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Home My WebLink About0147 SPRING STREET `1 rl S�P�nc� S-}Y�¢T �J -- 1 FIE Application number ............... Fee........................................ ...... .................... • BARN,%UABLE. ga MA.1;6 p. luilding Inspectors Initials.. . ........&nQPA t639. UAR 22 20 19 To14/hl OF tl� Date Issued.... .4..1...........�;.................. HAMM�EMap/Parcel.... 0. .......-(......... 6s........................... ... TON" OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/\VEATHERIZATION PROPERTY INFORMATION Address of Project: "Si— NUMBER STREET VILLAGE Owner's Name: aa-x f- Phone Number Email Address: PUR-koo, car^-. Cell Phone Number Project cost VO-,CDCD Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize A (,0,,\8P to make application for a building permit in accordance with 780 CMR Owner Signature: Date: L1126Z12 t TYPE OF WORK Siding Windows (no header change)# Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 11 layer of shingles) Construction Debris will be going toy CONTRACTOR'S INFORMATION Contractor's name C 0 Home Improvement Contractors Registration(if applicable) # (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor-F—,rac 4Goviv,-e -Cx-tdh-I 1 0 Kr P4,M1,111,co i Phone number,42)SI 6 ALL PROPERTIES THAT HAVE STRUCTURES MR 79 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. f APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X , X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signatur Date a All permit applications are subject to a building official's approval prior to issuance. 1 he commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street w=: Boston,MA 02111 h •` www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Q Please Print Legibly Name(Business/Organization/Individual): ;c_ A ro v A-e_ Address: ( Y,g n eA- 1Zs� City/State/Zip: @.CL�, p aG 7 3 Phone#: _c�6`6 T5___5_Y Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2, I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. We are a corporation and its 10. Electrical repairs or additions 3: 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 1 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. Other 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 a new affidavit indicating such. #Contractors 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: 6 A t'c C W( +e r Policy#or Self-ins.Lic.#: INC V 01 I'f '7 GCAS Expiration Date:Sn 1-20 Job Site Address: 1`/7 _f;i-- City/State/Zip: 171'ywVA,11' vaG 0/ 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 and penalties of perjury that the information provided above is true and correct Signature: /� Date: /44, C5-0, go Phone#: Official use only. Do not write in this area,to be completed by city or town official 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#: c: Cornmanweal#h:of Massachusetts Division of Professional Licensure Board of Building.Regmtations and Standards Const�rrvisor CS-os66s4 `s ices: 10109f2019 4 ' ERIC J ARONNE C 14 CYGNET ROAD ; WEST YARMOWN MA OW3 Commissioner — " a _ I ....._�____.�.�._ • � . U/LB �D¢97L77Z¢9ZCI16CZLffL fl�<?��G[ld3fl F. Office of Consumer Affairs&Business Regulation; HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Ind viduai before the expiration date. If found return to: Reajstration Expiration Office of Consumer Affairs and Business Regulation 091/13f2019 .10 Park Plaza-Suite 5170 ERIC ARONNE' Boston;MA 02116 ` ERIC J.ARONNE' F 14 CYGNET RD W YARMOU i H,tvlA 02673 E- Not valid without signature Undersecretary i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.. Map v Parcel Application # 2�0'/� �r� Health Division V "Date Issueda(69 Conservation Division Application Fee Planning;Dept: `Permit Fee` o Date Definitive Plan Approved by Planning Board Historic - OKH = Preservation/ Hyannis F Project Street Address '1 p c a Village n S Owner c m o.0 Address I y P � S''{ Telepi one l `83 a PermiRRequest t3 , ` o e-n ti;-t Squargfeet"�1 st floor`eAstingproposed 2'nd floor: existing proposed - Total new Zoning District Flood Plain Groundwater Overlay J Project Valuation 1 0 0 Construction Type w .o' vv\ cQ _ Lot Size , Lf � ,S!, �-�- Grandfathere'd: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family : Two Family ❑ Multi-Family(# units) Age of Existing Structure 6 Historic House: ❑Yes No On Old King's Highway: ❑Yes �No t Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other �1 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 1 `Z Number of Baths: Full: existing 1 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 0 Other i 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:Aexisting ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No if yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number SSQ 8 Address Licensed# C S S't D 0 o s-0 4� f Home,Improvement Contractor# -2 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM,THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 S FOR OFFICIAL USE ONLY APPLICATION# ,j DATE ISSUED MAP/PARCEL NO. a ADDRESS VILLAGE y .rS OWNER I DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE I ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r - I DATE CLOSED OUT 'I ASSOCIATION PLAN NO. f ,per The Cotntnonwealth of 11fassachusetts \ Departtnent ofXndustrialAccidents (Q Office of Investigations' 600 Washington Street Boston) MA 02111 wwtiV.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/lndividual): Address: Q City/State/Zip: bo2U. Phone ID I l Are you an employer? Check the appropriate box: Type of project(required): 1.❑ i am a employer with 4. ❑ 1 am a general contractor and 1 6 0 New construction employees(full and/or part-.6in.e).* have hired the sub-contractors listed on the'attached sheet. T.KRcmodeling am a•soleprpprietor or'partr]er These sub-contractors have Demolition ship and have no employees - S. �.[] employees and have workers' working for me in any capacity. 9. ❑Building a ddition [No worker's': 's'•eo insurance comp. tnsurance. . 5, [] We are a corporation and required.) 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.[]Roof repairs insurance required.] t c, 152, §1(4), and we,have no employees. [No workers' ` 1311Other comp: insurance required:] *Any applicant•that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homcowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors.must submit a ncwaffidavit indicating such. 1Conlractors that check this box must attached an additional shcefshowing 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: lam an employer tliat 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). f MGL c, 152 can lead to the imposition of criminal penalties of a Failure to'sccure coverage as required under Section 25A o fine tip to 31,500.00 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 n er the pains and penalties of perjury that the information provided above is true and correct l _ v Si atiue: Dater — Phone Offccial use only. Do not write in this area, tb be completed by city.or town offcciaL City Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town CIerk 4.Electrical Inspector S.Plumbing Inspector 6. Other . information and 1.n* ftucti®ns 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 tiustee 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 not any of its political subdivisions shall . enter into any contract for.the performance of public work until,acceptable evidence of compiiance ith 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-coneactor(s)name(s),�address(es)and.phone numbers) along with their certificates)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 aunr ber 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 investigations has to contact you regarding the applicant. of the affidavit for you to fill out in the event the Office of g Please be sure to fill in the peirnuttlicense 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 under"Job Site Address" the applicant should write"all locations in (city or policy information(if necessary) and 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 fo any business or commercial venture (i.e. a dog license or permit to brim 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 lndustrial Accidents Office of Investigatla-Us. 600 Washington Street Boston, MA 02111 TeI. #617-727-490.0 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dill Town of.Barnstable Regulatory Services BARNSTABLE, Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder LLL Q X DAU0 VICD"11W, 5 .� C , as Owner of the subject property hereby authorize �� D to act on my behalf, in all matters relative to work authorized bythis building pernut application for; `-1 S (Addr3ss of J b) .. 0 Signature of Owner Date Print Name If Property Owner is applying for permit please complete the . 'Homeowners License Exemption Form on the reverse.side. Town of Barnstable Regulatory Services Thomas F. Geiler,Director IARNSTABLE, K"-1a Building Division AIfD a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.tovyn.barustable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION m e� Please Print DATE: YS JOB LOCATION: P �^S S r l t 1 Q \ 5 number street I village "HOMEOWNER": M L 5.+n b 0 S. VC-V �r—i ` work phone# name home phon e# �—t c M CURRENT MAILING ADDRESS: y ( " I S 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 Persons)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 1 o9.1.1-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&Reg-ulations 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. 0:\WPFILES\I-ORMS\homecxempt.DOC t � C # � 1 .r D � Y• - j { ►.a� S I y, t r l i. I f - Ar 1 A rb l/ � r r'�' i ate I 'I q } t �,�• �- 1 � - � � a � 1 ...� i ' .. \. '. F � - . . Y ',_C _. �R �• - ' f 4 License or registration valid for i ndividul use only tioa expiration date. If found return o: I ' ... ssRegulation riTt 'ir� before the exp _ ROVEMENT CONTRA office of Consumer Affairs and Bus ine CTOR HOME IMP 10 Park Plaza .Suite 5170 Registration: 128708 T 286217 Boston,MA 02116 Expiration N51912011 Type0dividu ;. Ntr 33 BO JEFFREY T ^ OKt i .--_ 1, JEFFREY BQOKER ri J _ signature g i 85 GRANITE ST J t valid without sign I l\ '' �/ Undersecretary FOXBORO,.MA,0203 l Massachw5ctfs Department qt Puhlt� S ifetN i Boitrtl of Bwlding Regulations and:StandxrtJs. t ucfio:,Supervisor L'iccnse. Cons r 4n -Lice se:: CS 51800 Restricted to _00 JEFFREY T -BOOKERX :...85'GRANITE'ST r, FOXBORO,-MA 02-b5 , . !—`jam 'Expi[atign: `6/18/201.0 t (ummititionit. .Tr#:..7346,