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Home My WebLink About0056 FARM HILL ROAD t{/ wa :,;., ... •1 mS..- .5 de. o... .x.b!!?'+..:.:. » dwr, :.iEa ".t ;r:. rf:'a` :u T.:.. :4.,, .." *; . L ': ��1'�t:''' ,.77 -q, ,., r � . -. xi i it �>"r� u}, 'S -Kt �,a,� .��4}�p �tnN'�S T , '` 'H �f ,', x ti11 r. 0� 7 ''y3 q a4kn. K y o st "V�. m t o .t �� r <�x'"'r'., ;t l ;i`�rµl;y ra".v 4.N`.� '�-��g�n.,� ,y 4.a x yid nY o : ` A , t - P , . , , 0 a >' , f ,. s , 1 4 s .', r s - ;I ;� tf a I,.. I + i " `il .St,,E,y S h Q �'. �.r a a � t:., 6 . E 4. + i `r '�' A r .s 'a + '"+ `k n, 4 &,_' { } v, rf c j a f 4 ,t, f 'C I' ,'� T r *: a , n o' i. 4' 8 r .. is �.. , f_' , I ." 4 q'° a , . . , T — - a a r t � c_..... .. ,. L1` w — - Fed ~ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION I Map Parcel oq Application # Health Division Date Issued s � Conservation Division_ Application Fee Planning Dept. t Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 56 pagm Village �L��r l k rV15 f a Owner v l(7 N F-AI-U Address �6 P/+P..M !-1 r'C L wZ.D Telephone 617 180 4 k Z-7 Permit Request i s C1I_/EN A F A4 o D iF - tivv' � ��2 W p t?H7F r.L P L.A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tgtalrnew _ .Zoning District Flood Plain Groundwater Overlay °= ; Project Valuation "3 , o do Construction Type 77 CIO Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting d ocumentatrbn. 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 Number 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 Detached garage: ❑ existing. ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �4} i IJ +6i (, Telephone Number_ G �7 16o Z7 Address S-6 1TR-R.1 1 t1-6 AL) License # Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 51 ler FOR OFFICIAL USE ONLY 4 APPLICATION# DATE ISSUED `F MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION f Y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL C J FINAL BUILDING r b DATE CLOSED OUT ASSOCIATION PLAN NO. 77te Cansmomveahh of Massachusetts Diparbuent cr,ffndustrial Ac ciderrf QfikeofInvestig dons 600 Washington Street wwm urassgovfdia Workers' Compensation Insurance Affidavit:Builders/Cnntractors/Electricians/P'lu nbers Applicant Information Please Print 1.egib ,Na=(Busniaation'ludividuai) r;) l+e-A-L� `Address: E 0- 2 M 4 i b L R-A) 03:6 722- 6 ,(7 `16 p t CitrylstatelZip: L e M& Phone 9-7 Are you an employer?Cheep the appropriate box: Type of rect]ro' 4. I am a general contractor and I p (required): 1.El I am a employer with g 6- ❑New construction. employees(full andforpart-time).* have hied_the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on.the attached sheet_ 7- ❑Remodeling ship and have no employees 'These sob-contractors haze 8. E]Demolition working capacity- employees and have workers' +n. for me in any � tY- g_ E]Budding addition [No workers'comp-insurance comp_insurance.l required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3-0 I am a homeowner doing all work, officers have exercised their 11. Plumbing repairs or additions mysel€. [No workers'comp- right of exemption per MGL 12.El hoof repairs insurance required.]a c.152,§I(4),and we have no employees-[No workers' 13-0 Other comp_insurance required.]' •Any auplicant @cat checks box 1 nms4 also fill out the section below showing rhea workers'compensation policy iafmmiatiam T Homeowners who submit this.afhd n it indicating thev ate doing all work and then hire outsi&contractors must submit anew affidavit indicating such. FC'ontcactats that check this boas mast attached an addirionA sheet showing the name of the sub-comma as and state whether ornot those entities ham employees.Ifthe sub-contractors have employees,they must pnnd&their workers'comp.policy number. I am an employer that is'prosddinng workers'compensation insurance for try employees. Below is Cite policy and job site in,fo"Ratiom Insurance Company Nance: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Aiftach 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 S 1,500.00 and/or one-year imprisonment,as well as ci%ril penalties in the form of a STOP WORK ORDER.and a fine of up to S250.00 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 c a&"der tha pains and penances ofperjttry that tit e info rmationprotrcdedabm�e is true aitd correct Si t - 6/-7 !�d Z`7 Official use only. Do not write in this area,to be completed by city or town official City-or Town: Permit/License# Issuing Autliority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - - 6 Town of Barnstable • ' Regulatory Services VE r° Richard V.Scali,Director Building Division anaxsrABLF. Tom Perry,Building Commissioner sass. 200 Main Street, Hyannis,MA 02601 �Eo►ee�a www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print "DATE:-. �i25 LGtt JOB LOCATION: 7^6 ralk g iZ,z j,� G>�y�YiyN�S�Die j number street village ..HOMEOWNER': b V I/> 1 name h6me phone# work phone# CURRENT MAILING ADDRESS: �Lo R o co G 5 i L J<D i1) H OZ 106 city/town state -zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. , The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proc dures and requirements and that he/she will comply with said procedures and requirements. CSignature 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. n 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 t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 IKE * lARNSTABLE. � 9� 16 9. �� Town of Barnstable ArED MA't A _ Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 P .operty Owner Must Compl e and Sign This Section If sing A Builder I, as O of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this b ding permit applica n for: (Address Job) Signature of Owner Date 7 Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. �r e� Q;\WHILESTORMS\building permit formsTYPRESS.doc Revised 061313 r V V e ry f m w: y � o �ry p 6 1� L - n- � x ,: -'-.,_• � ate, ,, ... � h _ m • - s r Designed: 2/26/20 14Note:This drawing is an artistic $s $i fUl interpretation of the general appearance of Printed: 2/26/2014 iU .�.� "1 REM the design. It is not meant to be an exact rendition. PSI-Healy.kit All Drawing#: 1