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o�
.o Town of Barnstable BuiR i g
-� Post,This Card So That it,is Vkible.;From the Street App'roved,Plana Must be Retained on Job and this Card Must be Kept :
" Posted Until Final Inspection Has OMMMASM
Been Made ' °
µor° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final lnspectidwhas:been made
Permit No. B-20-1999 Applicant Name: Vladimir Doklev Approvals
Date Issued: 07/31/2020 Current Use: Structure
Permit Type: Building-Addition/Alteration-Residential Expiration Date: 01/31/2021 Foundation:
Location: 351 LAKE ELIZABETH DRIVE,CENTERVILLE Map/Lot: 227-014 { 'M1^ Zoning District: RC Sheathing:
Owner on Record: LIU,XISUO TR Contractor.Name'`Cape Cod Renovation LLC Framing: 1
Address: 18 THOROUGHBRED DRIVE Contractor License: 194808 2
SHERBORN, MA 01770 ( Est. Proiet Cost: $48,000.00 Chimney:
h n renovation. Bathroom renovation. Re. lace two extenor Permit Fee. 294.80
Description: Kitc e o p $
doors. Replace windows. Insulation:
Fee Paid: $294.80
Project Review Req: NO STRUCTURAL WORK. GLAZING REPLACED IN HAZARDOUS Date: a 7/31/2020 Final:
LOCATIONS AS DEFINED IN 780 CMR MUST BE.TEMPERED OR
EQUAL. � y Plumbing/Gas
a
Rough Plumbing:
Building Official
i Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized byth s permit is commenced within"six months after issuance. g
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas:
work until the completion of the same. '
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing Rough:
2.Sheathing Inspection - - �:_:-... '- g
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
ON49��iE
's O_ffice C1�t ..� Map= = � # IS-3�
• Ac�P��^r `Parcel .L�
. Date Issued
- Fee �f S•
engineering DepC(3rd floor) House#
r : BARNSTABLE,
d 19 f 059.
r rEo Ma+" -
TOWN OF BARNSTABLE ;
uilding Permit Application `
Project Street Address /
Village
Owner ddress
3 /
Telephone 7 ���IA II -
r CAR-
Permit Request
lA x,a4
A
First Floor square feet
Second Floor square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
r
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House s✓¢ Unfinished
Old King's Highway
Number of Baths No. of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other _
Builder Information
am'' e� �2�
. (. �-'(�t;f'i'a�.��.�� •�,T/elephon Ne umber ,'505— 770- ?f.&(a ,
v"A"ddressl 97j T/Ajt-- Cot4G— '6J.. !Lice e# C)6, �5
tu yL-t C�2�9� //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
A F .7
SIGNATURE DATE G
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR,OFFICIAL USE ONLY
c .a
07
•PERMLfI'NO:
D iSSUjD
M P/PARCEL NO.
ADDRESS ;, VILLAGE
OWNER 1 r
DATE�OF INSPECTION: Vk
FOUNDATION
FRAME
INSULATION '
FIREPLACE - -
ELECTRICAL: ROUGH FINAL a �.
PLUMBING: ROUGH FINAL
GAS: I ROUGH FINAL t ,
FINAL BUILDING
DATE CLOSED OUT
t
' I
ASSOCIATION PLAN NO.
OWN
f Barnstable
The Town o .c�
•v f � �"�$ Departinent of Health Safety and Environmental Serve
•' Building Division
367 Main Strut,Hyatmis MA M 01 .
Ralph Ctos=
Off ce: 509-790-6227 Big CM=
F= 508-775 3344
For office use oniY • '
Permit no.
Date AFFIDAVIT
HOME n"ROVEMENT CO� TORIA
CAZION�
SUPPLEMENT TO PERMIT
coon,alterations;renovation,���=co�o�
MGL c. 142A mgaim that the"rt constrn ed
remotial, demolition or consuuaion n, weMng units or addition to to �mijaccm
��g containing at least one but not more than
fa cerQo� bong�►iQ
to such residence or building�done by registered
quirt mc=
Type of Work:
Esr.
Address of Work:
OR6ner.Name:
iicati on:
Date of Permit App '
I herct<certify that:
Registration is not required for the following reason(s):
Work excluded by law
'Job under SI.000
Building not own Pied
Owncr Pulling own permit
Notice is hereby gi%'en that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING
NOT wrMEHA
FOR APPLICABLE HOME ROVEMENt'
VE ACCESS M THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A
SIGNED UNDER PENALTIES OF PERSIIRI'
I bcreby apply for a permit as the agent of the
Dated n
t conuactor. ame
Regisu = No.
OR '
The Commonn-calth of Massachusetts
srl: r _�yy Department of Industrial Accidents
;s ` �. �'1� OIIIC80//QYCSD9allOdS
600 11'ashin.;ton Strcet
Boslon.Afars. 02111
�• Workers' Compensation Insurance ARdavit
____.�- Please I'1ZITVT Te tbly -
An[�ii c�ni niorTnwiion
U�
nnme-
- 6 G
ohnnef
I am a homeowner performing all work:myself.
a sole proprietor and have no one working in any capacity
❑ I am an employer providing wori:ers' compensation for my employees worl:tng on thts�ob.
co-
m
nddretc• -
citl. phone#•
in�ur�nce co police#
❑ I am a sole proprietor. general contractor, or homeowner(circle one)and have hired the contractors listed below who
the following workers' compensation polices:
nv n�
address:
cih phone#!
cu n nolicv#
nm inv nstne,
address:
city phone#,
in—Tur9nr rn nolicr#
:Attach additidnal'sht e!if aeeessa w:: .��c^ --+' �'r�t •+••+.::
Failure to secure coverage as required under Section:SA of 516L 152 an lad to the imposition of erimiaat penalties of a fine up to 51300.U0 ao�
une veary imprisonment as ivell as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against ma 1 understand thz
copy of this statement may be forwarded to the Omcc of Investigations of the D1A for coverage verification.
1 do hereht•cerrifj•u der the pains aPf penalties rjurr that the information pntndded above is true and co
.0 �Sianatute� 2
PC.f�� L fS �t es+
Print name-� _on
ofticiai rn use only do not write is this area to be completed by city or to aMcial
ein or town: permiUlicense# ri8uilding Department
(3t.iccmdug Board
check if immediate response is required (311mi thews rtmce
�tiaith Department
contact person:
phone#: mother.
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for
employcrs. As quoted from the "la.+", an emplityee is defined as every person in the service ofanother under am,
contract of(tire, express or implied. oral or written.
An rnrplur r is defined as an indi�ideal, partnership, association..corporation or other legal entity, or any two or n
the foreaoin engaged its a joint enterprise, and including tite legal representatives of a deceased employer, or the
recci%,er or trustee of an individual , partnership, association or other legal entity, employing employees. However
`'owner of a dweilinL house having not more than three apartments and who resides therein. or•the occupant of the
dwc1ling house of another who employs persons to do maintenance, construction or repair work on such dwelling
or on.the r,rounds or building appurtenant thereto shall not because of such employment be deemed•to.,be an empic
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 anv
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 chaps:
been presented to the contracting authority.
77-
r 'i. .. 'rt::;•ti , _ . .•.. jFr keTN;y,.:17'r�:J.'.cjlL��•�•�-'•:auw.'n:::•a���•�.�..77r .•. ..
Applicants
Please `;1l in the workers' compensation affidavit completely, by checking the box that applies to your situation an
supplying company names, address and phone numbers 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 tite 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 requi:
to obtain a workers' compensation policy, please call the Department at the number listed below.
�. .�-�• .w.+.!ss.. - � .v..1w....-�... '.S"'_.:L: _. . . •:'.:�::..:.L'C i�..-...... ......,�.'/r ♦� �•_y�c.�.7.•.•ate••
City or"towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. F
be sure to fill in the permit/license number which will be used as a reference number. 17te affidavits may be ret=L
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 quest
please do not hesitate to give us a call. ,
77
7.
The Departments address. telephone and fax numbei.
The Commonwealth Of Massachusetts ¢„
Department of Industrial Accidents
Office of Investigations F" '
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
nhnne -0- (617) 727-4900 cxt. 406, 409 or 375
.' . TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE ...:...
JOB. LOCATION
Number Street address Section of town
"HOMEOWNER" L 7 �► cC; 5 7 /-z �"3 G 7 �%/ ,/�. ..' ..
Name Home phone Work phone - -
PRESENT MAILING ADDRESS
City town State Zip code
The current exemption for "homeowners" was extended to include owner-occupie
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:
Person (sj 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 to six 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 Offic.
on a form acceptable to the Building Official, that he/she shall be responsi'
for all such work performed under the building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes responsibility for compliance with the Si
Building Code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minimum inspection procedures and requirement_
and that he/she will comply with said roc u es and requirements.
HOMEOWNER'S SIGNATURE W .
' APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35 , 000 cubic feet, or larger, will be required
Ito comply with State Building Code Section 127. 0, Construction Control.
I
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 engages a person (s) for hire to do such work, that such Home Owne
shall act as supervisor."
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for • licensing Construction Supervisors, Section 2. 15) . This lack of awarene
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 act-
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities, ma
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.
•
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DATE: 15 REVISED
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