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HomeMy WebLinkAbout0124 SEABROOK ROAD I a y S c��b�oo1a ,30t-1 -- 030 Town of Barnstable U11d1I1 n g Post This Card So That rt is U�s�ble,From,the,Street Approved„P<Ians,Must be"Retained on Job and thi5,Card Must'be Kept �ARDitTrAB1.E. • a v„ .. ,� ,� *r" Post1659- ed Until Finallnspectwn Has Been Made" �E iWhere a Cert�ficate:;of Occupancy s Required;such Building shall Not,be Occup�edgun#Ili a�Final-lnspectaon has been made ,:' Permit liilt w •. . ,. e, a ;,M _�,�..a� „�..� .w . , �, �x._ �_ .tea., ,: ., :r , .. :ate .-. m,.y... ... , ,•�" , Permit No. B-19-1543 Applicant Name: MCGOVERN,GERALDINE Approvals Date Issued: 05/23/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/23/2019 Foundation: Location: 124 SEABROOK ROAD, HYANNIS Map/Lot: 307-030 Zoning District: RB Sheathing: Owner on Record: MCGOVERN,GERALDINE Contractor'Narne r, Framing: 1 Contractor License: Address: 50 WOODBURY AVENUE 2 HYANNIS, MA 02601 Est Project Cost: $ 10,000.00 Chimney: Permit Free: Description: During the work performed under express permit B-19 652, $101.00 r; considerable water and structural damage was, Insulation: found:Specifically Fee Paid: $101.00 the south wall of the property will be required to be recoristrcuted. Date 5/23/2019 Final: Additionally a number of the floor joists,ceiling jolst'and roof rafterw °_" will need to be repaired g , F Plumbing/Gas Project Review Req: a Rough Plumbing: OW Building Official � Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed,by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application andAIJe approved construction documents for which,i its permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall ee in compliance with the local zoningby taws a d codes. g This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. g" ;F The Certificate of Occupancy will not be issued until all applicable signatures by the Building andFire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work zi Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed m" 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons con ing with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: .� Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: r \� r � a i i 1 Q' Application Number............................................................. TOWN OF i A HARNSTABM RS7ADEt nsne8. Permit Fee...:.. . ......... ....:..........Other Fee:....................... 03 ,.`� 20P MAY -? AH 8: 57 TotalFee Paid............................................................... TOWN OF BARNSTABL T TON val by:........ ......... .on...... .... .`�:. BUILDING PERMIT map......1.5 1............. ..Parcel.... .020: ...................... 1 APPLICATION Section 1 -Owner's Information and Project Location Project Address 124 Seabrook Road Village Hyannis Owners Name Jeffrey and Laurie Brown i I Owners Legal Address 50 Woodbury Ave City Hyannis State MA Zip 02601 1 i Owners Cell# 508-988-0150 E-mail Jeff.Brown.USN.RET@gmail.com F_ { Section 2 -Use of Structure i Use Group 1olo ❑ Commercial Structure over 35,000 cubic feet , i ❑ Commercial Structure under 35,000 cubic feet ❑✓ Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ✓❑Renovation ❑ Pool ❑ Insulation Other—Specify � P Section 4-Work Description fDi ir_ing the wnrk nPrf_nrmP_d under Px rn PSR TnPrmit# R-1 P-R'37' mnsiderable water Rnri StruGtl mi_ damage was found. Specifically, the south wall of the prosy will he required to he reconstructed. Additionally, a number of the floor joist, ceiling ioist and roof rafter will need to be repaired. i { 1 Last undated: 11/15/2018 i i Application Number........................................... Section 9- Construction Supervisor { Name Home Owner (Jeff Brown) Telephone Number 508-988-0150 Address 50 Woodbury Ave City Hyannis State MA Zip 02601 Number N/A License Type N/A Expiration Date N/A License N yp xp Contractors Email Jeff.Brown.USN.RET@Gmail.com Cell# 508-988-0150 { 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 andrhe Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Self(Jeff Brown) Telephone Number 508-988-0150 Address 50 Woodbury Ave City Hyannis State MA Zip 02601 Registration Number N/A Expiration Date N/A I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR,and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date s Section 11 —Home Owners License Exemption Home Owners Name: Jeff Brown Telephone Number 508-778-8330 Cell or Work Number 508-988-0150 Ijunderstand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 Cv1R the Massachusetts State Buildia Code. I understand the construction inspection procedures,specific inspections and i documentatio y 780 d the Town of Barnstable. Si Date 05 "IPLICANT SIGNATURE Signatur Date 05/01/2019 *revyrown 508 778-8330 T nt Name Telephone Number ( ) mail permitto: Jeff.Brown.USN.RET@gmail.com Last updated: 11/152018 ----- -. .._. I Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval }} I Section 13— Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: I I (Address of job) Signature of Owner date j Print Name i 1 i - {I { Last updated: l 1/i5/201 s 1 t i ApplicationNumber.................................................... Section 5—Detail I Cost of Proposed Construc#o" e-- Square Footage of Project Approximately 950 SQ/FT i Age of Structure 59 years (built in 1960) Dig Safe Number N/A # # Of Bedrooms Existing 3 Total#Of Bedrooms(proposed) 3 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics j l ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors i ❑ Plumbing ❑ Gas ❑ Fire Suppression � ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom 1 Water Supply ❑ Public ❑ Private. I Sewage Disposal ❑ Municipal ❑ On Site 1 Historic District ❑ Hyannis Historic District . ❑ Old Kings Highway r Cavossa Disposal [ p Debris Disposal Facility: p I am using a crane Yes No ? Section 7—Flood Zone 1 Flood Zone Designation Outside Flood zone , Within or adjacent to a wetland,coastal bank? Yes ❑ No �✓ Section 8—Zoning Information i Zoning District Residential proposed Use Residential Lot Area Sq.Ft. 9360 Total Frontage 80' Percentage of Lot Coverage 11% #of Dwelling Units(on site) 1 Setbacks Front Yard Required 20' Proposed > 20' Rear Yard Required 10' Proposed ' 10' l Side Yard Required 10' Proposed ' 10' i Has this property had relief from the Zoning Board in the past? ❑ Yes ❑✓ No i j , r } s Last updated. 11/15/2018 i MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MACDOUGALL SURVEY WILL NOT ASSUME LIABILITY FOR ANY OTHER USE). 0; m O� SCAB 3 ROOK R oA D gg 800 9 LOT 17 #124 LOT 19 SNEO LOT 18 8Q, LOT 13 `LOT 12 I CERTIFY THAT THIS MORTGAGE INSPECTION PLAN WAS PREPARED IN ACCORDANCE WITH 250 CMR SECTION 6.05 OF THE MASSACHUSETTS RULES & REGULATIONS FOR THE PRACTICE OF LAND SURVEYING. THE BUILDING SHOWN IS NOT AFFECTED BY A SPECIAL FLOOD HAZARD AREA AND DOES -CONFORM TO THE LOCAL ZONING BY-LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REQUIREMENTS OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 40A SECTION 7. REFERENCED DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIGHTS, RIGHTS OF WAY, EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. IF ANY THERE BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT, TOWN: HYANNIS DATE: 01/24/19 APPLICANT(S): JEFFREY H. & LAURIE E. BROWN CERTIFY TO: JOHN W. KENNEY, ESQ. SCALE: 1 =30 SH OF4S TITLE REF: 2742/094 MacDougall Surveying PLAN REF: N,45 & Associates EDWARD y� FLOOD ZONE: P.O. Box 2428 A. COMMUNITY PANEL: STON 25001CO568J Mashpee, Ma. 02649 28 DATED: 07/16/14 PH. (508)419-1086 CELL. (774)327-0617 Ai LANo S email: macdougallsurvey JOB# 11242 Ocomcast.net The Commonwealth of Massachusetts Deparhnent of IndustrialAccidents Office of Investigations if 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Plumbers Applicant Information «-� Please Print Legibly Name(Business/ on/Individual): e t w..l D rol4m) -- Address�/ � i a, ar ve � J0,r V M A vZ&0 / City/State/Zip: JJ jaNw'r.5 fn4 OZ60 Phone#: 501?- ri88 — 0150 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,i.* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. R]Remodeling ship and have no employees These sub-contractors have g, ❑Demolition wor for me in an capacity. employees and have workers' _ Y 9. ❑Building addition [No workers'comp.insurance comp• t wed] S. ❑ 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 myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no t employees.[No workers' 13.❑Other comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire`outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby jy undep4epains and penalties of perjury that the information provided above is true and correct Si//ature: Date: D 5 cI Zd iI/ Q - &nLk=, . 0 S Phone#: -GE3- 988- 0/StP Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General 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." t MGL chapter 152,§25C(6)also states that"every state or local licensing agency sliall 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 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 thief 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 Commonweali l of Massachusetts Department of Industrid Accidents (ice of I,nvestigatiow 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Town of Barnstable Building Department c� Brian Florence CBO URNsraet,B. Building Commissioner � 200 Main Street, Hyannis,MA 02601 esv a�� act www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: 05/01/2019 Please Print JOB LOCATION:124 Seabrook Road, Hyannis, MA 02601 number street village "HOMEOWNER":Jeffrey and Laurie Brown 508-778-8330 name home phone# work phone# CURRENT MAILING ADDRESS:50 Woodbury Ave Hyannis MA 02601 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 mi um inspection procedures and requirements and that he/she will comply with said procedures and equ' a ts. Si a omeowner 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 to amend �I and adopt such a form/certification for use in your community. Town of Barnstable Regulatory Services BAMSTABM Richard V.Scali,Director ��� Building Division MA'l A Tom Perry, g Buildin Commissioner 200 Main Street,Hyannis,MA 02601 www.townolbarnstable.us Office: 508-862-4038 Fax: 508-790-6230 Owner's Liability Insurance Waiver Owner Name: Jeffrey Brown Owner Address: 50 Woodbury Ave,Hyannis,MA 02601 Telephone: 508-988-01 W E-Mail: Jeff.Brown.USN.RET@gmail.com Property Location: 924 Seabrook Road,Hyannis,MA 02601 Permit#: I hereby certify that I am the owner of the property. I am aware that the licensee does not have the liability insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Si a Owner Date f i i �AIT LT (1 oil I I I I I I 1 11 111111 FRONT ELEVATION 0 PROVIDE GUTTERS & DOWNSPOUTS AS NEEDED 124 SEABROOK ROAD, HYANNIS, MA FRONT ELEVATION SCALE: 3/16"=1.0' I F DRAWN BY: J. BROWN SHEET# 1 i I , 1 , i .Cr ASHjNqL§ST 5' T.W. 12 4g Cr �i J6 5 T.W. i I i p 44 I t 1 LEFT SIDE ELEVATION RIGHT SIDE ELEVATION 124 SEABROOK ROAD, HYANNIS, MA SIDE ELEVATIONS SCALE: 3/16"=1.0' DRAWN BY: J. BROWN SHEET # 2 i i f i i - . . . . [ Ilm I Ll I I II I III Iry-riTyT PROVIDE GUTTERS & DOWNSPOUTS AS NEEDED REAR ELEVATION 124 SEABROOK ROAD, HYANNIS, MA REAR ELEVATION SCALE: 3/16"=1.0' DRAWN BY: J. BROWN SHEET#3 i _ I i WINDOW SCHEDULE KEY oTY. OESORMON ROUGH OP9 NO W—ACTURERAMEL 1 AMONG YBIpOW 4'-4 7/9•x r-4 7/8' ANDERSEN AWIOZO B 1 OCUME HUNG(MULLED) W-7 19/Hr x r-9 11C ANDERSEN TA28/8-3 c 8 DOUBLE HUNG r-10 1/8'x 4'-9 1/4' ANDERSEN TW28" 0 / DOUBLE HUNG r—to 1/6'x S—s 1/♦' ANDERSEN TW EW 1 E 1 CASEMENT V-0 1/r x Y-8 3/r ANDERSEN CN235 44' ol 1'-102" 13'-5"�' 1b'-4"-��-11'-82"-- 3'-ti" O © O ti -1N -p BATH BEDROOM 3 BEDROOM 2 CC KITCHEN �-ler HALL FIRE PL. N c LIVING ROOM BEDROOM 1 v7� � g' 16' 16'-24 "' 3'-8 MAIN FLOOR PLAN 124 SEABROOK ROAD, HYANNIS, MA FLOOR PLAN SCALE: 1/8"=1.0' DRAWN BY: J. BROWN SHEET#4 i r MAIN FLOOR FRAMING PLAN 2 x 8's ® 16" O.C. OR EQUAL. 124 SEABROOK ROAD, HYANNIS, MA FLOOR FRAMING (EXISTING) SCALE: 3/16"=1.0' DRAWN BY: J. BROWN SHEET# 5 FOUNDATION PLAN 124 SEABROOK ROAD, HYANNIS, MA FOUNDATION PLAN (EXISTING) SCALE: 3/16"=1.0' DRAWN BY: J. BROWN SHEET#6 i 1' x 8" RIDGE TYPICAL ROOF CONSTRUCTION: 151b. FELT PAPER, ASPHALT ROOF SHINGLES, 7/16" STRUCTURAL PANELS 2 x 6 RAFTERS AT 16" O.C. ATTIC t2 Qs PLATE HT. -64"11' 11'-64" — . WALL CONSTRUCTION: N EXTERIOR SIDING T.B.D. TYVEK OR EQUAL BLDG. PAPER, 7/16' PANELS oBEDROOM BEDROOM R13 FIBIERGLASS NSULDS AT 16" o.c., 'Go 1/2"X2 PLYWD P.T. 2x4 SILL PLATE WITH MAIN FLR LEVEL EXISTING SILL SEALER SILL HT. * 5/8" F.C. SHEETROCK ADJACENT TO ALL LIVING SPACE a t A 1 CAR GARAGE co eam Z W SLAB 10" POURED CONC. FDN. WALL ON c EXISTI G 20" x 10" CONT. KEYED CONC. ' FTG'S .. 24'-0" SECTION 124 SEABROOK ROAD, HYANNIS, MA SECTION (EXISTING) SCALE: 3/16"=1.0' DRAWN BY: J. BROWN SHEET# 7 ROOF CONSTRUCTION: 151b. FELT PAPER, ASPHALT ROOF SHINGLES, 7/16" STRUCTURAL PANELS 2 x 6 RAFTERS AT 16" O.C. 1" x 8" RIDGE ROOF FRAMING PLAN ( EXISTING) 124 SEABROOK ROAD, HYANNIS, MA ROOF FRAMING (EXISTING) SCALE: 3/16"=1.0' DRAWN BY: J. BROWN SHEET# 8 f a Application number ...�... .... Fee BAR.VSTABM Building Inspectors Initials....... 39- Fo l 1 DateIssued...................... ... ....... ..........//..11................ Map/Parcel... . V ... ...... .. .................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 124 Seabrook Road Hyannis NU BER STREET VILLAGE Owner's Name: Jeffrey H. Brown Phone Number 5 0 8-7 7 8-8 3 3 0 Email Address: Jef f.Brown.USN.RET@Gmai 1.com Cell Phone Number 5 0 8-9 8 8-015 0 Project cost$ 3 0 , 0 0 0 . 0 0 Check one Residential --Z— Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize Self (Jeffrey H Brown) to make application for yixt19 n accordance with 780 CMR Owner Signature: Date: 2/26/19 F— TYPE OF WORK ✓ Siding ❑✓ 11 Windows(no header change)# ✓❑ Insulation/Weatherization ✓ Doors (no header change)#2 Commercial Doors require an inspector's review ✓ Roof(not applying more than I layer of shingles) Construction Debris will be going to Cavossa Disposal, Barnstable Transfer Station CONTRACTOR'S INFORMATION Contractor's name Self (Jef f rey H. Brown) Home Improvement Contractors Registration (if applicable)#NIA (attach copy) Construction Supervisor's License# NSA (attach copy) Email of Contractor Jef f .Brown.USN.RET@Gmai 1 .com Phone number 5 0 8-9 8 8-015 0 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No Of yes please attach floor plan with exits marked) Dimensions of each Tent X X 5 X Additional tent dimensions can be attached on a separate piece of paper. Purpose 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 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 combustible.: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Jeffrey H. Brown Telephone Number 5 0 8-7 7 8-8 3 3 0 Cell or Work number 5 0 8-9 8 8-015 0 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 T o "nst Signature Date 2/2 6/19 APPLICANT'S SIGNATURE Signature Date 2/2 6/19 All permit applications are subject to a building official's approval prior to issuance. �. � The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street - Boston,MA. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): .L f r(, 3"w Address: A City/State/Zip: J A nl N « fOA Phone#: 8 01 50 Are you an employer?Check the appropriate bog: 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 constriction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. W Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. 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 myself.[No workers' comp. right of exemption per MGL 12.M Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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 certi nd&, 'ns and penalties of perjury that the information provided above is true and correct. Si mature: Date: f12 2f� ZD/ Phone#: /U Jo7`� ' `� a GY?/S4) Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General 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." an of its political subdivisions shall Additional) MGL chapter 152,§25C(7)states `Neither the commonwealth nor y p Y� P enter into any contract for the performance of public work until acceptable evidence of compliance with the ins urarice requirements of this chapter have been presented to the contracting authority." Applicants ' Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to-your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city-or town-that the application for the permit or license is being requested,not the Department of cr_..,_.....7' f —P rPrnriri to fn obtain a workms' Industrial Accidents. Should you have MY uiucz5uvus L V6 �g� •4 J �� —- compensation policy,please call the Department at the number listed below. Self ft=ed 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: Thd Comrmnwealth of Massachusetts Department of Industrial AQddents Office of Investigatims 600 Washington Street Boston,MA�2111 Tel.#617-727-4400 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 www_m. gov1dia