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Home My WebLink About0037 RIPPLE COVE ROAD 3 7 1' �P P I e Cave dal. Z S zONZ fn NN Z � i r- m n �= _ . F . r.-._.. . - - .... 70 ------- --- .. - .... - - - --- - - zi 0 J 1 i f 0 I Town of ]Barnstable *Permit# 3dD(p1 te ql Expires 6 months from issue da . # q Regulatory Services Fee DC,7 v Thomas F. Geiler,Director g�E Building Division BP` 'oN Tom Perry,CBO, Building Commissioner 0 OF 200 Main Street,Hyannis,MA 02601 www.town.bsm table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. Not Valid without Red X-Press Imprint . Map/parcel Number t/ (Oa Prope -ddress 37 ✓u P�ILGJuR. /�—(� 41S. Residential Value of Work ��000� Minimum fee of$25.00 for work under$6000.00 /Owner's Name&Address or �37 �i�P�•G G cam,. K� • ��r '''^� • - - Contractor's Name C•f 4beJ/V 64-Telephone Number d&fro Home Improvement Contractor License#(if applicable) 3 onstruction Supervisor's License#(if applicable) 'y Workman's Compensation Insurance . Check one: ❑ I am a sole proprietor ❑ XM the Homeowner I have Worker's Compensation Insurance Insurance Company Name tiV1L1 th•+ y`�-l/",.•t�-�.G6V'h Workman's Comp.Policy# b ZZ Vl A 77 Y0 J+ 3 yZ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to IL$CO ❑Re-roof(not stripping. Going over existing layers of roof] k3//Re-side ❑ Replacement Windows. U-Value (ma_Xir um.44) *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. Home Improvement Contractors License is required. SIGNATURE: Q:Fm ms:expmtrg y Revise071405 �� Iioard:6f�Bi��itin iteaulafi'rinti aud�Stafiitatvs 6 HOME IMP OVEMENT CONTRACTOR Registratiio 136667 tr row b312006 IType C+C&REMOD€ ft CHRISTOPHER DOta t K 35 MOCKINGBIRDLV W.YARMOUTH, MA 02673 = °.ISE,p� Town of Barnstable ]regulatory Services � m8s iE'g Thomas F.Geiler,Director �°iE'ot•`m r Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma.us ,ffice: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder as.Owner of the subject property hereby authorize C+C- � �'�-� —,4 YW bil ift o act on my behalf, in all matters relative to work authorized by this building permit application for. 3? let of (Address of Job) \ (0 G6 /6 (0 i afore of Owner Date Print Name Q:FORMs:owNEnERMISSION f ' Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia' Workers' Compensation Insurance Affidavit:BuRders/ContractorsMlectricians/Plunnbers Applicant Information Please Print Legibly Name (Businesslorganizaticnandiyidu4: C{ + &*V6lXtA b-6;6--&—e Address: 4� WI-a t ,,,r,.a tnJ L.tJ , w ' City/Stat*71p - 'D Z G 73 Phone M S-,0 e - F l 3 - a 9 F � Are ou an employer? Check the-appropriate box: Type of project'(reguired): am a employer with _ 4. ❑I am a general contractor and I s, New construction employees (fall and/or part time)* have hired the sub-ccntractors 2. lam a sole proprietor or partner- listed on the attached sheet t 7. Remodeling ship and have no employees 'These sub-contractors have & ❑ Demolition workbag for me in any capac#y.. workers' comp.insurance. 9. [] Building addition [No workers' Camp.insurance• 5. ❑We are a corpgration and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doig all work right of ex=43t ion per MGL HE.❑ Phimbmg repairs CY; additions myself:[No workers' comp. c. 152,§1(4),and we have no 12.[3 Roof repairs insurance regarded:]t . employees.[No workers' 13.❑ Oflier camp.insurance required.] ' Any applicant that checlm box#1 mast also fill out the section below showing their workers'compensation policyinforrnatioa Horneownen who submit this affidavit indicating they an doing an work andthen hire outside contractors mmt submit anew affidavit indicating such. on b actots that check this bus meat attached an additional aheet ahcwina the same of the sub-oontractom end ibex•workae comp,policy Information. am an employer that t providing workers'compensation Insurance for.my employees. Below is the polliu and job site nformatton. into t mripanyName: Lid ' ��G•t,es,;e,` ,., �o14 #or s.iic.:r 22 U rs 22 UJ4-3 q7— nak: 1 lob Site Address: 37 X�lorte,r Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secvre-coverage as required under Section 25A of MGL c. 152 cari lead to the imposition of criminal penalties of a fee up to$1,94090 and/or one-year impris as well as civil penalties in the.forra of a STOP WORK ORDER and a fine of lag to$250.00 a day against the violator, e a vised that a copy of this statement maybe forwarded to the Office of Iayestigatims of the DIA for insurance co ge cation. I do hereby certify r the alms and 'es perjury that the information provided above is true and correct, r tore: Date: �0 0 Phone e3ro offie"al,ash . De M Aft area,.e be lemptefti€,let of s &i City or Town: Permit/License# l Issuing Authors y (circle one): 1.Board of Health 2.Building Department 3.Chy/T1 own Clerk a.Electrical inspector S.Plumbing Inspector l 6.Other I Contact Person: Phone#: 4-15 Map Parcel rmit# 9 a 1 /cConservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued ' Jt-' �9 k Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) - Fee Engineering Dept. (3rd floor) House# �tME Bldg.) BARNSTABLE. MA Iaref' 1°Mt i g ft!and 19 t6 9, FO Na+► APPLICANTMUST ASIIM TOWN OF BARNSTABLE CO M 6 x�oHE TO Building Permit Application CONSMUCTIOX PrUctit dress 3Vig Owner p�� `{ r 7`yG-- Address Telephone Q Permit Request First Floor square feet ' Second Floor square feet Estimated Project Cost $ 12 OZ> Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-.Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name �� Telephone Number. Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TO SIGNATURE DATE BUILDING P MIT DENIED FOR THE FOLLOWING REASON(S) '. FOR OFFICIAL USE ONLY P MIT NO. _ DATE ISSUED M P/-PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: _ FOUNDATION _ FRAME , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ` FINAL GAS: ROUGH s tzl.,-121 FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ( + 4 1 i 1 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ---------- ----- Please print. DATE �/ f ...:... JOB. LOCATION_ 3 `�/�� Co y/- Number Street address Section of town "HOMEOWNER" ,�o�A/ w `T� G'/'7 • 3 9 7 � P g 7 . '. . .. .. Name Home phone Work phone . - PRESENT MAILING ADDRESS 4/ Cra 77-A 6 L- S 7 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as su ervisor. DEFINITION OF HOMEOWNER: Person(s)' who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Offici, on a form accp-ptAble to the Building Official, that he/she shall be responsib for all such work performed under the building permit. (Section 109. 1.1) The undersigned "homeowner" assumes . responsibility for compliance with the Stz Building Code and other applicable codes, by-laws, 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. HOMEOWNER'S SIGNATURE 7 a ` APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code. Section 127. 01 Construction Control. I I HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction' Supervisors, Section 2. 15) . This lack of awarene often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home 'bwner acti as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma. communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. ettt TheCununorrWcaltli of Atassacllus •�a: _... �:�yr Dcparnnent of Industrial Accidents l _ office film esM29oas 600 !f ashitrI"Iton Street :� ''� +"'• Boston.Mass. 02111 Workers' Compensation Insurance.ARdavit ---' nn *— Altcnnt Inform on ati • Please PRINT le,jn'ps"•� name• 73 dv � � I am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity ❑ 1 am an emplover providing workers' compensation for my employees working on this job. camlinny name• acid e• - -- - eiri•• phone#: incsl�nce co noliey a ❑ 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comp•tny n•tmc• address! cih•• Rhone#! incurnnce eo nelicv# , t:�...ii.- '.N--:T.:_• uienr�rr•.v'.ia�sa.?T•f.yZ•77Thet' ;�w �F!"�!r� _ �•:'7S m e• address: city phone#: incurs lee co polio# Attach additioaal'sheet if riiee�sa _:-•.�s,- .:�f'�,rr r"o r+" ``:.;'"`+`' Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of crimioai penalties of a fine up to 61SOO.00 aad/ux une years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for or.. ge veriBeation. l do hereAr conic•under t! pains and penalti pery'uq•that the information pm-ded above is true and correct Signature ' au Print time Phone#, official use only do not write in this area to be completed by city or town official 7Dep4nment eit, or toN n: pertaitJlieeaseQuildi�Liceas0 check if immediate response is required QSeleet�fieaith contact person: phone#;. m0ther inwised319S P1A) 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 emplgree is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An enrpinrer is defined as an individual, partnership,association.corporation or other ;-gal entity, or any two or more c the fore=oin 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 t more than three apartments and who resides therein, or the occupant of the owner of a dwelling house having�,no P 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 1.52 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 tiie 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 hay been presented to the contracting authority. ;• - � _ h :.,i •a.try ,r` 7• •�+,f', � `1 :.�_. 3.._ •i. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying rcompany names. address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. yi:•: •'•iyr 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. }++ti..�.�!!•}!�� ... ... .. �� "' .' ".r.. ..;;,�ws:...., ^•,�f�yi: :.ice::. .tiir.':'e.�:.:�"+'''• :a5:r :w.F..•...._ �.r.Y.w ..: .77'7 . ,. •�Zl...�•.-•_Q •J"'�• .1 n1iY.• '!'�-::,,elb'^. ^•'l••ilr•.: The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ — Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 i The Town of Barnstable • �,$ Department of Health Safety and Environmental Services 1"9. Building Division 367 Main Strut,Hyannis MA 02601 OHice: 508-790-6n7 Ralph Cross= F= 508-775-33" Building Commis For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PEnmr APPLICATION MGL C. 147 A requires that the-reconstruction,altetadons,renovation,repair,modernization,eonvemm improvement,.mracm-1, demolition, or construction of an addition to any prz- owner oeaspsed \ building containing at least one but not more than four dandling units or to situ=cs WMch are adja=t to such residence or building be done by registered contractors,with certain exceptions, along with other requirements- 0, Type of Work: � �� "% Est Cost Address of Work: '3 17 L42L-tL Oaner.Name• r,5 Date of Permit Application: I herein certify that: Registration is not required for the folIow•ing reason(s): Work cmduded by law Job under S1.000 Building not owner-ooarpied Owner puffing own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITFHVNAEGIS�D CONTTtACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS M 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 n,,A Owner's name PLOT PLAN FOR LOT N �' Indicate location of garage or accessory building Additions with dashed lines -------------- sewerage disposal (cesspool) ED Well I I•z 0 I I (Lot....... ...........ft. rear) Abuttar's Abuttot's Name Name Lot# Lot Rear Yard ' 0 ............ ...ft. _ I R If this Is a If this is a —� i d corner� corner lot, write in write in w name of name of other street. Sideyard HOUSE Sideyard other street. "j 5— h. ——l�— ft. s I � Set Back ........ .....ft. I . 4W 1 Lf (Lot.........`.........ft. frontage) p------------------- /J (Name of street) / Information / Supplied by Mirk North Point • f / 1 lli• � �1 1 \` • i i r • A 4