HomeMy WebLinkAbout0102 COMPASS CIRCLE /O a Corhpcss Ci r,
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r. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application# ,�O
Health Division
-
Conservation Division Permit#
Tax Collector Date Issued O�
Treasurer Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address o �� f�y.IS C o�'( Ap
Village 1
Owner L Address
oTelephone
Co Permit Request qac? vA MAV 00
OJ�
S re feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new
Zoning ' trict Flood Plain Groundwater Overlay
Project Val tion 4.3®0•00 CCoAn ttrru ti ype
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Vv
� Dwelli g Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
7,<-- Ag of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No
s ment Type: ❑ Full ❑Crawl ❑Walkout ❑Other
j sement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
'— Number of Baths: Full:existingnew Half:existing new
9
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room Count
r-.
C
(,�j 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:❑existingf ❑new4ize
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: �?
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Z
Commercial ❑Yes. O-No- If yes, site plan review#---._`-
Current Use Proposed Use
/ BUILDER INFORMATION 5�1/�-3 7V9 ! 17
Name �i� c/ Telephone Number 7 g �7
Ad s '� r'aJ .r,>G6 X-C CC/`��� License#
�� h S /Vl 4j Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A L 0,6
SIGNATURE�=��1 /� „ _
.� � -.--,.DATE y- C/
FOR OFFICIAL USE ONLY ,
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS' VILLAGE
P OWNER
2 �
4 DATE OF INSPECTION:
f ,
FOUNDATION PIZ-
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
a '
FINAL BUILDING
i
DATE CLOSED OUT
r
r
ASSOCIATION PLAN NO.
r
s
1
E'O ti Town-of Barnstable
P °^ Regulatory Services
SAR"AEA$ Thomas F.Geiler,Director
&61g Bi&fflmor�1V1S10I1
b
Tom Perry,Building Commissioner
200 Main Street, Hyarmis,MA 02601
Office: 509-862-4038 Fax; 508-790-6230
Permit no.-
Date_r � 7
AFFIDAVIT'
HOME IMTROVEMENT CONTRACTOR LAW
STJPPLENIENT TO PERMIT APPLICATION
MGL c.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
requuements.
C.os P/ f
Type of Work '�✓ G✓ ��Jh !�C o�/1? __.
Owner s Name' L
Date_of.Application
I hereby certify that:
Registration is not requited for the following reason(s)
❑Work excluded by law
❑Job Under$1,000
❑Building not owner occupied ,_
Owner.pulling own permit
Notice is hereby given that:
OWNF, PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES.OF PERJLTftY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registation_N o.
Date L---,,0vne1'ls.Name
. O
Q:fomshaineLffidav
The Commonwealth o Massachusetts
Department of Industrial Accidents
c Office of Investigations
600 Washington Street
Boston,MA 02111
.� www.mass.gov/dia
fidavit: Builders/Contractors/Electricians/Plumbers
Workers' Compensation Insurance Af
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): a✓,v-Q'
Address: 10,� C C1-106—PSoS
City/State/Zip: `_S' 0 Phone.#:
'Are you an employer?Check the appropriate bog: - .Type of project(required):.
1.❑ I am a employer with 4' I im a general contractor and I
_ ._ - 6. New construction .
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- (listed on the-attached sheet. 7. 1 CgRemodeling
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
comp.insurance.$
[No workers' comp.insurance
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11. Plumbin repairs or additions
3.❑ I am a homeowner doing all work ❑ g eP
myself. [No workers' comp. right of exemption per MG 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#1 must also fin 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 DU for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury=that the information provided above is true and correct:
� Sign=attue•��: c's-t.A� � Z�f��Z��iu�a,a��' �- Date• (�'l y- ® _ ,
Phone
Official use only. Do not write in this area,to be completed by city or town o jcciaL
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
of 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( )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 yobs situation and,if
necessary,supply sub-contiactor(s)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 wiite"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 lnfttrial Accidents
Office of Investigations
600 Washingtcai Street
Boston,MA 02111
Tel. 4 617-727-49Q4 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax#617-727-7749
www.mass.gov/dia
;✓` The Commonwealth of Massachusetts
Department of Industrial Accidents
• r Office of Investigations
600 Washington Street
W= Boston,MA 02111
s� www.mass.gov/dia
Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
�...�APPUcant Information Please Print Legibly
��'N=_C (Business/Organization/Individual): . Ab d teW •�. /r � [�
` `Address
A-�:Qi State/Zip Phone
Are you an employer? Check the appropriate box: Type of p�construction
(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. Ne .
2`DK I am a'ole props etor.or partners.,, listed on the-attached sheet. 7. Remodeling
L '_q- ship'and have no employees. These sub-contractors have g, ❑Demolition
workm foi me_a cy a aci employees and have workers'
t 9. ❑Building addition
[No workers' comp insurance comp. insurance. 10. Electrical repairs or additions
r"iequued:]: 5. ❑ We are a corporation and its ❑ P
3.❑I am a homeowner doing all work officers have exercised their 11.❑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.❑ 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.
ZContractors 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.
Ir ereby under the pains and penalties of perjury th the informati provided above is true and correct
Si� _a`ture: ' Date:
Phone#: -Eg 770
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 foz 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 4 617-727-4900 ext 406 or 1-877 MASSAFE
Revised 11-22-06 Fax 4 617-727-7749
www.mass.gov/dia
ZHE Town of Barnstable
pp Tp� ,
Regulatory Services
txsTns , : Thomas F.Geiler,Director
A,•� Building Division
AjFp�,1
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
CF70B LOCATION
number street vill ge
t
C==HOIytEOWNER',:,,,.•�`�� w�O��1'[�I
name home phone# work phone#
CURRENT MMONG� ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellirio of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance,with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
, Signature•of omeoowner
Approval of Building Official
Note: Three-family dwellings containing 35,600 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,'as part of the permit application,
that the homeowner certify that he/she understands the responsibilities.of a Supervisor. On the last page 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
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��„�•"" TOWN OF BARNSTABLE Permit No. ______.20660
e
I "�W� Building.Inspector Cash _$ 20,0�'1�21H
OCCUPANCY PERMIT Bond
No building nor structure shall be erected, and no land, building or structure shall be
used 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 Cedar Acres Realtv Tnist Address Great Pond Dry,Smith Yannmth
lot #17A > 102 Gass Circle, Hya-ruis
� f
Wiring Inspector �t.•--' Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department / In date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE 4OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
..................._..r. ......_.._........._, 19� ................----..��Building�Inspector,....._._..
Assessor's map and lot number .....I I� !... ^... .L•( V ° 't,
........................
K.S
Sewage Permit number ......7 ......J.O
°`TNE.r TOWN OF BARNSTABLE
Z BASH5TODLE, i
"6 9 BUILDING INSPECTOR
..�,o wnY a'
APPLIA ►r .r,P:.�L�J
CATION FOR PERMIT TO ......................................�....................................................................................
I F
TYPE OF CONSTRUCTION ........!A fiI.4) -,,/ '� �fV
....................................................................................................................
....................` ..-.....Q...........
19. f�
TO THE INSPECTOR OF BUILDINGS: i
The undersigned hereby applies for a permit according to the following information:
Location .............f h,...........:. . ov/i/ ri' f •:..Li�.../1 /.........
Proposed Use ` F ^� �' -� -T .........................y
................................................................................................................
Zoning District Fire District
r
Nameof Owner ......................................................f ; i r�Addr,ess ....................:.......................................... . .�.'............
f _ .
Name of Builder r ..:? .r....^ ...'' r, , . .Address ....................................................................................
Nameof Architect ............a.....................................................Address ..............................,.....................................................
Number of Rooms T ` .. ..................Foundation �.
Exterior ......:.................. Roofing ........._ ..f. .. ........... ..... .... .... ....
41
Floors ........................................................................................Interior
t/ .................. .., ...i1..........(J•...................
Heating ..... .A ..� , - f .:�..?�...............Plumbin '. ..�. �.�.......................
.................................. g .... .. ... ..
Fireplace ' .r�.......................Approximate Cost "....... ...tl..................................
........ ...... ............................. .................ti:.
Definitive Plan Approved by Planning Board ________________________________19--------. Area ..........................................
a
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
_w
fir
_ �.-.F_-_____
✓ F
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ....... °................ ...................................',..........
Cedar Acres Fe alty .Trust' A=310-403
20660 tir
No ................. Permit f r .... .....one......s... ..�..Y.........
i single famil welling
Location ....102. . ... ...
Compass Circle. . ...................... . . ............... ........ . ..
Hyannis
...............................................................................
Owner Cedar Acres Realty Trust
............................ ........I.....................
Type of Construction fr
...............ame...........................
y�
.......................................
.................................... ``......................................
Plot ��17A
......................... .. Lot ,�._...,.,................
October 11
Permit Granted ........................................19 78
Date of Inspection ....................................19
Date Completed ......................................19
1
PERMIT REFUSED Y
................................................................ 19
.................
Approved ................................................ 19
...............................................................................
...............................................................................
i
Assessor's map and lot, number ..:: .�..v.L.0....W.^.�() ` 7
K1 SEPTIC SYSTEM MUST BE .
Sewage Permit number .'... . ........................'.=.............. t INSTALLED IN COMPLIANCE
�j N.
R /� R WITH ARTICLE I IT .STATE
Qy�F THE Tyr T 0 11 1 \ • 0 F J B r1 RIST XEt TOWN
GJ.'
Z BARNSTeBLE,
039.
�o Mpr a•
BUILDIH:GLr INSPECTOR
APPLICATION.FOR PERMIT TO .... .... �r . .. ...... ..................... .............. ...............................
TYPE OF CONSTRUCTION ........ .. ... . .. . .. . .................. ...............................
. . ...
.:....... . .....::... ...........19../..0
TO THE INSPECTOR OF BUILDINGS: _
The undersigned hereby applies,for a permit according to the following information:
Location ........... ................. ..
ProposedUse ...................�,J ...4.., ................... ......................................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner :......
J . . ..
�'L .. �� ss. .................� ......... C !
A
Name of Builder .... ::. ��. ddress ......................................................
Nameof Architect ........... ....-.....................................Address .................. ........ .. ............................................
Number of Rooms .................. ................Foundation ........ ...............
Exterior ..... Yi.. ... r..... ..��'�li: . . . Roofing ...... •T•. .. ..... !/�. /.1....
Floors Interior ........ ...........
.... ................ . .... �. ............
Heating / .........101..t.............Plumbing .........; �:..... , c . .........................
Fireplace ...............�.. .... .... .......... ....................Approximate Cost ......... .................................
Definitive Plan Approved, by Planning Board -------------------—-----------19_______- Area ............. ... ..................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH �Q�
6
JAI X22
3 � •
Y
1
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .... .. . .,L,4,�?....
Cedar Acres Realty Trust .
0 20660
.,Nql................. Permit for ........one story............................
single family dwelling
.........................................................................
Location ...........1.02..C.o.mpas.s...Cir.cle*.............
. .... .. . ........ . ...... .......
Hyannis
...............................................................................
Owner
Cedar Acres Realty Trust
..................................................................
frame
Type of Construction ..........................................
................................................................................
"Plot ............................ Lot ............#17A
..................
October 11 78
Permit Granted.........................................19
-Date of Inspection ........./........... ............19
--'.,Date Completed ... ............... ............19
PERMIT REFUSED
................................................................. 19
......................... .....................................................
...............................................................................
................................................................................
...............................................................................
Approved ................................................ 19
...............................................................................
................................................................................
I HEREBY CERTIFY THAT THIS 1:CON-DATION
IIS LOCATED ON THE LOT AS SHOWN ANb
CONFORMS TO THE TOWN OF
ZONING REGULATIONS REGARDING SETBACKS !`y
FROM STREET LIMES AND LOT LINES.
DO
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''Town of Barnstable *Permit#
Expires 6 months from issue to
Regulatory Services Fee ���
Thomas F.Geiler,Director
Building Division �-
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number "31 c7 r —? Ir
r
Property Address 0-
Residential Value of Work�,&C;70�� Minimum fee of$25.00 for work under$6000.00
Owner's Name&Addr ��r)ess �d/� �✓� Cj
Telephone Number 't'� ��7
Home rovement Contractor License#(if applicable)
Constructio upervisor's icense#(if applicable)
❑Workman's mpe ation Insurance
Check on : ®PRESSPERMIT
❑ I am le proprietor
I e meowner
01
e Wor is Compensation Insurance jf MAY 1 2007
TOWN OF BARNSTABL E
Insurance C an N e
Workman's Comp. o
Copy of Insura a Co liance Certificate must be on file.
Permit Reques check box) r
i Re-roof(stripping old shingles) All construction debris will be taken to �/t✓ fYl �h
❑Re-roof(not stripping. Going over existing layers of roof]
❑ Re-side
Replacement Windows/doors/sliders. U-Value (maximum 44)
*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.af�f r �sio
A copy of the Home Improvement Contractors Lic e'ts ZTre i-J
SIGNATURE: v�/ .�. dry>>rj 3
Q:Forms:expmtrg
Revise061306
The Commonwealth oflllassachusetts
,Department of Industrial Accidents
Office oflnvestigations
d ' • 600 Washington Street
Boston,MA 02111'
WWW.mass.govldia '
Workers' Compensation I, surance.A-ffiddvit: Builders/Contractors/Electricians/Plumbers
A licant%formation Please Print I:e6ibl
Name(Business/Organization/IndiAdual.): , f"�
Address: 15F Y
City/State/Zip: dS� !'"�//�/� Phone.#: `C7
Are you an employer? Check the appropriate bog: :Type of project(required):•
1:❑ I am a employer with 4. ❑ I am a general contractor and I
6. ❑New construction .
employees (full and/or part-time),* • have hired the sub-contractors
2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling
These sub-contractors have
• ship and have no employees 8. ❑Demolition:
ivoikin for me in an capacity. employees and have workers'
g Y P coin insurance.
' 9• ❑Building addition
[No workers comp.insurance p•
10. Electrical re airs or additions
required.] 5. [] We are a corporation and its ❑ p
.3 lam a.homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions '
myself.[No workers' comp, right of exemption per MGL 12•7 Roof repairs
insurance.required.]t c. 152, §1(4),and we have no
employees. [NO workers' 13.0 Other
comp,insurance required.]
*Any applicant that checks boi#1 must also fill out the section below showing their workers'compensation policy irfamration.
t Homeowoers,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have
employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number.
ram an employer that is providing work s'compensafion insurance for my employees. below is-the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. Expiration Date:
lob Site Address: City/State/Zip:
'Attach a copy of the workers' compensation p icy declarah page'(shovt•ing the policy number and expiration date).
Faiiure•to secure coverage as required under Se on 25 A of MGL c. 152 can lead to the imposition of crimina_penalties of a
fne q to$1,500,00 and/or one-year impriso ent,as well as civil penalties in the form of a STOP WORK,ORDER and a fine
of ur:to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the 0ffice of
Inve tiQations of the t)IA for insuzance coverage verification. '
I hereby certi 9y under thepains•andpenalties of Jury that the inforrnat:•on provided above is true and co—rect.
SiPllc'llrz o��� Ltd Date
Phone-:
Off�cial use only. Do not write in t his area, to.be completed by.city or town ofjiciaZ
City or To•,Yn: Termit(L•icense t
iS�LIn�Authority(circle one):
:1.Board of Fealth 2.Building Department 3.CitylTo irn Clerk c.Electrical;nspector 5.Plumbing Inspector
6.Other
Contact Person: Phone ft:
Town of Barnstable
a pp THEVI
Tp
Regulatory Services
'
BARNST.ABLE, : Thomas F.Geiler,Director
y MASS.
��, =6,9• Buildinu Division
tEn � Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.toNvn.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEO«'NER LICENSE EXEMPTION
Please Print
DATE: > l
JOB LOCATION:
number / street �^ (� village
"HOMEOWNER": L Off �.✓OC�d�I�C� J C�IJ ��� �� �aC
name home phone work phone f
CURRENT A AILING ADDRESS:
ty/town state zip code
The current exemption for"homeowners"was extended to include o«ner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person wlio constructs more than one home in a two-year period shall not be considered a homem ner. 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"homeowmer" assumes responsibility for compliance with the State Building Code and other
applicable codes; bylaws,rules and regulations.
The undersigned"homeowner" certifies that he/she understands the Town of Barnstable Building Department
um inspection procedures and requirements and that he/she will comply with said procedures and
r uirements.
6�—
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger w-ill 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 pemvt is required shall be exempt from the proNisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);proNrided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Nary homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q
Rules&Regulations for Licensing Construction-Supenrisors,Section 2.15) This lack of awareness often results in serious problems,particula-ly .
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would c.ith 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 permt application,
that the oomeowner certify that he/she understands the responsibilities of a Supenrism On the last page of this issue is a form currently used by
several towns. You may caret amend and adopt such a forn,/cenification for use in your community.
Q:fot7ns:homeexempt