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Town of Barnstable Building
? i Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
TARMARM M Posted Until Final Inspection Has Been Made. Permit
i6sa
ate. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-19-2016 Applicant Name: William McCluskey Approvals
Date Issued: 06/19/2019 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 12/19/2019 Foundation:
Location: 40 BOXWOOD DRIVE,WEST BARNSTABLE Map/Lot: 216-057 Zoning District: RF Sheathing:
Owner on Record: SCOTT, RYAN Contractor Name: WILLIAM J MCCLUSKEY Framing: 1
Address: 65 BRETWOOD LANE Contractor License: CSSL-102776 2
CENTERVILLE,MA 02632 Est. Project Cost: $4,000.00 Chimney
:
Description: Add R-38 fiberglass, R-37 cellulose, R-19 fiberglass,R-19 cellulose, Permit Fee: $85.00
and R-10 rigid insulation to the attic.Add R-19 fiberglass to the Insulation:
Fee Paid: $85.00
basement.Air seal the attic plane and basement with expanding
foam.General weatherization. Date: 6/19/2019 Final:
Project Review Req: Plumbing/Gas
Rough Plumbing:
Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
i
Cape Save Inc.
7-1) Huntington Avenue
South Yarmouth, MA 02664
Tel: 508-398-0398 Fax: 508-398-O ILDING DEPT.
MAY 2 0 2020
3/11/20 TOWN OF BARNSTAg
lE
Brian Florence CBO
Town of Barnstable
Building Division
200 Main St.
Hyannis,MA 02601
RE: Insulation Permit 19-2016
Dear Mr. Florence:
This affidavit is to certify that all work completed for 40 Boxwood Drive,West Barnstable has
been inspected by a third party Certified Building Performance Institute (BPI) Inspector.
All work performed meets or exceeds Federal and State Requirements.
Sincerely,
William McCluskey
e
Town of Barnstable b Building
-� Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
• RAENt3TABI.E,
NAM 'Posted Until Final Inspection Has Been Made. Permit
1d39
` ;Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-19-1304 Applicant Name: NOYES, EDWIN W& DEBORAH JEAN Approvals
Date Issued: 05/24/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/24/2019 Foundation:
Location: 40 BOXWOOD DRIVE,WEST BARNSTABLE Map/Lot: 216-057 Zoning District: RF Sheathing:
Owner on Record: NOYES, EDWIN W&DEBORAH JEAN Contractor Name: Framing: 1
Address: 40 BOXWOOD DRIVE Contractor License: 2
WEST BARNSTABLE,MA 02668 Est. Project Cost: $20,000.00 Chimney:
Description: SIDING WINDOWS AND DOORS Permit Fee: $102.00
Insulation:
Fee Paid: $102.00
Project Review Req:
Date: 5/24/2019 Final:
Plumbing/Gas
Rough Plumbing:
Building Official
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Plumbing:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same.
---The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final:
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
Application number.S..—, ...........3.......
Fee............... . ... ...................................
BM Building Inspectors Initials.....a.D..........
Y.
Date Issued.... .............................
Map/Parcel..dl.k................................................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SlDfNGAVINDOWS/DOORS/rENTS/STOVES/WEATFMFJZA'nON
PROPERTY INFORMATION
Address of Project:
NUMBER STREET VILLAGE
Owner's Name: aA (104 Phone Number in A
U
Email Address: ryom9U 90,01,cr^ Cell Phone Number 1l 4) 239-6 LAS 3
Project cost$ �x;000 Check one Residential U/ Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
Siding � Windows(no header change)4 QO F-1 Insulation/Weatherization
Doors (no header change)# 3 Commercial Doors require an inspector'i review
Roof(not applying more than I layer of shingles)
Construction Debris will be going to Gatnsk�L Tf,0,14cr S+A4 ico
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration (if applicable)# (attach copy)
Construction Supervisor's License 4' (attach copy)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN hISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
*For Tents Only*
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
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: I` a,n JCOT�
Telephone Number (Tlq� a3$-64%3 Cell or Work number (plc,
I understand my responsibi ies u der rules and regulations for Licensed Construction
Supervisor in accordance ' h 7 C the Massachusetts State Building Code. I understand
the construction inspect' p ced e , specific inspections and documentation required by 780
CMR and the Town to
i
Signature Date
P NT'S SIGNATURE
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
Town of Barnstable
THE rq� Building Department
c� Brian Florence CBO
anxlvs'r[u�I.s,
Building Commissioner
mass. 200 Main Street, Hyannis,MA 02601
16gp
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
p DATE: Please Print
a
JOB LOCATION: 65 JD(K� Nr U✓e ^�`�l�sl4�/�
Inumber 1 street village�1
'HOMEOWNER": I_luQ✓t SC64 -7 inh. �I A d3A `�"I h
g3
narkb home phone# work phone#
CURRENT MAILING ADDRESS: G S 9re4Q00j LV1
CemeNkik M 0�63a_
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 co&eowne
ulations.
The undersigs that he/she understands the Town of Barnstable Building Department
minimum i quirements and that he/she will comply with said procedures and
requirem
Si 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.
HOM EOWNER'S EXEM PTI ON
The Codedatesthat: "Any homeowner performing work for which a building permit isrequired
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
assJpervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of
a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15)
This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed
persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,
as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a
Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend
and adopt such a form/certification for use in your community.
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/IndividtW): kw
Address: (15 WtWtgj L
City1StaWZip: .2 Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.El 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• Demolition
workingfor me in an capacity. employees and have workers'
Y aP t3'• t 9. ❑Building addition
[No workers'comp.insurmce comp.insurance.
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
incrrrarrte required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
*Arry applicant that checks box#1 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 vybether 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 squired 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 d year' nment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day tit o e advised that a copy of this statement maybe forwarded to the Office of
Investigations of the D r' c c erage verification.
I do hereby certify he d es of perjury that the information provided ab ire is true and correct
Si mature: Date:
Phone#: �74WY
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Liceuse#
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 152, §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-conhactw(s)name(s),address(es)and phone numbers)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 in trance 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:uaJa oiij quest ons re-gard g+he Law or;fyou are required to obtain aworkers'
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 bum leaves etc.)said person is NOT required to complete this affidavit,
The Office of Investigations would hike 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 Iudastriat Accidents
Epee of Znvestig-at ew
600 Washington St=t
Boston,MA 02111
Tel,#617-727-4N6 ext 4.06 or 1-M-MASSY
Fax# 617-727-7749
Revised 4-24-07 wwwm=,gov/d1a