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HomeMy WebLinkAbout0071 BETH LANE 1 �% 7 �� .� i i 1 f sf ... Town of Barnstable TOWN OF V!�,pif- .g y. �pFZHE 1pk� Regulatory Services ?' Thomas F.Geiler,Director �.' � JUL — �� �. s" MASS.ss. ` Building Division y MASS. �pren 3,ts Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# ?aQ 9031 FEE: $ SHED REGISTRATION 120 square feet or less t h Lane- mnt Location of shed(address) Village M, I &&S Property owner's name Telephone number 2--72 12- Size of Shed Map/Parcel Sienature Date Hyannis Main Street Waterfront Historic District? Old Icing's Highway Historic District Commission jurisdiction? Conservation Commission_(signature_is_r_eq.uired)--- -- / (Sign off_hoursfor_Conser_v_ation 8:00m9:3.0_.&_3:30-4:30-- ) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 �WVMNP_,.; OEM, g _,, W 9g, -WIN UR, is �,l,,.­..,,,,_ " , 11_� - b 1161 g `,Y%, A 1- 11-1 N -1 INE, 'MMiw4�g, l4i Ma— WO 11 RM M WWI' wu 5- wj IRIN t pl, g 4 yq IV a., Y L 4t" M6 a rl ""M -Hot M� N12, MOU. R NA, w�, 0 1 Va, 'U, �Nfi?,,ff En --,w A INS X A�Wf rR ANN t R pf, rl f, 15 5 41 _,P 0,114 ZZ &W_i, D M wl,4 'M MW Al AR U qWWN 0,101 iR R., -g, 0 gm OR "N'-1i MR, .w-_ x; Emil y - OR 7r gq-w B N8 ilk Zft� 10-K T, .vg�" MEN MO ZEN, "M 77 Ow. AD NAME -p P NOMURA FTN-Ij into N,-t CN VA IN ggA-%, R, gg lum "E;r U AM% OR p�m4 owl 0 P. .t--F6 lot N `0 Tg P % U07 27 _0 "WOm 1� -now w .4 _w_ NUM lg% 0,� v.m-, 411;,=W_lv� -1 -- ­­.�,g, 52 %R!"WROOS- t INUMR, 'R Vff� M-0 Wwqw NO. 'MM A n "M .,9 , �, "go-an, ;k gnT w Q 0, R -,,�-RMKWU ,w! , E - - - g � tQx n­ gmg,- Ot A, qll­ 0, Y'N 5'. ivy 40 lwizi M-6 I 'AN "M R. Nbe MAN I UN OR% TOWN OF BARNSTABLE AUILDING PERMIT APPLICATION„- Map Parcel :Application # o� Health Division Date Issued Conservation Division Application Fe Planning Dept. ~ :`Permit Fee, Date Definitive.Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address �/� -ere_ Villagey Owner Address Telephone Permit RequestCD Square feet: 1 st floor: existing proposed .2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valua Z2' ,P 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 ����' Historic House: ❑Yes ;I-INo On Old King's Highway: ❑Yes ;lo Basement Type: .Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ®o 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: ❑Gas ❑ Oil (Electric ❑Other Central Air: ❑Yes 36c, Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing O 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 ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V�� �a Telephone Number �dP 7 ddress � License# 9 �. Home Improvement Contractor# ; Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V�/�s � �® �/ Telephone Number Address ������ ��`" J License# elc> --k r4' q Home Improvement Contractor# A Worker's Compensation # Y' r ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE .7 �. w TOWN OF BARNSTABLE BUILDING PERMIT„APPLICATION•,, k1a d�- Parcel \ p ,Application # d Health Division Date Issued :k Conservation Division : Application Fe G Planning Dept. Permit Fee, Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address Telephone ® � -�';7f' 7 N , Permit Request �i.-�,�j �T,�/G� M Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Val ua on��,P 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 �� Historic House: ❑Yes ;WNo On Old King's Highway: ❑Yes N�'fNo 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: ❑Gas ❑ Oil (Electric ❑ Other Central Air: ❑Yes )i(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing Ll 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 ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number S� je Address M Ln License # r ,I 4 � Home Improvement Contractor# �n�,�T{� �� .j Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f SIGNATURE DATE r- qYq i FOR OFFICIAL USE ONLY 3 APPLICATION_ # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER, DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- ' 600 Washington Street Boston,MA 02111 i. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): cz'API Address: City/State/Zip: Phone.#: e you an employer?Check the appropriate box: Type of project(required): 1. am a employer with 4. I am a general contractor and 1 6. ❑New construction employees(full and/or part-.time).* have hired the sub-contractors .2.❑ I am a sole proprietor or partner-' listed on the'attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g.'❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers' comp.-insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 3.1myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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: �� A' Policy#or Self-ins.Lic.#: X 0 /.2 f 7 Expiration Date: Job Site Address: -,;;�/ devf� I A' City/Statdzip: 4/� 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si afore: , Date: Phone Offuial 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, ti 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 tiustee 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 mploys persons to do maintenance, construction or repair work on such dwelling house dwelling house of another who e 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 insurancerequirements 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-conti actor(s)name(s),address(es)andphone number(s)along with their cerdficate(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 Oflisials .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 permittlicense 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 (Le.a dog license or permit to bum 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. _The Commonwealth of Massachusetts . Department of ladustrid Accidents Office of Iavestigadens- 600 washin&n Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-7z7=7749 Revised I1-22-06 www.mass.gov/dia �I 1 Massachusetts- Department of Public Safety ' Board of Building Regulations and Standards Constructibn Supervisor License ;,License: CS 60349 Re_stricted to: 00 JAMES Te LEBOEUF 4 l 7.1 BETH LANE HY.ANNIS, MA 02601 `t Expiration: 1/5/2011 Commissioner Tr#: 9302 ,per �� � = Board of Building Regulations and'Standards (} HOME IMP✓��R��OVEMENT CONTRACTOR Registration\159015 Exprat�on::_3%24/2010 Tr# 265640 . �- -71 p D.BA& BARNSTABLE COUN-CONSTRUCTION CO. JAMES--LEBOEUF, 71 BETH LN ` r HYANNIS,MA 02601 " Administrator f ' License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards j One Ashburton Place Rm 1301 Boston,Ma.02108 �. ,I Not valid without signature l r ,,,, Town of Barnstable • °� Regulatory Services. BAMMANX F waL Thomas F.Geiler,Director 16596 1 a 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.t o w n.b am sta b l e.m a.u s 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. (Addresi of Job)' Al Ja mb� - OR Signature of Owner ate w ,ea( Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FO RMS:O WNERPERM IS SION �THE r� Town of Barnstable Regulatory Services sasrtsiwsre, Thomas F.Geiler,Director MASS. . g Fo; " Building Division Tom Perry,Building Commissioner 200 Main.Street,--Hyannis,MA 02601.. _ www.town.barusftble.ma.us Office: 508-962-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMMON Please Print DATE: JOB IACAnDN: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: eityhown 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. DEFINMON OF HOMEOWIN'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 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 bomeowner performing work for which a building pemrit is requasd shall be exempt from the provisions of this section(Section I D9.1.1 -Licensing of constriction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners wbo use this exemption are unaware that they are assvrning 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 bomeowncr is fully away: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 t:)wns. You may care t amend and adopt such a formdcertification for use in your community. Q:forms'.homccxcmpt MO # 7/8/2009 09:54 Bryden & Sullivan Insurance kas-*Town of Barnstable 1/2 ® KS DATE(MM/DD/YYYY) MO® ACORD . CERTIFICATE OF LIABILITY INSURANCE °ems 5 07/08/09 .-ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden Q Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 1 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Travelers Commercial Lines INSURER 8: James LeBoeuf DBA INSURER C: 71 Beth Lane INSURER D: Hyannis MA 02601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECT PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY bAN7P, E ;:: (Per accident)'r`— .M. GARAGE LIABILITY AUTO ONLY„'A ACCIDENT ANYAUTO EAACC $ OTHER THAN AUTO ONLYi`�`"' AGC ,:; !l, EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE 1. 'b DEDUCTIBLE RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER_ EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE 6KUB0498N14909 05/14/09 05/14/10 E.L.EACH ACCIDENT $ lOOOOO OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS NOTE: OWNER EXCLUDED FOR WORKERS COMPENSATION BENEFITS CERTIFICATE HOLDER CANCELLATION TOWN-18 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF BARNSTABLE BLD. INSPECTOR IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR SOUTH ST. REPRESENTATIVES. HYANNIS MA 02601 AUTO ED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 _. Y: G A s � � v s x R3 } F I W - 1 1 77 �i-- , v4 r - S 7 er a � r �' � TOWN OF BARNSTABLE 2.2 7 d 9___ Permit No. _'_ 1 sAUSTAU""" . .. Building Inspector Cash ------- OCCUPANCY PERMIT Bond __- k_I__ No building nor structure shall'be erected, and no land, building or st ucture sha 1 be used for a new, different,' changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C. & F." Builders Address .,Box EE _ Falpouth Lot #45, 71 Beth Lane _ - Hyannis Inspection date Wiring Inspector s /f r" .. Plumbing Easpector� Inspection date Gas Inspector L Inspection date /Engineering Department —//;f ���,, / l ` Inspection date J THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 4 le�1114-001, ........................................... ........ . Building/Inspector f r t map and lot M ? r ......0.2.�....1..1 ... V' � r OFTHETO / SEPTIC S`YS� Sewage Permit number ..........,</W.i................................... I:a M.,. INSTALLED IN CO • House number ........�f./................:......................:................. WITH TITLE ""3a e� EMRONMENTAL C C ob39• TOWN OF BAfRNSTAN E"" ONs r R BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....Cal... /xI,............................................ TYPE OF CONSTRUCTION ..................NAV..�.........�.j��°f!'1 z......................I.................................................... ................. �..,.//.. ..C„� .19.. � r TO THE INSPECTOR OF BUILDINGS - J The undersigned hereby applies for a permit according to the following information: /� Location7/.. .. '.A02.A............ U��?. ..........i4-14!))!2,-7.�.a.......Ala[..:...:!k.J.c-21,-/ .....r i Proposed Use ......s,t./k!1.�j..`�-C......... Cifr 11:!v ...............................................................:. ........................................ Zoning District .......a.............1!1.P�J .........Fire District � .... Name of Owner .....G:. :.. �Gl ....' Address ...6...�. :.../ ......! .0 !/12.�14A.......... Name of Builder ... l=Gl....../....—X ..............Address ...... .... ✓ 7' -Name of Architect ..................................................................Address .................................................................................... Number of Rooms .......... ....................:...............................Foundation ..../, .�7 .... Vh��: .. .......... Exienor w . lJ ./l2f.E. ......................Roofing f... .. ....... Floors l�.!..L. l✓1/,l G ......t" .0 �/ ....Interior ........: .z". .... .!'................ . .. Heating ........Y.1. ?.C./�1...L..................................................Plumbing ............. pf../'....................... Fireplace .............b:�.............................................................Approximate Cost ......&�..U. ....................... .. ....... Definitive Plan Approved by Planning Board ________________________________19________. Area ........ ?Y...:. ..'......... Diagram of Lot and Building with Dimensions Fee .............. ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH i 7 t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. VA Name .......... .. ................. & F BUILDERS or v .... Permit for ... ........!�"U......... k�, Single Family Dwelling ........................................................ .............. Location ..Lot #4 5 71 Beth Lane .............................................................. ............ ...Hy..... .......nan .....is.............................................OwnFr t...C & F Builders .............................................................. Typ e"of Construction ....TjAm.e......................... -4t ................................................................................ Plot ............................ Lot ................................ Permit 'Granted .... December .11, ....................................19 80 Date of Inspection ....................................19 Date Completed ..................... 9� PERM17 REFUSED ...................................... 19 . ............................................... ................................................. .......... . .. ................................................;. .... tv ................j:n.. ................................................ Approves .............. .................................. 19 ................................................................................ .............. ... ........................................................ a,�Assv- �r's map and lot`nGmb�}r ..... THE S ,a P ewage Permit ;number ............ .rn2.: .................................. �} / Z B8SB9T11DLE, i House number �/• f r6 9• . ,.. ... ................................................... ,sue / 'f0 MAI i -TOWN OF BARNSTABLE tV: BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......... ...:. ..ed r,t;!:'.. ..... �.... 1., c�'r;'�I%r.l.................................. TYPEOF CONSTRUCTION .................. t........................../:............................................ - TO THE INSPECTOR OF BUILDINGS: r The undersigned� hereby applies for a permit according to the following information: � ?..... ; ..............................:. ..: ...Locationr . •`/ ........... / ......... .... i - Proposed Use ....... f 4 ..1. ......... ..y............................................ 11�Zoning District ...... k� F' . Fire District - Name of Owner ... n ......... a�r t� ....: ............. .Address �f��!J•,!t, // I /��,!;;i �l.................. Name of Builder .... ":.......�.. ,� .f�.✓7..... ..r..............Address .. ,�.y.�.. 7..... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ............��.. .................:..............................Foundation ..�.l2C./ti?s'.... .......L....�: ... ,..,.�............. . . . .. ......Exterior ..........L.. U 4yZ"ifg .......... .0 Floors. .................lA: l.�...... .f: f !`-/....Interior ........:.��,!.l^ ...L�/i?..!.. .................. „ - Heating ........ ./.?. ./f�?..L..l....................._.............:........,.Pl.umbing ...., .... .. ..............1... ./�.:;G?�- ........... Fireplace .............,�.ta.............................................................Approximate Cost .......:.. ..�f �rv.........�....................... Definitive Plan Approved by Planning Board ________________________________19________, 'Area ........ t`.... ........... Diagram of Lot and Building with Dimensions Fee .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... ..................... �1 ...., ......_...:.,.� st.�.c�.r,. a w....:..:.... ....�:.-:-. ... ......_:.. .,.,r 1.. _�...:.:.::r...-). ......." ,. ..�... .. ..... _. _.. .. .. . UP- ~ . F ~~I^~~E~. . ' , ` ' R�2749 Oz�e Stn� " No ----- Pemni� for -------.��,--.. � —'7Z4S 'o le Family Dwell ' �.�., ------. —.. —.. Location ..Lo±...#,4 a...7.1''J3et.h'.��&r*e......... ' � ----,—Hyallnli&--------------. � C�vnpr --------' ',r �`�� ......F.7Ar��a m � - of ~~ '~'~^^~^ ^ Dec emb er �� uo - PermitGranted --.�—lV Date of Inspection ---lP Dote Completed ----lg � � ` PERMIT REFUSED ................. ---' — --» '----'f—' ---- —~----'' ................ 8�—.. .�--------. U ` ---...---~—.--.— ---..--.---~— W C | Appnov*d ...'L—�—.'—..--------. lg � \ ' . -----------------~--~—~—'-- � -------`------------^'---^^— | � | ^ G o v tt „dam 40 '� { � �, '.�Y. 4 11,E .# 'Y-{."`_ �'�. �� � t j'"• '�V � , p i� ;t � ti+ t {? � , '� ,� �` � � � ♦ ram- � R 7 In 14' or— +91 k.. q � w-..... _.........., ...,,....-......�....r....._..,,,,,�„n...,n,.,.�.,. ++..wra..,.m..e.z....,w..,..a..w-..x-.,..�;.....-,...-».,..o•v�.•,.......-........._.....�..,..-.,.-«.._..-..•w-^��,.._a.-„....s-.- ...,.,n„.....r..,.,�...- . ..... /� ». ....-,.. .. ,.......,a.. .._-_..........,..w.�,..:,..w..w..+,..,.w..ir..w.a..c.. #�� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �T 1 Map `� Parcel 74 Permit# 7 Health Divisions Pwd a;&V Date Issued Conservation Division,� Fee 2 , Tax Colle (�� SEPTIC $ . SYSTEM I��Q�� EE Treasur INSTALLED IN COMPLIANCE WITH TITLE.5 ` Planning Dept. ENVIRONMENTAL CODE AI,Q Date Definitive Plan Approved by Planning Board TOWN REOULATd0n4S Historic-OKH Preservation/Hyannis Project Street Address 7 Village A� Owner (7�$�!c�'�' c��oc� U • Address .7/ 'ETc�� C A'• '�1� Il Telephone 77 1` a 9 47 7 Permit Request 4!Z(Vi-60 -;oe.ZX-1.Z J'.lrcab , 2- Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cos Zoning District Flood Plain Groundwater Overlay Construction Type W 1o0 Lot Size a Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W/ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes Flo Basement Type: 0 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: ❑Gas ❑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 rAttached garage:❑existing ❑new size Shed:❑existing ❑new size Other: -Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name 031 lc'T'~ Z 4Pe6 Telephone Number i Address �J � � �'�' �y License# - Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �,74� U SIGNATURE DATE 2 FOR OFFICIAL USE ONLY - PERMIT NO. DATE ISSUED. - MAP/PARCEL NO., `� x - • - 'f - ADDRESS ti,, sR - VILLAGE OWNER '' 1 - ' • M � - •..' 4: r `, ,^ice #- DATE OF INSP•ECTION1.' FOUNDATION - FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH. '•- FINAL PLUMBING: ROUGH." A FINAL GAS: ROUGH FINAL r " FINAL BUILDING f DATE CLOSED:'OUT ASSOCIATION PLAN NO. , y The Town of Barnstable 9 Department of Health Safety and Environmental Services ►�� Building Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4038 - Ralph Crossen Fax: 508-790-6230 Building,Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT 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. z Type of Work: Estimated Cost c Address of Work: Owner's Name. 4m Date of Application: '7, °�S I hereby certify that: Registration is not required for the following reason(s): Work excluded by law oJob 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 IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY l hereby apply for a permit as the agent of the owner. �Date Contractor Name Registration No. 2 �6�99 �R, 7 .Z Date Owner's Name q:fbr ms:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents :== - OfffCB of/ollest/gatfons : t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name l "-d MAT z ehP dl- location city�Y ' 4 J phone# I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workin in amp capacity %/%%%�m/m////%/%%�� I am an employer roviding workers' compensation for my employees working on this job. ❑. .providing . com anv.name. :.:..::......: . ....::;;:. ..:.;.<:.::;;:;:.:. . ............:..:::: city phone# insurance co. .. ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have e following workers' compensation polices: com anv name. :. ................ :.::;•:;.;...:.:. :..::::.:..............::::::::::.:::.::.::.:.................:::::.:..::::.:. ..::........::.::.... ......... .. «:�<•>::>:::::>»:.;::: > >::...:;:::;::::> ::;:>:::>::>::;:;..;;..:.:::>.:;:>. hone city ........... . ...:: � �... .. .... ..... :.::;.;;:.; .. . ...... insurance oft U Now XX address: , x. ttty':. . on .. ...... :.... lit v 0 in uranc Failure to secure coverage as required wider Section 25A of MGL 152 can lead to the imposition of criminal penalties of a oneAimm to SI,S00 nd and/or one years'imprisonment as well as civa penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against ma I understandthat a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties ury that the information provided above is truo and correct Date / —.�6 v 9 9 Signature — Print name VL� Phone# 7 O .�O 2 official use only do not write in this area to be completed by city or town official city or town: petmit/llcense# ❑Bufiding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen'so Office ❑Health Department contact person: phone#; - ❑Other_ (revised 9/95 PJA) Information and Instructions P 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. 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, emploving 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 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 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 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. 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 rewrned f o 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 01flce of Imlesugatlons 600 Washington Street Boston,Ma. 02111 fan#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 • The on otuarnstaixe • tt'a'°Y'3.O Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 NAM - �a1 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMP17ON Please Print DATE e —/6 _ �9 JOB LOCATION- 7 number stoat village -HOMEOWNER (7AA7zV' Z<40oc�4� J 7 d'o.7 a 7 name home phone# work phone# CURRENT MAMING ADDRESS: cty/mwn state rip code The current exemption for"homes"was extended to include Qwner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,grovided that the owner actsSllflCf VISOT. : DEFIIVPPION OFHOMEOWNER 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 strucdues 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 re onsi role for all such work performed under the building limmiUSection 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,miles 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 requiremems. of Ho 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 E EMIMON The Code states that: "Any homwww performing work for which a building permit is regnired shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner eagages a persons)for Wm to do such work that such Homeowner shall act as supervisor-7 Many homeowners who use this c=zption are unaware that they are assuming the responsrbllides of a supervisor(sac Appendix Q, Rules&Regulations for I.iaasimg Constmcnon Supervisors,Section 2.15) This lack of awatenas often results in serious problems. particularly when the homeowner hirer unlicensed pasons. In this case,oar Board carrot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is WdmsWy responsible. To ensure that the homeowner is folly aware of hislber responsibilities,many communities require,as part of the permit application. diet the homeowner caoify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by sevaai towns. You may case to amend and adopt such a amwc ttiScation for use in your community. '�s �i�5 no.iY�.�o�.s, raiYNvu�oe+ ]KK • 3 ____________________ Hfl v 4se'C 9�� � t B��p Y- � 153, ....+oro4r T r•a+�Fie o f S D � L � .•.oi.�rmM..s c _._. •wi.»r•f.oa• __.__ ae.0.s.+•i1^J o.i '�.4NM/Y•�YdV a 5RY¢ Hya 3 i .aewn�+laaxs 7 MYtlO o� • � AT91�T µT1YA9TJ 1N0'A.I O-.I•.ri l' ++e� Y �1•r/I' fi i ia + - nollvron�v-re nalvro 1 ------- aa�an �g9 s s £ s c4fl6¢I"1 .9 6 B � LLU -i {--'4 IncZ a N�d'Id moo td JLi�ld % _ _ r .a•-,..w•n�...d,..o,i•,m.-mu r.d le D t A S � v'v TTO uuy.w,d II.'.I \11 TC 11 �7 zZZ� 62 Xi /001e) 019L, TAN< , IN I D"FLVC2o pIr MA LOT-# -4S , . 60 C ...- .. - -.: 'YM'a•., ,. t�!!4 �;r�,. .�rri."'} �a'� .. Fr K" .."'�1' aCP'�.ari:A ��g ii F# {'�'}r�Z z.3. { .y s ,1.. L.OJ- "I CEk.'7IPY THAT TNC PROPOSED HOL),'F_' 5'HUWN JAI TPIS F'LAAv CG�Uu7�ll,t$ c.eA-A�� ro rNF 7Z)w A.1 OF eAkNS`TorhC 4- .- ZOiv/u%, 29GiJ LA T-/O AJ.S", P419AJ OPA.Y✓S77,41,6?46- 1 OWNERS BU 'f LDER : CZ—,4 R,000 .� FLvniAJ /o Cat 7 p/Tc Pk" 2S" 1i1 A Y e ��� NOT E