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HomeMy WebLinkAbout2286 MAIN STREET g'�v , � n �� � a _. - J - I _ a y .. V a �.. _ - �. .. � � U .. .. �. P.. � � �, r .. .. �, m z i '. @ - k 4 - C'. - .. N ,.. i� ... - _ - a �. .. �. a �. '�, .a � '... ,. .. � .. :, . � < v _ .. .. e i _ � s�. � ,, .. - � � � ,. .. _ � .. -�. .. - �. 1 �: .. ., u :� .. - _�� `` Application number. .....�.............�.J�......... Fee .�...1. ..... ............................................ NAASZ� Building Inspectors Initials.. ............................... SEP 2 4 E z�l� Q 1BI Date Issued.:.../........ Map/Parcel..... ................ .................. TOWN OF BARNSTABLE FM&T-`" EXPEDITED PERMIT APPLICATION: ROOF!SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Qa�f Owner's Name: W1 -S� JOAI�$ Phone Number__cg() 3 Email Address: Cell Phone Number,, aZ ,�2 99129 Project cost S ;Z, 042,:60 Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ D ors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No ' (If yes please attach floor plan with exits marked) z - Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back _ left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Q11/ �sS Telephone Number ,� 2 Cell or Work number ®9`362--9'�Q 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 ' / / �i� Date . 9/a 9 APPLICANT'S SIGNATURE Signature v Date All permit applications are subject to a building official's approval prior to issuance. 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 Name(Business/Organization/Individual): IA/l.)Q;Q t Z! `jjAZ _ Address: .2-2 UI 6 IKA City/State/Zip: ,51 � hone#: 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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 l 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.❑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.[3 Other comp. insurance required.] *Any applicant that checks box#I 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 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 certify under a pains and penalties of perjury that the information provided above is trld correct Si ature: V Date: � 1 Phone#: N , 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 Gen ral Laws chapter 152 requires all employers to provide workers' compensation for their empl ees. Pursuant to this sta te,an employee is defined as"...every person in the service of another under any contract o ire, express or implied, al or written." An employer is defin d as"an individual,partnership,association,corporation or other legal entity,or two or more of the foregoing enga din a joint enterprise,and including the legal representatives of a deceased a oyer,or the receiver or trustee of individual,partnership,association or other legal entity,employing employ s. However the owner of a dwelling ho a having not more than three apartments and who resides therein,or the cupant of the dwelling house of anoth who employs persons to do maintenance,construction or repair work such dwelling house or on the grounds or buil g appurtenant thereto shall not because of such employment be de e ed to be an employer." MGL chapter 152,'§25C(6) so states that"every state or local licensing agency shall wit old the issuance or renewal of a license or perm t to operate a business or to construct buildings in the co monwealth'for any applicant who has not produ d acceptable evidence of compliance with the insuran coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of i political subdivisions shall enter into any contract for the pe ormance of public work until acceptable evidence of mpliance with the insurance requirements of this chapter have een presented to the contracting authority." Applicants Please fill out the workers' compens ion affidavit completely,by checking the bo es that apply to your situation and,if necessary,supply sub-contractor(s)n e(s),address(es)and phone number(s)al g with their certificate(s)of insurance. Limited Liability Companie (LLC)or Limited Liability Partnership (LLP)with no employees other than the members or partners,are not required to arty workers'compensation insuran . If an LLC or LLP does have employees,a policy is required. Be advi d that this affidavit may be submi d to the Department of Industrial Accidents for confirmation of insurance c erage. Also be sure to sign a date the affidavit. The affidavit should be returned to the city or town that the appl ation for the permit or licens is being requested,not the Department of Industrial Accidents. Should you have any q estions regarding the law r if you are required to obtain a workers' compensation policy,please call the Departme t at the number listed low. Self-insured companies should enter their self-insurance license number on the a pro hate ' e. City or Town Officials Please be sure that the affidavit is complete and printed ibl . The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office o estigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which a used as a reference number. In addition,an applicant that must submit multiple permit/license applications in y gi en year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site ddress" a applicant should write"all locations in (city or town)."A copy of the affidavit that has been officia stamped o marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file fo future permits r licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtainin a license or perm not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.) aid person is NOT quired to complete this affidavit. The Office of Investigations would like to t nk you in advance for yo cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and lax number: e Commonwealth of Massach tts epartment of Industrial Acciden Office of Investigations us Washington,Street Boston,MA 02111 Tel. 617-727-4900 ext 446 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia i Y Town of Barnstable �4q6(t59 7 OF T Expires 6 months from issrre tlate .,RxsrAst� ; Regulatory Services Fee 16& ��$ Thomas F. Ceder, Director AlfD �>< Building Division Tom Perry, CBO, Building.Commissioner 200 Main Street, Hyannis, MA 02601 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 %-R— 7�D � %> e Residential Value of Work ��`G Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 6U, Contractor's Name � `V 4- Telephone Number Home Improvement Contractor License#(if applicable) C-21 PERMIT Construction Supervisors License#(if.applicable) J ❑Workman's Compensation Insurance SEP 2, 5 ?�O� Check one: ❑ I am a sole proprietor ` OWN OF BARNSTABL ❑ I am the Homeowner 9�1 have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# � Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) 117�tgc Re-roof(stripping old shingles) All constructs debris will be taken to � (' L� ❑ Re-roof(not stripping. Going over existing Layers of roof) �r�`�49v e- idslQ_ l><tX(tC` �C� WI;�Li� jVu ❑ Replacement Windows. U-Value (maximum ,44) *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. vement Contractors License & Construct Supervisors License is required. SIGNATURE: Q:\WPFIL:ES\FORMS\Express\EXPRESSPERMIT.DOC THE T° Town of Barnstable Regulatory Services r + y&UMST MASS. Thomas F.Geiler,Director `��fo;p;�►`` 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: ar'�1S1��6e� (Address of Job) tgnature of Owner' Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q :FORMS:O W N ERP ERM IS S I ON Town of Barnstable ' Regulatory Services HAM BLE Thomas F.Geiler,Director 03 �� Building Division AIEp � 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: c'ty/town state zip code The current exemption for"homeowne s"was extended to ' clude owner-occupied dwellings of six units or less and to allow homeowners to engage an indi 'dual for hire who oes not possess a license,provided that the owner acts as supervisor. EFINITION F HOMEOWNER Person(s)who owns a parcel of land on whic he/she r sides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or de ch structures accessory to such use and/or farm structures. A person who constructs more than one home in a year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Officia a form acceptable to the Building Official,that he/she shall be responsible for all such work erformed under bui in ermit. (Section 109.1,1) The undersigned"homeowner"assumes respo sibility for ompliance with the State Building Code and other applicable codes,bylaws,rules and regulatio s. , The undersigned"homeowner"certifies t he/she understands e Town of Barnstable Building Department minimum inspection.procedures and requ ements and that he/she ill comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwe ings containing 35,000 cubic feet or larger ill be required to comply with the State Building Code Section 127 0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any omeowner performing work for which a building permit is req ired shall be exempt from the provisions of this section(Section 109.1.1 -Lice sing of constriction Supervisors);provided that if the homeowne engages a person(s)for hire to do such work,that such Homeowner shall ac as supervisor." Many homeowners who se this exemption are unaware that they are assuming the responsibiliti s of a supervisor(see Appendix Q, Rules&Regulations for Licensing onstruction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires.unlicen ed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner actin as Supervisor is ultimately responsible. To ensure that the horn wner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/s`k&vnderstands 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\homeexempt.DOC o APPROVED Assessor's office(1st Floor): ���9_ Assessor's map and lot number -s "Y Barnstable Conservation Commissio o`THE To Board of Health(3rd floor): PTI E Sewage Permit number Engineering Department(3rd floor): �^ Signed I,E ga 0 = DMUSTULE House number. ENVIRONMENTAL CODE `6 9• Definitive Plan Approved by Planning Board 19 TOWN REGULATIONS o Wit A,APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:60-2:00 P.M.only y TOWN . OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �L � �f�f311/� i�/A�Dr1/S , �1 0DF� ;120 gffd& PD/ed TYPE OF CONSTRUCTION p,�!®®, �, 1'!J�. �/dG'�/T�G �j L S%�!/V�I�tiS P.T,�W,��C //�GC� s ��fJ.Si 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location -W 86 /72AIAl S57- w', AAPii)6 7-14164E. �9 021s/o 9 Proposed Use 110hife /K�}/il/ /i��it�CC' �DBf' A" rA tJ7 — AOQCI 47' 96 Zoning District Fire District Name of Owner Address .12810 IV, A; c5r W ,F3i9�f�A1�5n&�r Name of Builder.".SM 7— JQA146 Address c574JWE- Name of Architect Address Number of Rooms / Foundation Exterior �N.i°yAGL- 'S�yt//iL� // P Ping R��.c.4C �/�l/a/Ni` 1✓A�/G'F /I SQ. Floors Interior Heating Plumbing Fireplace Approximate Cost Area Q Diagram of Lot and Building with Dimensions Fee �00 PORCH AP-CA t 9x 14c/10 C 11%11: � iA 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 No 34.520 permit For Alterations/Add Porch Single Family Dweling Location 2286 Main Street t •t 5 t . _ Barnstable ' Owner Wilson T.. Jones" -fr Type of Construction - Frame Plot t-7 Lot - ,+ i• , ma's,,..-� ` August 12; ,19 91 . � • � E }}` Permit Granted w Date of Inspection 19to } " Date C` pleted {19 cs Pfa7 Jj 14 CC 0 nt Ewe nj -4rM 0ti IT Fl ---------- 'Fr rt-111 1 0 9 RV C I i i i -- F-LeV(-1TIoN -t- 1AC)6HT OF 5TROLTU ' 163 )/A �I 12. Q'i I " -30 _ zt A t 1 L � l � 5 13AN UPPoRrLAQ.R_i'R_.EZ_Q_ F-m 5m 0�� RECEIV.ED ,jUL '1 5 1991 0!D KINGS HIGHWAY APPROVED QKHRHDC l� - 1 j1 0 SAND LEDGERS A 0 P.T.W. 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