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HomeMy WebLinkAbout0047 CASTLEWOOD CIRCLE y� Casfler.>xd� Clr, \� _— _. o�t► r :Town of Barnstable Perms Erpires 6 montks from issue date Regulatory Services Fee 1ARNSIABLE, MASS9c� , Thomas F. Geiler,Director ffL Building Division Tom Perry, CBO, BuildingiCommissioner e , 200 Main Street, Hyannis, MA 02601 - www.town.barnstable.ma.us . Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number .6 7' Property Address G� VjjC/O � AA (l�l �1CN ❑Residential Value of Work (501 Minimum fee of S35.00,for work under S6000.00 Owner's Name&Address o` W �\C" Cam-; LO � -0— c) C, e_ �I c�.n✓�iI 1`�\Pt Contractor's Name Telephone Number Home Improvement Contractor License,#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: MARQ1 I am a sole proprietor I am the Homeowner 'OWN OF BARNSTABLE ❑ I haveWorker'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(stripping old shingles) All consti6ction'debris'will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side , Loo (e(:e S Sot } r #of doors Replacement Windows/doors/sliders: UtValut ma imurri .44 #of windows *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 Le"tter.of Permission—, " A copyof the Home lmprovement Contractors License& Construction Supervisors'License is r req:u' ed. SIGNATURE: Q:\WPFILES\FORMS\building perAt formsTXPRESS.doc Revised 070110 ' The Common wealth.ofMassachusetts Department of Industrial Accidents i Office of Investigations 4 .600 Washington Street 1` vBosion, M4.02111 ,- `www.mass:gov/dia Workers' Compensation InsuraiiceeAffidavit. Builders/Contractors/Electricians/Plumbers Applicant Information ;.' Please Print Legibly Name (Business/Organization/Individual):. Address: C 2. - City/State/Zip: c-,- i µ Phone #: G_ 2_ Zo 2� Are you an employer?Check the appropriate box Type of project(required): 1.❑ 1 am a er em to with 4. �-I am a general contractor and I employer 6. ❑New construction employees(full and/or part-time).* have hued the sub-contractors 2•❑ 1 am a sole proprietor or partner- listed on the attached sheet. # 7 ❑ Remodeling ship and have no employees These sub-contractors have 8: Demolition working for me in any capacity. workers',comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its ]0.❑ Electrical repairs or additions require officers have exercised their right of'exemption per MGL . 1 I.0 Plumbing repairs or additions 3.`LJ 1 am a homeowner doing all work g P myself. [No workers' comp. c:152, §]`(4), and we have no 12.E] Roof repairs insurance required.].t employees. [No workers' 13.❑ Other °comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy information. t Homeowners who submit this affidavit indicating they are,doing all work and,then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheetshowing the name of the sub-contractors and their workers'comp..policy information. I am an employer that is providing workers,''compensahon insurance for m'employees.'Below is the policy and iob'site , . + information. s " Insurance Company Name: - f` Policy#.or Self-ins.'Lic.#. $ Expiration.Date: Job Site Address: 'City/State/Zip: Attach a copy of the workers'compensationFpolicy-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$250.00 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 hereby c ify under the pains andpenalties'ofperjury that the information provided above is true and correct Si ature: Date: 3 AOL t e- u Phone#: (' =`y ZU Z-- 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: 7 Pti'one#: 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,,person§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.iii 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 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 LL:P does have employees,a policy is Tequired. 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 burn 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 Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia r TFIE Town of Barnstable, � � 1 f- �P.. Regulatory Services y -A utttrsrwsM : Thomas F. Geiler,Director Muss $ ibs¢ ,a Building Division Tom Perry, Building Commissioner 200 Mait-Streei;_Hyannis,MA.02601 www.town-barnstable-ma us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOVNER LICENSE EXEMPTION Please Print DATE: `,y KCIJ_C_ 2U ` JOB=LOCATION: f ! e-vu �CC IY\°" number \ street village .'HOMEOWNER":, 4. �Q. `\\cc..rM ! C�$ Z. G22— 5-6 9 -7 I Ida 0 name V home phone# , work phone# CURRENT MAILING ADDRESS: 1 S Q Vy O G 0-\ C C—t` e city wn state rip code The current exemption for"homeowners"was extended to include owner-occupied.dwellinl?s 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 HOMEOWNNMR Persons)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 constrgcts more than one home in a two-year period shall not be considered a bomeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Budding Official, that he/she shall be respor;sible for all such work performed under the building permiL (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 minirmirn inspection procedures and requiremcnts;and that he/she will comply with said procedures and , require ents. � Signature of H-y6wncr Approval of Buflding.Official Note: Thrce-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. H01l3EOWN•ER'S EXEMPTION The Code states that "Any homcowoer perforning work far which a bui3ding permit is rcquirrd shaD be exempt from the provisions of this section.(Section 1 D9.1.1 -U=nsi:hg of ctmstruction Supervisors);provided that if the homcotyner engngrs a posan(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this cxcrrrption arm unaware that they are assurTing the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bf rn trsults in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person as it wDuld wi th 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 pemit application, that the homeowner certify that heshe understands the responstbilitics of a'Supervisor. On the last page of this issue is R.form currently used by several towns. You may care t amend and adopt such a forrr/ccttificatiom for use in your community. ip `{4 THEr Towns of Barnstable Regulatory Services Thomas F. Geiler,Director 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 Property Owner Must Complete and Sign This Section, If Using A Builder as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to wprk authorized by this building permit application for. (Address of Job) t , Signature of Owner Date Print Name If Property Owner is applying forpermitplease complete. the Homeowners License Exemption Form on .the reverse side. r Town of Barnstabkf-l°wi [lip f AWNS 1 BLE Regulatory Services,, ti Thomas F.Geiler,Director ' FGB 20 F 3: 4 0 tA1tN3TABt,£. 9$ 1639. Building Division '°gyp A Tom Perry,Building Commissioner-- .--w ,--f 200 Main Street, Hyannis,MA 02601 7 i v l�j o u www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# A)957,3 FEE: $ GN SHED REGISTRATION 120 square feet or less Location of shed(address) Village U' SC`1tWl C-k�W$ Property wner's name Telephone number �xIz - 6 y � Size of Shed Map/Parcel# Fe *9tu a Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? v Conservation Commission(signature is required) 1 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. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 Map Page I of I Town of Barnstable Geographic Information System Parcel Viewer] Custom map—] Abutters Map Size Zoom Out I fl In JPG Map: 273 ............. ..............:..................... I I ............. .. Location: 1° 273016.5, # V � AA Owner: 320 73033 273044 2 6� #325 273058 #3573066 # 2 .. .......... #3 Location In ......................-................. Map&Parce ICU Location Acreage ,/2 ,15 13 AA 0 'Current 0% 'j i7 ......................................................... & 273112 Mailing Addi fol 273067' 273 ti im #4 A, ez, d'Appraisaed I ................... 7-: Extra Fe atur # IF Out Building Land j R Buildings #so- Total Apprai CI 2 7 3 11 lV71---, y- w/ 273056�w 'Assessed V FR� 5,- -J- Extra Featur - F e Out Building Land Buildings Set Scale 1" =1541 Aerial Photos < Total Assess Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comment: BarnstableMA v0.2.91 'Prod MUM!] V\,OPQ, Z(b 6-7 c,ui,,k7 f (0 SUS �-00 http://www.town.bamstable.ma.us/arcims/appgeoapp/m4p.aspx?propeftylD=273057&map... 2/16/2007 �- � essor's map and lot number ....M.. ......r0.3. ........... Sewage Permit number ,. y "S {.................................................. /A, Cl li �Q0*TNE'r '- TOWN' OF BA ASTABLE Z 33AWST"LE, i "6 BUILDING INSPECTOR i l ���� ��fio ra /G X 20 4 APPLICATION FOR PERMIT TO ..........�`� ..............,.................................................................`.............................. TYPE OF CONSTRUCTION .... . )VOIf1 o�4... .... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 17........ S, / ICU r!7 (_..,/ 7`G/e ProposedUse � .2.w....................................................................................................................... ZoningDistrict .... 1............ ...................................................Fire District f .............................................................S r... Nameof Owner ..�.....:..� :......:.....................................Address ................................,......s....................'...��/,�„M Name of Builder 11 'llaYl�... YY)1�� Address................................ .............. Name of Architect ....... 0.n.. ..........................................Address ........6Y.. ...e............................................................. cement b1 Number of Rooms .....................................................Foundation ............ ) ................... ..............�.. 1��I P ciri l se .,al�::. ?1 ! 7IA...1° 5 ��h,d s .. � Q� .........................................Interior .....pt.y. "3/( Floors ..Y...................................................................... ............................................. 1/ Heating ..... ....lot ......................................Plumbing .......NeV Fireplace ........../V/J YJ .......................................................Approximate Cost ...... ,7a©© ........................................ ... ......... Definitive Plan Approved by Planning Board _______________________________19________ . Area ✓�� ........e7— Diagram of Lot and Building with Dimensions Fee .. .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH `J I hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable regarding the above construction. Name ..`fir ?tCr„ ................... . . . _ � 11, Peter H. A=273-57 �837 add to singl�e ......... Permit" for .................................... family dwelling . -------.---.. ----------..---. . 47 Caatlnmwoo6 Circle Location ---------------------' Hyannis _ .----.--------.------------.. � � Peter B. Crowell - O,,or, ...................................... '________. ' frame Type .. � . . ...... � ' . . _ , Permit Grant ^ ' ' � --- of —'r--''~'' -_- Completed --. ^ � ' (ERMIT lV '------' -----' . ___--^" -------' � —~------------,---~.—.—.--,... ^ � � --------.—.----...--.—,----.. . � � Approved lQ � _--------------. ' . � ^ ^ --------.---------.-------.. . . � -------`------~-----^'—^--^— � . � . &` � i es map and lot number .:..1..1:........ �.. ....: 7 G os T Sewage Permit number .......... ?; yFTHE T�1`I "✓' ` TOWN OF 'BARNSTABLE ^rF t BAWST4T E, • kJ - 90o NAM. - t� RI �� IO ' I SPECTOR o uaY APPLICATION FOR PERMIT TO ...........34V7.' ...:� 1�.l.Lc �I,.YA.................�..'X..�� ............................... TYPE OF CONSTRUCTION { !I!!.d��. .................19.7 q ....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... 7.........lr. .,s. 1. .. .41........4.. .raLi ........................................................................................ ProposedUse ........ . .YJ1.1..1. .....Rkv.rn........................................................................................................................ Zoning District ... ...../...................................:.............Fire District ... . ... l I. ................ ...................... Name of Owner B.e.tjC ~...f'1,.:.��Q.��.�1..............Address .....SR..F��(5 ck.......Y.dl�..��:Y/:�I��..`-<c�.r Name of Builder .r�a.4�1.Y12Q.n ................Addressc1C('� �7 !.c. � e... Name of Architect .......� � Address .........N/ ...... ............................................................ Number of Rooms'...........1'................................. ....................Foundation • Exterior 5............Roofing ... $.1�CJ.4.1.. ....��'G�e7.1.. .�. 5....................... Floors ...... ................................................................Interior ..... ... Heating ....f.::.l7.ot...14414.r.......................................Plumbing .......&eN.4D.......................................................... 1�o y�`e yDO�, Fireplace ......... .... ..................................................................Approximate Cost ........Z��........................................................ Definitive Plan Approved by Planning Board ________________________________19________- Area .......................... Diagram. of Lot and Building with Dimensions Fee .. .......................................... ki. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Q Namee ................... Location 47 Castlewood XXXIN Circle Peter. H; Crowell -Date Completed PERMIT REFUSED , ----------------------..—~... � ' . , ��� �A l ell o� to C._ �o rt o ' o C� Qt � ace `fit QQ r s Y) r o