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HomeMy WebLinkAbout0306 CAP'N LIJAH'S ROAD 3� .�► s e a a _ Town of Barnstable *Permit# ere s 6mthe fr date : Regulatory Services 'Fie' tSOV . Richard V.Scali,Director ,i ► 6 Building Division L�� �STp61-� Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 ' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEWMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Pry operty-Address­�3 6 CAP 1-4 6 SA K5 1� �� CC-N' T5 P-V 11-1_4E� NA Q 0z 6 3 ©2, °Residential alu Work$ .Q b 0©.'_ `Minimum fee of$35.00 for work under$6000.00 _ [Owner's Name&Address I A r1 i--TE-g Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: ° Construction 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 Insurance Company Name - Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. r Permit Request{check-box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to MAC. b4%V0j ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and-inspections required. Separate Electrical&Fire Permits required. '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. �-SIGNATURE:. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC 06/20/16 f 27M Cammomrealtit q,f Maysrrchuset& Department afradzubialAcc idaT& Offike Of IkVeSftatMM. 600 WashfiWwz Street Boston,ALA 02111 . - 1PFPI_VLH:ass gov1dia Workers' Cumpensa6=Insurance davit Builder-s/C nmt a-cturstEIectriciansfPhimbers Applicant Infmmafrlkn Ple2se Priut Ily ALA o 4 P mom Are you an employer?Checkthe appropriate box: T of project r % I am a general contractor and I Y P ] { enu ed}= I.❑ I am a employes with. g 6_ ❑NewNe eonstucticu employees Cfull aexdtor par-time)* have breed the sib-ca�ctars listed cat he El I am a sale proprietor orparta-er- i�e attached sheet I ❑Rernodeliug slap and have no employees These sob-contractors have g_ ❑Demolition worizing far mein employees and bavexvadrrs' ��fY- $ 9..❑Building addition [No S4 ddmLS'Comp.rre©=nce comp_icsaranrr r -1 5. ❑ We are a corporati=and its 10-❑Electrical repairs or adcSiHons 3. I am a homeoumer doing all work officers have exercised their 1L❑Plumbing repairs or additicra myself[N8 workers'c=p. rightof§I{ dwe have no per MGL L�Roofrepairs insai ante regnired_]? employees.Lwo Viers' ❑Other camp_insurance required_] &Artyapg5cz=datcbedsbos#1—stalsoMcaittheswdcmb9awshu►dag&ervia me compensadmpaBryinfo¢mseicm. I Mnmeoacaem Who submit¢his sffidzvg i ifEre ag tLa_y Rm dmz6-zU Wad and then h€ce autd&cont=t=—.St submit anew affidavit mdicabnp sari, ICaatmct=tbat c'heck tbis box mast r tacked sa 9affifir al sheet shouiag the n—of Hze sub-cflmacscma snd stye WLethec ar nat tbnse mdtieshn-& empluyees.Ifthesab-cao�ctfleskmempIoyeL%theymmutpmvidL-dw&trarkr&CMMP•PalicymmmbEL lam an erripr fliatisprauirling�var$ers'coeetperesafioee uesrirarece fvr ecry enrPFoS�ee $etoty is flte prrlic�areal jnb site ' Fre�mvreatian . Iusucance Company Name: Porficy 41 or Self-tips.Lic. F�pirafoa Date: Job Ste A.ddres CitglState!l�sg: Attach a-copy of the workere compensationpolicy declaration gage(showing the policy number and expiration date). FaR=to secure,coverage as required under Section 25A of M(ff_a M caa lead to the imiposidon of criminal penalties of a fine up to$00D:OD anilor ade:y6ir imprisonment:as well as riiil penalties is$he fo=of a STOP WORK ORDER and a tine of up to Moo a day Winst the violator. Be aoisdsed.that a copy of this statement maybe forwarded to the Office of Investigations of$te DIA for coverage Leffficahm I aFa!terry cerhff under aced panels A.C�eeJ"r}'that the uafarma#ims pt nvtrisd abm�s is trots and c trrrect �fLRU21]pate: . OJIcid use are£!: Do rwtwrite in flats area to be evinpfeted by city artopm a greiaL . City or Tana: PerntdUcense;g Isstdng Autha &rle one L Soard of$esIth "�.Buz UngDeparlmeat 3:[StylTowa Clerk 4.Electrical Inspector S.Ptebiag Inspector 6.other Contact Person Phone#: -- 6 Tuformation and Ins efions . Macsachoseft C�eaa1Laws cTzgp 152 recrs an employe�rs'fo gro�Md-,woil= compe=sationforfhe=emplayees. Pmsaani-to this sib,au Iaye�'is defined ate.every personin to seavi.ce of aaotber Tinder auy mad ofhi, =qX=M or iirrpliet%oral or written." An employer is defined as"an indryidual,parfn=& p,assocfifian;cmporaffim or other legal ettdy,ar Emy two or more of the foregoing=gaged is a Joint cut2Tdsp,and aichidmg the legal repnese:ob'&M of a deceased employer,or the recciver or trustee of an mdiyidmal,partomsbrp,associstion or other legal entity,employing employees- However the ownerr of a,dwel inghorse having not mote than theme ap mime Eds and who residestherein,or the o,=4r-nt ofthe - dw eIling house of mxd=who employs persons to do mai3te ance,co nstra ion or repair woi.an such dwelling house or on the grounds or bm- mg app thereto shaIl not because of such employment be deemed to be an employer." MGL chaptera 152,§25C(6)also states that"every state or local licensing agency shal[wiffihQId fie issuance ar renewal of a Tcense or permit to operate m business or to construct buildings na the con rriGn vealth for any applicant`:-Who has notprocI ced acceptable evidence of compnan.m with the insurance coverage rf_-q ci" Additionally,MGL chapter I52,§pCM states-Neither f e,connnorrwcalfh nor nay ofits political subdivisions shall meter torn any contract for the pex-Barmance ofp' Iic worts m3til acceptable evidence of complia<o.ce with file ice. re q==en is of this chBpt=have been p;e sensed to the contracmng anfh ojty." Please fi]l oirt fhe wor3=' compensation affidavit cnmpleinly,by chwIdng the boxes that apply to your situation and,if necesSalY,�PPIY sub-contra�s)name(s). addresses)and phone nnmber(s) along with their=t if cate(s) of msmxce. Lmmited Liability Companies(LLC)or Laaited Liability Parii�hips(LLP)wi$nno employees osier than the members or partn=s6 are not rbq m rd to cant'worlie& conipe r safion mmixanm_ If an LLC or LLP does have earcpIoyees,apolicyisrequaed. Be advised that this affidayit maybe sobmiffi--d try f e;Depa-lmentoflndustrial Accidents for confirmation of ms<u-,m=coverage Also be score to sign and date the atrrdayit- The affidavit should , be retrnned to the city or town that the application for the:permit or license is being rvF=9 A not fhe Department of Traci,ref,«I 1i c1-; mt-_ Slluvldyogahate any questions regarding the law orJfyon air remedm obfant awogs' compmsation poIiey,please call the Dep a tnexit at tho rmmbea listed below. Self-fimurd companies should ear tliea s elf fi err=ce license number on the appropziate line City or Town Offfl-cials Please be sure that the afdavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till om in the event the Office ofIuvestigations has to con actyoureg'mding the applicant_ Please b e sure m fEl in the pence' cease number which ch will be used as a m&rcnce number. In addition,an applicant that must submit multiple perrnTH cCnSe appliz ati®s in any given year,neei only submit are affidavit indicating eat p olicv aifo=ELtion(if necessary)and nodes`Job Site Address"tie:applicant`horld write"all locations iri (crtY or. town):'A copy of the affidavit that has been officially simnped or marked by file city or town may be provided to the applicant as ' of that a valid affidavit is on f1e for futm a putts or licenses A new affidavitmivst be fillled out each year.-Where a home owner or dtizem is obtaining a license or perm]±not related to any business or commerau venture (ie. a dog license or perrok to bon leaves etc-)said person is NOT wed to complete this affidavit The:Office of Inyestiog�would like to thank you in advance for your coopeiun and slionl d you have any quons, please do not htsitate to give us a call. The Dep7trri=Ys a ddrew,t 4 phone and fax rmmbea: COMMMW�Slft OfM&13 � f�tc�of ut. �ioa� �R4 washhg m B MA 02111 Ta 41' 617-727-4900 cEIt 406 car 1477IL4. E Revised 4-24-07 -gDg� r ,r Town of Barnstable Regulatory Services 'e rr t Richard V.Scab,Director 6 39. Building Division. Paul Roma,Building Commissioner MO Main Street,Hyannis,MA 02601 www.town.barnstable-maus Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must r Complete.and Sign This Sectio If Using A Builder I , as Owner of the subject operty hereby authorize to act on my behalf, in all matters relative to work au orize y this building permit application for. (Addres of Job) **Pool fences and are the resp nsibility of the applicant Pools are not to be ed or utilized before ce is installed and all final inspections e performed and accepted. Signature-of Owner Signature of Applicant t Print Name Print Name ' - .. j, is - ♦ ` Date , Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services ° pI Richard V.Scali,Director Building Division Paul Roma,Building Commissioner noes. e39. M�� 200 Main Street, Hyannis,MA 02601 Fp www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: Aj JOB LOCATION:`• ®� CA P li L i r a number street village "HOMEOWNER": AgA m T �'Cl �� `�.. 5d8 4 a �b a name home phone# work phone# CURRENT MAILING ADDRESS: c*-. CA p w Li-tA N S 7�3 r Cr..lwde-,j mot, t*XA city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building 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 ements qnd that he/she will comply with said procedures and requirements. r Signature of Homeowner, Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner- engages.a 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Town of Barnstable �0*IHE l° Regulatory Services D� 1 P o g ry Thomas F. Geiler,Director • SARNSTABLE, Building Division °lFa ray Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 _ Fax: 508-790-623( PERMIT# 1�1 F0 `J FEE: SHED REGISTRATION 120 square feet or less Location of shed(address) Village ILA N P H I bEw FC-L-TEP, 00 MAE- RaEl out Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? / Old King's Highway Historic District Commission jurisdiction? / Conservation Commission(signature is required) G% Sign off hours for Conservation 8:00-9:30 &3:30-4:30 PLEASE NOTE: 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. THIS FORM. MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 ril- f. Irk t� A t. ! 17 f4 �t„ rya •`. - M LnT�z3 selsrr' . -LIRO"IL KELLzT:,Q . ENGINEERS--SUBV$1COR$. ' 346 J.ONG POND DRIVH SOU'Y'E3 YASMOUT,MAM 026" CE FIE 'DT PLAN SCALE i�o. DATE i :AIY: REF IIIIC LoT if t?[At�t BooK: . z?Z . �:AGR: .q . . ,.3q •��,Ros�y Nt`td�. EASr�: .cNARfaE� . !�1: . . 107 eA:y�R S 1RV Yci '.;,�U¢#�,ST.4 j 073 5'T;fjNLEY. . . . . . r COMFY:-THAT THE . .. ... 0,000, SHOGUN OAr;TEAS P!Aid S LOCATED T Old THE �tli0UUD AS >1t 410t601i .CHARS F STANI.EY AP'c�t L I AH•5 RopD DATE ��'!� /G�/�/ � �0 PETITIONER C.ENTERVI.LLE MASS. o2b3.2 . 'REGISTERED. LAW SUR,VEY.40t Oc �Ile,a�. Town of Barnstable *Permit#,=-;� Expires 6 months from issue date Regulatory.Services Fee �x. � � . �,�I E Thomas F.Geiler,Director Building Division Iq In rED MA'1 A - Tom.Perry,,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 Property Address y ('c�.A A L tc>l�'C �� C N'1 -uA t- /`'Y4 G L V Residential Value of Work , ©6 y Minimum fee of$25.00 for work under$6000.00 —T Owner's Name&Address AL.Ao?i �1i)F-ti FE-L�v A ri rj ` - A -306 C�Q=.�� L%TA;-�� �o CCU °;�LV �,L K4 D,;(43A Contractor's Name t[lnay C ; L y gC kT Telephone Number � _�o? Home Improvement Contractor License#(if applicable)_ ❑Workman's Compensation Insurance Check one: -PRESS PERMIT P"fam a sole proprietor ❑ I am the Homeowner JUN — 3 20.8 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTASL.E Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file: Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �o,rto stab t° r�wt5 ei' . ❑ Re-roof(not stripping. Going over existing layers of roof) 2Re-side ❑ Replacement Windows/doors/sliders.U-Value (maxims *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: —2 , QAWPFILES\FORMS\building permit forms\EXPRESS'.doc 111 i Revise020108 Of Town of Barnstable *Permit#1=7;� q,O Expires 6 months from issue.date .�� Regulatory Ser vices Fee W� TO BARNSI'ABM Thomas F.Geiler,Director 9@, MASS- �� Building Division PIED Nlpy A Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 1 Property Address 506 C an -.1 L—6A 5 j �' EN'i ,� � I- /�'►,4 G f', a� (Residential Value of Work'`q . 0 6 C) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ALJiN? 1 H r6F.+t9 r—E-L-1-EP- A r t\j NAruzF_ Eels� P.�J,I L•L— K4 D;l t 3r;Z Contractor's Name �k AyA�1t���y 6de� �r' • Telephone Number��O�_�o7� Home Improvement Contractor License#(if applicable) �o ❑Workman's Compensation Insurance IT Check one: X-PRESS PERM 9211'am a sole proprietor ❑ I am the Homeowner ,JUT _ 3 2008 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) e Re-roof(stripping old shingles) All construction debris will be taken to r,1 tab t° i r��5 i p✓ 7f. ❑Re-roof(not stripping. Going over existing layers of roof) [IRe-side ❑ Replacement Windows/doors/sliders.U-Value (maximum ? *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. 6S -Z Wd E- Nnr ou SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information L.y k Please Print Legibly l/ Name(Business/Organization/Individual): • is 146 ty e_ Address:_ C g oil City/State/Zip: CQ VI 1 e�f ✓i �� U V t� Phone.#: ` !�aS 737 Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction .�fnployees(full and/or part-time). Remodeling 2.® I am a'sole proprietor or partner- listed on the attached sheet 1• ❑ g ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.•insurance comp•insurance.$ ieqaireA] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself- [No workers' comp. right of exemption per MGL` 12.Woof repairs insurance required.]t c. 152, §1(4),and we have no pp employees. [No workers' 13.❑ Other •S' comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-conftwtors and state whether or not those entities have employees. If the subcontractors have employees,they must providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimbial penalties of a fine uip 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 Investizations of the MA for insurance coverage verification. I do hereby ce u er the ains•and pen " s of perjury that the information provided above is true and correct Si afore: Date: Phone# ebb— 28 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"...eve person in the service of another under any contract of hiie, "...every 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 representative's 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." e e state or local licensing agency shall withhold the issuance or. MGL chapter 152, §25C(h7 also states that"every g g y renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant w.ho 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 compliance with the insurance enter into any contract for the performance of public work until acceptable evidence of mp . 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 certificates)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have - employees,'a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the 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 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 io any business or commercial venture (i.e. a dog license or permit to born 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 De<partcnent of Iadustrial Accidents ' office of Investigations 600 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext 4•06 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia TH E Town of Barnstable F Regulatory Services BARNSrABg Y tE� Thomas F.Geiler,Director �}'pl16.59..0.�� - 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 rY Prop er Owner Must t Complete and Sign This Section If Using A Builder 6>V 1 tF L—T-�11 , as Owner of the subject property hereby authorize �Z lC dA O Q- LY,,JC-4,(� 7(Z to act on my behalf, in all matters relative to work authorized by this building ermit application for: DG Gq P r) L ��NT 6—&V( t-L46 0a63 IR (Address of Job) 1. Signature of Owner V Date Print Name . If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. F SHE Town of Barnstable ° Tp� Regulatory Services swtzxsrwat a Thomas F.Geiler,Director 9 MASS. 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a'license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER ' Person(s) who owns a parcel of land on'which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building pemrit. (Section 109.1.1) - Y The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations.. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ,• . Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1,.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeownei 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. e �A ✓� VO�YI/IIZOOLCl/PQ�AJ2 O�i/(�GQQ6Q�fN•CUe(.G6 - 7 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrafionn.112676 Board of Building Regulations and Sthndards UExpirat on 4%1,5/2Ob9 Tr# 131509 One Ashburton Place Rm 1301 s'V ,Types BA Boston,Ma.02108 RICK LYNCH HOME IMPROVEMENTS' RICHARD LYNCWJR �. Y Jf' 86 ENSIGN RD. CENTERVILLE,MA 02632 Administrator Not valid without u • ;p� �1ie -�o�.�vrreovzure� a���actzccaella � �j Board of Building Regulations and Standards License or registration valid for individul use only s HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrdtion ,_,:112676 Board'of Building Regulations and Standards Exprratron_ 4%15/2009 Tr# 131509 One Ashburton Place Rm 1301 " :r Boston'Ma.02108 ���Type DBA RICK LYNCH HOME MPROUE�M�NTS RICHARD LYNCH JR'' 86 ENSIGN RD. tCENTERVILLE,MA 02632 Administrator Not valid without u y��,. •e TOWN OF BARNSTABLE Permit No. ----------_---------------- -- »�T.,� Building Inspector • Cash --- ----— --— — � ma --- -- - a MAI , OCCUPANCY PERMIT Bond -_ / "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19...... _ ................................................................................._......._..........._._._ Building Inspector ess or's m-ap an to number . ................./_ ;, , . SEPTIC SYSTEM•, US , � a . 1NSTi1IC1:ED 1N COMPLIANCE �0� /✓'G, WITH TITLE 5 �. . Sewage Perrr»t number `.....................i ENVIRONMENTAL CODE �1 VD SA D�THE TO TOWN - OF ^ JJ t114 Mm 1 BA"STABLE,...' Wtt F e MA88. . .—.!• i 2 4p i63q. 9� B.0 I LD I N,G Iam NSPECTOR. Ic APPLICATION FOR PERMIT TO ..... ..... ................ .... ..... TYPE OF-CONSTRUCTION ............. ..............................i................................... ..... ` .�C/h /7........19' � E TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according t the folloaiving infor tion: Location ..../C.l..G'.. ..............��........................ t........y/ ..1. ........ ......... I ...... ProposedUse ...... ............................................................. _ - : r....... f Zoning District ... Fi're District ......� ^. ................. g ��r ........ i Name of O.wner:. lGlal'�?�•�.'•• ................. Address ! -.mac—�...` `� .�".........�... -,`�........... `... d ►. Nar'ne Fof, 1.34 lder ...,.... .��.........:.........�� ..................Address .... ................................................................. ` ...... t .... .... f 3. F Nameof Arcfi'itect: .................................................................Address .......................................................................... . ...... Nurnfjer -of'Rooms. ............. ..................................................cleFoundation ....... ........... ............... .......................... Exterior ......... ......... ........ ... ........................Rbofing ..............:e %`.":'' .....:t::.c.`:.-.;�..........................y........ oc Oet/ ilosx�; ........:�.........................Ir tenor ...... ' " ''�.... .................... ................� G(J 's. r -Heating .fz....................:...................:..........Plumbing ......... ... ..............................,..............:. Fireplace .::.......: ..................................................................Approximate Cost ......�®, .............................................(, ; E Deffnrktie3 Plan Approu�d by Plartnmg;'Board _ .--------------__—-----19-------- Area .... >� Diagram,of Lot.and :Building with D.imen$ionsl Fee ..........Z..�......................... SUBJECT TO APPROVAL .OF .BOARD;OP HEALTH: , II ja \ /� . ... a CNNINV I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding he above construction. No ........................ ....... ............. Y, CHARLES F. r No%..22913.. Permit .for ..Two..:Story.......... n le Famil Dwellin ................ ..�'......................(I............. Lot #24 306 Cap' t .Lijah' s Road r Location ................................................................ { Centerville ............................................................................... Owner Charles..F.....Stanley................... I Type of"Construction , Frame ' s ............................................................ Plot ............................ Lot ................................ March 17, 81 Permit Granted ......19 Date of Inspection .............................. . Date omple r`�.19 tR PERMIT REFUSED ....... 19 5 �* 2.0 . - . %........................0............................ . .` . .................................................... ' - -�o ;� k „ Ms Approved ............................................. 19 ............................................................................... r i ... ......................................................... F a Assessor's map and lot number �`r �.......�.j '•••••••............. Yti 7- Sewage Permit number ... ..... ...G tHEtO�y TOWN OF BARNSTABLE Z EMOSTADLE, i "b q �•� BUILDING INSPECTOR 0 MPY Ar. r APPLICATION FOR PERMIT TO ..... •` . ....I.-. f.C.-r... 1.P.. . ..:f...C. ..............................- TYPEOF CONSTRUCTION .................. ...fir...°.....::....... ..... .......:............................................................ .r s .!%...`.::.:..................... .......19......... —TO'Tti'e-rnrs�PecTOR-OF-BtJtL-DINGS. The undersigned hereby applies for a permit according to the following information: Location .... .................. ........ ....... ........ ProposedUse ....... .....!..... '::.:`........................................................................................................................................... l ZoningDistrict .....................................,G._..... ........................Fire District .............................................................................. Name of Owner'.'......... I.................,{...... .....................Address ....^........ -::'... . '....�r.'.-....... !................ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ........................Foundation ' Exterior ... �..--�-/j ...... ......................................... r r .......... ...... ...�� ................................Roofing .................:.::................ .Interior . Floors .........................:............�..........:................................. .........:.......................................................................... f - r H.ea.tin r ..........................Plumbing A'} ...... o Fireplace .........................Approximate Cost .........�.� .......... .......................................... .............................................. Definitive Plan Approved by Planning Board ________________________________19________. Area ......... ���'.................................... Diagram of Lot and Building with Dimens.ons Fee -'�-.................. . ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 . ti r 1 � 5r i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding.the above construction. Name .................. '.......%......`......C`:....../. ............... STANLEY, CHARLES F. ( 193-110 No „2 2 913 Permit for „Two Story .................. w Single Family Dwelling .........._................... .................................... Locdtiion .,,Lot #24 306 Cap 't Lijah ' s Rd. .............Centerville. ..................................... ' Charles F. Stanley ' Owner ...................................... Type of Construction Frame ............................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .......March 17,.........19 81 .................... Date of Inspection ...... 19 Date Completed ...............�...........:......19 f r PERMIT REFUSED r .............................. .............................. 19 ............................................................................... f ................................................................................ T.......................................................... ...........! .Ir/=.. _�.................. Approved ................................................ 19 ............................................................................... �tDE CAPN L.L1'A t-I 5 Ro A D w Az- 100-00 ^ I /e t :w o LOT 23 jj SH OF M�4 N N THOMAS 4w S E a /9330® OQ • LoT 24 1 HO MAS E.KELLEY CO. €. ENGINEERS-SURVEYQRS -,- 346-QNG,pOND.DRIVE SOU-IU.yARMOUTH,hiASS. 01664. CERTIFIED PLOT PLAN 1 / LOCATION } SCALE . (��. 30.�. . . . . DATE .MWlc PLAN REFERENCE . ... . . . .. . ... . . PLAN BooK z77 . A&C- .98 3q . �RgSt�y N)�t; • EAST: . CN<1RLE5 . !�: . . �07' SAYER.Y. : :SuRyE�'of�,PAUC-rt�5T2/� 1973 FPR •C H A STD ry LE Y. / I CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON C-HARLE5 F. STANLEY C-AP\N LIJAH'5 ROAD DATE &j19�1 PETITIONER: CENTERV I LLE�MASS. 02632 REGISTERED LANO�SURVEYOR • ; ' I �� �, ��� g � '._J'' �,