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HomeMy WebLinkAbout0149 LONGVIEW DRIVE ��Q ka V iPI1J1Jf , f lr r y Town of Barnstable *Permit#9 -n k " Regulatory Services Expires 6 months m issue date _. BARN .� � p MASS. V.Scali,Director 039. 017 Building Division 1 ���1�� � t _ Paul Roma,Building Commissioner PS ABLE200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Map/parcel Number < Not Valid without Red X--Press Imprint n Property Address +l ao « �nlfcrvll E- J Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 i c 1 Y� V�Owner's Name&Address C- ( 4 Contractor's Name Telephone Number l / �. O?S / 092fD Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) PWorkman's Compensation Insurance Check : g�Tam a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) UYRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to l9At ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r ired. SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc 01/25/17 r— c� ti 27w Ctamw mrveah*of-asrrdrusetts Depa'tnwt qflfu hzs-tria1 Acciderds • - O; ce of Im rzVadv=s . 690 Washington 1.9 reet • 4 FPfI Fv M111img r/din Wnrlmis' CanipensaUmissumince Affidavit Bcdldez7slCuatracfursMecc{ricians/Phmahers Applk,�mf IfI,Y maf nn Plea5e pxin 3II3E - au 'Are you an employer?Checkthe appropriate ba= ` T of project r . L❑ I am a 1 � . 4 ❑I am a gemrA contractor and I Y p ] { ecluired}: o empl ees(fca an dfof part-fiime * 1aVe hired$xe suit-contacts 6. El New conzfxu i a 2.❑ lam a sole*mp:detor orpatfaer- listed on- the.attached sheet. 7 El Remodeling drip and have do employees mesa sub-contactom hale 8-,❑Demalifion. a wo� r ng foe in any capacity. �to� ��$ndhave wo�rsT 9. �B.uiltiing addition. . ENO grs a comp_kmnxtcecomp- ]_ 5. ❑ We are a cotporafion and ifs 10-❑Eleetdcal repairs or aadidans — ama-ltotneoTmer-doing a1f officers have exercised their 1L0 Plm1bsngrepaim or additions. set£ wokk=' of a rfian per MGL � �o - c.152,§1{4kaadwehasreno 1...❑7 Roafrepairs . ;r+�nre required-]Y i3_❑Other employees-ITo wormers' comp_insam-m required.1 `A app��dbatcT�ed3bos 1 alsoffioa these�tioabeTocv vagt6eirwo$cexs�compevsabnupcTagiafo�aaa fi ffameaa nets W1.submit c'fris dfidavu m&c lmg tHey axe dm'�Rnwc it and dies hire outside con=cmrsmast.sahmk a new affida&iadica1;n SUCIL rCaauacfog8 cber3�flsisbmcmustatte ffiadditi"21 shed shavcrngthenmneof1hasvl�mxhdstaftwbegmornatftseeaddeshn* employees.Ifthesub-tautactu sUve emplgyees,they fl it srnrkess'tamp.palm abet lam art errrplr r fleaf�prmRdircg n�Qrkcrs'cotrpertsrl air i�rszirarace jvr rrs}*elripin}�ees $eloov is fhepaficy arrd jafi site FIIft7t7rra�fOlL ' IrME�Ce:COnzpanyNB=: 'Pooficy 41 or Self-cgs.Iic_¢ �piaatiouIhte: Job-Site Addr CifylStaf sg'�, Affach�y athe warkers'compensationpolic£declaration page(showing the polity,number and e=piration date). Failrue to secvm cavwage as requiredunder Section 25A of MGI.c_1572 can lead to the imposit' of criminal penalties of a fine up to$UOU Oa andlar one 3Tear impdsonuxedt;as w61I as civil penalties in the farm of a STOP WORK ORDERaud a fine of up to$250_Da a day against the violator. Be adedsed that a copy of this sfatement.maybe forwarded ta the Office of InvvesEgadons of the DIA form" Ur=c4ffCav=gevMrrErat1oJL Ida hereby ca yy, tits h arrd psrraMes of vad cry thatthe informa€wipr mi&n[abme iv bus mid carrect Phone ik t3jj"rsial uss ctrrf�. I7a rtat ttrrta in fFt�irreQ,trr be t:vrttpletc�d by cify artarwrr n;jj`rciat City or Town.: Perat Aikense# has wgAufl=4(cacieaw): L Board-of$eaHh 1kildrug Depariment 3.C ty/Fown Clerk d:Flectrical I=pector 5.Phmmbing Inspector 6.Other Contact Person: Phone it: Information and lastructionS Massar efts GMaal Laws chapter W reggaes all,`Y'OYCES ID PrUVide Wmix&=mP=';at 0Il for fheir eulployees. Pmsa this sfatnin,an ,Ioye�is defined as":eYeTpPess°n in foie sravice of .other under amy cmtmd of 1�r, j J M prGS9 or i133PH A,oral Or Vitff®.." An eznpkyer is dcfined as-an.mdivld�aal,P am' aSSDGIaf &A corpor�on or othm legal eatdy,Or�Y two or more of the;foreg;oiug �a3� ,���'�the Legal re�ESentIPes of a deceased employer,or the receive[or trustee of an individual,p�iP,association Or otheg legal entity,employing eorployees. Hov7ever the owner of a dWelIinghomsehavnlgnotmoretllant{¢ee aparEmeufs andwho residesfiiereal,or the occapant ofthe"- another who employs pcasons to do ma�ance,�•,,,cfr��-F;ter,or repay work on such dweIIing house'dw Mng house of ano or on the grounds or bu mg,apprnrte antthcref o shaHnotbecanse of such earploymerdbe de�edfn be an employ=¢7 MGL chapter 152,§25C(6)also sties that¢everystate or local licensing agencyshallwNhb.old flee issuance or o erafe a baseness or in construct bmld�gs en the co--u=wealth for any tea ewaI of a ficeuse or permit top „ applicantvQh lea s as notprod-aced acceptable evidence of complzance with tTie insurance c necl- o4emge requ+ fits Additionally.MGL cdlapfra 152,§25C(�status¢Neitherthe _ nor�y o Political snbdivi-sims shall ce of ublic wotic u dil table evid�mce of compliancev�h me iaso¢`�ce. far erfumnan. �P . contract p an P _ea,irr IniD .�/ rn rj m�. ,�y:' r�emmcrl of- is chapirabavelieenprese�edtn the nfr��anfho A-pplicants- Please flI oi>f fine wo�eas'compensation affidavit cornple#nly,by g the boxes fhat apply to your situation and,if and nennmb s along�viathwrce�cafe(s)of nece$sarp,supply sob-contractors)namo(s), �s(�) >� �) s 7(p 4gith eu>pIoyees other than the ensta'ance LimiiadLiabr p Compmnes(LLq or LimitedliablZityPar ) no members or parfness,are not rbgaaed fn carry WoAr&co�j3ensafi[m mernxn ce, If an LI.0 or LTA does hate employees,apolicyisregnired: BeadYisedi3>affhisaffidaFitmaybesnbm�edto heDepafinentof lndusfiial Accidents mr conEmafm of msnrmm coverage Also be sure to sign and date the affida vif The affidavit should be•refrlmed to tithe city or town that the application for the permit or license is being regnestA not the Department of Try al.A_c:q =:L-L SSionlayou have auk,fines claS regHrdmg t ie IaW or lfyon are regaaed to obfRM a WOIiC=' conupe�sation portcp,Please call the D�ariment at g3e number Uy,r.i below Se f-insored cn¢gsaDies should ealt�r their self-msaraa ce license number®.the line. . city or Town Oiff als Please be sore that the affidavit is complete and prided IeglIy. The Depar(menthas provided a space at the bottom of the affidavit for you to fill out in the event the Office of lnvesti.gatzons has to co�actyolz g the applicant fill in the permitlIicense number which v�be used as a reefemnce nzMber. In addition,an appIicmt Pleas a be sure to . that must sabmt nlultrple P=3:VHcrose applitofions in any given year,need only sabmit one affidavit T„.i- i;,,g curt p 0Hcy iafonuation(if neccssaly)and under`Job She a_ddr $e applicant should write man loc Y or town)--A copy of the-affidavit that has beea officiallp stamped or madced by f3ie cry or town nay be provided to fine - applicant as proof tilat a valid affidavit is ou file for fafnre'pmma#s or Hcauses_ A new affidavitmust be fiIled o ct each year.Where a home ov,*ner or citi=is obtaining a license or permit not jaitmd to any baseness or commercial vtmbre - Cie_a.dog license or pemlt to bum.Ieaves e#c-)said pmrsan is N0T regakcd to complete'tilts affidavit Th.e pffi=of Investigations Wouldlike to thank youia advanco fur your cooperation and should you have any gmcstims, please do nothesifate in giveul8 a call. The De] ffii, e=fS address,telephone and fax numbrar . cbmmwwealth Of MamazhuttR , DepadmentGf Indial Aci3ent f �of� fio� . �4�a�gtan Sizes aw11 Fax#a7`27-7M R.evised424--0 T masg�'d Town of Barnstable Regulatory Services oF ,y Richard V.Scali,Director C Building Division BARNSTAEM srnsa ' Paul Roma,Building Commissioner i 39. ��� 200 Main Street, Hyannis,MA 02601 ED www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: Lee� Tl)� ('�f' VV ber village `Tl©1v1E0W / name home phone# work phone# CURRENZMAILINGADDRESS: city/town state zip co 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` F;me7wnnts eoer" es that he/she understands the Town of Barnstable Building Department minimum inspection procedures an eq and he/she will comply with said procedures and requirements. fsignatu_.._ _ 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06M/16 � _ I t WE Town of Barnstable j Regulatory Services ` A ` Richard V.Scab,Director PIAW ;. Building Division. Paul Roma,Banding Commissioner, 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-962-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize. to act on.ray bebA in all matters relative to work authorized by this building pertnit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date f QYORMS:OWNERPERIMSIONPOOIS 10�3o�1t��. a �S P Town of Barnstable *XOP Permit �� Fxp' onths fro issue date r regulatory Semees F f WSMARi.F. f 8 A� Z��2 • . MASM . ��' . Thomas F.Geiler,Director SAfter�� Building Division L m 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 ®g� Not Valid without Red X-Press Imprint Map/parcel Number —p� n An.i-1 Property.Address t !�J'7 e-u.� DV1 i J('. T��� t ,S'bc Minimum fee of$35.00 for work under$6000.00 Q Residential Value of Work Owner's Name&Address iG)') qvI ( Co tt �j PC) / Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I_am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing Iayers-of roof), Re-side #of doors 3 Replacement Windows/doors/sliders.U-Value ' (maximum.35)#of windows l ❑ 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: ✓�% The Commonwealth of Massadiusefts 1earfinent of Indi4stfial Acciden& Office of Investigafions rs 600 Washington Street Boston,MA 02111 wnrru Mass govldia Workers' Compensation Insurance davit: B.utde.rs/Contractnrs/E•lectric anslPb mbers Applicant Information Please Print Legibly- Name{gosmesworganm ondridvid.1):�t�j169�/�Q A.ddess: � �4 l9l�.t..J I�YI ' • . CifyfSifateJzp: n; ei.ur Cle Phone:# Are:you an employer"Check the appropriate box.. Type of project(required): 1_❑ I am a employer with 4- ❑ I am a gme al coiittractor and 1 6_ ❑Ne°w constntction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partsie r- listed cm the attached sheet. 7. ❑Remodeling ship and have no employees These -contractors have g_ ❑Demolition working for me in any capacity. employees and bane workers' 9. ❑Building addition [No workers* comp.insurance comp.insurance-1 5. ❑ We are a corporation and its 1 D.El Electrical repairs or additions required:] ice have exercised thei r 1l_ Plumbing airs or additions I air a homeowner doing.all work. ❑Plbi g right of exemption per lafGL myself. [No workers'camp. 12. hoof repairs insurance required.] c. 152, 1{4),and we have no e e ]r employees. o workers' _13: OtherS1 comp.insurance required.} *Airy apphcaut that checks box#1:must also U am The section below showing their wwkets'compensatwn policy informatiaa I Honieovvners who submit this affidsvit indicating they an doing&U Vred and then hire outQ&contractors must submit a new affidavit indicating such. f Counctors that check this boa[mast attached au additional street showing the name of the sorb-com=tors and state whether or not those entities have employees. If the sub-,conima-urs have employees,they amst:provide their W"k-us'camp.policy number. - I alit an employer that is providing workm'congwnsation insurance for iny emplery Beloiv is fhepsffcy and job site inforrrtairan Insurance Company Name: Policy#or.Self'ins.Lic.9: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the wG kern'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c. 1-52 can lead.to the imposition of criminal penalties of a fin up to$1,50D_00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 Im-estigations of the DIA for insurance coverage verification I do herek,ce under t spirt:s andpenablies ofper�rrrry that the inforinafiion providedabow is.b�ue and correct Si #fire: 0:bate- 0--_ Phone#: offidal use only.. Do not write in this area,to be completed by City or totwi of ciaP Qty or Town: Permit./Ucense# Issuing Authority(circle one):. 1.Board.of Health 2..Budding Department 3.Cityffown Clerk d.Electrical lnspecter 5.Plumbing 6.Other.' r,.,,..r Foe¢nn•. Phone#C °0HKE Town of Barnstable Regulatory Services MARNSTABLE Thomas F. Geiler, Director 9 MASS. 16 59,+"`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 0260.1 www.town.barnstable.ma.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print cJOB LOCATION'. 15�1 �Dj'Iy(JI tew Vy 1 e Cep ` e number street village "HOME.OWNER":'__Pl cY.W,/ �J name home phone# work phone# CURRENT MAUNG-ADDRESS: (0 C Go s lhi 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) t. The undersigned"homeowner"assumes4esponsibility-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. Si'�ture ofHomeowner���: 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. n•\wpFii.F.S\FnRMS\huiiding nermit forms\FXPR-ESS.doC _ _. of sty rqy, ti 0 + BARNSTABLE, 9 ,�� Town of Barnstable prED MA't A Regulatory Services Thomas F. Geiler,Director Building Division _Thomas Perry,CBO Building.Commissioner 00 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 'i Fax: 508-790-6230 Property ner Must Complete and Sig �This} ction If Using A B .•ld :t c. J�, as O er of the subj t property - hereby authorize to act on y behalf, in all matters relative to work authorized by this buil 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 reverse side. . QAWPFILESTORMS\building permit forms\EXPRESS.doc