Loading...
HomeMy WebLinkAbout0298 OCEAN STREET Town of Barnstable *Permit# Q00-7 0-::118 2S Expires 6 months from issue date 1 regulatory Services Fee ' Thomas F. Geller,Director Building Division �--, Tom Perry, CBO, Building Commissionerr�0 G.L.- 200 Main Street,Hyannis,MA 02601 www.toun.barmtable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ap/parcel Number operty Address C�C'�°�>7 S�o +��n,`5 4 6.2 }'Residential Value of Work �l ddd•Db Minimum fee of$25.00 for work under$6000.00 �,mer's Name&Address r nntractor'sName Telephone Number773 j 2 ome Improvement Contractor License#(if applicable) sor's-L-ic znse#-(-rf-appiievble) ]Workman's Compensation Insurance. PRESS PERMIT Check one: ❑ 1 a sole proprietor MAY 11 2007 L.i'I am the HomeoRmer ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABL� surance Company Name f ?' �/� fJ t�d�`-�. AgelueV ��p e , (4/1f e N� _orkman's Comp Policy# spy of Insurance Compliance Certificate must be on file. :unit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to__ f ti�►�i 4 54 Jw 4 ❑Re-roof(not stripping, Going over existing layers of roof) le-side eplacement Windows/doors/sliders. U-Value �J y (maximum.44) r.' Where required: Issuance of this perrrut does not exempt compliance with other town departrnern��rr�ft� i.e.Historic,Conservation,etc. l a ***Note: Property Owner must sign Property Owner better of Permission. A c py of the Home Improvement Contractors License is required. ,GNATURE: Ila 60 *01 Wv I I AVW t0Ol Forms:expmtrgtu :vise061306 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wi*.mass.gov/dia ' Workers}Compensation Insurance Affiidavit: Builders/Contractors/Eleetridans/Plumbers Applicant Information Please Print Le 'bl Name(Business/organizationadividual): . �C I • •Address• ^ City/State/Zip: 4 n n, _5 /`? 6,112610 Phone.#: S 6 Are you an employer Check the appropriate box: :Type of project(required):. 1,❑ I am a employer 4. ❑ I am a general col&actor and I mP with b, New construction . "employees (full and/or part-time). have hired the sub-contractors listed onthe•attached sheet. . V19eemodeling 2.❑ I am a'sole proprietor or partner- b These sub-contract ha ve ave ship and have no employees 8. ❑Demolition -workingfor me in an capacity. employees and have workers' Y P tY• $. 9. ❑Building addition [No workers' comp,ms»nce comp,insurance, 10.❑Electrical repairs or additions re aired.] 5. [] We are a corporation and its a homeowner doing ill-work officers have exercised their 11.0Plumbing repairs or additions ' right of exemption per MGL myself.[No workers camp. 12, �Other frepairs l insurance.required.]t c. 152, §1(4),and we have no 13. SJ� i� 1NtrdW 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 anew affidavit indicating such. tContractors 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 theft 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: - lob 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 tip to$1,500.00 and/or one-year imprisonment,as well as civilpenalties 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 and r the pains and/penalties of perjury that the information provided above. ss true and correct Si tare: . . Date: Phone# � ��1a 32 Official use only. Do not write in this area, to•be completed bycity 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 nstr coons 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 ehapter.152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall 'enter into any contract for,the performance of public-work untii acceptable ewdenee-of•comj1!anee vwith: ie 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 Departoent 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 pemut.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 set€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 fo 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 C©.Mmonwealth ofMmsarhusetEs Dtpait mient of l a.ft%Wai Accidents P-Mm of Investfigatdous 604 Waste Street B�WQn.,.MA 02111 . . TO.#f 17 727 400 ext 406 or 1- MASSAFE Revised 11-22-06 Fax#617-727-7749 WWW.M=.80V/di0 THE 'Town of Barnstable -� pF Tp� Regulatory Services * BARNSfABLE, Thomas F.Geiler,Direetor MASS. %639• Building Division �ATED MP'1 A b 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: JOB LOCATION: C 4 e?41` / `S. number stre village r / l , "HOMEOWNTER': �f JC l� h name home phone# work phone# CURRENT MAILING ADDRESS: 5,cm city/town state zip code The current exemption for"homeo Anvers"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 requirement �. Signature of Ho eo r 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." t, 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:foir,is:homeexempt 1 J t' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3)-S Parcel Application# �6 �" Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee —456 Planning Dept. Permit Fee t S_ob Date Definitive Plan A proved by _ nning Board Historic-OKH eservation/Hyannis Project Street Address 004 D&CO 5 Village i+q 1 s Owner M!ciia \ � , FItl A Address �3UMe, Telephone Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation L�,.O(� Construction Type -J0%+1'6 J Lot Size Grandfathered: ❑Yes O//No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure i9 WSJ Historic House: ❑Yes U<o On Old King's Highway: ❑Yes No Basement Type: lull ❑Crawl ❑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 Total Room Count(not including baths):existing j-1 new First Floor Room Count Heat Type and Fuel: ®"Gas ❑Oil ❑Electric ❑Other VVA Central Air: ❑Yes 0No Fireplaces: Existing New Existing wood/cohl stover Yeses; .0 No N � � Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing Eknew size ff "b' Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: l -C > Zoning Board of Appeals Authorization 0 Appeal,#_ Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# o , Cn .�.m Current Use Proposed Use BUILDER INFORMATION Name ch vfAA Telephone Number 5-6$ 77.7'1i2_qz 'Address M Sf. License# 6-AnM off(L) Home Improvement Contractor# Worker's Compensations#�J 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE S _ ��' 7 FOR OFFICIAL USE ONLY a .. PERMIT.NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i i DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. , r Department of Industrial Accidents Office of Investigations s 600 Washington Street Boston,CIA 02111 w www.mass.gov/dia ' Workers' Compensation I4surance Affidavit: Builders/Contractors/FIdctdclans/Plumbers Applicant Information A Please Print Legibly Name(Business/Organization/Individual): M ICU `F,eI Address: �� n r City/State/Zip: nne5 D)L(ob I Phone:#: Are you an employer? Check the'appropriate boa: -Type of project(required):, 1.❑ I am a em Io er with 4. [] I am a general contractor and I P Y 6..❑New construction . employees (fall and/or part-time).* have hired the sib-contractors 2.0 I am a'sole proprietor or geriner- listed on the- ttached sheet. 7. [remodeling ship mdhave 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. 10. Electriealre arcs or additions equired] 5, ❑ V e are a corporation and its ❑ P g , officers have exercised their , '3. I am a homeowner Join ail work � 11.❑Plumbing repairs or additions Myself o workers'co right bf exemption per exercised. y [N �• 12. Roof repairs insurance requited.]t c. 152,§1(4), and we have no employees. [No workers' 13:�ther comp.insurance required] • *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomnadon. t Homeowners who submit this affidaoitindica6ng they are doing all work and then hire outside contractors must submit anew afdavitindicating such. $Contractors that chec}c this box must attached on 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 providt their workers'comp.polidy number. I am an employer that is providing workers cornperisatiart insurance far my employees.•Below is.thepolicy and jab.site information, Insurance Company Name: policy#or Self-ins.Lic,#: Expiration Date: fob Site Address Citylstate/Zip: Attach a.copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required tinder Section 25A of MGL c. 152 call lead to the imposition of criminal penalties of a fine rip to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER amd 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 CIA for insurance coverage verification. I do hereby certify under t� 'e nd penalties of perjury that the information prgvided above,is true and,correct: Si at ire:. /f Date: 777 Phone 4• -b 7 2S-- 42?Z Official use only,.-Do not write.in this area, fo be completed by city or town official City or Town: PermitUcense# 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#: • . . N Inform a io and Instructions • r 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 hiie, 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 =,-ebm trusts-•of an individual,partners as or other legal entity, employing employees. Tioweyer the nr 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 suchAwelling•hnuse or on the grounds or building appurtenant thereto shall notbecause 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,azceptable evidence of compliance with the insurance coverage required!' Additionally,MGL ohapter 152,•§25C(7)states'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,•theyperfonnance of public workuntil'acceptable evidence of compliance withtlie insu mce requirements of as chapter have beenpresented'to the contracting airtfiority." Applicants Please fill out the workers'compensation affidavit completely,'by checking the boxes that apply to your situation and, if necessary,supply sub-comcactor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnershipa(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, B.e 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 ls being requested,not the Department of Industrial Accidents;Should you have any questions regarding the law•oi•if you are required to obtain a workers'•. compensation poliey,please call the Department at the number listed below, Self-insured companies should Winter heir self-insurance license number on the appropriate-line. City or Tows 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 pesnmitlicense 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-inf=ation(if necessary)and under"Job Site Address"the applicant should write"ailocations'in . (City-or town)."A.c'opy'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 ventute (i,e.a dog license or permit to bum leaves-etc.)said perm is NOT required to.complete this affidavit, The Office of Investigations would]rise to thank you in advance for your co operation and should yeu have any questio.__,,,- please do not hesitate to give us a call. The Department's address,telephone-and fax number;• ' Dgp rot of��al A oci s' Office of lnycWgAtions Boston,MIA�2111 T6.4 617-727-00-0-ext 4.06 ar l-0 77-MA.SSAFE Fax�617-727-7 7 . 49 Revised 11-22-06 l P�oFTHE Thy Town ®f Barnstable o� Regulatory Services BARNSTABLE, Thomas F.Geiler,Director MASS. 1639• Building Division lED �a 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 Q Please Print DATE: JOB LOCATION: 25 �e�01 S Gr lldrl/5 number / �-- street p 7 village "HOMEUIWNER': / /I C��/1 /"/C��� RO " / ��- /2 name home phone 4 work phone 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 HOMMOWNER 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 requirement Signature of HomecAner 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 EXE]lIEPTION 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 homeovmer 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:forms:homeexempt I °FETo►,ti Town of Barnstable Regulatory Services r • +`� BARNSCABLE, • v MASS& Thomas F.Geiler,Director 1639. A,Ep MA+� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date �]�b 7 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Ae No V4 I*W Estimated Cost Address of Work: �j ?l o ec11 (o Owner's Name: Date of Application: 7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: S-- 7 07 Date Contractor Name Registration No. Date Owner's Name Q:forrns:homeaffidav fi� ��• � �. $,UILD�IN,�= �D+IyvIS,I+ONE � `� ,b �� r �� J ,; sE F C1a'S 'C M�'" ' ,h , + 'i��:: :4� � tin "'a fTr ,IS S,TRLDC.I f A� /�®R PR°EMISESA S B� ENS wt �sI+NSPECTE�'ju RIE LOWING IOIAT�IONS k' ' ' ak a tr� tr rk 39 i r jif" ®F TH »�Bp�L1ILL�D_ aI ,`�G��COghDE�',A DOR Z�j NIcN�G . ♦ry ya '".3v hyY�ta�y,Y'� ��E u��� +�'b,����,.k"i L'P�' N+'y 1�9Y�S �..�'���� W, AM MA ry €# rpm K .. ji _ � y�s.,.,"k'•. �`�` x.� � I -ry,fi1r YOU AvRE'HEM ZEBY N�i a�F :I T �+ ' ads , e tv.4 �x + z frro 3E y � _ N� ?ADDITI� nNAI'�f'`� O° S `�LL B'E UNDERTAKEN11 5� JP N TdHE$EP;` ;MI�SES'; ,f HEPREM�I4SiYSA+ .Lt .i 'd�YS,-Cyau4�'+F 4v ,� tmr ..+ =} � Gy8r ° � II.,THE' �B01VEVIOnLATI ,jNtS «^�� ACT D rA�RE10�p�'���o` x Ar� M � REMO�VIl�1G THIS NOTICE WITH P UT N. � �7 xi h P IMIAMUM,A�`hI�O��T�I4G�N�SH�A�L�B�E�� ��� ME A TO�XAIFINE F NOTt K r'S Ms M , RL T�, �� �all � , y�, ti � airy t zg d t tyE �t W� lt�Z llissiO)Ilj ggs �>i-+ .£,.�.«.sel��:l..$.Yi�� �.���«..t;,.�,.di�' pan'"*s'�d� rc5�atl�a'G>��idt.6n��� 'd"a*�'sN„� c"Y: :�w?a�.��'�A • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �f Map Parcel Permit# 2` 3 a- Health Division 91gA3 Date Issued � 1 Q y' _,t. Conservation Division Ae ss Application Fee Tax Collector '� Permit Fee d • �' 0 Treasurer 45 D I SCANT MUST OBTAIN A SEWER Planning Dept. CONNECTIONG PERMIT FROM THE CONSTFU 0 SON PRIOR TO Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ef AA/ S T. Village _t & Owner /� ,yr,� /> C�� Address / VV Telephone Permit Request _ke e- --Ayo Square feet: 1st floor: existing proposed :$We- 2nd floor: existing �r� proposed _5-�o7e_ Total new S4i'9e /jg0 Zoning District Flood Plain Groundwater Overlay Ile Project Valuation /:.4,aoo° °° Construction Type Lot Size 0./�f Grandfathered: ❑Yes ?2rNo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 8a Historic House: ❑Yes 2'No On Old King's Highway: ❑Yes a'No Basement.Type: ®Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ® Basement Unfinished Area(sq•ft) 7,,33 Number of Baths: Full: existing — new Half:existing ® new Number of Bedrooms: existing new e..� Total Room Count(not including baths): existing / new ° First Floor Room Count f Heat Type and Fuel: ❑Gas 5iOil ❑ Electric ❑Other Central Air: O Yes W No Fireplaces: Existing 0 New O Existing oo coal stove: Yes_ ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:Cs &isting ®new size Z -To :Z Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: �f U7 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ M Commercial ❑Yes A No If yes, site plan review# Current Use -Proposed Use--- BUILDER INFORMATION Y. Name_ I le Telephone Number Address > w ST= License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS'RESULTING FROM THIS PROJECT WILL BETAKEN TO , ill GG cov�2 SIGNATURE DATE g�lJ,? " DS s FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEL NO. •! � rr ADDRESS VILLAGE OWNER DATE OF'.INSPECTION: L J' FOUNDATION �.1✓ FRAME P? INSULATION /t✓S & O FIREPLACE ` 4 ELECTRICAL: ROUGH FINAL" PLUMBING: ROUGH FINAL," . r 1 GAS: ROUGH FINAL r r, FINAL BUILDINGol DATE CLOSED OUT07 �► j ASSOCIATION PLAN NO. o w .a RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 11�, a d Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE _ square feet x$64/sq.foot= x.003I= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft` � , >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= . (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee/77 6 ' IN t projcost I The Commonwealth of Massachusetts Department of Industrial Accidents — office oflayes0fit"s t 600 Washington Street Boston,Mass. 02111 Workers' Cam ensation Insurance Affidavit INN �01 location: (/t"2/tA ST' • ci hone# I am a h meowner performing all work myself. I am a sole pr etor and have no one wor= m. ca achy ��//��%%%///////%/%/%%% %%%%%%%/%O�%%%%/%%////G/%%/%%//%%/////%%%/%///%%%%/��///%%%%%%/%///////////%/G/%%%%/ din workers co ensation for my employees working on this job. m1 rove mP :•::::.^.:.........:.::.::::.:.:.:::::.:::.::::::;.}::>:; .>;>::>:>:.>::;:«:;<>::»:;:»:>:;.}:£)}:.:::::.:.:::::::4:::::-..:..: :...............::..............,...:.,.}::..r......:..:...:..................... ... . :.......... ........... ................ .............. .......................... ..........4..........;.,; :•}};4:4:{•:+v{{4:4.v:{.}v:0}ii.,�}{}Jfitt•: :. :.•.:n..:v... ....... ...?.};+.4:}:•}}::::4:?Q}}.}:•:;:•:;^}}:;{:y::::.::•;•))%:}:v::•?jy::::•:}:•::w:w::.4:r,.:::.::.v �[a. .........:...................:..::..:::::::::.}:v:L•}):�:::.:�::}:Sv.i::•:i:)i)i::.'iir� �:•:•:{4}}:^:}••ti:::}{):•:!L:Lti?3}i:nv:.... ,.... -:::......:..........::v.::::.:::..........::w::::v:vnv.,....:::.:v:^w::::.....v..::::::•.v.yr::............................. .......v.....vv:�v'i):::...y.,4 4.}k•:F vii::};:.::.. •v:4Y'. •'•••� Sf«5:;.;::j�i{�`:`:`?':::::;::;;�:;:4i:;}::';.,:y{;!ti;;;;;;;;;;;;;;;;;i:�.?}Y.•}}:•)::v:}:v:•fv: ...................:.:::..:......::::.•......:::^v:::::::.:v:::::}:�}:;•):;4}:vw::::v'ivi:-i?+i:•:•:hii}i}:�:::}+iii)):$T:�}::::}::::':::........'..Yi:•:•.tt•:n.v^•{^•.. v, alt ':.�ri�suran ❑ I am a sole proprietor,general contractor, or homeowner one)and have hired the contractors listed below who have coensation ohces; ::.:::::.:.,t:•:::4::.::.::::.,:::::::,:.::.:.:..::..::::::.:::::::.:.::t.:.,}:;;<:::<}..,..,:.�:<.^ }•:::.::t;.}:.:<. win workers P.........................:::.�:.�:.�:.........:.�:::::::..........:...... �...,:..:.).v}.::\.::..:.,:.::.� folio mP ................... .......................:....:..................:..:,.. the ...... . .........................:.:...............:.:.:..............::::.:.::::.:,.::::.:::::.:::::::::::::::.:.:::::•.:}:.:�}::}>:.:;:};:.:{.}.:.>::.?}::�::>«.};:.:{.}:.}::.}^t ... % •\.•..: .t.v ;:•)e;>+ ?i`E�i2':'i»�i ` ; ;i ........... .......... ................ ........... ......-....... ............................ •. ,,:..::::.:::.^. F{{4)};{•vv;}{;:v:}..5:::4}):ir^}:>{?.:::}...}v}t,.•;4}:'�}}i:4:• ........ .n.... ......r. ........ ...................... .... x:v?+•:::.. w:.v:...........,.. 4.w.w::•. {v, v}v� iti i}'.;:;:.;. '<L:}: }. ... ............... '.:.::):v:)::4}::.)::i::.....e.{•:.v}::•:::.v...:.:...........: •.;;..:;:•;•:.....:..::::.;..:.:.:.:.:ii;.;}:)•.4}}:•ist•:4;;.}:+:•}i}i:•}}:v;4::..:::::::!.:::•.,. .a�'dre .. ::::{•}:tip}:•}:.::. ..•• �:.} Mai ................... ..........................................:........................::::::::::::::�.v:ti:•)'F.4'}}::'•.4=:t%iY::•i:;:Lv::.:nYr:;{.n}v:::rvv-.:<:}:{:..... ......... ...... ............ ......... ............ ............ {•::nt.., v.:::•:n.. .x•}:4.h}:::::.4":t.•v. .v}•.}'t•.•::t,•h••x Yi\.v :::::;•:::::v.�::::n.•:::}::v:::.:::::Fw::Fi::::•v;,w::;::::::.v:•...-v:.v::w:::::v,v:•................... ...................vyv::::.vv.v:;r^:v:::::n•...t v...... n...:;.......... .•F.v}?Y^:.•.v:.}iY:2Y:•v:•}i?}:;:r ..... ..............:•.v,f./•.. ..suss... ..:.v.v:n4it'{S{G};{{•::::.. y.'. ::•:: ..F.......•..... r.. ..... ....... .......t......... ........... .............. .:...........::.... rr::vv{:t.}F.:{:{.:,.}:v:v,rr}+F{�}.4'. F...r....... ........ ../........... ..........v...r ......................: .............:... .....:.vv::.... ........:� .::tw::::::.v•:.}:?{r.•}'i{•vf.4}}:n.... ....:yv:rt v Y{. •ri:,N.;?{.ti,:{:''{4 r..n...r:••::•: ...v::::::•:.�::4:4}:::::............ h:+:•nw::;::{t•.......{.:,.4•:;•:.::::::4})::,:v:t•.........4Y..r..nv::•..;4`',{'•p. ...:.............:.:.........::.::.v..............:.. :: .....,......... . hone. ,....,.:... ............ ............. ............ .............. ............... ..xi}}}'4)'r-Y;•4:},;w:ti:'r,:;:<C:{;):Cn.•ijiki\;Y,.}�+�:!: .................: �::.:.::::::::.:.:..:.::::::::::::.:�:::::::::::•i^ii:�:)}i.:•:•$))}iii:i:•:•ii}i}}}}i:�}:;iFi;:ji•i•}i:•F:::?:{i:;:?4:::vx. nv .n... ............. ............ .............. .....^........... .-........... ......v:.v:t•}:w•.....:::•::.;•....:• :::......v.t .... v.. 'v{Yi•�?4:•4}:}:{•}'{{::{•}:?v}}}: .... ... ..... ... ...................:..::::::•:::w;.:v:•::v.:,:}:4Y{•}......:............,, muss... ::.:{4:::,n}w:•:).;; •:{.v .... .... ....... .... ...:.................::::..... ............v:nv::•:::::.v:::....... .:::::. .......:;};;:..suss;;.v.: Lt;):•}.v........,:x}:{•:ih:'4}•:t,:;:,ik{h•}: .. ...:. ................... ....^.. ........... ......................::••::::........... ...........::::.�:::..;..... ..... ....,...... •w.:vv:•:::4:.>.vF:4::Y::}.+-w rwv. -}:3i'>• 'h+hi t^:::: tti}}:{•:•:4::4i}))}}:•}:{•i:•::•:::::.{:?{;::L::':Y>:•:;::::�:::�'i::::{:.v:::;;>:•i}{: :}:;:•. I'ri3then¢e`ca's>:a <:<>•:}::<{;::;.:}:{..:..::.,...)..... ......... .. v....:::...........v:::;..• ......:.vt::t:;;:i.:;{:�}:•.v v^v:;:::+...r...:•}::�i'4):?.}• ..}.::•r.v:�i:$4:;i? ........ ......::::::::.:::.::.:};::::::�:{•:::)):>));;}:•})})•>):.}.........::::.v.�::•::::;:.v:.})}:t4)}:•�::....:.v4:ti4i:•::::•:4;4'•}:';v:'4:) ........^r:.�::::•vv::::..t '•{?:.h+}) ' .............:..................::..................:.:...:.............:r::................v:•:::..................::::.........^........• ...... ^••..•. }...v.:r:y.}}'4'f v:::::::�?......rr^....<:+iY•vri• :: 4':•}r::•:•:::•v:;{•}:•: ...... .......... ........... ...:....n..• ............... ........ vt.•^•.vv.v:r::w::;;..:........;;...- t F:•.^4\..:...: h•.':vv'....:>::}• :<><> .......... ............ .............. v...:r.v:::;:::.:v:::::::.v:::....:.w:..:;;. \•l)}'f.4.:?4k.v:•,y},'}:.;}::i:':2 ........... ........�:::::::::::.v::::.•:•:�:::.v+v::•:.v:•:..:•::•:::::r.v::v;suss...' t:}}:{::}}}:4)):w:n....-...::v:.v:::::::::w::::::^v::::w:;}:•}},:w::•:::4}}}:{.!}}:•)::i ....... ............... .......... .... ...........................n..............:v:.v.v .}:!:54:•;}):4:•• ..r::^v:::::::::.x:':F.}}:::::...{�::.::::v: ...............:::::::::::::::::.}::r::.,{r.:w;::{;::r.:r:::.v;..........• v:::;.....r.v:•:•:}}ti:{v:.:{:i:..... x::, v}:4;, .. ......................:•::w::;v:.v::::::.�:4y:::n..............:v.::...........:v.::.:..:::n {w::...^n..............-..:h}:•}}..,....:: '•}{v}:•:{•):::tvr,^; lw:::::::• .... ..... ..,..... ...... ....... ......................... ........... ............. ...r:.v:^n.••:::::v::::::•• ..... .... .....:.:}:tiv.....::::. ..::r.{.: wrv^.:r:: ......... ...... ......... ........ ........ ............ ........ � ::h`:•:�i}}:{:'::+w:::44Y:.;{•:{v:x•;...;}?:tiff}•}":v;: :$yt•}).............. rC)}X ti4}irF�"}::•i:{S•}})::;,...••. :.......... vr.;...;;.... :::::::yr :::v.::::::.. .:...... •..........:v:....• r::.:x::;::::x....,.•t:w:::.....:nv......::•:v•::::•:�v�:.�.,....v v;••:v:v:�tv:v:�:v:w: .w:. ............!:....:::::.v:::::;:::::::vim !.�vy:-::::�...p......:.:;.:'''?:;j•i:;i::�i:::t::::::::v:::})i:4}}:.v:tt4i:i:;:}::{•ii:�i:i�:{•i�i}}:.�::::?�:<�}}):�i):�ii:;?.i:�}iti�::.}::v:l:•}i:?:•i:�:;{{i:;:}i::::::..... gafture to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties+of a fine up to S1,90.00 and/or one yam,imprisonment as well as civil,penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OfUce of Investigations of the DIA for coverage veriScation I do hereby certify under the pains and penalties of perjury that the information provided above is trtu and correct Signature Phone# Print name s official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board response is required QSelectraen'a OMce ❑check if immediate reap 4 ❑Health Department contact person: phone#; _ ❑Other (fcvised 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their loyee is defined as every person in the service of another under any contract employees. As quoted from the"law", an emp 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 section 25 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,.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 completely,by checking the box that applies to your situation and Please fill in the workers' compensation affidavit ne numbers along with a certificate of in��rance as all affidavits maybe supplying company names, address and pho submitted to the Department of industrial-Accidents for confiirmation 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 LS 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 amce of Investlgadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 MET Town of Barnstable Regulatory Services 9BAMNSTABL&g Thomas F.Geiler,Director �A 1639. �0 leDMA�p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.Type of Work: A6/lO,I LL''�f �jAP,7ply XJ ��IPAl Estimated Cost Address of Work: z;Z/� ®GP�fy ej�: / jiy%5 Owner's Name: I�IfLl,&l tA % We1, Date of Application: 91-0_7—dam I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied [j�'Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav Town of Barnstable �pf ZHE Tp� ' Regulatory Services • Thomas F.Geiler,Director MAM 9� 039. Building Division ArED 1��� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: / C? - �p- JOB LOCATION: �/g V mAl ��' ZI number street v pge Q p "HOMEOWNER": AC/ //C`c6 S yU ///"$0�D S— v_��•�(/'1��%J name home phone# work phone# CURRENT MAILING ADDRESS: ILL 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 l09.1.1) 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 requirements. Signatu 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 of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.I S) 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 be/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:forms:homeexempt 1` i t ri � 4 t , f ( 1 - 27 e 3,6 „ ��- I ( � E � obb E /+ 11II I ce I n� . �If - In���ll �k�l►gat 1 ` Move, �i�hfi c,�hl� 16,i �a � �;�ht ►nfo -FG►� �i�l'tf ���r►'i i I i i � I J k� V � ; h' �o llr - Nil M ti .40 M cam sd . �S `-s �� .. � �i.�,;..:... �� +1� ,�ti� �Yrr: ._ f '3.._..,. . �,. \41• `' , � ^� jr !IV) it jk � Qb I f r+F - �fi) _.. _ t t ' _ � _ � .. _ _ .. — f' _. _ _ _ _ _ _..y.. .. _ .. _ _ .. _ � __- - t _. t _ {� 1 �� _ +a 111t` i, _ -.. .. _ .}t._ - . _ . _ . . _ - +r- - _ _ -- - - - 1 - -- - �� - - {, _ �. .. �; !, { i� Ni�'wdN :9 S �•O'Z9/ �`` �OO.OL •' � h % ACO ,9s 6s a oo•oL h Q N a ' OD `�71• `A� Q to to z to QZ vZ z o � � O c� 144 kv } Q � • e 'zv e ry I�.SI X� S2 6r oe .Op s•.v,, .L. ,v 2� s , i t i tea® t _ � r 4 f k f i + t 3 ( ► - � v � � � � l 1 i I 44- I I V i- I IT 1 ti . I . , J- -4 l f l P t �e t � . . � k ti 1 I ti � . � I , 1 1 . p I { 11 I t.. I i. w i � 1 - I Wu e t . I - qlL"T I� trJaQ I I �. 1' { I 1 i 1 4tN! -)120 woJ� dT If I _ I i ti � 1 . ! 1 l: I f 1 p 1 i r „ t i t , 1 f d �� ' I Lfj 1: lui I I - - ---- C 1 I I j 4 1 • i i i a _9 i I I t ' I j I s 1 I I t 1 I I 1 • I 1 I s . L I � I I � i I - j ! i t f o i t