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0122 SEVENTH AVENUE (HYANNIS)
/W 12 i Via Town of Barnstable Building ' •' T, N Pot This Card So ved Pula ns M,�u.s�°.ts skb e.�-.R a„e�ta`.i n�e`d�o�n Job�"3a•c,^�. �xCs nd a ro� Must be Kept•• `, M^ �" Posted UntilFinal In spection Has Been Madea y � a h "C rteficate of Oecuspancya Required,:uch Building shall Not be Occupied until a•Final Inspection has en" Permit NO. B-18-3479 Applicant Name: MARVIN W. NEWLAND JR. Approvals Date Issued: 10/29/2018 Current Use: Structure Permit Type: Building-Deck Expiration Date: 04/29/2019 Foundation: Location: 122 SEVENTH AVENUE"(HYANNIS), HYANNIS Map/Lot 245-061 _ Zoning District:. RB Sheathing: Owner on Record: WASSERMAN, MYRNA R Contractor Name:` .MARVIN W. NEWLAND JR. Framing: 1 1- Address: 27 LITTLEBROOK ROAD Contractor;- cense 158410 2 4 SPRINGFIELD,NJ 07081 _ Est Project Cost: $ 14,000.00 Chimney: Description: Install deck with Azek and new railings Permit Fee: $110.00 • Insulation: Fee Paid:f $ 110.00 ' { Final: Reviewer's Note: I `$ 4 � Date 10/29/2018 _ Replacing an existing roof top deck. a RMcK p d Plumbing/Gas s Rough Plumbing: Project Review Req: s '. Building Official Final Plumbing: '-; Rough Gas: 0� <F Final Gas: `kt Electrical This permit shall be deemed abandoned and invalid unless the work aiatho'nzed by this permrtcis commenced within six months after issuance. Service: All work authorized by this permit shall conform to the approved application and3the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structur s�shall be in compliance with the local zoning by"laws and codes. b F. Rough: This permit shall be displayed in a location clearly visible from access street or_-oad and shall.be mainta,i�ned o.pe`nfor public inspection for the entire duration of the work until the completion of the same. Final: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Low Voltage Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Health 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection 5.Prior to Covering Structural Members(Frame In ec ' Final: 6.Insulation 7.Final Inspection before Occupancy f� Fire Department Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. ti n� Applicadon Number....`. .....�g.......��.....1�.:L.................. s * * ........................' odlea Fee.................:......B0ILDIN� DEPT PermitFeo................ 1 . OCT19 ZOO Total Fee Paid....................(.(.11....................... .................. TOWN OF BA AYWNIRMSTA-Ki Perm"PrOval by......ze .On... BUILDING PERMIT MV ........ ............. arV............ el. ................... i APPLICATION Section 1 — Owner's Information and Project Location Project Address Owners Name ` Owners Legal Address t 2 Z,. 7 � � { City t -i4� s 0 '� State Zip � C9 Owners Cell# � Z (P (r ��" E-mail. Section 2—Use of Stractare Use Grroup ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Two Family Dwelling Section 3--Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alamo Rebuild Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ S61W ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4-Work Description r } I- 2 Alm Rai Z�' T A.qt Tmdafie&_219=1 9 r Application Number.............:...................................... Section 5—Detail Cost of Proposed Construction o 00, Square Footage of Project 2 ,- Age of Structure Dig Safe Number # Of Bedrooms Existing 3 Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics a ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ HeatingS ❑ Masonry Chimney ❑Add/relocate bedroom System my ey , Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway, r= Debris Disposal Facility: I an using a crane ❑ Yes 9/No Section 7—Flood Zone j Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ . Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. S Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No bast tmdated:2/92018 • o�gWAS I / r G O'er S i • ro r a ii e �• 2 1� � 1 • 1� i I7� i y Commonwealth of Massachusetts Division of Professional Licensure i�_�J Board of Building Regulations and Standards Constrgctior tSUpervisor CS-093605 E��pires: 12/03/2019 i MARVIN W N EWLAND`JR ., 35 SAMOSET ROAD ;';> MARSTONS MILLS MA 02648 N Commissioner . ... .. ..-_.. . _ : � �, .� c�/fie (pam7rzoae o��f pcu�u�eCld Office of Consumer Affairs&Bu'siness Regulation -HOME IMPROVEMENT.CONTRACTOR TYPE 'IndMd_u R eaistration�, Expiration - 1584I 05/17/2018 MARVK W.N �ND JR` — h MARVIN W NEW LAVDaJRp k { 35 SAMOSET RD e�•.'�`�— i"' --""T a . MARSfiON MILLS,MA 02648 Undersecretary ` Co Y07L, - F . S i 1 Registration valid:for individual use only before the expiration date. If found•return to - Office of,Consumer Affairs and Business Regulation One Ashburton,Place-Suite 1301 d. Boston,'MA 02108 . i of valid without signature The Commonwealth of Massachusetts` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ N) g,UA t� Address: City/State/Zip: ' 'hone#: -7-7¢-= gq L5 1 i Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction , 2.aI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling „ ship and have no employees These sub-contractors have g• ❑Demolition working for mein any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.incnran�, comp.inanrance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work - officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑ .oof repairs insurance required.]t c. 152,§1(4),and we have no 13 ,_,/R � +� , _employees. [No workers' LLCC + comp.insurance required] *Any applicant that checks box#1 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 anew affidavit indicating such.' tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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.#: 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 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 be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenaltio of perjury that the information provided above is true and correct Sianature: Date: r Phone#: 7 V! - Official use only. Do not write in this area to be completed by city or town official r City or Town: Permit/License# 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#: 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-contractors)name(s),address(es)and phone numbers)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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations 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: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia Town of Barnstable jt J Building Department Services ;l i ...rr►:as Brlrn Tloremee,CEO ,���� ilutldfug�►mtnlsxkoner 200 AWK gftol.biyaenU,h&%OW1 ww%.v.a6an,b gin mtbit ma.n% {)fflcc: S©$91,24tx#S Fax: 5OS-700-6 10 Ptoperty Owner Must Complete:cud Sign This Section If Ushi >,A Builder a"Owner of Clio sulker pro eviv to won my lxhakf... in a0 matters relative u %vork AmAiori d by this building Pruxt nppliradon for.. '^ Y. 1c17� (A,dtlressof Job) *13wl.fcncc%and Mures are the Mpnn 04ty of the:thpliclnt. Pools are not tip be filled or utilized`before fence is inualled and all final ittxpectarna nre perfotmeti and amepfecl. d "gp:uurecol`C)aucz $lgnattu¢orApp4coic , Cnat a«c, Punt Now 10 l7a[w ��0{LUS:04YNF?ItP�I!►iL4}�O?lt'AOl.4 i tl.rr FIA'I N 6� i `6 4F 4, f Application Number............................................ Section 9—.Construction-Supervisor Name_$AA-CL) 1seV( D-J'&Telephone Number Address'; !gym D '5 E7 CitynAC� 6�1 G(,e State zip Qom, (� 4 9 License Nt tuber '3 � License T e2�� yp Expiration Date `L <> `Z-o_ Contractors ErriailN �e -1� �u� C"s h'v4�!.•dell# 77 f �p I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CNR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of B le.Attach a copy of your license. Signature / Date Section.10—Home Improvement Contractor., Name_MML L) + W N'7'JA-tj�)-)h-T61ephone Number • `7 �p�T (t Ad es�s' 1►t1aS��'i�-� City meg j S Mj State d A-:Tip 0 2& Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CUR and the Town of B le.Attach a copy of your EUC... Signature""'- Date Section 11-Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I Understand my responsii llitiies under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedun-es,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date r APPLICANT SIGNATURE Signature Date Print Name tJ 1AY. .R-W Z Telephone Number=`77c f / r. E-mail permit to: 14JC re.c....i .r:.mm/limo I Section 12—Department Sign-Offs Health Department © Zoning Board(if required ❑ I-Fistoric District ❑ Site Plan Review(if required) ❑ Fire Department ❑ i Conservation ❑ For commercial work please take your plans directly to the fire deparbnent for approva.L � Section 13—Owner's Authorization I, , as Owner of the-subject property hereby authorize _ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) ' Signature of Owner date Print Name ti Last=detm&2/92018 RIO Town of Barnstable *Permit# ' G Tres 6 month�.jrom issue date ' Regulatory,Services 3 e ■MMSTAsi MAss. , R`c and V.Scali,Director 16 Buildin Division �, Paul Roma,Building Commissioner Q�N Of � - 200 Main Street,Hyannis,MA 02601 � � www.town.bamstable.ma.us �' G Office: 508-862-4038 LE. Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint `J Map/parcel Number 1. 1 a . Property Address ❑Residential Value of Work$ �� Minim. um fee of$35.00 for work under$6000.00 Owner's Name&Address ►✓,u;A A✓A 1-✓a GAS a. M h•�' l 'Z 2 � 1�}I/�.. w4 b1 tiA-yV /e&T f Contractor's Name 't•('r�YZ Mh ymc-A+� M y `•�y p' Telephone Number 7 /}g',a-`gibe-s Home Improvement Contractor License#(if applicable) •,.//$��,� Email: f'DMib � Co Mc f. .VF� ` 4 , Construction Supervisor's License#(if applicable)' C s 6Z-S'O.7 7 ❑Workman's Compensation Insurance Check one: © I am-a' sole proprietor` { ❑ I am the Homeowner: ❑ I have Worker's Compensation Insurance ,• F ` Insurance Company Name Workman's Comp.Policy# t' Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction•debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side w Replacement Windows/doors/sliders:,U Value _ µ(maximum.M#of windows a pZ c P�ate c,ys w►.�pzv G.�I7?f �✓a` ye o#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: , , q Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 ' A t „ 4 � • L T Ile Commompmkh q,f Maysadi Departwout afrnd=rialAcciderats Q, e 1MWStkWiWU 600 WashhWon&reet Boston,MA 02111 - iPPtn-v#1 asmgf)FMdtll Waorlors' Coinpensatian Insurance Affidavit BcederslCantract6rsMectdcians/Pluxabers AppEcatt lufmmlafron Please Print�E y Adclre= 2 4 12,O A-M o c&'4 2 CrtY-/Statm1�- 9A-A/0,-VLC-# Plu=4- 7 FI-e15 3- Are you au employer?Check the approgriat = T of ect r �,� am a general contractor and I Type pi o] t �}= I.❑ I am a employer v�iet 6. ❑Idew Coasi9C6= fiz11 arm * havehiredihe sole-coaftactm 2. I am a sale propEietar listed oathe attached sheet, 7- ❑Remodeling sh p and have no ezmpl ees These sob-comtractars have g_ ❑Demolition w Q forme is employees andh1ve wodoers' �Y�t3`- .�.a# 9. .❑S,nilc&ng ad3ifica I1�TO Wodmrs,Comp.irnsuma a CQBmp.iM%Ura... required-] 5- ❑ We are a corporation and its 10-❑Electrical repairs or additions 3_ ama daiug all work officers have exercised theft 1L❑Plumbing repairs or additiom myzeLE a woe ' - tight a§I{ �dwe have noon per MGL 12.❑Roofrepa rs tan inenre required,]f employees.[NO wariness• 11A'Other kV1A1a0 1 courp-ksurance mquh ] R c rl e4 m swJT •dap apg&sm 'a'st cbedsbaa#1 mast aLsa fll ouEthe sectioabeia�v g fie¢ao�cexs�cu�peasatioapn i��sRi� Wbo submit dns mdidaut imdzcatiag dwy ne dam-O vPeai[sad.din bite aatsi&coatmctars—st svkmit a new sffiaav1t mdicfftiaa sacs, ICanLmc6WsYfiztcbecYthkbmcnsyststtmrly saaddiiimalsbeetshowmgftaameofthesob-c�zad stale vhethcarmtfhaseenitiesbave aopk"es.Ifthesub<a4laLctmsbacetmgIoyws,tfiey=stp &e!rwadEE&cmup•pGrzy ez lam are euiplaPcrr flint is prQuidiirg tvarlrers"coir�eresedzart irusriraaca far ae}�earplFy�ee� Belvtiv is flte prrticy arui jab ata Issurance:Company Nam: ' P4ficg or Self-ice Lim F-pirstion Date: Job Ssfe Addie= C ylStafel x: Attach a•copy of the workers'compensationpolicf declaration page-(showing the policy number and expiration date). Failure,to secure coverage as required under Se�4ion 25A of lj��157 caa lead to the imposition.of criminal penalties of a fine up to$L 50D 0D andf'or one--year imprimnmeot,as we11 as rim penslfi is$ie fa=of a STOP WORK ORDER-and a rme of up-to$250-01 a dap agaiast the violator. Be a&mod that a cagy of this sbkmeat maybe forwarded to the Office of Investigations ofthe DI.4 for insut:mce coverag5ywff firm l za kere-by csd#y Pis andpsn of pedk7 that the iafbrwsi vnpr i&d abm�e is-hw and carrect DEa iimature: te_ 10, • _ ' , . O�iat use ochry: Da curt wi to in fh€s area,tit be.ar afjmp&ted by rate aF&M daL My or Town: Pern>iflI kense;9 Issuing Authority(dreie one): *Bond of Health r.Buffffing Department 3.fSlyfro n Clerk 4 Electrical Inspector .5.Phmmbfig Inspector b.Other Contact Person Phow#: 6 orm►ation and Instructions s r' M Ss ar h=Cff,Clebez-g Laws chapter M regoares all eanploy=to pravlde work &0=�pmsaton for ffieg"T'layees- Pffrsaantto this ,an empkyw is defmcd M' .eVMypers6n.Mthe sm-vice of Meru der airy co,tcarr_ofhfir, mq3m=or implied,oral or vrhen" Air emplvyM-is dsf=ncd as.ran mdivulna.I,parfnedhT,association;ccaporatm or other legal e013fy,ar CmY tWo or more of the foregoing is a Joint ,and including the legal of a deceased employer,or fiie receiver or trustee of an individual,per,associatioon or of her legal entity,employing employees- However the owner of a,dweIImg house havmgnot more =ap than thar[meots and who resides therein,or the occ¢pant of the - dwoUing house of another who employs persons to do mamten m,r f,r,Sf�'[Lr�f-i on Gr repair work.on such dwelling house or on.the grounds or bol mff ap pmn wrjt thereto shall not because of such employment be deemed tto be an effiployer" MGM chaptEr 152,§25C(6)also sates that"every state or local licensing agency shall withhoId$ze issuance or renewal of a license or permit to operate a business or to contract bwidkV in the commonwealth for any applicant Who has not produced acceptable evidence of compliance with tim bj.; once•coverage required" Additionally.MGL chapter I52,§25C(7)states-Nmfhe:rtha co=mm ealihnor any ofitsPolitical subdivisions shall MI ter into any contract for the prance ofpnbIic work u ma acceptable evidence of compliancev?ith the fiM=Znce.. reCj1M7U1ne33fS of this chat have been presented to the c ml acts aufhoUtY." A.ppli- . Please fDl oiof the wo33eas' compensation affidavit complet-Iy,by g&e boxes that apply to your sitnaiion and,if sub-contxacto s es)anphonad �ber(s) along with their cet[i dc�(s) of nexe.ssary,supply r(s)nam.e(), address( irLmnance. L=,tDd Liability Companies(LLC)or LimitedLiabilityPartonrs lips(LIP)wiffino employees other than the members or partners,ale not regimed to corny workers'compensafia a i sm-mcee If an LLC or LT P does ha4e employees,a.policy ismquired. Be advised that this affidavit may be snbmitfedto iheDepatt:nent of Industrial Accidents for conEmmaiion of insurance coverage. Also be sure to sign and date the affidavit: The affidavit should be retum(--d to the city or town that the application for the permit or license is being requested,not the Department of ; T xhLgtrj9..cc =:Es Should you have any gaestians regarding the law or ifyou are required 1r)obtain a worms' eomp=sation poHcy,please call the:Departm eat at the amber listed below. Self-insared canPanies should ends their s elf--m suran ce lic©se number on the appropriate line. City or Town OfElcials Please be sure that the affidavit is complete sod prh tDd legibly- The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of lavesdgafions has to comactyoaregm jmg tb a applicant_ Please be scn e in Ell in the peuLk/Iicemo.manbm whirh wM be used as a ref�nce nommber. In-addition,an applicant that mast snbmft multiple pewlicense applieatiams in any givea year,need only sabmit one affidavit mdicaiing c't policy infonnatian(ifnecessary)andunder'rlob S>$Addre d'ffie applic a shouldw33t--'all locations in (citY ar. town)_'A copy of the affidavit that has been offficiaRY stamped or marked by the city or town may b e provided in the applicant as proo�tbat a valid affidavit is on f Elc for 5:1tor permits or licenses A new affidavhmust be f Me d OiA each not related to business or commercial vaot= year.Where a home owner or ciiizea ss obtammg a license or perart mY Le.a dog license or pemit to bum leaves etc.)said person is NOT reqojmd to complete this affidavit o In would hlae to thank u in anvance for your mope�ion and should you.hav-e any qu estions, The Office f ye�ligad-^ns po please do not hesitatz to give us a call. The DeparlmeafS MI&Ms,telephone and fax=Mber- Sth of ' De cif. At �nt� f�[ce of��tioaa� . Bastm,Irk(2111 ? Fax 617`27 7M B.evised.4-24-D7 � m�gavidia Town of Barnstable " Regulatory, Services Richard V. Scab,Director. ►�� Building Division. Pant Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must -Complete and Sign This Section If Using A Builder I A A as Owner of the subject property hereby authorize 6Crt ✓-4,5zb -1 ►vo to act on my behalf; in all matters relative to work authorized by this building permit application for.. io2ol� SF=:\/a T-4 hvF-: , WE! t 4k t\J ►GIs 0 (Address of Job) **Pool fences and alarm are the responsibility of the applicant Pools are not to be filled.or utilized before fence is installed and all.final inspections are performed and accepted. Lure-of. Owner , Signature of Applicant r2 Nit LJ t4 SS C 944—A J t� .� M ea,�rRrft�•c%c riot Name Print Name Date QYORMS:OWNERPERMISSIONPOOI S Town of Barnstable Regulatory Services " pk Richard V.Scali,Director Building Division swer .E. Paul Roma,Building Commissioner KAM 039�- ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 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 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 Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said 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 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)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&Regulations 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 under-stands the responsibilities of a Supervisor. On the last page 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. Q:\WPFILES\FORMS\building permit fomis\EXPRESS.doc 06/20/16 • /i • j t�, .zcense or registration valid foc ndrvidul use oul?� 1^ efore the expiration da{e If found return touiation I -PA. of Consumer Affairs and'Busines§Reg II 10•Park Plaza-Smte 5170 Boston, -A 0211E I , �I Not valid without-signature Massachusetts Department of Public Safety OFBoard of Building Regulations and Standards . #, License: CS-025077 4 Construction Supervisorx PETER C MEOMARTINO 29 BOARDLEY RD SANDWICH MA 02563 r CA,. Expiration: Commissioner 04112/2018 j: 5 ---- — ( '.. V�ee�pamirrza�ruve�i o�C�/�,aaabclucael�_;, j Office of Consuiner-Affairs&Business Regulation 1il `HOME IMPROVEMENT CONTRACTOR 11 Registration::, 1�5831 Type. Expiratior�_==- f1 Individual ear ix PETER MEOMARTII `0= PETER MEOMARTINO 29 BOARDLEY RD SANDWICH,MA 02563 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-025077 S;F- Construction Supervisor i y PETER C MEOMARTINO ' 3 ,29 BOARDLEY RD T" SANDWICH MA 02563" Expiration: 0411212018 Commissioner T 'K Town of Barnstable oti, 1 (04,)L 5-;;z �.� Regulatory Services Expires 6 ma d, from issue date Fee KAWL 059. h�e� Thomas F.Geiler,Director 1 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstabid.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL.ONLy Not Vafid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work �6U,00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 0A Contractor's Name Telephone Number_IS0% 1?5 f j Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) i r,nA 7Workman7s Compensation Insurance A h Check one: ElI am a sole proprietor TO\fVNI OF gARNSTAR�E 5r I am the Homeowner ❑ I have Worker's Compensation Insurance nsurance Company Name dorkman's Comp. Policy# 'opy of Insurance Compliance Certificate must accompany each permit. -rmit Request(check box) (� Re-roof(stripping old shingles) All construction debris will be taken ❑Re-roof(not stripping. Going over existing layers of r000 ❑ Re-side #of doors g f g4w r i w—J OOrs Replacement Windows/doors/sliders. U-Value_ a `4 (maximum.44)#of windows *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. NATURE: PFILESTORMSIbuilding permit formsOTPLESS.doc ised 070110 r The Commonwealth ofMassachuseits I Department of Industrual Accidents E 7. ;J Office ofInvestigations 1 ili:; ij " '600 Washington Street 4 / Boston,MA 021.71 r r WWW.mass ggv/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address a City/State/Zip 5; C ' Or `1)Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 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 prroprietor or partner- listed on the attached sheet t ?•. ❑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 10.❑Electrical repairs or additions equired.] officers have exercised their 3.. 1 am a homeowner doing all work right of exemption per MGL 1 LE] Plumbing repairs or additions myself. [No workers' comp. c.152, §](4),and we have no 12,❑ Roof repairs insurance required.]t employees.[No workers' comp, insurance required.] 13- Other *Any applicant thatchecks box f I must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'camp.policy information. I am an employer that is providing workers'compensation insurance for my em'ployees Below is the policy 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 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for.insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si .store: Date: Phone#: - T75- t 1 10 Official use only. Do not write in this area;to be completed by city or town official City or Town: Permit/License# Issuing Aut:hority'(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other r- . r J 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 Iegal 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 withbold 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 are1required 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 iii the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pennit/Iicense 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 burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would bke 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 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Town of Barnstable 0 Regulatory Services i Tbomas F. GeBar,Director 16A g Building Division �Eoi L Tom Perry,Building Commissioner _ 200 Mam'Strcc Ayanni ,MA 02601 WWW-town_b arnstable_ma.us Offf-�c: 508-862•4-03 8 Fax: 508-790-5230 HOMEOWNER LICTWEE E7 7r=ON n p. Mcase Print DATF�C �G[ fJ y�I/ ' r �," JOB 1 ocAknom (�a J�°tU`e. number street village name V rne(� bo phone# wmk phone At _ CURRENT MMIQ C!ADDRESS: DO (_ Q n�4. eity/tawn state up cod. 'Ac c==t 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 w BOMEowi mR Porson(s) who owns a parcel of land on which he/she resides or infcnds to reside, an which there is,or is intended to- be, a one or two-&=dly dwelling, attached'or detached structures accessory to such use and/or fawn structures. A person who constrgcts more than one home in a two-year period shall not be considered a homeo nrs. Such "homeowner"shall submit to the Building Official on a fo>m acceptable to t6c Building.Official, that he/she shall be r=orisible for all such work pcdbrmed'undcr the building permit_ (Section 109.1.1) The'vnderaigwd`homt:owme assumes responsibility for co=lia.nce with the State Budding Code andother, applicable codes, bylaws,ruIes and regulations. nc tmdcrsigncd'homeowner"certifies that,he/she.understands.the Town of Barnstable Building Department ,4mirm m inspection procedures and rcquir-entaots and that he/she will comply with said procedures and requircrment s. igna ' f Harncmvna kppmvzl of Build ng•oi$cial 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_ #AaowNER,9 EXEmmbN The Code states that "Any homcowacrpefommrg work for which a bzn�ding prnvit is required shaD be c cxnpt frrsrn the provisions of this section.(Section l D9.1.1-I icaisiag of construction Supervisors);provided That if the homcevmrr impgrs a p=w(s)for hire to-do such . work,that rush Hameownasha�l art as supervisor,• Iv�amy homeowners who use this.rzrmpti�are unaware that they are aunm3ing the respcnsrbiliScr.of a supervisor(see Appendix Q, Ri�1es&Rrgulati®s for Lieamsing Cons Supervise s,Section 2.1.5) This lack ofawa=c=often rzsulzs in serious problems,particularly vhai the homeowner hires unliecased pasoas. In this ease,our Board cannot proceed against the unlieerzsed person as it would with i licensed ;Vpervisor. Then homeowner acting u Supervisor is nlfirr>ately responsible To crim=that the bonieawriar,is f zly zvrac of hislhcri=poasibilioes,many communities rcquirS as part of the pamit zppieadon, rant the homcowncr certify that hrlshe understands the respcmnb1 tics of a Supervisor. On the last page of this issue is a,form eurrartly used by :veral towns. You may care t amend and adopt such a forni/oernfiradon for use in Your ccm=mnity. oFTy Town of Barnstable Regulatory Services - u.xxsrAsc,� ' MAM Thomas F.Geller,Director ` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.ma.us O$ice: 508-862-4 03 8 Faz:....508-790-623 0 Property Otie-emust _ Complete and Sign This Section If Using.A Builder h ,as Owner of the subjert,pnoperty h ere by autho n 7p to act on my behalf; in.all matters relative to work authorized by this binding permit application for. (Adds7ss ofJab) $;gnat„m of Owner Date t Print Name ti If Property Owner is applying for permit please c ornple te. the Homeowners License Exemption .dorm on :the reverse side. Town of Barnstable *Permit# LRrirt6.01 t�! �of+�rove dole ' Regulatory Services Fee .p s KA_ v "�% S Thomas F.Geiler,birectar, Jp.,p/ f L APD BuildingDivision/l Tom Perry,CBO, Building Commissioner ® 2010 200"Main Strect,Hyannis,MA 02601 Tawp wVwJown.bamstabJr.ma.us IV op U/gR%�Officc: 508-862 4Fax;508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without RedX-Press Imprint, Map/parcel Number--._.__. r /�/� {�— Property Address� ^i { tTv� � __ ' rs n Y�l� D __. I t�`_ .._ Rcaidentinl Valuo of Work.,11- 1000, 00 mini..foo or S25.00 for work under ` Owner's Name&Addressi - 1 �� tit , YM Contractor's Name-, _ _ Telephone Number L�( � _. Home Improvement Contractor License#(if applicable)____ _ _ _ -- Construction Suporvbor'c Liocoue It(if applicablo) ❑Workman's Compensation Insurance " Check one: ❑ I am a sole proprietor 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurnnce Company Name Wurlurlau's Culup.Policy Copy of Insurance Compliance Certificate must accompany each permit. PermitRFgnest(rhrckhrix) . ❑"Re-roof(stripping old shingles) All construction debris will be taken to_._..... ,-_^ ❑Re-roof(not stripping. Going over existing layers of roof) Re-side .. ,,r. #ofdoora" Replacement Windows/doors/sliders.6-Value— _:,(maximum:44)#{of windows `where requiral: Lespsnce of this permit does not exempt compliance with other town deprrimrnt regulations,i.e.Hutoric,Conservation,ctc: - `'}*Note Property Owncr must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SLGNA'I'URF _ ._ —_ Q3\VPFILES\F0RMS\bui1ding permit fonrs\EXPRL•SS.dac Revised 090809 l , f A ` C ' ` a'he G'orrrrnonweatth ofMassachuselis Department oflndu triaiAccirlenis 1 Office of In vestigations 60.0 Washington Street Boston,MA.02I17 r�.�ysi rvivrv,ntass:gor/die Workers'Compensiitiun Insurance Affidavit:BuilderslContractors/ElectriciAns/Plumbers Applicant Information I� Rlense Print Legibly Name(Business/Orgaiiiisti6h4ndividuai): y4�1t V(f<�� 'F11Li I`l :Address: AQC CitylStatefI,t _ G" V1 t Ofio�phone if:_ � f. �� Are you art einploycr2 Chcnpp o _ Type or project(required):L[] I am a employer with 4. []I am a general comimotor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New consuilction 2.U-I am a sole proprietor ur partui:r_ .listed on the afiacliFA shoat. 7. Remodeling: ship acid have noemployees These sub-contractors have g. Demolition working for meany capacity. employees and have Workers' - [No workers'comp.inaumnco comp.insurance:{ re 9. ��Building addition quired.) 5.Q We area corporation..and its 10,U Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or midi tions myself.[No workers'comp. ri)?ht of exetpptlon per MGL 12"Ej Aoof rapairc insurance required.)t c:152,§1(4),and we have no employees.(No workers' 13.E Other! _ comp,insurance required.) , 'Any applicult that checks ba fil must also fill out the,section below'showing their workers'odmpcnsetioa policy information. t Eomcowri.is Who submit this affidavit indicating they are doing all work and then hire ouiside contiaetors must submit a new af6davitindicadng such. tContreelors that chick this boa hrmt attached an additional slice t showing the name of the subcontractors and state whether or not those entiiies ha4ic crnpioycw. Vthe aub-contraeton ha-m omployow,they Mwt prcvido their"rod on,oomp,po!iey numbe, I am.an employer that is providing workers'compensation insurance for my employees. Below is the poficy and job site inforin6tiori:. - - Insurance Company Name: Policy#or Self-ins.Lid.#i y .: ;Expirulion Datc:__M. Job Site Address: _ . City/State/Zip: Attach a copy of the workers'compensation policy deciarniton page(showing the policy number and expiration date); f Iiailure to secure coverage as required under,Scctinn 25A of MGL c.152 can lead to.the imposition of crimitial penalties of a fine up to$1,500A0 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to t250.00 a day against the violator. Be advised that a copy of this statement may forwardod to the Office of Investigations of the DIA for insurance coverage verification. I do her certi y srniter,I�pain=s andf pariafties ofperjnry that the information provided above is trice and correct Si ature�F 1-1 IKI Ct.a�4-2�fY�- Datei 07 jlciai use only. Do not write in this area,to be completed by city or town officiate City 017 Town:_T YcrmiULieeasa# .� _ Issuing Authority.(circie one); I:Board.of Health 2.Building Deparimant J.0q)Town Clerk. 4.Electrical Inspector 5.Plumbing Inspector 6.0ther_.. r�,;.,teeiooroerr• _.�_ _ Phnne#i , i Towni of Barnstable OF 7 IHjE �ry a Regulatory Services snaxsrARM , Thornas F.Geller,Director v buses Boding Division. o rat" Torn Perry,Building C6fllmissioner 200 Main Streel, Hypnnis,MA 02601 wwtv:town.barnstable.ma.iis Office: .508-962-4038 Fax: SOQ11-790-6230 HOMEOWNI%R uciz?JSE FXEMYTION ^ Pl-ke Print DATE_•);`C ➢ (! t YO I ` JOB WL AI ION: f- t"I Xtt �5+__�Q CIS �— numher - - strut village „ttoMeo�vrl�x"��l�r�_s�1L�.st`?�'ririrt•� 'i`.)�' �-7`�- t'�il___. nami frame phone# work phone11 CURT*-NT MAp_PIO ADDRF.SS: af.'JC—QI"C..•I1L'r —3-zCEL --- -- cityltown +state zip rode The Utalout cxwnption for."Fiosnooivnbrc"♦vdu extended to uiclude nume�clef ivied t1we7111;pS of six"uT1i15 or less and to allow homeowners to engage an individual for ttire who does not possess&license, R ro oYldcd-that the owner acts,±s,_ supervisor: ilp:l+'fifTT10N OT HONf>',OwNER _ Person(s)who owns-a parcel'of land on which he/Sbe.resides or intends to reside;-onwhich there is,or Is intended to be,a one or two-family dwelling,attached or detached structitres accessory to such use and/or farm 6tructuics. A person who constructs more than one hnrne in a two-year period shall not be considered a homeowner. Such "homeowtier"'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be res�ionsible for all such work pedorrned under the building permit: (Section 109.1:1) The uddersignod"homeowner".assumes responsibility for compliance with the State I3itildingCode and other applicable codes;bylaws,piles and regulations. The undersigned'%oinrowner"certifies that he/she understands the Town of Barnstable Building Department "minimum inspwtidn procedures and requirements and that he/she will comply with said procedures and requirements. , Ananuo of enwner - Approval of Building Official Note: Three-family dwellings contair6g.35,000 cubic feet or larger will be required to comply with the State.Building Code Section 127.0 Construction Control. )IOMEOWNER'S LXEMPTION The Code states that."rhiy Iioincowner performing work,for which a building-permit is-tr:iuiri it shall be exempt from the provisions of this section(section.109,1.1 licensing of construction Supervisors);pmvided that if the homeowner engages a person(s)for hire to do such wnrr,thm such Homeowner shelf act as supervisor." -Maw homeowners who use this exemption arc unaware that they are assuming flit rtsponsibilities of a supervisor(se Appendix(2, Rules&Regtlations for Ucensing Construction Supervisors,Section 2.15)This lack of awareness often results in scrims problems;per 1iwl-d when-die homeowner hires unlicensed persons.In this case,our Board cannot proceed against the unlicensed person as it would vntA a licensed Supervisor..The homeovvaer actingtisSupervisor is ultimately responsible; - - -To ensure that the homcowne-is Fifty ewarr.rif hislher responsibilitim many communities require,as pelt of the permit application, that the homexivenerccnify that he/she understands"the responsibilities of a Supervisor. On-the last tpagepf this issue 6 a form currently used by suverat towim You may care tamend and adopt such a fo n✓ccriificafion for use inyour community. _ Q:\\YPFI I.GS\FORNI Sthotn=cinpi.l7UC 3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Parcel: ` y Application v� �� Health`Division '!,�5`'l - 7 1 Date Issued d� Conservation Division - Application{ Planning Dept. Permit Fee -0 Date Definitive Plan Approved by Planning Board 1�! Historic OKH Preservation/ Hyannis Project Street Address 1 22 7th St.rdPt / Z Z S���/�77f 14P/�• Village -�/A i S Ownerrna W� sett Address 8499 :Orchard Road , Zionsville PA ' Telephone 267-784-9742 18092 Permit Request RPmnv,. existina cabinets , floor covering countertops , sink e . Install new flooring, lighting, cabinets , countetops., sink3.,a & a P P fiances . ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed '. Total new Zoning District Flood Plain Groundwater Overlay _ Project`Gal ton 5 ,Q n Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supp rting d um'entation. 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: ❑Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If � p e Yes site Ian review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER_OR.HOMEOWNER) '-Name _ 'Mgrna WA.-,carman Telephone Number 267-784- 74 Address 8499 Orchard Road License# 7; nn. T; l l e, PA i sn92 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE " -� U _ _ FOR OFFICIAL USE ONLY `APP4ICATION# - DkfE ISSUED. MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION ' FRAME ` INSULATION .FIREPLACE ` j. t. ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH j FINAL GAS: ROUGH FINAL FINAL BUILDING rTTTT a f 1 a + DATE CLOSED OUT ASSOCIATION PLAN NO. ; s `t r The Commonwealth of Massachusetts Department of Industrial Accidents ' ) Office o f'Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation XnsUrance Affidavit: Builders/Contractors(EIectricians/P.lumbers AppUcant Information Please Print Legibly Name (Business/Organiza ion/TndividuaI): `M -Wasserman Address: 122 7th Street City/Sta-te/Zip:_ Hyannis: MA. 096_7_2 Phone 267-784 742 Are you an employer? Check the appropriate box: Type of project(required): 4�Q I am a general contras and T Ke 1.❑ I am a employer with w conshuction employees(full and/or part-time).* 7. R emodeIing vc hired the ontractars tie 2❑ I am a'sole proprietor or partner- Its n the shed sheet ® ship and have no employees These retractors have 8.'O Demolition workers' wanking for me in aMy ca yees an pacity. 9. ❑Building addition o Workers' 1nc�rrancC rap.insulance.f �� 5. we area corporation and its 10_❑Electrical repairs or additions required] officers Iiavc exercised their 11.�Pl-ambing repairs or additions 3Ymysclf I am a homcow—nni doing all work ' [No workers' comp.y rigbt of exemption per MGL 12.0 Roof repairs iasT=cc required_]t c. 152; §1(4),and we havt no 13.[] Other employees. [No workers' carttp.insurance regtri ed.] *Any applicant first cbmki box#1 must also fill out thr r=tinn blow showing thcu workers'cornpmsahon policy infoarmtion. t Homcownen who submit this aff davit indicating they am doing all work and thin hire outside eontr-adors must submit a new aI5davit indicating such. ICanlractors that cbcck this box nmst attacbcd an additional sheet showing the name of the sub-cmft-aLt- and state wbetbet or not thosd cntitits have arployr-M. if the sub-ontraeton:have tnployccs,they roust providb their workers'comp.pDbcy number. I curt avt employer that is praviding workers'compensation insurance for my employees. Below is the polity send job site information. Tncnrance Company Narn Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/5tate/Zip: Attach a copy of.the workers, compensation policy declaration page(showing the policy number and expiration date). Failure to srcurc coverage as required under Section 25A of MGL c. 152 can lead to the imposition of ci imil a1 penalfics of a fins tip 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. Bo advised that a copy of this statcmcrit may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the informations provided above is true and correct Simatiue: Date: October 2 Phone#: 267-784.-374 Official use only. Do not write in this area, to be completed by city or town offzclal. City or Town: permitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: 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. HOWr tha 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 an 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 commonwealth for aMy applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ohapter 152, §25C(7) states 'Neither the commonwealth nor any of its political subdivisions shall enter into any contract.for rho performance of public work until acccptablc evidence of compliance with the in- --ice 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, i-f nccrssazy,supply vdb-oantractor(s)name(s), address(cs) and phone numbmi s) along with their eertifieatr(s) of bsurancz. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no-employees other than the nambers or partarks, are not required to carry workers' compensation insurance. If an LLC or LLP does have smployces, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial kceidLnts for confirmation of insurance coverage. Also be sure fo sign and date the affidavit The affidavit should >c returned to the city or town that the application for the pest or license is being requested, not the Department of ndustrial Accidents. Should you have any questions regarding the law or if you are req Tircd to obtain a workers' :ompensaEon policy,please call the Department at the number listed below. Self-insured companies should enter their ,clf-il=anGe license number on the appropriate line. :ity or Tower Officials 'lease be sure that the affidavit is complete and printed Icgibly. The Department has provided a space at the bottom ,f the affidavit for you to fill out in the event the Office of Investigations has to contact,you regarding the applicant 'Lease be sure to MI in the permit/license number which will be used as a reference number. In addition, an applicant hat must submit multiple permit/license applications in any given year,need only submit oap affidavit indicating current obey information(if necessary) and under`Job Site Address" the applicant should write"all locations in (city or )wn)."A copy of the aff davit that has been officially stamped or marked by the city or town may be provided to the pplica. t as proof that a valid affidavit is on file for fuhrre permits or licenses. A new affidavit must be filled out each ear.Whcre a home owner or citizen is obtaining a license or permit not related to any business or commercial venture _c. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit he Office of Investigations would hkc to thank you in advance for your cooperation and should you have any questions, [case do not hesitate to give us a call to I;epartmant's address, tcicphone•and fax number. The C6mmonw-t-,9th of MassaGhusotts Dg3arhnent of Iudustdal Accidrrnts Office of Luvestigatians 600 WashingtGn Street Boston, MA 02111 Tcl. # 617-727-49-O.0 ext 4-46 o-r 1-V7-MASSAFB Fax# 617-727-7749� ;d 11-22-06 W W.mas�.gov/dia Ff _ 1 Town of Barnstable Regulatory Services I BAPJWAat.e. ; Thomas F.Geiler,Director 639. 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE:nr-tnhar 28 , 2nQ8 JOB LOCATION:- 1 2 2 7 t h R t r P e f- number. street village "HOMEOWNER": Myrna Wat44 rman 267-784-3742 name home phone# work phone# CURRENT MAILING ADDRESS: 8499 Orchard Road ZinnGVi11P, PA 18099 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 be responsible for all such work yerformed 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 Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. SignatVlof 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 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)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&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hives 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:fornwhomeexempt Assessor's office st Floor): Sp C Sy�M MUST B� Assessor's map:and lot number 7 of THE To Board of Health(3rd floor): LLED T d� Sewage Permit number - 7/) 07�1^P� 5 BABIISTAME i Engineering Department(3rd floor): —� �' ���{f� ' 4'``' ' rasa House number / Z 7i S��O'�`� i' W�� a � �� 1' 3 °o trio• ®0' Definitive Plan Approved by Planning Board I 19 o war d, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF . BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ec 1 .5 leLI -r _M / �' 117`/ -5�C0V-1} FZc'O P— l7VO,17u/I TYPE OF CONSTRUCTION 6-61) /tj197� 410 VLAj8C1? / 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ✓. 51--VLW FAI 4-14C7 W Proposed Use IVC—W <(30AUU 11 J , 1344i rcx-s, Zoning District 1 Fire District ' L;i/ 6rcu L ,ed Name of Owner j''V#-RT/iV WitSsZ7Z'"/7W Address V•,T O t©P 1 Name of Builder ,7rCSL7H ice. RKTRONi 7T< Address f3e'X ;7,%F S- /De4y7hiJ' oz66o Name of Architect /V✓& Address Number of Rooms 'TWO Foundation #bl Exterior IN%t/ME 4CE-P'97Z, � /iti°6 c7 Roofing 14Prc Floors S� c')X ll; -4 lkz�1 L"A 5 �/'J Interior <5"�'i'� 7 %2d Heating Tz�t�C7� ila �i�'. hel /n/a �.r�J�h4 Plumbing ��t: /34 Fireplace /4✓�t U0i)rApproximate Cost Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 500994 , WASSERMAN, MARTIN No -348 93 Permit For Build 2nd Floor Addition Single Family Dwelling .fi Location 122 Seventh Avenue W. Hyannisport y f I Owner - Martin Wasserman r c. Type of Construction Frame i - Plot Lot :> , F � t Permit Granted November 36, - 19 89 ? Date of Inspection.0 _02/ (b 19 Date Completed 19 r y , � "r Y y �`- a.�.+r`-..,/KYt. ..a.•. K .. -f�.t-� •,�••:s47; . .-a � a s +' .� `K s++i:n. Assessor's office(1 st Floor): Assessor's map and lot number 7 Q�o�THE `. Board of Health(3rd floor): Sewage Permit number s Z BA ST&BLL i Engineering Department(3rd floor): Q rued— House number / 039.-\®m Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF - BARNSTABLE BUILDING INSPECTOR ' ♦ P APPLICATION FOR PERMIT TO 60 t7,5 fZ(ICr C[ .31 ' X oN .5;6n j) 140 0V!•/7 TYPE OF CONSTRUCTION (/t/!ro/7 /VO VEMBER 19 _ 5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r _ Location /a9 s VD/TV /� Vf! Proposed Use NCN C3E�/L�U�, ���hruM► 9• S�1`f�a�a ��E"?4• Zoning District Fire District 2 Gi/1/ �ruo ,ed Name of Owner 1##-XT/N WfiS3_EXm47V Address _PIZ, V 6 D Al, T, 070Q,/ Name of Builder TaSEPt! TY ;)t-nl d Ni T/ Address 3 vX a y(P S 0z60 Name of Architect N�!� Address Number of Rooms 7-WO Foundation A11A Y Exterior W H/fE Ct)/M SIliA16CEJ Roofing dV !f i 4-16 Floors S/,g CbX Jab , w� IXZ%�" pgK fT,Brl"J Interior y Heating i_rt CC-D HiY� ��/. h e d/ snls c!�.riJ�7hG Plumbing 13 , tall o(+-/ 1-6 Y Fireplace ly�� AZ,+1JC CHI�W#V/70t ('0brApproximate Cost ��b' A Area �J Y Al Diagram of Lot and Building with Dimensions Fee . rd A._ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. Construction Supervisor's License 000994 A=245-06? WASSERMAN, MARTIN No 33393 Permit For Build 2nd Floor Addition Single Family Dwelling Location 122 Seventh Avenue W. HVannisport Owner. Martin Wasserman Type of Construction Frame Plot Lot Permit Granted November 30 , 19 89 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/ 9/ _ -_.. _.,__ _,. New 3kot4o Gtmz zm t' FLvOlt _ ;' r SecnND ,il1 Tl, 0.00F 1Z'" 7no io+.[>L.S LLaNE FtAo4 F4a+r eLEvn*lov. ` .31 CKA UE E 15rIN6 cw..(-y to . � 3' Aa.'a it W ayes E, Nq `4001: WAIF\NN •�,"• - .. . 1 - — ��s+ .fi � • 7110 Pe�/'LI SEl:..1J%ICb E• [F� F c� _ n i" �`.. f ,'HR I mils 'MAAnN W MSltAnIAN= z. a '�'�• .. ° A* ' � . KN1:YI�'I- //��w®w t.- �• 71NwM II:tEv'1,J_ ��1 L ICI• s--. 4. 12L W. • FRout 1 LC'Fr SLEV FMwS O1NwF�wyx+w ' _re 1 4 w , .__. •QMI YOI A,thr'. ty ' • ,.. .. i i F- �,. :`ti of 3 is 1}7 t i�' t. w . .•,ra ti 1 i:. I 14' iU / v � 4, r Istnly s ►.c.l ? x + MFLJ vti } � i LEE_j �_--I t� 37 • Rw61aT,ELEVt1T[+.I Fl V'• f��x e�` v1 I$� 'y ' rf t ZN' Rko�l ' i'1I11 �1111 �1�1 ❑1 � �> +��t �-"� � fir.{5 �f��... 9dF� � 111�11 III T � 0 *.• t T tnR �m'<5• nfii+anN.W d:�L i f ASSERMwI �:. 1 t.:. - sat•' L �.: -'i. -: _ DAIS: 11 IV Q'I ;p 1'1 f'�`. •~w :. •6uCkly, 13L SEVC NI« AyE, 1 W. 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M.RTIN W SSER,^" -----1 t � �.sy d ._r'»Yr "�� ac�u•'v' I t.vi w«w'��r w m .,r 1 YA 1 �l3 e�P iIK - 1 W. -11ANLS PORT,.MA- j�f T% 4 }t',s. s,wF,:, } _"•+ '.#. .":+ ,: p: L Se'coNo r--L.00z NCnnL FR MhE 4LnN .3e J Y _ or r 1 ' Vxa01f 9N.Alrl P-ic A 11. ,�sf .f,t +ow•'1'x r ,� 31 .397 Az y a w w cn: ::`:4 4 r 1<..__ :..r-. "- i. .,.. -:&: ,. .S`. ?: ......��''�•>.:.. 'r r.u.i","' S .-e-., ..:' t :,.�-7r.-;; ,.r.. r +-.:' sc Sit a.} dr + ra, ;,.,-7 -...... .0_--+.,•v,r x+.« ,.- ,y. �,.�G._..�<.;.. v, ...tom w...:a. ..:.b.. �,-..•. ,. ,�tvr _:.. .... .....: � .::. �' '^' -� � ..i r:.., ........ ,�-r .�,.., -"'h:,:.w, C'3..I.S-- „ ''t [>:� . _: �'.",_t.. �.i .�7 x. 1- •.; ,. .,:'w- C n y,.. � i _ .y':t,; Nr p.,- ...-a: ...1'.._.,�,..,. s+::.-,.a�v ro..7...$:. .�-: ....-.<.Y�. .-„[':. .:=r.a » �-.- ..-..,- 1'.r'tl~. :.'_ ,� s. '•.ym--:'.." , -�r'-'" ;'3f' •.>,tf:< _ �'.. -r. �. • -c ra ..,:_.. R.w. '-.:� s. .,: .-: �.yn.,:,; � ,_>_.. .. ._._._ _'�. m• rs': xt' -� t 7i :i=.4y .„;.,Mt a:N✓A-f! ,'.V 1S/ 0 >G�' .rh ✓ '�-. rµ RJ. 1.. 1. :t1 }.° ��.- •� "!f�. .Y•'4 J .1.,-.' ..p - R' 3� ..ao:. :«sne4K v a p,.•.y. .,p, ^..^..t.. �.3 !� f' .:.. i� ,s.. .v,r^r• ..� �, .::i - - i x ,� � 'f-�"' .ern. :•'.. ,.. .,..o. :q.,:w n,�..-••.z: ... w-n. -r..� '--�.F C,a-- .- 'r- �W t+ •�._ !~*4. rz -u . _• 'L y`tt, _..r _y, :5'` „?-�-•'- !.., z `." 'It4e �'. .'rc p JAMES E. EGAN, P.E. _ AREA CODE 508 I 3135-2044 c/Y./,�°GAL � Z� f ,• STRUCTURAL ENGINEERS 585 MAIN STREET BOX 642 DENNIS, MASS. 02636 Feb. 13, 1990 -Town of Barnstable Building Department Re: House :Alteration, Jay Petroni, Builder 122 Seventh Ave. W. Hyannis Port, MA. f S Dear Sirs, 1 At The request of Mr. Jay Petroni , I have reviewed . the cross section construction of the house addition for roof support and horizontal thrust forces. My computations indicate that the roof is t adequately supported for vertical loads under, maximum snow and wind loading for this area. IT Further, the horizontal thrust loads ' are picked up adequately by the secondfloor ceiling joists ;' „ 1 ` • : } ,, and ties to stud wall plates. Also, the vertical -double 2 x 10 supporting the roof rafters is adequately braced for: torsion by `, t = s the cathedral box beams. " 17. i" 1 trust these- comments will answer, quzstionsMyoa r i may have �on .this phase of construction, however, i Fe- please contact this off ice for any additional 'IT questions you may have. 1 # Very truly yours, 14 James E. Egan, P. E. OF }JAMESE EGAN;,x Ei STRUCTURAL';; y t_No 22691 � 6 ASS/pNAI F :