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Home My WebLink About0292 MEGAN ROAD G �,_ice-- �.ep % ` '�/ _ �y��.�.;��,.✓ Z-0 itt Fig✓X0 f '"� _ . I .�,C',',. ,.,•cam t .. .. - 1 r L A ;� I _ aTp� �N OF A9� 7+�,�P\ r• f, , c o CRAIG. Al' 01 - R - t� 27483 105Ci it M. \ kilt.JR. • ` '-`-. -n e. r -.. Y. - �t`rG��C',Y'Y �� "y�� 1 �n` r�_' � ' t Yid, t � , Li 1 A 291 -- Lot #276- ! Assessors map and lot number ......................................... --� �- ` 76-573 (Inactive) F r S°`ewage Permit number ..............................................I.......... d Z BAUSTADLE, i House number ............... 29.......................... r rues. � �O t639 ♦� TOWN OF BARNSTABLE BUILDING I . SPECT{OR APPLICATION FOR PERMIT TO Allow 10' x 12' Metal. Storage Shed to be placed in ......... - backyard on top of wooden floor. TYPEOF CONSTRUCTION .....................:............................................................................................................... 09i..................1982... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 292..M ...egan Road,...Hyannis,. ...Ma....... .......................................... :................. ...................................I......... .. ........... .......... ............... . .... . . Proposed Use ....Storage Shed in rear of back hard of existing house ..... ........... .................. .............,.. ..................................................... ..Fire District ... HXanniS Zoning ,District :............................................:......................... ....................,:.............................:............ Name of Owner ....C�IRE ? r , s .............. Address Name of Builder' N A ......Address ' Nameof Architect ....NSA......................................................Address .....NIA....................................................................... Number of Rooms NIA .......Foundation ....N/A Exterior ...........................N/A..............................................:.......Roofing ................................................................ FloorsN/A......................................................Interior ..........NIA................................................................. . ,,.,. Heating .....N/A........................... ...Plumbing ........N/..A................... . ............... ........................ ................................................ Approx�ate Cost of Shed: $600.00 Fireplace ....................N/.A.................................................. ...................................................... Definitive Plan Approved by Planning Board __P)4x__24s------------197?___ Area 120 Sci. Ft. Diagram of Lot and Building with Dimensions (*) Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH (*) See attached diagram -= proposed shed indicated by red line. k OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to--all the Rules and Regulations Lofthe T of Bar stable egarding'the above construction. No ................................... PP_ GRIFFEN, CLAIRE or Build ....... 0 Permit f ............................. Storacfe Sh'ed ..........................Storage Location .2.9.2...Megan Road.......................... .. .... .. .. ....... .. annis .....................Hy.......................................................... Owner ...Claire Griffen............................................................... Type of Construction Frame .......................................... .................................................................... PlotLot ..................................... ....................... -February 10, 82 Permit Granted ......................................19 Date of Inspection .................................... .............. ..... Date Completed ... ..19 Assessor's map and lot number ....2g1.. Lot #276 76-573 (Inactive) Sev✓ages Permit number Z DARISTADLE, i House number .................292................................................. 'oco�MAO& er' 39 QED MPY a\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Allow. 10' x 12' Metal Storage Shed to be placed in .......................................................................::............................... backyard on top of wnoden floor. TYPEOF CONSTRUCTION ..................................................................................................................................... .................. ..d...!...................19��2.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... ... 292 Megan..Road. ,..Hyannis. . , .. Ma. ...... ........... .... ...... ........... . .... ..................................................................................................................... Proposed Use „.Storage..Shed. .. ... in rear. ..of..back.. ...yard of..existing. . ..house......................................................... . ...... .. .... ...... .. .... ......... ......... .... .. ......... ...... ........... .......................................................Fire District ...Hyamis Zoning District ............FS..... ................................................................. Name of Owner CDU FF �1 GRI ........Address Occupant-(xailer, 292 Megan 1 1. , Hyannis Nameof Builder. ......N/A.......................................................Address .....N/A........................................................................ Nameof Architect .... .......................................................Address .....N/A........................................................................ Numberof Rooms .... �A.......................................................Foundation ...N�A................................................................... Exterior .....................N.A.......................................................Roofing .........N�A.................................................................... Floors } Interior ,.d/A HeatingIJ/..............................................................Plumbing .......N WA................................................................... p N/A Approximate Cost o. Shed: $G00.00 Fireplace ................................................................................. ...................................................... Definitive Plan Approved by Planning Board JAZ_24!____________19 72___. Area 120 Sq. Ft. .......................................... Diagram of Lot and Building with Dimensions (*) Fee $5.00 SUBJECT TO APPROVAL OF BOARD OF HEALTH (*} See attachdd diagram, -- proposed shed indicated by red line. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bar-r tab elel regarding the above construction. �r A .. 1 f ,,f GRIFFEN, CLAIRE A=291-276 a9i- a7� 2.-'U04 Build Storage No .... ........... Permit for .................................... Shed Location .. 9 2 Megan Road ............................ Hyannis...................................... Owner ,.,,Claire Griffen Type of Construction ,Frame ............................ Plot ............................ Lot ................................ Permit Granted February 10,19 82 Date of Inspection ....................................19 Date Completed ......................................19 14-3 l . s. �R---{ "( r .. ,•.. ±`� `.' �2 x-i ` � tom' � _ tq Ik � - L c� = r� In 1 v r -a o.� tea' -- f1 L1 c\.j i ` 'IA Q rn Z. mo LA lKttb i�v\1 rl Q �e. P' �~,�;a,' �:� { �3� ,, \� ,� 1 B �, � Q� 1• � � as .�y+ VJ� � l� t� \,�1 t� (�� v: � 1 J �-• r 1C;�i�>.,u , I r �'i. !ii F ,i JT - _ � i� .. f ORs 570 WEST MAIN ST2ET HYANNIS, .MASS. Q2601 TEL 775-393.P - I' t ' r SE'TI, r Assessor`s ma, and lot number . .. `..... . .. `NJT, SYSTEM MUST g� p �.y -. . . . . W!" yj� EjC IN COMPLIANCE ¢..:Y 5-73 6/L '/C // -. y' 74 tl A ty ICLE ii SeATE �. Wit, �1 Sevira a Permit• number ............ `�� TOWN QyoFTHETo o. ` _ TOWN OF BAR.NSTABLE i BAHH9T&BLE; i NAG �� BUILDING INSPECTOR -D -APPLICATION,FOR PERMIT TO . iVf' /�C� .%.....L',...... ,� TYPE OF CONSTRUCTION ........�2!!!��ctl.4` ..1'° '/?isfX....... .............`.�.f ....................................... `� =c ........ !�l..s.......................19,....� TO .THE ,INSPECTOR OF BUILDINGS: s j The undersigned hereby applies for a permit according to the following information: Location ....�7•` �/ ��`. ✓Dd� �•✓i✓J.f/ .................................. ......................... ......... ......................... ........... ............................. ProposedUse ...............1............. z-- .....1.r. ............. .........:................................................................................................... Zoning District ...........Fire District ....,,lJ'.. . Name of Owner ..... . ................ ................. ..........Address .//•�. `�/ !�/1.�.......! . ��y�. , Name of Builder ./�!r� l 4 � .00 ..`V /'��i�j• �.....................Address .............................. .......�: Nameof Architect .........................................................:....:...Address .................................................................................... � !��° C/✓ Number of Rooms ..................................................................Foundation ..� ...... .........�..:/%....................................../.. Exierior ...... Ire.. $! ... ../,C,/' ......................Roofing ...... J,p� ...... o................s..... ` r Floors ".T./..�1 ,........0` iL Interior .... ✓ Heating ` ��.... .��' �.... ... ..z:............� Plumbing ..... 1��......................................................... ... 2. Fireplace .... .... S ................................ ........Approximate Cost .../..s ....................... ..5 . Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area wm........ ....... i Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH EA f � t+;Y OD cis _ zT 15e . Y6. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ��.... .......... .... ...................... W. E. D. Realty Trust 18�34 1 1/2 story, NoT....I.......... Permit for .................................... sinlfa' family dwelling .................................................................. �Hamegan Road " Locatio ....................................................................................Hyannis. ................................................... 05 W. E. D. Realty Trust Owner ................................................................. . Type of Construction .....frame..................................... ................................................................................ cil Plot ............................ Lot ......#57 lei .......................... November 24� 76 Permit Granted .............................. .......:'j 9 Date of Inspection ......................... ........19 54 ,Date Completed ................................... 19 PERMIT REFUSED ......................................................... 9 -1,4 ............................................................... or ............................................................................... 1V ..................................................................*"*'****"**' . ............................................................................... Approved ................................................ 19 .................:............................................................. ............... ............................................................... Assessor's map and, lot number �!............9./......... Sewage Permit number .......................................................... Q °`T"Er°�� TOWN OF BARNSTABLE ii i SABISTLBLi, i "6 9 o waY°r" BUILDING INSPECTOR � APPLICATION FOR PERMIT TO 6< y : ........... .TYPE OF CONSTRUCTION ............ ...................................................................... �. ...........!........`............................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...............................................:..........................................................,............................................................................ -Proposed Use /;/ ... / ............................................................................... Zoning District `l�s' �" '� Fire, District /�� .5 .......................... .. .. ........................................................ Name of Owner !......1'O%%/ �/r s7`'j/ /�sli✓ J� f ,�'�/;.../� ...............................................Address ............................................................_..........:.....:.:.... Name of Builder .............��........:. `.,;1/ f .. J✓� .f,� ��/vti ....... .... .........................Address .................. .............. ...................F:................... Nameof Architect ............................................:.....................Address .................................................................................... Number of Rooms ................ ...........................................Foundation ;............... ................................................................ ��% r�J :f� ,f ..�� ..........Roofing �/ Exterior ;.. ................................................... `. ...... Floors Interior ......./?�....................... . : .,. ...................................... .................................................................................... Heating /' �'/J.�...........................................Plumbing .........e, . ...'.......................................................... ......... .................. Fireplace ..................................................................................Approximate Cost �i � ins Definitive Plan Approved b Planning Board pp Y 9 ----:--- - 9 - --. Area .................... .... Diagram of Lot and Building with Dimensions Fee .. � �� ......................... ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH -A i � I 3fl01 of 1 S& . Y6 I hereby' agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . !� ..................... ...................... W. E. D. Realty Trust =291-2�r,/ k M334 1 1/2 story, No . ' ....:........... Permit for .................................... singlre family dwelling j ....... ................................................................. . nLocatio Megan Road Hyannis ............................................................................... Owner W. E. D. Realty Trust 1 Type of Construction frame f � ' Plot ............................ Lot ... �657 y Novemb� 4 76 't Permit Granted ........................................19 Date of Inspection .....1-9 Date Completed .. .................................19 PERMIT REFUSED .. 19 .................................................. !...................... S ........... .� .. ........... ................... ................ ... .. ....... ................. ................ o ��.. ................ t Approved .,... . . ... ..../... ../ ......... ...... 19 % ..................... ......................................................... A r pFt ,, Town of Barnstable *Permit#,c,009o�'iG,3 tip Expires 6 months rom issuejtaje Regulatory Services Fee . aacuvsrnate, r� 1639. ,0� Thomas F.Geiler,Director Building Division -PRESS PER IT Tom Perry,CBO, Building Commissioner 0 C T 2 2009 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN a�� ` Office: 508-862-4038 9ax:�M _TL3�LE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �y Not Valid without Red X-Press Imprint Map/parcel Number 6�' / �a f Property Address �� a /V L(14AJ le0 JC Residential Value ofWorr&7500 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name lam✓ /2_ �Co Z Telephone Number Home Improvement Contractor License#(if applicable) �� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole,proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) XRe-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter.of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re uired. SIGNATU C:\Users\decollikWppData\Local\Microsoft\Windows\Te rary I e et Files\Content.Outlook\4STGU5QO\E)PRESS.doc Revised 090809 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 .` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel4ibly Name (Business/Organization/Individual): Address:. C�a/ / City/State/Zip: Phone #: eqC? Are you an employer?C eck the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑ New construction I am a sole proprietor or partner- listed on the attached sheet. . 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance,$ 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 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 1311 Other 4:4 comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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. tContractors 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 andjob site information. 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(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 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 cer ' ender the poi d penalties of perjury that the information provided above is true and correct. Sin ure: Date: d/ 10 167 Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions I � Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal 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 dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter-152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to'sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate ro riate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture -(i.e. a dog license or permit to bum leaves etc.)said person is NOT required 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,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia oFzl,F r� Town of Barnstable o Regulatory Services w Thomas F. Geiler,Director snMWABLE, MAss. 1679. ,�� 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 //��' C� Please Print DATE: o JOB LOCATION: G��C number sstt t village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: c /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 re *reme ts. Z r e of Homeowne 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, ll 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:\WPFlLES\FOR.MS\homeexempt.DOC �s►,Ero„s Town of Barnstable tis Regulatory Services BARNSTABLE, MAes. $ Thomas F. Geiler,Director 039. & 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 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) Signature of Owner Date ' Print Name If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2� Parcel Application# _ 6V / 0 37- Health Division Conservation Division Permit# Tax Collector Date Issued 17 11 Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village r--Owner�� / c -� �i(�G�`/'��/V Address C GTelephone—V I �`�U s�' � ® �, f`7` 6-01 8-,2 91 / (P�b Pier i-Request-=a7;,�2te0_ OW,J& xe�Y y Y/-] IreV// Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Floo PIS Gro d ter Overly - oL �`i1,a, Project Valuado A _ - -- , on truction Type �----- i 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 a Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal st ve: ❑Yes ❑No 0 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existi g ❑nR size:)' f Z- Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: f "± Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ _Commercial ❑Yes ❑-No- If yes,site plan review# N co Current Use Proposed Use N BUILDER INFORMATION `,, Name �� Telephone Number //�O �� 'V6 ),U Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNAT REY" c DATE D FOR OFFICIAL USE ONLY i i ; f PERMIT NO. DATE ISSUED 1 --� MAP/PARCEL NO. ADDRESS VILLAGE, L15 OWNER z � R i 1 DATE OF INSPECTION: s FOUNDATION FRAME INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. 1 r The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations . _ 600 Washington Street Boston,MA 02111 see www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl CNaMe--(Business/Organization/Individual): . Il -I c�Address'= C=� CS�p�/ ,� —7 7/—7 P'v City/State/Zip: Phone.#: Are you an employer? Check the appropriate bog: Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. New construction . . employees(full and/or part-time).* have hired the stab-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. ElRemodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' Y P tY• $" 9. �Building addition [No workers' comp.insurance comp.insurance. equired.] 5. We are a corporation and its 10.❑Electrical repairs or additions E3�I�CJ�i am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions i right of exemption per MGL myself. [No workers comp. 12.)gRoofrepairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . .13 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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. lContractors 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. lam 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: City/State/Zip: 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 DLA for insurance coverage verification. I do hereby rti un r the pains a pena of perjury that the information provided ove is true and correct t-Si atur ,^ "'_ �. Date: / — Pho J#:vv 2) Official use only. Do not write in this area,to be completed by city or town of' ccial City or Town: PermitUcense# Issuing Authority(circle one): 1.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'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal 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 dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies"(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. "The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have an question's regarding the law or if you are re uired to obtain a workers' Y any g g Y q compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the*applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves-etc.)said person is NOT required 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,telephone-and fax number: e Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washingto i Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia E Town-of� Barnstable Regulatory Services EAM."A13 Thomas F.Geiler,Director 9 MASS. ,63g •�� ]wilding Division �'�rED MPI a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PFM IT 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 A �, requirements. T e.of W--ork_ _ Estimated Cost O J � Address-ofWorki~ vXx, Owner's Date of Application-_6 . 0here�by Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 []Building not bwner-occupied Own r pulling qwn perrnitt Notice is hereby given that: OWnRS PULLEYG THEIR OWN PERMIT OR DEALING 1G WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND D 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. �J 0 'OR . Date Q:fa=homeaffidzv tHE Town of Barnstable OF Tp� "o Regulatory Services xszns�, : Thomas F. Geiler,Director 1639. .�� Building Division A�Fo �a 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 JOB CATION:, a d2 number street n/�J �v5 ge HOME VERY �� /`� 0 F_j name home phone# work phone# /,/4j: U-RRENT MAILING ADD R_-ESS:--- ,4 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 mini m inspection cedures and requirements and that he/she will comply with said procedures and re ire nts. C c e`of Home"' r'"~ 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:forms:homeexempt , �-7701 �► , The Town of Barnstable �. Department of Health, Safety and Environmental Services Building Division 6 39. 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: Name: ��/�//�� D/�l/'��`Z Phone#: Jr�O"' 7? 5;0 Address: p2�o� �Of7N leexx Village: Xlll Type of Business: Map/Lot: INTENT: 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: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is 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 matter,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 excess 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 pickup 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 unde ed,have read d agree the above restrictions for my home occupation I am registering Applicant: Date: LJ Homeoc.doc