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Home My WebLink About0087 HIGHLAND DRIVE . , . . . .µ :. <<, �� .. .,�. �. `n. � �,: "n�. � _ - .. � ,. - „ � :.� - - i.. i ,. � �.` _: ..; .: ., -.. .. S T .. Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Pre-application for Business Certificate Date O Map Parcel b Applicant Information Applicants Name WPSA'P"U(�,�/` A A Applicants Address Email Address VI66,Wyy� i 1 e-I Mfg 02&PZ2 Telephone Number r`-�a2!%a Listed Ej( Unlisted ❑ Business Information New Business? ---------------------------------------- Yes No Business is a registered corporation? __`-_ ------------------. Yes No If yes Name of Corporation Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? --------- Yes No ' If yes then a Home Occupation Registration is required-See Building Division Staff Name of Business Lk Business Address T- ton Type of Business �` �5�_I .ate '1rlA BuildinE CompussAoner Offi a Uge Only tion ' Building Commissi GK Date Clerk Office Use Only Town of Barnstable w Building Department �opSHe rOk%y Brian Florence,CEO Building Commissioner BARNSTABLE, 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us �prED MA{A Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION RRGISTRA.TI N Dater Name: Phone#: ,)b� - Z�n - Zlls�) Address: Village: Name of Business: �,' � 1�� -Y Pe Y\i�Y l A J. Type of Business: Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1 A of the Zoning ordinance,provided that the 0 X C activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual r- (n alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal � —i residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the Z Kr following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located M within that dwelling unit. Cn C • Such use occupies no more than 400 square feet of space. C � �r- • There are no exte rnal alterations to the dwelling which are not customary in residential buildings,and there X is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. -n v iK `7'' R'r1 • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular � - .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess C: 0 ` of normal household quantities. n D • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard.. • There is no exterior storage or display of materials or equipment. Z There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to + exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • if the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersi_ d, ere � ee with the above restrictions for my home occupation I am registering. Applican Date: Homeoe.doc Rev.10/17 oc1HE Town of Barnstable *Permit# OExpires 6 nronth' oni issue ate Regulatory Services Pee + 3ARNSPABU, + Q MAC $ Thomas F. Geiler,Director 16319. rEDMP'IA J 11�� I�� Building Division Q Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us- Office: 508-862-4038 Fax: 5087-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Y 1 i1r T 62-cps? Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License,#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance - Check one: - PRES ❑ am a sole proprietor JAN El the Homeowner ❑ I have Worker's Compensation InsuranceOWN OF �A"S`� Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to El Re-roof(not stripping. Going over existing.layers of roof) ❑ Re-side #of doors [`Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *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 m' Improvement Contractors License& Construction Supervisors License is. Myetluf ed. SIGNATURE: QAWPFILESTORMS\building permit foans\EXPRESS.doe Revised 090809 `, 1 The Commonwealth of Massachusetts Department of Industrial Accidents !'� Office of Investigations 600 Washington Street ' -rJ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/0 g ion/Individual): ( 1e. q NAN-PS',p\/ -City/State/Zip:��.hu;I)f�. .Yl f��632- Phone #: 3I �.Ylb a , 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 employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub=contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.1 _ quired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions �3; ham.a homeowner doingalhwork,- officers have exercised their 11.❑Plumbing repairs or additions tm self= o workers_com " right of exemption per MGL y [N p • 12.❑ Roof repairs insurance quired.],I c. 152, §1(4),and we have no 1 t he_.. employees. [No workers' 1.3_ 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. tContractors 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. I am an employer that is providing workers'compensation insurance for any 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 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 may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby certify nd r the pai,s a penalties ofperjury that the information provided above is trice and correct Si ature:. Date: 1i7- Phone#: 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#: ril . 4 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,constriction 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 1.52, §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-contractor(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' 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 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 ermit/license applications in an given ear, need only submit one affidavit indicating current that must submit multiple p pp Y g Y Y < °� _(city or policy information(if necessary)and under Job Site Address"the appl icant should write a]] locations in ( y 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.inass.gov/dia > Town of Barnstable OF1HE Regulatory Services 1ARNSTABLE, Thomas F. Geiler,Director MASS" Building Division TED � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print E::i:)_ 0 c)66 Lo.__ c_ n_TlO: 4'00q nJ Qom. Ce,--,A eV, number street village "HOMEOWNER": lA)Q_s)S�,I] I)AQsney name home(phone# work phone# CCURRENT MAILING ADDRESS, k 4 g 6 4 C P2, &enuI t M A Oab 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 c ures and requirements and that he/she will comply with said procedures and requireme i C rgnatare-of omeowner - 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 persons)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 certify 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 form/certification for use in your community. Q:\WPF.ILES\FORMS\homeexempt.DOC III �THEr, Town of Barnstable Regulatory Services BAftNSPABLE, ' Thomas F. Geiler,Director 1639. � � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.rna.us Office: 508-862-4038 Fax: 508-790-6230 Property er Must Complete and S'gn This Section If Usin A Builder I , as Owner of the subject property hereby authorize V to act on my behalf, in all matters relative to work utho ' ed by this building permit application for. (Address of b) Signature of Owne ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the vetse §idE. Q:FORMS:OWNER.PERM1SSION