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HomeMy WebLinkAbout0527 WAKEBY ROAD ,-,�.. .. �� ,_ ,�. _.�n_.._ _ ,.��.� _ .. .._. .�._ , - - - - - - - --� - - - � �� ��� b� Assessors :map and lot number .....® . . y •X t Sewage^sPermit number _........{!A�{/Lpc1 (�p lliLt<��I OLG✓j'J . °`7NEr°��' E. TOWN OF BARNSTABLE B ARNSTABL UM& E'0 i63 9 O YPy d' BUILDING - INSPECTOR ' 'F • APPLICATION-FOR .PERMIT TO ....................... .................................... TYPE OF CONSTRUCTION ..........W 0 ��`�".. i .............................................................................. ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �17 wa� +ve.... vG. /`� € I c�5 �°f� .............. ........... . .....................................d............................................................. �e,020a / � oProposed Use ..................................................................................................................................:........................................... Zoning District' ......... `�,'Z""...............:.............................Fire District ........e........zv....t pS'FL...vi..E..................... Name of Owner ... 1 ........ 2�( �........Address ... O �r ...... S ............, Name of Builder. 1. `^�(L2n.Ce-....-'... 1.� ?:?.0.�Address ... s ...('`�!n ` S7� . /1��'�!� ...... ................................................ Nameof Architect ......................S.:A.M:C.............................Address ............................ ....................................................................................... Number of Rooms• .............................Foundation ......e O)el c.22.t..........6 -q.c�t........................ .............................,. Exlerior •....... 2�1 vR Z 1 - .I........................................Roofing ......ems Q�^� 1T ...................... ............................ ... ................................... .. . . ............. . Floors V n h5�2AQ \.......` ...........E C o,•R;,.PCT..........................Interior D 2✓< wo, �� ........�.............................................................. J Heating .....:..........Plumbin ..........yz 8.� Fireplace ........................ ...................................................Approximate Cost 4 00 <.0 0 Definitive Plan Approved by Planning Board _____________---------,------__19--------. Area .......f...... r.... .............' Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i 1, I hereby agree to conform to�all the Rules and Regulations of the Town-of Barnstable regarding the above construction. Name ....................... `:e................................................... Clark, Barbara '19822 Addition No ................. Permit for .............................:...... •4 1 r L - r ............................................... . ............................ Location• .............. ke Rd. ire�clr�1 Marst:ons Mills Owner .......Braxtiara..Clark................................ } • Type of Construction ....W nd..F.ram,e..............°. - - • ..... . ..................................... S ' ? Plot ........................ Lot ............. T � - 4 -Permit Granted December 9........19 77 Date of Inspection•.. ..............:.19 Date Completed ...............19 }° PERMIT REFUJ'SED ,y ....................... ... 19 ............. ............. ....................:...`............... -- k� - - { .L .�... . - - . T ........ .................................................y.-................... 1 u � } Approved ..................... ......................................................... , 3 1- 77 .- Assessor's map and lot number., ..;.............. � SEPTIC SYSTEM MUST BE Sewage Permit number ....... i�/ !1 ... ...�%�?..j �.oC ` INSTALLED IN L"OMPL'jANCE �j - i� WITH ARTICLE it STATE Q I\IT Y. C AND 'TOW.M. ;y OF THE r �Q� °o TOWN OF' BARNS 4blLi w t o. i 33AW5TA33LE;' N C) ° o�Ya. BUDDING INSPECTOR ' O 39• IN .C; APPLICATION FOR 4 PERMIT TO ......0%.d.1'd\..... oY " TYPE OF CONSTRUCTION. ...........w ....... R4<^f.....•.•••••.•••.••••.•• ....... .....Q.e c 2i!'1 ......19.17. TO THE The undersigned hereby applies fora permit according to the following information: Location ........... .zr7..........!N ............./`,w ........!'I/. ....................:..................................... Proposed Use •. �O 2 0 0 l'� ............................................I......................... Zoning District .........: .... v�Z Fire District ......Ce,,}�tv�IJC QS-tZ2�i1�C. p .... �. . ...... Name of Owner .... C�KL(....<t f,>.......Address ...1 O° 6 0 7 Z 'k .5+ v+S q,//5 ►....................................................................... Name of Builder ....� Ce .... ...Ql.(V.�KAddress ...... �*'�tnT',Irir`� ST A�/)IS �'............. . Nameof Architect ......:............... ...........................Address .................................................................................... t �� ++ Number of Rooms �.. �...../Z Qa Foundation ...... . .Y..4.2Q::t�.......61�e c� ............................ .................... ....... . ......................... Exierior .......1.2-AT. e......... .-.11........................................Roofng ....... T ....................................................... Floors ......V/..).V..1,44.6I..........E...t.H(I .........................Interior ............ ................... Heating L c-foe)c ...........................Plumbing ...................................... .:.Z.....e a... ................................. . ......... Fireplace ..................................................................................Approximate Cost ....... .�.O.Q..o. �.....................: Definitive Plan Approved by Planning.Board -----------_____-_-----------19-------- . Area ....... ............ Diagram of Lot andBuilding with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable r garding the above construction. Name ............ ....... .....:► f.................................................. _ .. _ 6 Clark, Barbara No A�§4.... Permit for ....Addition.............. .. . ........ .................................................................... Location ...... ................... .1.119............................. Owner ....UrVara...Clark................................ Type of Construction ..........Wood..Frame.......... ................................................................................ Plot ............................ Lot. ................................. -Permit Granted .......Pq.c.P,:%b q:K.... c . Date of Inspection ....................................19 Date Completed .................//is 19 PERMIT REFUSED ................................................................ 19 ................................................................................ I...................................................................... ...........I ............................................................. ............................................................................... ApprO-ved ................................................. 19 .................................................................... ............................................................................... is { if it Aj 10Al g fi M i �� C�L _ CERTIFIED MAIL RECEIPT U.S.Postal Service _U N ,CO O Postage $ o, 0266r CO ruCertified Fee �q Return Receipt a Receipt Fee ! n �1l.l (Endorsement Required) CGQ V He 'C3 Restricted Delivery Fee p (Endorsement Required) Total Postage 6 Fees $ ni Ln RBC lent's Name ( ae Print Clearly)(To be completed by mailer) C3 - --e 11-- O Street,Apt.No.;or PO Box No. oSlat IP.4s iPS Form 3800,February 2000 See Reverse for Instructions I Certified Mail Provides: ■A mailing receipt ■A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: ■Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt add present it when making an inquiry. PS Form 3800,February 2000(Reverse) 102595-00-M-1489 I of r Town of Barnstable - Regulatory Services vI'E� Thomas F. Geiler,Director 039. �0 Building Division Peter F.DiMatteo Building Commissioner 367 Main Street, Hyannis, MA 02601 Office: 508-8624038 Fax: 508-790-6230 September 26, 2001 Mr. Robert Bourque 527 Wakeby Road Marstons Mills, MA 02648 Re : 20 Brenda's Lane Dear Mr. Bourque: It has come to my attention while reviewing lottery and permit activity, that there is a discrepancy in your submittal. The building plans are in apparent conflict with the site plan. Mr. Mitch Trott of our office has notified you of the conflict. In accordance with the Massachusetts State Building Code and the Barnstable Zoning Ordinance Growth Cap, all building permit applications and permits shall be exercised in a continuous and expeditious manner. With this in mind, I now request that the disparity be corrected by October 10, 2001 or your application will be considered null and void. Th ou for your consideration. -Sincerel Peter F. DiMatteo Building Commissioner PDM/ek Bourque92601 ; SENDER: I also wish to receive the ■Complete items 1 and/or 2 for additional services. following services(for an w to Complete items 3,4a,'8nd 4b. 0 ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address •9 permit. 2.❑ Restricted Delivery d � ■Write'Return Receipt Requested"on the mailpiece below the article number. rY N ■The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. delivered. p O 0 3.Article Addressed to: 4a.Article Number 4b.Service Type �,/ c /y' ❑ Registered 6G Certified , 02/ � ❑ F�ER/Return Mail ❑ Insured L rn Cn UJI ��- i��/ Return Receipt for Merchandi a ❑ COD cc 7. Date of Delivery/ o w py �f 0 ceiv d B • e) 8.Addresse 's es (Only if r quested Y and fee is pa' ) t 6.Signatu A ee r gent) ~ T X w PS Form 3811,'December 1994 it 102595-98-B-0229 Domestic RrKtutn;F3eEelpt rii � t = �t i UNITED STATES POSTAL SERVICE' First-Class Mail q, Postage&Fees Paid It USPS Permit No.G-10 •Print yo&n&ffd dyes and.7lR.Cadaja4hi8-bex-6 �y���'�� M+a"`M fir.:...w.=+t+....,^:. .,.r w w yti.k...!'...,,�) f. T7'., i-K 1` r -'!' t.r.r y!a.'T-o:r,*'Y•ii�.:.p,rY.r+a...,.,raa.pµ.....-y{w. _ `OFINEr, The Town of Barnstable WO„ BARN LX. Department of Health Safety and Environmental Services �prfo► °'0� Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection 1C (,i Location Permit Number 3 / Owner '��Y-G 0-`-9 Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Please call: 508-862-4038 for re-inspection. Inspected by `bc.cl-4.. Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division / �/ ��?���% Date Issued Conservatiop.Division Feelop ` SEPTIC SYSTEM MUST,,-Tax Collector����a� .... : . . INSTALLED IN COMPLIANCE ,,,—Treasurer WITH TITLE S - ENVIRONMENTAL CODE AND Planning Dept. TOWN REGULATIONS Date Definitive Plan Approved by Planning Board ^ c ' rp, _A �v r! Historic-OKH Preservation/Hyannis Project Street Address 5 7 e Village 5 �1 S 117 'Its, /� Owner - 4J A r / dull Address Telephone Strdp— C/a 0,1-- /a,, Permit Request Ncw S e-60 c,'-C:1 be OIL W/94�(I fly cp`ea' S . f -rCg" (CAI�('�F-trf�f,4e CL If Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost , m Zoning District Flood Plain '" Groundwater Overlay Construction Type W o-00 Lot Size 5 e-S Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Y Two Family ❑ Multi-Family(#units) Age of Existing Structure "77/ Historic House: ❑Yes XNo On Old King's Highway: ❑Yes /$E No Basement Type: Full P Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing �2 new Total Room Count(not including baths): existing 7 new First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes �No Fireplaces: Existing New Existing weed6=1 stove: Pes ❑No Detached garage:0 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 ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION r Name w/V Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE c • FOR OFFICIAL USE ONLY r • ` PERMIT NO. 3 - d DATE ISSUED - MAP/PARCEL NO. Z , ADDRESS '` VILLAGE OWNER DATE OF INSPECTION: - - - FOUNDATION FRAME i r1'--� .-�_� --•�„� INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: RdUGI > FINAL FINAL BUILDING .p. s t DATE CLOSED OUT•., ASSOCIATION PLAN`.Y C2 C: r i I C'! a; cu i °41ME Tplr._ The Town of Barnstable • ■nnrrsr�. • 9 M � Department of Health Safety and Environmental Services 16 9- �` Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner January 11,2000 Compass Bank Attn:Ralph E.Geary 1029 Route 28 S.Yarmouth,MA 02664 re: 527 Wakeby Rd.,Marstons Mills Map 028,Parcel 049(Lot B-3) To Whom it May Concern: With the information provided,it has been determined that the above mentioned property is buildable from a zoning standpoint. Sincerely, Ralph Crossen Building Commissioner c t LOCUS_MAP / AS97:'on MAP 2e .sra i ,oaorLL au KAaAr pvli7'IR n+/ 41 NM FWVIEW q1REy r asmcr �T.,,aP'65) Lot B-1 fdm uxo v. a / c„aKn c.K K2Y lOt/ALA 43AM S.F. i•s..isw;Pm<sK 6.JLOT"vim ---SCTOACK 1A1 A17ES xamSETBAAOC Is' (s.00.-la.ex> - O TAPDSETBACK 137 O L — __� — — — — ti ORM[R LO7 L:NCIo.r. r a' ce :ur pcsftacr: CP 9 • SKr 1611Y Lot B- / QJ /� LOt B-2 '� caar�y ier a Z4,I1&F. \ �/L,• (..wso.•S Ptr,,,.9, d o�mr -•Q Q4Aa0 fiF. ri b Z9p AGES Qo 3 MAW cr U)O Aga (Shape-21.04) - oa ( I orro. n.r A✓ I I / I I E27A,10 00MITAL �,• in � N A Dmp Ralph E. Geary Mortgage Originator South Yarmouth Office 1029 Route 28, P.O. Box 280 South Yarmouth, MA 0266 (800)322-9313, Ext. 7392, Fax(508)394-3526 Pager(508)387-7316 _508.7 f r r l L 'ks rv� q -1 y1o1 z._�b�_� �{ ;�p o vt, �ti •�e- w-�-g G{ i.� 5 5� � J''� l or -� �,�..[ y _ss Na • • � _ ' -hors-� �� O. o�� � `S�a9 �t AALC � it WS �c.ts�`S Z z� jln.� �. C a�_� -� onz C.� �� �ems' �. )V•^^� �.� b c.'o�.r, F -----.i•.-•r.,.r:..MT�Ai-rs�r.�^-.w��^��n... .,..;,.,, :�.,..-. ...-.:o-..—�•w-+..=:.-�.r�.<-7-w�c*r.Qt".''�.3-ti_:.'.`.'hi',..�.�RA:`K;;a iiw,.;;�ju..-rF=:,.F�-b;s�,o'.y.����<al�f��"-.".'" . `pf TNEIO� 'The Town of Barnstable BARNSTABLE. Department of Health Safety and Environmental Services "fFo►��• Building Division 367 Main Street,Hyannis,MA 02601 • F Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice r r Type of Inspection 4 Location Permit.Number Owner Builder One notice to remain on jobsite,one notice on file in Building Department. r e following items need correcting: i / 1 -a, (—Ikt rCUln -14,,_ t CgK. t I q_'1,7 I ? Z N C P 1 (5) -j�;o (-,- 0( «,44 . r Q S 4,►, P-P--P AL--, V r {' Please call: 508-862-4038 o re-inspection. Inspected by Date �� ( I C/ ; —� ...... : .: ..... fOX. • 'SMOKE �ETE�T�R� :. :. . .. ...... ... ....:........ .... x ' . ; .. ....:.... :..... . ..........:.......... .... .: ... . : ..... ............ . ....... Ai, S . s.... .... _ ...... ...... ...... __ .................. _ ...... .... ._ U . ....:.... GC:�-G1: i i i i i i E i i 5..........-:7 : .......A. ........ .... :.,..... .............._....................... .......x.....-....... .........-..............-.-. .. ._........_.....................:_5. ..... _ ._.. ............... _.._ ... ._.. ........ ...... _....._;........... ............:........_.._...._._ .. ..... ..... .... ...... _ .... : . : Gt r i i . sC -- ___ ............._.........._....._..._ __....... _..... _...... ...................... _ _ ...._...... i - -.... _ ..... - -- -- - ---- -- .. .............- --- - -- - - - .._........................ .r.. ..... ..................... ......... _........ .... - - .... _.... __......--- - --- - ..........--- -- - - -- - = _... ..._....._...._._.._......._.-...............:.............:........._..:_ �__......:..... i i M/ : i i : : _...:..............:...........:.............:............i........ _ ........ .... 9 _ _...,.. :.......... .............:.............i............ ............ :s ..... _� .:. i - __......,..............._.........:.............:......................... ..... ...:...........'........._.'......... : .,..._........._................ . ._ ... ...._.. ......... ..... .... ..... _..._ ...... .......... - . .. Ll x ... ............. ._... ._. . ....:.... ...... ..: ... .... i i : i i i MMM■■ ■ ■ ■■■■ ■ ■■■■■■■■■■■■■■■■ ON No ■■ ■■ ■■ ■ ■■■■ ■■■■■■EI /lM■■1 ■■■■11■■■■ ■ ■■ ■■ ■■■ ■■■■■■ErE&r■■■1 ■EEMOMERNEEE, ■ EM■I.iM�'2A mommomM■■■■■■■MEMOmommo ■ ME no ■E■EME■ ■■■r■■■■■■■■■■MEEEEME ■■■M■■■NOREE■ ■51 E ■ ■■■■■■■■■■■EE EM■eEE MEIN GAM� IF '� ICE■MMEE ME■■EEME■EE■■ ■MEMME ■E■■■■■■M ■ ■■■■®moM■■■■■J■■■■■■■■MME ■ ME 11111010 BEEN EE■■■ill N _ !IO/I/I�® �EOEM■�!■�J■EE®■®■!�II�■�■EE■EE E■ r glow MORER111■M■OME■■EEEM ■ IMUMAII11 MEN 0 WWI-Am Ell Ill E■■MOMEOtMMo■■!l;�O■■�■■ EM■■ ® ■E■EEM NO EMIR qV 119 ME, EM ;OEM MME E NONE E■■■EMMM EEC! ■■NIN ■■�■ M■■��� 1 MMEMMME ■ t °F WE r� The Town of Barnstable • &AXNsresc.. • 9q, 1639.' .0� Department of Health Safety and Environmental Services 'OrEo " 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 f SUPPLEMENT PTO PERMIT APPLICATION 'MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion; improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:ei re KEF/ A-dd.t T-.d r Est. Cost /d o / Address of Work: 15-0-7 WA ke- 2 r /1Q�-�,5 77Jat 5 ELLS� ^4 Owner's Name -/Cw h:24/ A 1Z o Gc..2—a Date of Permit Application: c©- I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR �- - ct �r - Date Owner's Nanlf `, ,� __— The Commonwealth of Massachusetts N =-r:�._ = Department of Industrial Accidents Office 911085#92 ONS 600 Washington Street -. � Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: T=dZe-� /� U c-t."ta CA-C location: -1- �7 LIA-&-1 12et city fX 4--c'.a'�"� �'�`J phone# `� ayA-1 1-77 © I am a homeowner performing all work myself. ty . . '//////%%/%/%%/O///%%%%%%/netor%%%//h///a/O%/%%%%%/%%%ve no one%%%%/%%�%%% %%%%//%%%%/%%%%%%%/%%%/%/%/%/%%/%%%�%%/�%%�%�%%%%%�%%�%%%%�O/%%/ Q I am an employer providing workers' compensation for,my employees working on this job. company n m . aildt 'Inoue .p # :<? >«<'<> <` >`<:.::: : :...:::::<:::<:::::<::::: »<> <:: ::::::.::::: ;:;::;:: : ;�0` :::::f>«<:« :<::':: ::`::::::`:::?: . : : < s?7 ......>:'::::: >`>:>?> > « :`%>:"�'ol >::> rnsnr n %/ I am a sole proprietor, general contracto , or homeowner( ' cle one)and have hired the contractors listed below who have . the following workers' compensation polices: company>.names::>::<::>::>'::>:<:::.:: ::> .................. ::::::.:::::::..:. :::: ': .....:•:.::::::::::.:::::::::::::.::::::::::::.:.-.::.::::::%:::: ::::::::..:::.:.:.....:::::::::.. :...........::.......... .:::.:::.: ::::.::::::::::::::.:.:::.:::::::::::::::............. :::::.:::::::::.:.:.:.:. :address::>::>::::::::>..::>::: ::;::::.....::::::::::::::::>::;>::::.:.... ::.::::::.:::.:::.._:::::•::::::::::::::::.::::::•::::::::•::::••:::::::::::::::.::::::.::::•::::.::::: 1. :.::::::::.;;.;'::::.;.%,.::::*.:x......................................................................:........:::.:::: . . .. ........ ...........:::::...........:", .......,'... .::................:::: ::: . : : .: : . ........ ............:..:.::.::.:.... .............................................%%:........................................................:.............................................Wi:•:�ii::?:4iiiiii}ii:JiY.iiJi:�:iJ:iiijii::i' r;•i:::::::::::._:::::::::::::::::::::::i.i% ....... isL`v:v'iii:3:•iii:•ii:•i:•i�i:•iil:i:{titi4i>i}iiiii}i:::.}::.:i:•:.;:::v:.`•i i}iti3j::is:ii::}::::::::ii: i::i::::i::::::::i:}}}i'-'**':: ::::isi::ii:ii:i?iiii::i::ii::i::i:::i::i::ii::::i:`::}:,v::Ly:ii:::::}::::: .. ..... 90i... .:::v::::::::::.........................................................................................................................-.-.-........................................ ..... :. ::: .i: •rii::i::•riv:.itr w:::v::::. .............�:.�:::::._:.�:::::::._:::::::::::::.�::::::::::::.�::v:::•:.�::::._::::::•:::::::. ::::::::::.::::::.....�...�.�......::.�::::::::.�:::::::::::::::::::::.�:::.�:: :::::.•:.�::...: ...... ... ..::.....::�......:•::: .:. ... .. yam' ;ii:':iii::::i iiisti::::iii:(:::i::i::::i::i::i::::isti::^:ti:iii:L:...:.iii:{:}iiiiii}iiii::iiiiiiii ii'iii::iii'::iiiii:^::i%:isisii::ii?iii:isi?iii}isiJiiiiii:::i:ii::i::i::i::ii::ii::::.:::::.:': '+iii:::::::. .._. r.>}i. +?Y :::,i k .ri":::i:>.ii:t.....::i:ii::F::::i::i::i:::: h::::..::.. :. :.�:::.:...:: :........... .. ........ ........:................... :clh?Y phone#, �. .,...,. tr . ........:::...:::::...:.:.::. _.. . :::. ..: : ::.;:>;.;.;:::::::.::.;:::.:;:.;:::.. .. - ......:.:::::: :.;:.>;:.;::.;:.;;:.;:.;:::.>::.:.:;:.,:.::.:::::: ...........................vn...... ... 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Irafiu a to secure coverage as regdred under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ' and penalties of perjury that the information provided above is tries and� . - . /Ct,-1� < . — eo eet 7 Signature Date t�c` , , l'' _ Print name .a 4 � K,a� -r-'re, Phone# V,d"aLft-77 official use only do not write in this area to be completed by city or town official city or town permit/license# - ❑Building Department ❑Licensing Board ❑checkif i mmediate response is required ❑Selectmen's Office • ❑Health Department contact person: phone#; - ❑Other Gad 9/95 PJA) - Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a . dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. _ Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. City or Towns Please be sure that the affidavit is complete and primed legibly. The Department has provided as space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the '&iik/liceose number which will be used as a reference number. The affidavits may be re�mMio the Department bimail'or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have nay questions. please do not hesitate to give us a call. The Department's address,telephone and fax number- The Commonwealth Of Massachusetts Department of Industrial Accidents IMCO of IWOitlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 Y 790 CMR AppmWk 1 - Table J3.11b(continued) Procriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Area'(Ya) 1).value= R-value R-value' R-value' Wall Perimeter Equipment Efficiency' puka$e R value° R-value' 5701 to 6500 Hating Degree Days Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 13 -"- 19 10 6 85 AFUE 15% 0.36 38 —13—25— N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X is% 0.32 38 13 25 N/A N/A Normal Y 18% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: �� � p 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table JS.2.1b: .Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and 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 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for 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 insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 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. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include 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 bi sements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. °. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ` If the building.utilizes electric 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 exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a _...Y NOTES -. . a).Glazuig areas and U-values are maximum acceptable levels.Insulation R-values are minimum acceptable levels. �- R-value requirements are for insulation only and do not•include-i dturai'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). 43 . - ;� '�. - . . •�• '�•^• '• •, �; i -' r r••.« . . `•;�- - s + '�. .s t--_ '; Z''`.: .- :aft • , • ♦ � '1 •�, 'ram. ,�� •ice fj,' �• ry -'a � ' '� '. ` > ��- . 1. .> •, , .I �. .� ..�� . .r•.• }S a�a '. �c.: i ice•• ._ rz+).y.. ..+•.��.iw v�+�'!�!'^-""+•. }` yi 7 . � -_ •�.;� r ;.,_•='-tea . c, - � _ ` � — _ ,���r�-r- � `.—. --—^-....ram-- +• ._.-- .� q- " FRAMING SECTION ALL DIMENSION LUMBER SHALL BE KO SPF NO.2 OR BETTER. x COLLAR TIE ti 2 x/GRAFTER (3) &X6 r8Efjrkl S SHINGLE O.C. W/15 L8. FELT rIx PINE FACIA R-30 KRAFT FACED FG amrs R-13UNFACED FG BATTS SOFFIT VENT W/(o-MIL POLY VAPOR BARRIER PINE SOFFIT (15, 1 ,o FLOOR) 0XV WAM arc. i I 2x4f FLOOR JO I STO.C./19 _ (isr R 2Nn FLOM) A CIO I 1 1 1 1 1 i - SILL SEAL �' 03 ANcNOR BOLT @ 6.-0. O.G. "CONCRETE 'e o FOUNDATION WALL I , • � I The Town of Barnstable °�TME tom° Department of Health Safety and Environmental Services Building Division tuxrrel'ante. ' 367 Main Street,Hyannis MA 02601 MASS. 039. �D tillA'1� Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 //�7 JOB LOCATION: 5_0 number/ _ street village "HOMEOWNER": ?f,0 name p home phone# work 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 su eR rvisor. 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 a1_I such work performed under the building permit, (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that-such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. - QTORMSIDICEN yr