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HomeMy WebLinkAbout0021 LEONARD ROAD � � ,��ti�� ��- _I �� � ��� S ��� ��� � �.� �� ; � _ rn� s � � .:� - �� _� r Town of Barnstable D Building Department °FTHE r°k� Brian Florence,CBO Building Commissioner snxrasrAsr.E, 200 Main Street,Hyannis,MA 02601 nsnss. wwW.town.barnstable.ma.us �pTED MA'S h - Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: a::�� a Name:_ ��jS �o�llOdS Phone Address: a` J���t�ll.Irtit �lil Village:*�M� Name of Business: OI(�l W?N'�G( I ��/®✓� a Type of Business: / r ly 1 C�a�~TS Map/Lot: c�i 10�R — I INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling:'there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in.excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the'Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: ^ �o�^„^rz/ti /.�h?/YynY✓ Date: Homeoc.doc Rev.10/17 Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street,'Hyannis,MA 02601 www.town.bamsfable.ma.ns '. . Pre-application for Business Certificate j Date �' ^1 Map Parcel O Applicant information Applicants Address.'a 11'mi n i-e ; RCj (0 3-40 A >l Addiess 4le&WW 1�,� - 1,,.�OCh��Gh oo,coyn TelephoneNumbea Listed[I Unlisted' :Business information New Business? - No Business is a registered corporation? ________________________. Yes ` If yes Name of Corporation Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? --------- Yes No If yes then a Homee/Occupation Regisfiation is regdmd—See Building Division Staff Name of Business ��cr'e I nt'�<'� Business Address a Type of Business 17Y—f 0 C MrIS B>rildmg Commissioner Office Use Only Conditions Building Commissioner Date Clerk Office Use Only CAPE COD ,,, , 1NSULATI0N '' ®yiam / 9j 11I FAM IA TTS II SEA OUTTIIII INIUTATJON ICIII'NO7o 1-800-696-6611 � $ d Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation; Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to*the specifications listed on the building permit application. All work has been inspected by a certified Building Performance .Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner PropertAddress Village A `b 2 l eoo Insulation Installed: Fiberglass Cellulose R-Value. Restricted Unrestricted :. Ceilings Slopes ( ) ( ) ( ) x ( ) ( ) Floors Walls Diver y o r k F40r�C'� Sincerely 2peHryE ssi r, President Ins ation, Inc. r, ► TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Ai OF + P T A Application #�� �.SU)s 3 ID Health Division I�4 ;f� Date Issued /o Conservation Division Application Fee Planning Dept. , Permit Fee r,35 ,00 T ,. .� Date Definitive Plan Approved by Planning Board:. all)s'� Historic - OKH _ Preservation/ Hyannis Project Street/Address J Village 2 ,VWZ s Owner 21W,) 0 /f/.f �, [�,[G,�J�,� Address ts Telephone JO t, 7 Z/ 3 40.2 �- Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4 G Construction Typel%�oG� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family PL-, Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 2111�No On Old King's Highway: ❑Yes 4No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 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: 0 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 C, Telephone Number Address License# ,j Home Improvement Contractor# �a 4?t-9'J — Email Worker's Compensation #�,�1r�a� v ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE R ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 7 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. mass save � R S@Wgp though wwgy efficiency PERMIT AUTHORIZATION FORM 11 DENNIS CONNORS ,owner of the property locatedat: (Owner's Name,printed) 21 Leonard Rd HYANNIS (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor iisted below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owner's Signature Date r FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date • 0$1L7 For Office Use Only Rev.12132011 ._ ... _ -- -- - . _ ._. _ _ _ _ - - _._ _- • - - "�""' � t�s Mas:;acFtuSett:=, :(Jr�pat'finent.of F'�:r•rhlic.Safety • ', ' ..:Board of Building,130gulations and Standards Con.\h•nction 5uper\isor • License; CS 100988 HENRY E CASSIDY' 8 SHED ROW a WEST YARMOUfiH ,' 3 Expiration 'Commissioner .11/11/2016 = c � VIC � x a Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 t Home Improvement Contractor Registration. Registration; 153.567 Type: 'Private Corporation Expiration: 12/15/2016 -Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY - 18 REARDON CIRCLE t: SO. YARMOUTH, MA 02664 Update Address`and return card.Mark reason for change, SCA 1 :i 20M OS/11 ' Q Address Renewal' Employment Lost Card Office of Consumer Affairs&Business Regulation License or r y .. ..- -- V/ee cpoo�r��za�uaec�lC/a�C�/�cWaac%ccaeCti -- -" g registration valid for individul use only V�, OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: '1:53567 Type: office of Consumer Affairs and Business Regulation xpiration: ; 1;2L15(20:16 Private Corporation 10 Park Plaza-Suite 5170 d «� Boston,MA 02116 CAPE COD INSULATION INC HENRY CASSIDY` 18 REARDON CIRCLE r SO, YARMOUTH,MA 02664 Undersecretary qNvalid sign e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations F ' 600 Washington Street Boston,,MA,02111 b www.mass.gov/dia °y Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly A Name (Business/Organization/Individual): / Address: _ 1) felt x� � J City/State/Zip:--Do& a Phone #: J� ram' 1�4cj' Are you an employer? Check th 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 working for me in any capacity, employees and.have workers' comp,,insurance.t 9. [],Building addition [No workers' comp. insurance p•. ' 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 per MGL 12.❑ Roof repairs . insurance required.] t c. 152, §1(4), and we have no ,. 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'compensation insurance for my employees. Below is the policy_and job site information. Insurance Company Name: ,T l�i 1� � / i ✓ �9 '? � �"b Policy # or Self,ins.L;ic.#: i Ld �' Expiration Dater - ` k Job Site Address: 2 City/State/Zip: Attach a copy of the workers' compensation policy dec aration_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 Investi ations of the DIA for insura coverage verification. . _ . I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct. Si nature: z" Date:. Phone#:' 1 54 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#: CAPECOD•27 BDELAWRENCE FDATE(MMIDD/YYYYI CERTIFICATE OF LIABILITY INSURANCE 6/30/2015 THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS,UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE'A CONTRACT BETWEEN THE'ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER; IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,.Inc. PHONE FAX 434 Rte 134 A/c E : we No: ($77) 816.2156 South Dennis,MA 02660 E-MAIL ADDRESS: _ INSURER($)AFFORDING COVERAGE NAIC N INSURER A;Peerless Insurance Company•see LIBERTY MUTUAL INSURED INSURER B.:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc. INSURER C 18 Reardon Circle INSURER .South Yarmouth,MA 02664 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR-THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION,OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE-TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER ADDLISUBIR MMIDDY� POLICY LIMITS ,A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FY1 OCCUR CBP8263063 04101/2015 04/01/2016 DAMAGE TO PREMISES Ea NTErDOnce $ 100,000 . MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES'PER: GENERAL AGGREGATE $ 2,000,000 XJ POLICY❑jECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER:,$ AUTOMOBILE LIABILITY „a COMBINED SINGLE LIMIT $ Ea accldenl ANY AUTO BODILY INJURY(Per person) '$ ALL OWNED SCHEDULED HIRED AUTOS BODILY INJURY(Per accident) $ AUTOS AUTOS WNED PROPERTY DAMAGE $ AUTOS Pereccident $ UMBRELLA LIAR -OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ OED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER _ B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ WCE00431901 06/30/2015 06/3012016 OFFICERIMEMBER EXCLUDED? N I A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yes,describe under - - DESCRIPTION OF OPERATIONS.below E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES'(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certlficate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD YOU WISH TO OPEN A BUSINESS? ., For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you perrriission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 'l3 ill in please: 'it°V!: f APPLICANT'S YOUR N.AMEJS: ^ ✓'>11 17Qd� ✓�1 S Y►Y�6rS i r hi.t r i ^i .i fr BUSINESS YOUR HOM ADDRE f C4-r S 6 Uppt� 02601 r5 i Ih'La •r2yt llrAd d109 TELEPHONE # Home Telephone Number NAME OF.CORPORATION NAME OF NEW'BUSINESS S Pe C.. T1PPEO,F BUSINESS G . fi I$THIS A HOME OCCUPATION? X YES NO° '. }} ADDRES$,OF BUSINESS.. '' : �_ �. MAP%PARCEL NUMBER +'" '�t [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER'S OFFI E MUST COMPLY WITH HOME OCCUPATION This indivi al e inf d f ny p r ES AND REGULATIONS. FAILURE TO it requirements th t pertain to this type of busines��JL COMPLY MAY RESULT IN FINES. A ize ig ature* COMME TS: JQ b / (3 2. BOARD OF ALTH This individual has forme oft a pe -t npq ents that pertain to this type of business. Authorized Sign ture** 1W ST wOMPLY WITH ALL COMMENTS: WIARD01 IS h4ATERIA1 R R€GWLA;IP 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable Regulatory Services Thomas F.Geiiler,Director { Building Division KAM t®g Tom Perry,Building Commissioner Mpt k 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m&us Office: 508-862-4.038 � Fax,5009-790-6230 Approved. ^� Pee: 0-O Permit#: -20 13 0 6 r,3 HOME OCCUPATION REGISTRATION Date: Name: alnrl l E &Z160r- Phone#: 107- 6 K, 3a-So Address: 1 /eokiG✓t/l Village: IMAMl� Name of Business: Type of Business: GV L7M?' i�b mje1�" Map/L.ot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation widhin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,proNided that the actiizty shall not be discernible from outside die dwelling. there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or ground«ater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the folloving conditions: • The acffi*is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dvrelling vouch are not customary in residential buildings,and there is no outside eiddence of such-use. • No traffic v6E be generated in excess of normal residential`plumes. • The use does not invoh e the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or exploshre materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing die Customary Home Occupation,and not vadun the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one-,an or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 dres,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed in the Customary Home Occupation irho is not a permanent resident of die I dwelling unit. I, the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant. (. ��yL Date: V-9?—/ I i Homeoc.doc Rev.01/3/08 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a&9' Parcel 019 V - a}Permit# °?L ! 3 it-; L Health Division 15--3 Date Issued 8' A.7 O . Conservation Division 27 Ailtl j :A�Pication Fe 6 Tax Collector : t, (y Permit Fee S0 w Treasurer SEPTIC SYSTEM MUST BE ffi INSTALLED IN COMPLIANCE , •Planning Dept* WITH.TITLE 5 Date Definitive Plan Approved by Planning Board ' 4 ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Al LEDOA/ZD RD Village RYANnI(S- Owner DENMIS -J• CoNN02S Address „oll LE0i)AI2D RDA NYArJMIS Telephone 509-1l8'56 Sy Permit Request T ca�ts,s�vc7 A 5o X fl ( FAR Square feet: 1st floor: existing -Y proposed 6- 2nd floor: existing 7 proposed Total new Zoning District Flood Plain Groundwater Overlay ,Project Valuation Q =Construction Type Lot Size o13 . Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type' Single Family. Two Family 0 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.) al Basement Unfinished Area.(sq.ft) Wa _ Number of Baths: Full: existing a new CS •± Half: existing a O new Number of Bedrooms: existing` new: C1 Total Room Count(not including baths): existing f new "First,Floor Room Count Heat Type and FueC Gas ❑Oil ❑ Electric ❑'Other Central Air: ❑Yes No Fireplaces: Existing New . K Existing wood/coal stove: ❑Yes No Detached garage:®existing. ®new size Pool:0 existing ❑new size - Barn:0 existing ®new size Attached garage: existing O new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ .Appeal# Recorded Commercial; ❑Yes: ❑No If yes-site`plan-review# - - In • —�.�. xr �- k t--_ ` Current Use Proposed Use BUILDER INFORMATION Name rt,_NL6 60 t�k",I t S Telephone Number Address nZ( 4 fa A k q License# 14V,dr-111,A1C6 MA 0c4 6d f Home Improvement Contractor# Worker's Compensation# ° ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L. - SIGNATURE DATE /51/7�� FOR OFFICIAL USE ONLY ~ PERMIT NO,- DATE ISSUED _ =� MAP/PARCEL NO. j ADDRESS,- } VILLA611 OWNER DATE OF INSPECTION: FOUNDATION �'.�0 !1l 4 hf�• � sl o y �' .1117 4 H" FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL: PLUMBING: ROUGH FINAL GAS: ROUGH_ FINAL co ` `m` FINAL BUILDING H w tz 5 r -' SSTt DATE CLOSED OUT ram, .�. cz � tE0 ASSOCIATION PLAN NOs cgs` to Q F F tum d5 ` M i 1 i `own of Barnstable �F•�HE fOK, • • . Regulatory Services Thomas F.Geiler,Director i a $ $uild%ng Division k Tom Perry,Building Commissioner • 200 Main Street', Hyannis,MA 02601 . • Fax; 508-790-6230 Office: 508-862-4038 permit uo. • Date AFMAVTT j[OME ZgROVFMENT CONTRACTOR LAW SUpPLEMENT TO PERMIT APPLICATION conversions GL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization.ccu ied M or construction of an addition to any pre-existing owr� P •improvement,removal,demolition, 17T1tS or to structures which are adjacent to b��g containnig atleast one but not more than four dwelling certain. residence or building be done by registered contractors,with n exceptions,along with other such requirements• 0 011 ...• ���, Estimated Cost Type of Work f ® I Address of Work: C Owner's Na�� lication: d Date of App I I ereby certify that: gegistration is not required for the following reason(s): []Work excluded by law ' []lob Under$1,000 (]Building not owner-occupied `®Owner pulling own permit Notice is hereby given that: OR DEALING WITH UNREGySTERED 0yMRS PITLLTNG THEIR OWN I'ERIVIIT CTORS FOR A.PP7 ICA$fE HOME RaRO TX�'+ D DER M L E 142A, C0N`� I,gp&TION PRO GRAM OR G ACCESS TO THE ARE SIGNED UNOERPENALTIES OF PERJURY Thereby apply for apermit as the agent of the o AU, ' RegistrationNo. Contractor Name. Date OR d7 fit/ �'h Cortixri6nveath of ll�"assachusetts ' • -'- - partrnent of.Xndush'iar,4eddents' . SQO'Washington Street - • Boston;Mass..bZJTZ orders'.C m ensatl a,bsurance Affidavit-General Busineseses 3' +�� 1,. 1„f ,•R'Y++, ••iTirt�Sr'�•+ " M.loop .-+ .. • . �,..tJ" — L state• (� antlBai/�atiug3stablishmeat . fizjl address: sineSs tie: []Retail❑Restaur Antos etc.)' CM work site loca d havd no one ' 33R, Q price[�SaTes(in.cladbag Real'Vst ei �i.a sole�rcPnor an ', _ ,• .•r.• • . yrorkiug capacity. , to time' Other o //%///o M, ees full fJ4 SLt em to wig ' ////%%�///%/%%/%�'/�///�%/%%///%%%/� .s•ab., . I an %////%////%%// /.y// ////////%%�/ for my employees wor]ang on thI 9 %% %l d ,g v�orkers' ensation _ •_ 121 over pr0�1 , r„ ,,t..r.:. :.'t• •r S''wi?%•: i;,`F'h 1 ;,�7,t�:;(^,'''..aa i. ++:. .y' ' :i aman• U•.{'<,' 4' -A rt .i" 'rtl'+L=S.•: +: rat j:14� . ";y f•: •1 ' 'w' ii•,, - M7••*' 1 ':1.17ttf••{ i',�• ' . .'t'• tt1.,;'f•'..r �.• r•�'�'%L . 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Snell;;it•',_'+ •3•'• ' . e to$1,50D.DD SII or ena�ties of afro uP insiiranc-' b ositLonofcrimfnails Failure to secure caveragz as required and erl Section 25A of MGL 152 can lead to the imp 1 e teas re as cep the idrm of a STOP WORM ODDER and a finz of$100.00 Ii day against m°' Y underafan t}� oite years'imprisonln n be fory,•arded to the Office°rinveitigations ortlie llWor coverage verification. copy # ent Pay ' o this statrm. the ains and penalties i5f p erJury that the inform ation provided above is frua and corlec I dfi hereby eertifY under p Date 7 SI aature 15 # d 7 �'' - Print IIame _ do not write in this area to be conpietcd by city or town 0MCW ❑Bnud miing pepart nt ofriizlu+eonlY permitliicznse# ❑Licensing Board City or to,vn: ❑Saiectmen's Office (]Heelth Departnenf [�chackif irnmeaRte,response is required []Other Phone#; contact person: ' ttevisedEept7Ao3) • Znforxbiatioia and Xiastruetions• +• oxkers c ensatidix far their. f ' alL'aws•cha ter 152 section25 re cues all em1?oyers to xovr�.c.w : q 1 Tvlassachusett�Eerier p erson in the service of another under any contract oted'from the t`Iaw"., an employee is.defined as every p '4loyees• As oral or.written. . of hire;express or i1T] l76 ' artners ' , association,corporation or other legal entity, or any two or rngre of employer•is defizied as an individual,p tAn he foregoing gaged m a joint enferprise, and including the legal zepresentatives of a deceased,employex, or the xeeeiver or azoershi association or other legal entity, employing employees. 'However-the owner of a trustee of.an individ ,P p' occ• ant bf the dwe ' -house bf- dwelling house ham not more than three apartments and'who residc therein, or the, up hmg another who emp�03'sFersb�s to cio rnabj=anc,- constriction or repair work on such clwellnrghouae.Or on the grounds or tthereto shallnotbecause pf su;�,eri�ploymentbe'deenzecltobe ati employer. ,•1 building.$Ppurtenan • . •.. ., •'' • :,:.. ' L cba ter-152 section 25 also'states fhat'every. state or Ibcal licensing agency shall Withhold the fssuanco or renewal IyIG P Y applicant of a Icense or pe?"�?t to operate a business or to construct buildings in the.conlnnonweaIth for an a Ilcant who has not iodated acceptabo of dence'of compliance wig enter in o afhe n a coutractcoveragfor theerformance Ofpye req ublzc work untr'T p of its olitical subdivisions shall y coirimonwealth nor.any• P p P acceptable evidence of compliance with the insurance requirements of this cha ter have beta resented to the contra authority: . • / ..,. ,ApFlieants •. •. t a lies to •oux situation., Please • Please f $ze w as'• ensatit affidavit completely,by checking the box tha .pp ... y supply company name, address arid phone numbers along with a certificate of insurance as all affidavits maybe submitted to fhe Departme11t'of industrial Ad**dents-for confixrnation of insurance coverage. Also be sure to sign and date the affidavit. The davit should b e returned to the city or town that the application for the p ermit or license is being not the pepntment 6� dustrial A.ccidert . Should you have any questions regardiri the'"law"or if'you are requested, lease call the D artd=t at the niuAcr JistAbe10W- li eP •c ensation q r uilr o taw a•vtiworkers. omp P cY P. , • , y eg111a ed to � , E. • • , %. J r . • • 1• City or Towns . , • , Pleasebe sure that the affidavitis complete anc�printed legibly. The Department has Provided a space at tbd tbottoni of the a� yit f�you to fill otlt in'the event the CJifice of Investigations has to contact you xegardit�g the applicant Please 0L. th ermltJlicense number•which wM be usecl as a reference number. '�'. e.affi8apits maybe eturnedtq. be,sure toin a 1? , • �ai�or F AX unless othe'r'armgements hovebeen made, the p ep artm�t l?1`. 1 • • • �• d �ou1a •you have cations, The Office of Investigations would like to t BnI y'ou in advance for you cooperation an s y �y ' hesitate to give u5 a•calL... ' please do moth +fie Depai{ment's address,telephone and fax number. . - The Commonwealth of Massachusetts Deparbnent.of industrial Acdclents . Ufa"oI Weftetwns 600 Washington Street Boston,Mz. 02111 fax M. (617)727-7749' Town of Barnstable Regulatory Services BAMSTABrs, Thomas F.Geiler,Director � A �9 •�� Building Division lEv��e i Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 4 o y JOB LOCATION: AI LGOMARD RD WfAMNIS number street village "HOMEOWNER": I)EMNIS CBNNO2S 508 name home phone# work phone# CURRENT MAILING ADDRESS: P.O. 130X !9 5 W.14YANAIISP0PT MA Oafola 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. t 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. ignature of Hom ner 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." k 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 � 0 LOT 1 �b 0 - - - 6, ti - - - -_�"- - 19, ° LOT ILOT - ., LOT 12CO 14 00 " 100 LOT 15 LOT 16 ,�2 COX Oq G�.. rA % Imes vv us`� � . '�C, Ur-)• Q-,\A aA,�S iLLLE t �s �' ►i e,,a S �L ho)-4 5`� a�� RJe�� s Its d� ✓y j fip k4 sc IO �� San©