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4 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 0 7..'o Application # JQ.; [A
Health Division ` Date Issued y�
Conservation Division ' Application Fee c
Planning Dept: `Permit Fee;
Date Definitive;Plan Approved by Planning Board
Historic = OKH _ Preservation/ Hyannis
Project Street Address %0 S7 P 1 y c--/ 12�
Village Co 7'0 7
Owner o��?_ Address �/0,5 7
Telephone i Gi 7 ]2 V 3 3
Perm irR Oqu=2st-_--N /2t�+�..v .o c u�/.��/ �•�c� fvss�vof �.r�c�t�- �c v��
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District' Flood Plain Groundwater Overlay
Project Valuation / oo--- Construction Type C«n�•�t ac-r .•�'�K'S nor
Lot Size �o �/5` Grandfathered: ❑Yes Flo If yes, attach supporting documentation.
Dwelling Type: Single Family ,� Two Family ❑ Multi-Family(# units)
Age of Existing Structure 0.51 Historic House: ❑Yes ❑ Wo On Old King's Highway: ❑Yes dNo
Basement Type: ❑ Full ❑ Crawl YNalkout ❑ Other
Basement Finished Area (sq.ft.)' o Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing: 02 new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing 3 new First Floor Room Count
Heat Type and Fuel: OGas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes Oslo Fireplaces: Existing o New Existing w6p,d%coal stove: Lffes Flo
Detached garage: ❑existing ❑ new size Pool: ❑ existing ❑ new size _ Barn!9j,existin03 neR size_
Attached garage: ❑ existing ❑:new size _Shed: ❑ existing ❑ new size _ Other:
F Mkti g��i�y.
v A
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial`❑Yes ❑ No 1f yes, site plan review# y --
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER).
Name Aa Telephone Number
Address _los Rd License #
_ 64'elfz t "'>7� Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
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SIGNATURE ! Gar DATE 61 7 /�
4
FOR OFFICIAL USE ONLY
j ..
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
r,
OWNER
' DATE OF INSPECTION:
FOUNDATION W4YL q l`r O
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
3
s
The Commonwealth of Massachusetts.
.Depar'finent of"ndustriaCAccidents
_ Office of Investigations'
600 Washington Street
Boston, MA 02111
i• wwlv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plumberg
Applicant Information Please PrintLef�ibly
Name (Business/Organization/Individual): G V re% O 1a' y-
Address: t
City/State/Zip: c,C 4V I 4 0 .G 35Y Phone-#:-6/7 V-77 q 74-
XY
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ 4. I am a general contractor and[
I am a employer with 5 Q New construction
employees (full and/or part:flm.e).* have hired the sub-contractors T.
listed on the attached sheet. :(�Remodeling
2.0 I am a solepxoprietor or'partrier-' These sub-contractors have
Demolition
ship and have no employees
employees and have workers'
working for me in any capacity. 9. ❑Building addition
[No worker -insurance s'•comp.•insuran comp. insurance.t
S. [] We are a corporation and its 10.❑ Electrical repairs or additions
j required.] .
J 3'.❑ I am a homeowner doing all work officers have exercised their I i j Plrunbing repairs or additions
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
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 hire outside contractors must submit a new affidavit indicating such:
tContractors that check this box must attached 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 providb their workers'comp.policy number.
X 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 fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimirial.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 maybe forwarded to the Office of
Investigations of the MA for insurance coverage verification..
I-Yo hereby certi under the pains and penalties of perjury that the information provided above is true and correct
Date- 1 —
Si afore: P
Phone# (O 7 X /
[or
ial use only. Do not write in this area, to be completed by city or town officiaL..
Town: Permit/License#
ng Authority(circle one):ard ofHealth '2:Brilding Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
her
Phone
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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 tiustee 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
o'r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL'chapter 152, §25C(6) also states that"every state or local Iicensing 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) slates`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 v zth 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-contzactor(s)name(s),-address(es)and.phone numbers) along with their certificates)of
r than the
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees othe
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 fh�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 permitllicense number which will be used as a reference number. In addition, an applicant
that must submit multiple perinit/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 Ijavestlgatlans-
600 Washington Street
Boston, MA 02111
Tel. # 617-727-490.0 ext 406 or 1-877-MASSAFE
Fax # 617-72777749
Revised 11-22-06 www.mass.gov/dia
J
Town of Barnstable
o Regulatory Services
Thomas F. Geiler,Director
� )3.ARN6TA9LE,
•
M" Building Division
ATFoy a Tom Perry,Building Commissioner '
200 Main Street, Hyannis,MA 02601
www.town.barustable.ma.us
Office: 508-862-4038 Fax: 508-790-'6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: �/f: �00
JOB LOCATION: Alkz V �
number street villagep —7
"HOMEOWNER": L—s�a:l!(A p �/�r�11+� 6/f7 3 7� 7 a 3� � y l / 62c�
name / / home phone# work phone#
Gf
CURRENT MAILING ADDRESS: { P6 GI 49
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
requir ents.
,k
Signalure of Homeowner d4
~ Approval of Building Official J
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,
ularly
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results s serious problems, a licensed
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:\WPFiLES\FORMS\homeexempt.DOC
Town of Barnstable
Regulatory Services
R M
" iARNSTABLE, Thomas F. Geiler,Director
�Fp � Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis, MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 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 a t on my behalf,
in all matters relative to wor uthorized by this building permit applicati for,
(A ress of fob)
Signature of Owner Date 1�
Print Name
1
If Property Owner is applying for permit please complete the .
Homeowners License Exemption Form on the reverse side.
0:FORMS:OWNERPERMISSION
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S'[nM S_Otl.__CDI� ...5TKAV-_(`�1.4-x-36(A C�
1. 4- % T.O. WALL EL, PER SITE PLAN MAX. SLOPE = 2% (1/4'PER FT,) PROVIDE SWALE TO DRAIN (NOTE 5)
7'' tl32DIT
2' Minimum over (TYP. WALL)
#4 @ 18' o.c,
horiz,
#5 @ 24' o,c,
vert.
Fir, Grade EL. W/ POSIT. PITCH #7 @ 12' o.c.
vert.
SEE NOTE 5.
#7 @ 12' o.c. �44'
81 4 15'
MAX. MIN.
3' Minimum BOTT/2' SIDE Cover
1 ' .MIN, <TYP, Footing)
0
#4 @ 18' o,c,
#6 @ 12' o.c_/ #5 @ 12' o.c, top & bottom
'-10
RETAINING WALL ® FRONT
GENERAL NOTES AND MATERIAL SPECIFICATIONS
1. All workmanship to conform to the requirements of the Massachusetts State Building Code, latest edition.
2. For site location and grading information, see the "Site Plan", design by others.
3. Provide sufficient temporary bracing and shoring to permit the safe installation and completion of all war .<H OF p,�q
without damage to property, house on abutting lots, and without jeopardizing the safety of any person(s).
4. Concrete: Minimum 28 day strength, f'c = 3000 psi, 3/4" aggregate, design per American Concrete o�� MICHELE
Institute Code, latest issue, max. slump = 4". \` R•
CUD
a.) Steel reinforcing bars: New billet .steel, ASTM A-615, Grade 60. 070 i .
bJ Provide Vertical Control Joints).@ 25' o/c Max., AS REQUIRED
cJ Provide Horizontal Corner Bars, AS REQUIRED, #4 @ 18' o/c vertically, 2'-0' x 2'-0', STRUCTUF: L
5. Place of / r r fill solt behindi P -V V
3-1/2' DIA WEEP H❑LES AT 8' ❑/C W/1 C Y EA END F❑R HYDROSTATIC RELIEF BELOWqc`
SURFACE AT BASE, AND AT IT ❑/C AT TOP "❑F WALL ON 11' PLAN LENGTH RETURN S�OIVA'-_
RETAINING WALL MICHELE CUDILO, P.E.
SECTION Consulting Structural Engineer
Centerville, MAssachusetts 02632-1979 mcudilo®comcast.net
ODIFICATIONS TO EXIST. 'RESIDENCE Drawn By: MC Date: 08/1 0/09 Drawing
105 PINEY LANE Checked By: RETWALL Scale:NTS
COTUIT, .MA S K— 1
File Name:. Project No.:2009-1 1
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� ) 'Par
cel' rmit# f 414195'
Conservation Office(4th floor)(8:30-9 30/1:00-2:00 7 . 0 SIG Date Issue
Board of Health(3rd floor)(8:15 -9:30/ 1:00_4:45) . e _
Engineering Dept.(3rd floor) House# IKE
SEPTIC S T BE
De . . . and 19 INSTAL LE - 1ANCE
IVWTN
TOWN OF BARNSTABft ' O NTAL C®1D� ID
70771 M RE-rhI P,—,�.
Building Permit Application
Project Street Address 16s AsNg,;J &40 z
Village T rk,q f`
Owner 2�pg2 =gJ5�,1#,-gyy Address 126*,0 47-V•
Telephone
Permit Request 'Oeg,-i o d.F-i- /C.TGffjE_ y
•
:First Floor S_ square feet
Second Floor — square feet
Estimated Project Cost $ /d 000
Zoning District Ae' Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use _S�NCr�tz� ,G,�,►,r`y ��'f,o�,uc6 Proposed Use 54y.
Construction Type wcmo
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure 49-0� ¢ Basement Type: Finished ✓
Historic House ^!v Unfinished
Old King's Highway A10
Number of Baths 2 No.of Bedrooms .3
Total Room Count(not including baths) First Floor 6
Heat Type and Fuel Central Air No Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None ✓ Sheds
Other
Builder Information
Name Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE z4lf=. DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
I
Pe FOR OFFICIAL USE ONLY
PEA MIT NO. I 44q
D ISSUED
M /PARCEL NO.t ► } r _
ADDRESS VILLAGE
OWNER k d
i 3
DATE OF INSPECTIL ~
FOUNDATION ;
L� '•�; Cam- -
FRAME'
INSULATION _ 4'
FIREPLACE -
ELECTRICAL: ROUGH FINAL `
• R t
PLUMBING: ROUGH FINAL ,
GAS: ROiJId� ,..: FINAL i
FINAL BUILDING 5-.
DATE CLOSED OUT' :}` t '
ASSOCIATION PLAN NO::
The Town of Barnstable ,
' M Department of Health Safety and Environmental Services
see
� Building Division
367 Main Street,Hyannis MA 02601
Office: 508 790-6227 Ralph Crossen
Fax: 508 775-3344
Building Commission
For office use only
Permit no.
Date
AFFIDAVIT
HOME n"ROVEMENT 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-adsdng owner occupied
building containing at least one but not more 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
tequireme=
Type of Work: ��:c� vng� Est Cost %a.oaa
Address of Work:
Owner.Name•
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under SI,000
Building not"owner-occupied
Owner pulling own permit
Notice is hereby given that: CONTRACTORSOWNERS PULLING THEIR OWN PERMIT OR DEALING WITH i1NREGTST
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
Z-�
Date Owner's name
' The Connnoay walllt of Massachusetts
Department of Industrial Accidents
n``- i _:!� 011/ceolloyesl/ga1/o�s •
.1 i; ' 60011 aslrington Street;
' :� ���,;'• Bunton.Mass. 0 111
�• Workers' Compensation Insurance.AMdavit
a "'""'
Annhc�nt mtormation• • •. lv• ,�; ,,; , " • •_.__
mmir• lflvy..,q � � SttRr tJ
location- >vS_
city eoTv. ^-1.4 phone if
❑ 1 am a homeowner performing all wort:myself.
❑ 1 am a sole proprietor and have no one working in any capacity
❑ 1 am an employer providing workers' compensation for my employees working on this job.
cam nny name•
address•
citx• nhone#:
insurance co nniicv#
,.•... ,... ...,_...,.. ,.,. . . .. .,,... ..ram..
1 am a sole proprietor,general contractor, homeowner circle one)and have hired the contractors listed below who have
the following workers' compensation polices::
company name•
address. 72 AfIle A-yjyj :..
c � n���e`6 /ice phone#•
insurance co, '6 neiiey#
j.�++%;:� •".--;-!:: "cnr✓. :e:.•-aa�ss�.?'+►?';--MeR;�sli^LG} .:?3,�,�iaia _�ayEl?0!J�47�3?S�'•'r•'7�='!'�':f_�i!RS �„is��+!1L+" .A14.3?S'!'+�'�.''ai
ctimpam•name•
address: - -
city: phone#:
inenc�nwa w•. •• policy# '
:Atiach additional'sheit if iiiieRli i.:-.i - -;_f'�^H"�'�"�'�=```• °'�`+�• •" _ ':+s�
Failure to secure coverage as required under Section 25A of MGL 153 can lad to the imposition of criminal penalties of a fine up to S1.500.00 and/or
une Years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day apaiast me. 1 understand that a
copy of this statement may be forwarded to the Oface of investigations of the D1A for coverage verification.
I do hereby cerdfj-under the pains and penalties of peduly that the information provided above is true and correct
Signature x /ll Q l V� V GL� Date
Print name Phone#
of iciai use oniv do not write in this area to be completed by city or toga ofnciai
city or town: permit/lleense# nDuilding Department
(3Lieensing Board '
0 check if immediate response is required QSeleetmen's Office
C311altb Department
contact person: phone#;, riOther
(mused 3•195 P3A)
Information and Instructions
Massachuschhs General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an emplm►ee is defined as every person in the service of another under any
contract of'h'ire. express or implied, oral or written.
An empinver is defined as an individual• partnership,association, corporation or other :,gal entity or any two or more of
the fore=min,engaged in a joint enterprise, and including the le-al representatives of a deceased cmplover, 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
dwcllinf, house of another who employs persons to do maintenance, construction or repair work on such dwelling Douse
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter F52 section 25 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 in coverage required.
Additionally. 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.
.• .'„'+.Iw - yam.'. ��-• 1� .. 1. "1°c r •Twc....r.•...
7 {la:Pf:.• a• .: • •.1:�'•r.....Jai av Via,:w �[+..' �•'A �1'•'[{.5.:4r:•�.ei:;?..`� •"J*:� `
is►' .. ..... .. ... .. :'Rr. .� ��!'•:•' i�,j:.w.f!Y!.Tfy411 17"'�: •V.'i:' - .1'
Applicants
Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation and
supplying company names. address and phone numbers as all affidavits 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.
!-. " .� ._... � -Y: ;• •-�`�'�.:Y:,�,,1:;•<u`F.. w vL'�.,!-. ..L:'�.��..r..'�'l1{Yti. .r..Sii '.f{�]�Y �Mt['.T!z.�i. .` '777-_• ..
Cite or Towns
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of lnvesti_ations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
t..'—•��;-..''.t'o..r`�Y•�'tst+' _i :�.. •j:+^... ••rne�r..ac<..«�.ii h+s'i: :�..•',.'.. 1•:.i�:::ir.�:.'..:, y ..�a:r: .w;:F.�..«...:`.
�.r.4�.•� ... �� r.: y Yiaw.J'�:^ . .. •, +�1 !�Q• •• ./ ni�Y. .'1....RI..'y 'w.:'�Y ..yy..:
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
.. Office of Investigations :..,...
r; 600 Washington Street _
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 ext. 406, 409 or 375
• TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print. -
DATE
JOB LOCATION AOC P.',s"_1 ,aoxho 7-
Number Street address Section of town
"HOMEOWNER" L
Name Home phone Work phone
PRESENT 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 such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is _ intended to be, a one to six 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 acea-ptable 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 Stat
Building Code and other applicable- codes, by-laws, 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.
HOMEOWNER'S SIGNATURER�
y�
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
"Yqy
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner 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
Home Owner engages a person (s) for hire to do such work, that such Home Owner
shall act -as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenes
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it would with licensed Supervisor. The Home "dwner,'actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities, man
communities require, as part of the permit application, that the Home Owner
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..
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Assessor's ma and lot number ..�/a���..e.. ..1621. ..fd /T �O'�
p � ......J ./ I/f/r"7 THE
a�f� � /l . %� • `/7- 6 >'' "fr r vk
Se\(/age Permit number .............. C,e-"O`.? . .. Sys , �u° w ♦ .
'apirCC SYS E
House number .......................................................................... ;.;A�
WITH
- r i vMEN'T �
TOWN 'OF.. `BARNSTARE vvt �EGULJ ® S
,.
BUILDING , 'INSPECTOR
APPLICATION, FOR' PERMIT TO : ..ADD..T.a.::EXIET ING...UWZLLILICI....................................... . . ..........
f
TYPEOF CONSTRUCTION ..... ...WQOD..12A10............................................................................................
...]a .0 YIBER......17.....�.....19.86.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit accordingsto the following information:
Location .......a1Q5..,?1.N4X..R Aas...CQ. . ... A.S. .......................................................................................................
ProposedUse .....a ..9.Qm......Ulu.).................................................................................................................................
Zoning District ...Fire District ...C.QT.U.IT.
Name of OwnerIMM?,T..&..F.FAN.QU...JLBRICK..........Address .LO.5...RINEY .R.0A.D.....U.T.U.T.o......M.A.#..........
Name of Builder- .CHARGES„E......Ij11,MBLIN...................Address .1.7.Z6...RENT Q.WN...ROAD,....U.MI.T.................
Name of Architect ................................Address l9: .RARRQR...L.QCP.......GLD.GLOSM....ML...........
Number of Rooms .1.............................................................Foundation RXISMING.....C.QN.CRaTE..............................
Exterior ....vNi)..13B.11. L... ...................................Roofing .........A., RHA.LT...S.H.IRGLE.S.................................
Floors .......CiARJ.'ET...ON...W.00...........................................Interior ......DRYWALL..................................6........6...............
Heating ..ELECTRI.0...B.ASE.BOARD......... ......................Plumbing .N(J. E......................................................................
Fireplace .......NONE................................................................Approximate Cost ......$155•QD.,.QD.......................................
Definitive Plan Approved by Planning Board------------____--------------19_______. Area ....23.Q...SR....FT............
Diagram of Lot and Building with Dimensions Fee ..... Q....QQ....
.....................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
ole.. o
't wle
I
t
C
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.
.� �:�..�� ... �.....`..
Name ... .. .� ........
HEWICK, ROBERT & FRANCES
36130"1 ADDITION
No ................. Permit for ....................................
Single Family Dwelling
...................' Single. Family........................................... t
. 105 Piney Road
Location ......................................
COtUlt
Ili ......... ...................... ................... ,
Owner Robert & Frances He.wick =
Z; ..................................................................
TY' a of Construction ..........tame.....................
F .........................................• . - ............. ..........
AL
' Plot ............................ Lot .t-............................
*December,22,> 86
Permit Granted ............................ ...19
Date of In `�`..................' /' 19 k.....
'Date Completed ........ .. ... ....19 t
� art • � -� � .. � *_
t <
L ,
i
Assessor's map and lot number
r�>r fTHEj
,�?`�I ,- �.f,":,>r C,t•h`r7G./fa;,.�'['' •LJr. b� �`
Sewge Permit number
IA"ST"LE i
House number 039.
Mnea
SEC YAY a�
TOWN OF . BARNSTABLE
BUMPING INSPECTOR
APPLICATION FOR PERMIT TO ........�.n 1...T.O... re......................................................
TYPE OF CONSTRUCTION ................�!0:01D...E..R.a MH .:........................................................................................
....DECFtulBER.......;1.7..,.....I.....
19.86.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .......1..0_5...P.TN..)�-Y...KOA.D.:...C.Q.T.UTER......RA ............................................................. ...................................
ProposedUse .....alN...RQ P.M......�U.N.�................................................................................................................................
ZoningDistrict ........................................................................Fire District ...0QT.TJIT............................................................
Name of OWnerR®BEMT...k-FR,A[V05... IFWMM..........Address .1,.10.5...F-1N.—Fy...&0A..a? ...fW:4'.U.LJ..........MA............
Name of Builder' ..R LE ...a I-i•1.1.Ma ITV...................Address ..�.?.2 ...j.F, POI'LN...F,;QA .................
Name of Architect ;T•Oki•N...AA�QU.H................................Address 19...HA.&B-•10...L0.0P......C..j.QtI•.S•T.J,?.R......MA,.:%.........
Number of Rooms....1:.............................................................Foundation FXl•ST.T.11C......0 0 ky.Q.R. MqT.F..............................
Exierior X!aQR..Wk V-.�T.:..sTTDIk'G..................................Roofing .........4.S,PH.'.AT.:T'.. ?H ANC.T.,N5.................................
Floors ......QAk,?P,T...2L.i,1Q.0.n..........................................Interior ........QRY. &E,,T_:...........................................................
Heatingf ..2...... a.. .!?................................Plumbing .......................................................................
Fireplace .......MUF................................................................Approximate Cost ......-'Z1. KQ�?.T.n.Q......................................
Definitive Plan Approved by Planning Board -----------_____,-----------19____ . Area ..... 3K.3.Q.e...F: e.........I
Diagram of Lot and Building with Dimensions Fee .....?59,...OQ.... ........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
'P r
47 r
iv
qL
} 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.
r' Name ........: ....:a`�G!..........' ....................................�
HEWICK, ROBERT & FRANCE/S
_G 7C J A=020-076
�r.
No ...30301 permit for ...Addition
Single Family Dwelling
.......................................................................
Location 105 Piney Road
...............................................................
Cotuit
...........................................................................
Owner Robert & Frances Hewick
..................................................................
Type of Construction .......Frame
...................................
...............................................................................
Plot ............................ Lot ................................
December 22 , 19 86
Permit Granted ....................................
Date of Inspection 19
Date Completed ......................................19
J
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