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HomeMy WebLinkAbout0100 STRAIGHTWAY --- - - - - � i I- �� �� �� �pF THE rp Town of Barnstable *Permit# y%3/ ~per Expires 6 months from issue date + BARNSTABLE, + Regulatory Services - Fee 17 9� 6 9' e� Thomas F. Geiler,Director A 3 • a� tED MA+ Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 - Fax: 508-790-6230 OCT 9 2002 EXPRESS PERNUT APPLICATION - RESIDENTIA �QNI, E B�R����ELE Not Valid without Red X-Press Imprint Map/parcel Number cM 1 b Property Address 6 LL. 4-n Z 5 EI Residential Value of Work 432-co,Qo Owner's Name&Address I M-1 ALY fCz of Contractor's Name co yk ru Xoo Telephone Number_(9?)Y 2 b—j Y�a 2 Home Improvement Contractor License#(if applicable) 3 2 3 Construction Supervisor's License#(if applicable) 0,-7 8�7 ❑Workman's Compensation Insurance Check one: M I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance .Insurance Company Name Trzwe 12r s, Workman's Comp.Policy# Permit Request(check box) QQ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roofl ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 �?` ..i�e `tna?aanuvrzcuea�t'l ¢��L'�cc„Nz,��ctSe�l3 BOARD OF BUILDING RIrGULATIONS License: CONSTRUCTION SUPERVISOR Number:,CS 078496 Birthdate. 08/24/1965 I .. Expires:08/24/2004 Tr.no: 78496 Restricted To:, 00 JEFFREY L LAUZON _ 34 OLD FIELDS RD + $ANDWICH, MA 02563 Administrator ' ✓die a,�.,�eo�tLe�lU �� �ll�zas2c/cuse�i =t�. " Board of Building Regulations and Standards r HOME IMPROVEMENT CONTRACTOR ``may Registration: 132838 Expiration: 04/09/2003 Type: DBA CR CONSTRUCTION JEFFREY LAUZON 34.OLD FIELDS RD. _� i TOWN'OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel /( D Permit# 1390 S Health Division = Date Issued Conservation Division Fee ' G )Q e/`fax Coll V , /4 ,_�freasu Planning Dept. Date Definitive Plan Approved by Planning Board t Historic-OKH Preservation/Hyannis Project Street Address /ee Village di✓/VJ ;t Owner 4=_InX - / LL Address Id© 1 G/fir WA i/ Telephone '_S"e4- -7 2— ' je Permit Request p L ei n / Cr f/` dVi ti n n WJ , -�� Square feet: 1 st floor: existing proposed '2nd floor:existing proposed Total new Estimated Project Cost ® Zoning District Flood Plain Groundwater Overlay Construction Type - Lot Size Grandfathered: ❑Yes ❑No- If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) I Age of Existing Structure fE&A? r Historic House: ❑Yes �No On Old King's Highway: ❑Yes No Basement Type: A Full ❑Crawl ❑Walkout ❑Other i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) j Number of Baths: Full:existing ! new. Half: existing new 1 Number of Bedrooms: existing_ new i Total Room Count(not including baths):existing new First Floor Room Count r ,I Heat Type and Fuel: �J Gas ❑Oil ❑Electric ❑Other. Central Air: ❑Yes ❑No Fireplaces: Existing X 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:10 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name 0 Telephone Number 7 7-5-- 3 I Address l o o -S�4 A t CT µ r_ W*N License# ley A-ivny/S fYl U ZG c/ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED = •'r MAP/PARCEL NO. 14 r ADDRESS VILLAGE OWNER DATE OF INSPECTIO0;. - FOUNDATION FRAME _ ".."' � -- � r - - •, . r INSULATION F FIREPLACE '. ELECTRICAL: ROUGH FINAL rr s PLUMBING: ROUGH t FINAL GAS: ROUGH FINAL' : - - FINAL BUILDING' 'DATE CLOSED OUT ASSOCIATION PLAN NO. ' qhhch6. Vinyl Replacement Windows PRrR/OrWelded Vinyl Single Hung Windows • Welded Casement, Bow, and Bay Windows MANUFACTURING, INC. • Insulated Glass So. Egg,Harbor Rd., P.O. Box 498, Hammonton, NJ 08037 ,, • Commercial Residential 609.567.0090-92 FAX:609-567-4177 P A C K I N G L I S T OF-11. DC-11 .z.; SUCKSWORTH ENTERPRISES, INC. BUCKSWORTH ENTERPRISES, INC U ; NYRICKS ST. 63 NYRICKS ST. SOLD 3 T 79 SHIP R T 79 ' BU:C.1..::. TO: T0: 3ERK.EY NA 01779 BERKLEY NA 01i79 1Pper E : 230 17 BldingJLot 1: Route: 13 EASTERN CONK NRGHASE OKDER;NUMBE;Q v. . R.ER I I IBEf? 0 0f,RL TESL N. CAYTON 347616 06J28199 07/12/99 01 J D.H.B. ASSOCIATES OUR TRUCK QtJANTlTYr> .; r?�FV, xi ". ESGAI EM 'RI( ", NIT, TOTAL PP 4u r uaa, 7 19 3J4 z 48 3J4 WHITE 14310 DOUBLE HUNG WINDOW INS251. 3 A03 A09 SERIES 2400 WOOD SIZE Loc: CT46 ,CT7 ,CT12 FULL LOW E 27 3114 z 48 3J4 WHITE 14310 DOUBLE HUNG FULL SCREEN N6271. 3 S03 S0's SERIES 140012400J WOOD SIZE ------ ---------------------- ---------- ---•------------------------------- -------------------------- --------- ------ 1 19 3i4 z 3b 3J4 WHITE 24210 DOUBLE HUNG WINDOW 1,15250. 4 A10 All, SERIES 2400 WOOD SIZE a - - -- ----------- -- - --- ---- --- --- --• r --- -------- ------- 1S 3J4 z 0 0 HUN N6277. 4 SO4 SO4 IES - J240 1 33 314 314 E BLE WIND ki 914150. 5 All A11 SERIES 1400 WOOD SIZE loc: CT7 FULL LOW E 1 33 3J4 x '.3.3fi4 UNITE 28210 DOUBLE HUNG FULL SCREEN N6177. 5 SOS SOS SERIES 240.0/2400J WOOD SIZE 1 11 3J4 z 48 3J4 UNITE 18310 DOUBLE HUNG WINDOW N5150. 6 Al2 A13 SERIES 2400 WOOD SIZE loc: CTH50,CT7 .FULL LOW E -- -- -------------------- -------- --M----------------------------- ------------------------ ------- ------- 1 11 3J4 z 48 314 WHITE 183d0 DOUBLE HUNG FULL. SCREEN A6277. 6 S06 1.06 SERIES 1400/240IJ WOOD SIZE ------'- ---------------------- ---------- ---------------------------------- -------------------------- •-------- -------- •" PAGE 1: 1 CONTINUED DUPLICATE r��TME 4 �'� � Barnstable K"aThe Town of • sestvernsta; • Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME H"ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERAUT 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: ,r 0 L L' 1/✓G /1 W /N bo 11stimated Cost 2_576 o Address of Work: 6i A a 16 14 T WA /-/ ANi✓1 S, Owner's Name: . Date of Application: 9// 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 (DOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME ff"ROVEMENT 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 q:forms:Affidav •°p`+ta' Department of Health Safety and Environmental Services Building Division • 367 Main Street,Hyannis MA 02601NAM • Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSEEBETt MON Please Print JOB LOCATION: /D d .5-?QA> c Yr mla� `�AiV/Yt S numbs t Saar village "HOMEOWNER": 67//'M A 14, 1914 X -4-0 f-7 7S- 3 3 91 `/j''�4 Dame home phone# work phone# CURRENTMAQ.WGADDRESS: 1,06At VTRdalG!�rlti� /town / �smei cW zip Code The current exemption for"hp "was extended to include of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,Mg�dded that the acts as=eer Asor. DEFIIYiTiON OFHOMEOWNER Person(s)who owns a parcel of land on which helshe resides or intends to reside,an which there is,or is intended to be,a one or two-family dwelling,attached or detached structuuras 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 - t>•soonsible for all such Work performed Linder the buildingg e�Secdon 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 regniremeritr and that he/she will comply with said procedures and VP 11 Signore of Homeowner Approvai of Building OtHccial 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 HOMEOWNF.it'SEXEMMON The Code states that 'Any(meow rer performing stile for which a building permit is required Shall W exempt from the provisions of this section(Section 109.1.1-1 Imsmg of won Supavisorsr provided that if the homeowner engages a pasou(s)for bhe to do such walk that such Homeowner shill act as supwisw r Many homeowners who use this enoemI I Im unaware tha dwy ao as g the rapomwitin of a supervisor(sec Appendix Q. Rules A Regulations for I3ocusiog Co muction Supavisom Section 2-13) This ls&of awaeunas often results in serious problems. particularly when the homwwnw hires unlicensed sed persons. In this one,as Board eaumot psocad against the un iceased person at it would with a licensed Supervisor. The homeowner acting as Supervisor is uitinw*mW sibla To ensure that the horawwrta is Mly aware of hislher responsibilities.tawny communities 1 lath .as part of the permit application. that the homeoamer,certify that hd*e 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 formicer0catum for use 10 your eommtnity. The CommonweaUft Oj MaSSaCnuseUS Department of Industrial Accidents Met 011fireSMSMONS 600 Washington Street Boston,Mass. 02111 Workers' Comvensation Insurance Afridavit :111,OWN" name: E M Al R Z-L, �-9 location: JL2 6 7—R,41C-91WI�-q t CitV kly 0 ghone# 3 e I am a homeowner performing a all work myself I am a sole etor and have no one coo in aci ❑ I am an employer providing workers'compensation for my employees working on this job.:::: :::::::::::::::: ............. .............. .............. .......... ........... :;iA ......... ....... ...x. ...... ........... .... . ... . ................ .. ........ .. .................. ..... ....... . " .... .. ......... . .. ................... ................... . .. .. ..... .... ................. ................................... ............................ ....... ............ ............ .... ... --;. .......... ........... .......... . .... ..... . ... ........... ........ ......... ---------------- ...... . ... ...... ...... . . .. ............... .. ............. .......... ..........A ............ .......... ........... ............ insuran Ce, Cl I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'sensation polices: ............................ ...... .... ....... ...... .... ...... .... ........ ........ ................. ........... .... ...... ...... ...... .... ...... ....... .. ................. .................. :.-X ......... ................. .............................. ... ......... ............. ..................... ...... ........ . . ... . . . ............ .. . ...... ...... .......... .... X . ... . .. .............. .... .. . ........ ...... ... .................... ........ .......... ... . .... -xx- ....t►dtite . HX. A.; ....... ........... AM:, ............................. ................... ........ ......... M.. . . . ........ .......... ............. ............ F"VIAMOVIMMA9-------- ........... . MOM. ........... EVAIIII71117 .... .... ------------ ----- ............. .......... ........ ................ ........... ............. al: . . ... .. game! .Oht ........ .................. ...... ......................... ...... ........... ... .......................................... ............................................................... ...... ....................................... ........................................... ................... ............. ......... .................. .......................................... .......................... ... .......... . .......................... ....................;. ... .... ........................V....................... . .. ..... . .. .. . . .. ..................... X................. ............ ........... . . ..... .. ........................ .. ... ........................ . ......................................... ......................................... .. .................................. ....................... ............. ............ .. .. .. .. ... . . . ............ ... . ...... ...... . ....... . .............. ......... ........................... ............ .............. . .......... ....... ....... .. ........ ....... . .. . . ...................................... . . ... . . .... . ... . .. .... .. . ... ....... .. . ................ . ........................... ................................ ....... 11 .... ....... ........ ... . . ....... EMU" ................... N g x Failure to secure coverage as required under Section 25A of MGL 152 csa lead to the impoaitlon of etimloal pmaifles of Otte up to S1,M00 and/or one years'Imprisonnent as well as dyn pensities in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verincatim I do hereby certify under the pains mid penalties of perjury that theutfonnation provided above is ft,and corned 2 signature, -----Pate // :2 L2L&41� Print name ---------- oflidal use only do not write in this area to be completed by city or town offldsl kid city or town- perudwicense# OBuildingDeparbneut C3LIcensing Board CC3che&if immediate response is required OSelecimealsOlke I 01baith Deparbuent c, 0 contact persow. phone N; 4evind 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any comtrac: 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 bottcam 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 peanidlicense number which will be used as a reference number. The affidavits may be mumia 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 imlestlgadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat 406, 409 or 375 I