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Home My WebLink About0075 STONEY CLIFF ROAD 75 Shone Cl/'�:c 7as a 0 , ti u 7,ePEs Phtiffll 1 Town of Barnstable *Permit# Fapires n bnths r date Regulatory Services Fe • sAarisrwsi.E, • - Thomas F.Geiler,Director _ �xl Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus 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 Z J 570 i'1 e-1 _Gd i ❑Residential Value of Work Uy; Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address W1 �) t�m 75 04 tU k Cev erViI) eTMA Contractor's Name Y f�;�`6�� 1�� 5' Telephone Number 7 7 q 22 05az Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C��L 0I 1 ❑Workman's Compensation Insurance C ck one: [ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name - Workman's Comp.Policy# .Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to \n N ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ ;Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand 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 Con actors License&Construction Supervisors License is equired. SIGNATURE: G% i Q:IWPHLESTORMS\building permit formsT)TRESS.doC Revised 053012 J Office of�onsumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration f�,,172472 Type: Expiration S727L2014 Individual E� P ICK CLIFFO. . r PATRICK CLIFFQ,�D f I 12 BALDWIN RD DENNIS, MA02638� --"��'-- Undersecretary i I Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License-: CSSL-105051 A PATRICK CLEFF91RD 12 BALDWIN ROAD�? Dennis MA 02639 I `✓..{ . J1 ,r�s�" Expiratior Commissioner 06/02/201 f License or registration valid for individul use only before the expiration date.. If found return to: Office of Consumer Affairs and Business.Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 ' Not valid wi u't signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License:CSSL-105951 PATRICK CLIFFgRD - 12 BALDWIN ROAD Dennis MA 0260 I Expiration Commissioner , 06/02/2016 * lARN3rAE1 E. • 039. ,0� Town of Barnstable - Regulatory Services Thomas F.Geiler,Director 'Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.us Office: 508-862-4038 r Fax 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, II )Cdvh I 1A4 , as..Ownex of the subject property hereby authorize Pal c� k C"yUe'rA to act on my behalf, in all matters relative to work authorized by this,building permit application for: 75 5 �,n e�/ C�J L f C�hl er✓i II� (Address of Job) 712 Signature of Owner ate I,�jllcUwl l�u 1-0� - Print Name If Property Owner is applying for permit; please complete the Homeowners License Exemption Form on the . reverse side. QAWPHLESTORMSUilding permit formsEXPRESS.doC Revised 051811 t �tNE 'Town of Barnstable Regulatory Services . Thomas F.Geiler,Director 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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 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 V 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 Le ibl r ff Name.(Business/Organization/Individual): �c Le C11A Address: J City/State/Zip: J S' Phone#: ;1 ( ,;� 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 mployees(full and/or part-time).* have hired the sub-contractors 6. ElNew 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 8. ❑Demolition working for me in any capacity. employees and have workers' 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.❑PI bing repairs or additions myself o workers' comp. right of exemption per MGL y � p 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. 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 insurance coverage verification. I do hereby certifyzwe 'ns and p a o jury that the information provided above above is true and correct. Si ature: Date: . / Z�^` Phone#: / / .Z G 5 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#: �9 Q:.... ........ .r Assessor's map and lot number ...... .... ... ....... ., Sewage Permit number !. . ......... Z BARNSTABLE, i Housenumber• ........................................................................ M B.Ae p 1639. \0� �r TOWN OF BARN" SwT � BLE .4' toHTITLE ENVa1 f4TAL COEDE A} BUILDING INSPE"CTIffRou of vos BUILDING c Qom,/ APPLICATION FOR PERMIT TO .f/u. ...... Uh ................................................................................. /,�) odJ�Lam� TYPEOF CONSTRUCTION ..........�N.Q.............tl ................................................................................................ x .......................l .V...�....... .19. -TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......1. e� {� ��// ,. S�40'! C11�� ......... ... .. .. . .... ......... .... .......................... ........................ .......................................... ProposedUse . .................................. ................................................................................................. ZoningDistrict .......................Fire District ......................0.......4.......L/)................................................. .......................................... Name of Owner .�i' vh7 r,n Address 7`sfe— �`-'l .................................................................. ............... ......... ................................................ 5 SS Name of Builder . .i�...:5..... .� ...�...............Address ` Nameof Architect ..................................................................Address .................................................................................... Number of Rooms •........Foundation C....L e h1dr-e. Exterior :...Gteood....5. ln Roofing Spf1A' . .................................... ...................................................... ......... Floors Interior ....u4 d........................ ....... .. ., .....' .................................... L Heating 4 L G /�.................................................Plumbing ............................... ..............................................................:................... Fireplace ..................................................................................Approximate. Cost ... . ........................... Definitive Plan Approved by Planning Board -----------_-------------------19________ . Area ...... z.......................... Diagram of Lot and Building with Dimensions /,p ` rGr Fee ................................. SUBJECT. APPROVAL OF BOARD OF HEALTH rmCkA R, �,L lqodi r1dw _ y s , o apse 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. Name ...... .. . ....... .......... ..................................... Construction Supervisor's License S/ �/� GRIFFIN, MR. 27184 Permit for Add Sun Room air ........................ Location .....7.5..StAne-Y..ClUf.......................... r �_ y ................Ce terzUle................. .............. Owner ....... .....................:............ Type of Construction Frame.............................. A ......... �? Plot ............................ Lot ................................ r 'Permit Granted . QV.ejjber. 6r......:........19 84 z r 4 Date of Inspection ....................................19 Date Completed %,��$......... ........ .. 19 Assessor's map and lot number ...... .... .. .....-. .................... ypF THE Sewage Permit number .<o ..r't Z EAR33TADLE. i House number ............... ..................:.....................: MAB6:.......:..... 90 o i63q 9� ON TOWN OF BARNSTABLE L BURD"ING INSPECTOR " 1 APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPE/OF CONSTRUCTION ............:......................................................................................................................... > .......................1 /.;........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......................................................................... ..................................... ............................. Proposed Use .. L::c.�..... !.......t:.... .................................................................................................................................... ..... ..... Zoning District ..................r.. ...C..............................................Fire District ......................`.._4 .......................................... Nameof Owner ............::........................................................Address .................................................................................... sl- Name of Builder .t:. �.........G E .�. �. ..�. `...............Address .......................` .\? �l �` r � .. ...................................................... Nameof Architect ..................................................................Address ....................`.............................................................., 1 Foundation Number of Rooms �, Exterior /' ,,, E .....Roofing ..:....:,:... . r..1 I ...................................... r � ' Floors ........ Interior ...................... !, r , Heating .......................Plumbing ...............................:........................... .................................................................................. Fireplace pp ?T� .................................................................A Approximate Cost ........................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ...... / ....................... Diagram of Lot and Building with Dimensions f Fee ...... '.`�.. ......................... SUBJECT,-TO APPROVAL OF BOARD OF HEALTH �44 I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name. .. ...... .. ......................................................... Construction Supervisor's License .............. ............... GRIFFIN, MR. A=190-2 27184 Add Sun Roan No ................. Permit for............A....................... Single Family Dwelling ................................................................ ........... .. Location' 75 Stoney Cliff ................................................. .... ........ Centerville Owner Mr. ...Gri.f fin........................................... ..... Type of Construction frame.......................................... Plot ............................ Lot ................................. Permit Granted .......November 6,..........19 84 Date of Inspection ....................................19 Date Completed ......................................19