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Home My WebLink About0036 PENELOPE LANE ,3b �°e.�ejo �e 1.r�e. J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ..i42 Parcel 017 Permit# qd Health Division (X�4—i-ar��4W 05:''7 � - b� Date Issued 3 )6 Conservation Division Feed Tax Collector Application Fee Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address ai�- Village CA--k T Owner Address 2.2- Wc"�. 27. Awaxnvits Telephone boss 3c4o— a'74-7 Permit Request C_ Square feet: 1st floor: existing /athered: 2nd flo . existing proposed Total new Valuation k�o c' Flood Plain Groundwater Overlay Construction Type Lot Size : ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ ulti-Family(#units) Age of Existing Structure e: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑C 1 ❑Walkout ❑Other Basement Finished Area(s .t.) Basement Unfinished Area(sq.ft) Number of Baths: 11: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count ` Heat Type and Fuel: ❑Gas ❑Oil 0 ectric ❑Other Central Air: ❑Yes ❑No Fire ces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:❑exist' g ❑new size Shed:❑existing ❑new size Other: j 0 Zoning Board of Appeals Authorizatio ❑ Appeal# Recorded❑ a t Commercial ❑Yes ❑No If yes, site plan review# 7 N Current Use Proposed Use - ).: `L ,y BUILDER INFORM TION "F Name elephone Number Address �2 '"'� License# (2s Home Improvement Contractor# 4 W a AC0 Worker's Compensation# / g ALL CONSTRUCTION DEBRIS RESULTI FROM THIS PROJECT WILL BETAKEN TO Qk0-0-,� d� ,SIGNATURE /' DATE ` l FOR OFFICIAL USE ONLY PERMIT NO. DATE'ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER !r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Department of Iridusti ial Accidents Office.of Investigations' 600 Washington Street Boston,-44 02111 ' ••'� , it www.mass.gdv/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluanlbers Applicant Information Please Print Legibly Name (Business/orP=ation/Individual)• R • '�e�b�. Address: 3c��e �,►.Q C�T��C- ' City/State/Zip: C`,o Ty k-r Phone#: Are you an employer? Check the-appropriate box:. Type of project(required):. 1.❑ 1 am a-employer with . 4. ❑ I am a general contractor and I ' � 6. ❑New construction _, mployees (fall'and/or p art time).* have hired the sub-contractors 2.[2 I am a sole proprietor or partner- listed on the attached sheet $ ?• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor mein any'cap workers' comp. insurance. 9.tY• ❑ Building addition [N comp o workers' . insurance 5. ❑ We are a corporation and its 10. Electrical-repairs or.additions officers have exercised their ❑ aired.] � 3.LvJ I am a homeowner doing all work right of exemption per MGL ME] Plumbing repairs or additions myself;[No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers`' 13.11 Other .jj c.�C comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `F ' t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew elEdavit indicating such tContractors that cbeckt his.box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirati,6n date). Failure to.secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminalpenalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOPVORK ORDER and a fine of up to$250.60 a day against the violator. Be advised that a copy of this statemenf maybe forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify under th p ' and penalties of perjury that the information provided above is true and correct. Si ture• Dater. Phone#: 5b g gc9Z -z co Z�( 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#: Information and Instructions Massachusetts General Laws chapter 152 tequires`all employers to provide e ww of another natioe . undern f theircontr employct ofees pursuant to this statute, an employee is defined as ...every person m the s Ce express or implied,oral or written." , association,carporation or other legal entity,or any two or more An employer is defined as__an indzvi0921,.,partpersb -, . 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. How�er:tlte occupant of the owner of a dwelling house having not more than three apartments and nhttour IIesothetem,W°Obn such dwelling house dwelling house of another who employs persons to do maintenance,cos repair appurtenant thereto shall not because of such employment be deemed to be an employer." or on the grounds or building MGL chapter 152, §25 C(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 chapt ) 7 states"Neither the commonwealth nor any of its-political subdivisions shall ..er 152, §25C( eIIter into any contract for the performance of public work until acceptable.'evidence of compliance with the insurance ter have been presented to the contracting authority. iegnirements of'this chap Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone nnmber(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the ers' compensation insurance. If an LLC or LLP does have members or partners;are not required to carry work 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 an of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the app Please be sure'to fill inthe pencmt/license number which will be used as a reference number. In addition, an applicant ' multiple ermitllicense applications in any given year,need only submit one affidavit indicating current must submitP <. thatshould write all locations in (city or policy information(if necessary)and under lob Site Address the applicant sho tom)."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-an 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 burn leaves etc.)said person is NOT required to complete this affidavit. The office of Investigations would line 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 1, -ce qf jnvestagations . 600-Washingfca Street Boston,MA 02111.' 4 Tel.#617-727-4900 ext 406 or-l-877-MASSAFE Fax#617-727-7749 Revised 5-26,05 wwwmass.gov/dia . r 1 E, Town of Barnstable Regulatory Services 3 , g Thomas F.Geller,Director AT�� ;•`' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 0ffice: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION - MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but notmore than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work: Estimated Cost 'A 1 yob Address of Work BCD ', eC 9_+opA �.�+►�� Owner's Name: +� Date of Application: 2-o l-b co I hereby certify that: Registration is not required for the following reason(s): E]Work excluded by law []lob Under$1,000 []Building not owner-occupied E]Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:formshomeaffidav ' M Town of Barnstable Regulatory Services Thomas F.Geller,Director MAMBuilding Division Eo 1�� Tom Perry,Building Commissioner 200 Maier Street, Hyannis,MA 02601 www.town barnstablema-us Fax. 508-790-6230 dice: 508-862-403 8 HOMEOWNER LICENSE EXEmM0N Please Print DATE ' JOB LOCATION 8c0 street i village number o S� �.'36o titQ� wm2 2So2� work bone# SOMI;OWNEIt name -home pbone# p CURXENTMAZWG ADDRESS: cityltown state zip code The gent exemption for"homes:'w as extended to include owner-occuyied dwelling of six units or less and engage as individual for hire who does not possess a license, to allow homeowners to provided that the owner acts as super or- DEFINITION OF HOMEOWNER person(s),who owns a parcel of land on which he/she resides or mac essotends o reside,to such us eandlorch efarm structures.re is,or is dA ed to be,a one or two-family dwelling,attached or detached structta r?'-year period shall not be _ NNMe person who constructs•more than onuei hom �on form acceptable to the Building Officia e mel that helshe shall be ' e in a two •homeowner"shall submit to th g r onsible fo all such work erformedunder the building-permit (Section I09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other 'applicable code's,bylaws,rules and regulations. certifies that he/she understands the Tows of Barnstable Building Department The undersigned"homeowner' minimum inspeetibn 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 12.7.0. Construction Control- HOMEOWNER'S EXEMPTION Th'Code States%bat: ,Any homeowner perfon3ing work for wbich a building petaut is required shall be exempt torn to to dQ h provided that if the homeowner engages a P of this section(Section 109.1.1-Licensing of construetim Supervisors)'pro work,thaf such Homeowner shl"act as supervisor." Appendix Q, homeowners who use this cxemptitm are unaware that�y an assuaaog the responsibilities of a supervisor(see App upervisors,Section 2.15) This lack of awareness often results in serious problems,particularly Rules&Regulations for Licensing Conshvction S wbo4 the homeowner hires unlicensed pions' in this case,our Board•cannot proceed against the unlicensed person as it with a licensed as ervisor is ultimately responsible. ,Supervisor. The hoassowaer acting as communities require,as part of the peruut application, To ensure that the homeowner is fully aware of bis/hcr responsibilities,many that the homeowner certify thathelsbe understands the responsibilities of a supervisor. On the lastpage of this issue is a form eurrendy used by several towns, you may care t amend and adopt such a fmmVecrtificatim for use in your corranunity. IN5TALL: (}3b ONE(i y- t 500 GALL.�OAi SfFfFC TANK ONE t f 1-3 OC1TlET DfSTftUTEpN 80X{tt-20 Rated2 THREE(3)-500.'GAl!ON LEACH:CHAMBER5 MTH 4'OF 5TONE ALL AROUND + 53.89 7MENT 54 + 54 76 ION 5Y5TEM. r a i► _ L0T.6r _ .T'�0 : To".--N7ATER . . — ea-25 653 5F_ i _ 52 + 5 91 .� + 53.45 ._ t 51.52 53.45+ �- , 52,.04 50.28 50.47 Electric and ephone Boxes b 3 �. 'ae . ._ 51.52 4 54 - a it pp •,S"'� ��s�� 48,:95,� � =f 47,77 - = " �/ 48 d Prcippse�t Drweuaay N 47.65 -20 SERVED 47.3$ VATER. .47.13 7 46:72 - " s t y�� T s ti 1 I i s I f f t F � c