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Home My WebLink About0110 HIGHLAND AVENUE __ R -� � � _ o ,� �� r t. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION p mCF . Map V Parcel I Application # . ^I ��✓v Health Division Date Issued Conservation Division a4e Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis roject Street Address Village Owner �fdGP��u�cz /� L� -t Address Telephone _,/—e� - - /3 Permit,Request-- , s9 o? 1 , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation-j &0-4D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: &15u'll ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: ,3 existing _new Total Room Count (not-including baths): existing new First Floor Room Count Heat Type and Fuel: Q/Gas a6ci I ❑ Electric ❑ Other ;. Central Air: ❑Yes U11 o Fireplaces: Existing New Existing woo ef/coal stove; ❑Yes ❑ No Detached garage::4 existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: D e fisting 0 new size_ Attached garage: M existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ON C Tf Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ( -cam Telephone Number Address License # I .Home Improvement Contractor# IIEmail 9 61MAg- ld Cf 7 (� �'`l� Worker's Compensation # 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY t APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i s 3'lie C'omraoinvealth off?blFcrssr diusetts Dep wt7rre�,4 o,frndrrstrialAccideFds Of re aflmwtigadons t 600 Was rfrigton J, eet -'y Boston,M 021.I1 - tiers' Campensaf an lns �e Affidavit:Bmldei-s/C,untracturs�EIectricians!Plumbers Applicant InfGrmat on _ Please Print Le��iIy 1`1a17YP. '/ Addiess Cififtatefi:,_ �D P" phones Are you an employer?Check the appropriate box: Type of am a genera contractor and I Yp project' (required).-- 1_El I am a employer u�rth. ❑I l 6_ IkTe:w consfructi� employees @.Z atidlor par# time* have lured.the mbt-ccmtractors i �. I am a sale props ietoz;orpariner- listed on.the attached sheet. ?_ ❑Remodeling and gave na ern 1 gees. I7ie3e smb conEractors have p 8- ❑Demolition. wodring forma in any capacibrr employees aridhave workers' ' � zE 9_ Building addition [Na workers,camp_insuranc& comp.insuranaI ❑ rezlaired] $. ❑ We are a corporation.acid its 10'❑Eleetacal repairs or adatioms 3. I am.a homeommer doing an work •affacexs have em-rcised their ❑F3um6in ie g pairs or additions Dq-V if[No workers'camp- rigfit of exemption per MGL L.�R�ofrepaiiS :ismame required-]i `c.152,§l(4k and we have no emplogees_[No workers' 13.❑Other comp.insurance required.ji Amy appEicrvrtfistchecUbas gl mnst also lM oulthe sectioaberawshmsing dmkv;odele compensatiaa policyiaformsdaa 0 i3omeorwaers who submit d5is af5dm is indicating they are•doing all wal=4 dLm 1fre outside contracros nmst submit anew affidavit indiF9�suclL r fCoutracturs tl at check this boot m=attached as additinal sheet shouting the name of the sub-contmaom said state whether ornot those eaddesbare ' employees.If the empIoyees,theynou tpmuide their worker'-romp.policy number - I aim all earplv}.trr fJerrt fsprrnitii>tg workers'conperesa on inmirancefor Sri}*cmpl��e'es Selo�v is�7repoticy rued jab sofa' ii�•�armrrtzon . . Insumace Com.panyName: P01icy or Self--ins.Lit. E- piratiouDate: Job Site Address CityfStaWzip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). . Failmm to secure coverage as required.under Sez6on:25A of MGL c.15"7 can lead to the imiposition of rdmirnaI penalties of a fwe up to$1,50D.0U and.-'or one-year inprisonmeat,as wen as chil penalties.in the fa=of a SIDP WORK ORDER and a fine of up to$250_00 a day against the violator. Be adsised dint a copy of this statement maybe forwarded to.the Office of laves gati C ofthe DIA for insurance coverage verffica ion_ I do liiere-by cmlif}t rlaudg!r thif prints a7id penah�ias 0. ' �}'filattlur hTormrrfz &Fronded abm a is true mid ctrrrect Phone i€ �6 t Ofjfcfrd use anly. Da oat err&e in this.area,Aa be c�rinpteted by effp artonwn offictal • City or Tana: Pernaf Aense# ImuingAuthority(circle true): L Board of ffeaIth 2.Building Department 3.CitylTown,Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#- Taformation and lastructions Massachmetts General Laws chapfPr 152 reTo S all employers to provide worker'compensation fco ilieil employees. p {n this ,an aaplayMe is deed as.'—every person in the service of another under any contract ofhire, empress or huplied,oral or writtum" An EvTroye-is defined as can individaA pmtamssh�,awociadian,corporation or other Iegal entity,or any two or mare of the foregoing engaged m a joint entnrprmse,and including the legal aepres=b Ives of a deceased employer,or the receiver or trustee of m iadMdmL paxinmship,association or other Iegal 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 mab te,an m,crosauciion or repay wow on such dwelling house or oa the g-rotmds or bmldmg alip thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also sties that"every state or local licensing agency shall withhoId fxe issuance or renewal of a license or permit to operate a business or to construct btuildmgs in the Commoawealth for any applicant who has not produced acceptable evidence of compliance with the insurance,coverage required." Additionally,M(IL chapter 152,§25C{7)stains"Neither the com arrwealE nor a'ay of its political subdivisions shall enter into any cont-act for the p erfomianee ofpnblic e�o�uni�I acceptable evidence of compliance witTi the>m s cd• re,TM, nts of thi chapter have been presenisd to the contracting auihozity-" AppHcan-fs - Please;fDI out the worker'compensation affidavit completely,by checking file boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), addresses)and phone numbers) along with their certificates)of n,crrrance. Limited Liability Conmparries(LLC)or Limited Liability-Partnersbips(LLP)withno employees other thauth-e members orpartaeas,are not required to carry workers' compensationfism-ance- IEanLLCorLLP does have employees,apolicyisrequired. Be advised thatthisaffdxVit maybe mbmitied tor the Depa--tmentofIndusnal Accidents for confnmatron of Tn mran ce coverage- Also he sure to sign and date-the aidavit: The affidavit should be retimrned to the city or town that the application for the permit or license is being requested,not the Department of L -,strial A rci demos. Should you have any gnesiions regarding the law or ifyou are reed to obtain a workers' onapensationpolicy,pleasecalltheDeparimentatthenumberlistedbelow. SeIf-Roared. rfiheir e self-insurance license number on the appropriate line. City or Town O$cials Please be sure that the affidavit is complete and prod Iep bly. The:Department has provided a space at the bottom of thin affidavit for you to,till out m the event the Office ofInvestigations has to contactyouregarding time applicant Please be m=to fill in the penlit/licrose nnrinber which will be used as a reference number. In addition,an applicant that must sabmit multiple permit/license applications in any given year,need only sabmit one affidavit indicating current p olicy info=&dorl(if necessary)and under"lob Site Address"the applies should v;rite"all locations-in or -own)_"A copy of fhe-affidavitthathas been officially sf - cl or markedbythe city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permitnotrelatedto any business or commercial venture (i_e. a dog license or permit to bum leaves etc.)said person is NOT reqdred to complet:this affidavit The Office of Invesligafrons would 1-kM to thank you in.advance for your cooperation and should you,have any questions, please do nothesaate to give us a call- The Department's arl&=;telephone and fax number: The C:G.MMMWeattt of Massachnsds ' IIagait neat of 1adustial Accident f�ffitee 4f�•�e.�fig�,tio--� �4-4 Stan Stt�et Bastan,MA Q2111 Tt,-L #617 727-4900 ext 4€6 or 1-977-MAS � Fax 9 617 727 7M Kevi=14-24-07 W W - ��c AWC wide to Wbad`Corrstracdarr in ff4g 4 Prod Ai•ar :1I0'mptr INrrrd Zarrt Massachusetts Check ist for Comoance gn a'rR5301•2 I;lY el 1.1 SCOPE. - _ • ` . - � -.. _k [;�7pprianr'• Wind Speed{3-sec ----- - .110 mph Wind Fxpimure Catagcry___...______ ____ Wind Exposure Cafegary--:..........._Engineering Required For Entire Project.......................................0 12 APPLICABIL TIY ' -plumber of Sbfles(a roof which exceeds B in 12 siope shall be considered a sfory) stories 5 2 sbries Roof F`iIr#t _- . _- - - - -(Fig 2) Mean Roof Height - -- - -- ------(F9 2}�-_-__,.--:_._. -- -- ft'`-'33' Building Width,W__ _ _ _ _-- __(Fg 3)r_ ---_fr 9 BtY Building Length,L Building Aspect Ratio(LN ` 3:1 F• hlaminal Height of Tallest Opening? - -• -_-_(Fig 4)-• _ _ 5 GB' • 1.3 FRAMING.CONNECTIONS „ General compi-rancewFJi framing mnne(%ans_.._- (Tablet)-- ---- --------------=:---- 2.1 FOUNDATIDN Foundation Walls meeting requirements of 780 CIJiR 5404.1 ...................... ----------- -. -------••-- - - -----------•--•-•---•--•------ - ---- - -- Concrete Masonry. -- ------ - ---- --- --- ---- ' 22 ANCHORAGE TO FDLINDATIONt3 51B`Anchor Bolts imbedded or 5/8`Proprietary Mechanical Anchors as 3n alternative in concrete only Bolt SRCchg-general__..__..:-----:•--•--.---_---- [Table 4) ..... in_ Gott Spacing from end(oint of plate Bolt Embedment-concrete,-_ (Fig 5).:. : _-_ _- in.>r _ Bott Embedment-masonry_._.. - -- ---_(Fig 5). ,?- -- _-- in-'-1 - Plate Washer_'_-.__.__• L 3`x 3-x%' 3A FLOORS Floorframing member spans checked ____-- (per 7BQ CMR Chapter SS) -- Maximum Flow Opening Dimension FuA!-!eight Waff Studs at Floor Openings less than 2`from Exterior Wall(Fig E)---------------------------------- .----:•` MasdrniJin FlaorJoist Setbacks Suppoffing Loadbeararg Waifs or Shearwatl- _-Fig 7).�- _----.__�_ _ -�.<d Maximum Canfilevan d Floor Joists Supporfing Lbadbearing Waifs or 5hearwall_-- (Fig 8)_-------------_---�_, _��. ft 5 d -F1oorBr�cing at Endx�afIs_....,_.------_<-----_.-.---[Fig 9)-- ' ----- - - - • Floor Sheathing Type 730 CMR Cf-iapter 55)----=�--�- FlowSheathing Thiclmess.�- __—-- --(perr 730 CMR Chapter 55).....-w in_ floor Sheathing Fasferung _--__-- --__-.-_-(Table 2)- d naffs_at in edge 1_; infield , A4A YYIJ .S r. - Wall Height Laadbearing wags. - _ - (Fg If)and Table 5) hIDh4 nadbr adng galls--. (Fig 10 and Table 5) __:__ f1 Wan stud Spacing _-- --- ._.._._(Fig 10 and Table 5)-- _in s 24 a.r- Wag story Mats - � --- - --(Fgs 7 l t B) - -' _ft c d s ^p 4.2 D; T DR-WALLS' Wood 5tirds it_in. _ htcn�aa�earing ells._----j----- :-.-Jable5} _ _._.____._2x_--ft_ui. Gable End Wall Bracing' . -J FA HEQ1t Endwall Studs_------ --•Fig 10)_ _ --- - -- WSP-AHL-Flow Lerigifi _- (Fg 11) r _-___. ft�:W13 Gypsum Cang Length(if WSP not used) .. (Fig 11) -_. _-_--ft?_0_9W -and 2 x4 Continuous Lateal Rrac_-Q 5 ft o.c.-(Fig 11)_-...................__... or 1 x 3 ml[ing fimbg strips @ 16`spacing-min_With 2 x 4 blorlcu• g @ 4 fL spacing in end joist or truss bays Double Top Plafi: . SpGca Length - (Fig 13.and Table 6)-_- -� -_ —ft _ Sptrca Gonnetion(no.of 16d common nails)_ (Table 6)_ _ — A FVC Guide to Wood Carrst-mc on in IH gfr tend Areas: IIO Fnph Firrrd Jerre ' Yfassachusetts Checklist for Compliance(rsg CT�IR5301_Z.r_1)i Laadbearing ball Connections - - Lateral (no_of 16d common nails)-- - _ (Tables 7) Non-Luadbearing Wag Connections Late�iai(no_of 16d common naffs)--_--(TpLble 6) -- Load Bearing Wag openings(ramrd largest opening but cheek all openings for compliance to Table 9) Header Spans -------(Table 9)--- Sill Plate Spans --- --- ----(Table 9)- ----- —ft—ut-`1 i FLA Height Studs (no. Df studs)__ (Table 9)___-.___:--- r Non,-Load,bearing Wail Openings(record largest opening blrt check all openings far compliance to Table 9) HeadeeSparm._-___— -' _—.—_--_(Table 9)__—__ —_— --t}_irr_s 12' Sig Plate Spans.___ -;—_ (Table 9).. . _ft_in__<12' Fug Height Studs(no.of studs)__——_ (Table 9)____ --- Exterfor Wag Sheathing to Resist Upfdt and Shear Simuffaneousfy4 _ Nfinimurri Builoing Dimension,W . Nominal Height of Tallest Dpaningz __•-------------- 5 Sheathing Type—_-_.____-__(note 4)_�_--- Edge Nail Spacing -- -- (Table 10 or note 4 if Feld Nail Spacing---_— __--- --(Table 10)_____---- — in. Shear Connection(no.of 16d common nails)(Tablet Perceait Fug-Height-Sheathing.__-L-__-_-(Table i D)_ �_-__ 5%Additional Sheathing for Wag with Opening;-VW(Design Concepts)_______-—. Maximum BLAding Dimension,L - Nominal Height of Tallest Dpening?-----------•-----------------_•-•------------------••-- Sheathing Type----- ------- ---(note 4) ---_ _------- ---- Edge NO Spacing-_._ _ _(Table 11 or note 4 if less)__-- __ irL Feld Nag Spacing---_-- --- —.-:_(]"able 11)__ -__—_-- ----- in_ ShearConnection(no.of 16d common nails)(Table 11)__...__,_ ~--- -----_---------•_ _ Percent Full-Height Sheathing— (fable 11) 5%Additional Sheathing for Wall with-Opening y 6V(Design Concepts) _---__—_-- Wall Cladding _ Rated for Wind Speed?—--- -- --—----- - --------- - 5-1 fZOOFS Roof framing member-spans checked?-__— _(For Rafters use AWC Span Toot,see HBRS Websife) koof Overhang --- ----- -------- -----_-------(Figures 19)_-__:____- ft s smager of 2'or CI3 Truss or Raff:er Connectiond at Loadbearing Waits _ Proprietary Connectors . plf Lateral-----,.____ ___--_(Table 12) plf - Shear_— --(Table 12)--__ __-_- —S= pff Ridge Strap CDnnectiions,if collar ties not used per page 21__- (Table 13)__- -._—_.T= pif Gable Rake Dutlooker_.__-___---_-.: -----_ F ure 20 ft s smaller Df`Z or L12 . Truss or Rafrer Connections at Non4_mdbe:aring Walls - Proprietary Connectors Upfd1—-__._� _.-_-_— (Table 14) [b_ Lateral(no.of 16d common nags)--(Table 14)------__-------------------------L= . Ib_ Roof sheathing Type-- - _ (par7BD CMR Chapters 53 and S9)__........... RoofSheafhing Thickness_—__..__ _ -_._-- _ _in_?711fi WSP Roof Sheathing Fastening—___ (Table 2) — _ t Nc•tes .1. _ This checklist shall be met in ft entirety,ecdudmg the specific exception noted in 2,to comply wth the requirements of 7-BD CMR-s301.21.1 item 1. ff the checldist is met in rls entirety then the fallowing metal straps and hold downs wr-not required per the WFCM 110 mph Guide: a. 5tael Straps per Figure 5 - b. 2b Gaige Straps per Figure 1 i c Uplift Straps per Figure 14 ci All Straps per Fgura 17 e. Comer Stud Hold Downs per Figure 113a and Figure lab 2- -Fxcepti=Dpe ning heights of-up.to ti it shall be permftad when 5%is added in the percent full height sheathing - 'nequir ernents shdvm in Tables 10 and 11. 3- The bottom silt platy in exhidDr walls shag be a minimum 2 in.nominal thickness press=trued#2-grade. Af C Ga de to 1 0orl Corrsfrrrc iatt zrt f�i,�h !3 rrcdf[reas_ IIO rr;spfr IKud-7 C Massachusetts CheckUst for Compliance(780 C&i12s301-2:J'I)I 4. a_ From Tables ID and If and location of wall sheathing and Suildtng Aspect Ratio,deter rnfne Percent Full-Heighf Sheathing and NA Spacing requirements = b. Wood Structural Panels shag be minimum thickness of 7116'and be installed as foliows: i_ Panels shall be installed Vtdi strength axis parallel to studs. Ft. All horizontal joints shall occur over and be nailed to framing. iFL On single story mnstruc6on,panels shall be attached to bottom plates and top inember of the double top plate.- . iv. On two story construction,upper panels shalt be attar_hed to the top member of the upper double top plate and to band joist at botfnm of panel Upper attachment of lower panal shall be tirade to band joist and Iower attachment trade to lowest plate at first floor framing. v. .Horizontal nail spacing at double top plates, band joists,and girders shall-be a double row cf ad staggered 9 3 inches on tenter per figures below:Vertical and Horizontal Nailing for Panel Attachment 5- Glazing protection:a)'new house or h6riznnfal addition—required if project'is i mile or closer to shore(generally.south of Rte.28 or north of-Rte.6) b)verfical addFdDn-not required unless there is e.:tensive renovation to The first boor c)replararnentivWdows—needs energy conservation compriar pc only(chap 93) 6.1Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B maybe obtained from the American Wood Council (AWb)wahsKe. t�+um�u�sa t - •Ar l` �! - u i I r l ( 3 = F a = R R.,.t [r - !u ;i 0 it [ [ Yf d [ Lk r ([ i, [ E tr7 - [ It u a [ r[ It •. NA>;.�<?�—Ai¢H._. _ � ,.. _ °k UK[LlsF7"rEFW tX]IhAE61klLIDGESpACMtTEML - See DaWl on Next Page _ - Detail _ I Vertical and HDA7Drilal hlalung , Verfml end HoAmnf-al Nailing for Panel Attachment . for Panel AflacfLmant ,,C{ - Tay Town of Barnstabk . Regdatorp Services • E RlS7Ncrl Sit•4 4 .. . . Ml--�-.��► - Rich -d V.S=4 Dirmt r Swif&mg DiVm0n • TamPerry,Em1rMEr Ca ianer 200 Mam street Hpa=j.s,MA 02601 www tDWnI2M9tablemaIIs ofce: 509-862-4.038 Fay 508=790-6230 Property Owner Must Complete and Sign This•Section If•Using A Builder ' Qwn.er of,tb-subject pro ` P�•Y• • he�bya�rtborize - a�. • .,� to act oa. • �i Myb932A in all matters relat«to woik aiaonzed bytlus bmlc i permit application.for. G . ( of job) 1 es and alarms are the res ponst7bs7iyof the applrcaut Pools are not to be fMed or Utilized before fence is installed and aI1 fusal ' inspections.are..pmfo=d and accepted. S' of Ownfr ` S of Applicant .PintName pint Name 3 ,-CY/� • ` Date • ' Q.rViLLC�.V R1�G.0.Li+CiY11A�LLi�.f.�V� • - �� Town of Bamstable Regulatory Services, r � Billiard V.SraA Director , $uffdiag D&hdoxt. F Tom Perry,Ruff mg Commimdonrx ' FQa 2 �a 200 Maio.Sfrc4 Hyaaais,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 " HQMEiQ'pP�i .tTTr�sEEI�QN JOB:C= VWZP nnmbcr" ham pha=* wo�cPbonc . T /G'ORREN T M�GADDRESS:�� up code The current cxemption for`-homeowners"was extr-nded to include owner-occupied dwellings of six units or less and in allow homeoVeners to engage an individual for haewho does notpossess a license,ytoyided thatthc owner acts as supervisor_ D3Fn-7U0X OFHOMEOwiUR peison(s)who owns a-parcel of land on which he/she resides ar int- to reside,onwhich there is,or is intended to be,a one or twn- famiTy dweIIing,alfa ebbd or detached stucimes accessory to such use and/or farm stn,r b=s A person who consUucts more.than one home in a two-year period shall notbe considered,abameownen Surd.`homcawnce'.shaR sabmitto$ie Bmlding Official on a fn= a='r table to the Bra7dmg O$uial,thatbr/sbe shaII be respans�ble for aII surhwa�pe cd�derthtb�Idn�yc�it {Section 109.L1) a mne:_c onsf ance WHLtbs Siafe Big Cade and other applicable codes, The;ffidarsigaed`�iameown�' resp �7dy for PR bylaws,roles and regahtiom- - th `�omcowner"ce<tdies thatbe/sbe rnrientands e Town ofBarnstable BmMkg_Dcpaztmatm inspecfm "TheUndersigned. i- I dines and i=em regneuts that hclshc will comply wifh said proeedmzs and regnaeme�. j SiY of$nmcawnrr �Appsv�al ofBm�d"mgO�ciat ' ' Note. Three fSmny dwtni 3p containing 35,000 rabic fhet or lm:get wMbe requirc&to comply wrththo SiafaBtalding Code Section f27.0 Constrvcton ContmL RDMM0W M•S MMannrr The Code states that allay homeowner performing work for Which a bui7dizrg permit is reed shall ho exempt from the provisions of this secf=(Section I09-U-I.irP-n-g-M of cons me ion Supervisors);provided that if the homeowner engages a person(;)for hire fn do such work,that such Homeowner shalL act as smper 7bor." Macy homeowners who use this exemption are tmaware.that they are aovr mmg the respons�iT awareness often of a supervisor (see A.ppendiZ Q,RnIes Bc RegaFatioas for Licensi,,g Canstrucf on Sipervisors,Section 2-15) This L3ck of a results in serious problems,parficularlp when ffu homeowner hires mTceased persons. In'this case,our Beard cannot proceed agsffi3st the,u3iricensed person as it would with a ri—sed Supervisor_ The homeowner aef xg as Supervisor is ultimately responsible To ensure fkat fiie homeowner is foxily aware of his/her responsibilydes,many caanannifi-s require,as part of the p it appIzrafznn,flat the homeowner certify that hehhe understands file respon sMiTdies of a Supervisor. On f Iasi page of this issue is a form cnrrerctiy IIsed by scieraI towim Yon may,rare t amend and adopt such a fa rmIceridicafIoa for use in your mmmumify. _o Bavised 061313 . XX � X COTUIT BIRD GARDEN CLUB - 2015 O P 79 80 81 82 83 84 X 85 86 87 88 X 89 90 91 92 93 94 95 96 97 X 98 99 100 101 X 102 103 104 105 X 106 107 108 109 X 110 111 X 112 113 X 114 115 116 117 i /�� - � A �� ' COTUIT BIRD GARDEN CLUB - 2015 O P 40 X 41 42 43 - 44 45 46 47 48 X 49 50 X 51 52 53 54 X 55 56 57 58 X 59 60 X 61 62 63 X 64 65 X 66 67 15,16 68 69 X 70 71 72 X 73 74 75 76 HONORARY 77 78 X Town of Barnstable 1HE Regulatory Services do Richard V. Scali, Director. • Building Division sznaia BAST�LE sn[uv �,�, 0%NNS*A9LE.CBOFRVILLF.C9NIf•HYAtti3 Nusioxs nius•osmm�ut•xssr.n"xsnait s63q. .m Thomas Perry, CBO 1639.2014 °rFDN1o.�► Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs ` Office: 508-862-4038 Fax: 508-790-6230 April 15, 2016 Joanne Miller 110 Highland Ave. Cotuit, Ma. 02635 RE: 110 Highland Ave., Cotuit,Map: 020 Parcel: 137 Dear Applicant, This letter is in response to application number 16-538 submitted to do work at the above referenced address. Unfortunately,the application can not be approved at this time because of the following: 1) The application is relying on an existing open building permit(application number 201408182) which to date has had no passing inspections. Please do not hesitate to contact this office with any questions: Respectfully, WfrLLauzon _ Local Inspector j effrey.lauzongtown:barnstable:ma.us (508) 862-4034 4 wr d i I i IN TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Man Parcel 13'7 Permit# rT S a Health DivisionO/f_ 0_3 Date Issued 6_nI . ra"k -I ' —® Conservation Division 2,1 6 5 Application Fee �y Tax Collector S; (2 — 11�L —S 0 � Permit Fee �U Treasurer 1��.. �'o��. SEPTIC CYSTC- 1 ,UST DE INSTALLED IN COMPLIANCE Planning Dept. WRT} TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGUL TIONS Historic-OKH Preservation/Hyannis Project Street Address AD Village ee Owner �� .. � ��G Address Telephone Permit Request Square feet: 1 st floor: existing proposed` 2nd floor: existing proposed Total new` Zoning District Flood Plain . Groundwater Overlay e t n) Project Valuation ggg,!�4®'0 Construction Type o , Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supportingld°cumenta ion. co co KI Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Cn Age of Existing Structure 3g Historic House: ❑Yes ❑No On Old King's High ay: ❑Yes ❑No Basement Type: Full • ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 'new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove, ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: existing ❑new size Shed: existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address /D �' License# = Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r i SIGNATURE DATE i FOR OFFICIAL USE ONLY 4, 1 PERMIT NO. DATE ISSUED tv-- _ MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: a 1 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUG142 FINAL PLUMBING: ROUGH-��,' : :. ' FINAL GAS: ROUGH N i t i FINAL FINAL BUILDING r lug"vo 1, t ezz"_* a*r� - SPf a �n � 'DATE CLOSED OUT t < ASSOCIATION PLAN NO. s v _ The Commonwealth of Massachusetts Department of Industrial Accidents Office Vallyesti92tions - 600 Washington Street Boston,Mass. 02111 `ray Workers' Compensation-Insurance Affidavit MEE— location y'e-, ci �r7 hone# -X Z— 3 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [] I am an employer providing workers' compensation for my employees working on this job F ._ w, r2?'�'r� C �c^m•F`x.:r.�". ;^' ,�A.•^,sY }7.A : I C r•�ir )kX i_r yrM'r+'z o! `s� rtt.. 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Q.il`r,'•R[,,..lr i,l, _h.C.4'A�,�,"-n! `�"Yi#��.a.a�do�..+,C.a.iFB:I\�:,v,.,T'�:i [] 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 tx+u�: rC Xfir'zi ulwY i t�rf4yr mar .r y+s vro+yf' �' Pt,Et r- {j-,t'.. *w�'�� > '�3+ 'i t -s t'" et-< •`p' .t 3 i It .r1r r i U�x' " lea'$`Y1•TZr<+fL'Et`v w LrA'g�g�.,tr'i n "3 ..N r .! ,x'ar x, i @-E*H r�Ctaf .S'�a 'r'yR F:-} �com an nalries rsly -a y iT? v:' �.-'s .,iz''[ A '' t r +� ,r s f a'�' -�. •W' S Y s r �i �,«p s,. r {-„yd,b`.�iy}a�{..,�,4 �'Y�,. .-,�aS �"- .. s. '4 x�t' ��y�� "35�� ,"Y�'_�r"P�.�r.. �xsi F�,.� „f�e,�P,31' �,tT .!?. �vN.n.:S•i�.s ,�'�ra !�""L�`+-i3�'"''t4a�%,.,x�u •r$'3.iGl ��%�?�''se�t )�xr�'"+,fr rx•L,y_, it 1,�. �'yy ��;?,' t ) �. ti Y� `3.v� r�5+< ,..: tl t �r - '` � a rr Tt .r{ � t3rv^k�i 1 T S U' r` 7� Ar{ r P `S' "3u S ! 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FBe` d" %1y,�y r�,.3�s3h+.i �,�� i+e t ts � - `�Yte'F-A'�S! a". -�.rS `4i"'�Yv y �`i It Z „�l)s�"+� +t�'k.��r X�• ch'[ i`� .G+S,f "fit >.�i�3•.�}3�tah��`.vK'�'?1 ... ifaddress � �S `[F# v M1 �n ri y C e 55 e a r r.,t:. � �'•' rt. yr..w ;'�4�tiN ''" x bps* r a-. i �, Xe1�-r +a,t». 1>P1 ^'v �r;<F.t'v � Sr F,,,�, r era Sty��'Nl�..-„La,`'fi".a�+'��s;t'"'p,� Me ;1giiiiii L+f"'�S a�'y". .�n'rr { 4 �:;� .�� 1 S r P3* a cH.. �7r s' a vu -FYa , 3 #z`' ' ! rr�- 3 4 !' }�-sl^sr i 1` if..t� '� C� •ri el latl" yT.9 iY i +M�a��'Sc`f t�:�C iv ih f f f y a ,•i z[- axr�;,i'k��-fiY r"'�v�zs�t,� '6��""�f. -.;t'?"`s#+3.,''.�,, ti rij ti f a}t x r'��,.,�.,r.r 4`��.r t�+s t,I r Vim'' •��' hS t(:. a 5 2 ,,:e .t �i.�,-'' r�,u+�,:J,v.�L,e� ua'.: -u3`•�'s s,--.e�-r` .,•�' -a n �-e��'a?. �' pr „-�-+`'t - i" `1 r - + G i` r E � _ 4'r � .,,T+..��.f' ,�.,� , SCn$llranCeCOfa$ r '`;u'Y-�e¥�y xS`•'.•31�`'�1 S x ur' � t DOIICI',t�- :>•'..S ,r-:' ,._ '. .-,o. '. �'�^tr.X"Ti'��. t-.•tie x,?., Failure to secure coverage as required under Section 25A of MGL 15Z can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify unde the pains and penalties of perjury that the information provided above is true and correct. D Date c �' Signature /f�, / Print name / e / / ( ! l`t° Phone# 3- 3 official use only do not write in this area to be completed by city or town official city or town: permit/license# F—Building Department ❑Licensing Board check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; (—(Other J f [i I (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance 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. 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. The affidavits may be returned to the Department'by mail or FAX unless other arrangements have been made. The 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. i' 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 A • t Town of Barnstable h�P Regulatory Services $ BAMSMU. ' Thomas F.Geiler,Director us�ss. 9`Spr16339..tA`0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. 0 4 Estimated Cost Ci4 Address of Work: A) Owner's Name: Date of 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 (kOwner 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. n OR Date Owner's Name • 1 x N89°l0'00"W 126. 37' — J c' I � h � � — N89°�5'30"E 111. 06' LEWIS POND ROAD RES.. ZONE.' "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: _MML21____ REGISTRY OWNER: ALICE_M00RE_BY PRISCIL.LA OLI._SPAO GUARDIAN _ DEED REF: _LZM7Z}3 _____ BUYER: DATE: _ll��/�3______`______ PLAN REF: _189�49 __ ^---- _----- SCALE:l"= 30'___FT. I HEREBY CERTIFY TO L'LIMQ JTH MO_R,MG4G CO_____ tH OF Rtq ______'THAT THE BUILDING ��P � YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS tea PAUL CONSULTANTS SHOWN AND THAT ITS POSITION DOES ____ CONFORM A. �", TO'THE ZONING LAW SETBACK REQUIREMENTS OF THE MERITHEV N 143 ROUTE 149 A No. 32098 Q ___BA8L.STABLE___ __AND THAT 9p TOWN OFa� MARSTONS MILLS, MA. 02648 IT DOES_ NO_T _ LIE°WITHIN THE SPECIAL FLOOD HAZARD �9ECISTER��Q,� TEL: 428-0055 AREA AS SHOWN ON THE H.U.D, MAP DATED_VZJ/- -- dy41 LAS13 FAX 420-5553 Co unity—Panel 250001 0021 D �� THIS PLAN NOT MADE. FROM AN INSTRUMENT 10535 DPC PAUL A. ME RITH W, PLS — SURVEY, NOT TO BE USED FOR FENCES, ETC. The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: J� Gc L a number street,/ �rI village "HOMEOWNER": J O0 " -3 n e home phone# work phone# CURRENT MAi11NG ADDRESS: ///d A Dom•(3r-S' 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 requirements. Signa're o 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. �s i �y �t n a x 8' yX �K� S st e m, sTmpp � �7} . • . / e Home Depot # 2680 , 39 LONG POND ROAD , PLYMOUTH , MA 02360 , . ( I,t�e Mar 11 14 : 34 : 29 2003 ^file saved as : £ : \6n\becks\3110CCC5 .DEK Deck Layout . � %Q «y, . vy; . . . . . g/\ \ . . . . d/\ \€ TOWN OF BARNSTABLE BUILDING ' INSPECTOR TO THE INSPECTOR OF BUILDINGS: �- --- -t-14 The unclersiqne� hereby/ 7applies fo a permrit�ccorcling to the folla�win infor 419n: jZ zl� ... (z 7�� Zoning District ...... ..11. .......................... ..............Fire District .........�w..... .............1��................d.... qz Name f Own r. g �* ......................... Number of Rooms ....659:.. ...........Foundation ...... - .................... Exlerior ............. 0.......................... ........00.0?4.7.(�� ...Roofing ........ . ... . ................................... Heating ........... .............. ....od. ..........Plumbing ............0......I. .. ................. ...... ............. Difinitive Plan A ed by Pla ��-�Vj r A nning Board --- d1f-----196 V. @�e /6- 00 Diagram of Lot and Building with Dimensions vp.,: ozx > 50 .............7. rri | hereby agree to conform to all the Rules and Regulations construction. Noma ..............................}�..`--.�.' Redmond, Chester I. onlY3` 37 1455?... Permit for ......one story No .............. ........................ sale fa dwelling .. .....:............... t ' a Location .........�i�hland Ave. Fart. & Lewis Bond Rd. M i Cotuit " Owner ........Chester I. Redmond ............................................. i Q Type of Construction frame ......................... 0 ................................................................................ Plot ............................ Lot ................................ -Permit Granted � � T November 24 ....... ..... . � Date of InspectiDrT 070A< Date Completed .......... ..7rL �i 0_19 i r� `PERMIT REFUSED _ ................................................................ 19tiG �L4 ''' k ,�,. n, / 10 ............................................................................... -� ` �� ................................................................................ ............................................................................... c' o� ............................................................................... � c Approved ................................................ 19 ............................................................................... ^� .................... .......................................................... g i OpTF{�l Town of Barnstable. *Permit# E.cpires 6 months from issue date BARNSTABLE. • Regulatory Services Fee �t�S 4ALfa Thomas F. Geiler, Director 'D �`bAltD Building Division X.PRESS °" Tom Perry, CBO, Building Commissioner ''GG 200 Main Street, Hyannis, MA 02601 Qr�l4 AUG 13 2Q09 www.town.barnstable.ma.us Office: 5 4 Fax: 508-790-6230 % N W BARNSTA L EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 65;�? o 13 / Property Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �c.lL�� 1 Contractor's Name Telephone Number v Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I a sole:proprietor I am the Homeowner ❑ l have Worker's Compensation Insurance Insurance Company Name Workman's.Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) e-side Replacement Windows. U-Value (maximum ,44) *Where required: fssuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. Ho e Improvement Contra s License& Construct Supervisors License is required: SIGNATURE: Q:1WPFfLES1F0PMSlExpressl PRESSPERMIT.DDC The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations + a 600 Washington Street Boston, MA 02111 www.mass.gov/dfa Workers'.Compensation Insurance Affidavit: Builders/Co>ntractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: L City/State/Zip: �� Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I 6: ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner listed on the attached sheet. T. 0.Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition. [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.[VI am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t. c. 152, §1(4), and we have no s employees. [No workers' 13.Q Other s ` comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy infom+ation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. lam 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 fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 penalties of perjury that the information provided above is true and correct. Signature: Date: .. _ —or 19 Phone #: S d� �� 3X3,/ Official use only. Do not write in this area, to be completed by city or town official .City or Town: Permit/License 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4,Electrical Inspector S.Plumbing Inspector or Other _ y 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 tiustee 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-,,,pith 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-contiactor(s)name(s), addresses)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 confwmation 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 futurc 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 tharLk 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 1-8774MASSAFE Fax 4 617-727-774.9 Revised 11-22-06 www.mass.gov/dia r i �� r Town of Barnstable Regulatory Services a.BARNLF Thomas_F. Geiler,Director o "yq- lBailding Division m Toni Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: S08-862-4038 Fax: S09-790-62 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative.to work authorized by this building permit application for. . (Address of job Signature of Owner Date Print Name If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division PrFD � Torn Perry,Building Commissioner v -200 Maio=Street;—Hyannis,MA 02601 R".town.barnstable.ma.us Office: 509-862-4038 Fax: S09-790-6230 H0l•1F_OWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': �crric{' � -G —/� name home phone# work phone# CuRRF-NT 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. DERNMON OF HOMEONVTER 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 siructures 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.be/she understands the Town of BpTmtable,$uilding Deparhnent minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Sign 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 Tbc Code s 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 persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this rxemption are unaware that they are assuming the responsibilitics 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 prococd against the tmlicrnscd person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responstblc. To ensure that the homeowner is fully aware of his/her rrsponnbilities,many communities require,as part of the permit application, that the homeowner certify thit he/she understands the responst`bilitics 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 fom-Jccrtification.for use in your community. GE��Gf��' HIC Ii�► F� �� . a a• • aiaaa A O p , , ® s Engineering Dept. (3rd floor) Map © D Parcel_ � /hermit# /7 00 House# �`!/�G �C_ - Date Issued 2 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) �W t "Fee� 3 Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) p 1HE yY� 19 � SER M 6 E 7 TOWN OF BARNSTABL11 . T . Building Permit Application RV !3,0 kiPT6 E N TA L C0�DT rUNID Project Street Address Village Owner Address Telephone Permit Request — First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 61QQ . Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family UXTwo Family ❑ Multi-Family(#units) Age of Existing Structure j-t— Historic House ❑Yes ❑No On Old Kirtg's.Highway ❑Yes ❑No Basement Type: a Uri, ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing _ New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including bath . Existing New First Floor Room Count Heat Type and Fuel: ❑Gas it ❑Electric ❑Other `% Central Air ❑Yes No Fireplaces: Existing _ New Existing wood/coal stove ❑Yes allo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) 02 C'Gth� ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name ,t 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 SIGNATUR DATE BUILDING PERMIT NIED FOR THE FOLLOWING REASON(S) :� g ,. . �. �, 'I .. , . . . , ! s"� .. � � � ', , � y � ' � 1 �'.. � `-. � ' e _ � a � � ` �.. y i e � � P � � I i t • � . 1 , t �TMe The Town of Barnstable Kma e�ar►srnerE. � -- �m� Department of Health Safety and Environmental Services 1659. � Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen 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,alo with other requirements. Type of Work: / Est.Cost ef� - � Address of Work: Owner's Name q 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 MOROVEMENT 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 Ow is Name • The CO/lt/1loitN'caltit of ifassacliusctts Dt:partnunt of Industrial.9cciJutts ` 1 officeo/inveMil/ons 7. 600 li<asltington Street Boston,Alas. 02111 Workers' Compensation Insurance Afridavit c i tvChong# r 7 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity .....tTw.nuM.•�.r.++w-ass•.?"•+z• .8.t1�?•!f'A�e�n"�Iw77V457!•'�rw7n," *- ... *„+' `.!.;'µy^T.""':"'• •tw:r....w�.Y{+e-+-..-.-s•�. I am an employer providing workers' compensation for my employees working on this job. company name: address: cite: lihnne#: insurance co. Policy# i" , .. ,,.; ._ar,.. .;�,,..-...,1,..,,,........:.rw•..-,.w+...»r1--...-..,.......:..,....c,... ......�.�T.�w�w•.a..n5�i,..—._--'a'S!!.r,,.�.•-....--•.,-.—^-,.r..�. ...�.... 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: comnanv name: address: city phone#• insurance co. 120licl# � .• - _... vrT7t;: '.„�_vy.�;•.:^.T�r.Y,e.f^'T'9!'_``_. •:tiee•rre�--1��.;f,r.,r�w.,.y;•.r,F�:_r.`!'.+.: ar^er..-,•y„ma�-re��--�•-z� _._..�_...-_..mac_..- - ..__...:Jrx• a.... Jr�y �.:�L/:�aa►r - - - + �`•^'�'�::,':+�.�a:ii+-rr �_�a.i+:s:s company name: address- city: (shone#- insurance co. policy.# .Attach additiO al SllCet tf necessary f z:' t:.. 3f r:•F::;�1�.rii;,w ; -- r� •�'_"' :. -."__-_.".sue -- - - - - ass. •--rw = Failure to secure coverage as required under Section 25A of 1.1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andior one years'imprisonment as well as civil penalties in the form of a STOP 1VORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Once of investigations of the DIA for coverage verification. 1 rlo hereht cerlif.1 tdrr the pains and penalties of pery'un•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 y ' city or town: permit/license# rIBuilding Di artment ❑Licensing Board check if immediate response is required ❑ Selectmen's Office Health De artment • p O . contact person: phone#: MOther : Uev,sed R04 PJAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an enrplotpee is defined as every person in the service of another under anv contract of hire, express or implied, oral or written. An enrpinrer is defined as an individual, partnership, association. corporation or other legal entity, or anv two or more c the foregoing enLaged in a•joint enterprise, and including the lei-al representatives of a deceased emplover, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the 0WIler of a dwelling_ house having not more than three apartments and who resides therein, or the occupant of the dwcllino house of another who employs persons to do maintenance , construction or repair work on such dwelling ltous; or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section '_5 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 anv 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 ha% been presented to the contracting authority. 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 i.1dustrial 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 tite number listed below. City or,ro.,•ns 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. Pleas( be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The 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 ►^-aw v.-rt+»— .. .. ..-��w.m.•r-rw•vn.►r.+.+.vw�rtw.,. •,.....rw. '4�!!--"^e�w..aw—.w...�r+-++wrx•eN+MvaCT'.�-^.'-.vn+.�•wor.wrea...v+ TI'le 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 • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE •_ . .� / ' . ' .. • �=:::�', Lze JOB• LOCATION "Number Street address Section of town "HOMEOWNER" 0�0 — 3 _.. • Name Bome phone Work phone PRESENT . MAILING ADDRESS C j.tyl town State Zip c: The current exemption for "homeowners" was extended to include owner-occ: dwellings of six units or less and to allow such homeowners to engage an dividual for hire Who does not possess a license, provided that the owne: acts as supervisor'. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwell` attached or detached structures accessory to such use and/or farm structz A person who constructs more than one home in a two-year period shall not considered a homeowner. Such 'homeowner"• shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be resnc for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes .responsibility for compliance with th 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 requ#emic and that he/she will comply said procedures and requirements. HOMEOWNER'S SIGNATURE "n APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be requir to comply with State Building Code Section 127. 01 Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for W. ich,at- buii_ permit is required shall be exempt from the provisions of this section. (Section 109. 1.1 - Licensing of Construction Supervisors) ; provided t. Home Owner engages a persons) for hire to do such work, that such Hon shall act as supervisor. " � Many Home Owners who use this exemption are unaware that they are assu the responsibilities of a supervisor (see Appendix Q, Rules and Regula for .licensing Construction Supervisors, Section 2:1S) . This lack of a often results in serious problems, particularly when the Home Owner hi unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home Owne as. supervisor is ultimately responsible. .. •. To ensure that the Home Owner is fully aware of his/her responsi.biliti communities require, as part of the permit application, that the Home certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. Yo care to amend and adopt such a form/certification for use in your Comm-, �G,� i0 �/ 1 ��w o,� _ .L x � � 3 ��D;��. ', _ � � �a �c � f � ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION /4 Map O� Parcel 3`7 Application ® Health Division Date Issued /2,8/l6 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village 7� Owner 'ok _ Address Telephone Permit Request ez Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type a 1 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure U Historic House: ❑Yes 2-K-0 On Old King's Highway: ❑Yes ❑ No Basement Type: U'!�ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: _.3' existing _new F r e Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas Oil ❑ Electric ❑ Other Central Air: ❑Yes )kNo Fireplaces: Existing New Existing woo oal stove:; ❑Ys ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: a isting O;new--0size— Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ,L,s i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��-r iZ�-�� r Telephone Number 1 Address /D L License# Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l/' o�/— !x FOR OFFICIAL USE ONLY It� i APPLICATION# Ir DATE ISSUED I MAP/PARCEL NO. ADDRESS VILLAGE I OWNER I� i� DATE OF INSPECTION: FOUNDATION c FRAME r`4 A INSULATION FIREPLACE t= ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT �` ASSOCIATION PLAN NO. `_ 1 ' The Commonwealth of Massachusetts Department of Industrial Accidents ; t , CIL ` ; Office of Investigations 600 Washington Street t Boston,MA 02111 e www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers- Applicant Information Please Print Legibly Name (Business/Organization/Individual)' c- Address: r City/State/Zip: ct Phone #:' V - 1w ..3 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. g, ❑ Building addition [No workers' comp. insurance 5.'❑ We are a corporation and its required.] I officers have exercised their IO•❑ Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per-MGL 1 L El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' 13.❑ Other comp.insurance required.] ;Any applicant that checks box#I 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 most submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'romp.policy information. ]'am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site t 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 andpenaMes of perjury that the information provided above is true and correct Si ature: Date: 4 Phone#: �' L e only, Donot write in this area;to be completed by city or town official wn: Per-mit/License# thority(circle one):f Health 2, Building Department 3. City/Town Clerk -4. Electrical Inspector 5.Plumbing Inspector erson: Phone#:` III. - Cl- 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 employgr 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-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 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 thatthe 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 permittlicense 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 obta'ning a license or permit not related to any business or commercial venture (Le. 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: The Commonwealth of Massachusetts Department of Industrial Accidents G-Mce of Investigations 600 Washington Street Boston,MA G2111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www-massgov/dia Town- of Barnstable Regulatory Services Thomas F. GeUer, Director 'dam BuiIding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.ttiwn.barnstab le.m a.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ~ JOB LOCATION: l� 670� .. number LIP street village "HOMEOWNER": dt�/v�>� e _A/Ile,< name home phone# work phone# CURRENT MAILING ADDRESS: 3`j 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 licenses 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'ibi 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 fans structures. A person who constructs inure 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 • requireme ts. � .. `` . Signs f Homcowncr • Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or Iarger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any hbmeowmer performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Liccnsing•of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." ;e Many homeowners who use this cxemption-an:unaware chat they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 7-15) This lack of awarcnrss often results in serious problems,particularly when the homeowner hires unlicensed ersons. 1n this rase,our Board cannot proceed against the unlicensed anon as it would with a licensed t"' P P ga P Supervisor. The homeowner acting as Supervisor is ultimately rrsponsible. To ensure that the homeowner is folly aware of his/her responsibilities,many communities require,as part of the permit application, a that the homeowner certify that helshe understands the responsibilidr�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 fomJccrtification for use in your community. Q:forms:homccxcmpt of TftE Jolt, � t R�uuert Rr r i Town of Barn* stable ArE p MA'S k Regulatory Services Thomas P. Geiler,Director Building Division Thomas Perry, CBO )wilding Commissioner. 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma'.us Office: 508-862-403 8 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. C;lUsersldccollik\AppDa-talLoca[\MicrosoMWindows\Temporary fntcmct FilmlContcnt.OutlooklDDV87AA-71EXpRESS.doc Revised 0721 10 � T beorL �a� t LT - a-,,ka T �`.'Cam. •� �4Li i�i � •" ��.,i 11��. �— 318V15NdVa � t s r Alo t l N8910'00"W 126. 37" 'tip' ' • y , N89 25'30"E 111. 06' LEGS POND ROAD f RES. ZONE..• 'RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE: :'"C" . Bank Use Only TOWN: _C0-]VLT_- -_REGISTRY OWNER: ar. Kcoa_a� PRtsc�sPaONorJ GUARDIAN DEED REF: _L935Q13----------BUYER: -XAN"N-ZJV-1fZ4J '8---------------------- DATE: _IzIZVJJ------------ PLAN REF: -189Z49 __ ____SCALE:1"= 30'___FT. I HEREBY CERTIFY TO ----- `�h OF �q ___________________________THAT THE BUILDING �� YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �� PA. y�� CONSULTANTS SHOWN AND THAT ITS POSITION DOES _--_ CONFORM o AA�RA. ti TO THE ZONING LAW SETBACK REQUIREMENTS OF THE 143 ROUTE 149 �o Q TOWN OF BARt SEABLE_____________AND THAT �p� 9 No. 8 �a� MARSTONS MILLS, MA. 02648 IT DOES-101- LIE WITHIN H.U.D.E SPECIAL FLOOD MAP DATED �?f��ARD Fss,a�q isTaROSJQJ TEL: 428-0055 AREA: AS SH WN ON THE FAX 420-5553 Co unit -- a^A1 250001 0021 D ,r ra« NOT DE FROM AN INSTRUMENT 11116zQr nz�i, To f� - Date /1 � dl Time 940 WHILE YOU WE OUT M ' of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message Operator AMPAD 23-021 -200 SETS G' EFFICIENCY® 23-421 -400SETS CARBONLESS 2M TOWN OF L311FZNSTIIFSLE r {. y" BUILDING DEPARTMENT ti Y` 7 -a_a--=----------------HOMEOWNER LICENSE EXEMPTION M1�e Please print ------- _ �� . , DATE ti X�t ' JOB LOCATION Number treet Address Section Of "HOMEOWNER" Town , Name l3 3s. Work Phon �S PRESENT MAILING ADDRESS ?��v � t yrt�l3�# �r♦ '+ Town C ty;The current exemption for ."homeowners" was extended to i uocchned dwellin s of si PrChod nclude owner- Y 7arAA x units or less and to allow such homeowne 8 tpbsN r:rbnc�age, an in ividual for hire who does not possess a license,hlb,-Owner acts as su ervisor. e, pro_ y}_d d t`DEFINITION OF HOMEOWNER; Mid �Per$on(s) who owns a parcel of land on which he/she resides o at �reside, on which there is, or is intended , r �dwelhin attached tone to r ihten'd 9 ached or detached structures accessory oto such luse aand/ort�x structures. A person who constructs more than one home y ,rw pie=iod 'shall not be considered a homeowner. in a two= � to the .Building Official on a form acce t year: ry; a' y, Such homeowner" shall subm t n�thayheshe shall be P able to the Buildin G, ~ nbui�di'ng hermit. res onsible for all such work erformed .under the z 5 9`fficial ' (Section 109 . 1 . 1 � ) - - r The undersigned "homeow _ � ; sState; Building Code andnothersappliumes responsibility for compliance with,Ft; s~ ' regulations, pplicable codes, by-laws, rules and " . T ofhe undersi ned "homeowner" gcertifies that he/she under Barnstable Building Department minimum inspection stands the Town requirements P ion procedures and M1 Vh i 4s•('y: i x{ .HOMEOWNER'S SIGNATURE " APPROVAL OF BUILDING OFFICTAL p kl I t Three family �5 required to com dwellings 35 000 +, Controls . p1Y with State cubzc feet, or lar , Building Code Se ger, will be Section 127 . 0 C truc II ons tion °'r NfGC5 K HOME OWNER ' S EXEMPTION Ifs{?- The code states than : "Any HOM(e +.vner performing work for which. a building.;; ' 4 J permit is required all be exempt, from the provisions of this section'-`.... (Section 109 . 1 . 1 - 7.icensing of Construction Supervisors) ; provided thatify<i` Home Owner engages a persons ) for hire to do such work, that such HOme; ., 5` Owner shall act as supervisor. " �''' Home Owners who use this exemption are unaware that they are assumin' responsibilities of a supervisor see "' Rg P ( Appendix Q, Rules and Regulat�.ons�'-- for ;Licensing Construction Supervisors , Section 2 . 15. This lack,.of • '��Hr,. awareness often results in serious problems , particularly when 'the"Home' >;{,' tlrOwne=',hires unlicensed persons In this case our Board cannot proceed �� sagainst. the unlicensed person as it would with licensed supervisor., r � ,,Home.. Owner acting as supervisor is ultimately responsible. 1+ To-ensure that the Home Owner is fully aware of his/her responsibilities� 5 x; many communities rea'i.ire , as part of the permit application, that the Home i Sy'i Owner certify that h /she ,'nderstands the responsibilities of a supervisor. On`, .the last page of: h.i.s i.;;sue is, a form currently used by several towns. `4. ,� Y•ou may care to amen and adopt such a form/certification for use` in..your ,r r community. , uc - d + w 1 r fifi pegIL 2 P, Ai-P d Assessor's office(1st Floor): 0�D I Assessor's map and lot number z poi THE toy Conservation > SLEPTiC ',,,eau -� Board of Health(3rd floor): INSTA LEO M Sewage Permit number WITH SAA Engineering Department(3rd floor): ENVIRONMEW ° 0 House number /U JFJI Definitive Plan Approved by Planning Board 19 TOWN REGUL� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 14)"V(, 19 1--3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: , Location �� (�0 �Gu �✓ / _ l Proposed Use Zoning District Fire District Name of Owner C�id�cP /�ZG � Address //0 Name of Builder w u e 1— Address Name of Architect X) Address Number of Rooms Foundation Exterior Roofing Floors Interior 1 Heating Plumbing Fireplace Approximate Cost 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 Supervisor's License Ow'V e Y' MILLER, JOANNE ' No 35830 Permit For BUILD DECK. Single Family Dwelling Location 110 Highland Avenue f Fy ` Cotuit f Owner Joanne Miller Type of Construction Frame s; '' Plot Lot Pefmlt..Granted May 3; 19 93 Date of Inspection 19 Date Completed 19 nJ _ rpVt 5 gg