HomeMy WebLinkAbout0231 LONGVIEW DRIVE 3 / ,�.oh�vi ecJ ��
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .
Map �� ) Parcel Application b
Health Division Date Issued
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board l K, S 6N r
Historic - OKH _ Preservation / Hyannis
P�rojectStreet Address 7 y,,'e Lo U
=Village-
�Owner_ 0-n Address_ 6 Ag S s 4S .4 xt --ion
' a:.�66
TelepF hone d rO � �� ; S Z
Permit Request -- A �d /��i� S ��:�� r 2
_ Q f- f%L V \ Ltr FA e 16,j..Q� O iV..
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 3�=�J 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 new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove --❑YesH❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑`new -size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ; f
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Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
- - ---- (BUILDER OR HOMEOWNER)
60 Sa ``` [Telephone Number---►
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Qddre- ✓�?�ss s 6+ v e, License#
Nnd , 'Hole Improvement Contractor#
Ems S a a S 0- ' 0, � �` � 1L�^�' �� Cc "� Worker's Compensation#
ALL'CONSTRUCTION-DEBRIS-R`ESUL-T SING-FROMTTHI PROJECT-WIL-L BE TAKEN`TO-�
S ATURE `s �` L DATE-
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FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
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OWNER
DATE OF INSPECTION:
,l
"t
i FOUNDATION
r'
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH f FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
' DATE CLOSED OUT
4
ASSOCIATION PLAN NO.
s
y
,flue Compromvealth of-Massacdrusetts -
Departwent of 1ndr &id Accidents
- 01i cc of fm igations _
600 Washbigton Street
Boston,MA 02111
wynnmass gorldia
'tnrkers' Cumpensation Insurance Affidavit:Bgilder-stCantractars/EIectdcians(Plambers
Applicant Inftarmatian Please Print Lem'bly
CNam (E 11CRIP�c FPr80 3{F a� �+' -+V 4t I/�►rF /V 174
AI A c LZ 3 L ph-c-lW� sbe 1X o f S-Z (. e
Are you an employer?Cheekthe appropriate box~ Type of project(reguh ed):
I. general com�ctor and I G. ❑New construction
�
.1 I am a employer with 4. I am a employees(full andlorpart time).* have lured the sdbr contractors
2.❑ I am a sole prqpzie#or or partner fisted aathe attached sheet` 7- ❑Remodeling
slip and have no employees. These mib-coutractars have 8. ❑Demolition
Working forme in any capacity. employees amdhave workers' 9. ❑Building addition.
[No-W-iod ms'Comp-insurance Comp.msuranml
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 1L❑Flumbingrepairs or additions
mysel [No-workers'camp- rigout of exemption per MGL 12.❑Roofrepairs
insumnzerequired-)i c.152,§1(4h and we have no
employees.[No wodr,ers' 13.❑other
comp.insurance required.]
*AEEygTKczafhstcbec1mbos0E1umstalsofiII cut the sectionbeIowshovingtheir•a0Ae3t campeasatianpoRcyinformai oz
T Iiameowamwho submit this afhdanda inffic ag they are daing sllwcd snd d=b me oum decantracton— submit anew affidavit indiczdng-szirh
rCau=Ct*+ ff=,bea this box mast s tachad mt.additional sheet shoasngthe ram of the sub-cantrxctamazid,stxte whether arnat•rbose en itieshav�e
employees.I€the sab-caatnctotsIm employees,they xmtstpmuidetheir workers'comp.poliy number.
lam an errrplopr tliat is pr4n ding ttForkers'comperusiziian inmirance for my*employ oes: Below is tfiepoEcy arm job site
infornzadom
Insurance Company Dame:
Policy t'or Self-ins.JUc.;k F—iwiration Date:
Job SibeAddress_ colState zip:
Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date).
Failure to secum coverage as requiredunder Section 25A of MGL m 157 can lead to the imposition of criminal penalties of a
fine up to$1500:00 anctfor one-yearimprisonmeut as-well as cavil peualties.in the form of a ST(3P WORK ORDERand a fine
of up to$250-00 a day against the violator. Be achised that a copy of this statement may be forwarded to the Office of
Investigations of the DFA for insurance coverage verification.
I afa hereby csrdify�under the pains andpaualfies ofpet;hiy thatflte infarma#imjprmi&d sabm�e is bare and carrect
�t�ature:> ".J� •�.n•c..�.rL
t)joZdal use aniy+. Do itot write in f area,to be wtapieted by city artairn odjrciaL
City or Town: Permitlt iceaa.se#
Issuing Authority(drde one):
L Board of Health 2.Building Department 3. itp-Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Mstrnctions '
Massa rhmi--tts General Laws chapter 152 requires all employers to provide workers'compensation f r their einpIoyees-
Pmsuzatto this statute,an MPInyZC is defaed as.'.every person in the service of another under any contract of hire,
express or iinpliecl,oral or wnftmi."
An Moyer is defined as"an.individual,partnai±h p,association,corporation or other Iegal entry,or my two or more
of the foregoing engaged in a joint enterprise,andinclodmg the legal representatives of a deceased employer,or the
receiver or trastec of an indfvidnal,partn=bip,association or other Iegal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the -
dweIlmg house of another who employs persons to do maintenance,construction or repair work on such dweIIi ag house
or on the grounds or building thereto shall not beano of snch employment be deemed to be an eurployzr"
MGL chapter 152,§25C(6)also states that"every states or local Iicensbag agency shall withhold$ie issuance or
renewal of a Ecense or permit to operate a business or to construct buildings in the cotumo,awealth for any
applicant who has not produced acceptable evidence of compliance with the amorance.coverage required."
Additionally,MGI.chapter 152, §25C(7)states-Ieftherthe eommcmwean nor any ofits political subdivisions shall
mtrz mto any conirant for the performance ofpubho woik u at acceptable evidence of compliance veith the inscu-aac6._
reqiirements of this chapter have been presented to the contracting ardhoiity.7
Applies ,
Please fol out the workers'compensation a$tdavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sol' contractar(s)name(s), addresses)and phone numbers)along with their cm-bfcate(s)of
„cr„-mce. Limited Liability Comp ames(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not rego±7cd to carry workers' compensation ias ce_ If an LLC'or LLP does have
employees,a policy isregnu-vL Be advised that this affidayit maybe en7m,itti--dto the Department ofIndustrial
Accidents for confnmation of insurance coverage. Also be sure to sign and date-the affidavit. The affidavit should
be ret=med to the city or town that the application for the permit or license is being requested,not the Depa tmeat of
jTdnstrLl Acddcnfs. Should you have any questions regarding the law or if you are rued to obtain a workers'
compensation policy,please call the Department at the nunber listed below. Self-inmaed companies should entrr their
self-jiisurar,cB license number on the appropriate line.
City or Town Otticials
t -
Please be sure that the affidavit is complete and prited.legibly. The Department has provided a space at the bottom
of the affidavit for you to fll out in the event the Office of Iuvestigati ans has to con act you regarding the applicant.
Please be sure in fM in the pennitMcemse mnmer which will be used as a reference number. In addition,an applicant
that must submit multiple permftlIfcense applitations in any given year,need only sobmit one affidavit indicating c*Tir t
policy in�rnatian(if necessary)and under"Job Site Address"the applicant should wute"all locations in (may or
town)."A copy of the-affidayk that has beca officially stamped or marked bythe city or town may be provided to the
applicant as proof that a valid affidavit is on fle for frtm: penmits or licenses A new affidavitmust be filled out each
year.Where a home owner or cftizen is obtaining a license or permit not related to any business or commercial venture
Cie. a dog license or permit to bum Ieaves eir_.)said person is NOT repaired 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,•tlephone and fax number:
M
Ike CommmWmIt of I chus&M '
DE gP: , tint of 1ndustiak Accidents
Bostou,MA G�111
TeL#617' -4900 eat 4-06 or 14 MA.S AFF,
Fax 6 617` 27 7749
Revised 4-24-07 -mRS5 qldia
'dawn of Barnstable
Regulatory Services
pfr r � Eir.Iiaz d V.Sea,Direcinr
Buff iag bividon.
t = Tom Perry,Em7dmg Commoner
200 Mum.Strom Hy is,MA Q2601
w4vs.to aiwd2hie m!;F IIs .
Office: 508-8624039 _ Fa= 508-790-Q30
JOB I:OCAQ6t�L- c 3�, Ccr ` V"C- a dJ�- to 7t s V L l l? o�(y 3 L
• nnn�a s�sct �
�oowr
Hama h®cph®c# � svostip&onc-,-
T- RFss 0,4.4`sr4. G A4,1170n . C•-L-766
CQB.RgI-T-MAIf�TC'-
cod=
r* nt eaceruption for`9iomeowners"was extended to iaclpde owner-occMied dM-01�s of six emits or Tess and.to avow
Thehnm=wn=s to.engage an kffiyidml for hire who does notposscss a licrosq provided thatthc owner acts as mpm-tizor
DZFDE LON OF HONMWNM
P eson(s)who ovms a parcel of I�ad on which helshe resides or intends to resides do which ire is,or is intended to be,a one or two-
fmjZy dwelling,atfa chbd or detached ct,uctm-es accessory to such use and/or fa=shunt mr, A paean who contacts more than one
home:m a tevo-year period shalt not be eansidrred,ahameown=- Such%omeownee.shall Mbmitto 11e BuMin Official on a fJ3m
a==ptable to the:Bur-Idmg Offial,lhathdsha shBn be resyonsibls for aIl such warkpesffimed undertba buUff=ueggrt fSect M
109.L 1)
The ar, `�iomeowner"a responsibs7�'p fur compliance witTi the Sfafe Bux1dmg Coda and offier applicable codes,
bylaws,rules and re b*bti -" _
'n=uadmmgaed`homeownex"cmtifres thathelshe understands the-Tov a of Barn stabTo BmZdmg Dcpmt rntm Timm inspection
proms mdroquamm=ds ancjtu±hedsbe writ comply wifk said procedn=androcFi=Mds.
sip��� •
ApFurJ ofs=Bdm9OffiQad
• Note_ 'Three-family(iwcMngs mnfaiiimg 35,000 cabic feet or largert wMbe reqmicedta comply wifafar Sta$Bui7dmg Coda
Sec iam r27.0 Constriction Couta L
HDAMVMM s pox
The Code states that: `Any homeowner perf ormiag work for which a b—I permit is required sh O be exempt
from the provisions of this secfinn(Sec#pn 10911-Lir=ns L,-of cons mdion Supervisors);provided that if fire homeowner
engages a persons)for hire to do such work,that such.Homeowner shahl act as supervisor."
Many homeowners who use$iis e=mptiam are unaware that they are assuTmtmg the responmITTId of a supervisor
(set Appendioc Q,Rnbs&Regulations for T i�Canstracfinn Supervisors,Section ZLS) This Iark of awareness often
results in serious problems,pardcaIarly wh=the homeowner hues m+rcer se persons. In tires case,our Board canaat
proms agaftL,st the unIrceased person as if would with a n—sed Supervisor_ The homeowner acting as Supervisor is
ultimately responsible. ��u � as art of the
To ease that the homeowner is f dly aware of his/her respoasr7irMes,many requi rem p
permit appHr!2 eon,dat the homeowner certify tnathelshe anderstaads file responssby-HIIIes of a Supervisor. On fire last page
of this issue is a form currently used bp.severzl towns. Yon may care t amend and adopt such a fo rmlcUrfifuation for use im
your cammnxofty.
Rzd=d D61.313 .
i
ofT Town of Barnstable
Regulatory Services
X&M $ Richard V.ScA Mrecbr
"59-
Binding Division
`romrerrp,Bmirrmg commoner
200 Main Street Hya=*MA 02601
WwW fu�er.3arasfablerua_us .
Office: 50M62-4038 Fac 508-790-6230
. Property-YOwner Must .
Complete and Sign Tb1s Section-
If Us ing A Bu9de7r
as Owner of the subject PIoPefty
bem�pavtboN7P to act on mybeba.If,
in all matters MhtiVe to work auffi0&-ed by-6is building permit application for. .
(Address of Job)
'Fool fences and alarms are the responslz7ii7Of the applicant Pools '
are not to be filed or 4i5wd before fence is inst2Iled and all final "
inspec-ions.are pedo=ed and accepted-
S of Owner Signatam of Applicant
PrintName hi=Name
Date .
�Fo o DOLS '
'6
THE to
Town of Barnstable
■ Regulatory Services
=ARNSTABM ;
MAC Richard V. Scali,Director
.q s63 ��
1°rE Building Division
Tom Perry, CBO,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 t Fax: 508-790-6230
Building Permit Procedure for Residential Addition Or Remodel Or Dock
❑ Determine map and parcel number and enter it on application.
❑ Historic District Commission,200 Main Street, approval required prior to construction/demolition
for any properties located in a Historic District:
• Old Kings Highway Historic District(north of the Mid Cape Highway)
• Hyannis Main Street Waterfront Historic District(See map for boundaries)
• Historic Preservation(if applicable).
❑ If ZBA relief(Special Permit or Variance is required for Project):
❑Copy of ZBA decision
❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of
ZBA decision date
❑ Approvals from the following departments are required and can be obtained at 200 Main St.:
❑Health Department {8:00—9:30 A1VI&3:30—430 PM {as of March 2°d,2005}
❑Conservation Department (8:00 S9:30 AM`&3:30—4:30 PM)
❑Tag Collector {can be obtained from Building Department}
❑Treasurer {can be obtained from Building Department}
❑ Permit must contain complete owner information,full description of project,correct square
footage of project,valuation of project(do not include hvac),building detail for Assessor's
Office, complete builders information, including signature and date of application.
❑ 5 sets of reduced house plans measuring 11"x 17".scaled 1/4"= 1' &fully dimensionalized
are required. Plans must include a foundation,cross section,framing schedule, insulation detail &
floor plan showing location of smoke detectors(located with a Red `S'.)
****** IF USING ENGINEERED LUMBER AND/OR STRUCTURAL STEEL,ENGINEERING
DATA MUST BE PROVIDED******
❑ Plot plan or mortgage survey required for any addition.
❑ Workers Compensation Insurance Affidavit form must be submitted for any workers hired. In the
event the homeowner takes out the permit, subcontractors hired must supply this. Copy of Insurance
Compliance Certificate must be submitted.
❑ Mass Compliance Checklist
❑ Construction Supervisors License&Home Improvement Contractor's License OR
❑ Homeowner License Exemption Form must be submitted if homeowner is acting as general
contractor or builder for the project.
❑ Property owner must sign Property Owner Letter of Permission.
❑. A NON-REFUNDABLE Application Fee must be paid upon receipt of application number.
All checks should be made out to the Town of Barnstable
❑ CEMMMYS: Need Home Improvement License,no plot plan required
❑ PIERS AND DOCKS:Need Construction Super License AND Home Improvement License. OWNER
CANNOT PULL OWN PERMIT.
❑ Projects requiring the use of a crane must complete the forms issued by the Aeronautics
Commission
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