HomeMy WebLinkAbout0025 LAUREL ROAD o a
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.
Map6 Parcel '' i' Application #
Health Division Date Issued 412-11"
Conservation.Division Application Fee
Planning Dept. ~`• Permit Feb
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis x
Project Street Address
VillageCA
it.v ii
Owner 4- r�� Address �� �� `7' �T` ;r�"� ��
Telephone v• ''S' �o a-
Permit Request w
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Gv-Sc2.S c�`�
Square feet: 1 st floor: existinglproposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation_S S^ 0 Qd Construction Type
Lot Size d car(!J Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(# units)
Age of Existing Structure SP, Historic House: ❑Yes C90 On Old King's Highway: ❑Yes
Basement Type: MFull ❑ Crawl ❑Walkout ❑ 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 in bath : existing new First Floor Rom n
( 9 g � o Count
Heat Type and Fuel: ❑ Gas r1ciI ❑ Electric ❑yp / Other
Central Air: ❑Yes ®'No Fireplaces: Existing New Existing wood/coal stove: ❑Yes C�1'No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing (3 new size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 1
Commercial ❑Yes Crl'No If yes, site plan review #
Current Use Proposed Use s
N)
c.- C::
APPLICANT INFORMAT N
(BUILDER O OMEOWNER) T"
Name 's 6, c c- Telephone Number d (,- _ A
Address License#
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNAT RE DATE /`� a
Z
FOR OFFICIAL USE ONLY
f
;O'PLICATION#
DATE ISSUED i
MAP/PARCEL NO.
f ADDRESS VILLAGE
Y
OWNER '
K
1
3 DATE OF INSPECTION:
FOUNDATION
i
FRAME / d o �3.af-
INSULATION 7�3�u
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
,k
GAS: ROUGH FINAL
FINAL BUILDINGo*,qlbhbejt-
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r—
5
The Commonwealth of Massachusetts ,
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers
Applicant Information Please Print Le bl
Name=(Business/Organization/IndiviAual):
P.tn V- t a c
A—ddress:7;�;;
City/State/Zip: Phone.#: I ryi
Are'youan employer? Check the appropriate box: Type of project(required):
4. I am a.general contractor and I
1.❑ I am a employer with 6. ❑�40=9'
cction
employees(full and/or part time).* have hired the stab-contractors 2. I am a sole r rietor or artner- listed on the attached sheet 7.
❑ proprietor P
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity. employees and have workers' 9, Q Building addition
[No orkers' comp.-insurance comp.insurance-t
ed] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
--- officers have exercised their 11. Plumbing repairs or additions
�-. �I am-a homeownerodoing-all-work � ❑ g P
myself-[No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance-re 'red:]!t_ c. 152, §1(4),and we have no
-
r--— employees. [No workers' 13.❑Other
comp.insurance required.] .
*Any applicant that checks box#1 must also fill out the section below showing their workers'coon policy information.'
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new af8avit indicating such.
tContracton that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors have employees,they must providt;their workers'comp-policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job 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 tip 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 DIA for insurance coverage verification.
I do her under the pains7dpenalties of perjury that the information provided above is true and correct
CS S' Date: -- _
i a —
Phone#:
Official use only. Do not write in this area,to be completed by city or town offtciaL
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#:
i
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 hue,
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,construction 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 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-contractors)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
that must submit multiple permit/license applications in any 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
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
(Le.a dog license or permit to brim 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 C6mmonwealth of Massachusetts
Department of Industrial Accidents
Qffice of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-490.0 ext 406 or 1-977-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
'ENERGY-CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00)
Applicant Name: Site Address:
print
Town:
Applicant Phone:
Applicant Signature: Date of Application:
NEW CONSTRUCTION: choose ONE of the following two o tions
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR
NEW ONE- AND TWO-FAMILY BUILDINGS
MAXIMUM MINIMUM
Ceiling or Slab
Option 1: Basement
p Fenestration exposed Wall Floor Perimeter
U-factor floors R-Value .R-Value Wall R-Value AFUE HSPF SEER
R-Value
R-Value and De th
National Appliance Energy
.35 R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of
4 ft. 1987 as amended,minimums or
rester as applicable
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
❑
�. REScheck Version 4.1.2 or later variant Option 2: software analysis must be completed
(780 CMR 6107.3.2) .
REScheck—Web which can be accessed at http://www.energyeodes.gov/rescheek/
ADDITIONSbR ALTERATIONS TO EXISTING!BUILDINGS.OVER 5.YEARSOLD*
*Buildings under 5 years old must use option#1 or#2 in New Construction section above._
Complete the following formula to determine the % of glazing:
(a) Gross Wall & Ceiling Area equals Formula: (100 x b= a)
SF
100 x %of.glazing.
(b) Glazing area equals SF b a
If glazing is <:40%o use.the chart below. If:glazin is>.40 %:proceed to "SUNROONI" section
7SO-CMR TABLE=6101-:3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS T____-O EXISTING
SOW=RISE-RESIDENTIAL BUILDINGS
MAXIMUM MINIMUM
Fenestration Ceiling and Wall Floor Basement Wall Slab Perimeter
Exposed floors R.-Value
U-factor R-Value R-Value R-value ` P,-Value and Depth
..39 R-37.a R-13 R-19 R-10 . R-10, 4 feet
a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling
area(i.e. not compressed over exterior walls, and including any access openings).
SUNROOM—An addition or alteration to an existing building/dwelling unit where the total
glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the '
addition.
Note: Owner to fill out Consumer In ormatzon Form (found in Appendix 120.P)
SHE Tp Town of Barnstable r .
'
Regulatory Services
saxxsreece, : Thomas F.Geiler,Director
MA93.
1639. Building Division
lED MA't A Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
vt ww.town.barnstable.ma.tis
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
f� Please Print
DATE:. 4,, A y
JOB LOCATION: 5— �_
number treet village
"HOMEOWNER': Q.
name home phone# work phone# �t7 J °�y/-`
CURRENT MAILING ADDRESS: I
�
city/townstate 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
CS
equirements.
re of omeown
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 _r
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 fon- /certification for use in your community.
Q:forms:homeexempt Y
I
�Hera,� Town of Barnstable
` Regulatory Services
r r
r SAMNAMSTABLE r Thomas F.Geiler,Director
019. 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, Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by uilding 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 thereverse=side:'"`
Q:FORMS:O WNERPERMISSION
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Asp .�sor's map'and' lot .number ......... `� � �`S ��iJ ✓'�G�+ V � � �� `
^ 7 y .......r.. . ,. 4 SEPTIC SYSTEM MUST BE
INSTALLED IN CO 1 ✓1�. � tr4v 3 MPLIANCE,
9yage.rPermit number ..:...-...J�:...... ......
WITH AI'TICLE II STATE
SANITARY CODE:A WN
JQ�FTHETp�: .. + TO N ! OF BA1 ' � I Afflff
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Z HARNSTODLE;
oo �YFY =. YU" DING INSPECTOR�
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APPLICATION FOR PERMIT TO 4 ?I� ,V..... W `ar. ......................................................
4 TYPE OF =CONSTRUCTION .... ....... : ........ ...............................................................................
c;
;4 .....,� ................................19.���.
IT!
TO THE INSPECTOR OF BUILDINGS:
The undersigned ere applies fo a i acco�di to�theollowing information:
Location ........... !....1............................ .....................a... ..............................................................
ProposedUse .f�!Ei ... ... .............� ...•.........................................,.........................
•
Zoning District .................. .:.................... .............................Fire District .......... ..
Nameof Owne .... ......... . ...........Address ............... .... ...............�. ... ..........................s.
Name of Builder ..
� . ..... ..........`. ..� � .Address ...... ........... • 04.
Nameof Architect .................................:................................Address ................................................................... ................
Number of Rooms ..........ti ................................. —,Foundation ....:............ '� ....... .................. ...........
Exterior ........... ....`......... . ......................a..............................Roofing .............. .........:..:........................................................
Floors ...........................................Interior ... ........... ................................................
Heating .......... .... ........ ... ..........................Plumbing ...... t..v.............................................................
Fireplace ....... ..............................:...........Approximate Cost ............. .. .........'. ...... .........................
Definitive Plan Approved by Planning Board ----- -----7-________19 7 _. Area ..... a.... . .)X- . ......O�
C) d
Diagram of Lot and Building with Dimensions . Fee / '.
SUBJECT TO APPROVAL OF BOARD OF HEALTH
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I hereby agree to conform to all the Rules and Regulations of Chen of Barnstable regardi a above
construction.
Name ........................................................... ...... ...........
Eagan, William
F «
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1 ?� <• remodel garage
No ................y. Permit for. ....................................
,to lst floor
..........`.... ... ... ... ....................... .. . ,
Location' .......25' Laurel Road.. .....:............ y
F _
Centerville
........................................................ ......................
' William Eagan ,
Owner .. .................................. ... ..
Type of'Construction ...frame
..................... ... .......... i
-Plot ............................ Lot ..... . .".t...................
K
May 7 76
Permit Granted '
Date of-Inspection........
l .......19
' Date Completed f ..... .. .,19 �
v
PERMITLREFUSED :.
.............. 19 w .
....... ...... ........ ........ .... .........
♦ ..................."�' .........;...... ......t:...................... _ J `• `
.... ..... ..............................................................
Approved _.
Assessor's map. and lot number ..........................................D �" 7` ��
Se,hage .Permit number ............. .......................................
ET°�� TOWN OF BARNSTABLE
Z B_ARISTAME, i
"e BU.ILDING INSPECTOR
pY O Y a. �
APPLICATIONFOR PERMIT TO ..................................te?................................... .......................................................
Y TYPE OF CONSTRUCTION ..................::: .*-?`J ...`•.. ......................................................................................
.......... .....4.......................19.
TO THE INSPECTOR OF BUILDINGS:
The undersignedrherebyfapplies for a permit according to th.�e, following information:
Location .t •....... .`"y ......:'.. ...... .:....................:--'....... ..t... � ............................................................................
?' +' : �"` _ � „+ 6`1
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ProposedUse ................................... .................................................. . .............. ..............................................................
• Zoning District ........................................................................Fire District ........ ............ .. ... . ..............................
Name of Ovvner�� C..........'�...?. .' � {rcr........:Address ' F :. ... .. . ... ....
....� •.
Name of Builder -......,..:,.Address ...................... ...........................................................:.
Nameof Architect .......................................................................Address ......1... .....,... ...... ..................................................
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Numberof Rooms ....................................................................Foundation ............................................................ >................
le—
Exterior -- l �...+� S.t�t ` .........................................
......................:.......�.....`......:.....;:..............................Roo-ing ...+.-':.`:'.�:�............�..
Floors ......................................................................................Interior ............................. ......................................................
r .. ............................. / 1 �
HeatingPlumbing/.... .....................................................................
Y
Fireplace .. ..............................................Approximate Cost
Definitive Plan Approved by Planning Board _____.-=J __ --------19_!_? f 'Area �I..� f��.��. .........'t'.,+
Diagram of Lot and Building with Dimensions u` Fee �/ ".r r , .............................................
1
SUBJECT TO APPROVAL OF BOARD OF HEALTH
a
I hereby agree to conform to all the Rules and Regulations of(the Town of Barnstable regarding,the above
construction. {
Name ....................................:..........................................
t Eagan, William A=230-35 t
ti
remodel garage
ti No ........... �=Permit ,for ....................................
to ]s t floor
.......................................................................... ....
Location 25 Laurel Road
Centerville
...............................................................................
William Eagan
Owner ...................................................................
Type of Construction frame
i
................................................................................
Plot ............................ Lot ..................................
+ Permit Granted ............!u. ...................19 76
y Date of Inspection ............ .......................19
Date Completed ............ ...........19
PERMIT REFUS D
4 ............................................ �.......... . 19
........... ...................... .................................
. .. .... .....:...........................
....................... ........ .......................................
4 Approved ................................................ 19
. ...............................................................................
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