HomeMy WebLinkAbout0094 HARBOR HILLS ROAD .�
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TOWN•OF BARNSTABLE BUILDING PERMIT APPLICATION
Map �- � Parcel Permit# 7
Health Division : Date Issued
Conservation Division FeeCA
7 �
Tax Collector I
• =�3 'd�
Treasure - •
Planning Dept.
Date Definitive,Plan Approved by Planning Board ;
Historic-OKH Preservation/Hyannis
Project Street Address _ 111 It r be r A) I S
Village vg r► S i `7J` /✓S rq -
Owner Ktnn Jk s• e 116V Address ')ZceJ 1-A 5G4,0(`d1
Telephone (781) -R'75 I SZ?I'
.Permit Request rd6 1 s 1366 sg.
` t s S �Aat
�p�osG —'1�ODd
Square feet: 1 st floor:existing proposed 2nd floor: existing proposed Total new
Estimated Project Cost I 166"' Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size -1 a t re 5 Grandfathered: ❑Yes 0 No If yes, attach supporting documentation.
/ b+
Dwelling Type: Single Family Two Family 0 Multi-Family(#units)
Age of Existing Structure a Historic House: ❑Y Ld Yes o On Old Km s Highway: ❑Yes ZN
9 9 9
�Pt' � v►s
Basement Type: ❑Full VCrawl ❑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: M/Gas 0 Oil ,0 Electric 0 Other
Central Air: 0 Yes W No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes to
Detached garage:0 existing ❑new size Pool:0 existing ❑new size ' Barn:0 existing ❑new size'
Attached garage:O 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 Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A 4A D14,-Ra .1
�SIGNATURE DATE _ ��'1 -98
FOR OFFICIAL USE ONLY
PERMIT NO. -
DATE ISSUED
MAP/PARCEL'NO. r'' + rt c• '"' - _
a ADDRESS _ -. ;,'VILLAGE •[ L . . r
OWNER -
r
DATE OF INSPECTION: {
FOUNDATION _. - _ - € - , ;
FRAME
INSULATION - +
• FIREPLACE - - t • f y ° t .. -y` -. i t f.
4 r 1
}
4
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL ,
GAS: ROUGH` FINAL -
FINAL BUILDING _ `•
DATE CLOSED OUT '
ASSOCIATION PLAN NO. '
°F VE A
The Town of Ba
rnstable
: .LuvsrnsUL e
9eb 1659. ,0$ Department of Health Safety and Environmental Services
Argo ''' Building Division
367 Main Street,Hyannis MA 02601
c
Office: 508-8624038 Ralph Cressen
Fax: 508-790-6230 Building Commissioner
Permit no.
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.
rC
Type of Work: Estimated Cost fll,w --
y
Address of Work: Ps z bdf �19 1)s
Owner's Name: b o A t4 ''j. 146116 y
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job Under$1,000
Building not owner-occupied
[-Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
11 —13-18 �• /a_vl
OR
Date Owner's Name
q:fbr ms:Affidav
- --- - - -- The Commonwealth of Massachusetts
+, -- Department of Industrial Accidents
ONCe 011=e509 offs
• 600 Washington Street
.v
J'` Boston,Mass. 02111
Workers' CoTTensation Insurance Affidavit
�11C�nF�jt/tiQ['lit;l�tD[` L ^�� y i�������
name: i� A A f`1"h J. / j� 11 C�f
location: / L /t ci r b 10 I` All 115
-city, Ayy V1 dli S phone#
(� I am a hollfeowner performing all work myself.
❑ I am a sole pro rietor and have no one workin in any ca acity
❑ I am an employer providing workers' compensation for my employees working on this job.
company name:
address: ..
city phone#:
insurance co. oiicv#
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the follmiing workers' compensation polices:
company name:
. .........::........ .
.:.
address.
dtv phone#•
insurnnce co. piney#
campanv name: . .
.:....
address:
city phone#c
..
insurance co. ;<:..:.; . . ...: ... ::.:::..:;.:..;:. :.. piney# .... ..
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a tine up to SI,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S 100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification.
I do hereby certij under thepluns and penalties o.Cferjury that the information provided above is true and correct
Signature �) Date f 13-q$ _
Print name ✓1 t 4 Jr. A 16 Phone# 7d I— R75— /g 0 `T
otIIcial use only do not write in this area to be completed by city or town ofilciai
city or town: permit/license# []Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's 0llice
❑Health Department
(contact person: phone#; ❑Other
(roved 9i95 PJA)
Information and Instructions `
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any corm-,:,.
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 receive.,c:
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 section 25 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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.
City or Towns
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. The affidavits may be returned io
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations wound like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
NO
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
emce of imresfigauOns
600 Washington Street
Boston;Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
i
The Town of Barnstable
OpTME
S11 �o Department of Health Safety and Environmental Services
Building Division
yBAMisa 367 Main Street,Hyannis MA 02601
i639. ♦0
�prFO MA'I A
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
HOMEOWNER LICENSE EXEMPTION
p Please Print Z 14-7—
DATE: 11
JOB LOCATION: 9 t I4arbe 411Is '�J
number street village
"HOMEOWNER": �C✓fnf,4 5. /"'^^,,�� 16 b6i) R75-i8an �,1, 1>�
name I home phone# work phone#
CURRENT MAILING ADDRESS: l R GC 0� La n?—
&Jd o r I7 3r�
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 procedures and requirements and that he/she will comply with said procedures and
requirements.
-{ tin
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 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 to amend and adopt such a form/certification for use in your community.
Q:FORMSIXEMPT