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HomeMy WebLinkAbout0015 LOCUST STREET �- - �I Town of Barnstable *Permit# ado Expires 6 months from issue date Regulatory.Services Fee + BAMSrABLE, MAC 9 Thomas F.Geiler,Director� z639 ' 'OlED MP'1 A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office' 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Map/paKcel-Nunibqr Number "53 0% Cap-ert�y_Address=,, /5' I—oc u "F ;t 14 t A4 ,v f11/A- ��.2�of El Residential—Value of Work_ n1 tlo c� Minimum fee of$35.00 for work under-$6000.00 �Ownei's Name&Address Liu,_I����-wi es k Yh W p?L6.62 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) :.X-PRESSPERMIT '. ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor APR A 2013 Gam-th� e-Ho own`e`r, ❑ I have Worker's Compensation Insurance TOWN.OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) Re=roof-(hurricane nailed)(stripping old shingles) All construction debris will be taken ❑Re-roof(hurricane nailed).(not stripping. Going over existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value - (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red_ S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: _ Q:\WPFILESTORMS\building permit forms\EXPRESS.doC . 3 tie Cornmonivealth of Massachuset s .department rr,jlndushial Aceidews Gffice of Invesfigafions ' 600 Washington 'Street Boston,Ali#2111 n*nnv.:xr aS&gVV1di Workers' Compensation Insurance Affidavit Budders/Cuniz actorslEI.ectiici.�nslPhimbers Applicant Information Ptease Print LegibI Nop_4Budne�Qrgani ion&dividnai): �O 7-i- il rf tat Zip ": Phone ik .v,Y 7? 1.--;- -a o �- A're-you-an e-ployer-�-cheek the appropriate bore Type of project(required): _❑ I am a ern. vath .❑ I_arn.a-1 contractor and I employer 6. ❑Newconsirwtion employees(frill an&or par"me).* have hired the sub-contractors 2.❑ I am a sale pmgxie2ai or partner- listed on the at#,ached sheet y. ❑Remodeling ship and have no employees T�sub-contractors have $_ ❑Demolition working forme in any capacity. employees and have workers' 9.7 ❑Building addition [Na tvorlcers'comp. 'insurance comp-insura,rrm Z st red j 5. ❑ We are a corporation and its 10.❑Electrical repairs or additionshorrwner cioi all work officers haveercised dir 11.❑Plumbing repairs or additions right of exemption per IYIGL. myself [No workers'comp. i?=M;16erfrepaim ir3suuarace required.]T c. 152,§1(4),and we have uo employees.[No workers' 13.❑tamer comp.insurance required.] 'AEy applicant that chea-s box#1.nm-t also iiIl ont the section below showing their weAele compensation policy information I Homeowners who submit this afhdx"inddicat ng they are doing aH-at and then hire outside contractors must submit a new affidavit indicating such lContradurs the check this box must attached an additional sheet showing the uame of the sub-caaftactm and stare wbether or not those enemas ha--e employees. Ifthe mA-amtraciors have employees,r'heyn ampmvide their work'tamp.policy numb- lam an employer tliat is pmvitffng workers'eo.ngl msaffaii inm ce for tay emplay€em BeI©iv is tlta po iq� atzd job site informadon. Insurance Company Name: Policy a or Self-ins-Lic.# Expiration Fate: Job Site Address: Gityl'State/4: Attach a carpy of the workers' compensation policy declaration.page(shoving the policy number and expiration date): Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of Criminal penes of a fine up to$L 500-00 andlor one-year imprisonment,as well as civil penalties in Ire 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 ftxrwarded to the Office of Investigations of tie DIA for insurance coverage verificatio 3 db hereby cerh sander than pains andpenahies rrf perjW7 that the infor,rtation print'ded ab va&hw and correct = Phone#- S©s -7? Or tot'm oci 5� f�, curl mass only. Do tart tvt7ts in art�c,la be ctrmrpW0d bV city a L City or Town: PeranitAlcense if Issuing Authority(circle one): 1.Board.of Health 2.Budding Department 3.CitprrownClerk 4.Rleetrical Inspector 5:Phimb ng Inspector 6.Other °FVET � Town: of Barnstable regulatory Services >A tNSrABLE, * Thomas F. Geiler,•Director MASS :r �A 1639. Building Division lE�MA'I - • _ Tom Perry,Building Commissioner; 200 Main Street, Hyannis,MA 02601 www.town.barnstable:ma.us Office:. 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Prink . _.^� 9 1_`DATE:, JOB-L-OCAT_ION__: �.�number street village �.._ T <��n.l�dKcQ (m�70 [`HOMEOWNERZ1- a7L.i.. work phone hi. -tom name home phone# P �URRENT MAILING ADDRESS: 1-1,u -" state zip code city/town 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 minimum inspection proce ures and.requirements and that he/she will comply with said.procedures,and requirements. Signa a 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 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 theme omeovvner „ 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�^a+�x' adopt such a form/certification for use in your community. °F t ray, . .y * BARNSTABL.E '* MASS.9 ,�� Town of Barnstable prEp Mp`l a , Regulatory Services Thomas.F. Geiler,Director Building Division Thomas Perry,CB0 Building Commissioner' 200 Main Street;, Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-403814'�. ..�� Fax. 508- 0-6230i tAk Property Gtwrier Must Complete and Sign This SectiO IeG If Using`A'Builder , as O er-of the subjec roperty hereby authorize to act on behalf, i in all matters relative to work authorized by this bull g 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 - V-Efse-sid Q:IWPFILESTORMSUildinPermit forms\EXPRESS.doc oft , Town of Barnstable KE Regulatory Services = swiwszwsM • Thomas F. Geiler,Director 9 MASS, 1639. Building Division ♦0 ABED Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.m a.0 s Office: 508-862-4038 Fax: 508-790-623( PERMIT# .-,,M69 Ob 3 / 0 FEE: $ 60 SHED REGISTRATION 120 square feet or less 5— Z"D Co SA— S�' . /�1`/mot►� S Location of shed(address) Village -iD tA-e VkaV-y Rt�-Llllo..o 5'0 -7-7 05-2 Property owner's name Telephone number Size of Shed Map/Parcel# . SiIKAire Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 I I PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. _ THIS FORM. MUST.BE ACCOMPANIED-RY A C' PLOT PLANE' :6 WIV $1 NVr gf17Z Q-forms-shedreg f "� REV:042506 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out In r ;,", +' a e- JPG Map: 309 4 30 28 Owner: 309055 309058 � %t� ' Location: N 40 309057 � . 309088 18 � ' ail 'Ur STrtrEr Location In Map &Parce Location Acreage lu .. LU Current Ow Mailing Addi o 309116 441 r5 x€ 309116 iU 15P j 3D9113,��""� • Appraised 1 Extra Featur Out Building -_ Land Buildings Total Apprai 309125 309127 u 7 4.18 309128 Assessed V N to r1, e sue= Extra Featu ; ° 309126 Out Building . . #3 _ Land Buildings Set Scale 1" Aerial Photos m [ Total Assess Copyright 2005-2007 Town of Barnstable, MA All rights reserved.Send questions or comm( BarnstableMA v0.2.91 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=309115 1/18/2008 Town of Barnstable *Permit# ' 0( y t Expires i months from issue date Regulatory Services Fee_=- 1 Thomas F.Geller,Director L Building Division Tom Perry,CBO, Building Commissioner 1 200 Main Street,Hyannis,MIA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ap/parcel Number operty Address 15' 40 G fAYA-V"vvc'� M✓ - � ao Residential Value of Work �9 00+ Minimum fee of$25.00 for work under$.6000.00 xner's Name&Address_Ar-F-Mtb 6R,-G`1 w•o Pj& t4.t�_Aayyw S i7. )ntractor's Name V fPr,� YY4 W►'Vro,13 Telephone Number_ o�•�$D- r Me Improvement Contractor License#(if applicable) � &0'2 dl ]Workman's Compensation Insurance. Check one: ` I am a sole proprietor ❑ I am the Homeowner 0 L i 2 9 2007 ❑ I have Worker's Compensation Insurance TOVVNOF BARNS] surance Company Name ;orkman's Como Policy# opy of Insurance Compliance Certificate must be on file. srmit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to Vi4r►�'ip cJa-h 1 Iry4�,u sEf` ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission: A copy of the Home Impr eme t Contractors License is required. ;. GNATURE: Forms:expmtrg ,vise061306 The Commonwealth of Massachusetts Department of Industrial accidents Office of Investigations 600 Washington Street Boston,MA 02111' www.mass.govldia ' Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmization/Individual): at- =. i� �t7 V�� �►� tiut Adu�aa ��+ �'1••ti'VVt%� .c jam.b4W`e.. ' • --�r_ City/State/Zip:_r_g�si 4 miA. c .b z Phone A: 6 0' T, 98- IT2 1.7 i? Are you an employer?Check the appropriate bog: :Type of project(required):. 1.❑ I am a employer with 4. [] I am a general contractor and I 6. ❑New construction . employees (full and/or part time}.* • have hired the stab-contractors -attached sheet: 7. ❑Remodeling 2.XI am a'sole proprietor or partner- listed on the sub-contractors have ship and have no employees These s 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition o workers' com insurance comp,insurance,$' P 5. We are a corporation and its 10.0 Electrical repairs or additions required.] ' 3.❑ I a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right 6f exemption per MGL 12,[]Roof repairs insurance.required.]t c. 152, §1(4),and we have no 13.❑ Other_ employees. [No workers comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Komeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached as additional sheet showing the name of the gub-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: lob Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certify under thepains•and enal ' s ofperjury that the information provided abovg is true and correct. Si tore: Date: 101791012, Phone#' SO age — get 7 Official use only. Do not write in this area, to.be completed by.city ar town official. City or Town: PermitUcense# 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 mstructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a' joint enterprise, and including the legal representatives of a-deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of.the dwelling house of another who employs persons to do maintenance,construction or repair work-on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced,acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter-152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public-work until acceptable evidence of.comp$a cc_with:tlie 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-contiactor(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 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,telephoned and fax number:. The Cam onwWth of Mmaohusetts _ Dopartmmt of Wustdal Accidents O iae offilvesdigations 600 WaAingt6 Strut BWon,MA 02111 • . TO.#617-727;040 ext 406 or 1-7 MAS.SAFE Faye#617-727-7749 Revised 11-22-06 www aapv/dia .QF1HaTp�y Town of Barnstable Regulatory Services BART4STA-Ex, ' Thomas F. Geiler,Director .� Y� Building uilding Division Tom Berry, Building Commissioner 200 Main Street Hyannis,MA 02601 WW W-to wn.b arnstable.ma,us office: 50 8-862-403 8 Frx: 5 0.8-790-62-3 0 Property Owner Must CoMplete and Sign This Section If Using ABuilder I, lG �VLD h , as Owner of the subject property hereby authorize fAtMV to act on my behalf, in-11 matters relative to work authorized bythis building permit application for, , LO ww,T 'S-r +t'YA,NN t S (Address of Job) � a z Signature of pcaner I D.te • IM 1A'R •Gf I Md ND Print Name 6 ✓ �� m �r� ol'-Wa � License or registration valid for.individul use•only Board of.;Building Regulations and Standards before the expiration date. 'If found return to.. .: HOME IMPROVEMENT CONTRACTOR Boaril.of Building Regulations and Standards One Ashburto7t Place Rm 001 Registration 124074 Boston,Aia;02108 Expiration 75/9/2009 Tr# 129558 .Type DBA Co nrad.Remodeling F= u t Jeffrey Conrad �F , 535 PHINNEYS t valid without signature I: CENTERVILLE,MA 02632� Adnunis trator i