HomeMy WebLinkAbout0160 MARSTON AVENUE (3) � - - - -- - - - -- -- - ---- - Rigs— lib -- q) 6b5
i
i
I
i
i
a
IN IZ M EAC
KEEPING YOU ORGANIZED
No. 10230
H163
nFO
SU AESTRAM MIN.RECYCLED
�v INMATM coNTENr�o�
Cap WF&wSc=ma PM-CONSUMER
SM2M
MADE IN USA
GET ORGANIZED AT SMEAD.COM
Application number.............,..1.... ... ....3q6.
Fee..............................................................................
sAwm
As» OCT 3 o Zoos
Building Inspectors Initials......................................TOWN OF BARNSTABLE
:,
Date Issued............ t........... ........
_ooS
Map/Parcel.................................................................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: UA.4 IT Ague-g VILL &V' o AtiN� �Cz�
NUMBER STREET LLAGE
Owner's Name: T FE V0 e_ i ffo% S Phone Number O A--
Email Address: Wutk;(J��Owi ion Cell.Phone Number (3 o i) 7 q 2`9
f
Project cost$ LOB 000 Check one Residential Commercial
OWNER'S AUTHORIZATION
� m
As owner of the above property I hereby authorize 5 �(,Q
to make application for a buildo pe in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
Siding Windows (no header change)#__L_ Insulation/Weatherization
0 Doors (no header change)# Commercial Doors require an inspector's review
Q Roof(not applying more than Llayer of shingles)
Construction Debris will be,going to V � 2
AtCCeLS 5 02A,,iL Rca_ Ct to j ®w� W AT (L S-eA
CONTRACTOR'S INFORMATION
Contractor's name ►F_S
Home Improvement Contractors Registration,(if applicable)# 102-g 2,,7 (7-01*20 attach copy)
Construction Supervisor's License# La $ • 40, 2(1 (attach copy).
Email of Contractor fiEiLLnw S (3J tL N (vtA-' • —Phone number( S'D9 `17fo .a
ALL PROPERTIES THAT HAVE STRUCTURES OVER 5 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
*For Tents Only'
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X , X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLI 'S SIGNATURE
Signature Date ?� `
All permit(Pplic
a ' ns are subject to a building official's approval prior to issuance.
Division of Professional Licensure
Board of Building Regulations and Standards
Office of Consumer Affairs&Business Regulation Construction Supervisor
HOME IMPROVEMENT CONTRACTOR
TYPE: Individual CS-040858 Expires: 09/30/2021
Registration Expiration JAMES D FELLOWS
102827 07101/2020 5 MAIN ST
JAMES D.FELLOWS MASHPEE MA 02649 '
D/B/A FELLOWS BUILDING 8 HOME IMPROVEMENT
JAMES D.FELLOWS
5 MAIN STREET
MASHPEE,MA 02649 Commissioner
Undersecretary ti
_.
Construction Supervisor
Unrestricted -Buildings of any use group which contain
less than 35,000 cubic feet (991 cubic meters) of enclosed
Registration valid for individual use only space.
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston,MA 02118
r
Not Vd)Id without signature Failure to possess a current edition of the Massachusetts
o State Building Code is cause for revocation of this license.
k / For information about this license
4 v' Call (617)7273200 or visit www.mass.govidpl
awr'wvow pope
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(Business/Organization/Individual):
Address: VK A_J A) S -
City/State/Zip: ozb %one#: 2 6 �f
-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
6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2. 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 h'• $ 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 I I:❑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:
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 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 nd naId ofperjury that the information provided above is true and correct.
Signature: Date: 30
Phone#:
Official ksepnfly. 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 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. Anew 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:
P P
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
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
Shirley and Bob Palardy
Property Managers
Harbor Village
160 Marston Ave.
Hyannisport,MA
Fellows Building
5 Main Street
Mashpee,MA 02649
To whom it may concern,
The Governing Board of Harbor Village Condominium Association has
given unanimous permission to proceed with the proposed work on#19
Harbor Village.Fellows Buildingwill be performingthis work.
Thank you,
Assessor's office(1st Floor):
Assessor's map and lotnumber -o �D /��► ��� ' yo*THE
Conservation ' ��♦ ♦lop
w
Board of Health'(3rd floor): _ '�71�LL ;
Sewage Permit number
MASK
Engineering Department(3rd floor):
House number
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and.1:00-2:00 P.M.onlyt
` TOWNS OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION — "
' 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following.information:
Location ZL '
Proposed Use 41, �e Lvr IL
Zoning District Fire District S
Name of Owner ��d�L� Address
Name of Builder ��� C,�� `C )4(Xt Address S 'CGS Y W oyd 4
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior
Heating Plumbing l'
Fireplace Approximate Cost L4®ep
Iv
Area f V
Diagram of Lot and Building with Dimensions Fee
i
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regard' the abo a construction.
Nam
Construction Supervisor's License
BABCOCK, CHRISTOPHER
�.4
No 35480 permit For RE-ROOF
Single Family Dwelling
LocatJv Marston Avenue ,
Harbor Village 19,,.
Hyannisport t( ��
Owner Christopher Babcock r
Type of Construction Frame
Plot Lot
t
Permit Granted October 28 , 19 92 y
Date of Inspection Q 19
Date Completed �� ` 19
q
z -
!- } el. �y1
i k
HOME IMPROVEMENT ONTROR 1
Registration 105119 OR
Type - DBA i
Expiration 07116194
Walls const-
suction li {
rray A. Malls 4 Remode
78 Statian Avenue
— --- - Sout" .Yarmouth MA 02664
1•
x
s
4 I
i