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Geiler,Director 1 ArEt!MA't A " TO N OF BARNSTABLE Building Division 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 17), ® � Property Address A 4s'\ Residential Value of Work ,6.900 Minimum fee of$35.00 for work under 6_ $ 000.00 Owner's Name&Address C. V 6 A N Nj Contractor's Name_ ® T Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) y ❑Workman's Compensation Insurance . Chect ne: a sole proprietor - ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company.Name " -------------- Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. ?ermit 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] L?Re-side #of doors JIVReplacement 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: ''Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. GNATUREc i WPFILESTOR IMbuilding permit formslEXPRESS.doC :vised 070110 'Nl issachusettsI erit of Public S tfet� Board of Buildiations and Standards Constructio isor License License: CS 4686 Restricted to: 1G 4 ROBERT C SCOTTI J¢ � 41 APPALOOSA WAY �.. MARSTON;$MILLS;MA 02648 Expiration: 10/9/201' Tr#: 5631 Office,Cwmkmr rs urines hou I i HOME IMPROVEMENT CONTRACTOR l £ Registration .1,52575 Type: Ex iration} p' �/,-•1�1/,2012 - Individual C IC DESIGN )3dT�NG ROBERT SCOTTI 41 APPALOSA WAr^k � 4 I � Q � MARSTOBNS MILLS MA<02§48 Uiidersecretary .t ' The Commonwealth ofMassachuseits 1 Department of`Industrurl Accidents '; Office of Investigations l i�!,�� I 600 Washington Street a j Boston, MA 02111 e I www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant-Information Please.Print Le gib Name (Business/Organization/Individual): L 1 SS C, e.,S k,c,VN Co V\S;,t g Q ` \n Address: Ll I A10 0 S. A Oa GPI V` 6 City/State/Zip: 0,rS�a.� ., o i 1 S o r A Phone #: �© �s �018 Are you an employer?Check the appropriate box: Type of project(required): 1. ❑ 1 am a employer with 4. ❑ I am'a general contractor and 1 6. ❑New construction 'A ployees(full and/or part-time).*, have hired the sub-contractors 2• I am a sole proprietor or partner- listed on the attached sheet t, 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑"Demolition working for me in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp_ insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.0 I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no '12.❑ Roof repairs . insurance required]t employees.[No workers' 13.�ther 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. �Contracfnrs that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers compensation insurance for my erirployees. Below is the policy and job site t information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: . Job Site Address: City/State/Zip:. Attach a copy of the workers'compensation�pohcy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby certify ynder the pains and penalties of erjury that the information provided above is true and correct oe Siznafore: NA Date: Phone#: S6 IS LA CC Ck b O 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 Inspectgr 5.Plumbing Inspector 6.Other Information and Instructions Massachusetts General Laws chapter.152 requires 0 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 dd 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.". f 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 onto 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 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 Deparb:nent at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate liner City or Town Officials e- davit is complete and to e Please be sure that the-affidavit printed legibly.: The Department has provided a s ace•at. the bottom P P g Y P P P 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street z Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MA.SSAFE Fax # 617-727-7749 of T TOWD'of Barnstable a Regulatory Services r $ - ;Thomas F. GeHer,Director ` Building Division r Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.b a rns tab l e.ma.us Office:_ 508-862-4038 Fax: 508-790-6230 Property ier'Mi st Complete and Sign This Section A' 'If Using'A Builder • 9% • -- . a 4C as Owner of the subject•propextY hereby authorize C - Q to act on mybeha.if,- is au matters relative to work a thoriwd by this budding permit a lication for. Pp• 1 a " .b (Address'of Job) tk, 1gnatun? of Owner Date -W ., , ( 1 A-, - - • s If Property Owneris applying forpermitplease comple e. the h Homeowners Licewe*Exemption Form on the`reverse side. : 4 Town of Barnstable ��. o Regulatory Services I Tbomas F. Geiler,Director WCA a63� % Building Division . IFD Tom Perry,Building Commissioner 200 Maid-Strcct;_AypO, MA 02601 ?rWW.town_barnstable ma.us Offi-ce_ 508-862-4038 ,F 4 `Fax. 508-790-S230 A . HOMEOWNER LICMNISE E Ir=ON' Please Print DATE JOB LOCATION: number street village name be=phone# work phone# CURRENT MAILING ADDRESS: eitylumm state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six lots 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. DEMNl'rION OF HOkEOWNTER 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 constrgcts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official Du.a form acceptable to ttie Building Official, that he/she shall be r=orisrble for all such work performed under the building permit. (Section I09.1.1)t . Th,c imdcrsigacd`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The imdcrsigacd"homeowner"ccrtifr;s thatbe/she,understands the Town of Barnstable Building Department r„-nir„nn,inspection procedures and remrirrments and that he/she will comply with said procedures and requirements. Signature of Hotncuwncr Approval of Building•O$cial - Note: Threc-family dwellings containing 35,000 cubic feet or larger will be required to comply with the ' State Building Code Section 127.0 Construction Control. HOMEowNF.R'S EXEMPTION .The Cade states that Any homeowner performing worTc for which a building parrot is rcquirrd shall be exempt from the provisigns of this section.(Sectian I D9.I.1-Creaming of construction Supervisors);provided tha t if the homoovtmer engages a pasw(s)for biro to do such work,that s�uCch Homeowner sb;Ln act as supervisor." Many homeowners who use this=muption are unawar c that they arc asm mig the Tcsponsibrlities of a supervisor(see Appendix Q, Rules&Regulations for Lie^+^ng Construction Supervisors,Section 2.15) This lack of awareness bAm results in serious problems,particularly when the homeownq hires unlicensed pawns. In this ease,our Board cannot proceed agunsl the unlicensed person as it would with i liearsed Supervisor. The homeowacr acting as Superrisor is ukti rmtcly responsrblr To crisure that the bomeovmcr is fully aare afhis/hresponsibilidrs,many communities regnm-e,as part of the permit application, that the homeowner certify that he/she understands a• stands the responsibilities of a Superyisor. On the last page of this issue is a•form currently used by several towns. You may carat amend and adopt such a forrdccrtification for use in your cornmunity. THE.? TOWN OF BARNSTABLE .. BAHB9TSIILS, i 0 3 9 a`��0 BUILDING INSPECTOR A P APPLICATION FOR PERMIT TO . ...fi'L !!i.. ....... .................... TYPE OF CONSTRUCTION .. ...................�..... .... .. .... 8 ................................IA...........1977.r TO THE INSPECTOR OF BUILDINGS: k, The undersigned hereby applies for a permit according to they following information: Location .. .. .�. ....... n 2/17C�............G.T�......V� .. T��X ..... �!.............-.F/ T<.:. .Q-21 Proposed Use ........ :9n..... ..A.k".<.erQ . ....�. w...ae.4--".-rC�t.................................................................................... Zoning District .......... -C...................................................Fire District&-NT,---R.1,1AA- Name of Owner NoR.rn(,r..i.T.....5- �ee..5...7K.0............Address .......... ...... Nameof Builder .................. ..............................Address .................... aR ........................................ Name of Architect .................. Q K ...........................Address ........................�.�.....�............................................ Numberof Rooms .................G............................................Foundation ��..... 1 .�Wit.... ........... . ...................... Exterior .Q �- .. eg/G//vl.Gf. . .......................Roofing � � G ..................................................................... Floors d�U .. .. ........ j!J� !/...................Interior ..... ............................................. V / / .................... 0..`..�...�. QCsol� �........................Hea Heating Z �.. l.......... . ....................Plumbing .............................. Fireplace ..... . ............. .......................Approximate Cost ..... J... ................. ................................. Difinitive Plan Approved by Planning Board ------------------------/4_19 Diagram of Lot and Building with Dimensions ^-I W a U- C m Q _0 U0�1. K( � w U) T E a Z � � )A two �Tr)2� r UJ > U_I < � m �o (� I �� I�looR I �- O _ 14 O co O Qu~i j�l �J __-� 7.h� 767 N Z X-,� o �� IS3 � Pjj U) I-- LL, z 6 C) \ c ,10 0 � k I '` z d LLi I---. 0 ! w U I Z [D _3 II + I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .....GGuG�.......................... ` D�ozzmaot Homes, Inc. No ... Permit twoo±oznr for ---.. ----- � .single---- ���� — ..---.—,. | Location --.. ---------.— Centerville ----_---.---.----._.----.---. � ' | ' � Owner ---.--Normeot..Hmoma��..Zrx��__.. ) . | Type of Construction ------'f rAme---.- ` -----.,'......--.------------- �� Plot --------_. Lot —..x9� .................. � . / 2� �2 Permit Granted -=^~^~^y ��' lV ' �� / -------------' /\ ��- .210 ' ' . / ~~ Date of Inspection ....................................19 Date Como|m�� --..��~����^�..��`��lq ' � | c� PERMIT REFUSED -�* -.-------.--.---------.... lg � ~ ...--..—~..-----~—.—.—.—~~...—.— . ^^'~~^^^~^'-^'^^'~^^~^—^^^'~^`^--'—'—'—^'' -'--^----^---^'----^—~^'^^^^^^^^^' —^--^'~'`~'~^~^^^^^^^^^^^^^~-'~^'^—''—^'' Approved ................................................. lA ^ --------.----.--.--.—.—~—..—.... . -------.,--.---------........,.,, � �-� ~ Assessor's map and lot:numb ... I1� THE ro`° Sewage Permit number" .0.:. A a BARa9TAU • House number ............ ..... rwa ' •.' �� t639• ` TOWN '' O.F. ::BARNSTABLE BUILDING{ INSPECTOR APPLICATION, FOR° PERMIT TO ! ...... . :.......... ................................ ...................................... TYPEOF CONSTRUCTION ......... ......� .4!.. .. ...:...................................................................... »i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby' applies for a permit according to_the following information: q Location ...:.......�.�..a`..�.......fl.a. q)(......0 0 ......... ��!L'� (!.. A ................................0 4?�`...t. �..........:........ ProposedUse .............�J r. ... .....�G���.��.....�C��1................................................................................................... Zoning District .........1.- ...................................................Fire District L`:r /..�..��.....C:•C�7 '�14C Name of Owner . 5`.�` ....4�..ha.ti�...................:...........Address .�.�C�.......�5}1,lf.ly....Qtly ............................. Name of Builder- �_NA...MAC,... ................Address ..I7a'Sew.?0\......k4.........l. 5 per................ Nameof Architect ..................................................................Address ........:........................................................................... Number of Rooms .........................(........................................Foundation ...>5..� ��.re �. ................................................. Exterior . .....7 I.\......... .......................................Roofing .......ioa&PRH...................................................... Floors ......66.cmA%....... .....W.4o?4............................Interior ............�X: CAPMY. ................................................ Heating `..C�sn re.............:........ ....Plumbing N.1. :... -) Fireplace ......................w�, ..............................:................Approximate Cost .................1.c. ........................................ Definitive Plan Approved by Planning Board -----------_______-----------19=_______. Area ...........�......T. ................. Diagram of Lot and Building with Dimensions Fee. SUBJECT TO-APPROVAL OF BOARD OF HEALTH /00--Q0 a- ��ar� '►�\nw 1�4 ion wooC�`'weM" c6 G o no V 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 ...... CHASE, LARRY No Permit. for B.U.ILD...GA.RAG.E .. .. ....... ..... ....... .. Accessory To Dwelling ............................. ................................................ 82 Ashley Drive Location ................................................................ Centerville ...........................I....................................................... Owner ......�j�jy...Chase . ............................................ Type 6f Construction Frame ........................................ ................................................... ............................ Plot .... .................... Lot ;,.n.......... .................. A!�ril "20 , 83 Perriiit Granted ...... ...............................1 9 Pate of Inspecti ......(0/ .....i9io Date Completed .........................................1 9 Ali lie f ' ,.-,hy,a.my•..fit-+d i : • K7i+ �i I I i x• T e x, • i ,.a I i 1 {. i F r , I la r 9MORya$c r , 1 i r 4 L' kk t a I f _ I ` { , s -- 6 t r I L EVI-C�-tASC a '!!' 'o�3'(�1+�1 ' ; �/ + 1 � ,f � � i —s�-fi°,.'."t.. I -i-•- 'r-c-'---+-^-`-� i,. ' � � � ___I_ i .._..' _ ,••,�'-'-.tea-.-,--".-......�- - - _.^; I - ;--.;..� �---- ; �.4"•'- •- r ' v I t r r : ' Y ; r r • ---- -TOPw ity = R` l71 , , t r i i gypsy L �� � - `• -= - � I j � � • r i r _, 6ST I PQ-Q.g,•tIS_,_' r r , Assessor's office(1st Floor): Asse'ssor's map and lot number ' '; =9� o*THE To Board of Health(3rd floor): jpja,�, MT 5 Ewage Permit number ,�,�g • ngineering Department(3rd floor /J, E'r.,"� far MENTAL COD = bm", 4DLL House number - t v2 '�'' ,' ` `FOWN����-TA N`�' ° ra 9. Definitive Plan Approved by Planning Board 19 y y,ram I MAI 6 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only L TOWN OF BAR.NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO e),- y) a �j-'AR 1V11.S ?O & B TYPE OF CONSTRUCTION T—w W I)Q L) P246145' —T 19 90 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location S a-. ��1�1-'4 DT � 0 9- Cr-1U^Ae Q v k( (E nck Proposed Use 1poRLk Zoning District / i Fire District Name of Owner 6,!M R Y C AA SE Address a i L y DP)Uf ,, CF/v't f-1eo P U-C Name of Builder n10 R-��C q 4- Cb�Ll S-f e 1)C-4-1 ON Address c 4 DE b b iES L.Ak6, Mge<_'fo iu M(J/S Name of Architect T>R I--y JD PIN ID06 C-1C Address InA 1')') F Number of Rooms Foundation �3 S-& LUAU Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost }t3 D D Area Diagram of Lot and Building with Dimensions Fee J ev/ OCCUPANCY PERMITS REOUIRED 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 9,0 96 CHASE, LARRY T I�. No 33529 Permit For Build Porch ! Single .Family Dwelling r Location 82 Ashley Drive Centerville " Owner Larry Chase r t. . Type of,Construction Frame , Plot Lot- Permit Granted February 23 , 19 90 Date of Inspection 19 /��n t Date Completed l©/ ! 19 rc } + \,d .. � a f ` ' ry 3k t r � t t r � -