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Home My WebLink About0108 WHITEHALL WAY 1 f 08 LJ F�i�-a+ ka 1 1 [..cha t.( e J - - - - - F� r Town of Barnstable *Permi9t# 96 S 3 S �o �cti o Expires 6 months from issue date Regulatory Services Fee aaxNSTA `�' Thomas F. Geiler, Director Muss �p 1639 Building Division rFd 2 4 Z008 Tom perry, CBO, Building Commissioner - OWN OF B��NST 200 Main Street, Hyannis, MA 02601 AE3LE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wvUhout Red X-Press.Irnprint Map/parcel Number Property hAddress k! �N�S .�-- Residential Value of Work 4-�'6 a'Cam' Minimum fee of s25.00 for work under S6000.00 Owner's Name 8c Address 'TTJ� Contractors Name__ � Z1fv' l�("� Telephone Number `� � � � Home Improvement Contractor License# (if.applicabt'e) 1 � ❑Workman's Compensation Insurance Check one: ,RfI am a sole proprietor lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of insurance Compliance Certificate must be on file. Permit Request(check.box) AIA 6] Re-roof(stripping old shingles) All construction debris will be taken to r _ ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum,.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign.property Owner Letter of permission. A copy of the Frome Improvement Contractors License is required. SIGNATURE: . n Q:\WPFILESTORMS\building permit forms\EXPRESS.doC 'R evi c e(17 t11(1 R ✓jam �om?i�a �`/�cao �u�aeJa ` Regulations and Standards Board of Building g HQME IMPROVEMENT CONTRACTOR Reglstrjti, n 125982 Tr# 264908 Expiration 4/612010 s s e uidual j iX; Pi TY�i ;Yt1 MATTHEW M.DUNH LI L g;� MATTHEW DUNHI�L °f I :. 16 SWAIN CIR ° Administrator MASHPEE,MA 02649 j or registration � 1 egistration before the ex valid for individul use onl Board Piration date. If fou Y I of Building Re nd return to: One Ashburton PI gulations and Standards j Boston,Ma,02,08ace Rm 1301 �j Not v a li d wi t hout signature i ' I �� p o�.�,aaaac�iueetta ;/lie �ammaaruuP,at� �, , t g Board of Building Regulations and Standards � HOME IMPROVEMENT CONTRACTOR Registrat on, 125982 T 2649 '08 M Ex ►ration 4/6/2010 I?frn li Type Ind idual MATTHEW M.DU,NH LL z fW MATTHEW DUNHII11 16 SWAIN CIR x"% Administrator MASHPEE,MA02649 _ .___. t. License or registration gistration t valid for i he expiration date. use only ndividul I Board ofBuildin Iffound I ' One g Regulations return to: i t Ashburton place and Standards J Boston,Ma,02108 R►n 1301 Not valid without si 1 1 The.Common weaZfh of Massachresez`ts Depcartrrsent of Industrial Accidents Office of In estigations 600 Washington Street Basforz, MA 02111 �- wwlv.rrcass.gav/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El ectricians/Plambers Applicant Information Please Print Ledb Nainee (Eusincssloreaniza on/lndividuan: �l/AJy� y�l�� i • Address: �� (a.OA-t� CE�C.� - .. • City/StatelZip: Ah JZ441 J Phone.#: 9D` 9? 9 l Are your an employer? Check the appropriate bo�c: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction 11playces (full and/or part-time).* have hired the Ebb-contractors 2 a'sole proprietor or parintr- Jisttd on the attached sbcct. 7. El ship and have no croployecs These sub-contzactors have g; ❑Demolition employees and have workers' woil=ing for=in.any capacity. 9. ❑ Building addition [No workers' romp,insrTr_ranc C°�.insurance.t: S. ❑ We area corporation and its 10.❑ Electrical repass or additions rtgairtl] officers have exercised tl>Lir 11.0 Plumbing repairs or additions • 3.❑ I am a hDra owner doing all work myself [No workers' camp. right of exemption per lv1GL 1Z;§5Ro0f repairs in crrrancc r t c. 152, §1(4), and we havc no employees. [No workers' 13.❑ Other comp, m5urancc required] *Any applicant that ehccSu box#1 roust also fill out the section blow showing fficir work='compensation policy information_ t Homeowners who submit this affidavit indicating ffity arc doing all work and then hire outside cunt mctors must submit anew a$aavit indicating soda. tContraetnrs that check this box unut attrthcd an additional sbcct showing the name of the sub-coma d and state whether or not thost cntitics have crnploycrs. if the sub-ranhscto s have csaploy=r.,they must pm-vide their workers'comp.policy number. lam an employer that is providing workers'.compensation insurance for my employees Below is the policy and job site information. Inniranca Company Name: Policy#or Sctf--ins.Lic.#: Expiration Date: lob Site Address: 1d`� L�l}'f MU- LN_a �Sl��/5,�� City/5tatc/Zip: Attach a copy of theworkers' compensation policy declaration page(showing the policy number and expiration date). Fa Failure to secure coverage as required umcLmr Section 25A of MGL c. 152 can Iead to the imposition,of criminal penalties of a 1 tot lip to S 1,500.00 and/or one-year imprisonment, as woll as civil pcnalties in the farm of a STOP WORK ORDER and a fir of up to $250.00 a day against the violator. Bc advised that a copy of this gtatrmtrit may be forwarded to the Office of lavcstigations of the bIA for rncr,rar,cc coverer c vcrificatdon ldo her cent under the pain .and penalties of perjury that the information provided above is true and correct Si c: VDatc: d� — Phone f- O fizlal use only. Do not writer in fats area, to be compLeted by city or town officireL City or Towa: PermitfLicewe# Iggid g Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Tnspector 6. Other Phone#: o�YH�r� Town of Barnstable i Regulatory Services r �sAxrrAs '�` Thomas F. Geiler,Director Fo;A. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner-of the subject property t hereby authorize �� y�y/ to act on my behalf, in all.matters relative to work authorized by this building pernut application for: (Address of J"(ob) N* gnature of weer Date �AvE�rl�N�2o Print Name 4 If Property Owner is applying for permit please complete the Homeoamers License Exemption Form on th'e reverse side. Town of Barnstable �vo�YHEr�o Regulatory Services v, T -�^ Thomas F. Geller, Director + BARNSTABLE, MAC Building Division pTFD �a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.to-A,n.b2rnsi2b1e.rna.us Office: 508-862-1038 Fax: 5.08-790-6230 HOMtOWNER 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 t' r. supervisor. DEFINrTfON 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 permst. (Section 109.1.1) for compliance with the State Building Code and other The undersigned"homeowner"assumes responsibility applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department w rnirdmurn 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 ROMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomring work for which a building permit is required shall be exempt from the provisions of this section(Section Iog.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(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.1S) 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 Hrith a licensed Supervisor. The homeowner acting as supervisor is ultimately responsible. To ensure that the homeowner is fully awarc of his/her resp'onsibilitics, many communities require,as part of the permit application, that the homeowner certify that he/she understands the rrsponsibilitics 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 foraAcrtification for use in your community. :. e,U-4- i� �2�6 „Assessor's office (1st floor): oFTHETO As,sessor's map and lot number .... ..... `'�. Board of Health (3rd floor): 3 � �• fO � Sewage .. Permit number .............................. . ........:3...... Z BA NSTADLE, 0 Engineering Department (3rd floor): �n �� 'o $ a 7 � Al Tom' O 39• 0 House number. .. - p'�Dmo APPLICATIONS'PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... .'S (� C • 1 ./�J E' /l t w'l G� .. . .. .. .. ..... ................... .... ... . TYPEOF CONSTRUCTION ...... ............................ ........................................................................................... •........................ ....19.. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for af�permit according to the following information: Location ( '� c (.i� `,._JCC.............U................................................................ r E ProposedUse .....S.......{. .. -� ....... ' �..... ................................................................................................ /(Lt Zoning District ...... ..,....................................................1..........Fire District ......... Gn l`S Name of Owner ��.P..!'!........�.. ! ...Address ........�.......! x ................. ....................... .................. ......................................... \ /7 Nameof Builder .....:.... ..{C.. ................................. ...Address .................................................................................... Nameof Architect ..................................................................Address ....................................................!.e.............................. Number of Rooms ........`=� � .�. ......��J✓?C.�..e... Foundation ......... .. .......... IX ..Exterior ..W .. �..��:.. .....�eS J ..!....:. .......Roofing .............. ., .........C'.. ...... `..�r ................ J Floors �..1 � y'1 C/�, � ,� � ( ..................Interior rieating ........ ........... ...........�..`'`:--..............Plumbing .....a�....�e`:"C.�:�................................... J � Fireplace ...................................................................Approximate Cost �0 C�777-.� Definitive Plan Approved by Planning Board ---------_/__ �_!z19--- Area,1.......f................................... Diagram of Lot and Building with Dimensions Fee ' SUBJECT TO APPROVAL OF BOARD OF HEALTH " C X� _ I r f i ) OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / /T �� Name ............ .................... .. ........ ........... Construction Supervisor's License ` .... .. ..... GREENBRIER CORP. A=�r 1 32493 11 Story ,No ................. Permit for .......?........................... Single Family Dwelling ......................................................... Lot #3 2, If Mc--G- &e .ZjLive Location ................................................................ ..................! Y. nA S....................................... Owner ...Greenbrier Corp. s. ............................................................... Type of Construction -..F...r...ame............................... ................................................................................ Plot ............................ Lot ............................... Permit Gran+ed ....Rec,ember 8.,.......19 88 .................. Date of Inspection ....................................19 Date Completed .................19 1111-90