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HomeMy WebLinkAbout0133 NOTTINGHAM DRIVE J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel D 9 Application # o?&"� 7 7D3 Health Division Date Issued Conservation Division Application Fee Planning Dept. ' Permit Fee 22 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address p-1��n r �M1)r 1'v e Village C 'tctei'YI l`e 33 Owner F_I een to.a D.5a Address 33 14&1I 4 ham vr_ Telephone 5 (� Permit Request D C o a S5 'J Y w/ ex Aavldll nG' FQQo J Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.- N Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's-iiL hway: 2 5Yesp 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 6 a 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 (BBUILDER OR HOMEOWNER). Name MXL IM Ak,5. Telephone Number 3 CDR 3 9R Address `D i +) License # [DaHlb 1 ar 01h . MA- 0&6 6 4 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO�I SIGNATURE DATE y.. r FOR OFFICIAL USE ONLY APPLICATION# J. _DATE ISSUED MAP/PARCEL NO. 4 ADDRESS VILLAGE OWNER F DATE OF INSPECTION: M urFO.UNDATIORUA-1 ic:rul FRAME - - - - INSULATIONS FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL h GAS: ROUGH FINAL t; FINAL BUILDING ti DATE CLOSED OUl f i ASSOCIATION PLAN NO. F, ''- The Commonwealth ofMtssachusetts Department of IndustrialAccidents. Office of Investigations I Congress Street, Suite 100 t Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg bl Name(Business/Organization/individual): Cape save lnc. _ Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check-the appropriate box: Type of project(required): 1. 1 atn a,employer with 4. 0 1 am a general contractor and 1 6. Q New construction employees(full andTorgart-time}:� _ have hired the sub-contractors _ ?.❑ 1 am a sole.proprietor,or partner- listed on the:attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have 8_ E]Demolition workingfor me in an ua acit employees and have workers' o y ' P y 9. ❑ Building addition [No workers'comp'.insurance: coup,insurance.* required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3:❑ 1 am a homeowner.doing all work; officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp: right of exemption,per MG 12.0.Roof repairs insurance required.,] t employees4[No d We sve no 13,.0'Other Insulation. comp.insurance required,]. *Any applicant that checks box#1 must also fill outthe section below showingtheir workers'compensation policy information. t Homeowners who submit this affidavit indicating;they are doing ati work and then hire outside contractors must.submi1 a nmrlaffidavit indicating such. Contractors that check this box must attached ail additional sheet showing the name of the sub-contractors and state whether or not thoie entities have employees: If the sub-contractors have emplove.es,they must::provide their workers'comp:policy number: 1 am art employer that is providing workers'compensation insurance for my employees. Below is the poticy and jobsite information. Insurance Company Name.: Wesco Insurance Company Policy#or.Self:ins.Lic.M. WWC3085613 Expiration Date: 04/09/2015 nnrr Job Site Address: 3 Lv D ( (�`v City/State/Zip: A,n f v i, I 1 l° Attach a copy of the workers'compens on policy declaration page(showing the policy aumber-and expiration date): Failure to secure:coverage as required under.Section 25A of MGL c. 15.2 can lead to the imposition of.criminal:penalties of a fine up to 81,500.00 and/ozone-year imprisonment,as well as civil penalties in the form:o£.a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be-advised that a copy of this statement may be forwarded to.the(Office of Investigations of the DIA for insurancexoverage verification. 1 do hereby certify,under the ruins and pen allies of Per' P that the in rmad n provided above is true and correct Sianature*1 Date `_ L phone#:_5Q9-398-Q39$. w Official iise.oidy. Do not write in dris area,.to be ediFipleted by eit}i.or to►vh.official. City or Town:. Permit/License Issuing.Authority(circle one)i 1.Board of Health 2 Building-Department 3.CitylTown Clerk 4.Eiectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone#: ,4co_ CERTIFICATE OF LIABILITY INSURANCE `MI�°`'' 4/14/20I4 THIS CERTIFICATE.IS ISSUED AS A"MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the.policy,certain policies may require an endorsement. A.statement.on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER: NAME:..T Colleen Crowley Risk an Strategies y" PHONE (781)986-4400 AIC No:(781)863-4920 Laig.15 PaCella 'Park.Drive n ADDRESS.ccrowley@risk-strategies.com Suite 240 '.INSURER(S)AFFORDING COVERAGE .-NAIC 3 Randolph M& 02368 INSURERA:Selective Ins. , of America INSURED iNsuRERB:Safety Insurance CompanV 33618 Cape Save, Inc. INSURERc Wesao Insurance Ca_mpany 7' D Huntington Ave INSURER D INSURER E': South. Yarmouth. MA 02664 INSURER.F: COVERAGES CERTIFICATE NUMBER:CL1441475243 REVISION NUMBER:- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED:.TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM.OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS'OF SUCH,POLICIES,LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS.. INSR". ADDL SUER ._.. ,POLICY EFF POLICY EXP LTR TYPE OF INSURANCE- POLICY-NUMBER -MMIDD . MMIOD LIMITS GENERAL LIABILITY EACH OCCURRENCE: <$. 1,000,000 X COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence) $ 100,000 A CLAIMS-MADE Q OCCUR S1994480 0/16/2.013 0/16/2014 MEDEXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $. 1,000,000 GENERAL AGGREGATE $ 2.,000,000 GENI AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY X PRO- X ,LOG __ $ AUTOMOBILE LIABILITY Ea S-INME I NGIMI 1,000,000 BIx ANY AUTO BODILY INJURY(Per person) $ ALLOVYNED X SCNECrULED 208700 1./6/2013 1/6/2014 BODILY Peraxident $:AUTOS AUTOS.. - I ) N NON-OMED PROPERTY'DMAGEHIRED AUTOSAUTOS $ X UMBRELLALIAB N _. .. _. .. ... OCCUR EACH OCCURRENCE' $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 [7ED RETENTION oil S1994480 0/16/2013 0/16/2014 C WORKERSCOMPENSA7TON Officers Included For wCSTATU- OTH- AND EMPLOYERS'LIABILITY Yi N X OR I S ANY PRGPRIETORIPARTNERIEXECUTIVE Coverage E.L.EACH ACCIDENT $ 500,000 OFRCER1MEMBER EXCLUDED? N❑ N IA (Mandatory In NH) W4C3095633 /9/2014 /9/2015 :E.L,DISEASE-:EA EMPLOYEE $ 500,000 nyes,describe antler DESCRIPTION OF OPERATIONS below, E.L.DISEASE"-:POLICY LIMIT $ 500,600 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(Attach ACORD:101,Additional Remarks Schedule,if more space is required)' Issued as evidence of .insurance. Issued as evidence of insurance. Th elsch Engineering, Inc. is- listed ,as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION ID3ongl3capelightcompact.,Org" SHOULD ANY OF THE ABOVE DESCRIBED.POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED' IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact Attn: Margaret Song PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195.Main Street Barnstable, MA 02630 � chael .Christian/CLC - ACORD 25'(2010/05)' p 1988-201:0 ACORp CORPORATION. All rights reserved. INS025(20I005)o The:ACORD;name and logo are registered marks of ACORD UP Office of Consumer-Affairs acid Business Regulation 10 Park Plaza -,Suite 5170 Bostogi Massachusetts 02116 Home Improyemerit COntract6r Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Trlt 249649 CAPE SAVE INC WILL-IAM McCLUSKEY 7-D HUNTINGTON AVENUE " SOUTH YARMOUTH, MA 02664y Update Address and return cards Mark reason for change. SCA 1 cJzoM-Dent. Address Q Renewal -Em ployment >Lost Card ❑,.. . VfLC i(iO�gUl7t4i/tt!l6Cl.LLf2.4�V!/GCIJ:IfGCf"a'i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT.CONTRACTOR `before the expiration date. If found return to. egistration: o 171380 Type: Office of Consumer Affairs and Business Regulation Expiration 3%1- h16. Corporation O.Park Plaza-Suite 5170 r g- s' Boston,MA 02116 CAPE SAVE INC. WILLIAM MCCLUSKEYt� # 7-D HUNTINGTON AVENUE SOUTH YARMOUTH MA 02664 Undersecretary Not vaIi ithout signature j Massachusetts -.Department of Public Safety �✓ Board of Building Regulations and Standards Construction SupenisorSper�alh License: CSSLA02776 WILLIAM J MC C;�USKE `% 37 NAUSET ROAD West Yarmouth 1qA 0 7r3 r I \ Commissioner 06/28/2015 I Housing ®� ® Assistance Corporation Cape Cad HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. , I hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency" ) on 'tie property located at: . 133 N Cen-l-ery i The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1: I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I ve read the provisions of this agreement as listed and freely give y consent. me Owner: (Signature) t Date: 62 1 Agent: (signature) Date: f Cape Save Inc. 7-D Huntington Avenue Isf' ; 2 9 f sf ltT South Yarmouth, MA �f 4 02664 AV ..,��� Tel: 508-398-0398 Fax: 508-398-0399 8/23/12 `l Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 133 Nottingham,Drive, Centerville has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 cellulose Basement: R-19 fiberglass in box sill& 2" Thermax on foundation walls All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable *Permit# Expires 6 months from issue date X.PRESS PERM'*rRegulatory Services Fee 3 2007 Thomas F.Geiler,Director Q 7/2-3/6-7JUG. 2 Building Division TOWN OF BARNSTP%6$erry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 C) Property Address l3� nd o C�� � `�i OZb 32� esidential Value of Work C Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1 e—fY\ Contractor's Nam )C L r�G�1. 1� Telephone Number �, S' IY Y_R)e) Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: PIam a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# t' t" ;4 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over / existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 _* The Commonwealth of Massachusetts �M 1 Department of Industrial Accidents _ Office of Investigations d ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Legibly ------. ► 1 A � -� �----�N� ame,(Buss/Organization/Individual): � e� P()&5fi ' Address: -; r r�r 6,21e a— � d Ili, �.w>,.��'• 2 n � � Q. L_ City/State/Zip Q,7 =I O P_63 Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the stab-contractors _, 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp,insurance.$ 5..❑ We are a corporation and its 10.❑Electrical repairs or additions am�a-homeowner doing all work`< - officers have exercised their 11.❑ lambing repairs or additions .a right of exemption per MGL i my§elf [N,o workers, comp r 12 Roof repairs ut .� s. c. 152, §1(4),and we have no msuranceaequired:] 13.❑ Other „employees. [No workers' 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.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 Investi¢ations of the DIA for insurance coverage verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct" Si'nature: Date',J Phone#: Official use only. Do not write in this area,td 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#: Informnation 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 e re a to of the foregoing engaged in Joint enterprise,and including the l gal p resentLves of a deceased mp y er,or the receiver or trustee-of an individual,partnership, a sociation or other legal entity,employing'/employees. However the owner of a dwelling house having not more than , ee apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repa' work on such dwelling house or on the grounds or building appurtenant thereto s not because of such employment a deemed to be an employer." 152 25C 6 also states that"every st to or local Iicensing agency sh withhold the issuance or IvIGL chapter ,§ ( ) renewal of a license or rmit to'operate a business or to construct buildings in a commonwealth for any applicant who has not roduced•acceptable evidence of compliance with the' urance coverage required." Additionally,MGL chapt 152, §25CO states"Nei 1 r the commonwealth nor y of its political subdivisions shall enter into any contract for. a performance of public rk until acceptable evide ce of comp?iarice with the ins�ance requirements of this chapter ave been presented•to the contracting authority." Applicants Please fill out the workers'compe ation affidavit co etely,by checking a boxes that apply to your situation and,if necessary,supply sub-contractors)n me(s), address(es) d phone numb s)along with their certificates)of insurance. Limited Liability Compani '(LLC) or Limite Liability Partne ships(LLP)with no employees other than the members or partners, are not required to arty workers' c peeration ins ance. If an LLC or LLP does have employees,a policy is required. Be advise that this affid it may be sub 'tted to the Department of Industrial Accidents for confirmation of insurance cov age. Also b sure to sign rid date the affidavit. The affidavit should be returned to the city or town that the applica n for the p t or licen a is being requested,not the Department of Industrial Accidents. Should you have any ques ns regar g the law r if you are required to obtain a workers' compensation policy,please call the Department at a numb r listed be ow. 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 legibl . e epartment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Invest! us has to contact you regarding the applicant Please be sure.to fill in the permit/license number which will be us s a reference number. In addition,an applicant that must submit multiple permit/license applications in any given -ar, ed only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" lica the n hould write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or k6d by city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits r h eases. A ne affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pe t no related to any b iness or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT re ' ed io complete this affidavit. The Office of Investigations would like to thank you in advance fol your c operation 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 ofkawachuis' s Department of Industridents Office of Investls 600 Washington Boston, MA 02111 Tel. 617-727-49QG ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 www.rnass.gov/dia OF'THE r Town of Barnstable Regulatory Services 1ARNSTABM Thomas F.Geiler,Director � MASS. A Building Division iOlEp�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 7 `/ -2— �✓/,-7 JOB LOCATION: tr!)-3 C1ey1 k)r_U I' 1� number streeet village "HOMEOWNER": J7d 576 6 name q home phone# work phone# CURRENT MAILING ADDRESS: 1 �D �j LLp ff� city/town state zip code i 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.BuiWing Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 ict 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 .. .L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION R Map Parcel -ECG T' a6 Permit# �? �- Health Division 2 Date Isued Conservation Division Z° `�`1 Fee . 030 Tax Collector - t/�I�� Rio 1 �/,,;� BE SEPTIC SYSTEM MUSS' Treasurer ° x INSTALLED IN COMPLIANCE Planning Dept. WH TITLE 5 ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Preservation/Hyannis Project StreetAddress A)b zlg 66pom (U� Village i t ® 6uvw �e�e+c: 1 r Owner ��[ �-t% gags_ G.-b4NAddress 1.33 /�J® /Ar_/fjgm-2)R. OVi lk Telephone02�' 1 Per it Request � � K e w.l I/r 6 i•) � e 1 e i �S e Si� �== 011dof S fiN ,1 NI Akre of- & u Square feet: 1st floor:existing ,proposed 2nd floor:existing proposed Total new Estimated Project Cos ' Zoning District Flood Plain Groundwater Overlay Construction Type _=J k ftJA4 &r Lot Size l J, 6n r4Grandfathered: ❑Yes ' 2"No If yes;,attach supporting documentation. Dwelling Type: Single Family Gd/ Two Family ❑ Multi-Family(#units) Age of Existing Structure_ - SV Historic House: ❑Yes [4o On Old King's Highway: ❑Yes W fWo Basement Type: iKull ❑Crawl ❑W//alkout ❑Other Basement Finished Area(sq.ft.) T Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing -3 new Total Room Count(not including baths): existing �P new First Floor Room Count Heat Type and Fuel: J ❑Oil electric ❑Other Central Air: ❑Yes 9<o Fireplaces: Existin 1 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 0 Appeal# Recorded❑ Commercial ❑Yes p'No If yes,site plan review# r ` a Current Use Proposed Use 09,0ked • - BUILDER INFORMATION C -*m Name l�IP/moo ) X✓Wi26t2�/h6ttTelephone Number Address AP qs- MeaQu-4JAJ • License# r7d`I M4 T'a ✓ II _6" Home Improvement Contractor# l d 0`7Z14 ' Worker's Compensation#' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S - SIGNATURE _V_JqZaA, DATE FOR OFFICIAL USE ONLY, t PERMIT.N_ O. r - :fK- r: ..a `• ,•. �- ..' � . _ .. < '•'_ ._. DATE ISSUED x. 1 •, - _ _ = . i MAP/PARCEL NO. , ,'` ,✓., p ,r *'• - ,''` 5 ' ��`A ' � + 4 f•t '.• ��'1 r,' ' r..< • , !"` �� +•�'. x 1.5 - - '" t�� _ - � �,I ::'• r,+ 1 y j ADDRESS.. {; �'' sad } > ,,VILLAGE; OWNER r X r 't ( ! 4. DATE OF INSPECTIO FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINALS s•rn, r r PLUMBING: ROUGHS �» FINAL GAS: __ ROUGig [3 ^• FINAL r.. 4 - > `• ' �. FINAL BUILDING't -- a w § � m ".s {'� T t •.f .r 'rsi� I Y ; r Y - ' e, -! »k .� < t� 4 r i �Y� � - ♦ Al; DATE CLOSED OUT a 1 µto e t ASSOCIATION-PLAN NO. ;+1 , 3 x x �Im r The Town of Barnstable . �rww r • 9 & Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 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. L Work: W I Gt, -C�rll T Est. Cost Type of .�� � � l l4 5(l jiV61Nn in V WC dC�i c0,L Address of Work: .1 x a T/M&tin= Owner's Name : Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 51,000. 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 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. _ell P /IZ , OR Date Owner's Name ---A' CA . Vy -- t� ,NA rro� MA[ANE- TIJ/'l NfD� 778�667/� 19�4 11r r' i n4 r , _.___i1y��=��11_.._ - ._....... _Fuv.NsrtLloAl 7(:/,n't•'':. i'I-�rl Moo y. f s(MALT$_cor I ♦ /tLT I> mAwe Z" OJ t rZ �a"Lr� r Y• —--_. . . _ .. _- - _----- ff - >)Wyl �IDutG 4T71J.I-M47C4 Vl �Y �T IxL /x] gJpon RAKE A NVM8t2 j C_^1•r __ _..- (L £_ Ixv Iry I Ix8+�i3y�Tl1 WOOD _ .. .. o1'TRIM I70OR f W IJfuU ♦ I - 1�' rl/�IJI.ILU BUTT/T-tx JT.ALUM/VIU�•L JJ L� txxjr/aL- eJ iIJ U ���_ ill y i iK , A' /in�u♦D 1?H 7RIE Lr WOAD MA rut .. x '* __o a'a x v voP PLAT E/ I, •e c; Ax4y6JN,.�., �.,/,.5..ivUs y- 7 AMo lukAf) o vI.Q. l P S � T .1 � t � lx4 ♦IIpE W C�x 1/N L '//�•'I'/A)r�I+LD I,I A' JA♦?LC'Nllo £:v'I.fit.H.I:. ` r dnNft/l�O( �,1/230 r,L�T dxEY C/b"�• n�.J✓ LC .v Asses. or's ma and lot number ..: .... ...... ............ _ p SEATIC SY�'T 1r�.�T7aI`L �,��� MT BE WWI a#-i SO �'€.l41�E Sewage Permit number .................. .................................... 194M c Q�oFTNETo�♦ TOWN OF BARNS . .: .W.:. : i BARNSTABLE. "6 O MP BUILDING INSPECTOR O•E '7 Ar• r i, APPLICATION FOR PERMIT TO ................?.c:.fXP.ry./. '...... �' .C??r. ....................... .................................. TYPE OF CONSTRUCTION ..................7...i- .t? .. ......................................................................................... ........ /'!../..... ..............19.2c TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: >J Location ........L'©..�. .. ........../l .: . ./../....f ..�/. f! .....l��i.G�!.�. k l �` ProposedUse ......:... .�` 'fir ./ice...... L./j...... ................................................I......................... r Zoning District ............... .......Fire District .............................................................................. Name of Owner ... } %'f ..... .e;::/i'?..�./+4� .F'l/....Address ..t .. .............. ..r5f.:.k�... `...r p(lie'.f.ne.. �S$- Name of Builder .::�rf�. (. !..�. ..!.�.d ?'IIe�.- Address ..f.. .1....`���!Lt/ Z✓..I ..�. .t.S... '" 'os1lS •t 4 Name of Architect .............: ~:.Address, +, Number of Rooms . ...Foundation ... d v �..�' d / t .......,:... CI.. .G... �.... i.. Exterior �.1..!!✓J,l��. .................Roofin ?9 .�. ,..... 7. T !�.liP.. �. g ......... . �! r � / Floors 41 � � J.�ss.ar:�t`�i..�.. Interior ........�c3............ .�.:e.��.�_"�t,l. :........'...... . �. ............ S <. . Heating / /— a .....Plumbing ........... �A.G...... i Fireplace ....... .33--:.(..:r-..A...................................................Approximate Cost ........ ..� ............... Definitive Plan Approved by Planning Board --------------------------------19-------- Area ....1..a�.o. .... 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 ........... ..... . ...../,4•'•• .................. . ........ Simonelli, Bart No 17651 Permit for ...one,•s.torX_, ..............ing A family,..dwelling.................. Location ........194tt. 1Rgh.4rA..Rx ve.................... I hereby certify that the fireplace chimney base is on a tenteryx�.�s............................... solid footing in accordance with Owner ..........�Daxt...S.LIAMeIII......................... fireplace standards and said ° fireplace meets State Building ' Type of Construction ...........frame.................... Code specifications. ................................................................................ - #106 Plot .......................: lot ................................ ✓Mason 's Permit Granted .........April..22............19 75 fitness 1 Date of Inspection ....5/ ...................197 Date Completed ......................................19 Z � ................................................................ 19 3 ................ ........................................................... ............. ....... .... + .............................................................................. ' Approved ................................................ 19 ...................... ........................................... ............................................................................... 4. rLl__-__ -. 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'f � , } ,n' y11 Nf _ � k r LEA H-I AIA I"f �A {000� Y:E`i4C": IC P'd7 I 7� �, {i"} x`wy >i?�*Mso 000.04 fo �EiPTai 1®'K ,�� � ( #f". fa��g j'@S �an4 � Yt" I { 4. 3.e.X f4 5Y._ f E j 6 JH ,D ®(y /JCNi�'''® I _ T��•�I'! /'F @' '!4+'iT' ��.>P�^' a t4 y - a i 9Mstop ;,, { 4l aa�?*I 1"OF a a 4V S OO O® 1. N ti, f f Y'l, k f4 1 Y: ll.M M1 :F 3: r ' a� r�c f x { ' t 'F,,p .]�F Y j[ Yk 11 _ u h `l. Y Y fir' Lar I'mf I y +a �J Y,a 'i J�*k, •:- . i �JI ' ,� j �o� R�)E cN{, , *. v . .. v 9UN(KIS r d ��4 A p NOS 22152 0 - . F w �E4k a (y�SiEP��=�t # F.�a L y Y 'il A` 1it; ry T !f Y } ' L _ rr 44 - _ `:1.,n _� y tY ^ i 1� Y � __ ___ :i' T.- '.• _:..—.. _ + .. yr 4 .... �.. .. ;E PLOT PLAN SHOWING IN BLOCATION OF BUILDING I CENTERVILLE A R N STABLE MASS. FOR BART SI M 0 N E L L I { SCALE. I = 30, OATE'APRIL 15 1975 ` CHARLES N. SAVERY INC. REG. C.E.a L.S. 712 MAIN ST. HYANNIS , MASS. 131 140 141. I0o,00 LO7 I O G 15, O O O S. F: o 0 0 0 2 2i + ! OT 2l- 105 CONC. FOUNDATIT4 : ' 20.5- So.o, 29.5±1 1n +o 4 1 Lc), I I f j 100. oo• f NOTTI NGHAM D R I V E I { .>+ �. I `te;e�Dv Certifv ^f that t`1E 4uliaina FAi�fs � �'t the ground a^ S!aa�n on this ray a; sq.. IS t t!1Q tmning v, re Ilemerts of the 7ow,� NJ. 0, o t Ba S 942C �h table, _ registered land Surve1►ot -•--� THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE. -I 55 o