HomeMy WebLinkAbout0018 CEDRIC ROAD 1 _. 1 r 4
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THE r Town of Barnstable *Permit�0/00 3 6�
Expires 6 month om i.
y � Regulatory Services Fee `
BARNSTABLE,
9cb 1639.MASS. � Thomas F.Geiler,Director
Building Division
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
Property Address /rd CP��C,e .yrP2Yil/e Aid
Residential Value of Work Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 14'e-9r�f' eG,,,�
AP
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Chec one: -
am a sole proprietor MAy 31 '�
I am the Homeowner
❑ I have Worker's Compensation Insurance TQ'A' 2013
YY
Insurance Company Name 'y OFPn -
Workman's,Comp.Policy# Srge�c
Copy of Insurance Compliance Certificate_must accompany each permit.
Permit Request(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to i&-azu''wae 2/1
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ 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
re red.
SIGNATURE:
C:\Users\decollik\AppData\Local\Micros6ft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
1 he Coarnnon-weaalih Of Massachusetts
Depaartinrent of Industrial Accidents
Of five of f Invesligtat ons
' 600 Washington Street
,w
Boston,M4 02111
wma mass.gosr'd%o
Workers'Compensation Insurance. fidavit:Builders/CGntr-.ictoi-s/ElectliciansIplumbers
Applicant Information. Please Print Le gib
Na1t7e_(Busirse€sxOraatias�hidiidual= ��rPL /� . /s��
C iy;StateJZrp:&,Fe—,v��Vz- �Z.e. IAML Phone#. 737 d-P6 2
Are you an employer?Check the appropriate box; , T of project(required):
1_❑ I am a employes with 4- ❑I am.a general contractor and I
�'pe p J { .� =
employees(full andror part-time).* have fired'the sub-contractors 6.. ❑Nev constsaa tson
2 ❑ I am a sole proprietor or partner listed on the attached sheet. 7_ ❑Remodeling
shipand have no employees.ees. These sub-contractors have
pS. ❑Demolition
wcTkin, forme:in an; ca cit,,F. employees and hatie'a workers'
g Y Pa 9_ ❑Building,addition
corn insurance.
[No orkers'comp-insurance p
rrecl.] �. ❑ Sze.are a eorporatiou and its 10_❑Electrical repairs or additions.
(-37 -a ma homeowner doing all work officers have exercised their 11_Q Plumbing repairs or additions
mysel£*[No workers'comp. right of exemption pas IaIGL 12.❑Roofrepairs
insurance required.]1 c. 152, §1(4),and we have no
employees- o workers' 13.❑'Ether
1'�`[N
comp_insurance required_];
'Any appal-cant thatchecksboxi l mum also fill outthe sectionbelow showing theirworle s.'compensation policy infonnation-
Homeowners who submit this:affidm it.indezatine.they are doing all molts:and then here outside:contractors must sobntit a new,affidavit indicatian such-
!Contractors that check this box must attached an.additions@ sheet showing the nauxe of the sub-contractors and state whether or not those endues have
employees. If the sub-cantractoss have employees,they must proUzde their workers'comp.policy number.
I rain an einployer that is proi i:dinrg nwrkers'coralpensation insrarauce for my earplolwm Belon,is tile,policy,and job it :
inform,alirira,
Insurance Company Frame:
Policy it or Self-ins.Lic-w: Expiration Date:
Job Site Address: City{StateiZ.ip:
Attach.a copy of the:workers'compensation.policy declaration page(shoving the policy number and expiration date).
Failure to secure co aefage as required.under Section 25A of MGL c, 152 can lead to the impasition of criminal penalties of a
fine up to$1,500_00 an&of one-}year imprisonment,as well as cMI penalties in the form of a STOP WORK ORDER and.a fine
of up to MOM a.day against the violator. Be advised that a copy of this staterneut may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi nder tare pains and penalties oAf perjrary that the infortriartion prasided above is lane and correct
Si! ;tore;: r
Official use only. Do;tot write in this(area,to be,completed by citty or town of ciaL
a -
Cits or Totin: Permit/License
Issuing An:thwity(circle once):
1.Board of Health 2.Building Department 3.CitvfTo`vn Clerk 4..Electrical Inspector.5.Plumbing Inspector
6.Other
Contact Person; Phone#:
6
OpTME TO Town of Barnstable
�L
Regulatory Services
g Y
9Bn MASSSetE'�a Thomas F.Geiler,Director
0
3
9.
�16 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: --131,112 /J /
JOB LOCATION: �0 C.PO'.�/C tee A40l le4lllle F
numb / L street i village
c C�"HOMEOWNER": �fP�-��/� �C/7e �J -737(c��� Sl�i7l�
name yhome 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 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
proce res and requirements and that he/she will comply with said procedures and requirements.
ignature 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
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.
i
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
model: BREWSTER
7"ET°�♦ TOWN OF BARNSTABLE
i
i 13ARESTAZLE. i
0 pY.��O� BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .......... uild One Family Dwelling
.........................................................................................................
TYPE OF CONSTRUCTION ....................wOOd....�ame......................................................................................
................................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to-fhe following information:
Location / /f a"el
Nf4I4/, e—
�Of...... �1............(.lV�/.(.... . dP..........T.(f3lP�//. ��... .............. .....................:....................................
ProposedUse ..........ReSldentia.l......................................................................................................................................
Zoning District RD-1 ........................Fire District ...Centerville-Osterville
................................................ ............................................................
Name of Owner ...Norma Realty..Cor�. ,,,,Address .,,Ashley Drive Centerville
Name of Builder .or.me.s.t Home,s.�..Inc............... .address same
..... . ......:.............................................................................
Name of Architect .......nOne................................................Address ....................................................................................
...
Number of Rooms 6 Poured Concrete
.................................................................Foundation ................. ......................................................
Exterior Siding Roofing Asphalt
................................................................................ ....................................................................................
Floors Carp...... ..................................................Interior ...................Drywall................:.............................
Heating Warm—Air plumbing 1 Baths
................... .................................. ..................................................................................
es........................................................Approximate Cost �20�000.........................................
Fireplace ...................y ...........
Definitive Plan Approved by Planning Board ________________________________19________. �5'60 _o �
Diagram of Lot and Building with Dimensions �� ®�
SUBJECT TO APPROVAL OF BOARD OF HEALTH
) X w
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I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
a n
Nameo .....L41"t- o�.V�........................
i
Norma Really Corp. e
No ... ... Permit for ,,,,,,one story
single family dwelling
...............................................................................
Location ..ff Cedric..Roa. .....
d (Pindridge. . ...II)
............. .... .... . ................. . .
Centerville
............................................................................... F
Owner ..............Norma Realty..�O.�'............. I
i ' C
frame t L_
Type of Construction .......................................... .�
................................................................................
f
Plo
t ............................ Lot ............1`...................
O .
September 27 72
Permit Granted ........................................19
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I
Date of Inspection
Date Completed ....1.`� ..��,•..el.�.�l��'��
PERMIT REFUSEDL
l LL
................................................................ 19
L „
...............................................................................
........................................... .... ........................
I 4.
l:: ............................................................................
...............................................................................
L _
i
Approved ................................................ 19
...............................................................................
...............................................................................