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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map o�49 Parcel- Application
'?C�l
Health Division Date Issued 30
Conservation Division Application Fee
Planning Dept. Permit,Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/ Hyannis
— Y
Z � T Ze�i '/ �� D Z�Project Street Address � �L_ ��� , 3Z
Village
Owner Address —:�X J466
Telephone - J " 15OZ
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Ji
// Q Flood Plain Groundwater Overlay
Project Valuation 5 t(5. Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su orting dgcumeptation.
S 0
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) n
"46 t
Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings ighwayµ=U Yet ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other '
Basement Finished Area(sq:ft.) Basement Unfinished Area (sq.
Number of Baths: Full: existing new Half: existing navy
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
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
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name / � Telephone Number
Address q,� � �7 License # C S+ D&go 5g
Home Improvement Contractor# Um 600 f&yol
Worker's Compensation #
� �tiisy <
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROD CT WILL BE TAKEN TO
7 ZJ 0267
SIGNATURE DATE
r.
4
FOR OFFICIAL USE ONLY
APPLICATION#
r
DATE.ISSUED,
s MAP/PARCEL NO.
i
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
�• JWFO.UNDATIONu) 4_ {,tj iisb:"yil itl
FRAME
.INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
p PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
Y
b
ri 3
' The Commonwealth of Massachasetts
Ln Department of Industrial Accidents
Office of Investigations
IV 600 Washington Street y
Boston,,MA 02111
www.mass.govldia'
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/lndividtal): Tupper Construction Co. , LLC
Address: 79B Mid Tech Drive
City/State/Zip: West Yarmouth, MA 02673 Phone# 508-778-0111
Are you an employer?Check the appropriate box: Type of project(required):
1.El I am a employer with 4. ❑ I am a general contractor and I g ❑New 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:+ 1• ❑`Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for.me in any capacity. workers'comp.insurance. 9. ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation:and its
required.] officers have exercised their 10.❑'F.,lectrical repairs or additions
3.❑ I am a horneowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions
myself. [No workers'comp. a:t 52,§1(4),and we have no 12.❑Roof repairs
insurance required:]r, employees. [No workers'
Ot
comp, insurance required.] (1'❑ lief
*Any applicant that checks box ifl.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 their workers'comp.policy information.
lam an employer thaiisproviding workers'compensation insurance for my employees. Below is the Policy and job site
information.
Insurance Company Name: AEIC
Policy#or Self-ins.Lic.#: 'WCC 5005593012012 - Expiration Date: 10j03 j2013
Job Site Address: 284 Main St'.' City/State7.in: Centerville MA 02632
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,m 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.umler a pa an penalties of perjury that the information provided ahove is true and correct
Signature: Date: 9 2 5 2 013
Phone#:_.. 508-778-0111 {
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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Dec. 19. 2012 4.37?Mo, $ 24 P. 1t2
AGuKuI. 2/19/2012012
CERTIFICATE C PLIABILITY INSURANCE DATE 1M/Oy
N � 2/1
THIS CERTIFICATE IS ISSUED AS A FATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poilcy(Les)must be endorsed. If.SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT NAME: Lora Lowe
Southeastern Insurance Agency, Inc: A�icNoez; (508)997-6061 FNe (508)990-2731
439 State Rd. EMAIL
ADDRESS:
P.O. Box 79398 PRODUCER
CUSTOMER ID 6• -...
N. Dartmouth, MA. 02747 INSURER(S)AFFORDINGCOVERAGE NAIC0
INSURED - - INSURER A: Arbella Protection Insurances
Tupper Construction Co LLC _.�—
pp INsuRERs: AEIC
INSURERC: CNA Surety
27 Roberta Drive .......
fNstsfER n
West Yarmouth, MA 02673 INSURER E:
INSURER F11
COVERAGES CERTIFICATE NUMBER: 12/13-2 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L SI TYPE OF INSURANCE INSR 4WD POLICY NUMBER MWDD I(MMMNYYYI i LIMITS
GENERA.LIABILITY - I 8S00008743 11/0112012 11/0112013 EACH 4;RRENCE $ 1,000,000
I -E TO RENTED
X COMMERCIAL GENEPAL IIASI,IT'Y 1 asYAC S rE~arrur c+�cce1 $ 100,000
._......( ..., r _... _.
..
G:AiI S-rMDE :. OCCUR i MEG EXP(Any one person) 5 5,QQ
A i PERSONAL a AD V NJURY _ 1,000 00
. ` 'GENEPALAGGREGATE 3 2,,000,000
..............................
_. sI n
GENT AGGREGATE L IM!T APPLIES PER: >'RODUCTS-COMP;OP AGG $ 2,000,000
._'_ PRO. -
POLICY JECT LOC { $
AUTOMOBILELIASILITY S666240000 12101/2012 12101120131 COMBINED SINGLE
'Ea wcioon1) $ 1,000,000
ANY AUTO
- BOD'LY N.I!iRY(Per person) $
AL.OWNED AUTCS --
A X�5"iEDULEDAU 4S B-----.PY... accident) $ +�
PROP.RTY DAVAGE.
X =+RE?AUTOS 'Pereccide,11 $ INC
UMBRELLALM HOCCUR � ,_A HO tUPRONCE $ _.______........._-.
EXCESS LIAB ClAit�S ttAO= I AGGRE AT $
__..._ �W...,._....._
DFDUCT6 E RETENION $ `
WORKERS COMPENSATION v)N - WCC5005593012007 10/03120121010312013
AND£MPLOYERS LIABILITY
',AN''PPOPRIETORtPAPTNEPr- EC_I7iVE RICHARD TUPPER I - --,-.I FR?::tiAC:f l'?Nr $ 500 00
O�FICERrME4d6..REXDLUDEDo N1Af --.....»---
i6,datoryinNH) �' '-INCLUDED FOR WC COVERAGE E L DISEASE-EA EMPLOYE 8 500,000i
f yss descnoo v de* .....
DE.,UR.PT IOra OF OPERATIONS t altm E._.DISEASE PO:ICY L.1.11 $ 500,00
on or theft of money or I 7106891302/28/2012 02/2812013 Limit of $10,000
C property.
DESCRIPTIONN OF OPERATIONS!LOCATIONS I VEHICLES(AttachACORD 101,Addftfonal Remarks Schedule,it more space Is required) '
ill.jaiio@csgrp.com
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Conservation Services Group
Attn: Bill Jul i o AUTHORIZED REPRESENTATIVE
50 Washington Street
We thorough, MA 01581 Lora Lowe
1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109)• The ACORD name and logo are registered marks of ACORD
OWNER AUTHORIZATION FORM
v ( n2
(Owner's Name)
owner of the property located at
Z ti�y / � , S�•RG 7�
(Property Address)
(Property Address)
hereby authorize
(Subcontract )
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.
i
Owner's ig at re
l
Date
I
1tttJll # etts'x Department of Public Safety
tp7HBarr it0 Board f Ruilding Reoulaticn and Standards
Nwa,w 12D20
(8.77)2741274
• _ !cerise.
Y ��€
CHARD S`t'LWPER
70 81; - �OR �.
WEST 1lARLC3✓1EI s .
63mt a
Expiration
" ma WAM€safoRom n"00 Commissioner 12/3112014
W"I"
y x
� q ccc ut: nea A31 Lins, :it�
i � � gig l vp ut Saar Wo "E t PROVEME CON-TRAt TOFt
Oda�
K f ►lorr , Type:
Ct l� � xtilado 1 t4 individual
�i a
1C�RD TUP R
Rt j rt� U3HlVA
RICHARD UPPER
�U el"�47Tt tl l �l � 29 RoWrta Drive
` AAA& W.YARMO •AAA t)n
U" t;aderaecretary,.
r?Sk4j, TUPPER
CONSTRUCTION CO.LLC
79B MID-TECH DRIVE,WEST YARMOUTH,MA 02673
PHONE: 508-778-0111 FAX: 508-778-5010
WWW.TUPPERCO.COM
Date: I P :3 /j3
Town of Barnstable
Thomas Perry CBO
200 Main Street
Hyannis, Ma 02601
(508) 79076230 fax '
Re: Insulation Permits ;
Dear Mr. Perry
This affidavit is to certify that all work completed for permit application
# D I 06 17 61
Issued on has been inspected by a certified. ,
Building Performance Institute (BPI) inspector. All work performed meets.
or exceeds Federal,and State requirements. ` a
t e
w.r.4
Sincerely,
Ric rd Tupper
License # CS-69058
R.
` Town of Barnstable
�114
ET �Qn Regulatory ServicesTO N OF _R RNIST n,E
��
Thomas F.Geiler,Director
BARNSPABLE' ' Building Division 2,1+3 AUG 13 y 4: 12
Ep39.
a` Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
PERMIT#<— FEE: $ 3
SHED REGISTRATION
RESIDENTIAL ONLY
200 square feet or less
Location of shed(address) Village
VQ,o ?40(4 nit C�'/l��`�
Property owner's name Telephone number
7 'Jog -- 6�A
Size of Shed Map/Parcel#
Signa Date
Hyannis Main Street Waterfront Historic.District?
Old King's Highway Historic District Commission jurisdiction?
If over 120 square feet,you must file with Old King's Highway
�Conservation"Commission"(signature-is=required)_ C__
tSign_off-hours-for C-on§ervation-8;00=9:30&3:3_ 0�j0�
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE.A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN
Q-forms-shedreg
REV:052813
Y
,
- 'own of I�arnstable / to (q3
*Permit#
Expires 6 months from issue date
Regulatory Services Fee
Thomas F.,Geiler,Director
Building.Division
Tom Perry,CBO, Building Commissioner.
200 Main Street;73yams,MA 02601
www.town.barnstab le,ma.us'
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT.APPLICATION RESIDENTIAL ONLY
Not Valid withowt Red X-Press imprint.
Map/parcel Number ,
Property Address R4 m ou n !�t. &fkfV i
6[ Residential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address fmd 0 ,
N x'
Contractor's Name I"!, Telephone Number CI
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) j e �✓
❑Workman's Compensation Insurance
Ch one: v�,�;
I am a sole proprietor
❑ -.I am the Homeowner AN ..
❑ I have Worker's Compensation Insurance
Insurance Company Name -F( �i%JN1 OF BAt NSTALE
Worl man's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
/Re-ro0'f(stripping old shingles).,All construction debris will be taken to.. 4 Cd
.❑Re-roof(not stripping,;Going over existing layers of roof)
w
n Re-side
El Replacement Windows/doors/sliders. U-Value `(maximum.44)
Where required: Issuance of this.permit does not exempt compliance with other town department regulations,ix.Historic,Conservation;etc.
***Note; P,roperl3Jw er must si roperty Owner Letter o.f.Perrriission
A c y�of�th }Home p tment Contractors License is required.
SIGNATURE;
Q:Foi-ms:expmtrg
Revise061306
. The C07nMOnweaith of Massachusetts
Department oflndicstrial Aecidents
Office of1"nvestYgations
600 UrashinAdon Street
Boston,AfA 02111
` VIMmass..gov/dia '
Workers" Compensation Xnsurance Affidavit: Builders/Contractors/1;'lectricians[Plumbers
Applicant Information Please Print Le 'bI
Nagle (Business/Organization/Individual):-
•Address: ( a�
City/State/Zip-,'`1 �.�1�IS �" Q p�Yt N PhORCA
---------------
-----------------
Are you an employer? Check the appropriate box:
1.❑ I am a employer with 4..[] I am a general contractor and I -Type of project(required):.
�-�m loyees (full and/or part-time).* have hired the sM-contractors 6• E]New construction
2.L'9 1 a a sole piroprietor or partner- listed on the•attached sheet. 7. itng
Remode ' �❑
ship and have no employees These sub-contractors have g Demolition
working for me in any capacity. employees and have workers'
:[No workers' comp.insurance comp.insurance.$ 9• []Building addition
required_] 5. ❑ We are a corporation and its 10-El Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their . 11.❑Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL'
insurance,required.].t c. l52, §l(4),'andwehaveno- 12-ER cofrepairs
employees. [No workers' 13.0 Other
COMP.insurance required]
*Any applicant that ebecks box#1 must also fiR out the sredon belowshowing thcir warkm,compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and thin him outside contractors must submit a new Affidavit indicating such.
1Cdntractnrs that ebcck this box must attached an additiomalsbect sbowing tho mini of the sub contnctrns and state whether ornot those entities have
employers. If the sub-contractors Uve employees,they must pravidh their workcrst comp.policy number..
Yam an enzplayer that is providing workers''campensat[on inmrance for my employees information. Below is the policy and job site
Insurance Company Name:
Policy#/or Self-ins,-Lic.#:
Expiration Date:
------------
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaratiau page(showing the policy number and expiration date),
Failure_to secure coverage as required tinder Section25A ofMGL 6. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the farm 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 stateme
Jn nt maybe forwarded to the Office of
vesti ations of the bJA for insurance covera e verification.
Xdo hereby certi under ep ins•a allies ofperjutjr that the information provide abov ,is true and correct
Sienature: 3 I t
Date:
Phone #: 10 _
Official use only. Do not write 1n.this area,to be completed by city ox town official
City or Town: Permit/License#
Issuing Authority(circle one);
.x.Board of Health 2,BuildingDepartment 3. City/Town Clerk 4.Electrical Inspector S.PlumbingInspeetor
6. Other-.
P
Contact Person; phone#/:
/ •1HF I
t" yof �y� . .T6wn of Barnstable.
. .� Regulatory Services
�xNsre��.
y asass $ Thomas F.Geller,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street Hyannis,MA 02601
TM'w.town.barristable.ma.us
Office: 508-862-403 8
Fax: 502-790-6230
Propexty Owner Must
Complete and Sign This Section
If Using A Build-6r
as Owner of the subject property
herebyauthorize to act on rnY behalf,
in all matters relative to.work authorized by this building permit application for:
� w i
�10J -
(Address of Job)
Signature of Owner Date
Print Name
QTOR.MS:OWNERPERMIS S ION
// ec
< Bba 1 9 ing "In'Kion�a�ds�an ar s
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 124310 . Board of Building Regulations and Standards
Expiration: 6/1/2011. Tr# 284683 One Ashburton Place.Rm 1301
Type: Individual Boston,Ma. 02108
James Curley
�... _e _
-
James .Curley,
287 Fuller Rd. A
Centerville,MA 02632 Administrator without signature
Massachusetts- Department of Public SafetN
Board of Building Regulations and Standards
Construction Supervisor Specialty License
License: CS SL 99138 I
Restricted.to: .RF,WS .
JAMES CURLEY " I
287 FULLER ROAD.
CENTERVILLE, MA 02632
Expiration: 1/28/2012
(•ommissioner Tr,#: .99138
Boa d of Buildino R Q
�__.bul;ttinns.and..St�ndards=-�,�.. a �.• "g for nl dlidul use only
HO E IMFROVEM NT CONTRACTOR bef lsiration��ali ore the a iration date. a foundreturn to:
Re 's1_r4fion-;124 0 y,, —.--Board-ofBtri ding-R7e i'lictitl`"sand S�n.dards
E jration / H2g " Tr# 1. 0873 One Ashburt Place Rm 13
Type lndlvid.al" Boston,Ma.0 108
James u'ley
..James urley
287 FRd.
ull r.
e, A02632. Administrator Notyali without t ,Mure
•��� ark
i
' iAssessor's Office(lst ®�� Permi
floor) Map ' "'"7- Parcel � t# 1 02 9/02:
"
Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00), Date Issued
Board of Health(3rd floor) 8:15 -9:30/1:00-4:45) Fee
Engineering Dept.(3rd floor) House#
� 0 tom , —
) '• �k 4
Jay d 19
g l
' TOWN OFiBARNSTABLE
r Building Pe it Application
/ 3 y 4
v Project Stre s
,/'Village '
AOwner v- Address
Tele hone ' ZZ
-- eeJOf'4 7 ,S— �3O
ermit Request
First Floor square feet
Second Floor square feet
,/�stimated Project Cost $
Zoning District b Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure !! D Basement Type: Finished
Historic House N Unfinished �—
Old King's Highway /v
Number of Baths No. of Bedrooms
Total Room Count(not including baths) 2 First Floor
Heat Type and Fuel WVat: Central Air Fireplaces /
Garage: Detache ah—, Other Detached Structures: Pool
Attached Barn
None Sheds .
Other
Builder Information
Name Telephone Number
Address License#
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 BRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO
/ Y
SIGNATURE DATE
BUILDING PERMIT DENIED FO THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
e
PERMIT NO.
DATE ISSUED `< '
MAP/PARCEL-NO.
` ADDRESS E VILLAGE '
OWNER
DATE OF INSPECTION: ,
FOUNDATION
FRAME `
INSULATION I I w e
FIREPLACE, I
ELECTRICAL: ROUGH FINAL ;
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
i
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. I
1 _ The Town of Barnstable
NAM P Dent of Health Safety and Environmental Services
epartm
Building Division
367 Main Street,Hyannis MA 02601
Ralph Cmssca
Offl= 508 790-6=7 Building Commit-
F= 508775-33"
For office use only .
Permit no. ,
Date
AFFIDAVIT
HOME EffROVEMENTCONTRACtORLAW
SUPPLEMENT TO PEMMT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,mod=b=don,cow4l"on,
improvement,.rtmoval, demolition. or construction of an addition to any pre-exasizzgo }
upied
building containing at least one but not more than four dwelling units or to st =tur s are
acent
to such residence or building be done by registered Contractors,with certain CWCOons, along with othe
Type of Work: Est. Cost
Address of Work: oZ
Owrrer.Name:
Date of permit Applic Lion:
I hereby certify that:
Registration is not required for the following rcason(s):
Work caduded by law
Job trades SI,000
Building not owner-occupied
Owner pulling awn permit
Notice is hereby given that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING WiMUNREWI�ED
FOR APPLICABLE HOME IIAPROVEMM4T WORK DO NOT HAVE .ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER.MGL c 142A
SIGNED UNDER PENALTIES OF PER,TUR
I hereby apply for a permit as the age ova
If
Date
n nam Registration No.
OR�f}-T - �S 9� ►�
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please pri
DATE .. �. � r•— :. ..:� �. ...
JOB. LOCATION
df
N er Street address Section of town
"HOMEOWNER" f aver
Nhme Home phone Work phone-•-
PRESENT MAILING ADDRESS z* . ..
20.z
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 responsil,
for all such work performed under the building permit. (Section 105.1.1)
The undersigned "homeowner" assumes responsibility for compliance with the Si
Building Code -dad other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she underst nds a Town of
Barnstable Building Departure minimum inspection proce res nd requirement:
and that he/she will compl w' h said pr ed and quir ent
HOMEOWNER'S SIGNATURE
--Ze
APPROVAL OF BUILDING OFFICIAL
Notes. Three family dwellings 35, 000 :cubic feet, or larger, will ,be required '
to comply with State Building Code Section 127. 0, Construction Control.
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 Owr:
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 awaren
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,' m:.
communities require, as part of the permit application, that the Home Owner
certify that he/she understands the responsibilities of a supervisor. On t
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.
r
Assessor's office (1st floor): FTNET
Assessors map and lot number ......................... ................. Q '
N't d c
ward of Health,(3rd floor): �-� •� �� � t%omiS e 4t�. `!3 5 _ Z •.
Sewage Permit .number ....... .........:.................................... �'C S.rs c lit _ BaEasTauLE, S
Engineering Department (3rd floor): --�, Q- 9°o %6 9•
House number ........................L........:..V...M'.. �pypva�
APPLICATIONS PROCESSED 8:30 9:30 A.M. and; 1:00- :00 P.M. -only; SEPTIC SYSTEM MUST ME&
IN COMPLIAN"TOWN OF BARNSTAfifNED
IT" TITLE5
B U I L D I H I N S P E C T NVIRONMENTAL CODE fl. '
TOWN PEOULATfC,,
APPLICATION FOR PERMIT TO .......... .'0611N
TYPE OF CONSTRUCTION ......... L(1!YY[......... ... ../....................................................................
..•.!..... ............... .................19 ...
�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the lowing informs ion:
.... ...
Location .................................................................................... kv��&................../ .. ..........................
�� /...........................................................................................................
Proposed Use ..........................�...................
/`,jq.
Zoning District Fire District ......�: 6 S
Name of Owner `.IC.IIJ. ...�dm`� � �/......Address ����..�'! �� � .f.//yG'�..
........... . ..... ...................................................
�/1'f�f(J Al ...............Address ..........................
Name of Builder ./ ............... .... ........... .. ..........................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ................................................................:.Foundation ..............................................................................
Exterior ....................................................................................Roofing ....................................................................................
Floors ......................................................................................Interior ....................................................................................
Heating ....Plumbing
Fireplace Approximate Cost ..... ....
.............. ......................................
ro Definitive Plan Approved by Planning Board _______________________________19________. Area �`-' x
Diagram of Lot and Building with Dimensions a45.i...Fee ...... ................
SUBJECT TO APPROVAL OF BOARD OF. HEALTH
7C
s ,
�A�rJI`a� •' .
,
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town arnoegardi.ng..,he above
construction.
Name .......................
Construction Supervisor's License ....................................
,'. O'NEIL, KEVIN & A=209-44
PAULA
1 2 369PermitAccessor to, No . : � for ....................Y............... �:
dwelling swimming pool
... .... ......................................................
�a
'A Main Street, Centerville
't Location .......................................
�.
Owner Kevin. . .. ...
& Paula. ...O'.Neil. . ..................
... . .. .. ........ . ... .. . ....
w
G Type of Construction
.......................`.......,..................rt:.........................
Plot ................... ...... Lot ................................ t _
e
Permit Granted ............. .May„20, ,, 1 q 86
°l
Date of Inspection ....................................19 _ �r
61
Date Completed
Lr n- ' .a -• rt � � - 1' 7
r�M �
i
A`ssessor's office (1st floor)-' *THET
Assessor's map and lot number da� (ta..,,� U 11,F., L Pao off♦
ornss re ?cam f— •
, e%ard of Health (3rd floor): y
Sewage Permit number ..................................................... i�c Sy. c rid -_..i E8S39TODLE.
Engineering Department (3rd floor): "639. \0�
Housenumber .................................... ..............
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-r2:00 P.M. only
TOWN OF BARNSTABLE
BUILDING INSPECT R
J Y± `-
.eAPPLICATION FOR PERMIT TO ?vr/i1 ............
TYPE OF CONSTRUCTION �.�f�!!?�lfi?!R-j.e........................ .............:......................................................................
..................... .....................19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following inform ion:
ll�cl�i, ..................:� ......s...........................
Location ...................................................................................... ..,. .. ..... .....
Proposed Use �'
...................._- . \ ......................................................................................................................
(ter �-
Zoning District 1�{;� ..%�.. ......Fire District ......\: .......... .C' :
Name of Owner /t t'U/� /f�
� � � �f(/C/ Address r..=���..1.:!.✓�.�� � ���/lt/1 �C
........... ......................................................... .........................................................
111�
Name of Builder v S "d / ....Address
Nameof Architect ..................................................................Address .......................................:............................................
Numberof Rooms .............................................I....................Foundation ..............................................................................
Exlerior ...........�:%...............................................•...............:.........Roofing ....................................................................................
...............................................Interior ...............
Floors .....................................................................
Heating ............................................................................... Plumbing ................g............................... ...............................
/ vpvo
Fireplace ..................................................................................Approximate Cosy .,/ Q. ....:................................
Definitive Plan Approved by Planning Boa`rd''--------------------------------19________ . Area `—Q x..........................................
Diagram of Lot and Building with Dimensions �
Fee ....... ....... ...............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I �D
�.,�- 1 �
T1 rb "At
T �
i
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS g
I hereby agree to conform to all the Rules and Regulations of the Town of'Barnsta le regarding the above
construction.
AI
? 9
,. Name -,,. !; ,
Construction Supervisor's License .................................... i
O'NEIL, KEVIN & A=209-44
PAULA
9-44
No ... Permit for ArX-'.95. Q.Kly..t:.Q..........
. ...................
vj
Location.. Main Street,...Ce..../er.V.ijjp......
........................... .... ....
..........I....................................................................
Owner ...Ke.v.in..&...P.au1,a..WNP-:L1...................
Type of Construction ..........................................
................................................................................
Plot ............................ Lot .................................
Permit Granted ......................M a.y..20.....19 86
Date of Inspection ....................................19
Date Completed ..................... ................19
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