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HomeMy WebLinkAbout6/8 HIRAMAR ROAD CG 6 Town of Barnstable Building Department F rti Brian Florence,CBO Building Commissioner BARNS i►MA = 200 Main Street,Hyannis,MA 02601 MASS. i639. ��� www.town.barnstable.ma.us �Eb MA'S F Office: 508-862-403 8 Fax: 508-790-623 0 Approved: Fee: Permit#: HOME OCCUPATION RAGISTRATI& Date: ©U �l� Name: � eo�✓" Phone . . I Q7, L(�7 Address:v " e ra iY74 Village: 5 Name of Business: Type of Business: ' Map/Lot: VJ 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 are 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 registeri/nag. Applicant: w'' �` lfiC^' Date: v r � 4 Town of Barnstable Building Department °pT11E rO�kt, Brian Florence,CBO Building Commissioner nnaNsr M4 = 200 Main Street,Hyannis,MA 02601 KAM www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: C% HOME OCCUPATION IIGISTRATION Date: O I 01(9 Name: ls' Phone M Address:0 6 Village: S v � © Name of Business: C) 6 ( Type of Business: Map/Lot: gc/— 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 ofmaterials or equipment. • There are 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. EN Ca Date: Applicant: � Town O1 bairnstawe Building Department Brian Florence, CB 0 r� Building Commissioner `�' 200 Main Street, Hyannis,MA 02601 www.towm ba=tab1e.ma as Pre-application for Business Certificate Date 7 „- Map A�Paricel � Applicant Information --ApplicatsName Coefkc+ Applicants-Address. O Email Address t J� aa Telephone Number Q6 Listed❑ Unlisted ❑ B&D 530�_ -Business Information New Business? es No Business is a registered corporation79_ S_���S�j__ yes No If yes Name of Corporation Does business operate under the registered corporate name? es No Is the business a sole proprietorship or home occupation? ......... No If yes then a Home Occupation Registration is required See Building Division Stag' Name ofBusiness DQ26 U _ ,d etL, Business Address tIY2.,0y, Type of Business CIP n, Bnj g Commissioner Office Use O Con ' 'ons L Building Commissio er -� Date � Clerk Office Use Only YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40,00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the.Business Certificate that is required by law. , / DATE: ° am r, Fill in please: ;i APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS r �3 TELEPHONE # Home Telephone Number 'tb( Z-3 NAME OF'CORPORATION: 3 '. ru NAME OF NEW BUSINESS TYPE OF BUSINESS :b eka IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER Z G � (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. .You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMM ISSIONER,'S OFFICE ' MUST COMPLY WITH HOME OCCUPATION This individual has been ' for of any 4errequirements that pertain to this type of business.RULES AND REGULATIONS. FAILURE TO MP uthorized Si a ur Y MAY RESULT IN FINES. g _ COMMENTS: 1(� ( Q"T v ^ 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: oFTHE� Town .of Barnstable -Regulatory Services . ' BAMSPABLE, 9 MASS. g Thomas F. Geiler,Director 1639•iDren►��0. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 8, 2011 Dear Property Owner, This letter is to inform you that Regulatory Services canvassed the general area-of Hiramar and Fresh Hole Roads on Friday afternoon, March 4, 2011 in an attempt to assess the current conditions of the properties located,in this area. This department recommends that all landlords personally inspect their property in order to obtain an accurate assessment of their individual rentals. For your convenience I am identifying the findings in a generic list below: ... • Broken window panes and storm doors. Failed glass h • Missing storm doors: • Torn or missing screens Broken glass strewn along.the perimeter of dwellings • Broken glass surrounding dumpsters and in parking areas • Peeling paint •. Uncontained outside storage of household trash • Abandoned appliances outside • Missing or clogged gutters e Failure to post contrasting'house numbers ' • Rotting window sills and support posts • Missing or broken outside lighting fixtures • Blocked egress including a rear exit nailed shut. In addition, landlords should confirm':that all units have the adequate number of operable smoke detectors properly placed,as required and units relying,on fossil fuels are also required to have - carbon monoxide detectors.. Please feel free to contact me directly;at 508-862-4027 in the event that you,require.additional information concerning this letter.; i erely; Robin C.Anderson Zoning Enforcement Officer CC:Chief Paul MacDonald,BPD,Debra Dagwan,Town Council Town of Barnstable THE Building Department Services � OF Tp� Brian Florence,CBO o� Building Commissioner aaxraszas 200 Main Street,Hyannis,MA 02601 Mass. v� i639• ��� www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: S � Name: �Ci 1.�� 1�Z Phone#: Address: S mkc_ 12-hN Village: , 4 (0°S Name of Business: ( � P ,� �/�tAS �C- f . Gp � , U3 Type of BusinessJNNP,_013c! Map/Lot: a L` 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 are 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 bg 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:c��l'7 Date: 02� Homeoc.doc Rev.06/20/16 �piKEr, Town of Barnstable *Permit# t Expires 6 nionths from issue d RA t s,AatE Regulatory Services Fee P MA85. $ Thomas F. Geiler, Director. 1619, Building Division . Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab l e.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 Property. Address iO� t , Residential Value of Work �95(�� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License 9(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one:, -PRESS PERMIT IT ❑ I a sole proprietor I am the Homeowner JUL. 2 2 2009 ❑ I have Worker's Compensation Insurance TOWN OF BARN STAB E: . Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old'shingles) All construction-debris will be taken to— El Re-roof(not stripping. Going over existing layers of roof) ❑` Re-side Replacement Windows. U-Value (maximum .44) ; *Where required: Issuance of[his permit does not exempt compliance with other town department regulations,i.e. Ffistoric,Conservation,eic. ***Note. Property Owner must sign Property Owner Letter of Permission, Home I rovement Contractors cen Construct Supervisors License is required. SIGNATURF{ Q:\WPFILES\FORMS\Express\EXPRESSPERMIT.DOC Revise060409 , 'a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 .�•'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information )) Please Print Legibly Name(Business/Organization/Individual): t4�c1r-e� d✓Jet- 9% Address: 75 W94M _D City/State/Zip:&f51111414 PA 00 65{�•;one.#: 6_0$' Are you an employer? Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with ❑ 6. ❑Ngw-construction employees(fLll and/or part-time).* have hired the sub-contractors .2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling 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 workers'"pomp. insurance comp. insurance. equired.] 5. ❑ We are a corporation and its 10.0Electrical repairs or additions 3.W 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 ��®0 W comp:insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy infomiation. t Homeowners who submit this affidavit 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 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 cri_mirial 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 f do hereby certi under the pains and penalties of perjury that the information provided above is true and correct. Signa. Date: "' 2 Z _ 0 Phone#• 50 Official use only. Do not write in this area, to be completed by city or town officiaG .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Department.3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter I S2 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 of the foregoing engaged in a joint enterprise,and including the legal 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 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 . lic work until acceptable evidence of compliance with the insurance enter into any contract for,the performance of pub 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 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 permit/license 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" Lhe 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 to any business or commercial venture (i.e. a dog license or permit to btirn leaves etc.)said person is NOT required to complete this affidavit. The Office of In 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 eommonwealth'of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-NIASSAFE Fax# 617-72777749 Revised 11-22-06 www.mass..gov/dia Town of Ba rnstable bX Regulatory Services Thomas F. Geiler,-Director, Building Division PrfD a Tom Perry,Building Commissioner a 200 Main:Street,—Hyannis;MA 02601 vr"Aown.b arnstable_ma.us Office: 508-862 4038 Fax: S09-790-6230 HOl\ZEOY NER LICENSE EXEMPTION Please Print DATE: '— Z Z —Q JOB LOCATION: G/�' �iP �+�' num cr J j street village HOMEOWNER": � �1� ' name home phone# work phone# CURRENT MAILING ADDRESS: 7Y �� VIM 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 farce 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) ibility for compliance with the State Building Code and other The undersigned"homeowner"assumes respons applicable codes,bylaws,rules and regulations. The undersigned.."homeowner" certifies that.he/she understands the Town of Barnstable,Building Department ==um inspection procedures and requirements and that he/she will comply with said procedures and re ements. Signatirr,of Homcov ncr Approval of Building Official Note: Three-family dwellings containing 35,00 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 rsing of construction Supervisors);provided that if the homeowner rngages a persons)for hire to do such of this section(Section m.1.1 -Lica work; that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they are assurrring the responsibilities of.a supervisor(see Appendix Q; Ru.lcs&Regulations for Licensing Cmstmction Supervisors,section 2.15) This lack of awarcness. results :oftcn in serious problems,particularly when the homeowner hirts tmlicenscd persons In this case,our Board cannot proceed against the rs unlicensed peon'as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the bomcowncr is fully aware of h;s/hcr resporrs�10itirs,many communities require,as part of the permit application, that the homeowner certify thkt hc/she understands the rcsponsibilitirs of a Supavisor. On the last page of this issue is a form currently used by several towns. You may cant amend and adopt such a fm-m/ccrtification-for use in your community. i � rok Town of Barn-stable a r Regulatory Services u 9xNSrABM Thomas F. Geiler,Director F%6 Building Division 0 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 Property Owner Must Complete and- Sign This Section If Using A Builder 1 ` as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit applicatioa for. '(Addzcss of rob) Signature of Owner Date Print Name If Propertry Owner is applying for permit please mplete Homeowners License Exemption Form on reverse side. I * �-7 07255 Town f Barnstable rermit# _ PERMIT 0 X PRESS PE . 6 months from issue date DEC-0 7 2007- Regulatory Services E � Tomas F.Geiler,Director TOWN OF BARNSTABLE - ��R� Building Division. SS �ER1E�®IT Tam Perry,CBO, Building Commissioner DEC I :Q 2007 20o Main Street,Hyannis,MA 02601 www.town barns table.ma.us OffiS � hlTi3 Fax: 508-790-6230 EXPRESS-'PERAffT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 2 9 4 Property Address I� 1 R1��"t - LAA Residential Value of Work 2 1`l Q Minimum fee of$25.00 for wor under$6000.00 Owner's Name&Address L i G ��ti t�C�-t c�;� tit rr • 1,64 oz2-7 Contractor's Name ^/ ✓�� `''' R'° Telephone Number• ,,6-0 2 573 6S Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ a sole proprietor M I aim the Homeowner ❑ I have Worker's Compensation Insurance . -Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request 'heck box) Re-roof(stripping old shingles) All construction debris will be taken toqAF-1A 0 v" 1 ❑Re-roof(not stripping. Going over existing layers of roof) 0 Re-side Replacement Windows/doors/sliders. U-Value (maxi im .44)- *Whcre.required; Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Lrope7rty Owner must sign Property Owner Letter of Permission. f e Home ovement Contractors License is required. 3IGNATU"RE: �Torms:expmtrB tevise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street " Boston,MA 02111, wlvw.mass gov/dia ' Workers'Compensation Insurgnce Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J Please Print Les?iblY �N31rie(Business/Orgmdzation/lndividud): An/C�/�� !/�� CityfStateJZip:_F/4 %4/,4. Axt Phone.#: a " 057 'S ✓�� Are you nn employer?Check the appropriate boa: :Type of project(required)-.1.E1.1 am a employer with 4. I a e a general contractor and I 6. ❑New construction . .employees(full and/or part time).*• have hired the sub contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees . These sub-contractors have g, 0 Demolition for me in an capacity. employee4 and have workers' • ��rkin any ty 9. ❑Building addition . 0 workers' comp.insurance comp,insurance,$' Electrical repairs or additions �� 5. We are a corporation and its 10.❑ officers have exercised their 11. P repairs or additions. �3' I am a homeowner do'"-'e71 work . � � F •. �niysel£'[No w rkers';`com�. right bf exemption per MGL 12. Roof repairs insarance.-re d f - c. 152, §1(4),and we have no ke � employees.[No workers' 13.[l Other :.. comp,insurance required.] *Any epplieant that checks box#1 must also fill out the sectiea below showing their wmi=s'compensation policy information. t>Iormowners,who submit this affidavit indicating they are doing all work and tlien hire outside contractors must submit anew affidavit indicating'such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contmetois and state whether ornot those entities have employees. if the sub-contraems have employees,they must provide their workers'comp.policy number. I am an employer that isproylding 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). Faflure,to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 thq violator. Be advised that a copy of this statement maybe forwarded to the.Office of" _ Investigations of the 1)IA for insurance coverage verification. I do hereby certi under pains and pe of perj that the information provided above is true and correct Date. Si tore• ��.�.....-..�„ Phone# Official use only. Do not write in this area, tb be completed by.cfty. or town:official, City or Town: ' Permit/License# Issuing Authority(circle one): .1.Board of Health 2.BuuldmgDepartment 3.City/Town Clerk 4.Electrical Inspector-5.Plumbing Inspector 6. Other Contact Person: Phone#: � t Town of Barnstable Regulatory Services snxMAE& Thomas F.Geiler,Director 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, , 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 ' Ho.meoRmers.License Exemption Form on the reverse side. QTORM&OWNERPERMISSION ' fy I Town of Barnstable Regulatory Services . .. BARNRTABt.E Thomas F.Geiler,Director 9 MARR. 9, 16S9. Building Division ATED HAA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 R7viv.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ` _ — I O — Q 7 2 D CJOB-LOCATION:'-� f /� -y-------"""`""`-'"•=nu er street C �� village (� "HOMEOWNER'-': 1✓�y�GJ �N 0,c 56s O - 0 F, YC !Ulf -03 7'✓5Y 5/ home phone# work phone# CURRENT MAILING ADDRESS:_ e C,/Z 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 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 inspection procedures and requirements and that he/she will comply with said procedures and requ, tents. gnawreof omeo� 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 fom-/certification for use in your community. Q:forrrts:homeexempt TOWN OF BARNSTABLE BUILDING,PERMIT APPLICATION Map 0�1 Parcel Permit# �V Health Division Date Issued `�� Conservation Division Fee. Tax Collect Treasur d 1 Planning Dept: ' Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street ddress Ale'IMPIt Village 94A / ` Owner U Address '7� UMY Telephone Permit Request Squar ���t floor: existing proposed 2nd floor: existing proposed Total new Valuation � Zoning District -Flood Plain Groundwater Overlay Construction Type 2A wr Lot Size h 1�et?+e Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Multi-Family(#units) r— Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes ANo Basement Type: ❑ Full *rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: *Gas ❑Oil ❑Electric ❑Other ' Central Air: ❑Yes *0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes Q8(No Detached garage:❑existing ❑new size' Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing 0 new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION ^ Name qC Q Telephone Number 02 2 Address 7 y License# c�/ J Home Improvement Contractor# Worker's Compensation# . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C/"m&1e SIGNATURE DATE FOR OFFICIAL•USE ONLY PERMIT NO. DATE ISSUED N - MAP/PARCEL NO. ADDRESS -_Fr; VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r { r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k - GAS: ROUGH FINAL FINAL BUILDING } DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts — - Department of Industrial Accidents ==EiOlfice of/aYestlgatioas _ 600 Washington Street - Boston,.Mass. 02111 Workers' Compensation Insurance Affidavit name: - G S t location 2 l M hone# 7 2 Z I am a ho eowner performing all work myself. I—a le rietor and have no one worlan ln�' anv�;apacity I am an employer providing workers' compensation for my employees worlQag on this job. : : :;:;' :::::::;:>;;::<:«< camaanv<name .. ... ... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: cons an name. :.:... address i::>•'>v4:i:.;.:.!.j.:.'.}>.::4:.:{.•F.:{:::•i:i. .i ...' ............ :: : Nine e... ........ .... Ji?}is'i ' .................................................................................................:.............r::ir.v::ii:�:::r:r:r:::::::::.•n�r:r v :v:::::::::.�::::::•:::�:.i:J:{Jw:::.�:. ............. .................................................:..::•::.::.v�:.v..::....:..n:n......................-................:-:.. :.:.... ...v........ ............... ......................:. ................. ..:. ........................ .......................n:::v::.:.......... ........:-.:::.v:::.::•.::............:.:{v.•:::.�::::............. .i:::::^:?iiii:v:::::::. ...:-..::........:.........v:......::::n?v:::::..�..::-i:::i�vi:.::.. aa�:name:..:.;:.:::<:<::::»:::»«;.:•:.:?;::::.;:.;.: address. ...: ....... . dfa i poi :::;:;{lrro >?:< ; iy ;i ;.cif.%� t :'?i:� ••a�u=snc Failure to secure coverage as regnired under Section 25A of MGL 152 can lead to the imposition of zdi penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the office o vestigations of the DIA for coverage verinmflon. I do hereby c theP d P fPedury that the information provided above is tM and correct Sigaeture Date / (r'J' Print name zJZ U Phtme# ---- official use only do not write in this area to be completed by city or town otfldal city or town: permit/license# (]Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person• phone#; -- ❑Other (mvued 9195 PIA) Information and Instructions a Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. anp ed, An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mori the foregoing engaged in a joint enterprise, and including the legal 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 ance 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a Icense 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,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. PENN PPlicants 'Please fill in the workers' compensation affidavit completely,by checidng the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe s omitted 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`Uw"or if you :are required to obtain a workers' compensatioh policy,please call the Depz=ent at the number listed below. City or Towns 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 pemiitllicense number which wIIl be used as a reference number. The affidavits may be rehaned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. %ii,/ The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Inyesugalioas 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 °FtNME r The Town of Barnstable r � * BARNSTABLE, • 9�A Thomas Services 3;9. rFo Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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 any pre-existing 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 exceptions,along with other requirements. Type of Work: OG Estimated Cost Z&w Address of Work:,// Owner's Name: ` ,v Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Owr er-pulling-own-permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO 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 gistration No. Date Owner's Name glorms:Affidav The Town of Barnstable • BARN MBLE, • 9 M g Regulatory Services `l'AiE039. 0.a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER_LICENSE-EXEMP-T-ION`� -- ``�Please-Print": DATE:-2--t'7 " 17 JOB LOCATION: M� w�S nl �r street vil Gge (/ 2 ..HOMEOWNER": name G, home phone# work phone# CURRENT MAILING ADDRESS: s S z Gd l ty/own 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, mop vided that the owner acts as supervisor. DEFIIVITION 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"ce s that he/she understands the Town of Barnstable Building Departme mspecti90roqbdures and requirements and that he/she will comply with said proce s re eme �S re.o- omeowner 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. Q:FORMS:EXEMPTN [ ] [R292 145 . ] �` LOC] 0006 HIRAMAR ROAD CTY] 07 TDS] 400 Hy KEY] 203407 ----MAILING ADDRESS------- PCA11041 PCS100 YR100 PARENT] 0 BOLOS, NICHOLAS & FRANCES L MAP] AREA] 63AD JV] 380732 MTG] 2008 BOORAS, PETER A & JOAN SP1] SP21 SP31 15 KETCH LANE UT11 UT21 . 19 SQ FT] 1440 SQUANTUM MA 02171 AYB] 1945 EYB] 1980 OBS] CONST] 0000 LAND 18000 IMP 36600 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 54600 REA CLASSIFIED #LAND 1 18, 000 ASD LND 18000 ASD IMP 36600 ASD OTH #BLDG (S) -CARD-1 1 36, 600 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 6 HIRAMAR RD HYANNIS TAX EXEMPT #DL LOT 71 RESIDENT' L 54600 54600 54600 #RR 0723 0107 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 07/86 PRICE] 137500 ORB] C107407 AFD] I LAST ACTIVITY] 08/10/87 PCR] Y R292 145 . P R A I S A L D A T A • KEY 203407 BOLOS, NICHOLAS & FRANCES L LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 18 , 000 36, 600 1 A-COST 54, 600 B-MKT BY 00/ BY ML 9/87 C-INCOME PCA=1041 PCS=00 SIZE= 1440 JUST-VAL 54 , 600 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 63AD -- TREND EXCEEDS STANDARD NEIGHBORHOOD 63AD HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 180001 LAND-MEAN +Oo 546001 54197 IMPROVED-MEAN -320 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 1000] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R292 145 . ISP E R M I T [PMT] ACTIO01 CARD [000] KEY 203407 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY STREET Hiramar Rd.: HyBnni,s F H 7,3 LAND 292: .r BLDGS. 7 15 OWNER R�.at G•yR fib. P�'"0�,• TOTAL oZJ 6 i) _ LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: BLDGS. Ol TOTAL LAND O, BLDGS. TOTAL /53 NO 06. LAND Jon Ell zabeth C- Tr,� LGL Trust)- 12-19-73 Ctf, 0213 0) BLDGS. � roraL iLLA n -+� LAND BLDGS. r TOTAL 1 LAND BLDGS. TOTAL LAND BLDGS. TOTAL 'LAND INTERIOR INSPECTED: BLDGS. TOTAL DATE: Z; 7 Z \ LAND ACREAGE COMPUTATIONS Of BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE_ Al 7, . / u 0 y o u LAND CLEAREWWONT BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND / 0 - 100 a BLDGS. LOT COMPUTATIONS LAND FACTORS — TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND /U ROUGH TOWN WATER rn BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY BLDGS. f-UUNUAIIIIIv LAND COST Gone.Walks Fin.Bsmt.Area Bath Room Base t I EILDG. COST d Cone.Blk.Walls Bsmt.Rec. Room St. Shower Bath Bsmt. _ O p PURCH. DATE Cone.Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE. Brlek Walls Attic Fl.&Stairs Toilet Room Roof RENT Stone Wells Fin.Attic Two Fixt. Bath Floors Piers INTERIOR FINISH. Lavatory Extra Bsmt. F I A14 1 2 3 Sink D D . s/` % 1/4Attie Plaster Water Cie. Extra EXTERIOR WALLS Knotty Pine Water Only Double Siding Plywood I No Plumbing Bsmt.Fin. Single Siding Plasterboard Int.Fin. L hingles TILING CC fi Cone.Blk. JGF P Bath Fl. I Heat 1660 , Face Brk.On Int.Layout Bath .&Wains. 8— Auto Ht.Unit (� Veneer Int.Cond. Bath Fl. &Walls Fireplace Com.Brk.On HEATING Toilet Rm. Fl. plumbing Solid Com.Brk. Hot Air Toilet Rm.Fl.&Wains. Tiling Steam Toilet Rm.Fl.&Walls , Blanket Ins. Hot Water A, St. Shower � yo Roof Ins. Air Cond. Tub Area Total Floor Furn. ROOFING 2 2-zA COMPUTATIONS- Asph.Shingle Pipeless Furn. Q S.F. G O Wood Shingle I No Heat S.F. Asbs.Shingle Oil Burner S.F. ' Slate Coal Stoker S.F. Tile Gas S F. OUTBUILDINGS ROOF TYPE Electric S.F. 1 2 3 4 5 6 7 8 9 10 1 213 41516 7 819 10 MEASURE! Gable Flat Hip Mansard FIREPLACES S.F. Pier Found. Floor �_ Gambrel Fireplace Stack Wall Found. 0. H.Door A✓ LISTED FLOORS Fireplace Sgle. Sdg. Roll Roofing f` Cone. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE Shingle Walls Plumbing Pine Hardwood ROOMS Cement Blk. Electric Asph.Tile % Bsmt. lstp/7 TOTAL 0 Brick Int. Finish .PRICED Single 2nd 3rd FACTOR REPLACEMENT 3 3 O OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. DVvLG. P,,6l E IC. a- �_t2._ .S •`!y _ = 01.3 .3 2 / 9�1 a �/U 0 t 2 3 4 5 6 7 8 9 to TOTAL TOWN OF SA82Q8?88I.F f gzpORT BMPOBT S LIIM IXTAIIY/QONTINQA NAME (LAST. FIRST. MIDDLB� _ DIVISION /0» HOTS DETAILS i owERVATIONs-mmIZE EVI)ENCE. SERIAL IS ETC. 02