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0044 WOODBURY AVENUE
Z141 /9 VE Application number Fee........... ('0 ............72.7...... ......................... Building Inspectors ........Initials...UD Date Issued... ............................ Map/Parcel............................. ......F............. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 44 Woodbury Ave Hyannis NUMBER STREET VILLAGE Owner's Name: Lorraine Mitchell "Phone Number 617-797-5921 Email Address: Cell Phone Number Project cost$ 7,200.00 Check one, Residential X Commercial OWNER'S AUTHORIZATION As owner of the above"property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date:, TYPE OF WORK Siding Wiiidoiws(no header.change)# Insulation/Weatherization E3 Doors(no header change)#. Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to S&J Exco Dennis CONTRACTOR'S INFORMATION . Contractor's name Anatoli Sivitski Zl-?e Home,lmprovement,Contractors Registration(if applicable)k 168043TI�2 (attach copy) Construction,Supervisor',License 4 106040 (attach copy) Email of Contractor capecodihc@gmail.com Phone number 617-710-1061 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATION NUMBER............................................................ *For Tents Only*. Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours. of 8.00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number F I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLIC T'S SIG ATURE Signature 44a&g; ate 4/18/2019 All permit applications are subject to a b aiding official's approval prior to issuance. The above rites i - . s ec fications p p and conditions are satisfactory and are hereby accepted. BELCAPE CONSTRUCTION,LLC is authorized to do the work as specified. Contract total: $ a If acceptable,initial here: Payment will be made as such: 1 11 Deposit 1/3 $ 4 Start day payment 1/3: $ Upon completion .1/3: $ J Date: // / Signatures: �iJ41 Note:No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. You,the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. Accepted By: Date: THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL: 44 Woodbury Ave Hyannis The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Bwlders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /C� -brc. rUG/�O�r lr c Address: �{ 9-z>0C/fWcc —X &4_1e ` City/State/Zip: Oy e Dl Phone#: .�lj'—'6 F,1 97 Are you an employer Check the appropriatebox: Type of project(required): 1.El I am a employer with . am a 4 I general contractor and 1 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 have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance•= required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner do all work officers have exercised their I L Plumb' doing ❑ mg repairs or additions myself[No workers'comp. right of exemption per MOL 12.❑Roof repairs insurance )t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance requfred.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compenseflon policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside conbactors must submit anew affidavit indicating such. ;Contractors 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 inform adom d Insurance Company Name: iC/ M (�Q&4 Policy#or Self-ins.Lie.#: 42cz O Z�!Lfa Expiration Job Site Address: `1 7 City/StaWzip: h cc syr./$• Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL 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 forpsarance,coverage verification. I do hereby c ' u pains enables of perjury that the information provided above is true and correct. Si Date: Phone#: SO —6" — 97,90 Qfjkial use only. Do not write in this area,to be completed by city or town of 4cial 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#: Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement:Gantractor Registration f s Y Type: LLC Registration: 182457 BELCAPE CONSTRUCTION LLC 4 ;<< Expiration: 02/05/2020 42 WOODBURY AVE HYANNIA,MA 02601 ? ; Update Address and Return Card. SCA 1 G 2OM-05/17 r'�.e �irziriouve¢�l�o�.%/�rrs�a ur.1eCG3. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only 17�fP.;E:LLC before the expiration date. if found return to: RiiqIstratior�__-_ 901raffion Office of Consumer Affairs and Business Regulation j82_7--� ,02/05/2020 10 Park Plaza-Suite 5170 BELCADE COW 7$17RTIpl 1L Boston,MA 02116 ARLOU DZIANIS�V -—= -s 42 WOODBURY A& t'� 1 WIthOUt signature HYANNIA,MA 02601 Undersecretary 9 t��tr�onvar a�th b iaSsadiuset s n b I�r4fs�oriic�as��t `; T t � t Y ° J wiry s � 5 > j t ,ANATOL.1 SIUFSKI 27 MIt�L;`P4NCXDRz,� WESY YARMO THE AFA 0267 °t e _ r ' OVt,771� + — x t , Y" r � N.+nxN.w..u�w.+�,w+rv,,,.e.a... r.�wOSnl..�ww.J. s+lsnaw,w.nk.M.+«...�....� �.vn+...Mrn+,.r�e.r++a+e.ucro.i�, +a..�.�w�w.r�ss...+.+.Wle4f .n..,urwrM .T �.Yc j• ` _Mrf _ Y w .� J ' Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M s chusetts 02118 Home improvenLLU('.� tntractor Registration Type: Corporation CAPE COD HOME IMPROVEMENT,INC. Xv Registration: 168043 27 MILL POND RD w Expiration: 12/06/2020 WEST YARMOUTH,MA 02673 1 • 9�f�"Srd Syav�� sca 1 0 2oM-05/17 Update Address and Return Card. -we 0P.1.011160'aw Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY, Corporation before the expiration date. if found return to: fL8 ]EXpiration ' Office of Consumer Affairs and Business Regulation 12/06/2020 1000 Washington Street-Suite 710 CAPE COD Hi p.': NT,INC. Boston,MA 02118 ANATOLI SIVIT 27 MILL POND R WEST YARMOUTH,MA 02673 Undersecretary: Not ith6ut signature Al.. • � r r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Anatoli Sivitski • b Address: 27 Mill Pond Rd City/State/Zip: West Yarmouth, MA 02673 Phone#: 617-710-1001 Are you an employer?Check the appropriate bog: Type of project(required): 1. ✓ I am a employer with 3 4. I am a general contractor and I , employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' y p Ty insurance.: 9. Building addition [No workers comp. insurance comp. 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 11. Plumbing 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 13. Other employees. [No workers' 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. :Contractors 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: AmGuard Policy#or Self-ins.Lic.#: R2WC940123. Expiration Date: 06/03/2019 Job Site Address: 44 Woodbury Ave City/State/Zip: Hyannis, MA 02601 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of 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 and penalties of perjury that the information provided above is true and correct. Signature: '� SGr/� Date: 4/1812019 Phone#: 617-710-1001 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#: f ® DATE(MMIDDIyYM ACO � CERTIFICATE OF LIABILITY INSURANCE 06/15/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR.PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy((es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endomemen s. PRODUCER CONTACT NAME: Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY PHONE 508 775-1620 �Noll: A OR lsullivan@doins.com 973 IYANNOUGH RD INSURERS AFFORDING COVERAGE NAIC a HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B CAPE COD HOME IMPROVEMENT INC -INSURER C: INSURER D: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 [INSURER F: COVERAGES CERTIFICATE NUMBER: 281511 REVISION NUMBER: 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE PREMISE Ea ocaure $ DAMAGE TO MED EXP(Any one $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per dent $ UMBRELLA LIAB _d OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X I STATUTE OERTH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED9 I WAI NIA WA R2WC940123 06/03/2018 06/03/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 NIA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwdANorkers-compensation/investigations/. CERTIFICATE HOLDER' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Anatoli Sivitski , 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE West Yarmouth " MA 02673 Daniel M.Croyey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ,acoR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ik. — 1 06/04/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY PHONE t. (508)775-1620 FAx A/C No): E-MAIL ADDRESS: ISUIIIvan@d0in$.CDm 973 IYANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601, INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURERE: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 410125 REVISION NUMBER: 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 All; REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH,RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR P 1AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF MUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INER ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WV01 POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGET RENTED .PREMISES Ea occurrence $ MED EXP(Any one person) $ , N/A .PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ I�POLICY❑ PRO ❑ LOC JECT PRODUCTS-COMP/OP AGG $ CTHER: $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO 1 BODILY INJURY(Per person) $ r,LL QbVNEo 'SC!IEDULED I N/�, BODILY INJURY Per accident $ .4UT05 NON-O PROPERTY DAMAGE ) ( NOrJ-C�JeNt . � $ - I iIREDAUTOS AU TGS Per accident UMBRELLA LIAR OCCUR - EACH OCCURRENCE $4 _ EXCESS LIAR CUIIMS_;ADE� N/A AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION X. STATUTE ER AND EMPLOYERS'LIABILITY Y.I N - ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFF ICER/MEMBEREXCLUDED? N/A NIA NIA R2WCO23262 06/03/2019 06/03/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - - - -..DESCRIPTION OF OPERATIONS below - - E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VczHICLES (AJORD 101,Additional Remarks Schedule,may be attached if more space is required) Woikcrs'Compensation benefits:%ill he paid to i.;assachusetts employees only. Pursuant to Endorsement WC 20 03 06'B,no authorization is given to pay claims for lenefits to employees in,:-us oC,er than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance show, t poli�v in force on the dale that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insul }. The StatuS of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search lool at www.mass.gov 1v,I'/w_,, ers-,ompensation/investigations/. CERTIFICATE. HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Anatoli Sivitski ACCORDANCE WITH THE POLICY PROVISIONS. 222 BUCk Island Road 6-8 AUTHORIZED REPRESENTATIVE Writ Yarmouth NIA 02673 ' j . Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) 11 c ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, Map- Application Parcel c9- _c #� Health Division -Au�"1 u q .-1.7 P A-e N' Date Issued Conservation Division S :`.Appli;cation Fee SV Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address >is C,}� Village �� l Owner �S ,�. � %��r <-c_ Address. Telephone Permit Request ►o�Z Q�✓L`� Square feet: 1 st floor: existing proposed Q 2nd floor: existing proposed (Z)_Total new Zoning District Flood Plain Groundwater Overlay Project Valuation e ® a Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U' Two Family ❑ Multi-Family (# units) Age of Existing Structure Ie1 _ Historic House: ❑Yes W-?Z On Old King's Highway: ❑Yes 4-No Basement Type: mull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) n Basement Unfinished Area (sq.ft) 1�0 Number of Baths: Full: existing I new d Half: existing new Number of Bedrooms: 2 existing-0 new Total Room Count (not including baths): existing new a First Floor Room Count Heat Type and Fuel: ❑ Gas 5Oil ❑ Electric ❑ Other Central Air: ❑Yes C9-<o Fireplaces: Existing <5 New o Existing wood/coal stove: ❑Yes EiNo Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: C= Co o z a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -n Commercial ❑Yes ❑ No If yes, site plan review# rA. mn Current Use Proposed Use 3 oo' a w cn APPLICANT INFORMATION w rn (BUILDER OR HOMEOWNER) Name ,4, ii J&-�!�, Telephone Number ` Y Address �,���.,J,J (� License # GS i9:®/✓� 5�� S Home Improvement Contractor# Z©`�Q/ Workers Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOt-� r� SIGNATURE DATE z .i� FOR OFFICIAL USE ONLY APPLICATION# i DATE ISSUED Yl .` Ufi is ; .-MAP/PARCEL NO, ' r, t ; l } ADDRESS - VILLAGE OWNER 1 ' I�� 1 L DATE OF INSPECTION: �P �. FOUNDATION='3. s FRAME -INSULATION".! S FIREPLACE I , } ELECTRICAL: ROUGH FINAL et PLUMBING: ROUGH FINAL { GAS': r ',. ROUGHi FINAL FINAL BUILDINGx is rt ;DATE.CLOSED OUT :. . ASSOCIATION PLAN NO. M � i f i S I The Commonwealth of Massachusetts Y Department oflndustrialAccidents Office of Invesei ations • g 600 Washington Street . t Boston, MA 02111 www.m ass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electr.icians/Plumbers Please Print Legibly Applicant Information Name (Business/Organization/Individual): Lim Address: City/State/Zip: 1*�V4::cS Phone Are you an employer?Check the appropriate box: Type of project (required): 4. I am a general contractor and I l. ❑ I am a employer with ❑ 6. ❑ New construction * have'hired the sub=contractors.. eiri loyees (full and/or part-time). -- ---•Remo .. - . . 2. am a sole proprietor.or partner- listed on the attached sheet. 7.'❑ emodeling ship and have no employees These sub-contractors,have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition NO workers' comp. insurance comp. insurance.$ 5 ❑ W are a corporation and its 10.❑ Electrical repairs or additions re . e,quired.] . � 3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions Myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),.and we have no employees. [No workers' l3.❑'Other comp, insurance required.) Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy in formation. t Homeowners who submit this affidavit indicating lhcy arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetors that check this box.must attached an additional sheet showing the name-of the sub-contractors and state whether or notlhosc entities havc cmployccs. If the sub-contractors havc employees,they must provide their workers'comp,policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company.Name: Policy# or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of 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 cert� under the pains and penalties ofperjury that the information provided ab ve is Itue and correct. Si ature: -a Phone#: .. il Official use only. Do not write in this area, to be completed by city or town official City or Town; Permit/bcense# Issuing Authority (circle one): I.Board of Health 2."Building Department 3. City/Town Clerk 4, Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#; Information and hstr uchons Massachusetts General Laws chapter 152 requires all employers to prov;de workers' compensation for their employees, Pursuant to this sLatule, 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.inclMdual, partnership, associalion, corporal;on 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 a❑ individual; partnership, associalion or other legal entity, employing employees, However the owner of a dwelling house having Dot more [ban three apartments and who resides (herein, or the occupant of the dwelling house of another who employs persons to do mainlcnancc, constniction or repair work on such dwelling house or on the grounds or building appurienaot Lh'ereto shall not because of such employment be deemed to be an employer." L MGL chapter 152, §25C(6) also slates 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-vvho has not produced acceptable evidence of compliance with the insurance coverage required.' Additionally, MGL chapter 152, §25C(7) stales "Neither the commonwealth nor any ofits political subdivisions shall enter'into any contract for Lheperforrinance ofpublic-. ork until acCepfable evidence ofcompliance with the ins�Uancc requirements of this ehapterhave beenpresented to the contracting authority." Applicants Please fill out.the workers' compensation affdavit completely, by checking the boxes that apply to your sitz�ation and, if necessary, supply sub-conlraetor(s) name(s), addresses)and phone numbers)along with their cerlificate(s) of insurance, Limilcd Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than the members orpartners, are not required to carry workers' compensation insurance. if an LLC or LLP dots have emp]oyees, e policy is required. Be advised that this affidavit may be submitted to the Department of Indu should strial Accidents for confirmation of insurance coverage. Also be sure to sign and date th-e affrdavit. The affidavit be returned to the city or town Lhat-the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain e,workers' compensation policy,please call the Department at the number listed beloW, Self-insured companies sbould 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 al the bottom of the affidavit for you to fit] out in the event the Office of Investigations has to contact you regarding the appli cant. .Please be sure to fill in the perrniAcense number which will be used as a.rcference number• Ln addition an applaGurtteni that must suburit multiple pcnnit/license applications in any given year, need only subrnil one affidavit indiea ling (city or ".lob Site Address" the ap Policy information(if necessary)and under plicant Should write"aJ1 ]ocahons in town),--A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affdavit is on file for fli turc permits or licenses. A new affidavi gust be filled nti t each year. Where a home owner or citizen is obtaining a license or permit not related to any bUS]nesSof commercial YeDture (i.e, a dog license of permit to burn leaves etc.) said person is NOT required to complete this ati'davil, The Office of lnvesfigahons Would like to -an�yun-ia-ad�`aflr�°t�r nnn��ahnrl and should 'have any questions, please do not hesitate to give us a call. The Department's address, tclephonc and fax number: The.Coomonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02 1 l 1 Te). # 617-727-4900 ext 406'or )-877-MASSAFE Fax # 617-727-7749 Revised 4-24-D7 www.mass.gov/dia I R • r Town of Barn-'stable } Regulatory Services p ua.ea $ Thomas F. Geiler,Director t639 % 'rEo�c�c� 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 Builderr, A//jLG ��' /� , as Owner of the subject property hereby authorize �D®w4 la1 ohs `�/��I�01�/ to acf.on my behalf, . in all matters relative to wprk authorized by this building permit application for• (Address of rob) Signature of Owner Date Pent Name If Property Owner is applying for permit please:complete.the Homeowners License Exemption Form on the reverse side. Q:FORM5:0 W7�ERPERMISSlO]�' Town of Barnstable Regulatory Services nAaxnAsL-1— Thomas F. Geiler,Director MAREL Building Division �rEp µpt Tom Perry, Building COn1I11iSSiDner 200 Main Street;_Hypnnis, MA.02601 R'Wv.town•barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 I3OhdEOwNER LICENSE EXEMPTION P)care Print DATE: / JOB LOCATION: / lwaaJd61!'ye/ "9ye— yph�> //✓�Td��� number street village HO1r1EOWNER":.(o�rGio�e 77Ii���ie�l 78/-yys/ dW-q Dell X .7 7 name. home phone# work phone# CURRENT MAILING ADDRESS: '-'au °qe C!�e' • ��-'��D�ll �i� DvZS�9a`� 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 Super`,risor_ DEFIItMON OR BOMEOW7%ER Persons)who owns a parcel of land on which he/sbe 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 constrgcts 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 r c 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.be/sbe understands the Town of Barnstable Building Department mi.nimutn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homcowncr Approval of Building O$tcia) 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 pernvt is required shall be exempt from the provisions of this scrtion.(Scc6on 1D9.).1 -Licensing of construction Supervisors);provided that if the homeowner engages a poson(s)for hiro to do such work, that such Homeowner shall act as supervisor." M°any hDMrDR'nms who use this cxcmption an unaware that they an:assuming the responstbilides of a supervisor(set Appendix Q, Rules&Rcgv)ations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn results in serious prob)cros,particularly when the homcowncT hires un)iccnscd persons.'In this ease,our Board cannot proceed against the unlicensed person as it ti•Duld with a licensed Supervisor. The homi covencr acting as Supervisor is u)tirratcly responstblc. To cruvrn that the homeowner is fully aware of hivbcr responsibilities,many communities require, as part of the permil application., that the homeowner certify that hdahe understands the n-sponnb0i6cs of a Supervisor. Dr)the last page of this issue is a form cun=t)y used by scvcral towns. You may care t amend and adopt such a fomr/ccrtifrcation for use in your community. Q:forrru:homcczcmpt . Office of me6ry�r Aff Tres`BdsinessR�egu > License or registration valid for individul use only j HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration1,09010 Type Office of Consumer Affairs and Business Regulation s Expiration:. 911:lQ12 DBA 10 Park Plaza-Suite_5170 Boston,MA 02116 PIL INGTON&sqv u Donald Pilkington�-'k 21 Broad St - Medway, MA 02053 Undersecretary Not valid without signature 0 m 0 D a) Z ~ a D0 � — F. CO : � DC7 a (D � D GG `! y --4 e C�a�rvrrzorturPal�i N S 0 Consumer Affairs 8113 siness Regulation� a License or registration valid for indivi C W , C IPROVEMENT ON dul use ly N �: :ion: OR before the expiration date. If found ret to; g o =_ 109010 pe:, Office of Consumer Affairs and B n: 9G.1/2012 ess Regulation Z Cn DBA 10 Park Plaza-Suite 5170 c X IS Boston,MA 02116 m ! rn < - O o Undersecretary s �—"-` - --- -- _ _ Not valid without signs - ^ f C�.•� � �� z o-x''L i 1 f _ ___ _ � � �� ���+✓✓✓ l ,' .; _. 2411— 7 0 , ., 36„ 3.3., fi -- . a 2W2436 2W2436' v" . i r> Mol RW3315 FV ry 4. o' N F B30RT 2, DISHW DE90R b co /�. - i/ Ch - - -- : _.. r- �1 (DCIO co U i --- rn co O Z 2:3 N Ul cl 12 11 z ;t, • � - t-�..Jr (�--`_ t J -� ��� � !Ca�/...-. ��� lti,4-.'r:l!o�_ :-a v�.S�Dc�. G✓i4c.`:; (� _ f'1J t_� �/2.l��j 1�-i iZu c--i�_ G.,�.t-c•-�-5_.._�.�.c=�c.r.„�C7 _ Li I 3311 7 0 .411 } i 2411..:.:. ; to .t n• ,i 33 3611 r3011.... . __ 24 33 y i, 2W2436 2W2436 i�' i �- RW3315 FVI iv cD DE90R F !� ^B30RT 24.DISHW P co r M - ,. -- co - -- i m - - -- -i O �- c�-� 231�96 11CD r. 12" 1 111 1,q s ' TOWN OF BARNSTABLE BUILDING PERMIT_APPLICATION Map Parcel'. Application # < ,_ Health Division Date Issued Conservation-Division Application Fee Planning Dept. : Permit Fee Date Definitive Plan Approved by Planning Board Historic.- OKH Preservation / Hyannis Project Street Address \A/190 hl ),rw AVO Village a r)n f -S �— ��� r Owner Lo(�Mr 1 ae, !"t ►��,i � Address.J �' EQ C)rl �1� Telephone —Lf —S `\ I A Permit Request O�� 1 , (, '' Square feet: 1st floor: existing proposed 2nd floor::existing proposed Total new Zoning District /^!', Flood Plain Groundwater Overlay Project Valuation w. V Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 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: ❑ 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: ❑Yes ❑ No Detached garage: ❑ existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Y Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) f IJ , I Name Lorca'ne- " i�K2. t Telephone Number `C S �T Address i P6 _a n �� I e License# Q M `v A 02- Home Improvement ntract " Worker's Compensat' n # Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE T KEN T,2 G-F SIGNATUR "DATE d FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. f 1 • ` ADDRESS VILLAGE OWNER i 'i b DATE OF INSPECTION: i . 1- FOUNDATION 't FRAME it , • j INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 'y FINAL BUILDING a DATE CLOSED OUT ' x 1 ASSOCIATION PLAN NO. a 1►+E Town of Barnstable Regulatory Services SAMPTAIRHAM.E Thomas F. Geiler,Director plED AAh; Building Division, Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fa;: 508-790-6230 PLAN REVIEW Owner: �'-( f C(F L Map/Parcel: 3 Z -7 . 8 S^7 Project Address r� LJ ��1�U/2-:Y Builder: w The following items were noted on reviewing: Reviewed by: �. kb--lAC Date:, Q:Forms:Plnrvw The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPUcant Information Please Print Le 'bl �e(Business/Organization/Individual): C,6 A r-'9 iREte` e/Z p Phone.#: Are you an employer?Check the appro'.pnate,bog Type of project(required): �-4.._ I am.a general contractor and I L❑ I am a employer with ❑ ^^� -? 6. ❑New construction . employees(full and/or part-time):*._-- �bave Hired the sub contractors) 2.El am a'sole proprietor or parts 1 r �"fisted on the'attached sheet.' 7. ❑Remodeling ship and have no employees These sub contiactors have g• Demolition working for me in any capacity. employees and have.vrorkei s'- 9 ❑Building addition r[Noeq workers comp.-insurance E-conip.-',insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions _ ___-- _ officers have exercised their ll.❑Plumbing repairs or additions 3: I am a homeowner doing all work --- p -� right of exemption per MGL m self o workers eo �, —12.� Roofr airs ---�-y [N a ❑ .. . . �4 ance re- ed. A ^ �"� c. 152, §1(4), and we have no - -� ) 13.❑ Others ' �= ^w - �- employees. [No workers' s „4 comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensati.on 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-cont wtors and state wbcther or not those entities have employees. If the sub-contractors have employees,they must providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: . Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 maybe forwarded to the Office of. Investigations of the DIA for insurance coverage verification. I do hereby cerli under the pains•and pen ' of pe ' r#2hat the information provided abo a is true and correct Phone# Official use only. Do not write in this area, to be completed by city or town offeciat 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 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, §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 vdth 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 permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp 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 future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obb.daing a license or permit not related to any business or commercial venture (Le.a dog license or permit to burn 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 calla The Department's address,telephone-and fax number. The Commonwealth of Massachusetts Dcparhment of lndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-490.0 ext 4.06 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia Town.of Barnstable �OpIKE Tp�� Regulatory Services Thomas F.Geiler,Director BARNSM13M MASS. 039. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabIe.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION {��_ `� Please Print �DATE:�v aJ 0 Y CJOB-LOCATIO.N7 w�o U�� n number / str t village ',MOM,EOWNER':— 1�/ 0j I -7 name home phone# work phone# CURRENT MAILING-ADDRESS: Al. h V ' city/town state zi coU-e 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 requiremen s and that he/she will comply with said procedures and require nts. 6Sikna fe of Homeowner Aporoval 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. • r oF1HEro Town of Barnstable Regulatory Services BMWVMAssBM Thomas F. Geiler,Director �$Ai6 9. 3 `0� _ . rE0 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 Sectiolsl If Using A Builder I L Q 1 Q a�'t �''1z .►�Sl_ I J ; as Owner of the subject property hereby authorize f to act on my behalf, in all matters relative to work authorized b, ;this building permit application for: f O ti r 1 M4� .(Address of J b) F { Signature of Owner Date ( n((oo Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. (1•T:l1RAAC•(1WNI=RPFRMT.CC1f1N Assessor's map and ,lot number .,—,3.. ........J�.... ............. �d �oFY ETo�`f Sewage Permit mbar ,°,>R..�v` ...................:..... �a < �•a 9 C S q[ � it 11DLE, • L SE p • i S�E IVI House- number .: :. .....:............................................ a.� INSTALLED I t } q ®MPL �MPY Or• r LE 5 OWN OF BARNS (B� �. , BUILDING INSPECTOR APPLICATION FOR PERMIT T06 61114......... 3 .... TYPEOF CONSTRUCTION ....................:.........................:................................................................::..:................... .... r ........ .......19 r TO THE INSPECTOR OF BUILDINGS: The undersigned here applies for a permit .according to the foll wing information: Location �: t,1.! r'✓-may %Z. ...:.,�!` !/!�`.5...............:.. ProposedUse ...... ? ............................................................. .............. ............................................. ................. Zoning District .... ..:................................................//................Fire District /..... ..�.. ...../ .................... ........../ ........... Name of Owni /..: °l� l.?�l(....'. .Address Name of Builder /. .... ./...�'...!�11........ ...'........:......Address ✓..1'�!1/.'I �.r�...,.�� ....... Name of Architect ...' Address ............................................. Numberof Rooms .................................................. ..................Foundation ............................................... ....... Exlerior p ............Roofing ............................................... .- .......... ................. ....... .......................:................ ....... .....,.. Floors ........'[.l.Q d ............ ........::Interior ::. Heating .... ........Plumbing ......... .............................. Fireplace ..................................... .....Approximote.,_Cost... ic✓".� ... ............ .�. . Definitive Plan Approved by Planning Board ---------------____-----------19_______. Area ...... s1l .... ......�...... ® Diagram of Lot and Building with Dimensions == Fee � .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY, PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to:all the Rules and Regulations of the Town o rnstable regarding the above construction., ' :.....Name �` .......... ........... .................. Constr'ction Su Supervisor's License p . tMITCHELL, FRED a . 25287. Replace Deck No ................. Permit for .. ................................ (T¢ i '.Single Fanly:DIae•l, ing ' cLocation 1.7..Wogdbury. Ave.... ............ i '....... HYahnis Owner ... . d .1.4..i..tch ............................. JI Type of Yh Construction, F.KAM............................. 0 ..... ..... ...................... ........................... Plan .... ....................... Lot..............r................. ZT Permit Granted ..July..6! :. ��'...19 83 - `4 Date of Inspection ....................................19 , Date Completed .A......� v; ..�....19 - �/ x• 1 UJ e �a « : 110 I X 'Al u I r. G � o Assessors map and lot number .. .... � d�� 7NEt0 Sewage Permit number ............. d I BARNSTABLE,AM i House number 1639 r • �0 iO�rC MPY p,. To OF BARNSTABLE BUILDING INSPECTOR . 1APPLICATION FOR PERMIT TO ........... ............................................................4 .................j..................:.......:.. TYPEOF CONSTRUCTION ...........:............................. ............................................................................................. ........� ... .............19 TO THE INSPECTOR OF BUILDINGS: ` The undersign ereby,,,applies for a permit according to the following information: Location ..�j. f 7lha r ,`�, cr..... F"., " r......... / `-t/„/!z !i�/�:5.................. ................................... �� ,� ....... .............................. .....................Proposed Use ..... _ ............................ ............................. ......... .................... .. .. Zoning District ..... ....................`..^~.. .................Fire District ..�............................................................................ Name of Own '?rir .,./....L..�.: v` 21/.. ........Address .. ...... '�'"'%......... ...... ..:..r.a�4 Nameof Builder--,.... .................Address ...............................................w..,........................�....... Nameof Architect ..................................................................Address ..................................................................................... i ) Numberof Rooms ..................................................................Foundation .:.....Q�r ....................................................... Exterior ............ ...................................................................Roofing .................................................................................... 0 Floors .............................................7........�...........Interior .................................................................................... Heating .........:.:......................................................................Plumbing ........................... 4� Fireplace ..................................................................................Approximate. Cost ....... ` .........'...................... . .... Definitive Plan Approved by Planning Board ___________________-__ �f.. 19 ---. Area .... ............... Diagram of Lot and Building with Dimensions Fee .� SUBJECT TO APPROVAL OF BOARD OF HEALTH s; 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. Name ...................... ............................................................ ~ Construction Supervisor's License ................��.....................'�- MITCHELL, FRED A= 07-57 2-5287 R lace Deck No ................. Permit for .. ................................. .......sirl-glze/ .p .n.. mP.114g.............. a Location .11-4r.Wo.od.burx...Aven.ue.............. ........ ..... .... ....... .. .......... ..... Hyannis ............................................................................... Owner Fred Mitchell ........................................................... Type of Construction ..........Fr.ame.................... .... ....... ................................................................................ Plot ............................ Lot ................................ Permit Granted .......Jul.y 6..................19 83 Date of Inspection ....................................19 Date Completed .......................................19