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HomeMy WebLinkAbout0030 BREZNER LANE 91 -""-7 Ne, n i� rF y 4 q t n tl 6 „ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ���' Parcel ppli ti In #� Health Division / Date Issued c;2 MJ y Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Streetfit Address -60 , CZN&W LIV, dai tZE;CUl LLe Village &Nrba'ar /w. DX Owner Address 51) Telephone Permit Request /AffT1Z1V a- ALcly fi V_ , dam - /�� r /c i,,U �Z�/"j Jam'��Z✓�C�, 1�'�L' /�adi�V t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed-4—Total new,-� Zoning District Flood Plain Groundwater Overlay Project Valuation A,060 OA Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach setp4orting de-umation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) �d� Age of Existing Structure 4 Historic House: ❑Yes No On Old King''s Highway: Ye ►❑ No Basement Type: R Full ❑ Crawl ❑Walkout ❑ Other 3. Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new ' Half: existing new-C9, Number of Bedrooms: A, existiwe new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 2'-G'as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes gAb" Fireplaces:. Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: 44sting ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No . If yes, site plan review# Current Use r Proposed UseA F �� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number R3` 41 Zd Address :��/A9&�-- License# & ic���� .mil1� �Z�.3�i, Home Improvement Contractor# 5—di- 7 7 r Email , Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNAT"RE ��'v4o'Au�� DATE- '�l L FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE rr OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION I to FIREPLACE _ ELECTRICAL: ROUGH FINAL i '3 i' PLUMBING: ROUGH i FINAL GAS: ROUGH FINAL FINAL BUILDING m zJi S `l DATE CLOSED OUT t ASSOCIATION PLAN NO. 1 cc}}' S'' e Commomped&ofHassachms r ; Dqw*nmt a�fhrdslricdAccadentK _ Office vfhwinnt law ' 600 Wt:sh ngton rS�fi r'eet Boston,MA 02 wa m masngofldw Warke& CampensafituInsurance Affidavit BOders/CantractorsMectricians/Rumbers APPEcant Iifarmafaan Please Print Tx-giMy Name(Basme�sJC3uizadion�„ ���: G ? Tiy0�9t� dress 7P JC D �G/�A.IGr atylstatfi-zipze L 4/`%G4r- �/,/ Phone#k �- l3 4 , Are you ait employer?Check the appropriate bow: f T o 'ect ( 4. aius cctor a>rd I 3'Pe. �o1 �r mod}_ L[I I am�a employer with ❑ I onixa 6_ ❑Neu,*o=shuctiou g0pioyees(€till and(orpait-time}* havemredthe sub-eoutrac6m I v/I am a sole proprietor orpartner- li�te-d on the attiched sheet. y- ❑Remodeling ship and bane no employees These mb-contractors have g_ ❑Demolition working far me in any capacity employees and have workers' 9- ❑Building addition [No Workers'Comp-insurance comp-fnsarranrn 1 , ] 5. ❑ We are a corporatiaaand its 10.❑Electrical repairs or additions 3111 am a homeowner doing all wort: officers baN,,-e exercised their II.❑Plumbiag repairs or additions, mymM[No workers'conT- right of exemptionper MGL I2 0 Rnofrepairs MhU anremguired-]l' c-152, §1(4),andwe have no l3�Otbes employees_[NowodM& . comp-insurance required.-I ' *-Any zppUaml tb=tdhedLsboz#1MntalsoMovtthesecrioab9owsh=ia5ffieir mdeeiemmPemsmdaapoTic7- 1Homeowners trho subffit this 1d�divrt In�1C3tiIIg they HIE doing aIIt7n�e sad thpn}roe autade c aCtnrs mnst 5ulwk a new sffidaeit ink rnri, tContramrs tbst check this box mast attached sa addidansl sheet dundng the Time of&a 5x&-rmt2Cun amd stag whether ornot 11mo zanks have employees. Ifthe mb-caatmctmshum employee s,tl Ley must prtruide ffiar warless'comp.pohcpnumber. lam Belau is Ste pa cy an.d job site irtforr'rtatiratt. . Insurance Company Name: Policy 4 or Self-ius-I.ic.;k FxpirationDate: Job Site A.ddiess City/Stabr~1Ztg: Affach a copy of the workers'compensation policy declaration page'(sho°wing the policy number mid ezpnation date). Failure to secare coverage as mgairedunder Section 25A of MGL r 152 can lead to the imposition ofcriminal pwalties of a f m up to$1.500.0a and/or one-yearimprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fim of up to$250.00 a day against the violator- Be advised that a copy of this staten=rt maybe forwarded to-the Office of Iuvestigatims of the.DIA for mere coverage vacifica#ion- I do here fp r tke prmrs atrc£panoTfces a.�'pe�uaJ'fftrtt fha izz rmatiQnprmi&dabat*e is bus.anr£.correct . Phone (? usa only. Do not warms in this area,to be<completed by doz ar town officiaL City or Town: PaMIR License# Issuing Authatity(circle one)r: 1.Board of Health 2.Butff ing Department 3.CityH-awn Glark 4.Electrical Inspector S.Plambing:Inspector .6.Other Contact Person: Phone#: 6 . t information and ]Instructions ° Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuanrto this statute,an wployee is defined as 1`...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,partnersbip,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 tnrstee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant Who has not produced acceptable evidence of compliance with the insurance,coverage required.'' Additionally,MGL.chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their ceraficatc- s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other than the members or parblers,'are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance Coverage.- Also be sure to sign and date the affidavit The affidavit should be returned to the city or-town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is oa 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 aiidavt 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 Coraimnv�ealth of Massachusetts `4 Depaitmeat Qf Ind al A(ccidmts . . Q-�iiee Qf Ti�v�tig�atFans ' 6(}G Was ingtan Stz,!�et Bnstw,MA 02111 T,-_I.#to 17 727-49W act 406 or I4 hEkSWE Revised 4-24-07 Fax#617-727- 49 wwwxamgov/dia l � ��� ar�z��zo�teuealCLo � r«.rcac�lc�ez'E Uffce pf Consumer Afffatrg&Jluilhess R�gnt Lion NME IMPROVEMENT CO�TR/ZC'LOR i istraE"on - ,52773 Type 9. ICpiratiQn 9/28/2014 bBA I I J GROUP " f t. y jt.. - DANIEL WOOD LE I C RC 196 S CUDDER BAY � t. 2 0263 r MA to LE - cre IL - rse V ode CENTER U Y ( License or t egtstratton valid for tndtvtdul use only _ ._ ; i 'bore tl[c Axpira#ton date. If found t�trScn to Office of Consumer Affairs andusmes`s_Regulation 10 Parl'Plaza Sutte 5170 Boston .MA 02116 I - I Not valid without signature I 1 Massachusetts Department of Public.Safety a i Board of Budding Regulations and Standards r, , Cunstructiurt.bu cry isttr:1..&,. .F roil , - ,I � 2 3 License .G'$FA-062822 DANIEL C W06D 196.SCUDDEI2 BA CIR.` � • 1 r p . CENTER E MA 02633 r 14" Expiration ._ Commissioner 03/28/2014 �l 0 f ' ` �'ME Town of Barnstable o� Regulatory Services # siUTT.CPA= • MASS. Richard V.Scab,Interim Director 6:59-- Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8,­-_ Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section. If Using A Builder . as Owner of the subject property hereby authorize �i�7U^Aida to act on my behai� in 0 matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are pe ormed and accepted. S tote of Applicant riot Name Print Name. Date - Town of Barnstable -. Regulatory Services ' of T Richard V.Scali,Interim Director °-� Building.D"ion 1 &ARNSTABLA Tom Perry,Building Commissioner mass. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Offa-ce: 508-862-4038 Fax: 508-790-62-0 HOMEOWNER LICENSE EXEMPTION - Please Print DATE: JOB.LOCATION - number street tillage "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityAown 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 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- fa.mily dwelling,attached or detached structures accessory to such use and/or farm.strictures. 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 109A.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use.this exemption are unaware that they are assuming the responsibilities•of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness.often results in serious problems,.particularly when the homeowner hires unlicensed persons. In this case;our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. - L *TNE TOWN OF BARNSTABLE • MARNSTIBLE, "AB& 1639- 0 M BUILDING, INSPECT.0 APPLICATION FOR PERMIT TO ................................................................... . . .. ... TYPEOF CONSTRUCTION ....................................................................................................................................... .................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...Aot..Y.g......... r .....Q.r ............ .................. Proposed Use .... . ......................................................................................................... ............................ . ZoningDistrict .... ... ......................................a............................Fire Fire District .... ..................................................... I t 0 ....... 7iL V-S Name of Owner qVJ S , *//--ZtP..4.............Address 71.0...... q.k....... . . ......................... ............ . ........... .... PName of Builder &11� ck� aQ--1 ...... .........'..SO... .......Address ....AJ. fName o A........Address ........ ............................................................ 14 Number'of Rooms .... ......................................................Foundation ............................................................................. Exierior ............ . ..................................Roofing .... 1?4a: .............................................. Floorsr..................:'.�................................................................Interior ....674��.Cj.................................................. Heating ........... . .................................................................Plumbing ....... .-4 I-9- - _.................................................................... Fireplace ..... Approximate Cost .......91.;,... .......... ................................................................. Definitive Plan Approved by Planning Board ------------------------------ 70 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH �e 3 2, b-7 < < M 0 L.L 0 z >: 0 EL < LJJ Uj (.0 <1.- Lid V �o' 0 (-D 10L. Z-- < (D � 7- LL1 (f) < CL < Ld i-- < Y-12 2- n e N I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name g ..Q..............04-11-- ......... Hatch,. Edward S, 4 t P No ....�55..2.. Permit for .....one story........... ........single faml.ly d.gelling D...Brezner Lane............................... Locatio ................................................................ Centerville ................. ...............................:........................... Owner ... Eaw rd S, Hatch 7 Type of Construction . frame ................. . Plot .........................:....'Lot .......... 1.4.9................ r �I � r i -3© o Permit Granted ctober..11 19 72 Date of Inspection Date CO*%d ! .. . . .. ............. j 8 3 Co�YP � PERMIT RE SED ................................................................ 19 ((� f ............................................................................... I r, ............................................................................... ............................................................................... Approved ................................................ 19 , a ............................................................................... t le"u FN "".fjr f IL To IAA-I�(��, e-7 1 O A7 VAIt Fz n3 lie A II 1 L