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HomeMy WebLinkAbout3695 MAIN ST./RTE 6A(BARN.) a ar yjYJ�t�rr �,S/q�(� �, e ya,s..tt ``J i^��Y,,�,�� �,/^r O�(f I!��. �J�••. t '1��'��f%'�3.��+ 9ete '��f't",�J�l�)Yfa•;>dj��y,( ,�l�i, l.Ix �t''�r Y 'f t: x�l'�,f>�1 a �l 'Gja���". ,, s., .,: , r l i n td iL'YF 1+;�n+� ti u;. .,F< ,3:r. �..��4f ��' ...,,. (��,rYJa y.,,� f"ll�tXi �� �,ii, r } .}a 1€, 3i Y,,t,t {rag,., y ` l s. )7u�err!'<, jn, ��' �• f / � f _ �+X JA U y 1. �., Ilf,.. P wN� r`1 V jr��l U r a t ) ola/� 5f �oFIMME C�t�3 �/Town of Barnstable *Permit# O Expires 6 months rom issue date Regulatory Services Fee * •n MASS.SS. Thomas F.Geiler,Director rED N1A't A PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner LIAR 3 0 2010 200 Main.Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABL Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid.without Red X-Press Imprint Map/parcel Number 7� l /� Property Address G i, q, 111,q o IS11Ce e7 , Aqz kq S/lq6 �L /® t� [Residential Value of Work (J 0 _ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address C /� I h 6(0 177e �3 5 1�1^g skeer , A W 570h( ln4 Tele hone Number ; Contractor's Name I f.J S P p Home Improvement Contractor License#(if applicable) )q� Construction Supervisor's License#(if applicable) �� d ❑Workman's Compensation Insurance Che one: I am a sole proprietor ❑.I am the Homeowner ❑ I have Worker's Compensation Insurance / / a p Insurance Company Name i Q 0 ► L lJ�t4 0 °( A�19 `— Z115 o k ii�C1... Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) �Re-roof(stripping old shingles) All construction debris will be taken to ";❑Re-roof(not stripping. Going over existing layers of roof) ❑' Re-side #of doors 41 ❑ =Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows nir:*Where:required:-Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r' re uired. SIGNATURE Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 690809 �` • f The Commonwealth ofMassachttsetts Department of Industrial Accidents 1'a Office of Investigations f' r 600 Washington Street t Y Boston, MA 02111 wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information `�'� Please Print Legibly Name (Business/Organization/Individual): \�\✓� �7)�r 7�. lE / 1 Address: AlIQ S��bl pt S City/State/Zip: Q ` -C`3 Phone #: ��� -�7-'� 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 1 6. ❑New construction pltiyees (full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers'comp. ❑ Building addition [No workers' comp. insurance comp. insurance.# 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I required.] a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL c. Roof repairs insurance required.]t c. 152, §i(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: tContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob 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 certify i r the pains and penalties�rjury that the information provided above is true and correct. t ! I Signat Date ure �! Phone#: ­IC54C4( 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 S. 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 o her legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representativ s of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity, e ploying employees. However the owner of a dwelling house having not more than three apartments and who resides erein, or the occupant of the dwelling house of another wh{o employs persons to do maintenance, construction o repair work on such dwelling house or on the grounds or building appurtenant thereto shall'not because of such employ rent 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 operatea business or to construct building' the commonwealth for any applicant who}has not produced acceptable evidence of compliance with thet surance coverage required." Additionally, MGL chapter 152, §AC(7)states"Neither the commonwealth nodany of its political subdivisions shall enter into any c tract for the performance of public work until acceptable evidence of compliance with the insurance requirements of th chapter have bee�rr presented to the contracting authority.' Applicants Please fill out the workers' comp• satio'n�affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)n me(s), address(es)and phone number9s)along with their certificate(s)of insurance. Limited Liability Companies(Q%C)or Limited Liability Partne hips(LLP)with no employees other than the members or partners, are not required to car orkers' compensation insu once. If an LLC or LLP does have employees, a policy is required. Be advised th` t t is affidavit may be sub/ ub itted to the Department of Industrial Accidents for confirmation of insurance coverat . Alse pe sure to sign nd date the affidavit. The affidavit should be returned to the city or town that the application\for the p8 it or licens! is being requested,not the Department of Industrial Accidents. Should you have any questiN regarding be law o�if you are required to obtain a workers' compensation policy,please call the Department at the number liste belo w. 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 legr ly. The Department has ovided a space at the bottom of the affidavit for you to fill out in the event the Office of In estigations h9•s to contact y r regarding the applicant. Please be sure to fill in the permit/license number which will e used as a.rference number. addition,an applicant that must submit multiple permit/license applications in any giv year, nee`` only submit one af5d`vit indicating current policy information(if necessary)and under"Job Site Address"th applican should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or arked b the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits o license A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or per n t rela ed to any business or commercialenlure (i.e.a dog license or permit to bum leaves etc.)said person is NOT requ ed t complete this affidavit. The Office of Investigations would like to thank you in advance for your co ration 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 Massachus Department of Industrial Accident Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia 1 a THE Tod, Town of Barnstable r + Regulatory Services BAR'ST^$LE• r Thomas F. Geiler,Director 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 I� as Own -of the subject property hereby authorize iw�. �'L\ to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address;of Job) Signature of Owner at Print Name 'n for permit lease complete the If Property Owner is applying p p p y Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSiON r ,F4 r Town of Barnstable o Regulatory Services =MartsrABLE Thomas F.Geiler,Director Wss. 9g,A 1639. a,�� Building Division ` TfDy 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: 1 s JOB LOCATION: 1 number street village "HOMEOWNER": \ name home phone# work phone# CURRENT MAILING ADDRESS: Aindi ' state zip code The current exemption for"hom extended to incl de owner-occupied dwellings of six units or less and to allow homeowners to engage for hire who do not possess a license,provided that the owner acts as supervisor. FINITION OF OMEOWNER Person(s)who owns a parcel of lhe/she resi es or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or tached s ctures accessory to such use and/or farm structures. A person who constructs more than one home in a two-ye r period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Offci 1 on form acceptable to the Building Official, that he/she shall be res onsible for all such work performed under the u.,ldinR vermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibilk for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she unde tands the Town of Barnstable Building Department minimum inspection procedures and requirements,and that e/she will comply with said procedures and requirements. Signature of Homeowner r i Approval of Building Official f Note: Three-family dwellings containing 35,000 cubic feet or 1 er 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 i �quired shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeo er 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 responsibili'es of i supervisor(see Appendix ar Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often resin m serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed p on as it would with a licensed Supervisor. The homeowner acting as Supervisor islultimately responsible. To ensure that the homeowner is fully mare of his/her responsibilities,many communities require,as pa of the permit application, that the homeowner certify that hdshe 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:\WPFlLES\F0RMS\bomeexempLD0C !Niassachuse'tts- Department of Pui;ltz '-4 tti So:u•d of Buildtn!_, Re!-ul tti.w n� tnd St tndards Gonstru:ction SupervisorSpeciaJt•p L'icense_. License: GS SL 99406 a Restricted to:_ RF,WS,DM KIM BASSETT 3775 MAIN STREET GUMMAQUID, MA 02637 t; t Expiration: 1 2/1 21261 1 ('ummi siuni r Trtt: 99406` :. — Iloxeleof u Bi,ildif)"l.e�itJahoi s aiiu Slattuurtla Y HOME`IPAPRO4EMEN� CONT, 1 1CCIISQ Oi rcgtstraLo4 alid for ndivrdul j 4ACTO52o , hefoxe14 tht<erptratt°�n date If found t etw n ass $ r Registration� 159706 Board of 8ntidng I�.egulat�ons nntl Stardards� '. ` Exptrabon # 5/1 10 Tr# 268660 One AshhPrto Place a 1 e_ Indfividual Bostc)ti'-Md.d O R►n 1301 $ KIM MBASSETTii o KIM BASSETT Z� II 3775 MAIN ST ''� / GUMMAQUID,MA 0263 ---' ., Administrator. " Not valid.withq�t signature f Town of Barnstable *Permit#y 007cl s a3 . Expires 6 months from issue date X-PRESS PERMIT Regulatory Services Fee s NOV 2 7 Thomas F.Geller,Director 2007 Building Division 8ok ' TOWN OF BARNSTAj3LE Tom Perry,CBO, Building Commissioner / /00 e7 200 Main Street,Hyannis,MA 02601 www.towiLbamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work ZCA-' i Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /�AIrctjti 41 V M-C Contractor's Name r l/I Telephone Number Home Improvement Contractor License#(if applicable) �Oy Construction Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: ❑ I.am a sole proprietor ❑ I am the Homeowner E;-+'I ave Worker's Compensation Insurance Insurance Company Name ,L h f Lam, Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over' existing layers of roof) (� Re-side I 'q- T? Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: perty Owner fisign Property Owner Letter of Permission.,Py - �Sop of the Im r ontractors License is required. SIGNATURE: . Q:Fonns:expmtrg. Revise061306 mc'. ISSUE DATE 09,104/2007 -� RODUCER THIS C':RTIFIC'ATF IS ISSUED AS A MATTER OF 1'NFORMATiON ONLY AND � ilier McCartin CONFI RS NO RIGHTS UPON THE.CERTIFICATE HOLDER.TI IS CERTIFICATE l ba Dowling&O'Neil Iris Agcy DOES :10, AMEND,FXTF..ND OR ALTER THE COVERAGE AFFORDED HY'THE POLICS BELOW. In')West Main Street [yannis,NfA 02601 COMPANIES AFFORDING COVERAGE � INSURED 'I➢liatn}N C.rUStOfI �iba Wi➢liam W Croston BuildingContractor ! COMP..NY AA.I.M. lvlatual Insurance Co, I 0 Box Box 138 I.E7'1 ;R Pster','i11e,MA 102655 THIS IS TO CERTIFY T IIA,r,rHE PouciES OF INSL R AN E LISTED E:D EIl ( )W HAVE.B2EN ISSUED TO THE INSURED NAMED ABOVE F'OR THE-POLICY PERIOD IND➢CA I FL'),NOT1g'ITIISTAND➢NG AIVI'REQUIR5MEN 1',TERt OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE..MAY BE ISSUED Olt MAY PEKTAIN II1 INSURANCE.AFFORDED BY THE PQLICIES DESCRIBED HE'RELN IS SUBJECT i TO ALI."F.WE TERMS,EX(A.L1SIZ)NS AND CONDITIONS OF SUCH POLIO LS. LI.V1T5's1iOW'J MAY HAVE.BEEN REDUCED BY PAID CLAIMS. CO —` ' :FFF:CSIY6 FULIL'Y FCPIRATION Te LT.RI r}'P@UF INSURAN(:E �POL(C4 NUMBER POLICYY ! DATE'',WDDNY1 DAYE(MMIDDNY`) LIMITS� -{ I I GENLRAL LIABILITY I GPNERAL AGGREGATE . I li I okLODUCrS•(:U�4P;6 �CUMtv'IER:'IAI.GSNPR.AL 7.,ADiLIT'! I —�.-..--..----�_...•.�_�- I PFASONAL 4,ADV MURY _ =CLAIMS MA1311=00CJR t^-I I � �PACH OCCURRENCE^�`_..�..� �^_�•- �C;OWNER'S&CCNVTRAC70R S Fr.GT. I `FIRE DAMAGE(Anyone line; EA76NSE(Anymx pmw) .. � ��.. ' AUTOMOBILE L.tAB[L[TY CUtdBL4LU SINGLE 11—�-11 ANY AUTO } 1 I All.OWNED AUMS. ( i - BODILY W1URY SCHEDULED AUTOS i 1 HIM)AUTOS � I. I I�JNQN-OkNED AUTOS I m MILY INJURE' j taRAGEi,IAHILITY ! I(Fa'ccndmf) PROPERTY DAM AGE . .E\C&SS LIABILITY __.__,L? amt.A FORM I i r--- ---^-- *TA- TUTORYREGATE OJ'DIERTHANUMBRELLAFORM f WORKERS COMPENSATION AND LtMYTS "THER EMPLOYERS LIABILITY X rHa PRopwE row I r 1,000,000 F.L tiACH:ACCit)1r;S I' ' A �RMI:RgtEXEf,UrfVE � I I � 3 JfrFICIPRc ARE-1 10Zi4r>C :L1L: 1 J 9/Vi%�i}�7 09% 8/7 00 , 0003INCL EXCL E - tY . m , 0 {- tI EL DI PLOY SE-EACH t, D(K}o 4Ilt7E"d I$/DESCRII'TIf)N OF OPERATIONS OR 1,0CATIONS: II f IVYILI:IA!vi'W CROSTON IS NOT COVERED BY I'P.IF:ti4'(?RlltrRS'CC)MPE.,'SATION 1'OUCV. i i 1 *, i __.'Agne rNOLLD JY OF fHE ABOVE DESt RIHPD POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE yl MHF.REL(' HE ISSUING COMPANY WILL ENDFAVORTO14AILj V,-RIT`rU-NNOTICU..TOTHEI;ERTIFICAf,; i OLDER IN .MELT 7q THE C.kr1 3l'1'FAILURE S 1'O MAIL SUCH NOTICE 8f#AI.L IVSPUSF.TJa OHLIGA'I(iN (OR t IAIs(L PY OF ANY KIND t TON I'I{E COMYAA7Y,ITS AGENTS OR REPRESLNTATIVES II ALTHURI, E:2REPRHSF.,7ri' TIVE. ' �P�. ✓�ie V�o-avrrea�,uuea�i o���'�ac�ucaeC�� _.__--- -- r r x t$Sl�krd of Byjlding4q%ulations and Staudardi3 Licegse yr reg�strattuh vahii for tndt�itul use oq IMPROVEbtE(VT CONTRACTOR I j ' before the ex�tratloiitate< ffou fte fr tion ;:r I t�lrsturn to, h00023 Board of Buildin R.e ul ttiona cf Stattclartls -Expiration g 6/8/2008 One Ashburton Place Rm 130.1 :" f . p Type DBA Boston,Ma.02108 PfLL CR TON BUILDING CONTRACTOR VILLfAi4,VROSTON S ; k /� hi'kNN1€, _ �Z Beu Ad+n+ 3tratpr -- _ �s ;+� kalil t+ithoyit�ign. �4 i y 4 4 . The Commonwealth ofMassachusetts Department'of l'ndusfriaZ Aeddents ,ffi f' vestigations s 600 Washington Street . ,= Boston'mA 02-1-11 V)dw.massgov/dia Workers'Compensation Insurance Affidavit; Builders/Coritractors/Eleeti;iciatts err' A licant Information .Please Print Name(Business/Organizatioa/individual); Address: G w Y ' City/state/Zip: �-w��� � ,. l�ZG f-r -Phone.#:_ 6'r� �'g, /'4�y Are yob azf:MplQyer •Cheekthe appropriate boat: 1,� :Type ofpioject(required I am,a with_ 4, [❑ I am a general contractor and I employees {full and/oz part time),*. have hiredthe stab-contractors S. ❑New construction . 2•❑I am a'sole proprietor or partner= listed on the'attached sheet: 7. ❑Remodeling ship•andhave no employees These sub-contractors have B. ❑Demolition. -Working for me in any capacity. ernployeeo and have workers' [No workers' comp.inqu=ce comp. insurance.$'• 9, ❑Building addition required.] $. ❑ We are a.corporation and its 10,(]Electdcal repairs or additions '3�-I aara homeownez dying all:�vozk — ----officers have exercised their 11:❑Phmmbing repairs o=additions myself,[No worzcers'camp, right 6f exemption per MGL insurance,requized,]t c. 152, §1(4),and wehateno 12,❑Roofrepaizs . . employees, [No workers' .•13<❑ Other ' gorrzp,insurance required,] *Any spplicant thatchecla box#1 must also fill out the sectiodbelow showing their workers,compensation pohayinfom�atiao. 1 Homeowners,wha submit this a$davit indicating they are doing all work and then hue outside oontractors mutt submit a new 1Ccntraetbrs that check this box must attached in additianal•theet shaving tha.name of the pub affidayitindicating su ch, contraotors sod state whether arnotthose entities have employees, If the sub-contractors We employces,they must proAdb th*workers,comp,polidy number. Ian an employer.ifiatisprovidingi+orkers'gompexsatian insurance formy employees, Below is.thepolicy and fob sfte'' information, Insurance Company Name Policy#or Self-ins,Lid,#,• ?vq S GG Expiration Date; -/ 9 10Y fob Site Address' // City/State/Zip: -rvt S /�k f`2L ' 4-3�s Attach a copy of the workers' compensation policy declaration page* (showing the olio number and e policy xpu'atioa date),• kilure,to secure coverage as required;tmder Section25A;of M-CTL c. 152 can lead to the imposition of criminal fine tip t$ 50.00z.d and/or agar one-year imprisonment,as well as civnpenalties in•the form of a STOP WO ORD R and a fine Ofpenalties of a up to$250.00 a day against thg violator, Be advised that a•oQPy of this statement maybe forwarded to the Office ofInvesti ations of the b for insura ce covera a Verification. I do hereby cent' `der the p ' s xd penalties o,perjury that the informatiox provided above is true and correct. Date; Phone# Gf LBORrd We only. Do not write in this area,tb be completed by,city or town official Town., ' Permit/License# . uthori:7(circle one);• of Health 2,Building Department 3., City/Town Clerk 4,Electrical Inspector 5. Pluzc�ing Inspector Persan: Phone#• .��1gg�� gg� egg gg�g@ �gq g @�®g g ®g g g p� - V�s u u U L+.1LU51..9. U1-1 K,9..•.�.IL.B-N 8�.-dl U k �+x'n.�'un Massachusetts Genzr 'Laws chapter 152 requires.all employers to provide workers'. compensation for then emploYees. Pursuant to this statute,an employee is defined as"..,every person in the service of another under any contract of hiie, express or implied, orala wtittem" 1 An Employer is defined as" individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in aj int enterprise, and including the legal representatives of a deceased employer, or the receiver or trnste6•of an' :1,partnersb'-p,association or other legal entity,emp'oying employees, However the owner of a dwelling house having otmore than tbree apartments and who resides IN rain,or the occupant of the dwelling house of another who emp ys persons to do'R+aintenance,construction or air work on such dwelling house or on the.grounds or building appurte thereto shall notbecause of such emplo? entbe dee=dto be an employer." IvIGL chapter 152, §25C(6)also states t"every state or local licensing agency s all withhold the issuance or renewal of a license or permit to'operat a business or to construct buildings in he commonwealth for any ,� applicant who o oduced,acce tab evidence of compliance with tfieiin -ance coverage required," . tw hasn t r P . PP P P ' Additionally,MGL ahapter..152, §25C(7)eta 2Iejther the commonwealth nor ,y of its political subdivisions Shall enter into any contract for.th6,perfrnma�ce 6f. bl c.workuntii aceeptablo '8 of•compl&7ice 7ithtbe in e' requirements of this chapter have been presente to the contracting authority;' Applicants Please fill out the workers' compensation affidavit lately,by chec ' th ox68 that apply to your situation and,>f necessary,supply sub-confiactor(s)name(s),address( )and phone numb r(s) ong with their certificates) of insurance. Limited Liabilify,Comp cures(LLC) or Lima ad Liability P artocrs ' s(LLP)with no-employees other than the mor bers'o of re ed to c workers mp ensation' e. If an LLC or LLP does hav e r artners aze n P � � � P , nt o Industrial employees, a policy is required• Bp advssed that thins affi vmt may d to the Departroe f Accidents for confirmation of insurance coverage. Also b sure to s' a d date the affidavit. The affidavit should be returned to the city or town that the application for the pe it or lic ns is being requested,not the Department of Industrial Accidents, Should you have any questions regardm the o if you are required to obtain a workers,' comp ensatioh'policy,please oall the Dapartment at the n=ber��' 0 bie w. Self-insured companies should enter their . self insurance license number onlhe appropriate'line City or Towp Officials Please be sure that the affidavit is coaaplete'and printed Legibly, apartment has provided a spacq at the bottom of the•affidavit for you.to.fill out in the event the Office of Inves gi ons has to contact you regarding the applicant, Please be sure to fill in the parmit/lieense number which will be as a ref6reiice number: In addition,an applicant that must submit multiple permithicensa applications in any giv n dar,Heed only submit ono affidavit indicating current Policy information,(ifnecessa y)and under"lob Sife Address" at licant should write"all-locations in (cit5'°r town)."A copy of the a�davit that.has been officia.Uy stampe r edby the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future p e• is or 'ceases. A new affidavit must be filled out each Year.Where a homeowner or-citizen is obtaining a license o ermit t relatedfo any business or commercial venture (i.e. a dog license or permit to biun leaves•eto.)saidpers64 OT rued to complete this affidavit. The Office of Investigations would like to thank you in a ce.for your cooperation and should you have_any questions, please do not hesitate to give us a call. The Deparimeut's address,telephone•and fax number:. A4 W, rltputraIr4finduswal Acoid=ts 0 6 Washing 5a TO.0 617-727-4000 ext 4.06 or 1-S77—K-ASSAFE Revised 1I-22,06. FOX#617-727- 749 - � � ��•�,��� . f - �, Town'of Barnstable Regulatory Services 9&ON 8LE, Thomas F.Geiler,Director wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ffice: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Gl�daz , as Owner of the subject property herebp authorize i`yJ to act on m7 behalf, in all matters relative to work authorized b7 this building permit application for: (Address of Job) Signati}te f Owner � Date , Print Name Q:FORMS:0VNERPERMIS SIGN Town of Barnstable *Permit �S 8(e 9 CF ZHE T°� Expires 6 months from issue date WtNSTABM• �; Regulatory Services Fee v MASS. m Thomas F.Geller,Director s639• �0 �'pTEDMAyp Building Division X-PRESS PEA Peter E DiMatteo, Building Commissioner 367 Main Street, Hyannis,MA 02601w S F P 1 7 2001 Office: 508-862-4038 TOWN OF BARNSTABI E Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map:parcel Number 3 17 A,1 c i+/ mot' cac Property Address ) T Value of Work $ O� ❑Residential Owner's Name&Address Telephone Number 3 2 ' Contractor s Name .2 �?I Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) r r p17syo� ❑Workman's Compensation Insurance Check one: © I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name a^- Workman's Comp.Policy Permit Request(check box) - ir old shingles) Re roof(stripping_ g ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value ( 44) ❑ Other(specify) • uired: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Where req Signature J Q:Forms:cxpmtrc:rev-070601 t •' °Assessor's 6ffice-(1st floor) Map - Parcel Permit - Date Issued 16 / -f Fee , ` --"'Engineering Dept. (3rd floor) House# la ng t.(1 or c of Ad . Bld BARNMBLE. MAB fi rtive an a an ' oa :_ , 039, TOWN OF BARNSTABLE _Buil ' P ng ermit ppl'cation Project Street Ad s �o ✓ �� G l✓1 (5/ Village / Owner /` ¢ 4'41 6 Address 4•-n -r' Telephone Permit Reques o SC 0 0 Alell � d� el' First Floor square feet ; V Second Floor square feet ' Estimated Project Cost Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family 0 Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway—0 E Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other / Builder Information Name `d �(/6f rr I ,f cJ G' 1\1 Telephone Number 7 SZ-0 11-A 5 7 Address/,3,:�-S— Ls—,e4 License# GAT ti 1.�, e_ d,,� L_ 6 / Home Improvement Contractor# fa � Worker's Compensation#O C ya I f,3 O 5 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCT1ONBRIS RE ULTIN FROM S PROJECT WILL BE TAKEN TO 2Gl /I ' i SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) t FOR OFFICIAL USE ONLY PERMIT NO. ! ! DATE ISSUED , MAP/PARCEL NO. ADDRESS ' VILLAGE r . . J r , OWNER DATE OF INSPECTION: FOUNDATION FRAME , 'INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ } + ' '` .x• � � f r . ! ! 1 to ' ! DATE CLOSED OUT ; ASSOCIATION PLAN NO. , The Town BAR., of Barnstable MASS.. tee$ , Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA o2601 Office: 508-790-6227 Ralph CaysseII FAY- 50R-775-3?" Data T !d AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PEkWAPPLICATION MGL c. 142A requires that the"reconstruction,alterations;innovation,repair;modernization;conversion, improvement, remotial, demolition, or construction'of an addition to any pre-adsting owner occupied building containing at least one but not more than four dwelling units or'to strvWuec which are adjacent to such residence or building be done by registered contractors.with certain exceptions,along with other r+egtunemeats. Type of Work: e Woo ke J r le GI/r, 4� G 0 .�! Fat Cost Address ofw---k: 3 OKnerName: W// e,, Date of Permit Application: I herein,certify that: Registration is not required for the follos ing reason(s): Work excluded by law Job under S1,000 Building not owner-acarpied Oarer pulling own pmuit Notice is hereby given OWNERS PULLING THEIR OWN PERMIT OR DEALING Nvrm UNREGISTERED CONTRACTORS FOR APPLICABLE HO,\fE TWROVENt ENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION FROG -*,,%, OR GUARA.NrrY FU?�'D UI�'DF—R I~;GL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date ConAactoPfSme Registmuon No. OR Date Owner's name issessor's office(1st Floor): es . :Assessor's map and lot num. = 3 9 C �o�THE toy Conservation(4th Floor): �` 13 J•.+a-�� SEGO 7 1C Sys— Board of Health(3rd floor): ANN INSTALLED'Sewage Permit number N C® WITH TIT •a)o. d' Engineering Department(3rd floor): q ENVIRD House number r 3& GS ,Qj ����dTi4L C Definitiye Plan Approved by Planning Board 19 TOWN REGULATIONS APPLICATIONS PROCESSED 8:30 9:30 A.M:and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby japplies �for a/�pe/r�mit according to the following inform tion: Location W"/`i / "�I//v ��1 I ✓F/ ✓Vn Proposed Use OfVeme, W 0dp L;P I 0 Zoning District Fire District (�C� Name of Owner Address t Name of Builder Address Name of Architect Address 17 Number of Roorps / Foundation 4 Exterior Roofing ll Floors Interior I I Heating ! v Plumbing Fireplace J Approximate Cost Area Diagram of Lot and Building with Dimensions Fee r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tola7me 7qkq,g�UboveqepijVnstruct Construction Si ipervisor's License ��s= � i LAMB, ALBERT R. ?J� No Permit For CONgmRTTrm SHED Location._3695 Main St, Barns ahlP owner -Albert' R. Lamb TTT r Type of Construction Plot Lot Permit Granted June 13 19 94 ; 4 Date,of Inspection: Frame { 19 ` r Insulation A g Fireplace 19 Date Completed SS a tom"• i�`: � } , f ti 3 Town of Barnstable r Zoning Board of Appeals Special Permit n Decision and Notice ---------------------------------------------- ------------- Appeal No : #1 991 -29 'i Applicant : John Squibb ----------------------------------------------- ------------- Summary of Relief Sought : At a regularly scheduled hearing of the Zoning Board of Appeals , held on June 13 , 1991 , having been originally heard May 09 , 1991 , notice of which was duly published in the Barnstable Patriot and forwarded to all interested parties pursuant to Chapter 40A of the General Laws: of Massachusetts (MGL) , the applicant , John Squibb , representing the owner of the property Albert Lamb , III appealed to the Board for a Special Permit under Section 4-4 . 2 of the Barnstable Zoning Ordinance , "Change from One Non-Conforming Use to Another" , to permit the reconstruction and an addition to a non-conforming accessory building . The applicant ' s s i to is shown on Assessor ' s (Map/-Far-c-e-I N.u_m_ber 3:1=7-%03-4_.;7 commonly addressed as�'3694 Main Street , }Barnstable MA, in an RF-2 , Residential F-2 D i s"t-r i-c"t: - The applicant ' s request was heard by Board members : Ron Jansson , Gail Nightingale , Dexter Bliss , Richard Boy and Chairman Luke Lally . Summary of Evidence: The applicant , Mr . Squibb is a contractor for the owner , Mr . Lamb and represented the appeal before the Board . Mr Squibb described the location and factors that he felt justified the granting of a special permit . He also described the plans to reconstruct the 336 sq . ft . accessory structure with an addition to it for a total of 660 sq . ft . The accessory building is to be used as a home studio for Mr . Lamb . The reconstruction and addition will be located within the side yard setback area of the lot . The location for the reconstruction was chosen so as to not block the visual aspects from the home to the adjacent County Farm fields and to retain a larger , undisturbed center area on Mr . Lamb ' s lot . . The Board quest:ioned the use and location of several scattered buildings located on the site and question the structural condition of the building ' s remains . The Board also discussed the proposed use of the structure as. a studio for Mr . Lamb ' s Landscape Architecture profession . No one present spoke in favor or in opposition to this appeal . i The Board decided that a site visit and review of the materials was needed to assist the determination of facts related to the request . The public hearing was closed and the matter was scheduled for discussion at the June 13 , 1991 meeting of the Board . Finding of Facts : At the June 13 , 1991 meeting , the Zoning Board of Appeals made the following finding of facts as related to Petition #1991 -29 1 . The applicant is seeking a special permit to extend a pre- existing non-conforming building and to convert the building for use as an architectural landscape studio which is technically a business use . Such use not being "customarily incidental to the primary use" . 2 . The primary use of the property is for a residential dwelling and is zoned for only single-family residential . Business use is not allowed within this zoning district . 3 . The lot is narrow, being 63 feet fronting on Route 6A and a width of approximately 81 feet at its widest point . 4 . The reconstruction of this structure would produce a total of four ( 4 ) buildings on the small lot . 5 . With such a large number of buildings Located on the small site , the replacement of this deteriorated 9 foot by 18 foot structure with a structure measuring 12 by 40 feet would be detrimental . 6 . The proposed use of the structure would not be in keeping with the spirit and intent of the Zoning Ordinance . The vote on the findings of fact was as follows : AYES : Jansson , Nightingale , Bliss , Boy and Lally NAYS : None Decision : Based upon the evidence presented and the finding of facts , at a meeting held on June 13 , -1991 , by a motion duly made and seconded , the Zoning Board of Appeals voted to deny appeal #1991 - 29 for a special permit The vote was as follows : AYES : Jansson , 'Nightingale , Bliss , Boy and Lally NAYS : None Appeal #1991-29 for a Special Permit is denied . l Any person aggrieved by this decision may appeal to the Barnstable Superior Court, as described in Section 17 of Chapter 40A of the General Laws of the Commonwealth of Massachusetts by bringing.,an action within twenty days after the decision. has been filed in the office of the Town Clerk. /_ Chairman r I' Clerk of the Town of Barnstable, ' 'Barnstable County, Massachusetts, hereby cer.tify •that twenty (20) days have elapsed since the Board of Appeals rendered its decision in the . above entitled petition and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this day of r .pains and penalties of perjury. 19 under the l ' Distribution: Property Owner Town Clerk Town Clerk Applicant Persons Interested Building .Inspector Public Information Board of Appeals Assessor's office (1st floor):.' = ✓f� ', TMET is map and, lot number Board of Health (3rd floor): Sewage Permit number ................................................... L 13ABd9TADLt. J Engineering Department (3rd floor): '° MASIL 26 9 Housenumber ................:.r..:.:....:.......:.................................:. Definitive Plan Approved by. Planning Board ______ ________________________19________ . APPLICATIONS,PROCESSEb. 8:30-9:30-A.M. and 1:00-2:00 IP.M.'only TOWN O.F . BARNSTABLE . `BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... ....................... ..... .Y�.. ......................... TYPE OF CONSTRUCTION. + ; .............. � 19 TO THE INSPECTOR OF BUILDINGS: The "undersigned hereby-applies for a permit,according to the J Ilowing information: AV- r � r Location' :.........:.. 0...G�..��..r...........� ..: . .............. ................................................. Proposed Use ..... ` ...:.............:..................:.:.... ............................ ......... Zoning District ....................................Fire,District . 4 ' .................... ......... ..... .f..P.......,.....•..,..•............ ..• Name of Owner•.kll� ..,... .`.. J.I:I.!....J....!..........Address . .:�YC'li..�.:. 1..1..:. .. .. Name of Builder .....j '' ... 1..1.1 ....... ................Address ........: ............................................... Name of Architect ....7!'S' .................................Address ........:... let ......................................../'............................. Number of Rooms .........:'.v...................................:..............Foundation ........... . Exlenor ........00. :...Roofing ..... .. . Ap.. ... .W... ..... ✓ Floors (� ......�. ..............................................................Interior .........: Heating ..............''.:.............:....:.............................................Plumbing ........ 4 ' fireplace - •...................... .............................. ' ......Approximate Cost ....... .7 n' 2� Area4�.............................. 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 B.arnst e r i g t bove construction. Construction Supervisor's Licens ..:. ..... ......... ...:,..,... -LAMB, ALBERT R. III ` Permit for ,Enlarge Storage Shed .{ ;.Single F.ami1X Dwelling Location 369.5 Ma n...S.t.T:e.et. ............... aJ,e............. ................ Owner .. Albert R. Lamb,. ....I.II............. L - Frame Type of Construction' ............................ ........................C. .............................a Plot ..... ....... ...... Lot '.... ...:......... . ..:.. .... ....... March .. Permit Granted ................... 6... ..............19 s, . 89 Date.of Inspection ........ .�19 •-�'4„i. f� '. - - .......... Date Completed ......... 19 1-41 • - `fit_. `•-' � �� , �� � ; � '�7 ,� '~ _ram- .. • f .. i a _ I k�- Wil- - -------------- -YN i I 1 R� 11., � - JI Y I _ � f ........ �x� ;- ,.�.._ �I.I!ale•}+.—tn=-t i.��t'� j: , --- `( IR► � � RftF ai;' AW i r