HomeMy WebLinkAbout0100 BREZNER LANE it � .. -,
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Town of Barnstable illn
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Post This Card So That��t�s Visible°From the Street ;A roued.;PlansMust be R,etamed,on Job,and this Card�Must�be Ke;;_t ��
Posted Until Finallns ecton Has,Been;Made. '- F f y p
Where?a'Certificateof Occu anc. is Re u red such Buildm' µshall Not-:be Ckcu ied until a;F�nal Iris ectionzhas been made Permit
P., YY .q._<.z.N.' R g p.._>.. ,, .. .,s P, „,,
Permit NO. B-16-1526 Applicant Name: SWEENEY,GRACE Map/Lot: 230-048
.Date Issued: 06/23/2016
Current Use: Zoning District: RD-1
Permit Type: Shed-Residential-200 sf and under Expiration Date: 12/23/2016 Contractor Name:
Location: 100BREZNER LANE,CENTERVILLE Est Project Cost: .,$0.00 Contractor License:
Owner on Record: SWEENEY,GRACE � � �.
P,ermlt Fee $35.00
Address: 100 BREZNER LN Paid $3 5.00
CENTERVILLE, MA 02632
Date A'k 6/23/2016
Description: install an 8x10 shed
Project Review Reci install an 8x10 shed
1, Building Official
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This permit shall be deemed abandoned and invalid unless the work authorzed by this pemrt is co within six months after issuance.
All work authorized by this permit shall conform to the approved application.and the apprpyed construction documerits,for which this permit has been granted. `
, .. r ,
All construction,alterations and changes of use of any building and structures shall be it compliance-with-the,16bal zoning%laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same.
s. a>, 4
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and fire Officials are provided on this,permit.
Minimum of Five Call Inspections Required for All Construction Work
1.Foundation or Footing ' `
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue�lmmg isi Called ;-
4.Wiring&Plumbing Inspections to be completed prior to Frame Insp, ion. k � ?/ '
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation
7.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.
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
e.+
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Town of Barnstable ;wo EMt�
`"E'+ tio Regulatory Services
Richard V.Scali,Director LQ/�
9 AS& Building Division DFPT.
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i°tE Mp.� Tom Perry,Building Commissioner July o ryry
YQ
200 Main Street, Hyannis,MA 02601 �� ��
www.town.barnstable.ma.us 0p8A191VS748t,,
Office: 508-862-4038 Fax: 508-790-6230
PERMIT# FEE: $35.00
SHED REGISTRATION °
RESIDENTIAL ONLY
200 square feet or less-
Location of shed(address) Village
Pro rtY owner's name ,. . , Telephone number
Size of Shed ' , Map/Parcel#
_ : lzo
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
You must file with Old king's Highway
Conservation Commission(signature is required) -
Sign•off hours for Conservation 8:00-9:30'&3:30-4:30
PLEASE NOTE:j IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THISFORM MUST BE ACCOMPANIED BY':A
PLOT PLAN
Q-forms-shedreg {
REV:040914 '..
Town of Barnstable Geographic Information System June 2,2016
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DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:230 Parcel:048
boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel
„j 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:SWEENEY,GRACE Total Assessed Value:$269100
5�7 are only graphic representations of Assessors tax parcels. They are not true property Co-Owner. Acreage:0.27 acres Abutters
boundaries and do not represent accurate relationships to physical features on the map Location:100 BRUNER LANE <
' such as building locations. Buffer
i
1T Town of Barnstable *Permit# �Yz1 � l
X-PRESS Expires 6 months from is a date
NOU 17 SOUS Regulatory Services Fee
Thomas F.Geiler,Director
OF BARNS-TABLE Building Division
TOWN Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.townbarnstable.ma.us
`Oft: : 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
p/parcel Number 2� oLO it
pertyAddress /08
41 Sods F�
Residential Value of Work Minimum fee,,6f!$25.00 for work under$6000.00
mer's Name&Address ( ?Oe"gz jr—
ntractor's Name a 8 t AT /�ys7� Telephone Number
-me Improvement Contractor License#(if applicable)
nstruction Supervisor's License#(if applicable)
Workman's Compensation Insurance
Check one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
;urance Company Name
orkman's Comp.Policy#
ipy of Insurance Compliance Certificate must be on file.
emit Request(check box)
9 Re-roof(stripping old shingles) All construction debris will betaken to Af ?Z;le -Py/-ri -V-r-c-
❑Re-roof(not stripping. Going over existing layers of roof) .
❑ Re-side
❑ Replacement 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: wner must sign Property Owner Letter of Permission.
Ho a rovement Contractors License is required.
.GNATURE:
Forms:expmtrg a
vise071405
c � 1 ne c,ummonweactn of inassacHusetts
Department of Industrial Accidents
'Office of Investigations
' d 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/orp3ization/In&vidual): ^�o f�2"T' T. M U S T4
Address: 16 viE
City/State/Zip: asT�2/llG� ,�i} %one#: S a $ -42o -say-a
Are you an employer? Check the appropriate box:. S- go cc¢�D Type of project(required):
1.❑ I am a employer with 4.0 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$ 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or.additions
3.❑ I am a homeowner doing all work right of exemption per MGL ME] Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no
insurance required.] t employees. 12 woof repairs
eq ] [No workers''
comp.insurance required.] 13.❑ Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: �o
t Homeowners who submit this affidavit indicating theyare 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 their workers'_comp.policy information..
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.Lie.#: 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 maybe forwarded to the Office of
Investigations of th or insurance coverage verification.
I do here certify der/helpains nd en al ' s of perjury that the information provided above is true and correct
Si e:. �� `6' rA Date:*
Phone#:
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#•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
ral or written.
express or implied,o
An employer is defined as`_` d at tuMbip association, porporation 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. HOWL er:*e
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 io do maintenance,construction or repair workvn such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor,any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable:evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority.
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if.
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners; are not required to 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 number listed below, Self-insured comparries 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 app
lict
Please be sure to fill in the permit/license number winch will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for.future permits.or licenses..A new affidavit must be filled out.each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and.fax number:
The Commonwealth of Massachusetts
Department of Industrial.Accidents
Office of Investigations
s 600-Washingion-Street .
Boston,MA 02111
Tel. #617-727-4900 ext 406 or-1-.877-MASSAFE
Fax#617-7274749
Revised 5-267-05 www.mass.gov/dia
The Commonwealth of Massachusetts
Deparfinena of hida� trial Accidents
Ofj�ice of Investigations '
600 Washington Street
Boston,MA OZIII
www.mass.gov/dia
anon Insurance Affidavit: Builders/Contractors/Electric%anslPlnnbers y-�
Workers CoinPens, Please Print Le bl
Information •_ � r� � �,; ' .
i licant `
-
Zaine
4.ddress•
y Phone :
City/State/zip:'. /► a Z'
;Type of project(required).
ire oa an employer? Ctieckthe,app. Oat I am a general contractor and 6, (]New cobs melon.
�I a'�PlOyQ�opart-time).* . _g ha_ve hired the sub-contractors, ❑ Remodeling
employees (fta an TR
rietor or artzLer- listed'on the attached sheet;
I am-a soleprop P These sub-contractors have S. •❑ Demolition
• ship and have to employees workers' comp.insurance. 9. ❑ Building addidon
working for Mein auy'capacity. .
o workers' eon=p.
insurance 5• ❑ we are a corporation and its 10.C1 Electrical repairs or.additions
(N officers have exercised their airs ox additions
required.] right of exemption per mm _1Y.❑ Plumbnig rep
3,❑ I am a homeowner do g aIl work • a 152,$1(4),and we have as 12.IgRoof repairs
myself.[No workers comp. employees.[No workersi
urancerequired.]t ] 13•,❑ Other .
ins comp.insurance required.
•''must also fill outthe sectioa.below showing their workers'compensation policy umformation _
�y applic�t thatchecks box#1 m doing all work eudthanhire.otstside co cactws must submit a new affidavitindicatitxg such
Hemeewnets who submitthis affidavit indicating they s^asa on:
Contracts thsi check this bex must attached at additional sheet showing the acme of the sub•contrectors aadthaa.wcrkeis'romp: sc3+
employer that is providing workers'compensation insurance for my employees.Below is the policy and job site
Taman
information.
(nsuranee•Company Name: �..
Expiration Date•
Policy#or Self-ins.Lie.#:
- /,n:►� �/le'�i�EiL G City/State zt a��ii/1
Job Site Address: v°' iration date). 3 z
of the workers' compensation policy declaration page(showing the policy number and•exp. .
attach a copy _•._. .___4<_- _1 . ._._• ; ,__ penalties of
F ailure to,secure coverage as required tinder 5 ectiona2S5�well
as civil �enalties m the form ol-52ca�-le-d-tO Ike ff a S OP W o p k ORDBI�L and:a:iine -
fine up do$1,S00,0 and/or one year bnprisoument, P
of up to$250.00 a day againstthe violator. $e advised that a copy of this statement
may(ie forwarded to.the Office of .
for insurance coverage verification.
Investigatidns of the DIA
I do hereby certify under the pains and unities of penury that the information provided above is true and correct.
Date: /0
Si atare:
Phone# S ••r. 7� .. �.
p•
Official use`oriiy: Do not write in this area;to be completed by city or town off rein
City or Town:
4. PermhUt ense# -
Issuin Authority(elrcle one):
1.Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing In
g spector
6.Other
Phone#:
r'nn•Fnl•f�PTSOIi: — '
• f � -
Information andInstr ' ctims•
Massachusetts General Laws chapter 152 fequires all employers to provide workers' compensation for their c4loyees.
Statute, an employee is defined is"..every person in the service jof another under any contract of hire,
express
xrs� .to this omiplied,coral or written•"
`a ,. : • : a tilers ip assoaation, Fgrporation mother legal entity,or aaY two or more
An employer is defined as`: f1Pa�;P '
of the foregoing engaged is a joint cnterprist and incb&ugthe legal representatives of a deceased cniployer,or the> ;
arts ,association of other'legal entity,employing employees. Ho�t ►er:tbe
receiver or trustee of an individual,p � P
owner of a dwelling house having not than three apartments Sind who resides thencin,ortlie occapant of the
dwelling house of another who employs persons to do maintenance,construction or iepaaz woik•on such dwelling house...
...
or on the grounds orbu:•�g appurtenantthereto•.shallnotbecause of such eaiploymentbe deemedto be an effiployer. �.:.
MGL chapter..152,§25C(�also states Wit,,... y.state or local licensing agency shall�vith6�old the issuxace ort _
renewal of a license or perms to operate a business or to construct buildings in`thetommonwealth for any
a flcaat R lice s not produced acceptable e�dencetof compliance with the insurance coverage required."
ill}
' all MGL chapter 152,�ZoC(�states"Neither�e com��veatth riot any of its'political subdivisions small
dditton y, 'mcc With the instlr
�' erformance of bhc work untfi acceptable evidence of compll ,
enter into any contract for the p antbori "
ted to the Contctmg tY
iequaemeats of this chapterhavebeenprosen •
. Applicants ', .. .•.
lete ,b� checking the boxes that apply to Your situation and,if.
Please fill out the,workers' compensation��ss�aad hone naimber(s) along ceriifieate(s)of . . •
necessary,sapply,sub-contractior(s)nanie(s), ( ) P y�no employees other than*
insurance. Limited Liability Companies(LLC)or LimitedLiabfiityPariaerships(L•LP)
members or p artacrs; are not required to carry workers' compensation insurance: If an LLC'or LLP•does have
is r aired ., advised that this affdavzt may be•submitted to the Department of Industrial
erriployees, aPolicy required. .,..., .
Accidents`for`confizmatipt of insuiance coverage.. Also be'sure to sign and datethe affidavit: The afiidavit should
be retiuned to the city ar townt the applicationfor the permit.or license is being requested, not the Department of
uestions regarding ffie law cr if you are required in flfi '
Industrial, .ccideats .Should you have any q
compensationpolicy,please call theDepmt=t atfhe cumber listed below, Self-insured companies should entertheir
self insurance license number on the appropriate line -
City or Town Officials
davitis complete and tedlegi'bly. TheDepas bienthasprovided a space atthebottom
Please be sure that the afii- mP P� the licant.
of the affidavit for yzal
ou to�out iu the event the Office of Investigations has to contact you regarding app
Please be sure'to fa m thcpe�nrt/hccnse numb w be used
need o�y su�bm�'t o affidavit indicating In addition, an current
thatmatsubmitmultiplepermitlljcenseapphc any given
necessary)and under"Job Site Address-''tde applicant should write"all locations in (��ar
policy information(if V� -vided to the
town)."A copy of the•affidavit that has been officially stamped or marked by thA affidavit mast be filled u each
as proof that•a valid affidavit is•en$lo for;future permitp or licens
year,Where a home owner or citizen is obtaining a license or permit not related to any business or commeratal venture
dog license or permit to bum leaves etc.)said person is NOT required to comp �
The Office of T.nvestigatious would like to thank you in advance for your cooperation cad should you have any questions,
please do mothesitate to g'►►veus a call..
The Departments address,telephone and fax,mupber: `` ; ,
_. . �. R -
The Conunonwealth of Massachusetts
'alA id tCI Y
I-4altment'oflndustn
.office of Itivesigat�ons
. . . r . .600 Washington Street
V
.. • .':'::�?' .•� 'Boston,MA 02.111�. .
` "Tel.#617-727-4900 ext 406 or-1-877 MMSATE
'Fax#617-727-7749
V
�j►�,A,, Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 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 cy 8�R �- IV& STa , 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
Q:F0RMS:0WNERPERMISSI0N
License or registration valid for individul use only
Board of Building Regulations and Standards
before the expiration date. If found return to:
HOME IMOVEMENT CONtRACTOR Board of Building Regulations and Standards
Registration. 108639 One Ashburton Place Rm 1301
2006 Boston,Ma.02108
-- �idual
ROBERT I MU Y _
Robert Musto
ee � °'
105 Bonnie Briar Dri Not v id without signature
Osterville,MA 02655 Administrator __..--_____--_-------- - ----
.. o
THE
TOWN OF BARNSTABLE
STAME.
,639.
a M BUILDING INSPECTOR
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 ..... ........ .............. ..................... ............................................................
ProposedUse ... ............................................................................................................
Zoning District ...... Fire District ...............................................................................
Name of Owner ..!A.................................................GA� PsLAciclress ..... ......av,........... ..............................
Name of Builder ........................Address ...
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ................................................. ..................Foundation r"Welt? O.C.
................................ ............................
....................................
Exterior ...... ...Roofing .....
Floors ..... .....................................................................Interior ..........Z;...........0..&Ply o c
... .........................................................
Heating ........0/.)".........Q.-?1 ...............................Plumbing ......... ..........:............................
160 -00�
Fireplace ........ ................................................................Approximate Cost ........�9.....................................................
Definitive Plan Approved by Planning Board -------------------—-----------
Diagram of Lot and Building with Dimensions
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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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 . . .......... .. ...... ...............
hL
-^"°°^ _^i=^
- /
'
I5I58 add to
No —����'.-- Permit --.----..^�^*�^='..
d»�» /
--� . _.____.______._ | i
�� ��� � �
/P0 8rezner `
Location ................................................................Centerville
` ^
|
_.--..----.—.—~..--.--.---.--.---' /
Edith G~.,~. '
Owner ---............_.........._._._._____'... /
�
Type of Construction —.—...�ra��------.,. { '
--~--.—,.—.—.-----..------.--- `
' #34 |
Plot ............................ Lot ................................
�
r
\0m
Permit Granted .......June
...2O ___]9 72
/JO -S-17q^]7- _
Dotaof |nspaction ...............lg ,
uo*, Completed qv �
PERMIT REFUSED
� __--...--.—.—..-----.—.-- lV |
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—'--'----------'----'---'---'—''
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Approved .... lA
-------.---------.--.-------.
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