HomeMy WebLinkAbout0800 BEARSE'S WAY (24) �� ��+s
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TOWN.OF BARNSTABLE BUILDING PERMIT APPLICATION
Map i Parcel Permit# 710q . r C�
Health Division �- 1-a�'1 5 4 Rf,S'-ABLgate Issued5 ZA 71L�'4
Conservation Division 4 �'G ( ` °11 j: 2 application Fee
Tax Collector Permit Fee
Treasurer (-V f S f ON_"""-1'PIoICAWT MUST OBTAIN A SEWER
CONNECTION PERMIT FROM THE
Planning Dept. ENGINVERIMG DIVISION pRIOR TO
CONSTRUCTION,
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address G A9 ��rPt'� b� f n aT 2S
Village t�alpe_ O-vSS ace[ S �.d�:M,n���►�
Owner Address
Telephone %-.S_,f --77S- --73
Permit Request ( y '11 if er T-DI n a 12.0 a k" ba e le 74 �Iee/2aa y✓/ , ,1�,� ,
7
Square feet: 1 st floor: existing proposed 2ndJf1o . existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation _'Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) 1 ,aKOn m1Mv"
Age of Existing Structure .3S__Vrs inn ,l, Historic House: ❑Yes UNo On Old King's Highway: ❑Yes ❑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
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Zo
❑Oil ZElectric ❑Other
Central Air: ❑Yes Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
P g g
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 Aut orization ❑ Appeal# Recorded❑
Commercial ❑Ye
s No If yes,site plan review#
a ►`
Current Use A n lw v Proposed Use /,���—uo!,q
BUILDER INFORMATION
Name l Telephone Number O �5
Address 900 ._License#
lvy� S Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION 7�S RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 0 5 /-E4 l o g
c`
r ,
FOR OFFICIAL USE ONLY
PER-MIT NO. -
^, j r
DATE ISSUED C
MA?/PM4CELfNO.
ADDRESS •VILLAGE L
OWNER -
DATE OF INSPECTION: J
T FOUNDATION _
i
FRAME t_
INSULATION
FIREPLACE
ELECTRICAL: ROUGH 1 FINAL
PLUMBING: ROUGH FINAL `
GAS: R0UCH:� ?; FINAL
FINAL BUILDING ?
r Er-
DATE CLOSED OUT
_ Z -
ASSOCIATION PLAN NOS:
r
�r
i
r
The'Cvmtnaniveajth of jVlass chuseits
'
• perparhnent of.XndustriaT Accidents' /�,�'
600 Washington Street -
• Boston;Mass• .1121I '
=� •� 'pFrorkers'.Com ensation.�nsuranceAffidayit"GeneralBusines`ses "'
, ,..�> `" "'f'fra.•}`'hyl'+"• ''iftq,.r"�f • �t • 1... ji.• - ••''' ' ' •'' ..
state' "vr
site iocatio>i foil address :' : ' []Retail[]•RestaurantBaF/Eatiag Bstablishme'nt • .
work etor and have no ont; $Issiness Ty e, Real Uale.,Autos etc.)'
E] X am.•asoleprcpr o officeo Sales 0mclu&g . ,
zg any capacity. other
etn 10 ea'wit: etn'lo'ees fill Sc' azt tune): []
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fnsiii•�nc-' ositionoiErim�! �
Failure to sect]rt coveragE as required under Section 23A of MGL 152 can lead to the imp
penalties�n the form of a STOP WORK o�DFJR and a{fine of ffi100.00 a day against me. X understand that}
i rSsonmettt as wEll as ctvilp , ' r
one years imp be{o�yarded to the office of Investlgatiom of the DlAfor coveragE verification.
copy o f this statemeut may '
b ce i er a gain and penalties of perjury that the injformation provided above is true an
I do hereby Date
print Hems � -
tm'ite in this area to be completed by city or torn Official
°fiioialuseonly do no � permitliicense# []$uiidingDepartxaent
. ❑Licensing$oard
city or towns Qselectmeuis Ofrce
C3Rm1thDepartment
[}•checkif inmE response is requkred j]Other__.___"__
, phottE�;
contact person: '
{l,v1%&dstpt.203) _ _
. ' . Znf'ormaflon and Zinstructions•
. al L'aws chapter 152 section 25 requires all employers to provid'c•woricers, compensatidn for their•
Massachusetts GezieT .
cl3jpIoyeeS: .As quoted'from the 1`1a(w"., an employee is.defined as every person in the service of another under any contract
Of hir 'expr•ens or it P d oral or written,
e,
' , association, corporation or other legal entity, or any two or rngre of
An empl�}►er is defined as an individual,p•a ers hip
the foregoing engaged•iu a�joint.mferprise,and including the legal representafives of a deceased,mrployer, or the-receiver or
artoershi association or other legal entity, emplo�ng omPloyees• 'However•tho owner'of a
trustee of an individual,p Px
av e]hng house hay�g,-nottnore than three apartments and'wh°resides therein, or the,occupant�b the dwelling house b£
ersOns to do nai.n'keuauce, construction or repair wdrlt on such dwelling liou5e or on the grounds or
another w110,eurpio3's p ,
ant thereto shall notbecause Qf sucli.. m#joyment be deemed'to be ari employer ,.
cha teT 152 s ection 25 also' fhat'every state or local Reensing agency shall withhold the frssuanc�dr renewal
MGL P any applicant
of a license or perVa?t to operate a business or
construct buildings in the.cbmmonweaIth for an a licant who has
not roduced acceptable evidence of compliant a with the fns o anCe coverage
v tracgfor the r erforrnan a of public work unit
P of its political subdivisions shall enter mt y P
cozrnnonwbalthnor.an3�•
acceptable evidence of comPh�nCe e uran�requu eraents of this chapter have betn presented to the contra
authority
Applicants .. � to our situation.,Please •
Please is.toe Viers'• ensatiorr Rf6&vit cornpletely,by checking the box that applies y
su p ply company name, a an'd ddress phone numbers along with a certificate of insurance as all affidavits may be subrrutted
artrnent of $ustrial A6"dents-for confirmation of insurance coverage. Also'be sure to sign and'date the
to the Dep
affrda vitr The afficant should be returnedto the city or town that the application for the p ermit or license is being
d, not the Department of Industrial A ccideuts. Should you have any questions regardiri the'"Iaw"_or if'you ai e
requeste lzoy please call tt►e D aTtment at the number Iisted;�elow. '•,
requiredto�Otain a•y�,orkersr•compensationpQ
city or Towns • t
t has rovided a ace at the bottom of the
e affidavit is e' � lete and.printed legibly. The.D eP artmen p; . . ti sP, .
please be sm•e•tbatth• , �
affidavit for you to fill olit in the event the Office of Investigations has to contact you regarding the applicant; Please
a er which w�l b e used as a reference number. T i. .affidavits maybe returned tq.
the erait/licens numb -•,
be-sure to fr17;m reP , r ements have been made.' . .
a��nt•b� Or F. X un1fS5 Other'arrang .. •
the D ep ' • ho'd 1 you have estions
veStigations vmuld lie to•thank y'ou in advance for you cooperation ands y anS'QU
The Office of In ,
please do nothesitate'to give us a caTL
The Dep
�{ment'se ddress,telephone and fax number:
The Commonwealth Of Massachusetts
Department.of Industrial.Ax dclents
. Biome>ai la�es>il�eria .
600,Washington Street
Boston,Ma. CZ111
fay.#: (617)727-7749
E r Ton of Barnstable
you °W�. .
o� Regulatory Servides
• Thomas F,Geiler,Director
f aaxr�srtat�,$ .
Building Division
'�tFp µAS k
Tom ferry,Building Commissioner
200 Main Street, Hyannis,MA 02601 ,
Fax: 508-790-6230
Office: 508.862-4038
• permit no. •
Data
AFFIDAVIT .
XIMP�MERNT TO ER YM APICONTRAL C TOR w CATION
MGL c.142A requires that the"reconstrmticA alterations,renovation,repair,modernize eo oc uP ied ion,
improvement,removal,demolition,or construction of an addition to any pre-existing ow4
bu0ding containing at least one but not more than four dwelling units or to structures Wbich are adj scent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements,
Estim4ted Cost 100
'type of v�ork• l�
Work• 50
Of
- Address 'Q
-�t)'o
Owner's Name• ,
Date of Application:
05 917
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:
Owms PULLING THETB OWI�t PERMIT OP,DEALING WIT11 LS m2ROVEMENT UNREGISTERED NOT Rkn
CONTp,ACTORS FOR APPLICAB'IE ROY
ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUND UNDER MGL c,142A,
SIGNED UNDERPENALTIM OF PERJURY
Thereby apply for a.permit as the agent of the owner:
Contractor Name Registrationl�io.
Date •
OR �•.4 Co 1,
11 Owner's Name [ 7
oFt�>•�
Town of Barnstable
Regulatory Services
RAPOMM , : Thomas F.Geiler,Director
MASS
,m� Building Division
ACE p ' Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 - Fax:,508-790-6230
HOMEOWNER LICENSE EXEMPTION
K q 1 J-1 Please Print
DATE:_�cJ I GYi t lJ
JOB.LOCATION: 00 � . Qt �j E'
number , s t village
Ni A Q C 1 (0 fin, , (i
'HOMEOWNER' '7�� Ulf O 0 �9 0
name nn I home phone 1# work phone#
CURRENT MAILING ADDRESS: - w�rA
city/town state zip code
The current exemption for"homeowners"-was extended to include owner-occupied dwelling of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided thafthe owner acts as
supervisor.
DEFE'gMON 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
re a �tsf � -
V �e�wofAomeAmer
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 perr-dt is required shall be�exeriiprofronithe piovisioirs
;of,this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a personal for hire to do such
work,that such Homeowner shall act as supervisor."
Many'bomeowners 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
weral towns. You may care t amend and adopt such a forrnkertification for use in your community.