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HomeMy WebLinkAbout0080 LONG POND CIRCLE ;7 4, W 0 -"% - z", -1 5 ";,0 ONE 7. �t'-if Ar ­Q7 7,rg 56q FSO 'RI 4 U'A .JR ltRtl`)iU 0 TV i "M W., 5k t 'M "R."'R#F M aUi I ON MA J."51 M- 01", 044, 4 "gf 5,� IN, Mn 'Z5.--- j, "n It,1.�H'ig' �" �".1 �g'w Vial 1"Y' !&t'�j �.jj i-, a -EINI"�FA"R, g x m Qc� -'4 W �Q qK A 9!�Alt t6 VIN "IR Alm INX* M W, g, g";p'k N T V" gw OAi n & "wim kw, -EN �,T M IPQ Ir 'Iff A (1100; 1 Mi VK- 0-11-1111-1111--f RR V, lvw., 'pow gg g W�,m no A� W., 'TP 0 W. gm;, 4X:5'19,- � Zp!,&,',.qn ig 3i �,R ROOM "X All, r2 AM, �3,mt N." C i� POOIMI -M tll.lil�a�K, "t"W AR ,M"t; Y iz-,Yva �fr MAP p M't �,V 'M 3 J;A 'v J irj -�'RVI "q tf"- ­g�g 1�Mal 0' M,�NP" 61, ;g a W1% �E P�. f wi, )v. V"r, v "'t -qw -t &p-1 " —6") R �Oh i ,,, al V, RIP?,"."l, Tgl. V�D 4 WO '7 Tli "Fr n'. �'IMVRS -ql �wg ym c wl mo I rtl"� g, RaIn&', 4tli�,oyt 006 4 Tom Barnstable *Permit#J`o�of�73�a Regulatory Services 6 � E .. 9� 1659. ..Thomas F. Geiler,Director Building Division .Tom Perry,CBO,.Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma us, Office: 508-862-4038 Fax: 5,08-790-6230 EXP SS PERMIT APPLICATION - RESIDENTIAL ONLY Not VaMd without Red X-Press Imprint parcei Number Map/ ' Property.Address c:►��� /�(�+1G� I��I �. i .�eu1� i`t �1t �I �t ❑Residential Value of Work ;�'Z C/o �- Aunimum.fee of$35.00 for work under$6000.00 .Owner's Name&Address r7�i4.: Contractor's Name 90}f Telephone NumberG ' Home Improvement Contractor License#.(if applicable). J -7 �?� Construction Supervisor's License#(if'applicable)' 5 ❑Workman's Compensation Insurance V,4�am a sole proprietor. NO V.2.9 20�2 I am the Homeowner T®� El have Worker's Compensation Insurance /V OF g ARlvsr Insurance Company Name A8t� Workman's Comp.Policy#. a Copy of Insurance Compliance Certificate must accompany each permit. Permit Re. (check box) 2 I II Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing-layers of roof) `Re-side u #of doors ❑ Replacement Windows/doors/shders..U-Va1ue (maximum 35)#of windowsEl ' Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate EIectrical&Fire Permits required. *Where required Issuance ofthis 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 Su pervisors ervisors 'c Li ease is e uir p SIGNATURE: y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly, Name(Business/Organization/Individual): U Address: City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. L❑ I am a em to er with 4. ❑ I am a general contractor and I P Y 6. ❑New construction . . mployees(full and/or.part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• � 9. ❑ Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. 11.❑5Pw6bing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.ffRoof repairs insurance required.]t , c. 152, §1(4),and we have no employees. [No workers' .13.❑ Other 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. $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. 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. Lie.#: 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 DIA for insurance coverage verification. I do hereby 7certrfy erthepa' andpe lti o hat the information provided above is true and correct Si ature: C c Date. _ Phone#• / `� ✓J�,�/�' 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#: - t a� • . r 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 o another under any contract of hire, express or mplied,oral or written." An employer is defined as"an individual,partnership;association,corporatio or.other legal entity,or any two or more of the foregoing engaed in a joint enterprise,and including the legal.repres tatives of a deceased employer,or the receiver or'ttustee of ap individual,partnership,association or other legal e tity,employing employees. However the owner of adwelling hortse having not more than three apartments and w resides therein,or the occupant of the .,dwelling h©use of anothe\ who employs persons to do maintenance,co ction or repair work on such dwelling house or on the grounds or buil g appurtenant thereto shall not because of s ch employment be deemed to be an employer." MGL chapter 152, §25C(6) .0 states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit,(o operate a business or to constr ct buildings in the commonwealth for any applicant who has not produced?�Ccceptable evidence of compliance with the insurance coverage required. Additionally,MGL chapter 152; §2 (7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the perfo ce of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been pr ented to the contrac '�g authority.", 1 Applicants Please fill out the workers' compensation affidavit ompletel by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)narne(s),address and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limit Laability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' co ensation insurance. If an LLC or LLP does have employees,ia policy is required. Be advised that this affidav� ybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be'su to sign and date the affidavit. The affidavit should be returned'to the city or town that the application for the permit.o license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the w or if you are required to obtain a workers' compensation policy,please call the Department at the number listed low. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials }' e Please be sure that the affidavit is complete and printed legibly. The Departure has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to c tact you regarding the applicant. Please be sure to fill in the permit/license number °hich will be used as a reference umber. In addition,an applicant that must submit multiple perm t/license applicati1cE in any given year,need only sub 't one affidavit indicating current policy information(if necessary)and under"Job Bite Address"the applicant should write"aall locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or to may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit . ust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business on commercial venture (i.e. a dog license or permit to burn leaves etc.)s4id person is NOT required to complete this affida { The Office of Investigations would like to thank you in advance for your cooperation and should you ha e�ny questions, please do not hesitate to give us a call.. O The Department's address,telephone-and fax n`ben: . The Co anwealth of Massaohusetts Depa ent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0.2111 Tel. ##617-727-4904 ext 406 or 1-977-MASSAFE i Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia :* OF THE T� Town-of Barnstable ti Regulatory Services 9sn M cE AS& Thomas F.Geiler,Director 1639.�Fo rr,A�" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,.MA 02601 www.town.barnstabIe.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder AAACmA (4,Yl , as Owner of the subject property_ hereby authorize �Iak%dk C'lAOi A to act on my behalf, in all matters relative to work authorized,by this building permit: so AA (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 performed and accepted.. Signa Ownergnature of Ap . ant ` t LAI 0�'_X- rd Print Name Print Name Date Q:F0RMS:0WNERPEFMSSI0NP00LS 6/2012 tT Town of Barnstable r Regulatory Services * saRtvsrascs Thomas F.Geiler,Director Mass. 1639. .�� Building Division . rFDMA'{a ,� i Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601f < R'R'R'.town.barnstable.ma.us J j Office: 508-862-4038 i Fax: 508-790-6230 !; 1 HOMEOWNER LICENSE EXEMPTION j. Please Print'` � f DATE: n - f JOB LOCATION: number street village "HOMEOWNER": ' name l�home phone# work phone# CURRENT MAILING ADDRESS: J city/town state zip code The current exemption for"homeowners"was�e tended t iinclude owner-occu ied dwelling s gs of six units or less and to allow homeowners to engage an individual f ' e w o does not possess a license,provided that the owner acts as supervisor. / DEFIN ON OF HOMEOWNER Person(s)who owns a parcel of land on whichIhe/s•Ntiesides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or detache structures accessory to such use and/or farm structures. A person who constructs more than.one home in a tw.jj ar period shall not be considered a homeowner. Such "homeowner','shall submit to the Building O&.iallon form acceptable to the Building Official,that he/she shall be responsible for all such work erformed unde th buil ermit. (Section 109.1.1) a The undersigned"homeowner"assumes responsibility w ompliance with the State Building Code and other. applicable codes,bylaws,rules and regulatio E The undersigned."homeowner"certifies than /she understan the Town of Barnstable Building Department minimum inspection procedures and require m nts and that he/s will comply with said procedures and requirements., / Signature of Homeowner a Approval of Building Official t Note: Three-family dwellings containing 35,000 cubic feet or larger wilbbe.required to comply with the State Building Code Section 127.0 Construction Control. . i HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required sha�kbe exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engage a persons)for hire to.do such work,that such Homeowner shall act as supervisor." v Many homeowners who use,this exemption are unaware that they are assuming the responsibilities of a su*.ervisor(see Appendix Q, Rules&_Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in seno'r�s problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it Kcpu]d 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:forms:homeexempt Oftice�Co� i �rs&B. smess Regulation HbME IMPROVEMENT GO,NTRAGTQ'R Registration: y172472 Type - Expiration: <t?/27h2014' Individual' P IVCK CLIFrbO � it PATRICK CLIFFOI�Plz' ,r 12 BALDWIN:RD `e ,—• ������ ; DENNIS MA02638 a, A %In7Undersecretary ; U Massachusetts-Department of Public Safety .,Board.of Building Regulations and Standards Consfructio.n Supenisor Specialt License: CSSL-105951 PATRICK CLIFFO)ZD I • r 12 BALDWIN ROAD c _ Dennis MA 02639 ` 'a Expiration 06/02/2016 Commissioner License or registration valid.for individul use only before:the expiration date..If found return to: 'Office of consumer Affairs and:Business Regulation 10 Park Plaza-Suite 5170 ((' E ;' Boston,MA 02116 o Not valid wi out signature • U Massachusetts - Departme.'nt of Public Safety £' Board.of Building Regulations and Standards Cunsfruction Superi"isor Spechilt License: CSSL7105951 PATRICKCLIFFURD = _12 BALDWIN ROAD ' 4 Dennis MA 02631F. I ' , ,,j I ` Expiration 06/02/2016 Commissioner _ r Assegsoks Office d 0 ce 1st floor Ma ) Permit# N—'ert .ion Office 4th floor Date Issued' Board c:' Health 3rd floor Engim,ring Dept. (3rd floor) House#Planning Dept. (1st floor/School Admin. Bldg.): S �T!CBE Definitive Plan Approved by Planning Board 19 INSTALLN�i@ (Applications processed 8:30-9:30 a.m.& 1:00-2.00 p m) v;*- A ENVIRONMENTAL CODE AND TOWN OF BARNSTABLE' ' Building Permit Application �j ® o Protect Street Address ��J & Village r Al 6,,--yiZZzw. Fire District (3wner J am/' a/y A-Al/ t A/ Address A 7-3® y Telephonc -7r Permit Rcauest: 0"'/ ee/a/ef< ®n/ Zoning District Flood Plain Water Protection Lot Size i Slv Grandfathered Zoning Board of Appeals Authorization Recorded Current Use ea 5 Proposed Use Construction Type Existing Information Dwelling Type: Single Family\/ t� Two family Multi-family Age of structure d z —5 Basement type e-o^✓e49-7'A.- 73 L— f/4 Historic House Finished Old King's Highway '��' Unfinished ✓ Number of Baths No. of Bedrooms Total Room Count(notilncluding baths) / First Floor Heat Type and Fuel Ca 45&entral Air /✓B Fireplaces Garage: Detached Other Detached Structures: Pool Attached Bam None Sheds Other Builder Information Name Telephone number Z- / Address 73® t743"Z-. License# 0 '7—s—C;> /-/ 9 Home Improvement Contractor# /%9Z Z 2- Worker's Compensation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GO^/ 'Vie. Proiec 2Co/st � Fee( aa SIGNATURE DATE 9S' BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) Sr� �' •��I BPERM T 2/2 4/9 5 3 5�J FOR OFFICE USE OINLY 209.039 80 Long Pond Circle Centerville ADSS VILLAGE Jean & •Tony Antin - OWNER DATE OF INSPECTION: - FOUNDATION FRAME INSULATION ` ` , f FIREPLACE _ ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: a . ci/ " ,nv fit DATE CLOSED OIT� 'A> i ASSOCIATE PLAN ' �p3 wWiF ��• ' 1 1 w04. - VJIK w • 12 ' f�LE?a-FR FtAd.Rt `t�yg i FLAN . - :,�r. -�•ssxxrai-xt-ccr�._:.a..c-:a-. • 'ScMP' +N FEU 5.25/lG.* 'tF r 1 �4N G`D , +tax ►N''�TA.u:. -\ -rb4�.'�►+�EN FTSKS Tad aF f�A►F rf ,Q/ -f0f F,'.,>Y �4")K 9 4 LEI L I 7Fi, ill :. JO M� _ t - _ _ { r .f #G44 Mf y , t n. 4 x G Al.-I C t #" ' vita _Pk ST.,1 TD N u�.i.C. :pC:r:BTF,R1t� , of -a 4xCm.PosT q *r ` LL fll ; btu l S R • 2' Lam. --- .: . � •, ,,.,. :.r-.x- �: :- mac.,'-.: ��; .. ,=.:a�_ -r.,:..•' _ -- ..,'r "�' � zv,. ... :;r, „ __ _ ""�i:{ L .�a r- a a: s• • F- ;i 11/ /Ad 17:02 `$6177277122 DEPT IND ACCID 16 001 20partment 0JJn4L;tria1—Accinfd 600 Was, fon. bast James J.Campbell &Ion, l amach uI6 02 f f f Commissioner Workers' Compensation Insurance Affidavit eiuoe���isee) with a principal place of business at: do hereby certify under the pains and penalties of perjury, that: () i am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number I am a sole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contraaor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation porcies: �A2,�1s13 F GF / ®l r� ticsc Contractor Insurance Company/Polity Humber RAY Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing ail the work myself. undEr5Lzr— :i a coy f of&.Ls will be forvrzrad tc Lf1C Office cf IrvestJ2dcns of the DIA for coverage verification znd that fzii;:,re to secure CCYe12€e Z-<rEc,:i,,et1 under Sc- Lon 2:P,of MGL 152 can iead irnpc5ition of Criminal penzl;;e<consisdne of a fine of up ro<_1,5GC.G0 ar.Gler crc Y(2.,'i-nprL(cdt^c-m µ(-!; 2s Civil pen2lk.s in t". fc.=cf STOP WORK ORDER end a fine of S 100.00 a dad• s me. SignedLis 111 day of 19 Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOT,TN OF BARNSTABLE BUILDING PERMIT -j : - - : The Town of Barnstable BAR\STABLE, �e� Department of Health Safety and Environmental Services ► " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775.-3344 Building Commissioner For office use only+ Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. r � Type of Work: �F.'t1 Lr�' �G�d.'�i o✓ Est. Cost r® ®o 4 Address of Work: grl�" Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT PAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY i hereby apply for a permit as the a ent of the owner: Z J��t/ 1D Contractor name Registration No. OR Date Owner's name •��Fz ti z , 9Air `'ft�y 2 X to LAYON R&f 'K4 FLA Roo F _ 1 *TIE LVL MkA.M INTO ckAr. i f FRAMER of P-6OF FAW / 4X 8 w/2x4's Hu►A Fla i...VL.. �IMf op 3-13/40.^14i LV L c Rosa.P.>EA M Ir 4%c-5TUO.Fovr 4 - y7 ONVER �1DGrE 71e 3 J ROOF r TIE LVL IlJTO FRAMEOF ROOF FRAME VJ/ILAG-'S HU►* F=RC*4 L.V L 7,17 f; 4xG g U16 Ro->T --- Psoul w- UNVER R►DGrE -ne•5 a ovop-L P -1 2 Ac G `T t ST5 - - IL {{ I t, I- '` �� �}'Kf3?-��: • PROV{D6 4 N P. V) I Pc.Ci-rC TvPaFA�..I. F .'S T x X N I �-- N � ��"S1.MPi.�or1 L�32io j4)x(or7-- 's `1RVr P V►TER I/4u LVl- GrAf-,i.E TZ�,—. ; i �