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Home My WebLink About0054 UNCLE WILLIES WAY 6q Untle loi ll i of W a to-7-1 c0 _I OFTME Tn , Town of Barnstable *Permit# rzoP ires 6 months from issue date Regulatory Services ee Bnxrvsrna[E, nrnss. Richard V.Scali,Director a, Building Division Paul Roma,Building Commissioner 200 Main Street Hyannis,MA 02601 D 3 www.town.barnstable.ma.us U WI Office: 508-862-4038 ftVVam; 08-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Property Address Vw e, Atar vn esidential Value of Work$ JJ-_ b 0 `Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t5�CQ .� t''d' ��_� t7 y 14 Cte W t ((e Lj Contractor's Name P&M . Telephone Number Home Improvement Contractor License#(if applicable) /3 Email: (tan, 4,,`, d , "u-7 Construction Supervisor's License#(if applicable) J " 0 "6.� ❑Workman's Compensation Insurance Chec one: [ m a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑R of(hurricane nailed)(not stripping. Going over existing layers of roof) . side eplacement Windows/doors/sliders.U-Value v (maximum.32)#of windows , #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building it forms\EXPRESS.doc 06/20/16 �"E Town of Barnstable Regulatory Services Richard V. Scali,Director ► Building Division, Paul Roma,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 I, V'Soi 31a,- tr t!!� 4- ?> ; as Owner of the subject property hereby authorizel - to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final { inspections are performed and accepted. Signature-of Owner Signature&4Xpplicant Print Name Print Name Date + Q:FORMS:OWNERPERMISSIONPOOLS -� -Town of Barnstable Regulatory Services oFIHKE y Richard V.Scali,Director ti Building Division MRNSTesL Paul Roma,Building Commissioner MASS. 1639. 200 Main Street Y Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: i number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 shal[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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc 06/20/16 LLOZ/LZIOL ` JauoIssIwwo :uoilejidx3. -V,;1 , f IL090 VW SINNVAH N*2131S302iOM L£ � -V21VHO AH10WI1 d o josmiadnS uollonj4suo0 V699Lo-S0 :asuaol� spJepuelS pue suolleln6aa 6ulpling;o pjeog ?, /!la#eS o!Ignd 10 luawlaedaQ sllasnyoesseW 1� . nG� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 136590 - f Type: Individual Expiration: 8/5/2018 Tra 290877 TIMOTHY O'HARA T.t; TIMOTHY O'HARA �N 37 WORCESTER LN. i HYANNIS, MA 02601 ` t 1�Update Address and return card.Mark reason for change. Address 0 Renewal ❑ Employment Lost Card SCA 1 C; 20M-05/11 ��e�aom�no�rruieall�o�C�/ll�c�oac�cc.�elta ---- ---`-- �_Office of Consumer Affairs&Business Regulation License or registration valid for individual use only —- -HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 136590 Type: Office of Consumer Affairs and Business Regulation Expiration__.,8l5/201;8, Individual 10 Park Plaza-Suite 5170 == Boston,MA 02116 TIMOTHY O'HARA TIMOTHY O'HARA i• 1,,p} `f 37 WORECSTER LN -S HYANNIS,MA 02601 Undersecretary Not v without signature .77w Cori mornvealth.of Vas-machusetts eptErkner tcxfIrndus-lrialAccidents - • r = Of -ce,of Imwsligatiom. 600 Washington Street Boston,41A 02111 ivivi masmgav/dia 'Wark-ers' Campensatian Insurance Affidavit:Bmldexs/Gnntractnr&/EIectri,cianslglunbers Applicant lufarmaiian Please Print f eebly r7tTiE'�Susazessrlgan�a4ionffnidaal} ! c "�1 City/Sta-tZip= � Phonen: Are you an employer..Cheekthe appropriate box: Type.of project(requir q: a am contractor and I '.❑ I am a employer ve�ith. El a (i. ❑New consfrascEiorx m ees(full andfor part-time).* 'have hired the sub-contractors n 2. am a sole proprietor orpartner- listed ontile attached sheet. 7. ❑Remodeling. s9up and have no employees. . These sub-contractors have . g_ ❑Demolition warring for me,in any capacity. emmployees andhave wodcess' 9..❑B.IIilding addition [NoSL" dd=W camp,insurance comp.insurance.t rewired 1 5- ❑ We are a corporation and its ME Electrical repairs or additions 3.❑ I am a homeoumer doing all work omen have e=cised,their 11-❑Plumbingrepairs or additions myself[No warkets'camp- right of esempfion per MGL 12-0 Roofrepaim insurance requited.]Y c.152, §1(4h and we have no employees.[N workers'o 13.El Otfies comp-insurance required-] tAny appfitsatIfiat chedimboz Pi mast also Mcatthe sedFoabciowsbzwing the rwoaexs'campersariaupariepinfo�suo� #Homeownem who sub=dt dus afiidn n 2m&cxtm-4 they axe cheap zu war sad,then hie aumde caatmctors m— sahmit a new aMdavi2 irz;na s dL ICan=ctoisthst r11-1r This box mast attached mt.addition l sheet showing then2me of the so-cwtucb s and state whelhec ornotthose entitieshave emp9o3ees.Ifthem1t- -txctamhave employees,theynmst•prnidetheir wadm&cmp.palicg number- Iam art ezfiployRr f7eat is prouiduzg n�orkets'canrperesaiiolz irzsrirarzce form}*emp£a}�ees $etow is dig palicy and jvb side information ' lnsivance company'Nrame: Policy or Self-ins_Lic_ ExpirationDate: Job Site Address citylStatelZp: Attach a-copy ofthe workers'compensationpolicy declaration page(showing the policy,number and expiration date). Failure to secure coverage as regturedunder Seztion 25A of brIGL m 152 can lead to the imposition of criminal penalties of a - Sae up to$1,50D.OG aadlor arie--yearimpdsotune-"f as well ascivil penalties'in the form of a STOP WORK ORDERand a fine of up to$250-00 a day againd the violater. $e advised did a copy of this statement maybe fnrwarded to the Office of Imvestcgations of the DIA for insurance coverage verfEcation- I da kere-6y=6fy ruttier tits pains arzripsrz ' s o:f�rer�wJ'fJiarfFie inforRtaiior>prmirTed abmw is ties arrd correct Sit3zatiire: '� Date 116 Phase OBIcial use only. Do not write in 693 area,to be completed by city or town oocial city or Town: PermitUcense# hmning kUdwr€ty(cirde one): L Board of Health 2.Build'ing Department 3.[ity1rown Clerk 4 Electrical Inspector S.Plumbing Lxspecter 6.Other Contact Person: Phone#: -- -- -- - -- - 6 - ormation and fustructious Massachuseffs Gdnmal Laws chapter,152 requires an employers to provide wa:jj-,eas'compensation for their employees: p=Snmt tb this sty,an mp&yw is defect as_' -every persdu in the service of another under any,ca"fract ofhne, express or implied oral or written-" An emplayer is &-tined as"au individual,partnership,assorieion;corporation or oilier legal entity,or any two or more of the foregoing engaged iu a joint Vie,and including the Iegal represeniafives of a deceased employer,or the receiver or t ngtee of an individual,p ip,association or otherlegal entity,employing employees. Howryer fhe owner of a.dwelling house having not more t3Ha three apartments and who resides therein,or the occogant of the - easom to do maintenance construction or repair work.on such dwelling house dwelling horse of ano�.er who employs p , or on.the grounds or building appurten them o sbzH not because of such employment be deemed to be an employer." MGL chapter 152.§25C{6)also sfatcs that"every state or local licens-i7rg agency shall withhold the issuance or renewal of a Ecen a or permit to operate a busm-ess or to construct buildings is the commonwealth for suy a-pplirantw'ho has notproduced acceptable evidence of compliance with th:e insurance coverage required.- Additionally.M(ff chapter 152,§25CC7)states¢Neither the commamvealth nor any of its political subdivisions shall enter mtD any contract for foie pm-5 ante ofpubho work uaa acceptable evidence of compliance V ija the i mu=C-6.. rurL=memfs of this chapter haveBeenp=mtedto the cortractinganfhonty" Applicants Please fill l or t the workers'compensation affidavit completely,by chug i�]e boxes that apply to your situation and,if necessary,supply sub-conftactor(s)name{s), address(es)a ndphonenumber(s) along withthea'cerbficate(s) of b3sul „ce_ Limited Liability Companies(LLC)or Limited Liability Partnerships(Lire)wft no employees other thm the members or partners,are not mquaed to carry worke& compensation.i asuranee_ If an LLC or LLP does have empioyees,apolicyismquire . Be advised that this affidayitmaybernbm;ttt-.dtotheDepartmemtofIndustrial Accidents for confirmation of in�Ce coverage_-Also he sure to sign and date the affidavit---The affidavit should be refvm(-,d to the city or town that the application for the permit or license is being rmpesle(L not the Department of Trrh.cfri�1 A ccidearfs. Should you hate any gnasdaas regardmg the law or if you areguire:d re to obtain a workers' compensationpolicy,pleasecaII fad Departmentof the numberlistedbelow. Self-insuredcompaniesshouldentertier self-m ce license number on the appropriate Ime. City or Town officials t Please be sure that the affidavit is complete and primedlegiibly- The Departmaathas provided a space at the bottom of the affidavit for you to fill out in.the event the Office ofInvestigafions has to contact you reganimg the applicant_ Please be s rie to fill in the pm: itllicrose number which will be used as a refev.nce number. In-addition,an applicant that must submit multiple p emuHIicense applications in airy given year,net-,d only submit one affidavit indirafmg current p olicy inlfbmation Cif necessary)and under`Job Site Address"the applicant should write"all locations in (may or town) "A copy of the-affidavit that has beeat officially stamped or maimed by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for furore pmmifs or licenses_ A new affidavit must be filled out each year.Where a home owner or citizen is obtai wing a license or pamait not related to any business or commm sial veni<n•e tie_ a dog license or peunit to bum leaves e#c.)said person is NOT rmTf=d to complete this affidavit The Of of Investigations would hke to tfiank you in advance for your cooperation and should you have any questions, please do not hesifatr to give us a caIL The Department's address,telephone and fax number_ f-ate the of Massachnsdt; . Degaitamt of 1adusfdd Accident% Off 1ce Of IaVe&tigAtia= �Q�4 Stan.Sty - �Q T6,L 4 617' -4900 QXt 4-06 W 1-977MAS F- Revised¢2447 �w v_mas.5_gWjdi& F r� r .. _ •'tea. __. - ♦ .� •�� .�i■' �!' � � �r'yM °J.'/ •� , ■ I� x � 0 i a� MW oe M - - • 4 "i y �-54 Lu)c,(c- W+ 0 i'�- i- s 979VISNdv fit:► !s%f l YOU WISH TO OPEN A BUSINESS? i .. For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you. must do by M.G.L:-it does not give you permission to operate.) You must first obtain the necessary signatures on this format 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. P DATE: — Fill in please: �}F APPLICANT'S YOUR NAME%S: T � Z��O e S FC'l�N��"QFS�'"'o''� 'tji' " BUSINESS YOUR HOME ADDRESS: "]L/ U hVCLC;. Wj�l c-S . W4 Y NY�IQ�N(�5 A _ c3 �-Eol `7l9a TELEPHONE # Home Telephone Number 1 EW AM NAME:-OF CORPORATION NAME OF_NEW BUSINESS,' T1CPE OF:BUSINE55 ISTHIS A F.AT! :NO ADDRESS D.F:.BUSINESS. :i` ::•:, „� :L W.aGIC .- .PARCEL NUMBER . . (Assessing)._k: r . When starting a new business there are several things you must do in order to be.in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. —.(corner of Yarmouth Rd. & Main Street) to.make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SID R'S OFF E This individual h e in or o any pe it requirements that pertain to this type of business: ',AUST� COMPLY WITH HOME OCCUPATION �'� :MULES AND REGULATIONS. FAILURE TO Aut orize ignat r OMPLY MAY RESULT IN FINES.-.. MMENT t 2. BOARD O- H L H This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: S. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. ' Authorized Signature* COMMENTS: Town of Barnstable Regulatory Services THE tp� o Richard V. Scali,Director Building Division BARDWABM MAS& $ Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: d �. Name '�� / kR��`S ��N�ND�' S Phone#: �� 1Y a3� Address: �j.y U W CL c (.�(�(C�" wd y Village: Name of Business: Type of Business: (f L 6'119 r'1 N G Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to ' exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. , • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applican ' Date: Homeoc.doc Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$140.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you.must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367` ; Main Street, Hyannis, MA 02601 (Town Hall) DATE:C� '1- F � (� Fill in please: APPLICANT'S YOUR NAME/S: + nP BUSINESS YOUR HOME ADDRESS: � 2 TELEPHONE # Home Telephone Number SO NAME OF CORPORATION:. 224'5 S C-61-1 j,K-9 l/c %! O vim- NAME:OF NEW BUSINESS TYPE OF BUSINESS L i)-r-i� IS THIS A HOME OCCUPAT ON? :� YES; NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER -� [Assessing] When--starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST .GO TO 200 Main St. - (corner of Yarmouth -Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has,bfen.in r ,•ed off an,parmit requirements that pertain to this type ofbusines UST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Au_hor' ed Signature** COMPLY MAY RESULT IN FINES. OMMEN • _ V J C ,r' A St U P r 2. BOARD OF HEALTH This individual•has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSI NG NG AUTHORITY This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** . COMMENTS: Town of Barnstable Regulatory Services Thomas F.Geiler,Director • a�rexsT mix, Building Division MASS.v� z Tom Perry,Building Commissioner iOrEn 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: a a Fee: O 3 S'e �}-D Permit#: HOME OCCUPATION REGISTRATION Date: —`'I�� . Name: tLr''1 C y S S Phone Address: 15 UN C t t. 4 (I Village: Name of Business: r5vs V(f T� b Type of Business: Map/Lot: _q, INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation Fvitlnin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelliig: there shall be no increase in noise or odor;no Visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or grounndmater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the folloii ing conditions: • The activity is carried on by the permanent resident of a single fanuly residential dweUig unit,located within that dwelling um it: • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evddence of such use. • No traffic will be generated in excess of normal residential volunnnes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or li<a7-udous materials,or flammable or explosive materials,un excess of normal Household quantities. • Any need for parking generated by such use shall be met oil the same lot containing the Customary Home Occupation,and not Aitli ni the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles'relate'd to the Customary Home Occupation,other than one sari or one pick-up truck not to exceed one toil capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing die Customary Home Occupation. • No sign shall be displayed indicating lane Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed un the Customary Home Occupation ivino is not a pernnarnent resident of the dwelling unit. I,the undersign d,haveead. agree with tine above restriction m s for my home occupation I a registering. Applicant: o o Da Homeoc.doc Rev.01/3/08 °F THE J°k Town of Barnstable *Permit 9� Expires 6 mo ihs roni issiee da e Regulatory Services Fee + BMWTAHLE, 9 MAC � Thomas F.Geiler,Director. rfD MA'I A Building Division . Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www,town.barns table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION —. RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/paicel Number Property Address (��Ir_& (Residential Value of Work 11 3 S 0 1 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name �d77yP—� f .� Telephone Number U ty 7 70 /V Home Improvement Contractor License#(if applicable) Construction Supervisor's License.#(if applicable) -PRESS PERMIT _ Workman's Compensation Insurance Check one: FEB 4 ❑ I am a sole proprietor 2010 ❑ I am the Homeowner ' 9U1/N OF BAR(VSTABt. I have Worker's Compensation Insurance Insurance Company Name S '"►`�J y� G� Workman's Comp.Policy# 3 Copy of Insurance Compliance Certificate must accompany each permit. Permit R;Re-roof e t(check box) F� (stripping old shingles) All construction debris will be taken to �d'1��Sf j (W6 toybr ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side #of doors. ❑ Replacement Windows/doors/sliders.U-Value (maximum.4.4)#of windows *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 the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: G W'�/U► Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 4. Boston, MA 02111 ` Z � wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information.. A / T�Please Print Le ibl Name (Business/Organization/Individual): "JVJV_21F4_1 Address: City/State/Zip: C-15-A-tt_F:,C- VL LLt M 7c Phone #: 6 G4 77( NY Are you an employer?Check the appropriate box: Type of project(required): 1.[�I arri a employer with t- 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7, ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P Y� 9. ❑ Building addition [No workers' comp: insurance comp. insurance.l 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 1 LE]P1 imbing 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 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:fill Policy# or Self-ins.Lic.#: b 73 1 'V ` (( Expiration Date: Job Site Address: (�`� G�Glj��s City/State/Zip: tl✓l�S �Z01 Attach a copy of the workers' compensation policy declaration page (showing the policy num er 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 andpenalties of erjury that the information provided ab ve is true and correct. Signature: Date: . 7— .l �(D Phone#• 77k lh-/l 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#: Information and Instructions Massachusetts General Laws chapter.152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eniployee 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, constniction 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-contractors)name(s), address(es)and phone number(s)along with their certificate(s)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 pen-nit 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. 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 Site 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 fature 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia 4 �YHE r Town of ]Barnstable y° Regulatory Services _^�'�"B Thomas F. Geiler,Director rcaes. 039.c� � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 vnm.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 Prop e rty Owne r Mus t Complete and Sign This Section. If Using A Builder as Owner of the subject property hereby authorize fiaawa to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) . 65*1 C-� Signa e of Owner Dat s � Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. O:FORMS:OWNERPERM1SS10N Town of Barnstable F THE Tp� Regulatory Services * Thomas F. Geiler,Director ABLE, MASS. Building Division AIE1) 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: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone#/ CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 dq 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 fomi/certification for use in your community. Q:\WPFILES\FORMS\homeex empt.DOC `) a P� GTIe 1°iomrixonwea�i o�✓�aaaac`ervetla �\ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 'vm Board of Building Regulations and Standards Registration 1100285 One Ashburton Place Rm 1361 E�cpirat�on 6/15/2010 Tr# 268322 Boston,Ma.02108 14Type Private Corporation i WENZEL FRAMING,-1N� IT ; I Mark Wenzel 45 Whidah Way q 1 Centerville,MA 02632� Administrator Not valid withou ure . Massachusetts_ Board of DEPartment nt Buildin"Re public 4C—Onstrucfion S �'ulatinns and $:Itet1 Lice` uperlis S#andards rise: CS 9055 r'"<.- °r License • Restricted to 00 „ RK I MA r§ .F A WENZEL ,. .,r ,•�, <4b WHIDgH Wgyx :4 _ CENTERVILLE Mq p2632 ttaaf- Expiration: 611712010 Tr#: 26876 "L_U rLJ 1N5 CUTUIT PAGE CERTIFICATE OF LIABILITY.INSURANCE CSR B TE(MMIDOYNYY, ::•- WRNZE50 09 18 09 4DMAN & ASSOCIATES INSURANCE THIS 6ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ��NANCIAL SERVICES INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR HYFISMOUTH RD.. ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. HYANz72S MA 02601 PhOne:508-715-6-010 Fax: 08-790-0249 - -----•. •----.-__. 5 I INSURERS AFFORDING COVERAGE LE TTSD INSURER A: SCOA . -- - ... .._--.. .---INSURANCE Co. INSURER 9; ST PAUL.TRAVELERS -- --- WENZEL FRAMING INC_ I._.. IINSURERC 45 WHIDAH WAY _... _... -- —...... ....— _.. -_._..._I CENTERVILLE MA 02632 INsuRERD. ""'---' INSURER C: COVERAGES THE POLICIeS OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS"TWI'U -- - - T — __..... • P3LfCYEFF�19V2 `PiOPLkPIRATIaR LTR NSRq TYPEOFINSURANCE POLiCYNUMBER _ - DAT2 Mmr�1, bAT® MM/ODIYY - LIMITS (GLUNERALLIABILITY �- I EACH O CCURRENCE� Ia 100000 0 - —C�GOMI MERCIALGENERAL�LABILITYI CLSL4OOS22 09I 07/10/1007/ a/ EPRISE S_O_OO_00CI-AIMS MADE ^. 00CUR MEO _ EXP(Any one por*.on) J 4 5000. [PERSONALaADVINJURY "a 1000000 '-- -.I OEN'I_AGGREGATE LIMIT APPLIES PER ----CENERALAGGREGATE S 2000000 —' POLICY J GT PRODUCT$_COMP/OPAGG $2000000 I I AUTOMOBILES LIABILITY '^ -- _ ._---- --- ANY AUTO i I I COMBINED SINOLE LIMIT fEAocc ---. ......�... I �Al identl l OWNED AUTOS I - SCHEDULED AUTOS BODILY INJURY - L I _ HIRED AUTOS NON.OWNEDAIJTOS I 30DILYINJURY I (Per eccldant) PROPERTY DAMAGE I a l - (Per mccident) (GARA08 LIABILITY ANYAUTO AUTO ONLY-FA ACCIDENT 6 I, I OTHER THAN EAACC!.8- — AUTO ONLY: ACG I S I E%CESS/UM9RELLA LIABILITY I - EACH OCCURRENCE I OCCUR' I l CLAIMS MADE S AGGREGATE 3 — DEDUCTI9LE -- -- _._ RETENTION S 8 IWORKIICOMPENBATIONAND ) -- B EMPLOYER3'LIABILITY I ITORY LIMITSy I ER ANYPROPFIFTORIPARTNERfEXECUTIVE #.7PJUB903X38.9508 07/10�09 I O7/1O/10 E.L.EACPIACCIDENT -s 100000 OFFICF.R'MEMBER EXCLUDED? -__. _-- Ifyyes,daacdbe under El,DISEASE-FA EMPLOYE 8 100000 SPECIAL PROVISIONS bobw --• •- _ _ OTHER EL.DISEASE-POLICYLIMIT $ 500000 DESCRIPTION OF OPERA710HS!LOCA710MS/VEHICLES/67lCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS co co CERTIFICATE HOLDER '' CANCELLATIONto _ MYHOM,EK SHOULD ANY OF THE A20VP DESCRIBED POLICIES BEgANCELLED KPORE T C#�XPiRAT10 HEREO DATE TF,THE ISSUING INSURER WILL ENDEAV4 TO MAiI 31L DAYt3^4niRITTEN NOTICE TO TMIS CERT7FICATl1 HOLDER NAM26 TO THC LEFT,BUT FAIERRE TO DO SO BHALL MYRNA WILLIAMS IMPOSE NO 08LIG ON OR LJABILrIY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 14 B MILNE ROAD REPRESEHTATIV 9, OSTERVILLE MA 02655 AUTHORIZED REP ESE ATI E ACORD 15(2001/os) ANN LOUIS E CQ ACORD CORPORATION 1988 ,�� ''• TOWN OF BARNSTABLE Permit No. ____________-_.-.-_ Building Inspector Cash °Val• OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used, for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to '• 4, Ba43ett, Sr Address Baas Rtver, 1,1A Wiring Inspector c %� .ri Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department fJ. - `. -; f Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19_ .. _ ........................................................................_.......................__........ Building Inspector Ass'sessor s map and lot number �- z- 2- �.. .... S M MUST 6E pF t e Tod M v� Sewage Permit number ... . ELED.......................... � �Y !P'! COPJIPLIANCE �^ � A ARTICLE 11 ST"r�TE®W� t BARNSTABLE i o/ House number ......................... ......../..............,.............. �W039. C�� PAID _ -.. ro NAea twk TOWN OF BARASTABLE' BUILDING ) N.'SPECTOR APPLICATION FOR PERMIT TO ...... ....... ....... .. .... l .. .................................................. TYPEOF CONSTRUCTION ........ 1 '' .................................................................................................. :............ 3 .......19?V.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the'following information: Location ... �L-.. .....l.Y........ .... ...... .................................................................................... ProposedUse ..... . ................................................................................................................................................ ZoningDistrict ....�� .....................................Fire District .............................................................................. " Name of Owner ...................................................Address Nameof Builder ..........C�..c_.......�...........................................Address ......................................................?............................ rNdme of Architect ........7�o"^..^....-......................................Address ........................................................................ ........ Number of Rooms ...........Foundation ............................................. ....................................................... ................................. t ,Exterior ....... � a .... . .-----.Roofing ..........� "�, . .......................................... Floors .......' . ... ... .................Interior ....... ........,. .... .... ........ .........0.............................. Heating ..../. .........................................Plumbing ......... Fireplace ... • . ..........................................Approximate Cost .�..: :s ... ............. Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area ...../'Y .?�.... ................. ' Diagram ofNLot and Building with Dimensions Fee ... . . IS33.'.....- SUBJECT TO APPROVAL OF BOARD OF HEALTH >� I hereby agree to conform to all the Rules and Regulations�of-the Town of Bar table regar ing the above construction. i �`Name ..... .,... ::. ..• ........... ................................ �L -- ' ��- Assessor's map and lot number . '+ Sewage Permit number ................................. ....................... �`" o+► .�" BAUSTADLE, House number ......................... .° ...; ......................... :o rAea 039. r o 0 NOR TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION- FOR PERMIT TO ~'�:.................`-.............�... . .........../.................................................. ,-�CUr its,. - TYPE OF CONSTRUCTION ........................................................................................:............................................ ..........................: ..; .......19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... '.'.' ......:....f ._K...................:...................................................................f '' �?�a, c J Proposed Use ........ .......... ..................................................................................................I......................... Q. Zoning District ..?e et . ..........................Fire District .............................................................................. ~ Name of Owner .. r:}� `x-`e.a : "'.................Address ..:ate..... y .b. _:. .,:` `.o:..`. !:.`ice-..... Nameof Builder ..........`.a `..........................................Address ................................................................................. Nameof Architect ........`.'.......................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. r Exterior ......................................Roofing `...,`� .............................................. .................................................................................... LIB r Floors ,.............................Interior ......................................... .......................................... �... Heating .........:...........................................................Plumbing ...............V................................................................. Fireplace ......:f.^.... ..' .......' :.................................................Approximate Cost .'7..! r'................................... ................. �„ ' Definitive Plan Approved by Planning Board s___________________-----------19--------. Area .....�.��........`�:.............. Diagram of Lot and Building with Dimensions Fee -� SUBJECT TO APPROVAL OF BOARD OF HEALTH +' oi i I hereby agree to conform to all the Rules and Regulationsof°the Town of Barn table regarding the above construction. 1 / . Name ..! 1 Ck. :i�l , [-:..`. �<' Bassett, J. A. Sr. *I A=292-10 20655 one story No ................. Permit for ..................................... -Y ....... ............single fami.�,,)r dwelling....... .......... Location ......5.41�.Unc.l.e.Xi.l................y... ...... ... V .................... ............................................ Owner .......J.-...A.....B.a.sse.t.t.,...SK�..................... .. . ...... . . Type of Construction .......fr.=g........................ .....................I........................... Plot ............:............... Lo 119 Permit Granted ....... ..t.o.ber...1.0..........19 78 Date of Inspectio ....................................19 Date Complet d ......................................19 PERMIT R USED . .................. .. ...... ..... 19 ................................ ....... .. ........ .... ... .... ....... ......................... .......................... ......I.. ............ .. .. . .. ............/.. .... ... .................... Approved ................................................ 19 ............................................................................... ............................................................................... Y SOIL LOS \3C11 L><✓L,V/,Vr•�i.�r/G:r�+s�V/ / .tJY ��i.'Q 2'".PEASTONQ „...LOAM 8 FILL 12"MAX / ° e 0 0 4%.1. D I S T. BOX /a'MIN. 1000 � 24"MIN. ° t , a, � 1000— .GAL. d o b� ••.---•� .:.w..:. „��..� GAL. I, °' • PRECAST OR ;1 SEPTIC I. o, ,° t d I 5+► I: a BLOCK ` TANK I;'°a•'o . �SYE_EP�,A�G�E QPIT �` � • I i t, 1 i� r I'r''1 �„�{ . n u o o F+ a' � p0 0 I 170 Q -- 20' MINIMUM FOUNDATION 1 I ' . I I I '/:" WASHED STONE . µ ELEVATION SKETCH r. 10° ----j Dane. RATE SCALE, 1"_ 4' TEST BY P atrck,n,tsm,a ,y°+w1t►/- r=:r TOWN INSPECTOR: FINAL M;A$Jt4 fe _ BACKHOE -OPERATOR ; TEST MADE ON L. r 14 .� � t+�•wctrrnre� t � 1 ltx+D qnl� TNT fi'� �1� ra SE�' i976 " f 0�� -�• ►,/,! ' tam ,yrr't� CC►�Y �'O,Pc'�� Tza T/>✓�., f �R4� �f � � �;.'a� .�0.15✓/,y t�r „S',FzT'•,�T f+iG,C, t ,I > '*+ L tit 1 Lot r eqJ 5L Mirk To 't-i - 13.� a f x � Y:. t)Es��m��d��/� �ow� tta:�:��:��r:l~,�'=.�3CUQ.p,:cJ �i/v ga•-d�y�y�� r S Ao'�>art//� J"8s x c�SD ;�r" =• �1 >'' 7-0 AoD ELEVATION SCHEDULE ?G ~' PROPOSED SITE PLAN I INV. AT FOUNDATION ' 4 }� SEWA91 SYSTEM DESIGN 2. ! NV. INTO SEPTIC, TANK � + IN ��,, ,.} 1I NV. OUT OF SEPTIC TANK = JOO. a " `N !yr!?"l pw „ 4. INV. NTO t1kSTRIBUTION BOX " 60'rfli-41w-z_,ne: it, 4',,-1 WAY) SCALE: I"t Z! f' 5 i NV OUT OF DISTRIBUTION BOX 6. tNV INTO SEEPAGE PIT r "' CAPE COD SURVEY CONSULTANTS N_ i L9i1I ROUTE 132 3i Y . v"<'. 7, BOTTOM OF PIT - w„ - e t I ^KU14NIF - HYANNIS,MASS. l'Y: A DIVISION BOSTON SURVEY CONSULTANTS, INC. B. BQTTOM OF STONE LAYER g. _ ! ,,'�!«:?'.�'..Sal'' arc.��°`• ..