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Home My WebLink About0019 SUNRISE ROAD t II a e �optHe r Town of Barnstable *Permit -7 P Expires 6 nrnnths from issue dale Regulatory Services Fee_ + BARNSTABLE, +{` moo MASS.039. � Thomas F. Geiler, Director Argo�,t a, Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 . wwW.town.barns table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY f Not Valid without Red X-Press Imprint Map/parcel Number , rProperty Address ❑ Residential Value of Work ��.�.C� Minimum fee of$25.00 for work under 6000.00 �.c Owner's Name & Address---� C d � �•_ n Ur 2C Contractor's Name Telephone Number - 6 I Ionic Improvement Contractor License#t (if applicable) Construction Supervisor's license#(if applicable) ❑Workman's Compensation Insurance a, �y �� Check one: ❑ I am a sole proprietor NOVa [�l am the Homeowner 0 6 2008 ❑ I have Worker's Compensation Insurance TOWN O1= BARNSTABLE Insurance Company Name Workman's Comp. Policy#-- Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) �te-roof(stripping old shingles) All construction debris will be taken to �" --- ❑ Re-roof(not stripping. Going over existing layers of roof) C�J Rc-side ❑ lZeplacement,Windows/doors/sliders. U-Value (maximum .44) *Where required. Issuance of this pennit does not exempt compliarice with other town departmenrregu hat ions,i.e. Historic,iconservation,-etc. ***Note: Property Owner must sign Property Owner er of Permission. C. CX, A copy of the Home Improvement Con a ors License is required. { Y I c SIGNATURE. ❑' � �= Q: WPFIf..ES'.f=OR S\hOild g ennit fornis\ PRESS.doc Revised 10060 Cti The Commi onwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111' wwwanass.gov/dia Workers} Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gib Name(Business/Organization/Individual): . K ,&-' �4 k Address: , City/State/Zip:� iti;� U I Phone.#: Are.you an employer? Check the appropriate box: Type of project(required):, I.❑ I am a employer with 4. [] I am a general contractor and I 6. El New construction . employees(frill and/or part-time).* have hired the sub-contractors Remodelin 2.❑ I am a'sole proprietor.or partner listed on the attached sheet 7• ❑ g ship and have no employees These sub-contractors have g• []Demolition employees and have workers' working for me in any capacity. 9• []Building addition [No workers' comp.insurance comp, insurance.$• required.] 5. [] We are a corporation and its. 10.❑Electrical repairs or additions 3. ] I a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance,required.]t c. 152, §1(4), and we have no I3 ❑ Other employees. [No workers' comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provido their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verific 'on. I do hereby c rt' der the pains nd penalties of p ry t the information provided abo is true and correct. Si ature: Date: 6 • ?`2 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#: JLIXIL I All" .JVILl JL 11,8 SAI �daoa�a� Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hiie, express or implied,oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced:acceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL ehapter..152,§25C(7)states "Neithe'r the,commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of complariee with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Comparnes'(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or 'Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person,is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number;. e Cow.onw(e :th of Musaehwou DQpaztnent of lndws al A,cei&nts Office of Invest gatlQns 600 WaAingtoxi Street Boston,.MA 02111 T . # 6.17-72.7-45-00 ext 406 or 1-977-MASSAFE Fax##617-727-77-49 Revised 11-22-06 www.mass.gov/dia z� 'Town of Barnstable �of Teti Regulatory Services BARNSrABLE, . Thomas F. Geiler,Director MASS. 1.639.. ,�� Building Division lED µA't A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: S08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: m g",. number n n street r village "HOMEOWNER": _ name � home phone work phone# CURRENT MAILING ADDRESS: 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"certifie he/she understands the Town of Barnstable.Building Department . minimum inspection procedures d re ements and that he/she will comply with said procedures and r ts. J Sign re of omeowner 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 fonr✓certification.for use in your community. Q:forms:homeexempt SMErOwti Town of Barnstable ` Regulatory Services t &lR WASLE, w y WASS. $ Thomas F.Geiler,Director a Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: S08-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, 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. Q:FORMS:OWNERPERMISSION /off Asse;sor's ma and lot number ...................... ........... iG �nh� iD� F?ME T i� 'r Gj sus Tl9w/L rfu- /T a . Y v)t Q! t. .� o ewage Permit number — INS LLED (IV House number ........................................................................._ r ��d�r�$� 8� T$ o "�639 NMEN�'�L y REG LAi`joiys � TOWN' 'OF ,BARNSTAB BUILDING"' INSPECTOR . APPLICATION FOR PERMIT TO ........................................:..:..J.a�..... ..,�.G� ..............................................:.. TYPE OF CONSTRUCTION ............C.P?4W0.<,.9......... '..................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for appermit according to the followingf information: Location ...47 .5v•V A15l: . �t® 1/ C. �l - 7.. ...............: ............................................ ........... ........................................ ProposedUse ...�f.le'L•v.c .................SV. ` ....'��a�'! ^............................................................................. Zoning District ........................................................................Fire District .. P!Ll ............ J� d��. / ................. Name of Owner ..(/ .......... Q12. F .f .....................Address .`.�j... .5!.v ;S ....P�....of............. +°(.... Name of Builder' ...:. .fit!ll� .............. Address J "�... ............... ................................................... Nameof Architect ..................................................................Address .................................................................................... �Qv 2 dNumber of Rooms ..................... .........................................Foundation ... . .......,...............:.... ...................... ' Exterior 45:d43'L........ ...... ..� �.!l.......:Roofing ......... �: .` Floors .................................1...................................................Interior ...��.. ... ..�....�U.G.. ��............................................... rie-orn-g x:n-:?:..:....... a /.:��2................................ ...Plumbing ............................... J Fireplace ............AfP.-�� ......................................................Approximate Cost .....��f:................... ............. Definitive Plan Approved by Planning Board ________________________________19________. Area ..u.�f................. Diagram of Lot and Building with Dimensions Fee .......... . ��............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. Name .... ` ...................................... LORRAIN, PAUL 24386 ADDITION No ................. Permit for .................................... mingle Family Dwelling Location 19 Sunrise Road � ................................................................ . Centerville ...................Paul............................................................. cg� Lorrain � ;� t j - Owl6er .................................................... . - - - . ............... f Frame Type,of Construction .......................................... % ................................................................................ C <7 Plot ............................ Lot ................................ Permit Granted Sept2 ,.....................t .......19 A. Date of Ins cioi*o-e P 4 , I Date Completed ..... . .... ......<I......19 I CZ z-1 fit Ai Assessors ma and lot number ....................... ne p G L`.�s.�ly«.. <_ F THE T jewage .Permit number ......................... .............................. Z BA"STADLE, i Housenumber Mb a........................................................................ O 79• �0 TOWN OF BARNSTABLE . BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... . Ed / 17 rs�,'.1, '....................................... / > n6� i�E�lfir-sG TYPE OF CONSTRUCTION .................:................................................................................................................... ,. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... !- ( . G.. .... ................................... ..................... ..................................................::...... ....................................................... Proposed Use ... •.;1a -rf� '�+-'L `arl„� �c� .v-• .. ..........r ................... Zoning District. Fire District .. ...........:..........tV5lef �i9 U l �2.a2 r�v ... C' ;vfe57�'r�{1�G' Nameof Owner ..:......:............. .... .....................................Address ....................................................... Name of Builder' ..... /. Address ............... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms toy.............................................Foundation ..r r�•2�^G. Exterior ... .. Roofing ...>�..... `..' ; - r f i'i 4.ti..d cy f r F... .!� ..... Floors 'r Interior F ................................: .................................................. .................................................................................... Heating g ' . ............ -',"'. ......... ..Plumbing / G ........ ...................Fireplace ............ '' '. { '.........................................................Approximate Cost ..... Definitive Plan Approved by Planning Board ---------------____-----------19--------. Area �`- f ...................... ..... . ........... Diagram of Lot and Building with Dimensions Fee ............ .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name v'`' .. .......................................................... ... .. LORRAIN, PAUL �v �O9,=251-108 24386 ADDITION No ................. Permit'for .................................... Single Family Dwelling................ Location ...19 Sunrise Road ................................................ Centerville ............................................................................... '� Paul Lorrain Owner .................................................................. Type of Construction ..Frame........................................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ,, Sept. 21 19 82 Date of Inspection ....................................19 Date Completed ......................................19 T joA PST PC) . /yl�r FST ,fvo , � y0o. F � , { � � f F � � � � � � � + � F 1 1`; � � � � I F�'. I � � � � 1 � � , � � � I � � . � � � � �� 1 I ( ; ,; � � � � 1 * , � �� , i � �. I t ; � I � f. . � I � , � � .� { � � � � � � � 1 f t I � � � I � t � � � r f I i _ f � i ! � f