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HomeMy WebLinkAbout0047 MOORING DRIVE r . r o�T"E, Town of Barnstable *Permit#c:�;�C52—_6 C- col 'y Expires 6 months from issue date Regulatory Services Fee BARNSTABL, Thomas F.Geiler,Director hLAss. 9�A 039. ,•� Building Division TFD MP't A Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstitble.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY y� Not Valid without Red X-Press Imprint Map/parcel Number. o Property Address CC4, ,� INl_.o o-� �,yZs - - + _ residential Value of Work ( ZQ o Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1� E,J j�T`i-} �T� T— Contractor's Name �� ��� Telephone Number Home Improvement Contractor License#(if applicable) . ❑Workman's Compensation Insurance 2008 Check one: Um 3 ❑ I am a sole proprietor �0WN OF B ARNSTABLE SR am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name � A-5`j F_k—1 lz Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to e-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.If-Value (maximum:.. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Hiltoric,Con ationj'etc. ***Note: Property Owner must sign Property Owner Letter of Permission. T -c p rty g P tY A copy of the Home Improvement Contractors License is required. W Z' W SIGNATURE: © r1t Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street . Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Businessiorganization/Individual): Address: ( g (Zo S so" 4-City/State/Zip: P-�l rz__po w .v K ( hone.#: S �b 5 7- zS — 3`Z S Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. Fj I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors 2.❑ I am a'ole proprietor or partner- listed on the attached sheet_ 7-emodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employe, and have workers' 9 Building addition [No workers' compin .- surance comp:insvrance.$ required.] S. We are a corporation and its 10.❑Electrical repairs or additions 3.�4)1 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 c. 152, §1(4),and we have no insurance required.]t employees. [No workers" 13.❑Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below sbowing 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. 1__Mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employ—. If the sub-contractors have employees,they must providb tbcir workers'comp.policy number. lam an employer that is providing workers'compensation insurance Jar my employees. Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 socurc coverage as required under Section 25A of MGL c. 152 can lead to the imposition of r rimirial 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 WA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correrl Signature: Date: — _p $ — Phone#: S' LF z �� 3`7 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 Cnntact Person: Phone#: Inform ation and Ins tg'UCtions 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." fined as"an individual,partnership, association,corporation or other legal entity, or any two or more An employer is de �P P 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,constriction or repair work on such dwelling house e o employment be deemed to be an employer." building f such or on the grounds orb g appurtenant thereto shall not because •� issuance or withhold the licensing agency shall wr 2 25 also states that eve state or local g g y MGL chapter 15 , § C(6) "every 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 form 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,i.f necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of Liability Companies L or Limited Liability Partnerships (LLP)with no employees other than the 'insurance. Limited L ty mp (L C) h' P o partners, are not re quired uired to c workers'compensation insurance. If an LLC or LLP does have membersr p q carry mP 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 licenso 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 permittlicense 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 on;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 maybe 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 born 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 Departmamt of Industrial Accidents Office of InvestigatIM 600 Washington Street Boston, MA 02111. Tel. #617-727-4900 ext 4-06 or 1-M-MASSAFF Fax# 617-727-774 9 Revised 11-22-06 . www.mass.gov(dia Town of Barnstable �oF SHt3 r�ti Regulatory Services saxNSTAa Thomas F. Geiler,Director 9, MASS. 1639. Building Division �TfD I'u'�A Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 KrmY.tovvn.b arnst2ble.ma.us Office: S08-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ' JOB LOCATION: �E o t �, Cs i](Z 7J number street village .HOMEOWNER,., name home phone# work phone# CURRENT MAILING ADDRESS: $ �� S S C O 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. Signature of twne, 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 prrson(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 homeowncr 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. �.. SAW .: �pQYHE�Ok� Town of Barnstable Regulatory Services M Ass�'�` Thomas F. Geiler,Director rFo�a�a 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 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. TOWN OF BARNSTABLE Permit No. ----------_--------- Building Inspector A �a! Cash ------------------ ----- 'o0'lCYY.�P OCCUPANCY PERMIT Bond ----_----_--- "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 oath VaT'i nisi-h 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. ..................................................1 19_........_ ......................................................................._................................_._._ IL— Building Inspector ' � 9 Lo-r 1 Z Z. . agoIL z A v c� ZC"_SCJ�J t L ,LOT _ tJ V it 1 0 Q Qits E.(1'?Tlt•,K 14sr a U W � Ft�cj#_j 4s K; r PLAN SNOWING FOUNDATION LOCATION COTUI Tt MASSACHUSE T TS OWNED BY: C C DA('..._ ^C L r_�5 P IVLA•LTy TC'U5T SCALE: $` w40 " DATE: J U(`I' ZC- ) l c)lF3Q NORMAN GROSSMAN-----—REGISTEREDLAND SURVEYOR I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED � SJ� ON THE LOT AS SHOWN AND CONFORMS TO THE TOWN �y�F3 'yG OF BARNSTABLE ZONING REGULATIONS REGARDING , II0RAIAN � SETBACKS FROM STREET LINES AND LOT LINES . ; GROSSMAN 12775 () NORMAN GROSSMAN R.L.S. DATE �''✓Q suwN��� PO "Assessor's.,map and lot numb . .....f�.,.'...,�..:........Zell..l.✓.:...� THE ..°F Sewage Permit number 3 .� INSTALLED SYSTEM o� f f IN CO Jt House number .:::.............................!.7............................... -� WITH TITLE r NAG a L 639 i' ENVIROOVIVOEfl9TAL iQ.� n'wAr'�►�� f ` T r. TOWN OF BARNSTABLE`R :. T:. ... BUILDING AAS, PECTOR APPLICATION FOR PERMIT TO X . TYPE OF CONSTRUCTION 4N4 :.2� /... . ........ ...... ... .. . .. ................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin to the following information: Location ...G .l.......�1.4�:....... ....... . X..... . ........ ................ ProposedUse ......1.......... ............ ... ........................................................................ .............................................. ZoningDistrict ..........:. .. . .... .. .............................................. ........ . .. Nawn ........................... ......................r. . . ...Address ......................... ........Name of Builder Name of Architect ..........................Address ............... Numberof Rooms_..................................................................Foundation ............................................. J J , Exterior .. ��¢....Ce;a��....... ............:.........Roofing ...... Floors ........!....`..................... ...........................................Interior .04 4—.44 .. . ......... ........................... Heating .... ... .......................:..Plumbing .................................................................................. Fireplace ................ a E—e................................................Approximate Cost ............................................ Definitive Plan Approved by Planning.,Board __ _4-/-- ________19��_ . Area "� . Diagram of Lot and Building with Dimensio s Fee Q ....................................... 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 above construction. " Name �E..�.. .............................. rrCEDAR ACRE` REALTY TRUST No 2239.3..... Permit for ..One..............5tor.......Y........... • Singe...F`. ?nY..Dwe,l,ing...............Location .- Lot. . .....#.110. ...47. ...Mooring Drive. " ... .. .. .... .. .. .. ...... .. ..... .... - E Cotuit 1 Cedar Acres Realty Trusts Owner .......:.......................................................... J_ h �� Type:of Construction ...Frame.......................... .............................................. ............................... Plot Lot .................................. ° Permit Granted �T.. ...3.1...........19 80 y ........... , .,. - Date of Inspection=:......... ................19 1 Date Completed'.. Lf ........19 " PERMIT REFUSED .......... .................................................. 19 t ion,....................................................... ....................................... ............« .r </..... ......i:.i..� ............................. .!......................., - " Approved ..................................:............. 19 ................. .. ......................................................... Assessor's map and lot nurr jer ....,r .........Z .0 > 1� pF T E Tp� Sewage Permit 6umber i ✓ r ` ( — Z BAWSTABLE. i House numbe"r ................................... .. ........ ....................... 9 nes 9 Apo,s639. 00 �F�NAY a� (,,�,TOWNf -, OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO z . r G" j TYPE OF CONSTRUCTION r''F...:.:':' '1...... r �� .... ..'...... r .t` `�.,:.t ....................................... ,` � X r ....... .................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... r'k ..........................................r !" ? t�XG..';... ��................................` C Proposed Use ... fit �........ ................................................................................... p ................. ............... ..... ................. .............. ........ ........ .. ,� q Zoning District / ...................................................................Fire District ....::..t:'..?C ?':.................................................. Name of Owner ..........Address .............................................................. Name of Builder .....Addr s r ........ i ..! ........ es ........ .... ... .............................. Nameof Architect ..................................................................Address .................................................................................... Number of rRooms •-.�..w.............�.,.�..................... .....A Foundation ...4......`.l.J..a...................�...`..!.:r....t.......+.' ............................. � s .,... . C „ �Exteror . ...............Roofin�f r !�� fit? tf « . Floors .....................................:.....................✓.........................Interior Heating Plumbing ..�............................. .......................................... g ............................. ................................................. Fireplace ................ ....f :.......I................................................Approximate Cost .......................................... ..................... / 6 () Definitive Plan Approved by Planning Board _`_44A1l_ --------19vf _. Area ......... . ...................... Diagram of Lot and Building with Dimensions Fee ....'......................................... � SUBJECT TO APPROVAL OF BOARD OF HEALTH sf 1 � � I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ` Name % .... '.................' A ��,� A=24-128 CEDAR ACRi;S REALTY TRUST No ..22 3.9.3.. Permit for One Story Single„Family„Dwelling,,,,,,,,,,,,,,,, Location ,Lot #110`•4„7 Mooring Drive .................................................. Cotuit ............................................................................... Cedar Acres'Realty Trust Owner ..........................:...... ............................ Frame Type of Construction .......................................... Plot ....................'�...... Lot ................................ �t Permit Granted ...........►7irly....31.,.........19 80 Date of Inspection 19 Date Completed ' t PERMIT REFUSE 9.............................................. ... .. .. .... . E*1-­- ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................