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0014 THREE PONDS DRIVE
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P ..,,,> V�v PU;1., bt a; xs � !#nxt:'t f l ,.:6 r` r tCtE + �d;rr�. r F•x. e Jtt, aAr4:,7, z+,: � . 6 .,{ ,,� ,: :: , , a ., ru,k.< Sdr�,C:,. .•. E f�l.�r . . ,,.F a{.,.:�,s e r�„':...f. � e e_, ..x .:t, tr ,ria ,:, @fa.#'Sei s. ,.6-.1 :r,. s !,�a,b,.$5•- ,�., ,:3,1 „rj .�' .,y.t4 J., aq�b '•?;A'�4, t,s,. Ita,,., � av':dp•:5 tw. ., f a' .n;5 ah,,,,,zr F � ,, a � pp, �, ?�," }!y k �{, .p� °� �i{�iu� .�,i:.t, f•P i t f t Y d�'„a �, s".>o v rl+ 'Y :"? ,.. :$+r,..; •:k!' ,:.s�i" D'#'-T•.- '�Ct( !'t�r $I se�A-', t�s+ •�.7),,�.S�o�'•x%T, .s r'X�}',,."� r'�i 2,.n:. 'f pY:l.6� >s spa ,p c,'tt., �::,f 4;< r ��'fi. , Town of BarnstableB, uilding ' 7 1k „.,1 m•,�n ; .,.?3.w +, e Post-This Card So That its=U�s ble;From the Street A 'roved.Plans�Must be=Retained onKJgb and;this Card Mustbe,Ke t „ h «: RA}tTttTPArlLE, ., 6 £Posted UntilFinal Inspection HasrBeen Made �� � , Permit earie° Where a Certificate;of Oceu,pancy. s Required;`suchBuildmg:shall Notbe®ccupied4until a Final Inspection.has been,,mede . „s Permit No. B-20-667 Applicant Name: Walter A Alexander Approvals Date Issued: 03/03/2020 Current Use: Structure Permit Type: Building.-Addition/Alteration-Residential Expiration Date: 09/03/2020 foundation: Location: 14 THREE PONDS DRIVE,CENTERVILLE Map/Lot 193 182 Zoning District: RC Sheathing: Owner on Record: MAILLOUX,JEREMIE JOSEPH Contractor,-Name: ,.VINTAGE CARPENTRY INC. Framing: 1 ContraCtOrpLlCen'se 1,09457 Address: 1611 MAIN STREET 2 �� WEST BARNSTABLE, MA 02668 Est Project Cost: $7,000.00 Chimney: Description:' STAIRS'AND LANDING-BUILD STAIRS AND LANDING FOR WAY OF 9 Permit Fee: $85.70 Insulation: EGRESS SECOND FLOOLR ON THE LEFT SIDE OAF HOUSEPaid $85.70 A �A d�CCU Project Review Req: Date 3/3/2020 Final:QK 3' ' �t Lscrn. Plumbing/Gas Rough Plumbing: . _ . .. . rDO This permit shall be deemed abandoned and invalid unless the work a thonzed by this permit iscommenced withinff cial six months after Mn Final Plumbing: 'All work authorized by this permit shall conform to the approved appikkibn and the approved construction documents for which�this permit has been granted. All construction,alterations and changes of use of any building and structures,shall tie in with the local zoning by laws and codes. Rough Gas; This permit shall be displayed in a location clearly visible from access sheet or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: Ar ., n nd Fic Official r r vi• n hi rmit. The Certificate of Occupancy will not be issued until all applicable signatures by theme Bwldi a Fire,Officials are' p o cled o � s pe Electrical Minimum of Five Call Inspections Required for All Construction Work s 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue ingyisanstalled _ :, Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: oFtHE rqy� 318b1 \N1811V1q j0 NMp o,Application Number.. � U ( HAMsAB p rmit Fee.................................Zoning District..... .... 1d3 a �NI®1r''fn a TotG Fee Paid............................................................... ...... rl�' 2 2 /� TOWN OF BARNSTABLE �� Permit Approval b On..3.. �-.2GY PPY...... . ............. BUILDING PERMIT ' Map................. .................Parcel........ ...................... APPLICATION Section 1 — Owner's Information and Project Location Project Address SeANNED Village g Owners Name — MAR 0 31010 r Owners Legal Address / / ✓, j�;a t,,,�a ;,a l� City &V/ OAWSS iO4 State Aw Zip Owners Cell # 5-09 3 71('6 E-mail 'I LA yg;K y - Section 2 -Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 - Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild d Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Foundation Only Other- Specify 5 s L A&c , Section 4 - Work Description r� dr 4Feilyme 5 OV, 4 Last updated: 1/31/2020 i Application Number............... Section 5—Detail i Cost of Proposed Construction!7iQ06 _Square Footage of Project Age of Structure , ' Dig Safe Number # Of Bedrooms Existing _Total # Of Bedrooms (proposed) k 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6— Project Specifics a tfi 0'.i 3 ❑ Wiring?i t fi 0 �A�Vo ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal /�On Site Historic District ❑ Hyannis Historic District ( ❑ Old Kings Highway Debris Disposal Facility: �///�- I am using a crane C Ye(ER o Section 7— Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8— Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 1/31/2020 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A, m / �C&,L DATA SCANNED MAR 0 3 2020 out, - 'H nqu raS� Two ns G ' � AWI.Q�� j , ! .Z x9* WE 'c�a.�,r �s ry t Y '� E � ,^•t- 6 r : M ""° s oil as a: G a s UR'f� �WW f A -�'' r �� q. '�y z"�-w*>w t�k •MIT - r t�, i$� ,, ata.F4`�"`a '2tiri a'c. 1t• .< a" as .ki t .} ^�' �� '` P �Ji �-•a-3 ^�-ern �'`�g E ��, ��a �•^�r��" '.M1 "' WWI x g,. o� R w Fre. e a. Eel,'Why; r � �0 3� v s Viz, a�+",.,.raa�•+�'%#. �;s� � �', iha+dam IN 1",z _ p� # wy� Ogg ' r }1 3}Yt r,<� R Z hG a r: d n3 f 'e �FCfi Pk7 �pRfptad'. ArQSN4Tf '.tKt� �a� a oA � 5� � 1 j' fi�i'�� f� $�'����' • ✓y ���� #a � ,tr � � ,,qqywry �r 1 a' > tza �4,`,�,•�i,`�. y,Ya° j � HbRTttu�rY X•.aY� � t'�,: a _b��� �, t �"T�°"r� •r ��� �� sx,. * § . - 5 •4j 5 S��y� .T� Y.M .- - e x ;gib._ i k. •- .. . - l � %-f,.x � .. .. 7ve -•ram f � ��/�,L.�� / r � fi d r � '..mot.. -r]'f���r1` �• �{ .�P +�2'�'>� �a _ ;�y o- �Y• 111 r ;�y�y i "�.i% _ y� The Commonwealth of Massachusetts Department of IndustrialAcciknis Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciams/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatim/Individual): 1// C Address: / City/State/Zip: 4 2Z98Phone M 0 " % 0 Are you an employer?Check the appropriate box: Type of project(required): . 1.14 I am a employer with. 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [ New construction 2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition working for me in an aci employees and have workers' Y capacity. 9. ❑Building addition [No workers'comp.msurince Comp.insurance.$ , r ed. 5. ❑ -We are a corporation and its. 10.❑Electrical repairs or.additions ] officers have exercised their 11. Plumb' repairs or,additions 3.❑ I am a homeowner doing all work ❑ � myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no 4 employees.[No workers' ME Other • comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then him 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 4 employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Y 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ClJ Policy#or Self-ins.Lin M. U/A I I d!!4 D 2 Expiration Date: Job Site Address: q nt,e afj s d�,:P City/State/ZiP4AAn, t 6-a% C?°W 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,aswell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify_under the pains and penalties of perjury that the information provided above is true and correct: Signature: 0/& Date: Phone#: S019 991 1 0�e F[0jTk1a1only. Do not write in this area,to be completed by city or town official n: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.EIectrical 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 iri the service of another under any contract of hire, 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 constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(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 retained 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 an questions the law or if you are to obtain a workers' y y� �� y r�� 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 firture 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 to 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 bike 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: ' The Commonwealth of Massachusetts Dvm tment of Industrial Accidents Qffitce of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia .'..�' �P �/'(117Z/l1ll�GUtPQLlf1 O���ZJdCLC�[G'3P�lif _ office of Consumer Affairs&.Business Regulation HOME IMPROVEMENT CONTRACTOR. TYPE.Corporation Registratlon' Expiration 109457 .�,09/15/2020 VINTAGE CARPENTRY INC X WALTER k ALEXANDER�, 12'KIRBY ST y SOUTH DARTMOUTH MA.02748 Undersecretae Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructibri`dpervisor CS-045315 EXpires 03/27/21 WALTER A ALEX ENDER{ 12 KIRBY STREET SOUTH DARTMOpUTH MA 027W- t 1)yS t`� Commissioner v-- 3 _. y SA IPY R a Vk �' s a< ` r ` ,t c ° air \` s _ \ �. .` \\ *Abh \ �. R ON mi u a / °� ya `\ ~ w 21 kila \ 92 Av All \ \ a l, �> w\ No \ \� v \\ ` 40 \ ' Mp,, Q \ va S v alai v IV 01, a� fi16, t` p ? e C& der p � Am \ p \\A ApplicationNumber........................................... Section 9- Construction Supervisor Name V C,� Y��Y Telephone Number �Z 999 ,� 0 t �, Address /2 K 1M)-1 City �'. : State Z Zip 2 � License Number CAS -O'�5,31ff. License Type C a Expiration Date .3 / 6 ' Contractors Email (/1 ntaC.ay ao, f mrr7 Cell # 909 961 9900 T I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature U&4) a ~ Date._ 2� 1A a I` Section 10-Home Improvement Contractor- Name _ v Name C// Telephone Number &!2 992--nog, Address /� /�I+Y city rn State Zip, Number 10 Y5 Expiration Date 9/ 0 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a.copy of your H.I.C... Signature PA aZM4M& ... .Date Section I I -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number F I understand my responsibilities and Ve les and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date q' APPLICANT SIGNATURE Signature �� - r_ Date _3/.�kao Print Name Y 6)t X2,ndjoy "Telephone Number gag -J9 a !! -- E-mail permit to: �/ aC Y fv4 d c® Last updated: 1/31/2020 Section 12 — Department Sign-Offs Health Department Zoning Board (if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ g Conservation For commercial work,please take your plans directly to the fire department for approval. Section 13 — Owner's Authorization I, � P�niY, / �,�//a,� , as Owner of the subject property hereby authorize_IAIUa. A lew.,A to act on my behalf, in all a matters relative to work authorized by this building permit application for: (Address of job)kidn ature of Owner date Print Name �i 1 d f i i • i Last updated: 1/31/2020 , t �It, 1VG 0,920 It Ao 20 Ax a� A y Thr-ee Avds- 0 12 aEpI. 31 a��, �I,.: _ � • y���/� .. y /Y v _ 84 1l AIV& LA F R m THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�-C&F- T� L DATA, ',�� s..-,. y ^air Vq,�..�,,, r^ x`" •""'"�6„`, :. ' ka` s e �w h TOWNS OF BARNS = T�I'�' Permit No' _ Bli lftg'Inspector > ,eiw Cash 1 a � OCCUPANCY 'PERMIT Bond' _ t Issued to Taf�;l Treee M Address " Y o 7777 Wiring Inspector Ir!sPection date Plumbing Inspector f r ,_ s A Inspection date 5 cras .lI1S peptOr } r T ,}-d `p ° C`.'.rya ,s"4"t:. c 'v" • u,.., me a .t �. i"f ,�ry, � +•wYection date ri jr ,•Engineering Department � 0� � C%C', Board'of Health z 4 Inspection date l THIS PERMIT WILL NOT BE VALID, 'A": THE BUILDING SHALL NOT BE OCCUPIED. UNTIL., SIGNED BY THE BUILDING,INSPECTOR, UPON SATISFACTORY COMPLIANCE REQUIRE MENIIS 'WITif 'TOWN AND IN ;ACCORDANCE WITH SECTION 119 0 OF THE MAS3ACHUSETT$``ATE „_BmLDING CODE. ' 1 f . w #1{ r ::: •f sY .», 19 $ w•. .R b :max' • ••••••w/.w '�'�. �rP�'M�� _ � }�.i Budding,Inspector .e- TOWN OF BARNSTABLE 24 79``_ Permit No. _----.-- ,AUnA Building Inspector u.. Cash --- ---------- eSO OCCUPANCY PERMIT Bond Issued to is(- is bets a s n ia'.'- Address 7 ? n pP'03^nc, rtr' i l e Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .. . mil' ..}�` -_!`-�' .:f :.-• e� ...................................................... 19......«« ...........................................«.............«......------«....«......................«..«.«... Building Inspector 'THE .-.-Town of Barnstable Permit# 1?)"- 1 1- 6 SS mont rom issue date ;.r,Regulatory Services MMSTABLEF y '$ Richard V.Scali,Director fp + Building Division Paul Roma,Building Commissioner, 200 Main Street;Hyannis,M.A.02601 �. www.town.barnstable.ma:us �� Office: 508-862-4038 r Fax: ?V -6230 EXPRESS PERMIT APPLICATION.-- RESIDENTIAL ONLY . Not Valid without Red X-Press Inwrint 4 Map/parcel Number v - - x.. �14' _ cis°{�r;v C°CA e Property Address )Inree (1 2 tV�� i - ✓❑�Residentiai f''Value of Work$ _3;w Minimum.fee'of$35.00 for,work.under$6000 00 Owner's Name&•Address. f C M%el Contractor's Name l t trvVf?f lmkt,Co - . Telephone Number .� -2Co4 2�1(05 Home Improvement License#(if applicable) 196®(nl Email ffMACCO(t6C6i. l�WnO��} •CAM Construction Supervisor's License#(if applicable);!' CS - Dq 1223 :k k ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I the Homeowner, I have Worker's Compensatton Insurance Insurance Company,Name' �e�CV>ti'f1 5 �U.t�tXJtI U[Qf1Cf" Workman's.Comp.Policy# lbcc JM50\(A%(O1�0((c ~ Copy of Insurance Comp lianceCertificaU'inust accompany each permit s Permit Req st(check box) [ Re-roof(hurricane nailed)(stripping old shingles) All constructiondebris.will bejt ken t IS Re-roof urricane nai❑ (h led)(not'stripping :Going over existing layers of roof)., Re-side f.wind . , ❑ ReplacementWindows/doors/sliders.U-Value (maximum.32• )#o _. � ows of doors'.. *Where required: Issuance of this permit does not exempt complian¢ with other town department regulations; e:Historic;Conservation;etc. > :.N. ***Note:. Property Owner must sign Property Owner Letter of Permission. ` A copy of the,Home Improvement-Contractors License&Construction Supervisors License is required. ;SIGNATURE: C'A+ cLo Q:\WPFILES\FgRMS\6uildmg permit forms\EXPRESS.doc 01/25/17 v , a Deparhment[rf radaslria2`Accidents- 600 WaslibLgioxi S`6wd ` Boston,MA 02111 G'" ' tvfv►�a�:c���dia - = Wkw1mrs, C Iusurauce Affidavit:Euildexs/Cuntracturs/Medrkians/Plmmbers cant IufmmiatinII Please Print Name r w nda� � cfty/staff a Ale), Phone.4'k- —4& ,A 2Y(s1 Are you an employer?:Checkthe appropriate bar: Type of project(requirecl}: 1.211 am a employer with 4 ❑I am a general contractor and I 6. ❑New oonshmcfibn employees(andforpart-dime).* have hired the subr-coatcactaas 2.❑ I am a sole prop: etor orpartner listed on.the attached sheet 7. ❑Remodeling sfi£p and have no employees These sub-cemtractors have g_ ❑Demolifion .. w far mein a employees and have wod rrs' °� any •` 4..❑B,uild"mg addition , [N¢Wod:ew comp.im%U- ce comp.insurance-1w required-] 5. ❑ We are a corpozaticm and its 1OL❑Electrical repairs or id&ffous of have exercised their 3_❑ I am a homeowner doing all words 1L❑Plug repairs or additions n7mdf.[No workers'rnmP- rim of won per MGL L_[�]R ofregain inc c.15.2, 1 andwre have insurance ietpzir•ed_�! � (� mo employees-[No workers' f c, 13_❑Oilier cam-insnaame -] •dap app��at cber�sbos�l mast also fiIlo�the sectionbeTaw�iag 6ieawa¢Tceis`comp�satinapoTicgi�ofmsaa� #I ameo�vners wbD Sub¢aEt fb Ada«iu�icatiug Y eie 8m�tdF wo�c and Hiea hie autsid�[omn ntsmnst submit a neW affid1Yst iudies>ina=d ICaunattostititt e�eet ibis bmc must gVachr��.additi�al suet shofiiug tine n�of the snb�a�cmoa snd state whether�notthose�ritieshsee employees.Ifthesnhtnaftactnubweemployse,tfie}'mnstpmvi&t ek wadEen'comp.poliynumber- lam an EdDiv is AsrpaHg.y and jobs*e trcfibrinaliart, // � /Qf� r //- Insurance Cc /`�Cd(�/'1811f5 >KJ� :/_Q.I40A21LZZ Policy 4-orself-ins-Lic_; (t)C COM R J?&726 to apirahaaDate: -? o�7 Job Me Address_ I� X-ex /odrd� j ywl t e 'CitglStEWTAP. 6A lee V i e ,A4+ Attach a-copy of the warkere compensationpolicy decl�rafion page(showing the policy nusaber and expiation date): Failure txa secum coverage as required under Section 25A of MGL a 157 can lead to the imposition of criminal penalties of a fine up!o I,540 Oa sadfor one-yearimPfiso�ent, well as rivil peualiies im the fain of a STOP WORK DRDERand a e of uplo$25&0!0 a clap against the violator: Be adidsed fiat a copy o€this statement=.ay be forwarded to the Office of = ' Imrestigatiom of DFA for insuroom coverage mrificafion T do ker4zIiy andpziiaMkYafpzdW7 thatthe irffarwrafzvnpnnik s dabmv h truce and correct lz= Sionatore: i 2 '. Phone OjFcial aw aanIy. Do not wrRe in flies area,€cr be.=mpfeted by snip artattan rjoWal City or tan=" PeruidlT;sense f " Esmag Aut1writy(cnr.Ie ow): - L Board of Health r:E.BmEffing Department 3.CAyfrown Clerk 4L Electrical Inspector S.Plumbim g Iusltecfmr`, 6.Other Com#act Person Phone#: _ Information and Instructions r N. masmchoseft Ge3ieaal Laws ffiZptW ISZ regM=all may=to Pam&wwlcers'coa�ea on fni theiF e�Ioyees. this Stgtofr,an arpinym is defined as.=.every peasanin.the service of another mider any contcar,E ofbire, r express or implied,oral or writs An fzT&YEr is define d.as"an mdi4i3 A per,assocfion;c oxpora oa or other legal extiy,or any two or more of the foregoing=gaged in:a joint etPdprise,and inclndmg the legal rep==b&W of a deceased employer,or the receiver or trvstes of an individual,palt=Mhrp,association or otherlegal entity,employing employees- HovPever the owner of a.dymMmg horse having not more than 113ree apartments and who resides therein,or the occupant of the- dwmllmg house of aoothm who errlgloys persons to do mabt===,c av1r=t;on or repair Work.on such dwel ing home or on the grounds or bmldmg appnrEen thereto shallnotbecause of such employmentbe deemed to be an employer." ' MQ,dupter 152.§25C(6)also states that"every stria or local Rcensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct bufldb3v in the cormmonwealth for any applicant-who has notproduced acceptable evidence of compL- ce with the insurance.coverage regafr " Additionally,MGL chapter 152,.§25C()states¢I mffierthe eCmm�lwf'=alfhnor any ofrLvpohtrcal subdiv].slOns shall PM ter fi tD any contract for theperfnzmaace ofpublicworkuubl acceptable evidence of compliance with the hmn-ance.. roTnrem nts of dais chapter have been presented to the co g anflaozity:' Applicants PIease 5II oht the workers'compensation affidavit completely,by g the bo=that apply to your situation and,if necessary,supply sob-coniracbor(s)name(s), addresses)sndphonenumber(s) alongwithffi=certificate(s) of -btTinsurance. Limited Liabdity Companies(LLC)or Limited LiabPartnexships(T I P)with no employees other than.the mr-rh7ers or partners,are not requhed 1n carry workers'compensation ce- If an LLC or L P does have empIoyees,a.policy isrmpire . Be advised fast this a$dayrt maybe snbmiftedto the,Department of lndnsfrial Aecideats for con5nnaiim of fiMn=ce coverage. Also be sure to sign and date the aidavit: The affidavit should be mtrmm(--d to the city or town that the application for the permit or license is being requested,no t fire D ep arhnent of „ .A- =is_ Sbnv.Idyou have any questions regarding titer la:v or ifyon ate regviredt3 obtain a woIkM' compensaiaonp �Y,please,lease call the Department at the numbm listed below. Self--fion ed companies should enVz their self-insurance lic mse nmber on the appropriate line. City or Town officials t _ Please be sou a that the affidavit is completes and prin:becilegRly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the office oflnvestigaflom has to contactyouregailing the applicant. Please be stir=to fill in the pen� itlliccase mnnber which will be used as a refimmce nnmber_ In-addition,an applicant that must submit mutliple pe=iVlicanse applitmfions in any given year,need-only sabmit one affidavit indinsfingcun ent policy infaanatian(ff necessary)and under'Job Site Address"the applicant sliould VMtr-"all locations in (may or town)_"A copy of fiber-affidavit that has been.officUly stamped or n1m3ced by the city or town may be provided to the applicant as�proo-fthat a valid affidavit is on file for bltm peunifs or licenses Anew affidav�tmvst be bIled out ParTi ' year.Where a home owner or citzen is obtaining a license or peomit not relairr7 to any business or conunea-c�al�� (Le-a dog license or permit to bum leaves ete.)said peasan.is NOT req�d to complete this affidavit The office of Invesdga ions would like to thank you in a ce for your coopexaiion and should you have any questions, please do not hesitate to give us a call. The DepartmenfS atidress,telephone and fax numbem_ 'F]�e C.O n t E c)f Massachmetts ' •, . met af1idlAoDidenta . face r�X�tio� . t'm waahakan Stl-,d B MA 02111 Fax 6.17 727 7749 Revised¢24-07 .m a s9.9PgIdia- i dF"E� Town of Barnstable Regulatory Services ' MASS. ` Richard V.Scali,Director 1639. Nua Building Division Panl Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder --T—el 2t'M I L /rl ►L wo K , as Owner of the subject property hereby authorize M CP t W TQQ61 -Tnc I&9k l(M ye% to act on my behal f in all matters relative to work authorized by this building pertnit'application for. l %ds rec riy n (VA I (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are perfofnned and accepted. ' iue3- S' f Owner , SidnIture of Ypplicant, -J-02 M1e MA«LWh ,+dl Iwer Print Name Print Name , 9, I3 I�- t Dae QTORMS:OWNE"ERMISSIONPOOIS Town of Barnstable Regulatory Services Richard V.Scali,Director t Building Division ' * sestvsrAI= Paul Roma,Building Commissioner MAM ��� 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: JOB LOCATION: number strut - 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. y 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 requirements. . 1 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. I 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-097223 Construction Supervisor KEITH OLIVER 124 NEW HAMPSHIRE AV9.=. SOMERSET MA 02726 Expiration: Commissioner 0111812018 Construction Supervisor Restricted to: s of any use group which contain Unrestricted-Building less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetl of this V State Building Code is cause for revoca�A S.GOV DPSIcen` DPS Licensing information visit:Wes- z i A6 O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/11/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Joanne Bretton Southeastern Insurance Agency, Inc. PHONE (508)997-6061 FAX A/C No (508)990-27 31 AIL 439 State Rd. ADDRR :jbretton@southeasternins.com P.O. Box 79398 INSURER S AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER Merchants Mutual Insurance Com 23329 INSURED INSURER B-AEIC M & E Contractors Inc INSURERC: 281 Orchard Street INSURERD: 281 Orchard Street INSURER E: New Bedford MA 02740-3274 INSURERF: COVERAGES CERTIFICATE NUMBER:2016-1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER D Y Y M D/Y Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE TO RENTED - PREMISES Ea occurrence Soo,000$ BOPI086100 7/6/2016 7/6/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 g POLICY❑JECTT LOC - PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: - $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS peracdde t $ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5 000 o00 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION CUP9147937- 7/6/2016 7/6/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WCC50050148672016A 7/6/2016 7/6/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE - .. Joanne Bretton/JB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS11125 rgmamt Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachu-setts 02116 Home Improvement Cdazor Registration Registration: .185061 Type: Corporation Expiration: 4l19/2018 Tr# 287999 M & E CONTRACTORS INC. MARTHA ALAS ? 281 ORCHARD ST. w NEW BEDFORD, MA 02740 44-1 Update Address and return card.Mark reason for change. SCA 1 d'o 20M-05/11 Address Renewal Employment Lost Card ' ��e Tpa�rr�tarztrreaCt�ol�C�il�GfcJ�aolt�Je��.t Office of Consumer Affairs&Business Regulation License or registration valid for individual use only OME IMPROVEMENT CONTRACTOR . before the expiration date. If found return to: egistration: ,a1g5.061 Type: Office of Consumer Affairs and Business Regulation ' . xpiration:�'9%2016- Corporation 10 Park Plaza-Suite 5170 Boston MA 02116 M&E CONTRACTORSi NC = rye MARTHA ALAS 281 ORCHARD ST. F ;' NEW BEDFORD,MA 02740' fy',, Undersecretary t all ut signature R , , d Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Masf�hbusetts 02116 cry ,. Home Improveme" ractor Registration Type: Supplement Card • Registration: 185061 M&E CONTRACTORS INC. 0 -'1 _ . W. Expiration: 04/18/2018 281 ORCHARD ST. '" NEW BEDFORD,MA 02740 Update Address and return card. Mark reason for change. SCA1 Co 20M-05/11 A.14.n - n r-N_Qk�-esal F-1 511 1n ent._ ns- f. ar,4 Vlae�aneo�zaneaeal�a���/�.cravacLia�e� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only . TYPE:Suoplement Card before the expiration date. If found return to: rat*Ion Ex iration Office of Consumer Affairs and Business Regulation =" 1 04/18/2018 10 Park Plaza-Suite 5170 M&E CONTRACT" . Kt '� �` Boston,MA 02116 yy KEITH OUVER -- 281 ORCHARD NEW BEDFORD,MA,0 740 Undersecretary Not valid without signature „ osessor's mop and lot ipumber ... ................................... _ �TNe �jmit number ......Sewage Pe .... .............�J.... a <4rG/ ..'?'ii i BARNSTABLE, i House number ... .7 .../'f`1. ..................:.................................. r _ q ooD ar e .a\0m kg8 SYS �fii �G�_,h. UST TOWN OF A R N 0kipL TITLE e ilto I4EIYTAL Cor)E A UUILDIHG INSPECT � n3Ji-�OIN” APPLICATION FOR PERMIT TO .... �4.....��r?,...s?l.�J . ........�?�7 .... . ............................................. . ............................................................:............................................ TYPE OF CONSTRUCTION .... ....................... ' ��.........19. TO THE INSPECTOR OF BUILDINGS: x "' ty , The undersigned hereby applies for a permit according to the folio ig information: 3 Location �L...®. ....1....�...... t`IP�� �Y�!!�-? S�Q�� � IZ✓/ L.. ?.. ................................... .............. ..... ........ . ...... ......... .. ProposedUse .. �� 1 N�. ......................................................................................................................................... ZoningDistrict .....�...........................................................Fire District ............ ? ........................................ Name of OwnerZ,0...*.19,r.0.F.....k.�' . aq.k............Address 1-11.j�lge1x � �.vtgemag7.-q......... Name of Builder L-f.1/ :!!!4.............Address /. ! . Jt�1J.!.y ✓%.... . .,A /Lf x ..... . ........ .Name of Architect ..................................................................Address .................................................................................... Number of Rooms ......... ...................................................Foundation 1�.��tf'r�...L.. 7/ C % L� ....................... Exlerior ..C� .. �Flr✓�a'/e '................................Roofing .....T7���`//q� / .��i✓�I: .... .. ...............: Floors .6—rl P�C� Interior ... P r��/� Heating ..�1:�.��....::.. ...........:: .:.:..... ....,...........................Plumbing ..........................................,.....................,.................. Fireplace .....tO.qiO..................................................................Approximate Cost cS D Definitive Plan Approved by Planning.Board ________________________________19________. Area Diagram of Lot and Building with .Dimensions Fee ................ ...................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH -So)-7 d— I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ....��t'......... ....................... ' ,,pr ;oA NIAK, LEO & IRENE� ;Nr 24794 1 z Story No ...................Permit for .................................... Single Family Dwelling ......................................................... Lot #47 14 Three Ponds Drive Location ................................................................ Centerville ............................................................................... 0�wner ... eo....&...I.re.n.e...L e.s.n.i.a.k........... .. .... .. .. .... .. .. .... .. .. . .. .. Type of Construction ..... ........................ ................................................................................ Plot ............................ Lot .................... ........... Permit Granted February....1 6...........19 83 .. .... .. ......... Date of lnsp&n(�dl.s- .*7.................19 Date ?.......19 0j,1 /93 PERMIT REFUSED ................................................................ 19 .. ............................................................................... .............................................................. . ..............................................................I................ ............................................................................... Approved ................................................ 19 ............................................................................... r. ............................................................................... AL Assessor's map and lot siumber ... ' r ......... .... t FIMET Sewagop Permit number �.... .-().......... <. 191r7�?u r Z HA"STAXLE, i House number ...� .... � ro NAea p� A ......................................... p 1639. 0� TOWN OF BARNSTABLE BUILDING INSPECTOR . APPLICATION FOR PERMIT TO � . ,.. !..........�r Y. .........................:.... ...: TYPE OF CONSTRUCTION .... s" ' A !'' .......................................................................................................... ........................e.. j .........19..!� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1,.Pl. .... .Z...... r !fs'� t�. ,t...... ..tv...// .:.. 1 ProposedUse ... : .../.... .. ...........I......................... ZoningDistrict .... ........../ j .........................Fire District ............� -....... ................................................... Name of 0wner/?5-0„*',t,(,.r.A). ....1. ( .s�N,� 1?t ...........Address A f .. '� ..... �u{I i�tla cl7... Name of Builder) ! L, (1t,t»tfl/t/�............Address '7°' ..d�tl7// r �f r�:r'9i ............. .................................................... ., . ...................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms T� .......Foundation ..". .. . ........................................ ....... Exterior ................. .......................................................Roofing ........:. ....... ......... ....:G..... ............... Floors :.............:........_...5'"...... Interior r 1.cqC " Heating �5 f t.. i ....� _ . . . Plumbing................................................................................... Fireplace .....f''.n..................................................................ApproximateCost ........................................... Mr � r Definitive Plan Approved by Planning Board ___________________-----------19--------. Area �y.-'6.........�% r V�........ ............... Diagram of Lot and Building with ,Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam �... k lGv ................... } i LESNIAK, LEO & IRENE A=1913-1 2 H/3-I19A 24794 12 Story No ..............+_t Permit for .................................... Single Family..Dwelling.......... „ Location Lot #4 7 14 Three Po d , r Centerville ............................................................................... (:)'caner ..LEo...& Irene Lesniak ................................................... Type of Construction „Frame ................................ ..................................................................:............. Plot ............................ Lot ................................ February 16 , 83 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed .................:....................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 a ............................................................................... ............................................................................... 7 . , 'l� H.� TOWN OF BARNSTABLL BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION z Please print. " DATE S ��� . Ik , JOB; LOCATIONh— t . /�I �C Number Street Address-;Y fi Section Of Town "HOMEOWNER" Name n �� ' Home Phone Work Phone PRESENT MAILING ADDRESS City/Town State Zip Code .. The current exemption for "homeowners" was extended to in occuolude owner- ied dwellincts of six units or less and to allow such chomeowners to engage an individual for hire who does not possess the owner acts as su ervisor. a license, Provided that DEFINITION OF HOMEOWNER; Persons) who owns a , parcel land on which he/she resides reside, on which there is, or is intended to be, a one tosixrfamily to dwelling, attached or detached structures accessoryto s my structures. A person who constructs more than"one home in a two-year such use and/or farm period shall not be considered a homeowner. Such "homeowner" so Year to the Building Official on a' form acceptable t.o the Building hall submit that he she shall be res onsible for all such work eBuildin un buiTdin ermit. g Official, (Section 109. 1. 1) der the The undersigned "homeowner" assumes responsibilityfor State Building Code and other applicable codes b ' compliance with the regulations. y-laws, rules and The undersigned "homeowner" certifies that he/she Barnstable Building Department minimum inspection procedures- and understands the Town of requirements p cedures- and HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Notes Three family dwellings 35,000 cubic required to comply with State Building CodefSectio Control � or larger, wil�rbe a n 127.0, Construction HOME OWNER'S EXEMPTION The ,code states that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2. 15) . This lack of awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person-as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the -Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that ,the, Home Owner certify that he/she understands the responsibilitids'r of, "a "supervisor. On the -last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. f f S is i 14 i I i s i I it y i t I t ----- ------- -------- - - T ---- —— -- ------ � 1 ;S--_ -- -- -.c —l —Alt el/ ----- -----------_ Al m2�(3 -- is-y w --- --- ----- l I� ---- - -_ - 1 . - -- - -- - - --- --- - ------ -- - -- - - _ - -- - - - __ _ _ ------ -- - T �---- -- ----- -- --- - -.- -------- ------- . . ._ _ __ . _ - ----- --- -- I- - --- -- - _ - - -- - - ---- - -- - --- ---- - -- -- - - _ . __ -- - -- -- ---____r... _ _ - -- - _ _ _ . _ _ _ _ _ --- ------ ---- - ---_ -_ __ _ - -- - - - - _ _..___ _ . - -- ______ . _ . _ _ __ __ _ __ _ _ _T________ ___�_ ___ __ _ _ ___ __ . ___ � � _ _ �t __ _ } at s /Assessor's office(1st Floor): '' ^s+ Assessor's map and lot r. n mber 3 �a �%k.L� "'�' '"`A ��fpTwt Conservation ' d Board of Health(3rd floor): Sewage Permit number 70 ITCA Engineering Department(3rd floor): House number °ear Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2W. P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO R T hi f,, � N LA tq C iR cS tA I%1 '(D OC A- TYPE OF CONSTRUCTION _ ��� F a%tA-/77 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a"[[ d f permit according to the following information: nn /` Location �� Q P A 14 11 rye Po n D� brt� , Gin Proposed Use aAl (�eC_IX_ I Zoning District C� Fire District G g D UPI J21 Name of Owner Ca EAL* ,J f M A4 I �� t� Address �C� 1 Name of Builder Address 1 Name of Architect Address Number of Rooms P!/- Foundation ::%OA-)o(y 6,C 5 Exterior Roofing /-Jzti e Floors `� ` Interior Heating / M Plumbing �- Fireplace e.- Approximate Cost I Area L? ' cro Diagram of Lot and Building with Dimensions Fee �a( AUe N D OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ISO, I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regard' g abov construction. Name � Construction Supervisor's License MAILLOUX, ROBERT J. 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