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0058 TREE TOP CIRCLE
„ �:J d� ��� �� 1 . . . �� �� ALTE.R.RATIVE W-EATHE:RIZ:ATION I - Tfl�ata ' r5 Aate• q 1Af ToWn•of Barnstable 200 Main St ,.. `7i�Yf-,[',:'1,''...i•-`:'-;�Y':is .:•'''•k ....k;? ���lZ�c_ �'_`'""l Hyannis,MA 02601 ;rr:' :: '!''r;•yf ., , Re:Pernnit# �" `>`, "'- --Villages ;; � s °"U Its -- _�;^.;., .:s'�d:; ,:r.' r:..�• �i�':'�;_ - '`ems. n.;%a':�,•�:•r:i{;_':�, we `dcl�at :�kie insulation/ a.:t �'2 r.:� ,t. •Vti. '.:1, 1een co P 13j l<; i: ,`,::J,"fft1... - i�..�.-.. r••: _ •.,.' '.�ia ,bxnplet � �a7*'�an ce wit} 'i?� 's;.: '-�>���!•-..'_' � _.,' J�•�r:^'•''�:,.. .t '�'•� r; ..,a. ,.91�.:V"-�:L�f iY.:w:�': •:.:N.1.. �iT�:��::;�':9-�'}., ' •.AAA. ..J... '.f.::.' •.�:y :.4: ,:. •.'.:.��':l ..:ff:. ,1,� �,: ..fit:. `a-n.::.:<.: >•'.r'; �!• '"fie i•:1'%: `.✓.'.: ..{"' Tg J•, +��.,y _ •L': -'t,:f`-:°: ,'.7•_r\:'' �`S.ay'.f•: -W n. •:•ll.r.:y'3i! , .�t1• •�.• :'y:;::i:,:'... .:>.fir:'?..�.•� t'.i"-fir.<" Ir�:'fi Regards • :{Ay�'.rti:i! ..L '�jt�..�;', °•JJ•"L �,'.•,:�t'.'.'.i�.:>i�,.•.Sa.Sw;r:Li. ^.'t.•f:Y;^.`.:!th '�`d, .:'.i' :,', �{•l�_'::a:'•�:••;C;f:l;•f:u:.t•:�,Y�:... - Timothy Cabral, President CSIr105454 58 DICKINSON STREET I FALL RIVER MA 02721 1 (508)5674240 1 ALTERNATIVEWE, THE-R[Z".ON@OMAIL.COM Town of Barnstable Building BAROWA s Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MAIM Posted Until Final Inspection Has Been Made. Permit i630�a�� Permit l i ll 1. ,39. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-313 Applicant Name: ALTERNATIVE WEATHERIZATION INC. Approvals Date Issued: 01/29/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/29/2019 Foundation: Location: 58 TREETOP CIRCLE, MARSTONS MILLS Map&ct1: 150-032 _ -i Zoning District: RF Sheathing: Owner on Record: BAXTER,CHARLES R&ROSEMARIE I Contractor Name: .ALTERNATIVE WEATHERIZATION Framing: 1 INC. Address: PO BOX 246 2 WEST BARNSTABLE, MA 02668-0246 E --- Contractor License: 175683 i � Chimney: Description: Weatherization �. Est. Project Cost: $4,090.00 Permit Fee: $85.00 Insulation: Project Review Req: � J Fee Paid: $85.00 Final: Date: 1/29/2019 p Plumbing/Gas Rough Plumbing: 1 Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. t """y� rl Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing Lam-- 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: ' All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r Application number........ .................................... ��2�:1,� Date Issued.......... . •�� 2 2' Building Inspectors Initials.... . p/parcel......:f V............. ............................ n Ma - TOWN OF BARNSTABLE 00 EXPEDITED`PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION _. Address of Project: .F j NUMBERS, ```- T V11LAG c� Owner's Name: ,�SL/nCt�j P, � P.l' Phone Number..` --yoZ Email Address: CM „�-�./t�c./" Cell Phone Number Project cost$ Check one Residential y Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize C-�t�✓�Q.�" to make application for a building permit in accordance with 780,eMR oe Owner Signature: _ LTI�Q,f,�" Date: l TYPE OF WORK E3 Siding O'Windows(no header change)# . Insulation/Weatherization. ❑ Doors (no header change)# Commercial Doors require"an-inspector's4e.view 0 Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name X- 7 L rjyya Home Improvement Contractors Registration(if applicable)# (attach.copy,) Construction Supervisor's License# // w/ (attach copy) Email of Contractor Q,��' lid pone nu er - . �'lC1,�7 t.Je /Jlrc3t1�7'l. number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY MIN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between.the hours of 8:00am--9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPAICA 'S SIGNATURE Signature Date �S . All permit applications are subject to a building official's approval prior to issuance. �F tHE T�k Q� y Town of Barnstable •BA D Building Department Services RVSTALE. + MASS. v 90o i6jy. �00 Brian Florence,CBO ATFO,pAA�A' Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, Rosemarie R Baxter , as Owner of the subject property hereby authorize 14 Zf/1GY.�110� IdJ���ZLZ- !b7� Ito act on my behalf, in all matters relative to work authorized by this building permit application for: 58 Treetop Circle Marstons Mills (Address of Job) Signature of Owner Sign re of A licant Print Name Print Name Da e I The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 ,N www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): L E I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have em ployees and have workers'comp.insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no-employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.M XWO(19)58867158 Expiration Date:6/8/19 Job Site Address: j�Y T�_ e_�� City/State/Zip://(/` w, Aj¢ Attach a copy of the workers' compensate n policy declaration page(showing the policy number and expiration dale). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a p Iti s f perjury that the information provided above is true and correct Si afore: Date: ` �J Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i �® DATE(MMIDD/YYYY) /�C�A CC> CERTIFICATE OF LIABILITY INSURANCE 06/11/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: PHONE Anthony F.Cordeiro Insurance Agency A/c No Ext: 508-677-0407 FAX No): 508-677-0409 hIL 171 Pleasant Street AnnREss: HSouza@Cordeirolnsurance.com Fall River,MA 02721 . INSURER(5)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual INSURED -INSURER B: Ohio Security Alternative Weatherizatlon -INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE Fx_1 OCCUR PREMISES Ea occurrence S 300,000 MED EXP(Any oneperson) S 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑JECT LOC PRODUCTS-COMPIOPAGG S 2,000,000 PR - OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) S B AUTOS ONLY AUTOS OWNED X SCHEDULED Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) S X HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY X AUTOS ONLY Per accident S X UMBRELLA LIAB MX OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE S 1,000,000 DED I I RETENTIONS S r-/N WORKERS COMPENSATION PER ETH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? n I NIA XW058867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000, DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary&Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT f ©19V-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD f kit { ' �1 .tau 5ttpt�flf�csr . ♦ash a:."i.. d61ft3Y2019 s Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Map 02116 Home Improvern `W'1ntractor Registration . , Type: Corporation :^+ {- f s Registration: 175M ALTERNATIVE WEATHERIZATION, INC. ='.- ;:.i .- � .� - Expiratlon:- 05/28/2019 2 LARK ST ! - --- FALL RIVER,MA 02721 \ ct, Update Address and return card. Mark reason for change. SCA 1 i5 20V-OS!'•t _,-Q Address n Renewal 11 Fenninmant ❑Lnst.r%im q --!574• iK:r*w,nrr:i"';errjlf a,"�rws+ar�rvclf - Office of Consumer Affairs&Business Regulation r, HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Oon 9x0muon Office of Consumer Affairs and Business Regulation � yy i175M 05/28/2019 10 Park Plaza-Suite 5170 ALTERNATIVE WEA 7Ij4tR1ZATl_0N,INC. n,MA 02116 TIMOTHY CABRAL 2 LARK ST FALL RIVER,MA 02721 Undersecretary of v O Si ait<tre TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map . Parcel". Application # ``d 5 7 to Health.:Divis'ion - Date Issued l _ Conservation Division Application Fee T Planning Dept. Permit Fee i Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis �L1' Project Street-Address S� '12p� rOJD Village Owner J Address 67 Telephone___ Permit Request �All Square feet: 1 st floor: existing proposed 2nd floor: existing _proposed Total.new . Zoning District Flood Plain Groundwater Overlay Project Valuation % ,J�67OConstruction Type. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 411". Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes #lo On Old King's Highway: ❑,;Yes No Basement Type: JarFull 4`101rawl ❑Walkout ❑ Other ; Basement Finished Area(sq.ft.) C _ Basement Unfinished Area (sq.ft). Number of Baths: Full: existing new Half: existing _ new, Number of Bedrooms: J existing —newrM w -� Total Room Count (not including baths): existing new First Floor Room Count6— Heat Type and Fuel: ❑ Gas ❑ Oil z1fEbectric ❑ Other Central Air:_J;��es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes _,,12rfQo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ,rOA c-I/,J Telephone Number 5-0 Address 5_9 License# 7� 6_0 Home Improvement Contractor# Worker's Compensation # I' C c:� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ®ATE / // FOR OFFICIAL USE ONLY APPLICATION# -DATE ISSUED. MAR/.PARCEL NO. { ADDRESS i VILLAGE " OWNER , DATE OF INSPECTION: FOUNDATION, FRAME FRAME 'INSULATION,,, iXe vk FIREPLACE '1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:.- w- ROUGH : , FINAL 4. FINAL BUILDING ° Q' 7 /3 !i P)ac. .,...::.DAT_E CLOSED OUT ASSOCIATION PLAN NO:_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi' 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Lembly Name (Business/Organization/Individual): Address: City/State/Zip: Phone Are ou an employer?Chec the appropriate bog: I am a employer with / 4. ❑ I am a general contractor and IF6. e of project(required): employees(full and/or part-time).* have hired the sub-contractors New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. . Remodeling ship and have no employees These sub-contractors have g ❑Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance comp.insurance.$ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their HE Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required] t c. 152, §1(4),and we have no 12.[JRoof repairs 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 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit as 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, am an employ infoo er that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name: x Policy#or Self-ins,Lic.#:�vwG Sao ,e/g/70 /;l n!! Expiration Date:_ Job Site Address: 15-9- City/State/Zip: a 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 fne up to 11,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and pen ' of perjury that the information provided above is true and correct Signature: Phone#: Official use only. Do not write in this area to be completed by city or town official City or Tows: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 08/07/2011 04:52 5087527172 PAGE 02/03 ����® CERTIFICATE OF LIABILITY INSURANCE DATEIMMND(YYYY) `r' O8/0812011 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackstone Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 37 Harvard Street Suite 213 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01609 INSURERS AFFORDING COVERAGE NAIC a INSURED INSURERA A.E.I.C. Linnell Enterprises INSURER 0; 59 Freeboard Lane INSURER C: Yarmouth, MA 02675 INSURER D! INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR ME TYPE OF INSURANCE POLICYNUMBER D ! LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES Ee FNT o ca 5 CLAIMS MADE M OCCUR MED EXP(Any one par-.an) 3 PERSONAL B AOV INJURY S GENERAL AGGREGATE S GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY PROJECT M LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (EA aeeidanl) ALL OWNED AUTOS BODILY INJURY g SCHEDULED AUTOS (Per person) HIRED AUTOS NON-OWNED AUTOS (POoRLd9 ) $ PROPERTY DAMAGE a (Par omldont) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT`- S ` j ANY AUTO OTN�R:TFIAN EA A= S AUT ONLY' EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE I S OCCUR CLAIMS MADE AGGREGATE` G DEDUCTIBLE u g RETENTION i WORKERS ILIABIIrIjION AND 17�- TOVII Y LIMITS ER A ANY PROPRIETORIPARTNER/EXECLRIVE WCC5007447012011 8/1/2011 8/1/2012 E.L.EACH ACCIDENT Is 100,D00 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EALOYEE IS 100,000 It ee�EG`Ideecrtbe under SAL PROVISIONS below E,L.DISEASE•POLICY LIMIT 19 500,000 OTHER David Linnell Is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SkOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Building Department DATE THEREOF,THE IS$UINO INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN 367 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO$0$HALL Hyannis, MA 02601 IMPOSP NO OBLIOATION OR LIABLITY OF ANY KIND UPON THE INSURER,In AGENTS OR REPRESENTATNES. AUTHORCMD REPRESENTATNE N r. ACORD 26(2001108) 0 ACORD CORPORATION 1988 FROM L FAX NO. : 5083621294 Apr. 25 2011 01:43PM P1 Q9dEFiAI CARPENTRYRooFINGPLOYYIN(� FULLY INSURED DAVE Lp* 31..JFL 508.4tt-1294 YSM16k�MA02PS Property Owner Must Complete and Sign This Section If using A Builder as Owner of the subiect PrOP" eceby autho>sae_ - �A V 1 . � l to act on my bebal�T' in an mattes ZelatiVe W vml-k authoalaed by this bidding peamit aPPlicmtion for. ,sue -; TAP Cr I1�e S 2�s, MLL5 (A,ddim of Job) Date Signature of Own= Paint Name ryp(1PUA.2'n�A�'��� i - .vrassacnusc[ts - ucp:u tmcn[ or runnc _-)arc[V Board of Buildin_ Re-ulations and Standards Construction Supervisor License ` One- and Two- Family Dwellings License: CS 71507 j DAVID J LINNELL JR 59 FREEBOARD LN YARMOLITHPORT, MA 02675 a 11.. Expiration: 8/11/2013 ('unmissiuncr Tr#: 2398 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR s before the expiration date. If found return to: Registratiora�120659 Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration2lt9f20;12 Tr# 294382 _.....I i Boston,MA 02116 Type:��landividuaf==ixlU LINNELL ENTERPRISES DAVID LINNELL 59 FREE BOARD YARMOUTHPORT,MA 02'675 Undersecretary Not valid without s!P re y - _ o TiPEE .Tom �CiecL.E - ?�:_�` k. F�GE- _$;` '`o,F - ��� .PAVE�yEM" --•. - $�'89 • - b = .- I Ac _ f t 1 f -1 t iG 1 1664 O • , _ . _ `ter . _���- - �/'- - . -- � .. - -_ - ' - - - 'i 1� 45 - IV) t - ......:... - - - -_.,•fir.[•3..::: BAXTER RESIDENCE - MARSTONS MILLS MA. SCALE: -5-F F__1 c ,5'{s DRAWN BY: C. BAXTER DATE: r /Z5 , ®� /Soi s)4F-D a o 1 F f Q �2-Soo ...Tom' . CQCLE7 .._.... BAXTIR USIDING - MARSIONS MILLS MA. SCAII: Za' c. "1- r1 DRAWN BY: C. BAXtIR DAtf: ��� z��� t - I I ' I 3 44 -ilo i BAXTER RESIDENCE - MARSTONS MILLS MA. SCALE: `le r DRAWN-BY: C. BAXTER DATEB�� i � ����tz,5�► .__Grp��NG-_._._.. 4 GS,r �G\ G 3S �vrLc� . y . 3 BAXTER.RESIDENCE - MARSTONS MILLS MA. SCALE: r DRAWN BY: C. BAXTER DATE. �6�� _ . .Ex�..�`C'1✓J Cam_. _ _�_�_R�� _-_.---------- �.v i use c,s-rc NG UJ l AJ0 w5-l A;) _pliU 121 f , f!�1�ERS�II.1 Gam.. �iJ nN6-. kl r,v rX� -- A rX!57-1 nl 6 Jt -- HIn cJ5 `�G BAXTER RESIDENCE— MARSTONS MILLS MA. SCALE: N Q1(.:.Q.<3AXr.FMt, rE;. ONE 10 H.W- F-k-t 5771"1 BAXTER RESIDENCE - MARSTONS MILLS MA. SCALE: 4- G! TER DRAWN BY: C. BAX DATE: isN Vi u101 ox iy E ��z�'tdnl U ppVvt"1RSN G1J r� -PAN_G i 3� EN, 2Xg AN wvyw�rvr - 44x f 04OJT so, s o -vats i BAXTER RESIDENCE MARSTONS MILLS M. SCALE: , PaR -i- _ _ ��'c�' 0�� r_�..5' DRAWN BY: C. BAYTCR DATE: i TOWN OF BARNSTABLE BUILDING PERMIT:APPLICATION Map - Parcel`' °r Application # 7 Health'-Division Date Issued Conservation Divisions-. Application Fee JrD Planning Dept. Permit Fee �Z Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis r Project Street Address Village Owner Address S ;5 Telephone_ i Permit Request .L� Aeil .�. 41, 15 9 Square feet: 1 st floor: existing proposed 2nd floor: existing S?proposed Total new o Zoning District Flood Plain Groundwater Overlay Project Valuation J 0 o 8D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑.Yes 44 No On Old King's Highway: ❑Yes ❑ No Basement Type: ArFull ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full-. existing SL new b Half: existing new Number of Bedrooms: ,3 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 4'Gas ❑ Oil 'Electric ' ❑Other Central Air. O es ❑ No Fireplaces: Existing New 0 Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ 3 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review # o Current Use Proposed Use 77 wr APPLICANT INFORMATION rn (BUILDER OR HOMEOWNER) Name ,2i4t/%O Z11LIAl " Telephone Number ,SS°F 5T Address License# 7/S4 7 Home Improvement Contractor# 1,2 4 4 SY Worker's Compensation # A.-IC ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ;P'_052 SIGNATURE �� DATE 2 1 FOR.OFFICIAL USE ONLY y APPLICATION# 6ATEISSUED MAP/PARCEL NO. . ' ADDRESS VILLAGE OWNER r i , DATE OF INSPECTION: , 'FOUNDATION f7� 0� �vg Af -FRAME S 8O¢ 6S' SG Q O 081Y�? s INSULATIONL j? _1Wpxcg 1;6i FIREPLACE y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL `FINAL BUILDING ll,(Q rA L; ' F 1.,c) pLv DATE CLOSED OUT ASSOCIATION PLAN NO. ; .oF'xET° ti Town of Barnstable Regulatory Services • z+.xxsrwsr..e. uwss. $ Thomas F. Geiler,Director. o;9..c"�� - Building Division Tom Perry, Building Commissioner 200 Main Street; Hyannis, MA 02601 www.town.barnstable_ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign "This-Section If Using A Builder I /�i�szfQs , as Owner of the subject property . hereby authorize zl"� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) / r Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable yea OF SHE Regulatory Services • Tbotnas F. Geiler,Director awRxsrwstt:. NLkSS_ Building Divlision p�PTf1 .19- A,Ib Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 Ym w.town.b arnsta bl e.tna.us fce: S08-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EX1EMPnON Please Print DATE JOB LOCATION: number Stcct village "HOMEOWNER": work phone# name home phone# 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. Th'e undersigned "homeowner"certifies that be/sbe 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 EXEMYTION The Code states that "Any homcowna performing work for which a building permit is rcquircd shall be exempt from the provisions -f this section(Section I og.1•.1-Licensing of construction Supervisors);provided that-if the homeowner engages a person(s)for hire to dos.ucb fork,that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they arc assuming the responsibilities of a supervisor(sec Appendix r ales&Regulations for Licensing Construction$upervisors,Section 2.15) This lack of awareness often results in serious problems,particularly ,hcn the homeowner person as it would with a licensed hires unlicensed persons. In this case,our Board cannot proceed against the unlicens upervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibrlitirs,many'communitiet require,as part of the permit application, at the homeowner certify that he/she tmdcrstands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by Yon]towns. You may rare t amend and adopt such a form/certification for use in your corranunity. I I i REScheck Software Version 4.1.1 Compliance Certificate Project Title: baxter job Report Date:07/09/08 Data filename:C:\Program Files\Adobe\Acrobat 7.0\Setup Files\Untitied.rck....rck Energy Code: Massachusetts Energy Code Location: Marstons Mills,Massachusetts Construction Type: 1 or 2 Family,Detached Heating Type: Other(Non-Electric Resistance) Glazing Area Percentage: 6% Heating Degree Days: 6137 Construction Site: Owner/Agent: Designer/Contractor. 58 tree top circle linnell enterprises marstons mills,MA Permit Date:7/6/08 Compliance:Passes Compliance:7.7%Better Than Code Maximum UA:26 Your UA:24 Gross Cavity Cont. Glazing UA Assembly Area or R-Value R-Value or D.. Perimeter U-Factor Ceiling 1:Flat Ceiling or Scissor Truss 60 30.0 0.0 2 Wall 1:Wood Frame,16"o.c. 105 19.0 0.0 6 Wall 2:Wood Frame,16"o.c. 28 19.0 0.0 1 Window 1:Vinyl Frame:Double Pane with Low-E 8 0.031 0 Basement Wall 1:Solid Concrete or Masonry 70 0.0 3.0 12 Wall height:4.6' Depth below grade:4.0' Insulation depth:2.0' Floor 1:All-Wood JoiSt/Truss:Over Unconditioned Space 60 19.0 0.0 3 Compliance Statement. The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 4.1.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. 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. Name-Title Signature Date Project Title: baxter job Page 1 of 4 Data filename:C:\Program Files\Adobe\Acrobat 7.0\Setup Files\Untitled.rck....rck Report date:07/09/08 f Board of Building Regulations and Standards' HOME IMPROVEMENT CONTRACTOR Registrat ona 120659 E-1101ration 19/2010 Tr# 263092 FAType:_DB LINNELL j ENTERPRISES DAVID LINNELL`JR _— a 59 FREE BOARD LAXE— YARMOUTHPORT, MA 02675y 4 Administrator r - i }if �C' I,'id fLr r gis ra Ion valid for.individul use only i before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid without signdu jj r paninw�uuea�t/ ..J A i • Board of Building Regulations and Standards / Construction Supervisor License s r i l License: CS 71507 - 4 Birthdate`- 8111/1968 �EXp ration J,,T/2009 Tr# 2182 �'.,k�Y stnctton._1 G DAVID J LINNELL'JR� 59 FREEBOARD LN::_ y YARMOUTHPORT,MA 02675 Commissioner e p ,�aeucfivae�,ta, 5 . t I ;/rze -Vomv�rwnu�ecr,�a'a� Board of Building Regulations and Standards Construction Supervisor License % I License. CS 71507 i a i Bi>thd_ate*-8111/1968 ``Exp mat n r��!12009. Tr# 2182 .� f 5— j ;ljRestrnct'dn 1tG 1 :A =�J (tV DAVID J LINNELLR�` �, 59 FREEBOARD LNG . YARMOUTHPORT,MA 02675 Commissioner j I ------------ GRANITE'STATE INSURANCE COMPANY 730 00 -81-23 13102 013-66-0807-oc PENNSYLVAN:A SD9AV I D L 1 NNELL JR Member Companies of YAR!OUTHPOORRT,LMA 02675-0000 American InWfttloml Group EXECUnVE OFFICES: 70 PINE STREET, NEW YORU. N.Y.ID270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.Od MYCOCK INS AGCY WORMS COMPENSATION AND EMPLOYERS PO BOX 437 LI"LITV POUCV INFORMATION PACE COTU I T. MA 02635-0437 INDIVIDUAL RE L 004 2 08 OTBFA VVORKIMACIM NOT SHOVOI AQOVE SEE NAME AND ADDRESS SCHEDULE - WCa 610 ear s PmtcY room UM art standard tea et the tmnarodlo vastam addrau Finam 08/01/07 To 08/01/08 etltrtt A. Vi"1 r!CONWOUSBdan Pat One of the"kV GOB"tO the VJ=k rs O0111080s8Uon Law of the stun Qsw how MA I0. Emplottm LlaMlkV Itiltdan0ew Pall Two of me PaRev applies to the wore in each+ atabe Rated M+Wn 3A. ( 711e Utrtits of our llab8ltV under Part Two st+oc Iogfi4f InIury bV Accident S 100,000 e80h addant 800V Injury bV INseeae $ 500.000 Pon"NMR 801SW blunt bV olsaus S_ 100_.000 each erm3fwjm a. Othat SOM inlfur ow Part Thrum of the Polity apples to the sfthm If env.ILsted SEE ENDORSEMENT - WC200306A The OMMIvin for this pollen wltl be determlrlad bV our Mamuts of Rnla. Clnafteoam. Rates and Rating Plans. M Istenne don n drad bdow Is srdJeer to vertReattarl nand gunge bV audit. t Ntnttess COen tuvraapr ealwatad total It3hepat Eflimsted D149eoaangan slob OF RC► Remhim A....,n 3 You mUalgNlao ❑X Avaud D a Yaor SEE EXTENSION OF INFORMATION PAGE - WC7754 I OWN=e(OWAMr(OCE"MrUM AMLMAMA eV IMAM Enom SOY OCTAL EStarAt®txautylru ll h,d4MW halo..hltmtm aalasenoM et arelah m cull m made, ❑ seat- mussy ❑ ooa.mny ❑ ua„ttty p1�o5lrtN etUat a'1D° "v SEE ATTACHED FORM SCHEDULE - WC990612 08/30/07 ASSIGNED RISK 66 N , beuc Dale raaulegOntco Authoriead Ropresm! we Q0 QC 01 79raT INS;ICtt="1'C t`rlev ' i The Commonwealth.of Massachusetts Department of Industrial Accidents furOffice of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors(E]ectricians/P.lumbers Applicant Information Please Print Legibly Name (Btuincss/orgmtizationitndividual): Address: City/StatelZip: Phone.#: aF -�'��/'�'�S�� Are you an employer? Check the appropriate box: Type of project(required): I am a employer with 4. ❑ I am a general contractor and I 6. ❑Now construction employees(full and/or part-time).* have hired the sub--contractors [2-❑ I am a•sole proprietor or partner- listed on the attached&beet [7. ❑R�taodeling ship and have no employees These sib-contractors have g, ❑Demolition employers and have workers' working for me in any capacity. $ 9. ❑Building addition [No workers' comlj. incir,ance Comp.insurance. rf quired] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El I am a homeowner doing alI work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL. 12. myself [No workers' comp. ❑Roof repairs msuran�required_]t c. 152, §1(4), and we have no 131:1 Other employees. [No workers' comp.insurance required-] Any applicant that eh=j=box#1 nMIA also fill out the,section blow showing their wo-k='eoxnpcam ion policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside cantrectors must submit anew affidavit indicating such_ TContractors tbat cbmk this box must attaclrcd an additional sheet&bowing the name of the sub-cmtractrns and staff wbctha ur not those entities have anploycm. If the sub-contractors have crr>ployccs,they musf.providC their workers'comp.pobey ninnber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. lann-ancc Company Na �v Policy#or Sclf-ins. Lic. #: Expiration Date: Job Site Address: $-?, �-P�i �i�• City/State/Zip: 1471� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requircd imder 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 statcmcrit may be forwarded to the Office of Investigations of the DIA for ineu_rancc coves e verification. ' I do hereby certify under the pa' d penalties cf perjury that the information provided above►.s true and corre f. Date: '5-"G v Si attire• nn p- Phonc# Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: 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 rccciver 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 Iocal 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." AdditionaIly,MGL ohaptm 152, §25C(� states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable cvidcnco of comipliznce with the inssurance 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, i.f occessary, supply sub-contractors)mame(s), address(cs),and phone numbers) along with their eerti fieat--(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no.cmployecs other than the nambers or partners., arc not required to carry workers' Compensation insurance. If an LLC or L,LP does have :mployecs, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial kcidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should nc returned to the city or town d at the application for the permit or license is being requested,not the Department of ndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' ,ompensation policy,please call the Department at the number listed below. Self insured companies should enter their ;clf-irnsuranGe license number on the appropriate line. :ity or Towp Officials 'lease be sure that the affidavit is complete and printed legibly. The D cpartment has provided a space at the bottom ,f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant 'lease be sure to fill in the permit/bccnsc number which will be used as a reference number. In addition, an applicant eat must submit multiple permit/liccnse applications in any given year, nred only submit onF affidavit indicating c=6rd olicy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or )wn)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the pplicant as proof that a valid affidavit is on file for fi ii e permits or licenses. A new affidavit must be filled out each cat.where a bnme owner or citizen is obtaining a license or permit not related to any business or commercial vcnt urc -c. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit he Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, lease do not hesitate to give us a call. ie Department's address, telcphonc•and fax number. The Commonwealth of Massarhus-etts Department of Industrial Accidents Office of Investigations 600 Washington Stret Boston, MA 02111 TeI. # 617-72 7-490.0 ext 4-06 w 1-8 77-MASSAFE ;d 11-22-06 Fax# 617-727-7749 � " www.mas3.gov/dia `. fl//•L_ Llll((LC lU /7 UUu UU1 I.11I 11C11 Ulf 1/1 //161/ rr u�u iar i.u.r. �v •..�.... .. .•••- --•�•�-• I1�Zassachusetts ChE�clilisf fog- Compliance (780 cOiR 5301.2-I_I)' 4 a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio, determine Percent FLill-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction, panels.shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the lop member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing- v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a) new house or horizontal addition—required if project is 1 mile or closer to shore (generally, south of Rte.28 or north of Rte. 6) - b)vertical addition—not required unless there is extensive renovation to the first floor c) replacement windows—needs energy conservation compliance only(chap 93) 6. Wood Frame Construction Manual (WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. / .-WHEN THIS EDGE RESTS ON FWA ING USE W NAILS AT 6-o,_. Ir II . ,a II w 1 II n II ' 0.0 1 1 1 1 I I ¢Z pj 1 rl I I It I I 1•F I , 1 1 •< I IIf r t Ir F i� ii i i JJ 1 i� li v w n li I a Crd ii w ii ii $� I r ,I i i fi + + ' FRAMING MEMBERS l l W u i 1 EDGE k DI JTERMEATE '+ 1 1 � I Il.zw II U r LU 1 d U II Q I. 1 1 w 1 I 1 1 It I I � 1 r- 3-MIN I.L H 1 1 .- 1 . � I I 11 11 __J_�1_._-_-_-_ ____-•i- --L_-- ' DOUBLE EDGE - rJr---- - STAGGERED 3'MIfJ NA1t SPA.CkJG I NNL PATI`ERN PANEL PANEL_ — �+•� PA14EL EDGE DOUBLE NAIL EDGE SPACYVG DE"rAL See Detail on Next Page Detail Vertical and Horizontal Nailing Vertical and Horizontal Nailing for Panel Attachment for Panel Attachment I e /2 5. , oo , /5:0l o� I i v xl2i SWED Y q9 � �® J P�F 0s� -- . jJ l5?''-x----- �o 7.s-raQy:F�arw 1257oa 1 BAYTIR RESIDING - MARSIONS MILLS MA. WP^� ; 15 SCA«: 2a� pva cc 3 DRAWN BY: C. BAXTER DA1f:zlt7/�0. I • V' i Q i n � E E I f E i BAXTIR RISIDINCI - MARSTONS MILLS MA. p���2 3 SCALE:%` O v DRAWN BY: C. BAXTER DATC:z�''�� " r t l` . 0. i s *; - i z �5 T - _ F � — i 5 ' i - cA P BAXTIR RISIDINU - MARSTONS MILLS MA. �.�...S�tt ... 11� 2. .: 1:. .___ - DRAWN BY: C. BAXTER DA1C: t v V i� . i s � t 7 j } e �' }. i Py BAXTIR RESIDING MARSTONS MILLS MA. ' ' SCAlf:l�-t' .............. ....... ....._�;—_—_ ..-_ �.__... -'--.... ...._. .... ..._..... --.. .. _ � ��.s��a... t DRAWN BY: C. BAER DATA?lr7 0 OA U 1 [A)5tJL44 T'O/',,J G, Z LOID AA AJ /Vt�J/f, l2°�X t b" 3 aoL4W F"6" Lle,, 6 og C.4A.Y I/ Li LVL vo xr,� iyt� SMt�IIT _ >/ 2 SC2t"�>SD 40A�c j"i d 5`I' C op cni5rov<v �DUPI �lfTl�l m wl t\j 1 c 14 Bra ..�. 7EAIJ xPaNO MEW W4U-S :� IstQVc i" 2, R J - c15^C'tNG P,,41,-41 � bC1TC1�1�`YV b � I JP. •��'"�l� Lt9l Z.L..�J�.�� C�(JC"5(1?� F �d� 1AlIu"57r7AJ(5 C= 30'� Q P2,T1 i OAJ ti 1 �t - rjz41Sa Pw Zx iO RAFrrQ S @ I6"Cie. �1STc�1G /V6W tjMMA � _ l . i AREA PLY 7 roUNDq U6A/ EX 115TIMC9 ° lrV s uLA'�t aN p 4 ._ • -, BAX1IR RESIDENC� - M�RSIONS MILLS MA. lam,.......-. CAI _ C..yl .- ----.---..---- --- -- . -DRAWN BY: C. BAXT�R f •. "�t J fd "� t� !.e tads ©nl A�jC�k�� PAWAmmon �t -� -N- Fn7 t Uzi I tin(CATE3 NMV z.J4"S. 4' �� �v" O�l D�_ �U A C.L . ��E, S`►"l!�''S`. cvrurl��IS YL.,.1v.,t `.tih:J+.a.d'* .�.rT' ��{'�/ya,ft.t'�4.".•^''I�e"`14"'^S•':,M i•� -� W •t✓V `'.��+7tv "'�:�"1'iunq'i+`e'�Y � �,' •i.� -��...,�y,�. J '1 'y'3"1� ^a.k" tiq :�;,�`ts�,"�4 �.. l!.fE�xr�'�$�.. `of1NE t �o� Town of Barnstable ' BARNSTARLE. Regulatory Services ,. Y MASS: SI. `b t0q Building Division -- 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice . Type of Inspection Location S�� /itt-6Tn02 Permit Number Owner Builder I One notice to remain on job site, one notice on file in Building Department. The following items need correcting: f-on& 10q1u c 7-1 vsj s r ALL _ 44n(zo -r _ 0LZ -r Mao 3 0$ �S . -7-y-- �a�co►ti. Pc.,a-ram c JaffEle E. r �Ij Please call: 508-862-40-8 for re-inspection. Inspected by Date =�• ' 1 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map 1 Parcel. 0-U Permit# �rl Health Division 2003-D`12 '� `� 63 =3 �D 'r oN t6TABLE Date Issued Conservation Division L v3 2002 APR —4 Pj 155 Application Fee Tax Collector 1 1 Permit Fee Treasurer D `_�_�--~� D I V I S I D FJ --�EPTIG SYSTEM MUST E E Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board VMW TITLE 5 ENVIRONMENTAL CODE AN[ Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address i re,u To Village Owner Address `J012 OrC1.49— Telephone &31 �Jqq 10`7 . I I Permit Request ex Ib�Aroo Cv ' X I - ' a �a � Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio �� ©� Construction Type Lot Size d WO ; Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family X Two Family ❑ Multi-Family(#units) Age of Existing Structure f0 Historic House: O Yes "o On Old King's Highway: ❑Yes 4lo Basement Type: �Full ❑Crawl O Walkout 0 Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing O new G Number of Bedrooms: existing new �_ (AiKovlett I bA" A,r 3 /w,-_ 'ialQ� Total Room Count(not including baths): existing S� new�_ First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil Electric O Other Central Air: ❑Yes 4lo Fireplaces: Existing 1 New�_ Existing wood/coal stove: ❑Yes 4-00 Detached garageZO existing ❑new size Pool:❑existing O new size Barn:0 existing ❑new size Attached garage,�fexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# Current Use Proposed Use �—B—U'ILDER INFORMATION Name c1 .[.(� �. L� (`�►� 1 `I (� Telephone Number 7(� Address r - License# Q 7 15 0 m© Home Improvement Contractor# J Q O&J 9 Worker's Compensation# 02 MLJ1R7gQ ALL CONSTRUCTION DEBRIS RES LTING FROM THIS PROJECT WILL B TA N 0 CtrryloA/h �anI SIGNATURE DATE FOR OFFICIAL USE ONLY 7 PERMIT NO. DATE ISSUED MAR/PARCEL NO. 4-' ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION q-30-�J FRAME pj� INSULATION ®K 71?!®13 , `* FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGY1 f:;' « FINAL GAS: ROUGHS FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO.'° r a - � _:.i:":,SR^;,7rti��,r33y: r .-,-r.. .- --•- ..3 "�=•• <,r .r-i.-i,..=.i, �a.,a.,"-Cc�^1w.w, u! �' .. ._... .. .-. .. a-. +. • WP`OF tHE The Town of Barnstable BARNSTABLE. � Department of Health Safety and Environmental Services, 9 MASS. 0a PEED MP+� Building Division - 367 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: C h(-r to 5 . X+e r Map/Parcel: Project Address: Builder: IJX.VI 8 L in r-le. The following items were noted on reviewing: r�v5+ e �cnd ►�� ►'�,�rr, cif '-t be odhove armed-e n �OnGre;1-� `514h r►wsf bP �% rnn�'n,�-�-, w►�''�• c����(` �.�'t►e�' t urckr conrre,�e_ Reviewed by: Date: Q q:buiIding:forms:review - ' .� / . }� a �� �` �-r � �� �x �✓ �� . � _ _ __ { . � r RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE / b y square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 71 square feet x$64/sq.foot= 89 x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft,. 1 >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) R6 Permit Fee f °pIME T°�,• Town of Barnstable Regulatory Services B"NSHAS& ' Thomas F.Geiler,Director Mass. � 9`b°TFo;A�A`0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-962-4038 Fax: 508-790-6230 Permit no. 1 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. G�, Type.of Work: //I�1dc�zz- Estimated Cost / �� Address of Work: Sb �i'a2 Owner's Name: Date of Application: 9 I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 OBuilding 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: p r/ Date Contractor Name Registration No. OR Date Owner's Name ` 1 S 1. • Tfo C2AFt,Appendix 1 Table d5.2..1b(continued) ih Fossil Fuch Prescriptive Packages for Ong and Two-F=4 Rrafdeatial Bulldlags Hated wi MAXIMUM MINIMUM Wall Floor Userccas Slab Heating/Coaling C11a�g Glazing Ceiling Perim � Equipment Mcicnc? Area'(•/.) U-valuel R-value' R-value' R-valu Rwa ( R-value? package 5701 to 6500 Hating Degm Daye Noral Q 12% 0.40. 38 13 19 10 6--6Normal R 12% 0.52 30 l9 19 10 6 85 AFUE ' g 12'/. 0.50 38 13 19 10 Normal 13 25 N/A N/A T 15% 0.36 38 6 Normal U 15% 0.46 38 19 I9 10 83 AFUE 13 25 N/A NIA v 15% 0.44 33 6 15 AFUE w 15% 0.52 30 19 19 10 Nonmetal 13 2.5 N/A N1A X 18% 032 38 NIA Normal y 19% 0.42 38 19 25 N/A 3 19 10 6 9DAFVEy 18'/. 0.42 386 90 AFUSAA 18% 0.50 30E?l 4 19 IO i 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: i 4. %GLAZING AREA(#3 DIVIDED BY#2): 50 5. SELECT PACKAGE(Q --AA-see chart above): NOTE: OTHER MORE INVOLVED US R THI5 INFORMATION.DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK BUILDING INSPECTOR APPROVAL: YES: NO: q-foams-080303a r 780 CMR Appendix 1 Footnotes to Table J1 .2.Ib: doors, skylights, and •3 Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example, 3 f of decorative glass may be excluded from a building design with 300 ft of glazing area. 1 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with g Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for the National Fenestration Rarin whole units: center-of-glass U-values cannot be used. The ceiling•R-values do not assume a raised or oversized truss construction. If the insulation achieves the full walls without compression, R-30 insulation may be substituted for R-38 insulation•thickness over the exterior insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. include Wall R-v m alues represent the su .of the wall cavity insulation plus insulating sheathing ('if Used). Do not exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement d,.:scribed in Note b. ' slabs.Add an additional R-2 for heated slabs. The R-value requirements are for unheated 3 If the building utilizes elettric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or Day exceed relected package. uirementscof the closest ciency required ity or tothe ewn see Table J5.2,1a For Heating DegreeY q NOTES: a) Glazing areas and U-values are maximum acceptable levels..Insulation R-values are minimum acceptable levels. It value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available,include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). I I (_ The Commonwealth of Massachusetts Department of Industrial Accidents � ----_ _--- _ Offrce o//nyesti9alivns.. - - � •. 600 Washington Street _-- Boston,Mass. 02111 c Workers' Com ensation Insurance Affidavit / �A01,2 ,� Al I name: location: hone# I am a homeowner performing all work myself ' ❑ I am a sole r rietor and have no one working in any ca achy s' com ensation for my a lapees working on this job. worker x y r.Y:3Yt FL!.4 ri iy:{;}wr? 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Faflure to sectu a coverage as requtrednnder Section25Abf MGL 152 can lead to the imposition of c iminalpenaltles of a$neap to 51,501).00 and/or one years,imprisonment as welias dyU penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me Im�derstmmdtliat a' copy of ads statxmentauy be forwarded to the Office of Investigatipns of the DIA for coverage verification ' :- he! ai d enalties perjury tha�the-that -the -ouided-abnve.iss d orrect - I da li-ereby cert�fyu -p p / Date Signatures "Pfioae# Print name offtcw we only do not mite in this area to be completed by city or town official p emit.Aicens e# OBadlding D epaitrnent city or town: ❑Liceming Board ❑Selecbnen's Otace contact p ers on: �r•U:•+T; Information and Instructions Massachusetts General Laws chapter" section 25 requires all employers to provide workers' compensation for their , an employee is.defined as every person in the service of another under any contract employees. As quoted from the `law .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-er-repair work on such dwelling house or on the grounds or nant thereto*shall not because of such employment be deemed to be an employer: ,...: • building appurte c MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance br renewal of a license or permit.to;operate a business or to construct buildings in the:commonwealth for any applicant who has not produced acceptable evidence�of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfoamanee•of public*ork, iiftffi acceptable evidence of compliance with-the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and pply�g company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and '^ should'be retumed to the city or town that the application for the permit or license is date the affidavit. The affidavit being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"of-if yo u ed to obtain a workers' compensation policy,please call fire DepaitbiEa atthe number'listed below:. are requir -- - City or.Towns _ -_.._ - .r --_ ._ - - . ' ...._ .. . . - •� Please be sure that the aff'idavit is complete and printed legibly. The Department has provided a space at the bottom of ie affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please ' ermrt"Thrcense nwnber wchwilLbe used as a refeieiLce nurril?er. Tfie affidavits may'b'e'rte•. be sure,to fill in the.p _ - _ - ' `am of FAX unless other arrangements have been made. the Departmerrtby ,�,,.• . The Office of Investigations would like to thank you in advance for you cooperation and should you have any�uestions, . 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 Otfifce of 1nYestlgauons 600 Washington Street.. :f Boston,Ma. 02111 r fax 9. (617) 727-7749 : phone#: (617) 727-4900 eat. 406, 409 or 375 OWN � • t �d�y'.� .lYijl/!)ZOnll�E�f/L r 2!(iL�OJ4. ref � hoard ePBtyi .-ft u)~a#ions and Stan HOME IMF' :VEAIIIONT.�GOPITRACI'OR _ R trat i20659 ID 04 LINE ERL6 ENTER OAVIID L(NN4L j! �f -•ram_ 59 FREE BOARD'•LAA I YAI?MOUTHFORT,'MA 02675 Adzpidtrator I �fie�;ecimamryuue '�"°" '• :� .�'R``�"F-_�1'���c -rays ;t_ tll S r 4*g �' � r_� :0:8�h1'r��� 3 :;,�9•' 34'60� RIO aA\UID�J LINNt=L��{.�p(R? ' ry � �59k R B4Oq 1.p�EN;� ��r x;:; s3 >. r• .-•-- =: o ��RMOOUTIiP RT A.•026r7Y5; _ �r Admrrosf�ator i 04/04/2003 10:18 `15315431553 SI-APLES223 F'Al t lai FROM FAX NO. : %836%1294 Apr. 134 2003 09:33AM P1 Town of Barnstable Regulatory Services 2 � �'�g,t,^seiYer,Dirrrmr Wv Building D1v1fi1on Tom Perry, 9a4ldYag Comm+uitoAa 200 Main SUUe HY"R ie,MA 02601 Of im i08.962-4038 lax. 508-790-6230 Properly C}waer Must Complete and Sign This Section if Using A Builder as Owmr of the s*ea property h=byau,&orixe ``` W ac[on My beb&, in all matters relaece�e to wt> autha� Yrg pe=%appEwioa for(addrem of (A Job) 4 40 Si�aat>st�e er D ti Print%7=- 1 � VOWStOWN1aAPaM1 nN Zd Wdtib:Zti �BGZ V0 'add b6ZTZ92eOS 'ON Xdd woa3 Town of Barnstable :THE Ipy� do Regulatory Services Thomas F.Geiler,Director RAMSTA13M - 9� MA ��� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.b arnstable.m a.us Office: 508-862-4038 Fax: 508-790-623( PERNHT# �d/U?u 70 FEE: $ SHED REGISTRATION 120 square feet or less 4zt Tcf Cjk,C,ie nM i, : MAJ5 Al t l[LS Location of shed(address) Village Property owner's name Telephone number gtx !Z( isn o3Z Size of Shed Map/Parcel# . ry C" 6-2�� Signature Date o vco Hyannis Main Street Waterfront Historic District? co Old King's Highway Historic District Commission jurisdiction? O - Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 LPLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE a COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM. MUST BE ACCOMPANIED BY A PLOT PLAN �- 2� c, o Q-forms-shedreg b // REV:042506 ` V r r /5,o l E i i s R ' r . k I 37.y` 7. sroQy FCA> Mi5l I _.- __—_ __ _..,._.—.. � ���'...-�!:mFc':=L'-�o..:6^s^.c:�SEL'i;'�+?l�aS,`??k�U•e:xnexx"_�.'-�;:,--3c�—�.=_'..."��^"'a2.-.—"=�',f_=""`.w'�^.i.�.'��:,,.,.-:....� N.D_._S DVt/_A<__. BAXTIR RISENCI - .AARSIONS MILLS MA. SCALI:Za/ DRAWN BY: C. BAXTIR DA1E��s� f f r . r„ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Iro Parcel ��3 Permit# 3 s Health Division C. _�� ' Date Issued `1 2 ?AOC7 Conservation Division ho !91> Fee "7 7 Tax Collector SEPTIC SYSTEM MUST BE Treasurer INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 5_6 7�-6 TOP 5—`11ZC46_ Village /LW-S(�IN-6 M1LZ,S Owner Address �//��� VY Telephone wl-31- 41f!?— �41E;g ` Permit Request /Z&3 7145—zAl O/1 ?(0 Square feet: 1st floor: existing proposed 2nd floor: existing !J proposed © Total ne Valuation _ Zoning District Flood Plain Groundwater Overlay Construction Type 4,'eV 0 Lot Size Grandfathbred: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) ^ Age of Existing Structure 30 y1a Historic House: ❑Yes )<No On Old King's Highway: ❑Yes XClo Basement Type: 91'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) © Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new O Half:existing O new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing 57 new D First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil Electric ❑Other Central Air: ❑Yes )ELNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ,)qNo Detached garage:Xvisting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:.❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes >k10 If yes, site plan review# Current Use Proposed Use I BUILDER INFORMATION Name owl ovx?w el, Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -0 V FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUEDlet ••; " `"� �, _ MAP/PARCELNO. ,k .. ADDRESS : VILLAGE OWNER iii DATE'OF INSPECTIO! if FOUNDATION - FRAME , INSULATION FIREPLACE - ELECTRICAL: ROUGH: "' FINAL ' PLUMBING: ROUGHS t: FINAL.- GAS: ROUGE = FINAL. f FINAL BUILDING M _ DATE CLOSED OUT +� a b xi 0 > ; ASSOCIATION PLAN NO.M ,, . .� The Town of Barnstable , .►`0� Department of Health Safety and Environmental Services rEo Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 ! Ralph Crossen Fax: 508-790-6230 Building Cointnissi= Permit no. Date AFFIDAVIT HOME IWROVEMENT 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 az least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [3Job Under S1,000 gn Huitowner-occupied wer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR fi Date Owner's Name q:forms:Affidav Q,Ssac 1useta .,i••�� The Commonwealth of - -_---� Department of Industrial Accidents Omcaifftwestfgst�oas Ix t 600 Wasisington Stred M s ': ass. OZlll �. Boston, <-•- ce davit / Worktfs' Com msation Insan %////////////////%%///�///%%i/i/����,,,,i/;: ,win =n� CL�/�� ?� location ✓ C� �� — Z` U' hone W & city S� I am a homeoWn�P�aU wMk . 0111SOMM , le p 'etor and lave no tme m I am a so �vorlaag oa this job. Y:i:::q:<{:'::::i y?:..;.;.+•.}::.... 0 NO (�����uY1.�n .. .. ,..v��'.. •4,•...},:•:a•Y�..:.h,•. ":xvnv.L•.v:Y:.f{{:::ii}:2?is::::;?;�i:4:v:::':'?:.:.�.v:::: as —l— 4. 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Massachusetts General Laws chapter to eP is defined as every Peron is the service of another under am ----cc - ,rnplovees. As quoted from the"law", an emP Y . �f lure. e1•press or implied,oral or written- oration oz other legal entity,, or am Two or mor c z. ed as an individual,partnership, association, corp Io . . or the recc:•,=- - •-fin emplot er is defined eves of a deceased emp and including the legal rep love-.s. However the O' n%=of a the foregoing engaged in a joint enterprise, emploving emp ' associasion�or other legal aunty, =ustee of an individual,par nershtP, who resides Mein, or the occupant of the dwelling ho'.ue �. y- not apartmentsand dwelling house hating canstcu work am such dwelling house or on the faun: ; another who employs persons to do maintenance , be deemed tube an employer. x building aPP urtenant thereto shah not because of such employn� state or local licensing agency shall withhold the issuance a ,MGL chapter 152 section 25 also stairs tbat every the commonwealth for any appiicant whc of a license or pest to operate a business or to construct buildings red. Additionally, nrzther the not produced acceptable evidence of compliance with����c°�a>e � ^ P enter into any eonMace for the Performance of public work uL� commonwealth nor any of its political subdivisions shall _ chapter Have been presented to the cont:r=— acceptable evidence of come with the iastaaace ss :applicants checlangthe box that applies to Yom situation and :Please fill the workers' compensates aff Uvit cnPlefY, a certificate afiasmaa�as all amdavits may be is supplying ompany namCS,address and.phone mmsb for ion of insurance coverage Also be sure to si=n a.: c D artmeat o f industrial Accsde�s licatioa for the p o-license L submitted to eP be retarnedto the�Ortowathatthe aPP - date the affidavit, 1be Accide�s. 1 � yt. have�'gnestzons regarding the "law" or not the D artmeat of Ind at the member below. � listed 0e requested, , �p p�eY,P�caIlthe Department are required to obtain a ,��� ......... limp! r/ r�irr���"!�/r%ir.. City or Towns The DW has provided a space at the.bottom c:-ne sure that the aiida*is complete and P may' re the applicant. Please � Pleas„be �DffiCe of inVC.Ztl �to C�y°u Tag zmdavit for you to fM out in the event member, The a$davits may be r t^ be sure to fill in the perm�iic®se�bQwluchwillbe used as a refereaa b marl or FAX unless other havebeeamada the Deparnneat y . operation and should you have any qu=om. Tne 0fnce of Investigations would Liilm to thank you in advance for von co ,,1C=e do not hesitate to give us a call. % am /r .. d fax Abe. Tne Deparuneat's address'telephone aci - , The Commonwealth Of Massachusetts Department of Industrial Accidents Oftice of 1098SUMUDDs 600 Washington street Boston,Ma. 02111 fax*: (617) 727-7749 phone #: (617) 7274900 .eat 406, 409 or 375 no CAR Appwdis Tsb1s is=(conomed1 ud witb Fo:sO Faeb pm6pde pselrsn for Oss sad Twe-Fsmap Rnldmdal Haildiap ggs Cell WaII Floor Hammm: Slab ti�8��r� CoaHng Glazing G1a� Will Area'(%) p.vai=2 R,-h-' �*� Ri govsitd Fzr3caIIe 5701 m 6500 Hntmg Dew D+l� . 19 10 6 Normal Q 12% GAO � 6 Normal g 12% O3Z 30 19 19 10 SS AFUE i9 10 . 6 S 129A OM3i N/A. N/A Normal T 15% 036 38 � � Normal 19 10 19 19 10 6 u Isb GA6 N/A WA is AFUE V lss 0.4t n 13 25 Is AFUE 6 W IsN� 032 30 19 N/A Normal x IMe am 3= 13 25 WA N!=A!FEIE 19 23 WA WA Y 1i1A 0�42 >3 19 10 6 90 Z 18% GAZ 19 19 10 6 90 AA ID OJO � 1. ADDRESS OF PROPERTY: ./1�' /1i1G S 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING.- 4. %GLAZING AREA 03 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED M=� G ENERGY REQUIREMENTSINFORMATION. ARE AVAILABLE. ASK US FOR BUILDING INSPECTOR APPROVAL: YES: NO: q.forms-t980303a 780 CMR Appendix J Footnotes to Table JS2.1b: assemblies (mcludiag sliding-P,� gym, skylights, and i Glazing area is the ratio of the area of the g conditioned but=hiding opaque doom)to the gross wall basement windows if located in walls that mclose �y be�� �e U-due requirement. area,expressed as a percentage.Up m 1/o of the total glazing deli with 300 ft of glaung area. For example,3 fl=of decorative glass may be excluded fium a bW is accordance with 2 After January 1, 1999,glazing U-vaiv�must be tested and documented by the the National FenestrationRaring Council M= test P or talxen from Table J1S3a. U-values are for whole snits:center-of Sim U-values mot be use& ®, the insulation achieves the full The ceiling R-values do not assume a raised or ov�.trr�SS R-30:won �Y be Substituted for R 38 insulation thickness over the exteior wales mom' _� the sum of cavity insulation and R.38 insulatiom may be subsfimtd for R-49 insulation. �g Rsh� tt pied f cavity insulation plus insulating shembing(if used)-Far vmntlated ca'fings. insulating the conditioned space and the ventilated portion of the=100E shag (if used). Do not include 4 Wall R-values represent the sums of the.wall cavity.i�8tion plus mSnlatmg requirement x�nld be met EITHER exterior siding,structural sheathing.and interior all.For e�a&Iwpla,an R-19 imwlating Wig• wall requirements apply to by R 19 cavity insulation OR R•13 co* iastilsti0n ld� R-6 o metal-same construction. wood-frarise or mass(concrete,masoMp logy waII���,�such unconditioned do not apply to erawlspaces,basements, The floor requirements apply to floors over uncondWongdspaces or garages)-Floors over outside air must meet the ocmg `entL less than SO%below grade must •Tl.e entire opaque portion of nay individual basement waD with as average depth im doom of conditioned meet the same R-value requirement•as abov&Vade waves. wndows sliding 8 basements must be included with the other.glazing. gesem� doors must meet the door U-value requirement d:srn'bed in Note b. R 2 for heated slabs. 'The R-value requirements are for unhemted slabs.Add as additional - 3,4,or S. if you plan to install more ' If the buiIding.utilizes electric revstance heating use compliance approach of cooling cp*cm the equipment with the lowest than one piece of)seating equipment or more rhea selected efficiency must meet or exceed the efficiency required p�8L 'For Heating Degree Day requirements of the closest city or tow see TWO`J521a NOTES: g.�are minimum acceptable levels. a)Glazing rims and U-values ate maximum include �� R-value requirements are for insulation only tbaa 035.Door U-values must be tested opaque doors in the building envelope must have a U-value no b) a with the NFRC test procedure or taken from the door U-value and documented by the maaufacmrer in aeeordaa U vai=rating for that door is not available, include the in Table J1.5.3b.If a door contains glass and an door U-value to determ� compliance of the door. glass area of the door with your windows and C��hm a U-� than 035). One door may be excluded from this rec;nirem etrawl space wall iactutdes two or more areas with c)If a ceiling,wall,floor,basement way. cif the area-weighed avenge R-vauue is greater than or equal to different insulation levels,the component o==comply if the�weighted average U- the R-value requirement for that component. Ghszing or door cep value of all windows or doors is less than or equal to the U•vahse requirement(035 for doors). ESTIMA TED PROJECT COST WORKSHEET Value LIVING SPACE (high end construction) square feet X$115/sq. foot= above average construction) � square feet X$96/sq. foot= i (average construction) square feet X$57/sq. foot= 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 °pTME r Department of Health Safety and Environmental Services Building Division - tinaNsrAnt.s. = 367 Main Street,Hyannis MA 02601 Mess. 9 1659. Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village / ..HOMEOWNER": name hone phone# work phone# CURRENT MAILING ADDRESS: - a1,l�l 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 pro and r em 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 to amend and adopt such a form/certification for use in your community. Q:FORh1S:EXEMPTN MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 7 r< 2f�0 Checkedby/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 7-11=2000 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 50 Your Home = 41 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value 'UA ------------------------------------------------------------------------------- CEILINGS 144 30.0 0.0 V 5 WALLS: Wood Frame, 16" O.C. 276 19.0 0.0 17 GLAZING: Windows or Doors 18 0.400 7 DOORS 15 0.350 5 FLOORS: Over Unconditioned Space 144 19.0 7 ------------------------------------------------------------------------------ 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. ner Builder Desi / 9 Date i i LL MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 -- - - - - - - - --- - DATE: 7-11-2000 Bldg. Dept. Use CEILINGS: [ ] 1.. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-19 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 Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 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" 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: 1C ~ [ ] 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: [ J All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. t, - TEMPERATURE CONTROLS: [ ] ' Therinostats 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. - -- HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% 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) ------------------------- r owz<wf,-- 2 �� i Ej I I I Ext'STtNG- �E��-!�"Xl5"R�Cr � II 8 - �- El SCALE /!•/�.�'/=:�'�4-/, =/�' ° CA DATE SVN.tS 20co a I j I przV Y� w Wiz.�. DRAWN BY V� DATE JCJ (SLC\� C"RtST-1n1G II v(L-1,1i .- ----- --— _ SCALE -=/f" DRAWN BY Cam?, DATE rU crrF3 . ' �. f-fA2Dru�or� Fi.00r2. �lN Dry ES�rt�r�cro.�J f --- .2. 3 _Szn-TZ- /&l f, • 25 : T=ZPAJL� 8acK-wl f:,-NL17E- U//A1DOw -. 2 U)tAJlbcJS,:_AYD. TILT WASI-j� SEc A BEZ�CcJ 6. t4 R.E'e�s�, cam L f/vG <� T_• _ i 1 2'O" _ !.vlvDOuJ_il.lcl� f-�( ' /Zd--05 u+c,EA,&91'r F2.12_cSPfsTMAS DR c�l�GbuJ st�.t_OF lVElci�✓iivGba(J M!/5=r �3E ..+4�1t �, R V,2E_ E�O/-�C lb1FJ1ITS FCXE FZaUT !'!7�2C7d�f Ull v!XJcU Io'orr 1 a 32„ 6,r j RTH 30 C`IlJ.'JG Gc/c1�VCr j --_ 4V 6 3rr / 2)cy Lf Vrr JG CoOM DtJ j�RE NOTE OAK-rt=f` I�t�f C(�ricE- P/J;-J6 0�t� _ scaEE DRAWN 9r C✓ DatE.7ZJ/`l. Z�00 Gut2E__SC2�i-`tyln�G 7o HU1 UP inl5()/-.4TLO!_V_ NOTE OFF',-ET AJ F�XUAA),9 I!O/U S, A30 oa>4T7- l.tll.J 5. 6,_n.r�r=T �2�?Totil_.►�a��Ed Ga��IGE = BLS — -d N�uJ 120 i / - 'C / rau Nor- 2" OFFSET IAJ FOUal RTIOtiJ FJ=ZKa.@ IZ" oG w/D(k 6A?ACJA)& I I I 2`Or T : i I -t(MNCy 'nJ i krr-Rgoo/vl DaDu5/a/ll.._F2cLllDhTfd�1 SCALE LIZ p •"", //� •,J Grp.�,11T DRAWN BY DATE veering Dept. (3rd floor) Map l,�O Parcel 42jeiMermit# -"2,L+ TCJ House# Date Issued ' 2_9 —9 ;oard of Health(3rd floor)(8:15 - 9:30/1:00-4:30)14JM /!�— !Fee 3�� Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/SchoolAdmin. Bldg.) Definitive Plan Approved by Planning Board 19 SEPTIC zd t' 6 INSTALL LIANCE TOWN OF BARNSTABLE WI 5 Building Permit Application ENVIRONMENTAL CODE AND Project Street Address J7&-. ,�/ C� 1 TOWN REGULATIONSoo ��� Village Owner A6o Address Telephone l ` Permit Request s, ,,,",�_ r� ?4 I First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Z2 �dC� Zoning District �' Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑Na.b h. Dwelling Type: Single Family l Two Family ❑ Multi-Family(#units) Age of Existing Structure , Historic House ❑Yes QrNo On Old King's Highway ❑Yes &o Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other - Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New -a-Half: Existing New I No. of Bedrooms: Existing -2.. New Total Room Count(not including baths): Existing „Z New _Z�--First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other j??a . Central Air ❑Yes M No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No ,Garage: Detached(size) Other Detached Structures: ❑Pool(si e) ❑Attached(size) ❑Barn(size ❑None ❑Shed(size) ❑Othe/(si Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use . 7CONSTRUC71ON / � Builder Information Telephone Number/�ie,��' �o ,P� ,� License#f� ,00� Home Improvement Contractor# /070.4ff 6�L� Worker's Compensation# UCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS TRUCTURES ON THE LOT. UCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE /� DATE UILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �"n� o . t-1 L . �e FOR OFFICIAL USE ONLY F PERMIT NO. 4 DATE ISSUED' r, MAP/PARCEL NO. 3 '" n ADDRESS VILLAGE OWNER Y I, DATE OF INSPECTION: FOUNDATION 2 Z FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH; ` FINAL GAS: ROUGjj FINAL FINAL BUILDING i �77 _ -DATE CLOSED OUT r ASSOCIATION PLAN NO: X 91.6 6 0 X 89.8 571 '31 1, ..� .�,_ '•.,' � - - - - � ; '` 58 163 1 3 2 r` 59 .5 X 74.9 { �." - ,t r 0.7 / - X 85.1 { \\\ i/76.3 t -- - X80.8 . ti - - -- 35 5: 80.9 • ' r 7 >/8 .4 � '�` „ , , ✓fze T�arrvnzavuueai o�✓ ta�rueCl� DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION.SUPERVISOR LICENSE ,..Mub'er, -: Expires: Restricted To: 00 YILLIAM R PONERS ABIGAILS NAY S SANONICH, MA 02563 i.7 77..7...7..^-^^•..�,�^'R^ram•-��re ' �/ee"lOonamoxu,�a¢`!�i o�✓�aoaaa�iraeQ'e 'i ENEXEM HOME IMPROVEMENT CONTRACTOR Registration 120659 Type - DBA Expiration 02/19/98 LINNELL ENTERPRISES DAVID J. LINNELL ADMINISTRATOR 'ff FREE BOARD LANE ` YARMOUTHPORT MA 0261�- I ' WE rq� The Town, of Barnstable MUMAB'M �0� Department of Health Safety and Environmental Services 1 ram" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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,alloo�ng with other requirements. Xype of Work: %"le��— �� �' r _ Est.Cost ,,,/Address of Work: /Owner's Name '40,00 ✓ Date of Permit Application: -o 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 hlte eby apply for a permit as the agent of the owner: teaDa Contract r Name Registration No. OR Date Owner's Name The CU11111 onivea1111 ofAfassachusellti Departnumt of 111d"strial.4ccid nts _ ' 'r ! • . 0/Iiced1/lvestigalions •�\�':;" =i �' hflll ri'aslritr�;wit Streer Buvotr.Alas. 02111 Workers' Compensation Insurance Affidavit IIilic�int rnftirntatititi• Ple•tse PRINT'legt tiv loci ion, /cw 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity _ [1 I am an emplover providing workers' compensation for mN employees working on this job. cmmvnm• name, adtlres�• . city nhnnc#• incurnore cn nolicv# 0 1 am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: cmmp•:m• nnmc• - adtirrsc• ' city phone it• incur-inrc ro policy _ cmmnnny n•ttnc• ad:l resc• rity nhnnc#r - incur•tnce co policy# Attach additio_nai sheet if necessary % --•_ -^+%".`^ _" " ��' '- e.�r..� +L-�� �•�r'�•��� F::ilurc ro secure cuycraee as required under Section 3A of NIGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 andiur une N cars' imprisonment::.Well.15 civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a cope of ehis statement may he forwarded to the Oflicc of Investigations of the DIA for coverage verification. 1 rio hercbr cerrift unt/cr pains as enalties of pery'u •that the information prodded above is true and co ct. Si2.nature Datc Print name ��y/lJ �ilv/r/.� Phone official use unto_ do not write in this area to be completed by cin•or town official city nr tmyn• permittlicense# rtBuilding Department C3Ucensing Board Q check if immediate response is required C3Scicctmen•s Office l C311calth Department EE contact person: phone#: r•1Other. s. Information and Instructions Massachusetts-General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th employees. As quoted irom the -law-. an e»1Ptm•ee is defined as every person in the service of another under an%• contract of hire, express or implied. oral or written. An emPlm•er is defined as an individual. partnership, association, corporation or other legal entity. or anv two or inc the foregoingenuaucd in a Joint enterprise, and including the le=al representatives of a decc:asctl employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However t! owner of a dwelling house haying not more than three apartments and who resides therein. or the occupant of the d%+--clling house of another who employs persons to do maintenance , construction or repair work on such dwellim_ he or oil the :rounds or building appurtenant thereto shall not because of such employment be deemed to be an employ MGL chapter 152 section 25 also states that ever-,•state or local licensing agenc}• sl►all withhold the issuance or renewal of a license or hermit to operate a business or to construct buildings in the commonwealth for any applicant ,n•ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perforntance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coyeraae. Also be sure to sign and date the affidavit. The affidavit should be returned to tite 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 require to obtain a workers' cotnpettsation policy. please call the Department at the number listed below. Cin• or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pl; be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retumec the Department by mail or FAX unless other arrangements have been made. The Office of In•esti=ations would like to thank you in advance for you cooperation and should you have any questic 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 NVashington Street ,-� Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 — 5-03; 9:29AM: s 2 5 . lo Ova a • - �`�Stt7ff5. - 3 A O UlMgrz7. w./.•:.gR el7Gr�f G. r�n�D;.:.Rio.lklsk ATidjj - It 9 i _ �, -•- Y Pt �SLV� TLC� !2 x /4 _\<AO. Fro 77nJ�C,. BAYHR RESINNU - AARSTONS AiLLS M. ACL<--_::. DRAWN Y: C. BAXiIR DAif?1s�°� A 0 p LOTS /5-�c5 37 ' BAYHR MINE - MARSIONS MILLS MA. Pgol®J-iO SCALI:2a' DRAWN BY: C. BAXTIR DAH: 9//oz • I � I I I ' iy -.� SMOKE DETECTORS O.K. BA STABLE BUI DING DEPT. `�-n-s EV1l S> �tOKE DETECTOR RE EMENTS LAW. N THE DITION OF A AIL NEW B RO M WILL T IGG.ER AN UPGRADE F HE SMOKE DETECTORS �� . . 0 LE HOUSE YOU MUST , PLAN AC RD NGLY AND HAVE YOUR } ELECTRI AN TA OUT THE PROPRIATE - - PERM AT THE I tRE DEPART ENT. °7 0 , r , fir 1`7" -. .�-- - �..�_. __.�...�.���_ .�._-��_ --___ ---� : �_-mow.,.� � •�� 0% 13 p I Ero BURR MENU - MARSIONS MILLS MA. - � Sp��. �;�-� �- � 7E�4/415 SCALE: 1. 6 `' REV SH �T .� PtA��� _.. _ DRAWN BY: C. BAYTIR u DATE: ` �/ - 3 i W e G .... . ..... T 'I Dili BAER RISIDENCI - MARSTONS MILLS MA. - --... :__:_:___.:--. SCQit V8-.* RIV MU DRAWN BY: C. BAXtfR DATA: /�/� q 8 TZ . ...._ fry J/ 1 /Z:/:Z:Z://:Zl/:/Z= i 'j . , ;:• . ,.._.. .--......__� PN ± BAXIER RESIDENCI - MARSIONS MILLS MA. - SG 1 :%2 _�`o__._.._-. REV HIT Aj_ .. ..... ......_� DRAWN BY: C. BAXiER DATE: 9 �® . ...- jy�6 & AJG 9.1 a I r- �l , 47/ i 3 _ �Cl STD ��Z,,,. t0`2" x 13 '�rF SPEC dw .. O - — e)(JI-\-JD l�L ?J d��'7CJliU Cam" a/z, - 5� : :: 0:_: '. - - - Q"`0`' 149 -- 2��Z �/ r UJ BAXTH RESIDINCI - MARSTONS MILLS MA. - -" ' - _ ._ sp - _ _ z-- ---SCALD: -� KV SDI fT ::"_ ' : 5lD ..: " t A_.4�ot '. :.:.._.:.:::-: :.. - - DRAWN BY: C. BAXIIR y :... Rlbo a 3 U r7 � HO J M (-AU ©- :�c1� � -- 5 7 R.o. 2f,2- all 2 7w Z 31 O IS. Li CL -ET _ BAYHR HSIDINCI - MARSTONS LLS MA. —ate v�� / - -..- SCALE: `�z`'=l `e" RCV MIT DRAWN BY: C. BAXifR DATE: 6 4 IL 32`� ZR�fi6 'I 271b�i • . : - Pam: TOP DEG-1���,v.�D Fr_Ca�r�. __... _ . . __....-___...__._ o_ i�.xc����1 l Is r l4/00E 1D. _2?�-��sT BAXTIR RISIDINCI - MARSTONS MILLS MA. - (Z)C uc�� SCACf= — - REV MET �,I�-- — - �� DRAWN BY: C. 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