HomeMy WebLinkAbout0034 LAFRANCE AVENUE �� ,la �.
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Application number.. � T
Fee .&.....�.1�..1..:.. ................................................
V4
Building Inspectors Initials.... .......................
sk AUG 2 6 2019 �I ��
Date Issued:........../,�....9.....11...................................
p/ el..4�,.).w ...t..V....!... ..
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: _ Y
NUMMgR STRE VIL E
Owner's Name: . (,( Phone Number T - 30, �
e-A
Email Address: 64Ptell Phone Number
00
Project cost$ O r� Check one 'Residential ' Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize C C ,✓'
to make applicati f a b "1 ' g Rermit ' a c ance with 780 CMR -
Owner Signature: Date: "� 1 i
ci
TYPE OF WORK
Siding ❑ Windows (no header change) # ❑ Insulation/Weatherization,
❑ Po6ors(no header change)# Commercial Doors require an inspector's review
ID'Roof(not applying more than 1 laye of shingles)
Construction Debri&will be.going to L.A
kn14
CONTRACTOR'S INFORMATION
Contractor's name G� S. Op ZJ
r• �
Home Improvement Contractors Registration(if applicable)# �Q (attach copy)
Construction Supervisor's License# 11.�� (attach co y)
Email of Contractor CA "PhKon e numb r Y3 q,3
ALL PROPERTIES THAT HAVE STRUCTURES OVER 7 EARS OLD OR IF THE JECT PROPERTYIS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
z .y
APPLICATION.NUMBER.............................................................
*For Tents Only*
Date Tent(s) will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X , X. X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
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
Fuel source being used LP tank 20 lbs. or> Yes No___, if yes, a gas permit is required.
Natural Gas Yes No , if yes, a gas permit is required.
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
HOMEOWNER'S LICENSE EXEMPTION
s .
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 CMR 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
OLICANT9S SIGNATURE
Signature Date
All per lic Uonare subject to a building official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
i
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): 010 1 b1A Ct rA Ui,
Address: �®
City/State/Zip: Phone#: �� SIT
Ar you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).*. have hired the sub-contractors 6. ❑New construction
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, ❑_Demolition
workingfor in an capacity. employees and have workers'
Y P tY• 9. ❑Building addition=
[No workers'comp.insurance comp.insurance.t
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing,all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption pet IVIGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no t
employees. [No workers" 13.❑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.
;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'comp sacion insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: J Expiration Date:
.3 Job Site Address: t City/State/Zip: .
Attach a copy of the workers' compensation policy declaration page(showing the policy nu er and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine 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 ainst the violator.-Be advised that a copy of this statement may be forwarded to the Office of
Investigatio of the a cove age verification.
I do hereby c rtt er th pains d nalt' o 9'-that the information provided above is true and correct.
Si an afar �' Date: Val
Phone E-2
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.Plumbing Inspector
6.Other
Contact Person: Phone#:
f
sit. c�
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-contractor(s)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
(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 Comnianwealth of Massachusetts'
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-7274900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
Jan. a. 2019 9:44AM No-: 1551- P. i
A00MY CERTIFICATE OF LIABILITY iNSURANCE na s1n
la
THIS CERTIFICATE IS i33uED AS A mATTER OF INFowAvON ONLY AND CONFERS NO R10HYs UPON THE CERTIFICATE HOLDER.THIS
GERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED$Y THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCIE DOES NOT CONSTITUTE.A CONTRACT BETWEEN THE ISSUING iNSURER(S),'AUTHORM
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .
IMPORTANT: If the ceMf mte holder is an AADiTIONALINSURED,the pollcypes)must be endorsed. N.BUBROGATiON IS WAIVED,rudjeetto
the ferns and conditions of ft pola)I,eettaln pollctae may require an endorsement A statement on this eeAificate does not canter rights to the
certificate holder In lieu of such endorBAnte s.
PRODUMR Benson Young&Dawns Iris SLWAcr Kathy,Jones
59 Havilami Street PHONE (sea)432-1478 FAX 50 4301532
Po Sox 558 t4ftkahAones6BYertd0.tmm
Provineetown MA 02657-0559
"uTd Insurance Co 2390
Paul COlburn
PO BOX 608
Truro MA 026OB-.
COVERAGES CERTIFICATE NUi IRM REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF 11 RiANCE LISTED WS-OW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD.
INDICATED- N07VdTHSTANDiNG ANY REQUiREMEO.7SW OR CONDITION OF AMf CONTRACT OR OTHER DOCUMENi WTTi RESPECT TO WMGH THS
CERTIFICATE.MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE A fPORAED irY THE POLICIES DESCRIBED HERE[N IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICfE&LWIS SHOWN MAY HAVE BEEN R_FOUCED BY PAID CLAIVZ.
aaucY POLtcYtato-
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CERTIFICATE HOLDER C CEL LAT10N AI CS5287
_ SROUIP ANY OF Tt(E ABOVE CESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATIONDA'm YHEP8QF,NOTICE i ALL BE OBNVERED m
ACCORDAi M NfiiH WE POLICY PROWSIOr -
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-- MA 42666-
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1988-201000RD COLORATION. All rights reserved,
ACOR0..26 12,014101) The ACORD namm and Iogo are'reOW"ed marks otACORD
Commonwealth of Massachusetts
Division of Professional L'icensure.
Board,of 8uildmg Regulations-and Standards
Consknod l� {�Ip gvisor
^�~ fires: 10/28/2022
CS7113102 �p
LUCAS,P CO�BURN
m OAK STRE& y C
HARWICH MA f02045 ` r'
i
Gornrnissioner �y
i Office of Consumer Affairs&Business Regulation.
HOME.IMPROVEMENT CONTRACTOR
TYPE:Individual
Registret �N Expiration
10368 08/06/2021
Av
} LUCAS P.COL RN
� 111
LUCAS P.COLBURNry
269 OAKST v! � ,r�.alCG.(,,e40i ;
HARW ICH,MA 02645 Undersecretary
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map_ �ll✓ Parcel Permit#
Health Division /ep__ 'IJ/,y Date Issued
Conservation Division F EJ P T ® � &V
Application Fee
Ta�Collector Permit Fee
Treasurer
Planning Dept. CONNECTED A .0 IT
Date Definitive Plan Approved by Planning Board
Historic-OKH WA Preservation/Hyannis C
Project Street Address
Village
Owner Fggl_? cAJA-PAS A ess
Telephone 4�20, 7'7/— 5>
Permit Request L. �' FJ 're
7-1
AL
Square feet: 1 st floor: existing roposed 2nd floor: existing proposed F' Total new 4�
Zoning District Flo Plain /� Groundwater Overlay
�•, o
Project Valuation C struction Type
j.
c`n t
Lot Size .b 2 randfathered: ❑Yes ❑ No If yes, attach supporting mentatkfi. a
C zt
Dwelling Type: le Family Two Family ❑ Multi-Family(#units) p /
3
Age of Existing Stru re L' Historic House: ❑Yes No On Old Kincra
g's Hi way: C�es No
Basement Type: ❑Fu Crawl ❑ alkout Other Af h
Basement Finished Area( ) /�� Basement Unfinished Area(sq.ft)
Number of Baths: Full: existin e9 new Half:existing new 0
Number of Bedrooms: existing_ new _ I
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Gentral Air: ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove: O Yes- 4NO
Detached garage:❑existing Xnew size Pool: ❑existing ❑new size am:❑existing new_size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial El Yes --)4-No if-yes,site plan review#
Current Use � ,Li(—Proposed Use
n
1,(1',4
BUILDER INFORMATION �-7Name �c .P -%T Telephone Number ' / ��
Address Z—A License# Zilk
Home Improvement Contractor# N
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO T'/
SIGNATURE . � ,G�� DATE
FOR OFFICIAL USE ONLY r he
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO. 01-0
r r
ADDRESS - VILLAGE -
OWNER
DATE OF INSPECTION: ? , ,
FOUNDATION ; r
FRAME
INSULATION `' r
FIREPLACE { r
'yr R
ELECTRICAL: ROUGH 0 FINAL +, ,
PLUMBING: ROUGH n FINAL`-
GAS: ROUGH FINAL
_ 1
FINAL BUILDING �
DATE CLOSED OUT
ASSOCIATION PLAN NO. f+
t
f -
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE ,
New Buildings $100.00 f b
Residential Addition $50.00
Alterations/Renovations $50.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
are feet x$96/sq.foot= x.0041=
plus fromFbeow(if applicable)
ALTERATIONS/RENOV TIONS OF EXISTING SPACE
square feet x$64/sq.foot= x.0041=
plus fro elow(if applicable)
GARAGES(attached&detached) V
square feet x$32/sq.ft._
l x.0041=
ACCESSORY STRUCTURE>120.sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf-1000 sf 75.00
>1000 sf-1500 sf 100.00
>1500 sf-Same as new building permit: x.0041=
square feet x$96/sq.foot=
STAND ALONE PERMITS
Open Parch x$30.00=
(number) ao
Deck _x$30.00=
(number)
Fireplace/Chimney x$25.00= .
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00 6�
(plus above if applicable) g
Permit Fee
Projeost
Rev:063004
J
Town of B arnstable
Regulatory Services
Thomas F Geilerj??rector
Building Division
TomPerry, Building Commissioner
200 Main Street, Iiyannis,MA 02601..
www.town.barnstable.ma:us
office: 508-862-4038 Fax: 508-790-6230
Properly Owner Must
Complete and Sign This Section
If Using A.Builder
Ep vA
PA-5 as Owner of the subject ro eI, l � property
rty.
hereby authoriip-: to act on mybehalf l
in all matters relative to work authorized by this building permit application for;
(Addidss of Job)
G Signature of Owner Date
Print Name -
ICJ�7e 7- l a�/ - Y n✓< d 6 y
l rtJ
` ! W ra o rr� , G oY !� E'er t J6r
g/a 2 /7`
�it9 C:I•w7 p'A d.� f �l5�.i=.s r*•
4 �cvsl, rr ti r s l vldG L ira::� <o is'I '.$ s
_ rock.
7 t•i c
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On
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C. n Y
c•�a 7`/� '. a le, f;:S 21 a ."
/
OF V'i or
FRANK FRA1W�
-+ SG
` = CONERY H CONERY y;
0
Na 6232 4 ,Q Na 6579 Q I
a
TFyOt ' o�Fs/ST��� ��!
sURY� �� ,{ FSoMAL�aU
PLAN- OF . LAND
O OWNED 6Y
Al. :J e We kv.
FRANK -CONERY 5 •TRENTON 5T.:
HYANNIS, MM; 02601
" I�Ciis?iRRO!(GiNI'cQ!!4 LJWD SVpVE1'Mi
--- wAaaAa"u6n"owraawtr osW nowvmwlw.(Loge FORM)an
5047ioeAOE 2%
1 DENNIS E. NELSON, an individual, 53560
of Marblehead, Essex County,mmad men
�.�
being aawroeied,for consideration paid,and in full coasidecadw of
------ SEVENTY-FOUR THOUSAND NINE HUNDRED and no/100 »-«----- (574.900.00) DOLLARS
g t to FREDERICK W WADAS, JR., an individual,
the tend in Barnstable (Hyannis), Barnstable County, Massachusetts, together with the
buildings thereon, bounded and described as follows:
mmdpft ud mambrc,if a4)
PARCEL 1
Beginning at the southwesterly corner of the land to be conveyed at the
northwesterly corner of Lot 13 on a plan hereinafter mentioned in the easterly
line of a roadway sh-jwn on said plan; thence easterly by said Lot 13, one hundred
(100) feet to land now or formerly of Eric Rosengren; then northerly in line of
last named land, sixty-two (62) feet; thence westerly by land now or formerly of
Thomas Morgan, one hundred (100) feet'to the easterly line of said roadway; and
thence southerly in said easterly line of said roadway, sixty-two (62) feet to the
point of beginning.
Being Lot 14 and a strip two feat wide from thw southerly side of Lot 15 as shown
on said plan. i
PARCEL 2
Northerly by land now or formerly of Cranston H. Montcalm, at ux, as shown on
said plan, one hundred (100) feet;
Easterly by Tsnd now or formerly of Eric Rosengren, twenty-eight (28) feet;
Southerly by land now or formerly of Helena M. Moser, one hundred (100) feet;
t
Westerly by roadway known as LaFrance Avenue, twenty-eight (28) feet.
Being the Southerly portion of Lot 15 as shown on a plan along with Lot 14 and
a strip two feet wide from the southerly side of Lot 15 entitled: "Resubdivision of
land in Hyannis. Barnstable, Mass., property of J.A. LaFrance, Scale 1 in. - 40 ft..
July, 1927, George F. Clements, Civil Eng'r., Hyannis, Mass." said plan recorded with
Barnstable County Registry of Deeds in Plan Book 21, ,Page 63.
M
Subject to and together with the benefit of all rights, rights of way, easements,
y� reservations and restrictions of record, if any, insofar as the same are in force and
applicable.
For title see dead of Eugene investment Corp. to grantor recorded with Barnstable
w County Registry of Deeds, Book 4104, Page 341.
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F.W. SHEET METAL.WORKS
34 LaFrance Ave.
Hyannis MA 02601 i
( Iadiv&d—JowTeaub—TeombinCommon)
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I-CEFMFY THAT.THM MAN SHOWS
THE ACTUAL i..00 TION OF THE
STRUCTURE -ON THE LAM AND
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THAT IT CONFORMS V"Tti �!
BY-LAWS OF.THE TOWf4
F SHE Tp�
The Town of Barnstable
g Regulatory Services
�a39. �e
o► .y. Thomas F. Geiler, Director
Building Division
Peter F. DiMatteo, 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: �A-���E/5��� �� Estimated Cost ��82�
Address of Work: 3�4 `A ERA-AJCE 4 uf-
Owner's Name: -rfeEp IVA
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
E]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 a permit as the agent of the owner.
Date Contractor Name Registration No.
OR
1.5-
k 5-
Date Owner's Name
q:forms:A ffi dav:rev-070601
Town of Barnstable
Regulatory Services
t Thomas F.Geiler,Director
1ARNSTABL&MAM
•
r
9q, 0 9. �.�' Building Division
ArfD �a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: ` - S�
JOB LOCATION: _q�—' &.4 lky:— 'I/,4-.AJ Aj 15
number street village
"HOMEOWNER': 24Z 7 s
name home phone# work phone#
CURRENT MAILING ADDRESS: S /�f E A cS . '4801'1i�
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
inspection procedures and requirements and that he/she will comply with said procedures and
r irements. / >
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,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:homeexempt
- The Commonwealth of Massachusetts
JA i Department of Industrial Accidents
Office of Investigations
600 Washington Street, Th Floor
Boston Mass.. 02111
i ,
Workers'Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors
35'a.•�Ta° t:�:'+ r" .'!ate �: a -'� P,� -:s'x z
A pll in�i ma i'ona `,'. a x y�::, r.1 +B P 2I�11T? W isr*. � ,4",4V a.�.� "r'��.�x��:�,
name: 1 p-E� (�,A 12,4'5
address: 13� I—t4"EXA-A)Ce 4v&-
cit /v AJ t S state: I hone#i 7 / IJ49
wok site location full address):
am a homeowner performing all work myself. Project Type: New Construction❑Remodel
❑ I am a sole roprietor and have no one working in any capacity. ❑Building Addition
❑ I am an employer providing workers' compensation for my employees working on this job.
coin anv name:
address:
city: hone#•
insurance co. Q0liCV#
❑ 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:
company name:
address:
city: _ phone# '
insurance co. Dolicy# ;
3,. `M" 'ya!
company name:
address:
city: hone#:
insurance co. olic #
�-
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 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$100.00 a day against me. l understand that a
copy of this statement m be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and/penalties of perjury that the information provided above is true and correct
Sign re l� � _ Date
Print name �Nr C PI e—& 6(451 0 Lf ! Phone# 21 Z . 6d 960'2'�
official use only 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
❑Health Department
contact person: phone#; ❑Other
(mvised Sept.2003)
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.
4
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.
Ir
1`05 „. - �w.°4'EV, , 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 sure 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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street,7t°Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone #: (617) 727-4900 ext. 406
U /lYo
i
bA.-) /die
�t► t�,,,�� Town of Barnstable
s
0;r-
Regulatory Services _
` BAMSTABIX Thomas F. Geiler,Director
Building Division
Thomas Perry,CBO,Building Commissioner r
�r 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-190-6230
April 12, 2005
Frederick W. Wadas
34 LaFrance Ave.
Hyannis, MA 02601
Dear Mr. Wadas:
This letter is in regards to your application for a permit to build on your property at 34 LaFrance
Ave., Hyannis. The plot plan submitted with your application package shows an existing garage on
the lot to the rear of the house. In viewing this structure this seems to have been converted into
something other than a garage. The building department has no record of this conversion,taking
place. Can you please clear this up?
In regards to your submitted permit application your plans show that the proposed garage has a
second floor storage area. This area shows a bay window, full dormers and a full deck off the
second floor. If this is truly a storage area why are these design features necessary? Please
enlighten us as to what the purpose of this area is. Thank you.
Sincerely,
Thomas Perry
Building Commissioner
TP/A W
�FIHE Tow Town of Barnstable
Regulatory Services
BAMSTABLB. ` Thomas F. Geiler,Director
9�pr 16 9 g
6. Building Division
eo,ua�
Thomas Perry, CBO,Building Commissioner
` 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
April 12, 2005
Frederick W. Wadas ,
34 LaFrance Ave.
Hyannis,MA 02601
Dear Mr. Wadas: w
This letter is in regards to your application for permit to build on your property at 34 LaFrance
Ave.,Hyannis. The plot plan submitted with your application package shows an existing garage on
the lot to`the rear of the house. In viewing this structure this seems to have been converted into
something other than a garage. The building department has no record of this conversion taking
place. Can you please clear this up?
In regards to your submitted permit application your plans show that the proposed garage has a
second floor storage area. This area shows a bay window, full dormers and a full deck off the
second floor. If this is truly a storage area why are these design features necessary? Please .
enlighten us as to what-the purpose of this area is. Thank you.
Sincerely, {
Thomas Perry ,
Building Commissioner
TP/AW
TOWN OF BARNSTABLE Permit No. ------% }-
-Building Inspector
saaan►tii Cash - —- /
■ua • ,;,
1i
OCCUPANCY "PERMIT_ Bond
"No .building nor structure shall"-'be. erected, and no land, building or structure shall be
used=for a.new, different,..changed, or 'enlarged'. use without a Building Permit Aherefor
first"having been obtained from.the"Building Inspector.No building shall be-occupied until a
certificate of occupancy h'as been issued by the Building Inspector:"
Issued to `Ailit--pony Dedeic o.- �- . .,..._. .. ..Address B.ox 367 y CenteYVille y 1A
34 I?aF-_rane_e•1k enue. 11aann1 s -
Wiring Inspector" � ;. --, Inspection date
Plumbing Dispector' � � Inspection date
Gas Inspector r, 'Inspection date
f%. .-
.'Engineering Department !' '" Inspection date
r /'tG �/1�1
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON "SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
... �. .. i 19 ... ..Buil�m`g Inspector'
b
YE H ON E 775-6764
FRANK CONERY
REGISTERED ENGINEER
REGISTERED LAND SURVEYOR
5 TRENTON STREET
HYANNIS, MASS. 02601
June 20, 1979
Town of Barnstable
Main Street
Hyannis, Mass. 02601
Gentlemen:
A test pit and soil analysis tests were made on
Lot #14 on April 26, 1979, with the following results.
011 to 1211 Loam
1211 11 1441I Sand and small stone
No ground water at 144i1.
Soil analysis
3% Moisture
12% Retained on #4 screen
0 11 11 it38% 1, 1 0 11
Ao
5% " " 9200 "
if Passed a #200 screen
The Commonwealth of Massachusetts State Building
Code in Section 723.2 presumes a supportable bearing
load of 2 to 4 tons per square foot for soils in the
above catagory.
The building to be constructed on this property,
including dead load, live load, wind load, snow load,
etc. will weigh less than 4000 pounds per square foot.
I hereby certify that 10" foundation walls with
no footings will be adequate.
Very t'luly yours,
Fra' Cone PE
Copy to :
Mr. Anthony W. Dedecko
148 Park Ave Box 367
Centerville, Mass . 02632
'`"• �Assessor's ma and' lot num 7 ,
r y T E
Sewage Permit number .... .......... ..........................
Housenumber .................. ....... .............................. �
E MAI
TOWN OF BARNSTA GU CODE AND
EGUt APONS
BUILDING INSPECTOR-
APPLICATION. � f 1
APPLICATION FOR PERMIT TO ...... ...4 ...... .....................
TYPEOF CONSTRUCTION ....................... &. ..............................................................
�... � ...............19.�.ef�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ............. /g.!4. 4' ......* .C. ..... ".....ff ....... .........................................
- .
ProposedUse °......................................................................................................
ZoningDistrict :.......................................................................Fire District ..............................................................................
Name of Owner !11 M1a.�N.••r .�1� ®...Address � .7A �
....... .......... .... ......... ........!;41��qA,!�!�..C_
Nameof Builder ...........,,�l �!''l. ............................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
do
Number of Rooms .......... ............ ..��..............................Foundation ......................'�. .Q. .,T ........................
Exterior ............. ..........Roofing
Floors �-1.........................................Interior L(/ (l ae
Heating .......... ..............................Plumbing ..............(....... f!
............................................
Fireplace ........................ .... rsi+A'............................................Approximate Cost ...... ...:.. ®.�................ ......
Definitive Plan Approved by Planning Board ________________________________19________. Area Yr�9 ..S.�.f......
Diagram of Lot and Building with Dimensions FeeQ.................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
7
�a
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Nam ....................................... ...........
Zedecko, Anthony A=269-47
AV
• No .1.21400... Permit for ...I..rtory-dwe-1.1-i-ng
elzlj.........................................................................
Location ....34.-W-rance Ave;Ave;.........................
............................................................................... •
J�
Owner ......An-thony..Dedeek-o...........................
Type of Construction ............Woocj....................
...............................................................................
Plot ............................ Lot ................................
Permit Granted .............Jjane. 26:-n.-t......19 79
Date of Inspection ........................... 19
Date Complete,
1A.......
PERMIT REFUSED
...........................................................0....... 19
4-1
........ . ...... . ................
......... . ...... . . . .. ... . ........ ........
......... ... ... ......
M
........... .... . .... ................
0
Approvel 0-.0 ........... 19
W
............m. ......S.......................
............................................ ..................................
M ,
Assessor's-map and lot number-�. .......... . ..... ........� .. � �tee r
�o o�
Sewage Permit number S.......................................
Z BAUSTADLE. i
House number c MAM
39, �0
TOWN OF ' BARNSTABLE
.4. BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .......
t..r :;.ir:.::. X...' :.. ?....... ...:.... ::.. ........ . .....................
TYPE OF CONSTRUCTION ' <''r�^'
.....................................................................................................................................
............................R. -...............19. ....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .............1 . � ...................................'" ..... '"..x'........ �......... ..� ` ...��`...'�:'
...' ......�'
X.
ProposedUse ................ .......}.. ..................................`. .........................................................................................................
ZoningDistrict ........................................................................Fire District ..............................................................................
'wt,r,r.. .� wa .r' is �` s } ' ' !
Name of Owner !:.... .. ....' �:... ....Address ........•.'".':' .:r'...... ..::'.....:........:` "...�: '.� .:...'.....� `.,
• '
Nameof Builder ................ .......:...................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ;/ `.. ..Foundation
Exteriorr'... ............ I..............Roofng ./... .:... ...........................................................
Floors 6�, aD r,`_ ...
.................. '.:.........:.....:...............................................Interior .............:.......:...:..'........ :...................................................
Heating .......... ......
` :r..`...r.:.:f:...!....... ....'::..............................Plumbing .............. .....G`• ...f.:#............................................
..:.:..... tt
f" ��r"� .. �..
Fireplace ..:.................................`".............................................Approximate Cost .............................�..... ...........,....................
Definitive Plan Approved by Planning Board ________________________________19________ . Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH /
r
hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name s ...............'.....................................a::..............
ri
_
D-`--'--, ^ n^�~~y/ , A-269-4/
No 21400-- Permit for l .Atzuzy..dzwall.iuz*
-
^
---ati-- -----'-u�Type of Construction W
701....................
..............................................................................
Plot ................../ Lot ..;.............................
/ Permit. . ~....
�
8 June
Date Completed"\. ..............................19
'
PERMIT~ ~~
..................................................tl.......... 19
i'111
---...
-'-''^ -^~'-' / r ^^-----'--
~
''-'---^---' -^^-'---~--~----''
-------'-' -'--'-^'---^'^---'-^
� �
Approved ---------------- lQ
°
�
� -----.----------..-----~---.
-------'---------~^---~~^'-^'
^
'
�
� ��
THE T TOWN OF BARNSTABLE
2
i BARNSTABLE. i
M6 9 BUILDING INSPECTOR
�E17 MAY p'
APPLICATION FOR PERMIT TO .................... .... ......................................
TYPEOF CONSTRUCTION .....................................................................................................................................
6�qec W
.......................................;X.19.4-(-
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .... `... s;/ .. ".., �v ',................................................................................................................
ProposedUse .............................................................................................................................................................................
ZoningDistrict ............................................ ...........................Fire District ..............................................................................
Name of Owner f'.! i✓Ik ..v.•....... .Q(Lf4�'y .....Address .. !l'4��1f�.� �. X..` �®............
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ...............................................................................
Exterior ....................................................................................Roofing ....................................................................................
Floors .......................................................................................Interior ....................................................................................
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ..................................................................................Approximate Cost .......o...........................................................
Difinitive Plan Approved by Planning Board ________________________________19________.
Diagram of Lot and Building with Dimensions
N
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ..................................................................................
Homeyer, Frank J.
No ..1? Permit for ...demolish frmQ„
dwelling (damaged by fire)
...............................................................................
Location 34. LaFrance. ...Ave.rnus
................... ......... . ...... ......
Hyannis
Owner Frank J. Homeyer
............................. ,
Type of Construction ...,frame i
............
Plot ............................ Lot ................................
Permit Granted ...................March...�................19 66 ,
Date of Inspection ....................................19
Date Completed ...... r... ............19 i
ipp
t
PERMIT REFUSED
....... ..................................................... 19
...............................................................................
................................................................................
............................................................................... i
...............................................................................
Approved �/.. .
................ ........ . ... ......
!
� / ...r... .........................................................
a
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#;
,9c FRANK � F:RA
NIc
Q COW Ry CONERY 7,
No. b2
No 6b73
Tf
u
ONAIL
PLAN of LAND
I CERTIFY THAT TH18 PLAN SHOW$- MASS.
THE ACTUAL LOCATION OF THE OWNED By
'__4TRflJCTURE ON THE LskND AND h CC
THAI' IT CONFORMS WITMTqV`•; \' FRANK CONERY 5 TRENTON 57.
BY-LAWS OF THE TOWN
HYANNIS, MASS 02601
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