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Sewage Permit nu/tuber ......:.:.....;...... .. ..............L...........:..
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House number .................:....................................................... vp s
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TOWN OF BARNSTABLE
BUILDING INPE T Rom-. � S C 0 •
APPLICATION FOR PERMIT TO ...! U.1... ............................S `
TYPE OF CONSTRUCTION ...... .. ............. . c?`. 11 :..................
'
S .......3.................19.8
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit ac_ccordirig to the following information:
Location ...l.p �.`�"...... a......w �.5..�.w..�.hv�......�� �� ....... !e.!� v.. .... ...... .�. ....................
Proposed Use .......... ........... ..v-y�N..N... .y..........aa.w. �L. .. ! .5 .........................................................
Zoning District ``.... ...............................................`
' ........................ .....4. ............................. Fire Distri.ct ......:a,.......................
Name of Owner. ..�.......� .�?`�► ' 'Cut. ��.h..�.,:OAddress .....�4 C?�rc.`� ....5�.:`l�.r±,...
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Name of Builder S . . . ......Address
Name .of Architect ..................................................................Address ......................................................................
Number of Rooms 3..A.1� 1 NI'x.....).��.�k.... .Lt�....x�° 'kFoundation .>.S>.0 .`\.... �Zl. C.S L .
• r
Exierior ..'C..... .�.� : .............Roofing ..... ........................
Floors W G.!��• `�O �1 c�. C. -.�. .. .......Interior .........................................
Heating .. ........ `.q sC:-.-CA.... W.aA.`.e.k...Plumbing ............... ...... ................................
Fireplace.y............... ................. .............. ......................Approximate. Cost ...........3.�.'.. ...�.�............................
Definitive Plan Approved by Planning Board ------------__----------------19 Area ..........................................
Diagram of Lot and Building with Dimensions Fee
c\ SUBJECT TO APPROVAL OF BOARD OF HEALTH
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OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS -
I hereby agree to conform to all the Rules and,.Regulations of the Town of Barnstable regarding the above
construction.
Name J4.0,-t, .r�er ....- .....
Construction Supervisor's License ..... '1 p:Q..........
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THEO CONSTRUCTION A= 1121-11 -16
28144 One Story
No ................. Permit for ....................................
Single Family Dwelling
...............................................................................
17Z-
-
Location
Lot 23, 1 3 West Wind Circle
................................................................
Osterville
...............................................................................
Owner Theo Construction..................................................................
Type of Construction .................Frame..........................
................................. ..............................................
Plot ............................ Lot ................................
Permit-Granted ..... ly
.. ...... ....................19 85
Date of Inspection Z...........................19
Date Complet/......................................19
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TOWN OF BARNSTABLE 281A4
Permit No. -----------------------------
s,an i Bili1dd11g Inspector cash
OCCUPANCY 1"PERMIT Bond .g
Issued to Theo Construction Co. Address', ' r
Lot 23. 173 West Winn Circle Hare,-.>i11� 1
-- i
Wiring Inspector �� Inspection date �� "'^
Plumbing Inspector Inspection_ Inspection date
V / •J
Gas Inspector Ate.,... � ° -� Inspection date 7 OG t 8,
xEngineering Departmen� �f Inspection dater
Board of Health {' :>C1 �`, Inspection. date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL.
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN '
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUBETTS STATE
BUILDING CODE.
19. �
Building Inspector
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��,..�•�ew TOWN OF BARNSTABLE
BUILDING DEPARTMENT
t ssaISTAIM = TOWN OFFICE BUILDING
°b t679• �� HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FROM: Building Department
DATE: /D
An Occupancy Permit has been issued for the building authorized by
BuildingPermit #........... r�. � ........_.... ....................................................................._...._.........._.......................„._. ...»_..
issuedto ...... ... l _. ..........................................................._.. _ ....... ...�.._
Please release the performance bond.
I HEREBY CERTIFY THAT TN/.S LOT/J NOT LOCATEp /N FEDERAL F4000 HAZARD ZG1iVE
%,w showN ON THE FEOEmw. FLOOp INSURANCE RATE MAP FOR THE . TOWN OF
F�92 T SLE , CpwUN/Ty mma' NO.?Soon/•owim EFFECT/YE DATE Lo-oi-63
—AVBERT E. R Y ONO, R.4.S DATE NOTE: NORTH ARROW NOT TO ~O
BE USER fOR SOLAR PURPOSES. k y
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THIS PLOT PLAN WAS NOT MADE FRO,y FOUNPAT/ON LOC.4T/ON PLAN
AN /NSTRI/MENT SURVEY ANO 45 FOR THE LOT 23 W t S T�11 I Q C) c le'.
USE OF THE BANK ONL Y. MPER NO
CIRCUMSTANCES ARE OFFSETS TO BE J j; A2&5 TAIa LE M At
USED FOR FENCES, WALLS, HEDGES, J.
ETC. TN-66 COX3 sr. Cam.
OWNED BY: 50. vA?-MOUTH �"�A
/ H Of Mgs��c� ARMY ENGINEERING INC.
y 60 EAST t ALMOUTH H/GHWA Y
ROBERT
o E.RAYMOND 0E.aST FALMOUTH, AM. O.Z536
9 No.21583
GISTEP�QJ�,o SCAbE•„3o, OATE���Zo S SHEET'/�/
oN NOS° AVW BY: C/i(ECKEPBY APPR BY= PLAN NO.
v77+/ /LE2
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Assesso ) /l /is map and lot number ....../.> .... ........ THE
QyoF toy♦
Sewage Permit number ...........�J../-- 7/.J,I,
/J2 Z BARNSTABLE, i
House number. /.7 "A°a
90� 2 67 9.
a�0
TOWN OF BARNSTABLE .
BUILDING INSPECTOR,---
APPLICATION FOR PERMIT TO .............. ....... ....
TYPE OF CONSTRUCTION ............�M..QS. ,..s-�..........�.�..0-
...�. ,............................................................
...... r-.........3.................19.a '
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
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Location ...L. 2. '...... ...... C�. . ......� '� '�. �.�� ..... .�. ....................
i
ProposedUse ........... .�. .� ........ ..G`r►•.�...4.y:........ ..` ,1� �..�!�. ..........................................................
ZoningDistrict .................. .. ...............................:.Fire District ..............................................................................
1
Name of Owner 7M.v4.......�...�.`.?S'�Y.C'�'1C.!ti..�..�.�4ddress .....s�. .�:.........
Name of Builder ... �� `... 't® .4C.\ `1.�......Address ...SO............ 7. �1....
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms 3.A.1R.......�AN%N..... ?.�.�oundation ....... ...............
4 .
Exterior ..W.\'1A ....C,.Y. - `,C.............:.....................Roofing .....A.5.�07..... 1 �.�.. ....................
Floors W C� 4�.... "�..�. ��.....L. .�. .�.......Interior ............................................
Heating ...6..m,,&....... .P.O. W.5 V,.(...Plumbing .............C�K..... ................................ �
Fireplace pp 1-.............................................................Approximate. Cost ........... .f...d.......0....... ......................
ro / � ..... ��
Definitive Plan Ap
proved ved by Planning Board _____________________________19_______. Area
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
d
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OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. JWLn,.��
Name �;..�. ,
Construction Supervisor's License .....�.1..6.p..P/........
THEO CONSTRUCTION CO.
28144 Stor
No ................. Permit for .. One............Y..............
..........aingle..Family..Dwel-i.71g....................
Location Lot 2L.A7.3..West...W1nd••4Gircle
Osterville
Owner .....Theo Construction
............................................................
Type of Construction Frame
................................................................................
Plot ........................ Lot ................................ r r
Permit Granted Jul 3,- 85
.................................19
Date 'of' Inspection.....................................19
Date Completed ....../07.. BS......19
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
J-o-r a 3
Map Parcel O ��� Permit# 6 3ce G
Health Division 2 W-%53 Date Issued ft7In 2
Conservation Division 6 S, ? 6D._ Application Fee
Tax Collector �,Z o Z Permit Fee t (o
Treasurer SEPTIC SYSTEM PAUST BE
INSTALLED IN COMPLIANCE.
Planning Dept. WITH TITLE S
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANL
Historic-OKH Preservation/Hyannis TOWN REGULATIONS
(;Village
' ct Street Address �� Ly5 S� W �� �-� rc-\�
KZ) ��S�r L-\ o Address �-] '-;k- LA �5�
Telephone 5 a j�,- D-A (09
Permit Request__74�-op-os-,� V' C k S�O�� - SV�Yt(—O�� O1!\ 0. (\,
Square feet: 1st floor: existing proposed I lo�� 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation aZ� Construction Type S A
Lot Size a- b, loq`� } Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family �EdS Two Family ❑ Multi-Family(#units) j
Age of Existing Structure Historic House: ❑Yes ..lo On Old Kin 's Hi 6 hwa : O'Y
9 9 g y es Q ).;n No
QX
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
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Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �„ a
Number of Baths \Full: existing new Half: existing C:1 new
Number of Bedrooms!z4texisting new ``' co
cn r
Total Room Count(not including baths): existing new First Floor Room Count `n
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other I
Central Air: ❑Yes ;0 No Fireplaces: Existing T 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 ,®No If yes,site plan review#
Current Use Proposed Use 3 - S
BUILDER INFORMATION
Name ar ����� — �c�s _iRt�elephone Number 5og 3�3- 6b
Address License# �� q
Home Improvement Contractor# L7
Worker's Compensation# 35 UJ11& C- --:T-3�'3cj
ALL CONSTRUCTION DEBRIS RESULTING FRW THIS PROJECT WILL BE TAKEN TO _kkc_CV--,� t S--Q�
DATE
SIGNATURE
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED �
. MAP/PARCEUNO.
ADDRESS— ' r���_ VILLAGE
OWNER
r
DATE OF,INSPECTION-
9 -1`? -u 2
FOUNDATION o
FRAME
- t
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH2 a,. FINAL
C: '
GAS: R0U'G1-W4 FINAL
FINAL BUILDING
DATE CLOSED'OUT �
ASSOCIATION PLAN NO.' "'
—� . The Corrimanwealth of Massachusetts
-- _-- :Department of Industrial Accidents
_ — 0lfice o!la�esti9,019 s .
600 Washington Street
Boston, Mass. 02111
Workers' Com ensation Insurance Affidavit
01,
FBI
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I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who.
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MAMMONI
i
•:C:.ff.
�:.;�:.•
•
a fine np to
rauure to secare coverage su requiredunder Section 2SA of MGL 152 caulead to the imposition of exi ninal penalties of 51 and/or
,500.D0
one years'imprisonment as well as civR penalties in the form ors,STOP W ORK ORD R and a fine of S100.00 a dap agaWt me. I mtdersfsnd flint a'
copy of this statemeatmay be forward to the Ofilce o vesti;atiPn+of the DIA for coverage veriIIcation.
- - —ereb -erti en -of-perjury thot the-information-pr-o3idLd-abnxe_iss _��c irec! —
1 da h y fY-u -�
Date 0
W� :Phone# - 01K
' piiilt name �.{10•�C�z����-
oMclal we only do not write in this area to be completed by city or town oMdal
"permit%license# [{Building Department
city or town: ❑Licensing Board
❑Selectmen's OMce
❑ checkif immediate response is required OHealthDepartment
phone#; ❑Other
contact person:
555
M1.viu.{f 9/95 PYA) '
Information and Instructions
Massachusetts General Laws chapter�152 section 25 requires all employers to provide workers' compensation for their
from the `law , an employee is.defined as every person in the service of another under any contract
employees. As quoted
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 ina 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
'shall not because of such employment be deemed to be an employer:
building appurtenant thereto
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'
shall enter into'any contract for the pmfon�nance of public work until
commonwealth nor any of its political subdivisions
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contacting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
Please
g company names, address and phone numbers along with a certificate of insurance as all affidavits may be
supplysubmitted 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".pi ifyQu
are required,to obtain a workers' compensation policy,please cff` he Depa anent at the number'listed below:. —
City or.Towns .
complete and printed legibly. The Department has provided a space at the bottom of�ie
Please be sure that the affidavit is
affidavit for you to fill out inthe event the Office of Investigations has to contact you regarding the applicant. Please.
e m t"Ilicense number which will be used as a refeieace naBi i.'Tfie---iZ avits 1*-' r •'�_;t�,.
besute.tofillinthe.p - ;.
the Department by mail,of FAX unless other arrangements Have been made. 5
The Office of Investigations would like to thank you in advance for you cooperation and should you have�estions. .
please do not hesitate to give us a call.
The Department's address,telephone and fax number: •.
The CCommonwealth Of Massachusetts
_Department of Industrial Accidents
emce of Investigadolis
600 Washington Street
Boston,Ma. 02111 _
fax#: (617) 727-7749
" phone : (617) 727-4900 eat. 406, 409 or 375
Tabs jS h(ena!bmurd) 9.00d viiti Foss g°s!'
procripttre facks;ts foram A"Tw-'F"ly
MA7iaM Glaziag Floor Bu me lE
� ctasc�
dazing Ceiliaw Wall ' ��� W rT�
Ai='(•/.) U•valuc� A-valuca R•vslua R �
p a= sm to 6540 Se: Dam*Di7s'
6 N°sss'!
Ig 10 . Nrttmal
Q 12:'■ 0.40 33 13 14 • 10 6
R. 11Y; OSZ 30 19 6 95 AFUE
1J 19 10 Noma!
g 12% OSO 31 71 IiIA 1'Yf
T• 15% 0.36 . 3t 1] 6 Normal
3= 19 lg 10 t?AFVE
U .13■/. 0.46 13 23 NIA. Ti/A
y WK 0.4.4 3! 6 tS AFVE
30 19 14 10 Nanaal
W 13Y■ 0-52 NIA
13 u TJ/A Narasal '
X .IE'/. O.7Z. 3i lg 23 WA WA
Y 16y. 0.42 3i 6 90 AFUE
!3 19 10 90 AF UE
L AATE•/. O1 30
19
L ADDRESS OF PROPERTY:
. OR WALLS: to g
2. SQUARE FOOTAGE OF ALL EXTERI
3. SQUARE FOOTAGE OF ALL GLAZING.
4, %GLAZING AREA(#3 DIVIDED BY#Z):
5: SELECT PACKAGE(Q—AA-see chart above)::
G ENgZGY'REQtTIREMENrS
• NOTE: •OTHER AILABORE LE•ASK US FOLVED OR THIS INFORMATION.
ARE
N12-c►n I`°(2n •1 NU(A COO
BUILDING INSPECTOR APPROVAL:
YES: NO:
g4orms-f9a0303a
Footnote's to T'able'J5.2.Ib:
Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doorso the swaI
basement windows if located in walls that enclose conditioned sparraa mabutb xcluded from the U--value requirement.
area. expressed as a percentage. Up to 1/o of the total glaring design with.30o ft=of lazing area.
For example;3 fti of decorative glass may be excluded from a building gn .
= After 7anuary 1, 1990, glazing U-r+alues-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-�Iass U-values cannot be used.
The ceiling R-values do not assume a raised or oversized =;s CCmtruCtIon. If the insulation achieves the full
insulation thickness over the exterior walls without compression;OnRCeeinsulationg uea�p��bthe um for cavity
insulation and R-38 insulation may be substituted for R-49 insulaiz � must be laced between
insulation plus insulating sheathing (if.used). For.vendlased ceilings,.insulating. g p
the conditioned space aad-the ventilated portion of the.roof. used). Do not include
Wall R-values ropmsent the sum of the wall eavity.k lation plus insulating shearing (If
exterior sidings structural Sheathing, and interior drywz1L For example,as R-19 requimment.couid be met EIT I• ER
ex
ex plus R-6 tas
R-19 cavity insulation OR R-13'cavity insulation ulaing sheathing- Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall.constructions,but not apply so metal=frame construction.
'The floor*ruiremenis apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements,
eq
or garages).Floors over outside air must meet the ceiling requireme=.
Tl:e entire opaque portion of any individual basement wall with an average depth less
than Sdoorse of 0%blowea�nd'tioned
mc_t the same R-value requirement.as above-grade walls. Windows and sliding gl
bc,ernents must be included with the other glazing, Basement doors must meet the door U-value requirement
d-scribed 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 S. if you plan to install more
than one piece-of heating equipment or.morc�than one pieta of cooling equipment, the equipment with the lowest*
efficiency must meet or exceed the efficiency required by the selected package'
For,Hcating,Degree Day requirements of the closest city ortown see Table JS.Z.Ia,
NOTES:
a) Glazing areas and U-values are maximum acceptable.levels.Insulation R-values are minimum acceptable levels.
R-value requirements arc for insulation only and do not include strutt=ZI Components'an 035 Door U-values must be tested
b) Opaque doors in the building envelope must have a U-value no greater cadurz or taken from the door U-value
and documented by the manufacturer in accordance with the NFRC test p'for that door is not available, include the
in Table J1.5.3b. If a door contains glass and an aggregate U-value razing
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'(Le.,may have a U-value greater than 0.35).
c) if a ceiling, wall, floor,basement wall,slab-edge,or trawl space�' component
mprago R a]ue is greater than oes two or more r equal eas tth
o
different insulation levels,the component complies if the area-weighted
the R-value requirement for that component. Glazing or door components comply if the area-weighted,overate U-
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). •'
43
INE 1 Town of Barnstable
Regulatory Services
sa MASM ram. ' Thomas F.Geiler,Director
Mass.
9 1639. `0�A Building Division
�AlED n+A't
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: SV.x��1d"� \�\�� 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
❑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
I hereby apply for a permit as the agent of the owner:
— \5- O'a ki\� VGLsar,!_; - 1 a5 !l�5c/
Date Contractor Name (Zaz Registration No.
OR
Date Owner's Name
Q:forms:homeaffidav
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 f
square feet x$96/sq.foot= I I Z x.0031= '
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot= x.0031=
plus from below(if applicable)
ACCESSORY STRUCTURE>12.0 sq.i't,
>120 sf-500 sf ` S 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=
(mmzber)
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) e
Permit Fee
projcost
/HEREBY CERTIFY TiXAT IN/S GOT/3 NOT ZOCATEO /N FEOE�'Ak F,L 000 HAZARD Z1\\
"AS S110WN ON THE FEOEAW, F�.000 INSURANCE RATE MAP FOR THE - TOWN OF
F�9Q T SSE C UN/Ty PANEL, No.-�0001',"-, °f EFFECTIVE DATE io-oi-e
/g5
PERT E. R Y ONO, R.4.S GATE NOTE: NORTH ARROW NOT TO o~
BE Z1SEp FOR SOUR PURPOSES. Z Z
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P or -04AN WAS NOT MADE f, no FOUNDATION 4OC.4T/ON P4AN
b .iN INSTi1&A cNT SURVEY ANO Is FOR THE LOT 2- KJ
3 � ,/
(/SE OF THE BANK ON4 Y. UNDER NO
CIRCUMSTANCES ARE OFFSETS. TO BE njA2
FOR FENCE, WA44,3,, HER ES,
�. Ttko Gxj 3T.
OF Mgs��cy AWOW ENGINEERING /IbC. -
ROBERT G.4 60. EAST F,44MOUTH I,l/Ggm Y
ca RAYMOND y E,4ST FALmo[/TH MA. 0.2536
t 9 No.21583 Q
°.� 9 o a� JCA,X: oATE: SHEtET:
FCISTS �J�'' /~sap (v00/es- /o14/
oN NOS° OR,4WN BY- ChWCKEOBI4 APPR BY: P4,4N NO.
Property Location: 172 WEST WIND CIRCLE -- MAP ID:-121/011/016/
Vsion ID:7463 Other'ID: `'' Bldg#: 1 Card 1 of 1 Print Date: 07/3P72002 12
,Sl.r�r�1"� �:�"i�:r��`�"s.�+_+t�c'"�at�•xs" is"&......�_ .. . - i 4Srw�•fa�.?•'."�5''�'E� aid''A'' +n k�, ,�,,,, ,�,ra,'�•'?��"'3°rig rL n� �,��,.•�» .h• C s"^Y.:«:x 'ems.r+r-+ne�y{ �..
ElementDescription -} �__._ .. •..w...�" �i..�'.�1"�..•.�:' �. _. '. ! r �: - ..,�:: 'C � .�'�:�•-. 1.n�`.�c.•rim r.... . S„`..r..
G>r ommercta ata ements
type ape o ementDescription
Model 1 esi Heat
,-
Grade C Average Grade Frame T Je
aths/Plumbing
Stories 1.5 1 1/2 Stories $p.rI C
Occupancy 0 CeilinglWall
ooms/Prtns
Exterior Wall 1 14 Wood Shingle /o Common'Wall '
2 11 Clapboard Wall Height - • •• a1 �eZ'f
Roof Structure 03 Gable/Hip
Roof Cover 03 sph/F GIs/Cmp 14 -- —�
14
ntenor Wall 1 5 Drywall
'e"`CVUiVD K �±
Z Element Gode Description Pactor
nterior Floor 1 14 Carpet omp ex
2 12 lardwood Floor Adj
Unit Location
Leating Fuel 03 as umber of Units
Heating Type 5 of Water
SAC Type 1 None Number of Levels 4 GAR 2 FHS
%Ownership 6 BAS 2
1�edrooms 4 4 Bedrooms r BMT
athrooms 2 Bathrooms 6' `js,14_, -- 1. _�.,...... . ,
0 Full Total Rooms (7 Rooms nadj.Base Rate 60.00
ize Adj.Factor 1.01017
ath Type Grade(Q)Index 1.01 -
'kitchen Style ` 14
dj.Base Rate 61.22 40
Bldg.Value New 129,419
Year Built 1985 -x
ff.Year Built (A)1990 g
rml Physcl Dep 10 t ,
uncnlObslnc 0
con Obslnc 0 q �
i Code escn tion Percentage pecl.Cond.Code 4 � l�t ��L' ,/ r
IUIU tng a kam luu Specl Cond%
Overall%Cond. 90
�eprec.Bldg Value 116,500
code n Description nits U nu ce T r. Dp Rl YoCna APr. Value
Fireplace , 1170
o e escrtption Living Arearross niostneprecvalu
e
rs oor ,
BMT Basement Area 0 12.24 12,73 4
FHS Half Story 728 728 42.85 44,568
GAR Attached Garage 0 336 118 21.50 7,224
WDK Wood Deck 0 196 20 6.25 1,224
!It!IM UrM_LivlLease Area Blfg it. 1 129,4w,
' l0C TION 1 SEjwA6'E PERMIT IM
• �- -a3M lesT :w�� CtrclP
�. VI.LLACE
.�
ervl,
it
..1NST
�A A LLE0R'S N�AE i� ADDRESS
• UIL0E R "FOR OMINE R`,
e cPP ea� I�ys
So thou
0 A T E PER-MIT. 1SS.UED
DATE CO-MP.LIANCE ISSUED
f .
1 '
i
it
. 3y
f
�.of c�3
EX15fIN6 6'DOOR
FROM HOU5E
PROP05ED NEW DMCK(12'XI4'APPROX)
I.ZXIO Pf FRAME @ 16"O.C.
2.LEDGER PafED 1/2"W'LA65 32"O.C.
10-II" 3.J015f HANCU5 @ LEDGER
4.WL 51PE J015f5
5.2XIO Pf TRIPLE REAM
6..(4) 12"m X 48"DEEP%A5 W/ANCHOR5
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Project: 5ca1e:1/8"m1'-0" Drawinq:
Betterl ivi ng PACINO p�5,bFNa
PATIO ROOMS 122 M5fWIND CIRCLE A'
052RVILLE,MA 012655
100 Otis Street Nothboro,MA 01532
Phone(508)393 0400 Fax(508)393 0340
Date:8116102 15hA I aF I
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Property Owner Must Complete and Sign This Section If Using A Builder
as Owner of the subject property
hereby authorize Betterliving Patio Rooms (d.b.a. —Patio Rooms of America) to act on
my behalf, in all matters relative to work authorized by this building permit application
for (address of job)
Signature of Owner Date
Owner or Builder (as Agent of Owner) Must Complete and Sign This Section
as Owner/Authorized
Agent hereby declare that the statements-and info ation on the foregoing application for
(address of job) V-1 \3�\ C���L�� are true and
accurate, to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
pv
Print Name
Signature of Owner/Agent Date
d 3;...c��o...•�....w,c�.��..�:.....,..�.�....,r.-i...�W:c. .� .�e:�S.:ur..:. �2 ..r#P;=��;�1t
aRckitvuset
i .�. Amite. uilu G�oilei.(78U G Ap en 1'�5 Pion' r
The Massachusetts State Building Code (780 CMI) includes provisions to ensure that houses and
house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION
FORM is to be filed as part of the building permit application when a builder/contractor or homeowner,
constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a
special energy conservation exemption option for "sunroorn" additions to an existing house (780 CMR,
Appendix J, Section J1.1'.2.3.1). This FORM is not intended to prevent a homeowner from selecting a
"sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only
intended to assist homeowners in becoming aware of some of the important energy conservation and year-
round comfort considerations involved in selecting and utilizing a "sunroom"addition.
The connection of "sunroom" structures to residential buildings may create comfort and energy,
consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In
the selection and constructiori/installatioii'of"sunrooms", included below is a non-required,.open-ended list
of product and design considerations that a homeowner may wish to consider before actually
constructing/installing a "sunroom". It is recommended that consumers carefully review these options with
their designer, builder, or contractor, iir order to minimize potential energy consumption and/or house
discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired
are important considerations.
PRODUCT AND DESIGN.CONSIDERATIONS RELATED TO "SUNROOMS"
Solar Orientation and Natural Shading
• Type of Glazing
Insulating value
• Solar heat gain
• Frame materials
Glazinb to frame sealing and ;asketing materials/seal durability and/or
weather tightness of the sunroom
• Adequate ventilation - Operable windows and fans
• Applied Shading'Systems
• Insulation level in floors, walls, and ceilings
• Possible Sunrooni isolation from the main house via a wall and/or door or slider
•• Heating and Cooling Methods: EflIciency, Zoning and Controls
Homeowner Acknowledgment
The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual property owrer.(not the
owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FORM prior to
issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential
building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read
the information in this document concerning sunroorn comfort and energy conservation.
�J�-,-- �-cam-•—� �_ 3-O— � ..
Signature of Actual Building Owner Date l
�'(`J�6�_Ck C\_(,,
Print Name Address of Permitted Project
Owner Address (if different than project location) Owner's telephone number
rc .f - ti .n7�en7.n"
>me en' c on'.sfe 4��(I4 ._. : : '_ i`¢� egailciress"sunrooans ,
Exception: Sunroorn Additi m .N
.ons/_Co.nsuei` otificatio.n Suhi. s, as defined in 780.CMR .
Appeitiilx ix n 13F11h;t 1 IONS; 91u11u excrrips! f�titt tlio ccmptianec rcquicem�nts set forth in 780
CMR J 1.1.2.3.1 and. J 1.1:3-provided that the actual,property owner (not.the owner's agent or
representative) of the structure onto which the sunroom addition is being made, provides a signed
copy of the Sunroom "CONSUMER INFORMATION FORM" (found in 780 CMR, Appendix B)
to the Building Department. This signed"CONSUMER INFORMATION FORM" shall be
submitted to the building official-as a requirement of building permit issuance, and shall remain as
part of the construction documents. If such sunroom additions are separated from the main house by
a wall and are conditioned spaces, then a readily accessible manual or automatic means shall be
provided to partially restrict or shut oft the heating and/or cooling uiput to the sunroom addition
space. That portion of a wall that separates the sunroom addition from the existing
building/dwelling unit, if an existing exterior wall, shall be allowed to remain and neither that
portion of said wall or any fenestration within said portion and common to the sunroom addition,
need comply with the thermal envelope requirements of Appendix J.
cg�+,� cfio�t .t~el���� AnaenclYd2 O�I?J,I+'II�IITIOr1S,to:pro�3e.;a'rTef
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780 CMR J2.0 DEFINITIONS
SUNROOM: A_n addition to an existing building/dwelling unit where the total area (rough opening
or unit dimensions) of glazed fenestration products of said addition exceeds 40% of the combined
gross wall and ceiling area of the addition.
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�Fel�� ' r .eype
��eai tF3��atine�odc.�nd:�o�,tJe,tocated g��ed�a�te � nt€n�
FI+ZF '�`IONS':�a sofound_ inAPPetsiiz�cB
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AC®RD CERTIFICATE OF LIABILITY INSURANCE DATE(47MIDDm)
PRODUCER 06/27/2002
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Joseph McKeone ONLY AND CONFERS NO INGHTS UPON THE CERTIFICATE
JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATEI DOES NOT AMEND, EXTEND OR
P.O. Box 333 ALTER THE COVERAGE AFF RDED BY THE POLICdES BELOW.
Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE
INSURED _
Patio Rooms of America INSURERA: Hartford
dba BetterLiving Patio Rooms INSURER B: Arbella
100 Otis St INSURER C:
Northboro, MA 01532 INSURER 0: i
I INSURER E: I
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY ERIOD 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. XCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
kJ5 POLI F EC POLIC (PIRATt N
LTR TYPE OFINSU RANGE POLICYNUMBER DATEMM1DD DATE MMIDD LIMITS
A GENERAL LIABILITY 35 UUC 35019 11/01/2001 11/01/2002 I EACH OCCURRENCE S 2,OOD,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one rire) S 100 000
CLAIMS:L9ADE OCCUR MED EXP(Any one person) S 5,000
Jr-
ATEP�ONAL&ADV INJURY S - 1 D00 000
S — 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
n POLICY PRO- I
PRO UCTS-COMPIOP AGG S 2,000,000
J'eCT �LOC
AUTOMOBILE LIABILITY
B MM 97 09 98 12/11/2001 12/15/2002 COM INED SINGLE LIMIT
ANYAUTO (Eaa cwont) $ 1,000,000
ALL OWNED AUTOS 1 -
SCHEDULED AUTOS BOOI�YINJURY $
(Per csrson)
X HIRED AUTOS --
X NON-OWNED AUTOS 8001 Y INJURY S
(Per apdtlenl)
PROP RTY DAMAGE $
(Per abrment)
GARAGE LIABILITY
AUTO ONLY-EjN
ANYAUTO
OTHE THAN
AUTO NLY:
EXCESS LIABILITY 'EACHlpCCURR
OCCUR �CLAIMS MADE AGGREGATEDEDUCTIBLE —RETENTION $ —
A WORKERS COMPBILJTY ON AND - 08/01/2002 '08101/2003 CSTATULIMITEMPLOYERS'LIABILITY WBCI3935 TtDRY LIMITE.L E CH ACCI _ 1100 000
E.L.DII EASE-EA EMPLOYEEI S 1DO D00
E.L.DISEASE-POLICY LIMIT S 1 000 000
A OTHER 35 UUC 35019
Property 11/01/2001 11101/2002 1
I
DESCRIPTION OF OPERATIONSILOCAT(ONSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS "
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1
CERTIFICATE HOLDER I X I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION ll�
SHOULDANY OF THEABOVE DESCRIBED POU¢IES BECANCELLED BEFORE THE:EXPIRATION
Insured Copy
DATE THEREOF,THE ISSUING INSURER WILL II�NDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF AN'KIND UPON THE INSURER,IT!,AGENTS OR
REPRE NTATIVES.
AU RI D REPRESENT
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ACORD 25-S(7/97) Q ACORD CORPORATION 1988
.fi. -- :�PZG l'O'Yi?Ain09F/•/?fit;!%i � :i�r. .!'. .. .
1==: / board ui ltuiidi'n, ite,u!ations and. ��arv4_• ;
?_/ ii ar o c--
=i
Lir-ense arregistration valid_._ ir.divieai use
HOME IMPROVEMENT =;1:^,OR
E T COl1iT. b €n e the :viratian date.. l i found rer*ir!,.ta:
•!Q .-� ::�::,...-.,` - a Br aid of Build'n._Regul4t: ns fi.Jt a is
Peg stratiiin`.:::;`.251os ,. _b�._^ :c:. 2r:: _ ,d4;rds
E pir-at,'ion-10621/03 rr..e.4shpi;,tur.Place R;n 13001.
--;_Type -Dlvate Co.rper 2tion
PATIO ROOMS oF..,3,0_SiON=-II
t -
ANDREWS MALON• -r
100 OTIS ST -..;_.. .
of
NORTHBOROUGH, MA 01532 - ---- V -.-�, -----------...._._.
Ac iri tsator -Not valid v,;th.out si,ERature
-:. _:1.., -- :•ys4�. ;y'v,• '(Osi:=,.oa!a=,5'l:Eati� irU �.�::1:+.C�ad8u4
r, v BOARD Or.Sir°i_Ji-G REGtJLE+,TIQi�?'S
:,..
* zrµ: License: CONS-RUC T ION SUPERV!SUR
�Jt
K
r ,r �' 02120 2rJQ1 . Tr.r7o: 7227
Restricted Td: 1;G :.
ANDREA'T MA•-ONE
41 WAS-HINGTON ST42'
NA T ICK, IVIA 01750 Aarninistrator
AFrrMV71T
In accordance with Article 1 Section 114. 1.3 of the
Massachusetts State Buildirng Code, Z certify that all debris
resulting from work associated with Permit #
will be properly disposed cf at EL--
licensed solid wastes disposal facility as defined by ?M- GL
C'i1., S150A. l
Signature of Permit Applicant
EJ HARYEY & SONS in wed, r reststoA/r=
68 HOPKINTON R D Print name of Applir3Slt
W E S T 5 0 R Q , MA = t�E7 �G�yrN6 P9`� rZ S
CR E 1351 1581
Firm Namb (if any)
Address
Effective September 12 , 1991 the Department of '.Health/Code
'Rnforcement acting under Chapter 2 Article 13 of the 1986
�l GY1rlC?1
Worcester Revised Ordinances iccraiiG.> i,rr+t
,..,_ of .-a-
Of
. debris generated as a result of this permit. The proof
Shall be a dated and signed receipt front the licensed
disposal facility containing zhe following information,
A description of the debris, 7.he weight and volume of the
debris and th6 location of the disposal facility. The
receipt must also have a sign.a-ure of the owner/operator of
the disposals facility.
Failure to comply with the requirements of r-his ordinance
ill result in action by the City.
w
TOTAL P,02