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HomeMy WebLinkAbout0003 PASTURE LANE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel � ,`yx �f;j 4,�� �i.JItjS1 B LE Application #o?d/ 6 3(o�7�L Health Division p Date Issued Conservation Division Application Fee Planning Dept. Permit Fee co Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis `Project=Street Addre/s/s 3 Village r�rt+ �H �TS ,=Owne�`�/"l�a( e��I/�L i rQ s Address Telephone � o Permit Request Re MOv-e $- Pe ce s v c,, to e f/r Dec�� 16 K1 z. 30-M e 6LS. e-Y- 5, Nti d cc N: . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay °Prof aluatio GQ4 f Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 0 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 new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use ----.. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NamT e 1 � Q 4 �-� Telex p o e Nuafjer" "� -- — AAddress cgs `� Cccs f7e Pt, License-#- C S o 6o 21 V A40-5 4 h{c 04- O Z6 mprovement-Contractor# ` I ' r 7 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DA E U } FOR OFFICIAL USE ONLY APPLICATION# .DATE ISSUED I` MAP%PARCEL NO. I ADDRESS VILLAGE T , ' OWNER r a 3 DATE OF INSPECTION: rti FOUNDATION FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ,F FINAL BUILDING �f . DATE CLOSED OUT; ASSOCIATION PLAN NO. r Town of Barnstable Regulatory Services `+ =naxsresta. MA-9& Richard V.Scali,Director Eo;A. A 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 1 L i�r , as Owner of the subject J property hereby authorize �� j�,¢gi/0 to act on my behalf, in all matters relative to work authorized by this building permit application for. —3 YOL-z, (Address of Job) ""."Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before.fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant ` Print Name Print Name - Date Q:FORMS:O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services ��oFme rotyy Richard V.Scali,Director Building Division t 3xsra$ Tom Per BuildingCommissioner Mass. Perry, 1639• ��� 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: number sheet village "HOMEOWNER': name home phone# 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 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. _ t 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. Signature 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&ReguIations 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 Iast 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\building permit fomis\EXPRESS.doc Revised 061313 - ttte uonwwnweaan ofmassacnuseus Deparhnent of Industrial Accidents • Office of Inveyfigations 600 Washington Street ' Boston,MA 02111 www.mass govhga Workers' Compensation Insurance Affidavit:Buffders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/0T nizafion/lndM&aD: C. (t ` LJ-a 64 y Address: $'S 6(L(,e6,J(-e �o- City/State/Zip: Gt -�e - p 2 one Are you an employer?Check the appropriate bow Type of project(required): 4. I am a eral contractor and I 1.❑ I a employer with 6. ❑New construction Ioyees(frrtk and/or part fime).* have hired$re sub-contractors 2. am a sole proprietor or partner- listed the attached sheet 7. ❑Remodeling and have no employees' These sub-contractors have ship emp y 8. ❑Demolition working for mein any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp,insurrance$ required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am a.homeowner doing all work ' 11.El Plumbing repairs or additions myself- [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance regnired.]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 intnrmation. t Homeowners who submit this affidavit indicating they are doing aU work and then hire outside contractors must submit a new affidavit indicating such. *ContractDrs that check this box must attached an additional sheet showing the nzmc of the sub-contractors andst dz whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that is provulZag workers'compensation insurance for my employees Below is the policy mad job site information. r 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 o. 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 immure coverage verification. I do hereby certi the Indallies of perjury that the information provided above is true and correct S Date: .. Phone#: Official use only. Do not write in this area,to be completed by city or town offzciaL City or Town: PermiMcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrieal Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone ff: Information and ]Instructions Massachusetts General Laws chapter 152 requires all*employers to provide woikers'compensation for their employees. Pursuant to t3nis st dirte,an employee is defined as"...every person in the.service of another under any contract of hire, express or implied,oral or wriften." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged m'a jomt 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 perfurnra ace of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting m thorhy." Applicants Please fill out the wodcers' 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 regi=d 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 pemnit 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 nimzber 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 till 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 pemnit/license applications m 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 is (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 airy business or commercial venture (-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 than 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 De-parfinent of Industrial Accidents office of l atvestigatiom Goo washingull fit. Boston=MA 02111 TeL#617-727-4900 ext 406 or 1-877-NMSAFE Revised 4-24-07. Fax#617-727-7749. wwjn ,Vv1dia Z SD W.Ta. Ktl w°or SO S n ea,.y7 . P = y D � Z a''s �s w m. i396Isf IL N 76 l(�.JS.''E z0 C FZT3 a- - lo°000 S.h .�i /oo° w 16*riy %.obo CERTIFIED PLOT PLAN OF V $ ��s oT 21 PASTaRX A.APC ROBERT Ny4tztjIs Pa r I BRUCE HARED I N C°No su SCALE, 'IW 414)' DATE - 3 /2./f84 Gll1J 'RINGt C . I CERTIFY. THAT THE L—E' CLIENT BAD SHOWN ON THIS PLAN IS LOCATED DIST'RED 93042: THE GROUND AS INDICATED AND E©IJTEREJOg M4r ONCIVILAND CONFORMS TO THE ZONING LAlWS Tk ENOINEER ' RVEYOR DR.BY: OF BARNSTAOLfi MA8 . -- 7 12 MAIN S T R E ET CH.AlY� ` -- i _...._ . ._. ....._ : I _ _ ir ' I j _.1 O.C.. r - - - -- ! -- a i I I I , I Aar p; I I ,, ; t a.l _. a.:•:'.'�'"`+ ai., ..� ;.,..��.,..:".:-. .�:.,.r :� ��. _�.. .I. � GK� ..�U/`6Ki�G� K �a I j , • ' I ' I Co�e�G ��fi ink i I 1 I ,I.._ I I tt✓... O � ! I I Li _ le Mau I_ _ _Cie, , �...-_ _.. _ _ _ _ _ ._ ._..___ _ .._.._ _._. -_.. .__.-.. _._ -•_-- _ ....__ _ I , I , . .........I... I i.. : . I � I t i ' I I i ; I I � _ , � I ; I _ : a,�to ; I � I All 41 I -- -� ilk � _..{. _ ru�I PIh- r 1 I z „ y �1 I �) avxl® Ph. _Strn�en i 3 as use. n _ ------ __ _ __,_ J,____ - - I � r____.'_. 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EMOD Boston,MA"02I16 s ERIC LUB RANG - 85 BLUE°CASTLE DR M�$FIPEE,MA 02649 - - i Under secretary of va is wit ron it bo„�•� se TOWN OF BARNSTABLE Permit No. 26202 ` Building Inspector a,eaST.n Cash --------------------- --- � rua r +bsa x °RAI '"� OCCUPANCY PERMIT Bond _______._ --------0//*Aay� Issued to Bayside Building Co. Address lot #21 3 Pasture Lane, West Hyannisport, Wiring Inspector , Inspection date Plumbing Inspecto%, ti 1 Inspection date P-Gas Inspector Inspection date s, ^ ' rS A FA,/,frs+�f".h'Ye.•ra)._,/ir> fi.3, ' 4A...iaea f�4- Engineering Department Inspection date -,Board of Health ,, Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SMALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 14 7... .... ........... . Building Inspector R - - FROM TOWN OF -BARNSTABLE mri. Fra�nc�s3[-:'s Lahteine E3UILD146 DEPARTMENT Town.. VnN cJa1\]risi-Y.w w.w Y.wiR`•Sn�++r.r.T ... ..< ♦.Ngb-b.q L'N'lt GYM i+I!•+ 9R A`�'Mi4A'C A. � 367 MAIN STREET HYANNIS, MA 02= Phone: 775-1120 ' SUBJECT: ' FOLD HERE DATE - June 14 1984 AA S S A.G E r . Work has been a mpleted under Building Permit t26202 fts de BuiWr ng Co.) Please-release Bcd. .• Pd".EI.wW+At.4�+':�+.lir4!�F,+F M4"Y-t s.'�TY'�'�#4PRax'MW S m�NRS�p w lF SIGNED r t .DATE - i REPLY ' - , - - - SIGNED N87•RMI + . RECIPIENT:RETAIN WHITE COPY;RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. ra < 0-4 rR m rvj Ile .N Z14 cn FZ7 .�. 14 IL LA- \ ,-• o in ocwA in 06 ` m - 1 r Ic eat z _ _ i C6 2 z f�; -i 1 a N Z V - z0 t Rf O e� O p ti O 0 1 11 aop Asessor's map and lot number ....< .. .�� .r� `K. �� ®`°r' A"A G //��/�� THE 6k 9 Ida v Sewage Permit number . ��' d _ �i to pprr 14. 'i .Sr I Em I�ifUST 0 Z E9SB9TABLL i House number_ ..... ,t PLLEb IN CC�f1�'�PLIANC�90 "b` ....... WITH TITLE 5 '"�d""Ya. TOWN OF BARN�S,TABIE�DE AND a BUILDING INSPECTOR w.r .. APPLICATION FOR PERMIT TO ................ ........ ... . .... ........... ..` % ......... TYPE OF CONSTRUCTION ..... ........:....................:.......................................... PC ........... ..........19. :S TO THE INSPECTOR OF BUILDINGS: The undersig ed h eby applie or a�er.mit.mccorclin to he following in rm tion: C ,Location ...... .... ........ .... ..... . . .: . .. .Z . ... ... �............................................ LYU �. . ProposedUse ?/A?x '...f............................................................................................. Zoning District ....... ........ .. .. ..................................Fire District .......... / 441 ....................................... F Name of Owner U...... P ..Sad. Address��i���.�J.���tl/'�?�``�...................... . Name of Builder .......zl-�21- . ........................................Address ........... .................................................. Name of Architect ..... �` ............Address � ....1� '�/........................ ........ .. ... ..........'....................Foundation ........ ... ............... ............................................ Number of Rooms ................... ......... �{ Exierior ....v ......� �`... ���................................Roofing .................. %L ................................... Floors .....(J ... L .Zl!.`.... ............ . ...................Interior ..... ....... ..�1 .... Heating ......... .............. % .. .......... .......................................Plumbing ...... �.... ..Cl . Fireplace ........ .......................... ............................... .Approximate. Cost ... � `'/. ................................. Definitive Plan Approved by Planning Board __ ______________19�7 _ ` �Area ....... .... . .. . . Diagram of Lot and Building with Dimensions Fee ......... .. SUBJECT TO APPROVAL OF BOARD OF HEALTH y 5b 17 4-1 r *� OCCUPANCY PERMITS REQUIRED FOR NEW D LINGS 1 hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable regarding the above construction. -0100 &r I Name ..... .�1,? .. . . ... . ....... ....... Construction Supervisor's License ...... ../Pry ` ^ ^ - - ' -- ' = . , - ' . � ' Ilk ` -----~--...—.--,-----.----.—.. Location ---..��.Paotore-Laoe---'---. ........................... � . Owner --- . Co. ..--`--'—'' —--_--_---'—'. Type of Construction ---.��40�.------.. ..................... ..-..—.-------.,------- ' 2l Rk� =- �� —.—.. .~—..—.. .-------.--.. �i� 2� ' 84 � -) /' ^ � -pqrmh Granted ---.����u..--.'---lg —~' ^ - - Dote �i | .... ............................... . . ' �lg . � wo,= Completed~ ` ' . . . ^ , IA TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIONcl ' Map 2 � Parcel No Avlo"kO►o a w Permit# Health Division rr�n,s �./af �tl �I� �3 Date Issued S s 6r Conservation Division Application Fee : Tax Collector Permit Fee 4� 3, x�'.-c Treasurer Planning Dept. Q 3 I 'Acre i Date Definitive Plan Approved by Planning Board ri 'z-8C�- Historic-OKH Preservation/Hyannis 7 Project Street Address �yP- Village Vatn 9 Owner FO)T (,�,I f IaS Address P9'3�✓2f C� Telephone 5(>6 79® a�9�- Permit Request PN-11-Tiolp 9zS-c V-),e-rt l Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. Project Valuation y0 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family /Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 31K10 On Old King's Highway: ❑Yes Q46 Basement Type: Q Full ❑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 0 Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size _ Pool:❑existing ❑new size —Barn:0 existing ❑new size-- Attached garage:❑existing ❑new size �'�"" Shed:❑existing ❑new size Other: ` Zoning Board of Appeals Authho •zation ❑ Appeal# Recorded❑ Commercial (J Yes YNo If ,es site plan review# Y Current Use E;Qy R-nov'f Proposed Use Ft/411 ov'i AD017 BUILDER INFORMATION Name K vr-T S 6 nc, R' Telephone Number 509 76 0— 6 a 0 0 Address 7 SGo S DC-eaNvie License# ciC 6�7z Q3 W. D,"t);S P?,fSS va O a Home Improvement Contractor# 0�9 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO buelP SIGNATURE DATE e111;71o3 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE- OWNER DATE OF INSPECTION: FOUNDATION FRAME F/'21r1 0/c SZIS 0 .3 INSULATION ''a -,V,.�U FIREPLACE ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL GAS: ROUGH ,FIINAL FINAL BUILDING � ..S Q3 ®/Pc 1: DATE CLOSED OUT ASSOCIATION PLAN NO. u The Commonwealth of Massachusetts - -'-' Department of Industrial Accidents Office 01HYe5080fts _ - 600 Washington Street --_ Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit � ... name: L`iJ Q°S-��l" ,� Y location. ' S C o �1,5 o f eso y,,.i city U A A i< yl'/A•S� - -phone# .5 4 7 6 o c�a ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workin in ca achy ////////// %%%% / %��%%///%%// %////%/%%%/%%%%%%%%%%/G/G�//%%%%/%%%%%%///////%�%%G/%%/�/G%%%////%%/%%%%/ [�! �an employer providing workers' compensation for my employees working. this job. : :::::::::::?? .................... ... ::::.. . ..:::.... address-" �.�' � �6•t?� ;:.. �::.. .... .:. :..:.: ......:..... . .phone# i . .::::.::....... insurance co r a' :: oh i::..:. . .;. :. :#., :: .; ..::.::...::.. .... . .... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices; a on: an name ::.::::::::::.:::::..........::::;::::;.. .................................. ...:....... .......Y::: Y::::: <:......: :<+; ;;:::::<i; :��?;;:?::<::: ::;:;;:f::: :::::L::<:>:it•::: :::}{<j;:;::`:;:;:;:::;;}:::: j>;:::::}::;:;::j'f:::i::;:?:::;::;:::::::;i::::;:::ii..... sf dre15:::'... ;:>:;:: .... ................ ................. ... r.•X{?:{??:::•ti:':-iii:tiff::.vp;:.:v:•}:;?i:^ii:•i:•......?v.'-i.:$:(Yv�:•:.iY!{l:::i. .........................................:.....................................................................-...................... ..::.vn•.v: .............. ................... ............................. -............::::.:v:.v:::::::::.�::::::.v::::::.:v::::::•::::.:i-nv:::::::.vn:w:::::.v::::::::...,v:v:r:.. x::..brv:::�{v:.::.vvi:•..: :>;Y::vi::{?�ii:i•i:v:<•:iiii::ii:«{?O:•i::v:::.........?;:nv.v::::::::::v::::::::w::.�::::::.�.v:.v::::::::?•i}F-i:::::::::•.v::.v::::• :�;i{if •ii":'•:ii:Ji:•:fii:??4:ii:?4:•ii'•:i'::•::•iiii:?i•:ii}i;{•i::�:•i?Si:•i:•i:}�iii:�isi•::::::L::-iiiiii:i?i::�iiiY•i:i:i:?J'J;ii:�}iiiiii??{ii:v::::::>�i::::::�i1i::�•"y'"•: ..................::.::::::...........................t.. .... one SJ•A{xv::::::::::::i !:::i:riii:iiv};Yi;:j:;'r:;:iL:iC::i(:j}j:; .. ..........................: .......................... ....................................................v::::v........ :::::::::.:...t::•................ii:•.v.:viJ:^:{O::w:{{{•i:v::.....:..h'•'•;n.J.v . :•.v:::::•..............::v::::•::::::::::r:.::........•v::.v:::::::.v:::::::::•:::.................:•::.v:::v.v:::::::::.v::•.�::::::•.::.......�: ev .�#.:•_.:•;.:{�i:W.i::::::..:_:.�?.i:.::.:.:?????.i�:.;:•.:i;;?:;.;:,y;.y:.::?.{.;.iY.•:?:ii:?:L}iii:::�:i:}Jv{::•::'i esnraitee:cai;;::;;" ;:{.>:>;:.�:::.:.:•:,:.:.::::::..:::.: ::;:::::•:::.::. ,,.,,,........... ......... opi ;:.::.::.: "fie>tihb ... >0 ? > > '•nyni�an Farm a to secure coverage as required wider Section 25A of MGL 152 can lead to the imposition of crhninsl penalties of a nne up to S1,500.00 and/or one years'imprisonment as wen w civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true.and correct Signature��_ ��� Date t Print name �,a ti l l G�.f�Gt Phone# - �`;a ,9 7� 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 ❑checkif immediate response is required ❑Selectmen's Office ❑HeaI Department contact person: Phone#; - ❑Other (devised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 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 Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe 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. 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 permrt/license number which will be used as a reference number. The affidavits may be mtachRl 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 give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imlestlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 `optMe Town of Barnstable Regulatory Services # BA NSTABLE. = Thomas F.Geller,Director Miss. 9`bpl16119;.�A`'� 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: 51})e � f,4 s-3 KabY l ` a �'�� Estimated CostO o°O Address of Work: 3 I'g S L Al Owner's Name: Date of Application: �� v I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑lob Under$1,000 []Building 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 MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby a ply for a permit as the agent of the owner: °3� 3 0S ate• Contractor Name Registration No. OR Date Owner's Name RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 -��' `rb Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSBEET NEW LIVING SPACE ` square feet x$96/sq.foot= S3 x.0031= / 3°S 6 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= 1plom below(if applicable) _ GARAGES (attached&detached) square feet x$32/sq.ft. 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: square feet x$96/sq.foot= x.0031= 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) �S , Permit Fee °FIKE'Ohti Town of Barnstable Regulatory Services " S" KA�& Thomas F.Geiler,Director 1619. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A. Builder 6 I, VPT WA (-a ri S , as Owner of the subject property herebyauthorize �vdT en. DIBI} LE cawstki v- to act on my behalf, in all matters relative to work autho ' d ythis building permit application for(address of job) f' Signat//ure of Owner ate Print Name • W (OV A (ai Y A Z <� Te 2no��vi�aa-rture¢�l/ D ,f t•ajt .'G' acstl�.c1P, 3 . i} fit? Board of Building Regulations and Standards �_I j� HOME IMPROVEMENT CONTRACTOR ! Registration ::138059 Expiration: _2110/2005 Type,..DBA KB CONSTRUCTION KURT BOETTCHER 7 SCOTT S OCEAN VIEW RD W.DENNIS,MA 02670 G� _.:...:_......:..........:...:......... . -�dministrator BE)AR1B f?I~ 6EEGl�t ATIONS;�. leense CON.�,TR fCTION> 4TPI~R}}SOR Number ;CS 067193 �� E3rrEhdate 1.1120f)�55 . �� � Ex�t►+2� 1��20l�flt#3 � �r . r nta 17014 r kURT BOETTCHF_R 7 SCOTT OCEAN VIEW R3 W DENNIS Admi �strator 1. ALY, STRUCTURAL FRAMING MEMBERS" 3dALL BE- #1, #2, OR STANDARD- GRADE LUMBER WITH E-1, \t- ..1,.100,000 PGI. '..:......................... 2. FRAMING MEMBERS SHALL BE _F_.................................:' DOUBLED" UP AROUND FALL OPENINGS �---�-- m� .....�..w_...wm.....,..... BOTHVERTIGALLX AND ...:..._..,......._.,....._..�.,....�..,.,�.........u._ .....,_w..,.._.N..._....v__�...a..._...�.._._.�1 ,.......,.:.w,:" _...:.:,..._.,t - R HORIZONTALLY. 3. DOUBLE UP ALL FLOOR JOIS'ES RUNNING DIRECTLY UNDER AND PARALLEL TO NON-BEARING g PARTITION WALLS. f k. ALL FRAMING SHALL BE COMPLETED ACCn'7 r% fie- 15TLod- I f 1PON SL , 0 37 _.. ..._ _ . ,......,.-... ,.......,... .......... L �a 'au9_766L9bt f pptME r Town of Barnstable *Permit#_ M 6 9 P� � Expires 6 months front issue date sARIvsrASLE, : Regulatory Services Fee 9 MASS' g c� 039, Thomas F.Geiler,Director A'fDfAA�`a Building Division Tom Perry, Building Commissioner Office: 508-862-4038 200 Main vStreet, Hyannis,MA 02601 X.PR IT j Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY APR 2 9 2002 Not Valid without Red X--Press Imprint TOWN OF BARNSTABLE Map/parcel Number ��!� �J � G G t� � t • y Property Address Y A ALL Residential Value of Work e0 Owner's Name&Address Contractor's Name �LT C'eyf if I-F 4rc Telephone Number Home Improvement Contractor License#(if applicable) 6pzp 6 it Construction Supervisor's License#(if applicable) P*orkma-ds Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance ; =z Insurance Company Name Workman's Comp.Policy# �0 Permit Request(check box) C!rRe-roof(stripping old shingles) k ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ` ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised 121901