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HomeMy WebLinkAbout0243 NOTTINGHAM DRIVE a a Po f u Application number ../1...-11 ....... CC Fee.................................................... .................. ...... n �, ; SUN 27 20 Building Inspectors Initials............... ............. ..�, r►�' ® 9 n ff��LL Date Issued...`Y.... ..............7............................. AISIABLE Map/parcel...)..7.......... ....................... TOWN OF-BARNSTABLE -- --- - -- _ EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address-of Project: &Zl' Vie- NUMBER. fJT��GI� S VILLAGE Owner'_s Name;; Q Phone`Number_�f Email Address: (�/� ��ell Phone Number✓ /_ Project cost$ Check one Residential;^v� Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF-WOR10 7Z� ' © Siding b??Window�eader change)# E-1 Insulation/Weatherization ED-Illoors(no header change)# 07 Commercial'Doors require an inspector's review Roof(not applying more than 1 layer of shingles) . Construction Debris will be going to 61,�Y,�Psz:Gk 00" CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) i Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents Only* , r'_M Date•Tent'(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION -. Homeowner's Name: ::L/w �� � Telephone Number � / Cell or Work number. I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the T of Barnstable. Signature Date /0'� l/ APPLICANT'S SIGNATURE Signature � / Date Gf � All permit applications are subject to a bui ding official's approval prior to issuance. The Commonwealth of Massachusetts -Department of Industrial Accidents - Office of Investigations 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 7 �_ AV 5Z r.� Address: a17 .G� y City/State/Zip: /V Phone#: / A� � 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 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 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 working for me in any capacity. employees and have workers' • ❑# 9. Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical re airs or additions r ired.] 5. ❑ We are a corporation and its P 3.V am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions 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.❑ 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. 1 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: k 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 certify un r thepains d ,en ties of perjury that the information provided above is true and correct: Si ature:� Dater (Phone#)- Official use only. Do not write in this area,to 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' co ensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of an er under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or ther legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal represents ves of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal enti ,employing employees. However the owner of a dwelling house having not more than three apartments and who re des therein,or the occupant of the dwelling house another who employs persons to do maintenance,constru 'on or repair work on such dwelling house or on the groan ; or building appurtenant thereto shall not because of such ployment be deemed to be an employer." t , MGL chapter 152;§25C(6)also states that"every state or local licensi agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct uildings in the commonwealth for any applicant who has not produced acceptable evidence of compliant with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commo ealth nor any of its political subdivisions shall enter into any contract.for the performance of public work until acc table evidence of compliance with the insurance requirements of this chapter have been presented to the contractin authority." Applicants Please fill out the workers' compensation affidavit completel ,by checking the boxes that apply to your situation and,if necessary,supply sub-contratoi s)name(s),address(es)an hone number(s)along with their certificate(s)of insurance. Limited Liability panies(LLC)or Limited iability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' co pensation insurance. If an LLC or LLP does have employees,a policy is required. Be vised that this affi vit may be submitted to the Department of Industrial Accidents for confirmation of insuranc- coverage. Als 'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the ap 'cation for t-e permit or license is being requested,not the Department of Industrial Accidents. Should you have any estions yegarding the law or if you are required to obtain a workers' compensation policy,please call the Departme at th`e number listed below. Self-insured companies should enter their self-insurance license number on the appropriate ' e. City or Town Officials r Please be sure that the affidavit is complete and"rmi \TheDe'bly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event t,e O estigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number will b used as a reference number. In addition,an applicant that must submit multiple permit/license application give ear,need only submit one affidavit indicating current policy information(if necessary)and under/`Job Sitess"the plicant should write"all locations in (city or town)."A copy of the affidavit that has ben officiaped or m ed by the city or town maybe provided to the applicant as proof that a valid affidavit is p n file for permits or lic ses. A new affidavit must be filled out each year.Where a home owner or citizen is optaming a l or permit not re ted to any business or commercial venture (i.e. a dog license or permit to burn leavgs etc.)said is NOT required complete this affidavit. The Office of Investigations would like to thank youance for your coopera n and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone afid fax number: The Commonwealth of Massachusetts , `Department of Industrial Accidents Office of Investigations 600 Washington Street y ... Boston,MA 42111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727.7749 www.mass,gov/dia Town of Barnstable *Permit# 6?60 1? Expires 6 months jrom issue date �� � PERMIT Re ulator Services Feed S� 60 g Y SEP 2 1 2007 Thomas F.Geiler,Director Building Division Cag1Z7/07 TOWN OF BARNSTABLE ' Tom Perry,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 ZI 6 l<1�_ Property Address y 3 AlQ /lf (, � eO06 iC Residential Value of Work Minimum fee of$25.00 for work.under$6000.00 Owner's Name&Address A1,E ` a 5�3 wag;< ,-Yt4 D@/�c/i ,, a Contractor's Name lG oL�� O Telephone Number Home Improvement Contractor License (if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor © I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �,V S lr1 ��� d-tt ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: erty Owner must sign Property Owner Letter of Permission. A y of the Home Improve nt Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations . 600 Washington Street Boston,MA 021I1 ' www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/PIumbers " Applicant Information Please Print Legibly Name (Business/Organization/Individual):. j i Address: r-2 7Ll f it S X a_ City/State/Zip: � ���'lC - Phone.#: Are you an employer? Check the appropriate b x: Type of project(required)red):. 1.❑ I am a employer with 4. I am a general contractor and I employees (full and/or part.time). * have hired the slrb-contractors 6 New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' insurance.$ 9• ❑Building addition o workers'comp. insurance comp. equired.] 5. ❑ 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.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL insurance required.] t c• 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' A3.0 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. lContractors 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 Piave employees,they must pravidb their workers'comp,policy number. lam 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 tip 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 da against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi atio the DIA or insurance coverage verification. 16 her y certify a er the alms d a al 'es ofperjury that the information provided a ve is ue and correct Siena Date:471 Phone #: FOther only. Do not write in this area,'to be completed by city or town ociaL n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector S.Plumbing Inspector son: Phone#: SEPTIC *STEV7M—UST ��� a INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE AND TOW11 BA1TI TOWN OF you THE T�� STAB L E Q y j BABBSTABLS, i ' e 9� 1639. BUILDING INSPECTOR 5 APPLICATION FOR PERMIT TO "* d ,5. P .`.......0�1 G.:... .ra.r .t.�rr�1(.......... .j. I.1�f: r .... TYPE OF CONSTRUCTION ........................ .W...d.n. ."...[.C', 1/ ................................................ . ......................... .......................... Q. .......19.. TO THE INSPECTOR OF BUILDINGS: The undersigned, hereby applies for a permit according to the following information: Location .......`.:!`d..�...11...r,�...........b®.1. }j.'U. .�i�A.�?1.......v�,. ......................................................................................... ProposedUse ............ eS�.QIC.N............................................................................................................................................. Zoning District ............l.l J)..:1 ..........................................Fire District .eC#i-o.V-.J l.e ....Oj.lety-dl . Name of Owner .......N.Q.J .rhr.J../........P.Unt.J......�.&%ddress .........��VjVr.!.....ib4 ..................................... is41, f ✓ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ......................A/.U./.U...!;-'..........................Address .................................................................................... Number of Rooms Foundation ....... Exterior ................................ 1.!...�.N. ..............................Roofing .................�... ,j. .. !4 J ....................................... Floors �� .I.. ..................................Interior ...............�./j yl�l!°.4..!........................................... ��oo A-/ fj' Heating �t.F.....................`.'............................Plumbing ....................... ................................................... Fireplace .............................. ...�5...........................................Approximate Cost .............f� .. . Difinitive Plan Approved by Planning Board ---------------_---------------19--------. Diagram of Lot and Building with Dimensions I x lU0 I hereby agree to conform to all the Rules and Regulations of th Town of Barnstable regarding the above construction. Name ... . •n.......... �..... �� :......................... :i NORMST HomES. INC. No ,(�r ..... Permit for .. ................ one farm y frame ...�....e........ frame .................... Loco liOno AvktAX bAm. lvv.................. .................Gent sruille,..l�3ass,.. ................... Owner ...No>tiRAB ate-9=05.,...I= ........................ Type of Construction .l..stwt.frame............ ................................................................................ f Plot ............................ Lot .....25...................... Permit Granted A49ust,..30...................19 73 - I I R Date of Inspection .....W-1 .............19 , Q 1 Date Completed ...� 1 - PERMIT REFUSED I ................................................................ 19 .....................................• .................................... f ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... -