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HomeMy WebLinkAbout0067 GLEN ROAD _f l7 /Z)t 714 -Town of Barnstable Building anx�srnst� Post This Card So That it is.Visible From the Street-Approved Plans Must be Retained on Job and this Card Must'be Kept v mmsa. Posted Until Final Inspection Has Been Made. er' Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-1004 Applicant Name: ALIOTTA,ARMAND A&GAETANA M Approvals Date Issued: 04/01/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 10/01/2019 Foundation: Location: 67 GLEN ROAD, HYANNIS Map/Lot: 267-107 Zoning District: RF-1 Sheathing: Owner on Record: ALIOTTA,ARMAND A&GAETANA M Contractor Name: Framing: 1 Address: 164 LOOMIS RIDGE Contractor License: 2 WESTFIELD, MA 01085 Est. Project Cost: $0.00 Chimney: Description: 8'X14'SHED Permit Fee: $35.00 Insulation: Fee Paid: $35.00 Project Review Req: Final: Date: 4/1/2019 Plumbing/Gas Rough Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after.issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building an Fire Officials are provided on this permit. Electrical d Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: r . Town of Barnstable VErp�i wilding Department Services Brian Florence,CBO fuxxsrasrs = Building Commissioner kci¢a �prEd Y9. w`°� 2DD Main Street, Hyannis,MA 02601 wwmtown.barnstable.ma.us / Office: 508-862-4038 Fag: 508-790-6230 1 Pxnffr# $35.00 SHOD REGISTRATION RESIDFNTIAL ONLY 200 square feet or less 7 Location of shed(address) e Property owner's name Telephone number. 8 a J I a �- Size of Shed Map/Parcel# 0 �° 0 0 iv -n � r 2. Signat.ife Date „ Hyannis Main Street Waterfront Historic District? eV Old Kings Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&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 BF ACCONWANIEIa BY A PLOT'PLAN Q forms-sbedreg REV.08/6/17 Town of Bamstable Geographic Information System September 8, 2007 j.z .. 41, 207106 t ti., )287109 f „ �€{`1�3 ! � ""i�+ �rf#385T i r ' r v �� �� � n r• 288030 ,trr a s a #85 288029 267104 �41 r #77 #7 .,'M;sX. MIR ��} f / 267103 #23 40aq p #48 .267109 #72 267108 gee 0 116 eet -� Y '� 298022 054 DISCLAIMERS:This map Is for planning purposes only. It Is not adequate for legal Map:267 Parcel:107 boundary determination or regulatory Interpretation. Enlargements beyond a scale of Sale Parcel 1°=100'may not most established map accuracy standards. The parcel lines on this map Owner:PARKER, DEBORAH L Total Assessed Value:$246500 . - 0,,,1,f are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.22 acres Abutters W 9. boundaries and do not represent accurate relationships to physical features on the map Location:67 GLEN ROAD such as building locations. t BAer Town of Barnstable Building Post ThisyCard So,That it is.\/rsible`°From_the,„Street App'rovedPlans Must be Retained on Jobaand thisCard Must;be Kept „ - dARh'lTCABI.E. � a� �� Permit 6 Posted UntihiFinaf Inspection Has Been Made xr l, � � 3 �aa Wtiere�aCertificate of Occupancy is Requ►red,such Budg shall Not be Occuped until a Finallnspect�oq has been made Permit No. B-18-3583 Applicant Name: Henry Cassidy Approvals Date Issued: 10/31/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/30/2019 Foundation: Location: 67 GLEN ROAD, HYANNIS Map/Lot 267-107 Zoning District: RF-1 Sheathing: H, Owner on Record: ALIOTTA,ARMAND A&GAETANA M Contractor Name;'-;,HENRY E CASSIDY Framing: 1 y` Contractor License; CS400988 Address: 164 LOOMIS RIDGE � 2 WESTFIELD, MA 01085 :�- Est Project Cost: $4,500.00 Chimney: Description: 4 hours air sealing, 3.5" R13 faced fbg batts to 100,�scI A common Permit Fee: $85.00 wall with 2" rigid bd.,crawlspace 530 sq ft 2"`rigid bd witF required Insulation: Fee Paid:' $85.00 fire rating to perimeter walls Final: Date 10/31/2018 Project Review Req: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Gas: All work authorized by this permit shall conform to the approved a pplication;ancl the,approved construction documents for�whkfi this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by I,a r d codes. Electrical This permit shall be displayed in a location clearly visible from access street or�road and,shalhbe mamtamed open for public inspection for the entire duration of the work until the completion of the same. ? Service: The Certificate of Occupancy will not be issued until all applicable signatures bykthe Buildmg and:Fire Officials are providedon this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: - 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons con with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: ' Town ®f Barnstable Permi RegulaE{t 1g yf � ,ryi�eY e lf i Date: ltf 61 E Direlc.tor0, Thomas e► er Building LPJvision=. . t, Fee: BARNSTABLE. ' Tom Perry, Building Commissioner MASS. i639• 200 Main Street, Hyannis, MA 02601 Argor A www.town.ba_rnstable.ma.us Lill Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT � ,� Owner: Phone: f.7 Install at: � C'/�✓� __ Village: Map/Parcel: Q� `:V� Date: l Stov. -y. t-�_A UsecD _ -� B. Type: Radiant r-Gj!�jrla ing� C. Manufacturer: v"j .Ly._ . Lab. No. D. Model No.: �T� ,,�, ✓ �� Chimney ' A. New/ 1✓ ' tiri �If existing, please note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue? c D. Pre-fab Type and Manufacturer ason nt• mined Hearth A. Materials: B. Sub Floor Construction: Installer z:�<g Name: Address: Phone: Location of Installation; . /— H.I.0 Registration # Construction Supervisor# OR check Homeowner Installing, no license required APPLICANTS SIGNATURE APPROVED BY: i o Please make checks payable to the Town of Barnstable *This constitutes an of stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove _ Rev 103107 ' Town of Barnstable o Regulatory Services y xsZns Thomas F. Geiler,Director v rtAss. 1639• Building Division pTfD hW�h Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: p� f street / village number "HOMEOWNER": /, zl�l'i� name home phone Il work phone{J CURRENT MAILING ADDRESS: Ae - !�lil`�%/%'mil G - j jr,�-• Q [_�., i�� cityltwn' state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided 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 A), 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. SignatureQfM meowner 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 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/certification for use in your community. Q:\WPFLLES\FORMS�homeexempt.DOC . OF—(HE T 'Town of Barnstable Regulatory Services RARNsrnsLE, ' Thomas F. Geiler, Director , KAS& �. 16jq. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 rvwtiv.town.barnstable.ma.us. Fax: 508-790-6230 Officer 508-862-4038 Property er must plete and. Sign This Section If Usi A Builder s ' as Owner.of the subject property hereby authorize to act on my behalf, in all matters relative to work autho d y this building pernit application for: ( ddress of Jo ) Signature of Owner Date Print Name 1 If Property Owner is applying for �errxiit pleas complete the Homeowners License Exemption Form on the reverse side. f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 'mow s' www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le[ibly Name(Business/Organization/Individual): •Address: City/State/Zip: %1 � �—�' Phone.#: � �' Are you an employer? Check the appropriate box: .'Type of project(required):, 1.❑ I am a employer with 4. [] I am a general contractor and I 6.- New construction . employees (full and/or part-tune).* • have hired the sub-contractors 2.[1 I am a'sole proprietor or partner- listed on the'attached sheet. 7. E]Remodeling ship andhave no employees These sub-contractors have g. Demolition working forme in any capacity. employees and have workers' t 9. L_1 Building addition [No workers' comp,insurance comp, insurance, . required.] 5. 0 We are a corporation and its 10.�•Blectdcal repairs or additions � . 3, I am a homeowner doing all work. . officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 152, 1(4),and we have no 12.[]Roof repairs c. insurance required.]t § employees. [No workers' 13. Other C' _> comp,insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowom.who submit this affidavit indicating they are doing all work and then hire outside.contractors must submit a new affidavit indicating such. lContmctors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the WA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Simature te r~ �,.. __ Date: 12- =cam• . v -- Phone#: rofficialuseonly. Do not write in this area, to be completed by city or town official,n: " Permit(License#_ Issuing Authority(circle one): -1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other Contact Person: Phone#: ` G 4V p 1 A S t t a OFT � ' .e a Q, q t' I lo K$ � t r . aAny c loth d. ¢¢ AN Ty I O � � joy, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued I I� Conservation Division Application Fee Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address �12 90mi Village P r✓L•o'�.0 Owner r Address Telephone Permit Request r Square feet: 1 st floor: existing aootroposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �` 500 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 ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing (v I/ new Half: existing A _new Number of Bedrooms: ca- existing .3 new Total Room Count (not including baths): existing new 6> First Floor Room Count Heat Type and Fuel: )XGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes �(No Fireplaces: Existing ✓ New Existing oo /coal stove: a Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 2"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 Qv ntig ri a yt,4 ��!o- Telephone Number Address re>leh goad License # 0.• 0,2, D Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DgfLp SIGNATURE DATE D FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t MAP/PARCEL N0. L ' ADDRESS. R VILLAGE OWNER DATE OF INSPECTION: f. FOUNDATION' FRAME r INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL ROUGH FINAL f FlNALBUfLDINGi '� • �€:..� ?-� -�s�` �, DATE CLOSED OUT L ASSOCIATION PLAN NO. Town of Barnstable � . Regulatory Services ` Thomas F. Geiler, Dixector Building Division Thomas Ferry, CBO, Building Commissioner 200 Maul Street, Hyannis,MA. 02601 www.town.barrista bkma.us C-O t Officer 508-862-4038 Fax: 508-790-6230 PLAN RE VIE W owner:-4 y6 7—rd- Map/Parcel: 7 �0-7 Project Address 67 6--L 6 ilder: 1`] tf C The following items were noted on reviewing: g��i2crarM w� � bDcc) 2 t 7-0 c ob C t��t—Une2 f tq S L LA--770 Ifc� S' TV c_o b C-6 rI- irr c- t rf SU t-0 -70/Y I OT S u CA-776 PIV Y D� Reviewed by: Date: Q:Forins:Plnrvw The Commonwealth of Massachusetts Department of Industrial Accidents .. r' Office of Investigations 600 Washington Street t Boston, MA 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information II /� Please Print Legibly Name (Business/Organization/Individual): AV►��Q(gC1 0 �'p - grbc� d�60��0�- Address: �7 le vt dC ^d City/State/Zip: h S 0� O a�0/ Phone #: q-9t:� Are you an employe •Check the appropriate box: Type of project(required): 1.❑ I am a employer with ' 4• ® I am a general contractor and I 6. ❑New construction * have'hired the sub'contractors.. _ _._ ___. employees(full and/or part-tune). _..._.._ . .. 2.❑ I am a sole proprietor:or partner- . listed on the attached sheet. 7. ZA Remodeling ship and have no employees These sub-contractors have ,g, �Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp. insurance./ .] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions required 3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing 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 employes. [No workers' l3.❑ Other e comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy information, t Homeowncrs who submit this affidavit indicating they arc doing all work and then hire outside contractors must submil a new affidavit indicating such. tContractors 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. fain 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: (D1 . e KD0.� n S (�bt City/State/Zip: Y)V 4 6 610/ Attach a copy of the workers' compensation poli JL declaration page (showing the policy number grid 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. 1 do hereby c tify under the pains andaenq1ties of rjury that the information provided above is trite and correct. S i nature: a ' 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 6. Other Contact Person: Phone#: t 1 Information and fnstructzODS for their eM0r Masskers achusetts General Laws chapter 152 requires all employers toiprlhe'serwor'Ce of another P underoany contract oplhyees. Pursuant to this statute, an employee is defined as ".,.every person express or implied, oral or written." gal chtitY, or any An employer is defined as "an individual, partnership, °C�thte le al corporation epres'ntatives of aedeceased employer,ooLheore of the foregoing engaged in a joint enterprise, and Including g or trustee of an individual, partnership, association or other,legal entity, employing employees. However the receiver 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 o�o°construct bugildgngs nc{n thel co�mhmonavealthsfor any r renewal of a license or permit to operate a business o applicantwho has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MOL"chapter 152, §25C(7) states "Neither,the conunonwealth nor any of its political subdivisions shall pliance with the ins�uance enter,into any contract for the perfonpance of public-work until acceptable evidence of com requirements of this chapter have been presented to the contracting authority." Applicants Please fi11 out.the workers' compensation affidavit.completely, by checking the s along that their apply to your situation and, if necessary,supply sub-contractors) name(s), addresses)and phone numb ( ) g PP Y in Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than t e members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have emp)oyees, e policy is required. Be advised that this affidavit may to submitted to the the aDffr Department ofaffidavitIndustrial lshould Accidents for confirmation of insurance coverage. Also be sureg n and 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 es should enter their number listed below..Self-insured companies self-insuran°e 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.permitllicense number'which will be used as a.reference number. In addition, an applicant that must submit multiplepermit/license applications in any given year, need only submit one affidavit indicating cu Y D Policy information (if necessary)and under"Job Site Address" the applicant should write"all locations in town).""A copy of the aff davit 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. Anew 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 wouR]iiC�e to Lh�rr1�Y°nfD3�-0u�G°orPratinn 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 lndustrial Accidents Office of InYestigations 600 Washington Street Boston, MA 02111 Tel 4 617-727-4900 ext 406 or 1-877-MASSAFE - Fax 9 617-727-7749 Revised 4-24-07 www.mass.gov/dia The Commonwealth of Massachusetts y Department of Industrial Accidenfs Office of Investigations 600 Washington Street l�. Boston, MA 0.2111 yy www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Otganizationflndividual): K•� / QWreh C e. Address: �� Comore_ elbeL9 City/State/Zip:3L p PA. stop Phone M Are you an employer? Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 6 ❑New construction 1.❑ I am a employer with employees(full and/of part-time).* have hired the sub-contractors.. . _ _._ 2.)4-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 forme in any capacity. employees and have workers' 9 Building addition comp. insurance.1 [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] 3.❑ I required.] a homeowner, all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'. comp. right of exemption per MOL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13'Z Otheri • comp. insurance required.] ro0 *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 sub-contractors and state whether or not those entities have employees.. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information Insurance Company Name: Policy#or Self-ins. Lic.#: C$ 1 0 3-t1. Expiration Date: /' ova?' Job Site Addre &7 (cot City/State/Zip: �C S Attach a copy of the workers' compensation policy declaration page(showing the policy num er 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. I.do hereby cert' /under the gins and penalties of perjury that the information provided above is true and correct. Si nature; Date: Phone#: �j. 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 Phone#: Contact Person: t ��oFzt+r ray Town of Barnstable ` y� o Regulatory Services R,s-r Thomas F. Geiler,Director MASS. Building Division reo►uy" Tom Perry,Building Commissioner 200 Main-Street, Hyannis, MA.02601 wwmtown.b arnstable.ma.us Office: 509-862-4038 Fax: 508-790-6230 HORH;OWNER LICENSE EXEMPTION r Please Print �/ DATE: / 1 I Q I 1 0 JOB LOCATION: Q 2 Dal Jmannis f44 number street village "HOMEOWNER': Air name �home phone# work phone# / CURRENT MAILING ADDRESS: `& /..DD IY�LS Itl. 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. DEFINTrION OF HOMEOW1ER 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 constrgcts more than one home in a two-year period shall not be considered a homeoRrler. 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 tha.t•be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re ements. gnatiure of Homeowner . Approval of Building Official Note:IThree-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 persons)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(set Appendix Q, Rules&Rcgiulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bfien 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 rasp onsibili 6 rs,many communities require;as part of the pemnit application., that the homcowncr certify that hdshe 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 fonn/certification for use in your community. Q:fon-ns:homccxcmpt -THEr, ti Town of Barn-stable ' Regulatory Services a sAaxsrAsr a Thomas F. Geiler,Director 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 " ProperLy'O nier Must ' Complete andtSign.This Section. If Using ABuilder I> , as, er of the subject.property hereby authorize to act on my behalf, m all matters relative to work authorize y this adding permit application for: (Address f Jo Signature of Owner Date' Print Name If Propery Owner is applying for permit please co et e Homeowners License Exemption Form on the verse side. Q:FORMS:O WNERP ERMISS)ON DIME Town of Barnstable *Permit# '{ Expires 6 mont s from issue date Regulatory Services Fee ' Thomas F.Geiler,DirectorSS IT ® � Building Division v� 3 rED MAi APR - 9 2008 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTA►BLE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press imprint. Map/parcel Number. ` / Property Address � � Ct L1=IV (�v a-0✓1 t S Residential Value of Work l oo o Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address n M�Al 0 AL! 0 TT-P Contractor's Name 06 99 G C V J&4 Y,4 IV Telephone Number S(7 8 Home Improvement Contractor License#(if applicable) S ❑Workman's Compensation Insurance C eck one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [�(Re-roof(stripping old shingles) All construction debris will be taken to NP A All 14 70"V ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. ww/SIGNATURE: Q:\WPFILES\FORMS\building it fomis\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of.Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le. bly Name(Business/Orgatri=ion/Individua): V D/2 4 Address: 6 /Vd U T( 614-C ttiq y City/State/Zip: N y/+��N�'/S MA o261 Phone.#: / (SO��.b1fS` A'2 Are you an employer? Check the appropriate bog: Type of project(required): .1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full.and/or part-time).* have hired the sub-contractors 2. 1 am a•sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.•innn'-dMe comp.insurance$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions .3.❑ I am a homeowner doing all work officers have exercised their ILL]Plumbing repairs.or additions right exemptionMGLt o per myself[No workers comp. 12.Ef Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp,insurance required.) *Any applicant that cheela box#1 must also fill out the section below showing their wmicers'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. 1Contractors 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 workcts'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins.Lic.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 crimifial 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 flW a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.. I do hereby certify under thepains-an penalties of perjury that the information provided above is true and correct Si attire• Date: 2 Phone k O S Official use only. Do not write in this area,to be completed by city or town official 71 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 subdivisi ons shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of thin 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(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If anLLC 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' h 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 Towp 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 (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 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.govldia -HAKI'S CONSTR UCTION 76 NAUTICAL WAY HYANNIA,MA,02601 PHONE#508 685 7142 FAX#508 534 9048 REGISTRATION#153203 NAME: Armand Aliotta JOB ADRESS: SAME ADRESS: 67 Glen Road TOWN: same CITY: Hyannis JOB PHONE: 413-562? 92 STATE: MA FAX NUMBER: ZIP: 02601 We hereby submit specifications and estimates to furnish and install new roofing as follows. 1. The existing roofing will be striped,the roof deck will be inspected for rot and the owner will be advised of any replacement needs. 2. Any minor repairs on the roof deck will be done without any additional charges. 3. During the striping of the existing roofing the building will be coveted with blue tarps to prevent any damages to the siding shingles. 4. A layer of ice&water will be installed on the intire roof. 5. At all eaves of the roof new 8 inch drip edge will be installed. 6. 30 year arch shingles will be installed doing 6 nails per every shingle ( which is required by the building code). 7. 3 inch opening will be cut at the pick of the roof create ventilation in the attic of the building. 8. The opening will be covered with shingle vent 2 which will be fastened with 3 inch hand nails. 9. All the pipes on the building will receive new aluminum pipe flanges. 10. The siding shingles and the flashing on the lower roof will be replaced. 11. This price is for the entire house. r 12. After the installation of the roof a detailed clean up will be done, the yard will be inspected for any nails with a heavy magnet. 13. 15 year labor warranty will provided in writing by HAKI'S CONSTRUCTION. 14. Workmen's compensation and public liability insurance on above work will be taken out by HAKI'S CONSTRUCTION COCOA - V5 r N Y woO 0 The following is estimated for 3.000.00 dollars Proposal accepted by------------ ----3-�------------------------------------------ Board of Building Regulations and Standards . License or registration valid for individul use only HOME IMPROVEMENTCCONTRACTOR before the expiration date. If found return to: Registration 153203 Board of Building Regulations and Standards xpiration 11/3/2008 Tr# 253249 One Ashbu E rton Place Rm 1301 I i`Type 'DBA Boston,I\Ia.02108 JD HAKI'S CONSTRUCTION EDGAR GEVORGYAN: � . 640 MAIN ST.#2 ."`.� - HYANNIS,`MA 02601 - - --- Administrator LNtI W bout signature J l Assessor's map`and lot number..... E 3,j�ewage Permit''number l-(. ....:. ........lIC......�.`.... ......... ...... Z BARNS LE, i House number'.........................:: .......�*'.....................:'.. OM fr. a TOWN OF ' BARNSTABLE 'BUILDING. ) INSPECTOR APPLICATION FOR PERMIT TO ........ .. .......� � . ........ ............. _ TYPE=•OF CONSTRUCTION ............ ... ....... ............. ............................................... ............ !. .?. ................................................ :?? TO THE INSPECTOR OF BUILDINGS: ; The.undersigned hereby applies for a permit according to the f lowin information: .� �Le� / ' Location .. . .7......:4.•.... . ...... ...........(� '`y'-� ..... 00, ;7.,Z 5 ' ............ . .............................................Pro osed' Use . ..... "... . . . ... .. .. ............:.................... { 13 Zoning District ... :.'..`...`.:................................ ..:...............Fire District ..... ..:: ......................................... Name of-Owner 42'd'`� �r Address ......'S Name;,of• Builder .......��' ....Address'....�.� 5,.�,e urn.... ..� �•...... :Name of Architect ....Address ' Numberof,Rooms ..................................................................Foundation ............................. ......................... Exterior ............................ ......................................................Roofing ,................ .............................. .................................. t r S� Floors ...............I. ...............................................:..............:.....Interior .......................... ..................... .................. Heating < • � - G�2�... .................................Plumbing ..a7.................................................. j Fire lace l v ......Approximate. Cost � .... s... Definitive Plan Approved by Planning Board ___ __________________ ____19:_ _____ . Area c.1.. .................. ' ._ i7 f „ Diagram of'Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 construction. ` 2�p_ Name ... .... ............... ......... ......... S Construction Supervisor's. License . '[SHRANK, LEON S No k 2 5 8,4 6. Permit for ...Build...Gar aqe `` Y AC. �55.4Y....to...D�? l,�,inq .......... Locatiori 6 7.. .GJ:�1�..RA.ad........ ... :.. , West Hyannisport Owner, ,S17.>:Anl.................................. Frame Type'of. Construction .......................................... , . . V'✓ �; Plot .....:. ......... ......... Lot .;.............................. Permit Granted •..DeC. 6 s•.......f r �1 q 8 3 ............... ���� •�j -ID ate,of.�nsp i ' r? :19d / h Date' Complet d �� w - � � Lam•,/� �/ �i P r � f. �r / / ", ���' ,�+.. f � `" "••w,.� �,•� � �✓: _• ram.��• y JA r� lAssessor's map and lot number`... ���*....".....?.. ....... c THE to 6. 6 Q �y ,,Sewage Permit -'number r = 33AR3STA.BLE, i ouse number ........................... M6H . . 39 a HAR TOWN OF BARNSTABLE BUILDING INSPECTOR • • f APPLICATION FOR PERMIT TO `.. � �y TYPE OF CONSTRUCTION ............ . ..:.....................................:....................................................................... ................................................ y. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the fo.11owin information: �� �� Location ...... .... , ...... � .............................................................................................. ProposedUse .................��...�................ ............................................................................................................. .0... /3.................r.................................Fire District ..........� ` 'z`'�`'off?..............:............ Zoning District ............... Name of Owner �� .............. ........ Address '. ............ . ............... �. ............... .......................................................................... J 9�3 Name of Builder A ..........................Address Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ........... .....................................................Foundation ............................. ........................................... Exterior ............................. ......................................................Roofing .................. ..............................:................................... ...........Interior `.�'"""" Floors ...............�..................................................... ................................................�................................ Heating ................ .........................................................Plumbing. ..............: ��....: .................................................... d C� Fireplace .....................I'....•....................................................Approximate. Cost ..............��:................................ Definitive Plan Approved by Planning Board ________________________________19________. Area ........: - 3..................... Diagram of Lot and Building with Dimensions Fee f ` -`�............ f ; ; .... .. SUBJECT TO APPROVAL OF BOARD OF HEALTH r' 44 y1: ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS `1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding'�the above construction. Name .�r_,..y .............................................. Construction Supervisor's License .....:..... � -G SHRANK, LEON A=267-107 -- 4 Y No Z�5846 permit for Build Garage A ye soz.Y...ta...D.Ws~llinq................ Location .6.7...Gle-a...FW d...........:.......:............ Owner ..... ................................. Type of Construction .....Frame........................ ............................... ............................................. r Plot ............................ Lot ................................ Permit Granted ......Dec-....6.�.........:......19 83 ; Date of Inspection ....................................19 s Date Completed .....................19 - _ . F 965'3 s _ _ 1341,61 G _L ` 7T rim lifton� i�� L�¢�f • I sM�K :ETEC 0 � REUI WED _ —� A�w ( i — BARNSTABLE D G DEPT. DATE �W� ~Tyv ?, — 7 MaSh�►N { _�..0 GRADE=RiEQ -I-RED RTANT S ATE BUIL ING COD _REQUIRES+HE-UPGRADING-OF D ARTME T DATE - FII E EP D ECSO ES FOR TIHE NTIRE D ELL NG WHEN .— S EOKE DET -BOTH IGNATUES ARE- EQ IRE-D-FO IT 7 NI_OR MO I -! PI G A'-EAS 'RE ADDED OR CREATED. Wj{.E_A-SERARA 1 f P€a� I LATIOYV® ETEC� A OUI,RED FOR THE dq- S IN TAL - - � pE MIT- . .. � :F - � _ RICAL SMOKED R X.E€L€C-T a SA ISFY THIS REDUIRE EN 'AHBpN MON�pXlpE MASUSTgE/NTA( CARMg� ACH(ISE17 BUI(�WG 11 _ I , I � 70 f I ILI I - -__:C;.._L_ - - j - - --- - - = -- - - - -- - - - 1-14 _ - - - -- - - - � - )��- �► r C"Ilo l � N i } I 7 `1 - - � U / .UT IN l.)EN to v j /i TEE C'C,%1., C t7, 4;1 MU1..LtON W1N[.;�.N.1 CaV�ArS 3 t j 1 i i - _ f 'L> Ly{L�!ti�G '�, MATw NOVliF-- i I • t T ' c; v� t�