The URL can be used to link to this page

Home My WebLink About0029 LEONARD ROAD � � L�N,�►,Q.o � t-�y,��s � � zb8� alg �� I i 1 �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . Map Parcel d�g `Application # w �Z �� T V ; Health Division °'� r � y Date Issued Conservation Division ��/ /' Application Fee Vt. Planning,Dept: Permit Fee} £[Qa Date Definitive Plan Approved by Planning Board IIDD Historic = OKH Preservation / Hyannis c� �j Project Street Address O1 / L2rn�.rd y l�c� I r� —(�� 1 7e. L � Village L K, f w i F Ownerv,rLe 1�2_avl� ✓ Address Telephone 2 0 Permit Request C_ `— w 'c 34 cir Fd-xI.(a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation1'o0o u!` Construction Type Lot Size ' Grandfathered: U Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ' Two Family ❑ Multi-Family(# units) Age of Existing Structure 3 3 Y✓J Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other cyc")I Basement Finished Area (sq.ft.) PSO Sri F Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing VV Number of Bedrooms: a existing _new Total Room Count not including baths): existing new First Floor Rlao( g ) g m Cou?yf Heat Type and Fuel: ❑ Gas pQ Oil ❑ Electric ❑ Other Central Air: ❑Yes A No Fireplaces: Existing A New Existing woo /coal stove: Yes d'No �9 - Detached garage: ❑existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: existirp ❑view size_ Attached garage:4 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Q .No If yes, site plan review# Current Use Proposed Use - -- - - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ; l Name 4i�v_ �&Q y44k_eo Telephone Number l/ -2 3o-62 �j Address a `o�w��_v�!/ License# Home Improvement Contractor# Worker's Compensation"# u ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE < DATE FOR OFFICIAL USE ONLY x -APPLICATION# j. DATE ISSUED MAP/PARCEL NO. "ADDRESS VILLAGE OWNER s DATE OF INSPECTION: -FOUNDATION 4F " FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL S PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO. s r: L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name,(B_usiness/Organizarionllndividual): Ll �o Q•�"� J • Addr-eSS� ^ . City/State/Zip: Phone.#: A _ r_e�y__ou�--��an-employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees (full and/or part-time).* have hired the sub-contractors 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 employees and have workers' working for mein any capacity. $ 9, 0 Building addition comp• insurance. [No workers' comp.insurance required],__r.---) 5. We are a corporation and its ME]Electrical repairs or additions �— - _��' officers have exercised their 11.[�Plumbing repairs or additions 3 a homeowner,doing-a I work _ F -=--� ri t of exem lion per MGL �imys 1f [No'work re s' o P P 12.❑ Roof repairs inc,,,�nce_requiied]`t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' 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. tC �r ontractors that check this box must attached an additional sheet showing the name of the sub-contras and state whether or not those enlitirs have employees. if the subcontractors have employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: . Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of rrimT,;al penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of _ Investigations of the IDEA for insurance coverage verification. I do hereby ce n e the pains-and penalties of perjury that the information provided above is true and correct: —Si ature:� Date: X09' _ Phone#: Official use only. Do not write in this area, to 6e 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#s Information and Instr°uctions 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." AdditionaIly,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 con�liance with the incur ce 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, i.f necessary, supply sub-contractors)name(s), addresses) and phone numbers) along with their certificates)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 Towp 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/licensc applications in any given year, need only submit onp affidavit indicating current policy information(if pecessary) and under"Job Site Address" the applica.at should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum 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 e6mmonwe411i of Massachusetts Dep rtm=t of ludtls al A rcid=ts Office of Luvestigati.ons 600 WashinatQn Street Boston, MA 02111 Tel. # 617-727-490.0 ex t 406 Pr 1-V7-MASSAFE Fax# 617-7.27-7749 Revised 11-22-06 www.mass.gov/dia f Town of Barnstable pYHe Tp� Regulatory Services BARNSTABC.E, Thomas F. Geiler, Director P MASS. q, ,639. 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 JOB LOC—ATION:a numm�b�eefr�- street)) yr lage / q / „HOMEOWNER': a__----, r. name home phone# work phone# CURRLNT.MAMINGADDRESS: SGl 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 OR 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,Hiles and regulations. ` The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mini spection procedures and requirements and that he/she will comply with said procedures and re rrements. r 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. �oF'TH.E L Town of Barnstable Regulatory Services Thomas F. Geiler, Director q�A •t6Jq �� re1619 a Building Division Tom perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.toivn.barnstable.ma.us Office: 508-862-4038 Fax: S08-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, / , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the=reverser5de� Page 1 of 2 Town of Barnstable Geographic Information System New Search H, Parcel Viewer Custom Map Abutters Map Size Zoom Out fl 'In _ o— "" R.r @ o- JPG Map: 268 Parcel: 018 F 0 F 268014 Location: 29 LEONARD ROAD I q18 268015 N28 268016 Owner: RICHARD, JANET M &BEAULIEU, ANNE M teaHARO ROAD '� Location Information Map &Parcel 268018 Location 29 LEONARD ROAD Acreage 0.23 acres - ;a ._ Current Owner Mailing Address RICHARD, JANET M & BEAULIEU, 268019.i -` 421 ANNE M 268018 654 GREEN ST-APT 3 ia29 ,j ~' '' ' CAMBRIDGE, MA 02139 268017 N 39 I Appraised Value (FY 2009) Extra Features $4,200 Out Buildings $0 Land $164,900 �-� Buildings $89,800 Total Appraised $258,900 9 �'.{268022• iiN18 268023 Assessed Value (FY 2009) 428 268024 38 Extra Features $4,200 -- 48 Feet Out $ Buildings o Land $164,900 Buildings $89,800 Set Scale 1" = 4g� I Aerial Photo-s MAP DISCLAIMER Total Assessed !t258.900 . Copyright 2005-2008 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.3357 [Production] file://C:\DOCUME—I\permit\LOCALS—I\Temp\NKGSMOU7.htm 5/18/2009 I f s l - 1'; i p C l