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HomeMy WebLinkAbout0030 CEDAR STREET 3 o C.����-- S-�; 2 11 3)1J4 Town of Barnstable *Permit, "s Regulatory Services fee 6 months from issue date BARNsrnsi.& � MASS. Richard V.Scali,Director:a' ok �1- r J_ .• 6 t639. Building Division 3'- '�• Paul Roma,Building CommissionerAl o P 200 Main Street Hyannis'MA-02601., 4 2oi7 www.town.bamstabfWinlla iks'Oj� Office: 508-862-4038 � 11SrA . L,�Fax: 508-790-6230 EXPRESS PEPMT APPLICATION }'RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 77 Property Address �t�,aQ S 0A�NIIS Residential Value of Work$ Q�00 Minimum fee of$35.0.0 for work under$6000.00 Owner's Name&Address `1/A�l e� o�-�' � CD . 13L/l ' Contractor's Name iike-bl a� W t I L-t-Ls Telephone Number 7 Ze6 Z 31— 7Do y Home Improvement Contractor License#(if applicable) 313 Email:,M,k, @_aw 61 0(�DPeA,4 5we-.0iz eo Construction Supervisor's License#(if applicable) 4Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Fig-g,/1 zj� V , Workman's Comp.Policy# the l ftQat,> Copy of Insurance Compliance Certificate must accompany each permit. . Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken toi(-FMB ❑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: ❑ 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 r' quiredoe SIGNATURE: - Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC 06/20/16 The Colmrnarrtpe¢ah*qfM dh� Ly, Dep=ftnevit of ludrtstrid Acddazts - Ore of.iitafie�s 600 Washirigtorr Street -- Boston,MA 022111 - F -- k6'fPli3#flasmgorldia , Warkers' C Insu;F:tail Affiavid B�dIders/Cun&a tor&TIedr ciao h mbers APPEcantInformiation Ple ase Print s Name(B EMMigam rtmlEnr�-�rina7�- ��j � O� 1�'�`•(S Citg�' fa 27 �6Phone i,'_- _ !7 w Are you an employer?:Checl£the appropriate bay: Type of project(reg�eti) am a g cmmcor and ` ' " ' I.❑ I am a employer itfr ElI ft d I 6- ❑New o ca employees(fish andfor paz#timed* have luretf�e sob coat�oas' p 2.❑ I am a sole proprietor or,partuer-, listed onthe attached sheer. 7- ❑RemodeHng 04 and have no employees ..Mese nab-comdractms have 8. ❑Demolition',. , Wang forme in citg any capa _' 4 w employees andhave wodoers' 1 9..❑S.uilcHngadxiitionP• [No wodce&comp.hw=nce' ° 1 Electrical or aeons required-] "s5. We arm a cospoTatifla and its ti ❑ r officers have exercised t 3_❑ Iam a homeowner doing All vrork - I❑P1umbRag regains!or additions - myself o work=' ngU of exempfim per MGL y❑ comp- c_.1 1 and�eaarezpo 1' Roofr E . im re ance recpnired-]Y , § {4 h M ,. ,'�<' �Fl�-moo _ 1�_Of?tfier' .•t- , camp-msuransce regdaed.) } *Any W icxmtdmtchets'bos#1 mast alsa SIlouttbe sectioabdowshU tug 9ie¢wo&ea'compmsarianpeHcpinffiMMaa¢L F ameoataerswbosabt afs3a is taiiagtheyaxedampsIFwowsaddseahireaufsidtca��+*�mastsdhmitanetvsMdze :mdicabaasuch , ICaat> Sszt check ibis boar mast attached s m addinianal d wex di=ing the--of the and state whether ar not tbase eafitks ha ee ` employees tiradU!M'imp.palicg amaben lam as Setow is f iepv cy and job site infmmatiars. «, Insumce Company irame= Poficy 4 or�e1f-ins_.Lic F pigstiaaDate: Job She Addae= 3(D' 4feL -ST__ ,M CitglStatrd� ; Attach azopy of flit wort-e:re comapensationpolicy declaration page(showing the policy number and expiration date). Fame to secure coverage as requimd udder Se4clioa 25A of MGL m 157 can lead to the imposition Qf crmu nal penalties of a ' fine up to$1,500 00 andfor o6i:y&irimprismm=3k n wiU as tivil penalties in the faun of a STOP WORK ORDER and a fme of up is 4-00 a day against filie violator- Be ir&ised tuna a copy of this sbkmenl may.be forwarded fn the Office of 1mvedtAtiom ofthe DIA.for ihsumnce coverage verification- Ida lnergby car*under did As and pen a r:' thatthe in ormadexprin•-ided abcty is hug and correct Sitatare: Date- Phonet M , _. — Ojofcial we agnIp Do not writs �err,to be completed by chip afta te"n a faeiat i ' My or Town PtrffitlLieense:g Lwiting Authority Cc rvIe true): L.Board of Heal& Bwl Depar t 3.gown Clerk 4.Electrical Uspec ur 5.Ph=Mm g Inspecter 6.other Contact Person ` Phone 9: lbaformation and Instructions p f MRcc irrTct s Gebe_g Laws cTigpirx 152 requires all empIoy=to provide worms'comPeasafion for i eg emplofees. p �this Vie,an ernplvyee is dcfined as;eveaypersanin$te scdvice of anot3r under any cor�ract ofbire, f. express or implied,oral.or " Au �Tayv is defined as°`an me Mffi al,par[neasb3p,associ on,cDrporaiion az otTzer legal enfiiy,or any two or more of the foregoing eengaged in a 1'oint ,and inclndmg the legal repre wfatives of a deceased employer,or the: to ees_ However the o �' ,associafion or otherlegat entity,employing emp Y trastee f mdividnal, receiver or P owner of a.dwelling horse hav ngnot more than three apartments and vrho resides therein,or the occupant of the - dweIIing house of another who employs persons to do mai•ntm ce,cam*action,or repair wo3k on such dwelling hose � e tends or vrtenat¢iiiereto sbaIlnotbecanse of snrk emp I eut be deemed to be an employer or on the pro b��g aPP MC3,chapter 152,§2SC(6)also states 13iat'everystafe or local licensing agency shall withhoId$ie issuance or renewal of a license or permit to operate a business or to construct bwldaigs is the commonwealth for any applica iwho has not produced acceptable evidence of cnmphan.ce with the Insurance.covexage requirecL Additionally,MCM chapter 152,§25CM sues=Neither the commomwealth nor nay ofifs pDPECB1 subdivisions shall enter into any contract for flie person M=ofpnbho work um±iI acceptable evidence of complian ce with$ie n,s�n ce.. regimeoi=ts of this duptra have been prEsentedto the con +a MthOaty_" A_ppric=Is , Please fill Dirt the workers'compensation of E&V t completely,by ched� the boxes thatapply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone nnmber(s) along WiLthar=tficate(s)of Insurance_ Lim rt d-LbbR4 Companies(LLC)or Limited LiabMty'pmtn=zhrps(LI,P)widi-no employees other than the members or parinex-4,are not regtmed to c ry workers'compensatr®.msm�mce. If an LLC or LLP does have employees,apolicyisrequired. Be advisedthattbisa$dayitmaybesnbmlimdtofi�eDeparimaeatoflndustcit Accidents for confirmation Df m m=covezage. Also be sure to sign and date the affidavit The affidavit should not be retrmmeti to the city or town that the application for the permit or license is being reque3tr�, Department of . „ "dents. Should u have any questions*�mg the law or ifyon ale req redto obt$m a workers' T r�ncirial l�sc1. you mnnpcnsatioup ?i�d below. Self-ias<n ed companies should err their o1i please call the D arfine�at the nnmbeT s elf_fi c❑r-an ce Iicerase member on the appropQiafe line. City or Town Of Fxdak f _ that the affidavit is lete a ndpri�cdlegiibIy.'The Departmenthas provided a space at the botfnm Please be sore, �p rant the affidavit for you to fill out in the event the Office ofl�aves� o has to coniactyo¢repot ding the applicant of y Please be sin a to fIl in fae pen t/ crosse nwnber which wM be used as a mfere:ace number. In-addition,an applicant that must submit multiple permWl ce e applib&ans m agy given year,need only submit one affidavit indicating rr rcu t Policyy mfotaation Cif•necessary)End under` ob Site Address"the applicant should write"all locations in (ciLy or- town)"A copy of•the-affidavit that has been officially stamped or maimed by the city or tovm maybe provided In the - applicant as Hiroo-fthat a valid affidavit is on file for fatm e permits or licenses Anew affidavit must be filled Diet each year.Where a home owner or citizen.is obtaining a license or pmmit not related to any busmcss or commeresal v=3t= (i_e_a dog license orpmmit to bum leaves etc_)said person is NOT rcgiredto complete this affidavit The Office ofInyesfigafi=wouldlgrz_to ihankyouio.advance for your cooperation and shouldyon av'e any questions, please do not hesitate to give us a call. The Deparfmmes address,telephone and fax number: Tha COnMQMVMaIft of massarlh ` Deem Gf Iz d A00i:denta ice of� �fio� - �Q4 B MA OiIII Tt,-L.4 617-72749W wt406 or 1477 MASa Fax9 617 727 774-9 Revised 424-07 9P'gIdi3. �V Town of Barnstable Regulatory Services • �_, • Richard V.S ' Director ass. - ►� Building Division. Paul Roma,Building Commissioner a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 509-862-4038 Fax: 508-790-6230 Property Owner,Must Complete and Sign This Section If Using A Builder I. �A��^'�R� �,e���1 �v5� as Owner of the subject property hereby authorize T It V�(zr�-S to act on.my behalf; in all matters relative to work authorized by this building permit application for. �Da S r (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 s ecdons are performed and accepted. Sigatur of Owner f Signature of Applicant Print ame Print Name D QYORMS:OWNERPERMISSIONPOOLS Town of Barnstable �> . Regulatory Services oOF Richard V.Scali,Director Building Division Paul Roma,Building Commissioner MASS 639• M�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Z, 3 Please Print o � JOB LOCATION: 2 Z2 num er if village "HOMEOWNER": 5 0 � 9CLA,,0 name home phone# work phone# CURRENT MAILING ADDRESS: (7 C�it/Yv ' - 62,9, 6G ity/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. T and gnedl"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pr edur' and r uireme is and that he/she will comply with said procedures and requirements. Sign of omen 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 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Details Page 1 of 1 Licensee Details Demographic Information Full Name: MICHAEL A WILLIAMS caner Name: License Address Information City: Rochester State: MA ipcode: 02770 Country: United States License Information License No: CS-101155 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 7/26/2016 Issue Date: Expiration Date: . 8/27/2018 License Status: Active Today's Date: 2/13/2017 Secondary License Type: Doing Business As: tatus Change Reason: License Renewal Prerequisite Information No Prerequisite Information ^ f . http://elicdnse.chs.state.ma.usNerification/Details.aspx?agency_id=l&license_id=290110& 2/13/2017 Office of Consumer Affairs & Business Regulation - Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources• Home Improvement Contracting HIC Registration Complaints Registration# 168313 Home Improvement Contractor Registrant MICHAEL WILLIAMS Registration Home Page Name MICHAEL WILLIAMS . Address 692 WALNUT PLAIN RD City, State Zip ROCHESTER,MA 02770 Expiration Date 02/19/2019 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund histo[y. Back To Search ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. y https:Hservices.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=168313 2/13/2017