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HomeMy WebLinkAbout0247 BEARSE'S WAY / 1 �' _ _ qf to (.0/i 00 COxfogod NO. 752 1/3 ESSELT`TE 10% , 1J . — lye III, Town of Barnstable Building t iPas�t�ThCard�So That it.isQUisiblesFrom'the�,Street `=A roved,xPlans Must be Retained on•J,o.bg,andd this�`Card:Must�be Ke t� �• BABNS[ABLB, i l .k 3 s ,� .::"sra ' ';..•. pp. y� �,,1 "'' yrx "' ' 7 �.. �", '� s o "� 16 Posted UntiFinal InspectionHas Been Made , ° , � �� �; }� W . sa :'. Permit s Where a'Cert�ficate:of°.Occui anc !s Re utred,s�ch Buildro ,sha11 Not be Occw ied until a Frnalxlnspect�on has been made „ Permit No. B-19-2262 Applicant Name: Robert Rostocka Approvals Date Issued: 07/12/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/12/2020 Foundation: Location: 247 BEARSE'S WAY,HYANNIS Map/Lot. 310 003 Zoning District: RB Sheathing: Owner on Record: DIAS,ANTONIO C ContractorName ROBERT A ROSTOCKA Framing: 1 Address: 247 BEARSE'SWAY Coritrctor License: 113252 2 4 d M HYANNIS, MA 02601 Est. ct Proje Cost: $3,524.00 Chimney: a ' .� Description: Insuation&Air Sealing. (?ermit Fee: $85.00 Insulation: Project Review Req: Fee Paid% $85.00 7/12/2019 Final: 6, Plumbing/Gas Rough Plumbing: ' $ Building Official -` Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after,issuance. All work authorized by this permit shall conform to the approved application and the.�approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zonirigyby laws and codes. This permit shall be displayed in a location clearly visible from access street or r'ioa and shall be maintained open for public nspection for the entire duration of the Final Gas: work until the completion of the same. r. x Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Bgildingiand Fire Officials'are providedRon this permit. Minimum of Five Call Inspections Required for All Construction Work . Service: 1.Foundation or Footing MR � 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: °fYME r 'Town of Barnstable %Permit# P� �{ Evpires 6 inonths f ni issue dale * Regulatory Services Fee * sasxsrMsr.e, v� MASS. Thomas F. Geiler,Director b .elED MA'I N. Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY jj Not Valid without Red X-Press Imprint Map/parcel Number 4 �� Property Address 2 S SM?q ' 0 Residential Value of Work U Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ~f 1 R.t2 AV e- lQ Contractor's Name L-_0.Cr �Q e,S Telephone Number !KS `-4 3:a`j ------------ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) G S Sd KWorkman's Compensation Insurance Check one: -PRESS PERMIT I am a sole proprietor ❑ I am the Homeowner APR 6 2010 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE, Insurance Company Name N� Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑. Re-side S n. ry #of doors Replacement Windows/doors/sliders. U-Value �lufU'� _(maximum .44)# ofwindows , *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 Aqun SIGNATURE: Q:\WPFILES\FORMS\buildin �,t ,\EXPRESS.doc Revised 090809 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations j 600 Washington Street Boston, MA 02111 ma y' www.mass.gov/dio Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): L-,QTr t. ko64o — Address: ��( ,.c c 42��•e City/State/Zip: C.q,,,,.'I" ;g Phone #: 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 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. Q Demolition workingfor me in an capacity; employees and have workers' Y9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions ._....--myself. [No workers'._comp, _ right of exemption per MGL 12.O:Roof..repairs :... .. insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 131:1 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 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 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 insurance coverage verification. 'I do hereby ce tify ender the pains andpenalties ofperjury that the information provided above is true and correct. Signature: oW Date: I% 1 Phone#: "`d?ld — � 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,constriction 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 maybe 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: w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-87.7-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia i "` a oFiwE Tpy, Town of Barnstable Regulatory Services f MAS&saxiv — Thomas F. Geiler,Director .� sa fo 39. 0. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 Property Owner Must Complete and Sign This Section if Using A Builder I, n�- n q.-- S ,as Owner of the subject property hereby authorize C1n11-_1F_111 kojnbbs to act on my behalf, in all matters relative to work authorized by this building pernit application for: a L� C-1 r S e S �iU L S (Address of Job) INMClZbIb ig of Owner Date Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable N � �oF zwe r � o� Regulatory Services. * Thomas F. Geiler,Director swxxsrnst,E, Mnss. 039. ,�� Building Division '°rsn naA�m 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"; 1' 4 name t home phone# work phone# CURRENT MAILING ADDRESS: t , 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.3 5,000 cubic feet or larger will be required to comply with the State Building Code Section 121.0 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\homeoxempt.DOC Massachusetts- Department of Public Safety Board of Building Revelations and Standards Cons€ructlon;Supervisor License License: CS 50833 . � Restricted :: 00Vp � LARRY KO�NTOS E 171 MAGAZINE ST " CAMBRIDGE;MA'02139 ` a a Expiration:•2/22/2011 C'on missioner ' Tr#: 10585 r. II ue , Board of Building Regulations any --------- -- — --- Q HOME IMPROVEMENT CONTRACTOR I License or registration,valid for individul use onl RACTOR RegistraGo�< Y t 100663 before the expiration date. If found return to: OIU Expiration Board of Building Regulations and Stan_lords r 622/201 Q Tr# 268586 ,, One Ashburton Place Rm 1301 f: Type DMA Boston SUBURBAN REMO®ELIN;G GO r Larry Kontos 171 Magazine bridge, MA 02139 ' = Administrator —*No without signature -- Town of Barnstable FtHE Tp� - ti Regulatory Services Thomas.F. Geiler,':Director,` J + BARNSTABLE. MASS. g Building:Division 1639 ♦0 Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.mams Officer 508-862-4038 ! Fax: 508-790-6230 EXIT ORDER -DATE: LOCATION: `f_7 EAks E7 S .Y UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING-CODE, SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IIMMEDIATELY DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING PURPOSES LOeAL INSPECTOR SIGNATURE OF RECIPIENT ODEM DE SAIDA DATA: LOCALIDADE: ' DE ACORDO COM .O PROVISORIO 780_CMR, CODIGO DE CONSTRUCAO DO ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE DEIXAR DE USAR, IMEDIATAMENTE; A AREA DO PORAOBASEMENT PARA O .,PROPOSITO DE DORMIR. INSPETOR LOCAL ASSINATURA DO RECIPIENTE i '1 ��-� qol g91 � � � TOWN OF BARNSTABLE � ` . t. V; BUILDIK,( PERMIT PARCEL ID 310 003 GEOBA8E IfD 22577 i ADDRESS 247 BEARSE'S WAY PHONE HYANNIS i ZIP - LOT 37 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 69527 DESCRIPTION NEW WINDOWS/DOOR SHINGLE FRONT STEPS PERMIT TYPE BREMOD TITLE RESIDENTIAL ALT�ONV CONTRACTORS: ARMANY RONNIE S. Department Of ARCHITECTS: Regulatory Services TOTAL FEES: $153.00 BOND � CONSTRUCTION COSTS $15,000.00 tME 434 RESID ADD/ALT/CONV 1 PRIVATE * BARNSI'ABLE, 1639. A1� FD MP'� BUILDjING IVISION BY I I / d -` — DATE ISSUED 06/17/2003 EXPIRATION DATE I 77— p r TOWN OF BAEtNSTABL y R BUILDINq PERMIT 4 � .PARCEL ID 310, 008 GEOBASE ID 22577 ADDRESS _ 247 .-.BEARSE`S "t AY r A p��y,T•y�* t 'PHONE , } i HXAN4�F...,4„4? 10 51t F a 4 ki' 1 t i p "S f t L. !n 1 a, J r•� �./yf �'1 S s r yp ;}�y, k s 1. J d 2 } f f: M f f a 4,t� e�"Q C+'��4� },.�� Y .Vv`f� M1 t-4 �` .nT ` f }: t 9 ,� f•� tit' 1 d / 5b ��K+-iS ty: N 1 kJ ,.:•�;+ _'yam ./v� �',�''{S�? ��q.�...•_�Ey t 4 �y,�+ `DOOR y y� 4 n�.y �7,1.�.•.'•�rx mop.y 4yr�'��r.+v L's�r}�: A"f 1 .P +�i ' r�•�, R�F'r �*�( j t t 7-''+ - .f4t� C W"'- 1 �^s?ry�''9P/;i.iV�v-p yjY.Ct�.fpj*A�,/.r©�F4(Zv t7.i7.S 7LV l7 .t.'+ Lr¢'�QJLV t "�47TE.#'' k fiF lT'' T�'PE+ .•4%t44 f�*.� 1� ,.i,T . h R $.I.DENrJ.1�d�� L3.,1;i13�/�y�NU S �. y t ,`z yrx i•.x�4 1 i>:f�k� tr M- 1 .. + i ..� y �'7,f k N` R TORS ARMANY.,�RONNIE ' *Department of ARCHITECTS`: Regulatory Services , Ir, TOTAL FEES: $153.00 . x , I BOND $.00 CONSTRUCTION "COSTS :`$15,000-00 'f ; : �. .�. I' __,._ �&34 RESII7µ-ADD�,�4.�T/CQNV _ 1•, , PR.IV�S.TE ;0.� , � ._-;.�_ _; - r. o; MASS. 163 A� 'r`BUILDLNG IVIS'ION A BY f =IRATE ✓: SSCTBD t 0/1"7:/2068 EXPIRATION DATE w ,d.�. ac .w.frr Z:,. �._.�,,... .t..ya .f.._, �w •,�.a,� 1.�..c..,.-..w..,w....s,:... PeM� ..,_..,.,,f ...s�.'.:._r ,s f.� w.}� :.n't`�z.:,�` ;.i a....s..a��__._a,.� THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR,PERMANENTLY:EW CROACHMENTS ON PUBLIC PROPERTY,NOT,SPECIFICALLY PERMITTED`UNDER THE BUILDING CODE,.MUST BE APPROVED BY THE.JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM:THE CONDITIONS OF ANY APPLICABLE SUBDIVISION:RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND INHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION I HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR { 2. PRIOR TO COVERING STRUCTURAL.MEMBERS ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS' PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 I 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH . .. OTHER: SITE PLAN REVIEW APPROVAL I WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON.THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- I' TION. NOTED ABOVE. TION. I M e� `I 11 1 I Y I I� I y E II I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION `4 Map �r Parcel Permit# ` 9-q Health Division' �' s3O'm 6 I /y ln r u �1 -f ;BLS Date Issued �- Conservation Division f 113)0 3 4 ^^ Application Fee Tax Collector ADO 2 t3�9L / ��/O Permit Fee Treasurer D �� ��.1_A'l p3 � ISIO ��®TIO SYSTEM MUST E INSTALLED!N COMPLIANOE ,a �J Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANU TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address d �/ Z ��i�-riod Village A A/4s - /"[ k Owner fcmm JA_ (A c i k am_ Address Telephone / CD j! Z2 1 cc// Permit Request' F-Ai, n-N ,.i`fA-;,�,/�2 _ L�fi�y C%J�1V_J, J 9",CZ d At 1QLQ1- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation e173C2 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structu a Historic House: ❑Yes No On Old King's Highway: ❑Yes W No Basement Type: Cull ❑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 bath's): existing new First Floor Room Count Heat Type and Fuel: ❑Gas' L Oil ❑ Electric ❑Other Central Air: ❑Yes & o 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: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial El Yes l/No If yes, site plan review# Current Use �@ S'� Proposed Use 9&4,kdX BUILDER INFORMATION Name C Telephone Number 7_ �ZO ZA-29C) Address 0+ ,�(�)�r L. S� License# L c /f 4��/� rr S LN Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �- / �-�- ,y FOR OFFICIAL USE ONLY r PERMIT.NO. i' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE F} OWNER I I = DATE OF INSPECTION: FOUNDATION h FRAME r INSULATION , FIREPLACE ELECTRICAL: ROUGH-1 -4 .: - FINAL PLUMBING: ROUGH: FINAL GAS: ROUGHKl -% FINAL ' FINAL BUILDING F ' DATE CLOSED OUT - ASSOCIATION PLAN-NO. r' � r r r SHE Town of Barnstable yWP�OE 1p��O�n , Regulatory Services anaxsn+H , ' Thomas F.Geller,Director , HAM 9 163q. ��� g Buildin Division �pjFD MPy A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no- __ Date AFFIDAVIT HOME MUROVENIENT 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. i Type.of Work: � Cy R Estimated Cost D- 0-7 Address of Work: AJAW / _ Owner's Name: OrL m p �Q� C'Q An Date of Application: 7�� c52 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMMNT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name 611 Registration No. OR r +e Owner's Name _ AdQ--'\ The Commonwealth of Massachusetts Department of Industrial Accidents Office oflaseSORI/oos 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit AME name f`� A�/7 I'e`t7u�7 location. :2 U 7 phone# city ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workin in ca achy %% %%��%%%%%%%��/...... / er rovidin workers' compensation for my employees working oa this job.:::::::?}:::.....::?}::?.:......: :::::::::::;:,},:}.>.;: I am an em 1 g :.::.:.::::.:...... ,:,:.:....:... . l� l)� r a. h........., •d :;:�:,> �:�':!}` :}`{�:;{i::':•:�:Gi:�:�ii��f�:^�t?Y>.>.Y.}:.i'}�':i:i:i�{;}:;{:ii�;i:"•�i•:�:;�:;'::::�::,::�':::,+.�:�:;�:•��•j:�:f::.;:•-:{;`::Y:':�:t+�ii:��:�M1:v'�:�:�:i?+::r:???�:?;i:?i•:•::::is L P >.?F!,`:!�:};:i;,';i.;.;'�i:�...,,�,::i::i�`�•••:>.i:� ..;:':':''.f;:!:i?i':;::':�'?:; Yjy:?:�:�:'r:i;i::::i:}t':t;:i:{i:::y::j•i.;}:;.;:.�`:: ':si:'t:}::;;,:::.�,}i';::::;i_YiM1viyti;:}:>:;i:;i:::ti,vt{ti!{i±!ti;;::i: F lions# I n `''UI�rtN rrrr ❑ I am a sole proprietor,general contractor,or,homeowner(circle one)and have hired the contractors listed below who have the following w rkers' compensation....o.....l...i...c.....e....s....; ............ ..: ...:.:.:.:.:.:..�..:.::..-.:..:.,..:...:....................:.:.:.:.:.:.:-.::..:.:.:...................:.:.:.:.:..�..:.:..:.:.:;...:.:.:.:..r..:.:.:.:.:.:.:.:...:::::.:.:.:....:.:.:.:.._..:.:.:.:.:.r.:.:...;...r.:..:.:.:.:.:.:.:.:.:.:.::....;...:..:.}.::.:::.:::.::::::{.:{:::::r:::r:.:»:<:>:::<:>:>.::...:..:::::..::::.... e. ........ }' ....... ..r........... ........:....... .... .4.: ............................... -.r.r..r........ ...r...,... :. ........... ............. ................:......t............. ... ,.....................:......:.a... ,....... r...............:...e:r::.:::::r•}::.:fi+::::;pii's:..^:?4:t;!�?••{.:{{r :4:;:�iii'ii:i?i%::::i::;i:;:i:: ?:i{iiii�ti?ri:i:}':i:::}ti<:::{:iii::i:{:}iTi:;i i:::;i :;i'rsii::i::ti:iiiii'i'vi?ii;•}}iT:;{-:•:�:}:::::v::::::::.�:.........:::::.....:. .......::::.:•p;:::.}}'4::t4:'�iii:i<i�ii•r;•}{:�::•}ii:i•i:i::•iii:{i?ii? :'::Yii';};.:yy;Si:::;:�:j>i{i:'�:?yi:'c�•.;�i};:;:;:}:;:;:;:�:;:t�;:•;:;�:{:;:;:�j::yy� 'r,:;Yii:;i%:::>1:::?;i;;:;;;,:y:;i:;i}:;:.r•>;:i:�i)S;:v;;};;}?�?>..}r{i?;.;- say ......................................................... .::::::•:.�:::::::.::�:r.},..; :::•::::::•:::. .................. .............................::::::::::.�:::::.�:::.�.:�:::::}:r:?w:• ..............:.:::.gin..• :•:.. .:::;L:6:r:�•4vv.�:h:'}::•Yv}:?�:•rr '''��.�•'�'j�ry:::+C}`<:i"::�:�:4i:;'}:;}:;:;i::{ ;;�;iC;,.%?i:;;:,.}j;:�:S�;:i?::;i:i�iy :';Si:;i:y' ,i .iF;i:��:r;:::f:{v:i;:S;�:ii}�:�:��':"!�i:4:'`)vJiiii::i:fS>:v:::vi>if:�i':Jiii::i.ii:;}:;:;i.:•}:'.?iiii:?•:v:??^:?.rv:•::•:}:C:•:•:::::.�::w:::::vw:::::......:....::: ....:...... •e•:# j; .. .... ....i:::,•::•,{:C;:y;i?:'. ::$i:{<{:::;i:;:•,'}�ii:!}�:ii:Yi!C{i ti:.M1 is ii'"?ii�'rryi>}i:i .............................................:..::........: :?:;y}^iir}i}}ri}rr}r}i:;:j•:•}}:i vY:ii{?}:{v};•i}i:•::v:;}::?•:i::j;;ii:;;i'i}:r::::...:.ir:�riiiii :::..::•r:•:�:•i:•v;i:•}i:•r•rii>ii:4:�ir:;'r,'•i}ii:Ji:4i:L-'r'ri:::�iii'i::4r:4:•ii'i`ii:4:?i?!...........;0:;;{::::.::::.�n:::::;::.::.�:::................:............. .................:+:::::•::.i:nv:::nv:•�i•rr:;Lr}::.....::::•..::::::•.:�..}:::{?•}:6}:•:v}::::.}rr}:•}ir:•:-i:::!?;.; .. .. ...... \i, .. ::;Yd�:'_:::�:�is�:�: <;'::::%.::i?::�:i:%::`::i�:�:�:��2�:�ti�$:: ::�::;:::::�22� is�:; :;�::%�::�iii:,•i;r ��=<'��:��::}:;:;;%;:•.'.+:?.>:•}:•}:::}:•}•;;:;•}}>:.r:;•r::;•: {.r:•}:;•}:•;;•:.:y::.}•:.:.:...::•:.}:;•}:•}::•:}}:• r:;.};;:;•:r•::'}':::.`::•::•v.:>?::�:::c.;:.}:-::::i::::.r;;r;}:-r:;•r::;r:?;•:s}:•:;::•::.:.;{.:,.,}.:;:-}r:;;:;•}:;•:;;}::•}}• .nsurauc gy�aze to aec�e coverage as req�red mrder Section 25A o[MGL 152 can lead to the imposition of eriadnal penalties of a line np to S1,SOO.QO and/or one yam,irnprisornrreat�weIl a,dvIl penalties in the foam of a STOP WORK ORDER and a fine o[5100.00 a day against ma I�derstand that a copy of thb statement may be forwarded to the Office otInvestigations ofthe DIA for coverage verification I do hereby certify the pains and penalties ojperjury that the information provided above is trru and eorred Signature Date Phone Print name # ofgdal use only do not write in this area to be completed by city or town official city or town: perndt/license# ❑BuUding Department ❑Licensing Board response is required. ❑Selectmen's Office ❑check if immediate respo q ❑Health Department contact person: phone#; ❑Other_ _ (Umevieed 9/95 PJA) ' r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. ,.r 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 section 25 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,neither the commonwealth not 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 x, Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation,and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an Y: date the affidavit.' The affidavit should be returned to the city or town that the application for the pernut 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. City or Towns 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. The affidavits may be retmrned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. , fflWepartment's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of hivest1gallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 ` � � �le i000m�rreovuu o���aaaac�zuaetla s BOARD OF BUILDING REGULATIONS' License: CONSTRUCTION SUPERVISOR ;, 7 Num'bet CSC 061450 ! Bi h t 1 18F 9770 i �3� Ftes 0 800'5 Tr.no: 10879 Res�tri fd RONNIE S ARMAttkY 40 .ONTMALE ST ROSLINDALE, Administrator J y Board of Building.Regulations and Standar ds { HOMIE INRpl,�d"EMiENT CONTRA`C-O:R Regrst---I- 145,68 003 ,1 _ e hBA sue¢ Priority Services Ck G z� RONNNIE ARMAWY ,-,\ ' 40 MONTVALE ST 5: RO,SLINDALE,MA 0q-1f3=1 - - __.Adm4n►sfrator—.__.._� . O a• a INVOICE FOR JOB: DATE: TERMS: /J 9 , � f/ Zx /l? Yeiqde1- Fe ,,,tio✓e + I l�e f/'I cP c— ve + Pee e Al CP 3 ) / ® VIA- l w I1" owl Signature: Date: Signature: . Date: FIRE Tati Town of Barnstable Regulatory Services BA MABM y MAW. �, Thomas F.Geffer,Director �A .i63q rf1639 A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building ermit application for: (Address of Job) - C _ Ca 1� - 6J Signature of Owner Date Print Name Q:FORM&OWNERPERMISSION