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HomeMy WebLinkAbout0161 FOX HILL ROAD } X v a, m}C'� ,y . 4 Y_�Cl ,t x a y ��7, �+,Jv't yea„a IF..II,I.�.I;;�1,�,r"I��I.-I�I;,1I;��1I-,,e 1I�I��,,I;,%-���,,,:-II.,,�--,.1;.;�;�II,1Ij.�"1�.,1�,i�c��,.I�,I�1�II I�I-,.�I.�,�,�,1..F.'.,4,p 1:.I-I�I;,i,.�:,�:���,-2 I:;.I,I 1,1,�,,:�,1-��'�,,Il�e�,,��:1-,I,��,I,:-,I"j%���"I,,�1,.�,:�I;-,��-����-.�I,-1�-��-;i II,I-1iI,�,I;.,:I",iI.1�,,I,I.1",�,I,,,�1.,i1',.,�--,�,I��I,.�.-:,,I:-,-,�,I1,-,:II,::-�,�t�I�I-.,.��,,,!�;,I kl�—.I1�I,,-:I II�1�-�.I,.I,���I'-7.:-�,l,',,I.i,%,:;,',�,�,1��,::,�.�,,,�;�I.I,,���:,-I 1�1: � ,,ry q -xt Q�V� ,� � w+@, +u� -Iy; .1 7... 1 f'r'�✓ it s Y.. i .a� °'a•' .:""' i`k.� :: ,r- ' ' ^ u• � h,.£a,,t C, .'"�'.. t. ;re' asFt ,'� �i «A. ;w 4%:,,d�.. .r �roj .y.,,,a.. t a" d fK ;., ., ,fix aS,.W., f^ ,.' 4 f,. c. � .. v l,,. `1;-, - �e ,a� "5 nw'£ �.� �' r 3 y}`.t r, ,�5 n .. ,.O' .�$'._ . k YtYt 1? 4g� " ry t1 �t�,. ". ,d rmd p tr k1 . n* r �a „''E�'t s "« ® ,v a 4a,Pp;a+< .,u z y .v„r .a F, «, n .� t` c ;; - ,y.iu'� xp'- 4.. ., . �® ,. ' , It , .. , , . n .. ,` A .. t 3 p < fl `i , a u O ,.}� _ 9 s a" ;i a : Y [i,. - ;i 4.. i. II I. Id . . r n r` , Q pp r Town of Barnstable *Permit# D/ / Expires 6 mon rom issue date Regulatory Services Fee i R • BARNSfABLE, + � MASS. Richard V.Scali,Director 16;9. ArED MA't A Building Division , Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY q6 Not Valid without Red X-Press Imprint Map/parcel Number I . &,� i61 Fox ki(AS Property Address o Residential Value of Work$ ��CQ ,C d Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JCS �P S MCC 6N iJe_ C. 6"_�_X�uj Contractor's Name PTelephone Number �©0 Home Improvement Contractor License#(if applicable) /33 )62 Email: fV"k /9 im 6--kC0jr4,-i"`eT Construction Supervisor's License#(if applicable) CS `0 23 FOT PRESS PERM ❑Workman's Compensation Insurance "" Check one: KI am a sole proprietor DEC 0 8 201/ ❑ I am the Homeowner TO 1 n'N `F ❑ I have Worker's Compensation Insurance VV OF it c phfSrABL Insurance Company Name 1 f 11 V C Workman'`s•Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �AsNs a b ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.. ***Note: Property Owner must sign Property Owner_Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: 4X� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC ' Revised 061313 M1 o e1-71 `t�mtticrnxct flassrrelrrrs ffeparftnmt 6f,fu 3rut id Accidents -- - to arrsiatiorzs 600 Waykington Street Briton,MA 0-211I ' orkec-s' Compensaticiulnsm-ance Affidavit:$uQldersfCu-utmctors/MectricianMumbers AppUcant Iufn of ort Please Print Lepibly I�Tame( �1�an�zatio�vidnaf}_ f'`8 4-e/` �d�C` City/StabxJZip= Cf��e/c�� GGP /`- f, Phoneme c.5'0 Are you an,employer?Check the ap7Gpriate btrx: Type of project (r l_❑ I am a e1Up loyer with 4 ❑ I am a general confractor and 1 6- ❑I f--w wnTaucioa ez�%ogee {full andlacpark#ime)* �avehiredfhe sub:-conbmclm. Listed I�i n a safe proprietor or partner on the attached shse 7_ ❑Rrmodeling ship and have no employees These sab-contractcrs have g_ ❑Demolifioa -,vorkLug -Fo-rn in any capacitlr emplo and have workers' g- ❑Building addition o wo lints'comp.ir�tran�e comp_tnsnrance_I 5_❑ We alp a carporafiauand'ifs 10_❑Dectrical repairs or additions r a'a homeI offsress h"'exercised tbeir 3_❑ I am. rn�=ner doing all tivork l l:.❑Plumbing repairs,or additions jrseS£ do tvorlmrs camp- right of e tgfioager TvfGL 1 ❑RD frig filalmncer aired_ F c- 152. §1(4)} and we haveag �i I- emplayees_[No workers; comp_insurance reg6m;d.j 'Any Eppl Kilt f,Zt che[ Tian 41 must also fill out the srcaon bgovr chi u-hag infa t H.,wG e_s ut o submit dvs sfiidsvA i�+& taey are tieing ll tccnic s Elim hire o sides coatiacmrs pipet submit s :s dIrit mr�u g snrTi =Ca�c Ears tfist cTiacic this bmc mist=<+=rh�r7 s�sdditinnzl sweet shoicmg l nam of the sdr cis�md sts��chene[erupt tlwsa� -t fi3vg �P�S'e�- Lr�srk-contacfv�s h-fie empIaS�s,rlle3=must pzuvine t1r_r�a€S�s'comp.pe]icp n�ahez � o�an entFi,�yer rhnf rspra��idur�t►cor�t=rs'coxq��rrarlran insrtr�zrrce fat-rri}*syee.� �alvtF is tf���Zrc}rzrcd job szl� irtj`ormtzfia;*t< - ` Inm=c,e Compau_fName: Pol y 4 or St ifinp-UC_- Expiration Date: Jab Sit£A d&-eS : •Cifylstaf zip: Attaclit a copy of the workers'compensafiou policy declarstion pab(sho;wim„the policy number and expiration date). Failare to suave cmurrage as requirednuder Section 25A of MGL c 1522 can lead to the imposition ofcrimirnal penalfies of s fine up to 51,50D_00 andtor one-yearimprisonment;as well as civil penalties is time form of a STOP WORK ORDER-and a fine of up.to V50-00 a-drag against the violator_ Be advised that a copy of this statement may be farwarded to the Office of Iuvestigatio_-..s of the DIA for instrra ncz,coverage verification- _ . . __ ... _ ._. . _. _.... . .-.._ .. ._ .-_.._... ..-- -- --._ . . ._ . .. ._-. ... .. .....- --... _..-..__ ._. .... . Ida hRr-eby c n nder-the ns imd penaUiss a# w-y thatth irtfomrta#ian prcnadsd Afi4sre�s anrf correct Signature: Ply 9- SOFs--- €3UFciaL use only. Da not swrita=in this Area,tg ba compered by cii�ar tnw a�icraL City-or Towa: _Pm-raitlLicense ff Issuing Authority(drde oae): c 1.Board of$ezltl 2.'BuTdin g Department :3,Git-Tj'FGx-a Qerk 4.Electrical Fnspector S.Plumbing bLTecfor 6.E0her contact Person: Phone#_ 6 Information and Instructions G Massachusetts General Laws chapter IS2 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 mte_Tpn_se,and including the Iegal 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 sues dwelling house or on the grounds or building appu tenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also s` ,es that"every state or Iocal licensing agency shaII withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for: ��.�r applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states "Neither the comm, onweal`h r.-or any of its political subdivisions sliall enter into any contract for the per orm_ance of public work until acceptable evidence of compliance,with the in_;,-Liaace requirements of this chapter have been presented to the contracting authority-" Applicants — Please fill out the workers' compensation affidavit completely,by chc;ezdn the boxes that apply to your sita.ado a and,if necessary,supply sub-contractors)nme(s), address(es) and phone nombe,-(s)along with their certificate-(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Puy era-ips(ILLP)verb no employees o ccr tha_a the members or partners,are not regi iced to carry workers' compensation;,sir•ance_ Tl;:-,)LL.0 or LLP does have employees, a policy is requi-eci Be advised that this affidavit may be album fttcd to the Depzd-went of industrial Accidents for confirmation of i�ems.-rence�ove_age. Also be sure to sign and date the a it da- L Die,affidavit shol,ld be returned to the city or town that the application for the permit or license is being requerted, not the Department of industrial Accidents_ Should you nave any questions regarding the law or if you are required to obtahi a workers' compensation policy,please call j:h=l Depa_n'ment at the number listed below. Jeir.insured companies should enter, their self-insurance license number oa the aupropr- e line. City or Town Officials Please be sure that the ai, davit is csmp'_ete and printed legibly. The DepaYm ent has provided a space at the bottom of the affidavit for you to ill out si toe event The Office of Investigations has to contact you regarding the applicant- Please be sure to fill in the permitlLcense number which will be used as a reference number. In addidcn,an applicant that must submit multiple permitllice- se applications is any given year,need only submit one al�davit m' icamzg C'u.�ent policy information (if necessary) and under. "Job Site Address"the applicant should V111rite"all locations- _ (city or town)."A copy of the affidavit+drat has been officially stamped or marked by fie city or town may be provided to the applicant as proof that a valid affi::avit i.s on file for future permits or licenses_ A new affidavit m,.,st be Ued out each year_Where a home owner or citizen is obtaining a license or permit not related-to any business or commerci al venture (ice.a dog license or permit to burn leaves etc.)said person is NOT required to complete this afhda,-it 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: Tle Commoawmak&of lvlassachi s�its Dv ariinent of 1ndustrka1 Accide.-, s Office of favestipti ax3..s Gq0 Waslungtaa StQ Boston,l 021 i I 1 tl,9 Gl 7 727-4900 W 406 or I-9777 hLkSS FE Revised 4-24-07 Fax F': 617-727-7^l41a, -viwW.I ass—gav i a nl Al THE T� Town of Barnstable. Regulatory Services �snxrvsi.Eg Richard V.Scali,Director i639. �63y16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, C , as Owner of the subject property hereby authorize Pa to act on my behalf, r r in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are perfonned and accepted. S ature of Owner, S'ignatdTe of Applicant Print Name rint ame Date QTORMS:O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services �oF Toty,� Richard V.ScaIi,Director , Building Division s MASS.& Tom Perry,Building Commissioner nsass. �$ 1639• ��� 200 Main Street, Hyannis,MA 02601 ATFD '�A www_town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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 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 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. 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 persou(s)for hire to do such work,that such Homeowner shalt 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. rvrsor. On the Iast page of this issue is a form currently used by several towns. You may care t amend and adopt such a formfcertification for use in your community. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 r } Massachusetts —Department of.Public Safety J Board of-Building Regulations and Standards ' Ctmstruction Super0ior . , License. CS-0731..85'�r` ROGER T COX A . 19 SOUTHEAST CENTERVILLE VIA 3 4 i �,,4,.�1J.. • ,r �g`� Expiration Commissioner 03/1212016 i ,A ��e tGa��r�rrrs��ruerrlf�a/C�/t`a;drm�rrseff �;ii� r. Office of Consumer.Affairs&Business Regulation Ltc�tlse or r@gistratian valid for individul use only NOME IMPROVEMENT CONTRACTOR before theexpiration date.. Iffound return to: (' tegistration: 133775 Type office.of Consumet Affairs and Business Regulation � xpiration 8/7/2015 Individual 10.Park Plaza-Suite 5170 Boston;NA 42116 Roger T.Cox - Roger Cox 19 Southeast Lane Centerville,MA 02632 - — AN Undersecretaryd without signature }