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HomeMy WebLinkAbout0016 HADRADA LANE Ap, CSC . �g a V S�- Ov 0. Nr t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map Parcel Permit# � 1 4 3 � , .Health Division C� �L�a313� Date Issued g- 2 7- D J 'Conservation Division Fee i Tax Collector I lk t o In3 C SYSTEM MUST BE ApptFe00Treasurer LEDIN COMPLIANCE V) WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODEOWtced in By TOWN REGULATIONS Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address l b 11 ti O R A D A L A AN E Village C L iU ra- eR V 7 L L, IF C E/J 7 ILY'0 Owner t2© CR T l.J E/AJ 5 r,01 Al Address 1� A/a D R /4 04 19cAJe = 01 63 2 Telephone SO S Ll a( o Y S 7 i r` Permit Request X4L ✓�Q - e-� i �ry V.0 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ' try Valuation$ Zoning District Flood Plain Groundwater Overlay 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 r'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 `^ BUILDER INFORMATION Name Ro 3 ZR J W IF/A) 5 rIF/ Telephone Numberrs o Address i G /J g 0 R 19 D A L N License# C tF A) 7-9 lev z L L7 m /9. v 2 6 3 a Home Improvement Contractor# - Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER - I DATE OF INSPECTION: m m M FOUNDATION 0 b a C;�me.µ J p'6 p S IL- < Q FRAME INSULATION t ; FIREPLACE " 2 ELECTRICAL: ROUGH '�' c"v FINAL r'l o PLUMBING: ROUGH FINAL F GAS: ROUGH FINAL FINAL BUILDING r - - (i (� If two`- ff o v i DATE CLOSED OUT ASSOCIATION PLAN NO. t i � � t The Commonwealth of Massachusetts Department of friditst al Accidents Office.of Investigations- ' . 600 Washington Street t Boston,MA 02111' w. j www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elechicians/Plumbers Applicant Information Please Print Legibly Name(Bu4iness10rgaaizat10vb&v1du4' t�o (1�i l.J L l RJ .S'i ! A)Address: i G 14 0 DO L A Od City/State/Zip• :,� ,z n ;'�� V i i_t M A, a a G 3 2 Phone#: �a 9 ' y 2 �. tr 8 ?,S - Are you an employer? Check the appropriate box:. Type of project(required):- 1•[] Z am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction have hired the sub-contractors employees (full'and/or part time). listed on the attached sheet.$ 7. ❑ Remodeling . 2.[] I am a sole proprietor or partner- ' ship andhave no eirngloyees These sub-contractors have S. �0 Demolition working for me in any capacity, workers' comp.insurance. g ❑ Building addition [No workere comp.insurance 5• ❑ We are a corporation and its 10.0 Electrical repairs or.additions required.] officers have exercised their t of ex lion per MGL 11•❑ Plumbing repairs or additions I am a homeowner doitrg all . � � p - • . Myself.No workers comp. c. 152,§1(4),and we have no.. 12.❑ Roof repairs insurance required.],t employees. [No workers' 13 Other iQ�2"P�d1 e 5[ �-S camp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Floateewaers who submit this affidavit indicating they are doing an-work and then bire outside coutaetors must submit anew affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers''pomp:polieY srfo�mation. I am an employer that is providing workers'compensation insurance formy employees. Below,is the policy andjob site. information. Insurance.Company Name: Policy#or Self-ins.Lic. #: Expiration Date ' Job Site Address: City/State/Z : Attach a copy of the workers' oinpensation policy declaration page(showing the policy number and•expiration date). Pale to,secure covers required under Section 25A of MGL e. 152 Bari lead to the imposition of criminal penalties of a fine up to$1400,.00 an or one-year iulprisomnent, as well as civil penalties in the form of a 8TOP'W ORK 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 certify under the pains �ddpena�ltdiesof perjury thatthe information provided above sstrue andcorrect Date:• oG '� Si atllre: ' Phone# S B "6 y a2 a 1? 7 :5 Official use only. Do not write in this area,to be completed by city,or town official City or Town: Permitlhicense# Issuing Authority(circle one): 1.Board of Health 2.Building Deparkunent 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other ContactPerson: Phone#: Info rmation and Instructions chapter 152 Y uires all employers to provide workers' compensation for their employees. Massachusetts General I'a� person in.the service of another under any contract of hire, pursuant to this statute, an employee is defined as"...every express or implied,oral or written :' or two or more •. : artpers>}ip association, rporation or other legal entity, any ,_.. An empleyeP is dcfiried aa;" ?mchvi¢aa1,•,P '° employer,or the' of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased emp Y , association or other legal entity, employing employees. HOWOY.er:the receiver or trustee of an individual,P ant of the owner of a dwelling hous a having not more&an three apartments and who resides therein,or.the occup ellin house of another who employs persons to do maintenance,construction or repair wo?ktin such dwelling house dw g urtenmtthereto shall not because of such employmentbe deemed to be an,employer." or on the grounds or building?PP MGL chapter 152,§25 C(G)also states that"every.state or local licensing agency shall withheld the issuance or any Tenewal of a license or pew to operate a business or to construct buildings in therommonwealth for ed. licant who,has not produced acceptable evidence-of compliance with the insurance coverage required."• , ap 1iCanally,MGL chapter 152,§25C(')states"Neither the commonwealth nor any of its-political subdivisions shall Ad 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' comp ens. affidavit comnpletely,by checking the boxes that apply to your situation and,if necessary,suPPly sub ships name(s),addresses)and phone �sh s ng(LLP with �ye s othiT th�1he insurance. Limited Liability Companies(LLC)or Limited Liabty �P ) does have ensation insurance. If an LLC members orpartaers; are notregnired to y workers affidavit may be submitted to the Departmenor t of Industrial employees,a policy is required. Be advised that Accidents for confirmation of insurance coverage.. Also be sure to sign and date the aff davit. The affidavit should e returned the crtY or town that the application for the permit or license is being requested, not the Department of b re arding the law Qr if you are required to obtain a workers' Industrial Accidents. Should you have any questions g �shy;d meter tbefr comp ens ation p olicy,please call the Department at the number listed below.. Self-insured comp self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom P the applicant of the affidavit for you to fill out in the event the Office o which fI b used as as reference member r In addition, an applicant Please be su re'to fill in the permit/license ense numb that mnstsubmitmultiple 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 P davit that has been officially stamped or marked by the city or town may be provided to the tA�)"A copy of the affi applicant as proof that.a valid affidavit is on-filo for;futar e wm? n�ot ����wine S�commercial v�e year.Where a home owner or citizen is obtaining a hcens permit (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit lions would like to thank you in advance for your cooperation aid should you have any questions, The Office of Iuvestiga please do not hesitate to give us a call. The Departnent's address,telephone and.fax m nber: The Commonwealth of Massachusetts . 1 kpartment of Industrial Accidents ., ..Office qff Investigations 600'Washingfon$treet V { �t Boston,MPi 02111.. _ t 406 or'1-877 M.ASSA�FE Tel. #617 727-4900 ex Fax#617-727-7749 Revised,5-2645 www.mass.gov/din oFE Town of Barnstable Regulatory Services srasia; Thomas F.Geiler,Director 01, ��, .�► 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 Permit no. i Date AFFIDAVIT' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization;conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: AF,PL_ACL STC, 5 q 269Cd Estimated Cost Address of Work: 1 G 14 A D R 1g 0 A t,19 tj i; C 6 'rc? 3 2 Owner's Name: &3 0'r 1.c)ly 1 A) S*rO I A Date of Application: I hereby certify that: Registration is not required for the following reason(s): []work excluded by law Job Under$1,000 ❑Building not owner-occupied J-_-50wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIG ER PENALTIES OF PERJURY I hereby apply for a permit as gent of the owner: Date Contractor Name Registration No. 1�4 5— �- Date Owner's Name Q:forms:homeaffidav Town of Barnstable CE INE Regulatory Services txsTeB Thomas F.Geiler,Director MAM � . �.� Building Division A�fO 1iA°� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 1 #19 y R/3 0 A t_j9 O C e E N tlf i,L number street village "HOMEOWNW: R 6B 9—i0 (,J 5 dt)_S I/A/ So g Y 4 o YS 7 f( name home phone# work phone# CURRENT MA ING ADDRESS: I I-al A D R A rJ AD U 9 N L= c aA)ra)? V I�t' AMA oa �32 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 res�onsible for all such work performed under the building hermit. (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 minirrnim inspection procedures and requirements and that he/she will comply with said procedures and equirements. e, • Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code hates 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 fomi/certification for use in your community. (1•fnrmc•hmmnw•Pmnt - -- - - - /�s_D�" _ j I / l GOT 0 �G0714 a ((QD��AIl f p 5� SP1A Est SMA� p���cN 13'j `� aN�- ci L7 Rs A ' p `t ` -sf-�t/��G� ,c�YncJ 7— ��G'e�°�"®®eta 71. 70. � /d�'�@®Y C@,CT/�'Y Tsslr47y' T6A� ®e✓/d.�icst. - '.3�dt3�6l� ®A/ ;""/'a CLAN /97 L.00A:PTWO ®A/ 77,0& w�®6i�l13 <9..T 1 "OWA-1 hs@�@0a/ .��1� 9'�,1�Y /T Fi��1 C} A S yti ��7F� COe�/F®�� TO Ts+v/e�' �'�.4✓/,a�/� _`�,�.`l"'-`' �ryf\" i ,. H z x- cape _ ( ------------- TOP RAIL CAP RAIL Ili �r. I ,I bpi RAILING GUARDRAIL DUST CLEAT END low T�'Z �► NG 1� BOARD r � I I. y:4TWNGER AOBg s �'P1Plt`s m Ire, u x eft '� Y Town of Barnstable Regulatory Services BMWSMBLE. Mass. �, Thomas F. Geiler,Director ATEo,r,prA 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 _PLAN REVIEW Owner: L.)e h S+q_ Map/Parcel: < A g C) 9 Project Address its t- c,�\,,a de, Ly, Builder: u-)V�Q"V- The following items were noted on reviewing: o Reviewed by.: � q Date: ✓—Z 2 —D '� Assessor`j maw and :,lot .number ... - :.., „t........:�,..(�.. `- T' SEPTIC SYSTEM , c. r, 'Z INSTALLED, MU T'=BE Sewade (?ermit, number IN RCMP E r ........ ... 7 WITH ARTICLE LIENC MS,, -'- TLAY E II STgTEQ HEry TOWN OF B A R „ (Lo Town .m 3 ABLE. BUh�LDING INSPECTOR 27 ,FG.'MPy Or•, .ht r7 .wa '^-: G - — ►fie - /f �. r �e�o"• V Vim/ �= APPLICATIONFOR'")PERMIT TO ............ ' TYPE OF CONSTRUCTION .. ......�.� .. .f.....'t'..... ... ...:d.... ......... .. ............. ............ i ..................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permi according t the following information: Location ...... .. ..... ..................... Proposed Use Zoning District ..... .'a •••.............................................Fire District �,t `� �?I. ..�°'::.. i... /�`°�''ff Nameof Owner �. ..�. .... ........Address ........ ..,.r>.................................... Nameof Builder ....................................................................Address .........................:....................... Name of Architect .Address ..................................................................................... Foundation .1-41�/:. Numberof Rooms ................k!..................................... ......., ............. . .-�-� � ,Ex1e for ......... ............................................................. ....... Roofng ......4.Ae.............. �. .......................... . t �• Interior ,. Floors ............................................. �!...... ................................... Heating .....!.... .4..d, . ..j.+!... r..... d. ......................Plumbing .............. ..................... Fireplace :........... ... .................Approximate Cost : .a. ......................................... .... Definitive Plan •Approved by Planning Board ________________________________19________, Area tiZ .k........ ...... .. . Diagram of Lot and Building with Dimensions .. . ......... 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.,. . ......................... Capewide Development E 18452 one story, , Niim . ............. Permit for .................................... t . i single.family dwelling - L8 ation CJ..... adrada Lane............................. V Centerville ............................................................................... a Owner ..:........Cap.ewide. . ..Develo. pment ................. ...... . .. ...... ................. r frame Type of Construction .......................................... < Plot ... ..................... Lot ..........:#16.:........... f June 11 76 y Permit Granted ........................................19 Date of Inspection r Date Completed ... �1.' �✓/� ...........19 PERMIT,REFUSED f....................... ................................... 19 a........................ ...................................................... •4 ` ` ................................ R... ................................... r . ................ ............................�-'.... ' .Approved .................I.......... 19 ...........................................................:................ Assessor's map, and,,lot number y !'. ...... 1 Sewage-Permit number ' y r.......................................................... TOWN OF BARNSTABLE ypF TN E i MA"STABLE, i y MA8,6 of �O i639• `00 oV Ar- BUILDING INSPECTOR APPLICATION' FOR'PERMIT TO ............ ..�° ............i�` !i. � r.;�....................... .. .f J.•.. ..... ....... f�r .. .. r� TYPE OF CONSTRUCTION .........::n... ...L..... .......... y`....:h::{..`... ............•....................................................... .................. ....19.'✓ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby] applies for a permit according tot1 the fyllo`wing information: Location ..... ;.T.J!.'.: .........t!. �:........ . ./..�t..fYA!¢ / ��.� J{......tl` `1................................................................................... a' ProposedUse ..................,c:::.."....::.......�.:...y-~ ...................................... :........, ................V ................... ............ . .Fire District •,'` � s`,+` 'Y 1 � �• J'•/ `y� Zoning District ............. , .............. ................................... ?.;, ::!!.t: .... ..:F: .. :..........................:................. Name of Owner �� CJ '.y .`?,,..!'...........................................Address �.;.�'!:! i! " >...�} ' Nameof Builder ..Address r.................................................................. .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number. of Rooms ..........................................Foundation .ram h '�r/•.. Exterior ..........y.................:.......................................................Roofing ......:.....:..: .,t.......:..r....•.�t:...............;............................ Floors .• - ..:.....................................................................Interior ..........:.:.: ..:............r........`:...........:............... �' ..� ''.. .Plumbing �• Heating ......:.. t. ....... .r:............ ,,,. ......................................................... •r i'' ` Fireplace ..............1..................................................................Approximate Cost .....!;.:..: : .:.:...................................... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ............................. Diagram of Lot and Building with Dimensions Fee '�,. I 4!. `':`�.1r........ SUBJECT TO APPROVAL OF BOARD OF HEALTH I � 1�t� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable.regardin the above construction. Name',::. ..: ............„ .� ,.a•. tapewide Development A=148-96 r. 18452 one story, No ................. Permit for .................................... single family dwelling ............................................................................... Hadrada Lane Lbcation . .......................................................... Centerville . ............................................................................... Capewide Development Owner .................................................................. frame Type of Construction .......................................... ..................I............................ ................................ Plot ............................. Lot ........... ...... Ju4e 11 76 Permit Granted .................................. .....19 Date of Inspection .......... ........................19 Date Completed ...........I.........................19 PERMIT REFUSED ................................................................ 19 ....... .................... ........... ............... . .. ........... . .......... . ........................... ..............................I..............I..................................... ................................................... Approved ................................................ 19 ............................................................................... ...........................................................I.......... /3zrr( • /:p$-nc,7. ,. �a'� �. ..fir AA It l � a z rt K' } I 11, �-�nur--ee+:.,, u<. ...xM...r........rn.r,.m..,.».»..w.....-..r.w u.:.-........r e....,nyvur �) "�`�y,J�r}• '�1C�6..�'8 _�.3C�' �i�T�r?'t �" � /�';7C�, r�7�. ,✓"-`.�'-�7'"/C' �7.�i�,l.�." , x ,�3 .13E/. AeC e-,)(. A-' '.S�t�W�/ ®A/ 9'.Wi APL..�.L i97 LOcA9T4eO 42A/ TNT D9i GeC��1.Vt� sq4g WjWOWAl t OA?49cR/ a*a/a 7*oWq7' iT f i 5xi' Wn drl&/MS Or7 ®MCP"/J*'! civic. ��v�ia✓��,�s `�ri,p-,�._ v4,�° - t �";=��x�