HomeMy WebLinkAbout0019 DELTA STREET �'� Lam-
9 Q
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711 Slo
of Town of Barnstable *Permit# ? 7 93 9
Expires 6 months from issue date
MAM : Regulatory Services Fee Zf—, ®-a
�e� Thomas F.Geiler,Director
Building Division X-PRESS PERMIT
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 J U L 1 5 2004
Office: 508-862-4038
Fax: 508-790-6230 TOWN OF BARNSTABLE
EXPRESS PERM APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number Z��
Property Address
['Residential Value of Work o, .rO 9 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address & .Z
o zi�3
Contractor's Name Telephone Number 78/
Home Improvement Contractor License#(if applicable) r
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ am a sole proprietor
0 I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate'must be on file.
Permit Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to ;54X.M STf9-,o CCU 721"SA6f21
❑Re-roof(not stripping. Going over existing layers of roof)
E'Re-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this pern it does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
Signature
Q:Forms:expmtrg,
Revisc063004
1 • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map, Z1 Z_ Parcel Z // Permit#
Health Division - L1 d Df,(e 4S. 0°` OF RNS IAA a Issued
Conservation Division a Vlh
� ,# s{ 3 PH �: Igp�lication Fee
Tax Collector���/�/ Permit Fee b
Treasurer SYSTEM
s p-$ y
VfSIG;4 �
Planning Dept. UMMMTp _J__#OF 9EpR00MS
Date Definitive Plan Approved by Planning Board r;
Historic-OKH Preservation/Hyannis
Project Street Address / � t T4 57X 6fr
Village
Owner !tif Address 33 7`
Telephone - g LIf ��
� IVGTdAj 61%
Permit Request 3voZ_-P �>EClC
94//41 25coA17- 57 6i S s-- Af11_11%16 S .7
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation �S�d`a • oD Construction Type
Lot Size /4, 7/3 S-f. Grandfathered: ❑Yes O No If yes, attach supporting documentation.
r -
Dwelling Type: Single Family &--' Two Family ❑ Multi-Family(#units)
Age of Existing Structure 3 24 x-S Historic House: ❑Yes � On Old King's Highway: ❑Yes
Basement Type: O'Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing �- new !f- Half:existing new
Number of Bedrooms: existing_ 3 new
Total Room Count(not including baths): existing new First Floor Room Count 41
Heat Type and Fuel: ®'Gas 0 Oil , 0 Electric 0 Other
Central Air: ❑Yes 0* o Fireplaces: Existing V New Existing wood/coal stove: ❑Yes �o
Detached garage:O existing ❑new size Pool: 0 existing ❑new size=��Barn:O existing ❑new size
Attached garage:O existing O new size / Shed:Ming ❑new size ar Other:
_ Zoning,Board of Appeals Authorization ❑ Appeal# Recorded
Commercial O Yes R-l`Jo If yes,site plan review'#
Current Use Proposed Use
BUILDER INFORMATION �1U�S7?E'Nf CoN1YK7' /lE Lotr.v
Name /fYii�•ri�y Telephone Number
Address, License#
41eat-Aa c A"Z4 Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE �� /8
FOR OFFICIAL USE ONLY
c
PERMIT NO.
1 :
DATE ISSUED
MAP/PARCEL NO. i
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
r
FOUNDATION rp /b Q /t 9• /�� G f Q7
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH - t= FINAL,
PLUMBING: ROUG i- FINALS
GAS: ROUG FINAL
04-
FINAL BUILDING ®tC
s
N �
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
_ Department of Industrial Accidents•
- 600 Washington Street .
J Boston,Mass. 02111 .
Workers' Com ensation.Insurance Affidavit-General Busine§ses
7�,'�, '4roisSro.• '. ..YF:crvwF��•'•Y.,,",. .. .L,• .'aa^.. =.a: ..:1".3led§] -
• address�� ,A/J /
"i L%/�/�/✓7 S. j state: �/� / zip: yhone# /��l �8fi z
work site location full address):
0 I am•a sole proprietor and have no one $lisiness Type: []Retail❑RestaurantBar/Eating Establishment
working in any capacity. ❑0 ce❑ Sales(mcludmg.Real Estate,Autos etc.)
I am an em to er with em to es(full& art time: Other
�/E//%%/ %//%%/%%/��%//// //%%//%%%//�/�%%//G%%%/�/%%�%%//%�/%
I am an-egpl yer providing workers' compensation for my employees working on this job.
:1, ..ii.�•..t:�:t •}. .�p•. 'S•...• '�il ,•iv. w �'I.l:r • .C:• _
COIIl^an'.name• :' ; ,,L :,. d'r•':. `T: + "' _ i.
address: ...5 r
.risiirarice.c'os .+^ .
�Pfam le proprietor and have hired the independent contractors listed below who have the following workers'
compensation polices:
x,;'`• .;•`•Lr';;:",:aid?:•, .-r.
co'm an 'aamtir
fioae
Insurance
r:t'•i.:'♦ ' •� ..}: r'O 1C c#.� .•j r.�.,, �•:a'• :''r:+`{`'*••:i•
�.•`.ire:�'dr .r•:;°•: ,.',;
com`ari na
address:. .; :•
.. ;• ,c.., ?�''�:•t.:i ;.^ yam. •+ : _ '
wsurance*`C&, ° = -
Faffure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 andlor .
one years'imprisonment as well as civil penalties la the foim of a STOP WORK ORDER and a fine of 5100.00 a day against ma I understand that$
• copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. _
I do hereby certify under the pains and penalties of perjury that the information provided above is truettnd c rrect
' - ate •'�l 3 40 T
Signature phone#
Print name
official use only do not write in this area to be completed by city or town official
city or town: parmitNcense,# (Budding Department .
[]Licensing Board
— ❑checkif immediate response is required OSelectmen.'s Office
O$ealth Department
contact person:
phone#; ❑Other
—" (tevaed sept 200)
Information and Instructions,
Massachusetts General Laws cliapter152 section 25 requires all.employers to provide workers' compensation for their.
employees: As quoted from the law'', 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 mgre of
the foregoing engaged in ajoint enferprise, 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 owh.er of a
dwelling house having not more than three apartments and who resides therein, or the.occupant of the dwelling house of
another who employspersons 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 bean employer. :.
MGL chapter 152 section 25 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,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 in the workers'compensation affidavit completely,by checking the box that applies to your situation..Please
supply company narae, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
-of Industrial Accidents for confirmation of insurance coverage. Also�be sure to sign and date the
to the Deparhnent
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 ofI•ndustrial Accidents. Should you have any questions regardii4ihe"law"or if you are
kers.'•co ensation policy, lease call the Deparment at the number listed below.
required to obtain a:wor •., mp P GYP � .
City or Towns .
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 Mi,in the pernat/licens.e number.which will be used as a reference number. The.affi davits.may.be.returned to
inaiq or FAX unless other•arrangements have been made.
the D�eP artrrrent by. ..
The Office of Investigations would like to thank you in advance for you coop eration 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
no of kivesfigaugns
600 Washington Street
Boston,Ma. 02111
fax M (617)727-7749
phone#: (61.7) 727-4900 exL 406
Town of Barnstable
o„ Regulatory Services
13ABtvsznBIX : Thomas F.Geller,Director
MAM
�b 1 .��A Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.harnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Cf Please Print
__DATE: /
q o
JOB LOCATION:_ �/ � C7 �j7�E�—� // % �1/+i✓�J
number street p/ ! village
"HOMEOWNER!':��I ��NN 1 �S��O(� —7�$�
name / home phone# work phone#
CURRENT MA -ING ADDRESS: 33 /3 ee-,t 4 9x S ]�
`e 1*-I rt/6 7a A) /��-SS o Z/ 7 3
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 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.
`25- ?
Signature ofomeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feefor 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
oFtHF,r�,. Town of Barnstable
Regulatory Services
`* BAMMBLE, ' Thomas F.Geiler,Director
Mnss.
039.9�pTE0 MA'S ea Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
I
Permit no.
Date
*34
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT 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
requirements.
���� v
Type of Work: Estimated Cost C.F✓NS�ueT7�aw
Address of Work; If _57,Zz je �
Owner's Name: lc-ctiN
Date of Application:
I hereby certify that:"
Registration is not required for the following reason(s):
i MWork excluded by law
❑Job Under$1,000
❑ ilding not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
Date wner's Namf—
Q:forms:homeaffidav
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LOT 2
A.M. 292-209
S�4 33� � MIT�ctrE�cs
o Q ' LOCUS MAP
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LOT 10 208-91
LOT 3 ASS SSOR'S MAP.- 292-211
A.M. 292-212 :... ZONING: "RB"
A.M. 292-211
10'-10'
SETBACK
AREA=10212�S.F. S.• 20'—
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PLOT PLAN OF LAND
�O k;;; 19;;;;; LOCATED AT
19 DELTA STREET
BLOCK ,,,,,,,,,,,,, �.
�������--���� HYANNIS MA.
PAD
PREPARED FOR.
r MARY E' KENNEY
IN
o Ill SCALE: 1 =20
S�4 3300„ JUL Y 29, 2004
,P,%�AAAAA REV
FEZ s•� REV
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LOT 4 ►
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A.M. 292-212 : tiff, w YANKEE SURVEY CONSULTANTS
I e �q� suF UNIT 1, 40B INDUSTRY ROAD
R O. BOX 265
♦vp��erz�� MARSTONS MILLS, MASS. 02648
TEL• 428—0055 FAX 420—5553
SHEET I OF I JOB '53732 JF