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Home My WebLink About0025 WOODBURY AVENUE a��v �� __ i �p�'oFTME Town of Barnstable *Permit# 7 Expires 6 months from issue date MAM Regulatory Services Fee & p � Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 _ Office: 508-862-4038 X-PRESS t `R Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL OAkj 1 6 2004 Not Valid without Red X-Press Imprint TOWN OF BAD:;; Map/parcel Number 3 0 1? Q Property Address [-Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address LIo dv L " Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 0-4 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate'must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to Q � �vtr•►OS �-- ❑Re-roof(not stripping. Going over existing layers of roof) Eg-Re-side ❑ Replacement Windows. 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. Houle Improvement Contractors License is required. Signature Q:Fom-s:expmtrg Revise063004 Engineering Dept.(3rd floor) Map Parcel ',» 9' Y Permit# (�� House# ' rl?s Q rr. y`' Date Issue Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) SEPTIC SYSTEM MUST BE Planning Dept. (1st floor/School Admin. Bldg.) INSTALLED I PLIANCE WI Definitive;Plan Approved by Planning Board i 19 E AND �- E ; ENVIRON N a NS s` TOWN OF�BARNSTABLE TOW N 'F°'�' s Building P,,//e��rmit Application Project "Yet Address �U�U Y�Ur 1-j U Village E Owner Addressq.vv�.Ci Telephone -7 71 -l u t 5 r Permit Request via- (� A VA First Floor square feet Second Floor square feet Construction Type L,r i of QAK� Estimated Project Cost $ 0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family M Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ANo -On Old King's Highway ❑Yes QrNo Basement Type: U Full bLCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 400 Number of Baths: Full: Existing;— New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas aOil ❑Electric ❑Other Central Air ❑Yes WVo Fireplaces: Existing Id 0 New Existing wood/coal stove ❑Yes ❑No Garage: 5LDetached(size) d1J xQJ-L Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) r ❑Other(size) =1 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes RNo If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number [ (Q C Address gs a 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 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED' _ MAP/PARCEL NO. 7 - ADDRESS VILLAGE " OWNER DATE OF INSPECTION:. FOUNDATION FRAME r INSULATION 6 .FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ri3 S ROUGH r FINAL GAS: Iq- ,', ROLSG`H FINAL , _ FINAL BUILD if DATE CLOSED , _ ' r 1 ASSOCIATION PP ,ANIO.a la . The Town of Barnstable Department of Health Safety and Environmental Services 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 F . 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: Est.Cost Address of Work: Owner's Name Date of Permit Application: 1 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. OR Date Owners Name The Cu»rmoitivealth of:I&.v.%achuscrtr Department of IndtrrtriQl.-�cciderrts V 3 1 • F 0lticeollnvest/gatlooS 600 !f'aslrinl;ton Street •�� ,:' Boston. A1uas. pZlll Workers' Compensation Insurance Affidavit � It :tntinforntation• Please PRINT le��( Y _ name, catinn� city ohnne d 17 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity [i I am an employer providing workers' compensation for my employees working on this job. emmmarn• name: adtlress- • city ahnne#• insurnnce co. rplicv!! [ii I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: cmmrinni• name, adclresr. sits !hone#- insuranre ro. nnlicv 0 -+-t.. -- _- r�:i : ^��t7�••r�.-...5 _ .:._ ...w-�. ..i...._... _ cmmpnnv nnmr* atldresc� city phnne#- insurance co nnlic�•# Attach additional sheet if neccs_sa_ry -- * --+� y y. _ _�":r::% ''.�"'•=`� + °-- �' ^_ F:lilure to secure cuveraac as required under Section io Z5A of NIGL 152 can lead to the imposition of criminal penalties of a line up t 51.500.OU ndiur unc s cars' imprisonment as hell as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a cope of this statement ma% be forwarded to the Office of Investigations of the DIA for coverage'verification. 1 tlo hereby ccrrif•tattler the pains and penalties of perjure•that the information prorided above is true and correct. Sianature Date Print name Phone# ' of-coal use unN do not write in this area to be completed by sin or town official , ci» or tmvn• p:rmitJliccnse# r•tBuilding Department C3Liccnsing Board !]check if immediate response is required 0Scleetmen's Ofricc ! E311ealth Department ... contact person: phone#; nUther `% Information and Instructions , Massachusetts General Lays chapter 152 section 25 requires all employers to provide workers* contpensatian for th emplo'N-'ees. As quoted from the "ta��". an emplgree is defined as every person in the service of another under art% contract of hire, express or implied. oral or written. An emplurer is defined as an individual, partnership, association. corporation or other legal entity, or anv two or me the foregoing en a`_cd in a joint enterprise. and including the le al representatives of a deceased employer, or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. However�? owner of a dwelling_ house having not more than three apartments and who resides therein. or the occupant of the divc1ling house of another who employs persons to do maintenance , construction or repair work on such dwelling: he or oil the _grounds or building appurtenant thereto shall not because of such employment be deemed to be an empioye MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or hermit to operate a business or to construct buildings in the commonwealth foram applicant who Itas not produced acceptable evidence of compliance'svith the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into anv contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. .L Applicants 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 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 affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are require. to obtain a workers* compensation policy, please call the Department at the number listed below. City or I ON n5 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. Pit be sure to full in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Ittyesti_ations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to _give us a ca11. . . 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 #: (617) 727-7749 (41—,) 777_.lOOfl P'vt 106. 409 or 375 • TOWN OF BARNSTABLE ; • BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . • . DATE fl•J _l7 JOB_ LOCATION Number Street dddress Sec ion of town "HOMEOWNER"7-L, Name Home phone Work phone PRESENT MAILING ADDRESS S c,)ac)&AY ` = - i V . C ty town State Zip ccde The current exemption for "homeowners" was extended to include owner-occ-u= 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 r side, on which there is, or is intended to be, a one or two family dwellihc attached or detached structures accessory to such use and/or farm structure:. A person who constructs more than one home in a two-year period shall not bF ' considered a homeowner. Such "homeowner" sha1.1 submit to the Building Of__: I on a form accept ' able to the Building Official, that he/she shall be resons: for all such work performed under the buildinc permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the uilding Code and other applicable codes, by-laws, rules and regulations. he undersid ned "homeowner" certifies that he/she understands the Town of arnstable Building Departament minimum inspection procedures and requirement nd that he/she will comp with said procedures and requirements. IOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be required 0 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,- &-building permit is required shall be exempt from the provisions of this section (Section I09. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a persons) for hire to do such work, that such Home Own 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 awaren: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the nlicensed person as it would with licensed Supervisor. The Home ''Owner" act _ as supervisor is ultimately responsible. % .,. To ensure that the Home Owner is� fully +aware of his/her responsibilities, ma communities require,: as part of the permit application, that the Home Owner 'certify that he/she understands the responsibilities of a supervisor. On t Last page of this issue is a form currently used by several towns. You may- -are to amend and adopt such a form/certification for use in your community. CA;;x r • V I 1.�1�w rzM T , �x °DTI. N fL eme Jotfor — !.s m �. _ IIOIY�elIIS.�.1./� ■ f Ili