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HomeMy WebLinkAbout0264 HINCKLEY ROAD CY � w i Town of Barnstable *Permit# 010 76 S5 a S_ Expires 6 months froin issue date 1 SARNSTAHl.6. Regulatory Services Fee Q-5 �51� v nAss $ Thomas F.Geiler,Director i639• �� �F4tAA`'A' Building Division L_ Tom Perry,CBO, Building Commissioner � c 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY P Not Valid without Red X-Press Imprint 1 Map/parcel Number 216 D (c2 Property Address �� EY [`residential Value of Work /�/�,, Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 3"�i' /,r'� S'AA­e—' -As Ab�- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)❑Workman's Compensation Insurance X-PRESS PERMIT Check one: am a sole proprietor lA S E P — 4 2007 am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) y� /ARe-roof(stripping old shingles) All construction debris will be taken to /R� ` C/ ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regula�erlhs ottiC G'onsgrvation,etc. ***Note: Property Owner st sign Property Owner Letter of Permission. Home Im ro e t Contra tcense is required. C 41 SIGNATURE: Q:Forms:expmtrg i1<=` Revise071405 - I The Commonwealth o fMassachusetts Department of ludustrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 . www.m ass.gov/dia Workers"Compensation Insurance.Affidavit;,Builders/Contractors/Electricians/PIumbers Applicant,Information Please Print Le 'bI Name(Business/Organiiation/Individual):. ° h �/1�ti✓ Address: iw City/State/Zip: Phone.#: 5 6 S P 86 2•- 2 76 0 Are you an employer? Check the appropriate box: 'Type of project(required):, 1.❑ I am a employer with 4. ❑ I am a general contractor and T 6. ❑New construction . employees(full and/orpart.time).* have hired the stab-contractors 2.❑ I am a'sole proprietor or partner- listed on the•attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. 0 Demolition. worldm for me in an capacity. employees and have workers' g Y P h'• . 9. []Building addition comp.insurance.$ [No workers' comp.insurance required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions '3.�] I am a homeowner doing all work ❑ , g . myself [No workers' comp. right of exemption per MGL 12.p!rRoof repairs insurance,required.]t c. 152, §1(4),and we have no employees. [No workers' . •13.0 Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or notthose entities have employees. If the sub-contractom have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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 1DIA for`izurance covera e verification, I do hereby fy:ender the ins-and penalties o perjury that the information provided ab ve is true and correct Sienature; �� Date: g164/07 _ Phone#: J g�o ' Z7 fbS 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 CIerk 4.Electrical Inspector 5.PIumbing Inspector 6. Other Contact Person: . .Phone#: r �oFINEl . Town of Barnstable Regulatory Services r + BAftNSrABLE, : Thomas F.Geiler,Director Ar Ash Building Division Eon Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Q� Please Print 07 u f DATE: f/ J JOB LOCATION: ! o 1/� I�� 9/ /y=� /✓M S n'uummber ,��1 street village "HOMEOWNER": �J" //['W"+ name home phone# work phone# CURRENT MAILING ADDRESS: 2—k ��• ci /town state zip code I The current exemption for"homeowners"was extended to include owner-occupied dwelli�n s 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 he/she understands the Town of Barnstable.Building Department minimum inspect' n pr cedures and requirements and that he/she will comply with said procedures and e irem a 09`��f�o� gnat re 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 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 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 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. Town of Barnstable *Permit#;,C?61�5 f Expires 6 onths from issue dale Regulatory Services Fee SEp 1 7 ZOO7 Thomas F.Geiler,Director N S ABLE 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 PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address f►r /I� 6Y BResidential Value of Work J .J v U 4 d Minimum fee of$25.00.for work under$6000.00 Owner's Name&Address / Contractor's Name let T C©lUr //`rC Telephone Number 7 76 ?y// Home Improvement Contractor License#(if applicable) s/�CV� Construction Supervisor's License#(if applicable) E4-orkma.n's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation su,,raannce L, Insurance Company Name g r '7 '4 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) 2"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 c f the Ho a Improvement Contractors License is required. SIG NATURE: Q:Forns:expmtrg Revise061306 • The Commonwealth of Massachusetts Department of Industrial Aecidents Office of Investigations d 600 Washington Street Boston,M4 02111 , www.mass.gov/dia Workers` Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ ® Please Print LeLribly Name (Business/Organization/Individual):. a,y /� /�G?' ('dnT.�T Address: 3f iMd,bg: tin City/State/Zip: �►pia/Ap Phone.#: XF 776 Veyoan employer? Check the appropriate box:4. I am a eneral contractor and IType of project(required):• 1m a employer with ❑ g 6. ❑New construction . employees(full and/or.part;time).'" have hired the su'b-contractors 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7. ElRemodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 .❑Building addition [No workers' comp.insurance comp•insurance.# required.] 5. We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.0 Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGL 12,E] oof repairs insurance required,] t c. 152, §1(4),and we have no employees. [No workers' .13. Other J/,911V-6 comp. insurance required.] *Any applicant that checks box A must also fill out the section below showing their workers'compensation policy information. t Homeowners who subruit this off davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors 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 lave employees,they must providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurancefor my employees Below isihe'policy and Job site information. hh�� Insurance Company Name: r'rT L Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: �� *JU7/f City/State/Zip: 0� Attach a copy of the workers' compensation policy declaration page(showing the policy nu er 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 iip 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 a e pains• penalties of perjur3,that the information provided above is true-and correct: a 19 � Date: Sitetare; Phone#: FL 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 CIerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ��F1HE I°�y . Town of Barnstable. Regulatory Services nARNSTABLES. ' Thomas F.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstab l e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauthorize 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 Q:FO RM S:OwNERPERM IS S ION Island Sidug and Roofing a division of.?ZLTConstruction,Inc. Proposal to: September 15, 2007 Timothy Shay 54 Hyannis Ave. Hyannisport, Ma. 02601 We are pleased to submit the following specifications and estimates for re-siding: Remove existing cedar shingles and flashings. Install aluminum drip edge on windows and doors. Install Tyvek house wrap or similar, Install Red Cedar Perfections,--.... ing existing courses if possible. Remove existing tar&gray ' oof over walkout bay and install rubber roof. Clean up andhaul away all debris to landfill. We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of $5500.00 No deposit, Payment in full due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc. carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the wofk as s ified. Payment will be made as outlined above. Date of Acceptance: Signature Start Date: Signature 31 Manni Circle Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 • Fax 508.420.1776 • 2:mail caperoofer@caperoofer.com i MR _ , Isms 30 A } 1� �t �c ,r f n 'pr' 4} <�� k ' '�l 1k.ray' 1 +; S rr 1 t1' i IN r AIR.-.. w '., hl 4 .: 1.. r n,x ,w 4 l/ie.(c' //%Icartu(�rac�a a�✓l�aac�urkfla _ { y aoai d o ;IB.t,L:19-Regulation • s and S HOME Ib1PRO VEMENT CONTP,ACTOt _ 3Cense or registration vaLc�for�nii«,c Ikcfoi e!;e ex n tion date kr#•Registrat►on P Ir tU Ord i etal, Cx 135�86 ,hoard of Building Regu, dons Ashpprtoil PP ce I:m]30P PP+[a 0210 VT d n CONST INC `�[3A=1StANQ�^,CUING&ROOFIN RrN 'IE TAYLOR `� t , ?ERUILLEs 4 0236�a 1_5�r3 z i yy( } .M a k r, a } E1J,�nus;1 a,i3r - jklynny,pill VVIA. s v: Assessor's map and lot number ...�.�v.....v. ....... KF C SYSTEM MUST BE INSTALLED IN COMPLIANCE�� a,T „ r- c Sewage Permit number ./..&.�t.....�/� 'l /� ...... WITH ,�° (e Ii�.-':- 11 STATE SANITARY CODE AND TOWN °fT"ET°�° TOWN OF ARN�TXWLE •89H39Ti►DLE, i t "6 q 0 N ,•� BUILDING INSPECTOR AY�'' APPLICATION FOR PERMIT TO ...�"" ' `..!. '!......../.................. .... .......... ................................ TYPE OF-CONSTRUCTION ....................` C..."'."'. ................................................................................ ........���............�............19 7. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ........jeCk....................t.(.�� .�!!.`)q.1....$.............................................................................. ProposedUse . . ...........4G.C.4k,. .....................................................:......................................................... Zoning District ............ ............ ..............................Fire District ....... ........ .Q�1!71'1-. ........................................ / Name of Owner l3 Q. .v.L,.. . .... .....�...............Address .. �.Y. ??. Y`"la!C.r............................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect .......................................................:..........Address .................................................................................... Number of Rooms .........I.....................................................Foundation ..... .5' .. ..................................................... Exterior .. /.. .... .4r.....................................................Roofing ....."12 1 .................................................. Floors . ...................................................................Interior 2 e ..... . . . Q ............... .. .........I..Y1/�P. . ........................................ Heating ...... 1./..f.' ............................................Plumbing .............................. ................................................. Fireplace ................ ..............................................................Approximate. Cost ...............j. .....�'................P Definitive Plan A roved b Plannin Board ________________________________19________. Area ........ .. ... . Approved Y 9 Qo Diagram of Lot and Building with Dimensions Fee '�� m ' SUBJECT TO APPROVAL OF BOARD OF HEALTH i T ' 3 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 2 Name ���� .... L..:............... � ^=,^=^es" Joseph ~~r° � . � ax�1 tm ' No —�����— Permit for ----- =^^ . ' ---J���:��./zv������.-----.. .......... ' ' Road �ocpnpn-��.f��^=r�=�w=�—.^~^---.. f---- ....................... .............................. � A �m Owner ... �moerJoseph | ru�aa� @r° --------------. ------ ~ � ^ � Type of Construction -----..�����----. ---.—..^---..----------------. Plot ------^--- Lot ----------' Permit ~....e~ .' -- ' �� Date of Inspection 6 Do�a Como|o�a � —. —'���---/��l9 �� . .-~ ' �A PERMIT REFUSED �� ^ / - +` -----'-----...—__------- l9 ' � ^ � -----.--.................' -----� ------. ^—_.—,.—..--....-------^�---����. .......................... —.------...------.--....../�----- i ^ Approved ................................................. lg . / ^ -------------.—..--..—.------.. / . ` | -------'-----------,—..~.—'�^'�, ^*, � | | | �