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Home My WebLink About0018 PLYMOUTH AVENUE 1 g fL y NOUT- A v� 0 -z rY let Ij Town of Barnstable *Permit# Reulatory Services Fee e date 6 months jrom issu + IARNSTABLE t � dd v� 1MASS. !a! Scali,Director 9. Fp `l 4U0 2 2014 Building Division . Tom Perry,CBO,Building Commissioner TOM oF: �l 200 Main Street,Hyannis,MA 02601 � NSTA town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number t L9 `06 i 0 Not Valid without Red X-Press Imprint 1 Pro erty Address I / Residential Value of Work$ Z� 000 00 Minimum fee of$35.00 for wor under$6000.00 Owner's Name&Address / lei (19ttz-a/* � 6, Contractor's Name dv— &W4t--1X1W4 RIOTelephone Number 7V-YS9'(o Home Improvement Contractor License#(if applicable) / " Email: Construction Supervisor's License#(if applicable) A 0- ❑Workman's Compensation Insurance Check one: r ❑ I am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance J-®N/V Insurance Company Name P ce r (�jgX1VW�1 �s Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping: Going over 4irrg- of roof) Re-side F �A ' Replacement Windows/doors/sliders.U-Value/'i� f`�p l (maximum.35)# windows JAM&—�4 # doors:. ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home I ovement ContpdVoDrs License& ns on S ervisors ense is required SIGNATUR Q:\WPFILES\FORMS\building permit forms EXPRESS.doc Revised 061313 s� �or�x�t'cxr€sc�al't�rz��assrre.�rfs DV=ftnort affWas&ial Accidents 600 Was* igton Street Bastany AM 02�1I WF4-w ma vgoi-ydia '-orker�' Compensation ammuce idavd:Builders/Cnntractorsf0ect icianMumbers AppUcant Tmfarmation Please Print Lepibly , 10 d rdrko CifylStateJZip: R 1S Phoneme 51'0 2 Are yan an employer?theck the apgrapriate bu-c T f project : d-_.� ver : contractor and'I Y�o �'o r I ��- 1_❑ I am a employer withL �-� I a a l � 6- ❑New anstructioa emtployees(full arEdlorpart-fUne)* havehire the mb-coalfors. 2_❑ Inin a sole gropzietor orpartner- ., Listed on then attached sheet 7- ❑Remodeling ship:and hxue no employees These vab-contractors have g- ❑Detnolifroa w -for m e in ari• ci r_ emplo}�anal.have workers' orking Y capa. t3 1 9_ ❑Enildsng addition �4lotkElS comp_ineiiraiice. comp_msaranca �-- � 5_❑ We are a corporation and its 10_I Electtical repairs or additions h fSoress ave exercised fhi sezr 11-❑Plumbing am a homat�ner doing all Uvoi,� g repairs or additions 1-12.0 Roof irr £ o workers' right of e�snpfiou per MGL i33.�1Jr=e requited.]1 c_152,l§1(4} and we}axe no eroployees-[NauM'=S' e _0 of "K 57nii+ W! comp-ms�reg6md.l 'Amy EppUcrnt tnxt cfieds box-1 matt slsa fill olt the sectiaab00W chaWb1gv Their�ao�ceis�cottapentatioagviicg isEflisndion t Humecwii s rrM smbmrt this 2i6dsvit i„TIC tc taey are+ining nff uzak and glen hits oatside:contxscrms smbc=a new rffidsrit mffirolm sadi_ tCbnttactsrs tmst rT A- this boa mast sttadied ffi sc3ditiansI meet siioscm5 be a off ffie soft his z�stale abet aec ac not 13�sg ems fsnle enqvlayers_ ift ba sub co-nimctrsis h,se employees,they m ut pmvide tb r warkrss'comp.policy n�bez I aryr an san�Zriyer that is prmdditag tt�or�Prs'c-a�arurlrun ansrrrcuace j"ar m�emp£ayee.� �eTotF is f3teFoUc1.artd job sire tr3for•rrratr�:t- - _ Insurance Compan-(Name: Policy 4,cr Self in£_Lim Fxpiratio:n Dste: Q a G3ob_Sit � -��d / /o(#-L- ifylStafel ': �/N � Attach a.copy of the--vmrkers compensate m palm(Ieemration gage(spar rthyp-olicy ri>tmbar wad E epu anon date}. Failure to secore coverageas required under Section2SA of MGLc. 152 can l.eampositionofcriminal penalties of a fine up to$I,50D.Od andlor ave-year imgri'aon as weI1 as civil penalties mi of a STOP WORK ORDER-and a fins of up.to$250.00 a.day against the violator_ Be advised that a COPY of t maybe forwarded fa the Office of Imredigation.s of the DIA for in%wance coverage 7 - cation_ Idd hErre �t its And pena e Trot nra n pravidRd bt e is lnta avid correct Bate Pho=#: Off ZcfaL use aril•}. Da runt write in this area, a bs camtpreted by city ar town official City or Town: Per-mitlLicense# Issuing Authority(arcle orLe): L Sward of Health $uff ng Departraeut I Gityfrawn Clerk d_Electrical Inspector S.Plumbing Tnsp�ector 6.Other Comtact Peratlll: Phone 9-- 6 Information and Ins ctio-Us Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursu2ntto this sta-t-ate, 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 clefmc:d 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. 1-1 owever 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 Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonweait'a for an.y applicant who has not produced acceptable evidence of corapliance witli the insurance-coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the comp, onweal h rlor any of its political subdivisioas shall enter into any contract for the performance of public work until acceptable tviderice of compliance vila the iasu-raact 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 si'Lation and,i.JL f necessary,supply sub-contractor(s)name(s),address(es)and phone m=ber(s)along with their c tnbificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Pa.lDershys(I-.LP)veith no employes other than the members or partners, are not requLTtd to carry workers' compensation inDr-ance_ If an LLC or LLP does have employees, a policy is required_ fie advised that this affidavit may be albTitted to the Departi-nent of industrial Accidents for confirmation of rosin-ance coverage. Also be sure to sign and date the a,ffidav t- '11e aa.fcatrit sboi-11d be returned to the city or town that the application for the permit or licerse is being r:.cFuesed, not the Department of Industrial Accidents. Should you rave any questions regarding the lava or if you are required to obi in a workers' compensation policy,please call fh Department at the number listed below. Sell insured companies should enter dieir self-insurance license number on u_e Pqppropr ate line. City or Town OfEcials 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 an out in the event the Office of Investigations has to contact you regarding the applicant- Please be sure to fill in the permitllicense number which will be used as a reference number. in addition—az?applicant that must submit multiple pt1='tllicense applications in any given year,need only submit one affidavit indicating current policy information(ifnecessa-y) and under"Job Site Address'the applicant should write"all locations M. _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be.provided to '11e applicant as proof that a vat d affidavit is oa file for future permits or licenses. Anew affidavit mast be filled out each year_W hem 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 Ieaves etc.)said person is NOT required to complete this aflidaNait The Office of lavestig tions 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: Tle Comm iwt-,aI&of Massaclhusets De artmtmt cif Industrial Accidents Office of kyesf gatFau,�i 600 washhagtou St f,-et Boston. 021II Tti,A 617 7-4900 w 406 or 197TINL4SS_ATE Revised4-24-07 R�xf 6I7-727-7-744 Town of Barnstable FJ Regulatory Services �oEViE rOtyy Richard V.Scali,Director °^ Building Division ` ■ rt - t �� Tom Perry,Building Commissioner brass. 200 Main Street, Hyannis,MA 02601 �Eo r a www.town.barnstable.ma.us' Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ' Please Print DATE:jr— ,-Z-JOB L-)O GAIIO moi J L- 57� number /� street vi�e�f O� rjW 'HOMEOW_NER'":= law �.(�Q�l�P��,� JC' d name home phone# work phone# CURRENT MAILING ADDRFSS: / [ OIL qk_, a&J-� ity/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 6erformtij under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the Sta Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"home/ 'er er9eTal he/she understan e�, of B stable Building Department minimum inspection proced s en and at h she will co ly wi sai r `c dares an requirements. S� aiure om wner� ,� wx ., Approval of Building Official x 1 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'<Anyhomeowner 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 persons)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 last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomms\EXPRESS.doc Revised 061313 i �1HE T Town of Barnstable Regulatory Services �snxx IEg Richard V.Scali,Director 1639. . °' 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 - as Owner the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this g permit application for. (Addres f Job) "Pool fences and alarms the responsibility of the applicant. Pools are not to be filled or d before fence is installed and all final inspections are perfo ed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:O WNERPERMIS SIONPOOIS Town of Barnstable PO4amd'L °FTHE r ate: Regulatory Services _ � °.� Thomas F.Geiler,Director B�uvSTABLE. ' Building D1V1SlUn 9� l `0� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: M S C 4A 41E L CT 2 flF-I R.p Phone: 7 7 I- 5 y?j 7 S t3 �1 Install at: i g ;P LJ '►*J T4 4,j e_ uV*," ' 13 Village: 4,4 AW Is Map/Parcel: Date: -Z7-0 p Stove cj A. New Used B. Type: Radiant/Circulating C. Manufacturer: Lab.No. . D. Model No.: r--e.So v-;M Chimney A. New Existing f existing,please note date of last cleaning 10 Zoos* B. Flue Size . C. Are other appliances attached to Flue? 4900L '�j a r c3wc� D. Pre-fab Type and Manufacturer E. Masonry: Line alined Hearth A. Materials: 15VU GkG B. Sub Floor Construction: Installer Name: Address: Phone: '^� Location of Installation: / rvlo � L�A NAII f APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector