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Home My WebLink About0238 LAKE ELIZABETH DRIVE 38 a-,e�e rllwjce-t-� Zr. P;HON°E ;CALL':; 'FO� L DATE /& TIME §2P. M. OF � �~ PNONEU �L��L� �2 YQUR(klL PHON AREA CODE UMBER EXTENSION PLEASE�/.i_L MESSA E WILL CALL AGAIN :'CAME TO,, `� WANTS SEE YOU SIGNED �I1IVEISa1_ 48003 NOTE ` y,. Engineering Dept: (3rd floor) Map o Parcel . ' 0 Permit#' �- House# Date Issiled Boa oor)(8:15 9:30/-1:00-4:30) Feecr Conserva 1 h floor)(8:30-9:30/1:00-2:00) Plannin st floor/School Admin. Bldg.) �TME rp;_ De by Planning Board 19 - BARNSTABLE, ��C -. MASS , 16 39• TOWN OF BARNSTABLE, Buil 'ng Permit Applicatio Project Street Address 3 Village �C-� �l L L Owner T o Address .TelephoneIlk , r Permit Request ` First Floor square feet Second Floor square feet ,Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection . Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family f Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes Ldo On Old King's Highway ❑Yes olO Basement Type: ❑Full ravel ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing �i New d Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing �j New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other'- �� - Central Air ❑Yes erfO Fireplaces: Existing New Existing wood/coal stove ❑Yes Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) �� ❑Barn(size) Z.Wo-ne ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use C uild�Infor�matio�� Name 0 1-5 Telephone Number Address LIC ELF"QA . B W License# L r /-t Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G DATE BUILDING PERM DENIED FOR THE FOLLOWING REASON(S) � r FOR OFFICIAL USE ONLY PERMIT NO. , r DATE ISSUED MAP/PARCEL NO. _ i •, 1 1 ADDRESS f VILLAGE '� -s• ' i_ OWNER' DATE OF INSPECTION: FOUNDATION FRAME .. INSULATION w` FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL. °FINAL'BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. - i r - F A. -able The T'O' wn of ab lum �$ Department of Health Safety and Environmental Services Building Division 367 Mafia Stress,Hyannis MA O2601 Ralph Crosses Office 309-790-6227 Building Ca=issicn—. Fax: 303-7904Z30 For off ce use only Permit no- Date AFFMAVIT HOME MoROVEMENT•CONTRACMR.LAW SUPPLEMENT TO PERMIT APPLICATION MGL G 142A requires that the "recoastructfon, alterations, renovation, repair, modernization. conversion. improvement. removal+ demolition, or construction of as addition to any prreztstia9 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 czccptions,ato with other requirements. Type of Work.. ' � Fat.Cost Address of Work: &Y - Owner's Name —_A2 Date of Permit Application: — I hereby certify that: Registration is not required for the following reason(s): Work ezciuded by law Job under SLOOQ _Building not owner-occupied _ X Owner puffing own permit Notice is hereby given that: OWNERS .PULLING 'ITS OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR TION PROGRAM OR GUARANTY FUNDF'UNDOVEMENT WORK DO UNDER MGLO 142A � ACCESS TO TSE,ARBITRA SIGYED UNDER PENALTIES OF PERJURY I hgfgby iy for a.permit as the agent of the o er. q a� Dan utractor time Registration No. OR g Date Owners Name r , S �r The Commonwealth of Massachusetts Department of Industriirl Accidents Office ofloyesmunfons - 600 Washington Street - == ;�• Boston,Mass. 02111 Workers' Comyensation Insurance Affidavit'X �nae: t. 10 E I -I- ") -?:;g I E on: city hone# ( v I am a homeowdEr performing all work myself. ❑ I am a sole proprietor and have no one working in anv capacity Zf ❑ I am an employer providing workers' compensation for my employees working on this job. company name* address- city- phone#- 0 insurance co. 201iCV# ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city phone#• : .. :>z>::;. insarnnce ca. Dirty# MR- ... %0//%/%%//////////// ~~ .��//��/�i com anv name: address- city phone#• .. :: .............. insurance co. Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a One up to s1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of S100.00 a day against me. I understand that a COPY of this statement may be forwarded to the OMce of Investigations of the DU for coverage verification. I do hereby cad der the pains and penalties of erjury that the information provided above is true d correct Signature Date _ Print name Phone# official use only do not write in this area to be completed by city or town official dtv or town: penmit/lleense 0 Mudding Department ❑Licensing Board ❑checkif immediate-response is required ❑5eiectrtren's OfIIu ❑Health Depattunent contact person: phone#; ❑Other (mvvw 9/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their an employee is defined as every person in the servi r ce of another under any cont employees. As quoted from the"lawc 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 . 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 —,I.,. to do maintenance , construction or repair work on such dwelling house or on the grounds o: arV Wry •tav wur.v�.. t........�� _� 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor anv 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. loin/%/////// Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies ttoy��s� be R f supplying company names, address and phone numbers along with a certificate of insurance , 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 t^ the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please o 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 ImtestlDatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ease print. D E sr Av v `T JOB CATION 23g l ale ��za�et(a Dr��e Ce�a� vl�`c i Number Street address Section of town HO WMEOWNER" l' iav,n l)'i�"rot d /77 rJ - 55 3 Name Home phone Work phone - PRESENT MAILING ADDRESS 23B l-alCe ��Z3�en �\ Ck_a\g41& -A oz6 3z— 3 6.Z� 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 such homeowners to engage an in- dividual for hire who does not possess a license,, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" ertifies that he/she understands the Town of Barnstable Building Departs nt minimum inspection procedures and requirements and that he/she will comp y with-- said procedures and requirements. HOMEOWNER'S SIGNATURE ,GL/G� APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. f HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner person (s)a engages p (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that he t y are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ' Owner,' actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/tier responsibilities, man communities require, as part of the permit application, that the Home Owner 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. RE-ROOFING ❑ If located in OKH or Hyannis Historic'N.ct - Certificate of Appropriateness required unless same color/same materials sp ified on application [ Map/parcel number Sign-offs m: ax Collector Treasurer of squares of shingles or square footage of roof to be shingled specify stripping old shingles or going over old roof. If going over ❑ho roof layers exi now []what size are ra at is span? CCoPmplete dwelling information for the Assessor's Dept. - if known �Workman's Comp. form �ome Improvement Contractor Affidavit RESIDENTIAL ONLY) ❑ Home Improvement Contractor's License OR Homeowner's License Exemption(RESIDENTIAL ONLY) ❑ Check expiration date on license COM RCIAL WORK-No License is required. - Fee q-forms-PERMITS I Rev 6/2/98