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Home My WebLink About0060 HARRISON ROAD .'1 d t YY c. �XF. :i, �ii� �� .+. Sl, r5. 'TA: 'r� s. 'S k"'. Z^ .:{v •: te,.. .� s _ r.,rF ( �, ;.H' •./'�':. .3r,? A!' a.,�' - �+ i�, d:, 3..k:' 'ft'R w�e.:f+'3 1 5;�" .Ym R y' .•��:t ..�'.. ,.�. a�, e ..,. ^ a �py , r m r� r : a 4 F a u a n , r 0 . L w s, n p .: < q 4 a 0 " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION "Applicati it Map- Parcel,;,, I on (_Ac rx Health'Division 'Date Issu.Qd i'Catio,h Fee Conservation Division Appl Planning'Dept:, Permit Fee Date Definitive:Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Address /,o/IX R I fed' Village Owner 0 A Address 4 &,2110^1 A 19, Telephone Permit Re' ques't RI-M 6, Z-r, L-,e-x Y f-11-1 J'7-&-R /P t-16y_/J C t t Square feet: 1 st floor: existing—proposed 2nd floor: existing—proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 U Construction Type r-1?4 m Lot Size Grandfathered: LJ Yes Ll No If yes, attach supporting documentation. Dwelling Type: Single Family Ll Two Family J Multi-Family(# units) Age of Existing Structure Historic House: Ll Yes LJ No On Old King's Highway: LJ Yes L] No �J' Basement Type: LJ Full Ll Crawl Ll Walkout LJ 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: Ll Gas LJ Oil L3 Electric LJ Other Central Air: LJ Yes LJ No Fireplaces: Existing New Existing wood/coal stove: LJ Yes Ll No o Detached garage: LJ existing LJ new size—Pool: LJ existing LJ new size Barn: LJ existing L) new size— Attached garage: Ll existing LJ new size —Shed: L)existing U new size Other: I Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll Commercial LJ Yes LJ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name R V Telephone Number ' 5-Q Address A, 1.3 y License# 00 S-r 9 4 /--I A . Home Improvement Contractor# 1 415-1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /3 ffi ,,�tvf r 4 -rl SIGNATURE DATE i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ; ADDRESS VILLAGE C - OWNER DATE OF INSPECTION: i FOUNDATION r► r ,. ; FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL �~ GAS: ROUGH FINAL FINAL BUILDING ; DATE CLOSED OUT ASSOCIATION PLAN NO. . r f {�.. Ch! �'*.f't .n.r-..fr� � CXf�Y�.•e ,+ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' 600 Washington Street Boston, MA 02111 w4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Tnformation Please Print LeEibly Name(Business/Organization/Individual): /f t-/0 P(,ten A Address: A /a City/State/Zip: ` e 0 — `la Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [] I am a general contractor and I ' ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .2- am a soleproprietor or'pa. er-' listed on the'attached sheet. T. Ej Remodeling ship and have no employees These sub-contractors have g•'0 Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'-comp.•insurance comp. insurance.# required.] 5. 0 We are a corporation and its '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other r�e^ram 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.aff davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors 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. Xam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name- Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip':_ 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 crimirial penalties of a fine tip to 31,500.00 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains andpenalties of perjury that the information provided above is true and correct S' afore u( Date: r Phone#: P t" 0 V Official use only. Do not write in this area,to be completed by city or town official .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions �� r 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 tiustee 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 mploys persons to do maintenance, construction or repair work on such dwelling house dwelling house of another who e 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." v p Additionally,MGL chapter 152, §25C(7)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 insurance 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)andphone number(s) along with their certificates)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' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complae"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 permititicense number which Will'oc used a.s a re rencc rL�:.:�ber. Iu ad dr'tio 3n appl=ranf that must submit multiple permitflicense applications many given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or that has been officially stamped or marked by the city or town may be provided to the town).".A copy of the affidavit applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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: The Commonwealth of Massachusetts _ )department of ln.dustri-di Accidents Office of Iavestiptions• 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext.406 or 1-$77-IvIASSAFE y. Fax# 617-727=7749 Revised 11 22-06 . www.mass.gov/dia IKE1.1 . Town of Barnstable Regulatory Services . • ,uu,sr,►st.E. KAM g Thomas F.Geiler,Director 16 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 r Property Owner Must Complete and Sign This Section If Using ABuilder I, rJ A( C° H , as Owner of the subject property hereby authorize A-LI / /A . ''/� J° to act on my behalf, in all matters relative to work authorized by this building permit application for. L(Adssb) Snatuw'aer Date Print Name If Propea Owner is applying for permit pleas —,mp e e. Homeowners License Exemption Form on e �yerse ' A 9 Q:F0RMS:0WNERPERM1SS10N `t •1. i Town of Barnstablee ' y��•THE tp�yT Regulatory Services • _ sAxxsrtsre. • Thomas F.Geller Director Building Division PIED A Tom Perry,Building Commissioner 200 Mairi-Street,_Hyannis.MA 02601.. www.town.barnstabl e.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 4. number street village "HOMBOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state up code The current exemption for"homeowners"was extended to include owner-occupied dwellinVs 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 HOMMOWNER 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 Bu>7ding Official on a form acceptable to the Budding 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. Signatirm 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. HOMEOFVNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is rapirsd shall be exempt from the provisions ;.. of this section(Section 1 o9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homedwncts who use this exemption are unaware that they an assutrsing the responsibilities of a supervisor(see Appendix Q, Rules'&Regulations for Licensing Construction Super-visors, Dft Section 2.15) This lack of awa== en results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board 6annot proceed against the unlicensed person as it A Duld with a licensed •.Supervisor. The homeowner acting as Supervisor is ultimately nsponsnble. w. To ensure that the homeowner is fully swan of his/her rt:sponsibilitia,many communities require,as part of the permit application, tha-1%, a homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by scvctaI towns: You may care t amend and adopt such a formcertification for use in your community. � orms:homccxcmpt ✓ram � � , oard of Building Regulations and Standards , C t or eniis License !" R Construction"Sup <G CS .5592- � License Birthdate 812611947 T 831 }Expiration 8126//2009 h Restriction 00 i i f 3 I DAVID A PERRY �� 6 � � 24 LAURIES.LN Commissioner MAR$TONS MILLS MA 02648 }�,- ------------- - 141ti` Board of Braiding Regulatiods a_nd Standards o?�z�r�o�uueal �aaaac/ivaeCCa HOME IMPROVEMENT CONTRACTOR License or registration.valid for mdiv�dul"use only Registration: before the.expiration date: If fourid'return to 102153 Board of Building Regulations Elugxpiration g ns and Standards 6/30/2010 Tr# 280307 One Ashburton Place Rm 1301 Type Individual Boston,Ma.02108 DAVID A.PERRY:! + David Perry ?'i ' r 24 Lauries Lane .Marston Mills,MA 02648 v_ :N Administrator Not valid"without ' nature z' a . 1 k r psi .•1 a� e k 3 Al E - F MIN� Ll y q a r as v I I - �� s'� ^..>..-� .,' w.w-+swssx.«u�..•s.[.. .,"h.. ... ;' -'� �.. � .r�. '� $" '.��rt Yr ""a s � .. 1 S74 r 6.7 ,k If ybo. L� 2 `N /vo 1 . �' • red• j2 � ! � _ I , W tp r Ag• a 1. A. HA R R r s o H q , • 606. Q� �i/ins •. /1�+� r / r • r (( 96000. ( r OAD CA ' R �SV r NR r Q / V, f N � 0 ' VM t �� R92o': � ,t �, � 4:M :if. �dh] - F� � �, �e �! v' � � T 5 f��/Y/Y(�• �•..('T L �f��• .. '+ .• �i5�. .... 1 41,Y"f� Af SUBDIVISION of LAND CENTUVILLE. SAAMA B L E-A4ASS �•' As SURVEYED FOR' Stale. In w-1-4040• Apni 17. 0956. .; 7 .• :�, Dearse�eilloW• CGvil Fnipreers CelaT[AV«L.f•C.fr Coo i:21 1oI