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Home My WebLink About0140 DUNN'S POND ROAD s_ I tnginq'ering Dept. (3rd floor) Map :0 Parcel 012 Permit# a?aZ 3 3 House# Date Issued J/ v Board of Health(3rd floory(8:15 -9:30/--90--4�30) 9� �2-9 0� Fee ? '�S',00 .C t:,A4"w� Conservation Office(4th floor)(8:30- 9:30/1:00-2`:00) EIUA4na TlP m 1 Ft1iE SEPTIC S ST BE 19 INSTA ,E IAN9CE Wi TOWN OF BARNSTABLENVORONME O®E AND Building Permit Application TOWN REGULATIONS roject t et Address y l� ��_,,�,, ,r, ,r�� lJ. L�7fQ- Vil age Owner Cc--cis u ti r_ L vLt�4��CZS't Address 1 yc3 ��r�tct rs Pt—,�J 12� Telephone --> - y Permit Request G -Yu�-� 1 p' 2-0' X 1 Ll First Floor (p_ CC3c. square feet Second Floor square feet Construction Type Estimated Project Cost $ 1 Zoning.District Flood Plain Water Protection Lot Size L!--:::z Grandfathered ❑Yes ❑No Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure I" Historic House ❑Yes "o On Old King's Highway ❑Yes A�LNo Basement Type: oft Full ❑Crawl, ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ob -- j oOp Number of Baths: Full: Existing�_ New Half: Existing New No. of Bedrooms: Existing --'I. New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: AGas ❑Oil ❑Electric ❑Other Central Air ❑Yes allo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No G;rage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) M,None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# 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 .L,j— `7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 'h i FOR OFFICIAL USE ONLY �s VFj r PERMIT NO. i DATE ISSUED _T ;'{ • - MAP/PARCEL NO. ADDRESS VILLAGE , OWNER 4 y DATE OF INSPECTION:. FOUNDATION f 1 FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - s» PLUMBING: R( i7H FINAL GAS: RIH ^ FINAL _ - ^s [M FINAL BUILDING _ �F x lJ DATE CLOSED OUT'", f ASSOCIATION PLAN;tI ` The Town of Barnstable Department of Health Safety and Environmental Services fo Building Division 367 Main Street,Hyannis MA 02601 f Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissions For,office use only ; Permit no. Date 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. �ype of Work: C�:�.�� Fc Est. Cost rOQ . Oa `/Address of Work: t4cj PyMkir.=k c Al A- Owner's Name ca9-1 r':r.jE Date of Permit Application: LI - P7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building 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 MOROVEMENT 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 The Commonwealth of.1 fassac h usetts a~iJ Department of Industrial Accidents `�. 8=9&1,7F9S/gat/offs •�.� i i w 600 N'a.vNit;;t��t Street ti+. .. Z. • ': Boston. A1ass. f12111 ` Workers' Compensation Insurance Affidavit dpphc•tnt tnformatian• Please PRINT Ie�Ui j� IrXnarnc: Cmz,r-tj a- L%j cAw-, %-j fx.--o— a Z. C t i 1 am a homeowner performing all work myself. l am a sole proprietor and have no one working_ in any capacity •y...�.�:9.r.s...�s 1[r[T�'+ '"1.7!!n+;..X.`.....►,+w..iwnl.;�w��r.+. �w► •wu.w'y..'w'..... +.�..+.w...—.�..w.+..._....--...... [I I am an eniplover providing workers' compensation for.my employees working on this job. cnntnan• name: address• city: Ithonc#• insurance co. , Win.9 [� 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: comnanv natne: ndtires5• cin nhone##• insurance co. nniiev 9 cmmnnnc name: adtlress• rite- phone##• insurance co. a F::iiurc to _ :''^: `" - __rAttach additianal sheet ifnc sy eea ^ % ^ ". secure coveraecas required under Section 35A of 111GL 152 can lead to the imposition of criminal penalties of a line upto S1.500.110 andiur one%cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement mac be forwarded to the Office of investigations of the DIA for coverage verification. J o berehr certift•under the pains and penal ies olperjun•that the information prodd7aba is true and correct Si_nature � Date �—� �-7 Print name [ 'off\N ti t= ��:c �-1V T Phone .r�.r�.rcrr — w officini use unit' do not write in this area.to be completed.by city or town official city or town: permit/license it t'tfluilding Department Licensing Board 0 check if imtnediate response is required selectmen's Office C3I1calth Department contact person: phone tt: mother�_ r TKT information and Instructions ' Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for the:* employees. As quoted from the -law-. an emplimee is dcfincd as every person in the service of another under an,., contract or hire. express or implied. oral or written. An entplt rer is defined as an individual, partnership, association. corporation or other legal entity•• or any two or more the forcuoing cnLagcd in a Joint enterprise. and including the le-al representatives of a deceased employer, or the receiver or tntstee of an individual • partnership. association or other legal entity, employing employees. However the owner of a dwelling, house haying 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 dweliing hoc or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer MGL chapter 15? section 's also states that even 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 commoni•ealth 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 11 been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying, company names. address and phone numbers as all affidavits 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 cite 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. City or 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. Plea be sure to ftli in the permit/license number which will be used as a reference number. The affidavits may be returned t� the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question: 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. 021I1 fax #: (617) 727-7749 phone >r: (617) 727-4900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION P ;ease print. DATE L[ OB. LOCATION Number Street address Section of town HOMEOWNER" Cv9--%N 1-3 C, L vS Name Home phone Work phone fir• PRESENT MAILING ADDRESS lti.o �vn ,• s �c�,,, � MIN 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, 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 OfficiE on a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes , responsibility for compliance with the Sta Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements Zan xthat he/she will comply with said procedures and requirements. OMEOWNER'S SIGNATURE __ APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER' S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction. Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ' Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/bier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the la--t page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. STr�i• Iu I _ La I ,.._ + 1 1 1y 6 At O 111 ln Z d {�AtL.1M ;W-s Z'1C(r1+jItf . cM �� $ Gt.� 4xf �S U - earl &A "o-5 777 •Z�r t s.` --� ► �,�.� �'.� `� Vic. K.� �--� � C I ' I i 4 t •-� �� -`ram.N�.E2 N��.j ., OP lob Ll Li cl Nww E i t '.:.,.. r h o, UNRSGISTI AND LAND MJ1 NMM! 93920 0M sROR P.tGBr A7TORiVb'Y;BARON k HINE5. P.C. PW Boa 1.d;NDB) GMAC MORTGAGE CQB_ ORA110N OF PA FLM PU1I13M of oym.ELLEN A, TERRIL REGISTERED LAND APPUCA1. ORR)NE LUCKNURR =01UMON BOOK., PAM bA7CE 0 22 6 8CAM CERTa'YCA78 OF MUI 51752 FLOOD HAZARD INFORMATION pW 1n1m& 1(614 E„- WS); 30, FMOD-W cc> 11Ipm NO.! 250001 - MN$:C ASSESSORS YAP PAP U 09.95C DAnZI; A S/85 Ilwm._ .._ PABCBG: ..� ,MORTGAGE INSPECTION PLAN 140 D UNN'S POND ROAD, B.ARNSTABLE, MA LOT D 100.00 LOT 30 `a •UD I .� LOT 31 + LOT 29 it ' 7 100.OU DU1V,117'S POND ROAD. MORTGAGE„UNDER- . USE ONLY THIS IS THE RI SULT OF TAPE MEASUREMENT, NOT THE RESULT DFSn OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE AUPJE1i1tt7 INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER 130 WEST STREET, WALPOLE, MA 02081 THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED TEL.:(800)287-8900 FAX.,.(308)fiW4512 DEED OR ENCROACHMENTS WITH RESPECT To BUILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN, THE- LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN OF A SPECIAL FLOOD HAZARD ZONE. MARIO DOMINIC � THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER MANDANICI WAS IN COMPLIANCE WITH THE LOCAL ZONING BY—LAWS IN No. 18841 EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL Cr91E SETBACK REQUIREMENTS ONLY). OR IS EXEMPT FROM VIOLATION L� ENFORCEMENT AC71ON UNDER MASS. G.L. TITLE VII. CHAPTER 40A, . SECTION 7. GENERAL N071 S. (1) The declarations made above are on the basls of my knowledge, Information, and belief as the result of a mortgage inspection tape survey made to the nonnal standard of care of registered land surveyors practicing In Massachusetts. (2) Declarations are made to the above named client only as of this data (3) This plan was not made for recording purposes, for use In preporing deed deaerlptlana or for conatructlons, (4) Veiflcations of property line dimensions, bulldbng offsets, fences, or lot ewfiguration may be accomplished only by an accurate Instrument survey, Po ml) { I .,r f a� p 3 x� � r jai Ai ol E< x` {j r • p r a a 1 s 12/171 Q } __ �e ,r. S � s l; Mom• Y � v , '41k 1, �� —___ ��Z 7��S ._ �"��; �"' £`-.`��'•.�..,a•rs�' �„ Y'.;k ��"* f P a 1� ,P�� 4'a " *v,,�iw+. T , r p � �. 46- d 77 i s o p z ..k