HomeMy WebLinkAbout0008 MARINER CIRCLE ' l G�i !r� �/Y'L'� �
� ♦ �-� ��►,E,,,� Town of Barnstable * rmkthsE�T�resissue dat
Building Department Fee
i - a
. �„B�, . Brian Florence,CBp
ALAr� 1 ¢ ,��' Building Commissioner ,h0 f i c.
iOrEo n ° 200 Main Street,Hyannis,MA 02601 1�
www.town.bamstable.ma.us 116'
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address , OQ v[ n `e `� Ci r C ` V, 1 A 020
Residential Value of Work$-q"a)7 c2 d Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address (' Ct+1 G A C1 D e b o rq l'\ _ G i S 0✓\
2 CkgPVv1g A P-A , P,t Hwt,(�Kd. CT Oe / O�
Contractor's Name 7CI M PS D q V�f OC_t Telephone Number 03—L1 2 0 -.S 13 1
�Home Improvement Contractor License#(if applicable) 11 -I B + 3 Email:
Construction Supervisor's License#(if applicable) d$ 67
lKWorkman's Compensation Insurance
Check one: �Gt1 l JC�Ck0 '7
❑ I am sole proprietor.
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance APR 10 2018
Insurance Company Name s C���\GCS TO�A 11 N OV HAHNSTABLE
Workman's Comp.Policy# u 6
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Requ st(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)
9 Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum 32)#of windows
#of doors: .
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: ✓1 -
i
Q:IWPFMES\F'0RMS\EXPRESS2017
�OFSHE rpk� Building Department
o� Brian Florence.CBO
'f Building Commissioner
sA xNSresr,E,
v� MI&S& ,�$ 200 Main Street, Hyannis,MA 02601
039.jDtEo 39i a www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
^� HOMEOWNER LICENSE EXEMPTION•
11 (0 U Please Print
DATE. I
JOB LOCATION:
numberstreet village
"HOMEOWNER": b ri a
uhc! loodah
name home phone# work phone#
CURRENT MAILING ADDRESS: 5 2 a `
u)-P_St 06 l b 7
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occngied.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 insp do pr cedures and requirements and that be/she will oomply with said procedures and
. requ• eme
Signature ofH eowner
Approval of Building Official
Note: Three-family dwellings containing M,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 to amend
and adopt such a form/certification for use in your community.
'(HE r Town of.Barnstable �-
°; Building Department
vR&RNSMLV. Brian Florence,CBO
�pTEDN1A.Ip Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.maxs
Offk:e: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete•and Sign This.Section
If Using A Builder
as Owner of the su ect property
• t
hereby authorize o act on my behalf,
in all matters relative to work authorized by this building permit ap cation for:
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence s installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Natne Print Name
Date
Q;FORMS;OWNERPERMLSSIONPOOLS
Rev:10/17
the Commarnreakh ofMassad iusetts
Department o,f grufastiial Acciden
`�' - -- �}fce a,f1FnigtTtirrrrs
600 Washington,5'tr+eet
-- Boston,M4 02U1
NITor mrs' Compensation lnsnranceAffidavit:Btdlder-slContradursMechdcianslPlumbers
APP( - 'can#Infarmafion !� T 1_ Plea`seFrint
�-f Name(F3asme gar an a ua1 ' r ce rn GV�e� �/�P r�"\ + G`�
AL Ci rc 40" 02-63S'
CftyfSta-& Phone ik
Are you an employer?Cheektheappropriatrb ' Typeof project(required):
I_❑ I ant a era 1 urth 4. m a general contractor and I
P� 6_ ❑New comsftuctioa
employees(faUandforpad-time)-* ltavelmedthe suit-contractors
2.F-1, I am a sale propsietur or partner- listed an the attached sheet. 7- 0 Remodeling
ship and have no-employees These sub-contradors have g_, Demolition
wodring for me-in any capacity. employeesamdhavewod=e 9. ❑B,uildingadditica
[No uadaers' camp insm-ance comp_im=ml
required-] 5. ❑ We are a-oorporatiun anal its 10❑Electrical repairs or adchtions
3.❑ I am.a homeowner doing all%v le ofFcen have e=ised their IL0 Plumbingrepairs or addliticm.
=ysdi[No wagmts'camp- e#t of emampEon per MGL 17.0 Roofrepairs
i�,�„ce required,.]i c.152,§1(4h and we have no ,F.
employees:(Noarkers' 13- 90ther�t' �{,0a Q
'w
comp_inmamce required.] S t C1 i
',+kayappti�4�stcbeclaboarl— RIsafiIlcrattheswdanbgawsbmxiag&ekwoffcerec=persatiaapalicyiafaMsdua
#F ameow�ecstebo sab¢ait ebis af5da��d iv3ttstiag tLey ax�dain�a1F asn�a�dtbealtite aatsid�contractars�at submit anezvaffdseFt mdL
Z-0, tr,ct 7m 1Ty a cbEr]ct'h box roast stmrhe�sa additi®al sheet showing tt nam¢of�e sob c and stye whetLe[araat those eo tieslisge
empbyees.Iftbesdh-c=txdmshz emq)lcyxs,dieym=Stymrn ethek trarkea'tamp.paliyaumbeT-
I am an emplayer that is prfttzag warkers'congxwdion innirance for my*em ktn wff. HoTmv is Ifig policy arm job site
irrJormation
Insurance CompaayName:
Pflhcy 41 or SeFf ins Iic_ FxpiafioiiI}ate:
Job&te Address CitpfStateE7.np:
Attach a copy of the work-ere compensationpolicy declaration page(showing the policy number and espuadion date).
Failure to secure coverage as,required under Section 25A of MGL c.152 can lead to the imposition of ct'iminai penalties of a
fine up to$U00.0a anifor one-year onmenk as well as civil penalties.in the form of a STOP WORK ORDERand a time
of 4p to$250-0..a clay abainst the violator_ Be advised that a copy of ibis sbiemesd maybe forwarded to the Office of
Invesiigat ans o€the DIAL for insurance coverage veciftadcn-
F,do h ereby c, order th s and penalties o flay by tJraf flis hz f bran iE9Wrprm W alre is raid carrect
Sip �e: Date: 20 10
/
Phase G /6- _6 6
a,f�ial uW anly. Do not write in dds area to be-campletesd by cite artbnrn ah,fj`rcrat
City orTavm: PermiU iceuseS
Issuing Author'ity(code;one):
L Board of Health 2.Buffffing Depar(ment 3.#htrj rows Clerk 4 Electrical fuspedor S.Plumbing Imspertor
6.Other
Contact Person: Phone#:
— -- —- 6
ormation and lastructiolas ` ` ;
mz.s r szfFs General Laws chapter In regma-es an employers to provide wadsrds'compeas3.ion far their employees.`.
P=suantto this sty,an a pz7w is defined as.`°-.every person in the service of another under any contract ofhire.,
e2prtss or>mplie .oral or writtrn"
An Vnp&yer is demmed as`°ao.in parfneaship,asso�iom,oorpor�ion or other legal= or m two or more
of the f0reg0ii3g=gaged is a Joint enteapuse,andinch u:rmg the legal relses=±di ves of a.deceased employer,or the
receiver or tmstee of an individual,pa trip,association or otherlegal entity:employing employees- However the
owner of a dwelling house having not mare than three apar[ments and.-who resides therein,or the occq=t of the -
dwelling house of another who employs persons to do Vie,ca stru t;on or rtpair waAC on such dwelling house
or on the grounds or building agpm-tenantth=to shallnotbecanse of such a nploymeutbe deemedto be an employer."
MGL chapter 152,§25C 6)also sfadz th s that every stain or local U=2smg ageb cy shall wltlihold$e jasnance or
renewal of a license or permit to operate a business or to construct buildings in the comet onwealth for any.
applicant who has not produced acceptable evidence of cornpH=m with the hnm�^-re.coveXage required"
Additionally,MGI,rlIapter 152,§25dM states-Neither the comet wealth nor jay of its political subdivisions shall
=jms>vto any con tract for the perfmma ace 0f1ublic w m k m i E acceptable evidence of compliAUce with the mm m-m:ce•
requir�ents of this chapta,have Been presented to the contacting�,a m±hoi*f
please El oint the woticers'compensation affidavit comple rjy;by checIrmglheboxes that apply to your siination and,if
necessary,supply sab-eontractnr(S)name(s),z&T,�(es)and phonD n0 mber(s) along wththezr certldCE± s)of
,,s ,ce Lmm,�I ability Companies(LLC)or Limited Liabf7ity-partaeabips(LU)withno employees other.than the
members or partucr.%are not regtmed to carry woIkers'compensation i nsuzance If an LLC or LL2 does have
employees,apolicy isrmjaired. Be advised that this affidavit maybe sabmittLdto the Department of lnduslxial
Accidents for confnmation of incrnan rp coverage: Also be sire to sign and date-the affidavit. The affidavit should
beretnmed to the city or town that the application for the pe nit or license is being requested,not the Dep arlmenf of
Tr a ,t,;al 2s•_=denis- Shouldyou have any questans regarding the law or ifyou ale repaired to obtain a workers'
compensation policy,Please eolith=Depadmen¢at thennmber7istedbeIow Self-insured caaxpanies should entrs their
self-i sara„ce Hc=Sa nMnber on the line.
City or Town Officials
. t
Please be sure that the a$davit is complete and printed legibly. The Department has provided a space at the both
of the affidavit for you in frIl out in the event the Office of Investigations has to coitactyou regarding the applicant
please bes=tofllinthepeIMiVIiceasent=bervthichwillbeusedasarefeaeacenumber In addition,snappl?cant
that must submit multiple P=-b-Mcease aPPHtafims in any giveu year,need only sabmit one affidavit indicating conmt
(city or
policy information Cyncc�y)and under"Job Site mess"the applicant should route�aII locatiz��s in
awn)"A copy offhe affidavit that has been officially stamped orma k--dbythe city or town may be provided to 13re
applicant as prooftbat a valid affidavit is on Me for fie permits or licenses_ A new afar vitmust be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commmr-ial Tulin
e ado license or a to bum Leaves etc-)said person is NOT required to complete this affidavit
(Le. g P
The Office of Inveslig�ioas would lake to thank you in advance for your cooperafion and should you have any questions,
please do not hesitate to give us a call.
The Dependent's address,telephone and fax mambe5:
CoMMant?j2�aj*of I chusm� -
Degadment Qf li&tiak Accident
off i=of)�tve cc ti as
Goa washmzml Sire
Boffin,MA 0�111
2`qL 61T:T27-4900 Qit 406 or 1477 MA SAS
Fax 617 727 7749
Revised 4-24-07
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! �a PLAN SHOWINGXn
m Q9 FOUNDATION LOCATION
oN
--zap C
n�XNl COT_UIT MASSA HU T r � � � �
I� �, ,{� � c sE Ts � �
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F� � OWNED BY: � .� � ~ _ ;% m o
II v � rn ` T1 t/ Q
SCALE
Wig
� NORAfAN 6ROSSMr9N-- -- REGISTERED LAND SURVEYOR .� C I a
I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED
ON PHE LOT AS SHOWN AND CONFORMS TO THE TOWN OF BARNSTABLE ZONING REGULATIONS REGARDING r"
SETBACKS FROM STREET LINES'AND LOT LINES . Tl no'S"A ,` - �1 hi
No
Itsl
NORMAN GROSSMAN R.L.S. DATE .
S.0 .,
9 IA'
Assessor's map* and lot number ................... ;f,/ 0*,TH%THE E
Sew-age Permit number ....R.174.1..............................4............. ..... SE"C's
Ymm MU STABLE,
Douse number ............... .........g..... INSTALLED MAB
• 11V COAN 03
wnkmu 5
*
TOWN OF BAR.' ,N-9 I
CODE AND:K4
TIONS
BURPING INSPECTOR
APPLICATION FOR PERMIT TO ............ ... ................................... .......
..........................................
TYPE OF CONSTRUCTION ..... . .......................... .�)4................. .............................................
................. ...............194..Sw
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the,
he following information:
Location ...........2.3....... % ...................... 12 Ze,.tz OV...... .... .. ..................................
'Pol
ProposedUse ........ .. . .............. ....................................................................................................................................
Zoning District .............. .!......................................................Fire District .....�4�41................................................
Name of Owner ... ............. .. ...A/,$_..,74........Address ............y.........>/ ...............
Name of Builder . ................................. ........Address ....................................................................................
... .. ...............
Name of Architect ................Address .......
Numberof Rooms .................4-19............................................Foundation .................... ...........:........................
4A�;'VIdI04.
Exleriorje�.�. ...... .......ldk...... ...... ...............Roofing ..... ..... ..................... ........... ..............................
.. ... .........Floors .....zj/9 . .... ..................................................Interior ..... ....
....................................
- ------------
'Heating .... ........ . .... ..............................:...Plumbing ............. ... ..............................................................
... ....... .
Fireplace .................. ............................................................Approximate Cost ....... .....................................
Definitive Plan Approved by Planning Board _/- ---------19 Area ..... ................
Diagram of Lot and Building with Dimensi/ns Fee ........... ...........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the ckbove
construction.
Name ..
..... ........... ...... ......
'
r r `
CEDAR ACRES REALTY TRUST !
ti
i�o i .33:2.2.. Permit for ..One...Story..........
........S?-.? g..Fami.�,Y..Dwe, ling.............
Location
Lot #33 8 Mariner Circle
Cotuit
........ ........................................... ....................
OwnerCedar. . . ...A...cres. . ...Realty. ...Tr. ust. ..
... .... .. .. .. .. .. .. ....... ....... .. ....... ..
Type of Construction Frame ..
Plot.. ..... ......
.................... . Lot ................................ ;
Permit Granted Jul 28• 81
�'.........�......... .....19
Date of Inspection ....................................19
Date Co pleted .... ............../2P.Q- ...19 S"f
�
j�PERMIT REFUSED
�a
1 co
..... ....... 19
..� "
........... .. .
�In 7.11
. .. . ..............................................
. . . . ......................`..................
-IV .. ............................................. _
Approved ...1 ..........:................................ 19
r
Assessor's map and lot number ... . ".
ypF TM E TO
Cy �
Sewage Permit number ........................................................ ego y�
Z BARISTADLE, i
I.11 use number ..................................S.................................... 9 mum
Gp i639- \e00
'ATE p mo p
TOWN OF BARNSTABLE
BUILDING INSPECTOR
_ ,�� , '.
APPLICATION FOR PERMIT TO ..................,...-....y............... ............/.........................................................................
TYPE OF CONSTRUCTION ...... rr „% Ct 7!r?`e... /..., G; %1 -' '. ................................................
...... .��....: ...........................19' �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a�p�ermit according to the following information:
Location :./ " ... f.......d..� �a!r�!;.. {......?.::c% ........ < �?� ...................................
Proposed Use .... �(. C'�"`�' !.. ... .......... � .................................
Zoning District r�.:....... ............................................Fire District .....,.,. ...........•:...........................................
Name of Owner r......Address .
Ci......f...`.�...3. ......./. ....... ' ................
` f
Name of Builder � .......... .r..r ....` . ....... .......................................................Name of Architect .......Address
Number of Rooms r'? ......Foundation . `--�
ExteriorL�/t� •!a L.../�/ Roofing �� � LCC'r�'`.... /�L� ..............
— :.... ..................... ... ..................
Floors S .f .................. ��`��/,.�'��Cl�.
....Interior ....... ......................� /f............ ...............................
Heating A tl�.... A .i,. 0 Plumbing ...............`- .............................................................
Fireplace ................. .�.......� ..............................................Approximate Cost ...... '( L �.................................
Definitive Plan Approved by Planning Board ___- 1_ _________-9_ t:,�. Area
\, Diagram of Lot and Building with Dimensions ' Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH �•I
ti
t:
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name :!% !//.'` .................!;, ;%!'"riVG: �l�1....
CEDAR ACRES REALTY T US-LM
�3 3
No 23 One Story
.... Permit for ....................................
Single Family Dwelling
...............................................................................
Locati6n Mr.iAer...C.ir.cle
................ ...............................................
Owner ...C.e.da.r. ...Acres. . . ...Realty ty....Tr.u.s.t
.. .. .... .. .. .. .... .. .......... .... .... .. . ..
Type of Construction ..................Frame........................
................................................................................
Plot ............................ 'at ................................
Permit Granted
July 4 8.1..............19 81
Date of Inspection ......... ......................19
Date Completed ......./...........................19
PERMIT REFUSED
............. 19
............................. M ........ v...... -...........
...............................................I...............................
...............................................................................
...................................................................i...........
Approved ................................................ 19
...............................................................................
...............................................................................
TOWN OF BARNSTABLE --__------__-
s,' Permit No. _____________-_
1 ,��T� Building Inspector Cash —
OCCUPANCY PERMIT Bond ------
----�U
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
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.
....................................................... 19«.«....... ..................................................a.............«..«......««..........«..««..«.«.«.«
Building Inspector