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HomeMy WebLinkAbout0235 GREAT MARSH ROAD a33 lji� c<cr �C� �', - Al It Town of Barnstable *Permit# Tres 6 monthsh om issue date Regulatory Services Fee �, ks- a + lAEIVSTABLE, • s�a `�$� .Thomas F.Geiler,Director X-PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner APR 2 3 2013 . 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 5NAW�'TABLE EXPRESS PERAUT APPLICATION RESIDENTIAL 0 w4ff O . Map/parcel Number d �� Not Valid without Red X-Press Imprint Property Address J 315 O 67A (! e 4 ❑Residential Value of Work 3 o o o-, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JA o,7 E S Contractor's Name j��r— Telephone Number 5 y� S-s y S ; Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor 0'I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) / ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to�ARA7Sg��' �I i��/'�i` f ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side 4- #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: n-IUMV77 T:Q\,Cr%V K 4z%1..;1,4;nc ne mit form_q=RES$_doc The CrrMMOMIveaL&a,f' assachnsetts Denm'fnent of Indmir ied Acddenft Off we of Imrestrgad ons 600 Washington Street' Boston,M4 #211.1 . WMV-jnaMgov1 i+a Workers' Compensation Insurance_Affidavit- Budders/Contractor-s/EectricmnslPhmbers. pighcant Information .� /� Phase F nt Le bI Al Name Musineess/orgaai mB J dividwl): A-M6 S / ,'`�/I1/-I�/ �� . Ad�dtess: S�/ 12 D/4 CitylStat Zip: (c,J I R v t _a 6 3 Z Ph(me#: E0 "g' Are you an employer"Check the appropriate bo= Type of project(rexfaired): 1.❑ I am a employer with 4 ❑ I am a general centractor and I 6. ❑New for! employees(full mWorpnt-time).* have hired the sub-contractors Fisted on the attached sheet. �- ❑Remodeling 1❑ I am a sole proprietor or partner- These sub-contmctom have sbip said have no employees 8. ❑Demnlitiou woslring for mein any capacity. employees and have wodmrs' g ❑Building addition jN40 wotlets'comp.insinance comp-mgvcance. ] . 5. 0 We are a corporation and its 1 D.❑Flectticai repairs or additions required 3_ I am a homeowner doing all work officers have emus sed their 11.0 Plumbing repairs or additions o ight f exemption 1vfGL mys+eF£ [No avorlt�ers'camp- r exep p 12.❑Roofrepsus„ F c.152,§l(4)6 andwe have no I rsacsmmrE required.] employees- o�wmkers' 13. ]Other .�� ✓S/t' Sr�i�;t camp.insuiraom requh-ed.} I N VA,i' 4/;ER 1+7 'Amy Wtic=that chedm boa#1 mast also M oat the sectim below sbuu s their wo ke&ca®pmmt=policy m&m.,dan_ 72' m I Hameowaas who submit this of bmrd iud1cadug they Rm dm g&U wol mmd their hie oata de caotractors must submit a am afdwa ux1=tiu9 such lCamum a that cbea this box most attacked an-ad;r:an.t set shu"kg the acme of the s4b-cmtr+cbm and state wwhetbes or nottuse entities bare emplayem Ifthe mdt--a utoiaeis have emplayeas,fheym mpw ide their worke&tamp.policy n mmber- I wn an employer dud is provia ng.workers'compewmimrr insurance for my gmpEL'y' Below is the pa&Y an t,job site informatt�n. . lnsurance Company Name: Policy-or Self-ins-Liu 9: Fxpissticn Fate: Job Site Address: city/State/zip- Attach a mapy of the workere compensation policy de&ratiom page(showing the policy mimber and expiration date). Failure to secare coverage as required under 5ection.25A of MGL c. 152 can lead to the imposition of criminal penalties of a fim up to$1,500-00 andfor one-year imprisonment,as wen 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 itiat a copy of this statement may be forwarded to the Office of Investigahons of the DIA for h=zrance coverage veriffcatitm. ' I dcr kerelr}�czrh y ratrder#h -: ' s d pe a.{;p m}'ft?iat the inforNimff nn provided ahm is tot s an Siogtored cmrrect . � Date: Phone 9- offidal sm only. Do not wrke in this area,to be computed by city or tetvu offkia1 . QtyarTown: PermitoUcense# Issuing Authority(circk one): . 1..Board.of Health y.Building Department 3.( !y!I wn Clerlt d.Electrical Inspector S.Plawhing Inspector 6.Utiter.. :..: . Phone#: . I tl _ OFF TOij. P� ti MRNSrA4BLE, Town of Barnstable .. . ATEo Mai Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.mi.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ;as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: ' (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse side. 1WPFILESIFORMSIbuildin g permit fomvslEXPRESS.doc 1- i VE A Town of Barnstable Regulatory Services ' MUNSPABLB, ' Thomas F. Geiler,Director 1 39-SATED 39,E a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstoble.ma.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1V—'2 3 / JOB LOCATION: e2 3 C 6d,/"r- /)Ifa5•H Rd cc.Vi e 4, vi number street village "HOMEOWNER": 4. / r3��S V /I �/h Ni� rd fl 3 y name home phone# work phone# CURRENT MAILING ADDRESS: �) �lk�C r /�?4 K'S' city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied d'wellinas 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 sucK 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"ce es that he/she understands the Town of Barnstable Building Department minimum inspection proce res and.requiremoats and a he/she will comply with said procedures and requirements. Si atu o 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 eertify that he/she understands the responstbilities 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. _ CQ Q Anr .. .. .. - . Assessor's map and lof''number . .. ,.... BE INSTALLED IN C,OMKINCE Sewage Permit numberU5.......... ij...............:............ WITH ARTICLE iE SUM". SANITARY CODE. . PyOF7NE ♦�tp�t TO N OF .BARN 3 r I BARN TODLE, i „\ oe� "6 9.,e� BUILDING INSPECTOR am �' APPLICATION FOR PERMIT;TO ..............U t..................................................................... ................................ TYPE OF CONSTRUCTION PA....-'.........�... ...........'.. . ..................................................................................................... `-� !%I .......... . .............19!��7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to th//e'' following information: Location .......t"R!. ......L.2'.........Cry-e�� -....�e'`�s..`"\k.......................................................................................... ProposedUse ......4s. :-t...d ov..!!=................................................................................................................................... Zoning District ......... ... ..� ................................................................................Fire District �-.. �l✓Zvl....... . wf� ...................................... Name of Owner ... -t—. ....... .....................Address .............. .!� C't. �'". .. Nameof Builder ....................................................................Address .................................................................................... (c Lr Nameof Architect ..................................................................Address .................................................... ............................... Cc��c �Number of Rooms ............�1................................................Foundatio .................................................... Exterior . -.A �e^ S ..!.IV .. ..5.........................Roofing ........ g. ..i" ........................... Floors ....................................... .............................................Interior .......... ....'.... Heating 1.47t,� ' � C" "5....................Plumbing .............I...... .s..:.. ........................................... Fireplace ............./...................................................................Approximate Cost .......... Definitive Plan Approved by Planning Board ________________________________19________. Area .1.�.L.I.o.......................... Diagram of Lot and Building'with Dimensions Fee .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and-Regulations of the Town of Barnstable regarding the above construction. Name ................... ......... Smith, J. K. I No "17569 Permit for ,,,one story, sin le famil dwellin &. Y.................. ................. ''�• 2 LocatioK43�..rea. ...t Marsh. ..Road. ...... . ...... .... ...... .. ...................Centerville.............................. N Owner ...........J,.. K. Smith .............................................. Type of Construction frame . ................................................................................ Plot Lot ......... 2.................. Permit Granted .......January 28 19 75 Date of Inspection G�- 9 . Date Completed .... . ...... .. . r PERMIT REFUSED ........................................ .................. 19 ........................................................................... i .........................-...................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... C) Assessor's mop and lot number ................... 4. ..Sewage Permit number(-75-)......... .................. ........... ............ *1WE J.1 TOWN OF BARMTABLE 13 STABLE. 0 1639- NAM 'ED BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ ................................................................................................ V TYPE OF CONSTRUCTION ...........-�?:4 ............................................................................................................ ........... ................ ........ ... ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........Lc;t 2,2 Gluq f ............................................................................................................................................................................. ProposedUse ...... ................................................................................................................................... ,Zoning District ......... .................................................Fire District C., "/-/ZVI — Gj->1-"4, .,I/ .............................................................................. *Name of Owner ... ........... .............Aadress ......... 5 ........ ....................... ...................................................... I ( I ( .1 Nameof Builder ....................................................................Address .................................................................................... Ic f Nameof Architect ..................................................................Address .................................................................................... Id, 6- Number of Rooms ............. Foundation ....... j (V ................................................................. Exterior ......... .........................Roofing Cj, L .............................. ... ....................... ....................i............................................................ .. ,Floors q .. j...-.,..-,/............................................Interior ........... ....... ........ts....�..?.. 0. - .................... Heating .4�:,:........................................................................Plumbing .................................................................................. Fireplace ............. Approximate Cost .........I.................................................................... ............i.............................................. Definitive Plan Approved by Planning Board --------------------------------19--------- Area J.37/ .......................... Diagram of Lot and Building with Dimensions Fee .... ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH. CPO I hereby agree to conform to.all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Smith, J. K. No ..,, 17569 permit for ,,, one story, single family dwelling ......... ................................................... reat Marsh Road Location ................................................................ Centerville ................................................ Owrv-r J. K. Smith ti ....................... ....................................... Type of Construction game ............................. ................................... ............................................ Plot Lot ................................ Permit Granted January 28 19 75 Date of Inspection ........... .......................19 Date Completed ............k.........................19 1 PERMIT REFUSED . ..................................... I. ...................... 19 ................... 7...... ......................... Appove ................................ 19 ............................................................................... ...............................................................................