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HomeMy WebLinkAbout0486 WIANNO AVENUE�I II` I Application number ......... 0- Fee ...................................... -Do....... HARNSTA151 E A to 9 Building Inspectors Initials.......C451L. � I I A 1 *9 �Fo Date Issued. Me j.. ...2.... . ....................................... MIAMI I bARN,,MBLE Map/Parcel......... .......... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Li C (0 NUMBER STREET VILLAGE Owner's Name: Eo k tk 9,rt-Phone Number (-Q- (� - ?-5 0 j D Email Address: �T Cr,(-Z�j Le_5 vv\6,1( .�o v\Cell Phone Number (o (-j - 2- 50 7ro Project cost$ 2-04 C) Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorizell w)2� b ro e- to make application for g rpt in accordance with 780 Ck4R Owner Signature: Date: b2 TYPE OF WORK -Z- Siding Windows(no header change)# 3 Insulation/Weatherization ...... Doors (no header change)# Commercial Doors require an inspector's review v`-Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)#_ (attach copy) Construction Supervisor's License# 0 (attach copy) Email of Contractor &"AhOle Qlnqll) ) CDMPhone number_ ALL PROPERTIES THAT HAVE STRUCTURES ER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGN Signature Date Z l All permit applications are subject to a building official's approval prior to issuance. I The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): L - Address: City/State/Zip: ), 5 d4 4hone#: Are you an employer?Check the appropriate bog: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.X1 am a sole proprietor or partner- listed on the attached sheet. 7.pemodeling tl hip and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑Building addition [No workers comp. insurance p• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *My applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify r f e pains and enalties o perjury that the information provided above is trueand correct. Signature: Date: Phone#: �.;V 4� O( Official use only. Do not write in this area,to be completed by city or town official City or Town: Perinit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter f 52,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the 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 Office of Investigations 600 Washington.Street Boston,MA 0211.1 Tel. #617-727-4900 ext 406 or 1-877-MASSAFl Fax# 617-727-7749 Revised 4-24-07 www.rnass.gav/dia Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrg�ftit iV§b rvisor fr i CS-084521 �> --9 ires: 11/28/2020 � - .F TIMOTHY W BRUNELL'. J )� `u ` PO BOX 2h8 i / 1• ;- MASHPEE MA 6,649,_ n Commissioner /V4 ✓, worn"24ncaeaeffo� Ja, r9ellJ. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 193939`- 12/10/2020 TIMOTHY BRUNELL�., TIMOTHY BRUNELL 76 WALTON HEATH,WAY,�;,;i MASHPEE,MA 026491, Undersecretary i vv-L� S 3 Op THE r Town of Barnstable Building Department Services BAMSTAe[.r, : Brian Florence,CBO �� MAsa. � 1639. ��� Building Commissioner07 200 Main Street,Hyannis,MA 02601 e www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5084,90-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT I, //?r /7l` �o2c�NE'L , Construction Supervisor License # D hereby certify that I am no longer the Construction Supervisor listed on the l plicatio n for the project under construction as authorized by building permit # , issued to (property address) c-75TIG'2 ✓,``l-e on 2 / Z. , 201�'. I also certify that on Z / , 201�, I notified the property owner,that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building.Division. / 19 LICENSE HOLDER DATE q/forms/newcontr reference R-5 780 CMR rev:08/23/17 Town of Barnstable *Permit# �l Expires 6 months from issue date _ rABjZ, Regulatory.Services Fee 1639. ,0�' Thomas F.Geiler,Director �fDN1P�� Building Division oP38 PERIM� Tom Perry, Building Commissioner . 200 Main Street, Hyannis,MA 02601 0 C T 13 2005 ffice.: 508-862-40.3 8 ix! 508-790-6230 MOWN OF BARNSTABLE EXPRESS PERNUT APPLICATION - ' RESIDENTIAL ONLY Not Valid without IW X--Press Imprint parcel Number srty Address )1 Ct Y\Y\1n A j e-_ esidential Value of Work 2,01 non ' 'Minimum fee of.$25.00 for work under$6000.00 -r's Name&Address '�d`YZ Dom.(� 2T1 f\P�f\ . 1 � '(Y1.��ovJbr�aY �� 1 .e5�� rn�• �j2��j ractor's NamepL�C,�-r p��\ -..�_Telephone Number Le Improvement Contractor License#(if applicable)_ >truction Supervisor's License#(if applicable)_ lorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the homeowner 'have Worker's Compensation Insurance trance Company Name. ~� rkman's Camp.Policy# Q'R) — gS G(0�4 A O S ?y of Insurance Compliance Certificate must be on file. mit Reques ck box) � C) �\ RR roof(stripping old shingles) All co coon debris will be taken to \ 1 G rM O" ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other.town department regulations,i.e.Historic,Conservation,etc. ** Property.Owner must sign Property Owner Letter of Permission. *No . Home Improvement Con-tractors License is required. piature 0 ?om:s:expmtrg I isc063004 OVVE Town of Barnstable Regulatory Sex'Yices wamrAnix' Thomas F. Geilcr,Dircctor A'. Building Division TomPcrry, Building Conunissioncr 200 Main Strcct, $yannis,MA,02601 www.town.barustabIc.ina.us Office; .508-862-4038 Fax: 508 790-6230. Property Owner Must Complet&and Sign This Section ' If Using ABuilder • I, � ; as Owner of the sub'ect prope 4 .�� hereby authorize. . to act on mybehalf,_, in all matters relative to work authorized by this building permit application for. (Addres s of job) _ Signature of Owner . Date . Print Name OTORMS.OWNMER�Css10N 1 � fie Board of Building Regulat4ts-an tan ar� � One Ashburton Place - Room 1301 Boston. Massachusetts 02109 Home Improvement;:Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for chang Address Renewal Employment -O Lost Card DP8-CAI 0 5OM-04104-G101216 �ItC �00lLIlLO�KlM6K/L 00✓vlddd¢GLUdPUb ' Board of Building Regulations and Standards �---_. — --- HOME IMPROVEMENT CONTRACTOR License or regi.Stration valitt fur iudivid,Il lise only Registration*.. 103714 before the expiration date.'If found rcturo to: giExpiration:*:.. Board of ullilding Regulations:u1d Standards 7/9/2006 Uuc Atibburion Place RIn 1301 Corporation 13uslou, Ia.02108 PAUL J.CAZEAU•LT,&.S0NSJ0C- •Paul Cazeault 1031 MAIN ST ',``';:'`'' "r' LG•-_.�! rr�'✓ 7 OSTERVILLE,MA 02658 Administrator �Itr BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS . 026325 Birthdate: 10/20/1959 Expires: 10/20/2005 Tr.no: 8603.0 Restricted: 00 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Administrator -- = Board of Building ulations -- One Ashburton Pace,Ce Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2005 Restricted To: 00 PAUL) CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Tr.no: 8603.0 Keea ton for receint and „f Assessors_map and ,lot number .................... Sewage Permit number ...:............ . ....... Z BA"STADLE• i House number• ........................................................ .............. MAe6 G i639. \0� 0 YPY Or• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... 51R��T. ....................................................................................................... TYPE OF CONSTRUCTION ....P!M..W(? ... rn ............................:.............................................. YZI:l'... '...................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following. information: Location ...4 6... :��.N�fr.... ...l......( TL7L_iJ.►'L4 .... `r ............................... .......... .... Q Uc�2. FC2. p O Proposed Use ... ��--•• .... L Zoning District .................. ...I.......................................Fire District .............C.T.....�.............................................f:..l.. Name of Owner •Pe-r �G'! �C.11 (�J W f h) X�' ®STI'cY2�1�1(� ..................• .........................................Address .............. !"f.....!4 ?..............'........... Name of Builder ..........................Address Qi............................................rl ( Llt ..QC�W1(.�911� Yrl1q ..... .......... ...... !o crc c b On.... t QVM Pit� !� Name of Architect .�:�.�' b........?Q.!�Y?..................Address �'................................. .................... ..... .. Numberof Rooms /e...............................................................Foundationk:............................................................................. Exterior ............................................................................... Roofing Floors .................Interior. ...:................... Heating ..................................Plumbing �'.............................................................................. Dt�© .: gyp Fireplace y.�................................................................................Approximate. Cost '....1�...,�,i.................................. ................. Definitive Plan Approved by Planning Board -----------------------------19 —- Area ....G © ......... .................... Diagram of Lot and Building with Dimensions Feel/............ .... . ... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ; g the abov construction. /� Name . ..............�%;4. ............. . � . Construction Supervisor's License .................................... SCACCIA, PETER 26351 Build Pool Deck No .................. Permit for .................................... Single Family Dwelling ............................................................................... Location ...4.6.8..Wi.anno...Avenue......................... . .. .... ........ ............. Osterville ............................................................................... Owner .....Peter.........Sca..c.cia............................................ ...... Type of Construction Frame .......................................... ................................................................................ Plot ............................ Lot ................................ :!rmit Granted .................:19 84 �.ate of Irispection ...........................;........19 Date Completed ..........7e,,��V................19 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# �• !; ft Health Division Date Issued 27 Conservation Division ' /J q Feel•S� Tax Collector Treasurer573 —C F Planning Dept. Ir Date Definitive Plan Approved by Planning Board " Historic-OKH Preservation/Hyannis E Project Street Address Village Owner Address Telephone ©/a Permit Re est Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Co ® 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 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new I' Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel:))(Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ArNo Fireplaces: Existing JL� 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 a BUILDER INFORMATION ll Name ' Telephone Number11A Address License# r � �fl ly Home Improvement Contractor# Worker's Compensation# /EF 1)L//1 ALL CONSTRUCTION DEBR9 RESULTING FROM THIS PROJECT WILL BE TAKEN TO k SIGNATURE DATE FOR OFFICIAL USE ONLY L PERMIT NO. DATE ISSUED et MAP/PARCEL NO. Fit ADDRESS VILLAGE OWNER DATE OF INSPECT[ FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ The Commonwealth of Massachusetts z Department of Industrial Accidents ,d �- `=_� -_�� Olfict ollotyestigatio�s 600 Washington Street Boston Mass 02111 Workers' Compensation Insurance Affidavit it mgl name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ lArm a sole P=netor and have no one workin in arn►ca =tv ` I am an employer providing wo compensation my employees working on this job. comnnnv name: address: :.:... : city hone#:: _ — (7 insurance co. nnficV# G p� i/ 7- o /a,/ /Iamasoleprop , eneral contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo«ing workers' compensation polices: comvanv name: :.,:::. .:..... address: :......:{;,..::,.:.::. city: phone#- . ;: ..r comnanv name- :..: address- citN- nhone#= ......... . inspranccco. :::;... •.:.......... 170iicw :. ...::::::::..;•:,::�::;:;•:a. ::sr: <•k:».,.,:...::::<:•;>::: .::. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crtm4nal 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♦VORK ORDER and a fine of 31,30.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verilleation. I do hereby certify under the p d enalties of perjury that the information provided above is true an eorr Siffiature Date J Print name Craheeck do not write in this area to be completed by or town otIIdal permit/ficense# ❑Building Department .0Llcensing Board ediate mponse is required ❑Seleeatten's OlUce ❑Health Department phone#; _ ❑Other Usvwm 9:93 PJA1 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 cow= 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 receive. 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 Iicensing agency shall withhold the issuance or renews: of a license or permit to operate a business or to construct bindings 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 comracting authority. , . ..- . Applicants . Please fill in'the workers' compensation.affidavit.completely-,-.by_checldng the boxthat applies to your.situatim and-v, supplying company names,.address:and_phone_:zit b .-gong_with-a-certificate of insurance as all affidavits may.be submitted to the:Deparmneatof=jIIdLs i 1 Ac aeau-for:'confiaaationofiniuzz coverage.. Also be-sure-to-sign-and date the affidavit-"The affidavzt should be retained tome ciiy of town-tliat`the application for the permit or liceas`e is: being requested, not the Department of Industrial Accidents :shoals yrru haveanyquestions regarding the`.'law"or if Sou - _ are required Lo obtain a=wo ers'=compensation-poLcy=ple se i a -iihe DiijF eti[-at the number listed below. ------------------------------ City or Towns Please be sure that the affidavit is complete and-printed legiblyv= The Deparuneat 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 is the peimittliccnse number which will be used as a reference number. The affidavits may be required io the Department by mail or FAX unless other arraagements 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 Depa=ent's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents amce of luestfoatlons . 600 Washington Street Boston;Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable • FwaarsrAsrs. • Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. , 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 as addition to any pre-existing owner-occupied building contairiing 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: r 2194Z Estimated Cost ll� W ® o Address of Work: Owner's Name: _.Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [3Job Under$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 a ply for a permit as the agent of the owner. Date Con Name Registration No. OR Date Owner's Name q:fomu:AfTdav t P� � ✓� �J e 'C�'omrmtanuia,��l�i, n�. ,�av�c/zueeCl2 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 066147 i I Birthdate: 02/05/1967 I Expires: WOS/ = Tr.no: 7036 j Restricted To: 00 CRAIG J RILEY _ PO BOX 382 + / . OSTERVILLE, MA 02655 Administrator fMPR0*Mf ffN�I�Ae'f0���r' Registration 125799 Type - PRIVATE CORPORATION a Expiration 03/04/00 C.J. RILEY BUILDER INC CRAIG J. RILEY 67 FIRESTATION RD/PO BOX 382 5;ERVILLE MA 02655 ADMINISTRATOR I.I,'r'I1,tiL nl' I'CLiSr'lr.l()ll N;Ilid IUI' In,IIVIll11Al 11Cc "IIl1' I,c(,,rc eel,irau ,n ,.Llrc. II Ir,nnd n'lurn r,,: Onc- Ashl)urn,ll I'Inrc Itm I ;OI 02 108 --4�_ 00-35,000 cf enclosed space (MGL C.112 S.60L) 1A-Masonry only 1G-1 8 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIG SAFE CALL CENTER:1 800 3224844 r) Map Parcel o is Permit# House# oze Date I sul&d�, Board of Health(3rd floor)(8:15 -9:30/1:00--2:30) � I- Fee �3 ��'(,' M2.63t 5v Conservation Office(4th floor)(8:30-9:30/1:00-2:00) C J�4'�40��A�'l�,e�e�- L e4 Planning Dept.(1st floor/School Admin.Bldg.) T /k, Definitive Plan Approved by Planning Board =' 19 9 TOWN OF BARNSTABLE ' 1 41'4D Building Perm! pplication Project Street Address Vi 1 ge Address Vephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size f 1 7 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 7 Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing_i� New Half: Existing New No.of Bedrooms: Existing M New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ]Other Central Air ❑Yes ANo Fireplaces: Existing / New Existing wood/coal stove ❑Yes XNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) l Attached(size) ❑Barn(size) +None ❑Shed(size) ❑Other(size) Zoning Board of Appeals A thorization El Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use 1 Proposed Use der Information P Name Telephone Number Address License# ( r5 �,�� /Y_Z Q. Home Improvement gontractor# _�?� 7�T1 S Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PE M D D FO FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. 5' •7 DATE ISSUED MAP/PARCEL NO. °rs ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: tl FOUNDATION FRAME INSULATION FIREPLACE a ELECTRICAL: ROUGH ' FINAL PLUMBING� ROUGH FINAL 4 GAS: t�`.ROUGH FINAL., C? FINAL BUILDIAP�'-,� DATE CLOSED OUT' , ASSOCIATION PLAN NO. THE The Town of Barnstable a�arrsrnat� • ,0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 "Office: 508-790-6227 Ralph Crossen Fax: 508-790-6130 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR'LAW SUPPLEMENT TO PERMIT APPLICATION ` t � r' , 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: st. Cost /D0;6l7,0. Address of Work: Owner's Name X)7r— Date of Permit Application: 2 7./W I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A 4 _ SIGNED UNDER PENALTIES OF PERJURY I hereby ap ly for a permit as the agent of the owner: 02 � Date C nt Name Registration No. OR E Date Owner's Name I __=_--__, The Commonwealth of Massachusetts �^ J-. Department of Industrial Accidents Office of/nlr SIVIONS 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ am a sole pr netor and have no one worImC in%%any capac%I% ity �%%%%/%%%%%%%/%%%%%%%%%%/%%%//%%%/%/%/%%%%%////%// %%%%%%%%%%/%%%%/%%%%%%%%/%/%/%%%%��%%%���%%�%�/O/�%%%%%%%/, I am an employer providing workers' compensation for my employees working on this job. company name e address. City! Phone# �071b7� insurance co. VolicV# ❑ I am a sole proprietor, gen ral contractor homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name. city - ;... Phone#: . olicv#: insurance co ..........: company name- - address: ctty phone#: ........... insurance co> :, olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 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 pains and penalties of per' ry that the information provided above is truo and cone r � Signature Date Print nameIIIZA Phone# o fficialse only do not write in this area to be completed by city or town official wn: permit/license# ❑BuIlding Department ❑Licensing Board if immediate response is required (:]Selectmen's Office ❑Health Deparhnent person: phone#; ❑Other (revue 9/95 PIA) 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 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 peimit/license number which will be used as a reference number. The affidavits may be returned 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 Office of InllesUvatlons 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 7=CUR App.edt J Table JS3-Ib(continued) Ps mcl ptlre PaelcaM for Oae and Two-Family RnldmtW BnAdingg He"W with Fad FaeL MAXIMUM MINIMUM p1 9 Glazing �g wall Floor llaa�eat Slab Heanagic0olia8 Am'(K) U-vdue R valaa' R value' R valu2 Wall Flag SMpm� �ci� ParJcaae I Rvmh e' R vdud 5/01 to 6500 Hndng Degree Deny Q Ir/. 0.40 38 13 19 10 6 Now R 12% 032 30 19 19 10 6 Normal S 12% 0.30 38 13 19 10 6 8S AFUE T 13% 0.36 38 13 23 WA WA Normal U IVA 0.46 38 19 19 10 6 Normal V IS•/. 0.44 38 13 23 WA WA 8S AFUE W 15% 0.52 30 19 19 10 6 95 AFUE X 18% 032 38 13 25 WA WA Normal Y 13% 0.42 38 19 25 WA WA Normml Z 19% 0.42 38 13 19 10 6 90 AFUE AA IBY. OJO 30 19 19 10 6 90AFUE ` � e I. ADDRESS OF PROPERTY: , 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-080303a i 780 CMR Appendix J 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 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 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 J5.2.1 a 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 11.5.3b. 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). e) 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). _.. . � , •• : .. ,. ... , c1' atr 1�`i��i, \ 3.��1:';,':�_•i',�ti'1.a+kR'\; � .r 1 O� A n T ti M • ' N, N ,`` �• 1 _ '� m a p T CD G7 ~ fA rn m o v .+ o x r. s r• rn a z rn .�. a _ o m s o i• o r to v cJrn Z O p W (—) O p a co j W -.ter ri o, t O 1. _ m cll —r v -1� z � o zm � m � rn z i m r F1 1-1 I U� I�I� � U l�J U �. z I Ll 1:1 o a ❑a -IF] 9 I] d d El El Ll El[I � d 6 L' = G�, ❑c�❑ ace v E o Q F1 s o 0 c it Ll s o 47,m ' L e, z 11 a o � x o � Q - Y f O^ ' ' y Ilk cll -r v T � J � � z D a � rn rn — PAN-r�zY a i s m r F1 L-1 —1 —1 —1 LI -j - ❑❑ ❑D ❑ s d. ODD :IUD 04 6 . 6` L' C- ❑D❑ El❑ _ A ' 0 c 0 s c p � U 01 70 Q � L i m ' L l � ?C m O 7r) .0 1 x o � c � Q � ;f 14ovS1= UC'PF LG. QEL R l.tJt L,l OAS 13tJ 1 iAD : : j P 5 i } � .. , G?c4"r�iN!N -All,. att�a:S� lit t c�: t cvrA(Z., 0El C I)PpCM U-- ee_l la("U5 LoWe 2 Ua/CL ' w � � t i I 9-3t'7r-S UP4 4 �i(�V� i� IN _�.C7MC. .._,.... �s I L A-T-T I C E FE to CI I G�-, �S ! P a�CYL H OU t l a54Cxf� _ r G-ATZ),,-Cam - UL� a i 1 i f