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Home My WebLink About0576 CRAIGVILLE BEACH ROAD , �,. --red : .t . . ... .�.:. .:et [t �— l' .�- k f x%�,.�x. �i •r,'� s•'^ }� '•r�\ .. .a. .r„ s „ ,'"t;. .. t!, .?_ ,�$ f ; % S - J.°t'c t. j'-'rJ^i� '�- ;f.:r i d' +k.r` . :*I 'c¢ 1 .+.._ ,t. ''— 'f.,,ptr % uei, �. ire!.. �J: s �� F fi'.� ��. fiy clr .�,,� � ?'®� !ra �Lt a i, 4 xw. svT ,.� .y. f F tt f , t v rt {a ay'q.� ra r,. f� S,ui i` � .: ' ._ r .t' r„q,� E t Lw R k'r.}i F.�,` '3, i _ ,. g :' # e _ !.. .. a - III �. ^ .r < � ya a r ;r < y', kt Id i 4 { W is �'. r '" ,+ s r� s x ,le ,,e • °2:3 Kid ,e '- �:, '.� a ah,.a y �' t 1 t, - i,. d dC' Y ' tie -,M< - )�' a f y r Z. .Y'...5 {',III �} S C � t i )':.. t4 f, ,�;...: 2.t'.i a - 'a r }� ni i t_ 2 F^ f 7 A t tr { u 34jv' - 4k � <l.: y sr r `L i6 - - a- E X w y r 5 �, ,"," t t ,yyy1 1. V1. N,I I I I I :': 1,,I I I�' , , ; �;-� ,-, * . � ,," 1,I , ,, . , - .�q1':I : � ��'' I��'�, - " � ::, I `--� - —�I "r::�Z'� '�.. ," , , ' " r ,'- _ .- , 1. _ ^ r '. - j 'u. 1. ,� :t. .� t J jjggC _ - 't . . —s:. w 4, 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 2Q Map 2A Parcel " I Application # pp j Health Division Date Issued Conservation Division Application Fee 2� Planning Dept. Permit Fee ��✓ ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address - 5'7(Q C)ZkI�V I ILLE: ECA RONT_1� Village L--e Owner ,1�CS'�tS1 Address � � � t- [A) 6 , Telephone Permit Request .pl or— D-013TS 3bbIFLoo1,I _ n Opp A>� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District od Plain Groundwater Overlay m Project Valuatio onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach[suoporting'documntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ae c Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's!Highway:-,❑Ye ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other -aJ rill Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of,Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No 'If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) � t -_ Name � Telephone Number �`�Q �� -Address �SI�!�`� 't" 1 t�l License# Home Improvement Contractor# Email Worker's Compensation # ,ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# s DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OWNER i, DATE OF INSPECTION: FOUNDATION J FRAME C09 IlYl�� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t t GAS: ROUGH FINAL FINAL BUILDING 61911 l IFDa� I DATE CLOSED OUT i ASSOCIATION PLAN NO. ?Tie Cohnnorrivealth o,—Vassadiusetts Deparmment o,f ludusbial Acciderrtr - - Owe of investigations . n 600 Washuigion Street Baston,MA 02111 1VWt1t+H1a.SMg40V1dili '"Tarkers' Campensatian Insurance Affidavit Builders/ContractarslEIectr cians/Plumbers Applicant Information Please Print Le�bIv N' e(BasmesslDrgaaizationllnds*�z3na4�_ �`� � SS IS Address: Citylstatet(Zip: Ph( 4z Are you an employer?Check the apprapriate b Type of project(required): I.❑ I am a employer with Mil a generalcontractor and Iemployees(full.andfor part-timed* ve hired.the sub-contractors 6. New construction d on file attached sheet. 7. ❑Remodeling 2.El I am a sole proprietor or partner- 7 ship and have no employees. These sub-contractors have 8.,❑Demolition wail-ing for M6 in any capacity employees and have wodiers' 9. Building addition4=7alhomeommef orkers'comp.insurance Comp-insurance, ' d.] 5. ❑ We area corporation and its. 1 ❑Electrical repairs or additions 3. I doing all wow officers have exercised their 11.0 Plumbing repairs or addition% myself: [No worl:nrs',gip. right of exemption per MGL 12.❑Roofrepairs innzanre required_]I c.152,§1(4�and we have no . Other empIayees.[Naworces' LI camp.insurance required.) , 'tiny appFi mtthatcheckslws Pl mast also fillcutthe section below showing thieirworkers'compensation poHcyinformation_ I homeowners who sabmit dais aftidmgt indicating they are doing all wak and then}tire outside contractors mmst submit a new affidavit indicating such- =Cantracturs that check This boat must attached an additional street shooting the name of the sub-c+mtrwAaas anti state whether w not those entities ham employees.Ifthesubtantmamshwe employees,they zonstpmvide their workers'camp.policy n number. -Tam an elrtp1gvr that is prcnzding workers'conrpensa ion iuvirancefor my empLayees Below is die policy and job site - informalinrs Insurance Company Name: Policy 44 or Self-ins.Lic.4: Expiration Date: Job Site Address: CitylState/2�p: ' Attach a copy of the workers'counpensationpolicy declaration page(showing the policy number and respiration date). Failure to secure coverage as required under Section 25A of MGL c.1572 can lead to the imposition of criminal penalties of a fine up to$1,50D 00 andfor one-yearimpaisonanmf as w6ll as civil pe aalties.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 lac£arwarded to the Office of Investigations ofifie DIA for insurance coverage verification. I d o hereby fy?ar er the pains at nalties ofperjury thattlne information-pmided abmw is barb mid carrect ' CSitmuatnre: I Date: Q U&ial use only.'Do not write in dins area,to be compLeted by city ortoir n�Ociat R e City or Town: PermitUcense if Issuing Authority(esrcler one): 1.Board of Malth 2.Building Department 3.City/fown Clerk 4.Electrical Inspector S.Plumbing limpector 6.Other Contact Person: Phone#: information and Instruefions Massachusetts General Laws chapter 152 reqaires all employers to provide workers'compensation for their empIoyees. ` Purst=t-to this sbtn.te,an mr 7L yee is defined as."_.every person in the service of another under aay contract ofhi m, express or implied,oral or wntteu_" An Moyer is defined as'ran individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joi at enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,part ammbip,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 dweIImg house or on the grounds or building appurtenaiit 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 Iicrose 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 in:s an ce.coverage required." Additionally,MCrL chapter 152, §25C(7)states"]Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfozlnance ofpuiblic work uatl acceptable evidence of compliance with the;nc� nce. req rirem= s of this chapter have been present-d in the contracting avffiozity." ' A ppficants = Please fill Out the workers'compensation affidavit completely,by checlong fie 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 i„�ce. Limited Liability Companies(LLC)or LimitedLiab>7ityPartserships(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 maybe submitted to the Department of Industrial Accidents for confirmation of m suran ce coverage. Also be sure to sign and date-the affidavit The affidavit should be retinned to the city or town that the application for the permit or ficense is being requested,not the DePartineat of TrrT-r,cfir'aT Accidents. Should you have any questions regarding the law or ifyou are regod ed to obtain a workers' compensation policy,please call the Department at the number]listed below Self-insured companies should enter their self-h miran ce license number on the appropriate line. City or Town Officials t Please be sure that the affidavit is complete and primed Iegibly. 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 pen�itlli.cense number which will be used as a reference number. In addition,an applicant that must submit multiple pezmitllicens5 applications is any given year,need only submit one affidavit indicating orient a, policy infbrination(if necessary)and under"Job Site Address"the applicant should write"all locations ilia (c L or town)--A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicantPavit - as •roofthat a valid affidavit:is on file for fume permits or licenses. A new affidavit must be filled oiit each year.Where a home owner or citzen is obtaining a license or permit not related to any business or commercial venture (lie. a dog license or permit to bum leaves etc.)said person is NOT regr iced to complete this affidavit The Office o f Invesigatims 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: Thu�o.mmmW atlb�of Massachu&Ab, ' f D,pazt[aent cif 11adu,�tzal Aocidenta 1 cdlloe a I-Qv'egtigatto.= " Bwton�IAA GPI11 Tf,-L 4 617 727--4900 ext 4-06 Q,r 14 MAS&A TE Fax#617-727-7M Revised 4-24-07 mom- �� ;k Town of Barnstable . Regulatory Services a ropy Richard V_Scali,Director i Buffd1mg DivWon ae►MMMAMM Tom Perry,Buuilding Commissioner 200 Main Street, Hyannis,MA 02601 '°rEn tr►� www.townbarnstable mn us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER UCEM MOMOTtoN Please Print DATE: IS JOB wcATI013S'V, ,64 nmnbar - stcsct v�age 'Homs6vNER: i5tA) `--aycX�`y�A b� .M�� !O wow hone p� P CURRENTMAUANGADDRESS: �� SI�1- 1 �►'— _— --- - cityftwn 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 ads as supervisor_ DEFJNMON 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,aifached or detached structures accessory to such use and/or farm stiuchires. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall snbmitto the Building Official on a form acceptable to the Buuldmg Official,that he/she shall be responsible for all such work uerformed under the buiildingpermk (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"ceaiifies that he/she understands the Town ofBamsiable Building Department minimum inspection p and requir ents and that he/she wdl comply with said procedures and requiremeds_ sirkire 01 Flomeownff Appmval ofBm7dmgOfficial - _Note: Three-family dwellings containing 35,000 cubic fist or larger will be required to comply with the State Building Code Section 127.0 Constradion 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 109.11-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shag 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-IS) 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 My 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. Q_1wPFII ES\FORNMb0ding permit t=XERPRESS.doc Revised 061113 t` o �I . E t tl I i I' I: _ ,® - 65 f 1 Iq �c P� �� T s 9 0l ai er li ,! • i I ! I a i( fl �� e► . al li i 9 0I I n to tI 0 ( f qq i j e,2 9 ± _ IT 6v P-C5 ll� tit- (f c0 Pry - ` IPA r� /u