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Home My WebLink About0081 CROCKERS NECK ROAD �� C�c,,�ers �l/� �oad� i �� III OtIME T Town of Barnstable * � Expires 6'nionthsfrom issu ate Regulatory Services Fee + BARNSTABLE, * - y MASS. g Thomas F. Geiler, Director 1639• �Tfb MAt 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 Not Valid without Red X-Press Imprint_ Map/parcel Number O Z6 `' ` Property Address — `\ 2esidential Value of Work Sep�� Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address Contractor's Name Telephone Number ��S$ 'JS I lome Improvement Contractor License#(if applicable) _ "`f� � v y V\ I AA 6 T � Construction Supervisor's License#(if applicable) €t= f A 'mo t �f" fe W ❑Workman's Compensation Insurance Che ne; ov .1 d Z008 I am a sole proprietor L ❑ I am the Homeowner TOWN OF BA �NSTA ._ ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance.Certificate must be on file. Permit Request (check box) R ( g(stripping e-roof stri in old shingles) All construction debris will be taken to � U't v� ❑ Re=roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑, Replacement Windows/doors/sliders. U-Value (maximu HIIS1. l *Where required: Issuance of this pen-nit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permissi0 : '6 :JT n j A copy of the Home Improvement Contractors License is required. _ i� SIGNATURE;: Q:'WPFII_ES\FORMSIhuildmg permit roans\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents 0 ce of Investigations fi a .600 Washington Street n, A 02111 Bosto M ' www.mass.gov/dia Workers'.Coioapensation Insurance Affidavit Builders/Contractors/E etric s/Plumbers A licantInformation C � ASS1 c ®e sI � � C��ST��: leas riot Le ib� Name (BusinesstOrgaaization/Individual): O\p 2.r S C 0 Address: 9 city/state/zip: 6 \ i ` 1 1 1 Phone.#: 2- C1 b �j Are you an employer? Check the appropriate box: .Type of project(required):. 1.❑�aml(a)yse_oels,, Io erwith 4• ❑ I am a general contractor and Iy 6. ❑New construction(full and/or part-time).* have hired the sub-contractors 2. proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me 'many capacity. employees and have workers' .9 ❑Building addition o workers comp, insurance comp, insurance, e 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing aA work : officers have exercised their I1.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12 oof repairs required.]t c. 152, §1(4), and we have no insurance. . employees. [No workers' 13•❑ Other comp,insurance required.] *Any applicant that checks box#1 must also fill o.ut 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 provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 a.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 verification. I do hereby certify under the ains•and enalties erjury that the information provided above is true and/correct. Si mature: Date: Phone# l-� �-C,1 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#: 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 erreployer 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 biisiness or.torconstrue.t buildings in the commonwealth for any. applicant who has not pro.dueed•acceptable,evidence of compliance with the insurance coverage.required." Additionally,MGL ehapter.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 co:npl%zrice withtlie 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-contiactor(s)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 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 to any business or commercial venture (i.e. a dog license or permit to burn 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 co=oRwean of Mmsarhusetts DQpartmemt of lad-u t al Acoidezmts Office of 1aaves-fi gatioas 604 Washinatoli Street TO. #6,17-7-27-45Q0 ext 406 Qr l M•-MASSAFE Fax## 17-727w774 Revised 11-22-06 www.m=.gov/dia a License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 152575 Board of Building Regulations and Standards Expiration 9/11/2010 Tr# 274254 One Ashburton Place Rm 1301 yType=lndiuidual Boston,Ma.02108 CLASSIC DES IG 1Nr&CONSfTRUCITING ROBERT SCOTTf•%V 0 41 APPALOSA WA 7 ` �' 'r __. MARSTOBNS MILLSvMA 026'48 -- - --— ., w } Administrator Not valid without signature Boar of w mg egu aWm and tandards Construction Supervisor License $ j License: CS 46861 4 f l lix _ Bi.rthdate4\10/9/1.962 j Epiration 1/9/2009 Tr# 61:83 j rRestrvction - . `_ 1 ROBERT C SCOTTI4 t 41 APPALOOSA MARSTONS MILLS, M!X 02648 Commissioner I. � zHEr Town of Barn-stable ti ~Regulatory Services BARNWA13 Thomas o F. Geiler,Director MAes. o Building Division Tom Perry,Building Commissioner 200 Main-Street.Hyannis,MA 02601 - www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508=790-6230 Property Owner Must Complete and Sign This Sectio n g If Using A Builder I, Ad2IV61- lYJ as Owner of the subject property hereby authorize �Ddip'T j J`TJ to act on MY behalf, in all matters relative to work authorized by this building permit application for (Address of Job) Signature of OVTneS U Date M Yen r Pruit Name If Pro eedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side, nsnv r,.�c•nurt.r�vv>~va,rlecin�r Town of Barnstable �oF 1HErti ,�� Regulatory Servicesc BARNS ear a Thomas F. Geiler,Director auss. v�o �63� amp Building Division .� rfD � Tom Perry,Building Commissioner f 200 Main Street, Hyannis,MA 02601 LO ►n www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code ,.1. 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 Persons)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 -year period shall not be considered a homeowner. Such person who constructs more than one home in a two "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building?permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable.Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatirrc of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious.problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification.for use in your community. Q:forms:homeexempt Assessor's map and lot number �� 0�F r �C// -' V 7S- ypF TN E SEPTIC SYSTEM -MUST B swage Permit number ......,.C,� al.ff![ INSTALLED IN COMPLIAN WITH ARTICLE II STATE = BABBSTADLE, so House number .... ....... ................ ...:.. .... •.......' SANITAPiY CODE AND TO 9°m,,�MAS& t \0� r REG" LATIONS. c yav a, - TOWN lOF 'BARNSTABLE BUILDING , INSPECTOR APPLICATION FOR PERMIT TO .. 1? " O ..................................� 'r CP... • f _ ................ :.......... TYPE OF CONSTRUCTION .........: ..,.............: ........ . .....:..:......................................... ......, fir Gt ' ...........19...Z.: - +TO-'THE—INSPECTOR-OF...BUILDINGS: y -The undersigned hereby applies for a, permit according to thery following, information: .;—_ — •_ - -Pr Location r. ..�........� C! ...........(..9.�`..U..C.� .... .�.� .:.. Proposed Use .... i9.�t. .4...Y........ . f.-. z.. .................. .... ........... .................................... Zoning District .................. .........................................Fire District C ?�. �- C..�........ Name of Owner .........A ....Address . r�s 1...C OC. rIE e e'5 Name of Builder �1{ _ !d- 4 vT`�' ' S � .. . ....... ..�.L..... . ..�..�!............�,.Address ` �...'.fa..•... ..5..�rG..�.�7`.........�:4.�.,�... R9=Name of Architect ...... .......... ................ 46A.,Address Number of Rooms ............. ....................... ...Foundation s e -! Exterior ........ 1� 1��:........ �•?. .�.. .............Roofin /'I� C�............. .................... g . ./�............... Floors ... T��. `J ......e ....Ce 4...0 Interior ...... .................................... Fieating' ...... "S ........Plumbirig ........ - - Fireplace ...................................... :..... Approximate Cost .../�S.o U ...... ............... f• ........ Definitive Plan Approved by Planning Board __ ___________________________19________. Area ....69. ..�P..� .. ,1... Diagram of Lot and Building with Dimensions Fee �✓ -� SUBJECT TO APPROVAL OF�B AR OF HEALTH c/ k 4 r C C A rC' Gc I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above • construction. Name .... .. ........ .. .. �. ..... .......... _ ................ Mycock, Arnold No — ... Permit for ........add..t�. ^ � ------.------~--------.---. . . ` 81 Nack Road � Location -----.--.—..��----------... ` Cotoit , ----.---..-----..--.—.-------. ` . � ' . ' Owner ---.Pcr10l.d, _......................... ' frame Type of Construction .......................................... r� . ~z ' . ---..�.—.--------------.�—.�---- / ` ~ . . 'Plot ~� ------.--' Lot............. ------.. . � . ' 4 78 `o6'~h ' nh�6 —. --lP `�� . . . . " � � �_�� . . . Dotaof'|nspecion .� �� 4� c��'�— ]g vp,e Completed ^ ' PERMIT REFUSED -----�—.--..`=---.�—. �V ---- ' .-------~.---.--... ..---�---.--.. ' ~ . ^ --..—.—.---_...—.~.....--...--....— ---.~...~.—~---.--..—.—..~~—_-- . . / App�6vecl`_..______ ....... lQ '. ^ ---- .......... � --�—.--`—.-----.---'—~.....'.~--.. . -- ( � / i/ Assessor's map and -lot number ......:.: .......-...? .......... ^ of THEro sewage Permit number ........�� '�'�!!' Z BARNST/1DLE, i House number !� MA86 po,1639 00 .fI?Mo TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ./ r7 ::. ! « ....�C �.X.....`f................................ ............................. TYPE OF CONSTRUCTION .......... t f U r n� i .......... L .. :........5........................ ................................... 4 1. ...........19...: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /films CrL� l c, .- ..:..�....:....: �f. . .:..................... ..........................................................:........ ................................. Proposed Use .....f..".... . ..... ...... ...................................................................................................................... Zoning District r � ..................Fire District ... Name of Owner :.'.. '' .� ..f�.........��.. ar.C.. .....Address �... .. ..r ...C..G.... .. ......./...c . ....:........:..... Name of Builder ...!. .l? �.::.:.�.....-. :..�: /f" 7- uc_ Address .�r-f�� I :� . •. ..... ��.. . :......... .......... ... ... .. .. ...... . Y Ca; o Name of Architect :Address ......... Number of Rooms .........................:.Foundation Q T S�R� G Exierior � 7 -� ......................Roofings ..........................................^. .................................................................................... Floors -"� �.. �....�......� . i.......Interior .........�...... f� �. . .................................... ............... ............... ........... ..... Heating .......... .. .........Plumbing .................. ............................................................................... .... .. . . Fireplace ........ ........................................................................Approximate Cost ......... 5 `�. .:..�..`......................... Definitive Plan Approved by Planning Board ------------------------------19--------. Area ... S —....................� .......... Diagram of Lot and Building with Dimensions Fee ��................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH S c �, �� r a x a 1 IPIE _ - `( I !i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Mycock, Arnold A=20-96 r No ........20a,20Permit for ....add„t, ..Nglling ............................................................................... 81 Crocker;%eck Road Location ................................................................ Cotuit ............................................................................... Owner ......A1:'i Q.A..MY.9.oG..k............................. frame Type of Construction .......................................... Plot ............................ Lqt ................................ Permit Granted .,,, August -4 ............. 78 ......... Date of Inspection ................ ................19 Date Completed ... ...............19 PERIVI'IT REFUSED . 19 } �. .................... ....................... . .............. . . ......................... .......................................... ............................... i Approved ................................................ 19. ............................................................................... ............................................................................... I