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TO THE INSPECTOR OF BUILDINGS: a; The undersigned hereby applies for a permit according to the following information: Lot 6 Cedric Road Location ....................................................................................................................................................................................... Proposed use Residential ........... .............................................................................................................................................................. Zoning District ,,,,,, RD*1 Fire District ..,,,Centerville-Osterville Name of owner ,,,,, Normest Homes , Inc. Address .........Ashley Drive, Centerville Name of Builder ....NormeSt Inc ...Homes.?... .•.............Address ............same.............................................................. Nameof Architect .....riOrie ..,.Address................................................. ..........................................................,......................... Number of Rooms 6 Poured Concrete Foundation .............................................................................. Exterior Sldiri Ashalt Roofing ............ p ...... ................................................................. Floors Caret ...................Interior Drywall .............................. ................................... ................. ................................................................. Heatingwarm-..Alr........................................Plumbing ..........1. ...BatriS................................................... .....Approximate Cost 2.q.�00� Fireplace .....................yeS............................................... ......$.. ................................ Definitive Plan Approved by Planning Board ---------------_______________19 Diagram of Lot and Building with Dimensions SEPTIC SYSTEM MUST BE SUBJECT TO APPROVAL OF BOARD OF HEALTH INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE AND TOWN REGULATIONS, 91 s V 1 I,Sa X'74-7 9 1 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r garding the above construction. Name . ....... .............. ................................................. Noroest Homes Inc for ooneotuzz�, ^ � single family.dwelling , _.,---.—.....—,----_.-- . / RoadLocotkon��� ------ ..----..-----.-----.--- � ~e^ .~^ .i^^~ ~--^'----^^~'^---^~^'~---'------ ' � 0qrmebt. Hmnmaa Inc. � Owner ----`.------'^------'---` frame ^ Type of Construction —.------.^-----' _—.---.—..-----.^.-------.----.- ` #6 H Plot .—.---.—.--_ �t ................................ � / . . . ~ \ ^ / Pernit Granted ..... —..--.lA 79 ^ �. Date of Inspection ' 19 . uota completed 19 � ^'c*2�� PERMIT REFUSED '---'--.-'—.--.----.----._—. lQ ---.----.—.------------.-----' ................................................................................. :__._,__._,.,__,_,,,._,___,.~_,,.~,, , . — - ' ---.—~--~..--.—...-.—.—.,..-,..--..... r ^ Approved ~--------------- 19 ^ - . . . ' ` ^ � -------.-----..----..~—.—.---.. � ------------.--------~--...., , | ) �� �� F.agineering Dept. (3rd floor) Map 4 Parcel Permit# House# . Date Issued q _q -.9( oor ) Feei� ' Planning Dept. (1st floor/School Admin. Bldg.) THE Defini ' an Approved by Planning Board 19 ; • BARNSTABLE, ~n s9. TOWN OF BARNSTABLE Building P mitApplication Project S et Address e Village Owner Address Telephone �� Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes L<O On Old King's Highway ❑Yes to Basement Type: Erfull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) r/�— Number of Baths: Full: Existing_� New Half: Existing / New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil Lrflectric ❑Other Central Air ❑Yes 2<0,- Fireplaces: Existing New Existing wood/coal stove ❑Yes U+4-u " ^ Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Atta ed(size) ❑Barn(size) one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE to r 9l0 BUILDING PERMIT DENIED FOR THE FOL OWING REASON(S) { FOR OFFICIAL USE ONLY J is• _ - . PERMIT NO. r! t DATE-ISSUJED— v , MAP/;PAR.CEL NO. ADDRESS" I VILLAGE i 'IOWNI R DATE:OF INSPECTION: FOUNDATION ' FRAME " INSULATION _ FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS; ROUGH FINAL FINAL BUILDING ' CO DATE CLOSED OUT 2- 1 - 9� ASSOCIATION PLAN NO. • ' 1 7 The Commonr+•ca1111 nf!lfassachuselts - ` :ril �'- :--��•�� Department of Industrial Accidents ' ' O/I�ceo//m�estigatloas 600 l •aNN14,1on Street Boston.A1ass. (112111 ' Workers' Compensation Insurance Affidavit nam Inca ion- aOCin, I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity •...�•�!r�^.^--..-_%�-axG-. _ ,,. - .. .,7"�.r`s'::..._.-.- - .. - .- __ .•..,.,, �'-3' -'+.•....Z+.-+•--e•- I am an'emplover providing workers' compensation for my employees working on this job. company name, � Idres cit1 nhnne#• pniicv# insorince co ,a,,,,_,••. 1 am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: m anv nnmc• � idres cih phone#• insur-ince co , nelicv# �r �• - , .• — - _. Win:=- '?+•ec----r••�.. -T'rr«f-+;� - -arm••.•.�.�-�.-rr,•�:+w�c�.,si._. �..,� �..••.�+.-_ .q.�_a.i..:... com ern•nnmc• iddre s• cih nhnne#• surnnee co policy# w :Attach addi_tidnafshert if tiecasa ...... it.::. {.:•L.•e�:�...:...i�.'•P:sssrsf:._..:.. :•r.:.�..�• .....,,fir..•r.....•:.,•.�.�tirw�� ' 1Y:�9`...+... .Mac;.Z.+a. 4ilure to secure coverage as required under Section 25A of I11GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur one%cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement mad•be forwarded to the OMce of Investigations of the DIA for coverage verirication. ' 1 do lterrht crrtij tinder the pains and penalties of pe n•that the information prar ided above is true and correct. Q v Si_nature� Date 9 Print name /sDA) Cat/ Phone# official use unh• do not write in this area to be completed by city or town tlMd2l city or town• permitAicense# MBuilding Department ' C3Ucensing Huard check if immediate response is required [3Sclectmen's Omcc C3Iiealth Department phoneW: r9Uther contact person: . uevised;:95 rtA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the employees. As quoted from the "law-. an a nplitree is defined as every person in the service of another under an- contract of hire, express or implied, oral or written. An emplurer is defined as an individual. partnership, association. corporation or other legal entity, or any two or mor tite fore--ohm, enuaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tnistee of an individual , partnership, association or other legal entity, employing employees. However tli owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwel house of another who employs persons to do maintenance , construction or repair work on such dwelling; !te or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL cha'pier 152 section 25 also states that ever•state or local licensing ngenq% shall withhold the issuance or reneival of a license or permit to operate a business or to construct buildings in the conimonvealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither tiie 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 been presented to the contracting authority. .,.. .v,.•A,:`.,.�.=.• +' .:��.:..:.✓' .rat'.. :", . Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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 Vdtt have any questions regarding the "law"or if you are require-- to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie. be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned t the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question Tease do not hesitate to give us a call. I ..•tin'♦ �'..>. i•�w The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 nhnne.#: (617) 727-4900 ext. 406. 409 or 375. L4 _ of Barnstable _ The .Town Environmental Services • 1 • Health Safe and • KAM Department of Seal t3' ��¢ Building Division 367 Main Street,Hyannis IVIA 02601 Ralph Crosses Building Commissioner Office: 508-790-6227 Fax: 508-790-6230 For office use only f Permit no-_--- Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION ovation, repair, modernization, uires rec that the " onstruction, alterations, renovation, re-existing MGL c. 142A req removal, demolition, or construction of an addition to any units or to conversion, improvement, at least one but not more than four dwelling owner occupied building containing structures which are adjacent to such residence or building be done by registered contractors, with Certain exceptions,along With other requirements. Est.Cost t 33 'type of Work* , Address of Work: Owner's Name Date of Permit App iication• I hereby certify that: Registration is not required for the following resson(s): Work excluded by taw Job under S1,000. Building not owner-occupied _Owner pulling own permit WrM UNREGISTERED Notice is S p�G�� OWN p10 MITMOR ROVE WORK DO NOT HAVE OWNERS FUND UNDER MGL c.142A CONTRACTORS FOR APPLICABLE HO ACCESS To THE�rMATION PROGRAM OR GUARANTY L SIGNED UNDER PENALTIES OF PERJURY I hereby apply for permit as the agent of the owner: Registration No. Contractor Name Date ' OR �!� owner's Name TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. =. DATE JOB. i3OCATioN � - 'Number Street address Section of town Name Home phone Work phone PRESENT T MAILING ADDRESS City town State Zip c: • The current exemption for "homeowners" was extended to include owner-occ: dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a license, provided that the owne: acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwell= attached or detached structures accessory to such use and/or farm structz A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner"• shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be resDc for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes ,responsibility for compliance with the Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and'requiremE and that he/she will compl with said proc dares an requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BU=ING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be requir to comply with State. Building..Code Section 127.0, Construction Control. ROME OWNERS EXEMPTION The code state that: "Any Some Owner performing work for 'd idh A. bm permit is required shall be exempt from the provisions of this sectic (Section 109.1.1 - Licensing of Construction Supervisors) ; provided Home Owner engages a persons) for hire to do. such work, that such He shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are as: the responsibilities of a supervisor (se`e' Appendix Q, Rules and Regu for .licensing Construction• Supervisors, Section 2.15) . This lack of often results in serious problems, particularly when the some Owner t unlicensed persons. In this case our Board cannot proceed against t! inlicensed person as it would with licensed Supervisor. The Home Own as supervisor is ultimately responsible. :.t. a. To ensure that the Home Owner is fully aware of his/her responsibilit communities require, as part of the permit application, that the Home certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. Y care to amend and adopt such a form/certification for use in your com '