HomeMy WebLinkAbout0118 CHASE STREET 1
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Application number E-1.9 — ...... .........................
Fee ...................3.S...............................................
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K"& = OCT 1 Building Inspectors Initials....... .............................
8ARNSTA Date Issued.....�.o j �1. ........................................
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Map/Parcel...... ....LHS...W...................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: i 1 W 4,:r'NAi6 -I—
NUMBER STREET VILLAGE
Owner's Name: Wptl, k4 4-a I Ut-j D Phone Number ,GFs '17 6 3
Email Address: Cell Phone Number
Project cost$ v? 00 Check one Residential. X Commercial
OWNER'S AUTHORIZATION
1 �6� ✓
As owner of the above pro I hereby authorize ,�
to make application for mg p anc 'th 780 CM
Owner Signature: Date: 00
TYPE OF WORK
❑ Siding Windows(no header change)# ?j ❑ Insulation/Weatherization
❑ Doors(no header change)# Commercial Doors require an inspector's review
❑ Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to Y/�,"e)u T*
CONTRACTOR'S INFORMATION
Contractor's name W,P a Tu-S
Home Improvement Contractors Registration(if applicable)# 3 0 6 3 (attach copy)
j Zy
Construction Supervisor's License # <f S O-7 •7 Sao (attach copy)
Email of Contractor 4° (L" 45 7- /119-T Phone number LoS J-4 d
ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
• Iu��ranl�I+Ie�rn/�r VAII•IIIrT/\nTAI�/ IJIrTAn1/� Annn^11A/ nBrAnr A n�nwA/T/-A•/ nr_ IrrllrM
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APPLICATION.NUMBER............................................................ -
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*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent
Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required.
Natural Gas Yes No_____,if yes,a gas permit is required.
If food is being served at_your event please obtain a Health Department approval between the hours
of 8:00am-9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLIC 'S SIGNATURE
Signature Date
All permit applications are su ' ct to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): u v IN4 Ar& Gt,5
Address: 7 8 /VA Av W 46A,V' 0 n,
City/State/Zip: 9 Y^N 5 AA 229 6 Phone#: ;u�'� ��Z— 03 9`7
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• # 9. ❑Building addition
[No workers'comp.insurance comp.insurance. 10. Electrical r airs or additions
required.] 5. ❑ We are a corporation and its ❑ eP
3.❑ I am a homeowner doing all work officers have exercised their I I. Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.El other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy 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 certify under the ins and pe ties of perjury that.the information provided above is true and correct.
Si afore: Date: �� Z l�
Phone#: Z-_ a `f"7
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: Phone#:
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 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,§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 in 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 LLP does have
employees,a policy is required. 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 bum 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
Fax#617-727-7749
Revised 4-24-07
www.mass.gOv/dia
Commonwealth of Massachusetts
a® Division of Professional Licensure
Board of Building Regulations and Standards
t 1 i'-> Office of Consumer Affairs&Business Regulation
Construction Supervisor HOME IMPROVEMENT CONTRACTOR
CS-077800 TYPE Individual
E- pires: 06/27/2020 Registration Expiration
132463 02/07/2021
WAYNE T LOFTUS i' WAYNE T LOFTUS
78 ARROWHEAD DR �' D/B/A LOFTUS CONSTRUCTION
HYANNIS MA 02601
WAYNE T.LOFTUS �C --
78 ARROW HEAD DRIVE Commissioner �1k
r HYANNIS,MA 02601 Undersecretary
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Sewage Permit number .........................................................
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APPLICATION FOR PERMIT TO �\u �/�' ����c, ! /*�
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F�- TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for u permit according to the following information:
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Location ,/—.��.����~.—..X��.—,/ ' .------_—.—.--...-----------------__.
ProposedUse .......... ' �-- ---.—....----------------.----------------
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ZoningDistrict ..... --.----.---------..---Roe District ------ ...........................................................
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Nome of Builder ----------_-----------'A66res ---------------..-----------.. `
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� Number of Rooms ............I....................................................Foundation ..���.«.. .~�''-------.------_—__
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, Exiorior --���\A�.��—� �/-� �---------._RnoGng —..��]�J^ !��.--��.� .L---_-----.— '
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FirepFireplace �
|oa: ........... --------'------------ApproximooeCou ....... .__,___.~,,_~_,~
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Dofnh�eMon by Planning Board +' lV7q ' Area � /�/
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Diagram of Lot and Building with Dimensions ` Fee -~� �=-- _____
SUBJECT TO APPROVAL OF BOARD Of HEALTH �
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| hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .
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Hedlund, Walter u7. R-1A-07 L, 1440
21860 dwelling
No ..... Permit for .................
...............vf..j......................................................
ledrtz$ Chase St.
Location ....................................HSIT.W." .........
annis
...................Hyannis............................................
........................................................
Owner ...........Walter G: Hedlund
.......................................................
Type of Construction .......frame........................
................................................ ..........................
Plot ............................ Lot ................................
Permit Granted ........... ZD&r.......4..........19 79
Date of Inspection ..........................19
Date Completed .... ...............................19
PERMIT REFUSED
.................. .. ....... .. .........I... .......
........ ...... ....10
.............. ....:. .................................
................................. .. . .................................
.................................. .... ........ ......b-It... ..........
........... ....... .. ......./. ...... . ... .... ................
Approved ................................................. 19
................ ............................................................
TOWN OF BARNSTABLE
Permit No. -----------------
�.W3TA Building Inspector Cash ___---
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OCCUPANCY PERMIT Bond x cil1+�I��
"No building nor structure shall be erected,and no land, building or structure,shall be
u.Aed for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building-Inspector."
Issued to !'alter Iiedlund Address
�nt •=� �.��,l:l"f�'}R4t ,�i3'Y'E!E'�'_ NV�3t1f11S
Wiring Inspector. A; r, ° �;. - Inspection date ,
Plumbing mspector��, Inspection date
Gas Inspector � ���� ��i� � � Inspection date � � }➢�_y���
Engineering Departmenttff Inspection date /U G
THIS PERMIT WILL NOT BE VALID, AND THEE BUILDING SHALL NOT BE OCCUPIED UNTIL
1.
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS. Grr
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Building Inspector
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House number :...... .,. NMENTAI. 3
REGUU%T1
TOWN OF BA'RNSTA �
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...................j �/k...... ....................................................................
TYPE OF CONSTRUCTION .........^'!i : 7........t��!�''?.:...-'�.... ........................... ....................... ................
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TO'THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .. oy".. ..............J�.....:sT....... Itjf//Q/!'!'.C.f................................................................ ............................�.
ProposedUse ........ ........'C.A?.V\A ...........................................................................................................................
Zoning District .... ............................................................Fire District .............................
Name of Owner /1 Ti'2..... � Address ....�.q....t 14r4 1i!C! ... �Pmu � lZt�et�, ak/
..... ,..............""�
Name of Builder ..Address
.Name of Architect ..................................................................Address ....................................................................................
Number of Rooms �� '�...........�......................................c.............Foundation ...............�«�.�.... ........................................................
Exterior ......4RPA.R. .....'f%y��`!�.�. s....... ..:...........Roofing' .....a te I�, !!p!� ..............................
Floors ......0 !! 10P. �^'.....:?eA.....{A?!w! ?w..............Interior ....A tt t..
Cd�° p,Cio t_7 t,
—---�HcGrin - ---..PIumbin !'..�4....:...................:�:...
Fireplace .......... ............................................:................Approximate Cost ........ .�..O..Q..P.........................................
Definitive Plan Approved by Planning Board _ SV"' 19 7 9__, Area 3d........ l
Diagram of Lot and Building with Dimensions Fee ...... �-� ................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
t. Y Name ^f.. .. .... . :"....,� ...
Hedlund, Walter G. M307 L 144
"No 21860..... Permit far ....(I.V.Q.11ing..............
. ...............................................................................
Location ......I Pt...I...
........................Hyaanio$.........................................
Owner ...X41ter.. .........................
Type of Construction ..........fralpe.....................
.............................................I..................................
iPlot ............................ Lot ................................
Permit Granted ..............Dec-;.....4...........19 79
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT REFUSED
19............................................. ... ...
..........................
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....................................
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Ap, ....in ....................n ................. 19
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.........................................................
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