HomeMy WebLinkAbout0045 AMES WAY � h N
Y
F T Zol 1 0 C
Town of Ba
rnstable Permit#
Regulatory ServicesFapires ee 6mondrs romissuedate
1ABtY6TABLS,
MAM
,e� Thomas F.Geiler,Director
Building Division CEO/z-7/11
Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstabid.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 921 60 e
Property Address
t
Residential Value of Work Q 2,2 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address -�It(1aC(
4S _
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one: S PERMIT
I am a sole proprietor
am the Homeowner
I have Worker's Compensation Insurance I OWN
OF R
Insurance Company Name
Workman's Comp. Policy#
Copy.of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
0"Re-side
#of doors
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.-Historic,Conservation,etc.
***Note: O Prope wnef must sign Property Owner Letter of Permission.
AC py of Home Improvement Contractors License&Construction Supervisors License is .
Arred.
.IGNATURE: i
AWPFILESTORMMbuilding permit formsTYPRESS.doC i
.evised 070110
i
The Commonwealth of Massachusetts -
( Department of Industrial Accidents
( � L ' Office of Investigations
lsl � 1 600 Washington Street
Boston, MA 0211-1
>+ www.mass gov%diri
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
�-^
N3IIIB"(Busmcss/Organization/Individual):
CA-ddre-S } S �'S
City/State/Z p C-�fi�ed�t���e,
ao Phone #:
Are you an employer?Check the appropriate box: Type of project,(required):
1. 0 1 am a employer with 4. ❑ I am a general contractor and I 6..0 New construction
employees(full and/or part-time).* have hired the sub-eontraciors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet- # 7•. 0 Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp. insurance. g• 0 Building addition
[No workers' comp. insurance 5. 0 We are a corporation and its
ff� required.] officers have exercised their
I0.0 Electrical repairs or additions
�3. am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
u myself.[No workers' comp. c. 152, §l(4), and we have no 12.0 Roof repairs .
insurance required.] t employees.[No workers' HE Other
comp insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside'contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their woricers'comp.policy information.
lam 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,S00.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 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 unde the pains d enaltie of perjury that the information provided above is true and correct.
fS —afire: i n Date: --c A�l t i `
Official use only. Do not write in this area;to be,completed by city or town official
City or Town: - PermitlLicense#
Issuing Authority(circle one):
L Board of Health 2.'Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
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 with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have r
employees,a policy is Tequired. 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 Town Officials
Please be sure that the-affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hike 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. .. ;ss
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations'
600 Washington Street
Boston,-MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Town of Barnstable
Regylatory Services
Thomas F.Geiler,Director
� '� `. Building Division
PrEfl {k Tom Perry,Building Commissioner
200 Main-Sfrcct,_Hyannis, MA 02601
R ww.to wn_b arnstabl e_ma.us
Office_ 508-8624038 Fax: 508-790-5230
HOMEOWNER LIMNSE EXE =ON
Please Print
1_B-LocnrloN: S
number street, village
name • J hanic phone# work phone#
CLIR ZENrr hWLING tDDRFSS["" �. a
city/town state Zip code
Ti4e cturent cxcmption for"homeowners"was extended to include owner-occupied dwellings of six airs or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as-SUP or.
DEFRUnON'OF BOMEOWNMR
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 structnres accessory to such nse and/or fans structures. A
person who constrgets more than 6ne home in a two-year period shall not be considered a bomtsowncr. Such
"homeowner"shall submit to the Building Official on.a.form acceptable to the Building Official,that he/she shall be
respotistbie for all such work ycrfarmed'undcr the building pennIf (Section 109:1.1)
Tlac undersigned `bomcowner"assumes responsibility for compliance with the State Building Code and other.
applicable codes, bylaws,rules and regulations.
The imdcrsigned"homeowner"ecrtifics that,h she_umdcrstands thc,Town of Barnstable Bolding Department
inspection procedures and rci�nts and that he/she.will comply with said procedures and
requirements.
5i�-,• gnatisre•of`Homeosma��� _ : �_
Approval of Building,Official
Note.: Three-family dwellings containing 352000 cubic feet or larger well be required to comply with the
State Building Code Section 127.0 Constructibn Control
. HOl1�OwNER'S EX'EMPZION .
.The Code states that: "Any bomeowna pcfnrn>ing work for which a building permit is required shall be cxcmptfrom the provisions
of,this scc4n.(Sccdcin 109.1.1-1 i=Lgi+g bf construction Supervisors);provided tha t if the homeowner=gages a persons)for has to do such
wort,that such Homeowner shall ad as supervisor."
1 aay homeowners who use this txan rt twa
t they are asnnning the responstbt'litics of i.supervisor(sce Appendix Q,.
Rules&Regulations for Licensing Cmstruction Supervisas,'Scction,2.15) This lack of awareness bft=results in serious problems,particular}y
When the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with!}ic=cd
Supervisor. The horneowocr acting as Supervssoris uki irate)yresponstble
To cnsurc that the bomrowner is fnIly away=of his/hcrz*onnbilitirs,many convnunitics require,as part of the permit application;
that the homeowner certify that helshe understands the responsrbrlitics of a Supervisor. On the last page of this issue is a•farm cvn•erttly used by
several towns. You may care t amend and adopt such i formr>lcatification for use in your community.
4..
I
lie Town of Barn-stable
o
Regulatory Services
9 MAS& Thomas F.Geiler,Director `
1619, L%%
Building Division
Tom Perry,Building Commissionat
200 Main Street',Hyannis,MA 02601
www.town.b arns tab l e.ma.us
Office: 508-862-4038
• � - Fax: 508-790-6230
Property �er mus t
Complete and Sigti This Section
If Using A Builder
Y / , as Owner of the subject,property
hereby authorize to act on my behalf,
in all matters relative to work autho ' by this b ding permit application for:
( ss of Job)
Signature of Owner Date
Print Name
If Property Owneris applying for permit please complete. the
Homeowners License Exemption Form on :the reverse side.
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CERTIFIED PLOT PLAN
L 0 C A T 1 0 N: -CEA--'`7-4E.4e Z//GG ia— _
F O R: 41=-BE4-SO44-0LIJS� /jLj/�Gc,oDIr7aA/7-<54- , .
SCALE: 3o ' DATE: �,02/e z9, l.ge)G
R E F E R E N C E: 43E/A-/fp Zo T Z A9 S. 5 JA 0cJ A,/ o ff
/4L.��.2EG0/2���rJ �47'�i A/L�/ST�L3GE S� /.->
A E
fo�z ,Di9U .3 S
1 CERTIFY TO THE BEST OF MY KNOWLE GE E LAND SUR EYOR
AND BELIEF FROM INFORMATION ACQUI
THAT T:HEA*::,V-./.o/zT/oN SHOWN ON THI5 PLAN
4
IS LOCATED ON THE GROUND` AS SHOWN HEREON. OF
JOSEPH yG�
M.
w MONAHAN,JR. H
J. M . MONAHAN, No. 13860
JR . & ASSOCIATES NoE�E°p�
PROFESSIONAL LAND SURVEYORS _& ENGINEERS . IST
su
T.OWNE _PLAZA - .90.0. ROUT.E 1_34:.S.OU_TH ._D.CNN.I_.S., MA_55..
�S/SS
` ��
Assessors map and lot number ... ........ .......... . SEPTIC SYSTEM MUST B of THE to
r
INSTALLED IN COMP'LIA
���2� �
t Sewage Permit number ........:..................�........... ..... ........ � �, , . � •
WITH TITLE 5 .
House ''number ... Si ?...�(�. ......... ENVIRONMENTAL CODE M"a L
4p t639.
TnIMM RI�GUIL-et�T��S��q', �MPYa`e
TOWN OF BARNSTABLE
BUILDING ' I.NSPECTOR
APPLICATION FOR PERMIT TO ............... ....—.-.....l...F- .0 .. ..............:........................................
TYPE OF CONSTRUCTION Y'' ..........I.............. .....................................
....... �.....1 .................19....E6
TO THE INSPECTOR OF BUILDINGS:
The undersigned Ihe�reebby. applies for a permit according to the following
� information:
Location ��SJ..L.......2........ . . .......... ... �. .................` r !�l` ?lt�`e� ....... .. ...........................
ProposedUse .................P. .. . .. .......................................................... ......................... _ .. .........................
Zoning District ..................... .....................................Fire District .................C-0................................................
'
Name of Owner ..........`..?.....5. Address .....�3.�.... C�..J. ..� � s�� ....
Name of Builder .0 —��� z ,�4/ �? ......Address
Name of Architect .!'llQ , !`/S././��... .. . ..........Address p�....GA. .yl✓.V�a .Q ..... ..............
Number of Rooms ..........................:�.................................Foundation ...... �l /'o-C.... . g p........ . ...
Exterior ....................4.6,41_4'�. ,(S�.... ................. ......Roofing .......... ... € . 19.f................................................
Floors /0•• c
�� .Interior :.............. �--•�R�
Heating Plumbing ! �� Cl......... ./..
Y .....
Fireplace .................. .Approximate Cost .
Definitive Plan Approved by Planning Board -� --------19 A_rea .....
D.... ....lD.''Y................
Diagram of Lot and Building with Dimensions Fee ...... 7
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 of.Barnstable regarding the above
construction.
Name ...... . ..... ...............
Construction Supervisor's License .............................
p ... ..............................
�R. S L S TRUST
fib t 1 e
„• r
J No 2°303 permit for 1' Story
_
F. Single Family Dwelling
.... ..............................................
.'. Location Lot #2.. 45 !Ames Way
......................................� ,
Centerville
S L S Trust t. E
` Owner t
Type of Construction
Frame n
.••..••.•••...•••.....••••••.•................................. ............. t
iPlot ........................... Lot ................................
r r
r
t
LiPermit,Gran,ed May.J. 19 Sb
` Date of Inspection 19
Date Completed .............1
oFtxero TOWN OF.BARNSTABLE Permit No. ...?03......
BUILDING DEPARTMENT
Bear a I TOWN OFFICE BUILDING Cash
HYANNIS,MASS.02601 Bond X
CERTIFICATE OF USE AND OCCUPANCY
Issued to S L S' Trust
Address Lot #2, 45 Ames Way
Centerville, Massachusetts
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID,.AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
.... ... Z'..., 19.. !....... f/ !'✓LGL
Building Inspector
�� ay
s
o`���•. TOWN OF BARNSTABLE
BUILDING DEPARTMENT
11ARISTAU f TOWN OFFICE BUILDING
HYANNIS, MASS. 02601
�o rnr�•
MEMO TO: Town Clerk
FROM: Building Department
DATE: CZ G J Z f��
' An Occupancy Permit has been issued for the building authorized by
fBuilding Permit $ ... . . 43...................._......_.......................................................»..........»............»....._.................».� . ._�
issued to-�� .. JS7 .. ... Z.... � � Ax s;;../, �91 ......._...�e.c�J...._..
'I.
Please release the performance bond.
s
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L 'T r•.Y ii ria+W.. �.v nY.•'.S 'F i 11�Jq_ ,,.. y.
PINK-DEPT. FILE COPY/WHITE-FIELD COPY/YELLOW-APPLICANT COPY r ~
Z0
5 BUILDINGa
TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT
Am189-6 VALIDATION
DATE_ Ma 7 19 86 fit.
APPLICANT Lebel—S011oWB�. PERMIT NO.;
ADDRESS ' 131 Old Route 132, Hyannis 008121
(N0,) (STREET)
(CONTR'S LICENSE)
PERMIT'T0 Bllild dWelline ( li STORY_ SinPle 'fdI11i1V dWe]ljj]£f 'NUMBERN OF
G UNITS:-
'AT1'
(TYPE OF:IMPROVEMENT) NO.
' (PROPOSER USE).
(LOCATION) lot. #2 45 Ames WayCenterville zoNlNc:
INO.I (STREET) DISTRICT RC
BETWEEN
(CROSS STREET) ..AND _
(CROSS STREET)
SUBDIVISION
LOT BLOCK LOT: :
SIZE
BUILDING IS,TO BE FT. WIDE BY
FT. LONG BY FT IN HEIGHT AND SHALL.CONFORM IN CONSTRUCTION
TO.TYPE USE GROUP
BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
1'
AREA OR
VOLUME 000BOND
ICUBIU'SOUARE FEET) ESTIMATED COST 5(1 (Inn PERMIT •— 59 ,5
OWNER
ADDRESS13
BUILDING DEPT:
BY
vrrcrimr mT_37'UN—UU LIZ _
PROVED. By THE JURISDICTION, STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEW
GRADES
WELLcTr AS DEPTH AN LOCAON'DER THE BUILDING CODE, MUST BE AP
FROM THE APPLICABLE
PUBLIC WORKS. THE ISSUANCE OF THIS PER DOES NOT RELEASE THE APPLICANT FROM THE CONDITION:
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. SEWERS MAY BE OBTAINEE
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN
[ PERMITS ARE REQUIRED FOR
1. FOUNDATIONS OR FOOTINGS. MADE, WHERE A CERTIFICATE OF OCCUPANCY IS RE- ELECTRMECHANICALINSTALLATIONS.
PLUMBING
2. PRIOR TO COVERING STRUCTURAL ELECTRICAL, PLUMBING AND
MEMBERS(READY To LATH). QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIEC4 UNTIL
J. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE,
OCCUPANCY. I
POST THIS CARD SO IT 15"VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS +
PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS `
1 '
2
2 J 2
3
HEATING INSPECTING APPROVALS
REFRIGERATION INSP.EGTION APPROVALS
NFERING". ,
.. .. ...
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VV A6,D1 cim * CONSTRUCTION OF SANITARY DISPOSALo DESIGN FLOW GAL /DAY
7-0 E T A R H C A E
SYSTEM SHALL CONFORM TO MASS . L
LOAM MIN./INCH
ENVIRONMENTAL CODE TITLE V (REVISED 7- 1 - 77)
PROPOSED LEACH CAPACITY :
T 0 P CD F- Z- c- 14 AND THE TOWN OF 0,'�,�?/,/ < 7-
C HEALTH REGULATIONS .
(1--4 0 SEPTIC TANK, DISTRIBUTION BOX AND LEACHING
PITTO BE OF REINFORCED CONCRETE : 437 GAL/DAY
MIN. CONCRETE STRENGTH 3000 PSI
N "3 T- 7-CD C 0 7-7- MIN . STEEL STRENGTH 2 0,0 OOP 5 1
0 Cz�7-
0 Fn'O E =- iDl A'---O U/v 0" H 10 DESIGN LOADING
77cD A3 E-- Z IAV 7-/4 e- )-4 0 DRIVEWAYS NOTTO BE LOCATED OVER SYSTEM
/3 X- �-j 1? v 7 /;2-b UNLESS H - 20 DESIGN LOADING 13 USED.
2) fi /i! //Q AT ALL PIPES AND FITTINGS TO BE WATERTIGHT AND
To p Z-/V.S Pe"C-7-,-=- ,D T2 TO BE OF CAST IRON OR SCHED 40 P.V. C.
S I T E P L A N S H 0 W I N G PROPOSED CONSTRUCTION SH -L- OF 51
LEGEND L 0 C. A T 1 0 N %Z "CoXIT'-re Vl'ci'r
F 0 R : APPROVED 19
BOARD OF HEALTH
S C A L E : D A T E :
BUILDING SETBACK REGULATIONS PER EX IS T- I N G CON TOUR REFERENCE : 07-
BUILDING INSPECTOR OR BU ( LDfNG PROPOSED CONTOUR 4 p DATE AGENT
COMMISSIONER . Z -0^/.E 71> ' C
r,/tIN. FRONT SETBACK �c- EX I STING SPOT ELEVATION 17. 6 of
MIN . SIDE SETBACK PROPOSED WATER SERVICE —w—
G
MIN. REAR SETBACK TEST HOLE LOCATION R
CIVIL
C . R . SHORT INC . o. 27483
, . /STE
PROFESSIONAL LAND SURVEYORS L ENGINEERS At
1586 MAIN STREET (RTE. EBA) EAST DE NN IS, MASS. 02641