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HomeMy WebLinkAbout0181 CHASE STREET /of f, i Town of Barnstable Regulatory Services FTHE 1p� 1% Thomas F.Geller,Director AB Building Division BAMSTy iKnss. g Tom Perry,Building Commissioner t i63 200 Main Street, Hyannis,MA 02601 AEDMAA www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: E'ri lc a �- HOME OCCUPATION REGISTRATION Date: (J _� I 2 Name: 2l Cx lQ. G�OL7HAL Phone#: Address: l M �• LV Qn 1 S , M gooV Ii llage�F2,. n56U 9 Name of Business:�Yn-n/u_ P ;0 . I Type of Business: -LyhA l Q I1 L X CYVQb0 Map/Lot: 3 0 7 / 7 7 J� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be ` included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have ead and agree with the above restrictions for my home occupation I am registe ' g. /m Applicant: J Date: 0 Homeoc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS? ' For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: o?D Fill in please: Cj� w' APPLICANT'S YOUR NAME: ` BUSINESS YOUR HOME ADORE5S:14SI C,lia-- S-f- J OV 77(0- �l I yanhi Y1'1A r) TELEPHONE # Home Telephone Numbers •�`7 1 -�l SS NAME OF NEW BUSINESS TYPE QF BUSINESS IS.THIS A HOME OCCUPATION? YES fl_ vdlyouii,.6een;given approval from t AQDRESS OF BUSINESS 1 1 MAP/PARCEL_NUM.B..ER � When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM NER'S OFFICE This individ al h s eQ�n­f f any permit requirements that pertain to this type of business. orize S ature* OMM NTS:AJ0, 0 } 2. BOARD OF HEALTH This individual h be n in med of the r` it requirements that pertain to this type of business. Vhorized Signature, * COMMENTS: � . 3. CONSUMER.AFFAIRS (LIC NSSJJVG AUTHORITY) This individual has be ryifl rm t e,lice i rhg'"i a ents that pertain to this type of business. fCuthorized Signature COMMENTS: YOU WISH.TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 [Town Hall) DATE: bc)blvf Fill in please: APPLICANT'S YOUR NAME: l l/� BUSINESS YOUR HOME ADDRESS: I`� Gilts . �D TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS AHOME OCCUPATION? YES Have you been given approva from tl� j ADDRESS OF BUSINESS 1 1 MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM NER'S OFFICE This individ al h s enf f any pe mit requirements that pertain to this type of business. ( � '-Abt-Ir orize S' ature** -� OMM NTS: 0 �� — r 2. BOARD OF HEALTH This individual h be n in med of the wit requirements that pertain to this type of business. Vhorized Signature** _ COMMENTS: 3. CONSUMER AFFAIRS 4bei NSIJVG AUTHORITY) This individual has esrm t e..licebre ents that pertain to this type of business. LA6thorzed Signature*l*' J COMMENTS: I TOWN OF BARNSTABLE BUILDING DEPARTMENT"'. , HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION 1 1 C a S c -� ivumoer treet a ress S _ ec ion o town "HOMEOWNER" me e G ��1a �y��. — "r�7�6:71 a ome phone or P none � 3 .. PRESENT MAILING ADDRESS a y ?e hu ity town tate O I S I pcoe The current exemption for "homeowners" was extended to include owner-o dwellings of six units or ess an to allow such homeowners to en a ccupied ' 1v1 ua for hire who does not possess a license, 9 9e an in- acts as supervisor. (State Building Code Section provided that the owner DEFINITION OF HOMEOWNER: Person(s) who- owns a parcel of land on which he/she resides or intends to re= side, on which there is, or is intended to be, a one to six fami attached or detached structures acc ly dwellin , essory to such use and/or farm structures. A person who constructs more than one home in a• two-year period shall not considered a homeowner. Such "homeowner" shall submit to the Building' Offbcial, on.a. form acceptable to the Building Officiinal , that he/she shall be r for all such workunder the bui performed undli responsible • •'' g permi ection The undersigned "homeowner" assumes responsibility for compliance with . Building Code and other applicable codes, by-laws, rules th the State and regulations. The undersigned "homeowner" certifies that he/she understands Barnstable Building Department minimum inspection procedures the Town of *and that he/she will comply with said procedures and requirements. - quirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet " or to comply with State Building Code Section '27.0, Constru will be required ction Control . 8 _ - - HOME OWNER 'S EXEMPTION The Code state that : Any Home Owner Permit Is required shall be performing work for which a building (Section 109 eq exempt from the provisions of this section Licensing of Construction Supervisors) ; provided that if a Home Owner engages a Person(s) for hire to do such work, shall act as supervisor . that such ° Home Owner Many Home Owners who use this exemptior,„are unaware that t the responsibilities of a supervisor (see A for Licensingthey are assuming.. Construction Supervisors Section e2.15 �� Rules and Regulations. often results In serious Problems, ) This lack of awareness Unlicensed p Particularly when the . Home Owner hires unlicensed persons. In this case our person Board on c as I anno as; supervlsor is ultlmate�ylreSponsII e,%sed Supervisor, t proceed agalnst the The Home Owner acting To ensure that the Home Owner Is fully aware of his/her communities requirepart s/her responsibilities, many . certify that he/she understandsftheeresponsibilitie Permit tlon, last page of this -.issue is that the Home Owner responsibilities of a supervisor . . On the care to amend and a form currently used by several towns. adopt such a form/certification for use In YOU may Your community. i • Assessor's office(1st Floor): Assessor's map and lot number �. . Board of Health(3rd floor): Sewage Permit number WALL ' Engineering Department(3rd floor): / HoOff/NC UP IO C to J �� rasa ,� House number r ;. ° 1639 \em Definitive Plan Approved by Planning Board 19 �Fo way d' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �� (�, [1 r o e'.w TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location C a S G S r ` ' Proposed Use Zoning District ?\ Fire District 4!3 _y VA h� S Name of Owner �tr e�ev��`C � C,s l�.►� srsfr. Address ?a h A.,-As,4r Pi4o (..O e -���+SS Name of Builder S Z Address s i Name of Architect Address Number of Rooms h �� Foundation C e Exterior LA--1 Roofing A 5 oQ Floors A we a 4. Interior L c,'r: y-v c Heating AAA y6 e.Y L�-�h �`� Plumbing Fireplace Approximate Cost 3000. 00 Area Diagram of Lot and Building with Dimensions Fe r— - 1 e tr 1 -r.•^A u C) r C1„ase� Sk. OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name =u.. 2u QQ,Q. d- Construction Supervisor's License 7GALLAGHER, FREDERICK P. JR. No 3 2 813 Permit For ADDITION Single Family Dwelling y- Location 181 Chase Street Hyannis • Owner, Frederick P. Gall aghPr,--Jr, Type of,Construction Frame Plot Lot Permit.Granted April 21 , 19 89 r Date of Inspection 19 ~ • _ Date Completed A A/i �, 19 1 t. ,_ - .. �3-. " eti,,.f4 ``• "' i .. . N.t •.-' .,2•. y'k..i=.�-,�sr�-•,,,•.57,.��'r�r.Y'..�3c.r,N'�. ti ,..�r+ti.:vL�v"1.�`ty'""' L. t...•.v, .,'Itl-.f^�,;•i•w,. .�.,,_•�-. t- Assessor's office(1st Floor): f Assessor's map and lot number TH Board of Health(3rd floor): ° d� Sewage Permit number �1LL � w • f , - H00110N6 uP r SEu�E : BAHd9?ADLL Engineering Department(3rd floor):,. b j2 rasa House number _iTlf' t Z6� Definitive Plan Approved by Planning Board 19 �oyAY d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P,.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR m APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ��, A � 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ( 5 c '� Proposed Use e r o a Zoning District Fire District �I. 1�1� Name of Owner,-. " r e z ,,i e �. �a 1�a ,�,r . ,1� Address �e -�.a � �cr� /�� � - C� rt e 55 r Name of Builder Address t Name of Architect Address Number of Rooms Foundation 'C_ r 4 Exterior LA-?w A Roofing Floors A Interior Heating Q AA Plumbing �- t Fireplace Approximate Cost to r✓U. Area �"/.�L �)w .G►�- Diagram.of Lot and Building with Dimensions Fee'!��.d� 0 % F ` C LL t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name v . Construction Supervisor's License GALLAGHER, FREDERICK P. JR. A=307-177 J 7- /77 32813 r ADDITION No Permit Fo Single Family Dwelling Location 181 Chase Street Hyannis - Owner Frederick P GallaghPr; Jr. Type of Construction Frame Plot Lot • i c Permit Granted April 21 , 19 89 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/. TOWN OF BARNSTABLEi CERTIFICATE OF OCCUP kCY PARCEL ID 307 177 GEOBASE ID 2186 ADDRESS 181 CHASE STREET PHONE HYANNIS p ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 28098 DESCRIPTION 16' X 20' ADDITION (BLD PMT 426806) PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 O� _CONSTRUCTION- COSTS_ __ _ _ 753 MISC. NOT CODED ELSEWHERE * BARNSTABLE, MASS. 9 1639. A� ED� BUILDIiG'DIVI��I�OJ1�T _ DATE ISSUED 01/02/1998 EXPIRATION DATE L� -- - -----_-_-c� " l TOWN OF ABLE BUILDINGS -�ST' PARCEL ID 307 1�: E `` GEOBASE ID 21868 ADDRESS 181 CHASE;`JSTREET 3 PHONE `-- HYANNIS - ZIP, - LOT G� BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 268 � DESCRIPTION 16 X 20 ADb"N PERMIT TYPE BA I ;4ti= TITLE BUILDING PERMIT A CONTRACTORS: POOPERTY OWNER � � a- me t of Health, Safety ARCHITECTS: -�,.-.� and•Erivi ntal Services TOTAL FEES: $102`�30 1ME BOND $.00 per 'CONSTRUCTION COSTS $33,000.00 434 RESID ADD/ALT-/,CONY 1 PRIVATE *AFT'` A *` ' * HARNSTAb, # � MASS. t BUILD`G�DIVIStON �7 DATE ISSUED 11J94/1997,r - XPIRATIQN,kATI � �� � � )� � y `4. �t c � � j � 1 �- 1 � � r � n, �y LEl APPROVED N OF BARNSTABLE GAS Cl WIRING PLUMBING ❑-BUILDING f tl t - A..n -' • .. . ,1.! { :'"•k•_: PARCEL D 307 177 ,GFOBASE 1 16 213G8 . P. yADL2ESS 81 CHASE S`L'RES�'T f " k -.. . ` HYANNIS z I�UT j 4 k3L Od a T, SIZE OBA .; ; DEVELE3MEg3 ' ' {.- DISTRICT BY ;PERMIT 2 806 DESCRIPTION. 16 X 20 ADD' � PERMIT TYPE BADDI, r TITLR BUILDING PERMIT Al) TION' � :CONTRACTORS 0 P PR' 'T-Y .­OWN E c � Department'of Health, Safety A RCHITECTS _ e}t('.�R�4 p _ .. .• .:�..- • i�p and Environmental.Services BOND f /'�('') �ypy tHE CONSTRUCTION C, STS \' 3151 t3UQ-Q4 � 34 RE I :A1 D AL,T CGI�'L�' I.. PRIVATE P� 639. BUILD'GDIVISI0N - ! BY DATE:. SSI I? . �. /04/1997 EXP C� N LATE ti { t , THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT-FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL1NSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS i 2 2 2 . . ,�tiA c A P►S 3 t ' �t 1 'I'g;.HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 "� BOARD OF HEALTH OTHER t .r w;' SITE PLAN REVIEW APPROVAL r' WORK•SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOIDi IF CON- INSPECTIONS.INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARhD WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. It k f' d I I I m I II k . I I I { I I o I �4{ Engiheering Dept.(3rd floor) Map. J64 7 Parcel 172 Permit# - House#• Date Issued oor)(zs:15 =9�30/1:00-4:30) 3 1 ct GJ Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) ` { Planning Dept. (1st floor/School Admin. Bldg.) d 1HE 1q;_ Definitive pproved by Planning Board 19 s. ; • BARNSTABLE• i --i MASS tFO r'A�a- ` TOWN OF BARNSTABLE, r Building'Permit Application Sheet Address / /Jg5 Village`_��//a.��y S IPA r, Ownef?ram C 2 �'c — 4 ( : o y K A Address 7R�/ C /ate S z'' S /7�14,u..u; Telephone Permit Request 3 v S FT -f' u X • tnr } First Floor 'ISO-0 square feet Second Floor square feet Construction Type G¢.>o® Estimated Project Cost $ Zoning District '1,3,e.S Flood Plain ,t>6 Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure /9/37 Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: #ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1P.60 Number of Baths: Full: Existing J _ New Half: Existing New No. of Bedrooms: Existing New. o Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes �j No Fireplaces: Existing New Existing wood/coal stove ❑Yes XNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) `WAttached(size) U ",�'= r ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes )J�No If yes, site plan review# Current Use- �> Proposed Use Builder Information Name r' Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE l 0DATE _ oZ BUILDING PERMIT DENIED FOR E FOLLOWING REASON(S) 1 ti FOR OFFICIAL USE ONLY IT NO. PERM — `� •t DATE ISSUED MAP/PARCEL NO. t ADDRESS t VILLAGE F w OWNER - DATE OF,INSPECTION: FOUNDATION- FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ° ' FINAL ' GAS: ROUGH FINAL FINAL BUILDING ` _ a DATE CLOSED OUT t - ASSOCIATION PLAN NO. -r ATM!r� _ The Town of Barnstable ��� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crosser Fax: 508-790-6230 Building Commissio: For office use only Permit no., Date AFFIDAVIT ' HOME l[MPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 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. Type of Work: T 0'y -)4 2<2 0 Est.Cost Address of Work: L AAS i- sfi h�YA'`�•`.'' Owner's Name 10 u,::::. )-� A Date of Permit Application: !�-�� 3,0 l 9 2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. —..-,Building not owner-occupied wner 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 2pply for a permit as the of th a ✓- JJ � cl- Date Contractor Name Registration No. OR w . Tlrc• Cu»ltllun1rc111111 11f.-Vaslachusells Deptirttrre rlt of Industrial Aceide-flts y ' 1 ONCO,Of11ryestlgalloaS • \ji 71 hpO lf'ashi»(;tr»t Street -; Btivwn..11usr 03111 Workers' Compensation Insurance Affidavit llililicintinftirmati�ri — Plc'ts'eI'RINTIe`it�jv� —����—� _ name Inc tinn S MA nhnnc e 7'7 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for m% employees working on this job. cnniumv nnmt•- •rdrlrrce• _ city• nhnnc i!• in-mrnorr rn Holier t! 7. 1 am a soic proprietor. general contractor. or homeowner(circle otte) and have hired the contractors listed below who the Following workers' compensation polices: cnMMInt' nntnr' ndrlrrcc- cit•• nhnnc+�• incnr^nrr rn nonce•0 cmmnnnv n:ttnr' adrlrrcc- cir�•• nhnnc 1t• _ incur^nrr rn n01icy it _ Attach additional sheet if necessary �. .-..• _ ,�•.•:.,Y _; a.._�.......r. ••... ..:.. �..��..o�.r..v: tie �:"'..cuss—..n F:,tlurc to secure covcrnac as required under Section:SA of 1►1GL 15:can lead to the imposition of enmtnal penalties 01 a line up to S1.SO0.00 andrur unc cars' imprunnment as hell as civil penalties in the form of a STOP M-OR1:ORDER and a fine of 5100.00 a dad•against me. 1 understand that a Copy of this statentcut mas be furs•arded to the()free of investigations of the D1A for coversire verification. 1 do herchr crrri{t•uruler the pains and penalties of perjun•that the information provided above is true aged//correct. Si^_naturc DWe Print name Phone t. cin oRcmi use unh• do not"rite in this arcs to be completed by cin•or town o ciai e' or tnr�n• pernrit/liecnse# r'Ttluildint;Department ❑Licensing Board L Selectmen's Orr, t i. a check irimmediare respunse is required ❑ r t. (_Rticaith Department ' i phone#: contact person: t"tUther Information and Instructions Massachu.setts General Laws chapter 152 section 25 requires all emplovers to provide workers' cOW0e1tsa1i01l for employees. As quoted f Qom the "ia��". an c•»rptorer is defined as every person in the service of another under::n% contract of hire. express or implied. oral or writtcn. xw An c•mplur•cr is dcfi►icd"s an irrdi ideal�partncrskri,p;•association, corporation or other Ic al entity, c�r`•a�tt�, tt�o or the fore`_oine en�un_ed in a joint enterprise:and including the legal representatives of a dec6dset� employer, or the receiver or tn►stee of an individual , partnership. association-or other legal entity, employing employees. Ho\%,e,.•cr o\•ncr of a divellin,_ house having not more than three apartments and who resides therein. or the occupant of the dwelling, house of another Avlio employs persons to do maintenance ;construction or repair work on such dwelling.: or rnr the __rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic. MGL chapter 152 section 25 also states that cvcr .state or local licensing agency shall withhold the issuance or g mealth for sn� •1�:rl ofa license or hermit tooperatea business orto construct building s leant who lens not produced acceptable evidence of compliance with the in covernbe required. ,Aa�.:ionall�•. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the per1'0rm;.::ce of public work: until acceptable evidence of compliance with the insurance requirements of this ckiar:t-.. been prescated to the contracting authority. Applicants Picasc 'ill in tic workers- compensation affidavit cotrtpkctely, by checking the box that applies to your situation anz suepivin`= company narnes. address and phone numbers as all affidavits may be submitted to the Department of Industrial .-accidents for confirmation of insurance covera`e. Also be. ure to sibs and date the affidavit• Tile -.1avic should be returned to the cif}• or town that the.application for the permit or license is being requested. ,Accidents. Should you have any questions regarding the "law"or if you are requi-: r :he Department of Industrial obtain a workers, compensation policy. please call the Department at the number listed below. City- or Tmvils Pierre 7e sure that the affdavii is complete and printed legibly. The Department leas provided a space at the bottom the :l"davit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P'. be _ : to fill in the permit/license number which will be used as a reference number. The affidavits may be returner -:re 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 an}• quesm please do not hesitate to _give us a =11. The Deparitnent s address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (6177) 727-7749 nhone -. ;61—) _27-'900 ezr. 406. 109 or I . ' 1 J +� 50 Q pVJ oe - PP, 7C I /43�� I certify that this property :is located in Flood Hazard Zone C (out- side the 500 year flood) as idenldfied by the Department of Housing and Urban. Development (HUD) . Date o-7 z7 lg97 _ CERTIFIED PLOT PLAN HD LOCATI(:)N !?.rt1�5 ddd'3� liyygA/.#V SCALE . .®.�=,3c+' ... DATE C7 7 �9�7 Reg. :=Z PLAN C,EFERENCE .��:?. . . . . .. . . . . . . . . . . L/a-",Z> C ei&R-7— : ;Nti A . I certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING that there are no visible encroachments SHOWN HEREON , EITHER WAS IN COMPLIANCE THE LOCAL APPLICABLE ZONING or easements ,except as shown and 'Chat this NITEFFE'T WHEN CONSTRUCTED (W THBYLAWS plan- was ,prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL . "Supervision'. REQUIREMENTS ONLY),OR EXEMPT FROM l F VIOLATION ENFORCEMENT ACTION UNDER M.G.L. �/ LOIiG�iq , �� M TITLE VI I , CHAPTER 40A,•SECTION 7,UNLESS , ,000E .,O C�e�� OTHERWISE NOTED OR SHOWN HEREON. 22-141 50 SHEETS 22-144 200 SHEETS O.J r- • cv' A- Z o c✓ SS' • G 1'��'�o �oo>r S 2 � 'GDO-3 10 22-141 50 SHEETS nmw�n 22-142 100 SHEETS 22-144 200 SHEETS j�oo F SS e v� 1. iZ;dgti V��r �v GCY wa)7 pssarmn L so F,fi vCti-r ��l5( wit/S # Mo✓� ro„n v« 14 ociSz a9 G1<ay ��e�.ot• S�l�ti�j ►eS � . ,�cbr (aS^Scn,e 13 O, C. �.. 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[.d 411 �SSam3.1. vrtti3 Poe i �Z )SL AJSC-1 1 �J j Vct n rJOusz c.)raP $ r)�tis'les • C A�- 1C��T i YA k .a,11 l� Z A�j �u 1� Tu t-�u crS t A i\ -7c;S-T- U TZ ►9 �,�sv �a-r;a� ... �C.[�L � - ` 3ao� �. Us �G.�V`et cGJL►++'tC. 3�j1 C�aitS _ pe ^� 22-142 100 SHEETS 22-144 200 SHEETS 1 / ►/ . ` y oo � - -; 5 rv►`r--o -0 3G �• �� / ' 22-141 50 SHEETS ' amvao 22-142 100 SHEETS 22-144 200 SHEETS Oq ,E1l�STi ,v �oe� � t C101->-FrAC- TO TQ 12`YAUVr- oToS-r i A.> $')-) 1 n.) A-)-c C J r - ,S- r , _� +_ A _l r t t ` + r c-� Al + &' F-I 0 ry1 o vr- l5v6s,?l'u� S rYL`�5 0,0 -Pi3 3 co A r.14 5 z rZ:)eo 0- �'f/6 d AJ A S 'a • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print� ��------------------------- . DATES JOB_ LOCATION ef IaA� &_14.�,u ; S Number Street address Section of town 7 7 y- '(o"' "HOMEOWNER" ^ UC 2�' £'6L'G e ' �/� /�0C�C/� /'{ '�-►L_ Chi 9'•--78 .... Name Home phone Work phone . - PRESENT MAILING ADDRESS I /�A S z = _ � -- C-j'.t_Y7 town State Zip code The current exemption for "homeowners" was extended to include owner-occu-_ dwellings of six units or less and to allow such homeowners to engage an it dividu'al for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Perscn (sj who owns a parcel of land on which he/she resides or intends to r side, on which there is, or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structure: 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 Off_, c on a form acceptable to the Building Official, that he/she shall be respons= for all such work performed under the buildinc permit. (Section 109.1. 1) The undersigned "homeowner" assumes-. responsibility for compliance with the uilding Code and other applicable codes, by-laws, rules and regulations. he undersigned "homeowner" certifies that he/she understands the Town of arnstable Building Department minimum inspection procedures and requirement nd that he/she will comply with said procedures and requirements. OMEOWNER'S SIGNATURE -11 APPROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be required 0 comply with State Building Code Section 127. 0 , Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which �mbuilding permit is required shall be exempt from the provisions of this section (Section 109.1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owr. shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenE often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the 4nlicensed person as it would with licensed Supervisor. The Home "Owner.' act_ as supervisor is ultimately responsible. ,. To ensure that the Home Owner is fully aware of his/her responsibilities, ME ;ommunities require, as part of the permit application, that the Home Owner .-ertify that he/she understands the responsibilities of a supervisor. On th Last page of this issue is a form currently used by several towns. You may .,are to amend and adopt such a form/certification for use in your community.