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HomeMy WebLinkAbout0005 GINA COURT G co JJ j}fly , al ° a _ 'o ° a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, Map Parcel . '.Application # Health Division Date Issued 2, log Conservation Division Application Fee Planning'Dept; Permit Fee_ ?s Date Definitive Plan'Approved by Planning Board p/c �Zt�tiq Historic - OKH _ Preservation / Hyannis Project StrPPt A� C� n Village v: Owner V i n L f nL± �a • H f c.k® Address 001 rye �J • —,brr ors Telephone L4 S2_ `� l L1 Permit Request tie u44:,rac� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size ' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 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: ❑ e' isting ',,-A new size_ ..� Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: i >rning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ; Commercial ❑Yes ❑ No If yes, site plan review# w Current-Use - - Proposed-Use - N A-P-P-LICANT INFORMATION (BUILDER OR HOMEOWNER) Name..�e:�rAr�� � • (��.ru�• • TelephoneNumber� 1�0 � �`�— Address 5 �� �� vicense # C-S V6Z� �jeYW— &ACA• Home Improvement Contractor# 1 O yl Worker's Compensation # SAL-L_CONSTRU $I GTION-DEBRRE IS SULTING FROM THiS'PRO,JECT WILL BE T y AKEN TO o z __DATE , ( GNATURE .�° g i z � 1 FOR OFFICIAL USE ONLY r e APPLICATION# DATE ISSUED y MAP/PARCELNO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME r INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL .x --GAS: ROUGH FINAL ,Y FINAL BUILDING r { k DATE CLOSED OUT ASSOCIATION PLAN NO. K ;'3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 'y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Business/Organization/Individual): ddress-j 3 City/State/Zip: ` \ 0Z,?,6LJ Phone.#: '-?S l 58.5_ — Li 5 1,59 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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' 9. ❑Building addition [No workers comp. insurance . comp. insurance. required.] 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.❑ of repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 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. 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 lip 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. Ido hereby certify under the pains and penalties ofperjury that the information provided above is/true and correct. Uip-matuie: LzOLL-i (—.—at,--12S 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 A.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 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 d hone number s along with their certificates of necessary,supply sub contractors)name(s),address(es)an ,p ( ) g ( ) 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 ees�a employ policyis 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 may be 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. #617-727-4.900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22.06 www.mass.gov/dia °FYNET � Town of Barnstable Regulatory Services + BARNSTABLE, t MASS. $ \ ;Thomas F. Geiler,Director `bAr�o 5.N. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.b arnstab l e.ma.us Office: 508-862-4038 Fax: 508-790-6230� Property Owner Must - t Complete and Sign This Section If Using A Builder as Owner, of the subject property hereby authorize el / to act on my behalf, in all•matters relative t6 work authorized by this building permit application for: 3 a (Address of Job) GGI ✓ g'6 Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �ofVE r, Regulatory Serviee.s BARNSTABLE, f Thomas F. Geiler,Director Q MASS. 4,,, ib39• A,� Building Division TfD µA'1 Tom ferry,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: /j/ F—.D 9 JOB L ON: tmber sheet village "HOMEOWNER =/I/ /GKG 9.;2 name me ph e# work phone# CURRENT.MACLING ADDRESS: D city/to state zip code .w The current exemption for"homeo rs"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 regulat' ns. Tht,trrrder ' ned"homeowner"certifie at he/she understands the Town of Barnstable Building Department nunirnum ii s ction procedures and equirem.ents 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 complywith 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']09.1.1 -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 fora/certification for use in your community. O:fotmsrhnmeexemnt s_ Nlussachusetts- Department of Public Safety �UIM Board of Building Reaulations and Standards Construction Supervisor License License: CS 5821 Restricted to:. 00 r RICHARD D GARUTI 35 RIVER ST KINGSTON, MA 02364 TM � Expiration: 6/19/2010 T r#: 475 (bn„nissi Pile y , Boss o i mg egu a�o s an `t°an ar s HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return'to: Registration: 110834 Board of Building Regulations and Standards Expiration;'�1:1/9/2010 Tr# 278100 One Ashburton Place Rm 1301 = —=T . ival Boston,Ma.02108 i RICHARD i D GAR _ - UTI_. .. RICHARD GARUTIi ; 35 RIVER ST �i j'A" 35 KINGSTON,MA 02364`<.� Administrator Not valid without signature q ' r e -24 Assessor'ssmap and lot number ......................... ...... R'R G�/8�8/ P�cF THE ta�� 8/�3y ��- Sewage Permit number (,'91) .... Z BAHB9TAXE. i House number .....::.....:. ... ......... ........:.................:...... s Mae6 00 1 639 e�0 ' 0M a\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ..................................................... TYPE OF CONSTRUCTION ............ !......................................:................6................ ���a�\�✓..:...�.� ?...........19 K.k. TO THE INSPECTOR OF BUILDINGS: C ' Cow tt The undersigned hereby applies for a permit according to the following information: �U16 7 oGD V���/ Location ......... ................7A ...... . .-..`......-... ............... ..,..:. ......�..... ................................................. ProposedUse .... .�.n.�� <k ......�.acy\,\�1 ........................... ........................................................................................ Zoning District ... -Q Via. ?-..............................Fire District ��� ��`�t ��? `` `v Name of Owner ......-..�.....:... .......7.m. .......Address AA ' Name of Builder .-- ....►�C?5......... ...........rne ........Address ............ .,.0 !l.? :1.................................................... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ................ 0"T..............................................Foundation .......qCh�m..�.c�........C.,,--)()C.A-0 Exterior .....c.`.Aa vC�n A� ...Roofing 5 C?�1 � ��!',!\C . .................. ..............- ............................... �t.. . .................................. . 5�..... Floors ......0. ..................................................................Interior ...........,>� .�. .A>...A..N ........................................... Heating .... .. ...... C.k.. .................................Plumbing ............:.;L...... ?. ?..................................... Fireplace .........n. - ..........................................................Approximate Cost .......... t.u. ..........................,........ Definitive Plan Approved by Planning Board ________________________________19________. Area ................ Diagram of Lot and Building with Dimensions Fee — r�s 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. Name . �✓ ...`!.�...... ................... r......................... SMITH, JAMES K. A=210- 23211 One Story No ................. Permit for ....................... . ....... Single Family Dwellin ........................... . ..... .. Location ...Lot 67.t 5 Gina Cour ...............................;........... Centerville ............................................................................... Owner James K. Smith . .....James Type,of Con'struction ......Fr.ame......................... ........................................................................ Plot ............................ Lot................................. Permit Granted ..JAng...lag.................19 81 Date of Inspection ....................................19 Date Completed ................ .....................19 PERMIT REFUSED ................................ ...........................................7....................... .... 19................................................................................ ............................................................................... ............................................................................... .....0'0.'elp....knZ"F .......................... Approved ................................................ 19 ............................................................................... .............. .............................................................. �' � � • R ;f is -; f ... ,. , 4 Assessor's, map and lot number c2/ � -� o�/c n�A� � 8/ �oF toy THE 8/ 3 z/o - G i� �Q o Sewage Permit number / � _ • Ate" • • House number ............. ......................:. , C SYSTEM • • SEP11 IN ST D IN CID o a TOWN O F B AR N S T T'�L c®�E A� ' ,f. MENTA TOWN REG ' BVILDIHG INS;PECT_OR V APPLICATION FOR PERMIT TO S-? It?:X:}4 ' ...... TYPE OF CONSTRUCTION . . ,......... ........... .......................... .H. i TO THE INSPECTOR OF BUILDINGS: !/V�' �V ........ .W.. ...... .........19 .... The undersigned hereby applies for a permit according to the following information: K '/0-71 7 o1-D P64V Location ..........1:-c1 ......`1 .. .............:....:.....:.....'.:. . ......:.. �� : .? ....................�........... �..... ,. .... �. ............ '�� Proposed Use .... <?`m s ................................. ....................................................................................... Zoning District ...` �.5�.. �. ..............................Fire District ... w�� 4r.... S e!�Ul ...... Name of Owner ....�P. .M. ....... ...... M.� .......Address ........... !?.. T.a�'? ` _............................. K Name of Builder .; t540 '3.........`\......... .....:..Address ............` ?. �r.........:...:................. Nameof Architect ..................................................................Address ................................................:................................... Number of Rooms Foundation ...... .. :e� Exterior ..... bO. .... .��.i...............Roofing ............ .e . 's' ...... .74�(1 .................. Floors ....... JA—.1.................................................................Interior ........... ...eS`�....... .................................... Heating ........1\.. .........� a.................................Plumbing ............ ..... ........................................................ Fireplace .........0.(N.�..........................................................Approximate Cost ............T�J..s�. .f ................................... Definitive Plan Approved by Planning Board _____________________________19________. Area ................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I ' hereby agree to conform to all. the Rules and Regulations of the Town of Barnstable regarding the above construction. ' Name ............. Y` ..................... SMITH, JAMES K. 2 3 211' One tory 'No ............ .. Permit for .............. Single Family Dwell ' g Location ..............................Lot #r na...C.QI� ........... Centervi e .... ... ........................... Owner .. James...K. S ith:... r v C. .. .«. C - _ a Type of Construction ............................................ ....................... ,..... Plot ............................ Lot ............................... .. •. _ ram' 1 �' `#., � �: � ....... ,Permit Granted ......June .1....... 19 $1 �yq Date:of Inspection 9 -� -- Date. Comp let d ... .............f..2=2 .19 00/ +C• tr PERMIT REFUSED ........................................................''mot.. 19 1<1 . ..................................... �,. `•. •`mac, - 1 f } _ .................. ..'Y. ._,: ................................ .•....•J3 _ 'f ••'T,• `� ..?_ !\ `•,, ? ....... .- .................................... d` 1 Approved .. ............................... 19 ................... l l� l /ve T y „��""'• TOWN OF BARNSTABLE �11 Permit_No. _______-_--- Building Inspector { t.ern.a Cash - -- OCCUPANCY PERMIT Bond YC �/ "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 firsf 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 Jams K" smial Address -^� lot #7 5 Gina Gyurt, Centerville Wiring Inspector o /fy. Inspection date Plumbing Inspector Inspection date i r Gas,Inspector C���� �� •f��f Inspection date-40 A 81/ //Engineering Department , C�f C�!-�it� � 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. c.J�.1.'�C♦ o�,� 19.1', h ..... ................... .... .�....�, ........ �.. Building/Inspector ..._......._. �r 2-.ad�i,�! Ft.ow to c = � , .>✓.v. p,. �E Pj`I C "-neS,"V- U SK- l OC>C) 6QL-. I 'To r,s L -P C>>lGtJ t; -426 6.1?n. ! G�!CGDt.L�"T.`s0� ��:T'E: , i,�iN Z.ht:lJ• Oz �; � :� - 'C� � � r - 98. • " . . `/Jfa..irn� -�-�.:7. i. �,.P� U Q • Saf «fix qG,L Seprfc ,� � tit=l�� -� ,�-•__� � GRAM j_ wVvrW t /3/�.•1�1L� - ��•3 t-'t't Li (;GIZ'Cib="4 TI-JA-r T:-1= . 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