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Home My WebLink About0550 CRAIGVILLE BEACH ROAD S . r r , t , � �.. �, - — _ - n .' � � .� - r .. .. - r _. ,. ,. ,. ,. � w o _ .. a .� � - . . ,. < - 4 = v .. - _ ,.'. 'i �: :.. �. ' -.: � i l � ' ,. �. ., ' _ e. �, L .. ., �: �I I. �j y �' ., �. �I w. .: r. a :. � _, ,. � ..- .- �. r Y Town of Barnstable *Permit# aD a7i7 Expires 6 months from issue date Regulatory Services Fee /4 Y,66 X-PRESS PERMIT Thomas F.Geiler,Director Building Division AUG 2 4 2006 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTAOLE www,town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEMUT APPLICATION - RESIDENTIAL ONLY J Not Valid without Red X-Press Imprint Map/parcel Number / Property AddressCe hI ❑Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Z_I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) �a [i*Re-roof(stripping old shingles) All construction debris will be taken to (_ P, so- UJ6` ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side "[✓Replacement Windows. .U-Value (maximum.44) �� •Whererequired: Issuance of this pemvt does not exempt compliance with other town department rebttta icons,i.e.Ainoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. N® RSf0V_S"p� SIGNATURE: Q:Fonnt:expmtrg Revise071405 n ` f' t ne i—ommonweasrn of InuzaYucnuYessa �t Department oflndustrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 y www-mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electi icians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/individual): e Address: City/State/Zip: Phone#:_S:n j� —? —wslo Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ 1 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 t 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its 10.0 Electrical repairs or additions e equired.] officers have exercised their 3. I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.ZRoof repairs insurance required.] t . employees. (No workers' comp.insurance required.] 13.�Other u.9r✓� ccbr-ee-G. b *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 eoutractors must submit a new affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors mad their workers'comp,policy infoirnation. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and,pob 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 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: AA Phone#: !M R —�73 7^ 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 S.Plumbing Inspector 6. Other . Contact Person: Phone#: Information and. Instructions Y 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 regldrements 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 permitrlicense 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 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. T 617-727-4900 ext 406 or 1-S77-MA rr { an -" 617-/27-7749 Revised 5-25-05 yry.mass.4ov/dia Town of Barnstable t�, Regulatory Services pF THE Tp� o Thomas F.Geiler,Director x Building Division * sax►asrasce, v MASS' $ Tom Perry,Building Commissioner . iOrEo�,t" 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee:- dv Permit#: HOME OCCUPATION REGISTRATION Date: "3�'� 1 I o -- Name: `�G{ � .l �✓� Phone#: S'�i— 73 —9 a 5Yo Address: _S_522 aQ Village: r . Name of Business: Type of Business: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation t within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the j activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke, dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. ' I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. J Applicant: I Date: 3/Lf o 6 W Homeoc.doc Rev.5/30/03 " TO ALL-NEW BUSINESS OWNERS DATE: a57- p Fill in please:. r APPLICANT'S ?_ ;� YOUR NAME: �t�. ---� l.kx. •� BUSINESS�-+ /�O YOUR HOME A�RESS: �"5"® c:P-.►�r� Je p� �1 SW`.77J -ctZ-7� 1 m MOW e Joy T R,:. t,K`:,x d' TELEPHONE F. Telephone Number Home " '7'7 a NAME OF NEW BUSINESS b4:At6UZ� TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO - ADDRESS OF BUSINESS i5g,F�e MAP/PARCEL NUMBER 2,!Yg — O 3C When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is.intended to assist you in obtaining the information you may need. Once you have obtained the required signatures; listed below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). You MUST go to the following office to make sure you have all the required permits and.licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S PFFICE This individual has n ' formed f ny_permit requirements that pertain to this type of business Auth rized Signature** COMMENTS: 2. BOARD OF HEA This individual ha e n i orm d f the r it requirements that pertain to this type of business. thorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY} This individual has b n inform of th licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS _ Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIESAPPROVAL FORA BUSINESS CERTIFICATE ONLY. 4. y TO ALL N WBUSINESS OWNERS DATE: 43 ILI k5 . 9 M=1� _ { Fill in please: Wq W : APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: 4;15'D V: E-4C-� 1� 3 TELEPHONE Telephone Number Home Sa? --2-PS^' fC-Z NAME OF NEW,BUSINESS 'Q �' TYPE OF BUSINESS 5 - L6LArMtg4niZ lnf l at` IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YE NO= ADDRESS OF BUSINESS 'S fs R_ayPra MAP/PARCEL NUMBER T e-_a -- O 3_4 When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is.intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). You MUST go to the following office to make sure you have all the required permits and.licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd.. & Main Street) and you will find the following offices: 1. BUILDING COMMISSION OFFICE This individual has n infor e of any permit requirements that pertain to this type of business. Authoriz i g n a t u e COMMENTS: O -J �. .. 2. BOARD OPHEALTH This individual h b en ' for e 4 of th p mit requirements that pertain to this type of business. thorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha n infor d of a licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIES OV APPR AL FORA BUSINESS CERT/F/GATE Oft Y. x, '