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Town of Barnstable Building
e' - Post This;Card So That it is-Uisible-Frorn.the Street A roved:Plans Must,be;Reta�ned on:Job andthis CardMusl>be,.Ke t °-
.r BARNt3TAB1�. , i',; x�a`a>, u< i •"�yr. ✓, , PP. f r p j .� , �a. Psi -
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Permit No. B-18-1043 Applicant Name: Henry Cassidy
Approvals
Date Issued: 04/19/2018 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: . 10/19/2018 Foundation:
Location: 658 CRAIGVILLE BEACH ROAD,CENTERVILLE Map/Lot 246 006� Zoning District: RB Sheathing:
. �
Owner on Record: VALORIE, PAMELA M,TRUSTEE ntractor Name Framing: 1
Address: 658 CRAIGVILLE BEACH ROAD
Contractor I_icens�e 4 , 2
-'' Est Project Cost: $4,300.00
WEST HYANNISPORT,MA 02672 Chimney:
W Permit Fee: $85.00
Description: Cellulose blown in 720 sq ft exterior walls, 10m polxy to open R 7 t K
Insulation:
ground 880 sq ft crawlspace,R 21 closed cell spray foam to 360 sq ft Fee�Paitl�` $85.00
perimeter walls with ignition barrier over all exposed foam
Date 4/19/2018 Final:
Project Review Req: L
Plumbing/Gas
x
Rough Plumbing:
s Building Official
Final Plumbing:
fi
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved applicat on and,theapproved construction documents for-,whic this permit has been granted.
All construction,alterations and changes of use of any building and str''ucturesshallbe incompliance with the local zornng by lawsand codes. Final Gas:
This permit shall be displayed in a location clearly visible from access streeto'Rroac]and shall be maintained open for pubic inspection for the entire duration of the
work until the completion of the same.
p Electrical
a
The Certificate of Occupancy will not be issued until all applicable sign tunes by;the Bu Idmgand Fire Officials are prAouided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work
s;.
1.Foundation or Footing .: Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
J
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -
Map Parcel Permit# 0 �
,�°�lealth Diyision IV() ���%N" A Date Issued —
r
Fee
SEPTIC SYSTEM MUST BE
��i A INSTALLED lNCOMPLlANC�k�reasurer '"` WITH-TITLE$
ENVIRONMENTAL CODE
TOWN REGULATIONS AND
Rra Lnis
,Project Street Address � i 6(/f1�r &"/qchl &a Z&. x,*-
-,,-'village 01VI1 X 1/%/�� �'' . 4' _ e
Owner ic1�� f �1 b�F Address/ r�/� /'"7
/lephone ^����.� D/ 7 s7
.hermit Request
D s2� X/
Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new
,,,,�stimated Project CostfA 0 Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes . O'No On Old King's Highway: ❑Yes &KO
Basement Type: ❑Full (�Q�rawl ❑Walkout ❑Other
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
BUILDER INFORMATION
Name G1 Telephone Number
Address License#
' Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE c� ��0�''=' DATE
• . ' i FOR OFFICIAL USE ONLY ~t
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS+ . wVILL-AGE
OWNER �' . � � c F sY- - ✓�" ,4�` - 1 - _ . `�� _ '„ r f.
DATE OF INSPECTION: ,
FOUNDATION
FRAME
- , k � ` ,mot • -
INSULATION
FIREPLACE
+•, F y
ELECTRICAL: ROUGH FINAL
PLUMBING: RO ( ? FINAL` '_
GAS: ROQGI N FINAL
FINAL BUILDING co1 J
ME0� � '
DATE CLOSED OUT �� �g 0
ASSOCIATION PLAN N Q +r
S
4111
1
The Town of Barnstable
4 MAM Department of Health Safety and Environmental Services
a6T9 �0
Building Division
367 Main Street,Hyannis MA 02601 _
Office: 508-862-4038 I Ralph Crossen
Fax: 508-790-6230 Building'Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
'SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units'or to structures which are adjacent to
such;residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: ��/�'F,�C/ Estimated Cost ny y
Address of Work:
Owner's Name: U�/O AIJ
v Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
i
Work excluded by law
C]Job Under S1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
Date Contractor Name Registration No.
OR
Date Owner's Name
q:fbrms:Affidav
-= -_ -- The Commonwealth of Massachusetts
^�+._ Department of Industrial Accidents
..
Office 9110yvestigauans
C fa
"y' / 600 Washington Street
Boston Mass. 02111
Workers' Compensation Insurance Affidavit
� name: ,�Vl bl�f l• _��jf�`2�
I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working in any ca acity
❑ I am an employer providing workers- compensation for my employees working on this job.
compnnv name
address:
city: nhone#:
insurance co. oiicv#
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the follox%ing workers' compensation polices:
company name:
address:
city: nhone#:
insarnnce co. ..... niicv#_ _...
////l/.//'111=%//;
comnanv name-
address. -
city: phone#r
insurance co. oiicv#
Failure to secure coverage es required under Section 25A of MGL 152 can lead to the imposition of critninai penalties of a tine up to S1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a 6ne of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification.
I do hereby terrify'u der the pains and penalties of perjury that the information provided above is trup and correct
Signature Date
Print name Phone#
official use only do not write in this area to be completed by city or town official
city or town: permit/license# MuddingDOfflce .
❑Licensin
❑check if immediate response is required ❑Selectme❑Health D
contact person: phone#; ❑Other
(revam 9,95 PIA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any come=
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 reserve:
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 cr
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance 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 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.
City or Towns
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. The affidavits may be returned io
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 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 luvesugations
600 Washington Street
Boston;Ma. 02111
far#: (617) 727-7749
phone#: (617) 727-4900 eat 406, 409 or 375
I
The Town of Barnstable
Department of Health Safety and Environmental Services
Building Division
mart te. " 367 Main Street,Hyannis MA 02601
i639. 10�
ED MA'I�
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230
Building Commissioner
HOMEOWNER LICENSE EXEMPTION
.� Please Print
,-DATE:
/JOB LOCATION: (�b (�J�✓I t�J//C street /C.% /F'�'(//
J �number
e �f ) �s/ (/ village ` �U
/HOMEOWNER": /!/1Y/ /�I /, �/0, C 3 3 T 7Y.5)G.j
name home 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 su ep rvisor.
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 procedures and requirements and that he/she will comply with said procedures and
requirements.
4/ Signature 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 to amend and adopt such a form/certification for use in your community.
QTORMS:EXEMPT
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