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0288 WEST BAY ROAD
L� `J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t. - Dom'Map Parcel Permit# - Health Division q_— 16R Date Issue — �� 0 Conservation Division Z Fee 9 •b Tax Collector a0M f (�{G — 1�11.- LL. ��� a�, b O Treasurer l7 k N L Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address o9 9 Eve<T SAY Village 0STeOulu e / Owner Address ,may 4Gbsr 64Y �d Telephone Permit Request ?,P4_ 4cP U1,-v tbws Go r s i,L Fanirc,Y !«n� i(P/JA�r ,<zV .& A S d?ePe_,4CP A"7- !/o/' 7"rim Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuatio _� Zoning District Flood Plain Groundwater Overlay . 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 ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other 'Q' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �J Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new ��- Total Room Count(not including baths): existing new First Floor Room Count 2 QHeat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Z Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 2 Detached garage:❑existing Cl new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:O existing ❑new size Shed:El 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 Name �J(r 6A)57-1-v CWAA). IAI C_ Telephone Number Address—1c:2_9 // GeP4.) Aue , License# 76 ey D A(6Lu 164 =-7 Y6 Home Improvement Contractor# / 3l Jr 3 Worker's Compensation# WC Q Q aD(Ff ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DUi ps, 7 f- d SDI 9 a cosy SIGNATURE DATE /-`Z-oa 3 FOR OFFICIAL USE ONLY i r s PERMIT NO. DATE ISSUED t MAP/PARCEL NO. ADDRESS VILLAGE s OWNER ' DATE OF INSPECTION: ; FOUNDATION _ r FRAME INSULATION k FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE-:CLOSED OUT ASSOCIATION PLAN NO. i` v e f °F THE A The Town of Barnstable a�axsr�+ai.e. _ M g Regulatory Services �59 Thomas F. Geler, Director, . Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street.Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date — - 0 2 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair.modernization,conversion, improvement.removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors.with certain exceptions,along with other requirements. Type of Work: /1 MO D2L of F4vwcK Qd )Estimated Cost C20 M: Address of Work: &t9Q sr -84y Owner's Name �Pt D Date of Application: — I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law QJob 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 IMPRoVwmT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 14ZA. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. ��� k1 131 S3Y Registration No. Date D a Contractor Name I OR Date Owner's Name q:forms:Affidav:re v=07060I Tab1aJSZlb(eoa� Praeriptfre Paeimga for 0"m d Two•Fau*Reddmdd BaMbW Ruud wif6 Foal Fade MAXIMUM I MIIVQVIUM Glaang Glaang Ceiling Wall [loot Bu®mt MAD Area'0/8) U-vduer P.-Value R valva' & dpd Wall Pt a aa�Y� Pad=e. Rwa6sea &vaWd 5701 to 6500 Heating Dena Dada' Q MI. 0.40 38 13 19 t0 6 Nark R 12% 0.32 1 30 19 19 10 6 No m i 9 12% 0.30 38 13 19 10. 6 U AFUE T IM d.36 1 38 13 25 WA WA Nommi U 15% 0.46 38 19 19 10 6 Normal V 1S'/. 0." 3E 13 25 WA WA 95AFUE W 15% M2 30 19 19 IO 6 is A UE X 18% 032 3E 13 25 WA WA NOmd Y 18% 0.42 3E 19 2S WA WA Normd Z I!% 0.42 38 13 .19 10 6 90AFUE AA 18% 030 30 19 19 10 6 90 AFVE 1. ADDRESS OF PROPERTY: 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-f960303a Footnotes to Table J5.2.1 b: ' 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 fl of glazing area- 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 11.5.3a. 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 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. 'Wall R-values represent the sum of the wall cavity insulation plug 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. 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. TF.e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mcct the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned br..,ements must be included with the other glazing. Basement doors must meet the door U-vaIue requirement d_scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R4 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 J52.1a NOTES: a) GIazing 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 structural components. b) Opaque doors in the building envelope must have a U=vaIue no greater than 035.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 The Commonwealth ofMassachuse= Department of Industrial Accidents 600 Washington Street - - Boston,Mass 02111 Workers' Compensation hmra=e Affidavit name:' locati t re Pu a—P phone d ❑ I am a homeowner petering all work myself ❑ I am a sole etor and have no one wmidng is aav Moyer providing workers'aca my empicyees an this ob. as for wmiaa8 .... ..�.�,m..,.::::::::n.::.::::.{.:T:.::{.•...T:.TT:..,.�.:..>xr:::.}:.x..�>'.Ty..�.�.{?.....�>..r:.: ,..,:w, ... ... ". � .n..�?��:j:-+?.Cnac?.:.'"`.""•'}yl;n«';.:.«.;"'.'�".^".:":'!{:Ti i:.... :n:.. . n.........:..:::.:::.::................... .......,..... .....:.:.......:.............o � ay .. ,�.,. .. �d. ...n............... :.:::•: :n:::: .. ... .. rv.:::::•.v...,, ...:::+:x:W.\. :H^.:: --f.4T:::vh0.:..::.<i"i�f0>'•^. 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Fxg=to sense eo•aesp as:egaie up sad/or ms 7eaw yapei -m ina es dra pemma is tm foam of a srop WORE n l rI aid a ttn eenoom a"Y avd0t am Itmdastnd ehst s @Py of this stataeteat mn be toews:ded to the OlBse of Iat of tea DIAfo�.t�p trd0eatiasL I do hereby caafy uiedar d1 a paiw and p p =prvtdded aboas is ass a la Correa paw /- q -oa -_ Ptmt mime /�.4u�'t ce ,2� St Gfr,u s es >� sQ P 9 9 IqL otIIdsl me only do'not wetfa is tbts sera to be completed by city orta m of cki city or town: pemwuc, sa ❑BuadintDepa C-at ClUccusing Boazd ❑r ,itackifl=Lediatertqome is required Osele saws Ots+oe pHadth Depart eontactpenon: pbatrli; — �� linty Yl73 P1Al . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thr.r emplovees. As quoted from the."law", an employee is defined as every person in the service of another under any cow- of hire, --cpress or implied. oral or written. An emplover is defined as an individual, partnership, association, corporation or other legal entitty, or any two or more'of the-foregoing engaged in a joint enterprise. and including the legal repz ' e=atives.of a decrzsed employer, or the rocz"Ve: 07. trustee of an individual,partnership, association or other legal.e�ty, employing employees. However the owner of a ., dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelli house of another who employs persons to-do maintPnan�, eonst=ucticn or repair wa&on such dwelling house or on the aottabs cr building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also stases that every state or locai.lieensing agency.Shall withhold the issuance or renewal " a Iicaat who has of a license or permit to operate a business or to construct bi kdings in the-commcnwealth for any pp not produced acceptable evidence of compliance with the insurance coverage r+egnired. Additionally,Wei+ the contmonwealth not-.airy,of its political subdivisions shall enter mto nay caYart£or th,e perEormaace of Pubes until acceptable evidence of compliance with tha'insuranee rtq==C=afthis chapter have been presented to the contracting authority. '. -Applicants Please fill is the wori=' compensation affidavit completely,by checivn the.boxthat applies to.your and sapplyiag company names,address tad phone members along with a�cate.of insmaace as all affidavits maybe sum to the Dept ==of Industrial Accidents for cutlet afinsm==�8e• Also be sure to sign and ' date the affidavit The affidavit should be.retumed to the city or tow athat the application for the pemit or license is being mquested,not the Department of hu u trial Accidents. Should ygn have any questions regarding the haw„or if you _ lease caU the'Departmeat at the number listed below. . are rcqurired w to obtain a orkers' cempeasatiaa polio y�P. . in Willi.• City or Towns legibly. The D has tied a space at the bat=of ths Please be suer that the affidavit is complete and printed cgc�y. eP�� P� � �� Please - be for you to fill out m the event the Office of has to cotuact yen regarding app be sure to fill in the pCM*fiic=e member which will be used as a reference n�ber. The affidavits may be rc�Io the Department by mail or FAX unless other aaaagements have bemmade. The office of Investigations would hke to thank you in advance for you cooperation and should you have nay questions. please do not hesitate to give us a call. ERE- '.s address,telephone and fax= ber. The Commonwealth Of Massachusetts Department of Industrial Accidents amce of lmtesduadons 600 Washington street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE l �` square feet x$64/sq-foot= �3 9 W x.0031= ' 9 ,c) L4 plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf ` $35.00 >500 sf-750 sf 50.00 >150 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/?Roving $150.00 (plus above if applicable) Permit Fee projcost C Board of Buiidi°�Reg uiaf�ohs aad Standards OVF -r CONTRACTOR. HOME Of Regis rat►o •: EXpirattolug �• 0,61�412002 CtiC�,Xlrt ti RSG Constru St.Gea k�.r-; ` fJla�fice l - G . ve. Administrator 329 Coffin A Ne,,"3edford,ma 02'r A6 ' --- 71. Vr omvnzomcue " a�./ aaaac/zuaeltd �' BOAR�QF�BUILDII�'G REGULAETI_,,OO NS- ; Lloenses R. Numbei C 07621:0 Birftida� t2 n3� �. !Expires: OffTr.no: 76340 MAURICER ST GELAIS 16 LESLE , LANE EAST•FREEK TOWN, MA 02-717 Administrator I i I t 1 I ' Jrea►I•vi�ooa�.s S t,o r �a�c /I(�w �,ti oo� . I I i W j s+o aw 3 re c� a�laDe 1.` � ,se;{ 4f �'"' `w t t _ - �.7` '�`.. r ' '� , £ ` i�t,A, �� �,,,-5•�.i+7 �' �.:i-;l 3'. P��� ;�F.;f w'�;="'• :tt>�.r 6'�;3-I s�1 � >,,_a-' asL�•:!-'4►'j+*'�1 - �.'�,un�^,S�r_ i :� .6'_ � ..#':' �..+6W-�'•.•,}�``.~+�'.'4 w� .'�` ; - +�'•...i ti . x `'''..ir � •` ,✓i'•�'+ �.``4a�;�S'�:.'�,.�C� ; '��., •,F�' �i3�s �:�`,T,i%•w�•c�s''�?t�,=-s� �•!w��J ..�.'x.�•�;�`'�r : `e, C*� �i �� �'p • +� •.� � '�-1 Q a�;� f � _ r^•�j a`� r-jr� at' •: 1�'• ' '.-- 't ,•��. �`:fit y�...3.+�i ".+�. 'o-..lf t3.•�i A •. •f"' l �• �' -` `�A,ter i+� � 4 � +� .. `� .1' ^M i +��� •y+•� i�! _ ,1.i r•:i.�S.r' Lf.,i•� �C/j g .'yam; ;i x�„ J � —a_^. ,r _ -t �(� s- ., e J r� r.r v y+'� 4,� a? a���'xt. �+ a+.x�: ���.. :�•sM'/a.r_y�?-`s` � :t.E�%`� =4" .. �. x. .;��•s,+ '>,^J�My•r�,�'�,� >fw,{:t•r• � if•;=1r�t� _�{l:•Zs'i ar��`� M rt _ '• -r !P i _.,s�' ..y{,�',St�- J�• rr�• �' ..1. t �`•c' v #; s Y is�_� •f'� ��r >i���?y �r+� �/ _ -.;�� � `'t._ ':.r'� %''�`. �y"�`4'•t� "r t�~�,c;�}�='1 - - - _ •- ^r -�R"" '•f s t,r. � �,•+.1����-i,�i� yt,^`d�lJ_.-*�� iT�:��"v?� �` �"`r..,yL - �` •,s '' $.' •,�-{.-5�'- ��.�r�.tf•`•�f1�_19�� :':c••D�c '�.�� .a'1dz-•. � .^ .. � •= .)•�•�S � )�•,_•` � r,�.'L�,�.a.t��,��:. •_;+`,��'_!`„ yt• ••+•^ •• tf• •t •la " .s^��,y^+ ���.��• .J.r'�• � - - - !�. `"' -'•tea/. 1 � y.`• ,.��^t -:• � �� . �e� tit `�'►'�����,�Ae� ' `. -� ^• �� �e.`�1. .e� �a i��•j f;4`..f ��� :� '••�� 'Ity�_R . .s l 4- /• .�-r f, � y�a��.' 1 ti � ���a,a�-+.a✓� �,�•�,rJt����,��}�`Na - !°-^ "���•` -�.4' .•l�•r rf a's/�t"• �y'� ' , - d '�. •,' - j' a� F ► �}.`�\ _`� ki '1`�•x7,Ia' `:t� ,�`,,yy �, 1jY�,F .. .. .- 1 - ',1 -�' � �� � ,, t. _:+ .-.• ,1!•k' — (" .iL"�.+t..� �` ``� � 2 .�V M g � � �m 'ia�,�r.�,.a"+t�4,� rz at- C'• *33 •L' t ''I _ 31, �J 3 �^.�., �<S '- ,� '�.' 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'f � 2�.•1t/'"°'1 .rift.jr'xr 1.f,-•i tl rye s s��iL�'�. a`�,y�"r=' d ,t�a'a�si' �`t`I�riP :` 1'�....•� '.`•� +cR �+•< ,.fit. �Ey.';yC,f �...y. ., .4 •� �,��5 s K .ir.�� �� �x :7t`I 7•,3,\.� I.r � 'h Ci_.C- '• r,. ..1 �•-r.. :_ '�_� ' 1 f`.• .'�.••.a ,•YCt_S2�M�.�Y�..,-'+�.'r•i. --`'r^y S ,::trt �ty"(�1• �.a �.a� � 7 ,�.C•r`. �,, r r- ! 3 ,k;r__-,. s a •`ram~�r'sJ'•���r �Ty.�,'P r i'����•.r ���id �1� �K "'r - 1 •' r � � ti �;• „ 'Si~'�• - rJ I' "'�y. .t1 ^t,:-. `� r•^� iJ�;�1 c,,� ak t1� •�� •`Y t ..r•: '.• jay �}• "�"'�� S�r ��'•� `r'��v-•.'i��, _ s r. � •t ••�.�{r,.. _ ,y r 1t • , ♦ e•: `+:I� .'Y.it�.. Fdrx9{ ": .,h{�'�. •�� A x' • ,+ w a 1 1 `1 1 a,l y •�;°?• 3 ' .`s •+ _y S•`IIR .R +s, fir• •_�` `...i - �� �.?^��,, t.: ��' fq 6 .•� � n'�•rt..�+-A I oFt►E'� Town.of Barnstable *Permit# Expires 6 months from issue date Regulatory Services . — —_Fee, . : - f RA RZMABLE ' }�T /.ei �• a�}+n!�J` Ill 1 �i v� MASS i639. Richard V.Scali,Director �0 ATED MA'I A Building Division . JUi� - 2 ��14 . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN®�BARNS TABLE ALE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address SO a P. sidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ✓3t - T C/IV Contractor's Name , Awo!�kv Telephone Number a d 2 k 6v Home Improvement Contractor License#(if applicable) 1-? 76 Email: �- Construction Supervisor's License#(if applicable) �Y Xworkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �Uhave Worker's Compensation Insurance Insurance Company Name T)✓e Workman's Comp.Policy# / 3 S 3 c I Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) '*' �- --r (hurricane nailed)(stripping old shingles) All construction debris will be taken to Ait-�O-Vf ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders.U-Value i a (maximum.35)#of windows #of doors:—L— ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of the a Improvement Contractors License&Construction Supervisors License is (e qui red. SIGNATURE: Q:\WPFILES\FORMS\bu ' g p t forms\EXPRESS.doc Revised 061313 ire Comwor:yswaUh ofMassachusr?lYs Deparhuent ofludusft-hd Accidents 0,,07ce ofInvestigadons 600 Washhigton&reef Boston,MA 02LI1 www.rnamgm1dia Workers' Compensat€on Insurance Affidavit.Builders/Contractors/T,iectricianslPlumbers Applicant Information (� Please Print Legibly Name 03usfiwsgl0rgenizatioa&fflvidaal): Address-. 56 - CityiState'1Zip. �J - Phone# (56 26J Are you an employer?Check t&appropriate box: Type of t�m o'ect r re�" emplo yer 4. ❑ I am a general contractor and I 3[_ New Yer with �— 6_ ❑Neva camstnretion employees(full andlorpatt-fme).* have hired the sub`contaciofs. 2.❑ I am a sole propfietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition w for me in an c ci �- employees and have workers' odking y � � 9_ ❑Building addition [No workers.comp:invrranre Comp.rncnrancaY required_] 5_❑ We area corporation and its 10-0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp right.of esemgtionper MGL 12 €repa= lust a required.]I c"1.52, §1(4),and we have no employees-[No workers' 13_�Other comp-insurance required-1 *Any applinmt that checks boa-91 must also fill out the section beimv showing ihea wo%kere mmpensadou pollen iufbtmatioa_ T Snmeowners who submit this afhdavi t inffcsting they use doing aH mobs sad then hie outside contractors mnsi submit a new affidarit ingitsiing such tCantaicturs that check this hwx mast attached an additional sheet shmsmg the name of the sob-cauftactorG 3otd state whether omit those entities have em pkrfees. If the mTo-contmctms have empIogee%they unlit provide their twrkers'comp.policy ntmbes Xam an employer thatisprmddbq tt�orkers'compensadDn insurance for my emplvyae& Helots is thepolicy and job site information. Insurance CompauyName: Policy#or Self-ins Lim , 3� 3 Expiration Date:�j � Job Site Address: �o � ��� City/State/Zip: //S t/l Lt f✓,, Attach a copy of the m-orke.rs'compensation policy declaration page(showing the policy number and expiration date). i Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of rrirainal penalties of a fine up to$1,500.00 andlor one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a.day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance;coverage verification- I do hereby certify iirder Errs ns and penaTiies ofperfury that the information prmdded abov is but and correct Simature: Date: t� Z Phone 9- ✓ v O f Edai use only. Do not write in this area,to be completed by diy or town offi'c-iat City or Town: PertmtUcense# Issuing Authority(circle one): 1.Board of Health 2.Buffding]department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing.Ius£tector 6.Other Contact Person: Phone!#_ _ .. 6 Inforination and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied., oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other Iegal 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." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their cert�.:ficate(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance- If an LLC or LLP does have employees, a policy is required- Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confnuation of inch ce coverage. Also be sure to sign and date the affidavit Theaffidavitsbould be retuned to the city or town that the application for the permit or license is being requested,not the Department:of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents offim ofkve.stlgations 600 Washington Street Boston,MA G21 I I Tel.#617-727-4M W 406 or 1477-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.Mas13.gov1dia � f Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 I, 6 , as Owner of the subject property hereby authorize Am4t��.tUA.415' to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Sigkhure of C6er bate �67 ,ZA Pr' ame 4 If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRFSS.doc Revised 061313 Town of Barnstable r Regulatory 'Services j°�y Richard V.Scali,Director °* Building Division • nnuvsrABM Tom Perry,Building Commissioner 9Q� 1b ��� 200 Main Street, Hyannis,MA 02601 ATED �A www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION / Please Print DATE: (Y , [ JOB LOCATION: �d G number street village "HOMEOWNER": name 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 supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for.all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisdr. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forrns\EXPRESS.doc Revised 061313 i ANDER-5 OP ID: KG CERTIFICATE OF LIABILITY INSURANCE DATE(M212014 06/02/20 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 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 CONTACT Northwood Ins.Agency,Inc. PPS 540 Main Street, Suite 9 AIC No El:508-771-1632 AIC No: 508 FAX �93-2955 Hyannis, MA 02601 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC INSURER A:WESTERN WORLD INSURANCE CO INSURED Sean E Anderson Const, LLC INSURERB:Hartford Insurance Co 50 Trowbridge Path W Yarmouth, MA 02673 INSURERC: INSURER D: 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. I�jR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR TBI04142014 04/13/2014 04/13/2015 DAMAGE TO RENTED- PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $' 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Perperson) . S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION S $ WORKERS COMPENSATION PER OTH- YIN - ANDEMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA CERT WILL FOLLOW FROM CO 09/11/2013 08/11/2014 E.L.EACH ACCIDENT $j 500,000 OFFICER/MEMBEREXCLUDED? WITHIN 5 DAYS 500 0 (Mandatory in NH) E.L.DISEASE^-EA EMPLOYEE-fir 00 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE 'POLICY LIMIT ;Sa `L SOO,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) u °ram II .. CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL .BE DELIVERED. IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet (991m)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: . www.Mass.Gov/DPS 9 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-074101 ` SEAN E ANDERS4'N 50 TROWBRIDGE PA WEST YARMOLVIH NPA 02 c �..e..� Expiration Commissioner 0 212 4/2 0 1 5 �ie�p rzonlvealmz'a� �QCGOk"�e ' License or registrationa. valid for individul use only ffice of Consumer Affairs&Business Regulation j before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR 1 . Office of Consumer Affairs and Business Regulation >- Type: registration: . !A�770?S ; 10 Park Plaza-Suite 5170 fY LLC Boston,MA 02116 Expiration: ==1Q-12312Q:1_5_',. •r:-ma's,:•. j SEAN E.ANDERSON?,C.ONST�Rl1CTION LLC. SEAN"ANDERSON �,\ J`o j 50 TROWBRIDGE PATH-A` WEST YARMOUTH,MA 02673 Undersecretary I Not vali ithout signature. - I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# .Health Division T' -q/a i/ -(�� Date Issued l� Conservation Division Fee �� � y�l�G .6V add'( Tax Collector . . SEPTIC SYSTEM MUST BE Treasurer a INSTALLED IN COMPLIANCE Planning Dept. WM THE E ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village O S+e" Owner SA 24k,"_ Address Telephone a�� _��S-l�q�T la«! yz� 9eS"t� `" �� VAX Permit Request Z2u� l' G—� � � act LV L S _ AAA �, w•,,�iv<✓ UPzjvA)& C p A�e_ �N w Ae v �G Square feet: 1 st floor: existing I b ga proposed• 2nd floor:existing to o e) proposed Total new C3 Estimated Project Cost 30 6 o o Zoning District Flood Plain Groundwater Overlay Construction Type 00 t, Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family &r' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes' CLR66 On Old King's Highway: ❑Yes Ckilb' Basement Type: Ca4II B"rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 40 Number of Baths: Full: existing � new Half: existing © new b Number of Bedrooms: existing ':!> 'new Total Room Count(not including baths): existing Ci new First Floor Room Count Heat Type and Fuel: aas ❑Oil ❑Electric ❑Other Central Air: ❑Yes LA,PQo Fireplaces: Existing I New Existing wood/coal stove: ❑Yes O-N'o Detached garage:❑existing Cl new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:Sle"xisting ❑new size it e Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes GNVo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �JA-v kt. Y Telephone Number `•l2g-(9�31 Address t License# 85715,g0 �l`t�iw,dry�s V 4,Vs y4w- o 16,s Home Improvement Contractor# Worker's Compensation# 6 Y Do Lt g 3 9-oa ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PtRMIT NO. DATE ISSUED { _ MAP/PARCEL NO. ADDRESS VILLAGE err - OWNER 3 DATE OF INSPECTION: 1 �•' - -FOUNDATION ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL rl - PLUMBING: ROUMfi FINAL 1 GAS: ROUGH-4 0 5. FINAL •t. "- FINAL BUILDING 0E m EWEA Q DATE CLOSED OUT q . I-- Q fin - ASSOCIATION PLAN NO S N I . . "\ The Commonwealth of Massachusetts ---,"- De artment o Industrial Accidents .1.a1.!fI,,.,I 11 1 -- - __.. . P f . _ Office of/ncest/gatfons - . -_ +- 600 Washington Street �� SCsI Boston Mass. 02111 . . . , Workers' Com ensation Insurance Affidavit �o��i�oiooiooi'loll%%�/O%%%%%%%/� �����������MM name .� tb ,�6(4 by , _- location: 91 I W-&4-+. � -PU . ' city '®rg,-�V✓q(te phone# AU1('(,,t3! �❑ I a homeowner performing all work myself. . a sole r rietor and have no one working in ca achy %%//%%%/%%%%/%% //O%%%%%%%%%/%%%/O/%%%%%%%%%//%% %%/%/G�/%% I am an em to er roviding workers' compensation for my employees workingII on this job.: .:: :: : ::: ..........::::: ::: : :: cow anwnam ::.;:.;:.;:.;:%;::.::>:.: i <' hop i CI p tY I i :.:<Qlieu hsurance c / a sole proprietor, neral contractor,or homeowner(circle one)and have hired the contractors listed below who . ' have I - I the n workers' compensation polices: g ................................. ::::::::.::::.::::..;:.;;:.;:.;:.;;:.>::.;:.;:.::.;:.;:.>:.;:.:.,:::::.;:.:.;:.;;:.;:.;:.;...;:.;;;:.;:.;:.;:.::.;:.........-,".....:;«...i :>:<;::::::::::::>:«:::>:::<:>:: :........::::::::::.::.::::::::.............::::.:::.::...::::::::.:.::::.::..:.......:.:::::::.:::.::.: ::.::::::.:::. :.:::::.::.::::: cow anv.name:>;:::>::<<:;:::>::>::::::<:<::>:::>::>::»:;;;::>;::.,:;<>.:;::::> - ::.. i;ddr ................. ::::.;:.::;:.;;:.;:.;:.:>:::>:::«:>::» :<:>::»»::>:..........»:<:»::>::»»::>:<::>::>:;:>::>:.:.:::::::.:::.;:.;:;.;;;:.:.;:.;:::;::<::>.:;>:;:»::»::>::>::»><::<::;<:::;:.;:.;;;:.:: hone > C�trT'" ::><::> : »<<:z :: 2; :: :-:;:.;::.;»:.;;;:.;;::..::::<:::;`;is»::»:::;:;.>:;.;:.;:.:;.::;.;:;:.;:;.;;;::>::<::«::<:>:;:»:::.::.:::::.::.:::.:;:::>:>:::::»::»:;:.;:.>.- .>#::::;::>::-:::;:::>:<::::::::::::>::::::»::>:::i:::......:>::::< <:;;:::......:::«::i::>:;:::;:::`:.•':::5:<:`":::::'::::zi:::>;::::: . .. ...... olrcv msnrance:ca.. :;::.;::.::.:::.:.::.;::;>:::»;<:;•;::.;.;;<:::.;.:::::....:.:.:::..;:.; :;:..:.::.,.:....:;:....::.:.// ::::::::./%O%/11 I"" art na :: :. :,:.;.;.>;:;:>;:.: :.;:.;: address:::;>:;;.;.:;::»<::;,:»:;:::< .. ;:::: <bn h cr :<.; b -- >:�:::: tv- :.11::.. in�nranc o Fsfinre to secure coverage as required wider Section 25A of MGL 152 can lead to the imposition of criminal penalties of s Sne to 51,500.00 and/or one years'imprisonment as weII as dvII penalties in the form of a STOP WORK ORDER and s fine of 5100.00 a day against me. I underatsnd that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the p ' enalties of perjury that the information provided above is true and correct �� Date I-f -I i-:e0 _ - Signature � /� Print name `)fA-v►� U� 00-4I Phone# _f official use only do not write in this area to be completed by city or town official city or town: I permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required • . ❑Selectmen's Office . _ ❑Health Department contact person: phone#; ❑Other__ Oevised 9/95 PIA) . Information and Instructions p Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.' MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to.operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. . Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of*insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be re dim to the Department by mail 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 any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Dance of Invesugedons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 M CAR Appendix J Table J&Llb(continued) Prescriptive Packages for Ong and Two-Family Residential Buildings Heated with Fossil Fueb i MAXIMUM MINIMUM Glazing Glazing Ceiling wall Floor I Basement Slab Heaurig/Cooliag . �'('/•) U-value= R-value' R value' R values Wall Perimeter Equipmm Efficiency' Pwkage R value` R-value' 5101 to 6500 Heating Degree Days' Q 12% 0.40 38 0 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal 3 12% 0.50 38 13 19 10 6 95 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 , 10 6 Normal V Ism. 0.44 38 13 25 N/A N/A 83 AFUE W is% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38 13 23 N/A N/A Normal Y 18•/. 0.42 38 19 25 N/A N/A Normal Z 19% 0.42 38 13 19 10 6 90 AFUE AA 18•/.'' 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: g �� i82:i, � O s+V.�-c L le 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. 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 J$.2.Ib: 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 W of decorative glass may be excluded from a building design with 300 ft'of glazing area. '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 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. '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 basements 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 J5.2.1a NOTES: a)Glazing 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 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 43 / F ti The Town of Barnstable • anrwSTAi., e. �- Department of Health Safety and Environmental Services Eo;p. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ffl� Type of Work: Estimated Cost 3® e'r° Address of Work: Owner's Name: `7 #' elA�v— Date of Application: L4 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. f-�y 6614 r t (If Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav APR 4 ' 00 12; 58 PAGE - 002 furrIture shelf here AS.04 220 127; 82 WS636. 1CRHF$ 41 W3636. �WA243e' i rnVE 6ZLR L H. 24:BW S :B"21.3 1i -0 1%2 Z1.;;..3�!1! 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( j ' ����•= v�d !uj �.U2648 _ � r` *ice CT, �o�nnwvuuea�c o�./�aaoac�ivaeUa BOARD OF BUILDING REGULATIONS ., ` Ucense:_CONSTRUCTION SUPERVISOR 057540 • Number CS w Birthdafet 12128119.55 i `-Hi zpires S2M001 Tr.no: 12336 Reshictiad To: 1G, =— V � DAVIDJ LADY 121 TIMBER LMIE MARSTONS MILLS, MA 02648 Administrator i.: