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HomeMy WebLinkAbout0093 CROCKERS NECK ROAD 73 Cromem Neek r]a4a� i i pro ow Town of Barnstable *Permit# 1�� ��� � Fapir f months omissue date Regulatory Services Fe * BMWSrABLE, ��. 1 � Richard V.Scali, Director 639. Building Division X-PRESS PERMIT Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601. NOV 13 2014 www.town.bamstable.ma.us TOWN OF Office: 508-862-4038 Faa-A TM hE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Q f 9 ^U 4;t Property Address Q3 d,eocoe�.e 5 A-Ur c_k ,ev a D_ CcsT`,-,)i i� to A ©A 4 35 ❑Residential. Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address K?GH.�?i2D �io�c ,�Jaime Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor am the Homeowner ❑ 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) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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 copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: z) Q:\WPFILEST0RMS\building permit formsEXPREUS.doc Revised 061313 y F The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /C /G e A.12 n k -p Y LiF Address: A y Eck) 65 City/State/Zip: Phone#: 781 o0413 -38c39 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp. insurance.# required.] . 5. ❑ We area corporation and its 10.®Electrical repairs or additions • 3. I am 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 13.❑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 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalises of perjury that the information provided above is true and correct Si mature: Date: 11191-761il Phone#: 7 P/— 3 c'o-,5"- Official use only. Do not write in this area,to be completed by city or town officiaL _._. .. ..... - -. ... ........__............._... - ..... ....- -.... ..--Cityor 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#: 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 in 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 construct 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-contractor(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 or policy information(if necessary)and under Job Site Address the applicant should write all locations in (city town)."A copy of the affidavit that h y P as 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 pemut 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www mass,govfdia _ Of 7F�E • sMaxsresr.E, • • . , "� Town of Barnstable Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO' Building Commissioner 200 Main Street, Hyannis,'MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax:. 508-790-623 0 Property Owner Must 7ete and Sign This Section Using A Builder I , a Owner of the subject property • hereby authorize to act on my behalf, in all matters relative to work authorized by building p t application for: (Addres of Job) Signature of Owner r. Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:IWPFrLES\FORMS\building permit formslsmokeearbondetectors.doc Revised 050412 Town of Barnstable Regulatory Services e . pF Richard V.Scali, Director Building Division �uvsresrE Tom Perry,Building Commissioner M,►s.4 039. 200 Main Street, Hyannis,MA 02601 AEG Mfg www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 11611L/� JOB LOCATION: number street village "HOMEOWNER" 7,P1- 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" 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 requir en 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. 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. SM( KE DETECTORS REVIEWED vJ�r FA . 7 Bull G DEPTH DATE DATE FIRE DEPARTMENT i 6ioTH, iO'NATURES APE REQUIRED FOR PERMITTING + f r ir , �lr „�4 i R t j Town of Barnstable TOWill OF 8- "NSIABLE -0?.THE Regulatory Servicesn.} . 3. 3 7 o� . Thomas F.Geller,Director PM MARNSPABLE, ` Building Division �prF039. Tom Perry,Building Commissioner 260 Main Street, Hyannis,MA 02601 M 3�� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# 02©//O�G_ � FEE: $�'?.Se SHED REGISTRATION 120 square feet or less 9 3 Cse,c-kws, ec:k 9,c�- Co Location of shed(address) Village SD NTrws�- 34-nw1#-Zr Zi! - Oyu-`3906' Property owner's name Telephonenumber Size of Shed Map/Parcel# ` lo�L3��ola Signature Date Hyannis Main Street Waterfront Historic District?. �a Old King's Highway Historic District Commission.jurisdiction? Al 0 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30_&3,304:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF 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 Map Page 1 of 1 Town of Barnstable Geographic Information System New search Home Help Parcel Viewer Custom Mep Abutters "tap s"ze E ■ Zoom Out ®"I I"'in 9'. .� lPG Turn map layers on/off el — a �,rM — Turn a check boxes below '. Town Boundaries Road Names 07sOW Voter Precincts �31 Map&Parcel Numbers 02WW -'. Parcels �81 _ FEMA Q3 Flood Zones(Old Maps) Will be Superseded in 2010 - AE(100 yr flood) AO(100 yr flood) - VE(100 yr flood w/wave action) X500(500 yr flood) E ✓, Neighboring Towns Water F Streams Jetties OtgO/1 — Plot Edge ofWater Marsh 6127 13� Drainage Ditches gtcgu 0113 I Water Bodies Set Scale 1"=36 I April 2008 I MAP DISCLAIMER Transportation Copyright 2005-2010 Town of Barnstable.MA All nghts reserved Send questions or comments to GIS http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=019042&mapparback= 10/19/2010 e r O W N e Town of Barnstable Geographic Information System February 8,2011 o^oar d F 31 orooss Ilk sat - 1 ..r , .. #101 0 12 Feetrol {' 019049 — F,27 DISCLAIMERS:TW nap Y br 0—tg pulpoess piy.N k rat edr luate w Map:019 Parcel:042 ou - _r baery dahanahaeon r mgulalry haerpmt0m. Enlarger—Is bey-d a sa a Selected Parcel N 1-=too'may rat meal ehrtabNahed msp a acy standards.The parcel Nees an m this aP Owner STOYLE,RICHARD R TR Taal Assessed Value:$266300 are orty graphic repo dallone of Assessor's W parcels.They are rot bus property Co,,O e,S D H TRUST Acreage:0.46 acres Abutters W- E bnurrdarlea and do nol represrrt accurate rraBpehips 0 physical lastures on the reap Location:93 CROCKERS NECK ROAD such as building iocadpw. Buffer $ Aerial Photos Taken July 10,2009 Town of Barnstable Geographic Information System February 8,2011 02DO97 #31 020096 #81 020095 C #62 FO 00 OR / O 019042 93 O# 10`19041 #101 QO G� y 019049 #127 O ° 019040 ?° #113 019039 #125 0 25 Fe t D79050 - #102 DISCLAIMERS:This map Is for planning purposes ady.It ls ret adequate fa legal Map:019 Parcel:D42 bmndwy datam6agm m ng d"Inta uift n. Enlargements beyond a scale of Owner.STOYLE,RICHARD R TR Total Assessed Value:$286300 Selected Parcel N 1'=1a0 may not meet estahashed map awracy standards.The parcel Wes on Oft map .::...:.. are only graphic representations of Assessees tax parcels.They are not hue prapeny Co•Owner.S D H TRUST Acreage:0.46 acres Abutters t� � bourrdarles and do not represent acauata reWWnsh¢s to physical features on the map Location:93 CROCKERS NECK ROAD sm h as building locations. Buffer /' f } S D H TRUST 201 Cain Avenue Braintree, MA 02184 December 12, 2010 Town of Barnstable Zoning Board of Appeals Hyannis, MA 02601 To Whom It May Concern: I, Richard R. Stoyle, Trustee of the S D H Trust, owner of the property at 93 Crockers Neck Road, Cotuit, MA authorize Susan Hardy to file an Application for a Variance relative to that property. A copy of the current lease is attached. The deed is recorded with the Barnstable County Registry of Deeds in Book 6678, Page 253. The current Trust is recorded in Book 12819, Page 121. Yours truly. Richard R. Stoyle e . , r TENANCY AT WILL AGREEMENT AGREEMENT made this First day of November, 2006, by and between RICHARD R. STOYLE, Trustee of S.D.H. Trust. as Landlord and SUSAN HARDY as Tenant. WHEREAS, the S.D.H. Trust agrees to rent a single-family residence at 93 Crocker Neck Road, ' Cotuit, County of Barnstable, Commonwealth of Massachusetts, exclusive of the garage. i WHEREAS, the said SUSAN HARDY agrees to pay a rental of Six Hundred Fifty Dollars ($650) per month said rent to be due and payable on the first of each month in advance for such period of time as Tenant occupies said premises. WHEREAS, the said parties agree that the initial term shall be for one (1) year commencing November 1, 2006, and shall continue from month to month. Thereafter, either party may terminate said tenancy by giving sixty (60) days written notice to the other. WHEREAS, the said Tenant agrees not to do any repair work of any kind on said property or not to allow anyone to perform repair work on said property for the duration of said Tenancy at Will Agreement. The Tenant further agrees not to allow or deposit any substance which will cause soil contamination of any kind and/or description and further agrees to promptly remove any substan e which will cause soil contamination of any kind to the satisfaction of any and all:city, town, state, and federal authorities. The said Tenant agrees to comply with any and all city, town, state, or federal regulations covering use of said premises including, but not limit d to, health, safety, zoning laws, and regulations. The said Tenant agrees to vacate said premises at the appropriate dat and to leave said premises in the condition they were in at the time of the creation of said Tenancy, reasonable wear and tear excepted. All utility expenses such as electricity, gas, and telephone service are the sole responsibility of the Tenant. Charges of water above the minimal amount as set by the Town are the responsibility of the Tenant. The said Tenant agrees that she will at her cost obtain a Tenants Liability Insurance Policy covering the premises:, This Rental Agreement is non-assignable and any attempt to assign it is null and void. The landlord reserves the right of access to and ingress and egress to the garage as it determines and the right with reasonable notice and with the permission of the Tenant access to the residence. Such permission should not be unreasonably withheld. Landlord Tenant j4?�Z.tiit K�C�( RICHARD R. STOYLE, TRUSTEE SUSAN HARDY S. D. H. TRUST i