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Home My WebLink About0020 LOOMIS LANE o : J o� D ,,oam s i..n e [K� IF— —7— ►c� tME Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee * BARN 3rABLE, 1639MASS. `0$ Richard V.Scali,Director _ Z1 Building Division �. nn Tom Perry,CBO,Building CommissionPrEC :O 6 2016 200 Main Street,Hyannis,M'Ano26'I U'ttrr� ' -}- www.town.bamstable.ma.us 508-862-4038 �i Fa�::.508-790-6230 EXPRESS PERMIT APPLICATION' - RESIDENTIAL ONLY - Not Valid without Red X-Press Imprint Map/parcel Number =Z// Property Address 20 1-001721J G1D , Residential Value of Work$ 3��r Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ��OIJ61 d$ A_I_acz kE7 Contractor's Name Telephone'Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance r Check one: ❑ I am a sole proprietor 9-1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name AAIM /V� '�'� �/gy Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ 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) E]eRe-side Replacemen W oors/sliders.U-Value (maximum .32)#of windowsTo ' #of doors: _ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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-co y of the Home Improvement Contractors License&Construction Supervisors License is f! requ red. SIGNATURE: ' --� C:\Users\Decollik\AppData\Local\ icrosoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 i I Ile Commonwealth ofMassachusetts Deparfiner t o,f brrdhstrial Acciderds - - O)Twe of ImwfigadOnS ' 600 Washirtgton S`t wet Boston,CIA 02111 • ft�►vta:rltass,gov/dia Workers' Campensatian Insurance Affidavit-Builders/Contractors{EIectr cianslPlumbers A�pficant Information• Please Print Legibly �I�sxne:(Basi�ss�rgan�aon �laa1?-7��/L�i�.,,�eZG.�6� cz�Address:zz, Are you an employer?Cheekthe appropriate box: ' Type of project(required): I.❑ I am a employes with 4_ ❑I am a general contractor and I have hired.the sub-contractors 6. ❑New constructiontmtployees(felt.andlor part-time),* . 2-ElI am a sole pznptietor orpartnes Usted on the attached sheet. 7_ ❑Remodeling ship and have no employees. 'These sib-confractors have S-,❑Demolition working far me in any capacity_ employees and have workers' [No u;od mrs' comp.insurance comp.iusuranm N. 9. Building addition equired] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions I am.a homeoumer doing all u�orte officers have exercised their 11_ Plumbing repairs or additiew. Myself [No Workers,comp. ii&I of exemption per MGL 12. Roof repairs • ir�c,iramre required,]` � �1(4�and we have no . employees_[No workers' 13.❑Other camp.insurance required-) •clay app@icwttiatcheduboxPlIImst also filloutth�e section below shosringth&wa'tecs'compensatinapaTicyinfannaf mL I Hameaamen who submit ibis afiida<<u indicating they an•_doing all waa}and them bhm outside contractors nmst submit anew affidavk indicating such_ zcantnctorsthst ehea this box must attached am additional sheet shovdng the nuae of the sub-cautiwmm and state whether or mat chose entities hoe employees.If the sub-couftwtors have employees,they mustpmuide their uorkers'comp.poHU number. I am an erntplayer that is prmidingivarkers campensatian inmirim.ce for iny*employees Below is Elie policy and job site . informadam Insurance Company Name: Policy#or Self--ins.Lie_i' Rxpiration Date: Job Site Addre=— CitylState&t P: Attach a ropy of the workers'compensationpolicy dect-oration page(showing the policy ni tmber and expiration date). Failure to secure coverage as required.under Section 25A of MGL r 1572 can lead to the imposition of criminal penattdes of a fine up to$1,50U OD andlor one-year imprisonmatt as will as civil penalties.in the form of a STOP WORK ORDER and.a fine of up to$25t1_D0 a day against the-violator. Be advised that a cagy of this statement maybe forwarded to the Office of Investigations of the DIA.for insurance coverage tierificatim .Info hereby ca .p-midL,s tlLe its and psrtahFies ofpedury tltattlie informatiortpm idedabma is bars mid carrect SisnBture_�-, r-DFate:..-. Phone=��.. - �� - ��- •� ,. Off kcal me anky. Do not wi to art dift area,to be cormpWod by city ortonm officiaL City or T omu- Pert tlLicense# Issuing Alnthority(circle one): 1.Board of Health 3.Building Department 3.City,morn Clerk '4.Electrical Inspector S.Plumbmg Inspector 6.Other Contact Person: Phone#: i Information and lastructions Ma ccarhusefts CT6=al Laws chapter 152 req®rm all employers to provide workers'compensation for their employees. PmmLmtto.this sla aft;a a cOPL w is deed as."_.every person in the service of another uader any contract of lice, express or implied,oral or wrhmf f An ernproye•is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged is a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other Iegal 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 maim ea ce,construction or repair work on such dwelling house or on the grounds or budding appunf nanfthereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also sues 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 bnfldings in the commonrwealth for any applicantwho has notproduced acceptable evidence of compliance with the insurance.coverage required-- Additionally,MGL chapter 152, §25C(7)slates"Neither the commaawealth nor any of its political subdivisions shall eater into any contract for the performance ofpublic workuniii acceptable evidence of compliance with the insarance.. requirements of this chapter have been presented to the contracting authodty:" ecpm em , Agpficauts . Please fill out the workers'compensation affidavit completely,by checloa.g the boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phonenumber(s) along with their cm ificate(s) of insinu ce. L:inn t Liability Companies(LLQ or Limited Liability Partnerships(LLP)wnno employees other than the members or partners,are not required to carry workers' compensation insaraace. If an LLC or LLP does have employees, apolicyisreguired. Be advised that thisaffidayitmaybesubmittedtotheDt Ltmentof.Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retnmoed to the city or town th A the application for the peach or license is being requested,not the Depmtneat of Tn Li_s r A ccidmfs. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should en-mr their self-m suimce license number on the appropriate line. City or Town Officials t Please be sure that the affidavit is complete;and priLted.legiibly. 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 sine to fill is the pemnit/license number which will be used as a reference number. In addition, as applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating cmrent policy i u L ration.(if necessary)and under"Job Site Ad 1drms"the applicant should write"all locations in (city or town)--A copy of the affidavit that has been officially stumped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is oa file for fofure'peDnits or licenses. A new affidavit must be f JI-_d out each year.Where a home owner or citizen is obtaining a license or permit not notated to any business or commercial v=tUre (i.e_ a dog license or peunit to bun leaves etc.)said person is NOT required to complete this affidavit The Of 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 caIL The Department's address,telephone and fax number. t�amanwcalilt of Massachusetts ' Depaztmeat cif ladusftial Accident% �t�e of�tvesfig�tZo.� 6�T�ashingtan � �os�an�I1�fA E��11F Tf,-1. 617'27-4 �t 4€6 or 1-9�It3ASSAAFE Fax#617-727-7M Revised 4-24-07 Www.mass-govfdia Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division . BARNSTABLE, ' Tom Perry,Building Commissioner MAW 039. 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 LOCATION: 20 DC�VY►�S L 4&r C5tu r tl)a a number / street /' � village �y ,/ 2 "HOMEOWNER": /145 j �L�'L �� L/ 805 i0� / /� � v )e l J f name home phone# work phone# CURRENT MAILING ADDRESS10 zzt)m j L.- 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 prQedujes and requirements and that he/she will comply"with said procedures and requirements. i ure o wne 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. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.OUtlook\2PIOlDHR\EXPRESS.doc Revised 040215 Assessor's map and lot number � s � ,:....... . . ............ y y,� �� E,, ''Z ... . (�� SEPTIC SYSTEM MUST EGA � o Sewage Permit number .... l�A.:....... j . � INSTALLED IN COMPLI WITH ARTICLE II STAT Z BAUSTADLE, : House number ......................................................................... SANITARY CODE AND T S a ' 39• • C+ REGULATIONS, owaca� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR 'PERMIT TO ....4v(�,S„ !�!�t'� ....�2 x (� �-01"r'c�t—Ti; Yt'gaw1"EG .... ..........................................................................,........... TYPEOF CONSTRUCTION ..............................................................................:...................................................... ...........!........................:...........197. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................('t+S..............t-Clz SKY- u� .... ProposedUse .. ......��...N....`..................................................................... ............................................................. Zoning District :Fire District ..CS.�T>=3v! « �T; !3.V.(4� .......... .................................................. .... .... ........... 67 Name of Owner .. -V .L..`�K...I ....,!...A?Tf. .Stl........Address fr5. .. .i?=�MGS.�, ?,. .. l �t�s C W t-s�5 La ��t-t7F�vc�LEE Name of Builder ................8.4?l77. ........AH.00T.f............Address ..............................:.�..................................�............... Nameof Architect ..................................................................Address .......... ......................................................................... Number of Rooms ............ ...............................................:.....Foundation ...NA�.I�.KAY... f��44�4..s�ec ............... Exterior .......�1 O-1>p.............................................................Roofing ....../ .ice !a4........................................................... r � } Floors tsC/..�.'� .Interior 5f.. Q.. . K �''( u4 ........................................ Heating , l�?K e.....................................................Plumbing 8� � ............ . ... ...... ...ry......'.-............................. t Fireplace ...................... ........................................................Approximate Cost ......✓..../.-.................................................... \� (51 Definitive Plan Approved by Planning Board _____________ _ ________. Area 5 - - 1" ...........'. .r............. .. ......... Diagram of Lo n ui ding with Dimensions Fee SUBJECT TO A PROVAL OF BOARD OF HEALTH t dV Fes*e7 TV, 60 �o 71�5s. 34 1.1Art9y � Io �J �-c LoomF.5 V (N t G l iZ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ............. ... ...C1.62.ra,............. Patterson, Evelyn M. N 209 v a—dd— to —dwel—l�u8� `��nf — ..— -- ' | `` . ---------^---------'—'^----- -° 2O �oo��o �aue Location ....... —.-.— .-----~--------. Centerville —'------~^-----------------'' Owner ......... .�0�'Pattmr�o�----.�� ` `—� — ........... Type ofConstruction ----..��----- --------.-----------...-----' Plot ' �� ................................ . . . ' ---------. . � . Permit, Granted .. . Deue�bar .Il___lq 78 .. ------.� —' � ^ Date of Inspection — lq Date Completed ........ ..�.*��"..m.�...... q. > ��U� �� ' _..~ —_—,.—_...—..-------. lg r'.' ............................................. '.—.----.--~..—..----...-----:,.. . . ' .--.,---~~.—...---..----....---- �� ----- .--.-.—.—.--..~—.....,.-----.... � ^ Approved lg ---r---------`--' -------..�._----..--..----.—.-- . . ' ............................................................. �L Assessor's map and lot number .. :...: �.. ?..... o�TNe ro Sewage Permit number .... ........:!'.G: li E9HHSTADLE. i Hodsenumber ........................................................................ C MAO TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO { ...... I r f� < r*' T-, • -!: .*!c ...:.....:N ......................................................................... ..... ... ............... TYPEOF CONSTRUCTION ..................................................................................................................................... _ � r s ..........! i.......................19.?.:.:.. : ............ ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........!.............�.. 'A: ..............................................................r ......................................... ........................... ProposedUse .......r.................`.....::r..:.............................................................................................................I......................... Zoning District .....F.?.I,).......k.................................................Fire District ........C...`.............::.:..:........... Name of Owner ........:.i......` .:.........!.... .^......�.'.r'.=.....!........Address ...........�?..:1:f.............................._ r ' ��.......-..::......�.: Name of Builder ".? [ 'At-IF^-#-c.............Address -� he-rrs �A , ( 6; Fr-+ I, r'•vUiLt Nameof Architect ..................................................................Address .................................................................................... Number of Rooms 1.....................................................Foundation ..�1A 4G !•r f�-� �: .. . ..r ............. ........................... ...................................... - r v ...Roofing , u Exterior ...... Floors ' ..............................................................Interior j( .. . , ,,,: K. 1--A i Heating ' ..........................Plumbing Fireplace ..................................................................................Approximate Cost ........r `. .:.: ......................................... Definitive Plan Approved by Planning Board ---------------_---------------19--------. Area ..... .......�..................... Diagram of Lot and Building with Dimensions �. Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH - - - s rt r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. JJ Name ..... .................. ......... ......... .............. l Patterson, Evelyn M, ,A=2301-113 � 20903 add to dweIIJ�z7iy ' No --- h for ----.. ...........................................................t..... ........... 20 Loomis Lane Location ---------------------. Centerville ----.----..-----.-----------.. � �0. �atteraou ~`~'~' ---------------------- frame Type of Construction .......................................... ............................................................................... Plot ............................ Lot ................................ December ll 78 Permit Granted -------------]V Date of Inspection ------------lA Dote Completed ...................................... r ' PERMIT REFUSED _.____,—_------------- 19 � � ^ � � —'' � ~' ~^----~^^----'' ^— '— ................ ^—''�f^'—''x"'—^'-'�'—'' ............................. ....... ...... ................................ Approva6 . --.-� --------.. 19 . -------.------.—..-------.—.—.. / --------'--'---~'--^~--''~—^^^— | ) ! ' [ | ^