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HomeMy WebLinkAbout0052 STANLEY WAY �� �-1.�.n 1 e t r � �.. _� � � o ., e 0 n� n � a �� a ,. ... _ o ' 'S Town of Barnstable *Permit1.30 71 Expires 6 montl from rss a date Regulatory Services Fee • �xxsT « 1639. �0 .42013 Thomas F.Geiler,Director TOy�/N Building Division �-7 Bp Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 �8 1,5 r EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number -^ C Property Address .> S�-ra�cvl��� why CaPWN-e-our kX� 0�� � WResidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address avl k M.AJe 2 S(ztl�1 Contractor's Name . p j4,, - Telephone Numbe;9aT Home Improvement Contractor License,#(if applicable) Construction Supervisor's License#(if applicable) C C3 — Q[)!3 IR T 7 . ❑Workman's Compensation Insurance - Check one: I am a sole proprietor ❑ I am the Homeowner - ❑ I have Worker's Compensation Insurance Insurance Company Name Workman,sComp.Policy# . Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) . ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side #of doors Replacement Windows/doors/sliders.U-Value 3 _(maximum.35)#of windows ❑ Smoke/Carbon Monoxide.detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: _ _ ,4kr)n Q:\WPFILES\FORMS\b ilding rmit forms\EXPRESS.doG Revised 053012 r Tllte Commonwealith s,f Massochuse& _Dqlwhnent ofl'ndnsfrial Acciden s 09we of Invesgigadons . 600 Washington Street ,$asfon,MA 021.11 wwn"maMLgMAdirt. Workers':Compensation Insurance Affidavit Bnilders/Cn ctorstElectricians(Flu nbers Applicant Information Please Print Lelub y Name Address_ CeC�� Are you an employer?Check the appropriate boa: T of project r 4. I am a.. contractor and I � p ] (required): 1.❑ I am a employer with ❑ i al 6- ❑New tendon employees(fr,11 and/or part-time).* have hired the sub-contractors 2.. I am a sole prupfietor or partner. listed on the attached sheet. ?- ❑Remodeling These�:sub-contractors have ship atul have no employees: $_ ❑Demolition wodring forme in any capacity comp. havewo�ers' ❑1 9. Biding addition [No workers'.camp.fnv ranee omp.insurance - required-]] 5. ❑ We are a corporation and its 10-E]Electrical repairs or additions 3.❑.I am h6 eo doing all:work officers have exercised their 11.❑Plumbing repairs or_additions f o workers' right of exemption per MGL �� �. �F 12_ Roof repais insurance,re. ]T c.152, §1(4),and we have no ❑ employees [No workers'. 13.�Other psi v�9tAJ cam-inswance required �tny applicant fat cher ks boy#1 umst also M our the section below show mg then wmlets,comtpeasatioa policy iaformatium. 13oweflarn m ma rho-b n t this affidzvit indicating trey an doing all wmk and dum hoe outside connectors st mobmit a new afdnk indicating mclL lGo�actoxs that.check this box mast attached au additional shot showing the name of the sub-comma ins zn d:MU whedwr ornat those entities have, �emplayees.Iftbe:sub-cmbactrnskmemployees &e3'mnist provide&air workess'`comp.policy number. lam all employer that ispm iding workers'compensation.insurance for my emluln}i e& Below is the policy and job site. InformatimL Insurance Company Name:. Policy 4 or Self-iris.1 ic.#: Expiration Date: Job Site Address City/StateiZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure those cure coverage as required under Section 2SA of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1;50Q00 and/or one-year imp sonmen as, as civil penalties in the form of.a STOP W©RX ORDER and a one ofup to$250-00'a day against the violator. Be advised that a copy of this statement may be forwarded to Office of Investigations of the DIA'for insivance coverage veri Lion_ I rfv hereby certrfj,under thepain s and penalties e>f pRrjury that the information pr ov Aid above` true and correct Si Date: l Phone 9. . U,( ,ciat use only. Do not wrote in this area,to be completad by city or town arjjrciat IT or TO PermitlLicense# LUning Anthoriity"(tame one):. 1.Board of Health 1.Building Department 3.Cityfrown Clerk 4 £Iectrical Inspector 5.Plumbing Inspector 6.dther: Contact Person: Phone t!: 6 • * BARNSUBLE ' ,m Town of Barnstable A N10� Regulatory Services Thomas F. Geiler,Director Buildings Division M1 Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ifia.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section _If Using A Builder dit LA S�Y , as..Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit,application for: 2W61143Z- (Addres of Job) Si e of Owner Date - �L V-ek- gin, Print Name If Property Owner is applying for permit;please complete the Homeowners License Exemption Form on the reverse side. F Q:\WPFILES\FORMS\building permit formsUNPRESS.doC Revised 051811 �t Town of Barnstable Regulatory Services sn KASS.t�. Thomas F.Geiler,Director 1639. Building Division 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: JOB LOCATION: ` number street village "HOMEOWWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 of Homeowner t 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 r Massachusetts-Depart n't of Public Safe Ay. board pF.;Suilding Regulattons and Standards Construction Superx icr- License.: CS-009857 JEFFREY M C��TRAD .T 535 PH]TWEYS LN CENTERVWLE MA 02(r32 V, !s Expiration Cb4imissionerm -_ 12/23/203 ; fvlle rta�urrra�r-raerrl�,t`r l�c�>rirltuell;. • Office or Consumer Affairs&Business Regulation License or registration valid for individul use only a4OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: & . registration 124074 Type: Office of Consumer Affairs and Business Regulation. x iration 5/9/2015 DBA 10 Park Plaza-Suite 5170 o®r p Boston,MA 02116 Conrad Remodeling Jeffrey Conrad 535 PHINNEYS;N CENTERVILLE,MA 02632 Undersecretary 4. ot valid without signature { 9 - ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION aS 80d3P Map Parcel,' Application # O-4� Health Division Date Issued Conservation Division Pt- w&A -D4 - 0037 Application Fee Planning Dept. Permit Fee . O Date Definitive Plan Approved by Planning Board A �/?/a&- Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner F Address_Ti► Telephone r Permit Request it ?-ejon Ph Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )i( Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes No Basement Type: A Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 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 Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: >(Yes ❑ No Fireplaces: Existing New Existing wood/c al stovQ❑ ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ &..sting Qinew=size_ Attached garage' existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: '' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ iy Commercial ❑Yes XNo If yes, site plan review# W Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNE s �---- � � �me Teleph ne Number AddressLive License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �I,✓II°n SIGNATUR lfi ►^ DATE / i FOR OFFICIAL USE ONLY ' APPLICATION# DATE ISSUED MAP/PARCEL N0. i _ ADDRESS ! VILLAGE OWNER ] I DATE OF INSPECTION: s FOUNDATION Sages a 7 lSDas FRAME INSULATION FIREPLACE �i = ,E ! r ELECTRICAL: ROUGH FINAL r � PLUMBING: ROUGH 'FINAL GAS: ROUGH FINAL r FINAL BUILDING b SDI JD� i a DATE CLOSED OUT • ASSOCIATION PLAN NO. J J i f - af�He, Town of Barnstable . Regulatory Services BA MASS. • Thomas F. Geiler,Director 0►3 �9, Building Division ;. Thomas Perry, CBO,Building Commissioner " 200 Main Street, Hyannis,W 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW <eh W e�- Map/Parcel: Owner: t Project Address;52 S-6.Jh v " / Builder: O w WLs- The following items were noted on reviewing: os�' eel Conn Reviewed by: — Tt'� Date: 7/1)©p bey Lf UWE Q:FonnsTInrvw f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 'Applicant Information Please Print Legibly UT Name(Business/Organizationftdividual): Address: 4_Aa_ ,h &eY 4,ew City/State/Zip: Phone. `�— Are you an employer?Check the appropriate bog: Type of project(required): 1.El I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full andlorpirt-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 workingfor me in an capacity. employees and have workers' Y P tY 9. ❑Building addition [No workers'comp.insurance ' comp.insurance.$ required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions TNVysel£[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., tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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.M 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. do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct S ature: n/ Date: 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): 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 y 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." 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 until acceptable evidence of compliance 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-contractors)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 to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02 111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia r THE Tp Town of Barnstable �pF �y Regulatory Services BARNSUBLE, : Thomas F.Geiler,Director MA99 Fo3.ta•0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 vt'ww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HON'IEOWNER LICENSE EXEMPTION Please Print C". ATE: �'V_ OB LOCATION: number str t r villageHOMEOWNER': weiv ame hom 0hone# work phone# CURRENT MAILING ADDRESS: 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 be/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. GW Sign re 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 supevisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the liomeowner 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 fom✓certification for use in your community. Q:for ms:homeexempt 'I THE T°k� 'Town of Barnstable ` Regulatory Services r r BAMSTAB r a yLEA Thomas F.Geiler,Director 16.59. n 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 Us ing A Builder L , as Owner of the subject property hereby authorize 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 Print Name If Property Owner is applying for ermit lease complete the —�- P P P Homeowners License Exemption Form on the reverse side. Q :FORMS:OWNERPERMISSION. IV ------ ,-y r eta G4 C !'� P.�AI �1/ ORT .t :_r -- 7��VEd; CENT�RUILLE PA IL CANT: KENWERY _ ----�-- --. L,07° 6—,A 0 if i .�06'8p1 °' ,/. L�\�\�7! rJJJII JJr � h viii✓� � V ♦!//M .11 /rf/JJ�j�'1�( p; lJr , 4p �► �j�7 .16SS4 q r r EA EA J s Sq'HE' 4 OWL LOT 6 -- [PC], ED:$ 7/Z�92 -.. DATE MA RVI5 0' 001 � 3 FLOOD ZONE GAr; 1„ 3 . FLOOD PANEL: 250 �. DATE; 3/17/da PLAN REF: 199=7. I NfRL6v CE'CIFP ,AT '9�MOArrP E IN9PECr�'7 PLAN HAS BEEP!PREPAREC 6f1R; �afGf'' RfF: 164�7-3q7 CILt„ >3E�N & WHi rc NE LCCA'�N 6F THE DTWE U1eC gt69N a0E5 NpT CALL 04M N A 5PECIAt f zQNI�R lllU�1Ec q yyRVEY IS Y WAS RY FOR PRECISE QET1 RMUtA1�ON�BPtiDIHG LpCAT1UN5• YGNPAL O MENEIfi/LL SE r iNLY. SE NO 4NS1RULtEN7 SURVEY WAS PERfpR6{E6 ANO ctlCATI9N6 5 iuAN nHo uCMATE. 0 1 PEp tAISPECYlpN THE OYffJ UN9 APPEARS YD 60NFpRM Tp THE IOCAi EQNtNG MriAYi9 IN EFFECT 1HE STTiUCTUREB SHOriiI IR �11 gT�TMEr'1 W►Y ACRp68 Pt#pPFW^ LtNKgnYANKLU LAN0 e.R A Tli RESPE6T?p HpR AN,INSTfYUMt:N AT @af.'RM°!•iF.94NSfRJrflJ Yfl ' / AN,EH{SeGARtNENTS� IF ANY E ,Rll H niE ANY MEALL RE 9r,lSl,BE,S OF'NAT-NSCFAR SURVEY CpsiPANY W g4sµ1 NpT 8E A1l OOG FCft OAMA4ES RE3U�i1N3 FRpiA,AN U pR f-fi Yf'T `.Oln 'l:T�7,^i7 F^R.EF'FPBT AC110N UNDER MA GENERAL 4.GH CHAPTER kpA TGACE WgpECTCN. E ,T „�^sFFAeuCE OEEP 3NF3:ki. or pF THIJv PLAN FOR PUflP3SE5 CT1iER-/'1l�IA/N�y��/y�R//� J�yrty� EAE£MEW 8 F.!£Jlt�k WhA' SCE A C OF".CT.RECORD, V Lf l�d P •' ' :L INC .. AS THE 96A�r ARf O>:, t c. ®q���o0s5 YJA� KEE LAND SU-V��PY TELEP,��' 1� SL:�' 40 industr / Road, MG stOns Milis, MA02648 FAX;- 500-470-5553 pnkee5urv��r@c0rnGcst.6et www.ycnke0sjrvey.,4om �9562 J� i a i ._. .wen-+•.wm.. r. F � a ..w ._ o sue. v sZ ® -a IF- VN Q } 1 PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 06/07/07 TIME: 15:43 --- ------------TOTALS------------------ PERMIT $ PAID 50.00 AMT TENDERED: 50.00 AMT APPLIED: 50.00 CHANGE: APPLICATION NUMBER: 200703508 PAYMENT REF: CHECK G • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s Parcel Z Application# 0gq U Health Division e Conservation Division `?,OP` Permit# Tax Collector Date Issued Treasurer Application Fee t y Planning Dept. Permit Fee 4) Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis *0000ON le A - Project Street Address 1 t0 zx Village _ e_ v,( l'i Owner e_ e ddr ss Telephone S D 7 7 Permit Request v t o Square feet: 1 st flo :e ' ti proposed 2nd floor:ex, 'ng proposed Tota w Zon4 District od Plain rou wa r Overlay Project Valuation � v O Construction Type ll Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orti do ment Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old ng's hway: ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other �( Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new umber 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:❑existjng ❑n1`5?J size, L Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: , `j CEO Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes X No If yes,site plan review# ) M Current Use e S�(1�edl �-1 Proposed Use r- r BUILDER INFORMATION Name G//���0r10 i15=P_ Telephone Number 2 %/ Address C 0, -9,1 w /�� License# Y- 5o :7)e-w71,7I Is p .,) e�4 r Home Improvement Contractor# /o Worker's Compensation# NZzi ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c� f SIGNATURE DATE r - j L FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED c MAP/PARCEL NO. 4. I � ADDRESS VILLAGE �. { r OWNER ' DATE OF INSPECTION: 17 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH F +FINAL R. V yy PLUMBING: ROUGH FINAL ' r. g GAS: ROUGH' FINAL N f FINAL BUILDING } DATE CLOSED OUT ASSOCIATION PLAN NO. ,, s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map "` Parcel A5 Application# p Health Division 4W� Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee fIX h - Planning Dept. Permit.Fee N Date Definitive Plan Approved by Planning Board Historic=OKH Preservation/Hyannis C16 ; Project Street Address Sim le 1,0 a.V Village yiIle Owner pea l,(,/e n�i,4,'04# Address •s S7� Telephone --- 3-0 A- 717la'.-' )o 01-5 " C� Permit Request Re� ►*7 y e-- 3 n2 jl nt- i, / fl I92-0 de' . Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay SC Project Valuationte,9F 0 O Construction Type Lot Size ` Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. a� k-i Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Q Age of Existing Structure f Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O No Basement Type: ❑'Full 0 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) t Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new "Number of Bedrooms: existing new t { Total Ooom Count(not including baths):existing new First:Floor Room Count 1 J 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. s Zoning Board of Appeals Authorization ❑ Appeal# Recorded U. -„ Commercial ❑Yes No If yes, site plan review# r Current Use f 1,5't C`(e 441 cl�_.,/ Proposed_Use d 5/C F' % I/C / / BUILDER INFORMATION Name #°2a)Ia let /'P /1 Telephone Number h' 2 } Address 1 691 D, '13o 7 License# So e,,lo r::s 0 Home Improvement Contractor# /0 Worker's Compensation# /Y//"/ ALL CONSTRUCTION DEBRIS RESULTING.FROM THIS PROJECT WILL BE TAKEN TO �B .SIGNATURE 1�.�1 �.Y..�'`�..•�-��,' _� ' .. t .1� c��.. �� '`DATE �t. �V _^ _:.h,�•-: FOR OFFICIAL USE ONLY o PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street er Boston,MA 02111 M 5 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): P_ o n Address: Q, 0 , Yo x- 7/✓r City/State/Zip: sm e_,i7✓71_s_ .�l� o duo Phone.#: 7 / �3�- 2 y3� Are you an employer?Check the appropriate box: Type of project(required):. L❑ 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.;K 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 �'• $ 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 11.❑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 �7jeejz, 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. 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 certi der the pains and penalties o perjury that the information provided above is true and correct. Si ature: Date: Phone#: 17 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#: 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." 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 until.acceptable evidence of compliance 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-contractors)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 to 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. ##617-727-4900 ext 406 or 1-977-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 vww.mass.gov/dia Town-of Barnstable Regulatory Services * sAxr!srAe Thomas F.Geiler,Director 9 MAM M Building Division Tom Perry,Building Commissioner 200 Main Street, Hyamis,MA 02601 Office: 509-862-4038 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: e16 l -�C'i ��'L Estimated.Cost Address of Work: c,� � C �? e Owner's Name: / li�P� w o Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE ROME 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 agen the owner: v'U 0. Dat Contractor Name Registration No. Dat Ownerr'sName Q:fo=:hcmeaffidav I RESIDENTIAL: SHE -POOLS—DECKS-OPEN PORCHES-GAZEBOS FEE 'VALUE WORKSHEET APPLICATION FEE: $50,00 BUILDING PEPJM FEES: ACCESSORY STRUCTURES >120 sq.ft,(Sheds,gazebos,etc.) >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 USE DIEW BUILDING PERMIT APPLICATION x$30.00= $ 30 , 00 DECK (Number.) , Il�GROUND SWIlVlN1�G POOL S60,00 $ ABOVE GROUND SWilYIlYILNG POOL $25.00 $ RELOCATION/MOVING S150,00 $ (plus above fee if applicable) _ PERlYIIT FEE $ 3a', O Q:forms:dkcost ' •�V:Ofi3004 r °FTHF To of Barnstable, Regulatory Services �Bbun '$ Thomas F.Geller,Director �'ArED;9--A' Building]Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 5 08-790-623 0 Property Owner Must Complete and Sign, This Section If Using A Builder I, as Owner of the subject J property herebyauthorize o 110_a CS"1)Z'i11J1 to act on my behalf, in all matters relative to work authorized bythis building permit application for; . �r 'e o Lug Cz> e © 2,13,� (A dress of job) Signature of Owner Date D Print Name QFOPMS:01WN RPERMISSION �4 r. j �. _._._........._..... __- r f d�f'3' �i Z4 g r `[Q J I t ♦ R �C �• � v 1 0'�x Im1 �p,s'�,3' � � to C)` ro Ax ., R•- a i" ✓!e �ar�mzaaus�,alt/c�../�craoaclauaelta^� I BOARD OF BUILDING REGULATIONS I it I License CONSTRUCTION SUPERVISOR h� " 1 Number CS 022842 Birthdate 06/05/1945 Expires 06/05/2008 Tr. no: 25096 1 ' Restricted 00_ RONALD A GIRELL'1 I. PO BOX 745 E S DENNIS, MA 02660 P , Commissioner � Board o mg g latio s�n' uae a lords HOME IMRROVEMENT CONTRACTOR ' Registration: 104441 -' zk Expiration Z/14/2:Q08 Type Ind�vi�RI:: R.ONALD A. GIRELIJ , _I 1i 20 SAMUE 'S PATHS HARtNICi MA 02645 :✓ i ti Deputy Administrator 7 cr Lz P-ma LLS—TE—C TION APPLICANT. PERI S WENTWORTH TO yWN- CENTER VILLE z LOT 5—A - C\T' , S�6,O31p E -"r o i LOT 5-B ` .wCO p,. OF A •93 68' n�,a`,� . 9C w - LOT 6 PAU! Gs a A. - e Ver—Pi«EVtl N0.32 �8 Q °�s00s loty�L Lp�QaSaa�asa F PANEL.`,250001_0005C FLOOD ZONE. 'C-__ DATED 8119185: fy that this mortgage inspection plan was prepared for.° Plan is For D FIVE Bank Use Only the' building shown does N_OT fall within a special flood hazard zone. PLAN REF.Th . _ _199173 e location of the dwelling does _ conform to the local zoning by—laws in effect ----- at the time of construction with respect to horizontal dimensional'setback requirements SCa1t' 1 = 30 _- _' FT. or is exempt from violation enforcement action under Mass. General Laws Ch. 40A -Sec. 7. Date. PLEASE NOTE• The structures on»ths,fnspection were located by tape not instrument'and are approximate only. An actual survey is necessary for'a precise determination of the building location and eneroacbments, if any exist, either way across property lines.- This inspection must not be used for recording purposes or for.use in preparing deed"descriptions and must not be used for variance or buildingIan purposes. This inspection must not be used to locate property lines. Verification p p p y of bu'tldtng locations, property lure dimensions, fences eo lot isja configuration can ily be accomplished by an.accurate"instrument"survey which may reflect different information than what-is shown hereon. This inspection is not tie used for any purposes other than mortgage. Yankee Survey accepts no responsibility for damages resulting from said reliance. K44NKEE SURVEY CO SUL TINTS FAX 508-420-5553 Y 265, 40 INDUSTRY RD, MARSTONS MILLS MA 02646 PHONE.'508-408—0055 34 786 LAM HE Town of Barnstable Expires 6 months from issue date Regulatory Services. Fee HAxxsresi.e. : Thomas F.Geiler,Director t Building Division ®F z0�8 Tom Perry,CBO, Building Commissioner 42 ggR�g, 200 Main Street,Hyannis,MA 02601 4,64JE� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Sla pZ/ Residential Value of Wor t C Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address mid. 1ver Contractor's Name _ Telephone Number Horn mprovement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insure Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) / Re-roof(stripping old shingles) All construction debris will be taken to `J"2 i^ h- / h ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side • r ❑ Replacement Windows/doors/sliders.U.-Value (maximurn,A *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 is required. 1 SIGNAT . Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents rA Office of Investigations 600 Washington Street . Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Iicant Information Please Print Le�ib� Name(Business/Organization/Individual): i C Ir Address: rr City/State/Zip: p ln-C G f✓(� 0?,Q 2Yhone.#: a —7 Are you an employer?-Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the stab-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 working for me in any capacity. employees and have workers' 9 ❑Building addition comp-instuanceJ [No workers' comb.inctirance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions X,,&Iuired-, ers have exercised their 11.❑Plumbing repairs or additions 1 am a homeowner doing all work offic myself[No workers' comp. right 6f exemption per MGL 12)K Roof repairs c. 152, §1(4),and we have no Insurance require&]t employees. [No workers' 13.0 Other, comp.insurance regtrirecL] *Any applicant that checks box 01 must also fin out the section below showing their workers'compensation policy infionmtion. t Homeown=who subunit this affidavit indicating thr, are doing all work and then hire outside contractors must submit a new affidavit indicating such. lConttacton that check this box must attached an add itianal sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-conbwtors have employcos,they must pruvidt their v orkcrs'comp.policy number. j am an employer that is providing workers'compensation insurance for my employees. Below is the poUry and job site in ormation. urance Company Name: . Poli #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 tip 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 instrnance coverage verification. - �do hereby certify under the pains•andpenalties ofperjury that the information provided above is true and correct -ature: Date: Phone#: Of use only. Do not write in this area, to be completed y 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 ( nntactPerson: ____. 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 hue, 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." 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 until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants l ;' Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s) along with their crrdficate(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 Towp 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 ono 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 to any business or commercial venture (i.e. a dog license or permit to born leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would h7ce 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 Massachusetts Department of lndusWal Accidents Office of Iuvestigatzonc 600 wash nPn Street Boston, MA 02111 Tc1. #617-727-490.0 ext 4-06 4r 1-M-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable �Op YHE T�ti Regulatory Services t Thomas F. Geiler,Director BARNSTABLE. 9, MASS. 16g9. Building Division JfDyA Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 wmv.town.barnstabl e.ma.us Office: 508-862AO38 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print (DATE:OBLOCATION: number treet village HOMEOWNER": name home phone# work phone# URRENT MAILING ADDRESS: 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 ents and that he/she will comply with said procedures and minimum inspection procedures and requirem requirements. Signature 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 1 o9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to dos*uch work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption sic unaware that they are assuming the responsibilities of a supervisor(see AppendixQ, 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 fomdcertification for use in your community. �t oF1HE?I Town of Barnstable Regulatory Services BA"M ■ ASS. '� Thomas F. Geiler,Director �{'Ar1639. �m 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 application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Is / r 7 Assessor's ma and lot number /p crTlwI 3 P.1UST BE �! .......................... Sewage Permit number .. ............ .............. _ 1 �G.... a.. •.i• LtD IO4p N TOWN OF BARN � T "LE ypi THE. M E T��y . �4rP C� i 89SB9TSDLE, 1* "6` BUILDING INSPECTOR O 39• �0 y (` R's A��_ . APPLICATION FOR PERMIT TO ........... �.� ..... .. .............., .. TYPE OF CONSTRUCTION .. .................. �6R.... . 1�:. �'!`. --............ .............. ...............19v r1 TO THE INSPECTOR OF BUILDINGS: The undersigned heriby applies for a permit according to the ollowing'information: ✓. ..........................................� ..... a L cation .......... Y... ... ...... ......................... ................. ..... Proposed Use ..........I�....e-S.1. .... ..�. \..J... Zoning District .. .........I.U1... v....:.:...D ..... ..... .' . Fire District .......... . ............... ....... Name of Owner '`,/ ` //" "� ...Address 1 ........`..... r.. .... . ... .1.Name of Builder ........ S^� C��� ",—C) J�al Address ............ ................................ ...........,. Ate ... .. Name of Architect ............ ��`"`._": ......................:...Address ...............I........ ...:.................................. ............ � Number of Rooms............ .:.............................................Foundation .......I. .....�:... ..................................................... Exterior ...... , .. .1........ .. .....lea ............Roofing ........... ...1...... ............. ................. .. ..................... i ^,��' Floors ���/`- �" �'""' 4- .. Interior .. ...................... ... ....... .. Heating G� (/`emu` ... g .� ?wj. g < -- / ...........PlUmbin ......... .......... .... Fireplace .............v �-. .......................................Approximate Cost ..:........�'',/.........................-�............... ......... . ............... P/p10j< i9 9 05 73 Definitive Plan Approved by Planning Board -------------------_-----------19_______ . Area . ..�..................... I. � Diagram of Lot•and Building with Dimensions .41 . Fee ...... . . . .. .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' 5 "lJ 77. to IS-7 /a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,/V,4 Name .................................................................................. 17465 J. E. McCarthy N17465..... Residence O ............ Permit for .................................... .............................................................. Locat* Stanley Way .............. .......A......................................... Centervilke J . .........................................R "**** **"**'*'**"***"*"****'**,lI J. Eq' McC- rthy Owner .................................................................... Type of Construction Wood Frane .......................................... .......... ................................................................... 1 228 157 Plot ............................ Lot ................................ Permit Granted ............Aq�cg%bgr.......Z.19 74 Date of In spection ....... .... .... ....... Date Completed PERMIT REFUSED . ................................................................. 19 .................................................................................. ................................................................................ .............................................................................. ............................. ................................................. Approved ................................................. 19 ............................................................................... 157 [ ...."_..H ,�,.rl r-•.,..: y r .� 4, '•r-k",.'pp,1„,`," Im t .•f9•rR•1} %1))4`?5 5'`.`T.'"Q.`.��iu 4,69 1 8yi lM,. �.MYJV.g L',�W� r f- , f. t r r ,• r +b, i,., Ir) .I ti i FEE 'TOWN.' OF ' BARNSTABLEf ,r ASS.j . i o � • 4tnwrimYnnv B 1.9 14 ti i, •',r w THIS IS TO CERTIFY THAT A-'PERMIT-IS HEREBY GRANTED TO Y r d ti yy�'o tt .L CttR&taw...... t 9G S>elfe�'4 .ittsl tic, lsta:lew r M�•i O•. .... _ , r y(PROPERTY OWNER!". 4 6 UIDDR68IV • ' '� ' TO "{.1.._1ti AItBkUIYL9D/I i. 1 r+ 4 1 1 .:U1LTeR1 ; 6 A............................. m ° T]rxodr 1�tex+x irx I r .......]2 V y May 0�" r t ITYPH OF BUILDINOI. T p �••�"o I > IAPPROXIMATH 91ZQ1 Y " LOCATION '2Pnn eav TWlnar _ ` f ranect...... IHTRQHT AND NUMBHRI IVILLAOQ/ 1 + V•� VVVg s7' NAME OF BUILDER OR CONTRACTOR 1w dti a _ i7 A. 51...»4 tre.-h+a..tl e1N r APPROXIMATE( COST �. r I HEREBY( AGREE TO"10 NFORM.TO ALL ,THE' RULES AND REGULATIONS OF THE TOWN 1 � OF. BARNSTABLE; +REGA NG THE✓ABOVE .CpNSTRUCTION. 11 i - � 1 t ! x O VVNJJ'� J IO'NHRI t r r�tl - 1 (CONTRACTOR) ; �•; x . O U BUILDING INSPECTOR: r Sublecf fo Approval of Board of Healfh t r + '' 5r - �. a0.;!},., 0 TOWN OF BARNSTABLE BULK RATE COUNCIL ON AGING U.S. POSTAGE PAID 198 SOUTH STREET NON-PROFIT ORG. HYANNIS, MA 02601 PERMIT NO, 2 I � �� /� 7 ., ,: �.-, . r Yy ,y �. a+.._::�-."r".i,•+. ,.r 4w!w ..,.T .c..,:� +..e•. .r x�' '*+urn'-,� {W �,.0"' ":'�^e, _; / �. _z . '..... Assessor's map and lot. number ....... ..... ......... .......... r Sewage Permit number ...... !........................................ *THE T TOWN OF BARNSTABLE re I EAR33TADLE. "6 9 , BUILDING INSPECTOR APPLICATIONFOR PERMIT TO .............:..:............................................................................................................ TYPE OF CONSTRUCTION ' 4 t /................19. !„ TO`TH E`I'NSPECTUR—OF—BUILDINGS: The undersigned hereby applies for a permit according to the following information: { 7 Location ............ ................................. .......................... ProposedUse .......... S..�. ?.. .�r.......................................................... Zoning District/�. ..r..........� { �� � Fire District C&;�, _ � � ................................. .......... Wk yam Name of Owner ` CC4 2 yu-1 `f .�K r%C.lX.......:.... ..............................Address .... ..................... ........... ......... ... .. C} Name of Builder / /AR�t::e!.` � `�A�dress .......:....�.. ...� ....X� .,...........5/- Name of Architect ..............0.��....`....-. ............................Address ..................................r�-............................................... Number of Rooms ...............................................Foundation ....... `.:� � .. . .............................................................. v Exterior ........��. '?./.±!ir: f Roofing ...... . .. ..... f ` � C /� Floors ........ !!c:%y'�:.. / ..... .... Cc Z? ..................Interior .............J!�i ?r- t/ � �G L 11, Heating l���R^_o �` 1 t` !".:...�..`.f.�... ..........Plumbing ...... .........�......��.....;:��A Fs.1 Fireplace .............!:�.�. .............................. Wi .................Approximate Cost t// G. i . Definitive Plan Approved by Planning.Board -----------_______.... __ ___19--------• Area ....;'; ?�................... Diagram of Lot and Building with Dimensions ��� Fee -] l'.. ` SUBJECT TO APPROVAL OF BOARD.OF HEALTH 14( �! 11 7X, 4'u T k G A, 1 J — - — — r CC, f UK I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above -construction. Name ........................................... J. E. McCarthy �NoVe 1.7.46S...... Permit for Residen • .......................................................... . Location 5anelY . 1a�r .... Centerville Owner ......J. E. McCart )r I Type of Construction Wood Frame . .......................................... ................................................................................ Plot Lot ................................ Permit Granted ...December..•••••2..........19 74 Date of Inspection .....................................19 Date Completed .........:............................19 PERMIT REFUSED ................................................................ 19 ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... �u�zg��w •� •r 99bLI