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HomeMy WebLinkAbout0010 GOOSE POINT ROAD �� ��� �o�r�� �� . ------- �� i � ° �� i �; �� ��� I i I I i i i __ YOU WISH TO OPEN A BUSINESS? For Your Information: "Business certificates[cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Takethe completed form to the Town Clerk's Office,.1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: • � ram'.. APPLICANT'S YOUR NAME/S: � ,• BUSINESS YOUR HOME ADDRESS:' -! D g 5'v Y &3 3 so yb +"-U 11,-. wlaL. n Ito 3 2- i ,.. TELEPHONE # Home Telephone Number � NAME ;NAME OF N .. ..:: . . F,W:~gIJSINESS PE TYPEOE'BU5INESS / no!sza � T ISDDI Q0: V(] UIViBERp%PARCEL N .... �J [AA ?Ir!nA . MA When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSIO ER'S OF E This individ al h e n i o e o a y er it re uirements that pertain to this type of business. kv horized i na MUST COMPLY WITH HOME OCCUPATION OMMENTS: RULES AND REGULATIONS. FAILURE TO MAY HESUCT IN FINES 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: B. CONSUMER AFFAIRS[LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: r Town of Barnstable i �A Regulatory Services a Richard V.Scali,Director Building DivisionBARIMAZIX ,_- 9 MASS. Tom Perry,Building Commissioner qj 16g9. �0 j°lFD Mai s 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: `s Permit#: (3 01 `5-U�0 �- HOME OCCUPATION REGISTRATION Date: /5 Name: �nlj (cd!a rl oc'k� Phone#: .D&-6'3 3 M Address:� Village: e�F� yt t-I—C Name of Business: p P-0P'5-F.t`/ Type of Business: J�1J� Map/Lot-&� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned ve ead d agree with the above restrictions for my home occupation I am registering. Applicant: Date:�S Homeoc.doc Rev.103113 C. v_ 4�r l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # � Health Division Date Issued . L Conservation Division Application Fee _77 Planning Dept. ermitIV - ' Date Definitive Plan Approved by Planning Board �� Historic - OKH Preservation/Hyannis Project' Street-Ad!rlress �e o Village 'v� _�Y✓z� ; Owner_ i� + ���)� ��� 8PLUA C Address . M9 Telephone LL Permit Request c '6 ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation u 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 N � ' Basement Finished Area (sq.ft.) Basement Unfinished Ar peq.ft) ' Number of Baths: Full: existing new Half: existing ;newer Number of Bedrooms: 2, existing _new r;v Total Room Count (not including bath:3): existing new First Floor I loom Cou--nt Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: Ll Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 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-� �C �.�k Lai. BetA-r1C0 Telephone Number J� 7S— 3k5& AddreSS-1-t Gonglir 6. License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE— - :.v �� DATE 11 _ FOR OFFICIAL USE ONLY 'APPLICATION# !�.. DATE ISSUED MAP/PARCEL NO. -� ` ADDRESS — VILLAGE ,y OWNER DATE OF INSPECTION: ,FOUNDATION FRAME t' INSULATION . FIREPLACE 4' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'k i GAS: ROUGH FINAL " FINAL BUILDING E. £r x' DATE CLOSED OUT n ASSOCIATION PLAN NO. } The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A" licant Information Please Print Legibly ,-C7--Na—m—e(Business/_Organi -on/Individual): a' r''i S Address:_- I �P_ R State/Z-ip Phone #: 7 d C 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have g, Demolition ship and have no employees ❑hrP workingfor me in an capacity. employees and have workers' Y P n'• 9. ❑Building addition [No workers'comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. fL am-a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself.N 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 . comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the 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 weIl as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day-against the violatot. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the Da for insurance coverage verification. I do hereby,certify der the p 'ns enalties of perjury t the information provided ab a is true and correct Si ature: Da�= ;�2L3 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: w. Phone#: .ow- I Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pnrsnar tto 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 Iicense 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 ?lease 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 -mployees, 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 entertheir 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 commorcial 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 sliould 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 Tel,`#617-727-4900 ext 406 or 1-877-MASSAFE Zevised 4-24-07 'Fax# 617-727-7749 www.mass.gov/dia f 5, T Town of Barnstable Regulatory Services snxxs TAX rs, Thomas F. Geiler,Director MASS. 9�A 1639. tim� Building Division lfD MA'f 6 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office ..508-862-4038 Fax:•508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB-LOCATION;�_ ( �� number street vi lage , 0 1 ✓v "HOMED WNER—' sr �� �° C, r 1�41 C�Kt�hC 79�ly (" ®OD . name _ home phone# work phone# RRENT-MAILING-ADDP 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 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 minimurn inspection procedures and requirements and that he/she will comply with said procedures and requiremen N�• ..�, a reeoof Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the - State Building.Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION mit The Code states that "Any homeowner performing work for which a building per 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 fuDy 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. i Q:forrns:homeexempt j T. °FEE T Town of Barnstable Regulatory Services snxMAS Thomas F.Geiler,Director 0 9. $� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Prop e 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 a thoriz by this building permit (Address o ob) **Pool fences d alarms are the respo ibility of the applicant. Pools are not to be ed or utilized before fence i installed and all final inspections a e performed and accepted. Signature of Owner Signature of Applicalt Print Name Print Name Date QFORMS:OWNERPERMISSIONPOOLS 62012 01-06-201.1 a9 110240a ROME The Tom of 8amst Lfe _ ..�S�attbs.applicstt leak legal adwtes to PMPZM a Praparty warded dam@ reaWdon dmri mm. DEED RESTRICI10N WHEREAS,L Kri,00phe r �,i �F Lc wt r�t�f n Of - - (ter':name? T i�}i j P�,a e,1172)1 rlr 1b U4. 3-a- MA (a�dreas} 6 "Lb.3 is the owner of o0se E WT 014uj i llo, 14: loocatea- d (addrass� at , MA{hereinafter referred to as and.Aeinq shown on a plan entitled"Subdivision of Land In t�ar7terVr Ito, IAA, Property of , et recorded in Barnstable County Registry Of Deeds in Plan Book 0' Page Or on Land Court Plan Number WHEREAS, as the owner of said lot has (aw ekr s norm) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal.works construcbon permit in compliance with 310 CMR 15.000 State Environmental Code,Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS,the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200,State Environmental Code,Tittle V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,and authorizing the issuance of a building permit for the construction of a single family home on this property,is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, - a�ar sax sa.�ou rg duo �as.a NOW,THEREFORE, C�6 ,lr ,C f does hereby place the (ownees namng) following restriction on his above-referenced land in accordance with his agr rxir rat riththe. ,af: Hea,itl ;u* VQ 1%0 or.Shall run with the land and be Minding upon all,successors in title: .: 1. ��DMreX�l,r L "1144Ji'l .(A'- 177/e 12_ may have consbucted (address) upon the lot a house containing no more than �-- ( )bedrooms. a�mf'T�ah Rr'`}�;r��(� L3ru«,�e agrees that this shall be,permanent deed (w"T's nwo vj'I sit restriction affecting .located on/y( Ipo yr-AP and being shown on the plan recorded in Plan Book, _ Paged Or on Band Court Plan Eo title cf see the following deed: Book Page . Orland Court Certificate of Title Number Executed as a seated instrument day of er s signature wne s signature OMWS signature COMMONWEALTH OF MASSACHUSETTS ' ss 20 Then personally appeared.the above-'named known to me to be the person who executed the foregoing instrument and acknowledged the same to be free act and deed,before me, Public Notary My commission expires: (date) �eGdLBARt4STABLE REGISTRY O DEEM w041 (BA'i,F L. 'A I f 0ec f-41 rj x"A, L9.PaLb 68.9 Bach 0imu 0 P 14.0' t Fp, Living R— 8"k- 14 16.9 38.(Y Cn C) zrz AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Description NOW$ Not Totals Breakdown Subtotals First Floor 1464.0 1464.0 First Floor 12.0 x 68.0 816.0 12.0 x 38.0 456.0 12,0 x 16,0 192.0 Net LIVABLE Area (Rounded) 1464 3 Items (Rounded) 1464 The Town of Barnstable Department of Health, Safety and Environmental Services MULVMAtL l Building Division MAM g 1459• 367 Main Street,Hyannis MA 02601 rE0 MA{A Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: '�ay /S /q9`7 Name: LGi"f� 144 Y t k, La n c0-s f4,r Phone ##: 50'r 77?'9 0 D(51- Address: /D UGqne- Village: 60 Type of Business. 5-t ed y-o 'c i1W',ra I 6i'J(.r)q Cam V! V )MaplLot: 02 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. •-• Such use occupies no more than 400 square feet of space. -• There are no external alterations to the dwelling-which are not customary in residential buildings,and there is no outside evidence of such use. t.A No traffic will be generated in excess of normal residential volumes. .' The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. do,, There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. w There is no exterior storage or display of materials or equipment. w- There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. W- No sign shall be displayed indicating the Customary Home Occupation. a( If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. �✓ No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree-with the above restrictions for my home occupation I am registering. s Date: Applicant G S f - Of THE T 'Town of Barnstable ermit Erpires 6 month m tr ate °� Regulatory Services Fee , • BARNSTABLE, » Thomas F. Geiler,Director MASS. C �A 1639* Building Division Uk ON09 lfp MAC A Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us O(lice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wvithout Red X-Press Imprint Nlap%parcel Ntnnber / Property Address LD___�osF _ 0j' j Ab V fZesidential Value of Work *3 .&oo1 e ©- Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address Contractor's Name o ~� - Telephone Number SL� l - -- r I Ionic Improvement Contractor License t#(if applicable) 15�1�0 Construction Supervisor's License 8(if applicable) . ❑Workman's Compensation Insurance MAY 9 70�� Check one: 11'am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLF, ❑ 1 have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# __ Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to [P(<c-roof(not stripping. Going over J_existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where rcquired: Issuance o, this pennit does not exempt.compliance with other town department regulations,i.e. Historic,Conservation,etc. "'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: L� Q-\VI'PII_ES',I"ORMS\building pen-nit forms\EXPRESS.doc Revised 100608 The Comrnonwea fh of Massachusetts Department of Industrid Accidents, Office of Investigations 600 Washington Street Boston, AL4 02111 `- wtvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians[Plumberg Applicant Information Please Print LedblY Namf] (BusincsslOrg�nirAr;onlIndividual): � 13 Address: / 777 Ci /StatdZip: Gvf/ /�✓�� YG Phone.#: J� 7 5—q7V 7 Are you an employer? Check the appropriatz b,wq Type of project(required): 1.❑ I am.a employer with 4- I. -I am a gmr-ral contractor and I 6 ❑New constnwtion employees (full and/or part-tint).* have hired doe slip-contractors 2_❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Rzmodeling .. ship andhavcno employees These sub-contractors have g, ❑Demolition I employees and have work crs working for me in any capacity. 9. ❑Building addition No workers' comp.-ms�nce comp.aa Corncc$ 10. Electrical rc airs or additi, rhrzrrired.] 5. C1 We art a corporation and its ❑ p 3.❑ I am a homeown>r fining all work officers have exercised tbcir 11.[]Plum e bing rpairs or additi myself [No workers' camp. right df exemption per 1vIGL 12 ❑Roof repairs insurance r t c_ 152, §1(4), and we have no employecs. [No workers' 13.0 Other comp,binnancc rmquircd j *Any applicant that thccks box#1 must ah:o fM out the scctian below Showing ffic r workers'coropCnsafio¢r policy infrnrnatian t Hun=wacrc who submit this affidavit indicating Ibcy ata doing all worlcand the,biro outride contactors must submit anew affidavit indicating such ti arrtiactors thatcbmicthis box umat attached an additional sheet showing the name of the subtomftattuts and slate whether or not those cntitia have Crnployc . if the sub-cmtraetrns have eznployerr.,tbey must prvvi fib their worked rs 'cDmp.policy number. I am arc emplayer that is providing workers'compf!nsatian insurance for my employees. HdGw is the polity and job sits information. Linnancr-Company Nzan Policy#or Sc1f-ins.Lic.#: Expiration Date: Job Sites Address: City/StattlZsp: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration der Failure to sccurc coverage as required under Section 25A of MGL c. 152 can IeaA to the imposition.of crimzual pcualtics c 5na lip to 51,500.00 and/or one-year imprisonment,as well as civil pcnaltirs in the form of a STOP WORK ORDER and of up to S250.00 a day against the violator. Be advised tint a copy of this statcmatit tray be forwarded to the Offico of Invcstigalions of the DLk for r'nsuramc coves c verification. I do hereby c under e pains. d p n of perjury th.af the information provided abovaae��7s true and correct Si c Datc: Phone# SA ` !r-7:q / 1 Ofj7dd use only. Do not write in this area, to be completed by city or town offtciaL City or Town: Perminiceme# Issrting Aathority(circle one): 1.Board of Health 2.Building Department 3. City/To rm Clerk 4.Electrical Inspector 5.Plumbing InspectDr 6..Oth er I Y . Town of Barnstable Regulatory Services rMAsa& Thomas F.Geiler,Director 16196 a�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town-barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, !t j G 1-�E' 1^ u Jy C-D , as Owner of the subject property hereby authorize /1 t�j�j ,w 1�f� to act on my behalf, in all matters relative to work authorized by this building permit application for. f 0 6�0 D Se AD 1 key , 1 -(Address of job) zVol G4j � tore of er Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. A.CnD I.V.nTl MTV ID DCD I XTl1C111V / Town of Barnstable Regulatory Services - F sA>;xsrasz� ; Thomas F.Geller,Director MAM a6S9. Building Division PrED Tom Per ry,Building Commissioner ..... ..... _. .200 Mairi.-Stree Hyanais;MA-026D 1 _. . _.._. . .. _._.._..... www.town.barnstable-ma.us Office: 508-962-403 8 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATA: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: 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 be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersignc—"bo_meowner"assumes responsibility for co=liance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned.."homeawnet"certifies that.he/she understands'the Tpwn of Bar_pstable,Building Department ----- :-- minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to.comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that Any homeowner performing work for which a building pQ'mit 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 peson(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they an assuraing the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for l icmuing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hints 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 responsrbr7ities,many communities require,as part of the permit application, that the bomcovencr 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 forn/certification.for use in your community. Q:fDrms:homccxempt i Board building Regulations and Standards License or registration valid for individul use only e exp iration date. If found return to: H0-+5E lMPROVE.MENT CO,4TRA.CTOR before Board the Building Regulations and Standards Registraion: 119766 One Ashburton Place Rm 1301 Expiration 8128/2009 Tr# 132550 Boston,Ma.02108 lug 11 f e DMA !° 1Yp WEBB CRAFT DESIGN 1 owl S E DAVID WEBS 17 ACADEMY LN. Not valid without signature FA!MOUTH,MA Administrator Massachusetts- Department of Public Safeh Board of Building Regu lation .and Standards Construction Supervisor License .&.ut idenSe: CS 46189,. R*Vficted to:.,00 DAVID H WEBB 17 ACADEM a FALMOUTH MA 02540 Expiration: 10/29/2010 ('onunissiuner 1, Tr#: 5826 • r i G�RKERS GQMPENSATION AND',EM LQ (Et�S L ABILxl7'Y INSUR INCE POLIO( _ _ L r �s 'y3'��y&Yn rai ask-i,� tr F'."`a: _,. s I�forlr>natton Pale , h1 . �,...:A.� _<.....;��: `- s V�Q*Q��� Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00730202 1. INSURED: Prior Policy Number: WCV00730201 Tyndall Roofing, LLC Producer: 30 Jillian's Way Fredericks In Agency Marston Mills, MA 02648 Federal ID Number:204616445. Inc. Risk ID Number: 1046 Main Street Osterville, MA 02655 Business Type: Limited Liability SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/11/2008 To 7/11/2009 12:01 A.M. Standard Time at The Insured Mailing AddrE 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states li here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of ou liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund.States D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Total Rate Per Estimated Code Classifications Estimated Annual $100 of Annual No. Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment: Annually Estimated Premium (Minimum Premium) $500 Servicing Office: 25 New Chardon Street Boston, MA 02114-4721 Issue Date07/01/2008 Countersigned By: Date Copyright 1987 National Council on Compensation Insurance Form �ca9o � o93 �z1�, 165 OF MASSACHUSETTS strial Accidents treet, 7th Floor' ' usetts02111 JO.HN C.CHAPMAN, Commissioner - - <, its per M.G.L. c. 152, §25C(6) eminder that Massachusetts law requires,that ^se or permit from any city or town agency on Insurance Affidavit prior to receiving said exe_or hermit without first receiving a - ------------- -14 �+ i •F�Ie -Edit° �'�pls� He] � � � � � re r� ' xi� mI if w i _; ,. s, - , ' . ., � � �" ` ... 3 x - , #fDate: ' f�ecei rhmvurrt .> Mqjhidcef aid s? k. aw.. t'.'"".,vr"' �.�;� - <r°i ,s ' t�,.;" ..- ,'.; ,.. -s•. '`is. .c,;'7, :<a;�=t». -.�. a, a:.. '^�..� .�.��t,` ,�":..• �.�:. �:�#�,° :z ���Y. - . :� .�1 z��` �vc"� �'. T7 *b- N 4! _ V �D MEMO g ' ,�''„ FIE Edit 'Tools-'Hey _ ply, P' ' r 4 lots K IV 71 s IN a f �J. tiEM - LLl .,n ..�,,. .:�>.-. �::., ._ •v�:,. _ ;.�. „.. .:.�;. .._. .. ..,,. r .� '�..-:,," ..�' �'. it _.<:.», � , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town,: �� �� i/ ' MA. Date: Permit# Building Location: 10 150 VQ�D J Owners'Name: Cl . Type,of Occupancy: Commercial ❑ Educational❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ FIXTURES rr W W. Q_ Q U) U1 . UO = F�mUj _ O W W U in Q = I W 0 z O ar W O O l.. W N W m O ~ H Q 0 ttl ( U w w z a = W w o = zV Q J W �-' U) J LL U3 2 '�- H W W = W } Ix to "r c���{ Q~Q m w O z O in t— W ►— s a Q Q W W > O O W. z w H s n SUB BSMT. BASEMENT 1 FLOOR c o 57 2N7FLOOR 1 Vu FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: Durfee Plu Check One Only Certificate mbing 9 Hting ea , EC Corporation . Address:_51 Flax Street City/Town'. Dennis State:_MQ [I Partnership Business Tel: (508)801-8004 Fax: (508)258-0592 ElFirmlCompany Name of Licensed Plumber/Gas Fitter: Phillip J.Durfee INSURANCE COVERAGE: I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes.[21 No❑ If you have checked Yes,please indicate the-type of coverage.by checking the appropriate box below. A liability insurance policy 1.4 Other type-of indemnity ❑ Bond ❑ OWNER'S INSURANCE.WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application.waives this requirement. Check One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's Agent By checking this box :1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the.best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision oflhe Massachusetts'State Plumbing Code and Chapter 142 of the General Laws. Type of ense: By WPlumber �� .• ❑ Gas Fitter — � Title r-1 Gas Fit SI ature `Licensed Plumber/Gas Fitter City/Town []Journeyman License Number: 13774 APPROVED OFFICE USE ONLY 0 LP Installer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: L e.n�'$ tJ;'� MA. Date: Permit# o(QQCt3 Building Location: 10 gyp® e Qp°�n.( R Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential,® New:❑ Alteration:❑ Renovation:.❑ Replacement: Plans Submitted: Yes❑ No FIXTURES DEDICATED LU z SYSTEMS Z Z W Y tO.) 2.1 z y yN, O Vf Z IL O 6' 0: Z Z. W. W Z N Z _� Q z _ a W W OQ Q m H C C Xk H N Y YJ Q En Y O a N LL N G Q W O O W. Z W Q ]L S =kn 6 O O LL = = Z Q U. i Q = W W C OtI 0 ttu�l Q Q 1/) ~ ° 1A 1A> > O LU O Q. Z Z. tY1 F- H = Q I Q } H g g H W Q Q 3 3 3 0 SUB BSMT. - w dD 3 BASEMENT 4, w. 1nFLOOR s"'"' 2ND FLOOR °FLOOR -?"FLOOR 5T"FLOOR I T FLOOR JM FLOOR n �- FLOOR Installing Company Name: {) � , tnb F � ►� L Check One Only Certificate# Corporation ���•L Address: Li?f - City/Town: �'A� 4. State:_ ❑Partnership Business Tel; O - (� C 41 Fax:-5- !!6 ,: - N ( t ;✓ ❑Firm/Company Name of Licensed Plumber: a < D v�r ILI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes [ No❑ If you have checked Yes please indicate the type of coverage by checking the appropriate box below. A liability insurance policy„ (2( Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's A ent Owner ❑ Agent i hereby certify that all of the details and information I have submitted(or entered)regard' g this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed underthe a it iss' d for this application will be in compliance with all Pertinent provision of the Massachusetts.State Plumbing Code and Chapte` 42 f th eneral Laws. ey � Type of License: t Title ®Plumber •gnat: of Licensed Plumber City/Town Master APPROVED OFFICE USE ONL ++Noumeyman Lice a Number: 1 i