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HomeMy WebLinkAbout0027 FERNDALE ROAD (—..� c R i Vv c � � � � � � t� 1 Town of Barnstable *Permit#,Iz j66 -� O� Expires 6 months from issue date Regulatory Services Fee • .�� i6� `�� - � Thomas F. Geiler,Director " ATFOMA.tA ; X-PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner OCT ­ 3 2012 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us - office: 508-862a038 TOWN (DR-BARNUABLE EXPRESS PER "APPLICATION - RESIDENTIAL ONLY q Not Valfd without Red X-Press Imprint Map/parcel Number R'opertyAddress ( `7 Fr R1V V 1q L& 190A PF fAN*Js /Y1t a 0t L 0[— a2% 17 _ [,Residential Va1ue of Work J1®P Minimum fee of$35.00 for work under$6000.00 owner's Name&Address 1V G-L, SON t)V L J A Contractor's Name S L I Telephone Number 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# Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ZTn,9LAc ❑Re-roof(hurricane nailed)(not stripping. Going over existing-layers of roof) ❑ Re-side #of doors 0 Replacement Windows/doors/sliders.U-Value (maximum 35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *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 required. SIGNATURE: Q:MPFU MTORMSIbuildmg permit formsTIMESS.doc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibtLi ly Nanle(Busin ess/Organization/Individual): . A(EL�'O'J� SOLVE --Addr37 ess _CityLState/Zi 104, 0A Are you an employer?Check the appropriate box: Type of project(required):. 4. I am a general contractor and I 1.❑ I am a employer.with � 6. ❑New construction - employees(full and/or part-tim.e).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.t 10.❑Electrical repairs or additions required.]= - 5. ❑ We are a corporation and its � officersh exercised. have .❑Plumbing repairs or additions r<4`3`[�'I homeowner doing all worktheir 11 Plbi i dditi • myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification Ido hereby certify under th ey Ities of perjury that the information provided above is true and correct: S tur i ae: a� � 0 i 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,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, §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-contractor(s)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"1:he 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 may be 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 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 Comm mweaM of Massachusetts Department of tndustxial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax##617-727-7749 www.mass.gov/dia . 1 1e °FTHE r Town of Barnstable ti Regulatory Services yIE�, Thomas F.Geiler,Director . i639� 'hF „ Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must ; Complete and Sign This Sect"on If Using A Builder as Own of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building p t (Address of Job) *Pool fences and alarms are the respo sibility of the applicant. Pools are not to be filled or utilized before fe ce is installed and all final inspections are performed and accep ed. ' Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERI IMIONPOOLS 62012 a , THE r, Town of Barnstable Regulatory Services a r ' snxxsrAM4 : Thomas F.Geiler,Director Mass. �$p 1639. ,�� Building Division . TfD►rtp't h Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 .www.town.barnstable.ma.us Cffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION p� Please Print C DATE /� (/n/�f�3' —; /F- A'_ JOB LOCATION_ �1 / /V /7 L� '10,1, number street village lUC/,So� U� Sovy 'Jn 57- "HOMEOWNER": /rI�'�G G �' name home phone# work phone# CURRENT MAILING ADDRESS: � d %AAIAII 44 ti oZ(0vl- y city/town ....--" state � zip code....The current exemption for"homeowners"was extended to include owner-occupied dwellZgs of'six' its 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 requirements and that he/she will comply with said procedures and requirements. Signa ire of Homeo r-.•,____ 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 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 dd 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 w 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:forms:homeexempt i BE INSTALLED IN COMPLIANCE ' "Assessor's office(1st Floor): -� � �� O ,9 �v, °.� WITH TITLE 5 �Mf Assessor's ma and lot number ' p ENVIRONMENTAL CO E Board of Health(3rd floor): - TOWN REGULATION Sewage Permit number � • Engineering Department(3rd floor): House number+ �S a t; ssasyrsntc � � � Barr,�fch• � V � D � clue �o tayo. Definitive Plan Approved by Planning Board i 19 moo, Gr- �orw d Nn APPLICATIONS PROCESSED 8:30 9:30 A.M.and 1:00-2:00 P.M;onlyF TOWNS OF ' BARNS BLE 'BUILDING - IN-SPECTOR APPLICATIONFOR PERMIT TO — .f TYPE OF CONSTRUCTION t 19 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: t m, � Location �4-�-_A)n44-,=- R46 Z24AAVAJ i s ( L 7- 10 2 Proposed Use 4✓ Zoning District Fire District XX 0,�ym I r— Name of Owner �G�So/li c�®y!ram Address lCd- f2�r�®.n�� Name of Builder jcn.G� �- �o�v Address Name of Architect Address tt Number of Rooms ""�I Foundation Exterior Roofing 0 Floors ? -ter_! Interior 5' ,,�2 S Heating ^/10/1 G-- Plumbing ���--- Fireplace .0�20.017 Approximate Cost , cccr zzf Area _ S Diagram of Lot and Building with Dimensions Fee 019 �6 j � X Ila M OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construct' n. Name Constru ion Supervisor's License SOU'VE, NELSON No^ 4515 -Permit For Build Addition' to Garage l`= Single''Famil.v Ewell' nc� • �. � ;� - �� ' r Location 'Ldt #102 , 27 Ferndale Road ` Hyannis Owner Nelson Sou've i -1 Typesof Construction Frame 1 FM f Y r f _ Plot Lot it Permit Granted! ; :Auqust 12 „ si19 91 Date of Inspection r `13/-/ 19i _ + Date Completed ,�/?'19i`1� .19 t s . . 'F r' f TQ•I~ k + ,r [,i F ', s l /tf /'4 J/ ram.i f.� i'i'w t �°F f!�,J 4 f ''F , •r, f `� �� P f � � /•j � a f "�,.-"' '"."+ �.o- /�'}I"'r''Y-r�x`. � � r•er.t ,.M 6'vr'r'Tr ',...y�()�.x•y ep�k e"'-y'-„�r n-flr7Yi,,"y-,r s."^i"..-,-.<�+,•.,. ,,,,K,.r .a. ..� Assessor's office(1stFloor):, 0 9o�d q Assessor's map and lot number / TNEfto` " Board of Health (3rdfloor): �'� Sewage Permit number e w '� � -' i ssaas'rsncc t Engineering Department(3rd floor): 4� n F O` rua+ ;. House number °o 1639 Definitive Plan.Approved by-Planning Board 19 APPLICATIONS PROCESSED 8:36-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNS Ti BLECD BUILDING INSPECTOR APPLICATION.FOR PERMIT TO 1Fkb&aj2 (2h o4cl , • 4,O�r TYPE OF CONSTRUCTION �O�l`/J"!! 19 ! TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �E �1-F RO/-7 � , �/Y�1'i(J�tl/S CLIT 010 2 Proposed Use 7 ter Zoning District /�J, Fire District & Name of Owner / GlSO/li cSo� / Address /®c �`u��,o�� /`Yi,.rfnij-, /r S'r Name of Builder �Ja-c� L"f�� Address Name of Architect Ste - - Address Number of Rooms " Foundation ,(aW rG- Exterior -� ��L P Roofing "oy"'lzl-r— Floors � �- ter- �_. Interior /�✓� S Heating �/IO/1 �- Plumbing '10090A"�--- t Fireplace 4J? Approximate Cost Area A j-----__•_ •_..__. 5 Diagram of Lot and Building with Dimensions Fee 5 l -77 f �— — • l l ` � P I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construct', n. Name Construction Supervisor's License VE, NELSON A=290-009 Z No 34515 permit For Build Addition to Garage Single Family Dwelling Location Lot #102 , 27 Ferndale Road •; r Hyannis Owner Nelson Sou've Type of Construction Frame • �. r Plot Lot 1- A Permit Granted August 12, 19 91. Date of Inspection 19 Date Completed 19 s PERMIT COMPLETED SEP-26-2©01 12:11 B.RRNSTPBLE HOUSING 15097739312 P.01 Tiacpholic(50'3) 771 �\ • �� Barnstable Fax IS0,77`s--I=1.' 1 sas s, I� Leased Housing Dept.(508)771-739; 140 South Street•Hylnnis.Mass.02601 I`�OUS1 1� Authority ZONING VERIFICATION TO: Gloria Urenas FROM: Robert Hooper, Leased Mousing Coordinator RE: Legal Rental Unit Verification Date: QL------------------- Address: 27 Fe-rn dalr— Village: ,, -- Unit Type: ? Bedroom Size: a Map & Parcel No.: —79 0 - 0,02 The owner of the above listed property is entering into a contract with us for the rental of the property as fisted above. Please verify by signing below that the unit is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: , ;hank ou r your assistance in this matter. -ems _.�.��_�nature Print name _/�4S Date VIA FAX; 790-6230 MRVP Section 8 Rev.9/98 Equal Housir)-Opportuni.tv Age%.%' TOTAL P.01 � f ,� 1� ;. �- �- � � r �� 10 Otte ? id �ylow Al � a Y*, Alf. t r i ; Yw rw-s�� Wit* -� -,�:.•a.:.�sp -� �^� ..: F ti< ".,, m ..M1--s.:•. -.mow .....:. ... ......."F-i��rt':ffx« !{'4:c^i 'm.:o..u- X`:i;�l'•'A.c i'-zsYr'AsSFM3. ,rt'f ....,-.._.__. - _.. -._.. ar... - e�.rwPnx:.y9saa,.teuN.a. .-..+`++aBerwnaxssa......r- _--:...c.n<.+-, _ � Ll.SLB✓ -aY+'✓s�x�<'.?�'raWTi'ne!sRCsna�a -a±.:r.:»�r.»Y 1.a... - .' �,aweY _._:_._.«�..._,._u r.—.p..yu - � � �-. -._-r.+�Ya..rr..�.- .. sA� r..-.....b-am3x2.WEtie,rwi-,rT+4.a - J a s t n � �A g Q[. },O 0*4 1 i \N - f" �. 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