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HomeMy WebLinkAbout0035 OCEAN VIEW AVENUE �� Q� ,, Town'of Barnstable *permit Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division 11 / Tom Perry,CBO, Building Commissioner p(w" 200 Main Street,Hyannis,MA 02601 www.tow rn n.bastab le•ma.us Office: 508-862-4038 Fax: 508-790-62 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number o e Property Address 3 .r b G�/f i� ylG�?/ G&X�C i 7- Residential Value of Work�j .mod. Minimum fee of$25,00 for work_under.$6000.00 - Owner's Name&Address &AI lEel v el_ll l� Contractor's Name��f��� ��!G e*�e e �jq s.s"i�ivy Telephone Number Home Improvement Contractor License#(if applicable) ( - Construction Supervisor's License#(if applicable)' ❑Workman's Compensation Insurance X.pRE S PERMIT T Check one: 1�` ��77 ❑ I am a sole proprietor NOV 1 3 2007 I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE, Insurance Company Name Lt.b e fi u lns� w r Workman's Comp:Policy.# WC 9 ` � 31 5 2,-3 17 Y 7 017 T, Copy of Insurance Compliance Certificate must be on file, Permit Request(check box) eRe-roof(stripping old shingles) All.construetion debris will be takento Zr& 4G1Z Alm - ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (n axrmum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note Prop Owner must sign Prop tyOwneijLetter�pfPerrrussio�r. A y the Ho Improve t Contractors License is"r""equued. SIGNATURE; ' .Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department`of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers,"Compensation Insurance Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Le 'bI Name (Business/Organization/Individual): 0 �°(� �'/ "SSbd✓►;k U t"t. Address: City/State/Zip: 60tetll�6' Phone.#: 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 have hired the gub-contractors 6• ❑New.construction . w employees (full and/or part.time). , 2.❑ I am asole proprietor or partner- fisted on the'attached sheet 7. []Remodeling ship and have no employees These sub-contractors have 8.T j Demolition working for me in any capacity. employees and have workers' 9 Buildin' addition [No workers'comp.insurance comp. insurance.$ g required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Pl:1.3�ag' repairs or additions myself [No workers' comp. right of exemption per MGL e airs insurance required.] t c. 152, §1(4),and we have no P employees. [No workers' ..13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section belowshowing theirworkcn'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 additionalsheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors lave employees,they must providt their workccs'comp.policy number. X am art employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. . �^ Insurance Company Name: �(�el #744�� CO to Policy#or Self-ins.Lic.#: . C`� - � 3.z-7% -®(7 Expiration Date: o7l 2&r ' Job Site Address: ��w' ,�ti l City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date),., Faihire•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 penaltirs 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 10IA fox insurance coverage verification 16 hereby certify- er the pal •and pence 'es of perjuq�that the information provided above is true and correct: Sienature c Date: Ald/ O 7 . _ Phone#• J c/ 0 9 J� pC Official use only. Da 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#: pFZHEr Town of Barnstable r r Regulatory Services * * * BARNSTABLE, Thomas F.Geiler,Director �p i63q. �0 len +a 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 Property Owner Must Complete and Sign This Section If Using A Builder I, - e:C 61 d as Owner of the subject property hereby to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Sig tore of Owner Date Print Name ,11L If Property Owner is app lying for permit please complete the Homeowners License Exemption Form on the reverse side. . Q:FORMS:OWNERPERMISSION I �OptME ram, Town of Barnstable Regulatory Services Y t BARNSTABLE, Thomas F.Geiler,Director MASS. �U,, �e�9• p,� Building Division TFD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 �� k www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT 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. - 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 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. Q:forms:homeexempt F VAR WCIP Liner ISSUING OFFICE 181 Wo>lkers Compensation and INFORMATION PAGE Employers LiabiIfty Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Getup/Boston 1-323994 0000 LIBERTY MUTUAL FIRE INSURANCE CO. 16586 POLICY NO. TD/CD I SALES OFFICE CODE SALES CODE N/R 1ST WC2-31S-323994-017 XX X WESTON 102 REPRESENTATIVE 3000 2 YEAR ASSIGNED 12000 Item 1.Name of ROBERT MITCHELL DBA Insured PROFESSIONAL BUILDING& FEIN 44-4443556 Address 452 STRAWBERRY HILL ROAD RISK ID 169371 CENTERVILLE,MA 02632 Status 01 -INDIVIDUAL Other workplaces not shown above: SEE ITEM 4 Mo_Day Year Mo.Day Year Item 2.Policy Period:From 09-21-2007 to 09-21-2008 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in-item 3A.The limits of oul liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance:Part Three of the policy applies to the states,if any,listed here. SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4.Premium-The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rates LINE 110 Per$100 Estimated Code Estimated of RE- Annual Classifications No. Total Annual Premiums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 ( MA ) Total Estimated Annual Premium $ Interim adjustment of premium shall be made: ANNUAL This policy,including all endorsements issued therewith,is hereby countersigned by Autlwrized Retnrsentadve Date 09-18-07 Loc.Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol.H_G. Home State Dividend RENEWAL OF: 09-18-07 NR MA WC2-31S-323994-016 GPO 4030 R1 Copyright 1987 National Council on Compensation insurance WC 00 W 01 A License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 b 10 Not valid without signature aole„s!u!wPV�ndaQ Z£9Z0 dW'all!^�a3ua0 I. pe0b II!H fJl9gme"S Z9V l J3HO11W 1a390'd A3H011W 1183802i lenp ni' uj adK1 800Z19 0rL iuo�e>"d3 6900E L',uoe�;sl6aa H010`da1N00 1N3W3A0?ld. 3WOH'. ue s o►3alnSag$u!Plin� �fl U.�y v 77 y�FtHEtp�y TOWN OF BARNSTABLE • EAUST"LL i 0 039. �•� BUILDING INSPECTOR o Mnv a' APPLICATION Pe L CATION FOR PERMIT TO .. G.art..R............ ................................................................................ r TYPEOF CONSTRUCTION .............� a ** ..c................................................................................................... ..................�.J..�:�.............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according t the following information: Location ....... L� �!..�. Cs7 ......................................................................................................................................... Proposed Use .... ........................................................... .�.... ................................_../..........—..—..........................................„•..... ZoningDistrict ........................................................................Fire District ........ . T."`:....................................................... Nameof Owner ........:.......... .`............ .........!!1...............Address ......�.�!.....�............a--..........................f.................. Name of Builder .... !..�..G.�R�.t!L.� ..........................Address ....... ........................................... Nameof Architect ..................................................................Address ..........i.......................................................................... Number of Rooms ................o.............................................Foundation .0 .J?.e��- ..... 4?. ............................ Exterior '....S AY �...............}�.....`......................................Roofing .... -O' K.. ................................................... ,Q// Floors .......GIN�....L .............................................Interior ✓L/ w.. ....................................................................... Heating lr�d:d?� a- .................Plumbin .....r�G'.0.'.C� Fireplace ..................................................................................A roximatP Cost �...U` — Difinitive Plan Approved by Planning Board ________________________________19 . ]JI,-0own Diagram of Lot and Building with Dimensions E9 O l hereby agree to conform to all the Rules and Regulations of the wn of Barnstable regarding the above construction. cJ ✓ p /%�� Name ./4............................................ { Hayden, Robert F. No ...10951 Permit for add to single family dwelling.................................... Ocean View Avenue Location ................................................................ Cotuit ............................................................................... Owner .......�bert F. Hayden....................... i Type of Construction ....................fr=i............ i ................................................................................ Plot ............................ Lot ................................ December 22 19 66 Permit Granted ........................................ } Date of Inspection ..... T....f.. ................196 7 Date Completed ......................................19 PERMIT REFUSED i ................................................................ 19 ............................................................................... I ................................................................................ ....................................................... .................... 1 4 ............................................................................... Approved ................................................ 19 ............................................................................... .................... ........................................................ 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A DATA Assessor's map and lot number .......................................... Sewage Permit number .......................................................... y�F714ET0�y TOWN OF BARNSTABLE i • Q 9.a, BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ............................:........................................................................................................ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse .................:........................................................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ......................................................................Address .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ......... ........................................................................ Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area .......................................... Diagram of Lot and Building with Dimensions 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 above construction. Name .................................................................................. Hayden, R. F. A=34-�4A No ..1.NA... Permit for .......add to„single tami ly dwe 1l inR....................................... r � Location 12;72.Ocean...View..Avenue ................. .... ......... ............. Cotuit ............................................................................... Owner R. F. Hayden............................ Type of Construction frame .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted Julk 0 19 75 .................. . Date of Inspection ....................................19 Date Completed ....... .. ........19 PERMI REFUSED ...................................... ...................... ................... 19 .......................................... . ............................... ................................................................................ ..0..... ... ..................... Appro/�d/.'. �f��.. .. % . ... ... ....... 19 ................................................. ............................. ...............................................................................