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Home My WebLink About0063 RUSHY MARSH ROAD �.3 �� .J / ,\ � � t PROTECT T NAME: ADDRESS: PERMIT# LA_ (-e PERMIT DATE: 17 C J Ob LARGE ROLLED PLANS ARE IN:. BO SLOT Data entered in MAPS program on: BY: , q/wpfiles/forms/archive .. ` Q TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION / �/�� Map q Parcel � Permit# Health Division 9�-9�'� r Date Issued J Conservation NisFt -, S ' 120 Fee Tax Collector xi Treasurer' 61v51Z6w SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE A;K:D TOWN REGULAT Kit"I.- Historic-OKH Preservation/Hyannis Project Street Address 3 !�'r Village CO Owner kZj Ec Address Telephone 3 -" Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type W na D Lot Size 3 G,L o o Grandfathered: ❑Yes Cl No If yes, attach supporting documentation. Dwelling Type: Single Family 0' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �o On Old King's Highway: ❑Yes t�o Basement Type: U'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing / new Half:existing i new Number of Bedrooms: existing new Total Room Count(not including baths): existing S new First Floor Room Count 5" Heat Type and Fuel: ❑Gas ❑Oil &Electric ❑Other Central Air: ❑Yes &No Fireplaces: Existing No u,5— New Existing wood/coal stove: ❑Yes M'No Detached garage:❑existing ❑new size aoti�: Pool:0 existing ❑new size poou-,' Barn:❑existing ❑new size Attached garage:❑existing ❑new size goo Shed:❑existing ❑new size N��g Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name g,y44,k4-1 /9 Nn 2 Telephone Number 56 6-ya G 3 c-i 5-o&L.5"33-6 3�� Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 'Ic-4y n1 Pu k`P SIGNATURE DATE _ / a-o o FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO: ADDRESS VILLAGE OWNER _ p. DATE OF INSPECTIT: t FOUNDATION FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH, at` t • FINAL PLUMBING: - • ROUGH' ., FINAL y - ' GAS: ROUGHS FINAL , r FINAL BUILDING DATE CLOSED OUT M ASSOCIATION PLAN NO. -r' _ _ _ The Commonwealth of Massachusetts y - _ Department of Industrial Accidents r- Office 8110se5918 fops 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit F4110 0 a name L /V location 3 city o ., hone# S08- d O-o d 6,3 I am a homeowner performing all work myself. ❑ lam a sole ro notor and have no one working in achy I am an em 1 er rovidin workers'compensation for my employees working on this job.:.: ::: ::::: --anMOW d, name.: 8c�dress: cite phone# insurance co. ; > ' ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following llowin workers' compensationpolices: com anv name: »>:> ddr east: ..........................:: .::.;:,........ <one. .d ifisurancexmi:. M. ;.;.• c snv name::: address: :.::.......... :::. ::.. ..................... ::::: ::::::::........ :: city- qw. .. .. .............. a�tit arice of Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crhninal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in-the form of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a COPY of this statement may be forwarded to the Ofifce of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true.and correct Signature ., Date � 17 ZJc�LdCo3 =L. b -�' 'E r ►^ i� Phone# Jro x-S - (a.T Print name -- ofIIcial use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ce ❑check if immediate response is required ❑Se alth Department rumen❑Health Depsrtrnent contact person: phone#; _ Other El (revised 9/95 PIA) Information and Instructions " Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 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 insurance 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. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance 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`9aw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City 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 Investigations 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Invesugatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 °F THE A The Town of Barnstable • sextvsTasceL • 9� Department of Health Safety and Environmental Services 1659. Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Fax: 508-790-6230 f Building Commissioner 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 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 requirements. % Type of Work: 2c� Y `P-�r Estimated Cost Address of Work: 3 Owner's Name: DL CA A Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied �er 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. Date Owner's e q:forms:Affidav I EST/MA TED PROJECT COST WORKSHEET Value LIVING SPACE (high end construction) square feet X $115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X $57/sq. foot= GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK /6 g square feet X $15/sq. foot= S;, D OTHER square feet X$??/sq. foot= Total Estimated Project Cost c IAHFORM 1/3/00 The Town of Barnstable 0,*IKE Department of Health Safety and Environmental Services ' Building Division ' BMWSPABLF, ' 367 Main Street,Hyannis MA 02601 MAss.y� 1639. ATFD��p Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: j 02 O O v JOB LOCATION: G 3 number treet village "HOMEOWNER":)0 YC,4-L y a kagz K P% name / home phone# work phone# /7 CURRENT MAILING ADDRESS: Q--') city/town r� 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 o 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN Assessor's map and lot number :........ / .!... t` 4 �,*'rN F Sewage Permit number ..w. .. . :......:... Z BARNSTABLE. i House number ............ 1.9 �:....... : MAea �po�039. \0� MA,(a' TOWN .OF BAR�NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO � ` red�7 ...i f ....... � �.... ......... .................... ......... ...................................... ............................ TYPE OF CONSTRUCTION ...... ' . { u .......................................... ............................. ..................19..... TO THE INSPECTOR OF BUILDINGS: �e The undersigned hereby applies for a permit according to the following information: Location , . t . . f' � ...... . :f�.`... ..................... ••.. • •�•.•• •••••• •l ..• •••..••J.•• •• •••••••ro••• ProposedUse ..:.:.. ...;,. .� ..`... ......... ......... ....�..... ......................,..........:........,.. s.................................. ........... .......... P f C' % Fire District ... `.,,/,,,U.............................................................. Zoning District ..... l .....�.....................................................,� i � Name of Owner a';.. ..:...? ..... ` ............ ........Address .................<.... ..... ...........,,..:.......... .......... . ... f t ! (�! lT 1! `rh�� C jr` j� 311 Name of Builder,... •'..... k .............•.....Address ......... .................... ........ '..... Name of Architect ........�> f �°..r......... ....1`.... ............ Address t` ...1�f� .. G Gr ... .l.. ...�. ........ .. .... . 4 Number of Rooms .:,....:. '......... .......:. ..........:....................Foundation ... . ... . 4 ....................................................." � Exterior ..... T ..............................................................Roofing ..... .: �r . r � ...{..t..�.�:. Floors ...................... °,:...`.. `.......< •........ ...............................Interior ..:..... .......... f....... . .............,................................... Heating ... ....j..... ........ ......... ....... ....... .....•..Plumbing ........ ..........`......J..... ....................................(.�j Fireplace ... ......... ........ ....... ..... ...... •........ ........Approximate Cost .....�...... .. :............................... ... . r ,... • Definitive Plan Approved by Planning Board __ _______________________19________. Are a %".` .... �.. . Diagram ,of Lot and Building with Dimensions Fee ......j!.� .... . :........... SUBJECT TO APPROVAL OF BOARD OF HEALTH `? so.0 � Id f i -1 ' {r 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 Construction Supervisor's License. * ......?.............. t •LANDRY',- DUSTIN & MARGARET A E19-2 No 28815 Permit for ..ONe Story Single Family Dwellin .................. g ........................ ........... . � Location lot -a�iB,- 419 Rushy Marsh Road Cotuit ............................................................................... Owner ......Dustin. . . ... ... & Margaret. . . . ... Y Landr ........... . . .... . ...... . . .... . ........ Type of Construction Frame ` ............................................................................... Plot ............................ Lot ................................ x Permit Granted .......January...7..............19 86 Date of Inspection ....................................19 Date Completed ......................................19 � tv ST"et�cT�.ec >--s =TEa ZONE o N �s �G.vti 4�•.vs G o c,erE,Q - .Q F --_: �G o T �G A-�.� o.v T-.��- cyc oc..vp .c3 S-' ��✓ ft, SE T�4 C.�S Bti! TO�o p�c- Cf3 Q/SC �Ra.�/ T- - Z ._� � ��/O BxiST.S .vim o.c G.co�Ti c0tf Tim/iS PG.Q.v is .co AM o T - - s CAPE COD SUR` �� a erg - CONSULTANT �.eo�'�ss�c,..�,oG L,•�i✓C�`�uevE�o.e �� 3�4 3261 MAIN ST./ROUTE E q0' BARNSTABLE VILLAGE, MA ��.T��T •�/, 3- /�4z-oc� � l i"17-s (617) 362-8133 PAUL R. R� y O P •a No. 324 324 48 oe �EGlSTER�� Q�d - Q s�DyA1 LAya N 0 Z W • o d N a 3 5•00 N 0 0 \• m I �- S 75' - SC, N Ya