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I 1. ;.. ,, .y. ,.y e':. p. . . , .�.r.,y7; x _I - !`1. �'" 9''s R ° -. 1. ) .?' 1. 1. �� r` 3'"itF':: vnyi'�'F } - '11 A'.3' , R Y. .'S''',+ 11 . �:A7 t+.'*1. i tom' ,;1.,4 :.}} .. a V : . a 1. - - A _ „ : i`` " _ ,. _ _ „ , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P� T3�4�I�� F BARNS TABLE Map Parcel Q7 Application #g dl — O Health Division ;- `� , ; -6 M 2; 7 6Date Issued 4Fl/o Conservation Division ��� .Application Fee Planning Dept. �, ��� Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 3 ` ( t� N e Village eti�� V -�- Owner Address 3I 6Uat- we7 Telephone 6 O 7 7 /rJ Permit Request & A e f`l �xl q� Oct ck w:-d c% a4n � to `� uer .t) rg j Je— `ecti Gd �A=7; Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation*9&60,aC' Construction Type Ac k Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family r� Two Family ❑ Multi-Family units) Age of Existing Structure So 7 k eS" Historic House: ❑Yes M No On Old King's Highway: ❑Yes U'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 Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ Name 4© 'el— Telephone hone Number �Oe ° -,0 - g � y{ p be ��3, Address / ( Sok A caS� &lv,-e- License # CS -0 7Z Cep fee-v,l/ Al51°. pa-c2 Home Improvement Contractor# 133 77S Email ►'b Co X l`� P Co rn cc�Y -e Worker's Compensation # AJb ellib'o y e eS ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 3 DATE � /S a 1 FOR OFFICIAL USE ONLY u APPLICATION# -! DATE ISSUED I• MAP/PARCEL NO. ` ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL k FINAL BUILDING L� t rd DATE CLOSED OUT ASSOCIATION PLAN NO. f • . Depa�ien�nfJiu�ustrzglAccidenf� . - . Office ofInvatigafig= 600 WiTsAhzgtan Street BostO74 ffA 02HI • xnvtv_mar�gavldia Workers' Comp ensa ion Insraance Affidavit:BmZders/Contractors/Mectricians/Pl=hers Applicant Information PIease Print Ise gibly Name can: /o CO x (, , Elie Address: � JCT�C�•C�� / �I�7 � r - CitY/ zip: Phone#: Are you an employer?Check the appropriate ban Type of project(regmred): - I.El am a employer with 4. ❑Z am a ge�eaal canfractnr and I - Ioyees(faII and/or pale tie). have hired the sab-contactors G. ❑Nevi construction - 2 M I am a sole proprietor or parim r- listed an the afiached sheet, 7. ❑Rmaodeaag ship and bane no employees' 'These snb-c bave 8. ❑Demolition W n 1 i.I g far me in my capacity.. employees-and have workers' [No workers'comp.inarn-ance comp.incnrrnoe•# 9. ❑Building addition required.] 5. ❑ We are a coip6radon and its 10.❑Ble Eml repairs or additions a racers have exercised then 5.El am a homeowner drying all work� 11.❑Plumbing repairs it additions myself[No workers comP right of exempttinper MGL 12.0 goof repairs in�e �ri rem� ]f 152,§1(4),andwe have no employees.LNo workers' 13.❑Other . camp.imnrmce required] *AuyapplicanY tba±ch=Im box#1 mustalso M out the sxtfon below showing thcswui5='compcmafion policy mihrmation. t Hnmeawnas who submit this aidavit in icafmg they arc doing all work and then hire outside copbactoa mast sobmrt a new affidavit mdicatlng soclL $Coffins that check this bus mast affachod an additional shmtshowing fhe nzmc afthe sib-c=±mcfar,zndsb&-vA=fficr or not these c3i itics have employers lEthe snb-rnu]acfoa bave eupIvy=:s�they mustprovidc their wows'pomp.policy numb¢ lam an Moyer that is pravuEng workers'cozzTeasafon insarance for fizzy e7npIoyecs Berow is tke po&cy arzd job szfe inforrrrafion. . - - Insurmce Company Name: Policy#or Self-ins.Lic.#: FxpizatianDate: lob Site Address: - CRY/ : Attach a copy of the workers' compensation policy decIarafion page(sho�g the policy nu aber and expiration date). Failure fn sectae coverage as required uoder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a ime up to$1,500.00 and/or one-year hnprisonmexLt as weIl as civil penalties is the farm of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this stafsment maybe forwarded to the Office of Iuvestigati.ans of the DIA fir;n Sarncp coverage verification. I do hereby the pains and ender ofperimy tl&&a information provided above is true and correct Simat�e: Dam: 3 aT_dJ,S` Phone Of Zcial use only. Do not write in fits area fo be completed by city or town offirluL City or Town PermiFlL,icense 9 Issoing Authority(circle one): L Board of Health 2 BnildimgDepartcaent 3. CityTown Clerk 4.Rl=tdE2IInspectcr S.Plumbing Inspector 6.Other Contact Persia• Phone Information and Instructions A�asmalmse is C=era.Laws chapter 152 reqires alb employers to provide WOIkers'Qom MS,260n far then employees_ Pursuant to$sis start,a a empIoyea is defined as"_every person in the service of awfhzra under any cardzacE of hire, express or implied,oral or wr$ten." An ea Play er is defined as'an individita.l,padmmrshig,association,corporation or other Iegal w0y,or any two or more of the foregoing engaged m a joint enterprise,and iachding the legal removes of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,euphrying employees. However the owner of a dwelling house haying not mole 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 becanse of such empl�ymeut be deemed to be an employer." MGL chapt-er-152,925C(6)also sues that"every state or Iocal licensing agency shall withhoId the issuance-or renewal of a license of permit to operate a business or to construct;bwldiatgs in the ca unonWealth for any applicant who has not pro dnced.acceptable evidence of compliance with the incur-.nice coverage required." Additionally,MGM rhapter 152, §25C(7)states`Neither the commonweahthnor arty of its political subdivisions shall enter into aay conSxacEfor the performance ofpublic wozk until acceptable evidence of compliance with the inc nce re� e =ts of this chapter have been presented to the cant acing anthorhy." Applicants Please fiII out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone nmmber(s)along with their certificates) of i asura„ce. Limited LiabEity Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequir-d to cauyworl-,=' compensationm nce_ If ao.LLC or LLP does have. employees, a policy is required Be advised that this affidavit may be submitted to the Departmert of Industrial .Accident for conflunation of insurance coverage. Also be sure to sign and date The affidavit The affidavit should be refnmed to the city or town that the application for the permit or license is being requested,not the Department of Industral Accidents. Should you have ray questions regarding the law or if you are requited to obtain a workers' - compensation policy,please mUlhe Department at the nmmber listed below Self-insured companies should enter their - self-insdrance license number onthD appropriate line.' City or Town Officials Please be sure that fie affidavit is complete and printed legiibly. The Department has provided a space,at flee bottom of the affidavit for you to f Il out in the event the Office of IuvesS.gations has to contact you regarding the applicant Please be sure to fill in the pmmidliceuse number which will be used as a reference member. Iu addition,an applicant that must sabmif multiple pennh'llicense applications in any given year,need only submit one affidavit indicating cun-ent policy infozmaliou Cif necessary)and under"Tob Site Address"the applicant should write"aII locations in (city or town)_"A copy of the affidavit fiat has been officially stamped or marked by the city or town maybe provided to tho applicant as proof that a.valid affidavit is on ftle for feline 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 aomm ercial venture '(Le.a dog license or permit to bum leaves etc.)said person is NOT regrm'ed tri complete this affidavit The Office of Investigations would lilm to thank you in advance for your cooperation and should you have arty questions, please do not hesitate to give us a call. The DeparlmenYs address,telephone and fax Thu CommQrti�ealth.of M=ach=t s - Deparfmmt of In&ofdal Ac cUdmt; QMM of Itavmt tim% 6O Wad Sf=t _ Boston,NSA O�1 lI - ` a if 617=727-49GO et 406 or 1-U7 I�-SS Fax 4 617-727-774 L Revised 4-24-07 � �Wdia �TKEr, ti ToNM of Barnstable o� ` Regulatory Services F • + F 9 MASS,�$ Richard V.Scali,Director 9. " Building Division Tom Perry,Building Commissioner 200 Main Street;Hyai is,MA 02601 www.town.b arnstable.ma.us Office: 508-862-403 8 t Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize iec 2 Q( Cx to act on my behalf, in all matters relative to work authorized bythis building permit application for. -g..We I-S (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. ' Sig4gx&A Owner,.• Signat&of Applicant Print Na= Print e a l Date QTORMS:OWNERPM MISSIONPOOLS i Town of Barnstable Regulatory Services �oFT roiy� Richard V.Scab,Director BuMing Division • 4 E t MA-IWSrABM Tom Perry,Building Commissioner pQ� 1 ,a� 200 Main Street; Hyannis,MA 02601 CFO www.town.barnstable.ma_us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICEIQSE EXEMMON PlcascPrint DATE: • JOB LOCATION: number street village "HOMEOWNER": name bomc phone# work phone# CURRENT MAILING ADDRESS: cityhnwn state rip 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. DEFIIdITION 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 ofBamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature ofHomcowncr Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger w17I be required to comply with the State Building Code Section 127.0 Construction Confrol. 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 persoru(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:IWPFiI.ES\'FORMSMbuildmg permit f=s\E3tPRESS.d0c Revised 061313 R C ZONING _ , ONE ACPE A,REa -Y- RSSv^aef-j LLi7 z0' FRONTAGE y, P'`.0'- C7 �L /00 WIDTH Itc =r, G, Q 20 FRONT SETBACK TO aY ...� lO SIDE REAR ��: �-sc yam. G.G. `foig •ter.\7) Al ZO7 Sze, LOT 5Z n° E 86�t_'_____ Zor S ,w PF P.rKGe o ZoT nG4 r07 ` / 32't dT /G,you N 49° 3 4 ' 40. W i CERTIFY . THAT THIS LOT /s Nol . b_j I =0 INTHE . ivc�- Y�EaR LOOD .PLAIN AS DEFINED By THE H.U:D. FLOOD INSURANCE j_�;� FOP MORTGAGE' PURPOSES g ;yH OF .: Erg ," PATE MAP NO. ,�,� -- - CERTIFIED PLOT PLAN ?SOOI- 0020 8 . rFc s. �':` LOT 14 N. W, LANE }�� ,GLD''E _c irL _ L COcJ2 T 3 3 �f(o!o A �A FpsIST L LA CENTEP VILLE" BARNSTAB E M L ,, Date Su r ve tulor SCALE=I 401 o A T E _ .S- i4-86 ELDREDGE ENGINEERING CO. CLIENTRN I CERTIFY THAT THE DWELLING ESISTERE!) REGISTERED SHOWN ON THIS PLAN IS LOCATE, CIVIL I LAND JOB NO.86� ON THE GROUND As INDICATED AND ENGINEER [ SURVEYOR DR-. G'F= _ ' 'IV � OFBPNSCONFORMS TO THE ZCNtI�AWS �------- o F E3,4 TA LE', �A s N� 712 MAIN ST. CH.BY4.- 2$E HYANNIS, MOSS, SHEET OFbAtE RES. LAND SURVEYOR Details Page 1 of 1 Licensee Details Demographic Information Full Name: ROGER T COX Gender: Owner Name: License Address Information Address: Address 2: City: CENTERVILLE State: MA ipcode: 02362 Country: United States License Information License No: CS7073885 License Type: Construction Supervisor Profession: Building Licenses - Date of Last Renewal: 2/24/2014 Issue Date: Expiration Date: 3/12/2016 License Status: Active Today's Date: 8/10/2015 Secondary License: Doing Business As: Status Change: License Renewal Prerequisite Information No Prerequisite Information Discipline No.Disci line Information Documentum r http://elicense.chs.state.ma.us/Verification/Details:aspx?agency_id=1&license_id=26283.5& 8/10/2015 `� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only . _.. G} —,aHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 133775 Type: Office of Consumer Affairs and Business Regulation J r Expiration:. 8/7/2017 Individual 10 Park Plaza-Suite H70 Boston,MA 02116 Roger T.Cox Roger Cox 19 Southeast Lane �:�•., .,... .,,,;..:._ Centerville,MA 02632 Undersecretary of valid without signature Massachusetts-Department df PubRc Safety , �8J $oardt`of Building Regi7latiorTS-191 ii`Sfandards Construction Supers isor License:CS-073885 ROGER T COX� 19 SOUTHES T CENTER ?> ?✓ �' f`I Expiration Commissioner 03/12/2014 i i { i - 1 - i 1 j i t i z i i F Y t gem f !t Uq 1 , 8 1 e � , F f t s o � � -Y r' +r� h y `� e , 5 5 x _ • � , • f"k' l•i �.� " r"�.x '• " 4!' ` . . � •, . '• µme . � � �,,� , , r