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HomeMy WebLinkAbout0546 STRAWBERRY HILL ROAD r + Y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .Z �/ 9 .` Parcel l�' Application#C D200 � �7 Health Division Date Issued' D Conservation Division Application Fee K 0S� Tax Collector Permit Fee Treasurer 3 0 t. -7 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address a �✓ , f'r Li ie 1 l e Village ll lirYl 1 S Owner F"1 e— Address Telephone Permit Request X e^ Q i�i /i cla/ se�4 / asp/4r�l® Square feet: 1 st floor:existing 6 2/ proposed 6 21 2nd floor:existing W-3 proposed 412-3 Total new .� Zoning District - Flood Plain Groundwater Overlay Project Valuation o . 00 U Lconstruction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family.[ Two Family ❑ , Multi-Family(#units) Age of Existing Structure 1�! Historic House: ❑Yes ;d No On Old King's Highway: ❑Yes XNo Basement Type: X Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) 410 6 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 3 Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes - X No Fireplaces: Existing / New Existing wood/coal}stove: ❑Yes Ad No 'Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑:new tine Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: S _Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ „ Commercial ❑Yes 4No , If yes, site plan review# Current Use /41/a/C1'e- Proposed Use J L cn r- BUILDER INFORMATIONS " Name oW n e,41 Telephone Number — d Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE V --f' y FOR 1 E CIA ELUSE[NEIXY ^ kRPrCA Via# _ \ DATE SEED . / UAPA*REEFNO0 \ ADDRE GS 2@LAGEE ' { / O»NERB { ± ' , { DA, EDEASEE&T 0&\ , ƒ FQOND6p0»N \ FRUMBE ' / . f &&BLApDEN _ \ FIREPAGEE EL C mE L ROOGRH FINALA ® _ \ PEUMBI GO: RGOOHH FNA/L . . } / GASS: RODOEH FINALAL \ FI MBUg$ENGG \ . . DAT EOSEBI UT \ : : ASS@CIT|ONRPEANENQD. �\ The Commonwealth ofMassaehusetts Department of Industrial Aecidents Office oflnvestigations • 600 Washington Street Boston, M4 021II www.m ass.gov/dia Workers"Compensation Insurance.A€fidavit..BuiIders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. C 4/.le-C 1 Address: J'41G A;j City/State/Zip: ee x r«v'//r. Phone.#: J®J' 9-VY Are you an employer? Check the appropriate bog: -Type of project(required):, 1.❑ I am a employer with 4. ❑ I am a general contractor and I . employees(full and/orpart.time). have hired the sub-contractors 6. ❑New construction . t 2.❑ I am a'sole proprietor or partner- listed;on the'attached sheet. '' i 7. Remodeling/ryeu r ship and have no employees These sub-contractors have S. ❑Demolition . working for me in any capacity. employees and have workers' 9• ❑Building addition [No workers' comp.insurance comp.insurance.$ 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•❑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. tContractors that check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether or not those entities have employees. Tf the sub-contractors have employees,they must providb their workers'comp.policy number. ; lam an employer that is providing workers'compensation insurance for my employees Below is.the policy and job site information. Insurance Company Name: Policy#E 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 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify:ender the pains-and penalties of perjur},that the information provided above is true and correct: Sienature: Date: . 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.PIumbing Inspector 6. Other Contact Person: Phone#: °Ft► T�,,ti Town of Barnstable Regulatory Services snMszna MThomas F.Geiler, Mass. ,Director Eo;s;�& 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: of *i' Estimated Cost OD 01 Address of Work: f-�Q �� W' / /( Owner's Name: Date of Application: ��/M-6 7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 FIBuilding not owner-occupied 0 er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE.ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. R / D� Date 4n�er's Name Q:fotms:homeaffidav _ I 1 T•71D1e Js�n(eontiaae� . pmeriptiveFsck:ged for dueandTt *-F'=Sc ReoidedWBalldiaga$ested 'F'oseilF'pels ' 11fAXfhNM . 11iallMtlhl • Glazing Glazing Ceiling Wali Floored Slab i •Sea3iagiCooling Glaz 'la) LI-value= R-YsIner ' F{-vsIue� $•Yeluei WI1 •�IId0 Eop=,t Emciaagy Pic , ' R values R--Value ' ��-- �J7RLta 650R AextiagllggrcrDa--1 R 0.40 33 I3 19 � 4S? —30� i9 g 121e 0.50 36 13 19 10 I R36 33 I3 2S -NIA NIA. sle Normal , . 1J I5% 0,46 31 19 19 10 S Nomsal y 15% 0.44 31 13 23 NIA NIA U AFM Sy 13% 0.5Z 30 19 19 10 J aS ANTE 13'l. 03? 31 • 13 Z'1 NIA NIA Normal Y ;8'/., 0.4Z 3a 19 25- NIA NIA' Nomnl Z I8'f. 0.4z 31. 13 19 1Q 6 90 AFU E t o'/o p 50 34 19 19 TO 8 51 AFt7B I ADDRES S OF PROPEUY: 6 S)6 ,a e,J 6 e 2, SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3, SQUARE FOOTAGE OF ALL GLAZING; A0 0,1h 4, °I° GLAZING AREA 4#3 DIVIDED BY'42): ® /� 5—SELECT PACKAGE(Q--AA-see chant above)_ t NC)T$; OTHER MORE INVOLVED METHODS OF DE iERM�I�1G ENERGY REQUIREtY �t'I S ARE AVAILABLE. ASSK.US FOR THIS RUORMATI N, BMDING'INSPECTOR APPROVAL. `a'•ES:. NO: 4 fasts-f3c0303a , fl, PA tve.! �� un IF I�j f._ V�j i �8 sI '� .� Ai- 412 r . 4� �pF'THE,p� Town of Barnstable Regulatory Services ELUMSUBt.E. : Thomas F. Geiler, Director MAss 1639• A.�� Building Division lfp µp`l Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION (� Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": C�Gs/C 4W,3C/ �Ui 'yolpev name home phone# work phone# CURRENT MAILING ADDRESS: O a tea- d zG3 3 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 understands the responsibilities of 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. 40 I ] TOWN OF BARNSTABLE BUILDING.PERMIT,APPLICATION Map Parcel 1la ,Application# B -,..;Health Division'' Date Issued Conservation Division :Application Fee,_;/ Tax Collector Permit Fee i Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address a-W Village \ 1 9 � 1 f�,�� 151 Owner a�� A/4• ✓ Address Telephone �/ w/y D LG 3 3 Permit Request SOmg. g/ar c, J'lic t f �e .fie� 4.J 0oc� Pu�`•c�ef�—/ dieAJ mew 4s�0!% � V- Dirtst're r'Aarrr r Sam, acdls rr'.r✓/df/� Square feet: 1st floor:existing (o Z 1 proposed (021 2nd floor:existing y 2-3 proposed. y 13 Total new.,: .0' Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 11 N) Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporti g�documentation: Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Cyj c Age of Existing Structure Historic House: ❑Yes *No On Old King's Highway: ❑Yesrr' )(No Basement Type: ull ❑Crawl 1lllalkout ❑Other Basement Finished Area(sq.ft.) `1 O y Basement Unfinished Area(sq.ft) 100 Number of Baths: Full:existing ' A new Half:existing 00� new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing new — First Floor Room Count 3 r Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes W No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes �d 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__XNo - If yes,-site-plan review.# _----- - Current Use •t'cs i e_sc - Proposed Use M e BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Q7SLGNATURE"1 DATES d k FOR OFFICIAL USE ONLY u APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ti i DATE OF INSPECTION: I FOUNDATION FRAME 9c 9 hgib?, , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH •FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` r i' f' i E T Town-of Barnstable° ` Regulatory Services 9 AAM Thomas F.Geiler,Director �pl MAC� Building Division Tom Perry,]Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date AFFIDAVIT HOMEIMTROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION -, MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, •improvement,removal,demolition,or constructfon of an addition to any pre-existing owner-occupied building contaiumg at least one but not more than foux 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: P'G Q)r^ Estimated Cost /0 0 0 ! / . . ,Address of Work: cJ y(� J rl'_ LA) 6 C /'Y' #a Owner's Name: Date of Application: �Z�/ /0 7 I hereby certify that: T Registration is not required for the following reas on(s): (Work excluded bylaw ❑Job Under$1,000 W=90 wner-occupied 6 own point d' Notice is hereby given that: OWNERS PULLING THEIR OWN PERNHT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME 51PROVENIENT 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. • i Date Owner ame oFTHt r Town of Barnstable Regulatory Services > vsreecE Thomas F. Geiler,Director atnsa 039. •�� 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: �O Z�! JOB LOCATION: c.J _/ !i 111 i"� C�°/11 G/�LJ�lr' number street village "HOMEOWNER": eC/6 6 r- S08�q"� A1d 6 C/ .Sd name Q , home phone# work phone# CURRENT MAILING ADDRESS: C©,J AI Ir(A S)GLI L10,, 40 01,_ 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 �f 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 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. The Commonwealth of Massachusetts Department of Industrial Aecidents Office of Investigations • 600 Washington Street Boston, MA 02111 , www.m ass.gov/dia Workers"Compensation Insurance_Affidavit: Builders/Contr.aclors/Ele'ctricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Ga+>' Address: . Jo r'Q W be r 11 � �' City/State/Zip: Cc-a'tt-r t 1 It., l�l4 Phone.#: Are you an employer? Check the appropriate box: -Type of project(required):, 1.❑ I am a employer with 4. ]] I am a general contractor and I ' employees(full and/orpart,time).* have hired the sub-contractors 6• El 2. construction . listed on theattached sheet. 7. [k]Remodeling< a' r'-5 2.❑ I am a'sole proprietor or partner- '� . ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' co insurance.$' 9• ❑Building addition [No workers' comp,insurance �• • equired.] 5. We are a corporation and its 10.0 Electrical repairs or additions .3-Q,4 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myselL [No workers' comp. right df exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees, [No workers' A3.0 Other comp. insurance required.] . *Any applicant that checks box#I 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. tNntractors 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 lrave employees,they must provide their workers'comp,policynumbcr. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and f ob 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification Ida hereby certify:ender the pains.and penalties of pe ' ry the information provided above is true and correct: Siatnature: CZ Date: Phone #: ,�OC�' Official use only. Do not write in this area,'to be completed by city or town ofJ71claz City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Table as330(caatnsaw) j r-wafptire pseksgei for aae -F and?xo =4 Rmldeatial Bali diagl bested w lifi Pos*il'�"P�� 14'lAXfhiUM . . � cs " Stab •$estinglCoaling 4laung Glazing Ceiling WISH Flaar . Barites! ',at Egtdpment l:[fidcary� t`��) U-valnct R-veiue' ' R-Yalual X.y4a Wall r . F ge 5701 to 63DO Hattlag Ikgrcr Day:' Normal ' 17%. 0.40 31 13 19 14 Alormal R 1ZY� 0-52 30 19 19 10. 6 12% 0.50 31 13 19 10 .. '1S 'UB 5 NIA. Normal• T Ii . 03$ 31 13 25 •i�1/A TIarmaI u 15% 0.4b 31 19 19 10 ti' 13`!. 0.44 31 13 23 NIA ��'' . Y 13 AFM Rr 13% om 30 19 19 10 Normal 11`l. 032 31 !3 Z3 NIA NIA Norrrrai y 11`!. 0.47 31 !9 23 NIA WAS 90AFM Z • M 6.4z 31. 13 19 16 6 l0% 0.30 30 19 19 10 8 S+1 AFiT£ 1. ADDRESS OF PROPERTY; Cc A) 2, SQUARE FOOTAGE OF ALL EXTM- OR WALLS: 3, gQUARE FOOTAGE OF ALL GLAZING; 4, % bLAZINO ARFA.(#3 DIMED BY'*2): 1� 5, SELECT FA=GE(Q--AA-sea chant above); ; _N0Tp; OTF MMORE IN-VOLVED METHODS OF DEiEA Y 1 .G ENERGY REQUIRE�vTE t'I'S ARE AVAILABLE, ASK,US FOR THM INFORMATION, . r BMDING-INSPECTOR APPROVAL: • YES;. N0: q-Eons•©oQ303a ; 1 J j v z > I 1 i y G. 148" 97" 51" 36" 107" 67" 15'. 30" 12" 24" 49" 18" 15" 30" 365" Ila W1 53 MVV3400D W123' DW302424 OR 1 1188424�i ;3DB15 SL§36 �1188424 R Owi ---­---------- ------------ --------------- - 0 The Home Depot did not � a? measure or verify job site IIIEJ Customer takes 100% responsibility 0 1 :r X 0 ----------------- ------ 33REF-2D B21 R BC45L, W331524 r1231 L J. JE 41 33" 21 42" 7 43" 33" 36" 12" 24" 36" — 44," 28" 597V 884' 148" A All dimensions-size designations given are This is an original design and must not be Designed: 7/29/2067, subject to verification on job site and released or copied unless applicable fee has Printed: 7/29/2007 adjustment to fit job conditions. been paid or job order placed. Design I Fp 1 Drawing#: 1 Town of Barnstable *Permit# aD 7 Expires 6 moniks from issue date X_pRESS PERMIT Regulatory Services Fee S 2007 Thomas F.Geiler,Director AUG ©° Building Division TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �]Residential Value of Work � Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ( �4 S C CL 3_3 Contractor's Name c.l L�� Telephone Number-J"Of 9 e7<'r1'/04 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor , am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value_(maximum.44) *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 t4o4jome Improvement Contractors License is required. SIGNATURE: Q:Fonm:expmtrg Revise061306 E The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations V ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers Compensation Insurmnce.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // n Please.Print Legibly Nanie (Business/Organization/Individual):. I_ler Address: Co a-,t- -r-e c 4d:s, l / �i 4Z a,-► Z� City/State/Zip: Phone.#: � Are you an employer? Check the appropriate bog: Type of project(required):. 1.❑ 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. El New construction . 2.El I am a'sole proprietor or partner- listed on the-attached sheet. 7./L--:7.Remodeling ship and have no employees These sub-contractors have 8. Demolition -workingfor me in an capacity. employees and have workers' Y P tY• #• 9. Building addition [No workers' comp,insurance comp.insurance. 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 df exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no . employees. [No workers' 13. "Other j7L'G ' V 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. lam 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.Lie,#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(shoving the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL e. 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains•and penalties o t at the information provided above is true and correct Si afore: Date: d Phone#: v 6 Official use only. Do not write in this area,tb 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#: 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-conti:actor(s)name(s), address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Parinelships(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 workeis' 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 Sile 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 fo any business or commercial venture (i.e. a dog license or permit to bum 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: be Commonwealth ofMassaehusetts ` Department of 1'ndus6a]Moidemts Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia . j tJ OFIHE lglf, Town of Barnstable Regulatory Services -n BARNSPABLE, : Thomas F.Geiler,Director ArF MASS. A.�� 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: 91 7/9 7 JOB LOCATION: j,J r4 number PP street a c �1 /� village "HOMEOWNER": Cli d i fe f F e,11' ��'O 7 �J� 7Oto f/ name home phone# work phone# CURRENT MAILING ADDRESS: 1p— a, _fir 57-a e'er4 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 requirement /7 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 t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt .. ,_ - -. --� ✓. ,' ..- ._ � r� �:.c .,;:. '.._.,,t.....�h,,,�a4 r' ...s,F',,c.+..z+';-,LLB>_=..'-•.':� ...i,.�.s++.. �: ,..:,,.,fir�-�Y Assessor's map and lot numbn� ........ ............. r Sewage Permit number ........................................................... ' L• fT"ET°�, . TOWN OF BARNSTABLE i BAHHSTADLE, i 0 9.�\e�� `' BUILDING INSPECTOR - 'Fp YAY;Or. (V K APPLICATION FOR PERMIT TO .................................................................................................................:........... TYPE OF CONSTRUCTION .........:.:............. ................................................1977 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ALocation ..... ............. .../(Q I` .......... a ... ProposedUse ...................... '` ..... ..................................... .................... ...................................`.. y f Zoning District .....................Fire District .......................... ............................................... ..................................................... C� ..............................Address � � / r �.......... Name of Owner ......................................... ..`.. . .....{.... a Nameof Builder .....................................................................Address .....................................r ............................................ Name of Architect ,"" ........Address ...................... ....... ..................... o..................... ..,.. .... Numberof Rooms ................................. ...................'...........Foundation ......................................................... Exierior r .................�... ...................................................Roofing ......xi`-!��,............................................... Floors ........................U+ -^�J .................................Interior ............................-........., Heating .. /........................................................Plumbing .............!!................................................................... Fireplace .'� ....Approximate Cost - �...........................:..........................: _ .......................... r` r ('. Definitive Plan Approved by Planning Board ---------------------------j----19 Area ............... ....`.'................. Q ..."'.� Diagram of Lot and Building with Dimensions Fee .:....... .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH j o i /b At t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,Name .......4a......' .` .............. Danielle Trust A�=2*9--V$t (not plotted) 442..,W- S-qt, 2-9q-1&7 19304 1 1/2 story No ................. Permit for .................................... single family dwelling ................................................................................ Location -OVO Strawberry Hill Road ................................................................ Hyannis ............................................................................... Danielle Trust Owner .................................................................. frame Type of Construction .......................................... ................................................................................. Plot ............................ Lot ...........#16............... A .......... Permit Granted ...........June........... ...,5 19 77 Date of Inspection ..................... ..........19 Date Completed ........................... ............19 PERMIT EFUSED ................ ..................... ........................ 19 ............. ... .................. ................. ...................... ..............................7 ................ .................. .. ............ . . .............................................. .............. Approved ................................................ Is ......................................................................I....... ............................................................................... /s7--77 Assesr'sap and lot number ............ SEPTIC SYSTEM MUST BE INSTALLED' IN COMPLIANCE w : WITH ARTICLE I STATE Permit number ............... :.............................. 4 SANITARY CODE AND TOWN *THE t�� TOWN OF BARNSTG `���__ i BiHSTADLE, MAIM C ., ro° OMpYa\e�� r4 BUILDI-NG INSPECTOR APPLICATION' FOR PERMIT TO .� ............................................... ................................ % TYPE OF CONSTRUCTION ........... .. ............................... 19.7-1 TO THE INSPECTOR OF BUILDINGS: The undersigned herebyapplies for forr a permit according to thee following inf rmation: Location ..../` ..9....� ......C.!.`'' `' '6 ..k.IX ..r .......... ✓✓�::��........................................... ProposedUse ........................ .............. ... , d .................................................................................. ZoningDistrict :.......................................................................Fire District .......................................:...................................... Name of Owner - /� � '+ ....(. ................ Address ..... .. Nameof Builder .............. �' .....................:.........Address .................................................................................... rr , Nameof Architect ...........................................................:......Address ..................................................................................... � • Number of Rooms ....:.......................:.....................................Foundation ... ......................................................................... "' .... Exterior ................... ...................................................Roofing ...... .. ..... .............................................................. Floors .....................o`. ... .................................Interior .......................- ......................................... Heating ..�h/... ...............................................Plumbing .......�I......... _'.-.:...................................................... Fireplace ........................ Cost ........................ .,....... ----19 �o L � . Definitive Plan Approved by Planning Board ---------------__________ Area ................ .........�. ............. Diagram of Lot and Building with Dimensions Fee _-_ — SUBJECT. TO APR L OF BOARD-OF HEALTH spa • 3� • I hereby agree to confom to all the Rules and Regulations of the Town of Barnstable regarding the above construction. < Name 4�- � r. ............................ Danielle Trust f f- 19304 1 1/2 story No ................ .Permit',for .................................... ti i single family dwelling ........................ •••....• • Strawberry••••Hill.-Road•••••••••• •�' - -� __ Location.. ....................... ................... ............ Hyannis , Owner Danielle Trust , ................................................................. Type.of Construction frame i..s.,.....+........ ..................................:... .......... F r ~Plot .............. ...... Lot ...........'}.1.�.............. t June 15 77 Permit Granted 19 Y r f 'Date of Inspection 119 s- p .......... Date_ Completed-.... 3.. .........1,19 �. PERMIT REFUSED .. .................................... .19 ........................................... ................... ; �.. ............... ...... . ................................ t .....................: ....................................... ......... Approved ........................................... 19 - . ............................................................................ I OP pr1 k� laav to 644 sx 9 . d� RICHARD v A. ,i BMTER h CEIZTir-tEL7 p l:C>T pl—A." Grp Sites'"" LOCATION." Icy aw qt5 G6iZTlF-( T"AT' TNT .7ou -;Ooww P�--Ate R�F�C2c�.1GC t-i�ZEa�1 COAAPLVS W iTN TWG: 51vV=_LIWE AWC> SETV3ACK VC-QViczEV awTS OF -r"C- Lo-r '� RE6tS'i"'c�cD LA1-tD 5V2vrcYo�LS • 'j"1-115 M-A W I S LJ OT BAS E'er Ow A&.I OSTEi2ViLLr-- o R,C�ISS. %w-gmcJMEtJT -SUQVCY Tt4t✓ SNowur> APPL.tGA►JT KbT ESE USC--tom To r.>a:TE2Mi%4 l_OT LlWe15 RuL. k..wIJ4zp E E � = 955 RI HAM EE � E 5� ,,. �� '.. � � � �� ,EEC !�'E� z �.! 3 E4E J��l E'1 �•z"�E�&a £ 4 A ,. Pierce. Strawbe �E E r. •� E!? EiSE `E E f Resident �.' / ..i..� x3.� :b ;F: .r'ft: .��� u'�.?.... ...� ..u: Ply !�.•�' .: �� r i � :x 3J� 'm 5 a a --:.�-:. ,., ,- ,.�,> nib ,� :•�E .�. ...._. .a :� West.Main&Pine Street. On the x., hyannis/Centerville line. New tent, possible r overcrowding. All those extra people have been living there at least a year. Cars everywhere. tlti�l'£ 1 3' „ CbO _n St ':� �`£,�.....• -£-a� ' l\ ' w a •:. ............ Y' A L R