HomeMy WebLinkAbout0011 KENNEDY CIRCLE - FORMERLY 0018 BYRON PLACE � . _ __ _ __
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Permit#
Health Division ' _'g4' Or Date Issued [lam WL
Conservation Division a /m/ Fee
'1, r{ ?
Tax Collector ' Y t ' 6 , Application Fee
Treasurer
Planning Dept. d" ' ~� Checked in By
Date Definitive Plan Approved by Planning Board Approved By n
Historic-OKH Preservation/Hyannis C4
Project Street Address A Wdz
Village AJA114r
Owner f ! L• / ess 1,7zd /S
Telephone rO�2 7Z —0",4/
Permit Request�� � j�� L��,lI'�� -1144—,yd4z
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Valuation ��7x Zoning District Flood Plain Groundwater Overlay
Construction Type �&A
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes )37No On Old King's Highway: ❑Yes OrNo
Basement Type: ❑ Full ❑Crawl 0 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 0 No
Detached garage:O existing ❑new size Pool: 0 existing ❑new size Barn:O existing ❑new size
Attached garage: ❑existing 0 new size Shed: 0 existing Yew sizel0k Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name / Telephone Number 2
Address License# w
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESUL7 FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
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FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION .
FIREPLACE
ELECTRICAL: ROUGH FINAL -.
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
f .
DATE CLOSED OUT'
ASSOCIATION PLAN NO.
' r
Town of Barnstable
�FZHE Tp� '
Regulatory Services
IARMAB Thomas F.Geiler,Director
HAM
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
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. nn
Type of Work lc���� ���� Estimated Cost
Address of Work:
Owner's Name: �/�1 ?`'��TiffPd✓ �`+ `/�'
Date of Application: 9 ��
I hereby certify that: -
Registration is not required for the following reason(s):
OWork excluded by law
❑Job Under$1,000
❑Building not owner-occupied
Owner 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 a Registration No.
Date Owner's e
Q:forms:homeaffidav
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street 7'4 Floor
Boston,Mass. 02111
Workers'Compensation Insurance.Affidavit:Building/Plumbing/ElectricaI Contractors•
name• ®Ayt! !7AW�r L M I
address: �� �!� /y��/� 4Al
`
{ state; ZiR: phone# KZ
work site location(full addre s :
I am a homeowner performing all Avork myself. Pr ect Type: XNew Construction❑Remodel
I am a sole proprietor and have no one workingin an),rapacity. Buildiig Addition
ar"'' 'ry i n .a",'_° '1 Y.+r`f�ii.� a w o.. i�'cw� i •f `°�'a" :'rS r .y."^"4 ii• x, ,.. i7• 1rT1T :�.�'., u 11M121ii,N
�] I am an employer providing workers' compensation for my employees working on this job.
company name:
address:'
dty: phone 0:
Insurance co. policy
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❑ I am a sole proprietor,general contractor,or homeowner(circle one)andhave hired the contractors listed below who have
the following workers' compensation polices:
company name:
address
city: phone#:
insurance co, oltc #
^n f .7 t '.1i.7 SM ff. )'..• VV 7
•gl'ri�yS:r�:S .2:i� i�r'�. .tT+}ic . v+':4'+}i�'..e+'. .. �f�h.;d'�4`zn�-i��f'::7�.�..'t�iM1t..�a'1S`��t•�:..5*�1.'.�:p2.'aa.�.•..q�;ill.'•,'i,�P'1','�i?��litiF�te.:?�Y°,•4rAt;�f�r.r1}'���6:LG'.i°:�iTs.'{ %�'.'}�''ai�
'company name:
address:
city: phone#:.
insurance co olI #
N,a�-�...'"ii+��i,�'�•r°"',�SF,'�` et�....Y����.... ° '' � +:' •"a"�`.�?`�.'`�: 1�ae�"; ��+��! ' +".:" �� �..r, .a���'.":�, '•r
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition-of criminal penalties of a tine up to$1;500.00 and/or
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine df$100.00 a day against me. I understand that a•
copy of this statement maybe forwarded.to the Office of investigatlons of the DIA for coverage verification. '
I do hereby c A�e under a poi d p ties of perjury that the information provided above is true and correct
a _
Signa Date f� �(�'
Print name ( l- L- Phone#,V,?—�/
official use only do not write in this area to be completed by city or town official
city or town: permitnicense# ❑BuildingDepartment
check if immediate res onse is required []Licensing Board
❑ p q ❑Selectmen's Office
❑Health Department
contact person: phone#; []Other.
(revised Sept 2003)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all'employers to provide workers' compensation fot their .
the"law",an employee is defined as every person in the service of another under•any
employees. As quoted from . .
contract of hire,express or implied;oral or writteg. ,
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.
br 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 section 25 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,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. '
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Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, 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,please call the Department at the number listedbelow.
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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 contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference.number. The affidavits may be returned to
the Depaitment by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for.you cooperation and should you have any questions,
please do not hesitate to give us a call.
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The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts-
Department of Industrial Accidents
Office of Investigations
600 Washington Street,7 h Floor
Boston,Ma. 02111
fax#:(617)727-7749
phone#: (617)727-4909 ext.406..
oFtM Town of Barnstable
Regulatory Services
swxtvernBi.E. = Thomas F.Geiler,Director
MASS. A.�� Building Division
sec 1�
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
l�✓ Please Print
DATE:%✓ ��D� //
JOB LOCATION:
number street
�j�s�treee�t/ �/ °f�^J ' / village AJ
"HOMEOWNER': /4 1/6 // ;'(�� G. 'L�KgIt 4�/!/ �r /J`�,/OlO
name home phone# work phone#
CURRENT MAU ING ADDRESS: % y ���� AL
ci /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 a understands the Town of Barnstable Building Department
imection proc ures and require nts and that he/she will comply with said procedures and
rgna Ho a er
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 pern it 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.
QXornwhomeexempt
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SIAR IiliNc.A 6! The Horizon — Ideal for storing
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• End wall 40"double door&26"single door v
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FRONT EXTENDED PEAK PEAK GAMBREL
Shown in photo:10'.x 14'Horizon 7'wall shed—dark gray vinyl siding,gambrel roof,black roof shingles
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SIZE 1ID� M Mq M0A MUROMM
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III x IT 51,969.99 S43 $2,169.99 S57 $2,269.99$63 $2,549.99$57 $2,089.99$51 $2.289.99S3 $2A49.99F563 $2,649.99�$69 $2,579.99 669�52,779.99$15 $3,339.99[88 j$3,619.99�$94
8'04' $2,339.99�563l52.559.99�569 $2,669.99$fig $2,979.99[$75 $2,409.99[$63 J$2,629.99[$69
1 � $ 679.99$6 $2,899.99$75 $2,929.99$75l$3,149.99�$82 $3,759.99[$100J$4,059.99[S101
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10'x12' $2,459.99�$63 $2,679.99[$69 $2,789.99[$75 53,099.99$81 $2,539.99C0 $2,759.99�$75 $2,859.99�S75 $3,079.99C$82 $3,079.99C$821$3,299.99$88 $3,909.99[$100]$4,219.99'$107
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IG 10'x16' $3,089.99:$82 $3,349.99[SH $3,449.99[$BB $3,809.99L'$100 $3,139.99[$82 $3,399.99[$BB $3,599.99[$94 $3,859.99'$100 $3,839.99[S100�54,099.99[$107 $059.99C$1051$5,219.99'$110
12'x 12' $2,829.99r$75 $3,069.99:SB2 $3,169.99�92 $3,509.99�S94 $2,959.99$75 $3,199.99$82 $3,339.99[$88 $3,579.99�$94 $3,559.99$94 $3,799.99$100 54,579.99�%119$4,919.99�S105
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12'x16' $3,429.99[$88 $3,709.99[$94 $3,789.99� 100�$4,119.99�$101 $3.529.99$94 53,809.99�$100 $4,149.99�$101�$4,429.99$113 $4,299.99�$1131$4,519.99$119 $5,409.99�$115,$5,199.99�$125
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t Additional terms apply.See back for details. www.ShedsUSA.com/Homedepot or call866.616.2685 for the exact outside floor dimensions.
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8'x 14' $2.239.99[$57 IS2,459.99`$63 $2,569.99[$69 S2,879.99[$75 $2,309.99�$63 1=$2.959.99S75
$2,579.99'$94 $2,799.99�S75 $2,829.99$75 $3,049.99$82 $3,659.99$94 $3,959.99$100
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• 12'x 12' $2,729.99rS69 $2,969.99�S75 $3,069.99�$82 1$3,409.99'S88 $2,859.99$75 1$3,099.99$82 $3,239.99$B2 3.4 .9 88 $3,459.99$88 $3,699.99'S94 $4,479.99$113$4,819.99[$105
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When purchased on your Home Depot Consumer credit card Note:All shed dimensions are approximate.If preparing your own foundation/footing,visit our web site
Additional terms apply.See back for details. wwwShedsUSA.com/Homedepot or call866.616.2685 for the exact outside floor dimensions.
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