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HomeMy WebLinkAbout0330 PHINNEY'S LANE , s .. .� .. _, �f � _ � e r 4 o I � P i fI t Town of Barnstable *Permit# p Expires 6 months from issue date Regulatory Services Fee BM MSTASLE.MAM • 16 96 A,� `• Richard V.Scali,Director 3. D Building Division `` Tom Perry,CBO,Building Commissioner, fp. 200 Main Street,Hyannis,MA 02601 At�2.3 www.town.bamstable.ma.us Office: 508-862-4038 AFax:508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL OREY-C' Not Valid without Red X-Press Imprint Map/parcel Number Z 38 l 3 Z Property Address 3©0 P.H ( ►Ntj C- 5 L,g1i1= Jn-esidential . Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address- --k Ar(LC Al C(2-M K(E(Z 30 941ri116V13 lArJ Contractor's Name L. Telephone Number 15D? Home Improvement Contractor License#(if applicable)-- ° I Z4$1 Email: t:D �y'�1'2 @. 6- Ynj�)L, C-6 i'11 Construction Supervisor's License#(if applicable) C5 p 6-15 S7 3 ❑Workman's Compensation Insurance Check one: a I am a sole proprietor ❑ I am the Homeowner t ❑ I have Worker's Compensation Insurance . , Insurance Company Name , Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) t PRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to A Acol'p1� ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value `' (maximum.32)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red.S and inspections required. Separate Electrical&Fire Permits required. *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 c of the Home Improvement Contractors License&Construction Supervisors License is r uir d. SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 040215 b p i ?Ire Comm oznvealth of Massachusetts r ., �•`� Deparhnesrt cx,f']4dustrial Acciderds Of fire•ice o,f Investigations 600 Wa hington.S eet Boston AL4 02111 [gist-v.mass govIdia , MTarkers' Campensatian Insurance Affidavit.Builders/Contractars/EIectricians/Plu nbers Applicant Infannatian Please Print LembIy Nervef3asmessflDrgamzatrrsnRnd Address: r ��S?t� ��t�C��= (a/�1✓�� CityfStatel OL Phoaei�:" Are you an employer?Check the appropriate box: � Type of project(regnired)_ 1_❑ I am a employes with 4.❑.I am a general contractor and I employees(full arldl`or part-time_ _ have hired the sub-count actors 6. ❑New construction 2?,VI am a sole proprietor or partner- fisted on the attached sheet. 7. ❑Remodeling ship and have no employees. These sub-contractors have ' 8. ❑Demolition woding forme in any capacity.., f employees andhna wodcess' 9. Building addition. [NO Workers. camp,tshc�irrnre' • . cOII1p.It1.Sl2[a1BC?e.# ' ❑ d`�`� regntred] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ 1 am.a homeoumer doing all v�ork officers have exercised their 11_❑Plumbingrepairs ar'sdditions Myself[No work s'comp_ t of exemption per MGL 12.❑Roof repairs +ncnrancerequiied.]s , c.152,§IM and we havens' . employees-[No workers' 13-❑Other camp_insurance required_) "Any appficattbatchects box 91most also filloutthe section below Asowing&eirwalkeis'compeL.;R anpolkyinfonnzdmL, l l ameowners who submit ihia of Ldmlt indixanag tbey are dai9 all wo&and then lase outside contractors no t submit anew affidavit indicz=g sa,cb_ rCaatractors that check this boat must attached as additional sheet showing the name of the sdb-cmaractm and state whelber or nit those entities have employees.Iftie snb-caatractosshave employees,thegrmuiprmade their workers'comp.policy number. I am art elriplo,ivr that is prquiditg workers'congwisatfoll ittaairance for my enrpinsees.,ffetatp is thepplicy axed jab site it fornzadots < , Insurance Company Name: Policy A,or Self-ins.Lic.* _ . ry Expiration Date: Job Site Address: . . CitylStatelZip: _ 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 ci%ril penalties c.in the farm of a STOP WORK ORDER and s hi e of up to MOM a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DfA.for insurance coverage verification_ I do hereby cetlifj a the praxes wid penabYes afFet jur}that the infbrnzadun prm-i&d abmv is bue and correct ,Sisnature: Date: ! e/ '7 k Phone ik 'ZZ1 - 21 Official use.ortFy. ,Do not[mite in this area,to be campleted by city artorwn oociat City or Tomm: PermitlI,icense# IssuingA.uthority(circle one): d 1.Board of Health 2.Building Department 3.Cityffuwn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone it: 6 Information and Instructions ` Macsachusetfs Geheral Laws chapter 152 requires all employers to provide we 'compensation for their employees_ Pm scant to this sfztLt%aa.emplayee is defined as.--every person in the seavi of another under any contrast of hire, express or implied,oral or wi tinn_" An roy,8 is defined�s"a a individnal,partnership,association co oration or other legal errErty,or any two or more of the foregoing=gaged in a joint eturprise,and including the It representatives of a deceased employer,or the receiver or trustee of an m dIIal,partaersbip,association or o legal entity,employing employees. However the owner of a dwelling house h,Frog not more than three apartm and who resides therein,or the occupant of the - dweIIiag house of another wile employs persons to do m - cc,construction or repair work on such dwelling house or oa the grounds or building �; Tuten�r thereto shall not b arse of such employment be deemed to be an employer." MGL chapter 152, §25g6)also that"every state local licensing agency shall withhold the issuance or renewal of a license or permit to erate a business o to con<Strnct burZdioigs in the commonwealth for any applicant who has not prodnced a e ptable eviden. of compHance with the insurance_covex-age required." Additionally,MCL chaptrr 152, §25 7)states"Ne the�o*nmonwealth nor any ofiia political subdivisions shall enter into any contract for the pe ce ofpnblic rkun�T acceptable evidence of compliance with the in�,„a„ce. requirements of this chapter have been in contacting arlihozity_" Applicants Please fill out the wo k='compensation vit mpletely,by checking the boxes that apply to your sitnation and,if necessary,supply sub-ontactor(s)name(s), es)andphone numbers) along withthez certficate(s) of min rce. Limit Liability Compames(LL rLimitedLiability-Parinerships(LLP)with no employees other than the -a are not r to w ers' compensation in a mce. If an LLC or LLP does have members or partners, eq�ed � employees,a policy is required. Be advised affidavit may be submitt--d to the Department of Industrial Accidents for confirmation of insurance cove e: o be sure to sign and date-he affidavit The affidavit should be returned to!he city or town that the appy fo e permit or license is being requested,not the Department of la±- tjpj Accidents. Should you have any ons the law or if you are required to obtain a workers' compensation policy,please call the Departm at the er listed below. Self-insured companies should enter their self-insurance license number on the app . ;line. City or Town Officials Please be sure that the affidavit is complete and p legit) The Department has provided a space of the bottom of the affidavit for you to fll out in the event the ffice of Inv ors has to contact you regarding the applicant Please be sure to fill in the penit/Iicense number 'ch will be ed as a reference number. In addition, an applicant that must submit multiple pennit/Iicense applizati : m any giv year,need only submit one affidavit indicating crosent " "� or c n locations II policy nu�rmation(if necessary)and under Job Address th applicant.ho uld write III caiZ ( ' Lowe}_"A copy of the affidavit that has been offici stamped or ,arked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file future permits o licenses_ Anew affidavit must be filled oist Bads year.Where a home owner or citizen is obtaining a -cease or permit of related to any business or commercial venture (Le. a dog license orpem it to bum leaves etn.)said erson is NOT to complete this affidavit The Office of Inves�tigaiions would like to thank you advance for yo cooperation and should you have any questions, please do not hesitate to give us a caIL The Departments address,telephone and fax number- Tht of Irma sir u tts o Departramt Iii(iMt zal A • . Tfl-L 4 617'27-4900�t 4€6 or I SAFE ' Fax 9 617-727 7749 Revised4-24-07 W m gpgjdia �IME TO�ti snxxsTAsrs ' ,�� Town•of Barnstable ArED�A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner - 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 Property Owner Must ' Complete and Sign This Section If Using A Builder cizoc Kep- , as Owner of the subject property hereby authorize_ 1_PNe- :' to act on my behalf, A in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. n • t • e , QAWPHLESTORMS\building permit formslEXPRESS.doc Revised 040215 r Town of Barnstable Regulatory Services �oFTNE rQif,� Richard V. Scali,Director Building Division * swaxszasrF Tom Perry;Building Commissioner MASS. 16 39. ���� 200 Main Street, Hyannis,MA 02601 www.town.barnstabl .ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICEN EXEMPTION Please P nt DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone work phone# . CURRENT MAILING ADDRESS: - city/townXdedd state zip code The current exemption for"homeowners"was clude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire wossess a license;provided that the owner acts as supervisor. ON OF HOMEOWNER Person(s)who owns a parcel of land on which or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structure such use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be consideer. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she ble for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibili for co m lianc. with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she derstands th Town Barnstable Building Department minimum inspection procedures and requirements and that he/she will co ply with said p oced s and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing A 5,000 cubic feet or larger be r quired to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTIO The Code states that: "Any homeowne performing work for which a uildi permit is required shall be exempt from the provisions of this section(Section 109. .1-Licensing of construction S ervis s); provided that if the homeowner engages a person(s)for hire to do such work,th t such Homeowner shall act as su iso " Many homeowners who use this exemp 'on are unaware that they are assumin the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licen in Construction Supervisors,Section 2. This lack of awareness often results in serious problems,particularly when th homeowner hires unlicensed persons. In is case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner ting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities quire,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:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revised 040215 r r c�/he�panvrno�2ure�o�vvGaadac�ii�eGYd .: � Office of Consumer Affairs&Business Regulation License or registration valid for individul.use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: A-9816 Type Office of Consuriter Affairs and Business Regulation ll xpiration 1e82Ek1 Individual '10-ParkPlaza-Suite 5170 ca Boston,MA 02116 EDMUND V.LACEYJ EDMUND LACY JR. (1 = A'/ I 137 STURBRIDGE OSTERVILLE,MA 026-55 -�— Undersecretary `I of valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards ` License: CS-075573 Construction Supervisor k EDMUND V LACEYJR 137 STURBRIDGE D t. OSTERVILLE-Mg 026 - ' l"n•�: Expiration: .. Commissioner 09/19/2017 Construction Supervisor Restricted to: use group which contain Unrestricted-Buildings of any of enclosed less than 36,000 cubic feet Of 1 cubic meters) space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation S this license. DPS Licensing in visit:WWH►• MASS.GOVIDPS f' E File :Edit Tools Hel p ,,.—Y y : ® C I ®�® ? �. H f = _ - - - _ (Jet A lican PROPR2006010 p d TY.OWNE r. .V, Status A ACTIVE r 269211` ' Collect . y: ' la 0 ne r , Department >_ 6300 _B:UILDING_DEPART.MENT _ � SMITH DORIS D Close/deny - _ - Project7ActrYity �34 FiESIDENTIALADDITION/ALTERATIO . . ., .. Cartractar -: , i .. : . - — Workflow Description 1 ;=, 4DD STORAGE LOFTGARAGE,REMOVE EXIST; ADD DO,ORS;WALL s f f - _ jf3usiness', _ M _ Descn t&:-2 = r Fees effective 0510112006� E PatkinV isc - Assigned to s3 Property, "A �° s' -- ... .. - - -- - - 777 �'�` �'� Pro ert /Use Y Non-Conformrn .DatesJMrsc' �Permrks ��� ' - �i.'> g �Business �. .. r - a t,; Location ... ,, .. 330 Unrt .- Existing use 1010 r, - SINGLE FAMi'LYHOME 1 Reach to ''. f S#rest PHIN'NEY,S LANE .,:` .. .._ zoning RD 1= RESLD`1 „ AdiustFees `Parcer 230130 e r. I , .Munici a-hi CENT -CENTERVILLE Escrow t p y - k � _ flood;zone �,t,..��, �s Subdivision .,. •�. � . ...: i r; M_isc:Ch s . �_.. 9 - .,i �. , :LotlSechonlPhase 0 I ropastr SINGLE FAMILY HOME z P ed use 1010 �s > .. , fr. t.7 1. i ts� 'Pa mt Hrstor" B'etween- zornng RD 1 RESID 1 'r 5', y' = s � ,. and Aurjit�History" °� --- � Locatiarndesc LOT 11 i - ;� Summ Permit CopyApp - T' t - ._ ' Permit Alerts t [ Prerequisites- �Hazrd}Restr. t�;Names, Ali-j . onds,. [ SubAddrs - [ Text t PlaryReui w p -.,.. J 3 ... ... ^y _% . .. -, €: Lmk l'nsps Prior History �Inspectrons �Violatrons Reviews . (��Open Items ; �Wairnngs.. ti Fmd-Related .. n 1 of I � e 11 f. ro y5 ry v Maintain projectjactivity detail,for the current..applicationt. r 0. . I J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map L�y 0 Parcel Application# d o 0 6 O D Health Division fNO6 _� � ��� O�.v,a��� n ' Mit# Tax Collector Date Issued / Treasurer Application Fee Planning Dept. Permit Fee e Q e, Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ;3V Y' N W N EY5 L A�L Village e1` y1�. 1 Owner k3 ��rlvt,�/V 1WV) Address Telephone Permit Request 'bPAIV-- ' " _-- P n kv--+> L<fg- 7U G-kY2hCr(F Square feet: 1st floor:existing UOU proposed 5Wir 2nd floor:existing --proposed Total new k Zoning District OE Flood Plain Groundwater Overlay Project Valuation Construction Type y� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentatignz 1Z Dwelling Type: Single Family Q Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes / g g �9 No On Old King's High ay: O Yes �No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other f�1/rt�` r'IL�- Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing 2 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas A,I ❑Electric ❑Other Central Air: O1 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: a es ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:dexisting ❑new size 21 x q Shed:Yxisting ❑new size I '-'1 Z Other: Zoning Board of Appeals Authorization ElAppeal# Recorded❑ Commercial ❑Yes LYutNo If yes, site plan review# Current Use �'t�� Proposed Use —�__ nc� BUILDER INFORMATION Z Name t i kV 0 Telephone Number SO �7 Address 33Q � License# Home Improvement Contractor* t' Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S (cl`r-J SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. F. Y 4 DATE ISSUED- ' MAP/PARCEU,NO. ' ADDRESS VILLAGE ' OWNER - DATE OF INSPECTION: FOUNDATION - FRAME INSULATION FIREPLACE ELECTRICAL: = ROUGH FINAL f r PLUMBING: ROUGH FINAL GAS: ,ROUGH FINAL - FINAL BUILDING yak k 6Q t DATE CLOSED OUT ASSOCIATION PLAN NO. ' t i The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.maugov/dia- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg bly Name pusiness/Ora T177ation&dividual : 4 Address: �a� �0��✓ YS C..i, City/State/Zip: .(tl,J��^&//d MA 0 Phone , Are you an employer? Check the•approprlate box: Type of project(require): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6. EJ New construction employees(frill and/or part time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet:t 7. [Remodeling ship and have no employees These sub-coniactrs have 9, 0 Demolition "T working for me many capacity, workers' comp,insurance• g• diag addition [N workers' Mop.inswaace 5. ❑ We are a corporation and its C� t d officers o•VleZI repairs or ad2 'ons quned.] have exercised then �'. 3. I am a hondeowner doing all work right of caemption p er MGL 1.❑ mg repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no Roof repairs insurance required.],t . employees-[No workers' 13.❑ Ofl�er . corup,insurance required.] . . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policyinferr=tion: t Hcmeownen who submit this affidavit indicating they we doing all work and then him outside c=tmctars must submit&new affidavit tndicatiag Buck lcontractors ihat check this boa must attached sn'additionai sheet showing the name ofthe sib-contractors sad their workers'comp.policy ieorn2ation. I am an employer that is providing workers'compensation Insurance for.my employees. DelowirtheyolliDiandjobsits information. , Iwarance Company Name: ' I' h-c;,#or Swim.Lk#: t Doti: Job Site Address: y/ ip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required uadet Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,50Q.00 and/or one-year imprisotunent,as well as civd penalties in the-form of a STOP WORK ORDER and a fine of up to$250,00 a day against life violator, Be advised that a copy of this statement maybe forwarded to the Office,of Investigations of the DIA fbr insurance coverage verification. I do hereby certi nder t e p and penalties of pe ' hat the information provided above is true and carrel r tore; Date: � Z 7/0 Phone#; z O,ffi ild es¢ - Do f W Mftlft ft drwk to U City or Town: Pernit/License# Issuing Authority(circle one); } 11.Board of Health 2.Building Departmen` I City/—I own Clerk 4.Electrical inspector 5.Plumbing Inspector I ` 1 Contact Persoc: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide vkrkeW compensationfortheir employees. pursuant to this statute, an employee is defined as"...every person in The service of another under any contract of hire, express oriruplied,.aial or written." An employer is defined as•"an individual,pgmersnip,association,corporation or o er legal entity,or any two or more of the foregoing engaged ' •a joint enterprise, and including the legal represeutativs of a deceased employer,6r the . receiver or trustee of an in 'dual,partnership, association or other legal entity, Ioymg employees. However the owner of a dwelling house ha ' g not more than three apartments and who resi therein, or the oemip ant of the dwelling house of another wh employs persons to do maintenance, constru ' nor repair work=such dwtUing house or on the grounds or building t thereto shall not because of such loyment be deemed tob a an employer." MGL chapter 152, §25C(6)also es that"every state or local licensin agency shall withhold the issuance or renewal of a license or permit to erate a business or to construct lldings in the commonwealth for any applicant who has not produced a eptable evidence of compliance the insurance coverage required." Additionally,MGL chapter 152,§25 '�states'Neither the co MM nor any of its political subdivisions shall enter into any contract for the p ce ofpublic work until acc le evidence of co�liance with the insurance requrirements of this chapter have been ented to the contracting fiority." Applicants Please fill out the workers' cosapensation RM ' completely, checking the boxes ftt apply to your situation and,if necessary,supply sub-contractors)name(s),ad s(es)and ph a numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or ' 'led Li ' Partnerships(LLP)with no employees other than the members or partners,are not required to c work ' CO ation insurance. If an LLC or LLP does have �Y . is required. Be advised that Ibis avit be submitted to the Department of Industrial 1 eea a policy oY � P cy �. e•affidavit should Accidents for confirmation of insurance cpverage. Als e e to sign and date the affidavit. The- , be returned to the city or.town ttiat the application for the ' or license is being regaested,-not the Department of industrial Accidents. Should you have any questions regar the law or if you are required to obtain a workers' eens p ation oliCYp lease call the Department at the listed below. Self-insured companies shoulder their self-insurance license member on-the gTETft2tc if City or Town Officials . Please be sure that the affidavit is complete and Aria egibly: Department has provided a space at the bottam of t�ddaYit.ii r you to fill a d.in the event the of Inv has to contact you regarding the applicant - In an Tenant Please be sure to fill m 1he permrt/ficeasc camber wu`ibe used a reference number. add aPP that must submit multiple per applicati m any given year, eed only submit one affidavit indicating current policy information(if necessary)and under"7oh Address"the appli should write"all locations in _(city or town)."A copy of the af5di vit that has been oifi stamped or mmied the city or town maybe provided to the applicant as proof that•a valid affidavit is on file future permits or liceas A new affidavit mustbe filled out each ' year.Where a home owner or citizen is ob . ' g a license or permit notrelate any business or commercial venture (i.e.a dug license or permit to burn leaves etc.)said person is NOT required to c lete this affidavit The Mee of Investigations would hike to you m advance for your coope ratio d should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fag er: The C 7mTn om ealt'a of MnssachusettS Dqi rtment of Industrial Accidents Office ofis 600 Washington Street Boston,MA 02111 Tel. #617-t27-49100 ext 406 or 1-077- ASSAFE P Fax#617-727_7749 Revised 5-26-45 W Mass.aQv/diz y °Fr Town of Barnstable Regulatory Services • w ' saRrrSTAB E, " Thomas F.Geiler,Director 16 9. .� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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. Type of Work: � '1(/V�o, Estimated Cost r Address of Work: 3?2,3 t/jPt Y5,- (-Ayl(;)-' Owner's Name: �W ik- -A)_ Date of Application: `'f I hereby certify that: Registration is not required for the following reason(s): ❑ rk excluded by law ob Under$1,000 ❑B�ilding not owner-occupied 2bwner 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: 0 Date Contractor Name Registration No. OR 'r Date Owner's Name Q:forms:homeaffidav RESIDENTIAL BUILDING PERNIIT FEES, APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 . o Building Permit Amendment $25.00 FEE VALUE WORKSHEET , NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONSMENOVATIONS OF EXISTING SP. C f 0 Z 1 _square feet x$64/sq.foot ti 4f x.0041= plus from below(if applicable) GARAGES(attached&.detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf .75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041 STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 µav6; co+- IltS cnP kvuVcr W r-r kqLeh 0`-l-c'wt -84A�ND SV Z / PPYt'tu A�p� —u t'cl4ArNGC9 � CXtsfi�+� 'UOCAWIwo ft-0 M M Z�y �6v w�►-�wd 3a../t� T kip sro(11 (46 C Lcc w15:ppj6j,,ja t�rj c)4 (t, fAo ve 6)Ct STING or a O V (L k(;A D 'Do a�t- ' Town of Barnstable NP�OFTHE Tp��� Regulatory Services sAxtvsTAsr s, ; Thomas F.Geiler,Director 9 MASS. 039• A,� Building Division TfD Mp'l 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: Z JOB LOCATION: num�b1er/ p n \ p �street (J7/ Qvillage G ^�' "HOMEOWNER': 1"l�G(�l�w ✓"�/CI"JVQ jd�Olb y50 J�O � � 7� Z'u name f home phone# work phone# CURRENT MAILING ADDRESS: 0 26 3 2 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/s e-finderstands the Town of Barnstable Building Department minimum inspection pr edures and require nts and that he/she will comply with said procedures and req7 ents. Sign ture 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 1` 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 L 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 oF�KE (yJP� ti� Regulatory Services Thomas F.Geiler,Director BARNSTABLE. 1*,Ass. a Building Division \Z Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 — Fax: 508-790-623, qJ�r o 6 G� PERMIT# 9)335 FEE: $ r . SHED REGISTRATION 120 square feet or less Location of shed(address) Village -�2O�NIi�0 Property owner's name Telephone number rr � Z Z;� Size of Shed Map/Parcel# l � r 60 - Si a e Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF#ANOF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q4orms-shedreg REV:121901 t_oc -r' gN, FP' oPE v LI N ®T -fc R__A_1,-rE STANDARD LEGEND /'\ rr�- ___.._. NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY /ter,'/" Z, EDGE OF DECIDUOUS TREES ..��... .. _.. / \ � EDGE OF BRUSH J7 ORCHARD OR NURSERY V V EDGE OF CONIFEROUS TREES 3 I \ MARSH AREA I � �— / i EDGE O/ J F WATER /�--- K*i� — DIRT ROAD ~r H _ DRIVEWAY �—PARKING LOT 42 P• AV ED ROAD I� — — — DRAINAGE DITCH # 342 PATH/TRAIL PARCEL LINE MAP 326 �— MAP# E• 021 PARCEL NUMBER AP 30� #367 —HOUSE NUMBER -- 2 FOOT CONTOUR LINE 12 't —z0— 10 FOOT CONTOUR LINE Elevation based on NGVD29 J ❑ � r 30 tt! ;•�4.9 SPOT ELEVATION l c:x=x:D STONEWALL 2 i X_....._.._x... FENCE \ / t•*'� � ,�` RETAINING WALL 44 ❑ l -- —>--1—a--�— RAIL ROADTUCK ,__ ....- TO NE MAP f J Pao `1 SWIMMING POOL PORCH/DECK 4 5 ❑ 2 / J � 0 BUILDING/STRUCTURE # 3 E - = DOCK/PIER f / 4�1 HYDRANT \ " J MAP 3 0 O e VALVE MANHOLE O POST O FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T .o SIGN ® STORM DRAIN T N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimehics(man-made features)were interpreted from 1995 aerial photographs by The James 1"=100'scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE Q TOWER " e .0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimehics,topography,and vegetation were mapped to meet National Map Accuracy Standards 1 INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessor's tax maps. > LIGHT POLE O ELECTRIC BOX Assessor's map and lot number —?Uo........ ........0) *THE Sewage Permit number ... SEP"C SYSTEM MUST .. .... .... . V CO� 9TADLE, i House number ....... �:.......................................................... C0114 rags TITLE fi ., � � ENVIRONME ��wara�e TOWN OF BARNS rBE COTo s"ND: BUILDING INSPECTOR ,, APPLICATIONFOR PERMIT TO .....................................:...........................................................................:.:......... TYPE OF CONSTRUCTION .............................................:....................................:.....:............:............................... i .................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following, information: Location .........., ..."J-- .,e, -:...... r.�.�..�..L�....................................................... ProposedUse ......... .PP"...��' i..`�........ . ................................................................................................ ZoningDistrict .... ..............................................................Fire District ...................................... . Name of Owner ..`..a.1•.. ........ ..... �..e�..�1. ,.. ................Address :7. .f .... Name of Builder : .............................Address rPY!n�an�.i�. ./ ............ Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ............a....................................................Foundation ............................. .. ............................................. Exlerior 1"J !tz�dx.It..................... ........Roofing �.S.n.�15./.:1. ................ Floors ....&AA.Je—. -.�a?r�:�c►�. ................. .Interior 0)).ne.......n a.h..P.`1./.?e..� ........... Heating ... ':...........n.................................................................Plumbing .......—..—....�. .. .........®..... ..`� ........................ Fireplace ....�ti . ,..:........:.....:..............:.Approximate Cost1 � ...... ��. Definitive Plan Approved by Planning Board ---------------____-----------19_______. Area ..... c? ....... • ............... Diagram of Lot and Building with Dimensions' I g 9 Fee ............../i....................... ... SUBJECT TO APPROVAL OF BOARD OF HEALTH v v :D , n t a YO ire �t2r is I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ............................................................... i Hakel, Carl P. A=230-130 y 3 No ..217!t . Permi# for ...AddAri..to••dwe3:ling ............................................................................... Location .....330—Phin tearAs...La....................... ~' } ...............C.entervillp............................:........... Owner ..Carl..P... .Hakel................................... Wood Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................. Permit Granted .......... ..........19 79 r Date of Inspection 19 Date Completed ...... � .'3............19 ERMIT REFUSED N.�. ... �. : ....:............. 19 . . ......6....................................... 4 Y . �. . .. ..................................... - � ...... 3............................................ co M0 . VS , Approved ............................... 19 w . ............................................................................... 1• ,_ —