Plmabiagrepaim or addifi ms. -ocia�s' of esen�pfiag per MGL � iMVMM=aret,w�eLli c.15i2.gIMandwehaveMO L`� f �- ealpIoyem[TO WQ&E& 13. v et cOMT-inMERDW l •day�gs �sccT�dcsvaz ltmrstetsasna�tfiese oau�sv gaieawo�ce2 c�peasasnapor�epia�s on_ #ffa�eevmes�o snlm�sins emu`imp 6�ep axe slf aradc e�dthenhr�aaiad�co mess#safest saesv� t saCTL TCaam�c9mm- z?deckfula6ormvstrftrh3a -105®al shed shavdM9&M-D—ofthesaf!�sxad stile vrhed—araaMoss hive eupkyees. scorns'-mp.galkYmambar lain an in=ra=e br my emFk zes Berviv is thin pa&cp and jrrh site €ac„�orma�atL In umcacampmyflame: 'PORcy 5 or Self-sm l is--- E�pira4iunDate: Job Sate Address Cifp/5taf e� : Af#ach a copy of tILe workers'compensation policydectarafum page(shag the poficy,number and expiration iTate). Faye to secure covemp as requirednuder Sew 25A of MQ.e.157—can lead to the impos ion of criminal penaltQes of a fine up tag$UOD OD awYar onee gear impfiso=ed as weil as civil peuaHirs into farm of a STOP WORK OBDI Rand a ffne, of np to$2f0 OG a&y as iast the viohdar. Be advised 93at a copy of this sFate ned maybe 9svrded to the Office of Iayes*pfionss of the DIA for zasurance Coverage,veeifcatia L , 'Ida hereby cerfirl,radar fltspa iw andpwaNwafl7ayary thatthe.inb p mided abo's is[rare and wn-ect Sr Date Orwird use ralet� Da uat avrrts in thfs area,to be sa7upTetcsd by racy artarrn affaiaL City or'To,%= Fer�ice�sse� IssuingAn6writy(cask one): L Board of Heal i r.BTdmg Dgmrtmeat 3.CdYjTuvm Clmk 4 Elech ical Inspector S.Plumbing bVeector 6.t her Coact Person: Phone#: -- 6' ormation and Instructions Ijassachme ft Get=dj aws chaptm'152 rues all EEqaIo'y='3 pravj&vrE±me caI33pmnmti=fCrffiDir employees.- ,"a�to tha sib,ao•mIt',z�is defZsd es¢_�erypersanm die savire of anothe Uader aMYCMAMCt ofbnr' C213==or jCapl%ed,'oral orwriftr=.-" mm AIL�srp7oyer is d fiwd as-an is �p�� m,.amcfifi cmPm-dm or otim Iegal a y,or any two or of the ft gu ro�m a3aira a adinclndmgthe legal reF=zd:a i w of a d=ased emploY= or the re=iVr or t aLs of an ind3vidnal,p ,association or offi legol may,c=pj0ymg CM3pm9=S- However f o ownecof a clweIrm l�nsebavmgnotmoret3iaat3nre.apBd mets ands rcddesibezc,ostbe oa off=- dWMMagbouse of anof W who=pIM persansta do maidman=6 co am arrepai=wolC on sCCh dweIImg house or on_the W=3dS or bm-emg ajp ifi�imUnotbecause of saCh emplopm�be d=medin be an=:EPm9MA MCA chapter 152.§2SCC6)also stars fhat"&VMTstaia or Ioc2I spy agmmy shall wi hold fhe zssaance or ranewaI of a Fcerese or peru to operate m b•�ess or to construct b�dmgs is the eomraonwealffi for=y applicsntw•ho bas notprocinced acceptable evidence of caratplranr�wL&tTxe ass¢ran�coYexager " ,4&i'rf;r,T,any,MCrL chaptm I52,§2SCM stairs-Tedhmfhe ' - nor Ey ofit-s pc)Hb=l sobff1dmons shaft ear into tetrad for the pumice ofpublic wow m acceptable evideam of compliance Ti ffie msmraace. enfr of1his rhaptrahavebeenpresenfedin file confracf;ng.aothoz y." . Applicants Please fa obt file wMI='compensation affidavit conpletrly,by cfiecking the bm=ffiat apply to your sewn if nip,supply snb- (s)name(s). es)and phonennmb°r(s)aIongwIELti es em s)of inn c - L mtedUBbMEy Compames gMg or L=,tedLiabdity?Mt3= S(LI.P)•vn no=3PIDy=offi=ffim e, members or pa ba=r.,are not rimed fn cry wodo=e campen Imfirm ice_ If an LLC or 17 Y does have employees,apolicy is rrgaia4 Be advised-ffiAthis affidaykmaybe snbmzitfed to the Department of Industrial Ac-id fnr coafrmafm of insmMce coveaagm Also be sore fo sign and date the at3dav3t Tbc affidavit should' bereiz=edfnthecityortownthatfhaagplicaiicmforthe.pe or&ceaseisbcingreolaesf notthaDeparfineotof 5 adn sf�l A 0dde�s- Shanldyoa bavn nay gnesttons regarding the Ian or ifyovc are rued to obtain awoz3cas' ca�e�an pofiay,ple2se caU ffio Depmtnem at tha nnmber 1s bmnw: pelf-ms►nrd companies STioIIld en�t their self-�sat`�ce Iie®se�on die Ime: City or Town Officials . Please be sore tit the aifidavkis complete andp3j f dlcV-bIy- The Departmenthas pmm&&a space at ff=bottom. of the davit for yau.to fill Uot in ti�.a event the Office o �yesfiga s has to yDII g ffim apPb-c PIeasebesureto fllinfhzp=� i;emmbmwhichwffibe used asarei»mrnunbcc In addition,am3PPlic $ �.at sabmrt muNiple p s�plYt�it}ns in anp�vea yew need only mibnmt one affidav-4 mdumt3ng ean�t pOr olicy mfo=atLom[ifn y)and under-lob I&-_A ress�'$re apPIicas¢shouldwtife 6sII local ns in (may [own)"A copy of timef5davitfhathas bores officially stamped cr mm3mdbythe�y or town may be provided to fhe is on file for Bare mmi1s or Iice oses_ AntRw affidavitmust be filled obt ehr •that a valid affidavit p Iicaot as proof - aca - or ' notxelatzdto auybusmess or c m+a+� � year.Vlhcte abome owner or ctti�zs obtaining aliceose pe�.rt ern_ said =m is NOT to czmrpleto fits affidav$ tnbuml �. eaves P (ie.a dog license orpcunit ,) Tbe0fficeof&vesfigWimswUaldllb-_to.t3mnkyonimadv-mco for yourcoopezaicmancisbouldyonhaveany4IImsfims. - plmse do nothesitab to&min a call Zbe7kparfinemt's address,telephone md;E3cmmnbcr _ oil II Tf,.L:,P 617-TVAM w t 406 or 1-977-ILASSAFE Fax#617 727'749 Revisrd4-24-U7 Tn Zr I r Town of Barnstable Regulatory Services dF Richard V.Scali,Director Building Division t .Paul Roma,Building Commissioner. MA 0.796 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEEAIPnON Please Print DATE: —? — ?— JOB LOCATION: (//S TT/ kl'10_1 - / / /V /U/u S cumbber street village "HOMEOWNER": Fj U& �E ®/C-� _ ��/ _ 7 name home phone# work phone# CURRENT MAILING ADDRESS:/ cityhown 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. DEFINMON 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 pro edures and requirements and that he/she will comply with said procedures and requirements. Sigoatiue 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 EXEMMON 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 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:\wPFII.ES\FORMS\building permit fonns\EXPRESS.doc 06/20/16 Town of Barnstable . t Regulatory Services XAM` s�rl►ffi$ ' Richard V.Scab,Director. Building Division. Pawl Roma,Building Commissioner 200 Main Street Hyannis,MA 02601 www.town.bumstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must f Complete(and Sign This.Section j k If Using A Builder 1 ,as Owner of the subject property hereby authorize to act on my behal f in all matters relative to Work authorized by this building pemnit application for (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 Signatare of Applicant Print Name Print Name Date UORIM:oWNERPERMISSIOIeWIS 'I o2 d/. ' 5 Town of Barnstable *Pert# .� Expires 6 months m issue date Regulatory Services Fee '— * M Thomas F.Geiler,Director, ®/o�fjF.SS Building Division �w SEP 1 2013 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 , www.town.barnstable.ma.us TOWNFpRNSTp,BLE Office: 508-862-4038 0 8-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY r� Not Valid without Red X Press Imprint Map/parcel Number& C'2 40-S Property Address K J n .✓e e �- ❑Residential Value of Work$ L {G Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address d wl- Y Zi haj Tenn*;, -Ccf Contractor's Name AA t %\ Q. Pt)Z 1 Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ( ( � ❑Workman's Compensation Insurance I OhSpk 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 .1 ❑Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof) PR—Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ 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. SIGNATURE: QAWPFILES\FORMS\building permit forms\EXPRESS.doC Revised 060513 , .. - ---the Commonwealth of Vassachusetts 13epar�lt of 1}l il& Accidents Qhke oflmws iCgQttom` s 600 Washington Street Boston,M4 02111 wnnv.aria., gov/dia Workers' Compensation Insurauce Affidavit:Btinders/ContractoisMectriciansMumbers Applicant Information Please Print Legibly Name(13u a Organizationdndividuaq: A4,l 1. Adores_ x HwA•-e A A-f City/Stat&Zip: Ge j�e,( Vt ll c Phone 9- d 7) 4 G Are you an employer?Check the appropriate box: Type of project r 4_ I am a contractor and I y� pr ] (���= I_❑ I am a employer with ❑ general 6- ❑New cons5nsction employees(full and/or part-time).* have hired the sub-cantractors. 2-2 1 am a sole proprietor or papkten listed on the attached sheet y- ❑Remodeling sJup and have no employees These sub-contractors have S. ❑Demolition. working for mein any capacity employees and have workers' l 9_ ❑Building addition [No workers' comp.insurance comp.tnsurau required-] 5. ❑ We area corporation and its M.E]Electrical repairs or additions 3_❑ I am a homer weer doing all work officers have esercised'their 1 LFJ Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12..❑Roof repairs insurance required-]3 c.152,§1(4} and we have no employees_[No workers' 13.0 Other T(eJ 1 01 V'I comp-insurance reriuued-] *Amy Wlici vt that checks boa#I mast also fill out the section below shooing they wcakess'compensation policy Mbrioatiam. I Homeowners who submit this af[idavit indfc%Cag they are doing all wmk a'md then hire outside conuxctam nmst submit anew affidavit mdicat ng Md TChntractors tbat check this ban most attached as additional sheet showing the name of Hie sub-conti2a rs and state whether or not those em hies have employees. If the sub-ront acturs have employees,they Est provide their warkers'comp.policy number. I am an employer that is pravit ng workers'compensation insurance for my employeem Bel w is Ste policy and job site information. Insurance Company Name: Policy#or Self-ins-Luc_#: Expiration Date: r Job Site Address: City'Stawzip: Airtach a copy of the workers'compensation policy declaration page(showing the policy number and elation date). Failure to secure coverage as required under Section 25A of MGL c 152 can lead to the imposition oferiminal penalties of a fine up to S 1,500.0D 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 Imniestigations of the DIA for insurance coverage verification- I do hereby certify render thepains andpenalfies ofperjury that the information provided aboue is true and correct Si tore: / Date: Z Phone#: t7,U craI use only. Do not write in f)ds area,to be completed by city or town officiat City or Town: PermitUcense At Issuing Authority(circle one): 1.Board of Health 2.Binding Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone 9: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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-contractors)name(s), address(es)and phone number(s)along with their cerbficatc(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 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 bum leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would Ike 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: o. The Commonwealth of Massachusetts Department of likustrial Accidents _ - Office of kvestigadons 600 Washington Street Boston,MA 02111 Tel.A 617-727-4900 W 406 or 1-877-MASS: E Revised 4-24-07 Fay# 617-727-7749 www.mass_gov/dia Op THE A Town of Barnstable t Regulatory Services 4 anaxsr"LF. Thomas F.Geiler,Director i639• ���' °rFnMaja 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 I �2 , as Owner of the subject property hereby authorize �11/1, � �--�iw Z 1 to act on my behalf, in all matters relative to work authorized by this building permit Vi (AddreA of Job) LAA CQ60 **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. S tore of Owner Signature of pplicant 6"e-3 /In Print Name - Print Name Date QTORMS:OWNERPERMISSIONPOOLS 62012 "' a �1HE� Town of Barnstable Regulatory Services RARNSTAISM BLASS. Thomas F.Geiler,Director i639- �°rfnav,�► Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.rna.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": ' name home phone# work phone# CURRENT MAILING ADDRESS: 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official E 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. 1 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. C:\Users\decollik\AppData\Loca]Microsoft\Windows\Temporary Internet Files\ContentOudook\QRE6ZUBN\EXPRESS.doc Revised 053012 V/ZP.�6'/79i77L1Y/2LI/6LLLL/2�� —_--'_--_•!—� �. Office of Consumer Affairs&Business R gula on e�! License or registration valid for individul use my ' ME IMPROVEMENT CONTRACTOR before the eaptration date. If found return to W. eigistration: 119859Type Office of Consumer Affairs and Business Rerratron ' 2/4/2015 DBA 10 Park Plaza-Suite 5170 d ee•: MICHAEL RENZI CONSTRUCTION Boston,MA 02116 ;1� 't MICHAEL RENZI Y 387 PHINNEY'S LN CENTERVILLE,MA 02632 Undersecretary {� Not v d wi tout signature �< ' s �"a Massachusetts-Department of Public Safety. Board of Building Regulations and Standards Construction Super-visor I &2 Family License: CSFA-058266 : `mot:r'r'.♦ �� �k ��K4 � ��" P,� AHCHAEL J R&ZI _-• �� k'" y iP a 387 PHINNEWS LN a CENTERVILLE " �02632 j y i• '. ♦° $, X a 1♦ 1�'�a...... yr: n '. j41c Expiration Commissioner ' 01/30/2014 ,�. yp..� •y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map N Parcel Permit# Health Division ,. x`� Date Issued Conservation Division - r° a Fee -' � Tax Collector 4� +��- ~ �7100 Y*. Treasurer. LQ=0_ Planning Dept. } 3` ✓ Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis • , Project Street AddressOQ 5c>G Village *Owner 3 ,e _ Address c ,Telephone # ' • Permit Request i c> S i 9 r Square feet: 1 st floor:,existing proposed 2nd floor:;existing proposed Total new od .� Estimated Project Cost' ob Zoning District Flood Plain Groundwater Overlay. .Construction Type' Lot Size ;' Grandfathered: ❑Yes " ❑No 'it yes, attach supporting documentation. Dwelling Type: .Single Family 9" 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, U 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 .0_new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size- Shed:❑existing ❑new size Other: • Zoning Board of Appeals Au/thorization ❑ Appeal# Recorded❑•' Commercial ❑Yes la No If yes,site plan review# ' .Current Use Proposed Use BUILDER INFORMATION f, Name � o-,.r� ice �� Telephone Number - . c � �r�' .• Address .License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE - "FOR OFFICIAL USE ONLY :ram `. .. � � � ',,, - � - •o' , Y:;' 5�. } , 'I or PERMIT NOrJ DATE ISSUED MAP/PARCEL NOT � � � • '« • i ro-/.. ` � 4 ..i• •� :., . S3 Al i . - �,i •' - { `. ADDRESS VILLAGEOWNER lr� DATE OF INSPECTI N: FOUNDATION • i FRAME71 INSULATION 4 - FIREPLACE ` • �' _t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - 4 ROUGH FINAL # � '' •' � n• . - °' '� ¢ � w c= � � ._ ' ' • - r r ) ., a " t } ,`.. }'' ' �, . • ',gin � - � ' t � ' FINAL BUILDING . > ✓V tI I F a d � DATE CLOSED OUT ASSOCIATION PLAN NO: ; The Commonwealth of Massachusetts .___.._ Department of Industrial Accidents �' _ _- Olflc�ollosesligatloos 600 Washington Street - - f Boston,Mass. 02111 Workers' Cam ensation Insurance Affidavit �l name: �b e, F locations �'v'" �S / Au-C -7,;, y ci ti ox chi 61 hone# 7Y- v ❑ Ism a h meow=Performing all work myself Qum a sole have no one m�' ��� �////////////j%%% /�� 1 workin on this ob workers tnlsation for my crop ogees.-..:::::::::::g:::;:.:::::<:.:.. 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Y::.v};!•;{•. ............. order Section 25A of MQ.1S2 can lead to the of criminal penalties of a fine nP to S1,S00.00 and/or Faiinn to secmre coverage as regWrod one yam,imprisonment as well as civa penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understtmd that a copy of this statement may be forwarded to the OMM offtvesdgadom of the DIA for coverage verawation e.nallier o that the infornsation provided above is due and correct I do hereby certify under e p and p fP�! signature Phtme# Print name official use only do not write in this area to be completed by city or town official pemmitffiarue# ❑Bunding Department city or town: ❑Licensing Board re ❑Selectmen's Office ❑checkuimmediateresponse is required oHealth Department contact person: phone#; - ❑Other__. on,"d 9/95 Pled Information and Instructions , General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their Massachusetts Gen era from `9aw„�as employee is defined as every person in the service of another under any contract employees. As quoted of hire, express or implied, oral or written. le 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 association or other legal entity, employing employees. However the owner of a trustee of an individual,partnership,association of the dwelling house of dwelling house having not more than o stuuatints and on r repair r wok on such dwelling house or on the grounds or another who employs persons to do maintenance 31 building appurtenant thereto shall not because of such employment be deemed to be an employer. that eve state or local licensing agency shall withhold the issuance or renewal 152 section 25 also states every MGL chapter in the commonwealth for any applicant who.has of a Iicense or permit to operate a business or to construct buildings not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 regmrements of this chapter have been presented to the contracting authority. 510101251111110111 --------------- Applicants the box that lies to your situation and anon affidavit lately,by checking applies ens c�P Please fill in the workers camp be address numbers along with a certificate of insurance as all affidavits may supplying company names, P� o f age, Also be sure to sign and Accidents for capon submitted to the D artment of Industrial e� sub or town that the application for the permit or license date the affidavit. The affidavit should be returned to the ctti3' aPP not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you being' are required to obtain a workers' comp ensaticii policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the the Office of has to contact you regarding the applicant. Please affidavit for you to fill out in the.event � �, be zetm�to be sure to fill in the pemiit/license number which will be used as a reference member. The affidavits may the Department by mail or FAX unless other arrangements have been made. thank you in advance for you cooperation and should you have any questions. The Office of Investigations would Ike to do not hesitate to us a call. please � 00111 The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents mlestl Once of 1 adons 9 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 Town of Barnstable The 9� Department of Health Safety and Environmental Services ���,,,,j► Building Division .367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERNIIT 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 to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: OC r r 2 Estimated Cost �/3U� Address of Work: Owner's Name: / S Date of Application: I hereby certify that: Registration is not required for the following reasou(s): Work excluded by law Job Under$1,000 Building not owner-occupied [3Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MWROVEMENT 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 Date Owner's Name q:forms:Affidav s 44 ey BaXlctrn egurations and Standard. s��aa One�AS. urn :raP acme,Room 1301 ,a--,i aF ,� d mwwaYi ra. QrJ't ;n•� Ssachusetts g2108 --�',�.vt^Y:•. t r u*ax �+ f �e�;�'a �5 �:r<p-- +ta<-., ..:r,_: .. { F atractor_7 48egistration§e 83r _Expiration 09/27/2 x 7 r . �� _^a^` c{�� •a. � y c r �'''�'e,�:"C'"'g,'b'!' - kr's�'�.•..�. . .. ORIONW. IBM SHON- CIOFIELD O.�MEMAIN & REP ..- � . SHO Of .ED Y �.UPVW Y46 N�fls` M 0260i x �fi:. ' roc tm� p A V7 y�p•"mtfia'°.4' - gT .. u;, ,Y ,f� I 4