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HomeMy WebLinkAbout0430 OLD KINGS ROAD ci 5 23 Town of Barnstable - *Perm it# y� p Expires 6 months from issue date Regulatory Services Fee s ;r * BAMSTABM Richard V.Scali,Interim Director RFD MA't� 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 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 61090c(,3 Property Address 1�- Ef Residential Value of Work r 7Qr ,> Minimum fee of$35.00 for work under$6000.00 ` Owner's Name&Address ,�l �61111 /3c cy Gt �� /�-7lu f Contractor's Name ,E�l�� ����/� Telephone Numbe6-o&') T z;—e(;1 Home Improvement Contractor License#(if applicable) Email:r"''I C— S'.4 w0 ��j,�f Construction Supervisor's License#(if applicable) S O 9 6,Sr ❑Workman's Compensation Insurance Ch k one: I am a sole proprietor MAY 2 3 Z04 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE 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 ❑JRe-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 0 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. A copy of the home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 The.Commonwealth of Massachusetts - _ Department of IndustrialAccidents Office of Investigations .600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-iblY y/]V///A / i Name(Business/Organizafion/Individual): 1/� Address: � (cv�fl City/State/Zip: Phone Are you an employer?Check the appropriate box: Type of project(required): 1.ElI am a employer with 4. ❑ I am a general contractor and I ❑ ,employees(full and/or part time).* have hired the sub-contractors 6. New construction 2.9 I am a sole proprietor or partaer- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workin for me in an capacity. employees and have workers' g � Y � �• - comp- [No insurance. 9. ❑Building addition [No workers comp.insurance P required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11' Plumbing repairs or additions 3.❑ I am a homeowner doing all work � ❑ g P myself. [No workers',comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152, §1(4),and we have no employees.[No workers' 13. Other he comp.insurance required.] *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 hue outside contractors must submit a new affidavit indicating such. $Contractors that check this box must atfached 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'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby certify under the pains and e of perjury that the information provided above is true and correct Signature: Date: i Phone#: C( Official use only. Do not write in this area;to he 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 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(17 also states that"every state or Iocal licensing agency shall withhold the issuance.or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of luvestigations 600 Washington Sit. Boston,MA 02111 Tel,#617-727-4900 axt 406 or 1-877-MAS8AFB Revised 4-24-07 Fax#f 17-727-7749. www.mass.govfdia TME r Town of Barnstable Regulatory Services • a�axsrasts. n�ss Richard V.Scali,Interim Director i6gq. 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 I, Prei .Ur t ' i�1-1 ,as Owner of the subject property hereby authorize /yl i k e i uJCL. to act on my behalf, in all matters relative to work authorized by this building permit k"i acws (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 et Signature of Applicant - Print Name Print Name Date R� Town of Barnstable Regulatory Services oFTti royti Richard V.Scab,Interim Director Building Division EARNST a IX Tom Perry,Building Commissioner ' - 9� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6210 HOMEOWNER LICENSE EXEMPTION - Please Print DATE: JOB.LOCATIQItI: 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-occoied 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; n 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. Office of Consumer Affairs & Business Regulation,- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business OCABR Regulation f g � ) Consumer Affairs and Business Regulation 'v Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints . S Registration# 126252 Home Improvement Contractor Registrant M. A. SLIWA.HOME IMRPOVEMENT. Registration Home Page Name MICHAEL SLIWA Address P.O. BOX 1461 �.. - Massachusetts -Department of Public Safety CI St Z Board Building Regulations and Standards City, ate Zip MASHPEE, MA 02649 _Construction Supervisor Expiration Date 05/06/2016. License: CS-082655 -,..I IS WCHAEL A SLIWA PO BOX 1461 MASHPEE MA 02649 Complaints Details No complaints found for this registrant. �" " "' p p 9 �lz, Ex iration Commissioner 10/04/2014 You can also view arbitration and Guaranty Fund history. Back To Search (17 s Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5,170 ' Boston, Massachusetts 02116 Home Improvement Contractor Registration. # Registration: 126252 . m Type: DBA dig ; Expiration: 5/6/2014' Tr# 245716' f M. A. SLIWA HOME`URPOVEMENT' MICHAEL SLIWA P.O. BOX.1461 .€ MASHPEE, MA 02649 ``'Update Address and return card.Mark reason for change: SCA 1 e; 20M-05/11 Address ❑ Renewal. Employment �.Lost Card ' http://services.oca.state.ma.,us/hic/licdetails.aspx?txtS earchLN=2... 5/23/2014 INV ap and lot number ............................................ QyOF I E �it' number pO } Z BAH39TODLE, i Housenumber .......... ....: ... ......................�.....A...................... 9�0 M6 9 MAI TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... ......... ............. TYPE OF CONSTRUCTION ............. . .......; ,,,,,,,,,,,,,,, .. ............................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accorddii�ng/ to the following information: Location ................ .: .......... .............�f ./..4 Y......... ....... . ........... .�1 . .............. - � Proposed Use ..... ............ .......... ... .. .................... .................................................................. Zoning District ........................�` J.....................................Fire District .............. ........................... ........ Name of Owner ..../1 C(5 ....... Address �,5... `x:'...................... r Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ...:..............................................................Address .................................................................................... VNumber of Rooms .............!....................................................Foundation ........ .......................................................... .......... • ExI.&ior ....... ..... . ............ .......................Roofing ...........(.�...... ...................... .... . ..................................... Floors �..... ..............................Interior ..........�}..... . ....... ............................... Heating ;p.........�.1-f..1141...... ... . ....t-.....................Plumbing.............Z:... .1 Fireplace ... . ......................................Approximate. Cost ............. d . ........................ Definitive Plan Approved by Planning Board -------------------—-----------19--------• Area ...� .... :. .,.�r',., Diagram of Lot and Building with. Dimensions •� �Y 9 g Fee ,/ .... .......... .... SUBJECT TO APPROVAL OF BOARD OF HEALTH _ly OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Li Name ....... ... ........................................... Construction Supervisor's License ..0.0 /. Q U HANE, CONSTRUCTION 2 j to Permit for ... ...StOry ............... ..........::5.raga..?...F.?mily....Dwellin9......... 130 old Kin Location ..LD. ...9J..,....... s Road ................................... /t i � • Owner McShane Construction �+ f.................................................................. Type of Construction .Frame " ................................. ......................................... Plot .............................. Lot ................................ -, g 5 3 t May 10 .., Permit Granted .......y........�...................1l 9 Date of Inspection............................r:......19 t © Date Completed ..19 gl s17 [ l { Assessors map and.lot pber �+ a ft . a.. r THE rI eT11Se�vagef'`P i,rmt number ;........................... -^" • � � � BAHB9TaDLE, i House number .7:.� /,�...!�� ...... 9 JIM& ... ............ .......... .. ......... II I 6 pp,oa,�019. \0� }. {. T;.,e '�`a MAX a s� -�- TOWN OF BARNSTABLE BUILDING INSPECTOR - APPLICATION FOR PERMIT TO ......... .......1� ..:..... TYPEOF CONSTRUCTION .............�� ,..,,..,.,.......... ... .................................................................................... ..92 . w TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location .. .............. .... ....�Y.......... .............. 1...................................................... ............... ................ _� � � ProposedUse ...... c... -.� ,�...............`" ^ .......... ...... ................... ......................................I......................... ZoningDistrict ..........................I�.............................................Fire District ..............! 1. ................................................ Name of Owner ....1/ .�. . ........�-�`A. a�.:.......Address ...1P �° !. :'..'.................... ( r P � Nameof Builder ....................................................................Address ....:::............................................................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............. ................................................Foundation ........ ti 'p ....................................... .......... Exterior ......� .....6).-.l.L.. A.. ems+.......................Roofing ...........6...... .............................................................. . � '? ..............................Interior ..........�J.. p�Floors f,..... . D //.. ................................................ Heating...............�.I...L....I,:!L�.....� [...................... ..........Z.....!>r .!4........................................:........ I Fireplace xtl!.p.k— ......................................Approximate. Cost ............. �J . G.................................. Definitive Plan Approved by. Planning Board ___--------_-_____-----------19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH - w, y� f tr OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable regarding the above construction. 7 , Name ....... .�/........ ................................ .::,.... .. . ,s ' Construction Supervisor's•License t MCSH,ANE CONSTRUCTION, A=22-93 2 y No .....f�.......... Permit for ..1 Stor . Single Family Dwelling ............................................................................... Location ,Lot...97.........13. ... 0 Old. ...Kin. ...gs....Road .... .. .. ..... .... .. .. . Cotuit .......................................................................... Owner ...McShane Construction .............................................................. Type of Construction Frame .......................t......................................................... Plot .............................. Lot ................................ May 10 , 85 Permit Granted ........................................19 Date of Inspection ....................................19 Date'Completed ......................................19 l �n 1Z - -L3 i TOWN OF BARNSTABLE Permit No. _. Building Inspector uuw.a i Cash -----------T- i ,ew. Dal OCCUPANCY PERMIT Bond _____ Issued to McShane Construction Address �ot #97 130 Old Kings Roar:, Cotui . Wiring Inspector / ( ���r Inspection date Plumbing Inspector Inspection date �0 < r� Gas Inspector Inspection date Engineering Department .� ,/ Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 19 Building Inspector i � f '�. TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING NML 6 9 HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE:, / w An Occupancy Permit has been issued for the,building authorized by Building Permit '. �`�" "" ` ............................... . ..... .._.......�......... issued .to .. ...�.. ------------ ------_----- ......... _..... .-------------------------- _ _ ...... ._.e_ �. . Please release the performance bond. I MYCOCK, KILROY, GREEN & M.CLAUGHLIN, P.C. ATTORNEYS AT LAW 171 MAIN STREET BERNARD T. KILROY HYANNIS, MASSACHUSETTS 02601 OF COUNSEL ALAN A. GREEN AREA CODE 617 EDWIN S. MYCOCK CHARLES S. MCLAUGHLIN, JR. MICHAEL D. FORD 771-5070 ADDRESS ALL MAIL JAMES M. FALLA _ P.O. Box 960 HYANNIS, MASS. 02601 MARK D. CARCHIDI REFER TO FILE # March 26, 1985 Mr . Joseph Daluze Building Inspector Town Hall Main Street Hyannis, MA. 02601 Re:- Lot 97, Queen Ann Road, Cotuit Lot 88, Old Kings Road, Cotuit Both presently in the name of John J. McShane Dear Mr . DaLuze: As you know, both of the above lots are now undersized under the present zoning by-law. These lots were shown on an approval . required plan endorsed by the Planning Board in 1973 at a time when the lots met all of the then zoning requirements. On September 2, 1975, Lot 97 went into ownership separate from that of adjoining lot and on September 23, 1976, Lot 88 went into ownership separate from that of adjoining .lot and both lots have continued in separate ownership to the present. Our present zoning by-law grandfather clause gives buildability to both of said lots notwithstanding the increase in zoning. Very truly yours, ernard T. Kilroy BTK/djw CC: Mr . John McShane •r 1 ' a� co -I%_ `A) JV ( ti� � p "I CERTIFY THA T THE FOUNDA TION SHOWN ON ; THIS PLAN IS AS IT ACTUALLY EXISTS AND THAT PLOT PLAN OF LAND IT CONFORMS TO THE TOWN OF BARNSTABL E ZONING THE FOUNDATION SHOWN ON THIS PLAN L OCA TED IN REGULATIONS" CONFORMS TO THE KINGS GRANT COVENANT � `SN o i BAPNS TABL E - MASS. DA TE.• MAY 31, 1985 �4��E pA�ipasLP PREPARED FOR CHARLES s2 0I85, y McSHANE CONS T. CO. R. L . S. �(;�STV—Q @` DATe MAY 31. 1985 SCALE.• .!"-40 FT. FLOOD ZONE C o.SURV CAPE 6 ISLANDS SURVEYING f TEA TICKET — MASS. r t