HomeMy WebLinkAbout0032 ASHLEY DRIVE c i�� c
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YOU WISH TO OPEN A BUSINESS?
For Your Information: 'Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
�01.-mm DATE: 3 Fill in please:
..:. APPLICANT'S YOUR NAME/S: ylqQY �• �iwtc J
BUSINESS YOUR HOME ADDRESS:_ 32
TELEPHONE # Home Telephone Number (r&e) ti2_o — o i.
NAME,OF CORPOF�A710N, >`
NAME OF NEW BlJSINESS` TYPE OF'BUSINESS La4, cg.PF' rsz ,
ISTF�IS A HOME QCC�JPL�lr10N? YES CVO
ADDRESS QF:BUS111�ESSrMAP/PARCEL NUMBER .Z� [Assessmg]s
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIO ER'S OF E
This individ al e i e any pe it requir ents that pertain to this type of busine,�'MUST COMPLY WITH HOME OCCUPATION
Auth r' ad Sig * RULES AND REGULATIONS. FAILURE TO
COMMENTS: w
2. BOARD OF HEALTH
This individual has be n inforr7mt�ed of the permit requirements that pertain to this a of business.
P type
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS[LI ENSI WATHORITY)
This individual has b e inf a licensing requirements that pertain to this type of business. .
Authorized Signature**
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
Fill in please: Date: .3 IO lol
APPLICANT'S NAME:
YOUR HOME ADDRESS: _ 32-
�rcF,l A2
: BUSINESS TELEPHONE # CsoS,) 7_ HOME TELELPHONE #:
NAME OF CORPORATION:
NAME OF NEW BUSINESS w .^►xy ,q-f cp,�- S TYPE OF BUSINESS
IS THIS A.HOME OCCUPATION? Y NO
ADDRESS OF BUSINESS 32 A MAP/PARCEL NUMBER .(Assessing)
(Assessing)
Cr.,vrE,2...r�c..c..� 1'V►�i c�2C�3 Z �
When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of
Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd.
& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness in town.
1. BUILDING CO NER'S OFFICE MUST COMPLY WITH HOME OCCUPATION
This indivi I a e r'.:a fan permit requirements that pertain to this type of busin�LES AND REGULATIONS. FAILURE TO
r��
uthorized n ure*' - (;QP4126Y MAY RESULT IN FINES.
COMMENTS: " (/
2. BOARD OF HEALTH
This individual has been informed qtt it requirements that pertain to this type of business.
�� � �i�sr rpMPLY WITH�4LL
COMMENTS: Authorized Signature** HAZARDOUS MATERIALS REGULATIOP<o
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
I
Town of Barnstable
�oFzHE rq',
Regulatory Services
Thomas F.Geiler,Director
Building Division
awrursTeSt.s,
�. HASS. Tom Perry,Building Commissioner
4''°rEp .t►�� no Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee:
Permit#: R009 6I2- 7 7l
HOME OCCUPATION REGISTRATION
Date: SL2O
Name: q,44 t? Phone LfW —0-r—g
Address: 9?— Village: E2v LL ,
Name of Business: lJS-AV' jg!-Up-.� lo A:reRFrgt
Type of Business: 1^VL TCi9-PE- Map/Lot: ! L F
IN I'ENI': It is the intent of this section to allow the residents.of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity
shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase m air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings, and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does pot involve the production of offensive noise,vibration,smoke,dust or other particular matter,'
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
There is no-storage-or-use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met.on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment
• .There is no commercial vehicles related to the Customary Home Occupation, other than one van or one
pickup-guek,.not to•exceed-one torz.:capacity,and one trailer not to exceed 20 feet in length and.not to
exced 4 tires,parked on the same lot.containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
•"' If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
►'
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
• dwelling unit .
k I,the undersigned, e read�and�ee kkh.the above restrictions for my home occupation I am registering.
J Applicant:' ' Date: 3 TO O
Town of Barnstable
TME
Regulatory Services
� Tp�
qo Thomas F.Geiler,Director
Building Division
* nnruvsreu3M •
y MA & Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 50 -790-6230
Approved:
Fee: ZS--
Permit#: cQ�50 6 //,'
HOME OCCUPATION REGISTRATION
Date:
Name: q.9y2�? l.V'. �c 'MCIA Phone#:�0��
Address: 32- /LitLig DeL Village: i�2y clam.
Name of Business:
Type of Business: C: /, ' rn- --Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity
shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution. "
After registration wztin the Building Inspector,a customary home occupation shall be pernutted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located iNithin
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelliung which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic Nvill be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• 'There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities. :-
• Any need for parking generated by such use shall be met on the same lot conntanninng the Customary Home
Occupatioii;and not Aathin the required front yard.
• There is no exterior storage or display of materials or equipment.
• ° There are i'no connmercial vehicles related to the Customary Home Occupation,other than one van or one
picl up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No signs shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included:
• No person shall be employed in t1ne,Custoni, Home Occupation who is not a permanent resident of the
dwelling unit:
1,the undersigne ave read agree,,«tlr the above restrictions for my home.occupation Laura registering.
Applicant: _ Date: 3 4 [or
Homeoc.doc Rev.0&/08 .
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificate
s cos
t 3$ 0.00 for 4 ear .s. A Business
Certificate
town.. (which you must do b M.G.L. - it doe Y cate ONLY REGISTERS YOUR NAME m
s not
t give you permission to operate.) Business Certificates are available at the Town
Clerk's Office, 1' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices
at the Licensingcounter.
o
nter.
DATE:
Fill in please:
APPLICANT'S YOUR NAME: 4R`;
BUSINESS_ YOUR HOME ADDRESS:
Paz
TELEPHONE # Home Telephone Number: rzo 6,
NAME OF NEW BUSINESS ,� ��� �,y; �g , TYPE OF BUSINESS
IS THIS A HOME OCCUPATION?�_ES NO
Have you been given approval from the.building division? YES NO _
ADDRESS OF BUSINESS 3 &4t4--q 412 , M4 . o2(,3 MAp/pgRCEL NUMBER `)9
When starting a new business there are .several things you must do in order to be in compliance with the rules and regulations of
the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200
Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally
operate your business in this town.
1 . BUILDING COMMISSIONER'S OFF E
This individual has en infor d of any permit requirements that pertain to this type of business.
MUST COMPLY WITH HOME OCCUPATION:
Authorized Signatu ** RULES AND REGULATIONS. FAILURE TO
COMMENTS: . - COMPLY MAY RESULT IN FINES.
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business:
Authorized Signature** ry
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the. licensing requirements that pertain to this type-of business.
Authorized Signature*
.` COMMENTS:
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Permit#
7 r i.�F fir."";`i� �yLk Date Issued U
Health Division � �
0 7' J
Conservation Division u P : 3 9 Application Fee
Tax Collector_ Permit Fee
Treasurer
Planning Dept. -+4 w oo c 9-1--op
Date Definitive Plan Approved by Planning Board Co 0 K
� �2
Historic-OKH Preservation/Hyannis
Project Street Address 3,2,-
Village
Owner dO4L Address 76G /2/-
Telephone SO fs-- 139 2 G as
Permit Request �L�y,�vG /'iok/ i�isT�L1T/��
zuJ�LG//�1G To ��2aG � L-L-1/7-1f
50-e ST�11uo isri�/ t�✓SuLi3Ti��h/ 1�r's7�sve�L-
Square feet: s floor: existing �� proposed 2nd floor: existing wll* proposed !t r- Total new G '�
Zoning District Flood Piain Groundwater Overlay
Project Valuation ZIK Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family 0/ Two Family ❑ Multi-Family(#units)
Age of Existing Structure 3 /f2s Historic House: ❑Yes O-N'o On Old King's Highway: ❑Yes O-Nu—
Basement Type: @-rul-1 ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 9
Number of Baths: Full: existing 2 new G Half: existing a new G
Number of Bedrooms: existing 3 new 0
Total Room Count(not including baths): existing 7 new G First Floor Room Count 7
Heat Type and Fuel: UJ Gas ❑Oil I ❑Electric ❑Other
Central Air: ❑Yes O'�lo Fireplaces: Existing New G Existing wood/coal stove: ®es ❑No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:09existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes,site plan review#r
Current Use S "IlLt-/' t- 9PrrILV IsAvROtice. Proposed Use
BUILDER INFORMATION
Name Telephone Number
Address License# `
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGN- URE DATE
FOR OFFICIAL USE ONLY
PERMIT NO.
'~ ' DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION: i
FOUNDATION
FRAME
' INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
i
PLUMBING: ROUGH FINAL '
GAS: ROUGH FINAL
r FINAL BUILDING
' DATE CLOSED OUT
ASSOCIATION PLAN NO.
{
S ` L
y � 0'WR of Barnstable 1
:SAM Tho=P.Geller,Director
1659. Buildiug Division.
Tam Perry,Building Commissioner' '
• 200 Main Street, Hyannis,MA 02601
office,: 508-862-4038 . ' Fax: 508-790-6230
Permit no,
Date ,
AF>�AYiT '
HOME WROYMYMNT CONTRACTOR LAW
SUPPLBUM TO PERMi*.0 APPLICATION
a.142A requiies that the"reconstruction,alterations,renovation,repair,modernization;conversion,
• -improvement,removal,demolition,or oonstraction of an addition to any pie-existing owner-occupied
budlding containing at least one but not more than four dwelling units or to structures which aro adjacent to
suah residence or bvildtag b e done by reglstered contractors,with certain except}ons,along with other
re uh=ents. ;
4
Type of Wozk: �S /��•vT/�L �'�T�p�/ Estimated Cost
Address of Work:_ 3�2 f'FS/fly/ �j2 • c f�yT�,�ys u- �/9
� ,
Owner's Names T6�L � G
bate ofA plication: /a /�lo • ' .
p
I hereby certify that:
jzz#stration is not required for the following reason(s):
[]Work excluded bylaw
❑lob Under$1,000
[]Building not owner-oocupied
[l0wner pulling ow.a permit ,
Notice hereby glven thate ,
OWNERS PULLING THEIR OWN PER W OR DEALING WITH UMGIB MM
CONTRACTORS FOR APPLICABLE HOM3 ZUROYEMENT WORKD 0 NOT SX.YE
ACCRsS TO TEE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDERPENALTMS OF atimY
.lhereby apply for&permit as the agent of the owner: �
Date Contractor Name Registre tionlio.
v�L �,�Gj2 oR ,
Owner's Name '
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings $100.00
Residential Addition $ 50.00
Alterations/Renovations $ 50.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0041=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
/5 EeO square feet x$64/sq.foot= `0/l2y x.0041=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0041=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0041=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00= 30. "
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool - $25.00
Relocation/Moving $150.00
(plus above if applicable)
Permit Fee
Projcost
Rev:063004
Permit Number
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la Checked By/Date
TITLE:DAVID DONNAN
CITY:Barnstable
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE: Other(Non-Electric Resistance)
DATE: 10/13/04
DATE OF PLANS: 101404
PROJECT INFORMATION:
32 ASHLEY DR.
CENTERVILLE
COMPANY INFORMATION:
MAP INS. CO.
COMPLIANCE:Passes
Maximum UA= 166
Your Home= 166
0.0%Better Than Code
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Tress 1580 30.0 0.0 55
Wall 1: Wood Frame, 16" o.c. 890 13.0 0.0 62
Window 1: Wood Frame,Double Pane 139 0.350 49
Furnace 1: Forced Hot Air, 85 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications, and other calculations submitted with the permit application. The proposed building has been designed
to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release la.
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable
Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no
greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4.
Builder/Designer Date
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la
DATE: 10/13/04
TITLE: DAVID DONNAN
Bldg.
Dept.
Use
Ceilings:
[ ] 1. Ceiling 1:Flat Ceiling or Scissor Tiuss,R-30.0 cavity insulation
Comments:
Above-Grade Walls:
[ ] 1. Wall 1:Wood Frame, 16" o.c.,R-13.0 cavity insulation
Comments:
Windows:
[ ] 1. Window 1:Wood Frame,Double Pane,U-factor: 0.350
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? [ ] Yes [ ]No
Comments:
Heating and Cooling Equipment:
[ ] 1. Furnace 1: Forced Hot Air, 85 AFUE or higher
Make and Model Number
Air Leakage:
[ ] Joints,penetrations, and all other such openings in the building envelope that are sources of air
leakage must be sealed.
[ ] When installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944
L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled.
Vapor Retarder:
[ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls, and floors.
Materials Identification:
[ ] Materials and equipment must be identified so that compliance can be determined.
[ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
[ ] Insulation R-values,glazing U-values, and heating equipment efficiency must be clearly,marked on
the building plans or specifications.
Duct Insulation:
[ ] Ducts shall be insulated per Table J4.4.7.1.
Duct Construction:
[ ] All accessible joints, seams, and connections of supply and return ductwork located outside
conditioned space, including stud bays or joist cavities/spaces used to transport air,shall be sealed
using mastic and fibrous backing tape installed according to the manufacturer's installation
instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
[ ] The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
[ ] Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
Heating and Cooling Equipment Sizing:
[ J Rated output capacity of the heating/cooling system is not greater than 125%of the design load as
specified in Sections 780CMR 1310 and J4.4. _
Circulating Hot Water Systems:
[ ] Insulate circulating hot water pipes to the levels in Table 1.
Swimming Pools:
[ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
Heating and Cooling Piping Insulation:
[ ] HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the
levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Circulating Runouts Circulatiniz Mains and Runouts
Temperature(F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Tenip. Insulation Thickness in Inches by Pipe Sizes
Piping_S stem Types Range F 2"Runouts 1" and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD(Building Department Use Only)
Town of Barnstable .
Regulatory Services
BM Thomas F.Geiler,Director
t+s�►ss.
i63� .off Building Division
�Eo s Tom Perry,Building Commissioner -
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.'us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION '
Please Print
DATE:
JOB LOCATION: 32 G
number f� street village
"HOMEOWNER': �/ ��7 �✓J^ - — /—�(���
name home phone# bwork phone# j
CURRENT MAHING ADDRESS:
r
cityhown 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
s Wervisor.
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
resoonstble 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.
proval 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 froin 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 fomi/certification for use in your community.
Q:forms:bomeexempt
_�_--- The Commonwealth of Massachusetts
Department of Industrial Accidents
600 Washington Street
Boston,Mass. 02111
Workers' Com ensatj Insurance Affidavit General Businesses
. � .. • . ..
ame'
address:
ci
sta zi . ( hone#
work site location full address
❑ I am o sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment
working le any capacity. ❑Office❑Sales(including Real Estate,Autos etc.)
❑I am an em loyer with em 1 es fggg ull& art time). Other /
�I am em�loyet providing Nyorkers' compensation for my employees working on this job.
com any name:
'a re a
bone#
city: , G?
1nsiirance.co;l: .•: ., ..i .•: %.// %/
and '..,'% /' //.l9/%/// // %
�] I am a sole proprietor have hired the independent contractors listed below who have the following workers' •
compensation polices:
Coin an name:
address: :,
hone
city:. ;ti•!. <. ;(.r.g: .
insurance co. _.. .`:: ,.,•
com sn penis:
address:
ciEvr hone# ' ' '•:
iy .4
"o7icv4,
ftistirsnce co. ��//�//�� �/ �// %...•... .�.., . "j� .1.
Fallure to secure coverage as required under Section 25A of.MGL 152 can lead to the impoe u
sition of criminal penalties of a t me. to dersta00.andtor.
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I naderatand.that a
copy of this statement may be forwarded to the Office of Investigations of the DlAfor coverage verification.
I do ere ertify under the pa' s s of perjury that the information Prow
ided above is true and/correc
Date /
Stgaa
Phone#
i this area to be completed by city or town official
offic a only do not write in
permitfUeeme# ❑Building Department
city or town, []Licensing Board
❑Selectmen's Office
❑check 1f immediate response is required []Health Department ,
contact person
phone#; ❑Other
(revised Sept 2003)
1
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", 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 section 25 also states that every state or local licensing agency shall withhold the issuance dr 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,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
compensation affidavit completely,by checking the that applies to your situation. Please
Please fill in the workers'
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the
affidavit. The affidavit should be returned to the city or town that the application for.the permit or license is being
requested, not the Department of Industrial Accidents. Should you have.any questions regarding the-"law"or if you are
required to obtain a workers' compensation policy,please call the Deparhnent at the number listedbelow.
/ ////%%�////��%/////%���/////////��%O/%/%%%/////%%%///////%%� ///�/////%/%/%�%
City or Towns
Please be sure.that the affidavit is complete and printed legibly. The Department bas 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/lice use number which will be used as a reference number. The affidavits.maybe returned to
the Department by nail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in.advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
MIA
�i
The Department's address,telephone and fax number
The Commonwealth Of Massachusetts
Department of Industrial Accidents
flff W of Ims igatlgns
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406
pF E rp Town of Barnstable *Permit# 793y?
p� Expires 6 months from issue date
i BMWsTABM : Regulatory Services Fee
� �D&6 0 Thomas F.Geiler,Director pr
Building Division X-PRESS PERMIT
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 $E P 17 2004
Office: 508-862-4038 '
Fax: 508-790-6230 TOWN OF BARNSTABLE
EXPRESS PEPMT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address gL,/tz, /IfJP Cf�lEi�U/L�
E K�idential Value of Work 5_,V9 9 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address ,04Z 7-43ze
7Z"7- 2 ay�5,�.-rZ t-1z�y9
Contractor's Name XJJ%,O/Y1 d 2 Telephone Number
Home Improvement Contractor License#(if applicable) C 2.7 /.3
Construction Supervisor's License#(if applicable) ,T/,,1 e
Board of
Build
❑Workmen's Compensation Insurance "g Regulations and Standards
Check o
HOME IMPROVEMENT CONT
Ell am a sole proprietor ReIwsuation:. 12 RACTOR
7413
❑ I am the Homeowneran; 1p /2004
❑ I have Worker's Compensation Insurance TXne 4ndavidual
DAVhD H.DO
NNMNk_j 3`-
Insurance Company Name DAVkD DON;NAN :R ,__,_
fi7 HITCHINGPOST
CHATHAM, R 'Workmen's Comp.Policy# MA o2133
Copy of Insurance Compliance Certificate must be on file. �.._.
Permit Request(check box)
❑'IG-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping) Going over existing layers of roof)
❑ Re-side ,
l-Keplacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
e Improv ontractors License is required.
Signature
Q:Forms:expmtrg _
.y
oFtrq,,, Town of Barnstable
r a
Regulatory Services
* r
* BARNSCABLE•
v MAW. Thomas F. Geiler,Director
•
s639 ��
ArF1639 Building Division
Tom Perry,Building Commissioner
200 Main Street
Hyannis, MA 02601
www.town.barnstable.ma.us
Telephone: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using a Builder
as Owner of the subject
property, hereby authorize to act on my
behalf, in all matters relative to work authorized by this building permit application for:
(Address of Job)
Si ature o Date
Print Name
INEt��♦� ? TOWN OF f s-BARNSTABLE
i BABH9TAIILB. i �
639.
��'�� . BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ... U..!.41....�N�.'.j'�✓??�.�' ULVC.1111a(.�1.........................................
fit...... `/
TYPE OF CONSTRUCTION ..............AI.aQ.dl....!/'A/.7?:, .....:....;........ ...................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the fo`Howing information:
Location ..40/.. .l ?............... ..h. (.e!......L.//'1�............ . , .......................................................................................
ProposedUse ...................................................... ......................................................................................
�, � O.r fe�vr/
Zoning District .............:.�.::T.:.............................................Fire•District ... /.11.��fL.�..../.................................. .: ...........
Name of Owner ..&.q.-I)rJ.f../.T. .ro.c.,r....- Pjf;C ............Address ....6A./e.y......bk........5•.r�.N..tc-k.e! k.
Name of Builder 100AM411 1 a��'S...-T!� Address..... .. ....... ................ ....................................................................................
Nameof Architect ......NhwgC .............................................Address ........................__.............................................................
Number of Rooms .......... .....................................................Foundation .../..[1.4!�C.Q'..... Q:.a.G� ...............................
Exterior ...........,Sl.fJ1.l . .
2;n4:................Roofing ..... `fsS 11�f1 .......................................................
FloorsC... ' ..............................................................Interior .........Alkly&A. ...................................................
Heating ......f!cVAe, ............................................Plumbing ........9.".OAZ.II5.......................................................
Fireplace ............ ......................................................... pproximat .........A P Cost : ..... ................................. .... (/�
Difinitive Plan Approved by Planning Board ---------------__ /5N S'r
_____________19________. �� ad
Diagram of Lot and Building with Dimensions
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .... ............)...............®..................................
t
0oroeat Homes, Inc.
�
`
,
oroa otoz�r -
No ..����.�.-. Permit -----..-��---.. '
single family dwelling
........................`......................................................
Ashley Drive
Location_ ---.----.,--.-.-~..------,
Centerville
.......................................................
! �
Owner .........0ornn*at..loma�sx..Zoc�_____ .
|
Type of Construction ----..�����...--___
'
----^~^---~~^--'-^^^^-----^---- }
Plot
�IO8
---.�-----.. Lot _____.................
1
}
Permit Granted .........June
..27_____.]g 72 ^
� Date of Inspection lg | �
' !
Date Completed
�~~ PERMIT REFUSED
/
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Approved ................................................. lQ
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