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HomeMy WebLinkAbout0166 MARCHANT'S MILL WAY �f(������a��s m/��� � �� � , Ir Assessor's office (1st floor): . Assessor's map.and lot number ............................................ SYSMlM MUST BE Board of Health (3rd floor): .-. 1XF3,7ALLED IN COMPUANCE Sewage Permit number 'I'�'''�'L 2 NAR33TADLE. MAG Engineering Department (3rd floor): ENVIRO IMEPI AL CODE AND +oo�16339 House number •.:..................................._.......... ........................ TOV�A G�a� Definitive Plan.Approved-by Planning Board.____-_;-_.____-____ 19 �� EG'�L�YI� S ' - APPLICATIONS •PROCESSED. 8:30-'9:30 A.M, and '1:00-2:00 P.M. only 4 T.,OWN, `OF ' BARNSTABLE 'APPROVED'-? 8arnof�o o�>�o> t:a>a eommsAN I L D I H G . INSPECT 0 R .......................................... Cato TYPE :OF CONSTRUCTION �a� .. . ......... 9, TO THE INSPECTOR OF BUILDINGS: The undersigned'hereby applies for,a permit according to the following information: Location .... �C' .... J"�C�1 , �Loo ��-.. 1� .. � .................................................. Proposed Use .....eof./Ti .rM., .:................ .. ........._:.:..:.. ........ .. .................... Zoning District ....... .... .:, ......... .... : ......:.:.........:.....Fire District .. .� ................... ..... Name of Owner .... 4e.f ........... .... ` ........ ..Address : ? /r!%i19.1. 4;..f ..... 16 6 . Name of Builder Address .. 10:....4 S .V..l".L�„a ....................... Name of Architect .: . .....Address .....:... ......... Number of Rooms ........... .... .........................(.............Foundation �G ld'.0 +�. :: 1 4............... Exlerior ::.. .�C G?✓� : �t!t.6t .( ........:... .....................Roofing J � ................. Floors, .........W.s017.�11................:............. ........................::::Interior ...: .kf�0. '...::....................................................... Heating. .......I>{t"-G ! .(,(......... ................,.............. . :....Plumbing .`...... ..... ....... ............... ........ Fireplace ................ ..... . ............., ........ :...,,........Approximate Cost /••�('�/ .. . �'�.. .......................... AreaRo........................... Diagram of Lot and Building with Dimensions / Fee .............0.......... .... .... 01 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby'agree to conform to all fhe Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....: .-!f; .:.. .. Construction Supervisor's LicenseCl. ......... _ SCRIBNER, LIZ ADD; 'TO No 33054 Permit for `;.. DWIE LI 1G.............. Single Family Dwling r r66 MarchanttrMil ay...... Location - ...................... ....... H s y p anni orb 4 .. ....... .. . .a..; .. ,. _ ... ,.. _ Liz Scribn r* '., Owner... .. .- ......... .. . . ..... .. . ......... 4 wood frame l � . Typ6 ofv Construction ... ..... ........ ..................... �! .. .. ........ - Plot ............... ......... Lot f < t 2 Permit Granted ....j:q!Y...ll............ 89 4. Date of Inspection .............................f:...... d 9 Date Completed .................. .... .. ...:19 - 4p t� ��. -� `Y���'��`•r`4G'.yi. 4�:2,s, ,. ..:Tt`,• i �s,�. �a:.;'�fT d+:.••.$;'Yf«r; %fro i �� n....-w,;ti:�-K;.:�.»ar�Y,�-�.:.�:riv�.iFw,s _ �- ...1r,..^., - � -. t�'t�-s;W. +...�;f��.+d'-'�'.^i7t�tr,'�a Fit- -?zs,w'�.-zrrkf+ �.ti.rt;a�w..+.u,'`.rc+'•,.i'�a;-,:ti.»�y'.' . Assessor's office (1st floor): G oFTNETo� Assessor's map and lot number ............................................ Q� f Board of Health (3rd floor): Sewage Permit number ......... Z BARISTADLE. i Engineering Department (3rd floor): G oo "6 9 3 . \e� Housenumber ........................................................................ ' �o�p�n' 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 INSPECTOR r ��K PPLI ATION FOR PERMIT TO � OIU............................................................................................................................. TYPE OF CONSTRUCTION P✓.�d/� ..................................................................................................................................... ........J4�e..-6...•...........19. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' 4 Location f����... `:.... 1L�`T....a �'L "� .. .......' !!!S�,C7R .............................................. �'..... .... ............ ProposedUse .............................................................................................................................................................................. Zoning District ...... F r:...................................................Fire District ....l. " ! � 1 .......................................................... Name of Owner ... ..... '.�.�' " ::......................................Address /(��' Ig1"c C1,�fbrrr7`J?t/I- tA✓� ................... .................................... .I. .............. Name of Builder ..C.0/9cr s 0- . 7A, ?A'dt�.............Address ..%OY, 5/0 0",?V/L.�Lf...................... Name of Architect ... Lf9.��. ` 5. .. rr � ...........................f� ...........Address ............ /.... ........................................ tr / Number of Rooms .................................................................Foundation ..�012 (L(.Qe Exlerior C cC 0"-t �'�l/Yl.�e�f� - a A. I+-- ............... .................... ........................................Roofing ....�..V.................................................................. ...... Floors .........�....r�...�...........................................................Interior .....WQf� � //11 Heating `..¢C.t /'2(c= .......Plumbing ...................................... .......��....f;C......................................................... . ...................... C Fireplace ..................................................................................Approximate Cost .......°`........�................................................ Area ...-,?.t/.. .......................... Diagram of Lot and Building with Dimensions Fee �V............................................. I6� / OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name l' .`. ......................... Construction Supervisor's License � ��� ' .:.................................. SCRIBNER, LIZ A=266-025 ADD TO No 33054 permit for ..DWELLING............. Single Family. Dwelling.......... Location ....166...Marchant Mill...W..ay...... Hyannis ort ?...............................I.................. Owner Liz Scribner .................................................................. Type of Construction ..Wood..fr me.............. ................................................................................ Plot ............................ Lot ................................ July 11 89 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 i �O Y , 4t' Town of Barnstable *Perini l( Expires 6 montl sfro issue e ° Regulatory Services Fee MASS' Thomas F.Geiler,Director K►6}I 1639. p`4g. lFD MA't Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601, www.town.bamstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address JZ�Residential Value of Work Minimum fee of$25.00,for work under$6000.00 Owner's Name&Address 1pzmy Contractor's Name_ '�lf Telephone Number '�� "S'�(n Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �dorkman's Compensation Insurance Check one: S- ❑ I am a sole proprietor Wam the Homeowner have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Z2 Copy of Insurance Compliance Certificate must accompany each permit.. Permit Request(check box) 2"Re-roof(stripping old shingles) All construction debris will be taken to Yr� ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *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 Rome Improvement Con tractors License&Construction Supervisors License is reqA ed. SIGNATURE: l -r ��. The Commonwealth 'of kfl ssachusetts Department of Industrial Accidents .Office of Investigations h `V 600 Washington Street — Bosion, MA 02.111 f., www.mass.gov/dia " Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:" z9�x�1"��h%��1� 1� City/State/Zip: - Phone Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a em to er with 4. F I am a general contractor and I P Y _ 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 workin for me in an ca acit . employees and'have.workers' g Y P Y _ 9. 0 Building addition ' [No workers' comp:insurance comp.insurance.'. required.] 5. We are a corporation and its ME]Electri cal.repairs or addition 3. I am a homeowner doing all work officers have exercised their I Lo Plumbing repairs or addition myself. [No workers' comp. right of ex6mption per MGL 12 oof repairs insurance required.]t C. 152, §1(4),and we have no employees.,[No workers' 1311 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. iContractors 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: Policy# or Self-ins.Lic.#: Expiration Date:-- Job Site Addiess: /�l i / I, �' Cit /State/Zi .& .4J� 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 e. 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 fin( 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 o er thepains andpenalties ofperjury that the information provided above is true and correct: Signature: Date: I Phbne#: ' Official use only. Do not write in this area, to be completed by city or town official. , City or Town: Permit/License 'Issuing A uthori ty (circle one): , 1.Board of Health 2.Building Department 3.City/Town Clerk_ 4. Electrical Inspector S. Plumbing Inspector, `6.Other i 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-contractors)name(s), addresses),and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(UP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,'a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit_or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be.sure that.the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office.of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will.be used as a.reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)," A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The 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-MASS.AFE Fax # 617-727-7749 - Revised 4-24-07 www.mass.gov/dia �JHE rod Town of Barnstable Regulatory Services ' BARNSTABLE i Thomas F. Geiler,Director. rous.e $ 16 ED A�"`� Building Division Tom Perry,Building Commissioner '200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us { Office: 508-862-4038 Fax: 508779M230 Property.:Owner Must Complete and Sign This Section If Using A Builder 7 /17 �/ ��,�I�/Jjjf�" as Owner of the'subject property hereby authorize a/ 0 �Diz to act on my behalf, -in all matters relative to work authorized by this, building permitapplication.for. � 14�zv (Address'of Job).. Signature of Owner at Print Name . If Property Owner is applying for permit please complete they �; Homeowners License ExemptionTorm on the reverse side. k Town of Barnstable f T Regulatory Services Thomas F. Geiler,Director BARNSTABLE, MASS. Building Division Pr�D '�a Torn Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wtivw.town.b arnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print DATE: - --- --• � ...___..,_.._. . , JOB LOCATION.'_, street village ,. �� � • .4 ,number , "HOMEOWNER": work hone 4 name homephoneW p 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 f 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/sR6understands-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 tS a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often.resul 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 hc/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 fora/certification for use in your community. r, n.wrorn F(z\Fr)pml,\hnmeexemot-DOC `. ... DAVID-2 OP ID: KG ,acoR/!7 CERTIFICATE OF LIABILITY INSURANCE OAT06/29DfYYYYI C os/zs111 THIS CERTIFICATE IS 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 endorsements . PRODUCER 508-771-1632 CONTACT Northwood Ins.Agency,Inc. PHONE FAX 540 Main Street,Suite B 508-393-2955 A/C No ct): -. LAIC,Noj_`— E-MAIL - -- - --_.. Hyannis,MA 02601 ADDRESS: INSURE a AFFORDING COVERAGE 1 NAIC s INSURER A:Travelers Insurance - INSURED David Cox, Inc. INSURER B: P.0. Box 401 INSURER C: S Yarmouth,MA 02664 -- '�— INSURER D: INSURER E: rINSU R 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 MAY BE 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. ( - ....__..........:...:......... .....r COG r POLt POLICY EXP �� - . ...... -......._......._.-........_ INTR I TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY IYYYY I LIMITS GENERAL LIABILITY I EACH OCCURRENCE S 11000,00 A — DOMMERCIAL GENERfAL LIABILITY 6801481 M796 03M4111 03114112 G t�R€ � —— — — PREMISES;(�a occurrence) S 300,0— CLAIMS-MADE �OCCUR ME EXP(Any one person) S — - - 5,000 X Business Owners PERSONAL 11 ADV INJURY is 1,000,000 GENERAL AGGREGATE S 2,000,00 rGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00 _ _....I_.___. ._._-...--- - POLICY PRO- _ _JECTLOC S AUTQMOSILE LIABILITY (Ea a SINGLE LIMIT lent) I ANY AUTO BODILY INJURY(Per person) S - -.- L_ ALL OWNED r-1 SCHEDULED BODILY INJURY(Par accidents S^ — AUTOS (AUTOS NON-OWNED PROPERTYDAMAGE —~ S HIRE[ AUTOS Per accitlent�,___,.__ -..— s — UMBRELLA LIAB ;OCCUR EACH OCCURRENCE S ......... _ EXCESS LIAS CLAIMS-MADE AGGREGATE-d- S DED I RETENTION S $ WORKERS COMPENSATION WC STATU• OTH• I - X RY,LIMITti ..._. AND EMPLOYERS'LIABILITY BKUB910k742211 07/15111 07/15h 2 A ANY PROPRIETORIPARTNERrEXECUTIVE Y!N E.L.EACH ACCIDENT S 100,00 OFFICERlMEMBER EXCLUDED? N/A i (Mandatary In NH) I j E.L.DISEASE-EA EMPLOYEES 10D,000 D yea,tleslxibe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 500,000 5 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE 1HILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 Main Street Hyannis, MA 02601 AUTHORL'.ED REPRESENTATIVE ',y ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office 711!.njm is rs c' uisin� _egulat►.'n a I License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: ,100497 Type' i i 10 Park Plaza-Suite 5170 ; Expiration 3/25/2012 Private Corporation I . -Boston,MA 02116 DA 1 COX, INC i 5 , David Cox 19 LAVENDER LN ! W.YARMOUTH,MA,02, Undersecretary j Not valid without signatur f _ Ill tssachusetts =Department of Public Safch l p : Board of Building Rcoulations and Standards Construction Supervisor License �. Licenser CS 63537 Restricted to: 00 DAVID R COX , =? PO BOX 401 S YARMOUTH, MA 02664 r - Expiration: 10/15/2011 i Cominissiuncr Tr#: 5822' �. _ • 2