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0055 MELBOURNE ROAD
5'� N�i/auone i�1 i Town of Barnstable BuiIding w.Rnsrwa� =Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final inspection Has Been Made. oru•<" Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-19-3451 Applicant Name: TIRRELL, MICHAEL E&CARLA M Approvals Date Issued: 11/05/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 05/05/2020 Foundation: Location: 55 MELBOURNE ROAD, HYANNIS Map/Lot: 268-247 Zoning District: RB Sheathing: Owner on Record: TIRRELL, MICHAEL E&CARLA M Contractor Name: Framing: 1 Address: 55 MELBOURNE ROAD Contractor License: 2 HYANNIS, MA 02601 Est. Project Cost: $25,000.00 Chimney: Description: enclosing in 120 sq foot covered deck area to make a sunroom Permit Fee: $177.50 r .. Insulation: Fee Paid: S 177.50 Project Review Req: Must be insulated to code. Date: .,: 11/5/2019 Final: wC�� Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. e� Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:! Service: 1.Foundation or Footing 2.Sheathing Inspection ! Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed'" 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: __Building plans-are-to-be available on-site-. Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: I I.A n dmrmRi..r.w m,n a.ming. 3.All doon to in Ilnrvay 6ad8 gliding Rnlin door q.tenl. 1.wi�"r(.A)ru ba ll—q Rolling li W'indo—p.—. 4.W'indn�v(11).he It—,1316 C.RweR....... FgFln1G[gGgR n012 R/LL A AFW1v i O §6§ k E� L�� c r l.L9 ID f= � �^ ' •�" - - 4 _. _ � EOEIRC IEfR Iq REwx _ abXe cr►St �' � It a P+'PpCo�e � o p RMgon/M1a our. 4 O r<.RooR�wRImR rnww rzR FaoE a aaR�co Im1 a i.......,..µ.. oR M Ragn`�R` '1eA°�""pOfN"` Tirell Residence k 55 Melbourne Road ERSUMR...wsr ra noEw r-e• } e_y y ..q• ��•_e• Fcsmc r.f ems,ro anon Hyannis,MA 02601 EgFRHR!(.R9 A RJUFI NEW FRAMING 10•IS ,9 A_ 1 1�1 2..-1._G. MG M an.ra nao eumm A'JpIIW m AWtlI ooOAAf mRWlNw m AauN M�mAA m wip anxA xn eawu m wra asna xn wnu m wlq alOAu s - WM MDAMN i wiM L.AIION AmNo AOpmq m Amw Q a N0. NxNIIOn/lHux DOu xgxn xw m Mxm �wrptaro �1p Tirall Residence JS Melboume Road Hyanda,MA 0260, eUVAnoNa o. oaNe ora rwYxA ro imiAx B- 1 MR RN1nnx x+a Gmervl e d�a 9 a'-ep mama ur tvxRaws wwxa tR.o1n Nn m Rww a�.Msi is•ac.R+al ]'-e'.T901 R0. FAMO II4avW N RwN Rn aM w a Ra+Ro xn meows ro wm,esmuc a RauRa Rx ua nw a RWR�Inv) wwi ercnow rI(nsal r apt«m�ao� xtw nrsuu,av a Rauao ®a a i aem.m�puo ooe. ' vwva twa¢e unmt {•yr ma eomx ,•••^•.e.� Tirell Residence 55 Melboume Road Hyannis,MA 02601 xnr a wash a Raum Rw rt warn n Rwmo occK munnc oerut uxe r-r.r-0•Mau µ oerAas MG n1AA I n . loo nn -- CC a cL•1'I.1$ it r ® L .a Qs "/. - + cl I 6. ri r 1 S O I! r 1'9ir�i ESN OF VCHARD JAMES c N e T WHFA yf:. ��QJST'E�� Q' CERTIFIED, � . Q CER . IFIED, PLOT PLAN f svRyti r/- ,R S TA 3L E MASS. r a R. I' CERTIFY THAT THE 811J "y� O�HEARN, /NC, RG°S; R �r ;SHOWN ' ON THIS PLAN HAS BEEN 1348 ROUTE 134 LOCATED ON THE GROUND AS, INDICATED. EAST DENNIS, MASS. xf j- DATE:: SCALE JOB- N0. 32 — /S"4.5 . CLtENTc�51'y` [ s ATE EG LA D SURVEYOR DR:` BY .;^ =L r SHEfT - OF DSP Application Number... 1. ......... .....`...`�..1................. s s • BARNSPABLF, r MASS. oCT 201 Permit Fee.......... ..7...........o....Other Fee.....................,... a639. � 9 '- Total Fee Paid ` ............................................... ...... TOWN OF BARNSTABLE Permit Approval by.. .. r ...........on.. BUILDING PERMIT M .Parcel....... ?.Y7..............:..... ap....................................... APPLICATION Section 1 — Owner's Information and Project Location Project Address HV0,J 100Uy-A.1L Koa_d Village Owners NameA' ��' Owners Legal Address FS H-eibov a City14q 0,'11 State / / Zip 00 �d Owners Cell# v"69 '5.24- 0-1 / E-mail Nze-A 'v Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet in a Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory'Structure ❑ Change of use ❑ Demo/(entire structure) Y ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment El Sprinkler System t Addition ❑ Retaining wall ❑ Solar, ❑ Renovation ❑ Pool ❑ Insulation F' Other—Specify, t Section 4 - Work Description ell-&10 iqLtaie 07 4 eo�f ir(7/ S� Df1 Tact nndAted- 11/1 Snni R 9 Application Number.................................................... ' Section 5—Detail Cost of Proposed Constru 'o o Square Footage of Project v"Z d ' UL 2. k(f4 Age of Stricture, 206�° Dig Safe Number /�} # Of Bedrooms Existing Total# Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method MA Checklist ❑ WFCM Checklist ❑ Design 1 Section 6—Project Specifics } Wiring 0 Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑Add/relocate bedroom . Water Supply - ' ® Public ❑ Private Sewage Disposal ❑ Municipal ® On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes X No Section 7—Flood Zone 1 Flood Zone Designation �j Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Q � Zoning District /` Proposed Use JU 11 ro 0 Lot Area Sq. Ft. /JJ/AA/ Total Frontages Percentage of Lot Coverage /—C# of Dwelling Units (on site) Setbacks Front Yard Required 6 Proposed Rear Yard Required Proposed Side Yard Required lD Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No ° f Last updated: 11/15/2018 Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Telephone Number ' Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 .s CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: A' Lid 1 60' / -1a Ft_rC"` Telephone Number 45Df Cell or Work Number 601 6 c23—6®1 y p g� 1,Ctr �5 cP �' 5—ra/ I understand m responsibilities under the rules and regulations for Licensed Constru on u ervisor accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re uired by 780 CMR and �ble. Signature Date b /q d.(J/f APPLICANT SIGNATURE Signature Date d i,o ao/9 Print Name t1l Pal ff q �ja d �� l rp-e G Telephone Number SoZ,3—&0�7 E-mail permit to: '%ACAI-ff Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval Section 13 — Owner's Authorization as Owner of the subject property hereby authorize. to act on my behalf, in all matters relative to work authorized by this building p ermit application for: �� 66 -c/ h �� 7> ddress o Job) /C) 612 Si ature of Owner date di Q d E ` i r"re Print Name r _ i Last updated: 11/15/2018 I The Commonwealth of Massachusetts Department of IndustridAccidents 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 Leptibly Name(Business/Organization/Indivi(lual): 4 Address: ( HeIL City/State/Zip: 9 Phone#: c56 5d3- D�f 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 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•insuur nce.t ePA] . 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumb' repairs or additions 3.KIam a homeowner doing all work ❑ � eP ysel£[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I 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. *Contractors 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 worker;'comp.policy number. r 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.Lie.#: 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 DIA for insurance coverage verification. I do hereby certify under the pains and pen that the'formation provided above is true and rc�)_ Si ate: Date: 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Taws 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 budding 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 constrict 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 retuned 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 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 permittlicense 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: The Commonwealth of Massachusetts Dgwtment of Industrial Accidents, Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE ` Revised 4-24-07 Fax#617-727-7749 r:nim.gov/dia f OF�HEI - Printed On:7/8/2019 E ,� yo � Comp,,lainCall Report 9�p 73 °LILLIAN DRIVE:, HYANNIS.,;: i rEOMm° Case# C-19-2€17� Case#: C-19-217 Address: 73 LILLIAN DRIVE, HYANNIS Date: 3/26/2019 Owner Info: Property Info: MAYO, ANNE E MBL: 73 LILLIAN DRIVE 248-196 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Zoning, Unlawful Commercial Activity, Medium Priority Phone Complaint Summary: Occupant/owner Ann Mayo is operating a business from a tractor trailer box in her yard. She frequently receives shipments and has been observed going in an out of the subject unit often. Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: mckechnr Filed by: andersor Comments: Comment Date Commenter Comment 3/26/2019 andersor Caller is frightened of subject property and stated most of her neighbors are as well. v� �\ID Date: 7/8/2019 Town of Barnstable I �oFTHETpy Town of Barnstable Inspectional Services ` BARNSTABLE• Brian Florence,CBO v� 1619. �00q Building Commissioner °lEn Ma<'a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us INSPECTION REPORT Address : 73 LILLIAN DRIVE, HYANNIS Case# C-19-217 Inspection Type : Violation Inspector: mckechnr Description Date _ Unit S tus Comment , ... ..�..........�...�........ F Violation 03/26/2019ASSNo violation observed,-"pod" storage unit z i in driveway, one car behind the fence. See pictures ------- --- -- -..—_T ..--...... - 1 ......... _.--... ......_ __.. ... --- -.....- - ---- -- -- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 Map ' Parcel—A�l�' Application #_a6 Q U 6 S Health Division Date Issued Z-29P-67 vor Conservation Division Application Fee Planning Dept. Permit Fee ' —T= Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ` �"rrs..`r�J Village �� Owner f� (', ✓L� ( l ;c'Z.2e-cc. Address S:S`GI� .N �Yzt1�� � ���-1JIv�s:dam Telephone :fir,' • ,3�Q Permit Request ze2wiFIE- krtc S kvft u a"Riau L/rL � Guy t Bcb ai0�l 1�1�ter, LeAG� LiL ct� ( *T�LCb G�G�C�r � E�k.ftt�' (1�/I Ykk,� l,�A 4l,3i6" //` &-D gaMA /L►l CrJRA nZ. kaM e 1w E f-=&T &Jl� Rn i'92G", (�,4+ Square feet: 1 st floor: existinproposed 2nd floor: existing proposed Total new Zoning District lR 19 Flood Plain Groundwater Overlay Ak,> Project Valuation ��_ —Construction Type ,300 Lot Size Al l ACr-yS Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes t No On Old King's Highway: ❑Yes 1� No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Areas ft.( q. ) Basement Unfinished Area (sq.ft) k Number of Baths: Full: existing— new e5 Half: existing 'i new ` Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count 3r Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other .. Central Air: MYes ❑ No Fireplaces: Existing_ New Existing wood/coal sfove: ❑Yes J to Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage:6Q existing ❑ new siz Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION r (BUILDER OR HOMEOWNER) _. Name ACC AM W% Telephone Number 150 113 5,44 6 1 y Address X5- C&(W-t h,5k- 'D-R License # CS ` 05 0 181- A400 IN ��/Lv�4 Home Improvement Contractor# Email 61603:1Z6(�0 @ ya", 64wi. Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t SIGNATURE DATE �� FOR,OFFICIAL USE ONLY APPLICATION# I -DATE ISSUED MAP/PARCEL NO. c ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I' fPLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. : � ffFri Na= l . 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Tf [No wori�is't�nip_ tofe mpficidger�fQ IQafrepairs Eagu a=E!reqoired,_I-I c_15Z§1(4)sandv;,el7nmm-t} ffirc �� -[NCFworss' �'�. camp_msirmce require3 '"fuay aPISxxnt i�at checks bay rl act alw SIl ont t�section beTm-Pshnc�g iiiea wo��''mam�sstiau Hamecwn�s u�r,�ct�3vs s�d�:;� .g fey:.�Tram�=II�^=r r�h�*e autri�cox�e._rmss�si mh�it a s��zn�d.•zit m^�_sorb_ . .Co-n„�,�„-c Ynsi check this b�c mast st�chesE sa zn�tifi n„s7 sneeY shv�thn na�a of ffi= �mdslslz uhetuer ornnL�anse fi�xsT�.-� Emyiu '- if the saII{nUadas I=.Vf v ploy, m-7 Est pmvi3r tLmr wurh�romp.P�m=be lam =emFzzjy--r fhrrtis prfrtiEug f1rarkers'rompg r :ns 4ra-a=far nzy empLaygsr. Below is fhe pmzic}amd job aria ir,�orxxmric�{r� Iasuc rn Companym=b FIoE.cy#ar Self ins_Lic )Eg atiDn date= Job Sif--Aiidkss Attz Ta acopy of tn-WGI-kcm'wncpensaf=palicy ded-Arstiuu page- the policy nuurher sod ccpi mtic) te�: Faaum to Secfsson'_SA oEMOL c ISM.caa lmd to the mpositinm.ofcamiTTA pees of$ up to da_�Q andlor and yearim} as�veJ1 as c pe4a16 - fiie f6=of a STOP WORK OID�and a E an of. frz �.50.00 a d.sy agaim tine violator- lie advised fast a cngg of ffiis cf�rfPrn�,t may ceded tu'fht OfTnrt'"of LICeEfS�tiomofffieDZA for insc „ cumtEage c-xtirm . Ida hgn-V crx fp ruuYzr s Ad)?anah§k ufpejiuy fhatfhe k armation prM6&Zufxirre=is b-.W'c mat carroct SiEaatx� 33aEe 2,0/ — Q cisr£ cx�c D "t irr�in fkzs urecr�to ba cmV-eW by city ar ftrml tF�czn£ : City-or To-eeu 1F TceQse#. - Iss�n�r��afhazit�{mzIc aue�: , •: - L Board.-flead 2.. Iai gDtpm7tia.�ut 3.t fd�Q�rtQc�T ��FettricalInsge�tor .Pf�tbm h-Tctor -6.Gkher Wassad=dts.Geral Laws chapter L5 zegoaes a.0=Mlapeas to provide work-Ls'crimpe=atian far t$eir bPIoyees Pmso— 1n this s ,an mTlaye-is defied as Pegon in tht se-vice of anof�ea imd�airy coact of7ii ; express m iz plies dial orwrittm.-" . An anprgye7 m&5aed as aan individual,padna2*,association,ca�Md±ion Dr oilier legal eaifrfy,or aDy two or mare of$e fnregnmg¢rgaged m a joint enterprise,and including the legal repmsmtatives of a deceased cmplcyer,-or the' receivtt or tr o skee of an ind'rgidiml,parbncEshm,association•or other legal entity,employing employee;- However the hanse ha not more than time artments and who resides therein, or the occupant of the c o a dwe aP own z f llmg � • dwelling,hottse`of another who employs peasons to do roam Penance, constructioa.or repair work on such aweliing house or:m the grounds or buadmg appmtenaatthereto Shi Rnotbecause ofMC:h employmPn be deemed to be-an employer." MGL chapter 15� §25C(6)also stems th; 'every state or IDca.l llmnsmg agency,shall withhold the issuance or maewal of a license or permit to upetate a bnsiness or to construct buildings ha the camm.on calth for any applicant who has not produced acceptable evidence of coinplian.ce with the msm-ancz.coverage regrx red. Ad tionally, MaL chapter 152,§25g7)staffs`Neithm-the commonwealth nor any of its political subdivisions shall en,!r into any contract for the pe kimance of public Workvni:il acceptable evidence of compliance with the i���nce requrement S of this chapter have beet presented to the contracting ant ority A-PP.lica.nts . Please Ell out the wo2kers' compensation affidavit completely,by checloagthe boxes that apply to ycLr situziion and,if necessary,supply sub--contractor(s)name(s), addresses) and phone nu ber(s)along with elicit cer��n {s)of insurance Limited Liability Companies(LLC)or Lnni(rd.Liabi7ity Partnerships(IJ P)w�thDo employes other tban he rmembers or partners,are notrequu�"to carry workers' compensation inmra ca_ If an LLC or LLP does have employees;apolicy is requu�ed- Beadvisedthatthis affidavitmaybe submitted the Department o=Indus�al Accidents for contsmation of ID- ra ce Coverage Also'be sure to sign and date the at=1i davit The annda)at should be retuned to the city or tmim that the application for,the pezmit.or license is being requested,dot the DepalIMEnt of Industrial'Accidents. Should you have any questions r g T the law or if you a_re required to obtain a vrorkers' compensation poli_y,please call the Department at the nm aber listed below. Self-in red companies should enter their self-ii=mce license number on the appropriate Hue. City or Town Officials Please be sure thattlae azidavh is completb andpriated leglly. The Deparhnenthas provided a space at the bottom of the affidavit for you in flu out is the.event the Office ofln�sti Dns has tD contact you regarding�e applicant Please be sure to fM in the pevnitllieense nwnber which will be used as en.a referce number. In addidoa-an applicant that must sabmit multiple pemritllimnse applications in any given year,need'only submif one affidavit indicating ctnrent policy information(ifnecessary)and under"Job Sian Addmss'the applicant should write all locations in (city or town)."A copy of the affidavit that has beta officially stamped or marked by the city or town may be pro ti2ded o the- applicant as proof that a valid affidavit is as file fur futin-e permits or licenses A new aidavit must be Wiled oit each year Where a home owner.or citizen is obtaining a license or permit not related tD any business or commercial venhjre (i_e, a dog license or permit to bum leaves etc;)said person is NOT rt-- i to romplet!�this affida.�nt 'lie Office of Iuvi sti moons wPuld like to trunk you in advance foryoui cooperation and should You have any questions please aD not hesitate tr give ns a caIL. 74e D eparhnent s address,telephone'and fax number ` ' Tli�•�oihafMassachiLs� .. ..DqnTt=at of Ifichnftial.AQaideoats Din;Ilk&t11 Tel.i!:L 617, 7-4,90(�Xt 4mYG w.1`4 .M Revised . 24-J7. . THE rq, Town of Barnstable + Regulatory Services ' 33AMSTAsY Richard V.Scali,Director 16 19. `�� Building Division i 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 ThisSection If Using A Builder I, Cyr--L-, 4 ol,re,, ,as Owner of the subject property hereby authorize { � ; ,q-��� ,�r/; 11UiA&rl J to act on may behalf, in all matters relative to work authorized by this building permit application for. I i (Address of Job) j Pool fences and alarms are the responsibility of the applicant. Pools i are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. r Signature of Owner Signature of Applicant I ALA AOg\,' W l Cat.l' AV e - Print Name' Print Name D ate Q:FORMS:OPINERPERMISSIOI\TPOOIS Town of Barnstable Regulatory Services Richard'_ScaIi,Director Building Division f F ' rt rt F p xaasTsSL 8 Tom Perry, Commissioner i639 ,� 200 Main Street, Hyannis,MA 02601 gEn 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: cityhown 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 oa 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"homeownee'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 ofBarnstable 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 EREN.MON 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,RuIes&ReguIations 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 Iicensed 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. QAWPF=\FORMS\building per nk fonns\EXPRESS.doc Kevised 061313 I ,13ssac,luserTs Deoa'T.'nent aoc Sa3=, , r 3cary C„n%tru%:a.,n supers 3.,,r CS-050182 4 4 ALLAN B WILLIAMSON 25 CORRINE DR E FALMOUTH MA 02536 • E. t ° -- r s ,. 07/26/2016 f l ` Office of Consumer Affairs&Business Regulation =�___' HOME IMPROVEMENT CONTRACTOR Registration: 112161 Type: Expiration:. 3/12/2015 DBA z, , WILLIAMiSON CONSTRUCTION ALLA N WILLIAMSON I 25 CORRINE DR E FALMOUTH,MA 02536 Undersecretary- r i I OffiCjia' et�yw Affairs&Business Regnls►tion OAAEtlMPROVEMENT CONTRACTOR ` egt6watlOAV. 112161 Type: C q; VX2015 DBA wluarr+so�rcic i AUAN WiLLIAMSON' i 25 CORR?NEc E FALMOUTFI,IWA Vadenceretary {+ ,icense registration valid for iodivldul use only I.before tb"U.:' pi ration date• if found return to: Office of lgonn merAffaisrs and Business I�egislatpn . 10 Park P> za-Suite 5170 Boston,Will 02116 Not valid with t signature h INFORMATION PAGE INSURANCE 175 Berkeley Street Boston,MAM116 Issued by LM INSURANCE CORPORATION 27243 Policy Number WC5-31S-382437-014 Issuing Office 016C RENEWAL OF: WC5-31S-382437-013 Issue Date 09-25-14 Account Number 1-382437 Sub Account 0000 1. Insured and Mailing'Address ALLAN WILLIAMSON DBA WILLIAMSON CONSTRUCTION 25 CORRINE DR RISK ID 000935788 EAST FALMOUTH,MA 02536 Status 01 — INDIVIDUAL Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE ?. Policy Period: The Policy y period is from 1 —0 01-2014 to 1 — Insured's mailing address. 0 01-2015 12:01 A.M. standard time at the 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA I B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100, 000 each accident Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMAuals of Rules, Classifications, Rates and TION PAGE Premium: The premium for this policy will be determined by our Man Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per$100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration See Extension of Information Page Premium nimum Premium $ 500 �nium will be billed ANNUAL (MA) Total Estimated Annual Premium $ 780 )ducer 0004-156933 l MRAY & MACDONALD INSURANCE AGENCY IC 0 MACARTHUR BLVD 'URNS MA 02532 i 00 00 01 A ©1987 National Council on Compensation Insurance,lnc. 07/01/2011 All Rights Reserved WC 00 00 01 B (NJ) Page 1 of 1 i insurea copy .�' FP - _ _ -- - - - - S>��ETE TORS REVIEWED BARNSTABLE BUILDING DEPT. DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REOUIRED FOR PERMITING = sl �� • 319�i1SydJ°ii iVii,UJ. .._S5-n�iBo�eale A �I CA < A CO GL fa r.._-.___.._.._._..___....____.. _1.:tee.:._._.._.___.__.. ..........._.... •,.. �' ..�.. ..... . ._. . t_ .___-__.__.__._.-.._.... _.___.. ._.._.............. __.--... 2_.._...______...___....._._......_._._.__._. c�•1'I•IS • ..rs�/Y.91.Zcot�.��Y.b I .' I I I HI Ld IL 7 '�_— aY'....1^'. _ ..' •-' BxiccraN��.sxa¢ ._ _... -_.__ .v xY�,wk4�L_ _.�IrC26Ay .0 'GPo� - •poi�t L-�.t�..�—J�_ _...... 1—I �'i'A�MJ�s, ry� 3. S Cd • co Lt+, �uwl /6J U(VC•�SfieU ��I q ;4 uF BLE "99 'UN_' � OIVidOfa r 3 tea$ � pmpo B� y - w �G.OSG ........... ._ I x22 w, I �f Y 4q-o ABLE 0 AN 3 b o S ��N I x C7 i TOWN OF BARNSTABLE Permit No. 24092 I Building Inspector cashSam ,.,0. X, OCCUPANCY PERMIT Bond _ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Casey Homes Address� Lot #49, 55 Me'.bourne 'R®ad, W-. Hyannisport;' Wiring Inspector y` ' ✓'1 - Inspection date Plumbing mspectoil' Inspection date Gras Inspector vW! Inspection date n _ ✓an. .tart-f (e'.' !r 1_6 -<!r X Engineering Department °_ Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. �. ............ Building Inspector `4 Tr L / fir:af'r txYtµdw� ky N. c � a ;r s � ,� � ' /�/ /j � t '• � u are �,�k�� 3 r / p ` / f t K Y y Ir elw v t " s tP•`JS.,. Y ,Y IAJ �µtN OF M ^, t r~ r4 r x a EARN T I k { /sTE ' o CERTIFIED PLOT PLAN / y , r _ MAS S � pp J�� .�^ rr /� /'� r 7 �f J ME G I3JUfq NF i_1 I. R. J.B :v O�HEARN, INC., CERTIFY THAT THE U; �, 1�$HOWN ON THIS PLAN HAS BEEN 1348 ROUTE 13.4 Y , LOCATED ON THE GROUND AS INDICATED. EAST DENNIS , MASS. DATE S � SCALE "= 3O�;xf j J OR.: N 0. -?2 - 4.S CLIENT rj S e v ATE' ' EG L`A D SURVEYOR DR BY'; SHEET _ OF •- '' fs s'or's map and lot number ......d..g y/..,.:,&t 8EPTIC Sewage Permit number Q.. a .....:...... IIY �'A�E SYSTEM MUST BE d . ....................... �� CO MPLIANCE Z BABASTABLE, i 1 House number ........................ ........................... a/�/IT MAGM ....... � � H TITLE 5 0, 039. "ENTAL COD IVD A'Eow>,ra TOWN OFj;''BARNS BUILDING INSPECTOR APPLICATION i APPLICATION FOR PERMIT TO - .. ......... .. TYPE OF CONSTRUCTION .................... ..�f;i5 . .......................................................................................... a ......................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ��LLapplies ppfor a permit according to the following information: Location ................f�o.l......./..../.............."(.. J�. 2�'l.e......9 (9 0- ............................................................... Proposed Use .............. .e-S / deet.�e.q .t—.Ozzf:: . �?'ll.l. ...... Zoning F,!.g. Fire District �/ �f'�'/�!�'� g District ................ ................................. ........... . ..... . ....... .......................................... 3 0� ay s�Name of Owner ......C&sr.y........ ........Address .. ................ Name of Builder. .......C(' �.Y..... © ............Address ..... .. . S ..Name of Architect ..................................................................Address .................................................................................... ...........................Foundation ..........."�[C° e Number of Rooms ..............�1.�........:. � .................�............................................ c/cp,.p 60 ��'++�al�,�Sgn l� .s��� s Exterior ............... T ...... .fL................Sr..................l...f.....�Roofing .......... ,�-.,�f.... .! .................. ./...................... Floors �. /a-. ......:..................:...............................Interior ...............(/ZlReAmom.q...:.�`!/ Heating lT --5' ......Plumbing l 0 .......................... ...................................... w...................................................... .. Fireplace ............©.t?..' ...............................:.....................Approximate Cost .........4, 0 O !? ............. .,................... . ..... � Definitive Plan Approved by Planning Board -----------______-----------19________. Area ......1../..9.z.....5:........... Diagram of Lot and Building with Dimensions Fee B-- ............. . SUBJECT TO APPROVAL OF BOARD OF HEALTH Q40 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ................. ................ .... ... ........ . ... .. .... CASEY HOMES N" One Story ... One for .................................... S .....9.............. Location #49 55 Melbourne Rd. ... .................................................. annis ..... .............. Owner .....q�k§.qy..Homes................................. Type of Construction ........................... .......... ....................,:Plot ........................... ......... ........ Lot ................................. June 1,, - 82 Permit Granted ........................................19 Date of In heiUA4':"�-; .F .....................19 41 eted 19 Date Comp o,� Assessor's map and lot number .......................... TN E TOE Se kA2 7/ wage Permit number ......... ................................. 33AR39TAXE House number ........................................................ MASIL O 1639. a Mix TOWN OF = BARNSTABLE BUILDING INSPECTOR 4r APPLICATION FOR PERMIT TO Z-.A/ ......... ............ TYPEOF CONSTRUCTION ..................................................................................................................................... ............ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ................/.0.7' /' / e-/-/0 q ,-- -1 C rl, C:) 'I d ................................................................................................................................................................ ...................................................... Proposed Use ................................................... ............. ...... Zoning District ................!E.di..........................................Fire District .......... ................................................... Name of Owner ...... ....... .........Address ....30,y.k9.'1?....................1�101411-f ................................. Name of Builde'r' . ...................................................Address ............................................ ........................................ Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ............. �.2<.......................................Foundation ...... ........................................... ... .... .. . . ... ... ... ..... SA�zlol........7Z. ............Exierior ........ .......................................CI .. .......... 1 .... ................. V Floors ............ 7/a e/.e rt%.... .... .... ...................................Interior ............................. ..../�............I................ Heating ........ 6L.-51............ Plumbing ...........T41-.0........................................................... .... .... ............................................. ......... ... Fireplace ............ ......................................................Approximate Cost ....... ............................. Definitive Plan Approved by Planning Board --------------------------------19--------- Area ....../..../.17 s I- . ..... .................... Diagram of Lot and Building with Dimensions Fee .......... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ZName ...... ..................................... ................. T CASEY HOMES A� �Y 7 a No .?4092 permit for .One„ StoFy I Single Family„Dwelling............. Location Lot #4 9 55 Melbourne Rd. ................................................ West Hyannisport ................................................................................ Owner C.asey. ...Homes ... .... ..... ............ ............................. Type of Construction Frame Plot ............................. Lot ................................ Permit Granted .....,,June 1, ......... 19 82 ........... Date of Inspection ....................................19 Date Completed ............I...:.....................19 �Y Mgr too d/� Assessors map and lot number `,�` �o�T e roe Q�Sewage ,Permit number .. ,./,t .... .�. .. ....' O ro'" �°► Svs' . e 13AUSSTL UL i House number .....................:................................. ............... +� a 163q• \� TOWN OF 'BARNSTABLE BUILDING , INSPECTOR APPLICATION. FOR. PERMIT TO .`....... ...... f................................................... TYPE OF CONSTRUCTION qr ................9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............ .........YI .:+� .t71]>�{� ...... —'.:.........�)�•... .. i+'to .......................... ProposedUse ......... a IZ�.4.4.............................................................................:................................................................. Zoning District .................. .........................................Fire District ..... . ....................... ...................... ... R1 Name of Owner ........................... ..................9 6...................Address .�4?�.....�t�lr..�fl.�v �....��r.�....... WA6f�8t�/ Name of Builder' .HP. .J!:w�.W4-4.r...���.�...Address ..�-�.��.:4.4j. r.. emo, r��.�..�{�N���4':��......./ Name of Architect ........:&IA........:................................ .....Address .�h...:.................................................................. Number of Rooms .................1-J .......................................Foundation 4 Exlerior ........Roofing ..........�a..`�� 1 %lC�.f ...... i3 .................. Floors ............... .....................Interior ................. � Heatin ....................................................Plumbing ........................... ............................................ Fireplace ............................./}JG..�..........................................Approximate Cost .................... .z ... .-......................... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ......l.Z.v. .................... g g Dimensions Diagram of Lot and Building with Dime / i 'Fee. ............ ./..�.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding the above construction. f ' Name. . ........... QQQ l�l0 / SANSONE, LED 1 6 45552 � No................... Permit for ADDIT................10............... ,; Singlei. Family Dwelling V............... 1 Location 55 Melbourne Road .. ............................................................... West Hvannisi�ort .............................................sport Owner Leo...Sansone.................................... Typi.6f Construction ......Frame .................................... A ................................................................................ Plot .................... Lot .............................. ............... Perimit,"Granted . 19 83 Date of Inspection ........................... ......19 Date Completed .......19 Assessac;s map and lot number —w Sewage Permit number I �:�r.,�. SS BARNSTABLE i House number '�"S � I<�l s MM'a CFO Y0.Y a` TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........�ti...�a 1. 12-L1.... ........ —f .................................................. TYPEOF CONSTRUCTION ....................... ..l.................................................................................................... .....................� / ...............I9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby app�liiess� for a permit according to the following information: Location ............5�,�'............1v.:1�L ,C11�. ...... :..........//1),t... NI ? !Lr' ........................... Proposed Use ....... ..... ............................................................................................................................................... Zoning- District ................. .?—Az.........................................Fire District ..... . ............................................................ Name of Owner ..L ......... 1D�l.lrr:...................Address .c��'�..���t.�� Z<..?� tis� ... .....�'v:.../Y.�(flsrit/i��p�f r / Name of Builder' ..... .,F.. .,..Address .... �V(Vxt. ....... Nameof Architect ...........!!YJ.A..............................................Address ......................:.............................................. Number of Rooms ................. J/4 Foundation .......... Exterior .............N.L. .................G..........................................Roofing ..........�� ��'!!` L . ....... 1 . Floors .............. s'r `.:... ! .1 ` . ...................Interior .................M ............................................................ Heating ..................... .................................................Plumbing ............................'.::'..!•.:�`f............................................ Fireplace ..........................`..Al../I.:........................................Approximate Cost ......................l� �. Definitive Plan Approved by Planning Board ------------------ - .......... Kt - -------1 9--------. Area ................... Diagram of Lot and Building with Dimensions f Fee .............1. .✓.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i' VP/1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name. .... SANSONE, LEO A=268-247 No"V25552.. Permit for .ADDI.TI.ON Single Family Dwelling TT�....... ..... ........................ Location 55 Melbourne Road ................................................ West Hvannisport..................... Owner ..Leo Sansone Type of Construction Frame Plot ............................ Lot ................................ Permit Granted ..Sept. 19 , 19 8 3 Date of Inspection ....................................19 Date Completed ......................................19 d r G. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division "Date Issued Conservation Division Application Fee ... Plannin9 Fee Dept'. Permit F Date fin a e Definitive iti ve Plan Approved b PlanningB pp Y Board Historic = OKH _ Preservation/ Hyannis Project Street Address J�j? /l kCg14_V z-- Village f C14/V///-� Owner ��,cJ ��'���:a,��- Address Telephone 6U 7 Permit Request C oY1 Square feet: 1 st floor: existing Zd4roposed -2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,A Two Family ❑ Multi-Family (# units) 1q r Age of Existing Structure ! Historic House: ❑Yes ❑ No On Old King's Highway . 0 Yes'- ❑ No Basement Type: YFull ❑ 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 ount Heat Type and Fuel: � Gas ❑Oil ❑ Electric ❑Other e l� Central Air: A Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:;dexisting ❑ 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 APPLICANT INFORMATION /' (BUILDER OR HOMEOWNER) Nam c. iC����-` �ww � e Telephone Number 1A Z'7 lot'-3 Z-25 Address�� /le` ��G/r�o�� /Lo,� License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z FOR OFFICIAL USE ONLY - a APPLICATION# 4 DATE ISSUED 'R MAP/PARCEL NO. E ADDRESS VILLAGE OWNER DATE OF INSPECTION: } FOUNDATION :FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. S Ff�a The Commonwealth of Massachusetts Department of Industrial 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 Legibly Name(Business/Organization/Individual): 5� �1.'j-�l Address: City/State/Zip: Phone.#: C7Z(P� Are you an employer? Check the appropriate box: 'Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. 0 New construction employees(full and/or part-tim.e).* have hired the sub-contractors 2. listed on the-attached sheet. T. ]i'Itemodeling Cl I am a solepmprietor or'partner ship and have no employees These sub-contractors have 8.'Q Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'.comp.-insurance comp• tnsurance.t equiam a red.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3 E I homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs 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. 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 subcontractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers"Comp ensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 tip 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 certi enaltles of perjury that the information provided above is tru and correct Si afore: Data: Phone#: Official use only. Do not rite in this area, tb 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 Insttuctions 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-conti:actor(s)name(s),�address(es)and.phone number(s) along with their certificates)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 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 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: The Commonwealth of Massachusetts '. Department of Industrial Accidents Office of Iuvestigatims. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass..gov/dia 1f I Town of Barnstable o Regulatory Services ` Thomas F.Geiler,Director M IMMMBLE, ` MA & 9�A 1639• ,�� Building Division rEv �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 f Please Print DATE: 10B LOCATION: C=�494 �✓ ����� number r�� ,� street A / village "HOMEOWNER": SL- & C e �74 Ir/ 1�17- �X - 2— 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 ocPd d requirements and that he/she will comply with said procedures and requir e 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:IWPFILESTORM SVromeexempt.DOC Town of Barnstable Regulatory Services. saM MAM Thomas F. Geiler,Director nulls. n µ;+► � 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 l If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O W N E RPERM IS S ION Above-Grade Building Sketch Borrower/Client McGlame; Sean&Stacey Pioperty Address 55 Melbourne Road Cily West H annis ort County Barnstable State MA Zip Code 02672 Lender North American Mortgage Company Dimensions are Approximate Rooms are not to Scale 12.0' 10.0' Bath \\ Dining Bedroom Bath Kitchen Area \\ \ --�— 24.0' 28.0' Living Room \ Bedroom Bedroom 14.0' 20.0' 24.0' k A (10 M E i b U ,Li i r E I � t M3 7 v N __ Above-Grade Building Sketch - Borrower/Client McGlame Sean&Stace .ProNoy Address 55 Melboume Road West th ad ort L Cou Bamstable State MA Zip Code 02672 Lender North Amemerican Mort a e Com an r Dimensions are Approximate Rooms are not to Scale 12.0' 10.0': Bath Dining \\ Bedroom Bath Kitchen Area 28.0' S 24.0' Living Room Bedroom Bedroom 14.0' 20.0' 24.0'