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0593 LUMBERT MILL ROAD
�q3 �m bed � � �1 ��t. �. a a �� 5 � - � e 3 ��� _ � o 0 � , � � � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Parcel A lication # Health Division : Date Issued Conservation Division ; Application Fee �,aa Planning Dept. ' Permit Fee "o 1 c�o . 06 1A 1 Date Definitive Plan Approved by Planning Board S i oP Wb Historic - OKH _Preservation /Hyannis oZ1�1�3 Project Street Address '-.3 lzunby 7nC CJ Village ��-- Owner / // Q- l.�f -� Address .23 4409 AJ h a�& 1—1�//�le Telephone L776q' _31X Permit Request ACIC��.�3.dEaJr1 0 Q hamC Square feet: 1 st floor: existing I proposed 2nd floor: existing\700 proposed Total new J-30 Zoning District Flood Plain Groundwater Overlay Project Valuation �•ee Construction Typed Lot Size ��g� d Grandfathered: ❑Yes © No If yes, attach supporting documentation. Dwelling Type: Single Family lid" Two Family ❑ Multi-Family (# units) Age of Existing Structure ( Historic House: ❑Yes YNo On Old King's Highway: ❑Yes Ld No - Basement Type: ZFull ❑ Crawl ❑Walkout ❑ Other -i Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.f)= � � Number of Baths: Full: existing Z new Q Half: existing =m Q; newer Number of Bedrooms: �3 existing _new Q µ Total Room Count (not including baths): existing 6 new First Floor Room Count ,_u x Heat Type and Fuel: Gas, ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 0'No Fireplaces: Existing / New Q Existing wood/coal stove: ❑Yes ❑ No 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 3/No If yes, site plan review# Current Use 0" roposed Use a APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name � -� 4 7 Telephone Number 1 Address L3_C73 4uMZ�7W AVV License# /nl ` l� Home Improvement Contractor# C2 3 Z Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ADA*- SIGNATURE b"I DATE ,r FOR OFFICIAL USE ONLY j APPLICATION# it 4, DATE ISSUED z i MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: r " FOUNDATION Y FRAME 13 lige INSULATION �� ►3 Y "5 FIREPLACE fi ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL` FINAL BUILDING 6Z B 0L4.dj j DATE CLOSED OUT ASSOCIATION PLAN NO. w- •• G,� IL ;%-i. f Department oflndustrialAccidents .fwe f g o Investi ahans-- _ • 600 WashhWtoiz Street Bostoy;'MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Piwtnbers Applicant Information Please Prhat Leajy. -Name(Busmess�oiganization/Fndividnal),/ ��//'�/�,([ '/� .Address: C`ify/s`I3.tP,zi (�.��I l'+U W� l _ M(A U�{Q annt-# R1R Are you an employer? Check the appropriate box:' Type of project(required?; I.❑ I am a employer with 4: []I am a general contractor and I 6. - e N• ect r eqd employees(fuIl and/or part time).* have hired the sub ontractors 2.❑ I tam a sole proprietor or partner- listed on the attached sheet. 7. emodeIing shipand have no to�ees These sub-contractors have P y _ 8. 0 Demolition working for me in any capacity, employees and have workers' . co insurance•$ 9. El Building addition ' [No workers'_comp.�insirrance comp, 4�ed]_ 5. [] We area corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner loin aII work officers have exercised their [] g repairs or additions g II. Plumbin myself. [No workers' comp. right of exemption per MGL 12 Q Roof repairs insurance required:] t. c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.Msura ce required.] *Any applicant that checla 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 wodc and then hire outside contractors must submit a new affidavit indicating such. #Contractnrs that cbeek.this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have. ernployecs. If the sub-contractors have employees,they must provide their work='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 Daze: Job Site Address:_ IUm�f K(.Y City/St?te/Zip: �` %All 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 up 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 may be forwarded to the Office of Investigations of the DIA for insurance,coverage verification I do hereby c under pains andpenalkes ofPerjury#hat the information provided above is true and correct - Si Date: a` ' Phone# qN- Official use only. Do not write in this area to be completed by city or town offzeiaL City or Town Perfnit/Ucense# Issuing Authority(circle one): 1:Board of Health 2.BuildingDep•artmeut 3, City/Town Clerk 4,Electrical Inspector. 5.•Plumbing Inspector 6.Ot-her _ Contact Person: Phone#: �s r Town of Barnstable Regulatory Services MENSTasM : Thomas F.Geiler,Director mass. pr i639• A.O� Building Division ED AIIA'I _ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 7 Please Print DATE: r 1,3 J' JOB LOCATION: O ,rn�t/K i W�f 7�'�"1/a/k� number —{�street. village HOMEOWNER": ( i' Vd' name home_hnon�e# work phone# CURRENT MAILING ADDRESS: � _ //D g���JXJ 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 req ments. p 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 4 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 form/certification for use in your community. Q:forms:homeexempt oF'ME' Town of Barnstable ` Regulatory Services MUMSTABM Mass $, Thomas F.Geiler,Director 039• Al 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 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit: (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 ems, - IW •,. f �Y. .: :G .•.��.� - I . (( /•fir;..-r-' i - ,�-:'...� -�1 ._'' gib;a �_'c{�'tv' : � '-�� .. _- _ �, _- - - .-'� •`H _ _ �'.� _ a 8� �* MAN' ir mew 'y. 4 .. o i+4E` 9► V :�GL�V e oe OIL d a° AS5..� - '? Ono a.: o CJ�.IPi:+AET.�.4 TCs i'YC'r ' ��•GiSti Gp' ti1'fArQ@ :Ttisti4V Q� 'E' . �y ��=�`� - 71�` _ , - �- ': - � ..• ' ter»'^' - F ;�� :a V r[A CD Vi LV e r , V i i r 1 ff r _.. l H t ,ry N op a_ F.. G imp: .. a C Op 6 r l \ _._ 00 C � � �7 Y4. r � 0FJ g. L LA (31 W l GCA ;rj — (P ..Irk m 4— a way NEW WN�T A ix, -" a,1 7Z,.; TO Town of Barnstable Regulatory Services sa M i a AS& Thomas F.Geiler,Director '�Fnrwo+s Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 January 16, 2013 Pamela Divenuti 593 Lumbert Mill Rd. Centerville, Ma. 02632 RE: 593 Lumbert Mill Rd., Centerville, MA, Map: 146 Parcel 031 Dear Property Owner: This letter shall serve as notice that a stop work order has been posted by this office on the above referenced property. Be advised that all work must cease until such time that the stop work order is no longer in effect. This includes work being performed under permit application number 201206167. This stop work is issued because the interior remodeling is beyond the scope of the permit issued to reside and replace two doors and eight windows only. A separate building permit is needed for the additional work to bring the property into compliance. Thank you for your immediate attention in this matter. Respectfully, L. au on Local Inspector Jeffrey.lauzon2town.barnstable.ma.us .(508) 862-4034 6 I rom # AEI' I�ARN's I1IF �f;l{ iF (1��"+r► IMk'S IaN1� �� I'Idt�`�iltlle i FE 4�i��xR�It(G1Fk,tt v+tgl I '' ` a v s a�i1l �w'L�711I.�tF�.11t'�ttit���'�t�is y Ali If�t I1 I,IrI'w4.a tl�i i�p'llfdl �NFI1�1 fit'{ Il NAT I" XV. t` T H - hill yi �,11. 111�I l i 41I IRK ,Iililll %iAlt►-tftii "w" "+� 11r �,4 5 hi9 I 1'Itlt i � (IIi11C�� 1j �'114i #4ia-rl+i1 RI IA 111% 1 Wit, � ' - Ili 11 �IIIII�" - 593 Lumbert Mill Road , Centerville 1 /16/13 �x ..: ter, IL . w . _« V e.. �H g, ' e ,F lr .v, a `t r� s „ H�Mrro.dk �. 3 Y z t d:, F f Y d;e, 9 4 + N a ' " r 7 tF - x ; r r + } qh ,_ ,r .a h� ' Y - .; r 7 r r �w.l e'.. � +S .,[�"'.. ',4 '..rsJ.r +wr 7:..� w 5 Lu'mbert Mill Road,, Gentervrtle y� = y 1 x _ t . 593 r^Lumbert Mill Road, Centerville 1 /16/13 �� qqqqqq gg r I Zia 4 R ,�.. ...fir :V.yp.. 1 5.93j Lumbert Mill Road, Centerville r r� kA Y 93 Lumbert Mill Road ,r n 1 .. f 3 x a 3, 1 t i µ - i r. rM. r, x- a. « W v 4 i s r ; w e , 4 fi WEI A. 1y � Town of Barnstable *Per it# �� Regulatory Services > l 6m �s dr — snxxszne � �elP®��° n9.39. 1 Thomas F.Geiler,Director Building Division Or Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barristable.ma.us Office: 508-862-403.8 Fax: 508-790-6230 " EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Ly3Li-fZ\ M��U✓ �1 ��"�.t ��1►Li. �1 Residential Value of Work 7.5 UQ Minimum fee of$35.00'for work under$6000.00 Owner's Name&Address Contractor's Name N � ,VfAf� Telephone Number '?8k Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable). 4 9 Q ZI,I 13 [�Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name:. A n,p Workman's Comp.Policy# W CC-,-'5{51 cj 7iZ n pA2(0�7_— Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to AklL _->5F . ❑Re-roof(hurricane nailed)(not stripping..Going over existing layers of roof) Ee-side' #of doors 7. . . [Replacement Windows/doors/sliders.U-Value , 3 b (maximum.35)#of windows $ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: J C'\Users\decollik\AppData\Locai\Ivlicrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts Department of Industrial Accidents • Office of Investigations 600 Washington Street Boston,MA 02111 SV•Jr www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lekibly Name(Business/Organizafion/individual): Address: City/State/Zip: (,,, i- i� Phone W.: `7�31 GI�3. y�-�� - Are you an employer?Check-the appropriate boz: Type of project(required):.. 1.❑ I am a employer with 4. ❑ I am a general contractor and I : _ 6. ❑New construction . nployees (full and/oi part-time).* have hired the stab-contractors 2: I am a'sole proprietor or partner- listed on the attached sheet 7. [<emodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me.in an capacity. employees and have workers' Y P t3'� �• 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 H ❑Plumbing repairs or additions myself. [No workers' comp' right of exemption per MGL 12.❑Roof repairs insurance required_] t c. 152, §1(4),and we have no employees.[No workers' 13.❑ Other 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. $Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or not t 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 up 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains-and penalties ofperjury that the information provided above is true and correct Signature " "V Date: �u�.1C3�'�Z 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): J.Board of Health. 2.Building Department 3.City/Town Clerk 4.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 emp oyees. owever e 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 untii-acceptable evidence of compl.alice 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 necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of 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 employees, a policy is 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 fo any business or commercial venture (i.e.a dog license or permit to burn 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 eounnonwealth of Massa rh=tts Dvarrtment of Iridusteial AecidQets Qface of Investigations 60.0 Washingtcai Street Gaston, MA 02 111 Tel. 617-727-4 900 ext 406 ar 1-977 MASSAFE Fax#617-727-7770 Revised 11-22-06 ' w .mass,gav/dia. . L a�axtvsTna�, ,� Town of Barnstable RFD MA'I s Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner E 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, A ,as Owner of the subject property hereby authorize L`-O I M<::X -�- to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date twitt6t:_Z�� rV Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 f °w �IassachUmAt,� rtnWnt(2 uhisc Su#E � # Board ot:Buildrn�g.Rc,,wLttions 4nct Stan(!ir& r Cons#raction,Supervior License License CS 46498 RONALDJ MORGAN ? 2 SUnnMER ST WAREHAM MA,Q2571.; +� ��•'—�y�f` Expiration. 9/21/2013 �= x s i�.. C ttmmss��mer t i Tr•'= 6617 Office of Co �/ f �5& in 1 HOME IMP n U.ROVEME ego ahon'-..... ). NT CONTRACTOR Registration :1.,73367 ' Expiration ' 012.014 TYpe: R -__ Individual D MORGAN,, c yet t--�•;: � , RONALD MORGANa 2 SUMMER ST t 7 WAREHAM MA 0257} Undersecreta tT f Affairs and Ifusiness Regulation c Plaza - Suite 5170 Massachusetts 02116 ment Contractor Registration Registration: 173367 „ a r Type: Individual "ter Expiration: 10/1/2014 Tr# 2318,95 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card License or registration valid for individul use only before the expiration date. If found'retur_n to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid wi ut signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# jW162 Health Division Conservation Division Permit# Tax Collector Date Issued 6 -7 Treasurer Application Fee ' Planning Dept. Permit Fee f Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address J 93 &xit:7 -,m%// To Village C��f-P�(;�l / k__ Owner A C0FF I Cl 11Vd Q N-t,t y QYI A Address Telephone '77 Permit Request ennoucchpv n l r i W Y � ozu) Square feet: 1st floor:existing IJ` proposed 2nd floor:existing 6>5Q proposed Total new Zoning District �U' Flood Plain �� Groundwater Overlay n6 Project Valuation 4 i5n Construction Type Lot Size G acC° Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W/ Two Family ❑ Multi-Family(#units) Age of Existing Structure 30 Historic House: ❑Yes MZO On Old King's Highway: ❑Yes 21' o Basement Type: 9/Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1[56 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing .3 new Total Room Count(not including baths):existing Z 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:❑existing ❑new size Attached garage:®'existing ❑new size � Shed:❑existing ❑new size Other: hr C �a Zoning Board of Appeals Authorization, ❑ Appeal# Recorded❑ - Commercial ❑Yes - No -If yes,site plan review# C Current Use Proposed Use `=a ` BUIP.DER INFORMATION © r Telephone Number ( 7f-a73 7S67 �/�-�1 M?_ .Address L� I I * License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE LP- DATE 310 l. FOR OFFICIAL USE ONLY. 2 PERMIT NO. DATE ISSUED " MAP/PARCEL NO. ADDRESS VILLAGE , OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 0� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I I0/4 - - �a_.. 4 1 _� __ 1 1 I ; 1 1 ; , I _.w'�^ uuwl ..rvn:44•_..•1. ........_.{�__.�.-..._.�__.(_..._..-�._-'_ '_._...�._.'. 1--.._,_- •_ __+_«_..__. ._..,.).._._..i,___�_. i _._�.__._.{.__.._.I I _ -. I i I � ' I I I I I I 1 f I 1 • I I - -t----I �- r- I - --I •-'�'•-----i -�,L_.- .�_ .1._ 1 .i. _.I_.-r __-+ '.__ 7"'___ _+._ i. {_ I L. I I i I _ r lull an It CXL 10 001, OLD II i I I 1 _ I Ild I I ' I I 1 , i i i d ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111' www.rnass.gov/dia ' Workers'Compensation Igsurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Le ibl Name(Business/Orgmizationadividual): � `t U a- 1\J.�n o •Address _ I.3 ' p ?Z City/State/Zip: 1 �r �— Phone.#: ����� � 7. _ -! 7g3��- Are you an employer?Check the appropriate box: ;Type of project(required):. 1.❑ I am a employer to er with 4. [] I am a general contractor and I 6. ❑N construction . employees(full and/or part time).* • have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition employees and have workers' iyorking for me in any capacity. 9. ❑B ding addition [No workers' comp,insurance comp, insurance.$' 5. We are a corporation and its 10. El trical repairs or additions �quired.] • 3.LJ t�a homeowner doing all-work . officers have exercised their 11. lumbing repairs or additions right of exemption per MGL myself.[No workers comp. 12. Roof repairs , insurance.required.]t c. 152, §1(4), and we have no 13.❑ Other �C . 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. f Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors 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: r lob Site Address: 3 :�N (}'Q City/State/Zip: 9 L-, 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 up 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 CIA for insurance coverage verification. I do hereby c and r the pains•an penalties of perjury that the information provided above is true and correct . . Date:. �/0?3•a� , Si ature: q� —7 q Phone#: -` 1� � 73-7 / / Official use only. Do not write in this area, to,be completed by.city or town official. City or Town: ' Termit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.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." AdditionaIly,MGL ehapter-.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-ofcompl aace with:tlie 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,it necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of 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 employees, a policy is 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 fo any business or commercial venture (i.e.a dog license or permit to burn 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 Massaeiau.setts DVartmont of Industrial Accidents Offlee of f nvestigaidons 600 Washingtoli Street Bastan,MA 02111 Tel.#617.727-000 ext 406 or 1-977 MASSAFE Revised 11-22-06 Fax#617-727-7749 w .Mass pm/dia °FTME� Town of Barnstable ]regulatory Services r • iABT!STABLE, " Thomas F.Geiler MASS. ]?!rector D 9 1639. Mp l aim Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date 6 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. . -� . ObT-ype of Woik: n0 Estimated Cost t �Addrel f W_ork•- �_��-5 Owner-s Naine: "� Date-of Applic&ion: m _ 0'� I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied , Ownerwpulling-own perrmta Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD 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. Date r TOwner s Nan—e QIonnslomeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings 3100,00 Residential Addition $50.00 ' Alterations/Renovations $50.00 _p� Building Permit Amendment $25,00 + +.E VALUE WORMHEET NEW LIVING SPACE ___square feet x$96/sq,foot= x.0041= plus from below(if applicable) ALTERATI��O••NSSIRENOVATIONS,OF EXISTING SPACE (GtJO square feet x$641sq,foot= x,0041= plus frrcrn below(if applicable) GARAGES(attached&detached) square feet x$32/sq,ft. ACCESSORY STRUCTURE>120 sq.ft, , >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building pernrit: square feet x$96/sq,foot= STAND ALONE PERM3TS ~ Open Porch x$30,00= (number) Deck x$30,00= ' (number) Fireplace/Chi]== x$25.00= (number) Inground Swimming Pool $60,00 Above Ground Swimming Pool $25,00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcast RmO63004 a • Town of Barnstable IWE Tp�� „P Regulatory Services " Thomas F.Geiler,Director • BARNSfA'oLE, 9 MASS. 4,p 1639• p,� Building Division rfv � Tom Perry,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: I - `F� 101 JOB LOCATION: �'1._7 6- 7 &14e 11 i i _ number street village Sc TT ��' 1� � N q7g �643L ?7 . ��6,HOMEOWNER': name �j home phone# work phone# CURRENT MAILING ADDRESS: Imo/ I G /M- city/ wn 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 require nts. 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 t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 1 ?d 11,. , ¢ ° 5 r ri I* s bx� j tx t Pb'+ itr:6 fi IF rte f Y w)d -s r r s rib. 4.i Frr d Y_' t: ;3 a 1I'1.�;!-,1" jI 4Y"-" t:z tt _ �,,,:. t t' t - :. a a'ti?:�r{PW iK�;, , f: y e } -� y r {', i r1•• I q at 3 Y''t t'�" II I. NO, : # fit. -Y r a .'t -. %Ff _ , A `f4:, a _ °,'.. 1 .1, a , t {� .fit 4 ,, 1 y d`` i'"`4 S G 'S 1 ? I F t f ? J5S r Li 5 r I.. 4 d't '4 .r s z'' S+'aa 'i YYi # i} r is tit { i t } f 7 , -- v . �r. r r YY,," f },. •• St, 4* 'iyy, {t ! �S P .. f ..--7 t 4 4 t S d F }i t}'r.' , Y x '. 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TtUV,V Off' Tim �..� a° 1 Y ,F, `�Ga .r yt it- 1. l h»° dJ"!"i"6iCTtr��9. 1$ AKRI I'' bq ` V b r ac Ff. 7 + 4• ( y ? x t,If ,,� tI CIN'st� VrVrv.4A/C+ t�F R ^� ,.5 # . 4 t # p^ p G'i4A/1.� .'9P(/�itPVl3!►-�rt?:3 � 9?Z ;'� �' ° , , /y :G� R' .y �+ _ i;9: c' Ass is map and lot number ............................................." ( � pC 77 -` 71 - SEPTIC SYSTEM MUST BE .. Sewa 'e Permit number A INSTALLED IN COMPLIANCE .......................................................... } gS WITH ARTICLE, II STATE AR C`"�E ND TOWN 71 Qy�FTHEro�� TOWN OF BARN§TELA LE E9$BST"LE. i - ' ��•90ppv'a 309�.� , BUILDING UILDIN G INSPECTOR - 0 : - - ,APPLICATION FOR PERMIT TO ...... ....... .:......... . ....:..........:.................:.............................................:............:. TYPE OF CONSTRUCTION .r .................... �r�!??:"�..................... :........... :........r. = .......................&4Z.........19R.9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: o T 40M 0>coe r /'7.« �s7bAJs ,�� Location �� ................................. .....:..�y......... .! .................................. ....................... ProposedUse ..P.u!A5ll/.N" .G............................................... .............................................................. ............................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner v.l,,ry. .............Address ... Si.C.4........f.7..... ,� �t. Th./..�►....... Name of Builder .......Zjrrla........................................:..Address ...... .......................................................... Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ...................................:..............................Foundation . .s0.,ifX.4,-.4.......r—V,-ez"Za .........:..... Exterior ..LV..,0.A/......................... a �i i...............:.........................Roofing .... ... (/ . .. ............................................................. Floors ......................................................................................Interior ...................................................................................... Heating ... . .,..ld/........ .....................................:.........Plumbing ..:....................................:.......................................... Fireplace .... .....Approximate Cost u L� P Definitive Plan Approved by Planning Board.-----------_______-----------19_______. Area 1...... .......... ....:... Diagram of Lot and Building with Dimensions Fee �s SUBJECT TO APPROVAL OF BOARD OF HEALTH 2Q 5� 0� G,1 I hereby agree to'conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �. Name ....... ........ .. ...� Reilly, John M. - J 19528 1 ,1/2 story .............. Permit for .................................. _ single family dwelling . y................................ .Lumbert Mill Road. " . Location ... 44.Ne,44.. €?. .................... i M ........................................ John M. Reillyi.. ;w Owner ................................................................... frame`. -_ w Type of Construction fa.............. .. . .......... ' ............... .....:'�•................................i`.'.. .............. Plot ............... `...2....... Lot ........ #15 � r "=. . August 22 ' 77 Permit Granted ........... .. ... ...........:...:....19 t 6 � J Date of Inspection 7�.. . . ....... Date Completed .���,! ✓........ :`:19 PERMIT REFUSED .......................................... t 19 a; ....................................... ....................:..........' - 1Y . ................................. .. .................................... F ........ ... ...................... ......... ......... +` 11 r Approve ................................................ 19 .. .............................................................................. _ �C- All- Assessor's map and lot number ......................................., OC 7;7 77 Sewage Permit number .......................................................... *111E TOWN OF BARNSTABLE MARISTABLE, MASIL G INSPECTOR 163 9. a M B U.1 LDIA APPLICATION FOR PERMIT TO ........................ ............................... .�::....................................................... T 00,CONSTRUCTION ................................ YPE ................................................................................................. 7 ................................. . ........... 19 TO THE INSPECTOR OF BUILDINGS: The undersigned he/re/by applies for a permit according tb the following information: 10 Location — 'lon; 7- /1//1 .................................................................... ..... .. ... 4 wc j!r, ProposedUse ............................................................................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..........1:............................................/............Address .... .............. ,X - ................................................................. Nameof Builder ......................4............................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ....................................................................Foundation ........................................................................... Exterior ................../ ...................................................................Roofing .................o.................................................................. Floors ........................................... Interior �3 /7 ............. ....................................................................... Heating . ..........................I .........I ....0...........................................Plumbing .................................................................................. Fireplace .............................. ...................................................Approximate Cost ... ................................................................. fi Definitive Plan Approved by Planning Board ------------------------------19--------- Area ................................... Diagram of Lot and Building with Dimensions Fee .............t............................... 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 ................ ........ 0....................................... l meilly, John M. A~1*6 31 19528 ^� l lj�2 mtozy No ................. Permit for .................................... � single family dwelling ............'. Lumbert Mill Road � ...................... Ile Owner .......Jobo..M.'De.illy________... ^ frame Type of Construction .......................................... .................................................... - Plot ............................ Lot . � August 22 77 Permit Granted ........................................ Dote of Inspection ....................................l9 Date Completed ...................................... ^ PERMIT REFUSED � ` ___.__.. ___. ...~,-.~—~...—.—....—~.----...—~—.—' . ~'`--'^^^—'------^^~—'—^^^^^~'^^--^' - ' ^^'--'—^—'—'—'—^'^^—'—~^--`—^~^'~'~— ' Approved ---------------- lg ' ^ --------.------.........—'—..—,.. . - ----^------^---''----'—^~--^^'' � | � _