Loading...
HomeMy WebLinkAbout0082 SAINT JOHN STREET TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel= Application# �' Health Division Date Issued Conservation Division Application Fee _ i Planning Dept. -'Pe rmit Fee 6 3 S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address . Village Owner . �A 4L0-1J Wlddress . i1%u-r_ S. qerm & , Telephone 5v-1'r` Permit Request TAAR&rIn geWtAfJdK & O�6 Square feet: 1 st floor: existing_LLakd6!d 2nd floor: existing proposed Total new Zoning District ''� Flood Plain Groundwater Overlay Project Valuation An 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 ❑ 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: U G*aS ❑ Oil ❑ Electric ❑ Other �. Central Air: U�es ❑ No Fireplaces: Existing New Existing wood coal stove Yes,❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn ❑existing ❑ hew -size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 1 caning Board of Appeals Authorization ❑ Appeal # Recorded ❑ } Commercial ❑Yes �KN o If yes, site plan review# Current Use It �d Proposed Use 5)- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V {' �./V /� Telephone Number gH Address ►lI y, � License # 790 NiQ�fN� flA W 66' Home Improvement Contractor# PW6 Worker's Compensation # LL ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7r v SIGNATURE DATE T W FOR OFFICIAL USE ONLY ` APPLICATION# i °F DATE ISSUED MAP/PARCEL NO. -- ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION :t FRAME ;s. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ;t FINAL BUILDING _f DATE CLOSED OUT ASSOCIATION PLAN NO. :j r The Commonwealth of Massachusetts. Department.of Industrial Accidents Office of Investigations I ° �-'�` 600 Washington Street r Boston;MA 02111 c 1 www.massgov/dia Workers' Compensation Insurance Affidavit:`Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: t City/State/Zip:, Phone # Are ou an employer?Check the appropriate box: Type of project(required): 1,LM I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time):* have hired the sub-contractors 2.❑ I am a sole proprietor or partner-, listed on'the attached sheet.$ 7., ❑-Remodeling ship and have no employees These sub-contractors have " 8:``❑ Demolition working for me in any capacity. workers' comp.insurance. 9 Building addition [No workers' comp. insurance 5. ❑'We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions. 3.❑ I am a homeowner doing all work 'right of exemption per MGL A LEJ Plumbing repairs or additions myself. [No workers' comp. . c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t. employees.[No workers' 13.❑,Other comp. insurance.required.], *Any applicant that checks box tl I 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 a new affidavit indicating such. IContracton;that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.#; I C be -:1 1 1:� ( � Expiration Date: 1 S / Job Site Address: �� 11 City/State/Zip`: ,enA,) ,` 26 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 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby a fy under th d ` nalties of perjury that the information provided above is true.and correct. ' Si ature: Date: . �J Phone#: ��✓.7�6 " 9 r Offic liaIVse only. 'Do not write in this area,to be completed by city.or town official City or Town: Permit/Lice' nse# . 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#: r Information and Instructions 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 chapter 152, §25C(7)states"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 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 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. 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 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 to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hlce 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-Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tt1. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mas&.gov/dia r is �p THE Jp� O . EAENSP.IELE. MA&LTown of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, (B0 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 U,stzg A. Builder I, 41 as.Owner of the subject property hereby authorize �/v 3 [ �(/ ' - to act on my behalf, in all matters relative io work authorized by this building permit application for: (Address of Job) Sigkture o erne D to Print Nari-ie.. - If Property Owner is applying for permit, please complete the'Homeowners 'License Exemption Form on the reverse side. C:%Usersldeco)lik�AppDatalLocallMicroso.mWindowslTemporzry lntcmct Fi)cslContent.ont)ookADDV87Al.Z1EXPRESS.doe Revised 072110 Y THE Town of Barnstable OF Regulatory Services ? Thomas F. Geiler, Director = t�xxsrAst.c, _ Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4039 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street 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 tie 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 Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply witirsaid 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 !09.1.) -Liccnsing'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, Rul&s&Regulations for Licensing Construction Supervisors,Section 2.15) This lack ofawarcness 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/ccrtifhcation for use in your community. Q:forms:homccxcmpt Client#:40595 2NORTHBAYAS ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 05/23/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER _ CONTACT Dowling&O'Neil Insurance NAME: NE PHO Agency ac No Eat):508 775-1620 a/c,No; 5087781218 E-MAIL 973 lyannough Rd., PO Box 1990 ADDRESS: Hyannis, MA 02601 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc t"sugED Travelers Insurance Company Joseph Butler INSURER B:T - DBA Northbay Associates INSURER C: P.O. BOX 1197 INSURER D: South Yarmouth,MA 02664 INSURE RE: INSURER F: -" COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW.HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR ADDLSU­BR _ FF _ LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYYY MM/DD/YYYYY LIMITS' - A GENERAL LIABILITY MPF7496Y 0 1/25/2011 01/25/201 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY PREMISES ea occu ante $500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY[71 PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT- Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ - HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ B AND EMPLOYERS'LIABILITY IEUB3996X81211 1/25/2011 01/25/201 X WCSTATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" E.L.EACH ACCIDENT $SOO,000 (Mandatory in NH) EXCLUDED? N/A (Mandatory in NH) _ If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. ' CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S81056/M81055 LS1 ,. LIPPMv�� , ie mpf e i : f. . C il�n Pam"' 0 4%�g s y , office�faiBdsinesguactuhael�a t HOMEIMPROVEMENTCONTRACTOR ' Registration 128086 Type; ' Expiration: 2/22/2m DBA i N H BAY ASSOCIATE, JOSEPH BUTLER 91 SOUTH STREET SOUTH YARMOUTH;MA 02t04 ^ vim �— a 4 Undersecretary a _ �l,is,achusctt, - Dclr°irtnunt of Pubh� ),ifch. , Board of Builtlin�r Re-ulation, <<nd Stantla►.ds Construction Supervisor License ^ 'License: CS 71488 +: } JOSEPH A BUTLER t PQ BOX 306 E HARWICH, MA 02645 r Or Expiration: 5/24/2013 Tr,':,-169p6., a. e y r Town of Barnstable Approved 7 Regulatory Services Fee Thomas F.Geiler,Director Building Division Peter F.DiMatteo,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 ` Home Occupation Registration Date: 4Z — (3 _ �`_ Name: �© Phone#: 73 E C Address: M k i Sk Village: � S Name of Business: � C e—S S / Type of Business: /il 57"2 C b✓l-(a-(l - 2 Map/Lot: "7 7 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home.occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual 'alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,Humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by,such use shall be met on the same_lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed.indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home-occupation I am registering. Applic t: - Date: 1 s � Homeoc.doc