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Home My WebLink About1102 SANTUIT-NEWTOWN ROAD ///Jy/ t � ,. a G I� .. - ..n ..�i 'l�' o k Lm�� t►,E, Town of Barnstable *Permit # _load Tee 6 monthr m issue date Regulatory Services o� -Fee � � • BARNSTABLE, * L MAes. Richard V.Scali,Director �a ® Building Division APR 14 AA►►MM ft Paul Roma,Building Commission �/] /� ZG'� 200,Main Street,Hyannis,MA 02601_ °��/`/ www.town.barnstable.ma.us �R1�S 1 Office: 508-862-4038 Fax190-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL-ONLY Not Valid without Red X-Press Inprint Map/parcel Numbera Property Address /l ra 5r- +�t'�t- elf 01-6(6/ Rd' Residential Value of Work$ 006 Minimum fee of$35.00 for work under$6000.00 . Owner's Name&Addressu�� Contractor's Name Telephone Number. Home Improvement Contractor License#(if applicable) . Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) " ❑ Re-roof(hurricane nailed)(stripping old shingles) Ali construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ` ® Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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: / QAWPFILESTORMSUilding permit forms\EXPRESS.doc' 01/25/17 The CFl2TItf3'O nveakh gf.&SSa�JSSP F Dqw mt qfIndk&tridAccidem!s- Office afhnea4atiom ' ' 600 WashbW- ton Slwreet Boston,MA#2111 r Wcwke& cunappWIM T Inmr nice avid Bbfld'I Can rs/M n¢ ers APPEca t# atiGn Please Print Y . tut 4y Are you an employer?:Qtecla.the apprapriate bay Type of project(required}: I_❑ I an a employer with 4. ❑I azn a general=EtERctor and I employees(full andror part fiime * 1mvehiredt ie so�co 6. .❑New oaasiz au 2.❑ I am a sale etor or Ested cathe attached sheet 7`. ❑Wi g. 1 Mwe sib-congractars have- ship and hue no employees $. ❑Demolition Wad-Ing fiorma in any capacity_ empayees andhave wodmre' 9..❑S addition. ITo tom'oohng.tee: comp-;,Sa[2LU p I reTli I 5. ❑ We are a cospasaticn and its 10-❑Electrical repairs or additions; 3.8 I am a I,ameoumer doing all wmk officers have exercised heir IL❑Plunbiag repairs or addYfivas �of ememp6m per MGL f�o wodmrs'°omF- 1?❑Roof repairs ' a 15Z, 1 andwe have ago e ishstuance re�ea.j i § C� _ asplogem[No WadM& 13-0 Other cam-iusrzranw required.] 'may apg Hzst dedsbaa iF1 mast also IM v=t ca swffaabeIvwsb�Hue¢wa&ee mmpamff puricgi»f m=xff a ara�s�hosnbogtcbis im�r gtLeyshe3am�egcrm3c2aIff1m]imaatd&cm=cmrswsubmitanewaffidavitmaicatinasud s t cherktbE,bmc mast s�rbed>m saeIis�shiest sho ti+en—of e>e sub-caWmKma.=a stue v hedier arnatt use hsee empkyem Iftbeav&cmftzcIaeshaae-gQ*ees dey— p=He dwk tisadr�s' p.gaFicy mm$set . I am imeaipl ar Eliot is prouieiireg tvcrl{ets'c ategrerescdiare VL=ra",W f br Irzy OMF&.;W-t Be oev is thapa cy and jab sits irzformalr'vrL . 7ashffiace,Co mpany Nt rame: To-licy 441'or Setim licAk 1 piratiaziDafe Job Site Address: CitglSkafa p: Attach a-cupp of the wurlwxe comapensa&npolicy declaration page(showing the policy nmcmber and expiration cafe}. Fa&m t o semen coaeeage as required under Sec6=25A o€MaL n 1557 can lead to She imposition.of criminal penalties of a flue up to$l,5aa OQ ini for osie-gearimapd onmesd�as Weil as riViI peualb L- a She farm of a STOP WOFX ORDERand a fine of up-to$Z5M a day AVindt tihc violator. 13e adrise:d'tbat a cagy of ffiis statement may be ceded to the Ofke of Imuestigations oftihe DL4 fm Ica coverage vexiScaiam.. Ida hereby earhfp snider t&s pouts andpmahLw ofFerjep that the irefbima i upn*i&%1 abm a is true and correct ph=Irk 0AW d rasa aa* Do uat write in 616 are ih;err be t aer�plete+d by c*artbirn offic'aL' 'or Tassa: Permiff ieesse Issuing Azflai*y(circle one): L Board of Reg th I "mg Dgm1meat 3. awn clerk 4`Fectrical F S.plumbing bqmdmr 6.Mar Contact Person: Phone.#-. 1/= .nsl.maw -.• _ .a:I■l� �•■a.:.. _1 w..lr • -R [/ a] • t" •••..1rw rnaalr ul .1.ul t•I !■" t atua •'�- 'n •.nl n is w rnul- .n �.11 I •" an�/ . - _ ■aw•■ it ■. - r • :■t•■.a ■I•• :I• • r•I■1. :V •I ■■ - ' ■ /�1I / •% w f a3f■•�/ : .n ..•. •la: •1:. to�.w■IA• _k...•.I:.a•l■ r•/ •• .1■•1■ •1 ■a•a -_ �3.1•t • •: :/•• ••• • a.al - • ■■" 1• ••.a■• .�a•l:•�• aI : •.a �n1a •1■�- -I/• 1a n nI.' to- -_ - al :.�a•1YI■•a. • /i F �• �i./•• •• •1 ■a a •- • ■ ■ -- • aI u n• ■u. ■.l n.w■au _w•1.•h.n m n •■■ -_ �/■1 gnu ■• u: :+nu Is•- :•• •r i■ ••••as • •• - Int• 1.1 a_•n• ■• ..u - um ma .nanla.rrw :.l• ^•• :+va-. iaaan a n • raucnl • n- a• 1 u• a•a • a••ita ■• :utr a- .awu■ .1 a• ItAI-m.I■r •.• ■ ■ ■ua a •.n •'a■. •n ■ 1 ■- In■: ■•■w • na n � •av• • ■n ■n• :■••n 1:ra.m is� -u ■.1 ■/ •►rn - • a .t .+uu ••u iu • .«n�• ■• •- :n �!/ua • • ■ rlt- u� - � r�r I _/..: -■vu_ a . - 1 a ■ • ■ it - ■ -. •• • �! . • nal 11 ■ •- _1t" ■ U.Y/1�..`I. / .I r/•w■ I Y • i• • I■ _ 11 ■1 r/.In■ • t ■t / ■ .� ■ I / a - t• a ■f 1 r"/ a Y_ • - 1 ii1 r 1 I n • - f r of a•." n I• 1 / - • ■ t i• •• 1.•■. 1 / C2 ■_u la Y r� r.•:. a u•. n ruum w• r_Ii/ /• .n• 1• •• t■r. /■fl • v u• ■.1 Ana- nn. .n •a ■ r w u- r�•n au.n r • •1•1 •••la. mp :rr:�a r_• - •:1. • ut.n•.n - n i•- n n _n " a••n tea■aluw • n .a:n 1r a. •aqa • �..:lu1a• u INCIVITIturr.ra • _nm•.1 01 •n u •fArs ■nu�/ .■•a _ Gr•.• I rune Iar • ra a .e,u_ i• •ni. i1.1 m• 1■ •■n v o_I■•■ _n• a ara. .1 ■n• •r rnua :rm ■_Ina .e n a. :n. •.m- nnn a:1 _ •a: u al 1 ►� ■a•r_/ta • n n a■ lag ate• r./ uru■:m�. n naa aa. .• 1 . u aw a u n an•a • •_■ ••a2 :. l• as In as a frflt •••a. a ronu:;r w_■m n n a. r-aau • - .• a•an a• .a -a n: ■■ i■a-ACIPS in. • f•lac luaa u n- /va. m ilft . ■n ■•- •�;•w 1• •t ■nu.to as • n n .n r- ■• - _ I . w u Y_ . - ■■ a ■-�u- - u/- ■ : i■■. ■• • • ■■.n a• n ■ 1 u n• 1 n a u ■r••tr_■ul n n" •asnu • ra■ a a+u_ -•r:�1a1 t • n ra.■ n1 a. • a.a ■/- raj/.a'.t w 11•/ ! ••1 ■: -t/ • ■.+■•]t .[ •11■ 1.- • ■ •• :1 - �•atl �■ 1• ••a:■1. ••a■.•:1 •11at■wm r a•■ a a 1 • .. r.1 is as.1 u■ael 11 n■n■I /w r/ • •• - u n �■ run!•-n1 w ■•• • �•.- fa- 1 Blois •1 _1a - N■ - ll....a ii •la n- .tr n •`a1..11" n- �1 • • '"lED1. 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Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us Office: 508-862-4038 Fax: 508*790-6230 t- Property Owner Must f? Complete and Sign This Section 4 If Using A Builder I, tcl��(J�1��5C+1k^ ,as Owner of the subject property hereby authorize 1D � to act on my behalf, - in all matters relative to work authorized by this building permit application for (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 Owner Signature of Applicant xxc- Print Name Print Name Date Q:F0RMS:0WNERPERMISSI0NP0DLS Town of Barnstable Regulatory Services CIF Richard V.Scab,Director ' Building Division n t Paul Roma,Building Commissioner 039• �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: L//I Please Print JOB LOCATION: f�O l ro'-�^)J•c f,,,t ftw), Rd e — nnuum,.ber street village "HOMEOWNER": w1,1Jtd GIfr — 9CCW - name home phone# work phone# CURRENT MAILING ADDRESS: I I Q1 �A11 1�lJ:i ^ N�(tf fioW,A 1' eUU�'e/•� 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- f tmily 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 personas itwould 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 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:\WPFILES\FORMS\building permit formsEWRESS.doc 0620/16 Engineering Dept. (3rd floor) Map Parcel c5 Permit# House#, / Date Issued • Aoor)(8:15 -9:30/1:00-4:30) - Fee S22 o-b t ,5� r �-h floor)(8:30-9:30/1:00-2:00) School Admin. Bldg.) THE f Planning Board 19 BARNSTABLE. TOWN OFf BARNSTABLE Building PermitApplication - ct Street Address Village Owner Address Telephone ,S Permit Request First Floor square feet Second Floor square feet Construction Type •5 p� Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number 7 012 Address / License# Home Improvement Contractor# 1/ 9 / 7 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 i DA BUILDING PERMIT DENIED A THE OLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. - r r DATE-SSQEDa MAP/PARCEL•• NO. ADDRESS VILLAGE ` a } OWNER — — DATE OF INSPECTION: FOUNDATION + FRAME r INSULATION - - FIREPLACE r — ELECTRICAL: ROUGH FINAL —. s � PLUMBING: ROUGH FINAL ` . GAS: r ROUGH 'FINAL FINAL BUILDING � � DATE CLOSED OUTm } s t ASSOCIATION PLAN NO. ' THE r, The Town of Barnstable ,�arsTea�.• ,0�' Department of Health Safety and Environmental Services 9�0r6165-9. A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: Est.Cost 69-" Address of Work: O Zvi Owner's Name Date of Permit Application: f--— 3 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied 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 app y for a permit as the a ent wner: Dat on ractor I ame 0 Registration No. OR Date Owner's Name The*- CU/11111Ut1 h-eahlt of Atassacbusctt-ti jl 1za Department ottdustrilrl.4ccidc�trts '• J Ol�iceollnyest/gallons 600 1114.0t igtoir Street Bustntt, Mass. (12111 Workers' Compensation Insurance Affidavit .__._.. ..—.. - .,._.�,,..,.....�„•..mow......-----•--�r-�•'�_��.� �ii h—n rn i 1 P ,Z : .- a�- c ' I am a homeowne performing all work myself. !am a sole proprietor and have no one workin_= in any capacity _rri��..-r• Joy �.r�� I am an employer providing workers' compensation for my employees working on this job. company name: � atltlrecc• cit nhnnc tt• incurnnce co nelicv d I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below whc the following workers' compensation polices: om am• name• ddres cit, ehonc f!• insurance ro policy cram ln%• name, addre s- city• phone a� incur•tncc co neiic�•a r_��_ 'Attach additidn21 sheet if tiec + -o�•- VI'jju C iu secure*coverage as required under Section 25A of hfGL 152 can lead to the imposition of cnminai penalties of a fine up to S1S00.UU an une N•cars' imprisonment as wcIl as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand it cope of tttis statement may be funvarded to the OlTice of Investigations of the D1A for coverage verification. 1 do herehr cerrij•7/1 the pains arrd p !ties of perjure•that the information prodded above is true arid correct. Signature Date / a -3-- rint name L one# �S� - 7 r. of�rici2l use only do not write in this area to be completed by city or town official ty or town• permit/license N t'1Building Department Licensing Huard check if immediate response is required C)Selectmen's Office 011e21th Department contact person: phone#: r,10ther information and Instructions . Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for employees. As quoted from the "law". an emplaree is defined as ever},person in the service of another udder un� contract of hire, express or implied. oral or written. An etnpint•er is defined as an individual. partnership, association. corporation or other legal entity, or any two or the foregoing enuaged 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. Howeve owner of a dwelling house haying not more than three apartments and who resides therein, or the occupant of the dwcllina house of another who employs persons to do maintenance , construction or repair work on such dwellin, or out the -rounds or building appurtenant thereto shall not because of such employment be deemed to be an empi MGL chapter 15? section ''S also states that even state or local licensing agene}• shall withhold the issuance o renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any :applicant ivito Itas 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 chap' been presented to rite contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation 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 tiie 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 rep to obtain a workers compensation policy. pie--se call the Department at the number listed belo«. . .�. --w:.w•.-..•. �-�.. ...- ...rr.. �...•-_.—.••.►ww••..r�� , ... � .. ..air• ... ..�1�. .- '"Vi.1~I. .. •� Cite- or Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. be sure to full in the permit/license number which will be used as a reference number. The affidavits may be return. 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 queE please do not hesitate to give us a call. ..._ The Dep . . . . .,.. - artment's address. telephone and fax number. k The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, Ma. 02111 ' 07. .. ��i�2[24Ck2��LlQ�G[6 DEPARTHENT OF PUBLIC SAFETY CONSTRUCTION.SUPERVISOR LICENSE N ber: Expires: Restricted_16- GEORGE H RYAN 'f�,•,w-4 vrtA✓ '180 NINIGRET AVE NASHPEE, NA 02649 07 HOME. IMPROVEMENT CONTRACTOR Registration 119171 Type - DBA Expiration. 06/01/97 GEORGE RYAN HOME IMPROVEMENTS G�ie�c o ff�RGE H. RYAN ADMINISTRATOR — NINIGRET :-� MASHPEE MA 02649 ;