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0080 CHURCH STREET
IESSELYLE i wi � ' ►,� Town of Barnstable Building ans� Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept -"&3P Posted Until Final Inspection Has Been Made. Permit t6 �� 39. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1279 Applicant Name: Dean Fraser Approvals Date Issued: 05/21/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/21/2020 Foundation: Location: 80 CHURCH STREET,WEST BARNSTABLE Map/Lot: 154-007-001 Zoning District: RF Sheathing: Owner on Record: DAVIDSON,JOHN D Contractor Name: ser Construction Company Inc. Framing: 1 Address: PO BOX 598 Contractor License: 194747 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $5,940.00 Chimney: Description: 22 square reroof 9strip and replace) landmark pro weathered wood Permit Fee: $35.00 color; (veteran giveaway winner) Fee Paidj Insulation: :J $35.00 Project Review Req: Date: 5/21/2020 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced with�six months after issuan�2. icia 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. All construction,alterations and changes of use of any building and st pctures shall be in compliance with the local zoning by-laws and codes. Rough Gas: 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 work until the completion of the same. Final Gas: I 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: 1.Foundation or Footing - Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: , 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Per ns contrac ' 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: Town of Barnstable B -� uilding Post This Card So That.it is Visible From.the Street-Approved Plans Must be Retained on Job"and this Card Must be Kept 1 Posted Until,Final Inspection Has Been Made. �t 'Where a' Certificate"of.Occupency is,Required,such Building shallrNot be Occupied until a Final Inspection has been made. Permit Permit No. B-17-212 Applicant Name: Robert Hanflig Approvals Date Issued: 02/07/2017 Current Use: Structure Permit Type: Building-Stove Expiration Date: 08/07/2017 Foundation: Location: 80 CHURCH STREET,WEST BARNSTABLE Map/Lot:154-007-001 Zoning District: RF Sheathing: Owner on Record: DAVIDSON,JOHN D Contractor Name: Robert Hanflig Framing: 1 Address: PO BOX 598 Contractor License:' 173250 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $4,541.00 Chimney: Description: Installation of freestanding Pellet stove #t Permit Fee: $35.00 Insulation: Project Review Req: Installation of freestanding Pellet stove Fee Paid� $35.00 .� Final: Date: tf 2/7/2017 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. t Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained opepublic inspection for the entire duration of the work until the completion of the same. 1" Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:) 1.Foundation or Footing Rough: 2.Sheathing Inspection L__ ^# - 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 Town of Barnstable RECEIPT It 6"3 ,MASS tom " 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-212 Date Recieved: 1/25/2017 Job Location: 80 CHURCH STREET,WEST BARNSTABLE Permit For: Building-Stove Contractor's Name: Robert Hanflig State Lic. No: 173250 Address: 1120 Route 128A, Cataumet, MA 02534 Applicant Phone: (508) 564-7663 (Home)Owner's Name: DAVIDSON,JOHN D Phone: (508)362-4300 (Home)Owner's Address: PO BOX 598, WEST BARNSTABLE,MA 02668 Work Description: Installation of freestanding Pellet stove Total Value Of Work To Be Performed: $4,541.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Robert Hanflig 1/25/2017 (508)564-7663 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $4,541.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $35.00 1/25/2017 $35.00 XXXX-X M-X)M- Credit Card 7886 _._._._.....__......_...._..._..._.._........._.._......................................................................................................_............_..._...._.._......_................_._... __._......_............__...... Total Permit Fee Paid: $35.00 - s ` :THIStsISNOTzA PERMITS ,� Town of Barnstable .*Permit Expires 6 months from issue date Regulatory Services Fee snaxsrABLE, � KAM Richard V.Scali,Director A 1639. ♦� tFp a Dw INESS ITBuilding Division Tom Perry,CBO,Building Commissioner SEP 22 2015 200 Main Street,Hyannis,MA 02601 88 wNP F BAN TA� " .town.barnstable.ma.us Office: 50 4 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / 6"Y 0 0 70 Q 1 L o^t 2 Property Address 80 C�+y ti� S't V 6AW04(t P rh' Residential Value of Work$ /O© O Minimum fee of$35.00 for work under$6000.00 . Owner's Name&Address J.>�+� pG y'&Aro,v $� C��►`c� S-� I�v�f l�a NSA 5� P.Q SS ��f��s' Contractor's Name. �p�+,.> �0V,_S' a Telephone Number S OY V Home Improvement Contractor License#(if applicable) /0 2 q q Email: Construction Supervisor's License#(if applicable) �.S 0057 40� ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# aOC71 f° 020 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ' Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to if ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\bull ng permit forms\E RESS.doc Revised 040215 77te Comurorriveaith ofMassadtrtsetts. Departutmit o,f lrndr{strial Acciderds u ©}ice of Investigations . 600 Washbiglon Street Boston,?ALA 02111 impmunam,gov/din Workers' Campensaticm Insurance Affidavit:Blrilders/Contracturs/EIectricians/Plumhers Applicant InfGrM2tion Please Print LeeibIy Nye l Busmessfl�lganizationlJ ndipidoal}.Address: l e o G ��•e.{• S f City/State/Z* �e.s f'C..V, ram,-s k Phone--hk . -07 -3 6.2-DY 7 P, Are you an employer?Check the appropriate box: Type of project 4. I am a coeval contractor and I P ject(required): I_El I am a employer with ❑ g 6- ❑New construction employees(full and/or part-time).* have hiredthe sub-contractozs 2.0 I am a sale proprietor or partner- listed on the attached sheet, 7_ ❑Remodeling ship and have no employees. . These sub-contractors have S. ❑Demolition w for me in an capacity.• . employees and have workers' �g Y �tY [No workers'camp.insurance Comp.insurance-f 9. El Building addition required_] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3_❑ I am.a homeoumer doing all work officers have exercised their ILL]Plumbingrepairs or additions myself [No workers'comp- right of exemption per MGL 12.❑Roofrepairs insurance required.]F c.152, §1(4�and we have no employees.[No workers' 13.0 Other comp-insurance required-] *Aay appEicai Beat checks boa is1 nmst also fllo=the secdonbelowshouing their waskere compensation potty informirdo - I l anawwners who subn dt this affidardt indkzting they are doing all wcA and then here outside contractors—st submit a new affidavit indicating such. fCoutna rs that check this boat mtmt attached as additional sheet shouting the mmne of the sub-cantrzaDm and state whether or not those entities have employees.If the bubcaatmctorshave employee%they=15r provide their warkexs'comp.policynumber_ I am an eneplopr float is prauidug tc orkers'cougmisaharr iumiraizce forms*entpinsaees. $eTosv is Yltspaliry and job site informadom Insurance Compmy Name: Policy 4 or Self-ins.Lic.k 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 o€MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,54Q.00 andifor one-yearimpzisozraerd,as well as civil peualties.in the form of a STOP WORK ORDER and a fine of up to$250-OU a day against the violator. Be adiased that a copy ofthis statement maybe forwarded to the Office of Investigations of the DIAL for insurance coverage mrificatian- f do hereby certify under the pauis and pen alfies of .pedury that Ste inforwcatio7t ptrotz&d abmv is byre and correct Signature: Date: �Z- 'r / (. o l k Phone ik 2 2,17/ Ojoicfal use only. Do not awrrte in this area,to be completed by city or town officiaL City or Town: PeruuuitlLicense# Issuing 4nthority(circle one): 1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions hfim,c�etts Geheaal Laws cbapteir 152 requhms all employers to provide worms'compensation for their employees. Pursuat-to this s atate,an.mplayee is defined as."-.every person in the service of another under any confrad of hire, express or implied,oral or written." An ernpFayer 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 incinrlmg the legal representatives of a deceased employes,or the receiver or trustee of an individnA 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,conshvclion or repair work on such dwelling house or on the grounds or building appurtenant therein 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 commaawealth nor 6b:y of its political subdivisions shall enter into any contract for the performance ofpublic work u atil acceptable evidence of compligncc-with the insurancd.. Pm ilz eats of this chapter have been presented to the contracting anihouty_" Applicants Please fill oiut the workers'compensation affidavit completely,by checIdag the boxes that apply to your situation and,if necessary,supply sob-contractor(s)name(s), addresses)and phone nummber(s)along with their certificates)of inst:,-ance. Limitf d Liability Companies(LLC)or Limited Liabn7ity-Parinerslups(LLP)with no employees other than the members or partners,are not requfird to cant'workers'compensation insurance. If an LLC or LLP does have empIoyees,a policy is required. Be advised that this aftidavitmaybe submitted to the Department of Industrial Accidents for confimation of ins nice coverage. Also be sure to sign and datethe affidavit The affidavit should be retmnned to the city or town that the application for the permit or license is being requested,not the Department of Industial Accidents. Should you have any questions regarding the law or ifyou ate required to obtain a workers' compensation policy,please call the Department at the number listed below, Self-insured companies should enter their self-irLsuranca license number on the appropriate line. City or Town Officials . Please be sate that the affidavit is complete and printed-legJbly. The,Department has provided a space of 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 peumit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applinadons in any given year,need only submit one affidavit indicating current policy infonnation Cif 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 f Aare,peum#s 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 (Le. a dog license or permit to burn leaves etc.)said person is NOT reqaired to complete this affidavit The Office of Investigations would hke to than you in adva aco for your cooperation and should you have any questions, please do not hesitate to give us a call iThe Department's address,telephone and fax number: The Co=lonweatth of Massar,,hU&-,,-tts Department of Iuidu&tzal Accidents C irce of jaV tikatid= 600,Washingtan Stct- Bmton.MA GI I I F T(1-L#617 727-49QO Qx- 4-06 or 14 SAFF, Fax#617-727-7749 Revised 4-2"7 �I t • SAENbTABId:. � Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder j do acV/fs6410 as Owner of the subject property � ) P P riY ` hereby authorize J6 h11-1 ����� to act on my behalf, in all matters relative to work authorized by.this building permit application for: G Gvc�/�r/� Sf �it/� ���•. (Address of Job) A", CiA ature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services p oFT Richard V.Scali,Director 1 ° Building Division ` BARDMAJOM Tom Perry,Building Commissioner Mass. � i639 . 200 Main Street, Hyannis,MA 02601 plEG MA't� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the build 109.1.1) ingpermit (Section The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said.procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&.Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ""I WC0Y1/I!6[iZ(UC(Z((/L O U!LCLOOCLCIUM G6M. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only -, OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: .<102149 Type: Office of Consumer Affairs and Business Regulation 6/2 10 Park Plaza-Suite 5170 Expiration;�6%30120:1:6 Individual -' _ Boston,MA 02116 JOHN JOHNSON John Johnson PO Box 118 160 Cfiurcli W. Barnstable, MA 02668 Undersecretary Not v d without signature U Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor A" U.-J, License: CS-005409 . 1� JOHN J JOHNSO PO BOX 118 W BARN LE Expiration f:nmmic cinnar 06/21/2016 l i I r ��ff � TOWN OF BARN�TABLE ~ TEMPORARY CERTIFICATE OF OCCUPANCY 'PARCEL ID 000 000 102 GEOBASE ID ADDRESS 80 CHURCH STREET PHONE WEST BARNSTABLE ZIP - LOT 2 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT PEKMIT TYPE 91W. J YY E§IPTION @47EO96NHCVOHRMIT dONTRACTORS: L� Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: �INE BOND $.00 CONSTRUCTION COSTS $.00 753 MISC_ NOT CODED ELSEWHERE 1 PRIVATE P I EBARNS!'ABLE, MASS. s639. ED INS BUILDI. D BY DATE ISSUED 09/21/1999 EXPIRATION DATE 10/21/1999 DOO coo MA )1 A D I;2'. 00 Cr/ S�Uk� ' Nvl._ cd1sr svius, 1LT U13A E 11th LT WNYtA I (,.I Oro Department of Health, Safety and Environmental Services IPA u « � t * BARNSTABM • MASS. z639. ED MA'S� BUILDING DIVISION BY a THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. A i M I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 019 Alf 2W99 k. 1 HVEKTING INSPECTION APPROVALS GINEER NG EPA TMENT 2 BOARD OF HEALTH OTHER:yl r A C A- SITE PLAN REVIEW APPROVAL V � I L� c� /Z4 WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION NOTED ABOVE. TION. I �J I I BUILDIN .G. P .ERMIT I I t ,���✓• llJ� Gsj dt �iivG/�G � r� A ev 12M ` DIVC O ,rAw loow v Q'ia cr/v� VJ �r r Town of Barnstable *Permit# ~� Expires 6 months from issue date i gp MSTA t.e. : Regulatory Services Fee 1639. `0� Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner � PERMITESS 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 JUN 2005 1 S EXPRESS_PERMIT APPLICATION - RESIDEN "ttQ ARNSTAELE Not Valid without Red X-Press Imprint Map/parcel Number_1 , ()0 9 "00 f Property Address 9 C ►1 V 2 C J W A,rL M •�j 1.e Residential Value of Work pz Q C 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address -3—G� D,4 ts" Contractor's Name Z m 4 V "D, 7>4 lr i i3.9 a, V Telephone Number _-it b' DL Od'f"� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to RA P hs.sP 4 J—n9Nb T-i 1( ❑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. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature C4 Q:Forms:expmtrg Revise063004 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street, 74 Floor Boston,Mass. 02111 Workers'Com ensation Insurance.Affidavit:Building/Plumbing/Electrical Contractors. r . �. name: 6 K 7 b 61-1 D 9 0 12 address: 5 T— - city Vf a t !> a hi5T4/f. state: cS S zip: 624 E? phone# S_U�e �143 0LI work site location(full address): 0' C kv t L. •ST.-.. ® I am a homeowner performing all work myself. Project Type: ❑New Construction ZIRemodel I am4a.sole ePro rietor and nlhave �ngo�y one w�yorkin in an capacity. }1I'F'�11 Builyd�iyri Addition 9`ofr:::.w�•' Z%' .f3 :;SV�-'..^•d.• c.[it:� =�'+:,ist "•. �F:mlf� , i„Y�'1 4•l•'�} tT', �] I am an employer providing workers'compensation for my employees working on this job. company name: address:' city phone##• insurance co. olic �: •�a1f3a,•c�'�S�)::t¢a�:`tar�s�i�rm:3'-7�'to.�:a�:;LC�n.:'+.t'iairltFS�" .'"�4;,%:.i�j•a�Y;c"�il"'1j1:�q?�:i�4"x'"h!!'�i:..�.v�F''oVY•;'sls:�':ii: I am a sole proprietor,general contractor; r homeowner circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address city: phone#• insurance co. olic # } Ya?.�;•t{r�, 'i:.<a;Mi!PJ :�c'.a.��3R`«�.>�'.�% 1.�.c, a . . P$:�'' 'r�2t1'40..,'�ti,7�' �«.,, i ° " ,�•.��� ,q.. X ir..�.,,. .,C. �'. m •`r•��'.^:v_ 6+.'";•'>,;-''� Y,. •�7: �1�: %5'�i6. .�'•.u�°l:'..5+�:'�.za:t.` v�5ni: �8'l:.•t?ir1.i.�ti: 'L°° U '.ti. F �°d' Ts� •� 'company name: address: city: phone M insurance co. polig# ":� tl 410414fttae•.t� ug'C.essra, " �#'. � `� ci r a~" r'$1 ' :si�°� ` 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$1;500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a• copy of this statement maybe forwarded to the Office of investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature 1, 'D, Date _ 6 — /fin C� Print name -DA-o yi3sct�V Phone# ra S> 1-Y3 0 d (contact ficial use only 7writeis area to be completed by city or town officialty or town: permitllicense# ❑Building Department ClUcensing oard check If immediuired ❑Selectmen'Bs Office ' ❑Health Department person: phone#; ❑Other. vised Sept.2003) G } i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all-employers to provide*workers' compensation fot 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 writterl. . An employer is defined as-an individual,partnership, association,corporation or other,legal entity,or any two or more,of the foregoing engaged in ajoint enterprise,and-including the legal representatives of a deceased employer; or the receiver or trustee of an individual,:partnership,association or otlierlegal'entity,employing employees. Howewerthe 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 his chapter have been presented to the contracting authority. > YYMYat •�U •+'�t s ci. ' + Id3L�,i,ZY:J$"5 `v'.• ,'"•i, t}r •,M„• Y Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, 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. ` ,'.. rq��,µA7sY t .f •� �'\'Q$,�j��:,•:°`•sp 1�•.., sir,: (� City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference.number. The affidavits may be 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. , = Mtn } .The Department's address,telephone and fax number: The Commonwealth Of Massachusetts- Department of Industrial Accidents Office of Investigations 600 Washington Street,th Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 . , Application to. OpJPGP�,E.pJ .. Odd Kin''s Hi hwa : ,� . g g y Regional Historic District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings,or photo- graphs accompanying this application. . TYPE OR PRINT LEGIBLY J W� / ) ��•ftid SIJt4��' DATE r� ADDRESS OF PROPOSED WOR y K _ U ��yy +++ ASSESSORS MAP NO. /- { OWNER N 1 'f7 Sa ASSESSORS LOT NO. 009 w 001 HOME ADDRESS ('' 194 U n C-11 W ti 4 TEL. N0. 6-1'—�� AGENT OR CONTRACTOR Z-or n fJ T) DA-a 1"psG/'/ ADDRESS Ed' C r1 !Ji'1L] � / ^_^^ 41 �� In 2 AnJ4 5TPJJ p TEL. NO,.�G7� This application is for exemption of proposed exterior construction on the ground that: (1) It will not be visible from any way or public place. (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot,and, if an addition Is involved, show• ing location of existing building. C F_ Q -Sh t N(o t A S N-'i dz A oa i= W, i A r(.)A oli-7- S h i tir a J e y #T S r t v bt 1 � -7-r IC A-(2N�zt ,C 'b .S f n ;: W-144-s is Fn, dAt r F t)4yjcr p t1Grt SIGNED Space below line for Committee use. . t Owner•Contractor-Agent Received by H.D.C. The Certificate is hereby DaterC Time BY — � I! Date Approved The categories of work entitled to exemption are listed on Disapproved the back of this form. Po - or- S. Engineering Dept. (3rd floor) Map cti, � Parcel 0Q�QS � �Z �Permit# S2 ,1 fi House# g© eii Date Issued .J- ZS V Board of Health(3rd floor)(8:15 -9:30/1:00- ✓sue /c e Conservation Office(4th floor)(8:30-9:30/1:00-2:00) can 0 Planning Dept.(1st floor/School Admin. Bldg.) TIC UST BE 'Def' i l Approved by Planning Bo rd i} 19 c/ PLIANCE T WN OF BARNSTABLE CODE-AND TOWN REGULATIONS Building`Permit Application ;r Project Street Address F© C h U tL C. W Ie,S � A-- � N s f*L /e Village J � l I Owner �G R D. U 17) so t( Address �O 1,Yge ���s� � *IZN ST4- k Telephone 6 - Q Permit Request First Floor /1 36 square feet Second Floor Q At square feet Construction Type W C3 0 b Estimated Project Cost Zoning District R Flood Plain C Water Protection Lot Size Ll 3 , 599 S r Grandfathered ❑Yes ❑No Dwelling Type: Single Family . Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway )4 Yes ",No Basement Type: ❑Full ❑Crawl 'Walkout ❑Other Y Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 0 New �3/ Half: Existing New No.of Bedrooms: Existing New �- s Total Room Count(not including baths): Existing © New r First Floor Room Count Heat Type and Fuel: ❑Gas aOiI ❑Electric ❑Other Central Air ❑Yes MNo Fireplaces: Existing r- New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) - Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use uilder Information Name -J-o N ,4-a (i)go /J Telephone Number q3 0 d6-5 O' Address 6-Y, S l License# G O x P/R{l`-/o 4 'D*-TGe #tq-- Home Improvement Contractor# t)a 66yr 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 "7d-e-'k 4111* SIGNATURE DATE BUILDING PE IT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. . 2,9 t b DATE ISSUED MAP/PARCEL NO. ' ADDRESS f VILLAGEj, OWNER tk i - • *' DATE OFINSPECTION: 1 FOUNDATION FRAME U5 `P4 0p� INSULATION FIREPLACE ' j . ELECTRICAL: ROUGH FINAL - , PLUMBING: ROUGH FINAL GAS: tROOGH? ` FINAL Ix o FINAL BUILDING c) -1 tip OSi, - _ mm DATE CLOSED OUT- 0 ASSOCIATION PLAN W. 0 O 'Ro '2s LOT 2 LOT 1 43,597 s.f. (1.00 ac.) o - 0� JP� 0� ry%K`' 1h EXIST. FNDN. lb* GARAGE _tK DRIVEWAY 9 0� S \ EASEMENT ,`0 JOB # 97-318 CER TIFIED PL 0 T PLAN LOCATION : LOT 2 CHURCH STREET PREPARED FOR: (WEST) BARNSTABLE, MA JOHN DAVIDSON SCALE : 1"= 50' DATE : APRIL 1, 1998 REFERENCE ASSESSORS MAP 154 PCL 7 1N Of I HEREBY CERTIFY THAT THE STRUCTURE AFkNE yG� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. No. � -4541 f � Down cape engineering, inc. ( Q CIVIL ENGINEERS LAND SURVEYORS — "T --- ------------------ 9 19 mein at. yarmouth, me DATE REG. LAND SURVEYOR i - 'I S� - I f q 14-lazs Y- S ac vllva LoT Z 3,0 r Ira Nol %7 � S� �� �o .• lam. s�Mi�j � \ �0 9 CIVIL 4ff�4.61fLGE"izS L.A t.l D Sv t2VC YO 22 1 ST 34, ,,VS7'"•q--iLE/ A14. r ,tN OF O� ARNE H. G OJALA s NoCIVi 92 H SC�4G� , _�j O OTrc�'f1�� r' 291 1Si y? " 31F for q T E ``Q' • Application to g n 247. Old Kings Highway Regional Historic District Committee I in the Town of Barnstable for a CERTIFICATE FOR DEMOLITION OR REMOVAL Application is hereby made, in triplicate, for the issuance of a Permit for Demolition or Removal of a building or a structure or part thereof, under Section 6 of Chapter 470. Acts and Resolves of Massachusetts. 1973,for proposed work as described below i and on plans, drawings or photographs accompanying this application. TYPE OR PRINT LEGIBLY DATE C • ) q-7 7 ADDRESS OF PROPOSED WORKELQ RI J,IVA ASSESSORS MAP NO. T C OWNER cl(7 � � \)A\l(h_5Q)N `f' ,UY)= ���lIl K ASSESSORS LOT NO. D+ HOME ADDRESS v`y,�V M W f�RAP,i1S, I ,► A e=o� TEL NO-512, � 7 NAMES AND ADDRESSES OF ABUTTING OWNERS: Include names of adjacent property owners across any public street or way. (Attach additional sheet. if necessary). � LA ES1LViA 24 C�uEcH �� LO ��?��� = 1oi.x) l bK`�'BARLdLIARLE CDNSr-_ PVA `rte)1V _ C.CROCKLE 't3 AGENT OR CONTRACTOR 1 N b X)A TEL NO. (X a- o ADDRESS,( ) nx 52Rt 19) ARUM ���,� I►'6T� Dc�� �� DESCRIPTION OF PROPOSED WORK: If building is to be removed, give new location. Snap shots showing all views of building must accompany application. (Attach additional sheet, if necessary). . I �tK� c t�N XISf I�� 13utL..'D1NG � h10VF- SACIC 1 -D f1n1_D R-P glllL.� r r Ln t4 '� I� UU 1 Note: If approval is granted for relocation, a separate Certificate of Appropriateness is required for new location if within the Old King's Highway Regional Historic District. SIGNED rJ ' rJ Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C. The Ce if' ate is hereh�i t&J �"d ' ate l -S_ 'Date-_ JU Time nl^T 1 7IC1 By -� iAbLr- H I CFiWAY c Approved ❑— IMPORT NT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved 177 .a �o la G I5Jr-L =N C 115 P S F U., 10 k Lo •Lila \AX ^ FO R TIC AM ' FWTIN4j I.0 F'o --Gn012 Soya 7, onq,o 5a w - 4300 ._.. 2�.v 10`o N eO C1402CN ST, vJ 16 t�,Zw STA bLe - -A OF �c - J ME NE. S'RI; URA No f1�''1 £CISTE0 Y:; AL E��'� • TOWN OF BARNSTABLE .BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . DATE JOB LOCATION e ` 0 C WE N S1A_ Number Street address Section of town "HOMEOWNER" ,\'�i 0A N "D 4U 1 D-Ca N ... • . Name Home phone 4k;r*r-phene PRESENT MAILING ADDRESS W gST u s,rAL�.��. /ZliAL 0 City town State Zip code The current exemption for "homeowners" was extended to include owner-occup4 dwellings of six units or less and to allow such homeowners to engage an in dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (sj who owns a parcel of land on which he/she resides or intends to r side, on which there is, or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structure; 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 Of=i; on a form acceptable to the Building Official, that he/she shall be respons= for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the uilding Code and other applicable codes, by-laws, rules and regulations. he undersigned "homeowner" certifies that he/she understands the Town of arnstable Building 'Department minimum inspection procedures and requirement nd that he/she will comply with said procedures and requirements. OMEOWNERIS SIGNATURE PROVAL OF BUILDING OFFICIAL rote: Three family dwellings 35 , 000 cubic feet, or larger, will be required :o comply with State Building Code Section 127. 0 , Construction Control. HOME OWNER'S EXEMPTION y _ The code state that: "Any Home Owner performing work for which d buildinc permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Ow:. shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities ° of a .supervisor (see Appendix Q, Rules and Regulations for _ lcensing Construction Supervisors, Section 2. 15) . This lack of awaren: often results in serious problems, particularly when the Rome Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it .would with licensed Supervisor. The Home "Owner ace_ as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, me communities.: require, as part. of the, permit application, that the Rome Owner certify that he/she understands the responsibilities of a supervisor. On t last page , of ,this issue is a form currently used by several, 'towns. You may :are to -amend and adopt such a form/certification for use in your community. ;4� i lnformation and Instructions " Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers caunpensatietn etnnlmyces. As quoted f Qom the "1aW-. an e•rytplurer is dcfincd as ever), person in the service of �.I- t,-r under:;: contract of hire. express or implied. oral or written. An eniplaYer is dcfincd as an individual. partnership. association. corporation or other legal entity. or any m-o or the fure�_ning cnunucd in a joint enterprise, and including the legal representatives of a deccascTI employer. or tlt: recci%,er or tntstce of an individual , partnership. association,or other legal entity, employing employees. Ho«'e,.•: rnvncr of a dwelling_ house haying not more than three apartments and who resides therein. or the occupant of;he dig cllin�_ house of another N%-ho employs persons to do maintenance ;construction or repair work: on such dwellin: or oil the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an er.:-: .%,1GL chapter 152 section 25 also states that m-ery state or local licensing agency sIiall_witltltold the issuance c rti�al of a license or hermit to operate a business or to construct buildings in the commonwenitlt Car am" ic::nt Who lens not produced acceptable evidence of compliance with the insurance govern-c required. �a�..ionall�. neither the commonwealth nor any of its political subdivisions'shall enter into any contract for the per-,Qrntz::ce of public work- until acceptable evidence of compliance with the insurance requirements of this hce:: prcEc::tee to the contracting authority. �l'Iriic::nts P!--Lse 'ill in the %vorkers' compensation affidavit completely, by checking the box that applies to your situation c: su�civin_ company names. address and phone numbers as all affidavits may be submitted to the Departmcm of nc trial .-accidents for contirtnation of insurance coverage. Also be sure to sign and date the affidavit. The .'vit Jiould be returned to the cin• or town that tl:e application for the permit or license is being requested. n :ire Jcca tme::t of Industrial accidents. Should you have any questions regarding the "law- or if you are rec::: �ct�;n workers' compensation policy. please call the Department at the number listed belo�ti'. Cry or Twxns Ploy :-e _-urc tha: *tile affidavit is complete and printed legibly. 'Me Department has provided a space at the 50tt,:r the ;or ••ou to fi'il out in the event the Office of Investigations has to contact you re`ardin` tite applicant. F be _ : to fill in the permit/license number which wiII be used as a reference number. T7te affidavits may be return: -:te Depamne::t by mail or FAX unless other arrangements have been made. The Ofricc of inyestiaatioils would like to thank you in advance for you cooperation and should you have any ques- piecse do not Jtesitate to give us a call. Tile r-Depan;nent's address. telephone and fax number: Ttte Commonwealth Of Massachusetts Department of Industrial Accidents -• Office of Investigations - 600 Washington Street Boston, .Ma. 02111 fax rr: (617) 727-7749 ,ihune =. :6i-i -- --900 c�:r. 406. 100 or _ . - fi W1 � q 7P,o A �3 Y5SG--SS; NIAP • � ;1 / / moo\ ` 1 \g'r,% • tom- 30�;�. �s�__ :; . � - 1 \ �L4^/ �DG�I'l cczPc Inc,/.r7e�li'•n , /roc... L�T ? ;,ate su riva t'or,--s t�r� s? 1, sr��, A1.4. C+?><j MAiN OF I ARNE OJALA " 3 civlL 19.97 No. 792 / ^w wo io �dY a _._ • ' �T o. � yww o h < I H OO SIi111LiY . F Li IIQ a = o 0 �o 0 7C > O ti Ea o N oa T D Ty 1 II\\ r 1 + 1 L Lq Ts I1 i'. I to .pE \ Nu A� TO ( of O I I \ — o=« �•. z t C \\ N i t l ttr.2 a Y•y'c?i,,. q I P '2 i O -0 7 1 C v � h c s b 2 h � � h L n H �!1 ' II' I: � I .I� I. I T n e Q A s i T a p � t � � lJ i ip c �.IL Wr i y i i I i c - r � � a t 6. W I s � � r I' J I Q ? � d _ - w •t � I � s V h I � T I � - CZ I r mq an IAil II - a �— �- Qo —q ti s E I °• W P O `,� Ii � I a stool./J ili' a. r pi.",1 II r- 0 �Ya Y L� 0 3 ; r I J I n i I � I I i Ii I •�� a b � y T Q a � � d 4L. I t d '1 r E ' i' j T I o P� P T .o 3 r ' G w I y 6 I _ cq jp o T � b y , e . J a r z E T ti a a. 1 1 ` I Table JS2-Ib(eoatleaed) prderiptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fneb MAXIMUM MINIMUM Glazing Glazing wing Wall Floor Basement Slab Heating/Cooling Areal('A) IJ-value= R-value' R value' It-values Wall Perimeter Egwpment Efficiency' Page I It-values R value' 3701 to 6500 Heating Degree Days' Q 12% 0.40 1 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 12 10 6 85 AFUE T 15% 0.36 38 13 25 N/A WA Normal U IS% 0.46 38 19 19 10 6 Normal V 15010 0.44 38 13 25 1 WA WA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 38 13 25 WA N/A Normal Y 5% 0.42 38 19 25 WA WA Normal Z 19% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 30 19 1 19 10 6 90 AFUE 4. ADDRESS OF PROPERTY: o (rh S r 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: t 0 0-4 � 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): u0 63 734t' 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-i980303a 780 CMR Appendix J - Footnotes.to Table J5.2.1b: - ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights;and basement windows if located in walls.that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft'of decorative glass may be excluded from a building design with 300 ft'of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for 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(concre►e,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 ari 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 r 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 Pleating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 7 i. T R A V E L E R S C A S U A L T Y AND SURETY COMPANY OF A M E R I C A HOME OFFICE HARTFORD, CT License and/or Permit Bond Bond No. 103045259 KNOW ALL MEN BY THESE PRESENTS: That we, JOHN D DAVIDSON PO BOX 598 WEST BARNSTABLE MA (hereinafter called Principal ) , as Principal and Travelers Casualty and Surety Company of America , incorporated under the laws of the State of Connecticut, with principal office in Hartford, Ct, as Surety, are held and firmly bound unto TOWN OF BARNSTABLE , as Obligee, in penal sum of One Thousand and 00/100 Dollars, lawful money of the United States, for which payment, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the above bounden Principal has obtained or is about to obtain from the said Obligee a license or permit for A DWELLING UNDER CONSTRUCTION AT 80 CHURCH ST W BARNSTABLE MA ; and the term of said license or permit is as indicated opposite the space checked below: Beginning the day of 19 and ending the day of 19 x Continuous, beginning the Seventeenth day of March 1998 WHEREAS, the 'Principal is required by law to file with . The Town of Barnstable a bond for the above indicated term and conditioned as hereinafter set forth. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, That if the above bounden Principal as such licensee or permittee shall indemnify said Obligee against all loss, costs, expenses or damage to it caused by said Principal ' s non-compliance with or breach of any laws, statutes, ordinances, rules or , regulations pertaining to such license or permit issued to the Principal, which said breach or non-compliance shall occur during the term of this bond, then this obligation shall be void, otherwise to remain in full force and effect. PROVIDED, that if this bond is for a fixed term, it may be continued by Certificate executed by .the - Surety hereon; and PROVIDED FURTHER, that regardless of the number of years this bond shall continue or be continued in force and of the number of premiums that shall' be payable or paid the Surety shall not be liable hereunder for a larger amount, in the aggregate, than the amount of this bond, and PROVIDED FURTHER, that if this is a continuous bond and the Surety shall so elect, this bond may be cancelled by the Surety as to subsequent liability by giving thirty (30) days notice in writing to said Obligee. Signed, sealed and dated the /7 TN day of "47AIZC14 19 By incipal Attorney-in-Fast TRAVELERS- CASUALTY AND SURETY COMPANY OF AMERICA ', IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA,ha-s caused this instrument to be signed by its Senior Vice President, and its corporate seal to be hereto affixed this 2nd day:oT February, 1998. STATE OF CONNECTICUT j710 SURE,` TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA 3+ °off )SS. Hartford , � NAHiFORD, < a CONN. COUNTY OFHARTFORD George W. Thompson Senior Vice President On this 2nd day of February, 1998, before me personally came GEORGE W. THOMPSON to me known, who, being by me duly sworn, did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, the corporation described in and which executed the above instrument; that he/she knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; and that he/she executed the said instrument on behalf of the corporation by authority of his/her office under the Standing Resolutions thereof. My commission expires June 30, 2001 Notary Public Marie C. Tetreault CERTIFICATE I, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, a stock corporation of the State of Connecticut, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority remains in full force and has not been revoked; and furthermore, that the Standing Resolutions of the Board of Directors, as set forth in the Certificate of Authority, are now in force. Signed and Sealed at the Home Office of the Company, in the City of Hartford, State of Connecticut. Dated this day of , 19 r. 3y`+�,MO SUREE`co 4 HAAfFORD, y CONN. By: Rose Gonsoulin Assistant Secretary S-2435(7-95) TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA Hartford,Connecticut 06183-9062 POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT KNOW ALL MEN BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, a corporation duly organized under the laws of the State of Connecticut, and having its principal office in the City of Hartford, County of Hartford, State of Connecticut, hath made, constituted and appointed, and does by these presents make, constitute and appoint Noel J. Almeida, Fred W. Fay, Kenneth R. Forster or Rosalie B. Swift of Sandwich, MA, its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within the United States, or, if the following line be filled in, within the area there designated , the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking and any and all consents incident thereto not exceeding the sum of TWO HUNDRED FIFTY THOUSAND($250,000.00)DOLLARS per bond and to bind TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, thereby as fully and to the same extent as if the same were signed by the duly authorized officers of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, and all the acts of said Attorneys)-in-Fact, pursuant to the authority herein given, are hereby ratified and confirmed. This appointment is made under and by authority of the following Standing Resolutions of said Company, which Resolutions are now in full force and effect: VOTED: That each of the following officers: Chairman, Vice Chairman, President, Any Executive Vice President, Any Group Executive, Any Senior Vice President, Any Vice President, Any Assistant Vice President, Any Secretary, Any Assistant Secretary, may from time to time appoint Resident Vice Presidents, Resident Assistant Secretaries, Attorneys-in- Fact, and Agents to act for and on behalf of the Company and may give any such appointee such authority as his certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors may at any time remove any such appointee and revoke the power and authority given him or her. VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the Chairman, the Vice Chairman, the President, an Executive Vice President, a Group Executive, a Senior Vice President, a Vice President, an Assistant Vice President or by a Resident Vice President, pursuant to the power prescribed in the certificate of authority of such Resident Vice President, and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary or by a Resident Assistant Secretary, pursuant to the power prescribed in the certificate of authority of such Resident Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact pursuant to the power prescribed in his or their certificate or certificates of authority. This Power of Attorney and Certificate of Authority is signed and sealed by facsimile under and by authority of the following Standing Resolution voted by the Board of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA,which Resolution is now in full force and effect: VOTED: That the signature of each of the following officers: Chairman, Vice Chairman, President, Any Executive Vice President, Any Group Executive, Any Senior Vice President, Any Vice President, Any Assistant Vice President, Any Secretary, Any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. (over) MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 3-20-1998 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 1131 Your Home = 700 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1080 38.0 0.0 32 WALLS: Wood Frame, 24" O.C. 8100 15.0 3.0 526 GLAZING: Windows or Doors 228 0.400 91 FLOORS: Over Unconditioned Space 1080 19.0 51 -- ---------------------------------------7--------------------7---7--------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 andJ4.4. Builder/Designerlo-_�'o � Date J MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 3-20-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-38 Comments/Location WALLS: [ ] 1. Wood Frame, 24" O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: [ ) 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or, cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- Application to ` 248BP�S+�,ptSt{•P'PCH Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: j0 New Building ❑ Addition ❑ Alteration Indicate type of building: 0 House jZ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ w►tielt� 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE LC' 17 137 ADDRESS OF PROPOSED WORK w U�'(:Fl J` , Vti/. ANKJ �1� ASSESSORS MAP NO. — OWNER <1(�Ilt�l �:'�' �.1-t InlL C• h AV ASSESSORS LOT NO. HOME ADDRESSPo C��C� oC l O 1 I'D . 6 ��� L. NO. bGg'��'� pS / / FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). N I !'V i F\ 7� Clio RC :, St N , l. IVI� ob6g . Vf1-T"i ��l� I ��tQ CS) Cf,OCRp Pa AGENT OR CONTRACTOR �� � ri , + -` 1��1I •l J �� TEL. NO5 $. % % A D D R E SS V,,f O i—�'� 1% t lXJ / t�6Y��S iTl b t�OS� DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). `i�Jy�Q�,_ Signed Owner-Contractor-Agent Space below line for Committee use. Received-by-H D.C.M m � Date ' TAli he Certificate is hereby � /���'�� Date TACT I 71997 _ L-IdIlf ; By ,° � ;, u� . p,1ry,TeaRL , Approved ❑ IMPORTANT: If Certificate approved, approval is s ject to the 10 day appeal period provided in the Act. Town of Barnstable . Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE ��t{IT"L (:L AV-SA(NGI-S COLOR N A T PA CHIMNEY TYPE �P, (C COLOR �J ROOF MATERIAL��k U ���PR P l L- COLOR PITCH WINDOW A�� P,Sz��(s SIZE TRIM COLOR NA I U Rf) L- DOORS 7 ' TE- L- !KSV Lf) ( T,�D COLOR R( N SHUTTERS r'PbN-T C) N L Y COLOR GUTTERS / DECK I GARAGE DOORS COLOR SIGNS COLORS FENCE `vNF- ZA P- COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Site plan should show all structures on the lot to scale. SPECSHT i :. .. ,y. , , : , • i , • , -7777 77 - t 1 I 17 It }.. • � �.' .. ,,_ .:: _ - :'' - : : - _ � .. , I - 5 j _ .�_ t lit/ 0u S61 €j 457 , - 1 � r I E , � OJorP� Nt K t7 ,�y '1 - 1 rJ &*,IF k1+.rp0,J , I •Tory(,41 y Mpft�en ZD �l _ We 1 rr h rt ' . D'aO� t OV 674 .: v:s` syr►kl�y r fls,ik NOG I $Its C.� rI Co ?1' -fI K� G7 P • 4 SCALE: Y� ♦�wOVED Br: DRAWN BY 160 i NOV 17199T GG� � �� ) >.` DATE, '�� R£Yt5E0 TOWN OF s, 1 .. .>;.. DRAwm►G NUMBER VIC �. , n % Nmol C"+ 1661L1 �' t�5 � OIL IP r WOO PAIT LJ t � ys fff - g r. S ' - r. i F ; 4 r y 1 p . AAID U'r. ull;'W# - IV-