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Home My WebLink About0015 SECURITY STREET I 1 4 J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ok Map-- Parcel 1. ) F w Application # 0 '..1 Health Division Date Issued Conservation Division Application Fee " Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis PStreet Address 5�C�;(2L 5 Address ,,Tetepho_e'"� f�7- 1 Eer`mitsReq e t S7` 12 S c —z=Pf/I G- 1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tot new Zoning District Flood Plain Groundwater Overlay �P_roject Valuatiora� Zt�40 �o Construction Type f Lot Size Grandfathered: ❑Yes ❑ No If yes, ach supporting documentation. Dwelling Type: Single Family_ ❑ Two Family ❑ Multi-Family (# its) Age of Existing Structure Historic House: ❑Yes o 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: - ex' ng _new Total Room Count (not including bat : existing new First Floor Room Count Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other_ Central Air: ❑Yes ❑ o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached gara : ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zonin oard of Appeals Authorization ❑ Appeal # Recorded ❑ Co mercial ❑Yes ❑ No If yes, site plan review # Current Use _ Proposed Use APPLICANT INFORMATION (BUILDER OR-HOMEOWNER) Na m rg b StI0 l0 iTelephonewNumber--. 7 -5 /D $�9y Address' /� S�i?`/� License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sil NA U E= ®ATE 4 ' FOR OFFICIAL USE ONLY APPLICATION# k DATE ISSUED ,MAP/PARCELrNO.,. < ADDRESS VILLAGE OWNER DATE OF INSPECTION: "FOUNDATION.'-' '. FRAME INSULATIONN A< '� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS::� _:7 n ROUGH;:a :- FINAL a FINAL BUILDINGI-i DATE CLOSED OUT ASSOCIATION PLAN NO. --_—_The-Gommonw9a_UA_of if assaehr��et. =_ _- _- = Department ofIiidustrial Accidents Off ice of Investigations , 600 Washington Street _ Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:'Buflders/Contractors/Electr-icians/Plumbers Applicant Information Please Print Ledbly Ni-me�srorgm�izzflondn&vidua: i s 5-e (// City'/State/Zip: (iVP Sd . /1'll ( lI Phone.#: Are you an employer?Check the appropriate bog: -TypeEf ro'ect re uu e 4. I am a eral co ractor and I p ] ( q d''1.❑ I am a employer with ❑ F6. New construcizon ; employees(fuIl and/or part time)•*. have hired the gub-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- w for me ia•aa c employees and have workers' working Y $P�9• . [No workers' Comp.Insurance anc:e comp,insurance$' 9. El$uilding addition required.] 5• [] We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner.doing all work officers have exercised their 11.Q Plumbing repairs Or' additions Mysel£[No workers' comp. . right of exemption per MUL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no . employees.[No workers' 13.[] Other comp.insurance reccered.] *Any applicant that checks box#1 mist also fill out the section below showing their workers'compensation policy mfmmation. t Homeowners who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating such. $Contru3ctors that check this box mast attached an additioaai sheet showing the name of�b sub-contuactm and state whether or not those entities have employers. 1f the sub-c:onb=tnrs bave employees,they must provide their workers}comp.policy nocx cr. I am an employer that isprovidinff workers'compensation insurance for my employees. Below is thepolicy and job site information. 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 c. 152 can lead to the imposition of ciimiaal penalties of a fine up to$1,500.00 and/or one-year imprisonmeaf, as wen as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against thq violator. Be advised that a copy-of this statement may be forwarded to the Office of. Investigations of the DIA for finance coverage verification I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct; tS Vie- Date:_ Official use only. Do not write in this area,to be completed by city or town o ff-cciaL City or Town: PermitUcense# Issuing Authority(circle one): .'1.Board of Health 2.Bufiding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector r 6.Other Contact Person. Phone#: ' f OF THE r Town'.of Barnstable Regulatory Services BAMSTABLE, Thomas F.Geiler,Director, 9 MASS. 1639. p•�� Building Division lED MA'I . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601. ` www.town:barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �1 / Please Print Z �JOB'LOCATION:`5- --, 3 CUPI `5 L7 4 n S tr" number II'' street�(. �/ /village HOMEOWNER" '"6 V �Vl®�t O &77 ?mac=ram( "` 7 (L/C. V0 home / phone-/#,,-em work phone#: C�T MAILING ADDRESS " :. �Pr,E T7 LG�s ✓V t1s ! city/to{{wn state. zip code �F 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. .y 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'inteiided to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or'fann 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. 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 with sadprocedures and , requirements. ;. Sim g`r_ature of.Homeo er ,�,,� 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 F 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 persons)for hire to do such ow work,that such Homener 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&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often' results in serious problems,particularly ' when the'hoineownerhires unlicensed persons._In this case,our Board cannot proceed against the unlicensed personas it would with a.icensed 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 permitappli cation, 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:forms:homeexempt - �7HE � Town of Barnstable Regulatory Services • BARNSTABLE, • MASS. �, Thomas F.Geiler,Director 1639. �0 Fo 39►r" 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 h ,as net of the subject property hereby authorize Zto act on my behalf, in all matters relative to work authorized b s building permit. (Ad ess of Job) **Pool fences and al.rms are the responsibih of the applicant. Pools are not to be filled b 'fore fence is installed and po s are not to be utilized until all fi inspections are performed and cepted. 4, Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS c� VA vt e �. �- ., ..-� t - � f r S5 ` 1� � �� ,1 �.�r r 'Tr -LiN S E4� % 6�- s�r i �- vy C`T r _.D M S��-jLY7� , � '-- ,.+. �-e.� ri � _. i