The URL can be used to link to this page

Home My WebLink About0500 OCEAN STREET (14) 13 ('tn4 /g Ll 0 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ® U Permit# /2�(0 " I1esflh 7rVTM - �DIIIA `16 -rawA S&) 6 Date Issued 9 Conservation Division Fee �• �� 1 r0/ Tax Collecto ' !10� >'Treasurer Planning Dept. w r Date Definitive Plan Approved by Planning Board ' Historic OKH Preservation/Hyannis Project Street Add ess S Ay1 Village Owner 561nASGU Address U 161, t? u Telephone :Permit Request M D U6 t%X) 5riwA K1 `Gi,gel +0 2}( ) 1- r—t,,9 6 ce, 567-0 a&&- t, R o a e re ob Afolf 1, cv ' I °�r �Q. U.C: 3,�S iN � �-V cl P U, l • S+,3 Z -I-h®twk4e/ Square feet: 1 st floor: existing proposed 51ML 2nd floor: existing proposed '�kW. Total new Estimated Project Cost rl o 000 Zoning District Flood Plain ?_ Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)�b!' Age of.Existing Structure d Historic House: ❑Yes ulo On Old King's Highway: ❑Yes to Basement Type: ❑Full trawl ❑Walkout ,,❑Other Basement Finished Area(sq.ft.) _ d I /04 Basement Unfinished Area(sq.ft) _ IA Number of Baths: - Full: existing new J Half:existing / . new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas ❑Oil 1ZElectric ' ❑Other Central Air: ❑Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes too Detached garage:❑existing ❑new size NO Pool:0 existing Cl new size N_Barn:❑existing 0 new size No Attached garage:0 existing 0 new size Shed:❑existing '0 new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Olo If yes,site plan review# ' a Current Use �Sl� i` Proposed Use BUILDER INFORMATION Name-- Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ 1 FOR OFFICIAL USE ONLY" - t PERMIT NO.": DATE ISSUED',. MAP/PARCEL'•NO. `; - :~ _ � ' _ + ,. • E ADDRESS ` ;" VILLAGE r OWNER" • � ice. � .�' • ._ A ' � •, =.r+' - .KS e DATE OF INSPECTION': ��,,L , FOUNDATION , - - FRAME a d INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL -+ ` PLUMBING: ROUGH FINAL ? GAS: ROUGH_ FINAL _ FINAL BUILDING) DATE CLOSED OUT ASSOCIATION.PLAN NO. --- _ The Commonwealth: of Massachusetts ........ Department of Industrial Accidents _� Ar Office aflayestigatfgns 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance /////Affidavit MRM name: Y D location: city hone# I am a homeown r performing al work myself. ❑ I am a sole oronrietor and have no one n'orkin in any ca acity %/// %%% % %/%/ / /%/ %%% %////m/c/1;; ;;; ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: address: city: phone#• insurance cn. nolicy# r ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors Iisted below who have the folloning workcrs' compensation polices: companv name: :,:::. .:....... address: city: phone#-.. ..... imurnnce cn. /iii/ % comnanv name: address: phone r-insurance co. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a line of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the O ce of Investigations of the DIA for coverage verification. I do hereby certif• r the paints and pe ies of perjury that the information provided above is truce dhd correct L /q iSigturena Date / 2� ! / i(Print name ' y l A c >o 4174— Phone# �d— ocia!use only do not write in this area to be completed by city or town official ciy or town: permit/license# ❑Building Department C3Licensing Board (Cftn check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (m,jea 9,95 PJAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the?r employees. 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 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 receive: 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 c.r 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 renews: 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and :supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 levestloatloas 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 1ARNSTABLE, • The Town of Barnstable • r r r + 9� Department of Health Safety and Environmental Services '°rECN►o'�° Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: �e4n�(f A-4-7 [lam Estimated CostZb C�'� Address of Work: 0 609_ ll - u ,S 1141 r Owner's Name: r ' L AY=1 L Sd(1 Date of Application: 2 �� I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Fo�er 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 aT for a permit as the agent of the owner: Date Contractor Name Registration No. Da a Owner's Name I q:forms:Affidav Il .. V11A Depar `tth Safety and Environmental.S w m- Building Division ttrtsz�etE. ' 367 Main Street,Hyannis MA 02601 MASS. 9A 039. Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION St ( I Please Print ' DATE: `' 1 JOB LOCATION: ( cw6 s4l V) cJ 1 numb) y t t'i S��-Zw (� 7��et vil �2360,<(J"HOMEOWNER": � I ! name home phone# work phone# CURRENT MAILING ADDRESS: S4 Oki e S city/town Vstite 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 su ervisor. 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 Dep ent minimum inspecti procedures and requirements and that he/she will comply with said pro d requirements. Signature of Homeowner 9 Approval of Building dffificial 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN v VJ ^o goy ®�{' ,z 3 T/ ni s soo "A C�V ws ;.w 2 - 1 Ito w a 'StAZ�ore" �J 1 d� C �� w 5 2� i B boo o ��. Uh I� ( 9 _ oC 1 -v . 3 w 3 , Y, S sc) r. G�� 1 O � 3 I i I e 1 1 S-t S Al 61�10 Oil) ��l I _ 1