The URL can be used to link to this page

Home My WebLink About0054 GROUSE LANE sy ��__ ,\ _ - --- , J r Town-of-Barnstable *Permit.-# Zf�� Expires 6 months�from issuete da— O+" J �4 Regulatory Services e aaxtaSTABLE, : '" Thomas F.Geiler,Director 1639 �o ®� Building Division FDiN1A`'l Q9 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 ® Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1, Not Valid without Red X-Press Imprint Map/parcel Number 61 b r�J T eLl Property Address Ro ILL W, /]'"�J7✓v�� (Residential Value of Work 6000, Minimum fee of$25.00 for work under.$6000.00 Owner's Name&Address R06ER. AWMSOA) 1 3�3 w1"6[ t AlAimoi M Contractor's Name OAAK VOIL OK Telephone Number Home Improvement Contractor License#(if applicable) (7�JTJr�j ❑Workman's Compensation Insurance Vk one: 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 be on file. Permit Request(check box) _ ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-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 Improvement Contractors License is required. SIGNATURE: t� �►IW! GAL Q\WPFILESTORNI building permit forms\EXPRESS.doc Revise020108 u attods a n tandar s . our of i1 mg e g P ° :Construction Supervisor License License: CS 47667 Trek 2893 ' { ;"` tip, Expiration 9/112009 1i� � S PHILLIP M VOLLMER � � i t ' PO BOX 64 \t Commissioner COTUIT,MA 02635 xt HOME IMPROVEMENT CONTRACTOR, , Registration: 109558 Tr# 273897 Expiration: 9/21/2010 Type; Iridiuidual MARK VOLLMER i — MARK VOLLMERk Y� i 1455 SANTUIT NEW(pWN RDj% Administrator COTUIT,MA02635 4e � i�� e toar of ui mg egu aho s an tan ards onstruction Supervisor License License,:. CS 47667 1 Expirati4�n _9/1/2009 Tr# 2893 Restriction_ t PHILLIP M V0LLMER zl ,;. PO BOX 64 COTUIT,MA 02635 Commissioner i. . k �— t; or registration valid for individul use oonly License n before the expiration date. If found retu r Board of Building Regulations and Standards i ne Ashburton Place Rm 1301 O .02108 s Boston;Ma yy9 {yam Not valid without signature Y34 A / F �i i �1i i LY R 1, �L V. - ' '�,��'�- �•a.fix�'. �tT�ti Town of Barnstable Regulatory Services yMAE&BI Thomas F.Geiler,Director o a 16 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 ABuilder i L , 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) S� e of er Date Ro Print Nakne If Property Owner is applying for pen-nit please complete the. Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of Barnstable ' tt+r: Regulatory Services Thomas F.Geiler,Director MASS . .�� Building Division plEO►AA'l� Tom Perry,Bnilding Commissioner -200 Main--Street;Hyannis;MA 02601 ... ...... . ... _ _.. ___.__.... .. www.town.barnstable.ma.us Offfae: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityAown 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.helshe understands the Town of Barnstable,Buildiug Departinent 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 required shall be exempt from the provisions of this section(Section I D9.1.1 -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 parson"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 fomi/certification.for use in your community. Q:forms:homecxempt V 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 Q Please Print Legibly Name(Business/Organization/Individual): y'"l Vylti6� Address: .0, FQK ( q 02371 atT MAI City/State/Zip: Phone.#: d$-�l0�$'`�f5�� 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 * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time): Remodeling .2: I am a sole proprietor or partner-' listed on the attached sheet. 7. .❑, g ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'-comp.-insurance comp.insurance. '10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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.❑ 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 subcontractors and state whether or not those entities have employees. If the subcontractors have employees,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.#: 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 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$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 ceer�rtiiftJ under th pains and penalties of perjury that the information providedltabove is true and correct. Si tore: 4d�dl° Date: 2/ /� Phone#: af /n��0 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License#' Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 _. o_f_the-fore om -engag m a om -en—rP`i1s�� inelu�- n`g the leg a-rePresena'i�v�ekofy--deeased-em pi.�Tor#he---.-- - ------- _.... 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 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 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)andphone 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 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 affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. 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 permit/license 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 Departmeant of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 e:xt-406 or 1-877-MASSAFE - Fax#617-727-7749 Revised 11-22-06 www.mas&gov/dia 4 ' Assessor's Office(1st floor) Map �� Lot < Permit# q J 0 Conservation Office(4th floor) Date Issued Board of Health(3rd floor)(8:30-9:30/1:00-2:00) Fee 6-0 • 0 d' Engineering Dept.(3rd floor) House#1 �' -j�� "E Planning De r/School Admin. Bldg.) BARNSPABLE. Definitiv 1 pr ve by Planning Board 19 e TOWN OF BARNSTABLE Building Permit Application P G 24 US Project Str ress 7 Village A-&Aj -9 , �e2 T— ) t Owner h 0(- l S P`yAJ� A<P—S 7V Address Telephone '7 7 p�, ��,, Y✓' Permit Request -Total 1 Story Area(include 1 story garages&decks) O square feet Totaf2 Story Area(total of lst& 2nd stories) square feet 0 Estimated Project Cost $ F �; a Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Typ : .Sing�Famil Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House fi A Unfinished Old King's Highway d � Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name �' � Telephone Number 5- Address / /YIA'/N S License# ®q -L �— `�� i l 0,;-67_5 Home Improvement Contractor# Worker's Compensation# a4 7 ;"?7_p/ -9 y 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 L D F/ - �,> SIGNATURE DATE BUILDING PER IT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - PERMIT NO. 9308. - , 7/25/-95�- DATE ISSUED f 268 -'257r MAP/PARCEL NO. ADDRESS . 54:.Grouse Lane VILLAGE Hyannis OWNER Doris M.' Rynearson DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCI'ATION PLAN NO. PAID DEPARTMENT OF PUBLIC SAFETY ONE ASHBURTON PLACE, RM 1301 BOSTONr; `M4k,,92108-1618 4, CONSTRUCTION SUPERVISOR LICENSE ' Number- Expires: , Restricted To: 00 `lamt 4 i t JOHN K OROURKE ~~ Detach bottom, fold sign on 168 MAIN ST POBK 272 back, and laminate license card. YARMOUTHPORT, MA 02675 'Keep top for receipt and change !-of address notification. T> Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 00 - None Nu�ber " Expires: 1G - 1 & 2 Fatily Hotes Failure to ppsaans a eurrent Restricted To: DD Alaaaachasnt, t410MNi!dinp { Code is Gaveo for revocation =,JOHN K OROURKE of this Jima®' 2w, :.Y.168 MAIN ST POBK 212 YARMOUTHPORT, MA 02675 The Town of Barnstable t of Health Safe and Environmental Services e 1 9. e$ Department Safety ` Building Division 367 Main Stied,Hyannis MA 02601 Office: 508 790�227 • Ralph Cmssea Fax 508 775-3344 Btrrldutg 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 my pm-cdsdng 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 CWCPtions, along with other 130 Type of Worn: Address of Work: � ? Date of Permit Application: I hereby certify that: r , Registration is not required for the following n(s); Work nded by law: Job S1,000 B not owner-occupied. t Pig own Pit r k`r..: Notice is hereby ghen that: �, oRs OWNERS PULLING THEIR OWN OR D G WITH UNItEQS'IF.ItED CONTRACT FOR APPLICABLE HOME IMPROVEMENT WORK DO. NOT HAVE AC CESS M 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. •. O Date Oc es.name 11:02'94 1T:02 $81T7277122 DEPT IA'D ACCID Co,>:unio,Zwaalili of ffla6iaclza"401b 600 WU SIMd 02! James J.Campbell &Ion, "Iaasar�iaulta 1/ Commissidner Workers' Compensation Insurance Affidavit with a principal place of business at: (Gtlr/State/Zt� do hereby certify under the pains and penalties of perjury, that: I am an employer provid'mg workers' compensation coverage for my employees workin this job. L-M,a(L �Z, 2-t 7;L(?7- G/ J� Number P ri 0 r Company � 1 a Insurance P nY O I am a sole proprietor and,have no one working for me in my capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have lured ti contractors listed below who have the following workers' compensation polices. Contractor Insurance Company/Policy Nt m Contractor h lasurance Company/Policy Num. Contractor Insurance Company/Policy Num O I im a homeowner performing ail the work myself. I undestr:nG that a cots of this s:aternent will be fo..vearded to ire Office of lmestiptions of cite DIA for coverage veritfintion and that faiitm ccve%ge s reem«ed under Section 23A of MGL 152 can lead to the imposition of mrnbW penalties coMbdoe of a fine of up to S 1,500.00 ` years'ImprLso.-meet as well as civic penalties in the tom:of a STOP WORK ORDER:md a fine of$100.00 a day apinst mc. Signed this ` day of1.9 Lit 1permittee Building Department Licensing Board Selectmen Office Health Department ��