HomeMy WebLinkAbout0030 CIT AVENUE - - - ---- - \ vow r 3 -- --
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 3/ �a�-9� Parcel -70
Application#,
Health Division Date Issued ;
Conservation Division Application Fee
Tax Collector P b �
Treasurer'
Planning Dept. 4G �, ��� ' ,,:;; • ��RU-
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Date Definitive Plan Approved by Planning Board � v� �1S, ITO
Historic-OKH Preservation/Hyannis
Project Street Address 3 G C d AV Lzo 17 �
Village
Owner l g L . 6/C Address `3 rs C Tr A v yn it
Telephone 5o _
Permit RequestbL4F 46
Square feet: 1 st floor:existingproposed 0 2nd floor:existing 'V proposed V Total new
Zoning Diss Flood Plain Groundwater Overlay
Project Valuation U Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#,units)
Age of Existing Structure 1166 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) N Pr- Basement Unfinished Area(sq.ft) 6JA-
Number of Baths: Full:existing new D Half:existing ® new
Number of Bedrooms: existing b new
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
.i
Central Air: ❑Yes �Uo Fireplaces: Existing b New b Existing wood/coal stove: ❑Yes to
�,
4
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑never size!:
1 w
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
ca
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ r'
Commercial ❑Yes P No If yes, site plan review# _
Current Use Proposed Use .�'��.
BUILDER INFORMATION f
Name -N Telephone Number 11 u _Sz� "55? 1
Address !�g � License#
At AIJ NL5 Ak 0�20 1 Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING_ FROM THIS PROJECT WILL BE TAKEN TO LC- fh
T Olt
SIGNATURE x DATE
\ FOR OFFICIAL USE ONLY
. APPLICATION#
/ DATE ISSUED
\ MAP/PARCEL NO
/ ADDRESS ' VILLAGE {
OWNER ,
f .
I DATE OF INSPECTION:
» •
{ FOUNDATION
FRAME . }
INSULATION
FIREPLACE
f _ . . .
ELECTRICAL ROUGH \ FINAL
PLUMBING: ROUGH � FINAL
-
.
/ GAS: ROUGH? FINAL
\ FINAL BUILDING
-
f
{
DATE CLOSED-
OUT
�ASSOCIATION PLAN NO2 .
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The Commonwealth of Massachusetts
Department of Industrial Aecidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia '
Workers`Compensation Insurance-Affidavit.;.Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name (Business/Organizatioaadividual): k ��� �/ f�� , •
•Address: � �� � - .
City/State/Zip: qt c2ol Phone.#: 7 7 4`84 6 5S7
L
Are you an employer? Check the appropriate box:
�' 4. 0 I am a general contractor and I. Type of project(required):.
1 I am a employer with 6. ❑New construction .
' rap loyees (full and/orpart, me).* have hired the sub-contractors
�. I am a•sole proprietor or partner- listed on the'attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have S. ElDemolition.
working for me,in any capacity. employees and have workers 9 E]Building addition
[No workers' comp. insurance comp.insurance.#
required.] 5. Fj We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their
3.❑ I am a homeowner doing all work 11.�Plumbing repairs or additions
myself [No workers'comp. right df exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' .•13.❑ Other
comp.insurance required.] ,
*Any applicant that checks box#r must also fill out the section belowshowing their wm-kers'compmsation 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.
IContractors 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. rf the sub-contractors have employees,they must providb their workers'comp,policy number. ,
lam 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..#: j`L-�2 Expiration Date: 40'
Job Site Address:_,Sy0G ��1� `� 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a Erne
of up to$250.00 a ay against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Tnvesti ati ,bf e jDIA for insurance coverage verification.
I do he4 c rti un tLthe pains an penalties of perjury that the information provided bo a is
true and correct:
Simature: �' Date: `
Phone #:
Official use only. Do not write in this area,Yo 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 CIerk 4. Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phone#: `
a Board of Building Regailations and Stnudards
HOME IMPROVEMENT CONTRACTOR
Registration: 143942
Expiration' 8/17/2008
Type: Private Corporation
TOBY LEARY FINE WOODWORKING, INC.
TOBY LEARY
46 LAFRANCE AVE
HYANNIS, MA 02601 Qeputy,Aclministrator
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C0RP0vvl:AT I ON �� NEW
t i HFu inlORK—v"s CES nSi0T �v"071 3e➢ nA afa..•SEE AiAME �A"' i A 0 E SCHEDULE.
ITEM 2 POLICY PERIOD fZ0f A W,standard firne a'=V;a insureWs
mailing address
mot'. 01/01f07 :ra 01/01/08
ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed
here:
MA
R. Employers Liability Insurance: Part Ttua of the policy applies to the vverk in eawh state listed ifs i=e:1: -4 A,
The limits of our liability under Part Two are:
Bodily injury by Accident $ 500,000 each accident_
Bodily Injury by Disease $ 500.000 policy limit
Bodily injury by Disease $ �00,000 each employee
C. der -states irssumnc= ftrt Sit crik ibe razlffew anniie tar the stG.:*e . 4 PA m Rstnc
k
AK AL AR AZ CO CT OC DE FL GA HI IA IFS IL IN KS KY LA MD ME MI MN MO 95 M71 NE NE NH Ni
NM NV NY OK OR PA RI SC SO TO TX UT VA VT W1
ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All information required below is subject to.verification,and change by audit.
Estimated Total Rate Per Estimated
Classifications Coda Number
Remuneration $700 OF Re- Premium
i n�( (�
UN Annual®3 Year muneration IN Annual 3 Year
SEE EXTENSION OF INFORMATION PAGE WC7754
TAXES/ASSESSMENTS/SURCHARGES $1 ,012
i
EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) ' $284 MA
MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $24,41 7
If indicated below, interim adfustments of premium shall be made:
Semi-Annually El Quarterly Monthly DEPOSIT PREMIUM +
ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE WC990612
01/26/07 PARSIPPANY $2
Issue Date Issuing Office Authorized Representialve we 00 00 01
39967
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80i4R0 OF IN
a'
1 rXd�rx� udaa�a
{ LlcQnser CONSTf�UCT10N REGU,l.ATION.$ µ
tx SUPERVISOR
tVumber CS Q84605.
Sirkhdate 07/j8L1975
Ex�irea 07/18/2008
Ti-hO: 702:0
Restricted: 00'`
46 LA .- GEgyE
HYMMS
. MA 02601 ✓�� �, I
Codnm(ssionsr
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yy pUIME lO Town of Barnstable
Regulatory Services
BARNSTABLE. '
y Huss. Thomas F. Geiler;Director o
�A 1639.
�Fo M"A Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I,�t� yL"i a L r_ J c��L�, , as Owner of the subject property
hereby authorize C o_ 4 e a-r c4 to act on my behalf,
in all matters relative to work authorized by this building permit application for:'
f .
(Address of Job)
Signature of O er Date
Print Name
If Property Owner is applying for permit please complete the Homeowners License
Exemption Form on the reverse side.
Q:FORMS:OWNERPERMISSION
OFSHE Town of Barnstable
Tp��
Regulatory Services
�t BARNSTABLE,
Thomas F.Geiler,Director•
p MASS.
�A i639• A�0 Building Division
rFn � Tom Perry,Building Commissioner
.200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
-------------------_ ---- _—___--------=---_------_______=______________
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCAT
number street village
"HOMEOWNER":
na home phone# work phone#
CURRENT MAILING ADD S:
city/town state zip code
The current exemption for"homeo ers"was extended to in /dewner-occupied dwellings of six units or less and
to allow homeowners to engage an indi 'dual for hire who oes not possess a license,provided that the owner acts as
supervisor.
FINITIO OF HOMEOWNER
Person(s)who owns a parcel of land on which e/s resides or intends to reside, on which there is, or is intended to
be, a one or two-family dwelling,attached or de t ed structures accessory to such use and/or farm structures. A
person who constructs more than one home in tw ear period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building O rcial on form acceptable to the Building Official,that he/she shall be
responsible for all such work performed u er the buil ernut. (Section 109.1.1)
The undersigned"hom/sand
responsibility for co liance with the State Building Code and other
applicable codes,bylawations.
The undersigned"homhat he/she understands the own of Barnstable Building Department
minimum inspection prirements'and that he/she wil omply with said procedures and
requirements.
Signature of Homeowner
Approval/Not .
Official
ree-family dwellings containing 35,000 cubic feet or larger will be requir to comply with the
State Bde Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
tates that: "Any homeowner performing work for which a building permit is required shall be exem from the provisions
of this sec 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s) or hire to do such
work,thatowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(se Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious proble s,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would w th 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 pplication,
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:forms:homeexempt