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4'OWN,OF BARNSTABLE BUILDING PERMIT APPLICATIQN Q—
Map Parcel 0 DVL Application*
Health Division Date Issued-
Conservation Division Application F.
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address (J #it
Village 14YATJPJI
Owner ^ " ' — `� &`rA 1AA Address
Telephone ?2? 3 7 — 15
Permit Request QMMP< 6 X i_-r7 VOC &LkJ i��-�Z C� C 3
LAJ to
Iqz d6
Square feet: 1 st floor: existing propped 2nd floor: existing proposed Total new
Zoning District ���F166�Mo�dPlain Groundwater Overlay
Froje_ct_V.aluatioq Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes ANo On Old King's Highway: ❑Yes ; to
Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing DlNig E)Ep-r- new
Number of Bedrooms: existing _new nn99��
Total Room Count (not including baths): existing new Firs oor`I��c�rf�Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other TOWN OF BARNSTABLE
Central Air: ❑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: ❑ existing ❑ 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) - --- __
Name Telephone Number
Address PINE kl th% License # �i3W_
T
Home Improvement Contractor# PNW)
Email S4 If f TT_ 116 T NJ L- I_JY \ Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE C '�
i
FOR OFFICIAL USE ONLY
r �
APPLICATION #
DATE ISSUED
MAP/ PARCEL NO.
r .
ADDRESS VILLAGE
4 ,
OWNER
x
r
DATE OF INSPECTION:
t FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
ti ,
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
I
i .77ie Conzrrzarrfweajtls�jf?�rrsstza�tri�ett5
' Depewt ramt cif rndushza1 Accidefr#s
O,fx:e of 1Frz�res*gatiazzs
: . 600 Was, ngtoFa Street
_y Baston,41A.02111
" 1i'fYtf�filtiSS.�FV1�[jl(I
NVark-ers' Cu pensaiianInmmnceAffi aviLB-ni1ders/ContractursIE-le�cEricians/Phmbers
AppUcant Infin-matian p,� j Please Print Le. ily
Na Cghi .X)igarL .fi.T nx} 1�-W"+ .� -C��T�rT, `CJ�►�� �T`7 ���G'a
Address: io tU c `O iti c 2f
CityT/StatP.ljr Yam' ' M lw 24 13 Phom 4wk
Are you an employer?Gheckthe appropriafe bo= Tproject
I general contractor and I �e of r( �����
I.❑ I am a employer-with ❑ am a g ❑6- New coconstructionoctio
employees(full aadlorpart--timed* havelvred.the sub-contractor;
2. am a sole F proprietor ar er- listed onthe attached sheet, �- ❑Ramodeling
Il These sub-contrae-tors have
slip and have no employees. . S. ❑Demolition
wod4ing forme in any capacity employees and hxve worlcere 9. ❑Building additooa
[Na workers'camp.insurance comp.imurance-,
required I 5. ❑ We are a corporation and its 10:❑Electrcal repairs or additions
3 I am.a hnmaowner doing all work
ofcers have exercised tllear 1L Plumbic re airs or additions
.❑ tug ❑ g P
exemption myself,[No w right of ex
workers'camp- � per MGL 17.❑Roafrepairs
insurance required,]Y c.1,52,§1(4h and we have no,
employees.[Na wo&ers' 13.Offier
camp-insurance required.]
'clay appHMt.tbatcbedrsbasflEstalsoffioatthesecffonb9,orw-Jww y,ffiZmwuiRe&camp—safinapoycyinfotmadmL
Ilameosvners vrbo submit they are doing&Uwo*anti d en lme outside contractorsnmst sn1rmit a new affidarst iadicstie6-sash_
fCantractors that rherY This lrox must attached=additional sheet showsag thenameof tbz sub-cnmdras�a•and staEevthethec arnotthose eaddeshave
employees.I€thamff-conlactmshive empIopers,ihe}'mvrtpmuide their workerO-comp.policy number
I am art elnpia#�r t7trrt is prmzdng,nwarkers'catrrgertsrrh'ort ittsrtrarzca far err}*enrploy�ees BeIvav is flee palicy�rrrtd jeb srl�
it Parma om
Insumce Company brmu e:
'Policy 44 or self-ins-Lic-9- ExpirationDate:
Job Site Address_ CitylStafelzip:
Affa-ch a copy of the warkers'coaapensafion.policy declaration page(sh ping the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL m 152 can lead In the imposition,of criminal penalties of a
fine up to$1,500:40 and:!or one-year imprisonment;as well as civil penalties i n the form of a STOP WORK ORDE$and.a fne
of up to$250-00 a day against the violator. Be adiised drat a copy of this statement rnay.be forwarded to the Office of
Itavestrgatiams of the DI, for insutnnce,coverage t'ecification-
Ilira hereby cerdz-nauzr th0 pains arty£ a,fp thatAa info rm at=pro f-i-&d a5a,re is barge acid carrect
Sismature_ Date_ 1 f IMP
phone ik
t,►, cirri use an£y. Dv ttot irate in tlai;'mrea,to be mtnp£eted by tiiy artatrtz officitt
C'ify or Tom n.: PermiUUcense;ff
` Lssuing Autharity(drde one):
L B0 . of Health 2.Bufding Department 3.Cityffown Clerk #Electrical Inspector rr.Phrmbiag Inspector
6.Offie
Contact Person: Phone#:
-- — 6
ormation and Tas e ones : .. ..
Massachusetts General Laws chapter 152 regnaes all empIoyers to provide workers'compensation for their employees.
GYP mlltr t If11 z1,
puxsuantin flits stafnf,,an errrplayr�is defraed as."e erson m the serPice of mother Bader any '
express or-h=HDd,oral or written-"
An Toyer is defined a5_an individual,partamsb�,assDd an,corporation or other legal�ntiiy,or any two or more
of the faregomg engaged m a Joint entergtlse,and inclndmg the legal representatives of a deceased employer,or the
receiver or trustee of as aidiviffiA partn�p,associ CM or other Iegal entity,employing employees. However the
owner of a dwelling horse having not more than three apa dmenfs and who resides therein,or the occBpant of t -
dweIImghorse of another who employs pesons to do mgi:nfM ace,consfruction or repay w°Ik on such(IweIIing house
or on the grounds or building appurbmmat thr-mfo shall not bmanse of such employment be deemed to be an employer."
MCff_cbapinr 152,§25C(6)also states that 5`every stain or local licensing agency shall withhold the issuance or
renewal of a licerzse or permit to operate a business or to constr¢et buildings in the comm onwealth for any
applicant who has not produced acceptable evidence of cdmplianm With the iasurance_coverage required."
Additionally,MCA.chapter 152,§25C(7)states,=Neither the commonwealth nor a'uy ofits political subdivisions shall
inin any contact the perfomancc ofpublic work umf61 acceptable evidence of.compli�ce with.the fi��c6•.
Eatex regrurements of this chapterhav-e been p=cnbedto tiie confractiag anf Daty:'
Applicants � '
- Please fl out the worker'compensation affidavit completely,by checking fie boxes ffA apply to your siination and,if
necessary,supply sub-contractors)name(s), addresses)andphonenrmber(s) alongwiftflitir certifrcate(s)of
;,-mm-a„ce. L=itedLiabi-UY Companies(TLC)or Limited Liabiility-Pa-tac sbrps CLEF)Withno employees other than the
members or pmtam-s,sre not regahzd to cauy woiicers' compensation im ce. ][fan LLC'or LLP does have
employees,apolicy is regnfi-ed. Be advisedtlaat$ris of idayitmaybe submitin;d to the Depa-Lfmmt of Industrial
Accidents for confnmation of Dance coverage. Also he sure to sign and date die affidavit The affidavit should
be retained to$e city or town that the application for the peonit or license is being mquested,not the Deparfinent of
jr�tri111rcide�. �onldyon have any questions regarmg the law or ifyou are regoaed to obtain a workers'
conapensationpolicy,pleasecallthe,Depmta=tat the nUzoberUs�dWOW. Self-ins�nedcompanies should en rthen
self i m ce license m mber on the appropriate;line.
City or Town Of idals
Please be sm-e that the affidavit is complete andprhb-d leghly- The Department has provided a space atthm bottom
of the affidavit for youth fill out inthe event the Office oflnvesfigationns has to cou±MtyoB.regardmgthe agPlicant
P leas e b e sure to f171 in the pe�iYlIicense ntrnber which wiII be used as a reference number. In addition,an applicant -
fa t mu
t must sabmaltiple peaaWHcense applications in.any givenyear,need only submit one affidavit indicating current
policy i :Eb=. ation (if necessary)and Under"Job Site Address"the applicant should write"all locations in (c?tY G1
town):'A copy offhe-affdavitthathas been officially stamped or markedbyfhe city ar t.ownmay be provided to 1ho
fiIe r future e�TC�or licenses_ Anew af�davitmvst be filled OiA each
fo
applicant as proofthat a valid affidavit is o n P
year.There a home owner or citizen is obtzining a license or pcuah not related to any bnsinrss or commerzial ve re
a dog license or permit to bum leaves etc.)saidpersan is NOT reqaled to.complete this affidavit
The Of of lnve'stiggi°ns would like to tlsankyou in advMce for your cooperation and sbouldyoahavc any,gvesfims,
please do not hesitate to give us a call.
The,Deparfinenfa a.dcess,inlephone and faxnUmber: .
'Ih_e CammCmWea�of I�[as�aGhns t#s
Depasfine cif d is � dent
(etc=�ffio
-
1
Revised¢24-07 WW m gwldra- . .
Town of Barnstable
Regulatory Services
` N Richard V. Scab,Director.
►`� Building Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 . Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I � � m�`� i ""� , as Owner of the subject property
hereby authorize S V ( Z to act on my behA F
in all matters relative to work authorized by this building permit application for.
GW
(Address of Job)
**Pool fences and alarm are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
a
Signature of Owner tore of Applicant
Print Name Print Name
Date
QTORMS:OWNEUERMISSIONPOOLS
Town of Barnstable
Regulatory Services ,.
ptrT Richard V.Scali,Director .
Building Division
sARDWABLE, Paul Roma,Building Commissioner
MAS&
1639. 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
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
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 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 c&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 full aware of his/her responsibilities, many communities require,as part of the
Y P
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
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:\WPFILES\FORMS\building permit forms\EXPRESS.doe
06/20/16
i` Massachusetts Department of Public Safet
Board of Building R y
4 ulations and Standards License: CS_1p44
Construction Supervisor•
STEVEN LHETZEL` �,
72 PINE CONE DRf VE
WESTYARMOUjH 7tA¢p2673k
r
Commissioner Expiration:
07/27/26,17
)l �/e �pcvrce�caa�rcuealf�a�C�/l/�iascce�cnteG�i s:
I Office of Consumer Affairs&Business Regulat'ou e,
OME IMPROVEMENT CONTRACTOR Type_.; t
registration: 165119xpiration 1 =i7/2018,
Individual
1STEVEN HETZEL
STEVEN HETZEL t ,
'72 RWE CONE DR t
W.YARMOUTH,MA 02673 Undersecretari r
' t
i
Yachtsman Condominium Trust
Board of Trustees
500 Ocean Street
Hyannis,MA 02601
DATE 9 JQ / t j C
RE: Unit Yachtsman Condominium Trust, 500 Ocean Street,Hyannis
To the Town of Barnstable Building Commissioner,
The Board of Trustees for the Yachtsman Condominium Trust voted and approved the
attached proposal to be performed as is delineated in the request we received from the Unit.
Owners. Contractor, j k _ has been contracted by the Unit
Owner to perform the work as defined in a oposal.
This letter serves as notice of the Board's vote to approve the proposal,which has been noted in
the Minutes of the Board Meeting.
Signed Under the P ' and Penalties of Perjury this I_-3,day ofd'o_ 20/j�.
' Secre
Board of rustees
Yachts Condominium Trust
500 Ocean Street(c/o Manager's Office)
Hyannis, MA 02601
Enc./File ,
0 OKI
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