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Home My WebLink About0008 BROOKSHIRE ROAD A611 TOWN OF BARNSTABLE BUILDING-PERMIT APPLICATION Map Parcel S Permit# 6 � Health Division Date Issued Conservation Division Feed Ss '� Tax Collector% ®c mm/l Treasurer Cr b e Planning Dept. Date Definitive Plan Approved by Planning Board (1 Historic-OKH Preservation/Hyannis Project Street Address 93 yDr4no Village h bl Owner I soC-4Jp, � _ Cn r �'1 �� Address Telephone Permit Request v C— Square feet: 1st floor: existing J9 proposed 2nd floor:existing proposed Total new Estimated Project Cost '!2�-SQwoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes U,PQo On Old King's Highway: ❑Yes ElGo Basement Type: II ❑Crawl ❑Walkout 0 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 L Heat Type and Fuel: Vdas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Wlo` Fireplaces: Existing KO New Existing wood/coal stove: ❑Yes A 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 O Appeal# Recorded❑ Commercial 0 Yes r 0 If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number 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 s. - - SPERMIT NO. DATE ISSUED �� ~' r MAP/PARCEL NO. r ADDRESS •. `' " VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH -hFINAL n ~' a PLUMBING: ROUGH FINAL 'r r GAS: ROUGH FINAL t FINAL BUILDING A w r I DATE CLOSED OUT L _ ASSOCIATION PLAN NO. ,= �= The Town of Barnstable MAM Department of Health Safety and Environmental Services �0r Building Division g M. 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissione. Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW _ 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 to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.` c Type of Work: 1C' Q Estimated Co s® ,,", Address of Work: )coo t-s�1 c! ' Owner's Name: PIAK �- Date of Application: f �= I hereby certify that: Registration is not required for the following reason(s): Work excluded by law E]Job Under$1,000 Building not owner-occupied d6wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME E"ROVEMENT 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 - The Commonwealth of Massachusetts LtHz_ = =rm, Department of Industrial Accidents AW Offrcaollnyestigatians +� 600 Washington Street ..9X+' Boston Mass. 02111 Workers' Comiensation Insurance Affidavit '�n rc�E" �•rai uo %''�/�•/%%%%////% FIN /////%%P€ "••• `i'Yt%/%///////%/%%/��////////%i%//�,!///%//1111111A/O//////,�,,,, , name: Tl(t�4�-'-Lt^ 71S ancn L, c location- city hone 1t , I am meowner performing all work myself. w I ama sole prcmnetar a/nd have no one workin in yaany�capacity � ��/�/�/I.'b�//////.(/// ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: address: city - phone#� insurance co. nnlicv# r ❑ I am a sole proprietor,general contracto , omeown 'rcle one)and have hired the.contractors listed below who have c' . the follo«ing workers compensation polices: comnnnv name' address: .. aY dtv. phone#t insurance co. ....... //// ��//%/•�i comnnnv name- addresr. phone-#?--- - inuurance co. F&Uure to secure coverage as tired under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Me up to si.5moo andlor one vears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Me of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Olnce of Investigations of the DIA for coverage veei>Ieatiom. I do hereby certify under the pains anti penalties of perjury that Ae information provided above is tru.-and correct �� C� si2ature — Hate f®�- _ Print name 1�cerC�l� ;I'. C t�( `f Phone# -'op- '7-1�a �S79�;z oincial use only do not trite in this area to be completed by city or town otncial city or town* permitAicense 0 ❑Building Department QLicensing Board ❑check if immediate response is required ❑Selects.en's Office ❑Health DeparuUnent contact person: phone t!; ❑Other��, ttcn+m 9,95 P1A1 Information and Instructions r. Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thr employees. As quoted from the "law",an employee is defined as every person in the service of another under any ca..:.,,.-. 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 o: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec.;.z•�: 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 ofthe dwelling house of anther who employs persons to do maintenance, construction or repair work on such dwelling house of on the groins o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew, of a Irene 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,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work mr—? acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the coutraczng authority. ice`, . Applicants F Please fill in the workers' compensation affidavit completely, by checidng the box that applies to yaur situation and :supplying company, names,address and phone numbers along with a certificate of insurance as all affidavits 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,pleas e call the Depart�aeai 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 affidavit for you to fill out in the event the Office of Investigations has to court you regarding the applicant. Please be sure to fill in the peimitllic nSe number which wM be used as a refeumce number. The affidavits may be rcto reed io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would lice to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax munber. The Commonwealth Of Massachusetts Department of Industrial Accidents oftice of lnvesduadons . 600 Washington Street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �oFt►te r —� o Depaftfn ;.:.:.' ~` . --t71---.j.th Safety and Environmental bg:,;a.mce:, Building Division 9�tvsri+srE. 't+tnss. 367 Main Street,Hyannis MA 02601 t61¢ ,0$ . ED MOd 6 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 1nfumber street 8 village ER""HOMEOWN : iX i M A G 1i bow / v S�S "7�O 5 3q�P' name home phone# work phone# CURRENT MAILING ADDRESS: 'tM� city/town star 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 Officiak that he/she shall be rew oncible 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. Signanue 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 worst 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 persons)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 to amend and adopt such a form/certification for use in your community. i Q:FORMS:EXEMPTN