HomeMy WebLinkAbout0115 MAIN STREET (COTUIT) /io Xlon
�Sf.
� ,. Town of Barnstable
Building
.�xvsrwece Post This Card So That it is Visible From the Street Approved Plans Must be Retained on'Job and this Card Must be Kept
mcq& Posted Until Final Inspection Has Been Made.. Permit
�es9� moo$
Where a Certificate of occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-20-992 Applicant Name: 'Alexey Lebedev Approvals
Date Issued: 04/10/2020 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/10/2020 Foundation:
Location: 115 MAIN STREET(COTUIT),COTUIT Map/Lot: 009-011-001 Zoning District: RF Sheathing:
Owner on Record: SMITH, BRIAN F&KATHLEEN E Contractor Name: ALEXEY LEBEDEV Framing: 1
Address: 115 MAIN ST Contractor License: CS`-1�08208 2
t
COTUIT, MA 02635 Est. Project Cost: $ 11,700.00 Chimney:
Description: Remove and install new architectural style asphalt roofing shingles Permit Fe: $59.67
on entire house Insulation:
Fee :1.
$59.67
Project Review Req: Date: 4/10/2020 Final:
Plumbing/Gas
Rough Plumbing:
ff
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuan �C�a Final Plumbing:
All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures by the.Building-and,Fire-Officiais are provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing Service:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Final:
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final:
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Perso ng with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
���. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
Town of Barnstable
OF"E , Building Department. Services
Brian Florence,CBO
* MANSTABM * Building Commissioner
se3p �m 200 Main Street, Hyannis,MA b1®
www.town.barnstable.ma.us 0NG®[p7-
Office: 508-862-4038 OCT 18 2017 Fax: 508-790-6230
710WN 0,7gAf?NSg13
LE
PERWT FEE: $35.00
SHED REGISTRATION
RESIDENTIAL ONLY
200 square feet or less
Location of shed(address) Village
Property owner's name Telephone number
0// - G0 /T
Size of Shed Map/Parcel#
w
-/0 /2
Signature Date
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Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
You must file with Old King's Highway
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4.30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAYBE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED-BY A
PLOT PLAN
Q-forms-shedreg
REV:08/6/17
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s BOW 15 w
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TOWN of BARNSTABLE ZONING
BY-LAW DATED SEPT. 14., 1989
ZONE RF I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL
SETBACKS KNOWLEDGE. INFORMATION AND BEL I Ef THE DWELLING
FRONT 30' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS
SIDE 15' OF THE ZONING BY-LAW FOR THE RF DISTRICT,
REAR 15'
PROPERTY LINES SHOWN HEREON THE LOT SHOWN HEREON IS /N FLOOD HAZARD ZONE C
WERE COMPILED FROM AVAILABLE AS SHOWN ON MAP 230001 0021 D. DATED JULY 2. 1992.
PLANS OF RECORD AND DO NOT
REPRESENT AN ACTUAL SURVEY
ON THE GROUND,
THE DWELLING DEPICTED ON THIS PLOT PLAN
PLAN WAS LOCATED ON THE GROUND - -- IN
BY SURVEY ON OCT. 20. 1993 AND
EXISTS A$ SHOWN AS OF THE DATE C) � � BARNSTABLE, MASS.
OF LOCATION. :. .,�/r �(��'lw/ SCALE: I.'-40' OCT. 21. 1993
IA,/Zf/y�
THIS PLAN IS FOR PLOT PLAN EAGLE SUBYEYING & vNGrNEERING.,rNC.
PURPOSES ONLY AND NOT FOR 10 Seaboard Lane
RECORDING. DEED DESCRIPTIONS. Byannts, dta. 02801 "�
ESTABLISHING PROPERTY LINES ($f18� 7Pa�492P
OR FOR CONSTRUCTION PURPOSES, t .
0 20 CFO 80
PROJECT NO, 93-299
Assessor's offioe (1st -floor): /j
Asses 8r's map and lot number .... .�4.. .. / � /j� =SEPTIC SYSTEM MUST BE �pFTHErO�
Board of Health (3rd floor): q �� INSTALLED IN COMPLIANCE
Sewage Permit number .........1..��."'�Q.. . .P.d� WITH TITLE 5 •
Z BASd9TADLE, •
Engineering Department Ord floor): °� ENVIRONMENTAL CODE AND rasa
House number .......... to ♦�
d-� �r e:j... rl Q -S�s�t-�� � ��{ TOWN RECULAT9®NS �`�0mxfa�
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2i00 P.M. only
APPROVED
4,,,�,,-
8ernsta
ble ConservationTN OF BARNSTABLE
4_' =- �-`
Signed Date L D I N G I N S P C T O R
APPLICATION FOR PERMIT TO ............./. .. G.... �r'�>.. .......�A..........�r `-:....................................
TYPE OF CONSTRUCTION ........ .. G ....M.4x......................................... ............................................
/.................................19
TO THE INSPECTOR OF BUILDINGS:
The undersign d h by applies for rmit actor ng to the f Il�dformation:
Locat �/-C ....../.... .............. . .. ..... °f!.......................................................
ProposedUse ...........................a.4...... .....................................................
Zoning District ..........Fire District .......
Name of Owner .�. (C/Z� f....... .............. ...........Address ...�W....�... CY �.�
l i � .r............y!
Name of Builder .................................................s ..4W ..Address
Nameof Architect ..................................................................Address ..... ................ ........... . .............. ..... �. ............ ..
Number of Rooms ............... ........ ....... ..........................Foundation . ...... ..... ! ........... ?..d?�!`2.........
(� ll
ExIeriorW�.C. vl .... ...ti:L.,... ,7 . 916i
... .. .... ....................-Roofin ...... .... l� ................................................. ...
9
/ / .... ..... . .' . . .....,...............................................Floors (.�.(�,. .. �. . ...... ..1.... t+�+L? ....Interior .� ���" .
HeatingW�c.... ....................................Plumbing .........V......... ... ...
................................
Fireplace .... ..I....... ...k....... ....Approximate Cost .......... . �!�.�/ ........... ..............
Definitive Plan Approved by Planning Board (________-{-____19 5s__ . Area . /47
Diagram of Lot and Building with Dimensions
9 g Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
L
/l�l
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town ar able regarding the above
construction.
Name ...... ....... ......................../.................................
Construction Supervisor's License .(�/l/-t.•�J .�
MARK.WOOD CORP.
i N3 ;36 54... Permilfor 1.?...Story...........
_..
J Single Fkami1"y2.Dwelling
r ............................... _ _ j `.•,,.
F• ` Location ...Lot...# , 11 5' Main Street
.. ......... .....................I.........
Owner .....MarkwoZ Corp.'.........................
Frame
Type Construction ....:...
..........I ................... . . .... . ............................... z / /
Plot ............................ Lot ................................ ,
s^
26 c. 19 93
' Per mif' October-Granted ,...................... .�,..
Date of Inspection / ....�. -
L. Date Completed ..... a�.. . ..........:.......19
(r �
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Y
N SCH0 0NER DR I VE
N 86.45'05`E
175.01 . DO
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in
76.�
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LOT
W 81wo
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o e 43561 - S.F. Z ttl
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in
226.77'
S 8p007'15 W
32.0b-
S 7927.31-W
TOWN OF BARNSTABLE ZONING
BY-LAW DATED SEPT. 14. 1989
ZONE RF I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL
SETBACKS KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING
FRONT - 30' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS
SIDE - 15' OF THE ZONING BY-LAW FOR THE RF DISTRICT.
REAR - 15'
PROPERTY LINES SHOWN HEREON THE LOT SHOWN HEREON IS IN FLOOD HAZARD ZONE C
WERE COMPILED FROM AVAILABLE AS SHOWN ON MAP 250001 0021 D. DATED JUL Y 2. 1992.
--PLANS OF RECORD AND_ _DO NOT
REPRESENT AN ACTUAL SURVEY of
ON THE GROUND.
FRANK G
THE DWELLING DEPICTED ON THIS 3 WHITING N PLOT PLAN
PLAN WAS LOCATED ON THE GROUND Na.29869 oQ -. - -IN
BY SURVEY ON OCT. 20. 1993 AND Mks , i'►STEREO 3`y
EXISTS AS SHOWN AS OF THE DATE tA' BARNSTABLE. LASS.
C �J"
OF LOCATION. SCALE: I'-40' OCT. 21. 1993
<®li�/23 /
THIS PLAN 15 FOR PLOT PLAN EAGLE SOYEYING 8 ENGINEERING.INC.
PURPOSES ONLY AND NOT FOR 10 Seaboard lane
RECORDING. DEED DESCRIPTIONS. 8yannts. ,Va. 02601
ESTABLISHING PROPERTY LINES (608) 778-44ZZ
OR FOR CONSTRUCTION'PURPOSES.
0 20 40 80
PROJECT NO, 93-299
i
a
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
_ DA"STAU = TOWN OFFICE BUILDING
� M .
g '6I9• �� HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has
been is/sued for the building authorized by
Building Permit #...........` v ? .... .................................................................................................._................................
_
issuedto .......... / ( � ...................................................................................»....................._..__.._
Please release the performance bond.
BU LDI? G PPP_L?T NO. c� 2S� D�:_ `=Z —mod •
ASSESSORS P I CIL NO.
CONTINUATION Or ROAD BOND
The undersigZed owner/contractor hereby agree to maintain t::ei_ road bard it
force until the followinc, wort ita=s are cc=leted to the Sat_sfact_on of the
tngineer=g -Sec__on or. the Derar=ent at Public wars:
Ica-- and seed shoulders as soon: as
we-_aer De^_.its:
^iCn__UNI. �Z
ye
_A"tj mjYmy7i �mo- IL�Lj
(Pr-n t Iia=e )
,G
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TOWN OF BARNSTABLE 36254
PermitNo. ......:.........
BUILDING DEPARTMENT
t '�"" I TOWN OFFICE BUILDING Cash
....
HYANNIS,MASS.02601 Bond .......X.........
CERTIFICATE OF USE AND OCCUPANCY r
Issued to Markwood Corp.
Address Lot #1, 115 Main Street
Cotuit, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
January..21......... 19....94......... ......... ........�..........
Buying Inspector
17
TOWN Of BARNSTABLE, MASS ACHUSETTS
36254
DATE <,C iJ .Y O 19 PERMIT NO.
.717)/
.APPLICANT Own cT ADDRESSit
- (NO.) (STREET) (CONT R'S LICENSE)
Build dw,?ll.`y g 1 Single f�:Lat y GW,=J-1ilIg NUMBER OF 1
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING Kf
O� �F l :IS112 CreLCa Otl11C DISTRICT
AT (LOCATION) (NO ) - (STREET)
AND
BETWEEN (CROSS STREET)
(CROSS STREET)
LOT
SUBDIVISION - LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
Sewage #93-504
REMARKS:
BOND
110,000 FEE
160.00
AREA OR `.000 "4. f t. ESTIMATED COST
VOLUME
(CUBIC/SQUARE FEET) _ -
Markwood Corp. t _
OWNER .. F BUILDING DEPT. �'rw.. ,/✓�'�`
BY
ADDRESS
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST AI AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY -APPLICABLE SUBDIVISION RESTRICTIONS.
ATE—
MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS. PERMITS WHERE APPLICABLE
REQUIRED FOR
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL,. PLUMBING AND
ALL CONSTRUCTION WORK:
t. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST T�IIS CARD SO IT IS VISIBLE FR0�1 STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
rp
l , 9
2 2 2i4i� f /3 l
HEATING INSPECTION PRO ALS ENGINEERING DEPARTMENT
/ ^/+B ARD OF HEALTH
OTHER SITE PLAN REVIEW APPROVAL �YV1L' C.�C " ' XF
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
I
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
NOTIFICATION.
CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE.t
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R. CO MM O TH
OF "SACHUSETTS
=-E`= DE'ARTNFNT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
BOSTON, MASSACHUSETTS 02111
lames Camooel`
�o-m:sstone' WORKERS, COMPENSATION INSURANCE AFFIDAVIT
I,
(licensee/permMcc)
with a principal plac o businc r sidcn
Z�2Z
L�
(City/ tau/Zip)
do hereby ccri4, under the pains and penalties of perjury, that:
[ ) 1 am an employer providing the following workers' compensation coverage for my employees working on this
job.
Insurance Company Policy Numbcr
1 am a sole proprietor and have no one working for me,.
[ ) I am a sole, proprietor, general contractor or homeowner (circle onc) and have hired the contractors listed below
who have the following workers' compensation insurance policies:
Dame of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
0 1 am a homeowner performing all the work myself.
NOTE: PJcuc be aware that while bomeowncrs who employ persons IO do maintenance,construction or repair work on a
dwelling of not more tb= three units in wbicb the homeowner also resides or on the grounds appurtenant thereto arc not generally
considered to be Y
o emP t ers u.ndcr the Workers' Compensation Aa (GL C. 152,sect. 1(5)), application by a bomeowner for a license
or permit may evidence the legal sutus of an employer under the Workers' Compensation Act
1 understand that a copy of this statement will be forw2rdcd to the Department of Industrial Accidents' Oftiee of Insurance for.eoveriv
verification and that failure to sceurc coverage as required under Section 25A of MGL 152 can lead to the imposition of_wiminal penalties
consisting of a fine of up to S1500.00 and/or imprisonment of up to one yeu and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a da
day of 19
Signed this Y
Licensee/Permittee Licensor/Pcrmirror
' t
COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY ,
OF ONE ASHBORTON PLACE ..
MASSACHUSETTS BOSTON,MA 02108 (.:r=+r
.F of thla IJc�nr:;,.
EXPIRATION DATE a :I. :I. �.'_ '_y !.::E:!hd`;'T I=i,. :.:I_l i:::l_'t:l!:[';I::i'i CAUTION
RESTRICTIONS _ EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
;_- � / THEFT, PUT RIGHT THUMB
PRINT IN APPROPRIATE
0 6 BOX ON LICENSE.
i s I.r_l i iJ'i 1'i I I:::,!.:.:.. ..i'•\..I._
I I�
BLASTING OPERATORS
':i ' I{ .n:':''_ I; ;7r.:"r _ MUST INCLUDEPHOTO
m
L:�i:.;i,:l'•.i::::; f;is 1_ _ IV!ra
PHOTO(BLASTING OPR ONLY) FEE:_ -• -- --.=....
NOT VALID UNTIL SIGN BY LI SEE AND OFFICIALLY
HEIGHT: STAMPED-OR- F THE COMMISSIONER l i n I i
DOB: (J J�J J
+THIS DOCUMENT MUST BE « SIGN NAME INt11Li�bGE J Grl
�TURE LINE
THE HOLD THE PERSON OF SIGNATJ1fiE OF LICENSEE T
THE HOLDER WHEN EN- �
OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. COMMISSIONER
Q6F 7/Njj 3
Town of Barnstable *Permit#
Fapires 6 months from issue date
Regulatory Services Fee Sj
Thomas F.Geiler,Director
Building Division X-PRESS PERMIT
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 J U L 1'5 2 013
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERAUT APPLICATION - RESIDENTIXMIQUEARNSTABLE
of r Qr�Map/parcel Number �(�
Not Valid without Red X--Press Imprint
. � � .
Property Address J"��l�- v �( C—U7Ly
esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Lu mar s - M p 0 z� s
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
2"Tam the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
M"'Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission. i
A copy of the Home Improvement Con actors License&Construction Supervisors License is I1
requir i
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
The Comma twealth of Massachusetts
Department of Industyial Accidenris
WJOffice oflnvestigations
600 Washington Street
Boston,MA 02111
wnw.massrgovIdia
Workers' Compensation Insurance Affidavit.Baders/Comtractaral'E Ericiansd%mbers
Applicant Infarmation Please Print Legibly
Name(BusinessfOrganizationtln&6dnal): 1A w Las
�• ' SV i ' "
Address: AV `< 'ice
GityfSta&Zp:
6 y or 0,-,k 6 2 (- `'Phone# ►� ' L f 0 Z�`�
Are you an employer?Check the appropriate boa: Type of project(required):
1.❑ I am a employer with 4..❑ I am a general contractor and 1 6. [-]New cane on
employees(full and/or part-time).* hasTe hived the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet` 7- ❑Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolition
working for me in any capacity. empl°'Yees and have woxkers' g ❑Building addition.
[No workers'comp.insurance Comp-insurance.-I
d.]
5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised dm!ir 11.❑Plumbing repairs or additions
myselfgip- right of exemption per MGL
o worlaers' 12.❑Roof repairs
insurance regaued.]I c.1.52, §1(4),and we hime no
employees.[No workers, 13.Q�Other
comp.insurance required_];
•clay appbamt that checks boa#1 mnst:also 511 out the section below shntirmg then workm s'compensation policy informatiazL
1 Homeowners who submit this affidavit m&czung they are doing all wad end then bra outside contractors nmst subm A a new&Mdavit indicating mrh
:Contractors oral checlt this boat mast attached au additional suet showmg the mime of die sub-co»scmrs and slam whether or not those mifities have
employees. If the mob-cont radars have emPlagees,they mugTmvide their workers'comp.policy mtmber.
I am an employer that is providing workers'compensation imurancefor my enrlvin mL Belot`is the policy told jab site .
information
Insurance.Company Name:
Policy#to Self-ins.Lit.##: 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 rNuired under Section 25A of MGL c.152 can bead 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 1he form of a STOP WORK ORDER and a fine i
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 e,coverage verification.
I do hereby certi i9ndertkepiunsandpenalffesef, :`cry Mat the information provided above is true and correct
Si e: Duke: 1 ►f 3
Phone#
use only. Do not writs in this area,to be completed by city or town official
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#-
6
Town of Barnstable
0* Regulatory Services
i t
AM Thomas F.Geiler,Director
1639. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
DATE: `
s�7 1 I �.d 1, Please Print
r i` A�/
JOB LOCATION: ` `�<(^ r 6 6�y
number street village
HOMEOWNER!':— -3 / t U^� k.GLi1nI C.�:-� C)1,, ��9-YL
name home phone#( work phone#
CURRENT MAILING ADDRESS: 6 I 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 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
proc ures and requirements and that he/she will comply with said procedures and requirements.
Signa 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 i
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.
C:\Users\decollik\AppData\L.ocal\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
FEE Town of Barnstable
�o
Regulatory Services
• snxxsr" 9, •
MASS g Thomas F.Geiler,Director
iOrFn rna." Building Division
Tom Perry,Building 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.
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORM&OWNERPERMISSIONPOOLS 6/2012
Town of Barnstable *Permit# W?0 &j
Expires 6 months from issue dale
BALM" BM ; Regulatory Services Fee
MAM Thomas F.Geller,Director
039.
- SS PERMIT Building Division
Tom Perry,CBO, Building Commissioner
JUL - 2 2007 200 Main Street,Hyannis,MA.02601
www.town.bamstable.ma.us
Office: SD}UM&W BARNSTABLE F0
ax: 508-790-6230
EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number c cl 611 f C e l
Property Address S- f ri..1)i r1 f t. r d
dResidential Value of Work Z d' 0 0 " Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address �' rn l 'ek,4'✓
f 1 j Pm 4 rf .i r v-fe f (Frei f- �
a
Contractor's Name _l D lv �- D-V !J o Telephone Numbers
Home Improvement Contractor License#(if applicable) V -7 3-7
Construction Supervisor's License#(if applicable)
[6Workman's Compensation Insurance
Check one:
Q'I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
DUO r
[t>�Replacement Rrlifdows. U-Value b 3 z- (maximum.44) P A Ti c 1 cy(i,- cx.0
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property er must sign Property Owner Letter of Permission.
Home Im ovem t�Contractors License is required.
SIGNATURE:
c
Q:Forms:expmtrg
Revise071405
DAMSTABM Town of Barnstable
,. Regulatory Services
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I S ,as Owner of the subject property
hereby authorize tI wON ®' ��^ to act on my behalf,
in all matters relative to work authorized by this building permit application for:
CT 6 ) r
(Address of Job)
Signature of Owner Date
SVIA
Print Name
Q:Fomwexpintrg
Revise071405
� - - +�., --✓/ze �onr.»ra•rrtuerzl��. rf ='jltr�dac�useCld --
-\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
t Registration: 105737
Expiration: 7/20/2008
Type:- Individual
JOHN C.BOWDEN
John Bowden
28 Lady Slipper Lane ,�GZ�n•�
Marstons Mills,MA 02648 Deputy Administrator
BOARD OF BUILDING REGULATIONS '
License: CONSTRUCTION SUPERVISOR --
.i
---Number: CS 0i4224
Birthdate: 04/08/1954
Expires:04/08/2008 Tr_no: 22434.
Restricted: 00
JOHN C BOWDEN
BOX 26/28 LADYSLIPPER LN LN G-
MARSTONS MILLS, MA 02648
Commissioner
f
' The Commonwealth of Massachusetts
Department of Industrial Accidents-
_
Office oflnvestigations
' a 600 Washington Street
Boston,MA 02111'
www.mass.govldia
Workers,-Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information .Please Print Legibly
Name(Business/Organizationadividual):��,��f9/ L'• � ��h� rr
Address: 3 o
City/State/Zip: �'�J� �l1 Phone.#:
Are you an employer?Check the appropriate bog: :Type of project(required):.
4. I am a general contractor and I
1.❑ I am a employer with 6. ❑New construction .
employees(full and/or part-time).* • have hired the sub-contractors
listed on the-attached sheet. 7. ❑Remodeling
2.V1 am a'sole proprietor or partner- These sub-contractors have
' ship and have no employees 8. ❑Demolition
employees and have workers'
'working for me in any capacity. t, 9° Building addition
[No workers' comp,in.Urance _ comp,insurance. 101115lectrical repairs or additions
required.] 5. We are a corporation and its
3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions '
myself [No workers'comp. right 6f exemption per MGL 12,❑Roof repairs
insurance.required.]t c. 152,§1(4),and we have no employees. [No workers 13.[�Other`U✓L.6'Ii!Utt/�
comp,insurance required.] 0 Iry Ae I ece 04,A
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information,
t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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 provide their workers'comp.policy number.
Jam an employer that is providing workers'compensation insurance for my employees. Below 1s.the policy and job site.
information.
Insurance Company Name:
Policy#or Self-ins.Lic,#: Expiration Date:
Tob 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 maybe forwarded to the Office of
Investigations of the WA for insurance coverage verification.
I do hereby certify der acns•and penal 'es of perjury that the information provided abov/g is true and correct.
Si tore: t Date: ` 3 0 �-7
Phone#:
Official use only. Do not write in this area, to,be completed by.city or town official
City or Town; ' - Permit/License#
Issuing Authority(circle one):
:1°Board of Health 2.Building Department 3° City/Town Clerk 4°Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
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 ehapter.152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for,the performance of public-work untii accep#able evidence-of-compliance with:tlie 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,it
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 that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom
of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city'or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. -A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Depaxt nent's address,telephone-and fax number:.
The Cgmmonw"of mmaohUs'atts
Departmiemt of J dwt al Accidents
Offloo of Invesd igations
604 Washington Street
Boston,.MA 0..111 - .
TO.#6,17-727-4900 ext 406 or 1-&77-MASSAFE
Revised 11-22-06 Fax#617-727-7749
WWW.Mas&8 V/din
SSW fife(I St 1 r):
Assessor's map and lot numberQ � - pi THE tp
Conservation(4th Floor):
Board of Health(3rd floor):
Sewage Permit number F ;ssa�y►nt
Engineering Department(3rd floor)://� oo oe39.�`�d'
House number l�S7/�� IP7' ��e�r
Definitive Plan Approved by Planning Board
APPLICATIONS PROCESSED 8:30-9:30A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUI LNG : INSPECTOR
n t
APPLICATION FOR PERMIT TO �� 9�'!°')GLLC3t4 ,EsC/lL.D 1ev�
TYPE OF CONSTRUCTION -
f + 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:,
Location
Proposed Use
Zoning District Fire District
Name of Owner /' �`� Address'
Name of Builder ����� ' ���'`� Address
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior
Heating Plumbing
Fireplace Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
l
C:2-(�t/- X/-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r ding the 9pove construction.
Nan
Construction Si isor's License
ZIEMAN, ALDEN
No 36073 Permit For DEMOLISH
Building
Location- 115 Main Street
Cotuit,
Owner Alden Zieman
- -:Type of Construction Frame _
Plot Lot 1
August 5 , 93
Permit Granted 19 -
Date of Inspection: T
Frame 19
Insulation 19
Fireplace, 19 -
Date Completed 19 '
1 ,
,
' t