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Assessor's office(1 st Floor): p, r 3 K,
Assessor's map and lot number O 1 SE �E O*THE>O�`�
Board of Health(3rd floor): G ^�PUMC,�
Sewage Permit number ( INST >rr�/�+ •
Z BlHdST 4DLL .
Engineering Department(3rd floor): 2 —n zzj Lz g �a MAed
House number �J 7 �!6 CODE AND °,►�i639'a�e�
Definitive Plan Approved by Planning Board �� "mQNs o MPY
APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2:00 P.M.only -
TOWN - OF BARNSTABLE
BUILDING INSPECTOR _
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
I( f 1 1 19 �—
TO THE INSPECTOR OF BUILDINGS:
The undersign`eed hereby applies for a permit according to the following information:
Location � / Aftfl.s oti.s Au PVA-rJ A)16 ya-f—F, A4 OaI6�'V
Proposed UseC
Zoning District F Fire District
Name of Owner WI borm WI f�4 J+m Addressc77 !/IM A)5 Ar7 44MroU1Sit�IZ1�&Cx
Name of Builder 0 W P'lIE- Address
Name of Architect Address
Number of Rooms Foundation + f,UU Z-1�jB�
Exterior '_,_!r-Gj� S Roofing
Floors 1 .1a.[ Interior
_V Heating °t" � Plumbing
Fireplace Approximate Cost or)n Area
�� c9
Diagram of Lot and Building with Dimensions Fee
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.
e
r /`���Name ' '�
Construction Supervisor's License
KELLY, WILLIAM & JOHN MADDEN
i
• 1
1 _
No 32800 Permit For Build Deck 1
Single Fainily Dwelling
Location 37 Marstons Avenue
Hyannis o� rt A. .
Owner Willidm Kelly & John Madden
Type of-Construction Frame
Plot Lot ;
y'
Permit Granted April 14 , 19 - 89
Date of Inspection 19
Dat plet i - 19
Erg
}'. trM 0
4 00
yPisCQ
x TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION-
Map Parcel L 30 Application,#
Health Division Date Issued' a a`1 Og
Conservation Division Application Fee
Tax Collector Permit Fee
Treasurer (�
Planning a g Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address "R6m
Village ��N�(
Owner 5(afr 6), fJUll`* Address :0 AMA(-"
Telephone
Permit Request T=L-X n �U I,L F� TjQ (� ,1�5 /�� C L.1 I� �Yh 15,0002I",
i
Square feet: 1 st floor:existing proposed_5*dl C52nd floor:existinowproposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation IM Construction Type WORD
Lot Size �,�CG Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure it4q Historic House: ❑Yes O'No On Old King's Highway: ❑Yes ko
Basement Type: ❑ Full drawl ❑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
I
Total Room Count(not including baths):existing #(_new First Floor Room Count
Heat Type and Fuel: atas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes dN'io Fireplaces: Existing _ New_ Existing wood/coal stove: ❑Yes Flo
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size=
� 4,
Attached garage:a"existing ❑new size Shed:❑existing ❑new size Other:
Ct n
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ >
Commercial ❑Yes ❑No If yes, site plan review# }
Current Use Proposed Use ED
_ BUILDER INFORMATION-
amve"tzI ' E 6 Telephone Number S0IT- q.;03 -0.64
A License# C S oe-1 Z�15
5 jF- V)i`-L E; fy) A _ Home Improvement Contractor# 150 d07
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
/012
�/ SIGNATURES DATE
FOR OFFICIAL USE ONLY -
1
APPLICATION# '
=DATE ISSUED
MAP PARCEL NO.
5 r
r
r ADDRESS VILLAGE
>OWNER
DATE OF INSPECTION: j
FOUNDATION
i ff 1-L
FRAME � I� �- ��� �
l
INSULATION ^f Z�_
FIREPLACE
ELECTRICAL: ROUGH FINAL -
r -
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
t�
4.
r
Town of Barnstable
` Regulatory Services
Xdss Thomas F. Geiler,Director
°rEo,,,,.:• Building Division : �)
Thomas Perry, CBO,BuildingCommissioner
Ci
200 Main Street, Hyannis,MA 02601
www.town.barnsta ble.ma.us
Office: 508-862-4038 Fax: 508-790-6230
PLAN REVIEW
Owner: 5 . ( Map%Parcel: a r S r
Project Address_ ~7 � Wt-4iw-na,G- -�
rsuilder:-:
.The following items were noted on reviewing:
7-6 Cod
Reviewed by .
Date:..
QFomns:Plnrvw
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
CNa tie-(Busmess/Organization/Individual):
CiState/Z Q i F t t.t-rc Phone.#:
Are you an employer?Check the appropriate box: Type of project(required):
4. ❑ I am a general contractor and I
1.El I am a employer with 6. ❑New construction
employees(full and/or part-time).* listed
hired the sub-contractors
A2 [�Tama 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 h'• - # 9. ❑Building addition
[No workers'comp. insurance comp.insurance. 10. Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑ P
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 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:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip: .. r
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 ains and penalties of perjury that the information provided above is true and correct.
CSiatuie. Date: - ,(. C
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 4risurancecoverage. 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 maybe 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
Mice 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
�FTHE r Town of Barnstable'
Regulatory Services
• BARNSTABLE,
v MAss. g, Thomas F. Geiler,Director
16;. 1. 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
Property Owner Must ,
Complete and Sign This Section
If Using A Builder ,
I J :furl as.Owner of the subject property
�' l p p tY
hereby authorize `' 0 to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signatu o ner Date
Print Name
If Property Owner is applying for permit please complete the Homeowners License
Exemption Form on the reverse side.
Q
:FORM&OWNERPERMISSION _r
I
THE
Town of Barnstable
�pF Tp��
Regulatory Services
Thomas F.Geiler,Director
BARNSTABLE,
9 MASS. A
�p 1639• p,041 Building Division
lfD � 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
1
DATE: a 08
JOB LOCATION: . AA�TOU 15
number street •ilage
"HOMEOWNER': ff J
name I, ho a phone# work phone#
CURRENT MAILING ADDRESS:
�.
cityltown state zip code
The current exemption for"homeowners"was ex ended to inclu e owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for 're who doe not possess a license,provided that the owner acts as
supervisor.
DEFINITI N O OMEOWNER
Person(s)who owns a parcel of land on which he/she r s�i es or intends to reside, on which there is, or is intended to
be, a one or two-family dwelling,attached or detached ctures accessory to such use and/or farm structures. A
person who constructs more than one home in a twoyear\teriod shall not be considered a homeowner. Such
"homeowner shall submit to the Building Official on a facceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building t. (Section 109.1.1)
The undersigned" meowner"assumes responsibility for compy nee with the State Building Code and other
applicable codes, aws,rules and regulations.
The undersign meowner"certifies that he/she understands the To of Barnstable Building Department
minimum i i procedures and�requirements and that he/she will c �' ,ply with said procedures and
requ' nts '\willlbe
Si ature of wner
Approval of Build ng Official
Note: hree-family dwellings containing 35,000 cubic feet or larired°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.L I -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:forrnr s:homeexempt
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HOME IMPROVEfiAENT CONTRACTOZcpirahou date ft found rctasn to
iiegiscra:bon 150807 aoarcof 13urlding Regulations and-:StanG�ar
Ex nation r +'c c5)p1 ton Ptace Rm 13.01 P �73/2r08 .,
"' Type Iri�ividual �'cib;.114a 02108 {
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Assessor's office(1st Floor): ��•,, fye t
Assessor's map and lot number cx� G? 4 t.3 0 I �o�TW I
Board of Health(3rd floor): \ d�Q ♦w
Sewage Permit number -
S BA"STODLL
Engineering Department(3rd floor): u�,II � rnsa
Iuse number 'Yl o° 1639 ®�
finitive Plan-Approved by Planning.Board 19 0 raY a•
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
19 _
TO THE INSPECTOR OVBUILDINGS ' , ' u14
The undersigned hereby applies for a permit according to the following information:
Location -3 AU t1 V A-►�N l`-' � lT,/hA Oa`��a t
Proposed Use
Zoning District r Fire District % '��✓'vas
i l/ ,
Name of Owner Wi «co(m hG�� �44 , a-�i i� Address39 7 All �k NiU/S )Yl.�. d
in (
Name of Builder 0 W t)fL Address
,
Name of Architect (b Njr-7 Address 1
Number of Rooms Foundation - Sawa ! t-• ke-s
Exterior Wtd 4ir-cileS Roofing
Floors. T _IA,f Interior
/-
Heating Plumbing,. 1
Fireplace rid Approximate Cost
o - ,
Area Od
Diagram of Lot and Building with Dimensions Fee-
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 ��2�
Construction Supervisor's License wve��
KELLY, WILLIAM & JOHN MADDEN A=288-130
e
No 3280.0' Permit For Build Deck
Single Family Dwelling
t,
Location 37 Marstons Avenue
Hyannisport
Owner William Kelly & John Madden
Type of Construction Frame
Plot Lot
Permit Granted April 14 , 19 89
Date of Inspection 19
Date Completed 19