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HomeMy WebLinkAbout0025 HIGHLAND AVENUE 44 c;r . � Town of Barnstable ` "Permit dad oFtru tom; Permit# 2 Lxpires 6 nraNhs from issue(lore Regulatory Services Fee /y/y •# BtARVS A.13U, + y dASS. 1619. ��� Thomas F. Geiler, Director At Building Division Tom Perry, CBO, Building Cornrnissio�rl`l'e RESIT 200 Plain Street, Hyannis, MA 02601 www.town.barnstable.ma.us e 1( Office: 508-862-4038 7-OWN ()F �qq � 5 8 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL Q rH LE NO/ Yrrli(l rvilliorrl RedX-Presv IinPrir:l Map/parcel Nuniber Property Address, �❑ �drU c &�esidential Value of Wo1K �� ; Minimum fee'of$35.00_For work under$6000.00 Owner's Name & Address Contractor's Name !— Telephone Number n? Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)_ ❑Workman's Compensation Insurance Check.one: [�am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name f Workman's Comp. Policy# Copy of Insurance Compliance Certificate must 9ccompany each permit. Permit Request (check box) ' Ej 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) �e-side #of doors ❑ 'Replacement Windows/doors/sliders. U-Value (maximum .35) # of windows *Where required: Issuance of this permit does-not exempt compliance with other town deparunent 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 ired,3IGNATURE:qla =r S The Canrruorr►c'eallh ofAlassachusells -- - -- Department oflr dui lria]Accidents F— Of ice of liaylestignlions ):• 600 Washbiglo7i S'lreet ' 4 ivivw.ma.ss.gow1dia 'Workers' Compensation Insurance Affida`-it: Builders/Contra,ictora/El:ectiicians/Pl unbers Apphcant Inform iitio:n Please Punt Legibly 4:. Name(Business}Orgmiza6ongndivid[ia1): r� c Addre&s: City/state/zip: Phone #.:TL Are you a.n empla.yer? Check theappropriate boa.: T}pe'ofp.roject([equi[ed):1..❑ I ama employer tisrith 4. ❑ I am a general contractoruployees(fu'il.aud/orpart-tuue).� have hired die sub-con--t - O.New Construction 2 1 anda sole proprie=tor Or partner- listed on the attached sh . ❑Remodeling ship.and have no empio)Tes These sorb-contractors h - ❑.Demolition working :far me in any capacity. empleyees and hTve wor �Building addition [No�+orkers' comp,insurance comp insutance.5. Vr'e are.a co. aration.and0.❑Electricalrepairs ora.dditionsrerluiredJ ❑❑ :I am a.homeowner doing.all- work affcers have exercised tEJ Plumbing repairs or additionsthyself. (No work-m'comp, right of e:cemptiou per NNE ❑Raaf repairs innsurance:required.] t c. 152, §1{4):,and.give havemployees [No workers' ..❑ O#her �`1cornp.:insurance:required, 'Any appticarut that checks box#1.uwst also fill out the section below sbo-mug their workers'compensation policy infon=tiao- T Hameowmers who submit this.affidavit indicating they are doing all'wmk and then hire outside rontraciars must submit.a vew.affida,s-it indicating such. =Cantracum that check this box utust attached as additional:sim.et showing the came of the sub-contracwrs su.d stare whether or not'those entities have employees. If the sub-•cantractors:hs,;--e employees,.ihey.must provide their workers'comp.policy number. 117111 all entplq ter drat is providing irtsvrar.u..ce for tqi e►trplayews. Mow is the p.oiiry and jo'u site igforNI aLtlOit, Insurance Company Name: Policy#,ar.self-ins. Lic.#: Expiration Date: Job Site Address: City/state/zip— Attach a COPY of.the Workers' com'per[sation policy-declaration page(sho►i ng the policy number and expuirtion date). Failure to secure coverage as required under Section 25.A ofMGL c. 152 can lead to the imposition of criminal pemllties of a fine up to$1,500.00 and/or one-year imprisoument,as well as 661 penatti.es in the form of a STOP'WORK ORDER and a fine of up to$250.00 a day against the.violator. Be advised that a copy of this statement may,be.forwarded to the Once of Investigations of the D.IA f&insurance coverage verification. ado Ieerr� certify ttrr: r tPte pa'is of ti nfp�rjatry that the iarforntation protdded above is tru.o.and correct. Si atur : Da'te: 1l�' Phone#: � _" �'ZsJ "_ 3 FBoa:rd only. Do not write iat this area,io be conipleted by city or town ofrial Town: Permit/License# hority(circle one): Health 2.Bvildin.g Department 3. -Vyfrown Clerk 4. Electrical Inspector S.Plumbing Inspector son: Phone#: ��ol► ropy Town of Barnstable Regulatory Services N vjEXw WSB�',$N Thomas F. Geiler, Director. a619,. A,� Building Division ,Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www,town.ba rnsta ble.ma.us Office.- 548-862-4038 Fax: 508-790-6230 HONIEOWNER LICENSE EXEMPTION `( P Please Print DATE: k)C �6 1 JOB LOCATIori: ZS number �� street village "HOMEOWNE �' rLCS- �•� name home phone N work phone N CURRENT MAILNG 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 HONIEOWNER 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 farce 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 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 miniinum inspection rose and requirements and at he/she will comply with said procedures and requirements. . Signatur omeow r 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 oven results in serious problems,particularly when the homeowner hires unlicensed persons: In this case,our Board cannot proceed against the unlicensed personas 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 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/cerlification for use in your community. Q:IWPFILESIFORMSIbuilding permit formslEXPRESS.doc Y of THE Tp� . ■ HARNSI'ABLE, MASS. $ Town of Barnstable �IFD htA'�A .Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town,ba rnsta ble.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builders as Owne"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 Tf property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse.side. 0AWPFIf.F.SIF0RMSIbui1dinR permit forms\EXPUSS dnc Town of Barnstable *Permit# Expires 6 n ont/is from issue date X-PRESS PER gulatory Services Fee 5 Thomas F.Geiler,Director AUG - 2 2007 Building Division TOWN OF BARN tOEY,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 Q?Q o t4 Property Address esidential Value of Work 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address c V Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) ^� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Chec am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# A, m Copy of Insurance Compliance Certificate st be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to e-roof not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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. opy f the Home Improvement Contractors License is required. SIGNATURL:3 4!� Q:Forms:expmtrg Revise061306 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Iusurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): . 13 ks 1 C Address: 'Z to \ �'o Y\11 City/State/Zip: r Gzlb'� CPhone.#: S'�Q- Are you an employer? Check the appropriate bog: -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 stab-contractors 6. El New construction . 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7, emodeling ship and have no employees These sub-contractors have 8. Ej Demolition worlds for me in an capacity. employees and have workers' g y p �'• #� 9. �Building addition [No workers'comp.insurance comp.insurance. re aired.] 5. We are a corporation and its 10.❑•Electrical repairs or additions 3.[iam a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right bf exemption per MGL 12.P-R-6ofrepairs insurance required.]t .c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fin 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 anew 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 providt their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is.thepolicy 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 her y certi der the pain -and penalties of perjury that the information provided above is true and correct Signafar . Date: ee , 0 Phone k Official use only. Do not write in this area,tb be completed by city Or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuiIding 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 foz the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." II 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 workeis' 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 Sile 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 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 tc give us a call. The Department's address,telephone-and fax number:. . 'he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-49Q4 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 "'}teYi d 11-22-06 www.mass.goWdia i I Assessor's map and lot nu ber m .... - ale ��L - -a 9-?/ _ Tu/D �EO�/rDOcy `/OU,JC P� THE ��♦ Sewage Permit number .../f..... <Cc�s1y�/ _ 7&_144. Z /Z BAUSTa LE.WAR i House number L� . . .... . .............. . . v......................:...................... .. . . .. Q 4 �p 039. \00 f�MPY p,' TOWN OF BARNSTABLE 4 BUILDING .INSPECTOR APPLICATION FOR PERMIT TO 9Ow,�-!'huG "....lDt�rTlg�:�'..:. ...% .. S `L.............................:.. TYPE OF CONSTRUCTION ..........: .. ....................................................................................... a..�1.t .T ....... .........19.8L7. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ ��....... ..... . .�1.��...... . .. 1 ..!.T........ .....:...Q. ���.5 ........................ ProposedUse ......� .. ,• ........ ....... ?U©G� 4 ........................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ...Address ,ZS J~-{t {-I��•r,Cl �'1�51� � -T�:i�- .. (3ab3. �S tq.t�c�.t Nameof Builder .............t................. .............—.....................Address .................................................................................... Name of Architect .:............. Number of Rooms ............. ... t-qr!4c:........................................................ Exterior C.� �'/i iw�Lc J' Roofing ..: T....................................................... ................. .......:.. FloorsZ.......................................................Interior .....��::f ....s!i�!? �.................................................. Heating 0 4 ..... Gn-wz`.....................................Plumbing .`��T:...... lF7 f! '............................... Firepp ........Approximate Cost .......... lace .......................................................................... / 200 Definitive Plan Approved by Planning Board ________________________________19________. Area Diagram of Lot and Building with Dimensions Fee rfK. ©G - SUBJECT TO APPROVAL OF BOARD OF HEALTH c�ssprr�L- a►shwast'ilee, IjASA#'Ng h^Wj_,)Jn- 't- K lam,'-----i'�/fl�'T/O/✓ r�,/f,��!� `�S 0, Al'1�¢Darr S r,t'rsriw°S _ &F P7Vc /�v5r c I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ........ ................................. McMURRAY, ROBERT & KATHLEEN 23255` Addition No ...............:. Permit for .................................... t•: c .: ...Single...F. ?n .�.Y...DW4.j ,13j.ig............. _ Location ................ Cotuit _ "- ......... ................................................................. Robert & Kathleen' D1cMurray, Owner ................:................................................. _ Type of )Construction L Plot ............................ Lot ................................ ...June 2 .................19 81 j Permit Granted .....:..9. - - Date of Inspection.". ` Date Completed � ......19 PERMIT REFUSED ............................. ............................... 19 ....................................`.....................................i ... ` ........................................................................... r u Approved .................................................. 19 _ ................................................. ............................ / . ............................................................................... Assessor's map and lot number ( - ;f,i! - !� -p5 '7-,� �Gli U .-•�CG�/f i Rr y .lJU al�" •t � Q�,O Or,�, Sewage Permit number .:..l ............................. - °�c/` �`�'/c�• d`� K �� BAUSTADLE, i House number �d 9� MABa....0 :................................................. po,1639. \00� G 'FO YPY a' TOWN OF BARNSTABLE, BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... 410,01R....,e ;:...................... ................................ TYPEOF CONSTRUCTION .................... T !lr+ ........................................................:.................................... ........ . .LOX: .......��..........19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ �.-�......., �.!vs t`+l n � ..... �+�4,j .... .y. .. ......................................I` , ... .o '. Proposed Use ......� ..�?t 1} t.)......c 70936�45--,.!tl.............. .. ........................ ZoningDistrict ....�...................................................................Fire District ............................................,................................. Name of Owner ................................ �h�s ...Address .`�� ..'{�° H�a, ... }51� aT��z- Y)IN cjzz; Name of Builder fa.t..ca.1 ......................................................................Address .................................................................................... Name of Architect ........ S.........A u .......... ................Address ...............................................................0.................... Number of Rooms ..............................................Foundation ..... �-� K:........................................................ ..................... ........ Exterior r'pc ... `� /ti QG ..r....................Roofing .......4 �f�/JGT`..................................................... ................................ .......... Floors Interior /4z�.... /!�t..c:................................................... ......................................................................... ............. Heating ......... ............. zz-s,.+r ............. ...................Plumbing .. GCtt."`^..... ... T/t%✓............................... Fireplace ..............................................Approximate Cost ... �.Z ...................................................... 200 ; Definitive Plan Approved by Planning Board ________________________________19--------. Area :!.'^/?........../.......'.�........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f i ' /c . i i1 • f y x I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . �r Name ....................................:!..�....��.�................................ McMurray, Robert & Kathleen =20-44 J zo • ' No23255... permit for .Addition Single Family..Dwelling Location .... 5 Highland Avenue- .. ........................... Cotuit ............................................................................... Owner Robert & Kathleen McMurray ............................................................... Type of Construction ..Frame ; ............................................ ............................. F Plot ............................ Lot ................................. Permit Granted ....Jun..........,...............19 81 Date of Inspection ..... ...... . .....................19 r Date Completed 19 ' PERM REFUSED - , i ................. 19 f. ............................................................................... s ............................................................................... Approved ................................................ 1.9 �oF1HE low Town of Barnstable *permit# to ©�� Expires 6monthrfrom issue date ,,►MSTA13M : Regulatory Services Feet4a, � do 9 1639' m� Thomas F.Geiler,Director ��EDfiAP�A, x G ��� BuildingDivision Res Tom Perry, Building Commissioner P'�Wrr 200 Main Street, Hyannis,MA 02601 AUG O Office: 508-862-4038 TQWN OF 8 1��Z L Fax: 508-790-6230 B,qR EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 'NSTA9tE Not Valid without Red X-Press Imprint Map/parcel Number®C' L q Property Address esidential Value of Work /r., Owner's Name&Address „ z v VA GZ-Gz Contractor's Name ac�jl f-k Telephone Number "6 C F—j Home Improvement Contractor License#(if applicable) r f c_+ Ito. mzg� Construction Supervisor's License#(if applicable) Jam/ 9T co rty S! EVorkman's Compensation Insurance Chec r �a sole proprietor 9 i �the Homeowner o ❑ I have Worker's Compensation Insurance C� Insurance Company Name Workman's Comp.Policy# 1�' Permit Request(check box) !^ ❑ Re-roof(stripping old shingles) �co_ �_nstruction_debris will b__ e taken toy ❑Re-roof(not stripping. Going over existing layers of roofl Re-side ❑ Replacement Windows. U-Value (maxi_*num.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. r SignawLa rW Q:Forms:expmtrg Revised121901 Y Engineering Dept.(3rd floor) Map ,2Q Parcel Permit# 0 �j House# ' - Date Issued /a—5 6 9& Fee Cmrservation Ul o r e mi i an proved y Planning oar ; ' BA MATABLE. ` AIM ♦ 059.rE 0/& TOWN OF BARNSTABLE Building Permit Application Projec treet Address -�•��e�y Village tT- Owner C Address A—A4 Telephone Q 19 Permit Request r� . First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ C,oCa Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0--� Two Family ❑ Multi-Family(#units) Age of Existing Structure t c= Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ull ❑Crawl ❑Walkout Cl Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing_i` New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas LJ-61i ❑Electric ❑Other Central Air ❑Yes per- Fireplaces:Existing tl New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size)�_i (�n.yt Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes UNt' If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE BUILDING PERMIT DENIED FOR THE FOLLOWIN EASON(S) .4, FOR OFFICIAL USE ONLY PERMIT NO. t� 7, DATE"ISSUED_ - a MAP APARCEL NO. ; 41 7 ADDRESS VILLAGE OWNER 5 D AT Qb A.1 NSPECTs ON: FOUNDATION FRAME INSULATION FIREPLACE y ELECTRICAL: ROUGH . FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL _ SV _ FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i { r. The Contnton ivealth of Massachusetts a i� ,'` Department of Indtrstrial Accidents ;1 _. office 8110MV9211911S 600 fl'ashington Street Boston.Afa.v& 02111 `-' Workers' Compensation Insurance Affidavit -Xi ..w«wr«. ..-......rw......p�.-.� �w••�« Y....`L.wfRTw.�wM O4Pf..^'YM_. ,�ps+..•t-mow.'. �_.. .. _ ,Anrlic-ant Information• Please PRINT Ie�tbly . ..... ... ... .. name: \ — C locition• 1-1 ut.4 Ste' m a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity _ t5...m'�3�s:.:'"71' �f �?R7C�♦♦'�KfaK.'�'!:' AT!.s! �4�_L�W "" ����aalL.reri.r.�t'�.`+..s.^..r''��.-.�•.:Y�r 1....... ._ +.rX, -iYftlaYii,ia.- 1Ps.•. `�.� +,M .I am an employer providing workers' compensation for my employees working on this job. company name: address: city: Phone#• insurance co polio # Cl- , - .. s>r >, .. ••ry.r•*� .:,.y,yw •+K'??,: r +w.d•; .. .�a.1x;?a-w+�,!war;re..+y;q-7x»;!Ts:. ..'°.+s•� r 77" "n"' I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name- .a ddress sty phone#: insurance co policy# _- - C. -. V_r « r ....?1"frt)'a^"f"Y r'Y N{..t. J"".�'. -!At "T'r{yr_II^—ti "�'T r{+^4 g„ �!y+5-�¢ IIs "yG�-`• '�ad 5'�r.r.werr N►-ri.-dYhzt •�Dr':� '' Tg'"....�e'._ ^.. '��; company name: •tddress• city: phone#- insurance co ... policy# Atinc_h addi_tionafshcct if necessary �,? _ __ E r -•o— -1X91{i!?.5'4'IG. Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NYORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. 1 do here r certif•under he pains and penalties of perjury that the information provided above is true and correct. Signature Date ,& ��'.� Print name Phone# ?official use only do not write in this area to be completed by city or town official ' city or town: permit/license# fiBuilding Department C31,icensing BoardT I]check if immediate response is required QSclectmen's Office [3Hcalth Department contact person: phone#; nOther _ (revised 3195 P1A) . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their -_mployces. As quoted from the "law", an e►nploree is defined as every person in the service of another under any ::ontract of hire, express or implied, oral or written. An einpl(rer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the fore�_oin 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 dwclling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or oil the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even 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, 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 hal�e. been presented to the contracting authority. .I Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. 77777 p,•1Rs- -a ^t } 77s ' x ' City or Towns 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. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. r.awev:-r;+:•-_,.,..,,..,.. :.......-.rr.�...,.. _..-�+.+varr-.-r.,.:...•.�.: w-�-csw +.--+-.�;,+sR :"9",S"+w'�-""'^r'-e+..�w--- xa..r..z•'rt,�+z�s.tre�'.,-rr.ov.p!.N�rr.eawn=..-n.n.e Tile Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 °F THE tp� The Town of Barnstable 9� '� � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen I Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:��s Est.Cost!�� Address of Work: Owner's Name 2 \ Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied .Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Na Assessor's office(1st Floor)- 141/l/ Assessor's map and lot numb -- 20 - 0L i THE t Conservation(4th Floor). y' INSTALL,ED IN `, Board of Health(3rd flo DADl7 • Sewage Permit number WITH 77TLE TanLL . Engineering Department(3rd floor): ENVIRO EN 6�L C House number v2 TOWN rya JL-1IO Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:36-9:30 A.M.and 1:00-2-00 P.M.only TOWN OF BAR_ NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �Z 6 0-T3 TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ` Location Proposed Use C;PV_DA (L Zoning District Fire District Name of Owner?NAS ' YY�Cy Address Name of Builder Address Name of Architect Address Number of Rooms Foundation C�c�%Q jcuu � Exterior ��`� - �� �1 S Roofing Floors 1 Interior L11J 1= >j I S Heating J Plumbing i\ 10 Fireplace �� Approximate Cost (56 G Area Diagram of Lot and Building with Dimensions Fee ®� 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 `� Construction Siipervisor's License Y McMurray, Robert & Margaret 4�"3 S 3 No 3-6�7'9' Permit For BUILD A GARAGE Location 25 Highland Ave, Cotuit 1 Owner' Robert & Margaret McMurray Type of Construction Plot Lot Permit Granted. July 14 , 1994 `Date of Inspection: _ Frame ' 19' Insulation 19 Fireplace 19 } Date Completed 19 SIN 3 in �y r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION, -,.,.,,, = Please print. DATE �( JOB LOCATION `Z� B F��z L�. v:. Number Street Address Section 'Of Town HOMEOWNER" I�R©vlozcr l'ti- c AZO"(0 I S Name Home Phone Work Phone PRESENT MAILING ADDRESS �✓. _ \c�tyC `I� 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 such 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 to six 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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE ,1 APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or 'larger, will be required .to comply with State Building Code Section 127.0, Construction Control. MIScs ,u .y y HOME OWNER'S EXEMPTION The code states that: "Any Home Owner performing work for which a permit is required shall be exempt from the (Section 109.1.1 provisions of this section lding r - Licensing of Construction Supervisors) Home Owner engages a person(s) Owner shall act as supervisor, -�for hire to do such work, that°vided that if such Home Many Home Owners who use this exemption are unaware that the the responsibilities of a supervisor see A Y are assuming for Licensing Construction Supervisors, Sectiond2.155) Rules and Regulations awareness often results in serious problems, particularly hwhenathe°Home -Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. Home Owner acting as supervisor is ultimately responsible. The To ensure that the Home Owner is fully aware of his/her res onsibil ' many communities require, as part of the permit a li p sties, Owner certify that he/she understands the responsibilitiesnoftaasupthe Home ervisor. 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 r use in your 3sJ i 15 ' 34 ' 15 ' Shsde area is the Additional part to be added to the 16 ' existing footprint 30 14 ' �I 20 ' ront View Left Side 148. 7,2' Qrj 157, —-_ 31.8' ^' LOT 12 DECK —===_=HSE== 0 39f O -__--10.0' t� 8.3' 0 LOT 7 o ►� - o A 8513'00„fi, i LOT 8A RES.. ZONE. Plan is For RF This MORTGAGE INSPECTION FLOOD ZONE. C Bank Use Only TOWN:` COMT _ _ REGISTRY OWNER: RCBERT H & MARGARET A. McAfURRAY DEED REF: __6808 204 _ _ _BUYER: _EEFMA ' _ _ _ _ DATE: _4/93 — — — PLAN REF: 15�7 & 121 155 _SCALE. = _J0FT. I HEREBY CERTIFY TO SANDWICI CO DATIVE'B LVK OF YANKEE SURVEY ____________THAT THE BUILDING �Ep��� Mgss9c SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS o� PAUL ti� CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ CONFORM A. 40B (SUITE 5) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE � MERITHEW TOWN OF _ BARNSTABLE ------- -AND THAT A No. 32098 INDUSTRY ROAD IT DOES_NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD 9��Fs AFC�STER�� Q,� MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED_V2_,� 9Z__ soyA� iac►oso TEL: 428-0055 Co unit —Panel 250001 0021 D FAX 420-5553 � _____ THIS PLAN NOT MADE FROM AN INSTRUMENT 11480 BJS PA A. ME�2ITH IS SURVEY NOT TO BE USED FOR FENCES ETC. coMMo r y r c TH OF MA$SACHUS-IqTs DEPAR-,MENTOFINDDSTRN irACCIDEN -S ' 600 WASHINGTON STREET fames-' Canmei. BOSTON, MA.SSACHUSETTS 02111 Gomm:ssioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT gicenseelpermittee) With a principal place o residence at: (C iVS=M ip) do hereby certify,under the pains and pcnaldes of perjury,that [] 1 am an employer providing the following workers'compensation coverage for my employees workin'g on this. job. Insurance Company Policy Number (J I am a sole proprictor and have no one working for me. j] I am a sole proprictor,general contractor or homeowner(circle onc)and have hired the contractors listed below who have the following workers'compensation insurance policies: Name of Conrmaor Insurance Company/Policy Number Dame of Conmaor Insurance Company/Policy Number Dame of Contraaor Insurance Company/Policy Number Vl :m a homeowner performing all the work mvsclf. NOTE:.Muc be aware that wbile homeowners wbo employ persons to do cLIILCaaaC[,construction or repairwork on a dwehinc of not more t5an free units in wbicb tie bomcowacr aiso resices or on tic Erouncs appurtenant tbereto arc not S:eaeralhY eonsicered to be emplovers unccr tic Workers. Corr-pe=260C Act(CL C 152.sec- 1(5)),applie:tion by a bomeowoer for a Iieensc or permit m:v c%ji cacc tic kcal gurus of an Crnvlovtr under the G•or1crs'Comixasidoo Act. , 1. ur.dc ;: t:a;:cn:,,. eF t :r.::c nc :will be r'"orwa-ccc co crc lcca; �.r :r.:.!Accidents' Oinu aelnsuranec for coverare vc -.�:ien :rc '.5:cr,icad to "r imposition of -J L c ccn:isp:-c of:ii-c cr cp rc S ;�Q.GO�.G�or 1.^..pruonr..�.r or up to ore}c �.c c• pcn:: -cs is the form of:Stop Wort:Order:rd fine of S i oo.00 day gins:mc. Sicncd thi day of 30 7Q �[ . , 19 iCc:aoI r::r 1-3.1