HomeMy WebLinkAbout1074 CRAIGVILLE BEACH ROAD .,
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' Town of Barnstable *Permit#
Expires onths from issue date
Regulatory Services Fe 5
Thomas F.Geiler,Director
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
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address (A01
Residential Value of Work r 000 . Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address S() &L d4
Contractor's Name R4 Z'.{�'!?X�—1 `��� Telephone Number At Z 47
Home Improvement Contractor License#(if applicable) 7 "1 q
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance Check one: ' - PERMIT
TI am a sole proprietor
I am the Homeowner ,J U N 2 1 Z007
❑ I have Worker's Compensation Insurance
Insurance Company Name TOWN OF BARNSTAB4
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
t ,n -Re-roof(stripping old shingles) All construction debris will be taken to ,z�u m e!&=a
}
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44) �tR`� �_�
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Not joAc
erty Owner must sign Property Owner Letter of Permission. '� t' to Z '{(1( lO
G
p the Home Improvement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
1, The Commonwealth of Massachusetts
' Department of Industrial Accidents
Office of Investigations
' d 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibiy
Name(Business/Organization/Individual):
City/State/Zip: � r L� hone. .#:
Are you an employer? Check the appropriate bog: Type of project(required):.
1.❑ 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 These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• #. 9. ❑Building addition
comp.insurance.
[No workers' comp.insurance
required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11. repairs or additions
'3.El I am a homeowner doing all work ffi h id h ❑Plumb rea. p
myself. [No workers' camp. right of exemption per MG 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' . 13.0 Other leiF rL P
comp.insurance required.] .
*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 contractors must submit a new affidavit indicating such.
:Cdntractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance far my employees. Below is.thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: �0 CeAjea &U444 City/State/Zip: ( �Q
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby e -nd th ains-and pe Ities of perjury that the information provided above is true and correct
4, Si afore: - Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town ociaL
City or Town: Permit[License#
Issuing Authority(circle one):
1.Board of Health 2.BuiIding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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, §25CO 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 inrance
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-contiactor(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'
nation policy, lease call the Department at the number listed below. Self-insured companies should enter their
compensation P Y�P P mP
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 application in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Sile 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 bum 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:.
nc Commonw�lth of MassaGhusptts
Department of Industrial Accidents
Office of InvestlgatiQns .
600 Washington Street
Boston, MA 02111
TeL#617-727-4900 ext 406 or 1-877-MASSAFE
Fax## 617-727-7749
Revised 11-22-06
www.rnass.gov/dia
°F'(NE'ohti 'Town of Barnstable.
Regulatory Services
9BARNnsass. Thomas F.Geller,Director
•
Alfo �"� ]Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,NIA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230 ,
Property Owner Must
Complete and Sign This Section
If Using ABuilder
I, su-tam 61C)DVV) ; as Owner of the subject property
hereby authorize k- �a,� pP.�v1 ,tn �� to act on my behalf,
in all matters relative to.-work authorized bythis building permit application for: .
10 79 uai*'6i vi t e gwjl [&C(c�
(Address of Job)
all_
Signature of Owner Date
bsow Roow)
Print Name
Q TORM S:OwNERPERMIS S ION
Aig�eg`Wu��tiJns tnc tan arts: jl _
L►cenae or valid for individul use onlv:,•
HOME IMPROVEMENT CONTRAC Olt befcr.,e the expiration date. If found return to:
Registration: 134747 Board of Building Regulations and Standards
Onehb
Exp�rat on 1/14/2008 ,,Asurton Place Rm 1301 I
Type DBA Boston,Ma:021b8
RICARDO FERNANDEZ CARPENTRY j
RICARDO FERNANDEZ"
of
8 REDBERRY LANE -
WARSTON MILLS, h1A C2648
D;clii;ty Admi:nist�ati,i:" No 1,valid without
Signature
{
Town of Barnstable Buildin. •._
9AJL� rwa Post Th►s Card So That it is,Uisible Frorn;the Street Approved Plans Must be`Reta�ned on Job and this Card Must;be Kept
o ��$ Posted Unt�lFinal lnspectio.n Has'Been Mader y` 3 y „ °
'�Eoreal°i' Where a Certificate of Occu anc is Re wired,such Bu�ldm' shall Not be Occu ied u^t�l a Final Ins echo^has been made er �t
p,__ Yw g n g �p
Permit No. B-19-3911 Applicant Name: W. Ray Colwell Approvals
Date Issued: 11/21/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 05/21/2020. Foundation:
Location: 1074 CRAIGVILLE BEACH ROAD,CENTERVILLE Map/Lot: 206-131 Zoning District: CBDCB Sheathing:
Owner on Record: BLOOM, RICHARD D&SUSAN ET AL Contractor.Name:: SC Energy Framing: 1
Address: 5 MICHAEL ROAD Contractor License`: 194390 2
EAST BRIDGEWATER, MA 02333 Est. Project-Cost: $6,709:00 Chimney:
Description: Insulation;See Contract Permit Fee: $85.00
Insulation:
Project Review Req: Fee Paid1' $85.00
Date ~r° 11/21/2019 Final:
Plumbing/Gas
Rough Plumbing:
Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authonied by this permit is commenced withm'si months affer;issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structure s-;shallTbe in compliance with the local zoning by laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
5
work until the completion of the same.
".. Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are."'provided on this:permit.
Minimum of Five Call Inspections Required for All Construction Work ', Service:
1.Foundation or Footing , ,
2.Sheathing Inspection PT� _ ,TM � T Rough:
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:
"Perso acting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A).
c(� Fire Department
`z Building plans are to be available on site
�g- i All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
05/22/00 14:11
:MAY .2 2 2000
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a BARNSTABLE CONS EWVAVf0VVj'- ................................................................
Co ver Sheet Numberoftages including cover sheet:
.............................. .......................... .......................... .............................. ........ .................... ...................
To: o6 From:
7e,4 rsr� lro�s�ho
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Company: United Way of Massachusetts Bay
Phone. Phone.- 6-0 ?t1a'�7
Far Fax.;
.................................. ......... ......................................... ........................................ ...............................................
Remarks: 11 Urgent 0 For yourreview XReply
ASAP EJ Please Comment
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lls rx r . TOWN OF BARNS TABLE
X E 1 x
BUILDING DEPARTMENT ' x 1 t
HOMEOWNER LICENSE; EXEMPtiON '
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{ Pjease print. ?
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uyy
u .LQCATION
ree
q� s r a ress ec ono own s
i _W drl'1QI�1 OWNER1! : v = ' ii�7 e r r y ` s.ry t,fi'a.,r 7 e 4�S ai
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din
omeY p -
pone
ga pREySE1T` AIL
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F , s`f A;"iFit •xf e ly t{ty',S,..tk. d i .n• 4'f / y/— �� 7 ✓1/ C l.n Y � l r-v[i( t}j1�Y i i
own , All 'l �fJ 3 Rini 1d�1' � kf�1M}}f ;
a e r
+ p co e
cUrent exemption for y"h'omeown`er °
du�eIli'Rgs::of aaX•,un s > was extended: to nclud
its orz;�tess A . o allow such homeowners to .engage an.ui�ed
y ua for hire wfio does not°possess a 1 i cerise ° ,
acts'as supervisor.£ provided that the owner
(State Bu
i ng Code Section
r
t 'DF:INITION
( OF HOMEOWNER• ) }
Person s
) whoowns' a parcel of land on which he/she` re `
side ' on which .there is, or is intended to be, a one to six
or.. intends to re • .sattached or.-detached structures accessory to such use and/or famil stwelling,
;A person who constructs more than one hoy to a two- Y
ructures.
considered a homeowner. .: �I Year period shall not be
r <r, Such , homeowner shall submit to the Building,Officizl
fo aform;-acceptable to the°Building Official, that he/she .shall be r
,for all such work performed under `the bui•iding perms ,
esponsible w ec ion .
'il'he undersi ned. !' •
9 homeowner" assumes responsibility for compliance w
Building Code and ;other applicable codes, by-laws,
ith the State Sr
rules and regulations...
,The undersigned "homeowner" certifies that h
BOrns table Bdilding O'epartment. fiinimum inspection
understands the Town of
�and.that he/she will -compl with said p ion procedures and requirements Procedures and requirements:
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family ,dwellings 35,000 cub'
ao :comp.iy.with State Building Code Section is feet,''or"larger, wi 11 be require 127.0, Construction Control.
8 _:
•... _.
I t
HOME OWNER'S .EXE4TION
The Code state that : "Any Home Owner .perform in
permit 18 required shall be exempt from ghework for wh•Ich a ' building
(Section 109.1 .1 — Licensing of Construction SuperV1provislons of this section
`Home Owner engages a er sors) ; "provided p son(s f p vlded tti
Shall act as s ) or hire to do such hat. If a
U
► pervisor. wor.k� that
such.. • • �.� �,. Home Owner
Many Home .Owners who use�thls exemption are unaware :the. responsIbl•IltIes' of.a supervisoon are A awware : that the ••
for. L l ceps I n Y a`re assuming.
g Construction Supervisors, Section 2tl1540' Rules and Regulations•
of ten• resu i t,s; t n\§er l ous p�;ob l ems )• •
• Thls, lack. of awareness
Unlicensed persons. 'Particularly when the Home Owner hires
unlicensed tin. this case our. Board cannot proceed againsf%t
Person as It would
with I'icensed Supervlsor.. The Home O wner acting
-• r•W--.�.�...,. I s•u l t imate ly' respons i b t
To ensure that, the Home..:Owner is fully aware of his/hers
communities require as part of the permit application,
certify that he/she understands the responsibilities •.responsl.billtlep� Many
p cation, that the.Nome.' Owner
last °page of this issue' is a form current ) es of a supervisor . .
care to amend and adopt such a form/certification f you
.
Y used by several towns. You may
or use In your community.
/ R
fie
Y
• ♦ .• •\•,
Assessor's office(1st Floor):
Assessor's map and lot number-X.,
Board of Health(3rd floor): '
Sewage Permit number 2 gad r oo. (� �1 31� MM SYSTEM y n'
� .
Engineering Department(3rd floor): ; � ���-��'ti'=����' 0 CC
House number URTH MU -639•
Definitive Plan Approved by Planning Board 19E.
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only MWX REGULATIONS
A P P R 0
T.QWN OF BARNSTABLE
ggnwtabje Consery tion comff+!.D I N G INSPECTOR
S�gAed carts
TYPE OF CONSTRUCTION
19
r
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the followinginformation:
Location rat t !�Gl • �e&`ei2'(/0 Ile-
Proposed Use
Zoning District P= Fire District 'Q "/- `
Name of Owner .1' Address �KAOA) 4.1 Oc;1169
Name of Builder Address
Name of Architect Address
Number MR � �-- �ti Foundationri rVa4t-d— RoofinExte o9
Floors 64,te Interior w --
Heating Plumbing d
4� J00
Fireplace Approximate Cost �
i
Area
Diagram of Lot and Building with Dimensions ' Fee
l)��S
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r arding the above construction.
Name
Construction Supervisor's License
s
DUPUIS, RUSSELL F.
No 3 3t7 81 Permit For IPD - O
-Single Family De lung ,.:.
Location 1074 Cra g V�ille�3each Road ,
Centerville
Russell. F� Dupuis
Owner _ . ,r •
Type of.Construction Frarne
Plot Lot r.
41 '
Permit Granted May 29, 19 9 0 '
Date J Inspection 19
-Date.Completed 19 F
3
' t•f f' � I r L^ ..�
it 1. ' J1 '�� ! , I• , f 5 /`/'
t
r�;, ,T4 .�. _;_• ...F-. .:., ,.s�r;.��'"'"fa'.'..., >.s.'.a.,.-...,,r.-✓ •r n , '3' si ifita..t. ..y..ws._-3�'"i m,. ,,;;•,Y. .. ,. a .�. .. ... .,, t ...w ... iy ,
Ass e�,-sor's office(1st Floor), f f
Assessor's map and lot number
D OF TM E
Board of Health(3rd floor):
Se%3age Permit number .� 2 C'c� c Ov.nnS"' (i�n1 C7 r� • �� w
•,,,_,,,,'� S DASd9'foDLL'i
Engineering Department(3rd floor): Nua T"
House number $639. `� .
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR .
J/2 n
YA_PP-LICATION FOR PERMIT TO
TYPE+OF CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit
rraccording
(to the followinginformation:
Location .1(7 ( (—f c,.i,✓r I � !c� �E v 62 (/! Ile-
Proposed Use
Ff` Zoning District• j�� /� Fire District
Name of Owner , ,.v+ P66v, Stp Address . .
f Y
Name of Builder Address
Name of Architect Address
Number of Rooms �'� .--lu. Foundation . fi W
Exterior � Roofing
Floors ,'",t Interior
Heating Plumbing
<` � w
Fireplace _ Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee ' 1
lv,
1
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I:hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
<r' . Construction.Supervisor's License
DUPUIS, RUSSELI, F. A=206-131
�p6-I31
No 33781 Permit For ADD To
Single Family Dwelling
Location 1074 Craigville Beach Road
Centerville
Owner Russell F. Dupis
Type of Construction Frame
Plot Lot
Permit Granted May 29 , 19 .9 0
Date of Inspection 19
Date Completed 19
PERMIT COMPLETED IN
//91