Loading...
HomeMy WebLinkAbout0038 CEDRIC ROAD APtr � a o�tKME, Town of Barnstable *Permit# Regulatory Services Fpees6months Ssr,edate snxivsznats, r - �� MASS. 1639. Thomas F.Geiler,Director ♦� ATFo��A Ca fe- •7�3n 13 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 0 Map/parcel Number Not Valid without Red X-Press Imprint pf Property Address.2 S, P-1 c, ICh 6C-A V&//e7 . 40a619a [residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 6Cj6je,&1_- RA ► (JW67 MA . 6a6 3(:9- Contractor's Name J Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ��I"9 A p m4 ❑Workmen's Compensation Insurance Check one: JUL 2 9 2013 ❑ I am a sole proprietor 9-ram the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF 13ARNST.Ai3l, Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) C�rRe-side [✓�Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 'ma-m n #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: &J�_ a. . Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 060513 The Commonwealth of Massachusetts Deparment of.Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wn'"'.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Rumbers Applicant Information Please Print Leeibly Dame-Musin5w omltndividuat): IWO 4- �''City`lSta�bef7 p � � Lam- M.Q Phone Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6_ ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached.sheet_ 7- ❑Remodeling ship and have no employees Tliese sub-contractors have g_ ❑Demolition w for me in an capacity. employees and have workers' working Y1 9. ❑Building addition [No workers' comp_insurance comp.insurance. _--required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.L ZI am a homeowner doing all work officers have exercised their 1 LEJ Plumbing repairs or additioms myself [No workers'comp- right of exemption per MGL 12.0 f repairs insurance required.]b c. 152, §1(4),and we halm no employees_[No workers' 13. Other J 1 comp.insurance required.]; RalacpMeotu)(I)A611) •'A uy WpbcmA that checks boat#1 mast also U out the section below showing their workers'compensetioo policy infbrmation_ I Homeowners who submit this aflidaait imdwztin'g they are doing all work amd then hue outside contractors most submit a new affi&=indicating mcb_ tractors that check this boat most attached an additional sheet showing the vane of the sab-cam[actm and state whether or not those sties bave employees. If the sub-contmaors have employee%they—tstpmvide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far nry.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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certrfp under the pains andpenatfies�o! :ury that the information provided above is bw and correct Signature. Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 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, 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 representatives 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." 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-contractor(s)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 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 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 Ilse 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 600 Washington Street Boston,MA 02111 Tel.#617-727-4940 ext 446 or 1-877-MASWE Revised 4-24-07 Fax#617-727-7749 w .mass_govldia Town of Barnstable Regulatory Services •"MASS. " 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB I ON-. V�w�l�-l� U.Ir ---.��In�um/b�e/r �streej'")"�'- village «HOMEOWNER"_i�IJ�V l-l.�_� U) `�_ "�— gagrtg o6 /� `� ,gyp home-phone#--`^^" wv k_phone# CURRENT MAILING ADDRESS: �0 7&i t f(�l' (12 ONO city/to vT___, P, state zip cod e The current exemption for"homeowners"was extended to include owner=occupied dwellings of-six"' 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 rocedures and re irements and th he/she will com ly with said procedures and requirements. ['Si tore 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. C:\Users\decolR\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 �+E Town of Barnstable Regulatory Services ` MASS. 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 S ction , , . If Using.A Build i- •��� J., /2s Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by s building permit. (Addre s of job) Pool fences and alarms re the responsibility of the applicant. Pools are not to be filled or utilid before fence is installed and all final inspections are performe and accepted. Signature Pf Owner Signature of Applicant Print Name Print Name l Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 r model: Hyannis TOWN OF BARNSTABLE i i BAMST"LE, i 1639. �•� o u BUILDING INSPECTOR ar a APPLICATION FOR PERMIT TO B.uild. . ...One. ...Fam. ily .Dwelling .. .... .... ..... .. .... .. TYPE OF CONSTRUCTION Wood Frame ............... ..... 23 10...... . TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information: Location . .40./... ../...........l e,14 ...... �4.4'................. nl.fL'ri/r��. ...............:........ ... ProposedUse ..........Re.SiaEntial...................................................................................................................................... RD-1 Centerville-Osterville ZoningDistrict .......................................................................Fire District .............................................................................. Norma Realty Corp. Ashle Drive Centerville Name of Owner ....... .......................... ............ ....................Address ......................y................�......................................... Name of Builder ....Norme.st. Homes.... Inc•..... .....Address ...................Same .............................................................. Nameof Architect .....n011e..................................................Address .................................................................................... Number of Rooms 6 Foundation Poured Concrete .................................................................. ........... ................................................................. Exierior ............Siding........................................................Roofing ..............AS ? ]alt................................................... Floors ..............Cal'.pet........................................................Interior ..............Drywall................................................... . Heating ..........War.Tl1-nAir..................................................Plumbing ............1... at.h...................................................... Fireplace ........... eS................................................................Approximate Cost .........8201000......................................... Definitive Plan Approved by Planning Board -----------_______-----------19________. Diagram of Lot and Building with Dimensions , SUBJECT TO APPROVAL OF BOARD OF HEALTH 13 W � Mz O. o U — W Wz: W0i 1 " ISG Cn fl R B Pt �jv� v co �S G 160 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. L& Name . . ................... r Norma Realty Trust I 15846 one story No Permit for single family dwelling ............................................................................... g Cedric Road Location' ................................................................ Centerville ! .- ............................................................................... ; Norma Realty Trust Owner I c frame i Type of Construction .......................................... t I. c, ................................................................................ L C Plot ............................ Lot .................. ..'..?. I Permit Granted .....MIrY..22.......::::..19 73 " s Date of Inspection ......................:L...........19 c vy� Date Completed ... .. ... :..........19 PERMIT REFUSEDCk ; {, ................................................................ 19 <„ L ..................................................... .t........................ a L ................................................... ...................... �__ •� ............................................................................... } C .............................................................................. C. Approved ............... 19 t c .............................................................................. cl ............................................................................... Town.:of.Barnstable *P*rnr#: Expires 6 months fro m•-issue date. ' Regulatory Sexvices Fea.t ✓�f 9� MASS. Thomas F.Geiler,Director i6gq. 10 e PIED 39. A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 SEP 2 6 2003 ,p EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY +� Not Valid without Red X-Press Imprint TOW NSTABLE Map/parcel Number Property Address 'RD C EKILED t 1,(E, MA - QQ,6-12 [Residential '/ Value of Work Owner's.Name&.Address KPfaf) B zw�j 319- 0-et uc 2b C �aI Contractor's.Name Telephone.Number P_ Home Improvement Contractor License#(if applicable) , e' L Construction Supervisor's.License.#(if applicable) ry Cn > ►-- ❑Workman's Compensation Insurance _ Check one: ❑ I am a sole proprietor ❑ I am the Homeowner `_n ❑. I have Worker's.Compensation Insurance.. co M, Insurance Company Name Workman's.Comp.Policy# Permit Request(check box) Q Re-roof(stripping old shingles) All construction debris will be taken to A Li-T c— 11 , �.1 Sfr("5 ❑Re-roof(not stripping. Going over existing layers of roof) ,Re-side a 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: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q:Forms:expmtrg Revised 121901 Town of Barnstable Regulatory Services saxivsTastE, Thomas F.Geiler,Director Mass q 9° 1639. A Building Division °plfD MA'S , Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 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 L� c to act on my behalf, in all matters relative to work authorized by this building permit application for: F (Address of Job) ' �m W26 /03 S' ature of Owner Date Print Name 0:FORMS:O WNERPERMISSION ITiC' /" 9-7g Assessors map and lot number ............................................ - SEPTIC �fT ET SYSTEM MUST BE Sewage Permit number �" G�Z,. ... ... (t/. .1�t .� �� �, . . IINI TALLE© IN COMPLIANCE . r k,,"+lITFI ,A 2TICLE II STATE' 1 11 BAR33TABLE, MARL Flouse number .... .. .................................................... SAITA��.Y CODE AND TOWN 9°° te39. 0� 0�0 a� ,. RCG-ILATIONS. TOWN OF BARNSrTABLE BUILDING INSPECTOR L dl�» 4 APPLICATION FOR PERMIT TO ........'d �...�.... 01M.. ..................................................................... d�®� ' N+� TYPE OF CONSTRUCTION ..... �..: ..�............................................................................................................ ...................... .+...I'.. Z79119 K TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1C, t..uv��'eif11i�1L Location ..................................................................................................................................................:............................... i Proposed Use .........l� ha� q�lciC1(311 Zoning District .....................[4-.11CL............ .....Fire District C--k e-�/ N�........................................... Name of Owner .... Bi .V�1....�i �+t-0-A111..... ......Address ..... ............... Name of Builder ......1�®17. alhiC.........................Address ...P ............................................. Name of Architect ................Address ........:..................... Number of Rooms ..........!o....................................................Foundation ......Wt2G lv l� rtN ii ... ....... .o. �'... �?... . . .................. Exterior ...cAq. 'aoav-ck _T-� ........................................Roofing .................................................................... Floors C�4�l��eVly� ml;J�Ftx .....................e.................,.............................................Interior ......f�4'............:............................................................ Heating i�(,e ti ti9fw @ i� Plumbing ...........�r ..lp�-1/ Cpt C .............................0 Y\ ............................... Fireplace ..............................Approximate Cost 3 S®Q G""_ . Definitive Plan Approved by Planning Board --------_-----------------------19________. Area t ....�........... of Lot and Building with Dimensions o J Diagram 9 Fee ...:................� SUBJECT TO APPROVAL OF BOARD OF HEALTH I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above ` construction. ( _� Dk/r\�Name ......... ...................... ........................................... Gittleman, Samuel 20870"' add to dwelling No ................. Permit for .................................... .............. ...... Location ......v.;*Cedric Road...................................................... Centerville . ................................................................................ Owner ............Samuel..G.ittl.eman................... --Z ..........;.. .. ........ . ...... T' frame Type of Construction .......................................... ............. .................................................................... Plot .............................. Lot .................. ............. November 29 78 Permft- Granted ..............;..........................19 Date of Inspection /...1.... .........19 Date Completed ..........19 PERMIT REFUSED ............................................................... 19 ................................................................ ........... :7. 7-z ................................................................................ ................................................................................ .......................................................................... Approved...........................................I...... 19 ....................................................... ......................................................................... Assessor's map and lot number .........�........... -�-.-- Qy�F TN E tp�y Sewage Permit number .......... .............. :>. ,y // !/ • BJBHSTADLE, i House number ...... ....!...................................................:....... 9 MAO& rt G� 1639- \0� iPl�`'0 ppV p,. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....................... c.i......c7,c..ar►..c?r.....f ....1n...................................................... TYPE OF CONSTRUCTION .... ........................�.. F .. f.19��. �i �t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ' z i r i 4. `-1 no u,. ProposedUse ......... ...................r e�►..�°;h.................................................................................................I......................... Zoning District f� Fire District � !^ -� �t t ............................................. .........:. ................. ........................................... �jQ �V, Litt 1V—.. 1V1 �q are Name of Owner ......................................................................Address ... ..... ... ....ep v. ..e Name of Builder 1`� ..-� -."�y"�tC k� .....Address ... � ° .^' Nameof Architect ..................................................................Address .................................................................................... Number of Rooms k"....................................................Foundation kloek �cowvPA -f ,dtt*va ............. ................ ................................................ Exterior ...dq.".�....*.a...y....................:...�........................................Roofng .........�.`'r a c ........................................................... Floors t t''J1( Interior ......r!n!^f.klecl .................................................................................... .............................................................. 4 Heating ...... ` ......... rt.r.........................................Plumbing ...........�.o ! '6�:.,..........^ ............................ Fireplace ..:...............................................................................Approximate Cost ....... ....................:......................................... Definitive Plan Approved by Planning Board ---------------____-----------19--------. Area 7Z. v if .................................... • Diagram of Lot and Building with Dimensions Fee + F SUBJECT TO APPROVAL OF BOARD OF HEALTH f 9 4 ' I I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... .... ................................................. Gittleman, Samuel ' . A=17Ve; r No .......�87. Permit for ...add.,to ...............................................................:............... Cedric Road Location ................................................................ Centerville ............................................................................... Owner Samuel Gittleman ........................................................... Type of Construction .........fr...ame .... .......................... ........................................................................ . .... Plot ............ Lot ................................ i ovember 29 ' 78 Permit Granted ....... ................................19 Date of Inspection ......... ..........................19 Date Completed ................. ....... 19 ERMIT EFUSED ..... 19 :� ... .!.. .... ............... ............................... .. .......y..................................... ..................................................\...................... Approved ................................................ 19 N....................................................... ................. ..................... .................................... ..............