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HomeMy WebLinkAbout0092 SKUNKNET ROAD ��u s .. , - _ , _ . : , ��. .. �. ,�- :� _ N � _ �. e .. . F . . .: , � �. �� i ,� { r. 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 191 Parcel III Application# uV� -G Health Division Date Issued tb 0 Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 9;) SKutiK"ET 90Ab Village ��uaE6Zydu� Owner f RA"exs #%A• pv%_SiFM- Address 'SAOA Telephone Sol?--1-IS- ►opq Permit Request `RF-C-0 '>TT%0c._T PWPT E9J'Tit-1 1)LA;FbtZ.A4 ��q lets y F� .T Square feet: 1st floor:existing 1-75(m proposed 2nd floor:existing 01A proposed / Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑,No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes 1VNo Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) a Basement Unfinished Area(sq.ft) IsIL. Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing —new First Floor Room Count —1 _ f Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other C:l Central Air: ❑Yes X No Fireplaces: Existing _New Existing wood/coal stove: ❑Yes No a _ Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new. size3 Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: `= Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ,t rn Commercial ❑Yes j No If yes, site plan review# Current Use Proposed Use BUIL_-DER:INF•ORMAT OI N Name � `S dU1• �.,�s� Telephone Number S'09-°775- 10I Address 9`4 License# aoTmvIuut, AA C3�b3`� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /Q6 _i_kAk5AZ S;-mpok) SIGNATURE DATE (0-1O-0-7 5� 1 FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL NO. < ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION F FRAME INSULATION FIREPLACE f` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 4bl i 41,271 p W , w DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofMassachusetts Deparfinent of Industrial Aecidents Office of Investigations 600 Washington Street Boston, .LIMA 02111 , www.mass.gov%dia Workers"Compensation Insurance.A€fidavit;,Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print LeQibIY Name,(Business/Organization/Individual): R An C_oS AA- . PVLS,F'tk �Address:T- I'D So"O J"er Ro.•8 Cit /State/Zi C - yiLLe � �� Phone.#: 509-325- 100 '. P. } Are you an employer? Check the appropriate box: -Type of project(required):, 1.❑ I am a employer with 4• ❑ I am a general contractor and I employees(full and/or partalma).* have hired the su*b-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 g• ❑Demolition workingfor me in an capacity. employees and have workers' y P ty 9. []Building addition [No workers' comp. insurance comp.insurance.$ re aired 5. 0 We are a corporation and its 10.❑Electrical repairs or additions q-"'�`] ' officers have exercised their "3XI'am a homeowner do gall work, 11.❑Plumbing repairs or additions "' ' �-'�'� --= �•- F. right of exemption per MGL ' rnysecl ,[No workers comp. 12.❑Roof repairs �smance required:]t' c. 152, §1(4), and we have no employees. [No workers' 13;A Other ex,M5 t.R-, 0 comp, insurance required.] , 'Any applicant mat checks box#1 must also fill out the section below showing their workcrs'cmnpcnsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entitics have employees. If the sub-contractors'have employers,they must providb their workers'comp.policynurnbcr. , lam 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 ofMGL c. I52 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certifya.rnder thepains•andpenalties ofperjury that the informationprovidedobove is true and correct .-. y Simature: - Date"[" C?"I0pU7 Phone #: s-oa-T7S-i ool Offzcial use only. Do not write in this area,Yb be completed by city or town aj1j7c1aL r City or Town: Permit/License# Issuing Authority(circle one): ' 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector S.PIumbing Inspector 6. Other Contact Person: Phone#: °FVE�o Town of Barnstable Regulatory Services � r�iE$; Thomas F.Geiler,Director °rfo;9..,p�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 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. Type of Work: -PE31J►t7 O7tiz`i Pcq, 2.�1/S7`h�S Estimated Cost '3bp C::AddIess o'f Woik' qa Owner's*Name:<�-T_4L*X1S kA. �v LSt F� (Date`ofApplication: )0-10'0�7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK 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. OR , Date } -6er's,Name t Q:forms:homeaffidav 4 . , 1 �oF�Ht T Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F. Geiler, Director MAssi 039. ,�� Building Division TED�.t A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10-10-01 JOB LOCATION: lO1 �11ti7iatGJJE �� CF1JT£2yttlt number street village "HOMEOWNER": iC.� Da-'?-75- 1001i _-jD8--790-WYIS name home phone# work phone# CURRENT MAILING ADDRESS: %) '!SK vuX►JE-' No Q AAA Oa63a 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 requirements. Signature ofReAeowner 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 cominunities 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 caret amend and adopt such a form/certification for use in your community. FA Qid kSf 2 ( f f sr UL LL y3 f `-9 } ` + I Ti CD W i E b Pa i LLI I ' t 4 0J) 9 au g j O ' ee J v Uu Ile 9 5-1 10 co q 3 p a i ` II •A9 a to t f}F C- o�7NEtp TOWN OF BAR.NSTABLE i 8ARNSTLBLE. "6 Q19- M BUILDING INSPECTOR �FPY a' ' APPLICATIONFOR PERMIT TO .... ......................................................... f............ .................................. TYPE OF CONSTRUCTION ....1:�/pr! ....... �i .� `y�. :~; ......' ' '....................:'......... J r .........................3. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location L.67........�.....�ffU�/f./f/ .......�,`,�a.........0 .....................:........:... ProposedUse .........:L........................................................................................................ Zoning District .................................Fire District ..�� ':-.. ........................................................... Name of Owner .V+'V FSTf} � e/tvV Address U y �rJ 1 C6 N%f4 Name of Builder �= ........CG.. ..........................Address ./f.../:.... os............ :.... ...................... Name of Architect .....5. F ........Address Numberof Rooms ..................................................................Foundation ......................................................................:....... Exienor ......o°D..... �p�` ��'....:.........................................Roofing ..../ .....!/-.......L/T1.................................................... �'vGA &vim Floors ` ...........................................................Interior ... .. .................................... .... ...:.................:...:..... 14 Gv T� ' Heating '�...............................................Plumbing ...... :... ........ C ....... ................................... Fireplace ..... ..5...................................................................Approximate Cost ©U U......................... ... . ... ... Definitive Plan Approved by Planning Board s____________________-----------19________. Diagram of Lot and Building with Dimensions ��, SUBJECT TO APPROVAL OF BOARD OF HEALTH Co � �® � Q-- 5 r fp0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ ................................. ` ~ ' � / ' ` ( Y � � ' ' . 1 single family dwelling Centerville frame -1 73, ` ^ i rZI ' — PERMIT REFUSED � =^ | lV ' - ----' ----. | � . --...-------------.----. / __________.____.,,_.._,_ [ ~. Approved ' / ................................................ lV ' . -----------------.—.—. -------------,—~~—.~—. . , ^ '