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HomeMy WebLinkAbout0066 MEGAN ROAD -- - /� G 7Yie�a� /��d � � � Town of Barnstable *Permit O�3 pQ� # Expires 6 months om' ue d Regulatory Services Fee IMM MABLE, i `�� Thomas F.Geiler,Director o 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 Imprint Map/parcel Number ZVI Property Address n 6 z /esidential Value of Work L�R � -� Jed y Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address z/ barL74 s7 Contractor's Name Telephone Number Home Improvement Contractor License'#(if applicable) Construction Supervisor's License#(if applicable) ®PRESS PERMIT ❑Workman's Compensation Insurance 1 APR ® 9 2012 Che .one:. g1have sole proprietor the Homeowner Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name I 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 layers of roof) ❑ Re-side ❑Fence over 6' #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *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 I oveme tractors License&Construction Supervisors License is require SIGNATURE: Q:\WPFILES\FORMS\building permit fonnsTYPRESS.doc Revised 051811 Tie CommanwealM of 1iV m- achineft DVwt»tent of Irt&a1zial Accidents Office of Inymfigations 600 Washington,Street Boston,MA 02111 mni6t mamgou/dia Workers'Compensation Insurance Affidavit:Bmlders/Con rs/Flectricians/Plnmbers Applicant Information Please Print LegibName Address: CitylStateJZip; Phone 1* © — 2- Am you an employer?Check the appropriate boa: Type of project(required): 1-❑ I am a employer with 4. ❑ I am a,.general contractor and i employees(full and/or part-taw)' * have hired the sub-contractors6. ❑New construction2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees These El Demolition working for me in any capacity. employees and have wwkers' [No workers'tromp.insurance comp.insurance 1 9. ❑Budding addition mod] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3 I am a homeowner doing all work, 11_❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.7 Roof repairs insurance require&]T c.152, §1(4X and we have no 13.❑Other employees-[No workers' camp.insurance required.] •Play appltcant that chedEs Los#1 mast also fill our the section below showing their workers'compensation ply iafnrmation_ I�ameoavmeis who subunit this affidnk mdfcatiag they are doing all woat ad then hue outside councans must sohanit a new affidavit indicating suclL TCoatractars that dk this WE must attached as additional sheet showing the name of the sub-cautfactocs and state whether ornot dose entities have � emphr ees. If the saL coatactots Lave em*oYees,they must provide t beir workers't nap.policy ntnaber- I I ape an empinyw that is pr ouiditg workers'compensalian,insurance for my sarptayaees. Below is the policy and job site inforiTmtion. Insurance Company Name: Policy#or Self ors.lic.#: Expiration Date: Job Site Address: City/Statelzip: 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 DIA for=' trance coverage verification. I do hereby certify under tit � - hies of � to In t�ton:ptmritdrd a ' true and correct 7 Si tune: Date: '-D d. --0 -- Gf'✓� Phone#: Gi,,V al use only. Do not awrf&in this area,to be completed by city or town o fucgaL City or Town: Permit/License 4 Issuing Authority(circle 1.Board of Health 2.Budding 'Department 3.City/Town.Cler)k 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- 6 IKE Town of Barnstable Regulatory Services 9 "B $' Thomas F.Geiler,Director `bAr 1 39.,a`� ' Building Division 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 st'ree'/� village "HOMEOWNER": R I 1 I—r Z name j' _ home phone# ��� work phone# CURRENT MAILING ADDRESS: �2'Y `y 6 677 ity t wn 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 detached1structures accessory to such use and/or farm structures. A person wbo 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) L - The undersigned"homeowner"assumkes 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 requ' nts and e e will comply with said procedures and requirements. Signatur of meow ner t Approval of Building Official j 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 uselthis 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 fonns\EXPRESS.doc Revised 051811 i _ 16 9. Town of Barnstable 9� i639 `fig' . ArED MA'S a Regulatory Services Thomas F. Geiler,Director Building:Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.us Office: 508-862-4038 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 my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) -�� /�. Signor e o Owner . Date - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 051811 �oFr►irroty� 'Town of Barnstable *Permit# a. ire nrnnlhsjronr iss dale Regulatory Services E.r 6 ^' HARYSrABLE, MSS. � tb1q. a Thomas F. Geiler,_Director,or�MAC Building Division Tom Perry, CBO, Building Commissioner SEP 22, ?010 200 Main Street, Hyannis, MA 02601 T0VWPE www.town,barnstable.ma.us t" f � ��`' Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Vaiid without Red X-Press Imprint Map/parcel Number Property Address A -,6�� M P�Residential Value of Work 6'00 .,:�• Minimum fee of$35,00 for work under$6000.00 Owner's Name & Address . 7ljj �/� S� T 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 ❑ 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) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Ej Re-side 2 #of doors eplac Rement Windows/doors/sliders. U-Value (maximum .35) # of windows *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:IWPFILESIFORMSIbuilding permit fonnsTXPRESS.doc Revised 072110 Tlie Coitittiortta'ealtli of-,Ifassaclitisetts - — - Departmertt oflridustrial Accidefrts Office of Invesfigafions 600 Washiiigt'ofl Street f. Boston, :' 4 02111 }6 ww.,wass.goVIdiff IlVorkers' Compensation Insurance Affidavit: Builders/tConti-,ictol's/Electiicians/Pl:umbers Applicant Inform_atio:n Please Print Lefibly Name. (Busine&&rOrgauizab,3n:Zndividrtal);= rek) ` Ad&t.ss: qb E L Clt lStat&zip: I) ' Phone Are you an employer?Check the appropriate boa.: T}pe of project(requited): L❑ I am a employer with 4.�am a general contractor and I . ecx:iployees(felt and/or part=tiiue). * have hued.the sub-contractors 6- ❑New constriction I❑ I ani a sole propriedor or partner- listed on.the attached sheet 7- ❑.Remodeling shipand have no employees These sub-contractors have p � S. ❑.Detno.lition working :for me in any capacity. employees and have workers' [No workers' comp,ince comp-insuace.t �- ❑:Building addition nsura ra required.] 5. ❑ We are.a corporation.and its 10.❑Electrical repairs or additions 3.❑ .1 arm a.hometnvner doing all work officers hive eaceirised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per NMGL iris-urance.reguffed.]T c. 152, §1(4), and.we have n 13o 12.0'. Roof repairs employees.[No workers' ❑ Other comp.Msurauce real awed.1 Any appticaut thatchecks box#I.must also fill out the section below&bo•wing their worlteis'conrpensa:tian policy inforvrstiao- Y Hanteowners who submit this affidavit indicating they are doing sit wont and then hire autside contractors must submit.a vew affidavit indicating sucl rCantraclnrs that check this:boot!Host atucbed an additional:sheet showing the tame of the sub-coutractars anal stare wbethier or not those entities have employees. If the sub-contractors have emplo}ees,.ihey.un�st provide tbeir workers'comp.policy number. I am an e>✓►plt?fer that is praurdirrg itro>wk�rs".conrperrsation iresrrrrrrrce for tl�y'ettrpZoJ ens. Beloti'is the policy and job site inrformadvit. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date.- Job Site Address: City/State/Zip: Attach a copy of.the workers'compensation policy declaration page(shoi«ng the policy number and expiration date). Failure to secure coverage as required under Secti+oa 25A of MGL c. I52 can lead to the imposition of criminal penalties of a fine up to S1.,500.00 ancfor one-year imprisamuent,as well m 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.D.IA for insurance coverage verification. I do ltby certify ttrrder Else paints and pa tath'es of Jtjarry that the n forrrlrrt!'oxr prmdded abotrtt is true and correct S.i a.ture: Date: Z -2—ol a Phone#: YZ 3 6 QfficiaL use only. Do not}sprite in this area,to be complcrted by cifLElectricad aL City or Town: Permitl IssningAuthwity(circle one): 1.Board of Health 2.Building Department 3. C`.iry town Clericnspector 5.Plumbing:1,nL-,.:pec:tor, 6,Other Contact Person: The C6,innionweahlt ofllfassachusetts Department ofInditstrialAccidents t—I Office of Investig atlons . ( , 600 Waskington Streel l Bvstot.l AL4 02111 fvn.,t.ruass.igowdia Vorkers' Campensation Insurance Affidavit: Builders/+Con:tr.-tctoi-&Tlectiicians/Plumbers Applicant Information Please hint LegibIv Name (Btisine&-,'Orgm1 zo6on�7udividcaal): Address: City/state./zip: IV --/ II`� `e?2 11one#: / 16— /� Are you an employer;' C ecic the appropriate box.: Type of project(required). 1.❑ I am a employer with 4. ❑ I am a general contractor and I riaployees(full and/or part-time). * have hired the stub-contractors 6- ❑New ronstnTc.tion I am a sole proprietor ox partner- listed ou tine attached sheet. 7_ ❑.Remodeling slup.and have no employees These s'ub-contractors have g_ ❑Demolition working :for me in any capacity. employees and have workers' [No workers' comp,insit ance comp_insurance..? 4 ❑Building addition required-] 5. ❑ We are.a corporation.and its 10.❑Electrical repairs or additions 3.❑ :I ant a.homeotivner doing all work officers have exercised their 11,❑Plumbing repau-s or additions myself [No workers' comp. right of exemption per 1fGL 12.❑Roof repairs insurance required.]r c. 152, §1(4), and we have no employees.[No workers' 13..❑ Other comp.:insUrance,required.] Any applicant that checks box#1.nmst_also fill out the.section below drawing their workers'cowpeusation policy information. t Homeowners who submit this.affidsvit indicating they are doing all worts and then hire outside contractors roust submit a uew affidavit indicating such. =Contractors that cbeck this box 7nua attached in sddltlonsl:sheet showing the name of(be sub-coutrtictors sn.d state whether or not[hose entities have employees. Ifthe sub•-contsactors.bsve employees,they must provide their workers'comp.polity number. I art art eviplay er that is pros iding workers'coutpon rah°on i vvtrawce for rrry ,etvrployees. Beloiv is Cite poiicy raid job site it forNt aliGrL p Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: �J t lr Job Site Address: �� �lV � C�itydState/Zip:*bera�ndexpination4ate). � 'O&WI Attach a copy of the workers'compeursationPolicy dec araLion page(sho�virtg the policy Failure to secure coverage as required undex Section 2.5A 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$250.00 a day against the-iola:tor. Be advised that a copy of this statement may be.forwarded to the Office of Investigations of the.D.IA for insurance coverage verification, I do hem y Ce-rti an:dA-th uts and par lh'es of perjury tit at the is farrrratiott prm7ded.a bove is trrtyt.e and correct r f V Si ature: Date: Phone#: cSA /C� O c1a1 arse ocily�. Do r of tsrite in Phis area,to be coinpltrted by cite or rota=n official .. 'a,t�y_orTown: Permit/License# Issuingrluthoiit),(slide one): 1.Board of Health 2.Building Department 3.L`.itwTown Clerk 4, Electrical Inspector S.Plumbing Inspector 6, Othei, Contact Person: Phone#t P..�I"Er° Town of Barnstable ' Regulatory Services sa.EfSTBLE'$� Thomas F. Geiler, Director ra ,r Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta b le.ma.its Office: 518-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION yry� Please Print DATE: L—�� JOB LOCATION: — number street rr L village „F(OMEOWNER" O2y 7- -- name home phot e N work phone N CURRENT MAILNG ADDRESS: I —T c /to n 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 �athe/sh�ewill comply with said procedures and requirements. Signat o orneowner Approval of Building Official , Note: Three-family dwellings containing 35,000 cubic feet or larger will be required tocomply 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 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 cannotproceed 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:IWPFILESIFORMSIbuilding permit formslEXPRESS.doc Revised 072110 of 1HE Tp� r BARNSTABLE. Fl 9 �. Town of Barnstable ArfD MA'S A Regulatory Services Thomas F. Geiler, Director Building Division Thorn, Perry, C130 Building Commissioner 200 Main Street, Hyannis, MA 026 www.town.barnstable.mi. Officer 508-862-4038. `.,,Fax: 508-790 6230 10 erty,,,® Lei Mus,v,'- o COM Ie :e arid'sign This S w'tllbn If SI A Burl'der I, as Ow er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized y this building pern-ut apphc lion for: g (Addr ss 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. Q:\WPFILES1F0KMS\building permit forms\EXPRESS.doc H Revised 072110 IV o 7 2 u 0 { w 1 _ F J TFF_tED PL.0T : PLAN KA is s , t A ENCE: `.B'IZ7rvq LoT ` S//OWWON P4 A OFf/ AIV"I-S. W/LLO�I�/:5.'' .�QECaI��G�'D fN T R R�. A RE E i9 S'N T � r. Y Dom" s _ � ' B'�R � � O D � 2 3 O A E �tffgE8Y CERTIFY THAT THE BUILDING REG: LAND SURVE"Y 5Ml0WN ON TH15. PLAN 1S LOCATED ON 1" fE. G'ROUN0 AS SHOWN HEREON AND T, KAT 1T CONFORM . TO THE 0 N 1 N G BY - LAWS. ,OF. THE TOWN OF �1HOFAj,1 3 RN„4'T.4.BGLG" W-HE. N C .0NSTRUCTED. ., - 4° VEBETi * FBARNST'AB:.LE SURVEY. CO,NSUL.TANTS ( NGh� . � F WE::ST YARMOUTH, MAS3 - i�zSEPTIC SYSTEM MUST''BE � INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE AND TOWN �PyofTHE.ro�o REGULkro WN OF BAR NSTABLE s DA"STLDLE. NAM Cb 0 N BUILDING INSPECTOR PY a\e Ole APPLICATION FOR PERMIT TO ...rjev...... ......... ............... .. ......................... .................. :,. TYPE OF CONSTRUCTION ...... ...... ... . . .............................................................. .. ... .19 TO THE INSPECTOR OF BUILDINGS: F The undersigned hereby applies for a permit according to the following information: Location ..........:� .....j �........� :'1. ...... "� ....................l�' ...................... Proposed Use .......... ..�:�.�... .......... ......................... ................. ................................... rr � ( � r Zoning District .................................................... .................Fire District Name of Owner .6�'"•••... ...:..... ......, :.......:...Address .....�?o Name of Builder c .....................................................................Address .................................................................................... Name of Architect t 4. f c•r ..................................................................Address .................................................................................... Numberof Rooms .......... .... ,. ......................................Foundation .......<......... �.......................................................... Exterior .........' .11-1.............. .... ... .. ... .................Roofing Floors .......................................... .Interior .........: ......e..................... Heating ......... ............. ....................................................Plumbing ......./...................................................................... Fi"replace .. ...........1...... ......... .........Approximate Cost ........r2..).......... ..p........................... Definitive Plan Approved by Planning Board --- ----____19---�_?- / .S Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH a I hereby agree to conform to all the Rules and Regulations of the TowyBarnsta a regarding above construction. Name ..... .. ...... .................. ................. Dacey, Alliam E. Jr. No ....16247... Permit-for ..........one story ....... .......................... single family dwelling ................................. ..... Location�U..Me.gan Road ...... ........ Hyannis ............................................................................... Owner ...........William E ....................................................... ► Type of construction ..............................frame............. ................................................................................ Plot ............................. #113 Lot ................................ Permit Granted ......... ...................ig 73 Date of Inspection ...... .........19 Date Completed .... %A.......19 PERMIT REFUSED ................................................................. 19 ............................................................................... ...................... ......................................................... ............................................................................... ................................................................................. Approved ............................................. —- ........................................................................... ...............................................................................