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Home My WebLink About0583 IYANNOUGH ROAD/RTE132 .-�- � Jam, z _ _ _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 11A Parcelµ \ -Application # a�-t Health Division ; Date Issued L Z- Conservation Division °71 Application Fee Planning Dept. _:. Permit Fee Date Definitive Plan Approved by Planning Board / Historic - OKH — Preservation /Hyannis Project Street Address Village "d4 k)(S n nA Owner JU 0"i o Address I( tqp�Q_tV4�, Telephone rc�� `�2 Permit Request , G Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation '9C Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq:ft) r a V ; '-D Number of Baths: Full: existing new Half: existing - ne\ r Number of Bedrooms: existing _new Total Room Count (not including baths): existing _ new First Floor Roolount Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other $ co M Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 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, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name `L Telephone Number Sa (d l o License # LA 1601 Actress Mkt s Home Improvement Contractor# Worker's Compensation # P40 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE tb`� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: -FOUNDATION - FRAME INSULATION' ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'GAS: ROUGH"" "'. '' FINAL 'FINAL BUILDING`'- DATE CLOSED OUT s ASSOCIATION PLAN NO. j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 c www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/PIumbers Applicant Information Please Print Le0bly Naive(Business/Organization/Individual): Address: 4N City/State/Zip: �Q Are you an employer? Check the appropriate box: R7. 0 roject(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I w constructionemployees(full and/or part-time).* have hired the sub-contractors 2.[� I am a sole proprietor or partner- listed on the attached sheet. tmodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its i l i repairs or additions t❑ Electrical required.] officers have exercised their 10. s 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1..❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.V Roof repairs insurance required] t. employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information: I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby certify under the pal c of perjury that the information provided above is true and correct Signature: Date: Z. Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Phimbing Inspector 6. Other Contact Person: Phone#: ` e Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"..,every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association, corporation or other legal entity, or any two or more 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 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 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"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 (Le. 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: . r The. Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Wasl ington Street Boston,MA 0.2111 Tel. # 617-727-4900 ext 40.6 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.m:ass..gov/d.ia P , jHEr, ti Town of Barnstable +. Regulatory Services ucrxsresr..E. � � �* Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstab I e.ma.us Office: 508-862-4038 Fax: 508-790-6230 f - Property Owner Must Complete and Sin This Section �.i P g n If Using ABuilder I as Owner of the subject•property hereby authorize A)-"M to act on my behalf, in all matters relative to work authorized by this building permit application for. ( dress of Job) Z 2 Z of Signature of Own r Date lv� 06( Print Name ' If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of Barnstable THE w� y� 0 Regulatory Services Thomas F. Geiler,Director ? NUM 16sp- -R, Building Division PlFOj Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA 02601 Rww.to wn.b arnstab l e.ma.us Office: 508-962-403 8 _ Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPT ON Please Print DATE: <' JOB LOCATION:_ number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: eity/town state zip code r The current exemption for"homeowners"was extended to include owner-occupied dwelliilu 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. DEFU=ON OF HOA2EOVrrj\ER Persons)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 constrrlcts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"'Shall submit to the Building Of5cial on.a form acceptable to the Building Official, that he/she shall be responsible for all such work performed imder the building?permit. (Section 109.1.1) r 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 r„i„iT,-,utn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official - f' 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. HOMMOWNER'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 1D9.1.1-Licensing of construction Supervisors),provided that if the homeowner engages a persons)for hire to do such work,thath Homeowner shall act as supervisor." 71 11y homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supavisors,Section 2.15) This lack of awareness bft=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 licrnsed Supervisor. Tbc 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 hDmeowrier ratify that hrlshe understands the responarbilities of a Supervisor. On the last page of this issue is a form currently used by scvcral towns. You may care t amend and adopt such a fomr/certification for use in your community. Q:fDrrns:homccxcmpt i� ll(I lKhusetts- Department of Public SxfetN BWIM of Building Regulations and'Standxrdti Construction Supervisor License License: CS 46443 WAYNE L PADDOCK 110 SAWMILL,RD MARSTONS MILLS, MA 02648 Expiration: 5/11/2013 ('unmiis'siuner Tr#: 5809 4S TOWN OF BARNSTABLE SIGN PERMIT - PARCEL ID 311 044 GEOBASE ID 23036 ADDRESS 563 IYANNOUGH ROAD/ROUTE PHONE HYANNIS ZIP - LOT 245 . L BLOCK LOT SIZE i DBA DEVELOPMENT DISTRICT NY _PERMIT 52374 DESCRIPTION BOURNE VISION CONSULTANTS PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: P ARCHITECTS: Department of Health, Safety and Environmental Services i TOTAL FEES: $10.00 BOND $.00 �tNE CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE , Qi► * BARNSTABLE. # MASS. 039. A�O� FD M1►1 BU DIN 'DIVIS ON B Cam. DATE ISSUED 03j26j2001 EXPIRATION DATE - � ' � RECEIPT DATE No. 8112 RECEIVED FROM w ► - ` � �� ` 0 1 ADDRESS DOLLARS $ u FOR / �y✓>.•r .✓/''G .r �/�Y�t +' �..C /�rL� a±+i AMT.OF CASH IR�I�►► ACCOUNT I AMT.PAID CHECK BALANCE I ORDER I BY �..�f''ffi✓'s..-".�" '--` r Town of Barnstable *1HE A Regulatory Services Thomas F.Geiler,Director _ L 9' MASS.$ Building Division - 059. �ArED MAC a Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit Applicant:/-'�)A'; )5191-a4 & ; /Zle-Ag� Assessors No.,� '�c�c�/L.v� UtJ"lOvtO Doing Business As: , , G �✓ u c_ r't•yT� Telephone No. Sign Location Street/Road:: /62 G Z e�, C- / Zoning District:�Old Kings Highway? Yes/layannis Historic District? Yes/l o�� Property Owner iva ne: _Telephone: Address: ( Z Village: AA-I,> �� s 1 ✓J - Sign Contractor Name: Telephone: Address: Village: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. d 1Je R Is'the sign to be electrified? Yes (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. / 4 Signature of Owner/Authorized Agent: Date: 0 3 / /,/C,/ Size: Permit Fee: Sign Permit was approved: Disapproved: Signature of Building O ficial: Signl.doc rev.8/31/98 s /h�j Pi's I C� f 71 Aft i c .. a2N4 \ \� � 2 Ng J O 0 ® 22':_ r� A , 00 , o q 1 a �5r4 '�. LP-ASED r 1 HEREBY CERTIFY THAT THE STRUCTURE, SHOWN HEREON, PLAN SHOWING STRUCTURE WAS LOCATED IN THE FIELD ON ON �4r,�1i,. Z9� 19Q/. ea- IN Q.t c.� g(34STERED LAND SURV OR ��.e,�.r`%fi'C;9 �y�„4/,y/� MASS. • o /' , SCALE - Im -'rO DZiE ! �`1N Of 1(4 DAMES 4�� c 7 7✓ CAPE COD SURVEY CONSULTANTS w LAPSLEY, '^ ROUTS i32 FolsTsl' ' HYARlNIS i MASS. do sum