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Home My WebLink About0024 GREENBRIER LANE ........+� �.. j .1 i 5 a oFTME Town 'of Barnstable 116�D 9 FJP�tY o *Pert Regulatory Services " 6 °� fro°' d R�tKA terms s Fee ��e$ Thomas F.Geiler,Director Building Division -A SS PERT Tom Perry,CBO, Building Commissioner JUL 200 Main Street,Hyannis,MA 02601 Office; 508-862-4038 www.town.barnstable.ma us TOWN OF BARNSE TABLE EXPRESS PERMIT APPLICATION - RESIDENTLAL.ONLY508-790-6230 Not Vafid without Red X-Press Imprint _ Map/parcel Number Property Address Q C.n// rl►!� 1 ❑Residential Value of Work 3 Y O Minimum fee of$35. 0 for work under$6000.00 Owner's Name&Address contractor's Name A l Telephone Number_ S Q tome Improvement Contractor License#(if applicable) S :onstruction Supervisor's License#(if applicable) (� ]Workman's Compensation Insurance Chek one: Q Iam a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance surance Company Name orkman's Comp. Policy# Ipy of Insurance Compliance Certificate must accompany each permit. snit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of r000 L7 Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum .44)#of windows *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 Improvement Contractors License required. &Construction Supervisors License is IATURE: j FILESTORMSIbuilding permit formslEY? SS.doc wed 070110 i The Co jnmdn wealth of Massach usetts . Department of. Industrial Accidents i Office of Investigations. 600 Washington Street U. Boston, MA O2I.71 www.mass gov/rliri Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information- Please.Print Legibly Name (Business/Organization/Individztal): M T 1�-eo.� % ��✓•-f fkf/ �[P/t/ Address: 3 ey Nt�ti� City/State/Zip: -Ce.,T-fkt-u� Phone #: 5'Q' Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 2.� employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction , lam a sole proprietor or partner- listed on the attached sheet t ?•. [].Remodeling ship and haver no employees These sub-contractors have S. ❑-Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself.[No workers'comp, c. 152, §](4),and we have no ]2.❑ Roof repairs . insurance required] t employees.[No workers' comp. insurance required,] 13.❑ Other *Any applicant that checks box f 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 they hire outside contractors must submit a new affidavit indicating such owing t #Contractors that check this box must attacbed an additional sheet shhe name of the sub-contractors and their workcrs'comp.policy information. I am.an m ployer that isprovidi q workers'compensaion insurance for my&nployees. Below is informadom the policy and job site Insurance Company Name.- .Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 0� �� h Q.✓ /l1 4,1( City/Statmop 7 ,fj Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Fatfure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition'of criminal penalties of a fine up 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 S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for.insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and tarred 3i nature: Ve1�r�t n i Date 7 el f 'hone#: �Ud" 7 �!`�C to Fo-ffwiZe only. Do not write in this area;to be completed by city or town-ff vial City or Town: - Permit/License# Issuing Authority(circle one): L'Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6. Other L - i Information and Instructions Massachusetts General Laws chapter]52 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an emplayee 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 Iegal 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 I52, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit td operate a.business or,to construct buildings in thi`cou imoh`wealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage 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 with 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-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 LLP does have employees,a policy is Tequired. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confumation�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 Iaw 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 affidavit for you to fill out iii the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill i;i the permit/license number which will be used as a reference number.•In.addition, an applicant- that must submit,n ultiple permit/license applications in any given year, nee&only submit one affdavit.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 must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any,business or commercial venture (i.e, a dog license or permit to burn 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 Commonwealth of Massachusetts na r` Department of Industrial Accidents Office of Investigations' ' 600 Washington Street Boston, MA 0j111 Tel. # 617-727-4900 ext406 or 1-877-MA-SSAFE 17w 4 Ae1'7 '7,3,7 '7-7An ✓/ze �o m��w�zusea//z o�✓�aaaczcl rcaelta Office of Consumer Affairs&B smess Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration::�1;11859 Type: Office of Consumer Affairs and Business Regulation Expiration: 10 Park Plaza-Suite 5170 2/4/2013 DBA Boston,MA 02116 I, MI AEL RENZI tONSTRUCTIOI J. MICHAEL RENZI' 387 PHINNEY'S.LN; a� i( CENTERVILLE,"MA 0263�-r Undersecretary Not val' thout signature ' Massachusetts- Depur-truent of Public Safet, 1 Board of Building Reirulations and Shurdar Construction Supervisor License dti License: Cs 58266 Restricted to: 1 G MICHAEL J RENZI . `§ 387 PHINNEYS LN CENTERVILLE, MA 02632 Expiration: 1/30/2012 ('gnunisvinnc�. _ Tr#: 13520 I r Tawn of Barn-stahle Regulatory Ser-vices BARN rAss P, Thomas F_Geiler,Director Building DivisiOn Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town_b arnstabi e.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete anct Sign This Section If Using A Builder I �1� 0 rA (/ A l.A 9-7\S , as Owner of the subject.property hereby authorize ftA to act on my behalf, in all matters relative to work authorized by this buildrng permit application for. (Address of job) T Signature of Owner D Print Name If Pro erty Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Espires 6 _--- . 0 •�esaMAS�►e Reular ttl• g Fee 9Qj , Deb/ 'ThotnatT]A' hf , ' B D !l Peter F.Dih atteo, Building Commissioner 367 plain Street. Hyannis,MA 02602w ' �'�� Office: 508462=n38 iT Fax: 508-790-6230 DIVISION APR 3 2002 _EXPRESS PERIIIIT APPLICAMN - RESMEEZU4:40 Y Q Not Yalid withow Pad X-FrwImprim I 'NSTABLE lap.parcel Number roperry Address cx-.17 �62��2 4;Lesidenrial Value a SVork wner's Name&Address )nuuctor's Name f/" *_r A4�PW Telephone Number �i'- e if ? 5'f 5me improvement Contractor License (if applicable) /sae 8 instruction Supervisor's License=(if applicable) �Wqt m=,s Compensation Insurance Check one: Q I am a sole'proprietor Q I The Homco%%Mu ( ve Worker's Corns anon Insurance umnce Companv Nime )rkmaa's Comp.Policy mit Request(check box) ❑ Re-roof(stripping old shingles) F Q Re-roof(not stripping- Going over cdsting layers ofroot) Q Re-side' . Replacement Windows. U--Value (ma d==.44) n r ❑ Other(specif-) -Where required: Lssuaace of this permit does not exempt corttpliaaoe with other tom depattr=t regulations.i.e.Historic.Conscm-2tion.::c. t:jtttre rms:eapmtrs:r.�-0106U 1 y; � aH,�p�Ni��?VIP�;/�E=�l'!1�°N,`rT�CO�,N�•�IA�CT '`� ` - LA � �r. `� fome,spot Ht H, � x ? s .f3 "i GALL�. 1 i 1 - I oFTMEr The Town of Barnstable do Department of Health, Safety and Environmental Services NAM Building Division �pr*6 359�p10� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration ��(� Date: Name: L UG Phone#: /7 yLy Address: Village: Type of Business: ; y Map/Lot: �� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess Of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: 1_� Date: Homeoc.doc ��•'"` • `, TO OF BAR,NSTABLE ' . I Permit No. 9 e Building Inspector sAWxucN Cash OCCPAN.CY PERMIT '+ . Bona U- 'No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be,occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Greenbrier Dev . Corp, Address Box-510, Centerville l nt; .1 Z ?4 CrpPnhrt Pr i-n,nP Gvr fit Hvann Wiring Inspector ell, '� � Inspection date/ Plumbing Inspector !�+ 1 Inspection date, �. �-.spa. t� Gas Inspectorvre J Inspection date e *f 4 k-- "r/9 Engineering Department - — l �r ff � /ri Inspection date `l THIS PERMIT,WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE,BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. /40 Building Inspectors. v - i