HomeMy WebLinkAbout0037 MEGAN ROAD � ��
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s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel = Permit#
Health Division 4_
7_9 zw-Ok Date Issued v(�
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Conservation Division Z UO Fee DD .
Tax Collectors �•
Treasurer °� ,
g a� 4�, INSTALLED IN COMPLIANCE WITH TITLE 8
Planning Dept. ENVIRONMENTAL CODE AND
Date Definitive Plan Approved by Planting Board ' TOWN REGULATIONS
Historic-OKH Preservation/Hyannis ,
Project Street Address 3'? rYl e ash
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Village21caLAN \S
Owner Address _ !1 If�ea ,4
Telephone
Permit Request � (�/ �..Q_
)A,oySC,
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Valuation �6 Do-®('� Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size . 33 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure a r S ' Historic House: El 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 -,3 new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: &Y"Gas ❑Oil ❑ Electric ❑Other
8entral Air: ❑Yes ❑No Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:Cl 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
� A BUILDER INFORMATION
Name A� o W-f_ d"w Telephone Number
Address License#
Home Improvement Contractor# ,
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
T
SIGNATUR 0 DATE h*/
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FOR OFFICIAL USE ONLY
f ie '
rr PERMIT NO.
DATE ISSUED :
MAP/PARCEL NO. �— !
ADDRESS .. 3-. �` ` VILLAGE _. . }^� ti -
OWNERS ftz
DATE OF INSPECTION
FOUNDATIONi,' ,�xl
FRAME t :
f INSULATION "
FIREPLACE 7
ELECTRICAL: ROUGH FINAL
S _
PLUMBING: ROUGH. - FINAL }= ( s e
GAS: ROUGH et t: FINAL
FINAL BUILDING Ion
t t A` -
DATE CLOSED OUT
ASSOCIATION PLAN N62 !3 it
1
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< _--� The Commonw o
Department Of Industrid Accidents
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on Street 600 WosJ:ingt
Boston,Mass 02111 '
lion Insurance davit
workers Campensa %�////
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I am a homeowner performing all worker
❑ I am a sole pnetor and have no one is
for wading an this job.compensation :...::::}:..:.::.:{.>::::{::::::.}::.:.::?{4}:i??{;::»;:{.;;
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of eeimiod eaaliiea of a Brie up to S1.500.00 andror
mmderSeetlon ZMA, f MGL L4 ens ldd to the P
•FaOtire_ta sectaps coverage,n?�4 �.
a
one years'imprisomaeat as weII as dvDpe:aiilties"in tho foam of s STOP fo DIA eBer ovetiSntlon. 0 a day against rue.
copy of this statement may be fozwu' ed to the()M=of laveatlg
� �o f information ptovidcd above is Ow.o�d co ed
I do hereb certify under the pa>Qss � -
�� 0-- Dam _
siffiature 0 —6 I W)
Print name
olIlt3ai we only do not write is this area to be completed b7 tity
or town oIDdal
perudi ieense# ❑Buffding Department
city or town: QI.icensing Board
❑Selectmen's OfIIce
❑check if immediate response is required (]Health Department
phoneme ❑Other
contact person:
(tevww 9i95 PJA)
Information and Instractions
assachusetts General Laws chapt -17
er 152 section 25 requires all employers to provide workers' compensnaenv for o�nv
14 � 10 ee is defined as every Person m the service of another ,
employees. As quoted from the `law , an emp y
he oral or written.
of hire- express or implied,d,
or
An employer is defined as an individuaL partnership, association, corporation or other g d m'employe or or the reecerry two or more ei..
tide foregoing engaged in a joint enterprise, and including the legal represses However the owner of a
trustee of an individual,partnership, association or other legal entity,.emp oying employees.
dwelling house hasping not more than three apartmea ; and who resides t or the occupant of the dwelling house of
another who employs persons to do maintenance, consuitcnon or mPair work M such dwelling house or on the grounds or
e of such employment b
building appurtenant thereto shall not because:deemed to-be an employer.
ea shall withhold the issuance or renewa:
,MGL chapter 152 section 25 also states that every state or local licensing agency applicant who has
of a license or permit to operate a business or to construct buildings in the commonwealth for any pp
not produced acceptable evidence of compliance with the insurance coverage erequired.d.o�e�ubhcwoI ?
commonwealth nor any the
of its political subdivisions shall enter into aa3' P
�,„-,., of this chapter have been presented to the contra
cdra-
,,,
acceptable evidence of compliance with the i
authority. µ` . .
:applicants
_., . clieclang the box that applies to your situation and
Please fill in the workers-'_compensation affidavit copspletely,by'-:
supplying company names,address and phone numbers along with a cerdficM of insurance as all affidavits maybe
pmitted to the Department of Industrial a Also be sure to sign and
{ .caamatron of msarance coves$
sub hcatioa for the permit ar license is
date the affidavit The affidavit should be retarned to the csty artovyp__ the aPP
being requested, not the Department of Industrial Accidents.. Should yan .
ave any q regarding the "law"or it rou
ensation policy,Please call the Depast2nent at the number listed below.
are required to obtain a workers' comp
City or Towns
The Deparmneat has provided a space at the bottom of the
Please be_sure_that the affidavit-is complete and Printed legibly. the applicant. Please
atthe
affidavit for you-tafill'out inthe eve _Of be of- .. dIias WcantaetYcu nga
be sure to fill in the permit/license comber which will be used as a.refereace
mimber. The affidavits maybe returned t^
the Department by mail or FAX unless other arrang= have been made."
The Office of Investigations would Moe to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call. zrllf
FEMEM, R
MIZIMMIAMIAM
The Deparanexxt's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
0111ce of Investigations
600 Washington street
Boston,Ma. 02111
fax*: (617) 727-7749
phone#: (617) 7274900 eat. 4069 409 or 375
°F tME 7, _
° The Town of Barnstable
' Department of Health Safety and Environmental Services
1659
o►A{ Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Comer
Permit no.
Date
AFFMAVIT
HOME IMPROVElYSE11VV T CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation.repair,modernization,conversion,
improvement,removal,demolition.or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work. eG� Estimated Cost
Address of Work: ,'1 ie a Vl V, 1
Owner's Namel)ew CeQ --k
Date of Application:
I
I hereby certify that:
Registration is not required for the following reason(s):
OWork excluded by law
[31ob Under$1,000
OBuilding not owner-occupied
❑Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
0, a:�=a
ace Owner's Name
q:foams:A ffidav
rc �-
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°F THE
The Town of Barnstable
snaxsrnBM
9NAM. Department of Health Safety and Environmental Services -
�p 039. ♦0
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
PLAN REVIEW
Owner:'[( Ul o� V'ta 1n'�(� Map/Parcel: 149 S .
Project Address:37 MP4 RI N Builder:
0
The following items were noted on reviewing:
n PA L-W1A- -f6tbe. Uhc%elr CGrh eVs cLC oteclk
+nee .6e- v; n t4d en sat �-
Please call 508 862-4038 for re-inspection.
Inspected by:
Date: 3 N lao
q:building:forms:review
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The 1 own o
OFIHE 1py�O Department of Health Safety and Environmental Services
Building Division
URNSTABL& = 367 Main Street,Hyannis MA 02601
iKAss.
9 1639.
�prFO MA'1 a ,
Ralph Crossen
Office: 508-862-4038 Building Commissioner
Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: CIE) c
JOB LOCATION: 3-7
village
i number street,• _/
.HOMEOWNER": .s l C.�4k U '. ) , U
name home pho # work phone#
CURRENT MAILING ADDRESS: Za 'e
ci /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 minimum inspection procedures and requirements and that he/she will comply with said
rocedures d r it ents
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 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 to amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPTN
Mar-28-98 12:06P P.01
4
LOT 131 ..
i N�8�3 09 rr
CV
LOT 130 i
rrrrrrrrr ,.. 3�f O
rrl ri♦rr
•'� iiir �!ii Y V
OR
rrr. 7
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LOT 129
f
RES. ZONE- 'WB" This MORTGAGE INSPECTION Plan Plan is For a3 FLOOD ZONE- "C"
TOWN: HYAN.NIS_ REGISTRY OWNER: U_TE_)Y Wff_
DATE: REF: 5 ,73 ___ BUYER• .XAT'HLF.E &f-&DdYlD-aABCH/BALD---------
DATE: ---
_VeV-V----- —_ _ — -- ---
_ _ PLAN REF: _•�1' 7 _SCALE:1"— la—FT.
_FT.
I HERRR�g.Y ERTIFY TO bf LL.AME& ___________ -----�---
MOJ AC� CO. _____ THAT THE BUILDING ti�H ur vu YANKEE SURVEY
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS ��� t'Ey CONSULTANTS
SHOWN AND THAT ITS POSITION DOES _ CONFORM x PAL 40H (SUITE 1}
TO THE ZONING LAZY SETBACK REQUIREMENTS OF THE � MtRITsN:W y
TOWN OF ___46d84Y,�TABLE-------------AND THAT NO.3ppag INDUSTRY ROAD
IT DOES__X9_T_ LIE WITHIN THE SPECIAL HOOD HAZARD o MARSTONS h1IUS, MA. 02648
a �►ss a�' Ja
AREA AS SHOWN ON THE H.U.D. MAP DATED}�/19�.8,t_ TEG 4,28-0055
,r,,�9� ��tios
co u 't — ne 250001 000 . FAX 420-5553
THIS PLAN NOT MADE FROM A RUMENT 93304 DCB
SURVEY, NOT 70 HE USED FOR ENCES ETC.
n
t 1 ,
OFZHE Tp�, Town of Barnstable *Permit#
26 1 WOi
Expires 6 monthsfrom issue date
Regulatory Services Fee
w BARNSrABLK
9� s �' Richard V.Scali,Director
arFD pM't A
Building Division om(�
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.usl JAN 14 2016
Office: 508 862 4038 OVEN OF RA Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTI LE
2 q�� Zs9 Not valid without Red X-Press Imprint
Map/parcel Number (�Property Address "'
3 -7 In r-&AW l"/�
`'� l✓tom 14 d
esidential Value of Work 7m, o-t Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 0 1'v 1 � A 7u&,' 6h-(,b
Contractor's Name AY I;7 kA/,_---/30.3 Telephone Number
Home Improvement Contractor License#(if applicable) r �/'� Email: Y�l L. Cn4^
Construction Supervisor's License#(if applicable) 696 /
❑Worlanan's Compensation Insurance
Check one:d
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Reques eck box) ..,r
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to _A1-6VWt�-(ff MJ F t tz—
❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows
#of doors:
❑ 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: kQ0 o
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 061313
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesdgadons
600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric'ians/Plumbers
Applicant Information PIease Print Legibly
Name (Business/Organization/Individual):
Address: (7 .
City/State/Zip: .a Phone#:
Are you an employer?Check the appropriate box:
l.❑ I am a employer with 4• [9 I am a general contractor and I Type of project(required):
employees(full and/or part-time).* have hired the sub-contractors . 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling
ship and have no employees These sub-contractors have g• Demolition
working for me in any capacity, employees and have workers'
[No workers'Comp. insuranCe comp. insurance.: 9• ❑Building addition
required:] 5. We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doingall work officers have exercised their [] g pairs or additions
11. Plumbing re
myself. [No workers' comp. right of exemption per MGL 12 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
3a.❑ I am a homeowner acting as a employees.[No workers' 13.❑Other
general contractor(refer to#4) comp,insurance required.].
*Any applicant that checks box#1 must also fill out the section below showing their workers'co
mpcnsationpoficy 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.
tContractm 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:-','L 3 ? 14 t 6-Aw '�, City/State/Zip: ,
Attach a copy of the workers' compensation policy
p po y 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 DIA for insurance coverage verification.
I do hereby ce fy under a pains and pe alties of perjury that the information provided above is true and correct
Date:
Phone#:
Official j�rcial use only. Do not write in this area, to be completed by city or town ofciat
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
. Information and Instructions : =
Massachusetts General Laws chapter 152 requires all employers to Provide workers+comPeaaation for their employees.
pursuant to this statute,an eatplq►tt is defined as"...every person is the service of another under any contract of hire,
express or implied,oral or written."
on of other legal entity,or any two of Moro
An eaepl�is defined as"an individual,Par�ershR , '�iQ4�co a of a deceased employer a tht
of the foregoing engaged in a joint enterprise,and inc the le Kowa+ ver the
receiver of trnsdx of an individual,partaershrp,associatsoa of other legal entity►,employing employees.occupant of the
owner of a dwelling house having not more than three nerd who resides therein.ia.or the
dwelling house of another who employs Persons to do maintenance,c���a work an such dwelling house
of on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employe="
MGL chapter 152, 425C(6)also states that"every stab or Ioeal Ikenda;sgesey s1"wlthkold the issuance or
renewal of a Ikense a Pernik to operate a buslnees of to eonstrud bdldtip Is the eommoawealth for ssq
applkaat wbe here not produced saepbdds svldenes of compilaaree wit!~the[maraaee csvefap nQ "
Additionally,MGL chapter 152,425C(7)states"Neither the commonwealth nor any of its political subdivisions shall
public eats into any contract for the peferanace fb o lie work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Appiletats
Please All oast the workers,compensatiaa affidavit completely,by checking the boxes that apply to your situstiaa and,if
necessary.sWply sul}coa ctor(s)name(s),addrtss(es)and phone number(s)long with tlra certit3cate(s)Of
th
insurance. Limited Liability Companies(LLC)or Limited Liability Puuwshipe(L.LP)with no employees other than the
miemben or putora,are not required to carry wo Lies'compensation insurance. If an LLC or LLP does have
employees,a pommy is required. Be advised that this affidavit May be submitted to the Department of Industrial
Accident for confirmation of insurance coverage. Abe be su si
n to p and date the atlldavit. The affidavit should
be retuned to the city or town that the appBcadcu fat the permit err license is being requested,a st the Department of
Industrial Accidents. Should you have any questions regarding the law err if you an required to obtain a prod= -
compensation policy,Please call the Department at the mamba listed below. Self-Wagedwapaaies should eater their
self iasuraa� license number on de VP PC!ab 1insL
City or Town 001dak
Please be sure that the affidavit is complete and grinned legibly. 11e Dgmwwnt has provided a space at the boa m
of the&fB&vit for you to fill out in the event the Office of Investigations has to contact you regarding the apptxanL
Please be sure to till in the permit(license number which will be used as a refaenae muaba. in addition,an applicant
that must submit multiple pamiUlieease applications is any given year,need only submit one affidavit indicating current
policy infarmstioa(nf necessary)and manta"Job Site Address"the applicant should write"all locations in (city of
town)."A copy of the affidavit that has been officially stamped err marked by the city or town may be provided to the
applicant as Proof that a valid affidavit is on file for firtrae permits of licenses. A new affidavit must be filled out each
yew.Where a home owner of citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license of pen-nit to burn learn etc.)said person is NOT required to complete this affidavit
The Oaks of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a calL
the Department-s address,telephone and fax munba:
The commonwealth of Massachusetts
Department of Industrial Accidents
otlles of Investliptlons
600 Washington Street
Boston,MA 02111
Tel. #617-7274900 ext 406 or 1-877-1vtASSAFE
Fax 9 617-727-7749
Revised 11-22-06 wwy,mws,gov/dia
n Ju1..30. 2015 11 : 51AM Dowling & O'Neil No, 7431 P. 1/1
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
Information Page WC og 00,01
Atlantic Charter Insurance Company VDAC
NCCI Co. No.:29211 Policy Number: WCV01243700
1. INSURED: Prior Policy Number: New
Robert Tyndall
Producer:
80 Brigatine Avenue Miller Mccartin, Inc. DOA
Hyannis, MA 02655 Federal ID Number:999100972 Dowling&O'Neil Insurance
Risk ID Number: Agency
PO Box 1990
Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS
Other Named Insured;See WCE106 Other Work Places: See WCE107
2. POLICY PERIOD. The Policy Period Is From: 7/15/2015 To 7/16/2016 12:01 A.M. Standard Time
at The Insured Mailing Address
3,. COVERAGES..
A. Workers Compensation Insurance: Part One of the policjr applies To the WorkeP C�inpensatlon haw of the-states 1ste - -
here: MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed In item 3A.The limits of our
liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500,000 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 06B
D. This policy Includes these endorsements and schedules:
See WCE105
a. COVERAGES: Rati premium PI ns.All nlonnat on requlree will be d be beloned w w s subject t our o venficalllonof eend change by audit.Rates 6
Code Premium Basis Total Rate Per Estimated
Classifications No. Estimated Annual $100 of Annual
Remuneration Remuneration Premium
See WC 00 00 01
Minimum Premium: Deposit Premium:
$560 $8,830
Interim Adjustment: Annually
Total Estimated Premium $8,373
Servicing Office: Surcharge(s) 457
25 New Chardon Street
Boston, MA 02114-4721 Total Premium and Surcharge(s) $8,630
Issue Date 07/21/2015 Countersigned
Copyright 1907 National Coundl on Compense0on Insurance Form:100mv
IKE
BAMSTABIX «
MASS. Town of Barnstable
.eTfD�a
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038' Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, �!hd,a ,zk, ,as Owner of the subject property
hereby authorize 1`I- W to act on ray behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner bate
+ h
v(5 (,6A td
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
Town of Barnstable r
Regulatory Services
Richard V.Scali,Director
Building Division
Tom Per Building Commissioner
ass.
v M $ Perry, g
�p i639• 200 Main Street, Hyannis,MA 02601
rEn t ° Www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number K 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 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 .
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.
' r 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 congtruction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
r
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction`Jiii7er"ri5or
License: CS-046189
DAVED H WEBB
32 F.R U ie Road
Woods Hole MA 8254
Expiration
10/29/2016
Commissioner
Unrestricted-Buildings of any use group which
- contain less than 35,000 cubic feet(991m3)of
enclosed space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Licensing information visit: www.Mass.Gov/DPS
1,
C�le�pan�rear,cuecz��i a�C�aac�uael7a
Office of Consumer License C r Affairs&Business Regulation or registration valid for indiviidul use only �
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration. 19766 Type: Office of Consumer Affairs and Business Regulation
Expiration;_- --
8/28/20 DBA 10 Park Plaza-Suite 5170
„- :ti7_
Boston
,MA 02116
WEBB CRAFT DESI,G-'.= "j4Y:_it j
DAVID WEBB � _i: i
25 MEADOW VIEW DRr.� -:->�'."
:,.
_ /LI
EAST FALMOUTH,MA 02536 Undersecretary Not valid wrthout signature
i
Town of Barnstable
Regulatory Services
OFtHE?p�
Thomas F.Geiler,Director
�* Building Division
9 MASS. g Tom Perry,Building Commissioner
.1 39-�a 200 Main Street, Hyannis,MA 02601
www.town.barnstabie.ma.us
Office: 508-862-4038 Fax: 8-790-6230
Approved:
Fee: �.s
Permit#:
HOME OCCUPATION REGISTRATION
Date:
Name v Phone#• �`�"L4 O - O v&
Address:c -7 MJ2Cf al-) ie C:/.' Village:
Name of Business: �_
Type n'Business �'� a t:
IlVTENT: 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: r-
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit. i
• Such use occupies no more than 400 square feet of space. -
• dwelling which are not custom in residential boil ' and there is
=
There are no external alterations to the d
llmg customary duigs,
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 matte
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 cess 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 is 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,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: e Date:4';�b 10(�a
0
Homeoc.doc Rev.5/30/03
• � 7 y 2
�oFi�� Town of Barnstable *Permit#
Expires 6 months from issue date
saxtvsz�i.E,
Regulatory Services Fee_
v� Thomas F.Geiler,Director
p'ED N 9.
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 0C s ��
Office: 508-862-4038 7.OVVnl 3 ® ZLQ3
Fax: 508-790-6230 ®� lV
EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLYS-4&/VS-rA,,LE
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address M 1EGf N VA"( AN N T S , W'1 .
Residential Value of Work # J oo-
Owner's Name&Address P P, PT LTEA " • A2� tt—r-a
Contractor's Name Telephone Numbers
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one: r
❑ I am a sole proprietor
® I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# _
Permit Request(check box)
-❑ Re=roof(stripping old shingles) All construction debris will be taken to -- ss- - - • -v -
- ❑-Re-roof(not stripping. Going over existing layers of roof).---.--.
❑ Replacement Windows. 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.
Home Improvement Contractors License is required.
Signature \
��Q.
Q:Forms:expmtrg
Revise053003
f
P . �4
°FTC lo,,ti Town of Barnstable
Regulatory Services
9 DMASS AMSTABMg Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
�Y
ProP a Owner Must
Complete and Sign This Section
If Using A Builder
I, Z)a.U t C� Q S Cr��� g•1.dL ,as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
y0. S
(Address of Job)
s lO 3a 0
Signature of Owner Date
Print Name
4
11.IIl�D 1.R C.f1R7ATCD 7)IID�ATC CT(ITT -