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HomeMy WebLinkAbout0042 SILVER LANE =L dp.,e., L.�it/� _.__ � _ _ �THME Town of Barnstable sPermitm,6-17- w Ex�t�res 6 months from issue date �.� Building Department Fee 35. —_ „ST,,8 Brian Florence, CB 9cbA 163 ,0� Building Commission@r rFv met s 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ®V 2 0 t Office: 508-862-4038 V Fax: 508-790-6230 TO141A+ ; EXPRESS PERNUT APPLICATION - RESIDENT Y Not Valid without Red X-Press Imprint Map/parcel Number c> Property Address 41�7plesidential Value of Work$ Imo© � � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address D Contractor's Name Telephone Number 7 Home Improvement Contractor License#(if applicable) I S 3 1 Email: lic-T2.O,¢ ZC�iZ �tiL4�'� IV C Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: V—I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name —� _ Workman's Comp.Policy#l"r— L -goal l C7 3,)—I j ® � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 4� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.h)#of windows #of doors: *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 o the Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: QAWPFILESTORMSTMESS2017 The Coma-romvealtli of Massad rusetts DV artrrrent afIndustrialAccrderrts - l3ffl-ce of1m*wdgations ' 600 Washikigton&—eet. Bastvn,MA 02111 111mv.viassgovIdia "W'arkers' Campensation Insurance Affidavit:BnilderslC,antra:ctnrsMecbricianslPhumbers Applicant Infarmatean Please Print l �'bly Nw=(���aa�atign aly C i Addresr Z(/ 1,141, ,o� City/Sta,&ZZ : Phone 4' !% ' d- 2 'q'2 Are you au employer?Clio the appropriate bow: ' Type of project(required)- 1.❑ I am a employes.with 4. ❑I am a general contractor and I 6. [:]New construction employees(fall an&oc part-time).* have hked the sib-coat[a dots 7 I am a sale proprietor arpaitner- Mded oa the attached sheet 7•:❑RemodeHng �lup and have no.employees. These sob-contractors have $ E]Demolition woriziag for me in any capacity- employees and have wo&ers' y. ❑RAdmg addition [No wodmm° comp-i asurzt,ce Comp.rnsura MI reV. ed] 5- ❑ IWe area corporation anal its 1 ❑Electrical repairs or a d ions 3-❑ I am,a homeommer doing all work officers have exercised fireir IL_ ❑Plumbingrepairs or additiam mywZ a�wtoikus'r'dmF- 1 Roof r right of emmpfion per MGL ep� �iamn=e eq &]i c-152,§1(4�andwehaveno employees nce[No wodn�esf'�r� 13.❑Other comp-iasma r�iired-] r ;Any ap Ukznt&atcbed3boxrl— alsoffiouttbLesEdanbeLoAshu%idnfdmk vroakeWcOIDPpn5atiII peHcyk5xnizII04. Hamemwna s wbo submit dbfs xEM2i*f&catiag tb-Y are damp aU woat and dies hire autsi&conftactprs,rm submit a new of flat indientino sucb- fCb=&d=iffk t-rb-,Jtthisb=rgustattachedasaddirionalsheerdwwingthenameofdmsub-contsctm:sandstadewhetimornotfianseeatitiesbave empbyees.Ifthesab-c t ctmshareempleyee,dfiey=stpravidethekworke ca=p.pG1kynumbez I am art ertrpI�yx�r f7irrtispratfdir�ydaorkers'corr�eresrrttrrre irrsrirarrrs for ary*entpIvy�ees Betoav is the pnticy ar�ri faFa sde arrformatiam Insurance Company Nam: -Policy,4,'ar Self-ir&Lic-, 1 L l -q.)-C/C 3A-Expim&nDale: Job Yee Address , l�c -`► City/Statetzip: -�empiratbion Attach a copy ofthe wort-erscosapensatioupolicyded2ration page(showing the policy number te). Failure to secure coverage as required under Section 25A of MGL a 15,can lead to the imposition of criminal penalties of a fine up to$1500.0U andror me pearimp fimunenk as we11 as civil penalties in the farm of a STOP WORK�ORDERand a free of up to$250-00 a clay against the violator- Be adtnsed that a copy of this statement maybe f warded fn the flffce�of Investigations of the DIA for insure coverage mrificatiosL I do hereby cep,f r witzler theprtins and penaWks o fpsr,ju.1?'thatthe formidcvrrpnadi(w abmw rs hP and rrect Si�ainre: Dare � �l Phone ik 01 '1•3.7%5,�' OfOkial use 0711. Do irat wrfte in this area,€rt be win pieted by da2p artawn atj`icrat City or Town: Permiff tense g Issuing Authority(ch-cle one): 1.Board of Elealth 2.BuffTing Department 3.CityMown Clerk 4.Electrical hmpector S.Plumibiirg Inspector b.Other Contact Person: Phone#: ormation and Instructions Massacbnse#ts Geheaal Laws chapter 152 regn=all employers to provide Wcak='compensation for their employees. P tD this statnfe,as mvp&y=is defined as-6.every person in the service of another under airy contract of hfi-e, express or implied,oral or wr>tina." An eTT.vyer is defined as"an individual,parfneasb�,assocgiw corporaion or other legal entity,or any two or more of the foregoing engaged in a joint and including the legal representafives of a deceased employer,or the receives or tract=-of an indiyidnal,partaeship,association or other legal entity:employing employees_ However the owner of a dwelling house having not more;than three spar meats andwwho resides therein,or the occupant of the - dwveIli ag house of anoihter who employs persons to do maw ce,c;+*��ct►on or reps r work on such dwelling house or on the grounds or building aPPurt=m±1h=to shaRnotbecanse of sarh employmentbe deemedto be an employer." -MGL chapter 152,§25C(6)also sues that revery state or local licensing agency shale withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commoawenith for any. applicant-who has not produced acceptable evidence of complranre with the bsurance.coverage required:" Additionally,M(H-ahapt�x 152,§25CC7)states'Neither the co=anwealth nor iay ofits political subdivisions shall enter into any contract for the pmfoun anoe ofpablic work m3ff acceptable evidence of complies ce with the;n s.,7a„der. re UiL eats of this d aptea'.have been preseo:ded to the con:trar�a a3hoiity-" Applican ts- Phase fill out the wonders'compensation affidavit completely;by checking&e boxes that apply to your siination and,if necessary,supply sub-contractor(s)nam e(s), addresses)and phone-m— er(s) along with their certificates) of h=mlce. Limited Liability Companies(I.LC)or Lunt Liabl7ity Parfnetships(LIP)withno employees Other than the members or partners,are not required to cauy wormers'compensation msarmce. If an LLC or LLP does have employees,a policy is requited. B e advised that this a$dayif maybe snbmitb�;d to the Department of Industrial Accidents for contnmafon of insurance coverage Also be sure to sign and rat e6m affidavit. The affidavit should beretamed to 1he city or town that the application for the pewit or license is being requested,not the Department of Ti,dastrial Accidents. Shouldyon have any questions regarding the law or ifyon are required to obtain a workers' compensation policy,please call the Department at the rmmb er listed below. Self-fimut d companies should enter their self-insurance licaose number on the appropriate Ime. City or Town Officials T _ Please be stye that the,affidavit is complete and prirded legibly. The Department has provided a space at the bottom of the aff idavit for you to fill out in the event the Office ofInvestigations has to conf-act you regmdmg the applicant Please be stun to fill is the pennh/liccme n nber which will be used as a refer e:nce number In addition, applicant {fiat mast submit m_ultiple petmWlicense spplit:ations in any given year,need only submit one affidavit indicating cmxeut olicy fi fu ation.(if nece�y)and—(i "Job She Address"the applicant should write"all locatives in (may or p town)-"A copy of the•affidavit that has been officially s maped or marked by the city or tovin maybe provided fa the applicant as proof that a valid affidavit is on file for fbfm "pezml s.or licenses. A new affidavit-must be fiIled Olt each year.Where a home owner or citizen is obtaining a license or penmit not related fQ any business or commercial-Vmtzc (ie_ a dog license or permit to bum leaves etc-)said person is NOT rcqoired to complete this affidavit The Of 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: Thu Carman *ofMassach - ' Deparfinent of Indust l Accidents Office of Xavegugatzo-= 60a-Waaffiom stmd B 0�111 Tf,-I.4 617 727-4 oxt 4-€6 Qr I-a77 MA MAC Rf,-vised 4--24-07 , gQ1T�c� oFIME T�s. Town of.Barnstable Building Department MASS.v Brian Florence,CBO `bATE1 9. ate` Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 568-790-6230 Property.Owner Mush ,Complete,and Sign This Section If Using A Builder I y ' 9&4 as Owner of the subject property hereby authorize r to act on my behalf, in all mattexs relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms 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. SignatKe of Owner Si tore of Applicant CA�� Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:10/17 I x v vv u vi "ai ua is lviv,�pFTHE Tpk� Building Department o� Brian Florence CBO �( STAB Building Commissioner v MASS. $ 200 Main Street, Hyannis,MA 02601 s6;9• ♦0 'OTFo nN►y" 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: r, 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 Hermit. (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 understands the responsibilities of a Supervisor. On the 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. C�/ie �nnza�aauea�C�a 4 a Quice ofCc:�sumer Aifxia&business ReecRta;:'' H0 1E if,7?P^'�-P4Ei,.T CC)NTRACTO�+ - =gi5trat°on Ty Corporation rJeTore the exp- --� nr individua(u \ iMra iOn gNpi_ L ion CiIce of Co Se only 01/07/2010 nsu• �1afe. !f fOund return to _ 7'J Farlc?t rnrr 5�7pS and 6 gulat,en aza FSue usirie§s Re C E�,EMODEI 1t`� 3osto�,MA 6} 1]u { r: , I �JeiroaV - Carl Os'-9 U •20 Cap&,r,,Note S. mpipth,PIA 3? G Unat dersecr�'� adld fvath�r� chu5etts Commonwealth ai Massa sure is d Standards of Professional L Division RegufationsNsor Boar of Building / B° Const`,4-t,o[N jj s.p812512019 CS-1p4107 s UEIRDa CPA PTAfN R► ppYEs Rf2q • SpCU HYARMCU�VUIS5�30-� Commissioner g>aPeN%Soul?V ff Ch eofi°5 d co^4t3ct% % js CJTmetels)of v` aUt\d.%119 et�y91 co e 55`tvl 35 000 C�brc space e Massac..setts \U en e o1 to of tbls t eamo�°canon e S a Cotre lot<e thgSv%cenS ovldpt. to P°SSe S Is ca on ab°' mass.9 State o tB��,dioE ��for32 °r Cat,lg1'11�27- BUILDER INFORMATION LALL �4,Ab - - -'� �- -—�- Telephone Number 77 � Y7 �`Z i 1��+- License# Home Improvement Contractor# Worker's Compensation# STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TORE DATE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 515 Permit# Health Division Date Issued Conservation Division �• ID-1Application Fee Sr0"T'/A � Tax Collector _ d ` Permit Fee Treasurer " Planning Dept. Date Definitive Plan Approved by Planning Board A Historic-OKH Preservation/Hyannis ,y„��(Y► Project Street Address Village Owner Pit,%1\v R VA e-0 Address !GA114 Telephone Permit Request jMoq mt { je. ssJ� �c� fiu u. 1, rutn�+� 0� to Rok LnL 6 LOVV14Ak, w ti Ato Square feet: 1st floor: existing lOb 5� proposed ` 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation `�� Construction Type ti*\ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family GV Two Family ❑ Multi-Family(#units) Age of Existing Structure l�l�� , Historic House: ❑Yes )IkNo On Old King's Highway: ❑Yes ❑No Basement Type: It Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing qr� k new Half:existing new Number of Bedrooms: existing new 0 Total Room Count(not including baths):existing new First Floor Room Count CD r a Cy Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other rn Central Air: ❑Yes i/No Fireplaces: Existing New Existing wood/coal stove: L Yes No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exiting ❑new size' Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: — —; o r— Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ — Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �� / Y�l: ��°s bj&tl Telephone Number Sdcc),- 39/0 Address License# CGS 1`j 3 7 2471 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE . DATE FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEL NO.'r ADDRESS VILLAGE OWNER DATE OF INSPECTION:' j FOUNDATION FRAME 16,A INSULATION _,(�irvS v o/ y,/® G°,�C ✓h r FIREPLACE ELECTRICAL: ROUGH FINAL ~` PLUMBING: ROUGH FINAL GAS: ROUGH t FINAL - FINAL BUILDING �� v DATE CLOSED OUT _ • i . ASSOCIATION PLAN NO. 1 � � °FZHE 1p�, Town of Barnstable ti °-^ Regulatory Services snxxsTasLE, " Thomas F.Geiler.Director 3:te.`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,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: A&� /.,i, Estimated Cost `! Address of Work: 1'Lt-�, L Owner's Name: ®Cie Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 . ❑ ilding 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 1/1, AZ cb Dat Owner's Name Q:forms lomeaffidav Y k Ply N.a/• WEST j f� e •►'.r..+rSTgEFT .,.,,�,GYPPpIPPf1OM; L7 / r~ t Harr t `�• a . It - l/py, /auam�ss w granw..w \•• . • ice' w•�.•- L.C I22QLT N Y� irr A r.a.i •TOI+ � -✓ _ AUCTMN COwPa• ar .� � � /f aM r ��LL/,Yf Goa1/M GOM•� fY atwat - NT 9 i LJ SE/V•S POND ^ ' /{oars, ♦• _ '�• "'' •i _ r I •� y �• � //21 \ � q�P�•v � w = MA7 a< PrYlw wrfrrr�ratt.r - pg /e/ar qua.. •` ,� ait aat<n 99 'Z , z i rpn•nrY"� i _ p PLAN OF LAND /N MVANMp BARNBTABLE P" E.P.C. TRUST �� �.'..� .•�...�•:��.. .rirfr trr►t:N.7 fq/1fI t \* -A'�►/N- CMARLId SwveR�-/.vC siora "'` .s•.>•• f.�e'.r..a.w Cw/o/wwpa•/ 9 sa�_ PYM.v.V/, �... .• �oei y°'Qwr.t-Y3 erOP 113 Y'.�n 6 S L CA O RO.RERTY LIN M Y N-OT BE ACCURA E STANDARDLEGEND NOTE:not all symbols will appear on a map 2 ..MAP 8 GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES r EDGE OF BRUSH # 3 --*- � ORCHARD OR NURSERY EDGE OF CONIFEROUS TREES MARSH AREA /• / -. • . --- EDGE OF WATER DIRT ROAD J DRIVEWAY PARKING LOT PL�PAVED ROAD DRAINAGE DITCH M ————— PATH/TRAIL PARCEL LINE 2we 1 E MAP# 5 HOUSE NUMBER 21 PARCEL NUMBER MAP #teas F 2 FOOT CONTOUR LINE 4# 1 f —ice— 10 FOOT CONTOUR LINE Elevation based on NGVD29 4 5 ;;4.9 SPOT ELEVATION STONE WALL \� ,_...._..._...._.... -X—X— FENCE J9 RETAINING WALL —1—t—I— RAIL ROAD TRACK _-- STONE JETTY MAP268 woo .. SWIMMING POOL _-? PORCH/DECK 15 ❑ BUILDING STRUCTURE �_ A= DOCK/PIER HYDRANT e VALVE O MANHOLE o POST p'P FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T .o SIGN ® STORM DRAIN M PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetarian were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE TOWER " e 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards UGHT POLE O ELECTRIC BOX s 1 INCH=40 FEET* enlarged style. on the map. at o scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessors tax maps. The Commonwealth of Massachusetts z Department of Industrial Accidents M0lfice o1/nYe5t/g0t/1717s 600 Washington Street -== Boston,Mass. 02111 Workers' Compensation Insurance Affidavit location �;� 0 il'E >1 _ V hone# � I am a how owner performing all work myself. I am a sole r rietor and have no one worldn in ca achy / / %O//G�%%/%%%%%%%%%%/%//%%%%/�O%%/G�%/G/%%/%////////%%//%/ workers' co ensation far my emplogees working on this job. •din ............ ..... .. ... ............... mployer rove mp inant an :.:.::.:..:.::....::....,..>:.>::>;>}}•}::.}:. '?{KJ : ...:....:........ hn alistian ❑ I am a sole proprietor,general contractor,or homeowner(circle on acid have hired the contractors listed below who have workers cow ens the following .....................::::::::::: p.lices: :.::.�:..... .._:::::::::::........:..�::::::::::........::.:�:::::::.:.'............::.:::.::::::::.:.::......::::.�:::::.:........::.:::::.::::.:..:.:::::::::..�:.. :...... .::.: :tom »< > ;i;?; .i ? :i#:;ii<i;iari:;;i; ici;t::;:::;v::;::a:;:;:; :;::i:;;'a:i:::i<;:i;:;;<::;:;}a:;};:.;:;::::;:::}}>::a?;;•}}}:}}:a?:.::::..:`2:.:.�•...:`�: 5.... :» y h.. `�'`ririe :tl t.Lt•`'���%v i ,.n.•..r.ia :.. ..:....• .•:..:•:::::vi:J::::}:w::•}::}:vv:v:}:}:4:i}:v}::•::v:i:bi}:.$::::!•:i:::?::.}}:•}}liii:}..<}.;..;p::::?•::v?i`}:ini.,.;:?..; 0 :.flint 4:<O. .. r............... ....r................................. :..�:: :ail :;:}^:y;;ii:;:;:ii:^''::::?i?:;:;:;i:j�{::i:;!L;(y;;`f;:;'f,.;i:>,.';:t.:„r'iiii:'v<^:tY:�:titi::iii:;:j'::4:<hv:iii:'}:?i ii:t}::•}:iii:i:i"� r';:;}):?;i:••i'•tii:•}'Y:v;:-!}�}::ii'-':ti:,:�.•..v:::v}ti..:.,::.:...:•::.•:::•::::::::•::::.:::,:;•:::::�..:::::. .:.. arts ..........:.�.:::::::::::.�:::::;::::....:::r.�:::::?.}•:?:.);.):?.}•::::.;r:.:.:.:,•:::::r:::.::.:::.:::•:::�:.:..::::.:::.....:.:::...:.•,..t ::.::::r.....::: t'• ::;::;;�::�:$::�:;;Si}i:;•;:�ii:•i:;:i::•i istaiiiii::!i:tY;;:::.:o):.}}))}:•)>}::.:.::. ::.�:::..::........ tttt•; •i:U: .. .n.w;..v.. ........?•:i}}.;•:...........................gin:.:::.:. }::::::x:.,}}:??•)}:•:));+:}}::?::::: 4}}}${:j?ii'•):ni)iii}:'Oi):•)iii'l.4:•i)}i}}:?:.;:r .............. :::......... .....n....... ............... .:::.i:::::::•:.�.�::.�:::.::tv.:t::::.::::.}'nt'•}::-::•{v:}ii:':•ii:�i:'•''' ................uv.�.:.!.i:... :::::::::.:::•}:?•::::::::.•}:•ii:!4:•i:::::.'.v::!t!}i::w::::.�:::::n::n...•;,......::•:::n:::•.............................. ::�.isi::}::::}}.!;i:•i:j^:•ii:it;):)::%:t;.}:i::!.;:.�.;::::,it:::::::::::::::::.::..:...........:.::.......... w.tin:•.:.:::::::::::t•}:?•?•ii:v:•};•i:t':)isty:i:::tC'::::?P:•i}I•iy::i:•:!t;:;ii::;i•}:•i }}:!t?:}:ii•:�}:•i::v:?J}'.::•::::.y: xxx Oli TIl11TAIZCPr:COtr:.>:"i;�;::?};::;:;;,::;:.::>:;:.}};::;:::,.:.�:;.;.,:,;:.::...:,.....:, . Failure to secure coverage as req�red wider Section ZSA o[MGL 152 can lead to the imposition of crhninal penalties of a Sne nP to 51,500.00 and/or one yam,+imprisonment a,wen as civil penalties in the form of a STOP WORK ORDER and a Ste of$100.00 a day agstnst me. I understmd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is trua and eorred Signature Q?fri.E�9 V' aE I.-I 0 Date 9�1f7�©� Phone# Sty!/' 7��'��� Print ` official use only do not write in this area to be completed by city or town official perroitilicense# ❑Buffding Department city or town: ❑Licensing Board ❑Selectrrren'a Office ❑checkif immediate response is required ❑Health Department contact person: phone#; - []Other Uevued 9/95 PJA) Information and Instructions es all employers to provide workers' compensation for their er 152 section 25 re General Laws chat q� Massachusetts Ge P employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance 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 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for yo u to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please- be sure to fill in the pe'"rmit/license number which will be used as a reference number. The affidavits may be reiu�to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 ,w f 1 Vi�YV ? Cb a en ecti .1 .. a MEWING";State` ° wn The Massachusetts State Building Code(780 CAM) includes provisions to ensure that houses and house additions meet energy efficiency standards. .This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall,seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR, Appendix J, Section J1.1.23.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size,figuration,orientation,form of construction or percent glazing,but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/mstallation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a"sunroom".It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential--energy consumption and/or house f the company or individuals to be hired discomfort issues. In addition, the qualifications and reputation o p y . are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain e Frame materials • Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods:Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.23.1, requires that the actual yrooyerty owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. A `� Signaloe of Actual Building Owner Date Print Name Address of Permitted Project Owner Address(if different than project location) Owner's telephone number The 'Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 9MOOT JOB LOCATION: 1/Z number // street village "HOMEOWNER': ftY1,r,6 k/L® '291 7 V/ name home phone# work phone# CURRENT MAIIJNG 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. Sipav 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 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:EXEMPTN s J � P. e � oak � VI) T I E PAGE 11 FERENCE ween 112/01/2001, and 111/19/2002' LOT/BLOCK DBA EXPIRED- i A-6 49 2950 20 96 PARC 1& 17 D 14 �D 14 r 20 LC37 3 23 & 24 54 LC22 63 119 33 132 E 6A ( 39& UNN TOWN. OF BARNSTABLE I ...:�:.. BUILDIz a' PERMIT t. PA.RCED ID 268 155 GEOBASR ID 17163 ADDR�''-3 42- SILVER LANE PHONE - HYA,NN I S..... . LOT 19 BLOCK LOT SIZE DB= DEU%��LOPMENT DISTRICT HY pi..RMIT . 63755 DESCRIPTION CLOSE IN ALCOVE py,RMIT TYPE BREMOD TITLE RESIDENTIAL ALT/CONY C.)NTRACTORS: PROPERTY OWNER Department Of J. ,ARCHITECTS: Regulatory Services T4TAL' FEES: $75..00 F BOND $.0t3 , CONSTRUCTION-;COSTS $8,000.00 , Q, 43; .-RESID ADD/ALT/CONY 1 PRIVATE s6g9. . BUIUDING D ISI N BY ---• +� DATE ISSUED 09/13/2002 EXPIRATION DATE v THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS.ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED i FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE I t.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- 2.PRIOR TO COVERING STRUCTURAL MEMBERS ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTI APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 6 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2u BOARD OF HEALTH - OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON.THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA TION. NOTED ABOVE. TION.