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0025 OVERLEA ROAD
10'3 drAL— Town of Barnstable, '� er xxsc�ai8 S sum g 200 Main Street,Hyannis,MA Tel.(508)862-4644 f679• �0 ' erfD MA'�e INSPECTION REPORT Permit: Building - New Construction - 1 or 2 family Residential Use: Date: 6/24/2020 3:52 PM Inspector, : barrowsd Permit Number: TB-20-1586 Name: LINSALATA, RALPH & LINDA Address: 25 OVERLEA ROAD, HYANNIS Unit No. Inspection Type Inspection Item Status Comment Building Admin - BA- Copy of Applicant's NIC need license attached Construction License Inspection Overall Comment: Overall Inspection Status: FAILED Re-Inspection Date: t Inspector Signature Owner Signature Total Score: 100 'w Town of Barnstable � RE�CEI PT 0 UA XAn 200 Main Street, Hyannis MA 02601 508-862-4038 ' Ra11 . Application for Building Permit BUILDING DEP r. Application No: TB-20-1586 Date Recieved: 6/24/2020- JUN 2 Job Location: 25 OVERLEA ROAD,HYANNIS 4 ���� T O�yN OF Permit For 8 Building-New Construction- 1 or 2 family Residential A g y RNSTABLE Contractors Name: State Lic. No: Address: Applicant Phone: (508) 771-1040 (Home)Owner's Name: LINSALATA,RALPH& LINDA Phone: (508)771-1040 (Home)Owner's Address: 20 SURREY LANE, WESTON,MA 02493 Work-Description: To raze and replace existing structure with a new 4 bedroom,4.5 bath cape style home Total Value Of Work To Be Performed: $1,000,000.00 Structure Size: 0.00 0.00 16746.00 Width Depth Total Area '&hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing;a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Brian Dacey 6/24/2020 (508)171-1040 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $1,000,000.00 Date Paid Amount Paid € Check#or CC# Pay Type Total Permit Fee: ,$5,225.00 6/24/2020 $5,100.00 XXXX-XXXX-XXXX- Credit Card . ;� 8093 Total Permit Fee Paid: $5,225.00 6/24/2020 $100.00 XXXX-XXXX-XXXX-� Credit Card 8093 6/24/2020 $25.00 XXXX-XXXX-XXXX-i Credit Card } 8093 y d • Q ._ i : g TT _ 777, �. goo rr' o ; 0% go AD v v 107 797 CMD ` ` c Of le 3 v n V x:, V r C�♦ � ,s. ... ..-,. �IM ... .ter rx:'` o,.•: =',♦ +r� _:.r 's >�-'. It Y -a . 7 � .:..w. ..:..... /� -- ;�....� .. .- .' -- •. •:ate v1 s' _ -:t ..rD. - , -�s_._ .. .. .,�_ ..-..r0 .. ,.., re•N1.r 2..;+: .L♦..' �-...... .,. R - _ i 1.: .l+ _ A - :,..> �•. ,•..> ::. :r. .. a _ ..,_�. _.� �. ,_,._. - ...:�.� ,.._ _.,..r :.,. 3 i3y:5�.t1 - .�.na-: y � ti. - n s. �Y 'h N-`fir .. n..ne.+.. ,3r•:.:...�, .....-.. �'_.:-. 3 f �s .. .. m, ...:. ... � -' .a 's 4 er .�i ,�t:. � �...+ba A. < } RESIDENTIAL PROPERTY 4✓ MAP NO.. LOT NO. FIRE DISTRICT STREET H annis Ort SUMMARY 3fXX 41 Overlea Road Y P H j4LAND287 10 OWNER , j �— _ 7 S LAND RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: BLDGS. /r Foley, Joan L. & Mintz, Richard G. (Trs. ) 11/25/68 351 ' 110 I2? B TOTAL —. --&-6c�nstenee'-G-- tens en - -�6- Gti.6 -672 15, LAND 5 ,: 8 O - �- =. 1.35ac BLDGS. Y.. . oran,Robert_F._ & Horan,Constnace C. ,Trs. , TOTAL Over lea R'ty Trust5-4-78 73945 F �� v ;r r LAND n//�r1Y I b /,,� / s 1 2_.1= •-re �� — BLDGS. TOTAL LAND '- TOTAL LAND BLDGS. dt TOTAL LAND BLDGS. TOTAL Subdivided fiscal 79 LAND j INTERIOR INSPECTED: -- - remainder on this lot is 1. 35 rn BLDGS. - —__...\--- I — TOTAL DATE: i 0 --. LAND ACREAGE COMPUTATIONS r_ ,, i BLDGS. LAND TYPE # OF/ACRES PRICE TOTAL D//EPR. VALUE TOTAL HOUSE LOT --- -- /.`� .? ) .' J 7 T// S�� _ , t , 7 7 % LAND CLEARED FRONT .C' _ _� — BLDGS. REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT — TOTAL REAR _ LAND BLDGS. m TOTAL — — ---------- — --- ----- LAND ------- - - BLDGS. LOT COMPUTATIONS LAND FACTORS TOTAL —T__--- —•_ VALUE _ - DEPTH STREET-PRICE DEPTH % FRONT FT. PRICE TOTAL DEPR. COR. INF. LAND FRONT _ — HILLY TOWN SEWER ROUGH TOWN WATER BLDGS. HIGH GRAVEL RD. TOTAL — -- — ---- — LOW DIRT RD. LAND SWAMPY NO RD BLDGS. MASSACHUSETTS QUITCLAIM DEED SHORT FORM (INDIVIDUAL) 881 I, William Lampros, of East Dennis, Massachusetts , formerly of ty�isaul�rseQtsx Andover, Essex County, Massachusetts being unmarried, for consideration paid, and in full consideration of-� �ln� � �dr0�yt aollarsusand-- grant; to of with Vixtlatm -COUtnttn28 thelandin Barnstable, in the County of Barnstable and Commonwealth of Massachusetts , bounded and described as follows : [Description and encumbrances,if any] NORTHEASTERLY by the junction of Scudder Avenue and Overlea -Road, twenty-two and 55/100 (22.95) feet ; NORTHERLY AND NORTHWESTERLY by Overlea Road, two hundred ninety-eight and 64/100 (298.64) feet ; SOUTHWESTERLY by Lot 5 ,. two hundred thirty-six and 27/100 (236.27) feet SOUTHEASTERLY one hundred sixty-three and 30/100 (163. 30) feet ; and NORTHEASTERLY eighty-six and 68/100 (86.68) feet , by land now or formerly of Clara Y. Loughlin; NORTHERLY sixty-six and 40/100 (66.40) feet ; NORTHEASTERLY one hundred seven and 70/100 (107 .70 feet; EASTERLY one hundred two and 69/100 (1,02.69) feet ; and SOUTHEASTERLY one .hundred sixty-seven and 05/100 (167 .05) feet , all by land now or formerly of James B. Laughlin All. of said boundaries are determined by the court to be located as shown on subdivision plan 17308-D dated May !974, drawn by Cape Cod Survey Consultants, Surveyors, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 546, Page 72 with Certificate of Title No. 67672 , and said land is shown thereon as Lot No. 11 . Said land is subject .to the rights granted in an easement given to the Cape & Vineyard Electric Company dated June 13, 1947 being Document No. 20,971. Said land is subject to the rights granted in an easement given to the Cape & Vineyard Electric Company et al dated June 9, 1965 and being Document No. 97 ,197• For title of the grantor. see Certificate of Title No. 74537 dated June 19, 1978, Land Court Case No. 17308, recorded with said Registry of Deeds, Book 603, Page 107. my . hand and seal this u ust iltxnra� day of .........A.... ..................) 19..8... .......................................................................... .......................................................................... f mili.,,(tommlanilur at4 of Ismar11aafts Essex ss. 19 Then personally appeared the above named. William Lampro s his free act and deed before me and acknowledged the foregoing instrument to be .................................................................................. Notary Public—�caQg�cg� g4 My commission expires 19 (*Individual—Joint Tenants—Tenants in Common.) ULAPTER 183 SEC.6 AS AMENDED BY CHAPTER 497 OF 1969 Every deed presented for record shall contain or have endorsed upon it the full name,residence and post office address of the grantee and a recital of the amount of the full consideration thereof in dollars or the nature of the/other consideration therefor, if not delivered for a specific monetary sum.The full consideration shall mean the total price for the codveyance without deduction for any liens or encumbrances assumed by the grantee or remaining thereon. Ail such endorsements and rocitals shall be recorded as part of the deed. Failure to comply with this section shall not affect the validity of any deed. No register of deeds shall accept a deed for recording unless it is in compliance with the requirements of this section. ;,. fAss ssar's map and lot number F THE T Sewage Permit number PTIC SYSTEM aUST BE Quo Its �L�.�D INCt.� PLIA��C> � o House number ..... Z BAUSTADLE, .^yv�'!'.v..............................� �`"s yJ y rues �is��avz �'; x G• "rfoePYa� TOWN OF BARNSTABLE ''BUILDING -" INSPECTOR Jr APPLICATION FOR PERMIT TO s` C..�.. f: �" ` ��Y ........ .................................................... TYPEOF CONSTRUCTION ..................................................................................................................................... .........Ap... .......7..............197 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor atiOR, Location 4T.. .�1. ........ V w k.e:.Y.1.....R o ... � :�l�!!l t: .'.!�........... .. ............................ ProposedUse .... `/.................W.....,—..... . .`... ......................... ....................................................... ZoningDistrict .................... .......................................Fire District .............. ... ... ....................................................... Name of Owner .., ...X�e; c r'.../�'�r o;1JE'..:/................Address ....al Y. r*rla l....An; s.4......1'��` s9Y� 7 .. r� Name of Builder ?9 �..Y'........Address ...... 3 .N� .... e...,t.� . Nameof Architect ..................................................................Address ......................... ...............: Number df Rooms Foundation r Exterior C..... .�.t.N.�. . .s....C..!.d...f�d ��'Pnt.) 6�j h �..... ...........r....... ...Roofing .......��... ............................................................... Floors CA.(P.A�..... r ....©. i ...............................:........Interior ..... .1 ?�.'"• V 5.P................... Heating ,............Plumbing P Ca we r ..................... I. qs Fireplace ..Rcd.......13:r.tc:...................................................Approximate. Cost/. Definitive Plan Approved by Planning Board -_J _---------19 Diagram of Lot and Building with Dimensions Fee 7............. ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH L L� r f,'`1 �� a� a � ,r° Loy 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 . .:.....................;/. . Construction Supervisor's License ©� �o ®� M�IANEY, SYLVESTER 1 - 27127 Permit for ....1 Story.............: "' t Sin le Famil Dwelhn _ .................................. '..................�..................... 25 Overlea RoadLocation ......................................... L Wannis ...................... port.................................. - Sylvester MaloneY.. Owner .......X.............................. ....................... Type of Construction ...Fri............................ -� Plot ............................ Lot ................................ 4 t - �; r, - Permit' ....October•••2.2•>..........:19 gq Q Date of-inspection(.' + ....�....�� .�19 a0 4- Date Completed ..1.21 .........19C.4 _ _ ` ' � I r TOWN OF BARNSTABLE Permit No. __•_ 7,�,________- Building Inspector Cash -•--------- -- ....�` OCCUPANCY` PERMIT --- -- Bond _-__ a Issued to %ri y--',r.:,st[.rs mait3zlS`� Address Wiring Inspector + '`ry _ + j ,.�' !�.� 1 _ Inspection flats, "'- ., Plumbing inspector, f. " Inspection date Gas Inspector .�/ Inspection date - f'Y, X Engineering Department ��� Inspection date Board of Health �� '7 ,_ ,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 AND IN ACCORDANCE WITH-.SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. � ........ � � Building.•Inspector ...•...»� »»»»»» • � e q� PS'•'x i'y .'°f .. � '"�' �'^ .. •'�� J .....:� °�' S•�'• �. .'i. ��: s�^,t•` � i .1-Ea"'+-+ :�" e • ..� T°�` TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 rssaas = riva TOWN OFFICE BUILDING '639• HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM Building Department DATE: June 27, 1985 z An Occupancy Permit, has ,been issued If or the building authorized by BuildingPermit 27127 #.... ......... »»..........................................................» » . ...»»»�» »......................»... t issuedto ..................».........»....».».» 'lvestex' honey .. ..»..............»».. .............................. Please release the performance bond. 16'.21/2' 35'0" I j I i I 1 I --h-1o1rz e-�nci j . tecttl ari N Rarnst le Bid +� - t.� -- j Appro by: UNFINISHED Doi I j Permit ,- /UF i UNFIMSHED SM KE D ECTOR REVIEWED � I i LIA I I 0I BARNSTAB_E BUILDING DEPT.;. DATE j Meted FIRED PARTM T DATE BOTH SIGNATURES ARE REQUIREi FOR PERMITTING I I .. ...::.... .. ..:.:........:. i i 29'-113/4' 11'ilo IT-2 1/4' I j i I -- ,, r'•c - - . a?' - Anaave G dsr sin to \ Rarest Ie�1 Dept. 14'-21/2' 35'-0' 16-01/2' \\ \ r.,D,2- App ed' 1'405/8' 2'g05/B' �OV y. -4'-212' S'-912' -4'-212' -6'-7'-- 4•-1,i/d' S'11/2' 4'1 98 anite p a+d tU on 5 h eo . ' p ch wImlGlja astone I,&. d�attemfig — --- -- 6'-61/2 661 1 7 I MO ` ? 1D'-61Ar I 5'-10,O. 16-1112" s � walla oak,setec BARNS TAB M terl � �-� 5'white oak select, pad-� \ '-' d•D• ," L �—I 4-0 E ILD� e area wood furor en Ineerea wood nor I h.4_�— _I _s ,, 's G' amine _ Q EP - I with cut - t with aarewt D ageare � � A�;, /.FOYER I e 101 0 KING _ 6 0 �OOM 1 'A CLOSET ; .xl. .� nD2 T . „< 2s6wa ., ,� P TM D TE n 1 MASTER_ _ i STUDYAIBRARY I COATI: t \ I r. B'A'SN E",11 , , SIGNA -114(1 ^ 2x6 waL -.J Y Un 14:D' �aK I TUBE RE REQ PERMITTING mk 090 109A. ------ -- A whteoak•setect. raj 1I a,ed wd Rom� NSAI th square wt `�N. ; ______ a N my m 2ad'waLL . I I (-2x6 wall I 2x6 :1 ,I �! 1. I MASTER- tmoA 1 DI,awNa�uQx d BEDROOM. 20-I ' o ____I______-__ 113 . a .we PAr Y A.y:g-xI u Y e �r m , C • �..-.�. _� anal. I I � I I I I S T-0' ate e t o Classic `.P I 5'white oak,select, .. I w/12 tensml I red wlrodflov FIREPLACE NOTE: angle. Heat n Gla,BOOOCL Series, I \ I r •� with square cut 1 - -- I Peastone I amewau.elx f._ f I � _ .Parking Court I II C FAMILY m' 1 I I i 1 I i -I LAUNDRY/ Z ROOM I ' I - -.-- 11 1 MUDROOM ` �. 108 aka1104 .Aerv.le. Y ; ' I i t u.M ---- ®i I ... I I IS'white oak:sale;t, I KITCHEN - 5 white K. tact I } Z 1 I c I engineered wood floor I 107 -engineered re d(l t�- - _-_-_ with square cut 7103/6- 'th squ uu11 S 1 SLOEj-,- ._. ip- -- tor,Porch t c I M �I aREANFASr to U8'f ROOM- I •• x 1 r �" ;�. ,r 4'�U'I_.. d'-95/8•-jT�6 95/B_�`__ 6'-1t 3)8'. I �:-O1 1'- -^\ 10'.-�12- REAR TERRACE I r s 87B sq it 20 high sitting wall seU-P,d field stone /B 2 2 3/B . T)r ��291'-1i 3)4' 11'-10' _ 12'-2116' �-4Y'CtIA �FX,3'tL.YYc�-+I�t'AY/1r.-ib'/4CY"�5;�4.�1�'GAxb"l�A,r c N i i I 7'-91/8' I ap 3r K SNIe Gutt -_ V W I ... ------------- -----:.,___.___I_fz�_I_OS .c. - ,. n:.: -- Barnstable Bldg. Dep II , 1: 8'-93/6' ClASET' _ �• TH BZ, i 1 - - p 2 ; �� = proved i A by: .!'.:• .- b¢CLOSET .; - s ///'qyy,,, t ,.g .'Permit V _ _ 1 --- ----- : �1/6:,2z6 wal �•: Rat L -slope i i a Roof Section I O I 1 'F— I BEDROOM j ., I �mars-0.nc -die �� = BEDROOM 202 HALLWAY OS I ^_ I © B'11/l 20,z 3s u4ner.aq r (0''1'A { 6wa0 _ 20, Y'+n. 2z6 I 3 301 3'-4' I� I I C1.05 Ili mz-6�IG�LOS 1- _ 3 lot!mv-Slope - I'"k b' 209 I,'+7 205 I a- - any — 4+6 J 1 :3.:: :__ ._.._ '-: , I BAT it .. 3 -- E- I 2x6—it a - j r. N 6 I� STfING 'sND10 6 RI R QDM I j. b BEDROOM I GYtt , L-----.------ --`---- _—. .. `___.__� I%ze—� ; .. ,.. .-Ds- I � I 11':738 — 3?, —7-03re1 SMOKE DE ECTORS REVIE ED i BARNSTABLE BUILDING-DEPT. � FIR DE AR ENT Ga.TE BOTH SIGNATURES ARE REQUIRED FOR pEaAIITTING i Ds Y 1 .. K Slyl tt- ---'d' 1 i I S DS •1;;.,:::.: 0S I DS .. _I _ K Style Gutter ` .. ,.., ...... s \ _ • ..:,..... -.K-S le Gutter"".:' ;:: •. 1 - n I: 3- 1 12 12 F 1�.;.,....,...:..... . . _, arnstable Bl dg. Dept. _ ........... .......... Approved� -": ::.: = bye I \ Flat L—Slope _ I I \ I ,==_ Perna i t Root Section r I .i___ ----------------- I r. l::N;::::::� 33 I� x�.::::...:::.:::: � I - =:3=_.::..........:::: UNRNISN6 .: \ 1 = -- _..__ DS ,.1=_:::=3==:==3333 I ATTIC - __ 301 If—diti—d space _ ___ 1/4:17. per Enstalfatlon Manual- r I �=�== ...:.:.. .,, Rat Low-SbP 7. .: Rool Section 4 ;..�, '`\ 111 ' f __ ___..�.p__ ---------" - I "---- ------ - _ - ..0 ..:...... _ . -; .-- P —'.. _ _ - - .... - - { _ 1 - _ 7 I }} I 41/4.12 I. - F " : -h —"' ..—.—f style .. ..... �. _.__._ t 1 0s oso SDS ' I: } .. 7 ,2 SM �K DETECTORS REVIEWED I i. . BARNSTABLE BUILDING•DEPT. D i 7 FI E D PA TMENT 0 ,TE BOTH SIGNATURES ARE REQUIRED FOR PF_RMfMAj._ Assessor's map and 'lot number ... ........ *TNE Sewage Permit number .................................... BABH4TABLE, House number .......c—,2 SAM ............................................. . s639. TOWN OF BARNSTAB-LE - BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................................... ...... x.................................................. TYPE OF CONSTRUCTION ...............YYd.......a.......cA............F ...t-....rj......re) C................................................................ .............. ...........5 ...... ..............197.44 ... .. .. .... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inforT,ation: r ......................... ......... .............1— Location .... ...............Qvct 4 Pd., ../ Iq - .................................................................... Proposed Use .... ... C r rr . , .................. ............. ...................................................... ... .......... ZoningDistrict .................... .......................................Fire District .............. ............................................ S ...................y ' 4/.9 ern A v Name of Owner ... M44a y e- v Address ....!;�..... .......:&I ......................./................... ...............I...... Name of 'Builder ......7......... .........Address ....... Nameof Architect .................................................................Address .................................................................................... Number of Rooms ........................7.......................................Foundation Exterior ...Roofing Aa!?An.�.-r....... ......................................... ................................................ ... Floors ...........................................................................Interior ................................ ................ .................................. W A5T Heating .........;...Plumbing ..... .......... ...... ....................... Fireplace J?-.A......RV. ................................................Approximate Cost ...........�p........................................................ Definitive Plan Approved by Planning Board ----------19 Area .... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL-OF BOARD OF HEALTH Lo Z-- ¢ --- 7q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1, hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NameZ................ ............... "Id Construction Supervisor's License (a ............................... MALONEY, SYLVESTER A=287-155 No 27127 Permit for ....12 Story Single Family Dwelling ............................................................................... Location Lot 1.1, 25 Overlea Road , Hyannisport ............................................................................... Owner ...Sylvester Maloney Type of Construction ame ...................Fr ....................... .. ................................................................................ Plot ............................ Lot ................................. Permit Granted .........October..22.........19 84 Date of Inspection ....................................19 Date Completed ......................................19 /7 -- 17 � F t Z.A 204:37' o 83;73' 3z� i C (� C w 1 / j G � l 4 / L o+. r� f°y M 31,0 8 Cq i-.SF" 77.94 CURVE RADIUS ARC 52 . 51 20 .52 x JOB # 87-17 CERTIFIED PLOT PLAN PREPARED FOR. LOCATION: L-7 OVERLEA ;RD , HYAN;'.,P0RT SCALE: 1 =50 DATE: REFERENCE: LCP 17306D MARK HORAN I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED,-ON THE GROUND AS SHOWN HEREON. BUILDING CONFORMS TO SETBACK. REQUIREMENTS OF THE TOWN WHEN CONSTRUCTED,'` OF down cape engineering ARN€ y� CIVIL ENGINEERS A LAND SURVEYORS Rnl ITF .n- > z_v n i IYu_ _ 7- - ;,A, _ - �A A_ i+y Sian y- ' vC I;IJH I Assessor's,office oor): Q C Assessor's map an of number S Board' of 'Health (3rd'floor): EM S'BE d� t_ • Sewage;Permit number ...:...,.:$,Z.'...�,�. -. e ..... INST Z B9H39TODLE, Engineering Department (3rd floor): �o raea i 6 q. 0� Is O� 3. �! � HODS@ number ....:........... ................�.z.`�................'....... � ���� Definitive Plan Approvedzby Planning BoardbKG : _ VLA RM APPLICATIONS`,PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only 41 i ~ _ �. r ` T,OWN OF BARNSTABLE BUILDING- - IMSPECTOR L APPLICATION.FOR PERMIT TO :........ .°I4 75v�LL ..9. o �+ r� ,,,:, r . i .. �'..u.. /. f ... . TYPE OF CONSTRUCTION / r,t l } 3 TO THE INSPECTOR OF BUILDINGS: , The-undersigned hereby applies for a permit according to the following information: r /- � .......... . Location .. . ?.... !1.4<t..! ` ...... ............................. 1.................................................. .. ..... n Proposed Use ................SwXMA.k�...-.....:. ............ .. ..... .�. . Y / Zoning District :... .L...................:...................................Fire District ......:...[ l�?z„n -G ... .... r Name of Owner ... t..' //^� ff'....:............Address ......................�.. Name of Builder . 14 ...Address ......... l .. .. ...... ..... ..... .. ... .mot Name of Architect ......... / ........t'r ...............................Address . Number of Rooms ...........:.............../:............... .....................Foundation . ............................. Roofing Exie• ior ............................. ....................... .. .... ..... _ ...... ...... Floors .................:....................................................................Interior .................................................................................... Heating' ........ ...Plumbing .....:...................................................... Fireplace ................ ...:..............................................................Approximate Cost ........ ..I: w- ....,..........:.............:.. %•.• .... Area & X' 3 ca- t Diagram of Lot•and.Build-ing with Dimensions_ Fee. �........ ' ... .....0 r f . f • . 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 .. ...... . .................... ................ Construction Supervisor's License ....C/iJ.O U a CAREY., DENNIS "327+6L BUILD SWIMMING No ........ . .....Permit for ...........................1,0'OL r Access o ryto Dwelling r. .... ................................................................ �_ocation ...2?5...0 v e r 1 e a...R.d'....`........ .......... Hyannisport �. ......................t.......'}......... , , Dennis Carey ` -w l Owner ............. - ........ ...... . ............. G'aTv. 5'feel'/' d = r r a - Vinyl :Lined { � - t Type of Construction .......................................... gPlot . ' ....r ..... � Lot'.. : ........ - ..... * ........ � �' - ,� .,.••.���-� •�� :,' - Permit�Granted. ..Apri14 3 j 19 89 w Date of In`s-pec#,gn....... ............................19 Date"Completed £ ..4. ...}�... 19 � .. � �y ` - � �i Sri �•/�/' - r� �� - go 14 c2 , of � y. ..'�'� ,;� •, •r , r.�Z , � J Assessor's office (1st floor): y� 1 �. FT MET Assessor's map and lot number ....?.`..... .....:?.......I. -'..'S./t ^� Quo off♦ Board of Health (3rd floor): Sewage Permit number �.'... 1....,1�a...p............. Z BARNSTODLE,MAII i Engineering Department (3rd floor): N r 'oo 039. 0� Housenumber ........................................... ..5........................ DNA Definitive Plan Approved by Planning Board au�___________________________19________ . APPLICATIONS PROCESSED 8:30-9:30.A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR _.0 t S �`vc N c a APPLICATION FOR PERMIT TO ..........r: � ,� �1' ,P •' TYPE OF CONSTRUCTION 4�...!Iv........... ¢� t �.,,.... . :...........................................„ . .. ................. 19 TO THE INSPECTOR OF BUILDINGS: f The undersigned hereby applies four a permit according to the following information: Location .. .!!.?,�..[.'OA......)..................... u;1.i� ....................................... T • Proposed Use ............... �!/�n,.,tr,ca,............ 01 Zoning District �:F. .....................Fire District yam,r.. ' :.......................... p ............... ......................... t Name of Owner ........ er�.!^.f.�......... .................Address d ./e-a .o� .................................................................................... Name of Builder Gaye C.,o)rt �,w.e Z� �(�� ,� v�/f � : Address ................. . . ... ..�l�s,st�, S ./lravehe.4 �. L..C- l r Nameof Architect .......................T . ...................................Address ......{{........................................................ Number of Rooms ..............................................................!...Foundat fio : Exlerior ....................................................................................Roofing ............................................................................... Floors ......................................................................................Interior .................................................................................... Heating ...................Plumbin ¢ r Fireplace ................................i.................................... .............Approximate Cost ............ dd' v �(O 04 Area .......................................... Diagram of Lot and Building with Dimensions Fee �— 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 Z '�`: ��%;r'� Construction Supervisor's License ...r .0�.��.v........ CAREY , DENNIS „ A=287-155 No .32761 Permit for ..,_BUILD SWIMMING POOL ......................... Accessory To Dwelling Location .....5 .Over . . ......le...a.....R.d........................... H anni_s ort Owner .....Dennis...Ca.reY.............................. Type of Construction $a.lv,.. steel/vinyl line , ............................................................................... Plot ............................ Lot ................................ Permit Granted ....April 3 19 89 Date of Inspection ....................................19 Date Completed ......................................19 I -3 P� AWE Town of Barnstable *Permit 4,40lExp Regulatory Services Fee 6 mo frgssa • RUWgrABLB, MAM Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press Imprint lVJ Property Address C P � �-, ►4-I�DN'l-S f a P`�Yb"�6�. ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �s"6v/E ' Le la—® 1-42)7Pfl Contractor's Name 1 (.�C.l� yr Telephone Number � 0 Home Improvement Contractor License#(if applicable) `9t;J�� Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ;,&I am a sole proprietor ❑ I am the Homeowner Nov �'6 ❑ I have Worker's Compensation Insurance 2®�3 Insurance Company Name �/)(S a Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) /� �Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 9L1_"-U U4 bt q_ S-62 j ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 Im rovement Contractors License&Construction Supervisors License is equired. SIGNAT ^� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 Em' ail . The Commornreafth ref'Massae huseft Depart of buhu iid Accidents Office of lix lestigafrons 600 Washington Street Boston?,MA 02TII wn," mass go'Rfdla Workers' Compensatian Insurance Affidavit:Builders/Can'tractors/FlectriciansMumbers Applicant Information Please Print Legibly Name aksmessldrganizaiion&dividnal)_ {L-� Address:City/State/Zip: �C nn 0 0� Phone#: 'Et)6 Are you an employer? ecktbe appropriate box: Type of project(required): 1_❑ I am a employer with 4- ❑ I am a general contractor and 1 6. ❑Newemployees(fu11 and/or part4ime)* have hired the sub-contractors. am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-oontractors have S. ❑Demolition woricing far me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insutmce l required-] 5..❑ We area corporation and its 10..❑Electrical repairs or additions 3_❑ I am a homeowner doing all want officers h ve exercised their 1 LE]Plumbing repairs or additions myself-[No workers'camp- right of exemption per MGL 12. repairs required.] ❑Roof insurance f c_ 152,§1(4�and we Ira>.�e na (` employees-[No Workers' 13.00 ther C � comp-insurance required-] *Airy appti�at that checks boa#1 mast also fill out the section belowshncving their wadcere compensation policy it&rroatiorL Hameowaers who sabmit this affidavit m dkstmg they ace doing all wm t and Mien hire outside contractors ntnst submit a new affidavit mdicsaag such- lContcactors that r1ma this but must attached as additional sheet shorting the name of the sub-eoaftxrors and state whether ornot those entitks have erupkgees. If the strb-cantractnrs have empIcyees,they mast provide their workers'Comp.policy tubes I am an employer that is providing it orirers'compensation insurance for my employees. Below is the policy andiob site information. Insurance Company Name: - Policy#or Self-ins-Lic-4: Expiration Date: Job Site Address: City/Statel7ap: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dale). Failure to secure coverage as required.udder 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 ffie DIA fiDr insurance coverage verification_ I do hereby certify under the pains an tties of that the information provided above is true and correct Si ture: Date: Phone#: 0jfficiai use onty. Do not write in this area,to be completed by city or town ofJ''iciaL City or Town: PermitUcense ff Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CiVrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - - _ - 6 U J Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. ' Pursuant•to.this statute,an employee is defined as"::.every person in the service of another under any contract of hire, express or implied, oral or written An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the., owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for'the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been.presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their 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 maybe 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 eater 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. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commanwealth of Massachusetts Department of Industrial Accidents Office of InvestigatiOns 600 Washington Street Boston,MA 02111 TO.#617-727-404 ext 406 or 1-977 MASSAFE Fax#617-727-7749 Revised 4-24-07 • www.mass,govldia , l 1 s . �aTHE T Town of Barnstable Regulatory Services 9 �,` Thomas F.Geiler,Director �p i639- �� - r 6.19. 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 n as Ownet of the subject property hereby authorize C il C-2 M C to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms 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. Cel- Signature of Owner gignatuie of Applicant r Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 62012 1 � r Town of Barnstable Regulatory Services 4 i aaxr�sTwsr>✓ Thomas F.Geiler,Director y KAM E1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street. village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:_ cityltown 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&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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 --------------- Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-078687 � BRUCE P MILLS=.` 16 CROOKED POND HYANNIS MA 02601 l Expiration 05/29/2016 Commissioner C�1 e a»vnaoazcaea z _ Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Type- egistration: :136003 / xpiration 5/30/2014 Individual BRUCE P.MILLS I I € BRUCE MILLS 16 CR*OOKED POND HYANNIS,MA 02601 •-' Undersecretary r v Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-078687 BRUCE P MILLS 1' 16CROOKEDPOND J _ I HYANNIS MA 02601 i /* Expiration 2, II 05/29/2016 Commissioner License or registration valid for individul use only before the expiration date. If found return to* ulation �. i Office of Consumer Affairs and Business.Reg 10 Park Plaza-Suite 5170 Boston,MA 02116 f- i Not valid .it " ut signature P i f f ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division - � f Date Issued Conservation Division =1- _ ,; ' Fee , . Tax Collector " Treasure 0 y SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANC Date Definitive Plan Approved by Planning Board WITH TITLE 5 _ ENVIRONMENTAL CODE A� Historic-OKH Preservation/Hyannis TOWN REGUL1%fI0�N`'S Project Street Address c S_ d✓e79_-CC- 4 �d Village A1%-7,4eV V is 612_1 r9—� 1 _ Owner �'n!.� 's Address -ZS- Ofry1,629-- koA-40 Telephone -- .3-o Y� Permit Request 0 ur'L rR u (9 r90 tq0 Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new �00� Estimated Project Cosh Zoning District Flood Plain Groundwater Overlay Construction Type 1)= l Lot Size Ac c Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure `f Historic House: ❑Yes �No On Old King's Highway: ❑Yes XNo Basement Type: XFull ❑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 0 Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other 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 BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY .1 I71ZMIT-NO. s ATE ISSUED r MAP/PARCEL NO. ADDRESS 3 - VILLAGE OWNER; ' a �•$ r 4... - , a DATE OF INSPECTI ` FOUNDATION ©/'A f , 'r. FRAME '��<ok e af 3?3 0. . 'O c-: INSULATION r FIREPLACE ELECTRICAL: ROUGH �°„�� ,a. FINAL t PLUMBING: ROUGH '1 FINAL03 - ,r GAS: ROUGH :?j FINAL FINAL BUILDING _ l rn ( } DATE CLOSED OUT t:n fit ASSOCIATION PLAN NO. Y , i rrC V,- al uc,. WER S`ylVeSLer Maloney APPLICANT -- �'.'nr.zs : Z'<Zrey c7-ux *LAND COURT PLAN D, 'Trf •, Ir9-8755 --- - XNSUS TRACT IV&� N/F Laughllir. kyr AVAII.,'lgL 163.30' r N/F Laughlin leo t 11 i Teck �4 ' I _ #25 F.� 66.401 ----------------- _J. Q Y Lot 5 WJF Laughlin ko 22.95' A 0 103.21 1 OVERLEA NOTE: Referenced property m -7 — description appears to be inaccurate. dwelling ,y,;i yj 250001A %?":rti 413178 i': ._., ZONE C MORM 6E PLOT PLAN OF LAND 'Ore.' r/I/SPLOrPLA/YWASNOrMADEFPOMANINSTRUM'ENr !N WVEY, rNESECERr1F1CAr1 i'YSAREM'ADE 70 THEABOVE AM'ED a/ENT AND ARE fW wR TGA(;£PURPOSES CW L Y. E) A RN%5 TA®� Y CCRI NO CIRCUMSTANCES AR£ rN£DISTANCES SHOWN TD I..t 60' ?UNl' 25, 19s5: - REUSED TOESTABL/SHPROPERrY LINES OR FOR CON - SCALE '-MUCTlON PURPOSES..MIS PLAN IS Nor r0 BC USED FOR HAYWARD -E0 YN TON a W/L L IAMS," INC.. 7ECa?D#VG OR DEED DESCRIPTIONS AND APPL 14-S ONL Y ro SURVEYORS ,- Cl V/z_ 'ENGINEERS WbMONS ExiSriNG AS OF ME LwTE.SHOWN HEREON. 7 BROADWAY TAUNTON h1ASS ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE square feet X $55/sq. foot= GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK �� square feet X $15/sq. foot= G voo OTHER square feet X $??/sq. foot= Total Estimated Project Cost i g990915b The Town ofBarnstable 94� Department of Health Safety and Environmental Services 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: F,�p'ex-H -b6z-k Estimated Cost Address of Work: Owner's Name: /c r S ��- C Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law E]Job Under$1,000 Building not owner-occupied jbwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME EmROVEMENT 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 lO � Date Owner's Name g1ornu:Affidav Fm�r ow Depar ill ;�::.` .nth :safety and Environmental tie.;,m_-aoe:,. Bailding Division 367 Main Street,Hyannis MA 02601 s639• ,�� Fp NAA'I� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner. HOMEOWNER LICENSE EXEMPTION Please Print DATE: /0,�! �9� JOB LOCATION: 01/fffY?—L6_7f— A-""'r-Y ®d y-,// number street i village "HOMEOWNER")��""S' -7 9 e) 3-0 name home phone q work phone d • CURRENT MAILING ADDRESS: l ' Y 7 Tcity/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. DEFINPPION 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 ro dures 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&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 personas 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 T � - I , s i , i I } t `17 t I. .. ' I : - ..r _ 4 it -. '.. t M� : r { { i : .. �' ..�..,,.,..:.,,..n.ery,., nmra,•. t ;...,: ., rlv �S- r,. .,nar> , .... .,.n 1 ! ��RP .4 ' ..,+ M , I : .... f j ` A I The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers, Co m ensation Insurance Affidavit name• ���l n�! Y �� location: oG D V E7ZCe 9- city L` -t� A-1,1 14, S��0?-j- phone# I am a homeowner performing all work myself. Q I am a sole%/ro///rietor and have no one working i a n any achy %/% ��/% c�//%%%/%//%%%%%%%/G�%/%/%/%%%%///%%%%/%//%%/���%%%%%%%�%///%%%%/%/�/%%%%%�i, I am an employer providing workers'.compensation for my employees working,on this job.: companvname• l. t'> 3 �::. ✓ . .Ji. .....;..:::<:>:: �.:.:.:; .. .;.:::: ... :>::;::::;;:.;.;::;:;.:: ...... ...... ..... ............ KX aararess .. ..: .. .,..g:.- • phone#. �,�..� _.. . ..: f :.:......... insurance co. ci!r r c t - "�" : ): y4 s >.. �,;✓�' I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: wm anv name. address. .. city .. .... :::: ;,:. .................... <:::..:.......................................:...................... iti�nrance ca ,.:. ,''/%/%%/%% canv name:.....: :::-;.;>:<.>;;:.;,.; >: -, address. ..::..:... >.::.;. ..... ........ XX% one#: , :.:.:.:::.:::::X....:: :. .:. in� oli n co..r ance 11/ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Bile up to S1,500.00 and/or one yeah'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true.and coned Signature ` ' � - Date T/3 ` Print name Phone# ----------------- official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑other. (revised 9/95 PJA) Information and Instructions . Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 section 25 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,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 to 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 levest1gadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375