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HomeMy WebLinkAbout0013 MARC AVENUE " i(3 /�7arc kJrt . THE l Town of Barnstable *Permit#.,;,� C6(, i Y Expires 6 months from issue date Regulatory Services Fee 11 Thomas F.Geiler,Director L, + iARNSTABI.E,�k � 9gpT ���$ lippilding Division fD MA't (I/;A Tom Perry,CBO, Building Commissioner R 2008200 Main Street,Hyannis,MA 02601 OVVN op-AP,NST www.town.barnstable.ma.us Office: 508-862-4038 www.town.bamstable. m.us 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY . Not Valid without Red X Press Imprint Map/parcel Number Property Address i [a Residential'. Value of Work '3, 000 Minimum fee of$25.00 for ork under$6000.00 Owner's Name&Address e� �� ✓G ��'` Contractor's Name ,% y am Telephone Number 5:D$ a P Home Improvement Contractor License#(if'applicable) ❑Workman's Compensation Insurance Che one: I am a sole proprietor ❑ I am the Homeowner' ❑ I have Worker's Compensation Insurance / J Insurance Company Name ' RZ e_ Workman's Comp.Policy# `, Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Ej e-roof(stripping old shingles) All construction debris will be taken ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side° .. ❑ Replacement Windows/doors/sliders.U-Value (maximum.35) *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 copy of the Home Improvement Contractors License is required. NATURE: SIG. QAWPFILESTORMS\building permit forms\EXPRESS.doe Revise020108 n— t - .. ;i. � fie �arrvrrzo�rcruecil/,l o��i�a.f/i%caeCId � °- �' Board of Budding Regulations and Standards License of registration valid for individul use pnly HOME IMPROVEMENT,CONTRACTOR before the expiration date.. If founA return to:,, Registration:, 152891 Board of Building Regulations and Standards Ezpqration 10f5/2008 One Ashburton Place Rm 1301 TYpe DBA Boston:ma.02108 . Liit_'_ii,r HOME IMPROVEMEfTS . MARK MULLIN In PFRflI'AVM ` b- _.._ L l',yRENAM, MA 02538 -• Deputy Ad inistratoi Not valid without signature S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizati on/Individual): OM I - 1 (AA !\f Address: City/State/Zip:: r A M Phone.#: �00 Are 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.® 1 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 me in an capacity. employees and have workers' y p �'• 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ 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. XContractors 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 thepolicy and job site information. Insurance Company Name: c1L-ra( ✓ 2 LA0 Policy#or Self-ins Lic. #:U�3 L 2?z J — OL .p. Ex iration Date: Job Site Address: /S (Y14af— AV-& . City/State/Zip: Iy y l Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine-up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: i!? / ii/s2 Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector , 6.Other Contact Person: Phone#: 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.permittlicense 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable °F t�r� Regulatory Services RNSTAB9� �'�$` Thomas F.Geiler,Director Eo; Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder F _ . .k as Owner of the subject property hereby authorize ✓y a;g jr M& l`e/,t to act on my behalf, in all matters relative to work authorized by this building permit application for. 3 (Address of Job) Signature of Owner a 'Date Print Name if Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION V � Town of Barnstable �'VHE r, Regulatory Services BARNSTABI.E, Thomas F.Geiler,Director 9 MASS. g Building Division lE0 MA't 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: 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:for ms:homeexempt oFTN�>9 TOWN OF BARNSTABLE 35678 Permit No. ...... ......... BUILDING DEPARTMENT TOWN OFFICE BUILDING039 Cash .... °r►,, HYANNIS.MASS.02601 Bond N A R E M O D E L CERTIFICATE OF USE AND OCCUPANCY Issued to JON GORDON Address 13 Marc Avenue, Hyannis t.. USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. . April 2 93 19................. ............. ............... Building Inspector x F Tw�> TOWN OF BARNSTABLE 35678 Permit No. ..... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 Yl 6S9• N/A .�a+►Y� HYANNIS.MASS.02601 Bond R E M 0 0 E L CERTIFICATE OF USE AND OCCUPANCY Issued to JON GORDON Address 13 Malc Avenue, Hyannis f jf d k USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORYCOMPLI-ANCE WITH TOWN REQUIREMENTS AND'IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. April 2 93 ...... , ... ....... ................ 19................. �. !< ✓.................... Building Inspector 4 i r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please prin DATE a ,) f3 JOB LOCATION ( AN( AYeAve F � Number Street Address Section Of Town "HOMEOWNER" AA �0()dll �7� a31? Name r Home Phone Work Phone PRESENT, MAILING ADDRESS 7 3 �Q/ Z . City/Town State Z`�—Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellings of six units or less and to allow such 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, alone to six family dwelling., attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in atwo-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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE A/0,1 �� APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 /cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. MIScs Y ti HOME OWNER'S EXEMPTION The code states that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2. 15) ., This lack of awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. ' Assessor's office(1st Floor): Z,s2- - "Z SEPTIC SYSTEM MUST BE ssessor's map and l nu er INSTALLED IN COMPLIANCE *THE Conservation `�/ � � ' ,V WITH TITLE$ " Board of Health(3rd floor): :• I/ Sewage Permit number `�. ENVIRONMENTAL CODE AND : MUMBLE rua EngineeringDepartment'(3rd floor): TOWN REGULATIONS °° i670 s� House,number 11 --7-:11 ?a� o ew Definitive Plan Approved by,Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30-A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING IN PECTOR APPLICATION FOR PERMIT TO /� oA P TYPE OF CONSTRUCTION 19 5- TO THE INSPECTOR OF BUILDINGS: The undersigned by applies for a permit according to the ffollowi g information: Locatio Ile Proposed Use Ae-5Idp%l Q I r Zoning District 1' 6 Fire District ���/1/f Name of Owner o �� 6'��` ©� Address Name of Builder WA Address Name of Architect /(('(l Address Number of Rooms /f Foundation Exterior UV�l I Roofing Floors Interior 51 PP I�rJG J Plumbing �✓� /Heating g Fireplace y Approximate Cost S / Area IJO A re A CA A-A4 e Diagram of Lot and Building with Dimensions Fee . t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ' g the above construction. Name Aee Construction Supervisor's License i GORDON, iJON No 35678 Permit For REMODEL & RE—ROOF Single Family Dwelling Location 13 Marc..Avenue Owner Jon Gordon Type of Construction Frame Plot Lot 1 Permit Granted February 26 , 19 ' 9 Date of Inspection 19 i� 1�4te omp£dted r � 19 ` W I 4 A`