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HomeMy WebLinkAbout0740 STRAWBERRY HILL ROAD 7yo -Stxanva r� {�// ed. Jam __ � L F T Town of Ba> yistable �x ermit'#U �� `X' Expires 6 monfirs jroan issue(late tawaNsrABr�. Regulatory Services Fee �a NMR& Thomas F. Geiler, Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.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 �fo ❑ Residential Value of Work Minimum fee of S25.00 for work under$6000.00 Owner's Name"&Address Contractor's Name `w Telephone,Number_ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ipr-SA P MIT ❑Workman's Compensation Insurance SEP _ 2009 Check one; ❑ I am a sole proprietor TOWN OF'BARNSTABLE"- 5d I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name - Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Wf Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of poor) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with othu town department re,ulations,i.e.hfistoric,Conservation,efc. *"Note: roperty Per ust sign Property Owner Letter of Permission. Home rov ent Contractors License & Construct-Supervisors License is required. SIGNATURE, Q:\WPPILrS\PORNhf,S1.Lxpress\EXPRESS WIT.DOC . e The Cotntnotnvealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Ele'etricians/Plumbers Applicant Information t� Please Print Legibly Name(Business/Organization/Individual): �Nyaob Address: � 7eE.�✓Q�ndt� JdL I� Phone.#: soF - 3�0-6 ��� City/State/Zip: (:"��`rLv,2CC ct' Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor.and I 6. []New construction employees(firll and/or part-time).*_ have hired the sub-contractors 2.[] I am a sole proprietor or-partner-' listed on the attached`sheet. 7.. 0 Remodeling'. ship and have no employees - These sub-contractors have g, Demolition, working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.$ ' We are a corp ired.] 5. oration and its r eq 10.[]Electrical repairs or additions 3. I amu a homeowner doing all work officers have exercised their 11,[]Plumbing repairs or additions \ myself. [No workers' comp. right of exemption per MGL 12❑f Roof repairs insurance required.] t c. 152, §1(4), and we, 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 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: 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 cri_muial penalties of a fine up to$1,500.00 and/or one-year•irrpiison,nent, as well as civil penalties in the form of a STOP WORK ORDER and a fine_ oft p to$250.00 a day against the violator. Be advised that a copyof this staternerit may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1":dohere:bycerti u der the s a penalties of perjury that the information provided above istrue and correctDate:S — Phone#: . Offcial use.only. Do not write in this area, to be completed by city or town official .City or Town: _ Permit/License# Issuirig Authority(circle on 1.Board of Health 2.Building Department 3.�City/Town CIerk..4.Electrical Inspector S.Plumbing Inspector 6. Other 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 tiustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrnents 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 Iocal 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 . of public work until acceptable evidence of compliance with the insurance enter into any contract for:the performance 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 numbers along with their certificate(s) of e and hone g necessary,supply sub-.contractor(s)name(s),address(es) p ( ) 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 ees e . to policy is required. Be advised that this affidavit may be submitted to the Department of Industrial y a p y q and date the affidavit. The affidavit should Accidents for confirmat ion of insurance coverage. Also be sure to sign 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 p e e call the De 'arbnent 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 permitilicense number which will be used as a reference number. .ln 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".lob 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 to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. �-t r,,= e� fr. stigatiors wo„1d like.to thank you in advance for your cooperation and should you have any questions, �..v please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts ` Depaitment of Industrial Accicicnts~ , 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 Tow of Barnstable. y�Q-OFYHE tp��� Regulatory-Services :7hornas F.-Geiler,.Director. R.kRNsra sr-e. Building Division .` Tom Perry,Building Commissioner 0 2Q0'Main=Street,—Hyannis;hfA 02501 , wwFv.town.barnsf ble_tna.us Office: 509-862-403 8 4 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ` Please Print DATE JOB LOCATION: �710 number street V-llage "HOMEOWNER": name hame phone# work phone# CURRENT MA V•PLING ADDRESS: � ff ox `971/ city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellintrs'of six units or less and to allow.homeovrners to engage an individual for hire who does not possess a liccnse,providt d that the owner acts as SuperV]sor. .-. _ 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 wbo 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 be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) ibility for compliance with the State Building Code and other The undersigned"homeowner" assumes respons , applicable:codes, bylaws,rules and regulations, The undersigned."homeowner"certifies that.he/sbe understands the Tpwn of$arnstable,BuildingDepartment r—,f _ ection pro ures and requirements and that he/sbe'will comply with said procedures and Signatix Homcown ` ,4}sproval of Building Official Note: Three-family dwellings containing 35000 cubic feetor larger will be required to romplywith the „ M. . -State Building Code°Section 127.0 Construction Control. HOhfEOwNER'S EXEMPTION The Code states that: "Any homeowner perforrning work far which a building permit is required shall be exempt from the provisions of this section(Section 1 D9.1.1 -Licensing of construction 6wpervisors);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 arc assurning the responsibilities of a supervisor(sec Appendix Q, Ruics&Regulations for Licensing Construction Supervisors,Scction 2.15) This lack of awareness often results in serious problems,particularly when the hoTnCDwner hirr_s unlicensed persons In this case,our Board cannot procccd against the unlicensed persori as it would ould with a licensed. Supervisor. The homeowner acting as SupeTisor is ultimately responsible. To ensure that the bomcowncr is fully aware ofhis/hcr mspormbilitirs,many communities require,as part of the permit application,. that the homeowner certify that he/she understands the rrsporLnbilitics of a Supervisor: On the last page of this issue is a form currcndyuscd by` several towns. You may care t amend and adopt nucb a forrrVEMtification.for use in your community. 1 � r Town of Barnstable Regulatory Services rBAAx>� LE, Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,M.A 02601 wwvv.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790- Property Owner Must Complete and Sign This Section If Us ing A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signatnre of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 014C . Ass ssor's offioe Ost floor): THE Assessors map and lot number �. Board of Health (3rd floor): Sewage Permit number .....�..... .....................::`:..". ..... 2 DAW3TULL Engineering Department (3rd floor): oo rb 9. Noose number ........................................ ............... : .:............ '`�OYaY ale APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE - -,BUILDING INSPECTOR APPLICATION FOR PERMIT TOU, ! Ip-Vti_` .... ...`.. ....... TYPE OF CONSTRUCTION - .1........................................................................................................................ \_%! .. .---.. ..........19RI TO THE INSPECTOR OF BUILDINGS: The undersigned �hereby applies for a permit according to the following information:: Location 10!� 5 41QN.y-wW. .*.....;;R .............':• .. .... ..........`..' ckl ...................................... Proposed�'�Use �. Zoning District ............................................Fire District ... t -Name of Owner 1..... ......... ......���( . ................Address ...!.1. . Nameof Builder . ..............._..... ... ............. .. ..............................Address .............................,. . ..... ............................... Name of Architect ................Address . ................................. Numberof Rooms ..................................................................Foundation# ...... ....................... o- p`�.............................. Exterior .......... .a-�V........ ... ....��...... �.......... �.1Y-� (� .. Floors :. .... ...................................................Interior .........(..Z............ ........................................................... . ............... I ..................Heating ...� ....; ....................•....Plumbing d Fireplace .....c ..........................................................................:Approximate Cost Sao ...........!.© ........................s . Definitive Plan Approved by Planning Board ---------_------------------------19________ . Area .................................... a Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Z ;► 1 Q w OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. f sr' _ Sys Name ....................... .. ../../..................... . � ' i Construction Supervisors License .` . . ........... _ LANGFIELD, DAVID A=250-007 No 313 3.L..... Permit fcr.A) DITION Sin Location .........5... a _.. _ ............ .....Hyannis........................................ Y Owner ..Davi:d Langfield,,,,.,_ , .. ,,, Type of Construction .. .:: =A::=:............................ r. . ....................................... w .................... r Plot ............................ Lot October 22 r Permit Granted .......... . �....19 8............... Date of Inspection ....................................19 Date Completed 19 r 1 4 Asassor's offioe (1st floor): �THE T Assessor's map and lot number ✓ �' .. �. L... ..!1..: G x?� f a. Q�° off` �7E MUS Board of Health (3rd floor): `, �"ti i:� � � O fO Sewage Permit number ® � � BASBSTAM.MTH . ;i Engineering Department (3rd floor): : TITLEs �o r pe House number ,C ......... a" � ��� �� ,g'.�; °,,��esq.tr`0 ........ ..... .................... �5 n —yam � 'ter`.� ., D YPT APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only. � ' REGULATP�, JI. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. ....� !(1... ... .... ..... .CZ1! ,r....... ................... .....�......... TYPEOF CONSTRUCTION ............... .......... ......................................................................................................... ..... --- n._-----...19 ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .Location .....` 5........q&.Mwxq,�.. ...............\.� .............. .......... . . .. . ........'.. ........ ` ........................................ ProposedUse .............................................................................................................................. a. OOV Zoning District ..............................................Fire District ... .... Name of Owner .. ........ .G................Address t !"I... ��. ... ... ..... .. �. ..... . ..... ��=T� Name of Build .Address . ......... Nameof Architect ..................................................................Address ....................................................,................................ Number of Rooms .........It .. ...................................................Foundation ur.`i...... ' 4 Exterior C�Z�o✓L..... Ie3�F--�,�1�_ coz4 oofing ..... .. ...... ....................1...�.� �...�.............. Sa�G�l j/ Floors ...... /......................Interior ......... .Z........ 91 Heating ...0-4........... .. .. ..��!1�. .........................Plumbing ............ .......,............... .....�:.�.�.�- .................. Fireplace ..... ...............................................Approximate Cost .... ..I dj® tC�..................... Definitive Plan Approved by Planning Board ________________________________19-------- . Area ...... ......................... o� Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH jj ►_�_ _ -r S t 4, o f _ - _ r, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS / I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / eisr ��,_C I Name .. ...... ..�(............ ��s w Construction Supervisor's License ............ .. ................... LANGFIFLD, DAVID z;j�J r ' No 31332 Permit for ADDITION..................... Single,le Fami.lY..Dwl .in ............. .................. .. ..... .......... .� 10A� =-7 ,,,,padt - - Location i T ...... y 17� r 1 Hyannis......................................... C. Owner ....David...Lang.field:..................... " �._ f i - �• „�-+ Frame n. .: � •., ,...k r �.; � i � _ •'•, Type of Construction ...................... ................... .-'3 a± v _ ..... Plot.4' ......................... Lot ................................ Perm- Granted ... October 2L:,... 19 87 c Datel of Inspection .............19 'l'_ n r s r Date' Completed .... :0.�..�7.................1 s M1 r w .-� _ '• - ,,,E C7