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BUILDING PERMIT NO. 3 Dn E Ale6 a7, / 9,9
ASSESSORS PARCEL NO. /6 $ -030
CONTINUATION OF ROAD BOND
The undersigned owner/contractor hereby agree to maintain their road bond in
force until the following work items are completed to the satisfaction of the
Engineering Section of the Depar=ent of Public wortis:
' lca= and seed shoulders as soon as
weather pe yits:
y other (explain) l,yS7- L
z 2i1/�-h1l9 10/z_ C)00,4j Se-�6F eor,c_--voxd
LC CATIO'N: L3 # /,Z 'r `1 S Uuv�C�s�L i2e�cr' ��UTbx urLLr R
SIGN (G t /CO:;1.RACTOR) (print name )
61
EL G ACT ORLZATION V
T01WN OF BARN STAB LE,'MAS SACH USETTS 'BUILDINU P RMIT ,E
A=169-30 DATE jUne 28 , 19 91 PERMIT NO. N'9 014'j28 -
APPLICANT Bayside Building Co. ADDRESS Box 95, Center` illp_ #005645
IN 0.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PE9.MIT TO wild Dwelling (-1j) STORY Single Fa we*11 nCl DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED
AT (LOCATION) Lot#12, 95 Donegal Circle, Centerville ZON I NIS CT_ RC
D ISTR
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP —BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Sewaq,2#91-146
AREA OR 1300 sq.' I&t. $ 73,500.00 PER s
VOLUME ESTIMATED COST FEEMIT 104. 00
(CUBIC/SQUARE FEET)
OWNER bayside Buii'l-ding Co.
ADDRESS B BUILDIox 95, Centerville NG DEPT. I �4
BY
nI )
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE' MUST BE AP- i
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIREO FOR .
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED AFOR
ELECTRICAL, PLUMBING NO r .
FOUNDAT-IONS OR FOOTINGS. MADE.. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMB*ERS(READY TO LATH).
3. FINAL INSPECTION BEFORE, FINAL INSPECTION HAS BEEN MADE.,
- OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROV#LS, PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
6 A
3 I HEATING INSPECTION APPR6VALS ENGINEERING DEPARTMENT
Tb %,,a 2 0 y BOARD OF HEALTH
'21
OTHER
SITE PLAN REVIEW APPROVAL
PERMIT BECOME NULL AND VOID IF CONSTRUCTION WORK SHAA,�PROCEED UNTIL THE INSPEC- PERT W INSPECTIONS INCICA
TOR HAS APPROVED THE VARICULIS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR F
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
. 7 ,
pf TMf>0 TOWN OF BARNSTABLE
� .Permit No. .
34428
BUILDING DEPARTMENT
I ' 1 TOWN OFFICE BUILDING Cash ................
7 YL 6)9. `
'�towr HYANNIS,MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY s
Issued to Bayside Building Co.
Address Lot #12, 95 Donegal. Circle
Centerville, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS:PERMIT WILL NOT'BE VALID, AND THE BUILDING SHALL.,NOT BE OCCUPIED'.UNTIL,
SIGNED BY THE BUILDING INSPECTOR UPON 'SATISFACTORY COMPLIANCE WITH=TOWN
REQUIREMENTS AND IN ACCORDANCE�WITWSECTION'119 0 OF.THE M'ASSACHUSETTS,STATE
BUILDING CODE.',
i
Au ust 2 7 -f .-� -
.... .. .. ... a. 19 9 1 . ..
Building Inspector `;
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I A- , - ==�
m /��C&l
DATA
tK Ai
dARNSTABLE, MASSACHUSETTSBUILDIN
' ✓j-30 §'
!,r DATE I')liJ7!.' 7 19 _ PERMIT NO. fog
a ICANT'_ Baysicie- ijui1Uli1Cj ( f;
; � OOSG9
i ADDRESS :-ili'r: 95 Celi r >•i 1 1 Gt
(NO.) (STREET) (CONTRS LICENSE)
PERMIT TO Build UWI'11 �j'ICT ` NUMBER OF
1.11 STORY Sii'lC11 n ��C)•'11 A 1,W(�� 'I �trr DWELLING UNITS r
.. - (TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) - LOt #l2 i -) llCi I 1 L i 1 Ci.C'' l;d'rY?7.!'� tt: ZONING � rt
(NO.) (STREET) DISTRICT _
ff✓: BETWEEN AND
. (CROSS STREET) (CROSS STREET)
)l. •SUBDIVISION LOT LOT
BLOCK SIZE
BUILDING IS TO BE
FT. WIDE BY FT. LONG BY FT,. IN HEIGHT AND SHALL CONFORM IN CONSTRU.CTI
�.
TO TYPE USE GROUP _BASEMENT WALLS OR FOUNDATION - -
REMARKS: SewciC{C;?491-•146
AREA OR 1300 ' -' _
VOLUME �C3' t�" ESTIMATED COST 73/.SUQ•UO 3,' PERMIT a
t.
(CUBIC/SQUARE FEET) FEE �.-; I04A.0
t
OWNER —Ba jSide Buildii.0
ADDRESS BOX 951 CE:alte,r-If)-1L BUILDING DEPT.
;( BY
{i I
T THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITrHER�TEMPORARI'CY I
c111Dat. PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING=CODE,.MUSTBEA
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINE
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT CONDIT.10
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL
I" INSPECTIONS REQUIRED FOR 'APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE.APPLICAB LE'SEPAR ATE
�. ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE, REQUIRED„,.FOR
^.1"..FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY i5 RE- MECHANICAL INSTALLATIONS.,.PLUMBING
AND,
f,- PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL y C1',
MEMBERSIREADY TO LATH). _ y
1t 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, wW.
OCCUPANCY.- ,
—�
POST THIS CARD► SO IT IS VISIBLE FROM STREET '- FM
BUILDING INSPECTION APPROV LS
PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS °
21
G�:i L !/" rS� p/u
3 HEATING INSPECTION APPR VALS
St► ENGINEERING DEPARTMENT
Th W A we r-
1 G a'—. -Y
9/ V .. -7 �D EALTH' '
i'
OTHER SITE PLAN REVIEW APPROVAL
AN.
WORKSHAL NO PROCEED UNTIL THE INSPEC- PERMIT w!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICA.
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE, ARRANGED FOR F
NOTIFICATION.
1 '
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PIZZU rX, P.A.
ATfORNtYS AT LAW
039 SOUTH STREET
H'YANNIS,MASSAGSUSETTS 02601
MARTIN J.O'MALLRY,,)R„P,4•
STEVEN J,PIy7•UTI TEI.PPUQNE(0oo)Y7e-7100
-- FA�;SIMILR(aoe)7e0-0o7R
NWHAE,1,J. M111040'
April 22, 1991
Mr. Joseph DaLuz
Building Inspector
Town of Barnstable
Main Street
Hyannis, MA 02601
Re; Lot 12, Donegal Circle, Centerville, MA
Assessor' s Map 169 Parcel 30
Dear Mr. DaLuz:
My client, Baysi.de Building Company, Inc,,. , has requested that I
contact you with respect to the above-referenced lot which it has
has under agreement. Baysi.de Building Company, Inc, intends . to
construct a single-family dwelling on Lot 12, Donegal Circle. Title j
to Lot 12 was acquired by Barnstable Building Company, Inc. during
1971 . Thereafter it was deeded into David and Mary Burns, and in
197$ to Theodore Riggen the current owner. Title to this lot- has
been held in non-contiguous ownership since 1971 . y
The sub-division plan was approved on or about September9,, .1968 by
the Town of Barnstable Planning Board. The plan was a subdivision
approval required plan. The lot is 19, 200 -square feet and ' is
undersized because of a 1985 zoning change to one acre lots. The.
current zoning in the effected area is RC. Prior to 1971, the lots
had been geld in common .ownership under the name of Copley Turnpike
Trust. Since 1971, the owners of the lots contiguous to Lot 12 have
maintained successful "checkerboard ing11 in the chain of title.
Massachusetts General Laws Chapter 40A Section 6,the "old" :40A,
covers the lot ownership in question. 'Under this statute, the lots
were buildable in 1971 . At that time they were all "checkerboarded"
by conveyance to various unrelated owners: In 1971, Lot 12 came
under and has continued under the protection of Article III,
Chapter III, Section 4-4.5 (1) and (2) of the Town of Barnstable
Zoning By Law, This section involves pion-conforming uses and
provides in part that if "while building on such lot was otherwise
permitted" the lot' was checkerhoarded, a single family residential
permit may issue. 'As such, it is my opinion that a permit . should
issue for the construction of a single family residence.
Please call me if you have any further questions in these matters.
Veryr truly yours,
Ply,,/V.r.�;i•.±•�;..,,,;f'yL a�'�-a�/j'Y.�/A,v••Y"�"s.,.V,.Y"ts'T*V
Assessor's office(1st Floor):
Assesso}s map and lot number / 4,q 30
Board of Health(3rd floor): 1 q
Sewage Permit number 6
i 21 TAnt;a 2
Engin&ering Department(3rd floor): : f riCas
House number
Definitive Plan Approved by Planning Board 19o'Y�r
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only t ,
TOWN OF BARNSTABLE
BUILDING INSPECTOR _
APPLICATION FOR PERMIT TO
1�r
IN y U!/f �� /lld
TYPE OF CONSTRUCTION
19 q�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies.for a permit
according to the following information:
Location
Proposed Use
Zoning District /, C Fire District f
(�Name of Owner Address
oy
Name of Builder Address
Name of Architect / • ;R,6 v adJ� Address
Number of Rooms � Foundation
Eto 0 x ri r
.-Roofing
CWFloors �- v Interior / P
Heatin Plumbing �v c �
9
`� t3
Fireplace ,• N�0 Approximate Cost,
i t
r Area
Diagram O,KLot and Building with Dimensions F Fee
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
Construction Supervisor's Licenser.
r -
BAYSIDE BUILDING CO.
A=169-30 AW
Nor 3 4 4 z 8 Permit For 12 Story
Single Family Dwelling
Location Lot #12, 95 Donegal Circle
Centerville
Owner Bayside Building Co.
Type of Construction Frame
Plot Lot
Permit Granted June 28 , 19 91
Date of Inspection 19
t
Date Completed 19
OMPLETED 1111
PERMIT C
_.I �-.���
130
Assessor's office(1st Floor), /� /� /
Assessor's map and lot number In / !' �G' q - P 30 :f{ —� ¢ of t"E
Board of Health(3rd floor):
" STALLED
a IN COMPUA N"1 C. e w
Sewage Permit number
Engineering Department(3rd floor): ' WITH T'TLE 5 ;D"�ya LE
House number �� - i ENVIRONMENTAL CODE AND '°�039.6\��
Definitive Plan Approved by Planning Board 19:;;'T
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING ,- IN'SPECTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
19 C.l
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location j bInimai -
Proposed Use
Zoning District Iq C Fire District
Name of Owner //? �1 Address
Name of Builder Address //��
Name of Architect R6444e&4,1 Address 41_K&
Number of Rooms Foundation
I
Exterior � Roofing Z��
Floors Interior
Heating Plumbing
Fireplace //'0 Approximate Cost
� r Area
Diagram of Lot and Building with Dimensions �/� (� Fee
A�x
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
Construction Supervisor's License d�l 5
J
BAYSIDE BUILDING CO.
r:
F •NR 34128 Permit For l A Story
orT
Single Family Dwelling -
Location Lot #121, 95 Donegal Circle
-Centerville
Owner- - Bays`ide Building
Type of'Construction Frame r
n
Plot +y.�. Lot ,
Permit Granted: June _28, . -t g 91
0 Z/
Date of Inspection` ` �� 19 i
j
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PJASG//�E.NJ - �' OUNpL1TtOtJ r/cj"=
slLzl�-3
Town of Barnstable *Permit
Expires 6_111M,m' e
Regulatory Services Fee
=ARNSrAB"M •
MASS. $ Thomas F.Geiler,Director
1639. �0
prED MA't�
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town barnstable.ma us
Office: 508-862-403 8 Fax:.508-790-6230
EXPRESS PERMU APPLICATION - RESIDENTIAL ONLY
Lo
� Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address -/ 0 rQ(l Cam' CCLC
❑Residential Valf ue of Work, Minimum fee of$35.00 for work under$6000.00
Contractor's Name GS GLL_1V0U_3oon Telephone Number �' � �5�
Home Improvement Contractor License#(if applicable).
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
� am�the Homeowner AY 2�13
❑ I have Worker's Compensation Insurance 7,
Insurance Company Name OFAA
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)
❑ Re-side /1 tL-es� 1706 5e"4-3
M i #of doors
Replacement Windows/doors/sliders(U-Value (maximum.35)#of windows _'"'-77D
❑ 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.
SIG ATURE:- -
The Crrmmomvea t+h of Massachusetts
D4wrftwt of lulus€id Accidetas
(J,f ice o,, Invesfigations
' 660 Washington Street
Boston,M,4#2111
MVM rrirrs&gVV1dia
Workers' Cahmpensation Insurance Affidavit"BuUders/Cantyactnrs/Elec ric anstPhunbers
Applicant Information Please Print Legiblv
At�r3r
City/Stafie(Zip: �dl�S Phone# �� '3�4
Are you an employer?check the appropriate bo= Type of project(required):
I-❑ I am a employer with 4. ❑ I am a general contnetor and I
employees{felt andior path=}.
* Dave hir ac
ed the sub-c�ntFtns 6_ ❑Ideur oonsffs�.�ctiar� i
2.El am a sole prfllarietxai ar parttaer-
listed an the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolitioa
working for me in any capacity. employees and have wmleers' g_ El Bnitiiing addition
o wod=s'comp.insurance Comp.insuranr�
5. ❑ We area corporation and its 10.❑Electrical repairs or additions
egaired eavuaee doing a wrulC officeas lave exercised their 1 t_❑Plumbing repairs
3F '-I a ar additions
m as hom
iYrys eS [No workers-Camp right of exemption per ZAGL 12❑Rflof repairs
insurance required.]T C.152,§1(4)6 and we have no�3 employees-[No wmimrs' 13.❑father
comp.insurance required.
•Any app&3=than sheds boa#1 nms!also f[acut tine sectianbelaw Aa�g their waekeW cumpen-b—PQ�Y W--tier_
Y Homeowners who submit this afi oxvit M&caang they—doing sit uort sad rhea hire outside cant=wrs mast submit a new affidavit indicating such.
ICantradms VW chad taus bras mug attacbed as additional sheet showing the name of the uh-c�and state whether ar not mose entities hae'e
employe . If the sab.coutaders here emplvSeeN they,anrst Pm jde their tacrrlcee—P-PolicF`u-ber.
I urn an empl0;7ar that i5pMvi&1htg.avvj*e-n comperaralion inntrance for my ourploymm Bdoav is the po irp an d job site
inforr aden. .
fimurance Company Name:
Policy:9 or.Self--iris.Liam# Expiration Date:
Job Site Address- GityfSiattJJTp:
Attach a-copy of the workers'compensation policy declaration page(showing the ptaliicy,member and expiration date).
Failure to secure coverage as required under Section.25A of MGL c_ 15:2 can lead to the imposition of criminal penalties of a
line up to S 1500 00 and/or one-year imprisonment,as well as civil penalties is 1he form of a STOP WORK ORDER and a fine
of up to$254.00 a day against the violator. Be advised that a copy of this Statement may' be forwarded to the Office of
Im-est,gxdcns of the DIA for iusurance coverage veriffca#ian-
7 do here ce andpennAws rrfperAq that the information provider£above fs true and correct
0jffWa1 me only. Do not}write in this area,to be crrMPlate+d by city or teavn officiaL
Utycr-Town: PeramtUcense#
Issuing Authority(tdrele one): .
1..Board-of N�eltla 3.Buileliug I}epartrnent 3.i1I awn Clerk' .E1t:ctrical inspector S.Phbiug Inspector
s,�uvsrnsEz
q� 5 9 Town of Barnstable
pTEp Mp'l A
Regulatory Services
Thomas F.Geiler,Director.
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main-Street,' Hyannis,MA 02601
www.town.barnstable.ma.us '
Office: 508-862-1038+ t aFax: 508-790-6230
-F � ; � 1;t � �'jam �'h!`t � __ __��, _� �7"y. 1; •. .�I �" � ` .
A
Property Owner Must
Complete and Sign This S tiori r� r
`* If Using A Builder
I ;as Owner of e subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building pe application for:
(Address of Job) [Homeowners
Signature of Owner
Print Name
If Property Owner is applying for permit,please complet License Exemption Form on.the
reverse side.
n•tarpurr ectrnv�re�ti.,:is: . .e :.fi trvource a
�oFtl r Town of Barnstable
' Regulatory Services
BARNSfABM ' Thomas F.Geiler,Director
?AA9� 9 0
'�Eo M,F•� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.m.a.us
Office:. 508-862-403 8 Fax: 508-790-623 0
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
street
"HOMEOWNER
nameL home_phone-#-" work-phone
CURRENT MAILING ADDRESS:
02&3
city/town ''� state Lzip 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 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 un ersigned"ho eo ner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
proced es d i m ts and that he/s will comply with said procedures and requirements.
Si ature.of Homeow er
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 ofthe permit application,that the homeowner
ceitify 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 fomn/certification for use in your community. .
Engineering Dept.(3rd floor) Map� %Qy Parcel M&) Permit# aL'{f 3`7
House# A04 ante Issued 2 2 Q
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) ec.. / -d
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) L� TEM MUST�C
Pla. __ drnan:Bldg:) �EP"�Ci �MPLIANCE
INST
oard 19 E S AND
TOWN OF BARNSTABLE
Building Permit Application 01
Project Street Address (y L at K C L.L--
Village /Ly t` L L'—
Owner T t 410►`�4 tx- I-A HtILY-4- Address
Telephone n C� 4/ y y ,' �•
Permit Request /7/3 Co 41:— �,�/�b v sv►2 A,cq
•J
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ /,;z ® o ;
Zoning,District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yesio On Old King's Highway ❑Yes
/90
Basement Type: Full ❑Crawl L)Walkout ❑Other //
Basement Finished Area(sq.ft.) 6 Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing �_ New
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing_1�) New First Floor Room Count
Heat Type and Fuel:XGas ❑Oil ❑Electric ❑Other
Central Air ❑Yes KNo Fireplaces: Existing _I New Existing wood/coal stove ❑Yes o
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
Ij None ❑Shed(size)
/ \ ❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes,,-�No If yes, site plan review# -
Current Use P11 M c L zr PLC-� fAbeposed Use
Builder Information
Namedrll Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE OLLOWING REASON(S)
s _ FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED ,, f Y•4.
MAP/PARCEL NO' ` r-
- ._. � G + , ate ' - 1 R - ' ._ �••�•
ADDRESS ' VILLAGE
i
OWNER
a f
DATE OF INSPECTION:
FOUNDATION -
FRAME-y"
INSULATION -
y
FIREPLACE
- ELECTRI.CAL: ROUGH FINAL -
PLUMBING: ROUGH FINAL
GAS: - , ROUGH; FINAL-A'
FINAL BUILDIIg £`
DATE CLOSED 0
ASSOCIATION PL.4N•NO.
The Town of Barnstable
. RAJUMAJUX
_
tee$ . Department of Health Safety and Environmental Services
N„�► Building Division
367 Main Street,Hyannis MA 0260I
Office: 508-790-6227 Ralph Crossen
i
Building Commissi;
Fax: 308-790-6230
For office use only
Permit no.
Date
AFFIDAVIT
HOME 1WROVEMENT 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:Ag a u C b ^�� POO t— Est. Cost /0-4 G -Z
Address of Work: RV In-e'G-- L C L L�
Owners Name
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
Building not owner-occupied
Owner-puffing-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
,j Till' C1111111t//l tl•eazuJ UJ :1luS.tiQCJ111nCI1.S:
•-�- = Deparl"W111 Of Illljl"Vial.4ccid�•rin
�. ;,. •-:1� Offfc�allm�iestlOall�as
�':" i•; 6111111 arllhl„tun Street
11;« •�. . ' Bunton.Abysm U?,111
Workers' Compensation Insurance AfTidavit
r __
ii nnt`mformatirin= -- Mense PRINT•leiUP ---_....-.,^...�._
IAC�t1f1R• c/ S r`.t C>- ✓� t_ t t2 C L f5=�
cin• C ti7- c-1 u i L lfi- nhr>nr �a " Y L/ /
I am a homeowner performing all work mvself.
I am a sole proprietor and have no one%vorking in any capacity
I am an employer providing work ' compensation for my employees working on this job.
corn tam• na c•
adrlrccc•
it.•' hone th
i tr�nccrn• licv�
[', I am a sole proprietor.'eneral can trncto o homeoiv circle atic) and have hired the contractors listed beiow who rz%
the following workers compensation polices:
cmmT7:tn.• name!
:ltitiMcc•
cin nhnne 0?
in-mrinrr rn nniicvtl
emmn�m n:ttnr•
:ltltirccc-
-ire•• nhnne{t•
asur*t nniicv
lttach additional sheet if nreaiary• ;•� +� -•T�•� •.•�. ••.« e,i..�.r.• .......rrs ��_�_ ��'�
'ailurr to secure ettverare as required under tieetton.3A of A1GL I53 ran lead to the imposition of crimtnai ptualtiies of a line up to SIS00.00 aadror
nc,%care•imprtsnnmcnt as•.•cII:ts ciVil penalties in the form of a STOP WORK ORDER and a line ofS100.00 a day against me. 1 understand that a
opc =►t ttti.%statement mar he funrarded to the Office of lavestig2tions of the D1A for coverage verification.
rlv hercht•ct:ltif-t•trrrrl•_tJrcy�rrirrs ar d pciraltics of perjurr t/rar h in
ptsrt7ded above is trae wtd cvrr=
^^aturc
oar r
'rint nlme gone 0
ofrciai time unit' do not write in this area to be completed.by city or town oMciai
cin or town: permiblrcense# ri'lluiidinq Department
QLicensiag Hoard .
check if immediate response is required 1=5eleetmen's Once ►r-
�tleatth Ucpartmt�tt
contact per!ron• phonelt: r'tUther_��,
.�. — .k . . - _. �.•' i••.1/.. s.. /. .,.?.t.l`�'.;.•::✓i�i':r•l.•r..r�t.'1i•'F�y1i�'. Ir':I.: 1:.'I.' .1 .. .. •Il:i•1..'.
Information and Instructions
Massaclsuticats General Laws chapter 152 section 's requires all employers to provide .vorkcrs' compensation
MaSSa hUN As quoted from c ~taw"•an enrplit ee is dcfincd as every person in the service of :itttriltcr under
emplocontract of hire. express or implied. oral or written.
An cmpinrer is dcfincd as an individual. partnership. association. corporation or other legal entity. or any two c
the foregoing, cm.:aacd in a joint enterprise,and including the legal representatives of a deceased employer. or t
receiver or trustee'of an individual . partnership. association or other legal entit}•. employing employees. Howe
owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of tI
dwcllim_ house of another who employs persons to do maintenance , construction or repair work on such dW'ell;
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an eat;
o states that every state or local licensing agency shall withhold the issuance
MGL chapter 152 section =5 als
rencival cif a license or permit to operate a business or to construct buildings in the common vcalth for sn
applicant who has not produced acceptable evidence of compliance ti,%ith the insurance covemwe required.
Additionally, neither the commonwealth nor anyof its political subdivisions shall enter into any contract for the
perfomiance of public work until acceptable evidence of compliance with the insurance requirements of this chi:
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation
supplying company names. address and phone numbers as all affidavits may be submitted to the Deparunent of
Industrial Accidents for confirmation of insurance coverage. Also be sure to si;rt and date the altdavit. 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 retarding the "law"or if you are rec
. please call the Department at the number listed below.
to obtain a workers' compensation policy
City or 'Towns
Piease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the botT
the affidavit for you to J-111 out in the event the Office of Investigations has to contact you regardin=the applicant.
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retu.,
the Department by mail or FAX unless other arrangements have been made.
The Office of Investi=ations would like to thank you in advance for you cooperation and should you have any quc
please do not liesitate to ;,give us,a =11.
...... _ ... '... .. ..:-.
The Department's address. telephone and fax number.
The Commonwealth Of-Massachusetts
Department of Industrial Accidents -..
Office of 11westigatfnns
600 NIlashington Street
Boston,Ma. 02111
fax #: (G 17) 727-7749 --
. `� TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION p0tv tc G-J9 L C tt�C L
Number Street address Section of town
"HOMEOWNER" �r•,c�i 1 d� pq v£ q'1 L46
a: Home phone Work phone -
PRESENT MAILING ADDRESS al S����-�G L Cl /Z c L er
City town State Zip cow
The current exemption for "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, 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 OfficiE
on a form acceptable to the Building Official, that he/she shall be responsibi '
for all such work performed under the building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes . responsibility for compliance with the Sta
Building Code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
3arnstable Building Department minimum inspection procedures and requirements
and that he/she will comply with said procedures and re ments.
a0MEOWNER'S SIGNATURE �.
IPPROVAL OF BUILDING OFFICIAL
.gote: Three family dwellings 35, 000 cubic feet, or larger, will be required
=o comply with State Building Code Section 127. 01 Construction Control.
.�.4a
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