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HomeMy WebLinkAbout0353 MITCHELL'S WAY W4Y\17 i r,J M J NA-V i i i - i i i i I r Town of Barnstable Permit: � _ Regulatory Services Date: °F�HeTo�� Thomas F. Geiler, Director Building Division Fee: BARNSrABLE, Tom Perry, Building Commissioner MASS. 039. � 200 Main Street, Hyannis, MA 02601 AjFo �A www.town.barnstable.ma.us Office: 508-862-403 8 tFax: 508-790-623.0, TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT w Owner: Te-remv Arc Phone: 5Za 2 5 7 —/ / Install at: 3S3 A,- �, �/s (iA, Village: Map/Parcel: Date: 614-7/Zoi v Stove A. New/ Use B. Type: Radiant/Circulating C. Manufacturer: Lab. No. D. Model No.: Chim ey A. ew Existing (If existing, please note date of last cleaning) B. Flue Size 6 '' V C. Are other appliances attached to Flue? AU y D. Pre-fab Type and Manufacturer' &e- 1,6e r1oj E. Masonry: Lined/Unlined Hearth _ A. Materials: B. Sub Floor Construction: Installer Name: Dw At,*— Address: Phone: Location of Installation: H.I.0 Registration # Construction Supervisor# OR check Homeowner Installing, no license required APPLICANTS SIGN TURE u APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an of fr.cial stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 i The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations ' d 600 Washington Street Boston,MA 02111 ww'Mmass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information .Please Print Ledbly. Name(Business/Organization/Individual): . Address: City/State/Zip: Phone.#: Are you an employer? Check the appropriate bog: 'type o r oject(required):, 1.El I am a employer with 4. [] I am a general contractor and I 6 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. emodeling ship and have no employees These sub contractors have g, Demolition ..V ridn for me in an capacity. employees and have workers' g Y P tY 9. ❑Building addition o workers' comp.insurance comp, insurance. ' required.] 5. [] We are a corporation and its 10.❑•Blectrical 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.wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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-iris.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 maybe 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: Si afore: Date: 6 Z`t zoto Phone#: Z 3 7—iSU 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): A.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other Co ntact Person: Phone#: ........-- - -. _._ ....... - Q Who is responsible for making application for the ... __ . .permit? Application fora permit is required to be made by the owner or lessee or their agent of the building (e.g.; the HIC registrant ). If application is made other than by the owner, written authorization of the owner must accompany the application. Such written authorization shall be signed by the owner and shall include a statement of ownership and shall identify the owner's authorized agent, or shall grant permission to the lessee to apply for the permit. The full names and addresses of the owner, lessee, applicant and the responsible officers, if the owner or lessee is a corporate body, shall be stated in the application. Please note: It is the responsibility of the registered HIC to obtain all permits necessary for work covered by the Home Improvement Contractor Registration Law, M.G.L. c. 142A. An owner who secures his or her own permits for such shall be excluded from the guaranty fund provisions as defined in M.G.L. c. 142A. Back to Top Q. My contractor told me I need to obtain the permits for my construction. May I obtain the relevant permits from, my local building department, or is the contractor: - __ _ ........ . ...... _ _..._. . required to do that? While you may certainly obtain your own permits, be aware that if you do, you will fall into a homeowner exemption that will disqualify you from being eligible to receive recourse through M.G.L c. 142A, the HIC Law, or the statutorily authorized Guaranty Fund, should.a problem arise. It is the responsibility of the registered HIC to obtain all permits necessary for work covered by the Home Improvement Contractor Registration Law M.G.L. c. 142A. If the HIC you are contracting with refuses, you may wish to reconsider using that contractor's services. �,MEr � Town of Barnstable y r Regulatory Services 'HAS& ` Thomas F. Geiler,Director 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, = , 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 ob) ZY ZT Zato igna of Owner Date Print Na` e If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:OWNERPERMISSION ,� Town of Barnstable oFt� ti Regulatory Services snxxsrnsLE Thomas F.Geiler,Director tstasa 9� 039. ,�� Building Division aTF p IAA s 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: q7O/O JOB LOCATION: 353 /II/7 If ay y174/14t number © street I village "HOMEOWNER": Ie/e[�11V /Cr��/'Gl (SZts)237-ISKI name / home phone# work phone# CURRENT MAILING ADDRESS: S.3 ./n/ fZ'` I j S ILA /7Ya/t/I;,1 O Z.G v 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 re uirements. ignature Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or laige'r',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:\WPFILES\FORMS\homeexernpt.DOC q, t� T. i ti 4� 353 Mitchells Way, Hyannis 6/29/2010 i AA-0 I i • i d � Barnstable ight Travel 'mbursement Form Date RATE Iculate mileage reimbursement 0.505 EEItOdometerat De arived #Miles 'Town of BarnstablePermit: Regulatory Services ate:. ; °ptHe t�, Thomas F.Geiler,Director �- ti � Building'Division ee; S BARNSTABLE, Tom Perry, Building Commissioner Muss. 16yg. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner• C Phone: 0/. Install at: S a Village: W1./uhhi is Map/Parcel: 1 ®I Date: 2- Stove A. New Used B. Type: Radiant/ Circulating C. Manufacturer: 4 Lab. No. UZ- D. Model No.: Oa. Ch' ey . New Existing. (If existing,please note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue? A) D. Pre-fab Type and Manufacturer A// 7 -A /rr vh /C-sr E. Masonry: Lined/Unlined Hearth A. Materials: f--' B: Sub Floor Construction: Installer Name: Pam►^ �^ Address:36-3 Phone: C,510 qs 2 b 7- s U Location of Installation: 3 i H.I.0 Registration# Constructio7Servisor# OR checkomeowner Installing, no license required APPLICANTS SIGNATUREA&�=t���..�.�� APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 • Town.of Barnstable HE r�o y Regulatory Services Thomas F.Geiler,Director HARNSTAt3LE. • . M" Building Division prEO �a Tom ferry,Building Commissioner 200 Main Street, Hyannis,`MA 02601 veww.tom•n.b2rnsi2b1 C.Ma.US Office: 508-862-4038 Fax: 508-790-6230 IIONIEOWNER LICENSE EXEMPTION Please Print DATE: Z5 Z 0 JOB LOCATION: /�Ule�//C �a rioni' s number sh cet vtllagc -jr,r V/ 2,312 CO_S�- T,6 2-6 2-06 3 6 7 "HOMEOWNER": name home/phone# work phone# CURRENT MAILING ADDRESS.: 3TQ 6ar�lS77r�1P //!� 02601 .lGvcity{cfvn state zip code city 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 Buildding Department, minimum inspection procedures and requirements and that he/she will comply with said'procedures'and requirements. hiaatuW,4f Homeowncr r Approval of Building Official z Note Three-family dwellings containing 35,000 cubic feet or larger will be.regiiired to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomdng 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.- Man y homeowners who use this exemption arc 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 ! In this case,our Board cannot proceed against the unlicensed person as it would Arith a licensed when the homeowner hires unlicensed persons. Supervisbr. The homeovmcr 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�KEr� Town of Barnstable � o Regulatory Services '�uarrAs 'hUS& �; Thomas F. Geiler,Director 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 atwner'Mu. slt ' ,'G.dm fete and-,Sign This Section, p g 3 , . ff Using A Builder I, 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 fob) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.