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HomeMy WebLinkAbout0108 ELIJAH CHILDS LANE s n I . a .Town of Barnstable Building This Card So That it is Visible From,the,Street A rove Must,be Retained on Job�and this Card Must be Kep 7rA s� ! Post pp d-Plans�` t 81MVS Permit 63$ ...a,..w.... a- 1 Final spection Has t. f Occ W � uch Buildmg shall Not be Occupied until a Final Inspection has been,made - Where a CeJPosted 'rtifi ate of OccupancyBs Requ red s.�,..� _.,,..,:�,.m.....,.�. Permit NO. B-19-1354 Applicant Name: Denise Mulligan Approvals Date Issued: 05/20/2019 Current Use: Structure Permit Type: Building- Pool-Above Ground = Expiration Date: 11/20/2019 Foundation: Location: 108 ELIJAH CHILDS LANE,CENTERVILLE Map/Lot: 171-249 Zoning District: RC Sheathing: Owner on Record: MULLIGAN, DENISE A Contractor.Name`" „CROCKER SALES CO. INC. Framing: 1 Address: 108 ELIJAH CHILDS LN Contractor License: 104724 2 CENTERVILLE, MA 02632 ;' £~ , Est. Project Cost: $500.00 Chimney: Description: Install a slab for a Hot Tub/Swim Spa Slab will be 10"x IT Hot t Permit Fee: $ 125.00 t ' j Tub/Swim Spa is 94"w x 180"L x 60" High with a locking cover Insulation: Fee Paid:f $ 125.00 To be dropped in place on the slab I Final: Date. 5/20/2019 Project Review Req: Plumbing/Gas Rough Plumbing: 4 Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documeptsfor which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws aril codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. p i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building andFire Officials`are,provided on this;permit. Minimum of Five Call Inspections Required for All Construction Work:.; Service: 1.Foundation or Footing _'�� Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. _ Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT E J_r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcels` � . „ Application # Ao b HealthDivision "? Date Issued 3 Conservation`Division Application Fee a , Planning Dept. + Permit Fee Date Definitive Plan Approved by Planning Board -3111A� Historic - OKH Preservation/ Hyannis t . Project Street Address 106 C i Jam' L AJ Village t s �/'►f '✓r /� �'yl 0 2- 7 -�7 Owner'2) D' � r Address �� /r 1' 1 �Gi , fC� Telephone \1. — 60* - . Permit Request Ge - -- A)e_l.o S / .��Js Square feet: 1 st floor: existing � proposed 17�� 2nd floor:existing proposed--" Total new Zoning District Flood Plain Groundwater Overlay 3 espy Project Valuation'� ,D04,w Construction Type k?--Mfl ' Qj�-QYIL Lot Size o Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Q Historic House: ❑Yes U-W On Old King' s Highway: ❑Yes Basement Type: Wi-rull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) '�.�-j Basement Unfinished Area(sq.ft)_ 41 Number of Baths: Full: existing new °"' Half: existing new Number of Bedrooms: existing -mew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0°Uas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal stpve: d!Yes U<o Detached garage:-EK-xist Rg—®-aew--size=rPeaH-�-existi _ y ize, Attached garage: C4xisting ❑ new size /Sh --Gt y Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -- Commercial ❑Yes ®-No If yes, site plan review# Current Use A 0/71 Proposed Use �J C� / APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name MUPY 6v---) Telephone NumbersZ-- 67� E)/ /OLA ,Address / C 1 /d S 2-4) License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �Lial� C SIGNATURE -c.:�' 7� u--� �.-- DATE �g FOR OFFICIAL USE ONLY 'r 'APPLICATION# " -DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE r ` OWNER 1 DATE OF INSPECTION: , r FOUNDATION FRAME S c- y 23 o R �u��a�ra�tvn s h i c INSULATION ' FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i e GAS: ROUGH FINAL i FINAL BUILDING I bIIJ u 1:/,7cl(& DATE CLOSED OUT i ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents H Office of Investigations e 600 Washington Street <� Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 7)[���t •7 Address: 1083 Ell G? i ,/G/S L._. City/State/Zipce/.lv /-"/,/lam•.4114 6P45 P one.#: .��� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6: ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet. - .7. 9-Ifemodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in an capacity. employees and have workers' g Y P ty. 9. ❑Building addition No workers'comp.insurance comp. insurance.$ [ wo rkers' 5. ❑ We are a corporation and its 10.Q Electrical repairs or additions '3.© I am a homeowner doing all work officers have exercised their 11.0 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. xContractors 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. Iam an employer that is providing workers'compensation insurance for my employees. -Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.M 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 Iead to the imposition of criminal 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. _I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct 00 Signature: fir,:-�� Li. `r - Date: Phone 0•\5-03 _1:2�tM 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 4 �q 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 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, §25C(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 chapter 152, §25C(7)states"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 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 number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 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 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. In addition,an applicant that must submit multiple permit/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 maybe 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-72.7-4900 ext 4.06 or 1-877-MASSAFE Fax# 617-727-7749 Revised 1.1-22-06 www.mass.gov/dia I ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE-AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: ,�y`5�. ,�.� �iYC�G 7 Site Address: /06 FJ/'cZAJ (fh ,'/G.IS print Town: Applicant Phone: b l Applicant Signature: -J-41-414.-a 2 � � Date of Application: NEW CONSTRUCTION: choose ONE of the following two options). 780 CMR TABLE 6107.1 PRESCRIPTIVE.ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS.. MAXIMUM MINIMUM Ceiling or Slab Basement Option l: Fenestration exposed Wall- Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF S1iLR R-Value R-Value and Depth National Appliance Energy .35 R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987 as amended,minimums or seater as applicable Note: This form is not required if you choose either of the two versions of REScheck as.listed below. EVon 2: RESche.ck Version 4.1.2 or later variant software analysis must be completed -0—pti j (780 CMR 6107.3.2) REScheck--Web which can be accessed at http://www.energycodes.gov/rescheck/ � ADDITIONS-OR ALTERATIONS TO EXISTING BUILDINGS.OVER`5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b-a) SF 100 x — = % of glazing (b) Glazing area equals SF b a If glazing is<40% use.the chart below. If glazin is?,40'% proceed.to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM a ❑ Ceiling and Slab Perimeter Fenestration Wall Floor Basement Wall U-factor Exposed floors R-Value R-value R-Value R-Value R-Value - and Depth .39 R-37 a R-13 R-19 R-10 R-10, 4 feet a ;R-30 ceiling insulation maybe used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compress ed over exterior walls, and including any access openings). SUNROOM_—An addition or alteration to an existing building/dwelling unit where the total El glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P) r } I oFSHE r Town of Barnstable Regulatory Services BARNSTABLE, Thomas F. Geiler,Director MASS. 039• Building Division, TfD � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ,/,p—it JOB LOCATION: ��( //V��/7 GA " IDS number / 1 street j village "HOMEOWNER" name home phone# work 4hone# CURRENT 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 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.-forrrt 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 Bamstable 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 M.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) Thi's 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 t amend and adopt'such a form/certification for use in your community. Q:f0rms:homeexempt M• 5 A ' �°FTHEro Town of Barnstable Regulatory Services • BARNSTABLE, Q MASS. �,, Thomas F. Geiler,Director 1639.rFn 39.I A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 act on my behalf, in all matters relative to work authorized by this 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. QTORMS:O WNERPERMISSION Assessor's map and lot number .... 1.� .. ...1.7 : ...... ' yoF THe roe wage Permit number .................. :�f.... ................ SE "�`Q�♦„ PTIC SYSTEM MU§ WSTA� 11 ED y� comi.= S 1-BAHH9TADLE, i com House number ...............................Zo ............................... ,'.y A �O NAB& WM �r�. y wli$4 wit §. c MAX a�e TOWN OF B q �. LEa � AR 1 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ''" :....................................... ............................................................... TYPEOF CONSTRUCTION ....................................................... ............................................................................... ........ ....el..................9.,r?1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the jollowing information: Location .........�� .11(Xee .... d ..... .............................................................. ProposedUse ... /z,j ................ .... ............................................ ......................... ZoningDistrict ........................... ..: . ................. . ....Fire District ..... ....................................................... �j' Nameof Owner ........ .............. ........ .....................................Address ...................�:.......... ..... ... . Nameof Builder :...................................................................Address .................................................................................... Name of Architect ....Address:.. Number. of Rooms ..:. c .. :: . ...:.....,:Foundation ....`%� ......... ......... ..:....................... Exteriorr .............................. Roofing ... ! ........................................... Floors .1. .................................:....................::...:..Interior .... ... . . ... ��/. ...................... ................. Heating ....1. �.�..�.`�.................. . ............................Plumbing ......'.._......'. .`'— .................................. ' Fireplace ........................................Approximate Cost: ...:... Definitive Plan Approved by,,P_Lam nng Board ________________________________19________ . Area /.. ..... . .�...:......... Diagram of Lot and •Buildin wif' Dimerisions' s 9 g Fee ....... � ........... SUBJECT TO APPROVAL--OF' -BOARD OF HEALTH ��N I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ` NamevL. ................................................... ...r. x SMALL, ALAN E. 23340 o ................. Permit for ...One Story.......... Sin le Family Dwellin ............................................................. .............. Location ..Lot....#.0... U- ...9I.ij:41...Pjail.ds Rd. S Centerville , ............................................................ Alan E. Small Owner ............ ......... Frame i Type of Construction t Plot r ...............:.. : Lot' ........... ................. August 5, 3l e Permit Granted ........................................19 r . Date of Inspection ....................................19 f Date Comple ed ...... ........:....1 .:�j....19 m, a Va PERMIT REFUSED ...........t ... ............... 19 M /........... .. ................................................... .w• - Approved ,+ ` ..................... .. ........................... . ....................... A t�'��•._._j_����,�3 ,� ��� . .1.,1'^I`V71"1 .(db Q-}1+�iQ��S s.�i1��.`.+.�:�0,,7:1•tl� ��lti�flr> :It' �'w�+'c'�aSP`!{ •��5�'YY 10 1`+d "ari Cl�'sda a.on S� t�+v�ct S1t-►l �a II .�� -�•--� ! �r n"�n�S �r1 � ra.�M sh,wvo7 r;+v����r rro �t�,� '�rt��� -t•�oi1V�Q'1 �-tt��d � n Y ^F'i=�d pad cn-a l---A33 U,21 ! . ; 1;-Arq •nnI aco ol n i 1 if LS :•• h.� .,,�� .,�,, Jsla aa►d,Y �rnsq''S -z.- t: � - r � 0 07 dol OMT W/pt a s! t . it •�..\I�JUf �� � � r 1✓ � � T�T4fM µit � / C IN OI/1 IW Y�3'� ' ao n�[W7i nt„1 : 'J1v21 rlOU'v'to7Zr- �� z MO Ibd -1 V1Q1 . orb/ J Qd''2 SZq•z t`1`71S'� " •a d' CS ,. c• 1 SLR • S'7, �S osi PIP �� ,; ... i, w � •-•�b9 voo t -ems n 'cid ^' Ski' • •/ ost Acee _ -Ar- v-L �I � / 'rsd•% 'o£fc • 71 oI l rn(71'-4 1•-j Iy%= { r�,, {• S�'11 tl� � •� �'I "1 yvooa�sd � - •f�'IIVY\7� 3��15 �' I ` �„o�TM`r• TOWN OF BARNSTABLE Permit No. ------*2- ` Building Inspector saa�n�n q - Cash --------- Bond y,1-- `� OCCUPANCY` PERMIT -., "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Alan E. Small � Address Centerville T- I n 2 V 1 ;,' . nl,i I A!r- r.-„ -- cp-nt.p'+yi l 1_p Wiring Inspector lw�' Inspection date Plumbing Easpector ,rqe' ��, / ^�~ _�� Inspection date Gas Inspector , ti J f ye__yp r, c / ' Inspection date � - f -tftngineering Department ` f�� , Inspection date 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. 19 f Building Inspector o , ^',. r.. .. �.. •��.. .«' ..fix ':: n ' t t''t r 4',. t;. x �:. '.a .:.,. \ y.. Assessor's map 'and lot number ...................r � �•. { / + ...V F 7NE r $ewa a Permit number !.... ?................ d „ /y l 33AUSTADLE, i Houser number .............. ................z .......................... y MA86 GD i639• �0 �FQ YP,�pr• TOWN OF 'BARNSTABLE � + BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ...................................................................................................................................... - �• ... .................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location ...� .�-p.�......... -� /,�,...�.��,.....t��./�..�/x.�... :���.............................................................. ProposedUse ... ...... .................e . ./ ............................................................................................................................... ZoningDistrict ....... ................ ...........................................Fire District ..... ............................................................ .........................Address A��.-f (' Name of Owner j•., ••,••<....:4,�.,., ................................. ......:...:....................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................._........................,........................................... Number. of Rooms ..... .........................................................Foundation .... ................................................ Exteriork i;.. .....................................................Roofing ......... 1 f{ ................................................. Floors ?1� ..............................................................Interior .... s•,:....'.AC........... 1 Heating .....� ... `..�`'�.................. ......................Plumbing ......... ...........C *'<... .--a.................................. Fireplace ..:....... ..�::`,.:! ...�'7.........................................Approximate Cost ....... ... .r.. ....... Definitive Plan Approved by Planning Board __________________________ �/ , ------�9--------. Area .......... ............................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH p r � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NameiA....; /:.............................................. y A=171-249 SA1ALL,.ALAN E. No ..2 3 3 4 0 Permit for ...One...S.tor: Sin 1e ..............g...........F am i i.y....D.W e.1.1 i n ch............... Location ...Lot...# Elij.da-i.;.ChlIds Rd. Centervij,�e.................................. Owner.....Alan:.E.e...SmJ.I................. Type of Construction ...Fr.ame Fr.ame.......................... Plot .......................::... Lot ................................. Permit Granted ...August . 19 91 Date of Inspection ................ ...................19 Date Completed .............. ....................19 PERMIT REFUSED . ............................. 19 ........................... ........................... ................ r................................................... Approved ................................................ 19 ............................................................................... ............................................................................... T� A oFTME r Town of Barnstable rr �S ermrt# Regulatory Services EXPires 6 mantks f vm issue date ♦ ALANI.TIAT� i , Fee A.�bg Thomas F. Geller,Director CAD 14�1 TEfl MA'l Building Division /o/zlh► Tom Perry, CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 wwwtown.barnstable.ma us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL O ,y Fax: 508.790-6230. ( Not valid without Red X-Press imprint Map/parcel Number / 1 Property Address 11�61 Cd? /dS Z— 1Q ❑ Residential Value of Work Minimum fee of$35.00 for work tinder$6000.00 Owner's Name&Address C�GVL�� Q�,S ` t Contractor's Name Telephone Number < Some Improvement Contractor License#(if applicable) =onstruction Supervisor's License#(if applicable) ]Workman's Compensation Insurance Check one: - PERMIT ❑ Iam a sole proprietor Ller! am the Homeowner ❑ OCT 2,� 2011 I have Worker's Compensation Insurance TniiUN OF �ARlSTA� surahce Company Name orkman's Comp. Policy# ,py of Insurance Compliance Certificate must accompany each permit mit Request(check box) ❑ Re roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side X—I eplacement Windows/doors%sliders. U-Value #of doors (maximum .44)#of window *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic Conser vation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. ATURE: ------------- MES7011-NIStbuilding permit formslEXPRESS.doc :d 070110 I . , I rs The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA,02111 'www.mass,gov/dia.. Workers' Compensation,Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl �rNBIne (Business/Organization/Individual): .4VJi ,Ss. s City/State/Z p �®! , m� �y� �I'hone #: �oo '13 F- i employer? Check the appropriate box: employer with 4. ❑.I am a general contractor and IType of project(required): yees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction sole proprietor or partner- listed on the attached sheet. 7. Remodeling d have no employees These sub-contractors have g for me in any capacity, employees and have workers8' ❑Demolition rkers' comp.insurance comp.insurance.$ 9. ❑Building addition d.] 5. �] We are a corporation and its 10.[]Electrical repairs or additions am a homeowner doing all work officers have exercised their 11. El Plumbing repairs or additions myself. [No workers' comp; right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12.0 Roof repairs 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 certi under the pains and penalties of perjury that the information provided above is true and correct Si afore• Phone-# Of 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#: DIME Town of Barnstable Regulatory Services Thomas F. Geiler,Director MASS. & Building Division. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: U SOB"LOC—A_..0 C7 number / V / Astreet village name ome phone# f Q a work phone# l 1 �U-R.RENT MAILING ADDRESS:--`.D(J /J J Q/� C�J � c�, city/town state zip code The current exemption for"homeowners"was extended to include Owner-occupied dwellin s.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 asup servisor. DEFINITION OF HOMEOWNER Persons)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 comp require ly with said procedures and ents. Signature-of--Homeowner,",- z - 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. HOMEO WNER'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 applicatien, 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 several towns. You may care t amend and adopt such a fOrm/certification for use in your community. Q:forms:homeexempt THE Town of Barnstable } Regulatory Services* >santsrasca. + MASS Thomas F. Geiler,Director ED ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www-town.barnstable.ma.ns Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If-Using A Builder 1 r. as Owner of the subject ptop etty hereby authorize to act on m7 behalf, in all.matters relative to Work authorized by this building permit (Address of Job) Pool fences and alarms are the responsibility p ty of the applicant. Pools are not to be filled before fence is installed and pools are not to beutilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPERMIS SIONPOOLS I r yf__ R Town of Barnstable 1 : 17 ��iHErp�� Regulatory Services �^ Thomas F.Geiler,Director BAaMASS. ` Building Division 9$AT 0g9. a�0� Tom Perry,Building Commissioner } FDA 200 Main Street, Hyannis,MA 02601 (�E)`0// 21 n www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# t 05 FEE: $ SHED REGISTRATION 200 square feet or less Location of she .(�ss) Village &—e8 ' — ��� Property owner's name Telephone number x.�. /7 2 � 9 Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? J Old King's Highway Historic District Commission jurisdiction? 4 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042911 a phomit" t I l' _ 1 c utic _ _Ptloperttj:C P urge rvi i e 210.,o6' Flo. �ntibt o case 17. } ICJ i .C,7 ' ae dN,� 02 d S fn 1 27� Z70Q{ 0(�I'� o0d� �riQ: C °' OF Mood,fan¢ _ C el< ill . ° � � -ghat"1 --,nortgage Li ; ecti®n was. t�.�xxrec� or ,R�DER � rg�'P;C. �xnd CormpasS ua�1� �rSGvro S �� o �t�t dvepe vn, 1wre ,do es�ot,'cfc %n cz� e�ca c a �E�k-{food S T P ur � w _ r ati e.festive d.a of•`8 -1°�-8���td rdw locahbnl o su l ri ,:o(oQs --hu local ,eor4ng 6y-lavo n¢ 04 RV +con witlti ms ►ect horcontal dirrtsiona n Li pji Scale: 1 -- { MF 1#5 o ' e �firn Vtotattoti. error( et1�r1�' � 1 .C'd^ Dater .12 _.2 2 —p yam, :�, 1 tiP�''t� ibVS � 1 40. Sect 101 File-No._Q _ g aNteAm{ o fih se b�U1d s as shown on this. plot plan are`approximate only_ n,a tua� ertVel nes.Tk,e�sa1atif must. not be �foc . e C'6 Pow, F location and encroarhmetits, if any exist, either ay a p p } p used, e� ;Thls Ilan `emu .eS or for use in preparing deed descriptions and must no be used for variance or building plan s PurPQ�tGct Y�u.ra inn an+st.not tie used to locate property lines. Vetificat.ion• of building locations,. property line dimensions, fences or"ti Q tin bGn `t?IeaS fly he accomplished by an .accurate instrument survey which may reflect different information than what that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". ��'K-1 TAI IPANY INC. . r� ,AND SURVEYING ✓� . , "e� Street - Hanover, Mass. 02339 `• Phone: 781-826-718:.6 Fax: 781-.826-4823 4. WHE Town of B arnstable BARNSTABLE, • , Regulatory Services - MASS. 1639.,,0� eA Building Division ren Na+ 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 j w Inspection Correction Notice Type ,qf yInspection Location /08 �L/��1/� �y�L,DS ,rJ� Permit Number 20000,0 10 Owner Builder One notice to remain on job site, one notice on file in Building Department. ,a The following items need correcting: IN U �ENC 7'e1977U,t1S /- ) /O & 4e of yn" oe 04GttKaa 1 J IQ, '-Aw'r-i� T-aA m osa. TF CA cj< xy 1 1 1 1?3 — Please call: 508-86214 $ for r -inspection. i Inspected by y (c Date �{ Z3 0� t AF, Town of Barnstable *Permit# R 5 (D e� 3 (� •-�', Fa;plres 6lnbnths from Issue date Regulatory Services Fee "S& Thomas F.Geilert Director Building Division Tom Perry, Building Commissioner a� 200 Main Street,.Hyannis,MA 02601 Office: 508-862-4038 Tp • JUL .62005 Fax: 508 790 6230 VV/VVX OF EXPRESS PERWrAPPLICATIONsIRESIDENTIAL ONLY SARIVS7 =YaUd x-Pres Rap/parcel Number /7/ .41 -roperty Address /08 6-61, 4/}-1 CA114, ��. . ��NT�'�1/1 LLL d /4 to Residential Value of Work 9-62) Minimum fee of•$25.00 for work under$6000.00 hvner's Name&Address 'L MU U,16,441 lo ya-z-E 9A, rontractor_s_Name . �(��Limit/(�� � U�S�UL? Telephone Number ^ _, .come Improvement Contractor License#(if applicable) / `3 0 O A 8 Construction Supervisor's License#(if applicable) lWorkman's Compensation Insurance Check one: Ulorgmi asole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side . Replacement Windows. U Value (maximum.44)- Where required: Issuance of this permit does not exempt compliance with other tows department regulations,i.e.Mstoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improv Contractors License is required. Signature Q:ForS:expmtrg Revise063004 oFro,,ti Town of Barnstable Regulatory Services s � , Thomas K Geiler,Director MA39. �a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 f Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing.A Builder as Owner of the subject property hereby authorize U6 cT to act on my behalf, in all matters relative to work authorized by this building permit application for. zoo (Address of Job) Signature of Owner Date � o Print Name 4 y QTORM&OWNERPERMISSION Cx The Commonwealth of Massachusetts Department of Industrial Accidents z Office of Investigations ` 600 Washington Street Boston,MA 02111 ..' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/orpnization/Individual): Address: i¢L C�'7' --.l `- /Al S zo City/State/ZiP' V i[4, Phone"#: `��� 7 3 'r - -L'��1 C l LLg Are you an employer?Check the appropriate box: ;.. --T pe of project(required): 1.❑ I am a employer with 4. ❑,I am a general contractor and I 6. New construction loyees (full and/or part-time).* have hired the sub-contractors 7. Remodeling 2. a sole proprietor or partner- listed on the attached sheet. _ _ - "These sub-contractors have 8. ❑ Demolition ship and have no employees _ working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' comp. insurance 5. ❑ We are a corporation and its [No officers have exercised their 10.❑ Electrical repairs or additions required.] i of exemption per MGL 11.❑ Plumbing repairs or additions 3.El am a homeowner doing all work - � right�t � p - � - c. 152, 1(4),and we have no - myself. [No workers'comp. § 12. Roofrepairs` - - - - - lo ees. o workers' insurance required.]t 4P Y 13.0 Other 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 a new affidavit indicating such. . tContractors that check this 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�ani Jop 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains an p nalties erjury at the information provided above is true and correct. Si ature: Dater 7 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#: r , 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 hug, 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 workon such dwelling house or ou the grounds or building appurtenant thereto shall not because of such employment be d=ee iredtDbe ZR-ZuVloYer." } . g g �Y MGL:chapter 152, §25C(6)also states that"every state or local licensor a en shall withhold the issuance or permit to'o `erate a business or to construct buildings in the commonwealth for any renewal of a license or p p applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name. addresses)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with-no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LL;C 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 datethe 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitnicense 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit mustbe 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 Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE x Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia i w U . Bear-t 0, Bu gal", Rregt►o l u ns aYmd HO;NfE IMFUV ndarc EMEN?CON E�,gCTOR Registrafloa: 430088 f E' i t. tVn }lei>2006 lrl Widual EUGENE DUSSA Ul' Y EUGENE DUSSAIaT� 43 ERALEY,II=NKII CE'NTERVILLE, MA 02632 j Adtniuistr-ator � I � F �D f r cn v\ p V 1 O U\J ( `." P Lf tlD / .Ia� O IV