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Home My WebLink About0053 BELL ROAD 3'.3 cgE[. � �a r� � _ _ _ � `� 3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. � Application # Z C.oC`� �"�� Health Division � � �O!'nC� Date Issued dtq Conservation Division Application Fee Planning Dept. :Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis V J Project Street Address Village S1 Owner P -k— Cu "i ddress Telephone 6 Permit Request ,U_r-a e p tom-? o o cQ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 5 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: S'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: I'ncGas ' ❑ 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: FZoningP � REC'D Board of Appeals Authorization ❑ ❑ Appeal # Recorded ��Commercial ❑Yes ❑ No If yes, site plan review# � Current Use Proposed Use BY _ J APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name k Telephone Number Address y�l L L cJC License # �tA S4 a 5 NYC 0140 1 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 13!:1rN5 �J-� Iw✓ I SIGNATURE DATE Z) FOR OFFICIAL USE ONLY 4 -APPLICATION# ck` —DATE ISSUIEU—S3FUEU f ;MAP/PARCEL NO.. :i. : :: # ' r (J/v r ADDRESSj, r 1 I' y�u '` VILLAGE, i OWNER t r DATE OF INSPECTION: -zpA FRAME !� lINSULATIONJI. Q,,N,L A'10 41L`"Tn�-t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ,° FINAL I, f€WINA_L_BUILDING YOt1 4AL.I �• _: DATE CLOSEDOUT,.;f <<:v► , ASSOCIATION PLAN NO. The Corrimonwealth of Massachusetts Y Department oflndustrialAccidents Office of Investigations 600 Washington Street . t Boston, MA 02111 sy www.m ass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I-,eFibly - L � Name (Business/Organization/Individual): IJ T Address: S 3 1 �. R A C City/State/Zip: Phone Are you an employer?,ChecA the appropriate box: Type of project(required): m]. ❑ I a a employer with 4. I am a general contractor and I 5 New construction andlorpaIt-time). * have'hired the sub-contractors employees (full - -- -0------- -.- - - - 2.El am a sole proprietor.or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. 0 Demolition workin for me in an capacity. employees and have workers' g Y P ty 9. Building addition [No workers' comp. insurance comp, insurance.1 3.4required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MOL 12.❑ Roof repairs insurance required.] t G. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box fll must also fill out the section below showing their workers'compensation policy in formation. 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 attaehcd 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 jab 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 MOL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, prisonent, 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 cinder the pains a enalties ofperjury that the information provided above is true and correct. Si ature:- --a Phone#: V �— Official use only. Do not write in this area, to be completed by city or town offcciaL 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#: hform Massachusetts GeneraJ Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this sLatule, an employee is defined as "...every person in the scrvice of another under any contract of hire, express or impli-d, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any tWo or mord of lbe foregoing sogaged in a joint enterprise,and-including the legal representatives of a deceased employer,.or the receiver or trustee of ao individual,partnership, association or Dither legal entity, employing employees. However the ownr,r'of�a'dwelling{h�oi se�having Dot more..Lbamlhree•aparLnients�and who resides therein, or the occupant of the dwelling house of another who employs persons toldo maintenance, constniclion or repair work on such dwelling house not',because of.such'employment be deomcd to be an employer." or on Lbe grounds or building appurtenant thereto s-ha-d r—M MGL chapter 152, §25C(6) also states that "every state`or]oval`licensing age cy shall(withhold the issuance or reneYYal of a license or permit to operate a tlusrniss or to construct buildings in the commonwealth for any applicant tYho has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) stales "Neither the convnonwealth nor any ofits political subdivisions shall the insurance enter into any contract for theperforrnance of public-work until acceptable evidence of compliance with requirements of this chapterhave beenpresented to the contracting authority." Applican is Please fill out.the workers.' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-coniraetor(s) name(s), addresses)and phone numbers)along with their cerlificate(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 affrdaYil may be submitted to the Department of 1ndr.rstriaJ Accidents for confirmation of insurance coverage. Also be sure to sign and date th•e affidavit. The affidavit should be returned to the city or [own Lhat-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,worlcers' compensation policy',please call the Department at the number listed below. Self-insured companies should enter their self-inSuraDGC 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 affdwril for you to fill out in Lhe event the Office of investigations has to contact you regarding the applicant. Please be sure to fill n the permit/license number which will be used as a•reference number. In addition,an applicant that must submit multiple permiUlicense applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address'.' the applieani should write"a]l locations in _(city or town),—A copy of the of.davit that has been officially stamped or marked by the city or town rn'ay be provid e d Lo the applicant as proof that a valid affidavit is on file for fv lure permits or licenses. A new affrdavi l(nust be filled ntr t each year. Where a home owner or citizen is obtaining a license or permit not related to any businessor commerci a] venture (i.e. a dog license or permit to burn leaves etc) said person is NOT required to complete this a fi'davt(. The Office.of Investigations wou t e o �nn�rradve � p�rat'nn and shou➢d shave any questions, E. ,4 .r �.. please do not besitaie to grv'e us'a call. t t The Depar(ment's*address, telephone and fax number. The Commonwealth of Massachusetts 1 1� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te). 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 6)7-727-7749 Revised 4-24-07 www.tnass.gov/dia -rt�r� Town of Barnstable of .. o Regulatory Services Thomas F. Geiler,Director 165¢ ,$� Building Division Torn Perry, Building Commissioner 200 Main-Street_Hyannis, MA.02601 Rwv.town.b arnstabI e-ma.us Office: 508-962-4038 Fax: 508-790-6230 I30NIEOV NER LICENSE EXEMPTION Pleast Print DATE: -7 0 JOB LOCATION: J lrLl a oVoy is .nu�m'ber street vill gc "HOMEOWNER": Rg.i4scA name home phone# CURRENT MAILING ADDRESS: ' Re L C ck 1 city/toA 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_ SuperViSD - ` DEMIT'ION OF BOMEOW7\ER 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 constrycts more than one home in a two-year period shall not be considered a bb=owner. 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 procedur and requirements and that he/she will comply with said procedures and requirements. Sigma 'r of Homcown 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 sha11 be exempt from the provisions of this sccb'on.(Scc6on 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeotiYncr mgagcs a pc son(s)for hire to do such work,that:such HOMCDWncr shall act as supervisor." Many homeowners who use this rxemption are unaware that they art assuming the responsibilities of a supervisor(sec Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.1 5) 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 homtowncr acting as Supervisor is ultimately responsible. To cnsurc that the homeowner is fully aware of his/her responsrbihtics,many communities require,u part of the permit application., that the homcowncr certify that hr/she understands the msponrbilitics of a Superrisor. On the last page of this issue is a form eurrent)y used by several towns. You may cart t amend and adopt such a formr/ccrtifrcation for use in your community. Q:forms:homccr:cmpt , T Town of Barnstable 0 Regulatory.Services + MRTf6TABI.� F r ' MARLg Thomas F. Geiler,Director Eo Buildin g Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Of5ce: 508-862 4038 Fax: 508-790-6230 �j Property CY t r w tom 'fete a.nd Si x This Secon f ' p.If Usirz .ABuilder`` } as er of the subject property hereby authorize to act on my behalf, is all matters relative to work authorized by this wilding permit application for- (Address f Job) Signature of Owner Date Print Name If Pro e er is applying for permit please complete.the Homeown rs License Exemption Form on the reverse side. Q:FORMS:O WNERPE,1M1SS10N of Barnstable Geographic. Information s Y stem ewer Custom. Map Abutters Map Size Zoom Out w } :......":......::. .._._._.. Map: 292 292092 1 445 ! i Location, Owner: 292091 Y.:;... __. #465Location If 292084 Map & Parcf N x •14yf .oJ:�'' 292209 Location }; Acreage eage 7v• c< €...u.a a e sip y. g 090 y292210` 7 292085001 Mailing Add 83 ol :. v.;.;.. . 29221 t: APPrzaised ;< 2921080 <� ........................................ 292218 63 $. Extra Featu r z.`. zx: N 4 ::.. , ?:. 292085 002 20 Out Building Land '�' x'^'c,%:;`` '::�a'�;s;:: � �''�w N tg:"`^:�=•Nc\� Buildings RAMP DIAGRAM Bottom of Door '. -----------5'----------------� 0 Leading out from 0-door to edge 10' (Approximately) 0 0 0 0 0 0 All sides are 2 2X 10 Ramp is 30' long+- 5X5' 0 0 w 0 0 - 0 `V1�- -7 1 � � 5 V � 4 J ro _ rc Vl I rb 0 r� P - Y� .�_,. r ,. �_ � :� 5 A. �". �' 4 i. F r i _: 1 iys f �� ., a ,' "` ,, �. �; ��' �i l � ' cF Irma T tt Expim 6 months from issue date ,t�,�Rtc i Regulatory Services Fee a v� "'"� 1659• Thomas F.Geiler,Director � ,5 ,5 �e � Building Division Elbert C Ulshoeffer,Jr. Building Commissioner v P R E S S P E_ _I T 367 Main Street, Hyannis,MA 02601w MAY 2, 1 2001 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE , EXPRESS PERMU APPLICATION /y Not Valid without Red X-Press Imprint Mapiparcel Number / O Property Address -t-C- O Residential OR ❑Commercial Value of Work !a.3 t"00 7WA-1"1" go �v,�,1s Owner's Name&Address JdSeph �• �,� �se6� .2 /i iZ i) , Hy17/lawi f Contractor's Name /// //T ( �/Lj=� � Telephone Number) P Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 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's Comp.Policy# Permit Request(chZck box) Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side rZ%v.e w�> S `r- 3 31, Replacement Windows. U-Value (maximum.44) Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation.etc. Signature expmtrg