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Home My WebLink About0043 MEGAN ROAD °F1 , Town Of Barnstable *Permit { Expires 6 months fro e date Regulatory Services Fee taRNS kBLE, Thomas F. Geiler, Director v Mass. �P 1639. Building Division TFb MPS A Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www,town.barnstab l e.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 3 P IC-,w aD' T'Q pojej Zesidential Value of Work 70D M nimum fee of$25.00 for work under $6000.00 Owner's Name&Address NAP-1NDE-2 VA-rq. . � M+f�A-rj fYYP*,JwNt Contractor's Named f}t)CIF} tefe,-5e�,) Telephone Number ZD'92Z1 Home Improvement Contractor License# (if applicable) --E�6rkmari's Compensation Insurance Check one: ❑ I am a sole proprietor PERMIT ElI am the Homeowner 0--I'have Worker's Compensation Insurance AUG — 7 2008 Insurance Company Name BLE ToVVN OF Workman's Comp. Policy# Copy of.insurance Compliance Certificate must be on file. Permit Request(Check box) ❑ .Re-roof(stripping old shingles) All construction debris will be taken to ❑ 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 co ce with otri frl rwp,apartment regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property.Owner Letter of`Permissityn. A.copy of the Home Improvemeit Contractors License is required. ;r SIGNATURE n\WPFif.F.C\FnRMS\hail iin'o ne mit fnrmc\FXPRF..4S rfnr. The Comtnonwealth.of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www_rnass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Namr, (Businegs/Organization/Individual): Address: JCo Hap-461L. Vd City/State/Zip: JH40axn Phone.#: Are you an employer? Check the appropriate bar: Type of project(required): 1.❑ I am a employer with 4- -Yam a general contractor and 1 6. ❑New construction employees (full and/or part.tiroc).* have hired the st b-contractors 2❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑lZemodeling ship and have no employees These sub-contractors have g. Demolition wormingemployees and ha for me in any capacity. ve workers' 9. ❑Building addition [No workers' c Mop..mctn-anre comp.insurance. 5. [, We arc a corporation and its 10.❑Electrical repairs or addition ztquu�]I❑ I am a homeowner doing allwork officers have exercised their 11.❑Plumbing repairs or ariditioz myself: [No workers' comp. right of exemption per MGL 12 ❑Roof repairs incuranCe zequired_]t P. 152, §1(4), and we have no employees. [No workers' 13.�thcr�� comp.msuranec required.] To-to Q€- -C `Any applicant that chxlx box#1 rnust also NU out the section blow showing their wmi=t'coinpays4on Poficy infDM-atian- Hmncownat who subffut this affidavit in&acing they arc doing RE work and thrr hire outside contractors must submit a new affidavit indicating such tc ntm.cbrs that cbmV this box nnmt attathcd an additional sheet showing the name of the sub- o h-&cWa and stain whether ornot thosd entities have employees. If the sub-contractrna have employees,they must pmvidt their workers'comp-po5cy number. I am an employer that a providing workers compensatr`_on insurance for my employees. $elow is the policy and job site information. lns- rancc Company Name: Policy#or Self-ins.Lic.#: Expiration Date: rob Site Address: City/StafclZip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date; Failure to secure coverage as required wader Section 25A of MGL c. 152 can lead to the imposition of crimaial penalties of: 5nc 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 t of up to$250.00 a day against the violator. Be advised that a copy of this stattm rrit may be forwarded to the Office of Investi tions of the DIA for' base cov e verification. I do hereby certify under the pains amass of perjury that the btformation provided above'is true and correct Date: • Si / Phone#- 360 O facial use only. Do not write in this area, to be completed by city or town officiaL City or Town: PeruiiMcense# Isstring Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Elec[rical Inspector S.Plnmbing Inspector 6. Other oFTME� , Town of Barnstable • anxxsrnst.E. "� �� Regulatory Services iOrEn 3�s Thomas F.Geiler,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, / u `� N - 2 Nf-\D\J\p , as Owner of the subject property to act on m behalf, hereby authorize �� \C5�o/`1 � c� �� Y in all matters relative to work authorized by this building permit application.for: t r , (Address of Job) Signature of Owner Date RJR Print Name Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revise020108 Town of Barnstable o� Regulatory Services swuvsrns Thomas F.Geiler,Director 9�A 16 9. ,�� Building Division rE0 MAr� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 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 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. 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. Q:\WPFILES\FORMS\homeexempt.DOC _ � fie U aniimo�ruuea`� o�✓l/�aaeac�iuoelta �', Board of Building Regulatns io and Standards °j a HOME IMPROVEMENT CONTRACTOR Registration 147989 ,Wrajtwn 6 4 2009 Tr# 131R28 ; >� 1<< `Typ F—...j CA SABIANCA t 4 a FFI-hJE ERICSSON TORREST ' 16HOOVER RDY "' WEST YARMOUTH MA 02673 �e Admmistrator - .. - _ t L'icense.or registration valid for individul use only ; before the expiration date. If found return to: Y Board of Building Regulations and Standards One Ashburton Place Rm 1301 r Boston,Ma.02108 of valid w' out signature _ _ -- E, 08/0712008 03: 19PM FAX' OM I)AGE 2 OF 2 1181/07/2008 12:29 FAX 605 945 2048 BERKLEY ADMIN. PlERRE QJ002/002 Acadia Insurance Company Administeree.by Deikley Risk Administrators Company, U-C Fer ' 5 ,r fo'P.C).Box 939, p, S1) 75010930 510 E. lr%,n, Pinrro, So'w , Phone(605) 946-2144 Far(606)945-2048 Toll,Free(800" 1334-45e,9 Acadia NC,;I Carri-r Code 3339 gLqEtMQAjjE OF INSURANCt 1.Thn insturpd- WCIP M.20-20-001245-00 r Vagner j Depaula T Q# F 2rwtier 9MewAll 15A Sao Ln Fran: -1 IIMM.007 Centerville,MA 02632 To- 11/1012008 -he Celificate is, i83ued;as a mutter of infcxfrnilion orllly-and no rii4ht% _,pon the Certil.cate Hold,.r. This Ceftm*fimts ores.rot amend, extend or*lter the rove-age a(fc.rded by tho Prli;y!Iatid tt`!Lsvw. ILI(;Eftjj y th at-hat the Policy of 111,surance,das(jrlbed herein haN been iss.,jcd to lh,> isui edl named aboya for the)noliev ueriod incicated, N0TWM,.)st,,sn!�Mg any requven,-:ent,term or uor.dltlon rjf-,r!y contract tor other ducumeoL v if viv;respect to which this Cet icate!Iii0y�iv, i!Kued or may perfain,the insur.�rce aftorijec"by tne Policy da!5,--ribc-d hemin ils si bject to all the terms,ext-.Jusionv and Conditions of st-ic-ri Policy. P-Art One F Bodily injury ny Axid0r,11 $*jnvQ,WQ ,�.avh ziccldemi_ N't Two rj 13 C, 'r ,i,y�t"' ncdflly)rjury by[>kc-aAa $100,M0 each cmployFe. -Shu,uld the aAjuve Puliq be callmed before the exloirati.-iii date thereof,the Company wi;�endeavor to maii 10 days writtert noli^le,.0 the oelow maned Cerliflicate HoAder, bul fallurri to mall such rotloe sO-iall impose no obligaflion o!,111ablity of an t kind Lipcn the Compaiy. Cer;ficafi?Holder's Name and Addrom SOLE PROPRIETOR NOT COVERED. Town of Elurmtabla 11",Bin Street Hygnis, MA 02601 v�..di L),?Lo 1,.,w Markabing Aatociates tits Agency Tollemon Int. :1 o ISO Wells Ave- Newton,MA 02459 HA73140 . . 08/07/2008 02 : 28PM -211/ Town of Barnstable *Permit# 6 THE)O Expires 6 months f ont issue date • Regulatory Services Fee i SpgNSTAB E, ; MAss. $ Thomas F.Geiler,Director Fn Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 JUN 2 4 2004 Fax: 508-790-6230 - EXPRESS PERNIINot� P RE{ id witl out Red Inprint TOWN OF BARNSTABLE Number ak 0,0a.Tj lay Map/parcel Property Address esidenti al Value of Work Owner's Name&Address Contractor's Name Telephone Number improvement Contractor License# if applicable)_- Home Imp ( Construction Supervisor's License#(if applicable) WW-10�r man's Compensation Insurance Check one: I am a sole proprietor �je Homeowner Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) [] Re-side Replacement Windows. U-Value i �� (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 Improve nt Contrac -License is required. Signature Q-.Forms:expmtrg Revise053003 Town of Barnstable °F cjig r°�"o,� Regulatory Services Tbomas F.Geiler,Director 1 $ v� s6g9• p,� Bnilcling DivisYon TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . WWW,town•b arnstabl e.ma,us Fax; 509-790-6230 office: 508-862-4038 property Owner Must Complete and Sign This Section If Using A.Builder as owner of the subject property av,` to act on my behalf, authorize hereby in all rriatters relative to work authorized by this bun ng permit application for, (Address of job) Ole 4Dt Sig�atur of Owner r Print Name 1 063-A-047 YFII#BiS 11 40-45 DH NFRC 6100 Renovations Double Hung - Vinyl Argon/Low E' SC NaemW Ferte;iUdm ss RaLig CouW. or rieft NFItC`e web i�Poe t:t t�{rrra7f�orp .• wacor 0 03 beat un 0 . 2 0 4 _Do_eAldent Transe�tanoe Manlf Uff sti Ift ft"N =ftm w ivoca**x procSMM for dew nin9 whole product er W pa ftMn .f#RC ratings are deteneined fDr a fixed set of ari*=nmW cmam and s adk PMW 3 tES Lr; A c I ND f1::Er N tia cjArss, ssf ON-M, Le w '�.� mc��. o►��c- '�� .r ir6 Ocder #:3367129010001 40199 ES law ��/� fiNnW��t4nUlv.�iLllc Board of Boildiag Regutatioers land Standards HOME IMPROVEMENT CONTRACTOR Registration: 126893 Expiration: 8131Z404 ' Tom: Supplement Card Rome Depot At-Home Services s MARK AUDETTS 3200 COBB GALLERIA PKWY#26 22�,,,,,, jY.✓ kTANTk GA 30339 Administrator ; Assessor's map and lot number ...p.�C 1............................... SEPTIC SYSTEM M UST BE INSTALLED IN COMPLIANCE Sewage Permit number �r WITH ARTICLE II STATE A /SANITAARY CODE AND TOWN y�F7HE RATp�� TOWN OF 1JR StOt i • i DAUST&BLE. i a pYAr. R IL I G INSPECTOR Cam n�,�� J APPLICATION FOR PERMIT TO ........................c�......................................................�................................... ss // TYPE OF CONSTRUCTION ..........//w9g..•..................... /4:.��..... 4o................................................................ * ..........al z`.. ..... .f.............19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �O � � �!% 7�� c� � .................. .................................. . ...... .. ...................................... ....................................... .... ....... ProposedUse ...�f ..Z ...... ?�1? . ...... C.t/��/61✓,�............................... ................................ Zoning District ...... Fire District Name of Owner .... O.Ll/ � .... Address ..... �..... ... � .f ....... {�" "-I Name of Builder .�..............4 ................................../c .......r!.........................................................Address ............ ................. Nameof Architect ...... ..........................................................Address .................................................................................... Number of Rooms ........... ........ .......................................Foundation .'....... �.��... Exterior ....W&e) ..... ....................Roofing ..,1 J.. ............................................. Floors .....�/ ! ` .... �� c!'..... .............Interior ..../.......�HG�G�ff.-.&e ......................... .... ... .......... Heating ...../. �'�`��`� Plumbing .......�........................................................................ ......................................................................... Fireplace ............/.................................................................Approximate Cost .. >s�® ......................................... 7a- Definitive Plan Approved by Planning Board / -1- 19 ------- Area ../../S� .........d................. Diagram of Lot and Building with Dimensions Fee �} D'.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i )l J V r V P I hereby agree to conform to all the Rules and Regulations of the Town of stadregarg the above construction. Name . . . .......... ................ � Dacey, William E. Jr. / . 16429 one story No ................. Permit for ....................................single family dwelling --------------------~---.. � Road ---- --`—'-------'---------- ' ' ^-------------------------' W@Ll]i�ou E. Jr° Owner -------____.�,�~��------ ' �� Type of Construction -----f--------- / ...-------------.-----------.... � Plot --------_. Lot _____.. �l��...... / Perm itGranted --..�c32�..25-----]A 73 | � Dote of Inspection lA / , Dote Completed x�. ' �r / PERMIT REFUSED + � � -----.---------------.. lA / |.-------------------------- i —`------'-----------`'------'' | —`—'-----'----------^^—^----- \ ............,....................................',,`...'...,......,'... � [ � Approved ............................................... 19 � . ^ --------.---------.-------- . - ---------------------~^—`—^' | | ` L _