HomeMy WebLinkAbout0254 AMES WAY Z 59, �.
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION_ .
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Map Parcel.'.-1 lication #
Health Division Date Issued
Conservation Division Application Fee 45
�S
Planning Dept: Permit Fee;
Date Definitive Plan Approved b Planning Board
pp Y 9
Historic = OKH Preservation/Hyannis
Project Street Address
Village
Owner Address d:�� o� tvi`�r
Telephone66
l
Permit Request t
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District' Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: U Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ,0 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 ❑ 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 #
Current Use Proposed Use
APPLICANT INFORMATION
u (BUILDER OR HOMEOWNElere
me - lU _ /�-� Telephone Nu
Address License #
���`� /��� dG Home Improvement Contractor# .
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WIL BE TAKEN TO
tIGNATUIR(����,�� DA A
� a
a
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED .
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
'F
FOUNDATION
k . FRAME
INSULATION
FIREPLACE
r
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING I)'7131)o2 721116
r DATE CLOSED OUT
'$ ASSOCIATION PLAN NO.
I
FTHE roy, Town of Barnstable
�O
Regulatory Services
• BARNSTABLE,
y MASS. 0a Thomas F.Geiler,Director
�ArE%6 9'104.,0 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
NOTICE TO THE BUILDING DIVISION OF
CHANGE OF LICENSED CONSTRUCTION SUPERVISOR
owner of property located at
4-) �6 , hereby certify that
�� G �A is no longer Construction
Supervisor listed on the application for the project under construction as authorized by
building permit# 69GDo OO r , issued on 4�1 �l 200 .
i I understand:that the project under construction must cease until a successor licensed
Construction Supervisor, is submitted on the records of the Building Division.
PROPERTY 0 D E
q/forms/newcontr
reference R-5 780 CMR
rev:080102
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d 600 Washington Street
Boston; MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
/ Applicant Information Please Print Legibly
LName (Business/Organization/Individual):ddress: �S
city/state/Zip: Phone.#: ,v ®
FAre you an employer? Check the appropriate box: Type of project(required):
I am a employer with 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. T. O Remodeling
ship and have no employees These sub-contractors have g• Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• � 9. ❑Building addition
o workers'comp. insurance comp. insurance. 10.❑ Electrical repairs or additions
equired.] 5. We are a corporation and-its
3. I am a homeowner doing all work officers have exercised their 1 LF]Plumbing repairs or additions
yself. [No workers' comp. right of exemption per MGL 12.D.Roof repairs .
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑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.
tContractors 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:
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
PlEhone
s of the DIA for insurance coverage verification.
er ' nder the pains andpenalties of perjury that the information provided above is tr andcorrect:Datee ^' t
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#:
Town of-Barnstable
Regulatory Services
Thomas F. Geiler,Director
'1 Building JDivision
prED Tom Perry,Building Commissioner
a
200 Main:Street--Hymmis,MA 02601
vi'ww.town.b arnstable.ma.us
Office: 508-862-403 8 Fax: 5.08-790-6230
1101%0�_O PVNFR LICENSE EXE.MYTION
Please Print
DATT3 a�
D
JOB LOCATION: '
number street village
••HOMEOWNER'- .9L� T
name omc phone# work phone#
CURRENT MAILING ADDRESS:
cityltown state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwelliuf 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. •
DFFUI rMON OF BOMEOPVNER
Persons)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 workpPrformcd under the building permit. (Section 109.1.1)
The undersigned"bomeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations..
The undersigned."homeowner"certifies that.be/she understands the Town of Barnstable,Building Department
n nam ,um inspection procedures and requirements and that he/she will comply with said procedures and
re
Stgnatzrm�Zo Homcawna
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with.the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that "Any boincowner performing work for which a building parnit is required shall be exempt from thc provisions
of this section(Section 1o9.1,1 -Licensing of construction Supervisors);provided that if the homeowner engages a pQson(s)for hire to do such
work,that such Homcowna shall act as supervisor."
are unaware that they are assuming the responsibilities of a supervisor(see Appendix
Many homeowners who use this exemption arly
Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particular
when the homeowner hires unlicroscd 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 bomeownar is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that hcJs}re 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 sorb a fomt/ecr6fication.for use in your Community-
T r Town of Barnstable
Regulatory Services
Yxrr Besr $` Thomas F. Geiler,Director
o aim Building Division
m
Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town_barnstabl e.ma.us
Office: 508-862-403 8 Fax: 508-790-62
Property Owner Must
Complete and Sign This Section
If Using A wilder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application.for.
(Address of job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
tNE - TOWN OF BARNSTABLE FT Building
Application Ref: 200902357 Permit
* BARNSTABLE, * Issue Date: 06/01/09
y MASS.
�j 1639• Applicant: Permit Number: B 20090880
ArFO��p
Proposed Use: SINGLE FAMILY HOME Expiration Date: 11/29/09
Location 254 AMES WAY Zoning District RC Permit Type: RESIDENTIAL ADDITION/ALTERATIO
Map Parcel 170123 Permit Fee$ 76.50 Contractor PROPERTY OWNER
Village CENTERVILLE App Fee$ 100.00 License Num OWNER
Est Construction Cost$ 7,500
Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND
CONSTRUCT FARMERS PORCH 10 X 12 THIS RD MUST BE KEPT POSTED UNTIL FINAL
CHANGE OF CONTRACTOR 7/24/09 TO HOMEOWNER ION HAS BEEN MADE. WHERE A
RTIFICATE OF OCCUPANCY IS REQUIRED,SUCH
Owner on Record: BRATENAS,PAUL G 81 BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL
Address: 254'AMES WAY INSPECTION HAS BEEN M
CENTERVILLE, MA 02632
Application Entered by: JL Building Permit Issued By:
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET-ALLY SiDEWALK.OR ANY PART THEREOF,EITHER TEMPORARILY:OR"P ANENTLY:
ENCRO ACHE MENTS ON PUBLIC PROPERTY,.NOT SPECIFICALLY PERMITTED UNDER THE BUILDING"CODE;MUST BEARPROVED BY TH!ff JURISDICTION..
STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC:SEWER,S MAY BE OBTAINED FROM•THE,DEPARTMENT OF PUBLIC WORKS.
THE ISSUANCE OF:THIS PERMIT DOES,NOT:RELEASE THE APPLICANT FROk THE CONDITIONS OF ANY APPLICABLE.SUBDIVISION RESTRICTIONS.,
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK:
1.FOUNDATION OR FOOTINGS.
2.ALL FIREPLACES MUST BE INSPECTED AT T14E THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED.
3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION.
4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH).
5.INSULATION.
6.FINAL INSPECTION BEFORE OCCUPANCY.
WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS.
WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION.
PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF
DATE THE PERMIT IS ISSUED AS NOTED ABOVE.
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A).
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
2 2 2
3 1 Heating Inspection Approvals Engineering Dept
Fire Dept 2 Board of Health
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
77
vi
Map Parcel :'Application"#
Health Division -'Date Issued 1
Conservation Division ;'App'ijbatioh.,Fee MP
Planning:Dept. ."'Permit Fee
Date Definitive Plan Approved by Planning Board
6/1/69 A
Historic - OKR Preservation Hyannis
Project Street Address VVd:J fiqv
O-eo 4tv,1W
Village
Owner WOOO /A0 121 Address 7VA- AM 4 WU 4N,Ap
Telephone
(01A
Permit Request: pu ft 1-1
Sqbare feet: 1 st floor: existing—proposed 2nd floor: existing proposed--b—Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 00 Construction Type IVQ�:
Lot'Size Grandfathered: U Yes IM No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family U Multi-Family (# units)
Age of Existing Structure Historic House: Ll Yes U/No On Old King's Highway: U Yes 3/No
Basement Type: dFull Crawl Ll Walkout Ll Other
Basement Finished Area (sq.ft.)- Basement Unfinished Area (sj,,.ft)
Number of Baths: Full: existing; new Half: existing new
Number of Bedrooms: existing 0 new sn
Total Room Count (not including baths): existing !_Y new 0 First Floor Ro m couat,
Heat Type and Fuel: U Gas U Oil U(Electric LJ Other
r
Central Air: LJ Yes dN 0 Fireplaces: Existing New Existing wood oal stove: Ll Yes 2<0
Detached garage: 0 existing Q new size—Pool: U existing Ll new size Barn: L] existing LJ new size
Attached garage: U existing U.inew size —Shed: LJ existing Ll new size Other:
Zonirlg Board of Appeals Authorization Ll Appeal # Recorded L3
Commercial L]Yes Ll No If yes, site plan review#
-Curren't Use _—Proposed Use-
APPLICANT INFORMATION
(BUILDER OR.HOMEOWNER)
Name Telephone Number CO- 4 6- 44
Address
A A
License #
olov' I MA -0)- Home Improvement Contractor#
Worker's,Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE
1
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
Ak
K ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION 7 20 0
-. FRAME
INSULATION
{' FIREPLACE
y
ELECTRICAL: ROUGH FINAL
_.PLUMBING: ROUGH FINAL
GAS: ROUGH. FINAL
FINAL BUILDING
DATE CLOSED OUT
�. ASSOCIATION PLAN NO.
,per Tlie Comrnonwealifz of Massachusetts
.Department of litdustrW Accidents'
Office of Investigations
600 WYashington Street
Boston, MA 02111
www.mass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information f / Please Print Le 'bl
Name (Business/Organization/IndividuaI): MI C444 r �� �"`( `�►
Address:_ A0 T -
City/State/Zip: 06[�M RJ R.A UL&'�C Phone.#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. F-1 I am a general contractor and 1 6. ❑New construction
. employees (full and/or part-time).* have hired the sdb-contractors
2.X I am a•sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have 9. Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers' comp.•insurance comp.insurance.$
S. We are a corporation and its 10.[]Electrical repairs or additions
required]
3.[� 1 am a homeowner doing all work officers have exercised their It. Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
innuance required]t c. 152, §1(4), and we have no 13.N Other Ad
employees. [No workers'
comp,insurance required.]
*Any applicant that checks box#1 must also M out the section below showing their workers'compensation policy infommtion.
t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavitindimEng such.
tContmctors that check this box must attached an additional sheet showing the name of the sub-contactors and stste whether or not those entities have
employers. If the sub-contractors have employees,they must provi db 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 vp 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 bIA for insurance coverage verification.
Ido hereby certify under h .pa]i�nss•anndd penalties ofperjury that the information provided above is true and correct.
Si mature: FRO ,UVCv Date:
Phone 114- 441-7-
Official use only. Do not write in this area, to be completed by city or town offtciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instr'u&IO]AS
Massachusetts Oenezal Laws chapter 152 requires all employers to provide workers' compensation for their.emp),oyees:
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
epair work on such dwelling house
dwelling house of another who employs persons to do maintenance,construction or r
or on the grounds or building appurtienaut thereto shall not because of such employment be deemed to be an employer."
MOL chapter 152, §25C(6) also states that"every state or local licensing agency shall veithhold 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 15z, §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 cvideace of compliance Rzth 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, i'f
necessary, supply sub-contractors)name(s), address(cs) and phone numbers) along with their certificates)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 nurriber 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/liccasc number which will be used as a rcfcrcncc number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit onp affidavit indicating current
policy,information(if necessary) and under"Job Site Address" thn 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.Whcro a home owner or citizen is obtaining a liccns c or permit not related to any business or commercial venture
(ie. a dog license or-permit to born leaves etc.) said person is NOT required to complete this affidavit.
I'hc Office of Investigations would hate 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,tclephone•and fax number:
The C6mmonwe,4th of Massach=tts
De,-parttm=t of Ind>zsWal A.ccidonts
Office of Izavestigaati.ans
600 WashinPton St e;("t
Boston, MA 02111
TQ1. # 617-727•-490.0 exr 40,6 Qr 1-$77-I ASSAFE
Fax# 617-727-7749
Revised 11-22-06 vr1�v�!.riaaSs goy/dia
,
�p'THE rp�L Town of Barnstable
~` Regulatory Services
�� rA LE•�` Thomas F. Geiler, Director
reDrna�a Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.toivn.b,-irnst2ble.ma.us
Office: S08-862-4038 Fax: S08-790-6230
Property Owner Must
Complete and Sign. This Section
Zf Using A Builder
as Owner of the subject property
hereby authorize 1 V l I l �� ` to act on t.ny behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
ri UYV
Print Narne
I
If Property Owner is applying for permit please complete the Homeowners License
Exemption Form on th•e reverse side.
Town of Barnstable table
�pF SHE Tp�
Regulatory Services
• t,
Thomas F. Geiler, Director
sARNSrwat
MASS. $ Building Division
PTFD �n Tom Perry,Building Commissioner
200 Main Street, Hyannis., MA 02601
wwrv.town.barustable.ma.us
Office: 508-862-4038
Fax: 508-790-6230
HO)JEOWNIER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: village
number street `
"HOMEOWNER": work hone#
name home phone# P .
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
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 perrnit, _(Section 109,1.1)
The undersigned"homeowner" assumes responsibility for compliance with the State Building Code and other
applicable codes, bylaws,rules.and regulations.
The undersigned"homeowner" certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
ini
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,
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 1o9.1,1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)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 Appa�,cula�rl
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 communitics 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.
l
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��vnzoozu �vvC�ac�tuGe�
Y Board of Building Regulations and Standards I I
Construction Supervisor License
License 47291
: CS' i
�
a,
EXp!�ration 2%22/2010 Tr# 19135
� �Restrlcti� 1 Gl;��
F
MICHAEL J GARD
PO BOX 334r.J,
OSTERVILLE,
j MA 02655""h Commissioner
j
Boroff1�tn'g#eoa�n� an ar s License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 145637 Board of Building Regulations and Standards
Ex iration One Ashburton Place Rm 1301
P 2/16/2011 Tr# 283229
;fType DBA;= Boston,Ma.02108
z r r
MICHAEL GARDNER;BUILDER, '.`
MICHAEL GARDNERsf
e IF .
37 WATERGREEN GIR x'
OSTERVILLE,MA 02665Z7 Administrator Not valid without signature
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254 Ames Way, Centerville 5/22/2009
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pFIKE r Town. of Barnstable *Permit#
0 Expires 6monthsfrom issue date
T Regulatory Services
uu+srasre; Thomas F. Geiler, Director �
^S&
�� i639• ���a Building Division
Prfb MI*y -
Tom Perry, CBO, Building Commissioner s �let lOs
200 Main Street,Hyannis, MA 02601
www.town.barrtstab le.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 b -"
Property Address 7, � �1> loft at,'fie f�,/r f�
Residential Value of Work C7 Q Minimum f 'of$25.00 fo work under$6�000._00
Owner's Name&.Address pad Dow, bake 1�
-LO kmn
Contractor's Name ��I I C� I �� ✓� _ _Telephone mber��
r
Home Improvement Contractor License# (if applicable) _ 3
❑Workman's Compensation Insurance
Check one: X-PRESS PERMIT
(N I am a sole proprietor
❑ [am the Homeowner S EP — 2 Z008
❑ I have Worker's Compensation Insurance
Insurance Company Name 10 4- �rOWN OF BARNSTABL •
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof) r
[ Re-side ritm-r- On1�,
Replacement Windows/doors/sliders. U-Value d (maximum..44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
(' 1
SIGNATURE:
(1'\\WPFir.RC1F(1R A�fC1h��fl�i6,o.,P.,,,�t f��r,�',FYPR FCC.f��
i
✓lie -C�a7n7rtortuie2�i a�./�2asactucae�la
Board of Building Regulations and Standards f
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration :,145637 Board of Building Regulationsand Sta$dards.
Expiration..�ti1 9 6/200 One Ashburton P1ace.Rm 1301
Type <DBA Boston,Ma.02108
MICHAEL GARDNER BUILDER r
MICHAEL GARDNER
4 I
37 WATERGREEN
OSTERVILLE,MA 02655 Administrator Not valid without signature
e
t A� � ��ie,i�arrhr:���urea,� o�,/�aaaccc�ivaelta
t Board of Building,Regulations and Standards .
` } Construction Supervisor License
Lace sn e CS 4729,1
3 Upiraton 2/22/2010 Tr# 19135
Restriction 1G `'
,.V MICHAEL J ,GARDNER����l,� i'
' PO BOXJ.334
OSTERVILLE MA 02655 Commss�ouer
• is
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 WaMing-ton Street
$osto.M, AM 02111
wwtv.mass.gov/dia
Workers' CompensationYnsurance Affidavit: Builders/Contractors/Electricians/Plumbers
A-pplicant Information Please Print Le 'bl
Name(BusinessJ nization/Endividuan:
Address: (O
City/state/Zip: 'L� 6l .-
or
Are you an employer? Check the appropriate boy: Type of project(required):
1.❑ I am a employer with 4- ❑ I am a general contractor and 1 6 ❑New construction
employees (full and/or part-time).* have hired the slab-contractors
2 I am a'sole proprietor or pa -
list.cd on the attached sheet 7. ❑R-cmodeling
VV ship and have m employees These sub-conhactors have g, ❑Demolition
employees and have workers'
worling for me in any capacity. 9. ❑ Building addition
[No workers' comp.-imsurance comp.insurance.$
5 10.❑Electrical repairs or addi{ic
S. ❑ We arc a corporation and its
rtqulred]3. I am a homtowncr fining all work
officers have exercised tb-ir 11.❑Plumbing repairs or additic
❑
myself- [No workers' comp. right of exemption per MGL 12-❑Roof repairs
incrrranec r t c. 152, §1(4), and we have no ❑
�� employees. [No worrs ke ' 13. Other
comp.in u anec required]
*Any zppheant that ehxlo;box#1 rmi&t also fM out the r,=fioo}}Clow sbowing their wmi�='comp--Eon policy iafamm ion- .
t Elomcowncrs who submit this affidavit indicafrng Huey arc doing all work and thrn hire outside contmctors must submit anew of dzvitindiealing such
t�--antraetors that ebeck this box nuut attached an additional sheet showing the name of the sub- o fractors and d An whctbcr or not those cnti6cs have
rmployccs. If the subcontract o s have cnploy=r,they must provi&their workrrs'comp.policy number.
I mn arc employer th&is providing workers'cornpensah an insurance for my emptoyees. 3claw is the policy and job site
information
lunlra.nca Company I171mc:
Policy#or.Self--ins.Lic.#: Expiration Date:
rob Site Address: City/statclZip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and ezpirafion dab
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of Grin ifig penalties of
fine up to$1,500.00 and/or one-year imprisonment, as wcH as civil penalties in the form of a STOP WORK ORDER_and a
of up to$250.00 a day agzinst the violator. Be advised ffiat a copy of this statrm rrit may be forwarded to the Office of
Investi tuns of the DIA for r_nsurance coverage verification.
I der hereby certify render pains and penalties of perjury that the information provided above is true and correct
si e: 2 2
Phone
p 7zW use only. Do not write in this area, lb be computed By city or town offcciaL
City or Town: Permit/License#
Issuing Authority(circle one):
I..Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
• 1
oFINEr Town of Barnstable
Regulatory Services
ati"USS. e•
6 Thomas F. Geiler,Director
4Q p i �' `��
O a Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.ba rnsta ble_ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A,. Builder
Z PalrL I ' O , as Owner of the subject property
he authorize rn l k e—L ��� <'`f to act on my behalf,
in an.matters relative to work authorized by this building permit application for:
(Address off ob) .
A-C-67 or-
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the Homeowners License
Exemption Form on the reverse side.
i,.
-THE Town of Barnstable
��of rp�o
Regulatory Services
Thomas F.Geiler,Director
HARIlSTAB1.E, .
MA 9. Building Division
OrED Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
v%ww.town.b a r nsta b l e.m a:u s
Office: 508-862-4038_ — _ _ Fax: 508-790-6230
HOMEOWNER 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"h0QCOWnerS"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.
DEFINrTION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends'to reside, on which there is,or is intended to
be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes, bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a pc-son(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption aie unaware that they are assuming the responsibilities of a supervisor(ice Appendix Q,
particularly
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,
when the home
owner hire 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,
nstbilitics of a Supervisor. On the last page of this issue is a form currcnt]y used by
that the hcmcowncr certify that he/she unda-stands the rrspo
several towns. You may care t amend and adopt such a form/certification for use in your community.
TOWN OF BARNSTABLE Permit No. ------ 2
t uUSTAX a Building Inspector - cash _--
`
- OCCUPANCY PERMIT Bond _
No building nor structure shall be.,erected, and no land, building or structure shall be
{ used for a new, different, changed, or enlarged_-use without a Building Permit therefor
first having.been obtained from the'Building Inspectore No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Patel G.. Brat€ Address 1450 j+DT GAS Rf� i� c 13 t? i tR
lot #22.3� 254. Armes 17ay, (le nteryille
1 Wiring Inspector _ Inspection date
Plumbing Insp�ctor Inspection date E '
Gas Inspector, Inspection date
-f tl '
!' Engineering Department f t4- t�/ Inspection date b
THIS PERMIT WILL NOT BE, VALID; AND THE BUILDING: SHALL NOT BE OCCIIPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
� 1cad r
ci��a
Building Inspector
Zi� _..
slesss 's ma�i and lot number .... ........... pE
Sewage Permit number .. .............................. � »;
SEPTIC SYSTE�A
House number .a y #
INSTALLED IN CO E.
4 ... ................................... WITH TITLE ° 1679-Ar�•�
ENVIRON NTAL COD 0 MAV
TOWN OF BA R N S T ABEGULATIONS
DUILDINS INSPECTOR
APPLICATION FOR PERMIT TO ......q-...4A7M &G...............................................
TYPEOF CONSTRUCTION ....... . ....®............`........:..:...-................................... .:.. .......................................
........... ................19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according 0t'o the following information:
Location ........... ax........... Z3............4.m`Q,5.....W..... .WI.1......�-�L . .......
ProposedUse ...........�',`,`,1�.:�.....�SiGL• G . .......................................................... ...................................
Zoning District ..................................... . Y Fire District C !!I7 —✓�j(C ..... YcJi .........
E WAS
PRY./....�h...../.�✓�� .0 Name of Owner ..... .......... ................Address . ... ..........
Name of Builder .....{!\�, sell.../1z :.. /. !?...........Address 1 ,� ... .1 �1 'tZ� .........
.Name of Architect
Address ....?' ,� Trz-- c{1 ..................................
Numberof Rooms ........................ ....:.................................Foundation ........ ✓ ..........................................
c� // ids -s� 1d / ,�1� � ��;��� ..........
fxierior ............4��.�1.......�� �............�.�,�..............Roofing .......:...... .....
���� :rn Interior s $ C�
Floors ............... ...:..... .. 1. /.
r �1 g �..4 �1.� l�� ..........
Heating ..... �G Plumbing
Fireplace ........0.1.1 .............................................................Approximate Cost ........f�0c ......................................... ...
Definitive Plan Approved by Planning Board ------------____---------------19________. Area .......I.� F..'5�........,
Diagram of Lot and Building with Dimensions Fee � 7 7s
................./.........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH (,AJ�-�'
r
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. ev
I -
Name
r�
...................:.................................
BRATENAS , PAUL G. _7
y'No 2.2.JJ.3.....'Permit for .................. C
...F��t?�,�.Y....p1r1.s�.]a.rxg............................
` ocaron Lot..22......#.2. .4...Amees..Way........
• ................QAX?.hex:TTa..a.la..................................
Owner ..PAgl...G,....B.xaten.a-s.....................
ri
Type of Construction ..F.name..........................
......... ..................................................................
Plot ........................... Lot .............................
.1
. a �
Permit Granted ....April 14; -19 80 r
Date of Inspection ........•..............................19
c�
Date Completed —7 �10...............:.19 a
PERMIT REFUSED
........................ .. .......................... ... 19 K
CU vsA
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