HomeMy WebLinkAbout0036 GENERAL PATTON DRIVE .36 G�oi 8rr,� t�,e
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IPA Town of Barnstable *Permit#sR �3e2S 7
Expires 6 months fro rs%me date
Fe
rT Regulatory Services Fee
s,MSTAel.e, _ Thomas F.Geiler,Director e
aSS PERMIT Building Division n
Tom Perry,CBO, Building Commissioner 1`�
J U N 18 2008 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 5 0NNOF BARNSTABLE Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number o: 9
Property Address 26_ee�e,(Le p .
E�7esidential Value of Work C}73d Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 112 ':5 /lf,+- �+' IQsr Gloy�PlZ
��_¢x 516 5�m,l,Z9 /n� U�G�
Contractor's Name ,Q -' " Telephone Number
Home Improvement Contractor License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
r.. dam the Homeowner
❑ I have Worker's Compensation Insurance
3
i Insurance Company Name
Workman's Comp.Policy# `
Copy of Insurance Compliance Certificate must be on file.
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 rm o vo ,y-x;-.4'.�q
19,Re-side -r D�ai ion i1
®eplacement Windows/doors/sliders.U-Value (maximum.44)
'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 is required.
SIGNATURE:
Q:Forms:buildingpermits/express
Revised 123107
Town of Barnstable
y�P 0 Regulatory Services
RARNSTM
" Thomas F.Geiler,Director
16j9.9. +�a Building Division
PIED MA't
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
R'ww.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: 36
number street Ivillage
"HOMEOWNER': fit,=11Pf I .kF?r'`�1 g�AI"'- t3 -1.� z -�l't u S��� � 3yr3�3�
name home phone# work phone#
CURRENT MAILING ADDRESS: PO
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
P g
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
requir nts.
Signature of Homeo
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 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 insults 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 fomi/certification for use in your community.
Q:fortns:homeexempt
r
c SHE ..
r Town of Barnstable
ti
Regulatory Services
rMASS.I E$ Thomas F.Geiler,Director
�e3 a�. m
Enr� Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
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: ,
(Address of Job) .
Signature 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:O WNERPERMISSION
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):11Q -j 1 �L�/X�� 7 ]YL(/L�%` y7 °?J�P�✓'Z/eta ���'� '6 -
Ad&ess: U dam. o
City/State/Zip:
Are you an employer? Check the appropriate box: Type of pioject(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 stab-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, 0 Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
comp,insuranceJ
[No workers r,onap.insuaance 10.[/(Electdcal re airs or additions
�, re&] 5. ❑ We are a corporation and its P
3.L-I am a homeowner doing all work officers have exercised their I LaPlumbing repairs or additions
myselL[No workers' comp. right of exemption per MGL 12 Eifwf repairs
instance required.]t e. 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'conrpenset ion policy information.
1 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tCotrhactors 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-contraetars have employees,they must providb 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.Lie.#: 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 certify u the pains•and penalties of perjury that the information provided above u tru
e and correct
Si e• Date: 7
Phone#- SD-9-
Official use only. Do not write in this area,tb 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 representative's 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 fok the performance of public work until acceptable evidence of compliance with the insnra e
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(LL.P)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 pemrit 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-insuran"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 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 ono 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 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 io any business or commercial venture
(Le.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 advancc for your cooperation and should you have any questions,
please do not hesitate to give us a call
The Department's address,trlcphone•and fax number.
The Commonwealth of Ma.4satlhusetts
Department of Industrial Accidents
office of Investigations
600 Wwhingtan Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 Qr I 77-MASSAFE
Revised 11-22-06 Fax#617-727-774R
www.mass.gov(dia
TOWN OF BARNSTABLE BUILDING PERMIT:APPLICATION.,
n rr11 2 ��
Map Parcel: ' Application #� V ��
Health Division Date Issued .d
Conservation Division = :'Application Fee
Planning Dept; Permit Fee:
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address ^r� u?", (�`Cl (} ( �
Village �AAA Ci✓"V\Y, S i,
Owner ��-(�b'Lv Address
Telephone
Permit Request
Square feet: 1 st floor: existing i aroposed 2nd floor: existing proposed Total new
Zoning District r: Flood Plain \m+ IL� Groundwater Overlay
P oject Valuation21Q 00 Construction Type
Loi Size e �dV_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family C9 Two Family ❑ Multi-Family (# units)
Age of Existing Structure L' Historic House: ❑Yes 311_0 On Old King's Highway: ❑Yes 1'IQo
� � ��Basement Type: ❑ ❑ ❑Full Crawl Walkout LYUther �
C>
Basement Finished Area(sq.ft.) Basement Unfinished Area("ft)
Number of Baths: Full: existing new Half: existing new - v
Number of Bedrooms: existing _new a
Total Room Count (not including baths): existing new First Floor Roo.. Count F
Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other
v
Central Air: ❑Yes ❑ No Fireplaces: Existing A—New Existing wood/coal stove: ❑Yes No
t
Detached garage: ❑ existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_
o Attached garage: ❑ existing 0 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 gl q
Address t��A_ LLicense #
�" � ` • A Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � Lti
W'L•
SIGNATURE DATE �/
C+ p
FOR OFFICIAL USE ONLY
r APPLICATION# "
DATE ISSUED -
x MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
7
DATE OF INSPECTION:
FOUNDATION
FRAME D►� �'3 O`1
� o
INSULATION
� c
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
,.t
FINAL BUILDING
ti
J
DATE CLOSED OUT
ASSOCIATION PLAN NO.
Y
i
i
M
• •q. -
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):- C-
Address:
City/State/Zip: Phone.#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a Y emP to er with 4. ❑ I am a general contractor and I
6. ❑New construction
employees(full and/or part-tim.e).* have hired the sub-contractors
2.El I am a solepropriefor or partner-' listed on the attached sheet. T. ❑Remodeling
ship and have no employees These sub-contractors have 8. '❑Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
Wam
orkers'•comp.•insurance comp. insurance.$
ed.] 5. ❑ We are a corporation and its 10.[�Electrical repairs or additions
3. I a homeowner doing all work officers have exercised their l l.�lumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.[]�Other t1
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.
Icontractors 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.M 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 certify,and a pains and penalties of perjury that the information provided above is true and correct.
Signature: y Date: _
Phone#
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
L6. Otherntact Person: Phone#:
4
w
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
who resides there' or the occupant of the
ore than three apartments and w r In, P •
owner of a dwelling house having not m p
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."
i .
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-conkactor(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"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 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 e6mmonwWt1h of Massachusetts
Departnent of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
Tqy,
Town of Barnstable
111E
Regulatory Services
swartsresLB Thomas F.Geiler,Director +
s:.
MAS&
Building Division °e
ArFD � C Tom Perry,Building Commissioner
' 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us '
Office: 508-862-4038 Fax: 508-790-6230
v HOMEOWNER LICENSE EXEMPTION
Please Prints
DATE:
�t�] 10B LOCATION: l/
g `
number � street villa
HOMEOWNER
name home phone# work phone#
CURRENT MAILING ADDRESS: 4&,AA :Q
s '
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 o
supervisor.
DEFINITION OF HOMEOWNER A i
Person(s)who owns a parcel of land on which he/she resides or intends td'reside,'on which there is,or is intended to• d
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-fromeowner..tSuch
"homeowner"shall submit to the BuildingOfficial on a form acce tableib the Buildin Ofcial that he/she shall be
responsible for all such work performed der the building permit. (Sec"
.g ,* 1
The undersigned"homeowner"assumes responsibility for compliance with the State;Building Code and other
1 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&t he/she will comply with said procedures and
requirement
Signature of Hom er ?`'F`;•
Approval of Building Official ,
Note: Three-family dwellings containing 35,000 cubic feetdr larger will,be required to comply with the
State Building Code Section 127.0 Construction Control.,
HOMEOWNER'S EXEMPTION a
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/certifrcation for use in your community.
5'
-Q:\WPFILES\FORMS\homeexempt.DOC
- i
Town of Barnstable
Regulatory Services
r r
BAMSTeMAJqaBI E Thomas F.Geiler,Director
v 1619. �`0� Building Division u
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 _ C` Fax: 508-790-6230
r ` J
^ t3
r-
• Property Owner Must
�Al , Complete and Sign This Section
If Using A BuilZer
1 '
1
asubject property
a '
r ''hereby authorize to act on my behalf,
in all matters relative to work authorized by g permit application for.
YE
(Address of J )
Signature of Owner D e
Print Name
If Property r is applying for permit please complete. the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMIS SION
- - - --- ---
1
Vl-
V
r
lad
Assessor's map and lot number ..........................................
C jNtW BE
y INSTALLED IN COMPLIANCE
Sewage Permit number / ../ ...... ...... . ......:.............. WITH ARTICLE 11 STATE
GQ,lec� / c SANITARY CODE MD TOWN
QyofTNETo�y ?t)� TOWN OF BARN�* E
SS r
BA"STADLE. - - -
"6 9 BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ....q.d d........! .�Z0 r?:9....... . ...g X/S i n�...c?�w l�i rZ✓
TYPE OF CONSTRUCTION ....P!!�iP:M4............ ..... ......................................................................................
............ Y.'.. :... ..........19.71
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the followinJg� information:
Location ..! O.T.....Z.5.......t..' ..... .. ', ....Ger. erg...•, :Gt,�d.r?..@.....Ve.j. y N.V..:51...i'... .
Proposed Use ..1..!.�5�(.frola.G�.l..../o.4'�Yr S�Q C ........ �-?'I /l ... ��.m.................. ............................
.. ........ ........ .. ..... ....
Zoning District �Es� "� Fire District 14 �� 5 d i re .-�- 1 S r.qj
'I......"............ .................
Name of Owner tG/_3e1.!;GI eJ, S®. ;� .17 !'7 .�..?e:t nb12 tV�
Address ..................
r� cie V1 �ge
Name of Builder .ar1C�
............................:...........................Address .................... ........
Nameof Architect ....No.!q. ...............................................Address ....................................................................................
Number of Rooms I Foundation �o c, ��v �e w nCr, A®f[rl
.................................................................. ................................... ..........................................
Exterior ... .�......Ced r".... .�..!'t.9..1 �......................Roofing ... -� 11,�.��.... . .'.. .5.e..................................
Qf f
Floors 1 / 5COrC- " ... � C�Q i'�� Interior �' ..,... 3 or)..7.t?�...P �;ll/.. ...................
�... ......1Y.:.............. .......... ..... '�
Heating ... �eG7,1 1.G.....................................................Plumbing .�Cd !EF..........................
Fireplace �C' ....................................................................Approximate Cast 5Qpo
Definitive Plan Approved by Planning Board ---------------_---------------19________, Area �� . .'.. .........
Diagram of Lot and Building with Dimensions
Fee ........ ZI............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1�,5 y0�
l 201
60,00
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .... ' .�...-`.
•y.
Souza, Richard J. - '
`
`
n
�No --^600~ Permit for --./a � =
--- .,«---- ���.
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General Patton Drive `
_' ------.—,.------.------ '
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........................ ........................................
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Owner ............. ..Richard J._5ouza_____..
Typo of Construction ......................�����--..
_,___,___.__
---------------' | ~
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Plot ............................. Lot .................
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Permit Granted '--..=--- lQ , '
,
Dote of Inspection .� �
. � .
uo,e Completed
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^ . . ,
` . .
PERMIT REFUSED
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Approved ................................................ lA / �
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9 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION jft6 ;90
Map Parcel I Permit# �� 3
Health Division 0 ���' Date Issued 7 1-S 0-3
Conservation Division _ _ c> a 7-he/on Application Fee ^
Tax Collector SEPT*Qy1 (EP9 RI VAT r� a S d 0
Treasurer INSTALUo IN CO&IPLIANC�E
Planning Dept. �,® REGiJL��'iO�
ENVIRONMENTAL CODE ANt)
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address
Village KfAl r Is
Owner C4 V e Address 6ep X_ 121M g evf Z ��
Telephone Srd �d Z/ unf
Permit Request o 4ee, _x 's %vo k14e,4 bj', ' _ 0peti7"
el
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G✓ c ),s rye . R®® - --
Square feet: 1 st floor: existing rig-O proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 00 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 60 Historic House: ❑Yes kLNo On Old Kin 's Highway: ❑Yes Abo
Basement Type: ElFull ClCrawl ElWalkout ❑Other w4 o ®A, (rr�
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing new 0� + {v
Total Room Count(not including baths): existing Lje- new First Floor Room Count C)
Heat Type and Fuel: (Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: res ��,6o
OlDetached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ex sting ❑.-crew t e
cn �
ROAttached garage:❑existing ❑new size Shed:❑existing ❑new size Other: n,
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes qNo If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name ,eAl Telephone Number e S4 �f' �Z31'
Address •clr*) - 3 2 2 License#
*il
r �/�r✓rv,`5' /4.' , 62660 Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE
FOR OFFICIAL USE ONLY
PERMIT NO':
DATE,ISSUED
MAP/PARCEL NO.
ADDRESS'. VILLAGE,,
i OWNER - • r
DATE OF INSPECTION: ,
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL -
PLUMBING: ROUGH - _ FINAL
GAS: ROUGH FINAL r
FINAL BUILDING ,/�/�/ p a( 7/ZL
DATE CLOSED OUT t
,,.
ASSOCIATION PLAN NO.
i
J
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office PURIVOS MgOMS
_ 600 Washington Street _
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
hone#
C.
[] I am a ho eowner performing all Fork myself.
❑ I am a sole rietor and have no one working in ca acitp
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co I ensation for my employees:wO &on this job.
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aired miter Section 25A of MGL 152 can lead to the imposition 0 andlor
of crtmittal penalties of a Sae up to$1,500.0
gailme to accoze coverage a+zeq
one yam,imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a Sne of 5100.00 s day against ma I anderstamd a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriflcatioa.
I do hereby certi under the p ' and penalties of erj that the information provided above is truce and carted
Date 40 -03
signature � � � Phone# �'� �® - e
Print name
official use only do not write in this area to be completed by city or town official
permt/Acense# ❑Building Department
city or town: ❑Licensing Board
C3gelectnen's Office
❑check if immediate response is required .-ClHealth Department
phone#; ❑Other
contact person:
(revised 9/95 PIN
1
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.
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
PYs
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
p
a e required. Additionally,neither the
with the insurance cover Y,
not produced acceptable evidence of compliance w� g Q .
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
ce of com liance with the insurance requirements of this chapter have been presented to the contracting
acceptable eviden p
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
cuts for confirmation of insurance coverage. Also be sure.to sign and
submitted to the Department of Industrial Accid
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
not the Department of Industrial Accidents.. Should you have any questions regarding the"law"or if you
being requested,
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
a sure to fill in the peImrt/hcense number which will be used as a reference number. The affidavits may be retumed�to
the Depar
tment b 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
Office of InYesugatlons
600 Washington Street
Boston,Ma, 02111
fax#: (617) 727-7749.
27-4900 ext. 406 409 or 375
phone #: (617) 7 ,
RESIDENTIAL BUILDING PERMIT FEES.,
APPLICATION FEE
Tew Buildings,Additions $50.00
Alterations/Renovations $25.00 �
Building Permit Amendment $25.00
EEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot=
�® x.0031= I/. 9 O
plus from below(if applicable)
ACCESSORY STRUCTURE>120 sq.1t
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf-1000 sf 75.00
>1000 sf-1500 sf 100.00
>1500 sf-Same as new building permit;
square feet x$96/sq.foot= x.0031=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00=
(der)
Fireplace/Chimney _x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable) permit Fee
projcost
orAME, . Town of Barnstable
Regulatory Services -
'
L BnRxsrnat�, Thomas F.Geiler, irector,D
9�p �6?9• ��°� Building Division
TFD Mpj
• Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
• Fax: 508-790-6230
Pezmit 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. r
/ Estimated Cost
Type.ofWork:
Address of Work:°
Owner's Name: 4 A 4 A./ �Q e� �
If
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
Job Under$1,000
' ding 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.
Y
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner: /
Date' r Contractor Name Registration No.
OR
,�„+e Owner's Name
I
°ptHE Tpk, Town of Barnstable
P 1'
Regulatory Services
DAMSrABM
9 Muss. g, Thomas F.Geiler,Director
039. Building Division p�r�
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
INiWQ 'S A wt L L
as Owner of the subject property
hereb authorize � � /J
p - � - �(� to act on my_belialf,
in all matters relative to work authorized by this building permit application-for: _
(Address of Job)
7-
Sign= a of Owner Date
Print Name
J n
Q:FORMS:OVaiMPERMISSION
C27 t?�� �b�� ✓/te iOrn»rricaruue¢� o�, a�udeQ6
BOARD OF BUILDING REGULATIONS
"1-7cense CONSTRUCTION-SUPERVISOR
Number -CS. 046972
Expires 08/28l4D3
Tr.no: 2880
Restricted: .00
STEPH WHAL
EN M
'FIV.
POQ BOX 322
S DENNIS, MA 02660
1 Administrator
i
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 110650
i Expiration: 11/3/2004
jType: Individual
STEPHEN M WHALEN REMOLDE
I M'PHEN WHALEN
77 EISENHOWER DR.
COTUIT,MA 02635 l! �
Administrator
Town of Barnstable
FtKE o Regulatory Services
Thomas F.Geiler,Director
4*1 BARNSTABLE. _
9 MAN. Building Division
9
s63 •
iOtF .(s Tom Perry Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
COMPLAINUINQUIRY REPORT
Date: 3 Rec'd by: �—
Complaint Name: Map/Parcel
Location
Address: (S
Originator Name: N e l
Street:
Village: State: Zip:
Telephone:
Complaint Description:
L�VL V'\ A�? LOVA-1-CCC
FOR OFFICE USE ONLY
Inspector's Action/Comments Date: Inspector:
1,6f/ C A-tz d 6 /1/, 3
F d o ,02 b'Q - VS Y&(;'
Additional Info.Attache
S 7'E1/� k/�/R �/✓ �QN7R-0e 76
hr
Q:forms:complaint