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Home My WebLink About0091 ELDRIDGE AVENUEpr'ql E l c@ . �d�e Ave , "Town of Barnstable *Permit Imo__S(00 Expires 6 months fr issue date Regulatory Services , �"` � sARN9TABI.E,fr � � atru►es �� 11 0 3 ?� "'++ Richard V. Scali,Director .ergo ,t, Building Division 8tkTom 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 j . Pr�perry Address 6 L a R 110 G 87 '(�V6 h}YAN4 Is , M A - 0.2 6 0 1 Residential Value of Work$ S,SOO- ®a Minimum fee of$35.00 for work under$6000.00 wn Oer's Name&Address 5:A:N A I N A. N O G tJ LT t li A CONNLrMAR4�-, c\tiC� i; �YANt�I\S- MA 11601 Contractor's Name Telephone Number Home Improvement Contractor Licens i e#(if applicable). Email: Construction Supervisor's License#(if applicable) [nWor-kman's_Compensation Insurance Check one: , ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side fi[1 Replacement Windows/doors/sliders.U-Value ;_Jo (maximum.32)#ofwindows 1 1 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. ere'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 of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGhIATL-T�" a T- - QAWPFILESTORM b g pe it forms\EXPRESS.doc. Revised 040215 . The Commmr"eatith of Massachusetts D4mrhnmt of 1ndmshia1 Acride►as Of we ofln hgations rh r 600 WamUng1`on,Sweet Boston,MA 02111 rr ma�mgov/a Workers'-Compensation Insurance Affidavit:Bu[iltiers/Comtrachn-JElectric ans/Pbumbers Applicant Infarmation Please Print Lbly Name, 1):�aarct Y-)Q NOrve.cc Address : CrtyJSta�IZrp_ Cc r 0 Phone#: 50 8 Are you an employer? eck the appropriate.boa: 1.❑ I am a with '1 4. 0'I am contractor and I Type of project(seguired}: employer * have hired the said-coa�ctoas 6. ❑New construction employees(full an&or pact-time_ 2.❑ I am.a sole pmpcietar or partner- . fLsted on the attached sheet. 7- ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition employees and have wadcers' A wodcing fiat me in any capacity., 9. ❑Building addition [No worloers'Comp.insanance comp.insurance.Y d_] 5- ❑ We are a Corporation and its 10-❑Electrical repairs or additions ,3' I sal a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions � myself[No vA rkers'Comp- sib of exemption per MGL 12❑roof r4mirs invmnnce r' ]T c.152, §1(4� and we have no employvees-[No workers' 13.❑Other comp_insurance regviced.j •Any epphcsnt drat cbeeks bax#1 maze also Sul o u the section blow showing fludr wmkeW compensedw polky inimmatim T F€a®eoaraers who submit this affidasdt indbommg trey age doing ail work and then hue oaf conuactats mast submit a new affidavit indicating mdL 0 5 that check.this boo must attached am additim sheet awwh g the name of the sub-co :s and state whether cant hom eatuBes bsm emplayees. Iftbesab{oattacmasbaveeniployees,iteyan, pmvidethik war}rrs'comp.pnlicymmiber. Zany an emph-o,er that isproi*hkg nrorkers'congmisaiion'inmrance for my empiel-ees. Belowis the policy atmd job sate infmwalioat. Insurance Company Name: Policy#or Self-ins-Uc.4. Expiration Date: Job Site Address: tate/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 tD$1,500-00 muVor ogre-year imprisonmerd,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the-violator- Be advised drat a copy of this statement may be forwarded to the Office of Investiigations of IA fors insurance coverage verification. I do hersdry� ider the pains and penalties of perjury that the infoi oration pros ided abmw is true and correct Date: 3 I I S Official use only. Do not write in this area,to be completed by city or town ofciat City or Town: PermitfLicense g Issuing Authority(circle one): 1.Board of Health Built$ag Department 3.C itylrown.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:- Phone It: - 6 Town of Barnstable Regulatory Services of rOiyti Richard V.Scali,Director -Building Division BARNMBM ' Tom Perry,Building Commissioner v MAE& �p 1639. �� 200 Main Street, Hyannis,MA 02601 lED MP'1� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508.790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print ' JOB LOCATION: . 1 I 1 DG6 AJ4'" lu IS MA - oa LOl 3,jRA1 S7kl t3C 6 r number sireet village "HOMEOWNER": c'A nl A 1 N A NO G U C I R IA - SOIL - 8►S' -9 Af 3 X name home phone# work phone# CURRENT MAILING ADDRESS: 9 3 C O{4 m Cr/'!A RA C 1 ItC k 6- 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 buildingpermit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. r x 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: Tbree-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,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 personas 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\FORMS\building permit forms\EXPRESS.doc Revised 040215 saxxsTnsIX MAM Town of Barnstable �A�EO MA'S s Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 040215 Assessor's map and lot number ................ ......................... . 15E � 1P1 COMPLIAK .........................Sewa a Permit number .................. WITH ARTICLE 11 STATE D . QyofTNET,�y TOWN OF -BARN '.. 1ARNSTABLE, i "6 BUILDING INSPECTOR o 101 V APPLICATIONFOR PERMIT TO ... .... ..................................................................................... TYPEOF CONSTRUCTION .....� '�� '`...::..... ................................................................................ ...`.: Ze...... ....s�....................19 y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for as�ppe/err'miit/t according to the following/information: Location ... ProposedUse ..... .......:4-P.voilz ..� ��' .................................../. ..................................... Zoning District ....... �....................................................Fire District ...... ....... ... ....................................... Name of Owner � �F`.lYl = Address �� ..................................... .. .,� ./ .. .............�:... �� .. /�' r Name of Builder �! Address f .............................................................. '...............�............. •j• Nameof Architect ...................................................................Address ................:................................................................... oo Number of Rooms ..... [�................................................Foundation ��..... Exterior .�, . : � .............................Roofing .:.... j........................................................ .. .... . � . A J-.�iG C' Floors.f. /C . t. ..?............................Interior • GLa� Heating ........ ............................................Plumbing ...... ....................................................................... Fireplace .............. :.............................................................Approximate Cost ......�a.....2-j. ............................ . . ............ Definitive Plan Approved by Planning Boar -- ------19--?:!�— Area .... 1P....��-. ................ Diagram of Lot and Building with Dimensions Fee �0. SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 ' I lie Ye) ` _ Z..S� 91 , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .�. �.F r... ...` ��. lbacey, William E. Jr. 17141 one story, No.---.--. Permit for .................................... . . fam1 dnwalling */^ ---,-------~------.,.------- Location --_�� .�va�_________ ----.—_—.��------------- Owner .----William E. Jr. ---------------~— frame Type of Construction -------------- ----.- ^ � .^--- ------------..----. Plot ............................ Lot .......�34______--� . Permit G,ono*6 `' ` — y . . \ Date of Inspection � ...�!/.,��~=°—°, ' | Date Completed 1. �19 PERMIT REFUSED - ^—'---~—''~--'' —'. ' lA ^ � ' � ------`' k ' ,,___._____.____,____. —.------ . ' ....----...--.--.—.—.,------.--.. / ` ' ~---~—'--^------~^^—^^^—'----- ' ---------^^—,.---.--.^~—.-----. . ' . . . . . . , . . Approved ................................................ lg \ ' ' � --...----.--------.----------. | � -------`---.---------.—..--... ` ` , " Assessor's map and lot number ..�.!.a....�.......�.`.... REM BE YSTM z IN co s Yr PLI Sewage Permit number ................... .......... .. ...... t{N A § IfiARY n stATE f < 00 QyofTMEro�` TOWN OF BAni g ». f U�F�a EqA'�; •1^ `.+`� `� -,� � � �a" ,ice . APPLICATION FOR PERMIT:TO ...� /�` `` . as'' TYPE OF CONSTRUCTION ... h'- ......`?� /'h '1 `.. ......... y j . . . = yea e r. r .. ge`. .. �:. ..19 `... TO THE INSPECTOR OF BUILDINGS: he undersigned hereby a lies for a' ermit according to the followin information: � 9 Y PP � P 9 9 Location . ��./.. . /t(. . :�: ..... .j1:....... . .... ...rt. ll« ....... Proposed Use .......�,l( / `:,e.. ..... ....7 ..<f��„�C.�` f�./4 .................................. .61 . r ., Zoning District .... �'. -'C' .... . .Fire District ...ff_-y--fi ................................. ... .... r Name of Owner Gt.:�O.f.4l..... :�.. / .., ..Address ..�.. .... `f...... ..' t !.......................... ; Name of Builder .....r!.... . !............ �f .................Address ............................................................. . . ....... ........ Name of Architect .:...:.. ....:...`............`..........Address . , a uY Number of Rooms ....... ....:: .......................................Foundation ��. , � .�. '-x_. .. { .Mf ior . . , .................. Exle 5 ?.° .... ................... .... Floors ...Y ....... ...e . y.....:..............Interior 4 J Z+a ............. js Heating � ........ l '.'"'•.••• ". . . ........ ......... Plumbing ...... .................................... ' Fireplace ........ .....�/ . ..... .Approximate Cost ......: /:: .^ ......... ................. ........ . .................. .C. Definitive Plan Approved by Planning Board ��+- - - - 9 7 L Area ... ?./..IP... .... .:..:...... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF 'BOARD OF HEALTH a f 10 W. IL . ,.� Al 1..5 * y 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �G . ..e�.t... .... .f:... ..................... t- f .. . ._ .. Dacey, William E. Jr. a 962_ 0� / r Permit #17141 June 12, 1974 Build one story frame.+dwelling al/ �'id►-�d � �� I x rs 1 it EL Df' fp� 3 f FA pi LOT � a i h 1 S y \' 1 1• +, `. �� 'i!�Wr "I" 5"m i a � f ` as .q/Y3riM1" S'IC.4..E: '4 -3 DATE WE F.C"A E N C E 69//1(7 4 cp r 7. . —oii ell Y ��I r AYE + I4, CSE8Y CERTIFY THAT THE B U I L D I G REG.. LAND 5UR.. VE _ a� ' 0V"�tN O• Pad . TH (S PLAN IS L0CATED 10. N ,,t~G GROUND AS SHOWN HEREON AND i` H. A.T { f D 471 S C•,'O N F 0 R M T O T WE ' O,'NING BY — LA.WS OF, 'THE TOWN OR. ' , 1 �t� ofi>�>`gr , ls TA W H E M C O N S T.R U C T E D. V N STAB L E SURVEY C O N S U L.:T.A N T 5,A I N C�r 1 t , WEST Y r S «"� •� nr , �. RMOUT@4rAAAS G1nY4"F'nt7'tB6R{Aaft�.�S�,J n +.aur".�"t