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HomeMy WebLinkAbout0101 HOMEPORT DRIVE �� /� / - ,� ` i /�-�^/ - �• J6 Town of Barnstable Biilllilg r he StreetA� ovedRlans,Must be Retainedon Job ad this Cad`Must;be>Ke ,t - .' Post This Card So That rtis Visible F om t ,. p ,_x * IARNSCABIJE. v� .,. 2. .� pP, ,a 'rs ep r ., ..r Posted Until`"Final i639 ,.. Permit , Were a„Certificate of:Occu ands Re" wired,such B:uild�rig`shall Not be Occupied.unt�l a Finalslnspection has been made ` .,.,; ,,�.,. p ... yea: ,.,• t = <:, ,..,,. ,s:.;. % o.,. ., ., ,: F ;. ,,z. «. Permit NO. B-18-1879 Applicant Name: ALL CAPE ENERGY Approvals Date Issued: 07/06/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/06/2019 Foundation: .Location: 101 HOMEPORT DRIVE,HYANNIS Map/Lot 268 134 � Zoning District: RB Sheathing. Owner on Record: MORSE DAVID R JR&GISLAINE M z4tbkractor Name yALL CAPE ENERGY Framing`. 1 l' . . Address: 101 HOMEPORT DRIVE . Contractor License:. 166888 2 " s �. HYANNIS, MA 02601 \ F Est`Pr ject Cost: $9,000.00 Chimney: .Description: Insulation/Weatherization R Permit Fee: $95.90 { Insulation: Project Review Req: $95.90 �, Date 7/6/2018 Final: Plumbing/Gas Rough Plumbing: " Building Official i „• Final Plumbing:, .. . .. This permit shall be deemed abandoned and invalid unless the work authonzed;by this permit is commenced within six months,'h issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and e a thpproved construction d m ocuents for wh ch th s permit has been granted. All construction,alterations and changes of use of any building and structures shall�be in compliance with the local zoningby laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or:road and shall be maintained open for public inspection for the entire duration of the, x work until the completion of the same. Electrical. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are.provide`d,on this permit. Minimum of Five Call Inspections Required for All Construction Work:.'.' ` k � . Rough: 1.Foundation or Footing .. . .._ ._. . 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final:, "Persons contracting with unregistered contractors do not have access to the guaranty fund" as set forth in MGL c.142A). Fire Department _ g g g Y � , Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT NN .-� .....�... .. . A placation numbe ... .. r..P I DateIssued...................... .............................. c NAM Building Inspectors Initials........:. .. ..................... 1619. Map/Parcel.... /..................................... TOWN OF BARNSTABLE w EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY rNFORMATION Address of Project: 4 �o6�e �Y p ✓ ML Vlf? ' NUMBER STREET - LAGE Owner's Name: Phone Number7� j r I Email Address: Cell Phone Number dQ Check one Residential Commercial' Project cost$ - OWNER'S AUTHORIZATION --n As owner of the above property I hereby authorize 5� �W CA to make application for a building permit in accordance with 780 CN IR Owner Signature: J�e-� �Gw�-,� Date: .TYPE OF WORK . header change) ' � Siding a Windows(no head g )# EKsulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer/of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# D 3 (attach copy) Email of Contractor Phone number C6T;�3 ALL PROPERTIES THAT HAVE STRUCTU S OVER.7S YEARS OLD OR IF THE SUBJECT PROPERTY IS 1N -_., . ......�--. A..I AODDMIe► RIPMRF a PFRMIT CAN BE ISSUED. i APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No' es(If lease attach floor plan 'Y P p with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side F i HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CAM the Massachusetts State Building.Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. - _ ,F The Commonwealth of Massachusetts Department of Industrial Accidents pf.face of Investigations 600 Washington-Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/El Pctriiccians �umberrs Legib Applicant Information � 1► � � rug �e►��i Name(Business/Organization/Ir►dividual): Address: Phone City/State/Zip: 1 Type of project(required): Are. u an employer?Check the appropriat box* eneral bontractor and I 6• New construction 4. Iamag l.L\d 1�.a employer with_3_ have hired the sub-cOntractors employees(full and/or part-time).* listed on the attached sheet. 7. ❑Remodeling 2•❑ I am a sole proprietor or partner- These sub-contractors have _ g• Demolition ship and have no employees employees and have workers' 9• El Building addition working for me in any capacity. t COS. 0e• 10.[]Electrical repairs or additions [No workers'camp-msm=e 5. ❑ We are a corporation and its- required.] officers have exercised their 11:0 Plumbing repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 12,[]goof repairs myself[No workers'comp. c.152,§1(4),and we have no `® 13 insurance required.]t emP loyees.[No workers' then comp.insurance required.] compensation Policy'do' indicating *pay applir mt that checks box*1 mast also fill out the ee doing etaollwwo d then hire out�wing their 'ide contactors must submit a new affidavit indicafiag such t Homeowners who submit this aMdavtt mdreaimg they the name of the sob-contactors and state whether or not those entities have tContractors that check this box must attached an additional sheet showing number. e loyees if the sub-contractors have employees,they must provide their workers'comp•Policy. rrrp Io ees. Below is the policy and job site I am an employer that is providing workers'compensation insurance for my emu y information. Insurance Company Name: Expiration Date• Policy#or Self-ins.Lic.#: —1 1 e ��( City/State/Zip: �� Job Site Address: i V I policy num er and expiration date). Attach a copy of the workers'compensation policy declaration page(showing the P c' penalties of a Failure to secure coverage as required tinder Section as 25A of as MGL c• ten til�es in the form o lead to the af a STOP VJORIC on of ORDER and a fine fine up to$1,500.00 and/or one-year imprisonment, a well a evil P the violator. Be advised that a copy of this statement may be forwarded to the Office of of up to$250.00 a day against coverage verification. Investigations of the DIA for insuran provided above is true and correct enalties of perjury that the information p I do hereby certi under the pains p Date: ' Si e• Phone#: p ffeial e oy. Do not write in this area,to be completed by city or town official Per mitJLicense# City or Town: Issuing Authority(circle one): ector 5.Plumbing Inspector 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Insp 6.Other Phone#: Contact Person: 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 hi 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 buildin gs the commonwealth� for an 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 witb their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partnm-s,are not required to carry workers'compensation insurance. If as 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 penait/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 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 an business or commercial mmercial 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 nummber. The COMM Mwealth of Massachusetts I)OPartment of IndustW Accidents fie of Investigatiam 600 Washington Stint Dorton,MA 02111 Ted.#617 727-4900 ext 446 or 1 SAFE Revised 4-24-07 Fax#617 727-7749 WWW-M .90VIdia HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. o hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: M 4— The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic&basement insulation; exterior wail insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation to access the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)years after the weatherization work is completed. I have read the provisions of th)x ag ment and give my consent. Home Owner(signature) Home Owner email: Date:' i L4< Agent:(signature) Date: Agency Approved Weatherization Company All Cape Energy Alternative Weatherization Cape Cod Insulation Cape Save Cazeault Frontier Energy Solutions Lohr Home Improvement Agency Signature: Date: For Natural Gas Customers: I have received the National Grid Discount Rate Application form from my auditor. . I" Customer Thitials Client:762494 2ALLCAPEEN ACORD. CERTIFICATE OF LIABILITY INSURANCE ouls►2o1s TM SATE E ISSUED AS A MATTER OF 2ffWMA7=ONLY AND COIFEW No RIGHTS UPON THE CERTIRCATE HOLDER.TM CEIH ICATE DOES NOT AFfIRN1AT1VE_Y OR NEGATIVELY MOM%EXTEND OR ALTER THE COVERAGE AFFORDIM BY THE POUCIES BELOW.THE CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE TSSMIG MSURER(S),AUiHORMW RM IESENTATIVE OR PRODUCER,AND THE CE NICATE MOLDER. lM KMANT-.U the ceLtdr is an ATONAL 114SURED,the poUcyQ00 mud beendomed.U SUBROGATM E WAIVED,md*at to " the terrTLs and condbWas of the poftT,c ertab policies usa!/requfte an endorsenmmL A staRernerfR on this certificate does not eoido rights to the ate holder In Bw of such ems} cowim Dowft&Cff"bmurance Ate, =7M1Gn 908T781218 9731yannough Road -P.O.Box 19M ADDREM RMSUREMAFFOR COV81AGE Mm* Hyann!s'MA 02W e6u�tA �mme�o,� 02V fNsfHw ems: All Cape Energy I= a/o Shayne E Dewitt RIBURE RC PO Box 1492 moo: aE- BreMfster,MA OM F_ COVERAGES CERTUiCATE NUMB: RFViSM famul R: THE RS TO CMrWY THAT THE PD X;M OF MSURANCE LISTED MRAM HAVE WM ISSUE)TO THE RMOM NAME)ABOVE FAR THE POLICY P0l= MDICATED_ NORIAIR WNWMG ANY REQUffff% T,TERM OR CONDTTIONOF ANY COMRAGTOR OTHER DOCUMBIT WiM RESPECT TO WHICH THE CM 1 ff ATE MAY BE i SUM OR MAY PE WP^ THE MSURAN M AFMRDED ETY THE POLICIES DESCMM HERBN iS SUBJECT TO ALL THE TT3TIYG, EX=S"M AND CONDRIONS OF SUCH PACES_" MIS SW M MAY HAVE WEN REDUCED BY PAID CUM& LmlTYPE POLm Nia� Poucv Hff ow umm A QmERAL Lm mm CPS299346 M2M8 01112F2019 EAmocmNoomm slAODAN X awsMEFaaLGENfflALUAenm o lNTM si aC NEDEJPoftmepmm) $ PEF&)MAL&mvff4Uw sljxom GEMMALASOFMAM s2AODAM CaWLAGGFUMATELHUAPPLESPEft PRorwm-OOtpmpAGG S POLw P LAC $ Aeroioea.E LTna M CONS STN6L E LO ff ANY AUTO BODll Y Q1IURlf(Fa pecan) $ ALLOWHM SCHEDULM BWLYMUURY(Perecddm4 $ AUTOS AUTOS WED AUMS NO PC%%?ED PROPERTY DAMAW s AUTOS • s tn19HEILA UMHCXAM%4MM CKX= EACH O XXff5 3WE $ rl QC�SUAB AGefamm $ RETeam $ sATe. a WCSfATU NTH- ANY 70RIPARit TTW Y!N OD�IJOID? ❑ NIA EL EACH ACCOENf s if is r119 EL Dom-EA $ gym de�e u[der DT ifONOFOPEiATt(N6belo® ELOSEAw-pm=Lwr s f0PTWM0FCWEM7WMSIL& ACORDIVI,AdAltonWRemadmSehe&ftffm apacefsweed) Certificate of insurance for workers compensation will be issued by the carrier. CERTRCATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCINOW POWNS BE CANCBl®BtEFOM THE EMMATON DATE THEROF, WMCE VM J BE DE UVE RM M ACCORDANCE WITH THE POLICY PROVISOM AUFHORRM TATTVE 401988-MO ACM RAMM A9 rights mswve& ACOW 25(2010" 1 of 1 The ACORD nano and bgo we nqisbmW nu aft of ACORD LS1 ACORO® DATEPENDUNYM CERTIFICATE OF LIABILITY INSURANCE 01/240118 THIS C®tiIFICATE B ISSUED AS A MATTER OF INFORMATION ONLY AND coNFERs NO RIGHTS UPON THE ATE HOLDEEL TNB CERTIFICATE DOES NOT AFFIRYATiVMY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 71,8S iIEiiFICATE OF INSURANCE DOES NOT CONSTRUiE A CONTRACT BETWEEN THE ISSl9NG DWRER(S), AUTHOR® WRESENTATIVE OR PRODUCER,AND THE ATE HOLDER Ii1PORTANT: B the cede hnlder is an ADDITIONAL INSURE116 the poliic ns)must be endorsed. if SUBROGATION B WAIVED,subject to the terms and condithms of the policy,certain porgy may n quhs an endorsement A statement an the ceffifficate does not canter dglft to the certificate hokter in,liar of such s} PRODUCER CCKFACF Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY "' 775-16M FAx No - Isuffiven@doirmcom 9731YANN000H RD AFFo trurtcs HYANNIS NIA 02MI 00KNIER A• ATLANTIC CHARTER INS CO 44= INSURED e15URER B- ALL CAPE ENERGY INC ucc 61�D• PO BOX 1492 01SURER E BREVNSTER MA 02t I 91SURER F•. COVERAGES CERTIFICATE NUMGBER: 233251 REVISION NUMBER: THIS IS TO CER 1IFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVNTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. LTR TYPEOFB9AtRANCE �POLOVIR POIw3nnn POUCYEIm LUE S O0101IBiQALGENERALLJABUM EA.CHOCCURR134CE f DAMAGETORGaInED CIAws-tmm FIOCCUR pi S f LID EXP(Airy me prim)f WA PERSCIPW&ADVDIJURY f GEM AGGREGATELDWAPPUESPER: GENERALA( TE f POLICY❑JECT LOC PRODUCTS-COMP/CUAGG f FIOTHER f AUTO ELIAB M (�Ui®stMGLE Lou' f aria ANYAUTO BODiLYRAMY(Perposon) f ALL OWNED SrHEou1ID N/A BODILY KWRY(Per aoddmt) S AUTOS AUTOS NON-0WIaED PROPERTYDAMAGE f HIREDAUTOS AUTOS f it UNBREL ALUIB OCCUR EACHOCCURRRBdCE f EXCESS LUIB HCLAMISMADE N/A AGGREGATE f DED I I RETENTKMf f OTW rroRn�TS i�t X1 I ER ANDBWLOYERS LiABLUY Yin AANYPROPRIETCKtNVJrFNEPJEXECUTPJE EXCLUDED? WA WA WA VYCV01392900 01N2/2018 01/122019 ElEACInACCm9di $ 500,000 InmgFL otsEasE-EA f StO.= urges,d— urdw TiON OF OPERATIONS bebw E.L_DISEASE-POLICY Lair f 500,000 WA DES�iWNOFOPERAITOSJLOCAT IVBHQES(A1Xi1D11H,AddffhnWRamwksSd maybe I amaespaoe-seege Mrkers'Corr on benefits WIT be panl to NasSachusetts eDpbyees only.Ptusramt tD Endotsemerd=20 03 M B,no a thorb afion is given io pay claims for benefits W employees m states offm than Massachuseft if the ensured hoes,or has hired those employees outside of Massachusetts, This certificate of insurance shows the policy in force on the date that this cerificate was issued(unless the expoafion date on the above policy precedes the issue date of this certificate of insUrance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at wwwAomgavAmMNadeemwnWwmaonkmesggabonsf. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCWB@ POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIOUL AUnDR®REPBESBrrATmIE Daniel M-Cro ey,CPCU,VIOL President—Residual Market—WCRU MA 0 19N M4 ACORD CORPORATION. AO rights reserved ACORD 25(2014MI) The ACORD name and Ingo are registered marks of ACORD Commonwealth of Massachusetts { i) Division of Professional Licensure Board of Building Regulations and Standards i Constructio{tiSliohAsor Specialty f _ 3 CSSLA03842 11 4pires: 02/23/2020 Z4 's. SHAYNE DEIMTT,. ' 161 COMMOIV*WAY,," f BREWSTER MA02631 i Commissioner CILf L - 1 �. �%/�e Ua��to�aaiaiverrl//n`'�3�llru�ric��ur/�1� a Office of Consumer Affairs&Business Regulation a _ HOME IMPROVEMENT CONTRACTOR Registration t 166888 Type: f Expiration 7f1.9E 8 DBA NOW ALL CAPE ENERGY' — SHAYNE DEWITT tt✓` } 161 COMMONS i BREWSTER,MA 02361 Undersecretary . i ot6 it-zs 3 �( � GM Y � & 613 qi �ONEE r Town of Barnstable *Permit# 11 Q Expires 6 months from issue date Regulatory Services. Fee EARNSrnsi.E, : X-pRhbb 9� Mass.16;9. Richard V.Scali,Interim Director �0 QED MA't� Building Division NOV 18 2013 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEPMT APPLICATION - RESIDENTIAL ONLY cZ / Y7 Not Valid without Red X-Press Imprint Map/parcel Number c0 Property Address�j Tay Zesidential Value of Work$ 7�® Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address�//� y1 p r7')')oz? _(-e Av H�� e &!et 17I � t A ��Gc> Contractor's Name /fOd4& . C.,A r 7— Telephone Number �—O — 77,1 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) jo,_I'm ; C S 007 :` �:C ❑Workman's Compensation Insurance Check one: 0o'I 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 accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ,'Replacement Windows/doors/sliders.U-Value ®.a7 (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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&Construction Supervisors License is required. SIGNATURE: QAVvTFILES\FORM uilding permit form S.doc Revised 061313 V iX F � -_- 011ice of Consumer Affairs � t OME IMPROVEMENT CONBns,n�s Regnieho".. License or registration valid for individul use only I egistration TRACTOR: C before the expiration date. I'f found return to: .'Expirabon : 4z©18 Type. Office of Consumer Affairs and Business Regulation SNOW � DBA 1 10 Park Plaza-Suite 5170 CONSTRUCTIO - j i� Boston,MA 02116 _ L JOHN LOPEZ P �, 8 HOME PORT f ((� HYANNIS DR -a I`. MA 0260J.. — _ Undersecretaryc- � ..._ o � � Not- with sig ure 4 ✓ca{e' as` eni of Q a Standatas Use+{c _neegUtat ors an Massa gu;tdir9 R Uperi,�sot `\serge• co VLPoVLvp SO -jS VkN ExP. 2p1� 60 : ✓'' .„ cJ Cc,n�lss,Onet i i Trite f✓nMrrromsteaUh vfMassachusetts Deparbnen t of huhjs&ial Accidents - Office ofrnvat400ns ' 600 Washington&Y—eet Boston,M,4 02I'1'lt wt�nv.tl�aass.ga�dic� Wgrirea-s' Compensafian Insurance Affidavit:B.0 ilders/Contractors{EierfricianstMambers Applicant Information Please Print Legibly Name'(1 C ganiz anRn��idnat7: /4,10 U/ C- d,4•C T— 'ity/Stat>°1Zip- Phone Sod "7 7/ Are you an employer"Cteck the appropriate box-: Type of o'ect(required}: Yl� ln' l 4_ I am a contractor and I ❑ I.❑ I am a employer with � 6_ New coms5ntction; employees(full and/or part-time).* have hired the sub contractors 2.-jeI am a sole proprietor or partner- wed on the attached sheet 7. ❑Remodeling 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_inmu=e comp.ins manor: regntred-] 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions 3-❑ I am a homeowner doing all Work officers have exercised,their 11_❑Plumbing repairs or additions myself o workers' right of exemption per MGL 12❑Roof s insurance �d-]1 c_152, §1(4},and we have,no, . employees [No warps' 13_0 Other camp-insurance required-] *Aay wpUc=r hat checks boa 91 roost also fill out the section below showing 01ea vorkm'compensidon policy�rmatiao- Homeowners who submit this atddava indicating they am doing all track said dues hire ontade contractors most submit a neat si�davit inrivatiog such kxatimctors that cfiea this bax mast sttached an additional sheet showing the name of the stab-caak-3=rs and state whether ornot these unities have employees If the sttlrconbxcram hale empIoyees,they must provide their workers'comp.policy number. I am an empk5w that is prmiding it orkers'comperuadon kmirance for my employees. Belayw is die paUcy and}ob site information Insurance Company Name: Policy;g or Self-ins.Lie.#: Expiration Date: Job Sife 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 ihe form of a STOP WORK ORDER and a fine of up tzr$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of luvesiagations of the DIA for insurance coverage verification_ I do hereby certify a t PM-11SI idpenafties ofpedwy Mat the in,forma tan provided above is hue and correct ,........ ate,. Sitmatuxe: Q,aRial use only. Do not write in this area,to be campieted by city or frown officrat City or Town: PermitUcense ff lisuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrdwn Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuaatto 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"eutity,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 Iocal 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)and phone number(s)along with their certificatc(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 Departunent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtailli 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"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 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 Cou mauwWth of Massachusetts Depaiimmt of lndust ial Accidents offim of 1avestigat o-as 600 Washington Street Boston,MA 02111 TeI.A 617-727-4 ext 406 or 1-77-hgASWE Revised 4-24-07 Fax# 617-727-7749 ww.raass txnv/dia oFmEroy Town of Barnstable ti °* Regulatory Services 9inxiv IEMASS. g Thomas F. Geiler,Director 0.39. .;. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Owner of the subject property hereMalI otize.. J�V.7�-U ��A to act on my bebalf, in all tna.ttets relative to work authorized by this building permit ----- �-�---'(Address f Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. s igiiature'of Ow ner . S S "e of A ,plicant T.- Print Nanae Paint Name,: Q:FORMS:OWNERPERMISSIONPOOLS 62012 { it Town of Barnstable y°^ Regulatory Services MASS. Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-86274038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number, ', street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hue 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 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 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,pal icularly 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 respousibilities,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. C:\Users\de,oUik\AppDataEocal\Microsoft\Windows\Temporary Intemet Files\ContmtOudook\QRE6ZUBN\EXPRFSS.doc Revised 053012 Complaint Number: 1749 Taken bv: BUI .I�ING S-E,RVICS g Date: . L 5 10 00 _ - � . •t/,t Ma> parcel: G p W/ Referred to: _,UJLDG _ . it 0 SUBJECT OF COMPLAINT Business/Occupant Name: MERLASENO � �d Number 101 Street HOZEPORT--DR. Villave:,`. HYANNIS = 2 COMPLAINT,INFORMATIONp jAgh,45 a Complainant's Name: ., NEIGHBOR Address: 0A r a Telephone Number:' Complaint Description: UN REG CARS— RUNNING HAIR BUS. RENTING ROOMS. ETC g{. s � X eA + . v Actions Taken/Results REFER TO P.D.LSO BOSTON RE HAIR ALSO TO R J. TO CHECK. � Al . Date Closed uC ,7 op� 0104.1 t � . . :..n - /r C> L� Town of Barnstable Op SNE Tp� Regulatory Services c Thomas F.Geiler,Director Building Division aARNSPA11M M'S g Tom Perry,Building Commissioner s63.q: �0 '°rEo w►p't 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fix: 508-790-6230 Approved: q Peer Permit#: r/ g HOME OCCUPATION REGISTRATION Date: C-=Z /O y /-�( Name: L Z c- . Qnk�L :�c 2 Vl�O( Phone#: Address: O o r 1 11 r Village: o Name of Business: , C U 4— 0 YY_1 7,�, ,. �n Type of Business: Map/Lot: 1f�0 y 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-truekmotxo,exceed-one ton-capacity,and one trailer not to exceed 20 feet in length and not to exc-e-ed 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,hav ead and agr ith above restrictions for my home occupation I am registering. Applicant: 4 Date: zh O Homeoc.docRev.5/30/03 TO ALL NEW BUSINESS OWNERS . DATE: `� (1L4 Fill in please: *tirt4 >✓��- IZ �i(L. APPLICANT'S YOUR NAME: iM - �xw��`�" `' YO�$�ME �PDF S, (D BUSINESS sir% TELEPHONE n� t.. i Telephone Number Home NAME OF NEW BUSINESS TYPE OF BUSINESS_ IS THIS A HOME OCCUPATION? YES O Have you been given approval from the building• ivision? YES N ADDRESS OF BUSINESS MAP/PARCEL NUMBER 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. Once you have obtained the required signatures, listed below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall] or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) and you will find the following offices: 1. BUIl,DING COMMISSIONER'S ICE This individual has bee '�formed f a permit requirements that pertain to this type of business. o ' eatu COMMENTS: 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: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must_get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FORA BUSINESS CERTIFICATE ONL Y.