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HomeMy WebLinkAbout0230 CASTLEWOOD CIRCLEFF� 48, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION w Map 1 Parcel �� ' , - Permit# Health Date Issued 7/1 Conservation Division 471-1�4—`4 , Fee T Tax Collector> �C / �� EPTI" SYSTEM MUST �E Treasurer . JNSTALLED IN COMPLIANCE. �. : WITH TITLE 5 Planning Dept. : ENVIRONMENTAL CODE AND TOWN REOULlITfONS Date Definitive Plan Approved by Planning Board. Historic-OKH Preservation/Hyannis Project Street Address �3 0 r�S `TC. w�c p • c c L 6 Village 9/ �Z A -N' Al / S V Owner L✓�Zy�GZ u dZ Ga 4 % •Address i 3 Telephone Permit Request � jr� v v'S ' : C r Square feet: 1st floor: existing g0 4 proposed 2nd floor:existing proposed. . Total new :Estimated Project Co , 0OD . .Zoning District Flood Plain N4 Groundwater Overlay Construction Type Lot Size 9�- 1 s9 Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Er/ Two Family 0- Multi-Family(#units)' Age of Existing Structure °3 0 Historic House: ❑Yes . 2 o On Old King's Highway: ❑Yes ❑No Basement Type: ."Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) N�* Basement Unfinished Area(sq.ft) 4 D 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: O"Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 2' 6 Fireplaces: Existing New Existing wood/coal stove: ❑Yes X No Detached garage:❑existing ❑new size Pool:❑existing 0 new size Barn:O existing. 0 new size Attached garage:lZexisting ❑new size Shed:O existing ❑new size x Other: 4 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review#. Current Use Proposed Use ` BUILDER INFORMATION Name l41 Al Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ' l FOR OFFICIAL USE ONLY - PERMIT NO" - . . - • .. . DATE ISSUED - - MAP/PARCEL NO. - ?' <`" ' ADDRESS i VILLAGE S OWNER- DATE OF INSPECTIO`I ,' ` = - e, FOUNDATION FRAME ' INSULATION �' , _ r �- -�. _ '- - .. « ,. . . . . . _ .• FIREPLACE _ s ELECTRICAL: ROUGH; n. e-z FINAL �. y a ,•� ,� ,may � . i � _ •- ,� . . : f 4 -• r PLUMBING: ROUGH_ mr FINAL GAS: '' ROUGH' ., FINAL` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Town of Barnstable S • t:naivsrnei.e. • 9�A Department of Health Safety and Environmental Services rEc►��'' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. �t oe' Type of Work: �,v irn,t t..w.1- stimated Cost 00 p . Address of Work: ;L 5 4 GO S IrL JE G.�O B D C.) & . L �E f•-�-��/.6-N/y/S' Owner's Name: &7 Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied Ewner 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 Name Registration No. ♦ O Efate O er's Name q:fbrms:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents ^' • Olf�ce afln�estigatigns 600 Washington Street Boston Mass. 02111 — Workers' Comiensation Insurance davit nnfcsn , ormnfznttr / name: (A) #4 L i 1`' t� 06te t4 location: ;O C'''a'4 Y L E aW O O P �. 14tC t_f city AW Y AL M At I S hone# E3011 am a homeowner performing all work myself. ❑ ,I am a sole proprietor and have no one tivorking in amr capacity ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: address: :.: city phone* insur ce co. P011cV# r I am a sole proprietor, general contractor. r homeowner circle on and have hired the contractors listed below who have the folloning workers' compensation polices: company name• 1 ... address: :::•...:<:::...:.:.::.:. ..,_ :.:'•:fax.;;'.-;:.;:.;:,, dtv phone i!- msnrnnce co. polikV# ... .:....:.:..:. .:: camnanv name- :.._ .:... ;..::•::... address: city- phone M ituarance co. .:::: : " olicv# :. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well its civil penalties in-the,form of a STOP1VORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties perjury that the information provided above it tru.-and correct Signature Date Print name 6.. C,,nt,a use only do not write in this area to be completed by city or town official town: permit/license# ❑Building Department (]Licensing Board k if immediate response is required ❑Selectmen's Office❑Health Department person: phone#; _7❑Other9S PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any cow= 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 c: 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 renews.: 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. , Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your 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,please call thiMcpartment 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 contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference mimber. The affidavits may be reaaned io the Department 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. The Department's address,telephone.and fax number. r • . The Commonwealth Of Massachusetts Department of Industrial Accidents Office of InnesugatlOns 600 Washington Street Boston,, Ma 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 The Town of Barnstable WE Department of Health Safety and Environmental Services Building Division "B 367 Main Street,Hyannis MA 02601 �►ss. i639. rFD MA't� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: �r ��� 9 9 JOB LOCATION: We 4j 00 P e-I et C L F /,WYOwAf/ number street p village "HOMEOWNER": r GL /-' k U at opT�y &C A —2 �s .Z PZA name home phone# work phone# CURRENT MAILING ADDRESS:. O C+9$'yt-B wo o D Q / e C LAC Av a aAri4 M B olro / city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellynim 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-OfficiaLon 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 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 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. 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PROPFRTYLINES .........�.,,. , .. :-. - H UMBER 2>�-PARCEL NUMBER \ OUST N 1(1 2 FOOL CONTOUR LINE 10 FOOT CONTOUR TINE 66. / (•' SPOT ELEVATION O STONE WALL Jr l �A FENCE MAP,�2 72 f rI RETAINING WAIL 1.,� I i- RAILROAD TRACKS _ _ A STONE IfRY 4� _. 6 _- ,� • `P 2 7 SWIMMING POOL , \ / I(IJJ \ PORCH DICK I••//��///l� - / f� .I t 67 . 1 / L - 1 4.1 BUILDINGS/STRU(1UAE5 L -y\ -/ F+1F''• DOCK/PIER/IEl1Y ' `- ASSESSOR'S MAP BOUNDARY I i _ e vun a xAxxDlfs \ / ; O POST O" FlAGP01E SIGN m slDwowxs poll AA TORYIN I ES 5 LIGHTE1E08011' N��►P 72 z :.. { SITE MAP I O.B.GFOGRAPHI( XFORMAIION SYSTEMS UNIT 60 � I / j f SCALE: in feet j? 22 0 20 40 �_ \ 6. 7 r \ •, 1 INCH 40 FEE _ M 7 _I J ,'.tr - , t rvnrieir auunouni�Nu111 MI"Iti I IOCAlI0N5'mAHA�n f TRITON 1TA7'Mll IOEOORANH DATA INTAPHI1)IROM I9RY AIRIAL THIRDS ...................... # 2 .._..... `..........•� .,,.,,Tt�----1 : PAR 1101 OWI1NO FPOMI'-11WI00 NAIFRIKASSfSSOASMHSI"I. 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