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Home My WebLink About0112 CAP'N SAMADRUS ROAD /la C� 'n S�a.a�rccs ��b ... .�.--.... _�_ ..,, � ---,r.- �.r - __.. .. :. 4. __ .. _ _._ .. ._ . .� . k . _ .,. . 3�-0�3 '� r f� � , l t .�,� .. .. -.....wx.A:.:.e. y..i1. . _ „�. .. .v-vim _wxv.wa<�.c.,,.�m�.,«...f .......,,.��1«.,.r• ..._,.... .w �, .;w.. ,.,..,... ...�... .. - a.. .. .. .. _ .�...r. .+.. � i.,r.._-..,..way.,a._. ... . .... ....,.a.t.a.�.0.,.,ti..u�'tr'�:�uww„yw�•' oc vZmo °F11E r, Town of Barnstable �ermit#t" Expires 6 maiths fran issue �P Regulatory Services Fee T3AFiN5TABr.F r " Thomas F. Geiler,Director 1639. �0 plED Mt+'1 A 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 /J'`�Q� ^�jam( Not Valid without Red X-Press Imprint Map/parcel Number 03� 5 V- 13 Property Address �Z RAPT Sf �z✓rzr23 J�X (1—/ 'C 1 / i A 6 >14 3 S� -- ETf esidential Value of Work Z v Minimum fee of S25.00 for work under S6000.00 Owner's Name&Address \1 Contractor's Name �iy D/ L7- /t/O Telephone Number 7) V 836 X,01 Home Improvement Contractor License#(if applicable) 452 14 Construction Supervisor's License# (if applicable) (�t_ -5-1/% q .PRESS PERMIT �Vorkman's Compensation Insurance MAY w 3 2010 Check one: ❑-I am a sole proprietor TOWN OF BARNSTABLE ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name &irjLA Flim /t r J 6 Workman's Comp. Policy# ZDD/ UV 631 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 ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)# of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner m st sign Property Owner Letter of Permission. copy of the Ho a Improvement Contractors License & Construction Supervisors License is r 'qui SIGNATURE: i (7AA ' • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i 600 Washington Street Boston, MA 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): IUD /► 1 Ate . C- rT `T, YIH24 3� Address: 7i C�� U City/State/Zip: Phone #:�7 Are yo n 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 employees(full and/or part-time).* have hired the s Lib-con tractors 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 workingfor me in an capacity. employees and have workers' Y9. ❑ 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 myst;]f,..[No.work >s.'_eoznp,.....____._.........: right ht of exemption per MGL p i _. ,.-.__.._... 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: r4en., FR-m i � eitsm#oy Policy#or Self-ins. Lic.M. �06f W ��J Expiration Date: ��l�'Z®1D IIZ Jnyyi iQ,{� led' . City/State/Zip: C // M dot Job Site Address: � � 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 cer ' pa' s nd enalties ofperjury that the information provided bo a is true and correct. 'J Date: LO eo Signature: �,/ // / t� Phone#- 22 % B6 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Phnrip.#: 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-contractor(s)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 re uured to c workers com ensation insurance,' If an L LC of I T P 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 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 sire 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents 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 Of[HE Tph Town of Barnstable ~°^ Regulatory Services Mass: sa AS&iE Thomas F. Geiler,Director v �' fo3.,A 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 Usina A Builder as Owner of the subject property hereby authorize t,0;bV 7 T7M/- to act on my behalf, in all matters relative to work authorized by this building permit application for: / I N e1v (Address of Job). Paofr ner Date Print Name If PrT Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:FORTviS:OWNERPERM]SSION Town of Barnstable P�pFTHE Tp�� . o Regulatory Services • Thomas F, Geiler,Director • BARNSTABLE, '"�: ,m� Building Division lED �n Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barristable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �0 10B LOCATION: number street .village "HOMEOWNER": name home phone fl work phone I! CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&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 fonn/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC i D� �� C:o-�,c��—� '� �t. �,1 � �"�_Ott.� Z` r" �a ��Q ��. 5-�-�� ' Per vt.�c oLc�� - �;��7 ✓lee �°"""'a'Z"calf/a ✓` urfef�a License or re hon valid for individal use only of Consumer Affairs&Bess Regulation _ HOME IMPROVEMENT CONTRACTOR before the expiration dates If found return to: Region: ,157407 Type: Office of Consumer Affairs and Business Regulation Expiration: -1011/2011 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 J_P:C OM BUILDING, JOHN DALTERIO JR- 112CAPTAINSALMRUSRD: COTUIT,MIA 02635 "" - Undersecretary ot-valid(without si$ tare " Massachusetts- Department of Public Safety ` Board of Buil(lim, Re-ulations:end Standards Construction Supervisor License License: CS 511" Restricted to: 00 JOHN D DALTERIO JR 112 CAPTAIN SAMADRUS RD a COTU IT, MA 02635 cam_�y—mac Expiration: 10/6=0 (" nnni«inur Tr=: 5252 - W30/2010 15:12 5084209227 MARK W SYLVIA PAGE 01 P0413012010 THIS CERTIFICATE IS ISSUED AS A MATTER OF 011FORINlATION ONLY AND CONFM NO RIGI#TS UPON THE CERMCATE m LDER.ms CERTIFICATE DOES NOT AFFIRMTIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY HE POLICIES BELOW. THIS CERTIFICATE OF MUR=F, DOES NOT CONSTITUTE A CONTRACT DETwtEEN THE 13.4U[NG INSURER(S� AUTHORGM REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the CIMHkats holder 19 an ADDITIONAL INSURED,thslt P01*08s)must be enflamed. If SUBROGATION IS WAIVED,sutgect to the teems and eondltlose of the Palley.etertaln polities may regt6m an endar"nN nt, A 0:40 llsnt on this cerI ficate don not confer dghft to Bie carMcde holder In Beu of such errdorsemeel PROMMEN =."� Arny Ferrari Mall:Sylvia IM U MnCe Ag&M I PHCM 1 F/6z ag SDB 9227 771 Main Street SCO 428-0440 ;07:; m ®rk r9rtCe.c�m Oster ,MA 02655 U 7 � IHSllrtEfN9l aFPOanrNG COVEtrtkc,'ia NAIL s ItiSIl11ED - John Daftfio A' 112 Captain SamadrUS Roast IN>SI/R�i6: Cotuit Mil 02635 lusummc Mr�n; Fwm Four C-uo"y Insurarloe ixStiRER F; COVERAGES CERTIFICATE NUIIMER• REVISION MUNIO : THM IS TO CERTIFY TWAT THE POLICIES OF INSURANCE UST®BELOW HAVE BE3EN ISSUED TO THE INSPIRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT%MTH RESPECT Tb v*trCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEM514 IS SUBJECT TO ALL THE TEWS. FJtCttT.SIbNS AND CONDTTIDRrS OF SUCH POi eC(E5.LIMIT`S SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. lm R TYPE OF DtSOpmmm ADM aus" POt1CY KUlHB� t3� PO�r taurrs tAIOtAI.L1A81ury EACI•t OCCURRENCE S COMMERCIAL GEN*RAL u4MUTY uAmi CLAiAtstAADe ❑OCCUR MED Exv am pmm s PERSOHAL a nav JWLW i of AL AMMEGATE 8 GEJWL AGGREGATE LWITAPPUES PER: PRODUCTS-CONIPMP AG14 $ P my aR D Lac s 4UT69 nTM C()Mufmm SINGLE uwr S ANY AUTO 22 s4IRI BGORY INJURY(gar Peram) i ALL orvrt�AtPrOs .. i scrEouL®AUTbs SWILY INJURY F---W-o s HIRED AUTOS PROPERTY pAMAGE i IPo.wodoerrt} NON-01NNED AUTOS I y I. 00CUR EACN OCCURRENCEZLA AGGREGATEON 4 i D m EMPLOY uae try 2001W63 I7 9!l7P1016 X w1C t AT11 aTH AW PROPRIEitU E r N x OFFICERME MER EXCLUDED? ® N r s; EL EACH AC(MEiJT S 100.0QQ I in Ye E.L ltt ASe-ea ENSPt ; 500.000 Dma av OF OPERAnOas baW 15.1-DISEASE-POLICY UWr a !00 000 DESCRIPTIOlN OF OPERATU M I LOSATNCN$I VE►iCUM IAA ACO[m 1D1,A@RH60N RonDnlm Sri 1r,Brnore eptm M nqw� Job Loc-dom112 CaMin Samadru9 Rd CotuH,MA 02635 John Daterio IS inoladed under Coverage of Workers CoMpensa&m policy llgW. CER71RCATE BOLDER CANCELLATION John Daltedo SHOO D ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED SWORE 112 Captain Samadrus Rd THE MggRATION DATE THERE, NOWA WILL Be DELR%RF_D IN CatUi1,MA OMS ACCORMWE VM THE POUCY PROVISI Pax 50&428.6928 AUMUROo RW99iATNE ®1985.2(lDS1 QCt1RD cr>FtaariEeerrntu an�r;ag.m.......r 1 • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3$ Parcel ® Application# 6096 � 7 Health Division C-;2 do 1O260(49 Conservation Division / Permit# a� Tax Collector Date Issued Treasurer Application Fee S '' —D e> Planning Dept. f Permit Fee ' SFp C Date Definitive Plan Approved by Planning Board Z, Historic-OKH Preservation/Hyannis �G� Project Street Address Z Cow S S O Village CiDhjif f o n, ,� Owner�� lJG{ � "� Address Telephone Y2B Permit Request 6_e. ( 2-o i?e o `F h1 Square feet: 1st floor:existing proposed 50);. nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Type Wood PIPIME Lot Size " 6,9 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ 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 new Half:existing new Number of Bedrooms: existing new 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:❑exis ng ❑rf"drr siz�E" Attached garage:❑existing Cl new size Shed:❑existing new size S. • Other: 0 � S i _ c Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ° ss Z 3 Commercial ❑Yes ❑No If yes, site plan review# o0 m rQ r- Current Use Proposed Use Ln r" BUILDER INFORMATION v Name I Telephone Number Address Z License# 0 Z 6 35 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEB S RESULTING FR M THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - MAP/PARCEL NO. > r ADDRESS �x VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION FRAME lBrRW INSULATION _ FIREPLACE c ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL J FINAL BUILDING + DATE CLOSED OUT ASSOCIATION PLAN NO. + \ 1lrG VV/!r/!rV/r IYGWKIr Vj 1I1wUU wbILWU GLLU Department oflndustrial Accidents _ Office of Investigations 600 Washington Street' Boston,A" 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affida-vit:.Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le `bi Name(Btisiness/Orgmization/ludi-vidual): D ' Address: 1(2�.mC�-D7" S�it'rtQ�2;X�s City/State/Zip: ` 'OtIU,� 0 CSS Phone:#: Are you an empIoyer2 Check the'appropriate boa: -Type of project(requited):• . 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part time).* have hired the stab-contractors 2. New construction . 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• E3 Demolition ' working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance 9. -❑Building addition re aired 5. We are a corporation and its 10.❑Electrical repairs or additions q ] officers have exercised their , 3 I am a homeowner doing-ill work 11.❑Plumbing repairs or additions myself o workers' co right of exemption per MGL. Y � �P• - 12.�Roofrepairs 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 anew af6davitindicating such. $Contractors that check this box must attached an additional sheet showing the name of the'sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employges,they must provide their workers'comp.policy number. I qm 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: lob 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 tinder 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 maybe forwarded to the Off ce of. -- Investigations of the MIA-for insurance covorage verification. I do hereby ce nder t at nd p n hies of perjury that the information provided above is true and correct,- Si atur Date: Phone#: 7/ Sib 4,6 / Offzcial use only..-Do not write.in this area, to be completed by city or town ofciai City or Town: Permit/License# Isriing Authority(circle one): :1..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other ContactPerson: Phone#: Inform a ion' and. Instructi.®ns 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 hiie, 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 rPc-ejVa.r or_=�ee•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." 1vMGL 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 cordract 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-contiactor(s)name(s),address(es)and phone number(s) along with their certificates)of insurance. Limited Liability Companies*(LL.q of Limited Liability Parhaershipa(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 pemut.or.license is being requested,not the Department of Industrial Accidents.; Should you have any questions regarding the law•oi-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 ippropriate'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 permittlicense 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 ventate (i.e. a dog license or permit to bum leaves-etc.)said pers on is NOT required to.complete this affidavit. The Office of Investigations would hire to thank you in advance for.your cooperation and should you have any questio•M,_,_- I please do not hesitate to givens a call. The Depaztment's address,telephone-and fax number;: e Commonwealth of M=aehWCAtS f)epaztmmt of TadustdO AQ6 dents- MCC Qf Iny&S..0gati4ns 600 Washingtoii Stre% Renton,ILIA Cal l l Tel.# 617-727-49-0.0 ext 406 ar 1-$!7-MASSAFE Fax# 617-727-7?49, Revised 11-22-06 • f °0HEA Town of Barnstable Regulatory Services rB BM MASSS. A Thomas F.Geiler,Director �A i639. �0 lecrura Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. D �D Type of Work: (IMM Vf Estimated Cost �( Address of Work: 1�Z C �( S ,r � � �Q'• l T /�l` Q�� I Owner's Name: d Date of Application: �b I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Plwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Dal Owner's Name Q:fomis:homeaffidav �pS14E ti Town of Barnstable Regulatory Services BARNSrABLE, Thomas F.Geiler,Director y MASS. E1 M9. , � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: G�Z �14 �71 Al'a$ W, 1 r num er street village "HOMEOWNER":_ b AZTFluo Pp � 0 —' D 9- _M-9_36- 9 6l y name home hone# work phone# (-- I CURRENT MAILING ADDRESS: I I_Z_ C city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellinZss 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" omeowner"certifies that he/she understands the Town of Barnstable Building Department min' um' ec ' n procedures and requirements and that he/she will comply with said procedures and req eme s. Si aj re 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 persons)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. Q:fonns:homeexempt f I mil. I l zq I7;u H I i � ! I ;ail II � I �a I =1 ! L 1 i 1 JLI -- ., i LN I T. I?j'j .SW-OT4!NQ f/Yv� �✓ ram•• • ,2�'Y'"'� , ► �1 I I I f I-wRA-P bolhool I I I I I �% ;ft: rye I I I I I { I I Jrr� JI-- i -r .I►I,� I I 1 I I I l v I. Wv,— II �►�1 .5�f�L I I ! ! I I I I �.r:cnc�x t-- C I *f M.! v LIRIP VN o�trtit rrt4 P IAnDA,I 41 1.ran /1 Kf s)PFAICC, r]�Ii.R►�. i �'n'rla ITe 1�� UZ6� i I - I � I {f' I � iiyy >, %m nn It v� \ � I o� L POOL' � \ LOT 03Ulu -\ SHED I , ly 05 fPpa-, l� 1 r.,m O�4 1IU 1 1G If T 1 AA'C 9nlVTi'• "PP" Thly Tt OPT(•_A('-TP 1McZ0T'C'1TT0XT Plan is For X-111nn 17nAIP. "r+" t.✓V• {/V(.L/• •.f "'" AILV ALA VliV AJ AAT6/1 Ad LAV AV Hank Use Only ' """" AJVI 9". V- TOWN: SO.T 7 — - REGISTRY OWNER: LARLFS`_L_ &k EAMCIA-9._ffD_ff14L_1 DEED REF: s'T�;&LR — _.BUYER: �LO�Y�LD.I2ALIT�Y{IP�IR.� — — —_ -I DATE: -f1,21L>�/— — — PLAN REF: 1a C-_, g_-,= _ZSC:ALE:i' vr T,� I HEREBY CERTIFY TO PLY�(Q1lTLL�DI�T1r�(GF..0 __ La,� ,�� Nate: I y4mi(FF gTIRVFY f:__�_________—_THAT THE BUILDING �4`�N.�1��t� d t"AM0 r rT m A XTrnc I SHOWN UN THIZI' t`LA14 15 LULATC:D UN THE GROUND AS y■ .jI'l P"�+� `` l.viv.�V711tSiv ia7 lrf%n1tri H[ru kTf%T ;;� r0oiilv�v DOLES __-- COiri�vnivi 11I51 MER--NEW -f, 40B (SUITE 5) I Tf� Tts c+ 7!\AIi ATn i ♦Lf OcL9TOAt%V Ocnireot+ll L��lmc nt+ TL1 E� IT �} ry� IV 111L" 4VINis"i Lt1TT .i L" ►Ai A'Vli l�uq VIIT.I:,I�1 Li1�iJ Vt' Iii Li 1`0•'3�.Y rY TOWN OF __RdPAf..4TdPTR ___________ Amn TWAT I Nk"A hPI,Cp1�I� INDUSTRY ROAD I IT nnEC NOT l.iF Wi•THIN Ti-IF. SPEC'IAT Fi QQT� H47.4Rf� I �' 'i\i`f'�;°Xr"tip<, A'f MARSTONS MILLS. MA. 026481 AREA AS SHOWN ON THE H.U.D. MAP DATED_7�2_ __�___ I _�� TEL: 428-0055 1 Community-Panel V ,250001 OOIB D � �- ""�` � FAX: 420-5553 � may_ _____ THIS PLAN NOT MADE FROM AN INSTRUMENT 21"31' '/' � 1 fPACJ A.-MERITHI9W. PLS SURVEY, NOT TO BE USED FOR FENCES. ETC. . ct r e'F N -Z I fl s t A&+ P� 54MllVCU S C � is*t,•.� .. �� C.EQTIFIED pLbT PL.1�1�1 ' sr... LOCATIO" CoTo I T I CMQTIP-( T"A-r TI-It= 'P 01,1DATIpW 5"43%V►J pt_o.►.1 TZ F'cIZE�.10E WZR E 0" COMPL',(S WIT" TI-•IE S I vim.Li►-1� I D� �3 Alva SETl3ACK VE-QUIlZE�c�tEWTe, OF T14e To w►J OP- B A e W?,rA L,& Cnv e.T • RE(�ISf'C-�2CD LAIJp SU�VcYokS 1'"I5 OL-AW IS UOT AN OSTeizvkLll= o MASS• IWSrQc)AAEtJT � Ti4E= 6I4:.LJI.D APRI.I CA�1T I WUT 8E USco To DeT`eMI N& Lo-r LI r.t�5 � i tAssesso"r's map and lot number ........��..?.............`................ Sewage Permit number .......................................................... �0,*T11ET��` TOWN OF BARNSTABLE BMUSTSBLL "6 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............................................: 1<2 , ;.....:.................................................... TYPE OF CONSTRUCTION ��t1 Oe .� .�/ t .................................................................... ..................... ............................... ...... fix? .................... .......19. TO THE INSPECTOR OF BUILDINGS: _ --- The .undersigned hereby applies for a permit according to the following information: ProposedUse ............ Q/r?.......;;��,�h l I�...... !..'.. .................................................................................... Zoning District ...............Fire District � ......................................................... ........l.....................:................................................ .. Name of Owner .:.,_................................. ................ ........� .Address ...,..................... ..................................... v r� ,S - Name of Builder .......:............................................................Address ........................................ ................. ......................... Name of Architect --'— ........�.f.......................................................Address ............................�....................................................... Number of Rooms a Foundation .... .'.!� �. .' � ....................................... .............. ..................................................... �/U�t 1 ...... ......"'sl.. ......Roofing ..........Xs:'t 1.16zm � Floors /il fcv t;l fiG Gw�! / - 1:'+. Interior .......................... lumbin ::..:.. Heating .......................................................... � g .. ..... ... ..... ............................ ` �.�" �11- � 2 f ....................Approximate Cost ' Fireplace .. ...... :: �.:�.................................. t Definitive Plan Approved by Planning Board -----------____---------------19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee !..................... ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH w�•. 27_9c Bone furnished by builder: b4 David Silva - 41 St.Margarets St. 1 + Buzzard- Bay, Ma. i G- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............................. ... .... .... .. .. ,tee,• medcoill , Charles E. A=38-43 v No ......20.Q.7.5Permit.for .... ne...story...... ...............aingl.e...family.L.dwell.in.g...... . Location ...1.12..j0a 'ri.:Samad.rus...Rd...... f .....................Catuit................... } Owner ..........C.h.ar.l.es...E.....Me.dnhill...... ` Type of Construction ...........frame................... . .............. ....................................... ................... '1 Plot ............................ Lot ........,23................... ` Permit Granted ...............IAp.ril...6......19 78 Date of Inspectio ..... .............................19 Date Completed .. f PERMIT REFUSED ...................................................... 19 i f► �,. .�5. tj . ........................ ............ ............ ....... ................................. . ............................................................................... 4 ............................ .................................................. Approved ................................................ 19 ............................................................................... ................... ......................................................... Engineering Dept. (3rd floor) Map Paicel Permit# > :w�r - .F House# Date Issued (^ d Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 7 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 4_ 0 Planning Dept. (1st floor/School Admin. Bldg.) t T BE SEPTIC.SY Definitive Plan Ap roved by Planning Board 19 INSTALLED NCE WIT TOWN OF,BARNSTABLE N IR� �EN DE AND Building Permit Application TOWN RECULQTIZ Project Street Address j 1 {1 G axho ,,' ru s R6 Village _pfwl. Owner J D 1 1).D114Pr La � 3 r. Address Telephone ` Permit Request [-t-/0L A- I 51-t f-i 5 SAfT) Ono 6LI 5 11 Eg EOaT-VW- 147- First Floor WO square feet Second Floor square feet Construction Type X.Estimated Project Cost $ /200. cZ, Zoning District Flood Plain Water Protection Lot Size 29— Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure . s . Historic House ❑Yes )(No On Old King's Highway ❑Yes KNo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None Shed(size) ih "/fPA-ok, ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ti Commercial ❑Yes p No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO if SIGNATURE ' DATE 7 4 BUILDING PE IT DENIED FOR THE KQLLOWING REASON(S) ME 9 V 9 1//f f w . FOR OFFICIAL USE ONLY PERMIT NO. ,o DATE ISSUED. ' - _ • : MAP/PARCEL NO .tom ADDRESS - VILLAGE• - = OWNER - DATE OF INSPECTION: ' FOUNDATION I '' FRAME INSULATION FIREPLACE a ELECTRICAL: ROUGH FINAL _ f41 PLUMBING: gbl ;vGH a FINAL r^' C' GAS: ' up O FINAL - r I N� y �' � _ FINAL BUILDING > G - 2 O b ^ !�-. 2M0 DATE CLOSED OU'T»a Sr. ej �,Q ASSOCIATION PLANTrO A. k Qp C n � 11 J a m G a : m a m m o o _ . o� cc o : co 1 - Jill 11 13 a; iJ s i CDT o TOWN OF BARNSTABLE • BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION Z ekP7 A 3t1gfq �i7 T(.� Z 4 3 Sr l S D 0 v Number Street address Section of town "HOMEOWNER" J60NI Name Home phone Work phone . - PRESENT MAILING ADDRESS S -N.( �0 V 6 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Off icia: on a form accapt*able 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 Star Building Code and other applicable codes, by-laws, 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 com 1 wit s /'d pk9cedures and requirements. HOMEOWNER'S. SIGNATURE J Q APPROVAL OF BUILDING 0 ICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne- shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. - In .this case our Board cannot proceed against the, inlicensed person as it would with licensed Supervisor. The Home '. wner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Fier responsibilities, mar. communities require, as part of the permit application, that the Home Owner 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. i ' The C11111171 f11111'eall/1 of 1 tassac h useln •' i'" °, '"rj! ' - -•-_•=t;_ Dtl7UrlI11L'I11 of Industrial Accidents 011iczofIINCS1192llvns 600 !f'asNllhtulr Slrc•L•t Ururkers' Compensation Insurance Afridavit �ItPlicint iintormat�inn Plcnse PRTNT Ie�'@v name y Im� F{N I/ f210 Inc tinn- � l A-Dt •VS tin 0 1 M�: 026 -hone I am a homeowner performing_ all work myself. I am a sole proprietor and have no one working in an} capaciry I am an enipiover providing workers' compensation for my employees working on this job. rnnlunn%• nnmt •ttlrlrrcc• rift— flhnnC#• incnnnrr '-n --llrt' I am a sole propriemr. ventral contractor, or homeowner(circle on e) and have hired the contractors listed beio« who the ollowina '.vori:ers' compensation polices: emmn:mv nntnr- ndd rrcc• cir -hone�►• inciirnnrr rn rnnrnnnv n trot ntldrr— rlts•• -hone fry incur^nre rn -nllc�• �� _ �lttach additional sheet if neces� rv____'•^ � .:: :: _�s.r ..Iris 'I..._• L \�a...+�v: `-..+..►_.�:�....�.�r•�' Fa,iurc to b'ecurc cu%•craee as requtrcd under Se��"A of NIGZ 152 tan lead to the imposition of crtmtna!penalties of a lineup to S1.500.U0 anuiur unc cars' imprisonment :us w0l :is civil Penalties in the form of a STOP WORI:ORDER and a fine of SI00.00 a day against me. I understand that cop) of this statement nta% De furs•ardcd to the Orrice of Im•estirslions of the DIA fur coverage verification. !rio herenv cc i r rrricr / pr!r art p rraltics ojperjurr that the injormarion provided above is t7�� Freer. Sicnaturc Ialc 7 Print tame �� Q-! O Phone 9 ✓v 8—7 Z0 �y� ' 'ofrciai use unls• do not write in this area to be completed by tiny or torn ofriciai 4t ` city nr tms n rertnitiliccnse it r-It;uildin:Department C21.iccnsinc Board L t.. Jelectmen's Uftcc i. _ chcci: if immediate respunsc is reuuircd C:ticalth Department is r c phone 9: contact person: r"tUttler�— Information and Instructions Massachusetts General Liws chapter 152 section 25 requires all employers to provide workers* Willperls::tit)n emniol'ces. As quilted Isom the an cmpturer is defined as every person in the scn•icc of :tni?tier undo- contract of hire. express or implied. oral or written. An em im-er is defined as an individual. partnership. association. corporation or other Icual entity', or an%• two or the fore_ning cnunucd in a joint enterprise. and including the legal represcmativcs of deceased cthhplovc-. or :l,c rccci\•er or trustee of an individual . partnership. association-or other legal entity, employing employees. Ho«e•. c rn\•ncr of a dwelling house having not more than three apartments and who resides therein. or the occupant of tune dwellinu 110LISC of anotfler NvIto employs persons to do maintenance ;construction or repair work on such dwizilin__ or on the __rounds or iluilding appurtenant thereto shall not because of such employment be deemed to be ::n e:^c MGi_ chapter !52 section _5 also states that every state or local licensing a-ency shall ivithhold the issuance c: _tip al of a license or permit to operate a business or to construct buildings in the commonivenifli for sni' tern► Who has not produced acceptable evidence of compliance %vith the insurance coverage required. ACID.Aonally. ncithe- the commonwealth nor any of its political subdivisions shall enter into any contract for :he pert6rI11z::ce of public wort: until acceptable evidence of compliance with the insurance requirements ofthis beer: pre�;znted to the contracting authority. Appilcnnts P!e�se 'ill in the %vorl:c-s' compensation affidavit completely, by checking the box that applies to your situation c:-. sucpivin_ company names. address and phone numbers as all affidavits may be submitted to the Department of `ncustrial �ccideats fir confirmation of insurance covera`e. Also be sure to sign and date the affidavit. The should be returned to the cin• or town that tile application for tube permit or license is being requested. r :hc Dcra;t;ne::t of Industrial accidents. Should you have any questions regarding the "law" or if you are rec::: .v ob,�:in s \,vori crs' compensation pofic}•- plerse call the Department at the number listed below. City or Towns ;ure that tlhe �ffidavit is complete and printed legibly. The Department has provided a space at the born:;'- the ::• flay it for you to fill out iul tube event the Office of Investigations has to contact you regarding tlhe applicant. F be _ : to fiil in the permit/license number which will be used as a reference number. The affidavits may be return-1 -:le Department by shall or FAX unless other arrangements have been made. The Office of Ins ant*oils would like to thank you in advance for you cooperation and should you have any que piease do not hesitate :o _iye us a cell. The Deparunenr`s address. teiepilone and fax number. TIhe Commomvealth Of Massachusetts Department of Industrial Accidents Office of Investigations ` 600 «'ashinbton Street Boston, '. ;. 02111 fax ®: (617) 7727-7,749 rihone =. :61-1 -77-4900 e::r. 406. 1t!9 or _ . - Ps IG f 5 01'r- yew �x 61 RAftcf3 ! ' g/ CcNtec i Sky. �+i �f' knce �tes I .y Wed ScAlk. 6 � yT---t` 1 � 'l-rDRU 5? w;tidow =x s,S-�•• - RAC ( . �,kb RA�': �sm 9 3 2A6 ; i LIt l A - . . .. . . . . R a;/s ;��_� b� ; GIi 11 TN CR>ASi d to 6'3Y i NI l I w�.a,•..o7-7 OD 00 f A o ,0 rb • j j- 7 -!i -- 1 �1 1 j 'mom i I I --�` ir ; g . I � l: .A - t C o k O Cb N Z `CAz"l A. l N cr n o co i s ODCL np " a Ti 1) _._ .... ji .._ . °All ml - IN R a 1 - o TZ I o � • Assessors office(1st Floor): 1�J?� �L,�i' •�� ' Assessors map and lot number � �i��+� � i THE to Board of Health 3rd floor): �r�r�/) 1p"STALLED IN MY ., Sewage Permit numberVM�� L Engineering Department(3rd floor): E�av,98a�®MMENTAL t .saDtt House number Definitive Plan Approved by Planning Board 19TOWN IiEGUL t7' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN •, OF BAR.NSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO /9 V`' to )9W e l it y TYPE OF CONSTRUCTION (.tJ o C, t-r/9 d 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 11-Z C 192'0 $f9,r1 y(Irk 5 d C U( �n,'f Proposed Use 51 w )If 411 Zoning District Fire District C�-T� Name of Owner CA31r/C S meC1 C-�� Address C*ip tv s l(d� Name of Builder Address Name of Architect Address -/ Number of Rooms Foundation C 0 Al C fr g Ica Exterior c /c S Roofing Ass l7 S'1�w� 1,S Floors `5/0 f�f y wUU Q Interior S O U Heating Plumbing tiU�e Fireplace /lr U Ale- Approximate Cost 000 , co Area Diagram of Lot and Building with Dimensions Fee �7S i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin the above construction. Name Construction Supervisor's License t - , MEDCHILL, CHARLES . No 33518 Permit For Build Addition Single Family Dwellinq Location 112 Cap'n SamadruG •Rnad Cotuit Owner Charles Medchill Type of Construction Frame Plot Lot Permit Granted February 20, 19 0 Date of Inspection 19 Date Completed 19 cL C) (=may , 2 ct My =a L Y ' t• r ►.e«.... � .y-,,,. ,�._.' .+•r i�,..�. ,.`.iw"'."'rt ,^t��. �J7K,� 7F"+�'rwr-w.+}r�R,�...w,•.�-evn.�7'�SiR:+�"4'e+:rt:'n;r�4:o-�i°,..': 4 Assessor's office(1st Floor): 0�6 L/3 Assessor's map and lot number �Qyo�THE Board of Health(3rd floor): Sewage Permit number / (�(/ V i/1 f • / Z 21AS39TADLL i Engineering Department(3rd floor): r.sn House number Definitive Plan Approved by Planning Board 19 ��Nil d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE `: BUILDING INSPECTOR r APPLICATION FOR PERMIT TO �O �l✓e rl�j/n/ TYPE OF CONSTRUCTION w U 0 �1 �1'/�Ile t r� 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /12, Cfli�;, lv s/9.afJ Cl,-k 5 CUA, f Proposed Use Zoning District / Fire District Name of Owner C kq f/'r S /we�c�1/ Address //Z C44 w 5/9 10"1f Nrt4 s Name of Builder Address Name of Architect Address n 1 Number of Rooms Foundation C 0 Al /r y- TO o d /i 6 S Exterior S i w c �� 5 Roofing A 5 12 Floors 5A, 0/y Lyoo Q Interior Lv U U C1 S Heating Al 6,/1/e Plumbing ' P Fireplace N U Ne- Approximate Cost Uoo Uo� � / Area Diagram of Lot and Building with Dimensions Fee 5�� 7s / i /lo /1"I ial 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. r Name Construction Supervisor's License P :DCI --'-i, CHARI,ES A=038--043 p3ff`oX3 No 3351.8 Permit For Build Addition i • Single Family Dwelling Location 1 12 Cap'n Samadrus Road COtlllt Owner Charles Medchill Type of Construction Frame Plot Lot y Februar 20 90 i Permit Granted � 19 I Date of Inspection _ 19 Date Completed - 19 a PERMIT COMPLETED 1/1/ 13 Assessor's map and.lot number ..... 7Ne .......... Sewage Permit number/. . .. Z BAUSTADLE, i House number ........ �. !.., ;l!yf'l.•.,.::............................. ...... • 9°0 M"& 2639' 9� aUP a TOWN OF BARNSTABLE BUILDING 11SPECTOR APPLICATION FOR PERMIT TO .�a '�C. kl ....................................... -1 TYPE OF CONSTRUCTION .,�,�{!�l/1 1.... .�.!El ... �... .. ....... .....!......V "f.... ........ t.1.!, ...........� .............i 9R TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ..�.. .......... ............... { J� �!..s•..............:�.�............................................................ Proposed Use ... � t Zoning District ........:...................................................Fire District ..... . Name of Owner GI! .��....... C.1�\1.�.'..........Address ..� . ........ •K•�?t,........�e&.4•G fA.S............... /� „� i ' r Name of Builderl l !�? �1�? �'+�.a..., � ...Address .........F..�.......I..... i•Wrt��..... ................. p Name of Architect, ..................................................................Address .................... Nur,h er of Rooms .........Foundation N��. :. " .........J.....Roofing �� Exterior .............y... :. .................................................................................... / ............................................................. .....Interior ....................................�. Floors ....... :. / / Heating / Plumbing 1�f. �tRl�r �G ................................................ .... ... ...............,............. ........... ....................................... Fireplace .........................Approximate. Cost.omv..1- ........................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______: Area .......................................... I Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH v 7u I '�t 6� fig M OCCUPANCY PE MITS 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 .. ................- ... l .. ::'.' •:................. Construction Supervisor's License 0 .` .3................ ILLi CHA-FEES A=38-43 No .. 26584.. Permit for ..Swimming..Po.ol..... ............. .................. ...Pool SinglSingle Family Dwel in e v.................... Location ......112..Ca....p ...§emadra.s...Road ....... .............. . ... .. .. ....................cot.uit.............................................. Charles Me-dehill 'Owner .....................?............................................. Type of Construction ....Frame........................... ........... ................................................................................. .....................Plot ....... Lot ........................... Permit Granted ....June 14. ...........19 84 .......... .............. Date of'Inspection ...................................19 Date Completed ......................................19 'y Permit No- ----------- ,St"`'. TOWN OF BARNSTABLE 20075----- ---- r` e ---- ---------- 1 Building Inspector»n� Cash rya ----------------—-------- ----- 0 1 �, OCCUPANCY --PERMIT Bond -------------x----------'7�� 7 "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." -Issued to Charleq E. Medchil.l Address 4 Carver St. ,Buzzards Bay, NA 'l.at'-hJ 112 Cap'n Samadrus Road, Cotuit Wiring Inspector �- Inspection date 2441 Plumbing Inspect r �� d Inspection date , Gas Inspector Inspection date Engineering Department 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. 1JI Building Inspector f f r a r - �LL i a. 14,T - �r pl J sn�•pian�v� C/� JIAA + tJ CEZT%V-%aD P LbT PL A," r� $utTy� LoCATIO" T - f o, v IT I hs GMRTtFY T"AT' TPE: F;ut ,�TlOW S"o,.u►.1 �—A R FccZE�.ic Wr-e E o" C-OAAPt_-(S W t TN TWG 51 D'E.Lt"F ( oT 23 Aua SE-Tp�Ary V7r--QUtIZGAA&IJTS OP TNe To w U of "E3 A��t,K'�A�'t. � tJ}.� v�T s eV4 DATE ;,�cf I/,,✓ t e+s Ctct �-�- gAXTC�Z "('t-�l5 DLAN (S UOT BASED 0►4 A," 0STE2V1LLE o tWS�Ct1�tn�tJT 5v�vc;f �; Tt�L Ot=�5�r5 S�-Icw►..n APPLI CA►JT" q,� tJhT B E US C D To O e_T`oM t�t= L.o-r L l Wi S r C OAP-Le /V` `t = 11 t-t.. Assessor's map and lot number ....... tf......1-3............. n► 1 SewagePermit number .......................................................... TOWN OF BARN T�ARL ypi TN E tp� i BARNSTABLE, i "6 BUILDING INSPECTOR APPLICATION FOR .PERMIT TO ..........48'Z.l.lr�.......... . ........................................................ TYPE OF CONSTRUCTION ...............w.4?Q. .......1�. �`?.................................................................... Al�hjl .........19-7, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ............� 4emw.......�..................... C�-�:............T....Y......�' ....... ......... Location .................f .tlr=�../..v �. ...... �........ ProposedUse ........... �h' ./ ....... .M j.. .......1.'..d 'S. or.........................[......`.................................................. G3'tr`%l' 107/ do 6 i ZoningDistrict ............ .........................•................................Fire District ............................. ................................................ Name of Owner .(,;r/Irlc�''/.r�...�.....1..'..��/.//.Address . .L�. v/� IC ��" ��Z-7 ��S /F)s�•(.,(�' Name of Builder .. ��v fC� �� ..Address � � � � � ........ .............. ............................. ...... .... ............................ . ......... ... ......................... Nameof Architect ......................7..........................................Address ...................-.-�-'................................................... Number of Rooms ........7......................................................Foundation ....��.�� / a!/�t?� Q�✓C/E' Exterior ....&.k t--.....ae.Gly. e.........fi., ! .1.�� .......Roofing .......... v /'./1�� ...................................... Floors / l� �1.1 .. �.S...c`'0 /..�f' .Interior .........11) 'P' �.. �-- ......... c.-.............. ,.IV B .............................. Heating .... ,, /.�1.... �� .r 1/./ .--1 /�W/Plumbing .... ! ......Q� .... i ........................... Fireplace ..... ....................Approximate Cost ............ r „ .. �. . ..�...o.................. Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area S' Diagram of Lot and Building with Dimensions Fee � 1.��............. SUBJECT TO APPROVAL OF BOARD OF HEALTHQ A/Q s-SS-2`7-97 Bond furnished by builder: David Silva pI� 41 St.Margarets St. Buzzards Bay, Ma. Pj ti I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,. Name ........ ,! .... ' ...................... Ir Medchill, Charles E. No 4....2007-'�Permit for .. one st ...................1.9��Y..... sinjam 1 in ............. ........... ..... ..... Ca Location ...... P.. $n. .. f - .amad r.us..Rd'^ ........................ ....................................... Owner ........Charles...E,...Mp .................. ........ Type of Construction ...........Ramp................... ................................................................................ Plot .............................. Lot ...........23................ April...6.........19 78 Permit Granted ........... ..... Date of Inspection . ....119 Date Completed ....?I...............................19 PERMIT REFUSED ................................................................. 19 ................................................................................ ................................................................................ ........................................................ ....................... . ............................................................................... P. -Approved ................................................ 19 ..................................................... ......................... ............................................................................... -_ ss 3 8'^....z—/,3 C SEPTIC SVS I1h MUST t ? oFrNe ro Assessors_map and lot number .............. -'„ I INSTALLED II1 C0�p.pj.ti+;,fr't0- �Q� o Sewage Permit number/ti�o�,.c_.... .. y144''e��ggy�ppWII�TN TILE 15� � ENNII'pOItll�flEF7fi•iAL ClJ = •� : BARNSTABLE, i Housenumber ......................lur �6. ..................................... 9 MA/B TOWN REGULATIONS 0 MAY TOWN OF BARNSTABLE BUILDING INSPECTOR SW 1 Vwn.%�i f APPLICATION FOR PERMIT TO .T. .I��T ............................................ ........��...`........................ TYPE OF CONSTRUCTION ��. I.I.I V..../s-.�-Al....U .VLLS 3....7 0 ....9um........ v.............199.q TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...../*/".�..........(/4rs„�................. ! ."a............. ............................................................ Proposed Use ...Y.r.�.V. ;, � ...... ............................................. ................................... ..........................................................r._Zoning District ................ .. .:..........................................Fire District ..... U! .................................................... Name of Owner ..—,hpo:A!e t s.......M.9.0".A.tl..........Address 11L........agt A �e,6 ,CAYQI S............... Name of Builder ` ....F l .... .►... ...Address ... ..4�. ..�:NOCI�............................ .4.t(. aI'S k #' Nameof Architect ..................................................................Address ................:................................................................... Number of Rooms ...................... ........................Foundation v...... ./ Exterior .......... i .............................................................Roofing ........ !.. ................................................................ Interior ....... Floors ........�!..�............................................................. .................................................................. Heating ..........'N /.I...........................................................Plumbing .... � # ........ vC''............ Fireplace ..................................................................................Approximate. Cos?#..io Definitive Plan Approved by Planning Board ---------------____-----------19_______ . Area .......................................... Diagram of Lot and Building with Dimensions Fee ... .,J••4 . ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 7� 10, OCCUPANCY PERMITS REQUIRED FOR N W DWELLINCjS .� ) 40 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl regarding the above construction. Name ..�..Ct....... ................................ Construction Supervisor's License 0261§§' 13:.............. 1 -*:bMWILL, CHARLES 26584 SWIAM'aNG L y No ................. Permit for ................... Single Family Dwelling ............................................................. Location .....ll2.. ....SiWcras..Jbad........ E ....................CA::,u.t........:..................................... } Owner`i......Char-l.es..L'Jederil 1........................ Type of Construction F ............................... U=r `game => Plot a. ... ... . ............ Lot ................................ June 14, 84 Permit Granted ........:............................... 19 Date of Inspection :.:..:..............................19 7 Date Completed ...:...... i ..............19 I:>~r--��.; r' - ' . x• _ c. it , •-,-, -•_- - ® � � �, � - •: -a. r •-q t .A. r ARE WtlV7IC A t _ t 20, C Use Adi:!stable A-Frame Safety Linz braces M Wall Jo;nts • � � � , I 1 qr Indi a dy""A.' M.�m■ - I ,e Digging Lay6ut S.. -�..,. ; lam*�,,, . II •See"Wall Corner Detail' NSPI. (Typical a11.Corners) m TYf�E II..DIMENSIOhAL., '+° `° ago I= b \ ATIONS A8 APPLIED .T0 �"�' SPECIFIC: t l� <WEATHERKING POOLS • 1 q q q' Oversang of.diving board fr �r om edge w� , , ? ' `� I r �� of pool Is 2'-8 J/8"(t3 inches): 2..Wate'depth under tip o'diving boa d :�~`'� Plan t is a minimum of 72"at Point"A":_ Note_ r, t 3. Maximum board length is 8'-0". { : StainIm Steel.Wall - 2'-8 7/8" ( 3") Overhang Distance '•4. Maxfrzum:board hei ht over water is' ?""•�. 1 I Pane%41".High.All g I}.� ;Others 42",High. 20 Inc �. � 1 W.I'+/ � ��20"Maximum Height A�ove Water 1,-O• ,I�av►.w�; i;"' i S. Diving board must be centered in width 2. F r � �. ..• .:•I ' •.:'✓C4r .....,. r:�.._.:'of:pool:' `�. .• .. ., : . ��'. ,, .=F Minimum.Water LevFII 6. Refer:o manufacturers'specifications c 4" Below Top Cf-:i 8r-�•- for fulcrurnaocations. '= ■r 1 c_.w r I Point"A"... / �-Undisturbed Earth 7• Safety'Unes must`be mechanically at- I1 taghe i Viny on ones side:'supported'by UOY .a '. Note 2 ' /,' l Liner Over 2" Compacted Sarid 8:I A:ateji;'o adder* other a— PProved .4-0' `s-o' 14.-0' 1 rot p•. means•sha11 be provided at both the - shallow and,deep ends. P -ofile FOLLOW ALL APPLICABLE SAFETY AND i BUILDING CODES, AS WELL AS INSTALLA- TION INSTRUCTIONS FOR THE POOL. s{ AND ALL EQUIPMENT AND ACCESSORIES. 16 /6.. _ /6t1z' CAUTION: DIVE FROM DIVING BOARD ONLY. 1 " 46r34 RECT_ �I '6,r34 RECL i, /4 4 16 - /6- '•.SECTIONS SECTIONS �I[4' z-15'.,SECTIONS 15'SECr/0AS WEATHERKIN 'PRODUCTS,~INC. 4 /5 4-/brit + S-3 NC 900 C014NE,.S /°- s rz/PS /0-COMMCUPS EAST GREENWICH, R.I. 767 1611i 16v2l oRAwN: APP: J.P.P. 16!x 34 x 8 SGT II DATE Holiday Coping Layout Snap Strip Coping Layout 12-82 RECTANGLE 4 �! TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Q y3 ' Permit# 1 2— Health Division ��'' � �� Date Issued l Igo Conservation Division Fee`'76 Tax Collector'` SEPTIC SYSTEM MUST BE Treasurer.. �(�' J�`�/�o INSTALLED IN COMPLIANCE Plannirig`Dept. WITH TITLE 5 _ . ENVIRONMENTAL CCDf7 f`,-:D Date Definitive Plan Approved by Planning Board TOWN REO�LL"�81 °�' Historic-OKH Preservation/Hyannis G �P Project Street Address e 1 Z Village Owner 1 nYlYl D w—flEw , Jr Address 7— ��'(•�S F�1 . Telephone J Permit Request 1(o+ X 22- Of 6/9tS`ft" M>S'W— Square feet: 1st floor:existing r)Posed 2nd floor:existing proposed Total new 352 f � Estimated Project Cost onmg District Flood Plain Groundwater Overlay Construction Type IvV ocd_ m-e Lot Size o •sq Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling-Type: Single Family III Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes W4 On Old King's Highway: ❑Yes L`No Basement Type: U Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 5&O Basement Unfinished Area(sq.ft) (_+�L Number of Baths: Full: existing new Half: existing 2 - new Number of Bedrooms: existing new � Total Room Count(not including baths): existing 8 new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes & o Fireplaces: Existing _Z__ New Existing wood/coal stove: ❑Yes UK Detached garage:El existing ❑new size Pool:�isting ❑new size Barn:❑existing ❑new size Attached garage:( f existing ❑new size Shed:�ing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes IW"No If yes, site plan review# Current Use::51 VLGi L2. -CCu11[1N (11YllL Proposed Use BUILDER INFORMATION Name �6,A)h-e—r Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE CP FOR OFFICIAL USE ONLY PI RMIT NO. /f3 �9 DATE ISSUED MAP/PARCEL NO. - y A y ADDRESS x" VILLAGE OWNER / DATE OF INSPECTION:, FOUNDATION ; FRAME l9 �y ' INSULATION FIREPLACE ELECTRICAL: ROUGH"' i FINAL PLUMBING: ROUGH FINAL GAS: ROUGH`'- FINAL - FINAL BUILDING k= n DATE CLOSED OUT ASSOCIATION PLAN NO. ` f .f r LOT 22 53 03,E 0 p PODL � LOT 23 ti DECK 1pf "___--- -- SHED 0 UA _=0) SHED b::�y112 a 11 OVERHANG 1 _3 17p U LOT 24 RES. ZONE.' "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "C."- Bank Use Only TOWN: —CO=T _ _ REGISTRY OWNER: LDRYLESE. L(CIA`A1 i-M.PQ L DEED REF: _BUYER: DATE: PLAN REF: -L. CC4¢?,3- _SCALE: 1"= 40 FT. I HEREBY CERTIFY TO PLYMQ1lTf� D1�TG� �Q____ ais;`r1,E�f�, yANKEE .SURVEY ___„ -------- ---THAT THE BUILDING `y. ' SHOWN ON THIS' PLAN IS LOCATED ON THE GROUND AS y ?t P'ADL �': CONSULTANTS. SHOWN AND THAT ITS POSITION DOES _� — CONFORM A r TO THE ZONING LAW SETBACK REQUIREMENTS OF THEr{IYi'I�'� 40B (SUITE 5) fIo "38 rc I. INDUSTRY ROAD TOWN OF SARAYSTA,64—F, —----------AND THAT `'• ��•, :�� IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD i `';`�': `?':.`;�' MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED-V-W-Z__ TEL: 428-0055 Coramunitv-Panel # 250001 0018 D „." '`'` `' ` FAX: 420-5553 -a-� _____ THIS PLAN NOT MADE FROM AN INSTRUMENT ?1034 JF PAUL A. MERITR PLS SURVEY NOT TO BE USED FOR FENCES ETC. - i I General Specifications 2x6 Pressure Treated Subsill w/ Sill Sealer TH 35 Series floor Joists @ 16" o.c. 3/4" Tongue& Groove Plywood Glued&Nailed . 2x4/#2 or Better Studs @ 16" O.C. 2x4/#2 or Better Sole& Top Plates 2x10/ #2 or Better Roof Rafters 13/4" x 91/2"LVL Structural Hip Rafters 1/2" CDX Roof Sheathing&Wall Sheathing 15#Asphalt Felt Paper over Roof Sheathing Bird Woodscape 25 Roof Shingles.or equal Tyvek Home Wrap or equal over Wall Sheathing 1/2" x 6" Innerseal Clap board Siding White Cedar Sidewall Shingles All Exterior Trim to be#2 Pine primed and stain blocked Insulation Requirements Floors: R-19 Batts Walls: R-13 Batts Roof Space: R- 30 Batts w/Prop- a- Vent r 9, NY 191 61 14' 2910 67 3'6 12'1 1'11161'2 97"3 13'8"1 TT2 \ 59 \ &D i \\ \\ Existing Master Bedroom b I Proposed Master Bedroom Enlargement \ (NV B I / a'z'3 g1.5 \ Existing 2500 Sq.Ft. Home I // 'L I I I / I / I Existing Existing / Bedroom Bedroom N I I I I 00 i I � I I I . I ---- ---- ---------- 57 518 94 3'9 4 I. 3'2 75 7T'4 ji.3'9 1 �66 1792 9111-7 16 9'4"4 1 flan Sq ft 3474 DALTERIO ADDITION- 16' x .22' Master Bd .* Rm'. Public Health Division Town of Barnstable PO Box 534 Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 } 'r 1 5911 t6'S 43'6 c t New Foundation to Match Existing b n 8"Foundation Walls Existing 8"Concrete Foundation W/10"Thick x 20"Wide Footings to #4 Reinforcing Bars Q 411.o.c. Eo vertical in Keyway w #4 Reinforcing liars Q 2ft.o.c. Horizontal Connecting to Existing Foundation Walls rn n t ------16-1— -- --------— -----43'10—-------—----- —_...------ 5911 LIVING AREA 1582 sq ft Foundation Plan MAScheck COMPLIANCE REPORT 43+92- Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-7-2000 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 114 Your Home = 104 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value -___UA -------------F-------.-------------------------------------------- - CEILINGS 352 30.0 0.0 F , , 12 WALLS: Wood Frame, 16" O.C. 608 13.0 3.0 43 GLAZING: Windows or Doors 81 0.400 32 FLOORS: Over Unconditioned Space 352 19.0 17 -------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has-been designed to meet the requirements of :the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate. has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than' 125% of the design load as specified in sections 780CMR 1310 and J4.4 . Builder/Designer Date c:o;,. 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 - - -- DATE•: 1-7-2000 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No. i4i.A ; Comments/Location N :A FLOORS: [ ] 1. Over Unconditioned Space, R-1.9 Comments/Location AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside ,an appropriate air-tight assembly with a 0.5" t clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can [ be determined.' Manufacturer manuals for all installed heating and cooling equipment- and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape: Pressure-sensitive tape may be used for fibrous ducts. The, HVAC-1;,; system must provide a means for balancing air and water• systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. is � .• HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater thane125% ,of the . design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or .chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- The Commonwealth of Massachusetts Department of Industrial Accidents ;i Office all"esaatioos -_� 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: NJOhn -J). I—)A location city W`' hone# R I am a homeowner performing all work myself. ❑ I am a solt prietor and have no one worlds in aav ache /%%%%%%%/%%/%%// /%///%%O//O/y//////ti%l%//�'/O/////00%///icy/!G//O/ %'/%//O//////// /////////%///////O%/%/%/%%/%////%//O�%///%//%%%/%%/!%%////%//%///l//////////O%///%%/////%O%%%/%%/%//%/, workers' compensation for my employees working on this job.:;;: :::: ;;::;;;:;:;:::::;:::;}::>;;;;:;:::::::::;<,::::::;:::>:::::::; I am an em 1 P �g ............................::::::.::::::...::::::::.: .:. ::: . : .....,:.:.:::::.:::.::::::.::::::::::::::::..::.....::::::::::: ❑ P c a��are s ...................... K. v one, ci `<ollcv e co. o ' sura / m ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have .;the ' co ensation olices: workers No! followln P :a ::.;::;:;::;;'::.......... ... cam ...... .... .....:::••::::.:.:::.:.......:.. i:;y`{::::?:'::.`b::•'.; ;y�i :%ii:i�:'t5i:;'i<:<�'::�:'L:�':$J:i:':ii:$:i.�.�:!ji'r::iris:j•}:::%;:;isj:%:;:ri:G:i:T:::ri:':.iY::t�''riii':{�i:};i:;:4;n;:::::yR:Yii':?'fi:Y;'{:i�ijii:ist�iiri}:i�i:::<�iii`ii:;:;:%;:;%j:Y:�i:i:<}:: :+.%:::`i:�:�.�:: .11:''��'��:?Ci:::v:';:%i::}i~�'::;:i:::;;:%'?:i:::iji}j}:i:;;ii:i:•:i:;:;:i;Siti;:%;::;<?:Y3; a dre ................... .::::::::::::::::.:::.:.....::.:::.:,:.. �Win d' :4:•i:is+•:�::r::.;:., .....:................:......:.:................. .............................................:::::::::::::::::::::::::::::::::;ter;.:;::;::::.;::;;;.:.._:::::;.;:•;:.:.;:.: ...........::::.:::.:::.:.>;:.;;:.:;:::::::. .::::::::•:�::...•,:::w..•::•::::::?,Cris'^:v:w:x::::::::::, insurance'CQ::::.:::ni;;::•:•ri:<•:;•:•;::•:•:i:;.,<.ii;;:•:;:::::::..::.:::.::...:......::.:. IX c anv ad dress. ";n ................................................. ........... ::h 0 ..................................................::::::::::::::...........:::::::::::::::: ....... :'. . olicv Failure to secure coverage as required mtder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to 51,500.00 and/or one years'imprisonment as then Once otInv of a estlg SrO of the WORK ORDER for coverageOvee of ocatioa00 a day against me. I understand that a copy of this statement may I do hereby c under the p penauies PQlWy that the information provided above is trw•and correct (,�,Q� DateItolooSignature I Print name n I/ �/1�t,l G dr. Phone# ��—`t 0-1`T l official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑fig Department ❑Licensing Board QSeleetmen's Olnee ❑check if immediate response is required ❑Health Department contact person: phone#; Other. (mused 9/95 PIA) °F THE °� The Town of Barnstable &UMSTABM � 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. - I / Date O y 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 t I ' Address of Work: n Z Cpvrc%��'► l�S� S - (�'`^'"f Owner's Name: �- Date of Application:�I rl I �� I hereby certify that: Registration is.not'required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Owner 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. 1 u DO,90-URo t�)� Date Owner's Name glorms:Affidav ESTIMATED PROJECT COST WORKSIIEET Value LIVING SPACE square feet X $55/sq. foot= C� GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK square feet X $15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Cost g990915b t�r The Town oBarnstable Department of Health Safety and Environmental Services Building Division � MASS. w►ss. 367 Main Street,Hyannis MA 02601 ta39. �0$'Ar� Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: I I Z l�f��l N s V o-di .I S 'tiff/` f�I number street village "HOMEOWNER":VA nD. Dk4-�, 1o, Jr- - �OX- 4 ,o p 50--71 I (O name �7 home phone# work phone# CURRENT MAILING ADDRESS: ((Z c <N 5U-Vt�ws Imo" N+wA- YID A 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 (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 inspmits ction procedures and requirements and that he/she will comply with said procedures and e 'II i Sign 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 to amend and adopt such a form/certification for use in your community. Q.:FORMS:EXEMPTN Town of Barnstable Approved _ Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Officer 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: (� r/ Name: J6� DfiZrK-C- lo Phone#: .�7 l ?by 7 /'F Address: �IZ � � %C'�l Village: Name of Business: rk f Lpl ev Type of Business: Map/Lot: D 3ly D INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home ✓_ Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No`sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned, ve r ad ana ee ith the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Town of Barnstable *Permit# 20017o8i73 Expires 6 montirs from issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division 0 Tom Perry,CBO, Building Commissioner r 200 Main Street,Hyannis,MA 02601 www.towri.barnstable.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 O 3 Property Address 1z, r Q S,Pdq 1 PrivAt.S fttl �I Residential Value of Wo 7-�34)yF 00 'Minimum fee of$2 .00 for work.under$6000.00 Owner's Name&Address J D IO ID -DA-iTtvto 5U91V N-fa IV- A E�—[ 112, 03ff `N Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor DEC 2 j 2007 I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# s Copy of Insurance Compliance Certificate must be on file. N Permit Request(check box) CD CD ❑ Re-roof(stripping old shingles) Ali construction debris will be taken to =w ❑Re-roof(not stripping. Going over existing layers of roof] 4" Re-side 76-rCH l(/oCe—. 0 , 1wS0 10 q Replacement Windows/doors/sliders. U-Value tY (maximum.44) -_j *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.' ***Note: Property 0 er must sign Property Owner Letter of Permission. o y o Home Improvement Contractors License is required. SIGNATTJRE: � Q:Fomis:expmtrg Revise061306 T SHE Town of Barnstable Tp�� Regulatory Services BARNSTABLE. Thomas F.Geiler,Director 9 MASS. 1639• Building Division rFv �A 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: I(/� �� D JOB LOCATION: , / UL rr sum�e�r street village � flaJ lo 66 1r7/ .HOMEOWNER": q _Dtiut� /!/D —1 * N name home phone# work phone# CURRENT MAILING ADDRESS: (l� 1T� T S`I3' "/Lys 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"hom owner"certifies that he/she understands the Town of Barnstable Building Department minunum.ins ection p ocedures and requirements and that he/she will comply with said procedures and req ' e ent� S' re of Vmeown& 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 persons)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 fornt/certification for use in your community. Q:forms:homeexempt pFTHET Town of Barnstable Regulatory Services $"RNSTAB KAS& Thomas F. Geiler,Director � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Secti n If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this b ding permit application for: (Address of Jo ) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERM1SSION The Commonwealth ofMassachusetis Department of Industrial Accidents 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 Le 'bI Name (Business/Organizatio , ividuo : Address: City/State✓Zip: ( /7` 0�-eb 3 Phone.#: L' Y 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). * have hired the sub-contractors 6• ❑New construction . 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' insurance.#' 9. []Building addition [No workers' comp,insurance comp. required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3UZN-E_Lm 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 employees, [No workers' . •13.❑ Other comp. insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'campensation 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. l26ntractors 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 fiave employces,they must providh their workers'comp,policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 JDIA for ins ce coverajzr,verification. I do hereby rti .�n a ain •and enalties of perjury that the information provided ab ve is true and correct: Sienature: a Date: Phone #: �` _ Official use only. Do not write in this area,'tb be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4• Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: