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Home My WebLink About0435 OAKLAND ROAD �� e � _— _ � .� �7/�/�7 ,�� L Application number................................................ 2 6 Fee .......5.✓ .....6..... ........ .... .............. .. ... ..... Ak E�RRI�Sl7l8L8. • `` Building Inspectors Initials.... ......................... fDate Issued.... ................. .................................. J 2C.) a 011 OIAm �� ' �� Map/Parcel.............:................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: q G k�04 Qe\ NUMBER STREET VILLAG Owner's Dame: 0.• C 1N�u Phone Number �_<0 Email Address: %. - Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property Lhereby authorize to make application for a building permit in accordance with 780 CMR, Owner Signature: Date: TYPE OF WORK Siding Windows (no header change)# _� -Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)#'. (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 4 APPLICATION NUMBER n ` *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 l Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. 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. F- *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: a r_e_j vv�c M r-v-z,- Telephone Number 0 6 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�o -of Barnstable. Signature Date — A APPLICANT'S SIGNATURE Signature<C,K� Date All permit applications are subject to a buildin official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1'n " Please Print Legibly Name (Business/OrganizatiorAndividual): r V�/l� i Address: Li City/State/Zip: Phone#:_L< 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.❑ 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 working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3JA 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 13.❑ Other employees. [No workers' 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 certi under the pains and penalties of perjury that the information provided above is true and correct s Signature:. Date: Phone W 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 n 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),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. 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 021 U. Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Town of Barnstable Regulatory Services W� Thomas F.Geiler,Director Building Division MASS Tom Perry,Building Commissioner iblfp ray* 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ax: 508-790-6230 Approved: (�elll'�� Fee: - ems aO ' Permit#: -a HOME OCCUPATION REGISTRATION -- Date: t0i lj)y!� Name: rv<ra F t^'Ltj Phone#: Sa.f 77S 39/S' Address: 4 3S' olk.U-.,.60 tpJ, Village:T j!c, S Name of Business: Type of Business: Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration-to-the - premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;` and no increase in air or groundwater pollution. , After registration with the Building Inspector,a customary home occupation shall be permitted as of rights 1 bject to`.tle . � following conditions: srs • The activity is carried on by the permanent resident of a single family residential dwelling unit;located within 7 that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is c y no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date:--/V/411/111/_ Homeoc.doc Rev.5130103 YOU WISH TO OPEN A BUSINESS? TERS UR NAME wn (wh For Your Info rmation: Business certificates (cost$30.00 for 4 years). A business certificate ONLY,RE he Town ClOerk's Offi of 1 town FL.!367i Mai u :` must do by M.G.L.- it does not give you permission to operate.) Business Certificates are available a Street, Hyannis, MA 02601 (Town Hall) DATE: � : Ina r- Fill in please: a r APPLICANT'S YOUR NAME: Co D \ - BUSINESS YOUR HOME ADDRESS:�3S�i?�91e 1a��1rj< tl 7c�' 331.E t�Xc'hnor TELEPHONE # Home Telephone Number {`vc� 7 75- 3 /S' NAME OF NEW BUSINESS Cc f> ter-^nor}r�s TYPE OF BUSINESS �,�I—qA IS THIS A HOME OCCUPATION? ✓ YES N.O: Have you been given approval from the building divi ion? YES NO - AP/PARCEL N.UMB:ER ADDRESS OF BUSINES - 3�)- "r 3 S' o✓a �J When starting a new business there are several things you must do in order to be in co pliance with the rules and regulations of the Town of Barnstable. You MUST GO.TO 200 Main St.-(corner of Yarmouth Rd. & Main This form is intended to assist you in obtaining the information you may need. Street) to make sure you have the.appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ER'S OFFICE This individu I ha n tnfo d of any permit re ure ents that pertain to this type of business. Auth rize ignature f�G COMMENTS: a �v 2. BOARD, OF HEALTH This individual hasOed of a ne mit req drtain to this type of business. Anature"" -cl�) COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORIT This individual ha n infor d-ol the lic g6eu*&ments that pertain to this type.of business. Authorized Signature'" COMMENTS: YOU WISH TO OPEN A BUSINESS? in town ich For Your Information: Business certificates (cost$30.00 for 4 years). A business r toONLY available REGIS the Town TERS YOUR NAME Clerk' Office,e, 15 FL.,wh Main u must do by M.G.L. - it does not give you permission to operate.) Business Certificatesare Street, Hyannis, MA 02601 (Town Hall) DATE: I lS US el Fill in please: APPLICANT'S YOUR NAME: r-PRO 1` y BUSINESS YOUR HOME ADDRESS: Y3S"c:' L )end AM' r t �c's' 331� l'� cyan°r TELEPHONE # Home Telephone Number �vc� 7 7� 3 3/5� TYPE OF BUSINESS �;iLa gA NAME OF NEW BUSINESS Co ' IS THIS A HOME OCCUPATION? ✓ YES NO Have you been given approval from the building divi ion? YES NO AP/PARCEL N:UMB:ER ADDRESS OF BUSINES �3 Q C x4��T oQGoi 3�— When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO.TeOa eour 0 i St.-(corner of n this town.Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally op y 1. BUILDING COM7Auth ER'S OFFICE This individun4nfo d of any permit re wire ents that pertain to this type of business. rize ignature COMMENTS: v OA ,\ 2. BOARD. OF HEALTH This individual h4Autized formed of a pe mit req drtain to this type of business. O I ignature** O�) COMMENTS: (�. 3. CONSUMER AFFAIRS(LICENSING AUTHORIT This individual ha n infor of the liceg e ui ments.that pertain to this.type of business. 111 Authorized Signature" COMMENTS: