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HomeMy WebLinkAbout0073 LAFRANCE AVENUE 73 3 Ac— Town of Barnstable � ,*Permit# U 1,15"19 Expires 6 r tonths from is ue date Regulatory Services . 0-F& r _ l • anxxsznais,MAM • , Richard V.Scali,DirectorU FD .IA G 26 2015 Building Division p p y Tom Perry,CBO,Building CommissionSLE �e®W'u �� ��rl�S _b - 200 Main Street,Hyannis,MA 02601 A www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 2 Not Valid without Red X-Press Imprint Map/parcel Number � Property Address L-C� `r ��zv'1C� Q 7 ✓LV�., P-6sidential Value of Work$ 1.0 COO D Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Co✓•,tC1- Ce r Ch Contractor's Name Robelrj 47 Telephone Number 16 �Ge .: ®7r�� Home Improvement Contractor License#(if applicable) Email: ' 0cT�2o6 gD Construction Supervisor's License#(if applicable) ,E1Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance ti Insurance Company Name AIM Workman's Comp.Policy# 0 W6, D ®—7 9 ZD 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) E�J�e-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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 co f the Home Improvement Contractors License&Construction Supervisors License is re i d. w SIGNATURE: 5 Q:\W4ILESTORMS\building permit forms\EXPRESS.doC , Revised 040215 Tlie Comntoirflveakh of-Vassachusetts Deparattent of firdrrstria!Acciderds f3•f-ce bf r nveshgafiens 600 Washingion Street Boston,-41A 02111 irovis nassgovIdia Mr orkers' Co .ppensatiq_n Insurance Affidavit.Builders/Contractors/EIecfricians/Plu nbers Applicant Infmrmatian Please Print I*dbly NaMe(3usmesst�Drganaational}: �`� � Address: Gi t tatel - Lei b25fo ae Scg &33—o-7V Q tY - Pho -Are you,an employer?Check the appropriate box: Type of project{regnirerl): " 1. am a employer with 4 ❑I ama'geneaal contractor and I - , P - employees(full andl`or part-time).* have hired the sub-corikzactoss 6. ❑New oonstruction, 2. Tisbed on the attached sheet. I- ❑Remodeling El I am a sole proprietor or pautner- . ship and have no employees. These sob-contractors have .9. ❑Demalitiom worb far me in any capacity.g c employees and havre wodoers' 9. Building addition ` a ivrsrleers'co °i"nsurance C°mP-msuranMl tmP lO.❑'Electrical r or additions required-] .5. ❑ We are a corporation and its 3.❑ I am a homeowner d6mg all work officers have exercised their 11.❑Plumbing repairs or'additions myself [N o workers F- 1' right of exemption per MGL 2 � .._❑l�oafrepairs. imu ante required]s c.152, §1(4�and we have no Re �(d f^VI employees.(go workers' 13.❑•Other comp-inswanDe required.] 'tkay apPBcant that cheeks boa:91 ronk also fa out the section bek w showing th&workers'compeasatianpoliey informaticoL I Homeowners who subft dds afiidn*inBirating they are doing all wak and Ikea hire autsida contractors r m submit a new affidavit indicating sash. fCoatrsctors t$at check this bone must attached as additional sheet showlmg the none of the sub-comtraamrs and state whether or oat those ecditjes ham employees.Ifthesubtantractus have employees,&eyntsrprvrddeiheir worken'comp.policynumber. I am au employer that is pro><zdbW workers'corrrpensadon imuirance,for my employwes Below is the prrlicy and job site inforrnadam Insurance Company lEfamie: Policy or Self ins_Lic_ �l ©`�1G0 ZO s E�piratoaI}ate: Job Site Adda`ew- La rA,K C e citylStatelzip: Mo. Attach a copy of the workers'coaapensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c_ 157 can lead to the imposition of criminal penalties of a fine up to$1,50D O0 anNor one-Dear immprisonmerk as well as civil pertalties.in the form of a STOP WORK ORDER and a lime of up to$250_00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA for" cta coverage verifrcatioti- I rIa hereby certr.6,rirtder tPce ' s andpenahYes ofperfury that the information prmi&d abm a fs bue and correct Siimattxe_ Date: Phone 9 51A 6_201� 0oa"cial use only. Do not write in this area,to be complretesd by city ortotcn officfat City or"town: PermitUcease# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylrown Clerk d..Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r Information and Instructions Massachusetts Ge=ral Laws cbapirr 152 requires all employers to provide woil-,ers'compensation for their employees. p to this statmrfe,an.empZvyne is defined as."-.every person in the seavice of another nmder any contract ofhue, express or jaTlied,oral or wriitnn." An anplvyer is defined as"an individnal,p=taasli�p,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint entezgnse,and including the legal representatives of a deceased employer,or the receiver or tr stee 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 - dwelliag house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appr rtcnaut thereto shall not because of sach employment be deemed to be an employer." MGL chapter 152,§25C(S)also states ibat"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 P _ applicant who has not prod-aced acceptable evidence of compliance with the insurance.coverage regn=ed- Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor�y of Its political subdivisions shall enter into any contract for the performance ofpublie work unt a acceptable evidence of compliance-with the ius=c„ e:. requirements of thus chapter have been presented to the contacting authoizty" Applicants Please fill out the workers'compensation affidavit completely,by checki g d e boxes that apply to your situation and,if necessary,supply sob-contractors)name(s), addresses)and phone numbers) along with their certificates)of in=s,ce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than time members or partners,are not rbgo:irtd to carry workers'compensation ins=ce. If an LLC or LLP does have employees,a policy is regau-ed. B e advised that this affidayrt may be submitted to the Department of Industrial Accidents for confirmation of in�ce coverage. Also be sure to sign and date-the affidavit The affidavit should be retmnned to the,city or town that the application for time permit or license is being requested,not the Department of Indu ciriai Accidents. Should you have any questions regarding the law or if you are requ>red to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-m s r-a„ce license number on the appropriate line. City or Town Offalc'ials . Please be sore that the affidavit is complete and pried legibly. The Department has provided a space at the bottom of the affidavit for you to fill out i a the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/Iicense number which will be used as a reference number. In addition,m applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current p olicv information(if necessary)and under"Job Site Address"hie applicant should write"all locations in (city or town)!'A copy of the-affidavit that has been officially stamped or m.aiked by the city or town may be provided to the • applicant as prooftiat 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 vent nm (Le. a dog license or permit to bum leaves etc.)said person is NOT regcdred to complete this affidavit The Office of Investig�ons would at to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departments address,telephone and fax number. Tie CanMjanWealtir of Massacbu&tAb , Dega3.tment cif ladustdal Ac;oWents G$ce of jxLveWgatio.)a,% 604.Wasbi4oa S[zff--t o�MA Elul lE Tf,-1.:#617 727-4900 CXt 4-06 or 1•-9 IAA-SSA- � Fax 9 f l7`27 7M Kevised4-24-07 maw gQ�fdia BARNSTABIA "6 ,��' Town of Barnstable prFo Regulatory Services , ;iA Richard V.Scali,Director' is Building Division .` ,� r Thomas Perry,CBO y` Building Commissioner 20014ain Street; Hyannis,MA 02601 4 M Ir- . � ' - wwwaown.barnstable.ma.us - - ,, - e F Office: 508-862-4038 Fax: 508=79076230 ;„ r # ' Property Owner Must i r.. 4. Complete Sign This Section rA 4; If.Using A,Builder'il t c :'. e. .. t p _,F I, , as Owner of`the subject property c ^ f hereby authorize J/ d C .,. RG. j�l to act on my,behalf, yl < in all matters relative to Work authorized by this building permit application for: a (Address of Job) 4i/n Signature of Owner y :Date` y �.l\•-U: Vim'. 6� n+ 'E.. ' �,.° . �' 'r� s.. ra. Print Name If Property Owner is applying for permit,`please complete the Homeowners License Exemption Form on.the V _. reverse side. QAWPFILES\FORMS\building peimit forms\EXPRESS.doc Revised 040215 A Town of Barnstable Regulatory Services r �optHE r�ty,� Richard V.Scali,Director i Building Division * sAaxsresr.E Tom Perry;Building Commissioner MAss. pi 1639. ��m� 200 Main Street, Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-403 8 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 hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section - 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department_ minimum inspection procedures and requirements and that he/she will comply with said procedures and 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,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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 DATE(MMIDDIYYYY) ;RA CERTIFICATE OF LIABILITY INSURANCE � 8 26115 HIS TIFICATE IS ISSUED AS ATIVRETY OR NEGATIVELY AMEND, PON THE CERTIRCATE HOLDER THIS OF INFORMATION rEXTEND OR ALTER THE COLDER. THIS HTS UVERAGE AFF RDED BY THE PO CIES CERTIFICATE DOES NOT AFFIRM BELOW.EHTHIS ,SC OR PRODUCER,INSURANCE THE EF�I.DOES NOT HOLDER.TUTE A coMRACT.BETWEEN THE ISSUING INSURER(S), AUTHO IRMO REPRES IMPORTANT: If the certificate holder a�an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A autement on this certificate does not confer rights to the certificate holder in Ileu of such endorsemantled. oo ACT PRODUCERr{►x , (508) 759-3922 United Insurance Agency, Inc. PANE . ( 08 759-6595 N 199 Main Street kINSURERF� p.0• .BOX 1013 IN6URE 9 AFFORDING COVERAGE NAIL# Buzzards Bay, MA 02532 _ Mutual IN6URED Robert J Robicheau RJR .Construction 91 Pinkham Rd Sandwich, MA 02563-2533 REVISION NUMBER: COVERAGES CERTIFICATE N UMBER: HAVE THIS IS TO CERTIFY TS AN HE POLICES OF INSURANCE ANY REQUIREMENT,TERM ORDCOND ON OF ANY CONTRAC ISSUED T OR THE THE RDOCUMENT ED NAMED WRH RESPECT OLVVHIC 1 THIS INDICATED. NOTWITHSTANDING MAY BE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE OFINSURANCe U POLICY NUM9PR fW wY rDwYYYY LIMITS EACH OCCURRENCE S GENERAL LIABILITY OAMA TO RENTED COMMERCIAL GE NEPAL LIA13ILITY ' , w>,!IIS�B..LEAarsuaaDso) $ CLAIMS-MADE OCCUR ME EXP rNoro aeon) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE PRODUCTS-ODMP/OP AGO 3 GEN'L AGGREGATE LIMIT APPLIES PER $ POLICY PRO• LOC ' AUTOMOSII.E LIABILITY - Ee eccldoM SlNti.• Uulll' S BODILY INJURY(PAr pamon) $ ANY AUTO pODILY INJURY(Per m-Ndmt) $ AAIJTOSS OWNED ALTTOSULED NON-OWNED Peraodd�n) $ HIRED AUTOS AUTOS $ UNLLA LIAS EACH OCCURRENCE $ BRE OCCUR EXCESS UAB CLAIMS•MADE AGGREGATE Q DF20 RETENTION @ 1/14/15 1/14/16 X WCOTH- A VWKERS COMPENSATION VWC10060107682015Pti AND EMPLOYERS'UA19RM YIN E EACH AC DENT 100,000 ANY PROPRIETOWPARTNER/ExEC UTIVE NIA A OFR ERIMEMSER EXCLUDED? X E.L.DISEASE-EA PLOYEF 100,000 (Mandatory In NN) O na,deserlbeundnr E.L.DISEASE-POLJCYLIMIT $ 500 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONO/LOCATIONS IVENICL.ES (Attach ACORD 101,Additional Rennrla Schedule,Itroare epnce IA rogdred) The workers compensation policy does not provide coverage for Robert Robicheau t . ,< CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Y' 200 Main Street Hyannis, MA 02601 Au •D SENTATNE 00 is Dexte 01988.2010 ACORD CORPORATION. All rights reserved ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: :(508) 790-6230 E-Mail: st • �e cpomvrrea�acuec�lC�z o�—'��,�irJaac�uaetG Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR f gistration: ..124401 Type: /Expiration _6/'2t247.7 DBA RJR Construction Robert Robicheau 91 Pinkham Rd Sandwich,MA 02563 Undersecretary • r Massachusetts Department of Public Safety 1j Board of Building Regulations and Standards License: CS-060986 _ Construction Supervisor ROBERT J ROBICHEAU '.. { 91 PINKHAM RDA SANDWICH MA b25,3' _ �/►�"^'� l Expiration: C ommissioner 08/01/2017 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS TOWN 01"i BARNSTABLE BUILDING PERMIT APPLICATION Neap 7 Parcel 0 0 T ;!"_1§ i,Y� Permit# �fi 7 Health Division C'�- °r,' LE Date Issued g Conservation Division a ;;: Application Fee JV Tax Collector Permit Fee' ,2 S_- 0 6 TreasurerPlanning Dept.Dept. CONNECTED SEWER ACCOUNT Date Definitive Plan Approved by Planning Board # Historic-OKH Preservation/Hyannis Project Street Address —7 3 La. F r-&-rt to Ue-.. Village �a.Y)n 1"5 /} • 0a&0/ Owner Address Z ele e, h�T•.I2� �GLS�-��'S0 n �i Telephone SOFl — 2?0 — 7/3Y Permit Request d a Q &�h 51 42-JGr5TI n 6,1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size /fa Grandfathered: O Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ET �_ Two Family ❑ Multi-Family(#units) Age of Existing Structure 70 Historic House: ❑Yes R<o On Old King's Highway: ❑Yes @-NT I Basement Type: Bull ❑Crawl ❑Walkout ❑Other ,. Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing / - new f Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing 7 new y� First Floor Room Count .5 Heat Type and Fuel: /Gas yp ❑Oil ❑Electric ❑Other Central Air: ❑Yes U No Fireplaces: Existing New Existing wood/coal stove: ❑Yes o Detached garage:�d(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 al' o If yes,site plan review# Current Use ;! I m /y D tv e__1 Proposed Use jw / BUILDER INFORMATION �+ Name � Telephone Number Sod 7�6 -71 Address License# ALe h/S 12229 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO oflo SIGNATURE DATE FOR OFFICIAL USE ONLY PERMiT NO. -DATE ISSUED 7 MAP PARCEL NO. j ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME f e7 INSULATION 7 FIREPLACE ELECTRICAL: ROUGH FINAL" PLUMBING: ROUGH Is: FINAL GAS: ROUGH FINAL rn FINAL BUILDING co got m DATE CLOSED OUT ASSOCIATION PLAN NO. t , The Commonwealth of Massachusetts ;Department of Industrial Accidents e_ 600 Washington Street ' Bosion,Mass. 02111 " Workers' Com ensadon Insurance A.fFidavit General Businesses / VA y.. /b• �/a/i / Y t address: ��' 7/,y 0 . state: wor site location fu address: Establishment rietor and have no one Business ZYpe; [�Retail[]RestaurantlBar/E g I am a sole prop Office[]Sales(including Real Estate,Autos etc) working in any capacity. I am an em to er with eta 10 ees(full& art I ar- 0 Other / /// %%�'/? Gam//%//'/// r/ /// /%///.� / ®�/// ME kers' compensation for my employees working on this job. I am an employer providing Nyor ,. cam euV name: ..;,, •.. '4'S,iI••..<:• .' »,r•,:".• ,. '. •,, ';'. ••t't '•'•,:'.'f',,,J r. ad refs' "';\ t' , : .': ': y;,,• '.,:',;, • :� .�„ ,•+."• 1.':M,��, ,'f�t:•••,tip. • .. .. , :;,'. _ =. ,; hone�'• .. f .: :t.. City: r ;,' • •. •t. +,, <�. a'•T 'f. ' nsiiiance.eo;,,. . gworkers' . / I am a sole proprietor and have hired the indegeadent contractors listed below who have the followin com�msation polices: .t. Sii]E: ., ti."^' 't "''�„'•4? '•t'_' • �'�"( ' j.� "d' + t � S ti - COIIIF il,�t +:.,Y,y^ :.,. y: �, tit:'•,i.' , 1,tn. r, :Y •' �' ::.,,ti:,;ti Bone citv:.t; ',' 7,,; •� a 1.}i� ' rt.r ?.w ^�, :Y'.r,.. I t. �a ;5. insuri3nce Co . .• .':'• i= • / / /// / / :. .tt: ' ;"h ;• s.i S;:.;: .. fin'•Hera". ? ";�r�rv�.. •a:.���F: �%��•' ''•'' t.'�'?a.i - "r'•' com' e:'�' address: :., �', '• .. '; ;. ;~ .-. •. /'/y�1. Lhoui Of iristiTence'ho;�i' `,' ////// >S�/% d� %%/ // //�// // III r Failure to secure coverage 5 ism as required under Section 25A of M a STOP'WOAK ORUER-lead to the pand a Fine of Sjoa ag a d y fl.vdw�me. I aadC UP to gtsofandthata one years'imprisonment u well as Civil penaltiu In the form i copy ea this prLso ent.may he forevarded to the orrce of Investigation,of the DIAfor to verlfieation I do hereby certify under th ins andp nalties f the in ormatiorc rovided above Is true and correct Date __•___22 Signature 3� ','el� _ 7/ 3� v Phone#F Print name 4 - - official use only do not write in this area to be completed by city or town eificisl permitllicensa# []Building Department city or town: censing Board ❑selectmen's Office ❑cheek if immediaterespoase is requlred ❑Health Department , ❑other' • phone�, contact person: tteri,ed Sept 1CO3) — e _ i� Information and Instructions Massachusetts General Laws chapter�152 section 25 requires an employers the seovide workers' corrpensatim for their mi a of,anoth under any contract employees. As quoted from the"law",an employee is defined as every p , of hire,express or implied, oral or written An employer is defused as;an mdnudual,Partnership,association;corporation or other legal entity, or any two or more of the foregoing engaged"' a joint enterprise,,and'ineluding the,legalrepresentatives of a deceased employer,or the receiyer:or trustee of an individual, partnership,association or other legal entity,employing employees:.I3owever-tIie owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of 4 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. MGi.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 e with the insurance requirements of thus chapter have been presented to the contracting acceptable evidence of corripliane authority. Applicants t' i ti Please fill in the workers' compensation affidavit completely,by checking the box that+'applies to your situation ;Please address and. hone numbers along with a certificate of insurance as all affidavits may be submitted supply'company name,:. y P to the Depai triment of Industrial-Accidents for cobf%irmation of inmrarce 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 {..- rec�uested,not the Department of Industrial Accidents. Should you have any questions regard ng the-"lave'or ifyou"are' required to obtain.a warkeW compensationpolicy,please call the Department at the number listedbelow. City ot.Towns• ; Pleasebe sure.that the affidavit is complete and printed legibly. The Departmentlas 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 p t/hcense number which will b'e used as a reference number. The affidavits maybe returned to ,. the Deparimeni by inns]:or FAX unless other arrarigernents havebeen made. ike to thank you in.advance for you coop eration and should you have any questions, The Office of Investigations would l please do not hesitate to`give Us,. 'call; f- so NOME The Department's address,telephone and fax number.The Commonwealth Of Massachusetts Department of Industrial Accidents tlf�ca of le�e��ation� 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext.406 opt , Town of Barnstable Regulatory Services BAMS'rasr+E, Thomas F.Geiler,Director 9 MASS. fo p�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 � . 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: r Yl'i O ,�1 g La��,Estimated Cost / �P Address of Work: Owner's Name: l m S�".er5 oi✓ Date of Application: /Z- 213 `D I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Bu g not owner-occupied LLJOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED ROVEMINT WORK DO NOT HA CONTRACTORS FOR APPLICABLE RHOME M ACCESS TO THE ARBITRATION P OR GUARANTY FUND UNDERMGL cE�.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Contractor Name Registration No. Date 0 Date Owner's e QIb ms:homeaffidav fNE Town of Barnstable t)F tp�� Regulatory Services BARNSPABLE MA98. 9 i639, ♦0 � -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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: I0 �3' nn JOB LOCATION: 7 �� C.e 1� V e n/3 number I street vill ge "HOMEOWNER': �.h�P �ct;St-ei��l sor 79 V 713 name home phone# work phone# CURRENT MAILING ADDRESS: z,3 La. Frce.n e e city/town state zip code The current exemption for"homeowners"was extended to include owner-ocgMied 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_ mut. (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 inspec 'on procedures and requirements and that he/she will comply with said procedures and re uirement . Signa of Homeowner Approval of Building Official x 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 j 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 RESIDENTIAL BUILDING PERMIT FEES j APPLICATION FEE New Buildings $100.00 Residential Addition $'50.00 Alterations/Renovations $50.00 d.., d Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x..0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= L x.0041= plus from below(if applicable) GARAGES(attached&detached) $. square feet x$32/sq.ft.= 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: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck.... _ .. x$30.00= (number) Fireplace/Chimney . : x$25.00 (number) - 4 , . Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee O O f! -4 Projcost Rev:063004 owner Jane Masterson address: 731afrance ave. Hyannis map 269 5nFr 7 Fo 71,31 parcel 042 EA VES CLOSET BEDROOM= STAIRS �V 2'$'X6'-rCO. - �F- Q _ � k � m HVL a HALL sJ+ N 4 11W. m CLOSET BEDROOM EAVE 2nd floor Z.�'x4.�. z.��X4�.8. ,'n 4 u y KD YZ '( s ti-���- ► -8-2" 3'-11 " 6'-2"------------ 5'-8" 6" 5'-0•x 4'8• k O N N _ i- § � � N N Ho o� r 12'-0" o 48" e w 11-8" o o + c") v w Ch co h N tD x h I m N fp 5" J N j N m8-v 104. Cl) o �• o L 4.8' 2-0' 4-B' 12-0" 24-2" '