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HomeMy WebLinkAbout0048 OAK HILL ROAD i ya o - Rd, i it \ a \. a �� I I 1 �y I BUILDING DEPT. Application number • MAR 16 2020 Fee .............................................................................. MASS TOWN OF BARNSTABLE Building Inspectors Initials.......4�71.1`°' ............ Date Issued.....3...... .! . 11..4. ...................... —,0$S Map/Parcel.....:; ................................................... TOWN OF BARNSTABLE SCANNED EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION MAR l / 2010 PROPERTY INFORMATION Address of Project: NUM ER STREET VILLAGE Owner's Name: L()t Z ORi I\N f\ GD E LNcD Phone Number 508 -400- ��`'6 Email Address: I eI o n85C(1pc. �_Inc,+rncai t-rom Cell Phone Number 50'�- 1400 71a 53 Project cost $ o<,ar7 cam; Check one Residential �'' Commercial OWNER'S AUTHORIZATION . As owner of the above property I hereby authorize to make application for building permit in accordance th 780 CMR Owner Signature: G Date: 0 2) i 6 I ILO TYPE OF WORK M Siding Windows (no header change) # Doors (no header change)# EDInsulation/Weatherization E-1 Roof(not applying more than 1 layer of shingles) Commercial Doors require an inspector's review Construction Debris will be going to © Certificate of occupancy with no construction(complete below) Occupant/family relationship or business name or Existing amnesty apartment(attach a copy of recorded comprehensive permit) CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # i J (attach copy) . Construction Supervisor's License,# "(attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD'OR/F THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ............................................................ f *For Tents'Only* Date Tent(s)will be erected Removed on "`� ¢ number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. 1��T*Z'se of Event .- ` Check;one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. R If food is being served at your event please obtain a Health Department approval between the hours of 8:00am- -9:30 am or 3:30 pm 4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES * Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side o HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: 2 L//2 / C� c-D Telephone Number ,5 cJ — c� �',�, Cell or Work number 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. Signature Date APPLICANT'S SIGNATURE Signature f /� G Date —A; O All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department.of Industrial Accidents -' Office of Investigations V 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): /`Z IY2. C z .t-,- cp Address: y2 �D /a 1cs/ U I l C R C( l 11 / 7 e9 el City/State/Zip: Phone#:,�y3- qD o 7 'S S �3 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.tQ I am a homeowner doing all work officers have exercised their I LE]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. i 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 workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: _ Expiration Date: Job Site Address: 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 penalties of perj ty that the information provided above is true and correct. Si ature: Date: - A/a - v Phone#• n Official use only. Do not write in this area,to be completed by city or town off ciaL 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 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-contractor(s)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 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 Offlee of Investigations 600 Washington.Street Roston,MA 02111 Tel.#617-727-4900 ext 446 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable *Permit#c200 G 6,31 ITExpire 6 moni/is from issue date Regulatory Services Fee SEP 2 5 2007 Thomas F.Geiler,Director TOWN OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number r. O Property Address L/. !� 0 � ,4- N 1-1 � 2 aResidential Value of Work L d O Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address L- V I r 2 M, C 0 (- O oA L4 �` 2Z l� Contractor's Name Telephone Number 5 7� 77s-5Y S_S-- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor .�I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. J4t�; SIGNATURE: C Q:Forms:expmtrg Revise061306 1 The Commonwealth of Massachusetts ~' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.m ass.gov/dza Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):. CL4 i •Address: q L Q City/State/Zip: 14 Zv S �Phone.#: S o& 7 7 5 ' S Are you an employer? Check the appropriate box: -Type of project(required) 1.❑ I am a employer with 4. ❑ I am a general contractor and I . employees(full and/or part_time). have hired the sub-contractors 6. ❑New construction . 2.El am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• 0 Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition co [No workers' comp. insurance mP• 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 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.] , *tiny applicant tbat 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. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot 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 Whe 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 penaltirs 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 Iuvesti. ations of the DIA for insurance covers a verification. I do hereby ce fy:ender the pains-and penalties of perjury that the information provided above is true and correct: Sure;ien at C Date: Phone#: U (� 7 15 / S� Official use only. Do not write 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 CIerk 4, Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable PROF tliE r�ti o� Regulatory Services * BARNSfABLE, = Thomas F.Geiler,Director 9 MASS. �A 1639• Building Division lEo �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 LDA / Q /! ATION: -7 O �"'' 17 If 1 I'I /i9 �I//✓ /r` number ^ ,y� street village OWNER": Z �// -C I eocLbo .S -O� " y O O 7name home phone# work phone# NT MAILING ADDRESS: / C) 0 ,A 14 t r L L R city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and. quir ments. , Sig e of owner " Approval of Building Official PP g 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:forrnr s:homeexempt Town of Barnstable P 1' Regulatory Services 0sn MASAS. Thomas F.Geiler,Director E16 9. a��� Building Division Peter F.DiMatteo,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 D� PERMIT# (0'3 13 FEE: $ 4: SHED REGISTRATION 120 square feet or less Location of shed(address) Village COO O % c2/ 1- 6-S^ Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. r , THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN r: Q-forms-shedreg REV:121901 t NOTE:not all symbols will appwf on a mop GOLF COURSE FAIRWAY r vti^n EDGE Of DECIDUOUS TREES -�^ EDGE OF BRUSH ORCHARD OR NURSERY v vv EDGE OF CONIFEROUS TREES �y MARSH AREA —---— EDGE OF WATER DIRT ROAD DRIVEWAY —PARKING LOT _—PAVED ROAD — — - DRAINAGE DfTCH ———�- PATH/TRAIL AP 1 1 PARCEL LINE I J awilo E --MAP# 21 E PARCEL NUMBER #INN —HOUSE NUMBER 2 FOOT CONTOUR LINE --ice— 10 FOOT CONTOUR LINE Elewficm based on NGVD29 X 4.9 SPOT ELEVATION 48 oo STONEWALL -X—X- FENCE RETAININGWALL RAIL ROAD TRACK F STONE JETTY S C 10 F SWIMMING POOL PORCH/DECK [� q BUILDING/STRUCTURE aT F DOCK/PIER d� HYDRANT e VALVE a0 MANHOLE O POST 0" FLAG POLE T Q W N O F B A R N S T A B L E O E O O R A P H 1 C I N F O R M A T I O N S Y S T E M S U N I T ,a SIGN ® STORM LAIN ■ PRNIItflSf a IN FFH *NOTE:This map k on erdarpemeatof e **No-.lire pmael Dres are only g ook representations DATA SOURCES:Planimeni s(man-made features)wore wwpmw from 1995 coal*I%Mpla by The James — 1"=100'soile map and may NOT meet of property boundarks They are not hoe IomHom,and W.Song ay.Topopmpby and wgataft were inkrp Nd from 1989 aerial phoNmphs by GEOD 0 UHUIY POLE ❑ TOWER 0 10 20 Rational Ma Aaamay Standards atthk do not WWI relafiaah to ml ob Mion.Plan ,and were to meet Natal Aca Standards MdgMconservation.dgn 07/05/02 04:13:22 PM 10 rr ly F-7 J1 r4 ,t �. s.:;t��t ',,''j,"p♦. y^s `�, t_sZ�. �Jig JS- t)t Sr. rl q t > -r�;' .J::. •�. 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'tl Jy1>'fl S'i7 t:, ; i. .y` i it 7 The Town of Barnstable Department of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230_ Building Commissioner Home Occupation Registration Date: �lk' Name: `07 Phone#: SO'8-��5- Address: for Village: t/l/N1�S Name of Business: Type of Business: Map/Lot: UZ 7 FJ 0 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 pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires; parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1, the undersigned, have read and agree with the above restrictions for my home occupation I am registering. �+�,, Applicant, Dater Homeoc.doc Town of Barnstable �pp1HE 1pk, Regulatory Services P �p Thomas F.Geiler,Director �'" M MASS.. � Building Division �►ss. iOTE1 39. a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 - Fax: 508-790-6230 COMPLAINUINQUIRY REPORT Date: loa Rec'd by: + r i C•V Complaint Name: L u.ti: COG n Map/Parcel a t4 8 b SS� Location Address: Li Originator Name: L' Y Street: Village: State: Zip: Telephone: Complaint Description: S OA Ctre heSS Q,k, S ^— �1�.Je w stare ro AA `a-�,.a- � C�e 11,OS � 11 e FOR OFFICE USE ONLY Inspector's Action/Comments Date: /���6oZ Inspector: Oa z Z,, Additional Info.Attached Q:forms:complaint Op�7HE.ip , The Town of Barnstable '• BARNSTABLE. Department of Health Safety and Environmental Services 9¢ MASS. Op 639. �0 lfU MPS° Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection \a"en' `- Location '� � (',��C 1 1 t�}�1 . Permit Number v Owner f-'f-, p Builder One notice to remain on job site, one notice on file in Building Department. The following;items need correcting: e- all_ V 10r v Please call: 508-862 4038 for re-inspection. Inspected by {) 4 Na, v - Date 0 K- -)G-0a Town of Barnstable Regulatory Services Thomas F.Geiler,Director 9'" MASS. '� Building Division 039. �0 Atfp Mp•(s Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINT/INQUIRY REPORT Date: o Rec'd by: + A W Complaint Name: L u,i Cp e l Q Map/Parcel Location D `I Address: Originator Name: �Ij Y c. Street: Village: State: Zip: Telephone: Complaint Description: S < mess r i �a.�e `gyp Gt In e C-b t I.n 5 1h�J -� ln0 S ! FOR OFFICE USE ONLY Inspector's Action/Comments Date: GoZ Inspector:_ f Additional Info.Attached ` Q:forms:complaint # — 1 t .f) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel .0 O Permit# � Health Division 09!5uM —71,5199 f e`'''� � Date Issued q- Z Conservation Division % YS 1 10 r t Fee- C� Tax Collector Treasurer �� � w0 • Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis .� Project Street Address Oak 11f Y�,T,�ZA .Village Owner Address Hill Telephone — i l Permit Request $tIuare feet: 1 floor: existing proposed 2nd floor: existing proposed Total new , �.> valuation � .1 p Zoning District Flood Plain Groundwater Overlay S�f'Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single FamilY 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure 6 Historic House: ❑Yes No On Old King's Highway: ❑Yes o 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 f Total Room Count(not includin aths): existing new First Floor Room Count i Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes o Detached garage:;e=stin� e ❑new sizePool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑new size Shed:❑existing ❑new size Other: ��,„ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# SEP 5 2001 Current Use Proposed Use BV BUILDER INFORMATION Name Telephone Number Address License# .ore Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE c.eTeA0 DATE 81151 .101 FOR OFFICIAL USE.ONLY PERMIT NO. DATE ISSUED <; MAP/PARCEL NO. ADDRESS i 'VILLAGE OWNER' DATE OF INSPECTION `: FOUNDATION r t FRAME f INSULATION 7 - FIREPLACE r ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL - " GAS: ROUGH FINAL t 5, FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. f n�'P,oF("E T ~�• The Town of Barnstable BARNSTABLE. MASS. Department of Health Safety and Environmental Services 9 0 �A �679• �0 rFOMA�� Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: �� �— Map/Parcel: v y o Project Address: A � 10 Builder: 0 ' The following items were noted on reviewing: CD::i6kAvo � �w �- C��O-A -n - Ij t 1 - 0 eve l.jC_C Q o CD + U l Z t l Reviewed by: Date: 1 t q:building:forms:review i 1 t � i of __..-__- i � R s t _. 4 v i • I E I i I _ I i F,fME . . .� The Town of Barnstable 9j" MAE& �'$ Regulatory Services iOlED Mp a Thomas F. Geiler, Director _ Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: ;4�1' rbak- Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 [1Build1DZ not owner-occupied g2lw--ner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR / G Date Owner's Name g1orms:Affidav DepartmentofIndustriatACCIaenrs Oiffa.famrasaff-I lous _ 600 Washington Street - - Boston,Mass. 02111 Workers' Com ensation Insurance davitgil: s e: a ovation: - QA.. 5 ohone# ci I am a homeowner performing all work myseii: ❑ I am a sole VrOTMetar and have no one worldn in anv workers' enudon for my come ;::}.,.,..::.:},.:::::::::::.:::.:::::.:::......:.:.::..: :'.: :.:.:'..::.;:.::.::.:.::.:. emP........... .:::.::::.:..........,::::........:.::.:...................-.:.. .: .............:.:::..:...-...:.::..-....:......... ................. ......... ....................... ..:.,.... 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As quoted from the "law",an employee is•defined as every person in the service of another under any co= of hire, express or implied, oral or written. An employe r is defined\as`an.individual,partnership, associztion, corporation or other legal entity, or any two or more the foregoing engaged in a jointt enterprise, and including the legal representatives of a deceased employer, or the recen" 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,. r the occupant of the dwelling house of another who employs persons to do maintenance, conduction or repair work on such dwelling house or on the graunii building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or ren of a license''or permit to operate a business or to construct buildings in the commonwealth for any applicant who not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work.um acceptable evidence of compliance with the insurance" ,.�requireln of this chapter have been presented to the contractiz authority. ` Applicants 5 situation and Please fill is the workers' compensation affidavit'coanplecely,by checlang tie box that'applies to your names,address and numi ers salon wrth;a certificate of insurance as all affidavits may b e supplyingcompany p _ subs to the Department of Industrial Accidents for co�atian of iasnrerice co era8e.'. Also be sure to sign,anc, date the affidavit. The affidavit should be returned to the city-bitownthat tlie;applicatiaa,for the pernrit or license Is b ,per' not the Departtnem of Industrial Accidents: S aid you l*tea:,my'qu oar wg regardtng.the"law.'."or if u� , . are requited to obtain a a&uz' pensation policy,please call the Deparmcm at the number li;.;ted belo1w.. City or Towns Please be sere that the'affidavit is complete and printed legibly. The Departr 4ca has provided a space at the 6ttom,of affidavit for you to fill out in the event the Office of _ has to contact you regt&g the applicant.cant. be sure to f M in the peimit/license number which will be used as a reference.nn1 ier. The affidavits may be retinnFh is the Depar=cat by mail or FAX unless.odd arrangements have been made. :M� 'ons would ire to thank u is advance for you cooperation aril should you have any giresttons The Office of Investigatr you > , please do not hesitate to give us a'eaEL The Departure is address,telephone and fax number. The Commonwealth'.Of Massachusetts Department of Industrial Accidents Ofilce of lavadvadons 600 Washington Street Boston,Ma. 02111 .tar*: (617) 727-7749 phone.#: (617) 727-4900 eat. 406, 409 or 375 ' - - - , STANDARD LEGEND A 8 �NOTE:not all symbols will appear on a map _I t GOLF COURSE FAIRWAY g �o EDGE OF DECIDUOUS TREES # 2 EDGE OF BRUSH r i ORCHARD OR NURSERY V-V-7-V EDGE OF CONIFEROUS TREES > MARSH AREA EDGE OF WATER DIRT ROAD DRIVEWAY F—PARKING LOT PAVED ROAD Mn — - - — DRAINAGE DITCH L - - - - PATH/TRAIL 8 PARCEL LINE MAP MAPIto.4e-MAP# 21 F—PARCEL NUMBER #I060—HOUSE NUMBER 70 # ^ n 2 FOOT CONTOUR LINE 4 VX — 10 FOOT CONTOUR LINE - - -I Elevation based on NGVD29 ;•�4.9 SPOT ELEVATION o0o STONE WALL -X—X- FENCE RETAINING WALL I I I RAIL ROAD TRACK y STONE JETTY J SWIMMING POOL L PORCH/DECK BUILDING/STRUCTURE DOCK/PIER MAP HYDRANT 6 VANE O MANHOLE o ?POST p FLAG POLE T O W N O F B A R N S T A B L E 6 E 0 0 R A P H 1 C 1 N F O R M A 'T -1 O- N S Y S T E M S U N 1 T .o SIGN ® STORM DRAIN a PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James 1"=I"'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTILITY POLE n TOWER we Q �= 2U 40 NafionalMa Accura Standards at this p p physical I p P 9 P Y. 'mD PP P ry P ry do not represent actual relationships s to h ¢al objects Cor orofion. Planimetria,to o ro h and elation were ma ed to meet National Mo Accura Standords LIGHT POLE O ELECTRIC BOX s I INCH=40 FEET* enlarged scale. on the map. at 6 scale of 1"=100'. Parcel lines were digitized from 2000 Town of Barnstable Assessoi s tax maps.