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Home My WebLink About3512 MAIN ST./RTE 6A(BARN.) (8) a m0-1n o ce.n 1+ g w f: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma j� /j Parcel p�� L—— Permit# Health Division 02 Al!� Date Issued 1 r Conservation Division �� i✓Z I Z�� 1 `" Fee 00 � —r YSA JIUAETax Collector lab D C2k L a SEPTIC S Treasurer — 1 11. _ �-/ ,;� Ipp IN COMPLIANCE Planning Dept. VM TM E S ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis d Project Street Address -3 0 Zr30 Village Owner '� � ��/Z.�i1 Address �� Telephone Permit Request O� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation ;?_ U Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family kl Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2- new Half: existing new Number of Bedrooms: existing `2— new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 6 Gas ❑Oil ❑ Electric ❑Other Central Air: a Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: (J Yes ❑ No Detached garage:Z)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 Jd No If yes, site plan review# Current Use Proposed Use / B LDER INFORMATION Name Telephone Number Address License# eE_ - (L92 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ✓DATE2--- 'Y S s FOR OFFICIAL USE ONLY PERMIT NO. Y R + _� DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER y DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH C3 FINAL PLUMBING: RO176H,' FINAL GAS: ROUGH FINAL FINAL BUILDING r_3 .., '4 m f 1 n, Il DATE CLOSED OUT- ASSOCIATION PLAN NO. f ✓ • q, The Town of Barnstable Regulatory Services f Thomas F. Geiler, Director 'Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. 7- Date- AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: Owner's Name:' Date of Application: 2� I hereby certify that: Registration is not required for the following reason(s): OWork excluded bylaw []Job Under$1,000 ❑Building not owner-occupied DOwner pulling own permit Notice is hereby given.that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' Date Contractor Name Registration No. OR q:forms: day :rev-122001 The Commonwealth of Massachusetts = -- - Department of Industrial Accidents ,� -=� •- Ofllce of/osestigatioos ...... 600 Washington Street Boston,Mass. .02111 Workers' Com ensation Insurance Affidavit name: location: 51 a _ ci hone# 112H I am a homeowner performink all work myself. I am a sole prcTrietor and have no one worlds in anv capacity %/%%%%�/%/%%%/� % /%%/%%%/%% %//%%%//%% am an em to er rovidin workers' compensation for my employees working on this job.: : ::::: ::: tom a n m :.......;: 11 :a< INN tw Srisuraace %/ ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have e fo.. ... workers co cusslion polices: >::>:<:: gum an <:nam .......... :address......... .. ..:.:::::.::. :.. .:: .. .: • . ;... 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' O t Y Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of aiminal penalties of a Sue to 51,500.00 and/or one years'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 ads statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pasts and penalties of perjury that the information provided above is truee and coned Date Signature LIZ 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# :CIB lding Department ensing Board ❑checkif immediate response is required ctmen's Office lth Department contact person• phone#; er (devised 905 PIA) 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 peimit/licens6 number which will be used as a reference number. The affidavits may be returned fo the Department by mail or FAX unless other'arrangeiiients have beenmade. _.,....._.�...�_..r.:.:... .�.._..__.._- ._... . 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. ////O/ The Department's address,telephone and fax number: _ The Commonwealth Of Massachusetts Department of Industrial Accidents Me ot.lnvestivadens 600 Washington Street Boston, Ma. 02111. fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director .Building Division Thomas Perry,Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: (/ JOB LOCATION: S /V x number' ,o street G / village "HOMEOWNER": ' f (i[ (C41��e gOO —�(� Z —! b 7 537, name home phone# work phone# CURRENT MAILING ADDRESS: 3 S �.Z Z% 4,41 5 �fm�le ! � a ?�3d 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 S. ' a ' f Signature of7fomeowner 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. hi this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN L