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0697 OLD STAGE ROAD
w F. t . J Town of Barnstable Building snrtiv§txeie Post This Card SO4 hat it Js Visible From the Street Approved,'Plans Must be Retained on Job and'this Card Must be Kept 6 +�$ Posted Unt�I Finahlnspection .,as Bee Made z tprzte ;Whe're a Certificate of OccupancyNf Required,such Building shall Notbe Occupied until a Final`Inspect�on has been made Permit . . A. �Y ..�... ...,.... . .... _ w _ P _. _ Permit NO. B-19-3956 Applicant Name: WAYNE T LOFTUS Approvals Date Issued: 12/06/2019 Current Use: Structure Permit Type: Building-Deck Expiration Date: 06/06/2020 Foundation: V L Location: 697OLD STAGE.ROAD,CENTERVILLE Map/Lot: 191-069 Zoning District: RC Sheathing: Owner on Record: FULHAM,GERARD A& KATHLEEN R Contractor Name'. WAYNE T LOFTUS Framing: 1 Address: 697 OLD STAGE RD 'Contractor License: CS-077800 2 CENTERVILLE, MA 02632 Est. Project Cost: $2,592.00 Chimney:: Description: DEMO EXISTING 40"X96"DECK REBUILD 70"X96" DECK WITH Permit Fee: $ 110.00 RAILING ON ONE SIDE AND STEP ALONG FRONT Insulation: "Fee Paid:° $ 110.00 Project Review Req: Date 12/6/2019 Final: l �Z f Plumbing/Gas Rough Plumbing: This permit.shall,bedeeined abandoned and invalid unless the work authorized by this permit is commenced within six months after Iss an iCia Final Plumbing: All work authorized by this permit shall conform to the approved application and tfie`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures'sfiall,be in compliance with the local zoning by laws aril codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street o,i:road and shall be maintained open for public Inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: " 1.Foundation or Footing Service: 2.Sheathing Inspection w ` Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining isumstalled .. ; 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: p Application Number....... t l •n ................................................. * E AMBrABLE. * 1. 10 � MA88 Permit Fee.......................................Other Fee:....................... 05 �Ep MA'S A,e TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by..... . ........................On...i s....... BUILDING PERMIT DW9 Map.........,. ......................Parcel... :....................... APPLICATION € XT-` S4mwv' Section 1 — Owner's Information and Project Location Proj eet Address_ C 9 7 clt�j:> VillageC— Owners Name > Owners Legal Address City e-e - c-&,-c1 State /0A Owners Cell# 68 36 4f E-mail Section 2 -Use of Structure " Use Group 2 ❑ Commercial Structure over 35,0 cubic t� ❑ Commercial Structure under 35,OQ0 eubiceet ❑ °Single/Two Family Dwelling Section 3 - Type of Permit ❑ New Construction ❑ Move/Relocate - ❑ Accessory Structure ❑ Change of use El Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty' El Fire Alarm Rebuild [2 Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other-Specify Section 4 - Work Description j5yc ttiri G /J® X 96 DEc-lL Last updated: 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction �,2 6-9 2 Square Footage of Project Age of Structure r= Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design r'� . - Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Wafer Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard _ ' Required Proposed Side Yard Required Proposed ' q P Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 0LT-) ?air L i t - IV7 . Azet� icy 1A,wv,- !� D N �¢Nr�✓L- Barnstable Bld .Dept. Approved by: II Permit#: 1 g � aw, R�t-...� iy,---w•S'v -1 c+� "� y�e, "Y' Cy <,E.'.0 �.�7' .�}k.`.� •sue".`'fir.'� ��a '�. � X �.�"�*- x t '' � a. '��^ r T:3 s?�s `�`tl- N f '�' �[- .y .��"'. �`'* �.: o x lzJ � Y - - v r� :C.a /2 " Q C ' RITI FiED PLOT . PLAN L Or C A T i"O.N= C,�-.yTE,C✓ic.,r..� S C A-L E_ _ "a moo' GATE ✓vc y ie j� R E F E !t E N C E: B�ivy " GcT ./� A.S .3rYosvci .Go]":c .. -;e3 _—v/e i,Wx% og .oiC i9,r/.eKG1eO�E� •�i THE 1S-9,eA1Sri9 iff ,d-- �,E Cr Aa A_-y .0 A T E_. JGiL�-ps /iV:10511-09N :ISOO/'r 27fi t :H-E.RE.SY' CERTIFY TH_,AT. THE BUILDING R E 6 t_ NO U RNt If0-R. tft} NIF.N. "ON TH15 .P.:LAN: t5 L0C "ATE. D ON lfE 6'R"a3-UNTO AS. _5..H0WN `.HEREON ANp YttAT tr '" -..CONFORM TO THE � DsA 0rfid �G; �Y - �..Aw5 ..OF t' HE - TOWN OF w H E N - C ".O N 5 'T RUC T E D. �� GEORGE LOWE JR +tRt+iS't'�kBLE SURVEY C:QNSUL:TANTS, "1N � ��� is��¢�°z�� -,: . . E:.ST VAR uour.sa_ .. ee:c : � . •J /i7/liC/[U'CC/,C� (,//��j/:):iC/,C (il��i a-- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPES Individual R before the expiration date. If found return to: 43246463 0?✓07/2021 tion Expiration Office of Consumer Affairs and Business Regulation 132 1000 Washington Street-Suite 710 WAYNE T LOFTUS Boston,MA 02118 D/B/A LOFTUS CONSTRUCTION WAYNE T.LOFTUS VE _ 78 ARROW HEAD DRI HYANNIS,MA 02601'"' ry / Undersecreta Not val' without signature Commonwealth of Nasac husetts Division of Professional Licensure Board of Building Regulations and Standards Construction tSupervisor CS-077800 E, pires: 06/27/2020 F WAYNE T LOFTUS 78 ARROWHEAD HYANNIS MA 02601 Commissioner The COW nonlwealth ofMassachusetts Departr ent of Industrial Accidents Office ofInvestigations 600 Washington Street Boston,MA 02111 lv► .mass gov/dia Workers' Compensation Insurance AMdavit:'Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ),J6 r Address: 7 9 /'t(ZA()v.-3 14-6--4T p/z., City/State/Zip: N a 5 { .. Phone#: #. 4,0 c fO 3 2 t Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. ,_ 7. ❑Remodeling ship and have no employees These sub-contractors have , S.- El Demolition wor for me in an aci employees and have workers' Y capacity. - 9. El Building addition- , [No workers'comp.insurance comp.insurance.: ❑ 5. We are a corporation and its 10.❑Electrical repairs or additions required-] officers have exercised their - 11. Plumb repairs or additions 3.0 I am a homeowner doing all work � ❑ � P • 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 those entities have employees. If the sub-contractors have employees,they must provide their workers',comp.policy number. Y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. i r Insurance Company Name: — Policy#or Self-ins.Lie.#: 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 fi=rrance coverage verification. I do hereby certify der th(e pains and enalda of perjury that the information provided above is true and correct. Signature t7 - Date: 1L-:7 /�l Phone#• ,f'a rho _''03C2 Ojjtclal use only. Do not write in this area,to be completed by city or town ojficial 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#: Information and I uctions Massachusetts General Laws chapter 152 requires all employers to rovide orkers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person •the ce of another under any contract of hire, express or impli oral or written." An employer is de "an individual,partnership,association,corp o ' n or other legal entity,or any two or more of the foregoing a joint enterprise,and including the legal entatives of a deceased employer,or the receiver or trustee of in 'dual,partnership,association or other legal ,employing employees. However the owner of a dwelling ho ha ' not more than three apartments and resides therein,or the occupant of the dwelling house of another o loys persons to do maintenance, ction or repair work on such dwelling house or on the grounds or building thereto shall not because of employment be deemed to be an employer." MGL chapter 152,§25C(6)also that"every state or local lice ing agency shall withhold the issuance or renewal of a license or permit to o rate a business or to co ct buildings in the commonwealth for any applicant who has not produced acc ble evidence of comp' nce with the insurance coverage required." Additionally,MGL chapter 152,§25 "Neither the co onwealth nor any of its political subdivisions shall enter into any contract for the performan o ublic.work until table evidence of compliance with the insurance requirements of this chapter have been p to the con g authority." Applicants Please fill out the workers' compensation affida ' co plete y,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addre (es an phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or L' iability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' pensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affi may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also b' �`re to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the ` or license is being requested,not the Department of Industrial Accidents. Should you have any questions ' g law or if you are required to obtain a workers' compensation policy,please call the Deparmrent at the ber ' .i below. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legr Y. The Dep , ent has provided a space at the bottom of the affidavit for you to fill out in the event the Office of In estigations Vo contact you regarding the applicant. Please be sure to fill in the pennit(license number which will used as a re ce number. In addition,an applicant that must submit multiple permit/license applications in any en year,need submit one affidavit indicating current policy information(if necessary)and under"Job Site Address the applicant o d write"all locations in (city or town)"A copy of the affidavit that has been officially stamp or marked by ky or town may be provided to the applicant as proof that a valid affidavit is on file for firtare p its or licenses. n affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or p it not related business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is N T required to co 1 e this affidavit. The Office of Investigations would like to thank you in advance r your cooperation should you have any questions, please do not hesitate to give us a call. �t The Department's address,telephone and fax number: The Commonwealth of M aehusetts t Department of Industrial Am— is Qffice of Investigations 600 Washington Street Boston,MA 02111 Tel.#617 727-4900 ext 446 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www:maw.gov/dia A-Pp lication Number........................................... . Section 9- Construction Supervisor Name UL)A,a& kv-Ff'W S Telephone Number 66 8 06.Z - 03`'U/-7 Address 79 'PA-. City_ 6A evu 15 State /,lam - Zip - Ca24,6 I License Number e-15 0'77 8 License Type Expiration Date 7/2o2,0 Contractors Email 4ot- Cell# rO 9 r4o T o.3 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR an a Town of Barnstable.Attach a copy of your license. _ 12 p Signature Date l! a / 9 S Section 10-Home Improvement Contractor Name ,f. ft.,r* t-o S Telephone Number S©6 ,f6o Address 7�; City eA ti-,j(.5 State rv%4 Zip d d Registration Number 13.2 W 6 3 Expiration Date ©a Z 07 o a I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the T of Barnstable.Attach a copy of your H.I.C... Signature Date l ( .2l q Section 11 Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature � Date d Print Name , 6 ?T Telephone Number 03 2 E-mail permit to: 1o1pe-od1, ee , ,.�s P N� Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval: Section 13 — Owner's Authorization I, <e-y-^ 62 J, . d,-, , as Owner of the:subject property hereby authorize to act on my behalf, in all matters relative t6 work au orized by this building permit application for: 6� ® 36AX 4-ail- l N� 0.14 e, (Address of j ob) Signature of O er _ date Ka-4Je e.4 L Print Name - I Last updated: 11/15/2018 A Town of Barnstable *Permit , THE Building Department Services "�c6itofe f e • amwgmBm • Brian Florence,CBO 0 9. Building Commissioner s6;q. � iOlFo t�t 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ` CProperty Address J i� A Cc ik3 r q /1,]Residential Value-o� f Work-$� co Minimum fee of$35.00 for work under$6000.00 'O\er"wn -s Name-&Address-" Lrl�)F j� UJ$ of ! 4A - C PC 1 I II MA Contractor's Name Telephone N Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check_one:"_'.'� ❑ I am a sole proprietor k�h 2 6 I am the Homeowner ❑ I have Worker's Compensation Insurance �`��I/►fit ��� LL Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Pernut'Request-(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) JE�Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: •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:=4,�j kiln M &VhA Q:IWPFILESTORMSUilding permit forms\EXPRESS.doc 08/16/17 J f The Coas=o7nvea1&gjfManadruxdts _ ��aak�er�t cr,flft.�dr�b��cr�r��xt► Ore UaTI1?V�Ftlga (#71S Boston*CIA O2111 impt tma=gorldia Wurke& CanrpensatrenInmumuce Affidzvit-gnitders/ContractarsMectri "in fibers Pleasel-rmt I f SffiBUSffleSS�OIg�t2an zina _ �CM�_ JQ Ph. Are you an emplayer?Checktheappropriateba= ' Typeaf project(required): L❑ I am a emP 1 � 641 ❑I am a general coot mdar and I P 6- ❑New constmc6ba employees(full arYdfor part time).* have hireti•tfte snFr-coak�at�tozs 2-D I am a sale proprietor orgartuer- Tisfed aafhe,attached sheet. ?. Ell Remodeling These sab-cardractors hale s4ip and ha��e as employees $.,❑Demolifioa worlds„ forma in any capacity employees mdhave Wor EM, 9. ❑Building ad&iaa. [NO SG� comp.insurance comp-i[MM M I ❑ We are a cmporafienand ifs 10-❑Elr rhir�l reps ar adds 3? F aim a meager doing aI�vFar3c . ofllcers 3rave exercised fi %r 1 L❑PhmA ingrepairs or moos• se1E ers right of ege�tl P 7 . � �o v�utk .152, I( aadwe have na I')-El finmiance ietE ired][ C. employees.[No workers' 13_❑Other comp.IIIS<tLES'M required] '$ayapg&a 6sa[cbecsboaflmn alsoMoottheswficmbe1 wslundagfliea•amimeco=pBn t apmRqYiuF==5aL fi Somevaraecswho cabaret dris�dat�2 i eating they arm daiag agws¢ic su$tfieahaE ant9dCrernhartmeTmGF submit anew sfda7t inMrWt;na=rh fGaaimcturs 2d�e&tbjjbaxntias[scadseaffiaddiSmal shed shavdng the nme,of[be=nb-c mXudststevrhedMornot•druseeatitiesln-P- er LAMes.If theaub-caalsactashaveemplgw-,titeymvsI pmtade&ek wadkeWcmp.paHUmu bm I arrr are hmiraitae or mp en2ployeea: $elope is$[c�gaiicy,and jata a informaliam InSurarlce Company ifame: Po-ficy�or SeFf-m;s.Liu_�: �piratiauI?a�e: , Job Safe Address: Citv/StMWziP: Af f w&2 cagy of the workers'comppensation.policy-declaration page(shoving the policy number and expiration date). Faitore to secure coverage as require3 under Section 25A of MCL a 15-7 can lead to the imposition of criminal penalfses of a flue up to$Ua0:OD awYor one-year inpisonmeak as well as dvd penalties,sa fhe farm of a STOP WORK ORDER and a fhe, of up to$250-0!0 a day ag-ainst the violater. Be advised that a copy of this sfiatement.maybe forwarded in the Of of lavestigaiiom office DIA for i�nsmmce coverage y�frc�3ion_ ,Ida! ffly a the pains ' a.f try atfJ[s ucfa[rr�a€ioltprmutedabm�s is bus a�zd correct Ss r � :9,f jf£ial aw wily. Da not asrite in tih area,ter be sarupkad by[airy ortonrn nfrecat My or"Town: PermitUcense# Lssaing An irmr€ty(drde One): L Board of Healtli 1 Building Department 3.CiiylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Conact Person: Phone it: — -- - -- 6 e#is Geb=-I Laws cTzapiet M req==an employees to - way°camp ion for flies employees. =N. - fie,as�kyee is d�imed as¢.=UPersonin. e s avice of sour tmd=a¢y cMff�ct ofliae, espre ss or- Iiecl,oral orb." An���is as"au mdividnal,pazinmship,asso�i CMporaiion or oih=legal may,or may °or more of the=foregoing in aJoint Mbrpd=,andinclndmgIie se es of a deceased employer,or f= receiver or trastee:o andividnal,per,associai2on or. erIegal WtLty,�y g�P]Dy�- However the ownerofadwelliizg ebavmgnotmoretbantlnee artn and Who residesti�em,ortheocafi3ie- dwrlEing h ouese of who employs pegsans to do ,r-rn,ei act on or repair uric on.such dwelling house or on the g}oumds ar aPP iheaein sbaIlnotb ofsnrh employmea&be deemedto be an employes:'° MGL charpt 'r I52 §25C(6 states that"everysfate or =1 Hcen�+b agencyshaIl pPItilhoId ffie issuance or renewal of a Ticense or pe to operate a B ess or construct bundiags in thin commanweatth for may r " the msurance coverage eq��- odn acce fable evrdeaca of camp�ance with _ _ applicc�ntwho has notpr p AdditionQy,MGL chatt=152,• 25d J star aldeiti= a co mal i wr lay of its political subdivisions shall enter into any contract for the p of Public uaml acceptable evidcuce of compIi ancewifb.the insurance._ req�enEs of-iris cueshaveb presentedto the ardiioizfy:' APpHcant. Please flI o the worl ''imp affidavit coaPI ,by �boxes that apply,to your situation and,if necessary,Supply SIDII {s) s., e) Phone— m(s)alongwithfheircexticatr(s)of insurance. Limited LiabOy CorTamcs `C)orLbait5c.11ability Patieazhigs(LI P)Twi ino MEPIoyees ot3ier than th e members or parfnexs,are not reposed to works'cz mpeasalion i asrnance. If ao.LLC or LLP does have employee:.s,a.policy is required. B e advised this affid Yit may be sobmtue d to the Depar mcut of lndnstrial Accidents for confumatifln of msmrmce co Also I a sure to sigh and date the affidavit The affidavit should be�retnmed to!he City ortownthatthe appfi f&the emit or license is beingrr uesfed,notthe Depaz{menf of Iu!dtrs[r Acci dent s. M onldyou have any � dmg the law or ifyou are required to obtain a workers' comp ensationP oficL please can the Deparfoae t• ''the er listed below* Self-insured companies should entcr lh- self-msoraace licensemnmbes on the Cay or Town Officials - r Please;be sore chat the affuIavlf is completes and . The Depazimenthas provided a space of the bottom of the affidavit for you to fill out in the event the Office f Ti vesdga �s has to co�ctyoaregarding the applicant Please be sureis fi7lm the e�it'/licemr-number • used as areferenceammb= In addition,as applicant P that must submit maple prmIItllicense aPPlit�iions is year,need only sahm3t one affidavit m& ting cat policy infoa,�ation(ifwzess-my)and under"?ob a e applicant shouldwrite asII locations in (may O1 town)-"A copy ofthe•af�davitihathas been officially o� bythe eiCy or townmay be provided ib the ' applicant as proofthat a valid affidavit is on file;for p Iicewm Anew affidav$rmrstbe:fiIled out each year.gdh e a home owner or citi=is obtaining a - or p not zrlafnd�D any business or commercial vim= a dog license or pmmit to bum Ieaves et-.)said p is to complete this affidavit. Y The officeOfaVtsEgatj=woualt mto:thmakyoua ce fury ,cooperafi_and shouldyouhave any qumfnuns, please do nothesifai-,to give is a CA The Beparfmenfs address,telephone and fax m=ber; . ' C=MMTMtth of Depaxtaient ofJli A� is Office Of Ragtm."M&owl Te1.:t 61-1-' -49 0 cixt 4.06 or 1-9 MA&CAM Fax#61772-7 7M Rmised¢24-07 .m �r�t Town of Barnstable Building Department Services �THE Brian Florence,CBO Building Commissioner ' s�sr,►u, 200 Main Street, Hyannis,MA 02601 � www.town.barnstable.ma.us 165 M� Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print ATE:��,—- — y JO[�B LOCAT10N-._ r C(j O A rV I number street village "HOMEOWNER"_' A&M A01 7�� ' 61 , 9 name home phone# work phone# (CURRMCM—AM!�G-Atll) old ,%e W) cityhown• 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 uermitT(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 o dure d ents d that he/she will comply with said procedures and requirements. - g`r k_=-of-Homeowner f Approval of Building Official Dote: 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFHM\FORMS\building permit fotms\EXPRESS.doc 08/16/17 J �V Town of Barnstable wilding Department Services ` A ` Brian Florence, CBO ►`� Building Commissioner 200 Main Street,Hyannis,MA 02601 d/ www.town.barnstable.ma.ns J 1 Office: 508-862-4038 Fax: 508-790-6230 Property Owner M t Complete and Sign Thi Section If Us' A Boil r I as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work thorized by this b ' ding permit application for: ( ess of Jo **Pool fences and alarms are a resp 3 nsibilitp of the applicant Pools are not to be filled or utilized befo fence is installed and all final inspections are performed and�cc pted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 i " Town of Barnstable 200 Main Street, Hyannis MA 02601 508-862-4038 a Application for Building Permit £� ��I? 1 PP g Application No: TB-16-1619 Date Recieved: 6/8/2016 (24kAl e Job Location: 697 OLD STAGE ROAD,CENTERVILLE Permit For: Shed-Residential-200 sf and under Contractor's Name: SALT SPRAY SHEDS State Lic. No: 179394 Address: 235 GREAT WESTERN RD, SOUTH Applicant Phone: (508) 771-4195 DENNIS, MA 02660 (Home)Owner's Name: FULHAM,GERARD A& KATHLEEN R Phone: (508)771-4195 (Home)Owner's Address: 697 OLD STAGE RD, CENTERVILLE,MA 02632 Work Description: Building an 8'x10' storage shed Total Value Of Work To Be Performed: $2,331.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative'of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Gerard Fulham 6/8/2016 (508)771-4195 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $2,331.00 Date Paid 1 Amount Paid` Check#or CC# Pay Type Total Permit Fee: $35.00 6/8/2016 $35 00 Paypal Paypal Total Permit Fee Paid: Y $35.00 .�"`� a a�� o- � �� � � try '� �. �� t i, �� • ��x // 4. .cam ' Assessor's map and lot number ....... ... ... .. ... . . . . ...... .. ... ?H E ewage Permit number j y1�� . ........... 3 _ ABB TA DLE House number ........... V, M a i O t 39- f0 NAY d. TOWN OF EARNSTABLE DUILDIHG �" L SPECTO APPLICATION FOR PERMIT TO - l AA,, D 0C ��-�1.l..!!.............................................. TYPE OF CONSTRUCTION .............. . ..............1.../.././.. .............19.. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereb,,,applies for a permit according to the following information: t � Location ...... ............... ..... ..... ProposedUse ....1....................................................................................................................................................................... Zoning District .....C.....R TA...pI..I.... ....................Fire District .t�i.�t.✓..V...l..��.v.tl..,���. .. .. ... ........ Name of Owner/...1.11ex ...............................................Address ..�"T l'. ... ,/) ........... .... Name of Builder" .16.�`...... .....! Address��..�.L/......./.,A- A 4 .... ... ..T.... Nameof Architect ..................................................................Address .................................................:................................. _/ � � ' e Numberof Rooms .. P11!.,........... ............�............Foundation .............................................................................. Exterior ...lr.t. ��............ .:Q ..1.`'�............Roofing ..... ....... i Floors .....................................Interior ......... f "---Heating_._ ..:. /4 . ......................... .. - ......................................... .Fireplace .............yl" .........................................................Approximate Cost ... .... ..wit .......................... Definitive Plan Approved by Planning Board _____,------_______-----------19________. Area .. .. OQ Diagram of. Lot and Building with Dimensions Fee - ....... .. ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. o NameI..........................✓..V... ....... ....................... ` T /'rmer THO28PGO�, �I ��� Bnil�lNo —����.�.�. Pern�it for _ � —. ` � ' ~ ' S ' u le FamilyDweIlino ' 1 ----''~^—'—~--'`'�^'--''~''=-'~`—'---' ' � 697 OI�� Stage Rd. < Location --.---.---------------.. , | ` Centerville —..--.--...-----------.------.. , / Allen Thompson ` Owner ................................ � . Frame ' Type of Construction .......................................... -~--..—.�-----^.—.^.---,�--.---.. ~ ! ^ Plot ............................ Lot ............. .~ � . � i Ja���z�. l8, 83 t ' Permit Granted -------------]g � Do�a /7�w�� l x ~' ^~r~~~~' --°''"^�''°-----' ^- . | ' Date Completed ---- � ��~~� . ~ ' ' . . . / . ) . . ~ . ` , . . . . . . ~ ` . . . . . ) ' . s map and lot numb er . ......I. L SEPTIC Sys ,t INSTALLED ► � � ..............: UJIT1i Af` �CiX 11 S (99Pt.A Sewage Permit number .................,. .........._,........., SANITY =l1 R CO, Q�OFTNEtO�♦ TOW OF BARI ri Z BAWSTADLE, i SAM 9 N BUILDING INSPECTOR �D pY a' APPLICATIONFOR PERMIT TO .......... ....�................................................................................................ TYPEOF CONSTRUCTION .............. ...... ✓o................ ................................................................................ ................. ......... ....... .......19:74 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: well Location ....`1.. .. .......... ..►...!`T. •............!.... . ............................... ��- ................. .................... ProposedUse .......... .J.(.LN...�.................................................................. ....: ................................... �Q wk Zoning District .............If1. ................................................Fire Distract .....�R .........................................�......... Name of Owner ..... ... ..........Address �.j•Yd••/• ................. Nameof Builder ....................................................................Address .......................................r........................................... Nameof Architect ................ .........................1 .............Address .................................................................................. •, e t Numberof Rooms ..................: ...................................Foundation ....................� ................ .....`..:..`........... ........ Exierior ........... J? .......... '�. ,�............Roofing ................. .. .. .1.:.1..................................... Floors '���..................................Interior �.Cif Heating ......... '+ c........ .............Plumbing .....................1........... ........................... Fireplace ................ ...............................................................Approximate Cost .............. .................. . Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ........U7�..., :........ Diagram of Lot and Building with Dimensions Fee .......... ! ..�............... 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 .... .. ....... ...... .—..................^.......... ` 17840 one story, le W�e �x�e��. ������x.. --------. ' ~Old Road . -_--...� __- \��------.~------------ . , --------.�����������---------.. Owner ----J�..yC�. _________. . , Type of Construction .............fraome.................. ----.---------------------.. . ' ~ � P|ni --------'.. �� ----'C_____ � ^ ' July 22 75 Permit G,onu»6 ------------..�lg ' - - . � - - -^ - ^ Date of Inspection -----------��]A ^ Dote Completed �������/.���-----']q ' - � . L� � PERMIT REFUSED -----_—.------------- 19 ° i --------^------------------ ` _—~----.--.---------------... -- . . . . � ...--------------..--,.—.---.— . _ ` ----.-----.-------..,-----.,.- '- ` . . ` Approved ---------------- 19 , ' --------.--------------..--.. ' . . ...............................................................,.........,,' , � | 4� �a g41 Q 4 t 0 , a sQ49 i c �- D r L 1_:_ F �.. A. IV ..:. ..: C O C A T t .t•0': c ,vTE,e yic-,c E_ i C, ALL -DATE ✓ci<.y rB % } WE P'C'WE N C E: Bpi vc �o� z As �t/ow•v .�07--C':' � :S�vc�,ci. ov 4 ,0�:.9�v;e.ECc�o�� . .f L J L•'7� ,1 � , � �;�. D A T, E_ — zme-C_pS ZAi PGAN .BOQ{� 2�l� /—,QqE t RE`RESY CERT.lFY THAT. THE` 8Ui L D I N G REG. L ND SUR_V YOR SHt)'VrFN ,0N_ THIS P:LA,,N e9 : L.oCATED ON . . G tOUivD" AS `SHO..WN HF_REON AN0 T 0.N F O R M T O T H E Zti OF . CAwS :..OF tHE F.OWN OF W H E' N C...O N S: T R U'C T E D, 4 FORCE G -LOW�yR x 4 L < NSTf+rBLE SU'RVE°Y C`ONSU TANTS,` 1NC �L�Gis��'��b� � Q,. W E`-S T Y�A R M O U F M� ae e S g z.