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HomeMy WebLinkAbout0401 CRAIGVILLE BEACH ROAD a�+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel Application Health Division Date Issued P-7-2/ J Conservation Division Application Fee Pic Planning Dept. Permit Fee bate Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Ad)Tess /' �-- Village IxV;4r Owner Address ; r �Z , Telephone . Permit Request - . GG �- �✓' �' �' Square feet: 1 st floor: existingproposed� 2nd floor: existing ��� ro secl Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio 19e) Construction Type Lot Size es Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) = Age of Existing Structure Historic House: ❑Yes C o On Old Kings Highway:._0 YesS' o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ' Basement Finished Areas ft. "( q. ) asement Unfinished Area (sq.ft) -..Y. Number of Baths: Full: existing (4� new Half: existing Z new rim Number of Bedrooms: existing lonew Total Room Count (not including baths): existing �- new �'—' First Floor Room Count Heat Type and Fuel" XGas ' ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes, lo 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 ❑ No If yes, sit n review # Current Use Proposed Use _JET .yyj� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V Telephone Number A/ o1�z Address © / VU'p License# Q jS 1 '45P 3 W " 1 Home Improvement Contractor# " CJ Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE o'er. DATE l/ �� FOR OFFICIAL USE ONLY '- APPLICATION# DATE ISSUED MAP/PARCEL NO. i i ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 'i FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. The CommonnfeaUh of-Massachusetts -Massachusetts Department of l`aulmst /Accidents _ � r— Gl,�ce o,f Ix�ve_st'grrtiorrs 600 Washhugion Street Boston,MA 02I11 wnnv. iassgoiMia 'workers' CampensationInsurance affidavit:lluilders/Contractors/EI_ectriciansMumbers Applicant Information Please Print Legibly Name c% iddress: f e e . Ael4 CitylStatr'1Zip_ L'- `���� 1� D;�- one a Are you an employer?Check propria.te bo " T . o#: o act r u re. 4_ I am s contractor and I )W, project t� � I_❑ I am a employer with ❑ 6_ ❑New construction. e. loyees{full and/or part�ame}* have hired the sub-contractors. ?_ I am o sees proprietor or partner- listed on the attached sheet_ y_ ❑Remodeling ship and hazre no employees These subcontractors have employees and have workers, g_ ❑Demolition wor�ngfor me in any c city , 4_ Building addition [No workers' comp_insurance comp_insurance_ 5- ❑ We are a corporation and its 10. Electrical repairs or additionsrequired] ' 3_❑ I am a homeou net doing all work officers/rave exercised their 1I_.Q Plumbing repairs or additions myself.[No warkers'comp- right:of exemption per MGL 12_.0 Roof repairs ins urmce required_]$ c.152,§1(4),and we have net. employees-[No workers'. 13_.❑Other comp_insurance requiredi-]! *Army apptiuut ihat checks boa?I=nst also MI.out the section below showing Their workers'coW evsaiioa palieg i„f,r.M,& T Homeowners who submit this sffidavn mdkstkg they are doing an moire and rhea hire outside contractors nmst submit a new affidavit mdic%ting inch, IC=tractors that check this box must attached an addttionsl sheet shapring the name of the sir-cotes and state whether or not those eimes have emplo-fees. Ifthe sub-contsactorshace employees,they must provide their warkers'comp.policsnumber I am art employer that is prof idikg workers'camperurrtion insurance for rrtyr employees Relow is tine pa7icy an.d}ob site - informattart A Insurance Company Name: _ Policy;9 or Self-ins-Tic-4: —'Expiration Date: Job Si Add ess: � �"l'� C�G� i; - City/Stateizip: Attach a Dopy of the workers'cow sation policy declaration page(shoeing the policy number a on date}. Failure to secure coverage as required under Section 25A of MGL c_ 152 can lead to the imposition o criminal penalties of a fine up to$1,500.00i and/or one-year imprisonment,as well as coal penalties in the form of a STOP WORK ORDER and-a fine of up to S250.00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of hn estigations of the DIA fxyr insurance coverage verification_ I do herely certify tinder thepains and n,ltias ofpetfmy thattlie irrforrnationpratadedaboxreis true and correct _., Stenature: Date,: - Phone#: Of trial use only. Da not write in this area,to be completed by city or town officiaL City or Town:. PermitUcense# Issuing ckuthority(circle one): 1.Board cif Health 2.Building Department 3.CitylTowu Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Otther „ Cautct Person: Phone#" 6 e Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrafct buildings in the commonwealth for 211y applicant who has not produced acceptable evidence of compliance-w-ith the insurance.cover age required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance v ith 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-contractor(s)name(s), addresses)and phone number(s)along with their c a L'ificatce(s)of insurance. Limited Liability Companies(I LC) or Limited Liability Partnerships(LLP)},eith 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 Depa�ent of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. 'fire 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 requ17ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self insured companies s:aould 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 M 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 m,.?st be filled out each year.Where a homeowner 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 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: The Comznonwtalth of I M--,sachusetts Depazftment of Industrial Accidents Of I'm of%Vestig4tioas 600 Washington Street Boston,IAA G2111 Tel.A 617-727-4900 ext 4-06 or I-& MASSAFE Revised 4-24-07 Fax#617 727-7-749 • �I E l° Town of Barnstable Regulatory Services y MASS. Richard V.Scali,Director 4''OTF1639- 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, IhI4 YAllG ;as Owner of the subject property hereby authorize e-il e " to act on my behalf, in all matters relative to work authorized by this building permit application for. (Addre of Job ''Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are perfo ed d accepted. Si afore o r lf gnature of Applicant /1 PiTrit Name Print TGrrie i Date Q:FORMS:OWNERPERMISSIONPOOLS , Town of Barnstable Regulatory Services x �QFmE Richard V.Scali,Director Building Division RARN rnsM Tom Perry,Building Commissioner �6 200 Main Street, Hyannis,MA 02601 HIED ` www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number sheet village "HOMEOWNER": name home phone# work phone CURRENT MAILING ADDRESS: city/town 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. 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 constnicts 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"bomeowner"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 Homeowner 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 2.1S) 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:\WPFILES\FORKS\building permit fomss\EXPRESS.doc Revised 061313 i Massachusetts Department of Public Safety Board of Building Regulations and Standards ° License: CS-009691 Construction Supervisor i JOHN W SWEENEY r, PO BOX 711 WEST HYANNISfIO Mu 0: I 2 =. Expiration: Commissioner 08/12/2017 \. Office of Consumer Affairs e&Business Regulation ME IMPROVEMENT CONTRACTOR gistration 178287 Type: expirations 4/1/201:6., Individual JOHN W.SWEENEY p. JOHN SWEENWY 68 THIRD AVE. W.MYANNIS;PO:RT,MA 02672 Undersecretary y Tr , C_��e �a��arr�'ct�rcaecrlfL a`'C'/��CZJJC!(/crJefl,1 Oface ofConsumer Affairs,&Business Re;gulmian E, IMiaRQVEM1Ii"NT CONTRACTOR g,istratla 178, 87 Ty'p-e'c J axpl:r tio�n 41- / �1:E Individual JOHN W. S.,WE Y L JC:I,I,N SWi E WY 68,THIRD AVE. W. HYANNISPORT, MA 02872 Un.dersserctary :i Lice se or registration,valid for ii dividul use ommtl before the ox,p)jraktwo,t dato. If fosad retan't to: I Q►ffice of Commoner Affairs and B-48.noss Regulation j 10 Park Plaza� $Wt®5170, Boatwn., MA:0 116 m i w Not valid.wit-bi out sug,natu:ro a r 4 , m Affifim fi a q 9 d ## 77 il ,ter �k'a a y� 'F y$ f 1 rV th. � + MAT 3 .. t Y�' �' r e' ',t�.? 'T'i Y } J Jai w.� !7 •r,. �. k p( t y 34 R �LL{ Et M$ e. a 1 . YYaa }� `Sr. /0 o TO 19t A7Jt c c ly l- iC G Tr�v / tcOi� C 4Altj OO i COMMERCIAL BUILDIN APPLICATION FEE New Buildings,Additions $100.00 Alterations/Renovations $50.00 Building Permit Amendment $50.00 FEE VALUE WOR NEW BUELDINGS square feet x$140.00/sq.foot=— i Y . nea az _ .-^Poe— � a i I l el, St7CI�Z- -