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HomeMy WebLinkAbout0101 MONOMOY CIRCLE � , s. - �, . t �. �. ., ... -k�r-., ... ., .. }r.. � .. n .I ,. .e � ,. & a .. _ I� n � - od61 To wn own of Barnstable *Permit# Expires 6 r is from issue date Regulatory Services liee nA RVSrAe[.E. � $As& Thomas F. Geiler,-Director, BuildingJAVISion, .7� Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,.MA 02601 ��tifio�/� www.town.barnstab le.ma.us Office: 508-862-4038; Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address /O f Moplorkl7 =.� (r/ C�,� .QLy [wesidential Value of Work `/ 00, DG Minimum fee of$35:00 for work under$6000.00 s. Owner's Name & Address p cQor-q l ` Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ERMIT Check one: . ❑ I am a sole proprietor AUG a t� 2010 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name 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,t Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Ej Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .35)#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 OwnerLetter of Permission. A copy of the Home Improvement Contractors License &.Construction Supervisors License is r quixed. e� SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 The+C'ommozi.wealth of Massachusett's --- DepFtmearet of Industrial Accident's r = CI,Q%ce oflnvesdgatiotxs t:;• _ '600Washington Shwt Boston,ALA 02111 ' wuni mass.g ovIdia N o:*ers' Compensatiou Insurance Affidavit: Builders/Conn actors/Electricians/Plumbers fic-a t Information please l'ls-int I.e 'bh N ame, (EmaewAXgartizationd n hid ual): h-end'ot�P� MQ14O AA® / ltySa 'Zip: t.�t! g� (� - 2 phone#.40V' 71 7 Yl 7 Are you ain employer?Check the appropriate box.: Type cif project(sequined): i..❑ I am.a employer W.Ith 4• ❑ I ain a general contractor and I erI3171cfees(full and/or part=time). * have hired the sub-contractors 6- ❑New construction 2-❑ I am,asole proprietor orpartuer- . listed on the attached sheet 7. ❑Remodeling ship and hoc*e no to s These sub-eontractart have �P 8_ D Demolition ,arorking for me in any capacity. employees and have workers' 1 9. [1 Building addition [No markers'comp.insurance comp.insurx�noe.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3`;I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp- right of exemption per 14fGL 12.0-Roof repairs insurance required.] c- 152, §1(4) and we have no employees-[No workers' 13_❑Other comp_.:insuraiioe required.] r a •Ay appticam alit.checks box#1:nwst also fill out the section below showing their workers''campeasatian policy?information I Homeowners who submit this affidavit indicating they are doing all wcdk and then hire Outside contractors must submit a aew affidavit indicating sack LCaniracwrs that check this beer must attached an additional street showing the name of the sub-contractors and stare whether or not those entities have errtpioyees. If the subcontractors have employees,,they must provide their workers'comp.policy number. , lain an employer titatis proi�i g nporkers'coiripeiisadaii iitsurarice for ntv employees. Belotr is thepoUcy and job site in forrrttrtirrit, Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: ' Job Site Address: a CitylS#atr 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 2.5A of MGL c•_ 1.52 can lead to the imposition of criminaI penalties of a fine up to$1.,500.00 andlor 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_ I2o hembyr cerh_',fjJ it tPteptuftLs and penalties ofperjntty�that the iieformali©n protriddetd aboiv is trace and correct Si Date: rr lO ®!o Phone#: Sa�".' 7 7/.. '� 7 Y/ offinkl use only. Do not write in this area,to be coirepleted by city or totes o�cint City or Town: Permit/License# Issu ngAuthority(circle one): 1.Board of Health Building-Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• 6 8s Ito r- CF THE BARNMBLE, " Ass. i639. Town of Barnstable �� Regulatory Services Thomas F. Geiler,•Director, Building Divis/02601 Thomas Perry,CB Building Commissi 200 Main Street, Hyannis, www.town.barnsta ble Office: 508-862-4038 Fax: 508-790-6230 Property Owner Corn leteand Si n T h p g �. If U/ABer r e subject property hereby authorize ato act on my behalf, in all matters relative to work"authorized by thi uilding permit application for: a_ /(Addr of Job) Signature of Owner. Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILESTORMS\building permit fbnnsTXPRESS.doC Revised 072110. 3r �o HE Tqt, o* Town of Barnstable ti * r Regulatory Services ��,9STABLE, 4 � Sys, Thomas F. Geiler, Director re1 ,tON. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,,MA 02601 www.town.barnstable.ma.us Office: 518-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:��� IO JOB LOCATION: %U I I"I 04 ® �� (,( � C@ t+l�� V t 1 number street //�� // village „HOMEOWNER". 1�''O ND� L �f/V+, �77( -7P/ 7 name �p home phone# work phone# CURRENTMAILNGADDRESS: /-0 6 rO1403L40 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 Vnat,,e #,fHo d require nt and that he/she will comply with said procedures and requirements. meowner 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc . Revised 072110 A's'ses�ds map P and lot number ""' SEPTIC SYSTEM MUST DE INSTALLED IN COMPLIANCE Sewc,40e Permit number .............. WITH ARTICLE II STATE SANITA�Y CODE AND TOWN jOFTNETG TOWN OF BAR NTABLE BIBBSTOBLE, i 9� o pY',•0� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... •••..................................................................... ... �� TYPEOF CONSTRUCTION .................................. ................................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned reby applies for a permit according to the following &inmation: Location .......... .. . .:.............. v...........-1 •,�'....... .:...... ........ Proposed Use ..... &............................................... .........'.. ................ .. ....... . ...........................................................I......................... ZoningDistrict ................................. .......:..............................Fire District ... ... . ...................................... ............................ Nameof Owner .................. ...................................Address ..... ............................................ I� ...............1 Nameof Builder .................... ................................Address .................................................................................... r � Nameof Architect ..................................................................Address .................................................................................... Numberof Room ....:............................................................Foundation .............................................................................. Exterior .. .... ..........................................Roofing ......... r! .......................l,I........... ...... ........... leAe Floors .........................................................Interior ....... ..... ......4v ..................................... _.Heating. _...., . ......................................Plumbing ...........................:....................................................:. Fireplace Approximate Cost —3a/ ®a u�''� pp ........... ......../................. Definitive Plan Approved by Planning Board ________________________________19________. Area ...... 5. .0,.. ° ....:..... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding he above construction. Name1.4&:?.......Y..:...�. ................... Small, Alan �No __�24~pern�i {or ..poe ..story�___, � a�1 .. ' d�ell������.---.����--.-------. � ~ | �v� C1rcle ^~^~'^~A —'°r^---''^--------'----- | Centerville � .---.,`----------------..---- � ` . Owner .............Alao_8mall........................... _. ` ! . / Type of Construction --.. --_____. | ` � —~------------------------' ` Plot ...................... ...... Lot ..........#70............... � . 14 / March l5 76 > ' PermitG,onuad -------------]g ! Date of Inspection .u)"�'—]A ' Dote Completed .. .~) ^/----]A / \ . ~ PERMIT REFUSED ` } ----------.---------,. lV ^ | '`-----------'------------.— � . � ^—~.---.—.-------...----------.. \ ' ` + ' ------------....--.---..—.---.. \' . v ------`'--'--^--^^^—~—'''^'-----' ' ' ` Approved ................................................. lV ' � ' ' -------.--------..--,—.---..— / ________,_________.,~__,,,~,,, v � �` � Assessor's map and lot number .. ..........77n.:?.^+ Sewc4e Permit number ........... ..?......................................... }1 t"Er°�. TOWN OF BARNSTABLE Z HARNSTdDLE, i KAGL 9 , BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........1. :..... ..... t............................................................................ TYPEOF CONSTRUCTION ..................................................................................................................................... ..... .............. ..........19.. r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...................... ..:"'.........................................................................................:::............................................................. ProposedUse ........:.......:............................................................................................................................................................ ZoningDistrict ...............................Fire District .............................................................................. r �— Nameof Owner .................'.......................`..............................Address .................E.....:::........................................... ........... Nameof Builder ....................................................................Address .................................................................................... Name of Architect Address Number of Rooms Foundation Exterior .......... ...........!..'..::..........-..........................................Roofing , . .................................................................................... • L FloorsR ..................................................Interior Heating ...................................Plumbing r a Fireplace .............::...................................................................Approximate Cost ..................:................................................. Definitive Plan Approved by Planning Board ________________________________19________. Area ......:....................:.............. S Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................:............................................... Small, Alan A=L"--202 18234 on st ry, No ................iw,Permit for ................... ................ in sgle family dwelling� ............................................................................... ..................................... ................... M o n om o y Circle Location Centervi11e . .... . . . .... . . ..Owner ............Al.an...S.ma.1.................................... 1 / fame Type of Construction ........ .......................... ......................................... ..................... #70 Plot ............................. ....... PLA4 Rk�, R Permit Granted .......March...15.......)......19 76 Date of Inspection ...................../.........19 Date Completed ........... ..............19 PER IT REFUSED .................................... ........................... 19 ........................ .................................................. ...................................... ............................................................................... -44 Approved ...................... 19 ...................... .................. .................... q................................. t.t................... t BY la "' DATE SUBJECT SHEET NO. OF CHKD. BY DATE JOB NO. . .... I —7 O I i f� I h f �tN of� r �C>—'-,ATI Dt� TER.a/W-L- , A66 o BAXTER " No 2404111 �L A�J ���C---C 4"'�OISTSfk 41ok. p� s 4�—A4ovjO A CDT -10 } J CEeT/F',/ 7-1-M T r- E ,70IJ � q XT��. � AYE 61-10eVAI CIA/ Tr'V/.5 ,c1, AJ Ga v�o�'JS 7"v THE ?©,Vi,cL .G4GU5 0, THE P_E�r,Teee-�> 4&lc) jueve(CA vsq' t/l�l.e M A 710a-�,Q