HomeMy WebLinkAbout0111 PATRIOT WAY fit WA
r
1
l
s
o�Y rqi,, Town .of Barnstable
p ` E 6 months a iscae dat'
' Regulatory Services apres Fee
IMLIMSzasrX,
9� SS
16g9 � Thomas F.Geiler,Director
Bulauig Division
Tom.Perry; CBO, Building Commissioner
200 Main'Street, Hyannis,MA 02601
wwwtown:barnstable.ma us -
Office: 508-862403 8 Fax: 508-790-623 0
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY•
Not Valid without Red X-Press Imprint
Map/parcel Number f 9 Z Z 2 � .
Property Address 9l1 I`hrlracm wr, ('E iHtv1.�CE UZ�e3Z ;'
Residential Value of Work /SOD'Of 1YI9nimnm fee of$35.00 for work under$6000.00 `
Owner's Name&Address Su-Amu,., 7�ai Ir
1 1 C e"tk it v_A-4 'Cc-�ft*V cLLE i�uo; o
�3z
Contractor's Name ,. Telephone,Number
Home Improvement Contractor License#(if applicable) `
Construction Supervisor's License#(if applicable) r` X- h
❑Workman's Compensation Insurance" WIT
Check one: MA .
❑ I am a sole-proprietor 3 2012
" &I am the Homeowner71ti
❑ I have Worker's Compensation Insurance `''QwN OF
BARNSTA13LE
Insurance Company Name '
Workman's Camp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit
Permit Request(check box) .~•s
❑ Re-roof(stripping old shingles)'All coiistniction debris will betaken to,:_
❑ Re-roof(not stripping. Gomg over_ existinglayers of roof) : 1
IT Re-side ; S
5 #of doors.
}
❑ 'Replacement Windows/doors/sliders. U-Value `" a.(maiimum.44)#of windows
*)Vhere requirrd: Issuance of this permit does not exempt compliance with other,town department rrgulations,'i.e.Historic,Conservation,etc.
***Note: Property Owner must sign,Propirty Owner Letter of Permission.
A co of the rovement Contractors License& Construction Supervisors License.is
,
req re
IGNATURE: - a
1WPFILESIFORMS1building P=ft s1EXPRESS.doc
>vised 070110 ;F
The Commonwealth`ofMassachusetts
Department of Industrial Accidents
Office of Investigations ,
d '600 Washington Street
Bo' it,MA 02111 -
SJ',W www.mass.gov/dia . F
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le gib
Nam (Business/Organization/Individual) J13r !AJ t
Address:
(G ty/State/Zip: �C—N'tL R vt . M�, Q Lc'3 Phone.#: web $ .zz oZ
Are you an employer?Check the appropriate box:. Type of project(required):,' .
1.❑ I am a employer with 4-0'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.• r .7: ❑Remodeling
ship and have noaemployees These sub-contractors have g, ❑Demolition
e to ees and have workers'
workingfor me in an capacity.
mP Y
Y _
9. Buildingaddition.
[No workers' comp.insurance :' comp.insurance.# .
e 5. ❑ We are a.corporation and its- 10.❑Electrical repairs or additions
� quired. Y
]
3=U-I am e_homeowner doing all work officers have exercised their, 11:❑Plumbing repairs or addition's
myself. [No workers' comp. right of exemption per MGL '12.❑Roof repairs '
insurance required.]t c. 152, §1(4),and we have no '
13.❑Other
- employees.[No workers' f
` 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.
tContractors 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:.i
Attach a copy of the workers' compensation policy declaration page'.
age(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$1,50.0 00 and/or one-year imprisonment;as well as civil penalties in the form of a'STOP.WORK ORDER and a fine
P Y g PY y forwarded to the Office of
of u to$250.00 a day a ainst the violator. Be advised that a co of this statement may be
Investigations of the DIA foxAsurance coverage verification
I do hereby certify un e p " and penalties of perjury that the information provided above is true and correct.
Si attire"~ ., -- Date:..
Phone#: ,
Official use only. Do not write in this area,to be completedhy'city or town offciaL
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' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person.in the service of another under anyfcontract of hire,
express or' lied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including thZth
representatives of a ceased employer,or the
receiver or trustee of an individual,partnership, assoceatioii or egal.entity,emplo g employees. However the 4
owner of a dwelling\�ouse having not more than three apartmentsd who resides th ein,or the occupant of the
dwelling house of an ,ther who employs persons to do maintenonstruction o epair work on'such dwelling house
or on the grounds or building appurtenant thereto shall not becaf such emp ent be deemed to be an employer."
IvIGL chapter 152, §25C(')also states that"every state or locnsing ency shall withhold the issuance or
renewal of a license or permit to operate a business or to coct b ' dings in the commonwealth for any
applicant who has not prod ced acceptable evidence of comce th the insurance coverage required."
Additionally,MGL chapter 15 , §25C(7)states"Neither the co ealth nor any of its political subdivisions shall
enter into any contract for,the pe ormanceof public work untiable evidence of compliance with the insurance
requirements of this chapter have een presented to the contracthority."
Applicants
Please fill out the workers' compensatio affidavit completely by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name ,address(es)and hone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(L C)or Limited ability Partnerships(LLP)with no employees other than the
members or partners, are not required to c workers' co pensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised tha this affi vit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also a sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions garding the law or if you are required to obtain a workers'
compensation policy,please call the Department at t ber listed below. Self-insured companies should enter their
self-insurance license number on the appropriate lin .
City or Town Officials
Please be sure that the affidavit is complete and p rated legi\eartnenhe Department has provided a space at the bottom
of the affidavit for you to fill out in the event the ffice of Iations has to contact you regarding the applicant.
Please be sure to fill in the permit/license numb which wi as a reference number. In addition, an applicant
that must submit multiple permit/license applic lions in any ye need only submit one affidavit indicating current
policy information(if necessary)and under"J Site Addrethe app ant should write"all locations in (city or .
town)."A copy of the affidavit that has beenafficially stam marke y the city or town maybe provided to the
applicant as proof that a valid affidavit is on file for future p or licens A new affidavit must be filled out each
year.Where a home owner or citizen is ob g a license it not relat to any business or commercial venture
(i.e. a dog license or permit to bum leaves a c.)said person required to mplete this affidavit.
The Office of Investigations would like to ank you in advr your cooperate and should you have any questions,
please do not hesitate-to give us L call. 1 '
The Department's address;telephone-and Sfax number:.
Thle ConmonweaM of Massachusetts
Department of h dustrzal Accidents
Offlee of Investigations
600 Washington Street
Boston,MA 02111
Tel. ##617-727-4900 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax##617-727-7749
www-.mass.gov#dia
o'EjHE Town of Barnstable
�. Regulatory Services
+ BARNS MLE, f
MAes Thomas k Geiler,Dir'ector
EO M►►�' Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
.PropertyiOwier Must
Complete and Sign Xt,*,on,*.,
` if-Us rigA B �awnerohe subject property
herebyauthorize orze to act on mp behalf,
,
in all matters relative.to work authorized b this b ' g permit
(Ad ess of Job)
**Pool fences and ala s are the responsibility of the a licant. Pools '
are not to be filled befor fence is installed and pools are no to be
utilized until all final in ections are performed and accepted. ` k
Signature of Owner Signature of Applicant
Print Name Print Name
Date ..
Q:FORMS:O W NERPERMIS S IONPOOLS
Y
�tK T Town of Barnstable
Regulatory Services
Thomas F.
swxntsTAHc.E, : Geiler,Director
y HAss.
1619. �`0� Building Division
Fo Ntp�I
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
.3f 3 L
JOB`LO.CATION:-_t7 Pen vi-4.er-t w A_ CS-,-j7'Gv-L v t 1.L E M
number / street village
"HOMEOWNER SI} ,t�/U l Sd 1b SS j ).-LQ'L I1/4-
name home phone# work phone#
CURRENT"MAIL-ING ADDRESS:. M1 0-1
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 inspec ' procedures and requirements and that he/she will comply with said procedures and
requirem
Signature of 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 fonn/certification for use in your community.
Q:forms:homeexempt
F�HE ram, Town of Barnstable
Regulatory Services
* BARNSTABLE,
MASS. g Thomas F.Geiler,Director
�A t6gq. ♦�
rF%639. A Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
July 31, 2007
Shawn Doyle
111 Patriot Way
Centerville, Ma. 02632
RE: 111 Patriot Way, Centerville Map : 192 Parcel : 225
Dear Mr.Doyle:
This letter shall serve as notice that you are in violation of the Zoning Ordinance of the
Town of Barnstable with regards to a storage trailer that you have on the above referenced
property. This use is prohibited as per Chapter 240 Section 10. You must remove the
trailer by August 14, 2007 or be subject to fines of$100.00 for each day following in
which the property remains in non-compliance. Thank you for your anticipated
cooperation in this matter.
By Order,
*efeyKauzon
Local Inspector
Q:zonings
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o
Map I Parcel Application#L J6
` Health Division L k A02-5 3L
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fe
Planning Dept. Permit Fee 4-3o x-t- -i--S3s-
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis 10 a > / 40 e P
Project Street Address
Village
Owner XAA�W y 10— Le Address 11146-40T�4 e6 ZC-MV1&&
Telephone 5-0tr) 981— 2-Z-0-2--
Permit Request P-0 P100F
Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation�,nj !V� Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure 30 si'l-c Historic House: ❑Yes . & o On Old King's Highway: ❑Yes /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 ! ri w
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room,Count
Heat Type and Fuel QGas ❑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 ` 6 No If yes,site plan review#
Curr nt Use Proposed Use
BUILDER INFORMATION
Na (0Telephone Numbe
ddress 1 O' IVC (o ,� License#
Home Improvement Contractor#
c�2 2 Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAK N TO
IGNATU DA E
- FOR OFFICIAL USE ONLY
PERMIT NO.
4 '
DATE ISSUED -
MAP/PARCEL NO.
c y
r.
,ADDRESS } _ VILLAGE
OWNER
ti.
1
DATE OF INSPECTION:
f
FOUNDATION
FRAME
INSULATION
z
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
t
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. r i
l fm %_vrrw6vj,& vJ
\ Department of Industrial Accidents
Office of Investigations
600'Washington Street '
Boston,MA 02111
. www.rnass.gov/dia
Workers' Compensation'Insurance Affidavit: Binders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orca�ation/lndividual)
Address: \ �ok XJ) l-\k J
'ty/State/Zip: Phone#:�mg-&9,e?_2o(2
Are you an employer? Check the appropriate bog: 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 sub-contractors
listed on the attached sheet$ ❑ Remodeling
2.❑ I am a sole proprietor or partner- � •
ship and have no employees These sub-contractors have & ❑ Demolition
working for me in any capacity. workers' comp,insurance. 9. ❑ Building addition
[No workers'.Comp.insurance S. ❑ We are a corporation and its 10❑ Electrical repairs.or additions
required.] officers have exercised their
homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
elf [No c. 152, §1(4),workers' comp. and we have no 12.❑ Roof
insurance required.] t , employees. [No workers' �13.❑ Other .
comp.insurance required.] : • .
*Any applicant that checks box#1 must also fill out the section below stowing their workers'campeasation policy information: '
t Homeowners wbo submit this affidavit indicating they are doing all work andthea hire outside contractors must submit a mew affidavit indicating such
tr'.cntrgctors rt+wt.check thisbox must attached an additional sheet showing The name of the sub-contractors and their workers'comp.policy information.
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
do h reb certify under the pains and penalties of perjury that the information prov, d above is true and correct '
atnr Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town off iciaL
City or Town: < Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.Cityl—I own Clerk 4.Electrical Inspector 5.Plumbing Iaispectur-
6. Other
Contact Person: Phone#:
information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employee's.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,orafor written."
An employer is defined as "an individual,partnership,association,corpo' lion or other legal entity, or any two or more
of the foregoing engagied in a joint enterprise, and including the legal r resentatives of a deceased employer,or the .
receiver or trustee of an individual,partnership, association or other gal entity,employing employees. However the
owner of a dwelling hose having not more than three apartments d who resides therein, or the occupant of the
dwelling house of another who employs persons to do mainten e, construction or repair work on such dwelling house
or.on the grounds or building appurtenant thereto shall not be a of such employment-be deemed tobe an employer."
MGL chapter 152, §2516)also states that"every state or 1 cal licensing agency shall withhold the issuance or
renewal of a license or ermit to operate a business or t construct buildings in the commonwealth for any
applicant who has not p oduced acceptable evidence of ompliance with the insurance eoyerage required."
Additionally,MGL ehapt r 152$§25C(7)states"Neither a commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of until w until acceptable evidence of compliance with the insurance
requir=eras of thus chapt have been presented to Sue tracting authority."
Applicants
Please fill out the workers' co ensatian affidavit co le+�Iy,by checking the boxes that apply to your situation and,if
necessary, supply sub-contracto (s)name(s),address es)and phone mmiber(s)along with their certificate(s) of
insurance, Limited Liability Companies(LLQ or 'ted Liability Partnerships(LLP)with no employees other than the
members or partners,are notreq ' ed to carry Ivor ers compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be dvised that ,' affidavit maybe submitted to the Department of Industrial .
Accidents for confirmation of' ce coverag Also be sure to sign and date the affidavit. The-affidavit should
be returned to the city or town that the lica ' n for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have y qu. tions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Dep ant at the number listed below. Self-insured companies should enter their
self-insurance license number on the appr ' to line.
City or Town Officials .
Please be sure that the affidavit is comple and ' ted legibly. The Department has provided a space at the bottom.
of the affidavit for you to fill out in the exjjtent the ce of Investigations has to contict-you regarding the applicant.
Please be sure to fill in the permit/licensefnumber hich will be used as a reference number. In addition,an applicant
tat Est submit multiple permitnicense,�iapp]icati in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job S' Address" e applicant should write"all locations in. (city or
town)."A copy of the affidavit that has been offi ' stamped or marked by the city or town may be provided to the
applicant as proof that.a valid affidavit is on file for a pemuts or licenses. Anew affidavitmust be filled out each '
year.Where a home owner or citizen is pbiaining a li e or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn le etc.)said pers is NOT required to complete this affidavit
The Office of Investigations would lie to thank you in adv ce for your cooperation and should you have any questions,
please do not hesitate to give us a c .
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Inves#agations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406•or 1-877-IUiASSAF'E``°,
Fax#617-727-7749
Revised 5-26-05 WWW.mass.goV/m`a
°FINE l Town of Barnstable.
Regulatory Services
s +
` BARNSTABLE. Thomas F.Geller Director
9 'MASS.
q'prfp39.�A`0 Building Division
Tom.Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
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. ff
Type of Work: 'FaaV1 RIMC4t Z(2,Lex, Estimated Cost _/5010
Address of Work: �41,7 _L O-e 4 C�_nrr 45ay,LLt "4- Z-
Owner's Name: 54�c za
Date of Application: 2
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
[]Job Under$1,000
[]%iRding not owner-occupied
er 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 Signature Registration No.
Da Own is Signa
Q:wpfiles.forms:homeaffidav
Rev: 060606
Town of Barnstable
�OETHE Tp��
NP o„ Regulatory Services
BAMSZABLE, ; Thomas F.Geiler,Director
9 MASS.
�,,, t6g9• Building Division
jfD MP't
Tom Perry,Building Commissioner
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: O t!/
JOB LOCATION: � Pa� �-7 LA_ rezr_`,,144
number street ? village s��
"HOMEOWNER": �/7.�tc�iJ /L�. IJO L E �JCJ � 7
name home phone# work phone#
CURRENT MAM NG ADDRESS: SQ- 1E 4-s 0,/
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 woak 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 pr edures and requirements and that he/she will comply with said procedures and
requirements.
Signat of Horn'teemer
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:forms:homeexempt
Town'of Barnstable
P�OFTME 1p��
Regulatory Services
t3nxrtsznar.E,
Thomas F.Geiler,Director
v nsnss. $
4jA 059. A�� Building Division
Tom Perry,Building Commissioner
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:bl ow
JOB LOCATION: � ` \ 1 �J\ \� C��I V 1 f U
number 1 1�11 street 5C��11villa
"HOMEOWNER' A CZ_ -q c.
name ` home phone# work phone#
CURRENT MAIIJNG ADDRESS:
nz)2. t .
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 procedures and requirements and that he/she will comply with said procedures and
ements.
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 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:forms:homeexempt
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ghe 4WU•ing shown, hereon, does mot cfaU im a special 97E.�-Roo TO �
ham aria witK an of F'ectwe daze of S-19-j�5 ana4 qfW locafi'on, oP 5U10
the dwelling doeS conform,rto the local .$ mng 6y-laws tm efec/f
wtthe tune oFcrntstruawn wift mpectto horizontal dimen4 ona-S Scale: 1" -_40
S¢tbGriG�Z or 1S ¢1�(12r?1pt frorn V161a OrL ¢�,�rcetltiertz' Date: 2-2-D�
czctton, under 1►�lass. General laws a '40X-5eCt7L0, M T File No. pG -01 I S
PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise
determination of the building location and encroachments, if any exist, either way across property lines. This plan must not be
used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan
purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences
or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what
is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY".
COLONIAL LAND SURVEYIN
G COMPANY , INC.
269 Hanover Street Hanover, Mass. 02339 Phone: 781-826-7186 - Fax: 781-826-4823
My File Edit Tools
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Deka.l .... Application 20061634 * APP6can OVJN PROPERYOWNER ;•
Status A I ACTIVE "
Collect Owner 27242y
I ° Department ,6300;BUILDING DEPARTMENT _ ° a
SEAWARD WILLIAM F&PAIGE M ;
Protect/Activil* 434-,RESIDENTIALAD'DITIO,NIALTERATIO ;
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Town of Barnstable
Regulatory Services
HARNSTABLE ' Thomas F.Geller,Director
MASS.
9�pTfDMA�A`0 Building Division
Ralph Crossen,Building Commissioner
367 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
SHED REGISTRATION
Location of shed(address) Village
Property owner's name Telephone number
)o 9�- s
Size of Shed Map/Parcel#
,I"Z4 7d
Signature Date
Hyannis Main Street Waterfront Historic District? Nl
Old King's Highway Historic District Commission jurisdiction? q,
4hs-
Conservation Commission(signature required) 3 �
PLEASE NOTE: IF YOU ARE WITBIIN THE JURISDICTION OF ANY OF THE
ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION
FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
014—
THIS FORM MUST BE ACCOMPANIED BY A PLOT_PLAN
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RES.. ZONE.• "RC" This MORTGAGE . INSPECTION Plan is For
FLOOD ZONE- 'C'"
TOWN: — REGISTRY OWNER: ALBERT & STEPHAIVIE L FITZGERALD
DEED REF: 0_Z97 fig= _ _BUYER: _Y1LLI6M.� J•-� FAIG�M�A�D_ _
DATE: 3057— — PLAN REF: 327 26 —
_>,.. _ SCALE:1"= 30 ---FT.
I HEREBY CERTIFY TO LvQ1�Tl-mmj��ERj4N QgZ�A �_� at�;t,E. of «
_ THAT .THE BUILDING ' YANKEE SURVEY
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS
SHOWN AND THAT ITS POSITION DOES _ CONFORMa, ! H \`�' CONSULTANTS
To THE Zi�Ni;vG LL1ir or BAC1� ,tiE S nF �•rti; ;> � ' ' N 40B SUITE 1
'"ET IK R nrTTT�L'1�fT'TTT
TOWN of BARNST�B _�`
IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD I1E.'LARD J } f INTDUSTR�' ROAD
AREA AS SHOWN ON THE H.U.D. MAP DATED_ MARSTONS MILLS, MA. 02648
Co , unit P� nel 250001 0015 C TEL: 428-0055'
FAX: 420-5553
PAUL ERfTHEtiv, pp ----- THIS PLAN NOT MADE FROM AN INSTRUMENT SURVEY. NOT TO BE USED FOR FENCES ETC. , 0744 JF
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ELOREDGE ENGINEERING y"w/�.4r off✓. *'
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`-. GLIENT I Cc 'THAT THE. # :
EOIST.ERED R,Ef31STE.RED :HOWN THIS. PLAN IS. LOCATED
"JOB N0. ? �a Qk V- UND'-AS' INDICATED wND
CIVI+L I f L.AND R ..:.'
` n �Q TO HE ZO.NIN(3 LAWS
ENGINEER �.SURV'EY.C►R Di BA.
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33 N0. MAIN 'Sr 712 'MAfN ST. CH�BY
i; SO' YARMOUTH, MUSS. HYANNIS, MASS. SHEET- OF r►A �__� _ ..u..:17
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Assessors map and lot number ................................. Txe T
s—� SEPTIC SYSTEMMU
Sewage Permit number .....................:......1.: ....^ .1:..... INSTALLED
f� LLED IN CO
M1P s
n / - ABLE, •
House number .... ...� 441?cy/. .."✓. WITH TITLES =, MABa
ENVIRONMENTAL COD i63
Y d�•
' TOWN OF BARNSTwI� �`�T'oNs
BUILDING INSPECTOR
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APPLICATION FOR PERMIT TO ....,,tV� ..(. l.An> ...:.
f
TYPEOF CONSTRUCTION .....!W0d....................:...............................................................................................
............................. ..7.....19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned/hereby applies for a permit. according to
the following information::
Location .........yl... ........ foc/?.`1.1........5. �.41/..// ......
ProposedUse ..... a .......................................................................................... ................... ............................
ZoningDistrict !�- Fire District .................I G 'uF g ............. .....................................................1� ) r................... ................................
Name of Owner .....: l�!�.N......�T.....19.1/ CLq./Z", ...........Address ....... ..........................................................
Lc !1
Nameof Builder ......................................... Address ....................................................................................
Nameof Architect ..................................................................Address ..............................................................................:.....
Number of Rooms ....................7n.....................................Foundation .....!1%zx:�L-,>..................................
Exterior ...............l lll/7r�.......C-ejC:7(QZE.W<<!t!�A-5Raafing ........N S A.A.zt......... .... . . . .... .......................................
Floors ....S/Z96...1621�........./1(..49 v7 .�v.Z).....Interior ..........��!J0452 ......... ��� ���..,............
Heating ......... ......7:......<5 Plumbing ........../v.D ................................................
Fireplace ....Approximate. Cost
Definitive Plan Approved by Planning Board ---------------_---------------19________: Area .........-:113 .................
Diagram of Lot and Building with Dimensions Fee ............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH fL
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
C.
NameA............. jW.Vrq ........................
Construction Supervisor's License . .<�.a�... .......
r
GILMORE, JOHN H.
1 0 .28.4.95..... Permit for ....Su.i.1.d..A.ddition.
.........Si-ngl-e...Family..Dxellj-ig.....................
i T, •
Location ......Ul..Fatro.i.ts-WA '
* .Cen.teruill e................................
Owner .....John..R....GUmare............................ ,
Type of Construction. ...F.rame............................
s� f
......................................................... ;
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Plot ............................ Lot ...............
Permit Granted October 8, �- 19 85 i
............................
Date of Inspection .............. y.. r? .19 f '
e
Date Completed ............... ......................19 i•
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TOWN OF BARNSTABLE permit No. _------_20840
Building-Inspector
saassr Cash
OCCUPANCY PERMIT Bond __ X
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged_ use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Banner Home Corp. Address 716 West Main St., Hyannis
let #14 111 Patriot Way, Centerv111e
Wiring Inspector Inspection date
P-1
Plumbing Inspector-- f� Inspection date
it
Gas Inspectorw� Inspection date
ij
I/ Engineering Department Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR'UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
.....................i�.. .._............._, ......... ..Building Inspector ......................w....
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71
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CERTIFIED- PLOT PLAN
k G v -T. 14-- n� -rz i o-r LVAI
=2 NEW CONSTRUCTION ONLY
TOP OF FOUNDATION, IS FEET IN
ABOVE_ .LOW POINT :OF .A,DJACENT . c,�,a J1h sj'1AS Ir� UASsr z
ROAD.
SCALE: =Sv DATE :
7Y
ELOREDGE ENGINEERING CO.INC. G/Caz�/c-rz I CERTIFY THAT THE E-ovnr�.�TioN ,
CLIENT - - _-_
' EGISTERED� REGISTERED SHOWN= ON THIS PLAN•..IS LOCATED''
CIVIL I LAND J08 NO. 7elo ON THE ° GROUND AS INDICATED AND
ENGINEER$ SURVEYOR DR. BY: A___ M CONFORMS TO THE ZONING LAWS tr
- ..._..----- - OF BAR'NST L M S. 4
CH. BY: O'Z
33 NO. MAIN ST 712 MAIN ST P
`>O. YAH�VIUUIn i 'S� S ` 11-1Y^'yN1 �AA� �_. nF / / — - -- -
1 7
ANDSUR�VEYOR
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Fr
ssessWr's map and lot number '......D .....:................ �� THE
_ Pao Tory
? 7/` SEPTIC SYSTEM MUST BE
Sewage Permit number .................................. .
;64INSTALLED IN COMPLIANC A I STAKE, i
1`4�use number .......... ..................................................... WITH ARTICLE 11 STATE 'oo 039. ems
- SANITARY CODE A'ND TOiNN �ONaY
TOWN. OF. , B,ARNSTXjj1E
BURD11K . J*SPECTOR
APPLICATION /4 LIC TION FOR PERMIT TO ?r� .�`�.................. .: ...................)....Y....LY
�..... .. (�
TYPE OF CONSTRUCTION .... ..........,.A ..............:............................................
............ C?......3..k................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information
Location ...l-Z:.l...... .........�' �!5T.....�Q�!®��!....... ....................
J�e-�- ................................................
Proposed Use .............� ..�.�..................................:.....
Zoning District ...la .............................................:.Fire District .� .,�.. ............................. .?.! ....
4 Name of Owner .S,.`1.. ..00 i.Address ... .....0;!.... .... .��
Name of Builder ............... ....................:........Address ................................_25041&1\1.,
Name of Architect .................... ...::........................Address .....................................�3/A..............................
Number of Rooms ...............}� .....Foundation ..P2r.� -
x�. .,. .............. ........
Exterior ...�'..'..�.\`. (.,.,,�., a ............Roofing ..1V'�.' ...................................
Floors ..... ..V. ................Interior .................... .......................
Heating .1.7'`C11.�...... .�..R .'......Plumbing .. q.f..� ..........................................VQ�
Fireplace ......................... .t ......................:....:....Approximate Cost � �.. ...............
Definitive Plan Approved by Planning Board ________________________________19________. - Area ........ �........................`
o°
Diagram of Lot and Building with Dimensions _Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
` f
1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ing the above
construction.
Name .... . rl.....
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Banner Home Corp.
~N /��� — Permit for � .................stor .
'
-
single zomil u�a '
-------..—.—. ------..
_` ^
lll Patriot�u��
Location ------------���-------
_____.__.. l.�,_,_______
- ,
Owner Bome--
---~—..------ —..,------.
' frame
Cono�uchoh --.-----------.. ��
. ^ '---------------.
-----. ----. � .' Plot -- --.--- Lot ---..�I4...............
--
November 20 78
Permit Granted ............. ~` —]9
'
-
oote of Inspection
. .
uo,e Completed 7 .^ �.
. '
PERMIT REFUSED
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