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Home My WebLink About0186 SEVENTH AVENUE (HYANNIS) �� ,� �� I 1 I i 9 eeriiig Dept. (3rd floor) Map . 07 L/ S Parcel (J 7�^� Permit# `1 House# / / '� Date Issued �l Board of Health(3rd floor -(8:15 -9:30/1:00-4:30) i� 1 Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) 1HE Definitive Approved by Planning Board 19, SEPTIC UST BE INSTALL LIAIVCE TOWN OF BARNSTABLFENvIRONM ODE AND- Building Pe ' Application TOWN REGUU ATICNS Project Street Address AF6 Village Owner Address t. c ed 09e Telephone 6/17— 7a — to 0—m e k" 9,9e6 Permit Request r 6 First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 212::� Zoning District Flood Plain Water Protection Lot Size ,Grandfathered ❑Yes ❑No Dwelling Type: Single Family �wo Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ff< On Old King's Highway ❑Yes io Basement Type: ❑Full ❑Crawl. ❑Walkout ❑Other V7i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing�_ New Half: Existing New No. of Bedrooms: Existing _5� New X Total Room Count(not incl ding baths): Existing New First Floor Room Count Heat Type and Fuel: Gas Oil ❑Electric ❑Other Central Air ❑Yes 10 Fireplaces: Existing New Existing wood/coal stove ❑Yes Uo No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) 014one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FO OWING REASON(S) ^j) - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED t + MAP/PARCEL NO. ~� ADDRESS < VILLAGE, OWNER , • y _ DATE OF INSPECTION: FOUNDATION ' FRAME r j � INSULATION ` FIREPLACE - ELECTRICAL: ROUGH FINAL �.a PLUMBING: ROUGH FINAL GAS: ROif$H FINAL FINAL BUILDING �.. -L v-u f7P -✓^// 1/ Y DATE CLOSED OUT.' 3 y_ ASSOCIATION PLAI No. i °FTMe tqy, The Town of Barnstable 9� MASSM ' Department of Health Safety and Environmental Services rED n Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. k Date AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW ' SUPPLEMENT TO PERMIT APPLICATION t MGL c. 142A requires that,the "reconstruction, alterations, renovation, repair, modernization, Y conversion, improvement, removal, demolition, or construction of an addition.' to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cos . Address of Work: Owner's Name ��— Date of Permit Application: I hereby certify,that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name The Cont»tonll,calth of Afassachusettt ",ai Departnrc•»t of ludrrstrial Accidents l �. officeof/nvesV9171/ons •�\_;"' :r �'` h(lU 1Vu.vhhi,tott Street Bostotr. Ma.u. (12111 Workers' Compensation Insurance Affidavit li :in f'rtn i�ri• - _.. PI- P I - .....�._.....--_.a,.._... ....._. ----_- -- - m • / locat n• �to —� -0 If ¢ell 9/ I am a homeojlner performin 11 work myself. 1 am a sole proprietor and have no one working_ in any capacity [� I am an emplover providing workers' compensation for my employees working on this job. contn:tnv name: idd ress- city: phone f!• . insurance co. nolicv# [I 1 am a sole proprietor. general contractor, or homeowner(circle orre) and have hired the contractors listed below who have the following workers' compensation polices: comnariv name: add ress: phone#: insurance co. nnlicv# companv name: address- ' rip phone#• insurance co. policy# .Attach additional sheet if necessarya..�" °F�•'--•+ --��"" __"`•%•% " `'•^.',�^„�.• =+^ •^'-"::= '--' -- --_-.. . ..__�. ..---- :yie•� ..w.;.�:n. F:iiiurc to secure coverage:-is required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of alline up to 51.500.00 andior one years* imprisonment as well as civil penalties in the form of a STOP u•ORK ORDER and a fine of S100.00 a day against me. I understand that a Cop).of this statentcnt may be forwarded to ttte Once of Investigations of the DIA for coverage verification. 1 do herebt•certift•under tb pains and penalties er un•Mar the information provided above is true and correct. Signature Date ✓ oZ Print name Phone lTiciai use only do not write in this area to be completed by city or town official -� city or town: permit/license# rlBuilding Department CLicensing Board rl check if immediate response is required C)Seicctmen's Office f C311calth Department contact person: phone#: rj0Iher t information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers•.co�mp 115.1tion for the employees. As quoted from the -law". an empluree is defined as every person in the service of-another under any contract of hire, express or implied. oral or written. t � An eynplt rer is defined as an individual. partnership, association, corporation or other legal entity•, or any two or mo: the foregoingenLa�_ed in a joint enterprise, and including the legal representatives of a deceased emplover, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. Howeye:-tl- owner of a dwelling house haying not more than three apartments and who resides therein, or the occupant of the dw cl line house of mother who employs persons to do maintenance , construction or repair work on such dwelling he or on tite _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employc MGL chapter 152 section 25 also states that even- state or local licensing agency shall .withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonvealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers* compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cite 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 require, to obtain a workers' compensation police. please call the Department at the number listed below. Citv or,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. PIe be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Inyesti=atioils would like to thank you in advance for you cooperation and should you have any questio 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 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 - • TOWN OF BARNSTABLE .. BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION Number Street address S46tion of town "HOMEOWNER" 95?a 0// -9 S e Home phone Vqvk phone - - PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occsci=_ dwellings of six units or less and to allow such homeowners to engage an in- diviJu'al for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re side, on which there is, or is intended to be, a one 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 Offic on a form acceptable to the Building Official, that he/she shall be resuonsi_ for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the S: Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of arnstable Building Department minimum inspection procedures and requirements nd that he/she will comply with said cedures and requirements. OMEOWNER'S SIGNATURE IPPROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be required 0 comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a persons) for hire to do such work, that such Home OwnE shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction' Supervisors, Section 2. 15) . This lack of awarene ioften results in serious problems, particularly when the Home Owner hires ' unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Rome "dwner.' act _ as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma: communities require, as part of the permit application, that the Home Owner certify that he/she understands the. responsibilities of a supervisor. On th; last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. E