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HomeMy WebLinkAbout0095 ESTEY AVENUE °I� ��`t�W A�� - - - - - - � - - � :w OFTHE ram, Town of Barnstable *Permit# Expires 6 111011ths from issue date y Regulatory Services Fee + BARMASS. E, n 9�p 639. Thomas F. Geller, Director ATFb MA'S A 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 Intprint Map/parcel Number Property Address fS7� A u�< Residential Value of Work 411, Minimum fee of$25.00 for work under$6000.00 Owner's Name $c Address �a��� P0mR Contractor's Name DI L+ yy 7J Telephone Number I Ionic Improvement Contractor License#(if applicable) jl � Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance IT Chec ne: Fam a sole proprietor MAY 2 9 Z009 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTAE3L 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 U ! �46UI-tf &`T tb i'VL(, ❑ Re-roof(not stripping. Going over existing layers of roof) [IRe-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 of Permission. A copy of the Home ►mprovem nt Contractors License is required. SIGNATUIZE: Q.`"Pl-IIISTORMS\huilding permit forms\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Leeibl-Y Name(Business/Organization/Individual): , -Address: City/State/Zip:�� 1,np �5 f�o Phone.#: Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. Wam a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors 2:Q I am a sole proprietor or partner-' listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have g• Q Demolition workingfor me in an capacity. employees and have workers' Y P h'• $ 9. ❑Building addition [No workers'--comp.-insurance comp. insurance. required_] 5. Q We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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.Q 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. 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 employers,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.M 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 crimiriail penalties of a fint;tip 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. I do hereby certify der the pains and p n ties of perjury that the information provided above is true and correct 12 Si tore: Date: Phone#• J�V— — Official use.only. Do not write in this area,to be completed by city or town offu:iaL City or Town: Permit/License# F Issuing Authority.(circle one): 1.Board of Health-2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 'I . - r 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 - -- ofthe foregoing engag m morn enfe - ierpie ,o -he - rp -5-d`mgthe legal-represehmd��5ndeeas y - =- -- 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 sliall 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 ' evidence of com pliance liance with the insurance coverage required." applicant who has not rr�luce�-acceptableyr r L M 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 with the insurn-nce 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 UP 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 aiuuaVlt for yfivut uh $ eltthvfu t^�^VtL to ii a t % ri e u 3 -- __ t•rnt�reoarrttile.ar tile.apc—`- nlirst. J" Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 maybe 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 fo 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. # 617-727-49-00 ext-406 or 1-977-MASSAFE Fax# 617-727-774•9 Revised 11-22-06 www.mass.gov/dia oFt"ETo�,ti Town of Barnstable Regulatory Services 9BAJM ARS.i E iV , Thomas F.Geller,Director °TEpµlda 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,-EO►Z6-V, pop-rEg , as Owner of the subject property hereby authorize - rU F— W C 8 3 to act on my behalf, in all matters relative to work authorized by this building permit application for. Lts (Addre s of Job) S lure of er Da Print Name t If Property Owner is applying for permit please complete the Homeo-wners License Exemption Form on the reverse side. Q:FORMS:DWNERPERMISSION Town. of Barnstable IHE Regulatory Services BA.RNSrAsi•..e. ; Thomas F.Geiler,Director 'MA-9& 163¢. .`eg Building Division prFD Tom Perry,Building Commissioner _----- ...._._......-....200 Mait-Street,—Hyannis;MA 026-01. ,%,".town.b arnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOI17EOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption far"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 HOMEON'VNER 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 strictures. 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 be/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 Barustablq 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 rcquirod 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 ad as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsrbilities 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 msponsnbilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the=ponsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can t amend and adopt such a fomn/certifncation for use in your community. Q:forms:homccxcmpt �fVllyR.. KERS'CQMPsENSATION A D 'EIyIPL0YERS'LpABIL TY tNSURi4NCEP��ICY F>„,€.' k ..E;j cv � InforrnationPa O©QO D1, Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number' WCV00730202 1. INSURED: Prior Policy Number: WCV00730201 Tyndall Roofing, LLC Producer: 30 Jillian's Way Fredericks In Agency Marston Mills, MA 02648 Federal ID Number:204616445 Inc. Risk ID Number: 1046 Main Street Osterville, MA 02655 Business Type: Limited Liability SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/11/2008 To 7/11/2009 12:01 A.M. Standard Time at The Insured Mailing AddrE 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states li here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of ou liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states,if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100,of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment: Annually Estimated Premium (Minimum Premium) $500 Servicing Office: 25 New Chardon Street Boston, MA 02114-4721 Issue Date 07/01/2008 a Countersigned By: Date Copyright 1987 National Council on Compensation Insurance Forrr on and Standards License or registration valid for individul use only Board of 1uilding Rega before the expiration date. If found ret�:rn o: i H0;,1E IMPROVFP IENT CONTRA.CTOR Board of Building Regulations and Standards ��1 • Registration 119766 One Ashburton Place Rm 1301 Expii-ati66.-61128/2009 Tr# 132550 Boston,Ma.02108 WEBB CRAFT DESIGN �� + � ; DAVID WEBB _ � g 17 ACADEMY LN <, ,._�:, /i t Not valid without signature FAi,MOUTH,MA 02546 -�� p; ministrator Massachusetts- Department of Public Safeh Board of BuildinU ,r_ Re�sul<itions:and Standards Construc'ti64 Supervisor License .aul.,6dense: CS 46189 Rogricted to 00 DAVID H WEBB 17 ACADEMY-LN K# FALMOUTH, MA 02540 Expiration: 10/29/2010 ('ommissiuner E Tr#: 5826 -n - qSEP y I . -.'-. :. .. SEPTIC SYSTEM• MUST g -• Assessor's map and lot. number ... .. . . . ... � .._, 7/y_ ale'. 7-11- // /®- f K IN-STALLED IN COMPLIANCE . _ W" ARTICLE II STATE ice} �°l • Sewage Permit number ..................:................ SANITARY CODE REGULATIONS. ANp. TOWN .. s1 P�OF7NET0�0 TOWN. OF BAR.NSTABLE �. BAHB9TODLE; i y MAe6 a0 . : DU [ DNG IN PET R nw � C t ' APPLICATION FOR'PERMIT PTO S(.�✓.................................�1e�CXV 7 ' 'S�`'C1C�le TYPE OF CONSTRUCTION � .".!4.`.?�.� .................. .. ................................................ ... ..... _ r..... ..................... .................. ............................................. .............. ............. ..........19........ -TO THE INSPECTOR OF BUILDINGS: - - The undersigned hereby applies for a permit according to the following information: fLz S may/ Location ................................... ........� ........... � f!+' .. ProposedUse ......Z6�'P.ELzf�....................... ........................................................:................................................................... Zoning District .......... ......Fire District........ . . ..... Name of Owner P � .� ��C� . � l.� Address ......... .............. .�U... -S Nameof Builder ......X&�W.................................................Address .................................................................................... Name of Architect tieWE.....................................Address .................................................................................... .... Number of Rooms ...............� .........................................Foundation .....�GI&7N................................................. Exterior ............ ..... .. `t. .......................................................Roofing ... ,5. . il.. :................. ...... '............................. 14 PV Floors d............................................:.........:..Interior ....... .. .. .. ..... .........Heating 4.1..... //.........Plumbing .................................................................................. Firepp `—S. ..Approximate Cost ...z -2-� ODc� lace ................... ............................................... ..................................:. ........... Definitive Plan Approved by Planning Board ________________________________19______-_- Area ...... . .....16.2—b Diagram of Lot and Building with Dimensions Fee ou SUBJECT TO APPROVAL OF BOARD OF HEALTH 7-4 (9d - r S hereby agree to conform to all the Rules and Regulations of the wn of Barnsta le rega ing the above construction. Name .................................................................... Porter., George W. 1 No .............9740.... 'Permit for A4.4.'.U..Preseut....... Structure .............................................................................. Location ........................ Ave................. .........................................Hyjo=is....................... Owner ... Par tex..............v............ Type of Construction ........Wood......................... ................................................................................ Plot ............................ Lot ......M 324....L 2 ........... .......... Permit Granted ....November....... '1977 Date of Inspection A,1&7- Date Completed .......... 47:,-1../.....19 PERMIT REFUSED ..... 19 ....................................... .................. ...................................................... ........ ..... .................. .................................................... Approvea ................................................ 19 ............................................................................... ............................................................................. Assessor's map and lot number Sewage Permit number .......................................................... TNETO�yo� TOWN OF BARNSTABLE H9HH9TODLE, i Mb 9 BUILDING INSPECTOR t_ APPLICATION FOR PERMIT TO .....AdJ..................r........................45............................................................................... ' TYPE OF CONSTRUCTION �da ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 0� �S rt-y � �7Ulr6(/i�/�S ................................................................................:...................................................................................................... � f Proposed Use ...... C'�.. � Cz dt1Tl.�.: - .................................................................................................. ZoningDistrict .... ...........................................................Fire District .............................................................................. Name of Owner �? !fin � � '��'c !��...' �JYAddress 9<— /.+V �d fV/f// S ..................................................... ....................... Nameof Builder`M/ ..........................................................Address .........................................................`......................... 416- Nameof Architect ............N.`� ...........................................Address .................................................................................... Number of Rooms .........(....�W�......................................Foundation .........C_1�,�,c,N..�............................................. Exlerior (4.1nor).......................................................Roofing �'h // � �A"i;7 Floors ............ ..........................................................Interior ........ _;j. v.......�/�l,t-/.:!........................ Heating7r7ri W 119 a.............................Plumbing .................................................................................. I �- l Fireplace ...................1.�L:..` ..................................................Approximate Cost ... z .--2�,,OO..........................:........... � . 0 Definitive Plan Approved by Planning Board ________________________________19________, Area ..... is /b�� ....... Diagram of Lot and Building with Dimensions Fee :............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH �34 r-2- " let S Z" J I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ..... (�� ...................................................... '7- Porter, George W. `r :. 19740 Add'n resent No ................. Permit for ...................P................ Structure f p Location ......9.5`"Es tey Ave............................... ......HYARni s.......................... Owner ...... .......Y.............. Type of Construction .........WQ.Qd........................ ................................................................................ Plot ........ Lot .....!..324._..L 2 Permit Granted .................November:..109 77 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ......................................................... . 19 61 ze . ................................................................................ .............................................................................. Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's ma and lot number3/p THE 7�- Sewage Permit number ..... /, `. ... !l�Gf g .. SEPTIC SYSTEM M 7 _ / INSTALLED IN COM LE, i House number T s Mnea 00 i639 `00 ENVIRONMENTAL CO TOWN OF BARNSTATE RGULATIONS BUILDING INSPECTOR SUBJECT TO APPROVAL. 01 �� BARNSTABLE CONSERVATION COMMISSION A.=APPLICATION FOR PERMIT TO ................. ........... .n........................................................................ TYPEOF CONSTRUCTION ..................................................................................................................................... S g ........... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............�J...�.......... f ...... ... .. ... ....................... ........ ................................................................. Proposed Use ...� 1914...... .. A.4yA....77'� C I.� .... .. : ...../Clio .'....... .............................................. Zoning District .".....................P.f�° .....Fire District Name of Owner Gw.s...W. ...... ?:1f:.j:'P..r .................Address .................................................................................... e Name of Builder ........!...........................................................Address .Name of Architect ..................................................................Address .................................................................................... Numberof Rooms ................../............................................Foundation ........ .... ........... ................................................ �� -�-' Exterior ..................... ..............................................................Roofing .......... .... .. . ....:......................................... Floors ...... �i� .....Interior ✓�� .......&.............................................. Heating r .Plumbing Fireplace ..................................................................................Approximate Cost ........ d. .............. Definitive Plan Approved by Planning Board.____________------__-----------19 . Area ......C�.. L.. . . ............... Diagram of Lot and Building with Dimensions Fee 1 J` SUBJECT TO APPROVAL OF BOARD OF HEALTH J �Xc;�� I hereby agree to conform to all the Rules and Regulations of the n of Barnst le r rding the above construction. Name .. ....................................................... ............. r Porter, Geroge W. No 218 2..... Permit for ....Add...ta..draelliag 4 ........................................................................... I Location ....... S:tey...A.va.............................. ....................Hxnzs............................................ I Owner ...........GQ.Qrge..W.,..Part r.................... Type of Construction ...........fraraa.................... / Plot ........................ Lot . ........ ii Permit Granted .................. ov:•:•.13,19 79 3 Date of Inspection Z 9 S� Date Completed ... `:—,�. .. PERMIT REFUSED' t A• ....... ....... ..................................... 19 M ''. n20.4 ...... ......fl ........................... r �. €...... .................. { �} t Appr . . ::........... 19 ....................... ..................................................... i 1 Assessor's map and lot number ,y...... C�, I!......• 3/ 7s J �pf THE tp� f Sewage Permit number J • • " Z 33ASH9TADLE, i House number ........................................................................ so rase O 1639 eP0 0 TOWN OF BARNSTABLE BUILDING INSPECTOR • APPLICATION FOR PERMIT TO ...............! .... r. l` TYPE OF CONSTRUCTION ........................ ............ ..........19/., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... ..... al.... T. ! ........................... ....................:......... '. •izx. ;° ...!i a!° lAXY1 7!t... � C.? ..:r ... .................................... iProposed Use .... ... ...... , ... � �. .................... .......................... Zoning District .........................Fire District .........:....:. ........................................................... Name of Owner 'ors r...( ..... ?0.1771:eT"..................Address .................... ............................................................ Nameof Builder ..... ...........................,.................................Address .................................................................................... s Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .................Foundation � � :................................. ............................................................................... 4e-, Exterior ................. ....................................................Roofing .......... ,. ............................................... Floors ......(.,...........�...................................................................Interior ....... .........._......,....._...... ............................. t, > Heating ..................................................................................Plumbing ......... 1....................................................... Fireplace ................................................ gp� p ..................................Approximate�Cost .........s.�.. .�,, �.................................. Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area ...... ?.. ................ Diagram of Lot and Building with Dimensions Fee .. SUBJECT TO APPROVAL .OF BOARD OF HEALTH Cr7 i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regprding the above construction. Name .......r .:.................................................................... - � Porter, George W. , . - ^ . 21822 ^ Add to ' No -----.. Permit for ---�--..�������pg --------------------------. ' Location 9.5. ..���^------------. --�YAD{aia!------------------. _ . - . � � Type or Construction � ""' Nov. 13 0 Permit" " °"" Date Completed /ted ........................................19 --. /PPERMIT REFUSED EI.. —. 19 --. —.° .. V ..��.^°-------- , ' u \ � ` / --'' ---'^��' —'Y—'Y--................................ ...'...'. ................,................................................'' , ........................'...........................,,.....................'. . ` Approved ---------------- lQ \ --------------------------' -----------.--------..—.---..