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'l ,�1�i,��a ,� �" , I �:�" ,! ��",�,,,�, A, -, ill� hvvt�` hown, ,�,��.", ., "i i,i��,, ._M`11'11�,�� . 'i i,- _ " I li , � I, , 11i, �.,, "."" I_ 1, ,� � , � .", i- ,_ � ":� I 4 ", ,�"�,, ,-_1 it, ,�, 11110"', :;i . , ,.�__ ""., c �, 1 ,- i",I, Town of Barnstable *Permit � 760 f "��!�e�� PERMIT' Ezpbes 6 months jrom issue date Regulatory Services Fee. - NOV 3 ® 2007 Thomas F.Geiler,Director Building Division 01- TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstablema.us . Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address_3::,> NF YS /—,V, GEmt-rag r ❑Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ce'l 17 —26-7 7 Contractor's Name 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 LKII I am the.Homeowner I have Worker's Compensation Insur-ance J suxance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. PertA Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ,1 1,-%!ZWA., &SggL"e-- t]Re-roof(not stripping. Going over existing layers of roof) 0'Re-side ❑ Replacement Windows/doors/sliders. U Value (maximum.44) y 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation,etc. ***Note: Prop Owner must sign Property Owner Letter of Permission. A of Home ruorovt Contractors License is required I Ems... �r /I r� �IGNATiFRE. i �:Forms:expmtrg tevisa061306 o - Town of Barnstable �TNE r� Regulatory Services sAxxsr .E, ; Thomas F.Geiler,Director MASS. .+� Building Division ArED s Tom Perry,Building Commissioner 260 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:- 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE ' f JOB LACATION .'.: �® tee V n�u�mbJer j f y� s ( r_N village "HOMEOWNER": iJ"' 0 +1 C" iyt i o y r5<%E j -7/2,677 name dome phone# �a work phone# CURRENT MAILING ADDRESS:'c� �1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sit 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 sunervisoi. 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 resgonstble for all such work nerfom�ed under the buildingpermit (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 7inspection procpdures sAd requirements and that he/she will comply with said procedures and rm_-Q— c3(h'c Signature of Homeowner Appmval:of Bmlding Official` V ~k Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the 'thte 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,out 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 raayrare t amend and adopt such a form/certification for use in your community. Q:fotms:homeex The Commonwealth of Massachusetts Department ofYndustrial accidents Office of Investigations 600 Washington Street Boston,M-4 02111' wrvw.mass gov/dia Workersr Compensation TiilSurdnce Affidavit: Builders/Contractors/Eleetridans/Plumbers _Applicant information Please Print Lellibly �11ame(Business/Orgm izationftdividual): �il�/L/ I.4'M �i¢t/ 4,f Z16*7 aWr�R,f/( tCity/State/Zig:_ Phone. Are you an employer?Check the appropriate box: :Type of project(required):. L❑ 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.ElI am a'sole proprietor or partner- listed on the:attached sheet. 7. ❑Remodeling ship and have no employers These sub-contractors have 8. ❑Demolition . working for me in any capacity. employees and have workers' g ❑Building addition [No woers comp.insurance comp.insurance$' rk 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions re4��] officers have exercised their 11. Plumbin repairs or additions ' 3.� I am e'hameown doing" e71'rrkk ❑ g P right bf exemption per MGL [No workers' comp:' 12.❑Roof repairs msUran required J t''' ~ c. 152, §1(4),and we have no 13.❑Other ' employees.[No workers' camp.insurance required.] • *Any applicant that checks box#1 must also M out the section below showing their workers'compensation policy information. t Hon=woem.&4 o submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such. tr—ontractors that check this box must attached an additional sheet showing the name of the pub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.poficp number. I am an employer that is providing workers'compensation insurance for my employees. Below isthe policy'and job site' information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: - lob Site Address: City/State/Zip: .Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Fafiure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the,imposition of criminal penalties of a fine trip 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 thq violator. Be advised that a copy of this statement maybe forwarded to the.Office of Investigations of the DIA for insurance coverage verification 4 I do hereby a er the pains•and nalNes of perjury that the in provided a rove,is true and correct Si store: Date/fir •� _ Phone#: Official.use only. Do not write to ibis area,tb be completed by,city or town:official ` o T own: Permit/License# City r .. ty Issuing Authority(circle one): J.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ,Ungineeri;g Dept. (3rd floor) Map _ 230 Parcel / Termit# House# 30--3 to Issuedl^9� Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30e7- -,(Fee JK -AV CZ Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) , Planning Dept. (1st floor/School Admin. Bldg.) SEPTIC SYSTE F TEE Definitive Plan Approved by Planning Board 19 INSTALLED IN �E ' I LE, ` IRONNIEN Aid® TOWN OF BARNSTA�� s�►��E�v ' s Building Permit Application ,� Project Street Address 3 d 3 � �n nn o Loa le La 2 DOLL.. 0 T722�?3 Village_ _ &VI-fer1I► ,I� Owner I(��,_�, p 1). RAY Address '5rA yn e-a,,)4,0,— Telephone 2 71-,16 � Permit Request S-torp a P. e, First Floor p 9�j square feet Second Floor square feet Construction Type �o�� CLJ beam Estimated Project Cost $ a_ ra Zoning District Flood Plain Water Protection Lot Size IXy'w X 1 14) oL Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure )d 0+ Historic House ❑Yes ❑NAo On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other rc�uP, codl, Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing 3 New 3 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None �4.Shed(size) D x 1 ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2g No If yes, site plan review# Current Use Proposed Use Build Information 1. !� Name Telephone Number D — -7�D - "K5 o-d�, Address oZO - License# 04S-13 5 (�/. 8 Home Improvement Contractor# /0 ( 3 7 d Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE A DATE BUILDIIPI11 T I __gqfF LLO G REASON(S) FOR OFFICIAL USE ONLY - r. ,t r PERMIT NO. DATE ISSUED MAP/PARCEL NO. r - ADDRESS VILLAGE OWNER _ l DATE OF INSPECTION: FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: n•:ROiJ, H FINAL PLUMBING: r�RO06*` FINAL GAS: 14 ROjE FINAL , �. wj FINAL BUILIN DATE CLOSIrk(OJT : ASSOCIATION P,IYAN&0. , f 1 , 1 PLOT PLAN FOR LOT# Indicate location of garage or accessory building Additions with dashed lines------------- Sewerage disposal(cesspool) E Well I (Lot......�.�r..........fr- rear) Abuttm's '� ' Abuttcs's Name ( 1 I Name c- i JOYCE Lot/ Re ,-yam Lot K IZ ......... ..........fL It If this is n if this is c=er Lot, come- lot, write is J _ Write in nacre of name o1 other street. Sideyarc' HOUSE Sidcyard other su c_t. Set Bade I ... ..d......fL fi ° (Lot.......r'R.........ft froatage) . \ ----:_Pin n��s__ c�r►�,.,--------------------------- \ / (Name of street) / \ Information / \ Supplied by -VVI I-L I A T RAY Mark North Point ' i 9y i It fill IP �2r - o2x4" RAFTERS 13ot►+eD --� Notc: 'ALL Wouo r-:5 �vLr_ 17�mEN5roNl4t fiNE ��� .?b0 OLA"TL$ � ' ' ALL SNE7>S /SAVE � y"x 4" SuPPv R,?" 3�A'CES 6nel-E END LOUVEP-S qyq Ct\1cr- vvN) CpP,QCiZ 2x4" _PuRLINS posts i PLYW OD ��BLOCkINCs c q