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HomeMy WebLinkAbout0104 UNCLE WILLIES WAY Uncle- r 1 i o�TM� Town of Barnstable *P rm t#SO S� S Re ulato Services Expires ee(months from issue date j 9� 16396 Richard V.Scali,Director i639 �� 1 Ee prED MA't p Building DiVin Tom Perry,CBO,Building Commissioh$ 1 200 Main Street,Hyannis,MA 02601 �ARNS�ABLE www.town.barnstable.mf Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ,? Not Valid without Red X-Press Imprint Map/parcel Number.��c� �%P�) ��17 Property Address U✓v� (� ,t�,�) Residential Value of Work$ 10,42a4 40 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address q��a u?/1. C- 1O6( 4464 v�� Contractor's Name Telephone Number �SCo'o Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Vr I am the Homeowner ` ❑ I have Worker's Compensation Insurance Insurance Company Name cry �0 a Workman's Comp.Policy# � , rn 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 0,&A ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side l Replacement Windows/doors/sliders.U-Value b C (maximum.32)#of windows 3 #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\F0RMS\buildink9.01 f rms\EXPRESS.doc - Revised 040215 i= ~ ne ComrHomvealth o,f-Vassachusetts Departnerit of Indramial Accidents - - O,j'w' e o,f Imwstigadmo s 600 Washington Street Boston,MA 02111 f% -urnas£gtlt°1dia '"jokers' Campensation Insurance Affidavit Br ilders/ContractorslEIecEr cians/Plumbers Applicant lnformatian Please Print&gibIy Name3ussbteesslDzganvationflndivitinal}:° Address: - M ` C� f�tattl t.a �? Pllcn�� Are you an employee6 Cheekthe appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑I am a general contractor and I employees(full and/or part-timed* 'have hired the sub-contrackws 6_ New construction 2.❑ I am a sale proprietor arpartner- Listed on the attached sheet. 7_ ❑Remodeling ship and bane no employees. These m3b-contractors have 8. ❑Demolition woddng far me in any capacity. employees astd have workers' 9_ ❑Building addition [No woriaers'comp_insurance comp.i asuranir"e-1 ,,/required-] 5. We are a corporationand its 10_❑Electrical repairs or additions. 3.M I am a homeowner doing all work officers have exercised their 1.1.0 Plumbing repairs or'additions myself [No workers'camp- righf of exemption per MGL 12.❑Roof vegans insurance regaue&]'s ' c.152, §1(4X andwe have no ,--,� D employees_[No wore' 13_I,�I Other comp_insurance required.] •AnyappKcs thatchedtsbox91Est also fill outthesectionbelow showing their walers'compensation policy k5nnatiom Homeo nms who submit this afMmgt ind xa mg they axe doing all wort:and then him outside contractors nmst submit anew affidavit indicati 6-such.. fCantxamrs that chest this borax must attached as additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.Ifthe sob-contactors have empI"s,they nnxstpxmvr-ide their workers'comp.policy number. lam art etizpk-ler tliat is prn ditzg workers'contwesatiart inmirance for lTzf enrplgyees Below is fate policy and jab rrta irforrnation Insurance Company Fame: Policy 4 or Self-ins-Lic.4: Ekpiration Date: Job Site Address: City/Statezzip: Attach a copy of the workers'compensationpolicy 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$1,500:00 anYor one-sear imprisonment,as well as chil penalties.in the fog of a STOP WORK ORDER and a fine of up to MO-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fir a der the pauis and penabYes ofperjury that the urfor?rratiot>prmritled abm a it tru8 and correct Sit tahtre. A Bate: O — /S aCJ ,Phone g- _ Officiai'use only. Do not write in this area,to be ownpletesd by city ortown official City or Town: PernzitUcense if Issuing.Authority(circle one): 1.Board of Health 2.Budding Department 3.CitylTown Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ' Massachusetts G--n=Bl Laws chapter 152 requires all employees tn provide wormers'compensation for their employees. Pursnraatto this Sbt�,aa.e7nplayee is defined as."-.every person in the service of another under any contract of hie, express or implied,oral or " An exrTroye-is defined as"an mdividnal,pmtnersbip,association,corporation or other legal entity,or any two or more of the foregoing engaged n a joint enterprise,and including the legal representatives of a.deceased employer,of the receiver or trustee of an mdividoA partnershT,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwPlli g house of another who employs persons to do mahtexiance,construction or repair work on such dwelling house or on the grounds or building apprrtenantthemto sball not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct building$in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25CM states Neither the.commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work untl acceptable evidence of compliance with the instrran ce._ requirements of this chapter have been presented b the contacting authority_" _ Applicants Please frill out the workers' compensation affidavit completely,by checking ihe boxes that apply to your situation and,if necessary,supply sub-contactor(s)name(s), address(es)and phone number(s)along with their-cmttficate(s)of himma ce. Limited Liability Companies(LLC)or Limited Liability-Partnerships(LLP)with no employees other than the members or partners,are not required to cant'wormers' compensation ins=ce. If an LLC or LLP does have employees,a policy is regnired. Be advised that this affidayrt maybe,submitted to the;Department of Industrial Accidents for confnmaiioa of tolerance coverage. Also be sure to sign and date-the affidavit The affidavit shoulld be retuned to the city or town that the application for the permit or license is being requested,not the Department:of „ ,str•ial Accidents. Shouldyou have any questions regarding the law or ifyou are reqc±-ed to obtain a workers' compensation policy,please call tie Department at the number listed below. Self-insured companies shouuId enter their s elf-iT= ce license number on tie 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 ions has to contact you the applicant of the affidavit for you to fr11 unit in the event the Office of Invest quiz y regarding app Please be sure to fill in the pelma t stow number which will be used as a reference number. In addition.,an applicant that must submit multiple per nit/license applications n any given year,need only submit one affidavit indicating current p olicy iafbrmation(if necessary)and under"Job Site Ad_re_s the applicant should write"al[locations in (city Gr 'sown)_"A copy of-the-affidavit that has been officially stamped or maiked by the city or tows may be provided to the applicant as proofthat a valid affidavit is on file for f tare permits or licenses A new affidavit must be filled oirt each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial Yentare (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would lake to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Depar inent's address,telephone and fax number: Thu C_Gnjon- we�alttt of Massachusftts Ilepaitnent of 1adusfiak Aoc itienta C�itoe 4f ftvestigatio.= (500,V7ashiztgtan.S`ie�(-_t ostans MA G2111 TffL 4 617'27-4900 Qxt 4-06 or 1-a MAS&AFR Fax 617-`27-7M 1Zevised 4-24-07 mgQWdia anaivsrasr.E. * - 9� MASS& ' Town of Barnstable prFD µp'�A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ina.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder,. I, (ad'? W , 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) Signa e Owner Date Print'Name , If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. . QAWPFILESIFORWbuilding permit formslEXPRESS.doc Revised 040215 Town of Barnstable - Regulatory Services FTHE r°ifr Richard V. Scali,Director Building Division tSTAB Tom Perry;Building Commissioner nsass. v 1659. ��� 200 Main Street, Hyannis,MA 02601 �pIFD � www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 19a / '/ ZS JOB LOCATION: 0 nu her street 4111age l P "HOMEOWNER": Vui�`?�N�O /D7 l/iLt T � o name home phonee# ork phon CURRENT MAILING ADDRESS: e #fy /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 kL eowner 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 rs— �T a� Town of Barnstable *Permit# 1Dpires 6 months from issue date f �° Regulatory Services Fee Richard V.Scali,Director � s63q. y HIS Building Division TOWN OF BARNSTAKC Tom Perry,CBO,Building Commissioner BARN STAKE C 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY i C� Not Valid withoui'Red X-Press Imprint Map/parcel Number y 6 ` `V Property Address_� �rC>l��e V V° f f 11���1� l ls1 1 V,lt L—CT I [Residential. Value of Work$ w Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address c Q�0 11 e C �en-5 i W Ulfs 51 - UVDLA5C LDD-C. VJ r)n ICAT McL OZ Contractor's Name �Cwemnaoe&rvih Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance t Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit lst(check box) f Re-roof(hurricane nailed)(stripping old shingles)' All construction debris Will be taken to l Do 1!`WW14 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) c ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (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 Ho Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\buViperrmitfbrrns\EXP\7fss.doc Revised 040215 2Tie Comrlroitivealth of-Wassaclimsetts Department ofIndustrial Accidents - - Off we of Im estigations 600 Washington Street Boston,CIA a2111 tP►vt1.?n�as�govfilui . Workers' Campensatian Insurance davit:Bnilders/Contractars/EIectricianslPlumhers Applicant Infarmat an Please Print Le- lbI Name 3>15�sst10rgani�atian/f�diu�dnal}: C C(�l � Address: 6 u e— City/statmr :W duannI's kA Ma UD anew qq"Lq �0Z� Are you an employer?Check the appropriate box: Type of project(required). I.❑ I am a employer with 4. ❑I am a general contractor and'I 6. ❑New construction employees(full and/or part-time),* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and haze no employees. These sub-contractors have g. ❑Demolition watddng for sae in any capacity- employees and hate workers' 9. ❑Building addition INo workem'Comp.insu anre Comp_insurancel rapired.j 5. ❑ We are a corporation and its 10 ❑Electrical repairs or additions officers have exercised their 3. lam.a hameau�er doing all work. 11_❑Plunlbiag repairs or'additions myself [No workers'comp- -ri&t of exemption per MGL 17_❑Rnofrepairs insurance required-]a c.152,§1(41 and we have no employees-[No workers' 13.❑Other . compAnsurance required-] $Any apphcantdhat checks box#1 mast also fillovtthe sectionbelowshowing theirworkere compensation policy information_ 1 Romownecs who submit this affichwit indenting t1 ey am doing all wal said Ikea lase aubide contractors mint submit anew affidavit indicating such- 1Cantrsctors thit eheclr ibis boon must attached an additianal street showicz the mmne of the sub cnmtracton and state whether.ar not those entities have employees. If the sub-contr actors have emplayw%theymustpmvide their worker'romp.policy number. I am are Below is die polity acid job site' informafiom Insurance Company Nam: Policy t 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 serum coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50a 00 and/or one-year imprisonment,as well as civil penalties.im the form of a STOP WORK ORDER and a f`xme of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification i I do hereby c under thepains ar males o,fpeg'aty th hire urf nUa#ioit prmz&d a V Is tru$mid current $i i Date: Phone Official use only. Do not write in thb area,to be crrynpieted by cft}'ortown ofj`iciat City or Town- PerrmitlLicense# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.CityITown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information. and Instructions Massar husetts Ge'neral Laws chapter 152 recp:irm all employers'in provide workers'compensation for their employees. PmMuantto this statute,an.cnplayee is defined as.--every Person in the srrvice of another under may contract ofhire, express or implied,oral or write" Au errTIoyer is defined as"an individual,,parfnershT,association,corporation or other legal entity, or any two or more of time foregoing engaged is 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 apartment and who resides therein,or the occagaut of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dweIlmg house or on,time grounds or building appu�thcreto shall not because of such employment be deemed to bean employer." MCrL 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 thre insurance.coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor nay ofity political subdivisions shall enter into any contract for the performance ofpubhc work until acceptable evidence of compliance vrith the insurance._ requirements of this chapter have been presented to the contracting aL fhor fy_" Applicants Please fill ob t the wodcers'compensation affidavit completely,by checking t-boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers) along with their certificate(s) of fi cnrance. 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 msoiance. Bran LLC or LLP does have employees,a policy is required_ Be advised that this affidayit may be submitted to the Department of Industrial Accidents for confirmation of ins=ce coverage. Also be sure to sign and date the affidavit The affidavit should be r-ctnmm(-,d to the city or town that the application for the permit or license is being requested,not the Department of huL_, tial A ccidests. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number lisi�d below. Self-insured companies should enter their mP s elf-i RTC ce license number on the appmpriate line. City or Town OtfiriaTs f - Please be sure that the affidavit is complete and prited.legibly. 'Ihe 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 confect you regarding the applicant Please sure to,s to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indirat u g current policy it r rmation(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or `.own)_"A copy of the-affidavit that has been officially stamped or maimed by the city or town maybe provided to the ' applicant as proof that a valid affidavit is on file for future perms s 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 venta-e (ie. a dog license or permit to burn leaves etc.)said person is NOT rcqoired 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 Ca=mwealtbE of Massaehvseti-s , { Degarfrneni<cif 1rid�ial Aec��ni� Boston,MA Gl 111 Tel.4 617 727-4900 Q�- 4€6 or 1-&77= 5AFF, Fax 617-`2'-7M xecvised 4-24-07 mas,s-gWidia pFtHE Tp� * MASS. Town of Barnstable prED MA't► M Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 as Owner of the subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit application for: n F' (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHILESTORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services Richard V. Scali,Director Building Division * ST Tom Perry,Building Commissioner nsass. 9Q� zG39. � 200 Main Street, Hyannis,MA 02601 pTED www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE E 9W XTION Please Print DATE: JOB LOCATION: (/s� Zr). (�number s t village "HOMEOWNER% _ Ce �,SS �r n ome�phone ,# work phone# . CURRENT MAILING ADDRESS: ci /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 proced s and requiremen d that he/she will comply with said procedures and requirements. Signa#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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services � Thomas F.Geiler,Director Building Division + sAMSTA1314 stn9s Tom Perry,Building Commissioner ��fo .t►��� no Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: CZ 0 0 HOME OCCUPATION REGISTRATION Date: Name: n e- t'�t.�f r�ti 2 1 Phone#: S�'S` C yS-i 70 z 3 Address: Q Un C Z� (.W e (� Village: �1Q1 G✓1 N)-J Name of Business: \,Z (/PAQr In Type of Business: / �'►1 Map/Lot. _J/�Z IlVTENT.. 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. o 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 is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick=up ue�•notzo•excced•one for-..capacity,and one trailer not to exceed 20 feet in length and not to exl=d 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 dwffi g unit . I,the undersigns ,have ad and agree with the above restrictions for my home.occupation I am registering. o Applicant W 1 U� Date y � YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS 01 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 form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: O (6 10 Cl APPLICANT'S NAME: jolciru- f1'1• F&xruz�, YOUR HOME ADDRESS: 1-01A Qr Gde. i,U i I I I" -S UJCLyY t1M 0 ;) (o0 . x BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION: NAME OF NEW BUSINESS 30-i-c r,-L `5 TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES XC NO ,rya.-06-3--01 ADDRESS OF BUSINESS l0i-j ynCTT W ,0 e S wCLU - [- anryn ; ,ri-ck, MAP/PARCEL NUMBER (Assessing) Caro 1 When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is 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 town. 1. BUILDING CqAut IVER' OFFICE This indiv een ' f r e of ny permit requirements that pertain to this type of business. L rized Si ture** MUST COMPLY WITH HOME OCCUPATION COMMENTS J RULES AND REGULATIONS. FAn COMPLY MAY RESULT IN FINFS 2. BOARD OF HEALTH This individual been i formed the p rmi (e uiremen s that-pEXtain to this type of business. Authorize ignature** ":` `''` ., . . NR1ST GONlPLY WITH ALL COMMENTS: R47ARDOUS MATERms REGuLAroNs 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual hauaj nformedrof the licensing requirements that pertain to this type of business. Authorized ignature** COMMENTS: i n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mapes Parcel O Permit# ? `;7 a J Health Division C-.2 4-6 rye ,r, y� Date Issued Conservation Division 'Application Fee Tax Collector /0�+� a� Permit Feea o d Treasurer �,�� O a SCEPTIC SYSTEV MUST L_: Planning Dept. 7— A STALlE®IN COMPLIANCE WITlb THE 5 Date Definitive Plan Approved by Planning Board ;t1V1pO',gMENTAL CODE fist,4Z Historic-OKH Preservation/Hyannis Project Street Address = - rm , �� Le fL"l-Q- Village J40AIN Owner cam_ rC°_ Address Telephone 1 31j— 4-�- Permit Request �Oi2��c% 7� 'ht uz ?Iun A d Heal 4�e AU c. S'/h6lic-t C"_ -ad ciu 1 Square feet: 1st floor: existing 1160 proposed 2nd floor: existing 11S1'�) proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ir 33R)tD Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure 1-15- Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 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 Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other _ Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal°stove: gYes '❑ No etached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑-new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name �y,-Ai A ki 41eofu Telephone Number J_OT�-39�elf 6 Address ill/'` /lip le License# 05tq.307 �•YA�2i1?�ol�� /�t�9° Home Improvement Contractor# 1/163D Worker's Compensation# �i5�73oq j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE / DATE FOR OFFICIAL USE ONLY PERMIT NO: ' j DATE ISSUED f_ MAP./PARCEL NO. ADDRESS VILLAGE OWNER S DATE OF INSPECTION: I FOUNDATION FRAME INSULATION # FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL e.7,,e.vim FINAL BUILDING ] DATE CLOSED OUT } ASSOCIATION PLAN NO. -- The Conimonweatth of Massachusetts -' Department of Industrial Accidents Office offnyestfosaaffs 600 Washington Street Boston,Mass. 02111 Workers' Cam��tion Insurance davit location- !/D f/ V lode, A)I LL Jes ( * city l oy is , AOL� phone# ❑ I am a homeowner performing all work myself. 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'.:+L:a .J J;.}:.:.r. +:r'•: •'x+ <T.•xa}:.•;•,:h, •{3;. •v • �-:x-Y Roy:,.,••... .. ...... ........a.,:.,.a t. ...x:.,•Y?:. •. .... t.,. . : ?••rn• .. ::.2•:r :.}....,.... .v {. : ..nS......4•.........:m, ..4..,...,t ,..Si.,'.tt•.{.. 4•v....{ t;• .. ix; .ti•`:•r•.:L'r,: ...............\..:...^},.,..:.. 4..: ..^.,....::..r:::.:•,...x::::::r.....,{.v.^,..N.y...:.x.. ......n4..:..,{..{�: i.{•:.•.:Y{:•:• i :4:}3'4:•'.•}:`.::`v?:�^x•:$$:•}.'•:.v.:{4}}j:::::t�•.:{•�n?:,;.;.::... .,:r. a.:y^^..,....:....,...,.... ., n;.j4: yt n.>.r w ......,,.?. oli # •nyaraace:cn•.: .:.:.:.Y:.>}>:$:$:.}h::t�:::T}:•y:4}::•}:•}R:{.;.:4:;?G:... •.r:3...,?.:.. ::.G.:,?.; / Fnnme to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of Uftdnal penaltia of a fine up to$1,500'00 and/or one yeah'imprisonment as WCH as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me: I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u&the pains and penalties of perjury that the information provided above is trn•'and correct Signature L i"l �ll/1�4 (� Date Punt name SUetQ Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building DepE ent ❑Licensing Bo ❑checkif immediate response is required ❑Selectnua's e []Health Department contactperson: phone#; _ ❑Other,,,+_.,., WAwd 9195 P)ql Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any 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 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until chapter have been resented to the contracting i e insurance requirements of this hap p acc table evidence of compliance with th ep . authority. po Applicants I� please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe y 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 retained to the city or town that the application for the permit or license is Accidents. Should you have any questions regarding the`haw"or if you being requested, not the Department of Industrial are requiired to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the 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 peimi cease number which will be used as a reference number. The affidavits may be retume3'to the Department b mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents amce of investlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 . FtHEr Town of Barnstable a Regulatory Services s saxrasxaer. Thomas F.Geller,Director �Dp Sbj �1� 9 rEo 5� 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. * _00 - Type of Work: Estimated Cost 25 Address of Work: f0V olicle � / rY,1rLL,&S W4 , 1JAItS AA. ©26®/ Owner's Name: ?4A7 ZVI�Ig,eclS Date of Application: �7 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 Building not owner-occupied ❑Owner 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: -7, ��i4e //V6 3® e istration o. Name R N Date Contractor N g OR Date Owner's Name °F� Towti Town of Barnstable Regulatory Services 9 BAm i.s,� Thomas F.Geiler,Director m .6g9. , Building Division pTED MA'S a Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I — , as Owner of the subject property hereby autho 3_rize E. - La An rnn to act on my behalf,. in all matters relative to work authorized by this building permit application for: Ile (Address of Job) U. Signatute net ate Print Nam Q:F0RMS:0 VR,MWEP MISSION .'� ✓lee yr ad - �'` BOARD OF BUILDING REGU.LA4TIOWS xt `License:,G©NSTRUCTI"ON SUPERVISOR Number"DE S., 05.8307 �- " zRuesx;:®5/02/2004 Tr.no- 21686 Res�icte'd �00 STEVEN'M LEBARON L 54 TROWBRIDGE W YARMOUTH, MA olt73 Ad,lhistrat'or Board of Building.Regulations and Standards " HOME IMPROVEMENT CONTRACTOR RegLs vn' 1,14630 Expira4n. 1 /7/,2005 N _ .. r_ yType- lr�d�3idual STEVEN M.LeBX1RN CCISTRU� gfffrAN LeBAR0:iw1 " 54 TH.ROWBRIDGE PATIO _ C.z..., W YARMOUTH,MA 02673_ Administrator ivi __ Ad'm5fiistra`tor h • 11:�' CERTIFICATE OF INSURANC;E P -. ISSUE DATE,A! -JIB;-;'v PRODUCER I-22-03 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Ralph`Talanlan Insur an.ce Agency, Ltd. NO RIGHTS UPOiV THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, J Union Street EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOVV S . !t)eymouth, !iNIA 02190 COMPANIES AFFORDING COVERAGE COMPANY CODE SUB CODE LETTER A Phenix !\lutual Pare Insurance Co. INSURED COMPANY B LETTER i Steven Lebaron coraPANv 54 Trowbridge Path Road LETTER C W. Yarmouth, AIA 02673-1528 COMPANY LETTER D 1 COMPANY E I LEI-TER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED; NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPCT TO CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL HE!TERTHIS MS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. :O ! TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION. GENERAL LIABILITY DATE(MM/DD/YY) DATE(MM/DD/YY) ALL LIMITS IN THOUSANDS New XX COMMERCIAL GENERAL LIABILILIABILITYGENERAL AGGREGATE S 2,000, 07�01�03 07/01/04 PRODUCTS COMP/OPSAGGREGATE S 1,000, CLAIMS MADE OCCUR. ADVERTISING INJURY $ 1,000 I OWNER'S$CONTRACTOR'S PROT. PERSONAL& , EACH OCCURRENCE S 1,000 , FIRE DAMAGE(Any one tire) S 50 ? AUTOMOBILE LIABILITY MEDICAL EXPENSE(Any one person) S 5, f ANY AUTO COMBINED r SINGLE $ I ALL OWNED AD ros LIMIT / fSCHEDULED AUTOS BODILYINJURY $ 1 HIRED AUTOS (Per person) i NON-OWNED AUTOS BODILYINJURY $ GARAGE LIABILITY (Per accident) PROPERTY. •i EXCESS LIABILITY DAMAGE $ I EACH AGGREGATE I OCCURRENCE - OTHER THAN UMBRELLA FORM $ $ I s WORKER'S COMPENSATION STATUTORY AND S (EACH ACCIDENT) EMPLOYERS'LIABILITY S (DISEASE—POLICY LIMIT) 1 OTHER S (DISEASE--EACH EMPLOYEE), i i i SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL.ITEMS ' i ERTIFICAT- HOLDER CANCEL LA'TION• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY; ITS AGENTS OR REPRESENTATIVES. . .... .......... .....-. AUTHORIZED RE PR E S E N TATLyE .. --. ` i =:-&'RP&RATION 1988 Map Parcel 00','3.• 0 /V Permit# _ 3 00 q I House# /0 Date Issued ^' / Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 'Tg, Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) PlaIn'nu (1st floor/School Admin. Bldg.) _ SEPTIC SYST*E7 DeApproved by Planning Board 19 INSTALLED 1N �1 WITH TTOWN OF BARNSTA 41gONMENT �9 N REGULATIONS Building Permii Application Proddress 10 2 C.S WAVVil ( � V1 Owner kl/( ( Address � alllof kk? Telephone - �Permit Request First Floor /T,���� square feet Second Floor square feet Construction Type 1 0 CZ kDM JA­, Estimated Project Cost Zoning District. Flood Plain Water Protection Lot Size Grandfathered ❑Yes j No Dwelling Type: Single Family ! Two Family ❑ Multi-Family(#units) Age of Existing Structure ` Historic House ❑Yes �No On Old King's Highway ❑Yes ❑No Basement Type: j Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing i New Half: Existing I New No. of Bedrooms: Existing�7 New ✓C th Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes *No Fireplaces: Existing New Existing wood/coal stove ❑Yes XNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) one Shed(size) / N ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name ' Telephone Number 5 p Address License# Home Improvement Contractor# -� - Worker's Compensation# - NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE A? BUILDING PERMIT DENIE OR THE FOLLO ING REASON(S) r FOR OFFICIAL USE ONLY ; v PERMIT NO. 6XTE ISSUED ' MAP/PARCEL NO. ADDRESS . s VILLAGE OWNER ? t DATE OF INSPECTION: FOUNDATION f t FRAME INSULATION FIREPLACE - t , ELECTRICAL: mgOUGHS, FINAL :� Fes- � • i - - ! PLUMBING: R( GH FINAL' _ GAS: in in M FINALca k y FINAL BUILDING V ± }t r.. DATE CLOSED OUT; i- t�? 1 ASSOCIATION PLAN NO. rr _ CFAME T . y The Town of Barnstable e�uvsrasi.E. 9q� MAM ,0�' Department of Health Safety and Environmental Services ArFD MA'�� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: /AOL� O40�,-J Est.Cost �7J g Address of Work: D Owner's Name Date of Permit Application. I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner 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. O lei Date Owner's Na w The Commonwealth of:4tassachusctt-1 Department nt of Industrial Accideras � t �_va - : F olliceatlayest/gatlotts 61111 ff iaslritr„tun Street 4`'��.�-• Z. Bustorr.,ltrrsr. 02111 Workers' Compensation Insurance Affidavit --ii nn inf m inn.. PI P R I NT 61"-•--- ------ •�. hnn.r♦I am a hoZVeowner performing all work myself. I am a sole proprietor and have no one workina in any capacity 1 am an emplover providing workers compensation for my employees working on this job. cnntnanw• name. adrlresr. phone it• insurance rn. pnliev# 1 am a sole proprietor. general contractor- or homeowner(circle otre)and have hired the contractors listed below who hay t the following workers' compensation polices: cmmrlans" nate, adrlrra.• rip•- nhnnc!r• incrrrancr rn nniiry M cmmnnrn name mldr"v- rin•- nhnnc!t• incurancc co policy tt —77 Fa;iure to secure cos•craee as required under Section=.4A of AIGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 andiur une wears'imprisonment:is%well:ts civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. t understand that n copy of this statement ntav be forwarded to the O1iice of investigations of the DIA for coverare verification. I do Aercnt•cerri r +r der r ie prrias r penalties of perjun•tha c information prorided above is true w "correct Sicnature Date Print name Phone; ofTicial use only do not«•rite in this area to be completed by tiny or town oftkiai city or town: permitilicense if rJUuilding Department C31-icensinr Board L 1:check if immediate response is required 0Seleetmen's Omce 1 (:311c2lth Department hone th 00ther contact person: P p. t Information and Instructions MtiSsaehUNCUN General Laws chapter 152 section 25 requires all employers to provide workers' cnnipcnsatian for 1:; employees. As quoted from the • law-.an emptoree is defined as every person in the service of :ittc+they under any contract of hire, express or implied. oral or�vrincn. An rmp/orer is defined as an individual, partnership, association. corporation or other legal entity. or am, two or me the foreuoing enuaged in a joint enterprise. and including the legal representatives of a deceased employer. or the individual . Partnership. association or other legal entity, employing employees. HoN%,e,.•e- receiver or tntstce of an P P owner of a dwelling_ house haying not more than three apartments and who resides therein, or the occupant of the dwcllin�_ house of another who employs persons to do maintenance , construction or repair work on such dwelling ii, or on the__rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio. MGL chapter 152 section 25 also states that every state or local licensing aency shall %vithliuld the issuance oi- l-5renewal of a license or permit to operate a business or to construct buildings in the commonwealth for urn• applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally- ncithcr tite 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 citapt�r been presented to the contracting authority. Aplllicanas Please fill in the workers- compensation affidavit completely, by checking the box that applies to your situz"tion anc Supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affiJawit. 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 reauirc- ° to obtain a workers' compensation polic}•. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P' be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to give us a =11. 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 fax T: (617) 727-7749 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE _ ..... , J B LOCATION N er Street address Sectio of town " OMEOWNER" Name Home phone Work phone - PRESENT 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, 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 Officia on a form acceptable to the Building Official, that he/she shall be responsiblEl for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Sta± Building Code and other applicable codes, by-laws, 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which aabuilding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ' Owner actir. as supervisor is ultimately responsible. :. .,. To ensure that the Home Owner is fully aware of his/Fier responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. r _ 157.55 LOT /4 LOTH N 12 45'+ IDDeck , F46.2 HSE. 104- _ _ _ _ _ I /• Overhang 2$� N 15.86 99.14 UNCLE WILL IE'S WA Y RES. ZONE., RB FLOOD ZONE., "C" THIS mbFz-rGAGE INSPECTION PLAN IS FOR BANK USE ON Y TOWN:�IYANNIs REGISTRY OWNER: ✓UD/TH A. /CENT DEED REF:_6308/332 BUYER: JEFFREY C. d KANDY A. RUTHERFORD DATE: • 2122189 PLAN REF: 342156 SCALE: I "= 30, .1 heirle--B—y certify that to buiiding shown on this plan is located on ��NH OF Mgsf VANKEE SUFZVE1l the ground as shown and it o�� PAUL 9`a CONSULTANTS Position does c ntor= to the 4 A. �, 70 RASPBERRY.LANE zoning law setback requirement of MERIT'HEW N MARSTONS MILLS BARNS TABL E No. 32008 Q 9 ao MASS 02648 and does not lie within tf a special ��F�aE,;ISTEO flood hazard area as shown on �ipNgj L010 .th h. u. d. * flood map dated This plan not made from an instrument Paul A. Herithew, RPLS survey,__ not to be used for fences etc 4982 a CRYSTEX6 COATED TEXTURED SEALANT 35 Year .� C din atl '1 Limited ._ , - Wall I - amon:.qu co or�printed _ y - Warranty 1 G stMtr d - 3Seaon"NoChage" 1 � � steel wa11 Crystex coated i t r to a t 7 a t � xtu ed a Ian �� Covers _� Full contoured molded.resln R Q" �4MDeluxe.roll formed steel g ite with Cry Wh stx®coatetl - Atextured`sealant g . . aw Verti6ls6" Deluxe`box roll forrried - t . . � eel White 1 Rails' a�1° steel universal top a nd ll� „ bottom rails-painted. i Platesc. 6" steel universal top and bottom plates. Hardware: Stainless Steel. 1 Size: 48" Deep. Steel Core Frame Steel Core m P�JO \ Wall Copper Beading Alloy Alkaline lkaline Cleaned - G71 Hot-Dipped Galvanized Copper Bearing Alloy Cleaned Alkaline Cleaned Zinc Bonderized Coating G115 Hot-Dipped Galvanized Chromic Seal Alkaline Cleaned Primer Coat WeatEnamel Zinc Bonderized Coating Painted All P otedh er Coating Chromic Seal ROUND SIZE 48"POOL SQE$ Four-Color Printed Pattern Primer Coat 1 (approximate) ° C ryatax®Coat Textured All Weather Enamel 18ft.x 48 in OVAL SIZE Ah-Weather Sealant Painted Protective Coating x m. 24ft.x 15ft.x 48 in. POOLS ARE NOT DESIGNED Both Sides of Frame 24ft.x 46 in. 30ft.x 15ft.x 48 in. 27ft.x 48 in. 33ft.x 18ft.x 48 in. ®- FOR DIVING OR JUMPING! DELUXE ENAMEL COATED 4 Year Wall: Bronze plank steel wall . ZOW��y 3 Season"No Charge" Covers: Supporting contoured molded resin.White. Ledges:. 6" Roll-formed steel.White color. Verticals: 6" Roll-formed steel.White color. -}.Rails: 1"steel universal top and bottom rails-painted .. Platesa 'x 6" steel universal top and bottom plate's" Hfr. Hardware Z inc eDlchromate _ k t� " FrameY. Wall Steel Core t ti w f Steel Core Copper Beading Alloyy J Copper Bearing Alloy Alkaline Cleaned z ` Alkaline Cleaned G90-Hot-Dipped Galvanized "r G90-Hot-Dipped Galvanized Alkaline Cleaned t Alkaline Cleaned Zinc Bonderized Coating1 Zinc Bonded'w"oafing; Chromic Seal Chromic Seal - Primer Coat Primer Coat-` All Weather Enamel c 4 + All Weather Enamel Painted Protect ve Coating Painted Protective Coating, Printed Panern „ ROUND SIZE OVAL SIZE a - Both Sides of Frame : E dedor Poly 15ft.x 48 in. 24ft.x 48 in. r Textured Sealer L (approximate) C". 18ft.x 48 in. 21ft.x 48 in. 27ft.x 48 in. 30ft.x 15ft.x 48 in. MaN -Partra yea y � V, �'r` �' �p��Pcy ,��-� �..� L "�- v •r l"3 d.` L:. �.(:_ ?;e„ .,�€. ,�.,°.' "'f . ':Z s :3 y„ - C 'Assessors map and lot number ..............:..... 1. - L f'THE tO • Sewage Permit number . . .. House number = B9Ba9TSDL t ............................rib.�.I .......................... 1f5�TF NAM SEPTIC �S rALLED 1� CO"PF LIANCE °''�a MAX a`e TOWN OF BAR N�4 �,t A IDEND E. �l8RO . NIN BUILDING - INSPECTOR APPLICATION FOR PERMIT TO ...... t....... ..........:.......... - TYPE OF CONSTRUCTION ..0 .l. f LPG !`! :�1. .. ..!K.C� �....MeD i� aK......... .................19..:�':� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /...........� ......... ...... ..Y We ........... .......................... ProposedUse ....4. ! .. 7.` .... 6.1 4.1iVI ................................................................................. Zoning District .....B.sA ......................................................Fire District ./7 /..Y... ............................................ Name of Ownerp4 fRkh�/.9.e.:CU'lfl.1341114?A'Px�..P�:W4CAddress .,/G..!�1/1 � ..�AY .......5A.e..l�J Name of Build+ j'r/i�� /..4� 'D ' ,04k..'XAeS..AddressG,,, a. � �r17.....1./. c......S�c... .czywsl f l - Name of Architect / iSi��r.... 1� / .....Address ..,1 '¢ /7'.a....�.!/Z..rl Number of Rooms .............. ...............................................Foundation /��..../-V 1,1. .l h......(.a.r ONUs—l.:eE Exlerior .......{/.1�1��..Q..D............dl.i..J.s1.lnY....................Roofing ...A .. . ...F. .. .-r.................................. Floors .......... .sf...: �'..t .......... ....! .....................Interior .... ,�i�, 'r ! [ ................................... Heating ... . .. .c. "T ..Le ......................................Plumbing ....../...f.. t... .j��.��t`�.�................................... Fireplace ............. ./. .,d..............................:...........................Approximate Cost . .�14 emf°..... .... .... J.. Definitive Plan Approved by Planning Board l � �/S____l_ �___19_ ✓. Area .I..Q . .....S. Diagram of Lot and Building with Dimensions Fee 6.q SUBJECT TO APPROVAL OF BOARD OF HEALTHf ' jj � . i Wle,Li OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abo e construction. Pam/ A, S7,.,/ Name ...... :'!ZT,✓::... " Construction Supervisor's License .e.e.. 9...��. & SON BUILDERS, INC. r-''No .2652.6..... Permit for ... ............ Single Family Dwelling .................................. Dwelling Location ..Lo...t.. 14, Way ................... ................................................ Owner .....Petrord &. Son ................... ................... Type of Construction Frame............................. .......... ................................................................................. Plot ............................ Lot .................. .............. . Permit Granted ... ............. ........19 84 Date of,lnspection ............................:%.....'A-9 Date tomplejed ... ...ice"""""" 49 j,' , OF1,BARNSTABLE" ., Permit 'No 26526 1} x t Building Inspector r Cash -k B �!r� '"pY. OCCUPANCYf PERMIT ond ,. ;`Issued-toy ' 41Petroni & S6n Bxillders, InAddress ' f.4 1ot ��14 `i,. •1047.Uncle:Wifi ��ay. Hyannis` z 3 Wiring Inspector• l Inspection date `.L! plumbing,- Inspector x :.� �� Inspection date 'Gas Irispyeator Inspection date f , i Engineering Department Inspection date Board of'Health G Il ? Inspection datef/z` 2 TdIIS PERMIT. RILL NOT-BE VALID AND, THE BUILDING.SHALL.•NOT BE IOCCUPIED UNTIL•=, ' SIGNED, BY 'THE BUILDING jNSP,ECTOR' UPON- SATISFACTORY•'COMPLIANCE ,WITH TOWN`: r REQUIREMENTS AND .IN.ACCORDANCE`'r,WITH:SECTION 119-0 OF-THE�MASSACHUSETTS`STATE BUILDING CODE _ ,r ` . '. r: r~ - .. 1 ............................................. 1 Building -Inspector —'�.. °,ems TOWN OF BARNSTABLE BUILDING DEPARTMENT t sssassAm, : TOWN OFFICE BUILDING �� Y6 9• �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: 01/ An Occupancy Permit has h a been issued for the building authorized b P Y g Y BuildingPermit $#...: <»L `' ............................ ................................. ».».... ..................»........»..»» issued to ` ' :.......?`..» ' ..� ............... ...... .»......».».»..»» .. Please release the performance bond. I PLAN VIEW : 5CA L E C) 3Z ja3 Lr-AG 9 tl Apr 17 1 lo G.14 K CRVE Z 0 T 3 3 0 5 F ,,x RV,-vv X0,4q -oi 4ndrcv, PLAN VIEW SCALE : / 20 56, Prr -41 OL oo } ! ti 1. LUT / y 1 t /? 337. � 1 5 7,5�