Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0029 CHECKERBERRY ROAD
i k F �I:. __ _� w Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.toNvm.barnstable.ma.us Pre-application for Business Certificate Date Map c_Z(o1 Parcel d � Applicant Information Applicants Name ( & �/� , �'Ce Applicants Address Email Address Telephone Number �� �� �� Listed ❑ Unlisted ❑ Business Information New Business? ----------------------------------------• Yes Business is a registered corporation? ________________________. Yes No If yes Name of Corporation Does business operate under the registered corporate name< Yes No Is the business a sole proprietorship or home occupation? ___--_--_ Yes No If yes then a Horne O�ccuppation Registration is required—See Building Division Staff Name of Business Cat,`(" ' `` -/y Ls' Business Address Type of Business o Buildin ommissioner Office Use Only, Conditions a Building Cominissio Date of / I Clerk Office Use Only f' Town of Barnstable Building Department Ftt+e r�� Brian Florence,CBO Building Commissioner snxxsTnaLE, ' 200 Main Street,Hyannis,MA 02601 y mass. � Qj i639• www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: u AA,- Zl- RA�G C-4, Phone#: O g Address: �� `�'�� �'3�n�'Y Village: / "JA/! Name of Business: Type of Business: n/t/A) C7 W"'t Map/Lot:�� 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. Z • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. Q • Any need for parking generated by such use shall be met on the same lot containing the Customary Home j UJ Occupation,and not within the required front yard. U • There is no exterior storage or display of materials or equipment. Q • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one tL LLJ pick-up'truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to M v3 exceed 4 tires,parked on the same lot containing the Customary Home Occupation. O ZZ • No sign shall be displayed indicating the Customary Home Occupation. = H • 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 un' . a CC>- I,the undersigned,ha agree w' he ab s ons for my home occupation I am registering. O Z M Applicant: Date: ZS /1 UO<C>L C/) J.� Homeoc.do cc C3 } �tHE Shed ti r .. o� TOWN �ABEAMST OF BARNSTABLE Permit. MASS 9� 1639. 'OrFp A Permit Number: Application Ref: 201501970 20150813 Issue Date: 04/17/15 Applicant: THOMPSON, GEORGE & MARY S TRS Proposed Use: Accessory Structure Permit Type: SHEDS 200 SQ FT &UNDER Permit Fee $ 35.00 Location 29 CHECKERBERRY ROAD Map Parcel 269085 Town HYANNIS Zoning District RB Contractor PROPERTY OWNER Remarks 1OX10 SHED Owner: THOMPSON, GEORGE & MARY S TRS Address: 381 NORTH ST BRIDGEWATER, MA 02324 Issued By: pp POST THIS"CARD SO THAT IS VISIBLE FROM THE"STREET Town of Barnstable �TMETti y Regulatory Services ' � �� �-E �.{ -BARN STABLE OF R o" Richard V.Scali,Director _ r,,GG fftt y RNSTABL� t s MA-M� $ Building Division `' 1639. jDrEo�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 =� www.town.barnstable.ma.us Office: 508-862-4038 I Fax: 508-790-6230 PERT# V � o NII FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed(address) Village At C,-50- � �8 g� --e Property owner's name Telephone num er /o x la zj Size of Shed Map/Parcel# Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) VIC— Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COYEVIISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A 4 PLOT PLAN Q-forms-shedreg REV:040914 Town of Barnstable-Geographic Information System April 13,2015 ► 269163'" 269083 #409 a #20 269164 #142 ° .�•"�" ram~ 269081 #.133] 269084 CNECERgy�RRY Rp 4393 269138 #19 �4 x x 1 o- a�U� #29 269080 #123 �' a � 269087 #20 26908 WIN, 2 #30 269079 #113 t DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:269 Parcel:085 Selected Parcel a boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:DAFONSECA,FELLIPE&STELLA A Total Assessed Value:$192500 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.29 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:29 CHECKERBERRY ROAD such as building locations. Buffer Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/4/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit TO: Building Inspector(s), This affidavit is to certify that all work completed for 29 Checkerberry Street has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. Ceiling: R-38 cellulose; R-19 cellulose under decking All work performed meets or exceeds Federal and State Requirements. Sincerely, 77 William McCloskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address C keck f 6eq--v S+ Village 1 Owner C V 4o S ec k Address Telephone 508 1 8 / & 1 9 g Permit Request +o ' k e, cthlc SeA rk-H-1 014ne- 61A. g��Pn� 4:�Ogtwl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay sa Project Valuation l0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting c ecurrS tation. sr Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) = `0 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:=_]Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Otheri Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 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: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes -A('No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name MC1C1VJkCY1C0w SA-ve_l e. Telephone Number 6391 Address D License # �C (,� T76 5" of+►► 0 Home Improvement Contractor# « O Worker's Compensation # WW C ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO YoLPAVOWAb SIGNATURE DATE l 0 1 �' FOR OFFICIAL USE ONLY APPLICATION# c DATE ISSUED .MAP/PARCEL NO. 4 ADDRESS VILLAGE OWNER C Ir DATE OF INSPECTION: i' f�FOUNDALION FRAME Ir • FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT .. ASSOCIATION PLAN NO. • b o ` PARBCIPATING IT sale CONTRACTOR savi3. whrcuo energy ondency PERMIT AUTHORIZATION FORM I, F r*_:LLi P Ic `bA Fvt3SEcA , owner of the property located at: (Owner's Name, printed) 2..� ci4 E c--<e 21 cPP i ST, -i-{ yA IJO is .nA c52c� (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behal obtain a bui ermit to perform insulation and/or weatherization work on my pro Si ature -m7g Date74 FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: CCIL I P- Participatind Contractor Date Rev. 12132011 f 3' Tile Corrtmonwealth of Massachusetts Department of Industrial Accidents ' yy Office of Investigations , Y L^ I Congress Street; Suite 1.06 Boston,MA 02114-2017 S w www.mass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P.lumhers Applicant Information Please Print_Ledw Name(Business/Organization/lndividtial '. Cape Save Inc. Address: M.flyntItIg ton Ave City/State/Zip': South Yarmouth. MA 02664 Phone#: 50B-398-0398 Are you an employer?Check the appropriate boz Type of proaect(required): L[Z1 1 am a employer with 4. 1 am a general contractor and 1 employees(full.andlor parttime): have hired the sub-contractors 6.. New construction 2.;0 1 am a sole.proprietor or partner- listed;on the attached sheet. �. Remodeling These sub-contractors have ship and have no employees b hv 8. Demolition Q employees and have workers' working for me in.any capacity., 9. Building addition [No workers' comp.insurance comp.:insurance.; 5. We area corporation and its- 10.0 Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work: officers have exercised their 1 Ln Plumbing repairs or additions- m self. o<workers'com right of exemption per MGL y [N p. 12❑Roof repairs insurance required.].t c.152; �1,(4);and we have no employees. [No workers' 13,[d Other Insulation comp.insurance required.] I-Any applicant that checks box#I`musralso fill out the section below st owingtheir workers'compensation policy information. t Homeowners who s0mit this affidavit indicating they are dt in=.a11 work and then hire outside contractors must submit.,a new'aMdavi.t indicatingsuch. 0Contractorsythat check this box trust attached an additional-sheet shoeing the name of ihe'sub-contractors and state whether or iibf,46�et enfities h8ve employees. if the sub-contiwtors have employees,they must:provide their workehs'comp.-Policy number. I air an employer that is providing workers'contpensution insurance for Illy employees. Be%iv is thepolicy and-job site information. - Insurance Company Name: Wesco Insurance Company —. Policy#or Self--ills.Lic.# WWC3085633: . . _ Expiration Date: 04/09J2015_ n 11 Job Site Address: o� C ��'�`_e r err c� CitylState/Zip;_.t�C ah n.( Attach:a;copy of the workers'compensation policy decla ation page(showing the policy number nd expiration date):. Failure to secure coverage as required under Section 215A of MGYL c. 152 can lead to the.imposition of enminal:.penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form-6f a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage:verification. 1 do hereby cent under the ains and enaldes:of er' that the in orthat on provided above is tree and'corr&t Sienature: Date _ Phone#: _50$-398-039$ Official use only. Do not write in tlr s,area;to be con pleted.b.y city or town official. City or Town:,- Permit/Licgnse# _. issuing Authority("circle one): 1.Board of.Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5..Plumbingln so.ector 6.Other Contact Person: ' Phone#: AC40MOCERTIFICATE OF LIABILITY INSURANCE 4/14i2o14 THIS CER'nFICATE.IS ISSUED AS•A.MATTER OF INFORMATION ONLY AND CONFERS'NO RIGHTS UPON THE CERTIFICATE HOLDER: THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER'THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE'ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER! IMPORTANT: If the:certificate holder is an ADDITIONAL INSURED, the;pollcy(les)must be endorsed. If SUBROGATION.13 WAIVED, subject to the terms and coniitlons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer.rights to the certificate holdei in lieu ofauch endorsement s PRODUCER CONTACT NAME: Colleen Crowley ._. .. . ... .. .. Risk Strategies ccMany PHONE. (781)986-4400 F (781)963-9G20 !C-No: 15 Pacel'la Park Drive Anpgrss.ccrowley@risk-strategies.aom. Suite 240 INSURERS AFFORDINGCOVERAOE NAIC# Randolph Lam, 02368 fasuaERA:Selective TaS. oE' America INsuREo INSURER B:Safety Insurance CoMany 33618 Cape Save, Inc. INSURER'C:WesCo Insurance Company . _ 7 D Huntingto7n..Avve INS URERD: INSURERS: I.South Yarmouth M 02664 INSURER F: . COVERAGES1 CERTIFICATE NUM6tA:0L1441475243 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED.BELOW HAVE BEEN:ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY'REQUIREMENT,TERM OR CONDITION:OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED:AR MAY PERTAIN,THE INSURANCE'AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH,POLICIES.LIMITS'.$Hom MAY HAVE SEEN REDUCED BY PAID:CLALMS.. LTR TYPE OF:INSURANCE Owvn POLICY NUMBER.. fMM/DD EFF' MOMI IEXP - LIMITS GENERALLUABILRY._. ....... ._... _ .. EACH OCCURRENCE $ 1,.000,000 X COMMERCIAL GENERAL LIABILTY ltU PRE SES Ea oNccurrence $ 100,000 A CLAIMS 0ADE E OCCUR S1994480 O/16/2013 0/16/2014 MED EXP(Any:dne person) $ 10,000 PERSONAL kADV INJLIRY $ 1,000,000 GENERAL Ar__OREGATE $ 2,000,000 GEN'L AGGREGATE LIM IT APPLIES PER- PRODUCTS,-PRODUCTS:COMPIOPAGG $ 2,000,000 POLICY F41 T X ,toc AUTOMOBILE LIABILITY _. Ea4accideMtt G I 1 000 000 8Ix . ANY AUTO sob&INJURY(Per person) $ AUTOS 1ED X AUTo UlEO 208200 1;/6/2013` 1/6/2019 13 DILY INJURY(Peraccideno $ PfOPERTY DAMAGE ' HIREDAUTOS X AL(10N Peracadenl ` X UMBRELLA LIAR OCCUR X EACH OCCURRENCE $ 1,000,060 A EXCESS LIAB CLAIMS-MADE AGGREGATE s 1,000,006 DED RLTENTION : Si 199448:0 0/16/201.3 0/16/2019 g WORKERSCOMPENSATION.--- C ffcers Included.For YIC STATU= OTH- AND EMPLOYERS'LIABILITY Y/N X Mk R ANY PROFRIETORIPARTNERE>.(ECiJTiVE overage N!A OFRCERJMEMBEREXr!UDED? Q' E.L.EACH ACCIDENT $ 500,000 (MandatoryinNH) 3095633 /.9/201:4 /9/2015 EL.DISEASE-EAEMPLOYE .$ 500,000 if yes,desrride under RIPTIONOF OPERATIONS below. E.L.DISEASE<-:POLICY LMIT $ 5D0 000 DESC DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES iAttachACORD101,Additional Remarks Scheduie,irmore space lsrequired) Issued as evidence of insurance. Issued as evidence of insurance. Thielsch Engineering.;' Ina. is listed as: ;additional insured as respects General Liability as required by .written contract.., t 4 CERTIFICATE HOLDER CANCELLATION *song@cape ightcomgact.OrtJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCE4LEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE:POLICY.PROVISION& Attn: Margaret Song PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195 Maia Street Barnstable, Ill, 02630 chael Christian/CLC. ACO.RD 25(2010/OS)' . 0:1988-2010 ACOR4 CORPQRATiON: All rights,reserved. INSt125 Lzolo4s):o1 TheACORD name and.logo;are registere' marks of ACORD Office of Consumer Affairs and Business Regulation r 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cdntractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. " WILLIAM MCCLUSKEY = ` 7-D HUNTINGTON AVENUEAl _ , ' -� SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. scn i 0 20M-05/11 Address Q Renewal Employment E] Lost Card ��ilP�II/It/e[J'aUry,Celf�e��%l(.qi:;[<('flitr8ff" - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: -17.1380 Type: Office of Consumer Affairs and Business Regulation Expiration 3%14/2016: Corporation 10 Park Plaza-Suite 5170 i ' Boston,MA 02116 f CAPE SAVE INC. ff�� _ WILLIAM McCLUSKEY I 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not vali 'rthout signature i ! Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-102776 WILLIAM J MC C-LUSKEl x 37 NAUSET ROAD West Yarmouth NIA 0 673< g'z " Expiration Commissioner 06/28/2015 i iII . 1 g_ -/y r Town.of Barnstable 49,6,bU • *y�` Expires 6 mots om,jss Regulatory Services Fee • snaxsrna�E 11663 � Richard V.Scali,Director Argo MAC p Suil-d=i-n-g_Di= 1- - ---- - Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESSI PERMI ,APPLICATION - RESIDENTIAL ONLY ^�J Not Valid without Red X-Press Imprint Map/parcel Number(1C(Q`� Property Address ONCeS ��•. 0Zg-,,V Residential Value of Work$ R.am,tv Limum fee of$35.00 for work under$6000.00 Owner's Name&Address RX p G ��„�� Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: 1/Lt�_A"J—��. Cat, , Construction Supervisor's License#(if applicable) uu{.� Workman's Compensation Insurance I�dIAaV��®� ®�❑ Check one: ❑ I am a sole proprietor NO? _ ��� I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name n n Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ® Re-side ® Replacement Windows/doors/sliders.U-Value orJ (maximum.35)#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 co the Home Improvement Co ractors License&Construction Supervisors License is ire I SIGNATURE: —1 QAWPFILES\FOR in ennit forms XPRESS.d c Revised 061313 Town of Barnstable Regulatory Services c►te Totyy Richard V.ScaIi,Director Building bivision Tom Perry,Building Commissioner MARC- 2659. ��� 200 Main Street, Hyannis,MA 02601 pTFO MA'I� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: - Please Print 1 � � JOB LOCATION: d �� � �v`�' D 5-26,91 number street vill e "HOMEOWNER": f!i ��_ EC/� 1-08 -Zf O name home phone# work phone# CURRENT MAILING ADDRESS: S"+ Y' 5 2,0 (/ ea - C41town 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. DEFINMON 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. _ The un g�ed"homeo certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro d r tire is and that he/she will comply with said procedures and requirements. S re rol�i� 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,RuIes &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 t amend and adopt such a form/certification for use in your community. Q:\WPF1LF-S\FORMS\bui1ding permit forms\EXPRESS.doc Revised 061313 THE rqy, Town of Barnstable Regulatory Services * BARNSTABLE, •4� 9 MASS. 8 Richard V.Scali,Director z6;9. �m .19. a Building Division Tvm Per-r-y,-Building-Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Own Must Complete and Sig This Section If Usinguilder . I, AA._ D� , as ORmer of the subject property hereby authorize to act on my behalf, in all matters relative to work autho bythis building permit application for: A U "N r 0 ( dress of *-",-Pool fences and al are the response ility of the applicant. Pools are n be filled utilized before fenc installed and all final ctio are pe ed and accepted. Si er e o t Print Narne Print name Date Q:FORMS:O WNERPERMISSIONPOOLS _2- eti e C'tammayzn i of-Mrssuchaseffs Departmmt of hulrrsirial Accidents - �t��tioru Boston,MA d-211I - wmi nasmgm-ld a Wurker--s' CompensatianLisu u-ac Affidavit:B_uildersfCcntractors{ElectriciausMumbers Applicant Infmrmation Please Print Legibfy Namo(Busij�(7rganizationlbldividnal)= M r AA- �.✓r� e5w. A dress 219 Ca I�tat l &�,✓ ' -V 4- - 0"a Phone S`�� Are you an employer?Check du-appropriate bo-: Type of protect Crime&)- l_❑ I am a employer witty 4_ 1 am a general contractor and 1 6- ❑New constructoa Mlployees{fall andlorpait-time}* 1-mvehire-dtbe sub—contractors. 2_❑ I gin a sofe proprietor or partner- Iisted on the attached sheet 7- ❑Re=deliag ship and hm e no employees These sub-contractors have g- ❑Demolition Working for me M anyCapacity es employ and have workers' � 9_ ❑Building addition o aroters' camp_inwnance cam-tnsnranc r � 5_❑ Wle are a corporatim and its Itl_.Q Electrical repairs or additions 3. I ana a homernz nfr dbinb all wort officers Katie exercised fhe..r 1l_.❑Plumbing repairs or additions, Myself [No tvorlurn'COMP- c- 15.of�gfi d w per 1we n 17❑Roof repaas �.,c�xAnrFre�uind_]1 c_152,§1{4},andtseftsL`emo employees_[Nownrkers' l�_.❑O.tlier comp_insurance retlanred:1, -Any sppikz�ethst checis boa f1 most slsn 5ll o�tb°srzfinn belacF ch�F i}�ea a o3c�s�coaapevsstioaz pvii�ia� T XT ao- c--s who mbmit dais-Tdsvd i„%hc�v Mey are min g--Il T nak and then bire out i&e conhacmn most smbo�Ti a € driT *�?��n snrh tamtacmrs tnsf rT as this bar most stisched aze sddid nsI sweet shoicii�fl nnm=of @ie sd7 ors staig abet m[oenat tense e�iives fis� ernplu-�- if t2ia scL=-contmctuas lU-ee employees,dliq—1 Pzm-de thy. r o€k s'comp-Poltcy 11—b e- �a�an canpi�yer thrrtisptzrtz�rx�tr�ori}ers'competurliv�x trts'itn4lFCB forme�T errrpF�yees. Behar is the poiic,}rued}ob aztu rnformatfo:ra_ IUSEMance Company Name-.- Policy 4 or Self in:s_Lim ExpiratibnDate: Job Site Address: city/StatelZip: Attach a copy of the workers'compensation policy declaration page(shoveing,the policy number and expimtion date). Failure to secure cav�crage as required.under Sectica 25 A.of MGL c. 152 can lead to the imposition ofcrimimal penalties of a fine up to$1,50Q_Oa and/or one year imprisonment as well_as civil penalties in fhe fay of a STOP WORK ORDER and a fine of up to$250_00 a.day against the violator_ Be advised that a copy of this statement may be frarwarded to the Office of lun estigattons of ffte DIA for inmrance coverage vedEcatron_ I dri hereby c nt the r n Lties afpedgry 6atthe in]-ormat-r"an pratrzdezd aabrn,e u bwz and correct Siang _ �� Bate- �( � 1 Phone 9: QffEcirrl use and . Da net wj its in this area,to bs campleted by di�v or town ofiiciaL City or Town: IZrnIItT-a-CeUSe# Issuing Authority(circle orLe).: 1.Beard of$e2lth �2.Buff&ng Department I GitVTaR a Clerk 4.Electrical Inspector 5.Plumbing Empector 6.Other Contact Peman: Phone#:_ 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuautto 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 Iegal 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 Iocal licensing agency.sbalI'withhold the issuance or renewal of a license or permit to operate a business or to construct buildings is the common;=realtt.:for an.y applicant who has not produced acceptable evidence of compliance ovida fbe'irisui mice.coverage required."``_'., Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions snail enter into any contract for the pe -ormanee of public work until acceptable evidence of compliance rich the irisu1-ance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation a-Ddavit completely,by checking the boxes that apply to yrur situation and,if necessary,supply sub-contractors)na.ne(s), addresses)and phone n7Lnnber(s)along with their ceriri:n cal c-(s)of insurance. Limited Liability Companies(LLC)or Limited Liability PF,tn trshiipps("_LP)eiu no employees other h.an the members or partners,are not required to carry workers' compensation insir ance_ if an LL.0 or LLP does have employees, a policy is required. Fe advised that this affidavit may be s:bi ifted to the Deportment of industrial Accidents for confirmation of msL-nce coverage. Also be sure to sign and date the affd2 t_ 'Ilic afdavit sbould 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 obt=ha a workers' compensation policy,please call the Deuz-tment at the number listed below. Self-ins red comp tines Should enter. —Leir self-insurance license number on i e appropriate line. City or Town OfficiaLs Please be Buie that:the affidavit is oomplete and printed legibly. The Deparj=atat has provided a space at the bottom of the affidavit for you to fill out in tEhhe event the Office of Investigations has to contact you reg-ardijag the applicant Please be sure to fill in the permiJLcense number which will be used as a reference number. In ad.d ticn,an zppLcant that must submit multiple pennitfhu_rase applinations in any given year,need only submit one af,52davit indicaung 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 i1Ze applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit Jiilled out each year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ire,a dog license or permit to burn leaves etc.)said person is NTOTreguired to complete;his aifidw it_ The Office of Investigations would lice 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: Thb�Commanw'ealth of Nfa.ssachus t-s D,!gaii oat of Industial Accidents Q-�fiee Qz Iu'�esti�tlans 6-00 Wasbingtan Stet Boston,MA 02111 Revised 4-24-07 Fax s 617-727-7`t I ' �.mass,gnv�dia _ Assessor's Office_(lst floor) Map c (o 9 Parcel 0��� _ Permit# 1 -7 �� Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued Board of Health(3rd floor)(8:15 -9:30/.1:00-4:45) Fee . Gy Engineering Dept.,(3rd floor) House# oZ- i T5C 3 � TBE Planning De st floor/School Admin. Bldg.) _ NCE Dbfinlaved by Planning Board 19 �'� � � , AND TOWN OF;BARNSTABLE. Building Permit Application P �ff ,C� Villagey T Owner s Address ge Telephone O-Z)9—Z 9�— Permit RequestTi/�t.� . yF ;.'�-/�vx�' � ✓y8 dNG� ✓�3' ee. /Nl�D�7� 72/9 lQ 6tp- *Z2�0/✓c &_A1}7/Pf I&W!/�L-fAR First Floor square feet Second Floor square feet Estimated Project Cost $ 02.e*f>w Zoning District Flood Plain Water Protection Lot Size Grandfathered,? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type q�,� T" �,r26/ Commercial j Residential Dwelling Type: Single Family (/' Two Family Multi-Family Age of Existing Structure Basement Type: Finished Nt Historic House 0 Unfinished Old King's Highway �o Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces. e Garage: Detached Other Detached Structures: Pool..: Attached Barn ` None Sheds Other Builder Information Name or &4A 2j�Z/ '2 -- ,y Telephone Number !�2 6 9:7 Address . �,/S'�/Ub`7�1��Dprt-l-A/� C i,T' License# �.L Home Improvement Contractor# 106 72 Worker's Compensation# 091 WE,P�GQ/ 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 DATE 'T 2/ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED f ' MAP/PARCEL NO. - S ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION, - - FRAMEI < ' INSULATION , FIREPLACi - ELECTRICAL:' ROUGH •FINAL PLUMBING: ROUGH - FINAL ! _ GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` < 1 ✓l2� •IJGLyYiRYGO�lZCl�E'e2� O�. ti�2ZClQdl2�C:lZl�etla I I 1 I I OME .IMPROVEMENT CONTRACTORS REGISTRATION : Board of Building Regulations and Standards One Ashburton Place - Room 1301 I :Boston, lMassachusetts 02108 I HOME IMPROVEMENT CONTRACTOR -L Registration 100740 Expiration 06/23/98 Type - PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR F Registration 100740 CAPIZZI HOME IMPROVEMENT, INC. I Type - PRIVATE CORPORATION Thomas Capizzi , Sr . Expiration 06/23/98 1645 Newton Rd . I Cotuit MA 02635 CAPIZZI HOME IMPROVEMENT, INC Thosas Capizzi, Sr. I & ` Newton Rd. ADMINISTRATOR Cotuit MA 02635 I _ - t DEPARTMENT ONE AGJiBURo TUN, os ; H.b.'4Zr.:PJ.".'•.Y. •AUC_ION�SUPEOISOR LICENSE-" i :110 Expires: . © 00 ,{. Err 3f '�+;;� ►9�X��•CA�PIZ�I:EJR: - "� OdIVAL ' 2NSt1' Bl:�,,,.z A` 02668 . .. ' .The Commonwealth ofMassaehusetts Department of Industrial Accidents Olfles/11"OS ISVONS 600 Washington Street - Boston,Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information• 7- �� location: 6 // �% 4_5;72 j� QZ�3S phone 29 9SI1 ja I am a homeowner performing all work myself. I am a sole proprietor and have no One workin2 in an\ capacity I am an employer providing workets' compensation for my employees working on this job. company name: ,address: ci0.. phone#: insurance co ����% ��,a?��o/� policy a 08 e"'o- d 934,25? I am a sole proprietor. general contractor.or homeowner-(circle one) and have hired the contractors listed below who have the followin; workers compensation polices: company name: address: cih. phone N insurance co policy N company name-- adress• - cily phone insurance co policy q Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Brae tap to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of S100.00 a day against me. 1■nderiftod that A copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under t ins an e a%toes oof perjury that the information provided above is true and correct n Signature g Print name _ �G®�? Phone# 7/Zs^��1 official use only do not write in this area to be completed by city or town official city or town: _ __ _ permitAicense N r-1Buildiag Department OLicensing Board O check if immediate response is required OSelectmen's office OHealth Department contact person: phone N:_ __ -- rlOther trevised 1/95 P1A) s ble - • 0 fB arms to wn . . 0 : The T . Y >� Department of Health Safety and Environmental Sei4, ces ]Building Division 367 Main Street,Hyaaais MA 02601 Ralph Cmssca CC= 508-7904= Buagrag C.onmissionc Fmc 509-775-33" r For office use only permit no Date AFFIDAVIT HOME V"ROVEMENTCONTRACTORLAW SWpLEMENT TO PERMIT APPLICATION that the"raonstrnction,alterations;renovation.r won' MGL c 142A requires oonsut�on of an addition any p ot�aer ocN�� imprcvement..trmcnal, demolition. orare a*cmd building containing at least one but not more than fonr daRIling or m � to such residence or building be done by reg crcd vontra=m with attain aoceptions, along other i Type of Work / �xZaa� /?,qr✓T dAA-V Est. Al Cost f Address of Work: QA - �� ,e��la?f9 �� l' �'7s' Oc�•ner.Nam� G� �n1 Date of Penn it Application: I hercbr certify that: 4' Registration is not rnq&cd for the follo%%ing reason(s): I Work ctduded by law Job tmder SIAM Building not owner-Ooc*cd Owns palling oars permit Notice is hertby green that: OWNERS PULLING THEIR OWN PERMIT OR DEALING DSO NOT RAVFGIS AC To MIE rOR APPLICABLE HOME IMPROVEMENTWORK ARBITRATION PROGRAM OR GUARANTY FUND UNDER MG.c 142A SIGNED UNDER PENALTIES Of PERSURY µ I hcrcby apply for a permit as the agent of the ow"er: atraczar Ration No. Date } OR ' THE TOWN OF BARNSTABLE I STLBLE MAO& 039 BUILDING INSPECTOR Ca i-% C- �-k L % APPLICATION FOR PERMIT TO .......11�9§Rlp '!....F.:....................................................................................... . TYPE kAO %-z -5-1- . OF CONSTRUCTION .......................................... ...................................................................... ....................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....).7.v. ..... .......... r-,....... . . .... .. ........ qjLP4.........44AJZV`S........................... j ProposedUse ............................................................................................................................................................................. Zoning District .............I ...........................................................Fire District .............................................................................. Name of Owner ... ...............Address ... ...... ...4........................ Nameof Builder ....................................................................Address ..................................................................................... Nameof Architect ..................................................................Address ...................................... ..................... Number of Rooms ............11....................................................Foundation ...C C tL.C-..\ 3n....7— ...........I.............. Exterior .....S.�. sy. .�..%..........................................................Roofing .... .......................................................... Floors ....0.P.OS-n.......... A............................................Interior ...... Heating .... .....................................................Plumbing .......................................................... ............T V Fireplace .... .............................. ...................................Approximatp Cost ......... ......................................... Difinitive Plan Approved by Planning Board --------------------------------19--------- 6V2 X 2 Diagram of Lot and Building with Dimensions 'da V 7 L T I L I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ::��.. . . . ......... Name ....... . ... . . . .......... ......................... Coughlin, Joseph F. No .10578 -Permit for ....one store......... ......single familx.dwellinz........................ t Location �a Checkerberry,.,Road............... ............................Hyannis................................... Owner ......Joseph;F..,Coughlin.................... Type of Construction ......frame........................ ................................................................................ Plot ............................ Lot ........ .................. Permit Granted ........ 23...................19 66 Date of Inspection ......5.............19 6 Date Completed ......................................19 i PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... .................... .........................................................