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Home My WebLink About0004 CENTERBROOK LANE a � e Y ChIl. oFSKWE, Town of Barnstable *Permit Expires 6 nths frpm-imue date `ESS PERMI Regulatory Services Fee • snaxsTABLE. MASM t � E P 2 7 2011 Thomas F. Geiler,Director plEp Mp`l ►• WN, OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint �!!11 Map/parcel Number 1 �^ `� ll _( C can-'TzAt d2 L N Property Address r " " rl-E ^err 2 (2, 1 Ls12 t--1 f ( fir s Q �3 2 ❑ Residential Value of Work Y 06 0 0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address aJA» ; p CiV LY��'s a,00 Vic — :'�. �' tA�Y r ( ( off oM A hZ 1 2 C.. sJ Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ 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(stripping old shingles) All construction debris will be taken to d 4-A-�5s Q'. ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *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: Q:\WPFILESTORMS\building permit forms\E7CPRESS.doc Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 - Please Print Legibly Name (Business/Organization/Individual): V�S IVY} Address: —�"v" „ten l ,,..�_ (,l ( � 1 �(�D�fS�- (,Pj City/State/Zip: C(Wr tVf1[f Is< W 0-10a2--Phone #: tl a 3.;z3 C) Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). j 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No worker s' comp. insurance comp.insurance.$ 9. ❑ Building addition equired.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing 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. $Contractors 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 provide their workers'comp.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 DIA for insurance coverage verification. I do hereby%Z_� fy under the pains andpenalties of perjury that the information provided above is true and correct.Si ature: Date: 140 61 Phone#: 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#: �oFTHEr Town of Barnstable Regulatory Services BARNSPABLE, Thomas F.Geiler,Director y MASS. q,A 1639. Building Division jFn tuh�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7906230 HOMEOWNER LICENSE EXEMPTION ] Please Print DATE: —1,t` -7 l l I I,� �T JOB LOCATION: 51 ly b Ti)0 /1 AAi X C N`r v'�2 ( 1 ( t�• 'r'yt.A number street ' �,, village "HOMEOWNER": ��ylnJ � , IVA Jyet 0�q P�%OV3 Z (� �PZ Ll l.+&ty3 0 name ti hgme phone# work phone# CURRENT MAILING ADDRESS: �,, 7ur& ,Q/L(,J -C /y l I A rp"-' 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. i 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 uirements. igiiature 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 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, 1 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:forms:h.omeexempt � j 0*1HE T Town of Barnstable Regulatory Services * BARNSTABLE, MASS. g Thomas F.Geiler,Director - �p .s63q �0 rF1639 & Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us P. Office:' 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This ction If Using A Buil er as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work au orized by t ' building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISS ION 6 . ' >G > ' ,Assessor's map and lot number ....?�!�t�7.....r�l......�. ,/0 %THE t r e Sewage Permit number Z BARNS AILS, House Aumber ...............:.. . 9 rasa .. .. ............................................., �p t679. L/ ON Ar TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... �� ' �sC- J C/ � TYPE OF CONSTRUCTION .........../... to ......../ Cr 1.... ................................................. ........ ..�... / �-....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora pe7rr• 't according to the following information: Locationd �E ` �.....� ......../,•„( ,��v!.�'� ... !.. e.................... .` ................................................ ProposedUse ...... •... . ./., .gn.174............................................. ... ........................................................ C.Zoning District ...........................� ! ......................................Fire District / ...................................... Name of Owner ....�•;D.if.. e.(f11.r .h.rzro• ..�1, .......Address ..... .bc... ..........? �� ...• ....��w V . ,. Name of Builder .........� ��G�YI. ...................................Address ......................�...1 .. �.�',. ................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms /' .........�..........:.......................................Foundation ...s........�.�..1.��!...`..<?�!�r..:(.....:�........... Exterior ....... .�/..5.�.........�t/�.%iZ�......................Roofing r.......... . ........ . ........................ ..... ............................... Floors ...•••... . .....................................�..........�G;.�• •... ••••Heating ............... ...........�... U...... G::5 .............Plumbing .......!.. ......d�c<14A......................................... . ....... Fireplace .............:..!.. ............................................................Approximate. Cost ........f... " Coo................................... .�,.. .. � Definitive Plan Approved by Planning Board _______-e�2__�=--�___________19________. Area Diagram of Lot and Building with Dimensions Fee \ SUBJECT TO APPROVAL OF BOARD OF HEALTH C� (IX 'q 1yx � aG� �� e l j OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS !'hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / A Name �:'r.. . .... .. .� . ........ ��-�• Construction Supervisor's License .................................... GREENBRI ER CORP. A=172-1,81-' /7A No ...27529... Permit for ....One...Story............ ...... ........... % Sirfqle Family Dwelling ............................................................................... Lot 16, --S��hm"Dxi Location .........................................................�ye Centerville ....................................................... ... ...... Greenbrier Corp. Owner ..................................................... ............ .'g h r e .......... Type of Construction ............Frarre- ............ ................. ................................................... ...... ..................... Plot ............................ Lot .... . ........................ Permit Granted ....E:��?ry..19...........19 85 Date'of Inspection ....................................19 Date Completed ......................................19 --air TOWN OF BARNSTABLE 275?9 Permit No. ------------------------=--- I P.USTAU Building Inspector Cash -------------— - -- �Yl � - 9•'t0"y~` -OCCUPANCY PERMIT Bond __-__ Greenbrier Corp. j Issued to Address lot -w1b 51 Nottingham Drive, Centerville t Wiring Inspector r Inspection date Plumbing Inspector al ,r Inspection date Gas Inspector Q�'+� CL 1 �c%st�. , Inspection date �` ^� h Engineering Inspection date - -(l U Board of Health y1 �� Inspection date! �z 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. BuiI ding Inspector'v_�_/ .105EPH D. DALUZ - - - - 4TELEPHONE7 775-1120 Building Commissioner EXT. 107 G TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING • HYANNIS, MASS. 02601 i MEMO TO: Town Clerk FROM: "" Building Department ' ' DATE: j i An Occupancy Permit has been issued for therbu�ilding authorized by _. Building Permit 4i issued to F Please release the performance bond. � y �n� /3� s I>• l/��rr ...../. 7� ttAssessdr's map and lot number .... .. . . k 13 C. SEA'T I SYST M 4HE rO�� o Sewage Permit number ..... .c .....`f..t................................. * d L _"L a L�� WITH i„BASHSTABLE. i House number, 1� `� �� M^da .......... .............. ............................................ ENVIRONMENTAL 9 TOWN OF BAR.NSTABLE BUILDING INSPECTOR . r APPLICATION FOR PERMIT TO ...:. .4 ./ TYPE OF CONSTRUCTION ..ICI .. .... ��lyL:e.............................................................................. . ..6Z./F ...19........ �- TO THE INSPECTOR OF BUILDINGS: } The undersigned hereby applies fora rr 't according to t following information: Location .... .. � ..� .. .vl.r'�!!7... r�r................... .` .......� �...�-�..................... ProposedUse ........� . ............................................ ... ........................................................ Zoning District ........�Vc.............................................Fire District ......CA......................................................... . Name of Owner .... 5� 1. .d"l.�.G ..� 7.....Address .... Ja.er...... � ....�.t.d4 U Nameof Builder .........(5` .0.....................................Address ....................... .�..................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .........C......... ........................................Foundation .......... Exterior .......IJ1.......... ! ....r1..� ,1........................Roofing ...... ., � �i�l... ^ P Floors ! C•Lt� .. .......................Interior ....... .�. ....� .0 ................. Heating ... �ti .............Plumbing ......l.. c ......4.Ck.�A......................................... Fireplace ....................Approximate. Cost— coo G Definitive Plan Approved by Planning Board _______ ----------19_______. Area .L�1� ................ Diagram of Lot and Building with Dimensions �/ �/ Fee .....�7 1 ' " a D SUBJECT TO APPROVAL OF BOARD OF HEALTH < x 7 ,� i r c-e z cJ � 10 � ) x. G• n- e OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl egar ding Itle'lbov e construction. Name ............. .................... .... .....G ......:..... Construction Supervisor's License ...c�.. .lj..�.7..... � I --,,,GREENBRIER CORP. N • z- 'No 27529...... Permit for ...P??e„StorY............. r-.. " ••Single„Family,.•I�x,'ae►1 ...... �.ye ' ng Location Lot 16 i.................. Owner ..... reenbrier,Con.?............................ Type of Construction ..FK ............................ .............................................. ............................. t. D Plot ............................ Lot ................................ th Permit Granted .... ebruary,a9, 19 85 t Date'of Inspection .............................::..."19 Date Completed .... .... .................19 --- + 7 , 4 Lof l5 � N 39 19 0o tr LoT a a L in N o o 6,7`l t v l , f¢TM S 07 r �� t t S •041 9 , s x i l5 DOO.sp M 1,v 0. CERTIFIED PLOT PLAN t1F �S x' %Mlr.jCONSTRIICTI N ONLY RE uc ,:4 Lori rrrTtNGMgr� ,1 21u GtilT�s { FOUNDATION Ig v A FEE .'. IN Af��YEL0i1lftP41NT OF ADJACZNT _ , SCALE, fir„ -`30' DATE, e�� K SS. �.. CERTIFY THAT THE Fo��„�oarror% r ` >iN-OWN' ON` THIS PLAN 19 LOCATEp x,�?« DlSTE.RED REO STERED h CIVIL;" ON. THE $ROUND AS INDICATED A� I ` LAND CONFORMS "TO THE ZONING LASS t ENGINEER SURVEYOR •9,Ys „ � ,�,,, � , h ! , :Or, $ARN f TA! MAB 1 t � ¢ ,17t2' MAIN :.S.TREET -- S. "tHYANrt�tS MASS ". r a. Y RifEET.1,:AR...�. DATE, RE®. LAND SURVEY"