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HomeMy WebLinkAbout0076 LONGFELLOW DRIVE �� �(P � o �, v /� .. _ � F � r., � s r. �, � .. �; ,; ,., � ,. ... ,: -. ..,, . t' .. s .. � .- a .� - ._ ,.. _ a .. .. ... .. ... _ ,. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ® � Application# r�c �`��( Health Division Conservation Division Permit# Tax Collector Date Issued 6 56 Treasurer - Application Fee � Planning Dept. Permit Fee c�cJ Date Definitive Plan Approved by Planning Board a k 7 /a7 Historic-OKH Preservation/Hyannis Project Street Address 176 Village eL,--/l)%Z7t✓/L Owner 3lmmlzl y 1A1C 1-L_ Address �,61V 6%-L'7—Lo uJ 61Z, Telephone 77S �6 Permit Requ st V V tl- C"k og LA�A Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project-Valuation/, 00 D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑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 including baths):existing new First Floor Room Cunt _® V �9 Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other ` c Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/cg tove: 5-Yes L1 No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exi ting ❑view Cite w i Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# "- Current Use Proposed Use ar•7.rrrI DER INF nnA4 I(lN Name �Telephone,Number -� Address 7 tIV6azzo ) J License# C'/U 2�li(.(,c,, 0 e?_63 Z- Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGH NATUR - I r-DATES Z ?00 f. t^ FOR OFFICIAL USE ONLY 4, ti PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 3 OWNER DATE OF INSPECTION: . i FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i s i The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street �= Boston,MA 02111 ' M www.mass.gov/dia Workers" Compensation Insurance Affidavit::Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly N eam (Business/Organization/Individual): . Address: �Ci ./S�tate/Zi / G�il�t�/GL��lA/1�. D'Zd�y Phone.#: � 77J 7� Z tY P: Are you an employer?Check the appropriate box: Type of project(required):. 4. I am a general contractor and I 1.❑ I am a employer with � 6. El New construction . employees (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 g• ❑Demolition workingcapacity. employees and have workers'- for me in any P 9• ❑Building addition comp.insurance. [No workers comp.insurance equired.] 5. � We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumb' repairs or additions I am a homeowner doing all work ❑ g P 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' 13.0 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 isahe 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 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 ce under the pains and pen lties of perjury that the information provided abb e is ue and correct ""�i afore: Date: �J`` ; 2 Phone#: . .S 77S - 5'7� 2- — Official use only. Do not write in this area,to be completed by city or town offcciai 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 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,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-contcactor(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 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.Anew 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 Industdal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE 617 Revised 11-22-06 Fax -727-7749 www.mass.gov/dia Town-of Barnstable yP °� Regulatory Services * ss�ns Thomas F.Geiler,Director 9 MASS. 0;9 Buildincr DIVISIUn �rED MP'�► b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 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 build in be done b y�re_gistered contractors,with certain exceptions,along with other - requirements. �� .� Type of Work: � � �G ."'' Estimated Cost Address of Work: 1� Owner's Name: Date of Application: `Yv I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑ �ding not owner-occupied QO er.pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE 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 agent of the owner: Date Contractor Name Registration No. OR D-ate Owner's Name Q:fmTs:homeaEdav Town of Barnstable OF THE Tp� Regulatory Services sARxsTAs[E, ; Thomas F.Geiler,Director 9 MASS. �e39• A.� Building Division rF0 MA'I 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 DATE: JOB CATION: 6 numb s eet village "" "HOMEOWNER": / � 3 ' Z 2— name home phone# rk phone# CURRENT MAILING ADDRESS: 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 procedures an eq ' ements and that he/she will comply with said procedures and re - ents. ature 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. 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 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 Assessor's office (lst floor): ( SEA s /.��J, .�'.Ol,S.:. P"UL *THE t0 Assessor's:map and lot number, r! � e� („`QIMPLIANCE e�P.. ♦�' :f` " °t�"6T 8 d of Health (3rd floor): !�'� N TIT(,12 g: Sewage Permit number. :. ,. �..3.J......:,{' �y :° a 'ON�ENTAL t BAfldSTADLE. S AT �OD� MA�a Engineering Department (3rd floor) f T��/�i � � 1639• Ho4se number ......... .................. Definitive.Plan Approved .by Planning Board •___________ ________________19-------- APPLICATIONS PROCESSED, 8:30-9:30 A.M. and 1:00-2:00 P.M. 'only TOWN OF BARN' TABLE r BV t LDIHGt .INSPECTOR APPLICATION FOR PERMIT TO ....... (... 1. 1,S�ry ...... �..... . Q , s . TYPE `OF CONSTRUCTION ........4�...:......................................... . TO THE INSPECTOR OF`BUILDINGS: The undersigned' hereby applies for, a permit according to-the follow' information,`, y w Location '....... .. 1� � .. � ' �« ':' 1kz ......... ...... ... Proposed Use ... ` oQ.. � : ....... Zoning Di ict C- 4 -.�............ \ f •� .......Fire District .. .. .. . � T r Nbme'of Owner ... .: :... .:... �;,� :. +.'......Address Name of Builder ..�: ���... .... ..�...�..�.....Address :Q...l..�...�........©...��`.!�• ...'R �:��� QCIe. Name :of Architect .. .. .:.....:.......:...........................:.......Address Number of Rooms -� ........::......:.............. .:....... ...y......Foundation. ............... ... . Ex1efor ...... .... ..................................... ..............Roo'fing .......... .... ............ ........... ... Floors ..:........ .. Heating. ...: ........Plumbing Fireplace ....... .........:..............: ....... . .........:..........:.....:Approximate Cost .......... y......................... h\5. •®D Area : Diagram of,.Lot .and Building with Dimensions Fee . Q. r N..' : _----- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to.'all .the Rules and 'Regulations-of the Town of Barnstable regarding'the above construction: Name .4 ?' ....... .. :� .��.: . .............. Construction Supervisor's License .. . O'NEILL', BARBARA , d'. No 32084 Permit for BU.ILD...DECK......... Sin le F,amil Dwellin .. g'. .. .... .....Y......................g......... ...... .. .. .... 11 Location 76 Long Fellow. Drive„•,,,.,, C Centerville........... (71 Barbara O',Neil1. .... Owner .... Type of,,Construction .k x. Ill�,....:.. !!..................... _ ... ..... Plot- ..... Lot ... ....wr . .. ,Perrriit Granted �711.7;X..�� 9..... `. 19 88 .. .. ` Date of Inspection ... ........... ....19 ( � ��,� } .- ��• } _ co Date Comt fkted ............:..... .... 1,9 In Cr rtl IN .�`4' r...... _ �; � T cs?,�� F+�.� '*y'y��`y Y t�`,,�f*��t: ��r'S'*hn� .4. , ,� .,� � :z,.�:ar�2Ymaw:-•:�'v:-.; d d '�Ai'f'�J r m',, s a - -•• .n b..«R;�'�...'f�-. .fit �-'�•ro.�u. ";3 a. -r t 'f. .e., a_:�i:,:.: ..r v .:J:: , Assessor's office (1st floor): RA F 7HE j Assessor's map and lot number .''{.....: .....00 ..... ..... ��o Board of Health (3rd floor). �/ •^7' -eetvage Permit number ...........................�.. ....................... t SAR33TADLE, Engineering Department (3rd floor): °o rb 9• e� Hqusenumber ........................................................................ Definitive Plan Approved by Planning Board ________________________________19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........................ ...................... ......................................... ............ ...... TYPE OF CONSTRUCTION 4�- ..........4............................................................................................ .....�.�....`.1...................1958 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fort a permit according to the followi- information:q , Location l.f.� fie. �1,��,C'ji.�> �i�w. ) ��" V �6(1 c"".................................. ............................ ^. .................................................. �.......... Proposed Use Zoning District .c� k-ggk . (.................................Fire District r` Q\ ........... ...... .......... ... ..���...........�........-�- ..................................... Ux� Name of Owner ... ,-' ...............Address ................. .r�rd...... .....` ....................... Name of Builder �"��Address r��P,� 8C1Q � TJ��h1S �Cl o.......................................`.......... w..�... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ....................................................................................Roofing Floors .........`M.....................................................................Interior .................................................................................... Heating l �+� 'j ? ..............Plumbing Fireplace ..................................................................................Approximate Cost ....... Area Ma `qQ.� `..� . Diagram of Lot and Building with Dimensions Fee !� .6) c�- . htw OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform, to all the Rules and Regulations of the Town of Barnstable regarding the above construction. \S Name .................................................................................. Construction Supervisor's License .................................... O'NEILL, BARBARA A=188-015 No 32084 permit for ..Build Deck . ............. Single Family Dwelling.......... Location ....�6..LOn� .11ow...Drive....... Centerville Owner .........Barbara O'Neill .................................. Type of Construction ......Frame.. ......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ........July. j. ..............19 88 Date of Inspection ....................................19 Date Completed ......................................19