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Home My WebLink About0072 ISALENE ROAD lel?.e 0 5 00 Qd b9 f. r --- { ,_--_ _._-- -_ ---__ �- -- - -- ----- --- J i Town of Barnstable *Permit# 7 y/o P�pF tHB tply�p Expires 6►c nths from issue date � 4AS• Regulatory Services Fee U a�txsrAet•E, = y XAM g Thomas F.Geller,Director t639• �� ^ �ATEc ru►�" Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ? Office: 508-862-4038 P ` '. "t �V ,, Fax: 508-790-6230 1— EXPRESS PEM-1 APPLICATION- - RESIDENTIAL ONLf' Not Valid without Red g Press Imprint C /3 Map/parcel Number Property Address. i ��11Value of Work - ��esideutial owner's Name&Address own _ � � �`�/�� • 5 / Telephone Number Contractor's Name Home Improvement Contractor License#(if applicable) r I Construction Supervisor's License#(if applicable) r pJorkmanis Compensation Insurance Check am a sole proprietor ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance V1 Insurance Company Name D Workman's Comp.Policy Permit Request(check box) aken Re-roof(stripping old shingles) All construction debris will be t ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maxim''m•4 ) *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner mus 'gn Property Owner Letter of Permission. prove t Contractors License is required. Signature Q:Forms:expmtrg Revise053003 of r Town of Barnstable h Regulatory Services s BABN rAISL& ` Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862 4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder .;as.Owner..of the.subject ptoperty. ._......._.. .: hereby authorize i to'act on my.behalf,. in all matters relative to work authoiized•hy.this building•permit-application for: (Addtess of Job) t \ 7 CJ Signature of Owner Date p&t Name TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ft !�®y Permit#W- n '� 6 P a Health Division V�V Date Issued Conservation Division .S� � �fee Tax Collector �� `�� ` A.R cation Fee F Treasurer a>�"ked in B Planning Dept. .,i., � � �, Y Date Definitive Plan Approved by Planning Board -''k � Z�� Approved By 4 Historic-OKH Preservation/Hyannis Project Street Address 7 L T_S di I e- °tti ". W°c..-S+ Hal Village s Owner ®W%Ck _ v S ex- Address S NIA( Telephone 9 7 8 - 95-Z - 9 8 2 i11 Permit Request 8' e- s- Am e i` r Square feet: 1st floor: existing X 9 proposed 2nd floor: existing proposed Total�ew ray. Valuation Cb Zoning District Flood Plain Groun ater 0\�51ay Construction Type Wo 0A Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure - PQ r;5. Historic House: ❑Yes XNo On Old King's Highway: ❑Yes D No Basement Type: X�ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ��C� s5 , fit-. Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing a new' Total Room Count(not including baths): existing es new First Floor Room Count Heat Type and Fuel: )dGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes C No Fireplaces: Existing New_ _ Existing wood/coal stove: ❑Yes boo Detached garage: ❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use r BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DE7SULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �✓ �� FOR OFFICIAL USE ONLY vi d PERMIT NO. �. DATE ISSUED MAP/PARCEL rYO. ADDRESS ' VILLAGE ~� ' �n �_ �•3� � OWNER r-i �•_yi DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: -ROUGH FINALS PLUMBING: ROUGH FINAL- GAS: ROUGH '''FINAL i F FINAL BUILDING } DATE CLOSED OUT ,r f •_ L ASSOCIATION PLAN NO. w �„ n The Commonwealth of Massachusetts _ - Department'of Industrial Accidents ?� Office of Investigations .� 600 Washington street, 7` FZGGY Boston,Mass. 02111 Workers'lA Compensation Insurance Affidavit:Building/Plumbing/Electrical Contractors 'R�it� _.a c�--v ..w^ `�.��°'. "'n: - ^.ter^:-:xc. •.�'s':'PJfi c. .� 'h�anfitlla(iain:}. t' name: `� �—+ address: [] 2- �►-5 Q CO. ✓1 [� '�l�s ?-672- phone `�'��-��Z city T I l�/Q d1/1 f S h state: zio• work site location full address): I am a homeowner performing all work myself. Project Type: ❑New Construction embdel ❑ I am a sole Rroprietor and have no one working in and capacity. ❑Buildiri Addition CC��a�::M"'�*� :±':Ni_• 't:",r;:.SY.?'';; `<k..i;. ..�: "!�9'.i+. 3'!(°•` iG. =""w."?� .c,i ;1:;&— 'A.. .•d;v:: _ 4:;J?... f,......'��:�_ ... ..t.o. .a,°..�.�;??:..l',..at_ •7 - �rw Building Addition :...;>. ❑ I am an employer providing workers' compensation for my employees working on this job. , company name: address city: phone#• insurance gco. volicy# :. '.4�Ye:Gitab:,. •.xa^'�r�ui 3,eFa�^ '"b:...:..'::t� � '�4.+,,.;r: - .f.- ,s. d ...x..s.2R:u:5>�.a :"�.':4;:.:i'x2'.Gr.4'.:F�i:.:.. '::e .. ,,..... �, ?4�si�A'?-��_tt_:�;�i• :,L'� ' ,r��::^,:.. ,�::.r��_:�y�'; ':.�; �ti.;'c I am a sole proprietor,general rcontracto ,or^homeowner(Oircle one) and have hired the contractors listed below who have the following workers' compensation polices: company name address city: phone#: insurance co. policy# w. �,�,,.,..p.,....,..�..: ,. ..t. ,., �.,.:1�,.: ...�' .,..•s.,.,,�,,,E ,.. r- ;.�;,:: ';.e�. r;f•.., ,.,.5:�:.:-nd�•:1,� ati: rr,.. -,v-•. -company name' address- city: phone M insurance co. 1DONCY# `'-��F'r Y -ii'Cl• ",.'?i7wrs"+':�'::�� S>s�<.(Y:-J�:��C'ro��aY' tf FF dd�t�o4�a}:QQ1�eet'i }}��eceQsary qry�• n. �. _ TWt �. .... �..�.u. .-x....4.�f:�.,....5... .'.i1• �*�% n' �iTb�Fi.��l�i'� �� •'F7' �r'�P .':.�.�ii� dJ;f.y��lT C i�.+..:.P�'1J„A::Y.w'..-".Y .'�-�.`•i��T3.'r;'+i`[+i4;�•�uv''�j�.Y.e.:Ji'.,we.Wr` Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be f ar d to the Office If Investigations of the DIA for coverage verification. I do hereby certify under ai and penal es o pe ' t the information provided above is true and c rrect, Signature Date Print name nit C Phone# =officelialy do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑check if immediate response is required ❑Licensing Board ❑Selectmen's Office contact person: phone#• []Health Department (revised Sept.2003) ' ❑Other r Information and Instructions 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. . 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 section 25 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, 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. � e '�` c q�q;:;p, !!', 't.: -w.ri.�TAXp': ..,{�:��s�.;s"s,'q,�r�7r%• �°a?:� ':r,'.'tV6aax�+? r:x,ErswR.Y;•."Jh';r�;�4:�;:t>..« '�;, ,� ''"�d''7�' . .i .. .:. �. _�y..s::��"'t� r•.. .��'^` '�a'�.-�.-�,';• ,v;- � ..x� .`y:. e.Ly gip` yg •. � �.. Applicants Please fill in the workers' compensation affidavit completely,by,checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. w:+.. g'. f'.:'4 , ;'._vt�^�fr^t'•.i. ".' .., _ry ,K:=,,rrttaa,,,, `?'Yc?rL•c'.r'46: ::r N"t�",�,: .,�d:P:':=^' i"•.T..i§.�D' ':re :. .;�i.:.,AV ..;7;.,:`u.-•:,,„ .�rx .f';:. r ';t(+ t d"Gs$x •p ,...::^.:'f: ..' t� ^?<. .-..:. r .?.�" "t;mi. ,;. .A..:,S• t.. p.p.rF7.• L'z...�e `7t3' '• ;'3' .�i.,.t.'�F.:l.^, ..R7:. .�;.. x., :. .k-r an "' {.: t�' �.£,%aP,`:J•:.:., t ..y,?"F�,`','''.r.1.. < •,. }�... r`.'-�A .;c. $'�rt ror.,.a.fa�,<'dpTr:{ Qh�., .<w 3':�.,:':". sk+..S`<�M� -.6 ,,c?:.., ..�: `•, � a:' .y 4' '� � � 1 'd k � da o-1 '�%'M'0� } K,t t.0 �"^::e re •i 4 } �y55;� i W ..f• TF# f7T � *{MF � 'Ri+ev. F 4 r 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 sv-re to fill in the permit/license number which will be used as a reference number. The affidavits may be returned 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. r _ �/- ,,..r. _{ S ,�q�•,,F_' �+riA'. tY.. _ t^v'2cA� `3;k-lit``•:4..M 'sSi6` :'ik':x?iF<'.:Q7e«�-..yp :.e&!r`yy.,}a'�'b%%M�'.r..'.ii.gc; :-f.ir:. ..�,..:IR^:. `` i � 4J i Y �lvC:',Sy 'Ri::a,. WA'.... (4.r T�''vP•. :�: 1• y �'Y.'1'n8�: .F �h yi' �f� w'1vv t:.F�. •:�1?' :..r-'r.,f-.._ �:�Y: .Jv.":I+'. .� .A':Yc �'db1'Fi'�i`:f.}::.�� .f",r.F"n�h:r'�'e. .6 'L,.}it:. �.tfR.Jy�'�x t!w.r:.e ..q_ - :.)_••�� it .fi+ r i�� ::cl'L fr 1_ ,N..... -:. ..:.a.a. i:. .,'r.t... .. •'�!.' "-,o•:,' fr'+,�}if P.'t .:-b...;. .i,�;:`� m".F ^:'P:s'.'4.a r a.c:tb• ,,�.:r.s°:k• ..4.. -.{,:,':.+,. .`?3 s:,.:.��. :�t..... -'bs !�,• :a �,ro?;;+bhp;:.^.".c': ..9'1'!'s'i��,:,.:.n 'r''-'t• vex �_ ,gyp, t:.:� 4«.j�••i'�t5S:+ � •hP•W".s'b•`�akr�•'r •'�:,'.�.y:`.4f' �'1••^'.e4k�" �7-'14 �v:U#.'�f _7�i 4.a*dfirvnxiyrkY. €',.e«na..'�'F.e any..:,wv..w'is2'{.iv3•..crkt�'kF,in,T�...i-r.i: is..:,.�:.:..Jn.Ui k.k,5.,7 •.`9. `im.: The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents' Office of Investigations 600 Washington Street,71h Floor Boston,Ma. 02111 fax#: (617)727-7749 p � ) hone#: 617 727-4900 ext. 406 OF1HE r Town of Barnstable Regulatory Services ` MASS i.e Thomas F.Geiler,Director sbg9. `0� ArFD nnv't" 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 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. r Type of Work: esN a Cat Uyl Estimated Cost ` 01 O Address of Work: / ?_ Ts cd e ,n e_ S+ . Nde_s� o?-6 7 Z Owner's Name: ci� Date 6f 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 Owner 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 apermit as the agent of the owner: Date Contractor a Registration No. Date O s Name Q:forms:homeaffidav Town of Barnstable o„ Regulatory Services BARNSTABM Thomas F.Geiler,Director MAM 039. .�� Building Division Ar�p��p 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 Please Print DATE: - JOB LOCATION: Z .1s c� e✓1 P_ � e.s �0( -1) �number ��( street �i^� �/. village /� 7 c� 7 Q l.� "HOMEOWNER!' V1 D Wt a_S 1—1 us e-1— 9 7S`—�,�Z' 3r O G`7 '7 O O —7! � � name home phone#�+ work phone# CURRENT MAU-ING ADDRESS: 7(� C 2— �D VN Q 4— cam±. a , A t 9 Z. 3 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 suuervisor. 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' pe -on procedums and requirements and that he/she will comply with said procedures and requirem is ature 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. hTo ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, h 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:homeexempt 72 Isalene Street, West Hyannisport 02672 Basement/ 1st floor - New Bathroom 40 22 Existing Wall Bulk Head New Bathroom _ New Wall Bowl 1 Vanity 2 � S O O Shower S fit'eAJ�'