HomeMy WebLinkAbout0047 RUDDER ROAD —R cL, ,
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Town of Barnstable ,.,�� :*Permit 4S-1
' ® Expires 6 months from issue date
Regulatory Services. , uFee
t3nsivsrnst a. « 'UNI
� 16 �' Richard V.Scali,Direct a or /yt ��i'/Aye
Building Division �1/j vie
Tom Perry,CBO,Building Commissioner � 0
- --- - 200 Main Street,Hyannis,MA 02601 - - �� - --— -- --
www to_wn.barnstable.ma us 4 t
Office: 508-862-4038 Fix: 508-790-6230
EXPRESS PER.NIIT APPLICATION - RESIDENTIAL ONLY
i Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address aids oqtjo y
Blesidential Value of Work Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name �y Telephone Number
Home Improvement Contractor License#(if applicable) /4049 u. Email: Gw
I1 A LA
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Chec e:
am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name e
Workman's Comp.Policy# `
Copy of Insurance Compliance Certificate must accompany each permit. .
Permit Req st(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to'
❑Re-roof(hurricane nailed)(not stripping.,Going over existing layers of roof) -
Re-side p
[Replacement Windows/doors/sliders.U-Value ' -� "(maximum.32)#of windows
#of 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 Improvement Contractors`License&Construction Supervisors License is
required.
SIGNATURE:
QAWPFILESTOR26building permit forms\EXPRESS.doc
Revised 040215
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T7ie Comm omveakh q,f ifassrfcT=etfs ,
Depattwent nfgnd &id Act dents
O},�ce of lm.uwligaftvns
600 Wasiiiir;'gtou Street
Bosion,1741A 021-1I '
}t1fV14 masmgOrldia ,
— ""Tarkers' iCampensation:Insnt ance a B 'de C,nnfz°aci rsJFl�c6ric�anslP umhers -
Applicant Infarmafran - — — - Please-F`tint-feully-- -- —
Name(l3asareeanflndrvi3ual _ ca.y. �w.arc�� -�rC- �
Address: Vo -
CitylStatef r vow o. O3.7(17 Phan
Are JGII an employer?Check the appropriate box: Type of project(required}_
I.El am a employes 4 El am a general conirsctor and I'
�.,, �oyeea(full anclfarpart-iime)_
* h hi ave redIhe sub contractors 6-. ❑New constmctson
2.LJ'I am a sole pmpnetar orpartner- Usled on the attached sheet. 't- C odeliug
s 7xese sub-contractors have ltrp and have no employees 8. ❑Demalitiflg
wading forage in any capacity. employees and hne workers'
[No Mods'camp.iusmance comp.menrantp I' 9. ❑Building addition:
required-] $. ❑,We are a corporatim and its 10-❑Etecftical repairs or additions
3.❑ I am fiameo=er doing all tare officers have exercised their 1L❑Plumbingrepairs or a'dclitiaps
myself, a worms' fight of esemgtion per MGL
- ri 1?El Roof repairs
in ntanre required]i p c.I�2, §1{4),andwe have ga
- . employees-[N0 Markers' 131❑Other
COMP-insm:anre required_)
•AayappB=t&atChedsboxK nstRhoflloutthesecfi=b9owshuvdagdeavnAEecvmpeum&upoRUin5crosuue
t Hamwwaers who sub®ut ibis dUdaeu=&cxtm r they axe&mg 2n war sad dLM lore outsidecoatmctors mast submit a new afn-dar�t mdicatin rnrx
f Caut wWn iffmt check tI&has mast attached=additi—sl shEa dmdng the name of the sub-cotscou.sad state whether ar avt those entities ham
empiayees.If the suh-caatrat m have empIcyee%&e}'mustpmv-idetbeu vmrke&camp.policynumber-
I am an errepIayer flecrtisprdt}Rdin��vnrkers't;aurpertsafid�n irrsurarrce}nr�sr}'empl��ees JSeIoev is�dtepoticy avert ja�a site
inforlaafeorL
Insurance Company mama:
Policy,:For SeI€ins.Iic_ a Fpiaatioa Rafe.
Job Site Address_ City/State/Pap:
Aktach a cop} of the work-ere compensatioapolicy declaration page(showing the policy number and e=pa-ation date).
Fail=to secure coverage as regmredunder Section 25A of MQ.tw 152 can lead to the imposition of criminal penalties of a
fine up to$1,54aOD and ror one-'tee imgrisonrnerd,as Quell as civil pen nalties in the fo=of a STOP STORY ORDER and a#tee
of up to MO-DO a clay against the violator. Be adtrised that a copy of this statetned maybe Enwarided to the Office of
Investigations of the DIA for insurance-coverage verificatian
I dIo hereby csr€ify Under theprriras midpenahies o.fperjujy thattlie irr;foreratimi-prm-zcied abet%is hu/s and correct
S•i�ature: _;/�..---: ,IJwate: 6�1�//�
Phone (��'�-' 8j �/
Ojyi al aw anly. Da ant wr to in thb area,to be campleted by tip rartoo n official
City or Town.- PermitUiense#
Lmuing Afhority(cache anej:
1.Board of Health 2.Building Department 3.City1rown Clerk d:Electrical L spector S.Plumbing Fnspector�
6.Other
Contact Person: Phone 9: `
F e
Information and lastructious
Massachusetts Geer eral Laws chapter I52 req�es aII employers to prcrnide woeas'compensation far rhea employees-
Pmsuant-to this sate,aoz.enrplayee is defined as_=.every personin�.e service of another under arty c�r>iract ofhire, .
express or imgolied,oral or writtu."
An.M47IoyEr is defined as r°an mdxyidnal partaMMbip,assodafiom,carporaiion or other legal e tftY,or any two or more
of the foregoing=jgagt-,d is aJoint else,andinclndmg the legal of a deceased employer,or the
receiver'or trustee of an mdividnal,partnership,association or other Iegal enflty,employing employees- However the
ownex of a dweIIing house having not more thM three apartments and who resides therein,or the occupant of the -
dweUing house of another who employs persons to do maineaance,c ns a ti on or repair work an such dweIIing house
or on.the grounds or butadm' g apparf�n�them shallnotbecanse of such.employme�be deemed
to be an employer."
MI GL chapter 152,§25C(6)also stems that"every sf�or local licensing agency shall witTihold ffie issuance or
renewal of a license or permit to operate a business or to constract buildings in the commonwealth for any
applicantw•ho has not produced ameptable-evidence of compfiauce with the,iT,cnrar±ce cove]�age regnsecL"
Addiddonalb,M H,chapter 152, §25C(7)status¢Neither the commonwealth nor my ofitspolifical subdivisions shall
eater min any contract for the performance ofpublic work unE ac=ptable evidence of compliance with the incman ce..
rez=_rents of this chapter have been presenfrd to the confractnig aufhoiity_"
Applicants
Please fol out the work='`compensation affidavit completely,by ch=ldag lhee boxes that apply to your situation and,if
necessary,supply sub-confractor(s)naMe(s), addresses)and phonenumber(s)alongwiththeircertfacafe(s) of
insurance. Limited Liability Compmnes(LLC)or L=ated Liability Partamahips(LLP).withno employees other than the
members or partners,are not required to cagy workers'compensafion insmsnce. If an LLC or LLP does have
employees, a.policy is required. Be advised that this of 1da:vitmaybe submitted to the Depafinent of Iudnsftdal
Accidents for confmn don of fi sor-mce coverage_ Also be sure to sign and date the affidavit. The affidavit should
be retuned to file city or town that the application for the permit or license is being mgaesbA not the Department of
Ln2nstrig Accidents- Tin ildyou have any questions regarding the law or ifyou are reed to obtain a workers'
compensation policy,please call the Deparfinectt at the number l;sisd below, Self-rued companies should enter their
self-incmance license nnmber on the appropriate,at.
City or Town Officials .
Please be sci a that the affidavit is complete and priate•d legibly_ The Department has provided a space at the bottom
of the affidavit for you to fll out in the event the Office of Investigations has to corlf:act you regarding the applicant_
Pleas e be sure to fill in the pennit/Ircense rnrnber vthrch will be used as a reference number. In addition,an applicant
that must submit multiple permit/license appliZations in.any given year,need only submit one affidavit indicating current
policy in b ation(if necessary)and under"Job Site Ad_�ess"the applicant should write"aII locations in (cam'or
,� a or town
maybe provided to the '
ed or maimed b � � ay
e•affidavit that has bey officially Y �3'
town)_ A copy offfi ��YP
applicant as proof that a valid affidavit is on fle for furore permits or licenses A new affidavit must be fMcd out eaca
year.Where a homeowner or citizen is obtaining a license or penn>t not related in any business or commercial 4entm-c
(i.e. a dog license or permit to burn leaves etc.)said person is NOT named to complete this affidavit
The Office of Investigation would like to thank you in advance for your cocperation.and should youhave any qu�fions,
please do not hesitate,to give us a call
The Department's address,telephone and fax ln=3bM-
C.G.MMMWeajtjr of Mass chusf_- s ,
Depai mt cifladlstdat Awidents
ice of lvegt�g tio-=
604-wasbin Gll St.
Bad MA 02111
Fax 617 727 7M
Reviseii 4-24-07 g��
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Massachusetts -Department of Public Safety.
Board of Building Regulations and Standards.
license: CS405054
tee,
JAY C ANIARAL
40 YANT ST "
DARTMOUTH NSA 02747 .
Expiration
Commissioner, 0412912017
Cglie iorwyilnav;rcuea�t�0 !/4 cc�dac�ce�cllr
Office of Consumer Affairs&BusmesS Regulation
2 ME,IMPROVEMENT CONTRACTOR
stration:
9.:.i 163628 Type-
xpirat�on 718/201'6' Individual
JAY CHRISTOPHER AMARAL r r
JAY AMARA
4 O BRY&�H,
NO.D MA 02747 Uudersecretary
swnvsrAsr� r
_MASS. Town ;of BarnStab e
Regulatory Services
R►chard V Scali,Direetor. ,
Building Division ,
• -Thomas Perry,CBO` � � ,
Building Commissioner'
' • 200 Maui Street, Hyanaas,NIA 02601;
•wwwtown.barnstablema us.,
Office: 508;-862-4038. _ Fax. 508 790=b23U`
f. '1'rova Ovvrier. Must '
r
Complete and:Sign This Section
If Usifig A Budder
I, Ernest T. Bartell ,as:Owner of the subJect property
herebywithoriz6 J_ay_Amaed[ General Contracting: act on trip behalf,:
in.all:mattets:telattv.,e. to work autlionzedby this;busiding petgnit applicatton for: ,
47 _Rudde,r. Road, ;Hyannis, MA _ 02601
stmtute of Owner. IDate
Ernest T Bartell , _.
Pant Name.
If`Property Owner is applymgfor pernrt,please'complete;tlieRomeowner License EzemptionForm on the
reverse de:_ "
Q:IWPFM\.FOPMSViuUding permittftii!A�aSs&c ,
Revised,.04MIS M
y
i.u:w:u u� �a>a.rua_iau�e
_ P
Regulatory" Services
v�,ii+e t Richard-, ScaL,Director.;
. 3.
�Buflamg•Division.
s�ariscie; '
Tom Perry,Building Commissioner ,
�bf, bs9�- �� 2001VIam Street, HyanniS,l,. 02601
www.#own barnstable:ua.us
Office:, 75084-62=403 8
Fax. 50,9490
r
. _� HOMEOWNER LICENSE EXEMPTION: .
DATE:
6/2l /16 k ;:Please•Priat, .
1013loCATFON 47 -Rudder• Road Hyannis, MA 02601 '.
number. ._.. vtll
"Hohmo*Atk^ . Ernest: J. ;Bartell �574-286-4900
name:: ' '-home.phone#• wcA phone#.,
cv i;rrrlvtAu:>rtGADDRJESs:" ._;P.0 , Box_:;]048; Notre, Dome, ,I`N 46-556
Notre. Dame, ."I,N 46556
C1 ap code
ty/town state
The current exemption for"homeowners"was`extended to inelude owner occupied dwellings of six units oT less and to allow
homeowners to;.engagean individuaI;foi hire who does:not posQse license,provided that the owner acts as supervisor:
DEFINITINss,a
OF HOMEOWNER -
Person(s)wbo,:owns"a parcel bfaand;on which:helshe.resides of intends to reside,on which there Is,..gr is intended to b-, a one or.two `
family dwelling,attached,or defached'structures accessory to-such use and/or:farm structures.. A person who.constructs more than ore:
home inn two-year period=shall':not be conside=ed.a homeowner Suel "homeowner"shallisubmit to the 1#ulding Officiation a form
acceptable to the Building Official;that;he/she shall be;responsibie for�all such work performed under the buildingpermlt {Section.,
109.Ld)
The undersigned`"homeowner"assumes responstbilzty-:for,compliance with the State Buildg Code and otliei applicable codes;;
bylaws,rules"and regulattons: - .-
The undersigned'"homeownner"certifies that ha§he understands the.Town ofBamstal le Building^Department'minimum Inspection
procedures a Ad`;requlrements andthat lie/she will comply withsaid;pro'cedures:and requirements: '.
-Sigri&#ofHomeowner `
ApprovWW?Building Offictil. f
'Note. Three family dwellings containing 35;000 cubic feet or largerwdl be required to:comply,with the State Building Code::
Section IVA Constriction"Control.
HOMEOWNER'S EXEMPTION
The Code states that.; "Any:homeowuer performing work for which a building:permit is required shall be exempt a .
from the,provisions ofthis section(Section 10911-,Licensing of construction Supervisors),"providedahat if theEhomeo
ov wner
engages.4a"person(s)for"``hire.to do such workthat such Homeowner shall act as superYisor"
ofa supervsorMany hmnes m aheyareauig; ero w n h mhpnsiblities
(see Appendix Q,Rules Regulations for Licensing Construction Supervisors,Section.21S� This lack of awareness:often
results in seasons problems,particularly when the homeowner tares unlicensed persons.,-In th►s<case'i our Board cannot
r. s Tproceedmeunlcnflperoa mh msSapevsorisli
iiltimatel�responsi>ile,. � � ' ' .
To ensure that:the homeowner is fully aware of his%her responsibrties,many communities require,as part.`of th"e
permit application,that the homeowner certify thathe/she``understands the responsibili4es of aySupervisor.:.On the;last page. ,
of.this'issue is a:form;currently useday several towns. You ma y caret amend and adopt such a forim/certi>ication rot use in.
yo.ur'community._
Q IWPFIr ES1FQItiv1S\building pemut,-forms�E3 RESS.d00,
Revised 0403ls' >